Though, in the following pages, our single purpose is to present a chronicle of the work of the British Army Medical Service during those stirring scenes of the War which were enacted in and about Egypt, it is not possible to do so without including, from time to time, some brief narrative of the general course of events.
The situation in Egypt, following the outbreak of war in August of 1914, constituted a deeply interesting though anxious study for all who knew that country and had its welfare at heart. It was clear, however, that so long as Turkey maintained her neutrality, the position was not without many reassuring features. Obviously nothing would be done by the Central Powers to drive Turkey into the arms of the Allies: an attack, therefore, on any part of the Ottoman dominions, such as Egypt then was in name at least, seemed little likely to ensue. More. over, Egypt was possessed of superb natural frontier defences. To the north lay the Mediterranean, where the Allied fleets could be depended on to ward off an attack. Eastward stretched the Sinai Desert, which from time immemorial has presented a well-nigh insuperable barrier against an invading army.
To the west was the Libyan Desert, equally impracticable for an attack in force, while, both geographically and politically, any sort of menace from the south was highly improbable. As regards Egypt itself, thanks to the past wisdom of Cromer and Kitchener, the vast majority of the population had become thoroughly content with its lot under the British Occupation, and little likely to seize the opportunity of our embroilment elsewhere, to create internal trouble. The Imperial Government was, therefore, quite right in regarding Egypt as, for the moment, outside the pale of hostilities, and in devoting almost the entire strength and resources of the Empire to deal with the great conflagration raging so much nearer home. The major portion of the British garrison in Egypt, and with it most of the men of the Royal Army Medical Corps stationed in that country, were drafted to Europe where their services were most needed. Egypt was left, in the main, to the protection of its own army, now thoroughly reorganised and re-generated after more than thirty years’ tuition at the hands of its British officers. Moreover, part of the immediate scheme of the authorities at home was to use Egypt as a vast training-ground and depôt of the human material for the new Imperial Army, a purpose for which the country was peculiarly adapted, by reason of its central position between the eastern and western portions of the Empire. Though there was an interval – a highly dangerous interval, as sub-sequent events were to prove- when Egypt was wellnigh denuded of British arms, our troops soon began to pour into the country. Whole fleets of transports, packed with Lancashire Territorials, Australians, New Zealanders, the flower of the Indian Native Army, arrived at Alexandria or filed through the Suez Canal, and the dangerous dead-point was passed before it was well realised. How far, and for how long, the secret agents of the enemy had been at work in Egypt against us, it would avail little here to inquire. The fact that they failed, that the great opportunity for a popular rising passed by harmlessly, must be reckoned as one more spray in the perennial laurel-wreath of Cromer, for it was his wisdom that had created a contented peasantry in Egypt. This fact alone it was that now saved the day; the fellaheen, to the lasting credit of their good sense, refused to rise against us, and the danger passed.
It has been said that at the outbreak of war the strength of the contingent of the Royal Army Medical Corps then doing duty in Egypt was greatly reduced. Few officers and N.C.O.’s and men remained for service with the depleted garrisons. Before the end of 1916, however, the strength of the Corps in Egypt had risen enormously. How that army of doctors, field-ambulance men, and hospital orderlies came into being and what it accomplished, remains now to be told.
To the aid of the mere handful of Medical Service men staffing the two military hospitals at the Citadel, Cairo, and at Ras-el-Tin, near Alexandria, came first of all the three East Lancashire Field Ambulances, forming part of the 42nd (Territorial) Division which landed in Egypt towards the end of September, 1914. Then followed early in December the Indian troops destined primarily to guard the Suez Canal, accompanied by their field ambulances and two complete General Hospitals, which were stationed one at Cairo and one at Alexandria. The New Zealand Imperial Force with its field medical contingent arrived in Egypt about the same time, and towards the end of the year the First Division of the Australian Imperial Force reached Alexandria, bringing with it five complete units of the Australian Army Medical Corps fully equipped.
In the meantime Revolution in quite other and much more happy guise had come to Egypt. Her age-long master and oppressor, the Sultan of Turkey, had thrown in his lot with the enemies of the British people, and thus at a single stroke solved one of the most complicated problems that had ever perplexed our home statesmen. More than a hundred years ago Mehemet Ali, the first and the greatest of the Khedives, had said, “England must some day take Egypt as her share of the spoil of the Turkish Empire.” And now, by the Sultan’s own insensate act, the way to the fulfilment of this prophecy was suddenly opened. We made Egypt our own, indeed, but strictly in accordance with the Empire’s ancient altruistic precedent. We made her a sovereign, independent State under her own Sultan, and straightway set about the task of fighting her battles for her in the old-time British way.
That Egypt was now in for troublous times was apparent to all capable of the necessary world-wide view of a war that was destined soon to take practically the whole earth for its arena. It was clear that no enemy of Britain, wishing to do the Empire greatest harm, could fail to see that the destruction of the Suez Canal must constitute one of the most fatal blows that could be dealt us. But equally clear to all sides were the extreme, well-nigh insurmountable, difficulties of the task. That Turkey essayed this single-handed in January-February of 1915, transporting over some 150 miles of sandy, rocky, and almost waterless desert a force of 12,000 to 15,000 men, dragging with them half a dozen batteries of field-guns, at least one six-inch gun, and a number of heavy metal boats in which to effect the Canal crossing, must rank as no less than an act of heroism.
