New Zealand Medical Services in Middle East and Italy
HYGIENE DURING THE FINAL PERIOD IN ITALY
HYGIENE DURING THE FINAL PERIOD IN ITALY
When active warfare ceased and the unsettled position at Trieste was resolved, hygiene became the most important aspect of the medical services. At first in the Trieste area the prevention of malaria gave rise to some anxiety, as with lax discipline it became difficult to enforce the carrying out of the necessary precautions, especially as regards dress. The high incidence of venereal disease and the associated laxity of moral control and cleanliness caused great anxiety to the medical services and to the general command.page 681
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 Foligno, Perugia, and other surrounding areas. The lake water was unfortunately very dirty and generally unsuitable even for bathing. Bathing was available at Foligno. Skin infestations became very common and all blankets were disinfested, a thousand being done daily. All buildings were sprayed with DDT to counteract flies, mosquitoes, bedbugs, cockroaches, and fleas.
Water: When the troops moved into Florence they were housed mostly in good winter quarters with good sanitary arrangements. Swimming baths were available and the units had independent shower facilities. The buildings were sprayed with DDT. Although the incidence of scabies and lice decreased, it was still very high. Our Hygiene Company had control of the whole Florence area and supervised the city water supply and cesspits and refuse disposal.
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 Dick,1 described the conditions of refuse disposal as follows:
On moving into Florence we inherited a controlled tip, the outstanding feature of which was the entire lack of control, and one of the first jobs was to create order out of chaos. To describe adequately the state of affairs at a non-supervised refuse dump in a city teeming with poverty and with the smallest articles of salvage bringing in fantastic prices on the black market is impossible: it represents a low ebb in a sordid struggle for existence. The engineers were called on to erect a barricade fence, the area was posted with the wonder sign ‘proibite ai civile’, the help of the Provost was enlisted to keep out the teeming multitude of scavengers, and a satisfactory working arrangement was made with the City Council whereby the army supplied six trucks, the Council supplied labour, and bombed out areas were cleared of rubble which was used as covering material for refuse, and so a military tip was brought under control, and a city was helped with the healing of its war wounds even though some of its less fortunate citizens found the struggle for existence made harder.page 682
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 Hayward1 reported in July that cases of amoebic dysentery continued to provide the largest single group of cases under treatment by the medical division of 3 General Hospital. During the month thirty-four fresh cases had been diagnosed, including two sisters and one nurse on the staff of the hospital. In view of the continued incidence of amoebic dysentery among members of the staff, stools were examined from all the cooks. Of twenty-three cooks page 683 tested, five were found to have trophozoites of entamoeba histolytica in the stools. Only one showed amoebic cysts and he, after mild purgation, produced negative forms. Of the five positive cases, three gave no history of diarrhoea for the previous month. Earlier stool examinations had failed to show amoebae or dysentery organisms, and the one cyst-passer had had recurrent mild attacks of diarrhoea during the previous year.
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 Italy had shown that the finding of amoebic cysts in the stools was uncommon—only two out of a group of 100 cases of amoebic dysentery diagnosed in 3 General Hospital had shown cysts. While the only cyst-passer of the five cooks was theoretically capable of transmitting the disease, it was probable that daily stool examinations in the others over a longer period would have shown cysts.
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 WAAC personnel.
Venereal Disease: There was an appalling increase in the numbers affected by venereal disease in Florence and a particular increase in the syphilitic cases. The venereal disease rate was six times, and in one month ten times, as high as in British troops in the Florence area. The OC 102 Mobile VDTC considered this was due partly to the attractiveness of the women, but mainly to the wilful neglect of all precautions by the men. Some 70· per cent admitted that they took no precautions. The SMO 2 NZ Division considered there was inadequate discipline and moral laxity of the troops in an area so beset with sexual opportunities.
