War Surgery and Medicine
GENERAL HEALTH OF PRISONERS OF WAR
GENERAL HEALTH OF PRISONERS OF WAR
The health of prisoners of war in Germany and Italy seems to have been much better than one might have expected, and was certainly better than that of those who were prisoners of the Japanese. Fortunately there were only a few New Zealanders captured in the Pacific area, as against over 8000 captured in the North African and European theatres.
Accurate and complete figures of sickness for New Zealanders are naturally not available as our men formed small component parts of many scattered prisoner-of-war camps and working parties, but from general reports the sickness rate was not very high, and no extensive epidemics ravaged the camps. There is no doubt that the presence of so many Allied medical officers and orderlies among the prisoners of war was a contributing factor to their good health, and that the receipt of Red Cross parcels was most important.
These factors were also contributory to a low death rate among the New Zealand prisoners. The death rate per thousand from sickness was slightly over twice as high as the comparative rate within 2 NZEF. There were 105 deaths from sickness, the causes being notified as: pneumonia, 12; dysentery, 12; meningitis, 8; heart, 6; neoplasms, 5; pulmonary tuberculosis, 4; diphtheria, 4; toxaemia, 4; nephritis, 3; peritonitis, 3; enterocolitis, 3; malaria, page 470 2; cachexia, 2; other causes, 25; with causes not notified in the case of 12 deaths. Had sulphonamides and penicillin and other drugs been freely available to medical officers it is likely that the deaths would have been fewer still.
Typhus: Probably the greatest threat to health came from typhus fever, to which thousands of Russian prisoners and many German soldiers fell victim. Typhus fever raged through the Russian camps from November 1941. Two New Zealanders, Captain Foreman and Private Butler, NZMC, who, with Captain Stevenson-Wright, volunteered to go and assist at the hospital at the Russian camp at Neuhammer, developed typhus in March 1942, but both recovered. The sick at this hospital came from the 60,000 Russians in the nearby camp, where conditions were deplorable. Most of the cases treated in the hospital were suffering from starvation associated with hunger oedema, tuberculosis, dysentery, and typhus. The daily diet in the camp consisted of no more than 1200–1400 calories, and the diet for the sick Russians in hospital was 250 grammes of bread, 10 grammes of margarine, 10 grammes of sugar, and swede soup morning and evening. The hospital of twenty wooden barracks, each housing 100 patients, was overcrowded; there was no soap, medical supplies were very inadequate, and there were no laboratory and surgical facilities. There were 100–200 typhus cases in hospital at one time, and 80–90 Russians died each day. As far as typhus was concerned, good nursing was the only possible treatment. This description of the conditions of the Russians gives an indication of what could have been the fate of our own prisoners of war.
On 28 November 1941 there was an outbreak of typhus fever (the German fleckfieber, or typhus exanthematous) at the camp at Lamsdorf, where there were many New Zealanders. The first six cases occurred among medical orderlies who were working in the delousing station, which was used for Russians from adjoining camps as well as for the British camp. Prompt measures were taken by our medical officers. By 2 December all hair had been removed from the heads and bodies of all the 10,000 inmates of the camp, while an anti-louse campaign was in full swing, largely due to the arrangements made by Lieutenant-Colonel Bull with the Camp Commandant and senior German medical officer in regard to isolation, disinfestation, and improved facilities for personal hygiene. In all, 18 British developed typhus, with three, including one medical officer, succumbing.
Typhoid: There were sporadic cases of typhoid but no major outbreak among British prisoners in Germany. Each summer, in May, inmates of most of the large camps were given a 1 c.c. injection page 471 of German standard TAB vaccine. In 1944, at Lazarett Lamsdorf, one patient fatally perforated a typhoid ulcer in his terminal ileum.
