  THE RUSH OF WOUNDED AND RAPID EXPANSION OF HOSPITALS—SAVING THE SITUATION—PERIOD OF IMPROVISATION—SHORTAGE OF STAFF AND EQUIPMENT—HOW THE EXPANSION WAS EFFECTED—THE NUMBER OF SICK AND WOUNDED. CHAPTER IV During the first ten days of the crisis approximately 16,000 wounded men entered Egypt, of whom the greater number were sent to Cairo, and during those ten days an acute competition ensued between the supply of beds and the influx of patients. Fortunately the supply kept ahead of the demand, the pressure being eased by the immediate provision at Al Hayat, Helouan, of a convalescent hospital capable of accommodating 1,000 and in an emergency even 1,500 patients. At the end of the ten days referred to, the position was as follows: Heliopolis Palace Hotel had expanded to 1,000 beds, Luna Park accommodated 1,650 patients, the Casino would accommodate 250, the Convalescent Hospital, Al Hayat, Helouan, was accommodating 700, and if need be could accommodate 1,500 patients, and the Venereal Diseases Hospital could receive 500 patients. In the meantime No. 2 General Hospital had been transferred to Ghezira Palace Hotel, which was rapidly equipped, and at a later date became capable of receiving as many as 900 patients. Mena House remained an overflow hospital, bearing the same relation to No. 2 General Hospital as the Auxiliary Hospitals at Heliopolis bore to No. 1 General Hospital. It was quite evident, however, that the accommodation was still insufficient, and a further search was made for other buildings. At this juncture a building opposite Luna Park known as the Atelier was offered by a Belgian firm for the use of the sick and wounded. It consisted of a very large brick building, with a stone floor and a lofty roof, which had been used as a joinery factory. At first the idea was entertained of creating a purely medical hospital, and of keeping the Heliopolis Palace for heavy surgery, with the auxiliaries for lighter cases. This policy was found to be impracticable, and the Atelier was converted into a 400-bed auxiliary hospital similar in character to Luna Park. It was open for the reception of patients on June 10, and on the 11th was practically full of wounded. As it was evident that the accommodation was still insufficient, a further search was made, and the Sporting Club pavilion, a building in the vicinity of the Heliopolis Palace, was taken over, and converted into a hospital of 250 beds. It was at first intended to use it as an infectious diseases hospital. As, however, it possessed great possibilities of expansion if suitable hutting could be erected, another infectious diseases hospital was sought elsewhere, and wooden shelters were erected. The accommodation of the Sporting Club was raised by this means to 1,250 beds. The heat of summer was coming on, and the necessity for providing seaside accommodation for the convalescents from Cairo became obvious. Consequently the Ras el Tin school at Alexandria was taken by No. 1 General Hospital, and turned into an excellent convalescent hospital for 500 patients. It consisted of a very large courtyard, surrounded by (mostly) one-story buildings, and was about 400 yards from the sea. In the courtyard a Recreation Tent, provided by the British Red Cross Australian Branch, was erected by the Y.M.C.A. The whole formed an admirable seaside convalescent hospital. But even now the accommodation was not sufficient, and by direction the Grand Hotel, Helouan, was acquired, and converted into an additional convalescent hospital for 500 patients. This institution, however, was shortly afterwards transferred to the Imperial authorities and used for British troops. The structural defects in the Casino or Infectious Diseases Hospital, and the undesirability of using the Sporting Club for this purpose, necessitated the erection of an Infectious Diseases Hospital elsewhere. A beautifully constructed private hospital, the Austrian Hospital at Choubra, was commandeered and staffed by the First Australian General Hospital, and provided 250 beds. This hospital also was, however, soon transferred to the Imperial authorities, and administered as a British hospital. As the demand for accommodation for infectious cases increased, the artillery barracks at Abbassia were taken over by the Australian authorities, and converted into an Infectious Diseases Hospital which ultimately accommodated 1,250 patients. The needs continuing to press, the Montazah Palace at Alexandria was offered by His Highness the Sultan to Lady Graham as a convalescent hospital. The offer was gratefully accepted by the combined British and Australian Branches of the Red Cross In addition to these major activities, there were many other minor changes. The introduction of cholera from Gallipoli was feared, and in the grounds of the Casino a cholera hospital was erected in anticipated need, under the direction of the Board of Public Health, Egypt. Fortunately it was never required, but it was ready for use, and would have been staffed by the First Australian General Hospital. The final result, then, of all these expansions was as follows. The 520-bed hospital which landed in Egypt on January 25 had expanded into:
