Medical Services in New Zealand and The Pacific
IV: Hygiene and Sanitation
IV: Hygiene and Sanitation
The medical interest in camp construction and arrangements from the points of view of the health of the troops and the avoidance of epidemics had to be emphatically stressed by the DGMS and others before it came to be generally recognised. There had been a tendency for the valuable and extensive experience of senior medical officers in military medicine and hygiene and the importance of its application to be underrated.
Considerable difficulty was experienced in the early part of the war in obtaining and maintaining satisfactory conditions in the camps which sprang up all over the Dominion. A camp would be established for a few hundred men for a few days with the minimum number of temporary sanitary facilities, and overnight would be required to accommodate double the number of men for an indefinite period. By requiring a high standard of cleanliness and by waging page 251 total war on the house-fly, those responsible for hygiene saw this anxious period pass without serious consequences. Conditions gradually improved and ultimately became reasonably satisfactory.
The rapid increase of activities involving the construction of numerous camps throughout the Dominion, all requiring constant supervision, and the time taken up with discussions and perusals of plans caused a breakdown of the part-time service given by the local medical officers of health. This led to the appointment in November 1940 of the Principal Sanitary Inspector, Health Department (Mr Cowdrey1), as full-time Deputy Director of Hygiene (Army and Air), with the rank of captain (later major), his duties being laid down in general terms by the DGMS. In each camp there was a health inspector with NCO rank working under the senior medical officer, but a large trained staff was also required.
Training of Sanitary Personnel
It was estimated that 150 to 200 men would be required for field hygiene sections, sanitary inspectors in army camps and hygiene administration orderlies in Air Force stations in New Zealand and overseas. Trained sanitary inspectors are nearly all employed by the Department of Health and local authorities and few could be released for the armed forces. Arrangements were therefore made in December 1940 for the establishment of a School of Hygiene at Trentham Camp. The school opened on 8 April 1941 with fifty-two pupils, who were given eight weeks' intensive training in theoretical and practical sanitation by health inspectors.
The practical work consisted in part in the laying out and construction of a demonstration area, which proved to be of great value in the training of subsequent personnel, including combatants. The exhibits were constantly kept in good order by patients of the adjoining venereal disease hospital. After the school was properly organised and the demonstration area completed, courses were reduced to five working days and were under the control of the OC Medical Depot. Numerous courses were conducted, including a special one for combatant officers and several for RNZAF medical orderlies.
Field Hygiene Sections in New Zealand
1 Maj J. H. Cowdrey, MBE; Wellington; born England, 27 Mar 1882; health inspector; served in South African War and in 1914–18 War; NZPS instructor, 1915–17; Deputy Director of Hygiene, Army HQ, 1941–47.
As no qualified sanitary inspectors were available the personnel included plumbers, carpenters, bricklayers and others whose civil occupation has some connection with sanitation.
Suitable Grade II or Grade III men were selected and posted by District Headquarters and all were trained during April and May 1941 for eight weeks at Trentham as one class under the supervision of Majors Kidman and Cowdrey. Lectures and demonstrations were given by officers of the Department of Health and the Department of Scientific and Industrial Research. On the completion of the course the men were returned to their respective districts and were posted in small parties to the various camps for sanitary duties. No officers were appointed until October 1941, and the units were deficient in men and equipment till that time.
With the formation of divisions in the Dominion in 1942 the four Territorial field hygiene sections were mobilised as divisional troops, No. 1 functioning in North Auckland, No. 2 in the Manawatu, No. 5 in the Wairarapa and No. 3 in the South Island.
It soon became apparent that if the maximum services were to be obtained from these tradesmen and specialists they would have to have their duties extended beyond their advisory nature, and arrangements were accordingly made for the issue of tools and materials so that they could become small constructional units.
The work of the hygiene sections can be better understood if illustrated by the work of one of them. As a Territorial unit 2 Field Hygiene Section underwent a course of training at Trentham in April 1941. The unit was mobilised in December 1941 and entered the camp at Awapuni racecourse, Palmerston North, where it remained until disbanded on 5 August 1943. The camp was more fortunate than some in that it had four large and numerous smaller buildings in which to accommodate most of the troops. In it there were three cookhouses and seventy water closets and urinals in working order. The hygiene section inspected the sanitation arrangements of the camp – water supply, cookhouses, cooking utensils, storage of perishable foods (in most cases badly stored at first), messrooms, canteens, quarters, disposal of waste matter. Inspection was extended to surrounding camps – Wanganui and Dannevirke, and to vital points around Wellington – and later personnel were seconded for duty at these camps. Some camp units were tardy about improving sanitation arrangements, despite advice, and some original members of the section's staff proved unsatisfactory and were page 253 exchanged for tradesmen from the field ambulance in camp. Models of hygiene appliances were set up and a series of lectures given to officers and NCOs of 4 Division. Some of the Grade I personnel were transferred to the Air Force and to 3 Division, and a few of the unit were sent to Norfolk Island.
