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The New Zealand Medical Service in the Great War 1914-1918

II. Dysentery at Anzac

page 542

II. Dysentery at Anzac.

In the text it is stated that the earlier forms of Dysentery seen at Anzac were Amœbie. In order to avoid discussion on a highly contentious matter the references in the text are solely to contemporary documents and express the current opinions. But the following passage from the official history, Medical Service General History Vol. III. page 432 illustrates a conflicting opinion held by many Pathologists.

"After the evacuation of Gallipoli a large proportion of the troops, mainly Australian and Indian were employed in the Canal Zone. It is not surprising therefore that the two main diseases noted were Dysentery and Malaria. The Dysentery was a relic of Gallipoli, and was at first diagnosed almost universally as being amœbie in type owing to the fact that in the protozoological examinations Entamoeba, Coli had been mistaken for Entamoeba Hystolitica. As soon, however, as the laboratories were staffed with men trained in tropical medicine the true nature of the disease was shown to be bacilliary, and this continued to be the prevailing type throughout the campaign, although there was a certain proportion of true amœbic dysentery amongst Indian troops brought by them to the country."

A final review of the matter was made at the Annual Meeting of the British Medical Association, held in London in April, 1919. At this great congress most of the pathologists and sanitarians of England, the Dominions and the United States of America who had worked in the war zones were present. The conclusions arrived at were these: Dysentery is a disease of great military importance. Most diarrhœas occurring in armies are Dysentery; and the incidence of Dysentery in armies is directly proportionate to the activities of the pathologists. The knowledge obtained during the Great War was very valuable but much work and time will be required to reconcile the various divergencies of opinion and the controversies which have arisen in the attempt to explain and interpret the results of experimental observation.

As regards Amœbic Dysentery, the Liverpool School of Tropical Medicine had recently shown that infestation by Entamoeba Hystolitica is universal in England and apparently without pathological significance. Professor Yorke in his paper read at the Annual Meeting gave the results of over 4000 examinations of convalescent dysenterics. He found 11.5 per cent. of Entamoeba Hystolitica carriers. He pointed out that until recently carriers of Entamoeba Hystolitica were regarded as dangerous to the community and that it was held that so long as a man harboured the cysts he might be subject to a relapse of acute dysentery or to hepatic abscess; but, as the result of the examination of a very considerable number of persons who had never been out of England, it became clear that Entamoeba Hystolitica was indigenous to England and had been so probably from time immemorial. Thus, among 1,098 young recruits 5.6 per cent, were carriers and in 207 lunatics there were 9.7 per cent. Miners in South Wales were found to be more heavily infected than the rest of the community. These figures coincided with those of O'Connor and Wenyon in Egypt in 1917, where 5.3 per cent. of the healthy soldiers and 13.7 per cent of healthy natives were shown to be carriers.

In 1916 Clifford and Dobell carrying out investigations initiated by Wenyon showed that out of 110 New Zealanders from Gallipoli 11.8 per cent. were infested by Entamoeba Hystolitica.

As there is no character by which it is possible, with certainty to distinguish the vegetative stage of Entamoeba Hystolitica from Entamoeba Coli an error in diagnosis was easily made more especially having in view the high carrier rate of the normal soldier population in Egypt; hence possibly the confusion in the early diagnosis of the "Gallipoli flux.' We may conclude, then, that by far the greater part of the disease was Baccilliary not Amœbic Dysentery. The baccilliary dysenteries of the Balkans and Gallipoli were "Shiga" in type.

(for references see Bibliography Appendix II.)