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New Zealand Medical Services in Middle East and Italy



During the operations from 22 September to 22 October the medical work in the Division was almost entirely undertaken by the field ambulances, certain special cases being referred for operation to the active Canadian CCS and to the British neurosurgical unit page 626 attached to 83 British General Hospital. Our own CCS was not used at this stage. Evacuation from the active MDSs was by motor ambulance direct to 1 General Hospital at Senigallia, and many cases were referred there for primary surgery. During the second period after the Division had returned to the front from the rest area, the New Zealand CCS was functioning at Forli and undertook the bulk of the forward surgical work.

Evacuation was still to Senigallia by motor ambulance, with staging available at a British hospital at Fano. In both periods the bulk of the medical cases was handled by the field ambulances and large numbers, up to a third of the total, were returned direct to their units.

At 1 General Hospital a great deal of primary and the bulk of the secondary surgical treatment was carried out and all the medical cases were admitted from the Division. Cases were then evacuated by hospital ship from Ancona to Bari and admitted to 3 General Hospital. A small number of cases, especially during the first period was admitted to 2 General Hospital at Caserta, but evacuation from Senigallia to Caserta proved unsatisfactory, the convoys being held up and the patients admitted to British hospitals at Rome. Not being busy, 2 General Hospital treated patients from other forces as well as the overflow cases from Bari, and the unit was held in readiness for transfer to the Po valley when Eighth Army reached that area.

The transfer of cases from Caserta to Bari led to some difficulty as hospital trains were seldom available, but walking cases were sent on civilian trains. At Bari 3 General Hospital acted as the base hospital for 2 NZEF in Italy, accumulating cases for evacuation to New Zealand by hospital ship, as well as giving later treatment to all types of cases. Hospital Ship Maunganui took 311 cases early in October and collected another 50 patients from 5 General Hospital at Helwan.

The Convalescent Depot functioned in two detachments, the headquarters being at Senigallia and the detachment at San Spirito. The detachment, being sited near the base hospital, received almost double the number of patients admitted to the headquarters section—1868 as against 1029 for the last quarter of 1944.

A well-equipped camp hospital was functioning at Advanced Base and cases of minor illness were adequately treated and returned to their units. This relieved 3 General Hospital and was economical in all respects, and also provided useful training for the medical personnel. The admissions were from 100 to 150 a month and the average bed state about thirty.

An advanced section of the medical stores moved to Senigallia from Bari in October. The depot had continued to be of great use to all the medical units.

page 627

Work at the ADS

Buildings were taken over by the ADSs at this period because of the severe wintry weather and the impossibility of using tents in the muddy, waterlogged country. The buildings enabled the ADS to provide warmth, comfort, and resuscitation even in bad weather.

During the early period the active MDS was very close to the RAPs and a large proportion of the casualties was admitted direct to the MDS; much the same conditions were present when 4 MDS moved into Faenza later. At other times the ADS was called upon to carry out treatment in cases of delayed evacuation.

The Work at the MDS

This varied a good deal, depending on the use made of the CCS. For the first attack on Rimini the active MDS took over the functions of the CCS, except for certain types of cases which were sent on to the Canadian CCSs. The MDS operated on the large majority of the cases and evacuated them direct to 1 General Hospital at Senigallia by ambulance car.

Later, the MDS situated at Faenza was called upon to deal with many casualties before sending them on to the CCS at Forli, but operation was undertaken only on the very urgent of the major cases, and on the minor cases which could be passed quickly through to Senigallia. The performance of almost all the forward surgery at the MDS, followed by rapid evacuation to 1 General Hospital, did not produce as good results as those obtained during the second period when the CCS took over the bulk of the work in the forward area.

Work at the CCS

This unit was under command of ADMS 2 NZ Division during this period. It was out of action during practically the whole of the first period before the Division went out to rest.

After the CCS took over from the MDS on 18 October at Igiea Marina it dealt with over 600 cases, including 174 battle casualties, in twelve days. The unit then moved to a large school at Forli, and during December 762 cases, including 572 battle casualties, were admitted. The unit was strengthened by the attachment of a British FSU as well as of our own FSU and FTU, and also of Captain Hodgkiss, an experienced chest surgeon.

