New Zealand Medical Services in Middle East and Italy
REVIEW OF CAMPAIGN
REVIEW OF CAMPAIGN
Evacuation in the Forward Areas
The evacuation of casualties was generally satisfactory. Jeeps were utilised to save hand carrying in the forward areas, especially in the mountainous areas and at Arezzo, and on many occasions in the Poggibonsi–Florence area. Otherwise, evacuation of casualties was satisfactory as main roads were available. At one period when the MDS was in the San Donato area, narrow roads and tracks with a large traffic volume of fighting vehicles and, later, supply vehicles caused the length of time taken for evacuation to 1 Mobile CCS at Siena to vary considerably. One-way traffic immediately relieved the situation.page 592
During this period of operations 6 ADS functioned with two medical officers only. This was adequate under normal circumstances, but on one occasion when a considerable number of patients, some of them seriously ill, arrived at the same time, some could not be attended to as promptly as the medical officers wished. It was considered that three medical officers were essential to an ADS in action.
As a brigaded ADS making quick moves, the ADS on several occasions had difficulty in finding any MDS or CCS to which it could evacuate casualties. Some evacuations were made direct to a British CCS which had been located first.
The frequent moves of the field ambulance units during this short campaign are well illustrated by the story of one of the ADSs. At first it operated in a palatial mansion at San Casciano for three days, then shifted to a small school at Massandia for less than two days, dealing with twenty-three casualties. The next location was a large, modern Fascist school at Scandicci, where the unit remained two days. Evacuation was very difficult, necessitating jeep transport and a car post further back. Then a spacious storeroom of a building was used at Poppiano Nuovo and, later, part of a luxurious house belonging to a local doctor at Monterapolli. Casualties there were numerous. The company was then withdrawn and treated sick cases at Ligliano.
Altogether during this period over 200 battle casualties and nearly 200 sick were treated. Blood was drawn from five donors in the unit to supplement the supplies and eighteen patients were given blood or plasma. The personnel had been organised into three teams, each made up as follows: nursing NCO, evacuation NCO, resuscitation orderly, injections orderly, drinks orderly, two dressing orderlies, clerk, pack-store orderly, and three stretcher-bearers. Each team was able to operate independently.
Much more work was undertaken at the MDS than at the Cassino period. This was partly due to the late setting up of our CCS and partly to some temporary difficulty in evacuation. The New Zealand surgical team, which had its designation changed to 1 NZ FSU, at this period was attached to the active MDS, as was the NZ FTU. This weakened the surgical staff of the CCS, especially as Major A. W. Douglas was the most experienced New Zealand abdominal surgeon available at that time. There had been a change of commanding officers in all three field ambulances and their approach to the problem possibly was different from that of their predecessors.page 593
An opinion written at the time by the CO of 4 Field Ambulance is of interest:
It would appear desirable to utilise the ambulances' surgical amenities to the full, for the additional experience is of great value to both the surgeons and orderlies. It is only during actual battle conditions that the surgical departments of Field Ambulances have the opportunity of surgical work, and it is felt that the fullest opportunities should be given to the three Field Ambulance Surgical Teams before bringing surgical assistance from the CCS. Normally at the CCS the surgeons and orderlies have long and constant surgical opportunities, which naturally are denied to the ambulance teams.
Following the now accepted principle of excision and dressing of all wounds at the earliest possible opportunity, during this period as open MDS the greater proportion of cases have been dealt with surgically at the MDS. Over two thirds of all the battle casualties received complete surgical treatment and were fit to be sent on direct to a NZ Gen. Hosp.
As facilities for nursing are better at a CCS all non-urgent abdomens and chests were sent to a CCS for surgery.
This opinion, clearly enunciated, shows the ideas of the zealous young field ambulance officer. A more balanced outlook is shown by an older officer, a surgeon of a field ambulance surgical team, who gave an account of the work at the MDS as follows:
Type of surgery attempted during recent offensive of the Division:
1. Severe Cases:
Badly mutilated limbs requiring amputation.
Blown off limbs.
Severed main arteries.
Collapsed cases of compound femurs and compound leg fractures.
2. Light Cases: As many of these as possible were done but with only two surgical teams operating it was impossible to do them all. Everyone is agreed that the sooner after wounding a light case receives operative attention the better the wound will heal and the sooner will he be fit for duty again. With the very excellent surgical set-up that is now available with the Field Ambulances I would recommend that the aim should be to operate on all light cases at the MDS and to then evacuate them direct to the forward NZ Gen. Hosp. Many of the lighter cases could then be passed on to Base where the next surgery could be done. This would help to relieve pressure on both the CCS and the forward hospital, as well as being an advantage to the patient.
