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

Chapter VI. The Evacuation of Gallipoli

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Chapter VI. The Evacuation of Gallipoli.

During the beautiful autumn months of September and October, although old Anzac and its shell-haunted beach still retained its grim character, in the main, "greater" Anzac was a spent volcano. The Dardanelles Campaign had become of secondary importance in the opinion of those in authority in England; all efforts were at present bent in preparing for the big Loos offensive due to commence on the 25th September. No great addition to the Gallipoli Force could be made until after that offensive had taken place, it was possible only to send small reinforcements so as to enable Sir Ian Hamilton to maintain his positions, his army acting as a containing force for the Turkish Army so protecting Egypt or Townshend's Force in Mesopotamia, now nearing Kut, from further aggression.

The first move in the new programme was the relief of the Anzac troops who were, by now, non-efficient as a fighting force mainly through sickness and exhaustion. The Second Australian Division came in to relieve; the 54th East Anglian Territorials, took over our positions north of the Aghyl Dere; the 13th Division —what was left of it—rejoined the 9th Corps at Suvla. These moves were not completed until the 10th of September by which time the remnants of the New Zealand and Australian Division were resting in Lemnos. The rest was most urgently needed. The strength of the two Infantry Brigades, nominally 4000 each, had fallen, in the case of the New Zealand Brigade to 1050 on the 12th September, while the 4th Australian Brigade numbered only 875. General Russell, whose mounted rifle command of four regiments had totalled 2000, could now muster only 200 officers and men. The New Zealand Field Ambulance had dwindled to 5 officers, 82 O.R., and they had received 4 officers, 50 O.R. reinforcements since landing. Most of the R.M.O.'s attached to the Brigades were casualties by wounds or sickness.

That this wastage was not wholly due to fighting is evidenced by the fact that the New Zealand Field Ambulance admitted 1693 sick and 1435 wounded during the month of August. The sickness wastage had been extraordinary: at the end of August page 108nearly 100 per thousand per week. The strength of the Australian and New Zealand Corps in the first week of September was 25,175 officers and men, of whom 98 officers, 2194 O.R. were evacuated sick during the week; a wastage at the rate of over 90 per 1000 per week. The average losses by sickness at this time in one of the Armies in France averaged rather less than five per 1000 per week. The hurried movements of troops, the congestion in the Dere with it's attendant fouling of the ground and the lack of a sustained sanitary effort—almost impossible to maintain during periods of severe fighting—all lead to a dissemination of diseases already over-prevalent; while the exhaustion and physical deterioration of the men rendered them much more susceptible to infection. The following extracts from R.M.O.'s reports of the period are expressive. The R.M.O. of a New Zealand Battalion writes:—"There is much enteritis amongst the men of this battalion, many of them come to me in a collapsed condition from strain and overwork. The men are very willing, but they are quite unfit for more work just now." Here is another extract from the report of an R.M.O. of an Australian Light Horse Regiment: "With reference to the health of the troops of this regiment, I have to report that during the last few weeks there has been a high proportion of sickness accompanied by rises of temperature. Some of these may be influenza, but some are suggestive of early typhoid of which the numbers are increasing. So far I have had no notification of this disease amongst the men except by rumours from the base retailed by men returned from Mudros. The M.O. should be advised of any such cases, for in the present low state of health of the troops and the conditions of life in the bivouacs, the appearance of typhoid in epidemic form is to be feared, and stringent measures would be necessary to check this disaster." The epidemic had already broken out: a notification was sent to this R.M.O. of two cases of "enteric" in his regiment on 22nd August, 1915, a few days after his report went in. Daily notification of large numbers of "enteric" cases were reaching the A.D.M.S. from the base; the disease was disseminated throughout all units of the division. Early notification of bacteriologically diagnosed infections disease was not possible at Anzac as we knew it in France: many of the cases were not definitely diagnosed until some time-after they had reached remote hospitals in Egypt or Malta. A Bacteriologist with a mobile laboratory was in contemplation, but the suggestion of establishing such a laboratory on Anzac was for a variety of reasons never carried into effect.

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Obvious signs of war weariness were also noted by observant medical officers. One R.M.O. notes in his diary after a tour of inspection of his trenches: "The men have lost their old keenness for sniping and observing. They lie about the trenches taking little of their old interest in the business of fighting." Not only the medical officers but the combatant officers were keenly alive to this paralysing wastage. The following report from Brigadier General Monash is a lucid commentary on the position. He addresses the New Zealand and Australian Divisional Headquarters from Australia Valley on 17th August, 1915:—"I am becoming seriously alarmed at the persistently adverse reports made to me by the Regimental officers of the brigade as to the physical condition and health of the troops. Evacuations for sickness which could not be treated in the lines amounted to 150 in the last four days, and are daily on the increase, the principal complaints being tonsilitis, bronchitis and dysentery. There are also many sick men, not evacuated, who are set aside for light duty but are really not to be counted upon in an emergency. The medical officers also state that the physical fitness and powers of endurance of the personnel not actually reporting sick are much below normal. I should be glad if the A.D.M.S. could be asked to make a thorough investigation into the health conditions of the brigade with a view to advising what steps are possible to restore its fighting efficiency." A very striking report from one of the medical officers of this brigade is worthy of perusal. "The sick parade this morning numbered 42, of these 31 are not in a state to be depended upon as fighting men in any emergency, they are mostly incapable of any form of exertion. In the trenches I notice that many of those who used to be the keenest of our old hands now seldom shoot or observe; they have reached the stage of absolute indifference." This R.M.O. goes on to describe the condition of one young soldier in his battalion, now recognisable as a typical picture of War Neurosis, a term as yet unknown at Anzac. "Private … aged 18 undersized, was in one attack on the afternoon of the 26th [Hill 60]. He went forward with his platoon commander and 10 men. They took cover under a hedge" [probably the boy's statement] "the officer told them to fire a few rounds but private… could not discharge his rifle, nor even put it to his shoulder; he was told by his officer to crawl back, which he did. On the evening of the 28th his pulse was 120 his temperature 100 degrees. He could not walk in a straight line, he had violent trembling of the whole body with twitching. He was holding both hands tightly clenched together and on making page 110him loosen them they both shook violently. He cannot sleep, every shot makes him jump or twitch; he says he can never face fire again. This boy may be called a coward, but it is to be noted that he advanced under heavy machine gun fire and did not retire until ordered. I believe his nervous system, like his body, weak in the first place, has been permanently shattered."

Every effort was being made in August to check wastage by the establishment of "rest stations" in the ambulances. In the loose terminology of the time these rest stations were described as hospitals, whereas they were of course anything but hospitals. At the very best they offered only a few bell tents, the sick man brought his own blanket, great coat and ground sheet; an extra blanket was found by the ambulance. In some instances a stretcher was provided but the majority lay on the ground previously levelled to make a platform. Sir Ian Hamilton in his Gallipoli diary gives a pen picture of a C.C.S. at Helles, in July. "Walked through the different wards talking to some twenty officers and 200 men; mostly medical cases. Do not think things at all up to the mark. Made special note of the lack of mosquito nets, beds, jayamas and other comforts…. Too bad, when so much money is being spent, to see men lying on the ground in their thick cord breeches in this sweltering heat, a prey to flies and mosquitoes." Conditions were similar at Anzac in the ambulance rest stations but the medical unit were compelled by the instance of the military situation to retain every man possible on the Peninsula because once evacuated from the beach the soldier was lost to his unit indefinitely. It was necessary to return to duty men who were obviously not fit, in order to conserve the rapidly dwindling strength of Anzac. In their efforts the medical officers were often aided and abetted by the spirit of the men who, although not really able to carry on much longer, hoped to "stick it out" for the sake of their comrades, as every evacuation meant extra work for somebody: this, more especially in the case of officers.

