War Surgery and Medicine
IN this clinical volume, the first of three volumes of the Medical History of New Zealand in the Second World War, is recorded the most important aspects of the clinical work and experience of the New Zealand Medical Corps. Some subjects which did not figure prominently in our New Zealand experience will be covered by the Medical War Histories of the Commonwealth and the United States, which histories have been co-ordinated by the meetings of the Liaison Committee of Official Medical War Historians. The volumes produced by the various countries will together cover the whole field of war medicine and surgery.
In this, our New Zealand record, no attempt has been made to write clinical articles such as would be appropriate to a medical journal or a textbook. Subjects have in the main been dealt with chronologically, linking the First World War with the Second World War, and stating and evaluating developments in the course of the war. The short reviews of our experience in the First World War are useful because no New Zealand clinical history was written at that time, and they also serve to emphasize the importance of cardinal principles, especially in war surgery, and to show how similar problems arise in every war. With articles built up in chronological order there is inevitably some repetition and lack of clarity, but this approach was adopted deliberately with some subjects in order to give the reader a mental picture of what was happening at important periods during the war; for instance, how the wounded were treated in our Field Ambulances during the Libyan campaign or at the Battle of Alamein, Summaries of surgical treatment have been made for reasons of emphasis and ready reference. Statistics, some of them compiled with great difficulty, have been incorporated to illustrate the comparative magnitude of the problems, and War Pensions' experience has been drawn upon to help place the problems in proper perspective.
The articles are centred on the 2 NZEF in the Middle East and Italy, where most of our experience lay, but clinical work in the Army and Air Force in the Pacific theatre is covered where possible. In the Middle East and Italy we had a force which grew from 6000 in February 1940 to 36,000 in October 1941 and remained around the 30,000 mark until August 1945; during this period page viii 2 NZ Division served in the early campaigns in Greece and Crete and in all campaigns of the Eighth Army except Sicily. Its wounded totalled 16,456, apart from wounded who were taken prisoner (1326), and its sick over 100,000, although the sickness rate was low. The Pacific forces were smaller and served for shorter periods; the wounded in 3 NZ Division totalled only 227, but there were special problems relating to tropical diseases.
The New Zealand Medical Corps carried out its work in the Middle East under the overall administration of the Royal Army Medical Corps, and always in close association with other forces as far as clinical work was concerned, so that any advances in treatment were immediately available to us. It fell to our lot to care for very many casualties from other forces of the Commonwealth, and many of our own men were treated in other medical units, especially in British General Hospitals.
The clinical work of the NZMC reached a high standard in conformity with that of the British Army medical service, of which our Corps was a small but energetic part. It is of interest to note that in the New Zealand casualties the proportion of killed and died of wounds to wounded who recovered steadily fell from 2:5 in Greece and Crete and 1:2 in Libya to 1:5 in the advance from the Senio in the final stages of the war in Europe. The personnel of our Corps were all civilians recruited for service during the war. Only a few senior medical officers had seen service in the First World War and so had some experience of war medicine and surgery. The quality of our clinical work therefore depended on the training and ability of our civilian medical and nursing professions. Our nursing sisters did magnificent work throughout the war and our voluntary aids and orderlies gave excellent service. There was a relative shortage of specialists in New Zealand in the fields of neurosurgery, plastic surgery, chest surgery, anaesthesia, and, to a lesser extent, orthopaedic surgery., This rendered it necessary to rely on the RAMC to some extent for these services, and special British units were often invaluable to us. (It is satisfactory to note that there has been a marked development of these specialties in New Zealand since the war, and it is hoped that this will enable the medical services of any future expeditionary force to be self-sufficient.)
The development of specialist units overseas brought about a steady improvement in treatment, and field surgical and field transfusion units were invaluable in forward surgery. The introduction of sulphonamides and penicillin and the adoption of delayed primary suture brought about marked advances in wound healing. In the treatment of, disease the sulphonamides and page ix penicillin proved also of the greatest value, while in the preventive field, inoculations against tetanus, typhus and the enteric fevers, the use of mepacrine as a suppressive of malaria, and the use of the insecticide DDT limited disease and conserved manpower. All these developments and many others are elaborated in the appropriate articles.
Short lists of references have been appended to some of the articles when information has been obtained from medical journals. Most of the articles, however, have been written almost entirely from our own experience and from what information we have found in reports filed during the war. One wishes that more of our officers had recorded their experience in the form of surveys and special studies, and that an attempt had been made during the war to collect clinical photographs and drawings.
The articles have been written almost entirely by the Medical Editor with the help of his assistant, J. B. McKinney, but a few very valuable articles have been written in whole or in part by distinguished members of the Medical Corps-among them G. R. Kirk (Infective Hepatitis); E. G. Sayers (Malaria); J. E. Caughey (Q Fever); R. A. Elliott (Ear, Nose and Throat disabilities); H. V. Coverdale (Ophthalmology); W. M. Manchester (Plastic Surgery); W. M. Platts (Venereal Disease); J. Borrie (Clinical work among Prisoners of War); and D. T. Stewart (Work of a General Hospital laboratory overseas); and G. H. Gilbert, New Zealand Dental Corps (Plastic Surgery).
Other senior members of the Corps have helped by reading and giving valuable criticism of some of the articles and some have furnished fresh data. Among those we thank for this co-operation are M. Falconer, E. L. Button, A. W. Douglas, J. K. Elliott, M. Williams, H. K. Christie, K. B. Bridge, W. E. Henley, R. G. Park, W. H. B. Bull, J. R. Boyd, D. D. McKenzie, C. G. Riley, D. P. Kennedy, G. F. V. Anson, and T. W. Harrison.
A very important contribution has been made by D. Macdonald Wilson, who has supplied information and statistics from the War Pensions Branch which have enabled us to follow up the after-history relating to many of the important disabilities, and has also written the article on Essential Hypertension.
It is hoped that this volume, apart from its value as an historical record of the excellent work done by the New Zealand Medical Corps, will be of some service to future generations if New Zealand ever has the misfortune to be involved in another war.
T. D. M. StoutWELLINGTON 1952