At Tavarnelle we were unable to do all the light cases. There we had three surgeons but only two surgical teams so that it was impossible to keep two theatres going for the whole period of 24 hours. Therefore many light cases had to be passed on to the CCS. Also for part of the time resuscitation had to be done by the MDS. More recently when the 5 Fd. Amb. provided the open MDS, although there were three surgical teams available there were only two surgeons for the greater part of the time, so that it was impossible to maintain two theatres in operation simultaneously over a period of more than 4 hours during the 24 hour day. To achieve the ideal of operating upon all light cases at the MDS during any future similar Divisional offensive operations we would recommend the following set-up:page 594
1. Three MOs for Reception. In the absence of the FTU one to supervise the resuscitation and pre-operation Tarpaulin.
2. Three surgical teams, each complete with surgeon, anaesthetist, NCO, orderlies and own operating equipment. Organised on a 12-hourly basis there would be always two teams working simultaneously throughout the 24 hour period. When the pressure is on, all three teams could work simultaneously over a short period of 4–6 hours. Such a set-up would I am sure be able to deal with even more light cases than the total passed through the MDS at Tavarnelle.
The 1st NZ FSU was attached to the MDS during the greater part of this period and performed 90 operations during July and 30 during August. The large majority of the cases were of severe limb wounds. There were sixteen deaths.
It was noted by the FSU at the time that:
Abdomens: Generally operations on these are not done unless the condition is too serious to allow of transfer to the CCS, or if the CCS is sited too far away to be reached in a short time.
Adequate nursing facilities now obtainable with the addition of a nursing section have been proved to be of great value.
Chests: Are usually not done if the pleura is penetrated. Use of intercostal nerve block has been of definite value for relief of pain prior to transport back to the CCS for operation.
Penicillin has been used locally as a powder in wounds until supply ran out a few days ago. Sodium penicillin is being used for the same purpose at present. The crystals are coarser and owing to greater solubility, probably are absorbed more quickly. Recently penicillin Na has been used with much greater frequency parenterally in large wounds. If possible cases are held until they have received dosage for at least 24 hours.
Undoubtedly, the FSU and ambulance surgeons had displayed the judgment to be expected of experienced surgeons in the selection of cases to be dealt with at the MDS level. More surgery was probably carried out at the MDS as the CCS was understaffed, being short of three medical officers while at Siena.
Evacuation to the CCS except for a short period before one-way traffic was instituted was very satisfactory. Major Douglas drew attention to the frequent moves of the field ambulance units. Between 19 and 27 July his 1 NZ FSU set up its theatre in six different locations. With moves as frequent as these it was obvious that abdominal cases could not be adequately nursed, and the same applied in lesser degree to all serious cases not fit for immediate evacuation. All such cases undoubtedly should have been dealt with in a more static unit in this campaign, which meant that the CCS and the staffing should have been adjusted accordingly.
Blood reactions were more common at this period, and reactions were also noted following intravenous glucose injections. A quantity of blood had to be discarded, and also infected bottles of plasma and glucose saline. It was noted at the CCS that the supply of blood was very scanty, and because of the hot weather and the long distance page 595 it had to be transported was often stale, and undesirable reactions were too numerous. The position was somewhat eased when two refrigerators were installed at the CCS.
Shortage of Medical Officers
One of the main problems for the ADMS 2 NZ Division was the shortage of medical officers. At one period the Division was eleven medical officers under strength, including the CCS which was three officers short. As a result there was a constant changing of officers from one medical unit to another. Very often the officer staff of the closed MDS consisted only of the officer commanding, his second-in-command, the quartermaster, and dental officer. Regimental unit commanders were most co-operative in releasing where possible their RMO to ADSs and MDSs during busy periods.
Work at the CCS
During the Arezzo action and the early part of the campaign for Florence the CCS was not functioning and British CCSs were used in its place. At Siena it became the most forward CCS, within easy reach of the field ambulance over a first-class road. A British FSU was attached for most of the active period and both a Canadian and a British FTU were attached at different times.
The operational work largely consisted in treating the abdominal cases and the lighter wounded. Most of the large limb wounds had been treated at the MDS. Penicillin was used for chest cases and large limb wounds, and as a routine in gas gangrene. It was noted that gas infections were more common and, in consequence, the excision of all wounds was carried out.