Almost the whole of this work was undertaken by the staff originally intended to manage a 520-bed hospital, at all events until the latest developments. Reinforcements did not arrive until June 15, and even then they were not long available. To house the reinforcements of nurses two other buildings were taken at Heliopolis: Gordon House, opposite Luna Park, and the Palace of Prince Ibrahim Khalim, on the outskirts of Heliopolis. It will be noted that the greater part of the expansion took place in the immediate vicinity of the Palace Hotel. This step was alike deliberate and necessary, for reasons that will be explained hereafter. Methods Adopted in Organising HospitalsThe methods adopted in organising these hospitals varied. In the first instance Lieut.-Col. Barrett was deputed by the D.M.S. Egypt to seek for the necessary buildings, and when these were approved to negotiate with the owners respecting the rent. This proceeding proved very tedious and difficult, and in pursuance of a General Army Order another and simpler plan was adopted by the appointment of an arbitration commission under the chairmanship of Sir Alexander Baird. To this commission the determination of rent and compensation was referred when the acquisition of the buildings received the sanction of the Commander-in-Chief. It need hardly be said that a good deal of tact was necessary in these proceedings, and every attempt was made to meet the wishes of owners with regard to the buildings commandeered. Up till June 15 the number of nurses available was small, and it became quite obvious that, owing to the rush of sick and wounded, and the hot weather, some of the nurses would experience a breakdown. Lieut.-Col. Barrett accordingly visited Alexandria, and arranged with the Australian and Egyptian branches of the British Red Cross Society The Australian Government undertook to pay for the maintenance of the nurses in these homes, which were placed under the management of a joint committee of the two branches of the Red Cross Society, under the presidency of Lady MacMahon. Nurses were then sent to these homes for a week at a time, and derived great benefit from the sea-bathing. These vacations formed a welcome and healthy break in work of excessive severity. The following table indicates the dates of the principal changes which took place in the First Australian General Hospital. Chronology of the First Australian General Hospital
The Policy of ExpansionIt has frequently been said in criticism of the Auxiliary Hospitals that it would have been better to have taken over Shepheard's Hotel, or the Savoy. Neither Shepheard's nor the Savoy (particularly the former) is very suitable for hospital purposes, since hotels containing a large number of small rooms involve much labour, and consequently a large staff, and the authorities were faced with the fact that there was no staff available. Surgeon-General Williams had cabled to Australia for reinforcements long before the crisis, but the reinforcements did not arrive until the middle of June. Clearly the sound policy was to obtain buildings as close to Heliopolis as possible, to administer them with a small staff, and to use them as overflow hospitals. Shepheard's or the Savoy would have required a very large staff, and it was not existent. Even at Helouan the employment of civilians as officers was necessary in order to carry on. Arab servants were extensively employed by reason of the shortage of staff. They acted as menservants, sweepers, and the like. Motor AmbulancesWhen the Kyarra arrived in Egypt the British authorities did not possess any motor transport. There were some motor ambulances belonging to the The Arrival of the Sick and Wounded from the FrontThe end of April was reached. The bulk of the forces had disappeared from Egypt, and their position was only known by rumour; the hospital was gradually emptied of patients; Mena Camp had been abandoned, and Maadi Camp was reduced to small proportions. The weather was beautiful, and any one might have been easily lulled into a sense of false security. On April 28, however, a train-load of sick arrived. Its contents were not known until it arrived at the Heliopolis siding. The patients had come from Mudros, and numbered over 200 sick, including some 60 venereal cases, a matter of some interest in the light of subsequent events. On the following day, however, without notice or warning of any description, wounded began to arrive in appalling numbers. On April 30 and May 1 and 2 no less than 1,352 cases were admitted at Heliopolis. The expansion already indicated at Luna Park was at once effected, and some relief was obtained by transferring the lighter cases to Mena House—some seventeen miles distant. The last train-load of wounded arrived in the early morning of May 2, and deserves special notice, as many of the men were very seriously injured. There were about 100 cases; the train arrived at midnight, and was emptied by 4 o'clock in the morning. The bearing The following table shows the staff available from April 2 to August 18, and the work required of it: Staff, etc., of No. 1 General Hospital at Heliopolis, Including Auxiliary Hospitals
