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

Chapter IV. The Summer Months at Anzac. New Zealand Bases in 1915

page 59

Chapter IV. The Summer Months at Anzac. New Zealand Bases in 1915.

With the coming of summer and the degeneration of the military operations into a condition of stagnation—a veritable siege of the Anzac garrison—sickness, the enemy of all beleaguered garrisons, joined forces with the Turk and took daily an ever increasing toll of victims. In the first week of June, the evacuation's by sickness from the Anzac corps amounted to 456; but during the last week of the month, 818 sick were evacuated from the beach—a sickness wastage equivalent to 35 per 1000 per week, or one brigade a month.

Gastro-intestinal disorders had become almost universal by the end of June, severe diarrhoea with bloody and mucoid stools were the common symptoms. The rations were at first blamed: it was suggested that the excessive consumption of "bully beef" and fresh meat with a lack of fresh vegetables was the cause; others considered that the frying of the meat in the mess tins—every man cooked for himself in those days—and the consumption of army biscuits were the aggravating causes. What is one man's meat may be another's poison, wherefore, during the Armistice, our men swapped army biscuits for rye bread with the Turks.

By the middle of the month the first cases of "Enteric" or "Typhoid" were notified to A.D.'sM.S by the base and stationary hospitals at Mudros. There was an immediate search for carriers, those known to have had typhoid were evacuated and a request was made for a resident pathologist. The prevailing diarrhoea was now found at the bases to be baccillary or amoebic dysentery.

Flies, first noticed about May 15th, had become a pestilent horror towards the end of June. The D.M.S., Surgeon General Birrell, was consulted. His memorandum, although subjected to much humorous criticism, was on the whole quite sound in view of existing sanitary knowledge in the M.E.F. He pointed out that the breeding places should be located and that all refuse should be dealt with promptly by incineration or otherwise; the use of fly-papers was recommended. A very senior officer, a brigade commander, promptly indented for 4000 fly-papers and miles of string so as to festoon the dere—a reductio ad absurdum, which damned the memorandum. Crude petroleum was indented for, but page 60little could be obtained, for the reason that the Black Sea was closed and the Persian oil field inactive.

Sanitary methods were rigorously enforced. A sanitary officer was appointed to each sector of defence. Major Sinclair, N.Z.M.C., D.P.H., since dead, was then divisional sanitary officer; we have seen that he landed with the advanced guard, armed with a testing case and charged with an impossible duty, to advise on the purity of the water consumed by the half-maddened fighters struggling about the muddy water holes of Shrapnel Gully during the first days of the landing. Other medical officers and one dental officer, Captain McKenzie, N.Z.M.C.—who shortly after landing established a dental chair somewhere in the trenches near Russell's Top—were allotted to sectors of the defensive position and assumed sanitary control over the beach and other unallocated areas. In the trenches scrupulous cleanliness was aimed at: refuse which had previously been thrown out at the back of the parados, or promiscuously, was buried or incinerated. Wells were controlled; some water holes were condemned and put out of bounds; the issue of fresh meat was cut down for trench troops and alternative issues of potatoes and oatmeal were made. Lime juice was issued twice a week. R.M.O.'s were allowed to draw condensed milk, arrowroot, and bovril in small quantities for issue to walking sick; the regimental sick kitchen for light diets became a feature of the R.A.P. at a later date.

Towards the end of the month Colonel Manders complimented the medical officers on an improvement in sanitary conditions; but it was now evident that there was a serious incidence of "enterica" amongst the New Zealand troops; and that amoebic and bacillary dysentery were epidemic. It was suggested that the amoebic dysentery was imported by carriers from Egypt, but it was known to be endemic on the Gallipoli Peninsula in pre-war days, and it is now known, although at that time not proven that this disease may be fly-borne to the same extent as is bacillary dysentery. The "enterica" cases were, in part, due to infection by carriers, ambulatory and undetected cases, or ordinary carriers from Egypt, but most frequently by carriers amongst the Indian troops, aided by fly infestation, and open latrines. The first latrines had been dug on the beach at low water during the days of the landing: later, small trench latrines were established, but were not much used when the shelling of the beach areas became intolerable. Deep and shallow trench latrines had their adherents. The steep ground at Quinn's Post offered little space for shallow trenching, so that deep trenches page 61were used there until all available space was exhausted, when galvanised iron buckets or other substitutes and permanent latrines were established in or near the trenches. Infection by water was not an improbability: there was a very limited supply—about two pints per man daily—of authorised water; the wells were probably soon contaminated owing to lack of pumps and the surface pollution which was inevitable in the earlier periods of the fighting. The distance from the bases and the lack of pathologists and prompt notification of infectious diseases, bacteriologically diagnosed, prevented earlier segregation of the dangerous ambulant cases of typhoid, paratyphoid and dysentery, which were treated at the R.A.P.'s and permitted to remain as a source of further infection.

