The New Zealand Medical Service in the Great War 1914-1918
Chapter VII. Mobilisation of the New Zealand Division
Chapter VII. Mobilisation of the New Zealand Division.
After disembarkation at Alexandria about the New Year of 1916, the two infantry brigades of the New Zealand and Australian Division entrained for Ismailia; the New Zealand Brigade went into camp at El Moascar, the 4th Australian Brigade near the central railway station; the mounted brigades reassembling at Heliopolis. The camp, El Moascar, was situated in the desert about a mile to the westward of the town and was bounded on the southern side by the Sweet Water Canal, which separated it from Lake Timseh, and on the eastern side by the Abbasia Canal. To the north was open desert, mainly hard sand, and to the westward cultivated ground by the banks of the Canal which accompanied the railway to Cairo. The town of Ismailia, which owes its origin to the French engineers and employees of the Suez Canal Company, is situated at the junction of the Port Said, Suez, and Cairo railway lines. The European portion, built in the French style, cheerful spacious and well ornamented by public gardens and leafy boulevards, presented a fairy-like illusion of sumptuousness to the jaded troops from Anzac, so long exiled from any semblance of civilisation, more especially as life in the desert camp was at first very uncomfortable. There was a serious shortage of tents: most of the men were in bivouac only, which they found less comfortable than their old dug outs on the Peninsula; many indeed, reverting to their cave-dwelling habits, attempted to burrow into the sand. The nights were cold and there was a shortage of blankets, and at times even of rations. Equipment and baggage was still detained at Alexandria owing to congestion on the railways. The officers and men had with them only those few effects which they had carried on the person from Anzec. By the 8th of January conditions were improving but there was still much overcrowding in the tents when the 7th Reinforcements arrived. The transport and horses, which had remained at Zeitoun, were now coming into the camp, further reinforced, on the 17th of January, by the 2nd Battalion of the New Zealand Rifle Brigade, recently employed on the western frontier in guarding the railway during the Senussi operations. The 4th Australian Brigade joined us at Moascar shortly after, and page 136by the end of January the camp had assumed a more orderly and comfortable appearance. A good water supply had been piped in from the Ismailia water works by the N.Z.E. Extra tents had been procured. The usual streets of canteens and bazaar shops had been erected by Maltese and Egyptian traders and a certain number of Institutes were in course of construction by the Y.M.C.A. and the Salvation Army. The friendly hospitality extended to the officers of the Division by the French Club, "Cercle du Canal de Suez," was gratefully appreciated and a priceless boon after the, miseries of Anzac.
As important changes were pending in the organisation of the N.Z.E.F., now grown to dimensions far exceeding those of the "Main Body," we must review very briefly conditions at the Bases up to the end of 1915. In New Zealand, recruiting for the N.Z.E.F. was still on a voluntary basis, but it was stimulated to some extent by local recruiting committees. The numbers offering were constantly in excess of the military requirements of the moment, although the requests of the Imperial Government for reinforcements on a higher scale than previously agreed to were readily complied with. By maintaining the training of the Territorial Force and the Cadets, the N.Z.E.F. was continually fed by an uninterrupted stream of officers, N.C.O.s and men, the majority of whom having served for four years in the Territorial Force helped to stiffen the reinforcements drawn from the civilian population. Recruiting, attestation, medical examination and posting to training drafts admitted to camp at stated intervals, bi-monthly, was a function of the Territorial Force; sorting, training and final assessment of medical fitness for active service was in the hands of the Permanent Staff, combatant and medical, of the Reinforcement Camps. The regulations for the medical examination of recruits were similar to those prescribed in 1911 for examination of candidates for admission to the New Zealand Permanent Staff, and were almost identical with requirements set out in R.A.M.C. Regulations, 1905, Appendix No. 16. The age limit was from 20 to 40 years. Under instructions issued by the D.M.S. all necessary arrangements, including the selection of examiners, were made by the Territorial P.M.O.s of the four Military Districts, as a rule, experienced N.Z.M.C. officers of good professional standing. N.Z.M.C. officers on the active or reserve list were selected as examiners, and in outlying districts a certain number of civilian practitioners were employed and as neither the P.M.O.'s nor the examiners were whole-time men, a fee of 2/6 per recruit was payable. In the large centres the medical examinations were carried out at page 137night, mainly in order to suit the convenience of the recruits and of the examiners, who were engaged in private practice during the day time. It does not appear that the examinations were unduly hurried, the number of men examined per hour being from 7 to 8 on a average, which was in agreement with Army Council Instructions of December, 1914. The method usually adopted was the team system: each of the examiners being responsible for a portion only of the physical inspection. In the larger centres, where closer supervision by the P.M.O.s was maintained, there was efficiency; but in the outlying districts, where the selection of examiners was more difficult to adjust, the conditions were not so satisfactory. As early as November, 1914, it was reported that recruits were not being examined in accordance with prescribed regulations and that an undue proportion of men were found to be unfit for active service after arrival in camp. In the general enthusiasm and impetuous rush to join the colours, many men had hastily abandoned their employment, sold their farms or businesses, and had sustained considerable expense in reporting to recruiting centres remote from their homes. To such men—accepted by the Recruiting Medical Officer as fit, only to be rejected shortly after arrival in camp by the Permanent Medical Staff—the disappointment was keen, the refusal a disgrace, and the whole matter a subject for bitter complaint, often to the Defence Minister in person—sometimes the basis of a claim for damages or compensation. Ill informed criticism and accusations appearing in the daily press did much to shake the confidence of the public in the validity of the whole of the medical examinations, more especially where there was manifest a divergence of opinion: as in the instance of a man rejected at one centre, and, later, accepted at another. In the opinion of the Defence Minister the results of the examinations were not at all satisfactory, although he was quite prepared to admit the inherent difficulties in obtaining uniformity of results. In a statement made by him in the House of Representatives early in September, 1915, he made it clear that the irregularities complained of applied to a few men only, that most of the recruits who had passed the local medical tests stood all subsequent tests in camp. He was also convinced by information he had received that, in a few cases, recruits had deliberately tried to get the better of the medical officers by concealing disabilities at the time of the first medical examination; hence he did not consider it reasonable that compensation should be paid in such circumstances. To remedy these matters, a Supervisory Committee of two civilian medical practitioners. Dr. G. Anson, M.D., and Dr. H. A. de Lautour (Lt.-Col. page 138N.Z.M.C., retired), was established in order to assess the revision of classification at Trentham. It was found by the committee that from one to two per cent. of the recruits coming into camp after local medical examination were classed unfit on revision. P.M.O.s of districts were enjoined to supervise examinations of recruits in their district with the greatest possible care, in order to remedy the conditions which had given rise to so much adverse criticism, and they were instructed, no doubt in deference to public opinion, that the standards of physical measurements might be relaxed at the discretion of medical examiners, and that, owing to the establishment of dental clinics at the standing camps, remediable dental defects should no longer be considered a disqualification. Some pressure was brought to bear on P.M.O.s in the direction of urging them to accept examiners in outlying districts of whose qualifications for the work either they could not approve, or of which they had no personal knowledge—all this for the convenience of "back-block" residents who could not attend the larger recruiting centres without inconvenience and loss of time, and in order that the recruitment of volunteers might not be discouraged. All these difficulties had already been experienced in England, and in 1915, were under close examination with a view to betterment.
