The New Zealand Medical Service in the Great War 1914-1918
Notes For R. M. Os. — of the New Zealand Division
Notes For R. M. Os.
of the New Zealand Division.
These Notes are for the use of Regimental Medical Officers of the New Zealand Division.
They are not a resume of the duties of an R.M.O., but are a summary of orders and instructions which have been issued from time to time in Medical Corps Orders, and such other information as may preserve R.M.Os. from those errors of omission and commission which experience has shown to be most frequent.
During the two or three months Medical Officers are attached to Field Ambulances prior to being sent out as R.M.Os., they are expected to familiarise themselves with conditions in the Field. Amongst these the testing and chlorination of water, and the defensive measures against gas, and also the early treatment of gassed cases are of the utmost importance, and owing to their novelty to the recently commissioned R.M.O., require special attention.
2. Regimental Medical Establishment.
These Establishments vary in the different units. These variations and some other details are shown in the Table in the Appendix. In what follows an Infantry Battalion is referred to.
Each Infantry Battalion has:—
A. Army Medical Corps Personnel.
- 1 Officer (rank, Captain or Subaltern).
- 1 Corporal and 4 privates for water dutic
These details are "attached" to the from the N.Z. Medical Corps.page 2
In the New Zealand Division it is a rule for these water duty men to he exchanged every three months by the affiliated Ambulance. This gives them the opportunity of acquiring knowledge and practice in other branches of their work, and so fits them for promotion when their turn comes. It also contributes to the maintenance of discipline among them, as a few men detached on more or less independent duties are apt to-become slack.
The duties of this Water personnel are:—
- (i) The daily supervision of water supply and its purification for drinking purposes, as may be directed.
- (ii) To take charge of all apparatus and stores connected with the water supply of the unit.
These duties, therefore, include the testing and chlorination of water, cleaning of water carts, tanks, petrol tins, etc., ensuring that sufficient supplies of bleaching powder, alum and testing solution are maintained.
B. Regimental Personnel.
1 N.C.O. and 8 men, i.e., 2 from each Company.
Their duties generally are to act as sanitary police, to prevent soil pollution, and in detail to supervise:—
- (i) The preparation and care of latrines and urinals, including the filling in of same, and marking of old sites.
- (ii) The systematic collection, removal and disposal of refuse by burning or other methods.
- (iii) Construction of ablution places, and the disposal of waste water.
- (iv) The sanitation of cooking places,. horse and mule lines, and slaughtering places in the area occupied by the unit.
The R.M.O. will constantly instruct the sanitary personnel in their duties, and ensure that they are familiar with the most recent instructions re sanitary methods and apparatus.page 3
(2.) Stretcher Bearers. 16 men.
It is the duty of the R.M.O. to train these men, and as this training is of the utmost importance, to remember that the regimental stretcher bearer is in the majority of cases, the first to deal with the wounded man.
These men will be trained when the Battalion is out of the Line, together with at least 16 extra bearers, i.e. additional to establishment.
The subjects of training will be:—
1. Application of First Field Dressing. 2. First aid, especially in hæmorrhage and fractures. 3. Lifting and carriage of wounded. 4. Immediate treatment of gassed cases 5. Organised stretcher drill.
The last is the least important in practice.
The Field Ambulance will lend a N.C.O. to instruct in stretcher drill if requested to do so.
Training will be by lectures and practical work. Each, man will be made to splint the common fractures and apply tourniquets.
(3.) Medical Qrderlies
- 1 lance corporal as medical Orderly.
- 1 private as orderly and driver of the Maltese Cart.
These assist the R.M.O. in his Medical duties. They take care of the medical equipment, and such records as may be made.