While the CCS was operating in the Siena area it dealt with eight cases of gas gangrene. Two of these occurred towards the end of July and six during August. Of the six cases in August, four died. Four of the eight cases were prisoners, and in these there had been a long interval between wounding and operation, but in the other cases the interval was not unduly long. Treatment consisted of excision of the affected area, penicillin both parenterally and locally, and gas-gangrene serum. Bacteriological investigations were carried out by the mobile laboratory attached to 4 British CCS.
Of the abdomens, there were fourteen cases with intestinal injury and seven deaths. There were four thoraco-abdominal cases, with three deaths. The abdominal cases were treated by intravenous sulphadiazine, rather than by emulsion into the peritoneal cavity, and the results were equally good.page 596
Fasciotomy of the calf was carried out when the lower femoral or popliteal arteries were ligated, with definite success in at least two cases recorded.
Altogether, there were 964 battle casualties and 1970 sick cases admitted to the CCS, with 28 deaths. Among the deaths were German prisoners and Italian civilians as well as British, American, and New Zealand troops.
The conditions under which the forward surgery was undertaken were much superior at the CCS to those at the MDS, quite apart from the constant movement of the field ambulances. The urge to operate as near the line as possible, however, still persisted in the Division, even though with the evacuation over good roads little extra time would have been involved had the cases been dealt with at the CCS. The nursing facilities at the CCS were infinitely superior and the cases could be held as long as desired. The final results, however, were generally satisfactory and delayed primary suture could be carried out at the base hospital in the great majority of the cases.
Lieutenant-Colonel A. G. Clark, CO 1 Mobile CCS, stated that as far as the seriously sick and wounded were concerned this was the worst period of the Italian campaign. This was owing to the heat, shortage of medical officers, and the great distance between the CCS and the base. Air transport mitigated this to some extent.
Evacuation, though over good roads, meant a long, dusty, hot journey and a severe trial for serious cases. Later, air evacuation was arranged from Siena and this proved a great boon, but was instituted too late.
For the advance to Florence the hospitals were long distances from the forward areas, as 2 General Hospital was still at Caserta and 3 General Hospital at Bari, while 1 General Hospital was also on the Adriatic coast at Molfetta, some 20 miles up from Bari, though in June it had been arranged that 1 General Hospital would move over 300 miles up the Adriatic coast to Ancona as soon as the enemy was driven from that area. By the use of air transport from Trasimene airfield to Naples, any difficulties that might otherwise have been involved by the long distance from the CCS to 2 General Hospital were avoided. Air transport for the wounded and sick was both quick and comfortable, and there was not the need for the staging of patients in hospitals in Rome, where it might have been difficult to treat large numbers of patients as the hospitals there were only in the process of getting established after the move from Naples. It had been expected that Florence would be occupied without any difficulty and that general hospitals could then be quickly set up there. This proved impossible, and medical arrangements had to be page 597 adjusted and the Naples hospitals had to continue to carry out the greater part of the work.
As it was, the process of change created extra difficulties for 2 General Hospital. Some of the hospital trains on the Naples–Bari run were transferred to the Rome–Naples run. This affected the evacuation of New Zealand and other patients from 2 General Hospital to the hospitals and convalescent depots on the Adriatic coast and led to a steep rise in the hospital bed state towards the end of July. No road transport was available, nor was air transport, even for cases unfit to travel by road or rail, as all air ambulances were being employed on the more foward evacuation routes. By sending selected walking cases on ordinary passenger trains across Italy 2 General Hospital partly overcame this problem. This expedient was not used by neighbouring hospitals, and in consequence it was often possible for 2 General Hospital to send fifty patients a day by the passenger trains.
For a number of reasons all the hospitals in the Naples area became overcrowded and 2 General Hospital did its best to assist by accepting British, Canadian, and South African patients. The movement of hospitals to Rome from Naples led to general congestion in the hospitals remaining in the Naples area. The accommodation problem was aggravated by the arrival of the advanced parties from AFHQ, Algiers, as that headquarters was transferred to Caserta. Hospital buildings were requisitioned for the headquarters staff, an instance being the use of a Canadian hospital of 1200 beds for female personnel of AFHQ, and the closing of the hospital. Then, again, the invasion of Normandy meant for a time fewer hospital ships from the United Kingdom, and a resultant banking-up of the more serious bed cases and others who would normally have been evacuated early to the United Kingdom. The Oranje and other hospital ships arrived at Naples at the end of July and gave some relief.
