The Red Cross Policy: Wanted, a Definition
Before leaving consideration of the details of the Red Cross question, attention should be directed to the numerous changes in the policy adopted by the British Red Cross Society, Australian Branch. No less than three different types of administration were rapidly adopted. It was first placed in the hands of Surgeon-General Williams and the High Commissioner for Australia, in London; then it was placed under a committee in Egypt formed by the High Commissioner for Egypt, Sir Henry MacMahon, and six weeks later two Commissioners were appointed to take the work over. Nothing more clearly illustrates the state of mental instability in which a first experience of war had thrown the population of Australia. The policy which was adopted by Surgeon-General Williams in connection with the Red Cross administration is that which we believe to be sound.
When acting as A.D.M.S. to the Australian Force in Egypt it became my duty (Lieut.-Col. Barrett) to sanction or modify the requisitions of medical stores for the various hospitals and units, and the instructions conveyed to me were that I could sanction any requisition provided that it was reasonable. If, however, it represented a new departure it must be authorised by the D.M.S. Egypt. This meant practically that everything could be obtained from Ordnance, and many of the Red Cross supplies became superfluous. That is to say, any necessary goods in the Red Cross store were utilised, but if they had not been there the Government would have purchased them. In fact, it reduced the field in which the Red Cross could operate to comparatively small proportions. There is no doubt that, had it become necessary, I should have authorised the erection of shelter sheds and recreation huts in the various hospitals as a medical necessity. There was one advantage, and one advantage alone, in effecting these changes with the aid of the Red Cross. The action if sanctioned by superior officers could not be challenged by any one else at the time, and could be effected with extraordinary speed.
I took the view that it was the business of the Officer Commanding the hospital, with the aid of the matron, sisters, and medical officers, to let me know what was thought necessary, and unless the requirement was outrageous it was immediately supplied. As a matter of fact no single request for money or goods was ever refused or seriously modified. Owing to pressure of public criticism another policy began to make its appearance. It was asserted that it was the duty of the Red Cross officer to visit the various hospitals to find out what the patients ought to receive. It will be seen that such a policy removed from the O.C.s of the hospitals, or any one to whom they may have delegated their powers, the responsibility for determining what patients should receive. Such a policy sooner or later must result in the creation of an army of people who are worrying to find out what they can do instead of being properly instructed by those responsible for the welfare of the patients.
It further tended to place in the hands of irresponsible people some control over the medical management of hospital cases. If lay visitors can enter a hospital and provide food for patients, they may next wish to provide drugs, etc. It seemed that the policy laid down in the first instance was sound, useful, and healthy.
When the Commissioners took office they made a number of changes in detail. They shifted the position of the store; they printed different forms of requisition, and they took the goods out of the quartermaster's store and placed them in a store in the hospital, presided over by a volunteer. The goods were then obtained by requisition from the sisters and the matron. But as the President of the Red Cross Inquiry Court pointed out, with one trifling exception the method was not really altered. The control had simply ceased to be military, and had become civil. Consequently a large staff of capable people were withdrawn from their ordinary occupations in Australia, and devoted themselves to an administration which had been hitherto effected entirely by the soldiers. We do not think that the change was right or desirable. It resulted in the creation of another body, not responsible directly to the military authorities, to do what is after all subsidiary work. The inevitable tendency will be for the Red Cross to take on function after function which should be undertaken by military authorities. The Red Cross is already supplying many articles which should be, and can be, supplied by Ordnance. For there is nothing that the Red Cross can supply that Ordnance cannot still more easily supply. It is quite true that the British Red Cross is managed on civil lines, and the British Red Cross supplies goods and does not supply money. But with a full knowledge of both systems we are strongly of opinion that the military method of management is in every respect preferable.
During the Red Cross Inquiry recently finished, to which allusion will be made elsewhere, day after day was necessarily spent by the Court in endeavouring to decide what Red Cross should supply and what Ordnance should supply. What does it matter so long as the patient receives the articles? It does not concern him where they come from, and if the whole is under military control there is no need for this sharp and artificial line of demarcation. We are of opinion that in general the functions of the Red Cross should be to supply those additional comforts and accessories which make sick life more tolerable, to supply any goods which may be donated, and to make helpful donations of money in the way already indicated.
The presence in the store at Heliopolis of large quantities of goods—sheets, blankets, pillows, and the like—which could have been supplied by Ordnance, enabled us to rapidly tide over a great emergency. 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. If, however, the supply had been under lay control, we can quite imagine circumstances in which argument, requisitions, forms, etc., might have seriously delayed operations.
