War Surgery and Medicine
At Kokkinia hospital New Zealand medical officers and orderlies shared in the treatment of British, Australian, and New Zealand battle casualties from Greece and Crete. The hospital was well equipped, largely from 5 Australian General Hospital, whence came the operating theatre, laboratory, and X-ray equipment. Dental equipment of the New Zealand Mobile Dental Unit was recovered from Voulas camp. Dispensary stocks came from the Australian hospital, from 26 British General Hospital after it closed at Kephissia, and the Germans issued some items from the captured British Medical Stores Depots. Antiseptics and opiates were in good supply, but there was a shortage of sulphonamide drugs, dressings, adhesive plaster, and plaster-of-paris. German plaster-of-paris was used later, but its quality was very poor at times. There was a serious shortage of syringes, surgical scissors, and dressing forceps.
In the five months' operations at Kokkinia 68 patients died, while 2334 were discharged as cured or relieved, and 109 still required hospital treatment.
The clinical work performed in the hospital was considerable, as the following details show. Most of the patients came from Crete by air and practically all their wounds were suppurating, the men being very ill, hungry, thirsty, and poorly clad. Some of the patients from Corinth and Kalamata were in a similar condition.page 462
Head Injuries: Eighty-eight cases were treated, 19 being operated on. There were 13 deaths altogether among the 37 patients with perforating injuries; 14 of them developed cerebral abscess which caused 2 of the deaths. Four patients died within the first three days after admission. Dr Pfeiffer, the consultant neurosurgeon to the German forces in Greece, visited the hospital and operated on some cases, using Cushing's technique.
Chest Injuries: Most of the wounded with severe chest injuries died before reaching the hospital. Of the 100 patients admitted 5 died, all except 1 having other serious injuries such as head wounds. Haemothorax was present in 24 cases and empyema in 12. Of the latter, 2 died, 1 having a pyo-pneumothorax and a lung abscess.
Abdominal Injuries: Again, the severe casualties did not survive to reach hospital. Altogether there were 39 cases, of which 29 had perforating injuries, and of these 6 died from peritonitis or toxaemia.
Fractures: Some 349 compound fractures were treated, with 11 deaths and 27 amputations, while there were 68 simple fractures. On admission all fracture cases were X-rayed and then operated on, the wound edges being excised and the wound irrigated with hydrogen peroxide. Tulle gras or vaseline gauze dressings and plaster splints were then applied. Sulphonamides were given. The results generally were satisfactory, though deformity was commonly seen in the fractured femora, due to much bone and soft-tissue damage and to the lack of a portable X-ray plant. The treatment of individual fractures was on the following lines:
Shoulder and humerus. Abduction frames made by orderlies from Kramer wire were used. Only a few had thoraco-brachial plasters as there was a shortage of plaster.
Fractures of the elbow were put up at 90 degrees flexion, and in the mid-position of pronation and supination.
Two simple fractures of the radius and ulna required open reduction.
Hand wounds were put up in dorsiflexion of the wrist and flexion of the fingers.
Fractures of the femur were treated in Thomas splints with Kirschner wire traction. Balkan beams were used. Lower-third fractures were treated in a Braun splint with Kirschner wire extension through the tibial tuberosity.page 463
Fractures of the tibia were treated in plaster splints. When extension was necessary this was carried out by Kirschner wire above the malleolus in a Braun splint. A Bohler frame was available for the reduction of lower limb fractures.
The plasters were changed at monthly intervals unless offensive discharge or infection necessitated earlier inspection. At the change of plaster any sequestra present were removed.
Secondary haemorrhage occurred during the first month after wounding. Some mild cases cleared with packing of the wound, but several with bleeding of the femoral artery required amputation of the limb.
Joint Injuries: Of 132 cases 9 died from infection and haemorrhage and 9 had amputation performed. Plaster splints were largely used in treatment. One knee-joint case had been treated by German doctors by the insertion of two corrugated rubber drains into the joint and another across the popliteal space, and amputation was necessary when erosion of the femoral artery with brisk haemorrhage ensued. Blood transfusions were given to patients for haemorrhage and for secondary anaemia from chronic sepsis, orderlies being used as donors.
Nerve and Vascular Injuries: There were 153 nerve lesions, none of which was operated on in Greece, and 23 cleared up. Injuries of large vessels totalled 13, and some of the aneurysms were operated on and excised.
Simple Wounds: Some 613 major cases were admitted, many with very extensive wounds, and most were treated by the closed plaster technique. There were 15 deaths—4 from gas gangrene, 6 from sepsis, and 3 from secondary haemorrhage.
Jaw and Face Injuries: The 30 cases were mostly extensive injuries with much loss of bone and soft tissues, many cases in later years requiring grafting. Three deaths occurred within forty-eight hours of admission from pneumonia or sepsis. Lieutenant P. Noakes of the New Zealand Mobile Dental Unit treated the fracture cases with interdental wiring.
Eye Injuries: Forty-six cases were admitted and 16 eyes were removed, vulcanite artificial eyes being made by the dental department.
Burns: There were 2 deaths in 17 cases.
Tetanus: Two cases of tetanus were recorded and both died. Both had had previous prophylactic injections of tetanus toxoid, but no anti-tetanus serum was given after wounding. One of the patients was a Maori.page 464
Gas Gangrene: Sixteen cases of gas gangrene were recorded and 7 died.
Of the other admissions to Kokkinia there were 335 with minor injuries, 297 with infectious diseases, and 502 with other diseases. There were 8 deaths from disease, the causes being bacillary dysentery associated with pneumonia, pulmonary tuberculosis, gastric carcinoma, bacterial endocarditis, splenomegaly, oesophageal stricture, and empyema following pneumonia.