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The New Zealand Medical Service in the Great War 1914-1918

Chapter XXI. Demobilisation

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Chapter XXI. Demobilisation.

The outlines of a scheme for demobilising the N.Z.E.F. were drafted at an early date by the G.O.C. in charge Administration, Brigadier General Richardson, C.M.G., C.B.E. In 1917, he had foreseen the necessity for making special provision for the repatriation of disabled men, more especially the blind and limbless; and out of the projects devised to this end, the vocational classes for the limbless in Oatlands Park had grown to importance in 1918. Prior to the Armistice, in conformity with the scheme of demobilisation, the accumulation of low category details was gradually reduced by repatriation so obviating congestion in the Hospitals, more especially in anticipation of heavy casualties in 1918. The Division in France was also facilitating the return to New Zealand on furlough duty, of men with long service: in the case of the N.Z.M.C. both officers and men who had served continuously since 1914 were in some instances permitted to return to their homes for urgent business or family reasons; so that the process of Repatriation had been going on to a limited extent during the spring and summer of 1918, although temporarily interrupted during the mid period of the German offensive.

At the end of October, 1918, the figures upon which the scheme of demobilisation was based were sufficiently imposing: no less than 100,658 men had been embarked for the N.Z.E.F. in New Zealand ports, of which 26,109 had been repatriated and 13,910 had been killed in action or had died of disease overseas. The strength of the N.Z.E.F. in the various theatres of war or on the seas, was at this time 58,560 of which over 50,000 in France or the United Kingdom, and 3,500 in Egypt or Palestine. Repatriation in bulk was initiated immediately after the Armistice; the number of transports available, including most of the large ships then trading to New Zealand, was considered adequate to the purpose of embarking at least 1000 men per week and the time required to complete the evacuation of the war zones was estimated at twelve months. The problems specially interesting the Medical Services were:—

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(1) The embarkation of the wounded and sick; (2) The demobilisation of N.Z.M.C. personnel; (3) The provisions for reconstruction in New Zealand.

The Medical Headquarters of the N.Z.E.F. in London was in 1918 organised in various branches somewhat resembling those of the British Army Medical Service. At the head was the D.M.S., Colonel Parkes, C.M.G., whose duties comprised: general policy; liason with the "War Office; inspections; promotions and appointments of N.Z.M.C. officers; honours and awards. The office of the Matron in Chief, Miss Thurston, R.R.C., included in this branch, administered the N.Z.A.N.S. in England, France and Egypt, and controlled the female staffs attached to medical units. The A.D.M.S. Department, under Lieut.-Col. B. Myers, C.M.G., had charge of hospital administration; transfers and discharges; embarkation of sick and wounded; medical boards, and classification. Under this Department were: the consulting physician and the consulting surgeon; the president of the United Kingdom Medical Board; the officer in charge of medical boards and classification in London; the officer in charge of medical returns and statistics; the historical, medical research and war museum sections. The D.A.D.M.S., Major McKibbin, and his department, were responsible for: personnel N.Z.M.C., exclusive of officers; posting, transfer and promotion; training; reinforcements; sanitation. Included in this department was the Quartermaster's Branch, which was responsible for the purchase of and accounting for all medical stores and equipment supplied to medical units, including transports. The strength of Medical Headquarters was:. 7 officers, 74 O.R. during demobilisation, but was normally: 6 medical officers, 1 commissioned quartermaster, N.Z.M.C., 1 lay officer, N.Z.M.C. and 25 O.R.

The D.M.S., in the early part of 1918, had amplified and strengthened our hospitals so as to make provision for the casualties anticipated during the German Offensive. In order to relieve congestion in the medical units the principle had been adopted of supplementing the hospital ship service by ambulance carriers, improvised of the larger and better found transports.

The expansion of the hospitals by tents or the construction of buildings had increased the bed strength to a total of 6,495: the two large General Hospitals having over 1500 beds each, while the Convalescent Hospital at Hornchurch had a 1000 more. The number of patients of the N.Z.E.F. actually hospitalised in March, 1918, was:—in British hospitals, 26 officers and 1058 O.R.; in page 485New Zealand hospitals: 140 officers, 4,506 O.R.—in all 5,730 sick and wounded of all ranks, while the low category men or permanently unfit numbered nearly as many.

The necessity for providing specially trained N.Z.M.G. personnel for the service of reconstruction in New Zealand had been appreciated in 1917, and in accord with this policy Lieut.-Col. Wylie, C.M.G., N.Z.M.C. commanding No. 1 N.Z.G.H., was seconded, in February, 1918, and attached for training to Shepherd's Bush Military Orthopœdic Hospital and Lieut.-Col. Mills, late commanding No. 2 N.Z.G.H., was similarly detached to the Liverpool Orthopœdic Centre at Alder Hay. The intention was to form two military orthopœdic teams to be despatched at an early date to New Zealand, each team consisting of 4 surgeons, 1 surgeon in charge of physio-therapy, 1 radiologist, 4 trained masseuses, 2 N.C.O.'s gymnastic specialists, 1 expert plaster worker, 1 N.C.O. in charge records. The course of training in military orthopœdies was laid down as three months minimal, and was supervised by the army specialists, under Sir Robert Jones. The first of the orthopædic teams sailed in the summer of 1918, under Lieut.-Col. Wylie, and proceeded at once to organise special units in New Zealand, more especially Chalmer's Military Hospital at Christchurch, and Trentham Military Orthopœdic Hospital.