One factor in the problem which had attracted much attention was the number of rejections, then averaging about 25 per cent. of the recruits: the public of New Zealand had not yet realised the extent of physical unfitness normally present—they were to be more fully enlightened and disillusioned later on. Having in view the fact that the 6th Reinforcements arriving at Lemnos in October, 1915, on being classified, were found to show a moderate percentage of unfit by pre-war conditions, the 25 per cent. of rejection in New Zealand was certainly a generous assessment. Owing to complaints from Trentham that the physique of the 7th Reinforcements was not so good as that of previous drafts, the Surgeon General rescinded the previous instructions and increased the stringency of the examination.
As early as Januray, 1914, General Godley had realised that an experienced R.A.M.C. officer was required in New Zealand, to act as a Staff Officer to the Territorial D.M.S. and as an, instructor to the N.Z.M.C. Colonel Robin, in 1915, had recommended the appointment of a "regular" D.M.S. in his annual report—ultimately the New Zealand Government decided to apply to the Secretary of State for a senior R.A.M.C. officer of wide experience to act as D.G.M.S. to the Military Forces in New Zealand. Colonel R. S. F. Henderson, R.A.M.C., H.P.K., was selected. page 139by the Home Authorities and arrived in the Dominion on the 6th of September, 1915, to take up his duties with the local rank of Surgeon General. Two matters of importance had been attended to by this officer prior to his departure, at the request of the New Zealand Government: one was to obtain a supply of the latest medical publications and sanitary memoranda, and a quantity of army forms and returns generally in use in the Medical Department, of which there were none actually in New Zealand; the other was to secure the services of an experienced Warrant Officer of the R.A.M.C. to act as his Quartermaster. Sergeant-Major Gibbs, R.A.M.C., of the 9th Field Ambulance, B.E.F., then in France, was selected to fill this appointment Colonel Purdy, N.Z.M.C., remained on at Headquarters as Territorial D.M.S., and, later became a whole-time officer.
The new D.G.M.S. found, on arrival, in September, 1915, a reformed camp at Trentham, now all hutted, well roaded and drained; the work had been put through in a very short time by the Public Works Department employing very large gangs of workmen. A large "model" camp at Featherston, some 27 miles north of Trentham on the same railway system, was in course of construction, and was to provide accommodation for 7000 men. At Trentham as P.M.O., Major P. O. Andrew, N.Z.M.C. (Reserve), had replaced Lieut.-Col. Morris now commanding the Victoria Military Ward at Wellington Hospital. The general health of the troops was stated to be above the average, the camp population much reduced. The measles epidemic had reached its acme in July when 341 cases were reported; the first diagnosed cases of C.S.M. were observed about the 8th of July before the break up of the camp. The measles epidemic subsided but the C.S.M. outbreak continued. The vital statistics for the year, 1915, in New Zealand, show that an outbreak of cerebro spinal fever took place in July, when 40 deaths from this cause were registered. Only one death from this disease had been registered previously in this year, in January. In August there were 20 deaths certified; in September, 13; two, four and two deaths were certified in October, November and December, respectively. There was an increase by 100 per cent in the mortality rate of measles, but no evident increase in the death rates from simple meningitis, pneumonia, bronchitis, or broncho-pneumonia—which is suggestive that some of the deaths registered prior to July as due to measles were in reality deaths from cerebro spinal fever. The disease was little known in New Zealand, and was of an aberrant type when first recognised at Trentham: the rash and the catarrhal page 140symptoms were especially marked features. In the month of July 32 cases of cerebro spinal fever were notified from Trentham Camp, with 22 deaths. Two eases were reported in August and two in September, after which the disease disappeared for a time. A few sporadic cases were reported from the casual camps formed after the break up of Trentham or amongst soldiers on leave. The carrier rate investigated at Dunedin in a small sample of soldiers on leave was unusually high: 52 to 70 per cent.; whereas the carrier rate in 43 civilians swabbed at the same time was about 12 per cent. Undoubtedly the general carrier rate of the civil population was increased as there was a mild epidemic of the disease in the civil population in 1915 and 1916. Owing to a lack of hospital accommodation in the camp the bulk of the sick were treated in the tea kiosk on the Race Course, a large polygonal building with open sides, which afforded considerable floor space for beds, was easy to work, and provided an open air ward well suited to the treatment of pneumonia and cerebrospinal meningitis. This building became a model for future emergency wards building or built in Trentham and in other military centres.
As there was no supply of Flexner serum available in New Zealand or, then, in the Commonwealth of Australia an autogenous vaccine was prepared by Mr. T. Hurley the Government Bacteriologist, in the Wellington Laboratory, and was used, it is said, with encouraging results. Supplies of serum were cabled for to London and became available in late September. Prophylaxis was maintained by isolation of contacts, rigidly enforced, by nasal sprays and by general gargling with permanganate solution. A small laboratory was opened at the Trentham Camp for the purposes of throat swab examinations: an investigation of the carrier rate on a large scale was not possible for obvious reasons: the technique of this procedure was not as yet elaborated to that degree of facility and refinement which was made possible in later years. In the summer months, the epidemic having subsided, the troops returned to Trentham in limited numbers. Professor Champtaloup of the Dunedin University rendered very valuable assistance in all this work. His death in 1922 was a great loss to the Medical School which all members of the profession and his one time pupils, widely deplore.
