War Surgery and Medicine
Some of these points were found out by experience in dealing with desert sores in 1940. This diagnosis was often loosely applied to any localised septic lesion of the skin, occurring under desert conditions. It was thought to be a disease peculiar to the Middle East, but proved to be a staphylococcal impetigo modified by the local conditions. Streptococci were also found in the sores and were, some thought, largely responsible for the infection.
The lesions favoured the parts of the limbs exposed to dust and sand, and under conditions of poor resistance sometimes spread into the deeper layers of the skin, where they ulcerated and formed ecthyma. In almost every theatre of war in hot climates, ecthymatous sores were a constant trouble and caused marked discomfort, a serious loss of efficiency (especially among armoured vehicle personnel), and some sick-wastage.
When the First Echelon was at Baggush in September 1940 desert sores became prevalent. These septic sores were infrequent page 690 at Gerawla, where there was little dust and much sea bathing. At Baggush there was much dust and the troops were farther from the sea. The passage of motor transport in the coastal area of the Western Desert raised a fine, flour-like dust which pervaded everywhere and infected cuts, abrasions, and insect bites. It easily penetrated through the meshes of an ordinary gauze bandage and dressing, and in addition to being a means of reinfection it mechanically irritated exposed tissues. Acting on these facts, some of the New Zealand medical officers found dressings of an occlusive nature most successful. Where ordinary eusol and flavine dressings were found ineffective, dressings of saline or sodium sulphate covered with elastoplast for several days promoted healing. Such treatments became standard. Two important principles were to avoid doing anything mechanically or by the use of chemical agents which would damage the islets of epithelium on which healing so much depended, and to avoid maceration of the skin surrounding the sore as this led to extension. In Palestine an AAMC committee reached similar conclusions regarding the sores, and developed a similar treatment. Knowledge of effective methods of treatment limited the number of evacuations from the Division to base hospitals.
In the summer of 1941, when the New Zealand Division was in the Western Desert again, desert sores again proved troublesome. When RMOs were circularised with details of a new occlusive treatment found effective in 7 Armoured Division, admissions to medical units decreased. The treatment involved the use of an ointment made by crushing a tablet of sulphapyridine in 2 oz. of paraffin molle flavine and the covering of the sore with elastoplast or sticking plaster for three to five days.
In September 1942, after the Division had been fighting continuously in the Desert for two and a half months, there was an increase in septic skin conditions entailing admissions to hospital. In the belief that if the undue dryness of the skin caused by sun, wind, and dust could be relieved the incidence of desert sores would drop, the British authorities made a move to issue a cold cream to the troops as a prophylactic agent. But the Battle of Alamein led to such a fast advance that the cold cream never reached the units where it was most needed. In Italy in the cooler climate these septic skin conditions were much reduced in incidence. The introduction of sulphonamides, and later of penicillin, helped to obviate in the Middle East the enormous sick-wastage which had occurred in the war of 1914–18, though injudicious use of local sulphonamide treatment not infrequently led to sensitisation and the development of an eczema.page 691