'H.M.1' in Mesopotamia, or, How not to design a Hospital Ship

[alf mcm]

  The River Sick Convoy Unit was formed in Mesopotamia in June 1916 to evacuate sick and wounded down the Tigris by means of ordinary River Transports. After delivering their cargoes upriver they would return with patients on board. Some at least of these ships were intended to carry 2 Nurses. From June 1916 to August 1917 they carried a total of about 78,000 casualties. This total includes patients carried by the River Hospital Ship ‘SIKKIM’, which was the only dedicated hospital ship during this period, apart from 2 small convoys on H.P.2.

  Transporting sick and wounded on cargo ships was obviously not an ideal situation, and actual hospital ships were clearly required. The first of these, ‘H.M.01’, {also known as “H.M.1”} which Captain W.H. Wood took charge of on 5^th November 1917. After her initial voyage, without patients, Captain Wood wrote the report copied below. It is a long report, but only because there were so many design faults. This was a ship designed as a River Hospital Ship and some of his comments make you wonder why this ship got past the design stage. There was obviously a lot of time and resources, not to mention money, invested in this ship. In the end, due to design faults, it was rarely used as intended.

 

Report on H.M.1 by Medical Officer in charge H.M.1 on her first trip to Baghdad.

Sir,

  I took over my duties as Medical Officer in charge on November 5^th, 1917, at Basrah. The following points were noticed by me, which have brought me to a final decision that H/M/1 is not a suitable ship for work as a Hospital Ship in Mesopotamia, on the River Tigris.

1 .  H.M.1 is far from reliable, as shewn for the time taken for the round trip, Basrah to Baghdad and back. We left Basrah on November 26^th 1917 at 1.30 p.m. and reached Baghdad on December 16^th at 5 p.m. On the way up the boat had to go into dock for engine repairs at Amara, Kut and Baghdad. The boat was towed into Amara by a trug. The running of the engines was very unsatisfactory the whole way up. Many times we “banked in” while repairs were executed. About two days was the longest time the boat ran without being stopped for engine repairs.

  The same has happened on the way back to Basrah. We had to stop at Kut for work to be done in the dockyard. Wi left Baghdad on January 2^nd, 1918, at 1.45 p.m. - reached Amara on 9.1.1918 at 1.30 p.m. Arrived Basrah 12.1.18 at 8 a.m. Delay on the River with patients tends to anything but comfort for the wounded. ‘P’ boats of the ‘50’ class do the round trip in under 10 days.

2 .  The working of the boat by the R.A.M.C. personell is very difficult, on account of the design. The difficulty of working causes discomfort to patients. Difficulties arrive through

{a}. The arrangements provided by the designer for loading sick are not satisfactory. At present, all sick have to be taken on at the Main Deck. No arrangement is made for taking patients direct on to the Saloon Deck. The Saloon Deck has. In my experience – from October 1916, always been the most satisfactory deck to load on to, on account of the heights of the River banks and length of gangways required. Loading onto the Main Deck may be essential when the River bank is very low, or does not exist {that is, above a few inches}. The latter was the case on one occasion only in my experience, and that was at Shumran Bend, during the advance.

  Therefore, I consider arrangements should have been provided for loading to suit the River conditions, and not the River made to suit the boat. I consider the lift to be a very unnecessary piece of ship’s fitting. It does not, in any way, increase the comfort of patients. They should be carried direct on to the Deck on which they are to travel, and not put to the discomfort necessitated by the lift.

  Loading by the lift will cause embarkation of stretcher cases to be very slow. Therefore, the patients may, on occasions, brought to the boat quicker than we can take then on board. This means, in winter they well be exposed to the cold, and, in summer, to heat and direct sun rays. The climatic conditions do not give comfort to the patients. I consider the boat ought to be able to deal with stretcher cases as quickly as they arrive. This is possible on the “P.S.55” type of boat. I have seen a “50” boat embark 500 patients, mixed stretcher cases and walking in thirty-five minutes. It would take at least five minutes to embark one stretcher by the lift on H.M.1.

  I consider slow embarkation discomfort to patients in such a climate as Mesopotamia.

3 .  I consider the ship very dangerous

{a}  In case of fire, with the present design for embarking and disembarking, all stretcher cases on the Saloon Deck would be lost. Above, I have pointed out the time I consider necessary for getting a patient disembarked or embarked by the lift method, the only available method for stretcher cases.

{b}  Patients in the lower Ward are not protected, by any means, in case of collision on the River. On our first trip, the front of a mahela burst through the lower panels of the ship’s side, and, had a patient been in bed, he most probably would have been injured. Glass again, is dangerous, and unsuitable for sides of ship on the Tigris. On the first trip, three panels were broken.

