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War Surgery and Medicine

Experience of Pacific Force

Experience of Pacific Force

In the Pacific Islands skin diseases were proportionately a greater medical problem than they were in the Middle East. The incidence steadily increased as 3 NZ Division moved northwards towards the Equator. Skin disease in the Solomon Islands was the chief cause of attendance at the RAPs, and formed the greater part of the medical work of the Field Ambulances. Only the more chronic and more severe cases were evacuated to 2 NZ CCS, and yet these amounted to 449 in eight months. In one period of five months (March–August 1943) there were 202 cases, including 40 outpatients, treated at 4 NZ General Hospital at the Base in New Caledonia. The majority of cases were of eczema and dermatitis, page 698 with a fair proportion of ecthyma, and a lesser number of cases of tinea, acne vulgaris, and other infections. The more serious cases admitted to the General Hospital were treated as inpatients for an average period of approximately one month. Even then patients who were not down-graded had to be thoroughly tried out before allowing them to return to full duty. Many lesions tended to break out again when the soldier started to work and sweat in the hot sun. In the case of dermatitis of the foot, for example, the patient had to be given a trial of work while wearing heavy boots and socks.

Early in January 1944 the high incidence of skin disease in 3 NZ Division began to cause concern and brief surveys of conditions in the Vella Lavella and Treasury Islands were made by a skin specialist. It was found that the percentage of unit strength attending RAPs daily on account of skin disease during the month of December 1943 was as follows: Treasury Islands, 6–20 per cent; Vella Lavella, 6–10 per cent; Guadalcanal 1–6 per cent. These percentages do not refer only to new cases, but to all cases requiring treatment at each sick parade.

The causes of skin disease were found to be, in descending order of importance: sweat, trauma and infection, lack of washing facilities, infestation by larval mites, fungoid infection, standing in sea-water, sodden clothing, and sensitisation. Exposure to sunlight and diet did not appear to be factors. The incidence of skin disease was highest during the early periods of camp construction. As jungle undergrowth was cleared away and proper camps and tracks were established the situation improved.

Skin trauma could be prevented to a certain extent by suitable clothing, viz., shirt with long sleeves, trousers tucked into battle-dress anklets, boots and socks, and this was the order of dress during jungle manoeuvres. To combat sweat reactions, men were encouraged to wash frequently in fresh water whenever it was obtainable, and to apply dusting powder before dressing. They were also taught to report even a minor skin abrasion as soon as possible. Medical orderlies were taught to use aseptic technique when dressing these septic cases, for streptococcal infection was readily spread from one case to another.

In the Treasury Islands the incidence was much higher on Stirling than on Mono Island, and larval mites appeared to be the chief cause of skin lesions on the lower limbs. The presence of the larval mite on Stirling Island was apparently known to the natives, who avoided living there. Mosquito repellent (No. 612) applied to the exposed skin was found to be a successful prophylactic against these mites.

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Both in New Caledonia and the Solomon Islands there were numerous species of ‘poisonous’ trees and plants, which produced dermatitis on first contact with the skin. The foliage and wood-sap were highly irritant, and produced erythema and oedema followed by vesiculation and exudation. Other cases of eczema and dermatitis were the result of (a) sweat, (b) products of bacterial or fungoid infection, (c) chemical substances used in skin treatment, such as sulphanilamide, iodine, sulphur, acriflavine.

Ecthyma, a streptococcal and often staphylococcal infection involving the whole thickness of the skin, was exceedingly common in the tropics, both amongst natives and whites. As the ‘desert sore’ it was common in the Middle East, and as the ‘tropical ulcer’ it was even more common in New Caledonia and the Solomon Islands, where the hot, humid climate favoured bacterial growth. In the early spreading stage a haemolytic streptococcus was often isolated in pure culture, but in the chronic ulcer stage staphylococci, diphtheroids, and non-haemolytic streptococci were found in addition. In a number of cases virulent Klebs-Loeffler bacilli were isolated from the ulcer and sometimes from the patient's throat as well. No complications were observed amongst these latter cases in 2 NZ CCS, though peripheral neuritis was reported by Allied medical officers.