All these factors resulted in 2 General Hospital, which was equipped as a 600-bed hospital, having 738 patients on 31 July; on 2 August, for a brief period after the admission of a convoy of battle casualties, there were 817 patients in the wards.
It was mid-summer, too, and the volume of work, plus the effects of heat, humidity and flies, resulted in a greater amount of sickness than had been recorded previously among members of the staff, between 10 and 15 per cent of them being sick in August.
Casualties from the Division were received at 2 General Hospital following air evacuation from Trasimene and they arrived in good order. The great majority were dealt with by delayed primary suture shortly after arrival. Altogether 1317 cases, including 383 battle page 598 casualties, were admitted during July and 1070 cases and 364 battle casualties during August. Several very severe cases with wounds of the spine and hip were dealt with.
The opinion was expressed that in these cases and in fracture cases penicillin should be given intramuscularly from the earliest possible moment in order to prevent sepsis, as treatment of established sepsis was largely unsatisfactory.
The double bath unit had proved very successful in the treatment of burns and parenteral penicillin had also been of great value. The training of young surgeons for possible employment at the CCS was carried out at this time, as there seemed little prospect of obtaining surgeons from New Zealand.
This was a quiet period at 3 General Hospital and some patients were admitted from other forces. In July there were 917 admitted, including 162 battle casualties and 309 of other forces. In August 1113 cases were admitted, including 378 battle casualties. At the end of August 10,000 patients had been admitted in Italy and altogether 30,000 patients since the unit was founded. The treatment of fractured femurs by penicillin and delayed primary suture was still continued and results were very satisfactory.
Some of the Florence casualties were evacuated to New Zealand by the Australian hospital ship Wanganella on 14 August; that is, within a fortnight or so of wounding.
Very little professional work was done at 1 General Hospital during the period, during the latter part of which preparations were being made to shift the hospital to Senigallia. Altogether, 768 cases were admitted in the two months.
Admissions to Other Than New Zealand Hospitals
In July 1944, 44 officers and 536 other ranks were admitted temporarily to other than New Zealand hospitals. By the end of the month only 100 remained. In August the admissions were 46 officers and 574 other ranks, and 189 remained at the end of the month.
The large number recorded was due largely to the staging of cases at British units on the line of evacuation during this period; 2 General Hospital at Caserta was a long way from the front at Florence and many cases were admitted to hospitals sited in Rome. Special cases, mainly neurosurgical and maxillo-facial, were treated in British hospitals by arrangement, but their numbers were never large.
Special Surgical Work at this Period
1. The Use of Acrylic Plates in Head Cases: This was carried out by Major Shoreston at 58 General Hospital at Trasimene in cases page 599 of cranial defect deemed suitable and where infection was not likely to ensue. The moulded plastic was sutured to the pericranium and the wound sutured without drainage. It was said that the plastic gave no tissue reactions. The temporary results seemed satisfactory.
2. The Use of Plates and Screws in the Treatment of Fractures: This was done in two British base hospitals, both simple and compound fractures being dealt with. The technique used was that of Lane, with long six-inch screws and stainless steel plates. In addition, single screws were used across the actual fractured bone ends to prevent angulation. Most of the cases were of fracture of the femur, but fractures of the tibia and also of the radius and ulna were also plated.
In compound fractures wound suture was generally carried out and, if this was impossible, the muscles were sutured so as to shut off the bone from the open wound. Penicillin was employed both locally and parenterally. Early joint movements were carried out. The preliminary results were on the whole good, but great care in the selection of suitable cases was necessary and the approach became steadily more conservative. This experimental work was confined to two hospitals and was not attempted in our units. We felt that the results obtained by ordinary methods rendered plating unnecessary and undesirable except in specially difficult cases. The use of screws across the fractured bone ends, though efficient mechanically, appeared to be contrary to sound surgical principles. One bad case in twenty-five would make the use of plates and screws inadvisable. The difficulty we foresaw was that the surgeon performing the original operation did not, and probably would not, see the failures.
Scarcity of Experienced Surgeons
This condition had been developing for some time and was accentuated by the return to New Zealand of some of the more senior officers who had served for a long period with the force. The scarcity was felt in both divisional and base units. The CCS in particular could not function without the help of specialist teams from the RAMC, both as regards surgery and transfusion. It was unfortunate that we did not have in our own corps young surgeons available for what was the most responsible surgical work in 2 NZEF.
