With reference to the duties of N.C.O.s and men, nothing gave more trouble than the fact that men recruited in Australia were made N.C.O.s before their special qualifications were known. There is no officer in the Army whose position is so thoroughly safeguarded as the N.C.O., and nothing but the adverse decision of a court martial can effect his removal. Yet an unsuitable and even dangerous man, from the point of view of the sick, may do nothing to warrant a court martial (which no one enjoys). These appointments should be made therefore with great care. Such considerations, of course, lead to but one conclusion, viz. the necessity for sketching out these hospitals in time of peace. Scratch enlistments are too dangerous.

The "grouser" is always with us, and sometimes gives trouble. The particular Australian "grouse" was that the Australian hospitals should have been nearer the front than Cairo, and at last No. 3 Australian General Hospital was placed at Mudros.

Now we have always understood that a large base hospital cannot be placed far from a great city. A city grows in a particular place for natural reasons—water supply, lighting, transit, etc. The hospital gets the benefit of all these agencies, whereas it was necessary at Lemnos to create them. The result was somewhat disastrous as regards supplies, and might have been foreseen.

"Grousers" should stay at home, and exercise their privileges there.

The difficulties of obtaining supplies by requisition were easily surmounted at Heliopolis because of the broad policy adopted by the Officer Commanding the Australian Intermediate Base, Colonel Sellheim, C.B.

Ordnance cannot supply the varied requirements of a group of expert medical officers during a great war, and delays cause untold annoyance to active men. On the other hand, it would never do to give the staff a free hand to purchase when and how it pleased.

The institution of "local purchase orders" met the difficulty. The O.C. of the hospital sent in a requisition for something which could not be obtained from Ordnance, marking it "urgently required." The A.D.M.S. endorsed it, or, if it were an entirely new line, asked the D.M.S. to endorse it. The Ordnance officer then issued a local purchase order to the medical officer, who made the purchase. The method combined a measure of control with reasonable speed in execution.

We have no sympathy with the usual references to military red-tape. If the administration is competent, the military system is thoroughly sound from the business point of view, and from the standpoint of record difficult to improve on. It may be at times a little cumbersome, but it is much easier to fall in with it than to attempt to effect alteration during war. We never had any real difficulty with requisitions, although supplies were sometimes withheld from us on grounds of policy not disclosed at the moment.

There is no doubt that the erratic changes of staff were injurious. Some medical officers preferred the front, others the base, and an attempt was made to effect an orderly system of periodical exchange. Orders, however, were continually arriving to send so many medical officers, so many nurses, and so many orderlies, here and there, with the result that at the end of ten months the original medical staff had disappeared, many of the nurses were new, and so were most of the orderlies. Whenever there was a shortage of staff near the front, the base hospitals were depleted. These changes were inevitable in the circumstances, but they emphasised the value of the advice given by Colonel Manifold, that there cannot be too many unattached junior medical officers in a campaign.

The following report from Major Brown, Officer Commanding Luna Park No. 1 Auxiliary Hospital, shows what he experienced owing to these oscillations:

April 30	Opened with 296
	patients
May 2	790 patients	Staff: 4 sisters, 4 orderlies,
		and myself. With
		Captains Bentley, McDonald,
		and White
		from Light Horse
		Regiments.
May 6		Sisters increased to 13.
May 14	1,171 patients	13 sisters, 4 medicos, and
		40 orderlies (mostly
		untrained).
May 18	1,244 patients
June 7	1,099 patients	41 sisters (new).
	(also 65 Casino)
June 9	1,370 patients	"       "       "
	(also 65 Casino)
June 11	1,620 patients	"       "       "
	(also 65 Casino)
June 16	1,520 patients	Still 4 medical officers,
		Capt. Brown, Capt.
		Single, Capt. Lovegrove,
		and Capt. Craig.
June 17		Medical officers now increased;
		sisters also
		increased.

Palace of Prince Ibrahim Khalim (Nurses' Home).
To face page 198

With reference to orderlies, the work from May 3 has been done with 10 A.M.C. men and 30 men drawn from the patients.

On June 17, 40 reinforcement A.M.C. men were detailed for duty. Up to June 16 over 1,600 patients have been discharged. On May 23 the Operating Theatre was opened.

For the 1,600 patients we had six cooks with six natives to assist.

T. F. BROWN, Captain,
Officer in Charge, Luna Park.

Heliopolis,
June 17, 1915.

Of the 93 nurses belonging to the hospital, within a week of landing no fewer than 47 were taken away and dispatched to various parts of Egypt, viz.:

No. 1 Australian General Hospital was much inspected by keen and curious, as well as sympathetic, eyes. His Highness the Sultan, Their Excellencies Sir Henry and Lady MacMahon, the General Officer Commanding-in-Chief, Egypt, the General Officer Commanding Australian and New Zealand Army Corps, and many other distinguished people honoured the hospital by an inspection.

The following letters were written by three distinguished visitors. Two Corps Orders are also attached.

"Shepheard's Hotel, Cairo,
"May 20, 1915.

