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

Chapter X. Sailly sur la Lys

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Chapter X. Sailly sur la Lys.

By the 14th of October, 1916, the New Zealand Division was taking over its winter quarters and sector of defence at Sailly sur la Lys, relieving the 5th Australian Division, then on its way to the Somme area. The 2nd Brigade, with the 3rd New Zealand Field Ambulance attached, went into Armentières there joining Frank's Force, a unit less than a division in strength, including part of the newly arrived 3rd Australian Division, and responsible for the Armentières defences. No. 1 New Zealand Field Ambulance took over from the 14th Australian Field Ambulance a main dressing station, baths, and a laundry at Sailly with an advanced dressing station at Fleurbaix in the Port-à-Clous Farm. No. 2 New Zealand Field Ambulance relieved the 15th Australian Field Ambulance, taking over the D.R.S. at Nouvenu Monde, two miles south of Sailly on the road to Estaires with an A.D.S. at Eaton Hall. On the 20th, Lieut-Col. McGavin, late O.C. New Zealand Stationary Hospital took up his appointment as A.D.M.S. of the division, relieving Colonel Begg, C.M.G., who was appointed D.D.M.S. of the IInd Anzac Corps. General Godley and his staff were at this time in Baillieul and the corps comprised the New Zealand Division, the 34th Division, and the 3rd Australian Division. First Anzac, now composed of the 1st, 2nd, 4th and 5th Australian Divisions, was in reality an Australian Corps, the term Anzac no longer applied, in truth. IInd Anzac was still a part of the Second Army under General Plumer, whose command comprised four corps. The Second Army had a fine reputation, both for its fighting qualities, and for its administrative organisation, and had since 1914 maintained a dogged defence in the Ypres salient of evil fame, historic for its heroic sacrifices.

The sector of defence taken over by the New Zealand Division was that very battle ground where the 5th Australian Division had lost so heavily in July, in their disastrous raid against the Aubers Ridge, and was known as the Right, or Sailly sector, in length approximating to 5,600 yards and extending from Bois Grenier nearly to L'Aventie. There were two equal subsectors, each held by a brigade. To our right was the 56th Division of the First Army with headquarters at La Gorgue; to our left was page 228the 34th Division with headquarters at La Croix du Bac. The defensive system consisted of a continuous front line of sandbagged breast work with a secondary line 70 yards in rear; the principles of defence were similar to those in force at Armentières in the summer; the position was organised in depth. In each sub-sector two battalions were allotted to the front line and subsidiary line, the other two battalions of the brigade being in reserve. In the support line the main part of the garrison lived, each battalion spending, as a rule, seven days in the trenches. The reserves of the brigades in line were living in billets in very dilapidated villages, farms, and buildings, many of them abandoned by their owners, some still occupied in part, and of the farms, a few still under limited cultivation. The depth of the whole system as far as the subsidiary line was about a mile. The policy of the Second Army was at present, to rest and train the troops for the forthcoming spring offensive. The local policy of the Corps was to maintain, improve and strengthen the front line defences, and to be aggressive as far as fighting patrols and raiding parties were concerned, in order to obtain information, to injure the enemy, and to maintain a strong aggressive spirit in the divisions. In accordance with this policy large numbers of officers and specialists were detached to the various schools of instruction of the Second Army; the work of strengthening, repairing and improving the front line was pushed on. A very extensive scheme of drainage had to be devised and constructed as a small stream which ran parallel with our trenches, the Laies was running bank high, threatening to inundate our works, which were everywhere water logged. Our investigations of the enemy line by fighting patrols and by raids showed that No Man's Land was very swampy, that the opposing front line trenches were filled with water, dilapidated, and unoccupied, that the Bavarian Corps who faced us were living in their support lines, and seemed to be less inclined for aggressive tactics than ourselves. In order to obtain this information, very determined raids had to be carried out penetrating well back into the enemy positions, not without casualties on our part; we had 57 killed, 206 wounded during the month of November. Our losses during these raids were at times not inconsiderable, but apart from raids, the sector was considered a very quiet one, and there was very little artillery activity on either side. Much of the losses incurred by us were mainly through artillery fire during enemy raids, which were, with one exception, not carried out with any show of determination.

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The medical arrangements made for the evacuation of wounded in the right subsector were as follows:—Two regimental aid posts with bearer relay posts were situated at Rifle Villa, and Eaton Hall respectively, in ruined houses adjacent to the support line and somewhat strengthened by sandbagging. Both posts could be cleared by wheeled stretchers along the Rue du Bois and Rue Pétillon to the A.D.S. at La Croix Lescornex, thence by waiting motor ambulance to the M.D.S. at Nouveau Monde; each R.A.P. had four bearers of the ambulance attached and at the A.D.S. there was one medical officer and 15 O.R. N.Z.M.C. In the left subsector there was a similar arrangement, except that the bearer relay posts were not up at the R.A.P.'s which were in the support trenches; the evacuations by wheeled stretchers along the road proceeded to the A.D.S. at Port-à-Clous farm near Fleurbaix where there were two cars always in readiness and one medical officer and six O.R. provided by the 1st Field Ambulance Main Dressing Station at the baths at Sailly. It would have been quite feasible to have worked the whole sector by means of one M.D.S. with two A.D.S.'s but the system had been taken over as it stood by the division and was not materially altered. In case of raids warning was given to the field ambulance concerned. It was found by experience that special medical arrangements and a temporary redistribution of medical personnel was necesary in dealing with the casualties from organised raids. We were fortunate in this sector in being able to get motor ambulances up to within easy range of the R.A.P.'s, in most cases, as the sector, always a quiet one, had never suffered prolonged destructive bombardments. The village of Fleurhaix, although very considerably damaged by shell fire still afforded a certain amount of billeting room, and at our end of the village there were many houses still intact: as for instance Port-à-Clous farm. Further back, say 2,500 yards from our front line, the farm houses had scarcely been touched, and afforded billets for the reserve battalions of the brigade in line.

At Sailly, beyond the destruction of the church by fire in 1914, there was little evidence of damage by artillery, and most of the houses, the schools and factories, were available for billeting. The M.D.S. of the No. 1 New Zealand Field Ambulance was situated close to a large bleach works where the laundry and baths were established, and had at one time formed part of the toying sheds used by the "blanchisserie," consequently, it was not of a very luxurious character, but by the aid of linen hangings, it had been made serviceable, clean and bright looking. page 230At Nonveau Monde the dressing station was in a large, comparatively new garage associated with a distillery. Both field ambulances were evacuating to the 1st Australian C.C.S. at Estaires and were served by two motor ambulance convoys, the 22nd and the 14th. From the M.A.C 's a motor cyclist was despatched daily to the M.D.S.'s a tally of wounded and sick for evacuation was made which was taken back to the M.A.C. commander, who then so adjusted the number of cars in his convoy as to clear all main dressing stations in one trip daily. Emergency cases could always be sent on by us in our own cars as required. The evacuation of wounded presented no difficulties as the enemy was unusually quiet on our front, and our battle casualties were usually light, but provision for the sick of the division—at first very numerous indeed owing to the exhaustion following the Somme operations, and the execrable wet gloomy weather of November and early December—became the first and most important work of the medical personnel.