The Consultant Surgeon made the following comments on this subject in his report of July 1944:
There is a scarcity of experienced surgeons in the 2 NZEF at present and this condition always tends to be aggravated by the appointment of surgeons to administrative positions. If war was not for us a temporary phase of relatively short duration it would be essential in my opinion to have two divisions in the Medical Corps, one Clinical and the other Administrative, page 600 with officers given senior ranks according to their capacity to fill the positions in either branch. The anomalous position would not then arise of officers with high clinical capacity having their only chance of promotion in an administrative post—and on the other hand an officer of high rank gained by long service in the Field being employed in a hospital in a junior clinical position. I, however, appreciate that all our conditions are purely temporary ones and that the interchange of medical officers between the hospitals and the Division is highly desirable.
Work of the Convalescent Depot
The site at San Spirito proved an excellent one during the summer months. Swimming and boating provided suitable recreation. The average bed state in July was 478 and in August 517. During July there were only 74 battle casualties, but in August 286 cases were admitted. In July the medical cases predominated, forming 47 per cent of the total, whereas the surgical provided 22 per cent, the orthopaedic 20 per cent, and skin cases 11 per cent.
In August the corresponding figures were medical 36 ½ per cent, surgical 42 per cent, orthopaedic 14 ½ per cent, and skin cases 7 per cent. The hepatitis cases increased from 39 to 103. They were generally held in the depot for eighteen days.
Work of the Optician Unit
Two-thirds of the time of this unit was spent at the CCS and the rest at Advanced Base. The unit was kept constantly employed. During the quarter ended 30 September, 458 cases were seen and 271 pairs of spectacles dispensed. Ten refractions could be carried out daily.
Reorganisation of Hygiene Company
Preventive measures for the maintenance of health were improved by the expansion of the Field Hygiene Section into a company incorporating the two malaria-control sections. The new establishment making this change official was effective from 25 July 1944. In operation the new amalgamated unit was found to have a number of advantages. The OC 4 Field Hygiene Company could delegate most of the company office work to the officer commanding the malaria-control section, and thus have more time free for his duties as Deputy Assistant Director of Hygiene to the Division. Previously, the malaria-control units had been under the disciplinary control, as well as the technical direction, of the OC 4 Field Hygiene Section without being amalgamated. In addition, the total amount of administrative work was reduced.
The Field Hygiene Section with one of the malaria-control units was attached to Rear Headquarters of the Division. The other page 601 malaria-control unit was attached to Main Divisional Headquarters. This resulted in a continuous and complete coverage of the Division, and was considered to be the only satisfactory way in which hygiene and malaria-control could be achieved in a Division constantly moving on active operations.
The new establishment set up in the form of a field hygiene company represented the consolidation of all the establishments at that time engaged in hygiene work, and in malaria or typhus control and disinfestation and shower provision. All these functions were now under the one command and the personnel could be adjusted as conditions changed.
Looking ahead, it was planned to convert one malaria-control section into a typhus-control section in the winter. The other malaria-control section was to be disbanded, but, if considered advisable, those of the section considered most suitable for hygiene duties were to be taken on for shower section duties.
The shower section provided a much-appreciated service and in the three months from July to September, inclusive, 44,000 men received hot showers at the Hygiene Company's plant, while the clothing and effects of 150 men were disinfested.
The Florence campaign covered the period of maximum incidence of malaria, and the activities of the Hygiene Company were mainly concentrated on that aspect of its work. There were few cases in the Division. In July there were forty-one and in August twenty. It is interesting to note that headquarters of the Allied armies in Italy allowed an incidence of three per 1000 per week before special notification of an outbreak was necessary. This would have been about 240 cases a month for the Division, but its highest incidence was only one-sixth of this figure. This excellent result was achieved by:
The interest of senior officers, which was communicated by them to all ranks.
Continued inspectorial work by the hygiene inspectors.
Close liaison between medical and administrative branches, with the wholehearted co-operation of the latter in ensuring that offending units reported by the Hygiene Company inspector were made fully aware of their responsibilities.
By the aid of power and hand equipment flysol and DDT spraying had proceeded unremittingly. All breeding places were sprayed twice weekly and DDT was sprayed on vehicles, officers' tents, etc. Paris page 602 green and malariol were applied to water areas. The mobile role of the Division made larval destruction rarely possible. Repellants were used by the troops. Unit squads were instructed and assisted, their usefulness depending on the interest of the commanding officer and the efficiency of the RMO. Anti-malaria notices and posters were utilised freely.