"Dear Colonel Ramsay Smith,

"Allow me to congratulate you upon the admirable medical arrangements at Heliopolis, and upon the excellent hospital you have established there. One is at first disposed to say, 'How well the building adapts itself to a hospital!' until the true fact becomes revealed of the genius displayed in converting a decidedly refractory building into a place for the sick. You and your staff have done wonders and have once more shown that in the land of Egypt 'it is possible to make bricks without straw.'

"Australia may well be proud of the part she has played in this war, and I can pay no higher compliment than by saying that the medical arrangements of the Australian Army are as splendid as are the fighting qualities of its men.

"Above all I was impressed with the energy and enthusiasm with which the work at Heliopolis is being carried on, with the ingenuity and resource displayed at every turn, and with the thoroughness that was manifest in every department of the vast hospital.

"The generosity with which Australia has provided motor ambulances for the whole country and Red Cross stores for every one, British or French, who has been in want of same is beyond all words.

"I only hope that the people of Australia will come to know of the splendid manner in which their wounded have been cared for, and of the noble and generous work which the great colony has done under the banner of the Red Cross.

"Yours sincerely,
"(Signed) Frederick Treves."

"Turf Club, Cairo,
"June 21, 1915.

"Dear Colonel Ramsay Smith,

"I am just off to the Dardanelles, and then back to Cairo, but I felt that I must write and thank you for your kindness in sending me those excellent and interesting photographs, which I shall treasure, and the memory of the interesting day I spent with you at your wonderful hospital. I also thank you for your report and for the copy of Sir F. Treves's letter.

"You must feel proud of your work at Heliopolis, on which I heartily congratulate you. It is a monument of skill in administration and the surmounting of what would at first appear to be insurmountable difficulties.

"Hoping soon to see you again,
"Yours very sincerely,
"(Signed) A. W. Mayo-Robson."

"St. Mark's Buildings, Alexandria,
"June 5, 1915.

"Dear Major Barrett,

"I have been away at the front or I should have written to you sooner to thank you for the interesting visit which you enabled Sir Frederick Treves and myself to pay to your hospital and stores. I enclose an extract of a report which I made on May 25 to the Hon. Arthur Stanley, Chairman of the British Red Cross Society and Order of St. John in London.

"You may have noticed a minute published in the press with the approval of the G.O.C., Sir John Maxwell, in which it was laid down that all Red Cross work, except the Australian Red Cross work, should be under the control of the British Red Cross and Order of St. John. I hope you will not think that in drafting this minute in this way I wished to convey that we were not working in perfect harmony with your Red Cross, but I feel that we could hardly suggest to you that you should be in any way under our control. At the same time, I hope that when you either come here, or when I come back to Cairo, that we may have an opportunity of conferring together so that we may so co-ordinate as far as possible our mutual work.

"May I add that I went to the Dardanelles in a transport with over a thousand of your brave soldiers, many of whom were returning to the Peninsula after having already been wounded. It is impossible to speak too highly of their gallantry, and of the splendid spirit they displayed. I need not tell you that I heard of their fighting qualities at the front, since their heroic deeds in this campaign have already become a matter of history.

"Yours sincerely,
"(Signed) Courtauld Thomson,
"Chief Commissioner for British Red
Cross and Order of St. John, Malta,
Egypt, and Near East Commission."

[Copy]

Extract from a Report from Lieut.-Colonel Sir Courtauld Thomson, Chief Commissioner of the British Red Cross and Order of St. John, to the Hon. Arthur Stanley, dated May 25, 1915.

"A striking feature in Cairo is the remarkable work which is being done by the Australian Red Cross. They have not only two exceptionally large hospitals and the large convalescent home, but they supply the motor transport for the wounded for the whole of Egypt. They have also very large Red Cross stores which they have brought with them. With these articles they have been more than generous, and I am informed that they have given away to the hospitals for our own troops something like 75 per cent. of whatever they had."

Extract from Corps Orders, March 28, 1915

"Appreciation.—The D.M.S. Egypt, who visited the Hospital yesterday afternoon, has requested the Officer Commanding to convey to the officers, nurses, N.C.O.s, and men in the Hospital his appreciation of the work done and the thorough character of the organisation."

Extract from Corps Orders, May 1, 1915

"Appreciation.—The D.M.S. Egypt, Surgeon-General Ford, witnessed the detraining of the invalids who arrived here Wednesday evening. He asked Major Barrett to convey to the Officer Commanding his great appreciation of the excellence of the arrangements and the efficient and quiet manner in which the work was done.

"He congratulates officers and men on the splendid work they are doing and requests that it shall be communicated to them in Corps Orders."

Looking back, does it not seem essential that these hospitals should have been formed, at all events in outline, in time of peace? That their commanding officers and essential staff should have been marked out beforehand, so that on the declaration of war the gaps could have been filled in from the reserve without difficulty? Satisfactory appointments are much less likely to be made in the turmoil which follows the declaration of war than in the atmosphere of deliberate calm which prevails in time of peace. Had such an arrangement prevailed, the First Australian General Hospital would certainly never have been recruited from three States distant from one another hundreds of miles.

Finally, Australian hospitals in time of war should either be regarded as responsible solely to the Australian military authorities and Government, or handed over without reserve to the R.A.M.C., and placed entirely under the control of the British authorities. Where two different authorities exist, as in the case of the First General Hospital, a large amount of trouble and delay is almost certain to ensue. The adoption of the latter course is in our judgment absolutely essential if efficiency is to be secured.