The rest station taken over from the outgoing division had little to recommend it for our purposes: it had huts and tents for some 50 men; many of the huts were dilapidated and provided poor shelter, and for the severe winter in Flanders tents were, of course, out of the question. Material had to be provided out of the scanty stores of the C.R.E. which were to a greater extent required in the front line, as, owing to necessity for wintering troops in the Somme crater area, enormous quantities of timber and other trench materials had to be provided, leaving the Second Army temporarily a little short. With the assistance of some of the Pioneers and the bearers of the No. 2 Field Ambulance the more serviceable huts were covered with malthoid and lined with hessian, the ceilings with calico. New huts were built from the wooden frames of condemned structures and lined inside and out with malthoid spread on wire netting. Three Nissen bow huts were also obtained from New Zealand Engineer stores, each providing accommodation for 10 men. Each hut was fitted with a small stove; a footway of "duck boarding" connected each with the two mess huts. A kitchen, a butcher's shop and a bath house were constructed, the hot water for the baths was provided by placing a 400 gallon tank on a specially constructed brick incinerator, the dry refuse furnishing the fuel. Eaeh of the living huts was provided with floor, matting, beds and complete bed furniture, including sheets and pillow slips, while a few deck chairs struck a note of luxury in the improvised wards. Most of these additional page 231comforts we owed to the generosity of the British Red Cross Society, whilst the Australian Branch supplied bed covers, bed gowns, pyjamas and hanging lamps to light the huts.

By the end of November the sickness wastage for the division had risen to 8.4 per thousand per week, the highest rate for any division in the Second Army, and the matter was brought promptly to the notice of the D.D.M.S., Colonel Begg, by Surgeon-General Porter, D.M.S. of the Second Army and after the manner of all such "reminders" was duly referred to our A.D.M.S. for explanation. Delay in completing the D.R.S. and insufficient accommodation for sick in the field ambulances were the chief causes operating to inflate the sick evacuations. There was much bronchial catarrh, some influenza, of a severe type, in one case verified by post-mortem examination. P.U.O. was much in evidence, very likely trench fever; there were cases of broncho-pneumonia; middle ear disease, stirred up by the bombardments at the Somme; and local septic conditions, chiefly caused by pediculosis and scabies, owing to absence of bathing facilities during September. Our artillery had just recently returned to the division and were much debilitated by their long tour of duty. There were many obvious sanitary defects not as yet remedied: draughty, uncomfortable and dilapidated billets, poor cooking arrangements; absence, at least for the moment, of drying rooms, wet ill-drained trenches; hot ill-ventilated, stuffy estaminets; problems at present under consideration and receiving attention, but in the general remoulding of the sorry state of things, there was need for time, much material, considerable labour, and the expenditure of prescient thought. But while the fighting men were busy paying inquisite calls on their neighbours, across towards Lille, strengthening their front line, draining thei drowned trenches, surveying their No Man's Land, and attempting to make it a part of New Zealand, commanding officers had little time to devote to the frills of fireside arrangements; the men were working assiduously and were as a rule too tired and too careless to make much of themselves when off duty, the fever of the Somme was still in their bones—they were too restless to settle down and make a "cushy" job of it. Consequently they fell ill and the A.D.M.S. was duly admonished by the D.D.M.S., who in turn had received the expressions of disapproval of the D.M.S. Our wastage rate was exercising some slight upward pressure on the curve of the Second Army rate of evacuation for sickness.

In order to appreciate the true inwardness of sickness wastage rates in any army in the field it is necessary to understand that there are two types of wastage: first, the wastage of the division page 232caused by the evacuation of sick to the C.C.S. From such a wastage no harm to the Army reputation ensues, as the C.C.S. is an Army unit, the sick man is still chez-lui, at home in the bosom of the Army family. But if he has to be evacuated beyond the C.C.S. he passes out of the Army on to those dark and devious ways called the L.O.C., where in his further peregrinations through General Hospitals and the Convalescent Camps, he vanishes from sight and the Army mourns his loss, which now becomes an Army wastage. Evacuations from the C.C.S. are not wholly dictated by the severity of the case but are, more frequently a question of accommodation, hence, if divisions send down too many sick at a time, a eertain amount of overflow at C.C.S. follows, as the clearing station must clear to keep some beds open for battle casualties. The advantages, then of having adequate D.R.S. accommodation are two-fold: first, there is provision for comfort and treatment for minor ailments betimes, so warding off the advent of possible complications; and, secondly, it provides a reservoir in the divisional area which so regulates the flow of sick to the C.C.S. as to keep down both the Divisional and the Army rate of wastage. This latter is not in its essence a "paper" saving, it is a very real advantage as it prevents congestion on the L.O.C. units and in turn regulates the flow of sick and wounded to the home bases, so saving undue wastage to the Field Force.

By the Divisional sick rate we mean the average number per thousand evacuated weekly to C.C.S., the Army wastage is, of course, lower as it expresses the loss per week per 1000 of sick evacuated out of the Army area to the L.O.C. units: general hospitals and base hospitals. It may be of interest to compare divisional wastage rates as set out in the following table, showing wastage in four battalions of the 1st Brigade in Gallipoli in July, 1915, at Armentieres in July, 1916, and at Sailly in November, 1916, the period at present under consideration.

Table showing sickness wastage to L.O.C. from the New Zealand Brigade at three periods, in per thousand, per week.
Unit Gallipoli Armentières Sailly
July, 1915 July, 1916 November, 1916
1st Auckland 92.4 5.15 3.19
1st Wellington 23.8 7.76 6.17
1st Otago 26.6 9.16 11.21
1st Canterbury 44,8 6.9 8.85
Average for Brigade 46.9 7.2 7.35
Rate for Division 86.1 8.3 8.2
Average rate for Second Army, October, 1916, 5.56.
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The three periods have this in common: the sick rate was abormally high; each period was marked by considerable activity without heavy fighting. The last period, winter 1916, corresponds with the acme of the reaction following the hardships of the Somme fighting and in this way resembles the Gallipoli period. The Gallipoli wastage is now seen in its most lurid light. An approximation to the normal sickness wastage from a division would be something about the average of the Second Army wastage which varied between 4 and 6 per 1000 per week; we have seen that the Fourth Army had a rate of 8 per 1000 during September, 1916, a very high rate of wastage, due, in this instance, to an outbreak of dysentery and the unusually trying conditions of the Somme fighting. The average for the New Zealand Division during the first year in Prance was 5.7, but always higher than the average of the Second Army, which was rather under than over 5 per 1000 per week. During this winter, for every man evacuated for wounds from the Second Army, three men were evacuated for sickness.