This quixotic venture resulted, as all the world knows, in the complete defeat of the enemy, the capture of many prisoners, and the break-up of the attacking force. The preparations made by the Medical Service for the engagement were admirable. In addition to the field ambulances with the troops stationed at intervals in the length of the Canal, a number of temporary hospitals were established in the vicinity of the expected operations, and carefully-thought-out arrangements made for the treatment of such enemy wounded as should fall into our hands. Three hospital trains were also constructed and fitted out by the Egyptian State Railway, by which all wounded were rapidly removed from the Canal Zone and conveyed to the base hospitals in Cairo. The whole operation was a valuable one in many ways, for it not only gave a practical lesson to our R.A.M.C. men in field-ambulance work under desert conditions, but it brought the authorities in the Anglo-Egyptian Command to a full realisation of the quality of the Turk as an antagonist – a lesson that was destined to be driven home in much sterner fashion, as swift-marching events were soon to show.
With the repulse of the first Turkish attack on the Suez Canal, the part to be played by Egypt in the titanic struggle of the nations entered upon a new phase. The war, it seemed, was to be carried into the enemy’s country. The Mediterranean Expeditionary Force under Sir Ian Hamilton arrived in Egypt, established its base at Alexandria, and in April set out for the Dardanelles. Thence onward, instead of dealing, as hitherto, with a series of more or less disjointed happenings, it becomes possible to present a fairly well connected narrative of the work of the Royal Army Medical Corps in this part of the Near Eastern area of the war.
It is a story now of a great crisis triumphantly met and overcome. It begins properly with the earliest days of the memorable year 1915, when vast camps had to be established in various quarters to accommodate the British, Colonial, and Indian troops which were flocking into Egypt for training in such enormous numbers. Camp-life is safe and salutary enough, albeit on the largest scale, if certain elementary principles of sanitation and disposal of waste products are rigidly observed. Even in a small camp, moving on at no widely separated intervals to clean ground and fresh surroundings, these laws must be punctiliously adhered to, or harm will follow. But when large numbers of men and animals are crowded together within a circumscribed space and remain there for a prolonged period, the undeviating observance of all laws of sanitation and conservancy becomes literally a matter of life and death.
The true cause of the large amount of sickness which now occurred among the troops, mainly among the Colonials encamped in Egypt, lay not in a want of theoretical knowledge or ability on the part of the officers whose duty it was to safeguard local conditions, but in their inexperience of military life in time of war. An officer of the Royal Army Medical Corps is required, and rightly so, to be much more than physician, surgeon, and sanitary specialist: he must be able not only to instruct, direct, and discipline his own ambulance men in their work in hospital or field, but must be conversant with every detail of army camp-life and understand the soldier and his habits through and through. In these purely military matters the Colonial Medical Officers in charge of the hastily recruited Dominion troops, eminent as many of them undoubtedly were in their profession, could hardly fail to be deficient. That they eventually learnt their lesson, and learnt it well, is known to all. But in the meantime the inevitable happened. Among the troops encamped a very large number of cases of infectious disease occurred, these being mainly cases of measles, mumps, and intestinal disorders. Of mumps alone some 1,200 cases were treated among the Australian troops, and it is estimated that during the first few months of 1915 there was a continuous daily average of 2,000 men in hospital from these causes a sick-list which might, and should, have been obviated if the ordinary right procedure established in the British Army, as to measures of prevention in infectious complaints, and isolation of early cases, had been adopted in time.
But wherever lay the fault for this condition of things, it entailed a grave responsibility on the Army medical authorities in Egypt, and marked, indeed, the beginning of that long period of strain, ultimately developing into a supreme tax on all the medical resources of the country, for which, to those who took part in it, the year 1915 will be ever memorable – all that devolved on Egypt consequent on the launching of the British Expedition against the Dardanelles.
When the time arrives in which the whole story of the War can be reviewed in all its hydra-headed significance, this achievement of the Army Medical Service in Egypt – in dealing with the sudden enormous influx of sick and wounded from Gallipoli in the spring of 1915 – will, it is safe to prophesy, stand out well in the fore-rank of all that British energy and ingenuity have accomplished from first to last.
Human foresight, based on whatever past experience of warfare, could scarcely have computed aright the medical needs of an expedition such as that which was hurled against the Turks on the Gallipoli Peninsula. But some conception of what might soon be demanded of them seems to have dawned on our medical authorities at an early stage in the campaign, and they got to work betimes. Urgent demands for additional hospital supplies and personnel were cabled home. The two permanent military hospitals in Egypt were expanded. The two Australian hospitals, which had arrived in January, 1915, and had been established respectively in the Heliopolis Palace Hotel, near Cairo, and in Mena House, near the Pyramids, were also enlarged. The two Indian hospitals which had come out with the force from India, were similarly treated. The local medical resources of Egypt had already been requisitioned during the first Turkish attack in February, 1915, and now under the new crisis the Egyptian Government was again applied to for all possible aid.
Meanwhile additional hospitals were on their way out from home. No. 15 General Hospital with its equipment, stores, and personnel, reached Alexandria on March 15, and by April 1 had taken possession of the building ordinarily occupied by the Abbassieh Secondary Schools with 1,040 beds ready for the reception of sick and wounded. A second complete hospital, No. 17 General, arrived shortly after, and was located in Victoria College, Alexandria. Other hospital units were soon to be on the way. Two well-appointed hospital ships were in readiness to bring the wounded from the prospective seat of war at Gallipoli to the Egyptian Base. There was a shortage of hospital sisters and nurses.
