This paper, written by Dr M. G. Miller, © was published in Sabretache, the Journal and Proceedings of the
Military and Historical Society of Australia, Vol. LV, No. 2, June
2014, Pages 11-16.
The account of HMAS Sydney's medical service during the
engagement with SMS Emden off the Cocos-Keeling Islands naturally falls
into three sections. The first is a description of the medical
facilities available to the medical service before and during the
engagement, most of these being inadequate. Then follows an account of
the management of HMAS Sydney's casualties during the actual
engagement. Finally is the post-engagement activity, when suddenly a
large number, two sources give between 70 and 80, of German wounded
were evacuated from the wreck of SMS Emden to HMAS Sydney for treatment.
1. HMAS Sydney, a 5,400 ton British Chatham Class 6 inch light cruiser,
was commissioned into the RAN as a new ship in 1913 under the command
of Captain John Glossop RN., who had been seconded to the Royal
Australian Navy. She was armed with eight 6 inch (15.2 cms) guns and
was originally designed as a long distance cruiser with a pre-war crew
of 376, but was over-crowded with her wartime crew of 475 composed of
members of the Royal Australian Navy and the Royal Navy. She was
designed as a fighting ship and very little provision had been given
for the management of any wounded apart from a Sick Bay; there were
steep stairways, ladders and narrow passages that made the movement of
wounded men on stretchers through the ship very difficult.
The two medical officers were Surgeon-Lieutenant Leonard Darby, age 24,
the Senior Surgeon, who had qualified as a medical practitioner two
years previously in 1912 and who had joined the Royal Australian Navy
the same year. The Assistant Surgeon was Surgeon-Lieutenant Arthur
Charles Robert Todd, aged 25, who had qualified as a medical
practitioner in 1914 and had joined the ship only a fortnight before
the engagement. There were two sick berth attendants and, when the ship
was at action stations, stretcher bearers and a First Aid Party whose
usual occupations were the regulatory, commissary and clerical staff.
First Aid bags were also situated at each gun and at the fire control
stations.
Before the action, one of the stoker's bathrooms had been converted
into a permanent operating theatre. The bathroom was 10 feet (3.05
metres) x 8 feet (2.44 metres) and 7 feet (2.134 metres) in size and
was equipped with hot and cold water. Unfortunately this water supply
failed to survive the concussion of the guns, and, as Dr Darby wrote in
his report to Captain Glossop, it came 'black, muddy and useless'
through the taps after ten minutes of gunfire. However Dr Darby had the
foresight to ensure that an emergency supply of boiled water was stored
in the Captain's and the Wardroom's galley.
This permanent operating theatre was equipped with an operating table,
instruments and dressings that were stored for immediate use. It was
subsequently found, however, that the instruments for eye surgery were
so old that they could not be used and the immediate supply of morphine
had passed its use-by date and was ineffective. Unfortunately, only two
days before the action, the operating theatre had been cleared for
painting and there was very little time for the equipment to be
replaced and properly stowed, thus causing considerable confusion and
delay when the theatre was first used.When the ship went to action
against SMS Emden and the wounded men began to be brought down to the
sick-bay, another stoker's bathroom was converted to a temporary second
operating theatre. This was hurriedly fitted out with a mess table as
an operating table and equipment that was brought from the first
operating theatre. Six other bathrooms were also cleaned and served as
shelters for the wounded as they were brought below.
The Engagement off the Cocos-Keeling Islands on Monday, the 9th. of November, 1914
SMS Emden had put a landing party ashore on Direction Island,
one of the northern Cocos-Keeling Islands, to capture and destroy the
wireless station of the Eastern Telegraph Company. However the
Telegraph Company was able to send a message about the approach of the
Emden and HMAS Sydney was detached from convoy duty to investigate. SMS
Emden's wireless operator intercepted the message that dispatched HMAS
Sydney to the Cocos Islands and, when she saw masts on the horizon, SMS
Emden quickly weighed anchor. She was able to open well-aimed fire on
the Sydney causing fifteen casualties. The faster and more heavily
armed Sydney soon found the range of the Emden and caused massive
damage to her, setting fire to her stern. Her Captain, Karl von Müller
ran SMS Emden ashore on North Keeling Island, the northernmost Island
of the chain, in order to surrender and reduce the casualties.
During the action HMAS Sydney's wounded, some being very badly injured,
were transported below to the medical officers. These included a man
with a fractured right leg and thirteen different shrapnel wounds and
another with a chest wound that exposed his heart; this could be seen
pumping at the left front of his chest. There was a man with multiple
shrapnel injuries and a fragment of shell penetrating his eye, another
with severe burns from head to foot and a man whose foot was shot away.