There seems to have been some real difficulty in obtaining sufficient drugs and comforts towards the end of the month. Lieut. Sandham, Quartermaster of the New Zealand Field Ambulance reports to the A.D.M.S at the close of August as follows:—"I beg to point out that I have requisitioned every day for the last three weeks for arrowroot, cornflour, meat extract and brandy. The brandy I have been able to obtain only in very small quantities while the cornflour and arrowroot I have been unable to get until to-day, when I received six pounds of each. Meat page 111extract is unobtainable. I have not been able to supply the regimental officers with these comforts." The A.D.M.S., Colonel Beeston A.M.C., sent a message to Anzac Headquarters on the 31st of August, of which the following is an extract:—"Medical comforts are not forthcoming and, we are informed, will not be available for 14 days. Can anything be done to expedite supplies, as without them there will be a great diminution of strength?" A previous message reads:—"Medical officers cannot obtain a supply of simple drugs such as castor oil, salts, bismuth, from the advanced supply depot of medical stores, in consequence many cases of sickness, especially dysentery cannot be treated here." As against these complaints we must set in the balance certain considerations:—(1) The extraordinary amount of sickness prevailing, far exceeding anticipated requirements of drugs and comforts. (2) The fact that R.M.O.'s were drawing medical comforts in large quantities for the use of the battalion sick. And this somewhat against the better judgment of the A.D.M.S., who frequently recommended moderation in these demands, and ultimately directed that all such supplies should be drawn from the field ambulances and not from the advanced supply depot, with the counter signature of the A.D.M.S.; as heretofore. (3) Transport difficulties which were undoubtedly great: even ammunition, so essential to the operations, was not obtainable in sufficient quantities. Of the bombardment on Hill 60 on the 27th Sir Ian Hamilton says:—"It was the heaviest we could afford." In the ambulances, at least, there was no real shortage, as a statement of receipts and issues of the N.Z.M.B.F.A. for the last fortnight of August shows. The total amount of comforts issued to the unit for the period was as follows:—Arrowroot 8 lbs.; brandy 3 pints; cornflour 13 lbs.; cocoa 4 lbs.; candles 4½ lbs.; milk 238 tins; meat extract 7½ lbs.; rice 14 lbs.; sugar 115 lbs.; eggs 18 doz. Assuming that the 40 sick they were nursing were able to utilise some portion of the ordinary ration drawn for each sick man retained in the ambulance, the allowance for light diets seems generous enough. As regards the shortage of drugs, this was only temporary although it had nothing to do with the alleged orders of General Birdwood issued against excessive indulgence: "lest castor oil on Gallipoli should become the Australian national drink." All necessary drugs including emetine, were procurable at the end of the month. The question of the drug shortage is referred to in the final report of the Dardanelles which states:—"There does not seem to be any complaint as to the supply of medicine except in the case of page 112Australian and New Zealand troops, who were said to be short of the ordinary medicines, especially castor oil, and of the variety of food required for men suffering from illness. There is no dispute as to the fact that, at one time, the supply of castor oil ran short, the explanation put forward being that the supply was sufficient to meet ordinary demands, but that for some reason these troops required and consumed more drugs than the normal supply. This is probably correct, for there are no complaints of a lack of things in any other quarter."

That the rest stations did some good there can be no doubt. The New Zealand Field Ambulance, after arrival in the Chailak Dere, admitted to its rest station 94 patients of which 23 were discharged to duty and 28 evacuated, leaving 43 remaining under treatment at the end of the month. Yet the temporary relief which the debilitated soldier had obtained was quite inadequate to his needs.

The causes leading to the abnormal sickness wastage, which had material effects in determining the failure of the expedition and which was a characteristic of the whole campaign, in which more men were lost through sickness than were evacuated for wounds, may be considered from a variety of angles. The climate, almost sub-tropical during the summer, was an important factor. One of the first of the predisposing causes to be considered is the clothing of New Zealand and Australian troops. Nothing indeed could have been more primitive than their garb: a battered slouch hat, the red band of the pugaree, where it survived, faded to a pale apricot colour, a pair of shorts, daily growing shorter, worn inside out as a necessary precaution against lice infestation of the seams, putties and boots, an identity disc and a first field dressing completed their get up. The skin in most cases tanned a coppery brown from excessive exposure to the sun, the knees very often bandaged to cover up abrasions which became ulcers that refused to heal. Excessive insolation of the skin is, in all probability, injurious to white troops in the field, however beneficial it may be when used therapeutically in the treatment of localised tuberculosis in the high lands of Switzerland. In warfare the "shorts" and the kilts, however attractive, have this great disadvantage that they leave a large area about the thighs and knees exposed to all sorts of minor injuries with consequent infections which are disabling. It is said that a French General in command of British troops in the near east forbade the use of shorts not for hygenic reasons but because he considered them indelicate! Here, then, in the scanty clothing of the New Zealand page 113troops, was a predisposing cause to the prevailing sickness. Campaigning in such a climate for troops not seasoned to the tropical summer was prejudicial to their health. Not only was the clothing inadequate but the food and the feeding of the troops was unsatisfactory. There was much discussion then and afterwards on the subject of rations: that the issue was not suited to the climate; that there was too much meat and too little bread; that the sample of bully beef issued—Fray Bentos—was too salt and too stringy; that there was an insufficient supply of fresh vegetables and fruit; that canteen stores could not be purchased. On all these matters much evidence was given by officers of the division before the Dardanelles Commission— General Godley; Lieut.-Col. Begg, N.Z.M.C.; Lieut.-Col. B. Myers, N.Z.M.C.; Lieut.-Col. P. C. Fenwick, N.Z.M.C; and others. It was shown that many of the men attributed the diarrhoea to eating bully beef of the brand named. In the final report of the Dardanelles Commission the opinion is expressed that—" there was nothing actively injurious to health in the meat; but it was of poor quality, and, from being salt and stringy, it caused some intestinal irritation and so conduced to diarrhoea It must be remembered that the Australian and New Zealand troops had been at Anzac when the hot weather began, continually in the trenches, and without proper opportunities for rest, and that their energy and activity had been overtaxed. They were, therefore, very liable to ill-effects from food unsuitable to such weather." All shipments of preserved meat on issue to troops were subjected to close inspection and analysis by the Public Health Authorities in London, and it must be said in favour of the Fray Bentos brand that it was a favourite in France in '14 but, however palatable in a temperate climate, any form of tinned food becomes distasteful in a semi-tropical summer unless ice is available. A passage in Owen Butter's Tiadatha descriptive of the Balkan summer is vividly reminiscent:—

"All day they lay and simmered,
Stuck a blanket up for shelter,
Spent the sultry morning thinking
Of the things they would have given
For a long sweet draught of cold beer,
Bass or Worthington or Allsopp,
In a long cool lager beer mug.
Sighed and drank some tepid water
Ate some squishy-squashy bully
Moist and warm and very nasty."

