New Zealand Medical Services in Middle East and Italy
During December our New Zealand general hospitals were very busy coping with the Libyan casualties, though these were mostly transferred from British hospitals after treatment there. In all, 985 battle casualties and 1540 sick were admitted to hospital in the month from 2 NZEF, and of these 809 were transferred from British hospitals, a special effort being made to transfer all movable cases before Christmas. These battle casualties were mainly minor cases, though there were some severe compound fractures. Eight amputations were reported in our hospitals. During January most of the other battle casualties were transferred from British hospitals, some of them having already been medically boarded. Our head injury cases were dealt with by the neurosurgical unit at 15 Scottish Hospital, Cairo, but arrangements were made to transfer the cases to 1 General Hospital and recall Major McKenzie1 from the unit to look after them. Our facio-maxillary cases were mostly treated in the British special centre at Alexandria.
Practically all the serious cases were returned to New Zealand on HS Maunganui at the end of January, some sooner than they normally would have been, but the hospital ship was very well staffed to deal with them.
A review of the Division's wounded who reached the base hospitals and survived was made from medical board papers by the Consultant Surgeon. There was a considerable number of very severe wounds, including fractures of the long bones and amputations, with asso- page 294 ciated nerve injuries. Only three abdominal cases with bowel injury had survived, all having been operated on in the Mobile Surgical Unit. Few cases of injury to the skull, brain, or chest were admitted to base hospitals, but eye injuries were common and involved ten enucleations. Joint injury associated with subsequent streptococcal infections had been serious but not very frequent. Secondary haemorrhage was reported in twelve cases, in eight of which the bleeding vessel had been ligatured.
Most of the amputations had been necessitated largely by the original severity of the wound, and subsequent amputations had been due largely to damage to the blood supply of the limb. Severity of the wound was the reason for twenty-nine amputations, vascular damage for five, gas gangrene for five, sepsis for two, and haemorrhage for two. It appeared that nearly all the amputations had been inevitable from the beginning and that very few could possibly have been prevented under any conditions; and certainly in very many cases amputation was prevented by excellent treatment and great patience.
The fractures of the long bones showed excellent results and the majority of cases were evacuated to New Zealand in very good condition. The condition of the cases generally reflected great credit on the surgical staffs of British and New Zealand hospitals responsible for their treatment.
Battle casualties boarded and evacuated to New Zealand showed the following types of wounds (a case of multiple wounds being included more than once): Heads 20; chests 27; abdomens 3; amputations 47; nerve injuries 50; burns 3; fractures—femur 40, tibia and/or fibula 49, radius and/or ulna 22, humerus 41, jaw 4, spine 1, pelvis 5, patella 4, scapula 7, clavicle 6—a total of 179 wounded.
A surgical conference was held in Cairo in February 1942 to evaluate the results of treatment following the Libyan campaign. Papers were read by two of our officers and an account of the work of the Mobile Surgical Unit was also given. Points emphasised at the conference included the value of the Tobruk type of splint for fracture of the femur; the necessity to perform only temporary amputations, preserving the maximum amount of healthy tissue with non-suture of the wound, and the ligature of the vessel at the site of bleeding in secondary haemorrhage; and the referring of head cases to the Base for definitive operative treatment. Two series of abdominal injuries were reported—one from the First Libyan Campaign of 25 cases, with 40 per cent recoveries, and one from the Second Libyan Campaign of 33 cases, with 33 per cent recoveries.
Suggestions for improvements in forward surgery were made at that time by the Consultant Surgeon MEF as follows: More plasma page 295 should be supplied, and blood should be made available to the divisional units; sulphonamide in powder form should be supplied in tins ready for use, and as tablets added to the field dressing package; vaseline gauze or tulle gras should be prepared and sterilised in tins at the base hospitals and sent forward to field units for the treatment of burns. It was pointed out that the futility of operating in severely shocked cases at an early stage was sometimes not realised by medical officers in the forward areas, whose duty was primarily to resuscitate, and then to evacuate, the wounded for definitive surgery elsewhere.