Dr Leonard Darby was the Senior Medical Officer of HMAS Sydney during her engagement with SMS Emden off the Cocos Islands on November 9th 1914. After the action he wrote his report to Captain J C T Glossop, Commanding Officer of HMAS Sydney, and this was published in Australia in 1915 by the Government Printer of the Commonwealth of Australia. The report published below is taken from the printed copy but Dr Darby's original handwritten report is in the possession of the Manuscripts Section of the State Library of New South Wales. Gratitude is expressed to Mr Arthur Easton, Mitchell Library Archivist, who made the original document available for study.
The report describes the action from the point of view of the two ship's surgeons, working in cramped conditions, using the stoker's bathrooms as operating theatres in 105 degrees of heat. HMAS Sydney had seventeen casualties and their management is described in full detail. It must be remembered that the action took place before blood transfusion was available and it is illuminating to read how casualties, suffering from blood loss, were managed .
SMS Emden was very badly damaged in the action and beached herself on North Keeling Island. The report recounts how she had over 50 casualties and the difficulties that were encountered in moving them to HMAS Sydney and in treating them. The surviving German Medical officer was initially quite unable to cope, but, after recovery, he was able to assist with patient care onboard HMAS Sydney (the other German surgeon was blown overboard and swam to the shore, but lost his reason and died after drinking sea water).
Dr Ollerhead, the Medical Officer to the Cable Station on the Cocos Islands, volunteered his services and also came on board HMAS Sydney to help in the emergency.
Dr Darby was born in George Town, Tasmania, on the 3rd January 1890 and qualified as a medical practitioner at the University of Melbourne in 1912 with the degrees of MB. ChB. He joined the Royal Australian Navy in September 1912 and served as Surgeon on HMAS Cerberus and HMS Drake and was then attached to HMS Victory. He joined HMAS Sydney in May 1913 and was her Senior Surgeon until May 1918 when he was appointed to HMAS Penguin, the Naval Hospital in Sydney. He was given accelerated promotion to Staff Surgeon (Surgeon Lieutenant-Commander) after the engagement with SMS Emden and was promoted to Surgeon Commander in 1922.
Dr Darby had a distinguished career in the post war Australian Navy, retiring as a Surgeon Captain. Between 1927 and 1932 he was the Director of Medical Services (Australia). In 1933 he was appointed as Honorary Surgeon to His Excellency the Governor-General of Australia and in 1934 he was the Principle Medical Officer for Ships and Naval Establishments. After retirement he lived in Queensland. The actual date of his death is obscure but his entry disappeared from the Medical Directory of Australia after the 1962 Edition.
Dr M. G. Miller
SYDNEY-EMDEN ENGAGEMENT
9TH NOVEMBER 1916
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H.M.A.S. Sydney.
Sir,
I have the honour to submit a report on the action with S.M.S. Emden on 9th November, 1914,off Cocos Island.
At 7.30 a.m. 1 heard the rumour that a strange war ship was at the entrance to Cocos Island, 50 miles distant. Soon this was confirmed, and though we had had many false alarms previously, 1 went to the sick bay and gave instructions to S.B.S. Mullins to get everything below and prepare for action.
The stations for the surgical party are the fore and after ammunition lobbies for the stretcher bearers with their stretchers, and two theatres, one for each surgeon and his assistants, are prepared in well separated stokers' bathrooms, which are situated in the tube running up in the centre of the ship. The bathrooms are 10 feet by 8 feet by 7 feet in size, and are supplied with hot and cold water, also they contain lockers in which dressings can be stowed. Though not quite below the water-line they are well protected-above by two decks, and on the sides by armour and by coal bunkers. One of these bathrooms 1 have appropriated, and it is permanently rigged out as a theatre, with operating table, instruments, and dressings stored there for immediate use.
Unfortunately, only two days before the action I had everything taken up to the sick bay, and had the bathroom painted out, intending to return to it on this very day when the paint was dry.
