War Surgery and Medicine
Incidence in 2 NZEF
Incidence in 2 NZEF
In Egypt and other countries of the Middle East the troops of 2 NZEF were always subject to the danger of contracting typhus page 558 fever. In times of peace there were usually between two and three thousand cases of louse-borne typhus in Egypt. The poverty and miserable living conditions of the town dwellers favoured its propagation. The epidemic was seasonal, occurring annually between January and May, with its peak about April. During the war, as was also the case in the First World War, the incidence rose. In 1940 there were 4500 cases, and 9000 cases the next year. In 1942 the epidemic began as early as November, and by February 1943 the incidence had already passed the previous year's peak, and there was a sizeable epidemic in the civilian population.
For military reasons little publicity was given to the 1943 epidemic in Egypt, and most soldiers did not realise the risks involved in contacts with the native population, although general information on the control of typhus was published in 2 NZEF Orders in December 1942. In 2 NZEF there were six cases, with four deaths, at this period. The previous year there had been three cases, with two deaths, and then in October 1943 there were two cases, both of whom recovered. In 1944 and 1945 there were no New Zealand cases. The incidence was low but the mortality was high. Typhus also occurred among civilians in Syria and North Africa, and in the latter area one of our medical officers contracted it.
It is quite possible that there were cases of typhus not diagnosed and therefore not reported as such, and that the mortality was really lower. In June 1943, on the occasion of death from typhus in one of our hospitals, the Consultant Physician reported: ‘There were in hospital at this time three cases of “PUO” in which the clinical features strongly suggested mild epidemic typhus. It is apt to be forgotten that the younger the patient, the milder an attack of typhus is, as a general rule, and cases with scanty rash, or no rash at all, can quite easily be missed. The completed temperature chart, when the disease is over, will often give a clue to what the correct diagnosis was, and it is not too late even then to get a positive Weil-Felix reaction.’
The care of troops in the provision of good living conditions, adequate ablution, shower and laundry facilities, and a high standard of personal cleanliness maintained by the troops, reduced louse infestation to a minimum. There was a possible chance of infection by inhalation of dust contaminated with dry louse excreta, and avoidance of close association with natives was important.
Native labourers employed in Maadi base camp were compulsorily showered and their clothing disinfected each week, an elaborate delousing station being built at the entrance to the camp and controlled by the Base Hygiene Section.page 559
In June 1943 anti-typhus vaccine became available to 2 NZEF. There was insufficient vaccine available at first to immunise the whole of 2 NZEF, so priority in this form of protection was given to hospital staffs who might have been exposed to risks in nursing patients, and to hygiene personnel whose work brought them into contact with lousy natives. As more vaccine was supplied the whole force was inoculated. Most were inoculated prior to their move to Italy in October 1943 with three doses at weekly intervals, and ‘booster’ doses were given in Italy every six months.