 Section 14 of With the Royal Army Medical Corps in Egypt by Sergeant Major R.A.M.C. This LibriVox recording is in the public domain. Chapter 13 Army Dental Surgery in Egypt One of the most difficult questions with which the R.A.M.C. in Egypt has had to deal has been that of the dental treatment of the troops, the preservation of existing teeth by various devices, as well as the provision of artificial teeth, where the natural means of mastication have been found unserviceable. This matter lies at the very heart of the problem of the maintenance of fighting efficiency in an army. If a good and abundant supply of the right sort of food is a soldier's first requisite on active service, his next most important need is the wherewithal to make use of it. Under the old strict conditions of enlistment in pre-war times, only those men possessing a high proportion of good sound teeth were accepted for the army, and thereafter their fitness in this respect was regularly and thoroughly supervised by the medical authorities. But, on the outbreak of the present conflict, when thousands of recruits were needed, instead of hundreds as here to for, these conditions were necessarily and very properly relaxed. Provided a man was sound in all other respects, we could not afford to look him too closely in the mouth. The fact of his general health being good was taken to indicate that what teeth he possessed sufficed for all practical purposes, and would probably continue to do so for such time as the war might reasonably be expected to last. Very few in those days, as will be well remembered, entertained any suspicion that the war would run in two years. It was time, however, which proved the disturbing element in our calculations on this head, as indeed on all others. Under the wear and tear of prolonged active service, and the effects of hard-tack rations, the teeth of a great many men eventually gave out. The medical authorities found themselves faced with the problem of how to restore dental health and masticating power among the men, and so to retain them fit and well for the firing line. The problem became an acute one very early in the Egyptian campaign. The trying climate and highly septic dust and sand which were continually blowing into the mouths of the men and gaining access to their food, as well as the scarcity of water on the desert, which rendered proper cleansing of mouth and teeth intermittent and often impossible, all combined to aggravate the matter. It was not only that the absence of serviceable teeth prevented the due preparation of the food in the mouth, thus interfering with nutrition and resulting in general loss of vitality, but the decaying teeth introduced an active poison into the system, tending to a condition of unfitness for duty, and not seldom to the production of positive disease. Large numbers of men were continually being sent down from the firing line to the base, whose sickness was due in the first instance to the condition of their teeth, and at one time the problem, from a military point of view, threatened to assume serious proportions. As with all other difficulties, which have faced the medical authorities of the Egyptian Expeditionary Force, this problem was met and overcome by the same tried methods of combined energy, ingenuity and organizing care. The system of sending to the base, all men in need of dental treatment, necessary as it was in serious cases, was neither requisite nor desirable with those whose trouble was comparatively slight or only temporary in nature. Very early, therefore, in the advance of the force over the Sinai Desert, a new system was instituted. The main principle of this was to attach dental surgeons to certain of the field ambulances operating close to the front, so that dental aid would be available within a reasonable distance of all fighting units. The main function of these field dentists was to sift out all cases into their various degrees of gravity. Minor cases, requiring only treatment for the relief of pain or whether decay, limited to a few teeth, were so advanced as to render extraction unavoidable, would be dealt with summarily on the spot, and the men returned at once to their units to carry on with what sound teeth remained to them. Cases where the teeth causing the trouble were still of a useful character, and therefore worth stopping, cases where the need for artificial teeth existed, and cases in which some septic complication was present, were sent to the nearest casualty clearing station, where the dental surgeon in charge was furnished with proper equipment and mechanical appliances for the task. At the casualty clearing stations again, a second sifting took place, only those men needing comparatively brief treatment being there retained. The remainder, those requiring more or less complete dentures, and those needing drastic medical as well as dental attention, were sent down to the base to be dealt with by the permanent dental establishments at Cairo or Alexandria. This filtering system had at once the happy result of materially relieving the congestion of patients which had hitherto existed at the base, and allowing the surgeons there to devote more time to those patients urgently requiring it. Also, no doubt, it put a stop to a certain amount of malingering, the prospect of a return to civilisation, for what nearly always proved a protracted period while awaiting their turn for treatment at the overworked base depots, being an irresistible allurement to many war-worn men who, in addition, were demoralised by incessant agonising toothache. At the same time, the dental staffs available at Cairo and Alexandria were reorganised. Probably there is no medical officer in the R.A.M.C. who, if asked to name the hardest work branch in the core, would not unhesitatingly award the palm to his own particular denomination. It is certain, however, that the body of dental surgeons doing duty in Egypt have been second to none in energy and industry as well as opportunity for exercising these qualities. The entire work of the Egyptian Expeditionary Force, including the Sinai Desert Column, the Canal Zone Troops, the Western Force and the various British garrisons in Egypt, has been carried through by a staff of about thirty dental surgeons, a fact which speaks volumes for the organising ability of the senior officer in whose charge the whole dispositions were placed. Taking a typical specific period, we find that in this time a total number of 28,300 dental cases were treated, involving some 58,600 attendances at the depots. These included the cleaning and filling of about 17,000 partially decayed teeth, of which number about half required preliminary treatment in the form of nerve devitalisation and removal of septic root conditions, thus vastly increasing the work ordinarily called for in the process of filling. New dentures supplied during this period reached a total of only 4,000. This very moderate figure was undoubtedly due to the large amount of filling work done, and it represents a considerable economy to the public funds as well as advantage to the patients. In addition to the volume of dental work above indicated, over 28,000 summary extractions of hopelessly decayed teeth were performed within the same typical period, the men in nearly all cases being returned to their units forthwith. While at Cairo, the old system of attaching the dental surgeons with their mechanical staffs to the various base hospitals or convalescent depots was conveniently retained, at Alexandria a different procedure was adopted owing to the number, varying character, and wider distribution of the units involved. At this latter base the dental establishments were removed altogether from the hospitals, and their forces concentrated under one roof at the convenient centre of Mustapha. This central depot was named the Dental Annex, and it gave continuous employment to about a dozen dental surgeons and some 50 assistants, of whom 23 were fully trained dental mechanics. All the tooth troubles of the Alexandria District were brought to the Annex, and both work and workers being thus congregated on one spot, a vast economy in time and labour was affected. Another equally commendable arrangement was that by which all cases of fractured jaw, due to shot and shell, were concentrated at one hospital in Alexandria, where they came under the immediate care of the senior dental surgeon stationed at the Annex. Men injured in this way require the most skillful treatment and generally need splint appliances of a very ingenious and delicate character, specially designed for each case. Extensive bone grafting may have to be resorted to, and the contour of the face ultimately restored by what is known as plastic work. The introduction beneath the skin have sterilised paraffin wax to take the place of tissue lost. All this work comes within the scope of modern dental surgery. It is not pretended that a great deal of such work was undertaken by the R-A-M-C dental surgeons with the Egyptian Expeditionary Force, but those cases which fell to their lot received the best that scientific care and skill could afford them. As a general wartime policy, nothing but straightforward simple dental work was attempted throughout, with the single object of keeping as many men as possible fit for military service. The fact that to all intents and purposes we were a self-contained force was kept steadily in view, and all dental arrangements therefore made as complete as possible. But no man was treated from the personal humanitarian standpoint alone. Our dental surgeons were out like the rest of us, not primarily to alleviate human suffering, but to bring the war to a speedy end by maintaining the strength