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New Zealand Medical Services in Middle East and Italy



2 NZ General Hospital

During the summer of 1941 the greater part of the work of 2 NZ General Hospital at Helwan consisted in the normal care of base troops, including those of other forces in the surrounding area and Italian prisoners of war from a camp nearby. Battle casualties were not admitted in large numbers.

Infectious diseases endemic in Egypt accounted for the majority of the medical cases, and bacillary dysentery generally supplied the largest quota of cases every month, being more prevalent in the early and late summer. The majority of the cases were Flexner in type, but some seriously ill cases with some deaths followed Shiga infection. Other cases were due to infection by Sonne, Schmitz, Para Shiga, and Boyd I bacilli. It was not till May 1941 that sulphaguanidine began to be used in small quantities, but by August it was realised how successful it was in the treatment of the more severe type of case, and thereafter sulphaguanidine became the routine treatment in all cases of bacillary dysentery, and was even used by RMOs in camps for the lighter cases. There were only a very few cases of amoebic dysentery admitted, including one with abscess of the liver.

Slightly fewer than three hundred malaria cases were admitted during the summer months from both the base camps of Maadi and Helwan. In May and June 15 cases were admitted following infection in Crete. All the cases except two were of the benign tertian type and responded well to treatment.

Infective hepatitis had been common in mild form in November 1940, but there were few further cases till June 1941 and a minor peak of 77 cases in July. Convalescence was noted to be slow, the average case requiring five to six weeks before return to his unit. It was noteworthy that no cases occurred in Greece and Crete and that most cases arose in 4 Brigade, which had suffered from the disease in the previous September.

Skin conditions accounted for a high proportion of minor sickness in unit lines and also for many admissions to hospitals, where their chronicity kept many beds occupied. Seborrhoeic conditions were especially troublesome and fungus infection was common at page 228 times. Desert sores were noted to be common in September, when bacteriological examination showed the common presence of haemolytic streptococci as well as staphylococcus aureus and diphtheroids. In hospital these cases cleared well with local sulphonamide, rest, and vitamins.

Dyspepsia was a common complaint, the majority of the cases being functional in origin, though there was a small proportion of ulcer cases, most of them with a pre-war history. Unfortunately, the careful investigation of these cases in hospital tended to fix the neurosis and few of the hospital cases were subsequently of any use in the Army.

Psychoneurosis became a major problem and appeared in many forms. The large majority of the cases arose at the base in men either with a previous history of nervous disorder or with an unstable personality which could not stand the strain of disruption from their civilian surroundings. Anxiety states were common but hysterical states were not often seen. Exaggeration of minor disabilities such as flat feet was noted. Colonel Spencer drew attention to the danger of implanting ideas of disability in the soldier.

In May attention was drawn to the prevalence of functional disorders of the eye, with signs of diminution of visual acuity, contraction of visual fields, blepharospasm, photophobia, and weakness of accommodation. In May 28 cases were seen at Helwan hospital. Half of them were severe, all with hysterical amblyopia, only four of whom had been in Greece. Of the other half six had some degree of hysterical amblyopia, and one had been in Greece and two Australians at Tobruk. Major Coverdale1 considered that these men were hysteria prone and that severe cases were seldom really cured, and their disposal was made difficult by the wide diversity of views on this matter held by the senior medical officers. He considered these men should not be exposed to combatant service since, at the best, they would be useless and a source of weakness in their units.

3 NZ General Hospital

At Helmieh 3 General Hospital's medical admissions were similar in type to those of 2 General Hospital. The staff of the hospital was afflicted with sandfly fever in June, and the epidemic later spread to the base camps, from which further patients were admitted until September. The early diagnosis of the cases presented some difficulty, and convalescence was apt to be slow, with many patients suffering from lassitude and depression. Preventive measures were vigorously carried out at Helmieh. It was noted that there was a page 229 notable absence of anxiety neurosis among battle casualties from Crete. In September the hospital was authorised to expand to 900 beds.

1 NZ Convalescent Depot

This unit proved very valuable for the convalescence of senior officers after Greece and Crete, and also for servicing the divisional units in the Canal Zone at Kabrit. It reached a peak of 815 patients after the Crete campaign. All convalescents were made dentally fit before discharge.

