New Zealand Medical Services in Middle East and Italy
MEDICAL REVIEW OF CAMPAIGN
MEDICAL REVIEW OF CAMPAIGN
Throughout the campaign in Greece the work performed by all members of the medical units was of a very high standard, and special reference must be made to the work of the ambulance drivers and stretcher-bearers under the unusually difficult conditions. This was the first test of the units of the New Zealand Medical Corps in action, and its personnel had to adapt themselves rapidly to unaccustomed surroundings and weather conditions and to the constant movement from place to place. After three weeks' stay at one place—Katerini—where no wounded were received, the rest of the field work was interrupted by a series of withdrawals.
The establishment of the ADSs and MDSs of the field ambulances at their original sites was fraught with considerable difficulty, as at that time the general opinion held was that the Geneva Red Cross could not be relied upon for protection.
Work of the RAPs
The RMOs had to set up their RAPs sometimes in very hilly country and, by their ingenuity in the use of camouflage, protect them from the uncontested attacks of the German air arm. The wounded had to be brought in to the RAPs, sometimes from almost precipitous country and at times by long carries. Special light Neil Robertson stretchers were used with success in the steep country.
The evacuation to the ADS had often to be carried out by stretcher-bearers, but where possible ambulances and trucks were used, the small supply of Flint stretcher gear being very useful. The collection and evacuation of casualties by the regimental medical personnel was most conscientiously and efficiently carried out.
Work of the Field Ambulances
In the quiescent period before fighting began a certain amount of surgery, including appendicectomy, was performed in the MDSs of the field ambulances. Minor cases of sickness were also held in the field ambulances for some days until they had recovered and were then discharged to their units. A surgical team from 1 General Hospital, consisting of a surgeon and an anaesthetist and equipped with some extra surgical instruments, was attached to 6 Field Ambulance to enable major surgery to be carried out in the divisional area should circumstances make this necessary. (This surgical team performed a considerable amount of major surgery in Greece and Crete and furnished a most valuable report on its experiences, with recommendations which were of great value to our medical services later in the war.)page 135
When hostilities threatened, orders were given to the field ambulances by Colonel Kenrick not to carry out any but the most urgent surgery of the civilian type. During the campaign 4 Field Ambulance treated 350 wounded, 5 Field Ambulance 534, and 6 Field Ambulance 87.
Treatment of the Wounded
Treatment carried out by the RMOs consisted in the application of field dressings and the preliminary splintage of the limb as required. Injections of ATS in doses of 3000 units were given, and of morphine up to half a grain.
Wound treatment in the field ambulances varied according to the circumstances at the time. At the beginning of hostilities a certain amount of surgery was carried out at the MDS, especially that to which the surgical team was attached. When the withdrawal began the medical units were leapfrogged back as the combatant troops passed by them. Little but the most urgent treatment was attempted and the cases were evacuated for definitive surgery to 2/3 Australian CCS at Elasson and later, when that unit went back south of Lamia on 14 April, to 24 CCS near Larisa. This unit, with the section of 189 Field Ambulance, remained active until all casualties had been dealt with and the army—with the exception of a rear party—had retired behind them. When 24 CCS also retired south of Lamia on 18 April, treatment was carried out either in the vehicles of the ambulances as they withdrew or at car posts temporarily set up at intervals along the lines of evacuation. It was not until stability was reached behind the Thermopylae line that an operating centre was set up by 5 Field Ambulance at Kamena Voula in a Greek hospital, and a little major surgery—including an operation for a perforating abdominal wound—was able to be carried out.
The principles of treatment adopted were the excision of the wound, the prevention of bleeding, and the provision of drainage. Dressings consisted of the field dressing, and vaseline gauze had also been supplied both to the hospitals and the field ambulances. Acriflavine was used as a local antiseptic, and in some cases sulphonamide was administered by mouth to the seriously wounded men. Thomas splints, with metal traction clips fixed to the heel of the boot, were used for fractures of the lower limbs. Kramer wire and plaster-of-paris were also used for fracture cases, mainly at the CCS. The wounded admitted to 1 NZ General Hospital at the beginning of hostilities, who had been operated on either at the field ambulances or at the CCS, were found to be in excellent condition, and did not require redressing before being sent on by ambulance train to 26 General Hospital in Athens.page 136
The experience in the treatment of war wounds was a new one to the staffs of the ambulances, and the New Zealand medical services were strengthened by having a surgeon of considerable general and orthopaedic experience attached to a field ambulance as a member of the surgical team. The quality of the work varied very much, as was only natural, since much of the urgent and imperative surgical treatment of wounds was carried out by young medical officers with no previous experience of the treatment of war wounds, but under the circumstances the work was well and most conscientiously done.
