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

Operations on the2nd October, 1916

Operations on the2nd October, 1916.

The last operation, in which the New Zealand Division was engaged, was the taking of Eaucourt L'Abbaye by the 47th Division—now returned to our left—a hard fought soldiers' battle lasting two days and costing us many casualties. The 2nd Brigade were chiefly engaged although part of the 3rd Brigade was employed on the right. At 2.30 p.m. on the 2nd of October, the whole of the corps artillery was turned on in front of the New Zealand lines covering nearly 2000 yards,—no other division of the XVth Corps was moving—with this barrage oil drums ejected from mortars were mingled which, bursting after they landed, drenched the enemy trenches in sheets of flame. Our assaulting columns met with fire heavier than usual but, in spite of serious losses, had secured their objectives and a bit more than was required by 5 p.m. The oil drums had worked dreadful havoc; two groups of German dead, some 30 in all, were found in a holocaust so burnt as to be unrecognisable. But our casualties for the day were heavy: 106 killed, 108 missing, 378 wounded, of which some were reaching the A.D.S. by 5 p.m.— mostly severe wounds—many compound fractures. Rain fell during the night. By 6 a.m on October the 2nd, 84 stretcher page 221cases and 148 sitting had already passed through the Flat Iron and wounded were coming quickly all that day. The motor ambulances were able to get up as far as Thistle Dump, evacuating from there direct to M.D.S. By 6 p.m. 388 wounded had cleared the A.D.S. and the R.A.P.'s were reported clear. The carry was long and very difficult for the bearers as the ground in the open was much churned up owing to the rain. On the 3rd again it rained, but the wounded came in steadily and by the 4th no New Zealand wounded remained in the field. The total wounded for the three days was reported to be 772.

In heavy rain the lean, exhausted units of the division were relieved by the 41st Division after 23 days' fighting, with a total reported loss of: 61 officers killed, 3 missing, 198 wounded; other ranks, 1036 killed, 702 missing (of these only 22 prisoners, nearly 500 killed), 4745 wounded, a total casualty list of 6743, exclusive of the sick, well over a third of the effectives. The medical units were relieved by the ambulances of the 41st Division.

The only units to remain were the N.Z.F.A, Brigades who long before the division arrived had supported the corps front and who still were in action when their comrades shook the mud of the Somme battlefields from their numbed feet. Of the medical arrangements of these units, there is not much to know, their medical officers living at Brigade Headquarters, visiting their batteries from time to time, their wounded carried direct to the nearest advanced dressing stations, all too close in some instances to the batteries. On the 21st October, Captain N. F. Hitchcock, N.Z.M.C., R.M.O. to the 2nd Brigade, N.Z.F.A., was killed instantly with two artillery officers by a shell which penetrated the Headquarters dugout of the 5th Battery. A most painstaking and faithful R.M.O. who joined his Brigade at Moascar. This made the third officer we lost at the Somme. The total losses of the N.Z.M.C. were 3 officers killed in action, or died of wounds, 3 officers wounded, 15 O.R. killed, 89 wounded, being a third at least, of the effectives of the three field ambulances employed in the collecting zone, or 13.44 per cent. of the total establishment. The ultimate losses were minimised by improved communications, and to the Turk trench the Maoris dug the saving of many lives was due. In all some 8000 casualties were handled by the Flat Iron A.D.S., British and New Zealand soldiers, the average rate of evacuation being about 100 per hour, during heavy fighting. A striking testimony to the work done by the N.Z.M.C. bearers, apart from their losses, was the result attained by the infantry parties of 200 led by their officers on the page 22217th, who found not a single wounded man of ours left out, but managed to get five casualties of their own.

At the corps collecting station, Lieut.-Col. O'Neil had a well organised establishment with adequate accommodation and good roads, all provided by his own parties and those of the 139th Field Ambulance attached; ultimately he had accommodation for 200 cases which he housed for one night during a breakdown on the L.O.C. which blocked the casualty clearing stations. In all this station dealt with 15,542 sick and wounded, of these 582 New Zealand sick, 2671 lightly wounded. The largest group dealt with in one day was 77 sick, 3122 wounded; the daily average being 150 sick, 500 wounded, evacuated at the rate of about 100 patients per hour.