The Chiropodist is (in the New Zealand Division) struck off all other duties, and is directly under the. orders of the R.M.O. In addition to the duties more stricrly pertaining to a Chiropodist, he is detailed to-supervise the use of preventive measures against Trench Foot, a duty which, in wet and cold weather, should keep him very fully occupied.
|Medical Companion and water bottle||1|
|Surgical haversack and water bottle||1|
|Field medical panniers pairs||1|
|Haversacks with shell dressings—|
|Cases, chemical, water-testing||1|
|Cases, water-testing, sterilization||1|
|Cases, instruments, Chiropody||1|
These stores are replaced or replenished through the Field Ambulances.
|Lamp, acetylene, with glass front (Authority: C.R.O. 845, dated 27-10-16.)||1|
|Beatrice Stove (Authority: G.R.O. 1896, dated 26-10-16.)||1|
"S.B." armlets and stretchers are an Ordnance supply. Crude disinfectants are an A.S.C. supply, and procured by the Q.M. of the Unit from the S.S.O.
A sufficient number of blankets (say 20) should be kept in the R.A.P. and will be obtained by the Q.M. of the unit. When an excessive number of wounded is expected, a larger supply of blankets and some medical comforts will be supplied by Advanced Dressing Stations, on instructions from A.D.M.S.
A Thomas' splint and suspension bar is kept in each R.A.P., and handed over with it to the incoming R.M.O., unless fine R.A.P. is being handed over to a R.M.O. of a different formation, when the splint and bar are taken away with the rest of the equipment. When this splint is used, on a patient, a replacement must be at once secured from the A.D.S. or M.D.S. Instructions for the use of this splint were issued with Medical Corps Orders, dated 24-7-17, and must be studied and practised by all R.M.Os. They should also instruct bearers in the application of this splint.
Although Medical equipment is on charge to the unit, the R.M.O is regarded as immediately responsible for it.
"Expendible" items, e.g., drugs and dressings, are demanded from the affiliated Ambulance of the unit in writing, signed by the R.M.O.page 5
In case of inexpendibie items being lost or rendered unserviceable, in demanding their replacement the R.M.O. must forward with his demand on the Ambulance a certificate stating exactly how, where and when these items were lost or rendered unserviceable.Such general statements as "lost by exigencies of campaign," "destroyed by shell fire," are insufficient. The statement should be something as follows: "…………These items were destroyed by shell fire in the R.A.P. at (location) on (date)." Unserviceable or broken apparatus should be returned, as they may be repairable, and at any rate, prove the genuineness of the claim for replacement. Empty thermometer cases and ethyl chloride tubes will also be returned.
Economy must be exercised by R.M.O.s in expenditure of drugs and dressings. An efficient R.M.O. rarely requires drugs, etc., not included in this equipment.
Items other than medical equipment required by R.M.O., are obtained from Q.M. of his Unit.
A Maltese cart carries the medical equipment, and is driven by the medical orderly. This 'cart is at all times at the service of the R M.O. With Artillery, except D.A.C., this cart is drawn by two horses—with other units by one. The Divisional Ammunition Column is provided with two Maltese carts.
5. Affiliation of Ambulances to Units.
For the purpose of:—
|1.||Movements of entire Brigades.|
|2.||Supply of medical stores to R.M.Os.|
|3.||Supply and exchange of water duty men to units.|
|4.||Provision of substitute for R.M.O., sick or on leave.|
Ambulances are affiliated to units as under:—
- 4 Battalions of 1st Infantry Brigade.
- 1st Brigade, N.Z.F.A.
- No. 1 N.Z. Machine Gun Company.
- N.Z. Divisional Headquarters.
- 4 Battalions of 2nd Infantry Brigade.
- 3rd Brigade, N.Z.F.A.
- N.Z. Pioneer Battalion.
- Nos. 2 and 5 N.Z. Machine Gun Company.
- 4 Battalions of 3rd N.Z. (Rifle) Brigade.
- N.Z, Divisional Ammunition Column.
- N.Z. Divisional Train.
- N.Z, Divisional Engineers.
- No. 3 N.Z. Machine Gun Company.
