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Occasional Paper 52: The RAN and the 1918-19 Influenza Pandemic

May 2019

Editor’s Note: This article first appeared in Issue 6 of Semaphore, the publication produced by The Sea Power Centre Australia in March 2006. We are indebted to them for their permission to reproduce the article.

Between April 1918 and May 1919, influenza, or its secondary complications, caused up to 50 million deaths, far more than had been killed in four years of war. Many died within the first few days of infection, and nearly half of these were young, healthy adults. The speed with which it spread has been described as ‘…perhaps the most extraordinary feature of this extraordinary pandemic…‘, for the easy transfer, from shore to ship and ship to shore, meant that even communities isolated by sea were vulnerable. A rigorous maritime quarantine policy reduced the immediate impact in Australia, but by the end of 1919 the nation had still suffered more than 11,500 deaths.

The ships of the Royal Australian Navy (RAN), dispersed as they were around the world, were certainly not spared. The pandemic occurred in waves and the cruisers operating with the British Grand Fleet suffered several outbreaks in 1918, with up to 157 cases in a single ship. Outbreaks in the Mediterranean were even more severe with the cruiser HMAS Brisbane recording 183 cases between November and December 1918, of whom two died of pneumonia. In all, the RAN lost some 26 men to the disease. When the cramped mess decks and poorly ventilated living spaces of early 20th century warships are recalled, it is perhaps remarkable that the toll was not greater. The saving factor was largely the ready availability of professional medical treatment.

Pacific Islands

Some of the most virulent outbreaks occurred in the islands of the South Pacific, where few among the indigenous populations escaped infection. The disease arrived on the regular cargo vessel SS Talune, which had sailed from Auckland on 30 October 1918, knowingly carrying sick passengers. Successively calling at ports in Fiji, Samoa, Tonga and Nauru, the steamer’s visits were marked by the first cases of influenza appearing ashore a few days after her departure. With local authorities generally unprepared, the infection spread uncontrollably, a situation aggravated both by the shortage of suitable drugs and the fact that local health workers were among the first to fall.

Hardest hit was the former German territory of Samoa, where inept New Zealand administration resulted in no attempts at patient isolation and the rejection of medical assistance offered from nearby American Samoa. With the forced closure of government institutions and stores, few people being in a fit state to assist with the distribution of food and medicines, and a growing number of uninterred dead, the Samoan situation rapidly became critical. On 19 November the military governor in the capital of Apia telegraphed Wellington for help, but had his request turned down on the grounds that all doctors were needed in New Zealand. Australia offered the only alternative source of aid.

The Commonwealth Naval Board was already aware of the developing regional crisis. The sloop HMAS Fantome, stationed at Suva in Fiji for police duties, had reported her first cases of influenza on 11 November, and soon had more than half her ship’s company incapacitated. More importantly in terms of an effective Australian response, of all government departments only the RAN had suitable assets at immediate readiness. On 20 November, the Board began gathering a joint relief expedition from among the available naval and military medical personnel, placing it under the command of Surgeon Temple Grey, RAN. The commanding officer of HMAS Encounter, Captain Hugh Thring, RAN, was then ordered to embark the expedition at Sydney and proceed at the earliest possible date to Samoa.

HMAS Encounter

Even today the speed of Encounter’s response must be admired. Her sailing orders were telegraphed from Melbourne on Friday, 22 November, and throughout the next day and night the ship’s company worked tirelessly to get in relief stores. Without any information from Samoa as to specific requirements, Thring loaded almost 150 tons of cargo ranging from blankets and tents through to drugs and dry provisions, expecting that these would meet any emergency. The weekend created further difficulties as shops were shut and some items not in stock had to be purchased. Nevertheless, on Sunday forenoon the medical teams embarked, the last of the stores were in by 1550, and ten minutes later Encounter sailed from Sydney.

Double inoculations

Encounter was not a modern ship, but she had led an active service life, most recently involving convoy escort and patrol duties in the Malay Archipelago and Australian waters. Just the previous month she had suffered 74 cases of influenza while operating out of Fremantle, and now, as a precaution against further infection, all members of her crew (over 450) were doubly inoculated. Encounter’s normal passage speed was only 13 knots, but this had to be regulated by coal consumption and navigational requirements. Without modern navigational aids, it was sometimes necessary to arrive at certain points in daylight, while fuel replenishment, and hence range, relied on an efficient logistics system. A coaling stop in Suva would be necessary, but naval stocks there amounted to only 300 tons, so the Naval Board arranged for a rendezvous with a collier. This vessel could not, however, reach Fiji until at least 5 December.

Strict quarantine

Arriving in Suva on 30 November Encounter took on half the available coal and, almost more important, 39 tons of water. With influenza still prevalent, Thring implemented a strict quarantine enforced by guards placed on the wharf. The ship’s company completed all coaling, rather than the native labour normally employed. As no one could return from ashore, Thring communicated by letter with Britain’s resident High Commissioner for the Western Pacific, C.H. Rodwell. The news was not good. The Samoan epidemic showed no sign of abating, with deaths in Apia reaching 50 a day. Moreover, a message from Tonga indicated that conditions there were at least as bad while the facilities for coping with it were worse. On his own initiative, Thring extended Encounter’s mission to include Tonga, but to avoid further delay, landed a nine-man team under the senior Army surgeon, Major Alexander, to take immediate passage in SY Ranadi. Unfortunately, the yacht broke down soon after sailing and was forced to return to Suva.

Sailing from Suva on the evening of 30 November, Thring called for 80 volunteers from his own ship’s company should it prove necessary to provide greater assistance ashore. Despite the dangerous and unpleasant nature of the work, and the fact that any party landed would be left behind – missing their first peacetime Christmas at home – all the officers and most of the ratings volunteered. It would be difficult to find a more telling example of the Australian Navy’s tradition of ‘service before self’.