At the corps main dressing station the New Zealand Section of three tent subdivisions had their own marquees of which one was fitted up as a dressing station with two operating tables; the teams worked in two shifts of twelve hours each. A special marquee was used for resuscitation from shock which at that date consisted in removing the clothing, putting on pyjamas, warming with bottles and hot blankets and transfusion of hypertonic saline solution. The anasthetics used were chloroform, and various mixtures of chloroform and ether. As the guillotine amputation was now condemned, the formal procedures were adopted, generally the eliptical flap method, the flaps packed with hypertonic saline solution. The objections to the "guillotine" method, only used in cases of advanced sepsis or gas gangrene, were these:—First a large surface of wound taking months to heal over with a disfiguring adherent scar; Secondly the necessity for further operation on the exposed bone. A very large number of splints were in use in these days, amongst them was the Thomas splint for fractured thighs, which Sir Anthony Boulby was at this time attempting to bring into universal use on the Somme, but the Liston long splint was still somewhat favoured in the ambulances on account of facility in transport. The memorandum of 1915 had advised the use of the Thomas splint by field ambulances but the method was not yet sufficiently stressed, much less enforced. We have seen that the D.M.S. was satisfied with the surgical work of the N.Z.M.C. teams working at the C.M.D.S.

Of the sickness wastage and the sanitary effort at the Somme, a few words must suffice. There was a markedly increased incidence of diarrhoea and "enteritis" noted during the lull in the fighting, this eventually proved to be the onset of an outbreak of bacillary dysentery: nearly 300 cases of "enteritis" were page 223evacuated from the corps collecting station during the latter part of the month. The condition of the battle field and back areas was insanitary to a serious degree. Flies were prevalent in unusual numbers and were found to be breeding freely in recent horse manure—nothing had been done on transport or waggon lines to check fly breeding—there were no fly proof latrines even in the divisional back areas, nor where there, in many instances, dug latrines in forward areas. Every shell hole became a midden or a latrine—as evidence of this, a divisional routine order issued about the 20th instructed commanders to dig latrines in bivouac areas and that all refuse in shell holes was to be covered with earth. The congestion of troops and horses coming and going, with the frequent changes of Divisions, led to an accumulation of all manner of refuse in the forward areas which could not be buried even, during these periods of strenuous fighting, as the conservancy of such a battlefield was well high an impossibility. During our stay at the Somme, over 100 cases of diagnosed bacillary dysentery were notified in the division. The earliest cases were evacuated during the last week of September, but the largest numbers during the second week in October; the discase ceased abruptly when the division left the Somme. The epidemic, which was common to the whole Fourth Army, was, at first, attributed to carriers amongst the Anzac troops and the 29th Division. Owing to the relative mildness of the dysentery caused by Flexner type infections, it was currently thought that the Shiga baccillus alone was capable of causing severe epidemics in armies. The bacillary dysenteries of Gallipoli and the Balkans were Shiga in type. But in consequence of the Argonne outbreak amongst the French troops in August, 1916, Remlinger came to the conclusion that the Flexner type was quite capable of developing great toxicity and causing severe epidemics. The Flexner type preponderated at the Somme as it had in the Argonne. Furthermore, it was known that the Germans were suffering also from dysentery; and as we drove them back, and occupied their broken lines, so may we have inherited not only their dugouts but their diseases; added to which, contiguity—probably infected water—else why the soda water found in Flers? —and the fly plague, and the exhaustion of the ill fed troops, were principal causes. The sanitary officer was frequently employed in the dressing stations, but a detachment of our sanitary section proceeded to Green Dump on the 18th and was employed in the erection of fly-proof latrines about the reserve brigade area and the dressing station. They also supervised the burial of page 224dead horses and food refuse in this area. By them the water supply at Flers was tested, and found to be free from chemical poisons, and its chlorination estimated; but this supply from wells, which was exploited by the New Zealand Engineers, could not come into general use as the site of the village was constantly under heavy shell fire and the road from Longueval almost impassable. Supplies for the trenches were chlorinated and passed forward in petrol tins by carrying parties. The Germans had thoroughly solved their water difficulty by sending up bottles of mineral water to their soldiers in the front line—large quantities of excellent soda water were found in captured dugouts. On September 25th, the following D.R.O. was issued:—"Even in the front line, at least one water duty man should be with each battalion to chlorinate water. It is essential that proper use be made of the measures issued to medical officers, which enable the water in petrol tins to be quickly and efficiently chlorinated: full instructions for their use have been issued." Four of the N.Z.M.C. water duty men were wounded in this duty.

In the matter of personal hygiene, little or nothing could be done for front line or reserve troops, with the exception of issues of dry socks. The following instructions were issued with regard to trench foot prevention. "Men in the trenches will be made to remove their putties and boots and socks, at least once a day to dry their feet and treat them with whale oil or anti-frostbite grease, and put on dry socks. Spare socks will be taken into the trenches by all ranks. Tight boots must, not be worn, nor should the boots be laced tightly. The above will be published in all battalion and company orders." Baths were available at Vivier Mills for the details camp between 6 a.m. and 9 a.m.: 170 per hour was the maximal accommodation.

