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The authors of the volumes in this series of histories prepared under the supervision of the
By Lieutenant-General Lord Freyberg, VC
THE publication of this volume of the New Zealand War History gives me an opportunity of paying a well-earned tribute to the work of our medical services during the campaigns, battles, and engagements in the
I have often been asked how it was that the 2nd New Zealand Expeditionary Force was able to carry on fighting over the five and a half years of the war, and in spite of heavy casualties maintain its high morale. In my opinion the chief among several reasons was because of the excellence of our Medical and Nursing Services, the efficiency of which has seldom been equalled.
When we came overseas from New Zealand to Egypt in
In a short foreword I cannot fully acknowledge the quality of help and advice we had both from our medical and surgical specialists, and from the director of the medical service. They planned ahead with great foresight.
Before we arrived in Egypt, they had studied the plagues and infections with which the
In the realm of early surgery, clinical treatment and nursing on the battlefield, the New Zealand medical service was outstanding, and many of our methods were copied by others. Our medical men displayed a high standard of training and imagination. Our medical leaders can claim that in the
In the turning movements at
Engineers, complete with bulldozers, prepared landing strips alongside the small hospitals, and on these improvised airfields transport aircraft came in to pick up and fly the wounded back to the big base hospital in
When the Division went to
This history tells the whole story of the New Zealand Medical War Service, and I hope that it will have the wide and general circulation that it has surely earned.
Deputy Constable and Lieutenant Governor,
THIS is the second volume of the official medical history of New Zealand in the Second World War. It has been preceded by the Clinical Volume in which important surgical and medical experience has been recorded and evaluated in case of future need. Also, it follows the unit history, Medical Units of 2 NZEF in Middle East and Italy, by J. B. McKinney, but it covers another field, concentrating rather on the story of the New Zealand Medical Corps in the campaigns in the
The record of the New Zealand Medical Corps in the First World War was admirably presented by Lieutenant-Colonel A. D. Carbery in his book The New Zealand Medical Service in the Great War 1914–1918. This present volume takes up the story where he left off, and briefly covers the inter-war years before turning to the mobilisation and campaigns of the Second World War. Each campaign has been briefly summarised so that the medical story may be intelligible, but the reader is also referred to other War History volumes. Medical histories are being published by other Commonwealth countries, and, in the
In the medical history of a single homogeneous division, problems and experiences can be analysed more intimately than is possible with a larger force. Thus it is felt that this volume has a significant contribution to make to the history of the Second World War. Despite
It is hoped that this volume will constitute a worthy record of those who served during the Second World War in the New Zealand Medical Corps.
The occupations given in the biographical footnotes are those on enlistment.
DURING the First World War the New Zealand Medical Corps, with all its members drawn from the medical and nursing professions and other sections of the civilian community, built up an honourable record of courageous and efficient service in
General demobilisation after the First World War was practically completed by
The staff of the Army Medical Department was reduced as the number of service patients decreased, and by
On
With the cessation of hostilities in the First World War and the subsequent general demobilisation, the public generally was apathetic towards military training. However, early in
After leaving school, boys were enrolled for cadet service until the age of eighteen years. They were then entered for service in a territorial unit until reaching the age of twenty-one when, if they had performed efficient service, they were transferred to the reserve. The amount of service required each year was thirty evenings for drill, twelve half-day parades, and six days' continuous training in camp. The number of evenings for drill was later reduced to twenty-one.
For the New Zealand Medical Corps training depots were formed at
Compulsory military service provided an adequate number of men for training, but the apathy and lack of interest of the majority of medical officers resulted in a steady deterioration of the efficiency of the New Zealand Medical Corps. The Director of Medical Services lived in
The lack of interest by medical officers in the training of the
Despite the prevailing apathy, good progress was made by both cadets and territorials. Courses of instruction for
During the later years of the nineteen-twenties there was a greater interest generally in defence matters. Younger members of the medical profession sought enrolment for service on the active list. Territorial parades, still on a compulsory basis, were well attended and the
In
The Chief of the General Staff,
During the next few years there was a definite resurgence. Those medical officers, senior and junior, who had lost interest were placed on the Reserve of Officers and were replaced by younger post-war graduates, some of whom had returned from the
In
Prior to the last compulsory parade, instructions were issued that all units would remain as units, with personnel serving on a voluntary basis. The response to the call for volunteers was very poor and somewhat disappointing to the Regular Force instructors. Much credit is therefore due to those officers, NCOs, and men who elected to remain on the active list, and who formed the foundation for the building up of the military units of
In
During the early nineteen-thirties there were very few volunteer territorials. Parades of the Medical Corps were held fortnightly and NCO classes were held in the intervening week. Weekend bivouacs were also held periodically but it was not uncommon to have an attendance of only about ten officers and seven other ranks. The cost of running these camps had to be borne privately, and the small honoraria received by the DMS and ADsMS in the three districts were given up at the request of the Minister of Defence and were not restored until
With the closing of the military hospitals in
The
On See section in later volume on RNZAF Medical Services.
As the years went by there was a gradual awakening to the fact that New Zealand should look to matters of defence. Scientific advances were making the rest of the world much less remote. Great advances in aircraft design, for instance, enabled pioneer airmen to travel from
Annual six-day training camps were held in various centres, and although the attendances at these camps were very small, partly because employers would not let employees have leave, valuable training was carried out. The officers were given advanced work in medical corps duties and the handling of field ambulances in battle. The NCOs and men had a syllabus of parade-ground work, the
Soon after his appointment as DMS, Colonel Bowerbank realised the great potential value of the Otago University Medical Company, but the chiefs of the services, though not unfavourable to it, found difficulty in allocating out of a very limited financial grant the necessary expenditure for training. In
A satisfying feature was the response of the young medical practitioners. In all three military districts the establishments were up to field strength, and in the Central Military District the numbers volunteering were so great that in
In
At his own expense, Colonel Bowerbank attended in
In New Zealand there was not the military organisation to make elaborate preparations, nor was there much public support or planning by the Government. The Medical Corps, as with other units, was wholly territorial. It had part-time administrative officers, each of whom received a small honorarium. These were the Director of Medical Services, and Assistant Directors of Medical Services for each of the three military districts (Northern, Central, and Southern).
On his return from overseas Colonel Bowerbank took another step in building up the organisation at Army Medical Headquarters by securing approval for the appointment of Major
In
After the First World War all medical and surgical equipment used by
Each military area throughout the country was issued with one pair of medical panniers, one medical companion, and one surgical haversack for use by RMOs at local camps of instruction. These were replenished on indent from the medical store at
During the depression years and the years following, however, no replacements were made to existing stocks and consequently the divisional equipment was drawn on to supply territorial camps, permanent staff depots, and army training schools.
As the DGMS reported to the Adjutant-General in
The result was that in
The DMS on his visit to
Panniers of a new pattern had been ordered, it being planned that they could be filled from existing stocks of drugs and dressings in which there had been little change. During
The staff establishments of the territorial units of the New Zealand Medical Corps in
On the strength of each territorial field ambulance at the outbreak of war in Strength of OffrsORs
Thus, in
In the years immediately preceding the Second World War, however, valuable planning had been made on a national basis by a Medical Committee working under the Organisation for National Security, which had grown out of the New Zealand Committee for Imperial Defence. To ensure the co-ordination of all preparations for any future war, the New Zealand Committee for Imperial Defence held its first conference in
The Committee for Imperial Defence in
This committee held its first meeting on
The membership of the committee remained constant from its inception to its dissolution, comprising Dr
In general terms, the committee was set up to organise the medical examination of recruits, the care of sick and wounded of the forces, and the medical care of the civilian population in any state of emergency.
As the Medical Committee first directed its attention to standards of medical examination of recruits, it is apposite to refer to the position in the First World War. At the outbreak of war in
Later, in
One important consequence of the low medical standard was that the New Zealand Government became responsible for the payment of large sums in pensions for pre-enlistment disabilities held to have been aggravated by service in the Army. In order, therefore, that better standards should be adopted in any future war and that there should be conservation and better application of manpower, the Medical Committee was formed.
At the outset in
The committee, with the assistance of Lieutenant-Colonel Bull, also compiled a Code of Instructions for Medical Boards which was published in
The Code of Instructions specified as its objects:
The medical classification of men to enable the Army, Navy, or Air Force to determine the type of duty for which they were most fitted.
The establishment of a standard system of grading.
It provided for a dominion organisation, under the Director-General of Health, with regional deputies in the eleven main centres controlling a total of twenty-five districts and with varying numbers of civilian medical boards in each district. Each medical board was to consist of two doctors and one dentist with supplementary staff. Later, an optician was added.
With Government approval the dominion organisation was set up early in
The examination of recruits, therefore, was carried out not by the Army, but by a civilian organisation under the Director-General of
In the early years of the First World War there was a system of dual control of the sick and wounded shared by the Public Health Department and the Defence Department. An important change in medical administration of sick and wounded came about in
With the intention of benefiting from the experiences of 1914–18, the Medical Committee set about defining a policy for the future treatment of sick and wounded servicemen. At a meeting on
On this basis, the Medical Committee made certain recommendations concerning the hospital treatment of sick and wounded
The policy approved by the Government was that all hospital treatment or investigation for sick and wounded servicemen, lasting more than twenty-four to forty-eight hours, was to be the function of the Health Department (through the Hospital Boards). It was thought that the Health Department was most favourably situated to review the facilities for medical treatment generally, to provide extensions to existing institutions, and to organise specialist treatment on a proper basis. In addition, where possible, the serviceman was to be treated in the institution nearest to his home.
It was laid down that the Army would hand over the sick or wounded soldier to the Health Department at the door of the civil hospital. From that point the Health Department would assume the responsibility for his treatment until he was fit to rejoin the Army. It was not fully realised, however, that the Health Department could act only in an advisory capacity to the hospital boards, which were independent and autonomous as regards the medical treatment and care of the patients in their institutions.
On this basis the army medical service arranged for only limited bed accommodation in camp hospitals. The function of these hospitals was to treat minor illnesses and lessen the call on beds in the civil hospital. To serve this latter end these hospitals did on occasion retain patients for more than forty-eight hours, many minor cases actually being retained up to a week.
There is no doubt that the policy limitation of the stay of patients in camp hospitals to forty-eight hours resulted in a number of cases of minor disabilities being unnecessarily transferred to civil hospitals. The direct result of this was that public hospitals, especially in
On analogy with the system developed in
In drawing up his Medical Appreciation for the Defence of New Zealand of
However, when this appreciation was submitted to the Medical Committee, majority decisions favoured variations which the DMS considered would establish the very system of dual control he sought to avoid. It was the opinion of the Health Department officers, who constituted a majority on the Committee, that:
The matter of honorary military rank either for officers of the Department of Health or Superintendents of Hospitals should be left in abeyance.
Discipline in civilian hospitals amongst soldier patients could be as effectively maintained by civilian medical superintendents without military rank, though it was agreed that the local Area Officer was to be called in as required to deal with any breach of discipline.
Convalescent and Medical Board Depots should have a civilian medical practitioner in command (preferably an officer in the reserve) as medical superintendent, but that such military liaison officers as were necessary would be attached for military purposes.
Within a few weeks of the outbreak of war it was necessary to make modifications in the general policy. The Director-General of Health was not prepared to accept for in-patient treatment soldiers suffering from venereal disease. In consequence of a ruling by the Minister of Health that such patients be treated in camp, contagious disease hospitals were erected in the three main camps (
The opinion expressed by a majority of the Medical Committee regarding the ability of the civilian staffs to maintain discipline unaided was quickly disproved, and the Army was asked to appoint full-time NCOs (but not of
As a result of a War Council recommendation in The activities of the
At a meeting of the
As already mentioned, the Director of Medical Services on
When Britain declared war on
In each of the military districts, Northern, Central, and Southern, an Assistant Director of Medical Services was employed on a half-time basis.
Shortly after the outbreak of war the Director of Public Hygiene, Department of Health, Dr
For some years before the outbreak of the war the Director of Dental Services was directly under the Adjutant-General, but in
With the outbreak of war the original purpose of the
On
At its meeting on
In
The This subject is also further discussed in Vol III.
It is appropriate that some of the duties and responsibilities of those controlling the organisation and maintenance of the Army and Air medical services in New Zealand from
DGMS: The DGMS was the responsible adviser to the Chief of the General Staff, Army, and the Chief of Air Staff in all medical
ADMS: The ADMS at Army Headquarters was the chief assistant to the DGMS in all his duties.
Staff Officer and Quartermaster: The staff officer and quartermaster was in charge of all medical stores and was responsible for the equipment of all medical units and for the proper accounting for and periodical inspection of this equipment.
Deputy Director of Hygiene: The Deputy Director of Hygiene was the adviser of the DGMS on camp sites, buildings, water supply, drainage, and sewage disposal. He made systematic inspections of the camps in regard to hygiene, health of troops, control of preventable or infectious diseases, and instruction and training in hygiene and sanitation.
Matron-in-Chief: The Matron-in-Chief was responsible to the DGMS for the organisation and control of the New Zealand Army and RNZAF Nursing Services. In her duties she saw that none but properly trained and qualified nurses were recommended for appointment in the Army, Navy, and Air Nursing Services, and she made the recommendations for appointment of matrons of the hospitals under the control of the DGMS.
ADsMS Military Districts: In a military district the duties and responsibilities of an ADMS, who was appointed by the DGMS, were similar to those of the DGMS at Army Headquarters. He was under the direction of the DGMS and responsible to him for the efficient training of the medical units. He had to keep his District Commander informed on all important technical instructions received from the DGMS, and advise him on all medical and sanitary matters. He controlled all medical units in his district and was responsible to the DGMS for their efficiency, as well as for the adequate supply of medical stores to all units.
This, then, was the nucleus of administrators responsible for the handling of medical problems associated with mobilisation and the provision of medical services for home and overseas forces.
DURING
By
With the number of boards arranged, and sessions of four hours a day each, it was expected to complete in four days the examination of the 39,900 men the Army proposed to mobilise. (In actual experience it was found that the army mobilisation did not achieve any such intensity as mooted in pre-war proposals. Up to
At the meeting of the Medical Committee on
The introduction of compulsory military service under the National Service Emergency Regulations
When conscription was introduced in
Under the National Service Emergency Regulations 35 et seq, the responsibility for medical boarding was transferred from the
As deficiencies in the medical examination system became apparent, modifications and additions were made to the Code of Instructions. On
There was a case in the earlier years of the war for a closer liaison between the army medical services and the Health Department, which was in executive control of the civil medical boards examining recruits, so that doctors could have been kept constantly aware of the disabilities likely to cause rejection from the Army. On this question of rejection the same problems were encountered in This subject will be further elaborated in Vol III.
There seemed to be a lack of appreciation by the Health Department of the problem of the convalescent soldier. Civil hospitals were not accustomed to arrange for the convalescence of patients suffering from ordinary illness. These were expected to convalesce at home. It was only in the more serious illnesses and in special conditions demanding prolonged treatment that any provision at all was made. When the Health Department originally arranged for the use of Hanmer and
The hospitals discharged the military patients to their homes for varying periods of sick leave before returning to camp, and this leave could be extended on the certificate of their local doctor. The inevitable happened, and the military authorities found that great wastage of personnel was occurring and that they could not check up on the men scattered all over the country. This led to the setting up of a ‘
The Army eventually built three convalescent depots to attempt to supply a more complete medical chain, but they were not completed until 1942 and 1943 and did not receive a great many of the patients discharged from hospital. The depot built for the Central District was given over to the Americans before it functioned as a convalescent depot. The civil hospitals were used for sick and wounded returned from overseas, and the Army had no military hospitals of its own at any stage, except for small hospitals in mobilisation camps.
For the admission of minor sick, small camp hospitals with the most modern equipment were erected in the three main mobilisation camps,
At the outbreak of war there were no military motor ambulances on hand to convey the sick from camps to civil hospitals. In some instances ambulances belonging to hospital boards were used, and where they were not available army service trucks were adapted by placing mattresses or stretchers on the floor.
In
With large numbers of men congregated in camps under conditions to which the majority of them are unused, there is likely to be a greater incidence of disease than normally occurs in the civil population. The DGMS (Army and Air) was insistent in his recommendations to camp authorities at the beginning of the war that the following points should be strictly observed:
Adequate air space and ventilation in sleeping quarters.
All damp and wet clothing to be changed at the earliest possible moment, and the provision of adequate drying facilities, and no wet or damp clothing to be permitted in sleeping quarters.
Adequate changes of clothing to be provided.
Avoidance of undue fatigue in the early stages of training, i.e., training to be graduated.
Provision of sufficient hot and cold showers.
Diet not only wholesome and well cooked, but containing those foods which have a protective value against disease, and the food to be varied and served in a palatable manner.
Sanitary arrangements to be above suspicion.
In regard to (1), it was pointed out that it was essential that each soldier should have 600 cubic feet of air space and that the distance between the centres of adjacent beds be at least 6 ft. In the early stages of the First World War proper attention was not given to adequate ventilation and air space, and when a serious outbreak of cerebro-spinal fever occurred, a number of cases being fatal, a complete disorganisation of training resulted. Points (2), (3), and (4) were the direct responsibility of the unit commander.
The efficiency of the medical services was sternly tried in the latter part of October and during
In the early months of
Neither the DGMS nor the ADsMS were first consulted regarding the design of huts, latrines, and showers, and strong protests by them when they pointed out weaknesses during the actual construction work or insanitary conditions were often ignored, particularly in the Central Military District. It was fortunate that the consequences were not more serious.
To some extent this was probably a result of the concern of one particular organisation to push ahead expeditiously with its own programme. The medical interest in camp construction and arrangements from the point of view of the health of the troops and the
On
It was explained that the army officers concerned proposed to recommend the appointment of a full-time Deputy Director of Hygiene. It was decided that, in future, the procedure to be followed in deciding on the location of a camp would include a reconnaissance of the site and buildings by the district commanding officer, AQMG, and ADMS, the Works Officer, and District Engineer, Public Works Department. These officers would furnish a report on the site. When plans were received at Army Headquarters, the Quartermaster-General would submit them to the Director-General of Medical Services and Deputy Director of Hygiene for approval from the medical service point of view. In
With the mobilisation of the First Echelon of the Special Force in September and October 1939, whole-time senior medical officers were appointed to
The senior medical officers were on the staff of the camp commandants in the mobilisation camps. They were responsible for the care of all sick, and were the advisers to the camp commandant on all matters pertaining to the health of troops, as well as being inspectors of sanitation arrangements. On sanitary matters each had the help of a sanitary inspector with the rank of WO I. Under the control of the senior medical officer were the military camp hospital and a contagious disease hospital where venereal disease patients were retained and treated. There was an arrangement between the Health Department and the Army whereby soldiers who contracted venereal disease after they went to camp were to be treated by the Army. If they had contracted the disease after attestation but before going to camp, they might be discharged from camp and become the responsibility of the Health Department. The senior medical officer had a number of medical officers to assist him. One looked after the camp hospital, while others were appointed as regimental medical officers to the battalions of reinforcements undergoing training. These were practically always medical officers who were themselves going overseas with the reinforcements.
The duties of these regimental medical officers were varied- holding sick parades, lecturing to the men on the maintenance of health, inspecting feet after route marches, inspecting barracks, kitchens, showers, and latrines, and giving the necessary inoculations.
Camp dental clinics were established in each of the three mobilisation camps, and all dental treatment was carried out at the expense of the Government after the recruits entered camp.
Preventive treatment by way of inoculation and vaccination was carried out. It was decided to immunise the troops in camp against tetanus before sending them overseas. All troops after the First Echelon were given two injections of 1 cc. of toxoid at an interval of six weeks; adrenalin was available in case of anaphylactic shock and the men were kept under observation for three hours.
Two injections of TAB vaccine for protection against typhoid were given at a week's interval. Individual reactions were generally marked and sometimes severe, and the preparation was adjusted so as to obviate very severe reactions. There was some difficulty in obtaining virile strains of organisms in New Zealand, a typhoid bone abscess being utilised at one time.
Vaccination against smallpox was also carried out. The troops of the First Echelon were done on the transports proceeding overseas
With the great development in the use of blood transfusion before the war, it was realised that blood would be freely given to the wounded. In order that the blood group of each soldier would be known in the case of emergency, it was arranged that each man should be blood-typed and the international symbol for his group entered in his paybook and marked on his identity disc.
As a result of a forceful report submitted by the Director-General of Medical Services (Army and Air) through the Adjutant-General to War Cabinet, venereal disease was treated in a sane and reasonable manner. The policy was almost revolutionary compared with the First World War precautions of barbed-wire enclosures and armed guards for such patients. It was at first watched with great misgivings and doubt by some combatant officers. The attitude of the DGMS (Army and Air) was that nothing would be accomplished by treating as criminals those troops who contracted venereal disease, and that too harsh a policy would discourage infected soldiers from reporting early and openly for treatment.
In each of the three main mobilisation camps small isolation hospitals, called contagious disease hospitals, were established, and here patients were admitted and in most cases speedily cured by treatment with sulphonamides. These hospitals were used for both Army and Air Force personnel, while
Primarily, however, in order to reduce manpower wastage, the preventive aspects of venereal disease were emphasised. In all camps preventive ablution huts were established and all troops exposing themselves to infection were encouraged to visit these huts on their return to camp. In addition, preventive ablution centres were provided in the main cities for use by all the services. Attempts were made to trace the women who were sources of infection. The educational approach was also used extensively and medical officers gave lectures to troops on the dangers of promiscuous sexual intercourse. This campaign, combined with plans on a broader basis for keeping men interested in healthy physical and
Early in
In
The Second Echelon was X-rayed in camp, but the operation of the system brought to light some cases of hardship where soldiers had been attested, had left their civilian occupations or sold their businesses, and had then been rejected in camp for tuberculosis. (As a result of the X-ray examination of chests up to
It was later accepted that the X-ray of the chest was really part of the initial medical examination and a responsibility of the Health Department under the civilian medical board system. In
The institution of an X-ray examination for all recruits from the Second Echelon onwards was the means of detecting tubercular cases who might otherwise have been passed as fit, but who would undoubtedly have broken down under active-service conditions. Doubtful cases were referred to specialist chest medical boards for diagnosis and decision regarding grading. Calculations in
The army authorities arranged for lists of all recruits for
At the outset of the war the New Zealand Army Board adopted the revised British Army war rations scale issued in
As regards
At this conference the medical officers were impressed with the obvious interest shown in the medical side by
Every effort was made to educate quartermasters and supply officers on the importance of modern diet standards and food values. On
The aperitif or psychological value, for which the cook and unit quartermaster were jointly responsible.
The nutritional value, for which the supply officer, the quartermaster, and the medical officer were jointly responsible.
The economic value, for which the supply officer and the purchasing board were jointly responsible.
Great interest was shown by all officers, and the practical result was a great improvement in the diet as regards food value and variety. Copies of menus were furnished regularly to the Director-General of Medical Services for his appreciation or criticism.
In
Although the DGMS on
It must be admitted, however, that New Zealand had no medical equipment to send with hospital staffs, nor indeed with the field ambulances, a deplorable state of affairs for which the medical administrators were in no way responsible.
The tentative plans made on limited information by the DGMS on 8 October stated that ‘it may be necessary to have two small general hospitals, but this is a consideration which can and will be dealt with after the New Zealand Force arrives at the area of operations’. It was considered necessary to have a convalescent depot but not a casualty clearing station.
Following more definite information the DGMS was able, on
The medical units called up with other units of the First Echelon for entry into mobilisation camps in
The officer appointed to command 4 Field Ambulance at
Training consisted in instruction in first aid, the system of evacuation of casualties, the work of stretcher-bearers, clerical and nursing duties at advanced and main dressing stations, the recording of casualties, field cooking, and in hygiene methods used on field service. By the time final leave came in the last two weeks of December the original group had become an efficient unit.
In the advance party which left New Zealand on Awatea were two men of 4 Field Ambulance, and they were joined in Dunera. At Wellington other Medical Corps personnel, comprising Colonel K.
The regimental medical officers and nursing sisters were split up among the transports and were able to establish small ships' hospitals to attend to any sickness cases during the voyage. The convoy sailed on
To form the field medical unit for the Second Echelon the officers and NCOs of 5 Field Ambulance, under Lieutenant-Colonel Aquitania on 1 May. The strength of the unit, including attached personnel, was 14 officers and 230 other ranks.
As planned, a general hospital staff was called up with the Second Echelon. The first members of 1 General Hospital began to assemble at
Embarkation on the Empress of Britain took place on the night of 1 May at
The staff of Empress of Japan. Its strength was 5 officers and 49 other ranks.
On
The Commanding Officer of 6 Field Ambulance, Lieutenant-Colonel Bull, entered camp at
With a total strength of 234, the unit embarked with other units of the Third Echelon at Orcades. Other ships embarking troops at
Officers and prospective NCOs for 2 General Hospital entered
Embarkation on the Mauretania took place at
After tentative plans made earlier in
The Nieuw Amsterdam with the third section of the
After the departure of 3 General Hospital no further medical units were formed in New Zealand to extend the medical services of
Medical reinforcements from New Zealand proceeded overseas with each general reinforcement and also on HS Maunganui.
Of the six transports selected to convey the First Echelon overseas, five were passenger liners and one a regular army troopship. The liners were the Orion, Strathaird, Empress of Canada, Rangitata, and
On all transports the health of the troops throughout the voyage was good. Each troopship carried at least one medical officer, three
Seven major operations were performed on the Sobieski—five of them for removal of appendix. On the
Ships' hospitals, although considered small should any epidemics have occurred, were sufficient for the voyage. The most common illnesses experienced on board were tonsillitis, mild influenza, measles, and diarrhoea. Preventive ablution centres were established at ports of call, regular medical inspections of troops were carried out, and some cases of venereal disease treated. In addition, medical officers gave frequent lectures on health precautions in the tropics, personal hygiene, and on conditions in
An epidemic of acute diarrhoea of unknown causation occurred on the Dunera. An interesting feature on this ship was the apparatus for manufacturing ‘eusol’ in bulk from sea-water by electrolysis. This solution was used for the daily scrubbing of troop-decks, mess tables, latrines, etc.
Shortages of medical equipment, particularly of instruments necessary for a major surgical operation, were frequently commented on in voyage reports from each transport, but no serious difficulty ever arose. The chief needs included drugs, nursing equipment, sterilisers, and surgical instruments; stretchers, splints, and bandages were also needed for training hospital staffs, and additional fittings were required in ships' hospitals.
Ventilation on the transports suffered, particularly at night, because of the necessity of keeping hatches and portholes closed and doors opening on to the decks covered with heavy blackout curtains. With natural ventilation thus reduced to a minimum, temperatures below decks at night were high, those taken at midnight on one occasion on the Sobieski ranging from 90 to 93 degrees Fahrenheit. Recommendations were made by the medical officer of this ship that hatches should be partially removed at nights and protective devices erected to comply with the blackout; also that screens should be built outside all doors leading on to decks to allow them to be left open at nights without the danger of lights showing.
The convoy reached
The ships which conveyed the Second Echelon overseas were the Empress of Britain, Aquitania, Empress of Japan, and
As with the First Echelon, medical officers, nursing sisters, and orderlies were posted to each ship to staff ships' hospitals and give medical treatment. The wearing of rubber-soled tennis shoes on transports was a source of trouble, just as it had been with the previous echelon. The medical officers of the First Echelon had recommended sandals but the Defence Purchase Division, on the score of cost, and also because of the lack of suitable leather, decided against any change. Leather sandals were issued for use on shipboard from
Ship's hospital accommodation proved adequate on all ships in spite of upper respiratory infection, common in the camps in New Zealand, being prevalent aboard. Among these cases a gradual progressive increase in severity was noted and the onset of broncho-pneumonia was not unusual. The isolation hospitals for treatment of venereal disease also had a small number of patients. German measles broke out on some of the ships, its incubation period corresponding with infection arising at
Medical supplies generally were adequate, although demands for particular drugs called for their replenishment at Empress of Britain were found to be useless, the tins being obviously many years old. Medical equipment was incomplete in important details, but medical officers were able to remedy the deficiencies from their personal instruments.
As the convoy drew near to Great Britain in
The Third Echelon embarked for the Mauretania, Empress of Japan, and
The medical arrangements for the Third Echelon were similar to those of the two preceding echelons. Influenza, measles, and mumps were the main causes of hospitalisation but in no case was the incidence serious. The medical officers on the transports were united in their recommendations that inoculations and vaccinations should be completed prior to embarkation. Where the troops were accommodated in hammocks their sore arms caused great discomfort and severe vaccine reactions were suffered by numbers of troops in the tropics.
At Ormonde. The troops who were disembarked found themselves submitted to considerable inconvenience and trying conditions in
In Egypt the first tasks for the Medical Corps were the planning of hygiene services to ensure good health among the New Zealand troops in a country totally different from New Zealand, and the provision of hospital services for the sickness and accident cases bound to arise in the best of conditions among any large body of men. For this important work there was sent overseas with the First Echelon an Assistant Director of Medical Services, This appointment of ADMS NZ Division was changed to
Colonel MacCormick arrived in
The planning of the medical arrangements for the overseas force was partly carried out in New Zealand.
On arrival, the ADMS found that the site chosen for the Base Camp was in the desert east of
The New Zealand troops came under command of HQ BTE (British Troops in
Already preparations were well ahead, and British and Indian engineers employing Egyptian labour had laid out the camp. Seven miles of tarmac road, six miles of water mains, and more than four miles of drains had been laid down. More than 150 huts had been built to provide cookhouses, messrooms, canteens, and shower-houses, though all the huts were not completed. Colonel MacCormick reported that the camp was only half finished when the troops arrived, and that, under these conditions, it was impossible to carry out fully many of the necessary health precautions. Accommodation for personnel was provided in tents, which were very difficult to erect because of the hard ground. The troops, wearing serge on disembarkation, arrived at
Shortly after the echelon arrived the ADMS gave a lecture to the commanding officers and the medical officers on important aspects of hygiene, disease, and sanitation. He pointed out the necessity for taking every health precaution because of the very low standard
The camp water supply came from the
As an added health precaution, in April the Hygiene Section emptied, cleaned, sterilised, and refilled the reservoirs at
The construction of a large swimming bath on the outskirts of the town of
A high incidence of infection of the nasal sinuses and of the ears was present in the force during the North African campaign, and the swimming bath was held responsible for many of the cases. Tests showed that, although the water in the bath was changed daily, there was a high bacterial count in samples taken towards the evening. The bath water was therefore chlorinated from
Efforts were made at different periods to ensure that all troops were taught swimming. There can be no doubt that the bath contributed much to the health and happiness of the men.
Shower-houses with concrete floors were constructed in the different areas of the camp. At first only cold water was available, but later arrangements were made for the supply of a limited amount of hot water, especially in the colder weather. The cleansing of the floor boards with antiseptics to prevent the spread of tinea was regularly carried out.
In each unit area water was piped to wooden stands for ablutions. Washing of clothes was also carried out here, but it was found necessary to prohibit this owing to the added demands on the water supply and drainage systems.
A camp laundry was built capable of dealing with the clothing of a thousand men a day and a contract made with an Egyptian to operate the laundry. Operations commenced within nine days of the
Each unit was able to arrange for washing twice a week and lists were carefully drawn up and checked, each man's garments being indelibly marked with name and number. The contractor was held responsible for losses and damage. The laundry was available to officers at a small charge, but private laundries in
Medical instructions given prominence in early unit routine orders for this period included the prohibition, because of bilharzia, of bathing in the
Careful thought was given to the determination of a suitable ration for the troops in See Appendix A to this chapter.
Alterations in the basic ration were made from time to time so as to substitute local products for overseas supplies and thus save valuable shipping space. This especially referred to meat, eggs, fish, vegetables, and fruit.
When operating away from the base camps the troops were put on a field ration and the penny-a-day supplementation was discontinued. Special provision was made for such items as dried fruits, ground nuts, boiled sweets, chocolate, and tinned fish, and ascorbic acid tablets, marmite, and cocoa were added.
The danger of infection from food obtained from civilian sources was stressed before the troops landed in See Appendix B to this chapter.
Most fresh food was cooked and eaten within twenty-four hours and when kept in the cookhouses was protected by wire netting or muslin shields. In the cookhouses a special room was set aside for meat. Storerooms were provided with safes for such articles as butter, jam, and milk and also for vegetables. The type of building erected for cookhouses and the material used made it almost impossible to keep them completely free of flies.
The importance of good cooking was not overlooked. Cooks chosen for the First Echelon were given courses of training at the
Precautions were taken to see that no man who had suffered from typhoid, dysentery, or cholera or who was suffering from venereal disease should be employed in the cookhouse or handle food. Cooks were supplied with three sets of white uniforms and facilities for washing and disinfecting the hands. Smoking in the cookhouses was prohibited, as was sleeping and the keeping of clothing in mess kitchens and storerooms.
At first, when infections such as dysentery and typhoid were prevalent in the camp, all personnel, army or native, handling food were suspected of being carriers. Laboratory examinations of the stools were carried out regularly when such conditions arose, and any cook found to be a carrier was promptly given other duties.
Basins of disinfectant (1 per cent cresol) were provided at the entrance to the messrooms for all ranks to dip their hands in before entering. After the meal all mess utensils had to be washed in clean soapy water and then boiled in special stoves and stored in fly-proof containers in the messrooms. Objection was raised by quartermasters that cutlery and utensils were an individual issue and signed for by the men. This, however, was overridden as it was held to be useless to sterilise dishes and then permit men to carry them in pockets or haversacks and leave them about the tents. Nevertheless, this ideal arrangement did not last very long; mess utensils reverted to an individual issue and remained so, while washing facilities provided by mess fatigues were seldom adequate for the number of men at each mess.
Troops were warned against taking any of the cool drinks supplied by the Egyptians. The native beer was also not to be trusted,
The ice-creams sold in
Flies were one of the plagues of
The 4th Field Hygiene Section caught in
Bedbugs made their appearance, too, during
The hard, stony condition of the ground made the use of trench latrines impossible. Bucket latrines were therefore instituted and were available when the First Echelon arrived in
At first troughs were used leading to open shallow pits, but this proved unsatisfactory as splashing occurred and the ground did not lend itself to proper soakage. Buckets were then introduced, and these were emptied and the urine carted away and disposed of well beyond the camp area.
Arrangements were made for the collection of all rubbish throughout the camp by contractors. The rubbish was carted by lorries, tarpaulins being used to cover it during transit, outside the camp and either buried or burnt as already described. A considerable amount had to be collected at the beginning throughout the camp area, especially in the quarries.
Four drums were provided at the cookhouses for kitchen refuse. They were placed on stands like a milkcan stand so that they could be readily dealt with by the conservancy contractors. In one drum was placed dry refuse such as ashes and bottles. In another were
Contracts were let for the purchase of kitchen scraps and fats. Bins with lids were provided at each mess for their collection. One drum was used for meat scraps but not bacon (because of the Moslem ban), and one was used for dry bread. A tin was also provided for fat. The bins were emptied three times a day and cleanliness insisted on. The money obtained was utilised to purchase extras for the men's mess.
The hard, stony, impermeable nature of the ground made it very difficult to carry out efficient drainage and ordinary pits proved quite inefficient. The sullage water had eventually to be piped through cement pipes from the cookhouses and washing stands to the perimeter of the camp, where large evaporating pans, sixty feet square, in sets of four, were constructed. Two pans were flooded with water to a depth of six inches after it had passed through large grease traps. Evaporation was complete in twenty-four hours, when the other two pans were used. The dried deposit was scraped out and sent to the incinerator. Later, the pans were used to grow eucalyptus trees and crops of cabbages, tomatoes, maize, etc., and the little grease passing through the large grease trap was dealt with by digging in frequently to prevent fly breeding. The grease traps were cleaned out every week, the layer of surface grease being removed daily.
The Egyptian labourers, of whom there were two thousand employed during the first year, proved a constant trouble as regards sanitation. They had polluted the whole camp area before the troops arrived and it took one hundred labourers two months to clean up the excreta. Then followed a long-drawn-out fight to persuade the natives to use the bucket latrines provided for them and to keep them clean.
Very large numbers of Egyptian labourers continued to be employed in the camps under the engineers in making roads, building huts, shower-houses, and latrines, on the staffs of
Regulations were drawn up to ensure the cleanliness of these shops and the apparatus used by the Egyptian barbers. They were required to wash their hands before attending to each customer and to provide clean covers and towels. Hair and shaving brushes had to be washed and soaked in 5 per cent dettol or carbolic solution for an hour each time they were used, and combs, scissors, and hair clippers had to be cleaned and soaked in 5 per cent dettol for ten minutes.
Medical arrangements in respect to sickness and accidents were put into operation immediately upon the arrival of the First Echelon. Fourth Field Ambulance established in HP ? hospital pattern; GS ? general service; RD ? ridge double.
More seriously ill patients were transferred to 2/10 British General Hospital at
It was soon felt that the New Zealand Medical Corps in
Successive detachments from 4 Field Ambulance underwent tours of duty at 2/10 British General Hospital and their training syllabi covered nursing, operating-theatre practice, radiology, massage, dispensing, laboratory, medical stores, administrative and general duties. The knowledge then gained was invaluable to our force, at that time inexperienced in military hospital administration, and later the staffs of our hospitals were also to benefit from the experience passed on to them.
Medical officers of 4 Field Ambulance proceeded to and from tours of duty as regimental medical officers to the various combatant units in training in
Discussions between Colonel Bowerbank and Colonel MacCormick before the departure of the latter for the
The Government's decision in the matter of medical services was announced by the Minister of Defence on
In Egypt the ADMS NZ Division (Colonel MacCormick) found difficulty in securing separate hospital accommodation and reported the matter to
It was arranged with
Three general hospitals, of considerably greater bed strength, were necessary in the First World War, and all these considerations, together with the fact that smaller units have a greater tactical mobility in all circumstances, converted ADMS NZ Division to this plan. He reported to the DGMS in New Zealand that the change of plan involved an increase of approximately 20 per cent in both personnel and equipment, though some saving could be effected as the third general hospital could remain on call in New Zealand. A recommendation to this effect was therefore made to the DGMS on
When endeavours were made to secure a location for a 600-bed general hospital, no site other than the Grand Hotel,
Negotiations for the hire of the Grand Hotel,
By the end of June the hotel building was nearly ready for occupation by medical cases but the contract for the building of an operating-theatre block had not then been let. The medical equipment for a 600-bed hospital had reached
The
At this time Aquitania and come from
No. 4 NZ General Hospital (with most of its staff drawn from 4 Field Ambulance) opened as a 300-bed hospital at the Grand Hotel,
The medical staff of 4 NZ General Hospital comprised Major Button, Officer Commanding and Senior Surgeon, Captain
The nursing staff comprised Miss
In the advance party of male staff there were 20 men of 4 Field Ambulance from 2/10 General Hospital, 7 men from 4 Field Ambulance,
Ordnance stores for a 300-bed hospital and medical stores for a 600-bed hospital were unpacked by the advance party, which also prepared living accommodation for the staff and got ready to receive patients. By 31 July the hospital had 188 beds equipped for the reception of medical, minor surgical, and convalescent patients. On the afternoon of that day 82 patients were smoothly transferred by 4 Field Ambulance from 2/10 General Hospital at
The medical arrangements for
Medical cases and minor surgical cases were admitted to 4 NZ General Hospital.
Cases requiring major surgical operation were admitted to 2/10 General Hospital pending the completion of the operating block at
Cases of venereal disease were admitted to 4 Field Ambulance (Camp) Hospital,
Infectious diseases cases were admitted to 4 Field Ambulance (Camp) Hospital,
Mental cases were retained at 2/10 General Hospital, but were to be transferred to 4 General Hospital as soon as suitable provision had been made for them.
A very complete passive air defence scheme was drawn up for 4 General Hospital in the event of enemy air attack.
As the number of occupied beds increased, the shortage of nursing staff, both sisters and nursing orderlies, became most apparent. Instead of the regular establishment of a 300-bed hospital, there was
The medical officers were accommodated in Dr Moore's house and the sisters in M. Chalom's villa, while the men were quartered first in Villa Gubalieh and then in the Winter Palace Hotel. The Grand Hotel was a building of several stories, and work was early commenced on the installation of a lift to obviate the need to carry bed patients up and down stairs.
By 11 August an emergency operating theatre was equipped and ready for use pending the construction of a permanent theatre block. All types of emergency surgery were possible except where X-ray control was necessary, e.g., in compound fractures. The admission of all New Zealand surgical patients, other than those requiring X-ray, was arranged from this date. On the two subsequent days the remaining patients and four New Zealand sisters were transferred from 2/10 General Hospital to 4 NZ General Hospital. Although the transfer of these four sisters gave a certain relief to the overworked nursing staff, such was the increase in the amount of work that six members of the TANS Territorial Queen Alexandra's Imperial Military Nursing Service.
The opening of the
On 26 August the first evacuation of invalids to New Zealand
Karapara. Of these, thirteen were patients of 4 General Hospital. There were also other patients boarded for return to New Zealand but they had to remain at the hospital in the meantime. Certain difficulties arose in connection with the despatch of the draft and on this account, as well as in anticipation of increased numbers of invalids after the arrival of the Second and Third Echelons, it was decided to cable Army Headquarters in New Zealand asking that the fitting of New Zealand's own hospital ship be accelerated. In the meantime the possibility of being able to share Australian hospital ship accommodation was investigated. The Australian authorities were quite agreeable to assist and did so by embarking fifty New Zealand invalids on their hospital ship Manunda in November.
Lieutenant-Colonel Kenrick became commanding officer of the
Twelve sisters, five medical officers, and thirty men from New Zealand medical units of the Second Echelon in
The arrival of 2 General Hospital in
The GOC visited 4 General Hospital on 28 September prior to its relief and issued a special order following his visit. It read:
With the arrival of further personnel the medical units of the
The eighteen sisters of the First Echelon became part of the staff of 2 General Hospital, with Miss Brown as matron and Miss Chisholm,
The defence of Egypt in
The shortage of medical equipment and supplies in
British operations against the
The already-prepared passive air defence (PAD) scheme for
On 18 June New Zealand units comprising 18 Battalion, 19 Battalion,
Arrangements were made for the sick—and possible wounded—to be evacuated to 2/5 British CCS at
On 24 and 25 June the acting ADMS NZ Division, Lieutenant-Colonel Kenrick, made a tour of inspection of the area and conferred with Colonel F. G. Smythe, ADMS
Equipment to enable 4 Field Ambulance to function as a mobile field ambulance was not received until
During the next few months more units of 4 Brigade Group moved up into the desert for the defence of the
The role of
From
No ambulance trains were at first available. A temporary arrangement was made for an ambulance coach to run daily with the
The possibilities of evacuating casualties by air were explored by ADMS
On 13 September the Italian forces pressed their advance beyond the frontier of
Members of 4 Field Ambulance, especially A Company, were given training under mobile conditions with battalions of the brigade group, in view of the apparent imminence of extensive offensive action. During October the unit, which was nearly forty under strength, evacuated 634 patients sick and wounded—mostly sick. Of this total 289 were New Zealand troops and 345 British. In addition, many patients were detained under treatment and, on recovery, were discharged directly back to their units.
During this period in the desert opportunity was taken by 4 Field Ambulance to view the arrangements in the field made by ambulance units of
It was realised that several additions to equipment would be necessary because of the changed functions of a field ambulance in mobile warfare in the desert. The unit's equipment scale was designed to meet those conditions met in
As a result tarpaulins were provided for 4 Field Ambulance and became standard equipment. They were used with a truck, such as the operating truck, as the principal support for the tarpaulin, one side of which was spread over the vehicle and the other sides pinned to the ground. Poles inside the tarpaulin raised it sufficiently high off the ground to provide coverage for twenty to thirty stretchers. The open end of the truck faced inwards so that the equipment was easily available for use inside the marquee-like structure. Such a structure could be erected in a few minutes.
Lessons learned in a training exercise in
On 7 November 4 Field Ambulance was relieved of all British patients, who were transferred to 215 Field Ambulance which had now opened up in the neighbourhood. The hospital work of the unit was thus cut by half. On the night of 18–19 October 4 Field Ambulance was bombed by enemy aircraft and the ASC drivers attached suffered four casualties—one killed and three wounded, one of whom subsequently died of wounds.
Lack of water constituted probably the greatest problem of desert warfare. In the coastal area the presence of salt as well as fresh water underground made it useless to sink wells. The main source of water for the force was by water train from
There was a further difficulty of distribution to forward and dispersed troops, for whom insufficient water carts and containers
The ration scale in the
Flies were bad in some places at first, but were not troublesome where an anti-fly campaign was pursued with vigour. In all places except temporary bivouacs and certain water-bearing areas, the deep-trench latrine was the approved pattern.
On 9 December British and Indian troops and elements of 6 Australian Division commenced operations against the Italian forward positions with marked success. Adjacent British ambulance units moved forward to establish ADSs to deal with the wounded, leaving 4 Field Ambulance stationary as an MDS to continue its function of the previous three months. No New Zealand combatant units took part in the offensive. The diversion of the Second Echelon (5 Infantry Brigade Group) to the
However, 4 NZ Reserve MT Company (to which Lieutenant
On 9 December, immediately following the capture of
The ADS staff consisted of two Indian captains, an Indian second-lieutenant (assistant surgeon), and Lieutenant Lomas. The two captains did the work of organising the reception of casualties and providing blankets, medical comforts, etc., for the wounded, whilst Lomas and the assistant surgeon attended to the wounded. They worked steadily for twelve hours until 2.30 a.m. on 10 December and commenced work again at dawn, continuing throughout that day. The MDS and MAC did not arrive until evening.
Every type of injury passed through the surgeons' hands in this period. Several limb amputations were necessary; there were about five cases of fractured skulls with herniation of the brain, and many with chest and abdominal wounds. The casualties were British, Indian, Italian, and Libyan. Casualties from 11 and 16 Brigades also arrived at 5 Brigade ADS, as they had trouble in finding their own ADSs. For his part in the action Lieutenant Lomas was awarded the Military Cross—the first award to the New Zealand Medical Corps in the war.
The main attack on
Fourth Field Ambulance was called upon to deal with only a few bomb casualties beyond the usual sickness cases. During December 202 New Zealand, 97 British, and 9 Australian cases were evacuated. In the last week of December the unit ceased to function as a reception and evacuation centre, and prepared for the move by road to the divisional base camp recently established at
On 17 November Colonel G. W. B. James, Consultant Psychiatrist, BTE, visited 4 Field Ambulance and with medical officers discussed the question of the prevalence of neurosis in the forward areas. General opinion indicated that the incidence was very small, at least in New Zealand troops, but it was suggested that any such cases should be treated with sedatives and held in the forward medical unit rather than be evacuated to a general hospital, where the complex increased, thereby making it much more difficult to return the men to their units.
In the campaign in December it had been possible for the commanding officer 4 Field Ambulance, Maheno, 1917–19; RMO 2 Div Cav Sep 1939–Sep 1940; CO
The holding of many more cases than previously planned.
The performance of major surgery as required.
The attachment of additional surgeons.
An electric lighting set for theatre work.
Use of walking wounded as blood donors.
Improvement of arrangements for clerical recording at the admission and discharge of patients.
When 4 Field Ambulance concluded its first period of four months in the field under active-service conditions, valuable experience had been gained in hospital work and field training, and the unit felt confident that it could undertake any role in field ambulance work.
The movement of 4 Brigade Group to the
In August the acting ADMS NZ Division, Lieutenant-Colonel Kenrick, drew attention to the fact that it was impossible for one man to carry out satisfactorily the duties of ADMS with the force in the field, and at the same time cope with such important base duties as the establishment of hospitals and convalescent depots. When Colonel MacCormick returned from his duties with the Second Echelon in
It was decided that there should be a
The DADMS NZ Division, Major Tennent, continued to assist the ADMS until appointed to command
The
In
It became obvious in September, after the departure of 4 Field Ambulance from
The 1st NZ Camp Hospital was therefore formed as a unit of
The inspection of hygiene and sanitation arrangements of
It then became an urgent matter to form a
The finding of a suitable location for
The advance party of 1 General Hospital, which had been working at
Huts were made from rather flimsy shelters formerly used as stables by British garrison troops. These were constructed of rush walls at the back and on either side and had a flat roof, the front being open. The walls inside and the ceilings were plastered and the floors concreted. An area in the middle of the open front was bricked up to form a duty room and kitchen, leaving a wide entrance door on either side. A protective wall of mud bricks 4 feet high was then built outside the huts. The absence of rain and the extreme heat
Drainage presented a difficulty. This was solved by digging down to 12 feet below ground level, where a porous sand sub-stratum was encountered. A sump of this depth had to be provided for each ward for the disposal of water used for washing patients. Dish water had to be disposed of through a separate drainage system.
The equipment for the hospital began to arrive on 23 November. The ordnance equipment had suffered considerably by damage and loss in handling on the voyage from
Construction work was still in progress when instructions were received on 13 December to prepare to admit patients. Casualties from the offensive in
By the end of
In one period of ten days 300 patients, mostly Australian, were admitted, and the total in hospital reached 376 on 31 January. During February there were 241 patients admitted. On 24 February orders were received for the hospital to be cleared. All patients were discharged or transferred in two days and all equipment packed and loaded on a train in three days. The unit had been chosen to proceed with New Zealand troops across the
When 2 General Hospital took over from 4 General Hospital on 8 October there were 472 equipped beds and 448 patients. During the following week two more wards were opened up, bringing the
The number of patients rose to a peak of 586 on 1 November, but the bed state fell steadily to 458 at the end of the month with an easing of tension for all departments. Most of the construction work in the hospital was then finished and the staff had become accustomed to hospital routine. Admissions for the month totalled 825 and discharges 863.
It was not until December that the theatre block was functioning. This block was well designed and of ample size to cope with all the work offering, though all the surgical work was concentrated at
The sanitary arrangements of the Grand Hotel building were quite unsuited to cope with a large number of hospital patients. Soakage and cess-pits were in use, some of them under part of the buildings, and these became overfull, offensive, and a danger to health. A new drainage system was put in and the drainage from the wards piped into a septic tank, and the effluent taken out into the desert three-quarters of a mile from the hospital. Two wards used for intestinal cases were still drained into larger cesspits to enable disinfectants to be used. Thereafter sanitary conditions were quite satisfactory.
In December, following the offensive in the
In January large convoys of patients arrived following the battles of both
By March the rush of the work consequent on the January convoys had slackened to a marked extent, added to which the hospital was serving only New Zealand troops; and, of these, the majority were on their way to
The casualties from other forces admitted from the First Libyan Campaign and
Of other surgical admissions, accidental injuries were relatively common both from road accidents and from games, especially football. Orthopaedic conditions of a minor nature were not uncommon, many being pre-war disabilities such as old osteomyelitic infections of the lower limb which were prone to break down in
After their arrival from
On
The unit was slow in attaining a reasonable standard of efficiency. A change of commanding officers took place in
In the running of a convalescent depot there were certain features that could be learnt only by experience, as it was a bridge between purely medical units and the training or divisional units. Although commanded by medical officers, the
Medical stores unloaded from the First Echelon transports were taken in charge and stored by Ordnance. In
During
In
In
In a) The checking of indents for medical supplies; (b) the maintenance of medical supplies for all camp units and medical inspection rooms; (c) the periodic inspection of medical equipment for all units; (d) the storage, care, and issue, on approval of e) the return to New Zealand of medical equipment placed on transports for the voyage to the f) such other duties as were delegated by the
In
The New Zealand
The unit took control of, and accounted for, surgical and medical equipment drawn from normal army sources, extra items purchased by the New Zealand Government for use by New Zealand medical units, a special donation of surgical equipment by Mr (later Sir) Arthur Sims, and some captured enemy material.
The chief advantages of having a New Zealand Depot of Medical Stores were:
Quickness of supply. This was an important factor in the case of units coming back to base areas for re-equipping.
Power for local purchase of any required surgical instrument not available from Army sources.
Training in Army accounting given medical quartermasters while on the staff of the unit.
The ease with which hospital ships could be re-equipped.
The ease with which new RAPs could be established for small out-of-the-way units.
Provision of a service for repair and replating of instruments. The depot had many instruments replated in
The important link given the DMS
The Third Echelon had arrived in
When
During February there were more than 10,000 New Zealand troops in
Fourth Field Ambulance and 6 Field Ambulance carried on with advanced training at the camp, with special reference to desert warfare, but were ready to go to
All medical units were short of staff until the arrival of the first and second sections of the
The type of men for medical units sent forward with the
(Note: Later medical reinforcements were all found to be up to the required standard, although the Medical Corps was required to board a number of men of each group of reinforcements for other units soon after their arrival in the
In his report of
The climatic conditions experienced at the base camps in
It became necessary in the summer to cease active training in the afternoon and have a rest period. Temperatures up to 116 degrees F. in the shade were registered in June and over 110 degrees often in following summers. Fortunately, it was a dry heat and little harm was done except for some loss of weight and general debility. Heat exhaustion was uncommon and when it occurred was due largely to the loss of salt associated with excessive sweating. Drinks of salted water, flavoured with lime or lemon, were used as preventatives. It was found that head covering was relatively unimportant and topees quite unnecessary. Sunburn, also, did not occur away from the seaside. Excessive sweating was inevitable and thus skin diseases, especially seborrhoea, were prevalent; the feet were especially affected.
The light drill clothing, with shorts and shirts the normal summer uniform, proved very satisfactory. In the winter months battle dress was worn and the cold nights made extra blankets necessary.
Rain was practically unknown in
Climatic conditions in the
The troops of the First Echelon arrived in
Epidemic diseases of the common types experienced in New Zealand did not occur in the troops in
Pneumonia, which had been dreaded owing to its marked prevalence and high mortality in
Many cases thought to be sandfly fever occurred, though very few phlebotomus sandflies were seen in the base camp.
There was a steady increase in the daily average of hospital cases from 97 in February to 178 in March and 276 in April, but at the end of May there were only 242. Nasal and antral infections and cases of otitis media and externa were common and the baths were thought to be largely responsible. Contrary to expectations,
During July there was an increase of hospital admissions to 557 following the employment of units in the
In August there was an improvement in health with only 462 admissions to hospital. Intestinal infection was less common as the troops became seasoned. Flies had become fewer in
The incidence of sickness was remarkably low throughout
Dysentery constituted much the commonest disease in the early months and was associated at times with serious illness. There were three deaths reported, one being definitely due to Shiga infection. Altogether, 500 cases were admitted to hospital from February to November 1940, and the types of infection were: Flexner, 22·4 per cent; Shiga 4·5 per cent; Schmitz 1·4 per cent; Sonne 0·4 per cent; amoebic 2·0 per cent; bacillary exudate 38·4 per cent; and indefinite exudate 30·9 per cent. There was no difference in symptoms between those showing definite bacteriological evidence of infection and those with no such evidence. It was thought that all the cases were due
Experience during the First World War had shown that venereal disease was widespread and of a virulent type in
In
A contagious diseases section of the camp hospital at
The campaign against venereal disease proved successful as the incidence of disease among the troops was relatively low. There were 33 cases in April, and at the end of June there were only 18 cases in hospital. The cases of gonorrhoea had responded readily to the sulphonamide treatment, and patients were soon returned to their units.
In July the cases increased to 39 and again in August to 47. The troops then proceeded to the
By the end of
The diagnosis of disease was fully confirmed before treatment was commenced, especially in the case of syphilis where dark-ground examination and Wassermann or Kahn tests were carried out. As regards gonorrhoea, stained slides were examined. The treatment carried out for syphilis was a minimum of four courses of weekly injections for ten weeks of 0·6 gm. of neoarsphenamine and 0·2 gm. of bismuth. There was an interval of one month between courses during which a repeat blood test was made.
The treatment of gonorrhoea was by means of the sulphonamides. Sulphapyridine was the drug given at that period and it produced very good results but was somewhat toxic. The greater number of the patients were rapidly and satisfactorily cured. In the resistant cases antiseptic irrigations and instillations were carried out, and shock
The rapid and efficient cure of gonorrhoea and soft sore, and the satisfactory treatment and control of syphilis, made the problem of venereal disease relatively unimportant compared to the serious wastage and virulent disease experienced by our New Zealand troops in
In the early period of the 1914–18 War in
A medical inspection was carried out as a unit parade once a month. Foot inspections were carried out by the medical officer and, when available, also by a chiropodist at regular intervals of about a fortnight. All native employees of the canteens, the laundry, and the bakery were examined monthly, and the general labourers were also examined from time to time.
Injections of tetanus toxoid were given after arrival in
The Second Echelon arrived in
To make all necessary arrangements for the arrival of the Second Echelon in the
The Director-General of the Army Medical Service, Major-General Sir William MacArthur, had control of only pre-war military hospitals and was unable to help in the matter of hospital location, in spite of his willingness to assist. Sick and wounded were generally dispersed to hospitals of the Emergency Medical Service (EMS). Practically all hospitals in the
Colonel MacCormick interviewed Professor F. R. Fraser, head of the EMS organisation at the Ministry of Health, who gave sympathetic consideration to the desire of the New Zealand Government for New Zealand troops to be, as far as possible, under the medical care of New Zealanders. Professor Fraser directed Dr Murchie, head of the hospital department, to afford all possible assistance in the furtherance of this policy. As a result Pinewood Sanatorium, near Wokingham, some 10 miles from the New Zealand camp in the
Situated in a pine plantation, Pinewood Sanatorium was a
At a conference in
As the New Zealand hospital had no equipment of its own, it was arranged that EMS equipment be used. Food supplies, drugs and dressings, etc., were to be drawn through the sanatorium, and the New Zealand hospital would likewise share the other services of water, gas, electricity, fuel, telephone system, and laundry facilities. The general basis of the financial settlement was that the
There were nine huts, each of which accommodated 36 beds normally and 42 beds in emergency. Each was complete with kitchen, storerooms, baths, lavatories, and heating. There were also a well-appointed theatre and X-ray block, cubicles for 36 nurses, dining and sitting rooms for nurses, and a kitchen block. Some of the wards were at first used for departments of 1 General Hospital, such as the quartermaster's branch, until huts were built for them. Administrative headquarters were improvised in a cottage. The male staff of the hospital was quartered in billets at Edgecumbe Manor, a mile and a quarter away, and the medical officers occupied unfurnished wards until they moved into East Hampstead Cottage some weeks later.
The first step in setting up 1 General Hospital was taken on
Minor epidemics of measles and mumps had developed on the transports on the way to the
A surgical team was called for urgently to help a small emergency hospital to treat severe casualties following an air raid on a large
A party from
In Egypt there was not sufficient personnel to staff the 300-bed hospital which opened on 24 July as 4 General Hospital, so arrangements were made to send reinforcements from
When 5 Infantry Brigade had a mobile role in the south-east of Georgic and arrived at
When inquiries were being made for a convalescent home, Maunganui May–Nov 1942.
During July and August 5 Field Ambulance undertook a series of field exercises in conjunction with 5 Infantry Brigade in its preparation for an operational role in the event of invasion. Particular emphasis was laid on the importance of maintaining contact between the advanced dressing station and the main dressing station. The unit also handled sickness and accident cases occurring in the New Zealand units. After two months in
September was the month of the
It had originally been intended that the Second Echelon should have been relieved of its operational role on 13 September, pending its embarkation for the
The postponement was not intended to be longer than would permit of the brigade leaving for the
Under arrangements with
Two ADSs and an MDS were established to treat these less serious cases. Besides taking patients back to the CCS or to hospital, the unit returned patients from hospital or, when required, transferred them to the Convalescent Home.
During September and October 186 patients suffering from various injuries, many of them due to football, were admitted to 5 Field Ambulance. A common cause of admission was respiratory disorders, for which during the two months 104 patients were treated, including 79 with only minor influenzal infections. The total number of cases evacuated by the ambulance beyond unit RAPs was 617. Most of the patients evacuated beyond 5 Field Ambulance were admitted to British military hospitals in the area. Infectious and venereal cases were sent to special hospitals and convalescents to
Colonel MacCormick had returned to the
The New Zealand force returned to
A total of 67 cases was admitted to hospital in November, while
The three camp reception hospitals staffed by 5 Field Ambulance were closed on
On the night of 1–2 January 1941 units of the New Zealand formation in Athlone Castle on 3 January at Liverpool, while Headquarters and A Companies, under
On 12 January the convoy proceeded to sea from Belfast Loch in the early morning, heading west in a zigzag course and then south. All ranks slept in their clothes in the danger zone and wore steel helmets and lifebelts while on deck. By 17 January permission was given for the removal of clothes at night. The hospital accommodation on the ships was taxed by the numbers of influenza patients, and nursing orderlies from the field ambulance companies were attached to their respective ship's hospital for duty. When influenza abated there was a mild epidemic of measles on board the Duchess of Bedford.
The voyage to
After the outbreak of war in
Places were kept for three of those on the active list in the establishment of 1 General Hospital, and they were sent to join the unit in
Many young medical graduates studying in
Before entering messrooms for any meals, all ranks will disinfect hands in cresol solution, in special basins provided.
All messing utensils must be washed in clean soapy water and then boiled in special apparatus provided. To prevent rusting of tin plates, a level teaspoon of washing soda should be put into the tub at each boiling. All dishes and cutlery must be stored in messrooms in fly-proof containers. Unused portions of sugar, butter, jam, etc., must be stored in fly-proof receptacles promptly after meals.
Medical Fitness for Employment: No one will be employed in the cookhouse, or in the handling of food, who has suffered from enteric fever, dysentery, typhoid, or cholera, or who is suffering from, or is under treatment
Cooks' Clothing: Each cook and man employed handling food will be provided with at least three sets of washable white uniforms. These should always be worn when at work, kept as clean as possible, and changed when dirty.
Cleanliness of Hands: A hand basin, soap, and a nailbrush will always be available for the use of cooks. There will also be provided a basin of cresol solution for the frequent disinfection of the hands.
Clothing: No personal clothing or private property of men employed in cookhouses will be kept there. A proper place is provided for hanging jackets, hats, etc., at entrance to cookhouses.
Smoking in Cookhouses: Smoking in cookhouses is forbidden.
No personnel will sleep in mess kitchens or storerooms.
Only efficient and conscientious men must be employed as cooks and mess orderlies. The latter should be inspected by RMOs before going on duty, should remain on duty for seven days, and be relieved in relays.
Cleanliness of Pots and Pans: Pots and pans will be cleaned and dried immediately after use.
General Cleanliness of the Cookhouses and Utensils: The cookhouses, sinks, chopping blocks, cutting-up boards, pastry slabs, mincing machines, knives, forks, spoons, and other utensils will be kept as clean as possible when in use and will be thoroughly cleaned after the last meal of the day. All utensils when not in use will be kept in places allotted to them and will be available for inspection at any time. No accumulation of old rags, tins, etc., will be allowed in drawers or elsewhere in the cookhouses.
Care and Preparation of Food: Only food which is in the process of cooking will be kept in the cookhouse. Food for the current day's use only should be kept in the preparation rooms, and must be protected from flies.
All meat and other perishable foodstuffs must be consumed within twenty-four hours of issue. An exception is made in the case of meat treated in brine tubs, but in this case it must be eaten within twenty-four hours of cooking.
Tinned goods should be opened immediately prior to consumption. Tins should be closely inspected prior to opening.
Preparation of Vegetables: Vegetables will not be prepared in the same sink in which pots and pans are cleaned.
Food Scraps: Food scraps, vegetable peelings, etc., will not be thrown on the floor but deposited in a covered refuse bin provided for the purpose. In order to prevent used tea leaves being processed for incorporation in tea to be marketed, units will ensure that used tea leaves are burnt in their own fires.
To prevent unsatisfactory functioning of sumps, the following instructions must be strictly adhered to:
On no account will any water, dirty or clean, reach the sumps, except through the grease traps provided.
No refuse of any description will be thrown into the sumps.
Standpipes will be used for the drawing of water only. No washing of plates, hands, etc., will be carried out at the standpipes.
Economy of water at sumps is essential to assist their drainage, which is difficult in any circumstances.
Grease Traps: The layer of grease on the surface should be removed once daily and the sludge in the bottom once weekly.
Refuse Swill Bins: The contractor will completely empty the bins and clean them to the bottom daily: in the case of swill bins, they are to be emptied three times a day after meals. The bins should be scrubbed if necessary and the surroundings kept clean. The lids of bins will be kept closed.
In order that a special effort may be made to combat this disease it is thought that more interest may be taken and better results obtained if all officers, warrant officers, NCOs, and men understood how this disease is carried from one person to another, and the methods taken to prevent its spread.