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It is questionable whether any alterations in the dietary—and some were made—could have improved the sanitary situation. The baneful system of individual cooking, then prevalent, would have ruined any ration however good; every man cooked for himself, every dug-out bceame a midden of fly contaminated food and food refuse. When the soldier should have been resting he was engaged in predatory expeditions in search of water and fuel for his kitchen, and when the final product of his cuisine was consummated, it, no doubt, was highly indigestible, however appetising. The individual kitchen was wasteful of energy and rations; its products too often a breeding or feeding place for flies. The large open latrine was a stone's throw away on the crowded hill side, and from kitchen to latrine there was much coming and going all day by the swarming hosts of winged enemies.

Of flies there was more than enough, and of many kinds. Lucilia Caesar, the green bottle fly was most numerous in the vicinity of the trenches; it bred in the dead bodies lying in No Man's Land. One of the favourite sights of the Apex, reserved as a rule for "new chums" was a periscopic vision of the body of a Turk lying not too far from the parapet completely wrapped in a write shroud of living maggots, larvae of Lucilia Caesar. It came to be known in 1916, by Wenyon's experiments reported by Stitt and Balfour, that Lucilia and the Caliphoroe green and blue bottle flies, were carriers of amoebic dysentery, and that after feeding on human dejecta, which were known to contain cysts of Entamoeba Histolytica, the excreta of the flies were found to be teeming with such cysts. Can it be doubted but these flies were actively disseminating one form of dysentery, the amoebic type. Further, the house fly was noted to be breeding quite freely in human dejecta: it was found by experiments carried out by the Indian Ambulance attached to Cox's Brigade that in the shallow trench latrines flies bred to perfection, the earth covering the small trench (3x2x2) being carpeted with larvae at the end of a week after filling in; even spraying the contents, before covering, with 10 per cent. Cresol solution did not seem to be a deterrent. Typhoid fever and the paratyphoid fevers with the various types of dysentery certainly could be propagated by flies bred under these conditions. Other fly breeding places were the mule lines and the manure heaps at the foot of the Chailak Dere. Incineration of the mule manure was well done by the Indians S. & T., after the methods practised in India—drying and burning in specially constructed heaps— at least during the dry weather. When rains came it was no longer possible to incinerate. There was much manure, much refuse page 115everywhere in unexpected places, the wreckage of the August battles and the hurried movements of troops by night. So far the requirements of defence, the exhausting labours involved in the digging of deep trenches and communications had left no time or energy to the tired troops to clean house or to organise conservancy. A new and very large area had to be assimilated, the frontiers defined or delimited by the bayonet, the defences secured before the necessary work of dealing with the sanitary problem could be taken in hand. Improper clothing, inadequate feeding, much exhausting work, little sleep, were the predisposing causes to sickness; the determining causes, fly-borne infection, over crowding, direct contact, and dissemination by carriers. Amoebic dysentery was known to be endemic in the civil population of the Gallipoli Peninsula prior to the war, due to water-borne infection; certainly, malaria and phlebotomus fever or sandfly fever, were common in certain villages; and malaria existed amongst the troops at Helles but was not recognised, if it existed at all, at Anzac. Sandfly fever, however, was fairly prevalent in the autumn. Typhus fever, although not uncommon among the Turks, happily did not afflict Anzac and, as this disease was later proved to be lice-borne, it was a providential immunity to a population almost universally lice infested.

Now that there was breathing time and fresh troops to man it, Anzac was to be put through an intensive course of supervision and sanitation. The dietary was the first consideration as the following documents show. The first is a letter from General Godley addressed on 10/9/15 to Anzac Headquarters in which he says:— "In connection with the health and general want of spirit of the troops of this Division I am convinced that the monotony of the diet is a factor largely responsible. The brands of preserved meat issued, particularly "Fray Bentas," quickly become unpalatable and the men prefer to do without meat rather than eat it. The meat is coarse in fibre, non-nutritious and too salt; in comparison with that obtainable from Australia and New Zealand, it has no place. I recommend that preserved meat of varied kinds, beef, roast and corned, roast mutton, sausages and tongues, etc., be obtained from the leading firms of the Commonwealth and Dominion. I also strongly recommend the establishment of a canteen where the men could purchase food of a variety suitable to their particular taste. Any expense incurred would be more than recouped in the improved health and morale of the men." To this letter Corps replied:—"All the points raised by you in your memorandum of the 10th instant have been and are under page 116anxious consideration of the Army Corps Commander. A special Commission visited Anzac recently and has submitted a very exhaustive report dealing with the subject of diet, and I understand that General Headquarters is taking action to carry out the proposals submitted to them as far as possible." This memorandum is signed by Colonel N. O. Knox, A.S.C., A.Q.M.G. of the Corps, who had previously been on General Godley's Staff in New Zealand and had organised the N.Z.A.S.C. The Special Commission referred to had been sent out from England to investigate and to revise the dietary. The question of canteen ships is an important one. It is a known proposition in dietetics that a ration however good, ceases to have full nutritive value if it is adhered to so closely as to become monotonous or distasteful. Appetite is so much a question of psychology, where daily food is available, and digestion and assimilation so dependent upon appetite that food, if it is to maintain normal nutrition, must be varied at least occasionally. Condiments are an essential ingredient in a well balanced dietary, not in themselves in any way nutritive, but acting as stimulators of gastric and pancreatic secretion and in some way, as yet not determined, as activators of the processes of metabolism. It would appear that no application for canteen ships was made before the end of May and that when the first ship—financed out of the old South African War Canteen Funds—arrived about August and some sort of a canteen was established at Imbros, supplies were so limited that the Anzac troops could obtain only very small quantities at a time. Condiments were of course much in demand, as they were not provided for in the rations; a singular omission, as the Japanese in their war in Manchuria were careful to supply—no doubt on the advice of hygienists—the sauces, pickles and condiments now agreed to as essentials to a balanced dietary. Condiments were never asked for by G.H.Q. It was the opinion of the Dardanelles Commissioners that had canteens been made available earlier there would have been a reduction in the sickness.

A very active sanitary commission organised in England in July had been sent out to the near East to advise General Baptie, V.C., P.D.M.S. on matters concerning the health of troops in Egypt and the Dardanelles. The Commissioners: Colonel W. Hunter, A.M.S.; Colonel Balfour, R.A.M.C.; Lieut-Col. G. S. Buchannan, R.A.M.C., of the London Board of Health; and Lieut.-Col. L. S. Dudgeon, R.A.M.C., Pathologist to St. Thomas' Hospital, in one of their earliest reports, (Cairo, August 10th) wrote as follows:—"We were struck by the severe type of enteric fever page 117found amongst the cases that have been inoculated in New Zealand. We have been informed that these inoculations had been made with a vaccine prepared from a culture obtained from a bone abscess of some fourteen years duration, i.e., an enfeebled strain of organism, and had given rise to little or no reaction. We therefore recommended that it would be a wise precaution to reinoculate the New Zealand troops with a stronger vaccine such as that issued by the Home Army." Because of this the reinoculation with Army T.V. of the New Zealand troops at Mudros was started at the end of the month of September. Of the controversy that ensued as to the validity of the New Zealand T.V. inoculation we shall speak later, suffice it to say that the preventive measure was considered necessary by competent authorities at the time.