As is invariably the case, weaknesses in any system are only revealed by costly experience. But while in the Australian Medical Service the experience need not have been so costly, we can at least profit by what has occurred, and frame a stronger and a better policy for the future.

On the whole, the record of work done in most trying circumstances is, we think, satisfactory. It is true that the universal democratic fault was evidenced in the lack of preparation for conditions which were fairly obvious. Nevertheless the adaptability and growth of the hospitals in time of great emergency were achievements of the highest order.

Yet it would be unwise to leave the subject with the usual Anglo-Saxon expression of satisfaction that the crisis was passed. The history reviewed has too deep a significance. It must be regarded not merely as an individual incident, but as an indication of the inefficiency evidenced by too many departments of the Empire.

The causes which found the medical services unprepared, which forced them to expand to the breaking-point, and which led to the criticism of the hospital authorities, are not departmental or sectional—they are national. If attacks on individuals are permitted, initiative will be stifled; if on the other hand we are content to follow the time-worn policy of "muddling through," the virile people who skirt the border lines of our Empire will sooner or later bid us make way for stronger men.

Our policy for the future must be one of scientific organisation and calculated preparation in every department. We must not only appoint capable administrators, but also trust them. We can again, if we like, obtain that temporary mental tranquillity which comes to a democracy—and to an ostrich—which does not or will not see the calamity which threatens it, but temporary beatitude will be purchased at the price of an Empire. Never was it more certainly true that the price of liberty is eternal vigilance.

CHAPTER XI

POSTSCRIPT

CLOSURE OF AUSTRALIAN HOSPITALS—THE FLY CAMPAIGN—VENEREAL DISEASES—Y.M.C.A. AND RED CROSS—MULTIPLICITY OF FUNDS—PROPHYLAXIS—CONDITION OF RECRUITS ON ARRIVAL—HOSPITAL ORGANISATION—THE HELP GIVEN BY ANGLO-EGYPTIANS.

One of us (J. W. B.) was invalided to England in the middle of November 1915, and returned to Egypt at the end of March 1916.

He resigned his commission in the Australian Army Medical Corps on February 28, and was appointed temporary Lt.-Col. in the R.A.M.C. on February 29. On his return to Egypt he was appointed Consulting Aurist to the Forces in Egypt, and was a member of the Council of the British Red Cross Society and of the Y.M.C.A. He consequently had an opportunity of witnessing the termination of many of the arrangements for which he had been in part originally responsible, and desires to make brief reference to them.

No. 1 Australian General Hospital with its many off-shoots, including the four auxiliary hospitals and the venereal disease hospital, was located in Egypt for periods of twelve to eighteen months. No. 2 Australian General Hospital was in Egypt about fourteen months. Yet it was stated that each and every one of these hospitals when established were to be temporarily located in Egypt for a few weeks. Luna Park, i.e. No. 1 Auxiliary Hospital, was in existence approximately sixteen months. An enormous number of sick and wounded, said to be 18,000, was passed through it with an infinitesimal death-rate, viz. four or five persons. Since the end of 1915, the No. 3 Australian General Hospital was moved from Mudros to the Barracks at Abbassia, Cairo. The expenditure necessary to fit the barracks for the reception of No. 3 Australian General Hospital and the time taken are very interesting, since they show how utterly impossible any such arrangement would have been during the inrush of wounded in 1915. Stress is laid on the value of auxiliary hospitals as the only practicable means of surmounting difficulties at that time, in the report of the Committee of Inquiry into the Administration of the Australian Branch British Red Cross in Egypt.

Looking back at the practical conclusion of the work of the Australian Army Medical Corps in Egypt, it is quite evident that the policy originally adopted was the only one possible in the circumstances, and the results have fully justified it.

The Fly Campaign

Very active steps were taken during 1916 in the direction of a campaign for the destruction of flies. The only addition that need be made to previous remarks is reference to the ingenious fly traps which have been devised. A large one was designed by Lt.-Col. Andrew Balfour, C.M.G., and is described in the journal of the Army Medical Corps of July 1916. A modified form of this trap, furnished by the British Red Cross in Egypt, costs about 16s., and was most effective. These traps have been known to catch as many as 20,000 flies a day.

The smaller trap, which can be used indoors, and is made of zinc gauze, was made in large quantities by the British Red Cross Society in Alexandria, and distributed throughout Egypt.

Another kind of trap, a Japanese invention, with clockwork mechanism, manufactured by Owari Tokei, Kabushiki, Kwaisha, Japan, has also been very successful. As many as 3,000 flies have been captured in one instance in an hour. It has a considerable advantage over the other traps in that its mechanism interests everyone.

Like all fly traps, however, the utility of these devices depends upon placing them in the hands of men whose business it is to see that they are properly baited and cared for, and on some ingenuity with regard to the baits. For the larger traps placed out-of-doors the best baits were found to be fishes' heads or the entrails of fowls, whilst the best bait for the smaller indoor trap was a mixture of beer or whisky and sugar.