Encounter anchored off Apia on the morning of 3 December. The harbour was small for a ship of her size and, when combined with a considerable swell and strong winds, made unloading extremely hazardous. Although the ship rolled through more than 20 degrees, within six hours `                                                                                                                                  the landing party (six surgeons, eighteen medical orderlies and three naval sick berth ratings) and their stores were safely disembarked.

Ashore Surgeon Grey and his teams immediately set to work, yet the scale of the disaster remained daunting, and for many of those afflicted help came too late. A Sydney newspaper reported that the Australians ‘…with their motor trucks are doing wonderful service day after day gathering up the dead, who are simply lifted out of their houses as they lie on their sleeping-mats. The mats are wrapped around them, and they are deposited in one great pit.‘

Economic and social collapse

Made worse by the deaths caused by exhaustion and starvation, the two-month epidemic eventually killed 25 per cent of the total Samoan population, and often more than half the male adults in individual communities. Economic and social collapse followed.

Meanwhile Encounter had proceeded direct to Tonga reaching the capital, Nuku’alofa, on 5 December. Here the British Consul advised that, although subsiding, the epidemic had struck down 95 per cent of the indigenous population and left 10 per cent dead. The situation in the outlying islands was just as bad. Thring attempted to get Fantome to bring out Major Alexander’s party, which had been doing good work in Fiji, but the sloop had experienced a fresh outbreak of influenza and remained unable to go to sea. Rodwell had no other craft available for the task.

Thring landed his last surgeon together with five orderlies and the remaining drugs and stores, but there was little more he could do. Yet even this small contribution was of great relief to the European and indigenous community. In thanking Thring for Encounter’s ‘timely aid’, the Consul remarked:

‘Though conditions had greatly improved before the party arrived there was still a good deal of work to be done of a nature that required professional skill and knowledge‘.

The party, he added, ‘…has been indefatigable… in efforts to eradicate the disease‘.

Effective measures

With Encounter running short of coal, Thring sailed for Suva on 7 December. Arriving two days later he received orders to return directly to Sydney. Encounter reached Sydney on 17 December and was immediately placed in quarantine. Only one member of her crew had shown any signs of illness during the voyage, and as testament to the effectiveness of the prophylactic and quarantine measures employed, none developed influenza.

Humanitarian assistance

Thus ended Australia’s first overseas relief expedition. This was one which, although unusual for the times, foreshadowed the now regular employment of the RAN’s assets to provide humanitarian assistance and demonstrate national interest in regional affairs. Indeed, in the context of the maritime doctrinal concepts of flexibility and adaptability, it should be noted that Thring’s orders were not restricted to providing medical aid. Preserving order in the Pacific was among the many subsidiary duties undertaken by the early RAN, and warnings of trouble brewing among the inhabitants of the Gilbert and Ellice Islands (now Kiribati and Tuvalu) had been received by the Naval Board in the weeks before the expedition.

While in Suva, Thring took care to discuss with Rodwell how best a warship might support his authority. On this occasion, no immediate assistance was necessary, but Encounter’s mission might easily have been extended to provide presence elsewhere, and back this up with a large landing force if necessary. It remains a poignant reminder that, by their nature, seaborne forces possess a variety of characteristics and attributes which are not necessarily present in other tools of government foreign policy.

Naval Health Services Memorial

Over recent timeswhat was the Naval Health Services has undergone a significant transformation, becoming part of a unified Defence Health Services organisation. To many past members of the wider naval community this has gone largely unnoticed. It is therefore fitting that a tribute to the valiant deeds performed by these dedicated men and women is recalled in a memorial located in the Mosman War Memorial Remembrance Gardens, situated near the site of our former largest naval hospital, at HMAS Penguin.

The Mosman War Memorial was originally dedicated to servicemen and women of the First World War but has since included those who served in the Second World War and subsequent conflicts. The poignant smaller memorial in commemoration of the men and women of the Royal Australian Naval Health Services was jointly unveiled on 30 August 2015 by the then Director General Health Capability and Director General Navy Health Services, Commodore Elizabeth Rushbrook, RAN and the President of the NSW Branch of the Naval Health Services Association and great stalwart of the Association, ex-POSBA Ron Rosenberg.

The ceremony was well attended by past and present members of the naval medical fraternity and their families. The guest speaker was Dr. Ken Hay. For this task he was well qualified as a former Sick Berth Attendant, becoming a POSBA (L), who left the service in 1967 to pursue a medical degree in Perth, WA. Ken later served as a Surgeon Lieutenant RANR but because of other commitments has since retired. Dr. Hay’s fine speech is worthy of a wider audience.

Royal Australian Naval Health Services Memorial at Mosman War Memorial Remembrance Gardens     Family Archive

Distinguished guests, ladies and gentlemen.

It is an honour and privilege to be asked to speak at this ceremony and to witness the culmination of the project to establish this memorial.

The project was conceived in 2013 over a lunch in Secret Harbour, WA, attended by John and Barbara Rae, Ian and Jan Lorimer and my wife Maureen and me. John, Ian and I had served together at Cerberusand Penguinin the early 1960s. At the lunch we discussed the closure of the naval hospitals at Penguin, Cerberusand Tarangauon Manus Island, where I served through 1965. We came to the conclusion that there should be a memorial to those hospitals and to those who served in them.

John committed to doing something about it and set about the recruitment or, more precisely, the shanghai-ing of Ron Rosenberg, President of the New South Wales Branch of the Naval Health Services Association, Jim Chapman, Jock and Tina Heath and others, all with the able assistance of Barbara. And here we are today.

I must say that without the optimism, dogged persistence and determination of John and Barbara the whole thing would most likely have been just another bright idea, the flame of which flared, fluttered and died.

Now, back to the navy hospitals and, by way of example I will focus on Balmoral Naval Hospital but most of what I say applies also to the Cerberushospital. I am acutely aware of, and ask you to bear in mind, that the time frame for my comments began 55 years ago. Also, the inevitable and continuous processes of change have rendered my navy experience incompatible with today’s navy.

