New Zealand Medical Services in Middle East and Italy
In the divisional area during the first three months of 1944 the incidence of venereal disease in the New Zealand Division was page 558 relatively low: January, 21 cases; February, 47 cases; and March, 35 cases.
In April there was a marked increase in the number of cases to 100, followed by a very marked increase to 213 in May and 174 in June. These figures include cases of non-specific urethritis which were not included in Egypt. The divisional rate became the second highest in Eighth Army. This was ascribed at the time to the large numbers of amateur prostitutes. The OC 102 Mobile VDTC considered that the attitude to the disease was unsatisfactory and that the attitude of the officers and their control of their men was an important factor. He also considered that healthy recreation and suitable rest areas had not been afforded the men in many cases, and that in those units which had arranged healthy leave camps there was very little trouble.
The majority of the cases in May were due to infection contracted in Naples and Pompeii. This led to Naples being placed out of bounds to New Zealand troops when not on duty. It was found impossible for the mobile treatment centre attached to the Division to treat other than our own men; previously it had treated large numbers of other troops at times.
The relatively large numbers of sulphonamide-resistant cases of gonorrhoea as well as the chronic cases of non-specific urethritis had necessitated the setting up of a special contagious diseases ward of thirty beds at 3 General Hospital.
The majority of the cases seen in the Adriatic sector had cleared up readily following the routine administration of sulphathiazole, and 82 per cent of cases were treated and returned direct to their units by 102 Mobile VDTC. In the Cassino areas there was a much higher percentage of sulphonamide-resistant cases, especially in those cases infected at Naples. This necessitated an increased dosage of sulphathiazole and evacuation to the Base. The prophylactic use of small doses of sulphathiazole by other troops, especially the Americans, was deprecated by our force, as this was held to lead to resistance to treatment by sulphonamides later and so make cure more difficult.
In May a third of the cases in the divisional area proved resistant and had to be evacuated. Penicillin had been in use in other forces before this and supplies were obtained by us when the position was beginning to cause anxiety. Fortunately, the resistant cases rapidly cleared up when treated with penicillin. The dosage was 100,000 units given in ten injections at intervals of three hours, and this effected cure in 95 per cent of the cases.
Although there was a large number of cases of urethritis in which the gonococcus could not be demonstrated, the general opinion was page 559 that these cases were largely due to gonorrhoea. They gave rise to great difficulty in treatment as they did not clear up under treatment by the sulphonamides, and local treatment, often prolonged, was necessitated.
Prostatitis sometimes arose in cases in which the primary symptoms had been slight and early treatment neglected. Instillation of silver proteinate through Ultzman's syringe once a week gave extremely good results.
Balanitis often gave rise to difficulty in treatment and healing was slow, especially in Maoris.
Soft-sore cases were often slow to heal and bubos frequently occurred.
During the three months, April to June, twenty-three cases of syphilis were reported. The Laughlan rapid flocculation test proved accurate for diagnosis. Treatment given at this time was by mapharsen and bismuth, sufficient penicillin not then being available for use in these cases.
Hepatitis had developed previously in half the cases of syphilis treated, the infection apparently being transferred from patient to patient. The boiling of the syringes after each anti-syphilitic injection, however, had resulted in hepatitis occurring in only one case during the previous six months.
A special venereal diseases ward was set up at 3 General Hospital, Bari, to deal with cases in the base areas, and also with resistant cases evacuated from the Division. At the beginning of February there were 22 cases in hospital and a further 30 cases were admitted, 27 remaining at the end of the month. The average stay in hospital was 35 days, with a maximum of 89 days. Sulphathiazole was normally used for gonorrhoea and up to 60 gms. given in four days. Sulphapyridine was given to cases not clearing up under sulphathiazole.
In resistant cases injections were given of 1 in 6000 oxycyanide of mercury and sounds were passed and the prostate massaged; if resistance continued, TAB vaccine was given intravenously to produce a hyperpyrexia of 104 to 105 degrees.
The 101st NZ VD Centre, which had just come over to Italy with 1 General Hospital, was attached to 3 General Hospital in April and took over the control of the ward. At this stage the number of patients was steadily increasing owing to the extreme difficulty in curing the resistant cases of gonorrhoea. The future was beginning to look bleak when, through the help of Brigadier R. Lees, Consultant Venereologist, AFHQ, penicillin was released for the treatment of these cases. Rapid cure was then possible in nearly all the cases.page 560