The New Zealand Medical Service in the Great War 1914-1918
Chapter XI. At the Bases in 1916
Chapter XI. At the Bases in 1916.
It was not without well directed effort and whole hearted enthusiasm that New Zealand had succeeded in recruiting, training and embarking some 30,000 men during the year 1916, a force equivalent to the whole of her peace time Territorial Force; in all, there had been despatched overseas some 60,898 men by the end of this year and there remained on the strength of the N.Z.E.F. at the end of December, 1916, 47,114 men with the division in France, with the mounted brigade group in Sinai, or at the bases in Egypt, England and France.
* The European population of New Zealand in 1916, was 1,099,044; men of military age: 243.376.
* Menigococcal infeciton in military camps during 1916. App. Parliamentary papers. 17
* The carrier rate of these trained men is stated to have been only 5 per thousand just prior to embarkation.
As early as January, 1915, the British Medical Association (New Zealand Branch), were desirous of doing something of a patriotic and practical kind in the national crisis, and with an assurance of substantial pecuniary assistance from the members, met in deputation the G.O.C. and the D.M.S. At this interview it was decided that the sum of money subscribed by the B.M.A., then over a £1000, would be best utilised in improving the accommodation for sick at Trentham Camp, which at this time consisted of a marquee with six or seven beds not provided with bed linen. The matter was referred to the acting Defence Minister, Sir Francis Bell, who approved of the motives of the subscribers. Meanwhile the fund grew and a party of ladies of Wellington district afterwards known as the Ladies' Military Hospital Guild, with Mrs. Luke, Mayoress of Wellington, as President, had offered to find all necessary beds, bedding, and linen for the hospital. After protracted deliberations in which three Government departments and the Minister of Defence were concerned, a contract was let by the 27th of April, for a sum of £2889, to provide a cottage hospital to be known as the Trentham Military Hospital, with accommodation for 18 to 20 beds. Of the inadequacy of this provision for a camp of 7000 men, the public of New Zealand were very soon aware when the first epidemic of cerebro-spinal meningitis broke out in 1915. The hospital was not then completed nor was it available for use until late in September of the same year. There was a good deal of feeling displayed against the Defence Department by certain branches of the British Medical Association about the delay in providing even the small hospital, the cost of which had been borne to a great extent by their subscriptions, in some instances individually very generous.* The epidemic provided the discontented people with a weapon to assail the Minister, who by the Statute was obliged to assume a single handed responsibility for all details of defence administration, not normally within the capacity of one man wholly to compass in war time, and which the Minister could not delegate to his subordinates.
* The late Major Savage, N.Z.M.C., of Auckland, subscribed £500.
The staff commanded in 1916 by the P.M.O., Lieut.-Col. Andrew, N.Z.M.C., an establishment calculated on a basis of 200 beds, was: 7 officers, one dental officer, 1 Q.M., 5 N.Z.A.N.S., 68 N.C.O.'s and O.R. N.Z.M.C. At the beginning of the year the D.G.M.S. had arranged that men rejected from the reinforce ments might be recruited to the N.Z.M.C, Home Service Section, and had also provided for their training at the depot at Awapuni and the usual examination for promotion. Frequent changes in the service owing to men transferring to other units and to drafts to the hospital ships was a cause of some lack of efficiency in the Trentham detachments, although from what may be gathered, the work, generally, was considered to be satisfactory. On the outbreak of the second epidemic, when the admissions to hospital amounted to over 800 for the month of July, further accommodation was required and the tea kiosk at the race course again came into use by the courtesy of the Racing Club, who were already finding accommodation for the medical officers and nursing staff, N.Z.A.N.S., in the trainer's quarters on the race course. Of the efficient and painstaking work of the whole medical staff during this trying period, there is ample evidence.