Special blood-transfusion panniers had been procured in Egypt for each of the field ambulances, but the rapidity of the withdrawal, and the consequent lack of stability in medical units, made it impossible to use blood transfusions for the wounded men, and dry plasma only was available, in small quantities, in one of the field ambulances. Fifth Field Ambulance was supplied with six bottles of plasma prior to the action in Greece and also picked up a considerable stock of plasma and glucose saline from the site of 1 NZ General Hospital during the withdrawal. Blood-transfusion facilities were available, but not used, at our general hospital at Pharsala. Intravenous fluid was given occasionally and a few Baxter Vacolites were available at the MDSs of the field ambulances. Morphia was used freely and doses of ½ gr. were given to seriously wounded men. Some of the medical officers in the ADSs were in the habit of administering pentothal to very severely wounded men in addition to ½ gr. doses of morphia. A solution of 5 cc. was made up and 2 cc. injected into the vein and 3 cc. into the buttock. The patient then usually slept right through to the MDS and thereby had a better chance of recovery.
Gas gangrene was comparatively rare. There were several cases of gas in the tissues, generally associated with localised gangrene of muscle or muscle groups, which responded well to free excision of the involved muscle. Serum was administered.
Evacuation by Road
The road evacuation was by means of the main axial road of Greece from Larisa through Pharsala to Lamia, then by the coastal road to Molos and Atalandi, and back again to the main road at Levadhia and then to Thebes and Athens. The roads in the mountain areas were narrow and in wet weather the surface became muddy and slippery. The main road generally was not very wide and ambulance cars returning for unit personnel, or for wounded and sick still in forward positions, found it difficult to proceed against the stream, of traffic during the withdrawal. The bombing of the roads was an page 137 additional hazard, but the force was lucky in not having any bridges of importance destroyed ahead of it on the main roads.
The road evacuation was undertaken by the Australian MAC, which serviced the whole of the forward medical units, British, Australian, and New Zealand, and carried out their work in such a way as to win unstinted praise from the New Zealand Medical Corps. On 16 April Colonel Kenrick had arranged with DDMS Anzac Corps for six MAC cars to be attached to each field ambulance during the withdrawal, so that each medical unit had cars at its disposal for evacuation of cases to the CCSs and 1 NZ General Hospital, and also to help in the evacuation of the medical units and the many casualties, nursed and transported by all the units, during the withdrawal.
Special car posts were set up, not only to act as relaying posts between the different medical units, but also as collecting posts for the wounded and to act as extra ADSs. As a rule they were staffed by a medical officer and orderlies. The successful evacuation of medical units and casualties was due to the way the medical transport was used, and to the ability of the officers of the Medical Corps to improvise and to commandeer, and to handle the difficult problem of collecting the wounded, scattered as they were over the whole line of evacuation.
Trucks were used to a great extent to transport wounded, and Flint stretcher apparatus was used as much as possible, but the supply was very limited. The smaller 15-cwt and 30-cwt trucks were found to be not nearly as suitable as the three-tonner. The wheel base of the 30-cwt truck was not long enough, and the three-tonner could not only carry many more patients and personnel but it could also carry much more petrol—a matter of great importance.
It was stressed by 4 Field Ambulance that all trucks should be self-contained, and that all drivers should have full information as to their destination. The field ambulances were not themselves self-sufficient as regards transport. This was partly due to an excess in equipment, as each unit had made efforts to supplement the regular army equipment with extras designed to enable more efficient surgery to be carried out. In the forward areas 15-cwt trucks were used by the RMOs, both for transport and also as RAPs.
When W Force first arrived in Greece the main railway was used extensively to transport troops to the forward areas, and a good service was arranged to Katerini. Much heavy equipment was moved in this way, including the bulky and heavy equipment of 1 NZ General Hospital. As soon as the ADMS NZ Division was stationed page 138 in Katerini, he arranged for Greek ambulance coaches to proceed daily from Katerini to evacuate cases from the field ambulances to 26 General Hospital at Athens.