Indeed, how little the authorities at home had pre-estimated the true nature of the coming campaign may be judged from the fact that the two General Hospitals, Nos. 15 and 17, had been sent out without nurses. it being intended that these base-units should land and be established on the Peninsula. This shortage of nurses in Egypt, however, could, it appeared, on an emergency, be made up by temporarily making use of local help, while detachments of trained Army nurses were being sent from home. It seemed, therefore, that all probable demands on the Medical Staff had been foreseen and provided for, and that there was nothing more to do but to await events.
The event, as it proved, amounted to little less than a cataclysm. What now followed came upon Egypt with all the unexpected suddenness of a thunderstorm on a serene summer’s day. The Mediterranean Expeditionary Force had sailed for some destination unknown, or known only to the few in authority. The great camps were almost denuded of troops. Egypt’s wonderful April sunshine filled the land with a golden calm, and the most bellicose of R.A.M.C. orderlies looking out from a hospital window over slumbering sunlit desert, or the Mediterranean’s tranquil blue, could scarcely conceive of war but as something infinitely remote and incredible. And then, with hardly a rumoured word of warning, the storm broke.
On the 25th-26th of April the first fateful landing on the Gallipoli Peninsula took place, and within a few days the wounded began to pour into Egypt, Shipload after shipload of desperately maimed and stricken men arrived at Alexandria. They came almost without intermission. In the first ten days no fewer than 16,000 cases were landed and distributed among the hospitals ashore. In Alexandria all available beds were immediately filled; and the rest of the wounded, the great majority, in fact, passed on to Cairo. There was a period very brief, indeed, but still fraught with possibilities unthinkable when the sudden strain thus thrown upon the resources of the Medical Staff in Egypt seemed too great for the avoidance of hopeless congestion and disaster. But there were a strong hand and a cool head ruling the affairs of the Army Medical Service in the country.
Everywhere, without an instant’s delay, the expansion of existing hospitals was taken in hand, and other establishments created, either in permanent buildings requisitioned for the purpose, or in little townships of canvas pitched in carefully chosen spots. In Alexandria, No. 15 General Hospital was expanded to 1,500 beds. No. 17 was increased to the same number, and eventually the accommodation at this hospital was raised to a total of 2,460 beds. A German hospital in Alexandria – the Deaconess’s which had recently been commandeered for our troops, was also pressed into the service, additional buildings acquired, and the military No. 19 General which soon arrived on the scene, installed in the premises. Another British Hospital, No. 21, arriving about the same time, was located in the Egyptian Army Barracks at Ras-el-Tin, and was rapidly opened out to a capacity of more than 1,000 beds. The old permanent British Military Hospital in Alexandria was more than doubled in accommodation. The Greek Hospital in the same town was called upon for aid. The Egyptian Government Hospitals in Alexandria, Port Said, Suez, and in six of the large provincial towns immediately prepared to receive British wounded and sick.
Meanwhile, in Cairo, still more extensive developments were set in train. It was to the capital that the authorities mindful of the danger of creating a state of congestion in the hospitals at the port of entry- transported the greater number of cases received from the Dardanelles. The permanent Military Hospital at the Citadel had its bed accommodation at once doubled, the number of beds here eventually reaching 775. No. 1 Australian General Hospital, which had been established in the Heliopolis Palace Hotel on January 25 with 200 beds, and had since been increasing steadily, was now swiftly expanded to 1,000. As the influx of sick and wounded steadily augmented, additional buildings in the neighbourhood were pressed into the hospital service, until over 6,000 beds were available in this quarter alone. The Egyptian Government lent its civilian hospitals in Kassel Aini and the Army hospital at Pont de Koubbeh. The Saidich Government School building was also handed over to us, and within a few weeks had been opened as a hospital by the Red Cross Society with a complement of 200 beds which rapidly increased to 650. The Anglo-American Hospital immediately placed its wards at the disposal of the British Army Medical Service. Later, a hospital was opened at Choubra – for infectious cases. No. 5 Canadian Stationary Hospital was established in the Cavalry Barracks at Abbassieh; and the fine building of the Egyptian Government Primary School, known as Nasrieh School, became a British Military Hospital with 584 beds. In addition to all these arrangements effected for the reception of the wounded and sick among our white troops, there were the men of our Indian Forces to care for. These were received by the No. 5 Indian General Hospital at Alexandria, which was rapidly expanded to 950 beds; and by No. 8 Indian General Hospital, which was installed at the Citadel Bijou Palace, and contained beds to the number of 900.
But the provision of hospital accommodation, as enumerated above, for the vast numbers of sick and wounded which so suddenly and unexpectedly poured into Egypt from the Peninsula, formed only part of the work of the Medical Staff. Extensive as were the arrangements made, they would have proved wholly inefficient but for an ingenious scheme of additional camps and depôts where the men could be received and cared for during the period of their convalescence. These convalescent establishments were, from the very first, of the utmost help to the authorities in the almost superhuman task of avoiding congestion in the main hospitals.
