New Zealand Medical Services in Middle East and Italy
REVIEW OF THE MEDICAL ARRANGEMENTS
REVIEW OF THE MEDICAL ARRANGEMENTS
The Consultant Surgeon was impressed with the medical arrangements of 30 Corps under the DDMS, Brigadier Ardagh, whose knowledge of desert warfare and appreciation of the clinical aspects of medicine inspired the confidence of those under him. The method of grouping forward operating units (CCSs) in one area, as had been done since Alamein, was thought to be a very desirable feature.page 447
Maximum use was made of surgical personnel, especially within the New Zealand medical units, by transfer and attachment. Fluidity of surgical personnel was essential for the efficient performance of forward surgery which, during the Western Desert campaigns, was a question of very concentrated periods of work requiring sudden boosting of surgical potential for the short active periods. Between 20 March and 18 April there were 695 wounded, mostly occurring in a few days at Tebaga Gap, and between 19 April and 13 May there were 590 casualties, likewise mostly within a few days. The necessity for spelling of surgical units during these active phases was not completely realised, and it had been common to place a single surgical unit by itself with an MDS in an isolated position. The result was that the unit was often flooded with cases requiring operation, an over-long operation list accumulated, and the unit exhausted itself in trying to do rapidly too great a volume of work. A grouping of surgical units would have provided a relief team. (In 2 NZ Division there were usually two attached surgical teams working with the open MDS in active phases.) The addition of an X-ray plant to an MDS when it was called upon to do forward surgery would have been of great value.
The organisation and work of the New Zealand field ambulances was excellent and earned much praise and reflected great credit on the commanding officers and staffs. The work of the CCS was of the highest order and the unit had deservedly earned a proud reputation, ascribed by the Consultant Surgeon to the thoroughness and conscientiousness of Lieutenant-Colonel Hunter and staff, especially the orderlies.
The General Hospitals
During the Tunisian campaign our New Zealand general hospitals were operating on the Canal, at Helwan, and at Tripoli, and they all received battle casualties evacuated from the forward areas. The majority of the serious cases were dealt with at 2 NZ General Hospital, sited at El Ballah on the Suez Canal, 649 battle casualties being admitted during the second quarter of the year, whereas only 135 casualties were admitted to 1 NZ General Hospital at Helwan. No. 3 NZ General Hospital admitted 740 cases during the latter part of the campaign, the majority being transferred from the British hospitals in Tripoli.
Since the New Zealand Division had moved from Syria 3 General Hospital had remained under Ninth Army, handling patients other than New Zealanders, except for a small number evacuated from page 448 forward areas and sent from Alexandria to Beirut by hospital ship. At first it was considered inadvisable to press for another move by 3 General Hospital in case the Division should return to Syria.
In November 1942, as Eighth Army advanced, the GOC 2 NZEF favoured a move of the hospital to Alexandria. To suit the overall requirements of GHQ MEF it was agreed to leave the unit in Syria in the meantime.
On 31 January 1943 General Freyberg signalled GHQ MEF requesting that 3 General Hospital be transferred from Syria to the command of Eighth Army. This led to instructions being issued by Ninth Army on 6 February 1943 for the hospital to close and pack forthwith in readiness for a move. When it was relieved by 43 British General Hospital, 3 General Hospital moved early in March to Qassassin, in the Suez Canal area, in accordance with GHQ MEF arrangements. However, 2 NZEF still desired the hospital to be located at Tripoli, and in spite of some opposition from GHQ MEF this further move was effected.
The location selected for the hospital was at Suani Ben Adem, south of Tripoli. It was 2 miles from NZ Advanced Base, near the Castel Benito–Suani road, and a short distance from Castel Benito airfield. The area had been used as a prisoner-of-war camp prior to the Allied occupation of Tripoli, and included a large stone Italian fort which later became the administrative block, with the wards in tents. It was well sheltered by gum and acacia trees, which also served to relieve the severity of the surroundings. The site was an excellent one for handling the casualties from the Division.
