Medical Services in New Zealand and The Pacific
II: The Medical Services of the Royal New Zealand Navy Afloat
II: The Medical Services of the Royal New Zealand Navy Afloat
The principal medical commitment at sea throughout the war was that provided by the two cruisers, initially the Leander and Achilles, and in the later stages Gambia and Achilles. An original war complement of two medical officers was subsequently raised to three in each ship, while the sick-berth staff of each cruiser was also eventually increased to six ratings.
It was never claimed that the normal medical work of a ship carrying 900 men would keep three medical officers fully employed, the increased establishment being the result of experience in similar ships of the Royal Navy, where it had become apparent that provision had to be made for the dispersal of an adequate number of trained medical personnel throughout a ship to ensure the maintenance of medical and surgical facilities in the event of serious damage with heavy casualties. Medical officers were, however, considered an integral part of the complement and were kept well occupied with other essential but non-medical duties.
One medical officer and three sick-berth ratings were employed in the armed merchant cruiser Monowai from 1940 to 1943, another medical officer was carried during 1943 and 1944 in the 25th Anti-Submarine Minesweeping Flotilla in the South-west Pacific, while sick-berth ratings were provided for a number of corvettes, minesweepers and other small craft.
The appointment to the 25th Flotilla illustrates some of the practical difficulties in arranging for the care of small detached units. It was created out of an effort to provide naval medical attention for a total complement of 325 in a group of five ships. In practice, however, it was found that the ships were so scattered in their employment that the medical officer's work was almost exclusively limited to his own ship's company of seventy-five at a period when page 170 there was a grave shortage of naval doctors for other appointments. An alternative plan of establishing him ashore in one of the island bases was equally unsatisfactory owing to the dispersal of the ships and their use of different harbours, and the appointment was finally terminated after eighteen months. Each vessel was, however, supplied with a trained sick-berth rating, who was able to obtain medical assistance without much delay from one or other of the numerous United States and British bases in the area.
The attached table of the disposition of the New Zealand ships carrying medical officers shows the variety of operational areas in which the cruisers were employed.1 Most of this work was in tropical waters, but it sometimes involved patrols and searches in latitudes south of New Zealand, where duffel clothing was necessary for personnel above decks, and for periods in the North Atlantic under winter conditions. Though the incidence of sickness and injury was generally low, and at no stage reached alarming proportions, successive medical officers in these sea-going appointments were required to deal with a wide range of medical and surgical conditions.
Medical Equipment Afloat
The establishment of medical stores and equipment was based on current Royal Navy scales, but it was found desirable to increase the number and range of surgical instruments. The sick bay of each cruiser carried a small portable X-ray unit, microscope and simple laboratory equipment, and efficient sterilisers for dressings and instruments, but there was insufficient refrigerated space for the proper stowage of lymph, sera and other products liable to deterioration. The newer drugs and chemotherapeutic agents were provided as they became available, and while endeavours were made to meet reasonable demands for additions to the range of drugs and appliances, the limited stowage space and the local supply position in New Zealand restricted issues to practical necessities and items likely to be of general use.
The equipment, though not elaborate, proved satisfactory in practice, no serious complaint being made of inadequacy in any of the special emergencies that did arise. Naturally, some improvisation and adaptation was sometimes necessary, utilising the skill and resources of the ships' artificers of various branches.
Blood products were not available at the beginning of the war and, apart from a rather meagre supply of glucose solution, ships had to rely on their own donors for emergency transfusions. In 1941 Auckland Hospital laboratory began the production of unconcentrated blood serum, the Navy assisting to provide some of the donors page 171 and obtaining supplies for issue to ships. The necessary refrigerated space for the preservation of this product was not always available, and it was replaced by American dried plasma and British dried serum, both of which were in abundant supply in the later years of the war.