Towards the end of September the first sanitary section was formed by the New Zealand and Australian Division. The earliest sanitary sections appeared in France about April, 1915, they were the First and Second London Sanitary Sections, Territorial formations, sent out originally to fill the place of the Sanitary Sections on the L. of C. whose duties are defined in F.S. Regs part I. Chapter 9 See. 85. Besides their duties on the L.O.C. these units were doing a lot of necessary work in looking after areas just behind the line that had no settled sanitary control. Sanitary sections were not part of the original establishment of the Regular Army but became a part of a Divisional Composition in August, 1915. The New Zealand and Australian Sanitary Section was organised to supervise the cleansing of the unallotted areas, the miles of roadways, beaches and communications that had no definite military sanitary control; cleanliness of the public thoroughfares was the first consideration and the erection of public conveniences. The men of the sanitary section, 21 in number, were not, at first, drawn from medical personnel, there was none to spare; they came from the Australian Light Horse and the Infantry, and were quite untrained, so that a course of instruction had to be arranged.

At Mudros, where the New Zealanders were in rest camp at Sarpi, there was a serious shortage of N.Z.M.C.: so many had been evacuated sick at the latter end of August the two New Zealand Ambulances could muster only 7 officers and 74 men. Inoculations with the R.A.M.C. vaccine, T.V., were proceeding; the site selected for injection was a few inches above the olecranon process of the left arm which was found to be preferable to the abdominal wall site previously used in New Zealand. A small page 118isolation hospital was established for scarlet fever and diphtheria, prevalent amongst the reinforcements. Early in October a medical inspection of men of the Mounted Brigade and their newly joined reinforcements showed that of the Anzac survivors 30 per cent. were B2 and that out of the Reinforcements:—21 were classed B2, 6 classed "C" by reason of minor disabilities, such as flat foot, old injury to knee joints and cardiac disorders. There was a severe outbreak of diarrhoea amongst the 6th Reinforcements shortly after arrival at Mudros, attributed to drinking bad water, undue consumption of unwashed fruit, fly-borne infection of food. Many of these cases presented dysenteric symptoms, the passage of blood and mucus, so that they were treated with emetine, grs. 2/3, followed by one grain hypodermically every other day with good results, in some cases. A certain number had to be evacuated to hospital. The use of emetine hydrochloride in amœbic dysenteries had been ordered by D.M.S.'s instruction dated 22nd August, 1915; at first there was no supply available at Anzac but early in September the drug was in use. At this time the army knowledge and practice in the recognition and treatment of the dysenteries was in a process of evolution. It was certainly believed to have been proved, at this time, that 60 per cent. of the dysenteric diarrhoeas of the Peninsular were amœbic in origin (O'Connor), so that in 1915 the drug, emetine, was extensively used in the treatment of the disorder with variable results; some deaths were recorded and attributed to the drug on evidence that is not absolutely convincing. At a meeting held at Alexandria on October, 17th, 1915, Lieut.-Col. Sir Ronald Ross, I.M.S., recommended the combined use of emetine and powdered ipecacuanha by the mouth and reported that 14 per cent. of the cases of chronic dysentery in British troops in India developed hepatic abscess. Major C. J. Martin, A.M.C., Pathologist to No. 3 Australian General Hospital at Mudros West, summed up the matter in a contemporary report;— He says: "From the latter part of August, 1915, to the end of September the prevailing type of dysentery in this hospital and among patients from neighbouring hospitals whose stools were sent to the laboratory for examination was amœbic. Early in October, however, it became evident, from the examination of stools, that bacillary dysentery was becoming more common than amœbic; and cases of the former disease began to find their way to the postmortem room. The variety of dysentery bacilli isolated from stools, and from the cadavers has been with one exception Shiga bacillus."*

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Up to the end of September affairs at Anzac remained quiescent. About the 23rd Colonel Beeston, A.M.C., the A.D.M.S., was evacuated with symptoms suggestive of hepatic abscess. In Anzac, since the landing, he had commanded the 4th Australian Field Ambulance with distinction until he replaced Lieut.-Col. Begg, N.Z.M.C., as A.D.M.S. of the Division in August. He was succeeded by Lieut.-Col. Tate Sutherland, A.M.C. O.C. 3rd Australian Light Horse Field Ambulance; Captain Dawson, A.M.C. was acting D.A.D.M.S. at this time—the 5th Officer to hold the appointment since the landing. About the end of the month a new kind of bomb introduced by the Turk and emitting evil smelling fumes suggested the possibitily of his using gas; unusual sounds were heard in his trenches which were interpreted as having some relationship to an impending gas attack. Fresh instructions were issued with regard to gas precautions and instructors were brought over to lecture the troops. The respirators in use at the time consisted of a veil with a cotton waste pad impregnated with anti-gas chemical. There was also a limited issue of "P" helmets made of flannel and fitted with non-inflammable cellulose windows. Both were stated to give complete protection against chlorine. Knapsack sprayers with sodium thiosulphate and washing-soda solution were provided for use in the trenches. A languid interest was taken in this instruction, but gas precautions were never effectually organised at Anzac. The wind was mostly westerly, Turkwards.

Towards the end of October some early indications of the onset of winter, occasional gales with colder nights, stimulated the preparations for the wintering of the troops. Rain fell on the 22nd, and the temperature dropped, but the weather otherwise was fine and warm.

The fall of Serbia and the retreat of the Russians from the Brest-Litovsk line were unfavourable to Anzac. Lord Kitchener's message was to dig in as there was no present intention of evacuating, but it was apparent that the Turks were receiving better ammunition than heretofore, as by the defeat of the Serbian Army the railway was now opened from Nish to Constantinople. Sir Ian Hamilton had been recalled to England; the D.M.S. Surgeon General Birrell bade his farewell in September; General Godley was temporarily commanding the Corps; General Birdwood commanded the M.E.F. until relieved by General Munro, who visited Anzac on the 30th. The gales of October washing away our piers and wrecking the lighters, so as to render communications with the shore or the landing of troops impossible for page 120a time, made it clear that our tenure of the Anzac and Suvla positions was imminently precarious and might end in disaster. Already the Government were calculating the cost of evacuation, General Munro strongly recommended it as he held that the position had every military defect, but Lord Kitchener still favoured digging in and hanging on, as the operations were holding up some 200,000 Turks. The centre of interest had shifted to Mesopotamia and Salonica.

Affairs at the Base in Egypt at this time may be considered briefly. We have seen that No. 1 New Zealand Stationary Hospital was established at Port Said. It was at first used as a convalescent hospital and had 500 beds in August. The No. 2 New Zealand Stationary Hospital commanded by Lieut.-Col. Parkes, N.Z.M.C, had been constituted the New Zealand General Hospital by recommendation of the D.M.S. in Egypt, Surgeon General Ford: and, by an agreement between the New Zealand and Egyptian Governments, we took over the Pont de Koubbeh Hospital of the Egyptian Army with 612 beds opened in August Major W. Byam R.A.M.C, remained on as registrar, his pay at Egyptian rates being found by the Dominion Government. No rent was charged for the building.

A concentration camp for unfit men of the N.Z.E.F. had been formed at Suez. The necessity for this camp arose early in August. Men unfit for further military service were being boarded in hospitals and posted to various convalescent camps, but there was great difficulty in keeping in touch with these men: many were lost sight of for a time, to reappear only when a transport was due to leave for New Zealand. They now clamoured for return, but by this time no trace of their board papers could be found although they claimed to be permanently unfit. On the other hand many cases were boarded for return to New Zealand but could not be found when the transport was sailing. A concentration depot near the port of departure was required. Ultimately a camp for 600 unfit and invalid men was authorised by instructions received from the New Zealand Government and by 21st August, 1915, was established with Captain Tapper, N.Z.M.C., in medical charge. Invalids were still returning to New Zealand in large numbers: the Tahiti took 500 in August, the medical personnel consisting of 2 N.Z.M.C. officers, 12 O.R., 4 nurses; the Aparima, carried 100 venereal cases under 1 M.O. and 5 O.R., N.Z.M.C. But owing to representation made by our Defence Minister, that 25 per cent. of these venereal cases returned fit to New Zealand, and further the G.O.C. N.Z.E.P., Gen. Godley, page 121directing that convalescent venereal cases should be sent on as reinforcements, no farther evacuations to New Zealand by venereal infection were permitted. The A.D.M.S. in Egypt was recommended to enforce prophylatic and preventive measures.