It is, of course, quite evident that the destruction of flies by traps is not logically sound, since the proper method of control of the fly pest is by the destruction of all refuse; but as that is impracticable in Egypt, the traps were of great assistance.

In 1916 the fly pest as usual became marked during two periods in the year; viz. at the beginning and the end of summer. At the height of summer the dryness and desiccation evidently prevent the breeding of flies, a fact to be borne in mind in Australia.

The returns given in the House of Commons respecting the Gallipoli Campaign place the casualties at 116,000, and the cases invalided at 96,000. As a very large number of the cases of the sick were due to intestinal infections, some idea of the damage which may be caused by flies can be imagined.

The discovery of bilharzia eggs and the organisms of dysentery and diarrhœa in the fæces of flies made it clear that the fly plays an even larger part in disseminating disease than has hitherto been understood. It really would appear that if the flies were destroyed infective diseases would fall to small proportions.

The Venereal-Disease Problem

The venereal-disease problem in the early part of 1916 gave very great concern, and active measures were taken to deal with it. In spite of all the ameliorating influences the problem reached its most serious phase in March and April 1916, as questions put in the House of Commons show (vide Lancet, April 8, 1916). I think I express the conviction of certainly 90 per cent. of medical men in stating that nothing but education and educated prophylaxis will ever enable us to get rid of this source of destruction.

Y.M.C.A. and Red Cross

The Soldiers' Club in the Ezbekieh Garden grew in favour and was extended in area and staff. In the autumn of 1915 some ladies became available, and did splendid service in the superintendence of the catering for the men in the Club, and by their presence there did much to help.

A more extended experience of the work of the Y.M.C.A. and of the Red Cross has given much cause for thought. The Y.M.C.A. organisation appears to me to be excellent, since it is the organisation which caters for the social welfare of the soldier, wherever he may be, whether in camp or at the base; and the work is conducted by men whose business it is to understand him and see that all reasonable wants are gratified. In Egypt as I write (July 1916) there are no fewer than forty-seven Y.M.C.A. huts and centres, and Y.M.C.A. officers in the desert, in the oases, and elsewhere, doing their very best to make the soldiers comfortable. In other words, the business of the Y.M.C.A. is to provide comfort by personal service over and above military necessaries for the men who are well.

The Red Cross Society, on the other hand, attends to the wants of the sick and wounded, and its functions have already been discussed. They may, however, be supplemented by the following definition of the work of the Red Cross which was furnished by the High Commissioner for Egypt, Sir Henry MacMahon:

"Government supplies all the necessities for the care, treatment, and transport of the sick and wounded, while the Red Cross supplements these necessities by everything that can in any way go to the comfort and well-being of the sick and wounded soldiers. The distinction between necessities and comforts is sometimes so indefinite that the Red Cross, wherever possible, endeavours to have both ready to hand for use when needed."

And later:

"A word must be said here about the work of the Red Cross Stores. The object of the Red Cross has never been to supply in any large quantities the goods which the War Office sends to the wounded, but it does its best to provide the troops with such things as the War Office does not supply at all or cannot supply at a given time. A State Department, bound as it rightly is by hard-and-fast rules, cannot work as quickly as a private body with more elastic regulations; moreover, the supplies of any department may change at times, hence it happens that the British Red Cross occasionally supply certain things more than the War Office can, or it may supplement the War Office supplies, and it does so until the War Office steps in again. Further, the Red Cross supplies many things or small luxuries which the authorities cannot possibly supply, and these are just the things which are most appreciated by the sick and wounded."

In other words, the function of the Red Cross is to assist over and above necessity, and to be ready to act in event of emergency.

The following lists of the Australian Branch and Egyptian Branch of the British Red Cross show that in both cases, but particularly in the case of the Australian Branch, the Red Cross is supplying articles which should clearly be supplied by Government. There is considerable danger in allowing this system to become too largely developed. In the first place in the case of the Red Cross there is no rigid system of accountancy such as military regulation requires, and the natural tendency for commanders will be to get goods in the easiest possible manner; nevertheless, it may not be the best thing for the service.

The British Red Cross safeguards the practice more fully than the younger branch, and its lead might well be followed. (See Lists on pp. 212-216.)

List of Articles in Red Cross Stores which must be requisitioned for by Commanding Officers of Units for the Care of the Sick and Wounded and where there is no Red Cross Store.

1916

To the Commissioners,
Australian Branch British Red Cross Society,
Shepheard's Hotel, Cairo.