It is impossible to get dysentery except through eating or drinking something contaminated by dysentery germs. In plain words it means that a person who gets dysentery has swallowed food or drink which has been defiled from a “latrine”. Hence the necessity for disinfecting the hands after using latrines.
It is most strongly emphasised that the idea that anyone coming to
It is obvious, therefore, that it is a disease that can be prevented by good sanitation. The infection of dysentery is usually carried out as follows (the precautions to be taken being shown under each heading):
Contamination of Body by Dirty Hands, Flies, etc.: Only purchase food from clean sources. Avoid unlicensed hawkers. Protect food from flies and dust. See that the mess orderlies wash their hands. Do not eat any food that appears in the least way tainted. Disinfect your hands after using the latrines and before meals.
Contaminated Water, Milk, Minerals: If in the least doubt boil the water. Tea is a good safe drink. Always boil fresh milk and keep all drinks protected from flies and dust. Only use minerals from recognised Army sources. Ice is almost invariably contaminated in transport and should not be put in drink.…
Uncooked Vegetables, Salads, Fruits: In no circumstances eat uncooked green vegetables (lettuces, etc.) and onions. Eat only hard skinned fruit (except red melons) with a sound skin. Dip in boiling water for thirty seconds, or soak for one hour in “pink” solution (permanganate of potash), the strength being such that the bottom of the container cannot be seen through the solution. After soaking, rinse in tap water. Tomatoes, dates, and figs may be bought if their skin is unbroken and they are treated in a similar manner. No fruit, vegetable, or other food is to be purchased from hawkers, who are forbidden to enter the camp precincts. Egyptian cheese is stated to be unsafe. Avoid overripe fruit. Grapes must not be eaten.
Melons are safe to eat provided they are bought from a thoroughly reliable source (of which one is the Nile Cold Storage and Ice Coy.). The best type of melon is the “Chilean Black”, followed by the ordinary water melon. Melons should bear the Government stamp.
It must be emphasised that the above does not authorise the indiscriminate purchase of melons from any source.
Do not leave any refuse about to attract or allow flies to form breeding places. See that lids fit all dust-bins and keep the bins covered.
Flies cause a spread of many diseases—not only diarrhoea and dysentery, but also cholera and typhoid fever, and diseases of the eye.
Units are responsible for the prevention of the breeding, and for the destruction of flies, within their own area.
The prevention of fly-breeding is mainly a matter of the efficient fly-proofing of latrines, and the storage of all refuse in fly-proof receptacles and the satisfactory disposal of same.
The best fly poison is a solution of formalin and sugar, placed in saucers, with a piece of bread in the middle for the fly to settle on. This solution will be prepared in bulk under the supervision of the Medical Officer in charge of the nearest medical inspection room or RAP, and issued to units as required. The solution is non-poisonous to human beings and animals. To be really successful it must be of a definite strength, and no fluid should be available with which the fly can satisfy his thirst apart from this solution.
All offices, messrooms, etc., should have some form of fly-trap.
The most efficient and easily constructed fly-trap is made by mixing together resin and castor oil, and whilst still hot, painting the mixture on sheets of tin or hoop iron or stiff wires (old telegraph wires, the wires used for binding bales of hay, etc.). These wires should have a hook at one end to hang from, and a piece of paper or cork at the bottom to prevent drips. These are hung on beams, etc. When covered with flies the wires and tins can be cleaned by burning, and then used again.
Units will arrange with the officer in medical charge of troops for instruction of their sanitary personnel in the use of sprays, preparation of castor oil and resin mixtures, and the best method of using formalin solution.
As the contamination of food is the principal danger of these parts, all food must be stored in fly-proof safes and protected from flies. It is most important to place in food safes food which is not cooked, such as bread, biscuits, cheese, jam, and sugar, and it is also necessary to provide similar receptacles for eating and drinking utensils. Fly-proof conditions should exist where food is stored, etc., prepared and consumed. It is realised that this is not fully possible, but it is the ideal to aim at.
Units must ensure that fly-proof safes are available, if necessary constructing them from scrap material obtained from the Garrison Engineer.
Everything should be done to prevent flies breeding and to reduce the fly pest. A plague of flies has a big bearing on health. Quartermasters should draw scale supplies of sprays, fly-tox, resin, oil, and swatters, etc. Every effort must be made to prevent flies from breeding and to keep all areas free of any material likely to encourage these pests.
All latrines must be boxed in. The seat and bucket type is not satisfactory.
Sanitary Police will be posted by units at all latrines from reveille to sunset:
To ensure that seats are kept closed and particularly that they are kept on top of buckets in cases where boxing is not complete.
To see that all ranks leaving the latrines immerse their hands up to the wrists in cresol solution (a 1 per cent solution, which is a “50” cigarette tin of cresol to 2 gallons of water—stronger solutions are no more efficient). During rush periods it may be necessary to reinforce the sanitary police or even station non-commissioned officers on duty to ensure compliance with orders on the subject.
Receptacles for disinfecting hands must not be inside latrines, but should be placed at least 30 feet from the centre of the latrine, and as near as possible to the normal route between tents and latrine. (For small latrines this distance could be reduced.) These stands should be whitewashed to facilitate location at night. The solution should be changed daily.
It will be found that hands dry very quickly in the air after immersion in the disinfectant, and no sort of discomfort is experienced.
Latrine seats must be scrubbed daily with soap and water and twice weekly with cresol solution. Buckets are cleaned by conservancy contractor after emptying. After cleaning, buckets should be wiped with pan-ol, and a trace left in the bottom. Pan-ol should be drawn from Unit QM.
The attention of all ranks is directed to the necessity of using sawdust freely in latrine pans and avoiding excess of urine in the pans by using the special urine buckets whenever possible. These measures facilitate incineration and contribute to the maintenance of a healthy camp.
In view of the prevalence of sandfly fever in this area, the following notes are published as regards certain preventive measures:
Sandflies breed very rapidly when the temperature and humidity become favourable, generally April to May, reaching their highest number in August and September.
Old rough and pitted walls and heaps of rubble are the usual breeding places. The undulating desert or ground with a smooth surface is less favourable. It is desirable, therefore, that heaps of rubble should be removed from the neighbourhood of barrack rooms, or when removal is impossible, buried in sand.
Proper conservancy in
Conservancy services are carried out by a civilian contractor with native labour, and the standard of the work they render is in direct proportion to the standard desired by the unit concerned. Sanitary officers and their personnel will greatly assist in the satisfactory carrying out of the service by closely supervising the work, insisting upon punctual and regular clearing of receptacles, verifying that all refuse is properly buried (when this means of disposal is used), or properly burnt (when incinerators are provided).
The principal points of Conservancy Contract are given below for guidance:
Motor lorries carrying iron receptacles will clear latrines, urinals, cess pits, catchpits, sumps, slops, rubbish ashes, old tins, refuse bins.
Hours of clearing will be fixed by Sanitary Officers. Two clearings per day, morning and evening, are stipulated.
The iron receptacles will have lids and they must be kept closed during movement. Dry rubbish in lorries must be kept covered by canvas covers during transport.
Until incinerators are constructed, trenches 2 metres deep will be dug and the day's refuse placed in them up to not nearer than ½ metre from the ground level. Covering sand will then be placed over them to 1/4 metre above ground level and sealed up with oiled sand under the responsibility of the Sanitary Officer. Old lorry sump oil is provided for the purpose of sealing the trenches. The trenching area has been sited 2 miles from camp.
When incinerators have been constructed (site ½ mile from camp) all refuse will be mixed with sawdust, tibben (chopped straw), etc., at the incinerators and burnt.
Transport receptacles and lorries will be cleaned and disinfected daily by the conservancy contractor's labourers, but latrine buckets, etc., will be kept clean by unit personnel.
Each lorry will be accompanied by 1 driver and 2 labourers plus 2 more labourers per lorry digging trenches and working incinerators.
Any complaints should be referred in writing to the Camp Adjutant.
Careful attention to the above points from the outset will help to create and maintain a satisfactory service upon which the health and comfort of all concerned depends.
Disinfectants, sump oil, fuel, etc., are obtainable.…
This condition is in a great measure due to salt loss owing to sweating. This can be prevented by supplying the following drink:
Half ounce table salt to a gallon of water.
Flavour with lime juice or lemon.
Earthenware jars (zeers) are possible breeding places for mosquitoes and they should therefore be turned upside down and thoroughly dried out twice a week.
Sandflies may breed in the constantly damp sand beneath jars and the latter should consequently be moved frequently.
The use of a common mug and the habit of dipping a mug into the jar are both undesirable practices from a health point of view. Where individual drinking utensils are not available men should use their bottles for drawing water.
TWO Italian armies had struck at
Then an ominous shadow was cast over the situation when German armies started assembling in Roumania at the end of
The voyage across the The medical units went to Date of EmbarkationDate of Arrival at Piraeus
All reached
In proceeding to a country not yet at war with
Although
Brigadier Large, RAMC, with headquarters in
There were two base sub-areas: 81 Base Sub-Area with headquarters at
Thus, at first,
There was no New Zealand medical liaison staff attached to HQ BTG in
The New Zealand Division and its medical services, although under command of the force commander and
On 10 March, when Colonel Kenrick reported to
The difficulties of terrain, bad roads, and poor communications—both road and rail—were at once apparent. When Colonel Kenrick crossed the shoulder of
The country itself was mountainous and rough, with some large plains, low-lying, boggy, damp, and malarious, the largest being those of
At the northern end of the plain at
Communications between east and west were poor, making the reinforcement of the eastern front from the Albanian front slow and difficult.
From the standpoint of supply and evacuation there was thus available one line of railway—very vulnerable to attack—one main road through hilly country with narrow side roads through passes at the
The climate of
Malaria: The low-lying and boggy plains of
The lesson of the First World War was not forgotten on this occasion and the New Zealand Division, as well as the rest of Lustre Force, had made preparations to cope with the problem before its arrival in
As far as the New Zealand forces were concerned 4 Field Hygiene Section at once began anti-malaria measures, carrying out a careful survey of the battle areas. Contact was at once made with local medical practitioners and information obtained as to the local incidence of the disease. Even spleen surveys were carried out on children in these areas and the spleen rate in the villages was found
The Hygiene Section proceeded to deal with breeding grounds by drainage and oiling, and to arrange for unit malaria squads to be formed to deal more intensively with the problem. Advice was also given to combatant units on the relative safety of areas as far as malaria was concerned. The force itself contained a malaria officer who had organised forty Greek foremen, each with a gang of twenty-three labourers, to deal with the problem from an army level. Arrangements had been made to equip three of these gangs for the New Zealand Division.
(Fortunately, as far as this campaign was concerned, only three cases of malaria were reported as seasonal infection did not occur until May at the earliest, with the main incidence in July, August, and September. Training in malaria control was, however, valuable for the future.)
Intestinal Diseases: These were very prevalent in
To minimise infection of the force by these diseases the Field Hygiene Section carried out a complete examination of the water supply in the different villages in the battle areas. Arrangements were made for the chlorination of water where necessary.
Typhus: Great epidemics had occurred in the
Venereal Disease: Syphilis and gonorrhoea were very prevalent.
Tuberculosis: There was a high incidence of 3 per cent of pulmonary tuberculosis in
Water Supply: The water generally throughout
Sanitation: Generally, the civilian sanitary arrangements outside
The defence of
The New Zealand Division shortly after its arrival in
In the Aliakmon line the Division was responsible for the defence of the right flank between the coast and the Pierian Range where there was the widest of the three gaps in the mountain barriers. Across the Pierian Mountains, which rose to three and four thousand feet, 16 Australian Brigade was to defend the Veroia Gap through which ran the
While the New Zealand Division manned the Aliakmon line, it prepared defensive positions behind the line at the
The Greeks decided to fight the Germans in rearguard actions at the passes along the Bulgarian frontier, 100 miles north of
Such, briefly, was the position taken up by a small British force, consisting of less than two infantry divisions with one armoured brigade and inadequate air support, assisted by two weak Greek divisions—the whole force now named
A last line of defence had been planned by General Wilson more than 100 miles to the rear at
From
Most of the men travelled the distance of 300 miles from
On 17 March 4 Field Ambulance joined in the move of
An extensive reconnaissance in the hilly country in the forward areas was undertaken by Colonel Kenrick and Lieutenant-Colonel Graves, and an ADS was sited 6 miles north of
From the moment of opening the MDS sick men were admitted from 4 and 6 Infantry Brigades and other divisional units, and evacuated by rail from
Sixth Field Ambulance, under Lieutenant-Colonel Bull, moved north in the wake of other divisional units on 26 and 27 March and established an MDS near
A survey of the areas of 23 Battalion and 28 (Maori) Battalion
Thus, by the first week of April the plan for the New Zealand field medical units had taken shape, and 1 General Hospital under Colonel McKillop was also open at
In an order of 2 April setting out the divisional medical arrangements, the ADMS NZ Division emphasised that all field ambulances should retain mobility. Therefore, not more than twenty-five cases were to be kept at any one MDS. These were to be cases expected to recover within four days. At the commencement of hostilities the ambulances would be cleared of all sick preparatory to receiving wounded. All other cases, including venereal disease patients, were evacuated daily by rail from
The medical services to
Here 26 British General Hospital was operating in excellent buildings in the modern and healthily situated suburb of
On the arrival on 8 March of the first two general hospitals of Lustre Force, 2/6 Australian General Hospital and 1 New Zealand General Hospital, a conference was held at Medical Headquarters in
The actual siting of
The choice lay between
The site at
The site was in a long, narrow valley running west to east, with rocky ridges of 900 and 1200 feet to the north and south. A stream ran through the valley, but the clay soil made drainage from wards and kitchens difficult. Considerable engineering assistance was necessary to make roads and install water supply and drainage. The protection of the
The arrangements placed two 600-bed hospitals on the L of C, one on the main road and railway inland to
Forward of the hospitals were placed two CCSs, the 2/3 Australian and 24 British CCS, the former at
In the Corps area of
In the New Zealand Division's area three fully-equipped field ambulances were available, one for each brigade, but under divisional control. They all carried equipment in excess of the regular establishment.
The medical plan as it affected the New Zealand Division can, therefore, be outlined as follows:
RMOs attached to battalions working from RAPs.
Three field ambulances, each with three companies and with established ADSs and MDSs.
One ADS was attached under temporary command to each brigade so as to ensure medical attention in any eventuality, the rest of the field ambulance remaining under divisional command. A surgical team of one surgeon, one anaesthetist, and one other rank was attached to the Division and allocated to an MDS to be available for major surgery.
One Australian MAC servicing the whole force in the forward areas and evacuating from the field ambulances to 2/3 Australian CCS at
Ambulance coaches from
Ambulance train from
(Note: A Greek ambulance train was taken over when the force arrived in
Special units were attached as follows:
4 Field Hygiene Section was attached to the Division and carried out the duties of the prevention of infectious diseases and the control of water supply and sanitation.
2 NZ Mobile Dental Unit was under command of NZ Division for the provision of dental treatment. (It was, however, the last New Zealand medical unit to reach
5 (British) Bacteriological Laboratory was available at
1 (British) Malaria Field Laboratory in
7 (British) Depot of Medical Stores was stationed at
On 6 April the German drive into both
The New Zealand Division was ordered on 9 April to withdraw from the Aliakmon line and the
Fourth Brigade had been ordered to
The enemy struck down the valley from
The withdrawal from the
The site of the MDS on the rising slope of the south-western aspect of the foot of
Sixth Field Ambulance cleared its dressing stations of patients when the Division began to withdraw and the two ADSs closed on 6 MDS on 10 April. All troops except the Divisional Cavalry had gone over the pass when the unit moved out that night. Near the town of
When 5 Field Ambulance moved from
The move of 5 Field Ambulance had to be made in two lifts as there was insufficient transport on the establishment of field ambulances at that period to carry all equipment and staff. The MDS,
An ADS under Major
The most difficult problem of the advanced medical units at
Thus regrouped, the medical units, with the rest of the Division, were ready for the coming action as the enemy advanced. At
Dive-bombers and fighters opened the battle for
On the 13th 5 MDS was enlarged to take 150 patients, and a steady stream of casualties, mostly wounded, were treated and passed on to 2/3 Australian CCS. In its work the MDS was assisted by 2/1 Australian Field Ambulance with men and equipment, the Australians concentrating on evacuation, the most difficult problem. Their extra equipment was particularly welcome. Stores for the New Zealand medical units had been slow in coming to hand, and the destruction of medical stores during a bombing attack on The bombing of
The display of the
The ambulance cars, which at that time had only small inconspicuous crosses painted on their sides, were draped with large Red Crosses on the roofs. The drivers then found that if they pulled out from the road convoys into nearby fields they were not molested.
The German air attacks adhered to a strict timetable, and it was
When the fighting began the wounded were evacuated to 2/3 Australian CCS at
On the 13th and 14th the 2/3 CCS and 24 CCS cleared patients to
Another order enlarging and confirming the instructions telephoned the previous evening, delivered by DADMS 81 Sub-Area and clearly instructing the unit to evacuate all patients and staff
Next day the patients and staff went again to
When this train reached
On arrival at
The nursing sisters, including Australian sisters from their CCS, had proceeded with the Mobile Dental Unit by road to
The decision had been made on 14 April, when the battle for the
The 16th Australian Brigade guarding the Veroia Gap was withdrawn across the Aliakmon and took up positions in the hills north of
Under strong enemy pressure 5 Brigade disengaged and withdrew according to plan during the night of 16–17 April. It was followed by 4 Brigade the following night, the moves being covered by 6 Brigade which had been held in reserve, and this latter brigade fought a rearguard action as all forces withdrew to
During the heavy fighting on and around
In 4 Brigade's area at
In the withdrawal the medical units retired with the brigades which they were serving.
The 4th MDS under Lieutenant-Colonel Graves closed at
The withdrawal had to take place with practically no The RAF fought valiantly against hopeless odds but it was decimated. On 20 April twenty-two German planes were shot down for the loss of five of ours, but only ten of our planes remained.
When 4 Field Ambulance was a few miles south of
When
The weather was overcast, with heavy rain and low clouds on the 17th, making it difficult for the German planes to take off, besides obscuring the moving traffic on the roads from the view
Difficulties of evacuation were manifest at this stage. On 16 April 2/3 Australian CCS had retired to the
On 17 April, at the hospital site at
Lieutenant
Covering the withdrawal of the rest of the
That day the enemy's furious assaults on the tiny force between
When Colonel Kenrick received word that 21 Battalion had been thrown back with heavy casualties he arranged for four ambulance cars to proceed immediately to
At the
About 2 p.m. word was received of the order to retreat. The RAP moved back under machine-gun fire from German patrols, while farther back the German main body waded across the river. Dive-bombers forced Hetherington and his staff to keep off the road as they moved towards
Wounded were treated and taken back by the 6 ADS detachment, under Lieutenant
Until 18 April the dressing stations of 6 Field Ambulance attended to men wounded in the enemy's incessant strafing of the roads. Extra ambulance cars from the Australian MAC joined the unit and a large marquee was erected to cope with casualties. By noon on 18 April the 6 Infantry Brigade rearguard was engaged with German tanks advancing towards
In the long retreat of 100 miles across
The Thermopylae line was based upon a spur of the
While the occupation of the
The hospital was well equipped with beds, linen, and medical stores and equipment and an excellent operating theatre was set up with equipment from the Greek hospital. Air raids on the convoys, reaching a peak on 19 April, gave 5 Field Ambulance a heavy day attending to the wounded. From 4 ADS, established about 3 miles up the road, wounded came back in a steady stream and admissions for the day totalled 83. The conditions and the attachment of the surgical team under Major Christie allowed the satisfactory performance of major surgery; and the opportunity was readily made use of, numbers of serious cases being dealt with during the short period the MDS remained in the Greek hospital. Abdomen and head cases fit to travel were sent on to
Lieutenant-Colonel Twhigg, however, formed the opinion that the performance of major surgery at the field ambulance was inadvisable, as the serious patients could not be held the necessary time, and, if any number of patients were held, it would overload the unit transport in further withdrawals. Casualties were evacuated by the coastal road 65 miles through
While the
The task of evacuation had its undoubted elements of difficulty and danger. By an outflanking movement the enemy could cut off the withdrawal of the Anzacs, and his powerful air force was ready to harass the retreating force, try to destroy the ships upon which they would embark, and smash at possible points of embarkation.
On 22 April 6 Brigade took over from 5 Brigade in the
The 2/3 Australian CCS at
While 6 Brigade, supported by all the divisional artillery, held the
In its withdrawal from the
On the night of 24–25 April, 5 Field Ambulance moved 20 miles to the beach at Glengyle with the main body of 6 Field Ambulance, all transport being destroyed. The remainder of the latter unit went with the commanding officer aboard the destroyer
After destroying non-medical equipment and jettisoning much medical equipment to provide room in the transport for wounded,
Orders from HQ NZ Division instructed 4 Field Ambulance to withdraw with 6 Brigade, while 2/1 Australian Field Ambulance was to remain to serve 4 Brigade. Fourth Field Ambulance supplemented the stretcher-bearers of 4 Brigade with an NCO and 16 men. On the afternoon of Anzac Day 4 Field Ambulance prepared to withdraw, this time south of the
As two companies of 25 Battalion were in action in the
Headquarters 6 Infantry Brigade requested that a light ADS be sited at the foot of the pass leading over the ranges to
At first light on 27 April the MDS was opened in a Greek church alongside the forest reserve, and the wounded from various units, who were by now concentrating in considerable numbers, were accommodated. A Greek hospital in
At 8.30 p.m. the vehicles were used to convey the New Zealanders to the immediate vicinity of the actual beach from which embarkation was to be made and the trucks and cars were then destroyed. During these last few days more and more medical equipment had been dumped, but no wilful destruction was permitted. At the last moment, medical personnel who were being evacuated took over individual custody of surgical instruments and other small items of medical equipment. (When the unit was remustered in
In the words of Major Speight:
At dusk on the evening of the 28th the vehicles began to collect from the olive groves where they had been lying up during the day and made their way down to the embarkation beach. The Ajax would be coming in at 0130 hours and the wounded would be able to go on her. An anxious hour followed. The troops were being rapidly embarked into other available ships and one wondered whether daylight would find a forlorn group of wounded and their attendants still sitting on the beach. However, shortly after 0130 a larger dark shape than any that had preceded it slid into the bay. It was the
At Comely Bank [Comliebank], where one hold was allotted to the wounded. That afternoon the Comely Bank sailed in convoy for Comely Bank, and the ship had been provisioned with an ample supply of blankets and medical comforts which were of great assistance in caring for the casualties.
The successful embarkation of all troops of 6 Brigade was completed by 4 a.m. on 29 April, and the vessels, including HMS Ajax, using all possible speed, arrived at
At 6 a.m. on 30 April the group of ships had increased to twenty-seven, the naval escort including the aircraft-carrier Formidable and two battleships, the Warspite and the Barham. This day passed without further serious interference by enemy forces, and at dusk the Thurland Castle set its course for
Another embarkation in the
While 5 Brigade moved to beaches near
The
The RMO of 18 Battalion, Captain
When 1 General Hospital arrived in Rawnsley by 3.30 p.m. with other British Army personnel. The ship was delayed in leaving by the pilot and missed its convoy. It remained in the outer harbour overnight and next morning was machine-gunned from the air and departed for Aba nearby. The ship eventually picked up a large convoy south of
The nursing sisters, unfortunately, did not board the hospital ship, which took its load of wounded out of the port of Voyager. A truck carrying nineteen of the New Zealand sisters overturned during the journey and several were slightly injured. The sisters had to lie up twice during attacks by enemy aircraft, and finally remained under cover in a little walled cemetery at
Nearly all the officers and orderlies attached to the Convalescent Camp at
There would appear to have been some misunderstanding in the original planning of the evacuation of the camp. The difficult problem of handling the convalescents was dealt with by Captain Slater and his staff most competently, the safety of their charges being the prime consideration. After capture Slater and his staff were able to set up a hospital at
Of the fifty-one orderlies of 1 General Hospital who were at Glencarn.
Throughout the campaign in
The establishment of the ADSs and MDSs of the field ambulances at their original sites was fraught with considerable difficulty, as at that time the general opinion held was that the Geneva
The RMOs had to set up their RAPs sometimes in very hilly country and, by their ingenuity in the use of camouflage, protect them from the uncontested attacks of the German air arm. The wounded had to be brought in to the RAPs, sometimes from almost precipitous country and at times by long carries. Special light Neil Robertson stretchers were used with success in the steep country.
The evacuation to the ADS had often to be carried out by stretcher-bearers, but where possible ambulances and trucks were used, the small supply of Flint stretcher gear being very useful. The collection and evacuation of casualties by the regimental medical personnel was most conscientiously and efficiently carried out.
In the quiescent period before fighting began a certain amount of surgery, including appendicectomy, was performed in the MDSs of the field ambulances. Minor cases of sickness were also held in the field ambulances for some days until they had recovered and were then discharged to their units. A surgical team from 1 General Hospital, consisting of a surgeon and an anaesthetist and equipped with some extra surgical instruments, was attached to 6 Field Ambulance to enable major surgery to be carried out in the divisional area should circumstances make this necessary. (This surgical team performed a considerable amount of major surgery in
When hostilities threatened, orders were given to the field ambulances by Colonel Kenrick not to carry out any but the most urgent surgery of the civilian type. During the campaign 4 Field Ambulance treated 350 wounded, 5 Field Ambulance 534, and 6 Field Ambulance 87.
Treatment carried out by the RMOs consisted in the application of field dressings and the preliminary splintage of the limb as required. Injections of ATS in doses of 3000 units were given, and of morphine up to half a grain.
Wound treatment in the field ambulances varied according to the circumstances at the time. At the beginning of hostilities a certain amount of surgery was carried out at the MDS, especially that to which the surgical team was attached. When the withdrawal began the medical units were leapfrogged back as the combatant troops passed by them. Little but the most urgent treatment was attempted and the cases were evacuated for definitive surgery to 2/3 Australian CCS at
The principles of treatment adopted were the excision of the wound, the prevention of bleeding, and the provision of drainage. Dressings consisted of the field dressing, and vaseline gauze had also been supplied both to the hospitals and the field ambulances. Acriflavine was used as a local antiseptic, and in some cases sulphonamide was administered by mouth to the seriously wounded men. Thomas splints, with metal traction clips fixed to the heel of the boot, were used for fractures of the lower limbs. Kramer wire and plaster-of-paris were also used for fracture cases, mainly at the CCS. The wounded admitted to
The experience in the treatment of war wounds was a new one to the staffs of the ambulances, and the New Zealand medical services were strengthened by having a surgeon of considerable general and orthopaedic experience attached to a field ambulance as a member of the surgical team. The quality of the work varied very much, as was only natural, since much of the urgent and imperative surgical treatment of wounds was carried out by young medical officers with no previous experience of the treatment of war wounds, but under the circumstances the work was well and most conscientiously done.
Special blood-transfusion panniers had been procured in
Gas gangrene was comparatively rare. There were several cases of gas in the tissues, generally associated with localised gangrene of muscle or muscle groups, which responded well to free excision of the involved muscle. Serum was administered.
The road evacuation was by means of the main axial road of
The road evacuation was undertaken by the Australian MAC, which serviced the whole of the forward medical units, British, Australian, and New Zealand, and carried out their work in such a way as to win unstinted praise from the New Zealand Medical Corps. On 16 April Colonel Kenrick had arranged with
Special car posts were set up, not only to act as relaying posts between the different medical units, but also as collecting posts for the wounded and to act as extra ADSs. As a rule they were staffed by a medical officer and orderlies. The successful evacuation of medical units and casualties was due to the way the medical transport was used, and to the ability of the officers of the Medical Corps to improvise and to commandeer, and to handle the difficult problem of collecting the wounded, scattered as they were over the whole line of evacuation.
Trucks were used to a great extent to transport wounded, and Flint stretcher apparatus was used as much as possible, but the supply was very limited. The smaller 15-cwt and 30-cwt trucks were found to be not nearly as suitable as the three-tonner. The wheel base of the 30-cwt truck was not long enough, and the three-tonner could not only carry many more patients and personnel but it could also carry much more petrol—a matter of great importance.
It was stressed by 4 Field Ambulance that all trucks should be self-contained, and that all drivers should have full information as to their destination. The field ambulances were not themselves self-sufficient as regards transport. This was partly due to an excess in equipment, as each unit had made efforts to supplement the regular army equipment with extras designed to enable more efficient surgery to be carried out. In the forward areas 15-cwt trucks were used by the RMOs, both for transport and also as RAPs.
When
When the CCSs were open at
In retrospect, it would appear that
Patients were transported in the ambulances and trucks of the medical units during the retreat and were sent on to
Hospital trains were used to evacuate from the
Hard rations were issued for the move over to Meat and vegetables, cooked and tinned.
Except for a slight incidence of mild influenzal colds the health of the troops was excellent, in spite of the cold and wet weather experienced in the forward areas.
Broken dental plates, caused by the hard biscuits, gave rise to some difficulty. The Mobile Dental Unit, which was to have been attached to the Division, was late in reaching
There was a depot of medical stores at
All of the New Zealand field ambulances were very well equipped, having not only the full army equipment but also supplementary articles acquired to enable the units to carry out surgical work more efficiently. When the evacuation of
The order for the destruction of equipment was intended to refer to the equipment of combatant units, as under the Geneva Convention medical equipment and stores should not be destroyed; it is interesting to note that the natural reaction of the New Zealand medical officers prompted them to act in the correct manner, and only with deep regret was any destruction of equipment ever carried out.
This illustrates the importance of a full knowledge of the Geneva Convention by all personnel, combatant and medical. Some combatant officers without that knowledge tended to insist on the medical officers under their command destroying their medical equipment, and the medical officers were not quite sure at times of the exact position or of their power to resist orders from combatants when the Geneva Convention was in question.
The subsequent story of the events in
The personnel, both officers and other ranks, had been tested under difficult battle conditions and had not been found wanting.
The senior officers had handled the strange conditions with skill. The ADSs had been placed under brigade command, thus ensuring close contact with battalions during the rapid movement of the troops during the withdrawal. Extra car posts had been placed along the lines of evacuation, each with a medical officer in charge, and these attended to casualties and collected wounded.
The MDSs had been handled well during the long retreat and attention given to the troops wounded by bombing and machine-gunning from the air.
The detailing of personnel from
The Divisional Medical Units: The responsibility for the forward units rested with the Division and the units retreated with the troops and were evacuated to
The Base Medical Units: Owing to the fact that the New Zealand base units were under the command of Headquarters,
As regards
Up to 19 April,
The
The critical position of the forces in
The Greek campaign was the first active campaign in which the
The observations made by senior officers stressed the difficulties of the campaign and the capacity of the New Zealand medical units to improvise and deal with unprecedented conditions, as well as their capacity to learn from their experience. Naturally, the main recommendations dealt with the necessity of being fully mobile, and, to ensure this, the provision of adequate transport for all field medical units; but there were other very important lessons learned by the Medical Corps from the campaign. They are dealt with separately.
It was felt by the ADMS NZ Division that he should have been instructed to go to
The
Early Arrival of Medical Units: It was considered by the senior medical officers that a higher priority should be given in the future to the medical units, so that they would be available from the beginning to service the troops and have time to site and establish their dressing stations before active operations commenced. Representations to this effect were made on 7 March by
Consultants: There were no consultants attached to the forces in
In the opinion of senior officers in the New Zealand force, the placing of the highly organised and elaborately equipped base hospitals as L of C units 200 miles from
It is likely that the decision to use the hospitals as L of C units was influenced by the difficulty of evacuation by a single-track and
The authorities were influenced, no doubt, in their decision to place the two 600-bed hospitals in 81 Base Sub-Area, by the fact that there were no other hospitals available, the smaller units of the old 200-bed type being no longer considered of value in the Army. There were also only two CCSs, so that no unit of that type was available on the L of C over and above what was required to carry out the urgent surgery. The 26th General Hospital was well established in
It was therefore decided that
It must be realised that the
The surgical divisional officer of
He further recommended that all surgical units situated away from the base should be small units, as mobile as possible, and should not
He suggested that the minor cases on the lines of communication should be dealt with by a much less elaborate medical unit, and that an advanced base camp was desirable where cases could be held following discharge. (At one time patients who would have very soon been fit for return to their combatant units were discharged from 1 General Hospital,
It was stressed by all the divisional medical officers, especially the field ambulance commanders, that the transport on their ordnance equipment was not sufficient to enable the unit to carry all its personnel and equipment, as well as to provide room for casualties to be evacuated during the retreat. The unit had often to be moved in relays by sending back unit transport, and with the congested condition of the roads, crammed with the retreating army, this was very difficult. Although the position was greatly relieved by the detachment of ambulances to all the units by the Australian MAC, yet further transport was deemed to be essential for the future. No. 1 New Zealand General Hospital had no transport and, though a few trucks and ambulances were attached at
Fortunately, all the field ambulances had had considerable practice in setting up and dismantling their units and this stood them in good stead in
It was quite impossible to separate the medical from the other convoys on the crowded roads and the
At times patients were sent off by ambulance from the MDS to a CCS or other unit and it was found on arrival that the unit had moved back, with no indication as to the subsequent location. It was felt that wireless communication between units would have been of great assistance.
There was a complete breakdown in the railway administration early in the retreat, and this might have led to very serious consequences. In future, this probable eventuality must be taken into account.
At the outset of the campaign there was a very general opinion that the German Army would not respect the
Fifth Field Ambulance stated that on 15 April the enemy appeared to recognise the
There can be no doubt that the Germans did respect the
The necessity for the medical arm to have full appreciation of the strategical possibilities, and not to stabilise medical units unless conditions warranted it, was fully borne out in
There was an unreal atmosphere at 81 Base Sub-Area at the beginning of the campaign. Arrangements were being made for work to be done by the Area engineers, and contracts were let to Greek civilians, on a basis which visualised a stable front for a very long period. At
There appeared to be some lack of proper organisation as far as the base in
Under instructions from
The main body of
In retrospect, it might have been possible, if the base authorities could have been informed of the position earlier, to have evacuated from the
On 19 April
On the 22nd he was informed of the decision to evacuate
All the transports on which New Zealand medical personnel were embarked proceeded to Slamat which, on its return journey from
There were only 50 survivors out of 1000 personnel, naval and army.
At the conference at GHQ MEF on 22 April it was decided that, owing to lack of transport facilities, it would not be possible to deviate from arrangements that severe casualties of all forces, including New Zealanders, would be held in hospitals at
For the New Zealand casualties it was arranged that all officers and surgical cases would be admitted to 2 NZ General Hospital and all medical cases to 3 NZ General Hospital. Following this decision, some 130 medical cases were transferred from 2 General Hospital to 3 General Hospital, the first patients that hospital had received. No. 2 General Hospital was thus prepared to receive battle casualties as soon as they were transferred from hospitals on the coast. The 1st NZ
In view of the fact that most of the New Zealand troops, including lightly wounded, went to
Contrary to expectations the condition of the troops themselves on arrival was remarkably good, and there were few cases of exhaustion and nervous breakdown. A divisional rest station was established at
As they left
The campaign in
Fortunately, there was little or no disease to cope with and the wounded could all be evacuated to the base, and many were taken off with the units to
THE New Zealand troops who were evacuated from Voyager and
Upon disembarkation the British, Australian, and New Zealand nursing sisters, totalling 150, were taken to 7 General Hospital while the troops marched to a transit camp near
At
When our troops landed on
The only military hospital on the island was 7 General Hospital—a 600-bed tented hospital established only a week before. This was situated on a promontory on the seashore about 2 ½ miles west of
The hospital accommodation at 7 General Hospital was quite inadequate to deal with all the wounded arriving from
On 26 April Colonel Kenrick went to
During the night some 400 walking wounded arrived at 6 MDS without warning, and in many cases their dressings had not been changed for a week. These men were all treated, the ADMS of the
On the morning of 27 April 5 Field Ambulance marched 8 miles to
One company of 6 Field Ambulance also moved on 27 April and established an MDS for
The weather was fine at this stage but the nights were cold. All ranks lived in olive groves; most of the troops were near enough to the coast to be able to enjoy a swim, and to some extent were able to relax and recuperate after the ordeal of the final days in
On their arrival at 7 General Hospital the New Zealand sisters immediately volunteered for duty and were posted to the nursing staff. The Matron of 1 General Hospital (Miss Mackay) was asked to take charge of all the nurses, including British and Australian sisters who had also arrived from
Miss Mackay had taken up the duties of Matron of 7 General Hospital and organised the nursing staff from all the available nurses with outstanding success. The hospital was then receiving 300 to 400 patients daily. With her cheerfulness, tact, and coolness at the most difficult times, the matron set a standard which could
On 28 April New Zealand
The stay of the sisters at Ionia. The crew, fearful of air raids, had fled to the hills, so volunteers from among the troops manned the ship. Australians were in charge and gave the sisters the few available cabins. The voyage to
The decision to evacuate the nursing sisters forthwith to
Until the end of April large bodies of troops were still arriving from Carlisle, which put them ashore at
Ajax at
In the first week on
No transport was available and troops had to march considerable distances, with the result that many men suffered from sore feet. On 30 April there were 126 New Zealanders, wounded and sick, among the patients at 7 General Hospital.
General Wavell flew to
The rich coastal plain of
Roads are not well developed. The main road runs close to and parallel with the north coast, with many river bridges. There are four roads crossing the island from north to south, all narrow and over hilly country. The southern end of the
Since the outbreak of war
Cretan recruits were withdrawn for the fighting in
The RAF found it impossible to send any but a very small number of planes to
It was originally intended that all troops from
For defence,
There was available in
The New Zealand units available were 5 and 6 Field Ambulances and 4 Field Hygiene Section, all without the minimum equipment. When the ADMS NZ Division, Colonel Kenrick, was appointed
The medical plan as it affected our troops consisted in the servicing of 5 Infantry Brigade by 5 Field Ambulance and of
A reorganisation of the forces in
British and Greek troops in the
The difficulties of medical organisation were enormous on account of lack of equipment, lack of transport, the mixed composition of the combined forces, and the general disorganisation following the evacuation of
In the New Zealand sector five tents and some medical equipment were obtained from 7 General Hospital and supplied to 5 and 6 Field Ambulances on 1 May to enable them to extend the facilities of their dressing stations. The 5th MDS was merely a protected area in a dry riverbed, with three tents set up and a tent-fly extended as cover for patients from 5 Brigade, while 6 Field Ambulance was similarly situated in providing medical services for 4 Brigade.
On 5 May the situation was relieved when the hospital ship Aba arrived at
In the second week of May small supplies of equipment became available, more especially personal clothing such as shirts and shorts, groundsheets, extra blankets, and underclothing. The weather was becoming more unsettled and all manner of ingenious forms of bivouacs were constructed by the men. Fifth Field Ambulance received additional tentage and medical stores and expanded the MDS, also making provision for an officers' ward.
The 7th General Hospital staff continued to be extremely busy and found themselves very shorthanded after the departure of the nursing sisters. Fifty-four men from 6 Field Ambulance were attached daily to the hospital. The CO 5 Field Ambulance, Lieutenant-Colonel Twhigg, also offered the services of some of his nursing orderlies, and sixteen of them were attached to the hospital from 10 May. Major Christie, a surgeon who had been attached to 5 Field Ambulance from 1 General Hospital in
The sadly depleted condition of the New Zealand medical units on arrival in
A major setback occurred when the SS Rawnsley (which had previously taken the male staff of 1 General Hospital from
When the troops arrived from
Ordinary lorry transport was in even shorter supply and so could not be used to make up for the shortage of ambulances. Each field ambulance had to rely on one 15-cwt truck and had great difficulty in arranging for the transport of patients, which had to be carried out in relays.
The number of field telephones in the New Zealand sector totalled only about twelve so that inter-communication was exceedingly difficult. The lack of motor cycles or other vehicles meant that messages and orders had to be taken on foot. For instance, when movement by day came to be restricted by enemy aircraft, the ADMS NZ Division found it necessary to spend most of each night travelling across country on foot to visit the field ambulances, which had no telephones.
From 1 to 12 May the enemy air force had concentrated on shipping to and from
At dusk on 13 May enemy aircraft heavily “blitzed” the aerodrome at
With the dispositions of New Zealand units provisionally settled, 5 Field Ambulance was situated near the threatened coast at
At
As the field medical unit attached to 5 Brigade, it was responsible for the collection of casualties in and around its sector, namely the
Lieutenant-Colonel Bull visited the ambulance on 16 May and recommended a change of location of the MDS, as the site at
On 17 May, at a conference at Headquarters 5 Brigade, it was agreed that the location of the MDS at
A two-storied house, the police station, was taken over to accommodate the receiving and dressing sections and the more serious cases; further accommodation was made available in the basements of nearby houses and in tents. The unit moved in on the afternoon of 17 May after a march from
In the main the medical equipment was that carried out of
The operating theatre at
At
Sixth Field Ambulance continued to function as an MDS in tents in its original location below
The 4th Field Hygiene Section moved to
On 17 May all except a few of the ASC drivers attached to the field ambulances were marched out to join a composite battalion being formed as part of 10 Infantry Brigade. This new brigade was formed on 14 May under the command of
The British hospital ship Aba made a return trip to Aba was no mean feat. It was not considered wise to bring the ship into
Fortunately, the sea was calm and within eight hours the patients were embarked, an operation which involved raising the ship's lifeboats from the water to deck level with patients aboard. Loading
On Sunday, 18 May, at 6.5 p.m., 7 General Hospital area was attacked from the air at low altitude, some bombs (four at least, possibly twelve) being dropped on the hospital area and towards the beach. Three British medical officers and two orderlies were killed, while another three orderlies were wounded. Among those killed was the surgical specialist; a New Zealand surgeon, Major Christie, was appointed in his place.
Arrangements were made on 19 May for 5 MDS to evacuate casualties to 7 General Hospital at 9.30 a.m. and 2 p.m. daily. This schedule could not be adhered to in later days, as convoys of ambulance cars and trucks were invariably halted on the road over very long periods while enemy aircraft strafed everything that moved. That very afternoon, as a prelude to bigger happenings next day, enemy planes flew to and fro over all areas occupied by troops, machine-gunning and bombing without restraint.
The usual blitz of Preparations for the invasion of
The two main centres of these landings soon became obvious – This figure is now known to be too high—approximately 75 gliders were used in the invasion of
The men of 6 Field Ambulance were at breakfast when the blitz started and immediately dived to cover. While the bombers and fighters of the
Then, with the cessation of the bombing and strafing, came the paratroopers and the sound of voices. Coming out of their trenches the men found themselves faced with the muzzles of Schmeisser guns, and the grim, set countenances behind them. Lieutenant-Colonel Plimmer and Major
At 7 General Hospital, to which some New Zealanders were attached, staff and patients were likewise rounded up. A German pilot, who had been wounded and was a patient, gained possession of a tommy gun and assisted the paratroops. In the burnt-out wards were the charred bodies of patients. The medical staff remonstrated without effect against being removed from their care of the wounded. They, too, were herded round the
The captive party, several hundred in all, remained out in the open for several hours. The padre and a small party were permitted to conduct a burial service for Colonel Plimmer. Several of the medical officers and men of 6 Field Ambulance attended to the wounded in the area—British, German, and civilian alike—and two officers and two sergeants from the unit were sent under guard to 7 General Hospital to carry out further treatment of a German with a severe chest wound.
About 12.30 p.m. the large group at the MDS was shepherded up the valley under cover of the olive trees towards Also known at the time as Daratsos and shown as such on some maps.
After several halts they approached the village of
The released medical group was then conducted to 19 Battalion lines about 6 p.m., and late that night reached 20 Battalion's positions near
The progress of the small party sent to 7 General Hospital was interfered with by a counter-attack by two tanks of
It was then decided to set up an ADS in a culvert under the main
With the coming of dawn they found they were on the seaward side of the coast road about half a mile from the beach. Through the centre of the area, which could almost be termed a valley because of the low hills on either side which swept down to the beach, ran a deep zigzag watercourse, dry and fairly wide. This passed under the road in a large concrete culvert, and over the greater part of the grass-covered area were the inevitable olive trees in their orderly rows. Towards the sea, at the edge of the olive grove, stood a small two-roomed cottage, and about fifty yards nearer
A camp stretcher, placed in the centre of the culvert, formed the table with just space enough on either side for the surgeons; there was little head room. A small fish kettle on a primus stove and an enamel plate formed the sterilising unit and was adequate for the few instruments salvaged from 7 General Hospital that were available. Anaesthetics consisted of a small stock of pentothal sodium and some Greek brandy and whisky provided by 18 Battalion. Blood was, of course, not available.
Incredible as it may seem, successful operations of a major type were performed and the patients transported in a 15-cwt truck to the naval hospital on the other side of
At 1 p.m. on 20 May the hospital area and the patients, with whom a small staff, including New Zealanders, had remained, was recaptured. The hospital was re-established immediately in large sandstone caves on the foreshore and an improvised operating theatre was functioning the same evening. In all, five large caves were used and as many as 500 patients accommodated. Four of the caves were used for surgical and the other for medical cases, and a great deal of work was very efficiently done there until the hospital was involved in the retreat.
New Zealand orderlies from the staff of
Prior to the invasion the regimental medical officers set up their RAPs in the most convenient positions in their battalion areas. For instance, 23 Battalion RAP was sited in a dry watercourse under olive trees close to Headquarters 23 Battalion, on a side road branching off the main
Few stretchers were available to the RAPs and medical equipment was very limited. It was impossible to bring any large medical panniers from
From the beginning of the invasion the RMOs of 5 Brigade near
A stretcher-bearer party from 5 Field Ambulance under Lieutenant Moody was sent forward with a company of 28 (Maori) Battalion to 22 Battalion on the night of 20–21 May.
In Moody's words:
We left the MDS at
Modhion about 8 p.m. and joined up withCaptain Rangi Royal 'scompany of the
Maj R. Royal , MC and bar;Wellington ; bornLevin ,23 Aug 1897 ; civil servant; served in Maori Pioneer Bn in First World War; 28 (Maori) Bn 1940–41; 2 i/c 2 Maori Bn in (NZ) 1942–43; CO 2 Maori Bn May–Jun 1943; wounded14 Dec 1941 .Maori Battalion . I was told to do this because this company was going forward as reinforcement to 22 Bn and it gave protection to my small medical party as isolated machine-gun posts and snipers were still active on the main east-west coast road. It was fortunate indeed that we had this protection as the Company successfully engaged and overwhelmed two German machine-gun posts on the north and south sides of the road. About 9 p.m. we arrived at 23 Bn HQ where we found an air of excitement and confusion; this was quite understandable as the military situation was very obscure. A runner from 23 Bn who was reputed to know this countryside well was told to take us forward and to link up with 22 Bn. On several occasions I toldCapt Royal that the guide had lost us, but the guide persistently maintained that he knew his bearings. (I had made long treks through this part of the island as Bearer Officer of B Company in connection with 5 Field Ambulance's plans for collection of casualties.) About midnight we came out on to the main road and proceeded through the village ofMaleme , but the guide asserted that it was not that village. We continued on our way walking westwards. The next thing we heard was a voice speaking in English and saying “Come on Tommy it is alright”. Then some hand grenades exploded. We had walked into a machine-gun post guarding the eastern end ofMaleme aerodrome itself. With this rude awakening we dived flat on the ground, waited for the burst of machine-gun fire which fortunately never came, and then collected ourselves in a culvert to take stock of the situation.Captain Royal 's orders were that he was to keep clear of theaerodrome as the German strength there was unknown. For this reason we decided to retrace our steps to HQ 23 Bn. (Little did we then realise that this incident may possibly have contained the seeds of victory in the battle of Crete . We were subsequently to learn, when we were prisoners of war, that a mere handful of theWehrmacht hung on to the vital airfield ofMaleme that first night.)We arrived back at HQ 23 Bn about 5 a.m.… Capt. R. S.
Stewart ,the RMO, was doing a tremendous job on his own … I remained with him on Wednesday 21st and Thursday 22nd. During these two days my men gave splendid service.… They were constantly exposed to ground fire, as well as machine gunning and bombing from the air, and they never once flinched or failed in collecting casualties from the battlefield.
Capt R. S. Stewart ; Gore; born NZ17 Mar 1906 ; medical practitioner; RMO 23 Bn May 1940–May 1941; p.w.23 May 1941 .
Captain
He had attended to numerous casualties, both at his tactical RAP and farther forward in the Fleet Air Arm encampment, when he received orders in the late afternoon of 20 May to move back, taking the wounded with him. Returning to his RAP he set out, guided by the Intelligence Officer, with 160 stretcher cases and walking wounded. Some of the wounded were carried on boards. After travelling up hill and down dale for about half a mile the party stopped to await further orders. By daylight no orders had been received; the Intelligence Officer had already left to bring help. He reached 21 Battalion's lines but decided that it would not be possible to bring the large party of wounded out over a ridge that was exposed to some enemy fire. In a clearing the RMO and the wounded waited. The German wounded in the party made a white circle from RAP gear and all the crowd sat inside it, being unmolested by the enemy planes that were active all around. Attempts to contact 22 Battalion or the RAP of 23 Battalion failed. At 5 p.m. on 21 May the group was surrounded and captured and taken back to a dressing station set up in Tavronitis village, where Flying Officer Cullen, an
At his RAP on 20 May Captain Stewart of 23 Battalion received wounded mostly from his own unit, and early on the morning of the 21st he was able to evacuate thirty sitting and lying cases on two 15-cwt trucks which, escorted by a Bren carrier, were returning to
That day sixty walking wounded were evacuated under the care of the personnel from 5 Field Ambulance. Unfortunately, some of the walking wounded found the rough, steep track leading parallel to the main road over the hilly country to 5 MDS too much for them. These returned to 23 Battalion RAP in a desperate plight on 23 May after the RAP had been captured.
Early on the morning of the 23rd 5 Brigade and 20 Battalion withdrew to a position east of the
They had the unenviable task of informing the wounded, particularly personnel of the
Longmore, Stewart, and Hetherington worked together in a dressing station in a stable attached to an inn in the Tavronitis valley, and they put through 500 to 700 cases with only seven deaths. The German field ambulances had ample and excellent equipment, including a water sterilising plant, and what they could spare they gave to the captured MDS. It was noted that our wounded suffered in the main multiple wounds inflicted by submachine gun, grenade, and mortar.
When the invasion began in the morning of 20 May many parachutists dropped in the vicinity of 5 Field Ambulance, followed by parachutes bringing equipment and stores. Throughout the morning this phase continued, and during this time the members of 5 Field Ambulance remained under cover, their only activity being to transfer the sick to the basement. A lull occurred about noon, but enemy activity was soon resumed. Almost total interruption of road movement resulted. The wounded from forward units could not be moved back in daylight. Casualties began coming in only from nearby units, and were supplemented by a number of wounded German parachutists.
No distinguishing signs identifying the site as that of a medical unit were displayed at first as it was considered undesirable to disclose the disposition of the fighting troops and their defensive positions. However, about two hours after the airborne landings had commenced,
At 4 p.m. on 20 May casualties began to arrive, these including several German prisoners. The first convoy of wounded was evacuated by truck to 7 General Hospital at 6.30 p.m., but while the truck was en route there it was first learned that German troops had captured the hospital. A medical officer and reserve stretcher-bearer parties from 5 Field Ambulance had been sent forward to the RAPs, and the evacuation of casualties to the MDS was arranged during the night. Bren carriers of 23 Battalion convoyed some trucks of wounded through to 5 Field Ambulance. At 2 a.m. on 21 May 7 General Hospital got a message through to 5 Field Ambulance that the unit could then take serious cases, but that it would be advisable for all evacuations to be carried out during the hours of darkness. It was possible to evacuate only four stretcher cases before daylight owing to the limited transport. In many cases additional operative treatment was given to patients at the MDS, as it was obvious that there would be some delay in getting them back to the hospital. Battle casualties admitted in the twenty-four
Throughout 20 May hard fighting among the olive trees at
During the day paratroops were dropped near 5 Field Ambulance and at 4.30 p.m. the advance of the parachute troops had brought them to slopes and ridges adjoining the valley in which the MDS was situated. The enemy were held by the
It was not possible to make any evacuations from the MDS during the night of 21–22 May, and by the evening of the 22nd there were more than 130 casualties held, many of a serious nature. By this time medical supplies were getting very low. Throughout 21 and 22 May unit stretcher-bearers had continued with their task of evacuating wounded from the battalions, having a particularly difficult time through being subject to air attacks and attacks by wandering groups of paratroops, as well as having to make long and strenuous hand carries over uneven ground. Fortunately, the weather remained clear and fine.
The RMOs in the
Captain Lomas had his Composite Battalion RAP at battalion headquarters, midway between
Headquarters 10 Brigade had two light trucks for all purposes, and these were used to evacuate the wounded. Later, the ASC drivers secured two more abandoned light trucks for the purpose. For several nights these drivers had to run the gauntlet of a machine-gun post manned by enemy paratroops, but they were never deterred and performed a magnificent task throughout the whole of the fighting in the
The days that were vital in the battle for
It was on 22 May that one of the bitterest battles was fought. The fate of
From 5 Field Ambulance at
Fifth Field Ambulance occupied the area used by 6 Field Ambulance up to the time of its capture; the latter unit at this time was functioning in a culvert about a mile further along the road towards
Casualties arrived in a steady stream throughout the afternoon and night, and before dawn the total admissions were over 200. Good work was done by the drivers of the trucks, some from 5 Field Ambulance and some from other units in the line, in carrying on unceasingly through the hours of daylight and darkness bringing in the wounded; and also by the ambulance orderlies who went out with the trucks. All trucks and ambulance cars were provided with Red Crosses and drivers and patients frequently derived considerable confidence, when negotiating the open roads, from the presence of lightly wounded German prisoners, who volunteered to accompany them so that in the event of interference they could intercede as far as they were able in having the convoy regarded as a protected service.
In the evening a small convoy of five trucks with two medical officers set out to evacuate wounded from 23 Battalion and from the
The clearing of the 23 Battalion casualties was a more difficult task. With orders to pick up wounded from that battalion, Lieutenant
The country was quite familiar to them as they had explored much of it in the three weeks before the invasion. At the rendezvous they found several wounded, some walking and other more severe cases, on the side of the road. Taking several stretchers, they followed a guide up a dry riverbed. This descended steeply, with heavy growth along the banks and overhanging its course, boulders strewn on the short level stretches, and small waterfalls every few yards. They soon met tired troops staggering under the burden of their severely wounded comrades in improvised stretchers of two poles and a blanket, and as time was short no time was lost in carrying out first aid. The orderlies took over from the troops wherever assistance was needed and very soon no orderlies were left.
Lieutenant Gray and a corporal kept on up the stream and after some time met the rear party. They were carrying in a blanket a badly wounded man, who had compound fractures of both legs below the knee. Helping to carry the man down that riverbed was most difficult. Already tired after four days of confused fighting and weary through lack of sleep, the party made slow, stumbling progress over boulders, on slippery shingle, gently lifting him over rocky falls every few yards, tripping and falling over trees and wood in their path, bearing the burning pull of the rolled edge of a blanket on aching fingers and hands.
In the shelter of the riverbed the strenuous work soon had them in a bath of perspiration, mouths and tongues dry from laboured breathing. It was too much for their unconscious burden and he was dead when they reached the truck.
Both trucks were by then piled with wounded. Conscious and unconscious men were piled on the floor – there were as many stretchers as could be carried, and the departure of the medical
On the way through York, a call was made at a Greek
Valuable assistance was given to 5 Field Ambulance in dealing with casualties by the surgical team from 7 General Hospital (Lieutenant-Colonel Debenham, Captain Gourevitch, and Captain Holt) which took over the operative work during the night. Evacuations from the dressing station were carried on throughout the night, 60 of the more serious cases going to 189 Field Ambulance hospital and 50 serious stretcher cases and 120 walking wounded going to the caves of 7 General Hospital. Bearer parties went out after dusk to assist in the evacuation of casualties from 5 Brigade. The lightly wounded were sent to 6 Field Ambulance and, of the serious cases, twenty went to 189 Field Ambulance hospital and ten to
At dawn on 24 May 5 MDS had been cleared of all casualties with the exception of eight wounded prisoners of war. This complete evacuation had followed a visit from Colonel Bull, acting ADMS NZ Division, the previous evening, with news that an attack on the area was expected. While the remainder of the staff went to caves on the foreshore for much-needed rest, a nucleus of the MDS staff – including the CO – remained in the building during 24 May, a quiet day on which only eight casualties were admitted. Aerial activity had continued throughout the day, but the Germans were waiting for further reinforcements for their ground forces to come from
On 23 May the site of 6 Field Ambulance, along with surrounding areas, was subject to severe aerial attacks which lasted practically all day. Two of the members of the unit were killed when two bombs dropped on the site. At this stage the unit was using the concrete culvert under the road as a reception centre and a narrow, deep, and dry riverbed for accommodating patients. The location was in an olive grove, where concealment was almost perfect and Red Crosses were not displayed. The unit, however, was becoming an unseen target in the general attack by enemy planes on roads and troop movements, and during the night a move was made to one of two cottages in a cleared area two or three hundred yards away from the road.
“About midday next day,” said Corporal P.
Curtis ,“… a machine-gun crackled through the camp followed by a bomb which narrowly missed the cottage, and another which landed near the watercourse fatally wounding two members of the unit. Those of us in the theatre were covered by a cascade of mud, bricks and tiles. Almost immediately after we had extricated ourselves from the debris an officer arrived for morphia saying that the two unit members had been caught standing one on either side of the ditch. We buried them after a short service later in the afternoon.
WO I P. H. Curtis ;Auckland ; bornTimaru ,16 Mar 1919 ; medical student; NCO6 Fd Amb 1940–41; 1 Mob CCS Oct 1941–May 1945.“It so happened that the patient on the table at the time was a German who asked us whether we were displaying any red crosses, and on being told no and why, said that if we did we would be left alone. As it was now obvious that we had been spotted and thus further attacks could be expected, this advice was followed and some ground flags were made from sheeting and red blankets, the area being mapped out with two of them and one on the roof of the cottage. It must be admitted that no further attacks were made on us after that although low flying, presumably for demoralising effects, continued.
“Shortly after this a signal was received saying that no further casualties could be taken by the Naval hospital so that it became imperative to find alternative accommodation and shelter, the nights being too cold in the open for badly shocked cases. Accordingly it was decided to take over the larger cottage for this purpose and it too was marked with the red cross.
“Time seemed to stand still and one day was very like another. The morale of the unit and patients remained high and at no time did the position seem hopeless, at least to those of us in the ranks without official knowledge. A rumour even reached us that the Germans were about to evacuate despite Lord “Haw Haw's” continued gloom about our prospects.
“Gradually the intake of casualties slackened until by Sunday they had practically ceased to come in. This, our first Sunday after the invasion, was particularly memorable for two reasons. In the mid-afternoon twelve of our bombers passed overhead to off-load over
Maleme , accompanied by prolonged cheering which could be heard for a considerable distance. These were the first aircraft carrying our insignia that we had seen since the invasion began. Later the same evening orders came through for our withdrawal and evacuation.”
On the afternoon of the sixth day, 25 May, the Germans attacked in force in the
On 24 May Captain Lomas, moving with Headquarters 10 Brigade, resited his RAP on the northern outskirts of
The 18th Battalion had been moved forward to the west of the Composite Battalion on 24 May and from the fighting near
When 18 Battalion retired behind Ven Archdeacon F. O. Dawson, MC;
On the afternoon of 25 May the enemy's fierce attacks produced about ninety casualties, which were evacuated with great speed once the defence line was broken. Here again the drivers of the light trucks did splendid work in the daylight, being subjected to aerial attacks most of the time. All the casualties had been evacuated by the time of the start of our counter-attack which led to the recapture of
In the retirement towards
Enemy pressure increased on this new line at
By 25 May the front line was only a few miles away from the medical units, which continued to receive casualties. During the day casualties from the air offensive were only moderate, but towards evening both 5 and 6 Field Ambulances began to receive a steady stream of heavy casualties from the fighting for
The evacuation was planned so that all equipment and the stretcher cases in the dressing station would be moved by transport, which necessitated three trips in the vehicles available, but the situation was further complicated by the necessity of detailing one truck to collect more wounded from forward areas. Delay also occurred because the prepared site at
The three marching parties, comprising the more lightly wounded walking cases and most of the staffs of 5 Field Ambulance and 7 General Hospital, halted within 500 yards of the church, but the tentage by the roadside was not found till dawn though one party, unable fully to resist sleep at the halt, were within a hundred yards of it in the darkness. Lieutenant-Colonel Twhigg and Captain Palmer and four or five others began to move stores to the selected site whilst awaiting the return of the transport. More tents were erected, Red Crosses displayed, and after hasty consultations the church was utilised as an operating theatre. The hamlet was deserted. Casualties soon came in, and those awaiting attention had, it seemed, the utmost faith in the
At first many were reluctant to remain in the tents while aircraft dived above them, but after the third dive without incident confidence in enemy respect for the
Through these unforeseen delays only two trips were carried out by the trucks before dawn. The first trucks left at 10.30 p.m. and were expected back for the second load at 1 a.m. on 26 May. When no trucks came, those remaining expected to be prisoners of war, and well they might have been had the Germans advanced during
As 7 General Hospital had had to leave 300 stretcher patients in their caves adjacent to 5 Field Ambulance and had detailed two medical officers and twenty men to look after them, the CO 5 Field Ambulance considered that an attempt should be made to evacuate the balance of his ambulance staff and as many of the patients as possible. The three truck drivers volunteered for this mission, but as a result of the air activity with the coming of daylight only one truck got through, the others being attacked and forced to return. The one truck, flying a
At midnight the CO 6 Field Ambulance (Major Fisher) had received orders from the ADMS NZ Division to evacuate 250 walking wounded, and as the unit still possessed only a single light truck, the majority of these men also had to walk. They reached the naval hospital and most of them were taken off by destroyers on 26–27 May. Then, at 4 a.m. on 26 May, Colonel Bull met Major Fisher and instructed him to move his unit to
Lieutenant Ballantyne and his small staff at the old site of 6 MDS found it was essential to bring all the 160 casualties into the
About 8 a.m. on the 27th the German advance was resumed, this time unopposed, and about an hour later the medical staff and Padre Hopkins were rounded up at the point of tommy guns by excited German soldiers and marched over to 7 General Hospital. En route an ugly situation developed when an English-speaking enemy officer accused the prisoners of shooting from the hospital building on his men. However, after the enemy had stolen their wrist watches, they were marched on until they came to an enemy RAP established at 7 General Hospital, and there they met the captured remnants of 5 Field Ambulance and 7 General Hospital.
A short time afterwards Lieutenant Ballantyne and some of the staff went back to the dressing station and found that one of the orderlies had been killed and another wounded in the assault on it.
At
At 6 p.m. on 26 May instructions were received from Colonel Bull to move at dusk to
During the night 2/1 Australian Field Ambulance had, on receipt of orders from
The New Zealand medical units proceeded to a transit camp about a mile and a half away on the
At the same time all walking wounded were directed to proceed from 2/1 Australian Field Ambulance along the same route and to follow similar instructions in respect to concealment at daylight. Two trucks were made available to assist with the more seriously
Two places with closely similar names,
Between
The party was joined shortly afterwards by another vehicle, also carrying a capacity load of sitting wounded in charge of Lieutenant-Colonel Twhigg. All the wounded were dispersed and, with limited means, dressings were adjusted and renewed, stimulants given, and a search made for water. The wells proved to be nearly three-quarters of a mile from the dispersal point. The only water available was what could be carried in water-bottles by those able to scramble to the wells. A truck was sent back for Colonel Bull but could not reach
In the later afternoon the party passed the divide and began to descend past
Other trucks from 5 and 6 Field Ambulances under the command of Major Fisher, CO 6 Field Ambulance, had proceeded beyond
About a mile south of
The trucks conveying the CO 5 Field Ambulance and patients arrived at the end of the road about 3 p.m. and there deposited the walking wounded at a walking wounded collecting post, under the charge of Captain A. C. Rumsey, RAMC, and a New Zealand staff.
At this point near
Immediately the walking wounded had been unloaded from the trucks, the vehicles were sent back along the same route to make contact with Colonel Bull and party should they have negotiated the road demolition south of
Colonel Bull and his small staff of Captain A. J. King, AAMC, and eight
At 5 p.m., a small group, Lieutenant-Colonel Twhigg and Major Fisher and some orderlies, established an MDS, on a previous order of Colonel Bull, in a church half a mile north of the embarkation control post at
As Corporal P. Curtis says:
We had gone about half a mile from the village when we came upon what seemed to be a stone church with a red cross painted on the roof, nestling in a sharp bend in the road. The roof was almost level with the road.