Dysentery: Summer diarrhoea and Shiga dysentery occurred from time to time. Rarely was it severe among British working parties. Most cases subsided in two to three days; some were hospitalised in the camps. Amoebic dysentery was not uncommon; it usually required long courses of emetine and yatran before cures were effected. Sigmoidoscopes were available both at Lamsdorf and Cosel hospitals for ocular control of the ulcers. A few liver abscesses were treated at Lamsdorf by aspiration.
Famine Oedema: In Salonika camp from June until September 1941 famine oedema abounded, filling the wards of the hospital. Food and essential vitamins were most difficult to procure, but supplies of fresh fruit from the Greek Red Cross warded off scurvy. With better feeding for the British prisoners in Germany itself, famine oedema was not seen again until the last phase of the war, following semi-starvation on the 600–mile march west from Silesia from January to March 1945.
Tuberculosis: There was a small but steady incidence of tuberculosis. Besides pulmonary tuberculosis some cases of bone and joint tuberculosis were seen. All such patients were given an extra diet containing an increase of protein. About every six months the cases of pulmonary tuberculosis would be transported to Königswartha Sanatorium, where major surgery would be undertaken when indicated.
Conditions at Königswartha were far from satisfactory, as accommodation was very poor, equipment limited, and there was a shortage of staff despite the transfer of British medical officers and orderlies to the hospital in 1942. After the arrival of Lieutenant-Colonel L. E. Le Souef, AAMC, in August 1942, administration, organisation, and treatment all improved, but Le Souef petitioned for better conditions with the result that in March 1943 the patients were transferred to Elsterhorst, where a general hospital for prisoners of war had been specially built. At Elsterhorst facilities for surgery were much better and special thoracic instruments had been obtained by then. Later in the year serial radiography was begun among prisoner-of-war working parties to detect cases of tuberculosis. After being passed by the Mixed Medical Commission, groups of patients were repatriated in October 1943, May and September 1944, and January 1945. All sputum positive cases came in 1944 to be automatically accepted by the German authorities for repatriation, and most of the other cases recommended were approved by the Mixed Medical Commission. The result was that there were few patients left when Elsterhorst was evacuated page 472 in February 1945 from the path of the Russian advance. Lieutenant-Colonel Le Souef was transferred elsewhere in May 1944 and his place as Senior British Medical Officer was taken by Lieutenant-Colonel Bull, NZMC, who published the following statistics of cases. Over 1000 British patients, most of them from the United Kingdom, passed through the hospitals. There were only 22 New Zealanders admitted and two died; but 20 more cases were first diagnosed after repatriation to England in April 1945.
Types of treatment given to the British patients were:
|APT right or left||339|
|APT failed or abandoned||44|
|Pleuroscopy with adhesion section||129|
|Pleuroscopy with section repeated||32|
It can be seen that full scope was given to the modern and the surgical aspects of treatment.
Estimated results of treatment were:
|Results||Conservative||Active (APT, etc.)|
|Number of Cases||Average Stay in Hospital (Months)||Number of Cases||Average Stay in Hospital (Months)|
|Improved||194 (28.17%)||9||185 (47.65%)||9|
|Unchanged||427 (65.39%)||3½||176 (45.36%)||6|
|Worse||32 (6.44%)||13||27 (6.99%)||12|
Improved Negative sputum after original positive.
Improved Normal or only slightly increased BSR.
Improved Increased weight.
Incidence of Active Pulmonary Tuberculosis among British Troops (Pleurisies and Fibrotics Excluded)
|Country of Origin||Numbers of Prisoners||Germany||England||Incidence per 1000|
The actual incidence was higher as a few cases in Germany did not reach the tuberculosis hospitals, and other cases were diagnosed after their return from England to their own countries.page 473
In a survey of War Pensions files at the end of 1949 Dr D. Macdonald Wilson found that 155 cases of pulmonary tuberculosis had arisen among prisoners and ex-prisoners of war, the number of cases diagnosed each year being: 1941, 4; 1942, 10; 1943, 8; 1944, 23; 1945, 70; 1946, 12; 1947, 14; 1948, 6; 1949, 8. Of these, 84 were not X-rayed at enlistment. The incidence among prisoners of war was over double that of the whole New Zealand overseas army group.