Balmoral Naval Hospital was more than just a place where ill and injured sailors, of allranks, were sent for medical or surgical treatment. In my view, the presence of that hospital, and the others, projected a powerful image of a navy that cared for and looked after its people in sickness as well as in health.

It also enabled the ill and injured sailors to be treated without leaving the comfort zone and the camaraderie of the mess decks. While in hospital they were in the company of, and were treated by, their peers.

These hospitals were the prime training venues for Sick Bay Staff. There was a Medical Training School at both Cerberusand Penguin hospitals. We junior Sick Berth Attendants learned the basics and the refinements of good nursing care under the supervision of some wonderful, old school nursing sisters likeMatron Maud Jones and Sisters Patti Vines, Barbara Lawry, Carmel Scarfe and others. We learned to understand and to dispense compassion. We learned the tolerance and patience required to nurse the ill and injured.

We were instructed in the ways of the navy by senior Sick Berth Attendants like Chief Petty Officers George Powell, Ron Josey, Doug Hay (not related), Reg Black, Les Hart and Bill Pope. Most of these senior sailors were World War Two or Korean War veterans.

There were senior doctors like Surgeon Captain Brian (BTT) Treloar, Surgeon Captain Armstrong and Surgeon Commanders John Cotterell and John Mitchell. Then there were a number of very junior, inexperienced Surgeon Lieutenants mostly serving out four year, post graduate, navy scholarship commitments. They were not much older than us and some envied our lifestyle. They contributed to our medical education. Many of them, after completing their naval service, went on to become highly respected specialists in various fields.

We worked in the hospital wards on general nursing duties and did the occasional one week of night duty. We were rotated through outpatients, laboratory, x-ray, specialist clinics, medical stores and ambulance escort and attended lectures in the Medical Training School.

After we had proven our worth most of us, by now Able Bodied Sick Berth Attendants, were seconded off to places like Royal Prince AlfredHospitaltobetrainedasLaboratory, Operating Theatre and X-ray Technicians. There was no formal or structured learning process, we just went off and learned what we could. It was probably not the best way for us to learn those skills but we did it and brought the skills back to the navy – and sewed on our right arm rates.

Penguinwas certainly not a bed of roses but, in the best traditions of the services everywhere, we made the most of it and it helped build our characters. As junior sailors we lived in an open mess deck housing about thirty people devoid of privacy, with just a single wooden locker and a bunk to call home. Relationships were sometimes strained but I never did witness a mess deck fight. We learned all about tolerance. We worked in two watches which meant we could only go ashore on alternate nights and alternate weekends. Our average age was about 21 and, while we were working, our long haired, red blooded, sun tanned, civilian peers flopped about on Bondi Beach and raised Cain in Kings Cross etc. We resented that and tried our hardest to offer them a little competition. The wet canteen was only one flight of stairs away and the entertainment highlight of each week was watching The Flintstones on a black and white TV set up in the mess hall. We were lucky to see the screen through the pall of smoke.

There was the occasional drama: at about 1030 on 11 October 1960 HMAS Woomera, while dumping obsolete ammunition, suffered an accidental explosion and sank with the loss of two lives about 20 miles off Sydney Heads. We were still undergoing training but most of us, still wearing our hospital whites, were despatched to the wharf at Penguin and put aboard a workboat. Surgeon Commander Mitchell was also there, as well as a few seamen. The boat got under way and we progressed through the heads and out into the Pacific Ocean. Some time later we saw a naval ship approaching. We had no radio so a seaman rating climbed onto the roof of the workboat with a couple of us holding his legs and proceeded to semaphore the ship using two sailor’s caps. It turned out the ship was HMAS Quickmatchand with all the survivors aboard was proceeding post haste into Sydney. So we turned about and wallowed back to Penguin.

And, of course, Balmoral Naval Hospital played a significant role after the terribleVoyagerdisaster. I had been posted to Leeuwin only a few weeks before. Don Nash, one of my contemporaries, was still there and wrote an excellent account of his involvement that was published in LCDR Jeppesen’s book, Constant Care.

We endured Penguin for about three and a half years during which time sailors who had enlisted with us in other branches had been posted to ships at sea, many for the second or third time. Then eventually our postings started to come through and we went our separate ways but sharing friendships that have lasted lifetimes and countless memories both good and bad. Not by design, but I never did go to sea.

The hospital at Tarangau was different. There we cared for navy personnel, their wives and children and the civil administration population at Lorengau. Then there was the estimated 14,000 indigenous population of Manus Island. They rarely required our services but when they did it was usually serious stuff.

Our one doctor worked hard at general practice medicine, surgery and obstetrics. The nursing sister administered anaesthetics. There was one Operating Theatre Technician, a Chief Petty Officer Pharmacist Rate and one Laboratory Technician – me. When we had serious surgical problems my job was to arrange blood transfusions by taking blood from donors, doing the blood groups and crossmatch then scrubbing up to assist the doctor. We did have the support of civilian, indigenous and some PNG navy people trained in these various fields. Another of my roles was to supervise the native hospital where we admitted those with non-life-threatening illness but requiring admission. Seriously ill native patients were admitted to the main hospital. The native hospital had a maternity ward run by a very competent native male midwife.

The nearest medical help was at Rabaul but only rarely did we need it, usually for worrisome obstetric patients.

My experiences there, with the support and encouragement of an enlightened and extremely competent doctor, Surg. Lt Brian McDonald, cemented my ambition to become a doctor.

The early 1960s were relatively quiet in terms of hostilities and natural disasters. The Vietnam War was still ramping up but it wasn’t long before some of my peers were on active service there with the helicopter squadrons serving ashore or in the destroyers on the gun line. The period since has seen medical staff who were trained in the navy hospitals serving in all sorts of hot spots involving hostilities and natural disasters. Some made the supreme sacrifice. This memorial honours all those who made the supreme sacrifice before, during and since the 1960s. It is also a memorial to the navy hospitals and acknowledges the service of all health professionals who have served in the Royal Australian Navy.