Crew members suffered burns and one man had an abdominal wound that was
soon to be fatal. Most suffered from loss of blood. The last casualty
was from the bridge, his left leg had been shot away at the junction
with his body
and he too was suffering from marked loss of blood. His carriage below
through the winding passages and narrow hatches caused significant
delay before he could be treated.
All patients, apart from the last, had arrived in a steady stream and
had to be assessed individually by a surgeon before operative treatment
could be given. Morphine and first aid was given while the assessment
was continuing and the Wardroom was commandeered to accommodate them,
beds and blankets were taken from the cabins.
The casualty from the bridge was given priority for immediate surgery
and was given a pint (0.57 Litres) of saline under his skin as blood
transfusion was at that time too dangerous for general use.
Unfortunately he died of blood loss and shock during the long operation
to close his wound. It is noteworthy that the safe use of blood
transfusion, containing citrate to prevent blood from clotting during
transfusion, was first described by a Belgian, Albert Hustin, in 1914,
the same year as the Sydney-Emden engagement.(2)
The medical staff worked for two hours, non-stop, in a temperature of
over 400 Centigrade, assessing the wounded and giving them treatment.
Surgeon Todd was handicapped due to his Sick Berth Attendant fainting
four times in the heat. There had been four deaths but the eleven
surviving cases were occupying beds in the Wardroom by eleven am. Most
were restless and groaning in pain and it was only then discovered that
the morphine had deteriorated in the ampoules supplied and was so
ineffective that fresh morphine had to be given.
As soon as the sick bay staff could be spared, Dr Darby ordered the
conversion of the sick bay into a better temporary operating theatre as
soon as possible. The sick bay had been flooded with water from the
fire mains and there was an enormous amount of work clearing up from
this and the recent activities.
The volunteer First Aid party, including the Paymaster and the
Chaplain, nursed the wounded and the wardroom was converted into a
hospital ward. The surgeons' work was frequently interrupted all
through the afternoon and evening as German sailors were being picked
up after they had jumped, or been blown overboard, from the Emden. One
man had been in the shark infested sea for nine hours, and in Dr
Darby's words, "...was brought round after much trouble. Next day he
was no worse off for his immersion".
It was impossible to do any operative surgery until the next day
because of overcrowding, the flooding of the sick bay, a shortage of
trained theatre staff and the need for the two surgeons to rest before
they could perform any reparative operative work. As it was, they were
up until midnight caring for their patients. The sick bay attendants
had been sent to bed at 10 pm and the surgeons then took 4 hourly
watches from midnight. Volunteers from the crew and the First Aid
party, even though untrained, also took 4 hourly watches doing the
nursing, under the supervision of the Paymaster and the Chaplain.
The Post-Engagement Period
Early on Tuesday, the next morning, the ship arrived off
Direction Island to find that the Emden's landing party had escaped on
board a captured schooner on the approach of HMAS Sydney. Dr H. S.
Ollerhead, the Australian Medical Officer to the Telegraph Station, and
his two assistants, came on board HMAS Sydney to assist the medical
staff and it was now possible to assess the wounded under chloroform
anaesthesia.
Chloroform can cause burns if used in direct contact with the skin and
accordingly, it was administered by a drop bottle onto a piece of cloth
stretched over a metal frame, called the Schimmelbusch mask. This was
placed over the patient's mouth and nose. Chloroform also has to be
administered slowly and very carefully by the anaesthetist as
chloroform poisoning and liver damage is always possible if too much is
used. Despite these limitations, a total of 2 pounds, or nearly a
kilogram, of chloroform was used during and after the engagement. Ether
was first used to demonstrate the value of anaesthetics by a dentist,
Dr Morton, in 1846, at the Massachusetts General Hospital in America,
but this much safer anaesthetic was not available aboard HMAS Sydney in
1914(3).
The first case to be operated on was the Able Seaman whose heart was
exposed, unfortunately he died of blood loss two hours after extensive
surgery to the chest. While they were operating on the next case, the
ship arrived off North Keeling Island, about ten miles (16 Km.)
north-west of Direction Island. SMS Emden was beached there and was
flying distress signals so HMAS Sydney anchored and a party under Dr
Ollerhead went aboard.
The exact number of German wounded on board the wreck is not known, but
according to Dr Luther, the surviving German surgeon, there were about
80.(5) Captain von Müller's Report to the German Admiralty stated a
total of 65 (6) but his numbers do not accord with the report of Dr
Danby of between 70 and 80. Julian Corbett in the "History of the Great
War", Naval Operations (7), gives 56 but does not state from where he
obtained this information.