It was late in November before there was anything approaching reasonable accommodation and comfort at the D.R.S.; there were then 26 huts in all providing accommodation for 120 sick, some 30 others occupied the roomy brick garage and the loft above it. The provision for heating and lighting arrangements for the huts was achieved by drawing stoves and lamps from the N.Z.E. stores, supplemented by donations from the Red Cross Society. As regards stores drawn from the Red Cross Society, there was a certain reluctance on the part of the Army authorities to avail themselves over much of the generosity of Red Cross depots: the reasons, which were partly military and partly strategical, were quite sound. One of these reasons was that the Army was averse from allowing mobile medical units such as the field ambulance and the C.C.S. to become encumbered by equipment or materiel, which although invaluable in providing for the more efficient treatment of sick and wounded in stationary warfare, might limit mobility in a war of movement. The essential characteristic of a mobile medical unit is mobility, and movement depends upon transport; loads are known and calculated in advance and a certain number of vehicles are allotted to the unit proportionally—any increase in loads must limit the essential mobility, on which depends the facility with which the unit can develop its tactical functions. It was an army ruling that only such stores as could not be obtained from Ordnance might be procured from the Red Cross depots; but as there were minor page 234difficulties of delay in obtaining ordnance stores by indent, many medical units disobeyed this rule. Infractions of the orders, however, were made apparent to the Army by means of the monthly returns of goods supplied, now furnished regularly by the Red Cross Society. Only such articles then, as seemed indispensable and which could not be drawn from Ordnance were obtained by the D.R.S. from the British and Australian Red Cross stores. Of the generosity and willingness to help of these societies little that is adequate can be said; to their munificence there was only one bound—the reticence of the indenting unit, fortified by the frugal hand of the A.D.M.S. whose duty it was to endorse all requisitions in terms of the intentions of the Army Commander. As was natural, there was some little diffidence on the part of our commanders in drawing from Australian Red Cross depots, as New Zealand was subscribing to the parent branch in England. It was thought at Headquarters in London that if New Zealand Units drew from Australian Red Cross that the Dominion should, in equity, reimburse the Australian Society. But there never was any serious question of reimbursement of the Australian Society. Lieut.-Col. Heaton Rhodes, our Red Cross Commissioner in Egypt in 1915, when he had drawn on Australia for supplies, had offered to make these good as they became available in our hospitals, but Mr. Norman Brooker, the A.I.P. Red Cross Commissioner refused to accept anything. Colonel Murdoch, the Australian Commissioner in England, and his successor, Colonel Hayward, had at all times refused to accept anything in payment; Colonel Murdoch from the first had advised Mr. Elgar the New Zealand Red Cross Commissioner in England, that it would not be necessary to establish stores in France as he, Colonel Murdoch, regarded the New Zealanders as Australians and would at all times do anything he could for us. So it was that in France the New Zealand Medical Units drew stores from the British Red Cross or Australian Red Cross, either or both, as was most convenient, and are much beholden to the generosity of the Australians in this matter.

As to the working of the D.R.S., it functioned as a tent subdivision of a field ambulance with some added equipment and stores; beds, for instance, and bed linen, and a supply of food stuffs suitable for the class of case treated. Prior to admission to the rest station the sick had been taken in to the receiving department of a field ambulance where, if the nature of the illness was not such as demanded immediate evacuation to C.C.S., they were detained for observation for several days so as to eliminate, page 235if possible, infectious disease. As a rule, the patient was kept in bed—that is, he had the use of a straw-filled palliasse and the blankets always carried by the field ambulances. If the ailment was now obviously a minor one, the patient was sufficiently recovered to proceed to the rest station for a week's convalescence. The D.R.S. took in cases daily at 3.30 p.m.; on arrival, the patient was carefully examined by a senior medical officer, he had a hot bath, he was then given a change of underclothing, a towel, slippers and pyjamas, and retired to bed. Rest was encouraged for the first few days. Four liberal meals on an improved dietary, including eggs, vegetables, and milk, were supplied daily. Later short spells of physical exercises and route marches formed part of the treatment. The seven days allowed at the rest station were generally sufficient for complete convalescence. 85 per cent. of the admissions were discharged fit for duty within the period prescribed, which, with the four or five days spent at the field ambulance, gave the soldier a liberal 10 days complete change and rest with abundance of palatable and nutritive food. On discharge the soldier went to the reinforcement camp—not to his unit direct. In some rest stations it had been customary to supply the soldier with clothing and equipment, but not with arms, so that he could return to his unit fully equipped for the field; a necessary provision in many instances, and in order to meet this requirement a small supply of clothing, boots and equipment was kept at the D.R.S. But the A.A. and Q.M.G. of the New Zealand Division did not approve of this for economic reasons: the reinforcement camp, close at hand, was in possession of the necessary stores, consequently it was better to send the convalescents there, where final equipment was provided for, and from whence they could rejoin unit with a draft under escort. As far as possible it was the policy of the D.R.S. to discharge convalescents when their unit was out of the trenches, so obviating a too sudden change from conditions of rare comfort and ease to conditions of appalling severity during the severe winter months. If discharged to their unit when in billets the men had at least a few days in which to get hardened before the next tour of duty in the trenches.

The eoal supply of the D.R.S. presented some little difficulty at first; the regulation issue of fuel at this time was: 3 lbs of wood, ¾-lb. of coal per man per day for troops not in the trenches, for troops in line, 1½ lbs. of coke and ½-lb. of charcoal per man per day. Most of this fuel was utilised in the company kitchens; a portion was earmarked for the divisional baths—great eaters of eoal. Luckily the divisional fuel issue was mainly coal, supplied page 236as a substitute for wood at the rate of 1 lb. to 2 lb. of wood. The amount of coal consumed in the baths was variable, but nearly always exceeded the total of the day's fuel allowance of the men bathed. It was exceedingly difficult for the army to provide extra fuel to field units, and local purchases of coal were not approved by the French Government as so many of their most productive mines were in enemy occupation; coal was scarce and high priced. There were now a large number of huts at the D.R.S. each furnished with a stove; the fuel ration was so inadequate that permission had to be obtained to purchase coal locally, at first out of a fund provided by the Chaplain's Department, but later' out of a special "hospital comforts" fund authorised by the G.O.C. in charge Administration in the United Kingdom.

There was, for officers, a rest house controlled by IInd Anzac Corps. At first established at Nouveau Monde and run by the 5th Australian Division, it was, in the winter of 1916, transferred to La Motte. The Chateau of La Motte au Bois was hidden in a clearing in the Forest of Nieppe, on the road between Hazebrouck and Merville. Surrounded by an ancient moat it had a romantic appearance and was so far back from the front line as to be much quieter than Nouveau Monde where the sounds of battle were distinctly too near and too individually recognisable to be conductive to rest for jaded officers. The chateau was well suited to its purpose as it had large handsomely furnished rooms providing a dining room, a library, and a billiard room; there was accommodation for 25 officers and their batmen. The period of rest allowed was 14 days and the class of case most suitable was the officer who was run down or suffering from some minor ailment which could be benefited by a quiet comfortable rest in pleasant surroundings. The chatelaine, Me. La Baronne de la Grange, who was unfailing in her endeavours to make the officer patients comfortable, remained in residence in a separate wing, and was widely known to the higher command by reason of her hospitality. A detachment of ours under Major Walton, N.Z.M.C. was detailed for the service of the Anzac Officers' Rest House; later Major Izard, N.Z.M.C. succeeded, and ultimately the whole detachment was relieved by Australian details in July, 1917.