One curious fact in connection with the epidemic was that the incidence was usually in the inhabitants of the huts and not amongst the tent dwellers. Professor Adami in his account of the epidemic amongst Canadian troops in Bulford in the winter of page 1413915, notes the same peculiar distribution, which he attributed to overcrowding in the huts and the increased risk of a carrier infecting a larger number of men.*
In October, 1915, a training camp for Ambulance Details and N.Z.M.C. generally, had been established at Awapuni Race Course near Palmerston North, at first commanded by a combatant officer under the direction of the O.C. Military District. The success of this camp was assured from the start, when Major J. Hardie Neil, N.Z.M.C., was appointed Assistant Camp Commandant and became responsible for the training of all N.Z.M.C. details. Certain Territorial Ambulances and Medical Officers were sent into this camp for their annual training, and the Medical Officers concerned as well as the O.C. District expressed the greatest possible satisfaction with the results attained. The need for a depot had been long felt by N.Z.M.C. officers in New Zealand, its realisation during the war and its undoubted efficiency was a source of considerable gratification to officers of the Corps. Some complaints had been made by Medical Officers of the N.Z.E.F. in Gallipoli of the lack of training of certain Medical Reinforcements officers and men; the excellent training and fine esprit de corps fostered at our depot was shortly to remedy this deficiency. Early in 1916 the Surgeon General was moving to have the depot placed under the command of an N.Z.M.C. officer, and ultimately when Lieut.-Col. Hardie Neil embarked for Egypt in February, 1916, in command of the two Sections of the Rifle Brigade Field Ambulance, which he had recruited and trained, he was replaced by Lieut.-Col. Tracey-Inglis, N.Z.M.C., recently returned from the first commission of the N.Z.H.S. Maheno, as Commandant of the depot when control passed to the D.G.M.S. The No. 1 N.Z.H.S. Maheno 10 officers, 67 O.R. under the command of Lieut-Col. J. S. Elliott, N.Z.M.C. sailed in November carrying N.Z.MC. reinforcements to Alexandria.
* The War History of the C AM C. 1914, 1915, col. J. C. Admi. C.A.M.C.
The Imperial Government in view of the large numbers of New Zealanders available, suggested the formation of a New Zealand Division; this was ultimately agreed to by the New Zealand Government in February, 1916, and the mobilisation of the Division was authorised by Corps Routine Orders on the 18th of February. Major General Sir A. H. Russell, K.C.M.G. assumed command of the Division.
The Medical Headquarters consisted of: Colonel Begg, C.M.G., A.D.M.S.; Major A. R. D. Carbery, D.A.D.M.S. The Divisional Sanitary Section, formed at Anzac for the New Zealand and Australian Division, had been disbanded on arrival in Egypt, the Australian Details, of which it was chiefly constituted, returned to their respective Units. A New Zealand Sanitary Section, Captain Connor, N.Z.M.C. commanding, was formed early in February from details carefully selected from N.Z.M.C. and other personnel; it included a borough engineer, an architect, several draughtsmen and a number of skilled craftsmen. A course of instruction in field sanitation was initiated for this unit and continued uninterruptedly for six weeks; material assistance was given by the 46th Sanitary Section, under Captain Rose, R.A.M.C., then at Ismailia. There remained one field medical unit to be mobilised in order to complete the Divisional establishment. At first the formation of the new Field Ambulance presented certain difficulties as there was a shortage of medical personnel. The A.D.M.S. in a report on the matter dated 15th February, 1916, comments:—"The shortage of N.Z.M.C. personnel in the field has been largely due to the ever increasing establishments maintained in L.O.C. units and the base formations. At Anzac we were unable even to keep up the strength of two ambulances owing to the reinforcements being absorbed at the base. Unless increased drafts of reinforcements are made available from New Zealand, it will be quite impossible to keep medical units supplied. It should be a principle that field units have first claim on reinforcements."
The important question of N.Z.M.C. reinforcements attracted attention during the period of reorganisation. In November, 1914, the Imperial Government requested that reinforcements should page 143be supplied by New Zealand on a basis of 25 per cent. for infantry and mounted rifles; and for artillery 7 per cent. per month; other formations, including medical units, at the rate of 30 per cent. per annum. Throughout the Gallipoli campaign on account of the high rate of wastage special requests had been received in New Zealand for extra N.Z.M.C. personnel, and steps were taken to meet these demands. It now seemed advisable that a higher scale of medical reinforcements should be maintained: it was suggested that at least 70 N.Z.M.C. would be required monthly, chiefly on account of the new formations provided, or at the rate of 80 per cent. per annum instead of 30 per cent.
There were at this time some 89 officers N.Z.M.C., and 960 other ranks in Egypt. A few details, medical students, who had joined the Main Body, were returned to New Zealand in February, but at the time of the formation of the No. 2 Field Ambulance a certain number of men were added to the N.Z.M.C. strength from the infantry units. These details with the available Medical Reinforcements and the new Field Ambulance from New Zealand, provided for the increased personnel of the Division. The new ambulance, to be designated No. 2 New Zealand Field Ambulance was ultimately formed by utilising "B" section of the Second Field Ambulance formed in New Zealand in 1915 and already in Egypt and a draft of officers and men from the Main Body Ambulance which had served in Gallipoli, with a certain number of details drawn from the Auxilliary Hospital—part of the No. 2 New Zealand Stationary Hospital established at Moascar Camp in January, 1916, under Major McGuire, N.Z.M.C.—and a proportion of stretcher bearers drawn from infantry reinforcements. Lieut.-Col. Murray, N.Z.M.C., was appointed to command this unit on the first of March, The two sections of the second Field Ambulance formed in New Zealand, and known as the Rifle Brigade Field Ambulance, under the command of Lieut.-Col. Hardie Neil, N.Z.M.C. late Commandant of the Awapuni Depot, became the No. 3 New Zealand Field Ambulance of the New Zealand Division. All three ambulances were now engaged in training.