In the first rush of wounded from the Dardanelles at the end of April, 1915, they enabled the already existing beds to be cleared of patients suffering from minor ailments, and in this way a very large amount of hospital accommodation became immediately available for critical cases from overseas. Thus at Heliopolis during the first week of May, when the wounded were pouring into No. 1 Australian General Hospital and its hastily equipped auxiliaries at the rate of 400 or 500 a day, the conversion of the large El Hayat Hotel, Helouan, into a convalescent depôt immediately relieved the situation. Later a seaside convalescent camp near Alexandria was formed in connection with the same group of hospitals, and proved equally valuable. Other convalescent depôts were immediately established at Mustapha near Alexandria, one specially for enteric cases in some buildings near Port Said, lent by the Suez Canal Company, others in the Palace Hotel at Boulac el Dacrour, in the group of mansions at Montazah lent by the Sultan of Egypt, in the Grand Hotel at Helouan, and at what was called the “Rest Camp” at Abbassich, which alone developed an accommodation of 2,300 beds; while a convalescent hospital which received officers only was established in the Sirdar’s house at Cairo. The Red Cross Hospital at Giza, Cairo, obtained the loan of the Walda Palace at Helouan from the Sultan, and thither dispatched its own convalescents. Lastly, to deal with cases where a long period of convalescence under medical and nursing care must intervene before the patients could be again ft for duty, the great Luxor Convalescent Depôt was organised, all the hotels at that place, six in number, being requisitioned for the purpose.
It is easy to construct in this way a catalogue of the hospitals and convalescent homes which thus, as if by magic, sprang up in all quarters of Egypt to meet a sudden crisis, the like of which perhaps never yet faced any Army Medical organisation in the history of the world. Such a list, however, reveals to the reader almost nothing at all of the real magnitude of the task involved. It conveys no idea of the enormous amount of physical labour which devolved on the all too scanty staff of the Royal Army Medical Corps and of the Australian A.M.C., leaving out of account the mental strain of devising and directing the multiplicity of operations.
At the beginning of the year 1915 the Director of Medical Services in Egypt had at his disposal for troops hospital accommodation to the extent of at most 2,000 beds, counting all sources. By May this number of beds had been increased to 13,000; but, under the spur of continued necessity, the amount of hospital accommodation in Egypt for our sick and wounded soldiers eventually reached a total of some 36,000 beds. During the eight critical months of the year 1915, extending from May to December, when the Gallipoli Campaign was in progress, thousands upon thousands of desperately wounded or disease-stricken men were landed in Egypt, yet in spite of the enormous influx, there was not a single one but had his needs well and promptly met. For each were provided shelter, a decent bed, the best of medical, surgical and nursing skill, food and sick-room comforts without stint, clothing where needed, easy transit from place to place by road or rail, and a cheerful comfortable home in one of Egypt’s famous health-resorts wherein to grow strong and fit again for the Empire’s service, if that might be; or, in the case of permanent incapacitation from duty, a berth in a homeward-going hospital-ship, excellently appointed and staffed.
How all this was successfully achieved on so large a scale and under such pressure of time and circumstance, becomes only the more remarkable when we consider in detail the difficulties encountered. Though, as soon as the situation was made known to them by cable, the home authorities took immediate steps to send out an adequate supply of medical personnel, stores, and equipment, the early and most vital part of the crisis had to be met with local resources alone. It was difficult enough to obtain at a few hours’ notice the necessary buildings in which emergency hospitals on a large scale could be established, and, when found, still more difficult to prepare them for occupation. In no single case of all the buildings pressed into service could use immediately be made of the premises on any considerable scale for the accommodation of wounded men. In all, the sanitary arrangements and cooking facilities were either woefully insufficient, or totally lacking. The two great public schools in Alexandria, where Nos. 15 and 17 General Hospitals were installed, possessed, it is true, well-appointed kitchens, but these had to be enlarged at once and additional latrine accommodation provided. The old Egyptian Army Barracks at Ras-el-Tin, where No. 21 General Hospital succeeded eventually in establishing itself on so commanding a scale, was at first not only entirely destitute of anything that could be called a sanitary installation, but it was in an indescribably filthy condition and, moreover, infested by vermin. The cleansing of this Augean stable and its transformation into a thoroughly good hospital in record time, was one of the most notable feats performed by the men of the R.A.M.C. The friends of the late Sir Victor Horsley, who was attached to this unit of the Medical Service in Egypt, will be interested to hear that the great surgeon, setting a fine example to the desperately overworked staff, himself insisted on taking a share in the cleansing operations, going down on his knees with the rest in the work of scrubbing the floors.
At Cairo, especially in the development of the group of hospitals which sprang up round the original Australian establishment at Heliopolis Palace Hotel, this difficulty in preparing the buildings taken to house the incoming thousands of wounded men, may be said to have reached its culminating point.
The first patients arrived at Heliopolis from the Dardanelles on April 29, 1915. By that time the original hospital had been considerably expanded. The tent equipment belonging to the hospital had been erected on the Aerodrome site about three quarters of a mile away, and subsequent developments had resulted in the capacity of this camp being increased. The skating rink at a pleasure resort known as Luna Park near the first hospital had been enclosed, furnished, and established as an overflow hospital. An infectious hospital had been formed in the Race Course Casino. In the emergency which had now arisen all this accommodation originally intended, for the most part, to serve the vast camps which had grown up round about Cairo, was pressed into the new service, the patients previously in possession, or rather all those not too seriously ill to be moved, being transferred to a convalescent hospital which was immediately established in the great hotel of Al Hayat at Helouan. This was furnished at once and lent itself to expansion at a pinch.
