Medical Services in New Zealand and The Pacific
I: Hospital Ship Maunganui
I: Hospital Ship Maunganui
THE Maunganui was an oil burner 30 years old with a speed of 15 to 16 knots. Her gross register was 7527 tons, her displacement 11,340 tons, her length 430 feet and breadth 55.6 feet. She was larger than both the Maheno and Marama which were the New Zealand hospital ships of the First World War. Plans were made for some 390 patients to be accommodated in 100 swinging cots, 100 single fixed cots and 95 double (two-tier) fixed cots. (The number of cots ultimately provided was 365 – 22 fracture cots, 84 single cots and the rest two-tier cots.) The conversion involved a good deal of reconstruction, which was carried out by the Wellington Patent Slip Company at a cost of about £50,000. In addition much special equipment was installed. Plans were developed at a series of conferences between DGMS, other officers of Army Headquarters and of other Government departments, and the Union Steam Ship Company, while the Prime Minister, the Rt. Hon. P. Fraser, took a personal interest in the ship. The accommodation in the ship was completely stripped and redesigned in the most serviceable manner.
A complete emergency system of lighting was installed, as well as electric lifts large enough to convey two stretchers from deck to deck, also with emergency power. A huge tank holding 700 tons of fresh water was built in to ensure adequate water supply between ports.
On B Deck was the operating block. This wing contained everything necessary for the equivalent department in a modern hospital. Operating theatre and rooms for sterilising, massage, X-ray, diathermy, and incidental purposes occupied the space where once was the music room, and nearby was a fully-equipped dental surgery.
Further aft on the same deck were recreation rooms for officers, for men and for nurses, while near the stern the plant was installed for a complete laundry, with modern drying rooms attached. C Deck was devoted mainly to wards.
The theatre block consisted of two main units: a plaster room and the theatre proper. Both were exceptionally well appointed when compared with civilian general hospital standards and were equal to the many demands that the Maunganui's varied roles made upon this important section of the surgical side. Not the least of these advantages was the proximity of the X-ray department, which greatly facilitated any procedures requiring the assistance of X-ray screening and radiography. In this connection especially, the orthopaedic work benefited greatly.page 298
The plaster room was fully equipped for the purpose – Hawley table, metal sinks and benches for the making of plaster slabs, X-ray viewing boxes, plaster bandage machine and ample cupboard and shelf space. The room was of generous proportions, enabling it to be used as an emergency theatre.
The operating theatre proper was even larger. A modern operating table with complete accessories and a powerful theatre lamp on an overhead rail, which prevented the lamp swinging to the ship's movement, were notable features of this important section. Adequately sized sterilisers provided hot and cold sterile water. There was even an artificial lung. Numerous extras such as ‘angle-poise’ lamps were in evidence and a large glass-fronted cupboard provided ample storage for instruments. Properly equipped washbasins were installed. The theatre and the plaster room were finished in a pleasing and restful shade of blue.
Anaesthetic equipment again was more than ample. In addition to the usual bottles and masks for general inhalation anaesthesia, the theatre unit also had a fully equipped McKesson gas machine and an Oxford vaporiser. Three large side rooms opened off the main theatre and plaster room, while adjacent to both was the theatre store-room and a surgeons' change-room equipped with shower and toilet, together with locker facilities. All essential lighting was duplicated on emergency circuits and the whole theatre block was ideally situated forward under the bridge on the promenade deck. The theatre was readily accessible to the main surgical wards owing to its central position and its proximity to the cot-lift.
One feature in which the Maunganui differed from conventional British hospital ship layout was in the siting of the autoclave. This equipment is usually placed in the theatre block, but in the Maunganui it was sited some distance aft on the same deck. This was undoubtedly a tremendous advantage in the tropics and prevented overheating of the theatre. The various specialist departments were all grouped together: theatre, laboratory, X-ray, dispensary and physiotherapy. In addition, all the main cot wards with one exception opened off this central area. This centralisation greatly aided the working of the hospital side of the ship, thus saving time and space. The Maunganui could embark patients, both walking and cot, rapidly.
The main dining-room was the main ward. Each of the eight wards had a different colour scheme, and where the lighting arrangements were changed, diffused lighting was installed over the beds.