In the outlined scheme of demobilisation an educational campaign was the most prominent administrative provision for tiding over the dangerous period of non-military employment and relaxed discipline following the Armistice. Within the scope of the educational scheme the special training of experts in the N.Z.M.C. was included, as the opportunity available for promoting the efficiency of the medical services in New Zealand was rightly deemed to be of national importance. To this end a small number of officers and men of the N.Z.M.C. serving in France had been returned to England for duty, so that they might renew their knowledge of clinical work in the Hospitals. And further, it was agreed that all those whose long service in the field units—where clinical opportunities were few—had militated against advance in their professional knowledge should be granted some months of study leave in England prior to repatriation. Similar courses for N.C.O.'s who desired to take up laboratory work, massage, radiology, pharmacy, or allied specialities, were already in contemplation.

In the larger hospitals—Brockenhurst, Walton and Hornchurch—beyond changes in personnel and increase of bed states, there page 486were no important alterations during 1918, but in each the organisation had been strengthened and the quality of the work had materially improved, keeping pace with the general progress in knowledge of military diseases and the injuries of war. At No. 1 N.Z.G.H., Lieut.-Col. P. C. Fenwick, C.M.G., replaced Lieut-Col. Wylie in February. The monthly admission rate for this unit varied from 587 in February to 1308 in September. It had been found in the previous year that the accommodation was inadequate to cope with the large numbers of casualties coming over from France. At Brockenhurst the increased bed state was provided for by the erection of Tent Sections; marquees to accommodate 16 beds each were erected in two sections, one being at Balmer Lawn, but the larger number in the central section. The bed state was thus increased to 1600 and the hospital actually accommodated 1661 patients during September the maximum bed state being attained on the 26th following the Battle of Bapaume. During this period there were 1820 admissions and 1282 discharges. The Massage and Electrical Department was considerably increased in staff and equipment, and a new building provided, in which over 5000 patients were treated during the year. Splint making was so developed as to provide a11 required apparatus, and many locally devised appliances were constructed in the shops of the hospital by skilled workers of the N.Z.M.C. trained at Shepherd's Bush. As part of the vocational training of the disabled, agricultural operations such as pig rearing, bee-keeping, poultry farming, and the culture of vegetables including potatoes, were successfully attempted and became profitable ventures. Curative workshops opened in 1917 were well attended and the classes in carpentry, metal work, sign writing, and lighter occupations, proved to have reparative value in relieving war disabilities. Recreation was well provided for by the Y.M.C.A. in their own hall and by the kindly and ever generous residents of the Brockenhurst district. The chief administrative difficulty was the very scattered disposition of the various sections. Certain auxiliary hospitals had been taken over from the Red Cross Society or private individuals during the period of occupancy, namely: an Officers' Convalescent Hospital at Avon Tyrell, the residence of Lord Manners, under the care of the Hon. Miss Manners, R.R.C., with accommodation for 24 officers; Morant War Hospital in Brockenhurst village, managed by a committee of residents, with beds for 70 to 80 patients, increased by tents to 120. Thornby Hill, the residence of the Misses Hay provided 24 beds for New Zealand patients. At page 487Lymmington, Home Mead, a large private house with an annexe about half a mile distant, provided 70 beds and was controlled by Mrs. Chenery. Another grave difficulty was the inadequate accommodation for N.Z.A.N.S. and female staff accentuated by the despatch of male orderlies to France and the substitution of VA.D.'s. The female staff grew to 247 inclusive, of which 86 were N.Z.A.N.S., and the housing of so large a female staff had to be provided for by renting various houses in the village until late in 1918 more convenient quarters were provided in buildings elected for the purpose in the hospital precincts. Balmer Lawn Neurological Section with its annexes under Lieut.-Col. Marshall McDonald, N.Z.M.C., Neurologist and Consulting Physician to the N.Z.E.F., had grown to be an important unit, and provision for a similar institution in New Zealand was under consideration. The Surgical Division under Major T. D. Stout, D.S.O., was now fully equipped with all modern requirements and organised in separate wards each reserved for special types of gun shot injury, with specially trained nurses in each. At the end of 1917, Capt. D. E. Fenwick, N.Z.M.G., late of the R.A.M.C. had replaced Major Bowerbank as Registrar and Officer in Charge of the Medical Division.