Before the action began at 9.30 a.m., there was only time to get things down below without proper stowing, so that there was confusion, and one could not put one's hand on things as quickly as would have happened at any other time. The No. 2 action theatre is not kept ready, but is hurriedly fitted out with a sick bay mess table as an operating table, and stores are taken along the tube from No. 1 theatre. Adjacent to these stations are six other bathrooms, which are cleaned up as well as possible under the circumstances, and are very useful as shelter places for the wounded as they are brought below. In addition to the water supply in the bathrooms I had an emergency supply of boiled water in the Captain's and the wardroom galley further aft along the tube. It was fortunate this was so, as ten minutes after our guns had been firing, the water came through the bathroom taps black, muddy, and useless.
On sighting smoke 1 went round the guns and to the fire control stations to see if the first-aid bags were correct, thence to see if anything useful had been left behind, and before 1 was able to get below, our guns had opened fire. The Emden soon hit us, and five minutes to ten minute's the first wounded man was brought below to me by an unengaged gun's crew, the stretcher party, having orders from me not to go on deck during the action unless directly ordered. The first man was " A," Ord. Sea., R.A.N. He had a fractured right leg and thirteen shell wounds besides. He was in great agony, and I gave morphia, and ordered Mullins, S.B.S., to attend to the wounds and quickly apply a splint, as by this time a constant stream of wounded men, who required urgent attention, was being brought below. The second case was " B," A.B., R.A.N., shot through the chest and bleeding freely,, with the apex of the heart beating through a hole in the chest, loud inrush of air through the wounds and marked air hunger. Pads were rapidly applied to the wounds with tight bandages and a large dose of morphia was given.
Before this case was attended C," A.B., R.A.N., was brought down. He had various shell wounds in the right leg, thigh, and buttock, and his right eye had been pierced at the same time by a small fragment of shell. "D". P.O., RN., and "E," A.B., R.A.N. were carried below immediately after. These latter. two were very badly wounded, and the former was in terrible agony. He had been shot through the abdomen left hypogastric area, the fragment emerging from the right lumbar region, leaving 8 inches of omentum hanging out of this wound. Besides this, patient was burnt from head to foot. "E" was shot through the base of the heart and soon died. I hurriedly administered large doses of morphia and attended to first dressings. Meantime, two more men, " F." A.B., R.A.N., and " G." Ord. Sea., R.A.N., had been brought down, and all available space near my station was taken up, so I gave orders to the stretcher party, some of whom had arrived to give first aid assistance to convey the wounded who were temporarily dressed to the ward room, and place them on beds and blankets taken from the cabins.
"F" was badly wounded in both feet, the left foot being almost shot away. "G" had a large gaping wound in the right thigh and had severe cordite burns of face, hands, and forearms. Whilst these men were being attended to, I received a message from the Captain to send for a wounded man on the upper bridge. I gave orders to the forward stretcher party to bring this man down to the theatre. Soon after this, all the wounded, with the exception of "E," A.B., who had died within ten minutes of coming down, had been removed to the ward room and laid upon the beds on the deck. This place was only protected by thin armour, but room had to be made near the theatres for probable fresh cases, and this was the only available space. Fortunately, no damage was done to this part of the ship, and now the Emden was not so dangerous. Another case, " H " A.B., R.A.N., who had been wounded in the left thigh and right arm, was soon dressed and taken to the ward room.
We were now clear round our station, and I went aft to see the wounded in the ward room, on my way passing Surgeon Todd's station. He had all this time been equally busy, and been handicapped by the fact that on four occasions his sick-berth attendant had fainted. He had attended to Lieut. "J." R.N., wounded in both calves and right thigh, with much haemorrhage;
"E," A.B., R.A.N., slight wound left knee; "L," Ord. Sea., R.A.N., severe cordite burns of face, hands, and forearms; "M," Ord. Sea., R.A.N., wounded left kidney; "N." P.O., R.N., shock and injury to left knee.