At the same time No. 2 Australian General Hospital, which had opened at Mena House near the Pyramids in the early part of the year, was installed in the Ghezira Palace Hotel, Cairo, and was rapidly equipped, Mena being retained as an overflow.
As time went on, and the rush of wounded continued, the Luna Park establishment was largely increased. A large workshop at Heliopolis, known as The Atelier, was taken, equipped and opened, being filled in a single day. Soon after, the Heliopolis Sporting Club pavilion was also commandeered and converted into a hospital which was rapidly enlarged. Subsequently hospitals for infectious diseases were opened at Choubrah, and in the Artillery Barracks at Abbassieh. In addition to all this, the outlet for convalescent cases from this Australian group of hospitals was greatly widened by the establishment, in the Ras-el-Tin School at Alexandria, of a seaside convalescent home. Also in the Palace, or rather group of mansions, at Montazah near the same town, which, as has been previously stated, was lent by the Sultan of Egypt for the purpose, an admirable convalescent hospital was created, where Australian patients could be housed. The work involved in the preparation of all these establishments was enormous; and it fell entirely on a staff which, under normal conditions, was required to perform only the duties of a General Hospital of limited size. Perhaps no better way of conveying an idea of what was accomplished by this devoted band of doctors and orderlies of the Australian Army Medical Corps can be chosen than by giving an extract from the quartermaster’s diary at the time. It deals with only 48 hours of a long-enuring crisis:
“June 8th-9th. During the twenty-four hours a large number of patients were admitted to the hospital. To each man my department issued lime-juice, biscuits, pyjamas, shirts, towels, mug, soap-bowl, plate, knife, fork, spoon, socks, handkerchiefs, and shoes. On the night of the 8th, or rather in the early morning of the 9th, we worked until 3.30 a.m.
The ambulance train did not arrive till 2 a.m. Prior to the arrival of the train, we received word that parties of wounded men were leaving for England and Australia by train in the morning. We had consequently to prepare twenty-four hours’ rations for these men, assembling for work about 6.30 a.m. on the 9th. Most of them were on special individual diet. Furthermore, a number of them entered the hospital naked, and had to be issued with hospital clothing for the voyage.
“After these were dispatched we went to work to make provision for the large army of wounded men who had arrived overnight. The extra rations, etc., were duly provided.
“Later in the day we received orders to convert a machinery workshop (the Atelier) into a hospital, to supply linen, blankets, stove, hospital and cooking utensils, to erect a kitchen, and to make special sewerage and ventilation arrangements. The beds were ready for occupation within twenty-four hours. While this work was in progress, word came that the club-house of a local golf club had been commandeered, and beds were to be erected immediately.At 3.30 p.m. on the 9th I I had a lime-juice at the bar in the club-house, and the people had then no idea of our intended occupation. At 6.30 p.m. the first mattresses and beds were delivered, and the hospital commenced. To-night, the 10th, the hospital is fully equipped and ready for occupation.
“The hospital completed yesterday is to be occupied to-night.
“It is extremely doubtful if any quartermaster’s department in the Army Medical Corps has ever been called upon to accomplish so much in forty-eight hours, when it is remembered that our staff is only for an establishment of one-seventh of the beds now available. Only one of my men failed to stand the strain, and, as he was dropping asleep at his work through sheer exhaustion, I sent him to bed.
“We now control six hospital buildings and two nurses’ homes in Heliopolis.”
The above extract fairly represents the state of things prevailing at the time throughout the entire hospital system of the country. It does not touch, however, on several important aspects of the crisis: notably what was done to organise and extend the female nursing section, how the supply of hospital equipment and material was maintained, how the transport by road and rail of such vast numbers of helpless sufferers was effected, and perhaps the most difficult, if not the most important of all how the problem of feeding the multitude was solved.
FEMALE NURSING SERVICE
In reviewing the part played by the members of the Queen Alexandra Imperial Military Nursing Service and of the Colonial nursing organisations during this period of storm and stress, it is difficult to award a due measure of praise without incurring the charge of dealing in extravagant eulogy. At the beginning of the Gallipoli Campaign there was no more than a handful of trained sisters and nurses at the Base in Egypt, and these were already fully employed. When, therefore, the avalanche of wounded from the Dardanelles descended so unexpectedly on the country, it was inevitable that a certain amount of confusion should result. That the resources of the Q.A.I.M.N.S. and of the Australian and New Zealand contingents, though at one time strained almost to the breaking-point, did not in fact break, but magnificently stood the strain, must be set down to two factors: – in the first place to the admirable system of training in the Alexandra organisation, which, succeeds in developing, apart from technical knowledge, the qualities of hard endurance, instant resource, and unflinching readiness to accept responsibility, to a high degree; and in the second place it must be ascribed to the ability and genius for organisation of the Matron-in-Chief for Egypt, Miss S. E. Oram, R.R.C. with Bar, upon whose shoulders from a very early period of the crisis fell the whole brunt in the management of nursing affairs.
