War Surgery and Medicine
CHAPTER 26 — Incidence of Disease in 2 NZEF
Incidence of Disease in 2 NZEF
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.)
As regards deaths from disease the record of 2 NZEF was a good one, aided by spectacular advances in medicine. There were only 190 deaths in 2 NZEF from 1939 to 1945, as against 1579 in 1 NZEF from 1914 to 1918 (Table VIII). It has to be noted that 1 NZEF had an average strength nearly half as great again (in round figures 40,000 as against 30,000), but its period was 4 years 2 months against nearly six years. The most notable reductions were in deaths from pneumonia, influenza, tuberculosis, typhoid, dysentery, and malaria. Most of the deaths in 2 NZEF could have occurred normally in a civilian population, except a page 751 handful of deaths from dysentery (8), typhus (6), infective hepatitis (6), and malaria (2). The death rate is almost exactly equal to that for deaths from natural causes for the RNZAF in New Zealand—100 deaths for a force of average strength of approximately 16,500—and very similar to the rate for the army in New Zealand. The average age of the forces in New Zealand was probably somewhat older.
In the group of 8000 who were prisoners of war, most of them for nearly four years, there were 105 deaths from disease (Table IX). Doubtless there would have been more deaths but for the good work of Allied medical officers in captivity and the steady arrival of Red Cross parcels.
Other wastage occurred with troops who had to be downgraded, although many did useful work as graded men. The causes for down-grading at 31 December 1944 (Table X) show that functional nervous disorders, pes planus, and hallux valgus predominated (a large proportion of the foot disabilities was mainly psychoneurotic in origin). Battle wounds and accidental injuries caused a number of down-gradings, but many of these were only temporary. Debility and various diseases of bones, joints, and muscles came in the next large group. Each month a number of men who had further deteriorated in condition were boarded for return to New Zealand. Their places in the ranks of graded men were usually more than filled by new down-gradings, so that the number of graded men was a steadily mounting total. Thus the number in 1944 is larger than it was in the earlier years of the war, although the causes of down-grading varied little.
2 NZEF (IP)
In the Pacific Force (2 NZEF IP) the causes of admissions to medical units were very similar to those present in the Middle East. Table XIA for the year June 1943 to July 1944 shows skin diseases as easily the most frequent cause, followed by septic sores, malaria, dengue, tonsillitis, dysentery, diarrhoea, PUO, influenza, and nervous diseases. There were very few cases of infective hepatitis, pneumonia, and venereal disease. As in the Middle East, the malaria figures were kept low by a carefully planned campaign by the medical services. Deaths from disease numbered only sixteen.
Invalidings to New Zealand arose principally as a result of neurosis, skin disease, asthma, and diseases of the joints (TableXIB). page 752 In down-gradings for base duties these conditions were also prominent, as were diseases of the ear, and pes planus and pes cavus.
In 2 NZEF, MEF and CMF, deaths from accidental injuries (314) totalled more than deaths from disease (190).
The Statistical Report on the Health of the (British) Army states that deaths from injuries in the Middle East Force in 1943 were only two-fifths of the deaths from disease. The explanation of the difference in proportion is probably that accidental injuries were higher in the New Zealand Force because of the high degree of mobility of 2 NZ Division, and the deaths from disease in 2 NZEF may also have been at a lower rate than for the British Army as a whole.
In 2 NZEF (IP) there were 16 deaths from disease, but 34 from accidental injuries, including 4 from burns.
War Disablement Pensions
War disablement pensions granted up to 31 March 1950 are shown in Table XII. The statistics apply to all three services. The number of servicemen demobilised from overseas service up to 31 March 1951 was 145,054, and from home service 66,734, and the pensions granted at least temporarily to these groups were 43,087 and 10,551 respectively. It will be noted that service within New Zealand alone gave rise to nearly one-fifth of the pensions. The generous outlook as regards pension administration means that some pensions have been paid for pre-enlistment disabilities not detected at the enlistment of recruits, and to some extent explains why nervous disabilities constitute the most numerous group.