of the firing line by any and every means known to human ingenuity. Looking through the official records of this branch of the R-A-M-C service, one is struck by the uniform smoothness and absence of delay with which the supply of dental material and appliances was kept up by the medical-based depot, as well as by the very formity of the demands made upon it. Though the necessity for the provision of either partial or complete dentures was kept at a very low rate, by reason of the enormous amount of filling work which was carried through, an average periodical supply of 8,000 or 9,000 artificial teeth was needed for the men of the Egyptian Expeditionary Force, but these formed only a small part of the material required. Besides multitudinous instruments, dental chairs, gas apparatus and the like, the actual manufacture of the dentures, these averaging perhaps 1,000 per month, called for a long list of articles. Moreover, a great proportion of this work was carried out by the casualty clearing stations far in advance of the base, and transport of the material and appliances, therefore, became an added and serious difficulty. Indeed, what has been accomplished in Egypt in dental surgery under active service conditions and often actually under fire, might well astonish the reader if anything like a complete account of it could here be attempted. Before leaving this department of RAMC activity, mention must be made of the high technical standard reached by the Army dental mechanics in all their work for the men. There are secrets in every trade, and in none more so, perhaps, than in the mechanical side of dentistry. Nothing would be gained by revealing here the actual composition of the enameled porcelain of which the artificial teeth were made, the nature of the filling amalgam, or the wonderful material of which the denture plates themselves are constructed. It must suffice to say that, as manufactured by the RAMC dental department, all these are as good and enduring as any supplied by civilian art. In regard to these materials, the word wonderful is used and used advisedly. The making of a denture that shall retain its usefulness against all the severe tests and vicissitudes to which a soldier on active service is likely to submit it is a far more complicated matter than may be generally supposed. Not only must the appliance be fitted and balanced with scientific precision, and be composed of material capable of resisting the hardest wear and tear, and even accidental violence, but it must have the quality of absolute immunity to the forces of expansion and contraction, both during manufacture and afterwards when in use. In the attainment of this property lies the vital trade secret, which must not here be touched upon. Suffice it that our Army dentists possess that secret equally with the foremost in their craft, and are using it to good purpose in their own particular contribution towards winning the war. CHAPTER XIV THE WORK OF THE MUSTIFA RECEPTION STATION, ALEXANDRIA THE STORY OF THE GROWTH OF THE RAMC RECEPTION STATION AT MUSTIFA, NEAR ALEXANDRIA ALMOST DESERVES TO RANK AS ONE OF THE ROMANCES OF THE NEAR EAST MEDICAL SERVICE, IF UNREMITING HARD WORK AND DIFFICULTIES VALORIOUSLY OVERCOME, MAY ENTITLE A RECORD OF SHARE DOMINANT USEFULNESS TO THAT NAME. At the beginning of the war the reception station was only a small affair, designed to minister to the immediate medical needs of the British garrison on the spot. It attended to minor ailments and injuries so little serious or of such a temporary character as to be outside the scope of a full-dress military hospital. Its activities were such as could be met by the services of one R.A.M.C. non-commissioned officer and an orderly, and a provision of four beds, sufficed for such cases as needed a few days detention and course of treatment. At the present time of writing the Mustafa reception station has grown into an establishment of prime importance, with a considerable medical and nursing staff, and a bed accommodation for over 200 patients. During the period extending from August 1915 to January 1917, many thousands of men have, for one reason or another, pass through its hands. Locality was the determining cause of its rise into military fame. Mustafa is a suburb of the great Egyptian seaport of Alexandria, where many of our troops disembarked. It is nothing more than a fine open stretch of seaside desert, eminently suited for a large military camp, not only on account of its natural advantages, but because of its contiguity to the place of disembarkation, to the railway, and to a good municipal water supply. Mustafa, with the district bordering on it, was therefore seized upon by the army authorities for a main concentration camp, where the bulk of the human material required by our operations in the Near East was stored pending dispatch elsewhere. A cloud of white canvas and semi-permanent buildings soon spread over the breezy, sun-stepped waist of Mustafa and its environs, and the little reception station suddenly found itself a master wheel in the great military machine. The real work of the station began with the inauguration of the Gallipoli campaign, and the opening out of the Egyptian Mesopotamian and Salonican expeditions still further increased it. Practically all the troops coming to and going from the great camp at Mustafa passed through the reception station for some cause or other. In such a large depot it was inevitable that many cases of slight sickness should arise. These were treated and, where necessary, detained temporarily at the station. Whenever a new draft of men came in all had to be medically inspected by the station medical officers, and given a clean bill of health before being sent among the bulk of their comrades in the camp. In the same way bodies of troops leaving the depot for the front were examined at the station, and certified as to fitness for active service. As the strength of the various regiments with the fighting columns became depleted, drafts were sent out from England to make up their deficiencies. Troops arrived from the European fronts for transference to the eastern, or departures of troops took place for service in France. A continual journeying to and fro between the base camp at Mustafa and the various arenas of war far and near went on, and all units involved necessarily passed through the hard-worked reception station. In addition to the labour and vigilance needed to ensure the thorough medical inspection of such vast numbers of men, a systematic inoculation of every soldier leaving the base depot was instituted as a preventive measure against the contraction of diseases such as smallpox, typhoid, paratyphoid, and cholera. In the period above named, no fewer than 35,600 inoculations were carried through by the medical officers of the reception station. As many as 1,433 men were treated in a single day, and in one period of four days, 6,000 men passed through the station for this purpose. As is well known, inoculation is wholly voluntary in the army. The men submit themselves to the process entirely of their own free will. These figures, therefore, speak volumes for the discerning power and judgment of our soldiers, at least as far as the eastern armies are concerned. Incidentally, they bear equally valuable testimony to the common-sense way in which the pros and cons of the inoculation question have been put before the men by our medical authorities in Egypt. It must be remembered that the figures above quoted in no way represent the whole number of men serving under the British flag in the east, who have thus allowed themselves to be scientifically protected against disease. They comprise only those who, for one reason or another, were embarked uninoculated, those who at first refused treatment, but have since been convinced of the error of their ways, and those who have been inoculated once, but who now require a second application owing to lapse of time rendering the first no longer efficacious. Another branch of work carried on by the reception station at Mustafar, less romantic, but scarcely less important, has been that of the destruction of insect pests among the troops. Not all the horrors of war are confined to the battlefield. Many a combatant will be inclined to agree with the writer that the discomfort, nay, absolute torture, of certain otherwise stilly nights of peace, endured in a verminous dugout or ship's bunk, will rank among the most terrifying of his war experiences. If the R.A.M.C. had no other claim on the gratitude of the fighting units for services rendered, it would deserve it alone for what has been done in this matter of ridding the men of at least one trouble of the personal kind in the midst of so many unavoidable public cares. A very large proportion of the troops passing through the reception station were found to be infested by different kinds of body parasites, especially those recently returned from the fronts or disembarked from the troopships. On their arrival at Mustafar the men of each detachment were examined by our medical officers, and, if found to be infected, were detained and given an antiseptic bath on the spot, or their clothing and effects being in the meantime thoroughly fumigated. By these means a new start in complete personal cleanliness was assured for each man. The gross amount of comfort thus created being best realized when it is considered that, on a rough computation, about twenty percent of all the drafts that passed through the station were found to be harboring some sort of vermin or other. It is not a pleasant subject upon which to dilate, but it is necessary to set down the fact in any account of R.A.M.C. doings which aspires to be a fairly complete