The table on page 80 indicates the number of soldiers returned to Australia up to September 25, 1915, and the reason for their transfer.

FOOTNOTES:

[6] Loss of teeth on, or immediately after, active service, should be attributed thereto, unless there is evidence that it is due to some other cause.

[7] Delete this word if no exceptions are to be made.

CHAPTER VII

SICKNESS AND MORTALITY AMONGST AUSTRALIANS--THE DANGERS OF CAMP LIFE--STEPS TAKEN TO PREVENT EPIDEMICS--NATURE OF DISEASES CONTRACTED AND DEATHS RESULTING--DEFECTIVE EXAMINATION OF RECRUITS--OPHTHALMIC AND AURAL WORK--THE FLY PEST--LOW MORTALITY--THE EGYPTIAN CLIMATE AGAIN--SURGICAL WORK AND SEPSIS--CHOLERA--INFECTIOUS DISEASES.

CHAPTER VII

In civil practice we had long been aware of the fundamental failing of the medical profession. Its members operate in a community as individuals. They seek to cure disease in general; they are conscientious to a degree in the discharge of this duty, and they give valuable personal advice respecting hygiene. But of the prophylaxis of disease they have little trained knowledge, and they are not seriously interested. The prophylaxis of disease really implies organised and co-operative effort, and can only be effectively undertaken by those public-health officials who are charged with it as a definite function.

In Australia at all events the inducements to enter the public-health service as a profession are not very great. The influence of the department is not very far-reaching, and the prophylaxis of disease is still in its infancy. One can foresee the time when the number of pract.i.tioners per 100,000 of the population will be fewer than at present, and the number of public-health officials will be greater. The transition from the one occupation to the other will only take place when a much higher standard of general intelligence prevails in the community.

What applies to civil life applies to a lesser extent to an army, because the headquarters staff of an army are as a rule excellently informed respecting the risk run by neglect of sanitation. They understand thoroughly that disease may do more harm than battles, and that outbreaks permitted to get out of hand are with difficulty controlled. In the Australian Army, by reason of its necessarily scratch nature, there was practically no instruction in prophylaxis. It was certainly not acutely understood, and the disastrous events which attended the formation of camps in Victoria and elsewhere show that the controlling authorities were either not fully informed of the risks, or if informed, did not understand the best plan of action. What applied in Australia was true to a lesser extent in Egypt, because Surgeon-General Williams and many of the R.A.M.C. officers who controlled medical operations in Egypt, and distinguished members of the Indian Medical Service who were a.s.sociated with them, had been through a number of campaigns in South Africa and elsewhere, and were aware both of the risks and the difficulties. Consequently some effort was made to avoid, or to minimise the effects of, some of the disastrous outbreaks.

In March and April, before the arrival of wounded, the number of cases in hospital was a source of common comment amongst the medical officers, who could not understand why healthy men under service conditions, camped on the edge of a dry desert, should be suffering from serious disease to such an extent. The diseases were for the most part measles, with its complications, bronchitis, broncho-pneumonia, and a certain amount of lobar pneumonia, infectious pleuro-pneumonia, and tonsillitis.

There were a few cases of cerebro-spinal meningitis. The impression made on a physician who had all the cases coming from the Heliopolis camps under his control was that these diseases were inordinately prevalent; but the following figures, obtained from headquarters and forwarded to the Government, show that while disease was more extensive than it should be, it was not excessive. Including venereal disease, the cases certainly did not exceed 6 to 8 per cent. of the force.

[ILl.u.s.tRATION: OFFICERS AND NURSES, NO. 1 AUSTRALIAN GENERAL HOSPITAL.

_To face page 86_]]

FIRST AUSTRALIAN GENERAL HOSPITAL

_Memorandum prepared to show the Extent of Disease amongst Australian Troops_

PALACE HOTEL, HELIOPOLIS, _May 8, 1915_.

(Report begins) "The following figures have been obtained from the office of the D.M.S. Egypt. Owing to the movement of troops out of Egypt, comparisons are apt to be a little difficult to inst.i.tute with accuracy. Nevertheless the figures given substantially indicate the position.

On February 15 there were 1,329 patients in hospital. The number of sick and off duty in the lines, but not in hospital, is not stated; but as it amounted to 423 on February 1, and to 644 on March 1, it may be a.s.sumed to be 500, which will give a total of 1,829 sick and off duty on February 15.

On March 1, 1,737 men were in hospital, 644 off duty and sick in the lines, or a total of 2,361.

On March 15, 1,429 were in hospital, 500 off duty and sick in the lines, or a total of 1,929.

On April 1, 1,217 were in hospital, 495 sick and off duty in the lines, or a total of 1,712.

The totals, therefore, off duty on the dates specified were:

February 15 (approx.) 1,829 March 1 2,381 March 15 (approx.) 1,929 April 1 1,712

It should be stated that the figures quoted above would have been very much larger were it not that a large number of men unfit for duty by reason of venereal and other forms of disease have been returned to Australia, and a considerable number sent to Malta.

There have been returned to Australia by the _Kyarra_ on February 2, the _Moloia_ on March 15, the _Suevic_ on April 28, and the _Ceramic_ on May 4, a total of 337 soldiers who were medically unfit for various reasons, and 341 suffering from venereal disease, or 678 in all. In addition about 450 were sent to Malta. If these soldiers had been added to the list of those reported sick and unfit for duty daily, the number would have considerably exceeded 2,000. The estimate of 2,000 sick and unfit for duty daily was studiously moderate, as pointed out in a private letter to Colonel Fetherston at the time when precise figures could not be immediately obtained.

It is gratifying to find that the amount of sickness is diminishing and that the amount of venereal disease, so far as can be ascertained, is also decreasing.

