Medical Services in New Zealand and The Pacific
VII: General Medical Survey – 2 NZEF (IP)
VII: General Medical Survey – 2 NZEF (IP)
The whole of 2 NZEF (IP) was under the command of the United States Forces and worked in conjunction with them. This applied particularly to the medical services, who were dependent on the facilities of the United States Forces for evacuation of sick and wounded from island to island.
Some difficulty was experienced in the early stages – before 2 NZEF (IP) was properly established – regarding the checking and recording of casualties and hospital admissions in the many cases where New Zealand soldiers were admitted to United States hospitals, and for the lesser number of United States personnel admitted to New Zealand hospitals. However, a satisfactory system was evolved for notification of admissions and the interchange of records of such personnel.
Medical administrative and technical instructions were issued from time to time by DDMS, 2 NZEF (IP), to meet the various problems of administration and treatment as they arose. A few of these instructions were reprints from instructions of the Australian medical services, from whom much useful help and information was gained.
Liaison with United States Medical Units
The American Navy was in administrative control of the South Pacific Area in which 2 NZEF (IP) was engaged. The United States Services were responsible for the transport of our forces and for the evacuation of casualties in the area. The American medical organisation was divided into three sections, controlled respectively by the Army, Navy and Marines. Each arm had its own hospitals and staff but their activities were co-ordinated.
To the 2 NZEF (IP) medical organisation was delegated the care of their own personnel and also of those of the Royal New Zealand Navy and Air Force and of all British nationals, including civilians. The widely scattered area, however, called for considerable elasticity and in effect casualties from all nationalities were admitted to the nearest suitable medical unit. A close liaison existed between New Zealand Medical Headquarters of the force and of the Division with their opposite numbers in the United States Forces. Interchange of records was arranged with the transfer of a patient and the Americans provided all kinds of supplies, both medical and ordnance. The liaison was a very happy one throughout the period, and our senior officers acknowledged the great help that was given them by the American medical services.page 71
The United States Forces established hospitals of 500–1000 beds in the Solomons, at first using tents and then replacing them with huts. As a result of bombing attacks underground wards were dug under the day wards and were roofed with logs, a layer of gravel and earth and then concrete, which provided the floors for the day wards above.
These were obtained mainly from United States supply depots, both Army and Navy. Some supplies came from Australia and others from New Zealand. Ample American supplies were always available, with equivalents for all essential items on the British scale. A Depot of Medical Stores was set up close to Nouméa under the control of DDMS, NZEF (IP). An Advanced Depot moved forward to Guadalcanal and for a time maintained a section on Vella Lavella. It handled Red Cross hospital supplies and National Patriotic Fund Board hospital comforts. Field equipment came from New Zealand, and consisted of standard British Army equipment obtained from Australia and the United Kingdom. Sera and local anaesthetics prepared in New Zealand did not prove satisfactory.
Long trousers and long-sleeved shirts were essential as clothing in the jungle, both for protection of the skin and as a precaution against malaria. Tight-fitting belts were undesirable. The canvas jungle boots supplied proved unserviceable, as they became cracked and leaked and were blamed for many skin infections, and also for the hookworm contracted during the occupation of Nissan. Strong leather boots and woollen socks proved the best protection for the feet and the most serviceable footwear. In the Solomons rainproof outer garments were necessary because of the tropical rain. Great difficulty was experienced in drying the wet clothing and garments that had been washed and unit drying sheds were provided later in the campaign.
Pioneering tools such as axes and slashers (machetes) were of special importance for the preparation of camp sites and bush tracks, for which purpose the assistance of bulldozers was also required, especially in areas subject to bombing.
Medical Arrangements for Assault Landings
In the absence of roads in the initial stages of assault landings, no wheeled transport was of any use and all equipment and supplies had to be carried by the staffs of the medical units. Before the assaults page 72 each field unit spent much time in the re-arrangement of its equipment so as to be quite independent of vehicular transport. The lighter equipment was put in canvas holders which were made to fit on with the web pack. The heavier equipment, for which panniers were not available, was packed into strong wooden boxes made with rope handles so as to provide a load of 100 pounds for two men. Even then considerable difficulty was experienced, especially when the equipment was unloaded from landing craft some distance from the camp site.
The priority equipment of the Field Surgical Unit which was carried with the first echelon weighed only two tons. It included an IP tent which gave a room of 18 feet by 16 feet for an operating theatre. There was a tarpaulin for floor covering and, besides the standard instruments and equipment, fifty gallons of water were carried in drums for immediate use, as well as kerosene, electric batteries and overhead electric lights, intravenous fluids, and even a mechanical blood suction apparatus made from a motor-tyre pump.