Please send to ———————— the following articles:

Quantity    Description

Clothing
Balaclava Caps
Cardigans
Cholera Belts
*Cushions, Air
*  "    Ordinary
Dressing Gowns
Facewashers
Fly Veils
Gloves
*Handkerchiefs
Mittens
*Mosquito Nets
Mufflers
*Pillows
*Pillow Slips
Pneumonia Jackets
*Pyjamas, Cotton
*  "    Flannel
*Quilts
*Sheets
*Shirts, Cotton
*  "    Flannel
*  "    Hospital
*Shoes, Deck
*Slippers, Hospital
*Socks
*  "  Bed
*Surgeons' Aprons
*    "    Caps
*    "    Gowns
*    "    Swabs
*Towels
*  "    Glass
Underpants, Cotton
"      Flannel
Undershirts, Cotton
"        Flannel

Foodstuffs
Allenbury's Diet
"      Food
Arrowroot
Beef Extract
Benger's Food
Biscuits
Bovril
Brandy
Ceregen
Chocolate
Cocoa
Cocoa-and-Milk
Coffee Essence
Coffee-and-Milk
Condensed Milk
Cornflour
Cornina
Fruits, Dried
"    Tinned
Glaxo
Horlick's M. Milk
Jam
Jelly Crystals
Lactogen
Lime Juice
Linseed Meal
Malt Extract
Oatmeal
Pickles
Plum Puddings
Port Wine
Robinson's Barley
"      Groats
Semolina
Soda Water
Sweets
Tapioca
Tinned Rabbits
"    Tomatoes
"    Tripe
"    Vegetables

General
*Absorbent Wool
*Bandages
*Bed Cradles
* "  Rests
* "  Screens
Books
*Brushes, Hair
*  "    Nail
*  "    Tooth
*Camp Stools
Cigarettes
*Combs
*Crutches
*Deck Chairs
Eau-de-Cologne
Envelopes
Fly Veils
Fly Whisks
Gramophone Needles
*Hospital Basins
*Hot-water Bottles
Housewives
*Insectibane
Looking-glasses
Matches
*Medicine Glasses
Old Linen
*Oil Heaters
Pencils
Periodicals
Pipes
*Primus Stoves
*Razors
*Razor Strops
*Rubber Sheeting
*Safety Pins
*Smoked Glasses
*Soap, Monkey Brand
*Soap, Shaving
*  "    Toilet
*Splints
*Sponges
*Tables, Folding
*Thermometers
Tobacco
*Toilet Paper
Tooth Paste
*Vaseline
Writing Pads

Note A.—As a general rule the Commissioners only supply goods that cannot be obtained from either Ordnance Dept. Army Service Corps, or Base Medical Depot Stores. Any O.C. requisitioning for goods of a kind properly obtainable from those sources should state on the requisition that the goods applied for cannot be obtained from the usual source.

Note B.—Regimental Medical Officers can obtain their requirements from the O.C. of the nearest Field Ambulance, who will forward requisitions to Red Cross.

————————————
Officer in charge of Hospital.

[All the articles marked * were permanent Government issues, and any of the foodstuffs would have been supplied by Government if necessary. There was no practical difficulty in obtaining any articles from Government on proper application being made.]

BRITISH RED CROSS AND ORDER OF ST. JOHN
No. of Patients ————        For the Use of Patients

List of Articles in Red Cross Stores which may be
Requisitioned for.

————191

To the Commissioner,
British Red Cross and Order of St. John
Gresham Buildings, Cairo.

Please send to ———————— the following articles:

Quantity	Description
B.D.M.S.	Air Beds (Rubber)
	Air Rings (Rubber)
B.D.M.S.	Air Cushions (Rubber)
	Ash Trays
	Balaclava Helmets
B.D.M.S.	Bandages
	Bandage Winders
B.D.M.S.	Bellows (for Air Beds)
O.D.	Bed Pans
O.D.	Bed Rests
O.D.	Bed Trays
	Bed Jackets
	Bed Pockets
O.D.	Blankets
	Blacking
B.D.M.S.	Boric Lint
	Books and Magazines
	Boot Brushes
A.S.C.	Bovril
	Biscuits
	Brandy
O.D.	Camp Stools
O.D.	Caps
O.D.	Cardigans
	Carrying Chairs
	Cholera Belts
	Chocolate
A.S.C.	Cigarettes
	Cloths (Pantry and Kitchen)
O.D.	Combs
B.D.M.S.	Cotton Wool
B.D.M.S.	Crutches
	Dressing Gowns
	Dressings
	Deck Chairs
	Eau-de-Cologne
	Face Flannels
	Face Nets
	Fans
O.D.	Fly Whisks
	Fly Veils
	Food Slicers
O.D.	Feeding Cups
	Games
B.D.M.S.	Gauze Tissue
	Goulas
	Gramophones
	Hair Brushes
O.D.	Handkerchiefs
	Head Shields
O.D.	Hot-water Bottles and covers
B.D.M.S.	Ice Bags
	Jug Covers
	Kit Bags
B.D.M.S.	Linen (Old for Bandages)
A.S.C.	Matches
	Mirrors
O.D.	Mosquito Netting
O.D.	Mugs, Enamelled
O.D.	Mufflers
	Mittens
	Nail Brushes
	Nightingales
	Officers' Outfits
	Operation Stockings
O.D.	Overalls
O.D.	Pants
	Pencils
	Pipes
O.D.	Pillows
O.D.	Pillow Cases
	Playing Cards
	Pneumonia Jackets
	Post Cards
O.D.	Pyjamas
O.D.	Razors
	Razor Blades
	Reading Matter
	Rum
B.D.M.S.	Rubber Gloves
O.D.	Shaving Brushes
	Soap (Toilet)
	Spirits
	Stationery
	Sweets
	Sun Hats
O.D.	Shirts (Flannel)
	"   (Cotton)
	"   Helpless Case
	"   Helpless Case (Night)
O.D.	Screens
O.D.	Sheets
O.D.	Socks
	Sponges
O.D.	Slippers
B.D.M.S.	Swabs
	Testaments
O.D.	Tooth Brushes
	Tooth Powder
A.S.C.	Tobacco
O.D.	Towels
O.D.	Urinals
	Vests
	Walking Sticks
	Whisky
	Wool, Absorbent
B.D.M.S.	Water Beds
B.D.M.S.	Waterproof Sheeting (Pluviusin)
	Extras