At the instance of the Minister of Health, at this time, the Hon. G. W. Russell, a Committee of Inquiry was set up late in August, 1916, to report on the conditions affecting the health of the troops at Trentham. The committee presided over by Dr. T. A. Valintine, Chief Health Officer for the Dominion, included Surgeon General Henderson, and Lieut-Col. Andrew, representing the Defence Department. It was found by the Committee that the sickness rate in camp was highest in those who had spent least time in camp and that the drafts nearing completion showed a more seasoned or less susceptible condition; or that men in the final stages of training were less liable to disease than recruits. 60 per cent. of the deaths were in men who came from the country districts; the country men suffered most as being most susceptible to measles, which seemed to predispose to both C.S.M. and pneumonia. No sanitary defects were found. The page 261provision of adequate drying rooms for clothing, hot shower baths, and well ventilated and not overcrowded huts with good drainage, faultless conservancy and an excellent dietary, gave assurance that internal sanitary conditions had no bearing on the disease. The Committee found that increased hospital accommodation was desirable, as there was evidence of cross infection in the crowded wards, for which reason they advised that new isolation blocks be provided so as to permit of segregation of the various types of infection, viz: measles, influenza, pneumonia and C.S.M. Further the Committee recommended the teaching of the elements of hygiene to the company officers and lectures to the men with the same object in view. The Committee expressed their admiration for the self-sacrificing work done by the medical staff.
It may appear from the above recital that there was a lack of forceful medical administration in 1916. As yet the D.G.M.S. was not permitted fully to control his department. We have seen that sanitation and military hospital administration were a function of the Public Health Department. That the question of hospital accommodation at Trentham was a matter not directly under the control of the D.G.M.S., although he certainly administered the personnel of the hospital. Further, we find the Minister of Public Health setting up a committee to investigate sanitary conditions in the Trentham Camp, a committee consisting of the very officers of the Health Department who were personally responsible for sanitary direction. The absence of any fully constituted General Staff, and the one man control of what represented the War Office, namely, the Department of Defence, to whom the G.O.C. and his staff were to a great extent subordinated, that and the dual control of medical arrangements could not make for smooth running and efficiency. The succeeding epidemics in the camps served to emphasise this lack of co-ordination in medical administration, which was inevitable under the conditions, but which, however disconcerting, was not in any way aggravated by lack of sympathetic understanding between the various parties concerned. As there were no N.Z.E. constructional services in New Zealand, both the Public Works Department and the General Manager of Railways, were concerned with the small matter of the cottage hospital at Trentham which became so complex a problem as to demand the attention of no less than three ministers, one important department and the Cabinet; a condition vividly recalling the difficulties of the medical services in England in the winter of 1854 during the Crimean page 262crisis. The good ship "Medical Administration," storm tossed on perilous seas, had too many strong hands at the wheel.
The medical arrangements made for the classification and disposal of invalids returning to New Zealand were complex; but above all extraordinarily sympathetic and humane. On the arrival of a transport or hospital ship, and prior to disembarkation, the invalids were inspected by a medical board consisting of a representative of the D.M.S., generally the local A.D.M.S, and a representative of the D.M.H., local health officer, holding honorary military rank, and the medical staff of the ship. The invalids were classified under the following heads:—
(a) | Invalids requiring immediate hospital treatment; |
(b) | Convalescents for treatment at Hospitals or Convalescent Homes; |
(c) | Convalescents fot to proceed to own homes; |
(d) | Men returned invalided, but now fit for duty; |
(e) | Any other category such as:—permanently unfit but not requiring hospital treatment. |
The classes (a) and (b) came immediately under control of the Minister of Health; the classes (c) and (d) under the D.G.M.S., whereas the last category (e) passed into the control of the Repatriation Department and, or, the Pensions Department. Railway passes were provided to the port of disembarkation for the next of kin in every instance; and the transport of the stretcher or walking cases was undertaken by the St. John Ambulance Societies and the New Zealand Motor Service Corps, a volunteer military formation. Ambulance trains were in waiting and on these trains the next of kin of the more serious cases were often allowed to travel. Both cot cases and convalescents for hospital were transferred to the nearest public hospital in their own district so as to be close to their homes; and in the case of convalescents granted sick leave. Facilities were provided for medical treatment, where required, by the local territorial N.Z.M.C. officers with certain restrictions as to duration of treatment imposed by the D.G.M.S. and supervised by the A.D.M.S. of the military district, who, in the case of further hospital treatment being required, boarded the patient and handed him over to the Public Health Authorities. The D.M.H. now made all necessary arrangements except the issue of railway warrants, a function of the O.C. district in all cases of transfer. The average cost of maintenance in public hospitals was 5/- per diem which was charged to the Defence Department.