The main body of the unit reached the new site on 19 March after travelling from Alexandria to Tripoli in HS Dorsetshire. The equipment was unloaded from ship to lighter in Tripoli harbour, which was then subject to air raids, and all of it had reached the site safely by 5 April. On the roof of the hospital building Red Crosses were painted so as to be readily visible from the air. Much skill and ingenuity was displayed by the staff of the unit in setting up the hospital without the services of engineers. Although the hospital was not quite ready, 100 patients were admitted by urgent request on 10 April and by 14 April 300 beds were occupied. By 30 April 520 of the 900 equipped beds were occupied, chiefly by New Zealand battle casualties from the Division as it advanced in Tunisia. Serious cases were evacuated from 1 NZ CCS by air but the bulk of casualties came by road, which was by then in good repair. From Tripoli patients were evacuated by hospital ship to Alexandria, although selected cases went by air to Cairo.
Battle casualties generally have arrived in very good condition with wounds adequately excised and clean. Fractures have travelled well. There have been no cases of gas gangrene requiring treatment in the hospital over the quarter. Of the abdominal cases with colonic wounds exteriorised only one case appears to have had adequate spur formation with a view to assist in early closure of the colostomy. Abdominal cases have convalesced well. Cases with penetrating wounds of the chest as a group have given rise to most problems in convalescence.
|1 Gen Hosp||2 Gen Hosp||3 Gen Hosp|
No. 1 NZ General Hospital received air convoys of three to four serious cases every two or three days, and air transport to Heliopolis proved an absolute godsend to the badly wounded men, who also stood the road journey from there to Helwan very well.
No. 2 NZ General Hospital treated large numbers of serious cases, including compound fractures, joint and feet injuries, and many abdominal and thoracic cases.
There were remarkably few deaths at the base hospitals, only three following battle wounds, all these being due to severe infection. There were only three cases of secondary haemorrhage and two amputations, which shows a marked absence of severe infection. There was no death reported in the abdominal cases reaching the base hospitals.
In his report of June 1943 the Consultant Surgeon 2 NZEF stated that the Tunisian casualties had been very satisfactorily treated, both in the forward areas and at the Base. There had been very little serious sepsis and very few late deaths. Large numbers of abdominal cases had survived and had been evacuated to New Zealand. A number of these had had preliminary treatment for closure of colostomy before evacuation. Late complications were uncommon. There was very little serious sepsis among the fracture cases, and little or no sepsis complicating wounds of the knee joint. Splinting of these cases in the forward areas had been very well done, as had the primary splinting of fractured arms and legs. In several cases, patients had been left in their primary splints throughout their page 450 treatment. Secondary haemorrhage and late amputations were both uncommon. As regards the head wounds, little operative treatment for late complications had been required at the base hospitals.
General Health of Troops during the Campaign
The sickness rate for the Division was very low, there being no incidence of infectious disease, except a short sharp outbreak of sandfly fever amongst a few isolated units late in April. During the whole campaign admissions to medical units averaged only 1 per 1000 per day. After the severe fighting around Takrouna there were some fifty cases of physical exhaustion. A few days' rest with provision of showers for all troops rapidly overcame the trouble. Experienced officers stated that for several days the shelling to which the infantry was subjected was the most severe the Division had ever encountered.
Diseases in Tunisia
The diseases reported to be prevalent in Tunisia were the same as those noted in Tripoli, with the addition particularly of malaria, and also of bilharzia and to a lesser extent plague, sandfly and dengue fevers, smallpox, and hookworm.
Malaria was of special importance as the local incidence was reported to be high. The season started in April but little malaria and few anopheline mosquitoes were in evidence before the Division left Tunisia in the middle of May, and only three primary cases were reported in the Division. Precautions, however, had been taken. Unit anti-malaria squads had been formed and trained and lectures had been given to all troops. Mosquito-proof bivouacs or bush nets and a new anti-mosquito cream were issued as the old cream was found to be useless. Flysol was used. Paris green and malariol were available and draining and spraying were carried out. Dress regulations were enforced.