Items marked—
A.S.C.	(Army Service Corps),
O.D.	(Ordnance Dept.),
B.D.M.S.	(Base Depot Medical Stores),

will only be provided by the British Red Cross on the understanding that the Military Departments have been applied to and cannot supply, or that it is a case of grave or unexpected emergency. Such a demand to be supported by signature of O.C. Hospital, which implies he has indented on the department concerned and failed to obtain.

N.B.—All indents to be countersigned by the O.C. Hospital.

The British Red Cross has definitely been placed under military control, and the Chief Commissioner has been attached to the staff of the Commander-in-Chief. The work goes on just as usual, but if necessity arose the Commander-in-Chief could exercise his authority.

I understand that in France the Australian Branch British Red Cross has now been placed under military control; the Director of Medical Services, Australian Expeditionary Force, being Chief Commissioner and the other commissioners and officers being graded with various ranks. To me this arrangement is definitely a step in the right direction, though I still think the British system in Egypt is better. The officers of the Red Cross in Egypt have no rank, but are under military direction, and the Chief Civil Commissioner is attached to the staff of the Commander-in-Chief; he has had the rank of Hon. Colonel since the war began. It is interesting, however, to note that the Australian Branch British Red Cross has passed through four phases, so far as the work in the field is concerned:

(1) It was a purely military organisation.

(2) When the High Commissioner in Egypt was requested to form a committee it became a combined civil and military organisation.

(3) When the Australian commissioners were appointed it became a purely civil administration.

(4) It has finally become a combined civil and military organisation, in which the military element holds control.

This step further indicates the logical development, in my judgment, of both the Y.M.C.A. and the Red Cross. They should both be regarded as definite branches of the service. They should both be organised in time of peace largely as independent organisations, and as part of the Reserve, and, on declaration of war, they should be incorporated in the service and placed under military control. The function of the one would be to attend to the social wants of the men who are well, the other to attend to the wants of the men who are sick and wounded.

I do not think that any other funds or societies should be permitted to interfere with military arrangements; all those who desire to help with money, with goods, or with personal assistance could do so through the one channel or the other.

As a corollary to the foregoing it is evident that there should be only one voluntary war fund, which should be placed under the control of a committee representing the Y.M.C.A., the Red Cross, and nominees of the Government and public, who could allocate the money subscribed to the Y.M.C.A. or Red Cross as necessity arose. The following list shows the unnecessary multiplicity of organisations and funds in the State of Victoria alone, viz. at least seventeen societies in a community of about one million and a half people. Even in Egypt enthusiastic people started an "Australian Comforts Fund," a "Soldiers' Outings Association," "Camp Welfare Association," and so forth, and these bodies simply did for varying periods the work of the Y.M.C.A. or the Red Cross as the case may be, in a more or less patchy way.

MULTIPLICITY OF FUNDS
(From "The Argus," Melbourne, 1916)

"WAR RELIEF FUNDS
"Objects Outlined: A Guide to Giving

"It is only when one sees the complete list of war relief funds compiled by the State War Council, in connection with its announcement regarding the supervision to be exercised over future collections, that the full extent of the relief organisations and the wide scope covered by the Victorian public's generous giving are appreciated. There are in existence here a score of war funds of one kind or another, and by the devoted efforts of their organisers and the warm-hearted support of the public the lot of our soldiers has been brightened, the burden of pain and suffering borne by the sick and wounded has been eased, a helping hand has been extended to the homeless, broken sufferers of Belgium, Poland, and Serbia, and a gleam of happiness brought to many a home in France whose erstwhile bread-winner is on active service.

"All the Victorian organisations have clearly defined objects, and are working along sound lines. The list of funds is to be increased shortly by the creation of a Repatriation Fund the details of which are now being worked out. The money raised will be devoted to the settling in suitable employment of soldiers who have fulfilled their service. A similar object is aimed at in the repatriation scheme which has been launched with such marked success by Mr. Rodgers, M.H.R. The objects of the other funds, which have been and are doing so much, are thus summarised for the information of the public by officials of the organisations:

"British Red Cross Society
"(Australian Branch)

"Objects officially stated as—'Red Cross work, to assist all hospitals in time of war.'

"Victorian Red Cross Fund

"For Australian sick and wounded soldiers (Lady Stanley Appeal). The proceeds are being and will be remitted to the Australian Red Cross Society, to be used by it for the benefit of Australian sick and wounded soldiers and institutions in which they may be treated.

"Red Cross Society
"(Victorian Division)

"Objects officially stated to be 'those of the Geneva Convention.'

"French Red Cross Society

"The raising of funds for the work of the French Red Cross Society.

