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War Surgery and Medicine

Tropical Macrocytic Anaemia

Tropical Macrocytic Anaemia

There was a fairly widespread anaemia among New Zealand troops in New Caledonia, particularly 4 General Hospital staff, in the early part of 1943. It was more marked among female staff. The same anaemia occurred to a less extent among United States personnel. An investigation was made by Colonel Sayers, assisted by the medical officers of 4 General Hospital. Apart from undue tiredness there was a striking absence of symptoms, and no evidence of other deficiency disease. Sore tongues, peripheral neuritis, and scorbutic symptoms were absent. The anaemia was found to be macrocytic in type. It appeared to be of nutritional origin and was probably due to a deficiency of some element in the Vitamin B complex.

In assessing the dietetic factors, the following points should be emphasized:

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The New Zealand troops were confronted with a diet (US Expeditionary Force Menu No. 1) to which they were entirely unaccustomed.


Owing to strong food dislikes the troops did not consume very important elements of the diet. This included valuable biological protein and a large proportion of the Vitamin B complex.


The cooks were inexperienced and ill-trained, especially in the preparation of canned and dehydrated foods.


Owing to the constant bad weather, the almost constant presence of pest mosquitoes, and the unattractiveness of the diet to their own particular palates, the personnel studied, especially the female hospital staff, missed many meals, preferring to remain in their tents under mosquito nets. There was a considerable all-round loss of body weight.


If the complete diet as laid down in Tropical Menu No. 1 had been supplied and consumed it is most unlikely that any anaemia would have developed. The complete diet was not supplied, and the food as prepared was not eaten in sufficient quantity, and no fresh food of any sort was available.

The following measures were taken. New cooks were appointed to the hospital and instructed in the preparation of dehydrated foods. A full-time messing officer was appointed. Marmite and Bemax were placed on all mess tables at all meals. Fresh fruit, vegetables, and meat were provided.

As regards treatment, patients with the anaemia responded immediately to the administration of liver extract and Vitamin B concentrates, but iron therapy, Ferri et Ammon Cit. 90 grammes a day, did not appear to influence the course of the anaemia. The anaemia soon disappeared, and a year later there was no evidence of its recurrence in New Zealand or other troops in New Caledonia.