Although a R.M.O. may draw stores from other than his affiliated Ambulance, it should be done only under exceptional circumstances.
6. Information, Orders, etc
When a Medical Officer is taking over from a R.M.O., either temporarily (as for leave or sickness), or when posted to a unit, he will receive from his predecessor a complete file of Medical Corps Orders, with the instructions, pamphlets, etc., which have been issued with them. He will give a receipt for these, and this receipt will be forwarded by the outgoing R.M.O. to the A.D.M.S. This file of Medical Corps Orders will be kept in Field Medical Pannier, No. 2.
Copies of D.R.O., C.R.O., A.R.O. and G.R.O. may be seen in the Orderly Boom of the unit at any time, and R.M.Os. should extract those Orders affecting their duties, supplies, etc.
Copies of books such as King's Regulations, Field Service Regulations, Part II., may also be seen in the Orderly Boom.
Each R M.O. should be provided with
" R.A.M.C. Training Manual."
"Sanitation in War," by Major P. S. Lelean, C.B. R.A.M.C.
"Hints for R.M.Os. of the Territorial Force," by Captain M. F. Grant, R.A.M.C.
7. Returns to Be Rendered to the A.D.M.S.
Pro formas for these returns will be kept in Field Medical Pannier, No. 2, and replenished by demand on the Office of the A.D.M.S.
(i) Weekly Sanitary Report—Z.M.F.2.
This must be rendered weekly by 9 a.m. on Saturdays. There is a space to be initialled by O.C of the unit.
The map references and results of tests of all sources from which drinking water is drawn must be given, using reverse of form if necessary.page 7
An addition to this report not provided for is a report on the water carts as regards their completeness in equipment, as laid down on the board, supply of alum and bleaching powder, and cleanliness. This will appear on the reverse of the form.
Distinction must be made between cases of venereal disease reporting, and those detected at the weekly inspection for venereal disease. The latter should be reported to the O.C for disciplinary action under K.R. 462.
(ii) Infectious diseases—Z.M. F.1.
This should be rendered promptly, so that disinfection and isolation of contacts may not be delayed. It is rendered as cases occur. The Company of the patient must be stated for entry on the "spot" map.
(iii) Inoculation return—Z.M.F.4.
This must reach Office of A.D.M.S. not later than 9 a.m. on 25th of each month.
Leave of attached Officers and other ranks is given from the allotment of the unit to which the soldier is attached. The R.M.O. will obtain his leave from the O.C. of the unit, and then forward this in writing for approval of A.D.M.S., who will supply a substitute to report to O.C. unit, generally the day before the R.M.O. proceeds on leave. Date of proposed departure must be stated. The R.M.O. will thus have an opportunity to instruct his substitute on local conditions, etc.
On returning from leave, the R.M.O. must report at once in person or in writing to the A D M.S., when the substitute will return to his Ambulance
9. Channels of Communication.
On all technical (professional) matters and questions of policy, the R.M.O. will communicate directly with the A.D.M.S. On other matters through the O.C. of the unit.
Suggestions or complaints on sanitary conditions should be submitted to the O.C of the unit before being forwarded to the A.D.M.S., so that O.C. unit may add any remarks, or possibly remedy the defect forthwith.
10. Patients Sent to Field Ambulances.
When a soldier is evacuated to a Field Ambulance, all his clothing and equipment (except ammunition) page 8should be sent down with him. This is the Quarter-master's business, but the R.M.O. may often help by reminding the Q.M. or N.C.O. immediately in charge of the patient. In the case of infectious disease, however, the R.M.O. will himself ensure that all clothing, etc., is sent down so that it may be disinfected. Small Box Respirators and P.H. Helmets must not be forgotten.
11. Dental Cases.
These will be sent to the Divisional Dental Hospital.
In cases of lost or broken dentures, the R.M.O. should enquire carefully to ascertain if the loss or breakage was deliberate or due to negligence, in which case he would report the matter to the O.C.