Surgery at Sea
Battle Casualties: As will be seen in the table of casualties, a very small proportion are classified as wounded in action, as compared with the numbers killed by enemy action. This disproportion is typical of naval warfare and is due to losses of ships under circumstances which may permit few survivors. The Royal New Zealand Navy lost two of its smaller ships, Puriri and Moa, fortunately with moderate casualties, but the number recorded as killed by enemy action includes 151 New Zealand personnel lost in HMS Neptune and a large number of Fleet Air Arm personnel lost on operational flights while serving with the Royal Navy.
The main actions in which New Zealand ships sustained casualties afford good illustrations of the effects of different weapons in naval warfare, and show how arrangements for the after-care of naval wounded are dependent on various factors, including the tactical situation, the ability of the ship to continue as an effective fighting unit and the distance from base hospitals.
The Battle of the River Plate on 13 December 1939 was a daylight surface action between ships in which the Achilles sustained slight superficial damage from shellfire. Casualties, all resulting from shell splinters, were confined to exposed personnel on the bridge and those in the gunnery control tower, and comprised 4 killed and 9 wounded, four of whom were classified as severe. The wounded, including one compound comminuted fracture of the leg and two cases of extensive wounds of the buttocks, received all necessary early treatment from the ship's medical officers. The ship remained in the area as an operational unit but was able, nine days later, to land the four severely wounded cases into hospital at the Falkland Islands, whence they were re-embarked on 1 February 1940 before the ship returned to New Zealand. On arrival in Auckland on 23 February, only one still remained a cot case, the remainder having returned to duty or become ambulatory.
On the forenoon of 5 January 1943, off Guadalcanal in the Solomon Islands, the Achilles was hit by a Japanese aircraft bomb which wrecked one of the six-inch double turrets and a super-imposed Oerlikon gun but did not penetrate the interior of the ship, which was able to complete the operation on which she was engaged. The page 172 effects of the explosion were considerably localised by the construction of the turret, the majority of the casualties occurring in the guns' crews, though others in the vicinity suffered from blast effects. Eleven ratings were killed outright and nineteen wounded, two of whom subsequently died from multiple injuries. The injured included four with multiple wounds and retained fragments which required operative treatment, and five cases of burns. Blast injury to the eardrums was present in a large proportion of the injured. All these cases received full treatment on board from the ship's medical staff and were retained until the ship returned to Auckland on 3 February, by which time only one required admission to sick quarters.
On the night of 12–13 July 1943, during operations in a United States Task Group off Kolombangara in the South-west Pacific, the Leander received a torpedo hit amidships, resulting in severe underwater and internal damage. The main casualties occurred below decks in boiler room, switchboard and repair parties. Some of the bodies were not recoverable until the ship was subsequently docked, and the list of missing included some upper-deck ratings in the port waist and HA gun deck, who are presumed to have been blown overboard by the force of the explosion. Twenty-two wounded were received in the sick bay, where prompt resuscitation measures were effective in all except one case with extensive chest injuries. The ship arrived in harbour eighteen hours after being hit, when seven cot cases and one ambulatory case were transferred to a United States naval hospital, thirteen less seriously injured being retained on board. In this action, in which the total death roll was 28, the majority of the injuries were wounds of the lower limbs and blast effects.
Casualties in the Moa and Kiwi in action against a Japanese submarine in January 1943 were treated by the US Navy, which also looked after the injured when the Moa was sunk by air attack in the harbour of Tulagi in April 1943, with 5 killed and 8 wounded. It is of interest to note that most of the injuries in the latter incident consisted of fractures of the ankles or os calcis apparently due to the violent uplifting of the deck.
In addition, the Leander dealt with some Royal Navy wounded personnel from HMS Kimberley off Massawa in the Red Sea in October 1940, and with Italian casualties after the sinking of the raider Ramb I in the Indian Ocean in February 1941.