one. There are other things to do in wartime under the Red Cross, besides organizing camp concerts and doling out cigarettes and chocolate to wounded soldiers. The treatment of skin diseases formed also an important branch of the work of this reception station. A special skin department was opened there, and eventually men from all the eastern theatres of war and even from the general hospitals in Egypt were sent to Mustafar to be treated for these distressing and demoralizing complaints. Two hundred of the beds in the station were permanently set apart for skin work, and at times of emergency, as many as three hundred and fifty skin patients have been under treatment simultaneously. In addition to the various kinds of work already enumerated, the routine duties of the station were numerous and heavy. A health inspection of every man in the camp was held weekly, and many cases of incipient disease were thus detected. The inspection was particularly useful in the matter of venereal diseases, wherein early recognition is so vital a factor as regards effective treatment. These were not merely cases of concealment, which very rightly constitutes a punishable offence in the army. Frequently the men found to be affected were genuinely ignorant of their condition. The volume of work dealt with at the daily sick parade at Mustafar can be easily imagined when the vastness of the adjoining camps is considered. The output of the dispensary in medicines and small curative items was enormous. Some idea of its extent may be gathered from the fact that there were twenty-eight separate stock mixtures designed for the amelioration of as many minor disorders constantly on tap. There also existed in the vicinity at one time a large detail camp to which men sufficiently far advanced in recovery from wounds and illnesses were drafted from the large general hospitals. This arrangement materially relieved the congestion in the hospitals, but it proved a severe tax on the staff of the Mustafar reception station, upon whom devolved the task of completing the cure of these patients. The station also ran an isolation compound, where all men who had come into contact with cases of infectious disease could be detained for the officially prescribed quarantine period. As a final word in the enumeration of the many activities of this hard-worked branch of the R.A.M.C. in Egypt, it must be mentioned that on four days in each week, a standing medical board sits at the station for the purpose of classifying into various categories of effectiveness the men drafted out of the camp. A peculiar and very trying feature of the work of this station throughout has been that, while the daily routine work went heavily and continuously on, the rest came in rushes, when drafts arrived, as many as 1500 men have had to be medically examined at a stretch. CHAPTER XV. THE MEDICAL ADVISORY COMMITTEE FOR THE NEAR EAST. IN THE MEDICAL HISTORY OF THE WAR, WHEN IT COMES TO BE RITTERN, TWO FACTS WILL STAND PROMINANTLY FORTH. THE AMAZINGLY HIGH STANDARD OF TECHNICAL EFFICIENCY DISPLAYED BY ALL BRANCHES OF THE ARMY MEDICAL SERVICE, AND THE EXTENT TO WHICH EXPERT KNOWLEDGE IN THE ENUMERE OF THE MEDICAL HISTORY OF THE WAR, WHEN IT COMES TO BE RITTERN, TWO FACTS WILL STAND PROMINANTLY FORTH. THE AMAZINGLY HIGH STANDARD OF TECHNICAL EFFICIENCY DISPLAYED BY ALL BRANCHES OF THE ARMY MEDICAL SERVICE, AND THE EXTENT TO WHICH EXPERT KNOWLEDGE IN THE ENUMERABLE DEPARTMENTS OF MEDICAL SCIENCE HAS BEEN CALLED UPON TO AID THE REGULAR R-A-M-C EXECUTIVE WITH THE FORCES. THIS LATTER MAY BE SAID TO BE A NEW DEPARTURE IN THE ART OF WAGING WAR, TAKING ITS INCEPTION FROM THE PRESENT CAMPAIGN. AND THE NOTABLE SUCCESS OF ITS ADOPTION CANNOT FAIL TO REVOLUTIONIZE ALL IDEAS FOR THE FUTURE. IF WAR, EXCEPT IN ITS MINOR LOCAL SENSE, BE DESTINED TO HAVE ANY FUTURE, A THING WHICH IT IS SAFE TO PREDICT, THE WHOLE DISGUSTED BLOOD-SATIATED WORLD OF THINKING MEN AND WOMEN WILL UNITE TO PREVENT. NOWHERE IN THE WHOLE AREA OF THE WAR HAS THIS INNOVATION BEEN MORE FULLY EXPLOITED THAN IN THE EASTEN MEDITARANIAN, NOR INDEED COULD GREAT A NECESSITY FOR IT HAVE EXISTED ELSEWHERE. IN THE FORGOING PAGES IT HAS BEEN FAIRLY THURRILY DEMONSTRATED AMIDST WHAT CIRCUMSTANCE OF UNEXAMPLE DIFFICULTY OUR ARMY PHYSICIANS AND SURGEANTS HAVE CARRIED ON THEIR WORK. NOT ONLY HAD ALL THE INJURIES OF WAR, ORDINARY AND EXTRAORDINARY TO BE FACED. NOT ONLY HAD THE COMMON ALMENTS INCIDENTAL TO ANY ARMY OF EUROPEANS ON ACTIVE SERVERS TO BE DELT WITH, BUT THERE WERE ALL THE DANGERS TO HEALTH INSEPRIBLE FROM THE EXISTENCE OF WHITE MAN IN TROPICAL COUNTRIES, OR UNDER SPECIALLY TRYING SELF-EUROPEAN CLIMATIC CONDITIONS TO BE FACED WITH RESOURCES OPTANABLE ONLY FROM A BASE THOUSANDS OF MILES AWAY. It is a matter of common history, however, that our medical service in the Near East held together magnificently against all these odds. This was due, of course, primarily to the efficiency, energy and devotion unfailingly displayed by all ranks in the Royal Army Medical Corps, but our officers and men, from the highest to the lowest, received incalculable aid from the experts permanently attached to every denomination of the service. It is not too much to say that every soldier in our armies fighting in the eastern Mediterranean area had, at his disposal, in the event of his critical illness or injury, just as much expert medical or surgical help as he could have secured had he been a wealthy inhabitant of Park Lane. Many of the most famous names in medicine and surgery are to be found in the R-A-M-C nominal role of specialists doing duty in this war area, and their services were equally at the disposal of the Commander-in-Chief or the humblest private in the ranks. But the medical authorities at home were not content even with this eminently satisfying and heartening state of things. They realised that the entire R-A-M-C organisation out here was working at full pressure, nay, at forced draught, and it could not be expected to have eyes at the back of its head. Such eyes, however, the Director-General now determined to provide for us, and the resolve took effect in a singularly happy expedient. A committee of five experts, each one preeminent in his own particular subject, was chosen and was sent out to the eastern Mediterranean in July 1915. Its allotted duty was to provide the whole scene of operations, and generally to advise the local executive authorities on any and every matter appertaining to the maintenance of health among the troops, but particularly to concern itself with the enormously important question of the prevention of epidemic diseases. Throughout all the near-eastern operations, this latter problem has ever been the gravest with which our service has been called upon to deal. The military difficulties at the Dardanelles, at Salonica, in Mesopotamia and on the Sinai Desert were all unexampled in their peculiar way. But it is doubtful whether they at any time surpassed in gravity that constantly presented by the problems confronting the medical service. As a single example of the kind of emergency we had to face, it may be mentioned that during a period of only six weeks at the end of the summer of 1915 a large number of cases of diarrhea and dysentery occurred among the troops dependent on the Egyptian medical base. Theoretically, of course, all these cases were cases of preventable disease. Practically a great many, possibly the vast majority, would have been prevented if only the hard-worked medical and sanitary executive throughout the military system had had time to look about it and to devise schemes for the future, both immediate and remote. This duty of looking about and contriving, admittedly of such pressing need and importance, was immediately assumed by the Medical Advisory Committee on its arrival in the Near East, and the fruit of the committee's activities soon became abundantly visible. The committee prosecuted its labours throughout a period of nearly two years, and some idea of the conscientious manner in which it performed the task allotted to it may be gathered from a mere itinerary of its travels. Arriving in July 1915, when the Dardanelles struggle was at its height, it spent the first four weeks in inspections in Egypt, in Alexandria, Cairo and throughout the Suez Canal area. It then proceeded to Mudrose, the advanced base for the Gallipoli force, where a large amount of useful inspection work was carried out. In September it crossed to the peninsula and made a thorough round of our positions at Suvla, Anzac and Cape Hellars. Then it journeyed back to Mudrose for more inspection work, returning to Egypt in October. Again in November it took ship for Mudrose, crossed once more to the peninsula for another series of inspections. It was back in Mudrose at the end of the month, when it almost immediately set sail for Salonica and the Serbo-Bulgarian frontiers, and there carried out an extended tour. This latter task occupied the greater part of December, and on its completion the committee made for Egypt once more. In 1916 the committee's movements were equally far-reaching and various. From January to April it remained in Egypt, carrying out a number of inspections in the contiguous war areas, especially the canal zone. At the end of April it again paid a visit to Salonica, passing thence to Malta, and finding itself back in Egypt by the month of June. It's now busied itself in the establishment of a head office, called the Epidemiological Bureau in Cairo, the object of which was to provide a centre with a periodical reports, clinical and statistical, could be sent from all medical units in the country, and where these could be tabulated and generally digested into practically usable form for the purpose of