The bath and laundry unit continued to function; and clothes were also washed by the individual soldier and by Italian washerwomen. Showers were made available by Ordnance to the brigades. The Hygiene Company made arrangements especially for the front-line troops. No lice were reported.
Water: Patterson auto-motor trailer purifiers were used by 2 NZEF at all water points, the water being chlorinated and filtered mechanically.
Sanitary arrangements gave rise to no new problems and the standard throughout the Division was maintained by all units. Otway pit covers with fly-traps were being used for the deep-hole refuse pits. This had reduced the flies in unit lines, particularly in the vicinity of cookhouses. Sullage water was also disposed of in the pit and helped to prevent fly-breeding in the lower deposits. The latrines were of the semi-deep pit type and were surmounted with fly-proof superstructures fitted with a fly-trap. Urinals were of the ‘desert lily’ type. The disposal of putrifying animal carcasses gave rise to some trouble.
Health of the Troops
This was, in general, very good during this fine summer period, but the admissions to hospital showed an increase from 1·73 per 1000 per day in June to 2·04 in July and 2·17 in August. The percentage of the force in hospital was 5·08 at the beginning of July, 5·98 at the end of the month, and 5·64 at the end of August.
Rations were excellent during the period. Fresh vegetables, cabbages and potatoes, in particular, were supplied.
Infectious disease was, as usual, responsible for the major part of the sick wastage of the Division during July and August.
1. ‘NYD fever’ accounted for 543 patients in the Division. The large majority of these cases were retained in the divisional medical units and the CCS and not evacuated to the general hospitals. They were mainly cases of three- to five-day fever which occurred in an page 603 epidemic in early and mid-summer. Many of the cases subsequently developed jaundice. Others were thought to be cases of ‘swine fever'. Sandfly fever was also considered to account for some of the cases; the vectors bred in damp rubble in all coastal regions from July to September.
2. Infective hepatitis was the diagnosis in 801 cases and, as already mentioned, many of the NYD fever cases subsequently proved to be cases of hepatitis. There was an increase in numbers in July and a still more marked increase in August, corresponding to the autumnal incidence of the disease.
3. Diarrhoea accounted for 45 cases, some of them proving to be cases of amoebic dysentery. Cases of bacillary dysentery were treated with larger doses of sulphaguanidine, the average course ranging from 100-120 gms. over five days. More satisfactory results were obtained than previously.
4. Malaria: There were 36 cases, 29 being in July. The incidence was low, especially as this was the height of the malaria season. Anopheles maculipennis was the mosquito prevalent in Italy. It bred in brackish, stagnant water and was largely restricted to the coastal areas. In winter it lived in houses, cellars, and stables. The malaria season was from March to November, with July and August the peak months. The common infection was benign tertian, malignant tertian being very rare.
5. Typhoid Fever: This disease was widespread among the civilian population and appeared to be virulent in type. Four cases were treated in 2 General Hospital during the two months, with one death. The patient who died had had six inoculations of TAB, the last one eight months before the onset of the disease. He died following two perforations of an extensively ulcerated ileum.
6. Pneumonia: Thirty cases of pneumonia were admitted to 2 General Hospital, but only nine of these were in August, by which time the disease had ceased to be of any significance.
7. Venereal Disease: There were 205 new cases in Italy in July and 96 in August. There was some increase in the syphilitic cases. Penicillin was available for both gonorrhoea and syphilis and seemingly good results were obtained by its use. The difficulties due to sulphonamide-resistant cases had been solved by penicillin.
There were 114 cases of physical exhaustion evacuated from divisional units; some of these were returned to their units from the field ambulances, but 22 cases were admitted to 2 General Hospital in July and 62 in August.page 604
|13–17 July—Attack on Arezzo||26||91||117|
|21 July–1 August—Attack south of Florence||107||477||31||615|
|Gunshot (rifle or machine gun)||69|
|Other causes, falling masonry, etc.||26|
|Average Bed States||July||August|
|1 NZ Gen Hosp||336||closed|
|2 NZ Gen Hosp||536||565|
|3 NZ Gen Hosp||605||626|
Evacuations to New Zealand by Hospital Ship
Total from MEF and CMF to end of July 1944, 7245.
|MEF (in Egypt)||395||6,202||6,597|