A second Anzac Corps was in course of formation: General Birdwood still retained command of the first Anzac Corps, General Godley was to command IInd Anzac of which the New Zealand Division would be a part. Besides assuming command of a Corps, General Godley still retained his statutory appointment as Commander of the N.Z.E.F. for the administration of which he was responsible to the Dominion Government. At the time of the visit page 144of the New Zealand Commissioner, Lieut-Colonel Heaton Rhodes, to Egypt in 1915, the appointment of a D.D.M.S. to the N.Z.E.F. was in contemplation. In January General Godley appointed Lieut-Colonel Parkes, N.Z.M.C., D.D.M.S., to the N.Z.E.F. The N.Z.E.F. base units, then in Egypt, comprised, the New Zealand Infantry Training Battalion, some 4000 strong at Zeitoun—an infantry base depot—the emergency clearing camp, Zeitoun, a formation controlled by N.Z.M.C., comprising "A" class men, recently discharged from hospital, the sick admitted for observation from the training depots, and the N.Z.M.C. reinforcements. There was also a New Zealand Overseas Base at Gizeh which was practically a Command Depot as it consisted of category men; and at Suez, the concentration camp, or Discharge Depot. Attached to each of these units there was a certain number of officers and O.K. medical personnel. The base details were classified in three categories at this time: "B" men, permanent "B" men, and "C" men. The temporary "B" men were those who had recently been discharged from hospital or convalescent hospital or were invalided by boards held in the divisional area. They were drafted to the Base Depot at Gizeh where they were classified weekly by the S.M.O.—the number in February being about 1000. Permanent "B" men were such as were unfit for active service with front line units; they were examined by a standing board who determined the classification. They were detailed to Base Depots, Headquarters N.Z.E.F., and to the New Zealand General Hospital. The "C" class men, after a final invaliding board, proceeded to the Suez Concentration Camp where they awaited return to New Zealand, or discharge to the United Kingdom if their homes happened to be in England.
At the time of the formation of the Division it was considered that there was an undue proportion of fit men both in hospital and the various depots. This view was shared by the D.M.S., M.E.F., Surgeon-General Bedford. There was a tendency, it was said, to treat soldiers invalided from Gallipoli with undue leniency. Many had been invalided to England or New Zealand for trivial conditions of disability. In September, 1915, there were 2,927 soldiers of the N.Z.E.F. in England whilst the number actually at Anzac was somewhat less, 2,840; at this time only 16 per cent. of the troops despatched from New Zealand were in the field. General memoranda dealing with the return of fit men to New Zealand had been cabled to Egypt by the Defence Minister. It is probable that Invaliding Boards of the period were not as exacting as was desirable; they were in many instances ill-provided with case sheets page 145and essential documents at the time of boarding. In view of these complaints every effort was now made to get together all available fit men in Egypt to complete the personnel required by the Division.
The important question of promotion in the N.Z.M.C. was at present under revision; a gradation list was in course of compilation. Owing to the fact that unit promotion in the field units had been the rule since the Expeditionary Force had first sailed, and that promotions were at the same time being made in New Zealand, there was some confusion and some dissatisfaction amongst the N.Z.H.C. officers and N.C.O.'s of the so called "Main Body." By regulations issued by the N.Z.E.F. the promotion of N.Z.M.C. officers now became a Corps matter, as the whole of the Expeditionary Force, N.Z.M.C., was classed as one unit for the purposes of promotion, but the promotion of N.C.O.'s still remained a unit arrangement as promotion up to the rank of sergeant could be approved by the O.C. of any medical unit. In one instance a water duty man had been promoted to corporal in Anzac by his battalion commander! The rank of staff sergeant did not, as yet, exist in the N.Z.M.C. Several recommendations had been made by officers commanding for promotion to this appointment which were not approved by the A.D.M.S., as he was of opinion that the experience gained, so far, by N.C.O.'s was not sufficient to warrant the extra rank. Two staff sergeants arriving from New Zealand with the Rifle Brigade Field Ambulance were obliged to relinquish the appointment on joining the Division. The method adopted at the Awapuni depot was to grant temporary rank only, which lapsed on joinging unit with the Division. There was as yet no gradation list for N.C.O.'s.
One other administrative matter we must consider. The New Zealand dental service was now to be reorganized; Captain Finn, D.S.O., N.Z.M.C., the dental officer whom we have seen evacuating wounded from the No. 3 pier at Chailak Dere, for which good work be had a D.S.O., was now appointed as acting administrative dental officer, attached to N.Z.E.F. Headquarters. The ideals of a compact dental service attached to a Division were not as yet fully attained. The opinion of the G.O.C. N.Z.E.F., at this time was that:—The O.C. of a medical unit to which a dental section was attached should be able to undertake the administration of the section so that a separate Dental Corps Headquarters was unnecessary. A dental section comprised:—one dental officer, rank: captain; one corporal, dental mechanic; one private, dental orderly; one private, clerk. Two dental sections were attached to page 146each field ambulance with nine panniers of equipment containing surgical appliances and prosthetic plant; the total weight of the equipment—7½ cwt.—thought to be overmuch for the ambulance transport; it was reduced later. In all, 11 dental sections were allotted to various units; including two sections to the New Zealand Infantry base depot, which was to accompany the Division, and one to the New Zealand Stationary Hospital. The Dental Stores Depot, holding a reserve stock of material, was mobile and had a staff of 1 Q.M. sergeant and one packer under the A.D.O.
By the end of March the New Zealand Division was nearly complete, the 7th, 8th and 9th Reinforcements had arrived; the three Brigades, the 1st, 2nd and the New Zealand Rifle Brigade, were at full strength and the Divisional Medical Units, the 1st, 2nd and 3rd Field Ambulances and the Divisional Sanitary Section, were mobilised and undergoing a course of training. The necessary medical personnel had been attached to the various formations.
At the end of January the 1st and 2nd Australian Divisions had occupied the front line, across the Canal, the New Zealand and Australian Division remaining in reserve in Ismalia. The New Zealand Mounted Brigade had been holding the outposts since February. By the 5th March our Division was moving out to Ferry Post and taking over the line vacated by the 2nd Australian Division now coming into Moascar for final preparation for entrainment for Alexandria and the Western Front. By the 8th the moves were completed and one section of the No. 2 Field Ambulance with the N.Z.M.B.F.A. were marched out to the canal defences to serve the Division and the N.Z.M.R. Brigade. "A" and "C" Sections of the Rifle Brigade Ambulance, henceforth known as No. 3 New Zealand Field Ambulance, arrived at Ferry Post from New Zealand on the 16th.
The No. 1 New Zealand Stationary Hospital, Lieut.-Col. McGavin commanding, hurriedly recalled from Salonika, took over the Auxiliary Hospital at Moascar. The New Zealand Stationary Hospital as it was now named, reorganised and re-equipped after the torpedoing of the Marquette was at first employed as a C.C.S., later as a stationary hospital. The total number of patients treated during its stay at Salonika was 6989 including 500 eye cases and 1000 dental; the work of the unit was very highly appreciated by the local medical authorities. They had only 48 hours notice of movement and left Salonika Harbour, sailing this time in a hospital ship, arriving safely at page 147Port Said on 9th March, 1916, and Moascar on the 12th. The establishment of a stationary hospital at Moascar was in part necessitated by the high rate of sickness prevailing in the New Zealand troops in Egypt and the overcrowding of the New Zealand General Hospital at Pont de Koubbeh which had 807 beds occupied. By the middle of February the divisional sick rate was as high as 25 per 1000 per week.