During October 15 abdomens were operated on, with 6 deaths. There were 10 penetrating abdomens with 4 deaths, and 5 thoraco-abdomens with 2 deaths. Included in the cases were 5 prisoners of war, with 2 deaths. During December at Forli 20 abdomens were page 628 operated on, with 8 deaths. Many severe mine wounds were encountered and many amputations had to be performed.

The conditions were almost ideal; central heating was available and the seriously ill patients were held till their condition for evacuation was perfectly satisfactory.

The Work of the Field Surgical Unit

The unit, under Major D. P. O'Brien, was attached to the active MDS during September and up till 18 October, and again for the last four days of November. For the rest of the time it was attached to 1 NZ CCS. During the whole period 230 operations were performed as follows:

Operations Performed Deaths
Oct Nov Dec Total Oct Nov Dec Total
Abdominal 5 14 19 1 3 4
Abdomen and thoracic 1 1 2
Chests 4 4 8
Major amputations 1 4 5
Fractures long bones 31 3 35 69 1 1
Ligation major blood vessels 1 1 2
Major joints 2 8 10
Gas gangrene 1 6 7 2 2
Wounds, severe 7 18 25
Burns 1 1 1 3
Secondary suture wounds 1 1 2
Minor operations 46 10 22 78
—— —— —— —— —— —— —— ——
100 16 114 230 2 5 7



Abdomens and chests: All operations on these cases were performed when attached to NZ CCS.


With the oncoming winter an increase in the number of chest complications was noted in the heavier cases such as abdomens. For the same reason, chests were now being held longer prior to evacuation.

Analysis of Deaths Prior to Evacuation
Time Cause Oct Nov Dec Total
24 hours Shock 1 1
24 hours Blast 1 1
24 hours Gas gangrene 2 2
24 hours Pulmonary oedema 1 1
10 days Anuria 1 1
20 days Peritonitis 1 1
—— —— —— ——
2 5 7
page 629

Work of the Field Transfusion Unit

This unit was attached either to the active MDS or to the CCS throughout the period. There was some difficulty with blood during the first period and many bottles had to be discarded. Conditions improved later, and little difficulty arose during the Faenza offensive when 117 transfusions were given.

Shortage of Medical Officers

The shortage was becoming more marked during the early part of this period and in September the Division was twelve officers short. The commencement of New Zealand leave for medical officers accentuated the position. The most serious shortage was in the senior officers, and especially in those qualified for senior professional work in the hospitals and the CCS. The position was relieved later by the arrival of reinforcements from New Zealand, many of whom had served in the Pacific zone.

Surgery at 1 General Hospital

For the first month from the date of its opening at Senigallia at the beginning of September, 1 General Hospital performed surgery of the type usually done at the CCS, many wounds having their first surgical treatment there. Most of the wounded arrived in very good condition after their treatment at the field units and their journey back along the fairly smooth coast road, exceptions being men with compound fractures of the femur where infection had not been controlled by penicillin. Two of these had to have above-knee amputations following secondary haemorrhage from the popliteal artery.

Six cases of gas gangrene were encountered in September, one of the septicaemic type being the only death. The others recovered following excision of the muscle groups involved. Gas gangrene had been more commonly met with during the campaign in Italy and occasional severe cases arose, especially in late cases. Penicillin proved to be very useful when combined with adequate surgical excision. A much higher proportion of wounds was subjected to primary surgical treatment, partly as a precautionary measure against gas gangrene and partly to ensure success when subjected to delayed primary suture.

Delayed primary suture was performed for many wounds, use being made of either calcium penicillin, sulphanilamide powder, or proflavine powder. Results were good but there was often slight infection of the stitch holes. It was found that the third or fourth day was the optimum time for suture. Whenever possible the deep fascia was closed by means of figure-of-eight sutures, including the page 630 skin and the fascia. Where this was possible healing was more satisfactory and the scars less adherent.

Two cases of rectal wounds which had not been detected in the forward units were seen, colostomy and drainage of the pelvic cellular tissues being carried out. Both had severe accompanying wounds and neither had intra-peritoneal involvement.

The notable feature of the September casualties was the infrequency of grossly infected wounds and, consequently, diminished toxaemia.

