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

Notes For R. M. Os. — of the New Zealand Division

Notes For R. M. Os.
of the New Zealand Division.

1. Foreword.

These Notes are for the use of Regimental Medical Officers of the New Zealand Division.

They are not a resume of the duties of an R.M.O., but are a summary of orders and instructions which have been issued from time to time in Medical Corps Orders, and such other information as may preserve R.M.Os. from those errors of omission and commission which experience has shown to be most frequent.

During the two or three months Medical Officers are attached to Field Ambulances prior to being sent out as R.M.Os., they are expected to familiarise themselves with conditions in the Field. Amongst these the testing and chlorination of water, and the defensive measures against gas, and also the early treatment of gassed cases are of the utmost importance, and owing to their novelty to the recently commissioned R.M.O., require special attention.

2. Regimental Medical Establishment.

These Establishments vary in the different units. These variations and some other details are shown in the Table in the Appendix. In what follows an Infantry Battalion is referred to.

Each Infantry Battalion has:—

3. Equipment.

The medical equipment of a R.M.O. is as follows:—
Medical Companion and water bottle 1
Surgical haversack and water bottle 1
Field medical panniers pairs 1
Haversacks with shell dressings—
Infantry Battalion 8
Other units 1
Cases, chemical, water-testing 1
Cases, water-testing, sterilization 1
Cases, instruments, Chiropody 1
Ammonia capsules 200

These stores are replaced or replenished through the Field Ambulances.

The following are supplied for use at each Aid Post, and procured by the Quartermaster of the unit:—
Lamp, acetylene, with glass front (Authority: C.R.O. 845, dated 27-10-16.) 1
Beatrice Stove (Authority: G.R.O. 1896, dated 26-10-16.) 1

"S.B." armlets and stretchers are an Ordnance supply. Crude disinfectants are an A.S.C. supply, and procured by the Q.M. of the Unit from the S.S.O.

A sufficient number of blankets (say 20) should be kept in the R.A.P. and will be obtained by the Q.M. of the unit. When an excessive number of wounded is expected, a larger supply of blankets and some medical comforts will be supplied by Advanced Dressing Stations, on instructions from A.D.M.S.

A Thomas' splint and suspension bar is kept in each R.A.P., and handed over with it to the incoming R.M.O., unless fine R.A.P. is being handed over to a R.M.O. of a different formation, when the splint and bar are taken away with the rest of the equipment. When this splint is used, on a patient, a replacement must be at once secured from the A.D.S. or M.D.S. Instructions for the use of this splint were issued with Medical Corps Orders, dated 24-7-17, and must be studied and practised by all R.M.Os. They should also instruct bearers in the application of this splint.

Although Medical equipment is on charge to the unit, the R.M.O is regarded as immediately responsible for it.

"Expendible" items, e.g., drugs and dressings, are demanded from the affiliated Ambulance of the unit in writing, signed by the R.M.O.

In case of inexpendibie items being lost or rendered unserviceable, in demanding their replacement the R.M.O. must forward with his demand on the Ambulance a certificate stating exactly how, where and when these items were lost or rendered unserviceable.Such general statements as "lost by exigencies of campaign," "destroyed by shell fire," are insufficient. The statement should be something as follows: "…………These items were destroyed by shell fire in the R.A.P. at (location) on (date)." Unserviceable or broken apparatus should be returned, as they may be repairable, and at any rate, prove the genuineness of the claim for replacement. Empty thermometer cases and ethyl chloride tubes will also be returned.

Economy must be exercised by R.M.O.s in expenditure of drugs and dressings. An efficient R.M.O. rarely requires drugs, etc., not included in this equipment.

Items other than medical equipment required by R.M.O., are obtained from Q.M. of his Unit.

4. Transport.

A Maltese cart carries the medical equipment, and is driven by the medical orderly. This 'cart is at all times at the service of the R M.O. With Artillery, except D.A.C., this cart is drawn by two horses—with other units by one. The Divisional Ammunition Column is provided with two Maltese carts.

6. Information, Orders, etc

When a Medical Officer is taking over from a R.M.O., either temporarily (as for leave or sickness), or when posted to a unit, he will receive from his predecessor a complete file of Medical Corps Orders, with the instructions, pamphlets, etc., which have been issued with them. He will give a receipt for these, and this receipt will be forwarded by the outgoing R.M.O. to the A.D.M.S. This file of Medical Corps Orders will be kept in Field Medical Pannier, No. 2.

Copies of D.R.O., C.R.O., A.R.O. and G.R.O. may be seen in the Orderly Boom of the unit at any time, and R.M.Os. should extract those Orders affecting their duties, supplies, etc.

Copies of books such as King's Regulations, Field Service Regulations, Part II., may also be seen in the Orderly Boom.

Each R M.O. should be provided with

" R.A.M.C. Training Manual."

"Sanitation in War," by Major P. S. Lelean, C.B. R.A.M.C.

"Hints for R.M.Os. of the Territorial Force," by Captain M. F. Grant, R.A.M.C.

8. Leave.

Leave of attached Officers and other ranks is given from the allotment of the unit to which the soldier is attached. The R.M.O. will obtain his leave from the O.C. of the unit, and then forward this in writing for approval of A.D.M.S., who will supply a substitute to report to O.C. unit, generally the day before the R.M.O. proceeds on leave. Date of proposed departure must be stated. The R.M.O. will thus have an opportunity to instruct his substitute on local conditions, etc.

On returning from leave, the R.M.O. must report at once in person or in writing to the A D M.S., when the substitute will return to his Ambulance

9. Channels of Communication.

On all technical (professional) matters and questions of policy, the R.M.O. will communicate directly with the A.D.M.S. On other matters through the O.C. of the unit.