The sanitary diaries of N.Z.M.C. R.M.O.'s and district sanitary officers, still extant, serve to show that the medical staff were triers and were acting up to existing lights. The following extracts from a sanitary diary are typical:—

"Refuse. Between the top support trenches and the fire trenches, refuse has been thrown over the parapet. All through the sector refuse is lying about; at X Sap I have noticed a foul refuse heap which has been there for several days, it is now swarming with flies. It should be covered in immediately." We knew later that covering in was of no avail, the flies had already laid their eggs, the larvae would emerge through an incredible depth of light soil. Incineration was the only remedy.

"Urinals and Latrines. Notices should be put in the trenches directing troops to these places."

The writer goes on to condemn the shallow trench latrines which had been abandoned at the beginning of the year in France—at least in the trenches—and advises deep trench latrines 6 feet deep, 2 feet broad, 10 feet long, with a rail supported on two biscuit tins filled with sand, with the usual "antisplash" apron of biscuit fin to prevent soiling of the ground by urine and the undercutting of the trench walls to prevent fouling. Such a latrine would suffice, he says, for 500 men. Disinfection with lime was recommended. The extract continues:—"The A.D.M.S. recommends Indian pattern urinals: holes to be dug 2 feet in diameter and 3 feet deep with graded stones from the size of a cricket ball below to that of a walnut above." The diarist next dilates upon the duties of the regimental sanitary detachment. "The regimental sanitary squad [sic] are not scavengers and should not be employed in the collection of refuse. I would make them responsible for the following duties: (1) Refuse pits to be page 62kept in sanitary condition and sprinkled with lime; (2) Night urinals [biscuit tins adapted] to be emptied in the morning, sprinkled with antiseptic and replaced in the trenches at sunset; (3) Supervision of latrines and urinals [Indian pattern] which should be periodically treated with lime or antiseptic; (4) Report all uncleanly areas in the trenches or bivouac to the R.M.O.; (5) Where pits are dug the sanitary men should have fatigues to assist them." All of which was in accord with current teaching as in F.S.R., Part II., Chapter X. On the dietary of the troops the sanitary diarists had something to say also:—

"Meat Issue. One half of the present bully beef would be ample, much of it is thrown away. The fresh meat issue is too large; with the cooking utensils [the mess tins only] available, the meat cannot be used before putrefaction sets in." [The meat became fly-blown by viviparous "green bottle" flies.] "Some men are suffering from boils and an intractable superficial inflammation of the skin [desert sores?]. I have asked for an extra ration of lime juice for these men for medicinal purposes. Bacon, cheese and jam are plentiful, and much appreciated, but the bacon is too salt and there is no water available for soaking. I would strongly recommend an increase in the water ration, the quantity allowed is not sufficient to keep the men healthy. I have measured carefully the milk cans for the supply of water and find that they hold 2¼ gallons when filled to the top. The water has been issued in these cans on the assumption that they contain 2½ gallons. Allowance should be made for this shortage." The water supply was jealously guarded; this haggling about two pints amongst nine men is very pathetic.

A note from Captain Baigent's diary:—"In May the New Zealand Brigade relieved the 4th Australian Brigade in Quinn's and Courtney's Posts. Sanitation was a very difficult problem in these days owing to the great heat, the prevalence of flies and lack of space. Courtney's Post would not accommodate the whole battalion, and the men not actually in the trenches were bivouacked on terraces. The only space available for latrines was on the slope exposed to snipers, thus necessitating the construction of sand bagged protection. Later on we were forced to tunnel through a knoll about 30ft in order to use a small protected hollow on the other side for latrines. Flies were our main worry. The men had the greatest difficulty in swallowing their food before the flies attacked it. Owing to the heat and the swarms of flies, fresh meat had to be cut up immediately it was received and put into dixies and stewed. My R.A.P. at Courtney's page 63was situated 30 yards below the crest of the hills, and the rear line of trenches. Wounded and sick were evacuated to the field ambulance dressing station further up Monash's Gully in charge of Major Murray. Drugs were drawn [direct] from the advanced supply depot of medical stores on Anzac Beach." On the question of the supply of drugs to the New Zealand and Australian Division there is more to be said later.