Dental cases must parade at the Dental Hospital with their tooth-brushes.
12. Eye Cases.
These are sent to the Ophthalmic Centre of the Army on special days, by a special Field Ambulance, to which the patient is sent by the R.M.O. The Ambulance and day and time to be sent are notified from time to time in Medical Corps Orders.
Where a man has broken his glasses, and the prescription for the lenses is in his pay-book, it is sufficient to send the prescription and broken glasses to the Ambulance, unless the error of refraction is of such a degree as to disable the man when he is without glasses.
Deliberate and negligent loss and breakage of glasses must be dealt with in the same manner as for dentures.
These cases are sent to a special Ambulance notified from time to time in Medical Corps Orders.
The whole unit should be inspected once a week to detect these cases. Disinfection of blankets, vide Note No. 19 (vide M.C.O. 476).
14. Ears are not to be syringed by orderlies unless specially instructed by Medical Officers. In cases where the mombrana tympani may have been ruptured by an explosion, the ear will not be syringed at all until (and if) such is directed after examination by a Medical Officer at an Ambulance M.D.S.
15. Soldiers Unfit for Further Service at the Front.
No medical certificates will be given by M.Os., nor will they give patients written histories of their cases page 9Nor should they express to the patient any opinion as to what they consider should be done with him.
In the case of soldiers whom they consider unfit for service at the Front through conditions other than sickness or recent wounds (in which cases they would, of course, be evacuated in the usual way), they will notify the A.D.M.S., giving the history of the case and reasons for their opinion. The A.D.M.S. will make arrangements to inspect these cases.
Inoculation will be carried out in accordance with Army Council instructions Nos. 1339 of 1916 and 522 of 1917, which were consolidated and issued with Medical Corps Orders dated 25-4-17.
The procedure adopted will be that laid down in D.R.O. 928 of 4-ll-16 (and M.C.O. 384 of 7-11-16).
If a complete Nominal Roll of a unit is well compiled, showing the inoculation state of each individual, it is easily kept up to date by adding the name of each soldier who arrives as a reinforcement or attachment, and erasing the names of those struck off the strength. Only the number of complete inoculations should be entered under the column headed "Number inoculated during the month."
17. Casualties-Diagnosis of.
Only the R.M.O. or the medical orderly under his instructions "will fill in the Tally Ticket. In all cases the R.M.O. will himself sign it. "In the case of sick he will see that the diagnosis is in accordance, with the" Nomenclature of Diseases."
In the case of injuries other than wounds, it will state whether these are battle 'casualties or accidental.
(i) Gassed Cases.
Gassed cases must be diagnosed as "wounded," i.e., Battle Casualty, or "sick," i.e., accidental.
A case is a battle casualty if it arises from our own gas when it is being used in action against the enemy. It is accidental when arising from leakage of our own gas from its containers, either during transport to or storage in the line: provided that such leakage is not directly due to enemy action, as an enemy shell striking a container.
Cases in which it is not known whether the gassing is accidental or a battle casualty, or whether the man has been gassed at all will be diagnosed "N.Y.D. (? gassed)."page 10
It must also be definitely stated on the Tally of each gassed case whether the gas was. Shell, Drift (i.e., Cloud), or Mine gas.
A diagnosis would appear thus: "Gassed—wounded—shell."
Cases of conjuctivitis arising from gas are diagnosd as "Gassed."
(ii) Shell Shock, Shell Concussion. Neurasthenia, Inability to stand Shell Fire.
These terms are not to be used under any circumstances. The diagnosis will be written "N.Y.D.N." (The last "N" stands for "non-effective").