Suggestions or complaints on sanitary conditions should be submitted to the O.C of the unit before being forwarded to the A.D.M.S., so that O.C. unit may add any remarks, or possibly remedy the defect forthwith.

11. Dental Cases.

These will be sent to the Divisional Dental Hospital.

In cases of lost or broken dentures, the R.M.O. should enquire carefully to ascertain if the loss or breakage was deliberate or due to negligence, in which case he would report the matter to the O.C.

Dental cases must parade at the Dental Hospital with their tooth-brushes.

12. Eye Cases.

These are sent to the Ophthalmic Centre of the Army on special days, by a special Field Ambulance, to which the patient is sent by the R.M.O. The Ambulance and day and time to be sent are notified from time to time in Medical Corps Orders.

Where a man has broken his glasses, and the prescription for the lenses is in his pay-book, it is sufficient to send the prescription and broken glasses to the Ambulance, unless the error of refraction is of such a degree as to disable the man when he is without glasses.

Deliberate and negligent loss and breakage of glasses must be dealt with in the same manner as for dentures.

13. Scabies.

These cases are sent to a special Ambulance notified from time to time in Medical Corps Orders.

The whole unit should be inspected once a week to detect these cases. Disinfection of blankets, vide Note No. 19 (vide M.C.O. 476).

14. Ears are not to be syringed by orderlies unless specially instructed by Medical Officers. In cases where the mombrana tympani may have been ruptured by an explosion, the ear will not be syringed at all until (and if) such is directed after examination by a Medical Officer at an Ambulance M.D.S.

16. Inoculation.

Inoculation will be carried out in accordance with Army Council instructions Nos. 1339 of 1916 and 522 of 1917, which were consolidated and issued with Medical Corps Orders dated 25-4-17.

The procedure adopted will be that laid down in D.R.O. 928 of 4-ll-16 (and M.C.O. 384 of 7-11-16).

If a complete Nominal Roll of a unit is well compiled, showing the inoculation state of each individual, it is easily kept up to date by adding the name of each soldier who arrives as a reinforcement or attachment, and erasing the names of those struck off the strength. Only the number of complete inoculations should be entered under the column headed "Number inoculated during the month."

17. Casualties-Diagnosis of.

Only the R.M.O. or the medical orderly under his instructions "will fill in the Tally Ticket. In all cases the R.M.O. will himself sign it. "In the case of sick he will see that the diagnosis is in accordance, with the" Nomenclature of Diseases."

In the case of injuries other than wounds, it will state whether these are battle 'casualties or accidental.

19. Disinfection.

The O.C. Sanitary Section of the area occupied, is responsible for the disinfection of billets and camps in which cases of the following diseases have occurred:—

  • Scarlet fever
  • Diphtheria
  • Small-pox
  • Cerebro-spinal meningitis
  • Cholera
  • Relapsing fever
  • Typhus

The O.C. Sanitary Section will be communicated with by the A.D.M.S. of the Division.

The O.C. Sanitary Section will generally demand a fatigue from the R.M.O. to assist him. This fatigue will be provided from the sanitary personnel of the unit.

In cases of other infections diseases, disinfection will be carried out by the R.M.O. A spraying apparatus and fluid for use in it will generally be lent by O.C. Sanitary Section when asked for in writing by the R.M.O.

Disinfection of clothing will be effected in the Foden Lorry. The location of this lorry is given in Medical Corps Orders from time to time.

With a view to the suppression of scabies and lice, it is well that the men's blankets should be sterilized in the Foden occasionally. The, number of blankets in a Company varies from time to time. The Foden can do 60 blankets pet hour with certainty of sterilization. Whenever possible the R.M.O. should arrange that the blankets are sterilized about every 4 to 6 weeks. By communicating to the A.D.M.S. the number to be done and date, suitable arrangements can generally be made. It is best to do at least one complete Company at a time.

The R.M.O. should ascertain that the men are getting their baths and change of underclothing once every ten days. He should inspect the bathing roster frequently and ascertain from enquiry that it is being adhered to.

21. Sudden Deaths.

In the event of a sudden death occurring outside a medical unit, when sufficient evidence is not forthcoming as to the cause of death, the body is to be sent to a C.C.S. for post-mortem examination.

R.M.Os. will forward the body together with all particulars available as to the cause of death, to the Field Ambulance. Os.C. Field Ambulances will arrange the transport of the body to the C.C.S.

22. Mutilation of Clothing of Wounded.

Preparatory to dressing a wound, it is frequently found necessary to cut the clothing in order to remove it without aggravating the injury or causing pain to the patient.

Although this matter is one for the judgment of the M.O. in each case, these officers will (as far as is consisistent with the welfare of their patients) avoid unnecessary mutilation of clothing, and especially of boots, gum, thigh.

Slacks and tunics may be slit up the seams and by completely unlacing ankle boots, and steadying the leg just above the ankle they may be removed without cutting the uppers or causing pain to the patient in cases of injury to the leg and thigh.

Needless exposure of wounded in cold weather is to be avoided, however, and under the circumstances it may be necessary to cut holes through the clothing in order to adjust the First Field Dressing, with the bandage outside the clothing.

R.M.Os. in their usual lectures on First Aid should explain this to Company Officers, Stretcher Bearers and men.

23. Medical Attendance Upon Headquarters

Headquarters Staff of Divisional Artillery or attended by a M.O. of one of the Artillery Brigades is the D.A.C., this M.O. being selected by the C.R.A.

Headquarters Staff of an Infantry Brigade is attended by one of the M.Os. of the Battalions of the Brigade, this M.O. being selected by the Brigadier.