the committee's preventive work. Thereafter the arena for this ubiquitous body's activities became two-fold. Four of its members, acting under special instructions now received from the war office, proceeded to Mesopotamia early in August, returning to Egypt only in April 1917, after a most arduous winter campaign of inspections. The remaining member of the committee retained his headquarters in Cairo, where, together with his two epidemiological officers, he not only attended to the heavy duties of the Bureau, but contrived to find time for inspection visits to the Alexandrian camps and also for voyages to Malta, Salonica and the Bulgarian frontier once more. In May, by common consent of the authorities, both at home and abroad, the work of the committee was adjudged at an end, and its members then returned to England for a much-deserved rest. Even thus set down in the dry matter-of-fact of a chronological sequence, the quality and extent of the labours of these five highly trained scientific men are sufficiently obvious. To have covered so many thousand miles of land and sea as their travels necessitated is in itself a notable achievement. But when one comes to examine the recorded results, the innumerable official reports on inspections and investigations, displaying so much patient assembling of facts, widely scattered and difficult to come by, and so many ingenious deductions and recommendations, the wonder engendered in the mind of the plain everyday man of action, is still more increased. The main facts that strike an unexpert but attentive reader of these reports is their scientific exactitude in dealing with detail, their Catholic breadth of treatment, their sound, moderate, practical common sense, and the extent of real learning revealed by the writers. In spite of the deterrents, inseparable from their travels, winter and summer, year in and year out, over scorching desert, stormy, submarine-infested sea, through lands swept by gunfire and pestilence, their passage clogged at times by deluge, arctic-like cold, mud, dust, blowing red-hot sand, and bodily discomfort unspeakable, these five-gallant gentlemen pushed nerdily, indomitably forward, and did what was expected of them, honestly and thoroughly, without swank, or more than passing slight enumeration of the difficulties encountered, where such mention was necessary to explain the quality of the results achieved. It must be at once conceded that the only way to arrive at a true perception of what the Medical Advisory Committee accomplished in the interests of the health and comfort of our armies in the East is to make careful study of all these reports from beginning to end. Some conception, however, of the scope, the variety, and the far-reaching effect of this committee's labours may be gathered from such general swift survey of them as is alone possible here. The main official raison d'etre of the committee's existence was to advise as to the prevention of epidemic diseases among the troops, and all their efforts, discursive as they may seem, were really directed against this one fountainhead of military inefficiency. They conceived their mission, limited in words to this one brief, concise phrase, as actually limited alone by the circle of conditions within which bodies of soldiers may move at any period of active service, whether at the base or in the firing line, whether fighting, marching, pent up together in the concentration camps or lurking in the foxholes of the bivouac, dugout, or trench. They realised the dangers to health appertaining to each particular environment and while thinking en masse, as is alone possible when dealing with vast armies, they yet, as wise men, saw from the beginning that the only way of securing a healthy community was to ensure an unlimited supply of healthy individuals. As a necessary corollary, therefore, the activities of the committee were destined to prove hydro-headed. Their functions, being only advisory and not executive, their acts naturally took the form of written reports, addressed to the different Surgeons General, whether of Egypt, Malta, Solonica, or Mesopotamia, within whose jurisdictions they had been labouring. These reports, for the most part, took one set form. Each was divided into three heads. First, existing arrangements or conditions in whatever was under investigation were accurately and punctiliously set forth. Then the conditions that ought to exist as a pure matter of principle were detailed. Finally, a series of clear, succinct recommendations was given under the imprimatur of the committee. Such recommendations embodying the changes deemed practicable within the limits of unalterable local circumstances. By this systematic procedure in reporting, the committee, at one and the same time, held up in full view the ideal, recorded the actual, and put in plain practical words the possible, which latter, as it always proves in human affairs, was just a happy give and take between the other two. Merely to record the subjects dealt with in these reports would in itself be a lengthy task. A large number of them were concerned with the solubility or otherwise of campsites, and the two vital matters of camp sanitation and conservancy. The committee, realising from the first, that in what may be called the domestic side of military life, lay the principle field for their activities. In regard to Egypt, the conditions under this head were of a very complicated character. Fast bodies of troops were continually arriving in the country, remaining there for various periods, long or short, and then passing on to the different theatres of war. The consequence of this was, that a number of very large camps of a more or less permanent nature were established in those parts of the country, which were easily accessible to railway or dock. The necessity for having these concentration camps close to the means of transport, and to a sufficient supply of good water, greatly restricted the military authorities as to choice of sites. The troops, therefore, in many instances, were inevitably too closely crowded together, and the sanitary and conservancy difficulties common to all camps were thereby largely increased. Sanitation is never wholly a matter of principle. Indeed, in practice, the sanitary enthusiast must be prepared to find all theoretic laws, even those of arithmetic itself, set at defiance. In sanitary science, twice-two may usually be relied upon to mean four, but twice-two-thousand may yield a wholly disproportionate figure. Arrangements sufficing for a small camp can seldom be made to work for a large one by the simple process of multiplication. And when, as was the case with these large concentration camps in Egypt, the ground was not only continuously occupied by vast bodies of men and animals, but these bodies were periodically changing, and, moreover, the responsibility for the sanitary arrangements incessantly passing into fresh hands. The difficulty of preserving sanitary law and order about each site became a very grave difficulty indeed. On every aspect, then, of this weighty problem, the committee focused the main part of its energy and attention, visiting practically every large camp within the allotted sphere of its influence, and fearlessly having it say, on whatever seemed to it, in need of reform. A general war against the specific germs of disease may be said to have constituted the next most important item in the committee's program. This, in its wider sense, includes all measures, such as inoculation, whereby a potentially germ-destructive condition is induced in the human body itself, ready to combat any chance invasion of disease-producing organisms. The committee thoroughly investigated the systems in force in the army as to this branch of preventive medicine, reported as to their universality, detected and suggested methods for filling in gaps in the vital defensive line, made recommendations as to improvement in quality and nature of the different vaccines or emulsions, and generally infused the whole practice with the latest conceptions of science relating to the subject. It went closely into the existing provision and equipment of base and field laboratories, and the methods of work in force therein, and rendered invaluable service by suggesting possible improvements in systems adopted and appliances used. But it was against the disease germ, which is yet was only a latent path for evil, the myriads of microbes pervading everything the soldier touched or consumed, that the committee's efforts were chiefly directed. In a tropical country, the physician soon comes from dread experience to regard every single thing, animate or inanimate, with suspicion almost invariably well grounded. The water used by the troops was everywhere subjected to tests, and the best methods for its purification on a large or small scale enumerated. Various new methods for the prevention and destruction of germ-carrying insects were devised. Apparatus in use for the wholesale disinfection of the soldier's clothing and effects was overhauled and valuable new appliances introduced. The preservation of food from contamination received all the thought and care it demanded in countries where not only winged pests are bounded, but where a highly-infective dust or sand continually dwelt upon the air. In this regard, the committee went very closely into the whole kitchen and food handling systems in vogue in the army at all points, and made them the subjects of many helpful and luminous reports. It also dealt with the serious problem of the existence of vast hordes of native helpers and labourers in proximity to all our camps in the near east. The difficulty of inducing these folk to conduct their daily lives