As we have seen, Lieut.-Col. O'Neil, D.S.O., relieved Lieut.-Col. Mill in January, 1918, at No. 2 New Zealand General Hospital. Extra accommodation for limbless was provided at Oatlands Park about this time by the construction of huts, and the general bed state raised to 1800. The accommodation was fully taxed during April and September in sympathy with the operations of the Division, when the daily bed state averaged 1662. Major G. Home, N.Z.M.C., had charge of the Surgical Division, with occasional assistance from Lieut.-Col. Acland, N.Z.M.C., the Consulting Surgeon, whose headquarters were at this Hospital Major A. Hoskin, N.Z.M.C., was in charge of the Medical Division in the latter half of the year. The substitution of female workers for male N.Z.M.C. personnel was stated to have met with considerable success at Walton and in view of this the feasibility of such substitution in other units was well favoured. At Oatlands Park the classes of instruction for limbless patients had prospered and at an exhibition of work shown in London in May, 1918, before the Allied Conference on "After Care of Disabled Soldiers," the exhibit furnished from Oatlands Park, the work of our limbless soldiers, was reported to be the best and most practical display in the whole exhibition. The course of training, to which many maimed men now owe their success in life, page 488started in bed, was continued in the classes during convalescence in hospital and ultimately completed by attachment for from three to six months to a workshop, factory, or similar civil unit in England prior to the soldier's passing into the control of the Repatiriation Department in New Zealand, where a system of subsidised apprenticeship ensured the launching of the pupil under the best conditions in his new occupation.

The Department of Plastic Surgery of the Face, under Major Pickerill, N.Z.M.C., was in 1918, transferred from Walton to Queen's Hospital at Sidcup, twelve miles from London. Extra officers were attached to the New Zealand Section there: Captain Marshall, N.Z.M.C.—severely wounded just before Messines—as Specialist Anaesthetist; Captain Rhind, M.C., N.Z.M.C., as Assistant; and Major Rishworth, N.Z.D.C., as Surgeon Dentist. The New Zealand Section participated in the fine work of the well known "Jaw" Hospital and was ultimately transferred intact to the Dunedin Hospital with 59 patients in 1919, so bringing back the expert knowledge of plastic surgery which had attained to such perfection during the war, and which was essential for the adequate treatment of some of the returned men.

At the New Zealand Convalescent Hospital at Hornchurch, with a capacity of 2,500 beds, the most important change in 1918 was the opening of a School of Massage. All through 1918 there had been an acute shortage of N.Z.A.N.S. personnel—supplemented in rush times by the good offices of the Canadian Army Nursing Service—but more especially a shortage of trained masseuses. To meet this the D.M.S. instituted a course of training at Horn-church in conformity with I.S.T.M. standards. A six months training was considered sufficient, but in order to comply with the New Zealand requirements a further course of three months in Swedish remedial exercises and three months in electrical treatment was required. Many of the candidates trained at Hornchurch were enabled to attain the I.S.T.M. certificate, and in this way our future requirements were provided for.

No. 3 N.Z.G.H., under Lieut.-Col. McLean, N.Z.M.C., late O.C. No. 4 New Zealand Field Ambulance had expanded to nearly 1000 beds, including the venereal section of 500 beds. Five new wards had been completed by February, 1918; shelters for the accommodation of T.B. cases had been erected on the hillside above the Hospital. The site, in a deep cleft of the downs, was very damp and drowned in mists during the winter, hot and breathless during the summer by reason of the enclosed nature of the ground and the tier like structure of the wards on the page 489Venereal Diseases Prevention hillside, all of which made the Hospital both uncomfortable and inconvenient. In the Venereal Diseases Section of Codford Hospital a notable decrease in the admission rate had been gratefully recorded: in September 1918, the number of patients under treatment was 240, whereas in the corresponding month of 1917, it had been 410. The V.D. admission rate had yielded a constantly falling curve for nearly 12 months past, the credit for which was claimed by the partisans of the various creeds of preventive belief. Some held that it was due to the free issue of prophylactic packets, contraceptives, and vigorous propaganda; others claimed a triumph for the E.T. or "Blue Light" establishments. The deterrent effect of Sec. 40a of D.O.R.A., under which a woman was sentenced to six months imprisonment for infecting a New Zealand soldier in September, 1918, was thought by some to be an effectual cheek on dissemination, but the difficulty of obtaining evidence rendered the enactment almost nugatory. The patrolling of the streets of London by ladies attached to the New Zealand Y.M.C.A. was an heroic effort much to be admired and possibly did some good. But above all the successes claimed for the abortive treatment of gonorrhoea as practised by army surgeons of the Dominion forces, the confidential nature of the work, and the implicit belief of the men in the efficacy of the treatment, unquestionably led to earlier declaration of infection and a more ready attendance at the ablution rooms. It appears to the writer that propaganda and the improved methods of post-coital disinfection in the ablution rooms had a marked bearing on the fall in incidence in the United Kingdom troops. The greater part of the men infected contracted the disease after discharge from the Convalescent Hospital. Large sums of money were often available to these men on sick furlough during which excesses were almost inevitable as a reaction from the stress of active service, wounds and prolonged residence in Hospital. It was in the admission rate from the Command Depot, to which all convalescents reported after their leave had expired, that the most remarkable reduction was noted, soon after the establishment of a special E.T. establishment under a skilled staff, including a whole time M.O. The work of the staff included the inspection of all new arrivals within an hour after reporting at the depot by day or by night. Microscopic diagnosis was utilised to the fullest extent, and a toilet, carried out by a trained N.Z.M.C. orderly, was provided which was in accord with the best practice of the period and included careful irrigation, the use of mild silver solutions and page 490calomel inunction. Combined with this institution was the abortive treatment department which followed the methods recommended by the Australian Genito-urinary specialists at Horseferry Road in London. Whatever the results, and in spite of the occasional complications, the method had this to recommend it that it attracted the men by its confidential nature, freedom from notification and loss of hospital stoppages. It brought the men and the surgeon together in the co-operative fight against disease, and by its moral effect proved to be the most efficient propaganda.

