DURING 1939 the Territorial Force in New Zealand was in the process of reorganisation from a cadre to a peace establishment within reasonable reach of its war establishment, and the National Military Reserve was being formed and plans for home defence were being revised. Shortly after the outbreak of war on 3 September 1939, the Government decided to raise a special force of one division and ancillary troops for service overseas or for home defence. Medical examinations were necessary before the men responding to the call for volunteers for the Army were admitted to mobilisation camps.

By 31 July 1939 the machinery for medical boarding was ready to operate at short notice. The country had been divided into eleven areas, and a Regional Deputy, a senior medical practitioner, was in charge of the medical examinations in each region. A total of 253 medical boards, each comprising two doctors and a dentist, had been chosen to meet the requirements and places of mobilisation of the Army. For their guidance these medical boards had the comprehensive Code of Instructions which had been printed in 1938.

With the number of boards arranged, and sessions of four hours a day each, it was expected to complete in four days the examination of the 39,900 men the Army proposed to mobilise. (In actual experience it was found that the army mobilisation did not achieve any such intensity as mooted in pre-war proposals. Up to 9 December 1939 nine of the eleven regions had been called upon to examine only 15,796 recruits. Figures were not available for the other two regions but they probably did not exceed 1000 each.)

At the meeting of the Medical Committee on 24 September 1939 it was stated that reports received and inspections made indicated that the organisation for medical boarding was carried into effect immediately and efficiently following the outbreak of war. The Regional Deputies, who functioned in a part-time capacity, were asked at that stage to report in regard to the Code of Instructions, the forms in use, and whether there was need to improve the literature or the organisation. The reports were generally satisfactory as regards accommodation and staff but a number of suggestions page 23 were made for the improvement of the Code of Instructions, the Army Instructions for conduct of medical examinations, and Army Form 355 (Record of Medical Board). Some of the suggested improvements led to amendments to the instructions.

The introduction of compulsory military service under the National Service Emergency Regulations 1940 (dated 18 June 1940) brought about certain alterations in official policy and imposed additional responsibilities on regional deputies and medical boards. It was therefore necessary to supplement the original instructions, prepared as they were primarily for initial examination under a system of voluntary recruitment.

When conscription was introduced in 1940 the Army demanded that boarding of the men on each ballot list should be completed within six weeks. This entailed the use of every available doctor at a time when practitioners were reduced in number and busier than ever with the introduction of more classes of benefit under the Social Security legislation.

Under the National Service Emergency Regulations 1940, Regulation 35 et seq, the responsibility for medical boarding was transferred from the National Medical Committee to the Minister of Health. The Regional Deputies became therefore, in fact, deputies for the Minister of Health, to whom the National Medical Committee was, strictly speaking, only an advisory body. The effect was to weaken the administrative control that had previously been exercised by the National Medical Committee, which had a body of military experience from the First World War, and concentrate authority in the Minister of Health.

As deficiencies in the medical examination system became apparent, modifications and additions were made to the Code of Instructions. On 2 December 1940 the definition of Grade I men, which had been ‘men who attain the full normal standard of health and strength and are capable of enduring physical exertion suitable to their age’ (the age limits being twenty-one to forty years), was qualified by ‘Fit for Active Service in any part of the world’. A new medical examination form (NZ 355) was drawn up to give a more complete procedure for examination of recruits and a record of pre-enlistment medical history, besides incorporating the amendments to grading classification. (Later, with the experience gained from the examination of men returned from overseas for health reasons, and from reports of medical officers overseas, the National Medical Committee drafted a greatly improved Code of Instructions giving more complete instructions to medical boards regarding grading and detailing the procedure to be followed in the case of various disabilities. The new edition, printed in February 1942, was page 24 made available to medical boards in the middle of 1942. Certain aspects of medical boarding were still unsatisfactory, and consideration was given in December 1942 to constituting selected medical boards staffed preferably by doctors with military experience, acting in a full-time capacity, but these were not set up.)

There was a case in the earlier years of the war for a closer liaison between the army medical services and the Health Department, which was in executive control of the civil medical boards examining recruits, so that doctors could have been kept constantly aware of the disabilities likely to cause rejection from the Army. On this question of rejection the same problems were encountered in Australia and Canada.¹

Hospital Treatment-Convalescent Depots and Camp Hospitals

There seemed to be a lack of appreciation by the Health Department of the problem of the convalescent soldier. Civil hospitals were not accustomed to arrange for the convalescence of patients suffering from ordinary illness. These were expected to convalesce at home. It was only in the more serious illnesses and in special conditions demanding prolonged treatment that any provision at all was made. When the Health Department originally arranged for the use of Hanmer and Rotorua, it envisaged the treatment of returned wounded men and not sickness cases from New Zealand camps. These cases, in its opinion, required no special provision. They were sent back to their units in camp at the end of their period of sick leave at their homes. The necessity for hardening up after a debilitating illness before being subjected to the conditions of a military camp was simply not understood. This, of course, was quite contrary to the military outlook.