  Collisions and “bumps” on the Tigris occur to every boat. These are due to conditions on the River itself, e.g. current, averaging four to five knots per hour.

{c}  In sailing H.M.1 the wind is an important factor, especially on the way down, when the boat travels with the current. I have noticed on this trip that the wind caused the stern of the ship to be blown across the River, and the boat is travelling sidewards, therefore increasing the chance of accident. The above happens when the screens {side} are not in use, therefore, conditions will be very much worse when patients are on, and all screens have to be down for patients’ comfort. I consider difficult navigation increases the chance of accident on such a narrow and rapid and bending River as the Tigris.

  Again, chances of accident are increased when the engines are unreliable.

4 . The arrangements made for drinking water by the designer have proved very unsatisfactory on H.M.1.

  Arrangements were made for distilled water for drinking purposes. The Chief Engineer, Lieutenant PETRIE, I.W.T., states that he is unable to provide distilled water. I am perfectly satisfied that his statement is correct, having satisfied myself by personal observation, as stated below.

  The ship can only distil 1.7 tons of water per day. This is just about sufficient for the use of his boiler. Therefore, none is left for drinking. The above figures were got by actual experiments on H.M.1.

  Lieutenant PETRIE, I.W.T., also states that the only way to keep the boiler in satisfactory condition is to use distilled water, as River water is too dirty. I am compelled then, to use River water for drinking purposes. The chlorination of the River water has to be carried on in very unsuitable tanks, only 3’ 6” high and 6’ 6” square. I consider a large-based low tank vey unsatisfactory, on account of difficulty of proper cleaning.

  I consider that, distilled water not being available, the water system should be investigated and arranged for convenience of sedimenting and chlorination.

5 .  I consider the boat will be very hot during the summer months, owing to conditions and arrangement of equipment on the ship.

{a}. All the beds are made of metal, which, in the summer, conducts heat so well that it gets almost too hot to touch. I consider wooden sides to the beds more suitable.

{b}. Beds are arranged fore and aft in the Wards. The beds along the sides of the ship will be difficult to protect from the sun’s rays. The whole of the Ward will not e able to be closed in with full side screens, nor, to my mind, will projecting screens be sufficient to keep out the sun’s rays. The screens made of canvas are unsuitable by themselves, in the very hot weather. My experience on the River leads me to say that it is always best to place patients with their heads to midships, and their feet to the side. Then the upper part of the body does not get the direct sun. The heat, of course, gets at the patient when the temperature is 120 degrees Fahr. whichever way he rests – either fore and aft or midships and side.

{c}. All cabins, such as Officers’ Ward, Sick Sisters’ and Nurses’ will be impossible to live in during the hot season. It has been impossible to live in large and more protected cabins than on H.M.1. Still, the ship has no available space which can be used for sleeping in summer.

{d}. I consider the pipes on the “Thermo-tank” system should be surrounded with some non-conducting material, so as to protect them from atmospheric heat, otherwise the air circulating in the summer will be hot, and very objectionable, just as the air from a fan, when hot, is objectionable. The system will, at all times, circulate air.

{e}. All galleys are exceedingly small, and will be excessively hot in the summer. The cooks have no means of getting away from in front of the fire, except by leaving the galley. I consider the galleys will be unbearable, even for natives, in the hot season.

  Even in November last, when I joined the ship, the cooks complained of the heat.

{f}. The Mess-room on the Main Deck aft, for W. Officers, is unsuitable even in winter. On January 2^nd, 1918, at 6.30 p.m. the atmospheric temperature was 54.5 degrees Fahr. The temperature in the Mess-room on the bulkhead was 105 degrees Fahr. From this I definitely say that it will never be used for its intended purpose in such a climate as Mesopotamia. The temperature is due to the boiler, which is next door.

{g}. The mental room will be impossible in summer, on account of heat.

6.  Accommodation for R.A.M.C. personnel is, by no means, sufficient, two cabins only being provided for Orderlies, making a total of four beds.

  One cabin only for two Sisters; this cabin is far too small for two sisters, and will be impossible in the hot weather.

  One cabin below was for an Assistant-Surgeon, and is now occupied by a commissioned Engineer. Assistant-Surgeons are not available for ships on the River. I am of the opinion that no Assistant-Surgeons or Sub-Assistant-Surgeons are on the strength of the R.S.C.U. The P.M.O.’s cabin and lab. is roomy enough, but much valuable space has been given for a lab. In my experience a lab. is absolutely unnecessary on a River boat, because work done in a lab. requires much time and personnel to obtain any reliable results. Again, all patients are on the boat for too short a time to do lab. work. Boats are used as a Convoy – not a General or Stationary Hospital. All laboratory equipment, to my mind, is superfluous, and only takes up valuable space. Again, trained personnel on a boat for lab. work would be a waste of valuable personnel.