The chief medical considerations in the camps and depots during the year had been the virulent epidemics of septic pneumonia and purulent bronchitis. In the first term of the year the 31st and 32nd Reinforcements had suffered from an epidemic of measles, rubella or morbilli—contemporary reports say both—which was complicated by fatal broncho-pneumonias. 75 cases of pulmonary infection resulted in 35 deaths, mostly at Brimsdown Bottom Isolation Hospital, Tidworth, during February, March and April. The disease arose on board ship and is reminiscent of the similar outbreak amongst our soldiers returning to New Zealand by the "Britannic" in July, 1902, at the end of the. South African War, referred to in chapter I. It was stated that the more serious form of the disease—whatever it was—was contracted at Newport-News, Virginia, where the ship had called to coal. Some of our men had visited a U.S. camp where the diseases had been prevalent and where purulent bronchitis as a complication had been very severe. The ventilation of the transports, especially at night, was defective, owing to the necessity for keeping the ports closed in the submarine zone, and for this reason the epidemic assumed graver proportions. In view of the seriousness of the outbreak and the necessity for determining the specific cause of the complications, Lieut.-Col. Marshall Macdonald, N.Z.M.C., the Consulting Physician, and Major Ritchie, N.Z.M.C., Bacteriologist at No. 3 N.Z.G.H., were detailed to assist the small R.A.M.C. staff at Brimsdown Bottom Hospital. Pathological investigations of fatal cases revealed conditions of acute bronchitis with copious purulent secretion, areas of consolidation and broncho-pneumonia, and emphysœma, with signs of generalised infection. The Bacteriologist noted the presence of Streptococcus longus, associated with B. influenzae, pneumococci and staphylococci. A streptococcus was occasionally isolated from blood-cultures. The invariable presence of B. in-fluenzae as determined by culture of the sputa by Dr. Eyre of St.

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Thomas's Hospital was a remarkable finding, as it put this type of pulmonary infection in the same category as the influenzal pneumonias seen later on during the year. The similarity of the necroscopic and laboratory findings with those reported in New Zealand during the winter epidemics is also worthy of note. Similar cases had been observed in France in the winters of 1914, and 1916; few if any in 1915. Purulent bronchitis was a frequent complication of wounds more especially of the chest, and usually the bacillus of Pfeiffer was the organism most constantly found, although there were no epidemics of influenza at the time.* The presence of a streptococcus as in Trentham in 1916, was a characteristic of the Sling epidemic of early 1918, but as another investigator, Capt Lowe, N.Z.M.C., Bacteriologist of No. 2 N.Z.G.H., had by blood agglutinations shown a definite lack of immunity to the pneumococcus in New Zealanders, all were agreed to adopt an immunising vaccine prepared by Dr. Eyre in collaboration with Captain Lowe and containing mixed organismst. The vaccine was known as M.C.V. (Mixed Catarrhal Vaccine) and had at first the following content:—

Pneumococcus 50 to 100 Million per ½ c.c.
Streptococcus 10 to 50 Million per ½ c.c
B. Influenzae 10 to 30 Million per ½ c.c.
Staphylococcus aureus 200 to 500 Million per ½ c.c.
Micrococcus Catarrhalis 25 to 75 Million per ½ c.c.
B. Pneumonia 50 to 100 Million per ½ c.c.
B. Septus 50 to 100 Million per ½ c.c.

The vaccine was designed to produce an artificial immunity not only against the first three virulent organisms most frequently found in fatal purulent bronchitis, but also to immunise against the other organisms found in catarrhal sputa and nasal discharges. The vaccine was made compulsory for all reinforcements; it gave rise to little obvious reaction administered in two doses at a week's interval, and yielded some evidence of immunising power during the influenza epidemics in England.

The lengthy report on the Sling epidemic furnished by the Army Sanitary Committee on February 28th, 1918, after pointing out the known fact that measles in armies was noted for the increasing severity of the cases during the progress of the epidemic and that the case mortality in such epidemics in the American Civil War had, at times, reached 20 per cent, while in page 492the siege of Paris as many as 40 per cent. of the sick had died, insisted that the hypothesis of a specially virulent type of measles was unnecessary to explain the high case mortality in this outbreak. Its seriousness was explained by the simultaneous presence of other catarrhal infections, a condition aggravated in the crowded and ill-ventilated ships and leading to massive mixed infections. Measles, cerebro-spinal fever, influenza, and acute tonsilitis had affected the troops on board the Willochra after sailing from New Zealand, but the full virulence of the enhanced infection did not mature until shortly before landing. Here we have an epitome of the plagues of Trentham and building stones in the world wide epidemics about to come.