The Italian Red Cross ran a venereal diseases hospital for infected women, the patients being supplied by military and Italian police, who followed up histories of infections and apprehended girls of whom they were suspicious. Those who were infected were then forced to remain as patients in the hospital, and, following treatment and discharge, were supervised and brought back to the hospital for further examination by the police. Over a three-month page 684 period, of the 45 per cent found to be infected, 20 per cent were suffering from syphilis, 78 per cent from gonorrhoea, and the remaining 2 per cent with disease of suspected venereal origin. The hospital accommodation was increased from fifty to eighty beds and it came under the supervision of the DADH. The APM arranged extra surveillance of suspected women, prophylactic centres were established in the city, and all brothels were placed out of bounds to the troops.
Fresh cases of venereal disease were:
|Total venereal fresh cases||192||95||139||261||473||402||1562|
|Total all cases||279||152||209||405||536||402||1983|
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 1940 to February 1945 in 2 NZEF, which was much greater in size than the force in the Florence area, was 4085. (This figure excluded those diagnosed as non-venereal, and comprised gonorrhoea 1826, venereal sores 1203, urethritis 476, syphilis 260, other diseases 320.)
The average monthly incidence per 1000 troops in 2 NZEF was:
|1940||1941||1942||1943||1944||Jan–Jun 1945||Jul–Dec 1945|
By April 1945 all the men in the Division who were receiving arsenical treatment for syphilis had completed their courses. All subsequent cases were treated by the speedier, though not totally proven, method of penicillin injections. Changes in treatment took place as the original penicillin treatment was found to require adjustment. In July the dosage of penicillin given for syphilis was page 685 changed to 30,000 units two-hourly for seven days, a total of 2,550,000 units. Penicillin was also given two-hourly in doses of 15,000 units for gonorrhoea.
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.
Graded Men in 2 NZEF
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 30 June 1945, there were 782 with functional nervous disease. Other large groups were: wounds 245, foot trouble 169, accidental injuries 172, knee disorders 92, debility 76, deafness 71, arthritis 52, fibrositis 50, eye trouble 50, ear trouble 48, skin trouble 44, hernia 43.
A survey made after a year's work by this unit showed that the following work was performed for New Zealanders: refractions, page 686 849; spectacles supplied, 529; hospital prescriptions dispensed, 228; referred for ophthalmological examination, 28; repairs and replacements, 98; other attendances, 132—a total of 1345 cases. In addition, 48 British troops were attended. The unit had been attached to MDSs, the CCS, 1 General Hospital, and Advanced Base. It was considered that visual disabilities often became aggravated in Italy. Repairs and replacements were not heavy and it was thought that the average soldier took care of his spectacles. Equipment was sent from New Zealand. The specially designed vans brought from New Zealand admirably suited the peculiar requirements for refractive and optical work—cleanliness and freedom from dust, permanency of fitting machinery and instruments, darkness for ophthalmoscopy and retinoscopy by means of window blinds, standard illumination for visual acuity and electrical equipment to give the required voltages for different instruments. The OC said that to have fulfilled these requirements under field conditions by any other means would have proved well-nigh impossible. There can be no doubt that the unit did very good work of great value to the force.
Evacuation of Invalids from Italy and Egypt
The NMHS Oranje took 702 invalids and 106 protected personnel from Italy and Egypt in July, thus relieving the hospitals of nearly all their serious cases and enabling them to reduce the numbers of equipped beds and staff. In August the HS 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.
United Kingdom Leave Scheme
When the scheme for leave from Italy to the United Kingdom was initiated in October, orderlies and ambulance cars were located at each of the six staging camps on the overland route to deal with any emergency cases. A proportion of the medical personnel not required for J Force or for essential duties was able to participate in the leave scheme.
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 Bari-Taranto area awaiting the arrival of ships.page 687
In November the Commander of J Force, Brigadier Stewart,1 returned from New Zealand and asked for a complete medical organisation for the force. Previously, in the absence of any specific information as to the destination of the force and its role in the British Commonwealth occupation force, it was not known whether the New Zealand component would have to supply its own medical units.