The Posts at Quinn's and Courtney's were both of great military importance, and of course hotly disputed, Quinn's especially, guarding the head of the right fork of Monash's Gully was a most dangerous death trap place where the Turkish works and ours almost adjoined. Affairs of mine and counter-mine, fierce bombing raids, even hand to hand encounters were not uncommon. The 16th Battalion of the 4th Australian Brigade had deplorably heavy losses early in May, but at the time described by our diarist the line had been more or less consolidated.

Captain Home, N.Z.M.C. of the Wellington Battalion writes of these posts and their difficulties. "Tuesday, June 1st. Moved this morning from Reserve Gully to Courtney's Post on the south side of our general position. Courtney's Post hangs by its eyebrows on the edge of a steep gully, and we are camped in bivouacs dug out on the declivity. Here it is a war of trenches and explosives, of bombs, grenades, mines and counter mines and other infernal machinery. We have dynamiting parties out every night and mines burrowing towards the Turk trenehes—as they are also mining towards us it is a matter of acute interest which side gets the blow up first. So far the honours are about easy, but the Turks have more than once rushed the crater, but none of them got back again, so that if they had the honours that time we took the tricks. My chief worry is the impossibility of proper sanitation on the crowded hillside, and flies are becoming very thick. When we first took over it was a sort of rabble (sic) ground, scrambling, unformed, loose tracks, and bivouacs scraped out here, there, and everywhere on the hillside, so that Colonel Malone said that getting the men out was like digging periwinkles out of their shells. They looked just like a lot of magnified rabbits, both in their earth works and their sanitary arrangements. Colonel Malone had the steep hillside terraced so that the men of a platoon could settle down side by side. Proper steps were made so that men could get a decent hold coming up and going down."

The Wellington Battalion was very highly disciplined and well organised by the genius of Lt.-Col. Malone. His domestic arrange-page 64ments were well cared for by his R.M.O. and his Quartermaster, Captain Dallinger, N.Z.S.C., since dead. In this battalion which did so much to organise and domesticate Quinn's and Courtney's the interior economy was always at a high level. Some form of company kitchen had been established, even at Quinn's, under the direction of Captain Dallinger, who had at one time been through the school of army cooking at Aldershot. There were trench fires and Flander's kettles, and no doubt there was expert refuse disposal. The water duty men were employed as medical orderlies at the R.A.P., one of them as sanitary corporal. This appropriation of water duty men was, at Anzac, for a time justified as there were no water carts in use. The bulk of the water arrived in barges and was stated to be already chlorinated.

In July was reached the height of the summer heat: night temperatures in spite of the sea breeze were higher than the day temperatures which ranged from 83° to 85°F in the shade at midday. Sickness had reached dangerous proportions: the weekly evacuations from the corps by sickness alone exceeded 400. A return received by the A.D.M.S. from Mudros showed that 61 cases of enteric had been diagnosed at the bases, in all 142 cases from the corps. Early in the month there was a cholera scare, one or two cases had been diagnosed tentatively—they proved later to be severe baccillary dysentery. Orders came from the D.M.S. to initiate anti-cholera inoculations. On the 7th July the A.D.M.S. distributed vaccine, prepared at St. Mary's, London, and by the 16th, 4000 men had been immunised; the reactions were mild. Two "cholera hospitals" were projected, one for each division. All water was to be chlorinated, but for various reasons this could not be done: of the canvas troughs issued to units for the purpose very few remained intact.

About this time the unusual consumption of drugs and medical comforts by the New Zealand medical officers was commented on. There was a shortage of castor oil, a drug much in favour at the time. There was sharp division of opinion amongst medical officers as to the merits of holding up sick at battalion headquarters, feeding them on medical comforts, drugging and treating them on the off-chance of keeping up effective strength. Some R.M.O.'s did not believe in the R.A.P. "soup kitchen," but thought it best to evacuate to the field ambulance who were holding all the sick that they could accommodate. The R.M.O.'s were trying to hold men in the ranks. Anzac was now one big hospital. Towards the end of the month of July, one of the brigadiers held a conference of his R.M.O.'s to discuss the page 65steadily increasing sick rate of his brigade; the concensus of medical opinion expressed was as follows:—"(1) The general health of the troops and their physical condition is below normal and is getting progressively worse; (2) No further steps can be suggested to improve hygienic and sanitary conditions other than change of bivouacs to a fresh, unused site; (3) The principal symptoms of the sickness are:—gastric derangement, bronchial affections, loss of weight, rapid pulse, dilation of the heart; (4) Predisposing causes: irregularity of rest and meal hours: restricted dietary as regards variety; heat, dust, and flies.