Another and a more serious outbreak was that which occurred on board the troopship Tahiti, in August, 1918. The transport carrying the 40th Reinforcements, including 21 officers, 10 N.Z.A.N.S and 1080 men called at Sierra Leone towards the end of August, where she had rendezvous to form part of a convoy. Contact was made with H.M.S. Mantua, a cruiser infected by a serious and fatal form of influenza. Within a few days of the sailing of the convoy, influenza broke out in the Tahiti, and practically the whole ship's complement was affected. A very fatal broncho-pneumonia which complicated the more serious cases, caused 68 deaths at sea before landing at Plymouth, and of the surviving sick, 116 in number, who were transferred to No. 3 N.Z.G.H., three died of purulent bronchitis, and one sister, N.Z.A.N.S. of cerebro-spinal meningitis. It is hardly possible to realise the difficulties of dealing with such a pandemic on board a crowded transport in a submarine zone, where ventilation was limited by reason of the closing of portholes at night, and where practically everyone suffered from the disease, including the three medical officers, the nursing sisters and the N.Z.M.C. orderlies. Much could be said of the zeal and fortitude of the O.C. troops, Lieut.-Col. R. Allen, D.S.O., and the devotion of the N.Z.A.N.S. and the medical officers who were unremitting in their attentions to the sick. The deaths which occurred daily and in daily increasing numbers until no less than 20 bodies were committed to the sea on the 4th of October, had a depressing effect on all, and led to a despondency and apathy in the sick, which in many cases seemed to determine a fatal issue. The cause of the outbreak was closely investigated in Codford, Captain Lowe, N.Z.M.C., coming down from Walton and working in collaboration with Captain Eagleton, R.A.M.C., pathologist at Sutton Veney, who had previous experience of the Sling epidemic.

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The opinion of these officers was that the condition was one of severe influenza complicated by purulent bronchitis. The Bacillus of Pfeiffer was demonstrated in 90 per cent, of the fatal cases in combination with Streptococcus longus; the changes found postmortem agreed with the usual findings in purulent bronchitis.

Interest in the epidemic, however, was soon diverted by the most serious of all outbreaks, the influenza epidemic of October and November in France and England. Several thousands of cases in the N.Z.E.F. were reported during this epidemic which affected the Division in France and the camps in England; the total loss from pulmonary complications probably exceeded 150 and in most instances the fatality rate in the pneumonic type was extraordinarily high. The New Zealand Stationary Hospital reported a complication incidence of 12 per cent in all cases of influenza admitted during October and November, and a mortality of over 50 per cent for the pneumonias. The large camps at Sling and Brocton suffered most in England. At Brocton there were 960 cases with 71 pneumonias and 47 deaths up to the 21st of November, 1918. On the 5th of October, the disease was made notifiable in the British armies in France, which had an incidence of 112,274 cases with 5,483 deaths during the winter crisis. Those who had seen the early cases of purulent bronchitis at Sling and Brimsdown Bottom and had marked the heliotrope cyanosis and helpless apathy of the fatal cases of the Tahiti needed no warning as to the outcome of the wholly similar cases seen in France and England at the end of 1918, and already foreshadowed in the reports of the cases observed at Trentham Camp in 1915 and 1916. Nor has the identical cause of this pandemic as yet been made clear: whether it was a virus of the camps bred in men whose vitality was lowered by stresses of war and so enhanced in virulence by passage as to reach in time to the status of a world plague, or whether it was a demonstration of team work by the already known organisms is as yet not fully determined. Whatever the causal agent, perhaps the results led in some way to a furtherance of peace by warning the human race to desist from war, whose hardships had weakened all alike against the common foe, disease.

When the armistice came the medical arrangements for demobilisation were well matured. On November the 30th the hospital bed states showed that there were in British hospitals: 63 officers, 1379 O.R. sick and wounded of the N.Z.E.F., and in the New Zealand hospitals, 172 officers, 4714 O.E., while there was a population of about 3000 category men in the Command Depot.