The Naval Hospitals – as we knew them – no longer exist. But they live on in the memories of those of us who lived and worked there; those who simply worked there; and those who were treated there. And they played a major role in the formative years of many impressionable young men and women.

It is not my place to comment on today’s Navy Health Services – I know little of them and there is nothing to be gained in comparisons of the ways of the past with the ways of today. And fifty years hence the navy will not be comparable with today’s navy. Change is inevitable and continuous.

To close, it is my hope and wish that this memorial will become a perpetual reminder that an old fashioned navy hospital once existed near this place. Perhaps, from time to time, an occasional school teacher will bring students here, show them this shrine, and the others, and ask them to research their history.

 

Naval Health Services – an Introduction

By CDRE Liz Rushbrook, Director General, Naval Health Service

I am pleased to participate in this retrospective glimpse of our Naval Health Service. The Service, like the RAN, came into existence just over a century ago and during this time we have learned much from past experiences. We now carry forward our fine traditions and the best of the lessons learned into a bright future.

As incoming Director General Navy Health Service, it is an enormous privilege and honour to ‘hold the tiller’ for the Navy Health Service. I am conscious of the excellent work done by my predecessors and the Health Service in general, and look forward to working with the Navy Health Service team to progress the effort so that we can collectively continue to achieve excellent outcomes for the Navy and the Australian Defence Force.

From my time as a medical student in Brisbane in the late 80s and early 90s and through my formative years as a junior medical officer providing primary and emergency care in the fleet, I collected many experiences and lessons that have formed the foundation of my energy and commitment to ensure the Navy Health Service is meeting its obligations. These have been reinforced and refined in recent years as I managed Navy and ADF health centres, hospital facilities and the Navy Health Service. In this context, there are some key areas that I will focus on.

CDRE Liz Rushbrook RAN                 RAN

The first is health service reform. In the Australian workforce and health service reform, the Navy Health Service has a significant role to play in the broader ADF Strategic Reform Program. Providing streamlined health services at sea, and ensuring our healthcare workforce is competent, current and effective is our core business and the yardstick for our performance. A key requirement is ensuring that our training continuum is best practice.

A wholesale review of our Medical sailor, Medical and Dental Sailor registration/licensing, Medical Administration professionalisation and health workforce innovation (e.g. the role of Nurse Practitioners, Physician Assistants and extended scope of practice for Allied Health Professionals) are initiatives on the short-term horizon.

The second is health service excellence. Professionalism and excellence within the Navy Health Services is fundamental to ensuring Navy can deliver the levels of capability that the government resources us for and expects us to deliver. Benchmarking, Standards, Clinical Governance and Continuous Improvement are the key to achieving health service excellence and I am absolutely committed to ensuring that the Navy Health Service is a leader in these areas.

My third area of focus is positive transformation. With important new reforms such as the new amphibious ships and other changing roles in hospital deployments it is important that we work closely with the wider Navy and other parts of Defence so that reliable health services are provided and delivered on time and on that we take care of the wellbeing and development of our Health Community during this time is important. I intend to ensure that I take every opportunity to listen to and communicate with the Navy Health Service team so that the Navy Health Service of the near future is one of which we can all be justly proud.

As a proud mother of three boys, Jordan 10, William 7 and Thomas 6, and with the support of my husband, Andrew, I look forward to working with the excellent men and women of the Navy Health Service to meet the challenges ahead, and quietly celebrating the sense of achievement that will be gained by finding and implementing some of the solutions.

Only one rule in medical ethics need concern you – that action on your part which best conserves the interests of your patient. Martin H. Fischer (1879-1962)

 

The Early Surgeons of the RAN

By Richard Gardner

Richard Gardner’s father was a well-known surgeon and a close friend of Surgeon Rear Admiral W. (Billie) Carr. Richard joined the RAN on his 18th birthday in May 1945 and served as an able seaman in HMAS Shropshire on her 1946 Victory Cruise. He recently visited Surigao City to revisit the Shropshire/Arunta Memorial to their participation in the Battle of the Surigao Strait.

Staff Surgeon Alexander Caw, RAN (1879-1924)

The first medical officer appointed to the newly formed RAN was Alexander Caw. His appointment as Staff Surgeon (equivalent to Surgeon Lieutenant Commander) was dated 1 August 1912. Caw was born in England in 1879 and came to Australia at an early age, being educated at St. Peters College and Adelaide University. After graduation, he went to England in 1908 and undertook a course of study, paying particular attention to ship hygiene. He joined the cruiser HMAS Encounter in England on 1 August 1912 as Staff Surgeon, being transferred to the battle-cruiser HMAS Australia on 21 June 1913.

Following the sinking of the German cruiser Emden in October 1914, the German threat in the Pacific Ocean was largely removed and Australia was incorporated into Vice Admiral Beatty’s battle-cruiser squadron based at Scapa Flow. Due to damage sustained in a collision with her sister ship New Zealand, Australia was unable to participate in that mammoth but inconclusive struggle amongst the giants in May 1916, later known to history as the Battle of Jutland. His colleague Surgeon Lieutenant Carr wrote: This doctor was an extremely competent surgeon and successfully carried out a mastoid operation at sea with a set of instruments borrowed largely from the Carpenter. Caw always preferred to do his own operative work on board in preference to sending cases ashore, and removed a considerable number of appendixes later in HMAS Australia with the ship rolling and pitching in the North Sea to such an extent that the operating table had to be lashed to the deck and the patient to the operating table. In spite of these drawbacks, Caw’s operations were invariably successful and the sailors who, at first, viewed these proceedings somewhat dubiously, ultimately preferred to be treated on board. Caw served in Australia throughout the 1914 – 1918 War. He resigned in 1920 and settled in Johannesburg, where he practised as an ENT specialist. He died there in 1924 at the young age of 45.

