New Zealand Medical Services in Middle East and Italy
Experience during the First World War had shown that venereal disease was widespread and of a virulent type in Egypt. Particular stress was therefore laid on the education of the troops in the knowledge and prevention of these diseases, and lectures were given by medical officers on the troopships and in Maadi. A policy decision had been made by the GOC 2 NZEF, on the recommendation of both the DGMS (Colonel Bowerbank) and the ADMS (Colonel MacCormick), that a full programme of education should be carried out and that no penalties other than a small pay stoppage should be inflicted for the contraction of venereal disease. It was realised that some troops would inevitably indulge in sexual intercourse and contract venereal disease. The problem was then tackled realistically and every effort made to lessen the incidence of disease and so save serious manpower wastage. Preventive measures were arranged without delay, condoms and prophylactic outfits were made available and early treatment centres set up, both in Cairo and in the camps, with trained orderlies in attendance. At the same time stress was laid on the importance of continence both from the moral and the health point of view, and the sordid conditions of Cairo were emphasised. The troops were warned that the use of preventatives and of the licensed brothels did not render them safe from contracting disease, but that a reduced incidence of disease had been proved to be in direct relation to the greater use made of preventive measures. An early treatment centre was set up in the licensed brothel area in the Birket, and the troops were urged to go there instead of delaying treatment until their return to Maadi Camp.
In Cairo there were two brothel areas, one of them licensed and the other out of bounds to the troops. A system of compulsory medical examination of the prostitutes which had previously been in force had recently been abandoned, but was later re-introduced by the civil authorities. This was never satisfactory in spite of some army supervision.
A contagious diseases section of the camp hospital at Maadi was page 82 set up on arrival by the First Echelon. It was staffed by 4 Field Ambulance and all venereal cases were held and treated there. Even before any cases of syphilis had occurred, Colonel MacCormick had arranged for a standard course of treatment and for the keeping of a register of cases. Following their first course at the CD hospital, syphilis patients were then referred to the nearest medical unit for subsequent treatment. A complete check on subsequent treatment was instituted.
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 Western Desert, with a resultant decrease in cases in September to 33. A detachment of 4 Field Ambulance was left behind in Maadi to staff the camp hospital, but later a special camp staff was appointed. The Contagious Diseases (VD) section then became separated from the rest of the hospital. Lieutenant Platts, who had had special training at the Connaught hospital at Aldershot, was put in charge, and laid down the lines of treatment and trained his special staff. Valuable assistance was given by Lieutenant-Colonel R. Lees, RAMC, adviser in venereology to GHQ MEF.
By the end of 1940 the CD hospital was able to take 70 patients, though the average bed state at that time was 35. In October, following the arrival of the Third Echelon, there was an increase to 68 cases, and the numbers after that fluctuated from 46 to 82 in March 1941, when the troops left for Greece. The incidence per 1000 troops per month had varied from 7·88 in March 1940 to 3·29 in December.
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 page 83 therapy by intravenous injection of TAB vaccine to produce a temperature of 103 degrees F. was sometimes given. A considerable number of cases of non-specific urethritis were treated by alkalinisation of the urine and injections of chloramine T or oxycyanide of mercury, and instillations of argyrol. Venereal sores cleared up quickly with the sulphonamides.
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 Egypt during the First World War.
In the early period of the 1914–18 War in Egypt 206 cases of venereal disease were sent to Malta. Later, following the return of the New Zealand troops from Gallipoli, 50 to 70 cases a week were admitted to hospital and, in March 1916, 149 cases were reported, a rate of between 9 and 10 per 1000 per month. Records of the treatment centre at the No. 1 Stationary Hospital at Moascar in 1915 showed a total of 94 cases of syphilis being treated in a period of two months. The treatment at that time consisted of injections of Karsovan and mercury.