At the extreme stern of the ship and on the open deck was the isolation ward, complete in itself and entirely separate from the remainder.page 299
Not only was the deck space utilised economically in the provision of wards and incidental accommodation, but the holds which once carried cargo and luggage were also converted into quarters of various kinds. Where No. 4 hold used to be, the NCOs and orderlies had their accommodation, while another hold became a messroom for the men.
While the power unit of the vessel itself was not changed, a complete emergency system of lighting was fitted and special conveyors were arranged for the transfer of food from the commissariat to various parts of the ship.
Events in Greece hastened the completion of the conversion of the Maunganui to a hospital ship. The Prime Minister urged the supervising committee to day-and-night efforts to expedite her departure, and the DGMS was given a free hand to purchase all the medical and surgical equipment necessary without having to await the approval of the Purchasing Board. The estimated date for completion had been 15 May, but the ship was got ready by 21 April 1941. This was made possible only by expeditious work in the conversion of the ship and the fortunate procurement of equipment, some of which was not available in New Zealand. In the meantime the British hospital ship Somersetshire had transported invalids to New Zealand from the Middle East in March 1941.
The Maunganui under the terms of her requisition, was manned and operated by the Union Steam Ship Company of New Zealand Ltd., the deck, engine and providore departments being staffed by the company's officers and the ratings being drawn from the New Zealand maritime unions. The medical personnel were selected by the Director-General of Medical Services and the sisters were appointed from the New Zealand Army Nursing Service by the Matron-in-Chief.
The staff of 104 medical officers, nursing sisters, and orderlies had been assembled at Trentham Military Camp. On 18 and 21 April they embarked and on 22 April 1 NZ HS Manganui left Wellington for Suez, with Colonel Murray1 as OC Troops, Miss Lewis2 as Matron and Captain Whitfield, Master. The Maunganui was not a unit of 2 NZEF and the staffing and equipping of the ship page 300 remained a New Zealand Army Medical Headquarters' responsibility throughout the war.
The immediate impression on the inspection of the ship was a very pleasing one. My personal expectations, knowing the difficulty of securing fittings in New Zealand, were far exceeded. It has been the unanimous opinion of all officers of the 2 NZEF, from the G.O.C. down, that New Zealand has every reason to be proud of its Hospital Ship.
Evidence of this was obvious from the remarks of a Commander of a British hospital ship then lying at Suez, who stated that he had commanded three hospital ships in the present war, had visited every hospital ship that had arrived in the Middle East, and that he was definitely of the opinion that the Maunganui was the best fitted and finest hospital ship he had seen.
The Maunganui was held at Suez until 10 June 1941 in order to take casualties from Greece and Crete. Invalids embarked for the voyage to New Zealand numbered 338. An allocation of forty beds was made to the AIF, in view of the fact that on each voyage of the Australian hospital ship some beds were reserved for New Zealanders. Thus on her first voyage the Maunganui took back a full load of patients, including many of the casualties from the Division's first major actions. On the succeeding fourteen voyages she was always a full ship on her homeward run. On her outward trips, too, it was customary to pick up British invalids at Colombo and Bombay and take them to Egypt, where they were transferred to a British hospital ship. Apart from about six weeks in 1942 when she was laid up for overhaul, and a period in 1943 when, because of an accident to one of her propellers, she was taken from North Africa to the United Kingdom for repairs, the Maunganui was always on service.
The Maunganui alone, however, was not sufficient to bring back to New Zealand all the invalids from the Middle East, especially after campaigns where casualties were heavy. Valuable assistance was rendered by the Australian hospital ship Wanganella, which carried many hundreds of New Zealanders, and by the Netherlands hospital ship Oranje.
HS Maunganui spent much of 1945 with the British Pacific Fleet. On her fifteenth voyage, beginning on 17 March 1945, the ship was diverted at Melbourne from the Middle East to the Pacific, and she went on to Sydney, to Manus Island, to Leyte Island, where the ship functioned as a general hospital under Lieutenant-Colonel F. O. Bennett, with Miss G. L. Thwaites as Matron, from 13 April to 21 May before returning to Wellington. Leaving Wellington on 28 June, the ship again headed for the Pacific and was the medical page 301 centre for the British Pacific Fleet at Manus Island from 7 July to 18 August before moving on to Hong Kong and Formosa with the American Task Force 111 to pick up patients from among the prisoners of war released from the Japanese. Most of these patients were brought back to New Zealand on her return on 8 October.