 

Group of five who served Australia 1913-1918. Fleet Surgeon Caw second on left                                                             AWM

The Hospital Ship Grantala: Doctors William Horsfall and Alfred Trinca

The Australian Fleet’s first duty in WWI was to escort the Australian Naval and Military Expeditionary Force to German New Guinea, which was captured in September 1914. The RAN’s first and only hospital ship HMAS Grantala accompanied the expedition.

Grantala, a coastal passenger ship, was requisitioned by the RAN on 7 August 1914 and quickly converted into a hospital ship, but being found too small for these duties was decommissioned on 22 December 1914 and returned to her owners. Grantala had a mixed naval and civilian medical staff, the senior surgeon being William Horsfall, who was appointed as Acting Fleet Surgeon to Grantala on 12 August 1914. His naval service was terminated in January 1915.

Alfred Trinca from Melbourne, the son of Italian immigrants, was appointed as a Civilian Surgeon in Grantala from 25 August 1914 on a daily allowance of 35 shillings. His service was terminated on 31 December 1914.

Trinca’s son Gordon became a Fellow of the Royal Australasian College of Surgeons and was a world authority in the field of road trauma.

Surgeon Rear Admiral William James Carr, RAN, CBE, FRACP (1883-1966)

‘Billie’ Carr was born at Thornton-on-Green, Yorkshire. He was educated at Marlborough College and Trinity College, Cambridge. He completed the clinical training for his medical degree at the London Hospital, where he remained as resident medical officer in 1909 – 1910 and then worked as a ship’s doctor on a tramp steamer. In 1911 the newly-formed Royal Australian Navy advertised in Britain for professional men to join the service and Carr enlisted on 9 December 1912. He was posted to the light cruiser HMAS Melbourne with the rank of Surgeon Lieutenant, seeing service in New Guinea (where he was present at the German surrender at Rabaul), the Pacific, North Atlantic and West Indies. In October 1917 he transferred to the battle-cruiser Australia.

Surgeon Captain William Carr  RAN

In 1920 Carr was posted to the RAN College at Jervis Bay and was promoted to Surgeon Commander in 1924.In 1925 he went on an exchange posting to Haslar, the Royal Naval Hospital at Portsmouth. On his return to Australia in 1927, he was posted to the Flinders Naval Base and he and his wife Leonora (Lenore) settled in at a picturesque house ‘Deep Ghyll’ overlooking Port Phillip Bay on Olivers Hill, Frankston. Referred to by the Melbourne Argus in its social columns as a ‘Beautiful Seaside Home’, the house was situated almost exactly halfway between Carr’s office at Flinders and his Melbourne clubs. In 1932 Carr was appointed Director of Naval Medical Services (DNMS) with the rank of Surgeon Captain. He succeeded Surgeon Commander Leonard Darby, who had won fame as Chief Medical Officer in HMAS Sydney’s epic fight against the German raider Emden off the Cocos-Keeling Islands in 1914. The RAN at this time had been drastically cut following the London Naval Treaty of 1930 limiting the number and tonnage of ships of the world’s navies, coupled with spending cuts during the Great Depression of the late 1920s and early 1930s. In spite of these setbacks, Carr managed to build up a system of naval medical training, including part-time training of young doctors in the Naval Reserve, and had planned the entry of women into the service as nurses. Apart from secondment of RAN doctors to the Royal Naval Hospital Haslar at Portsmouth, Carr arranged for many of them to receive postgraduate Surgeon Captain William Carr RAN training at his old hospital, the London Hospital.

The eight-fold increase in size of the medical services between 1939 and 1945 was handled efficiently, largely due to his planning. He fought to have all hospital ships run and manned by the Navy, but failed to convince the other services, and they were established as Army hospitals. The obituarist in the RACP Journal observed that: Whilst an excellent naval officer and administrator with sound judgement and good sense, Carr was always primarily a doctor and a very human person. He was popular with his subordinates and was sympathetic to the difficulties medical officers faced in a wartime transition from civilian doctoring to military service.

Surgeon Captain ‘Sandy’ Ferguson, RANR, wrote of Carr: I first met Surgeon Captain William Carr in World War 2 when I decided to join the RAN.I was greeted by a short, sturdy man, a perfect gentleman, who made me feel at ease and as one of his ‘sons’. Right through the medical branch, this feeling was pre-eminent, and his obviously humane attitude permeated to every dealing he had with the members of this branch.

As a junior Surgeon Lieutenant, I was posted to an infantry landing ship which was being refitted prior to an assault landing and found that the X-Ray machine on board was in a parlous state. I went to a Sydney supplier and ordered a new one which was duly installed before our ship sailed. I had neglected, in ignorance, to do any of the necessary paperwork, but, it being wartime, the supplier patriotically did as asked. On our way up north, our ship received frantic signals from Navy Office about such an unauthorised action, but on my return to Australia, Carr was kind, gentle and obviously fully understanding when he admonished me face to face. His way of doing things endeared him to all who served under him.

Among Carr’s many responsibilities was the vetting of candidates for entry to the Naval College, now relocated to the Flinders Naval Depot. On 30 November 1933 the Adelaide Advertiser reported that at the Adelaide University 14 candidates from Western Australia and 37 from South Australia were medically examined and interviewed for entry to the College. Candidates were interviewed by Rear Admiral Sarel (Royal Navy), Commander Showers and Mr. Cowan from the Flinders Naval Depot. Surgeon Commander Carr and Surgeon Commander James ‘Jimmie’ Henderson physically examined the boys.

Carr was appointed Honorary Physician to the Governor General continuously from March 1933, and Honorary Surgeon to King George VI from 1940 until his retirement. He was appointed CBE in January 1937 and was also honoured by election as a Fellow of the Royal Australasian College of Physicians. He retired in March 1946 with the rank of Surgeon Rear Admiral, the first RAN officer to reach this rank.

Surgeon Captain Leonard Darby, RAN, CBE (1889 – 1980)

Leonard Darby’s name will forever be associated with the most significant event in the fledgling RAN’s early history – the sinking of the German cruiser Emden off the Cocos-Keeling Islands in the Pacific Ocean on 9 November 1914.