After visiting the ward room I returned to No. 1 theatre and found that the stretcher-party had returned from the upper bridge with the above-mentioned wounded man. It had been a very difficult place to get at. However, with the aid of a Neil-Robertson folding stretcher it had been achieved with no great loss of time. This stretcher, by the way, was found to be most useful and well adapted to a ship of this class, with steep stairways and narrow hatchways and passages. The wounded man was "O." A.B., RN., his left leg had been shot away at its junction with the body, and was a horrible sight. He had lost a tremendous amount of blood, and was almost dead on arrival below. I sent for Surgeon Todd, and got the patient's clothes cut away rapidly, and had him placed on the operating table. We then administered one pint of normal saline subcutaneously, and started to trim up the stump, which consisted of a ragged end of skin, fascia, muscles, nerves, and vessels, longer anteriorly than posteriorly. In fact, there was scarcely enough flap left to cover the stump. After having made a few cuts in clearing away the ragged ends, the patient died. He had been wounded some time and the haemorrhage had stopped when he arrived below, but it was hopeless from the outset, and he must have lost a fatal amount of blood in a few seconds during a hot period of the engagement, when nothing could be done for him.This was the last of our wounded, excepting two slight cases -- "P.'' Ord. Sig., R.A.N., small fragment of shell in right forearm, and,"Q," A.B. R.A.N, slight wound in foot. These latter two were attended to some hours later. Cease fire sounded at 11.15 a.m. after we had been working two solid hours In confined atmosphere, and a temperature of 105 degrees F. The strain had been tremendous, and S.B.S. Mullins who had done wonderfully well with me, started off to faint but a drink of brandy caved him, and likewise myself. Our clothes were saturated with blood and perspiration, and altogether it bad been a terrific two hours of high tension. We had been ably assisted by the first aid party, and specially by Tilbrook, Off. Std., R.A.N., Holley, M.A.A. R.N., Paymaster Norton, R.A.N. and Chaplain Little, R.A.N.
The ward room now contained eleven cases, and most of them were restless and groaning in agony. The initial dose of morphia in no case less than ½ gr. had been of slight value and I have good reasons to suppose that the solution in the ampoules supplied had deteriorated. Fresh doses of, morphia were administered, and iced water, soda water, and brandy, to various cases as thought fit. The initial lotion used for wet dressings and cleaning was hydrarg. perchlor., mainly because it was convenient. The picric acid dressings in the first aid packages were found most useful in the case of burns. . During the, action the space below seemed like a mad inferno. The tube was full of men belonging to the ammunition and fire parties, and, at the best of times, there is little room here, so the constant supply of wounded men was considerably hindered. All this time we knew not how the fight was going. We could only hear the shouts for ammunition and the continued rapid fire of our guns. At one time we heeled over, and the operating table, with "O" upon it, took charge. It seemed as though we had been hit, but it was only a sudden alteration of course, as we soon found out.
Our constant attention was now taken up by two cases- "D" and "B". Normal saline was administered, in the first case subcutaneously, in the latter intravenously; wounds were re-dressed, and all methods of reducing shock tried. "D" was hopeless from the first, and died two hours after being wounded, after going through much pain. "B" somewhat improved after the saline, but air-hunger was pronounced and he complained of constriction round the chest, and tried to remove the bandages. There was oozing of blood from the wound and pulse was very weak. The other cases were not quite so urgent, but many were in considerable pain, and all that could be done was temporary until operative interference could be carried out. The ward room was hurriedly rigged up as a hospital, and lotions, dressings, and instruments were placed about. The first-aid party did excellent work now in looking after the wants of the wounded.
The actual extent of the injuries could not definitely be made out until the cases were on the table. As soon as the sick berth staff could be spared, I gave orders for the sick bay to be rigged up as an operating theatre with all despatch. This entailed an enormous amount of work on account of the state of the recent site of activities and of the sick bay which was flooded with water from the fire mains.
The muddle below was unavoidable owing to the lack of space and the speed with which one had to work, so it took some time to sort out things and have everything conveyed back and arranged in the sick bay.
Besides this, there were many interruptions due to requirements of the cases, and all through the afternoon and evening German sailors were being picked up from the water, some of them in a very collapsed condition. One man had been in the shark-infested sea for nine hours, and he was brought round after much trouble. Next day he was no worse off for his immersion.