An officer was standing near the entrance, and as we were still wearing arm brassards, he told us to go in and help with the wounded. We had seen no other dressing stations on our way across the island or any wounded either, although we might easily have missed them in the darkness.
The stone floor of the church was covered with wounded on blankets and ambulance stretchers ranged all round the walls and down the centre. The altar, in an alcove at one end, was covered with shell and field dressings and a little food—cocoa, tinned milk, sugar and biscuits. There were quite a number of medical officers and personnel there and we set to work bandaging, applying splints and making the patients as comfortable as possible. Some were walking cases but many appeared to be more severely wounded and could not be moved.
Later in the night we were split into sections, each working for two hours and then changing over and sleeping outside.
In the morning we had our first wash and shave for several days—there were two or three razors to go round with a few extra blades. It worked wonders with our morale. The weather too was a help, fine, sunny days and cool nights.
This dressing station afforded a good example of what could be done by improvisation. The medical equipment which had previously been gathered together was in a truck that had since completely disappeared. This loss of equipment was very serious, for when the MDS opened there were only two surgical haversacks, an assortment
For those on foot the march across the island was a test of endurance even for the fitter members of the ambulance staffs, apart from the sick and wounded. They set off in small sections at intervals, and each man carried two tins of meat and vegetables. In the cool of the first evening, and while the road was still good, the pace was steady and most parties had made good progress by morning, when they halted and hid in obedience to orders that they were not to show themselves during daylight. On the second evening the going was harder as the road gave way to a rough track, only wide enough for one vehicle, which wound up into the hills in the interior of the island. During that night the groups began to break up as they grew tired and became mixed with other troops on the road. By daylight they were all dog-tired and a bit bewildered as to their whereabouts and destination. They kept on till forced by enemy aircraft to take cover. The surrounding country was extremely rough and rocky, mostly covered in scrub, but with small clumps of trees growing here and there.
Lying dispersed among the olive trees on the roadside during the day while the
Proceeding to the beach on the afternoon of 28 May, Major Christie and Captain Palmer, the two reconnoitring officers, found that Creforce Headquarters had recently been set up in a cave on the side of a deep gully on the way to the shore. In other caves there were one hundred patients and some medical officers from 189 Field Ambulance, which had established an RAP for the wounded, many of whom were in a state of collapse. Another party of one hundred walking wounded arrived under the charge of a medical officer of 4 Light Field Ambulance. All the wounded were held back in an assembly area two miles from the embarkation point, in order not to betray details of evacuation to the enemy, squadrons of whose planes ranged overhead all day, repeatedly bombing the road and surrounding ridges.
The
At dusk all wounded able to walk – and it was amazing the determination which was shown to complete the journey – were led in three columns down the steep, dry gully among the scattered boulders and clumps of oleander bushes, to what in winter must have been the bed of a sizeable torrent. About three miles or less from
There was little disturbance from the air. A light mist descended in the hollows. After what seemed a very long pause parties of fifty were allowed to proceed, but there appeared some hitches in communications over the three miles between the beach and the waiting columns. As the night wore on an urgent message came for another 200 to proceed, and then for as many as possible to get forward with all speed. The going was rough and the pace too slow.
Some time before dawn the remainder were instructed to go back and disperse in the original area. Some, however, reluctant to reclimb the steep hillside, elected to remain nearer the embarkation point. All but seventy of the wounded were embarked, as well
Napier, Nizam, Kelvin, and
On the morning of 29 May Major Christie was attached to the staff of 189 Field Ambulance to assist with the treatment of wounded and Captain Palmer established an RAP in a cave used by
At the MDS at
On the afternoon of 29 May walking wounded were transported in trucks, flying
A hasty muster showed that some hundred more were in the column than had set out from the caves below the road end. With the naval guard, arrangements were made for a final scrutiny of the bona fides of all in the walking wounded party. Over 600 walking casualties had been passed through the collecting post above
By nightfall on the 29th almost all the patients were on the move to the point at which they were to be concentrated for the final move to the beach, and sections of medical units were gathered for embarkation, including 5 and 6 Field Ambulances, 4 Field Hygiene Section, 2/2 and 2/7 Australian Field Ambulances, 7 General Hospital, and part of 2/1 Australian Field Ambulance. To assist the walking wounded, a proportion of one medical officer and five medical orderlies to each group of fifty patients was allowed by the embarkation authorities. It turned out that this proportion was inadequate, as many of the patients required assistance and the track to the beach was a nightmare even for those able-bodied and fit. This track had to be negotiated in the dark, and many of the patients, who had been subjected to severe ordeals and privations, found it extremely hard going to keep up, and all were apprehensive that they might be left behind. It could quite well have been arranged to attach one medical orderly to each three patients, and this would also have afforded a means of getting more of the medical personnel down to the beaches in time. However, the instructions of the embarkation authorities were observed, and only a portion of the staff of the medical units reached the beach in time to embark that night.
There was some difficulty with the embarkation authorities on the beaches that night, as they were endeavouring to single out the fighting troops with first priority for evacuation.
The medical parties which had reached the beach, although massed together, had to be identified by Lieutenant-Colonel Twhigg before the beach master would allow them to embark. In the darkness and the confusion among the massed troops some members of the medical units who had strayed, or who did not report to the medical post at the beach, were left behind. A number of Glengyle, which took many wounded aboard. Altogether, some 550 wounded were embarked that night. All cases requiring treatment were cared for by the ships' medical staffs and army medical personnel, and officers and men of the
About six thousand troops were also taken off that night by the naval force comprising, besides the Glengyle, the cruisers
During the night of 29–30 May the staffs of 5 and 6 Field Ambulances and 4 Field Hygiene Section set off from
On the morning of 31 May arrangements were made with the embarkation authorities to evacuate those patients and medical personnel who had arrived overnight. At 4 p.m. eighty walking wounded were conducted to Phoebe, the minelayer
When the evacuation of
It was agreed that these cases would have to be left with a proper proportion of medical personnel to look after them, while walking wounded only would be evacuated. On the news of this difficult decision filtering down to all ranks, many severely wounded made efforts to be classified as “walking wounded” in order to escape becoming prisoners of war. Men with severe injuries displayed almost unbelievable fortitude in marching a distance of 35 to 40 miles over rough and stony roads at night in order to reach
In the words of the Colonel Kenrick had served as an infantry officer at
As the stretcher cases were left in the caves of 7 General Hospital and in the wards of other temporary hospitals, more than the required number of medical personnel volunteered to remain and become prisoners of war with them; so much was this the case that Colonel Kenrick had to issue an instruction that additional medical officers and nursing orderlies would not remain unless given a direct order by superior authority to do so.
With the ever-increasing gravity of the news from
No. 2 General Hospital had also been receiving convoys of Australians from
Battle casualties from The quota of hospital beds required by the War Office from
When information was received that evacuation from Aba had cleared 602 cases of sick and wounded from
A few of the more seriously wounded from
In spite of the severe bombing and fighting to which the troops had been subjected in
In the very early stages of the occupation of
An adequate water supply was available in most areas from wells, but some of these became fouled owing to poor water discipline. In the withdrawal water was not readily available and some of this was contaminated, but lack of individual water sterilising tablets prevented purification. At the time of evacuation cases of dysentery became manifest.
On their disembarkation at
The campaign in
In the short but fierce battle for
In a survey of all the medical services on
After the experiences in
The display of Red Crosses on the site of the hospital could not be described as inadequate. Red Crosses were painted on the three buildings, a large one in stones was laid out between the officers' mess and the sea, and one of similar size in cloth was spread out in the area occupied by the hospital expanding tents. The weather
Yet captured enemy orders indicate that those who planned the attack on 3 Parachute Regiment issued on 18 May describe the area as a “tent encampment” with a “hospital barracks” and “hospital huts”. The regiment was to land in the
The Germans verbally stated they had seen troops in steel helmets traversing the area before the attack. It seems to have been a German practice to forbid the wearing of steel helmets in medical units, and although this had no basis in the Geneva Convention, the Germans seem to have assumed that other forces should follow the same practice. Steel helmets were worn in the area, and troops did pass along the road running through the area to the beach. A study of German orders does not indicate that the area was required for further air or sea landings, which was one of the conclusions earlier drawn from the attack. The aim seems to have been to eliminate any opposition from troops expected to be in the neighbourhood of the camp. But this hardly excuses the sustained attack on 20 May on what must have been perceived to be a medical unit.
From all the evidence at our disposal it would seem that the
There was insufficient transport for the conveyance of the wounded. Walking wounded had not only to walk between the dressing stations and the hospital, but most of them had eventually to walk across the island during the evacuation. Lying cases had to be left behind at the medical units, both because of lack of vehicles and the impossibility of embarking stretcher cases at
Constant machine-gunning of the roads after the invasion made conditions still more difficult and often caused serious delay; it was only by strenuous efforts on the part of medical officers and drivers that the essential work was carried out. At times lorries were found
It was found that, generally, the German airmen respected the
The RMOs, especially those attached to 5 Infantry Brigade, experienced great and unprecedented difficulties during the violent and confused attack, particularly in the
Fortunately, their medical supplies were supplemented by German supplies dropped by parachute, and these were found to be of excellent quality, both as regards drugs and dressings, even containing tubes of glucose saline and surgical operating equipment. The RMO of 21 Battalion stated that he obtained adequate supplies of opium by this means when his own supply of morphia was exhausted.
All the RMOs of 5 Infantry Brigade, with the exception of the RMO of 28 Battalion (who was wounded, losing an eye), were captured. They remained behind with the seriously wounded, including a large number of Germans, when their battalions withdrew. Many walking wounded were able to retire with the brigade.
Owing to the nature of the fighting and the ground fought on, the regimental medical officers could expect little
The collection of wounded in the forward areas was carried out only with great difficulty in the chaos brought about by the scattered landing of the paratroops. Nevertheless, the work was conscientiously and efficiently done, and the seriously wounded had the benefit of continued attention during the difficult period of early captivity.
Difficulty was experienced in the siting of field ambulances, dressing stations, and hospitals. Neither the force nor the individual units had had any experience of an airborne attack. The 7th General Hospital had been established before any such attack was seriously thought of. The lack of transport and the conditions of the terrain made the siting of the dressing stations near the main roads a natural decision. It thus came about that the main hospital (7 General Hospital) was erected close to the shore in an area peculiarly liable to both airborne and seaborne attack. One MDS was originally placed at a crossroads and then under a culvert on the main road, positions certain to be subjected to air attack. The selection of sites was thus made very difficult, as the dressing stations had to be kept away from main roads and also from any open space where paratroops could be readily landed. The dressing stations had also to be placed in positions where they could be defended by the combatant troops. The differences of opinion which arose between the senior medical officers with regard to the siting of the units exemplify the difficulties of the problem.
Fifth Field Ambulance set up a very efficient dressing station in the officers' mess building of 7 General Hospital and did excellent work there, although the ADMS considered the site unsuitable. The 189th Field Ambulance established a large hospital in buildings at
The men arrived in
Shortly after the arrival of the troops many of them suffered from a transient attack of diarrhoea, and towards the end of the campaign mild dysentery was also present, but not to any marked extent.
A British hygiene section had been stationed in
There were no cases of typhoid. Venereal disease had been very prevalent among the garrison troops, but the incidence in our troops in the short and active period that they remained on
The casualties on In numbers of killed, casualties in
The team was first attached to 5 MDS and then to 7 General Hospital to fill the place of a specialist surgeon killed by a bomb on 18 May. The team was then attached to 189 Field Ambulance hospital at
Fifth Field Ambulance was called upon to perform a considerable amount of surgical work, both at
The actual wound treatment varied according to the skill and knowledge of the medical officer and it was natural that some of the surgery was not up to the highest standards. The surgical team reports instances of wounds sutured at the field ambulances with unsatisfactory results. Luckily, there was available our own surgical team and the skilled surgeons at 7 General Hospital, who coped with the greater number of the heavier cases and who had knowledge of the best surgical wound treatment. The wound treatment carried out by our surgical team consisted of débridement, with removal of all soiled and damaged tissue – particularly muscle – with free opening of the wounds and with acriflavine dressings. The serious loss of serum was noted in the large wounds, and also the relative freedom from injury of the nerves and blood vessels.
Fractures: After the usual wound treatment the cases were splinted as follows:
Femur: The Thomas knee splint was used and our surgical team employed a special technique. From ankle to mid-thigh was enclosed by two Cellona plaster bandages. A strong calico bandage was laid on this, passing over a spreader below the foot and coming up on the other side of the limb. Three more Cellona bandages were put on over this. The limb, complete with its plaster casing and extension, was now placed in the Thomas knee splint, the calico attached to the end with rubber tubing – if available – the splint slung from the Thomas crossbar on the stretcher, the footpiece applied, and finally the foot of the stretcher raised to provide extension by the counter body-weight method. This illustrates how one surgeon worked out a combination of plaster and Thomas splintage, which as the
Tibia: Plaster closed splint applied.
Humerus: Plaster back slab with collar and cuff, or Kramer wire splints. In fractures of the lower end of the humerus, extension of the elbow below 90 degrees was carried out.
Amputations: These were usually carried out for gross destruction of bone and joint. No guillotine amputations were performed, short anterior and posterior flaps were used, and the site of election was selected. The ends of the wound were sutured, but the central part was left open for drainage. No tubes were used. Main vessels were doubly-ligated and the nerves were simply cut across in the upper part of the wound. In amputations of the lower limb the tourniquet was used, but in the upper limb only digital control of the brachial or subclavian was employed.
In the case of shattered limbs the surgeon employed a simple rubber band just above the lacerated end, to be left on during resuscitation to control haemorrhage, leaving undamaged all the tissue above, through which the amputation would be performed.
Head Wounds: These were excised and the wound closed by use of an S-shaped flap. A head tourniquet was used and an improvised table formed from a stretcher, with a bandage between the bars forming a head rest.
Chest Wounds: These were dealt with very conservatively by aspiration and air replacement. Open sucking wounds, if not already sutured at the field ambulance, were closed, but few of such cases were seen. Detached pieces of rib were removed. No open exploration of the chest was carried out, nor was it ever considered necessary.
Thoraco-abdominal Wounds: All such cases produced by the German explosive bullets were noted to be fatal.
Abdominal Wounds: These were not very frequent. They were all explored at once. The small bowel was generally damaged, the large bowel frequently escaping in a surprising manner, especially in transverse wounds. It was noted that resection of the small intestine caused a heavy mortality. The mesentery and omentum were often found damaged, producing an abdomen full of blood. The rectum was noted to be often injured in sacral wounds, and these cases were generally fatal from toxaemia and probable peritoneal infection. No such case survived, although one lived for five days after a transverse colostomy. The bladder was sometimes injured and catheterisation was always resorted to if any doubt existed, and an in-dwelling catheter left in if any bladder injury was present. No cases of liver, stomach, or splenic injury were encountered.
Shock and Haemorrhage: Treatment consisted of the application of warmth by hot bottles, the relief of pain by morphia (gr. ½) and the splintage of fractures, the elevation of the foot of the stretcher,
Dried plasma in limited amounts was available at one field ambulance. It was necessary to cut down on the vein and use a cannula. Blood was not used, though transfusion sets and citrate were available at 189 Field Ambulance. The intensity of the surgical inundation precluded its use. The suggestion was made that a special blood transfusion team, consisting of a medical officer and two orderlies, should be attached to the Division, with supplies of dried plasma, a portable refrigerator, and a few pints of blood ready for use.
Gas Gangrene: Only one fulminating case was seen by Major Christie, with infection spreading up to the umbilicus; death occurred twelve hours after admission to hospital. Several cases of limb wounds showed gas in the tissues. These were treated by excision of muscle and muscle groups, and freely opened to facial planes. No amputations were necessary for this condition. Serum was given.
Lieutenant Ballantyne saw several severe cases at 6 ADS and cases were seen later after evacuation of prisoners to
Sulphonamides: A dosage of 2 grammes, followed by 1 gramme in two hours and then four-hourly for forty-eight hours, was given by the mouth to seriously wounded cases. No sulphonamide was used locally on the wounds.
Foreign Bodies: These were removed when readily accessible or large, but otherwise no time-consuming search was made.
Severity of Wounds: It was noted that the German wounded had much less severe wounds than our own men. The German aerial bomb, trench mortars, explosive machine-gun and cannon-gun shells inflicted more severe wounds than our .303 bullets. The Schmeisser bullet was as severe as a machine-gun wound, if fired at close quarters.
In
It was not until the later stages of the battle that it was known at Creforce Headquarters that so many medical personnel were remaining with the wounded. An order was then issued by the
In the hurried retreat to the southern coast close contact between medical units and with headquarters was difficult, and danger arose of two medical units both leaving personnel in the same area. This happened when, at 5 Field Ambulance MDS, two medical officers on their own initiative remained behind, and the nearby 7 General Hospital also left behind medical officers and personnel – a needless duplication. The medical officers generally acted without orders from higher authority, as they felt their individual responsibility keenly, and no definite ruling was available. Circumstances were such that instant decisions had to be made.
These officers showed a noble spirit of self sacrifice and are to be commended for their altruistic zeal, but the policy determining their actions should be clearly laid down by higher authority to prevent unnecessary loss of valuable personnel. Such was the lesson that was learned in the campaigns in
As regards the other ranks of the
The problem of the shepherding of the walking wounded across the island and giving them medical attention during that period was fraught with considerable difficulties. The majority of the slightly wounded had to make the trip on foot, travelling during the night on a road crowded with a rather disorganised medley of troops and refugees and a variety of vehicles, and lying up under the olive trees during the day. The force orders were that road traffic should cease during the day, but it was impossible to enforce the order strictly, particularly during the last days of evacuation. There were thousands of
Large dressing stations were set up by our New Zealand units as well as by British and Australian medical units, especially near the coast, where the men could be collected and helped during the embarkation. The steep and narrow road down the cliff to
The embarkation would have been speeded up – had it been realised at the time – if a larger proportion of medical personnel had been detailed to help the wounded down the cliff; this would have had the added advantage of allowing a large number of personnel of the medical units to be embarked when extra space in the ships was available. It was so very much a question of the speed of the embarkation, as the naval ships had to be as far as possible out of bomber range before daylight.
The troops who were policing the embarkation had an exceedingly hard task, since in the darkness they had to check all troops for their priority, as laid down by GOC Creforce. The large number of Greeks and
In considering all the circumstances the percentage of the force evacuated was satisfactory, and the number of wounded men, some of them seriously wounded, who got away from
The
Graded Men: The most important outcome, as far as our New Zealand force was concerned, was the attitude thereafter of the senior officers of all units towards the use of graded men in the Division. The severe strain thrown on men marching across the rough and hilly road so impressed itself on these officers that they considered that, in future, none but Grade I men should ever be accepted in any divisional unit – even if normally transport would be available. Men with foot disabilities, who had been detailed for duty in the ASC and other units with transport, were considered especially unsatisfactory in the Division. This attitude was so prevalent that the name “Creteitis” was given to it. It perhaps brought about some unnecessary transfers of personnel with minor disabilities from the divisional units. Fortunately, never again during the war was the Division faced with a similar problem, so the over-anxiety regarding the use of slightly disabled men proved to be unnecessary.
The Geneva Convention: It was recognised as a result of the experiences in
Value of Surgical Teams Attached to Divisional Units: There is no doubt that the attachment of a surgical team from
The loss of a specialist surgeon attached to 7 General Hospital made the team doubly valuable, and a second team would have been most welcome. The problem of whether the forward surgery should be done in the ambulances or at the CCS did not arise here, as there were no official casualty clearing stations and the general hospital was itself a field unit, so that there was little or no distinction between any of the medical units, each one in turn dealing
Improvisation: The New Zealand units landed in
Blood Transfusion Team: The impossibility of carrying out blood transfusions during a rush of casualties, without there being any special team available for that purpose, was recognised. Transfusion sets were available in 189 Field Ambulance hospital, but no transfusions were given. Our surgical team attached to this hospital recommended that a team of one medical officer and two other ranks should be established and attached to the Division, and that equipment, such as portable kerosene-operated refrigerators, should be obtained.
Transport: Naturally, in
Dispersal of Medical Stores: The stores of 7 General Hospital were all kept in one tent – in which it was stated that ether was also kept – and unfortunately this tent caught fire during the attack on the hospital. The dispensary tent was also burnt, so that nearly all the medical supplies were destroyed. The dispersal of all essential equipment and stores should be carried out under any circumstances, and especially where damage by the enemy is likely to occur.
There was every reason to be proud of the New Zealand Medical Corps in
Of the prisoners of war, 15 officers and 510 other ranks were wounded, and of these 1 officer and 36 other ranks died of wounds.
FROM
Colonel McKillop, 13 officers, and 69 men of 1 General Hospital arrived at
The matron and the fifty-one nursing sisters arrived in
An inquiry was held by Headquarters
Colonel McKillop was admitted to hospital shortly after the return of the unit to Maunganui on
When 6 Infantry Brigade Group, with 4 Field Ambulance attached, arrived in
At the end of May those members of 5 and 6 Field Ambulances and 4 Field Hygiene Section who were evacuated from
A training schedule was arranged as fully as limited equipment would allow, and the units carried out some interesting work on camouflage in the open desert. It was found that slit trenches could be effectively hidden from air observation by the use of coarse netting and less effectively by scrim. In addition, arrangements were made for nursing orderlies to undergo refresher courses at 2 General Hospital,
The 4th Field Hygiene Section supervised a course of instruction in hygiene and sanitation for representatives of divisional units and supervised the hygiene of the camp. Major Williams, OC
Considering the trying nature of operations in
On 5 May
Word was received by
The number of cases from the transports for actual admission to hospital was fewer than was at first indicated as the epidemic was on the wane, but it was decided to adhere to the arrangements already made. After admitting 290 infectious patients on 13 May, 3 General Hospital was isolated until 26 May, and as a result of the precautions taken the epidemic did not spread to the rest of the New Zealand force in
This unit under Colonel Gower had arrived in
As equipment arrived the hospital was gradually established, although it was well into April before medical equipment was received. On 24 April the first 134 patients were transferred from 2 General Hospital, a further convoy of 57 arrived from the
On 12 May all patients except seven were transferred to 2 General Hospital to make room for the admission and isolation of 261 influenza cases from the 5th Reinforcements, following the epidemic experienced on the voyage from New Zealand. The hospital and staff were isolated from 13 to 26 May.
On 29 and 30 May 387 battle casualties from
The Prime Minister of New Zealand, the
A survey of the strength of the medical units of the New Zealand Division on 12 June showed that, as a result of the operations in
In the following three weeks medical and ASC reinforcements were posted from Base, and these, together with thirty-nine volunteers (graded men) transferred from the infantry to the Medical Corps, resulted in the units being only sixty men short of full establishment. (This figure excluded first reinforcements of seven to each field ambulance.) The strength of units at the end of June was:
In base units there was a deficiency of seventy-three other ranks in 1 General Hospital and of twelve in the
A similar position obtained as regards medical officers. Divisional units were made up to strength at the expense of the base units, principally of 1 General Hospital which, though not functioning, was short of thirteen medical officers. When due allowance was made for the imminent increases of war establishments for 2 and 3 General Hospitals and 1 Camp Hospital, as well as the extra full-time appointments of a Consultant Physician and a Consultant Surgeon, it was assessed by the
Strong representations were therefore made by
The
At a conference of senior medical officers called by
The exchanges were limited in number as the ADMS NZ Division did not wish to part with his own officers just as they had become most efficient in field work. Some medical officers made requests for particular positions on the basis of alleged undertakings given to them in New Zealand. Such adjustments could not always be easily achieved and Brigadier MacCormick reported to DGMS Army Headquarters that, in his opinion, the only condition on which officers should proceed overseas was that they should undertake duties irrespective of time, place, or conditions. In his reply the DGMS maintained that he had made no promises of specific duties.
Re-equipment was a question of major importance for the medical units who had lost almost all their equipment in
The staffs of the medical units had also lost considerable personal kit as well as some personal medical instruments and books during the campaigns in
The question of the loss of books brought up the larger matter of hospital libraries. In a report in June
I submit that a medical library of books recognised as authoritative on their different subjects is a necessity for the proper functioning of a hospital either in peace or war. In peacetime the individual physician or surgeon has at his command a personal library of such books without which he could hardly function. He also has access to medical libraries and also to the individual libraries of his colleagues. The books are required for two cardinal purposes. Firstly, for reference in cases of difficulty, especially when the disease or injury is an uncommon one; and secondly, for post-graduate study so as to supplement the knowledge already possessed by the practitioner. In war, authoritative books are, if anything, required still more as no reference libraries are available and conditions are encountered which are not normally met with in civilian practice.
Brigadier MacCormick instructed the hospitals that it was a legitimate use of the funds placed at their disposal by the Joint Council of the
By the end of June 4 Field Ambulance had its medical equipment complete, but none had been issued to the other units. Indent had been made for a limited amount of medical equipment for training purposes only. None of the field ambulances had any ordnance equipment, and training without transport was necessarily limited in scope.
During June 1 General Hospital was able to draw the major part of its G. 1098 equipment from ordnance. No medical equipment had come to hand and the unit had nothing except the surgical instruments brought back from
On 14 July both 5 and 6 Field Ambulances received their I. 1248 equipment, so that all three field ambulances then had complete medical equipment. At the same time fifteen sets of medical equipment for RMOs were delivered, completing the Division's requirements in this connection. During July and August each of the field ambulances received eight motor ambulance cars, and in August the medical units also drew most of their ordnance equipment. It was also approved that each field ambulance should be issued with eight light tarpaulins (30 ft. by 40 ft.) and six 160-pound tents to
Before returning to the
The question of the open display of
Difficulties arose at this stage in obtaining an adequate supply of expendable medical stores for use in divisional units. This state of affairs continued for some months, but was, of course, due to the difficult supply position in the
On 15 July 4, 5, and 6 Field Ambulances and 4 Field Hygiene Section took part in a ceremonial parade for inspection by the GOC
This was a noteworthy occasion in that it was the first time during the war that all three field ambulances and the field hygiene section had been on parade together. The
Special efforts had to be made to raise the standards of hygiene and sanitation in
The latrines in
The general standard in cookhouses and messrooms was fair. Extensive fly-proofing was undertaken although the flies were not as numerous as in
Mosquitoes were scarce but anti-malaria control was instituted. The issue of cresol for disinfection was cut down to 1 ½ gallons per 100 men per month; it was also of poor quality and was conserved for use outside latrines and messrooms for sterilisation of the hands.
Although it was summer and 5 Infantry Brigade and the 4th and 5th Reinforcements were comparative newcomers to
The general health of the troops remained satisfactory during July, although many men felt the effects of training in an Egyptian summer and the number attending sick parades with minor ailments
The troops were issued with drill shirts and shorts for wear during the daytime throughout the summer and long trousers for wear during the evenings. This dress proved very suitable in every way. Pith helmets were on issue on return from
This was always adequate in amount and variety. Difficulties arose in the supply of fresh vegetables in the hot weather as much of the ration was unfit for use. Locally killed Sudanese buffalo beef was in normal supply.
Inoculations were brought up to date for the whole of the Division at the end of June, and blood groupings were also checked.
Intensive training was carried out during July and was especially valuable for the more recent reinforcements. Each field ambulance submitted a weekly training syllabus to ADMS NZ Division, who in turn submitted a summary of training to G Branch, Headquarters New Zealand Division.
Training during July included the following:
Route marching.
Erection of dressing stations in desert warfare.
Contents of medical panniers and use of recently issued equipment.
Water testing.
Gas:
Gas casualties;
Protection of food supplies against gas; and
Medical aspects of gas warfare.
Technical training.
Treatment of wounds.
Use of plaster.
Drugs, injections, etc.
Blood transfusions.
Nursing – nursing orderlies trained at 2 General Hospital.
Anti-malarial measures – practical work under direction of OC 4 Field Hygiene Section.
Treatment of VD – course at 1 Camp Hospital for three specially selected officers and six men.
Recreational training and interior economy.
Map-reading and message writing – for officers and NCOs.
The 4th Field Hygiene Section, in addition to the supervision of hygiene and sanitation of both
Water testing.
Anti-malarial measures (including a survey of the cultivated area on the banks of the
Disinfestation.
Supervision and chlorination of swimming baths,
On 22 May 1 NZHS Maunganui arrived at
The Maunganui was a ship of 7527 tons and, though thirty years old, was larger than both the
The theatre block was exceptionally well appointed and comprised the main theatre, plaster room, and rooms for X-ray, sterilising, massage, laboratory, dispensary, and diathermy, with a dental surgery nearby. All essential lighting was duplicated on emergency circuits and the whole theatre block was ideally situated forward under the bridge. The electric lifts were also connected to the emergency circuit. An adequate hot and cold water-supply to wards was fed from a huge tank specially installed to hold between 700 and 800 tons of water. There were refrigerators in every ward. Altogether, the ship was impressively equipped. Some of the special equipment had not been available in New Zealand and was secured urgently from Maunganui was described by the commander of a British hospital ship as the best-appointed hospital ship he had seen during the war, and Colonel MacCormick reported that it was the unanimous opinion of all officers from the GOC down that New Zealand had every reason to be proud of its hospital ship. The ship was staffed by 104 medical officers, nursing sisters, and orderlies under the command of Colonel
Maunganui Apr 1941–Feb 1942; died
Maunganui Apr 1941–Feb 1942, Aug 1942–Nov 1944;
The ship was held at Manunda in Wanganella, so it was a pleasure to be able to reciprocate on HS Maunganui. The co-operation of the Australian and New Zealand authorities in sharing hospital ship facilities was a feature of the medical services throughout the war. HS
The Netherlands hospital ship Oranje arrived at Oranje for use as a hospital ship to bring back sick and wounded from their forces in the Oranje was a luxury liner of 20,000 tons completed only in
The Netherlands Government was responsible for the cost of the conversion of the Oranje and for her upkeep, including surgical equipment and medical stores. The ship's staff comprised 327 officers and crew of the Oranje, as a member of the Allied shipping pool, made most of her voyages between the Oranje and the assistance of the Australian ship Wanganella enabled HS Maunganui to cope with the evacuation of sick and wounded from the
Divisional combatant units went to the
Kabrit Camp was situated 20 miles north of
Typical desert conditions existed in the camp area, which was subjected to frequent dust-storms. Drainage was most unsatisfactory. There was very little depth of surface sand and beneath it was a deep layer of impervious strata which precluded the deep soakage of ordinary drainage. The existing shallow soakpits were filled to overflowing within a few days of the occupation of the camp. It became obvious that the only effective system would have been the construction of covered drains leading down to the
Fifth Field Ambulance established a camp reception station and arranged for the evacuation of patients to 19 British General Hospital,
In view of possible amphibious operations in the future, swimming instruction was given to members of 5 Field Ambulance, especially as it was found that 30 per cent of the men were unable to swim. Training in combined operations with 5 Brigade was also undertaken, this involving crossing the canal in landing craft in assault exercises, landing, and establishing medical aid posts at a bridgehead. Amphibious operations, however, were not destined to be included in the roles of medical units in active warfare.
Fifth Field Ambulance returned with 5 Brigade to
In September the Division moved back to the
During the summer of
Infectious diseases endemic in
Slightly fewer than three hundred malaria cases were admitted during the summer months from both the base camps of
Infective hepatitis had been common in mild form in
Skin conditions accounted for a high proportion of minor sickness in unit lines and also for many admissions to hospitals, where their chronicity kept many beds occupied. Seborrhoeic conditions were especially troublesome and fungus infection was common at
Dyspepsia was a common complaint, the majority of the cases being functional in origin, though there was a small proportion of ulcer cases, most of them with a pre-war history. Unfortunately, the careful investigation of these cases in hospital tended to fix the neurosis and few of the hospital cases were subsequently of any use in the Army.
Psychoneurosis became a major problem and appeared in many forms. The large majority of the cases arose at the base in men either with a previous history of nervous disorder or with an unstable personality which could not stand the strain of disruption from their civilian surroundings. Anxiety states were common but hysterical states were not often seen. Exaggeration of minor disabilities such as flat feet was noted. Colonel Spencer drew attention to the danger of implanting ideas of disability in the soldier.
In May attention was drawn to the prevalence of functional disorders of the eye, with signs of diminution of visual acuity, contraction of visual fields, blepharospasm, photophobia, and weakness of accommodation. In May 28 cases were seen at
At
This unit proved very valuable for the convalescence of senior officers after
The camp hospital dealt with the minor infectious diseases and minor cases in the camps not likely to be in hospital for many days, as well as the cases of venereal disease. It eased the load of the general hospitals considerably as well as simplifying the isolation of infectious cases. Measles, mumps, influenza, and sandfly fever patients were admitted, and in May a special emergency hospital and convalescent area was set up to deal with the influenza cases among the 5th Reinforcements.
The number of venereal disease patients admitted to Maadi Camp Hospital gave rise to some concern, especially when in June and July the total number of cases in
The problem was one common to all forces in
In July and August 1941 a follow-up system was organised to ensure that all patients completed their surveillance at field ambulances after their discharge from Maadi Camp Hospital, especially as regards syphilis patients who now numbered 51, and that case records were sent to the DGMS Army Headquarters for any troops who returned to New Zealand while still under treatment. One medical officer in each field ambulance was given special training in the treatment of venereal disease so as to enable the follow-up to be satisfactorily carried out. By
A blood bank was formed at the Camp Hospital in
Of the three reinforcements arriving during this period, the 5th and 7th brought many cases of infectious disease with attendant problems for the medical services in
The following table shows the number of sick patients admitted to hospital for the period June–December 1941:
The surgical work performed in the hospitals during the period consisted largely of the treatment of ordinary conditions as met with in a civilian population of healthy young males, such as the repair of herniae, operations for appendicitis, the treatment of piles and varicose veins. More serious conditions such as malignant disease were seen only in small numbers. There were three cases of seminoma testes. Some cases of tubercular epididymitis showed acute symptoms with early abscess formation. Genito-urinary cases were common, and it was fortunate that Lieutenant-Colonel
After the Libyan campaign of December 1940 and January 1941 there was a lull in admissions, and in Maunganui on 10 June, so that only 32 operations on battle casualties were performed in July. The battle casualties did not call for the expected volume of work following the campaigns in
A report by Lieutenant-Colonel Ardagh on the 617 battle casualties admitted to 2 NZ General Hospital from
The review shows quite clearly the very small number of serious casualties admitted, mainly due to the impossibility of evacuating the heavy cases from
Lieutenant-Colonel Ardagh said:
We have again watched with great interest the effect of the early application of sulphanilamide paste to battle casualty wounds. The vast majority of the group had no sulphanilamide paste and it is the unanimous opinion of our surgical staff that so far as our close and controlled observations indicate, there is no reason to believe that sulphanilamide paste offers any advantage whatever: on that point we are quite convinced. Although we do not feel justified in condemning its use, we are firmly of the opinion that it causes unhealthy and sluggish granulating wounds without in any way preventing suppuration and infection. These remarks apply only to the use of sulphanilamide as a local application. In cases where sulphanilamide chemotherapy plus sulphanilamide local has been employed, we believe the beneficial results can be ascribed to chemotherapy alone.
During the period from July to September our hospitals admitted only 77 battle casualties, many of them being re-admitted from the
Due to climatic conditions there was more than the ordinary percentage of ear, nose, and throat conditions. It was thought that swimming, especially in the fresh-water baths at
There was little acute eye trouble, but a great deal of work was concerned with the supply of glasses for defective eyesight and in the treatment of eye infections. Eye wounds were not very common.
At Helwan 2 General Hospital had an X-ray department and full investigations could be carried out, though difficulty arose with fluctuations in the local power supply. The bacteriological laboratory was kept busy and steadily increased the scope of the work undertaken. It proved to be a very essential service to assist with the treatment of tropical disease, especially of dysentery. From
A dental department which was started in
A splint-maker was posted to the staff in
The out-patient service was very extensively developed at
The institution of an occupational therapy service was started in
At
Considerable numbers of New Zealand patients were admitted to British hospitals at this and all periods while the Division was in
On their return from
Extra equipment required or desired by medical units was listed and efforts made to procure supplies either through the army channels or from commercial firms in
Both consultants were busily occupied with boarding and the approval of boards, and in October, on their recommendation, the boarding form was altered.
The administration of the supplies and money sent over by the
The sick and wounded fund of the Joint Council proved especially valuable in procuring extra equipment for the rest homes and other units not on ordinary army establishment.
The many dentures lost or broken on hard biscuits in
Considerable reorganisation of hospital units took place in August. The arrival of the 6th Reinforcements allowed the re-formation of 1 General Hospital as an active hospital, and steps were taken to effect this. The male staff was gathered together from their relieving duties with other medical units and began training. Following the disruption of the hospital during the evacuation of
On 10 August
Other appointments made at this time were Lieutenant-Colonel Cottrell as officer-in-charge medical division 2 General Hospital, Major
Reorganisation presented many difficulties, especially, as was inevitable, when more of the most capable and experienced surgeons and physicians were promoted to administrative positions. This was found to be a recurring feature in later years. At this stage there was a pressing shortage of physicians. No. 3 General Hospital had only one general physician on its staff, after a rearrangement of physicians following a conference called by
There arose in the medical services of the
An effort was made in September to obtain medical officers from
The senior members of the hospital staffs were promoted to the rank of major at this time, thus removing some of the anomalies inherent in the rigid establishments. In the New Zealand Medical Corps there was no provision for specialist appointments dependent on the qualifications of the officer such as existed in the RAMC, the only appointments being those defined in the hospital establishments, such as that of divisional officer, and the provision for a limited number with the rank of major in the unit.
In the RAMC, on the other hand, officers were given the rank of major when they were qualified as specialists in different branches of the profession by the possession of senior academic qualifications such as the FRCS. This resulted in many young officers with recent qualification and short experience holding the rank of major, whereas in the New Zealand Medical Corps, in which a considerable number of older men volunteered early for service, there were several leading practitioners of the highest qualifications and with long experience who held the rank of captain; the majority of them later became divisional or commanding officers of hospitals. In course of time, with the recruiting mainly of the younger men, the position rectified itself, though some anomalies still remained, such as the inability of any of the specialists to be ranked higher than major if they could not function as divisional officers.
Clinical meetings were held regularly in our general hospitals and addresses were given both by visiting medical officers and members of our own corps. This had an educative and stimulating effect, undoubtedly improving the quality of our professional work.
At least one New Zealand general hospital was required to change its location in view of the impending offensive in the
The
Prior to the taking over of the administration of the
No. 1 General Hospital then began to take over
At their new site on the northern boundary of
When 2 General Hospital came to hand over to 1 General Hospital at
In his review Colonel Spencer made the following interesting comment:
It took us medical officers many weeks to become acquainted with ways and means, channels of communication, adapting our therapeutic ideas and demands to the supplies available to an Army hospital on active service, particularly in a sphere where supplies were of necessity almost always short. There were times when some felt that medical and surgical considerations
After the unit had moved from the hospital at
There is always the danger of a unit becoming too ‘set’, and we realised that the conditions under which we had been working had been as near to those of a civilian hospital as would be possible in an Army on active service. Since the unit moved out to their new camp we are unanimous that the change-over has been for the good of all concerned. Officers and men alike have already lost that feeling of staleness that was becoming apparent due to the sameness of work day after day under the trying conditions of an Egyptian summer. This applied perhaps more to the Other Ranks who had carried the weight of the hospital work, which had to go on whether the staff were up to establishment or not.
A mobile surgical unit, based on the head and chest units organised in
Operating theatre equipment was obtained from Morris Motors at Oxford; surgical instruments were purchased from several firms in
The surgical instruments and other equipment were fitted into separate boxes so that, if necessary, all the equipment could be taken out of the van and carried in an ordinary truck.
There was no similar unit in the British Army, and all the original British head and chest units had been lost in
An establishment of 5 officers and 29 other ranks, as well as 9 ASC drivers, was drawn up and tentage and ordnance equipment for a self-contained unit were requisitioned. Transport consisted of four lorries in addition to a staff car, a motor cycle, and the special van. A water cart was also supplied. The unit was able to work two surgical teams with full equipment for all types of forward surgery. It was first set up in
The DMS
That the unit is very handsomely equipped for doing surgery,
Has ample transport,
Has reached a high state of efficiency in all departments of its work.’
The unit rapidly reached a high degree of keenness and efficiency. Some doubt, however, was expressed by British administrative officers concerning the desert-worthiness of the van. The unit was ready for service during the Second Libyan Campaign. It was agreed by the
The unit which resembled the New Zealand MSU most was
The establishment of the
The 7th Reinforcements arrived in
It was now possible to finalise the long-deferred formation of a casualty clearing station which, as
Towards the end of June ten ambulances provided by the Anzac War Relief Committee of
The Matron-in-Chief
It was also decided at the conference of senior medical officers on 10 June that future promotions of NCOs above the rank of corporal should be on a corps and not a unit basis. Various anomalies had arisen through: (a) excessive losses in some units; (b) formation of new units; (c) arrival of reinforcement NCOs. The new system would ensure that the claims of all suitable men were considered for promotions. For the purpose a complete nominal roll was compiled. The system could not be of complete general application in that certain NCOs were specialists such as dispensers and radiological and laboratory technicians.
Promotion of NCOs was always a vexed question. In order to prevent difficulties and disappointments
When the 6th Reinforcements arrived at the end of
This system was applied fairly successfully with the 7th Reinforcements, but with a break of over a year before the arrival of the 8th Reinforcements, some of whom had substantive rank, the system was not so rigorously applied then or at later dates. Consequently, there were always grounds for a certain measure of discontent on the question. Unit promotion also came to be the accepted rule instead of corps promotion, except for first appointments to commissions.
A new medical position was established on 9 May when Major Kirker was instructed to assume the duties of senior medical officer
New forms were introduced at that time. Form NZEF 22 was printed and used from 12 May onwards in place of Form NZ 179 previously used for medical boarding, and Form NZEF 51 introduced to get confirmation from his unit of statements made by a man relating to injuries sustained in the forward areas.
A conference of senior officers convened by the
As opposed to conditions in
Numbers of soldiers of the 5th Reinforcements appeared before medical boards soon after their arrival in
During July 155 men were sent by commanding officers to ADMS NZ Division for regrading, and of these 149 were transferred to Base for reboarding. Orthopaedic cases, particularly flat feet, predominated and an unduly high proportion were cases from late reinforcements. This suggested the necessity for stricter medical examinations in New Zealand. The ADMS NZ Division commented that, to say the least, it was most uneconomic to train and equip men, send them overseas, and then, as soon as they reached the Division, start them on their homeward journey to New Zealand.
Instances were still brought to notice of men who should never have been accepted for service overseas. Cases with histories of head injuries, epilepsy, asthma, and peptic ulcer were quite common. The
Major Coverdale at that time stressed the desirability of retaining in the Division the many men whose eyesight was unsatisfactory for shooting but who could be used for other or non-combatant duties. He stated that the men deteriorated badly if sent back to Base, and further suggested that ophthalmic investigation at mobilisation camps in New Zealand would result in the elimination of unsatisfactory men from overseas drafts.
Graded men presented a problem in the a, 102 in Grade II, 42 in Grade III, and 370 in Grade IV for return to New Zealand. The analysis of only two months' medical boards—for July and August 1941—shows that 892 men appeared before medical boards in this period, and of these 86 were placed in Grade I, 56 in Grade
a, 247 in Grade II, 38 in Grade III, while 465 were graded for return to New Zealand. The most common disabilities in the last group of 465 were: functional nervous disease 76; organic nervous disease 29; accidental injuries 33; battle casualties 31; arthritis 37; gastro-intestinal disorders 25; peptic ulcer 17; otitis media 24; asthma 21; skin disease 21; respiratory disease 23; and rheumatic fever 11.
An analysis of the 600 graded men, other than those already on the New Zealand roll, at a, 415 Grade II, and 72 Grade III. Their disabilities were: foot disabilities 126; functional nervous diseases 70; accidental injuries 66; arthritis 41; cardio-vascular disorders 36; eye disabilities 33; otitis media 25; deafness 24; fibrositis 20; mental dullness 19; dermatitis 15; asthma 14; battle casualties 12; respiratory diseases 11; organic nervous diseases 11; gastro-intestinal disorders 10; others 67—total 600.
This was regularly carried out both by the staffs of the general hospitals and also by specially constituted boards at Maadi Camp Hospital where, at first, the consultants acted on the boards till they took over the approval of the boards from the
Attention was drawn to another aspect of the unfitness of troops by CO 2 General Hospital, Colonel Spencer, in July when, referring to the numerous out-patient attendances for opinions of specialists at the hospital, he said:
.… It would appear that COs of units are still very apt to try to get rid of men on medical grounds who are unsuitable as soldiers, or for other reasons. Pressure thus applied on a junior RMO is very difficult to resist. On the other hand, we feel that it cannot be too strongly impressed upon newly appointed RMOs that their mana with their troops depends to a large extent on the care with which they look after them in sickness; that they will not always have consultants handy to whom to refer their cases, and that the sooner they develop independence in diagnosis and initiative in treatment, the quicker they will gain the confidence of officers and men of their unit. The assessment of character is not so easy. Close harmony
During the greater part of
On the night of 4–5 August bombing raids on
On 11 August there was a concentrated and sustained air raid on Abu Suweir aerodrome nearby. At the
Despite the ordeal, personnel in the depot behaved with extreme coolness. Stretcher parties functioned normally between bombings and brought into the treatment centre the five casualties which occurred in the depot. These were mainly light wounds from shell fragments, but one man received a serious chest wound. Three of the more serious cases were evacuated to 54 General Hospital by ambulance. In no case did casualties occur among men in slit trenches.
After these raids the Area Commander instructed that as many troops as possible should be dispersed at night (an instruction which one group of New Zealand convalescents had earlier anticipated). Some 300 convalescents with a small cadre of staff were transferred each night to Chevalier Island, where a reception hospital was subsequently opened to obviate sending patients to general hospitals in the district for minor sickness. Under these conditions the depot scarcely functioned along intended lines. Sleep was interrupted and a few men started to sleep out of camp. Morale tended to suffer, and some who might otherwise have readjusted themselves well from mild anxiety states were found to exhibit marked exacerbations of their symptoms. A decision was made to return the less stable of these to the quieter
At the end of the first week in September there were heavy air raids. The 54th British General Hospital was severely damaged and rendered untenable. The continued bombing raids, apart from the risk to personnel, had minimised the value of
Coinciding with the transfer of the depot, Lieutenant-Colonel Tennent was appointed CO 4 Field Ambulance and relinquished his command to Lieutenant-Colonel Noakes, whose appointment was to continue until the end of the war in
An investigation of the functioning of the
A visit was paid at that time to 2 British
WITHIN a few months of the campaigns in
Thus, the New Zealand Division returned to the desert in
All the divisional medical units assembled in September at
The New Zealanders became a race of underground dwellers at
The health of the troops was generally satisfactory, except that desert sores and skin infections became very prevalent. The other principal illnesses were tonsillitis and dysentery, for which dust-storms were considered a causative factor. In the treatment of desert sores our units adopted with success the method introduced by
By the end of October all the medical units with the Division were completely reorganised and re-equipped after their difficult experiences in
On 22 October the ADMS NZ Division (Colonel Kenrick) attended a medical conference at Headquarters Eighth Army. For active operations it was arranged that there would be a casualty clearing station operating behind each division. In the case of NZ Division, the
At a conference held at GHQ MEF on 30 October it was decided that two general hospitals would move to
No. 2 General Hospital, with Colonel Spencer in command, made a most expeditious move and left
While at
Excellent work by the staff made it possible for the hospital to function within twenty days of its arrival at
Most of the ambulance trains from the
The broad intention of the British offensive was the destruction of the enemy forces in Crusader campaign was planned to carry
Eighth Army had two corps under its command to carry out the operation. Thirteenth Corps, which consisted mainly of infantry, included NZ Division,
The first objective of CRUSADER was the destruction of the enemy's armoured forces and this task was given to 30 Corps, which was to advance from the
The New Zealand Division, as part of 13 Corps, had the initial task of isolating enemy forces in the
As the campaign progressed these plans were considerably altered. That which had at first been incidental to the plan, the relief of
On 11 November the New Zealand Division left
The Division moved 14 miles to the north on the 19th and on 21 November was ordered to advance and carry out its part in the plan. Led by the Divisional Cavalry, the Division advanced northwards that night. The Divisional Cavalry captured
In the meantime the fortunes of the armoured battles had fluctuated and had developed into a running fight for the mastery of the key position of
Meanwhile, Rommel had collected his armoured forces and counter-attacked towards the Egyptian frontier. Crossing the frontier on 24 November, part of these armoured forces linked up with the garrisons at
On the 27th these enemy forces began streaming back from the frontier to re-enter the battle raging at 15 Panzer Division later in the day. By the 28th enemy armoured formations had begun to arrive in the
The enemy's intention was to annihilate the New Zealand Division and sever the corridor into
Thirteenth Corps was given the task of pursuing the enemy, and
The general medical plan for the Second Libyan Campaign was based on two lines of evacuation, one for 13 Corps and one for 30 Corps. The Corps' lines converged in the rear at Bir Thalata, 15 miles west of the main medical centre at
From the medical centre evacuation was by train from the ambulance railhead about 7 miles away, from a landing ground nearby, and by motor ambulance convoy to the main coastal road and thence back to
Behind
In the 13 Corps zone arrangements were made to have staging posts at 25-mile intervals ahead of the main medical centre. Twenty miles short of the frontier at
From there the lines of
The divisional plan, as during the retreat in
The experiences in
At a conference called by the
On the morning of 23 November 6 Field Ambulance (less A Company) was stationed in reserve in the vicinity of
On the morning of 24 November tank shells began to fall amongst the ambulance vehicles and the unit was moved a mile to the south to the entrance of a wide wadi, where a number of casualties from the tank battle were treated. One or two abandoned vehicles were discovered here and, having been made roadworthy, were added to the unit transport.
The convoy began moving up the wadi at 2.30 p.m., and shortly afterwards 6 Field Ambulance received instructions to go to a wadi 7 miles from
On 25 November Colonel Kenrick discussed with GSO I NZ Division (
The
During 26 November 5 Field Ambulance, less one company and the Field Hygiene Section, arrived at the MDS and dispersed its vehicles on the plain above the wadi. The ambulance remained packed in anticipation of a move into
Considerable numbers of German wounded were being admitted to the MDS and Lieutenant-Colonel Speight arranged for the release of two German medical officers and a number of German medical orderlies from the prisoner-of-war cage nearby to assist with the treatment of German casualties at the MDS. The German officers messed with the MDS officers and proved pleasant and co-operative in every way.
A convoy of 7 British MAC arrived on 26 November with twenty motor ambulances; the route that had been taken from 4 Field Ambulance MDS was 5 miles south of and parallel to the Trigh
Fourth Field Ambulance, following the overrunning of Headquarters 5 Brigade by enemy tanks, and on instructions from GOC 13 Corps, moved forward with that headquarters to join Headquarters NZ Division, and opened on 27 November a main dressing station alongside that of 6 Field Ambulance. Its presence materially lessened the heavy strain on 6 Field Ambulance's tentage and enabled part of the stream of casualties to be diverted.
During 27 and 28 November remnants of some South African and British medical units began to trickle into the MDS area. Tentage was allotted to these medical officers and they were asked to attend to the increasing numbers of Italian wounded coming in.
An attempt was made to pass the Italian wounded to the German medical officers for treatment but usually they politely sent them back. The New Zealanders found that the German medical orderlies avoided all contact with the
On the morning of 28 November the number of patients in the combined main dressing stations was 862, including 96 prisoners. Because of the danger of motor ambulance convoys falling into enemy hands, Colonel Kenrick had decided on the 26th to hold all wounded with the prospect of being able to evacuate them to
By this time three New Zealand field ambulances (each less one company which was operating with its brigade group), 4 Field Hygiene Section, and the
At 11 a.m. on 28 November
During 28 November the tank reserve at The story of the captured medical centre, and its 900 wounded, including 700 New Zealand casualties, will be taken up later in this chapter.
Colonel Kenrick and Major Macfarlane, DADMS NZ Division, moved through the corridor into
Colonel Kenrick arranged with Colonel Fulton, ADMS
At midday on 1 December information was received that the enemy had made a fierce attack on
On 5 December two ships with two escort vessels left Chakdina, under arrangements made by ADMS
Just as the moon was rising, a little after nine o'clock, the Chakdina, which was not a hospital ship, was attacked by a torpedo-carrying aircraft. Approaching at a height of barely 50 feet, the plane released a torpedo which exploded in one of the aft holds. Immediately the ship began to sink by the stern and in three and a half minutes it had disappeared.
Of those below deck—for the most part prisoners and the seriously wounded—few were able to escape. The men on deck had a better chance of fending for themselves, but many, too, were drowned, some by the upsetting of lifeboats, others by the suction of the
Farndale, and possibly some by the Thorgrim, but up to 79 were drowned. This was the only major misfortune in the evacuation of wounded in Chakdina as a hospital ship, without markings, appears unjustifiable.
Major Williams, OC 4 Field Hygiene Section, and three members of the ADMS's staff were on board, one of the staff being amongst the missing.
B Company 4 Field Ambulance, with Major Harrison as OC, came under the command of 4 Brigade Group on 18 November. The unit arrived at
On 24 November the unit proceeded 12 miles with
On 29 November the company moved west about 2 miles to where the brigade group formed a compact defensive formation. The ADS was within 100 yards of some guns, but it was impossible to select a better site. The evacuation of patients to
There was heavy shelling all day on 29 and 30 November, with the enemy ranging on the battery adjacent to the ADS. Several of
Capt C. Munro, MM;
There was heavy machine-gun fire and shellfire to the south of the ADS at 7 a.m. on 1 December. A tank battle was in progress and British tanks manoeuvred among the ADS vehicles. At midday the remnants of the badly mauled 6 Brigade withdrew through 4 Brigade and the enemy was in full view on the escarpment, south-west of the ADS. Patients were collected from Captains Sutherland and
On 29 November
Experiences in the fighting at
The
There were many casualties, both our own unit and German.
Most of the casualties were from small arms fire, and most of these were sustained almost at the unit objective. I formed the RAP in a slight depression near Bn HQ, and while the unit was digging in we started our search for the wounded. The cries of these men kept on for most of the night. We had great difficulty at times in finding our way back to the RAP. It was a very cold night, and the blankets were hopelessly inadequate. We packed the wounded together like sardines, and made each three men share one or two blankets. A few died during the night because of the cold. In the morning the RAP truck and ambulance car reached us and we got the wounded evacuated in relays.
The next five or six days were very unpleasant. There was constant mortaring the whole of each day. The casualties were evacuated in the evenings. Nothing except first aid and morphine was given to the wounded. The RAP truck hit a mine and was a write-off.
Just before the big enemy attack on 1 December our unit shifted farther along the escarpment. Here we had a fine RAP—a cave in the hillside which was full of Italian and German wounded. A few yards away was the remains of an Italian hospital, so we had all the equipment we needed and were able to attend adequately to the wounded—British, Polish and New Zealanders. We had no trouble in the evacuation of wounded from here into
The 4th ADS was supplied with eighteen trucks for the transport of its 120 patients during
The ADS for 5 Infantry Brigade was formed by B Company 5 Field Ambulance with Captain Edmundson Col F. B. Edmundson, OBE, ED, m.i.d.;
About 7.10 a.m. on the 27th
The German troops systematically looted all the vehicles of the ADS and commandeered medical and other equipment which was not in actual use. The unit's transport was taken over and driven away. The ASC drivers were marched away as prisoners of war, along with the other troops, in the direction of
The German commander,
Two regimental medical officers of units of 5 Brigade, Captains
On the morning of 29 November very few enemy troops remained in the locality. At 6 p.m. on 30 November a Divisional Cavalry patrol arrived at the ADS. The evacuation of patients and medical personnel was speedily organised and the convoy set off for Fort
The patients were transferred later to 19 Indian Field Ambulance MDS at
B Company 5 Field Ambulance reopened in the ruins of Fort
When 5 Brigade moved west from
During the campaign this ADS admitted a total of 700 patients, including enemy casualties. The entire company transport was captured or destroyed, as well as a considerable amount of equipment.
A Company 6 Field Ambulance (
The field ambulance company had travelled all through the night of 22–23 November with 6 Brigade and its first call to action came as it pulled up for breakfast. Elements of 6 Brigade had clashed with a section of the Afrika Korps. Working from the trucks and ambulances, with heavy shelling around the area, the men of A Company treated many wounded, mostly German prisoners whom they were obliged to leave behind, with water and a
Approximately 200 wounded were evacuated independently along the line of evacuation of 30 Corps by 6 ADS. The convoy consisted of twenty-one vehicles, including three ambulances (one of them German), a captured staff car, and 3-ton trucks, under the command of Lieutenant-Colonel
On the morning of 24 November 6 ADS set up again in the wadi east of
The next day the company moved westwards again in the wake of 6 Brigade. On the evening of 25 November while 4 Brigade attacked
By 28 November, counter-attacks by German armour had upset the general situation, although by this time a link-up had been made with the
On the evening of 30 November, after despatching the second of the convoys of wounded to
At dawn on 1 December an enemy force of forty to fifty tanks supported by infantry advanced north-westwards from
Just when the capture of 4 and 6 Brigades seemed almost a foregone conclusion, British tanks put in an appearance and saved the day. Later, the remnants of both brigades achieved an anxious but successful withdrawal to safety.
Most of the captured ambulance company were made to proceed on a long march across the desert to the west and were later taken in trucks to the prison camp at
The medical party under command of Major King, who had remained to care for the large concentration of casualties at the former site of 4 MDS near
At 8.30 a.m. an ambulance car with a badly wounded British member of a tank crew, accompanied by his RMO, was escorted in by two German motor cyclists. The medical officer remained with the detachment all day giving anaesthetics and doing dressings, and then left to try to rejoin his unit.
At 4.30 p.m.
At 5 p.m., a convoy of
Next morning, at 6.45 a.m., the MAC convoy with 304 patients moved off in an attempt to get through to a CCS, but within an hour it was stopped by an Italian column. This column made the convoy change direction but the captors made off at the approach of British armoured cars. Progress was slow and uncertain, but eventually the convoy reached areas clear of the enemy and made contact with 7 SA CCS.
Parties of
At dusk on 28 November the convoy of ambulance cars returned bringing food and water. Throughout the night the whole staff worked to prepare patients for the evacuation. Fresh dressings were given to all cases. Anxious moments, when enemy tanks passed close to the area, held everyone in suspense, as the numbers of extra vehicles must have been obvious. However, no closer investigation was made, and at 9.45 a.m. on 29 November the medical convoy left the area, although enemy transport was still visible to the east. A route was set to the south-west, with a small section of British armoured cars covering the rear. After changing direction to due south for some 48 miles, the convoy contacted 7 SA CCS at 4.30 p.m. and the patients, numbering 123, including 30 Germans and 17
On learning that 5 ADS were prisoners at
Actions early in December had led to the final relief of
The MDS, moving forward as the advance proceeded, dealt with a considerable number of casualties, both New Zealand and enemy. Blood and plasma, as well as intravenous drips, were given by the MDS, and early surgery and immobilisation of serious fractures were carried out. Evacuation to 62 British General Hospital,
When German troops at 5 p.m. on 28 November overran the area near Point 175 in which two companies of each New Zealand field ambulance, as well as the
The German forces took up positions on the high ground flanking the wadi wherein the medical staffs and wounded were concentrated. They opened fire in the direction of
A conference of the officers in the medical area discussed all aspects of the position and agreed that Lieutenant-Colonel Twhigg, CO 5 Field Ambulance, should take over full command. The most pressing problems for decision concerned rations, water, sanitation, and salvage of material which was scattered about the medical area. All food and water supplies were pooled, assessed, and rationed, according to patients held and staff, to each unit. The supply of
The
At 3 p.m. on 29 November the German command decided they would evacuate all their own wounded from the area. To do this they commandeered all the staff cars, ambulance cars, and other vehicles which were capable of being moved. Others which they could not move had been deliberately and secretly immobilised by ASC drivers, essential parts being removed from trucks and hidden so that the vehicles would be available should a favourable opportunity arise for parties to escape.
Prior to the departure of the convoy Lieutenant
On 30 November the artillery fire was intensified. When the Italian positions on the high ground surrounding the wadi were shelled, the
The work of Staff-Sergeant Henley Capt J. C. Henley, DCM, ED;
A German field ambulance had arrived during the morning and sited itself beyond 4 Field Ambulance in the south-western end of the wadi. German doctors endeavoured to get the Italian guns moved farther from the medical area, but without avail. These doctors, however, did valuable work in keeping Italian tanks, armoured fighting vehicles, and other combatant forces out of the area. The CO 4 Field Ambulance, Lieutenant-Colonel Tennent, helped one of the German medical officers to operate on re-wounded Germans in the German field ambulance operating truck under most amicable conditions. The methods employed by German medical officers were noted to be rather crude judged by New Zealand standards.
At 3 p.m. on 30 November the German troops, using further commandeered transport, withdrew from the position, taking with them most of their own wounded. The commander of the German forces, as a mark of appreciation of the work performed by New Zealand medical personnel, left written instructions that the Ariete Division appointed an Italian medical officer as commandant of the medical area. This individual proved himself to be most inefficient and exercised poor control over the Italian troops in the area, and they were guilty of obstruction and looting.
Intermittent shelling continued all day on 1 December and an enemy position which had recently been set up on the eastern side
At 8 p.m. on 1 December a convoy of six 10-ton diesel trucks and a few other vehicles arrived and the
The German field ambulance moved out early on 2 December and took most of its wounded. The Germans expressed their thanks for the way the New Zealanders had looked after their wounded and hoped that they, and not the
During the morning it was obvious that the
In their selection the
The medical staff detailed for removal, as well as some of the ambulant wounded, were hurried up the slope to the south-western escarpment where large diesel trucks were drawn up for their transport, and were taken away towards
The medical group taken away as prisoners of war (and not to a hospital unit as they had been led to believe) comprised 14 medical officers and 183 other ranks. They comprised Lt-
On the evening of 2 December the remaining medical officers in the medical centre reorganised their administration, a South African medical officer being placed in command. A party under Lieutenant-Colonel
At 3 p.m. on 3 December a conference of all medical officers was called by the Italian commandant. Through
On the morning of 4 December some 150 walking wounded, with Lieutenant Dawson, 6 Field Ambulance, were taken away in trucks by the
In spite of Italian promises, no water or food had reached the captured medical centre by 5 December; the patients were desperately in need of water, some having developed swollen and cracked tongues. After the evening meal that day the quartermaster announced that there were only 30 gallons of water left for a total of 860 patients and the staff.
Patients began to die rapidly from dehydration in spite of the distribution of water from the shares of those taken away as prisoners. Several of the patients appeared to die of cold as supplies of kerosene for heaters failed. In the
However, during the night the
At 7 a.m. on 7 December the remaining wounded and medical personnel of this convoy were transferred to four ambulance cars and thirty 3-ton trucks of 22 Armoured Brigade. At 9 a.m. they moved off to travel 46 miles to the rear section of 7 SA CCS, and arrived eight hours later. The patients were unloaded there and the medical personnel carried on down the axis of the Armoured Division to the frontier wire and 15 British CCS. Instructions were received for the New Zealanders to return to the Division at
The
Following the withdrawal of the New Zealand troops, a request was made for the
On 2 January the unit was temporarily attached to 1 Armoured Division as an advanced operating centre, in view of the probability that that division might advance rapidly a considerable distance from the main casualty evacuation axis. Unfortunately, other factors prevented the execution of this plan, and the
While with 1 Armoured Division, the unit was nearly captured again on
The New Zealand prisoners of war liberated at
The unusually fluid battle conditions on the vast expanse of desert in the Second Libyan Campaign, when there was no defined line between the opposing forces and supply lines were upset, created for the field medical units peculiar circumstances which were not repeated in later campaigns. All the field medical units, with the exception of B Company 4 Field Ambulance which formed the ADS for
The Medical Corps casualties in killed, wounded, and prisoners of war were:
Casualties among the ASC attached were 2 officers and 108 other ranks, mostly prisoners of war.
As prisoners of war, 43.8 per cent of the strength of the field medical units was lost to the New Zealand Division.