The setting up of the MDS and FSU proved to be a laborious and relatively slow process. In the Treasury landing the medical units landed half an hour after the assault troops, but it was six hours later before the tented MDS was ready to receive patients. In the meantime the first casualties were attended to on an LST especially equipped and staffed for surgery by the Americans. The short line of evacuation enabled the surgical staff to operate on casualties generally within twelve hours of wounding.
The casualty rate was 2.6 per cent of the troops in the Solomons, one-third being killed and two-thirds being wounded. The proportion of killed to wounded was much higher than in Italy or Normandy, this showing the deadly nature of jungle fighting.
There were difficulties both in rendering first-aid treatment to the wounded and also in evacuating the cases to the MDS from the jungle areas. Little could be done in the jungle except to apply first-aid dressings, Thomas or Kramer splints, and to give morphia and occasionally plasma. Morphia was administered by syrettes, which were freely available even in the individual first-aid kits carried by the assault troops. With troops on patrol at least one man in each section was trained in first-aid. The first-aid kit contained dressings, iodine, sulphonamide, alcohol, aspirin, morphia syrette, atebrin, sticking plaster, field dressing and a two-inch rubber strip from a motor tyre inner tube to act as a tourniquet. (Knife wounds which had a tendency to free bleeding sometimes called for a tourniquet.) page 73 The field dressing was contained in a tin or a waterproof cover, the American tins being most efficient in the wet and hot conditions, while the British field dressing was not sufficiently waterproof and became useless in the wet. The American dressings had the disadvantage of having a conspicuous white bandage and a large dressing pad, but had a valuable sulphanilamide content. The smaller British dressings were more serviceable. There were also difficulties in protecting the wounded and the medical personnel in the jungle from enemy assault.
Evacuation was by stretcher and barge to the Main Dressing Station, to which unit was attached one or other of the FSUs with adequate equipment to undertake the major surgical work. The minor cases were dealt with by the field ambulance staff. This setup was similar to that in the Western Desert. Wound treatment followed the Middle East pattern and relatively little infection was seen.1
Battle Casualties in the Islands: Extreme difficulties were experienced in the evacuation of seriously wounded men from the jungle. The patients had to be carried out along narrow tracks in dense bush, with the constant menace of Japanese snipers to contend with, and in some cases the ordinary stretcher could not be used. Movement was as a rule only possible in the daytime, and at night the wounded were kept under shelter in a foxhole until daylight. Barges were used when possible to bring the casualties round the coast of an island to the MDS. This was especially the case at Vella Lavella, while in the Treasuries wounded were brought from Mono Island to Stirling Island, and at Nissan the cases had to be ferried across the lagoon. For motor transport four-wheel-drive ambulance cars with lowered hoods were preferred to jeeps. Flint stretcher apparatus for fitting to vehicles was available if required.
From MDS to CCS at Guadalcanal: The casualties were taken to the CCS at Advanced Base on Guadalcanal by sea or by air, and at first the LSTs used in the landing took back the wounded. These LSTs of 2000-ton capacity could take 100 lying and 200 sitting cases and were fitted out by the Americans as surgical or medical ships. The surgical ships had a liaison team, a resuscitation team and a surgical team – in all, six medical officers and eleven men – and they were well equipped with an operation room and all essentials, including cooking facilities. Some of the immediate forward surgery was carried out by United States surgical teams on LSTs, on to which were evacuated the casualties which occurred in the page 74 first few hours of attack. The United States teams did excellent work and the landing ships proved most satisfactory for the evacuation of wounded between the islands.
Later, as airstrips were made on the occupied islands, the majority of the casualties were taken back by air by Douglas transport planes, which proved eminently satisfactory for the evacuation of the serious cases. Medical holding units were established on the aerodromes by our own or American units.
From Guadalcanal to New Caledonia: Evacuation was both by air and sea to the Nouméa area in which 4 General Hospital was situated. Hospital ships and transports were both used.
From New Caledonia to New Zealand: Evacuation was by ship, either hospital ship or transport, from Nouméa to Auckland.
The evacuation in all areas was under the administration and control of the United States Forces, and appears to have been carried out without a hitch and without interference from the enemy.