It was found impossible to do any operative surgery until the following day for numerous reasons, nor was it considered advisable on account of the condition of the wounded. The sick bay staff were too done up to get the theatre ready, with instruments and dressings sterilized for the first day, and neither Surgeon Todd nor myself were in a fit state to undertake operations until we had rested. Until midnight we were attending to the wants of the patients, doing dressings, giving hyperdermic injections, passing catheters, &c. The two sick-berth ratings were sent to bed at 10 p.m., thoroughly exhausted, and Surgeon Todd and myself took four-hourly watches from midnight. The first-aid party and volunteer nurses under Tilbrook and Holley, were told off into watches to do the nursing. Early next morning we arrived off Cocos Island, near the cable station, and having ascertained the damage done we took off the Eastern Extension Telegraph Co.'s Surgeon, Dr. H. S. Ollerhead, to help us with the German wounded. We then steamed back to North Keeling Island to the Emden. We now had the sick bay rigged up as a theatre, having unshipped the beds and made as much room as possible. Our great difficulty was lack of space and trained assistance. We had used up all the sterile towels on the previous day and had no chance of getting more.
The shortage of trained theatre staff, with lack of conveniences, caused much delay in the preparation of the theatre between each case, and the actual operations were delayed for the same reason. There was also much delay in getting instruments sterilized,.and one could not get what was required in good time. Consequently, the asepsis was not what it might have been. Later in the day we organized a theatre staff from volunteers. They helped to clear up, held basins and receptacles and and did remarkably useful work with composure that was astonishing, - since they were present at many bloody operations and gazed upon some sights to which none of them had been previously accustomed. Surgeon Todd acted as anaesthetist and Dr. Ollerhead assisted me with the operations.
The first case we took was "B," A.B. He had had a restless night, and from his dyspnoea and the oozing of blood, it was obvious that there was much blood in his pleural cavity. His colour was bad, likewise his pulse. Chloroform was administered. Examination showed that a fragment the size of sixpence had entered his chest in the right axilla and had tracked downwards and forwards to the left, through the pleural cavities, finally emerging through a large ragged hole just below the apex of the heart. In fact, soon after the injury the apex of the heart could be seen emerging with each thrust. A piece of the sixth rib had been carried away leaving a gaping wound. This wound was enlarged, a piece of the rib removed, and a search was made for bleeding points. This search could not be prolonged owing to the patient's condition, so I swabbed out the blood from the left pleural cavity, and a considerable amount of gauze was inserted therein and a tight binder and pad then applied. The patient was removed to the only bed left in the sick bay, and saline given subcutaneously. The patient rallied considerably, but later on haemorrhage occurred, and he died two or three hours after operating.
The next case taken was "J." This case was shorter and less serious. He had been struck from behind by a bursting shell and obtained numerous wounds in both lower limbs. His left leg had been traversed by a fragment which left a jagged sinuous hole through the calf, just below the knee joint. His right calf was pierced, having a large ragged hole, charred at the edges, the fragment being deep in the muscles. There was another smaller deep hole in his right thigh on the inner surface, and numerous smaller wounds on buttocks and back. The patient had had considerable haemorrhage which was controlled by plugging and pressure. Search was made for fragments, but none could be felt with a probe, and it was decided not to cut down and look for them because more harm than good would have been done. The wounds were, therefore, thoroughly cleaned and syringed out with hydrogen-peroxide and plugged with iodoform gauze and with careful dressing they remained clean, and patient was doing well when he left the ship.
There was a good deal of destruction of muscle and nervous tissue, but the main vessels and nerves had, presumably, not been damaged. An "X-Ray" photograph, taken at the Colombo Hospital, showed numerous pieces of shell in his right leg, none very large, and it was there decided that it would be unwise to remove them then.
By this time we had returned to the Emden, which was flying distress signals, and arrangements had now to be made for the transhipping and receipt of about 80 German wounded. The figures are the estimates of the surviving German surgeon, and there was never opportunity of verifying them, but they are considered approximately correct. All available stretchers, hammocks, and cots were sent to the Emden with a party, under Dr. Ollerhead, who did not return until the last patient left the Emden some five hours later. Even then some Germans who had got ashore could not be brought off until the following day (Wednesday). The transhipping was an exceedingly difficult and painful undertaking, as there was a large surf running on the beach where the Emden went ashore, and she was so much of a shambles that the shifting, collecting, and lowering, of the wounded into the boats was necessarily rough. They were hoisted on board us in cots and stretchers by means of davits, but there were no such appliances on the Emden One German surgeon, Dr. Luther, was intact, but he had been unable to do much, and for a short time was a nervous wreck, having, had 24 hours with so many wounded on a battered ship with none of his staff left and very few dressings, lotions and appliances. The state of things on. board the Emden, according to Dr. Ollerhead was truly awful.