The hospitals discharged the military patients to their homes for varying periods of sick leave before returning to camp, and this leave could be extended on the certificate of their local doctor. The inevitable happened, and the military authorities found that great wastage of personnel was occurring and that they could not check up on the men scattered all over the country. This led to the setting up of a ‘Sick and Wounded Branch’, which was placed directly under the Adjutant-General, to check up on and control all unattached army personnel. The Branch took over medical as well as administrative functions, and there was some difficulty caused by its lack of medical knowledge and co-ordination. The appointment later of a senior medical officer to the Branch for consultation led to improved control in matters requiring professional knowledge.

The Army eventually built three convalescent depots to attempt to supply a more complete medical chain, but they were not completed until 1942 and 1943 and did not receive a great many of the patients discharged from hospital. The depot built for the Central District was given over to the Americans before it functioned as a convalescent depot. The civil hospitals were used for sick and wounded returned from overseas, and the Army had no military hospitals of its own at any stage, except for small hospitals in mobilisation camps.

For the admission of minor sick, small camp hospitals with the most modern equipment were erected in the three main mobilisation camps, Papakura, Trentham, and Burnham, each having accommodation for thirty to fifty patients. Each had an establishment of five members of the NZANS, two officers, and twenty-five other ranks. (Prior to the completion of Papakura camp in 1940, a camp hospital at Ngaruawahia was similarly staffed.) The amount of accommodation and the size of the staffs were increased during the war.

Motor Ambulances

At the outbreak of war there were no military motor ambulances on hand to convey the sick from camps to civil hospitals. In some instances ambulances belonging to hospital boards were used, and where they were not available army service trucks were adapted by placing mattresses or stretchers on the floor.

In October 1939 the Salvation Army gave two motor ambulances, and about the same time five chassis were obtained and bodies built on them at the Post and Telegraph Department workshops, Wellington. An ambulance was presented by the Red Cross Society and donations towards ambulances were made by various organisations and individuals. An amount of £4410 was donated in this way for the purchase of army motor ambulances up to the end of October 1940. Subsequently, ambulances became available through army channels and the substantial deficiency was overcome.

Health of Troops

With large numbers of men congregated in camps under conditions to which the majority of them are unused, there is likely to be a greater incidence of disease than normally occurs in the civil population. The DGMS (Army and Air) was insistent in his recommendations to camp authorities at the beginning of the war that the following points should be strictly observed:

In regard to (1), it was pointed out that it was essential that each soldier should have 600 cubic feet of air space and that the distance between the centres of adjacent beds be at least 6 ft. In the early stages of the First World War proper attention was not given to adequate ventilation and air space, and when a serious outbreak of cerebro-spinal fever occurred, a number of cases being fatal, a complete disorganisation of training resulted. Points (2), (3), and (4) were the direct responsibility of the unit commander.

The efficiency of the medical services was sternly tried in the latter part of October and during November 1939 by a severe epidemic of influenza (streptococcal respiratory catarrh) in which between 30 and 54 per cent of the strength of all units in the mobilisation camps was affected, the incidence rates in the three camps being similar. Energetic measures were taken to combat the epidemic, these consisting mainly in an insistence on the medical safeguards for the health of troops already set out. The fact that there was not a single death and only four cases of true pneumonia as a result of the infection was evidence of the success of the prophylactic and nursing measures taken. Similarly, a milder influenza epidemic in May 1940 did not assume any serious proportions.

In the early months of 1940 it was found that on some matters in connection with camp construction and arrangements neither the Army Medical Service nor the Assistant Director of Hygiene for the district was consulted. It was felt that there should have been a greater degree of consultation between the Public Works Department, the Quartermaster-General's Branch, the Army Medical Service and the Director of Hygiene.

Neither the DGMS nor the ADsMS were first consulted regarding the design of huts, latrines, and showers, and strong protests by them when they pointed out weaknesses during the actual construction work or insanitary conditions were often ignored, particularly in the Central Military District. It was fortunate that the consequences were not more serious.

To some extent this was probably a result of the concern of one particular organisation to push ahead expeditiously with its own programme. The medical interest in camp construction and arrangements from the point of view of the health of the troops and the page 27 avoidance of epidemics had to be emphatically stressed before it came to be recognised. Otherwise the valuable and extensive experience of senior medical officers in military medicine and hygiene, and the importance of its application, tended to be underrated.