Cerebro-spinal Meningitis: In spite of the constant overcrowding of British prisoners of war in Germany there was never any major outbreak of cerebro-spinal meningitis. In one camp, Arbeitskom-mando E3 of Stalag VIIIB, there were three cases in 1943, and yet these occurred among the NCOs, where five men were sleeping in huts instead of the normal 24.
Skin Diseases: Skin diseases, particularly boils, became very prevalent amongst otherwise fit men when serving on working parties in Eastern Germany. Men often in what appeared to be the prime of physical fitness, who took great care of personal cleanliness, who worked in the open clothed only in shorts, would, for no apparent reason, come out in crops of boils, often situated on their arms, their axillae, neck, or face. These boils would frequently spread to become a localised, and at times generalised, weeping eczema, which would take weeks of careful nursing to clear. Nothing could be specifically blamed for their appearance, yet there was a general feeling that it was related to the lack of fresh milk, fresh fruit and vitamins; none of the men was proved to be a diabetic, and few showed any rapid improvement with vitamin extracts. Some men had their annual crop of boils in the winter, some in the summer. Undoubtedly the commonest ailment amongst 1000 men in a working party was skin disease, and of these, boils easily headed the list. One could rely on a steady 50 per 1000 men each month.
The Germans had a staphylococcal vaccine called ‘staphar’, which helped some. Colloidol manganese helped a few. Some even had to be admitted to the camp hospital, while others had to be returned to the main camp as convalescents.
Scabies: Where washing facilities were reasonable scabies was not seen, but in the crowding of the central camps it every now and again made a sporadic appearance. Treatment consisted in sterilising the clothing, either in a delouser or in a Serbian barrel. The skin was shaved and sulphur ointment applied. The Germans also had a colloidal sulphur preparation called ‘pellidol’ which page 474 was sometimes applied. The British Red Cross forwarded disinfectant parcels.
Tinea of the Feet was relatively common and responded to a proprietary preparation of salicylic acid 5 per cent.
Tinea Cruris also broke out from time to time. It usually required admission to the camp hospital, shaving of the pubic region and perineum, and then painting the large butterfly-shaped affected area, which usually extended from the root of the penis back to behind the anus, with gentian violet in spirit, or a German synthetic iodine, or with Whitfield's ointment.
There were also several victims of chronic psoriasis who could keep their ailment in check with chrysarobin for the scalp and cignolin for the trunk. Such men were best sent to working parties with good showering facilities.
Teeth: There was little increase in dental caries attributable to the life and the diet.
Goitre: There was a remarkably low incidence of goitre. In Lazarett Lamsdorf, which did the surgery for 30,000 prisoners of war, not more than ten men had thyroid operations in four years, and all these were for solitary adenoma.
Parasites: Bilharzial infection was seen, but rarely in patients who had come into captivity via the Middle East. It was diagnosed following a history of dysuria and haematuria. The protozoa were found in the urine, and on cystoscopy the characteristic ‘tubercle’ and cystitis demonstrated.
Frostbite: Those British prisoners captured in France in 1940 experienced a bitter winter between 1940 and 1941. No British Red Cross clothing had reached them at that time, and medical officers who treated men on working parties all testified to the minor frostbite which occurred among the men.
Following the great trek from Upper Silesia to Western and Central Germany in 1945, there were cases of frostbite. Major cases were hospitalised en route, and there treated by British or German surgeons. The lesser degrees, i.e., those with dry gangrene of toes, fingers or heels, were transported through to the central collecting camps between Nuremberg and Munich. These cases were treated by wound toilet to remove slough, application of sulphanilamide powder, and non-sticking vaseline (or cod-liver oil in vaseline) dressing. With daily bathing, dressings, and the return of warmer weather, these lesions rapidly began to heal, and were well on the way to recovery at the time of liberation on 6 April 1945.page 475
Prisoners suffered from certain occupational diseases.
