New Zealand Medical Services in Middle East and Italy
Work at the CCS
Work at the CCS
During the Arezzo action and the early part of the campaign for Florence the CCS was not functioning and British CCSs were used in its place. At Siena it became the most forward CCS, within easy reach of the field ambulance over a first-class road. A British FSU was attached for most of the active period and both a Canadian and a British FTU were attached at different times.
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 Siena area it dealt with eight cases of gas gangrene. Two of these occurred towards the end of July and six during August. Of the six cases in August, four died. Four of the eight cases were prisoners, and in these there had been a long interval between wounding and operation, but in the other cases the interval was not unduly long. Treatment consisted of excision of the affected area, penicillin both parenterally and locally, and gas-gangrene serum. Bacteriological investigations were carried out by the mobile laboratory attached to 4 British CCS.
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.page 596
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 1970 sick cases admitted to the CCS, with 28 deaths. Among the deaths were German prisoners and Italian civilians as well as British, American, and New Zealand troops.
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 Siena and this proved a great boon, but was instituted too late.
For the advance to Florence the hospitals were long distances from the forward areas, as 2 General Hospital was still at Caserta and 3 General Hospital at Bari, while 1 General Hospital was also on the Adriatic coast at Molfetta, some 20 miles up from Bari, though in June it had been arranged that 1 General Hospital would move over 300 miles up the Adriatic coast to Ancona as soon as the enemy was driven from that area. By the use of air transport from Trasimene airfield to Naples, any difficulties that might otherwise have been involved by the long distance from the CCS to 2 General Hospital were avoided. Air transport for the wounded and sick was both quick and comfortable, and there was not the need for the staging of patients in hospitals in Rome, where it might have been difficult to treat large numbers of patients as the hospitals there were only in the process of getting established after the move from Naples. It had been expected that Florence would be occupied without any difficulty and that general hospitals could then be quickly set up there. This proved impossible, and medical arrangements had to be page 597 adjusted and the Naples hospitals had to continue to carry out the greater part of the work.
As it was, the process of change created extra difficulties for 2 General Hospital. Some of the hospital trains on the Naples–Bari run were transferred to the Rome–Naples run. This affected the evacuation of New Zealand and other patients from 2 General Hospital to the hospitals and convalescent depots on the Adriatic coast and led to a steep rise in the hospital bed state towards the end of July. No road transport was available, nor was air transport, even for cases unfit to travel by road or rail, as all air ambulances were being employed on the more foward evacuation routes. By sending selected walking cases on ordinary passenger trains across Italy 2 General Hospital partly overcame this problem. This expedient was not used by neighbouring hospitals, and in consequence it was often possible for 2 General Hospital to send fifty patients a day by the passenger trains.
For a number of reasons all the hospitals in the Naples area became overcrowded and 2 General Hospital did its best to assist by accepting British, Canadian, and South African patients. The movement of hospitals to Rome from Naples led to general congestion in the hospitals remaining in the Naples area. The accommodation problem was aggravated by the arrival of the advanced parties from AFHQ, Algiers, as that headquarters was transferred to Caserta. Hospital buildings were requisitioned for the headquarters staff, an instance being the use of a Canadian hospital of 1200 beds for female personnel of AFHQ, and the closing of the hospital. Then, again, the invasion of Normandy meant for a time fewer hospital ships from the United Kingdom, and a resultant banking-up of the more serious bed cases and others who would normally have been evacuated early to the United Kingdom. The Oranje and other hospital ships arrived at Naples at the end of July and gave some relief.
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 page 598 casualties, were admitted during July and 1070 cases and 364 battle casualties during August. Several very severe cases with wounds of the spine and hip were dealt with.
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 Italy and altogether 30,000 patients since the unit was founded. The treatment of fractured femurs by penicillin and delayed primary suture was still continued and results were very satisfactory.
Some of the Florence casualties were evacuated to New Zealand by the Australian hospital ship 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 Senigallia. Altogether, 768 cases were admitted in the two months.