Shortly after arrival in Moascar there was a mild outbreak of G.SM. mainly in the 4th Australian Brigade with sporadic cases amongst the New Zealand troops. The originating infections no doubt, came from the Reinforcements, the contributing causes being cold weather, a shortage of tents, and a lack of blankets, causing a huddling together at night in the overcrowded tents. The carrier rate was shown to be very high: out of 114 contacts isolated, 41 were bacteriologically examined, of these, 9 were positive, giving a carrier rate of 21 per cent. It was well known at this time that the carrier rate was invariably high during epidemics. Dr. Arkwright, of the Lister Institute, working at Bulford in the winter of 1914-15 with the Canadian pathologists, notably Captain Ellis, C.A.M.C.—afterwards known to the New Zealand Division as O.C. No. 5 Canadian Mobile Laboratory at Baillieul—was able to demonstrate the fact that the carrier rate amongst non-contacts was often higher than amongst the contacts, that is, tent or hut mates. It seemed evident that room infection was not the usual cause of the disease but that the centre for dissemination might be the canteen or institute, a fact which would more clearly explain the sporadic nature of the incidence. The outbreak in the troops at Moascar was closely associated with rose measles, widely spread in the 8th and 9th Reinforcements and for which they were quarantined on arrival, and the catarrhal infections—mitigated in Egypt by the superior climatic conditions and absence of humidity—which had been, observed in New Zealand and elsewhere as concomitants of epidemics. Over a dozen cases were notified amongst the New Zealand troops, most of which terminated fatally. The preventative measures adopted were:—isolation of tent contacts and bacteriological examination of throat swabs, universal throat gargling parades, twice daily, using permanganate of potash 1-1000 solution. The numbers accommodated in tents was reduced from 12 to 8 men in circular tents, and from 25 to 16 in E.P. tents. The isolates were released from quarantine following one negative throat swab; but positives suffering from naso-pharyngeal irritation or catarrhal symptoms were subjected to local treatment and were retained in isolation page 148for three weeks. In the division a special method of universal fumigation was devised. A circular tent was sprayed with five per cent. solution of commercial formalin in water—as for the ordinary disinfection of rooms—by means of a Mackenzie sprayer producing a fine misty spray. The ventilators of the tent were sealed with paper, a formaldehyde lamp stood upon the floor so as to concentrate the vapours in the warm humid atmosphere. Under the supervision of a medical officer the men were passed slowly round the pole of the tent with instructions to take deep inspirations of the vapour through the nostrils, the mouth closed. Very few inhalations could be tolerated owing to the density of the formalin content. It was necessary to supply the spray manipulator, generally a N.Z.M.C. detail, with a gas helmet so that he could renew the misty deposit on the tent walls at repeated intervals. As the result of experimentation it was found that 1 gall of the solution sufficed for a company; 32 oz of commercial formalin for 1000 men; 2 galls, for 10,000. The time required was 40 minutes for a company, 220 men; and with four tents in use, a battalion could be passed through in one hour. As formaldehyde vapour acts best at temperatures approaching 76º F. and in the presence of watery vapour, the walls of the tent were first sprayed with hot water before the solution was applied; and, in order to maintain a high temperature midday was selected for the operation. The mobile laboratory, accommodated in a railway laboratory waggon furnished by the Egyptian Government and stationed at Ismalia, experienced the same difficulties in handling large numbers of isolates for bacteriological examination as were encountered in New Zealand. Captain Horne, I.M.S., the officer in charge, found that, without a very much larger staff, it would not be possible to deal with all isolates by throat swabbing, consequently samples of the contacts only were examined. The sanitary measures adopted sufficed to extinguish the epidemic, and cerebro-spinal fever played an insignificant part in the future history of the New Zealand, Division.
Towards the end of February venereal diseases became very prevalent: from 50 to 70 cases a week being admitted to hospital; at the same time the field ambulances were treating an unusually large number of cases of scabies, a disease unknown in Anzac. The relationship between these two diseases it not sufficiently appreciated. So far no energetic measures of prophylaxis had been adopted but in March instructions, emanating from the D.G.M.S. in France, led to a regular weekly venereal inspection page 149of the troops of the Division carried out by the R.M.O.'s Brigade; cleansing tents were also provided, where men returning to camp could report for a prophylatic toilet which consisted of washing with antiseptics, an injection of 2 per cent. protargol, to be retained for some minutes, and a final application of calomel ointment, As there was reason to believe that the public brothels of Ismalia were not sufficiently closely supervised, a medical officer of the New Zealand Division undertook this unpleasant duty. Aided by an assistant, bacteriological methods were exactly applied in the inspection of the licensed prostitutes with the resulting elimination of microscopically infected women. In this work the mobile laboratory gave valued assistance as did the local Medical Officer of Health whose duties of inspection and certification did not, by law, include bacteriological examination. A lock hospital, at Suez, provided skilled treatment for the isolated women. In the month of March the wastage by venereal disease was 149 cases for the Division: a rate between 9 and 10 per thousand. The A.D.M.S. pointed out in a memorandum addressed to commanding officers the clear necessity for cooperation by lectures, instructions and a. rigorous adherence to the disciplinary measures indicated, with united efforts of the senior officers as well as the medical staff. The results of these sanitary precautions were fairly satisfactory. The total sickness wastage fell to 12 per thousand per week during March. From this time onwards the percentage of evacuations by sickness by units of the Division was published weekly in routine orders: a vary useful procedure, as it attracted the attention of commanding officers to the importance of maintaining the health of the troops and it engendered a rivalry between battalions which was educative and stimulating.
The interior economy of units was a matter which was receiving sanitary consideration. A canteen committee was established to ensure control, sanitary and economic, over the camp bazaar and institutes. All mineral waters were subjected to rigorous examination, and factories not complying with the regulations enforced by the Division were put out of bound to the canteen purveyors. The R.M.O.'s who inspected daily were authorised to condemn eatables that appeared undesirable or were of poor quality. All mugs used for draught beer were to be washed in Condy's fluid— C.S.M. precautions—and cooked meat or eggs were to be served on pieces of bread laid on clean sheets of paper in order to avoid the risk of eating from badly washed plates. The kitchens of the units were closely supervised and page 150native servants were excluded; food was to be protected against flies and sand by gauze wire screens; covered refuse tins were installed and emptied twice daily by the sanitary contractor; standing orders were posted in a conspicuous place in each kitchen setting out the usual sanitary recommendations. The cooking also was supervised and special memoranda issued on the importance of securing variety and palatability in the food, and on the special methods of treating the rations so as to provide wholesome and attractive meals.—the underlying principle being that if a man is well fed on palatable food in his own mess he is less likely to seek edible and potable refreshments in ineligible places; and that adequate nutrition is a check on alcoholism.
