The proceeding adopted on arrival of the train was as follows: Two officers were on duty on the platform in control of guard and stretcher squad. The officer in charge of the train handed in a list of the number of wounded on the train, cla.s.sified into lying-down and sitting-up cases, those of gravity being specially marked. The train was then emptied carriage by carriage of the sitting-up patients, who walked to the hospital or were driven by the motor ambulances as the case might be, tally being kept at the door of the carriage. As soon as the train had been emptied of the sitting-up cases, the cot patients were removed by the stretcher squad to the motor ambulances, each of which carried a load of two patients. In serious cases an officer was sent with the patient, and as the distance was less than a quarter of a mile, the transfer was fairly rapid.

The Egyptian ambulance trains were on the whole good, and were equipped with necessaries and comforts by the Australian Branch British Red Cross. The Australian military authorities also provided nurses for the trains. The stretcher squads soon learned and did their work exceedingly well; but however well the work may be done, the removal of a gravely injured man from a mattress in a wooden bunk to a stretcher offers some difficulty and may cause distress. The construction of the wooden bunks left something to be desired. There is no doubt that it is desirable to devise a carriage of such a nature that stretchers can be inserted without difficulty under every patient, and his removal effected without disturbance.

The patients on arrival in the front hall of the hospital were provided with hot chocolate and biscuits, or with lime juice, and were at once drafted to various portions of the hospital. The lighter cases were sent to the auxiliary hospitals, and the more severe cases transferred to wards in the Palace building. Four sets of admitting medical officers with staffs were in readiness, and 200 patients could be disposed of in an hour. Prompt.i.tude was essential, as the trains sometimes followed on one another quickly. On admission the patients were bathed and given clean pyjamas. Their clothes and kit were sent to the Thresh Disinfector to be sterilised before being pa.s.sed into the pack store.

Every patient on entering the hospital was provided with pyjamas, shirt, two handkerchiefs, socks, plate, knife, fork, spoon, mug, and slippers.

The Red Cross Society provided him with writing-paper and envelopes, pencil, chocolate, nail brush, soap, cigarettes, tooth powder, and tooth brush.

[Ill.u.s.tration: THE LAKE, LUNA PARK, HELIOPOLIS.

_To face page 48_]]

As the equipment of additional beds involved the supply of all these articles, in addition to mattresses, blankets, linen, towels, kitchens, cooking-utensils, stoves, bedside tables, ward utensils, instruments, drugs, and bandages, the strain on the Quartermaster's department during this period of expansion was very great. The supply and distribution of food to the auxiliary hospitals occasioned considerable difficulty at the beginning of the crisis, but was satisfactorily adjusted.

THE AUXILIARY HOSPITALS

As the patients became convalescent they were moved to one of the auxiliary hospitals, and from the auxiliary hospitals to one of the convalescent hospitals at Helouan or Alexandria, and thence either invalided or discharged to duty. As the patients during transference to the auxiliaries were conveyed in a motor ambulance, and when transferred to Helouan or Alexandria were motored to Cairo railway station under charge of a N.C.O., some idea of the work thrown on the motor ambulance corps and on the staff can be imagined.

So far all the auxiliary hospitals were regarded as wards of the main hospital, and administered from the main building--the only possible method of administration at this juncture. It was generally believed that the Dardanelles campaign would be of short duration, and that Luna Park and the other auxiliary hospitals would soon be closed.

Consequently the expenditure of much money on these auxiliaries was deprecated. When, however, it became obvious that the operations at Gallipoli might last a very long time, and that in any event the troops pouring into Egypt from Australia and elsewhere would require hospital accommodation, an entirely new view of the matter was taken, and active steps were taken to permanently equip the auxiliary hospitals for more serious work. Of this equipment something must now be said in detail.

At Luna Park the central lake was emptied and drained, and was covered by an enormous shelter shed provided by the Australian Red Cross. The shelter with a modern kitchen provided by the authorities formed the dining-room for the patients, nearly all of whom were able to leave their beds. In addition an excellent operating-room was built in brick, barbers' shops were organised, and a canteen, store, and numerous comforts in the way of blinds, sunshades, punkahs, were provided. Ample bath and latrine accommodation was added. As time pa.s.sed, the palm beds were gradually replaced by metal beds, and the total number reduced to 1,000. In the event of another emergency, beds can be again provided, to the number of 1,650, but such a step will only be taken in the presence of necessity.

Furthermore in the case of Luna Park and the other auxiliary hospitals, the D.M.S. Egypt decided that the feeding of patients should be effected by contract, and the matter was therefore left in the hands of a well-known caterer. A large amount of Red Cross money was expended on the shelter sheds and on a recreation hut managed by the Y.M.C.A., and Luna Park became an excellent open-air hospital. It is the more necessary to draw attention to this fact by reason of the adverse criticisms which have been pa.s.sed by those who have only a superficial acquaintance with it. It will be sufficient to say that up to November 1, 5,500 patients had pa.s.sed through it, and there had been only one death, and that from anaesthetic. This remarkable result was not altogether due to the fact that mild cases were admitted, for latterly many major operations had been performed, for appendectomy, etc., and according to Colonel Ryan, Consulting Surgeon to the Force in Egypt, all the operation cases had healed by first intention. In fact Luna Park really represents the triumph of the open-air method of treating patients in a rainless country. The patients preferred it because of the freedom the gardens gave them, but they showed one peculiarity which could never have been foreseen. The Australian soldier was not very fond of chairs. He did not want to stay in the shelter sheds, but preferred to spend much of his day lying in bed, and had to be ordered away from it to effect any change. It is not unnatural that men who have been doing excessive physical work should prefer physical rest when they can get it.