A feature of the later casualties was the large number of leg and thigh amputations, mainly the result of mine wounds, a considerable number of traumatic amputations having been sustained. A small number of cases of gas gangrene, but none of tetanus, was seen. In the larger wounds, including fracture cases, parenteral penicillin was given for some days to ensure the control of infection. All types of cases were dealt with except fractures of the femur, which were evacuated as soon as possible to 3 General Hospital at Bari for definitive treatment. In October 200 operations out of a total of 500 were performed for suture of wounds.

Intramuscular penicillin was being used freely by this time for severe bone and joint cases and in chests. There were remarkably few deaths at this period. The two unit surgeons, Lieutenant-Colonel Bridge and Major A. W. Douglas, carried the heavy load of surgery in the hospital at this time, though for a period a surgeon from 2 General Hospital was attached to the unit and gave valued assistance. Some diphtheritic infection of wounds occurred and proved a serious complication.

Surgery at 3 General Hospital

The majority of the wounded admitted to 3 General Hospital had already had wound suture performed at 1 General Hospital, Senigallia. Fractured femurs, however, were especially sent to Bari for wound suture. The closure of colostomies was also carried out when possible. Foreign bodies were also removed in some of the chest cases.

Surgery at 2 General Hospital

The comparatively small number of wounded transferred from 1 and 3 General Hospitals had had wound suture already performed, so that little surgery was done at Caserta.

Neurosurgical Cases

The head cases were sent from the field ambulances to the special advanced head centre attached to 83 British General Hospital at page 631 Riccione, where facio-maxillary and eye cases were also dealt with. They were later evacuated to head centres at Loreto, Bari, and Naples and then finally admitted to our base hospitals at Caserta or Bari.

Review of Surgery

The Consultant Surgeon 2 NZEF, Colonel Stout, in October 1944 reviewed the developments of surgery in the Italian campaign.

The large majority of deaths was due directly to the severity of the injury and the primary shock produced thereby. This was shown in both the chest and abdominal cases, in which a large number of the wounded were brought in dead to the field ambulances, and practically all the others who died did so in the first forty-eight hours.

Undoubtedly the most valuable form of treatment was transfusion of blood, given early and sustained till operative treatment was possible. The giving of blood during transit in the ambulance had proved of great value. The early administration of glucose saline, both to combat dehydration and also to act as a preventative of anuria, was being carried out.

In mangled limbs, commonly seen after mine injuries, early application of a tourniquet just above the damaged area to prevent bleeding and toxic absorption, followed by early amputation through healthy tissue, had become the routine. The dramatic improvement following the removal of the devitalised tissue was vouched for by many experienced surgeons.

Anuria, generally the direct result of severe and prolonged shock, had caused many deaths and no treatment was of any avail.

Infection was being combated by adequate primary wound excision and the local and parenteral administration of penicillin. Gas gangrene had become more common but, except in a few fulminating cases, cleared up well with adequate surgery and penicillin.

Delayed primary suture of wounds had become the routine in simple wounds, in amputations, and in fracture cases and the results were satisfactory.

Chest cases with more thorough primary wound treatment and intrapleural penicillin had very rarely become septic.

Thoraco-abdominal cases showed a lower mortality when dealt with through the chest. A tendency to delay operation a little too long in abdominal cases had been noted, the pendulum having swung too far. In colon injuries the double loop colostomy was being carried out except in caecal injuries, where simple marsupialisation was all that was considered necessary. Rectal injuries associated with buttock wounds were common and sometimes apt to be over-looked. There had been an unusual number of abdominal wounds page 632 associated with evisceration of the bowel, and a more conservative approach was suggested in these cases which were almost invariably fatal.

Knee-joint cases did well with intra-synovial penicillin and adequate splintage.

Fascial incision following ligature of the popliteal and lower femoral arteries was successful in saving some limbs. A case of primary ligature of the lower part of the femoral artery dealt with by fascial split at that time was fully recorded by Major Owen-Johnston, and the subsequent progress for a period of years has been ascertained. Major Owen-Johnston wrote following the operation that:

If ischaemic gangrene does not develop in this case then I think that it can be accepted as a very good test of the efficacy of fasciotomy of the leg aponeurosis in preventing the onset of ischaemia where the popliteal or lower femoral artery has been tied in battle casualties.1

The importance of early and frequent hand movements in all arm injuries was fully recognised.

In burns the problem was recognised as one of shock, and adequate plasma was the essential form of treatment. Simple dressings without anaesthesia were carried out, and penicillin utilised both locally and parenterally.