The proceeding adopted on arrival of the train was as follows: Two officers were on duty on the platform in control of guard and stretcher squad. The officer in charge of the train handed in a list of the number of wounded on the train, classified into lying-down and sitting-up cases, those of gravity being specially marked. The train was then emptied carriage by carriage of the sitting-up patients, who walked to the hospital or were driven by the motor ambulances as the case might be, tally being kept at the door of the carriage. As soon as the train had been emptied of the sitting-up cases, the cot patients were removed by the stretcher squad to the motor ambulances, each of which carried a load of two patients. In serious cases an officer was sent with the patient, and as the distance was less than a quarter of a mile, the transfer was fairly rapid. The Egyptian ambulance trains were on the whole good, and were equipped with necessaries and comforts by the Australian Branch British Red Cross. The Australian military authorities also provided nurses for the trains. The stretcher squads soon learned and did their work exceedingly well; but however well the work may be done, the removal of a gravely injured man from a mattress in a wooden bunk to a stretcher offers some difficulty and may cause distress. The construction of the wooden bunks left something to be desired. There is no doubt that it is desirable to devise a carriage of such a nature that stretchers can be inserted without difficulty under every patient, and his removal effected without disturbance. The patients on arrival in the front hall of the hospital were provided with hot chocolate and biscuits, or with lime juice, and were at once drafted to various portions of the hospital. The lighter cases were sent to the auxiliary hospitals, and the more severe cases transferred to wards in the Palace building. Four sets of admitting medical officers with staffs were in readiness, and 200 patients could be disposed of in an hour. Promptitude was essential, as the trains sometimes followed on one another quickly. On admission the patients were bathed and given clean pyjamas. Their clothes and kit were sent to the Thresh Disinfector to be sterilised before being passed into the pack store. Every patient on entering the hospital was provided with pyjamas, shirt, two handkerchiefs, socks, plate, knife, fork, spoon, mug, and slippers. The Red Cross Society provided him with writing-paper and envelopes, pencil, chocolate, nail brush, soap, cigarettes, tooth powder, and tooth brush. As the equipment of additional beds involved the supply of all these articles, in addition to mattresses, blankets, linen, towels, kitchens, cooking-utensils, stoves, bedside tables, ward utensils, instruments, drugs, and bandages, the strain on the Quartermaster's department during this period of expansion was very great. The supply and distribution of food to the auxiliary hospitals occasioned considerable difficulty at the beginning of the crisis, but was satisfactorily adjusted. The Auxiliary HospitalsAs the patients became convalescent they were moved to one of the auxiliary hospitals, and from the auxiliary hospitals to one of the convalescent hospitals at Helouan or Alexandria, and thence either invalided or discharged to duty. As the patients during transference to the auxiliaries were conveyed in a motor ambulance, and when transferred to Helouan or Alexandria were motored to Cairo railway station under charge of a N.C.O., some idea of the work thrown on the motor ambulance corps and on the staff can be imagined. So far all the auxiliary hospitals were regarded as wards of the main hospital, and administered from the main building—the only possible method of administration at this juncture. It was generally believed that the Dardanelles campaign would be of short duration, and that Luna Park and the other auxiliary hospitals would soon be closed. Consequently the expenditure of much money on these auxiliaries was deprecated. When, however, it became obvious that the operations at Gallipoli might last a very long time, and that in any event the troops pouring into Egypt from Australia and elsewhere At Luna Park the central lake was emptied and drained, and was covered by an enormous shelter shed provided by the Australian Red Cross. The shelter with a modern kitchen provided by the authorities formed the dining-room for the patients, nearly all of whom were able to leave their beds. In addition an excellent operating-room was built in brick, barbers' shops were organised, and a canteen, store, and numerous comforts in the way of blinds, sunshades, punkahs, were provided. Ample bath and latrine accommodation was added. As time passed, the palm beds were gradually replaced by metal beds, and the total number reduced to 1,000. In the event of another emergency, beds can be again provided, to the number of 1,650, but such a step will only be taken in the presence of necessity. Furthermore in the case of Luna Park and the other auxiliary hospitals, the D.M.S. Egypt decided that the feeding of patients should be effected by contract, and the matter was therefore left in the hands of a well-known caterer. A large amount of Red Cross money was expended on the shelter sheds and on a recreation hut managed by the