However many there were, these injured men, about 35 to 40 being very
severely injured, had been lying without any medical attention for up
to 30 hours in a wrecked ship without water and in tropical heat. Their
wounds were crawling with large maggots and were seriously infected.
All available stretchers and hammocks were sent to Emden where, in the
Report of Dr Darby to Captain Glossop: "Men were lying killed and
mutilated in heaps, with large blackened flesh wounds ... the ship was
riddled with large gaping holes, and it was difficult to walk about the
decks, and she was gutted with fire."
The wounded were evacuated from SMS Emden to be taken by boat to HMAS
Sydney. This transfer was difficult, and most painful for the injured,
as there was a large surf running on the beach and the Emden was such a
shambles that the lifting, carrying and lowering of the wounded from
the ship onto the boats was necessarily rough, and SMS Emden had no
functioning boat davits left. When they reached HMAS Sydney the injured
men were hoisted on board, in cots and stretchers using her davits, and
taken below to the temporary Wardroom hospital.
SMS Emden's assistant surgeon had been blown overboard and had swum
ashore to the beach. There he had suffered from such severe thirst that
in desperation he had drunk sea water and died (8). SMS Emden's
surviving surgeon, Dr Luther, was physically unwounded as his station
in action was the stokehold, but was described by Dr Darby as being
"... a nervous wreck" for a short time as he had been alone on the
wrecked ship with so many injured men and had no equipment and none of
his staff. He was temporarily unable to help treat any injured on board
HMAS Sydney, but eventually recovered and was then able to assist in
the care of the wounded by performing surgery and giving anaesthetics.
As the German wounded were taken on board to the wardroom, it soon
became overcrowded and many of them had to put up with most unsuitable
accommodation for wounded men. They had to be placed along the
corridors near the sick bay and soon there was scarcely room to move.
All available cots and beds were drawn from the stores and blankets
were given up to them by the ship's officers, but these were
insufficient and some of the lesser wounded perforce went without any
cover. It must also be remembered that the already overcrowded ship had
taken on board not only the wounded but over 128 unwounded prisoners
from the Emden and from the attending collier that had been scuttled
after the engagement.
Further surgery on the patients from HMAS Sydney was ceased until an
initial assessment could be made of the German wounded. Drs Danby, Todd
and Ollerhead attended the more severe cases in the wardroom hospital
and directed the First Aid party on how to treat the simpler ones. Some
35 to 40 of the German wounded were very serious. Some had legs hanging
by ligaments, others had arms nearly blown off by shell explosion and
all these required amputation of the limbs. There were several with
severe facial injuries and one particular man had an extensive facial
injury that was severely infected with foul-smelling pus. The odour was
so appalling that, after cleaning and dressing the wound under morphia,
he had to be removed from the Wardroom to the fresh air outside. This
man died six hours later. Overall four German wounded died on board
HMAS Sydney.
During the action, many of the injured had applied tourniquets of spun
yarn, handkerchiefs or a piece of cloth to their limbs to stop
bleeding. This had saved them from bleeding to death but they had
failed to release their tourniquets, causing the limb below the
constriction to become gangrenous and require amputation.
Operations on the German wounded started at 6 pm on Tuesday the 10th of
November and continued until 4.30 am. on Wednesday the next morning,
involving some ten and a half hours of very intensive surgery. The ship
sailed to Direction Island on that day to return Dr Ollerhead, and then
set sail for Colombo. The last batch of German wounded were given
surgical attention during the day and the operating theatres had then
to be cleaned again before they could be used.
On Thursday the 12th. of November, attention was able to be given to
HMAS Sydney's own wounded. These had been stabilised before the wounded
from SMS Emden came aboard but had not been given any surgery. The
first patient had thirteen wounds due to shell fragments and one
fragment had fractured both bones of the lower right leg above the
ankle. In those pre-antibiotic days the usual treatment for a compound
fracture, that is a fracture that communicates with an open wound, was
amputation because of the danger of infection. However Dr Darby
attempted to save the foot and, after two hours of surgery the patient
was placed in charge of a volunteer nurse in the Commander's cabin. His
dressings had to be given under anaesthesia for the next fourteen days
but the foot was eventually saved.
By nightfall the three doctors had finished all the major surgery, Dr
Luther and Dr Todd alternating as anaesthetists and surgeons. There was
no time to treat the lesser wounded cases, these were treated by the
first aid party, and the wardroom hospital and its equipment had to be
reorganised. The patients were fed and nursed by the First Aid Party
and unwounded German prisoners helped with the German injured. The
casualties from HMAS Sydney were nursed in the wardroom, but often had
to be taken on deck because of the oppressive heat. The Germans filled
the waist deck, they were cooler there, although they were regularly
washed by heavy rain despite awnings and side curtains. A special
party, under the Chaplain, was formed to look after the feeding of all
the patients. The stretcher party attended to the movement of patients
to and from the sick bay but this was difficult because of the
overcrowding of the ship and the narrow hatchways and doorways.