page 263The early history of one of the chief military hospitals, King George V. Hospital, is associated with a period in 1916 during which the Rotorua Sanatorium, a balneological station in the hot lakes district under the control of the Tourist Department and provided with a medical superintendent, became a convalescent depot for returned invalids of the Auckland District. For reasons of discipline it was early found that some military control should be exercised at this depot The Superintendent, Dr. Herbert, was therefore given military rank as Hon. Major N.Z.M.C., a combatant officer, Colonel Newall, and some N.C.O.'s and details, in all 20 N.Z.M.C. were posted to the Sanatorium early in 1916. There was then a total of 150 beds available and a new polygonal block had been erected at Pukeroa Hill, which became the nucleus of King George V. Hospital, of which Colonel Newall was first commandant.
At Hanmer, also a Tourist Department Sanatorium in the vicinity of hot mineral springs in the South Island, somewhat similar arrangements existed. And at Lowry Bay in Wellington Harbour, a fine house lent by Sir Francis Bell, Attorney General, was used as a convalescent home, controlled by the Red Cross Society.
The importance of an efficient dental service for war had been recognised in New Zealand from the outbreak of hostilities,— dentists, as we have seen, were attached to the Samoan Force, the Main Body and the reinforcements. The Dental Sections with the Division had been organised by the Dental Administrative Officer now on N.Z.E.F. Headquarters. Dental work in the camps in New Zealand had increased enormously; large numbers of recruits were still being rejected by reason of dental defects, which meant a serious loss of man power. Recognising that no recruit should be refused for dental defect only and also that it was necessary to supply dental officers to the N.Z.B.F. at the base and overseas, the New Zealand Dental Association, in June, 1915, made a patriotic offer to the Government to treat all recruits gratuitously as far as time permitted, a charge for material only being made. This offer was accepted and for two years the dentists of New Zealand continued to give this valuable service. Dr. H. P. Pickerill, M.D.,1 who held the Chair of Dentistry at the New Zealand University Medical School in Dunedin, and Mr. T. A. Hunter, a prominent dental surgeon, were requested, in 1915, to furnish a report on the dental treatment provided for recruits in camps of training.2 And shortly page 264after the arrival of Surgeon-General Henderson, a Dental Corps was devised which came into being at the end of 1915. The corps consisted of: administrative officers; executive officers who with the mechanics formed the base clinics; the Dental Sections with the N.Z.E.F. units overseas; and lastly, civilian dental surgeons employed in military districts in so treating the dental defects of recruits as to make them dentally fit before going into camp, and in looking after returned soldiers. In all this work the Dental Association gave willing help. Mr. T. A. Hunter became Director of Dental Services on Headquarters at Wellington, and under his energetic administration the reinforcement camps were supplied with large dental clinics staffed with a liberal number of N.Z.D.C. officers, N.C.O mechanics and O.R. who were able to ensure that all drafts leaving were dentally fit. The work included dental prophylaxis and a vigorous propaganda, a moral tooth brush drill, which had a wide effect in keeping the men alive to the importance of oral cleanliness.
I have said that recruiting, even in 1916, was on a voluntary basis, but in August, 1916, the National Government of New Zealand, on account of the prolonged nature of the war and in order to avoid any possible delay in the regular despatch of reinforcements, decided to pass legislation providing for compulsory service.* The Military Service Act, 1916, provided for the formation and registration of a general reserve of all valid men natural born British subjects, between the ages of 20 and 46 years; but it was not until the very end of 1916 that the first draft of men drawn in the Ballot was called up. For the purposes of medical examination of recruits four medical boards of three officers each were constituted.
Of the base in Egypt in 1916, there is not much to be said: at present it consisted of a small camp at Moascar with a medical officer and an officer of the dental corps, and served the Mounted Brigade Group then in Sinai. There was a New Zealand Convalescent Home at Heliopolis, the Aotea Home; there were no other medical units than the Mounted Field Ambulance. The medical operations of this section of the N.Z.E.F. are dealt with in a separate chapter.
* The Military Service Bill in England, whereby voluntary enlistment was replaced by compulsion, passed the House of Commons in mid May, 1916.
