War Surgery and Medicine
CHAPTER 27 — Clinical Work among Prisoners of War
Clinical Work among Prisoners of War
FOR sick and wounded prisoners of war captured in Greece and Crete the major part of the clinical work, especially surgery, was performed in the early months at Kokkinia hospital, Piraeus, Athens. This hospital was opened on 9 May 1941 in a large American orphanage, only just completed, and was staffed by Australian, British, and New Zealand medical personnel. By early June the admissions to the hospital totalled 2038, made up as follows: from 5 Australian General Hospital, Ekali, 91; from 26 British General Hospital, Kephissia, 290; from Corinth and Kalamata hospitals, 260; from Crete, 1397.
At Corinth from 27 April Captain Slater and other New Zealand medical officers ran a hospital of 120 beds in the Ionian Palace Hotel. The medical officers were able to do dressings and simple surgical procedures, but cases requiring major surgery were transferred to the local Greek hospital or to a German military hospital. Most wounds were infected, one with gas gangrene, and the medical conditions included dysentery, but there were remarkably few deaths in the two weeks this hospital operated, despite the appalling lack of medical and sanitary facilities and the small amount of food. Some medical supplies were made available from the local Greek hospital. At Kalamata, in the south of Greece, Major G. H. Thomson, NZMC, and British medical officers set up a hospital in a hall.
In Crete the wounded were treated by the medical officers captured with their patients. Those from units near Maleme airfield were concentrated in the Tavronitis valley. Farther back near Canea Captain Ballantyne treated the wounded in his ADS, as did 7 General Hospital and Australian, British, and New Zealand medical staffs at the sites where seriously wounded were gathered on the road to Sfakia. The medical officers did all that their limited equipment would allow. By 23 May the RMOs of 5 Brigade, first Captain Longmore, then Captains Stewart and Hetherington, had joined up with Flying Officer T. Cullen, RAF, and staffed a dressing station in the Tavronitis valley. They worked in a stable attached to an inn. The German medical officers were overworked and were willing to let the captured medical officers page 461 set up their own dressing station for their own wounded with such equipment as the Germans could spare. At the dressing station some 700 cases were put through, with only seven deaths, before the wounded were taken by plane to Athens.
At Ballantyne's ADS near Canea eight patients died of gas gangrene and others of abdominal wounds for whom little could be done. The Germans were generally helpful with equipment, and in arranging early transfers to Kokkinia hospital in Greece. At Lieutenant-Colonel Bull's emergency dressing station at Neon Khorion, four of the 46 wounded died. The Germans were slow to provide medical and surgical necessities. The patients were moved to Maleme on 7 June and then to Greece.
For the sick from the main crowded prisoner-of-war camp near Galatas Lieutenant-Colonel Bull organised a 200-bedded camp reception hospital, and cases included dysentery, malaria, poliomyelitis, diphtheria, catarrhal jaundice, and malnutrition. Between 9 June and 23 September there were 1212 admissions with 23 deaths. (Of the 402 New Zealanders admitted 4 died.)
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.
Salonika Transit Camp Hospital
At Salonika, the most northern port of Greece, there was a transit camp for prisoners of war on their way to Germany. Conditions at the camp were deplorable in every way. In a period of six months some 30,000 prisoners of war were passed through the camp. At a hospital staffed by five British medical officers and thirty orderlies, including some New Zealanders, there were three thousand patients of all nationalities during the period. Seventy-nine of them died. Sickness included malaria, sandfly fever, pneumonia, bronchitis, diphtheria, jaundice, beriberi, nephritis, enteritis, typhoid, typhus, and poliomyelitis. Most of the surgical cases were sent to a Greek hospital under control of the Germans. At one time there were over 800 patients in the transit camp hospital, including ‘through’ patients from Kokkinia and other hospitals. Many of these patients were taken on to Germany, in a journey lasting up to eleven days, in cattle trucks, with straw for a bed and no blankets, very little food, and no medical attention.
Although 15 officers and 182 other ranks of the New Zealand Medical Corps were taken to Italy in December 1941 after their capture in the second Libyan campaign, it was some months before any of them were allowed to care for British wounded. Most of the wounded captured in Libya, including 206 New Zealanders, were taken across the Mediterranean by hospital ship. Some went to a hospital at Bari, where conditions and treatment were poor in the extreme; others went to a hospital at Caserta, where conditions were reasonably good, and where three British medical officers and orderlies who were allowed to work from December onwards were able to bring about improvements in treatment. While the staff was wholly Italian, they did not attempt to wash any of the patients, and bed sores were quite common. There were shortages of instruments and drugs.
