11-19 November 1914 (Excerpt 3)
After a short spell, Dr. Ollerhead, Surgeon Todd, and myself, with the assistance of 3 volunteers, got the theatre cleaned up with lotions, dressings, and instruments ready, and recommenced operations. The patient was a German with a shattered right leg, which was fractured and mutilated in the middle third. The wound was horribly offensive and alive with maggots, ¼ inch in length, gangrene had set in, and infection was spreading up the veins to the thigh. This was 36 hours after injury.
There was a tourniquet round his leg just above the knee, and though the man must have lost a good deal of blood, his condition was very fair considering all things. Under chloroform it was decided to amputate above the knee. This was done by anterior skin flap, and a modified skin and muscle flap by transfixion posteriorly. A good covering was obtained with a very satisfactory stump. Some difficulty was experienced in finding the large arteries, as they did not bleed freely on loosening our tourniquet. The patient was put to bed in the sick bay at 4 a.m. with two German sailors to watch over him. He began to kick the stump about on coming to, and had to be tied down. A large dose of morphia was administered, and we retired to rest after a cup of bovril at 4.30 a.m.
No sooner was I in bed than I was called up to this case and found him pulseless. Strychnine was administered and heart massage and artificial respiration tried without success. It was most disappointing, and I was unable to decide whether he had died from shock or from morphia poisoning. Possibly the latter as I had such disappointing results with our morphia previous to this case that I increased the dose. An injection into the vein after operation may have made a difference, but it was not available at the time of the operation, nor was it thought necessary.
Early on Wednesday morning the sick berth staff turned to and attended to a stream of less severely wounded, who had presented themselves at the sick bay. The remainder of the Germans who had got ashore at North Keeling Island, some of them wounded, were brought on board by a party from this ship, which on account of nightfall and the surf had been unable to return on Tuesday. We then returned to Cocos Island and landed Dr. Ollerhead, who was not able to come on with us. I cannot lay too much stress on the great assistance so generously afforded by the Eastern Extension Co’s Surgeon. He was always cheery and energetic throughout the 24 hrs he was with us, and he kindly left behind some instruments, lotions and dressings, which were most useful to me in after treatment. We then set sail for Colombo at 20 knots, much to our relief, having had to spend some 48 hours round the Emden after the action. We attended to the last batch of German wounded, only two of which were serious cases. One was put on the table in the forenoon, the other later in the afternoon.
After breakfast, “F” A.B. was the first case. Of course, he and many others should have been done before, but it would have taken at least 6 fully-manned operating theatres to have dealt with the cases as they required. This A.B. had the distal half of his left foot shattered by a bursting shell. Besides, there were numerous fragments buried in the tissues of the left leg and thigh. The outer side of the sole of the right foot was furrowed down to
the metatarsals and one toe was carried away. With Surgeon Todd as anaesthetist and S.B.S. Mullins as assistant, we cleaned up the wounds which were by now quite offensive, with hydrogen peroxide, alcohol and iodine, removing metal where possible, and draining the wounds. The left foot was amputated at the transverse tarsal articulation, sufficient sound tissue having been obtained from the sole to make quite a satisfactory covering. The case took some time owing to the number and state of the wounds. A drainage tube was left in the stump, which healed quite quickly. The patient has since been pronounced convalescent. During the operation the German Surgeon was attending to the dressings of his fellow countrymen on the waist deck, where they were taken after operation. The sick berth attendant was overcome and had to be sent on deck for an hour to recover. All this added to our difficulties, seeing that 50 per cent of our staff was “hors de combat”.
We next had “C” A.B. taken to the sick bay for operation. Dr. Luther (German surgeon) was anaesthetist and Dr. Todd assisted. This man besides having a hole in his left buttock and through the left palm, had various shell wounds all up the right leg, and a minute splinter had entered his right eye through the upper lid, carrying a minute fragment of the orbital bone into the eye and disintegrating that organ. I had hoped to be able to leave this case for a specialist in Colombo, but the eye became inflamed and swollen and a large amount of pus collected in the orbit, so that it was decided to remove the organ. On account of the antiquity of the service eye instruments it was impossible to remove the eye through the optic nerve, so I had to be content with cutting away the anterior portion of the globe, syringing out with weak antiseptic and draining the orbit with iodoform gauze. This temporary treatment saved any spread of the infection to the meninges, and the patient did well. On arrival at Colombo I advised further surgical treatment by a specialist, and the patient is now reported to have left the hospital convalescent. The next case was a German whose left forearm had been mutilated. Bellies of muscle had herniated through the skin, and both large vessels had been severed. A tourniquet placed on the lower third of the arm, had saved the patient from bleeding to death, but necessitated amputation of the arm. The German Surgeon now relieved Dr. Todd as anaesthetist the latter being unwell, had to go and rest awhile. S.B.S. Mullins ably assisted at the operation of circular amputation of the left arm. A drainage tube was inserted into the wound, and the stump healed with slight sepsis. This man refused operation at first, but eventually consented on the advice of his messmates and the German Surgeon. The next case was similar to the above only his forearm was even more damaged. He had managed to get a tourniquet placed round his arm, and was later blown overboard. He succeeded in swimming ashore through the surf and was brought off to this ship after being ashore for 40 hrs. Besides the above injury, he had a large septic flesh wound of the left thigh, which after became erysipelatous.