On 31 October 1940 a conference was held to discuss the question of hygiene and sanitation of military camps; attending it were representatives of the Army, Health, and Public Works Departments, with the Adjutant-General as chairman. The chairman admitted that conditions in some camps were not all that could be desired, but it had to be remembered that practically all camps had been established at very short notice. The urgent nature of most of the work required quick action, and the usual procedure of preparing plans and submitting them to various officers had, in some cases, been departed from, and, instead, verbal arrangements had been made on the spot by Army and Public Works officers. The sole reason for non-consultation with specialists in hygiene and medicine was the urgent demand for construction. The delay in completing Waiouru camp had seriously upset army plans and necessitated the occupation of temporary camps where expenditure was restricted to what were considered to be essentials, and economies were effected at the expense of efficiency and proper hygiene conditions.

It was explained that the army officers concerned proposed to recommend the appointment of a full-time Deputy Director of Hygiene. It was decided that, in future, the procedure to be followed in deciding on the location of a camp would include a reconnaissance of the site and buildings by the district commanding officer, AQMG, and ADMS, the Works Officer, and District Engineer, Public Works Department. These officers would furnish a report on the site. When plans were received at Army Headquarters, the Quartermaster-General would submit them to the Director-General of Medical Services and Deputy Director of Hygiene for approval from the medical service point of view. In November 1940 the Principal Sanitary Inspector, Health Department, was appointed full-time Deputy Director of Hygiene (Army and Air), and held the appointment throughout the war. The revised arrangements worked effectively.

Camp Medical Arrangements

With the mobilisation of the First Echelon of the Special Force in September and October 1939, whole-time senior medical officers were appointed to Ngaruawahia, Trentham, and Burnham camps, to which three assistant medical officers were later appointed. With the completion of the mobilisation camp at Papakura, the senior page 28 medical officer and some of the staff from Ngaruawahia were transferred there. Full-time medical officers were stationed at Narrow Neck, Motutapu, and Fort Dorset, while part-time medical officers were appointed to the Lyttelton Fortress troops and Wellington Fortress troops.

The senior medical officers were on the staff of the camp commandants in the mobilisation camps. They were responsible for the care of all sick, and were the advisers to the camp commandant on all matters pertaining to the health of troops, as well as being inspectors of sanitation arrangements. On sanitary matters each had the help of a sanitary inspector with the rank of WO I. Under the control of the senior medical officer were the military camp hospital and a contagious disease hospital where venereal disease patients were retained and treated. There was an arrangement between the Health Department and the Army whereby soldiers who contracted venereal disease after they went to camp were to be treated by the Army. If they had contracted the disease after attestation but before going to camp, they might be discharged from camp and become the responsibility of the Health Department. The senior medical officer had a number of medical officers to assist him. One looked after the camp hospital, while others were appointed as regimental medical officers to the battalions of reinforcements undergoing training. These were practically always medical officers who were themselves going overseas with the reinforcements.

The duties of these regimental medical officers were varied- holding sick parades, lecturing to the men on the maintenance of health, inspecting feet after route marches, inspecting barracks, kitchens, showers, and latrines, and giving the necessary inoculations.

Camp dental clinics were established in each of the three mobilisation camps, and all dental treatment was carried out at the expense of the Government after the recruits entered camp.

Preventive treatment by way of inoculation and vaccination was carried out. It was decided to immunise the troops in camp against tetanus before sending them overseas. All troops after the First Echelon were given two injections of 1 cc. of toxoid at an interval of six weeks; adrenalin was available in case of anaphylactic shock and the men were kept under observation for three hours.

Two injections of TAB vaccine for protection against typhoid were given at a week's interval. Individual reactions were generally marked and sometimes severe, and the preparation was adjusted so as to obviate very severe reactions. There was some difficulty in obtaining virile strains of organisms in New Zealand, a typhoid bone abscess being utilised at one time.

Vaccination against smallpox was also carried out. The troops of the First Echelon were done on the transports proceeding overseas page 29 and complaints were made of the discomfort suffered under the tropical conditions. The Second Echelon were vaccinated in camp in New Zealand and the camp staffs complained of interference with training. This led again to the vaccination being carried out on the troopships. At a later period when there was less urgency, the men were usually vaccinated in camp. The vaccination was repeated if no positive reaction occurred.

With the great development in the use of blood transfusion before the war, it was realised that blood would be freely given to the wounded. In order that the blood group of each soldier would be known in the case of emergency, it was arranged that each man should be blood-typed and the international symbol for his group entered in his paybook and marked on his identity disc.