In March a part of the Sanitary Advisory Committee, a member of which had inspected the old Division at Anzac, visited the camp at Moascar. Lieut.-Cols. Balfour, Hunter and Buchanan reported on the sanitary conditions existing; a part of their report reads as follows:—"We found that the sanitary requirements were receiving careful attention, the work going on included the substitution of deep pit latrines revetted with sand bags and covered with flyproof boxes, for a defective open seat and bucket system with incineration of faeces. The change of system will not only be beneficial as regards conveyance of infection by flies and dust but it will do away with the nuisance which frequently arises from acrid smoke, and should diminish the use of native labour about the camp, and the special risk of infectious disease which the presence of these labourers entail. The incinerators are mostly of open type, often broken and are not well adapted to burning bucket contents, especially if the native labour used for the purpose is unsatisfactory." The decision of the Sanitary Committee strengthened the hands of the Anzec troops who were strongly opposed to the system in use when they took over the camp, that is: open latrines on the bucket system and incineration of faeces in" the camp incinerators. The objections to this system were these:— The latrines were not fly proof. Incineration of faeces was very difficult to carry out except in specially constructed incinerators. Of these special incinerators there was not a sufficiency in the camps. Skilled labour was difficult to obtain amongst the Egyptians and finally, the process was so repugnant to Colonial troops that it could not be efficiently carried out by them. In this connection it is interesting to recall a system of individual incineration devised by the No. 1 New Zealand Stationary Hospital while in Salonika, and first suggested by Surgeon-General McPherson. The principle involved was one of segregation of liquid from solid excreta and page 151immediate incineration conducted in person by the user of the latrine the method consisted of so adjusting the two parts of a kerosene tin, divided perpendicularly by shears as to form two receptacles united each to the other by an extremity so that each inclined away from the point at which they touched; two inclined planes with retaining walls were so formed, one anterior to the other. A liberal sheet of paper was so adjusted in the posterior receptacle as to collect the solids, the liquid passing into the forward compartment. The paper and its contents were to be deposited by the user in a small incinerator controlled by a sanitary detail, constantly on duty within the latrine area. The urine of course was carried away by pipes to a soak pit. Very little training accustomed the users to this novel type of latrine which had every good quality to recommend it, but was more adapted to a small, well disciplined unit such as a hospital than to the ordinary needs of a camp population. Segregation afterwards became the rule in Prance, and incineration unquestionably is the council of perfection which was practised in all the large camps in England and in New Zealand. The deep trench system was recommended by the Sanitary Committee but it had been adopted by the Anzac troops as the most satisfactory solution of the incineration difficulties, in spite of the fact that the innovation was not well favoured by the local sanitary authorities. The trenches were dug 9 × 2 feet deep in interior dimensions which were not to be encroached upon by the sandbags used for revetment. In some instances, where the sand was usually loose, the walls needed staying by cross beams. Substantial fly proof seats were supplied by the Public Works Department of Egypt, and one trench was sufficient for a company for say six weeks to two months. This type of latrine is figured in Lelean's Sanitation" 2nd edition, page 251. In all these important preventative measures the New Zealand medical officers had much valuable guidance and help from Major Lelan. C.B., R.A.M.C., and Capt. F. Rose, R.A.M.C. of the 46th Sanitary Section at Ismailia, whose demonstrations of sanitary models were extraordinarily instructive. Capt. Austin, R.A.M.C., entomolygist to the Britism Museum, advised on matters apertaining to entomology, the chief being fly prevention. Plies were noted to be emerging from hibernated pupae in old manure dumps early in February, and by the 20th were increasing. In March they were fairly numerous about the camps. The main difficulty was the disposal of horse manure. A general routine order dated March 15th gave instructions that fresh manure from horse lines was to be taken to a site three quarters of a mile to leeward of the camp, there spread page 152out to dry and subsequently burnt. A small tram line was constructed to carry out this order, but the process of burning not proving satisfactory, burial was resorted to. The native labour employed by the sanitary contractors:—"Compagnie du transport des Vidanges du Caire," was never satisfactory. The chief profit in the contract lay in the refuse handling,—it is questionable whether the company even handled the refuse to the best advantage as much of it was wasted. Remains of bread and meat were apparently extracted from the refuse heaps and sold in the Bazaar. A good deal of valuable fat producing waste was not utilised. Much of this refuse was removed by barges on the Sweet Water Canal and dumped in the old dry Canal of the Ptolomies, at no great distance from the camp, where flies could breed in haste and we repent at leisure. Fly proof meat safes were attempted, as the Sanitary Committee did not consider it necessary to fly proof the kitchens; screening from wind, however, was considered very necessary for open kitchens, so as to prevent contamination by or admixture of sand with the food. To carry out these necessary sanitary precautions a good deal of material—timber, wire mesh gauze, matting and so forth—was required, but as was inevitable, the supply could not keep pace with the demand. Two important preventative measures demanded completion before the division sailed for France. One was inoculation with triple anti-typhoid vaccine, T.A.B., the other was lice disinfestation.