The surgical work carried out during the Pacific campaign by the New Zealand Medical Corps consisted largely of the routine civilian type of surgery (mostly of minor degree) necessitated in any large group of men. The ready evacuation of sick and wounded to New Zealand determined that some of the serious and most of the long-term cases were dealt with in the civilian hospitals in New Zealand. There were relatively few battle casualties in the three limited attacks on Vella Lavella, Treasury, and Nissan islands – only 85 killed, 12 died of wounds and 189 wounded. Our medical units attended to a small number of United States wounded, and the CCS also dealt with Fijian casualties from Bougainville, but on the other hand American units also helped in the handling of our wounded. Of the 182 wounded admitted to medical units, 6.6 per cent died, over 36 per cent were returned to their units in the forward areas from the CCS stationed at Guadalcanal, and over 31 per cent were returned to their units from the General Hospital and Convalescent Depot in New Caledonia. Some 4 per cent were graded for base duties and nearly 22 per cent, fewer than forty cases, were evacuated to New Zealand.
Types of Wounds
An analysis of the New Zealand casualties admitted to medical units shows that limb wounds were predominant, accounting for about one half of the cases, while head wounds, including the face and neck, comprised almost a quarter. Chest wounds and back and buttock wounds accounted for most of the remainder in nearly equal page 75 numbers. The abdomen was the site of main injury in only two cases admitted to medical units. It was reported from chaplains who officiated at burials that most of those killed in action were wounded in the abdomen.
After the Treasury Islands assault the CCS reported that the great majority of the cases admitted had flesh wounds, generally involving muscle. Compound fractures were present in a surprisingly small number of the cases. Of the major cases there were three of compound fractures of the skull but no abdominal cases.
The relatively high proportion of fatal wounds and the high proportion of minor wounds in the survivors was undoubtedly due to the predominance of rifle and grenade wounds. In patients admitted to medical units rifle bullets caused 40 per cent of the wounds, grenades 18 per cent, and mortar bombs 24 per cent. Shellfire and bombing were limited and gave rise to relatively few casualties.
During the whole period the CCS was at Guadalcanal the unit admitted only twenty cases of chest injury, and in nine of these grenade or mortar fragments had produced a haemothorax. All the cases made a complete recovery, three having foreign bodies removed at the base hospital and neither clotting nor infection occurred.
Surgery was patterned on that carried out in the Middle East. The withdrawal of experienced medical officers from the Middle East, notably Major S. L. Wilson from the forward surgical team, enabled the latest knowledge of wound treatment to be available. Major Wilson, who was appointed CO of the CCS, drew up a memorandum laying down the methods of surgical treatment then in force in the Western Desert, and this was circulated to the medical units as a technical instruction.
The wounds were debrided and freely opened up. Sulphanilamide powder was then dusted over the wounded area and sterile vaseline gauze applied so as to keep the wound open. No skin sutures were used.
Head wounds were dealt with by the field surgical units of the CCS. The wounds were excised and foreign bodies and bone fragments removed if possible, and the skin sutured with provision for drainage.
Chest wounds were excised, the muscle sutured to close the chest with no stitches in the skin. A preliminary skin suture was used for sucking wounds.
Abdominal cases were explored early after resuscitation.
The few amputations were dealt with by a modified guillotine type of operation, with the usual dressings, and the stump protected page 76 by a plaster bandage covering. In the leg a seven-inch tibial stump was usual, and in the thigh amputation was carried out in the lower third.
The original type of Tobruk splint was applied for appropriate lower-limb injuries, including fractures of the femur. The Velpean arm plaster was applied from the shoulder to the knuckle for any fracture of the arm or forearm. An external plaster slab was covered by a circular plaster and a plaster Velpean bandage. Plaster was used freely both for fractures and large wounds of the limbs and proved satisfactory, although drying was slow in the wet weather.
Sulphonamide was given by the mouth twice daily following wounding, but no special record cards were used.
Penicillin became available in New Caledonia about February 1944. It was used in a few special cases in the forward areas at that time.
The forward units were well equipped to perform surgery and extras had been provided, including suction apparatus, in both FSU and MDS, constructed from tyre pumps and Winchester bottles.
Anaesthesia: No special difficulties seem to have been encountered with regard to anaesthesia. Simple methods were employed and no special apparatus was available in the forward areas. The Macintosh ether apparatus became available at 4 General Hospital in 1944, but not in the forward areas, where its use should have been invaluable. The moist climate, however, prevented undue evaporation of ether. The routine anaesthetics were pentothal and ether; ethyl chloride, or a mixture, was sometimes used for induction instead of pentothal. Local and spinal anaesthesia and intravenous pentothal were freely available in all areas.