1 The patient's final result as recorded in November 1948 was that he was still experiencing cramp but had no pain in his foot, the sensation of which was normal. There was still weak action of his toe flexors. The soldier had been granted a permanent pension for a 25 per cent disability (15s. a week). He was employed driving a baker's delivery van. The original association of motor and sensory nerve disability had made the outcome still more satisfactory. There had been severe muscle loss but the patient had made an excellent recovery.


The winter in northern Italy was relatively severe, very wet and cold conditions being experienced. The plain of the Po valley became very muddy, making tank action generally impossible. There were occasional hard frosts, and light snow fell on the plains with heavier falls on the hills. The first fall of snow was experienced on 11 November both at Senigallia and Fabriano.

Health and Hygiene

In an effort to keep the sick rate of the Division as low as in the previous Italian winter, it was arranged that all men not actually in the most forward positions should have reasonably comfortable living conditions. All the field medical units, including 1 Mobile CCS, were well provided for in excellent buildings, and patients were treated under better conditions than had been possible the previous year.

page 633

Combatant units out of the line were also able to make use of buildings and so provide for the comfort of the troops in the wet and cold conditions. Each man was issued with five blankets and five pairs of socks, and extra battle dress and underclothing were held by all units to allow frequent changes during the wet weather. Gumboots, leather jerkins, and duffle coats were also available.

Actually, owing to a reduction in the number of cases of infective hepatitis and fevers, the sick rate in the winter months showed a decline on the rate during the summer months. Accidental injuries, too, were fewer with the comparative immobilisation of the Division.

The quartering of troops in houses, however, made hygiene a much greater problem. The houses were usually also occupied by Italian civilians, it being found impossible to evacuate all civilians from the divisional areas. There then arose the problem of skin diseases, and other infectious diseases such as diphtheria, contracted from close living with an uncontrolled and relatively poor civilian population. Unit discipline down to the platoon or section level ensured the best control, but hot showers, adequate disinfestation, and the use of insecticide powder were all enforced on men in the forward areas. It was found better to dust the man and his clothes with insecticide rather than spray the billets, although this was done where possible. Living in towns and villages, where drains had been destroyed by shelling and bombing and where wells were thus contaminated, also raised problems, but rigid inspection and policing by 4 Field Hygiene Company ensured an adequate measure of control.

Rations: These were as a rule excellent, with fresh vegetables generally procurable, but in November there was less fresh food and ascorbic acid tablets were used.

Water: Adequate filtering and chlorination of water from the village wells, with rigid inspection, was carried out. The wells were mostly large and deep and the water satisfactory. There was a shortage of water carts and of trained staff for water duties, and fresh personnel had to be trained.

Refuse: At first deep pits were used and burnt out regularly. Later, controlled tips were developed, but constant supervision was necessary as there was a tendency to use them for fluid refuse.

Latrines: Deep-trench latrines were used when possible and buckets were sometimes used.

Showers: Buildings were found to be essential for showers during the winter weather. The showers were freely provided.

Malaria Control: General measures were limited to spraying of buildings with DDT and flysol. The troops used nets and repellent page 634 cream, and mepacrine tablets were taken every evening, generally under the control of an NCO, till the end of the season.

Typhus Prevention: This was of considerable importance as the billeting of the troops led to a marked increase in infestation by lice and pediculi. The enemy troops were also known to be heavily infested with lice. An anti-typhus unit was formed out of one of the anti-malaria units and was active in spraying out billets with DDT. Spraying squads were attached to ADSs. It was considered, however, that the personal dusting of the troops with insecticide was more effective and this was carried out. No typhus infection was encountered.


Some general deterioration of the health of the troops was noted during this period, but this did not lead to any marked increase in the numbers evacuated sick. It was shown more in the lack of resistance to skin infections and mild general infections. The dominating factor was the marked epidemic of infective hepatitis which subsided during the winter.

Numbers of ‘Fever NYD' cases were evacuated from units. Many of these cases were diagnosed later as infective hepatitis, others as sandfly fever, very few as malaria.

Upper respiratory infections increased during the winter but pneumonia was never very prevalent or serious.

Diarrhoea and dysentery were much less common.