The 1st NZ Anti-Malaria Control Unit was attached to the Division on 23 April and carried out a survey of the divisional area and recruited civilian labour. A field malaria laboratory was available in the Corps area and the consultant malariologist was also in the area. The New Zealand malaria officer considered that the provision of protective nets or bivouacs and an efficient repellent cream were the best and only possible means of protection while the Division was in a mobile role.
Bilharzia was said to be very prevalent. To safeguard against infection strict instructions were given to hyperchlorinate all water page 451 used by the troops. This proved effective as only one case of haematuria suspected of possible infection was reported.
There were two cases of typhus in March with one death, but none in April or May. There was only one case of typhoid and, apart from a few cases of dysentery, no other serious disease.
In Eighth Army generally there was little sickness—only ·915 per thousand daily. Hepatitis was still present to some extent—in January 7·05, February 2·37, and March ·62 per thousand. Septic skin conditions were common, but desert sores were not seen so frequently. In spite of the prevalence of venereal disease in the civil population there had been no increase in the Army.
Showers and Disinfestation
Under Major D. P. Kennedy, 4 Field Hygiene Section with its captured Italian shower unit had been able to arrange hot showers at Tripoli for all troops of the Division. Owing to the continued movement and the difficulties of water supply, showers were not available again till after the battle of Takrouna. The troops engaged at Takrouna were infested with fleas, and shortly after the battle they were all showered and their clothing and bedding disinfested. The other units in the Division were treated later. The troops were all carefully examined during the disinfestation and very few of them were found to be infested with lice, the percentage ranging from 0 to 2 or 3 per cent. When infestation did occur, it generally followed the enforced occupation of enemy positions during battle, and once occurred when blankets used by prisoners of war were carried in trucks. During the battle of the Tebaga Gap, when thousands of prisoners were taken, the Hygiene Section was attached to the cage and supervised the sanitation and disinfestation. All the prisoners were examined and disinfested. About 16 per cent of the Italians were found to be lousy but comparatively few of the Germans. Guards and drivers associated with prisoners of war were regularly disinfested and the trucks sprayed with cresol. Occupied enemy territory entered following the battle of Mareth was often filthy, and precautionary measures, especially against lice, were necessary. RMOs carried out routine inspections and disinfestation was carried out as required.
During March no inspections could be carried out by the Hygiene Section and no work done in the workshop. During April the normal routine was resumed and sullage and deep trench pits, latrine seats, page 452 and urinals were provided. Refuse and the manure at the Mule Pack Company were burnt in pits and buried three times a day. During May the workshop was busy making latrine seats, fly signs, and slogans. The general level of sanitary care throughout the Division during the period was very good.
This was supplied mostly from wells, ample supplies being available, though sometimes brackish and generally saline. The wells were policed and the water superchlorinated before use. This was required because of the high incidence of bilharzia in the area. Reservoirs were available at Sfax and Sousse, and chemical springs were used at El Hamma.
These were excellent and the supply of medical comforts always adequate. Extra New Zealand Red Cross supplies were always available for patients. Ascorbic acid tablets were issued regularly at this period.
Expendable stores were in good supply throughout the period. Blood, plasma, both wet and dry, and intravenous fluids were always available in ample quantities. Extra stretchers, blankets, and pillows, etc., were kept loaded on a 3-ton truck and attached to the operating MDS, thus ensuring an adequate supply at all times.
This was kept in excellent order in spite of the long period in the field and the distances travelled.
Clothing was satisfactory. The changeover from battle dress to summer kit took place in Tunisia during the second week in May.
The troops were seasoned campaigners hardened to the climate of North Africa, with living habits adapted to the conditions, with established administrative systems of health care, and with a high morale as they at long last brought the North African campaigns to page 453 a victorious conclusion. In such circumstances, a good health record was almost natural despite the strain of a long campaign. Likewise, a wealth of experience had resulted in the perfection of a high standard of battle surgery, the established techniques of which will be reviewed in the following section.