War Surgery and Medicine
IN the Second World War the military authorities, and especially the New Zealand Medical Corps, became responsible for the health of all troops called up for the forces and thereby removed from their normal environment. In civilian life the men had had their health protected by health and sanitation services maintained by councils and other local authorities, and by national standards of hygiene controlled by the Department of Health, and they lived in good homes amply provided with washing, cooking, and sanitation facilities.
From their homes men went to mobilisation camps where provision had to be made for thousands of troops, all living in a new environment unavoidably crowded in comparison with civilian standards. Among other things, there had to be provided suitable sleeping quarters with ample air space for each man, clean cookhouses, good drainage and sanitation services, ablution and laundry facilities, adequate diet, suitable clothing and bedding, and camp hospitals. In the rush of the early days of the war it was not always possible to provide services of the highest standard, but these were improved as circumstances permitted.
All camps overseas had to have similar health services provided for them, and this was not always easy—water supplies might be scarce and impure, and in temporary camps only limited sanitary facilities could be provided. Additional hazards were imposed by different climatic conditions, and by endemic diseases unknown or rare in New Zealand—in the Middle East malaria, typhoid, typhus, dysentery and infective hepatitis, and in the Pacific all these plus dengue fever, hookworm, and other tropical diseases.
Preventive inoculations were given to guard against typhoid, paratyphoid, smallpox, and later typhus, but the whole army organisation had to make the maintenance of health and the prevention of disease one of its main concerns. The most important objective was the making of the individual soldier health-minded. And health, in the modern sense, is (as defined by the World Health Organisation) ‘a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity’.page 708
As has been stated in a hygiene manual:
The Army is a vast organisation, and in order to achieve its object with the greatest economy every man must not only be fully trained but must also be physically fit to carry out his duties in any part of the world. As the efficiency of a soldier depends so largely on his physical fitness, the importance of maintaining him in a good state of health cannot be overestimated.
The maintenance and promotion of the health of the troops and the prevention of disease are not the concern of the medical services alone, but are the duty of everyone in the Army, and can only be carried out if everyone is conversant with the laws of health, the scientific reasons for these laws, and the methods by which they can be put into practice.
Disease can easily be responsible for three to four times as many casualties as enemy action during a campaign, and it is only by ceaseless attention to sanitation that sickness can be combated and the Army maintained in a condition to carry out its object.
The aim of sanitation in the Army is military efficiency and therefore anything that will maintain or improve the health of the soldier and thereby aid his military efficiency must be regarded as coming within the scope of hygiene and sanitation.
In an Army on active service, diseases of all kinds become more prevalent for the following reasons:
Men are crowded together more closely and germs of disease can be more easily spread from sick to healthy men.
Men are not so resistant to disease, because their vitality is lowered through exposure to fatigue, mental strain, less satisfactory feeding and to unaccustomed climates.
The military situation may make it necessary to occupy unhealthy sites which would otherwise be avoided.
The chief causes of sickness in an army in the field are excremental diseases, such as dysentery, enteric fever and diarrhoea, and insect-borne diseases such as malaria and typhus fever, and virus diseases such as influenza and infective hepatitis.
It is essential that attention be paid to all the details of a soldier's life, namely his surroundings, clothing, food, work, recreation, and personal hygiene….