During 1943 the number of hygiene and sanitation orderlies required by the RNZAF for stations in New Zealand and overseas had exceeded the number required by the Army. It was therefore decided to establish a school of hygiene at the RNZAF Station, Swanson. On the completion of a course at Trentham by ten Air Force personnel in January 1943, they and their instructor proceeded to Swanson station and set up a demonstration area similar to the one at Trentham. From then on all training of airmen in hygiene and sanitation duties was carried out at Swanson. The existence of this school made it possible for every officer, NCO and airman of the RNZAF to be given some instruction in hygiene before proceeding overseas. The principal instructor was changed from time to time, but he was always a man who had been overseas and was therefore conversant with the conditions likely to be met.
As most medical officers had had little if any opportunity of studying the subject of military hygiene prior to enlistment, an educational policy was decided upon. Copies of lectures and other published papers on military hygiene were issued from time to time to all concerned. During 1941 a complete series of articles on fifteen separate subjects was issued to all medical officers. Later the papers were issued in one volume to all incoming medical officers. Copies of the Army Manual of Hygiene and Sanitation, 1934 and the Handbook of Military Hygiene, 1941 and 1943, were distributed to districts, while a copy of Field Service Hygiene Notes, India, 1940 was supplied to each ADMS. The last publication covered every aspect of military hygiene and was most comprehensive. A special article on ‘Purification of Water in the Field in New Zealand’ was prepared and widely distributed.
As occasion warranted, explicit instructions were issued by the DGMS concerning anti-fly measures, feeding of troops, avoidance of overcrowding and over-fatigue, washing and drying of clothing, and other subjects affecting the health of troops in general.
Water and Milk Supplies
The bacteriological examination and chemical analysis of samples of water and milk from Army camps and Air Force stations was undertaken by the Department of Health. Medical Officers of Health page 254 gave valuable information on the interpretation of the results of the examinations and made recommendations for the improvement of unsatisfactory supplies. This entailed a very considerable amount of work, more especially during the first two years of the war.
The supplies of milk and cream to camps and stations were arranged for by the Internal Marketing Department in collaboration with the Department of Health, the DGMS and the Director of Supplies and Transport. It was an accepted policy to purchase pasteurised milk if available and reasonably priced.
Assistance was given to the Department of Scientific and Industrial Research and to the Quartermaster-General's Branch in evolving a portable pumping, water filtration and chlorination plant capable of delivering up to 700 gallons of treated water an hour, and also a small filter which would deliver one pint of water a minute.
Assistance was also given in overhauling and testing some German filters and some Italian filters received from the Middle East, which after repair were sent to 3 Division and came in very useful there. Other filters were obtained from the Royal Army Medical Corps at Aldershot.
Insect Control in Camps and Stations
Apart from cockroaches and house-flies, camps and stations were remarkably free from insect pests. Right from the commencement an energetic campaign was maintained against the house-fly.
The control or elimination of cockroaches presented a problem, more especially on Air Force stations, until DDT became available late in the war. It was demonstrated that kitchens and messes could be freed from cockroaches in a few weeks by intelligent use of a 5 per cent solution of DDT in kerosene and carbon tetrachloride.
In one Air Force station kitchen block alone some 79,000 cockroaches were accounted for in twenty-seven days, the number varying from 11,500 in one day to 1500, and then gradually diminishing until practically all were eliminated in two months.
Oiling of Floors
As it was considered probable that the dry sweeping of the floors of huts had some bearing on the incidence of respiratory disease, an investigation was carried out in the main camps in the three military districts with the object of finding a means of treating floors to prevent dust arising during daily dry sweeping, and at the same time doing away with the practice of so-called washing of floors by sluicing water over them, after which the floors took hours to dry, especially in the winter.page 255
Experiments were carried out under the supervision of the ADsMS in June and July 1941, and resulted in the QMG issuing a special instruction on 15 September 1941 detailing a method of oiling floors.
Washing of Mess Utensils
It was considered that the methods adopted in camps for the washing of eating utensils were unsatisfactory and a likely means of spreading respiratory infection. The common practice was for each man to wash his own eating utensils in the common water provided for the purpose, after which he took them to his sleeping quarters, where they were placed with his other kit until the next meal. Apart from the possibility of further contamination of the articles after washing, the actual method of washing called for some investigation. The investigation was enlightening and resulted in the issue of new regulations in regard to dish-washing.