Men were lying killed and mutilated in heaps, with large blackened flesh wounds. One man had a horizontal section of the head taken off, exposing mangled brain tissue. The ship was riddled with gaping holes, and it was with difficulty one could walk about the decks, and she was gutted with fire. Some of the men who were brought off to the Sydney presented horrible sights, and by this time the wounds were practically all foul and stinking, and maggots 1/4 inch long, were crawling over them, i.e., only 24 to 30 hours after injury. Practically nothing had been done to the wounded sailors, and they were roughly attended by our party and despatched to us as quickly as possible. A cook's mate, named Fulton, did some exceedingly disagreeable work with, great credit to himself in connexion with this.
The best arrangements possible were made under the circumstances for the receipt and treatment of the wounded as they arrived. . All blankets and beds available were drawn from the stores, and most of the officers went without them. Still we had nothing like enough, and the German sailors had, in many cases, to put up with beds most unsuitable for wounded men. As they came on board they were taken down to the temporary hospital in the ward room, where Surgeon Todd and myself attended the more serious cases and directed the first aid party with the simpler ones. I tried hard to keep the sickbay clear and ready for operations later, but we were soon crowded out of the ward room and the sick bay had to be used as a dressing station, the wounded being placed along the neighbouring corridors and spaces adjacent and soon there was scarcely room to move there.
Besides the 70 wounded received that day, there were over 110 prisoners and 20 Chinamen from the sunken collier, so the crowding can be imagined, seeing that we were a crowded ship before. Of necessity the work done now was only immediate and temporary till the cases could 'be sorted out and put under anaesthesia in a clear theatre. From 35 to 40 of the cases were serious, the rest being more or less slightly wounded, and they were able to help themselves somewhat and wait. The condition of many was pitiable. Some had legs shattered and just hanging; others had shattered forearms ; othes were burnt from head to foot; others had large pieces of flesh torn out of limbs and body. One man was deaf and dumb, several were stone deaf, in addition to other injuries. The worst sight was a poor fellow who had his face literally blown away. His right eye, nose, and most of both cheeks were missing. His mouth and lips were unrecognisable. The tongue, pharynx, and nasal cavity were exposed, part of his lower jaw was left and the soft tissues were severed from the neck under his chin, so that the face really consisted of two curtains of soft tissue hanging loosely front the forehead, with a gap in the centre, like an advanced case of rodent ulcer. In addition, the, wound was stinking and foul with copious discharge. The case was so bad that 1 had no hesitation in giving a large dose of morphia immediately, and after cleaning the wound as well as possible, a large dressing was applied, and he was removed to the fresh air on deck. The odour was appalling and it was some time before the sick bay was clear of it. The patient lingered from four to six hours afterwards in spite of repeated liberal closes of morphia. Another face injury was almost as bad. Practically the whole right side of the face was completely blown away. His temporal, pterygoid, and maxillary regions were deeply exposed, and temporo-mandibular articulation was entirely removed. One had not time to examine these cases for minute details, but they were very instructive, and showed how. hard it is to kill a man with face injury. In addition, the wound was septic and most offensive. I had no hopes for his life when he arrived, but he seemed to struggle on and five days later, on arrival at hospital at Colombo, it seemed likely that he would live. Later news tells us that the patient is doing well and they hope to fit him out with an artificial right half to his face.
There were four cases of fractured forearm, two of which 1 amputated in the middle third of the arm - both did well. There were, only two cases of fracture of the lower limb, both being the leg, which was in each case badly mutilated. One was amputated successfully in the middle third of the leg by the German surgeon; in the other case I had to amputate through the lower third of the thigh. This case died.