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 Florence hospital and rest home with J Force personnel, thus giving the staffs an opportunity to work together as units before going to Japan, and also releasing other personnel for return to New Zealand. Major Archer2 was appointed SMO J Force and CO 6 General Hospital.
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 2 NZEF. Seven RMOs were also included in the new force.
During December the medical staff, which was chosen for J Force from the later reinforcements (13th, 14th and 15th), was gathered together in Florence. There were insufficient other ranks of the NZMC available in the reinforcements and some thirty or forty were transferred from other units. A large number of medical officers, however, was available from these reinforcements, but many were comparatively junior and the services of two more senior men were retained as surgeon and physician. In the case of the NZANS and NZWAAC (Medical Division) there was an ample supply of volunteers.
In December 1945 there was a vast improvement in the shipping position and, as a result, a greater exodus of 2 NZEF troops than had been anticipated and an acceleration in the final winding-up of 2 NZEF. The shifting of large numbers of troops to southern Italy for embarkation proceeded smoothly. Movement was carried out page 688 largely by train, with rather unsatisfactory accommodation consisting of box-cars, without seats and very draughty. The number of ships available enabled most of the troops to embark for New Zealand in December and January.
In Florence HQ 2 NZEF continued to function until the end of the year, but nearly all divisional formations and the divisional RAPs were disbanded. The only medical units remaining in Florence at the end of December were those of J Force. No. 6 General Hospital ceased to receive patients and those already held were transferred to the adjacent 100 British General Hospital, where a New Zealand staff looked after them. These facilities extended by the British authorities were of great value and enabled 6 General Hospital to pack its equipment for despatch to Japan. The 4th Rest Home also closed and packed, but 102 VD Treatment Centre continued to function, it being arranged that its equipment should be taken on the ship conveying the troops to Japan.
1 Maj-Gen K. L. Stewart, CB, CBE, DSO, m.i.d., MC (Greek), Legion of Merit (US); Kerikeri; born Timaru, 30 Dec 1896; Regular soldier; 1 NZEF 1917–19; GSO I NZ Div, 1940–41; Deputy Chief of General Staff, Dec 1941-Jul 1943; comd 5 Bde, Aug-Nov 1943, 4 Armd Bde, Nov 1943-Mar 1944, and 5 Bde, Mar-Aug 1944; p.w. 1 Aug 1944-Apr 1945; comd 9 Bde (2 NZEF, Japan) Nov 1945-Jul 1946; Adjutant-General, NZ Military Forces, Aug 1946-Mar 1949; Chief of General Staff Apr 1949-Mar 1952.
Wind-up in Southern Italy
In southern Italy the medical units were kept busy with the influx of troops from Florence. At Bari 3 General Hospital continued to function with a reduced staff, but transferred its patients to 98 British General Hospital and commenced to disband in January 1946; it was wound up by the end of that month. The detachment of 1 Convalescent Depot at San Spirito started closing in the middle of December, but it was necessary to use its buildings for some weeks to accommodate convalescents from 3 General Hospital. Advanced Base Camp Hospital was likewise busy, but began and completed its disbandment in January.
Medical Stores Depot in Bari was working hard collecting equipment for J Force, and also checking and packing equipment from disbanding medical units. The New Zealand Government had directed that all medical (I. 1248) equipment held by 2 NZEF medical units should be returned to New Zealand, where it could be handed over for civilian use or held as a military reserve. Allied Force Headquarters agreed to replace part-worn equipment with new or reserviced I. 1248 equipment. These replacements were collected by the New Zealand Medical Stores Depot, which thus gathered complete equipment for two 600-bed hospitals, a casualty clearing station, and three field ambulances for shipment to New Zealand. The I. 1248 equipment of 2 General Hospital in Egypt was similarly packed and shipped to New Zealand.