During the month of May the whole of the headquarters units left in Egypt came to London, including the D.D.M.S., Colonel Parkes, N.Z.M.C., and his staff, and set up their officers in Southampton Row. A New Zealand Medical Board was appointed forthwith and negotiations were entered into with the New Zealand War Contingent Association with a view to taking over their hospital at Walton-on-Thames—heretofore a civilian institution controlled by a committee with Lord Plunket as Chairman—which had 350 beds and a present total of 200 patients. This, by the generosity and self-sacrifice of the New Zealand War Contingent Association was ultimately accomplished; and in August, Walton-page 266on-Thames Hospital became No. 2 N.Z.G.H. under the command of Lieut-Col. Mills, N.Z.M.C. Early in 1916, Major D. S. Wylie late of the No. 1 New Zealand Stationary Hospital had been appointed to the command of the N.Z.G.H. at Abasseyeh, vice Lieut.-Col. Parkes, appointed D.D.M.S. The whole unit sailed for England in the N.Z.H.S. Marama in June, 1916, disembarking at Southampton, and taking over Lady Hardinge'g hutted Hospital, originally built for the use of the Lahore and Meerut Divisions in 1915, at Brockenhurst in the New Forest, about 14 miles from Southampton. The main portion of the establishment was a hutted structure of two wings of 10 wards, each fitted with 36 beds, a central administrative block, and the usual operating theatre, X-ray room, dental surgery, and dispensary. In addition to this section two large hotels in Brockenhurst, already in use as hospitals were taken over: Balmer Lawn Hotel, about one mile from the headquarters having 200 beds, and Forest Park Hotel, with a similar capacity. The scattered distribution of the three sections was not conducive to ease of administration as it meant increasing the staff. From September 1916, the admission rate rapidly rose in sympathy with the Somme operations and in the last four months of the year the admissions averaged over 700 a month; the total admissions for the half year being 3,846, with 1,100 beds available.
At Walton-on-Thames, the accommodation was increased by marquees and a scheme of building which was to provide four hutted wards of 70 beds each; the total beds thus brought up to 1040. A staff was gradually built up from category men amongst the patients; by kindly assistance from the Canadian forces who lent nursing sisters; and by the employment of a large number of V.A.D.'s. Both N.Z.M.C. officers and O.R. reinforcements were at this time urgently required to replace casualties in France. During 1915, the War Contingent Hospital had an average bed state of about 90, but in 1916, after conversion, the average rose to 500.
With the arrival of the training battalions from Egypt, it became necessary to open a new unit for the infantry base: the Commandant, Lt.-Col. Smyth, A.D.C., N.Z.S.C., took over Sling Camp on Salisbury Plain as a reserve group or infantry base training unit. It was also decided to form a command depot for New Zealand troops at Codford. The Imperial Government had early found that a general base depot was unsuited to the requirements of category men, whose training must differ considerably from that of fit men. The British Command Depots were originally medical units under the control of a medical officer; the page 267inmates were provided with special treatment, by physico-therapeutic measures, massage, electrical treatment, mechano-therapy, special baths, and graduated physical exercises; the course designed as a stepping stone from convalescent hospital to infantry training depot. Later, these units were commanded by a combatant officer with a senior medical officer assisting. Lt.-Col. Brown, D.S.O., N.Z.S.C, took command at Codford Gamp where the New Zealand Command Depot was established. Captain Aubyn, N.Z.M.C., the first S.M.O., was succeeded by Lt-Col. Pearless, late R.M.O. Canterbury Battalion in Gallipoli. The standing board transferred 467 category men to this camp; the "A" class men, including the dysentery convalescents who had been detained for tests, were sent on to Sling by Army Council instructions.