Routine Surgery: This consisted of a wide range of minor surgery, the management of acute abdominal emergencies and the treatment of a variety of accidents. The most serious accident occurred in the Monowai in the Hauraki Gulf in December 1941, when a misfire page 173 at gun practice resulted in ten casualties, including three immediate deaths and one subsequently, but as it was possible to admit those severely injured to Auckland Hospital within three hours, treatment on board was confined to first aid and resuscitation. Emergency abdominal operations were carried out at sea on numerous occasions, usually under very trying climatic conditions. The patients were not confined to the complements of our own ships, but included some from other naval vessels and merchant seamen from ships in convoy. Usually, cases operated upon on board were transferred to hospital ship or to shore at the earliest convenient opportunity, but it was sometimes necessary or desirable to keep them throughout recovery and convalescence. This was particularly so in the early years of the war when the employment of the cruisers on detached service entailed long periods at sea with infrequent visits to suitable bases, under which circumstances patients were retained throughout their full treatment and returned to duty in due course.
General Medicine at Sea
The greater part of medical work at sea concerned respiratory disorders ranging from common colds to acute lobar pneumonia and pulmonary tuberculosis, occasional outbreaks of the common infectious diseases, venereal diseases and skin conditions. The last-named group, particularly varieties of epidermophytosis, proved fairly troublesome in the Red Sea and Indian Ocean, but became even more a problem in the South-west Pacific. In the latter area skin affections, commonly in the form of extensive indolent ulcers and large weeping patches, accounted for a large proportion of the sick lists and attending lists. Many of these cases proved most intractable and required permanent transfer to a temperate climate. Digestive disorders of an organic type were comparatively rare, but gastro-intestinal symptoms were frequently noted in neuro-psychiatric cases. Comments on the incidence of certain diseases in the Royal New Zealand Navy as a whole appear in a later section.
Hygiene and Habitability of Ships
The most serious problem affecting health at sea, and one which was quite beyond the control of medical officers, was overcrowding. As the war progressed this question became more and more acute owing to the steady developments in armament and scientific equipment, which not only encroached upon the existing accommodation but required additions to complement far in excess of the designed capacity of ships. For example the Achilles, carrying 545 in peacetime, seemed barely capable of accommodating her initial war complement of 620 in reasonable comfort. More and more equipment page 174 was fitted as time went on, each item with its quota of men to operate it, so that by 1944 the same ship was required to carry no fewer than 882.
The resultant overcrowding was further aggravated by the abandonment of peacetime ventilation measures in the interests of the safety of ships and the maintenance of their stability and fighting efficiency in the event of damage. With side scuttles permanently plated over, and watertight doors always closed at sea, natural ventilation was well-nigh impossible below decks, and a large proportion of the personnel lived, worked and slept in compartments artificially lighted and dependent for ventilation on fans, suction pipes and blowers. An added factor contributing to the discomfort of life below decks in the tropics was ‘wild heat’, intensified by the removal of woodwork and lining material to reduce fire risk and facilitate the repair of damage.
It is difficult to assess the full effects of these conditions on health, morale and efficiency, but they were probably one of the factors responsible for the rather high incidence of pulmonary tuberculosis in the Navy.
The complexity of the problem was fully realised by the Admiralty, which appointed in 1943 a special Sub-committee on Habitability which not only collected reports but conducted its own investigations at first hand into living and working conditions under conditions of arctic and tropical warfare. Some of the recommendations resulting from this investigation will no doubt be incorporated in future warship construction, but the urgencies of war did not permit any appreciable alleviation of the problem during hostilities.
On the other hand, the Navy was fortunately placed in some other equally important aspects of hygiene and sanitation. Except in small ships, one did not have to rely on shore water supplies. For months on end, the distilling plants in the cruisers worked without interruption, ensuring not only a pure supply for drinking and culinary purposes and for the washing of clothes but also providing sufficient for daily fresh-water shower baths for all hands. Although diet was at times monotonous, the larger ships had good storerooms, some refrigerated space, and well-staffed and adequately equipped galleys and bakeries, so that food was generally well prepared and properly served. Disposal of garbage and excreta was never a problem, and though cockroaches infested most ships until the introduction of DDT, flies were seldom troublesome. Thanks to these favourable hygienic factors, dysentery and similar diseases were almost unknown, and the few cases reported were invariably the result of shore contacts.page 175