While at Leyte in the Philippine Islands on the fifteenth voyage the ship admitted 342 patients, most of them from other ships in the Fleet Train which was anchored around the Maunganui. The ship was used as a naval auxiliary hospital, half of the fleet being allotted to it and the other half to HS Oxfordshire. Patients were discharged to their own ship or, if this had sailed, to a ship which acted as a pool depot. Some serious cases were transferred to ships going to Sydney, and patients were also brought back to Sydney in the hospital ship when she returned.
At Manus on the sixteenth voyage the ship admitted and discharged 242 patients before sailing to Hong Kong, where 111 patients were embarked. Then 108 patients were embarked at Kiirun, Formosa, and later another 156 at Manila on the voyage south again. A few were discharged at Hong Kong, Formosa and Manila, but 362 were brought back to New Zealand where, except for some Australians immediately transferred to a United States hospital ship to go to Sydney, they received hospital and convalescent treatment before being finally repatriated to their own countries, most of them to the United Kingdom by the Maunganui on 23 November. The patients embarked at Hong Kong included civilians as well as service patients, and many of those embarked at Formosa were British service personnel who had been taken prisoner at the fall of Singapore; those embarked at Manila included many Australians from a United States hospital and a prisoner-of-war reception depot there. They all speedily put on weight and improved in health on the hospital ship, whose staff was kept busily occupied in their treatment. The Maunganui took the ex-prisoners of war to the United Kingdom on her final voyage beginning on 23 November 1945 and ending on 20 March 1946, when she brought back to New Zealand the last of 2 NZEF invalids from Italy and Egypt. By this time the number of patients carried numbered 5677.
Lessons from Experience
The most important matter in the administration of a hospital ship was stated to be harmony between the Army and the Merchant Navy. This centred on the careful choice of the Master and the OC Troops. On the Maunganui successive OsC Troops worked in the utmost harmony with the Master, who showed the army medical staff every consideration. The person next in importance to OC page 302 Troops was deemed to be the Adjutant, who also needed to be specially chosen for the position. With a strong Matron, nursing sisters and a small number of voluntary aids were favoured. It was thought, however, that a preponderance of the nursing orderlies should be males, as they have numerous duties other than nursing to carry out – to supply guards, deal with fractious patients, make up stretcher and baggage parties, and assist in emergency precautions aboard ship, including closing the watertight doors, evacuating patients from wards and manning lifeboats. The male establishment of the Maunganui (72) was held to be too small for all these purposes, especially as work was frequently heavy and exacting, particularly in tropical waters. The Maunganui had more nursing sisters than most British hospital ships and was thought to be the better for it. Even then some officers thought that thirty rather than twenty sisters was desirable, and that there should be two dietitians, three physiotherapists and an occupational therapist. It was agreed that any future decisions on establishments for hospital ships would depend on the size of ship, length of voyage, type of patient and adaptability of staff.
As regards the ship and fittings, it was felt that the Maunganui was very suitable for the purpose – she had adequate speed (averaging some 14 knots), stability in heavy seas, interior hospital arrangements well planned, and equipment of a high standard. One standing criticism was the lack of air conditioning, especially in a ship having to go through the tropics. Owing to a variation in requirements with every voyage it was recommended that a hospital ship should have six or more small rooms whose special purpose could be determined during each voyage, e.g., for plaster room, laboratory, special patients. It was felt that a reasonable amount of deck space for recreation was always necessary, as also was ample dining space for convalescent patients, and swinging cots and a reasonable number of wide fracture beds.
Other points submitted for consideration arising from the Maunganui's experience were: a proper landing stage at least eight feet long at the foot of the gangway for stretcher cases; facilities for landing stretcher cases by winch; adequate laundry facilities; no wards between watertight doors or below the water line; companion-ways as wide as possible; and provision of the best type of life-jacket.