Circumstances were such that it was difficult to arrive at an accurate figure for the total number of wounded (New Zealand, British, South African, and enemy) treated by the Division's medical units, but the following figures taken from unit returns at the time are fairly correct:
Of these 2660 cases, approximately
Equipment losses were heavy, being similar in magnitude to those suffered in
Pending the re-equipment of the field ambulances, in which there was a delay of some weeks, there was an acute shortage of expendable medical stores, much on the same lines as that which occurred when the Division returned from
Enemy depredations had also produced considerable deficiencies in the vehicle strength of the medical units. The following table
The general health of the New Zealand troops remained remarkably good from the time of the start of active operations on 18 November, particularly in view of the severity of the fighting, the shortage of water, and the cold weather. The only infectious disease giving rise to any anxiety was diphtheria, of which four cases occurred in November and six in December. Relatively few cases of dysentery occurred either in the field or on the return of the Division to
The standard of sanitation was reported as very high, as evidenced by the low incidence of sickness. In the desert shallow trench latrines were dug by the troops. In the field ambulances deep latrines were dug and fly-proofed box seats were used. All refuse was buried. Water was carried in two-gallon tins. Originally it was not chlorinated and had to be treated with WSP, but later the water drawn was satisfactory.
The original medical plan of the Division was entirely upset by the enemy mobile columns which roamed at will behind the Division and on its axis. No axis remained, and convoys went to and fro across the desert no-man's-land where armoured and motorised columns of both forces were roaming free and occasionally meeting in mobile battles.
When the medical units were concentrated there was only one medical centre for the whole Division where adequate surgical work could be carried out and numbers of casualties attended to. When this was captured the Division lost all its surgical facilities and the main medical units all their supplies and their power of evacuation of casualties. They were, however, able to carry on their function of caring for, and giving medical attention to, over 1000 casualties. Unfortunately, the supply of water was inadequate, but otherwise it was possible to give satisfactory attention to the wounded.
After the capture of the main units, 4 and 6 Brigades were serviced by their attached ADSs and were able to evacuate the fresh casualties to
The Division was undoubtedly well served by
The only serious difficulties in attending to the wounded arose because of the capture of the MDS centre. This resulted in scarcity of supplies, particularly of water, and was a serious matter in cases such as those of abdominal injury. The capture occurred the day after the main battle and prevented the evacuation of the casualties which had been held because of interference by the enemy on the lines to the rear. Perhaps it was as well that sufficient medical personnel were also captured to enable the wounded to be well looked after. The eggs were certainly all in one basket, but there seemed no protection for the eggs even if they had been well scattered.
The senior divisional medical officers had nearly all already had experience in
The arrangements made for the treatment of the casualties were based on the attachment of an ADS to each brigade to carry out the first-aid treatment whenever the brigade might be engaged in very mobile battle. At the MDS arrangements were made to carry out the more elaborate forward surgery. To enable this to be done, the
A generous gift by Mr Arthur Sims of
In the ambulances themselves there were many capable medical officers and some quite capable surgeons. It was fortunate that this was so, as the Division under the circumstances of the battle had to undertake the full responsibility of the forward surgery. The field ambulance surgical teams dealt with the routine wounds, and the MSU had referred to it specially selected cases. This arrangement, however, lasted only a very short time as it was found that in the rush it was impossible to restrict the work of the MSU, and, as had happened before, in
At that period wound treatment consisted in the surgical cleansing of the wound, the local application of sulphanilamide, the dressing with vaselined gauze and the use of enclosed plaster splints, the method recommended by Trueta. This treatment was carried out in the MDS, and generally no further forward surgery was necessary and the patients were staged along their journey to
The prolonged journey, however, was very exhausting to the more serious cases and the constant shifting aggravated any infection that might have been present. The first part of the journey by ambulance or truck across the desert to the railhead was particularly trying, and was associated with the constant danger of interference by enemy mobile columns. The surface was rough and at times the convoys had to be speeded up. The nights were cold, and at times there were insufficient blankets available. The adequate resuscitation of the serious cases was gravely interfered with by lack of water, especially during the period when the MDSs were captured. Some
The nature of the work performed in the ADS is shown in a very valuable report by Major Harrison, who was in charge of the only uncaptured medical unit, 4 ADS. This ADS treated altogether 448 casualties, 360 being New Zealanders. There were 15 deaths, 10 being New Zealanders, and casualties in the ADS itself were 1 killed and 9 wounded. Harrison stated that he limited his treatment to the ligation of arteries, amputation of shattered limbs, splinting of fractures, suture of sucking wounds of the chest, and aspiration of haemothorax. At times when casualties had to be retained for twenty-four to forty-eight hours, more extensive surgical procedures were carried out, such as excision of wounds, drainage of infected wounds, and removal of obvious foreign bodies. Treatment of shock was difficult owing to the shortage of water and hot-water bottles. Often there was a shortage of acriflavine lotion and once of morphia. Kramer wire splinting proved very valuable, and when supplies ran short they were replenished from captured enemy equipment. The majority of the cases dying in the ADS were badly shocked on admission, and practically all suffered from great loss of blood. Only one plasma infusion was given, and it was impossible to give transfusions after dark. The majority of anaesthetics given were sodium pentothal.
Harrison gave a classification of the wounded men as under:
(a) Parts affected:
(b) Complications and deaths:
This ADS had to treat the casualties from the attack by 20 Battalion on 27 November, and many of these were hit in the early afternoon and stayed out in no-man's-land until after dark, suffering more wounds as they lay, and were in a bad way when brought in. Twelve of them died shortly afterwards, either in the MDS, in
Supplies of kerosene and spirit were very short, and both sterilisation and heating became difficult. There were insufficient blankets for the large numbers of wounded, and this caused some distress as the weather was cold. Selection of cases became impossible and few casualties were admitted who had been wounded less than twenty-four hours, and many wounds were three days old. But, in spite of this, fulminating infection was rare. Very few abdominal cases were seen. Shortage of ether, morphia, and plaster-of-paris was serious. Food consisted of vehicle battle rations, and shortage of water made the use of
Patients admitted 190; patients operated on 112; post-operative deaths 15 (omitting 4 killed by shellfire after operation); other deaths 30, including 5 from shellfire, 1 under anaesthetic induction, and 13 who were either so late or so shocked that they could not be brought to operation.
In the MDS area a great deal of operative treatment was carried out by surgical teams formed from the ambulances' own personnel. Records show that by 4 December some wounds were showing evidence of severe infection. Moreover, the elastoplast extensions applied to fractured femur cases peeled off in eight to nine days and had to be replaced by a piece of wire inserted in front of the tendo Achilles above the ankle. On 5 December patients were becoming desperate for water; some developed projectile vomiting and were unable to keep down even sips of water. There was no intravenous glucose saline left and insufficient water for rectal drips. Some patients developed swollen and cracked tongues, which were extremely painful, besides sores of the lips. At that date there was only 30 gallons of water left for the 860 casualties as well as the
Behind the divisional area the medical centre of
The battle casualties admitted to 2 NZ General Hospital consisted mostly of cases of multiple wounds classified as: Soft-tissue wounds 145, fractures 29, heads 12, chests 14, abdomens 6, amputations 6, burns 4. It was noted that the chest wounds with simple stitching did well and those with elaborate toilet did badly. Sulphonamides did not appear to have lessened infection and sutured amputation wounds were septic. Thirty-eight of the cases were given an average of two pints of blood. Five deaths occurred, three of them within twelve hours of admission.
It was stated that the placing of general hospitals on the Line of Communication had saved several lives, and that if it had been possible to site them still farther forward it would have saved the severe cases from the extreme exhaustion noted on admission to the hospital at
Reports were obtained both from our own base hospitals in
Excision of wounds: This had generally been adequate and had proved valuable in preventing infection.
Drainage of wounds: In many infected cases insufficient drainage had been provided.
Primary suture of wounds: Such wounds were stated to be almost always septic and breaking down and the patients were toxic.
Amputations: The amputation of a mangled limb was often seen to produce a dramatic improvement in the patient's condition. Amputation had often been carried out at the site of election and primary suture performed. Sepsis had almost invariably followed, with breaking down of the stump. All reports urged the necessity of performing the primary amputation as near the wound as possible and leaving the skin unsutured. There had been a lack of skin traction in many of the unsutured stumps. Secondary amputations at Base, carried out for secondary haemorrhage and severe infection, had been common.
Compound fractures:
Fractured femurs had travelled well in
Fractured legs travelled well in plaster.
Fractured arms had mostly been treated in slings and simple splints.
Chests: Open pneumothorax cases travelled badly. Only one New Zealand sucking chest case was seen at Base.
Heads: Head wounds adequately excised and sutured with drainage did well.
Plasters: Skin-tight plasters had proved dangerous and their use was condemned.
Abdomens: The Consultant Surgeon
Tetanus: No cases had been reported throughout the Army.
Gas gangrene: Nine cases had been reported in the Army, none being seen in New Zealand cases at Base, though two were reported at the MDS centre.
Burns: Tanning treatment was being carried out and 10 per cent silver nitrate solution was being used in some British hospitals.
Sulphonamide: Oral administration had been unsatisfactory during evacuation. A special chart for marking dosage was advised.
The picture was one of serious injuries, severe sepsis, frequent secondary haemorrhage and amputations.
In summarising the treatment of casualties in the Second Libyan Campaign it can be stated that, as far as the New Zealand Division was concerned, primary surgery was carried out in our own field ambulances and in our MSU. Wound débridement was done, with the wound dusted with sulphanilamide and left open and, if necessary, drained. Plaster splints were applied to fractures of the leg and forearm. Thomas splints were applied to the thigh fractures and the upper arm largely treated in simple splint with a sling.
The MSU dealt with the abdomens, the chests, the heads, and many of the amputations. Early evacuation of all cases was aimed at, but circumstances prevented this and the majority of the wounded were captured and immobilised for eight days, when they suffered severely from lack of water. Eventually the casualties were evacuated by many stages to
There had been a large proportion of very serious wounds, and the unsettled condition of the divisional area and the prolonged and many-staged evacuation had resulted in a rather heavy mortality and severe infection, largely streptococcal, in many of the cases. Conditions in the forward areas undoubtedly prevented early surgical débridement in the large majority of the cases. Although the primary mortality of the abdominal and chest wounds was not heavy as recorded by the MSU, it was noted that only three abdominal cases were seen at Base, and very few chest cases, so it can be surmised that there was a heavy mortality in these cases during evacuation.
The performance of sites of election amputations with suture in the forward areas was noted to give rise to serious infection and disastrous results at the Base. Neglect of skin traction in unsutured stumps was also common.
Splinting in the forward areas was excellent. The
The DMS General Headquarters, British Troops in Warsawa, a Polish ship of 3000 tons, but was never actually used for this purpose owing to the ramming of the ship at
The ambulance train unit functioned from 28 November 1941 until 21 January 1942 and earned commendation for its efficient work.
A party of Somersetshire, which evacuated casualties from forward areas on the
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 Maunganui, Nov 1943–Mar 1944.
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
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
Suggestions for improvements in forward surgery were made at that time by the Consultant Surgeon MEF as follows: More plasma
The detachment of 3 General Hospital, which, under Lieutenant-Colonel Button as OC and Miss Hennessy as Matron, took over two wards of the Anglo-Swiss hospital at
In its four months at
All New Zealand medical units left the forward base with fourteen days' reserve of medical supplies. This, together with captured medical stores, proved adequate for requirements in most cases. In the latter stages of the action there was, however, some shortage of stretchers and blankets.
At a conference after the campaign it was recommended that there should be some increase in certain supplies to field ambulances, such as Kramer splinting, pentothal, sulphonamides in powder and tablet form, anti-tetanic serum, plaster-of-paris, and morphia in solution in capped bottles. An increase in the number of panniers and medical companions was also suggested, and instruments sufficient for emergency operations.
Motor ambulance cars proved desert-worthy, but it was apparent that, when operating over such a wide area, more than eight cars to each field ambulance were required. Twelve was considered to be a more suitable establishment, and all should be marked with large Red Crosses. Stretcher-carrying appliances in 3-ton trucks proved invaluable.
Events made it quite clear that, if the evacuation of wounded was to be carried out satisfactorily, either the complete lines of communication should be secure or else ambulance cars should be despatched with an adequate escort of armoured forces to protect them. Moreover, if wounded could not be safely evacuated but were held at main dressing stations, the field ambulance necessarily became more and more immobilised and more vulnerable to attack.
Further, in warfare in the open desert it was considered that evacuation should be carried out in daylight only. If evacuation by night was attempted the wounded suffered unnecessarily from the rough going, and there was a greater likelihood of the motor ambulance convoys being shot up by enemy columns operating in the rear.
The possibility of evacuating casualties from forward areas by Bren-gun carriers was thought worthy of further investigation as, when under fire, some RMOs found this the method of choice.
Theoretically, it was normal for ADMS NZ Division to be located at Rear HQ NZ Division, but in actual practice it was nearly always
The lack of wireless communication produced serious complications. Contact between the different medical units was often lost and an ADS sometimes did not know the location of the MDS. The MDS also was often out of touch with the administrative officer either of the Division or the Corps. In what amounted to an enormous no-man's-land, no other means of communication was practicable. The plight of our captured medical units would have been much less serious if they had been able to apprise the staff officers of their difficulties.
An investigation into the utilisation of field ambulances in desert warfare was undertaken by GHQ MEF after the Second Libyan Campaign. It was concluded that the infantry field ambulance was insufficiently mobile or flexible, and that it should be capable of holding and treating a considerable number of patients. Suggestions included an increase in ambulance cars to fourteen, a reduction in the number of stretcher-bearers, and the elimination of some of the G.1098 equipment.
It was considered that, when a field ambulance was called upon to function as part of an independent brigade group, a surgical team with its own transport and equipment should be attached; and that in any case one officer at least in a field ambulance should be capable of undertaking major emergency surgery. This would also entail the provision of surgical instruments sufficient for the purpose.
Some of these recommendations were later implemented when supply and other difficulties were overcome.
* * * * *
The experience gained in the Libyan campaign at some cost was applied in later campaigns. Fortunately, the same unequal and unforeseen conditions were not repeated, except for a day or so at
AFTER its momentous, and to some extent disastrous, campaign in
The medical units, along with the rest of the Division, celebrated Christmas
On Maunganui on 25 January, however, enabled all units to be built up to strength. These reinforcements, 10 officers and 117 other ranks, had been sent from New Zealand at short notice—and after the Japanese move in the
Early in
Fortunately, the protection offered under the Geneva Convention to hospital ships and medical personnel enabled the Maunganui and other hospital ships to continue their voyages to and from the
The first contingent of the women of the NZWWSA (Hospital Division) Afterwards changed to Maunganui on
Senior Commander Miss M. King, MBE; born
The eventual postings were:
Nursing Section:
Attached office Matron-in-Chief—1 officer (commandant)
Attached YWCA
Attached 1 NZ Rest Home—1 nurse
Attached 2 NZ Rest Home—3 nurses
The nursing section, comprising the majority, were posted to the various wards as assistants. In the wards their duties consisted mainly of bed-making, taking temperatures, taking round the meals, sweeping and cleaning, and helping in the kitchen.
Clerical Section:
The clerical section was absorbed immediately, particularly in the hospital offices, where the women replaced men who were sent off
In each of the three hospitals there was, at the time of the voluntary aids’ arrival, a shortage of staff in
During January the many battle casualties in the British hospitals in the Canal Zone and in
On 26 January HS Maunganui embarked 371 patients, including a large number of stretcher cases. On 18 February NMHS
Diseases: infectious 54; nervous 431; eye 85; ear 105; nasal 21; circulatory 126; blood 2; ductless glands, etc., 33; respiratory 243; digestive 157; metabolic 17; genito-urinary 26; skin 55; bones, joints, and muscles 274; urinary 28; alcoholism 7; debility 9; old age 65; malignant 14.
Battle casualties 684; accidental injuries 131; hernia 12.
The control of the
In
The
In the period November 1941 to February 1942 there was further disagreement as to the definition of command when the Mobile Dental Unit was in the field. The
The controversy was decided on
While with the Division, the Mobile Dental Unit comes under command of the ADMS as far as its location and duties are concerned. It should communicate with the ADMS on these matters. If necessary the ADMS communicates in turn with the
The OC Mob. Dent. Unit will presumably be the senior Dental Officer with the Division in the field, and in these circumstances is the principal advisor of the ADMS on dental matters.
When not with the Division the Mobile Dental Unit is under the
The Mob. Dent. Unit is intended to serve the NZEF as a whole and will therefore from time to time be moved where it can most usefully carry out its duties.
The decision whether the Mobile Dental Unit or part thereof is to be attached to NZ Div. or withdrawn from NZ Div. rests with the
When NZ Div. is under orders to move from one location to another, it will be the responsibility of the ADMS to raise with the
After this clarification of the position there was no further friction during the war.
As regards the
The need for convalescent homes in order to make the medical services as complete as possible had been realised for some time. It was most difficult, however, to find suitable buildings in a favourable locality. Many possibilities were considered and numerous inspections made by
The financial arrangements made for these rest homes were that the Army was responsible for rent, payment of (civilian) staff, rationing, and the ordinary articles of furniture such as tables, chairs, and beds. All extras in the way of curtains, floor-covering, and easy chairs were to be provided by the Joint Council of the
1 NZ Rest Home for 1
1Charge Sister Miss E. M. Sutherland; Dunedin; born Kyeburn, Otago,
3 NZ Rest Home for officers of
2 NZ Rest Home was for other ranks of
To the official openings of the rest homes were invited local residents and officials, many of whom had already generously interested themselves in providing outings and other forms of entertainment for the patients. Comfortable furnishings were provided in all the rest homes from funds made available through the Joint Council.
The important question of whether nurses in
In this connection British and South African nursing and auxiliary services allowed married women to continue serving, subject to efficiency. The Australian force returned all married sisters to
The
After considerable deliberation in
Medical examination of married women at regular intervals was recommended by New Zealand authorities, but this was not carried out in
Few administrative difficulties were experienced with married women generally and it was found that their efficiency was not impaired. (Up to
A major step in the organisation of a complete and efficient medical records section in
This last point alone was sufficient to secure the organisation of an adequate medical records section for the AIF from the start of the war, following a deputation from the Returned Services League to the Australian Prime Minister, who gave an undertaking that full particulars in regard to a serviceman's medical history would be available on his return from overseas. The Canadian forces had a medical records branch in charge of a medical officer on the staff of the
In
On
When
When in the
It would have been a decided advantage to have had a properly staffed and equipped medical statistics section set up and ready to operate with the First Echelon.
There was a change in the administration of Maunganui as a full-time and permanent New Zealand
The control of the issue of
The appointment of a full-time New Zealand
The
Fresh arrangements were made at this time for the treatment of venereal disease. War Office establishments had been issued for 50-and 100-bed VD treatment centres, which could be attached to any hospital and were independent as regards equipment and personnel. It was therefore arranged that the VD Section of 1 NZ Camp Hospital be disbanded and its staff and equipment used to form two such 50-bed treatment centres, one to be attached to 1 General Hospital at
In
The NZMC was greatly indebted to volunteer donors in regard to motor ambulance cars. Previously, a gift of ten ambulances had been received in 1
1In
Medical and dental officers trained in plastic surgery arrived in the
Plastic surgery training had followed a generous offer in
At the same time it was arranged by DMS
After delivering a series of lectures on maxillo-facial surgery to
A review of cases evacuated to New Zealand up to
On
They had come from Camp 75 near Llandovery Castle at
There was some doubt as to the recognised policy regarding the re-employment in 1
1In
A complaint raised by the Admiralty, Oranje would be regarded by the Germans as a troop-carrier and would be attacked if encountered on the high seas. The reason given was that the ship had carried to Oranje when she left
It was felt that the complaint arose through a misunderstanding, possibly to some extent from the New Zealand shipboard alphabetical category for such invalids being confused with the British medical grading classification, which also used the early letters of the alphabet. In consequence, the DMS GHQ MEF requested DMS
In addition, it was clearly laid down by DMS 1
1In this connection there was another qualifying factor that was taken into account. This was in regard to a disabled person who, though not specifically receiving medical attention, but who in the event of a troopship being attacked would be unable to fend for himself, was on humane grounds usually returned by hospital ship.
As a rule, battle casualties were not returned by troopship, nor were mental cases requiring supervision, asthmatics requiring treatment, gastric ulcer cases or severe dyspeptics, chronic dysentery cases, and any case physically incapacitated in battle.
After the battle casualties from the Libyan campaign had been dealt with and the serious cases evacuated to New Zealand, the hospitals settled down to routine work and, with a relatively low incidence of sickness in War Surgery and Medicine. These investigations were of great value in the management of the conditions later, as well as in stimulating the enthusiasm of the members of the medical staffs. The investigation of hepatitis was particularly valuable and helped considerably in the elucidation of the mode of transmission of infection, the opinion being expressed that the virus was transmitted by faecal contamination of food.
A series of cases of brachial neuritis of virus origin was reviewed, as well as some cases of agranulocytosis following sulphapyridine treatment.
A medical conference was held at 15 Scottish Hospital in
The Consultant Physician made a study of typhus in the civilian population of
Colonel Boyd also investigated the asthmatics and epileptics in
A review of the results of treatment of the cases of hernia and varicose veins was made by the Consultant Surgeon. This showed that the results of operative treatment of hernia were generally excellent, and that there was little disability in the force due to varicose veins. The only bad results in the varicose veins cases were due to excessive injections, leading to the blocking of the deep veins, and to faulty ligation or non-tying of the saphenous vein. Operation for varicocele was advised against, and the condition caused no real disability.
A review was also made of the results of operative treatment of the different internal derangements of the knee, and the results were found to be highly satisfactory as regards future fitness for service in the Division.
Reorganisation and re-equipment were major needs of the medical units of the Division after the Libyan campaign. Much medical equipment was drawn during January and, with the exception of a few items, all three field ambulances and the Field Hygiene Section were complete to I. 1248 scale by the end of the month. At this date some RMOs were still incompletely equipped. G. 1098 equipment (stretchers, etc.,) were obtained from Ordnance, but the Division was low on the priority list for transport and no new vehicles had been received by the end of January. Each field ambulance, however, had a sufficient number of motor ambulance cars to evacuate sick from units of its brigade group. The vehicles were serviced and overhauled by
During January the New Zealand Division moved from
ADMS NZ Division called on ADMS
Sanitary arrangements at Kabrit Camp were poorly planned and had been improperly maintained since New Zealand troops had previously occupied the area. Although units did their utmost to improve sanitation, the system generally remained unsatisfactory, in spite of representations to higher authority.
Very little serious illness occurred among the troops during January and February while they were at
A series of combined operations was undertaken by 4 and 5 Infantry Brigades to provide training for a possible seaborne invasion. For the purpose, the
The field ambulances provided supporting medical personnel for the practice assault landings by 4 and 5 Brigades and lessons were
Between 10 and 14 February 5 Brigade left the Canal Zone for
Fifth Brigade, although not actively engaged, remained in the
Meanwhile, 6 Field Ambulance had accompanied 6 Brigade from
On the return of the
In February it was decided that the New Zealand Division should move north to
At the direction of GOC
Subsequently Colonel Kenrick, in company with the AA & QMG, made an inspection of the divisional area between
The New Zealand Division began its move to
Fourth Brigade occupied defensive positions in the
Sixth Brigade was based on
Sixth Field Ambulance took over for an MDS the 100-bed Italian hospital in the centre of
Until the arrival of the newly formed
Pending the establishment of 2 General Hospital in
With the first opening of 1 CCS as an established unit at
When 2 General Hospital opened at
Patients for discharge to
On 6 April 5 Infantry Brigade, including 5 Field Ambulance, started moving from
Fifth Field Ambulance took over the operation of the MDS in the Italian hospital building from 6 Field Ambulance, which established an ADS at Camp No. 2,
While 4 and 5 Field Ambulances were running their main dressing stations, or camp reception stations, it was possible to undertake only a limited amount of field training. Fourth Field Ambulance was holding and treating an average of seventy patients, while 5 Field Ambulance had an average of fifty patients. After its arrival in
On 22 April A Company 4 Field Ambulance set out for the area above
From 21 to 26 May A Company 4 Field Ambulance participated in a comprehensive exercise with 4 Brigade at
B Company 6 Field Ambulance took part in a similar exercise with 6 Brigade from 29 May to 3 June.
Sixth Field Ambulance was located at
The defended area included some rough, hilly country, and the ambulances carried out training with mules for the transport both of medical supplies and casualties. The patients were strapped on the litters or cacolets, and Thomas splints were utilised in the training. The equipment was arranged in unit mule loads of 160 to 200 pounds and separated according to the different departments for which it was required, such as the reception, evacuation, cooks and quartermasters; so that, if necessary, an ambulance unit could be shifted readily into the hills and set up there with the maximum of speed and efficiency. The ambulances also took part in divisional exercises in the desert to the north-east.
The open-air life, the active work entailed in the construction of the defensive line and the manoeuvres, as well as the welcome change in climate and surroundings from the heat and sand of
The
There was a larger area and more buildings at
The ample sports facilities, the close proximity of the beach, the summer weather, and the opportunity of swimming in the
The majority of the cases sent to the depot from the hospitals made very good progress. The Consultant Surgeon reported, however, that cases with plaster splints did badly in the sand and should not be sent to the depot till the surgeon at the hospital had finalised treatment and applied the last plaster. Fracture cases kept for long periods in plaster developed muscular wasting and were slow to rehabilitate. Cases were also being sent for physiotherapeutic treatment when the depot was suitable only for ordinary massage and remedial exercises.
Our
The hospitals were rearranged to serve the Division in
No. 3 General Hospital, having been warned that it probably would be needed in
The hospital closed at
An outbreak of typhoid fever involving the VADs caused one death and led to doubt as to the immunity provided by TAB injections in New Zealand.
Arriving from
In both the
The sanitary arrangements in buildings varied considerably but, in general, were made satisfactory. In the camps, deep-trench
A very well-equipped divisional laundry was set up in
In
In
The Division was on the
Disinfestation was carried out regularly in the
In the
The refugees arrived in
Cases of typhus fever had occurred in the three months before the arrival of the New Zealanders, and in March a number of cases among civilians were reported from
Malaria was highly endemic in
At the outset arrangements were made to determine the areas where malaria was most marked and to combat the danger by field operations as well as by taking full personal precautions. The spleen rate in the different villages and areas was determined and highly infected areas put out of bounds. The spleen rate varied from 4 to 92 per cent in the different villages, and a very extensive investigation was made of the whole of the area of
Captain J. M. Staveley was placed in charge of divisional malaria control and sent on a course to No. 2 Malaria Field Laboratory,
As a result of these measures malaria in the New Zealand Division was kept within moderate limits. A high proportion of the cases occurred in two battalions stationed on the Turkish border, beyond which no malaria control was exercised. Fortunately, the Division left
Owing to the high incidence of venereal disease in
Sandfly fever was present to a moderate degree. There were a small number of cases of dysentery and diarrhoea and a few cases of infective hepatitis and measles. The small number of relapsing fever cases investigated at the CCS were treated successfully with injections of NAB. Typhoid and paratyphoid fevers were endemic in
Diseases reported in the Division in
The period spent in
At a stage before the CCS was functioning at
Advantage was taken of the quiet period to enable two junior officers in the Division to exchange duties every fortnight with officers attached to 2 General Hospital at
The dearth of medical practitioners in
In
It had been decided to rely more on the protection of the Geneva Convention, and additional large
At
A series of valuable clinical meetings for medical officers was conducted at
1The title of
There was a change in the administration of medical services in Oranje, and the appointment of Director of Medical Services was assumed by Brigadier
Colonel Kenrick was attached to Headquarters
The dispersion of
In
In the Second Libyan Campaign the New Zealanders had helped to relieve
By the middle of May both sides had built up their forces for further offensive action. The Axis offensive began on the evening of 26 May. After three weeks of heavy and costly fighting the Eighth Army, again leaving a garrison in
In
Each of the field ambulances cleared their patients to the CCS at
During July the light section of the CCS was set up as a staging post for casualties on a small sandhill in the Delta, alongside the main road and rail communications between
At a conference at GHQ MEF on 14 June it was decided that 2 General Hospital would move from
Having opened in
No. 3 General Hospital serviced Ninth Army, with only an occasional convoy of New Zealand troops from the Desert, till eventually it was shifted to
WHILE the long lines of vehicles were carrying the New Zealand Division from
Advanced elements of the New Zealand Division reached Mersa Matruh from
Arriving in
At a conference of ADMS 83 Sub-Area and senior New Zealand and South African medical officers on 23 June it was arranged that all South African medical units would leave
The DMS These American drivers were members of a volunteer Quaker unit which was formed in
The enemy was only slightly delayed on the Egyptian frontier in his drive from
On 25 June the New Zealand Division moved out of
At dusk on 26 June the divisional area at
The RMOs had a difficult time that day; one of them, Captain R. A.
Early on the morning of 27 June the seventy bomb casualties were cleared from the ADSs to 5 MDS. The ADS ambulance cars were met at the car post of 2 British MAC north of the divisional area by Major
The ambulances were quickly filled at the ADSs with casualties which had occurred during the day, and set off on their return to the MDS. The convoy was forced to retire to the ADS area as the Division was almost surrounded by enemy armour. Shelter was taken in a wadi, wherein some amount of protection from enemy shelling was available for the casualties and medical personnel.
During the afternoon both 4 and 5 ADSs were threatened by the sudden approach of enemy armour and had to be hurriedly brought in to a position close to Main Divisional Headquarters. One tarpaulin shelter was left behind by 4 ADS as there was no time to collect it, but otherwise there was no loss as ADMS NZ Division had warned the officers commanding ADSs to be prepared for emergency moves.
The detachment of B Company 4 Field Ambulance worked as an ADS at several locations during the day, the moves being occasioned by the proximity of enemy shellfire and our own artillery concentrations. For most of the afternoon the detachment was combined with 5 ADS, and later cleared patients from the RAPs of 6 Field Regiment and 18 Battalion to 5 ADS by means of an AFS ambulance car and trucks of 6 Field Regiment.
At 5 p.m.
During the day the ADSs in the battle area performed efficiently and the ambulance cars, both our own and those of the AFS, did wonderful service in going forward to RAPs and beyond to collect the wounded early. Emergency surgery and immobilisation of fractures were all completed well before the ultimate withdrawal took place.
At dusk instructions were issued that the New Zealand troops would withdraw from the area during the night. It was known that our withdrawal route to the east was blocked by the enemy, who had enveloped the positions from the north round nearly to the south. Fourth Brigade was given the task of clearing a wide lane through the enemy so as to allow the remainder of the Division through. Plans were made for an attack with the bayonet by the whole brigade on a narrow front. There would be no artillery support
This shortage of vehicles had its effect on the medical units, particularly 5 ADS which, of course, had also not been able to evacuate patients during the day. A request was made by this unit to ADMS NZ Division for extra transport, which he obtained after considerable difficulty. By 11 p.m. all the patients and medical personnel were crammed on the available transport ready for the breakout. The GOC's caravan truck, in which were the wounded general, his ADC, and Colonel Ardagh, had a
There was a considerable delay in the opening of the attack by 4 Brigade, which did not leave the start line until 1.45 a.m. on 28 June. Then the assaulting battalions advanced in formation on the unsuspecting enemy until they were at close quarters, when pandemonium broke loose. There was consternation and little ordered resistance by the enemy, though some of the clashes were fierce. Enemy vehicles were set on fire, but this unfortunately gave the enemy light to see us and probably caused more casualties than we would otherwise have suffered. After the infantry had gone forward, hundreds of trucks from 4 Brigade followed them in tightly packed formation. Engines roared, shells exploded, and machine-gun bullets seemed to be coming from every direction. Some vehicles were hit, some exploded, but the column went on through the gap. As the vehicles cleared the gap the infantry of 4 Brigade reorganised and, with very little difficulty or confusion, embussed, loading the wounded in any available space. They had accomplished their breakthrough. Fire from the flanks was still considerable but most of it was high and ineffective.
Meanwhile another breakthrough was made by 5 Brigade. The delay in starting 4 Brigade's attack limited the hours of darkness, and it was decided that the rest of the force would push on independently while the infantry attack was still in progress. The column accordingly moved off by wheeling to the right to make a detour from a point further south. A mile and a half to the south it ran straight into a German tank harbour. At close range the enemy opened fire wildly in his surprise. Had his fire been less hasty it would have been more deadly among the mass of transport moving nose to tail in the moonlight. The front vehicles of the column swung east to a route parallel with that of 4 Brigade, at a speed probably never improved upon by 3-ton trucks moving across open desert at night. Enemy fire continued against our transport as it came up to the wheeling point, but most of it was high and there were comparatively few casualties. Although the column passed through and over enemy troops for the first mile and a half of its eastward move, the Germans were so shaken by the mass of vehicles and guns boring through them that there was virtually no fire from them once the tanks were passed.
The New Zealand column had broken into three main groups during the move. One went due east, another wheeled back, then went south and then to the east. Another group got free by going to the north-west, resting overnight, and then returning east, and there were several smaller parties split from the main groups and making their own way out.
In the breakthrough three New Zealand and two AFS ambulance cars and two trucks were hit and set on fire, but it was possible to get many of the wounded and medical staff on to the remaining trucks and to continue eastwards. The GOC had a rough journey in his caravan, which was hit at least twice and had its windscreen shattered, but during the height of the battle he got out of bed and viewed the action through the window, likening it to Balaclava. At 10 a.m. the GOC's party, including medical personnel, moved away from the main column and later, as arranged by ADMS NZ Division, was guided to an aerodrome, which was reached at 1.30 p.m. A fighter plane was sent off to call up an ambulance plane, which duly arrived and at 5 p.m. took the GOC to Cpl W. A. Wilson; Dunedin; born NZ
In the first salvoes coming from the enemy 4 Field Ambulance also lost an ambulance car. The total wounded brought out in
During the breakthrough 4 ADS accompanied 4 Brigade, and Driver
The 4th ADS travelled across the desert with 4 Brigade all next day (28 June), making only a few brief stops to treat some of the casualties received from brigade units and burying some dead. All the casualties were attended to when the ADS staged for the night at 9 p.m. and erected a canvas. About 140 cases were treated between the time of setting up the ADS and four o'clock next morning (29th). Some forty of the cases came from 5 ADS. By 4 a.m. a convoy of twenty-seven vehicles (ambulances and trucks) had been organised and was sent off with the patients to
When it was proposed that the Division would fight its way back, arrangements were made on the afternoon of 27 June for 4 Field Ambulance to move back to the
From here 5 ADS evacuated forty patients to 14 British CCS before moving the rest of its casualties into the fortress. Here they were admitted into a specially constructed underground MDS which was to be manned for the next few days by 4 Field Ambulance, assisted by A Company 6 Field Ambulance, which had moved up to the fortress area with 6 Brigade on 27 June.
It was with difficulty that 4 and 5 Field Ambulances were found on the morning of 28 June and ordered to move back with the Division to the
Medical sections seem to have brought up the rear in the withdrawal. For instance, Captain
The three trucks carrying the wounded moved eastwards independently at slow speed. They travelled throughout the 28th and 29th, with the RMO attending to the wounded as occasion demanded. Although the patients included men with severe internal wounds and haemorrhage, no life was lost. This, combined with devotion to duty at
Likewise, Driver Burling, who was attached to 5 ADS and carried wounded men in his ambulance car, was separated from the rest of the convoy after the breakthrough but resourcefully found his way back to the
The action at
The Alamein line, where General Auchinleck had decided to make his stand, was at the end of June merely a loosely connected system of defended localities. The line, beginning at the village of The position was also known as the
When columns of 4 and 5 Brigades arrived in the fortress area on the morning of 29 June they re-formed north-west of the
On 30 June both 4 and 5 Field Ambulances moved some miles east and 5 Field Ambulance remained closed in reserve, while 4 Field Ambulance opened an MDS at Deir el Tarfa, which it maintained until 7 July. Each field ambulance had an ADS company operating with its brigade. Evacuations were carried out by
Our casualties were evacuated by desert tracks to the old road near the railway where a medical centre had been formed by 14 British CCS.
On the morning of 1 July the enemy opened the battle for the
On 2 July further attacks were repulsed, and the following day a valuable New Zealand counter-attack on the Ariete Division routed the
From enemy documents we learn that on 3 July Panzerarmee Afrika reported: ‘The enemy's strength, our own numerical weakness and overstrained supply position, all compel us to halt our large-scale attack temporarily’; and on 4 July the entry included: ‘Our intention is to hold our frontline positions and regroup with a view to encircling and destroying 2 NZ Division’.
The turning point in the battle to stabilise the line had been reached by 4 July, when the failure of Rommel's attacks led him to give orders to go over to the defensive. It seemed that Rommel would have to postpone the date of his much-advertised triumphal march to
As the positions in the 21 Panzer Division captured the empty fortress on 9 July. The front became almost static at this stage and the New Zealanders began to consolidate their positions between Deir el Munassib and
Facing a line which he had failed to pierce, the enemy was now confronted with difficulties of supplying an army with land lines of communication stretching 600 miles to the west; an army, moreover, which was in immediate need of reinforcement in men and equipment. Mersa Matruh and
In the early days of July 4 MDS remained open for the treatment of casualties and sick. Considerable quantities of blood, plasma, serums, and saline were given to patients, a number of whom had
On 1 July arrangements were made to evacuate cases by
On 4 July a reconnaissance was made of the route taken by
Medical equipment and
Casualties treated by the field ambulances from 27 June to 7 July were:
On 6 July 5 Field Ambulance moved west until it was just south of
Some 14 miles south of
In this action Captain
Captain Thompson, the MO attached to a NZ Brigade, followed up the attack on
Our active New Zealand MDS was strongly reinforced for the battle by the attachment of British surgical teams from
After the attack on
The MDS was staffed by 4 Field Ambulance from 16 to 27 July, when the unit was relieved by 6 Field Ambulance. During this period 2183 cases were admitted and treated. By 17 July a number of units of 4 and 6 Brigades were located close to and almost entirely surrounding the MDS. Requests by ADMS 2 NZ Division for their removal had met with no response. Then at noon on 17 July German bombers circled the area, heavily bombing the surrounding troops but obviously intentionally avoiding the
Eighth Army had been attacking since 10 July and it continued to take the initiative. On the night of 21–22 July, intending to exploit the enemy's known weakness in tanks and shortage of reliable infantry, another attack was launched. The main attack was made in the central sector by 2 NZ Division and
The task allotted to 6 Brigade was the capture of the eastern tongue of the
On the evening of the attack 6 ADS moved up just before dark to
Casualties were received early from shelling before the troops had passed through the minefields. The stretcher-bearers carried the wounded to the collecting points, whence the ambulances took them to the ADS, negotiating the minefield in the dark. Some of the wounded were cleared to the ADS in a commandeered 3-ton truck and a battalion RAP runabout. The first casualties reached the ADS before midnight and continued to come in and be evacuated through the hours of darkness. In the morning the ambulances were able to clear further wounded from the stretcher-bearer parks and the ADS was kept busy until midday, but by 1 p.m. all patients had been cleared to the MDS.
Situated about 2 miles behind 6 ADS was 4 ADS, and this unit also received and treated a proportion of the wounded, approximately 100 cases as against 230 at 6 ADS.
At 4 MDS there was an almost overwhelming amount of work, but assistance was given by British units. A mobile blood transfusion unit had been attached on 19 July, and 151 Light Field Ambulance and 1 Light Field Ambulance were located adjacent to 4 MDS. Two surgical teams were still attached, and the arrival of Light Section
From 9.15 p.m. on 21 July the MDS received patients in a steady stream. A high proportion of men were suffering from very severe wounds, so that it was necessary for Major Taylor's surgical team to work all night, while the unit's own operating section was busy until about 3 a.m. on 22 July. Then, at 6.30 a.m. casualties streamed in again and kept all sections of the MDS very busy. By evening 632 patients had been admitted during that day alone, and of these 394 had been evacuated to
Another very busy day was experienced on 23 July when a further 438 cases were admitted, and evacuation convoys left regularly during the day. On two ambulance planes seventeen severely wounded patients were sent direct to base hospitals in
In the desert towards the end of July it was clear that the initiative had been wrenched away from the enemy by what General
It was then evident that neither side was sufficiently strong to deliver a knockout blow to the other and that each required a breathing spell in order to accumulate the men, material, and supplies necessary for the resumption of full-scale operations. The full resources of the Eighth Army had been occupied in holding the extended front, and it had been impossible to form a real reserve and so allow troops to be rested, re-formed, and trained for fresh assaults. New formations were beginning to arrive in
The Eighth Army's casualties in battle during July were about 750 officers and 12,500 men; of these some 4000 belonged to the New Zealand Division—severe losses which testified to the bitterness of the fighting to stabilise the line.
In the vital and strenuous campaign following the Division's sudden recall from Panzerarmee losses for
Medical officers: 1 prisoner of war (Captain Feltham) Maj R. J. Feltham; Hunterville; born Ohakune,
Other ranks: 1 killed in action; 15 prisoners of war (plus 4 NZASC attached), and 8 wounded. In addition, three AFS drivers were taken prisoner and one driver wounded.
The medical units treated all the battle casualties and sick from the Division together with many British, South African, Indian, and prisoner-of-war sick and wounded. The grand total of these for the
In the period under review all admissions and discharges were controlled by the field ambulance, even when the Light Section
The British transfusion unit proved a boon. It gave 109 intravenous transfusions, while the MDS gave 193 and the ADS companies 46 transfusions from 24 June to 27 July. The transfusion unit, consisting of 1 officer, 3 medical orderlies, and 2 other ranks, was attached on 19 July and thereupon took over nearly all transfusions, giving 96 in the following seven days. Prior to this the field ambulance had organised its own separate transfusion squad and had used seventy blood donors for the supply of blood.
Air evacuation was established from temporary landing grounds alongside the MDS on 19 July and continued more or less regularly, upward of seventy cases being evacuated between then and the end of the month. These evacuations were carried out both by planes with
The ADMS 2 NZ Division, Colonel Ardagh, in an operational report, commented that for the first time in the war the New Zealand medical services had been able to operate under favourable conditions with a normal line of evacuation and regular channels of supply of equipment and reinforcements. Each ambulance had been complimented independently by 14 British CCS and the base hospitals on the excellent state in which the wounded arrived. This was due to the following factors: rapid evacuation, not only from MDS to base hospital, but from the battlefield to the surgical operating tables in the MDS; the performance of surgery as far
Colonel Ardagh also pointed out that although battle conditions, frequent moves, and uncertainty made routine administration awkward there had been no real difficulties. This was to a large extent due to good medical liaison between DMS
The
On 8 July the Light Section of 1 CCS was moved to
At this stage it became the policy in the
Towards the end of June the troops in
The heavy actions fought by 2 NZ Division from 27 June onwards resulted in a large number of battle casualties, and the trying conditions also produced a relatively high sick rate. The only New Zealand hospital able to admit patients from the forward areas was 1 General Hospital as 3 General Hospital was in
The first casualties arrived at 1 General Hospital on 30 June, and during July 444 battle casualties were admitted, some coming by ambulance train from
Many New Zealanders were admitted to British hospitals in
At 1 General Hospital it was found that the condition of battle casualties on arrival was excellent in most cases, owing to the efficient treatment received in forward areas. Air evacuation was a noteworthy improvement. Most wounds were clean on arrival at
After arriving at
At
After the July battles a lull of static warfare settled over the
Both sides wired and mined their front in depth. Our patrols went out almost every night seeking information and raiding, salvaging vehicles, and burying the dead. At dawn both sides lobbed shells at the other until the sunshine and dust began to create mirage effects and targets became blurred. From 10 a.m. to 4 p.m. quietness usually settled over the battlefront, broken only by occasional shell-fire and bombing raids, the latter decreasing as the
Big changes in command took place in the Eighth Army in August. On 10 August
Lieutenant-General W. H. E. Gott, Commander of 13 Corps, was shot down and killed when enemy fighters attacked the plane in which he was taking off for
On 20 August Mr Churchill visited our sector of the front. Speaking to a gathering of New Zealanders, representatives from all units in the line, the British Prime Minister paid the Division a striking tribute, saying: ‘You have played a magnificent, a notable, even a decisive part in stemming a great retreat which would have been most detrimental to the cause of the
During August the medical units were concerned mainly with the treatment of the sick. The relatively high sick rate of the Division was due to the prolonged nature of the battles and the trying conditions under which they were fought, not forgetting the summer heat with the water ration only three-quarters of a gallon a man a day. There was an increase in dysentery and diarrhoea (and later infective hepatitis) owing to the great number of flies, control being difficult because of the unburied dead lying beyond the forward defended localities out of reach of burial parties, and the prevailing wind blowing directly from the Italian lines.
On 28 July 6 Field Ambulance took over the MDS from 4 Field Ambulance on the same site,
The 6th MDS moved on 4 August to another site at
During the month 4 Field Ambulance treated 335 patients and 6 Field Ambulance
On the night of 30–31 August, Rommel resumed the offensive in a fresh endeavour to defeat the Eighth Army and capture Afrika Korps into the offensive. The light armoured forces watching the southern minefields fell back on to the main defences. During 31 August and 1 September the enemy established a narrow salient between the
Rommel could not risk bypassing the Eighth Army with its considerable armoured forces and he then swung north against our southern flank, which consisted of a deep east-west defensive line along the
During Rommel's attack eastwards the New Zealand Division had been holding the southern sector of the main defences on the high ground north of Deir el Munassib, shelling the enemy columns and waiting for a suitable opportunity to attack. On the evening of 3 September 6 Brigade, 132 British Brigade, and 5 Brigade launched a night attack with considerable success. The threat on the enemy's flank as he withdrew made him react violently. He made a number
In the initial stages of the enemy attack both 4 and 6 ADSs were in an area subjected to a degree of shelling and bombing, but fortunately neither unit received damage. The offensive by 2 NZ Division involved cutting three gaps through minefields. Ambulance-car posts were established at minefield gaps and, as usual, an ambulance car was posted with each RMO. Casualties arrived at the ADSs in a steady stream throughout the night of 3–4 September. They were given treatment and held in the ADSs. Additional ambulance cars and 3-ton trucks had been sent up from 4 MDS to cope with the evacuation of patients, but it was not possible to send any wounded back before daylight as it was a dark night and the route out from the ADSs was by narrow, rough tracks through minefields.
Evacuation proceeded smoothly in the morning and by 1.30 p.m. on 4 September the majority of the night's casualties had been passed on by the ADSs. By this time approximately 400 patients had been handled. Casualties continued to come in throughout the day, and by midnight on 4–5 September 4 MDS had handled 560 cases. A surgical team from 6 Field Ambulance was called upon and, together with the
During the night of 3–4 September at Deir el Angar Captain
From 1 to 11 September, the date on which the Division was withdrawn from the line, 4 MDS treated 744 battle casualties and 615 sick, of whom 234 and 289 respectively were New Zealanders.
The New Zealand Division was withdrawn from the line by stages from 8 to 11 September, being relieved by 1 Royal Greek Brigade and two brigades of 44 Division. The MDS was maintained by 4 Field Ambulance until 132 Field Ambulance set up nearby. Thereupon 4 Field Ambulance moved to Bir Hasein, near
From 17 to 19 September 5 and 6 Brigades, with 5 and 6 Field Ambulances under command, moved to a training area south of
Minqar Qaim: The plan for the
From the MDS evacuation was carried out by 2 British MAC to British units, either Corps or Army CCSs, whence the cases were evacuated to the base hospitals in the Delta and in the Canal Zone.
Alamein Line: Two advanced dressing stations were similarly attached to the brigades evacuating to the active MDS. Arrangements were made to carry out all forward surgery at the MDS and British surgical teams were attached for this purpose. Later a Field Transfusion Unit was also attached. A surgical team from the New Zealand CCS was then sent forward to the MDS, and later this was strengthened by extra equipment and orderlies to allow abdominal and other serious cases to be held and nursed for up to ten days following operation. Air evacuation from improvised landing grounds alongside the MDS was also utilised for serious cases. Ambulance-car evacuation by 2 British MAC was to the Army CCS at the L of C medical area, from where road, rail, and air evacuation was provided.
Evacuation to the MDS: The provision of twenty AFS ambulance cars at the beginning of the campaign built up adequate transport for the evacuation of cases from the actual battlefield back to the MDS. There were only eight ambulances normally available for each field ambulance at this period and five were destroyed during the
Evacuation from the MDS: This was regularly carried out by 2 British MAC. There was only one hitch when contact was lost during the retirement of
From the
The protection of the
The RMOs were faced with difficulties and serious discomforts in their work during this period. Their equipment varied considerably, some having a 15-cwt truck, some a three-tonner, but generally an ambulance was also attached to each battalion. In some cases a 3-ton truck had been especially fitted up for the RAP. Four-wheel-drive vehicles were obtained if possible, as sandy areas had to be negotiated and the desert surface was often very rough. Unit trucks and Bren carriers were utilised to take the wounded to the RAP and ambulances to transport them to the ADS. Frequently ambulances were utilised in front of the RAP.
Casualties from minefields and from bombing were frequent. The minefields caused many casualties amongst the ambulance
Wound treatment was simple and splinting, except of the simplest kind, was generally left to the ADS. Speed of evacuation was the aim. The sand and heat were oppressive and there was only the minimum supply of water.
The pre-
At the end of July a surgical team under Major S. L. Wilson was sent forward from our New Zealand CCS. This team at first worked in conjunction with the British teams, but later, when operations quietened down, it enabled the British teams to be released. The adequate provision for surgery by means of these teams, concentrated
The surgical teams at that time were all conscious of difficulty in lighting, sterilisation, and the nursing of serious cases after operation. Arrangements were made so that, in the event of the MDS having to move quickly, a section of a field ambulance under an officer would immediately take over the patients and nurse them until they were fit to move to the CCS.
The field ambulances were supplied with equipment for the giving of blood and plasma and personnel had been trained for this purpose. In one field ambulance dental mechanics proved eminently suited to this work. In the early part of the campaign blood drawn from seventy donors was used, and serum was also given. The position was markedly improved on 19 July when Captain D. D. Muir, RAMC, with his British field transfusion unit was attached to our active MDS. For transfusions there were then available highly skilled personnel and an ample and regular supply of blood from the base unit in
The OC British Transfusion Services provided boxes containing four bottles of liquid blood plasma and two sterile giving sets for issue to RMOs. Fifteen such sets were issued to the RMOs, thus providing a useful reserve for the Division. Serum, plasma, and saline solution had previously been given regularly at ADSs and, in anticipation of further operations, supplies of blood were similarly arranged. Blood supplies from 6 British Mobile Transfusion Unit were sent to ADSs daily in insulated containers packed with ice. Any unused blood was returned in twenty-four or forty-eight hours to the refrigerator and fresh supplies sent in exchange, thus avoiding wastage by deterioration.
A further development that contributed to good results was the provision of sterilised dressings and theatre supplies, packed by the team of
As regards wound treatment, the utilisation of sulphanilamide, both locally to the wound and also by the mouth, was standardised and a special label introduced for the recording of dosage given during the evacuation to the Base.
Vaseline gauze was the normal wound dressing and this was available sterilised and in ample supply. Tulle gras dressings were also supplied.
Fractured femurs were generally evacuated in Thomas splints, with posterior plaster slabs and circular plaster bandages incorporated with the splint, giving excellent stability and comfortable travelling. Fractured arms generally had light plaster splints applied. Fractured spines were sent down in body plasters. Difficulties were encountered in applying these plasters, and also plaster spicas, without a plaster table.
Heads: These cases were mostly sent to the base unit in
Chests: The suture of the sucking wounds proved unsatisfactory, being generally septic when seen at the base hospitals. Firm pads kept in place either by elastoplast or by a few strong silkworm sutures tied over the pad were therefore utilised.
Abdomens: Early evacuation militated against satisfactory results. The exteriorisation of the colon was utilised for colonic injuries. Sulphadiazine was first utilised for introduction into the peritoneum at operation. Gastric suction and continuous intravenous glucose and saline became routine treatment.
Amputations: These were numerous. Skin traction was frequently applied in the early stages and some cases lightly sutured over a tulle gras roll had done well. Generally the wounds were clean.
Burns: Tanning had ceased to be employed. Instead, sulphanilamide in small quantities and tulle gras dressings were applied. At the base hospital our saline bath unit was utilised for treatment of these cases.
There was less sepsis in the wounds than in the previous campaign owing to early operation and possibly to local sulphonamides. There were some cases of gas infection but none of the septicaemic variety, the cases seen being associated with deficient blood supply resulting in local gangrene of muscle groups. Amputations, however, even of the arm, had to be done for gas gangrene.
Pentothal was commonly used both for induction and for the shorter cases. Gas and oxygen was utilised by some of the surgical teams. Ether was used for the more severe cases.
The results generally were excellent and the experience gained in the Second Libyan Campaign had been used to assure first-class results. The work of our forward units earned high praise from senior British officers and British units on the L of C and at the Base. To this result the excellent British surgical teams attached to New Zealand medical units contributed greatly, as did the courageous work of the AFS drivers and other ambulance personnel.
The combination of skilled surgeons, adequate resuscitation, and markedly improved nursing facilities made a great difference in the surgical results obtained, and this was noted and commented on by all observers at Base. Colonel Ardagh, ADMS 2 NZ Division, a capable surgeon and a very able and forceful administrator, was largely responsible for the co-ordination and efficiency of the forward surgery in our Division at that period.
The Consultant Surgeon, Middle East Force, in his report at the time, had the following comments to make on surgery generally during the summer battles of
.… The surgeons at base units had nothing but praise for the work of their colleagues in the forward units, and few criticisms were forthcoming. I formed the impression that there was yet a further improvement in the standard of the work, and several divisional surgeons voluntarily stated that they thought the work was ‘first-class’. It was certainly an impressive sight to see so many severely wounded men looking remarkably well and free from pain, at all events, in these, the earlier days of their incapacity. From officers and other ranks who were casualties, I heard no complaints, in fact, much praise of the medical services.
During the period July to September 1942, including the battle of
A remarkable feature of the period after the Division's return to the desert was that the Field Hygiene Section was not with the Division as a complete unit from the end of June until 19 November. When the main body of 4 Field Hygiene Section reached the Mersa Matruh area at the end of June, it had to hand over its vehicles to 27 (MG) Battalion as transport was in short supply and the Division was to adopt a mobile role. As they would be an encumbrance, the workshop and disinfestor sections of the unit were sent back to
Before the end of July the Division was beginning to be pestered by a fly plague. At the end of July six members of 4 Field Hygiene Section were recalled to the Division, making eleven NCOs and men attached to the medical units, but still without transport or equipment. Sanitary appliances had to be improvised from discarded petrol tins and ammunition boxes, the only tools available being broken bayonets and tent mallets. The workshop at
In August the blistering heat of summer, the dust, and the flies were at their peak. Despite the most vigorous counter-action, the flies clustered everywhere. To some extent the fly problem was uncontrollable owing to unburied dead lying beyond the reach of
The area then occupied by the troops had been fairly thickly populated by native tribes and was therefore so contaminated that fly-breeding was encouraged. The coastal sector, particularly along the railway, had always been the most thickly populated area, and this suffered most from flies. Vehicles had a great attraction for flies, and each one of the thousands of trucks running from the coastal sector, particularly from supply points, contributed its not inconsiderable quota to those already living and multiplying in the divisional area.
Hygiene measures within the Division were made as complete as possible from the first. Owing partly to lack of materials and partly to the rocky nature of the ground, deep-trench latrines were not practicable except in certain rear areas. Shallow-trench latrines were used and changed every twenty-four hours, with the copious use of oil and cresol following burning-out with petrol. All refuse was burnt before burial. Fly netting at first was in short supply and was issued only to cooks' trucks, RAPs, and dressing stations. Flytraps and poisons were not available in the initial stages at
To make matters worse a cloud of mosquitoes, A. Pharoensis, covering an area at least 10 miles in diameter, was blown by an east wind from
The fly menace, with its accompanying incidence of diarrhoea, had reached such alarming proportions by early August that a rigorous drive was developed against it. A New Zealand Division routine order of 7 August directed units to construct as many flytraps as possible and gave details for their construction in an appendix. A conference presided over by ADMS 2 NZ Division was held at
The following day the intensified campaign against flies was well under way. A truck arrived from Headquarters
Models of improvised fly-proof latrines made from petrol tins, fly-traps of various kinds, and soak-pits were made and demonstrated to all units. For those units which were new to the desert, special lectures and demonstrations had been arranged and these had produced most gratifying results. A demonstration area was prepared at Rear HQ NZ Division and representatives of all units visited it. As a result they were able to produce appliances suitable to local conditions. Stress was laid on improvisation and nothing was shown that could not be made with petrol tins, a bayonet, and a shovel. Methods described in textbooks were of no use when the materials were not available; but the principles could be embodied in improvisation from salvage. Education was the responsibility of the medical services, but it was the responsibility of the unit to see that a high standard of hygiene and sanitation was maintained at all times. It was the thoughtlessness and carelessness of the individual which endangered health in situations where manpower was the most important factor.
The greatest handicap to a total anti-fly campaign had been the lack of material. It had to be recognised that while everything possible might be done to prevent breeding and to minimise infection, the psychological effect of killing flies and actually seeing them die was a great one. There was a pathological and psychological battle. The mere presence of flies has an effect on both morale and comfort which is almost as important as the danger of infection. Before the end of August the improved state as regards flies was most gratifying.
In regard to other sanitation arrangements, urinals were constructed of tin so as to form a pipe leading into a soakage pit under the sand—the desert-lily pattern.
Soakage pits were also dug at each vehicle and special pits, made from two petrol tins, constructed for cookhouses. All the pits were flushed daily with petrol. Altogether, the unprecedented conditions led to both a keen appreciation of the necessity for adequate sanitary measures and remarkable ingenuity and success in designing methods of dealing with the difficulties that arose.
Rations and the handling of them were specially investigated in view of the fly menace. Inspections carried out along the supply line from the field maintenance centre to units showed that precautions precluded the possibility of infection of food, except perhaps for bread, which was uncovered until it reached the field maintenance centre. The conclusion reached by OC 4 Field Hygiene Section after conversing with personnel of all units was that great satisfaction was felt concerning the rations. The standard was good and the supply sufficient. With the rations, plus those extras which most units provided out of regimental funds, it was considered that the diet was adequate.
While the men endured the discomforts of the desert a continuous stream of vehicles moved backwards and forwards over sandy desert tracks, great clouds of dust in their wake. They brought forward increasing quantities of food, water, and ammunition. The main items in the rations were bread, biscuits, bully beef, tinned stew, tinned sausages, cheese, and margarine. Then, with improved organisation, came fresh tomatoes, lettuce, melons, marrows, potatoes, onions, and limes. The water ration was small—one water-bottle and then one gallon a day for each man—for drinking, washing, and cooking; occasionally the issue was increased to permit of a real wash. In spite of all they had gone through, the men were comparatively fresh—fit, lean, and very brown, but not hard.
The incidence of diarrhoea and dysentery steadily dropped from its high level of July and early August, though it was still considerable. Its fall coincided with the reduction of flies consequent upon the strenuous measures instituted; other factors to be considered also were that the height of the late summer fly season was passing as the weather grew cooler, and that a certain amount of acquired immunity existed among the troops.
During August supplies of castor oil and sodium sulphate were short, but they improved again later. Sulphaguanadine became available in the Middle East Force in restricted quantities at this time and a supply was sent to the Division at the end of August for trial in the forward areas. It was found to be most effective.
After two and a half months of continuous fighting the troops were becoming more susceptible to minor illnesses, including septic skin conditions and sore throats. Infective hepatitis made its appearance and rose to epidemic proportions by October. There had been a number of cases of malaria, but most infections seemed to
Infective hepatitis first appeared in the Division at the end of September and then spread throughout Eighth Army. The disease was also present amongst the enemy troops at this time. It appeared that contact with infected troops or ground was responsible, and the infection arose when New Zealand troops took over from Italian troops ground that was grossly fouled and infested with flies. The flies and the difficulties of ensuring efficient sanitation added to the risks of infection.
Evacuation from the forward areas to the base, with a convalescence of four to six weeks, was proved necessary as cases retained in the Division were very slow to recover normal health. The disease caused serious wastage in the Division and it appeared that New Zealand personnel were particularly susceptible to the infection. No specific treatment was available, and rest and careful dieting was the routine.
Although hepatitis was only very rarely associated with severe illness or death, it caused marked debility with a slow convalescence and occasionally there was a relapse which necessitated invaliding.
It was found that the incidence in the different units was proportionate to the time they were stationed in the
The number of cases reported in
At this time psychoneurotic cases were being evacuated from the Division labelled as ‘battle casualties’. This led to difficulties as such designation was undesirable from the military standpoint, and inaccurate medically. At a conference of senior medical officers it was decided that the psychoneurotic cases should be carefully allocated to different categories according to their aetiology. Only those cases recorded by the RMO, on specially prepared forms, as having suffered from some definite battle injury or severe strain would in future be labelled as battle casualties, and in these cases the diagnosis of ‘physical exhaustion’ would be appropriate for those without any definite physical injury. (At this time GHQ MEF
The epidemic of infective hepatitis placed a big strain on base medical units, particularly 1 General Hospital and also 2 General Hospital, 1 Camp Hospital, and
Within a short time of becoming established at
The
Maadi Camp Hospital had persisted since the days of the First Echelon and had never been given an adequate establishment as it was felt that it could carry on with reinforcement personnel. Now that reinforcements were no longer forthcoming it was felt that it would be reasonable to set up a proper establishment, even if it was unlikely that it could be maintained at full strength. This was done in September and the unit became 23 NZ Field Ambulance, which designation it had originally been given at the end of June as part of the reserve formation organised in
A special truck equipped with a refrigerator for the storage of blood had been ordered by the New Zealand Government in January and arrived at the end of September. Steps were immediately taken to form a Field Transfusion Unit, such as the British unit which had proved so valuable in the
On 11 September Brigadier MacCormick returned from New Zealand and on 18 September resumed the appointment of DMS
A full report on this subject was submitted by Colonel Ardagh, ADMS 2 NZ Division, and a shorter report by Lieutenant-Colonel King, OC 4 Field Ambulance. Colonel Ardagh stressed three main factors in the successful working of a divisional medical service and in the efficient treatment of battle casualties:
Early collection and evacuation from place of injury to the nearest station providing surgery.
Provision of resuscitation at ADS and/or MDS.
Provision of efficient surgery as nearly as possible within the optimum period of six to twelve hours.
His report ran:
Early evacuation cannot be ensured without an adequate supply of ambulance cars on the line of evacuation, RAP to ADS to MDS. It can fairly be said that, unless casualties can be collected quickly, given initial treatment including shock therapy, and evacuated early to the nearest station providing surgery, the benefits of modern surgery and skilled surgical teams will be largely negatived; the result will be, in proportion to the delay past the optimum period, increased loss of life, limb or function, with relatively much lengthened periods of recovery and convalescence in general. It is well known that wounds in modern warfare are accompanied by considerable shock, apart from haemorrhage, and that if wounded are left lying out in the field or around RAPs for any length of time, with the attendant nervous strain from the proximity of shell or bomb explosions, this shock is considerably aggravated, just as loss of body heat and dehydration are accentuated by the delay in receiving resuscitation. The supply of ambulance cars necessary to deal with busy periods and thus avoid this delay can be effected by increasing the establishment to 20 cars for Field Ambulance as is the case in Light Field Ambulances, or by attaching extra cars whenever a Division is going into an active role.
2 NZ Div. has right through this campaign had sufficient cars attached by
Resuscitation which includes administration of fluids, warmth, comfort and especially relief of pain, with, in more severe cases intravenous use of blood and/or plasma must be available at an ADS, unless an MDS underground could be close enough to dispense with the necessity for an ADS. In the period July to August this was most essential at certain periods where travel was rough, as many patients transfused at the ADS would not otherwise have survived the rough journey to the MDS.
At the MDS, with surgical teams attached, resuscitation is necessary on a large scale, not only to prepare serious cases for operation, but to fit them for the journey, often long and rough, to the CCS or, in rarer cases to fit them for air ambulance evacuation to Base Hospital.
It is the definite and considered opinion of all surgeons and experienced Field Ambulance officers that ‘whole blood’ even if held in the refrigerator for 14 days is much superior to ‘plasma’, inasmuch as not only does it produce a quicker response, but maintains the improvement much longer. With this end in view and also in order to conserve supplies of blood, the administration of plasma may be used in conjunction with whole blood.
