New Zealand Medical Services in Middle East and Italy
Tour by Director-General of Medical Services
Tour by Director-General of Medical Services
The transfers of medical units between Egypt and Italy had (except for the move of 1 General Hospital and 101 VDTC) been completed by the time of the tour in March of the Director-General of Medical Services (Army and Air) from New Zealand, and Major-General Bowerbank was able to see for himself the complete layout on each side of the Mediterranean and gauge the efficiency of individual units and the functioning of the system as a whole.
One of the purposes of the Director-General's visit to 2 NZEF was to examine the medical arrangements on the spot and, if possible, propose methods whereby there could be a reduction in the number of medical units and, more especially, of medical officers. It had apparently been the intention to recommend a reduction of medical units in Egypt, but the DGMS found that the medical units remaining in Egypt (allowing for the projected move of 1 General Hospital to Italy) was the minimum number required for the servicing of New Zealanders as long as the reinforcement and training camp was retained in Maadi. He also found that the training base was unlikely to be transferred to Italy, firstly, because the restricted areas in Italy page 572 were unsatisfactory for advanced training; secondly, because it would be an advantage to have a base in Egypt when hostilities ceased; and thirdly, because of the expected high incidence of malaria and dysentery in Italy during the summer months.
The DGMS discussed with the DMS GHQ MEF, Major-General Hartgill, a New Zealander, the question of the transfer of 1 General Hospital to Italy. The latter agreed that the transfer was inevitable but insisted on the retention of a 300-bed hospital (5 General Hospital) for the treatment of sick New Zealand soldiers in Egypt. The DGMS was in full agreement with the arrangements made but, from the point of view of conservation of medical officers, regretted their necessity. (In point of fact, the splitting of 1 General Hospital into two hospitals did not involve extra medical officers.)
In Italy the DGMS inspected all New Zealand medical units and also spoke to all medical officers on the provisional rehabilitation plans for medical officers. In the forward area at Cassino he recognised that the principles underlying the medical arrangements of the New Zealand Division were mobility of the units combined with efficiency and the rapid transfer of patients from the forward areas to a unit where they could receive treatment for shock and, later, full surgical investigation. The siting of the MDS and CCS as far forward as possible had, he agreed, undoubtedly resulted in a marked fall in the death rate of battle casualties and a great reduction in pain and suffering.
After visiting the non-divisional medical units in Italy the DGMS was able to form his opinion of the necessity for three general hospitals, totalling 2400 beds, which had been questioned by the National Medical Committee. In his report to the Adjutant-General in New Zealand the DGMS stated:
It must be remembered that although 2 NZEF is, as far as possible, self-contained, medical arrangements and especially bed accommodation must be based on the requirements of an army of which 2 NZ Div. is only a part. It must also be remembered that medical officers are required for transport purposes, prisoner of war camps, hospital trains, etc., and 2 NZEF is not called on to supply any for these purposes. Although it is the policy to use NZ medical units for New Zealanders, evacuation during actual fighting must pass through certain channels, and it is by no means infrequent for New Zealanders to be admitted to British or American medical units. The same thing happens when men are on leave and are taken ill.
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.page 573
The total strength of 2 NZEF in Italy is roughly 35,000 and hospital bed accommodation of 2100 (900, 600, 600) gives a percentage rate of 6 per cent. It is agreed that each of these hospitals may be expanded in an emergency to 1200 or 900 beds respectively, but only as a temporary measure. In a comparison of the total staffs of military hospitals and civilian hospitals in New Zealand of approximately the same size, it has been found that the civilian hospitals had a staff of medical officers, sisters, etc., nearly one-third more than that of the military hospitals.
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 2 NZEF medical services. There had been some conflict ever since the beginning of the war regarding the relative needs of the Army overseas and the civilian medical services, for which social security legislation had increased the demand. The Minister of Health and the National Medical Committee were inclined to the opinion that the Army was relatively overstaffed and its hospital provision excessive. The DMS 2 NZEF had to press with the DGMS the needs of his force, especially for medical officers and for more senior men and specialists. Some experienced medical officers had been returned to New Zealand for service with the Pacific force, and some had been lost as prisoners of war, and their places had never been adequately filled. On his tour of inspection the DGMS realised that the requests of 2 NZEF were not unreasonable and the hospital provision not excessive. It was a pity that a period of four years had elapsed without a visit by the DGMS to the Middle East to see for himself the requirements of the force. He, on his part, would have had the opportunity of urging the appointment of non-professional medical officers in the medical units for routine administration, and also the page 574 earlier use of an optician unit overseas. The occasional differences with regard to the staffing of hospital ships would also have been more readily adjusted.