The British armed liner, the Empress of Russia, joined HMAS Sydney at
sea on the evening of Thursday the 12th. November. She had been sent to
help with the wounded and to relieve HMAS Sydney of the German
prisoners from SMS Emden and the Chinese seamen from the collier. The
weather was calm and on Friday the 13th of November, the unwounded
prisoners, the walking wounded and the cot cases were transferred. All
of the Sydney's wounded and the more serious of the German wounded were
kept back, including all those who had had surgery. New bedding was
also transferred from the 'Empress of Russia', this was very necessary
as most of HMAS Sydney's bedding that had been used on the patients
was, in Dr Darby's words: "...most horribly filthy, foul and
offensive." and had to be thrown overboard.
Now that they had more room, every case had a change of dressing, some
badly needing this. The remaining bedding and blankets were put through
the steam disinfector. The parts of the ship adjacent to the wounded
were in a filthy condition because the hot humid weather had
contributed to the rapid decomposition of blood and wound discharge
that had unavoidably leaked onto the corticene decks. The decks of the
sick bay, the ward-room and starboard corridors had to be scraped and
scrubbed, but despite this an offensive odour still persisted in the
lower decks.
It had been decided to make for Colombo because there was a Military
Hospital there and HMAS Sydney arrived on the morning of Sunday the
15th November. The German wounded were sent to the Military Hospital,
and when this was full to the Civil Hospital. The Sydney's wounded
remained on board but the ship was still in a most unsanitary condition
and the Colombo health authorities were brought in to inspect and spray
the ship. All this was done hurriedly as the Captain was anxious to put
to sea after coaling. She left Colombo on Thursday the 19th November,
her medical staff continuing to treat those of her wounded who had not
been taken off in Ceylon.
In concluding this paper it should be emphasised that in November 1914,
during and after the engagement with SMS Emden, the young medical
officers of HMAS Sydney treated the eleven surviving casualties from
their own ship and then were suddenly required to treat about 70-80
wounded German sailors from SMS Emden, of whom at least 35 were very
seriously injured. Dr Darby, who had qualified as a doctor only in 1912
and Dr Todd, who had qualified only in 1914, were required to perform
complicated chest, facial and abdominal operations and many amputations
under the most difficult conditions imaginable on board a ship that had
quite inadequate medical facilities.
Dr Charles Todd remained with HMAS Sydney until June 1916 when he
developed pneumonia following an attack of influenza and was returned
to Australia. He was subsequently invalided out of the Royal Australian
Navy in 1917 and died from chronic heart disease ten years later in
1927.(9)
After the action Dr Darby was given accelerated promotion to Staff
Surgeon (Surgeon Lieutenant-Commander) and was promoted to Surgeon
Commander in 1922. He had a distinguished career in the post war
Australian Navy, retiring as Surgeon Captain and a Commander of the
British Empire. He had held the positions of the Director of the
Australian Medical Services and then had two terms as Honorary Surgeon
to His Excellency the Governor-General of Australia. He died in March
1980.(10).
NOTES
1. Parts of the preparation of this paper relied on the Post Action
Report on the Action between HMAS Sydney and SMS Emden on the 9th
November 1914, by Dr Darby, the Principal Medical Officer of HMAS
Sydney, to his Captain. This was published in Australia in 1915 by the
Government Printer of the Commonwealth of Australia. [This is referred
to in the Notes as the 'Post Action Report']
2. Hustin, A. (1914) "Note sur une nouvelle methode de transfusion.
Annales et Bulletin des Seances": Societe des Sciences Medicales et
Naturelles de Bruxelles, 72e Annee, 104, 111.
3. In later years chloroform was used only for the induction of
anaesthesia and the much safer ether was then used to continue the
operation.
5. Post Action Report.
6. Captain von Müller's Report to the German Admiralty, in "Official
History of Australia in the War of 1914-18", Vol IX, A. W. Jose, page
202.
7. "History of the Great War", Naval Operations, Vol. I, Julian Corbett, 1920, page 384.
8. Post Action Report. Dr Darby wrote that "After much persuasion he
got a sailor to bring him some salt water, of which he drank a large
quantity, and straightaway became raving mad and died."
9. The Australian National Archives.
10. The Medical Directory of Australia and the Australian National Archives.