Another important medical establishment to be reconstituted was the dental hospital. As we have seen, prior to leaving for the Somme there were six dental sections attached to the division, but as there was as yet no provision for the transport of their heavy equipment they had to be sent to the base in August. Shortly after arrival in winter quarters the A.D.M.S. applied to page 237have the dental sections returned to the division. Late in October three dental sections, of these two incomplete, were sent up in reply to the demand, but it was found that three dental sections were insufficient to cope with the work which had now accumulated in the division. But the existing dental policy was to maintain a minimum of dental officers with the division and a maximum at the base and in England, so as to ensure that drafts arriving from New Zealand could be made dentally fit before going to the front. This policy had been agreed to by the late A.D.M.S., Colonel Begg, C.M.G., and Major Finn, D.S.O., N.Z.D.C., the dental administrative officer, at a conference held in the Somme area after the relief of the division, and had been confirmed by the G.O.C. in charge of Administration. But reviewing reports of dental officers of this period, it seems clear that there was a considerable amount of work to be done everywhere: even on the transports leaving New Zealand the dental officer who was posted to each transport was overwhelmed with work. At the bases in England and in the hospitals there was a shortage of dental personnel and at the base at Etaples the corps were fully employed. Wherever there were troops, there the services of the N.Z.D.C. were urgently required. This, of course, argues very high ideals of oral prophylaxis animating the zealous officers of the N.Z.D.C. Bat above all places, unquestionably the front line had most need of dental work: to save wastage, and to preserve the health of the fighting men; more especially as it was apparent that, owing to the shortage of dental personnel in the U.K. Base, many men were going forward with the reinforcements who needed attention. But in England it appeared that the only solution to the problem was to concentrate on dental work at the Infantry Base Depot at Sling as many men were arriving from New Zealand dentally unfit. In this impasse, the A.D.M.S. Colonel McGavin, called for a report from the senior dental officer with the division, Captain Dearsley, N.Z.D.C. Prom the report furnished it was shown that the dental condition of the division was very bad and that two dentists and four mechanics could not keep pace with the work. The mechanics were working half the night in order to complete 50 dentures and an equal number of repairs to plates during the week. Many of the reinforcements had been hurriedly supplied with dentures in New Zealand which now required remaking owing to shrinkage. There was some little difficulty in obtaining a complete equipment of expendible instruments, although normal requirements were fully and promptly met by No. 11 Base Depot of medical stores. page 238The most important part of the report, however, showed the solution of the difficulty, which was: to obtain the services of the many dental mechanics serving in other arms of the division and of the dental officers who were amongst the combatants; and to have the instruments sent over from England by the A.D.O. Major Finn. Armed with this report Colonel McGavin conferred with General Russell, and ultimately the G.O.C. N.Z.E.E. agreed to the temporary appointment of one dental officer and nine mechanics, all obtained from the division. So the dental hospital was established in November in a small communal school with a few huts attached. There were two rooms, one used by the surgeons, the other by the mechanics; heating, lighting and much needed repairs to the buildings presented difficulties which were not overcome for some time owing to shortage of material, but as the dental hospital was attached to the 2nd Field Ambulance for pay, rations, supplies and discipline, the field ambulance in conjunction with the Sanitary Section provided labour and material for repairs and the necessary alterations or technical structures. Days of attendance were allotted to brigades and other formations, Sundays were also work days and were devoted to officers. The N.Z.D.C. worked hard and well, in their first two months they treated 1702 cases; and owing to the close proximity to the trenches—the front line was only 3¾ miles away—of a fully equipped dental establishment capable of executing any type of work required, a soldier could come down from the most advanced positions and have efficient treatment without being more than a few hours absent from his duties in the line. A very important work performed by the dental officers this winter was the prophylaxis and treatment of "trench mouth" or ulcero-membranous gingivitis, caused by Vincent's organisms, now very prevalent amongst the men and in the opinion of some observers the cause of secondary lung complications of a severe type.

The duties of the Sanitary Section, now under the command of Major Sinclair, N.Z.M.C., D.P.H.—appointed in November, 1916—were, as may be imagined, very varied. The water supplies of the division were patrolled and examined from time to time for chlorination; pumps and wells were charted and the quality of the water noted; samples were collected from water carls and tested for chlorination. Three villages, Croix du Bac, Sailly sur la Lys, and Le Nouveau Monde, all situated on the pavé from Armentières southwards, and the last named town, came under the supervision of the New Zealand Section as regards page 239notification and control of infectious diseases and general sanitary precautions, such as: the upkeep of public conveniences, the collection and incineration of all refuse from civilian houses—there was a numerous civil population in all these villages—and disposal of refuse and latrine pail contents from all billets used by the troops in the village areas. Twenty-seven civilian labourers were employed in this work of conservancy and the usual cleaning of roads and drains. The inspection of estaminets, shops where food was exposed for sale, and slaughter houses formed part of the routine. In the case of the estaminets, owing to a serious outbreak of diphtheria in two divisions coming from the Somme, which had spread to the civilian population, certain precautions were rigidly enforced by the Second Army one of which was the adequate sterilisation of the glasses used for dispensing beer; all estaminets and canteens were compelled to cleanse drinking vessels thoroughly and to disinfect them by dipping in boiling water rim downwards, or by immersion in permanganate solution for five minutes, the latter being the more practical method; it was the duty of the sanitary sections to see that this was done. The Sanitary Section acted as the local Public Health authority, and as such had the sanction of the French authorities to deal with the civilians as with the military population. Adequate bacteriological or chemical examination or analysis were always at their disposal by means of the mobile laboratories of the Second Army. The section soon found the necessity of establishing a workshop in which a considerable amount of sanitary apparatus was manufactured for the use of units. In their "sanitary area" they had constructed a very large back feed destructor which was capable of dealing with the refuse of all kinds, both military and civilian in Sailly; a special straining and mixing shed was attached where the pail matter could be segregated, the liquid from the solids, the solids mixed with saw dust, dried and ultimately incinerated. Most of this work carried out with improvised materials found in the vicinity. Of the back fed incinerators there could be no doubt as to their efficiency.

One of the most important duties of the Sanitary Section was the daily disinfection of the blankets by means of the "Clayton" sulphur dioxide apparatus, a service undertaken with the object of combating lice infestation and the dissemination of scabies. The Fodden Lorry Disinfector, with two "Thresh" chambers, could deal only with 60 blankets per hour, 30 blankets being the maximum load for each chamber: twenty minutes were taken up in heating and expelling air; twenty minutes in steaming and page 240twenty minutes in drying, so that the output per diem was inadequate and furthermore the apparatus was required for other purposes. It was therefore recommended that all blankets in use in the division should be brought to the Clayton apparatus for periodie treatment. Men attending the baths brought their blanket—only one was in use in the trenches—to the Sanitary Section plant, where 1000 blankets or all the blankets of the bathers could be dealt with; the time taken being three hours, with some assistance given by two men per unit bringing blankets.