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During the year the hospital ships had continued to sail at one month's interval so that from two to three months elapsed without evacuations, but special transports for lighter cases had helped to fill the gaps. In July, owing to the torpedoing of the Llandovery Castle, hospital ships were obliged to travel via Suez and the Mediterranean. The Marama, in August, with a Spanish Commission on board called at Marseilles and, by decision of the War Office, was not permitted to pass beyond. Cot cases had to proceed overland from England, a condition which prohibited the despatch of the most serious cases so that the curious anomaly resulted that patients too ill to embark on the hospital ships went home in ambulance carriers. In November, both hospital ships were en route for England and were due in December; both, it was anticipated, could clear all the serious cot cases. A delay in the despatch of the Marama from New Zealand had caused serious inconvenience in England by congestion of cot cases, but now, the disappearance of submarines had removed all difficulties in transport. The fine transports Ruahine and Maunganui had been adapted as ambulance carriers, and the great majority of the low categories could be safely accommodated in the ordinary transports. In December, all four ships were loading, thus relieving the hospitals and making way for demobilisation of personnel and equipment. An Embarkation Medical Board under Lieut.-Col. Tracey-Inglis, N.Z.M.C., was set up in January, 1919: the duties of the board were to make provision for the supply of adequate medical personnel and equipment for the transports. The staff of each transport carrying 1000 troops comprised: 2 medical officers, 5 N.Z.A.N.S., 4 Red Cross workers (females) and 10 N.Z.M.C., O.R. Special arrangements were made for the attachment of additional female workers where soldiers' families were included in the draft and supplies of artificial milk devised by Dr. Truby King were carried for the use of the babies. The medical stores were furnished by the hospitals for the first ships, but in view of the large stocks of drugs and medical supplies held in New Zealand and the enormous advance in prices in England, it was considered advisable that returning transports should replenish stocks in the Dominion. The medical arrangements, then, for the evacuation of sick and wounded included: (1) hospital ships for cot cases and the more serious walking cases; (2) ambulance transports for walking cases still requiring a continuance of special treatment such as, say, physiotherapy and, (3) ordinary transports for disabled men or convalescents not requiring any treatment. The classification of page 495these categories was carried out in the hospitals for (1) and (2), for (3) at the Command Depot.

It was of the utmost importance that the increase of medical work during the early stages of demobilisation should not interfere with the existing scheme of medical boards and classification, as the importance of adequate boarding in England was thoroughly appreciated as a preliminary to the work of the Pensions' Boards in New Zealand. The collection and preparation of case sheets, reports, and provisional board papers was a matter to which a considerable amount of detailed attention was directed. All the "A" men were drafted to Sling Camp where they underwent a physical inspection prior to embarkation, while the category men were concentrated at Codford at the Command Depot; and those already found to be permanently unfit (C2) were assembled in the Discharge Depot at Torquay. As the New Zealand standing medical board in France was now no longer required, the President, Major Bowerbank, N.Z.M.C., with his staff, was recalled and established at Codford for the purpose of finally boarding the "B" group to be concentrated there. All case sheets and documents were forwarded to the depot—the medical history sheets had previously been filed at the office of the A.D.M.S. in London—and a board of from 10 to 14 medical officers was set up in specially devised quarters with a large N.Z.M.C. staff, the whole so organised and administered that at least 400 men could be adequately boarded in one day. The assistance of the specialists at No. 3 N.Z.G.H. was made available in doubtful cases and the service of the V.D. section furnished criteria for estimating the present condition of those who had records of venereal infection. The Board dealt only with "B" and "C" class men not requiring any treatment, and in the great majority of cases suffering from minor disabilities which did not at the time suggest serious pensionable disability; but it was precisely this class of men who later furnished the most intricate problems set before the Pensions' Boards in New Zealand, hence the necessity for considerable care in the preliminary boarding.

Demobilisation was proceeding apace and by January, 1919, the number of troops in England and Germany awaiting repatriation was 40,000 of which 14,000 with the Division. Six ships had sailed since November the 11th, eight were due to sail in January, and nine in February, ensuring a rate of about 7000 embarkations per month. The number of ships available was quite satisfactory but strikes in the London Dockyards had page 496delayed the first waves so that the programme was a little behind date, nor could it be hoped that the same volume of embarkations would be maintained.

At the end of January, 1919, the total number of sick and wounded in hospitals in England was 115 officers, 2796 O.R., of which 524 of all ranks still in British hospitals. Colonel Parkes, C.M.G., C.B.E., the D.M.S., had taken his leave of the N.Z.E.F., and, in reviewing the work of the New Zealand Medical Services overseas which he had administered during three years, admitted many shortcomings and mistakes in administration due chiefly to a lack of military experience, but which—as he states—were condoned and amended by the ever ready assistance and advice given by the Medical Authorities at the War Office, especially the D.G.M.S., General Keogh; and to the willing co-operation of the Directors of Medical Services of Australia and Canada he claimed to be much beholden for their help in matters concerning the Dominions. In these complimentary expressions he had the concurrence of all his officers of the N.Z.M.C. whose work had brought them into collaboration with the sister services of the Mother Country and the Dominions.

Colonel C. Mackie Begg, C.B., C.M.G., French Croix de Guerre, N.Z.M.C., replaced Colonel Parkes as D.M.S. But his term of office was of short duration: in January he succumbed to influenzal pneumonia after a very short illness. He had seen much service: in command of the No. 1 New Zealand Field Ambulance at Anzac, where he was slightly wounded, and received the C.M.G., while the Royal College of Physicians elected him a Fellow; later he was A.D.M.S. of the Division and ultimately D.D.M.S. of IInd Anzac Corps, afterwards the XXIInd Corps. For his work in this appointment he was decorated with the C.B. and had the French Croix de Guerre with star for the operations in the Ardre Valley in the campaign under General Godley. His long connection with the N.Z.M.C. since 1906, when he first joined the Wellington Bearer Company, his tour of duty as P.M.O. of the Wellington District, and his distinguished career in the war—the fruits of his many sterling qualities—made him alike the most experienced and distinguished of our officers. His body was laid to rest in the Walton cemetery on the 5th of February: his loss was deplored by all his many friends in the service.