The New Zealand Hospital Ship Maheno, Col. Collins, N.Z.M.C. in command, called at Anzac on 21st August and left for England on September 13th. She was inspected by Col. Howse, V.C., under instructions from Gen. Birdwood and the opinion formed on the ship is of interest to quote, as it comes from an impartial source. Col. Howse says in his report dated 30/8/15:—"I inspected the New Zealand Hospital Ship Maheno on August 27th. She has accommodation for 350 cot cases and 100 cases on deck. The staff, all specially selected, consist of N.Z.M.C. officers, 7; nurses, 14; other ranks, 61. She is well equipped with all the most modern fittings, having two operating rooms, X-ray room, laundry, isolation and observation wards. Many small comforts are provided for patients which one would only expect in a first class hospital ashore: for instance, there is a small library in each ward. The public of New Zealand subscribed £40,000 for the purpose of providing complete equipments and fittings adapted by New Zealand labour." Col. Howse finds some objectionable features: double deck cots which make surgical treatment and nursing exceedingly difficult; lack of single or double rooms for the use of very senior officers; that the quarters provided for N.C.O.'s and the men of the N.Z.M.C were inadequate.

Early in October No. 1 New Zealand Stationary Hospital was warned for departure overseas. General Godley had already applied to have the unit sent to Lemnos, but to his request there was no reply. Colonel Heaton Rhodes, the New Zealand Red Cross Commissioner, had also asked that the hospital might be sent to Mudros; he was informed that its destination was unknown. Ultimately it embarked at Alexandria on 19th October on the s.s. Marquette, with 8 officers, 28 N.Z.A.N.S. nurses, 9 N.C.O.'s., 77 O.R., total 122, in company with the 29th D.A.C., comprising 500 officers and men, 500 mules, and a quantity of ammunition. The Marquette was torpedoed on the 23rd when 60 miles from Salonika. She sank in 7 minutes with a loss of 18 N.Z.M.C., N.C.O.'s and O.R. and 10 N.Z.A.N.S. nurses drowned. The survivors were picked up after variable periods of immersion up to 10 hours, and carried to Salonika or to Egypt. The equipment, of course, was a total loss.

By the end of October the New Zealand General Hospital had admitted all the New Zealand sick and wounded then in Egypt page 122and had a bed state of over 700. By this time a total of 28,000 men had sailed from New Zealand in which total 95 officers and 1029 other ranks, N.Z.M.C., and 187 N.Z.A.N.S. were included. The casualties up to the 27th August, 1915 had been:—Killed, 1017; died of wounds, 451; missing, 638; wounded, 4327; P.O.W., 20; died of disease, 162. Total casualties:—5977; killed or died, 1630. The number returned to New Zealand up to 31st October, 1915, was 2000. The number of sick and wounded in hospitals in Egypt, Malta and England or elsewhere was 2,357. There were 10,000 men in the training camps in New Zealand where a new field ambulance, the 2nd, was in course of mobilisation.

By the 10th November, the bulk of the New Zealand troops and the 4th Australian Brigade had returned to the Division at Anzac looking much improved by their rest. The New Zealand Field Ambulance under Lieut.-Col. E. O'Neil, D.S.O., took up its old quarters above the Turkish bivouac in the Aghyl Dere; the N.Z.M.B.F.A. now commanded by Lieut.-Col. Murray, N.Z.M.C.— late Major in charge of Pope's Hill A.D.S.—established its M.D.S. near Chalk Hills but to the north of the old site occupied in August. Lieut.-Col. Begg, C.M.G., had returned to his appointment as A.D.M.S. relieving Lieut.-Col. Downes, A.M.C.—the 5th A.D.M.S. of the Division. One had been killed, one wounded, and 2 evacuated sick. Major Mathew Holmes, N.Z.M.C., was now acting D.A.D.M.S.

The return of the troops coincided with the visit of Lieut.-Col. the Hon. R. Heaton Rhodes, T.D., M.P., who had been sent out as a commissioner by the New Zealand Government to investigate conditions in the N.Z.E.F. in Egypt, Gallipoli, Mudros and Malta and to report to the Hon. the Minister of Defence at Wellington. After visiting the New Zealand Hospitals in Egypt and the New Zealand sick and wounded in Mudros and Malta, and after frequent consultation with the sanitary advisory committee, he came to Anzac and made a thorough investigation of conditions, sanitary and otherwise. He noted that the rationing had improved, that in addition to other rations fresh bread and fresh meat were issued three times a week besides rice and a small quantity of preserved milk. He found that there was a general demand for oatmeal as some of the combatant officers considered that this article of diet, when obtainable from warships, was very beneficial to the health of the men. He accordingly made arrangements for a supply of 20 tons to be shipped forthwith from New Zealand. The cheerfulness, patience and goodwill of this New Zealand Commissioner was very comforting and page 123helpful to all who came in contact with him, especially the sick, the wounded and the N.Z.M.C. officers both in Egypt, Mudros and Gallipoli. His report to the Defence Minister in Wellington published in appendices to parliamentary papers, Vol. 2.—19B., 1916, is a valuable commentory on the general conditions of the N.Z.E.F. during the Gallipoli campaign and a memorial of painstaking and intelligent endeavour. Above all his presence at the front in the trenches at Anzac made all alike feel that the people of New Zealand were fervently thinking of their men-at-arms overseas and bending every effort to secure their welfare and comfort.

The visit of the Sanitary Commissioners came a little later. Lieut.-Col. Dudgeon, R.A.M.C. was the first to arrive. He inspected part of the lines of the New Zealand and Australian Division occupied by the Australian Light Horse. His advice was to push on with the flyproofing of latrines and to enforce the chlorination of all drinking water. He noted a marked prevalence of gingivitis or pyorrhoea incident to a great extent in the older residents, considered by some to be an evidence of scurvy which certainly existed amongst the Indian supply and transport drivers at Anzac. For this dental condition which the Sanitary Commissioners believed to be a predisposing cause in gastro-intestinal disorders adequate dental treatment of drafts was strongly recommended. The provision of company kitchens and the abolition of individual cooking was another matter commented upon. All these measures, however, had already been under consideration and were strongly recommended by the local sanitary officers. Lack of material was one of the chief difficulties in completing the necessary sanitary work already in hand. Most units, had already, by force of circumstance, adopted the company kitchen. The need for greater economy in food and fuel was urgent. By now most of the scrub and the few olive trees originally on Anzac had been cut down for fuel or constructional purposes, so that it was necessary to make an issue of one pound of fuel daily per man. In most instances the type of kitchen adopted was the raised trench pattern with puddled clay and stone walls and suitable openings for kettles—as figured in the 1911 Manual of Military Engineering, plate 7—with small ovens ingeniously contrived of oil drums, kerosene tins and other heterogeneous metal containers. There was a chimney of biscuit tins, and in some kitchens a roof of galvanised iron—how obtained the C.R.E. had yet to learn—and a few sandbags for walls to close in the dug-out. In some instances a stock pot made from an oil page 124drum gave excellent returns in the shape of hot oxo and pea soup when tablets of these invigorating products became an issue in the colder weather. The fat of the ration was made into dripping to be used in lieu of butter in the best establishments, and a fairly palatable porridge of crushed biscuit was provided. During the gales of early November the flies became even more unbearable as they sought the refuge of the warm kitchens and dugouts. But lack of material for essential works, even overhead cover in the trenches, that is, in sufficient quantity, was a serious obstacle to he completion of the necessary work of sanitation. There were not even sufficient camp kettles to allow of a full issue to each company.

