Sir James W. Barrett

“ There is no doubt that the commander of a hospital must be a medical practitioner, and there is no doubt that in all matters relating to his hospital his authority must be final. In the last resort he must decide whether a patient is to leave the hospital or to stay; who should be admitted, and what the treatment should be. In a good organisation he will probably be very rarely required to express an opinion respecting these matters, but in the event of a conflict of opinion between say the consulting surgeon or physician and himself, there can be but one final arbitrament. ”

“ We have to remember too that our Governments of the Commonwealth and Dominion have sent us here at a great sacrifice to themselves, and they fully rely on us upholding their good name, and indeed doing much more than that, for I know they look to us to prove that these two contingents contain the finest troops in the British Empire (whose deeds are going down in history) , whom they look forward to welcome with all honours when we have done our share, and I hope even more than our share, in ensuring victory over a people who would take all we hold dear from us if we do not crush them now. ”

“ A very few men can take away our good name. Will you appeal to all to realise what is before us, and from now onwards to keep before them one thought and only one thought until this war is finished with honour—that is, a fixed determination to think of nothing and to work for nothing but their individual efficiency to meet the enemy. ”

“ The essence of the problem was learnt by a Brigadier-General who visited a number of young educated men in one of the camps, and asked them for their viewpoint on the subject. Their answer was that which every medical officer knows full well: that many men were influenced by the appeals which had been made to them, but that a percentage have indulged in this way throughout their adult life, and intend to continue to do so irrespective of anything medical officers, chaplains, or generals may say to them. It is this fundamental position which every reformer must face. ”

“ Under the new constitution of the Australian Red Cross money cannot be devoted to their maintenance, because it is not being used exclusively for the sick and wounded. Such is the ruling, although many convalescents use the clubs. It is regrettable that such a rigid ruling should have been established. It is absurd to permit men to become infected and then to assist them by doles of chocolate and tobacco, and yet to refuse to provide the necessary funds which assist so materially in preventing infection. ”

“ It is apt to be forgotten that in warfare there can be no holidays, or days off, and that the human being must be at his maximum of physical efficiency, and his digestion of the best. If his soundness is doubtful it is better to keep him for base duty at home, on guard duty at the base, or as an orderly in the hospital. It is simply a waste of money, and tends to the disorganisation of the service, to send such people anywhere near the fighting line. We made an attempt at one stage to roughly calculate what the Australian Government had lost in money by the looseness of official examination. ”

“ The worst of it is that Cairo is full of some, probably, of the most unscrupulous people in the world, who are only too anxious to do all they can to entice our boys into the worst of places, and possibly drug them there, only to turn them out again in a short time to bring disgrace on the rest of us.
"Surely the good feeling of the men as a whole must be sufficient to stop this when they realise it. The breathing time we have left us is but a short one and we want every single minute of it to try and make ourselves efficient. ”

“ There are in existence here a score of war funds of one kind or another, and by the devoted efforts of their organisers and the warm-hearted support of the public the lot of our soldiers has been brightened, the burden of pain and suffering borne by the sick and wounded has been eased, a helping hand has been extended to the homeless, broken sufferers of Belgium, Poland, and Serbia, and a gleam of happiness brought to many a home in France whose erstwhile bread-winner is on active service. ”

“ We have never wavered from the conviction that any one suffering from venereal disease should be treated by a medical practitioner exactly like any other sick person. In military service, however, an added element makes its appearance in that the soldier by his act has rendered himself unfit, and consequently must suffer some pains and penalties. It is no answer to say that other men have exposed themselves and have not become infected. ”

“ The Commanding Officer witnessed the occurrence, visited the happy scene, interrogated the sentry, and asked him what his duties were. The sentry answered, "To walk up and down here with me gun to prevent them prisoners" (the unfortunate convalescents) "coming down them steps, and to prevent them niggers jumping the fence!"
The hardest part of military work is waiting. The soldier who has the magnificent fundamental qualities of the Australian, and who can wait and obey, would be the greatest soldier on earth. ”

“ All thoughtful Australian officers we know tell the same story: "Give us discipline, and again and again discipline."
There is much to be said for the soldier. He will obey if he knows why an order is given, or if he trusts his officer and knows why it is given. But if he is uncertain on these points he pleases himself. Discipline cannot be enforced in general, except by properly trained professional officers.
Again, there was more drunkenness than there should have been from the same cause. One evening visitors passed liquor into hospital, and a hideous din arose. ”

“ He at once called a conference of medical officers and did what he could to limit the extent of disease.
The governmental action—or lack of action—is unsound, since the man who contracts disease is severely punished, but adequate attempts are not made to prevent him acquiring it. The notable departure made in the case of Cairo was the effort to make the men understand clearly what these diseases meant to them as soldiers and as citizens; to remove temptation from them as far as possible, and with the aid of the Australian Red Cross to give them a reasonable, healthy, and decent alternative. ”