{b}. Accommodation for native personnel is for twelve only; this is not sufficient when caste has to be considered in the working of the ship. The arrangement of the boat has considered caste to the finest points in cook-houses, pantries, etca., but personnel required to work the same has not been catered for.

  Sweepers are not catered for; the only place now available for them to sleep is “in a Ward”.

  In the summer the natives will not be able to live in the place provided on account of heat.

{c}. Accommodation for the crew is absolutely impossible for the summer. It is even too small for the winter. Forty-three men are living down an ill-ventilated place where the space is , in no way, sufficient for twenty-four in the winter. What will happen in the summer?

{d}. Accommodation for the engineers is not satisfactory. The cabins will be far too hot to live in during the summer.

  The summary of the above is;- The whole of the ship’s personnel will not be able to live in the allotted places in the summer, therefore, space will have to be provided. As the ship is now arranged, such space is not available anywhere, unless the Hospital arrangements are completely altered. To my mind, the boat will be totally unfit for the hot season, as staff, crew, Hospital personnel and patients will be all calling for open space and fresh air, and no space is available. At the present moment, it would be impossible to find room for a ship’s guard, which is carried for protection against Arabs.

7. I consider that much valuable space has been taken up on the ship by absolutely unnecessary Hospital structures, e.g., an operating theatre and preparation room are not necessary on all boats. It is not the practice of Medical Officers to send on to boats Cases likely to require urgent operations. Nor is it my practice to take patients known to me require urgent operations. This is a Convoy Unit. Since October 1916, only on two occasions as Medical Officer in charge of P.S.55, have I had to do any operating, and on both occasions it was only to stop secondary haemorhage, one by simple ligature, the other by packing.

  Again, much space is taken up with Hospital equipment, which will never be used on the River, e.g. splints. Usually, in fact in all cases, when splints are necessary, they are provided before the patient comes on board. Never since October, 1916, have I had occasion to require splints for patients, except once – for an accident to a native fireman of the ship’s crew of P.S.55. My above experiences are from carrying convoys of from 300 to 650 casualties.

8. During this trip much glass apparatus has been broken, after the utmost care to preserve it had been taken, by the

{1} vibration of the boat gradually shaking glass vessels down into a ring support, which eventually cracked the glass.

{2} “Bumping” of the boat against the bank, chiefly at bends in the “Narrows”.

  The above breakages are bound to occur on a boat provided with so much delicate glassware as H.M.1.

  Again, much of the glassware provided is unnecessary for a boat of such low space between one deck and the deck above, e.g. I have three Harrison Cripps’ irrigation apparatus to be suspended. If ever they were suspended, they would certainly be broken, unless an Orderly stood by them constantly and prevented swinging when the boat ran aground or hit a bank. Again, if glassware is not to be used, it must be stored, and this takes up space.

{9}. Arrangements for oiling the ship and working the ship will interfere with the patient’ comfort.

{a}. Every time oil has been drawn since I joined the ship, the lower Ward has been covered in oil, sometimes crude, and at other times petrol and paraffin.

  The taking of oil necessitates Arabs coming into the Ward. Firemen are also in the Ward. An estimate of about twenty natives all dirty and oilly, tramping about the Hospital portion of the ship. It is impossible to keep the beds and Hospital equipment clean. To try and preserve the deck, half the lower Ward has been covered with sand, which is washed away every time, as soon as the oiling process is finished.

{b}. Again, if any engine troubles occur on the trip, the Engineers have to bring the parts into the lower Ward, as there is no room to work in the engine-room. The Ward, at one end, is an Engineer’s workshop.

{c}. Again, when the bilges are pumped out, all the oil is pumped direct on to the deck.

{d}. Even to fill the drinking water tanks the forepart of the lower deck is always flooded with water, and, on more than one occasion, the beds and bedding have been wet during this trip.

  The ship has no sea-cock connected to the tanks, probably because the tanks were intended for distilled water, and not for River water. The supply of distilled water is impossible.

{e}. When the crew requires to work the anchors, or any other parts of the ship forward, they have to run through the Wards. This arrangement will interfere with patients’ comfort.

{f}. Wire-ropes etca., are fitted in the Ward forward, therefore, to use these the Kalasis work in the Ward. Already parts of beds have broken by the crew while working the ship.

Summary

  The arrangement of the ship makes the lower ward a work-shop for Engineers, crew, and a Hospital combined. A combination of the above do not tend to patients’ comfort.

10.  The sanitary arrangements and drainage system are not fully considered for the patients’ comfort and reliable working.