It was freely granted that the very arduous work called for was necessary and unavoidable. There was feverish preparation forward for the August offensive. Battalions were depleted, the average strength 25 per cent. below normal. The bacteriologist at Mudros reported the causes of the sickness to be:—dysentery of shiga type, amoebic dysentery and undifferentiated "enterica." The A.D.M.S. advised the D.M.S. that the health of the division was bad and likely to become worse and authorised a rum issue three times a week to act as an appetiser, a cocktail to coax the men to eat their rations—a very popular A.D.M.S. for the nonce.

One of the most dreadful of the sanitary problems was the disposal of decomposing bodies lying in the vicinity of the trenches, sorry memorials of repeated attacks by the Turks under Enver Pascha, who came at the end of June to drive the Anzacs into the sea, but left some 300 dead in front of our trenches; another holocaust, but, unfortunately, not a whole burnt offering to the gods of Ansac. From the decomposing bodies there came an unbearable stench in the trenches; an extract from the diary of a sanitary officer gives luminous if repulsive details:—"July 5th Decomposing bodies. Lime is urgently required to deal with this trouble. Enemy dead are lying within a few yards of No. X Sap. The stench is abominable and the trenches are crawling with maggots. Troops have to remain in the trench constantly, the smell causes them to vomit. It is impossible to remove or bury the bodies as a machine gun is trained on the spot." [Enemy trenches not many yards away.] "Lime would greatly improve matters as I have already found out."

Of these noisome dead, over 200 were buried on the night of 2/3rd July by the New Zealand Mounted Brigade. In other instances the bodies were sprinkled with kerosene and burnt; where the enemy trenches were very close to ours, it was necessary to use grappling irons and drag for them; the decomposing body page 66was hauled into our trenches, dragged on an oil sheet through the communications and buried in dead ground. There are strange stories of the bodies burning as was thought, from spontaneous combustion, and it has been surmised that the inflammable gases generated by decomposition within the abdomen were set alight by bombs or rifle bullets exploding cartridges in the dead man's belt.

To these major horrors were added the "minor horrors of war." Lice infestation, first noted at the Suez Canal in February, had now become a universal torment because of propinquity, inadequate means of disinfestation, and partly through ignorance of the life habits of the parasites.

Meanwhile military matters of great moment were in prospect as the following extract from the diary of Captain Guthrie, N.Z.M.C, R.M.O., of the Canterbury Mounted Rifle Regiment, shows:—"July 19th, 1915. One notices a general preparation on all sides, the supply depot below us is increasing steadily in size. Large boiler-like tanks are being put in place with pipes laid on; an engined pump is installed at Anzac. All communication trenches are being widened; a road along the shore to No. 2 outpost is being made. Last night a complete howitzer brigade came ashore, 18 guns. Men are practising hill climbing, Anzac beach and foreshore are piled up house high with all sorts of stores and ammunition. All this work is done at night time. Every precaution is being taken against gas. We all have masks; Vermorel sprayers are in the trenches. Some day, not very far away, more troops will land and an advance on a big scale will be made." With Anzac thus busily engaged and no fighting in prospect until August 7th, we can afford a moment to look back at New Zealand and its doings since the main body left, and what had happened at overseas and the home bases during the first year of the war.

In New Zealand, shortly after the departure of the main body, reinforcements on the highest scale had to be despatched at regular intervals, and in order to concentrate, train, and equip these reinforcements, a large tented camp was opened at Trentham on the site of the Dominion Rifle Association's Ranges, situated in the Hutt Valley, some 20 miles N.E. of Wellington on the Wairarapa line of railway and adjacent to the large station used for the service of the Trentham Race Course. Concurrently with the mobilisation of volunteers from the existing territorial force and the civilian population, the training of the territorials and cadets was successfully carried out during the year 1914-1915,page break page break
Colonel J. R. Purdy, C.B.ET.D., D.M.S. in New Zealand. (Died 1924).

