The Australian Army Medical Corps in Egypt / An Illustrated and Detailed Account of the Early Organisation and Work of the Australian Medical Units in Egypt in 1914-1915

by Sir James W. Barrett; P. E. Deane

The Fly Pest

At the Island of Lemnos, however, which was not under fire, and where there was room, the conditions appear to have been nearly as bad, and it is somewhat difficult to know why the fly pest could not have been got under at Mudros. At Heliopolis at an early stage the fly problem was seriously tackled. A sanitary officer was appointed, and charged with the duty of dealing with this important matter. The following precautions were adopted. All refuse and soiled dressings were placed in covered bins, which were provided in quantity. These were removed once daily. Any moist ground in the vicinity of these bins was watered with sulphate of iron solution, and sprinkled with chloride of lime. Fly papers in great numbers were distributed throughout the wards. The food in the kitchens, whether cooked or uncooked, was kept under gauze covers or in gauze cupboards. By these means the fly pest was reduced to small proportions. But with the least slackness in administration the flies were again in evidence. It was most instructive to see a floor covered with flies if fluid containing food material had been spilled, and to see dirty clothing covered with masses of flies. A piece of soiled clothing half buried in the desert appears to act as an excellent breeding-place.

It was impracticable in Egypt to cover all the windows and doors with fly-proof netting. The exclusion of the air in the hot weather would have been troublesome, and the best type of netting was not obtainable. Furthermore the precautions already enumerated kept the pest under in Heliopolis.

The fly problem was one of the most serious the army had to face. The passage of a dysenteric stool by a man who is really ill was often followed by the entry into his anus of flies before an attendant had time to intervene. Each of these flies might then become a source of infection and had only to light on a piece of food, cooked or uncooked, to cause further damage.

Circular issued by the Officer Commanding
the Hospital
Destruction and Prevention of Flies

Outside.

1. No rubbish heaps will be allowed.

2. All manure heaps shall be sprayed twice a week with sulphate of iron—2 lb. to 1 gallon of water.

3. All food in the Arab quarters shall be kept in a closed cupboard.

4. All rubbish boxes and open receptacles shall be removed from the premises and neighbourhood.

5. No receptacles other than iron tins with lids kept closed will be allowed to be used for refuse.

6. Every place on which garbage has been exposed shall be freely sprinkled with chloriated lime.

Wards.

1. All food and receptacles for food shall be kept constantly covered.

2. All spit-cups shall be kept covered.

3. All remains of food shall be removed at once to receptacles which are to be kept covered completely and constantly except when uncovered necessarily to receive waste materials.

4. Sisters-in-Charge shall use a liberal quantity of fly papers. Surgical soiled dressings shall be placed in special bins which shall be kept covered.

Kitchen and Mess Rooms.

1. All food shall be kept locked up or completely covered.

2. All remains of food shall be treated as in the wards. The responsible officer shall use a liberal supply of flat or hanging fly papers.

It need hardly be said that the enforcement of even these simple precautions is more difficult than giving the order.

A good sanitary officer, however, acting on these directions, can and did reduce the fly danger to small proportions. The flies were never exterminated, but were kept well under. The least slackness, however, ended in their rapid reappearance. As they are in all probability the principal cause of the gastro-intestinal infections, the matter is one of the first importance.

Typhoid fever made its appearance, and a proper statistical investigation should be made later on to show the extent of the damage done. The general impression respecting the result of the inoculation to which all the troops were subjected was that the disease was not so frequent and certainly not nearly so fatal as it otherwise would have been. Deaths were few.

The men had not been inoculated against paratyphoid, so that exact conclusions will be difficult to draw even when figures become available.

Many people suffered from Egyptian stomach ache, a form of disease which is as unpleasant as it is exhausting. It manifests itself by repeated attacks of colicky pain, apparently usually associated with the colon. The severity of the pains is remarkable, and the persistent recurrence speedily ends in a considerable degree of exhaustion. 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. In the camps similar troubles occurred. By reason of the lack of cold storage and the high temperature, rotten food was not uncommon, and caused outbreaks of incapacitating diarrhœa and ptomaine poisoning.

When, however, the problem is surveyed dispassionately, the remarkable feature of the work at Heliopolis and in Cairo was the low mortality, as the following table will show:

Burials in Old Cemetery, Cairo
From Arrival of Australians in Egypt, December 5,
1914, to August 14, 1915

British Imperial Force	77
Australian Imperial Force	155
New Zealand Force	50

In view of this extraordinarily low mortality, it is interesting to comment on human intellectual frailty. It was said that the hospitals were septic, that operations of election could not be performed with safety, that the climate was particularly dangerous, and so forth. One letter which reached us made reference to hundreds of deaths of brave fellows due to faulty camp and hospital conditions. Yet here is the fact recorded that the total deaths in Cairo amongst Australians from disease and wounds to August 14 were only 155. All men tend to generalise on insufficient instances, and the tendency in this case was aggravated by some physical discomfort experienced by the generalisers throughout an unusually warm summer—a discomfort accentuated by overwork and a conscientious devotion to duty under trying conditions.