The divisional baths and laundries operated by No. 1 New Zealand Field Ambulance at Sailly had a capacity of 1000 men per diem and had been improved by the addition of much needed machinery; the laundry employed 150 women and was capable of delivering 40,000 pieces of washing, duly repaired, in one week. During the winter months there was an inevitable increase in lice infestation and in the incidence of scabies in spite of the activities of the baths, now called "Cleansing Stations," caused by close propinquity in dugouts where blankets were communal property and usually shared by the men. It was even made a ground of complaint by the civilian population at home that men proceeding on leave were frequently infested and that they distributed both pediculosis and scabies in England. Methods of disinfestation in use at this time were faulty: as it was impossible to treat all men of a unit on the same day the clean mingled with the unclean in billets or dugouts, the regimental blankets were shared and the "carriers" who shunned the baths re-distributed the infestation. Another cause for the continuance of infestation after delousing was not recognised at this time: the fact, lately emphasised by Lloyd, that P. Vestimentorum sometimes lays its eggs on the pubic and axillary hairs where they remain undetected and undamaged by the bath. Apart from the danger from typhus fever, and the now growing opinion that trench fever was carried by lice—not yet fully established by experiment—the local irritation of the skin and infestations productive of impetigo in its various forms, were a serious source of wastage. Evacuation out of the division by sickness due to I.C.T. (local septic conditions), and to skin diseases, showed a definite increase during the winter months: both curves Were on a slowly rising gradient which determined a higher average each year from these causes. Scabies, also was much more common and was responsible for much of the wastage by skin diseases and I.C.T. such as furunculosis, superficial abscesses, and impetiginous manifestations. One of the causes of the spread of scabies was the page 242apparatus was used to disinfest blankets and by this means the blankets of all bathers could be dealt with in one day. The average number of cases of scabies coming in from the "spotting" officers was about 6.5 per diem in January, 1917; the average daily number under treatment in the ambulances was 129. It has been estimated that 25 per cent. of the sick wastage from the British Armies was due to simple skin lesious, the result of scabies or pediculosis.*

There had been a perceptible rise in the venereal curve during the winter, attributed to leave being granted freely both to London and to Paris; the average for 10 weeks up to January 6th, 1917, had been 11.4 cases per week, of these, two-thirds infected in London. Colonel Begg called for a report on this matter from the division; the report showed that very little venereal disease was of local origin. Suspected women in the area were brought promptly to the notice of the A.P.M. by the field ambulances; quarantine and inspection by a civilian medical practitioner followed; and, later, deportation by the French Army Authorities acting through the local Gendarmerie—if the woman proved to be infected. Weekly V.D. inspections were carried out in all units with good results, several cases being detected each week that otherwise would have been concealed. The A.D.M.S. had already made representations to the G.O.C. in the matter. As the outcome of much serious consideration it was decided to issue to each man a special card similar to that in use in the Australian Divisions, on which was inscribed a strongly worded appeal to men going on leave to follow Lord Kitchener's advice: to avoid strong drink and to respect womankind; to be chaste and to be temperate. But there was more than this, there was also an indication of the helping hand for those who had been led astray and very clear instructions as to where to report in London for prophylactic treatment. Several "blue light" stations for early treatment had been established both at Australian and New Zealand Headquarters and at many hospitals in London, where no questions were asked, no names were taken, and where all that could be done was done under highly expert advisers to eliminate the risks of infection post factum. Ante coital prophylaxis was not advised by the New Zealand Division, but in order that the man might be able to treat himself if not within reach of a blue light establishment, a nargol outfit was recommended and the men proceeding on leave were supplied on request with outfits which contained protargol jelly for injection and a calomel cream. Similar outfits were in use in the Navy and had been taken by us from German prisoners in Armentières.

* Official History of the War, Medical, Vol. 1, page 7.

page 243

At a time of minimal activity, such as the winter of 1916, in the Second Army when all other branches of the service were attending courses of instruction the need for some school for medical personnel became very prominent. For some time past it had been manifest that the training of medical officers joining the Division was inadequate to the needs of front line units. To remedy this, the formation of a divisional school for the training of regimental medical officers was brought up as a proposal to the D.D.M.S. IInd Anzac. Colonel Begg was heartily in sympathy with the movement as he had already expressed strong opinions on the matter in his first report on the work of medical units attached to the Division in June, 1916, wherein he had emphasised the difficulty in obtaining trained regimental medical officers, and the patent fact that in many cases no adequate training had been undergone by reinforcement officers. He had recommended that medical officers should receive a thorough course of instruction in New Zealand under experienced officers prior to embarkation and added that lack of training in N.Z.M.C. officers had greatly increased the work and anxiety of the medical administration of the Division. The D.D.M.S. decided to make the school a Corps affair; he appointed Lt.-Col. Irvine, R.A.M.C.—who was O.C. of the 102nd Field Ambulance of the neighbouring Division, the 34th—and the late Major A. V. Short, M.C., N.Z.M.C. then a captain, as commandant and adjutant of the IInd Anzac Medical Officers School. The selection was a happy one; Lt.-Col. Irvine was an experienced officer who had already shown considerable keenness in instructing the junior officers attached to his field ambulance and Captain Short, M.C., had had considerable experience in Egypt, Gallipoli and at the Somme, being a "Main Body" man who had graduated through the O.T.C. at Otago University; he was a good drill and in every way a very efficient young officer. The commandant prepared a syllabus of training which included subjects outside the purely medical considerations, and made provision for a variety of lectures by competent officers on R.E. work, the A.S.C. and transport services and other administrative subjects. The syllabus was approved and the school opened on December 1st. A small villa on the Merville road in Estaires was appropriated, affording accommodation for nine officers. The class proposed was four officers from each division, being 12; some extra billets had to be found; while mess equipment was provided out of funds lent by the D.D.M.S The first course was attended by ten medical officers: four from each of the Anzac Divisions, two from the 34th, who were very short of officers. The routine was as follows: 9 to page 2449.30 a.m. squad drill; 10 to 12, lectures; at 1 o'clock, lunch; lectures from 2 p.m. to 4; and dinner at 6. The lectures covered a wide variety of topics, and were diversified by various demonstrations at selected field ambulances and C.C.S.'s; there was even a riding school, and lectures on horse mastership and the diseases of horses. At the end of the course officers were set a general knowledge paper of 16 questions, embracing the various subjects treated during the course. The second session opened on the 11th of December; the D.D.M.S., realising the success of the venture, determined to extend the course to 11 days, and it was confidently anticipated that nearly all the junior officers of the three divisions would have passed through the school by the end of the winter. Meanwhile the Second Army had on the 2nd December, opened a school of sanitation at Hazebrouck, the course lasting five days. The school had its origin at a conference of D.A.D.M.S.'s and Sanitary Section Commanders called in Baillieul during November by Captain Copelands, D.A.D.M.S., Sanitary, of the Second Army. It was pointed out at the conference that uniformity of sanitary effort could be realised only by uniformity of training, and it was suggested that N.C.O.'s in charge Regimental Sanitary Detachments should receive instruction at a central school, and that R.M.O.'s should be given demonstrations in improved sanitary appliances and methods. Ultimately the Second Army School of Sanitation opened; each session had a duration of five days; a mess and billets were provided for the class at the Hotel du Faucon at Hazebrouck; the cost of messing was 19 francs for the five days. Captain Copelands was commandant of this school to which two medical officers from each division of the Army were detailed, in turn, to attend. The syllabus included lectures and demonstrations on field sanitation and special demonstrations in the methods adopted for the prevention of infestation by parasites, pediculosis and scabies, including diagnostic methods. The school was very popular, as apart from the valuable instruction afforded, it made a very pleasant break in the dreary round of duties of the R.M.O.