Colonel J. R. Purdy, C.B.ET.D., D.M.S. in New Zealand. (Died 1924).

page 67the number so trained exceeding the numbers trained in previous years, and the spirit of enthusiasm animating the trainees was of hopeful augury. The work done by medical officers of the territorial force, somewhat depleted in numbers by the demands of the expeditionary force, had been very satisfactory, and the training of the territorial ambulances had gone on uninterruptedly. The D.M.S., Colonel Will, V.D., as we have seen, embarked with the main body as A.D.M.S.; he was replaced by the late Colonel Jas. R. Purdy, T.D., N.Z.M.C., who had previously held the appointment and was now on the reserve. All the expert work in connection with the mobilisation of medical troops and formations, the recruiting of medical officers, the medical and sanitary supervision of the large concentration camp, and provision for sick from this and other N.Z.E.F. camps, besides the routine work of supervising the medical arrangements of the home territorial force, N.Z.M.C., had to be shouldered by the D.M.S., a general practitioner, a part time officer whose annual honorarium as D.M.S. amounted to no more than £150. This arrangement was felt to be anomalous by the general staff and, in his annual report in June, 1915, the general officer commanding the forces, Brigadier General A. W. Robin, recommended the appointment of a whole-time D.M.S. General Robin says:—"Under the present conditions of a small annual remuneration, the director of medical services can hardly be expected to sacrifice his private practice, which represents the major portion of his income, nor is the department in a position to demand more than an equivalent of his services."

The first duty of the D.M.S. was to recruit medical officers for the N.Z.E.F. This he did by enlisting the assistance of the British Medical Association (New Zealand branch), who published an appeal for volunteers in their journal. A second appeal was never made: volunteers were immediately available and continued to come in freely all through 1915 to furnish reinforcements, to man the new medical units formed, and to staff the training and concentration camps, the most important of which was Trentham, the final jumping off place for reinforcements.

Trentham Camp was situated, as we have seen, in the Upper Hutt Valley, a healthy country district, very thinly populated. Surrounded by steep hills, there was an area of flat country in the valley, the soil being a stony or gravelly loam, fairly permeable, the sub-soil, river gravel of high permeability; very dry in summer time but inclined to be damp and retentive of moisture during the winter months. The rainfall was somewhere about 60 page 68inches per annum, being 20 per cent. to 25 per cent. greater than at sea level in "Wellington. The flat land was in reality the old bed of the Hutt river now confined to a narrow swift stream at no great distance from the camp and affording pleasant bathing places for troops during the summer. There was somewhere about 400 acres of good flat land near the rifle ranges available for tents, giving ample accommodation to about 4500 men for tentage and training grounds, besides some 860 acres of broken, hilly land, part of it suitable for manoeuvres of the Anzac type. Pleasant enough during the summer months but when the winter of 1915 came, May to July in New Zealand—the low permeability of the top soil which contained a trace of clay, the heavy traffic in the roadless camp and abundant rains, produced the inevitable sea of mud, the concomitant of many previous camps in New Zealand, notably those inspected by Sir Ian Hamilton in 1914. Lack of floor boards in the tents, lack of drying rooms and a shortage of boots for a second issue, led to much discomfort, to which many of the newly joined recruits were as yet not inured. Since November, 1914, cases of measles had been notified to be slowly increasing, and in May a dangerous overcrowding which brought the camp population up to 7000 resulted in a serious epidemic.

The measles outbreak, at first of a mild nature, gradually increased in severity until, about midwinter, it acquired an unusual virulence. Cases were described as being "malignant": a suffocative type with septic bronchitis, and a haemorrhagic type "black measles" were observed. It is, of course, open to argument that the last named cases were indeed examples of the cerebro-spinal meningitis which broke out later. There was no military hospital then; in New Zealand, with the exception of a small camp hospital in marquees. The Wellington Public Hospital acting as a base hospital soon became overcrowded, so that a temporary hospital had to be improvised. The old plague hospital at Berhampore in Wellington, built by the City Council in 1900, during the plague scare, was taken over and enlarged by the use of marquees. This hospital in turn became seriously overcrowded and early in June had 87 patients with a staff of 3 nurses, 1 sergeant N.Z.M.C. and 4 O.R. A part time medical officer was visiting three times a week.