As much of the illness was minor, a considerable number of those evacuated from the divisional units were returned to their units from the field ambulances within a few days. During October 500 men, one-third of the sickness cases, were held at the MDS at Riccione and returned to their units. This number did not include cases of hepatitis as these were all evacuated to the base hospitals. The numbers per 1000 per day evacuated beyond the RAPs were 2·54 from July to September and 2·67 from October to December.

Prevalent Diseases

Infective Hepatitis: This disease completely dominated the medical picture, accounting in September for as many as 60 per cent of the medical cases. The New Zealand Division had the highest rate in Eighth Army. The Maoris were, as in previous epidemics, relatively unaffected. The number of cases reported during the period was: September 654, October 587, November 474, and December 206—a total of 1921. There was a sharp drop in incidence in January.

At 1 General Hospital, where the divisional cases were first admitted to hospital, a thousand cases were admitted during the last page 635 quarter of the year. The chief feature was the generally mild nature of the disease. In no case had there been any cause for anxiety, and on the average the icterus had been only moderately severe and tended to clear rapidly. Prolonged pyrexia had not occurred, nor had there been the abdominal distension seen in previous years. Pruritis was relatively more common. Dyspeptic symptoms had been almost universal and fevers generally low and of minor significance. It had been observed that there was no jaundice in a considerable number of cases and the diagnosis depended on the dyspeptic symptoms and typical onset, together with an enlarged liver. In these cases the dyspepsia was prolonged, difficult to relieve by the usual means, and tended to recur on leaving hospital. It had been noticed that men who had had jaundice in previous years, or who had been exposed in previous epidemics, tended to have milder attacks with only transient jaundice. It was noted also that the cases became more severe as the epidemic progressed. The liver was almost always enlarged, the spleen rarely so. Bronchitis and broncho-pneumonia were frequently associated with hepatitis. Special fat-free diets were prepared and skimmed milk powder was supplied to the hospitals. Extra protein and vitamins were provided.

Colonel Boyd, New Zealand consultant physician, made the following observations at that time:

Though it is perhaps not the final knock-out blow to the droplet infection theory in this disease, a considerable advance in our knowledge has recently been made by the demonstration of the infective agent in the urine and faeces. Filtrates were taken from both sources by Maj. Van Rooyen of the 15th (Scottish) Gen. Hosp., Cairo. The War Office having refused permission to carry the experiment further, the material was sent to Major J. Paul of the American Virus Commission who gave the filtrates orally to a number of volunteers. At the same time samples of blood serum from hepatitis cases were sent and these were fed to volunteers or injected parenterally. The results were:

Filtrates by mouth: Hepatitis developed on 22nd day.

Serum by mouth: Hepatitis developed on 35th day.

Serum parenterally: Hepatitis developed on 65th day.

The shorter period in the case of filtrates is, of course, likely to be due to heavy concentration of the virus in a small quantity of the carrying medium. In the case of blood serum the dose probably more closely approximates what occurs naturally. These discoveries largely elucidate many previously puzzling problems, e.g., the very low incidence among hospital staffs and nursing personnel, the relatively high incidence among British officers in the forward areas owing to the use of community mess dishes; the low degree of spread in such isolated formations as gun or tank crews who have their individual dixies, and the lack of epidemic spread in our prisoner of war camps. They explain too the part played by winds, dust, and flies in spreading the infection.

I mention these matters because I think it worthy of record that these experiments were initiated by Maj. Van Rooyen (who acknowledges the page 636 fact) as the result of the epidemiological work done at 1 NZ Gen. Hosp. by Lt.-Col. Kirk and his colleagues.

There were 1139 cases admitted to 3 General Hospital during the quarter, mainly transferred from 1 General Hospital. It was noted that a number of the patients had had severe attacks with residual liver enlargement which necessitated down-grading. The average stay in hospital was twenty-nine days, and another twenty-one days were spent in the Convalescent Depot. Half the medical cases admitted to the convalescent depots were suffering from hepatitis. (See table.)

Infective Hepatitis 2 NZEF, Jan 1941 - Dec 1944
Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total
1941 20 15 4 19 45 84 56 33 55 48 38 417
1942 52 16 3 6 17 8 13 47 374 952 695 341 2524
1943 85 37 23 14 18 30 36 35 52 40 62 144 576
1944 163 147 89 70 41 54 141 279 623 587 474 206 2874

Respiratory Infections: There was no increase in these cases during the colder months and no recrudescence of the epidemic of atypical pneumonia as experienced at Cassino. At 1 General Hospital a falling-off in admissions was noted when the really cold weather became established. Sinusitis was common. All forms of pneumonia occurred. Primary atypical pneumonia was often recognised in cases which would otherwise have been classed as PUO. Broncho-pneumonics formed the majority of the remaining chest cases. Only one case of empyema was reported. There were five cases of pulmonary tuberculosis and four of tuberculous pleural effusion.