Maadi Camp Hospital

The camp hospital dealt with the minor infectious diseases and minor cases in the camps not likely to be in hospital for many days, as well as the cases of venereal disease. It eased the load of the general hospitals considerably as well as simplifying the isolation of infectious cases. Measles, mumps, influenza, and sandfly fever patients were admitted, and in May a special emergency hospital and convalescent area was set up to deal with the influenza cases among the 5th Reinforcements.

The number of venereal disease patients admitted to Maadi Camp Hospital gave rise to some concern, especially when in June and July the total number of cases in 2 NZEF rose to 190, or seven cases for every thousand troops each month. The incidence had been almost as high the previous year when all the troops were in the Cairo area, but the attention drawn to the matter by Captain Platts, and the action taken by the 2 NZEF authorities, resulted in this high incidence not being reached again until after the conclusion of hostilities in Italy. A count was made of the New Zealand soldiers using the PA centre in the legalised brothel area in Cairo for a week in July and was found to be 2164. This did not include those who used other places and means of prophylaxis, and those who took no precautions at all. It was pointed out that it was necessary to correct the unwitting but dangerous sentiments conveyed by non-medical lecturers which tended to recommend the use of legalised brothels. Their existence presupposed freedom from infection, but most of the prostitutes had venereal disease. Captain Platts, after witnessing the regular examination of prostitutes, considered that every prostitute probably suffered from chronic gonorrhoea, and he found that every third prostitute had a syphilis treatment card.

The problem was one common to all forces in Egypt, and the page 230 closing of the brothel area to troops the following year resulted in a reduction in the incidence of venereal disease.

In July and August 1941 a follow-up system was organised to ensure that all patients completed their surveillance at field ambulances after their discharge from Maadi Camp Hospital, especially as regards syphilis patients who now numbered 51, and that case records were sent to the DGMS Army Headquarters for any troops who returned to New Zealand while still under treatment. One medical officer in each field ambulance was given special training in the treatment of venereal disease so as to enable the follow-up to be satisfactorily carried out. By October 1941 the incidence in venereal disease in 2 NZEF had dropped below three per thousand troops per month, and did not rise above this figure during the rest of the time 2 NZEF was in Egypt.

A blood bank was formed at the Camp Hospital in July 1941, and thereafter blood was drawn off by arrangement with Lieutenant-Colonel S. R. Buttle, in charge of the blood transfusion service at 15 General Hospital, to supply the needs of the forces in the Western Desert.

Infectious Disease in Reinforcements

Of the three reinforcements arriving during this period, the 5th and 7th brought many cases of infectious disease with attendant problems for the medical services in Egypt. The influenza epidemic of the 5th Reinforcements, and the measures taken to prevent its spread, has been described. Some influenza was also present in the 7th Reinforcements, and mumps and measles cases were brought over by both the 5th and 7th Reinforcements. Although a very few cases of mumps were reported for three months following the arrival of the 5th Reinforcements, there was no record of any spread to the troops in Egypt of any of the infectious diseases brought over in the transports. This is rather remarkable and is associated with the experience that the ordinary infectious diseases prevalent in New Zealand developed to little or no extent in our troops in the Middle East.

The following table shows the number of sick patients admitted to hospital for the period June–December 1941:

Month Dysentery Sandfly Fever VD Pneumonia Malaria Infective Hepatitis
Jun 124 ? 190 14 10 45
Jul 103 134 192 49 39 77
Aug 157 205 144 49 66 48
Sep 99 205 119 14 117 27
Oct 102 73 95 16 71 41
Nov 255 30 59 26 8 41
Dec 75 3 60 26 8 23
page 231
Month Diphtheria Mumps Poliomyelitis Strength of Force Total admiss. Daily Rate per 1000 Officers ORs
Jun 22 2 27,203 2190 2.7
Jul 27 2 30,981 1384 1.4
Aug 3 18 30,840 1900 2.4 2.03
Sep 1 2 30,566 1.9 1.6
Oct 6 35 36,220 2.0 2.2
Nov 2 104 35,102 ?
Dec 15 10 32,871 1540 1.4 1.4

1 Lt-Col H. V. Coverdale; Auckland; born Christchurch, 19 Oct 1898; ophthalmic surgeon; 2 Lt RFC 1918; 3 Gen Hosp Jan–Mar 1941; 2 Gen Hosp Mar–Sep 1941; 1 Gen Hosp Sep 1941–Nov 1944.