The rapid onset of dangerous symptoms and the early unexpected termination of many cases of pneumonia and the alarming death rate were freely discussed in the press of the Dominion at the time, so that public attention was focussed page 69betimes upon the epidemic, to the prejudice of the medical service. The Minister of Defence now realised the impossibility of carrying on his medical arrangements by means of a loosely organised part time territorial medical service, which, because of economy in the years during which the territorial force was coming into being, had not been provided with a permanent staff nor organised, as it should have been organised, for war. When the territorial scheme was first initiated in New Zealand, an agreement was come to between the Inspector General of Hospitals and the D.M.S. whereby all sick of the territorial force were to be admitted to the public hospitals under the control of the health department* Under this agreement the chief health officer had already made provision for sick and wounded of the expeditionary force prior to this date. In this extremity of medical disorganisation the Minister of Defence appealed for assistance to the Minister of Health. The Minister, then the Hon. Col. Heaton Rhodes, offered the services of his department freely, and as the result of conference it was decided that Dr. Thos. Valentine, D.P.H., Chief Health Officer of the Dominion, and Inspector General of Hospitals, should be appointed Director of Military Hospitals (D.M.H.), with the rank of Hon. Col. in the N.Z.M.C. His responsibilities were defined as being:—

(1)Provision for treatment in hospitals and convalescent homes of all sick and wounded of the N.Z.E.F.; (2) Sanitation of camps; (3) Control of N.Z.A.N.S. until posted to the N.Z.E.F.

The D.M.S. was made responsible for:—(1) Military organisation of the N.Z.M.C., training, appointments, transfers of personnel; (2) All medical arrangements (except sanitation) in camps and camp hospitals; (3) Medical embarkation and disembarkation duties; (4) Examination of recruits and, in part, invaliding boards. The new arrangement came into force in June.

Colonel Valentine acted with vigour as soon as appointed, and in as much as he already controlled the necessary hospital accommodation and was a government servant of long standing and had a staff of trained medical officers, he was in a much stronger position to act than a part time territorial officer. The "Victoria" ward at Wellington Hospital was opened as a military ward of 60 beds; large wool stores at Kaiwarra, providing accommodation for 150 beds, were placed at his disposal by patriotic merchants; the race course buildings at Trentham were appropriated, a large tea kiosk giving room for 100 beds, the

* Under the Hospitals and Charitable Aid Act of 1908. all public hospitals in New Zealand are in part maintained by rates, in part by Government subsidy and are under the part control of the Inspector General of Hospitals, who is also chief health officer.

page 70grand stand, the trainers' quarters, even the loose boxes came into use to accommodate the 603 cases hospitalised.

As regards the cerebro-spinal meningitis there had been much doubt as to the diagnosis in the earlier cases. At least three deaths from meningitis were reported in June, but were ascribed to influenzal measles or tubercular infection. One death at sea in the 5th reinforcements who sailed in June was diagnosed cerebrospinal meningitis, but it was not until July that the diagnosis was clearly established at Trentham by the late Prof. Champtaloup, Bacteriologist to the Dunedin Medical School and the Government Bacteriologist, Mr. T. Hurley, who had been called upon to investigate the conditions. The diagnosis was confirmed by demonstrating the presence of the Diplococcus Meningitidis in the cerebro-spinal fluid of a fatal case, and by culture of the organisms. There were six deaths from C.S.M. in July, others, less numerous in August and succeeding months, but the epidemic never reached the severity of that at Codford in 1914 amongst Canadians and other troops, or the epidemic of 1915 in Australian Camps.*

In July the maximum number of sick in hospital from all causes rose to 872: the Trentham camp strength was at this time 7498; there was serious overcrowding; on the 9th the D.M.H. advised breaking camp. This advice met with much opposition but in the end was acted upon, and on the 10th there was a general exodus, the troops being billeted or distributed in smaller camps in the district; only 2000 remaining at Trentham. This heroic effort broke the epidemic, it flatly subsided, nor is there much evidence to show that the scattering of the troops caused any dissemination of C.S.M. in the civilian population; certainly it had a beneficial moral effect on the troops and also upon the civilians, who in some instances had accused the defence authorities of criminal neglect. Partly in consequence of this accusation a public commission, to investigate the sanitary conditions at Trentham, was summoned by His Excellency, Lord Liverpool. It consisted of His Honour Judge Hoskins of the Supreme Court, Mr. William Ferguson, a civil engineer, and Dr. A. A. Martin, who had just returned to New Zealand after a period of service with the R.A.M.C. in France. This commission was sitting at Trentham at the end of July, 1915. The findings, given later, were in agreement with the opinions generally held at that time. It was agreed that there had been insufficient isolation of measles

* During the epidemic of C.S.M. in Victoria in 1915, 644 cases were reported with 888 deaths and 60.2 per cent. mortality. The outbreak included 421 cases in the military population of the training camps.