As a result of the battles of Minqar Qaim, Ruweisat, and El Mreir in the summer of 1942, 1800 more New Zealanders were page 465 captured and taken to Italy to join the 1600 captured in the Libyan campaign seven months before. From hospitals in Matruh, Tobruk, and Benghazi the 258 wounded New Zealanders were taken to Bari and Caserta, but these hospitals became overcrowded so that the Italians found it necessary to set up special hospitals at Lucca, Bergamo, and other towns. Captured medical personnel were transferred from camps to help staff these hospitals. Thus at Lucca 2 New Zealand medical officers and 80 orderlies were included in the staff of 13 captured medical officers and 104 orderlies who worked under Italians in looking after some 530 patients.
The captured medical officers were apparently expected to do dressings only, but conditions were such that they felt compelled to ‘infiltrate’ themselves to help at operations, where advice could be given to Italian surgeons, whose standards were low. Much of their work was done without anaesthesia. Their treatment of fractures was appalling. They never used anaesthetics for them, made no attempt at reduction, splinted them roughly with plaster-of-paris or starched bandages, and left them to unite in any position of shortening, angulation, or rotation. In cases admitted later, and by that time treated by British medical staff, incomparably better results were achieved.
Lucca was one of the better hospitals: general equipment was satisfactory and there was no shortage of bandages, gauze, and wool, but lotions for dressings were few, most dressing being done with some fish-oil preparation. There was a curious substitute for iodine. Sulphonamides were scarcely known, and the Italians seldom prescribed more than four half-grain tablets a day. (Later, when Red Cross medical parcels arrived, the British officers were able to prescribe the usual doses.) There was no chloroform, and only small quantities of spinal anaesthetic and intravenous pento-thal. There were no splints except Kramer wire, but plaster-of-paris bandages, never more than three inches wide however, were nearly always available. It took about two hours' hard work to put on a good hip spica for a fractured femur, and that with numerous Heath Robinson improvisations by the British staff. Sanitary and washing facilities were very limited in the old hospital building.
Red Cross food parcels began to arrive a few weeks after the prisoner-of-war hospital was opened at Lucca, where the food was rather better than elsewhere but still inadequate, especially in fats; and with their distribution large wounds which had been stubborn in healing commenced to heal as if by magic. Later clothing, boots, and books arrived through Red Cross channels, and patients could be discharged fully clad.page 466
After the fall of Tobruk many prisoners developed malaria in the transit camps of southern Italy, but little treatment was given. Those who reached Lucca were adequately treated as there were good stocks of both quinine and plasmoquine. Dysentery patients from nearby prisoner-of-war camps were common, and from one camp (Campo 60) sited on flat, marshy ground, there were over fifty cases of frostbite in the winter. When 120 starving and filthy Yugoslav patients were admitted after dreadful treatment by the Italians, there was a fear of typhus, but fortunately no cases developed.
Patients with major disabilities had their names sent forward by the medical officers for submission to the Mixed Medical Commission and in due course came before it for approval for repatriation. Arrangements for repatriation were protracted, and, apart from three New Zealand amputees included in a small group of British wounded and protected personnel exchanged in April 1942, not many sick and wounded were repatriated until April, May, and June 1943, when in a series of exchanges 60 sick and wounded New Zealanders and 114 New Zealand Medical Corps personnel were repatriated. A further exchange in September 1943 was prevented by the events of the Armistice in Italy, and medical officers and orderlies were taken north with their patients to Germany, where they continued their work.
Prisoner-of-War Hospitals in Germany
There were four types of hospital in which prisoners of war received medical treatment, namely, general hospitals exclusively for British prisoners, special hospitals exclusively for British prisoners, mixed general hospitals for prisoners of any nationality, and wards in local German hospitals. The hospitals for British prisoners were staffed by British personnel, including New Zealanders, under a German commanding officer. The mixed hospitals were staffed by men of all nationalities, including some New Zealanders. The patients treated in the German hospitals were those in districts where there were no special prisoner-of-war hospitals, or those requiring specialist treatment such as deep X-ray therapy, neurosurgery, or orthopaedic surgery. There were a number of specialists among the British medical officers, and these were employed in the hospitals in their own specialties.