The R.M.O. will procure all the information he can from the immediate associates of the patient as to the circumstances under which the condition has developed, e.g, undue proximity to an explosion, being buried, etc. He will also make a note of his physical condition, and state his own opinion on the case. This information will be forwarded in a closed cover to the medical unit to which the soldier is next evacuated. He must not express his opinion to the patient, but should assume an air of optimism and encouragement in handling his case:
(iii)"P.U.O." or "P.O.U.O." (" Pyrexia of uncertain origin ").
This is a permissible "diagnosis" in febrile cases, where the symptoms and signs are not sufficiently developed to enable the M.O. to make a definite diagnosis before evacuating the patient. While preserving the M.O. from the necessity of making a diagnosis on insufficient data, it must not be considered to completely satisfy the demands of medical science, or indications for treatment. It should therefore not be used for cases of definite disease, e.g., pleurisy, broncho-pneumonia, etc. Particularly, the M.O. must be assured that it is not covering an early case of some infectious disease, e.g, scarlet fever or C.S.M. It will be particularly used.for such cases as influenza and trench fever.
Trench fever must not be diagnosed as such; but if suspected, as "P.U.O. (? trench fever)," as it is not possible to be sure of one's diagnosis till after a few days' observation.
(iv) Mental and N.Y.D. (? Mental) Cases.
The R.M.O. will forward with the patient to the Field Ambulance to which he is evacuated a report page 11stating fully:—
1. Facts observed by himself. 2. Facts observed by others. 3. His own opinion as to the nature of the case.
This report will be sent by hand in a closed envelope, marked "Confidential." Under no circumstances will it be handed over to the patient for transmission.
G.R.O. No. 2485 of 31-7-17, defines Battle Casualties and reads as follows:—
"The following instructions will be observed when reporting casualties:—
All casualties caused by enemy weapons are Battle Casualties, i.e. the men concerned are reported simply as Killed in Action, or Wounded.
Cases of shell shock will only be reported as "shell shock (wounded)" when the D.A.G., 3rd Echelon, has notified the unit in the Field that this should be done. See G.R.O. 2384 (iv).
All casualties caused by British or Allied weapons ('including poisoning by lethal or mine gas) which are in action against the enemy, will be reported as battle casualties, i.e., the man concerned will be reported simply as killed in action or wounded.
In every case where, accidents are strictly flying accidents, and death or injury to an officer or man flying on duty results, the casualty will be recorded in precisely the. same way as a casualty which occurs in action.
All casualties, other than self-inflicted, caused by British or Allied weapons which are not in action against the enemy, will be reported as accidental, thus:—
- Killed (accidently).
- Wounded (accidently).
All cases of mine gas poisoning will be supported by a certificate signed by the Officer i/c of the unit concerned and attached to A.F.B. 213, sent to D.A.G. 3rd Echelon weekly, stating that the casualty was not due to neglect or disobedience of orders. Casualties of this nature caused by neglect will be reported as "accidental."
All self-inflicted casualties will in the first instance be reported as wounded (self-inflicted). When the case has been investigated, the final classification will be-notified by the G.O.C. of the Army concerned to the D.A.G., 3rd Echelon.page 12
For the purposes of these instructions, the word 'weapons' will be held to include gas, liquid fire, high-tension currents, and enemy barbed-wire, as well as all other instruments used in fighting.
In reporting casualties the special nature of the casualty will be indicated thus:—
- Killed (gas).
- Wounded (gas).
- Killed (liquid fire).
- Wounded (liquid fire).
- Killed (electrocuted).
- Wounded (electric shock).
- Wounded (barbed wire).
If the casualty is accidental, the word 'accidental' will be added.
When an officer or other rank who is both 'wounded and missing,' and has been previously reported (l) missing, (2) wounded, the second notification should read:—
- (1) Wounded and missing, previously reported missing.
- (2) Wounded and missing, previously reported wounded.
In the case where an officer or other rank is reported ' wounded and missing,' and it is desired to correct the report of wounded as well as of mising, thus:—
- (1) Cancel report wounded and missing, now reported wounded.
- (2) Cancel report both of wounded and of missing.