The much-to-be-desired fly proof latrines had not yet been universally adopted. Model latrines were erected in the dere by the sanitary section, but owing to the shortage of fuel any wood used in their construction soon disappeared—the troops even cut down for fuel the scrub which concealed them from enemy observation. Here was a real difficulty: any sort of timber was more precious than gold or even life. All the ration boxes which might have been used for flyproofing were used as fuel, the normal use in the field. The simplest form of improved latrine consisted of an oil drum with a movable fly-proof lid, as first devised in France early in 1915 by the London Sanitary Companies. They had two faults; the lid was movable, hence removed nightly; the lids were not self-closing. In certain places deep fly-proof latrines were constructed: that is, very deep broad trenches covered by planks and provided with movable lidded seats so constructed as to be self-closing. Substantially made, these deep trenches acted well and were moderately flyproof. As used in Egypt at a later date they had a serious defect that flies were able to breed in them, the larvae subsequently emerging, it is said, through six feet of sand. The only solution seemed to be incineration of the contents of the bucket-type of latrine; this again needed fuel. Nevertheless the persevering R.M.O. urged by the Sanitary Officer obtained some wood, by means other than those provided for in the Regulations, and when he found his wooden fly-proof covers vanished in the night, remade them with biscuit tin lids covered with sacking. Truly, as Sir Ian Hamilton says:—"Anzac was ever resourceful in the face of adversity."

The conservancy of the trenches themselves presented peculiar difficulties. In the Apex area certain readjustments of the trench system were forced on us by the certainty of heavier bombardments in the near future. An alternative front line had to be dug page 125close to the original, new saps and communications made, deep dugouts and shelters for the garrison provided. During the progress of these works, dead bodies were occasionally encountered, and sometimes a deep latrine wrongly sited or a filth trench had to be faced as the site must be included in the works. The ideal trench sanitation would preclude the possibilities of such unpleasant engineering difficulties. The presence of dead bodies is often impossible to obviate as the trench line develops automatically at the spot where the advance is held up with heavy casualties. Bodies become entombed in parados or parapet, or even in the trench itself if it happens to be deep and muddy as in the case of the ditches of Flanders in 1914, which in the struggle for Calais became at first a grave for the dead and later a shelter and a home for the living. Quick lime and cement were the only remedies for this kind of obstruction. It is otherwise with old pit latrines or filth trenches: in such ground the soil of the new work becomes contaminated by pathogenic organisms to a dangerous extent, disinfection is an impossibility and the certainty of infection of wounds suffered in such a locality is assured. The idealist in trench sanitation would ban all open latrines or filth trenches, between his front line and support lines; the area intervening should be ground undefiled by any such abomination. Of trench life in the Turkish lines we were able to gather a little information from a Turkish soldier who deserted to us about this time. Their food was very simple: in the morning at about 8 a.m. they had porridge made from barley grains; at midday there was cheese or on alternate days olives were issued as a relish to their barley bread; and in the evening white beans cooked with fat, or sometimes onions with a little meat: the daily ration of bread was 2 lbs. The porridge and the beans were stated to be unsatisfactory, but it kept them alive, and when the cold weather set in they had a ration of raisins in lieu of cheese. The deserter had seen coffee only once; tea was not used as they had no sugar, and unsweetened the beverage was not acceptable to the Turks. The orders were very strict about keeping trenches clean so as to ward off sickness: not even cigarette ends were permitted to remain, the trenches were swept out twice daily. Behind each trench was a small open latrine in which lime was used daily. There was only one doctor per battalion; slight cases were not sent to the field hospital but were looked after by the doctor; only very severe cases were sent to Constantinople. Iodine was reported to be very short—otherwise the doctor appeared to have plenty of medicines.

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The chlorination of drinking water recommended by the sanitary commissioners, was now strictly enforced, but owing to lack of experience there were some well founded complaints of evil tasting water. Certain initial difficulties had to be overcome, the chief being the provision of bleaching powder—a product which had not previously been used in the New Zealand and Australian Division. There was some confusion as to what was required, as chloride of lime had been an issue for water purification, but eventually a fair supply of the new preparation was discovered at the A.S.C. Depot. Again, there were no water carts of the new pattern—Ruston mark 4—which were not on issue to our division nor to any Australian troops at this time. Neither water duty men nor medical officers had any definite knowledge of the new method of chlorination. This was hardly possible as the process was a confidential matter even in France, and no official document dealing with the use of the cart had been issued. The old procedure of chlorination by chloride of lime and dechlorination by thio-sulphate was the only one taught to the troops who landed. Canvas troughs were originally provided for the purpose, but had ceased to exist except as issues on charge to battalions. The water duty men, perfunctorily trained in the first instance, and having no duties to perform, so they said, were rapidly absorbed into the R.M.O.'s medical establishment and became medical orderlies, dressers, or sanitary men. It became necessary, if chlorination were to be enforced, that these water duty details should be instructed in and encouraged to carry out the functions for which they were detailed. A new pattern water cart was kindly lent by a field ambulance of the 54th Division, a class was initiated and demonstrations in clarification and chlorination held. There was some show of ill will towards the new order of things, as the nursing of sick and attentions to the wounded seemed more honourable than water duties; however, all difficulties were eventually overcome and each brigade chlorinated daily in the 300 gallon tanks provided. The only danger in the provision of a pure water supply to the trenches —chance pollution in transit—was now eliminated. The water from the new wells opened up at No. 3 outpost was in all probability of very fine quality; there were no habitations in the vicinity to contaminate it, and it was otherwise well protected. But the handling at the large tanks where the water was piped into the Fantassahs for mule transport, offered some chance of pollution. Dust might have been introduced either at the principal reservoirs or at the smaller brigade tanks close to the line. All these dangers page 127now were countered and the water supply guaranteed in quality as well as quantity. The water at Anzac itself was brought from Mudros where chlorination in bulk took place. It was pumped into reservoirs on Plugge's Plateau and reticulated to various subsidiary tanks. The water question was a serious one at South Anzac: the daily consumption about 29,000 gallons and only four days' supply could be stored.

The last of the sanitary recommendations was:—The provision of dental prophylaxis. This had already been provided for by the A.D.M.S. who opened a "dental hospital" at No. 2 outpost, with four N.Z.M.C. dental officers, four mechanics, and essential equipment including the necessary apparatus for prosthetic work; and this apart from the dental work done by N.Z.M.C. dental officers attached to the Field Ambulances. New Zealand had certainly led the way in the provision of an adequate dental service for an Expeditionary Force and a dental hospital capable of carrying out any form of repair or mechanical work and the making of dentures and provided with cylinders of nitrous oxide gas and dental engines perched on a trenched hill side, cheek by jowl with a very noisy mountain battery, surely reaches the "limit" in front line dentistry.