Looking back on those first few weeks of stress and turmoil, when the wounded and sick were pouring into Alexandria, it is not easv to understand how, temporarily at least, a condition of absolute chaos and deadlock was avoided. But avoided it was; and, in the case of the female nursing service, by a variety of ingenious devices combined with whole-hearted self-sacrifice and devotion to duty. There were not only the hastily improvised hospitals and convalescent depots in Egypt to staff, the ships bringing the wounded from the shell-swept beaches at the seat of war, and the hospital trains transporting so many of them to Cairo and elsewhere, had to be supplied with sisters and nurses. In this latter regard especially, as, indeed, in all other departments of the nursing service in Egypt during the war, the V.A.D. contingent of the Red Cross Society and Order of Saint John rendered invaluable aid.
It has been said that there were comparatively very few Army sisters and nurses in Egypt at the commencement of the Gallipoli operations. Reinforcements of nurses were already on their way out from home, and immediately the authorities became aware of the true nature of the campaign, further detachments were got together and dispatched by nearly every ship sailing for the scene of hostilities. At a very early stage in the crisis adequate supplies of nurses had arrived in Egypt, and the situation had been relieved. Before the year was out, upwards of a thousand were available for duty. The extreme difficulty, however, of coping with the demand made upon the hospital nursing-staff in those first critical weeks cannot well be overrated. Great credit is due to the Australian nurses, 186 in number, who had come out in the Kyarra, at the beginning of the year, and had not only staffed the Australian hospitals, but had supplied detachments to various other medical units in Egypt. Until a sufficient number of the regular Army nursing-staff had arrived on the scene, the main work of tending the wounded devolved upon these, and on the New Zealand sisters, augmented by any trained local assistance that could be found, and by all the untrained yet willing helpers that the women of Anglo-Egypt could muster between them.
Thus No. 15 General Hospital, which, it will be remembered, came to Egypt without female nursing-staff, was at first entirely supplied from local re-sources, these being gradually replaced by Army nurses augmented by the V.A.D. To illustrate the methodical, yet unavoidably heterogeneous way in which the nursing-staffs of the various hospitals were finally got together, an extract is given below from the diary of No. 17 General, which, like No. 15, had been originally provided with male personnel alone:
” April 29, 1915- Two nurses were locally engaged.
April 30, 1915. Four Australian nurses lent from Mena House arrived.
May 2, 1915. Two Q.A.I.M.N.S Reserve nurses arrived from Cairo.
May 4, 1915. Six Australian nurses arrived for permanent staff. Ten Dispensary nurses arrived from different parts of Egypt for temporary duty here.
May 11, 1915. Six Australians arrived, lent from Mena House.
May 14, 1915. Four Q.A.I.M.N.S. Reserve from England.
May 26, 1915. Ten nurses (Lady Carnarvon’s) arrived here.
June 15, 1915. Thirteen Australian nurses arrived for duty here.
June 21, 1915. Ten Australian nurses arrived.
July 1, 1915. Ten Q.A.I.M.N.S. Reserve arrived from England.
July 2, 1915. Fifteen New Zealand nurses arrived here.”
The ten nurses who joined the hospital on May 26 were part of a detachment of 50 which the Countess of Carnarvon was instrumental in obtaining from England.
TRANSPORT: ROAD, RAIL, AND MARINE
Transport was from the first one of the gravest difficulties encountered. It began on the Peninsula itself, where the number of hospital-ships attached to the Expeditionary Force at the outset proved wholly insufficient for the task of evacuating the wounded, and many troopships had to be pressed into the service. But the main difficulty lay at the Egyptian Base. Motor ambulance vehicles to convey the wounded from the harbour landing-stages to the hospitals in and about Alexandria, to the railway station en route for Cairo, and again in Cairo between the trains and the various hospital units there, were woefully few in number considering the magnitude of the work entailed. The motor ambulances available belonged almost entirely to the Australian and New Zealand medical units thirty fine cars, the gift of the Australian Red Cross Society, having been brought to Egypt in the Kyarra early in the year, and twenty additional cars were eventually added to this fleet from the same source. A number of the ambulances were drafted to Alexandria, but the main body was installed in two large garages at Heliopolis and Ghezira, where they were in immediate call for service. For a long period they were under almost constant requisition night and day, but so well was the service organised and apportioned that practically no material delay in the conveyance of the wounded ever occurred.
The same may be said for the service of hospital trains between the great towns. These trains were provided and equipped by the Egyptian State Rail- way, and the service admirably maintained through the periods of crisis. There were six separate trains for the service, these being kept at Gabbary Station, Alexandria, which is conveniently near to the docks. The trains were designed to accommodate 100 lying down, or 150 sitting cases; and during the year 1915 many thousand cases were carried.
Upon the hospital ships, however, devolved the main and most vital part of dealing with the vast multitudes of sick and wounded men which flowed into, and out of, Egypt at this critical time. Froma very few regularly appointed hospital ships supplemented by hastily improvised “carriers” and troop- ships, which constituted the service at the beginning of the Peninsula operations, the number of these vessels was steadily and swiftly augmented until over sixty were eventually running. From the end of April to the end of December, 1915, many thousand cases were brought to Egypt; while during the same period as many invalided men were carried home to Great Britain, Australia, New Zealand, and India. All these ships, except those employed on the Indian line, were staffed by the Royal Army Medical Corps and the Alexandra and Colonial Nursing Services.
