War Surgery and Medicine
BY MAJOR-GENERAL SIR HENEAGE OGILVIE, KBE, DM, M CH, FRCS
Consultant Surgeon to the Middle East Force, 1942–43
IT was at the battle of Alam Haifa in August 1942, that I met a group of New Zealand forward surgeons for the first time, and began an association that lasted till the invasion of Italy. This volume records the happy co-operation that existed in the Second World War between the New Zealand Medical Corps and the Royal Army Medical Corps, a co-operation that was fruitful in advancing the standard of war surgery, in putting to a practical test many new methods, and in alleviating immeasurably the lot of the sick and wounded. Collaboration was constant, and to the mutual advantage of both. The administrative heads and the consultants of both services were in close touch. During battles the New Zealand medical units were often called upon to deal with large numbers of casualties from the British and other Commonwealth forces, and New Zealand patients were admitted to British units. In Tunisia in 1943 at 1 NZ CCS, which was augmented by special British units, including a neurosurgical unit, the principle of forward treatment of head injuries by teams of experts was first worked out.
The fighting in the Western Desert was the testing ground in which the principles of wound treatment learned in the First World War were re-established, in which methods applicable to the fresh conditions of mechanised and highly mobile war were worked out, and in which many surgical methods introduced since 1918, and others discovered during the first years of the war, were first given practical trial. The campaign in Europe in 1940 and the Abyssinian campaign in 1941 were too hurried for the purpose. In the Desert blood was first used in quantities that are now considered adequate; chemotherapy, undergoing tentative trial in 1939, was used on a large scale, first with the sulphonamides, later with penicillin; the use of gastric suction, intravenous medication, and exteriorisation of wounds of the large intestine, combined with the transfer of patients to forward surgical centres able to nurse them and retain them till their condition was stabilised, led to a recovery rate more than twice that in Flanders in 1918, even though the type of injury being treated page vi was, on the average, more severe; gas gangrene, the terror of the First World War, was almost abolished by early surgery and transfusion; and methods of immobilisation suited to transport along lines of evacuation that might extend to a thousand miles, the Tobruk splint for the lower limb and the thoraco-brachial plaster for the upper, were evolved.
In Italy the forward surgical units were pushed close to the fighting and advanced base units were sited a few hours farther back. Delayed primary suture of soft-tissue wounds, from three to five days after injury, became the rule. Air transport, seldom possible till the mastery of the air is assured, was exploited, and cases were transferred to specialist centres at the base within a short period of wounding. Penicillin initiated a fresh policy in gunshot fractures, enabling many to be closed by delayed primary suture, and in wounds of the chest, where early and repeated tapping of haemothoraces with penicillin instillation went far to abolish late deaths from sepsis.
The surgeons of 2 NZEF made a valuable contribution to the surgical potential of the Eighth Army, just as administrators and physicians helped to preserve the health of the 2 NZEF in the Middle East and the Pacific. Their service, along with that of their British and Dominion colleagues, was such that it can be claimed that the soldiers, sailors, and airmen of the British Commonwealth were better cared for in this last world conflict than any fighting men in the history of warfare.
W. H. OgilvieSeptember 1953