according to notions of the most elementary sanitary decency, not to mention any sort of real scientific cleanliness was well nigh insuperable. It had to be tackled, of course. It needed only a breath of wind from the right quarter, blowing over a dirty neglected native camp to carry a cloud of infected dust and flies capable of spreading contamination through a whole British division. Here the Argoside Committee rendered yeoman service going down into the deeps everywhere and unearthing sources of contagion which might well have escaped the regular sanitary inspectors no matter how conscientiously they held to their task. One very useful capacity in which the committee served during its two years sojourn in the eastern Mediterranean area is clearly indicated in these reports, although it is little likely to attract general notice. Whenever and wherever in the whole near eastern warzone some sharp, serious inexplicable outbreak of epidemic disease occurred the committee acted as a sort of breakdown gang or flying squadron which would proceed immediately to the threatened spot and take expert measures to stamp out the mischief. Over and over again the services of the committee were utilized by the regular medical authorities in emergencies of this kind and with uniformly good results. As an instance of this may be mentioned the sudden mysterious appearance of Enterica in the large camp at Moasgar near Ismailia in the Suez Canal Zone in August of 1916. Within a period of about a fortnight 23 cases of this intestinal disorder occurred and the authorities naturally took alarm as in such a crowded district practically unlimited possibilities for the spread of the disease were ready to hand. The advisory committee was promptly dispatched to the spot with the result that the cause of the outbreak was immediately discovered in some defective latrines and what might have developed into a serious trouble happily averted. Again one of the principal dangers to our troops serving in the east consists in the distressing and probably incurable tropical disease Bilhaziosis which has been referred to in previous chapters that this parasitic disorder has not developed long since into a serious menace to the efficiency of our near east armies must be entirely set down to the vigilance of the medical authorities all conceivable precautions against it having been sedulously adopted from the very beginning of hostilities but isolated instances of the trouble have cropped up from time to time traceable almost invariably the neglect of the enjoined simple precautions on the part of the men concerned the disease it has been clearly proved can be acquired by bathing in contaminated water drinking such water or even by the handling of fish from an infected stream in the autumn of 1916 some 20 cases of Bilhaziosis were detected at an Australian hospital in Cairo among patients diagnosed as suffering from quite a different complaint these men all came from one great military camp and it was obvious that what had occurred to these few might befall many more if the source of infection were not immediately discovered and removed the advisory committee were at once put on to the case they interviewed the men and drew from them the admission that contrary to orders they had all on one occasion bathed in a certain pool near the camp thereupon the committee journey to the place found the pool detected the Bilhaziosis organisms in it by microscopic examination on the spot and cause the necessary local measures to be taken to prevent a recurrence of the mischief in this particular instance of the committee's usefulness mention may be made of the special difficulty encountered in the work as throwing a little light on the general conditions of their task the Bilhaziosis organism lives a particularly complicated life partly in the water partly as a parasite of certain species of freshwater snail and partly within the body of its human or animal host the exact cycle of the various stages of its life need not be here detailed but the thorough character of the committee's investigation is evidenced by the fact that they went to the trouble in regard to this particular pool of identifying the organism in all its stages and even determined in what manner the original infection was conveyed to this isolated patch of water by searching for and discovering human fecal deposits probably native in the vicinity in which the characteristic lateral spind ovum of the Bilhazia worm was easily demonstrable it is not however possible nor is it necessary to attempt within the limited scope of these pages anything like a complete enumeration of this redoubtable committee's doings enough has been said above to show what a real influence for good its members exerted on the health of our troops under all aspects of the campaign End of Section 16 Section 17 of With the Royal Army Medical Corps in Egypt by Sergeant Major R.A.M.C. This LibriVox recording is in the public domain Chapter 16 Military General Hospitals in Egypt Part 1 The General Hospital forms part of the war establishment of the R.A.M.C. and its normal capacity as officially laid down is that of 520 beds the odd 20 being for sick officers its organisation, equipment and personnel are akin to those of the larger military hospitals in time of peace but the General Hospital has in addition the means of supplying to patients on their discharge such articles of clothing, equipment and odd necessaries as they may stand in need of in war time it is no unusual thing for a wounded man to arrive at a base hospital shorn of all his previous belongings or his clothing may have been so completely destroyed as to render it fit only for the incinerator of these General Hospitals two are officially allotted to each division taking the field at the time of the outbreak of the present war there were two permanent British Army hospitals in Egypt that at the Citadel in Cairo and the smaller one at Razeltin overlooking the harbour of Alexandria these however were equipped only on a peace footing with 250 and 120 beds respectively we have already described how under the stress of the Gallipoli crisis the hospital system at the Egyptian base of the Mediterranean expeditionary force was so established and developed as ultimately to reach a capacity of many thousand beds buildings of all sorts had to be acquired for the service of the wounded and sick in one form or another in all 23 permanent buildings nine hotels two places of entertainment seven schools four Egyptian army barracks 14 private houses were pressed into the service and one large camp hospital under canvas was installed this list however does not include certain convalescent depots such as that at Montazar which alone took over a thousand patients each there is perhaps no more exacting work in the whole army medical service than that which falls upon the staff of a general hospital especially under climatic conditions such as obtain in Egypt in an earlier chapter that dealing with the time of the Dardanelles ever launch of wounded to the Egyptian base an attempt was made to record what sort and measure of duty devolved upon our men and women alike under circumstances of urgency perhaps unparalleled in the medical history of the war but even under the normal busy conditions such as have existed in Egypt almost without a break since that memorable time the work in a general hospital is trying to the last degree monotony which is static which consists in a ceaseless even round of small duties none of them making any great demand on energy or interest is bearable because the mind is free to wing away at any moment into realms of compensating thought but monotony which is one never halting press of duties treading hard upon each other's heels duties by turns brain and body wearing heart aching or soul sickening a day long and night long giddy whirligig of sameness that gives one scarce time to eat or breathe or close a tired eye on a world that seems all suffering sorrow, bloodshed, death the man or woman who can plod serenely stole wartley on through day after day, month after month of such a life must be made of more than mortal tegment he or she must be qualifying for a saint's oriola and few there be of that ilk in the ranks of the R.A.M.C. it is not pretended that life in the huge base hospitals of Egypt was always moving at this ding-dong pace there were intervals between the arrivals of the convoys of wounded when the work eased up to such a degree as almost to create a feeling of leisure among the white-gowned orderly crew but such moments were all too rare generally the great busy organism fared along like a powerful well-oiled locomotive pulling a heavy load sometimes straining and puffing at a steep gradient sometimes swooping easily downward but for the most part driving steadily forward at top-gauge pressure through hill and dale the common give-and-take of busy days the object of these pages the presentation of an account as complete as may be of what the Royal Army Medical Corps did in Egypt during the Great War it is necessary to deal at some length and in considerable detail with the subject of general hospitals seeing what a conspicuous part these played in the conflict from first to last perhaps however the medium to the reader can be avoided and the desired object equally attained if the story be allowed to tell itself through the medium of certain extracts from a diary capped by an orderly who was continuously employed in one of these base hospitals during the most stirring period of the war as far as possible where all did so splendidly the names of individual workers have hitherto been omitted from this chronicle and it is not necessary to depart from