By the time he got to us his wounds were in a shocking condition and were crawling with large maggots. The patient was weak from loss of blood and exposure, and his life was saved on shore by our party, who gave him coconut milk through the night. His constitution was wonderful and his stature and physique were magnificent. He appears to have been the only man on the upper deck saved. Under chloroform, with Dr. Luther as anaesthetist and Surgeon Todd as assistant, circular amputation in the middle of the arm was performed. The case was somewhat more difficult owing to the great muscular development of the arm. A satisfactory stump was obtained which healed well, but for 3 days the patient ran a very high temperature, due to the erysipelatous wound in his left thigh. The remainder of this day (Wed.) was occupied in cleaning up and dressing wounds and putting up fractures, most of them under anaesthesia. At midnight we went to bed after a spell of over 40 hours without sleep. Early on Thursday morning minor injuries were attended to in the sick bay until breakfast. In the forenoon we did general cleaning up and dressing wounds under anaesthesia, and we opened up a knee-joint which had become enormously enlarged through an accumulation of pus not 3 days after receiving a small wound on the knee. A tube was inserted into the joint after free incision and much pus was drained away. By night we had finished off all the operations and the bigger work, as far as initial treatment was concerned, but we had by no means been able to take to the theatre all the cases which required careful and thorough attention. They simply had to be left to the tender mercies of the first aid party.
All this time we had to organize and arrange the hospital with its equipment, and the feeding and nursing of the patients. Up till now this had to be turned over to the first aid party, and they received the cases straight from the theatre. In the case of the Germans, we had a party told off from the prisoners to help our staff. We had two large wards, the Wardroom and the waist deck, and various special wards – a few cabins given up by the officers. Our wounded were in the Wardroom and were sometimes carried on deck, as it was very hot below. The Germans filled the waist deck and though cooler here, they were regularly washed down with heavy rain, despite the extra awnings and side curtains, and sweepers told off by the Commander. A special party, under the Chaplain, was told off to look after the feeding of the patients. The moving of the patients to and from the sick bay was considerable, and in consequence of narrow hatchways and doorways, combined with limited space, it was rather awkward work. The stretcher parties were kept very busy. By Thursday night one could look round with a feeling that some impression had been made on the work before one, and late that night the German Surgeon and myself sorted out the cases we proposed to send off next day to the “Empress of Russia”, an armed liner which had been despatched to help us with the wounded, and to relieve us of some of our extra 230 men. By 10 a.m., this ship joined us and we had all the wounded ready for transhipment. Fortunately, the weather was calm, and about 60 patients besides 100 prisoners had been moved within two hours. We sent over all the cases who could walk and about 25 to 30 cot cases.
But for the fact that we had to wait for our cots to be returned in order to send over more patients, the work would have been finished much quicker. We also got rid of 18 Chinamen, the crew of the sunken collier, and we had now more clear space on the decks for the wounded we had kept – 25 in all. I kept back all our own wounded men and the severest of the Germans, including the cases we had operated on. It was thought inadvisable to move these, and though the “Empress” had fine accommodation and plenty of bedding she had only two surgeons and one S.B. rating.
A fresh supply of blankets was obtained from this ship, and I had most of our bedding and blankets thrown overboard, as they were most horribly filthy, foul and offensive, and we had no chance of disinfecting them for some time. Having now more space and things being much straighter and cleaner, we could look after the remaining cases better, and were able to take down the dressings of and examine the cases we had done earlier in the week. Some of them sadly needed it. Between now and Saturday night we had every case thoroughly overhauled and were able to discharge them on Sunday in a fairly clean condition, though most of them were more or less septic. During these six days the ship was in a filthy condition and was stinking in all parts adjacent to the wounded. This was due to the foul wounds and the fact that the hot damp climate tended to rapid decomposition. We had the decks washed every morning with sanitas and each patient who could be was moved with his bedding and replaced when his position was dry. We arrived at Colombo at 10 a.m., Sunday morning, and after much delay from the shore, the military took over the wounded, depositing them in the Military Hospital till that was full, and then sent the overflow to the Civil Hospital. After the wounded left, the ship was in a most insanitary and dangerous condition and it was some days before she could be cleaned, as we were coaling for 2 days.
The corticene decks of the Wardroom, Sick Bay, and starboard corridor had to be scraped, as they were thick with semi-solid marine glue, which had been unavoidably fouled by dressings and discharges from wounds. All these places were then scrubbed out and next day the Colombo health authorities were brought off and they sprayed out with Cyllin the whole of the living places of the ship. It was only with reluctance and difficulty that I could get this done because the Captain did not attach sufficient importance to it and was most anxious to put to sea as soon as we had coaled. Even then it was very hurriedly done. There was only a slight attack of septic throats after but I was most frightened of an outbreak of erysipelas which fortunately did not occur.
Some of the remaining bedding was destroyed; the rest with the blankets, were put through the steam disinfector, and numerous heavier articles, such as gymnasium mats, which had been used as beds, were sent ashore to be disinfected.
At 9 am Thursday we left Colombo after having gone through a very trying ten days, and the whole of the staff was worn out and could very well have done with a rest. Instead of which we put to sea and had another operation the first day out.
It would be very difficult to imagine a more trying set of circumstances for the medical staff of a cruiser, and an action where so many wounded would be rescued. Had the Emden sunk before she reached the beach, our work would have been
just halved, as many wounded must have drowned. Thus we had an abnormal list in the enemy ship added to our own. The ship was overcrowded and most unsuitable at any time as a hospital ship; we were delayed 48 hours round the scene of action and we were 4 days steaming from the nearest hospital at 18 knots.
The services of Surgeon Todd, R.A.N. were invaluable, and he was at the disadvantage of having served afloat only 14 days, and those immediately preceding the action; also he was in indifferent health at the time.
I specially recommend the services of T. Mullins, S.B.S. whose endurance and energy were wonderful.