In January Lieut.-Col. Murray, D.S.O., relieved Lieut.-Col. Irvine as Commandant of the Anzac Medical Officers School, the latter taking up duties as Acting A.D.M.S. of the 34th Division. The building appropriated was in many ways well adapted to the purposes of the school. It was a modern Flemish house and had modern appliances, electric light and central heating, it made a very comfortable home for the mess and such students as could be billetted there. The course had been extended to 11 days and page 245with experience the syllabus of lectures had been much improved, partly by means of appreciations written by the students; the answers given to the papers set showed clearly that the knowledge imparted in the lectures and demonstrations had been well assimilated. Each paper had a final question: "State what you think of the course and how it could be improved." The answers to this question were a valuable guide to the directors. In most instances the lectures were given by staff officers, each an expert in his subject. The services of senior administrative officers of the allied divisions and the Corps staff were available and, in some instances, of attached specialists; many of the lectures were of compelling interest, dealing as they did with the most recent thought on war injuries and diseases of topical importance; such as:— trench fever, trench nephritis, shell shock, the treatment of the wounded and the effects of poison gas. A small library of official manuals provided by the N.Z.E.F. was placed at the disposal of each student; but there was little time for close study, the duration of (he course was too limited and the five hours devoted to lectures and demonstrations seemed to most students—and it probably was— sufficient mental effort for one day. Much added knowledge was gained by conversation and exchange of ideas after class hours, the commandant always willing to assist in these informal discussions. If the syllabus had any fault it was in the direction of over fulness: the wealth of information provided could not be wholly assimilated, in some instances, in the time allowed. There was naturally some overlapping in the lectures, which was not disadvantageous but rather helpful, as it served to impress on the class those points which seemed to several lecturers of paramount importance. Whatever the method adopted, there can be no doubt of the value of such a course of instruction; the quickening spirit of the field was an adjunct that helped both teacher and pupil to attain their ends and eschew academic speculations of no practical purport, and as such, to be eliminated; the added stimulus of emulation was provided by the examination and the fact that all papers were forwarded to the D.D.M.S. for perusal at the termination of the course. In the appendix will be found a typical syllabus and examination paper demonstrating the great complexity of subjects with which the medical services had to make themselves familiar at this period of the Great War, many of them subjects not taught in any existing manual in use in the medical services nor in the schools of instruction at the home bases.

The Second Army classes in sanitation at Hazebrouck continued during the winter, some medical officers passed direct from the page 246Corps training school to the Army school, their curriculum being continuous and lasting 16 to 17 days—a very grateful rest for an R.M.O. At Hazebrouck excellent demonstrations were given on the diagnosis of scabies at the 12th C.C.S.; the famous Second Army School of Cookery was also visited, beside various experimental sanitary areas. The Second Army had also a medical society—but very unlike our primitive institute at Anzac—the meetings were held fortnightly at various C.C.S.'s and were addressed by the foremost medical specialists. An ambulance car left the A.D.M.S.'s office at Sailly on the days appointed, to take any medical officers of the division, who could be spared, to attend the meeting. Thus it was that the medical corps were now participating in the opportunities for higher training made available to all officers of the B.E.F. in the whiter of 1916-1917, during which "the Army became a Staff College."

A divisional school of instruction in field sanitation was opened on the 8th January, 1917, at which the sanitary detachments of units, as laid down in war establishments, attended for a period of five days. The syllabus covered the whole of the duties of the sanitary personnel of field units detailed in Field Service Regulations, part 2, section 84, with added matter of contemporary importance. The hours of daylight were spent in outdoor demonstrations and practical work, the remainder of the day in lectures indoors. The working hours were from 9 a.m. to 5 p.m. with an hour's break for dinner. Two lectures were given in the late afternoon, each of 40 minutes duration, illustrated by coloured diagrams and models prepared by the Sanitary Section who had charge of the school. The regimental medical officers reported favourably on the improvement in the general interest shown in their work by sanitary men, in consequence of this course of instruction.

An inquiry into the work of the regimental chiropodists trained at the divisional school at Armentières showed that in the majority of cases the chiropodists were well trained and efficient, regimental medical officers were unanimous in agreeing that the work had been most valuable to the battalions on the marches to and from the Somme, and that in most instances the chiropodists were keen and skilful. As evidence of the necessity of constant attention to the condition of the infantryman's foot, it was noted that in one week ending September 9th, 1916, no less than 45 cases were evacuated to C.C.S. from the division on account of injuries to the feet from marching. The total evacuations during that week numbered 248 so that the loss due to page 247preventable foot troubles was about one-fifth of the total evacuations and more than four times greater than any other single cause of disablement. The battalions who had the best chiropodists had least foot trouble. There had been casualties amongst these specialists, some had been killed, as they were obliged to carry out all the usual duties of a soldier. They were not in receipt of any extra pay as in the British Array; their work was purely voluntary and in no way absolved them from other duties in the trenches. This was an anomaly which could not be allowed to continue in justice to the chiropodist and his work. Neither extra pay nor promotion to the rank of corporal could be provided for under existing regulations. It was not economic to train men for special duties which they were debarred from carrying out except in their leisure time, and with no extra remuneration. Repeated losses by battle casualty of the trained chiropodists employed on other work than their speciality was to be avoided if possible. The problem of trench foot prophylaxis with its elaboration of preventive details was now demanding much attention. For these reasons, the second session of the divisional school of chiropody opened at No. 3 New Zealand Field Ambulance, Estaires, on the 12th December. Major Guthrie, M.C., was again in charge. The class was billetted and rationed by No. 3 Field Ambulance, four senior chiropodists were detailed to act as assistant instructors, and two N.Z.M.C. nursing orderlies from each field ambulance were attached for training. In every instance the N.Z.M.C. nursing orderlies showed marked aptitude for the work and later on were of very material assistance in dealing with foot trouble in men admitted to the ambulances. The syllabus of lectures was comprehensive and laid special stress on the necessity for rigid antiseptic measures. There was no dearth of clinical material, as R.M.O.'s were instructed to send all cases in need of treatment to the class on special days. The supply of men with the necessary goodwill, education and ability to make efficient chiropodists is probably very limited in a division. As a consequence only a small proportion of the candidates at this course attained sufficient proficiency to satisfy the examining officers; but, by a routine order published by the New Zealand Division, a status was provided for the battalion chiropodist, his duties defined, and he became a whole time member of the regimental medical detachment. Some such arrangement had in some cases been arrived at in the battalions by making the chiropodist act as corporal medical orderly; an unsatisfactory solution as no one N.C.O. could perform both duties. There is a page 248clear indication for a permanent establishment of battalion chiropodists with the rank of corporal, and possibly a senior chiropodist with the rank of sergeant attached to brigades. An alternative would be to provide battalions with trained chiropodists from the personnel of Field Ambulances.

The winter of 1916-1917 will be memorable in Flanders on account of its severity; it was very wet and cold until the end of December; the new year opened with a fall of snow and an unusually severe spell of hard frost when temperatures lower than ever experienced since 1882 were recorded. Curiously, the intense cold snap at midwinter did not affect the health of the troops prejudicially, on the contrary, there was a decrease in the sick rate during the month of January, 1917, the average for the division being 5.43 per 1000 per week, a little more than the army rate. In the early part of the winter Vincent's angina was noticeably prevalent, but with the onset of hard weather the wastage by diseases of the respiratory system took a leading place; an unusual type of influenza with, in some instances, severe broncho-pneumonia as a complication caused many casualties. There was little doubt now, that the New Zealand troops were very prone to these respiratory infections, much more so than British troops—it was even said that the New Zealanders provided the whole of the pneumonia of the Second Army during this period. There could be only one explanation of the constantly recurring fatalities in New Zealand troops from this cause which had been recorded during the Maori Wars; in the South African War; in the camps in New Zealand; in Egypt; and again in France; the cause:—clearly a lowered or absent immunity to special types of the pneumoccus, an immunity which British troops, coming from a more densely populated country, had acquired in childhood.