Hospital supplies were generally adequate, and these were supplemented by supplies from the British Red Cross organisation, and also by surgical instruments saved by British medical officers captured in Greece. Improvisation enabled some equipment such as blood transfusion sets to be provided.page 467
Lazarett Lamsdorf is illustrative of a special prisoner-of-war hospital, and it had many New Zealanders on its staff and among its patients.
This hospital, opened on 13 October 1941, was planned to serve the needs of over 30,000 men and was undoubtedly the best designed and equipped hospital for British prisoners of war in Germany. It occupied six acres of flat land in a forest, and its eleven concrete buildings were fitted with double windows and wooden shutters. In every room was a large, efficient tiled stove. Six buildings were self-contained parallel blocks of wards, each holding from 70 to 100 patients. The five service buildings were the staff, administrative, and treatment blocks, kitchen and morgue. In the area was a large brick Red Cross as a sign for aircraft.
The ward blocks were divided into large and small wards with service rooms and with the necessary sanitary conveniences as in a modern hospital. The operating theatres were well equipped with efficient sterilising and full X-ray and laboratory facilities. Although the overall control was in the hands of a German medical officer, full control of the clinical work was given to the British, Australian, and New Zealand medical officers working under a senior British officer. The nursing staff, all medical personnel among the prisoners of war, lived at the hospital, while a daily party of general duty men was drawn from Stalag VIIIB, a mile away. There was a German chief dispenser in control of the stores, but otherwise the staff of the service departments was British. Besides physicians and surgeons there were anaesthetic, ophthalmic, radiological, neurosurgical, psychiatric, and ENT specialists available, either on the regular staff or visiting the hospital from time to time.
A Mixed Medical Commission of one German and two Swiss doctors visited the hospital twice a year to inspect it and also to determine which patients should be repatriated. At first the Germans insisted on all the preliminary investigation being carried out by German staff, thus necessitating the temporary transfer of the patient to a German hospital. Later the clinical reports of the British staff were generally accepted. Full case records were kept, with copies available for the Germans and the original for the United Kingdom, German forms being used. Admissions from the camp were arranged from a waiting list drawn up by the senior physician and surgeon at consultation clinics in the camp, and urgent cases were admitted at any time. Special accommodation was provided for the infectious and mental cases. page 468 The rations supplied by the Germans were meagre, but the Red Cross parcels enabled a satisfactory diet to be maintained, and four meals a day were served in the wards from a communal kitchen.
Entertainment and sport were permitted freely. In general, the Germans appear to have provided an excellent hospital with all supplies satisfactory except the rations, and allowed the British medical personnel to carry out their work with a minimum of control.
Surgical Work: Captain Slater, NZMC, was chief surgeon at Lamsdorf from October 1941 to March 1943 and developed the surgical service. A record of eleven months' work (March 1944 to February 1945) kept by Captain J. Borrie shows that 373 patients were admitted to one of the two surgical blocks. The patients were thoroughly investigated and records carefully kept. The majority were cases of appendicitis, hernia, rectal and genito-urinary diseases, orthopaedic problems, and nerve injuries. Simple fractures and late effects of septic gunshot wounds were common.
Peripheral nerve injuries were operated on by a visiting British neurosurgeon. Herniorraphy was performed under local anaesthesia, and the Germans finally agreed that none should work for three months after such operations. Deep X-ray therapy was administered for malignant cases at the University clinic in Breslau. In 1944 an inter-medullary nail was used with good primary results at the Breslau hospital in a case of mal-union of the femur. For the fracture cases excellent walking calipers and other splints were made by RAMC men from material obtained from Red Cross or German sources. Altogether opportunity was available for the performance of efficient surgical work.
The 432 complaints treated in the 373 patients were: appendicitis, 63; hernia, 50; fractures, 61; genito-urinary, 62; alimentary, 23; rectal, 6; peripheral nerve injury, 29; orthopaedic, 25; spinal disease, 13; joints, 26; osteomyelitis, 25; muscle and tendon, 3; tumours, 13; ENT, 7; minor surgery, 25.