Whilst on this subject reference must be made to the help afforded to the hospitals by Red Cross workers. Two schools of thought existed. Some Commanding Officers preferred to have no helpers, because of the trouble some of them gave. Others passed to the other extreme. Our own experience was that the workers organised by Mrs. Elgood were most helpful for the functions they undertook, with one or two exceptions, but those exceptional people gave a certain amount of trouble. They came not to help, but to criticise, and they carried their criticisms not to the Commanding Officer, but to the Australian public, and so caused trouble.
We are convinced that the Japanese method of organising the Red Cross is sound. It is organised and disciplined in time of peace, and when war is declared it becomes part of the army medical reserve and is mobilised for service. Every one is under military control, and consequently these crudities are avoided. If we were to repeat our experience we should have welcomed the visitors, but insisted that they should be under some measure of discipline, and that a serious breach of regulations should be followed by their withdrawal. In some instances visitors wrote to the Commander-in-Chief, and complained of the food the patients were getting. The Commander-in-Chief sent the letters on to us, and we then brought the visitor in contact with the Commanding Officer of the hospital, and the complaint was investigated. How much more direct and simple it would have been if the visitor who saw something he believed to be wrong had immediately asked for the Officer Commanding! But the "secret and confidential" candid friend is apt to become somewhat of a pest.
There is another and more serious aspect of the matter. 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. On one occasion green melons were issued to a large number of sick men by kind-hearted visitors. The men became so ill that the medical officer confiscated the melons, made inquiries, and only then ascertained the source of supply. A strong-looking soldier on a milk diet might evoke the sympathies of a lady visitor, who lodged a complaint regarding the supply of food, but the nature of his disease and the method of treatment adopted by his medical officer are surely the principal consideration. As everything conceivable in the nature of food and drink can be supplied through these diet sheets, the obvious course is to pass all Red Cross foodstuffs directly into the Quartermaster's department to be distributed in the ordinary, and the only safe, channel. This was the practice followed at Heliopolis.
The following articles were supplied in this way at the time of expansion, and show what assistance a properly controlled Red Cross system can render.
QUARTERMASTER'S REPORT BY LIEUTENANT P. E. DEANE
Assistance rendered the First Australian
General Hospital by Red Cross in Hospital
ExpansionApril
Skating Rink opened.
Abbassia Venereal Diseases Hospital opened.
Casino Infectious " " "
The following were obtained immediately on requisition on Red Cross:
May
Great rush of patients—Luna Park expanded, Palace Hotel expanded.
| Patients admitted in four days from | |
| April 29 to May 2 | 1,543 |
| Patients admitted during May | 2,650 |
Red Cross Supplies
| Sheets | 1,381 |
| Blankets | 1,038 |
| Towels | 4,394 |
| Pyjamas | 1,176 |
| Shirts | 238 |
| Handkerchiefs | 500 |
| Face washers | 1,000 |
June
Rush of wounded continues. Atelier occupied, Sporting Club commenced.
| Patients admitted during June | 2,862 |
Red Cross Supplies
| Pyjamas | 790 |
| Face washers | 1,000 |
| Sheets | 900 |
| Towels | 1,500 |
| Sponges | 1,500 |
| Handkerchiefs | 1,500 |
| Cotton shirts | 950 |
| Socks | 1,000 |
| Slippers | 500 |
| Pillowslips | 1,000 |
Special hospital organised hurriedly by the department on June 17. Ras el Tin Convalescent Home, Alexandria.
Red Cross Supplies
| Socks | 1,000 |
| Shirts | 1,500 |
| Pyjamas | 750 |
| Sheets | 750 |
| Blankets | 750 |
| Pillowslips | 750 |
| Face washers | 1,500 |
July
Wounded still pour in. Sporting Club increased by addition of tennis court wards, Atelier and Luna Park accommodation increased.
| Patients admitted in July | 2,194 |
Red Cross Supplies
| Sheets | 2,000 |
| Slippers | 1,000 |
| Pillowslips | 3,400 |
| Blankets | 1,900 |
| Shirts | 2,000 |
| Handkerchiefs | 2,000 |
| Towels | 3,000 |
| Socks | 3,400 |
| Face washers | 3,000 |
August
Choubra Infectious Hospital hurriedly established and equipped by the department; 400-bed tent hospital added to Sporting Club.
Red Cross Supplies
| Blankets | 2,000 |
| Cotton sheets | 1,800 |
| Towels | 1,700 |
| Handkerchiefs | 2,400 |
| Face washers | 2,300 |
| Socks | 2,800 |
| Pillowslips | 214 |