page 71contacts; that the hospital arrangements in the camp were inadequate; and that the overcrowding, coupled with lack of drying arrangements and excessive dampness in the living quarters, were the predisposing causes. As regards overcrowding, it was shown that the density of population in the tented area was about 575 to the acre, with eight men to a tent, and that the floor space in the huts, of which there were only 15 at this time, was only 31 square feet per man. The huts were unlined and of unusual size: 70 feet by 22 feet by 9 feet 5 inches and accommodated 50 men each. An officer of the N.Z.E. who had enlisted in England in the New Zealand Contingent assembled at Sling camp in 1914, and who had been wounded at Anzac and invalided to New Zealand, gave evidence showing that the conditions existing at Trentham in New Zealand were comparable to but a trifle better if anything than those prevailing in the camps at Sling, Bulford and Codford, during the winter of 1914.

The general health of the troops in Trentham cannot be said to have been good during the period under consideration. The total number of cases of illness of any description requiring hospital treatment from the opening of the camp up to July 22nd, was 2813 with 33 deaths, a mortality of 1.16 per cent. of the sick. In all some 13,607 men had passed through or had occupied the camp in the period, and taking the mean population of the camp as 4,500 men, the annual mortality of the soldier population, very crudely considered, approximated to seven per thousand. The annual death rate of the civilian population of the comparable class, males from 21 to 45, the arm-bearing population, for the previous 5 years in the Dominion averaged a little over five per thousand per annum. But considerable improvement in sanitation followed the inquiry: adequate drainage, good roading and acceleration in the building of the hutments soon improved matters. The Trentham Commission recommended that not more than 30 men be allotted to each half hut allowing 51 square feet of floor space to each man, and that the total camp population should not exceed 4000. A permanent P.M.O. was appointed to the staff of the Camp Commandant, Lieut.-Col. Moris, N.Z.M.C. took over the duties in July. Material assistance and valuable advice was given to the military authorities by a medical committee consisting of civilian doctors set up to act as an advisory board. In these deliberations, the New Zealand branch of the British Medical Association played a strong part.

Four new medical units were formed in New Zealand in the first year of the War:—"B" Section of No. 2 New Zealand page 72Field Ambulance, still in training at Trentham; Numbers 1 and 2 New Zealand Stationary Hospitals; and No. 1 New Zealand Hospital Ship Maheno. As the result of representations made by General Godley with regard to the necessity of establishing in Egypt a New Zealand hospital manned by representative New Zealand surgeons, the Defence Minister, Colonel the Hon. J. Allen, T.D., authorised the formation of the first New Zealand Stationary Hospital, which was accepted by the Army Council in April, 1915, with instructions that it proceed to Egypt. The personnel was drawn from the N.Z.M.C. of districts. Lieut.-Col. D. McGavin, N.Z.M.C, P.M.O., of the Wellington district, was selected to command the unit; he was at that time the senior major on the New Zealand army list, had seen service in South Africa, and had at one time commanded the Wellington Bearer Company. The officers were drawn from the N.Z.M.C. exclusively, several of them had active service experience and were territorial officers of some standing and prominence. They were a strong team surgically and medically; the majors, Acland and Wylie, surgeons of distinction, the former becoming at a later period consulting surgeon to the N.Z.E.F., and the latter O.C. No. 1 N.Z.G.H. at Brockenhurst in 1916. To the unit were attached an ophthalmologist and a dental surgeon, the latter acting as quartermaster. In all, seven officers, and 86 other ranks embarked on the N.Z.H.S. Maheno on the 20th May from Wellington, with orders to report for duty to the Imperial military authorities in Egypt. 31 ladies of the New Zealand Army Nursing Service were also embarked for service in the Imperial hospitals.

Up to May 2nd 7,928 sick and wounded of the N.Z.E.F. who had been evacuated from the Dardanelles were, or had been, under treatment in various hospitals in Egypt, Malta, and England so that the offer of a second stationary hospital from New Zealand was gratefully welcomed by the Army Council. Hurriedly mobilised, No. 2 New Zealand Stationary Hospital sailed for Egypt on the 13th June, 1915. The unit comprising 8 officers, 87 O.R. was under the command of Lt.-Col. Parkes, N.Z.M.C, P.M.O. of the Auckland military district. Like number 1 New Zealand Stationary Hospital it was well staffed as a surgical team: the Senior Field Officer, Major Savage, N.Z.M.C, was an eminent Auckland surgeon, whose untimely death from C.S.M. shortly after landing at Alexandria robbed the unit of its most brilliant member.