Dysentery: There was a marked drop in the incidence of diarrhoea in the Division, only 160 cases being admitted to medical units during the last quarter of the year. There were only 33 cases of dysentery evacuated. The cases of diarrhoea and dysentery admitted to 1 General Hospital fell from 48 in October to 16 in December. At 3 General Hospital the chronic cases of amoebic dysentery became a problem and investigation showed that there were many of these cases arising in Italy. During October 35 cases were reported, in November 34, and in December 39. The condition gave rise to general debility and prolonged treatment was required. The average period in 3 General Hospital of cases of diarrhoea was reported to be 14 days; of bacillary dysentery, 11 days; and of amoebic dysentery, 42 days.

Colonel Boyd, Consultant Physician 2 NZEF, in a lecture on the aftermath of infections contracted overseas, expressed the opinion that amoebiasis was likely to be the main problem in New Zealand page 637 and that the condition would give rise to difficulties in diagnosis. The main lesions encountered would be: (a) hepatitis and hepatic abscess; (b) caecal; (c) rectal. It had been found that in those developing hepatitis, 25 per cent had had previous treatment for amoebic dysentery, 25 per cent had never had any bowel symptoms, and 50 per cent gave negative results on investigation. Hepatic abscess generally developed in the upper and posterior part of the right lobe. Pain on the right side over the region of the liver was often present. The condition had often been mistaken for carcinoma of the stomach.1

Diphtheria: The mingling with the civilian population consequent on billeting of the troops resulted in sporadic cases of diphtheria. In the last quarter of the year 26 cases were reported in the Division and 37 at 1 General Hospital. During December there were 29 cases in the wards of the hospital as well as 6 cases of wounds infected with KLB. The infection was generally mild and responded to 48,000 units of serum. The cases did not clear up rapidly, a condition noticed previously in Egypt, where it was often necessary to have a tonsillectomy carried out to obtain negative swabs. There were very few cases in the other hospitals.

Skin Diseases: Furunculosis was very common at this period, as were skin infections generally. Penicillin was used for the severe cases with good temporary results, but it did not stop relapses unless associated with general dietetic and vitamin treatment. Ultra-violet light was used with good results. Scabies and pediculosis showed a marked increase in the Division, again due to billeting.

Malaria: Only 27 cases were reported in the Division during the last quarter of the year as against 67 cases in the previous quarter. The total cases reported in 2 NZEF were:

Sep Oct Nov Dec
Italy 43 14 8 5
Egypt 16 16 2 1

Malaria had not been a problem at all in our force, not even after the seasonal stopping of mepacrine. This suggested excellent control within units.

Venereal Disease: There was a relatively low incidence of venereal disease during this period. There were 54 fresh cases in September, 48 in October, 71 in November, and 61 in December, and diagnoses were: syphilis 8; gonorrhoea 98; soft sore 27; balanitis 20; urethritis 53; penile sore 13; gonorrhoea and soft sore 3; prostatitis 4; and others 6. The majority of cases developed after leave, especially to page 638 Rome. The number of fresh cases was three times greater than those reported the year previously in Egypt. In October there were 800 cases under treatment and 100 final tests were completed during the month. Penicillin had been introduced for the treatment of both gonorrhoea and syphilis with excellent results. In December it was noted that the first apparent relapse following penicillin treatment for gonorrhoea had occurred, but it was suggested that this was a fresh infection. Fifteen cases of syphilis that had not completed two courses of arsenic injections were given 2,400,000 units of penicillin in seven and a half days in one and a half hourly injections. Cases of prostatitis were given intramuscular penicillin and also local penicillin by Ultzmann's syringe with good results. Hospitalisation had been reduced by the use of penicillin, syphilitic patients being retained for fourteen days, and cases of gonorrhoea for less than five days on an average. The urethritis cases showed no organisms but marked pus formation. The symptoms usually appeared three to five weeks after intercourse.