By the end of January there were fewer than one thousand New Zealand troops in Italy, and within a few weeks these, too, were on their way home. The sick were transferred to 45 British General page 689 Hospital, Taranto, and were embarked at that port by HS Maunganui on 11 February, which date marked the end of activities of the New Zealand medical services in Italy.
Closing Days in Egypt
With the reduction of troops in Maadi Camp to fewer than two thousand (troops having being moved from Egypt to Italy for the formation of J Force) it was decided to close 2 General Hospital from 21 November, but a 100-bed expansion was established by a New Zealand staff at 15 Scottish General Hospital in Cairo.
In December all the New Zealand medical units in Egypt were disbanded with the exception of the office of SMO Maadi Camp. The final dates of disbandment were: Maadi Camp Hospital, 19 December 1945; 2 General Hospital, 28 December; Maadi Camp Hygiene Section, 26 December; and 2 Rest Home, 2 January 1946. Use was made of British units when required. When 15 Scottish General Hospital closed, the New Zealand patients were transferred to 63 British General Hospital (the old 2/10) at Helmieh. It was fitting that the British hospital which cared for our First Echelon patients should also tend the last hospital patients of 2 NZEF overseas. As in 1940, the patients remained under the care of New Zealand medical and nursing personnel. Patients suitable for evacuation by hospital ship were embarked on HS Maunganui on 15 February 1946 for return to New Zealand.
In his farewell message on 22 November 1945 on handing over his command to Major-General Stevens, after holding it for six years, General Freyberg said:
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 Greece and Crete, the battle to save Tobruk in 1941, the battle to save Egypt in 1942, El Alamein, the turning of Agheila, the Mareth Line, the battle for Cassino and the final advance across the Po Valley to Trieste. Always, as I see it, the Second New Zealand Division has been in the forefront of the battle. I do not believe I am overstating the case when I say that just as Mr Churchill inspired the nation by his words, so have you by your deeds. I am sure there is no finer fighting force amongst the armies of the Allies. I realise how privileged I have been, for no commander ever went into battle with greater confidence than I have done during the last six years and no confidence has been better justified. For all these long years you have gone on fighting, never failing, never faltering, never depressed, always cheerful. No commander has been better served.…page 690
During the six years of the war over 4000 officers, sisters, voluntary aids, and orderlies served with the New Zealand Medical Corps in the Middle East and Italy. With them were associated regimental stretcher-bearers, ASC drivers, dental officers and orderlies, and chaplains. They all applied to the medical services their energy, intelligence, and initiative, and attained a high degree of skill backed by careful solicitude for their patients. They earned the respect of the combatant units, and all officers from the GOC downwards gave their co-operation.
In a memorial oration in 1951 Lieutenant-General Sir Bernard Freyberg said:
The New Zealand Expeditionary Force landed in Greece in March 1941, and finished 50 months of fighting at Trieste on 2 May 1945. During those years we had to face grave and difficult problems, with heavy battle casualties and sickness. But, during the whole of those months and years, we were always battleworthy. We owed our efficiency to the type of men and women we had overseas, and to a great extent to our nursing and medical services.
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.…
In the opinion of members of 2 NZEF, and this opinion is borne out by comments from outside sources, the New Zealand Medical Services are without equal. The standard of surgical and medical treatment and administration of hospitals, casualty clearing stations, field ambulances and convalescent depots has been most important in keeping up the high standard of morale in your force overseas. The personal interest shown by the medical staff has established a sense of confidence in all who have come under their care.
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 page 691 Australia, Canada, South Africa, India, and the United States of America. Together, the Allied medical units, in association with motor, train, and air ambulance units, sought to achieve the fullest measure of service for the sick and wounded.
An extract from a letter addressed by Major-General W. C. Hartgill, DMS AFHQ, to Colonel Stout, Consultant Surgeon 2 NZEF, on the eve of his departure for New Zealand in August 1945, also illustrates the standard attained by Allied medical units, including New Zealand units:
.… 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.…