The attachment of a Transfusion Unit to the MDS is a big advantage as it supplies a skilled team to attend solely to intravenous therapy, thus relieving the MDS staff and surgical teams in busy periods of much work, and it ensures an adequate supply of blood kept at the correct temperature in the special refrigerator. The alternative is an easily available ‘Blood Bank’ provided by Corps. A shuttle service of blood between MDS and ADS was provided in August and in the recent battle and undoubtedly saved a considerable number of lives by early administration at the ADS. CO 6 Field Ambulance in
It will be accepted by all that at least lifesaving surgery should be done at the most forward operating centre for even the delay of an hour or two will deprive the patient of prospects of recovery and this is especially so in the penetrating abdominal wounds. In these cases provision should be made to nurse them in hospital beds and so hold them for the necessary period varying from 2 to 10 days. In static conditions, or in an advance this is always possible, for if the MDS has to move, sufficient personnel to continue nursing these patients in situ can be provided, and throughout most of the campaign as many as 20 patients at a time were held in the MDS, nursed in beds with an additional saving of life thereby. If a retirement should be ordered, or a sudden retreat enforced, it would obviously be necessary for the MDS to evacuate these patients, or to carry them with the Field Ambulance in ambulance cars. The alternative of leaving them with the enemy would not be voluntarily considered as it is certain that the enemy would in any case move them and would be unlikely in doing so to give them as good treatment as our own units.
Where the tactical situation makes it possible, or where the route of evacuation is long and rough as in the period June to September, more than merely life-saving surgery can and should be done at the MDS, except on rare occasions such as the period 23 Oct. to 4 Nov. when the CCS was distant from the MDS only two hours on a smooth main road. Once the optimum period is passed even a short delay of a few hours in providing surgery, and even in less serious wounds, lessens the prospects of quick recovery and control or prevention of wound infection, and increases the risk and degree of loss of function, as well as necessitating for such patients much longer periods of hospitalisation and convalescence.
So far in the desert campaign from June last it has always been possible and beneficial to the wounded to provide resuscitation, surgery and nursing at the open MDS without in any way impeding the ability of the Field Ambulance to close, move or open when and as required.
Lieutenant-Colonel King stressed the necessity of having attached to our active MDS two surgical teams, one of which should be a light section of a CCS with facilities for post-operative nursing. He considered the surgical team should contain three medical officers to allow a measure of relief. Strong support was given to the attachment of an FTU to the MDS and the highest praise expressed for
The lessons learnt are clearly enunciated in these reports, and could be summarised as:
The importance of a considerable increase in the provision of ambulance cars in the forward areas.
The great value of early blood transfusion with the attachment of an FTU to the operating MDS.
The need for the attachment of at least two surgical teams and a nursing section from a CCS to the MDS to ensure skilled surgery and post-operative nursing.
Early air evacuation is dangerous for abdominal cases and chest cases with any respiratory distress. It is eminently suitable for all other cases.
Wireless inter-communication between medical units is desirable in mobile warfare.
The value of sterilised dressings forwarded from the base.
Though circumstances were admittedly difficult at the time, it seems that the importance of the hygiene unit in the safeguarding of the health of the Division was not fully appreciated. When conditions were the most difficult in the history of the Division from the sanitation point of view, 4 Field Hygiene Section was allowed to remain at its weakest—depleted in numbers, without equipment and without transport, and, until August, dispersed among medical units. The unit was not re-equipped with vehicles until the end of October, when it was sited next to
It is recognised, however, that the steady supply of fly-traps and poisons, latrine lids, and the constant inspections by the hygiene personnel diminished the number of flies and checked the incidence of excremental disease. On 10 September the ADH 13 Corps stated that the sickness rate in the Division was the lowest in 13 Corps' area. This position contrasts with that obtaining in the enemy lines.
The enemy's deficiencies in hygiene and sanitation, with consequent deterioration in the health of his troops, played an important part in the outcome of the Battle of Panzerarmee to Field Marshal Rommel (then in
General Alexander, in a despatch published in The London Gazette on
These arrivals (of enemy reinforcements) which averaged about 5,000 men a week, This figure is now thought to be unduly high.
For a week or so in September most of the troops had a spell at
When the New Zealand Division withdrew for a spell from the
The New Zealand Division has been now in this Corps for some three months; during this time we have been through some arduous times together which have entailed much hard work, accompanied by no little danger. The three NZ Field Ambulances under your command have nearly all the time been the nodal point of evacuation and through the Main Dressing Stations have passed
IN September and October 1942 Eighth Army made its elaborate preparations for the offensive at
At the end of September, under conditions as similar as possible to those anticipated in the actual attack, the New Zealand Division worked out and tested a technique for the initial assault. The medical units of the Division took part in the special training of the Division. The particular aspect affecting the Medical Corps was the planned evacuation of casualties through the minefields, which is set out later. On 30 September General Montgomery paid a visit to the Division and spent twelve hours with the New Zealanders, during which he travelled many miles over the desert training area behind the
For the first two weeks of October brigade and battalion training followed the divisional exercises. During this period 5 and 6 Field Ambulances and 166 British Light Field Ambulance ran both ADSs and MDSs for 5 and 6 Infantry Brigades and 9 British Armoured Brigade which was under command. Fourth Field Ambulance was located in
15 Panzer Division was located in the northern and
The British 30 Corps was assigned the task of making the necessary gaps in the northern defences. In 30 Corps were 9 Australian Division, 51 Highland Division,
The 35 miles of front extending from the sea to the
The evacuation of wounded in comfort was possible only by the coastal road and railway, though there was an old road alongside the railway which, though not in very good condition, was available and was utilised to some extent.
The Alamein line had been stabilised for some time and it had been possible to make thorough preparation for the treatment of the large number of casualties expected from the battle, a number estimated at 12,000 apart from prisoners.
An ample supply of ambulance cars and some lorries for walking wounded were attached to the field ambulances to ensure rapid evacuation from the RAPs to the ADS and from the ADS to the MDS. Each battalion had also been supplied with an ambulance car before the battle. There were also ambulance cars and trucks available in large numbers for further evacuation to the hospital area at
A group of MDSs had been sited around the
Evacuation from this group of dressing stations, including cases of secondary urgency for operation, was by road to the hospital centre, which had been active for some time at
The 14th British Field Ambulance came first on the line of evacuation and was to perform the double duty of sorting out and relaying the serious cases to the CCSs, treating the minor cases, holding up to 400, and evacuating them continuously to 200 British Field Ambulance at
Evacuation would ordinarily be by train to the Delta and Canal areas from
The New Zealand medical arrangements consisted in the employment of two advanced dressing stations in the forward areas servicing the two brigades and attached troops. Each RAP had an ambulance
The active MDS had attached to it the New Zealand Surgical Team and extra personnel to enable it to undertake urgent surgery, including the abdominals, and to hold and nurse serious cases. Only urgent cases were to be dealt with at the MDS and the remainder sent to the CCS, which was within easy reach over a reasonably good road.
The ADMS 2 NZ Division, Colonel Ardagh, was granted permission to call on the NZ FTU and the Light Section of the CCS if conditions warranted their use. (Both units were called up.) A section of 4 Field Ambulance was detailed to take over cases from the MDS when this unit moved forward. Ample medical stores were available in the different units and ample
The 5th MDS was stationed in the narrow space between the main coast road and the railway, one and a half miles east of
When 2 NZ Division entered the line on 22 October, 5 Field Ambulance, under Lieutenant-Colonel McQuilkin, opened an MDS as already mentioned. A Company 5 Field Ambulance, under Major Dempsey, was placed under the command of 5 Infantry Brigade to run an ADS. One company (also A Company) from 6 Field Ambulance, under Major R. A. Elliott, provided an ADS for 6 Infantry Brigade. An ADS for
To 5 MDS were attached 2 NZ Surgical Team and a surgical team from Light Section
With dramatic suddenness, after weeks of static warfare, the Battle of
The opposition in the first stages of the attack had been mainly from mortar and machine-gun fire, with many casualties from anti-personnel mines, but in the second stage the infantry found strongly defended posts and snipers. Strongpoint after strongpoint had to be taken with the bayonet. At dawn on 24 October the battle was still raging, but by 7 a.m.
Each RMO utilised his attached ambulance car to collect accessible cases on the battlefield. Evacuation back to the ADS was carried out by cars sent forward from the ADS. The minefields through which the advance had been made rendered the collection of wounded very difficult. Stretcher-bearing was particularly irksome and dangerous, as it was necessary to pick up the casualties away from the main tracks, especially in the region of the minefields, and carry them to the ambulances moving on the tracks.
The New Zealand Division evolved a particular system of evacuation through minefields. Casualties at the start line were collected by an ambulance stationed there. All men were instructed before the battle that if they became casualties they must make their way to one of the definite brigade axes. There were two axes for 6 Brigade in its attack on
Ambulance cars were instructed not to leave the lit routes because of scattered mines, and men between the routes had to be brought to them by hand carriage. Ambulances had to proceed forward to the RAPs at all costs and not turn back with wounded picked up on route. If available, a 3-ton truck marked ‘walking wounded’ patrolled the routes.
The ADS commander had to avoid committing so many ambulance cars forward that he could not evacuate to the MDS. This minefield drill became the standard practice in the British Army.
All the medical officers attached to the British armoured units with our Division became casualties during the battle and our own RMOs took over their work. The type of work carried out by the RMO is illustrated by the citations upon which Captain Rutherford gained an immediate bar to his MC and Captain
After the attack on the night of 23–24 October and on the three succeeding days, says Rutherford's citation, 26 Battalion was in position on the forward slope of
Captain McCarthy was RMO to 25 Battalion in this attack. On 24 October his RAP was under heavy shellfire all day and, although he was at all times liable to become a casualty himself, he carried on with his work under great difficulties, never ceasing to attend to wounded whenever they were brought in. Throughout the night
An extract from the diary of Captain
In the evening (of the 23rd) after dusk troops began to form up.… The RAP truck was to go to the start line 20 min. after the Bn started, and to move up to the Bn with the remaining transport when the minefield was cleared.
Our troops moved forward about 2115 and crossed the start line at 2130. I took my place at the start line at 2150 hrs and received any walking wounded and directed them on.… We were in slit trenches or working in the ambulance which had duly arrived. Flying over our heads was a continual sweep of 25-pounder shells making a deafening roar.
Our transport came about 0100 hrs and we went up the track as directed.… I met some orderlies with wounded, filled the truck with two lying cases, and went further forward to collect two more near a front minefield. Machine gun fire and tracer bullets went past.
I ordered more ambulances. In the meantime there were more wounded up front, so I went off and got two Bren gun carriers and took these up to the same place and collected four more lying cases. I felt much safer in a Bren carrier with low-firing MG fire.… Four American ambulances came up so I sent one away full, left one with me half-full, and sent two up to Sam Rutherford (26 Bn). They did not contact him but came back full.
I was then given a guide and he led me in, but first I picked up some 25 wounded, and sent the walking wounded back and told them to get on the American ambulance. I eventually arrived at 24 Bn, filled up the ambulance and sent it back with the guide to collect my 3-tonner, which got lost but eventually arrived, and later an ambulance returned and I got cases away.
For the attack A Company 5 Field Ambulance under Major Dempsey was located just off Star track and behind a slight escarpment but in front of the artillery. A Company 6 Field Ambulance, under Major R. A. Elliott, moved up the Boat track and was likewise in front of the artillery. The ADS companies reached these sites just before the barrage opened and dug in and sandbagged the dressing posts. Sixth Field Ambulance was able to make use of slit trenches and dugouts already in the area. The first casualties were
Although not many casualties had been expected to arrive until dawn, a steadily increasing number poured in during the night. At 1 a.m. on 24 October ambulances began evacuating cases from 5 ADS to 5 MDS 6 miles away—some 5 miles being along a road. The evacuation from 6 ADS to 5 MDS did not start until first light, it being impossible to do so beforehand as densely packed armour was moving behind the ADS until that time.
The task of the forward ambulances working between the ADS and the RAPs was most difficult. The desert tracks were ill-defined and difficult to follow, and were congested with armour, particularly on the narrow tracks leading through the minefields. These latter tracks had, however, been lighted and marked by the engineers and could readily be picked out. The method of sending one ambulance forward with each RMO was welcomed both by the RMOs and the ADS. Communication between the RAPs and ADS was much easier, facilitating a call for more ambulance cars if necessary.
The task of the ambulance car drivers is illustrated by the citation giving Driver Henderson Dvr E. A. Henderson, DCM;
The
Three of my sections were attached to 5 and 6 New Zealand Field Ambulances (one at 5 ADS, one at 6 ADS and one at 5 MDS).… On the night the battle started (the 23rd) I was asked to deliver a case of fresh blood to 6 ADS.… It wasn't until 1.30 that our Field Service cars were called on to start working, and then five cars were ordered to 24 Bn RAP. I decided to go along as a spare driver. We drove westward on a dusty track crowded with tanks and Bren carriers getting ready to move out and cover the infantry positions at dawn. It was touchy work by-passing the concentrations of armour, since it was, of course, necessary to leave the proper path of the track at times and take a chance of running into a slittrench or perhaps a stray mine. However, we found the 24 Bn RAP truck without mishap and loaded three of our cars quickly. I was about to settle down and wait for more casualties to fill the two remaining cars, when a very excited padre came rushing up and told me that 25 Bn was a few hundred yards to the west and needed ambulances in the worst way.… It took us two hours to find 25 Bn, and by the time we got there, it was a good three miles west of where it should have been according to our informant. We had to work our way through and around tanks, across the British minefields, across what had been no man's land, and across the German minefields, before we reached our destination. We had to wait for an hour, in company with a great number of tanks, on the east side of the German minefield, while the engineers cleared a lane. When we did get there we found that neither the battalion doctor nor his RAP truck had put in an appearance. The battalion had just taken its second objective, but the wounded were still scattered all over. 25 Battalion did not in fact reach its objective on the night of 23-24 October. See also pp. 384–5 for account of the RMO's work during this action. From Ambulance in Africa by Evan Thomas. Copyright
Casualties began to arrive at 5 MDS before 12.30 a.m. on 24 October and Major McKenzie's attached surgical team was doing
Extra transport had been allotted to the dressing stations for the attack, for example, five AFS cars were attached to 5 ADS, but in the sudden rush still more transport was needed. Four extra cars were sent forward to 6 ADS on the morning of 24 October. Each RMO in 5 Brigade took an ambulance forward with him and 5 ADS had a further four ambulances in reserve to work forward. Arrangements had been made for 3-ton trucks to patrol the axis through the minefields and collect walking wounded. These did not function as they were not allowed up until after dawn. Their place was taken by an ambulance car, which ran continuously from 1 a.m. until midday on 24 October. One ambulance was lost in a minefield and the other two ambulances were used to evacuate from whatever RAP was holding the most cases. Reports from RMOs indicated that, although there were times when many more ambulances could
The ADS cars were not allowed to go beyond the MDS but were returned immediately to the ADSs with stocks of blood, blankets, and comforts. This was appreciated by the ADS commanders. But the MDS had difficulty regarding evacuation to the CCSs. These were only 30 miles away and there were apparently enough ambulance cars (AFS ambulances, 1 British MAC cars, sixteen NZ Section MAC cars, and six 3-ton trucks) but the turn-round at the CCS was too slow. At one CCS there was an interval of three hours between arrival and departure on the return trip. When the cars, sent away before 9 a.m., had not returned by mid-afternoon, there were 300 casualties waiting at the MDS to be evacuated. However, the situation cleared magically after ADMS 2 NZ Division had seen
On 24 October ADMS 2 NZ Division obtained permission for Major S. L. Wilson's surgical team from Light Section
Casualties continued to arrive, and throughout the night of 24–25 October and on 25 October 6 ADS admitted heavy casualties, mostly from British armoured units which were engaged in tank battles. After an initial rush on 25 October, 6 ADS managed to clear all casualties by 2 p.m. and thereafter evacuation kept up easily with reception. The Light Section of 166 British Field Ambulance arrived to assist at 5 p.m., but the heaviest work was then over. The staff of 6 ADS was tired and feeling the strain, its total of cases having reached 600 by 6 a.m. on 26 October. Thereafter, casualties were much lighter. This was also the experience of 5 ADS, whose admissions on 25 October totalled 94, on 26 October 68, and on 27 October 43.
At dusk on 26 October over thirty enemy planes dropped some bombs on front-line areas and bombed artillery positions behind. Wounded from this raid were brought in to both ADSs by AFS cars.
On the night of 27–28 October
In his operational report Lieutenant-Colonel McQuilkin summed up the activities of the MDS in these words: ‘No praise is too great for all the personnel—officers, nursing orderlies, stretcher bearers, drivers, clerks, theatre staff, cooks—all were eager and efficient. On these few days they showed their worth and reaped the reward of long dull periods of training and minor activity—the satisfaction of a job well done.’
Following the original ‘Break-in’ of the battle from 23 to 25 October, there was a ‘Dog-fight’ prior to the ‘Break-out’ and pursuit, as described by General Montgomery. In the second phase from 25 October to 1 November, the salient in the north was extended by 9 Australian Division, while the enemy wasted his strength in vain counter-attacks. Constant pressure was maintained by Eighth Army to keep the initiative and force the enemy to commit his reserve and expose his troops to the concentrated weight of the Army's artillery and air force.
The enemy apparently came to the conclusion that Eighth Army was staking all on a breakthrough down the main road in the north, and he moved his reserves to meet that threat. The Army was well placed to take advantage of the situation. A plan was made for the New Zealand Division to attack, along with 151 and 152 Infantry Brigades from 50 and 51 Divisions, south of the Australian sector and make a breach to launch 10 Corps into the open desert beyond the enemy's defences, thus dividing him in two.
The assault was to be carried out by 151 (Tyneside) Brigade and 152 (Highland) Brigade, with 28 (Maori) Battalion on the extreme right to clear an enemy position on the flank. New Zealand infantry were to take over the line during the assault and later move forward and relieve the assault brigades.
For the attack ADMS 2 NZ Division was responsible for the medical arrangements of the British brigades under the Division's command as well as for the New Zealand units. These attached brigades were
On the night of the attack, 1–2 November, the medical units were disposed as follows: 6 NZ ADS, for which a special site dug in by bulldozers had been made by the engineers, and 175 Field Ambulance ADSs on Double Bar track; 149 Field Ambulance and 7 Light Field Ambulance ADSs on Diamond track; two sections of 166 Light Field Ambulance formed ADSs for
All evacuations from the ADSs would be to 5 MDS and 155 MDS, the serious cases going to 5 MDS, where the two surgical teams were still attached. The 2nd NZ FTU was also sent up on 1 November to 5 MDS from
Surgical policy had to be adjusted to the demand for mobility should there be a ‘break-through’, when 2 NZ Division would go forward through the gap along with 10 Corps armoured forces. It was decided to limit the work of the surgical teams at 5 MDS to the most serious cases demanding immediate surgery. As the journey to the CCS area was only of about two hours' duration along a good road, the majority of cases were to be sent there to prevent accumulations at the MDSs.
It was 1.5 a.m. on the morning of 2 November when every gun on the Corps' front opened up a terrific barrage. One hundred and fifty thousand rounds were fired on a 4000-yard front during the next four and a half hours. Under this umbrella the assault brigades advanced. New Zealand sappers worked with the British infantry, lifting mines and marking lanes through which tanks and guns could advance in close support. Shortly after 4 a.m. word came through that the first objectives had been taken, and two hours later both brigades were on their final objectives and consolidating. Meanwhile, 28 (Maori) Battalion had cleared out the enemy pocket on the right flank and linked up with the Australians. At a quarter past six
Throughout the night of 2–3 November and the next morning the battle continued along the whole front. On the New Zealand sector the infantry came forward during the night, taking over from the assault brigades, and held the salient securely on 3 November while our armour widened the gap. It was clear that the enemy's resistance had been broken, and on 3 November our tactical reconnaissance aircraft observed lines of enemy transport moving west, against which the bomber force flung its full strength. On the night of 3–4 November 9 Australian Division advanced its line north towards the coast, the Highlanders advanced across the Rahman track, and early the next morning 10 Corps, including 2 NZ Division, began the chase. At the same time 13 Corps in the south advanced. What was left of the Afrika Korps, with some remnants of the Italian
By 5 a.m. on 2 November casualties were reaching 6 ADS from the attack and the wounded continued to flow in to the medical units for the next two days. At 9 a.m. 77 casualties had been received at 6 ADS, 50 at 152 ADS, and 120 at 151 ADS. At 2 p.m. a total of 302 patients had passed smoothly through 5 and 166 MDSs on their way to the CCSs. Of these, sixty-four were New Zealanders and the balance mainly British. During the day 6 ADS put through 268 cases, and the other ADSs a corresponding number, that of 151 ADS being over 400.
On the night of 2–3 November 151 and 152 Brigades and 23 Armoured Brigade passed from the command of 2 NZ Division,
The campaign culminating in the breakout at
In connection with medical arrangements generally the ADMS 2 NZ Division paid frequent calls to 10 and 30 Corps and also to the ADsMS of 9 Australian Division, 1 SA Division, and 51 Highland Division, and was able to make the comment: ‘The mutual co-operation of all forces in this respect was most pleasing. The medical arrangements by Army, 10 and 30 Corps were excellent throughout, and the organisation of medical supplies etc., and provision of ambulance cars left nothing to be desired.’
The standard of work at the two active ADSs was excellent and earned high praise from the MDS which received their patients.
The work of the ADS was primarily the collection of cases from the forward areas and the RAPs, and their rapid evacuation to the MDS. First-aid treatment was given to the wounds not already adequately dealt with at the RAP, and, apart from the simple means of resuscitation—such as the giving of copious hot drinks of tea, and providing comfort and warmth and, if necessary, morphia—blood and serum were given to the exsanguinated and collapsed patients.
Field medical cards were carefully written up, with prominent indication to the MDS as to any special type of case or advice on subsequent treatment. Splints, particularly Thomas splints, were also applied to fracture cases. The work of collection through the minefields was most efficiently carried out and the ambulance drivers, including those of the AFS, did fearless and excellent work. Both the active ADSs were working at high pressure during the battle.
The layout of the MDS provided for a special bypass road leading in from the main road, running alongside the reception, resuscitation, and walking wounded tents. See diagram on p. 382
EPIP tents were used for operating theatres and wards, and dispersal was limited to a maximum of 40 yards. The EPIP tents
The cases passed rapidly through the reception tent, where clerks entered all essential details and a medical officer sorted out the cases according to whether resuscitation and urgent operation was required, or for evacuation to the medical centre. The walking wounded were transferred to a larger holding tent where dressings could be adjusted, and from where they could be rapidly loaded into ambulance cars or trucks.
In the meantime a constant supply of hot drinks and light meals was provided, the special
The serious cases referred to the resuscitation tent were carefully examined and sorted into those, including abdominals, for operation by the attached surgical teams, and those to be dealt with by the unit's own surgical teams. Large quantities of blood, but also of serum and plasma and glucose salines, were given by a specially trained team, including dental mechanics, until 2 NZ FTU was attached. A very efficient forward operating centre was then complete and functioned smoothly.
By this time all the surgical teams were well trained and worked speedily and we had two very experienced abdominal surgeons. The abdominal cases were held and nursed before evacuation, and nursing orderlies from the CCS were available for this purpose.
The pre-
At Maj W. Mark Brown, m.i.d.;
Major
The unit took in cases from all forces in rotation with 10 British and 2/3 Australian CCSs and dealt with 380 wounded cases in the first twenty-four hours after the start of the battle. Cases of first urgency, including most of the abdominals, had been dealt with at the MDS, but they were able to deal with only a proportion of them. Even the CCS was not able to deal with all cases requiring operation, and many of these were sent on urgently by ambulance to the two British hospitals at Maunganui Apr 1941–Apr 1942; 1 Mob CCS and
During October alone the unit dealt with 1400 battle casualties and 2400 sick. Two hundred and four battle casualties were operated on, and altogether 264 operations were performed; forty patients were given blood and plasma transfusion, over 80 per cent being given whole blood. It was the unit's first battle experience and, in spite of the weakening of the unit by the loss of Major Wilson and the light section, it functioned well. Fortunately, thirty Mauritians were available as extra staff for stretcher carrying, as the wide dispersal made this work slow and arduous, especially in the darkness.
The nursing of the cases was under the charge of the six sisters attached and was especially arduous because of the rapid turnover of cases made possible by the very efficient system of evacuation.
The CCS continued to function at
At that time it was laid down that tents of the medical units should be widely dispersed, to the extent of 100 yards between the main tents. The 5th MDS, however, planned only for a forty yards' dispersal, considering that the improvement in our air protection warranted this. At the ADS level digging in by bulldozer and sandbagging was commonly resorted to along with dispersal.
There was an ample supply of ambulance cars attached to our medical units during this period. They were boldly and courageously used in the field for the collection of wounded, passing through the lanes in the minefields to clear the RAPs, as well as collecting cases to carry to the RAP. They worked at night guided by the lights along the tracks. Except for some delay at the medical centre on the first day of the battle, evacuation worked smoothly and efficiently in spite of the large numbers dealt with. The AFS drivers were, as usual, assiduous in their work.
The Consultant Surgeon
With the Light Sec. 1 CCS and 2 Surgical Team attached, 5 MDS was able to cope with the urgent cases, such as abdominals, satisfactorily. The CCS, with its Light Sec. detached, was not so fortunately placed, and though carrying out the work with great success … would have benefited by the attachment of two extra surgical teams.… Before the action the services of an extra surgeon, as well as those of the Consultant Surgeon, were made available, and an extra team was sent later after the battle from 2 NZ Gen. Hospital.
The blood transfusion service functioned perfectly, and blood seemed available to all units in very large quantities and was instrumental in both rendering many operations possible and saving many lives.…
The allocation of patients to the operating units functioned excellently, and the sorting out of cases for the CCS, by a Field Ambulance stationed between Hamman [Hammam] and Burg-el-Arab, was very efficiently done. The evacuation from the CCS area to the Base was also well-nigh perfect.…
The provision of air transport not only gave a better chance of survival to the very serious cases, but also allowed of their early evacuation from the CCS, so lightening the burden of nursing to the small staff of Sisters available. The rapidity of evacuation from the CCS area permitted of the handling of a very large number of seriously wounded in an incredibly short period of time. The
Further, in regard to abdominal cases:
Large numbers of these cases were operated on at the MDS and also at the CCS. There is no doubt that the most forward operating unit should give first preference to these cases after actual life-saving measures such as the control of haemorrhage. The results achieved after the
In confirmation of this latter point, a report by the Consultant Surgeon GHQ MEF (Brigadier W. H. Ogilvie) stated:
Abdominals were treated almost exclusively by the Field Surgical Units, the surgeons of the CCSs and the surgical teams sent forward from Base Hospitals by the AIF and NZEF.… The results appear to have been better than in any previous campaign. This very satisfactory state of affairs is only partly due to the short lines of evacuation, for under such conditions many hopeless cases reach the operating centre alive; credit must also be given to the high standard of technical work among the forward surgeons, to the advanced sites in which they operated, often at some risk, to the provision of beds even at MDS, to the routine use of sulphadiazine, intravenous fluids and gastric suction after operating, and to the policy of retaining abdominal cases till they had established equilibrium.… The field surgical units did grand work and fully justified the foresight of those who planned them as the solution of the primary surgery of wounds in mechanised warfare.
With regard to the actual surgical treatment of the different types of wound there was no radical alteration, but there was a more thorough carrying-out of established techniques and a better documentation of the cases.
The New Zealand style of
Head cases during the
Facio-maxillary cases were evacuated to the base units. Dentists attached to the CCS were utilised for the treatment of fractured jaws.
Sucking chest wounds were dealt with by excision of the wound and tamponage with a vaseline pack stitched loosely to the skin.
In abdominal cases difficulty arose in dealing with many late cases. Colonel Donald, British consultant surgeon to the forward areas, introduced at that time a small suprapubic exploration incision in doubtful cases to ascertain whether there was blood in the pelvis, a sign of intra-abdominal injury. Exteriorisation of the colon had become standardised. The retention of abdominal cases in the forward operating unit following operation had become the routine.
Amputations were frequently performed following the severe mine injuries. It was in these cases particularly that blood transfusions proved invaluable. They were dealt with conservatively, and site-of-election operations were no longer performed. Severe sepsis had been noted in traumatic amputations which had not had thorough wound excision.
Knee joints: A solution of sulphathiazole in oil was being utilised for injection into these joints at operation. The patella was being completely excised in compound fractures by many surgeons.
Anaerobic Infection: In the forward areas serious gas infection was uncommon, apart from a gangrene supervening on the destruction of the main vascular supply of the limb. Occasionally, in large wounds of the buttock, thigh, or deltoid, the muscle was involved to some degree but free local excision proved quite satisfactory. The presence of gas in the tissues was often noted without serious infection or toxaemia. Only the rarest cases required amputation, and that generally when the blood supply of the limb was seriously interfered with.
Sulphonamides: The dusting of a fine coating of sulphanilamide powder on the wound had become universal. Sulphathiazole was given intravenously in cases of anaerobic infection and intra-abdominally in abdominal wounds. Sulphadiazine was given to abdominal and head cases. For abdominal cases it was introduced by tube to the infected area for the first forty-eight hours. In head cases it was given intravenously in cases with dural perforation. Sulphonamide by mouth was given by routine to every wounded man, the dosage being noted either on the AF 3118 or on a special slip.
Serums: ATS was given as a routine. Anti-gas serum was given in cases of anaerobic infection or of gross muscle injury.
Blood Transfusion: The organisation of blood transfusion units had led to what was at the Battle of
The large majority of the New Zealand casualties were evacuated to the New Zealand base hospitals then sited at
A large proportion of very severe wounds from anti-tank and anti-personnel mines was noted, and bilateral crush fracture of the os calcis was present in several cases. Some serious and infected chest cases were seen. The amputations were generally satisfactory, but skin traction had not been fully utilised. The importance of the avoidance of the introduction of fluid or drops into the ears following blast injury was stressed.
In a few cases of fracture sent back without splints very definite evidence of shock was seen, in marked contrast to the condition of those adequately splinted, which arrived at the base in excellent condition. The deleterious effect of long journeys in severe cases was particularly noted by 2 NZ General Hospital at
The Consultant Surgeon
Summing up, one's impression of forward surgery at the battle of
There were certain lessons to be learnt from the work carried out by the Medical Corps during the Battle of
The carefully planned scheme for the evacuation of the wounded through the minefields proved highly successful and became standardised in the Army.
The main lesson was the great value of concentration of the medical units, especially those responsible for forward surgery, in the handling of large numbers of casualties. This allowed the even distribution of surgery between the MDS group and the CCS group. The utilisation of a field ambulance in front of the CCS group as a sorting centre and a treatment centre for the minor cases proved invaluable.
Early operation on the abdominal cases and the holding of these cases in the unit following operation gave excellent results. The surgical potential available was insufficient to cope with all the casualties in spite of the attachment of many excellent FSUs.
The planning for the advance of 10 Corps was entirely different from the first set battle as now mobility and long lines of evacuation had to be dealt with. Provision was made for a large number of mobile Corps medical units: two mobile CCSs, 15 British CCS and 8 SA CCS, and the light section of
One hundred and sixty-six AFS four-wheel-drive Dodge cars, each capable of carrying three stretcher cases or six sitting cases, were also available. During the advance two lines of communication were arranged, one along the coastal road and the other some 20 to 30 miles south, mostly over rough desert studded with small hummocks of camel grass. At first only small medical units could accompany the armour, but later it would be necessary to bring the other Corps units up to deal with casualties during the rapid advance by leapfrogging the medical units and leaving behind sections to nurse
The blood transfusion service had made full preparations and had ready an ample supply of blood. Medical supplies were ample and all field units carried fourteen days' reserve expendable stores, and an advanced depot of medical stores was to move forward with the Corps.
The armoured divisions all had a complete chain of wireless links. In each division each field ambulance was in direct communication with its ADMS and each ADMS in direct communication with
The 2nd NZ Division, as an infantry division, had no such wireless contact on establishment, 166 Light Field Ambulance of
Following the GOC's conference on the afternoon of 3 November, ADMS 2 NZ Division made medical arrangements for the coming breakthrough and advance. Both 5 MDS and 166 MDS were to close at midday on 4 November but 166 MDS would reopen on the site of 6 ADS. A section from 4 Field Ambulance was to move up to 5 MDS and nurse severe post-operative cases until they were well enough to move to a CCS. Sixth Field Ambulance was to move forward to the site of 6 ADS and be ready to move through with the Division as an open MDS. The wireless truck and 2 NZ Surgical
Shortly after midday on 4 November the Division, with 4 Light Armoured Brigade under command, left the
The aim of the Division's outflanking movement on
It was not until 8 November that the New Zealanders were able to advance again, and that day they pushed on to stop the night south of Mersa Matruh, still well away from the main road. At Matruh the enemy did not make a stand and, while 6 Brigade moved in to clear and occupy the town, the rest of the New Zealanders moved up to the main road west of
As it screened the advance 4 Light Armoured Brigade encountered road blocks and shellfire, but no serious resistance was met until a minefield was reached at the foot of
With the capture of
From the medical point of view the chase following the breakthrough was relatively unimportant, very few casualties occurring in the Division. In the first forty-eight hours after the move forward the Division's wounded were reported to be only forty. However, 6 Field Ambulance was called upon to treat 126 battle casualties (including 33 prisoners of war) on the morning of 6 November. Most of these cases came from a skirmish which developed about 7 a.m. near the area in which 6 Field Ambulance was laagered. In this action 26 Battalion captured 500
When 6 Brigade occupied Mersa Matruh on 9 November, 5 Field Ambulance, less one company, accompanied it. The sickness cases from the Division, plus occasional battle casualties, were handled en route to
In the advance from 8 to 11 November it was necessary to carry petrol for 200 miles and rations and water for six days. CO 6 Field Ambulance commented that this placed an unfair strain on unit vehicles, especially as the extra petrol for the ambulance cars attached had to be carried on them. As a result the chassis of three
On 12 November 6 Field Ambulance established an MDS south of
When 4 Field Ambulance, 4 Field Hygiene Section, and
Both 4 Light Armoured Brigade and
From
An Italian mobile shower unit was salvaged, repaired, and put into operation by 4 Field Hygiene Section. This equipment gave the unit a complete disinfestation plant when used in conjunction with its ASH portable disinfestor. In quiet periods the unit henceforth provided hot showers for the Division. Such hot showers were commenced on 27 November, water being drawn from a cistern of several thousand gallons located by 4 Field Ambulance. The water, if conditions demanded, could be sedimented, filtered, superchlorinated, and used again. This was done for the first two days the shower unit was in use, and it was found that the wastage averaged one pint a man. It was possible to provide hot showers for 1000 men a day with the equipment.
Thenceforth the campaign in
In November Rommel had retired to his old line at
The Division was equipped and trained for the task it was to undertake. During the desert campaigns complete mobility had been aimed at and achieved. The entire force moved on wheels or tracks. When complete it comprised two New Zealand lorry-borne infantry brigades (
The enemy position at
At
Twenty-five extra AFS cars were attached to 2 NZ Division and ten extra to 14 Light Field Ambulance to build the total of ambulance cars up to seventy-five so that mobility could be maintained in case of heavy casualties. In the event of complete isolation the medical organisation, by using available empty ASC trucks for the carriage of light cases, would have enabled many hundreds of patients to be treated and held or carried with the Division.
The 1st NZ CCS was moved from
The Army plan for the offensive at
A strong enemy tank force lay to the east. Clashes with this force developed on the morning of 16 December, but in the darkness the Division had not been able to get firmly astride the enemy's line of retreat. Our tanks and artillery engaged the enemy tanks but they were able to escape, along with other elements of the enemy force, through the gap between 5 and 6 Brigades, with few losses.
As an enemy rearguard was holding
In the actual movement around the flank of the enemy line there were no battle casualties, and the medical units were not called upon until the Division deployed across the enemy's line of retreat west of
From engagements on the morning of 16 December there were twenty-three battle casualties admitted to 6 MDS through the ADSs. One AFS ambulance car, with an American driver, a New Zealand orderly, and three patients en route from 6 ADS to 6 MDS, was captured by a German column. On 17 December the sick and wounded, totalling 84, were placed in charge of A Company 6 Field Ambulance, which was instructed to go back by the divisional route. The track proved so rough and so hard on the wounded that the OC, Major R. A. Elliott, decided to cut across down the
When the Division moved to the west of
Evacuation of the serious cases was effected by two
On 21 December 2 NZ Division moved to the coastal area near
The battle casualties and sick handled by the two New Zealand medical units in the
In regard to administration generally, ADMS 2 NZ Division was pleased to make the comment: ‘The Division was never better served by Corps and Army than in this period. Supplies were adequate and came forward quickly, extra ambulances were provided early, so that even in the long desert move we felt quite happy and confident that we could deal with all possible casualties; air evacuation was arranged quickly in answer to our signals.’
The enemy in
The enemy's defensive position at
Early in
Then on 12 January the Division moved forward to
For the next stage in the advance 51 (Highland) Division continued along the coast clearing mines and bypassing demolitions, while
During the next seven days the advance continued without any important engagements. From
Medical arrangements for the advance to
It was arranged that
Colonel Ardagh, ADMS 2 NZ Division, joined Main HQ 30 Corps on 16 January, at the request of the Corps Commander and
Before the actual start of the advance, 6 Field Ambulance on 13 January moved near to
Air evacuations from the landing grounds at
The 1st NZ CCS had moved to
The CCS dealt with 154 battle casualties and 331 sick at
The essentials for successful air evacuation in the circumstances were regarded to be the early notification to medical units of selected sites for landing grounds (the liaison work performed by New Zealand medical officers on the landing grounds was of great value and led to a recommendation that in future a medical officer should be attached to the air reconnaissance party), and a prior arrangement
In regard to air evacuation in this advance, the senior air officer in charge of air evacuations remarked to ADMS 2 NZ Division: ‘It was marvellous the way your medical units got so quickly on to landing grounds for air evacuation. The RAF were thrilled with it and felt at last it really had been a great success.’
The majority of the casualties were sent back by transport plane, but ambulance planes were also utilised for serious cases from the forward areas. The planes available for evacuations were DC3s, which took ten stretchers (18 of
Fifth Field Ambulance opened an MDS in the divisional area on the outskirts of
Under command of 30 Corps,
The value was demonstrated of fully mobile medical units with attached FSUs capable of carrying out major surgery in the desert. Their long and assiduous training in desert conditions, with staff specialisation, enabled them to shift and set up rapidly. Each section had its place on a standardised field plan and each man had his special place and work. The combination of truck and tarpaulin shelter worked well in the desert and many light tents, and other captured enemy equipment, were utilised.
For the first time adequate wireless communication was available between medical units, and this was to a great extent responsible for the smooth functioning of our medical units in spite of the rapid and frequent movements. The utilisation of transport planes for the evacuation of casualties from the forward areas proved practicable and most valuable. The attachment of sections of field ambulances to the landing grounds for the treatment and evacuation of the cases was found to be essential.
Head surgery performed in the forward areas by experienced head surgeons of a neurosurgical unit gave better results than delayed operation at the base. A mobile depot of medical stores of, say, two trucks, to carry stores such as bandages, anaesthetics, splints, etc., would have been useful, if available, to accompany the Division when cut off from supply sources. There were times during the advance from
In the three months from the launching of the offensive at
When the New Zealanders entered
It was arranged that detachments of 4 Field Hygiene Section should be quartered with 7 British Field Hygiene Section in
Regulations were drawn up by 4 Field Hygiene Section in English, French, and Italian, setting out the standards required by the British Army medical authorities in the conduct of all these business premises, which, generally speaking, were of a higher standard hygienically than in
While the New Zealand troops were resting outside
Altogether the effective enforcement of hygiene precautions prevented any outbreak of disease of an epidemic nature, and the health of the troops remained good. For the advance into
Early in February General Montgomery made a request to the Commander-in-Chief Middle East Forces that ADMS 2 NZ Division, Colonel Ardagh, be appointed
ALL
The enemy, fighting a rearguard action to delay Eighth Army's advance as much as possible, withdrew 21 Panzer Division to central
The Eighth Army commander, in response to an urgent request from General Alexander, hastened his advance towards the
On 28 February Commander 30 Corps called a conference of heads of services and stated that the increased tempo of the Eighth Army advance had been largely instrumental in forcing the enemy forces in central 10 and 21 Panzer Divisions were moving south and that a heavy attack by the major part of the enemy panzer forces was expected to be made against Eighth Army some time on or after 3 March.
The intention of the enemy appeared to be to catch Eighth Army unbalanced and surround it forward of the
The left-hook round the
Division were hurried forward to reinforce
The
When the Division moved up on 1 March both 5 and 6 Brigades had their ADSs, and 5 Field Ambulance under Lieutenant-Colonel McQuilkin opened an MDS within the fortified perimeter of
From the Corps medical point of view, however, it was considered necessary to have an efficient forward medical area so that patients could be rested, treated and fed, and the major cases operated on before evacuation by a long and rough road to
At a Corps medical conference called by Brigadier Ardagh a plan was devised to meet the tactical situation and, at the same time, provide a satisfactory medical service for the battle. The 5th British Light Field Ambulance, less three sections, and 151 British Light Field Ambulance were grouped with Light Section
The policy enunciated was that only life-saving and urgent major surgery was to be done and that, until it was seen how the battle developed, all other casualties were to be sent to Rear Medical Area at
As a precaution the ‘drill’ in case of a move being necessary at short notice, and if it should be impossible in the time to move all serious cases, was discussed. It was expected that even should the enemy armour or other forces occupy the area they would be mopped up or driven out in a very short time, and it was felt that if the severely wounded were there with the minimum staff to attend to them they would not be molested deliberately. On the other hand surplus staff, and in particular senior officers, would be taken away as prisoners as at
It was therefore laid down as a direction that prior arrangements would be made in such circumstances to leave the minimum staff
On 28 February the Corps layout had consisted of
From the 90 Light and 164 Light) and the panzer divisions of the Afrika Korps (
Facing these forces were 51 (Highland) Division on the coast, then
Fortunately, although enemy forces reached the
As the enemy was unable to penetrate our defensive position battle casualties were extremely low, the total of wounded in Eighth Army for the period from 6 p.m. 5 March to 6 p.m. 7 March, being 10 officers and 177 other ranks. One interesting feature was that out of this comparatively small number the total of penetrating abdominal wounds appeared unusually high, being approximately ten.
New Zealand casualties for the day of battle, 6 March, were fewer than twenty wounded, and these were dealt with at 5 MDS before being sent to
The forward Corps medical group proved most useful, and although the small number of casualties did not provide a real test, it was obvious that even this small group could have dealt satisfactorily with and provided major surgery for a considerable number of cases. It saved the badly wounded men a long ambulance trip to
The rear Corps medical arrangements also functioned well, and it was felt that had the casualties been as estimated (3000 over four to five days) the arrangements made would have ensured their being dealt with satisfactorily. Air evacuation by ambulance planes, though on a light scale, did average, over a period of four days, twenty-eight to thirty a day and proved a great help in evacuating the more serious cases.
Eighth Army continued with its plans to take the
The new outflanking operation closely resembled the left hook around
On 11 March the New Zealand Corps began a secret move to the assembly area in the desert. The force first moved back to
The New Zealand Corps was to move north as if directed against the
There was a sandy track to Wilder's Gap, Named after Captain N. P. Wilder, a New Zealand officer of the LRDG.
On the night of 19 March the Corps moved in close desert formation up to the line reached by General Leclerc's Free French forces. It was intended to lie up dispersed next day and advance by night. This would have coincided with General Montgomery's frontal assault on the
At 10 p.m. on 21 March, in full moonlight, 6 Brigade attacked with 25 and 26 Battalions, engineers of 8 Field Company cleared gaps in the minefields, and Sherman tanks of 3 Royal Tank Regiment went through the gaps. The attack was brilliantly successful, the vital feature, Point 201, being taken—as well as 1500 Italian prisoners. The capture of Point 201 gave us an important wedge in the enemy's defences. Later it was learnt that infantry of 164 Division arrived next morning to take over the defences of Point 201 from their Italian allies—twelve hours too late.
During the afternoon of the 22nd there was intermittent shelling, and a shell landed close to a British truck which happened to be in 26 Battalion's area. Captain Rutherford, the RMO, ran over to see if anyone was hurt. While he was dressing the driver's wounds a
Meanwhile, on the night of 20 March Eighth Army had launched its frontal attack in the north between the road and the sea. It met with initial success, a bridgehead being established, but this was lost on 22 and 23 March after a heavy German counter-attack. At this stage General Montgomery decided to switch his main thrust to reinforce the success which
The divisional plan was to utilise the MDSs of the field ambulances as forward operating centres, and to retain the serious casualties at the MDS for evacuation either by air or later by road when the road communication to
On the move to the assembly area and during the lying-up period from 11 to 19 March, when all possible measures for concealment were taken, no Red Crosses could be displayed by medical units and no tentage erected. All sick at this time were evacuated to 4 Field Ambulance under Lieutenant-Colonel King, which had been established on the first day of the move on the
The medical dispositions for the outflanking move were an ADS with each infantry brigade, 168 Light Field Ambulance with 8 Armoured Brigade, 6 Field Ambulance, under Lieutenant-Colonel Fisher, with the Reserve Group immediately behind Main Corps Headquarters, and 4 and 5 Field Ambulances and 4 Field Hygiene Section following the ADMS, Colonel Furkert, and Rear Corps some 25 miles behind. Some bomb casualties occurred at last light on 20 March and 6 MDS remained behind next day to deal with
The 6th ADS was sited in front of most of the artillery positions, only 400 yards from the infantry start line. Shells landed close enough for fragments to pierce the ADS tarpaulins. The ADS was busy all night with casualties after the attack was launched at 10 p.m. on 21 March, but most of the patients were
The Light Section
Admissions to 6 MDS began with a few at 3 a.m. on the 22nd, and then from 5 a.m. casualties came in steadily all day. The two operating teams from 6 MDS and the CCS surgical team, under Major S. L. Wilson, operated continuously all day and all night and part of the next day.
To assist 6 MDS, 4 Field Ambulance, with 1 General Hospital surgical team under Major K. Bridge attached, was ordered forward on 22 March. It left its B Company with 6 MDS to take the overflow of patients, and moved 7 miles farther forward to a position about 10 miles south of the Roman Wall. The following morning it received here some patients from 168 British Light Field Ambulance MDS. Later, on the 23rd, it moved back 3 miles as 6 MDS was then full, and opened there. It was joined by
While plans were being made for the full-dress attack by
Air evacuation was proceeding but was hampered by adverse weather. Accordingly, to clear medical units as much as possible before the main attack, a convoy of 3-ton trucks left at dawn on 25 March carrying all lightly wounded cases fit to travel by this means. They had been intended for Light Section
The attack was to start at 4 p.m. on 26 March, and ADMS and DADMS NZ Corps had a conference with
The plan to break through the enemy defences was in three phases: the capture of a hill feature,
The first phase was carried out in the early morning of 26 March when 21 Battalion in a moonlight attack took
Without a check the armour swept on in the centre to the final objective—a depth of 6000 yards. Furious hand-to-hand fighting took place to clear the objectives and the high ground on both flanks, but by dusk all enemy resistance had been overcome except for some posts on the left flank and important high ground on 2 Lt M. N. Ngarimu, VC; born NZ
During the same night 24 Battalion cleared the left flank, and 1 Armoured Division carried out the third phase of the attack by moving through the gap made by 2 NZ Division even before the flanks were finally cleared. This thrust took the tanks through to the outskirts of
This was a daylight attack and direct observation by the enemy resulted in an increase of the proportion of killed to wounded. For instance, RMO 24 Battalion handled 45 killed and 116 wounded, compared with 10 killed and 86 wounded in the initial advance at the Battle of In this battalion 50 were killed and 62 wounded on 26 March and 8 killed and 72 wounded in the initial advance at 1Maj C. N. D'Arcy, MC, m.i.d.;
The 6th ADS was sited alongside the embankment which was the Roman wall. Some of the tanks moving up passed through the lines and drew some anti-tank fire to the vicinity after the attack started. Casualties reached the ADS very soon, and in a night of work the ADS dealt with American airmen, New Zealanders, Germans, and
The 5th ADS received only eight wounded from 21 Battalion's attack on the night of 25–26 March. For the main attack, the unit moved through the first minefield to a position about one and a half miles behind the start line, and not more than two miles from all RAPs. The first casualties reached 5 ADS at 6 p.m., and from then on a steady stream continued for the next thirty-six hours when a total of 224 was reached, including 44 prisoners of war.
Between 4 p.m. on 26 March, when the attack started, and 8 a.m. on 27 March, 168 Light Field Ambulance and 4 Field Ambulance, reinforced by the 1 CCS surgical team under Captain A. W. Douglas, as well as by Major Bridge's team, handled 240 casualties. Everything worked smoothly and supplies were adequate. During the day 127 cases were evacuated by air ambulances and the holding situation thus eased. However, there were 400 patients in 4 MDS by evening. All reserve stretchers and blankets were in use but the situation was well in hand, especially as the enemy resistance had been broken and there were few further casualties.
The main New Zealand Corps, with 5 Field Ambulance, moved forward late in the evening of 27 March, and first light next day found them through the Roman wall and moving up the valley towards
Bad weather on 28 March restricted planes from landing on the airfield behind the
The total number of sick and wounded who were evacuated by
The number of troops in
As usual in the long desert journeys, the trucks of the field ambulances were grossly overloaded as they had to carry petrol for 350 miles in addition to seven days' rations and water. The provision of extra petrol trucks was considered desirable for such desert operations. The wireless links between ADMS 2 NZ Division, Colonel Furkert, and the field ambulances on the one hand and
The two New Zealand surgical teams attached to 2 NZ Division medical units from 1 General Hospital and 1 CCS did excellent work on the more serious cases and the New Zealand Field Transfusion Unit gave over 300 pints of blood and 200 pints of serum. The sick rate for the fortnight of active operations in the turning of the
The 1st NZ CCS remained at
Driven from the
On 6 April the attack was launched. After heavy infantry fighting a bridgehead across the wadi was won and 2 NZ Division, with an armoured spearhead, followed through on 7 April. As soon as there was room to manoeuvre, the pursuit force opened out into desert formation advancing north, harassing and cutting off considerable numbers of the retreating enemy. British armoured cars on the left met American troops advancing on
Near
Prior to the attack on 6 April 5 MDS on the
The Division moved on again on 8 April, but was delayed by an enemy gunline on the
On 9 April the Division made good progress due north, 6 Field Ambulance setting up and operating about one mile north of Ksar Heirich. Enemy aerial activity had increased during the day as the Division was beyond
The enemy withdrew behind the formidable mountain chain protecting
Opposite Eighth Army at
For some days from 14 April preparations were made for an attack by 2 NZ Division. In the medical arrangements the two surgical teams from
At 11 p.m. on 19 April Eighth Army began the Allied general offensive, which for the next three weeks raged along the whole front. This attack was carried out by 2 NZ Division in the coastal sector and 90 Light Division leaving
Acting with commendable initiative during the confused fighting on the night of 19–20 April, a small party from 28 (Maori) Battalion scaled the precipitous heights to the pennacle, the highest part of the village, where the enemy was holding out in a group of stone buildings. The Maoris charged the strongpoint and captured
The capture of the
The RMOs of the various infantry battalions had a trying time during the battle at Somer setshire, Dec 1941–Mar 1942;
There was a major difficulty in evacuation in the
As usual, the wounded man was first seen by his platoon medical orderly and evacuated to the RAP either by a party from the company or by the team held at the RAP. In this position the most that could possibly be done in the platoon or company area was the application of soft dressings, any attempt at splinting being impossible owing to very heavy enemy activity. Fortunately the battalion was concentrated in a small area and the timelag
The RAP was situated in a shallow winding wadi, in slit trenches and subjected to the heavy shelling, mortaring and small arms fire that covered the whole battalion area. The difficulties of work were extreme in cramped conditions with numerous casualties and inadequate cover. With a collection of many cases it was necessary to hold some above ground until they could be evacuated, thus adding to the mental distress of the wounded men.
The line of evacuation from the RAP was by hand carry to the RAP of the battalion on the right flank, to which ambulance cars could be taken in daylight. The approach was along the wadi in which the RAP was established, with moderate cover for a distance and then across open ground and a small minefield covered by shellfire to the shelter of the neighbouring RAP—in all, a distance of about one and a quarter miles. Five men generally made up the stretcher-bearer team, prisoners being employed when possible.
In spite of the difficulties of the position and the exhausting work of the carrying, it was found possible to maintain a steady stream of cases to the ambulance cars throughout daylight. Many cases were serious, there being at least three cases of fractured femur, two with penetrating brain injuries, two abdominal cases and many compound fractures of arms. For some of these it was necessary to replace blood loss with plasma in order to enable them to stand the long and uncomfortable carry, and the use of a Thomas splint and plaster proved of great benefit during evacuation to the MDS for forward surgery.
The work of the forward battalion medical orderlies in this area under heavy and continuous enemy fire was beyond praise. No wounded man was left unattended for more than a matter of minutes, and evacuation to the RAP was equally swift, the inevitable discomfort of the man with a fracture being brought to the RAP with soft dressings only being more than offset by the fact that no man suffered a further wound. The splendid work of the carrying parties from the RAP to the ambulances was such that when the RAP received a direct hit with a very heavy shell, the last casualties had been evacuated a short time before.
Casualties from the assault on
As these casualties were all transferred to 4 MDS that unit was kept very busy, and on 20 April 334 battle casualties, mostly New Zealanders, were admitted and treated. Both surgical teams worked long hours but there was no hold-up or undue delay in attending to cases. Evacuations were made to
At
The month of
To the north of the Eighth Army the
The Division accordingly moved to the north-west and took up positions threatening the gap in the hills before Pont du Fahs on 4 May. On 5 May 5 Field Ambulance opened an MDS a few miles behind
At dawn on 6 May the main Allied attack was launched along the axis of the Medjez el Bab–
On 8 May 2 NZ Division was ordered back into reserve near
The Allied success in the north made the position of large forces of enemy infantry on the
On 9 May it was decided that 4 Field Ambulance would proceed to
The first half of the long divisional convoy started for
As a Corps unit
The Consultant Surgeon
From the
The unit was mobile, having sufficient transport to shift in two stages. It had a regular plan for its layout which enabled the unit to set up quickly, each section knowing exactly its position in the plan. Ambulances were available for the transport of patients within the unit.
Lieutenant-Colonel Hunter, CO 1 NZ Mobile CCS, drew attention to the valuable work performed by British surgeons attached to the CCS. When 4 Field Surgical Unit (Major A. G. R. Lowdon and Captain C. Friedland) marched out on 11 May, it had been attached for nearly five months. The standard of work set by these officers was high and both showed undoubted professional ability. They were willing at all times to do everything for their patients, give advice to their colleagues and instruct orderlies, and it was a pleasure to have them under command.
The 1st Mobile Ophthalmic Unit was attached from 27 February to 11 April and from 20 to 30 April. It was most necessary that an ophthalmic surgeon should be available in the forward CCS to do eye cases. So many casualties suffered from severe multiple wounds, of which the eye injury was one, that it was impossible to evacuate them for eye treatment unless the soldier was to be subjected to a second operation, perhaps within a few hours. Major Moffatt, who had succeeded Major D. Browning on 13 March, worked so quietly and expertly that often the surgeons attending to other wounds did not note his presence.
The 4th Neurosurgical Unit was attached from 8 March to 11 April and from 19 to 30 April. Major K. Eden and Captain R. P. Harbord worked long hours in their effort to deal with all the
There was considerable argument as to the advisability of carrying out the major forward surgery in the field ambulances, especially when only a single surgical team was attached. It was held that the work could be more efficiently carried out at a CCS and that the extra teams should be attached to the CCS, concentrating the work in the one area and thus allowing of better utilisation of the specialists available. It was held that the lone operator was either overworked or wasted.
During the left hook at
This grouping of units had been done at
These had become a regular part of the medical service, attached either to a CCS or an MDS of a field ambulance. Their personnel and equipment had been standardised but was not entirely similar in the First and Eighth Armies. The operating theatres varied from specially constructed trucks to different types of tents. The most popular consisted of two EPIP tents joined end-ways. Lighting by separate units was obtained if at all possible, though in Eighth Army the unit of the parent field ambulance was generally used. Suction of some kind, usually improvised, was a necessary part of the equipment. Sterile guards were difficult to keep in regular supply and rubber or jaconette guards were substituted, except for special cases such as abdominals.
A visit by the Consultant Surgeon
At the
Colonel Donald stated that he considered it of more importance to stay with field units during fighting than to spend time at base hospitals where there was more supervision. He pointed out that forward surgeons had to deal with the worst cases and that a consultant surgeon, in addition to clinical aid, could help not only by checking the natural over-enthusiasm of the relatively inexperienced, but also by heartening them at the inevitable occasional periods of depressing results.
The New Zealand consultant surgeon,
Casualties from the battles of
Base hospitals were sited at
In connection with the air evacuation from
The Consultant Surgeon was impressed with the medical arrangements of 30 Corps under the
Maximum use was made of surgical personnel, especially within the New Zealand medical units, by transfer and attachment. Fluidity of surgical personnel was essential for the efficient performance of forward surgery which, during the
The organisation and work of the New Zealand field ambulances was excellent and earned much praise and reflected great credit on the commanding officers and staffs. The work of the CCS was of the highest order and the unit had deservedly earned a proud reputation, ascribed by the Consultant Surgeon to the thoroughness and conscientiousness of Lieutenant-Colonel Hunter and staff, especially the orderlies.
During the Tunisian campaign our New Zealand general hospitals were operating on the Canal, at
Since the New Zealand Division had moved from
In
On
The location selected for the hospital was at
The main body of the unit reached the new site on 19 March after travelling from Dorsetshire. The equipment was unloaded from ship to lighter in
The condition of the patients on arrival at the hospital at
Battle casualties generally have arrived in very good condition with wounds adequately excised and clean. Fractures have travelled well. There have been no cases of gas gangrene requiring treatment in the hospital over the quarter. Of the abdominal cases with colonic wounds exteriorised only one case appears to have had adequate spur formation with a view to assist in early closure of the colostomy. Abdominal cases have convalesced well. Cases with penetrating wounds of the chest as a group have given rise to most problems in convalescence.
Though neither 1 nor 2 General Hospitals was called upon to follow up Eighth Army in its advance from
No.
No. 2 NZ General Hospital treated large numbers of serious cases, including compound fractures, joint and feet injuries, and many abdominal and thoracic cases.
There were remarkably few deaths at the base hospitals, only three following battle wounds, all these being due to severe infection. There were only three cases of secondary haemorrhage and two amputations, which shows a marked absence of severe infection. There was no death reported in the abdominal cases reaching the base hospitals.
In his report of
The sickness rate for the Division was very low, there being no incidence of infectious disease, except a short sharp outbreak of sandfly fever amongst a few isolated units late in April. During the whole campaign admissions to medical units averaged only 1 per 1000 per day. After the severe fighting around
The diseases reported to be prevalent in
Malaria was of special importance as the local incidence was reported to be high. The season started in April but little malaria and few anopheline mosquitoes were in evidence before the Division left
The 1st NZ Anti-Malaria Control Unit was attached to the Division on 23 April and carried out a survey of the divisional area and recruited civilian labour. A field malaria laboratory was available in the Corps area and the consultant malariologist was also in the area. The New Zealand malaria officer considered that the provision of protective nets or bivouacs and an efficient repellent cream were the best and only possible means of protection while the Division was in a mobile role.
There were two cases of typhus in March with one death, but none in April or May. There was only one case of typhoid and, apart from a few cases of dysentery, no other serious disease.
In Eighth Army generally there was little sickness—only ·915 per thousand daily. Hepatitis was still present to some extent—in January 7·05, February 2·37, and March ·62 per thousand. Septic skin conditions were common, but desert sores were not seen so frequently. In spite of the prevalence of venereal disease in the civil population there had been no increase in the Army.
Under Major D. P. Kennedy, 4 Field Hygiene Section with its captured Italian shower unit had been able to arrange hot showers at
During March no inspections could be carried out by the Hygiene Section and no work done in the workshop. During April the normal routine was resumed and sullage and deep trench pits, latrine seats,
This was supplied mostly from wells, ample supplies being available, though sometimes brackish and generally saline. The wells were policed and the water superchlorinated before use. This was required because of the high incidence of bilharzia in the area. Reservoirs were available at
These were excellent and the supply of medical comforts always adequate. Extra New Zealand
Expendable stores were in good supply throughout the period. Blood, plasma, both wet and dry, and intravenous fluids were always available in ample quantities. Extra stretchers, blankets, and pillows, etc., were kept loaded on a 3-ton truck and attached to the operating MDS, thus ensuring an adequate supply at all times.
This was kept in excellent order in spite of the long period in the field and the distances travelled.
Clothing was satisfactory. The changeover from battle dress to summer kit took place in
The troops were seasoned campaigners hardened to the climate of
The priority of operation followed at that time was:
Abdomens, bleeders, sucking chests.
Amputations, fractures with swelling or bleeding, joint injuries, large flesh wounds, especially with swollen limbs and situated in the buttock, thigh, or calf.
Heads, eyes, jaws, spines.
The abdomens were treated as first priority and so were dealt with frequently at the MDS of the field ambulances.
The medical units responsible for this work were the MDSs of the field ambulances and the CCS. By the time of the Tunisian campaign the work had become highly organised and the staffs of the units fully trained in the different aspects of the work, so that large numbers of patients could be handled swiftly and efficiently. At the reception tent the cases were sorted and particulars taken, kits attended to, exchange of stretchers and blankets arranged with the ambulances, and the patient sent on to the pre-operation tent, to the wards, or to the evacuation tent. This work was greatly facilitated by prior sorting and information supplied by the ADS or MDS.
The pre-operation ward carried out all resuscitatory and other preliminary treatment, including washing the patients, the provision of clean clothing, and the checking and control of personal belongings. The patients were examined and decision made as to the urgency of operation and the resuscitation required. An FTU carried out the blood and plasma transfusions and a senior surgeon attended to the diagnosis, conferring with the transfusion officer concerning priority. At the CCS an X-ray plant was available, the types of cases normally X-rayed being:
Doubtful abdominal injuries.
Head and spinal cases.
Injuries involving joints, especially the knee.
Doubtful fractures.
Resuscitatory measures at that time were:
Blood, the main and generally the sole measure of importance. Generally two or three pints were given.
Plasma was given to counter haemo-concentration in severe burn cases and also to supplement blood.
Warm fluids given, such as tea, cocoa, etc.
Morphia, when pain or restlessness was present.
Warmth: excessive warmth had been found to be deleterious. Simple warming by blankets in a warmed tent was carried out.
Types of cases selected for early operation:
Abdominals: The diagnosis depended on: (a) the site of the wound and probable course of the missile; (b) local signs of abdominal injury such as rigidity of the abdominal wall, lack of audible peristalsis, abdominal distension, dullness in the flanks or pelvis; (c) general signs—shock and distress, signs of internal bleeding (pallor and rapid thin pulse). X-ray was used in doubtful cases, especially when diaphragmatic and retro-peritoneal injuries were present. Bleeding was found to be responsible for the early and serious symptoms, and sometimes prevented full resuscitation and demanded urgent operation for its control. Peritonitis was a late development.
Chest cases: The only cases which demanded operation were those with large chest wounds, open sucking wounds, and occasionally with bleeding from an intercostal artery. Only a pint of blood was generally given to chest cases.
Head cases: All injuries involving the scalp, skull, or brain were operated on if the general condition was satisfactory. The severely shocked and sterterous cases were left till signs of recovery were present and operation was felt to be justified.
Fractures of the long bones: The extent of the wounds of the soft parts determined the necessity and extent of the operative treatment, and vascular injury was of special importance. Splinting in any case was required and X-rays, if time allowed, were of value in certain cases, especially if any joint involvement was suspected.
Vascular injuries: Injuries to large vessels as shown by a history of serious bleeding, a pale and shocked patient, dressings soaked in blood, limb swollen and tense, loss of pulsation in terminal vessels, demanded urgent operation to prevent further bleeding and also secondary haemorrhage later.
Joint injuries: Although operation was often unnecessary, splinting was essential.
Foot injuries: These were very common, largely due to mines, and amputation was often required.
Facio-maxillary injuries: As a rule these did not require urgent surgery, but eye injuries might demand enucleation or removal of foreign bodies by the electro-magnet and dental splinting might be required for fractures of the jaw.
Spine: Might require a suprapubic drainage.