There was a marked increase in the P.U.O. rate for the division, a condition due to "trench fever" but not as yet wholly recognised. The disease was first described by Major T. H. D. Graham, R.A.M.C. in the summer of 1915, and was more closely defined in an article by Hunt and Rankin in the "Lancet" of November the 20th, 1915. The officers of the New Zealand Stationary Hospital at Salonica had independently observed the five day fever and Major Hurst, R.A.M.C., later consulting neurologist to Walton-on-Thames Hospital, had his attention first drawn to the disease at Salonica by Lieut-Col. McGavin, N.Z.M.C., in January, 1916; as Major Hurst states in his paper in the "Lancet" dated October, 1916. There was even at this time some reason to believe that the disease was lice-borne, though a full page 225knowledge of the fever and its importance was yet to come. Diseases of the respiratory system, which showed a high average in the divisional sickness wastage previously recorded, were below the average which we may attribute to the fact that the troops were almost exclusively living in bivouacs. Diseases of the nervous system, however, showed a threefold increase over previous averages, due to exhaustion and the heavy fighting. Some of the most severe types of "shell shock" were seen at the advanced dressing stations, conditions which Babinski describes as "oneiric delirium," probably caused by close proximity to an exploding shell. But the high controversies raging at this time, the new terminology:—"pithiatism," "hysteria," "psycho-neurosis." "war neurosis," and the differentiation of these obscure conditions were not as yet appreciated by front line medical officers. Our A.D.M.S. had already defined shell shock to be a condition associated with recognisable lesions; the other conditions, "hysteria," or "neurasthenia," he considered to be defineable as "morale shaken by shell-fire." On these criteria the N.Z.M.C. officers classified their cases. Delirium, stuprose states, deaf mutism, the presence of contusion and deafness due to rupture of the ear drums were accepted as good evidence of "shell shook" by concussion, if the case was so labelled by the R.M.O.; the other more complex and obscure conditions were classified as "debility" and were, at that time, not too sympathetically viewed by front line officers. The exact wording of Lieut.-Col. Begg's definition is now quoted as an interesting palimpsest showing one aspect of military thought in the obscure realm of the war neuroses in 1916:—"No man is to be evacuated as "shell shock" unless he shows obvious signs of definite lesion. Cases of unconsciousness following the bursting of a shell in close proximity, injured eardrums, paralysis or paresis, aphasia, etc., will be evacuated as 'wounded shell shock.' Cases of hysteria, neurasthenia, debility, etc., will be cleared as sick and shown under the above headings." This was a good working rule and was in accord with all later teaching and the local instructions issued by Surgeon-General O'Keefe, D.M.S. of the Fourth Army. The 1/1 South Midland C.C.S. which our stationary hospital had relieved, became a centre for the examination of the hysteria-neurasthenia type of cases, who were retained in the army area and returned to duty as soon as possible. Later we will reconsider this distressing problem of modern warfare; but it must be said now that the definition of the New Zealand A.D.M.S. did not please the neurologists.

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The sickness wastage rate of the division calculated as evacuations from C.C.S. out of army area to L.O.C. reached 10 per 1000 on the 23rd of September, the highest rate for the month, but in spite of all hardships and conditions which were of the severest nature even in modern warfare, the health of our troops was satisfactory to this extent that the mean rate of wastage was only 7.6 per 1000, whereas the mean rate for the whole of the Fourth Army was 8.4 during the six weeks we spent in the Somme Valley.

All during our operations at the Somme the New Zealand Stationary Hospital was busily employed at Amiens and some at least of our wounded and sick were fortunate enough to get there. During the month of October they admitted 679 wounded, 2228 sick; of the wounded 56 died and of the sick 2 only. At the end of the month there were 224 patients remaining, as their accommodation had been reduced by the opening of the convent schools. War or no war—though at Amiens the Gothas flew over by night to fill the role of the "sandman"—the little French girls had to go to school: with these war babies it was a case of "L'état de guerre, l'état normal." Another New Zealand medical unit, the H.S. Maheno, on her second commission, was plying between Havre and Southampton so that a New Zealander might by strange chances have passed from one of our ambulances to the New Zealand Stationary Hospital, thence by ambulance train to Havre, and by the Maheno ferried to Southampton, would have reached the 1st New Zealand General Hospital, then established at Brockenhurst in the New Forest.

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Major-General Sir Donald McGavinDonald McGavin, Kt., C.M.G., D.S.O. A.D.M.S. New Zealand Division, inter D.G.M.S. New Zealand.

Major-General Sir Donald McGavin, Kt., C.M.G., D.S.O. A.D.M.S. New Zealand Division, inter D.G.M.S. New Zealand.