THE AUSTRALIAN ARMY MEDICAL SERVICES IN THE WAR OF 1914-1918 VOLUME I PART I THE GALLIPOLI CAMPAIGN bu COLONEL. A. C. BUTLER, D.S.O.. V D.; B.A.. M.B.. Ch.B. (Carnb.) PART II THE CAMPAIGN IN SINAI AND PALESTINE bu COLONEL R. M. DOWNES. CM.G, V.D.; M.D.. M.S.. F.C.S.A. PART III THE OCCUPATION OF GERMAN NEW GUINEA bu COLONEL F. A. MAGUIRE. D.S.O. V.D.; M.D.. Ch.M.. F.R.C.S. and CAPTAIN R. W. CILENTO. M.D.. B.S.. D.T.M. h H. li'itlz 228 illustvatioiis, maps, arid graphs Sccoird Edition AUSTRALIAN WAR MEMORIAL, MELBOURNE 1938 Printed and Bound in Australia by Halstead Press Pty Limited, 9-19 Nickson Street, Sydney Regirtered at the General Post Office, Melbourne, for trans- mission through the post as a book. Obtainable in Great Britain at Australia House and from all booksellers (sole agent for wholesale distribution-The Official Secretary for the Commonwealth of Australia, Australia House, Strand. London, W C a); in Canada from the Australian Trade Commissioner, 15 King Street West, Toronto: in the United States from the Official Secretary for the Commonwealth of Australia, a5 Broadway, New York: and in New Zealand from the Australian Trade Commissioner. D I C. Building, Wellington. Ftrst Edition . 1930 Sccotid Edition . 1935 E PREFACE THE medical history of the Australian forces engaged in the Great War must, in one respect, have a limited scope. Australian administration in the field never reached higher than arniy-corps control. Apart from the expedition to New Guinea, Australia was not responsible for the complete organisation of any military force. Certain important niedical units were not contained within the organisation of the A.I.F., and, though its medical director came to exercise considerable personal influence outside the Australian Army Medical Corps, his authority was always confined within its personnel. The study of what may be termed the medical strategy of the war belongs, therefore, properly to the Imperial history, and therein has been admirably presented. Nevertheless, this work aims at being more than merely L presentation of the experience of the Australian army medical services. Each of the three parts that make up the present volume is in some respect a comprehensive study of the medical problems arising out of the campaign with which it deals. Thus, in following the Gallipoli Campaign, in which the Australian and New Zealand forces played an extremely important part, the writer has been inevitably concerned with the policy and the conditions that controlled the whole range of events from the front line to the base. A medical break- down near the front, for example, may be directly due to events far beyond the Peninsula: congestion at the hospital bases in Egypt and Malta may cause a damming back of the stream of casualties on the lines of communication, which may lead to a hold-up at Lemnos and Imbros, and this in turn to a block at the Gallipoli beaches, and so to delay in the clearance from the aid-posts at Anzac. The records recently made available froni England by the courtesy of the Historical Section of the Committee of Imperial Defence, through the assistance of Mr. T. H. E. Heyes (representing the Australian War Memorial), are so complete that the tracing of such causes has become largely a matter of industry. Thus, in fulfilling his duty of giving an adequate account of the Australian medical service, the writer of the Gallipoli section of this work found himself committed to the formidable task of dealing with the general problems of a medical service in combined naval and military operations, a vi PREFACE subject matter which, until this campaign, was almost entirely unexplored, and of which comparatively little has even now been written. Again, in the Palestine and, particularly, the Sinai cam- paigns the Australian light horse formed the predominant element in the arm most characteristic of these operations- the mounted troops. An Australian officer-the writer of this part-was, indeed, selected to act as D.D.M.S. to the Desert Mounted Corps, a combined British, Indian, New Zealand, and Australian formation. His contribution, it is believed, though concerned but little with the medical strategy of the campaign, presents the detail of medical work with mounted troops in a completeness not hitherto attempted in connection with modern warfare. But while in the main this history is concerned only with the carrying out in the A.I.F. of policy determined by the Eritish authorities, its writers feel little diffidence in claiming that its subjects possess general appeal and interest. The experience of a self-contained homogeneous force of the size of the A.I.F. may be more easily collated than that of the vast armies of Europe, and may be of value in illuminating the larger field. For example, there have been obtained from England-in addition to much material, only partly explored, concerning the Gallipoli expedition-the coded cards prepared by the Medical Research Committee for