The No. 1 New Zealand Hospital Ship Maheno was staffed by 7 officers, 61 O.R. and was commanded by Lt.-Col. the Hon. W. E. Collins, V.D., N.Z.M.C. Reserve, one time a very active and page 73industrious P.M.O. of the Wellington district, to whom the corps was much beholden in 1905 and the years that followed. The Maheno sailed in May: we shall find her at Anzac in September.

The 5th Reinforcements, nicknamed the "Fighting Fifth" were now well on their way to Egypt—July, 1915—and went into camp near Cairo prior to re-embarking for Anzac on the eve of the August fighting. The Pont de Koubeh hospital accommodated at this time some 300 sick and wounded New Zealanders, and was under the command of Major J. Powell, R.A.M.C., with, as registrar, Major W. Byam, R.A.M.C., who was later known by his work on trench fever. Certain N.Z.M.C. officers were attached to the staff as early as April, 1915. including the late Hon. Lt.-Col. Batchelor, N.Z.M.C., who took a very active part in promoting the early formation of the New Zealand stationary hospitals, as he realised the need of New Zealand hospitals for New Zealanders.

When the Anzac force left Egypt Lt.-Col. J. R. Thomas, N.Z.M.C. commanding the New Zealand Mounted Field Ambulance was appointed by Surgeon-General Ford, A.D.M.S. to the New Zealand and Australian Training Depot at Zeitoun, then 500 strong. Under him were several N.Z.M.C. officers of the reinforcements, and a number of N.Z.M.C. dental surgeons whose services were much in demand everywhere in the M.E.F. Later, when the New Zealand Mounted Field Ambulance was engaged in ambulance transport duties, in June, Major Mathew Holmes, N.Z.M.C. was appointed A.D.M.S. of the New Zealand Base. His appointment was confirmed by General Godley with temporary rank at Lt.-Col., but Holmes relinquished his duties in July at his own request, and proceeded to Anzac. He was succeeded as A.D.M.S., Base, by Lt.-Col. P. C. Fenwick, late D.A.D.M.S. of the New Zealand and Australian Division. A.D.M.S. New Zealand Base inspected the No. 1 Stationary Hospital on July 1st, They were newly arrived at Port Said. Lt.-Col. McGavin had at his disposal one house, formerly a school, 25 square E.P. tents, and some huts for messes and recreation room, but was short of equipment: what he had brought from New Zealand had been over-carried to Bombay. By the middle of the month the accommodation of the hospital was increased from 200 to 500 beds. A batch of 157 patients was transferred from the Egyptian army hospitals: 6 nurses and 3 motor ambulances were provided.

On July 22nd No. 2 New Zealand Stationary Hospital arrived after landing Major Savage, N.Z.M.C, suspect C.S.M., at Suez. Lt.-Col. Parkes was ordered to take over the Pont de Koubeh Hospital from Major Byam, R.A.M.C., then commanding. On July 27th, Major Savage was dangerously ill. He was seen by Sir David page 74Semple and Sir Victor Horseby but he died on the 28th. By his death the N.Z.E.F. lost an eminent surgeon and one whose known ability must have fitted him for a leading part in the future operations of the N.Z.M.C.

Serving the two New Zealand hospitals now established in Egypt, there was a convalescent home of 50 beds at Alexandria in the Mustapha district, controlled by Lady Godley. The staff consisted of a nursing sister and a few orderlies—"B" class men from the base depot at Alexandria. It was visited daily by a R.A.M.C. officer. The house was a fine one in a big garden and very comfortably furnished; discipline was strict; the feeding arrangements excellent; it was a well run establishment doing valuable work.

We have seen that many New Zealand sick and wounded had been transported in hospital ships as far as England. Some sort of a base for Anzac troops existed at Weymouth early in 1915, but as yet no New Zealand base. In order to provide for the New Zealand casualties reaching England at this time, the New Zealand War Hospital was opened at Mount Felix, Walton-on-Thames, on July 31st, 1915. The funds necessary for its initiation had been raised in England by New Zealanders with some help from the Dominion, but without any appeal made to the British public. Dr. Bernard Myers, M.D., a New Zealander practising in England, was the first medical superintendent, and the chief controlling and supporting body was the New Zealand War Contingent Association, of which the chairman was Lord Plunket, ex-Governor of New Zealand: a society destined to play a very felicitous part in promoting the welfare of the sick and wounded of the N.Z.E.F. quartered in or visiting the Home Land.