War Surgery and Medicine
IT has been possible to assemble sufficient statistics to give the picture of the incidence of disease in 2 NZEF.
Admissions to medical units from July 1941 to December 1945 (Table I), which covers most of the period after 2 NZEF was built up to strength, shows that much of the sickness was caused by the same diseases as affected troops in New Zealand. The commonest causes of admission to the camp and public hospitals from camps in New Zealand from 1943 to 1945 were, in order, influenza and common cold; diseases of bones, joints and muscles; diseases of teeth and gums (dental treatment of recruits was carried out in camps after their mobilisation); tonsillitis; skin diseases; PUO; venereal disease; scabies; ear and nose diseases; diseases of the nervous system. Most of these conditions were among the twenty most common causes of sickness in 2 NZEF. To them were added infective hepatitis, dysentery, malaria, and sandfly fever, which diseases were endemic to the Middle East, and to which New Zealanders possessed little or no immunity. Devastating diseases of previous wars such as typhoid and typhus fevers caused relatively few cases of sickness, due in part at least to artificially induced immunity, typhoid inoculations being given to troops from the beginning of the war, and typhus inoculations from late 1943.
In actual man-days it is likely that the skin diseases, infective hepatitis, and dysentery and diarrhoea caused the greatest wastage, with malaria, pneumonia and venereal disease next in order. Infective hepatitis kept the most seriously ill patients in hospital and convalescent depot for some six weeks, and pneumonia and some of the skin diseases caused almost as long hospitalisation.
The findings agree substantially with those of the British Army, which has more complete statistics. In the British Army in the Middle East Force in 1943 the greatest wastage was caused by malaria, infective hepatitis, tonsillitis and pharyngitis, bacillary dysentery, and psychiatric disorders in that order. In the British Army in Italy in 1944 the order was malaria, infective hepatitis, venereal disease, cellulitis and IAT, dysentery and diarrhoea.page 749
Sufficient figures are available to compare 2 NZEF and 2 AIF in the Middle East as regards incidence of dysentery, malaria, and venereal disease (Table II). In 1940 the 2 NZEF dysentery rate was over double that of 2 AIF, but in 1941 and 1942 there was not much difference. The malaria rate was similar in 1940, but the AIF had a much higher rate in 1941, and the NZEF had a higher rate in 1942. This corresponds with the years the respective forces were in Syria. For venereal disease 2 NZEF had the higher rate in 1940, but the rate improved considerably in 1941 and 1942, whereas the AIF rate increased to be double that of 2 NZEF.
The morbidity figures for 2 NZEF from 1943 to 1945 (Table III), remembering that most of 2 NZEF was in Italy in 1944 and 1945, show some contrasts as between Egypt and Italy. Dysentery, malaria, sandfly fever, and otitis media were more common in 1943 than in the later two years. In 1944 there were rises in the incidence of infective hepatitis (from an epidemic similar to that of 1942), pneumonia, diarrhoea, areolar disease, nervous disease, and venereal disease. Pneumonia doubtless increased as a result of the wet winter conditions, nervous disease possibly from the strenuous battle conditions at the Sangro, Cassino, and Florence, and venereal disease as a result of more readily available sources of infection.
The number of evacuations of sick and wounded from 2 NZ Division alone, and also the discharges to divisional units from Field Ambulances, during the campaign in Italy are shown in Table IV. The number evacuated from their units in one year almost equalled the numerical strength of the Division, though those able to be discharged to their units from Field Ambulances and the mobile venereal disease treatment centre did not leave the divisional area. Cases shown as NYD Fever would have been diagnosed at CCS or General Hospital, but the breakdown of this group is not known.
The fresh cases admitted to medical units each day averaged about 2 per 1000 strength (TableVa). The percentage of the Force in medical units at any one time varied from 3 to 13, depending on the number of battle casualties and the occurrence of epidemics such as infective hepatitis. Sickness cases in medical units averaged 4–5 per cent, but during the periods when the Division was actively engaged the addition of battle casualties raised patients in medical units to an average of over 8 per cent of the Force (TableVb).
Sufficient hospital beds had to be available for normal sickness and seasonal epidemics, as well as for battle casualties and the accidentally injured. TableVc shows the occupied bed states for base medical units in 2 NZEF over the year May 1942 to April 1943. page 750 The period July—December 1942 was a period of strain due to numerous battle casualties from the Alamein Line and an infective hepatitis epidemic. The monthly average of 2189 beds occupied in hospitals and 782 at convalescent depots is thus probably higher than the average over a longer period, but there was at times almost as much strain when one of the hospitals was shifting to a new location. An estimate in May 1945 by the DMS 2 NZEF gave the average number held in all base medical units at one time as 2100. Of these, it was estimated that 1500 would be sick, 300 accidental injuries, and 300 battle casualties. The average monthly addition to the invalids awaiting evacuation to New Zealand by hospital ship was judged to be 120, of whom 90 would be sick and 30 battle casualties.
Table VI, invalids evacuated to New Zealand, 1940–45, indicates the conditions for which soldiers were incapacitated for further service overseas. Nervous diseases and the group of bone, joint, and muscle diseases were the causes of most invaliding, while respiratory, digestive, and skin diseases contributed sizeable totals. It should be noted that most of these conditions were not peculiar to the particular theatre of service, but could have applied to any force, even in New Zealand itself. The New Zealand force in the Pacific had the same experience. For instance, tropical diseases as such were not the cause of very much invaliding to New Zealand, but conditions overseas, such as the heat and dust in the deserts of North Africa, caused conditions to ‘flare up’ whereas they might have remained quiescent in New Zealand in the troops concerned.
(From 1 NZEF in France major causes of invaliding to New Zealand apart from war wounds (Table VII) were nervous diseases, tuberculosis, respiratory disease, diseases of the circulatory system, impairment of the organs of locomotion, diseases of the eye, ears and nose, diseases of the digestive system, and effects of gas. Evacuations for skin disease were notably few.)