In regard to the work done on these ships by the doctors, orderlies and nurses of the Army Medical Service, the following quotation from an official report of the time will be of interest:
“I can attest to the care with which in both hospital ships and ambulance carriers the sick and wounded were dealt with, for it is within my personal knowledge that, during the days of stress following battle, neither officers, nurses, orderlies, nor ships’ companies thought of rest or refreshment. In the carrier ships, without many of the conveniences provided in regular medical establishments, difficulties were multiplied; and yet the apparently impossible was achieved, and the wounded suffered no avoidable hardship.
“Where all did so well, it may appear invidious to select any class of worker for particular mention, but I cannot refrain from bringing to notice in a very special manner the work performed by the Nursing Services under Miss S. E. Oram, R.R.C., the Matron-in-Chief. Whether belonging to the Regular, Territorial or Overseas Services, the untiring devotion displayed by these ladies in the very trying conditions on board ship at the Front is a recollection that can never be effaced from the memories of those to whom they ministered, and of every officer and man associated with them in their labours.”
And, it may be added, many of these heroic British women died at their posts, while many more were permanently invalided as a result of hard work and privation. The dangers, difficulties, and hardships to be met with on these sea-going hospitals are, indeed, scarcely realised by the public at home. Apart from the risk from enemy torpedoes and mines – witness the fate of the Braemar Castle, Britannic, Marquette (where nine of the nurses were drowned), the Gloucester Castle, and many others the day’s work on a hospital ship continuously passing from port to port with the most exacting and portentous cargo that vessel could possibly carry, is as much as, sometimes more than, human energy and hardihood can support. Here is a very terse, disjointed series of extracts from a diary kept on board one ship alone, the Dunluce Castle, which fairly represents the sort of life a ship’s staff of the R.A.M.C. lives as a matter of every day:
“Throughout summer of 1915 up to time of evacuation of Peninsula continuously carried sick and wounded between Gallipoli and Egypt and Malta.- Then ship lent to French service in winter 1916, and went to Valona and carried Serbians to Bizerta, Bana and Algiers.- She then carried patients from Egypt to Sicily for transhipment to Britannic. -Then from Egypt to England with full cargo of sick and wounded. Back to Egypt again with equipment and personnel of a stationary hospital for Mesopotamia.-Then to Salonika to fetch wounded. Then to and fro between Salonika and Malta up to October, 1916, with many wounded, also large numbers of dysenteric and malarial cases (on one voyage alone, out of the total patients, two-thirds were cases of malaria).- In October ran between Malta and Mudros, also one trip home to fetch No. 41 General Hospital for. Serbians. – Then Beypt to England, carrying a number of mental cases. After disembarking at Southampton went immediately (same day) to Havre, and brought over cases, including 130 sick and wounded German prisoners. Remained for rest of winter months doing cross-Channel work.-Back to Egypt in spring.”
The above may well be left to speak for itself, except – it may be here remarked no words can possibly convey to the unprofessional reader an idea of the difficulty of properly tending a ship full of dysenteric patients during a long voyage; nor of the responsibility, the anxiety, the constant vigilance needed, in the care of “a number of mental cases” under the same trying circumstances. One item in the excerpt, however, may be amplified here, by way of illustration of the kind of work which an R.A.M.C. ship’s contingent may be called upon to perform. Here set down in plain sober language are the real facts as concentrated, or rather concealed, in the laconic phrase “went to Valona and carried Serbians to Bizerta”
“On the afternoon of February 10th, 1916, the Dunluce Castle started to embark Serbians, some from an Italian hospital ship, and some from a small vessel that had come down from Durazzo that morning. The men were in a more deplorable condition than can be imagined. They were of those who had fallen out in the retreat, and, by some means, had made their way to the coast. Two died while being transferred to our ship. The embarkation was completed by 8 p.m., and we were instructed to leave for Bizerta at daybreak. By that time, however, in spite of the closest attention, eleven bodies were awaiting burial. I have never seen worse cases, and their moaning was pitiful; many of them had been unable to look after themselves for several days, and their condition cannot be described. – All were infested with lice, some with maggots, and many had horrible sores to which their rags were sticking. Nearly all were suffering from marasmus of diarrhea, and many were in the typhoid state. The odour in the wards and throughout the ship was indescribable, and disinfectants had to be freely sprayed everywhere. To avoid any risk of infection, the captain insisted on all clothing being burnt, as several cases could not be definitely diagnosed, typhus, cholera, and, in one case, smallpox being suspected. Many had to be fed hourly, and nearly all very carefully; but in spite of all that could be done by feeding, infusion, or any other means, the total deaths reached fifteen in the first twenty-four hours.
“An Anglo-Serb vocabulary of about fifty words was prepared, and a copy given to each Sister, which was a great help, and gradually the men began to throw off their intense depression, The weather on leaving Valona was by no means propitious, and added largely to the labours and difficulties of all those working in the wards.
“Bizerta was reached during the morning of Sunday, February 13th, by which date the death-roll had reached a total of thirty-nine. The improvement in the general appearance and condition of the patients during their stay on the ship was really wonderful, and we found them a most grateful people, whom it was a pleasure to serve. After disembarkation the ship was fumigated throughout, and kept in strict quarantine for a period of five days.”
MEDICAL EQUIPMENT AND MATERIAL
“There has never at any time been any shortage whatever of drugs, dressings, etc., in Egypt.”
This, and in his own words, is the testimony of the one, of all others in the Anglo-Egyptian Command at the time, best qualified to speak; and in view of the enormous demands made on the supply department of the Royal Army Medical Corps during the year under review, 1915, the words have very great significance.