Venereal Disease Policy

As a result of a forceful report submitted by the Director-General of Medical Services (Army and Air) through the Adjutant-General to War Cabinet, venereal disease was treated in a sane and reasonable manner. The policy was almost revolutionary compared with the First World War precautions of barbed-wire enclosures and armed guards for such patients. It was at first watched with great misgivings and doubt by some combatant officers. The attitude of the DGMS (Army and Air) was that nothing would be accomplished by treating as criminals those troops who contracted venereal disease, and that too harsh a policy would discourage infected soldiers from reporting early and openly for treatment.

In each of the three main mobilisation camps small isolation hospitals, called contagious disease hospitals, were established, and here patients were admitted and in most cases speedily cured by treatment with sulphonamides. These hospitals were used for both Army and Air Force personnel, while Trentham and Burnham hospitals also accepted any naval personnel from the Wellington and Christchurch areas.

Primarily, however, in order to reduce manpower wastage, the preventive aspects of venereal disease were emphasised. In all camps preventive ablution huts were established and all troops exposing themselves to infection were encouraged to visit these huts on their return to camp. In addition, preventive ablution centres were provided in the main cities for use by all the services. Attempts were made to trace the women who were sources of infection. The educational approach was also used extensively and medical officers gave lectures to troops on the dangers of promiscuous sexual intercourse. This campaign, combined with plans on a broader basis for keeping men interested in healthy physical and page 30 mental diversions during off-duty hours, more than justified itself in the relatively low incidence of venereal disease.

Chest X-ray Examinations

Early in September 1939 the Director-General of Medical Services discussed with the Director-General of Health the question of recruits who might be suffering from pulmonary tuberculosis. The necessity for X-ray of the chest of all recruits had been discussed in September 1937 at the Australasian Congress at Adelaide, at which the DGMS had been present. It was realised that the ordinary clinical medical examination probably would not detect early, latent, or quiescent pulmonary tuberculosis, and that an X-ray examination was the only sure means of detection, especially if the recruit, anxious to get away, withheld information as to present and past symptoms of the disease. Obviously, every effort had to be made to exclude infected recruits, and Cabinet agreed at once to the proposal for the use of X-rays of the chest.

In September 1939 Ministerial approval was given for a unit capable of undertaking chest photography to be purchased and installed in each of the three main military camps-Burnham, Trentham, and Papakura. The apparatus for each unit was to cost £800, and buildings had to be provided in which to house the plant and conduct examinations. The apparatus was available within a few weeks, but the authority to erect the necessary buildings was delayed and the X-ray apparatus could not be installed until it was too late to X-ray more than a few men of the First Echelon.

The Second Echelon was X-rayed in camp, but the operation of the system brought to light some cases of hardship where soldiers had been attested, had left their civilian occupations or sold their businesses, and had then been rejected in camp for tuberculosis. (As a result of the X-ray examination of chests up to 30 April 1940, 143 soldiers were found to be suffering from pulmonary tuberculosis and were discharged from military camps.)

It was later accepted that the X-ray of the chest was really part of the initial medical examination and a responsibility of the Health Department under the civilian medical board system. In April 1940, therefore, it was decided that all recruits should undergo the examination before they were called into camp, and arrangements were made by the Department of Health for this to be carried out at thirty-four hospitals, and the interpretation of the films made at the eleven largest hospitals. Thenceforth an X-ray examination of the chest was regarded as a routine for all recruits classified fit for active service. Army area officers made the best possible arrangements with the Medical Superintendents of hospitals, and every endeavour was made to have men who had to travel some distance page 31 for medical examination X-rayed immediately after that examination, so as to avoid a second journey with consequent expense and loss of time. This system operated fairly efficiently, but for various reasons many recruits entered camp before being X-rayed.

The institution of an X-ray examination for all recruits from the Second Echelon onwards was the means of detecting tubercular cases who might otherwise have been passed as fit, but who would undoubtedly have broken down under active-service conditions. Doubtful cases were referred to specialist chest medical boards for diagnosis and decision regarding grading. Calculations in 1940 rated active or latent cases among recruits at about 1 per cent, with figures for Maoris higher than those for Europeans.

The army authorities arranged for lists of all recruits for 2 NZEF to be supplied to the Health Department, and throughout the war officers of that department checked these lists to detect the names of those who were, or had been, on tuberculosis registers. Such recruits were specially examined.