Resuscitation was carried out by the personnel of the field ambulances in tents erected alongside the operating theatre. The Field Transfusion Unit originally set up was abolished and its staff absorbed into the CCS. There was no provision for stored blood, and the small amount of whole blood used was drawn off from donors, mainly ambulance staff, on the spot. Dried plasma, obtained from the United States Forces, was used freely in the main dressing stations with satisfactory results. Few of the casualties required whole blood in addition. At Vella Lavella, for instance, 154 pints of plasma were given and 14 pints of blood. There is no record of any serious reaction following transfusion of either blood or serum.
Experience showed that both blood and wet plasma kept badly in the hot humid atmosphere of the Solomon Islands. The high humidity, more obvious on refrigeration, softened the viscaps and permitted contamination along the moist thread of the screw-topped page 77 bottles. The stored blood had to be used within a week. Serum sent from New Zealand did not keep and was not used. These conditions determined the use of dried plasma. In regard to blood donors on the spot, due precautions were taken to exclude possible malaria. Apart from the malaria risk, it was not good practice to take blood from the forward troops, who were liable to suffer from nutritional anaemia.
The small number of serious casualties did not warrant the institution of a blood bank. If heavy casualties had been encountered, it would have been possible to send whole blood from New Zealand or New Caledonia by air to Guadalcanal and thence to the battle areas. If a blood bank had been established from blood sent from New Zealand there would have been a heavy wastage of blood as casualties were very light.
Gas Gangrene Infection
A few cases of gas gangrene were reported. Three cases were reported at Vella Lavella, one at Nissan and two at the CCS. The one at Nissan followed a crushed leg; the patient was given penicillin and several blood transfusions and amputation was carried out. The two cases seen at the CCS followed the assault on the Treasury Islands, and one died from malignant oedema infection associated with a fracture of the femur. The total of six cases with one death is a rather marked incidence considering the small number of 200 wounded. There was no gas gangrene in the cases which reached 4 General Hospital.
There is no record of any case of tetanus arising during the Pacific operation. Tetanus toxoid had been given to all the troops as a prophylactic, and an extra injection was given following injury. ATS was given when the toxoid immunisation was not complete.
There were very few deaths in the field ambulances, the large majority of deaths occurring in the field. At Vella Lavella there were only five deaths (only one of a New Zealander), three of the deaths occurring shortly after admission. At the Treasury Islands there were only five deaths in three months, including a Japanese soldier with an abdominal injury. At Nissan there were three deaths. This gives a total of thirteen, not more than eight being New Zealanders, and amongst these were brain cases and one burn case in which whole blood would not have been of any great value. At the CCS at Guadalcanal there were only two deaths in 2500 admissions, most of whom of course were sickness cases.
Treatment of Wounded in New Caledonia
Owing to the retention of the serious cases at the CCS till they were stabilised and quite fit to travel the 1000 miles to Nouméa, the few wounded received at 4 General Hospital were the lesser wounds or cases nearing the convalescent stage. The fractures were received in plaster splints and, except for the femurs, were soon sent on to New Zealand. A few cases were evacuated from the CCS direct to New Zealand. Special cases, such as one obstructive jaundice, were sent from Noumea by air to Auckland. All patients who would not be fit for Grade A within three months were evacuated to New Zealand as soon as transport was available. (Some 55 per cent of the wounded were discharged from the hospital Grade A.)
Very little sepsis and no gas gangrene was present in wounds at the stage patients were received at New Caledonia. No deaths occurred at 4 General Hospital during the nine months at its Dumbéa site.
Specialist Medical Officers
The relatively close proximity of the force to New Zealand did not call for any extensive specialist medical services, and in any case there were only a limited number of specialists available for posting to the force. In the event, little specialist work was done in medical units.
There were no orthopaedic surgeons, neuro-surgeons or genitourinary surgeons. Eye, ear, nose and throat specialists were on the staff of 4 General Hospital. A dentist trained in facio-maxillary work under Sir A. Mclndoe at East Grinstead was attached to the hospital, and he worked at times in one of the United States Station Hospitals on New Caledonia. The American hospitals provided X-ray examinations both in New Caledonia and Guadalcanal until X-ray departments were functioning in our own units – 4 General Hospital, 2 CCS and 2 Convalescent Depot. Radiologists were trained from members of the force. Two medical officers were sent back to New Zealand for six months' training and returned in December 1943, when they were posted to 4 General Hospital and 2 CCS.
