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 experience gained in connection with the establishment and extension of the First Australian General Hospital suggests modifications which should immensely increase efficiency. A base hospital modelled on the R.A.M.C. pattern may work exceedingly well in times of peace, or when staffed by R.A.M.C. or I.M.S. officers who have devoted their whole lives to the work. But base hospitals constructed during a great war, and staffed almost entirely with civilian elements the majority of whom are untrained in administration of any kind, do not work in all cases with the necessary degree of smoothness. It certainly does appear that changes in the base hospital establishment might be introduced with advantage.

In the first place there arises the question whether it is necessary for the Commanding Officer to be a medical practitioner, or whether, as in the case of the convalescent hospitals, he might be a combatant officer, or at all events a non-medical officer. The general consensus of opinion is that he should be a medical officer, though there is a great deal to be said on the other side. Almost the whole of his work is administrative, though he necessarily must have a good knowledge of clinical methods. But unless such an officer be selected not simply with regard to seniority, but with regard to experience in administrative methods, and unless he be tactful and watchful, troubles are very likely to ensue. His task is beset with difficulties if he possesses character and insists on efficiency. Whatever doubt there may be, however, about the Commanding Officer, there need be none about many of the other positions. A noteworthy feature of the First Australian General Hospital was the continual complaint from the medical officers that they had not come away to do administrative work. This distaste for administrative work was a constant source of trouble.

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. In the latter event a very small portion of his day would be taken up with the duties of the Registrar's office.

Similarly the orderly officer, whose business it is to deal with details concerning the rank and file, is usually a medical officer, and in some hospitals it is the practice to change this officer from day to day. At No. 1 General Hospital, however, his functions were so important that one medical officer was permanently told off to do this work. There is no doubt that the orderly officer need not be a medical officer, and might well be an invalided combatant officer, transferred to the army medical service.

Owing to modern developments another officer has made his appearance who is not provided for in any establishment—that is, the transport officer. Motor transport has become so large a portion of the work of the base hospital that a special officer is requisite for the purpose. There is no reason whatever why such an officer should be a medical man.

If these changes were made it would result in releasing at least three officers for clinical purposes.

The amount of clerical work that was necessitated by the returns furnished to the War Office, the Australian Government, Headquarters Egypt, and other departments was so great that a large staff of very competent clerks was required. The future establishment should certainly include not only a number of trained stenographers, but some one versed in statistical work. The lessons to be learned are so numerous and so important that something of the kind should be done. Furthermore, in the Quartermaster's department there was a demand not only for stenographers, but for men who had been accustomed to the methodical ways of a large warehouse.

Were all these changes made there is no doubt that the efficiency of the administration would be increased and the burden of the work lightened.

As regards clinical work other desirable changes might be made. Senior men who have been in full practice, and who come to a base hospital as physicians or surgeons with the rank of lieutenant-colonel, are apt to be entrusted with the detailed administration of medical or surgical wards. They are often unfitted by training for such administration and are frequently disinclined to undertake the work. 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. Our own feeling is that in such a position they would be far more comfortable and would be more efficient.

On the subject of specialists there is much to be said. It is almost incredible that a base hospital should have been formed without being provided with an ophthalmic and aural specialist. The change has been made since war began, but it seems inconceivable that any one should have contemplated the efficient handling of wounds and diseases without such aid. At the First General Hospital the ophthalmic and aural department was the largest and most heavily worked department in the hospital, partly owing to the fact that one of us had been appointed Consulting Oculist to the Forces in Egypt, and that much of the work consequently centred at Heliopolis.