{a}.  It is impossible to wash down the ship with a hose-pipe, as no arrangements have been made to protect Hospital equipment in the Wards below. If the hose is used on the “Fly” Deck, all cabins, beds etca., below are wet. All water runs down the side of the ship and through the decks, especially below the drinking water gravity feed tank.

{b}.  If the bath in the Isolation Ward is filled with water, and then the plug in the bath is drawn, the water runs out of the bath, and up through the scupper in the floor, the result being the bathroom is flooded. The water then runs into the Isolation Ward, through the deck, and wets the beds in the Wards below.

{c}.  If the Officers’ W.C. is in use, and the plug is pulled at the Sisters’ W.C., the user of the Officers’ W.C. is wet. Due to faulty drainage system.

{d}.  All rooms, e.g., galleys, bathrooms, native wash-places, etca., are difficult to keep clean on account of cement floors and bad arrangements for water outlets in floors.

{e}.  The drainage system has many right-angled bends, caused by small pipes running into a main drain. The above arrangement is very liable to become blocked at any moment. This would be very inconvenient with patients aboard.

{f}.  Fittings in pantries, etce., are almost touching the floor. This leads to an insanitary condition of places which should be perfectly clean.

{g}.  Not enough washing-up arrangements are provided. Nowhere in the lower ward is any such place provided, unless the process be carried out under a running tap, and so all dirty water and table bits go on to the ship.

{h}.  The position of the following cookhouses is such that they are exceedingly difficult to keep clean. “Crew: Mohamedan: “Hindu: and Sikh.” The working of the above cook-houses is very difficult, as it necessitates crossing parts of the ship belonging to the crew and engine-room, therefore always covered with oil.

{i}.  Patients in a closed lower Ward will be troubled with paraffin and petrol fumes, which affect the eyes.

{j}.  Again not enough table accommodation is provided in European pantries.

 

Summary

   It will be impossible, owing to design, to keep the ship, especially the lower Ward, as clean as a Hospital ship should be.

  Cook-houses and oil are too closely associated, therefore the latter are difficult and dangerous to work and keep clean.

  The working with food and pots will be very difficult owing to insufficient table and washing up accommodation in the European pantries.

 

My opinion of the ship as a whole is

        She is unreliable, cramped, over-fitted and dangerous, therefore not what is desired for a River  

        boat in Mesopotamia, where the River conditions are so difficult.

                                                                                              {signed}. W.H. Wood

  12.1.1918                                                                                  Capt. R.A.M.C. {S.R.}

                                                                                                              M.O. i/c H.M.01.

 

  I ought to draw attention to the faulty design of the Refrigerating Chamber; the door is single – the felting on the door is ½“ broad. In summer, when the door is opened it will admit enough hot air into the chamber to require hours to cool it. The door should be double, and the outer one properly fitted with felt. The chamber is in the warmest part of the ship.

  The fittings in the Dispensary were designed, not for utility but to carry the initial supply of drugs in “Tabloid” form. Most of these cannot be obtained in such form in Mesopotamia. All replacement of stock will be in bottles, etca., which do not fit the partitions, as the latter are far too small to hold bottles in general use.

 

                                                                                              {signed}. W.H. Wood

  12.1.1918                                                                                  Capt. R.A.M.C.

                                                                                                            

 

  As if the comments above weren’t bad enough, H.M.1. was only the first of 6 such ships {H.M.1. to H.M.6.}. None of them were much used.

 

Regards,

Alf McM

[seaJane]

Ouch!!! 

That's a fascinating piece, Alf. Do you have a printed source for it, or an archive reference? I think it deserves to be in my bibliography.

seaJane 

[charlie962]

After the scandal of medical facilities 1915/16 it is depressing to read such a report.

Naturally one wonders who was given the contract and why.

 

[alf mcm]

Seajane,

  The report is included within the War Diary for the River Sick Convoy Unit, WO95/5249/5, pages 69-75.

Regards,

Alf McM

[KizmeRD]

Somewhat disappointing to read that such was the case as late as January 1918. 

The extreme heat in Mesopotamia - alongside poor medical facilities, lack of clean water, flies, mosquitoes and vermin - led to appalling levels of sickness and disease. Despite the best efforts of medical staff, thousands of soldiers died, especially in the early part of the campaign. (I’d thought that the situation got better after Lieutenant General Sir Frederick Maude took overall charge in July 1916). 

In all, there were over 200,000 British Empire troops involved in the Mesopotamia campaign, and there were over 85,000 battle casualties - with even more men hospitalised due to non-battle related causes, like sickness (in total almost 17,000 men died from disease).

MB

[seaJane]

9 hours ago, alf mcm said:

Seajane,

  The report is included within the War Diary for the River Sick Convoy Unit, WO95/5249/5, pages 69-75.

Regards,

Alf McM

Alf,

Many thanks.

seaJane