this wholesome rule in the present instance it will suffice if it be mentioned that the operating theatre orderly whose diary is here quoted at length was well trained in all branches of R-A-M-C work capable of an accurate estimation of and deduction from facts it is needful to bear this in mind as the extracts in question not only deal with the work done but constitute in some measure an independent just and it must be owned rather intrepid criticism of certain of the conditions under which it was accomplished the writer however may well be left to make good or otherwise on his own account the operating theatre of a big military hospital in wartime is in a sense the eyes and ears of the place there is little that happens in the whole hospital that you do not see or get to know as theatre orderly the work takes you into almost every ward or department at one time or another and the business of most of the other orderlies in the building brings them to the theatre on various occasions we hear the surgeons talk between the cases and thus get a sort of second edition of matters discussed at the officer's mess the theatre sisters, bosom friends or enemies come to visit her in odd hours of leisure and volubly and voluminously unburden themselves of the latest rumours in feminine R.A.M.C. affairs the patients talk to us telling us weird tiles from the firing line that would never do for the papers but through it all we ourselves as the surgeons orderlies and thus the creme de la creme of the hospital orderly class maintain an attitude of immaculate discretion we are at once exemplars of reticence and receptiveness we are like the closed wooden moneyboxes of our schoolboy days quick to engulf coin but slow to yield it up again even to the exploratory persuasion of a dinner knife the inveterate gossip though cautious men of the world do not emulate him has nevertheless his part to play unintentionally and for his own easement he livens the dry dust of your day's work just as the full cropped bird of passage may cause the far mountain peak to clothe itself with verger the desert to blossom like the rose they have been tremendously busy in the surgical wards today and that is sure to mean hard work in the theatre tomorrow and for many days to come very early a big convoy of wounded arrived from the front a whole fleet of motor ambulances suddenly invaded the quiet of the hospital square in the blue dusk of dawn all loudly trumpeting like a stampeding herd of elephants directly the first vehicle turned the corner in the ghostly light the bell clanged out to summon all GDOs to the work of carrying the cases up to the wards I stood midway along the great main corridor and watched the stream of laden stretchers flowing by it is hard work stretch bearing and none but the youngest and strongest can keep on with it for any length of time I know because I have done my share of it in the past until I got PB'd for Shellshock and the desert and I parted company forever I wonder if anyone at home even the great DG himself quite realises the amount and variety of heavy work that ordinarily falls upon an RMC man on active service stretch bearing forms only a single part of it on a battlefield you often have to deal with a wounded man single handed get him unaided upon your own back and carry him to the zone of safety maybe a quarter of a mile away or more then a field ambulance moves with an unavoidable mass of necessarily heavy things tents, medical and surgical panniers bedding and what not all these must be loaded and unloaded tents pitched and struck the water and food needed by the patients and staff fetched and carried animals and vehicles cared for cleansed scarce anything we do but needs muscle as well as mind I stood and watched the steadily flowing stream of wounded men that pass by me in the dawning yellow light and wondered how much energy and hard work had been expended in the task of bringing them into this haven of sucker and security the last sunbeam of yesterday had probably seen them lying out amid the sandhills of Sinai a hundred miles away helpless, maimed and torn now before the sun could get another look at them they were back in the midst of law and order once more one little army of Red Cross men had contrived this laborious miracle for them here was another waiting all the resources of medical service at its beck and call to do more miracles in their servers kind eyes, soft voices gentle, clever hands comfort and spotless cleanliness order and quietude fresh plucked flowers blooming and waving near open windows a scent of new linen on the air the first sunbeams of the summer's morning like Jacob's ladders of gold dust gridding the tidy wards how, I bethought me, should all this the first impression of a general hospital strike a wounded, helpless man who but yesterday was brutishly blood-giving and blood-taking under the roar of cannon and reek of battle-smoke there were a couple of hundred in the convoy, perhaps and each man had to be got to bed his clothes gently drawn or cut from him his body washed, splints and bandages readjusted, perhaps food given his small personal belongings if he had any neatly arranged in the locker by his bedside his hospital kit drawn for him his military equipment taken to the pack-store and there left until he was well enough to reclaim it or until it was certain he would need it no more then came the medical inspection the doctor visited each bed in turn and made a thorough examination of the case deciding on future treatment the cases were of all degrees of gravity some needed only care and rest and nourishment to give nature all the chance she asked for others required close attention the constant vigilance of doctor and nursing staff through long weeks perhaps before the patient would have drawn away from the danger line others required special complicated appliances and apparatus here and there a man was marked down for operation as soon as the busy theatre could find time to deal with him or as soon as his strength had been raised to the necessary point of endurance and all of them meant increasing care and hard work for the orderlies sisters and nurses of the ward dressing and bandaging, blanket bathing operation and administration of food and medicine constant sanitary service the preservation of cleanliness everywhere the 101 nameless little officers due to the helpless sick and then there were the special things dictated by the subtropical climate in which we were working it was bad enough to have to endure bodily pain it was too much to have to put up with the added torment of heat and dust flies and mosquitoes little could be done to mitigate the heat that is when it was really hot in Cairo 120 degrees or so in the shade but the dust storms could be somewhat mitigated by wire meshed screens over windows and doors and mosquito nets over the beds would do the rest in special cases also the fan was a potent vehicle of mercy in our hospital at least on some brazen breathless afternoon I have passed through a ward and seen a fan steadily going over a flushed half conscious face of a man just reviving from an operation and returning perhaps an hour after there would be the fan still at work a woman doing it very likely but just as often one of the orderlies a man soon learns the trick of delicacy in these little things and of course he can keep on much longer at the job if in the surgical wards of a general hospital the work of an RMC orderly is trying enough with its incessant nerve harrowing crisis and ghastly scenes it is perhaps even more so in the medical division every hospital orderly by nature and temperament falls into one or the other of these two great categories surgical or medical and the qualifications requisite for each are wide as the poles asunder you cannot make a good surgical orderly out of one whose tendencies and abilities naturally belong to the medical side while any attempt to bend one trained in surgical nursing to the meticulous round of medical affairs but to waste time and good human material for medical ward work you must have a natural love of routine a memory as exact and unfailing as a ship's chronometer and a tireless, cheery patience and then I am not sure that you will last long at the job unless you are further equipped with a sense of humour and perennial kind or at least a lively appreciation of the grotesque you will need this humour to preserve your sanity the women in hospital work at least in tropical countries are wiser than we are they keep themselves mentally salubrious by a periodical letting off of steam they walk, so to say, among the gentler sex their male co-adjectors get the necessary reaction pirate wise, somehow or other emerge smiling, rejuvenated ready again for peace and quiet forgetfulness and forgiveness such as the hammer may be supposed to feel towards the nail after the due amount of clamorous collision you must not mind sparks nor what produces them if your life is an orderly in a general hospital ward is to be worth the living but that is another story which needs a different mood from that which besets me now I will jot down somewhat about it later in its place see the medical orderly his job the more I see of it the more thoroughly it fills me with something very like a version I can do anything for a wounded man but a sick man somehow chills me off it is a psychological matter, I think sickness, disease are abnormalities of demonic obsessions in the real biblical sense who can certainly deny it at least they change a man physically mentally, almost spiritually one might say, while their sway is over him a man is not himself when in their clutches who or what else he is be like, we shall never really know the day's