mechanical sorting, containing the total experience of the A.I.F. during 1915 in regard to sickness and wounds. These statistics, more complete than any as yet published of the campaign, have been tabulated, and are discussed in the present vo1urne.l ‘The Statistical volume of the British Medical History has not appeared at the time of going to press, and no information is yet available as to the result of expert scrutiny regarding the value, for statistical purposes of the clinical records on which rest the figures for sickness in the British Arhy for the year 1915; their value is known, however, to be less than that of the records for subsequent years. It 1s. perha S, desirable therefore to state, in connection with the medical records concerning &seas, in the Australian Force, which have hem used in the preparation of the graphs illustrating the incidence of disease on Gallipoli (Owen at fi 166.7). that a careful scrutiny was made of samples from the coded cards, in ordr to test (a) their quantitative accuracy; (b) their qualitative accuracy. This examination showed that- I. The requirements in respect of both (a) and (b) were fulfilled so far as the use tilade of the records dcmandod. 2, That as regards (a) any error would lie in the omission, not in the duplication, of individual records. and that therefore its elimination would have operated in the !irection of fortif ing the support,,given to the argument bv the figures. The Admission and Kischarge books, are the source of the “.Coded cards,” and the loss of these hooks is not entirely-though it is largely- rompensated for by the operation of transference of patients through a number PREFACE vii Again, the carrying out in a dominion army of certain principles laid down by the medical authorities of the British Army opens up the whole field of the relations of the dominion service to that of the Mother Country, by the side of which it took its place in the war organisation of the British Empire. The problems involved in this relationship, and the experience oi the medical service in their gradual solution, are matters which, so far from possessing a merely academic interest, come white-hot from the furnace in which have been moulded the latest changes in the British Commonwealth of Nations. For Australia and the other dominions within the British Empire the Great War itself was an episode within a vast experiment in national adjustments that is being made in the course of the onward march of humanity through the ages. In the microcosm of the Australian army medical service are tc be seen the uncertainties and compromises, the co-operation without compulsion, the union that is organic rather than formal, which characterise the relations between the various parts of the British Empire and have made its position unique in the history of the world, and which, during the war, not without some strain and friction, held the various medical services of the Empire in a verv close and successful co-operation. To come nearer home, there may be cited the complex questions relating to the ulterior consequences of the war in relation to national health ; the cost in impaired efficiency, and in the huge toll of pain and of pensions. With a comparatively small nation under the microscope, the national effects of war injuries may perhaps most easily be traced. Finally, there is the fact that the events here chronicled formed part of the war effort of a hitherto peaceful dominion, co-operating within the British Empire in a war of unpre- cedented magnitude and complexity. The administrators of the medical service of the Australian military forces were --like the regimental surgeons, the dental officers, the pharmacists, the nurses-almost without exception civil practitioners, who, with only militia training at most, suddenly became responsible for the medical side of a great military of medical units. It is therefore desirable to point out that the figures embodied in the gra hs are to he regarded as approximations. sufficiently accurate for the purpose of illustratin and validating the general conclusions as stated in the text. but not exact 6, the purpose of statistical comparison. ... Vll! PREFACE organisation. And one of the chief responsibilities lying upon the editor and writers of this work is to exhibit the problems of that “civilian” service in such a way that, if ever this dreadful experiment must again take place and Australia be again involved in a great defensive war, the experience of the Great War shall have been recorded and illuminated for her medical service, so that old difficulties may be met with foreknowledge, old pitfalls avoided, and, most important, that the new generation may face the new prolJlems that must arise through scientific advance with an assurance and a vigour begotten of that clearer knowledge of the essential principles of medical strategy and tactics in war which has grown out of the experience so dearly acquired in the crises of 1914-1918.