"Australian Patriotic Fund

"For the benefit of Victorian soldiers and their dependents, soldiers from any part of Australia and their dependents, other deserving objects consequent on service at the war, and the augmenting of pensions granted by the Commonwealth.

"State War Council's Fund

"For discharged soldiers. Its object is to assist in re-establishing discharged soldiers in employment.

"Commonwealth Button Fund

"A collecting body, which has used its organisation for collecting for various funds. It has collected for the Belgian Fund, Red Cross Society, Lady Stanley's Appeal, French Red Cross, Serbian Fund, Italian Fund, Russian Polish Fund, and for institutions at the front and in camps belonging to the different churches and the Y.M.C.A.

"Lady Mayoress's Patriotic League

"To assist in providing comforts, extra clothing, and foods for the fighting men in the navy and army.

"Belgian Relief Fund

"To assist in relieving distress in Belgium.

"Serbian Relief Fund

"To assist in relieving distress amongst the Serbians.

"Polish Relief Fund

"To assist in relieving distress amongst the Russian Poles.

"French Société Maternelle Fund

"To collect funds for the Société d'Assistance Maternelle et Infantile. The fund is administered in France, money and goods being collected here and sent forward.

"Y.M.C.A. National Appeal

"For the benefit of soldiers in camps, on troopships, and abroad, by providing recreation, games, stationery, literature, and comforts, and ministering generally to the moral and spiritual welfare of the Australian troops.

"Commonwealth Service Patriotic Fund

"Objects determined, as necessity arises, by a committee consisting of heads of departments and branches. Allocations to different funds.

"State Service Patriotic Fund

"Relief of distress resulting from the war.

"Education Department Patriotic Fund

"Relief of distress caused by the war, and for providing clothing and comforts for our troops.

"Railways Department Patriotic Fund

"Relief of distress in Belgium, relief of distress due to unemployment in Victoria, and Red Cross purposes in the proportion as nearly as practicable of one-third to each."

An additional advantage of the arrangements proposed would be that all those who assist would be under a measure of discipline. Neither men nor women helpers should be permitted to enter the war zone unless they visit it with a serious purpose and an earnest desire to help. If they enter in this frame of mind they will have no objection to submitting to discipline. If they object it is far better for them to stay at home.

It is furthermore apparent that Red Cross workers should be limited to elderly men of experience or younger men who are physically defective. In the case of the Y.M.C.A. young and healthy men are required, since their work is very arduous, the living at times rough to a degree, and there is not inconsiderable personal risk undertaken by those who are placed in advanced positions. In national wars every healthy adult is of great value as a soldier, and it is necessary to see that as few of such men as possible are utilised in these auxiliary services.

If the arrangements here indicated had been carried into effect, the work in Egypt would have been much better done and the activities of the Y.M.C.A. would have prevented a vast amount of trouble and disease. As it was, the value of the Y.M.C.A. was not apparent to the public at first, since its activities are not so dramatic as those of the Red Cross Society, and funds have never been provided for it on anything like the same scale.

In conclusion, with regard to the Australian Branch British Red Cross, there is something more to be said. As its name implies, the Australian Red Cross is a branch of the British Red Cross Society, and yet we have experienced in Egypt the spectacle of the Egyptian Branch and the Australian Branch of the same society doing the same work for different sections of troops engaged in a common cause. There were two Red Cross stores in Cairo, Australian and British, two stores in Alexandria, and two in Mudros. Would it not have been much better to amalgamate the two branches and administer the Red Cross in Egypt as a whole? The separation served no good material purpose, and whilst by the exercise of good sense some of the difficulties arising from the dual arrangement were obviated, yet this evidence of particularism was not advantageous.

Vast quantities of goods were donated to the Australian Troops by the Comforts Fund, and vast quantities of goods were given to soldiers in hospitals and convalescent homes by the Australian Branch British Red Cross. As evidence of soundness of heart on the part of the Australian public this action was beyond praise, but it is doubtful whether the methods were the best which might be devised. The generosity of the public lent itself to some abuse, and soldiers are known to have sold these goods to Arabs, and employed the cash as they pleased. It is difficult to draw a healthy mean between strict administration with proper restriction and lavish administration and abuse. It is doubtful to me whether it would not better conserve the self-respect of the soldier and be more dignified if these donations were to cease. In their place proper facilities might well be substituted for the purchase of such articles as the soldier required at very low prices. This is the plan followed by the Y.M.C.A., who never divorce personal service from any distribution of goods. If the pay of the Australian soldier—which by the way is the highest in the world—is thought insufficient, it could be increased by voluntary help conveyed through the proper official channels. If this system were adopted it would necessitate the appointment of a Y.M.C.A. and of a Red Cross officer to certain defined military units, and a well-organised method would at once make its appearance; in other words, we should substitute sympathetic order and justice for amateurish enthusiasm.

Does not the necessity for the foregoing criticism indicate our utter unpreparedness? For if we had possessed a national organisation for Peace and War, each and all of these problems would have been solved long ago, and we should have been spared the spectacle of willing helpers wasting their energy for lack of direction.

