New Zealand Medical Services in Middle East and Italy
Health of Troops
Health of Troops
A study of the table for admissions to medical units during the year up to 30 September discloses that the health of 2 NZEF was uniformly good, both in the long campaign from Alamein to Tunis and also during the period of rest and refitting at Maadi Camp.
The epidemic of infective hepatitis in the autumn of 1942, already mentioned, produced the greatest increase of admissions. Bacillary dysentery remained a common infection and each fresh body of reinforcements temporarily increased the number of admissions to hospital. Amoebic dysentery was responsible at times for 8 per cent of the total dysentery cases, especially after the Division had been in Syria, where the incidence was higher than in Egypt. Most of the dysentery cases responded well to sulphaguanidine and the average stay in hospital was about eight days. In Shiga infections the benefit of sulphaguanidine was enhanced by the use of anti-dysenteric serum, but the benefit of sulphaguanidine in chronic bacillary dysentery was only transitory and such cases were evacuated to New Zealand.
Malaria cases were relatively few; the Division was never in a highly endemic area during the malaria season and only occasional cases arose in Egypt, especially during the Nile flood. Of the 505 malaria cases reported in 2 NZEF from July 1941 to the end of March 1943, some 261 had become infected in Syria, where the Division was located for only the first month or so of the 1942 malaria season. The types of infection in these 505 cases and their 124 relapses were:
An epidemic of typhoid fever beginning in September principally affected the recently arrived 10th Reinforcements accommodated at page 480 Mena Camp and it continued until December, by which time there had been 169 cases with three deaths. It was considered likely that there were a number of sub-clinical cases who either did not reach hospital or who were treated as PUO (pyrexia of unknown origin) without any certain evidence of typhoid infection. There were other outbreaks among British troops at the time, but nearly all the New Zealand cases were due to D strain typhoid bacilli, and it was almost certain that the epidemic was spread from a carrier who worked on fatigue duties in a cookhouse at Mena Camp. This man was admitted to hospital with an acute cholecystitis from which D strain typhoid bacilli were grown from the gall bladder post-operatively. It was thought that some of the TAB vaccine used for inoculation of the troops in New Zealand did not give adequate protection against this strain of infection. The 10th Reinforcements were all re-inoculated with RAMC vaccine, which was followed frequently by severe reactions. Although there were only three deaths during the epidemic, many cases were very severely affected and pyrexias were prolonged and relapses frequent. In the typhoid wards of 1 General Hospital there were between eighty and one hundred cases severely ill at the one time. As a precaution, following this epidemic, the interval between inoculations in 2 NZEF was reduced from a year to nine months.
Pneumonia was responsible for a significant number of hospital patients, with peak numbers in the winter months. From July 1941 to 31 March 1943 there was a total of 218 cases, of which 54 were diagnosed as broncho-pneumonia; of the lobar pneumonia cases six died, and only three developed empyema. The results were due to the almost specific effect of sulphapyridine, later displaced by the less toxic sulphadiazine.
Sandfly fever continued to provide small numbers of patients but there was no epidemic at this period, and under the classification of PUO there was always a variety of short-term pyrexial illnesses for which definite diagnosis was often impossible.
A few cases of smallpox arose, sufficient to render it advisable to revaccinate the force. For the nursing of diphtheria cases the sisters were immunised after Schick testing, and a recommendation was made that sisters in all future reinforcements be immunised in New Zealand. Special care had to be taken to guard against diphtheritic infection of wounds, as infected wounds were slow to heal and in some cases were associated with polyneuritis.
For military reasons little publicity was given to a typhus epidemic which occurred in Egypt in June 1943, principally among the civilian population. About 400 cases a week, with a 25 per cent death rate, were reported in the Cairo area. There was insufficient page 481 vaccine available to immunise the whole of 2 NZEF, but enough was obtained to give the necessary three injections to hospital staff and to medical units, such as field and base hygiene sections, whose work brought them into contact with lousy natives. When more vaccine came to hand the whole force was inoculated.
The epidemic did not affect 2 NZEF, which had suffered only four deaths from typhus to that date. Units continued to carry out regular inspections to detect any cases of lice infestation.
A considerable number of cases were diagnosed as PUO in the forward areas, as an immediate exact diagnosis of many short-term fevers was impossible. The less severe cases making a complete recovery from one to four days were retained in forward medical units and discharged to their units. The more severe cases and those with a more prolonged fever were evacuated to the base hospitals, where a definite diagnosis was finally made in practically all the cases. The commonest conditions thus encountered were otitis media, sinusitis, prostatitis, pyelitis, rheumatic fever, catarrhal enteritis, bacillary dysentery and infective hepatitis.
Besides the infective fevers, the medical conditions of most importance to the force were the neuroses of many types, some surgical in nature. The battle neuroses cases, for which the diagnosis of physical exhaustion was introduced at this period, were dealt with (except for the severe cases) in the forward areas, where after a period of complete rest they were returned to their units. The cases evacuated to the base hospitals were given similar treatment and the mild cases were again sorted out and quickly sent to Reception Depot for return to their units. Unless this was done there was little prospect of these men ever being fit for the front line again.
The majority of the neurosis cases were of no further use except at Base, and over one-third were generally sent back to New Zealand. The non-battle neuroses arising from an inherent psychological weakness in the individual continued to be responsible for the downgrading of large numbers of men and considerable loss of manpower. The manifestations were many, but in particular were seen in dyspepsia, in headache following old concussion, in foot fatigue associated with minor degrees of foot abnormality, and in vague rheumatic disorders.
Dyspepsia remained a common condition and was investigated in hospital to exclude organic conditions such as ulcer. The majority of cases were found to be functional in origin and quite unsatisfac- page 482 tory as regards treatment and rehabilitation. Few who were hospitalised were ever fit for front-line service subsequently. There was a marked increase in cases of physical and nervous exhaustion among battle-weary troops as the North African campaign drew to a close.
Accidental injuries constituted a steady proportion of hospital admissions—in February 1943 one-sixth of the total. Traffic accidents were common, as also were burns, and casualties arose in sports such as Rugby football.