The adequacy of medical supplies for our armies in the Near East, the base for which was established in Alexandria, depended then as now on the skill with which the necessities of the various departments could be foreseen and provided for greatly in advance of the time they would be needed by the different units. Everything had to be brought by sea over about 3,000 perilous miles, a journey that never occupied less than three weeks, and might take eight weeks or more. To ensure, therefore, that the stores would be ready by the date required, they had to be ordered from home at a period so largely ahead of events that their exact nature and quantities could not possibly be gauged by the ordinary methods.
The requisition of these supplies would have been difficult enough if the problem had been merely one of meeting the medical needs of a single force of known extent within a well-defined and accessible sphere with good lines of communication. But the task was far otherwise in Egypt. The armies, first at the Dardanelles and then at Salonika, had to be supplied over long lines of sea communication, the most difficult known to military science. Not only at these places but on both the Eastern and Western Egyptian frontiers, there were great numbers of field regimental medical units, field ambulances, Casualty Clearing Stations, and Stationary Hospitals all depending on the Alexandrian Base. There were the Base Hospitals in Egypt – those ordinarily. In existence and those which sprang up everywhere at such short notice; also many convalescent depôts and camps; and the one constant demand of these was for an unremitting supply of necessary medical stores.
There was a fleet of 50 or 60 hospital-ships, as well as transports and other forms of craft, all depending on the same Base. The ambulance trains looked to Alexandria for everything they needed medically. Moreover, the Mex Peninsula and the sea-board for some miles from the Egyptian port were thronged with camps where troops were continually coming and going in vast numbers. With every camp and with every unit there was a Medical Offcer responsible for the health of its personnel, and medical stores were constantly required by each of them.
All these different centres of activities focused. their demands on the one establishment at Alexandria demands that were not only extraordinary: many of them were unprecedented in scale. And yet, there was never at any time any shortage whatever in drugs, dressings, etc., in Egypt.”How was it done?
The explanation is very simple, and can be state iin half a dozen words: Organisation, foresight, and energy rightly applied.
A new system was inaugurated. Instead of a number of Base Depôts for medical stores, each one obtaining its supplies direct from England, a single Main Medical Store Depôt for the armies in the Near East was established at Alexandria. This Store Depôt may be likened to a wholesale business house in civil life, and the various Base Depôts to retail shops. A wholesale business house is successful or otherwise according to the accuracy with which it forecasts the needs of its retail customers. This forecast must necessarily be made many months in advance, or the goods will not be ready by the time they are wanted. And not only must the right goods be available at the right time, but they must be there in the right quantity – not less, or trade will be restricted; and not more, or there will be unsaleable surplus to be jobbed when the demand has ceased: in both of which cases there will be loss of profit.
The Main Medical Store Depôt at Alexandria was run on exactly the lines of a wholesale business house, and with all, and more than all, the courage, judgement, and foresight indispensable to such an enterprise. The future needs of the armies in the field and all subsidiary services were carefully studied, and the probable quantities and kinds of material and equipment that would be required as carefully estimated.
HOSPITAL COMMISSARIAT AND SUPPLY OF INVALID FOOD
The ordinary channels of Army food supply were very heavily taxed during the first few weeks of the crisis, but magnificently stood the strain. The main crux of the situation, however, fell on the hospital kitchen staffs, who, even when the difficulty of obtaining the raw material of sustenance in sufficient quantity was overcome, had then to convert it into a form suitable to the needs of desperately hurt and helpless men. And to contrive that the kitchen organisation of each hospital and convalescent camp should keep pace with the swiftly expanding wards was a still greater problem. It is difficult to convey any real notion of the strain which thus fell on the quartermasters’ departments of the Army Medical Service at this time: still more to explain how the difficulties were met and so triumphantly overcome. No doubt the quartermasters of the Royal Army Medical Corps, and in no less degree those of the Australian and New Zealand contingents, here added conspicuously to their already hard-won laurels. It is a fine thing to gain “reputation at the cannon’s mouth.” The men who “go over the top” against a whistling hurricane of bullets, throwing away life as they would a spent match-stalk, deserve all the honour and glory that an appreciative but very busy nation has leisure to bestow on them; but there are times notably this of the great rush of Gallipoli wounded to Egypt-when the skimming-ladle and the butcher’s cleaver alone stand between tens of thousands of human beings and the neglect which means death. If the merit for bringing this war to a successful issue were to be apportioned according to the amount of shoe leather outworn in the country’s service, quartermasters would not be far behind in the reckoning.
Not the least of the many services rendered to the Army medical organisation in Egypt by the Red Cross and St. John Committee, must be accounted the way in which that body now carried out an ingenious and very useful scheme. This was to instal and furnish supernumerary kitchens at nearly all the hospitals, where the lighter and more delicate articles of sick-ward diet could be prepared. At a time when the regular staffs of the main hospital cook-houses were literally run off their legs with work, this assistance of the Red Cross ladies proved as opportune as it was invaluable.
And in this brief account of the means taken to feed the multitude of sick and wounded from Gallipoli, we must not leave unacknowledged the services of the many Egyptian catering firms. In the case of many of the hastily improvised hospitals and convalescent depôts, either by reason of special conditions or because of the impossibility of obtaining cooks and cooking-plant in time, recourse was had to the services of these local caterers: and in almost every instance the task entrusted to them was well and faithfully carried through.