Teno-synovitis: Men engaged in lumbering often developed teno-synovitis of the dorsal tendon sheaths of the wrist, and one attack in no way conferred an immunity. It is true to say that one attack predisposed to another, for one attack showed the patient an excellent way of getting a week's rest from work. The real danger to himself was to be labelled a ‘chronic invalid’, because one month's continued ill health meant return from the comparative comfort of a working party to the crowded discomfort of a central stalag.
Those who carried heavy loads of iron bars or cement might contract teno-synovitis in the tendon sheaths of the extensors of the toes, or in the gastrocnemius sheath. There was only one treatment—rest. If on the wrist, the forearm, hand and fingers were splinted on a padded Kramer wire splint, bound up tightly, supported in a sling and left for seven days. Similarly for the leg, except that the patient was also admitted to the camp hospital. No man could be trusted to ‘rest’ in his room.
Foreign Bodies in Eyes: These usually were stone or iron flakes, seen in men working lathes, or near lathes. They were usually readily removed with the aid of a binocular ‘lupe’, cocaine drops, eyelid retractor and eye spud. Sometimes an ulcer developed, requiring cauterising. Major Thomson, RAMC ophthalmologist, dealt with several cases in Lazarett Lamsdorf in which the anterior chamber of the eye was penetrated.
Conjunctivitis: This frequently arose in those near electric welding machines. Refusal to use the goggles provided was the cause of some; others had no goggles to wear. These were provided after protesting via the camp authorities to the Works Controllers.
‘Gefangener's Toe’: This was a compound comminuted fracture of the terminal phalanx of the great toe, the result of dropping a brick or iron bar across the toe. Most were accidents, some intentional. Either way, they were painful, but they insured a two-months' rest from all work.
Treatment under anaesthesia was to remove the damaged toenail, clean up the wound, and dress with sterile cod-liver oil in vaseline dressing. The patient was then admitted to camp hospital (if only to rest the foot), and kept there till the toe healed. These cases were frequently X-rayed to determine the extent of the bony damage. page 476 They were slow to heal, and frequently ended in a deformed toenail which would give trouble later.
Finger Injuries: Crushed middle fingers with completely severed tendons, blood vessels, and nerves necessitated amputation.
Hernia: Occasionally indirect inguinal hernia occurred while working. One man, subjected to operation by a German surgeon in a German military hospital, had bilateral inguinal hernia repaired by Bassini technique, but without excising the sac. One side promptly recurred, requiring a second operation at which the sac was excised.
Varicose Veins: If small, these were treated with injections of sodium morrhuate called ‘Varicocid’. This was partly successful; some were cured, some developed other veins. Larger veins required a Trendelenberg operation with ties in the thigh and calf.
As was only to be expected, mental disorders were in evidence among prisoners of war, but not to the extent that one might think. In general, the psychoneuroses appeared to be related to home conditions and domestic difficulties as disclosed in letters rather than to environmental conditions. There were those who became ‘browned off’ because of bad news from home—the death of a parent, disloyalty of a wife, etc. Several times it fell to medical officers to help initiate arrangements for a divorce.
Some men were mental misfits; they just could not settle down to the routine of the camp life, and asked for a change of working party. Some liked to change once a year, others more frequently. Usually only by way of some medical excuse, real or fictitious, could such change be effected.
Occasionally some member would rebel against British camp discipline. With such there was only one treatment—summary removal from camp, from the security of his environment and his friends.
Homosexuality was said to occur, but it was very difficult to get direct proof of such. Suicides were not common, but there were some suicides both in working parties and large camps. Others who became ‘Stalag happy’ literally tried to climb over the barbed-wire fences, being riddled to death by machine-gun fire from sentry boxes. Try as the British medical officers might, they could never persuade the German authorities to command their sentries that such men as these were usually mental, and that if they must shoot, they should shoot low.