A pathologist was attached to 4 General Hospital for a period and well-trained bacteriologists were on the staff of 4 General Hospital and 2 CCS.
On the medical side, Lieutenant-Colonel Sayers, a specialist, was Consultant in Tropical Diseases.page 79
Tours of the Solomons were carried out by an ENT specialist and a physician with special knowledge of skin conditions, advice on treatment being given to medical units and reports furnished on the problems involved.
Surgery of Civilian Type
This was carried out for acute cases in all the medical units, but the more chronic and specialised cases were dealt with at 4 General Hospital. Appendicitis was the most common condition requiring urgent attention. Accidental injuries were not unduly common. During the period of inactivity on New Caledonia sports injuries were responsible for a marked proportion of them. In the four months up to 30 September 1943 there were 126 cases of this class admitted to 4 General Hospital, mostly football casualties.
There was more than ample hospital accommodation, equipment and staff to deal with the routine surgical work and the small number of casualties reaching the Base were easily dealt with. (The hospital at Dumbéa was built and equipped on a lavish scale not usually associated with military hospitals.) Evacuation to New Zealand was so easy that cases requiring prolonged treatment were transferred to New Zealand. Fractures of the femur, however, were retained till firm union had taken place.
The casualties from the Fijian battalions, which were all evacuated to 2 CCS and then to 4 General Hospital, were retained during 1944 until all surgery had been finalised, as the American military hospitals had by that time moved on from Fiji and the civil hospital at Suva was fully occupied.
Health of Troops
The health of troops generally throughout the New Zealand Pacific force was of a high standard and in a large measure credit was due to the efficiency of the medical services. The general health of the Army Nursing Service and WAAC was very good and the sickness rate relatively low, with no incidence of epidemic disease.
Reports indicated that troops serving in the Solomons area required to be in the best possible physical condition. In this connection it was considered advisable that men over the age of 35 years should not, unless specially required, be permitted to engage in active service in the Pacific area. The general conditions of living, and the trying climatic conditions, showed their effects most on men of the older age groups, and also tended to exaggerate any pre-service disabilities. Men over the age of 41 were returned to Base at the end of 1943.page 80
It was very fortunate for the New Zealand troops that New Caledonia was not an endemic area for malaria. By the time 3 NZ Division was preparing to enter the malarious zone in the Solomons it was in a position to profit by the earlier experiences of the Americans in the same area. Lessons had been learnt, at the expense of fairly high casualties, on the need for a comprehensive malaria-control organisation and for strict anti-malaria discipline. The value of atebrin had been realised and it was more readily available. Preparations for the control of malaria in New Zealand troops involved the organisation of a Malaria Control Unit, the training of medical personnel in the diagnosis and treatment of malaria, and the training of combat officers and other ranks in anti-malaria measures.
The Malaria Control Unit consisted of a headquarters and three brigade sections with a total strength of thirty-six officers and men. The headquarters consisted of two officers (the commanding officer and one entomologist) and ten men, one of whom was trained in the laboratory diagnosis of malaria. Each brigade section consisted of one officer and seven men. Two of the three section commanders were entomologists and the other was an engineer. The Malaria Control Unit had excellent preliminary training in the malarious area prior to the New Zealand troops going into it. Parts of the unit worked successively on Efate, Russell and Tulagi islands from January 1943.
Colonel Sayers's pre-war experience in the Solomon Islands was invaluable and data supplied by him was published as a booklet, Malaria in the South Pacific. As Consultant in Tropical Diseases Colonel Sayers was sent to Australia and New Guinea, where valuable advice was given by Australian medical officers, particularly Brigadier N. H. Fairley.
In the training of the Division in anti-malaria measures all officers attended lectures and an instructional film, and they in turn lectured the troops; medical officers received sound instruction in the diagnosis, clinical features and treatment of malaria; unit squads attended three-day courses of instruction; and a pamphlet containing advice on malaria precautions and a reprint of the administrative order on the subject was given to every officer. A trained technician was attached to each field. ambulance, and at least one medical officer in the unit was also trained in thick film technique. Each man kept a malaria record card in his paybook.
It was decided that no short trousers would be taken into the malarious areas (the wisdom of this was later questioned as troops used to wear underpants only), repellent was issued, and atebrin commenced on embarkation. Atebrin was given regularly to all page 81 troops in the Solomons in dosage of 0.6 gramme a week and this was continued for a month after withdrawal to New Caledonia or New Zealand. Battle casualties were given 0.3 gramme per day for three days.
