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War Surgery and Medicine


MENINGOCOCCAL meningitis (cerebro-spinal fever) is essentially a primary infection which occurs often in epidemics and has therefore to be guarded against in a mobilised military population. On the other hand, acute meningitis caused by bacteria other than the meningococcus is almost always sporadic and is usually secondary to infection elsewhere, or to an injury to, or an operation on, the head.

Factors contributing to the susceptibility of young soldiers to meningococcal meningitis are the communal living and change of environment with the transfer from civil to military life, and the fatigue incidental to military training under varying conditions of weather. Circumstances tending to lower the resistance of the individual, such as previous attacks of disease, especially of influenza, may be considered predisposing causes. Therefore overcrowding, bad ventilation, chill and over-fatigue should be guarded against in troops.

Cerebro-spinal fever, which was made a notifiable disease in New Zealand in 1907, came into prominence in the First World War. There was a mild epidemic of the disease in the civil population in 1915 and 1916 and an outbreak of an aberrant type in Trentham Camp in July 1915, when there were 32 cases with 22 deaths. The camp was closed, but was reopened for a restricted number of troops in the summer months after the epidemic had subsided. In July 1916, after an outbreak of febrile catarrh, and later of measles, cerebro-spinal fever reappeared in the two principal camps. It became epidemic in August, but died out gradually in the summer months. In all, 51 cases with 36 deaths were recorded.

Between the wars the incidence of the disease in New Zealand declined. It rose again in 1941 and became epidemic in 1942, when 932 cases were recorded with 116 deaths. Of this total, 85 cases occurred in military camps. The incidence and fatality rates in the Army were not out of proportion to the civilian rates. (There had been epidemics in England in 1940 and 1941.) In later years the disease again abated.

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In 2 NZEF in the Middle East no epidemic of cerebro-spinal fever occurred—a satisfactory achievement. Sporadic cases totalling fewer than fifty were recorded in a period of five years, with only one death. The remarkable reduction in the mortality rate compared with the First World War was due to the introduction of the sulphonamides. When penicillin was introduced it was equally effective as a treatment.