Large flesh wounds: especially of the buttock, thigh and calf, owing to their liability to anaerobic infection and vascular injury.
The buttock wound was always suspect of associated intra-abdominal, rectal, or lower urinary tract injury.
Humerus: The most satisfactory splint for transport was the adduction plaster with a cap plaster over the shoulders, slabs well moulded round the upper arm, liberal padding in the axilla between the arm and the chest, the whole bandaged to the chest by circular plaster bandage, the forearm being included in both the slabs and the circular bandage, leaving the hand free.
Forearm and wrist: Plaster slabs were used with circular turns but without restricting movement of the metacarpo-phalangeal joints.
Femur and knee joints: The New Zealand
Tibia, fibula, and feet: Plaster splints were applied from the upper thigh to beyond the toes, but allowing of toe movement. All plasters were well padded and were also cut up before evacuation to prevent interference with circulation.
Two tables were used in the theatre. Improvised methods of concentration of electric light were used and standard lights were sometimes available. Arm boards were essential for the giving of
As regards wound treatment, the removal of skin had been reduced to the minimum and only definitely damaged and devitalised tissue was removed. All avascular and badly traumatised muscle, however, was carefully excised as a precaution against anaerobic infection. Only definitely loose fragments of bone were ever removed. Free and, if possible, dependent drainage was provided in all large wounds associated with much muscle or bone damage. Relief of tension was of the greatest importance and incision, both longitudinal and sometimes transverse, of the fascia was regularly carried out. Foreign bodies, especially clothing, were removed if readily accessible. If deep muscular gangrene was present whole muscle groups were removed, and if the whole limb was gangrenous amputation was carried out. Ligature of the vein in addition to that of the artery was being given up in the treatment of injuries of the main vessels. Injured nerves were dealt with only by approximating the severed nerve ends. The surgeon regularly wrote up notes after the operation, both in the operation book and on the field medical card.
Joints: No operative treatment was carried out in small perforating and penetrating wounds. Large wounds were excised, large accessible foreign bodies were removed, and the patella, if seriously damaged, was completely excised. The synovial membrane was sutured but not the skin.
Heads: Careful excision of the wound down to the bone was performed. Loose bone was removed and the skull nibbled away to expose the dura and brain wound. A combination of syringing and suction removed the pulped brain and accessible bone fragments or foreign bodies. Sulphadiazine was applied to the wound and also given intravenously following operation. The wound was sutured in two layers with thread and a small stab drain inserted for a few days. A plaster cap was used to keep the dressings in place. Diathermy was used to control bleeding.
Eyes: Corneal spattering was very common, as were penetrating wounds by small foreign bodies. The removal of these by the electromagnet was very difficult, many fragments being non-magnetic.
Jaws: Fractures were dealt with by dentists skilled in the application of inter-dental splints, or extra-dental splints, and pins were used in combination with a head plaster.
Chests: Large and also sucking wounds were dealt with by excision. A vaseline gauze pack kept in place by sutures was used to close the sucking chest. Ligature of bleeding intercostal arteries was sometimes necessary. Aspiration was carried out when respiratory distress was present.
Abdomens: These cases were given first priority. Diagnosis was often difficult, especially as wounds such as buttock and chest wounds were often associated with intra-abdominal injury. Catheterisation was always done before operation as a precautionary and diagnostic measure. Exploration was carried out either through the excised original gunshot wound or more normally through a separate incision. Lateral transverse incisions were sometimes used but vertical central incisions were generally employed. Exploration was not always carried out in liver or kidney injuries. Examination of the abdominal contents was carried out methodically, except when it was certain that the injury was strictly localised. The small intestine had to be particularly well looked at as multiple injuries were common. Suture of the perforations was always preferred to excision because of the lower mortality. Simple one-layer suture was carried out, even when excision had to be performed, with some extra stitching if time warranted it. Suture of the colon was done only, and that infrequently, in very small lesions of the caecum and right colon. In all other cases the injured gut was exteriorised and a colostomy with a spur formed. In lower sigmoid and rectal injuries a left side colostomy was made. Colostomy had been carried out in cases of severe buttock wounds to ensure cleanliness of the wound, but it had been realised that it was too heavy a price to pay and the practice had been discontinued, except when the rectum itself was involved. Liver wounds were found to require little treatment. Only very rarely was packing or suturing required to stop bleeding. Minor kidney injuries required no treatment. In severe cases exploration followed by nephrectomy or drainage was carried out. Association with a colon injury made nephrectomy advisable. Bladder injuries were sutured and suprapubic drainage was instituted, as it was for spinal cord injuries and urethral damage.
Wound Treatment: Primary skin suture was carried out for scrotal and penile injuries and also for wounds of the head and abdomen. In all other wounds there was no primary suture, and tulle gras or
Burns: Serious cases were treated with serum, morphia, and rest. Cleansing and dressing of the burns was left till resuscitation had taken place, and often only part of the burnt area was treated at a time and then only gently cleansed with saline dabs. Sulphanilamide powder or ointment was used, followed by tulle gras dressing. Tanning had been completely given up. The need of whole blood transfusion after the first few days was recognised, the haemoglobin often by that time having been reduced to 60 per cent or less.
Beds were provided in the field ambulances at the time of
Chests: If respiratory distress was marked, tapping was performed with air displacement in the first twenty-four hours. In
Abdomens: Treatment was stabilised in: (a) applying continuous gastric suction by means of a blood-taking set inverted and filled with water, so acting as a suction apparatus; (b) giving continuous intravenous fluid, glucose, and glucose saline, about 8–10 pints a day; (c) using Fowler's position; (d) holding the patient in the unit where operation had been performed for a period of ten to fourteen days before evacuation; (e) nursing on beds; (f) giving of fluid by the mouth in small quantities; (g) continuing suction for about four days and then shutting it off gradually. (Suction was not required for so long in large bowel cases.)
General Cases: Further resuscitation, especially transfusion of blood, was often required.
Patients were normally evacuated at the earliest possible moment as soon as they were fully recovered from the anaesthetic. Certain types of cases, however, were held:
Cases unfit to travel, whatever the lesion. These were held for further resuscitation.
Abdominals: As already mentioned, these were held for ten to fourteen days.
Chests: Severe cases were often quite unfit for travel and were held for several days.
Burns: Severe cases were too shocked and toxaemic to travel for some days.
Anaerobic infection: These cases were held for urgent treatment and to prevent change of surgeon.
Haemorrhage: If any danger felt of further bleeding.
Gangrene: Impending gangrene cases were held for observation.
On the other hand:
Head cases travelled very well, the only difficulty being restlessness.
Chest cases, if no distress in breathing, travelled comfortably.
Spine cases also were satisfactory.
All fractures, if adequately splinted, were no trouble.
Wounds were caused by different missiles, varying greatly at times. Throughout the campaign there was always a considerable number of mine wounds irrespective of any actual fighting. These wounds were caused either by the metallic mine exploding on the ground or by the new wooden Schu mine, which exploded about four feet above the ground and discharged numbers of shrapnel balls, causing severe multiple injuries. The damage to the feet by the ordinary metallic mines continued to be frequent and severe. In active fighting shell and mortar wounds became more common, and in certain phases bullet wounds produced the majority of the casualties. At one field surgical unit behind
This was not very prevalent during the campaign, due undoubtedly to the early and efficient surgery. There was some increase when
Some increase in gas infection was noted in
Routine local application by dusting from improvised pepper pots was carried out in all forward units. Tablets were given by the mouth for six days following wounding, and special cards were fixed to the field medical card by which the dosage given was checked.
The bad results that followed an attempt in the early days to carry out site-of-election amputations had led to the conservation of the maximum length of limb. Flaps were fashioned and small dressings of vaseline gauze held in place over the stump by two or three stitches. The badly damaged tissue in the traumatic amputations was thoroughly excised to prevent serious sepsis, which had been noticed so frequently in these cases. A great number of amputations of the feet were carried out as a result of mine injuries.
In surgery, many important advances had been made in the year since the pre-
The New Zealand Division's casualties in
HOSTILITIES had ceased in
In order to make room for divisional troops in
With the defeat of the enemy in
Nieuw Amsterdam.
The remainder of the men of the first three echelons came under the Wakatipu draft and were marched out of their units early in September preparatory to embarkation.
The departure of the furlough draft resulted in many promotions to NCO rank in the medical units and the posting of many reinforcements, but the units soon settled down with little or no loss of efficiency. It turned out that the great majority of the men never returned to the
The New Zealand Medical Corps suffered a grievous loss on
On
The efficient working of the New Zealand Medical Service as a whole was a tribute to Brigadier MacCormick.
The Allied landing on
However, six members of Dorsetshire on 9 July, as it was to use the equipment of the British FSUs. Off the south-eastern cape of
After landing the team worked with 3 and 21 CCSs and relieved the staffs of 21 and 22 FSUs in the Corps medical service under Brigadier Ardagh. On 17 July the team acquired some German surgical equipment dropped by parachute, and next day set up a separate theatre alongside 22 FSU in a cottage hospital at Ramacca. The team embarked on a hospital carrier on the 22nd for return to
Altogether forty-eight cases came under the care of the surgeon and, in addition, a large number of other cases was dealt with by the resuscitation officer. Four cases died without operation, never reacting to resuscitation, and four were dressed and splinted prior to an immediate move. The type of wounds varied from simple perforating wounds caused by small-arms ammunition to extensive multiple fractures and large gaping wounds caused by mortars and grenades.
There were two cases of gas infection or gas cellulitis, gas bubbles in stinking wounds, but no case of gas gangrene; one case of definite gas gangrene of the leg was operated on by the surgeon of the British FSU.
It was noted that, acting on instructions, wounded of United
The following comments were made by Major W. Mark Brown:
This has been a valuable experience to all of us. It is the first time we have worked in a densely populated country. The Field Ambulances we worked with always chose buildings if possible. This to my mind has very definite limitations as some form of adaptation is always necessary and considerable time and energy is necessary for the preparation. This fact was emphasised by the number of short moves we made, and always for a short period of time. Another disadvantage of short moves is leaving holding parties for serious and abdominal cases. These short moves may have been due to the exigencies of the situation or the reduction of the amount of transport available. I am sure they are to be avoided if possible.
With such limited time to observe, comment on the surgery may be objectionable, but the banking up of cases, as we found at the CCS, seemed to me to be due to all the surgery being done by the FSU. Many of the minor surgical conditions could be dealt with by the staff at the MDS or a minor theatre staff at the CCS. This would leave the surgeon specialist free for the serious cases.
There is a decided advantage in a large pre-operative ward with all the serious cases under supervision and resuscitation. I had graphic evidence of the advantage of immediate blood transfusion in one case of a mangled thigh when 2 pints of blood pre-operatively and 3 immediately after undoubtedly saved a life. During long continued action the transfusion officer needs spelling.
At the request of
It was necessary for a certain number of British hospitals to close, pack, and hold themselves in readiness to move to
In August it fell to the lot of 3 General Hospital to take the majority of cases coming from
Early in March when Advanced Base was being organised at
The detachment of the
After much prospecting for a suitable site for the
On
Another shift, this time to Della Madia, 17 miles east of
Meanwhile, Detachment
The CCS had set up a 210-bed, tented ‘holding hospital’ near
Besides the routine administrative conferences, medical and surgical conferences were held in the Middle East Force during this period. A surgical conference was held in
A special conference, at which our Corps was well represented, was held at
Provision was made, whenever there was opportunity, for clinical study, especially for younger medical officers. When the Division was resting, as many officers as possible from field units were attached temporarily to the staffs of base hospitals. Ward clinics, both medical and surgical, were held regularly and medical officers from the Division were welcomed, as they were to the out-patient
Arrangements were made for the training of medical officers and technicians in X-ray work both in New Zealand and overseas, it being considered that training for six months for medical officers and twelve months for technicians would be satisfactory.
After the North African campaign had ended a series of discussions was held in
It was 15 March before DMS
In April after a good deal of discussion, approval was given by Headquarters
It had become increasingly clear that the terms previously in use did not fit the conditions under which
The new grades overcame some difficulties and apparent inconsistencies by a clear separation from the categories originally evolved in New Zealand and the use of the letters A to E for grades instead of numerals 1 to 4. Grade A—Fit for general service in With reference to Grade B, the disability was to be specified in the man's paybook.
In conjunction with this change, which became effective from
In regard to medical boarding, DMS
The dearth of reinforcements from New Zealand for the Maunganui. The cessation of reinforcements throughout most of
The 9th Reinforcements arrived in Dominion Monarch, the medical section comprising 1 medical officer, 5 sisters
The 10th Reinforcements included 6 medical officers, 20 sisters of
The 8th Reinforcements,
In
This matter did not affect the
During this period there were difficulties in the staffing of medical units, in spite of the fact that the furlough scheme did not apply to medical officers because replacements could not be supplied from New Zealand. In
With the shortage of doctors in New Zealand in
The DMS
Thus it will be seen that for 3737 patients there are 66 medical officers. If we compare this with one of our metropolitan hospitals, say Auckland Hospital, we see there are at least 22 residents, 7 stipendiary medical officers and 56 part-time medical officers, a total of 85 for some (?) 800 patients. The rest of the table affords similar comparisons; 230 Sisters—trained nurses; 193 part-trained nurses; and 590 orderlies many of whom are employed as cooks, porters, etc.
Though the conditions were not strictly comparable, the comparison did show that the military hospitals were not overstaffed.
There was a constantly recurring complaint of shortness of medical officers in the hospitals, mainly on the surgical side, during the latter part of
Very few of the younger officers had had the previous surgical training to be capable of being rapidly and efficiently taught in base hospitals so as to bring them up to the standard required for surgical teams with the field ambulances or casualty clearing station. In
Suggestions from the
During the time
It was also pointed out that we had been able to reciprocate in some measure by looking after British and other forces in our hospitals in return for the considerable amount of work done for our men in the British hospitals. It would have been wrong to have expected
In retrospect, it would have been difficult to look after all our
The admission of many of our Division's cases to British hospitals, however, especially in the Canal Zone, lessened the strain on our own hospitals, which were never overtaxed, even when the epidemic of hepatitis was at its height. Arrangements were made for the transfer of New Zealand cases to our own hospitals for administrative convenience, especially to enable the serious cases to be boarded and prepared for evacuation to New Zealand.
On Maunganui Nov 1943–Jun 1944; in charge medical division
In order that the medical officer in each hospital performing the clerical duties of Registrar could be released for purely medical duties, it had been decided earlier to promote the senior clerks, who were staff-sergeants, to commissioned rank as Registrars. This change was effected at 3 General Hospital in
In these appointments it was found that there was no loss of efficiency and, as members of the Medical Corps, the new appointees
Whereas in Maunganui, and at 4 General Hospital
The Matron-in-Chief had raised the question of granting promotion and/or increases in pay to senior sisters who were in more responsible positions in hospitals. The matter gave rise to a good deal of discussion between medical administrators as it was not easy to select a small number of sisters for special treatment in this respect. Headquarters
As at
The voluntary aids (whose corps name had been changed from Women's War Service Auxiliary to Women's Army Auxiliary Corps in conformity with the change made in New Zealand) had also
Most of the WAACs have been here for nearly two years, during which time they have done their work with great efficiency.… Lately quite a number have been transferred to other hospitals where we hope they will carry out their duties in an equally satisfactory manner. There is no doubt that the presence of the WAACs adds very greatly to the efficiency of a hospital of this kind, and in fact, I do not see how we could have carried on without them. Many VADs have been able to look after minor wards to the satisfaction of everybody.
The strength of the medical units as regards other ranks at
A number of the members of the different units were on the sick list, but if they were added to the posted strength there was still a shortage of 70 men.
Staff changes during the year were considerable, partly because of furlough drafts, and partly because of the policy of giving sisters and voluntary aids a change by posting them to other New Zealand
At the end of the year the hospital was considerably short of staff, and this entailed harder work and longer hours. Deficiencies in establishment were 9 medical officers, 11 voluntary aids, and 44 other ranks. Some twenty-six graded men had filled vacancies caused by the departure of other ranks, but Colonel Pottinger was not very satisfied with their ability, making the comment: ‘Once a man is graded his mental outlook seems to alter and very few of the graded men compare favourably with the original members of the
This table of admissions from the month of the Battle of
Admissions to the
In the quarter October to December 1942 nearly half (950) of the admissions to 1 General Hospital were cases of infective hepatitis, mostly from the Division in the
In
In the October to December 1942 quarter there were increased numbers of convalescents admitted to the
In the summer of Maunganui on 22 July, the average bed state was 871. There were also many out-patients,
Apart from the typhoid outbreak, there was an easing of medical work at
While 2 General Hospital at
In the year
A study of the table for admissions to medical units during the year up to 30 September discloses that the health of
The epidemic of infective hepatitis in the autumn of
Malaria cases were relatively few; the Division was never in a highly endemic area during the malaria season and only occasional cases arose in
An epidemic of typhoid fever beginning in September principally affected the recently arrived 10th Reinforcements accommodated at
Pneumonia was responsible for a significant number of hospital patients, with peak numbers in the winter months. From July 1941 to 31 March 1943 there was a total of 218 cases, of which 54 were diagnosed as broncho-pneumonia; of the lobar pneumonia cases six died, and only three developed empyema. The results were due to the almost specific effect of sulphapyridine, later displaced by the less toxic sulphadiazine.
Sandfly fever continued to provide small numbers of patients but there was no epidemic at this period, and under the classification of PUO there was always a variety of short-term pyrexial illnesses for which definite diagnosis was often impossible.
A few cases of smallpox arose, sufficient to render it advisable to revaccinate the force. For the nursing of diphtheria cases the sisters were immunised after Schick testing, and a recommendation was made that sisters in all future reinforcements be immunised in New Zealand. Special care had to be taken to guard against diphtheritic infection of wounds, as infected wounds were slow to heal and in some cases were associated with polyneuritis.
For military reasons little publicity was given to a typhus epidemic which occurred in
The epidemic did not affect
In this connection it should be mentioned that
A considerable number of cases were diagnosed as PUO in the forward areas, as an immediate exact diagnosis of many short-term fevers was impossible. The less severe cases making a complete recovery from one to four days were retained in forward medical units and discharged to their units. The more severe cases and those with a more prolonged fever were evacuated to the base hospitals, where a definite diagnosis was finally made in practically all the cases. The commonest conditions thus encountered were otitis media, sinusitis, prostatitis, pyelitis, rheumatic fever, catarrhal enteritis, bacillary dysentery and infective hepatitis.
Besides the infective fevers, the medical conditions of most importance to the force were the neuroses of many types, some surgical in nature. The battle neuroses cases, for which the diagnosis of physical exhaustion was introduced at this period, were dealt with (except for the severe cases) in the forward areas, where after a period of complete rest they were returned to their units. The cases evacuated to the base hospitals were given similar treatment and the mild cases were again sorted out and quickly sent to Reception Depot for return to their units. Unless this was done there was little prospect of these men ever being fit for the front line again.
The majority of the neurosis cases were of no further use except at Base, and over one-third were generally sent back to New Zealand. The non-battle neuroses arising from an inherent psychological weakness in the individual continued to be responsible for the downgrading of large numbers of men and considerable loss of manpower. The manifestations were many, but in particular were seen in dyspepsia, in headache following old concussion, in foot fatigue associated with minor degrees of foot abnormality, and in vague rheumatic disorders.
Dyspepsia remained a common condition and was investigated in hospital to exclude organic conditions such as ulcer. The majority of cases were found to be functional in origin and quite
Accidental injuries constituted a steady proportion of hospital admissions—in
The employment of graded men raised many problems. During
A detailed survey of the position revealed many reasons for the large congregation of ‘temporarily unfit’ men in Base Camp. Some men were attending the out-patient department at 1 General Hospital for specialist out-patient treatment; others were awaiting operations at 1 General Hospital, but these had been postponed on account of the rush of battle casualties; others had returned from
It was realised that this congregation of unfit men in Base, some for indefinite periods, led to deterioration. The long periods of idleness and ennui spent in base camps by all soldiers were multiplied in the case of the unfit, and few of these could submit to them without feelings of exasperation and frustration.
Appropriate measures were taken to remedy the position. Men who were permanently unfit but had never been graded as such were medically boarded, some for return to New Zealand. With the return to more normal conditions after the rush of battle casualties and the infective hepatitis epidemic, it was made a rule that
Then, again, there was a good case for the better management of a case where the constitutional breakdown was likely to be permanent as far as front-line service was concerned. For instance, suitable employment at Base was a paramount factor.
This matter of employment was given emphasis by the Consultant Physician
In this connection it was decided at a conference of senior administrative officers at Headquarters
The Employment Officer no doubt provided some improvements in the employment of graded personnel in
To serve a double purpose—the useful employment of some of the graded men and the reinforcement of base medical units—it was approved in
On the subject of unfit or war-worn men the OC Medical Division 1 General Hospital, in his report for the quarter ended
The most trying and certainly the greatest part of the work has consisted in trying to assess and dispose of the large numbers of men who are chronically ill with minor complaints, such as vague pains, backache and dyspepsia. In many it is the natural combination of prolonged field service, age in the late thirties, and a general weariness. To be fair to all is very difficult as many have not given really useful service at any time and are very introspective and health-conscious. There is practically no malingering but many make the most of what are really minor complaints. There are those also who are really worn out and unfit for any further field service. Fibrositis is a common diagnosis which covers vague backaches, and pains in and around joints when there is no external evidence of disease. These men often fail to respond to any form of therapy and are frequent callers at RAPs wherever they are. Functional dyspepsias are more common than organic gastric diseases and often date from some unpleasant battle experience. They also fail to respond to any form of therapy. All these cases receive considerable care and attention and frequently have a prolonged stay in hospital before being placed in what is considered their correct grade. Men with three years' service are frequently not fit for further service overseas.
In an investigation the Consultant Physician, Colonel Boyd, found that from 1 September to 31 December 1942, 139 cases of functional neurosis had passed through the Reception Depot from medical units: of them 63 (44·6 per cent) were graded I and returned to their units, 61 (42·6 per cent) were graded II or III for base duties, and 14 (10·8 per cent) were graded for return to New Zealand. From May 1941 to December 1942, 920 cases of psychoneurosis had passed through hospital, and they necessitated 1204 medical boards, which resulted in the following gradings: I and IA 8·2 per cent; II and III 50·9 per cent; and NZ Roll 40·7 per cent. In his report Colonel Boyd said:
It is obvious that nothing can be done to diminish the precipitating causes which are the very essence of active service, though it is a well known fact that the better disciplined the troops the fewer cases of nervous upset. It is clear too that the more careful the selection of recruits, and the greater
In an investigation at 3 NZ General Hospital at Not yet diagnosed (nervous).
After the conclusion of the Tunisian campaign it was found necessary to board medically for physical and/or mental exhaustion a number of men who had been through a succession of heavy battles. A number were returned to New Zealand, including some from the
All the hospitals had developed occupational therapy for cases of anxiety neurosis and found it of benefit for surgical patients as well.
At
Large numbers of out-patients from the base camps continued to be referred to
An interesting summary was made of the work done at the Ophthalmic Department at
In addition, 306 men were regraded, 198 for return to New Zealand and 108 for base duties. The number of men in whom the disabilities were present at enlistment was estimated at 200. Battle casualties were not included in these figures for medical boards. At this stage the number of men in
Although the health of the women's services in
In
Of the nursing sisters who were sick, ten were sufficiently ill to be medically boarded and returned to New Zealand, while 15 sick voluntary aids were returned to New Zealand. Among the nursing sisters the commonest causes of invaliding were cholecystitis (3) and functional nervous disorders (2), and among the voluntary aids typhoid (4) and pneumonia (2).
(In
A small group of protected personnel and sick who had been prisoners of war in
A larger group reached
On Cuba and the hospital ship Tairea after a six-day trip from
Of the repatriated prisoners of war admitted to 1 General Hospital, it was found that most were in good condition. Few had clinical notes sent with them. Of the thirteen men with enucleation of one eye, six had well-fitting and well-matched eyes supplied in
Three New Zealanders and one Australian were blind in both eyes. Sergeant
After TAB inoculation, medical boarding, dental examination, pay adjustment, and security examinations were carried out, the protected personnel went on ten days' leave prior to their return to New Zealand in HS Wanganella in December. Most of the sick and wounded were taken to Oranje on 24 November.
During September it was decided as a matter of policy that married
The Matron-in-Chief, Miss E. M. Nutsey, returned to New Zealand in the Oranje on 24 November, having been medically boarded as unfit for further service in the
Miss E. C. Mackay, Matron of 1 General Hospital, was appointed in Miss Nutsey's place as Principal Matron Matron Miss M. E. Jackson, RRC; Matron Miss V. M. Hodges, ARRC;
On 22 November at a conference at
This policy necessitated the maintenance of certain medical units in
The Lt-Col J. K. Davidson; Oranje continued to carry a staff comprised partly of New Zealanders, with a New Zealand army liaison officer in control of them. Lieutenant-Colonel DavidsonOranje Jun–Sep 1943.Oranje Sep 1943–Aug 1945.Oranje Feb–Jul 1942; SMO
BY October the units of 2 NZ Division had been rested and reorganised and trained for operations under quite different conditions from those of the desert warfare they had waged for two years. After their strenuous desert campaigns, the troops had recuperated at leave camps on the seacoast near
However, 4 Field Ambulance was given special instruction on subjects peculiar to the armoured brigade, such as methods of removing casualties from Sherman tanks, and it undertook special
Colonel R. D. King had been appointed ADMS 2 NZ Division on 15 June and his place as CO 4 Field Ambulance had been filled by Lieutenant-Colonel J. K. Elliott of 1 General Hospital. Within the divisional medical units there had been a consideràble change of personnel, opportunity being taken of the quiet period to effect exchanges between field ambulance and regimental medical officers. A number of medical officers had completed courses in gas warfare, tropical diseases, and anti-malaria work. Refresher clinics for RMOs had been held twice weekly at 1 General Hospital. In addition, weekly clinical discussions were held at Maadi Camp Hospital on subjects of general interest to medical officers. Among the subjects discussed were the treatment of battle casualties at RAPs, ADSs, and MDSs; modern treatment of burns; recording of cases in the field; the forward treatment of orthopaedic cases; special surgery- -head, chest, and abdominal injuries; sulphonamides; NYD neurosis; and the establishment of field ambulances. These meetings, being attended by members of all units in the medical chain, were extremely valuable for the review of techniques and results.
By July the field medical units were in a position to undertake general intensive training again (though the field exercises were restricted by the lack of serviceable vehicles) and this training continued throughout August and into September. Early in July Brigadier Kenrick in addressing all divisional medical officers emphasised the importance of training, with special attention to change of country and tactics, of bringing inoculations of troops up to date in view of epidemics in
The culmination of the training was marked by a ceremonial parade of divisional medical units at
In
It was recognised that if the British forces in the
This, in fact, is what did happen, and no major reorganisation in the field medical units of 2 NZ Division occurred until
After discussions during August it was decided to make 102 VD Treatment Centre a mobile unit so that it could accompany 2 NZ Division on future active operations. The Adviser in Venereology, GHQ MEF, was in favour of the procedure, which was a new development in the British forces. The change took effect from 31 August and the unit reported to ADMS 2 NZ Division on 25 September. A 3-ton truck was specially fitted up for the unit, and in
In September arrangements were made to draw extra vehicles and equipment to make the CCS fully mobile. The unit had been authorised to adopt the establishment of a mobile CCS on
Every effort was made to prepare the New Zealand force for a new theatre of war while at the same time keeping the actual destination a close secret. In preparation for a campaign in
The move of the Division from
Operations in
Besides all the divisional medical units (including 102 Mobile VDTC, 2 FTU, and
The DMS
At
During October 2 NZ Division moved secretly from
The medical units in the first flight were ADMS and staff, 6 Field Ambulance, 4 Field Hygiene Section, and 2 FTU; and in the second flight 4 Field Ambulance, 5 Field Ambulance, 1 Mobile CCS,
Not until the convoys were at sea was the destination announced. The voyages were short and on the whole comparatively uneventful, and the convoys reached
The vehicles and supplies were embarked in
The field ambulances established ADSs for their respective brigade groups as they arrived in
It was not long before there was a New Zealand general hospital established in Dorsetshire, disembarked at
No. 3 General Hospital was established within the Bari Polyclinic, a project conceived during the Fascist régime, and still incomplete at the time when war brought Italian industry and constructional work to a standstill. Vast, judged by New Zealand standards, and comprising some twenty buildings within the area of its walls, the Polyclinic was structurally complete as a medical centre at the time of its occupation by the Allied forces. Much exterior finishing of buildings, however, still remained to be completed, while there were practically no interior fittings when the
The main group of buildings was arranged in a shape similar to a horseshoe, from the outer sides of which wings extended at regular intervals all the way round. Within the curve stood a large two-storied building, apparently intended in the original plans as an administrative centre for the area. Connecting the open ends of the two sides of the horseshoe ran a verandah, from the centre of which rose a tall tower, planned as a solarium. In addition to this main compact group, there were several large detached buildings, the whole twenty buildings being contained within a high stone wall. The completed cost of the whole group, which had been intended to cover the civil needs of most of southern
No. 3 General Hospital occupied two blocks at one end of the horseshoe group for the hospital, as well as portion of the block at the opposite extremity for men's quarters. Sisters and nurses were accommodated in a separate detached building just inside the walls of the compound, near the main entrance. Neighbouring units operating in the Polyclinic area during this period were 98 British General Hospital, 14 Indian Combined General Hospital, 30 Indian General Hospital, field hygiene, and MAC units. The 30th Indian General Hospital was later replaced by 102 South African General Hospital, while the field hygiene and MAC units moved to other locations, 4 Base Depot Medical Store occupying one of the buildings so vacated.
Of the two blocks occupied for the hospital, the smaller one, given the name of
In the first instance, officers, sisters, and WAACs occupied part of the
Situated a convenient distance from the docks area, and only a few minutes' walk from the railway station, the hospital was in a good position for receiving casualties by ambulance, ship, or train.
For the first two weeks of
As 3 General Hospital was the first New Zealand hospital to operate in
The 1st
On 22 November at a conference in
When these moves were accomplished
Torrential rain which fell on the last nights of October gave the Division an initial experience of the conditions under which it would often have to live and fight in
The divisional transport began to arrive while the ground was sodden, giving all ranks their first experience in
In early November the Division began to move forward by road to join Eighth Army, which by this time had reached and crossed the Trigno River and, having captured
The vehicles of the medical units arrived between 29 October and 19 November, the first unit to receive all its vehicles being 4 Field Ambulance, and the last 1 Mobile CCS. In transit, mostly while unloading, a number of vehicles were damaged, two of 4 Field Ambulance's trucks, as well as the specially fitted truck of 102 Mobile VDTC, being rendered useless.
Although 4 Field Ambulance had not received all its vehicles by 3 November the unit moved north that day with 4 Armoured Brigade, reaching
Meanwhile, companies of 5 Field Ambulance set up dressing stations at
At
Movement of 1 NZ Mobile CCS was delayed by the late arrival of its vehicles, but on 18 November the staff was taken in ASC trucks to
The Allies were now nearing the strongest belt of prepared defences yet encountered in
On 14 November 2 NZ Division assumed responsibility for its sector of the line. In order to keep the arrival of the New Zealanders a secret until the last possible moment, 19 Indian Infantry Brigade was placed under New Zealand command and given the task of driving the enemy off dominating ridges and across the
The New Zealand infantrymen, helped by ropes, waded across the
The river, the bluffs, and the mud presented the most serious problems of the advance. Mules were used to supply the forward troops with food and ammunition, and supporting arms could be brought up only after a slow, hard struggle. Counter-attacks were repelled, and enemy fighter-bombers attacked the bridges. Strength was built up, and on 29 November the assault was resumed and continued slowly by day and night, with the infantry successively climbing and digging in, hampered at every step by mud and saturated clothing.
The Division began to advance on 2 December across the
On 7 December the attack on
From the middle of November onwards the medical units wrestled with problems totally different from those to which they had been accustomed in
On 19 November, when 6 Infantry Brigade moved up to the front line, 4 Field Ambulance proceeded to
Medical arrangements for both 6 Infantry Brigade and 19 Indian Infantry Brigade were undertaken jointly by 4 Field Ambulance and 33 Indian Field Ambulance at
The segregation of the operating centre was primarily due to the limitation of buildings, but it was found to be of great advantage as the operative treatment and nursing of the serious cases proceeded unhampered by the turmoil of a busy MDS. The treatment and nursing of abdominal cases was particularly facilitated by being done under good conditions in the hospital beds. The transfusion unit was in a ward of the hospital. With salvaged telephones the attached ASC personnel improvised communication between the unit's three buildings, and this was a decided help.
Battle casualties were evacuated via Scerni and
On its arrival at
For the initial main attack by 2 NZ Division in the Italian campaign special medical arrangements had to be made.
The operation envisaged was a type of warfare completely new to 2 NZ Division. In earlier campaigns the field ambulances had almost invariably been able to collect patients from the RAPs by ambulance car. In the
The general plan called for a crossing on foot in several places on a two-brigade front, the seizing of a fairly extensive bridgehead, up to several miles in depth, and when this was achieved, the building of two temporary bridges over which would pass the supporting arms and essential vehicles. Thus, even with complete success, several hours would elapse before ambulance cars could collect from the RAPs.
The regimental and ADS medical officers conferred to discuss the extreme difficulties expected. For one thing, it was certain that there would be casualties before bridges could be erected and ambulance cars could get through. It was decided that while the collection of casualties forward of the RAPs would follow the usual practice, using regimental stretcher-bearers augmented, when possible, by jeeps, evacuation from RAP to ADS would have to be by a combination of hand and mechanical carriage. The RMOs had to be prepared to hold their casualties at the RAPs for a rather longer time than was customary, and the ADSs had to be prepared to treat patients more shocked than usual owing to the longer lapse of time and the cold, wet conditions.
It would not be practicable to run ambulance cars nearer to the
The ADS area was in sight of the German positions and was frequently shelled. No
At 7.30 p.m. on 27 November the ADS stretcher-bearers went up to the battalion positions. Two and a half hours later they moved forward in pitch darkness with the files of infantrymen, squelching through the mud and wading across the icy streams of the
The battalions reached the northern bank and waited in silence until 2.45 a.m. on 28 November, when the artillery barrage opened and the infantry advanced to the attack. The MOs and stretcher-bearers followed up and established the RAPs in suitable farm buildings. The teams attached to 25 Battalion RAP found themselves approaching the crest of the low hills that rose from the bank of the river. Coming under shell and machine-gun fire, they were compelled to move back down the slopes. The other RAPs also experienced shelling near their positions.
The men from the ADS worked with the RAP personnel, treating casualties brought in by the regimental stretcher-bearers, until about 4.30 a.m., when the battalions were nearing their final objectives. They then assisted in the search for casualties left lying in the wake of the advance, and collected a number of wounded reported to be lying in minefields to the rear of 26 Battalion RAP. It was nerve-racking work, each man treading with involuntary but futile caution in the darkness. Only one man of the Medical Corps was unfortunate enough to tread on a mine. He died in
Throughout the night engineers had worked on the construction of two bridges, a Bailey bridge for 5 Brigade and a pontoon bridge on the 6 Brigade sector. At 8.10 a.m. on 28 November the pontoon bridge received a direct hit which destroyed one span, killed nine
However, at 10.30 a.m., the first ambulance car appeared at the 26 Battalion RAP, and the mere sight of one load of casualties leaving for the ADS seemed to make the situation less desperate. After another long wait ambulance cars and jeeps began to arrive at all three RAPs. The stretcher-bearers carried on searching for wounded. A stretcher-bearer from 24 Battalion used a cart to bring back wounded along the road and was not sniped at because he had a
At 4 MDS at
On 1 December B Companies of 4 Field Ambulance, 5 Field Ambulance, and 6 Field Ambulance all crossed the
It was decided to bring two
On 2 December B Company 6 Field Ambulance moved into the three-storied building in Sgt R. Williams, MM; born
A daylight attack on
When 6 Field Ambulance moved forward to
Casualties admitted to 6 MDS were, on 15 December, 172 and on 16 December, 115. Staff-Sergeant Burley WO 1 H. W. Burley, MM, m.i.d.; born
Before dawn on 24 December an attack was made by 21, 26, and 28 Battalions on Fontegrande ridge, west of the
The evacuation of the wounded presented quite a problem owing to the nature of the country and the difficult ground conditions. Because no suitable place could be found nearer the line, 26 Battalion RAP, for instance, was set up in a house about a mile from the
Medical arrangements for the final attack on 24 December were the same as previously. There were 152 casualties admitted to 6 MDS that day. During these rush periods three surgical teams worked continuously at the MDS. Evacuations were made by road to 1 Mobile CCS at
The extremely wet weather and the difficult country covered in the
Stretcher-bearing jeeps took the casualties from the resuscitation post to the ambulance car post where four-wheel-drive ambulances waited. These included twelve cars of the AFS, whose work in
In the static warfare that continued into
There was a change of commanders of 5 Field Ambulance on 14 December when Lieutenant-Colonel R. A. Elliott assumed command from Lieutenant-Colonel J. P. McQuilkin prior to the latter's return to New Zealand.
At
At
From 7 to 20 January at
Wounds at that time were mainly caused by shells or bullets and there were fewer mine wounds, hence very few severe tarsal injuries. Figures are available giving the percentage of wounds caused by different missiles at that period as follows:
At the same time, out of 751 wounded casualties with 1116 wounds, there were the following lesions: fracture of femur, 18; total fractures, 168; penetrating heads, 22; penetrating chests, 33; thoraco-abdominals, 4; penetrating abdomens, 34; eye, 8; burns, 21.
There were also 98 cases of exhaustion, more than half from the last three reinforcements. Good use was made of the Corps Exhaustion Centre.
There were 30 deaths in the MDS, a percentage of 4. Of these 13 were abdomens and abdomino-thoracics, 6 were severe multiple limb wounds, 5 were chest wounds, 4 were head wounds, and 2 were wounds of the spinal cord.
Operations performed by
The range of work undertaken by the forward surgical teams is illustrated by the records of
Operations performed: total operations 78; evacuated 55; still in MDS 6; died 17.
Type of case: abdomen 34; head 2 (both also abdomens); spine 1; chest 12; urethra 2; amputations 7; compound fractures 24; joints 7; facio-maxillary 3; flesh wounds 21.
Nearly all the abdominal cases were dealt with by this team and all were operated on. Three cases of gas gangrene were seen, and in two other cases infection appeared and caused death later, after evacuation. The necessity for more thorough excision of the wounds was realised, as infection of wounds was more prevalent than it was in the desert campaigns. Post-operative chest complications were common, probably due to the high incidence of upper respiratory infections at that time.
In January 33 operations were performed, 11 being abdomens. There were 6 deaths.
Full provision of blood was available, with one exception when on 6 December at
The practice at that time is illustrated by the figures showing the cases treated by the resuscitation officer and the number transfused.
Altogether in this group, 219 pints of blood were given to 106 patients, and 210 pints of plasma were given to 135 patients. The need for a relieving transfusion officer was stressed. This relief was normally supplied by the resting field ambulance.
These were a constant problem as the peasants would not leave their homes and attempted to carry on their normal activities in the forward areas. At
The wounded were evacuated from
From
The school taken over by the CCS at
A surgical team from 3 General Hospital was attached for a short time and then replaced by 8 British FSU, a British FTU being also added. Both units were of great assistance to us, but it was felt that we should have provided our own forward operating units, especially as the experience gained in this work was very valuable to those working normally at base hospitals. It was the type of work sought after by our own medical officers, who would possibly have felt more content in the inevitable lulls when surgical work was small in quantity and rather unimportant in character. The provision of an extra surgical team from the Base would have enabled us to carry on, except in times of great stress, without the help of British teams. An extra FTU was also required at the CCS.
The surgical policy at the MDSs during the
From
The opinion of the divisional units was not entirely supported by the British consultants, and there was a feeling that possibly too much stress was being laid on the urgency of operation and too little on the other factors determining the survival of the wounded man. The New Zealand consultant surgeon made the following comments at the time:
While the MDS was at
The performance of the primary operation as early as possible is the surgical ideal, but I feel that does not mean the performance of surgery in the actual battle zone under relatively unsuitable surroundings and uncomfortable and disturbing conditions for the patients and the surgical staff. A slightly longer delay is more than worthwhile if the operations can be more efficiently done by a more rested staff and much better nursing facilities and comfort provided afterwards.
The really urgent conditions of haemorrhage, the removal of mangled limbs, and the tamponage of sucking chests must necessarily be done regardless of refinements, but the rest of the surgery should be carried out under as good conditions as possible. It would appear that under European conditions the CCS will generally be able to be moved near enough to the battle area to carry out the primary surgery. If that is impossible, then the MDS that will be constituted a forward operating centre should be placed far enough back to enable the surgery to be performed under conditions comparable with those available at the CCS and under conditions which might render it possible to employ nursing sisters.
Elasticity of staff should be possible, to switch over personnel – medical officers, sisters and orderlies, to the place they are most needed, and that elasticity has been evident in the Division latterly.
Our main difficulty is the undoubted zeal of our medical personnel in the Division which urges them to carry more than their relative share of the treatment of the wounded men.
The surgery performed had become by this time fairly standardised and similar to that carried out during the Tunisian campaign. More wound infection, however, was encountered in
Lieutenant-Colonel Jeffreys, RAMC, was in charge of penicillin distribution in
Use in Cases of Fracture and Flesh Wounds: No. 3 General Hospital was chosen for trials in cases of fractured femur and tarsus as well as in chest cases. The method then adopted for ordinary wounds was:
Spray penicillin sulphathiazole powder on the primarily trimmed wound.
Evacuate the patient without disturbance of the dressing to the Base, and
Perform delayed primary suture on arrival at the base hospital by:
Spraying penicillin sulphathiazole powder on the wound and suturing with or without small stab drains; or
Putting in small rubber tubes through stab holes at the side of the sutured wound and instilling penicillin solution twice daily for five days.
With regard to fractures the same primary treatment was adopted and suture carried out at the Base, but:
The wound was not completely sutured, a defect being left for drainage in the centre.
Sodium penicillin was injected intramuscularly three-hourly, in doses of 15,000 units for five or more days.
The limb was put up in plaster and left untouched for three weeks unless complications arose.
Penicillin powder was also sprayed on older wounds daily for several days before secondary suture.
In Chest Cases: Sodium penicillin was used intramuscularly for infected haemothorax with temporary success, but relapse followed. It was then introduced into the pleural cavity with much better results and the potency was found to remain for more than twenty-four hours. In cases of sealed drainage penicillin was then introduced through the tube, which was clamped for several hours. It had been suggested that penicillin fluid should be injected in small dosage in the forward areas after each tapping of the chest, so as to prevent the onset of infection. There had been a notable increase in the frequency and severity of infection in chest wounds in the early Italian campaigns.
Drainage in Chest Cases:If infection supervened drainage by inter-costal tube was instituted and penicillin introduced daily through the tube. If infection still persisted, rib resection was found to be necessary not more than ten days later.
The results obtained at 3 General Hospital were promising, especially in fracture cases. Instillation into the knee joint was also practised with success. A demonstration of cases treated with penicillin was held at 3 General Hospital and was attended by the staff of 2 General Hospital and other medical officers, all of whom showed enthusiasm for the treatment.
There had been some increase in the incidence of gas gangrene and penicillin had been utilised in several cases with marked success. One patient recovered in spite of gangrene of all the adductors and the quadriceps complicating a shattered fracture of the upper end of the femur. There was spread of the infection also into the abdominal wall. Amputation was performed through the hip joint and penicillin given intravenously in glucose saline drip for three
The month of December was particularly busy for 3 NZ General Hospital at
The battle casualties arrived in good condition by ambulance train from
The hospital was short-staffed at the time, particularly as regards surgical officers. A surgical team was lent to the CCS for a short period but returned to the hospital before the heaviest work there. Fortunately, an orthopaedic surgeon was attached on 18 December and was able to treat the serious fractures. In the large buildings numerous special departments were set up and operating theatres constructed and elaborately equipped.
In the treatment of wounds penicillin was gradually introduced and secondary wound suture was performed in some cases. Dressing and the application of plaster splints was the common operative procedure.
During
The evacuation of patients from
The following assessment was made of the results of treatment of battle casualties admitted to 3 NZ General Hospital from the
The results in cases of penetrating abdominal and thoraco-abdominal wounds were satisfactory. Stomach and small intestine cases recovered well without complications, as did injuries to the spleen and diaphragm.
Wounds of the liver did not do so well and there were two deaths in four cases. Drainage of the abdomen in these cases was suggested.
A third of the penetrating wounds of the thorax were infected and five out of twenty-two had to have rib resection. It was advised that such cases be evacuated early from the forward areas and that intercostal drains should preferably be inserted at the base hospital where penicillin could be given. The instillation of penicillin into the pleural cavity and early evacuation was advised.
A comment by the surgical divisional officer, Lieutenant-Colonel Maunganui Apr-Nov 1942;
The severity of the cases in many instances has been notable. Multiple serious injuries are common, a number of cases having several such lesions as compound fractures of one or more limbs, together with penetrating wounds of the thorax and abdomen and multiple soft tissue wounds. These patients have travelled well and arrived in good condition. A justifiable conclusion is that these cases, almost entirely treated in
A blood transfusion centre for the Italian campaign had been set up at
The health of the troops in the first few months in
Accidental injuries showed a marked increase in November and accounted for 434 admissions to medical units out of a total of
In December the prevalent conditions in
In January the same diseases were encountered and there was no increased sickness in spite of the extreme cold and wet on the
This was known to be prevalent in many places throughout
This was very prevalent in
The number of fresh cases during the month of November was 42, of which 16 arose in
In December 55 fresh cases were treated, 35 of them gonorrhoea, 17 venereal sores, and 3 cases of syphilis. Of the gonorrhoea cases 82 per cent returned to their units, the remainder being sulphonamide-resistant.
In January there were 38 new cases, of which there were only 8 fresh cases of gonorrhoea and 1 of syphilis. It will thus be seen that there was a low incidence of venereal disease at this period.
Before leaving
This mobile laundry and bath unit was available in the divisional area and was set up at
The Field Hygiene Section made full use of its shower unit during the campaign. The equipment was badly worn but over 450 men a day were dealt with. At
This condition arose only in a very minor degree in the Division, although during the same period in
There were none of the factors present that made trench foot such a common and serious disability in
Full-scale winter clothing was worn during the winter months. Extra socks were available, and men of units in the forward areas were issued with a clean pair every night with the rations.
A liberal supply of
Water supplies varied according to the nature of the country and the location of the units. Wells, rivers, streams, and town water supplies were all used. The large proportion of magnesia in the water had a laxative effect, and unless the water was boiled and allowed to settle before being again boiled for tea, it tended to retain the chlorine taste. With the amount of unburied excreta on the surface of the ground, units were advised to exercise great care in the use of wells, most of which depended upon surface drainage. The principle was laid down that all water in
Rations issued to all troops were adequate and varied. They were the best issued to the Division during four years of war. The issue of fresh meat and fresh vegetables particularly was frequent and gave a greater variety to the meals.
In the matter of sanitation it was found that the first troops to occupy a town were, by reason of operational urgency, unable to give any time to the construction of sanitary installations. Succeeding formations of different nationalities occupying the area tended to do nothing on the principle that they themselves would be moving on within a short interval. However, partly due to active inspectorial work by 4 Field Hygiene Section, of which Major
Operations in
The outstanding lesson learned was the need for elasticity in all branches of the medical services, and an attempt was made to provide this by reinforcing one medical unit by another. As occasion demanded, companies and sections were split so as to have the minimum of personnel necessary for efficiency at resuscitation posts, car posts, and dressing stations.
Normal methods had to be adapted to meet local conditions. The ADS had to be located well forward and in a building. The lower rooms with a big fireplace found in most houses were ideal for the purpose. In most cases a section only of a field ambulance company was required as an ADS. The rest of the company was located further back to act as a car and resuscitation post and reinforce the forward section when necessary. This rear section also provided bearer squads for evacuation of patients from RAPs.
Equipment for the forward section was taken up by bearers, jeeps, ambulance cars or mule transport, and consisted of full resuscitation equipment with blood, wet and dry plasma, instruments, steriliser, dressings, splints, medical comforts, 40 stretchers, 100 blankets, and 20 hot-water bottles. Replenishment by the usual channels was adequate, 7 Advanced Depot Medical Stores being located at
The companies of 4 Field Ambulance were organised in half-company sections for use with 4 Armoured Brigade, and this proved most successful.
The practice as regards MDSs was to have two field ambulances open in buildings: the forward one to sort all cases and treat battle casualties; the rear one to act as a reception station for sick and such casualties as occurred in rear areas. As the fighting moved ahead, the forward MDS took on the work of the reception station, and the reserve field ambulance opened further forward.
The forward MDS consisted of the usual two companies of the field ambulance, reinforced by 1 General Hospital surgical team, 2 NZ Field Transfusion Unit, two relief surgical teams from the reserve MDS (and, if necessary, from the field ambulance holding sick), a relief transfusion team from one of the other field ambulances, and one section from the Mobile Dental Unit. This forward medical centre was then capable of treating and, if necessary, holding all types of casualties. No limit was placed on the surgical work to be done at this MDS, the policy being to leave the decision to the OC of the unit, as the evacuation time to the CCS varied for each battle.
The primary function of the rear MDS was to sort out all cases of sickness, holding those who would be fit to return to their units within eight to ten days. However, there were always a few casualties from shelling, bombing, or mines in the rear areas and one competent surgical team had to be retained at this MDS. It was usual, too, for 102 Mobile VDTC to be attached to this MDS to treat venereal disease patients within the Division.
The reserve field ambulance provided relief surgical and resuscitation teams, medical officers, and drivers for jeeps, together with extra stretcher-bearers if required by the ADSs. The attachment of a transfusion team to 2 NZ FTU enabled extra transfusion orderlies to be trained to provide a reserve within the Division.
During the campaign 1 NZ Mobile CCS was under command of 2 NZ Division. This resulted in all cases from the Division passing through a regular evacuation channel, and allowed for continuity of treatment with benefit to the patients. This unit at first had the assistance of a surgical team from 3 NZ General Hospital and later of another from 8 British FSU.
The mobile shower section of 4 Field Hygiene Section worked continuously throughout the campaign, an average of over 450 troops receiving showers each day. A small unit such as this could be carried on one truck, and if one was available for each brigade group every man would be able to have a shower at least once a week. The natural inclination of the Italian to ignore even the most
In the past
It was found to be essential to use buildings to accommodate medical units during the winter months in
In the buildings an absence of glass was universal following heavy shelling. Window-proofing by blankets was found to be both inefficient and wasteful. When a small supply of window-lite (pliable transparent material on a netting base) became available, it was most valuable. Temporary repairs to roofs were effected by the use of canvas covers until Italian labour could be obtained through the local
Heating was a major problem, but plentiful supplies of wood were available in most places and drum heaters with chimneys were built by units. The late arrival of kerosene heaters relieved a difficult situation. Difficulty was experienced with the primus stoves which were relied on so much in the field ambulances. Constant wear and tear was experienced and repairs and supplies, especially of spare parts, were a difficulty.
WHILE the Eighth Army had been striving vainly for a breakthrough on the east coast, the
Plans were made for a major offensive on the
The move was carried out in the strictest secrecy. In mid-January in the
Leaving the
The opportunity was taken to check over all medical supplies and vehicles. Indents for medical supplies were well met by 10 British Advanced Depot Medical Stores. Training and lectures were instituted.
The enemy's Gustav line crossed the peninsula at its narrowest point where rugged hills formed a series of natural obstacles most favourable to the defenders.
During January
The offensive at
The initial task of the New Zealand Corps, which officially came into being on 3 February, was to support the continuing American assault on
In the meantime the staff of 2 General Hospital had crossed the
When it was decided that this unit should go to
An advance party consisting of Lieutenant-Colonel
The hospital was located in a healthy area in the midst of agricultural land, well planted with deciduous trees, fruit trees, and vines, and partly encircled by the foothills of the
By 31 January three of the five wards in the wing had been taken over by 2 General Hospital and 123 New Zealand patients were in the hospital. The remaining two wards in the wing were staffed by New Zealanders on 8 February, by which date the hospital equipment had arrived, and the unit set about extending its accommodation by erecting tents and making itself independent of certain services of 2 British General Hospital of which it had been glad to avail itself in the early stages. Thus a New Zealand base hospital was established in time for the opening New Zealand operations on the
The ADMS 2 NZ Division, Colonel R. D. King, also acted as
On the
In view of the impending operations by
Five tarpaulin shelters were set up in suitable relation to the semi-circular roadway, dispersal not being attempted. Each shelter was provided with a base of a layer of gravel surmounted by a layer
When 5 Brigade moved into the line on 5 February, 5 ADS accompanied it and established a tented ADS near the railway line south of
The
Bombing raids on
The ground preparations for this attack met with increased shelling and on 16 February forty-five casualties were admitted to 4 MDS. The first Maori casualties arrived at 4 MDS at 2 a.m. on
In view of the good road and short trip of about one hour along Route 6 to 1 Mobile CCS, little surgery was done at the MDS, which accordingly reverted to its basic function of recording, resuscitation, and the performance only of such surgical procedures as were of immediate necessity. Attached to 4 MDS was 2 NZ FTU, and it became customary to send patients on to the CCS with transfusions running throughout the journey in the ambulance car. The provision of transfusion attachments for stretchers was found to be most valuable. It enabled stands for blood bottles to be clipped on the side of the stretcher and prevented a cessation of blood transfusion due to the needle pulling out when the car was travelling over rough sections of the road.
A large number of Schu-mine casualties, from the heavily mined railway embankment and other areas, passed through the MDS at this time. The Schu mine was a small box anti-personnel mine not detectable by electrical methods, and it produced a characteristic wound in which the foot was completely disorganised. Amputation was necessary for all such injuries, and this was usually performed at the CCS. The Singer-type army tourniquet proved quite unsuitable for these cases, and circles of tire tube were applied just above the damaged area so as not to interfere with the circulation at the site of subsequent amputation.
While preparations were being made for a second attack there were some casualties in the forward units. On the night of Pte I. Gunn; Rev H. G. Norris;
When the first
On the night of 21–22 February 6 Infantry Brigade relieved 133 US Infantry Regiment in the northern outskirts of
Difficulties were encountered immediately. Streets and roads had either vanished beneath masses of rubble or were gapped by giant bomb craters. Even men on foot found movement hard, while tanks of 19 Armoured Regiment were unable to get beyond the northern fringes. Despite unexpectedly strong opposition from the picked enemy garrison troops, 25 Battalion captured Point 165. By the end of the day it appeared that the action might yet succeed.
After the New Zealanders and Indians had been in the line for six weeks and had endured eight days of almost continuous fighting, orders were given on the evening of 23 March for the offensive to be temporarily abandoned. The troops remained in the line to hold their gains, but the New Zealand Corps was disbanded on 26 March and all formations passed under command of 13 Corps.
The approximate wastage from 2 NZ Division for the period of ten days following 15 March was as follows:
The medical units were busy but arrangements for treatment and evacuation worked smoothly, and at no time did the situation get out of hand. Physical exhaustion cases among the troops were becoming numerous prior to the relief of the Division.
The total evacuations from
Total strength of corps 69,700, excluding American forces under command totalling 11,000 (approx.).
(Note: Medical arrangements were based on estimated casualties of 2400 within the first fifty-six hours of the second attack, but the total casualties from 2 NZ Division and
In the
For instance, the RMO of 25 Battalion considered that the low proportion of killed (and died of wounds) to wounded in his unit, 37 to 160, could be partially accounted for by the efficiency of his stretcher-bearers. The stretcher-bearer was also subject to more than the normal combatant risk, as was also shown in 25 Battalion, where the casualty figures for the stretcher-bearer section were higher than for any other section in the battalion. Out of sixteen company stretcher-bearers, two were killed—one by mortaring, the other by a sniper. While the first stretcher-bearer was attending a wounded officer in an exposed position both were killed, their bodies being recovered side by side with the officer wearing a half-applied bandage. Five others were wounded and this, together with one taken ill, made a casualty return of 50 per cent. Reinforcement stretcher-bearers were not available and the remaining half of the section had to cope with the work.
Lance-Corporal L-
In the same way, the stretcher-carrying jeep and the ambulance drivers, provided from the members of the ASC attached to medical units, played an important part in the chain of evacuation in forward areas. They drove over roads subjected to enemy artillery fire and, at night, driving alone in the pitch darkness was a severe trial.
The RMO of 28 (Maori) Battalion, Captain C. N. D'Arcy, set up his RAP in the church cellar in
During the battle from 18 to 23 March Captain D'Arcy attended to all the wounded reaching his RAP. Conditions were most trying, but the skill with which the wounded were dressed was the subject of the highest praise from the dressing stations. For his outstanding work D'Arcy was awarded the Military Cross.
Another RMO, Captain A. W. H. Borrie of 24 Battalion, was also awarded the MC during the battle for
The ADS: The most forward of the New Zealand medical units in the battle for
At 6 ADS the operating tents were dug into the ground as the position was well within range of enemy artillery and mortar fire, though the
Owing to a strong possibility that tanks might have to be sent up the ambulance track to reach
From the time the infantry moved forward at midday on 15 March there was a steady stream of casualties, although not as numerous, however, as the medical units were prepared for.
The construction of the bridge across the Rapido on the night of 17–18 March enabled casualties from
The surgical policy adopted at the ADS was to do as little as possible compatible with comfortable and immediate evacuation to the MDS. The function of the ADS was, therefore, primarily that of an ambulance-car post and a resuscitation post for serious cases. In certain cases it was considered necessary to apply Thomas splints under pentothal to ensure comfortable evacuation to the CCS via the MDS. (Another important function of 5 ADS was as a first-aid post to the various British, American, and New Zealand artillery units, of which there were many within a radius of 3 to 4 miles, and to casualties resulting from the numerous traffic accidents on Route 6.)
The MDS: The first casualties arrived at 4 MDS at 3 p.m. on 15 March from 6 ADS, and by midnight seventy-four casualties had been dealt with. Evacuation from the MDS was carried out by NZ
On 16 March casualties admitted to 4 MDS totalled 78 New Zealanders and 12 British, almost all of them being sent straight on to the respective CCSs. Some of these came through 5 ADS, which was sited nearer
From 18 March onwards there was increased enemy shelling of the rear areas. A steady stream of wounded continued to arrive at 4 MDS and the figures for 18 March were 90 New Zealanders and 7 British, and for 19 March 89 New Zealanders and 5 British. As cases were banking up at the CCS it was necessary for more surgery to be done at the MDS. As casualties from
Casualties used to arrive at 4 MDS about 11 p.m. after being held in
Field Transfusion Unit: This was attached to the active MDS and was invaluable in the resuscitation of the serious cases, both those operated on at the MDS and those sent on for operation at the CCS. For the worst cases transfusions were arranged to continue during the trip to the CCS, and special clamps had been made by the divisional workshops to fix the transfusion apparatus to the stretchers. During the four months December to March a total of 506 cases was dealt with. Of these, 239 were given an average of 2·2 pints of blood and 184 an average of 1·6 pints of plasma. There were only seven reactions, none of them severe. During March only 2·7 per cent of the blood was discarded. During the second quarter of
The siting of the New Zealand divisional medical units during the battles at
The abdominal and chest cases, as well as the large majority of other wounded men, were sent as quickly as possible to the CCS and were there dealt with by a well-qualified and ample staff. Three theatres were in operation, and there was a bed capacity of 300. Nursing sisters were available for work both in the operating theatre and in the wards. The value of giving ample time for the resuscitation of the severe cases, especially the abdomens, was demonstrated. This led to a new outlook in the treatment of these cases. Early in the war the idea predominant was that operative treatment in abdominal cases had to be carried out at the earliest possible moment, and certainly within six to eight hours. Every
During the
Lieutenant-Colonel Button, commenting at the time, stated that the majority of the patients died because of hopeless multiple wounds, and that these cases showed little or no response to resuscitation and four cases out of fifty died on the operating table. None of the long-term cases (20 hours, 24 hours, 49 hours, etc.,) died in spite of advanced peritonitis. The impression was being confirmed that, although it was sound practice to operate as early as possible after wounding, the time factor of six to eight hours often used as a standard was not of primary importance. It was felt that adequate resuscitation was paramount, and that facilities for the giving of blood on the route of evacuation to the CCS were highly beneficial.
On admission to the CCS further resuscitation—-blood, warmth, and rest in a suitable environment—-was most essential. If a case failed to respond to resuscitation it usually meant either: (i) internal haemorrhage, or (ii) irreversible shock, the result of gross irrecoverable injury. Operation was undertaken when the blood pressure was 100/80 and rising and the pulse and colour correspondingly improved. This usually took three to four hours. The operation was
At operation the principles followed were:
arrest of haemorrhage;
suture of wounds of the small bowel;
exteriorisation of wounds of the large bowel. (Resections had been few.)
Post-operative Treatment: Adequate nursing supervision was essential for the patient and for the peace of mind of the surgeon. Tribute was paid to the great value of nursing sisters. Gastric suction was installed immediately the patient returned to the ward and, together with intravenous fluids, was carried on for about four days. Experience showed that, before operation, adequate resuscitation and, after operation, proper nursing to prevent the onset of ileus were the two biggest factors that made for success in the handling of these cases. The time factor and the presence of peritonitis seemed to be of less importance. They were largely controlled by nursing and chemotherapy. A CCS was usually the first unit on the line of evacuation which was adequately equipped to give these facilities. Thus it seemed that, given adequate resuscitation en route, abdominal cases were better handled in a CCS twelve to twenty-four hours after wounding than earlier at a forward operating centre with an MDS.
Lieutenant-Colonel Button's evaluation gives a very clear idea of the problems of forward surgery and the experience gained at that time, and it gave a valuable lead for the future in the treatment of abdominal cases. The chest cases were also dealt with at the CCS and, in general, did well. They constituted 7 per cent of the battle casualties. Aspiration was carried out usually twenty-four to forty-eight hours after admission. Four out of thirty cases had become infected. Penicillin was not available in sufficient quantity to allow of its use except in a few cases, though its value was recognised at that time.
The treatment of flesh wounds was adequately carried out, as shown by the general cleanliness of the wounds noted on admission to 2 General Hospital at
The neurosurgical cases were transferred to 16 American Evacuation Hospital sited near our CCS and treated with excellent results by Major Weinberger, a neurosurgeon attached to that unit. From there they were sent to 65 British Hospital at
Serious facio-maxillary cases were also sent from our CCS to 65 British General Hospital. The Medical Research Council's shock research unit was sited near our CCS, and two British laboratories were attached to the CCS. These units undoubtedly produced a healthy stimulus to scientific endeavour.
This team was attached to 1 Mobile CCS for the
In abdominal operation X-ray was considered to be of great assistance in planning the approach. Adequate nursing facilities at the CCS following operation were held to outweigh the advantages of operation two to three hours earlier at the MDS. This is a very significant commentary from a team with such long experience of work at the MDS.
In chest cases a more radical operative treatment was adopted and rib ends were trimmed and accessible foreign bodies removed. Inter-costal nerve block was utilised and thought to be effective.
During the period 1 December 1943 to 31 March 1944, 279 operations were performed with 31 deaths. There were 60 abdominal cases, with 24 deaths, and 6 gas-gangrene cases, with 2 deaths. The influence of cold and exposure was demonstrated by the death of 9 abdominal cases out of 12 operated on at
An analysis of the deaths according to the period following operation is of considerable interest:
The hospital opened at
There was a general freedom from severe infection in the majority of the cases, including injuries to joints, and chest cases progressed well following aspiration and the instillation of penicillin into the pleural cavity. Burn cases were dealt with by saline bath treatment. An improvised unit of two baths was set up and personnel were trained specially for the work. Good results were obtained, and when penicillin became available it was freely given to these cases.
No. 3 General Hospital at
Certain types of cases, notably fractures of the femur, were sent on to
The outstanding feature of wound treatment at this period was the experimental investigations carried out with penicillin. Major Scott-Thomson, pathologist to the penicillin control unit, set up a laboratory in the hospital in January, and certain groups of cases were selected:
For treatment with sodium penicillin parenterally:
compound fractures of the femur and tarsus,
cases of infected haemothorax.
For treatment with calcium penicillin locally to the wound:
soft-tissue wounds for delayed primary and secondary suture,
burns.
