Beyond the western boundary of the hospital, behind the officers' tents, lay an oriental garden. An oil engine and pumps at the river's edge supplied the water to it through channels. The machine was worked by an Arab who, as far as one could tell, prayed to it. In the garden, full of moist heat and splashes of colour, lived a colony of jackals, those extraordinary spirits of hell, whose wailing and hysteria are so amazing. I do not know how Darwin would have accounted for the particular note they strike. It is probably on a level with the roaring of the lion, in that it is designed to terrify. But the jackal does not terrify by such obvious methods as the lion. He plays on your eerie, ghostly, superstitious side. He brings up into the imagination the malignity and hopelessness of the damned. He seems to people the night with wailing horrors. To a man dying of thirst in the desert, the jackal must just give the final touch of despair that makes death and nothingness seem best. It must be strange to die, surrounded by jackals at their chthonian litanies.
Shortly after we reached Amara, the news came that Sir Victor Horsley had died. It was in a season of extreme heat, when death comes suddenly in many forms. Eighty officers attended his funeral in columns of fours, the most junior in front. He had a coffin. Wood was precious in Amara. There were some other bodies sewn up in army blankets. A long, dusty march of a mile to the cemetery, a shallow earth grave, a brief ceremony, the same for all, and a weary tramp home in the sun—that was the final picture. There is one detail to add, and that is the lovely playing of the "Last Post" over the graves. In him we lost the finest surgeon in Mesopotamia.
For many days after this we moved about as it were in a vast furnace. The nights were broken by sand-flies. Personally, I found the only way of keeping them out was to wear socks on the feet and hands, and smear the face and neck with some kind of ointment, on which their feet slip, so that they cannot find a purchase when in the act of driving their sucking apparatus into the skin. In the morning, what with the sweat and the grease, and the tropical exhaustion, one looked like few things on earth. Oil of citronella is only of temporary use; paraffin and creosote are of little good. Butter muslin nets are out of the question, as the heat is stifling under them. The burning of aromatic or pungent compounds is useless, and as for killing them, one might lie awake all night, scuffling and dabbing and slapping at the almost invisible forms without gaining the slightest benefit. In the day time they hide in cracks in the ground, under bits of matting or anywhere out of the sun. Sand-fly fever is a malady that begins like influenza. One aches all over. All the side of life that is enjoyment fades away. It is impossible to smoke, or eat, or drink, or read, or talk. In Malta, where it is indigenous, a convalescence of three weeks is allowed. It was not possible to allow that in Amara. The fever lasts two or three days, coming down in two main stages. The use of opium is recommended. As regards the use of opium in Mesopotamia, it was possible to gain the idea from actual experience that it was a most valuable drug during the hot season. If limited to three drugs and no more, for work in that country, I should prefer opium, Epsom salts and quinine. The quinine that we obtained through official channels was in the form of pink tablets and came from the cinchona plantations at Darjeeling that are run by the Indian Government. These tablets are coloured pink to prevent fraudulent selling, for they are handed out to natives in malarial districts in large quantities, free of charge, and natives are not great believers in medicine. The tablets are extremely hard and insoluble. Prolonged exposure to the action of dilute mineral acids produces no effect on them. We had, for the men, quinine parades, when five grains were swallowed as a prophylactic against malaria every day. They were amusing affairs to watch—serried ranks with water-bottles, standing to attention while the sergeant dispenser walked with proper dignity down the line handing a pink tablet to each man, who gulped it spasmodically, took a draught of water and returned to attention. It reminded one of a religious ceremony, of some strange communion service. In giving the quinine in large doses it was essential to dissolve it, if any effect was aimed at. Even then it rarely produced symptoms of quinine poisoning. The home preparations were more satisfactory to use. As regards opium, it was useful, apart from sand-fly fever, in those frayed, sleepless states of mind that prolonged heat induces. The English idea that a dose of morphia or laudanum at once induces the opium habit, though very safe, is not altogether sound. Other hypnotics were usually not strong enough to give long sleep; but here, to produce an effect with hypnotics, it seemed necessary to double the dose. This may have had something to do with some deterioration in drugs caused by the big demands of the war. But I do not think it was the only explanation. Of course, for those who dreaded the use of opium, and preferred chloral or bromide, it was only necessary to glance into the tents where the Chinese carpenters slept at night. There one saw rows of comatose figures and if you cared to lift the lips from the gums of those sleepers, you would usually see a little sticky mass of opium wedged in between the teeth. That was one way of solving the problem of sand-flies and heat at night and no doubt an admirable illustration of the dangers of the drug. But it is possible to find illustrations for everything.
At Amara, paratyphoid A was commonest in the troops coming down from the Front. It was not a very grave disorder, but sometimes, particularly when complicated by other factors, it was fatal. It must be remembered that many patients reached us as emaciated skeletons, in the last stage of exhaustion. Special wards were set aside for typhoid cases. Dysentery was also increasing, and wards were reserved for these cases. It was mainly what is called bacillary dysentery, for which Epsom salts is one of the best remedies. All typhoid cases, as soon as convalescent, were sent to India. That was because they often carry the germs in the intestinal tract a long time after recovery and therefore may become a source of infection. They spent on an average three months in India before returning for service. There was no place in Mesopotamia where convalescent patients could be sent with a reasonable prospect of gaining full health. About twenty miles beyond Aligarbi lie the Pashtikhu hills and there in those high altitudes a big military sanatorium might have been established. This would have saved endless transport difficulties, if a light railway had been constructed. But no doubt the military situation rendered the carrying out of such an idea impracticable. Heat-stroke in Amara was common enough, but it did not seem so fatal as at Basra. This, perhaps, was due to the air, which was drier and fresher. The supply of ice was also more adequate.
We had some unlucky spells. It is a curious thing that luck seems to enter into the matter of death rates. I mean that sometimes for two or three days at a time cases seemed to go wrong and die, on the slightest provocation. At other times, when the luck changed, the most hopeless cases would clear up. It was the same way in the operating theatre. It is the same way with everything, whether it be card playing, or business, or war, or love, or thinking, or sport. There are phases in which something seems to overshadow the scene. The direction of the current changes. For a time everything seems to go wrong. The machinery behind life, that is always helping you on, stops and reverses. And there is another aspect of the same thing which doctors sometimes see in a remarkable way. It is the occurrence of similar kinds of cases at the same time. For part of it there is the scientific explanation of infection by germs.
Ezra's Tomb.