Colonel Sayers's pre-war experience was also helpful to the Americans. When 2 Marine Division was sent to New Zealand at the beginning of 1943 after the Guadalcanal campaign, there was great concern over the high incidence of malaria in the division. Commander J. J. Sapero, the naval tropical diseases specialist, was urgently sent for to fly to New Zealand to investigate the situation, and he arranged to take Colonel Sayers with him as adviser. While in New Zealand Colonel Sayers collected his old malaria record cards, and on his return to New Caledonia he analysed them and made the information available to the Americans. It was of considerable value to them in planning their next campaign, particularly regarding the good and bad months for campaigning from the point of view of malaria. Colonel Sayers was also frequently asked to lecture on malaria problems to United States medical officers in the Army and Navy, and was frequently called in for consultation on malaria problems. His services were recognised by the award of the Legion of Merit.
The period during which the Division was on active operations in the forward areas, which were malarious, was the ‘off season’ as far as malaria was concerned. The incidence of malaria in the Solomon Islands increases in the months of May, June, July and August, during the rainy season.
In the earlier stages of operations malaria discipline tended to be bad, but measures were taken to ensure that full control precautions were adopted. It was obvious, of course, that malaria discipline must become bad when units were actually engaged in combat.
In the forward areas all men admitted as patients to medical units had blood films examined to detect whether or not they had become infected by malaria. This procedure was responsible for the discovery of a number of latent cases.
The standard of malaria discipline and the measures of malaria control adopted by the New Zealand force were the subject of comment by members of the United States Forces, who were impressed with their efficiency. In units with comparable service in the Vella Lavella campaign, the New Zealand rate was less than 0.1 per cent, whereas that of United States troops was up to 10 per cent.
The invaluable work undertaken by the United States engineer service in clearing the malarious areas in the New Hebrides and the Solomons was of the utmost benefit to the whole force, of which our troops formed part of an integrated team.page 82
Fresh cases of malaria developed in the Solomons totalled only 120, while 250 fresh cases, apart from readmissions, developed in New Caledonia among troops returned there. The incidence of malaria in the field, 0.8 per cent of the force involved, was very satisfactory – infinitely better than had been hoped for. This does not mean that a much larger part of the force was not infected and many developed attacks either in New Caledonia or New Zealand after the stopping of suppressive atebrin.
Of the 110 cases developed in the Solomons an analysis of the probable place of infection showed 43 from Guadalcanal, 44 from Vella Lavella, 11 from Treasury and 12 from Nissan. The higher incidence on Vella Lavella is easily understood because on this island the most extensive and most prolonged jungle fighting took place. The low rate on Treasury appears to have been due to the small native population, limited anopheline breeding and low endemicity of malaria among the natives. (Spleen rates for the islands were: Guadalcanal 77, Vella Lavella 67, Treasury 14, Nissan 51.) A large proportion of cases occurred on the base island of Guadalcanal, where at no time were New Zealand troops engaged in combat. A Field Park Company which was on Guadalcanal all the time had the highest malaria rate in the Division, and although the unit was close to an Allied unit where mosquito breeding was not well controlled in the early stages, it was thought there was a failure of malaria discipline.
Most of the small amount of fighting took place outside the real malaria season of February to June. Nearly all camps were on good sites, and malaria control on all islands was good. Malaria discipline was rather better on Treasury and Nissan than on the other two islands. Natives were usually some distance from the camps and not great in number – they were probably of less importance as malaria carriers than the seeded troops who were present. The highest strengths of New Zealand troops on the islands were 11,000 on Guadalcanal, 5700 on Vella Lavella, 4600 on Treasury and 6600 on Nissan. The incidence was so small that it would seem to have had little direct relation to the number of troops, but rather to lapses of discipline in individual units. This would be in line with experience elsewhere.
The number of cases of malaria occurring weekly in New Caledonia after atebrin suppression ceased was: 1st week, 15; 2nd week, 32; 3rd week, 54; 4th week, 62; 5th week, 45; 6th week, 17; 7th week, 8; 8th week, 7; 9th week, 4; and then only odd cases.
Arrangements were made to keep close observation on the troops after their return from the Pacific area so that little chance would arise of any introduction of the disease to New Zealand. Pamphlets giving very full information on the disease and its treatment were page 83 distributed to every medical practitioner in New Zealand and the disease was made compulsorily notifiable. Fortunately there were not many cases and the preparations made for the treatment of cases in hospital proved unnecessary.