When the CCSs were open at Elasson and Larisa patients were sent to them by ambulance car, and a regular evacuation by hospital train was carried out both to 1 NZ General Hospital and also to 26 General Hospital in Athens. The serious cases were, fortunately, sent direct to Athens. The train evacuation broke down soon after the fighting began. The first contact of our troops with the Germans was on 10 April. On the 17th Colonel Kenrick applied for a train from Larisa to take wounded back to Athens, but the RTO had left two days previously. On the 16th all troops had left the Larisa area except a rearguard, but 24 CCS and 189 Field Ambulance were still functioning. The daily ambulance train still continued to serve them, being worked by medical personnel and driven by anyone whom the medical officer in charge of the train could find capable of driving the engine. It seems that 16 April was the last day on which an ambulance train ran, as it is stated that on the 17th an ambulance train could not get to Brallos. It is probable that the train that left Demerli on 15 April was the last to travel with any Greek personnel, or be serviced by any Greek railwaymen. The RTO had left Larisa on the 15th and all army train organisation then ceased. The hospital train that had been promised for 1 NZ General Hospital from Lamia on the 15th at midday never arrived, possibly being a different train from that servicing 24 CCS at Larisa. The disorganisation of the Greek railway administration and personnel unfortunately almost completely removed the railway from the scheme of operations as far as the withdrawal was concerned.
In retrospect, it would appear that 1 NZ General Hospital was extremely lucky to have been able to evacuate its patients and staff by the last possible train to Athens. Great credit is due to Lieutenant-Colonel Boyd, the officer in charge of the detachment, for his energy and persistence in combating the strong opposition of the Greek railway officials and for his success in attaching the extra trucks with his personnel and patients to the already loaded train.
Evacuation During the Retreat
Patients were transported in the ambulances and trucks of the medical units during the retreat and were sent on to Athens as opportunity offered, for example, when temporary stability occurred behind the Thermopylae line. Urgent treatment was carried out at car posts or in the ambulances on the way.
Hospital trains were used to evacuate from the Thermopylae line until the 20th, although before that date the railway line had been page 139 damaged. As far as New Zealand units were concerned, all casualties were evacuated by ambulance car from the MDS either to 2/3 Australian CCS at Levadhia or direct to Athens.
Hard rations were issued for the move over to Greece and also for the forward areas. Fresh food and vegetables were made available on 1 April when conditions were more settled in the forward areas, but again, during the retreat, hard rations, consisting of M & V1 and hard biscuits, were the staple diet.
Health of Troops
Except for a slight incidence of mild influenzal colds the health of the troops was excellent, in spite of the cold and wet weather experienced in the forward areas.
Broken dental plates, caused by the hard biscuits, gave rise to some difficulty. The Mobile Dental Unit, which was to have been attached to the Division, was late in reaching Greece, and was stopped on its way to the Division by ADMS 81 Base Sub-Area because of the general situation and was attached to 1 NZ General Hospital. A sackful of broken dental plates was left on Mount Olympus—a pathetic relic of the New Zealand Division and a strange offering to the gods.
There was a depot of medical stores at Athens, near 26 General Hospital at Kifisia. No depot was established in 81 Base Sub-Area at Larisa and field ambulances indented for medical supplies from 1 NZ General Hospital before hostilities began. There is, however, no reference to any deficiency in supplies in any of the medical units in Greece. Some medical supplies and equipment were obtained from a tuberculosis sanatorium on the northern slopes of Mount Olympus, where 150 patients, abandoned by the Greek staff, were evacuated by a divisional unit and sent on by train to Athens.
All of the New Zealand field ambulances were very well equipped, having not only the full army equipment but also supplementary articles acquired to enable the units to carry out surgical work more efficiently. When the evacuation of Greece was decided upon, orders were given to units to destroy all equipment and supplies in excess of the minimal quantity that they were able to carry individually on to the ships. The Anzac Corps' operation order No. 2 of page 140 22 April gave the order of withdrawal, and included general instructions for the destruction of equipment other than that which could be carried by the men. The absence of any definite general or medical orders concerning medical equipment led, unfortunately, to misunderstandings both with relation to regimental medical officers and field ambulance units. Fortunately, every effort was made to transport as much as possible, and surgical instruments were especially preserved, the personnel of the units assisting in taking care of much valuable equipment. The order to destroy equipment that had to be left behind was received with great regret by the units concerned and was not fully carried out in any unit. In one case, equipment was placed in a store, with a Red Cross flag on the door and a note of thanks to the German airmen for respecting the Geneva Convention. In another instance one of the field ambulances at the final port of embarkation dumped, but did not destroy, the equipment. One field ambulance also arranged to transfer its ambulance cars to 26 General Hospital instead of destroying them, and these cars were of very great service later in evacuating patients and personnel, including nurses, from the hospital.