Leonard Darby was born in George Town, Tasmania on 3 January 1899 and attended Church Grammar School, Launceston. He graduated MB BSc from Melbourne University in September 1912. Later in the same month he enlisted in the RAN and was the inaugural appointee to the Naval Hospital at HMAS Cerberus. After a short period of training with the Royal Navy in May 1913 he transferred as the senior surgeon in the new cruiser Sydney. He was supported by an assistant surgeon and Sick Berth Steward 1st Class Thomas Edward Mullins who had served in the Royal Navy from 1900 to 1906. Sydney formed part of the escorting force to the 1st AIF troop convoy crossing the Indian Ocean to Egypt in November 1914.

On the morning of 9 November Sydney was detached to investigate an unidentified ship off the Cocos-Keeling Islands. Engagement with, and destruction of, the German cruiser Emden followed, with the death of four members of Sydney’s crew and the wounding of 13.

Officers of HMAS Sydney, 1914, Surgeon Lieutenant Darby middle row, first on left                                                 AWM

Following the action Surgeon Lieutenant Darby wrote a detailed report to his Commanding Officer Captain J.C.T. Glossop, RN, and this report was published by the Government Printer in 1915. The original manuscript is preserved in the Mitchell Library at the NSW Public Library. The report described in detail how the two ship’s surgeons, working in cramped conditions in the stokers’ bathrooms in 105 degrees of heat, treated Sydney’s casualties. Following these tasks, Sydney turned to the rescue and treatment of 45 serious casualties on board Emden. Of its crew of 400, 185 men and 10 officers remained alive. Darby was eventually assisted by one of Emden’s surgeons and the doctor at the Cocos Island Cable Station. Unfortunately, Emden’s second surgeon became delirious and killed himself.

The exemplary medical work carried out by Dr Darby, at the age of 25 and barely a year after he had completed his degree, was testimony to the eminence of the Melbourne University Medical School. Surgeon Darby received no medal for his part in the action, but valuable recognition in the form of accelerated promotion to Staff Surgeon, which would not normally occur until four years after his first appointment as Surgeon.

Darby was an able sportsman and first-class tennis player who won many championships including the Royal Navy Doubles Championship at Roehampton in 1923 paired with another Australian, Engineer Lieutenant Commander L.G. Carr. On the retirement of Staff Surgeon Alexander Caw, Darby thus became the senior surgeon in the RAN and in 1924 became Director General of Medical Services, which post he held until he was succeeded by Surgeon Captain Carr in 1934. The Melbourne Age noted that Darby’s appointment as DGMS …was a further stage in the complete ‘Australianisation’ of the RAN. Surgeon Commander Darby is the first RAN officer to hold this post, which had recently been relinquished by Surgeon Captain G.A.G. Phipps of the Royal Navy who completed a three-year term.

Darby’s final post was Principal Medical Officer of Naval Ships and Establishments in Sydney, which he held from 11 March 1934 until his retirement. This posting involved the oversight of Sydney’s naval hospitals, medical personnel and civilian specialists at visiting warships and hospitals (the Naval wing at the Prince of Wales Repatriation Hospital, Randwick, HMAS Kuttabul at Garden Island, the new hospital HMAS Penguin at Balmoral, and Canonbury at Darling Point during WW II). His medical and representational responsibilities greatly increased upon the arrival of the British Pacific Fleet in 1945.

Darby evidently enjoyed the representational aspects of his appointment, particularly during the war years when his wife was Secretary of the NSW Branch of the annual Red Cross Day Appeal. Among Red Cross gifts to the Navy was a mobile laundry presented in May 1945 that … will wash and dry 20 hospital sheets or 24 personal kits every 25 minutes. On his retirement in 1946, the Darby’s moved to Queensland where he died in 1980; he is buried in the Caloundra Cemetery. The careers of Carr and Darby proceeded in rough parallel, as demonstrated in the following table.

Darby                                                         Carr

Date of Birth              3/1/1899                                                  30/1/1883

Appoint Surg Lieut   23/9/1912                                                  9/12/1912

Surg LCDR                    1/4/1916                                                  9/12/1918

Surg CMDR                  1/4/1922                                                   30/6/1924

DGMS                            1/3/1927                                                 22/12/1932

Surg CAPT                 31/12/1934                                                 31/12/1934

Hon Surg/Psy GG      1/12/1932                                                    1/3/1933

Hon Surg/PysHM       8/11/1940                                                   8/11/1940

FRACP                                                                                               10/4/1943

CBE                              Jun 1939                                                       Jan 1937

Rtd Surg CAPT         24/1/1946

Rtd Surg RADM                                                                               7/3/1946

Surgeon Captain Alexander Scott Mackenzie (1886 – 1971)

Apart from Carr and Darby, the only other entries in the 1912 Navy List to continue a naval career were Alexander Scott Mackenzie, from Sale, Victoria, who was born in June 1886 and appointed to the RAN on 9 December 1912, and William Edgar Roberts from Wales, whose date of appointment was New Year’s Day 1913 – these were the last of the 1912 intake. They reached the rank of Surgeon Captain and Surgeon Commander respectively and served in WWII. Surgeon John Stuart Macfarlane served for one year in Encounter and then in Australia until he resigned on 31 January 1914.

Scott Mackenzie was CMO of the Cerberus Hospital during WWII. It is regrettable that so little detail remains of his life as he was obviously a colourful character, loved and respected by all ranks.

In Constant Care Jeppesen recalls a reunion at Richmond Town Hall where Scott Mackenzie was guest of honour. Jeppesen noted that not one of those who had served in the medical branch of the RAN prior to and/or during WWII would have known, or heard of, many of the anecdotes about Scott Mackenzie, Lionel Lockwood and Jimmy Henderson. Scott Mackenzie, in responding to his welcome: …proceeds to display an intimate knowledge of, and care for, all members of the branch whenever and wherever they served. That applied particularly to those alone in small ships at sea or in remote bases in forward areas. Out of uniform and without the bluster and eccentricities, which was more theatrical than natural, Scott was a compassionate man. Scott stayed and mingled with the crowd until quite late. He was last seen disappearing down the long passage again silhouetted against the light, with that unmistakable bearing and gait, with his right arm waving a jaunty farewell.

