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War Surgery and Medicine

Middle East Force

Middle East Force

The heat and debilitating conditions associated with camp life in Egypt tended to aggravate any disability due to varicose veins, especially if there was any tendency to the development of eczema.

Treatment: Men were referred to the New Zealand hospitals for both in-patient and out-patient treatment. From Base cases were referred to the hospital at Helwan. The more marked cases were admitted, but the minor cases were treated by injection as out-patients, and the injections repeated till satisfactory relief had been obtained.

Operation: The operative treatment almost universally carried out was the Trendelenberg operation, consisting of ligature of the internal saphenous and its branches at the saphenous opening, or occasionally, ligature of the external saphenous, at the lower part of the popliteal space.

There was a tendency to carry out this seemingly minor operation under local anaesthesia, and articles had been written describing this procedure. The result, perhaps inevitable, of this seeming simplification was frequently an incomplete and unsatisfactory operation. The vein was tied well below the saphenous opening and the smaller branches not tied at all, with the result that the condition was unrelieved. This led to serious administrative and psychological difficulties. It had to be explained to the soldier that a repetition of the operation was necessary for the cure of the condition and consent had to be obtained from him. The operation also tended to get an undeservedly bad name amongst the men. This skimping of operative techniques by unskilled or irresponsible operators—I purposely do not use the word ‘surgeon’ —was even more serious in its effects in the army than in civilian practice. In conjunction with the Trendelenberg procedure, injection of sclerosing solution was frequently made into the distal portion of the saphenous vein at the site of the operation.

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Injections: Apart from the injection of the main vein at the time of operation, as mentioned above, injections were given into localised varicosities involving branches of the main veins. These were usually given in an out-patient clinic, and repeated as considered advisable.