Medical Supplies: There was in Germany the equivalent of most standard British medical preparations in the way of lotions, powders, solutions, ointments, anaesthetics, and sedatives. These were indented for by British medical officers and were apportioned out from central stocks by German dispensers. Some of the earlier sulphonamide drugs (sulphapyridine and sulphathiazole) were supplied to British medical officers by the Germans, but a German sulphaguanidine preparation was not available. Penicillin, of course, was not available.
Throughout the war the German supply to hospitals of cotton bandages, cotton wool, and dressings was inadequate, the standard page 469 issue being paper bandages and paper wadding which were also used for German casualties in base hospitals. The paper dressings were useful as they were absorbent, but the paper bandages were unsatisfactory. Fortunately the British Red Cross sent liberal supplies of bandages, cotton wool, and lint in their medical parcels for prisoners of war.
Medical Equipment: The original hospital instruments consisted of German field hospital panniers, which were not unlike British surgical panniers. In some hospitals, as at Lamsdorf, the Germans issued a sigmoidoscope, a cystoscope, and instruments for laparo-tomy, thoracotomy, spinal anaesthesia, wiring fractures, and plaster work. For intravenous work the Germans had a very useful 2 c.cm. syringe with a side inlet on the barrel. Suture needles were usually of the French or split eye variety. Record syringes and needles were available in all sizes. Silk, cotton, or catgut were used for suturing, and Michel clips were obtainable for skin. Blood transfusion sets had to be improvised. In general the equipment supplied was adequate for most surgical operations done, including even excision of semi-lunar cartilages from the knee joint, and partial gastrectomy.
GENERAL HEALTH OF PRISONERS OF WAR
The health of prisoners of war in Germany and Italy seems to have been much better than one might have expected, and was certainly better than that of those who were prisoners of the Japanese. Fortunately there were only a few New Zealanders captured in the Pacific area, as against over 8000 captured in the North African and European theatres.
Accurate and complete figures of sickness for New Zealanders are naturally not available as our men formed small component parts of many scattered prisoner-of-war camps and working parties, but from general reports the sickness rate was not very high, and no extensive epidemics ravaged the camps. There is no doubt that the presence of so many Allied medical officers and orderlies among the prisoners of war was a contributing factor to their good health, and that the receipt of Red Cross parcels was most important.
These factors were also contributory to a low death rate among the New Zealand prisoners. The death rate per thousand from sickness was slightly over twice as high as the comparative rate within 2 NZEF. There were 105 deaths from sickness, the causes being notified as: pneumonia, 12; dysentery, 12; meningitis, 8; heart, 6; neoplasms, 5; pulmonary tuberculosis, 4; diphtheria, 4; toxaemia, 4; nephritis, 3; peritonitis, 3; enterocolitis, 3; malaria, page 470 2; cachexia, 2; other causes, 25; with causes not notified in the case of 12 deaths. Had sulphonamides and penicillin and other drugs been freely available to medical officers it is likely that the deaths would have been fewer still.
Typhus: Probably the greatest threat to health came from typhus fever, to which thousands of Russian prisoners and many German soldiers fell victim. Typhus fever raged through the Russian camps from November 1941. Two New Zealanders, Captain Foreman and Private Butler, NZMC, who, with Captain Stevenson-Wright, volunteered to go and assist at the hospital at the Russian camp at Neuhammer, developed typhus in March 1942, but both recovered. The sick at this hospital came from the 60,000 Russians in the nearby camp, where conditions were deplorable. Most of the cases treated in the hospital were suffering from starvation associated with hunger oedema, tuberculosis, dysentery, and typhus. The daily diet in the camp consisted of no more than 1200–1400 calories, and the diet for the sick Russians in hospital was 250 grammes of bread, 10 grammes of margarine, 10 grammes of sugar, and swede soup morning and evening. The hospital of twenty wooden barracks, each housing 100 patients, was overcrowded; there was no soap, medical supplies were very inadequate, and there were no laboratory and surgical facilities. There were 100–200 typhus cases in hospital at one time, and 80–90 Russians died each day. As far as typhus was concerned, good nursing was the only possible treatment. This description of the conditions of the Russians gives an indication of what could have been the fate of our own prisoners of war.