Some claims for pensions were coming in seven years after the end of the war, but their numbers were more than offset by the steady reduction in the number of temporary pensions paid. At 31 March 1950 the temporary pensions for Second World War service were 13,011, and the permanent pensions 10,065. Over 76 per cent of all the pensions were assessed at less than 40 per cent disability. Unfortunately, details of the disabilities of these groups are not available. It is of interest to note that 13,585 permanent pensions and 230 temporary pensions were being paid at 31 March 1950 for ex-servicemen of the First World War, and that 49 per cent of these were assessed at less than 40 per cent disability.page 753
|Disease||No. of Cases, July 1941 to December 1945||Percentage of all Sick Admissions|
|Nervous and physical exhaustion||1013||1.26|
|Otitis media and externa||1959||2.44|
|Total sick admissions||80215|
Wastage is related to duration of stay, and figures for the British Army MEF in 1943, for Hospital and Convalescent Depot combined, were (in days): Dysentery, 17; infective hepatitis, 40; PUO, 11.8; malaria, 24.4; pneumonia, 42.2; bronchitis, 24.6; common cold, 10.2; sandfly fever, 10.6; psychiatric disorders, 36; otitis media and externa, 24.5; tonsillitis, 14.3; venereal disease, 19.2; dermatitis, 32; boils and carbuncles, 24.3; scabies, 10.5; rheumatic conditions, 24.3.
Average: 24.7 days.
|Average strengths for||Aust||NZ||Aust||NZ||Aust||NZ|
|Hepatitis and catarrhal jaundice||545||2990||647|
|Nervous and physical exhaustion||329||558||114|
|Asthma and bronchitis||437||557||223|
|Blood and blood-forming||103||100||78|
|Teeth and gums||125||209||241|
|Nutrition and metabolism||16||12||6|
|Bones, joints, muscles, etc.||961||1201||558|
|Infection and infestation||2133||3353||3484|
|Average strength of 2 NZEF||31554||32538||26557|
In the Statistical Report on the Health of the British Army, issued by War Office, it is reported that in Italy in 1944 the mean duration of stay in hospital and convalescent depot was slightly less than 3½ weeks for disease, 4 weeks for accidental injuries, and nearly 7 weeks for battle casualties. A much higher proportion of the last-mentioned went to convalescent depot than of either of the other two classes.
|18 Nov 1943 to 17 Nov 1944||18 Nov 1944 to 30 Sep 1945|
|Discharged to unit from Field Ambulances||3740||2500||(estimated)|
|Battle casualties||4833||2441||(war ended May 1945)|
|Average strength of Division||20,500||18,000||(approx)|
The number of first attendances at RAPs (incl BCs) averaged 4405 for the months December 1944 to September 1945. With BCs excluded the average was 4205 per month.
|Sick &||Sick &||Sick &||Sick &|
In 1944 and 1945 the first figures for each month refer to Italy only.
The only two large epidemics (those of infective hepatitis) are reflected in the high figures for autumn 1942 and autumn 1944.
|All Hospitals||Convalescent Depot and Rest Homes|
|1 May 1942||1386||256|
|1 Jan 1943||2067||688|
|Average over twelve months||2189.2||782.9|
An estimate in May 1945 gave the average number held in all base medical units at any 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 of invalids for evacuation to New Zealand by hospital ship was judged to be 120, of whom 90 would be sick and 30 battle casualties.page 757
|Blood and glands||65|
|Bones, joints, and muscles||908|
Average strength of 2 NZEF, 30,000 (approx.).