During the month of December there had been an increase in the number of typhoid and paratyphoid "A" and "B" cases with an increase in eases of dysentery of baccillary type admitted to the New Zealand General Hospital. There was a parallel increase in cases diagnosed influenza or tonsilitis which, probably, should have been more correetly labelled P.U.O. As already noted the Sanitary Advisory Committee had commented on the marked incidence of enteric in New Zealanders accompanied by a very high mortality. Returns furnished by the New Zealand Record Office showed that up to the end of October, 1915, there had been 453 cases of enteric fever amongst the New Zealand troops, with a 20.5 per cent. mortality. The Advisory Committee recommended that all convalescent "enteries" (which included the paratyphoid cases) should be returned to their respective countries, the object to be gained being:—not isolation of potential carriers—but a longer period of convalescence. Against this decision Lt.-Col. Parkes, N.Z.M.C, had protested, as in many cases the diagnosis was clinical only and had not been confirmed bacteriologically: less than half the cases evacuated to New Zealand were bacteriologically diagnosed. page 153Lt.-Col. Heaton Rhodes, the New Zealand Commissioner, interviewed both the P.D.M.S., Surgeon-General Babtie, V.C., and the Advisory Committee in December, 1915, on this matter, and he was advised that fresh cultures for preparing T.V. vaccine should be sent to New Zealand. In a subsequent interview with Lt.-Col. Parkes at the New Zealand General Hospital, the pathologist, Mr. Armitage, N.Z.M.C., expressed the opinion that the majority of the cases investigated indicated a paratyphoid infection, that in this condition T.V. was of no avail as a protective measure and that he saw no occasion to doubt the validity of the New Zealand inoculations. The records of the Pont de Koubbeh Hospital showed that during the past year 245 cases of enteric fever in New Zealanders had been admitted and that 55 remained, the death rate being only 5 per cent. in that particular unit. From November, 1915, onwards all bacteriological and serological examinations in "suspect enteric," cases were being carried out at a central laboratory in Cairo; the chief reason being to standardise results from all the hospitals. The total number of cases of enteric fever in hospitals in Cairo on the 24th December, 1915, was 612, of these 120 were of local origin, and 4 cases of enteric, 2 of paratyphoid, and 1 of dysentery were reported for the week as occurring in New Zealand troops. This report, which was dated in January, 1916, shows clearly that the word "Enteric" had then, its old meaning:—Typhoid fever. There was much confusion in terminology at the time: the term enteric was used to cover typhoid and paratyphoid infections. Results of the bacteriological tests and the agglutinations carried out at the central laboratory, owing to mixed infections, and various vaccinations giving cross agglutinations, became so unreliable that the tests were abandoned about this time by order of the D.M.S. Of 84 cases, New Zealand patients subjected to complete investigation during October, November, and December, 1915, the results showed that 60.7 per cent. were indefinite; 4.7 per cent of the cases were proved typhoid: 4.7 per cent paratyphoid B; and 29.7 per cent. paratyphoid A. The typhoid cases came from Gallipoli as did the paratyphoid A; the paratyphoid B all came from local camps in Egypt. A circular memorandum entitled "The Bacteriological Examination of Cases of 'Enterica'" issued from the office of the P.D.M.S. in Egypt on 3rd February, 1916, showed that there was a very small proportion of true typhoid infection, and that the greatest proportion of cases were paratyphoid "A" in the Gallipoli cases. The whole controversy is so buried in obscurities of nomenclature and diagnosis as to be hardly worth while reviving, were it not for the fact that validity of the New Zealand immunisations had been page 154publicly impugned by the Sanitary Commissioners. A report written, when the mists had cleared a little in 1916, by Major Bowerbank, N.Z.M.C., officer in charge of the Medical Division of the N.Z.G.H. offers a stout defence of the New Zealand position in this dispute. He says: 'I have no hesitation in saying that the premises on which the opinion was formed were incorrect and the conclusions unjust, as the figures given by the Sanitary Commissioners referred to the 'enterica' group, not to typhoid alone." He goes on to show that his view of the matter is based on a close investigation of 303 consecutive cases examined with the assistance of Captain Armitage, N.Z.M.C., bacteriologist to the N.Z.G.H. in which all bacteriological and serological methods, then available, were applied with the following results: "The great majority of the 303 cases investigated at the N.Z.G.H. proved to be paratyphoid, and against this disease neither the New Zealand nor the R.A.M.C, T.V. could afford any protection; but with regard to the typhoid eases, the figures indicate that, whatever may have been the protection afforded by the New Zealand vaccine, the R.A.M.C. vaccine afforded no appreciably better results;" [in New Zealanders]. As in the investigation it emerged that: out of the proved typhoid cases a greater number had received both New Zealand and English vaccines than had been immunised with New Zealand T.V. alone; and the incidence of proven typhoid was no greater in New Zealand troops than in the British in Cairo at the same period.
By the recommendation of the Advisory Committee a supply of T.A.B. (triple vaccine against typhoid and the two paratyphoid "A" and "B" infections) had been indented for from the R.A.M.C. College in London. The vaccine arrived in February, 1916, and was used immediately to inoculate the incoming reinforcements. A triple vaccine was first used in the French Army in 1910, but in 1909 a similar vaccine was on the market in England, and was used to immunise civilians proceeding to India. The œther killed triple vaccine of Clovis Vincent was used by the Italians in 1912 during their war in Tripoli, but T.A.B. was not yet in general use in the British Army in France (see R.A.M.C. Journal, May, 1916). Inoculations were completed for all the division early in April: two injections were made, of 5 cc and 1.0 cc, at one week's interval, mainly in the pectoral region below the left clavicle. The reactions were brisk but not severe, so that only 20 per cent, of the troops were immunised on one day, allowing for one day's rest following the injection. The work was done at the field ambulances.page 155
The necessity of establishing a "delousing" plant for the New Zealand Division became apparent shortly after arrival in Egypt. The urgency of this consideration was indicated by a memorandum of the A.D.M.S. dated 7th February, 1916: of which the following is an extract: "Relapsing fever is now very prevalent in Ismailia. The mortality is fairly high and the drug required to treat it very difficult to procure [Salvarsan]. This disease is spread by lice infestation and the men of the division are largely infested. I wish to draw attention to the urgent necessity of forwarding the scheme for bathing and disinfesting of troops in the New Zealand and Australian Division." A scheme was in contemplation at Anzac which included hot shower baths and Serbian Barrell disinfectors in which the A.D.M.S. was much interested just prior to the evacuation. Some of the New Zealand troops had now been nearly 18 months in the field without any means of disinfestation, and relapsing fever was endemic in Egypt and at the time of the Moascar encampment there was a severe outbreak in the Egyptian Labour Corps at Ismailia. It was of the berberine type the invading organism being the Spirochoete Berbera carried by the body louse or the head louse. Another type of relapsing fever seen at Gallipoli was the Indian variety caused by the Spirochoete of Carter, a much milder type than the Egyptian disease. In the case of the berberine type of fever the body louse after feeding on the blood of an infected man remains inoccuous until the 5th day when it is capable of transmitting the disease up to the twentieth day. The Spirochoete is contained in the body fluid of the louse and may infect the minute wound caused by the bite when the parasite is crushed, as in scratching. Relapsing fever played a prominent part in the sanitary difficulties of the Balkan Campaign, of 1912-1913, when liee infestation became a cause of the spread of typhus fever. The association of these two diseases had previously been observed. It was mainly on account of the danger of, bringing typhus to the "Western Front that stringent orders were issued, at the instance of the French Command, to ensure that all troops from the East should be efficiently disinfested from lice prior to embarkation for France.