The methods used were:
Compound Fractures of Femur and Tarsus. The method originally adopted by Lieutenant-Colonel Jeffreys, RAMC, was to explore, cleanse, and suture loosely the wounds of the thigh on admission, and give 15,000 units intramuscularly three-hourly for five to six days. This method was altered later and penicillin was injected for five to six days before suture. Dressings were left unchanged for two to three weeks.
Infected Haemothoraces. Two methods were used:
Intramuscular injection was given for five days and the chest aspirated.
Sodium penicillin solution was injected into the pleural cavity and the chest aspirated. After rib resection and drainage, penicillin was instilled daily into the chest, suction being interrupted for some hours.
Secondary Suture. Two methods were used:
Application of calcium penicillin locally for five or more days until a swab from the wound showed no growth of staphylococci or streptococci. Wound was then excised,
Same as under (i) but suture without tubes.
Compound Fracture of the Femur: Five cases were treated with penicillin and a control series of five cases not so treated was available for comparison. Four of the five cases reacted excellently, one only partially. There was early healing of the wound, less toxaemia, and almost complete absence of fever. A comparison between the temperature charts of the two series was impressive.
One case of fracture of the tarsus healed well.
Infected Haemothorax: It was considered that penicillin was effective to a high degree, but infection recurred after intramuscular injections were stopped.
Secondary Suture of Wound: The large majority were very successful, with little difference between those with and without instillation by tube following suture.
Skin grafts and burns also did very well. The general results of the experiments were very satisfactory and encouraged the continued and more universal use of penicillin. Supplies, however, were scarce and it was some time before the treatment could be extensively adopted.
The healing of wounds sutured at 2 General Hospital was observed to be very satisfactory after the patients had been evacuated to
The organisation of the
An illustration of the amount of work performed is given by the record of the work of the mobile unit from December 1943 to March 1944. During that period 10,000 troops were examined, 6000 fillings and 550 extractions carried out, and no fewer than 5330
When the attack by
In preparation for a renewed offensive against the Gustav line the Allied armies in
During the first two weeks of April the sorely-tried infantry brigades of 2 NZ Division were withdrawn from
Reliefs and changes in disposition were numerous. Eventually 2 Independent Paratroop Brigade took over the northern sub-sector on 20 April from 6 Brigade, which went to a rest area, and 5 Brigade next day replaced 28 British Infantry Brigade in the
The sector in the
When the Condito sector on the right was held by 2 Independent Paratroop Brigade, that brigade had an entirely separate line of evacuation via its own MDS at
The methods of evacuation used were hand carriage, mules with litters and cacholets, jeeps, and finally ambulance cars. As previously, jeeps fitted with stretcher-carrying frames were invaluable for forward evacuation. The country was so difficult that some units were two and three hours' travelling time from
With the coming of spring the weather was mainly fine, with only occasional heavy showers and a consequent reduction in mud. The sickness rate was reasonably low. There was a steady trickle of battle casualties from enemy fire and patrol clashes.
During the first week of May Allied preparations for an all-out attack on the Gustav line neared completion. The Adriatic front was lightly held by 5 British Corps and the
When the attack began on 11 May, 6 Brigade was holding the
After a hurried night move from the rest area to the vicinity of
Fourth Armoured Brigade moved across to join 2 NZ Division on 29 May, by which time New Zealand troops had cleared the mountain strongholds of
From
On the coastal sector Allied forces had cleared the approaches to
In the upper
Medical units did not move forward until 30 May, when 5 MDS became the open battle MDS at
On 3 June 5 MDS moved to half a mile south of
An advance was made by 1 Mobile CCS on 7 June from
From the hills in the neighbourhood of
The Division's casualties for the period February to June were as follows:
In
On 22 March Mount Vesuvius erupted violently, covering the surrounding country with ash and also engulfing parts of small villages with lava. At
The sickness rate remained low for the four months to the end of March, the daily evacuations beyond the RAP averaging 1·3 per 1000, the highest figure being 1·5 in March. This compared with a rate of 3·08 in February for the New Zealand Corps as a whole.
The commonest illnesses were infective hepatitis, septic infection of small cuts, upper respiratory infections, tonsillitis, pneumonia (including atypical pneumonia), and exhaustion cases. Cases of sickness totalled 3261, whilst battle casualties totalled 2755 for the four months.
In the following three-month period from April to June the sickness rate in the Division increased and the evacuation beyond the RAPs was 1·8 per 100 per day. The commonest disease at that period was fever (NYD), similar in type to sandfly fever, acute in onset and settling down in three to four days. This was very prevalent, 520 cases being recorded. Diarrhoea in mild form accounted for 176 cases; hepatitis for only 109 cases. Other diseases noted were
Rations were adequate and varied, the best issued to the Division during four and a half years of war. The issue of fresh meat and vegetables was frequent and gave a greater variety to the meals. Medical comforts and
Full-scale winter clothing was worn during the period up to the middle of April, when summer clothing was issued. Extra socks were available and were issued in the forward areas during active periods every night with the rations. As a result very few cases of immersion foot, and those only of mild type, were seen.
The hygiene unit continued to work efficiently. It had special difficulty in clearing up ground vacated by other troops and in the handling of the numerous civilians in the area. A number of these were evacuated when congestion was marked, and the sanitary arrangements of those remaining in the area were supervised and lidded box latrines were supplied for their use. A directive from the GOC led to the maintenance of markedly improved sanitary conditions in the divisional area.
Shower and disinfestor work was carried on, and during the quarter ended 31 March 43,400 men passed through the unit's four showers, and 2245 blankets and the effects of 263 men were disinfested. In the following three months 42,362 men were given showers and
Refuse was burnt in the back areas and buried in all areas. Dead mules were buried by means of bulldozers. Preventive fly-control measures were carried out assiduously and fly-traps and fly-papers used. Efficient down-draft stoves were constructed and were used by the medical units.
In the divisional area during the first three months of
In April there was a marked increase in the number of cases to 100, followed by a very marked increase to 213 in May and 174 in June. These figures include cases of non-specific urethritis which were not included in
The majority of the cases in May were due to infection contracted in
The relatively large numbers of sulphonamide-resistant cases of gonorrhoea as well as the chronic cases of non-specific urethritis had necessitated the setting up of a special contagious diseases ward of thirty beds at 3 General Hospital.
The majority of the cases seen in the Adriatic sector had cleared up readily following the routine administration of sulphathiazole, and 82 per cent of cases were treated and returned direct to their units by 102 Mobile VDTC. In the
In May a third of the cases in the divisional area proved resistant and had to be evacuated. Penicillin had been in use in other forces before this and supplies were obtained by us when the position was beginning to cause anxiety. Fortunately, the resistant cases rapidly cleared up when treated with penicillin. The dosage was 100,000 units given in ten injections at intervals of three hours, and this effected cure in 95 per cent of the cases.
Although there was a large number of cases of urethritis in which the gonococcus could not be demonstrated, the general opinion was
Prostatitis sometimes arose in cases in which the primary symptoms had been slight and early treatment neglected. Instillation of silver proteinate through Ultzman's syringe once a week gave extremely good results.
Balanitis often gave rise to difficulty in treatment and healing was slow, especially in Maoris.
Soft-sore cases were often slow to heal and bubos frequently occurred.
During the three months, April to June, twenty-three cases of syphilis were reported. The Laughlan rapid flocculation test proved accurate for diagnosis. Treatment given at this time was by mapharsen and bismuth, sufficient penicillin not then being available for use in these cases.
Hepatitis had developed previously in half the cases of syphilis treated, the infection apparently being transferred from patient to patient. The boiling of the syringes after each anti-syphilitic injection, however, had resulted in hepatitis occurring in only one case during the previous six months.
A special venereal diseases ward was set up at 3 General Hospital,
In resistant cases injections were given of 1 in 6000 oxycyanide of mercury and sounds were passed and the prostate massaged; if resistance continued, TAB vaccine was given intravenously to produce a hyperpyrexia of 104 to 105 degrees.
The 101st NZ VD Centre, which had just come over to
In
The number of cases of pneumonia admitted to 2 General Hospital was 78 in February, 60 in March, 49 in April, 49 in May, and 28 in June. About half were found to be atypical in type.
Sulphonamides were not of any value in treatment and were also contra-indicated in the presence of leucopenia. No specific treatment was available. The condition was recognised later as Q fever, a virus disease which had been prevalent in the
Arrangements were made during the
Of fifty-two men returned to their units, eight and the two officers were re-admitted and evacuated. The majority of the cases were from the more recent reinforcements, particularly the 10th Reinforcements. Most of them were from three battalions, but there were men also from the artillery and engineers. Some concern was caused as the majority were very recent arrivals in the Division, and quite
In drawing particular attention to this in
This disease proved the commonest medical condition responsible for hospital admissions during the winter of 1943–44. Three hundred and ninety-five cases were evacuated from the Division from December 1943 to March 1944, inclusive, the incidence being much higher in 6 Infantry Brigade and much less in the
Some of the officers of the New Zealand Corps were called to a meeting at 1 Mobile CCS on
The enforcement of personal protection and use of mepacrine tablets.
The killing of adult mosquitoes.
Larvae control.
Discussion emphasised the importance of unit discipline, besides protection by suitable clothing, mosquito-proof bivouacs, and bushnets. A high incidence of malaria was forecast, unless rigid discipline was enforced, if the troops remained during the season in the areas south of
A circular sent to all medical officers by Colonel King,
The whole of pontine marshes where demolitions have neutralised previous preventive work, and the area north of rome to the apennines.
Unless precautions are taken during the malarial season from may to november casualties may be so high as to interfere with operations.
It is the responsibility of the medical services to teach Regimental Officers, NCOs and men the fundamental principles of protection. Each MO must be fully conversant with all methods in use, and with all orders relating to the control of malaria.
Measures to be adopted:
OsC and units must be made malaria minded, as the OC is responsible for anti-malarial measures within his own unit lines, and for the enforcement of all orders for the prevention of malaria.
OsC Fd. Hyg. Secs. will act as Special Malaria Officer for Division.
RMO is the advisor to OC Unit on all measures in respect of malaria control, the most important of which are outlined:
Camp Sites: Where possible
Personal Protection: This includes long trousers and rolled down sleeves from sunset to sunrise; proper use and care of bushnets and mosquito-proof bivouacs etc., instruction in the use of mosquito repellent, use of head veils and gauntlets for sentries etc., where practicable.
Unit Anti-mosquito Squads: To be trained by RMO and Fd. Hyg. Sec. on a basis of 1 NCO and 3 ORs per Inf. Coy. or equivalent sub unit plus 100% reserve. These will carry out anti-mosquito measures such as spraying of huts, tents, etc., and anti-larval spraying with Malariol on casual water within the unit's area of responsibility, or of appropriate drainage. By the middle of April necessary personnel should be trained and employed on Anti-Malarial work and the crucial period for larval destruction from May 1 to Aug. 31 fully exploited.
Every effort to destroy temporarily the breeding place of A. Maculipennis must be made, and there must be no july and august peak in malaria in
Protective Medication: Mepacrine (ASC Supply) will be taken daily, during or after meals, 7 days a week, preferably after the evening meal.
Fever Cases:
Officers and men to report sick at once. On no account to treat themselves if they have a fever.
Cases evacuated to a Medical unit.
The Sicilian campaign has shown that the reasons for the large outbreak of malaria were slackness in mepacrine administration in some instances, failure of MCUs to arrive early, and lack of appreciation by the troops of personal protection methods. Every individual officer and man must be taught to realise that the prevention of malaria is primarily the concern of the individual. Every officer and NCO must realise that it is their responsibility to see that the men under their charge adopt the measures of personal protection advised.
If all precautions are taken and medical advice followed the rate should not exceed 40 per 1000 per annum. Not as in last war in macedonia 100,000 cases in a force of 120,000 men; or in the brief Sicilian campaign where malaria cases (excluding those also among many BCs) exceeded battle casualties by 4000 cases.
An instance is quoted of one AA Regt. of 1300 men, living in highly malarious sites during the malarial season, having only 23 men down in six months. This was due to a good CO, a careful RMO and loyal cooperation by all ranks.
CHIEF CAUSES OF MALARIA—
IGNORANCE—LAZINESS AND PLAIN STUPIDITY.
CHIEF PREVENTIVES ARE
DISCIPLINE—KEENNESS AND INTELLIGENCE.
It is up to Medical Officers to supply the facts, stimulate all ranks to keenness, and if discipline is lacking to bring the matter to the notice of higher authority.
The OC 4 Field Hygiene Section and another medical officer had attended a course of instruction in malaria control at AFHQ,
During April two New Zealand AMCUs were formed and were at work, one in the 2 NZ Division area and one attached to 4 Armoured Brigade, and full anti-malaria precautions became effective on 28 April. One hundred and fifty officers and four hundred and fifty other ranks had by then received courses of instruction at the New Zealand Malaria School which had been set up in the Division. A poster and newspaper campaign was inaugurated and the courses were continued. The control units had been working hard, the divisional unit having sprayed 76 square miles of country adjacent to the
As a result of these measures the Division became malaria-minded, and the quality of the discipline was shown by the very small incidence of infection during the Italian campaign. In April only two cases of malaria were reported and in May only seven.
Up to the end of March half of the patients admitted to the medical wards of the hospitals were suffering from acute infectious disease. Infective hepatitis and pneumonia each accounted for 232 cases, atypical pneumonia being responsible for the great proportion of the pneumonia cases. There were 164 cases of psychoneurosis and disorders of digestion and skin disease were common, with 184
From April to June there were 1201 admissions to the medical wards, of which 553 were of infectious disease, 241 of digestive, 150 of nervous, and 123 of respiratory disorders, and 108 of skin diseases. Of the infectious diseases, hepatitis had diminished to 130 cases and there were 214 cases of pneumonia and 60 of bacillary dysentery, 10 of malaria, and 4 of typhoid. There was only one medical death during that period.
Many of 2 General Hospital's medical patients were transferred to 3 General Hospital so that admissions of hepatitis and pneumonia were common. The incidence of sickness in the base area was low throughout the period. It was noted that amoebic dysentery accounted for the majority of the relatively few cases of dysentery admitted. There were some cases of diphtheria and this infection was noted in some of the wounds. A high incidence of complications, especially polyneuritis, was observed.
The depot, which had been functioning at
The unit then had a bed capacity of 750, with emergency expansion up to 1270 beds. Altogether, 2346 cases were admitted from April to June 1944. Of these, 1100 were medical, 725 surgical, 364 orthopaedic, and 157 were skin cases. It was noted that the wounds following secondary suture had done well and that this treatment had markedly shortened the convalescence of these cases compared with men wounded in the North African campaign. The medical cases admitted were convalescent from pneumonia, mainly the atypical form, hepatitis, and gastro-intestinal disorders. In June accidental injuries accounted for a large proportion of the surgical cases. Sprains of the ankle and knee were common and there were many cases of burns. The attachment of six members of the
At the end of April a furlough scheme for medical officers was commenced and four officers left for New Zealand or the
In
THE administrative units of
The medical units concerned were DMS Office, the Consultants, Principal Matron, 2 General Hospital, Detachment
After the transfer of all these units to
Of the units involved in the transfer from
To establish a camp hospital at Advanced Base at
The other units arrived at
Meanwhile, on 25 February Allied Force Headquarters made the request to DMS
After the first divisional operations in
On Maunganui called at
A measure of detailed liaison was necessary between DMS Maunganui when she called at
The accommodation of the three hospital ships serving Maunganui, 368 beds,
With the transfer of three base hospitals and the
The only medical units in
Leave camps were organised in several areas and were freely utilised. Some were organised by divisional units, some by hospitals, and some by the
Throughout the period in
The transfers of medical units between
One of the purposes of the Director-General's visit to
The DGMS discussed with the DMS GHQ MEF, Major-General Hartgill, a New Zealander, the question of the transfer of 1 General Hospital to
In
After visiting the non-divisional medical units in
It must be remembered that although
There are also special units attached to certain of the hospitals to which New Zealanders may be sent for special investigation. For instance, the special neuro-surgical unit at 16 US Evacuation Hospital to which New Zealanders are frequently transferred who are suffering from brain and spinal lesions.
During the recent fighting, in which Indian, New Zealand and British Divisions were engaged, all casualties were evacuated by the best and quickest route, irrespective of the medical unit.
The total strength of
Another argument against the reduction in the hospital bed accommodation is that an emergency is likely to arise in the near future when the malarial and dysentery season commences in a few weeks.
It has been recognised that the original estimate of 10 per cent for the sick and casualty rate was too high but any reduction in the accommodation under the present 6 per cent rate would be dangerous and affect very considerably the efficiency of the medical services, and this, in turn would seriously react on the care of the sick and wounded New Zealand soldier. Under the circumstances, therefore, I cannot advise any reduction in the number of hospitals or medical officers.
As it was, in order to maintain an efficient medical service, it had been found impossible to allow medical officers to return to New Zealand on furlough as soon as combatant officers of similar length of service. Medical officers could not be released until replacements were available. As the DGMS found, this created a certain feeling of unrest, and he found it desirable to explain the reasons from the New Zealand viewpoint and to assure the medical officers concerned that every effort was being made to provide replacements so that they could proceed on furlough or obtain their release from the Army, and so help to maintain the civilian medical service in New Zealand.
The visit overseas of the DGMS was of great value to
After having been open for two and a half years,
The Prime Minister of New Zealand, the Rt. Hon. Peter Fraser, accompanied by Lieutenant-General E. Puttick and others, arrived in
In a special Order of the Day
At the end of May a further draft of sixty-two repatriated prisoners of war from
The second section of the 11th Reinforcements arrived in
This unit arrived in
A unit known as 1 Field Surgical Unit was officially formed on
On 25 July a new establishment became effective for 4 Field Hygiene Section, whereby the unit was combined with 2 and 3 Anti-Malaria Control Units to become 4 Field Hygiene Company, and extra transport was also provided. The change simplified and improved administration and proved very advantageous. In the following winter one malaria-control section was disbanded and the other became a typhus-control section.
At the same time a new war establishment was issued for 102 Mobile VDTC, enabling it to have extra vehicles and to raise the number and rank of its NCOs.
After the fall of
The shortage of medical officers in
Allowing for the arrival of four medical officers with the 12th Reinforcements, there was a deficiency of eighteen medical officers on the establishments of medical units. In addition, it was desirable to have a surplus of at least five to make provision for leave, sickness, and special detachments. Since
In the operations near
(With the return of 3 NZ Division to New Zealand from the
At this period there arose a marked deficiency in the numbers of medical specialists in
Throughout the war there had been difficulty with regard to the promotion of senior medical practitioners who were retained in hospitals because of their value as clinicians. The hospitals had rigid establishments with a minimal number of senior ranking officers, and only the commanding officer and officers in charge of the surgical and medical divisions had ranks above that of major. In the RAMC every medical officer graded as a specialist automatically was granted the rank of major, but this was not so in our Corps. In the early period of the war we had experienced senior surgeons ranking as captains. Later, it was impossible for any specialist to be promoted above the rank of major unless he became an officer in charge of a division in a hospital, for which position he might not be qualified, or unless he became CO of a field ambulance or of a hospital unit, when he was no longer available for his specialist work. Some recognition of the position was given by Headquarters
Because of demands on the Emergency Medical Service in
Making references to the subject in letters to General Bowerbank in
As you know, there is a very great shortage of medical men in the
New Zealand medical men, both in a service and civilian capacity, have played a valuable part in augmenting the all too few doctors at our disposal.… indeed I do not know what we should have done if the Dominions had pressed for the return of their officers who have given us such great help in the last few difficult years.
Many of the New Zealand doctors concerned were specially suited by age and qualifications for service in
In
The average strength of
As has been said earlier, it had been found impossible to grant medical officers furlough to New Zealand in the same way as other officers of the force. This was due to the fact that there were no replacements available and the medical officers could not be spared without lowering the efficiency of the service. Medical officers of the First Echelon with four and a half years' service overseas had still not been granted furlough. Some had had to be invalided back to New Zealand—not surprising when it was considered that many of the medical officers in the first medical units sent overseas were older married men.
When medical officers did go on furlough very few returned to serve in a) Those medically boarded as unfit for further overseas service; (b) Those asked for by Army Headquarters, c) Those granted compassionate leave; (d) Direct exchanges with similarly qualified men in New Zealand; (e) Exchanges of young medical officers with long service for senior house surgeons. (Less than 50 per cent of those returning wished to take up house-surgeon appointments.)
In
On a similar basis the voluntary aids were able to return to New Zealand after three years' service.
The status of the voluntary aids had recently been revised. The nursing sisters had always had the status of officers and wore badges of rank as such. Except for their few officers, the WAACs were rated as NCOs and privates. This debarred them from first-class rail travel in the
The
Major Tweedy suggested a
On
THE war in
To assist in attaining this objective 2 NZ Division was required by 13 Corps, and this brought to an end the pleasant respite from active operations. Moving secretly at night, the Division travelled 250 miles northwards through the outskirts of
In daylight on 13 July the first advance was made by 6 Brigade against this heavily wooded arc of peaks and Monte Castiglion Maggio and Monte Cavadenti were captured, and on the nights of 14–15 July and 15–16 July stronger opposition was overcome to take
At a conference between
Battle casualties from this first phase of the Division's advance towards
When 2 NZ Division returned to the line on 21 July, it was employed with 6 South African Armoured Division in driving a narrow wedge along the general line of Route 2 north of
The approaches to 4 Parachute Division and
From the time of its entry into the line, 5 Brigade made steady progress despite counter-attacks, while solid support was given by tanks of the armoured regiments and by the Divisional Cavalry.
The advance, across 10 miles of most difficult country, broke the Olga line and brought the Division into contact with the Paula line, which the enemy prepared to defend to the north of the Pesa River. At night men on the hilltops could clearly see the lights of
For this drive on a new sector to the west a new medical layout was necessary. The Division went into action in the
The site of the CCS at Maj D. P. O'Brien; born NZ
The line of evacuation for New Zealand patients to 2 NZ General Hospital at
For the period from 22 July to 5 August, by which date the part of
The Paula line was based upon the semi-circle of hills surrounding
An account of events given by Private
At 3 o'clock in the morning D. Coy. 24 Bn. moved away from Bn. HQ, stationed at the bottom of the hill, towards their objective, a small village occupied by Germans, some distance up the hill. After the artillery had plastered our objective, we followed in, discovering afterwards that we had gone through a minefield in the process. The bursts of machine gun fire offered very little resistance. The attack was a great success, the German prisoners actually complimenting us. Quite a few prisoners were taken. This action was all over before daylight. At approximately 6 a.m. tanks came up to give us support, casualties at this stage being practically nil. Morale was extremely good. Coy. HQ were established in a church and cellar. Machine gunners were also attached to us; the other platoons were in buildings close by. During the morning we communicated with each other quite freely, and when the shelling became severe, wireless was used quite successfully. In the morning the tanks gave us confidence and kept morale high. During this time there were several light attacks by German artillery and infantry. In the afternoon the attacks became more frequent and heavier. At 2.30 p.m. approximately, after particularly heavy artillery fire well supported by enemy infantry our tank crews…left us.
The morale at once dropped especially when a German Panther tank appeared in our vicinity and came slowly towards the church with machine gun firing rapid bursts; small arms fire was frequent but to no avail.
This account was confirmed by Captain Borrie, RMO 24 Battalion, who commented: ‘Intensive artillery bombardment of buildings after a few hours can cause acute exhaustion among troops even in a basement but with the right environment, exhaustion soon turns to exhilaration.’ After a few days' rest the men affected returned to the front line but quickly tired in other actions under shellfire later. No case of shell wounds was recorded in spite of the successive bombardments.
After very heavy fighting on the night of 30–31 July
Along the greater part of the front the Germans withdrew precipitately and South African armour began to forge swiftly ahead along the main road to the city. The South Africans entered
The brigaded ADSs were kept busy attending to patients and changing locations frequently as the advance continued. Evacuation of patients from RAP to ADS was by Humber ambulance cars and jeeps, and from ADS to MDS by Austin ambulance cars. The drivers of the ambulances and jeeps with the battalions did excellent work under conditions which were very trying, and sometimes had to bring the wounded out through enemy mortar fire.
During the battle for the Paula line a steady stream of casualties was admitted to 6 MDS at
In July 6 MDS had admitted 1479 patients—1107 sick and 372 wounded. The unit was closed on only two days during the month and on those two days it travelled over 200 miles. It had moved six times in twenty-one days—from open MDS to open MDS over 18 miles of winding hill road on 25 July, reopening in two and a half hours, and from battle MDS to battle MDS over 7 miles of road on the 27th, reopening in two hours. For the unit it was one of the busiest months of the Italian campaign.
The final battle for
An account written by Sergeant
The men who had been responsible for the splendid defence of
We received the blackened swollen dead recovered from under the booby-trapped buildings at
Fourteen deaths took place at the MDS and the bodies were buried in the cemetery down by the roadside. Into it went the horribly-burnt and wounded trooper who had died in Reception. Quite logical and conscious when brought in, he had answered to a question as to whether he had any pain in the stomach: ‘I ought to have; I've been eating green apples.’ Into it, too, went the Armoured captain who had fought to live with wonderful courage. And the Taranaki boy who had gone prowling and had been shot up by a jumpy-fingered American picquet.
There were 50 graves in it when we closed it down. A volunteer party worked on it, bringing in loads of tiles. They used these to make warm red paths among the graves and to enclose the mound of each as though the soil was flowering through them. The bounds of the plot were marked with planted tiles put in battlemented fashion, and the curves taken by the crosses followed faithfully the curve taken by the road. Two large stone flower pots of irises stood on each side of the entrance and a great stone pot with the same flowers stood in the very centre of the cemetery at the foot of a large cross. It was an exceedingly simple but very effective arrangement. Drivers of passing trucks used to crane out of their vehicles to watch it as they passed.
To establish an MDS nearer to the forward elements of the Division than 6 MDS, which was functioning on Route 2 near
As it became apparent that the enemy intended to fight in and about Maj I. H. Fletcher, MC; Waitara; born
In accordance with the regrouping, 4 MDS moved on 6 August some 6 miles to the west to the vicinity of
On 7 August 5 MDS moved from the
American troops of
The evacuation of casualties was generally satisfactory. Jeeps were utilised to save hand carrying in the forward areas, especially in the mountainous areas and at
During this period of operations 6 ADS functioned with two medical officers only. This was adequate under normal circumstances, but on one occasion when a considerable number of patients, some of them seriously ill, arrived at the same time, some could not be attended to as promptly as the medical officers wished. It was considered that three medical officers were essential to an ADS in action.
As a brigaded ADS making quick moves, the ADS on several occasions had difficulty in finding any MDS or CCS to which it could evacuate casualties. Some evacuations were made direct to a British CCS which had been located first.
The frequent moves of the field ambulance units during this short campaign are well illustrated by the story of one of the ADSs. At first it operated in a palatial mansion at
Altogether during this period over 200 battle casualties and nearly 200 sick were treated. Blood was drawn from five donors in the unit to supplement the supplies and eighteen patients were given blood or plasma. The personnel had been organised into three teams, each made up as follows: nursing NCO, evacuation NCO, resuscitation orderly, injections orderly, drinks orderly, two dressing orderlies, clerk, pack-store orderly, and three stretcher-bearers. Each team was able to operate independently.
Much more work was undertaken at the MDS than at the
An opinion written at the time by the CO of 4 Field Ambulance is of interest:
It would appear desirable to utilise the ambulances' surgical amenities to the full, for the additional experience is of great value to both the surgeons and orderlies. It is only during actual battle conditions that the surgical departments of Field Ambulances have the opportunity of surgical work, and it is felt that the fullest opportunities should be given to the three Field Ambulance Surgical Teams before bringing surgical assistance from the CCS. Normally at the CCS the surgeons and orderlies have long and constant surgical opportunities, which naturally are denied to the ambulance teams.
Following the now accepted principle of excision and dressing of all wounds at the earliest possible opportunity, during this period as open MDS the greater proportion of cases have been dealt with surgically at the MDS. Over two thirds of all the battle casualties received complete surgical treatment and were fit to be sent on direct to a NZ Gen. Hosp.
As facilities for nursing are better at a CCS all non-urgent abdomens and chests were sent to a CCS for surgery.
This opinion, clearly enunciated, shows the ideas of the zealous young field ambulance officer. A more balanced outlook is shown by an older officer, a surgeon of a field ambulance surgical team, who gave an account of the work at the MDS as follows:
Type of surgery attempted during recent offensive of the Division:
1. Severe Cases:
Badly mutilated limbs requiring amputation.
Blown off limbs.
Severed main arteries.
Collapsed cases of compound femurs and compound leg fractures.
2. Light Cases: As many of these as possible were done but with only two surgical teams operating it was impossible to do them all. Everyone is agreed that the sooner after wounding a light case receives operative attention the better the wound will heal and the sooner will he be fit for duty again. With the very excellent surgical set-up that is now available with the Field Ambulances I would recommend that the aim should be to operate on all light cases at the MDS and to then evacuate them direct to the forward NZ Gen. Hosp. Many of the lighter cases could then be passed on to Base where the next surgery could be done. This would help to relieve pressure on both the CCS and the forward hospital, as well as being an advantage to the patient.
At
1. Three MOs for Reception. In the absence of the FTU one to supervise the resuscitation and pre-operation Tarpaulin.
2. Three surgical teams, each complete with surgeon, anaesthetist, NCO, orderlies and own operating equipment. Organised on a 12-hourly basis there would be always two teams working simultaneously throughout the 24 hour period. When the pressure is on, all three teams could work simultaneously over a short period of 4–6 hours. Such a set-up would I am sure be able to deal with even more light cases than the total passed through the MDS at
The 1st NZ FSU was attached to the MDS during the greater part of this period and performed 90 operations during July and 30 during August. The large majority of the cases were of severe limb wounds. There were sixteen deaths.
It was noted by the FSU at the time that:
Abdomens: Generally operations on these are not done unless the condition is too serious to allow of transfer to the CCS, or if the CCS is sited too far away to be reached in a short time.
Adequate nursing facilities now obtainable with the addition of a nursing section have been proved to be of great value.
Chests: Are usually not done if the pleura is penetrated. Use of intercostal nerve block has been of definite value for relief of pain prior to transport back to the CCS for operation.
Penicillin has been used locally as a powder in wounds until supply ran out a few days ago. Sodium penicillin is being used for the same purpose at present. The crystals are coarser and owing to greater solubility, probably are absorbed more quickly. Recently penicillin Na has been used with much greater frequency parenterally in large wounds. If possible cases are held until they have received dosage for at least 24 hours.
Undoubtedly, the FSU and ambulance surgeons had displayed the judgment to be expected of experienced surgeons in the selection of cases to be dealt with at the MDS level. More surgery was probably carried out at the MDS as the CCS was understaffed, being short of three medical officers while at
Evacuation to the CCS except for a short period before one-way traffic was instituted was very satisfactory. Major Douglas drew attention to the frequent moves of the field ambulance units. Between 19 and 27 July his
Blood reactions were more common at this period, and reactions were also noted following intravenous glucose injections. A quantity of blood had to be discarded, and also infected bottles of plasma and glucose saline. It was noted at the CCS that the supply of blood was very scanty, and because of the hot weather and the long distance
One of the main problems for the ADMS 2 NZ Division was the shortage of medical officers. At one period the Division was eleven medical officers under strength, including the CCS which was three officers short. As a result there was a constant changing of officers from one medical unit to another. Very often the officer staff of the closed MDS consisted only of the officer commanding, his second-in-command, the quartermaster, and dental officer. Regimental unit commanders were most co-operative in releasing where possible their RMO to ADSs and MDSs during busy periods.
During the
The operational work largely consisted in treating the abdominal cases and the lighter wounded. Most of the large limb wounds had been treated at the MDS. Penicillin was used for chest cases and large limb wounds, and as a routine in gas gangrene. It was noted that gas infections were more common and, in consequence, the excision of all wounds was carried out.
While the CCS was operating in the
Of the abdomens, there were fourteen cases with intestinal injury and seven deaths. There were four thoraco-abdominal cases, with three deaths. The abdominal cases were treated by intravenous sulphadiazine, rather than by emulsion into the peritoneal cavity, and the results were equally good.
Fasciotomy of the calf was carried out when the lower femoral or popliteal arteries were ligated, with definite success in at least two cases recorded.
Altogether, there were 964 battle casualties and
The conditions under which the forward surgery was undertaken were much superior at the CCS to those at the MDS, quite apart from the constant movement of the field ambulances. The urge to operate as near the line as possible, however, still persisted in the Division, even though with the evacuation over good roads little extra time would have been involved had the cases been dealt with at the CCS. The nursing facilities at the CCS were infinitely superior and the cases could be held as long as desired. The final results, however, were generally satisfactory and delayed primary suture could be carried out at the base hospital in the great majority of the cases.
Lieutenant-Colonel A. G. Clark, CO 1 Mobile CCS, stated that as far as the seriously sick and wounded were concerned this was the worst period of the Italian campaign. This was owing to the heat, shortage of medical officers, and the great distance between the CCS and the base. Air transport mitigated this to some extent.
Evacuation, though over good roads, meant a long, dusty, hot journey and a severe trial for serious cases. Later, air evacuation was arranged from
For the advance to
As it was, the process of change created extra difficulties for 2 General Hospital. Some of the hospital trains on the
For a number of reasons all the hospitals in the Oranje and other hospital ships arrived at
All these factors resulted in 2 General Hospital, which was equipped as a 600-bed hospital, having 738 patients on 31 July; on 2 August, for a brief period after the admission of a convoy of battle casualties, there were 817 patients in the wards.
It was mid-summer, too, and the volume of work, plus the effects of heat, humidity and flies, resulted in a greater amount of sickness than had been recorded previously among members of the staff, between 10 and 15 per cent of them being sick in August.
Casualties from the Division were received at 2 General Hospital following air evacuation from Trasimene and they arrived in good order. The great majority were dealt with by delayed primary suture shortly after arrival. Altogether 1317 cases, including 383 battle
The opinion was expressed that in these cases and in fracture cases penicillin should be given intramuscularly from the earliest possible moment in order to prevent sepsis, as treatment of established sepsis was largely unsatisfactory.
The double bath unit had proved very successful in the treatment of burns and parenteral penicillin had also been of great value. The training of young surgeons for possible employment at the CCS was carried out at this time, as there seemed little prospect of obtaining surgeons from New Zealand.
This was a quiet period at 3 General Hospital and some patients were admitted from other forces. In July there were 917 admitted, including 162 battle casualties and 309 of other forces. In August 1113 cases were admitted, including 378 battle casualties. At the end of August 10,000 patients had been admitted in
Some of the Wanganella on 14 August; that is, within a fortnight or so of wounding.
Very little professional work was done at 1 General Hospital during the period, during the latter part of which preparations were being made to shift the hospital to
In
The large number recorded was due largely to the staging of cases at British units on the line of evacuation during this period; 2 General Hospital at
1. The Use of Acrylic Plates in Head Cases: This was carried out by Major Shoreston at 58 General Hospital at Trasimene in cases
2. The Use of Plates and Screws in the Treatment of Fractures: This was done in two British base hospitals, both simple and compound fractures being dealt with. The technique used was that of Lane, with long six-inch screws and stainless steel plates. In addition, single screws were used across the actual fractured bone ends to prevent angulation. Most of the cases were of fracture of the femur, but fractures of the tibia and also of the radius and ulna were also plated.
In compound fractures wound suture was generally carried out and, if this was impossible, the muscles were sutured so as to shut off the bone from the open wound. Penicillin was employed both locally and parenterally. Early joint movements were carried out. The preliminary results were on the whole good, but great care in the selection of suitable cases was necessary and the approach became steadily more conservative. This experimental work was confined to two hospitals and was not attempted in our units. We felt that the results obtained by ordinary methods rendered plating unnecessary and undesirable except in specially difficult cases. The use of screws across the fractured bone ends, though efficient mechanically, appeared to be contrary to sound surgical principles. One bad case in twenty-five would make the use of plates and screws inadvisable. The difficulty we foresaw was that the surgeon performing the original operation did not, and probably would not, see the failures.
This condition had been developing for some time and was accentuated by the return to New Zealand of some of the more senior officers who had served for a long period with the force. The scarcity was felt in both divisional and base units. The CCS in particular could not function without the help of specialist teams from the RAMC, both as regards surgery and transfusion. It was unfortunate that we did not have in our own corps young surgeons available for what was the most responsible surgical work in
The Consultant Surgeon made the following comments on this subject in his report of
There is a scarcity of experienced surgeons in the
The site at
In August the corresponding figures were medical 36 ½ per cent, surgical 42 per cent, orthopaedic 14 ½ per cent, and skin cases 7 per cent. The hepatitis cases increased from 39 to 103. They were generally held in the depot for eighteen days.
Two-thirds of the time of this unit was spent at the CCS and the rest at Advanced Base. The unit was kept constantly employed. During the quarter ended 30 September, 458 cases were seen and 271 pairs of spectacles dispensed. Ten refractions could be carried out daily.
Preventive measures for the maintenance of health were improved by the expansion of the Field Hygiene Section into a company incorporating the two malaria-control sections. The new establishment making this change official was effective from
The Field Hygiene Section with one of the malaria-control units was attached to Rear Headquarters of the Division. The other
The new establishment set up in the form of a field hygiene company represented the consolidation of all the establishments at that time engaged in hygiene work, and in malaria or typhus control and disinfestation and shower provision. All these functions were now under the one command and the personnel could be adjusted as conditions changed.
Looking ahead, it was planned to convert one malaria-control section into a typhus-control section in the winter. The other malaria-control section was to be disbanded, but, if considered advisable, those of the section considered most suitable for hygiene duties were to be taken on for shower section duties.
The shower section provided a much-appreciated service and in the three months from July to September, inclusive, 44,000 men received hot showers at the Hygiene Company's plant, while the clothing and effects of 150 men were disinfested.
The
The interest of senior officers, which was communicated by them to all ranks.
Continued inspectorial work by the hygiene inspectors.
Close liaison between medical and administrative branches, with the wholehearted co-operation of the latter in ensuring that offending units reported by the Hygiene Company inspector were made fully aware of their responsibilities.
By the aid of power and hand equipment flysol and DDT spraying had proceeded unremittingly. All breeding places were sprayed twice weekly and DDT was sprayed on vehicles, officers' tents, etc.
The bath and laundry unit continued to function; and clothes were also washed by the individual soldier and by Italian washerwomen. Showers were made available by Ordnance to the brigades. The Hygiene Company made arrangements especially for the front-line troops. No lice were reported.
Water: Patterson auto-motor trailer purifiers were used by
Sanitary arrangements gave rise to no new problems and the standard throughout the Division was maintained by all units. Otway pit covers with fly-traps were being used for the deep-hole refuse pits. This had reduced the flies in unit lines, particularly in the vicinity of cookhouses. Sullage water was also disposed of in the pit and helped to prevent fly-breeding in the lower deposits. The latrines were of the semi-deep pit type and were surmounted with fly-proof superstructures fitted with a fly-trap. Urinals were of the ‘desert lily’ type. The disposal of putrifying animal carcasses gave rise to some trouble.
This was, in general, very good during this fine summer period, but the admissions to hospital showed an increase from 1·73 per 1000 per day in June to 2·04 in July and 2·17 in August. The percentage of the force in hospital was 5·08 at the beginning of July, 5·98 at the end of the month, and 5·64 at the end of August.
Rations were excellent during the period. Fresh vegetables, cabbages and potatoes, in particular, were supplied.
The health and morale of the troops was benefited by leave arranged to
Infectious disease was, as usual, responsible for the major part of the sick wastage of the Division during July and August.
1. ‘NYD fever’ accounted for 543 patients in the Division. The large majority of these cases were retained in the divisional medical units and the CCS and not evacuated to the general hospitals. They were mainly cases of three- to five-day fever which occurred in an
2. Infective hepatitis was the diagnosis in 801 cases and, as already mentioned, many of the NYD fever cases subsequently proved to be cases of hepatitis. There was an increase in numbers in July and a still more marked increase in August, corresponding to the autumnal incidence of the disease.
3. Diarrhoea accounted for 45 cases, some of them proving to be cases of amoebic dysentery. Cases of bacillary dysentery were treated with larger doses of sulphaguanidine, the average course ranging from 100-120 gms. over five days. More satisfactory results were obtained than previously.
4. Malaria: There were 36 cases, 29 being in July. The incidence was low, especially as this was the height of the malaria season. Anopheles maculipennis was the mosquito prevalent in
5. Typhoid Fever: This disease was widespread among the civilian population and appeared to be virulent in type. Four cases were treated in 2 General Hospital during the two months, with one death. The patient who died had had six inoculations of TAB, the last one eight months before the onset of the disease. He died following two perforations of an extensively ulcerated ileum.
6. Pneumonia: Thirty cases of pneumonia were admitted to 2 General Hospital, but only nine of these were in August, by which time the disease had ceased to be of any significance.
7. Venereal Disease: There were 205 new cases in
There were 114 cases of physical exhaustion evacuated from divisional units; some of these were returned to their units from the field ambulances, but 22 cases were admitted to 2 General Hospital in July and 62 in August.
Total from MEF and CMF to end of
AT a commanders' conference at Headquarters 2 NZ Division in the
The demand for extreme mobility was not an idle one as the Adriatic sector was again to be the destination of the Division in a secret move across
No.
All the New Zealand medical units were concentrated in the one area with 5 MDS, under Lieutenant-Colonel Coutts, open to receive sick and evacuate to 1 Canadian General Hospital at
Eighth Army's objective at that time was to break the Gothic line which the Germans were stubbornly defending. The line was a formidable defensive system in considerable depth, embracing the entire breadth of the belt of interlocking ranges of the
When 2 NZ Division ended its long trek across
Though the New Zealand Division still remained in reserve, it was decided to move further forward to be nearer the main road along the coast, and on 5 September the move began. The Division travelled to the coast about 10 miles away and then north along the coast road for 15 miles to the vicinity of
For the first time in
From this area 4 MDS evacuated the sickness cases to
From 13 September portions of the Division moved towards the front line. On 18 September 4 MDS travelled 20 miles forward to a new location in the sand dunes right on the sea front at
On 3 September
On 28 August 1 General Hospital moved from
The move took HQ
As
When 1 General Hospital opened at its new site on 9 September on the coast near
The move of 2 NZ Division to the eastern sector again and the forward move of 1 General Hospital left 2 General Hospital rather in a backwater. It was planned that when Eighth Army advanced beyond the
Eighth Army began its attack towards the Gothic line on the night of 25 August, and by the end of the month it was breaking into the defence system along the Foglia River.
After capturing
On 22 September 5 Infantry Brigade, together with 22 (Motor) Battalion and 19 Armoured Regiment, took over from 1 Canadian Infantry Division and advanced through and north of
Sixth Brigade passed through 5 Brigade's positions early on 23 September, and at 8 a.m. forward elements were 5 miles beyond
Major Pearse, RMO 25 Battalion, was awarded the MC for his work in this action. On the night of 24–25 September he established his RAP on the infantry start line and, in spite of enemy shelling and with total disregard for his own safety, attended to the wounded immediately, repeating this performance on 26 September when his battalion had crossed the Uso River.
Between 23 and 29 September Major Pearse dealt with 105 battle casualties, 86 from his own unit and 19 from other units. He
For the collection of casualties the RAP jeep was used in the main, especially on the night of 24–25 September during the attack. This was the only method available, and served well in spite of adverse conditions. The stretcher-carrying Bren carrier of 20 Armoured Regiment was also employed as much as possible, usually forward of a collecting post to the companies, from which post the wounded were taken to the RAP by jeep. Cases rode very much better in the carrier. In the few cases that came back to 25 Battalion RAP in the carrier the patients were extremely warm and in good condition—the engine heat, reasonably comfortable ride, and sense of security in the carrier all contributed to the well-being of the patient. Major Pearse stated that the sense of security was to his mind an extremely important factor. There were times when the jeep had to unload and patients shelter for a short time from heavy enemy fire which could have been passed through in the carrier. The mental effect on wounded men was noted to be distressing. Major Pearse, a very experienced RMO, was firmly of the opinion that the ideal system of evacuation of wounded across the tracked fields and open country then encountered was by stretcher-carrying Bren carrier flying the
The 5th MDS, with 1 FSU, 2 FTU, and 6 Field Ambulance surgical team attached, was established on 20 September as the open MDS in the municipal buildings at
During the period 20 to 25 September when 5 MDS was open for battle casualties from this action, the operating theatre was working continuously, 144 operations being carried out. Evacuation took place to 4 Canadian CCS near
As it was necessary towards the end of September to have an MDS further forward than
There was a fairly steady stream of casualties—in the five days to the end of the month they totalled 140 battle casualties and 209 sickness cases. The greater proportion of battle casualties (120) was dealt with adequately by the MDS and FSU surgical teams, and after due rest many were evacuated direct to 1 General Hospital at
With the onset of winter, experience of forward evacuation in the low-lying areas proved that stretcher-carrying jeeps, even when fitted with chains, were liable to become bogged in the mud. The answer to this problem was found in Bren stretcher-carriers, which had previously been used by the armoured regiments and whose mobility and usefulness was welcomed by RMOs. A number of battalions immediately arranged for extra Bren carriers to be fitted to carry stretchers. Stretcher-carrying jeeps, however, still continued to be most useful and arrangements were made to provide them with all-weather hoods.
During the operations in September a high proportion of abdominal wounds was observed as well as many chest wounds. The percentage of bullet wounds was noted to be unusually high. The Division was under command of the Canadian Corps, which had its own medical chain; in view of the expected breakthrough beyond
After operation the cases were looked after by ward medical officers who carried out the treatment without reference to the operating surgeon. This had certain administrative advantages in rush periods but could not compare in surgical efficiency with the system where the operating surgeon supervised the after-treatment himself. The ideal in our opinion was for the operating surgeon to retain his control but to share it with a ward officer who could watch the case and report complications to him. If a senior surgeon was acting in the pre-operative room, he could make interim rounds of the post-operative cases while the operating surgeon was in the theatre.
The utilisation to the full of the surgical abilities of 4 Field Ambulance was a feature of the unit's activity at
Following the now accepted principle of excision and dressing of all wounds at the earliest possible opportunity, during this period as open MDS the greater proportion of cases have been dealt with surgically at the MDS. Over two-thirds of all battle casualties received complete surgical treatment and were fit to be sent on direct to 1 NZ Gen. Hosp.
As facilities for nursing are better at a CCS, all non-urgent cases of abdomens and chests were sent to a CCS for surgery.
The principle adopted was to hold cases awaiting operation only up to the time involved in evacuating to a CCS, and there awaiting treatment. In other words, holding cases at the MDS awaiting operation, if by so doing the patient will receive earlier surgical treatment, than if he is sent on to a CCS immediately.
In conclusion, the equipment of the ambulance remains at the high standard previously attained. With the advent of winter it becomes obvious that an open MDS can function satisfactorily only in buildings; as the canvas,
On the other hand, the Consultant Surgeon
In spite of the bad weather gradual progress was made in the divisional sector and the enemy was forced to withdraw completely across the Uso River. The coastal towns which anchored the sea end of the Gothic line were in the hands of Eighth Army, but the line could not be outflanked while the enemy clung to the mountains and made every river a defence line.
The country beyond
The weather became unsettled with frequent light rains, and the web of watercourses ahead of the New Zealand battalions as they strove to push forward held out no prospect of a swift advance. It was the German policy to fight at every ditch, using spandaus and mortars with a stiffening of tanks and self-propelled guns. His plan was to force a full-scale ‘set-piece’ attack at every possible point, and then, as the assault was made, to withdraw his main forces to the next line, perhaps only 1000 yards back, leaving small heavily-armed holding parties behind. By a counter-policy of repeating thrusts at short intervals to shorten the time for manning defences, 5 and 6 Brigades had hopes of getting the Germans on the run; but just at the end of September after they had crossed the
During the morning of 4 October 4 MDS, with 1 FSU and 2 FTU, moved to a new building, formerly an Italian children's hospital and sanatorium on the coast road at
The reduced length of the Allied salient and the general dispositions of units allowed the MDS to receive patients direct from the RAPs, with 6 ADS functioning only as a transfer and emergency aid point. On 5 October the MDS was reinforced by a surgical team from 1 Mobile CCS with equipment for a 50-bed ward, an X-ray truck, and six nursing orderlies. The unit was considerably nearer the actual battle zone than was usual, and consequently in a very noisy position from nearby guns, but it provided a fully equipped surgical and medical centre. This arrangement was commented on very favourably by visiting senior combatant officers, who expressed the view that such a set-up contributed greatly to the morale of the troops in the actual fighting zone. With the help of the engineers windows were replaced with windolite, the water supply on the ground floor was put into working order, and a portable lighting set was used to provide a lighting circuit in the building.
By 8 October the unit had three completely equipped and staffed operating theatres as well as the Field Transfusion Unit and an X-ray plant, an impressive collection of surgical facilities. Fortunately these arrangements proved over-adequate as a very limited number of casualties occurred in the divisional sector. The total admissions for the first week at
On 10 October 2 NZ Division moved to the adjacent western sector, which had previously been held by Canadians. No great increase in distances of evacuation resulted and 4 MDS remained at the same site receiving cases from 5 ADS, some three to four miles due west.
The weather started to improve on 11 October. An increase in the number of guns in the vicinity incited the enemy to some
The rain which made the crossing of the
This concluded a month of hard but unspectacular fighting by 2 NZ Division—a long-continued slogging match in the mud of the river basin against an enemy who could be forced back but not overwhelmed. The optimism of a month previously had not been fulfilled, because to fulfil it had been humanly impossible. What could be done by the Division had been done well. Our troops had advanced nearly 20 miles, in conditions which were ideally suited for defence. Here, if anywhere, was country which could well have
The moving west of the battle zone in the Savio River drive necessitated the opening of 6 MDS at
It was decided to withdraw the Division on 22 October for reorganisation and training to the
The widespread dispersal of the Division and the congestion of traffic necessitated the opening of 6 MDS at
For the greater part of November the Division remained in the rest and training area from
In 2 NZ Division discussions and schemes for reorganisation of units were a feature of this period. Reductions in unit establishments had been under consideration since early in the campaign in
In the medical services the changes were confined to the field ambulances. At a conference of senior medical officers convened by ADMS 2 NZ Division, Colonel King, it was decided that Headquarters Company be increased by 34 other ranks to make a complete MDS, that A Company be reduced to 3 officers and 42 other ranks and be a permanent ADS, and that B Company be eliminated. This would result in a total saving of 35 other ranks in each field ambulance. Total savings of all units in the whole Division were 104 officers and 2528 other ranks.
Reorganisation to this amended establishment was carried out during November, and the reorganised units were found to work well during the difficult battle conditions in December.
The New Zealand medical units followed a pattern of adaptation and progress. As the commanding officer of 4 Field Ambulance, Colonel Edmundson, recorded in
The past twelve months has been a period in which we have witnessed striking changes in our environment. Except for the short
.…Just as our medical services were adapted to meet the changing desert conditions, so the evolution continues with the variations of European warfare. We now have a reorganised ADS and MDS, each with their particular job to do on the line of medical evacuation.
From 22 November onwards the Division moved forward again to the fighting zone, assembling in an area west of
Although there had been some advance during November, the general position at the front was very similar to that prevailing previously.
On
At the beginning of December 2 NZ Division faced up to the Lamone River astride Route 9 with 5 Infantry Brigade on the left and 6 Infantry Brigade on the right, each with its respective ADS open near the main road. In
On the night of 10–11 December 5 Infantry Brigade passed through 46 Division, which had established a bridgehead across the
Under Major R. H. Dawson, 5 ADS across the Lamone River was strengthened and extra jeeps and
This method of evacuation with the use of the ambulance-car post worked well in the very difficult circumstances, and no case was over twelve hours in reaching the CCS, which Colonel Elliott considered a creditable performance when the state of the down routes was taken into account.
The first casualties from the attack reached 5 ADS from the RAPs at 1 a.m. on 15 December. The evacuation route was open at 1.30 a.m. so an evacuation of three AFS car loads was made, followed by another carload at 3 a.m. and five at 7.30 a.m. The ADS was then informed that no further evacuations would be possible that day as Corps had closed the road for Polish up-traffic. However, ADMS
Casualties were fairly heavy during the day and it was necessary to give them more treatment than usual at an ADS, as it was taking four to eight hours for the wounded to reach the MDS and CCS. Plaster was used for most fractures and thirty bottles of blood and plasma were used in resuscitation. At one time there were eight transfusions running simultaneously. Lieutenant-Colonel Coutts, CO 5 Field Ambulance, worked at the ADS and his assistance was invaluable, as Captain
New Zealand casualties passing through 4 Field Ambulance car post from 11 to 17 December totalled 191 wounded and 24 sick, the biggest day being 15 December, when there were 116 battle casualties. More ambulances were obtained for this day from 4 and 5 Field Ambulances to bring up the strength to fourteen ambulances, thus ensuring that no wounded were held back for lack of transport.
The MDS and CCS were both in
On 16 December 5 ADS moved into a building nearer to
After the capture of
The bank building used by the MDS was solidly constructed and offered fair protection from the heavy shelling of the town by the enemy, who during the night of 17–18 December had reached the
On the night of 19 December at nine o'clock, 6 Infantry Brigade and 43 Gurkha Lorried Infantry Brigade launched an attack under a heavy barrage and threw the enemy back to the line of the
The wounded included some twenty men of 25 Battalion who came from a platoon which was caught on the start line by the enemy's fire and by some ‘shorts’ fired by the artillery. Seven of them were painfully burned by a phosphorus bomb set off by a shell splinter. They found refuge in a building occupied by Tactical Headquarters 26 Battalion, taking the bodies of two dead with them. Some German wounded were also brought to this building from the forward areas. First aid was administered pending the arrival of ambulance jeeps and RAP staff to take them back to the ADS. Enemy shelling and mortaring was fairly severe and, after abating for a time, became heavy towards dawn, making the task of stretcher-bearers and ambulance drivers all the more dangerous as they moved to and from the company sectors.
Acting as ADS to 6 Brigade, the reorganised A Company of 6 Field Ambulance, now under Major
There was a rush period for 4 MDS on 20 December. Between midnight and eight o'clock in the morning 102 battle casualties were admitted. These were all cleared by midday and took from thirty to forty-five minutes to reach the CCS. The total admissions for the day were 142 battle casualties and 26 sick. No chest or abdominal wounds had surgical treatment at the MDS, but where necessary
On succeeding days there was a steady flow of admissions, the highest totals being reached on Christmas Eve with 40 battle casualties and 30 sickness cases. A shell hit one of the MDS buildings on 24 December causing twelve casualties in the street, but no MDS personnel were wounded.
At dawn on 24 December A Company 26 Battalion made an attack on the eastern stopbank of the
The month's admissions to 4 MDS reached the totals of 343 sick and 371 battle casualties. It was felt that casualties had definitely benefited by the MDS being located well forward in good buildings, especially as the number of serious multiple wounds appeared to have been higher than usual.
The end of
During the operations from 22 September to 22 October the medical work in the Division was almost entirely undertaken by the field ambulances, certain special cases being referred for operation to the active Canadian CCS and to the British neurosurgical unit
Evacuation was still to
At 1 General Hospital a great deal of primary and the bulk of the secondary surgical treatment was carried out and all the medical cases were admitted from the Division. Cases were then evacuated by hospital ship from
The transfer of cases from Maunganui took 311 cases early in October and collected another 50 patients from 5 General Hospital at
The
A well-equipped camp hospital was functioning at Advanced Base and cases of minor illness were adequately treated and returned to their units. This relieved 3 General Hospital and was economical in all respects, and also provided useful training for the medical personnel. The admissions were from 100 to 150 a month and the average bed state about thirty.
An advanced section of the medical stores moved to
Buildings were taken over by the ADSs at this period because of the severe wintry weather and the impossibility of using tents in the muddy, waterlogged country. The buildings enabled the ADS to provide warmth, comfort, and resuscitation even in bad weather.
During the early period the active MDS was very close to the RAPs and a large proportion of the casualties was admitted direct to the MDS; much the same conditions were present when 4 MDS moved into
This varied a good deal, depending on the use made of the CCS. For the first attack on
Later, the MDS situated at
This unit was under command of ADMS 2 NZ Division during this period. It was out of action during practically the whole of the first period before the Division went out to rest.
After the CCS took over from the MDS on 18 October at
During October 15 abdomens were operated on, with 6 deaths. There were 10 penetrating abdomens with 4 deaths, and 5 thoraco-abdomens with 2 deaths. Included in the cases were 5 prisoners of war, with 2 deaths. During December at
The conditions were almost ideal; central heating was available and the seriously ill patients were held till their condition for evacuation was perfectly satisfactory.
The unit, under Major D. P. O'Brien, was attached to the active MDS during September and up till 18 October, and again for the last four days of November. For the rest of the time it was attached to
Notes
Abdomens and chests: All operations on these cases were performed when attached to NZ CCS.
With the oncoming winter an increase in the number of chest complications was noted in the heavier cases such as abdomens. For the same reason, chests were now being held longer prior to evacuation.
This unit was attached either to the active MDS or to the CCS throughout the period. There was some difficulty with blood during the first period and many bottles had to be discarded. Conditions improved later, and little difficulty arose during the
The shortage was becoming more marked during the early part of this period and in September the Division was twelve officers short. The commencement of New Zealand leave for medical officers accentuated the position. The most serious shortage was in the senior officers, and especially in those qualified for senior professional work in the hospitals and the CCS. The position was relieved later by the arrival of reinforcements from New Zealand, many of whom had served in the
For the first month from the date of its opening at
Six cases of gas gangrene were encountered in September, one of the septicaemic type being the only death. The others recovered following excision of the muscle groups involved. Gas gangrene had been more commonly met with during the campaign in
Delayed primary suture was performed for many wounds, use being made of either calcium penicillin, sulphanilamide powder, or proflavine powder. Results were good but there was often slight infection of the stitch holes. It was found that the third or fourth day was the optimum time for suture. Whenever possible the deep fascia was closed by means of figure-of-eight sutures, including the
Two cases of rectal wounds which had not been detected in the forward units were seen, colostomy and drainage of the pelvic cellular tissues being carried out. Both had severe accompanying wounds and neither had intra-peritoneal involvement.
The notable feature of the September casualties was the infrequency of grossly infected wounds and, consequently, diminished toxaemia.
A feature of the later casualties was the large number of leg and thigh amputations, mainly the result of mine wounds, a considerable number of traumatic amputations having been sustained. A small number of cases of gas gangrene, but none of tetanus, was seen. In the larger wounds, including fracture cases, parenteral penicillin was given for some days to ensure the control of infection. All types of cases were dealt with except fractures of the femur, which were evacuated as soon as possible to 3 General Hospital at
Intramuscular penicillin was being used freely by this time for severe bone and joint cases and in chests. There were remarkably few deaths at this period. The two unit surgeons, Lieutenant-Colonel Bridge and Major A. W. Douglas, carried the heavy load of surgery in the hospital at this time, though for a period a surgeon from 2 General Hospital was attached to the unit and gave valued assistance. Some diphtheritic infection of wounds occurred and proved a serious complication.
The majority of the wounded admitted to 3 General Hospital had already had wound suture performed at 1 General Hospital,
The comparatively small number of wounded transferred from 1 and 3 General Hospitals had had wound suture already performed, so that little surgery was done at
The head cases were sent from the field ambulances to the special advanced head centre attached to 83 British General Hospital at
The Consultant Surgeon
The large majority of deaths was due directly to the severity of the injury and the primary shock produced thereby. This was shown in both the chest and abdominal cases, in which a large number of the wounded were brought in dead to the field ambulances, and practically all the others who died did so in the first forty-eight hours.
Undoubtedly the most valuable form of treatment was transfusion of blood, given early and sustained till operative treatment was possible. The giving of blood during transit in the ambulance had proved of great value. The early administration of glucose saline, both to combat dehydration and also to act as a preventative of anuria, was being carried out.
In mangled limbs, commonly seen after mine injuries, early application of a tourniquet just above the damaged area to prevent bleeding and toxic absorption, followed by early amputation through healthy tissue, had become the routine. The dramatic improvement following the removal of the devitalised tissue was vouched for by many experienced surgeons.
Anuria, generally the direct result of severe and prolonged shock, had caused many deaths and no treatment was of any avail.
Infection was being combated by adequate primary wound excision and the local and parenteral administration of penicillin. Gas gangrene had become more common but, except in a few fulminating cases, cleared up well with adequate surgery and penicillin.
Delayed primary suture of wounds had become the routine in simple wounds, in amputations, and in fracture cases and the results were satisfactory.
Chest cases with more thorough primary wound treatment and intrapleural penicillin had very rarely become septic.
Thoraco-abdominal cases showed a lower mortality when dealt with through the chest. A tendency to delay operation a little too long in abdominal cases had been noted, the pendulum having swung too far. In colon injuries the double loop colostomy was being carried out except in caecal injuries, where simple marsupialisation was all that was considered necessary. Rectal injuries associated with buttock wounds were common and sometimes apt to be over-looked. There had been an unusual number of abdominal wounds
Knee-joint cases did well with intra-synovial penicillin and adequate splintage.
Fascial incision following ligature of the popliteal and lower femoral arteries was successful in saving some limbs. A case of primary ligature of the lower part of the femoral artery dealt with by fascial split at that time was fully recorded by Major Owen-Johnston, and the subsequent progress for a period of years has been ascertained. Major Owen-Johnston wrote following the operation that:
If ischaemic gangrene does not develop in this case then I think that it can be accepted as a very good test of the efficacy of fasciotomy of the leg aponeurosis in preventing the onset of ischaemia where the popliteal or lower femoral artery has been tied in battle casualties. The patient's final result as recorded in
The importance of early and frequent hand movements in all arm injuries was fully recognised.
In burns the problem was recognised as one of shock, and adequate plasma was the essential form of treatment. Simple dressings without anaesthesia were carried out, and penicillin utilised both locally and parenterally.
The winter in northern
In an effort to keep the sick rate of the Division as low as in the previous Italian winter, it was arranged that all men not actually in the most forward positions should have reasonably comfortable living conditions. All the field medical units, including 1 Mobile CCS, were well provided for in excellent buildings, and patients were treated under better conditions than had been possible the previous year.
Combatant units out of the line were also able to make use of buildings and so provide for the comfort of the troops in the wet and cold conditions. Each man was issued with five blankets and five pairs of socks, and extra battle dress and underclothing were held by all units to allow frequent changes during the wet weather. Gumboots, leather jerkins, and duffle coats were also available.
Actually, owing to a reduction in the number of cases of infective hepatitis and fevers, the sick rate in the winter months showed a decline on the rate during the summer months. Accidental injuries, too, were fewer with the comparative immobilisation of the Division.
The quartering of troops in houses, however, made hygiene a much greater problem. The houses were usually also occupied by Italian civilians, it being found impossible to evacuate all civilians from the divisional areas. There then arose the problem of skin diseases, and other infectious diseases such as diphtheria, contracted from close living with an uncontrolled and relatively poor civilian population. Unit discipline down to the platoon or section level ensured the best control, but hot showers, adequate disinfestation, and the use of insecticide powder were all enforced on men in the forward areas. It was found better to dust the man and his clothes with insecticide rather than spray the billets, although this was done where possible. Living in towns and villages, where drains had been destroyed by shelling and bombing and where wells were thus contaminated, also raised problems, but rigid inspection and policing by 4 Field Hygiene Company ensured an adequate measure of control.
Rations: These were as a rule excellent, with fresh vegetables generally procurable, but in November there was less fresh food and ascorbic acid tablets were used.
Water: Adequate filtering and chlorination of water from the village wells, with rigid inspection, was carried out. The wells were mostly large and deep and the water satisfactory. There was a shortage of water carts and of trained staff for water duties, and fresh personnel had to be trained.
Refuse: At first deep pits were used and burnt out regularly. Later, controlled tips were developed, but constant supervision was necessary as there was a tendency to use them for fluid refuse.
Latrines: Deep-trench latrines were used when possible and buckets were sometimes used.
Showers: Buildings were found to be essential for showers during the winter weather. The showers were freely provided.
Malaria Control: General measures were limited to spraying of buildings with DDT and flysol. The troops used nets and repellent
Typhus Prevention: This was of considerable importance as the billeting of the troops led to a marked increase in infestation by lice and pediculi. The enemy troops were also known to be heavily infested with lice. An anti-typhus unit was formed out of one of the anti-malaria units and was active in spraying out billets with DDT. Spraying squads were attached to ADSs. It was considered, however, that the personal dusting of the troops with insecticide was more effective and this was carried out. No typhus infection was encountered.