With the campaign against malaria being so successful, the only real medical problem was caused by skin infections, which were very prevalent in all the forward areas and were the greatest cause of hospitalisation. There were many contributory factors. Abrasions, scratches and insect bites were common in the jungle, the hot moist climate favoured bacterial growth, water was sometimes in short supply, the washing and drying of clothes was difficult and the diet was sometimes deficient. Dirty blankets accentuated the trouble. A scrub mite on Stirling Island caused eruptions on the legs and ankles, and a furry caterpillar on Nissan also caused much skin irritation and pruritis.
The great majority of the cases were minor in degree but tended to become chronic under the prevailing conditions. Most of the more severe cases were due to eczematous dermatitis, frequently associated with sweating. Tropical ulcers were not very common, only eighty-one cases being evacuated back to the CCS. The ulcers were very indolent and slow to heal. They resembled the desert sores seen in the Middle East and responded to the same treatment. Boils and septic sores were fairly common, as were prickly heat and sweat eczema of the feet. Tinea of various types was often seen, but seborrhoea was not as common as in the Middle East. Sensitivity to the local application of sulphonamides, which were available freely from the American supplies, accounted for many intractable cases.
Treatment was carried out efficiently in the forward areas, but many cases were evacuated to Guadalcanal and also to New Caledonia. There were 1930 cases hospitalised altogether from June 1943 to July 1944. In spite of the large number of cases dealt with, only 115 men were eventually evacuated to New Zealand because of skin conditions.
There was a very low incidence of venereal disease in the force, only forty-four cases of gonorrhoea and two of syphilis being recorded in fourteen months. The prior education of the troops on the subject and adequate supplies of preventatives were undoubtedly influencing factors, but the opportunities for sexual intercourse were few and not nearly as great as in other campaign areas.
Outbreaks of dengue fever occurred in New Caledonia each autumn, the virus being transmitted by mosquitoes. Practically all cases could be traced to infection in towns and villages, while camps in bush areas were singularly free from the disease. Very few of the army personnel stationed in urban areas escaped infection. Some areas were put out of bounds temporarily. In the first outbreak which began in April 1943 the number of cases each month were: April, 120; May, 243; June, 83; July, 37. Of this total of 483 cases, 176 were admitted to 4 General Hospital and others to other medical units. In 1944 the admissions to medical units with dengue were: February, 15; March, 62; April, 94; May, 42; and June, 22.
Both bacillary and amoebic dysentery were endemic in New Caledonia and the Solomons. Mild attacks of diarrhoea were common shortly after the arrival of the troops in New Caledonia, and, just as in Egypt, dysenteric infection was probably responsible for many of the cases. One small epidemic of gastro-enteritis was considered to be due to Sonne infection. Strict enforcement of a high standard of sanitation kept the incidence of dysentery very low. In the Solomons flies were very prevalent in the jungle, and the Japanese had a high incidence of dysentery and contaminated any areas they had occupied. Under combat conditions it proved impossible for our troops to maintain strict sanitary rules and dysentery cases developed during the fighting in the three island operations. Apart from these early cases the incidence in the Solomons was slight.
Colonel Sayers was of the opinion that in future island operations sulphaguanidine should be issued to the troops, to be taken as a prophylactic measure during the first jungle assaults so as to obviate the initial wastage until the implementation of proper sanitary arrangements. A small number of cases of amoebic dysentery were diagnosed and treated in the hospitals.
Typhoid fever, though present in the civilian population, was not seen in our forces.
Hookworm was first noticed on Nissan in April 1944, two months after the landings, when anaemia and debility began to show up in a number of the troops. Blood counts then showed that eosinophilia was present in about 30 per cent of the troops. Treatment with 3 per cent tetrachlorethylene was carried out in the unit lines with satisfactory results. It was considered that the eosinophilia present was not wholly due to hookworm infection. An investigation at 4 General Hospital of 100 patients evacuated from Nissan showed page 85 little hookworm infection. Other varieties of worms and amoebae were found as well. It was judged that the infection was not serious and that there was no danger of the spread of the infection later to New Zealand. Colonel Sayers has expressed his opinion that hookworm would not be of major importance in any Pacific campaign.
Yaws was very prevalent in all the islands. In a survey of 100 Nissan islanders all showed evidence of active or quiescent tertiary lesions, while hyperkeratotic conditions of the feet were present in 93 per cent, sabre tibia in 26 per cent and active ulcers in 19 per cent. Injections were given to large numbers of patients at different periods.