The New Zealand Division had initiated its own scheme prior to the issue of these orders in March but the water supply presented itself as a first difficulty. The Ismailia water purification plant was not able to keep pace with the demands of so many camps, as well as the pipe-line supply for the Sues Canal defence system to the east of the town. The town water works were of a very special type designed by Puech and Chaballe, French page 156engineers; it dealt with the highly contaminated output of the Sweet Water Canal with an average bacterial content of 300 to 500 lactose fractors per c.c. Time was an element in the process of purification. Any attempt to increase the output would have been associated with deterioration of the quality. It was decided, therefore, to limit the supply to the camps and to install a new filtration system near Moascar for the purposes of military needs. As no water could be drawn from the Sweet Water Canal direct on account of the danger of bilharziosis, a general order had prohibited even bathing or washing in the Sweet Water Canal, owing to the fact that it was known to be infested with the Cercaria of Bilharzia Haematobia. In February the D.M.S., M.E.F., had published a circular memorandum on the subject founded on the work of Dr. Leiper, helminthologist to the London School of Tropical Medicine, which showed that endemic haematuria was exceedingly prevalent in Egypt—70 per cent, of the native population in Ismailia was infected—and further that the water of the Sweet Water Canal, its branches, marshes, pools and surface waters were more dangerous than well water owing to the fact that they harboured the intermediate hosts, two small snails, Bullinus Contortus, not unlike a very small winkle, and Planorbis Boissyi, a flat and very small snail shaped crustacean. The ova of Bilharzia after escaping from the human body per urethram or per ano, hateh out in water into free swimming Miracidia; the freshwater snails act as intermediate hosts, the larvae entering the snail's body, undergo further development into a opocyst which in turn produces innumerable Cercariae. The Cercariae, very minute, are free swimming, and gain entrance to the human body by penetrating the skin and mucous membranes. An infected mollusc may continue to discharge Cercariae for a period of three weeks. Bullinus Contortus was stated to be common in the marshes and ditches about Ismailia.*
* Dr. Leiper in 1919 informed the writer that a small water snail capable of acting as a host for the Cercaria exists in New Zealand.
By March, 1915. New Zealand had despatched overseas over 31,000 troops, of these 10,000 were casualties: dead, missing, sick page 158or wounded in hospital or invalided to New Zealand; 21,000 valid troops remained in Egypt. Over 122 officers, 1188 O.R., N.Z.M.C. had been despatched, of which: 55 officers, and 625 O.R. were now posted to the infantry division. Officers and men of the N.Z.M.C. had been through a special course of instruction, designed to prepare them for the Western Front. All danger of an invasion of Egypt from the Sinai Peninsula was now averted by the passing of the season of the early rains. In Mesopotamia, Kut was in the last days of its siege; our old comrades of the 13th Division pressing on to within 18 miles of the garrison, but held back by the Turks, also newly arrived from Gallipoli. At Salonika the eight allied divisions had not been able to render any material assistance to the Serbian Field Force now completely routed. A similar deadlock existed there so that all eyes were again turned to the Western Front. A general offensive by the Allies had been planned to take place in the early spring: Russia was to advance with her armies in the Bukovina, Italy in the Trentino; France and England, the latter now commanding a million men, were to blast out a way in the Champagne and on the Somme with a prodigious supply of ammunition. But Germany aware of all these preparations determined to forestall the attack by overwhelming the defences of Verdun under an avalanche of shells and threatening Paris with an army of 360,000 men advancing under a screen of artillery fire such as had never before been attempted. On the 21st February, the battle was engaged, the outer defences of Verdun had fallen, and by the end of March nearly a million of men had been east into a bath of blood and fire undreamed of in previous wars; the French reserves were being used up, English troops perforce taking their place in the line, so postponing the Allied offensive. Russia, in order to help France, had launched a premature attack only to meet with defeat.
All available troops from Egypt were now being hurried to the Western Front: the 1st and 2nd Australian Divisions of the Anzac Corps, under General Birdwood, were the first to embark, the New Zealand Division following on their heels. General Godley was to remain behind for a while, the IInd Anzac Corps was still in course of formation. On the 3rd of April the Commander-in-Chief of the M.E.F., Sir Archibald Murray, K.C.B., K.C.M.G., accompanied by H.R.H. the Prince of Wales, inspected the New Zealand Division at war strength. The great review was a moving sight indeed to all New Zealanders: the proud march past of our 20,000 horse and foot, harness on back and high of hand eager to take their place in the Empire's ranks in Flanders—the preordained page 159battle ground already dimly prevised in 1912 in the territorial camps of the Dominion. A new exodus from the land of Gosehen.
By the 6th April embarkation commenced in three flights. The New Zealand Mounted Brigade, under General Chaytor, now forming part of the Anzac Mounted Division commanded by General Chauvel, A.I.F., remained in Egypt and with it the New Zealand Mounted Field Ambulance, under the command of Lt.-Col. Hand Newton, N.Z.M.C. The New Zealand Sannary Hospital with 410 patients remained temporarily at Moasear. The O.C., Lt.-Col. McGavin, N.Z.M.C., had pressed a just claim for his unit to be converted to a C.C.S. for the service of the division, a provision contemplated by the New Zealand Government, but from a letter directed by the D.D.M.S. N.Z.E.F., to the D.D.M.S., L.O.C. dated 6th April, 1916, it would appear that it had been decided by the Imperial authorities that a New Zealand C.C.S. was unnecessary. Here was a most unfortunate misunderstanding. The stationary hospital possessed a fine surgical team which so far had not had much opportunity to develop its surgical ability. The cases treated at Moascar were mostly medical, one-third of them venereal disease. The conceptions of the functions of a C.C.S. were at this time, in the East, somewhat limited by local experience, vide the landing of the 1st Australian C.C.S. at Anzac prior to the landing of the bearer subdivisions. On the Western Front, stationary warfare had by now amplified the duties of the C.C.S., bringing it into line with the French Ambulance, or the German Feld Lazaret in the sense of bringing the surgical or operative treatment of wounds as close up to the firing line as possible. Early operation had soon proved its worth as opposed to the old South African policy of expectancy—any surgery that really mattered to the wounded man as regards the saving of life, was now the province of the C.C.S. probably the most important medical unit in the field, and the pivot of manoeuvre in the evacuation of casualties.
By the 9th April, the third and last flight of the New Zealand Division had entrained for Alexandria. Divisional Headquarters reached Marseilles on the 11th. The passage through the Mediterranean was uneventful for the old Gallipoli transports again freigthing Anacs to further adventuers.