Diet

At the outset of the war the New Zealand Army Board adopted the revised British Army war rations scale issued in June 1939, but with certain modifications to suit the New Zealander, such as butter in place of margarine, and more meat, cheese, and fresh vegetables. The diet was calculated by hospital dietitians, who found it adequate in protein, fat, and carbohydrates but lacking in minerals and vitamins B and C. On this basis the Director-General of Medical Services recommended certain adjustments in October 1939. The Nutrition Committee of the Medical Research Council, reporting separately in December 1939, made very similar suggestions.

As regards 2 NZEF itself, a conference of the GOC 2 NZEF, ADMS 2 NZEF, DGMS and others on 27 December 1939 at Army Headquarters, Wellington, decided that for the diet on troopships the Australian schedule would be followed as a basis, it being recommended that the GOC be granted authority to increase diets when necessary. It was further decided that all army cooks would go to a school of cookery in Egypt, and that green vegetables and fruits for consumption in that country be sterilised by immersion in potassium permanganate. The standard British Army ration in Egypt was accepted with certain increases, the GOC being authorised to apply to the Treasury for permission to increase it further if necessary.

At this conference the medical officers were impressed with the obvious interest shown in the medical side by General Freyberg. It was clear from his remarks that he regarded the efficiency of the New Zealand Medical Corps as of the utmost importance, that he page 32 was prepared to support the Medical Corps in all its requirements, and that he was keen to ensure the highest degree of hygiene in the force, including due attention to the quality and preparation of the food. The distinct impression of the medical officers was that the New Zealand Medical Corps was not going to be relegated to the background, but was expected to play a leading role in the campaigns of the Expeditionary Force. Throughout the war General Freyberg consistently displayed his emphasis on, and his appreciation of, medical arrangements.

Every effort was made to educate quartermasters and supply officers on the importance of modern diet standards and food values. On 9 March 1940 a conference of quartermasters and ASC supply officers from all camps throughout New Zealand was convened by the Quartermaster-General and presided over by the Director-General of Medical Services. The conference studied the three essential values of the diet of the soldier:

Great interest was shown by all officers, and the practical result was a great improvement in the diet as regards food value and variety. Copies of menus were furnished regularly to the Director-General of Medical Services for his appreciation or criticism.

In December 1940 the DGMS made strong recommendations for the appointment of a Director of Catering in order to provide a technical service to enable further improvements to be made in the dietary arrangements for the troops. This appointment was not made, although the RNZAF later had an efficient Food and Dietary Section with a Catering Director.

Appreciation of Hospital Requirements Overseas

Although the DGMS on 8 October 1939 in a medical appreciation of the First Echelon overseas (then planned to number 8000 troops) estimated the number of beds required for sickness cases if the echelon went to the Middle East as 800, with an increase to 1280 beds if the echelon went into action, no hospital unit was called up with the First Echelon to provide these beds. It was assumed that British military hospitals established in the Middle East would be able to serve the New Zealanders in the meantime. As it happened, when the First Echelon reached Egypt its sickness rate was not nearly as high as estimated, but nevertheless 4 Field Ambulance was called upon to run both a camp hospital and a page 33 general hospital, and also provide medical services for its brigade group in the Western Desert later. The diversion of the Second Echelon to England was a complicating factor, but as events proved there was certainly a strong case for sending a hospital unit with the first troops proceeding overseas.

It must be admitted, however, that New Zealand had no medical equipment to send with hospital staffs, nor indeed with the field ambulances, a deplorable state of affairs for which the medical administrators were in no way responsible.

The tentative plans made on limited information by the DGMS on 8 October stated that ‘it may be necessary to have two small general hospitals, but this is a consideration which can and will be dealt with after the New Zealand Force arrives at the area of operations’. It was considered necessary to have a convalescent depot but not a casualty clearing station.

Following more definite information the DGMS was able, on 20 December 1939, to reassess the hospital and medical requirements on the basis that there would be an initial expeditionary force of 6000 men, followed at intervals of about two months by two further echelons of 6000 men each; that the advanced New Zealand base would be in Egypt, 10,000 miles from New Zealand, and transport would be by sea; that medical units would be equipped on arrival overseas; that hospital and medical requirements would be essentially for the treatment, retention, and disposal of sick and wounded New Zealanders only; and that the force would be stationed in Egypt at least until the formation of the Division, that is, about five months. Taking these factors into consideration and estimating the wastage at 10 per cent of the force, the DGMS recommended that a general hospital of 600 beds, and a convalescent depot of 500 beds, should proceed overseas with the Second Echelon and a general hospital of 1200 beds with the Third Echelon. The first hospital could be expanded to 1200 beds if necessary. Apart from that, it was understood that a field ambulance would normally be called up with each echelon.

RAISING AND TRAINING OF MEDICAL UNITS