New Zealand Medical Services in Middle East and Italy
2 NZ General Hospital
2 NZ General Hospital
The surgical work performed in the hospitals during the period consisted largely of the treatment of ordinary conditions as met with in a civilian population of healthy young males, such as the repair of herniae, operations for appendicitis, the treatment of piles and varicose veins. More serious conditions such as malignant disease were seen only in small numbers. There were three cases of seminoma testes. Some cases of tubercular epididymitis showed acute symptoms with early abscess formation. Genito-urinary cases were common, and it was fortunate that Lieutenant-Colonel Ardagh1 had taken overseas his own special instruments, as these were not otherwise available.
After the Libyan campaign of December 1940 and January 1941 there was a lull in admissions, and in May 1941 the hospital had reached a low bed state of 256 in preparation for casualties from Greece and Crete. During the month two convoys of Australians were admitted from Tobruk, and two convoys of 131 and 375 from Greece and Crete raised the bed state to 967 on 1 June. In spite of these numbers only 58 battle casualties were operated on during May. Most of the casualties admitted during June were light cases and nearly all the heavy cases were evacuated to New Zealand on HS Maunganui on 10 June, so that only 32 operations on battle casualties were performed in July. The battle casualties did not call for the expected volume of work following the campaigns in Greece and Crete, as comparatively few of the serious cases were brought back. Altogether, 371 of the wounded (three-fifths of the total) became prisoners of war in Greece, and 1039 (two-thirds of the total) became prisoners of war in Crete.
A report by Lieutenant-Colonel Ardagh on the 617 battle casualties admitted to 2 NZ General Hospital from Tobruk, Greece, and Crete in April, May, and June 1941 shows that there were 849 page 232 main wounds. Of these 592 were of the soft tissues, 347 being of the limbs. There were 167 fractures, 67 being of the hand and forearm, and only five of the femur. There were only seven major amputations, none of the lower limb. There were no penetrating wounds of the head and only two penetrating abdominal wounds. There were 12 penetrating wounds of the chest, one of which developed an empyema. There were 18 injuries to the peripheral nerves, only one being in the lower limb. One death occurred in the hospital from secondary haemorrhage in the large veins of the neck. One case of tetanus from Crete recovered. A high percentage of the ruptured eardrum cases developed suppurative otitis media. There were only three cases of fracture of the jaw, all with excellent results following inter-maxillary wiring and later dental splinting.
The review shows quite clearly the very small number of serious casualties admitted, mainly due to the impossibility of evacuating the heavy cases from Greece and particularly from Crete, and also because such cases reaching Egypt were retained in British hospitals, particularly in Alexandria.
Lieutenant-Colonel Ardagh said:
We have again watched with great interest the effect of the early application of sulphanilamide paste to battle casualty wounds. The vast majority of the group had no sulphanilamide paste and it is the unanimous opinion of our surgical staff that so far as our close and controlled observations indicate, there is no reason to believe that sulphanilamide paste offers any advantage whatever: on that point we are quite convinced. Although we do not feel justified in condemning its use, we are firmly of the opinion that it causes unhealthy and sluggish granulating wounds without in any way preventing suppuration and infection. These remarks apply only to the use of sulphanilamide as a local application. In cases where sulphanilamide chemotherapy plus sulphanilamide local has been employed, we believe the beneficial results can be ascribed to chemotherapy alone.
During the period from July to September our hospitals admitted only 77 battle casualties, many of them being re-admitted from the Convalescent Depot and the majority light cases. There was only one fracture of the femur and three amputations, one of the thigh, and two of the upper arm. Four operations were successfully carried out for aneurysm. The total number of battle casualties of all forces admitted to the Helwan hospital from October 1940 to August 1941 was 1268, and there were six deaths.
Due to climatic conditions there was more than the ordinary percentage of ear, nose, and throat conditions. It was thought that swimming, especially in the fresh-water baths at Maadi and Helwan, was responsible for much of the infection. Otitis externa was very common, as was sinus infection. It had early been noted that old otitis media cases with perforation of the drum frequently flared up page 233 in Egypt with fresh discharge, and advice was sent to the New Zealand authorities to exclude such cases from drafts for overseas service. In battle casualties ruptured eardrums from blast commonly occurred and it was soon learnt that active treatment, especially syringing, in the forward areas produced infection in the majority of cases, but with simple toilet, and the active treatment delayed until the arrival at base under the control of a specialist, the cases did well and little deafness resulted.
There was little acute eye trouble, but a great deal of work was concerned with the supply of glasses for defective eyesight and in the treatment of eye infections. Eye wounds were not very common.
1 Brig P. A. Ardagh, CBE, DSO, MC, m.i.d.; born Ngapara, 30 Aug 1891; surgeon; 1 NZEF 1917–19, Capt 3 Fd Amb; wounded three times; in charge surgical division 2 Gen Hosp, Aug 1940–Oct 1941; CO 1 CCS Nov 1941–May 1942; ADMS 2 NZ Div May 1942–Feb 1943; DDMS 30 Corps Feb 1943–Apr 1944; died (England) 6 Apr 1944.