Surgeon Commander James Henderson, MC (1882 – 1955)

As the life of Surgeon Rear Admiral Lockwood is recounted in another part of this Review the last of the group of medical stalwarts between the two wars is James ‘Jimmie’ Henderson. Jimmie was born on a farm at Barnawartha in northern Victoria in 1882 and studied at Albury Grammar School where he excelled in classics and science. He worked on the family farm until he could afford to move to Melbourne to study medicine. He graduated MB BSc in August 1916 and immediately joined the AIF, which was in desperate need of reinforcements.

Attached to the 12th Battalion, his unit took part in the 1st Australian Division’s attack on the Hindenburg Outpost Line in northern France on 18 September 1918 which was the precursor to the final push to victory in November 1918. During the attack Captain Henderson established his Regimental Aid Post immediately to the rear of the Division and attended to the wounded under heavy shell fire. As the attack progressed he moved forward treating a large number of casualties in the open, showing utter disregard of personal safety. For his services he was awarded the Military Cross.

Following demobilisation in November 1919 James Henderson joined the RAN as a Surgeon Lieutenant and commenced duty at the Flinders Naval Depot. For three years from April 1923 he served in the cruiser HMAS Adelaide, this was followed by a return to Flinders. In 1929 he was lent to the Royal Navy for a year’s service and training. He was promoted to Surgeon Commander in 1932 and at age 55 in July 1937 he retired and was transferred to the Emergency List. Retirement was not to last long as with the outbreak of WWII in September 1939 he was recalled and resumed duties at the Flinders Naval Depot until he finally retired in 1950 at the age of 68. In retirement he continued some duties under contract, such as examining new recruits. He died in Melbourne in 1955.

These early surgeons formed the backbone of the RAN’s permanent medical services. In essence they played a game of ‘musical chairs’, as they were rotated and sometimes re-rotated between the small number of seagoing ships and shore establishments or were seconded to the Royal Navy ‘for service and training’ at the Royal Naval Hospital Haslar, and later to Carr’s old hospital, the London Hospital. They had survived the Depression and most had reached the normal retirement age well before the end of WWII. Their commitment was an inspiration to following generations of naval surgeons.

Nursing Memories of HMAS Penguin

By Christina Heath

 Christina Heath (nee King) served in the RAN Nursing Service first in a permanent role and later on a part-time basis in a reserve capacity for over 30 years. She therefore provides a unique insight, especially to Balmoral Naval Hospital at HMAS Penguin from its peak capacity through to its closure.

For serving personnel, HMAS Penguin was the ‘jewel’ of the RAN crown. One of five Sydney Harbour foreshore naval bases, she is perched high on Middle Head overlooking Hunter’s Bay and the sparkling waters of Middle Head and Balmoral Beach. With accommodation overlooking yachts, easy access to Balmoral Beach, national parkland and the bright lights of Mosman and Sydney city, it is the epitome of the dreams of most young people. In early 1977 when I served at Penguin as a RAN Nursing Service (RANNS) Officer on my first posting, I certainly considered myself fortunate.

I was sent to Penguin not to nurse, for which I thought I had joined the Navy, but to do a scuba diving course to prepare me for the tropical reefs of Papua New Guinea! The two-week diving course was sandwiched between my RANNS entry Junior Officer’s Administration Course (JOAC) at HMAS Cerberus and my future hospital posting at PNGDF Lombrum, Manus Island in Papua New Guinea. Each day at Penguin we practised diving skills in the open-air, saltwater swimming pool, birth-place of the ‘Australian Crawl’. However, the magic of that pool did not rub off on me.

After a while I decided to leave the scuba diving to the men, preferring to stay with my new snorkelling skills, which I considered much safer.

They proved quite adequate for me in the ensuing months in PNG when I spent some wonderful hours snorkelling amongst the coral reefs and tropical fish – so vibrant in those northern waters. I thank Penguin for the skills allowing me those remarkable memories.

Manus Island off Madang is only 70 miles long, and the PNGDF base of Lombrum was then linked to the town capital of Lorengau by 20 miles of dirt road – the major road of the island. In 1977-1978 the two RANNS Officers were the only two single white girls on the island, and along with the two RAN Medical Officers we worked at the base hospital at Lombrum with two civilian PNG Registered Nurses and numerous PNGDF Medic staff, caring mainly for the native community. For better communication RAN personnel were encouraged to learn Pidgin English. Patients would walk or canoe miles to attend the ‘Hausick’ where we attended to basic and emergency surgery, delivered babies, and cared for the common diseases of leprosy, TB, malaria, and tropical ulcers. Working long hours at times, days off were our own. If not snorkelling I would ride off through the palm trees on my Suzuki RV90 motorbike to Lorengau to see the markets, pick through the seashell stalls there and watch the islanders going about their business. It was an idyllic lifestyle, measured and tranquil – quite a contrast to that of my homecoming.

Later in 1978 I was posted back to Penguin to take up clinical shift working duties as a Senior Sister RANNS (equivalent to Lieutenant), working between the Medical and Surgical Wards of Balmoral Naval Hospital – the major RAN hospital. I was accommodated in the Wardroom of the base F with the other single officers of the time from Penguin and HMAS Platypus.

Ward work was extremely busy dealing with the pre- and post-operative surgical, and the multitude of medical patient conditions. Recently I found an old ward patient list of an after-hours shift I did around that time, crumpled up in an old navy raincoat pocket. It was a reminder of the hospital and the cases we treated. The top hospital Surgical Ward consisted of 38 beds. At the start of the shift only seven were vacant. The lower hospital Medical Ward consisted of 28 beds and at the start of the shift only one bed was vacant. So that day I was the Duty Nursing officer responsible for 59 hospital patients. In the Surgical Ward, the condition of patients ranged from orthopaedic complaints (fractured ankles, femurs, tibia/fibulas, knee injuries and back pain/strains), to general surgical problems (pre- and post-appendicectomies) and general post-emergency conditions (pneumothorax, sciatica and haematoma).