Another face injury was rather severe. He had his right cheek turned down as a flap from the level of the upper lip, in addition the mandible was fractured and a piece of skin, fascia, and muscle the size of a large plate was blown out of the middle of the inferior surface of the left thigh. Later, when we were attending this case, it was suggested to me that the limb be removed. but though there was much destruction of tissue and the wound was very foul, I refused to allow this to be done and after events proved the wisdom of this, as the wound cleaned up and the limb was saved. There were many cases of severe burns, two of which had head injuries in addition, and died on board. One of these was an engineer, who had suffered from pneumonia for six weeks on board the Emden. Altogether four deaths occurred on board us from among the German wounded. Most of the remaining cases had multiple lacerated shell wounds, with smaller or larger pieces of flesh blown away or penetrating tortuous holes, with metal buried in the tissue. Quite often this metal, was found just under the skin on the opposite side of the limb. Most of the wounds were charred. In one case a large amount of gluteal tissue was taken out in the region of the right anterior superior iliac spine, with fracture of the ileum. This man, in addition had a compound fracture of the right arm and numerous other wounds. A man was very lucky if he had less than three separate shell wounds. He was in a very low condition when we landed him, and it is doubtful if he will live.
In cases where large vessels of the leg or arm had been opened, we found tourniquets of pieces of spun yarn, or a handkerchief, or a piece of cloth bound round the limb above the injury. In some cases, I believe the majority, they had been put on by the patients themselves. One man told me he had put one on his arm himself. They were all in severe pain from the constriction, and in all cases where amputation was required, the presence of these tourniquets made it necessary to amputate much higher than one would otherwise have done, but no doubt their lives had been saved by the tourniquets. There was very little evidence of any skilled treatment before they arrived on board. Naturally the German surgeon had been very much shaken and handicapped. His station in action was the stokehold, which was uninjured. His assistant surgeon was less fortunate, his station being the tiller flat aft, and when they were badly struck, fire broke out above him, whereupon he went up and was blown overboard, slightly wounded. The steering party remained in the tiller flat and were unhurt. After being blown overboard the surgeon managed to get ashore, and during the night he lay helpless and exhausted, dying of thirst, along with a few others who had also got ashore. After much persuasion he got a sailor to bring him some salt water, of which he drank a large quantity, and straightway became raving mad and died.
Having now cleared up most of the immediate work, we had the theatre straightened up once more and cleared, after the constant stream of filthy cases had left it in a pretty mess. Operations had had to be discontinued at noon, but we recommenced at about 6 p.m., and did not stop till 4.30 a.m. Wednesday morning. The first case taken was a German whose right leg had been almost severed just above the ankle. The German surgeon, assisted by Dr. Ollerhead, with Surgeon Todd as anaesthetist, amputated the leg successfully in the middle third. The case did very well.
We now gave our attention to our own wounded, and after. dinner started on "A" This boy had over thirteen separate shell wounds, most of them very severe. They involved the right thigh, buttock, leg, and foot, both bones were fractured 2 inches above the ankle and, in addition, there was a large area blown out of his left groin, exposing the femoral vessels and spermatic cord. It looked at first as though we would have to amputate, but we decided to give him a chance, and after cleaning up the wound with soap and water, hydrogen-peroxide, and iodine, and removing the metal accessible, iodoform grains were inserted, and the leg was put up in a back and side splints. It took Dr. Ollerhead and myself, working hard, two solid hours to complete the case. Dr. Todd gave the anaesthetic, which the patient stood very, well. This poor fellow had been in considerable pain. He was now put in charge of a special nurse in the Commander's cabin. All future dressings had to be done under anaesthesia for about fourteen days, but the latest report is that the leg has been saved.
After doing the operation mentioned above, the German surgeon became more of a hindrance than a help. During the evening he broke four of our syringes without successfully giving a hyperdermic injection, and he was sent to take a rest which he badly needed. Next morning he had improved considerably, and he was able to take the place of Dr. Ollerhead when the latter returned to Cocos Island.
The next case taken that night (Tuesday) was "M". He had a shell wound in his back the size of a half-crown, just below the last rib on the left side. Earlier in the day he had retention of urine, and a catheter was passed, drawing off almost pure blood, so evidently the fragment had lodged in, or passed through, the kidney. The patient had had a good deal of pain and haemorrhage, but, apart from the pale colour, he was very fit. Under chloroform the wound was cleaned up and I traced the track of the fragment with a probe below the twelfth rib, 3 inches from the middle line, but could feel nothing. The wound, which was foul, was enlarged with a scalpel and 1 tried to get my finger on to the metal, without success. Eventually, before doing too much cutting, and from fear of carrying in infection too deeply, I decided to wait and contented. myself with draining the wound. The blood in the urine was much less on, the following day and the patient had no retention. He continued to improve and within two days there was no trace of blood in his water. . He was landed in hospital very fit but still with a fragmentin his kidney, and some slight discharge from the wound. Later news says that he is convalescent. It was now about 12.30 AM and, after a solid and anxious day, all were pretty well done up, especially the two sickberth ratings. They had worked wonderfully and had now to be sent to bed thoroughly exhausted.
