E. M. Huxley
June 24th, 1943

     In April this year I was posted to an Indian General Hospital to open a special hospital to deal with an outbreak of Typhus occurring among the civilian populations of Teheran. I arrived from Baghdad in the afternoon of April 11th. The official opening had taken place in the morning with the admission of twenty-three patients. The hospital consisted of tents to accommodate 1000 beds; a very wide open space had been selected for the site, which was ideal for the nature of the work to be done. The tents were divided into “Sections” of 100 beds; each section comprised three tents with one in the centre for the Sisters’ duty room, and the usual outer ones for the bath, utensils, etc. In addition there was a separate section for the admission of patients. This consisted of a Receiving Room, another one for dealing with the dirty clothing and shaving of the patients, followed by one for the bathing, which was on the warm shower system, and finally into the clean dressing room where the patients were dressed in warm clothing and given hot tea with rum added, before being sent to a ward. We also had another tent very nicely fixed up as an “Operating Theatre.” In addition to quite a fair number of operations which included two amputations of leg due to gangrene, as a result of Typhus. All the sterilising for the sections was done every day. Also Intravenous Saline Infusion Sets “kept always ready for use.”

     We also had a Red Cross Store which was opened daily for the issue of any comforts we were able to obtain for the patients. Our supplies being very kindly given by the American and Indian Red Cross, included such things as sweets, rubber gloves, milk, overalls and numerous other things which have been of tremendous value to us in this work. Other tents included a Dining Hall for all who were able to get up for meals. This was usually a very happy place to visit, as most of the patients were fairly well recovered before being permitted to attend. The Sisters also had a small compound fixed up as a dressing room – one large tent for the purpose and bath tents attached. There was a plentiful supply of hot and cold water, and all were able to have baths and complete change of clothing before leaving the hospital on changing duty.

     A word here may be interesting about the Sisters’ and Personnel’s uniform. The Sisters on duty wore Pyjama Trousers and Overalls. The overalls were all high in the neck and tied at the wrists. Rubber gloves were used for all dirty cases and dressings. The hair was covered entirely, slings or triangular bandages being used for the purpose. It was surprising to find how attractive many of them were able to make even this style of dress. In the early days Gum Boots were worn, but it was found that they were soon abandoned for the wards but continued in the Reception Centre. The personnel wore the same type of dress to work in as the Sisters, but shirts were used with long sleeves instead of overalls.

     My staff consisted of one Assistant Matron, thirty members of Q.A.I.M.N.S. (R), T.A.N.S., one member of I.V.A.S. (this lady speaks Persian), eighty Nursing Sepoys, Sweepers, Water Carriers, Cooks and Laundry Workers. The cooks were later replaced by Persians, as though the food taken by the two peoples is very similar, the cooking is a little different. We had, too, some Persian nurses. These were not easy to obtain, as nursing as a profession does not seem to be widely adopted in this country. There were about six who were able to work as trained nurses – the remainder, nine in number, were useful in that they could give drinks, wash patients, and help generally under supervision. They were all most willing to learn from the Sisters, and at the time of writing these notes they have become much more useful. The language was a little difficult at first, but this problem was solved by the employment by the Persian Government of interpreters, one to each section; among those were included one Persian and one Swedish lady.

     The working hours of the Sisters were divided into two sections, the first commencing duty at 1 p.m. and finishing at 8 p.m. continuing next morning until 1 p.m. when the second batch would take over. This may sound on reading to be a very long tour of duty, but it gave the Sisters a full twenty four hours away from the wards every other day, and during this time they were encouraged to go out as much as possible. Also the clothing for protection was completely changed with each turn of duty, and it meant a very large supply to meet the demands. Night duty was seven nights on with a sleeping day and full twenty-four hours off at the end. The Senior Sister on night duty acted as Superintendent at night and collected and wrote reports for the morning. Patients were known by numbers only. Great care was taken by all concerned that no number of bed was changed of any patient after his admission. This was not always strictly adhered to by the patients themselves, for on occasions any one preferring another bed to the one already occupied would, even though it would mean turning another one out, just put himself in possession, resulting sometimes in a very long search for what would appear to be a ‘Missing Patient.’ The average number of admissions up to the middle of May was 40 to 40 per day, our largest number of admissions on any one day being 72. We only admitted men and boys. Out youngest patient was a small boy aged five years. He had as well as a very severe Typhus – a thickly crusted scalp of sores which had a treatment ‘Starch Poultices.’ He was put in bed next to a very old man of about seventy, and everything that was given to the small one as regards sweets, etc., or any spoiling at all, had to be done just the same for his next door neighbour. The only omission was the ‘Starch Poultices.’