On 28 November 1941 there was an outbreak of typhus fever (the German fleckfieber, or typhus exanthematous) at the camp at Lamsdorf, where there were many New Zealanders. The first six cases occurred among medical orderlies who were working in the delousing station, which was used for Russians from adjoining camps as well as for the British camp. Prompt measures were taken by our medical officers. By 2 December all hair had been removed from the heads and bodies of all the 10,000 inmates of the camp, while an anti-louse campaign was in full swing, largely due to the arrangements made by Lieutenant-Colonel Bull with the Camp Commandant and senior German medical officer in regard to isolation, disinfestation, and improved facilities for personal hygiene. In all, 18 British developed typhus, with three, including one medical officer, succumbing.
Typhoid: There were sporadic cases of typhoid but no major outbreak among British prisoners in Germany. Each summer, in May, inmates of most of the large camps were given a 1 c.c. injection page 471 of German standard TAB vaccine. In 1944, at Lazarett Lamsdorf, one patient fatally perforated a typhoid ulcer in his terminal ileum.
Dysentery: Summer diarrhoea and Shiga dysentery occurred from time to time. Rarely was it severe among British working parties. Most cases subsided in two to three days; some were hospitalised in the camps. Amoebic dysentery was not uncommon; it usually required long courses of emetine and yatran before cures were effected. Sigmoidoscopes were available both at Lamsdorf and Cosel hospitals for ocular control of the ulcers. A few liver abscesses were treated at Lamsdorf by aspiration.
Famine Oedema: In Salonika camp from June until September 1941 famine oedema abounded, filling the wards of the hospital. Food and essential vitamins were most difficult to procure, but supplies of fresh fruit from the Greek Red Cross warded off scurvy. With better feeding for the British prisoners in Germany itself, famine oedema was not seen again until the last phase of the war, following semi-starvation on the 600–mile march west from Silesia from January to March 1945.
Tuberculosis: There was a small but steady incidence of tuberculosis. Besides pulmonary tuberculosis some cases of bone and joint tuberculosis were seen. All such patients were given an extra diet containing an increase of protein. About every six months the cases of pulmonary tuberculosis would be transported to Königswartha Sanatorium, where major surgery would be undertaken when indicated.
Conditions at Königswartha were far from satisfactory, as accommodation was very poor, equipment limited, and there was a shortage of staff despite the transfer of British medical officers and orderlies to the hospital in 1942. After the arrival of Lieutenant-Colonel L. E. Le Souef, AAMC, in August 1942, administration, organisation, and treatment all improved, but Le Souef petitioned for better conditions with the result that in March 1943 the patients were transferred to Elsterhorst, where a general hospital for prisoners of war had been specially built. At Elsterhorst facilities for surgery were much better and special thoracic instruments had been obtained by then. Later in the year serial radiography was begun among prisoner-of-war working parties to detect cases of tuberculosis. After being passed by the Mixed Medical Commission, groups of patients were repatriated in October 1943, May and September 1944, and January 1945. All sputum positive cases came in 1944 to be automatically accepted by the German authorities for repatriation, and most of the other cases recommended were approved by the Mixed Medical Commission. The result was that there were few patients left when Elsterhorst was evacuated page 472 in February 1945 from the path of the Russian advance. Lieutenant-Colonel Le Souef was transferred elsewhere in May 1944 and his place as Senior British Medical Officer was taken by Lieutenant-Colonel Bull, NZMC, who published the following statistics of cases. Over 1000 British patients, most of them from the United Kingdom, passed through the hospitals. There were only 22 New Zealanders admitted and two died; but 20 more cases were first diagnosed after repatriation to England in April 1945.
Types of treatment given to the British patients were:
|APT right or left||339|
|APT failed or abandoned||44|
|Pleuroscopy with adhesion section||129|
|Pleuroscopy with section repeated||32|
It can be seen that full scope was given to the modern and the surgical aspects of treatment.
Estimated results of treatment were:
|Results||Conservative||Active (APT, etc.)|
|Number of Cases||Average Stay in Hospital (Months)||Number of Cases||Average Stay in Hospital (Months)|
|Improved||194 (28.17%)||9||185 (47.65%)||9|
|Unchanged||427 (65.39%)||3½||176 (45.36%)||6|
|Worse||32 (6.44%)||13||27 (6.99%)||12|
Improved Negative sputum after original positive.
Improved Normal or only slightly increased BSR.