Prevention of Disease

Surveying the whole campaign, the fundamental fault of the Australian Army Medical Service was the insufficient attention given to, and stress laid on, the prevention of disease. Is it not obvious that there should be a staff of medical officers and orderlies, detached altogether from any association with the treatment of disease, who should devote themselves entirely to the problem of prevention? This staff should be presided over by a Surgeon-General who should be second only in rank to the Director of Medical Services in the field, and who with his staff should be armed with authority so far as the taking of steps for the prevention of disease is concerned. At present the medical officers in the Australian Medical Service are entrusted with dual functions, the prevention and the treatment of disease.

So far there has been no Military School for medical officers in Australia, and until they are properly trained the prevention of disease will not be as effective as it might be.

In the Royal Army Medical Corps there is a Sanitary Staff, but it does not seem to me that even this highly trained body occupies the high position or enjoys the distinction that the value of its services really demand, and I cannot but think that it would be far better to abolish the term "sanitary" and to apply to it the term "Prophylactic Staff."

The cure of disease in civil life always attracts the public; it is dramatic and strikes the attention. The efforts of the men who obviate the necessity for anything of the kind never receive the same recognition, because the evil never becomes obvious.

Conditions of Recruits on Arrival

Captain Lovegrove, A.A.M.C., was appointed Australian Embarkation Officer at Suez whilst I was in charge. He has contributed the following article to The Australian Medical Journal relative to the work he did during his ten months' stay.

"MEDICAL NOTES ON TROOPS FROM AUSTRALIA
LANDING AT SUEZ

"By Frederick Lovegrove, M.B., Ch.B.(Melb.), Captain A.A.M.C., Australia

"During ten months' tenure of the unique appointment of Australian Embarkation Medical Officer, I have had peculiar opportunities of observing the condition of our soldiers arriving in Egypt.

"The physique of our men has always excited the admiration of the British and Indian officers who have watched them disembark, and if an excess of high spirits in the troops has occasionally given an opportunity for military criticism, from a medical point of view this sign of robust health is altogether satisfactory.

"The time of the voyage to Egypt from Melbourne averages thirty days; but, owing to delays at ports of call, many of the troops spend five weeks or more on board ship. The fact that the death-rate is so low and the condition of the men so good on arrival speaks highly for the arrangements on the ships and the watchful care of the medical officers on transport duty. A few accidents and an occasional case of appendicitis form the bulk of the cases removed to general wards of Suez Hospital.

"Infectious disease, however, has occurred on a large number of vessels, and it has been possible to form some opinion of the epidemics present in the various camps in Australia, by noting the prevalent type of infectious disease on ships from different States.

"(1) Influenza has been far and away the most common complaint. Though some of the patients are still febrile on arrival, and are sent to hospital here, the epidemic is usually spent before Egypt is reached.

"(2) Pneumonia is occasionally severe, and is usually associated with an epidemic of influenza. Twelve months ago a certain percentage of cases developed empyema; for many months now there have been no cases of this kind.

"(3) Measles has been chiefly found among Victorian troops, and has been represented every month. South Australia has sent its quota during April and May. In some cases the epidemic has been wide-spread at first, and has worked itself out before arrival. In other cases a few men have been picked out early and isolated, and no epidemic has occurred. Occasionally a ship has arrived with a large number of cases, evidently originating after embarkation from some unrecognised case on board.

"(4) Mumps has been represented largely every month. This disease is practically a perquisite of New South Wales and Queensland troops. The long incubation period and impossibility of recognising the disease in an early stage makes a general ship infection the rule, and the epidemic is usually at its height when the troops arrive here.

"(5) Cerebro-spinal meningitis has not occurred as an epidemic, but has appeared on the returns every month, with one or two cases. Victoria has contributed the largest number of cases, except in November and January, when New South Wales supplied the largest number. Victoria has had a monopoly for the past four months.

"(6) Enteric fever has been remarkable by its rarity. Ten cases only have been noted; of which New South Wales contributed six, five from one ship; Victoria one in each of the months of September, November, and December; and South Australia one in December. No cases have occurred this year.

"Chicken-pox, scarlet fever, and roetheln have occasioned no trouble here. Small-pox, plague, or cholera have not occurred among troops on Australian transports.

"(7) Venereal disease. While the percentage of troops arriving in Egypt with venereal disease is not high—the actual figure is 0·75 per cent.—the total number of effectives withdrawn from combatant duty owing to this cause is sufficiently large to make the subject one of importance. In ten months 530 men with gonorrhœa and 90 men with syphilis have had to go to hospital immediately on arrival. Soft sores have almost always been cured on the voyage, so that practically all chancres seen here are syphilitic. By far the greatest number of syphilitic cases hail from Queensland and New South Wales, and while gonorrhœa is the main feature of Victorian venereal cases, the two previously mentioned States take the precedence here also. A rise in the numbers from Western Australia has lately been noticed. This may possibly be due to the fact that men from other States found to be suffering from venereal diseases while crossing the Bight are landed in Western Australia. There is a general rise in the proportion of syphilis to gonorrhœa, and this is particularly noticeable among Queensland troops, where the general ratio of one syphilis to six gonorrhœa is now more like one to one, and occasionally the cases of gonorrhœa are outnumbered by syphilis."