Trench foot, owing to its prevalence, had become a notifiable disease in the Army. It had been a very formidable source of wastage to the British Army in 1914: up to January 24th, 1915, it was stated by Mr. Tennant in the House, that there had been 9175 cases of frost bite, but Lord French, in his "1914," estimates that there were 20,000 cases in all, and cites the example of one brigade which sustained casualties to the extent of 700 in four days. French observers in 1916 were inclined to believe that the causative factor was infection by a mycelium which had been isolated by Professor Vuillemin, but there seemed to be a consensus of opinion amongst the English authorities, following the experiments of Lorrain Smith, that cold and wet with congestion of the limb in the dependent position due to pressure of the puttee page 249were the principal causes. Curiously the New Zealand Stationary Hospital reported about this time that they had had marked success in the treatment of cases by the camphor and borax method advised by the French authorities; but in the New Zealand Division the usual army precautions were in force. The use of thigh boots of rubber, the application of whale oil to the feet, and the daily issue of fresh socks to the men in the front fine trenches, with the provision of hot food at night, seemed to keep the disease in check. Our only serious outbreak, strange to relate, took place in the Divisional Train in men who were never employed in the trenches—drivers and loaders mainly. It was shown that these men were obliged to work in very wet and muddy horse lines, that their boots were defective, and that they had neglected to use whale oil. In his report on the cases the R.M.O., Captain G. H. Robertson, N.Z.M.C., noted that the circulation in the feet of the drivers and loaders was impaired by the pressure of the seat on the back of the thighs—they had all noticed numbness of the feet early in the day—and he also observed that the horses of the same company suffered from a severe foot infection at the same time. Provision was made for improving the horse standings in this company, and a proportion of rubber boots was issued to the men likely to be affected. On the whole trench foot did not trouble the division to any extent; injuries to the feet in marching were just as frequent a cause of disability. The very elaborate precautions taken by the division included the provision of drying and changing rooms close to the trenches, and the establishment of company kitchens in the support trenches, where hot food in special containers could be sent up at night to front line troops, and three good hot meals per day were provided.

Another war disease from which the division suffered, slightly was trench nephritis. Although there was a very slight increase in the general rate of incidence during the winter months, in all some 20 cases diagnosed nephritis had been evacuated in a period of four months. The condition was attracting considerable attention in the Second Army at this time and the disease was notifiable. As a war disease it had been first observed in the American War of the Rebellion in March, 1862, when it assumed epidemic proportion after a prolonged period of trench warfare. About March, 1915, the incidence of acute nephritis became noticeable amongst the British troops in France. Much investigation followed at St. Bartholomew's Hospital, where a special team made an exhaustive study of the disease without much light page 250thrown on the etiology. The incidence in the New Zealand Division was much less in January and February 1917, than in the British Armies, where the disease was much in evidence. Investigations carried out in the D.R.S. on all cases admitted in December and January, namely, 1136, showed that, on routine examination of the urine, only three per cent. of albuminuria was detected. This low incidence in the New Zealand soldiers of "transient albuminuria" was in very marked contrast to the figure arrived at by Captain Dixon, M.C., R.A.M.C., who reported in the examination of 4,085 sick in his field ambulance in three months, December, 1916, to February, 1917, no less than 21 per cent. of albuminuria in the absence of any other signs of renal disease.* McLean's observations on 50,000 healthy soldiers showed that there was some five per cent. of albuminuria, confirming the findings of McLeod and Ameuille, who found 4.75 per cent of albuminuria in British troops returning from a spell in the trenches, whereas the proportion in French troops was 1.6 per cent. On these and other findings the last named observers built up a theory of etiology based on a lowering of kidney tissue resistance by a slightly scorbutic tendency and excessive metabolic effort due to high protein feeding.

In view of this theory and the fact that Indian troops—the greater part non-meat-eating—were immune, the lessened incidence in New Zealanders and the suggestion of a lower rate of transient albuminuria might be attributed to the fact that our troops were habituated to a higher protein value in their domestic ration, and consequently demanded a higher meat ration than British troops. But this is highly contentious ground; more especially as to the scorbutic condition, if it existed.

By December the Division was settling down to make the best of its quarters in the villages by the Lys, many schemes were in hand to give added comforts to the billets, to improve the cooking of the company kitchens; to provide recreation for the resting troops. General Sir Andrew Russell was above all a great fighting general, but he had a very keen eye to interior economy as well. In this he was ably assisted by Lieut.-Col. Reid, A.S.C., the A.A. and Q.M.G., an accomplished "regular" soldier, with an unusual capacity for organising. With this officer the relations of the A.D.M.S. and the medical service of the Division were always happy. Both by the Divisional Commander and the "A" branch the recommendations of the A.D.M.S. invariably received earnest consideration and powerful execution. The need of the moment seemed to be expressed in one word:

* Lancet, June 23rd. 1917.

Lancet, September, 1916.

page 251"Rest." Our men were restless, overactive, and when in billets, away from the line, were prone to wander in search of distraction and to lack repose. Uncomfortable surroundings, monotonous cooking, little means of recreation were the chief causes of this restlessness. The first need seemed to be improvement in the messing—well fed men would presumably rest better, and be more contented.

A memorandum—"Hints on Cooking in the Field," had been issued by G.H.Q. and was distributed to all units in the Division. The matter was being pressed upon the notice of unit commanders. Lack of adequate training in army cooking was evident, but was destined to be remedied later on by the Army School of Cooking at Hazebrouck. The betterment of the regimental kitchens was a matter which General Russell and Lieut-Col. Reid saw to personally. They were determined to make an end of the damnable monotony of the eternal stew; their enthusiasm spread to the regimental commanders, much improvement in the messing arrangements followed. Regimental messing funds were established so that the army rations could be supplemented and a greater variety provided, in order that the men should be fed as well as all circumstances permitted.

Our heavy losses in experienced company officers at the Somme explained part of our difficulties in interior economy. Without good company officers no divisional sanitary or economic instructions could bear fruit. Billets unquestionably afforded poor comfort, owing to lack of light and fuel, and were not conducive to rest or contentment. Many of the buildings had been damaged by shell fire or other causes: wear and tear of war conditions; continued coming and going of troops. The billets in forward areas were mainly barns or lofts, often dark and impossible to heat; many of them draughty and in a tumble-down condition. The proprietors, willing enough—so they said—to effectuate repairs, complained of lack of material; while the troops, at present too much occupied with the defence system, had no time to attend to their own comfort. In the villages the billets were somewhat better—factories, schools and so forth, but proving of little attraction to the men. The inevitable alternative was the village estaminet. Ultimately by using our own N.Z.E. stores and by co-operating with the proprietors, who found some labour, the leaking roofs were repaired and the draughty walls made weather proof—straw, woven into mats, provided some mitigation of the hardness and coldness of billet floors; arrangements were made when possible for heating and lighting the billets and in this page 252way making them somewhat more homelike. Much more could be done by administrative or technical troops in this respect than by the Infantry.