After a spell of about half-an-hour, Dr. Ollerhead, Surgeon Todd, and myself, with the assistance of three 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, 1/4 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 an 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 1 was called up to the sick bay to this case, and found him pulseless. Strychnine was administered and heart massage and artificial respiration tried without success. It was most disappointing, and 1 was unable to decide whether he had died from shook or from morphia poisoning. Possibly the latter, as 1 had 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 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 hours 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 six 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 been since 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" taken to the sick 'bay for operation. Dr. Luther was anaesthetist and Dr. Todd assistant. 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. 1 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 breeding 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 hours. Besides the above injury, he had a large septic flesh wound of the left thigh which afterwards became erysipelatous.
By the time he got to us all 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 three days the patient ran a very high temperature, due to the erysipelatous wound in his left thigh. The remainder of this day (Wednesday) 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 three days after receiving a small wound of 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 been turned over to the first aid party, and they received the cases straight from the theatre. In the ,ease of the Germans, we had a party told off from the prisoners to help our staff. We had two large wards, the ward room and the waist deck, and various special wards - a few cabins given up by the officers. Our wounded were in the ward room 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 eighteen Chinamen, the crew of the sunken collier, and we had now more clear space on the decks for the wounded we had kept - 2 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 two days.
The corticene decks of the ward room, sick bay, and starboard corridor had to be scraped, as they were thick with 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 difficulty 1 could get this done because the Captain was most anxious to put to sea as soon as we had coaled. Even then it was very hurriedly done. 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 a.m. on 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 that we had another operation the first day at sea.
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 just halved itself, 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 four 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 fourteen 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.
The work done by the first aid and volunteer party was most useful, unstinted, and remakably intelligent. I might mention in this respect the names of :-
Frances Holley, M.A.A., R.A.N.
William Sweetland, 2nd S.S., R.A.N.
Frederick Tillbrook, Off. Std., 2 cl., R.A.N.
John Donnelly, P.O., R.N.Herbert Holmes, A.B., R.N.
James Hill, A.B. R.A.N.,
John Fulton, Cks. Mte., R.A.N.,
Below is a list of stores used during the period
Chloroform, 2 lbs.
Drainage tubing 1 yard
Sal. alembroth wool, 12 lbs
Absorbent wool. 18 lbs.
Surgeon's lint, 16 lbs.
Boric, lint, 10 lbs.
Bandages, 4-in., 10 dozen
Bandages, 3-in., 10 dozen
Bandages, 2-in., 15 dozen
Cyanide gauze, 12 yards each,
6 tins Moist gauze, 6 yards each, 1 jar
Iodoform gauze, 6 yards each,
1 carton Triangular bandages, 24
Iodine, 1 pint.
Mosetig battist, 6 yards
Christies tissue 6 yards
Catgut ligature, 3 spools
Silkworm gut, 1 tube (50)
Horse hair, 1/8 hank
Soloids sod. chlor., 12
Hyd. perchlor., 500 soloids
Hydrogen peroxide, 2 lbs.
Acid, carbolic, 1 lb.
Adhesive plaster, 2-in., 1 spool
Adhesive plaster, 1 spool
Picric acid dressings, 20
Lysol, 1 lb.
The above list is as near correct as it is possible to estimate.
The most useful antiseptics were found to be hydrarg. perchlor., iodine, and
alcohol, with hydrogen peroxide a most useful cleanser of foul wounds.
I have the honour to be,
Your obedient servant,
LEONARD DARBY, M.B.,Ch.B., S.M.0.
Surgeon, R.A.N.
The Commanding Officer, H.M.A.S. Sydney.
The Commanding Officer,
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