No. 3 New Zealand General Hospital was formed at Codford by taking over an R.A.M.C. Hospital in the Command Depot, it had some 330 beds available, and by September was partly manned by us: Lt.-Col. P. C. Fenwick, N.Z.M.C. in command with several R.A.M.C. officers temporarily attached by courtesy of the D.G.M.S. A third medical unit to be formed in the United Kingdom in 1916, was the New Zealand Convalescent Hospital in Hornchurch. The Hornchureh depot, under the command of Major T. H. Dawson had been the equivalent of a Command Depot and Infantry Base Training Depot, where there was accommodation for some 500 men, mostly billeted out. It was inadequate to accommodate a convalescent hospital as well. Consequently the Command Depot and Infantry Base Depot were moved as we have seen, and the New Zealand Section of the Convalescent Camp at Epsom was transferred to Hornchurch, which now became the New Zealand Convalescent Hospital; Major T. H. Dawson, a combatant officer commanding, and Major H. Short, N.Z.M.C., as S.M.O. By September the Hornchurch Convalescent Hospital had been refitted and command was taken by Lt.-Col. Tewesley, N.Z.M.C., late of the No. 1 New Zealand Field Ambulance. Electrical fittings and apparatus for physico-therapy had been supplied; the hospital still had attached a V.D. section, and the Discharge Depot. The V.D. section, 167 patients, was in October moved to No. 3 N.Z.G.H. at Codford and Captain Brown, N.Z.M.C. wounded at the Somme took command of the section which he retained until demobilisation.
The formation of three new medical units and the necessity for staffing Sling and Codford was a serious drain on the N.Z.M.C. reinforcements: of the three general hospitals, only one had a full establishment on formation, the others had to remain for a time understaffed with unusual strain on the personnel. This was page 268especially felt at Walton-on-Thames; but the lowered rate of wastage in the months following the Somme operations gave these units some respite from work and ultimately all of them were more or less completely staffed with N.Z.M.C. officers, with the exception of the Command Depot where the S.M.O. for some time was very short handed.
The London Headquarters Medical Staff now comprised the D.D.M.S., N.Z.E.F., Colonel Parkes, the A.D.M.S. Base, Lt.-Col. B. Myers, the D.A.D.M.S., Major McKibbin, N.Z.M.C., and the chairman of the Standing Board, Captain Tapper, N.Z.M.C. Their work during the year had been arduous and the arrangements they had completed were satisfactory, except in one matter, probably wholly unavoidable: the scattered distribution of the principal medical units which were not even on one system of railway, but on several. Hornchurch and Walton were sufficiently near London to be administered with some ease, but the other hospitals and the Command Depot were so separated as to he difficult of access and transfer of patients was both costly and tedious. The ideal distribution, possibly, would have been to have had one large general hospital, say of 2000 beds, within easy reach of both the Command Depot and the Infantry Base on the same railway system as the Convalescent Hospital. And as the position of No. 1 New Zealand General Hospital was dictated by the necessity for proximity to Southampton, the principal disembarkation port for wounded and sick from France, theoretically the Convalescent Hospital and the Command Depot would have been better placed in proximity thereto. The administrative difficulties in segregating New Zealand soldiers in the large drafts of evacuations coming over by hospital ship to Southampton must have been very considerable for the D.M.S. embarkation, Surgeon-General Donovan and his staff, who could not guarantee that all New Zealanders would be despatched after disembarkation to a New Zealand hospital. Again the fact that the New Zealand hospitals with the exception of No. 3 New Zealand General Hospital did not receive Imperial or any other troops but their own, and the fact that special types of cases always went to special hospitals, led to a waste of beds so that at times when the division was not fighting the hospital beds were not fully employed.
In October 1916, there were, as the result of the Somme fighting, 4740 sick and wounded in England. Of these the New Zealand H.S. Maheno took 370 patients back to New Zealand during the month. The wastage from the division was now at the rate of 300 per week. During the first six months in France the division had sustained approximately losses to the extent of 2,250 killed; 7,750 wounded; sick, evacuated to England, 1000. The per annum wastage was now estimated at 23,000, of which 2000 sick; 25 per cent. of all cases evacuated became "C" class: the total repatriations of unfit estimated at 4,375 per annum. At the end of the year the strength of the N.Z.E.F. in England was 12,124, of which the main groups were distributed as follows:—
New Zealand Hospitals, patients | 1,764 |
New Zealand Convalescent Hospital | 1,473 |
Command Depot | 3,449 |
Sling Camp | 3,229 |
Staffs and Hospital Staffs | 453 |
There were 4,636 reinforcements available, of which 1283 were at the Overseas Base at Etaples.
1 Afterwards Known for plastic surgery of the jaw at Queen's Hospital (New Zealand section), Sidcup.
2 This at the instance of the Defence Minister who was instrumental in foundation the N.Z.D.C.