Administrative control of the Medical Department in the London Headquarters was directed, during the remainder of 1919, by Lieut.-Col. B. Myers, A.D.M.S., and was chiefly concerned with page 497the problems of repatriation. As regards the N.Z.M.C. repatriation was wholly dependent upon the ordered evacuation of the sick and wounded and the gradual closing of the medical units on the Continent and in England. The strength of the N.Z.M.C just before the Armistice was as follows:—In France, 82 officers, 794 O.R.; in England, 112 officers, 426 O.R.; in Egypt, 15 officers, 99 O.R.; making a total of 209 officers, 1319 other ranks overseas;. The strength of the New Zealand Army Nursing Service was 311 N.Z.A.N.S. matrons, sisters and nurses. Including V.A.D.'s, female and male assistants attached, the combined personnel employed in the N.Z.E.F. Medical Services in Europe totalled 2605 in all. The demobilisation of this service, considered as "pivotal" could not proceed along the same lines as that of other arms, as it depended upon the rate at which the sick and wounded could be disposed of. Long service men, however, were given priority in embarking for duty with the transports, and as many long service officers as possible were released to engage in courses of instruction or post-graduate training. The special courses for officers adopted with a view to reconstruction in New Zealand were:—military orthopœdics, which included radiography and physio-therapy, splint making, plaster work and curative training; psycho-therapy and neurology; treatment of tuberculous soldiers; treatment of venereal diseases; R.A.F. medical services, pensions work; in each of these branches certain officers were trained under contracts with the Dominion Government.

The first medical unit to be demobilised was the New Zealand Stationary Hospital. The year 1918 had proved the most active of all in the history of this unit; the bed accommodation had reached 800 and the monthly admissions had varied between 700 and 1200 during the last twelve months of service in France. The hospital had served a variety of purposes in the Second Army: as a shell shock centre; as an infectious diseases hospital; as a C.C.S. during the Flanders invasion in March; as a pathological centre in connection with the dysentery outbreak in August and September; and as a general hospital with medical, surgical and specialist divisions at all times after the reconstruction of the unit at Wisques in February, 1918. Surgical teams had frequently been despatched to the assistance of the C.C.S.s during periods of heavy fighting; but useful as the work of this unit was, yet it was always a subject for regret by the N.Z.M.C. that the Stationary Hospital had not been constituted as a C.C.S. Originally raised as a surgical unit, it never had opportunity to page 498fully develop its surgical strength, indeed most of the original staff of surgeons went to strengthen other N.Z.M.C. formations. Yet the opportunities afforded to medical officers with the Division of acquiring clinical experience by attachment to the Stationary Hospital were not neglected: many officers with long service in the ambulances passed in time to the unit at Wisques and helped to maintain the traditions of this much travelled and much storied hospital which was finally demobilised on the 26th December. Their last Christmas dinner in the war was eaten in haste by the staff—with pack on back ready for departure on the morrow.

The ambulances in Germany were quartered near their respective brigades: No. 1 Field Ambulance at Monheim, No. 2 in schools and a concert hall at Mulheim on the right bank of the Rhine, across the bridge of boats; and No. 3 at Frankenforst: all within easy reach of Cologne. Their Christmas dinners were served just two days after their arrival in the Rhineland. There were plum puddings in plenty, but all deplored the absence of the turkeys which transport difficulties had delayed en route: flagons of rhineish made a poor substitute, although—as duly recognised—not lacking in cheering qualities. Of those who sat at the board that day, many had broken no other bread than that of the army on any Christmas morn this five years past; and still a few who could recall Christmas junketing at tables in the open desert near Cairo or on the dingy transports slinking away from Anzac. They had toasted the day on the edge of the battlefield for four long years, and now at the close of the fifth year there was at last peace on earth and a hope of good will for all mankind.

The A.D.M.S. was established with Divisional Headquarters in the offices of the Bayer Chemical Works at Leverkusen, four miles north of Mulheim. In these very factories Bayers had been as successful in the manufacture of phosgene—normally used in the synthesis of Salol—as they were in the production of aspirin, and it was said that much mustard gas had been produced here during the war. Recalled for duty in New Zealand and temporarily attached to the Ministry of Pensions, Colonel McGavin, C.M.G., D.S.O., was replaced early in January by Lieut.-Col. Murray, C.M.G., D.S.O., as A.D.M.S., and later Lieut.-Col. H. J. McLean, C.B.E., took over the appointment.