Strenuous efforts have been made by the A.M.C. to attack both forms of inefficiency by dealing with the causes, and with a view to avoiding future troubles the D.M.S. Egypt has appointed a committee of medical officers to inquire into the causations of the outbreak. It is unlikely that the committee can be very active just at present, because of the prior claims on the time of all concerned owing to the influx of wounded. At a later period it is hoped that an exhaustive report will be furnished for the benefit of future undertakings.

Most strenuous efforts have been made to limit the amount of venereal disease. General Birdwood, Commander-in-Chief of the New Zealand and Australian Army Corps, has personally interested himself in this question, and has through the O.C. First Australian General Hospital arranged for me to visit each troopship on arrival, all leave being stopped from the transport until I have been on board. The practice followed is to interview the commanding officer and the officers of the transports, to explain to them the gravity of the position, and to ask each and all of them to use all the influence he possesses with his men to deter them from exposing themselves to the risk of contagion, to draw their attention to the fact that on the physical fitness of the individual man depends the possibilities of success to the army, and to ask for the loyal and enthusiastic co-operation of every officer in work of such importance from a military point of view, and the point of view of subsequent civil life. The officers immediately parade the men, address them, and convey to each of them a printed message from General Birdwood. General Birdwood's letter to General Bridges, written during the early part of the stay of the Army in Egypt, is handed to the Commanding Officer to be read by him and his staff. There is no doubt that this systematic procedure has drawn attention to the gravity of the problem. It has always been responded to loyally by the officers concerned, and it has certainly limited the action of young and inexperienced men on their first landing in an Eastern country.

Other steps were taken by Surgeon-General Williams, who on arrival in Egypt called a conference of senior medical officers to consider the gravity of the venereal diseases problem.

It is satisfactory to find, notwithstanding the amount of disease which has existed, and which, while not excessive, is still heavy, that the mortality has not been as serious as it might have been. The mortality in No. 1 Australian General Hospital for February and March was seventeen cases out of a total of 3,150 admitted" (Report ends).

The following return shows the total number of casualties in the Australian Force up to July 16, 1915:

---------------+----------+-------------+------- Casualty.

Officers.

Other Ranks.

Total.

---------------+----------+-------------+------- Killed

110

1,598

1,708 Died of Wounds

46

740

786 Wounded

341

8,404

8,745 Missing

16

770

786 Died of Disease

--

43

43 ---------------+----------+-------------+------- Totals

513

11,555

12,068 ---------------+----------+-------------+-------

The next table shows the average length of stay in hospital of venereal cases at a particular date:

FIRST AUSTRALIAN GENERAL HOSPITAL

Total venereal cases admitted 1,288 Average stay of patients 16 days

THE ENLISTMENT OF THE UNFIT AND ITS CONSEQUENCES

Prior to the arrival of the wounded the medical service was inconvenienced by another circ.u.mstance. Men were continually arriving with hernia, varix, and other ailments which they had suffered from before enlistment, and which had been overlooked during the preliminary examination in Australia. In one case a soldier suffering from aortic aneurism arrived in Egypt, and similar instances might be given. The examination of recruits in Australia had been conducted by pract.i.tioners in country towns and elsewhere, often under conditions highly unfair to the pract.i.tioner. There is no doubt that the Government would have been well advised to have withdrawn a few men from private practice altogether, paid them adequate salaries, and made them permanent examiners of recruits. Experience of war demonstrates most completely the folly of sending any one to the front who is not physically fit. It is apt to be forgotten that in warfare there can be no holidays, or days off, and that the human being must be at his maximum of physical efficiency, and his digestion of the best. If his soundness is doubtful it is better to keep him for base duty at home, on guard duty at the base, or as an orderly in the hospital. It is simply a waste of money, and tends to the disorganisation of the service, to send such people anywhere near the fighting line. We made an attempt at one stage to roughly calculate what the Australian Government had lost in money by the looseness of official examination. It was impossible to make an accurate estimate, but the sum was great.

OPHTHALMIC AND AURAL WORK

When one of us joined the hospital as oculist and aurist and registrar (Lieut.-Col. Barrett) he was informed that specialists were not required, but apparently those responsible had formed no conception of the excessive demands which would be made on the ophthalmic and aural departments. The first patient admitted to No. 1 General Hospital was an eye case, and an enormous clinic rapidly made its appearance. It was conducted somewhat differently from an ordinary ophthalmic and aural clinic, in that (by reason of the remoteness of their camps) some patients were admitted for ailments which would have been treated in the out-patient department of a civil hospital. There were usually from 60 to 100 in-patients and there was an out-patient clinic which rose sometimes to nearly 100 a day. It should be remembered that these included few, if any, serious chronic cases, which were at once referred back to Australia. The amount of ophthalmic and aural disease was very great. The figures subjoined show the extent of the work done.

From the opening of the Hospital to September 30, 1915, the patients treated in the Ophthalmic and Aural Department numbered as follows:

Ophthalmic cases 1,142 Aural, nasal, and throat cases 1,474 There were 246 operations.

The ophthalmic cases may be roughly cla.s.sified as follows:

Ophthalmia (chiefly Koch-Weeks and a percentage of Diplo-Bacillary) 546 Affection of lids 15 Pterygium 8 Corneal opacities 6 Trachoma 17 Iritis 12 Cataract 8 Foreign bodies in the eye 14 Old injuries 9 Detachment of retina 2 Strabismus 16 Concussion blindness 4 Refraction cases: (a) Hypertropia 210 (b) Myopia 30 (c) Hypertropic astigmatism 230 (d) Myopic astigmatism 15 ---- 485 ----- 1,142 =====