round of duty in a medical ward is indeed a round the ring to which there is neither end nor beginning for if you take your work to heart you can never wholly separate yourself from it whether your spell of duty comes by day or night you come on duty at say 6 o'clock in the morning find the night orderlies pretentially wide awake bustling about in the early sunshine taking temperatures or lingering over little odd jobs loathe even then to break the spell of action that is on them and be away to their beds there is that curious heavy atmosphere in the ward that dwells over sleeping men at night and never over sleeping men by day the night sister is still in the bunk you can see her through the open door busy over her report and displaying an alabaster like prettiness under the pure white virgin light of the morning she is in no hurry to go either the junior orderlies just up fresh from early roll call are already on their knees in a row at the far end of the ward it is scrubbing day to day and the whole ward must be cleaned through before breakfast the harsh chorus of the scrubbing brushes and swish of the water join with the glad note of the birds that comes in through the open windows from the garden outside as orderly in charge you walk down the long rows of beds and take a look at each patient in turn exchanging a word with those who are awake this is a time of alternate pleasure and keen disappointment cases you well nigh despaired of overnight have perhaps taken a wonderful turn for the better others who were improving have lost ground all the odd perilous signs are light once more in wandering eye and flushed congested face and perhaps a form lies uncannily still and silent under the blue counterpane in the far corner the watching orderly nods grimly as you approach you take one quick look at the waxen mask on the pillow sharply you tell the orderly to fetch the stretcher squad and sharply you admonish another man hard by who indeed is doing his work well enough to lose a case is the most trying, irritating thing of all does any one at home I mean among the plain worker day men and women in the street really know what sick nursing in a hot subtropical country like Egypt actually means who has any more idea of it beyond the old pretty popular fancy of measuring out medicine three times a day cooling a fevered brow with lavender water and sticking a few roses in a bedside vase all these things and many more are done of course by the ministering angels of an R-A-M-C hospital ward in the east and pleasant it is truly to see the ladies of the Queen Alexandra's Imperial Military Nursing Service and the voluntary aid detachments flitting about a ward in their spotless white aprons and dainty caps carrying a sense of decent order and decorum wherever they go no one knows or is more ready to acknowledge the real value of nay the absolute necessity for the presence of a female nursing staff in a military hospital at all times than the writer of these lines if we orderlies did not fully and frankly acknowledge this there are thousands of grateful soldier patients in the army who would soon set the public right in the matter but what the public does not know and what it is our right and our duty to tell them is that practically all the hard work and assuredly all the dirty work of the hospital ward is done by the male nursing staff of the R-A-M-C and what work it often is it is difficult in a publication designed for the general reader where technical phrases must be avoided to convey a true impression of this matter without going into revolting details but a few guarded necessarily scanty words must be essayed despite all sanitary precautions in the field many thousands of our troops were attacked by bowel disorders enteric fever, dysentery and the like the greater number of these were helpless bedridden cases involving a constant care of the most intimate personal kind not only had each patient to be maintained in a state of cleanliness as regards his person and everything with which he came in contact but where his complaint was infectious all sorts of antiseptic precautions had to be scrupulously observed dejecta had to be disposed of in certain ways medically laid down utensils, garments and bed linen had to be antiseptically treated this rule also applying to the wards themselves and everything they contained to put the matter in plain words the orderlies in charge of these cases had literally to be elbow deep in filth of a highly dangerous kind morning, noon and night this element of danger in nursing cases of infectious disease must not be overlooked it applies of course in a great degree to the doctors and female staff of the wards but it is the orderlies who have all the dirty work to do who run the principal risk as are core records of sickness and yet there is never any difficulty in securing volunteers among them for emergency duty when outbreaks of exceptionally fatal diseases such as smallpox and cholera occur the fine spirit shown by our men in this regard during the whole of the Egyptian campaign has been beyond all praise to be shut up in an isolation ward for weeks and months on end doggedly enduring a life such as no malefactor ever had meted out to him by an outraged law and doing it cheerfully, faithfully for the end is just to behave like a hero there is no other word to fit the case it would not be a bad idea if a special decoration were instituted for men and women of this stamp and it might be called the Father Damien Order I know many a one who would deserve it and get it too if deserts had all to do with its award much the same need of incessant dabbling in loathesomeness obtains in the surgical division of the hospital where so many perfectly helpless cases are continually under treatment and here there is the element of the horrible added to that of the revolting I am not saying that a surgical orderly normally goes about with his heart in his mouth he would be a little service if he did personally long use is so accustomed me to the sight and handling of shattered and yet living human bodies that there is, I believe no terrible thing of this kind which could break my nerve but all the same experience does not lessen rather it heightens sensitiveness the more you see of war's terrible work though you are the more sternly tempered the more you dread it the more you see of suffering the more you suffer with it and the more sternly capable in the work of its assuation you become I have said that the climate has a deal of influence over hospital work in Egypt only those who have lived the year through in a hospital here can fully realise what that influence is in Egypt even in midwinter the days are always warm so long as the sun is up it is only the nights that are cold sometimes bitterly cold the Egyptian winter is very short however both days and nights for the greater part of the year are hot with a peculiar dead dry scorching heat that is particularly trying to sick and well alike and there is always an impelpable dust in the air that even on the stillest days steadily collects upon everything a dust that in all probability is capable of carrying the germs of almost every known disease when the wind gets up the dust gets up with it and the harder the wind blows the more dust it brings the dust storms in Cairo must be classed among the most unpleasant things that it is possible to conceive but there is something still worse that the old Arab city keeps for us when in its most venomous mood the heat alone is bearable and heat and dust together keep ordinarily just within the limit of human endurance but when a great sandstorm comes raging in upon the city of the desert and heat, dust and sand unite their forces against poor humanity the stoutest heart may well grow faint I always pity the white women and especially the little pale, peaky English children of Cairo at these times if ever there was a time when an orderly should not answer back encounter to unreasoning feminine assailment it is this many have attempted to describe a really bad sandstorm over Cairo city and in spite of heaping ossa upon pelion of ejaculation and superlative have wholly failed to convey an idea of the real thing I am not going to enter the futile competition I can only put in bold words how the thing strikes me suppose all Egypt were made of brass and suppose the sun gradually through many potentious days and nights developed enough furnace heat to bring this brass first to the melting point and then to dissolve it into lambant yellow vapor and then suppose all the winds of heaven to join together in one mighty hurricane to gather up all the sands of the Sahara to itself and hurl vapor and sand together in one incessant red hot resounding avalanche upon the town then you will get some notion maybe a trifle exaggerated of what Cairo is like in a typical summer sandstorm Camzin, Habub or whatever you choose to call the infernal thing now conceive yourself one of the medical staff in a big military hospital full of sick and wounded trying to preserve some degree of decency and comfort among the patients under these conditions the sand and dust are everywhere closed windows and doors are of no avail against them they drive in through every chink and crevice and smother everything patience, food, floors, furniture all alike a deep yellow twilight looms over the city such as London never saw in its palmiest days of November fog the electric lights have been switched on in the wards all the morning and added to this the wind outside keeps up a dreadful hollow banshee-like wail and makes every door and casement and skylight in the hospital rattle savagely so that you can scarce hear a human voice a dozen yards away of