The peace-time duties of the field ambulances were not very arduous: attention to the sick of their brigades and evacuation of the more serious cases to the casualty clearing page 499stations in Cologne comprised their chief activities. Influenza lingered with the Division during January and February, but there was no other serious disease, the sickness wastage falling to 6.5 per 1000 per week evacuated to L.O.C. But there was a decided increase in the venereal diseases rate which varied between 2 and 3 per 1000 per week, as the inevitable result of garrison duties in Cologne, where syphilis seemed to be very prevalent. Inevitably the sickness wastage curve showed a rising tendency during the three months of occupation, an upward trend due to peace conditions, and reflected in the wastage graph of the Second Army. Amongst the services of the Medical Corps an important duty was carried out by a party of 4 officers and 15 O.R. under Major Widdowson, D.S.O., N.Z.M.C., during January. They formed part of the Medical Commission sent in to unoccupied Germany to collect our sick and wounded prisoners of war who were now admitted to the British field ambulances. From statements made by repatriated New Zealanders who had been prisoners it does not appear that they were subjected to avoidable hardships; food was scarce and coarse in quality, undoubtedly, but otherwise our men were spared the grosser indignities and had been treated in the hospitals as well as circumstances permitted.

Means of recreation were not deficient in the Rhineland: parties of the N.Z.M.C. armed with the "Diggers' Guide to German," a production of the Divisional Press, visited the sights, explored the Cathedral, or were ferried up the Rhine to Bohn or Coblentz. But their chief pleasure was the Opera House, where they heard in song the great Saga of our Norse ancestors—saw and heard Siegfried forging his sword and Brynhilda, daughter of Wotan, riding the winds with the chosers of the slain—saw again, as at Crèvecoeur, and at La Vacherie, the twilight of the Gods and the doom of Valhalla.

Demobilisation and the handing in of equipment and transport monopolised much of the attention of the ambulance commanders. Step by step with the reduction in strength of the Division the medical units were demobilised in turn, No. 3 Field Ambulance being the first to close on February 4th, and No. 2 Field Ambulance just a month later. Owing to difficulties in obtaining railway transport, No. 2 was obliged to part with its cherished mascot "Murphy" a donkey brought with them from Egypt, who had survived the perils of the western campaign while many of his stable companions had been killed in action. What remained page 500of No. 1 Field Ambulance entrained with the last drafts on March 25th, the day on which the New Zealand Division ceased to exist.

It has been said that the New Zealand Division had failed only once in taking all its objectives, the same might be said of the N.Z.M.C. attached to the Division. Only on one occasion had any adverse criticism on the conduct of the field ambulances reached Corps Headquarters. The accusation made against them was that they had failed to clear the battle field of wounded at Passchendaele! Apart from this glorious failure the medical services of the Division bore a good name in France which they owed to the earnestness of their commanding officers, and the solidity of the rank and file. Above all, the relations of the medical branch to the combatant staffs of the Division had ever been cordial and mutually supporting. Our honoured chief, Sir Andrew Russell and the officers who in turn administered his "A" branch, Lieut-Col. H. G. Reid, C.M.G., C.B.E., D.S.O., R.A.S.C. and Lieut.-Col. H. Avery, C.M.G., D.S.O., N.Z.S.C., had always given to the medical arm the same intelligent consideration as they devoted to other arms in the Division. Many of the distinctions awarded to our officers came at the instance of the combatant officers who were partners in the operations so commemorated.

By June, 1919, demobilisation was well forward. The closing of No. 1 N.Z.G.H. coincided with the sailing of the "Maheno," the last hospital ship to leave for New Zealand; 158 patients from Brockenhurst were embarked on March 11th, which completed the work of the hospital. During its stay in England this medical unit had admitted a total of 21,004 patients. The New Zealand Convalescent Hospital, Hornchurch, closed in June, No. 3 N.Z.G.H. in July, but the Venereal section did not close until August when the remaining patients, some 200 in number, were transferred to a British Hospital at Chiselden. The Mt. Felix Section of No. 2 N.Z.G.H. had closed by the end of June, but it still had some 80 beds open at the end of August, and retained at Oatlands Park the limbless, still awaiting the fitting of artificial limbs at Roehampton. In all cases medical and surgical equipment and hospital furniture and stores had been shipped to New Zealand in such quantity and of such description as seemed most useful and appropriate, the remainder was disposed of by public sales. Personnel had embarked with the departing transports. A second orthopoedic team comprising six page 501officers under Lieut-Col. P. C. Fenwick, C.M.G., had sailed by August: medical officers taking their discharge in England replaced those bound for New Zealand and at the end of this month only 33 officer patients, and 319 other ranks, of which 14 officers and 126 other ranks limbless, remained. Medical Headquarters closed at this time, leaving Major McKibbon, O.B.E., N.Z.M.C., as Medical Representative at headquarters. A few medical officers, engaged in special training in military subjects or in post graduate work, remained in England, but the total strength of the N.Z.E.F. was reduced to 404 officers, 3,275 other ranks, and by October most of these had embarked for New Zealand.

* Official History of the War, Diseases of the War, Vol. I., page 213.

Eyre and Lowe Prophylactic Vaccinations against Catarrhal infections. Lancet, 1918 Vol. II. page 484,