     Our first visiting day was one to be ever remembered. It was arranged for two o’clock in the afternoon, and personnel were detailed to be on duty to receive the visitors and conduct them to the various sections. The crowd – men, women and children, began to collect outside the hospital entrances at 7 a.m. and increased steadily all the morning until the appointed hour arrived. They then just surged into the tents completely ignoring any of the people who were to have helped them. One felt it was more curiosity than real anxiety about their relatives. They all seemed so surprised to find them all comfortably tucked up in bed, and Staff around looking after their needs. The result of this for us was a complete disinfestations of 500 blankets, apart from all the other linen used on the beds. The next week a barrier of wire was placed round the tents and the walls opened, and the visitors were able to see the patients and chat freely, but on no account were any allowed inside the tents. Seriously ill cases were permitted visitors in this way every day. Others once weekly.

     The nursing of these Typhus patients has been extremely interesting. Many were admitted in a very toxaemic condition. Temperature low, probably due to the amount of washing they would receive in the Reception Centre. Plenty of fluid was given by mouth in all cases, and intravenous saline in the more ill cases who were unable to swallow sufficiently. The routine was fluid for two days, and after that liberal feeding in all cases who were able to take food. The mouths were treated with a solution of soda bicarbonate and boric, followed in the early days by a little honey, but this latter was unavailable, and a syrup made from sugar was used instead. Alkalines were used largely, and heart stimulants, such as Coramine and Camphor in oil. Heart failure is a very common symptom of the disease and has to be continually watched for, even in cases that would appear to be on the road to recovery. Rum has proved a very valuable substitute for brandy. The sisters usually make large jugs of egg flip with rum added each morning for the very sick ones.

     In addition to Typhus, a great many cases were admitted with such conditions as scalp sores, chest complications, abscesses and impetigo. Bed sores from easily, also gangrene. Incontinence was very common. Most of the cases were like this for the first day or so. A very large supply of linen, soap, mackintoshes etc., is required to run a Typhus Hospital. A low muttering delirium is another common condition, and many of the patients complained of headaches and joint pains. The mortality has not been unduly high for the number of extremely ill cases we have dealt with. The most difficult to cure are the older men; this in many cases is due to the fact that they take opium to rather great extent, and so become in time very emaciated, and have very little resisting powers. The patients on the whole have been very nice to deal with. They are usually very quiet a few days after admission, but as they gradually feel better become very happy, and are most anxious to help each other and the Sisters. One boy discharged from hospital found his way back after a few days, and would have been quite content to stay for some time as a helper, if he had been so permitted. With the coming of the warmer days, the Typhus began to decline, and our numbers are now very much reduced.

     About the middle of May the Indian General Hospital had orders to move, and this work was carried out by a Combined British and Indian Hospital. The number of cases at that time was 675. The Nursing Sisters all remained, but the entire personnel otherwise were discharged. The changeover was effected very easily, and not much disturbance made in the routine of the work.
I feel a little reference to the Sisters’ accommodation may be interesting. We were all living in tents apart from the hospital, but within walking distance. One afternoon while a large number would be having a little siesta, the rain commenced, and quite suddenly – almost it would appear as from nowhere at all – appeared a heavy rush of water which in a very short time completely flooded our tents. We made a great effort to rescue all our possessions from the floor, and finally had to take refuge in the nearest building until the tents could be dried or repitched. With the changing of the Hospital Unit we also had to move our tents again. The special day selected for the move, an almost record dust storm arose, and the entire new situation presented a very sad spectacle. We are now almost completing our service here, and the too far distant future will see us in different spheres of action. We have all been a very happy community, and I feel it will be with a little feeling of regret that we shall say ‘Au Revoir’ to our Typhus Hospital.