The investigation was carried out on 17 March 1941 at the Buckle Street barracks, Wellington, to ascertain the approximate bacterial contamination of eating utensils as washed under existing conditions. According to the usual arrangements, when the men's meal was brought to the messroom a container of hot, soapy water was also carried across and placed in the courtyard outside the messroom. On the day in question the container had in it about three gallons of soapy water at a temperature of 164°F., which would be described by most people as ‘scalding’. The meal in question was a light lunch consisting of dry rations only, and did not therefore involve the same washing problem as a hot dinner would have done.
When the men finished their meal and started to wash their utensils, the temperature of the water was 160°F. It was noted that no arrangement was made for the adequate scraping of plates, and each man rinsed his plate, cup, knife, fork and spoon in the water as he was best able to do without immersing his hand. No mop was provided for washing.
The knife, fork and spoon of one man, after being washed by him, was placed in a sterile glass jar with screw top. The knife, fork and spoon of a second man, after being washed by him, was immersed for three minutes in a solution of ‘Neomoscan’ (an antiseptic containing chlorine) at a temperature of 120°F., and then transferred to a second sterile jar.
A few minutes later, when the washing water was dirtier and its temperature had fallen to 137°F., further samples of cutlery were similarly selected and one set was immersed for two minutes in the ‘Neomoscan’ at 110°F. Each set was placed in a sterile jar and all page 256 jars were referred to Major Mercer,1 Consultant Pathologist, for bacteriological examination.
When 10 c.c. of sterile water was placed in each jar and shaken up, the water became turbid in all cases and was full of food debris, showing that washing had been inefficiently done. Had the meal been a hot dinner the evidence of uncleanliness would have been still more evident.
Details of Experiment
0.1 c.c., 0.5 c.c. and 1 c.c. of the water from each jar was plated out and incubated at 37°c. for 48 hours. The results were as follows:
Cutlery washed by owner in soapy water at 160°F.
0.1 c.c. of washings produced 200 colonies.
0.5 c.c. of washings produced 1200 colonies.
1.0 c.c. of washings produced uncountable numbers.
Cutlery washed as above and immersed for three minutes in ‘Neomoscan’ at 120°F.
O.1 c.c. of washings produced 1 colony.
0.5 c.c. of washings produced 10 colonies.
1.0 c.c. of washings produced 26 colonies.
Cutlery washed in soapy water at 137°F.
0.1 c.c. of washings produced 360 colonies.
0.5 c.c. of washings produced uncountable colonies.
1.0 c.c. of washings produced uncountable colonies.
Cutlery washed as above and immersed for two minutes in ‘Neomoscan’ at 110°F.
0.1 c.c. of washings produced 1 colony.
0.5 c.c. of washings produced 3 colonies.
1.0 c.c. of washings produced 5 colonies.
A few colonies of streptococci and staphylococci were identified. The organisms were nearly all chromogenic.
The following conclusions were reached:
The washing as carried out does not effectively cleanse the articles even after a light meal of dry rations.
Rinsing in soapy water too hot for the hands does not kill bacteria.
As the washing proceeds the water gets progressively dirtier and the utensils washed are progressively more heavily contaminated with bacteria. These bacteria can only come from the utensils previously washed and there is thus a direct transference of living bacteria from the eating utensils of one man to those of another.
Immersion in the disinfectant solution rendered the articles virtually sterile even though washing was not completely adequate. Still better results may be expected when the washing is carried out in an efficient manner.
A copy of the above report, together with recommendations, was forwarded to the QMG, who, in September 1942, sent out a memorandum to all districts pointing out that the difficult conditions arising from the unprecedented army construction programme precluded the installation of dish-washing facilities to the standard it was desired to achieve, and that it was now proposed to bring the wash-up troughs in all existing and new camps into line with this standard. The system of cleansing was to be as follows:
All plates and dishes will be scraped into a swill can with a rubber scraper in order to avoid unnecessary fouling of the wash-up water.
Troughs to be sub-divided into three compartments with a separate waste and plug, the compartments to be approximately 2 feet long … preferably of metal and of rounded section.
Hygiene on Transports
The question of transports was one in which the DGMS was especially interested and he made it a practice to inspect personally every transport carrying New Zealand troops. Transports presented particular problems in regard to hygiene and sanitation and the provision of adequate hospital bed accommodation to cater for possible sickness among the troops, especially as the ships carried more troops than the normal complement of passengers.
Prior to the sailing of the first troopships a list of instructions was drawn up for Senior Medical Officers on transports, who were in medical charge of all troops on board. The detailed instructions were incorporated in the manual of ‘Standing Orders for HMNZ Transports’ printed on 1 January 1940 and revised and amended in April 1941.