But in spite of all this sanitary effort the last days of Anzac were again to see an orgy of sickness. In the cold snaps that came in October epidemic jaundice broke out amongst the garrison, the veterans mostly affected. The epidemic developed a very severe form in the middle of November, one case of icterus gravis, dying at the C.C.S. on the 13th. Epidemic jaundice of armies had been met with in most wars since Baron Larrey first described a jaundice associated with haemorrhages observed by him at Cairo during Napoleon's campaign in Egypt. The fatal case alluded to above was of this type, indeed, from the petechial haemorrhages, it was at first mistaken for a case of C.S.M., but a post-mortem examination showed that it was haemorrhagic icterus. Weil of Heidelberg gave his name to the disease in 1886 by describing an epidemic jaundice in Germany. During the South African War, over 5000 cases were reported with a low death rate. The spirochoetal form of haemorrhagic jaundice with a high mortality rate was first reported by Tuada and Ito in Japan in the first year of the great war and several French investigators on the Western Front had already confirmed their findings in 1915. The outbreak we were observing was common to Helles, Anzac and Suvla, with a variable incidence of 2 per cent. to 10 per cent. in units. The speakers at a meeting of the page 128Anzac Medical Society, from direct observation, gave the incubation period as from four to six days, which corresponds with previous observations made by French army surgeons who described epidemics of jaundice in French garrisons some years after the Crimean War. The symptoms at Anzac were: a loss of appetite, flatulent distension, vomiting and a slight rise of temperature. Tenderness was noted over the liver and gall bladder with the usual signs of mild cholaemia. The duration, 12 to 14 days. The general opinion was that treatment could safely be carried out in the unit by starvation and free purgation; only one fatal case had been observed.

The French pathologists, Sarrailhé and Clunet, working at Helles, considered the jaundice to be a type of paratyphoid gall bladder infection, while Martin at Lemnos was partly in agreement. It certainly was not spirochœtal jaundice.

Of the few pleasant memories of Anzac which medical officers retain, most will agree that the meetings of the Anzac Medical Society organised by the ever-resourceful Colonel Howse, were the chief; and the hours of deliberation spent in the 1st Australian C.C.S., now moved to safer and more commodious quarters south of the Sphinx in Reserve Gully, will ever be remembered. The meetings originated in a sanitary conference held in September at which all the sanitary officers attended. Each area of defence had a sanitary officer attached; these sanitary officers were not necessarily specialists, nor did they command sanitary sections. At the conference many questions of moment were discussed:— Chlorination of water; lice infestation:—one very enthusiastic officer of the Indian Field Ambulance demonstrated specimens of the body louse, which he carried in an inner pocket in test tubes with gauze coverings, and like the pelican of the desert, had nurtured with his own blood twice daily; the characteristic differences in pigmentation of the two types—the "grey back" of the white man and the black louse of the Gurkha—were admirably demonstrated to a hushed and devout audience. At the next meeting on the 14th October, 1915, the late Sir Victor Horsley addressed us on the treatment of head injuries in the field ambulances: the principles he then laid down were not subsequently modified to any great extent. Other meetings followed and one of the most interesting was that held on 22nd November, 1915, when the question of epidemic jaundice of armies was discussed. At a conference held in Alexandria about the same time the disease was considered to be a secondary symptomatic jaundice due to congestion of the common bile duct fol-page 129lowing dysentery or "enteric" infection. Other discussions held by the Anzac Society dealt with the treatment of wounds in field ambulances, and the use of Eusol solution, recently introduced by the French surgeons at Helles. It is much to be regretted that the minutes of the Anzac Medical Society have not, as far as can be ascertained, been preserved. They would have formed a curious memento of the resourcefulness of the medical officers and of current opinion on local problems, not even yet thoroughly solved.

But the time was rapidly approaching when the Anzacs would be leaving Anzac and the M.E.F. abandon its hold on the Peninsula for a while. Several events of moment cast their shadow on the darkening days of the occupation. Lord Kitchener came; he saw—he hesitated—very much was at stake—but at last, reluctantly, he ordered the evacuation. The loose-end Anzacs assembled and cheered the great soldier lustily; it seemed to do him good; he smiled and waved his hand in almost affectionate response: he was at heart himself an Anzac. But all must be kept secret, the Turk must be educated to believe that we had taken up permanent winter quarters. To this end, all in ignorance of early departure, the erection of winter quarters by the garrison proceeded, warm clothing was issued and fresh material landed. Two events, however, must have brought the situation home to most observant officers with striking clarity.

The first was the blizzard at the end of November. On the 28th there was a bitterly cold wind blowing from the north, the heavy rainfall of the previous days was now followed by snow; slush and snow made communications very difficult; the trenches were very muddy, and in places nearly full of water. The 54th Division marching out suffered severely, and had several cases of frost bite. The N.Z.M.R. Brigade who were relieving the 54th spent most of the night in the open under very severe conditions. All day there was a high wind, communications between ship and shore and the evacuations of sick and wounded became impossible. On the 29th snow lay on the ground, it was freezing hard, eight degrees of frost were registered; there was no hospital ship available; the growing number of sick and wounded still held up. Many small craft and one destroyer were blown shore at Imbros and at Suvla. The piers were washed away. Worse still, the Turk put down an unusually heavy bombardment with brand new high explosive on Lone Pine trenches, killing and wounding a very large number of Australians including Major Millar Thompson, A.M.C., Divisional Sanitary Officer of the page 1302nd Australian Division. As the water barges had gone ashore at Imbros, no water could be landed at old Anzac. Troops were on quarter rations, 2 pints daily, mule transport was almost impossible, the dere were filling. On the 30th there was cold, bright, clear weather. There was no ferry boat to Mudros. The hospital ship was working with ships' cutters and patrol boats, 100 wounded and 378 sick were evacuated in this way. The "Beetles" being too low powered could not face the sea. The water shortage was acute; the night temperature fell to 24 degrees F.

The blizzard, if it killed the flies, brought with it a very dreadful loss of life due to exposure, chiefly at Suvla. In many cases both Turk and Britisher was drowned in the trenches. Frost bite of a severe type was seen in the Indian Brigade, several cases of gangrene of the feet occurred; but with the New Zealanders and Australians, things were not so bad, only three cases of frost bite of mild type were admitted to the New Zealand Field Ambulance and there was a proportionate incidence in the other ambulances of the Division. Strenuous efforts were made by all senior officers to counter the danger and a providential issue of gum boots about this time contributed to the success of their preventive measures.

A few cases of mild trench foot had been seen during October in the 7th Australian Brigade then holding the Apex. The weather was not cold at the time, the trenches were quite dry. The cause of the trouble could not be attributed to cold or wet, but it was found that the soldiers affected had not taken their boots off for many days. The tightly fitting pantaloons and puttees were the chief factor in determining stasis in the foot. All these cases had the typical signs of trench foot, swelling, tenderness, and acute pain of a neuralgic type, with areas of blunted sensation in the usual distribution, but they all did well and recovered shortly. Instructions were issued that men should remove their boots at stated periods when in support, and that puttees should be worn loosely applied. There was no trench foot following the blizzard: the condition then seen was true frost bite.