[Ill.u.s.tration: THE SPORTING CLUB, HELIOPOLIS.

_To face page 51_]]

At No. 2 Auxiliary Hospital, the Atelier, similar changes were made. The Red Cross provided shelter sheds and a number of comforts. The Atelier was certainly the easiest of the buildings to adapt, by reason of the relatively small number of patients and its s.p.a.cious surroundings.

At No. 3 Auxiliary Hospital the building could not accommodate more than 250 patients in any circ.u.mstances, but two large tennis courts were covered with matting and provided with a louvred roof. This proceeding was followed by the erection of wooden huts each of which const.i.tuted a ward of 50 beds. These huts were placed in convenient relationship to a central kitchen and other conveniences. The Sporting Club thus became an excellent outdoor hospital.

The creation of the Infectious Diseases Hospital at Abba.s.sia is another instance of the importance of prevision. It was organised by Major Brown (who had already organised Luna Park and the Atelier) as a hospital of 250 beds. By successive squeezes, and by the erection of tents, the accommodation was rapidly increased to 1,250 beds, and was then insufficient although typhoid cases were not admitted.

The work of extension was at first difficult, but soon became quite simple because a considerable number of officers and men became experienced in the methods of effecting desirable results, and in the art of adapting means in sight to the end desired.

THE CONVERSION OF THE AUXILIARY HOSPITALS INTO INDEPENDENT COMMANDS

Finally it became obvious that the mechanism was becoming too complicated, _i.e._ that the administration of all these hospitals from the Palace Hotel, and the keeping of the records at the Palace Hotel, had become impossible. It was accordingly decided to separate them and make them independent commands. This arrangement was completed about the middle of August, but it involved a fresh crop of difficulties. It was quite necessary that some one should meet the trains and allot the patients to the various hospitals. That was a comparatively simple matter. It was necessary that the hospitals should be properly staffed, and that those who administered them should receive proper rank, in other words that there should be a definite establishment. This necessitated a reference to the Australian Government, and consequently difficulties and delays.

[Ill.u.s.tration: THE SPORTING CLUB, HELIOPOLIS.

_To face page 52_]]

The valuable and almost essential part played by the Australian Branch British Red Cross, in effecting the expansion and in preventing a disaster, will be referred to in the chapter on the Red Cross.

The following table indicates the nature of the increasing demand on the hospital accommodation:

GROWTH OF THE HOSPITAL (FIRST AUSTRALIAN GENERAL) _Hospital opened on January 28_

Venereal and Infectious Cases

Feb. 13 186 cases 358 cases Feb. 15 200 cases (39 Ophthalmic and aural cases) 351 "

Feb. 25 324 cases (including 51 special cases) 422 "

March 1 477 cases, 46 special cases 404 "

March 15 532 " 57 " " 476 "

April 1 596 " 64 " " 283 "

April 15 567 " 52 " " 429 "

April 28 479 " 57 " " 433 "

April 29 631 " 57 " " 478 "

April 30 1,082 " 49 " " 469 "

May 1 1,324 (286 patients discharged) 456 "

May 2 1,465 (213 patients discharged) 462 "

May 3 1,492 453 "

Patients admitted to July 31, 1915 13,325 Deaths 102 = 076 per cent.

Largest number of patients admitted on any one day (June 8, 1915):

Australians 408 New Zealanders 85 British 325 Officers 10 ----- 828 ----- June 9 219 ----- 1,047 in two days.

Sick and wounded received at the First Australian General Hospital at the end of April:

April 28 195 April 29 469 April 30 529 May 1 354 ----- Total 1,547 -----

Surveying in retrospect this anxious and troublesome period, the outstanding feature is the mistake made in the constant a.s.sumption that the hospital expansion was temporary. It was stated that Luna Park would only be wanted for a few weeks; the Dardanelles campaign would soon be over, Luna Park would not then be wanted, and could be closed, consequently heavy expenditure on it was deprecated. Furthermore the experience gained makes it obvious that in war the Service cannot include too many medical officers--preferably juniors. The demand for their services here and there is practically unlimited. They should be young and unattached to any particular unit--in fact a junior reserve on the spot.

It should be remembered that the expansion of No. 1 Australian General Hospital was effected under the personal direction of the officer commanding, Lieut.-Colonel Ramsay Smith, who inspected all new buildings, gave his approval or disapproval, and was responsible for their efficient equipment when converted into hospitals.

FOOTNOTES:

[1] Including Luna Park.

[2] 20 Reinforcements.

[3] 38 Reinforcements.

[4] 195 Reinforcements.

[5] Auxiliaries separated and made independent.

CHAPTER V

CONVALESCENT DEPOTS--EVACUATION OF CONVALESCENT SICK AND WOUNDED FROM CONGESTED HOSPITALS--KEEPING THE HOSPITALS FREE--LIBELS ON THE EGYPTIAN CLIMATE--DISCIPLINE.