A large well stocked canteen, a barber's shop, and a watch repairing depot were established: all run by details from the division. The Y.M.C.A. had an institute in the main street with a cinema, but as a larger place of entertainment was required, a theatre was built by our Pioneers called the Kapai Theatre, with a facade reminiscent of a large Maori whare, and accommodation for 1000 spectators seated on rude benches. On the stage of this theatre a variety of talent gave nightly entertainment in conjunction with the Divisional Cinematograph. Amongst the more important engagements were: Lena Ashwell parties; the famous "Bow Bells" troupe of the 56th Division; the Band of the Royal Engineers; and later our own Divisional Pierrots, which the 3rd New Zealand Field Ambulance was chiefly responsible for organising, and to which they furnished, from their personnel, nearly all the orchestra with their instruments, and some of the chief performers, Lt.-Col. Hardie Neil, N.Z.M.C. acting as impressario,—another example of the various strange duties imposed on medical officers by the exigencies of the. times. An officers' club was established and provided a warm, comfortable ante-room and writing room for such officers as could not get over to the Second Army Officers' Club at Baillieul, to which a special omnibus ran twice weekly at appointed hours. In this way some attempt was made to organise the amenities of normal existence and towards the end of the year there were ample facilities for recreation, and an ordered social life for those who were out of the trenches, the moral and sanitary value of which was of primal importance.

The first Christmas day of the New Zealand troops in France was observed as a holiday, as far as trench warfare permitted. Ceremonial visits were paid by the A.D.M.S. to the field ambulances and the D.R.S. where 150 patients were comfortably housed. General Godley visited them at dinner time—the rude tables spread with Christmas cheer—his remark was short but emphatic: "You have done 'em uncommon well, Murray." There was a glorious Christmas tree in the afternoon in the divisional theatre for the children of Sailly and Bac St. Maur, which General Russell with important French officials attended, to receive the thanks of delighted guests in an wonderful speech delivered by one of the little girls. There was a reunion of the N.Z.M.C. officers who were not on duty at the billets of the No. 1 Field Ambulance, attended by the D.D.M.S., Colonel Begg: the second Christmas dinner of page 253N.Z.M.C. officers at which he presided. Peace and goodwill and frugal earousal was in every billet that night. Even in the trenches, all was quiet in No Man's Land; except that our artillery, the only disturbers of the peace, with the trench mortars and the machine guns fired a substantial amount of hate into the enemy's communicating trenches. The enemy made no reply. We had one man killed and seven wounded that Xmas Day.

The Germans had bottled up their wrath and on New Year's Day, in return for our Christmas boxes they sent over a sprinkling of shells aimed at our front line system without causing any damage or any casualties. We had our revenge on the 7th January, when the 2nd Battalion of the Rifles entered his lines before dawn, killing many of the 65th Prussian Infantry and bringing back 19 prisoners with the loss of 1 killed and 5 wounded. The weather now became arctic, hard frosts and heavy snow compelled a partial truce. The Lys was completely frozen over; any that could obtain skates made use of them; even the Prussians could be seen holding skating parties which our artillery rudely dispersed. On the night of the 3rd February, retaliation came unexpectedly in the form of gas shells. On a clear moonlit night our forward billets at Fleurbaix were shelled with a mixture of phosgene and high explosive, and the right brigade, the N.Z.R.B. had their front and support line freely plastered with 75 num. gas shells fired from trench mortars. Either the men did not realise that gas was being used or there was delay in rousing the sleepers, or in some instances the expiratory valves of the small box respirators, previously in use during the night—there were two separate bombardments—were found to be frozen together; all these and other causes, the combination of H.E. with the gas shells, led to a large number of casualties by gassing. The ill effects of the gas were not, at first, noticed, there was much movement owing to the dispersal of the sleeping men; it was late before the matter was reported, and many of the gassed men had walked considerable distances before they were received into the ambulances. 14 gassed were admitted to No. 1 Field Ambulance and about 20, including 2 officers, to No. 3 Field Ambulance; of these some 5 men died in the dressing station. The most startling feature of the whole occurrence was the fact that the men did not complain of any ill effects for many hours after gassing, and that the onset of grave symptoms, in the fatal cases, was abrupt. The cyanosis, restlessness, dyspnea and collapse, and ultimate death within a few hours, of young robust men, shocked the medical officers in attendance in this their page 254first experience of the extraordinary lethal effects of phosgene in high concentration. The treatment adopted was that laid down in the manuals—oxygen, camphor, and atropine. Only those who have struggled hour after hour with a fatal case realise how futile these remedies were. The value of continuous oxygen administration in the milder cases was manifest, but the necessity for a suitable apparatus with a closed face-piece was also obvious; the need of a liberal supply of oxygen in field ambulances was now fully realised by all; and for some time after the ingenuity of N.Z.M.C. officers had full play in devising apparatus for continuous inhalation which could be constructed from material normally available. The precautions taken in December by the division to revise anti-gas defences and the elaborate training carried out at the Divisional Gas School with the new small box respirators which replaced the helmet, had been dictated by the Army, who were, by their Intelligence warned betimes of the forthcoming menace of phosgene gas shells. Up to this time the use of lethal gas in shells, initiated by the enemy at the Somme, had not been very extensive. The year 1917 saw a very marked change. Stringent regulations, designed in part by the A.D.M.S. were now enforced so as to avoid the future possibility of delay in reporting and treating cases of gassing. All troops who had been exposed to gas were to be relieved at once, and any showing even the mildest symptoms were to be treated urgently as stretcher cases. All those who had been in the gassed area were enjoined to rest quietly for some hours afterwards. The net result of this, our first baptism of lethal gas was an earnest renewal of instruction in gas defences and gas drill with strict supervision of all anti-gas measures, preventive as well as therapeutic.

Our final revenge in the Sailly sector eventuated on the 21st February, when the 2nd Auckland Battalion: 18 officers and 500 men raided the opposing lines under a heavy barrage; the enemy were caught at 'stand to" and lost about 200, including 44 prisoners brought in by us. No. 1 Field Ambulance received 97 of ours and 13 German wounded from this raid. The methods adopted in this operation—for which the ambulance was duly warned—were as follows:—The A.D.S. personnel was pushed forward to form a collecting post and an extra number of bearers were sent to the bearer relay posts and regimental aid posts. Communication was kept up by a motor cyclist between the collecting post and the original A.D.S.; extra ambulance waggons were brought up to the nearest point on a road where wounded might be loaded and communication between the ear station page 255and the collecting station established by telephone and the car orderlies. Lying cases were despatched direct to the M.D.S. from the collecting post, where hot drinks, extra blankets and stretchers were made available. The A.D.S. became an administrative post only, keeping in touch with brigade headquarters and the M.D.S. All wounded were cleared by noon.

On the 25th February the N.Z. Division gave over command of the Sailly sector to the 57th Division at 12 noon, our medical units handing over to Wessex and West Lancashire Territorial Field Ambulances, at the same time relieving the medical units of the 25th Division. The A.D.M.S. reopened his office at Steenwerck; the Divisional Headquarters of our new sector: Le Touquet-Ploegsteert.