The order for the destruction of equipment was intended to refer to the equipment of combatant units, as under the Geneva Convention medical equipment and stores should not be destroyed; it is interesting to note that the natural reaction of the New Zealand medical officers prompted them to act in the correct manner, and only with deep regret was any destruction of equipment ever carried out.
This illustrates the importance of a full knowledge of the Geneva Convention by all personnel, combatant and medical. Some combatant officers without that knowledge tended to insist on the medical officers under their command destroying their medical equipment, and the medical officers were not quite sure at times of the exact position or of their power to resist orders from combatants when the Geneva Convention was in question.
The subsequent story of the events in Greece and Crete demonstrated clearly the wisdom of the Geneva Convention in insisting on the preservation of medical equipment and supplies, as it was to the benefit of our own sick and wounded captured in Greece and Crete that supplies should have been available for their treatment. The senior medical officers made valuable comments on the essential equipment and supplies for such a campaign.
The personnel, both officers and other ranks, had been tested under difficult battle conditions and had not been found wanting. page 141 Already they were displaying the resource and initiative that was to be a characteristic of the forward New Zealand medical units throughout the war. The territorial training in peacetime, however slight in some cases it might have been, had proved of value, and the training in the Army itself had been efficient and practical.
The senior officers had handled the strange conditions with skill. The ADSs had been placed under brigade command, thus ensuring close contact with battalions during the rapid movement of the troops during the withdrawal. Extra car posts had been placed along the lines of evacuation, each with a medical officer in charge, and these attended to casualties and collected wounded.
The MDSs had been handled well during the long retreat and attention given to the troops wounded by bombing and machine-gunning from the air.
The detailing of personnel from 1 NZ General Hospital to 26 General Hospital, Athens, for duty and probable capture in Greece as prisoners of war was a matter of some importance and anxiety, there being no authoritative ruling on the question available for the guidance of senior officers. The matter will be further discussed in relation to the Crete campaign, in which it assumed more importance.
The Evacuation from Greece
The Divisional Medical Units: The responsibility for the forward units rested with the Division and the units retreated with the troops and were evacuated to Crete as part of the main force and without any catastrophe. The whole retreat and the evacuation was excellently organised and executed in the face of great difficulties due to the powerful and efficient German air arm. The main body of all the medical units was safely evacuated to Crete, where 4 Field Ambulance was transhipped and taken to Egypt. They serviced their troops right down to the beaches and, except for loss of equipment, remained almost intact as units.
The Base Medical Units: Owing to the fact that the New Zealand base units were under the command of Headquarters, Athens, and divorced from divisional command, difficulties of evacuation arose. Contact between the units and Headquarters was not close. The units involved were 1 NZ General Hospital, 2 NZ Mobile Dental Unit, and NZ Base Camp units in the Athens area.
As regards 1 NZ General Hospital, the unit was an L of C unit under command of ADMS 81 Base Sub-Area at Larisa. Having no transport of its own, the unit luckily reached Athens by rail on 16 April and came under the direct command of HQ BTG, and page 142 by the very prompt action of Brigadier Large the main body of the unit was evacuated by ship to Egypt. The Mobile Dental Unit and the Base Camp medical units, however, were not so fortunate.
Evacuation from Greece of Sick and Wounded
Up to 19 April, 26 General Hospital cleared its patients satisfactorily by hospital ships from Athens. After that date walking patients were added to the base troops, and many were evacuated from the beaches. Only by the provision of more hospital ships could more of the serious casualties have been evacuated.
The DDMS, Colonel MacCormick, arrived in Greece by air on 5 April, a month after the arrival of the first New Zealand personnel. He had come to discuss with the GOC the sending of more New Zealand medical units, including 3 NZ General Hospital and a convalescent depot, to Greece. It was also proposed to establish in Greece a convalescent home and rest home for nurses and a Red Cross depot, and to send over the Mobile Surgical Unit when ready. This proposal had the warm approval of DDMS BTG.
1 Meat and vegetables, cooked and tinned.