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War Surgery and Medicine



At first it was thought that some attempts at isolation of cases should be made, but this appeared so impracticable under conditions in Egypt that it was waived and no efforts in this direction were made. It was found convenient to have these cases together, however, for ease of nursing, and this allowed the charge of a ward to be left to a junior member of the staff. Although some cases did not report sick, it became apparent that if men remained in the line the disease was more severe eventually and more protracted, and that the tendency to relapse was greater. Field units were encouraged to evacuate patients as sitting cases to base hospitals so that a full spell in hospital and adequate convalescence could be arranged. It was soon found to be a false economy to discharge men early or to hurry their return to the front line, because of the dangers of relapse, as well as the risk of continued poor health. Only those units who could give a full, unhurried convalescence were encouraged to keep their cases. The policy of having as many as possible of the New Zealand troops evacuated to New Zealand hospitals allowed a better study of the disease, and also allowed more satisfactory treatment as many other hospitals were inclined to discharge patients still jaundiced, because of lack of space, and among these one saw the highest relapse rate.

During the Alamein epidemic 1 NZ General Hospital and 2 NZ General Hospital handled most of the cases, and fresh demands were met by more tents being put up. Even though 1 NZ General Hospital enlarged from 900 to 1300 beds in a few weeks, most of the cases were accommodated in 80-bed tents, and were required to stay in bed except for going to the lavatory and ablutions.

In many cases conditions were not ideal and control was difficult, but the results were satisfactory and the criteria for discharge was disappearance of the jaundice and a clear urine and a few days of getting up gradually.

The routine (after the urine was clear) was 1 hour up first day, 2 hours up second day, 4 hours third day, 6 hours fourth day, and then off to a convalescent camp, where individual progress was page 506 watched and each case judged on its merits. In many cases livers were still enlarged on discharge, and it is a matter for conjecture whether these cases should not have been held longer.