|Gastric and peptic ulcer||51|
|BLOOD AND GLANDS||65|
|BONES, JOINTS, AND MUSCLES—|
|Pes planus and cavus||70|
|Tubercle of the lung||960|
|Other tuberculous disease||125|
|Other general diseases||1753|
|Nervous system and shell shock||1370|
|Eye, ear, and nose||1012|
|CPDI (pulmonary, indeterminate)||283|
|Other respiratory diseases||1293|
|Urogenital system and suprarenals||448|
|Organs of locomotion||1874|
|Effects of gas||567|
|Other general injuries and trench foot||80|
|Tubercle of lung and amputation of leg||3|
|CPDI and amputation of leg||1|
|2 NZEF, MEF and CMF, 1940–45||1 NZEF, 1914–12 Nov 1918 (Carbery)|
|Follg otitis media||5|
|Appendicitis and peritonitis||15||40|
|Acute abdominal conditions||8||14|
|Nervous diseases, functional||751|
|Pes planus, hallux valgus, etc.||178|
|Other diseases bone and muscle||49|
|Otitis media and externa||39|
|Nervous diseases, organic||25|
|Tumours and cysts||9|
|Disability||For Return to NZ||For Base Duties|
|Pes planus and cavus||13||103|
Some 60 officers are not included in the total of those graded for base duties. Some of those graded for base duties were probably reboarded later for return to New Zealand.page 761
|Area of Service|
|Class of Disability or Disease||Overseas||Japan||New Zealand||Total|
|Infections and infestations||1869||9||112||1990|
|Ear, eye, and nose||6418||15||1317||7750|
|Circulatory and blood system||1925||1||985||2911|
|Metabolism and endocrine system||380||1||172||553|
|Diseases of bones, joints, muscles||5003||4||1807||6814|
|Gunshot wounds and accidental injuries to bones, joints, and soft tissues||5997||23||1183||7203*|
|Tumours and neoplastic growths||149||48||197|
The total disablement pensions in force at 31 March 1950 for servicemen of the Second World War was 23,076, of whom 10,065 were classified as permanent and 13,011 as temporary.
The percentage of disability of these cases was:
|Percentage of Disability||Permanent||Temporary||Total|
It has not been possible to obtain an analysis of the disabilities for which pensions were still being granted at this date.page 762
This volume was produced and published by the War History Branch of the Department of Internal Affairs
|Editor-in-Chief||Sir Howard K. Kippenberger, kbe, cb, dso, ed|
|Medical Editor||T. D. M. Stout, cbe, dso, ed|
|Associate Editor||M. C. Fairbrother, dso, obe, ed|
|Sub-Editor||W. A. Glue|
|Illustrations Editor||J. D. Pascoe|
|Archives Officer||R. L. Kay|
|Draughtsman||L. D. McCormick|
the author: Colonel Stout was educated at Wellington College and at Guys Hospital, London. He served overseas for the whole period of the 1914–18 War, first in the Samoan Advance Force and then in Egypt, Salonika, France, and England. He was attached to 1 NZ Stationary Hospital and was seconded with a New Zealand surgical team to British casualty clearing stations during the battles of the Somme and Vimy. He was later Surgical Divisional Officer at 1 NZ General Hospital at Brockenhurst and acted as Consultant Surgeon 1 NZEF at the later stages of the war. He was awarded the DSO and OBE and mentioned in despatches. After the war he was attached as Surgical Consultant to the Trentham Military Hospital and later acted as surgical examiner for the Pensions Department throughout the inter-war period.
Proceeding overseas with the Second Echelon in May 1940, he served with 2 NZEF in England, Egypt, Greece, North Africa and Italy, first as Surgical Divisional Officer 1 NZ General Hospital and, from May 1941 till October 1945, as Consultant Surgeon 2 NZEF. He was awarded the CBE and mentioned in despatches.
In civil life Colonel Stout held the position of Senior Surgeon to the Wellington Hospital from 1920 till 1945, since when he has been an honorary Consultant Surgeon to the hospital. For many years he was a University lecturer in surgery and also an examiner in surgery to the University of New Zealand. He has played an active part in the British Medical Association and has held the position of President and Chairman of Council of the New Zealand Branch. He was also for many years on the New Zealand Committee of the Royal Australasian College of Surgeons. He has been associated with the University of New Zealand as a Member of Senate and also as a member and chairman of the Victoria College Council and as a member of the Massey College Council.
* Does not include all gunshot wounds, e.g., those of abdomen are included in digestive system.