Improved Increased weight.
Incidence of Active Pulmonary Tuberculosis among British Troops (Pleurisies and Fibrotics Excluded)
|Country of Origin||Numbers of Prisoners||Germany||England||Incidence per 1000|
The actual incidence was higher as a few cases in Germany did not reach the tuberculosis hospitals, and other cases were diagnosed after their return from England to their own countries.page 473
In a survey of War Pensions files at the end of 1949 Dr D. Macdonald Wilson found that 155 cases of pulmonary tuberculosis had arisen among prisoners and ex-prisoners of war, the number of cases diagnosed each year being: 1941, 4; 1942, 10; 1943, 8; 1944, 23; 1945, 70; 1946, 12; 1947, 14; 1948, 6; 1949, 8. Of these, 84 were not X-rayed at enlistment. The incidence among prisoners of war was over double that of the whole New Zealand overseas army group.
Cerebro-spinal Meningitis: In spite of the constant overcrowding of British prisoners of war in Germany there was never any major outbreak of cerebro-spinal meningitis. In one camp, Arbeitskom-mando E3 of Stalag VIIIB, there were three cases in 1943, and yet these occurred among the NCOs, where five men were sleeping in huts instead of the normal 24.
Skin Diseases: Skin diseases, particularly boils, became very prevalent amongst otherwise fit men when serving on working parties in Eastern Germany. Men often in what appeared to be the prime of physical fitness, who took great care of personal cleanliness, who worked in the open clothed only in shorts, would, for no apparent reason, come out in crops of boils, often situated on their arms, their axillae, neck, or face. These boils would frequently spread to become a localised, and at times generalised, weeping eczema, which would take weeks of careful nursing to clear. Nothing could be specifically blamed for their appearance, yet there was a general feeling that it was related to the lack of fresh milk, fresh fruit and vitamins; none of the men was proved to be a diabetic, and few showed any rapid improvement with vitamin extracts. Some men had their annual crop of boils in the winter, some in the summer. Undoubtedly the commonest ailment amongst 1000 men in a working party was skin disease, and of these, boils easily headed the list. One could rely on a steady 50 per 1000 men each month.
The Germans had a staphylococcal vaccine called ‘staphar’, which helped some. Colloidol manganese helped a few. Some even had to be admitted to the camp hospital, while others had to be returned to the main camp as convalescents.
Scabies: Where washing facilities were reasonable scabies was not seen, but in the crowding of the central camps it every now and again made a sporadic appearance. Treatment consisted in sterilising the clothing, either in a delouser or in a Serbian barrel. The skin was shaved and sulphur ointment applied. The Germans also had a colloidal sulphur preparation called ‘pellidol’ which page 474 was sometimes applied. The British Red Cross forwarded disinfectant parcels.
Tinea of the Feet was relatively common and responded to a proprietary preparation of salicylic acid 5 per cent.
Tinea Cruris also broke out from time to time. It usually required admission to the camp hospital, shaving of the pubic region and perineum, and then painting the large butterfly-shaped affected area, which usually extended from the root of the penis back to behind the anus, with gentian violet in spirit, or a German synthetic iodine, or with Whitfield's ointment.
There were also several victims of chronic psoriasis who could keep their ailment in check with chrysarobin for the scalp and cignolin for the trunk. Such men were best sent to working parties with good showering facilities.
Teeth: There was little increase in dental caries attributable to the life and the diet.
Goitre: There was a remarkably low incidence of goitre. In Lazarett Lamsdorf, which did the surgery for 30,000 prisoners of war, not more than ten men had thyroid operations in four years, and all these were for solitary adenoma.
Parasites: Bilharzial infection was seen, but rarely in patients who had come into captivity via the Middle East. It was diagnosed following a history of dysuria and haematuria. The protozoa were found in the urine, and on cystoscopy the characteristic ‘tubercle’ and cystitis demonstrated.
Frostbite: Those British prisoners captured in France in 1940 experienced a bitter winter between 1940 and 1941. No British Red Cross clothing had reached them at that time, and medical officers who treated men on working parties all testified to the minor frostbite which occurred among the men.
