The New Zealand Medical Service in the Great War 1914-1918
I. Note on Medical Arrangements for the Landing at Anzac.
The Official History of the War, Medical Services General History, Vol IV., gives much valuable information on this point, some of which is not referred to in the text of this book. The general tenor of the commentary on the failure of the wounded evacuations is as follows:—
|(a)||The initial failure of the medical services was due to difficulties with which not only the Medical but all other Administrative Services had to contend and was the result of a lack of previous training in amphibious operations and, more especially, to a miscalculation of the extent of the opposition. The original scheme prevised a rapid and considerable advance inland and the retention of wounded ashore for two or three days at least. The 15th, the 16th, and the 2nd Australian Stationary Hospitals were to be landed at once to receive the casualties.|
|(b)||The necessity for using the transports for wounded was not seriously considered, consequently they were not equipped for the reception of casualties.
"This seems an unfortunate oversight, for if there was any intention whatever to accommodate serious cases on the transports adequate equipment should have been provided…. What ever fault there was lay in the neglect to make provision for a reverse at the landings…. The conditions were worse at Anzac owing to want of small craft and of organisation for loading ships. The responsibility for this did not rest with the medical authorities…. There was neither means nor room for retaining the casualties ashore for the treatment or until they could be sorted out for embarkation on hospital ships or transports, as had been intended: It was imperative to clear them from the beaches as rapidly as possible. Unfortunately the arrangements for doing so broke down and the utmost confusion prevailed. There was no guiding or directing hand. The D.M.S. was on the Arcadian but the use of the wireless for obtaining information of what was happening was denied him. Classifying the casualties into seriously and slightly wounded became impossible—seriously wounded were embarked on the transports and slightly wounded on the hospital ships. The Gascon Hospital Ship, for example, had received 300 slightly wounded the first day and was consequently more than half full with that class of case and unable to take its proper complement of seriously wounded."
|(c)||The official history supports the contention of Colonel Nevile Manders, our A.D.M.S., that Lemnos would have made a suitable base for holding the seriously wounded as the following passage shows:—
"But it would have been feasible to establish hospitals with a large amount of accommodation on the Island of Lemnos, and if this had been done in anticipation of the landing on the Peninsula much of the trouble would have been avoided. The wounded could have been received there in the first instance and arrangements could have been made for their further evacuation to Egypt, Malta, and England. Unfortunately no hospital arrangements had been made on shore at Mudros nor any medical administration established there until towards the end of May."
As evidence of the feasibility of the establishment of General Hospitals on Lemnos it is to be noted that at the end of December, 1915, there were actually 2 general hospitals, 4 stationary hospitals and 1 C.C.S. open at Mudros with an aggregate bed state of 6,336 beds and a possibility of expansion to double that number.
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.)
III. Scale of Rations on Gallipoli.
G.R.O., Q.M.G., 13th April, 1915.
Rations Scale of:—
The scale of Rations after leaving Egypt will be:—
- 1¼ lbs. Fresh Meat or 1 lb. (nominal) preserved meat.
- 1¼ lbs, Bread or 1 lb. Biscuit or 1 lb. Flour.
- 4 ozs. Bacon.
- 3 ozs. Cheese.
- 2 ozs. Peas, Beans or dried Potatoes.
- ⅝ ozs. Tea. ¼ lb. Jam.
- 3 ozs. Sugar.
- ½ oz. Salt, 1/20 oz. Mustard, 1/36 oz. Pepper.
- 1/10 gill Limejuice. at discretion of G.O.C. on recommendation of S.M.O
- ½ gill Rum. at discretion of G.O.C. on recommendation of S.M.O
- Tobacco not exceeding 2 ozs per week at discretion of G.O.C. on recommendation of S.M.O
M.E.F., G.R.O. 2nd May, 1915.
"The issue of Cigarettes, Tobacco and Matches to troops is approved."
M.E.F., G.R.O., 294, 18th June, 1915.
"The following scale of equivalents will obtain when the various commodities are available."
- 4 ozs. Jam. 6 ozs. Preserved Meat, or
- 4 ozs. Jam. 10 ozs Fresh Meat, or
- 4 ozs. Jam. Golden Syrup, or
- 4 ozs. Jam. 3 ozs. Cheese.