New Zealand Medical Services in Middle East and Italy
Hepatitis: The incidence of infective hepatitis was much lower than in the previous year and it was of a milder type.
Pneumonia: Primary atypical pneumonia also was much less common.
Malaria: There were very few cases of malaria in the Division, 32, 19, and 18 cases being reported in the first three months of the malaria season.
Amoebic Dysentery: This disease continued to be a source of trouble as it was frequently found to be the cause of ill-health, especially in hospital personnel, and it was difficult to effect a cure. Major Dick, OC Hygiene Company, stated that the disease was endemic among the troops and that any soldier presenting with a history of bowel irregularity and malaise was vigorously purged and investigated for entamoeba histolytica; and that any soldier presenting with a similar history after return to New Zealand might well be suffering from amoebic dysentery.
Lieutenant-Colonel Hayward1 reported in July that cases of amoebic dysentery continued to provide the largest single group of cases under treatment by the medical division of 3 General Hospital. During the month thirty-four fresh cases had been diagnosed, including two sisters and one nurse on the staff of the hospital. In view of the continued incidence of amoebic dysentery among members of the staff, stools were examined from all the cooks. Of twenty-three cooks page 683 tested, five were found to have trophozoites of entamoeba histolytica in the stools. Only one showed amoebic cysts and he, after mild purgation, produced negative forms. Of the five positive cases, three gave no history of diarrhoea for the previous month. Earlier stool examinations had failed to show amoebae or dysentery organisms, and the one cyst-passer had had recurrent mild attacks of diarrhoea during the previous year.
The finding of apparently healthy men passing vegetative forms of entamoeba histolytica was unusual as the carrier state was associated with the passing of cysts. Experience in Italy had shown that the finding of amoebic cysts in the stools was uncommon—only two out of a group of 100 cases of amoebic dysentery diagnosed in 3 General Hospital had shown cysts. While the only cyst-passer of the five cooks was theoretically capable of transmitting the disease, it was probable that daily stool examinations in the others over a longer period would have shown cysts.
Poliomyelitis: A small epidemic of poliomyelitis was noted amongst the civilian population at this period, and a few cases arose in our force. In July one death occurred in 3 General Hospital; in August one severe case was reported from 3 General Hospital; in September two cases were reported in the Division, with one death in the CCS.
Chest Examinations of Hospital Staff: These were carried out by 3 General Hospital, and in August it was reported that all the staff of the unit had been examined and two very early active cases of pulmonary tuberculosis had been revealed among the WAAC personnel.
Venereal Disease: There was an appalling increase in the numbers affected by venereal disease in Florence and a particular increase in the syphilitic cases. The venereal disease rate was six times, and in one month ten times, as high as in British troops in the Florence area. The OC 102 Mobile VDTC considered this was due partly to the attractiveness of the women, but mainly to the wilful neglect of all precautions by the men. Some 70· per cent admitted that they took no precautions. The SMO 2 NZ Division considered there was inadequate discipline and moral laxity of the troops in an area so beset with sexual opportunities.
The Italian Red Cross ran a venereal diseases hospital for infected women, the patients being supplied by military and Italian police, who followed up histories of infections and apprehended girls of whom they were suspicious. Those who were infected were then forced to remain as patients in the hospital, and, following treatment and discharge, were supervised and brought back to the hospital for further examination by the police. Over a three-month page 684 period, of the 45 per cent found to be infected, 20 per cent were suffering from syphilis, 78 per cent from gonorrhoea, and the remaining 2 per cent with disease of suspected venereal origin. The hospital accommodation was increased from fifty to eighty beds and it came under the supervision of the DADH. The APM arranged extra surveillance of suspected women, prophylactic centres were established in the city, and all brothels were placed out of bounds to the troops.
In December 1945 there were 402 cases of venereal disease in 2 NZEF (399 in Italy and 3 in Egypt) against a total of 107 in December 1944 for a much larger force.
Fresh cases of venereal disease were:
|Total venereal fresh cases||192||95||139||261||473||402||1562|
|Total all cases||279||152||209||405||536||402||1983|
The magnitude of the increase in incidence is shown by the fact that the total number of cases of venereal disease recorded from the beginning of 1940 to February 1945 in 2 NZEF, which was much greater in size than the force in the Florence area, was 4085. (This figure excluded those diagnosed as non-venereal, and comprised gonorrhoea 1826, venereal sores 1203, urethritis 476, syphilis 260, other diseases 320.)
The average monthly incidence per 1000 troops in 2 NZEF was:
|1940||1941||1942||1943||1944||Jan–Jun 1945||Jul–Dec 1945|
By April 1945 all the men in the Division who were receiving arsenical treatment for syphilis had completed their courses. All subsequent cases were treated by the speedier, though not totally proven, method of penicillin injections. Changes in treatment took place as the original penicillin treatment was found to require adjustment. In July the dosage of penicillin given for syphilis was page 685 changed to 30,000 units two-hourly for seven days, a total of 2,550,000 units. Penicillin was also given two-hourly in doses of 15,000 units for gonorrhoea.
In November there was a temporary shortage of penicillin and sulphathiazole was used to treat gonorrhoea, but as many as 50 per cent of relapses was expected. An increase in complications of gonorrhoea was noted at that time.
In December a marked increase in complications arose and as a result treatment was again changed. For gonorrhoea penicillin was given in dosage of 30,000 units two-hourly for ten doses, double the previous dosage. For syphilis, because a number of the cases showed Kahn tests rising, a series of ten daily intravenous injections of marpharsen (0·06 gm.) were given, combined with 85 injections of 30,000 units of penicillin two-hourly.
Blood tests were routinely carried out in the American and Canadian forces prior to the men returning to civilian life. At 3 General Hospital the opportunity was taken to carry out the tests during July and August on a total of 671 men returning to New Zealand. Only four were found to be strongly positive and two weakly positive. (The Wassermann reaction was negative in these latter two cases.) It was concluded that as the incidence of latent syphilis among New Zealand troops was low, and there was little tendency to conceal primary syphilis, a strong case could not be made out in favour of applying compulsory tests to all returning personnel.
1 Lt-Col G. W. Hayward; born Cardiff, Wales, 7 Jun 1911; medical practitioner; 3 Gen Hosp Jun 1942–Nov 1945.