“ What was to be done with malingerers, of whom there was a small but sufficiently numerous percentage? As regards the first question: is a man, for example, who has lost an eye permanently invalided? Is he fit for base duty in Egypt, or must he be sent home? It is hardly fair to send him to the front and expose him to the risk of total blindness. ”

“ The Red Cross Society, on the other hand, attends to the wants of the sick and wounded, and its functions have already been discussed. They may, however, be supplemented by the following definition of the work of the Red Cross which was furnished by the High Commissioner for Egypt, Sir Henry MacMahon:
"Government supplies all the necessities for the care, treatment, and transport of the sick and wounded, while the Red Cross supplements these necessities by everything that can in any way go to the comfort and well-being of the sick and wounded soldiers. ”

“ The Y.M.C.A. organisation appears to me to be excellent, since it is the organisation which caters for the social welfare of the soldier, wherever he may be, whether in camp or at the base; and the work is conducted by men whose business it is to understand him and see that all reasonable wants are gratified. In Egypt as I write (July 1916) there are no fewer than forty-seven Y.M.C.A. huts and centres, and Y.M.C.A. officers in the desert, in the oases, and elsewhere, doing their very best to make the soldiers comfortable. ”

“ I only hope that the people of Australia will come to know of the splendid manner in which their wounded have been cared for, and of the noble and generous work which the great colony has done under the banner of the Red Cross. ”

“ The medical officer is alone competent to judge what food should be issued to patients. Visitors who criticise the diet of the patient are assuming a function which they are obviously unable to discharge. Diet sheets are provided for each ward, and on these is entered the number of different diets prescribed by the medical officer. These diet sheets should be the only and the final authority of what should be issued to the patient in the way of eatables. As it happened, ladies sometimes brought into the different wards of the hospital foods which constituted an added danger to the patient. ”

“ It is impossible to give accurate statistical evidence, but the Australian public seems to have been shocked that young, healthy, and well-fed men should in camp life have been so seriously damaged and destroyed. The causes as usual were measles, bronchitis, pneumonia, tonsillitis, and later on a serious outbreak of infective cerebro-spinal meningitis which was stamped out with difficulty and took toll (inter alia) in the shape of the lives of three medical men. The sanitation of the Broadmeadows Camp near Melbourne was not such as to provoke respect or admiration. ”

“ It would be far better to leave the actual detailed administration of the wards in the hands of a comparatively junior man with the rank of major, and to retain these senior officers as consultants only. Consultants of course possess great powers, since their authority as regards the clinical work itself is absolute. They can do as much or as little as they like, but they are in complete control and are absolutely responsible for the treatment of the cases. ”

“ It is almost certainly due to food infection.
It is obvious that the business of a sanitary medical officer is not merely to inspect buildings and kitchens, but to spend an hour or two a day in the kitchen quietly watching the preparation of the food and giving the necessary instruction and supervision to those who are preparing it. The inefficiency caused by food infections has probably done more harm than many battles. ”

“ When the Kyarra arrived in Egypt the military medical arrangements in that country were on a very small scale, and under the administration of the D.M.S. they rapidly enlarged. But the unexpected rush on April 29 found the British Medical Force to a considerable extent, and justly, dependent on the Australian Force for hospitals, medical officers, nurses, transport, specialists, and Red Cross stores. As there is really only one service and one object in view, it is quite unnecessary to emphasise the satisfaction felt by Australians in being of substantial service at a critical time. ”

“ There is no doubt that the possession of money and goods by the Red Cross will prove of vast service in every campaign by reason of its emergency value. In fact the rapid expansion of No. 1 General Hospital during the crisis of May and June would not have proceeded with such smooth expedition had it not been for the large quantities of Red Cross stores which lay to hand and were instantly passed into the Quartermaster's department. ”

“ Where two different authorities exist, as in the case of the First General Hospital, a large amount of trouble and delay is almost certain to ensue. The adoption of the latter course is in our judgment absolutely essential if efficiency is to be secured.
As is invariably the case, weaknesses in any system are only revealed by costly experience. But while in the Australian Medical Service the experience need not have been so costly, we can at least profit by what has occurred, and frame a stronger and a better policy for the future.
Australian Convalescent Hospital, Al Hayat, Helouan. ”

“ The day has gone by when it is possible to exclude from the force a man who possesses dentures or defective teeth, and it is practically impossible to complete the work for the recruits before they leave. So it became necessary at No. 1 General Hospital to borrow two dentists [193] from the New Zealand Government, to fit them out with Red Cross money and goods, and in this way to meet informally the difficulty. Subsequently the Australian Government appointed a corps of dentists, and the problem was to some extent solved, though even now the demand far exceeds the supply. ”

“ The examination of recruits in Australia had been conducted by practitioners in country towns and elsewhere, often under conditions highly unfair to the practitioner. There is no doubt that the Government would have been well advised to have withdrawn a few men from private practice altogether, paid them adequate salaries, and made them permanent examiners of recruits. Experience of war demonstrates most completely the folly of sending any one to the front who is not physically fit. ”