A small number of cases of infective hepatitis and a few cases of cutaneous diphtheria were recorded.
There were a number of anxiety neurosis cases evacuated from the forward areas, largely due to the debilitating effects of the climate and living conditions, but the problem was an insignificant one. It was recorded, however, that from the middle of December 1943 to the end of January 1944 a large proportion of cases evacuated to the CCS were suffering from psychoneurosis. In New Caledonia, as in the Middle East, numbers of psychoneurotic cases were boarded back to New Zealand as unfit for military service, before reaching the forward areas.
A study of psychoneurosis in NZEF (IP) was made by Major Adams,1 and this showed that this disability actually decreased in incidence when troops went into the forward area, thus indicating that a limited amount of active warfare produces less affective reaction than much stagnation remote from battle. In the force 26 men per 1000 became unfit for Grade A1 duties on grounds of psychoneurosis, which was just under one-sixth of those downgraded, and 10 per 1000 required invaliding to New Zealand, which was just over one-sixth of the total thus returned to New Zealand.
A study of those down-graded and employed on base duties showed that, unless possessed of some valuable specialist qualification, psychoneurotics could rarely be employed economically and that such men became more permanently confirmed in their disabilities.
The boarding of men judged unfit for full active service began soon after the arrival of the force in New Caledonia. The same problems as had arisen in the Middle East were present. It was found necessary to down-grade many men for pre-enlistment disabilities which had been hidden or had been overlooked at the original medical examination. Accidental injuries, most frequently due to football, caused some disability, but sports probably helped to reduce the incidence of neurosis. The static and limited life of the garrison force produced a number of psychoneurotics, but their number was not abnormally high. The condition of these men was found to deteriorate when they were employed on monotonous and uncongenial duties at the Base, as also happened in the Middle East.
There were relatively few men boarded as a result of sickness, the main disability being skin disease, and only a small proportion of these cases was sent to New Zealand. Asthma cases were returned to New Zealand.
Washing and Laundry
In New Caledonia the camps were located near rivers so that the troops had facilities for bathing and also for washing their clothes. Hot showers were provided later in the different units. Some laundry work was carried out by civilians.
In the Solomons water was plentiful in Guadalcanal and Vella Lavella but it was short in the Treasuries and Nissan. Distillation of sea water had to be resorted to and washing facilities were meagre. Also it was difficult to get any washing dry in the wet and humid climate. Drying huts were provided in all units during the later part of the campaign. A portable disinfestor was sent to the forward area in November 1943 and this enabled the blankets to be cleansed regularly. Field medical units were issued with petrol-engined washing machines (domestic type), which proved most useful.
Great care was necessary in the use of water in the Pacific area. Investigation showed that all streams were contaminated, and therefore all drinking water had to be efficiently treated both by filtration and chlorination. Chlorination alone was not effective as amoebic page 87 cysts required filtration for their removal. Troops in the jungle required individual water sterilising tablets and small filters. It was found that German and Italian types of filters were very satisfactory for the individual treatment of water and steps were taken to augment their supply.
During the earlier months following the arrival of the Division in New Caledonia it was noticed that some of the troops and nurses became anaemic. This anaemia was nutritional and was apparently due to an inadequate intake of essential foods particularly meat. The disinclination of New Zealand troops to eat certain American canned foods was an aggravating factor. Various methods were adopted to combat the anaemia. It responded best to yeast concentrates; liver by injection gave a slower response. Later, with the arrival of adequate and suitable rations, such as frozen meat and butter, from New Zealand, and the addition of fresh fruit and vegetables to the diet, no further cases were recorded.
It was felt that there was a need for the development of a special ‘jungle ration’ for active operations. The Americans had a ‘K’ ration and the New Zealanders a ‘battle’ ration, but neither was ideal and a combination of the two might have been more acceptable. What was needed was a ration easily carried, appetising whether eaten cold or hot, easily digested and requiring only a small quantity of water in its preparation. Essential constituents suggested were meat (preferably bully beef), palatable nutritious biscuits, compressed fruits, glucose sweets, salt tablets, chewing gum, coffee, tea or other beverage and dried whole-milk powder, plus cigarettes, compressed fuel and wet-proof matches; the whole ration and individual items to be packed in waterproof, waxed packing and the meals varied; items such as meat and milk powder to be packed in small cans containing a sufficient portion for one meal. Vitamin capsules were also considered necessary and the foods fortified with vitamins.