Hot showers were provided by the treatment centre for the patients in December. All brothels were placed out of bounds to the troops.

Anxiety States: One hundred and twenty-four cases were evacuated from the Division during the quarter to the end of December as against 174 in the previous quarter. The cases were all admitted to 1 General Hospital, which reported that they occurred mostly among new arrivals and mainly among the less willing.

Divisional Casualties, October-December 1944
Sick BC Total
October 1648 332 1980
November 1478 30 1508
December 1342 574 1916
—— —— ——
4468 936 5404

(Previous quarter, 6063)

Admissions to Divisional Units, October–December 1944
Oct-Dec 1944 Jul-Sep 1944
Hepatitis 880 778
Fever NYD 494 808
ENT 282 217
Accidental Injuries 456 639
Diarrhoea 162 304
Dysentery 33 49
Diphtheria 26
Malaria 67
Exhaustion 124 174
VD 193 196
page 639
Admissions to 1 CCS, October–December 1944
Sick BC Total Deaths
18 Oct–30 Nov 443 174 617 8
1–31 Dec 190 572 762 14
—— —— —— ——
633 746 1379 22
Types of Wounds as Seen at 1 CCS, October–December 1944
Bullet wounds 100 13·2 per cent
Shell'' 435 57·8 per cent
Bomb 79 10·5 per cent
Mine 54 7·2 per cent
Mortar 85 11·3 per cent
—— ——
753 100·0

Of these, multiple wounds 275

Admissions to 1 Gen Hosp, October–December 1944
Oct Nov Dec Total
Surgical Admissions 1747
Medical Admissions 1032 812 503 2347}4094
Principal Admissions—Battle Casualties 779
Hepatitis 489 369 137 995
Diarrhoea and Dysentery 48 38 16 102
Skins 74 47 49 170
Respiratory 78 58 37 173
Diphtheria 12 4 21 37
Anxiety States 19 57 46 122
Furunculosis 11 28 29 68
Evacuations from 1 Gen Hosp in October 1944
Evac. by hospital ship to Bari 1016
Evac. by hospital train 248
Evac. to reinforcement transit unit and unit 341
Admissions to 2 Gen Hosp; October–December 1944
NZ Cases Others Total
Admitted direct 67 60 127
Transferred from other medical units 417 246 663
—— —— ——
484 306 790
Battle casualties 51 74 125
Admissions to 3 Gen Hosp, October–December 1944
Admitted direct 478
Transferred from other medical units 1373
Total 1851
page 640

1 Colonel Boyd's opinion proved to be correct and chronic amoebiasis has been a cause of disability in a number of returned servicemen, but the number of new cases has diminished after some seven years. There were 148 cases accepted for pensions up to September 1949.

Admissions to other than New Zealand Hospitals

In September and October there were again considerable numbers of New Zealand patients temporarily in other hospitals. Some of these were in the forward areas in Canadian CCSs, in the British neurosurgical units, and in transit hospitals at Fano. In November a regular channel of evacuation through New Zealand units was functioning and the number was much smaller. Admissions to other hospitals were: September, 410; October, 528; November, 134; December, 151.

Deaths in New Zealand Medical Units, September–December 1944

There were very few deaths other than those occurring in the field ambulances and only two deaths in hospital in Italy other than from battle casualties, a remarkably small number in over 20,000 men in 2 NZEF in Italy. One of the two deaths followed an injury and the other was from a ruptured cerebral aneurysm.

NZ Other Total
Deaths in FSU 4 3 7
Deaths in CCS 16 6 22
Deaths in 1 Gen Hosp 10 4 14
Deaths in 2 Gen Hosp 3 3
Deaths in 3 Gen Hosp 1 1
—— —— ——
34 13 47
Casualty State 2 NZ Division, November 1943–November 1944 (NB: Accidental injuries are included in BC figures up to 31 January 1944.)
Sick BC Acc. Inj. Total Discharged (RTU)
18–30 Nov 260 228 (not recorded) 488 43
Dec 833 1,011 (not recorded) 1,844 228
Jan 693 217 910 159
Feb 813 328 166 1,307 160
Mar 922 811 222 1,955 252
Apr 695 109 216 1,020 161
May 993 272 249 1,514 305
Jun 1,099 165 172 1,436 357
Jul 1,279 593 237 2,109 415
Aug 1,264 316 181 1,761 401
Sep 1,523 451 219 2,193 382
Oct 1,495 332 153 1,980 583
1–17 Nov 781 118 899 294
—— —— —— —— ——
Totals 12,650 4,833 1,933 19,416 3,740
page 641
Casualties in 2 NZ Division During Period of One Year in Italy up Till 17 November 1944
Battle Casualties (including killed and PW) 6,094
Sick 14,583
Evacuated for medical boarding 288
Returned to units from MDS 3,740
Temporarily lost to the Division 17,225