“ What applies to civil life applies to a lesser extent to an army, because the headquarters staff of an army are as a rule excellently informed respecting the risk run by neglect of sanitation. They understand [86] thoroughly that disease may do more harm than battles, and that outbreaks permitted to get out of hand are with difficulty controlled. In the Australian Army, by reason of its necessarily scratch nature, there was practically no instruction in prophylaxis. ”

“ If the men themselves will let any who do not stick to this know what curs they think them in shirking the work for which it has been their privilege to be selected, then, I know well, any backslidings will stop at once—not from thoughts of punishments, but from good feeling, which is what we want. ”

“ I advisedly say 'the men must stop,' because I feel it is up to the men themselves to put a stop to it by their own good feeling. I wonder if they fully realise that only a few days' sailing from us our fellow-countrymen are fighting for their lives, and fighting as we have never had to do before, simply because they know the very existence of their country is at stake as the result of their efforts. ”

“ The officers immediately parade the men, address them, and convey to each of them a printed message from General Birdwood. General Birdwood's letter to General Bridges, written during the early part of the stay of the Army in Egypt, is handed to the Commanding Officer to be read by him and his staff. There is no doubt that this systematic procedure has drawn attention to the [90] gravity of the problem. It has always been responded to loyally by the officers concerned, and it has certainly limited the action of young and inexperienced men on their first landing in an Eastern country. ”

“ The Registrar, as the principal executive officer of the hospital, whose business it is to carry out the decisions of the Commanding Officer, is at present invariably a medical officer. The greater part of his work does not need medical knowledge, and the difficulty might be obviated by the adoption of one of two methods. Either the Registrar might be an educated business man or he might have such a one as his immediate understudy. ”

“ During the crisis of May, June, and July, a visitor could witness an eternal procession of trains discharging wounded at Heliopolis, of trains discharging wounded at Cairo for other hospitals, of sick being moved to and from the different hospitals in Cairo, and convalescents from the various hospitals being sent to the Cairo station for Alexandria or to the Bab el Louk station for Helouan. Without an adequate supply of motor ambulances such an organisation would have been impossible. ”

“ In March and April, before the arrival of wounded, the number of cases in hospital was a source of common comment amongst the medical officers, who could not understand why healthy men under service conditions, camped on the edge of a dry desert, should be suffering from serious disease to such an extent. The diseases were for the most part measles, with its complications, bronchitis, broncho-pneumonia, and a certain amount of lobar pneumonia, infectious pleuro-pneumonia, and tonsillitis. There were a few cases of cerebro-spinal meningitis. ”

“ Nothing the Australian Red Cross has done (or is likely to do) is more important than the establishment of the Soldiers' Clubs. Nothing has been more successful or is likely so to redound to the credit of that great institution. And yet, under the new Constitution of the Australian Red Cross, not a shilling can be devoted in the future to such purposes. ”

“ But of the prophylaxis of disease they have little trained knowledge, and they are not seriously interested. The prophylaxis of disease really implies organised and co-operative effort, and can only be effectively undertaken by those public-health officials who are charged with it as a definite function. In Australia at all events the inducements to enter the public-health service as a profession are not very great. The influence of the department is not very far-reaching, and the prophylaxis of disease is still in its infancy. ”

“ In time of war there is no doubt that invalided combatant officers would do very well, but no combatant officer would want such a position in time of peace, because there would be no subsequent career available. To effect a satisfactory solution of the problem it would be necessary to add to the establishment of a base hospital three non-medical commissioned officers of the same rank as the Quartermaster, preferably former Sergt.-Majors who have obtained commissions and who consequently know the details of hospital administration thoroughly. ”

“ The object of the Red Cross has never been to supply in any large quantities the goods which the War Office sends to the wounded, but it does its best to provide the troops with such things as the War Office does not supply at all or cannot supply at a given time. A State Department, bound as it rightly is by hard-and-fast rules, cannot work as quickly as a private body with more elastic regulations ”

“ A number of medical officers accordingly gave instruction to their men in the means of effecting prophylaxis and of preventing infection in the event of association with these women. The medical officers acted entirely on their own responsibility. They advised the men to avoid the risk, but as they knew a certain number would not take their advice in any circumstances—in fact the men said as much—they showed them how to avoid infection if they would take the necessary trouble. ”

“ So long as a sufficient number of men determine to adopt this policy, and so long as there is a sufficient number of women prepared to cater for them, the problem of venereal disease will continue to be acute in every country.
The opinion has been expressed elsewhere that the world will not be rendered more or less moral by the abolition of venereal disease, and instruction in the mode of preventing infection should be an [128] essential part of education. Because people are immoral there is no reason why they should acquire gonorrhœa or syphilis. ”