18. Self-Inflicted and Accidental Wounds.
The occurrence of these must be immediately reported to the O.C. of the soldier's Company, Battery, etc., and a note made on the Tally that the case is one of self-inflicted (or suspected self-inflicted wound) by marking it distinctly with the letters "S.I."
It must be remembered that a self-inflicted wound may be accidental or intentional, but in either case a Court-Martial will be required. The M.O. will, therefore, particularly note the position, direction, etc., of the wound, and especially if there is any blackening of the skin or burning of clothing, showing proximity of the weapon. He will note anything the man volunteers about it.page 13
The O.C. Sanitary Section of the area occupied, is responsible for the disinfection of billets and camps in which cases of the following diseases have occurred:—
- Scarlet fever
- Cerebro-spinal meningitis
- Relapsing fever
The O.C. Sanitary Section will be communicated with by the A.D.M.S. of the Division.
The O.C. Sanitary Section will generally demand a fatigue from the R.M.O. to assist him. This fatigue will be provided from the sanitary personnel of the unit.
In cases of other infections diseases, disinfection will be carried out by the R.M.O. A spraying apparatus and fluid for use in it will generally be lent by O.C. Sanitary Section when asked for in writing by the R.M.O.
Disinfection of clothing will be effected in the Foden Lorry. The location of this lorry is given in Medical Corps Orders from time to time.
With a view to the suppression of scabies and lice, it is well that the men's blankets should be sterilized in the Foden occasionally. The, number of blankets in a Company varies from time to time. The Foden can do 60 blankets pet hour with certainty of sterilization. Whenever possible the R.M.O. should arrange that the blankets are sterilized about every 4 to 6 weeks. By communicating to the A.D.M.S. the number to be done and date, suitable arrangements can generally be made. It is best to do at least one complete Company at a time.
The R.M.O. should ascertain that the men are getting their baths and change of underclothing once every ten days. He should inspect the bathing roster frequently and ascertain from enquiry that it is being adhered to.
20. Tetanus Anti-Toxin.
This is to be given only at main Dressing Stations of Field Ambulances. It is to be given to all cases in which the skin is broken; therefore even slight scratches should be sent down by the R.M.O. for this purpose. It is also to be given to all cases of Trench Foot, even if the skin is not broken.page 14
21. Sudden Deaths.
In the event of a sudden death occurring outside a medical unit, when sufficient evidence is not forthcoming as to the cause of death, the body is to be sent to a C.C.S. for post-mortem examination.
R.M.Os. will forward the body together with all particulars available as to the cause of death, to the Field Ambulance. Os.C. Field Ambulances will arrange the transport of the body to the C.C.S.
22. Mutilation of Clothing of Wounded.
Preparatory to dressing a wound, it is frequently found necessary to cut the clothing in order to remove it without aggravating the injury or causing pain to the patient.
Although this matter is one for the judgment of the M.O. in each case, these officers will (as far as is consisistent with the welfare of their patients) avoid unnecessary mutilation of clothing, and especially of boots, gum, thigh.
Slacks and tunics may be slit up the seams and by completely unlacing ankle boots, and steadying the leg just above the ankle they may be removed without cutting the uppers or causing pain to the patient in cases of injury to the leg and thigh.
Needless exposure of wounded in cold weather is to be avoided, however, and under the circumstances it may be necessary to cut holes through the clothing in order to adjust the First Field Dressing, with the bandage outside the clothing.
R.M.Os. in their usual lectures on First Aid should explain this to Company Officers, Stretcher Bearers and men.
23. Medical Attendance Upon Headquarters
Headquarters Staff of Divisional Artillery or attended by a M.O. of one of the Artillery Brigades is the D.A.C., this M.O. being selected by the C.R.A.
Headquarters Staff of an Infantry Brigade is attended by one of the M.Os. of the Battalions of the Brigade, this M.O. being selected by the Brigadier.