War Surgery and Medicine
FIRST WORLD WAR
FIRST WORLD WAR
IN the Middle East in the First World War the troops of 1 NZEF suffered from dysentery, as did their successors in 2 NZEF. All fresh troops were subject to attacks of diarrhoea, and large numbers of the more serious cases were hospitalised for dysentery. It was noted that New Zealand troops in general were more prone to dysenteric infection and suffered more severe attacks than did British or Indian troops.
The presence of horses in the lines in base camps in Egypt in the First World War made it difficult to maintain a high standard of hygiene. Throughout Egypt flies abounded in incredible numbers, and the general living conditions of the civilian population were worse than they were during the Second World War. On the Gallipoli Peninsula the sanitary and living conditions were exceptionally difficult. Referring to bacillary dysentery the British Medical History stated that it ‘was prevalent throughout the whole war. It first claimed serious attention when it broke out in epidemic form in Gallipoli in August 1915, where in three months it was responsible for a high proportion of the 120,000 casualties evacuated from the Peninsula on account of sickness.’ Many of the cases from Gallipoli were caused by the Shiga bacillus.
Figures for the total incidence in 1 NZEF are not available, but reports from 1 NZ General Hospital at Abbassia show that between 1 July 1915 and 31 March 1916 there were 6836 patients admitted, and of these 2524, or 37 per cent, suffered from diseases of the alimentary system. Dysentery and infective enteritis accounted for 1156 of the group, the highest incidence being in August and September. (Dysentery was earlier prevalent in the Samoan Expeditionary Force.)
In France the conditions of trench warfare were such as to make it difficult to maintain an efficient standard of sanitation. On the Somme in 1916 there was an outbreak of bacillary dysentery, mainly Flexner in type. There were 81 deaths from dysentery in 1 NZEF overseas.
No specific treatment for bacillary dysentery was available, and the attacks were often prolonged and very debilitating. Amoebic page 480 infection was treated with emetine both by injection and by mouth. A British survey published in Diseases of the War shows that for 2319 cases of dysentery from Gallipoli the time of treatment averaged seventy-five days. It was estimated that amoebic dysentery formed about 10 per cent of the dysentery cases from Gallipoli, 2 per cent to 7 per cent of the cases from Egypt and Palestine, and 2.8 per cent of the cases in France.
Experience in New Zealand between Wars
Dysentery did not cause any great civilian health problem in New Zealand after the return of 1 NZEF. Pensions cases were few. At 31 March 1924, for all forms of gastro-intestinal disease, there were only 43 men permanently on pension and 271 temporarily on pension. Some cases of amoebic abscess of the liver were recorded in ex-servicemen who had served in the Middle East. Occasional cases of amoebiasis have been diagnosed as late as 1948 and the infection attributed to First World War service, with the infection lying dormant since that time. Amoebic dysentery was not made a notifiable disease by the Health Department until 1926 and the first case was not notified until 1933. No further case was notified until 1941.
In the light of the experience with returned servicemen of the Second World War it is probable that a considerable number of those who returned from the First World War not only harboured amoebic infection, but also suffered various grades of ill-health, possibly for years afterwards. Such cases were either unidentified or, if pensioned, probably diagnosed as debility or neurasthenia. In many cases the infection probably remained inactive, and in most cases probably died out after a time.