The water and ration supply had become an increasing anxiety for the Administrative Staff at Anzac during these gales: mainly dependent upon supplies from Imbros, when the frequent gales prevented the daily replenishment of the reserve tanks, a water famine threatened. A condenser plant was in course of construction but owing to the "change in policy" unknown yet page 131even to the chief engineer officer, the plant was recalled. The filling of the Dere menaced the life of our most important well at No. 3 outpost, as it was just at the mouth of the torrent bed. Owing to water shortage, the only Thresh sterilizer at Anzac went out of commission.

A ration shortage was also evident at the end of November, a daily supply of fresh bread could not be maintained and biscuit was a poor substitute, as there was much gingivitis and dental trouble. On many days the available ration fell much below the value of normal war rations. A sanitary officer estimated several daily issues as furnishing from 3,300 to 3,400 calories each, and it was not possible for the men to utilise the full carbohydrate allowance in this ration as it was hard biscuit. Transport difficulties on land, rough seas, and absence of adequate shipping and piers contributed to a food and water shortage which, although never acutely felt, probably contributed during the last few weeks to weaken the garrison, whose metabolic demands for heat formation were not being adequately met. Certainly an appreciable loss in weight was experienced by nearly every one towards the end of the month. During the first three days of December, no less than 40 officers and 1352 O.R. were evacuated sick out of a total corps strength of 25,900; of these, some 24 from Anzac Corps by effects of cold.

Another event of minor importance early in December was the bombardment of the 16th C.C.S. at No. 3 outpost, with 5.9-in howitzer high explosive shell, entailing serious loss of life amongst the sick and wounded. The bombardment was intended for the Mountain Battery, a biscuit toss away, but the overs fell into the marquees of the C.C.S. No Red Cross convention can guarantee the protection of a medical unit which persists in keeping bad company: a noisy party of screw guns to wit; lack of room was our only excuse—the Turk could not, be held blamable. There were 280 cases in the C.C.S. of which 40 lying, one shell exploded in the surgical ward where the lying cases were, killing and wounding many of them—the ward was wrecked. The R.A.M.C. officers and men stood by and cleared the patients into the adjacent sap—shells falling all the time—until every patient was removed; there were 4 patients killed, 11 wounded. The shells were of a new type and horribly effective, it was clear now that Turkey was getting plentiful supplies of new ammunition and howitzers, and that if Anzac was not starved out or frozen by gales or blizzards, it would shortly be shelled out of the Peninsula. The heavy casualties at Lone Pine and at No. 3 outpost from shell page 132fire and the daily dusting of the forward trenches at the Apex made this only too clear. Lord Kitchener's advice to dig in had come in time. It was now clear to all that evacuation was the only way, and by the 10th the preliminary orders were issued by General Birdwood.

The medical arrangements for the evacuation were based on the assumption that there would be serious casualties when the rear guard parties were embarking, and that it would be necessary to leave many of the wounded behind in charge of a limited staff of medical personnel under the protection of the Geneva Cross, and in accordance with the Convention. I refer now to the arrangements made at Anzac only. The evacuation of troops had to be conducted in two stages: first, a reduction of the garrison to a minimal strength, calculated to hold the position for from two to four days, and a final embarkation of all guns and men to be completed in two nights. Hold or "keep" positions covering the beaches were defined; the embarkation of the small rear guard was to be at "Walker's Ridge and carried out in reverse order to the landing operations. It was during the final stages that casualties might be expected if the Turks became aware of our manoeuvre and followed up. During the preliminary steps to be completed before the 19th, the usual arrangements for the evacuation of sick and wounded would be adhered to, but during the rear guard movements, to be completed by the 20th, the lightly wounded men were, to embark with the fighting troops. Two hospital lighters were to be provided for the conveyance of seriously wounded, and the Vice-Admiral would provide boats off shore throughout the final stages when stragglers or walking wounded came down to the beaches. A proportion of medical personnel with accommodation for seriously wounded was to remain on the Peninsula until the evacuation had been completed, in order to tend such casualties as could not be embarked with the last of the rear guard. The following morning permission would be asked of the enemy, under a, white flag, for the medical personnel and the wounded to be embarked on the hospital ships, which were to remain. The total of medical units to be evacuated comprised about 8 field ambulances; 4 mounted field ambulances; 3 casualty clearing stations; 1 stationary hospital, the 1st Australian; 2 Imperial sanitary sections: the 5th Advanced Supply Depot of medical stores: and the New Zealand Dental Hospital. The tent subdivisons of the ambulances of the New Zealand and Australian Division were closed on the 12th and, curiously, the secretary of the Anzac Medical Society issued notices for a meeting to be held on the 19th. On the 12th the 16th C.C.S., page 133the Australian Stationary Hospital, and 3 field ambulances embarked. All sick—some 900 in all—were evacuated to hospital ship during the day. Some 2091 troops were embarked at night. On succeeding nights equivalent numbers of troops with a proportion of medical units embarked. The 18th was the first day of the final embarkations, the troops now remaining to cover the Anzac positions comprised 836 officers, 17,789 O.R., say a division, with field ambulance personnel, and 2 C.C.S.s, the 13th at Walker's Ridge and the 1st Australian C.C.S. 30 bearers from the ambulances had been distributed to R.M.O.'s, in proportion, to assist the removal of wounded on the last day; the New Zealand Field Ambulance detailed 2 corporals, and 12 men, N.Z.M.C. to the New Zealand Brigade and the N.Z.M.B.F.A., 2 corporals and 5 men to Russell's Mounted Brigade. The tents and the dressing stations of both these field ambulances were, by orders, left standing with a sufficient supply of blankets, lights, dressings, drugs, food and water, and the red cross flags flying. R.M.O. 's were instructed not to attempt to remove seriously wounded but to dress them and to leave them in the dressing stations. The medical units to remain behind were the 13th C.C.S. and the 1st Australian C.C.S., they were at Walker's Ridge near the pier from which all embarkations of the New Zealand and Australian Division were taking place. Old Anzac was using William's pier near Brighton Beach, at South Anzac. At the C.C.S. encampment there was accommodation for 2000 cases, adequate medical supplies and comforts, with food and water for 14 days. It was decided, that in the event of all the casualties being safely evacuated on the last day, the C.C.S personnel would also be embarked and that, in the event of a smaller number of wounded than anticipated remaining, the post of honour would be given to the 1st Australian C.C.S.; the first to land the last to embark.

The Turks were apparently quite unaware of our intentions. They were busily employed digging and repairing their barbed wire. Fires had been lighted by us in many of the sites previously occupied; all movements had been carried out at night. No unusual number of transports or hospital ships was visible by day, the weather very favourable, calm with moonlight and thick fog at night. On the penultimate night the two New Zealand Ambulances and the 3 Australian Light Horse Ambulances embarked at 7 20 p.m., on one of the "beetles" boarding the H.M.S. Mars, a pre-Dreadnought, where the officers, especially the surgeon, gave them a hearty welcome, a very good supper, and found them a place to bunk in. About 7,700 in all got away that night.

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Approximately 10,000 troops remained, these in turn were safely embarked the following night from three piers, almost the last to leave being the staffs of the casualty clearing stations. There was only one casualty. The following morning our warships found the Turks busily engaged in shelling the abandoned trenches.

From Mudros the Division sailed by various transports to Alexandria. Christmas day was spent at sea; the A.D.M.S., Col. Begg, on board the Huntsgreen, with the New Zealand Field Ambulance, presided at an N.Z.M.C. dinner party, amidst a scene of opulent luxury, as it appeared to the Anzac Garrison.

* See Appendix: Dysentery at Anzac