course these full-dress visitations of the elements are not of every day they are indeed rare in the season but once experienced they are never to be forgotten it is small wonder the Israelites were keen on getting out of Egypt I am keen enough that way myself sometimes it is in the wards of course that the great bulk of the outward obvious work of a general hospital is done to the amount of other work equally necessary which the RMC staff has to get through daily but which does not meet the eye of the casual visitor take the quartermaster's department as a first instance generally speaking we have no use for the genius in the army medical service we form together so to speak a great machine concerning whose composition it is of vital importance that every one of its parts should be of exact gauge and flawless metal but in which a single part of superlative merit is nowhere needed but there is one exception to this rule the quartermaster of a great military hospital in wartime should be a genius in his own particular line all our quartermasters in Egypt must have been so or the hospital service could never have held up as it has done against the mammoth strain to which it has been subjected this hospital of ours is by no means one of the biggest and yet in one year alone in 2015 we took in thousands of cases all these people as well as the large RMC staff had to be fed every patient had to be provided with bed linen needing frequent change a suit of hospital clothes and a long list of odd necessaries on discharge all deficiencies and his service kit had to be made good often this meant an entire new rig out of clothing the hospital required innumerable things furniture utensils cooking gear household materials and implements and the like most of which needed periodical renewal and everything except a few perishable food stuffs had to be obtained from home some 3000 miles overseas I take off my hat to the quartermasters of the RMC that they have done what they have done is obvious in the face of the accomplished fact but how it has all been accomplished fairly beats me then there are the clinical laboratories and the x-ray rooms to the laboratories go numerous specimens of blood sputum feces etc for microscopic examination and bacteriological treatment in our own little way here taking the same year as before we dealt with some 4000 or 5000 different specimens only one conversant with laboratory procedure will realize the vast amount of work involved in this each specimen has to be carefully prepared and treated before the microscope will yield any information about it it may have to be subjected to various reagents and several kinds of bacterial stains cultures on different media at certain definite temperatures will have to be made and examined at stated intervals all has to be done under strict aseptic conditions so that no alien element may intrude itself and vitiate the result the most simply equipped laboratory requires a bewilderingly extensive array of instruments and apparatus not to mention the brains needed to use them moreover a laboratory requires other things just as indispensable to the main object of its existence which is the saving of human life by prompt recognition of disease there must be little in the daily round of a military telegraph operator's life to achieve the grave tedium of his task but I wonder if the man who sent the following wire dispatched post-haste one morning detected a glimmer of humour in it coming as it must have done in the midst of an ocean of important messages bearing the grisly impressive war the message ran by a special messenger urgent a touch of the like-saving grace may have appeared in the reply regret having run out of guinea pigs owing to great demand for mesopotamia how about rabbits the x-ray room at a general hospital does for a wounded man much what the laboratory does for a sick one it supplies at once vital information as to his state which probably could not otherwise be obtained in time the location of a bullet or buried fragment of projectile or the precise nature and extent of a bone fracture if early ascertained may make all the difference to the injured man's chance of recovery to save him from an infinity of suffering recourse is therefore had to the rank and raise before every operation for extraction of foreign bodies where the making of a scaograph is in any way practicable having the photograph or rather the shadow-graph of the injured part before him in the theatre for constant reference the surgeon is unable to cut down straight to the bullet or whatever may be embedded in the tissues without making unnecessary incisions or spending time in exploration in the case of the fracture of a bone the x-ray picture enables a definite procedure to be decided on and all necessary preparations made beforehand and the patient is thus saved the risk of prolonged subjection to anesthetics in many injuries involving fracture the parts are so swollen and tender as to render any bedside examination in the ordinary way entirely out of the question and the patient therefore would come to the operating table with practically nothing known of his real state but for the help of the x-rays the dispensary is another department of a general hospital where a vast amount of work is done though the medicines prescribed in the wards are standardised as far as possible the usual combinations of drugs are subject to continual variation to suit the needs of the different cases and to accord with the ideas of different medical officers so that stock mixtures can be employed in only limited degree in addition an enormous number of special drugs have to be kept in readiness and the list of these is continually extending the same applies to surgical instruments and appliances as through the dispensing department of a hospital of instruments their name is Legion it is amazing what the development of modern surgery has rendered absolutely necessary in this way even in a field surgical outfit designed for use close up to the firing line while the surgical equipment of an operating theatre and a great base hospital has reached truly astounding proportions this is equally the case with all kinds of surgical and medical material specially devised splints for each variety of fracture bandages of all shapes widths and species of fabric dressings, plain or antiseptic surgical lotions of all imaginable kinds in regard to splints and special appliances necessary for the support of fractured limbs so great a demand for these arose in Egypt that the medical authorities established a factory in Alexandria where all such articles could be made and served out to the various units immediately thus avoiding the delays that occurred in awaiting supplies from home this factory was started in May 1915 and eventually 20 or 30 carpenters metal workers and saddlers found continuous employment there first intended to supply only the Mediterranean expeditionary force its products eventually came to be distributed to most of the war centres in the near east besides turning out large quantities of splints of the regulation patterns it was particularly useful as a place where any special appliance could be promptly manufactured to the design and specification of medical officers throughout the war area there is a department common to most general hospitals which is euphemistically termed the lavage room it is actually a special surgery and dispensary attended by all patients suffering from venereal diseases who are undergoing a periodical course of treatment here a very considerable amount of really hard and invariably disgusting work is done by the R.A.M.C. personnel attached to the branch dangerous work too as many a surgeon and orderly has found out to his cost but the work must be done by someone and it is tackled by our men with the same sang froid readiness and patient skill shown by them it is not necessary here to go into details of the work of the lavage room it involves many minor surgical operations the carrying out of many intravenous and intramuscular injections and a sharp supervision over a variety of matters of a personal kind closely allied with the work of the lavage room is that appertaining to the venereal wards that these wards are practically detention compounds is a fact upon which no other comment need here be made then that experience has proved it to be a necessary fact and one which adds inordinately to the difficulties of the staff employed it is easy to criticise the present scheme of treatment of venereal patients in the army but not so easy to suggest amendments at least it is certain that all that can be done in the stress and hurry of wartime is being done in Egypt but this and the whole group of social questions from which it arises will have to be reopened hereafter as a national concern it would be well if it were placed in the hands of a strong commission from which all lecture room cranks and puritan visionaries will have been rigorously excluded and in which none but practical level-headed, large-hearted far-seeing Christian men of a practical Christian world will have any say or sway and such a commission ought to be given power to act I am not addicted to italics as a rule but I feel the need for them here the army today will be the nation tomorrow if it be true as one military surgeon of long experience declared in my hearing that when our soldiers return from war ten out of every hundred of them will be tainted with venereal disease it is a tremendous fact that Brooks no dissembling the trumpet call that heralds peace must be for us as a nation but a call to another war that will need more than strenuous waging if we mean to keep our place on earth End of section 17