In the Medical Ward patient complaints ranged from headache and viral illnesses (tonsillitis and bronchitis, glandular fever, and hepatitis), to stomach ulcers, skin conditions, and convulsions. As the Army base was within close proximity on Middle Head, one or two patients were Army personnel.

In the 1970s, Medical and Surgical Ward were in quite separate buildings (implied above by ‘top hospital’ and ‘lower hospital’). Both had two floors. The Surgical Ward complex, at the top of the base near the gangway entry, housed on its upper floor the operating theatre with its anaesthetic and recovery room, and underneath the X-Ray, Pathology, Pharmacy, Outpatient, Dental, and Administrative Services. Down some 200 concrete steps from the top hospital, Medical Ward housed the Physiotherapy and Specialist Departments. Staff and patients called the connecting hill ‘Cardiac Hill’ and often used it for cardiac testing.

Cardiac Hill was definitely the quickest way between ward blocks, and could keep personnel quite fit. Patients when admitted to/discharged from Medical Ward Block were driven between levels. Discharge procedures always included a visit to MOIC (Surgeon Captain in Charge of the Hospital). However, staff collecting linen, picking up and delivering documents, and delivering pathology were not so lucky and had to ‘hop it’, as did the RANNS Officers on their afterhours rounds.

In 1979 I became the Medical Ward Nursing Officer-in-Charge, working with the Medical Officer in Charge of the Ward; firstly, Surgeon Lieutenant Noel Williams, and then Surgeon Lieutenant Bob Green (who became Surgeon Captain Green). I worked happily in this position until early 1981 when I transferred to the reserve listing and left full-time RAN life. For me this time in charge of the Medical Ward was the ‘icing on the cake’ of my naval years. It was extremely busy each day, but the Medical Officer and I worked with some wonderful Medics – WRANS and sailors. Civilian support workers too helped create some special moments.

Surgeon Captain’s inspection rounds occurred monthly. Piped into each of the hospital blocks, the Surgeon Captain, accompanied by the hospital’s Senior Nursing Officer, Senior Sailor and the civilian contract cleaners’ manager, inspected every cupboard, bed, kitchen, work, office and recreational area for tidiness, cleanliness, maintenance and upkeep problems, taking about a half hour to cover Medical Ward. One of my particular memories is of a Senior Nursing Officer of my time wearing white gloves, and each month running them along ledges with great gusto. She often focussed her search for dust on the staircase – a known hot spot – and each time dust was discovered Carlos, the Chilean cleaning manager, was crestfallen.

Besides the above recollection, there are two other vivid memories from that time. One was formed early in 1979, the day of an accident on board HMAS Melbourne at Garden Island. Under the command of Commodore David Martin at the time, chains of a winch on the ship flipped back causing injury to a number of sailors. Soon a convoy of ambulances transported the injured across the Sydney Harbour Bridge to the Balmoral Naval Hospital, with the less injured arriving at the Medical Ward. Without announcement, at about 1500 hours, Commodore Martin himself rushed through the front doors of Medical Ward right next to my office. I caught a flash of gold from his uniform as he crossed my line of vision to see ‘his boys’. His concern and compassion were greatly appreciated by his sailors who admired him such that they would walk over hot coals for him if needed. On retirement the Queen herself honoured him with a knighthood and as Rear Admiral Sir David Martin, he was later the Governor of New South Wales. Loved and respected, he died in office after giving his name to the Sir David Martin Foundation – Caring for Young Australians.

Medical staff, Balmoral Naval Hospital                                                                                                                                           Author

My last particular nursing memory stems from the relationship that the civilian Dr Brodziak had with Medical Ward. Once a fortnight this elderly, eminent, kindly ex-Army WWII veteran Consultant General Physician would do afternoon rounds with the Medical Ward Surgeon Lieutenant. Not only were the years in which he did this for the RAN the closing years of his medical career, but they occurred when the role of the General Consultant Physician was swiftly being overtaken by the new roles of the various specialist doctors. Tradition was that on the afternoon Dr Brodziak attended the ward, the Nursing Officer-in-Charge served him and the Medical Officer afternoon tea with Silver Service. It was very elegant and traditional and other worldly, in the hustle and bustle of busy ward life. The last day Dr Brodziak attended his rounds was a sad one, and he left that afternoon a solitary figure having completed many loyal years of connection with the Services.

After transferring to the Reserves in 1981, I returned and worked at Penguin three times – for two short periods 1981 – 1986, and one extended part-time service 2005 – 2007. By 1986 the Medical Ward was incorporated into a joint Medical/Surgical Ward in the Upper complex; a new impressive theatre suite adjoining the ward was completed allowing more major surgery; the hospital was accredited; and flow-through of patients had increased with shorter hospital stays. The Balmoral Naval Hospital was at its peak with full RAN staff.

I saw changes when I returned to the hospital some 20 years later. There were civilian nurses and doctors supplementing RAN health personnel and numerous patients were being treated at civilian hospitals. The Balmoral theatres were running, but few operations were performed. While I was there, the last operation was carried out. On 10 October 2006 with ABMED Heath Jones, I post-operatively attended the very last patient. After I left in 2008 the hospital closed to make way for a Health Centre. Current in-patients were sent for a time to Holsworthy Hospital and then transferred to the newly opened ‘RAN Ward’ of St Vincent’s Hospital, Darlinghurst – today Sydney’s RAN hospital facility.

I shall always remember Penguin with her fine Balmoral Naval Hospital, which was such a part of the base where I spent many happy years. Significantly I chose Penguin for my wedding celebrations. In 1986 I was married there beneath the trees in front of the Wardroom.

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