The only permanent loss to the Division consisted of those men downgraded as unfit for further service in the Division and those evacuated to New Zealand. This would be a relatively small percentage of the total.

A total equal to the strength of the Division passed through the medical units in the year.

Main Categories Cases of Fever NYD 2,039
Cases of accidental injury 1,933
Cases of Hepatitis 1,924
Cases of VD 1,028
Patients in Medical Units–Percentage of Troops in 2 NZEF
Italy Egypt Total Patients
1 Oct 10·62 (excluding BCs 4·94) 4·94 2947
31 Oct 9·96 (excluding BCs 7·84) 3·8 2698
30 Nov 9·81 (excluding BCs 8·38) 4·3 2847
31 Dec 9·75 (excluding BCs 6·98) 5·4 2720

The surgical work carried out at 2 NZ General Hospital, our forward base hospital, during 1944 is well illustrated by the following statistics:

Classification of missiles causing wounds, and also regional distribution of wounds and deaths, of the 2084 battle casualties admitted to 2 General Hospital from forward areas in 1944. (Lieutenant-Colonel J. M. Clarke)

Missiles Responsible Patients Percentage
GSW 276 13·24
SW (HE) 1072 51·48
Mortar 392 18·80
Grenade 146 7·00
Mine 148 7·10
Aerial bomb 25 1·19
Bayonet 1 0·04
Various 24 1·15
—— ——
2084 100·00
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Regional Distribution Wounds Percentage
Head wounds—Severe 51 123 5·9
Slight 72
Spine, involving cord 13 17 0·8
Spine, not involving cord 4
Neck, severe 3 0·1
Facio-maxillary 21 1·0
Eye 64 3·0
Blast effects—Ears 66 3·1
Other 24 1·2
Chest 53 2·5
Thoraco-abdominal 12 0·6
Abdominal 57 2·7
External genitalia 10 0·5
Major joints 117 5·6
Major nerves 103 4·9
Major vessels 52 2·5
Fractures, compound 352 16·9
Fractures, simple 8 0·4
Amputations—Major 55 2·75
Minor 15 0·75
Flesh wounds only 1153 55·3
Burns 15 0·75
Due to masonry 29 1·4
Due to abdominal wounds 9
Due to thoraco-abdominal wounds 1
Due to chest wounds 2
Due to uraemia 2
Due to pyaemia from infected wounds 2
16—0·8 per cent of total
Italy, 1944–Comparative Casualty Rates of Cases Admitted to all Medical Units (Rate per 1000 British troops per year taken as 100)
British Canadian New Zealand Indian African Total Force
Battle casualties 100 192 230 294 143 128
Accidental injuries 100 169 291 233 298 127
Burns 100 217 308 163 155 125
Diseases 100 153 161 83 110 107
All admissions 100 161 180 124 126 111
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Diseases in Italy, 1944–Comparative Morbidity Rates of Cases Admitted to all Medical Units (Rate per 1000 British troops per year taken as 100)
British Canadian New Zealand Indian African Total Force
Malaria 100 76 12 29 33 88
Venereal disease 100 136 107 52 172 102
Infective hepatitis 100 353 677 59 98 142
Dysenteries 100 76 202 106 134 102
Diphtheria 100 163 135 6 34 100
Pneumonia 100 100 526 86 125 113
Influenza 100 967 354 148 235 204
Sandfly fever 100 13 68 46 94 86
Enteric fever 100 791 256 32 38 170
Tuberculosis 100 48 73 589 560 138
Helminthic diseases 100 238 1329 1757 33 267
Food poisoning 100 70 30 230 626 116
Nervous disorders (incl. exhaustion) 100 156 161 61 181 107
Skin diseases 100 132 185 108 94 106
IAT 100 130 179 114 127 107
All diseases 100 153 161 83 110 107