Following the great trek from Upper Silesia to Western and Central Germany in 1945, there were cases of frostbite. Major cases were hospitalised en route, and there treated by British or German surgeons. The lesser degrees, i.e., those with dry gangrene of toes, fingers or heels, were transported through to the central collecting camps between Nuremberg and Munich. These cases were treated by wound toilet to remove slough, application of sulphanilamide powder, and non-sticking vaseline (or cod-liver oil in vaseline) dressing. With daily bathing, dressings, and the return of warmer weather, these lesions rapidly began to heal, and were well on the way to recovery at the time of liberation on 6 April 1945.page 475
Prisoners suffered from certain occupational diseases.
Teno-synovitis: Men engaged in lumbering often developed teno-synovitis of the dorsal tendon sheaths of the wrist, and one attack in no way conferred an immunity. It is true to say that one attack predisposed to another, for one attack showed the patient an excellent way of getting a week's rest from work. The real danger to himself was to be labelled a ‘chronic invalid’, because one month's continued ill health meant return from the comparative comfort of a working party to the crowded discomfort of a central stalag.
Those who carried heavy loads of iron bars or cement might contract teno-synovitis in the tendon sheaths of the extensors of the toes, or in the gastrocnemius sheath. There was only one treatment—rest. If on the wrist, the forearm, hand and fingers were splinted on a padded Kramer wire splint, bound up tightly, supported in a sling and left for seven days. Similarly for the leg, except that the patient was also admitted to the camp hospital. No man could be trusted to ‘rest’ in his room.
Foreign Bodies in Eyes: These usually were stone or iron flakes, seen in men working lathes, or near lathes. They were usually readily removed with the aid of a binocular ‘lupe’, cocaine drops, eyelid retractor and eye spud. Sometimes an ulcer developed, requiring cauterising. Major Thomson, RAMC ophthalmologist, dealt with several cases in Lazarett Lamsdorf in which the anterior chamber of the eye was penetrated.
Conjunctivitis: This frequently arose in those near electric welding machines. Refusal to use the goggles provided was the cause of some; others had no goggles to wear. These were provided after protesting via the camp authorities to the Works Controllers.
‘Gefangener's Toe’: This was a compound comminuted fracture of the terminal phalanx of the great toe, the result of dropping a brick or iron bar across the toe. Most were accidents, some intentional. Either way, they were painful, but they insured a two-months' rest from all work.
Treatment under anaesthesia was to remove the damaged toenail, clean up the wound, and dress with sterile cod-liver oil in vaseline dressing. The patient was then admitted to camp hospital (if only to rest the foot), and kept there till the toe healed. These cases were frequently X-rayed to determine the extent of the bony damage. page 476 They were slow to heal, and frequently ended in a deformed toenail which would give trouble later.
Finger Injuries: Crushed middle fingers with completely severed tendons, blood vessels, and nerves necessitated amputation.
Hernia: Occasionally indirect inguinal hernia occurred while working. One man, subjected to operation by a German surgeon in a German military hospital, had bilateral inguinal hernia repaired by Bassini technique, but without excising the sac. One side promptly recurred, requiring a second operation at which the sac was excised.
Varicose Veins: If small, these were treated with injections of sodium morrhuate called ‘Varicocid’. This was partly successful; some were cured, some developed other veins. Larger veins required a Trendelenberg operation with ties in the thigh and calf.
As was only to be expected, mental disorders were in evidence among prisoners of war, but not to the extent that one might think. In general, the psychoneuroses appeared to be related to home conditions and domestic difficulties as disclosed in letters rather than to environmental conditions. There were those who became ‘browned off’ because of bad news from home—the death of a parent, disloyalty of a wife, etc. Several times it fell to medical officers to help initiate arrangements for a divorce.
Some men were mental misfits; they just could not settle down to the routine of the camp life, and asked for a change of working party. Some liked to change once a year, others more frequently. Usually only by way of some medical excuse, real or fictitious, could such change be effected.
Occasionally some member would rebel against British camp discipline. With such there was only one treatment—summary removal from camp, from the security of his environment and his friends.
Homosexuality was said to occur, but it was very difficult to get direct proof of such. Suicides were not common, but there were some suicides both in working parties and large camps. Others who became ‘Stalag happy’ literally tried to climb over the barbed-wire fences, being riddled to death by machine-gun fire from sentry boxes. Try as the British medical officers might, they could never persuade the German authorities to command their sentries that such men as these were usually mental, and that if they must shoot, they should shoot low.