Some general deterioration of the health of the troops was noted during this period, but this did not lead to any marked increase in the numbers evacuated sick. It was shown more in the lack of resistance to skin infections and mild general infections. The dominating factor was the marked epidemic of infective hepatitis which subsided during the winter.
Numbers of ‘Fever NYD' cases were evacuated from units. Many of these cases were diagnosed later as infective hepatitis, others as sandfly fever, very few as malaria.
Upper respiratory infections increased during the winter but pneumonia was never very prevalent or serious.
Diarrhoea and dysentery were much less common.
As much of the illness was minor, a considerable number of those evacuated from the divisional units were returned to their units from the field ambulances within a few days. During October 500 men, one-third of the sickness cases, were held at the MDS at
Infective Hepatitis: This disease completely dominated the medical picture, accounting in September for as many as 60 per cent of the medical cases. The New Zealand Division had the highest rate in Eighth Army. The Maoris were, as in previous epidemics, relatively unaffected. The number of cases reported during the period was: September 654, October 587, November 474, and December 206—a total of
At 1 General Hospital, where the divisional cases were first admitted to hospital, a thousand cases were admitted during the last
Colonel Boyd, New Zealand consultant physician, made the following observations at that time:
Though it is perhaps not the final knock-out blow to the droplet infection theory in this disease, a considerable advance in our knowledge has recently been made by the demonstration of the infective agent in the urine and faeces. Filtrates were taken from both sources by Maj. Van Rooyen of the 15th (Scottish) Gen. Hosp.,
Filtrates by mouth: Hepatitis developed on 22nd day.
Serum by mouth: Hepatitis developed on 35th day.
Serum parenterally: Hepatitis developed on 65th day.
The shorter period in the case of filtrates is, of course, likely to be due to heavy concentration of the virus in a small quantity of the carrying medium. In the case of blood serum the dose probably more closely approximates what occurs naturally. These discoveries largely elucidate many previously puzzling problems, e.g., the very low incidence among hospital staffs and nursing personnel, the relatively high incidence among British officers in the forward areas owing to the use of community mess dishes; the low degree of spread in such isolated formations as gun or tank crews who have their individual dixies, and the lack of epidemic spread in our prisoner of war camps. They explain too the part played by winds, dust, and flies in spreading the infection.
I mention these matters because I think it worthy of record that these experiments were initiated by Maj. Van Rooyen (who acknowledges the
There were 1139 cases admitted to 3 General Hospital during the quarter, mainly transferred from 1 General Hospital. It was noted that a number of the patients had had severe attacks with residual liver enlargement which necessitated down-grading. The average stay in hospital was twenty-nine days, and another twenty-one days were spent in the
Respiratory Infections: There was no increase in these cases during the colder months and no recrudescence of the epidemic of atypical pneumonia as experienced at
Dysentery: There was a marked drop in the incidence of diarrhoea in the Division, only 160 cases being admitted to medical units during the last quarter of the year. There were only 33 cases of dysentery evacuated. The cases of diarrhoea and dysentery admitted to 1 General Hospital fell from 48 in October to 16 in December. At 3 General Hospital the chronic cases of amoebic dysentery became a problem and investigation showed that there were many of these cases arising in
Colonel Boyd, Consultant Physician Colonel Boyd's opinion proved to be correct and chronic amoebiasis has been a cause of disability in a number of returned servicemen, but the number of new cases has diminished after some seven years. There were 148 cases accepted for pensions up to a) hepatitis and hepatic abscess; (b) caecal; (c) rectal. It had been found that in those developing hepatitis, 25 per cent had had previous treatment for amoebic dysentery, 25 per cent had never had any bowel symptoms, and 50 per cent gave negative results on investigation. Hepatic abscess generally developed in the upper and posterior part of the right lobe. Pain on the right side over the region of the liver was often present. The condition had often been mistaken for carcinoma of the stomach.
Diphtheria: The mingling with the civilian population consequent on billeting of the troops resulted in sporadic cases of diphtheria. In the last quarter of the year 26 cases were reported in the Division and 37 at 1 General Hospital. During December there were 29 cases in the wards of the hospital as well as 6 cases of wounds infected with KLB. The infection was generally mild and responded to 48,000 units of serum. The cases did not clear up rapidly, a condition noticed previously in
Skin Diseases: Furunculosis was very common at this period, as were skin infections generally. Penicillin was used for the severe cases with good temporary results, but it did not stop relapses unless associated with general dietetic and vitamin treatment. Ultra-violet light was used with good results. Scabies and pediculosis showed a marked increase in the Division, again due to billeting.
Malaria: Only 27 cases were reported in the Division during the last quarter of the year as against 67 cases in the previous quarter. The total cases reported in
Malaria had not been a problem at all in our force, not even after the seasonal stopping of mepacrine. This suggested excellent control within units.
Venereal Disease: There was a relatively low incidence of venereal disease during this period. There were 54 fresh cases in September, 48 in October, 71 in November, and 61 in December, and diagnoses were: syphilis 8; gonorrhoea 98; soft sore 27; balanitis 20; urethritis 53; penile sore 13; gonorrhoea and soft sore 3; prostatitis 4; and others 6. The majority of cases developed after leave, especially to
Hot showers were provided by the treatment centre for the patients in December. All brothels were placed out of bounds to the troops.
Anxiety States: One hundred and twenty-four cases were evacuated from the Division during the quarter to the end of December as against 174 in the previous quarter. The cases were all admitted to 1 General Hospital, which reported that they occurred mostly among new arrivals and mainly among the less willing.
(Previous quarter, 6063)
Of these, multiple wounds 275
In September and October there were again considerable numbers of New Zealand patients temporarily in other hospitals. Some of these were in the forward areas in Canadian CCSs, in the British neurosurgical units, and in transit hospitals at
There were very few deaths other than those occurring in the field ambulances and only two deaths in hospital in
The only permanent loss to the Division consisted of those men downgraded as unfit for further service in the Division and those evacuated to New Zealand. This would be a relatively small percentage of the total.
A total equal to the strength of the Division passed through the medical units in the year.
The surgical work carried out at 2 NZ General Hospital, our forward base hospital, during
Classification of missiles causing wounds, and also regional distribution of wounds and deaths, of the
THE opening of
Patrol activity along the line east of the
In the buildings occupied by the medical units, kerosene and oil-burning stoves were used to keep all departments and living quarters well heated and comfortable for both patients and staff.
In the latter part of January the British Central Medical Inspection Room moved from the area, and on 30 January 4 MDS took over the responsibility for treating sick from British and other neighbouring units. Necessary evacuations of British cases were carried out to 5 British CCS at
At this time meetings of all available medical officers were held at weekly intervals. Short papers on different clinical subjects were
The Division continued in the line during February in a purely holding role which made the month one of the quietest in its recent history. For the whole month only ninety-two battle casualties passed through 4 MDS, all but eight being New Zealand troops. Most of these admissions were from mine wounds, and a few from patrol clashes and enemy shelling. Admissions of sickness cases for the month totalled 592, of whom 446 were New Zealanders and 123 British.
The weather during February remained calm and fine except for two days on which rain fell. The sickness rate of the Division remained remarkably low and the morale of the troops was excellent.
On 1 February A Company 4 Field Ambulance had passed to the command of the newly formed 9 Infantry Brigade, comprising 22 Battalion, the Divisional Cavalry, and 27 Battalion, and moved with that group to
During January and February when conditions were static the active MDS limited its surgery to the relatively few urgent cases and the resuscitation of serious cases prior to evacuation to the nearby CCS. Over one thousand sick and two hundred battle casualties were dealt with by 4 MDS at
Skins: 121 cases, including boils, which when associated with seborrhoea did badly.
Infestation: 82 cases (scabies 66, pediculosis 16). Benzyl benzoate cleared up the scabies cases satisfactorily.
Tonsillitis: 36 cases—many showed positive KLB.
Diphtheria: Faucial 14 and skin 6 cases. 96,000 units of serum were given to each case.
Fevers: 68 cases. The majority settled in twenty-four hours.
Hepatitis: 27 cases.
Respiratory: 44 cases. All except two pneumonia cases cleared up in two weeks.
Accidental Injuries: 39, none serious, some due to skiing.
Malaria: 2 cases.
During January and February the CCS was quite close to the field units. It undertook the forward surgery and looked after the cases of serious illness from the Division.
A total of 34 battle casualties and 319 sick were admitted. There were nine deaths, three of which occurred in the five abdominal cases operated on.
During the first three months of
A mild epidemic of diphtheria was experienced, with some diphtheritic infection of wounds. At 1 General Hospital in January there were sixteen cases of diphtheria with some skin infections. In February a total of 97 cases, including 27 carriers, was recorded in
No. 2 General Hospital continued in a backwater at
During January one convoy of 137 patients was received from 3 General Hospital, otherwise only occasional New Zealand cases were admitted during the whole period. The majority of the cases were local sick from nearby British units and overflow cases from British and Canadian hospitals.
No. 2 General Hospital reported fifty-nine cases of atypical pneumonia amongst British troops during February, whereas there were only thirty-four cases of pneumonia of all types recorded in
The unit continued to function in two branches, the main body at
The Consultant Surgeon, after his return from his tour of
Early in
In March a group of seventy-one disabled prisoners was examined in
Of 130 British and New Zealand ex-prisoners of war who arrived from
At 3 General Hospital during May, 438 ex-prisoners of war were examined and X-rayed. Only four showed any marked degree of malnutrition and the general condition of the great majority was good. Thirty-five were admitted to hospital, including eight with amoebic dysentery, two with duodenal ulcer, and one with bilateral tuberculosis of the lung. There were altogether 56 X-ray chest abnormalities—23 of old or healed tubercle, 6 of suspected active tubercle, and 27 other changes.
By the end of February it had been arranged that 5 Kresowa (Polish) Division would relieve 2 NZ Division between 1 and 7 March and that the New Zealanders would move to their former rest area around
Fourth Field Ambulance closed as the MDS for battle casualties on 5 March, handing over the buildings at
The only New Zealand medical unit to remain in
Through the dismal winter of 1944–45 Allied and German troops watched each other across the lines of the Italian front, which had now ceded its place in world interest to the battles in North-West Europe. In the long winter months twenty-five divisions of Germans and five of Fascist
The beginning of April found 2 NZ Division moving from its rest area towards the
Formidable river barriers stood in the path of 2 NZ Division as it prepared to attack. The six rivers from the
Field-Marshal Alexander's plan was to attack in the flat river country in the centre, thereby drawing off the enemy brigades from the marshes of the Adriatic coast and the
For the attack on the
For the attack 6 MDS was sited in one of the farm buildings scattered along the road leading to the Lamone River, which was about 500 yards away. The farm building was small and the outbuildings useless. There were only four useful rooms on the ground floor and an attached lean-to, the latter being used by the reception section. The theatre was in a room a little too small but quite sound, and sterilising had to be done in a passage. Across the passage in what had been a cookhouse, a room was prepared for the 4 Field Ambulance theatre team, the door being widened a little to take stretchers. The resuscitation section was in an old ox-stall. It was roomy and quite sound, had a clean brick floor, and already contained a Becchi stove, to which were added two kerosene heaters for warmth. Stretcher bays were contrived in the existing cattle stalls, which might almost have been designed for the purpose. Three tarpaulins were pitched outside on a broken-brick base to house the evacuation section, the pre-operation ward, and walking wounded. Later, another was erected for wounded prisoners of war. A car-park was formed by a bulldozer in a field alongside the MDS building and was paved with bricks. A circuit road in, bridging a ditch, was made by the engineers. So organised, the unit was prepared to handle a large number of casualties.
The MDS was to do only minor and toilet surgery, except for life-saving amputations and treatment of massive haemorrhages. The 1st Mobile CCS was quite near at
On 9 April at 1.50 p.m. a terrific bombardment was begun by Allied air forces and artillery on the Eighth Army front. Hundreds of heavy bombers, Fortresses and Liberators, followed by mediums and fighter-bombers, swung down with small bombs designed to kill men, shatter vehicles, and cut communications without blowing the impassable craters that upset calculations at
The enemy positions were battered for over five hours, and then at 7.20 p.m. the assaulting units attacked across the
In the evening of the 9th, soon after the infantry moved forward, the wounded began to come in to the MDS, 58 of them by midnight. The 10th was the busiest day, 157 being admitted. There was a slight lull in the afternoon, and then a flood of severe cases came in. Very few came in between 10 p.m. on the 10th and 9 a.m. on the 11th when 6 MDS closed. Fourth Field Ambulance's team then rejoined its own unit, then at
The members of 4 Field Ambulance established themselves at
Our infantry crossed the
There was a steady flow of casualties back to 4 Field Ambulance, these totalling 94 on 11 April and 103 on 12 April.
Crossing the
When 13 Corps took over this sector of the front 2 NZ Division came under its command. Then at nine o'clock in the evening of 15 April, in fine weather and with a new moon, 6 and 9 Infantry Brigades attacked to cross the Sillaro, the operation being completely successful, involving only sixty-five battle casualties. It was necessary for the advanced dressing stations to move daily to keep up with the advance.
The Poles on the left and the Indians (now of
The 5th MDS moved up to
By 20 April forward troops of 2 NZ Division had cleared
The opposition was now staggering under repeated hammer blows. Polish troops had entered
During 24 April forward infantry of 2 NZ Division crossed the formidable barrier of the river Po in assault boats. Opposition on the far bank was slight and a start was made by our engineers to bridge the river, a distance of some 600 feet. The bridge, Eighth Army's first over the Po, was completed on 25 April (Anzac Day) and that evening 6 ADS crossed this notable river, being the first medical unit to do so. The main part of the Division crossed the Po on 26 April. Owing to the difficulty of getting vehicles back across the river with the ceaseless advance of essential fighting transport, 6 MDS was moved over and established in
The difficult obstacle formed by the fast-flowing
Established across the Po on 26 April, 6 MDS had two operating teams and a capacity for thirty patients in its evacuation section, but the evacuation of patients back across the Po against the endless stream of traffic advancing over the bridge was precarious. On the 27th four ambulance cars left the unit to go south, but they experienced considerable difficulty in crossing the river. Eventually they were ferried across in returning tank ferries and hauled up the opposite bank by bulldozers. Later in the day 3 FSU and 2 FTU crossed the river and took some of the pressure off the unit operating teams. Admissions on successive days were only 29, 29, and 45, but the unit had to do all necessary surgery in case of hold-ups at the bridge. On 28 April these were considerable as the provost of 13 Corps objected to passing the ambulance cars over. After getting across the river the cars off-loaded at 4 MDS in order to make a quick return.
A move to the vicinity of
The night of 28–29 April was memorable—the Division brushed aside enemy rearguards and, after an all-night move, was firmly established in
Crossing the Piave River on the evening of 30 April, and then the Tagliamento and
In spite of Marshal Tito's claim to have taken the city a few days before, 98 and 278 Infantry Divisions and 4 Parachute Division), captured over 40,000 prisoners, and advanced for 225 miles over difficult country through the wreckage of German armies.
New Zealand casualties from 27 October 1944 to 2 May 1945 were: Killed in action 324; died of wounds 111; wounded
To the north of the New Zealanders 6 British Armoured Division had captured
By 2 May 15 Army Group forces had occupied
On 7 May the
Reviewing the historic month of April, when 1090 New Zealand battle casualties were admitted to medical units, ADMS 2 NZ Division, Colonel R. A. Elliott, made the following comment:
The medical problems of the month have been interesting and difficult but the 2 NZ Div Medical Services rose to the occasion. At this time, when the European fighting of 2 NZ Div has ceased, ADMS 2 NZ Div would like to place on record his thanks to, and pride in the medical units and RMOs whom he has the honour to command. They have done all that has ever been asked of them, and more.
Most of the casualties occurred in the early stages of the offensive. As the enemy became beaten and bewildered the opposition slackened considerably, and the advance tended to become more of a mopping-up operation. During the advance very many German wounded were captured, and ADMS 2 NZ Division obtained the release of prisoner-of-war medical officers and staff and established German hospitals, which later became a Corps' responsibility.
The majority of the RMOs at this period had only recently been attached to the Division, but they carried out their work efficiently. RAPs were set up in whatever suitable buildings were available
With the speed of the advance the distinction between reception and evacuation sections of the ADSs became purely nominal, as they had frequently to open individually as complete sections and then leapfrog each other. Besides working in two sections, the ADSs often set up casualty posts and this necessitated the attachment of three medical officers. Under the conditions pressing needs were wireless communication and small lighting sets.
The role of the ADS was exacting, necessitating frequent sudden moves, often over bad roads, demolitions, and improvised bridges; but, except on a few occasions, the ADS was always less than an hour's run from the battalion RAPs, and usually much closer. Casualties were relatively light, but the line of evacuation to the MDS was seldom easy owing to the speed of the advance and the difficulties of a narrow axis with many one-way stretches. A round trip for ambulance cars of six hours to the MDS, sometimes 40 miles away, was not uncommon. This time factor made it essential for resuscitation and immobilisation to be more thorough than was usually required at an ADS.
Houses were taken over wherever possible. The 5th ADS moved fifteen times in twenty-one days and the 6th moved on every day except five between 9 and 30 April. In spite of this, large numbers of cases were treated, though mainly during the early part of the advance. Each ADS treated 700–800 patients, of whom 500 in each case were battle casualties.
April was a month of great activity for all the MDSs, and as soon as the Division moved forward beyond convenient range of the CCS, the MDSs in turn were called upon to assume the responsibility of undertaking the major forward surgery.
Each MDS provided an operating team which was attached either to the active MDS or to the CCS. In addition, the FSU and the FTU were sent forward from the CCS to the active MDS from
The surgical work performed is illustrated by the record of 6 MDS team, which performed 152 operations during the month. These included six amputations, six compound fractures, five ligatures of main vessels, and two operations on main joints. One death occurred during a double amputation at the thigh. During May the MDSs were looking after the sick and also doing surgery as the CCS was nearly a hundred miles away at
The 3rd FSU was attached to the CCS for twenty-one days and to the active MDSs for nine days and was operating every day after 3 April. Seventy per cent of the cases were serious. Altogether, 150 operations were performed, with six deaths. One gas gangrene case recovered. Of the abdomens, six lived and six died (the only deaths). The abdominal injuries were very severe in type. The anaesthetics employed were: pentothal in 115 cases; pentothal and inhalation, 24; local, 4.
Transfusions were given by 2 FTU to 115 casualties: a total of 328 pints, 183 of blood and 145 of plasma. They were given to injuries of the limbs in 43 cases, chests 22, abdomens 39, heads 7, and burns 3.
During April the CCS admitted 1004 battle casualties and 454 sick, a total of 1458, the great majority during the first twenty-six days at
The incidence of the different types of injury among battle casualties is shown by the following figures:
For anaesthesia pentothal was used in 380 cases, whereas inhalation anaesthesia, half with pentothal inductions, was used for only 45 cases, and local for 37 cases.
During May 57 battle casualties and 498 sick were admitted, with three deaths; also five were brought in dead. At
During the static period evacuation of casualties from the front line to the ambulance units and also to the CCS was easy and rapid. When the Division moved rapidly forward the evacuation of casualties became difficult, partly because of the long distances to be covered and partly because of movement against the general stream of traffic at the many bridges. To counter these difficulties the ambulance units moved steadily forward and split up so as to leave personnel in charge of serious cases which could not be evacuated. Evacuation was by motor ambulance back to the MDS active at the time, and from the MDS back by road to the CCS. The only delay in the arrival of forward casualties recorded by the CCS was after the crossing of the
While the evacuation of patients to the CCS at
From
When the CCS reached
In April the heavy casualties from the Division were dispersed satisfactorily from the CCS by road, rail, and air to the two active base hospitals and were dealt with very promptly and efficiently. The air evacuation to 3 General Hospital was particularly effective, and serious cases in large numbers were admitted to the hospital, many within twenty-four hours of wounding.
As the advance continued, as already mentioned, evacuation became much less satisfactory and air transport rather meagre.
Remarkably few deaths occurred in the hospitals at this time.
During April 584 battle casualties were admitted to 1 General Hospital, but it was noted that very few were serious and that mine cases were less numerous. The casualties included 8 fractured femurs, 24 fractured legs, 18 chests, 7 abdomens. Thirty cases were transfused. There was more sepsis in the later cases, a natural sequence of the difficulties in the forward areas and, especially, of the long and difficult evacuation.
During May the admissions fell markedly to a total of 450, of which 37 came by train and 52 by air; 84 were German prisoners. The delayed primary suture of wounds had been the established routine for a considerable period and the results at this period were excellent. There were no deaths in battle casualties for the two months following the offensive.
Comparatively few cases of exhaustion were evacuated during this period. In April, when the battles were being fought, only fifty-two cases were admitted to 1 General Hospital.
Whereas during the first three months of
Altogether, 1021 cases were admitted to 3 General Hospital in April, including 495 battle casualties. One hundred and seventy-three cases were received by land, 477 cases by sea, and 371 cases by air. Serious surgical, eye, and facio-maxillary cases came from 66 British General Hospital,
A total of 553 operations was performed, including 33 for delayed primary suture and 68 for the application of plasters. Three cases of gas gangrene were recorded. The great majority of the anaesthetics given consisted of pentothal alone.
A serious explosion of an ammunition ship occurred in
In spite of the fact that many divisional medical officers were experiencing their first battle, the standard of treatment was high, few deficiencies being noted by the Consultant Surgeon
At first severe mine injuries were encountered and many leg and thigh amputations were performed. Then a series of severe abdominal cases was dealt with, many of them having also severe general injuries. Most of the deaths were in the abdominal group. A change to the horizontal position for the first twenty-four to forty-eight hours was made in the nursing of the abdominal cases at this period. This was more suitable for the shocked cases and facilitated nursing. The majority of cases operated on had X-ray films taken before operation, and the foreign bodies were generally removed. Parenteral penicillin was given to all wounds of any severity, including all abdominal cases.
At the base hospitals little sepsis was encountered and the delayed primary suture of wounds was carried out in the majority of cases with good results. A rapid turnover of patients was experienced and there were relatively few septic and toxic cases. The chest and head cases had done particularly well, with an almost complete absence of sepsis. Selected cases of nerve injury and cranial defect were operated on at 3 General Hospital so as to obviate delay, especially in the nerve cases, before operations could be carried out in New Zealand. The cranial defects were filled with bone chips from the crest of the ilium. At 3 General Hospital, and to
There was a marked deficiency of trained anaesthetists in the Medical Corps at that time. Cyclopropane was being increasingly used, and it was considered that all the base hospitals as well as the CCS should possess an anaesthetic machine to enable cyclopropane to be administered to suitable cases.
The opinion of the Consultant Surgeon
In mentioning the work of the New Zealand Medical Corps, recognition had to be given to the high standard of efficiency and conscientious work of the ‘other ranks’ of the Medical Corps, again especially in the forward areas. The nursing attention given by the men in the field ambulances and casualty clearing station was assiduous and capable, and many very serious cases were nursed through to safety without the benefit of being nursed by New Zealand sisters. The work of the sisters was held in the highest esteem by all, including the RAMC officers who had knowledge of their work.
Altogether, the work of the
After the cessation of hostilities in
The 4th MDS was moved up on 1 May from
The buildings occupied by 4 MDS at
In
Instructions were received on 20 May for the evacuation of
In June 4 MDS continued to remain at
With the opening of 6 MDS at
Ample facilities for recreation continued to be available during June. There were brigade and divisional sports meetings, cricket matches, and whenever possible swimming parties went to the beaches daily. Members of the units went on leave to
The only endemic diseases of importance in the first half of
The health of the troops had been generally excellent during the winter months, and with the decreased incidence of hepatitis the number of sick evacuated from the Division had diminished appreciably.
The number of sick admissions in the Division were 1030 in January, 815 in February, 1074 in March, 967 in April, and 1009 in May. At times up to 60 per cent of the cases were returned to their units without being evacuated beyond the divisional medical units.
The effect of accidental injuries in adding greatly to the admissions to medical units, with a loss of manpower—temporary, if not as a rule permanent—is well shown by the following table giving the
Administrative arrangements had been made for the prevention of malaria during the season, and this was of particular importance as the Division passed through areas in which malaria was prevalent. The malaria units were reconstituted and malaria circulars were issued similar to those drawn up the previous year. Protective clothing and nets, repellent liquid (dimethyl phthalate), and mepacrine were used. The OC 4 Field Hygiene Company was appointed special malaria officer and the RMOs acted as unit advisers, but the OCs of units were held responsible for the enforcement of actual measures in their own units. Unit anti-malaria squads were formed of one NCO and three other ranks, with equal numbers of reserves. The spraying of living quarters and also of any casual water in the unit area was carried out. (It was stated that the incidence of malaria in the forces in
The necessity of keeping camps away from villages and low-lying areas was stressed,
Any cases of fever were adequately investigated and blood tests taken. Medical officers were trained in the diagnosis from blood films and a malaria officer was appointed in each field ambulance. These measures proved satisfactory.
The cases reported in the Division were: January, 1; February, 2; March, 1; April, 2; May, 22; June, 12.
The hospital figures for the whole
No case of any severity was reported. Malaria provided no problem as regards man wastage or serious illness, because of the efficient control measures adopted by the Army generally and by 2 NZ Division in particular. The taking of mepacrine produced only very minor disturbance to general health in some cases.
During this period venereal disease provided the major incidence of sickness in the Division and there was an appalling increase following the occupation of the
The cases recorded in the divisional area by 102 Mobile VDTC were as follows:
The figures show clearly the enormous increase in the cases of gonorrhoea, soft sore, and urethritis during May and June, and also the low incidence of syphilis. The total for May exceeded the previous highest monthly total of 217 in
In January a marked improvement in the results of treatment of soft sore was brought about by daily examinations and frequent changes in the antiseptics used. Hospitalisation was thereby reduced from an average of twenty-two days in November to eight in
In a survey of the results of penicillin treatment for gonorrhoea it was found that of ninety cases there had been six cases of urethritis, eleven of prostatitis, and two of cystitis. These complications subsided under routine treatment. In March cases of urethritis arising two to three weeks after intercourse with no evidence of gonorrhoea were found to respond well to penicillin.
In June the dosage of sulphathiazole for soft sore was increased to 28 grammes (an initial dose of 4 grammes followed by four-hourly doses of 2 grammes) and this accelerated healing. The treatment of both syphilis and gonorrhoea had been much simplified by the adoption of concentrated penicillin dosage and the immediate results proved satisfactory. The enormous increase in the incidence of these diseases could thus be satisfactorily handled by the Mobile Treatment Centre and comparatively little disability and wastage occurred. This was in marked contrast to the First World War, there having been a truly remarkable advance in the treatment of venereal diseases.
Admissions to medical units were:—
The incidence of dysentery was very low throughout this period. In
Enlargement of the liver was noted in 103 of the 252 cases of intestinal amoebiasis at 3 General Hospital. Of the cases with enlargement, thirty-seven had had a previous attack of infective hepatitis and all these cases failed to respond to emetine. All but six of these cases had returned to normal within six months and none developed amoebic abscess. Of the sixty-six cases with no history of infective hepatitis, all were well after three to six months, but half of them still had some enlargement of the liver. It was considered as a result of the investigations that there was no conclusive evidence that the liver enlargement was due to amoebiasis.
In the months prior to the advance hygiene arrangements were routine—chlorination of water, burial of refuse in deep pits which were burnt out, use of deep-trench latrines, provision of showers for the troops, and use of the mobile laundry for washing clothes. Greater prevalence of lice rendered disinfestation more necessary and it was done either by dusting with DDT or by steam disinfestation.
During the advance the hundreds of dead animals, as well as dead Germans, created a problem. The animals were sprayed with tar oil, collected, and buried. A recovery vehicle was used to drag animals off the road and out of ditches. Civilian labourers and German prisoners of war were employed in these duties, and AMGOT took over the work after the advance.
During May hygiene was a problem in
THE early months of
Victory, and the cessation of hostilities, was naturally the forerunner of further changes. The DMS Matron Miss I. MacKinnon, m.i.d.;
With the ending of the war in
However, by 14 May a total of 67 medical personnel (12 medical officers, 12 a) the long lines of communication in b) the fact that New Zealand hospitals were still dealing with battle casualties, sick, repatriated New Zealand prisoners of war, and wounded German prisoners; (c) the closing of 2 General Hospital preparatory to its move to d) the late arrival of the medical draft of the 15th Reinforcements. When the post-battle rush of work had been cleared and the tension eased in
In the middle of
While the medical group was awaiting disembarkation there disembarked ahead of them 116 New Zealand prisoners of war who had been repatriated from
Only two of this first group of New Zealanders to be repatriated to Oranje for New Zealand.
In October Brigadier Twhigg, who had been
In the early part of
Pending the completion of arrangements for a building for the Camp Reception Hospital, a few patients were admitted to British hospitals. Early in December approval was obtained for the taking over of buildings adjoining the Emergency Medical Services hospital,
Steps were taken to prepare the EMS buildings at
It was considered advisable to transfer the hospital also. Suitable accommodation was found and made available at the Isolation Hospital,
The hospital staff completed the move from the EMS hospital,
On 9 April the first patients, six, were admitted to the hospital from British units in the
During April 250 New Zealand repatriated prisoners of war were admitted to the hospital, of whom 201 were still patients at the end of the month. The average period in hospital of the repatriates was approximately fifteen days. The number of New Zealanders in British military and EMS hospitals at 30 April was ninety-one, the majority having been direct admissions from British reception camps or from ports and airfields.
The repatriated prisoners of war, who began to arrive in appreciable numbers at the New Zealand Reception Group early in April, continued to arrive in a steady stream throughout the month, the total arrivals being 1427. Returning ex-prisoners of war came mainly through British reception groups, but a proportion reached the New Zealand Reception Group direct from Manston airfield which was the airport destination for New Zealanders.
As a result of privations and hardships immediately prior to repatriation, the general condition of the returned prisoners of war was poor, and a high proportion was found to be suffering from varying degrees of malnutrition and avitaminosis. Of the number reporting to
In April a medical headquarters was established in
In regard to the pressure on planned hospital arrangements it should be noted that the British, Canadian, Australian, and South African authorities on the whole met with the same experience with returning ex-prisoners of war. The Canadians at the end
During
As the Director of Hygiene, War Office, pointed out at a conference of the senior medical officers of Dominion forces on
When repatriation did actually occur, the situation proved very different from what had been envisaged. Firstly, the forced march of a large proportion of prisoners of war led to a higher incidence of severe malnutrition than had been expected from previous experience. Secondly, prisoner-of-war camps in
The fact, also, that elaborate emphasis had been placed on the psychological aspects of the problem was thought to militate against adequate provision being made for the emergency circumstances that
Note: The number of individual soldiers covered in this table is probably about 6000 as a number of those unfit had more than one class of disability. The figures are not complete for all New Zealand ex-prisoners of war as complete records were not available at the time of the survey in
In June the work of the hospital at
On 10 July many of the more seriously ill were cleared to the hospital ship NMHS Oranje, which took sixty-four hospital patients to New Zealand via
In the following months to September the demands on the hospital steadily declined as more of the men departed for New Zealand, mostly on transports. In September the winding up of the Reception Group came in for consideration. It was decided to close the hospital at
When, in
In July there was still no firm decision as to the constitution of the new force for the
Then on 15 August came the welcome news that
The reduced strength of
The first three weeks of July found 2 NZ Division still in the
The ADMS 2 NZ Division, Colonel Elliott, attended a number of conferences at which the organisation of a possible new force for service in the war against
On 24 July the Division began to move to a new area in the
In July 3 Field Surgical Unit and 2 Field Transfusion Unit were disbanded; they were followed by 4 Field Ambulance, which held a final ceremonial parade on 14 August before the remaining members of the staff were transferred to other medical units. The growing shortage of medical personnel as successive drafts left to return to New Zealand made it impossible to staff fully all the medical units.
During September the Division remained in the Trasimene area, but when it was decided to move into the
In
As 1 General Hospital was now no longer required, it began to disband as from 30 September, transferring its patients to 3 General Hospital,
In October the Division moved from
The 4th Field Hygiene Company was reinforced by the Hygiene Section previously operating at
When active warfare ceased and the unsettled position at
The Trasimene area gave less trouble as it was not a malarious area and there was a lowered incidence of venereal disease.
Water supply provided some difficulty as the local supply near the lake was unsatisfactory and water had to be drawn from
Water: When the troops moved into
The water supply was drawn from a series of surface wells linked up with pumping stations, where chlorine was added by a continuous flow from demijohns containing a solution of bleaching powder. Weekly bacteriological tests were carried out by a local civilian laboratory.
Refuse Disposal: The city refuse pit had to be rigidly guarded and controlled before it functioned satisfactorily on the Bradford system. The OC Hygiene Company, Major Oranje Feb–Sep 1943; RMO 25 Bn Jan–Aug 1944;
On moving into
The city sewerage system consisted of cesspits emptied by a civilian contractor.
Rats: The rat menace was investigated by the Hygiene Company. No rats were found harbouring typhus fever, bubonic plague, or Weil's disease. Efforts were made to keep their numbers down. The rat is suspicious of any new object and traps had to be left in position several days before being set, and also unpoisoned baits had to be left for five days before the poison was laid. The baits used were millable wheat or barley soaked twelve to twenty-four hours in water, bread mash and sugar-meal, and a dry bait of fifteen parts flour with one part fine sugar. The poisons used were zinc phosphide, arsenious oxide, barium carbonate, and red squill. Zinc phosphide, 5 per cent by weight, was mixed in any wet bait; arsenic oxide, 10 per cent by weight in bread mash only; and red squill, 10 per cent by weight, in a wet bait. When the rats were eliminated old rat holes were cemented up and buildings were proofed with wire netting.
Hepatitis: The incidence of infective hepatitis was much lower than in the previous year and it was of a milder type.
Pneumonia: Primary atypical pneumonia also was much less common.
Malaria: There were very few cases of malaria in the Division, 32, 19, and 18 cases being reported in the first three months of the malaria season.
Amoebic Dysentery: This disease continued to be a source of trouble as it was frequently found to be the cause of ill-health, especially in hospital personnel, and it was difficult to effect a cure. Major Dick, OC Hygiene Company, stated that the disease was endemic among the troops and that any soldier presenting with a history of bowel irregularity and malaise was vigorously purged and investigated for entamoeba histolytica; and that any soldier presenting with a similar history after return to New Zealand might well be suffering from amoebic dysentery.
Lieutenant-Colonel Hayward Lt-Col G. W. Hayward; born Cardiff, Wales,
The finding of apparently healthy men passing vegetative forms of entamoeba histolytica was unusual as the carrier state was associated with the passing of cysts. Experience in
Poliomyelitis: A small epidemic of poliomyelitis was noted amongst the civilian population at this period, and a few cases arose in our force. In July one death occurred in 3 General Hospital; in August one severe case was reported from 3 General Hospital; in September two cases were reported in the Division, with one death in the CCS.
Chest Examinations of Hospital Staff: These were carried out by 3 General Hospital, and in August it was reported that all the staff of the unit had been examined and two very early active cases of pulmonary tuberculosis had been revealed among the
Venereal Disease: There was an appalling increase in the numbers affected by venereal disease in
The Italian
In
Fresh cases of venereal disease were:
The magnitude of the increase in incidence is shown by the fact that the total number of cases of venereal disease recorded from the beginning of
The average monthly incidence per 1000 troops in
By
In November there was a temporary shortage of penicillin and sulphathiazole was used to treat gonorrhoea, but as many as 50 per cent of relapses was expected. An increase in complications of gonorrhoea was noted at that time.
In December a marked increase in complications arose and as a result treatment was again changed. For gonorrhoea penicillin was given in dosage of 30,000 units two-hourly for ten doses, double the previous dosage. For syphilis, because a number of the cases showed Kahn tests rising, a series of ten daily intravenous injections of marpharsen (0·06 gm.) were given, combined with 85 injections of 30,000 units of penicillin two-hourly.
Blood tests were routinely carried out in the American and Canadian forces prior to the men returning to civilian life. At 3 General Hospital the opportunity was taken to carry out the tests during July and August on a total of 671 men returning to New Zealand. Only four were found to be strongly positive and two weakly positive. (The Wassermann reaction was negative in these latter two cases.) It was concluded that as the incidence of latent syphilis among New Zealand troops was low, and there was little tendency to conceal primary syphilis, a strong case could not be made out in favour of applying compulsory tests to all returning personnel.
Throughout the war large numbers of graded men were retained overseas. They were unfit for full service with the Division and were employed in base units, though a small number with minor disabilities were used in special positions in the Division. From time to time some of those on unimportant jobs were selected to return to New Zealand because of the essential nature of their pre-war occupations, re-engagement in which would be of greater help to the war effort.
Much the largest group of graded men were the neurotics. Out of 2175 graded men at
A survey made after a year's work by this unit showed that the following work was performed for New Zealanders: refractions,
The NMHS Oranje took 702 invalids and 106 protected personnel from Empire Clyde evacuated 52 invalids and 198 protected personnel of the 6th and 7th Reinforcements. The Mooltan took 97 patients in November, and other suitable cases were sent to New Zealand on transports.
When the scheme for leave from
A new unit came into being in November when 1 Mobile CCS was disbanded as a CCS and reformed as a 300-bed general hospital, called 6 General Hospital. It was found possible to reduce 3 General Hospital to 300 beds, although there were as many as 12,000 New Zealand troops in the
In November the Commander of
Establishments were drawn up for a general hospital of 300 beds, a camp hospital, which could also function as an ADS if necessary, a rest home, a VD treatment centre, hygiene section, and an optician unit. It was decided to staff the Lt-Col K. R. Archer, m.i.d.;
As regards the Optician Unit, it was decided that it should remain in
For 7 Camp Hospital a new establishment of seven medical officers, a quartermaster, and forty-eight other ranks was drawn up. The establishments for 5 Field Hygiene Section, 4 Rest Home, and 102 VD Treatment Centre were also modifications of those previously used by
During December the medical staff, which was chosen for
In
In
In southern
By the end of January there were fewer than one thousand New Zealand troops in Maunganui on 11 February, which date marked the end of activities of the New Zealand medical services in
With the reduction of troops in
In December all the New Zealand medical units in Maunganui on
By this date the final details were completed for the winding-up of the New Zealand medical services in
In his farewell message on
I feel.… the important part we played was far in excess of the size of our Force. Looking back over the long years of war, it seems to me that we have been present at most of the vital moments such as the disasters of
During the six years of the war over 4000 officers, sisters, voluntary aids, and orderlies served with the New Zealand Medical Corps in the
In a memorial oration in
The New Zealand Expeditionary Force landed in
Major-General Barrowclough, who served with
It is a very terrible and shocking ordeal to be wounded in battle.… I am proud to acknowledge that the New Zealand Medical Corps has always operated in such a way that our soldiers have ever been able to carry with them into battle those encouraging and comforting thoughts [of the care and efficiency of the medical services]. I am certain that our morale was immensely increased by our knowledge of the efficiency of your organisation and by our personal experience of your fearless devotion to duty. If the New Zealand soldier has earned some reputation as a fighting man I say unhesitatingly that much of the credit for it must go to the medical services which it has been his good fortune to enjoy.…
On the same theme,
In the opinion of members of
The New Zealand Medical Corps, however, did not build up its standards unaided. It owed much to the RAMC, upon whose help it could rely at all times, and also at different times to units from
An extract from a letter addressed by Major-General W. C. Hartgill, DMS AFHQ, to
.… Your departure is another forcible reminder of the speed with which events are moving. It is rather tragic to see the wonderful organisation we have built up in the CMF dwindling away to a shadow of its pristine glory. However, it is inevitable and the sooner we can close down the better.
It may interest you to know that all the War Office Consultants after touring CMF have come to me and said that the medical set-up out here was easily the best of all the theatres of war and the clinical standard the highest ever achieved. The last Consultant said that it was now accepted in the Colleges at Home that we had provided the blue print for the future.…
The only two large epidemics (those of infective hepatitis) are reflected in the high figures for autumn
The middle column indicates an improved recovery rate for wounded as war medical science progressed and as lines of evacuation became more favourable. (If prisoners of war are also included, the only changes are that
Analysis of other columns must take account of more complications, but the severity of injury resulting in death (immediate or postponed) seems to have decreased as the balance of power in armour, air force, and artillery swung from the enemy to us.
(Additions to medical officers listed are RMOs sailing with combatant units and some MOs recruited in
(Deaths from disease in
Adams, Maj A. B., 268
Adderson, Pte A. A., 129
Adderson, Pte C. A., 129
Anson, Lt-Col G. F. V., 489
Archer, Maj K. P., 687
Ardagh, Brig P. A., 231, 232, 242, 281, 314, 327, 330, 331, 334, 335, 345, 349, 350, 363, 365, 371, 374, 381, 413, 417, 418, 422, 433, 446, 464
Ascroft, Maj P. B. (RAMC), 547
Ashworth, S-Sgt G., 133
Baillie-Grohman, Vice-Adm H. T. (RN), 126
Baird, H., 308
Banks, Matron L. M., 17
Beattie, Capt R. B., 279
Begg, Maj N. C., 621
Bellamy, Miss E., 308
Bennett, Lt-Col L. A., 521
Bicknell, Matron-in-Chief J., 5
Blackford, Mrs O. M., 580
Boag, Lt-Col N. F., 36
Bowerbank, Maj-Gen Sir F. T., 3, 4, 5, 6, 7, 8, 10, 17, 41, 54, 223, 224, 571, 578
Boyd, Col J. R., 73, 118, 138, 215, 237, 312, 484, 486, 487, 635, 636, 637
Boyd, Col J. S. K. (RAMC), 102
Brennan, Sgt H., 589
Bristow, Brig R. W. (RAMC), 234
Brown, Sgt R. S., 488
Brownlee, Lt-Col J. J., 309
Bryant, Maj A. L., 338
Bull, Brig W. H. B., 7, 11, 36, 106, 124, 158, 159, 163, 180, 183, 185, 187, 188, 189, 190, 199
Burley, WO I H. W., 510
Burns, Capt G. T. C., 279
Buttle, Lt-Col S. R. (RAMC), 230
Button, Lt-Col E. L., 53, 56, 253, 256, 295, 494, 518, 545, 546
Cawthorn, Lt R. W., 305
Chapman, Mrs G. H., 580
Chappel, Brig B. H. (RAMC), 159
Christie, Col H. K., 107, 124, 126, 160, 165, 166, 167, 178, 188, 189, 192, 193, 203, 206, 237, 463, 609
Clay, Capt D. C. L., 263
Clifton, Brig G. H., 281
Collett, Pte J. P. C., 186
Collie, L-Cpl A. F., 173
Coutts, Maj P. E., 177
Cowdrey, Maj J. H. (RAMC), 18
Cowell, Maj-Gen Sir E. (RAMC), 531
Cramer, Gen H. (German), 268
Croft, Maj C. R. (RAMC), 159
Crossman, Lt N. G., 279
Crowder, Capt (British MP), 87
Cullen, Fg Off (
Davidson, Maj J. K., 489
Dawson, Rev. F. O., 182
Dendy, Dvr B., 118
Dittmer, Brig G., 279
Dolan, Lt-Col S. O. (RAMC), 159
Douglas, Maj A. W., 390, 396, 413, 432, 572, 575, 592, 594, 630
Douglas, Maj H. S., 610
Douglas, Capt L., 148
Downes, Maj-Gen R. M. (AAMC), 6
Dunne, Maj B. J. D., 309
Edmundson, Lt-Col F. B., 266, 274, 331, 566, 590, 607, 619, 680
Eisenhower, Gen D. D. (
Elliott, Col R. A., 56, 381, 385, 409, 428, 512, 620, 622, 657, 679, 680
Feltham, Capt R. J., 348
Fenton, F. J., 10
Fisher, Col W. B., 115, 121, 159, 185, 189, 190, 427, 589, 605
Fitter, Sgt (AFS), 623
Fletcher, Capt I. H., 590
Florey, Sir H. (AAMC), 467
Foote, Capt G. M., 424
Forsman, Rev. Fr. E. A., 279
Fraser, Prof. F. R., 84
Friedland, Capt C. (RAMC), 443
Fulton, Lt R. A. D., 279
Furkert, Col F. P., 53, 59, 258, 276, 280, 286, 288, 298, 418, 427, 434
Gentry, Maj-Gen W. G., 259
Gerard, Rt. Rev. G. V., 263
Gilbert, Maj G. H., 309
Gilchrist, A. G., 279
Gillies, Sir H., 309
Gott, Lt-Gen W. H. E. 353
Gourevitch, Capt (RAMC), 180
Griffiths, Rev. R. J., 173
Grimshaw, Pte T., 122
Hall, Maj G. F., 624
Hanson, Brig F. M. H., 319
Harbord, Capt R. P. (RAMC), 443
Hayward, Maj G. W., 682
Henderson, Cpl E. A., 386
Henley, Maj J. C., 277
Hiddlestone, Rev. J., 185
Hodgkiss, Capt F., 627
Holley, Pte R. D., 424
Holt, Capt (RAMC), 180
Hood, Lt-Gen A. (RAMC), 578
Horan, Spr C. J., 118
Hunter, Lt-Col L. J., 108, 213, 327, 382, 395, 422, 442, 443, 447, 494
Inglis, Brig R. T., 2
James, Col G. W. B. (RAMC), 67
Jenkins, L-Cpl B., 185
Jennings, Capt G. C., 282
Kenrick, Brig H. S., 35, 56, 59, 61, 67, 68, 73, 74, 99, 100, 101, 106, 108, 109, 121, 122, 128, 135, 137, 138, 152, 153, 158, 159, 165, 187, 196, 199, 251, 258, 259, 261, 262, 315, 316, 323, 327, 330, 370, 463, 492, 531, 574, 576, 671
Kidman, Maj C. H., 4
King, Capt A. J. (AAMC), 189
King, Snr Cmdr Miss M., 299
King, Col R. D., 213, 260, 268, 272, 273, 274, 288, 298, 330, 371, 372, 381, 413, 427, 492, 508, 532, 562, 574, 582, 619, 620
Kirk, Pte G. S., 586
Lambie, Miss M. I., 16
Large, Brig D. T. M. (RAMC), 99, 100, 108, 109, 118, 132, 142, 214
Leclerc, Gen (French), 426
Lee, Brig E. A. (AIF), 119
Le Soeuf, Lt-Col L. E. (AAMC), 159
Lewis, Matron E. M., 224
MacArthur, Maj-Gen Sir W. G. (RAMC), 84
McBride, Maj F. R., 270
MacCormac, Maj T. J., 439
MacCormick, Brig K., 34, 40, 41, 42, 54, 56, 59, 68, 71, 81, 82, 84, 89, 91, 142, 148, 160, 218, 219, 224, 236, 237, 315, 326, 327, 370, 396, 463
McDonald, Capt P. N. R., 348
Macdonald, Maj R. A., 348
McKillop, Col A. C., 35, 85, 89, 100, 107, 108, 109, 118, 132, 213, 214
MacKinnon, Matron I., 671
MacLean, Matron-in-Chief H., 5
McMurray, Capt T. B. (RAMC), 510
McNaught, Lt-Col G. J., 270
Martin, Lt V. C., 279
Miller, Capt E. T. G., 622
Moffat, Maj (RAMC), 443
Money, Col R. A. (AAMC), 108
Monro, Maj-Gen D. C. (RAMC), 241
Montgomery, Fd-Mshl Viscount B. L., 353, 376, 391, 411, 417, 426, 427, 673
Moore, Capt P. W. E., 622
Morrison, Cpl B. A., 118
Munro, Lt C., 265
Murchie, Dr (British), 84
Murray, Col D. N. W., 224
Neale, Capt H. C., 56
Newlands, Lt J. W., 149
Nicholas, S-Sgt J. L., 272
Norris, Rev. H. G., 536
Ogilvie, Maj-Gen W. H. (RAMC), 398
Papagos, Gen A. (Greek), 98
Park, Brig R. S., 673
Pate, L-Cpl G., 428
Paul, Maj J. (
Perkins, Lt (AFS), 623
Phillips, Brig E. (RAMC), 374
Popham, Col C. (RAMC), 108
Powles, Capt C. P., 429
Pritchard, Cpl G. E., 539
Radcliffe, Col D. G., 648
Ritchie, Lt-Gen N. M., 331
Ritchie, T. R., 18
Robinson, Cpl C. C., 337
Rommel, Fd-Mshl E. (German), 104, 255, 273, 288, 298, 342, 355, 356, 373, 374, 406, 410, 423, 441
Ross, Sir J. S., 308
Rumsey, Capt A. C. (RAMC), 189
Salter, Brig D. M. (AAMC), 191
Savige, Lt-Gen Sir S. G. (AIF), 119
Scott-Thomson, Maj (RAMC), 549
Shaw, Col R. G. (RAMC), 55
Shoreston, Maj J. (RAMC), 598
Sinclair-Burgess, Maj-Gen W. L. H., 3
Spencer, Col F. M., 36, 228, 234, 239, 240, 246, 251, 256, 463
Stammers, Brig F. A. R. (RAMC), 645
Stewart, Maj D. T., 396
Stewart, Maj-Gen K. L., 687
Sutherland, Charge Sister E. M., 302
Swann, Pte A. G., 587
Thomas, Evan (AFS), 387
Thompson, Capt S. B., 344
Thomson, Maj G. H., 131
Tito, Marshal (Yugoslav), 656
Tremewan, Capt H. C., 279
Twhigg, Brig J. M., 89, 90, 106, 116, 121, 126, 160, 162, 163, 184, 187, 188, 190, 194, 275, 279, 309, 671, 673
Tyler, Maj J. M., 268
Van Rooyen, Maj C. E., 635
Vasey, Brig G. A. (AIF), 159
Watt, M. H., 10
Webster, Capt F. E., 279
Weinberger, Maj (
Weston, Maj-Gen C. E. (British), 159
Wilder, Maj-Gen A. S., 275
Wilder, Lt-Col N. P., 425
Will, Lt-Col J. H., 34
Williams, Pte R., 509
Willoughby, Maj E. E., 585
Wilson, Matron-in-Chief F., 5
Wilson, Maj R. (RAMC), 345
Wilson, Maj R. A., 333
Wilson, Lt-Col S. L., 274, 276, 279, 286, 353, 360, 363, 382, 390, 395, 396, 413, 428
Zuckerman, Prof., 306
Abdiel (HMS), 195
Abdominal wounds—
See
ADMS
Administration, Army Medical Services—
See Chapters—
Admissions to hospital, 230, 231, 239, 352, 369, 375, 465, 476–9, 520, 522, 548, 565, 598, 639, 661, 666
ADS. See under each campaign
Air evacuation. See Evacuation, sick and wounded
Air Force (Territorial), 5
Air-raid casualties (
Aliakmon R., 115
Ambulance trains. See Evacuation, sick and wounded
American medical units, 546
Amoebiasis. See Dysentery, Amoebic
Amputations—
Antral infection, 79
Anuria, 631
See
Athlone Castle (HS), 90
ATS, 135
Australian medical units—
Awatea (SS), 34
Bacteriology, 233
Barber shops, 52
Base hospitals.
SeeNZ Medical Units (General Hospitals)
British Medical Units (General Hospitals)
Australian Medical Units (General Hospitals)
See
Bedbugs, 49
Benedictine Abbey (
Birket, 81
Blood grouping, 29
Blood transfusion—
British medical units—
Casualty clearing stations—
Field ambulances—
Field medical units—
General hospitals—
see also
Base hospitals (unenumerated), 227, 228, 231, 290, 293–5, 311, 351, 367, 400, 618, 623, 626, 630, 643, 661, 662, 672, 688
British hospitals, 207, 293, 351, 570, 618, 623, 626, 630, 648, 661, 662, 672, 688
Connaught Military Hospital (
Medical stores depots,
Other MAC, 412
Brothels, 81
Cairo, medical conference, 311
Surgical conference, 294
Campaigns
Camp medical arrangements—
Camp dental arrangements in NZ, 28
Camp hospitals in
Camp hospitals in
Canadian medical units, 595, 597, 605, 611, 612, 614, 625, 627, 640
Carlisle (HMS), 155
Castiglion Florentino, 591
Casualties—
CCS. See NZ Medical Units and British Medical Units
Cerebro-spinal meningitis, 26
Chakdina (SS), 263
Chest wounds—
Chlorination of water, 43
Civil hospitals in NZ, 25
Climate—
Clinical investigations, 34
Clothing in Egypt, 78, 93, 406
In Tunisia, 452
Comliebank (SS), 131
Compulsory service overseas, 23
Consultant Physician,
Consultant Surgeon,
Convalescence in NZ, 16
Coventry (HMS), 194
Casualties, 173, 175, 178–80, 182, 185, 193, 197–9, 211, 212
Graded men, 209
Medical command, 159
Medical units—
Siting of units, 202
Cuba (HMS), 488
Deaths from disease,
Deputy-Director Medical Services, 30 Corps (Ardagh), 417, 418, 433, 435
Deputy-Director Medical Services (
Diarrhoea. See Dysentery
Director-General of Medical Services (
Director of Medical Services,
Dominion Monarch (SS), 469
Duchess of Bedford (SS), 90
Dysentery, 52, 79–81, 94, 203, 227, 282, 284, 311, 353, 367, 477, 479, 603, 636, 637, 669
Ear, nose and throat diseases—
Echelons,
Education on disease, 81
Egypt, medical arrangements and Base administration, 41–83, 213–49, 298–329, 462–90
Bedbugs, 49
Climate, 78
Consultants, 235
Evacuation of invalids to NZ, 300
Formation of—
Health of troops, 41, 45, 78–80, 214, 215, 221, 222, 479, 482
Hygiene and sanitation, 42, 47–52, 65, 70, 95–7, 221
Units. See NZ Medical Units
Maunganui (Hospital Ship), 37, 223–5, 231, 293, 298–300, 306, 478, 569, 570, 576, 626, 689
Medical—
Ophthalmic work, 486
Rank of reinforcements, 470
Reorganisation—
Unfit men, 78
Eighth Army, 250, 251, 254, 314, 327, 330, 331, 348, 355, 376, 391, 406, 418, 425, 427, 436, 445, 448, 499, 528, 607, 610, 615, 657
Empire Clyde (SS), 686
Employment officer, 483
Epidemics in NZ camps, 26
Epidemic diseases in Egypt, 79
Epileptics, 312
Evacuation, invalids to NZ, 59
Evacuation, sick and wounded—
Eye diseases, 228
Farndale (SS), 264
Fasano Rest Home, 571
Fascial split, 632
Felix Roussel (SS), 40
Field Ambulance equipment and training, 62
see also under each campaign)
see also under each campaign)
see also under each campaign)
Fd Surg Unit. See under Surgical Teams
2 FTU (Transfusion Unit), 381, 392, 395, 396, 403, 405, 407, 415, 421, 427, 429, 434, 437, 496, 500, 583, 585, 590, 592, 594, 607, 611–13, 616, 627, 629, 653–56, 658, 659, 679 (see also under each campaign)
First Echelon. See Echelons,
First World War, 1914–18, 1, 10, 11, 13, 26, 29, 41, 42, 48, 52, 55, 60, 70, 80, 81, 83, 102, 223, 520
Flies—
Food poisoning, 79
Forces clubs—
Formidable (HMS), 131
Forms (medical), 12
Forty-second Street (
Fractures—
Gas gangrene, 136, 206, 291, 519, 520, 546, 595, 629–31, 659
Gastro-enteritis, 79
see also under each campaign)
see also under each campaign)
Detachment, Anglo-Swiss Hospital, see also under each campaign)
Geneva Convention, 74, 140, 146, 147, 199, 207, 209, 257, 299, 459, 460, 514
Georgic (SS), 87
German invasion of
Glencairn (SS), 133
GOC
Gouraud barracks, 316
Grand Hotel, See
Casualties, 150
Communications, 101
DDMS, British Troops in
Food, 139
German invasion, 111
Greek army, 104
Greek navy, 132
Health of troops, 139
Hospital provision in, 143
Medical units—
Sanitation, 103
Venereal disease, 103
Water supply, 103
Hadassah Hospital, 468
Hague Convention, 310
Hasty (HMS), 194
Head wounds—
Health of troops in campaign—
Hepatitis (infective), 227, 311, 406, 451, 477, 479, 522, 556, 559, 561, 564, 603, 607, 634–6, 682
Hernia, 312
Hill report, 11
Hospital accommodation, provision of—
Hospital—
Hospitals. See Australian Medical Units, Base Hospitals, British Medical Units, Canadian Medical Units, New Zealand Medical Units, South African Medical Units
Hotspur (HMS), 195
Hygiene in
Ice-cream, 48
Incinerators, 50
Indian medical units, 62, 66, 257, 285, 497, 500, 504, 505, 543, 623
Infectious disease, 57, 69, 79, 227, 229, 230 (see also individual diseases)
Ionia (SS), 154
Italian campaign. See
Italians in NZ hospitals, 72
Climate, 631
Forces clubs, 566
Formation of field surgical unit, 575
Graded men, 685
Non-professional officers, 578
Plans for moving units north, 576
Promotion of specialists, 577
Recruitment of doctors from
Statistics, 604
Strength of
Transfer of medical units to
Jackal (HMS), 195
Janus (HMS), 194
Jaundice. See Hepatitis
Jervis (HMS), 194
Joint Council (St. John and
Kandahar (HMS), 193
Karapara (SS), 59
Kea I., 155
Kelvin (HMS), 193
Kent (HMS), 87
Khamsin, 78
Kimberley (HMS), 195
Lessons from campaigns—
Libraries, medical, 219
Casualties, 259, 260–4, 266, 268–71, 273, 275, 276, 282–3, 287, 289, 290, 293–5
Evacuation of casualties, 256, 266, 270, 271, 274, 280, 292, 296
Field ambulances in desert, 297
Hygiene and sanitation, 284
Loss of equipment, 283
Transport, 283
Medical—
Supplies, 296
Units—
Re-equipment after campaign, 312
Wounded treated, 283
Limb wounds—
Llandovery Castle (HS), 309
Maadi Camp, 38, 41–51, 79, 92, 213, 215, 301, 313, 342, 442, 689 (
See NZ Medical Units
Maheno (HS), 223
Malaria—
Marama (HS), 223
Maunganui (HS), 37, 214, 223–25, 231, 293, 298–300, 306, 478, 569, 570, 576, 626, 689
Maxillo-facial surgery, 90
MDS, 67 (see also under each campaign)
Medical arrangements, campaigns—
Medical reviews of campaigns—
Medical—
Mess utensils, 47
Metaxas line, 98
Military arrangements in campaigns—
Minaro, 664
Mine injuries, 662
see also under each campaign)
Mooltan (SS), 686
Morphia, 136
Mules,
Napier (HMS), 193
Nervous disorders, 67, 198, 228, 369, 481, 484–5, 564, 565, 603, 638
Nerve injuries, 311
New Zealand Corps—
New Zealand See
New Zealand Medical Units—
ADMS 2 NZ Division. See ADMS
SeeNew Zealand
Camp Hospital,
1 CCS, 242, 281, 317, 318, 325–8, 350, 358, 360, 380–2, 390, 392, 398, 401, 404, 405, 407, 413–15, 422–4, 428, 432–5, 437, 440–3, 448, 453, 462, 464, 465, 467, 493–6, 499, 501, 505, 509–11, 515, 517, 520, 526, 529, 533, 535, 543–8, 552, 555, 561, 575, 582, 584, 585, 591, 592, 595, 596, 613, 618, 620, 623, 626, 627, 639, 644, 648, 650, 651, 654, 656, 659, 660, 662, 664, 665, 679, 680, 686 (see also under each campaign)
Consultant Physician. See Consultant Physician,
Consultant Surgeon. See Consultant Surgeon,
See
SeeDirector of Medical Services,
See Deputy-Director Medical Services (
DGMS (Army and Air). See Director-General of Medical Services (
DMS See Director of Medical Services,
See 4 Field Ambulance
See 5 Field Ambulance
See 6 Field Ambulance
See 4 Field Hygiene Section
Field Surgical Unit. See Surgical teams
Field Transfusion Unit. See 2 FTU
1 to 5 Gen Hosps. See General Hospitals
See
See
Surgical teams. See Surgical teams
Training cadre (
VD treatment centres, 69, 82, 307, 489, 493, 496, 499, 526, 558, 559, 568, 575, 607, 664, 668, 679, 683, 687, 688
See
Nizam (HMAS), 193
Nursing service. See NZ Medical Units,
Ophthalmic work, 486
Oranje (HS), 225, 299, 300, 310, 326, 489, 490, 570, 597, 673, 677, 686
see also Joint Council)
Ormonde (SS), 40
Orthopaedic centres, 446
Surgeons, 577
Otitis externa or media, 79
Passive air defence, 61
Penicillin, 467, 518–21, 546, 548, 549, 558, 595, 599, 629, 630, 638, 662, 669, 685
Penthouses, 527
Pharmacists, 19
Pneumonia, 79, 80, 313, 480, 509, 556, 560, 564, 603, 636, 647, 682
Pontine marshes, 561
Posting of medical officers, 218
Prisoners of war, 141, 211, 212, 309, 310, 433, 441, 487, 488, 555, 570, 574, 647, 648, 671, 672, 674–7
Prisoner-of-war Camp,
Pyrexia of uncertain origin (PUO), 481
Qassassin, 571
Q fever, 560
RAMC. See British Medical Units
Rank of specialists, 238
RAPs, 134 (see also under each campaign)
Rations, 31, 45, 46, 65, 92, 139, 367, 452, 602, 633 (see also under each campaign)
Reinforcements,
Rest Homes,
Review of campaigns. See under each campaign
RMOs, 123, 218, 219, 234, 246, 350, 359, 360, 383, 384, 388, 431, 432, 438, 439, 610, 613, 622, 657 (see also under each campaign)
Roman aqueducts, 64
Sabratha, 466
Sanitary arrangements—
Sant' Elia, 582
Savio R., 618
Second Echelon. See Echelons,
Shortage of doctors in NZ, 471
Sillaro R., 653
Slamat (HMS), 148
Smallpox, 480
South African medical units—
Sulphonamides, 29, 79–82, 135, 206, 227, 232, 251, 295, 309, 311, 367, 399, 458, 460, 479, 523, 548, 558
Sumps, 51
Surgery, 53, 73, 134, 135, 203–6, 209, 210, 231–3, 286, 289, 350, 360, 361, 362, 364, 372, 429, 434, 442–4, 512, 513, 516–18, 544–7, 592–5, 598, 599, 613–15, 628–32, 662, 663 (see also under each campaign)
Surgical Conference, 294
Surgical teams (British). See British Medical Units
Surgical teams (NZ), 353, 356, 358, 360, 361, 381, 382, 392, 405, 407, 411, 413, 415, 421, 427, 447, 464, 465, 500, 505, 508, 510–12, 533, 575, 616
Swill, 51
Swimming bath,
Syphilis, 82
Tahag, 148
Tairea (SS), 488
Tennis shoes, 39
Tetanus inoculation, 28
Third Echelon. See Echelons,
Thorgrim (SS), 264
Tinea, 80
Training medical units, 2, 33–7, 141, 214, 222, 223, 226, 313, 318, 319, 492
Transport. See Evacuation, sick and wounded
Tummar forts, 66
Typhoid fever, 52, 103, 203, 321, 451, 478–80, 487, 522, 557, 565, 603, 665
Typhoid inoculation, 28
Typhus fever, 103, 152, 312–13, 323, 451, 463, 480, 481, 495, 523, 634
Ulster Prince (SS), 148
ADMS. See ADMS (
Repatriation Unit in. See Repatriation Unit (
Urinals, 50
Varicose veins, 312
Vascular wounds, 454
Venereal disease, 16, 29, 30, 80–3, 103, 203, 229, 230, 307, 316, 321, 522, 523, 557–9, 603, 637, 638, 665, 668, 669, 680, 683–5 (see also under each campaign)
Venereal disease, policy in NZ, 29
Venereal disease treatment centres, 69, 82, 307, 489, 493, 496, 499, 526, 558, 559, 568, 575, 607
Ventilation on transports, 38
Wakatipu draft, 463
War pensions, 1
Warsawa (SS), 293
Warspite (HMS), 131
Washing, 44
Wounds, 362, 456–9, 513, 518, 519, 549, 631, 639, 641, 642, 661 (see also under each campaign, Surgery, Abdominal Wounds, etc.
York (HMS), 180
Zaafran, 264
This volume was produced and published by the War
History Branch of the Department of Internal Affairs
The author:
Proceeding overseas with the Second Echelon in
In civil life Colonel Stout held the position of Senior Surgeon to the Wellington Hospital from