New Zealand Medical Services in Middle East and Italy
Lieutenant-Colonel Jeffreys, RAMC, was in charge of penicillin distribution in Italy and he visited both the CCS and 3 General Hospital and made arrangements for its use by our staffs. Fortunately, both Lieutenant-Colonel Button, the officer commanding the CCS, and the staff of 3 General Hospital had had experience of the treatment at Tripoli. Only a limited supply of penicillin was available and it was restricted to special types of recent casualties. Penicillin was first used prophylactically in a forward dressing station in Eighth Army on 10 January 1944, a supply having been left by Lieutenant-Colonel Jeffreys at 5 NZ MDS.
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:
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.