Y.M.C.A., and Luna Park became an excellent open-air hospital. It is the more necessary to draw attention to this fact by reason of the adverse criticisms which have been passed by those who have only a superficial acquaintance with it. It will be sufficient to say that up to November 1, 5,500 patients had passed through it, and there had been only one death, and that from anÆsthetic. This remarkable result was not altogether due to the fact that mild cases were admitted, for latterly many major operations had been performed, for appendectomy, etc., and according to Colonel Ryan, Consulting Surgeon to the Force in Egypt, all the operation cases had healed by first intention. In fact Luna Park really represents the triumph of the open-air method of treating patients in a rainless country. The patients preferred it because of the freedom the gardens gave them, but they showed one peculiarity which could never have been foreseen. The Australian soldier was not very fond of chairs. He did not want to stay in the shelter sheds, but preferred to spend much of his day lying in bed, and had to be ordered away from it to effect any change. It is not unnatural that men who have been doing excessive physical work should prefer physical rest when they can get it. At No. 2 Auxiliary Hospital, the Atelier, similar changes were made. The Red Cross provided shelter sheds and a number of comforts. The Atelier was certainly the easiest of the buildings to adapt, by reason of the relatively small number of patients and its spacious surroundings. At No. 3 Auxiliary Hospital the building could not accommodate more than 250 patients in any circumstances, but two large tennis courts were covered with matting and provided with a louvred roof. This proceeding was followed by the erection of wooden huts each of which constituted a ward of 50 beds. These huts were placed in convenient relationship to a central kitchen and other conveniences. The Sporting Club thus became an excellent outdoor hospital. The creation of the Infectious Diseases Hospital at Abbassia is another instance of the importance of prevision. It was organised by Major Brown (who had already organised Luna Park and the Atelier) as a hospital of 250 beds. By successive squeezes, and by the erection of tents, the accommodation was rapidly increased to 1,250 beds, and was then insufficient although typhoid cases were not admitted. The work of extension was at first difficult, but soon became quite simple because a considerable number of officers and men became experienced in the methods of effecting desirable results, and in the art of adapting means in sight to the end desired. The Conversion of the Auxiliary Hospitals into Independent CommandsFinally it became obvious that the mechanism was becoming too complicated, i.e. that the administration of all these hospitals from the Palace Hotel, and the keeping of the records at the Palace Hotel, had become impossible. It was accordingly decided to separate them and make them independent commands. This arrangement was completed about the middle of August, but it involved a fresh crop of difficulties. It was quite necessary that some one should meet the trains and allot the patients to the various hospitals. That was a comparatively simple matter. It was necessary that the hospitals should be properly staffed, and that those who administered them should receive proper rank, in other words that there should be a definite establishment. This necessitated a reference to the Australian Government, and consequently difficulties and delays. The valuable and almost essential part played by the Australian Branch British Red Cross, in effecting the expansion and in preventing a disaster, will be referred to in the chapter on the Red Cross. The following table indicates the nature of the increasing demand on the hospital accommodation: Growth of the Hospital (First Australian General) Hospital opened on January 28
Largest number of patients admitted on any one day (June 8, 1915):
Sick and wounded received at the First Australian General Hospital at the end of April:
Surveying in retrospect this anxious and troublesome period, the outstanding feature is the mistake made in the constant assumption that the hospital expansion was temporary. It was stated that Luna Park would only be wanted for a few weeks; the Dardanelles campaign would soon be over, Luna Park would not then be wanted, and could be closed, consequently heavy expenditure on it was deprecated. Furthermore the experience gained makes it obvious that in war the Service cannot include too many medical officers—preferably juniors. The demand for their services here and there is practically unlimited. They should be young and unattached to any particular unit—in fact a junior reserve on the spot. It should be remembered that the expansion of No. 1 Australian General Hospital was effected under the personal direction of the officer commanding, Lieut.-Colonel Ramsay Smith, who inspected all new buildings, gave his approval or disapproval, and was responsible for their efficient equipment when converted into hospitals. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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