Volume 27 Number 1 January 2019 Journal of Military and Veterans’ Health Comparison of Two Co-Located Infantry Battalions during the 1918 Influenza Pandemic RY ME A DI IT C L I The Australian Army’s Two ‘Traditional’ Diseases: Gonorrhea and Syphilis I N M E A N S A I S O S A C L I A Compensation in the Australian Defence Force A T R I T O S N U A IN C. The Journal of the Australasian Military Medicine Association Medibank’s Garrison Health Services Delivering a national, integrated healthcare service to the Australian Defence Force Through Medibank’s extensive network, Garrison Health Services provides seamless access to quality healthcare for the 60 000+ permanent and 20 000+ reservist uniformed ADF personnel— from point of injury or illness to recovery. The health of the ADF is central to everything we do. medibankhealth.com.au/garrisonhealthservices Image courtesy of Dept of Defence Table of Contents Short Communication Comparison of Two Co-Located Infantry Battalions during the 1918 Influenza Pandemic with Very Different Mortality Experiences ��������������������������������������������������������������6 Historical Articles The Australian Army’s Two ‘Traditional’ Diseases: Gonorrhea and Syphilis — A Military-Medical History During the Twentieth Century ����������������������������������������������������������������������� 11 Original Articles The Effects of Current Cold Chain Management Equipment in Controlling the Temperature of Thermolabile Medications and Temperature Sensitive Diagnostics, Dressings and Fluids in A Routine Australian Defence Force Operating/Exercise Environment ������������������� 23 Combat, Posttraumatic Stress Disorder and Health of Australian Vietnam Veteran Conscripts and Volunteers in the Three Decades After Return ������������������������������������������ 42 Compensation in the Australian Defence Force ������������������������������������������������������������������������������������������� 58 Medical CBRN Defence in the Australian Defence Force ������������������������������������������������������������������������������ 66 Review Articles Systematic Review of The Impact of Deployment on Respiratory Function of Contemporary International and Australian Veterans’ ����������������������������������������������������������������������������� 74 Homeless Indigenous Veterans and the Current Gaps in Knowledge: The State of the Literature���������������� 101 Front Cover Title: “Stars over R2E” Photo courtesy of James Savage Volume 27 Number 1; January 2019 Journal of Military and Veterans’ Health EDITORIAL BOARD CDRE Andy Robertson, CSC, PSM (Editor in Chief) Associate Professor Martin Richardson (Deputy Editor) Maj Gen Prof Dr Mohd Zin Bidin (Ret’d) BRIG Anne Campbell Dr Ian De Terte CDRE Michael Dowsett Dr Helen Kelsall COL Prof Peter Leggat, AM Benjamin Mackie David Robertson Tyler C Smith, MS, PhD Dr Darryl Tong Jason Watterson Australasian Military Medicine Association PATRON STATEMENT OF OBJECTIVES RADM Jenny Firman The Australasian Military Medicine Association is Surgeon General Australian Defence Force Reserves an independent, professional scientific organisation of health professionals with the objectives of: COUNCIL • Promoting the study of military medicine President GPCAPT (Retd) • Bringing together those with an interest in Geoff Robinson, NSC military medicine Vice President Dr Nader Abou-Seif • Disseminating knowledge of military medicine • Publishing and distributing a journal in military Secretary Dr Janet Scott medicine Treasurer CMDR Ian Young • Promoting research in military medicine Council Members CDRE Andrew Robertson Membership of the Association is open to doctors, Dr Peter Hurly dentists, nurses, pharmacists, paramedics and Rachelle Warner anyone with a professional interest in any of the disciplines of military medicine� The Association is Past President Dr Greg Mahoney totally independent of the Australian Defence Force� Public Officer Ms Paula Leishman JMVH is published by the Australasian Military Medicine Association 227 Collins Street Hobart Tas 7000 Australia Ph: +61 3 62347844 Email: [email protected] ISSN No. 1835-1271 Journal of Military and Veterans’ Health Editorial Wither Nuclear? Progress has been slower with other conventions� Bringing the Comprehensive Nuclear Test Ban Treaty In this issue, Heslop and Westphalen review medical into force would assist in reducing the numbers of chemical, biological, radiological and nuclear (CBRN) nuclear weapons�5 Progressing the Fissile Materials 1 defence in the Australian Defence Force� The ongoing Cutoff Treaty, first proposed in 2000, would also interest of militaries and non-state actors in these further restrict the availability of fissile materials weapons, while waxing and waning over the last 100 and, ultimately, nuclear devices�6 Recent issues years, continues, and requires appropriate military between Russia and the United States, however, health preparations� While chemical, biological and, have reversed some of the progress made with to a lesser extent, radiological weapons have received these treaties and will create further vulnerabilities� detailed attention, particularly since chemical Alleged violations of the Intermediate-Range Nuclear weapons use in Syria, nuclear terrorism and nuclear Forces Treaty, no progress on the Strategic Arms war have received less attention� This may be based Limitation Treaty, and plans for revitalisation of on the assumption that, with the exception of North nuclear arsenals, including developing smaller Kora, these weapons are better controlled and less tactical nuclear weapons, are also of concern�7 Closer likely to be used� But, given recent tensions, are scrutiny of this important area is required to ensure these assumptions valid? that we are better prepared for future conflicts� Internationally, Australia and other countries are Our first issue of 2019 contains a diverse range of protected by a range of treaties designed to prevent articles from mental health and operational medicine the acquisition and use of nuclear materials and through to infectious disease history� We continue to weapons, the most important of these being the get a good range of articles, but other military and 2 Nuclear Non-Proliferation Treaty � Other treaties, veterans’ health articles are always very welcome such as the International Convention for the and we would encourage all our readers to consider Suppression of Acts of Nuclear Terrorism, which writing on their areas of military or veterans’ health came into force in July 2007, and the Convention interest� We would particularly welcome papers on the Physical Protection of Nuclear Material, based on our 2019 themes of recovery, rehabilitation which came into force in February 1987, are also and repatriation, but welcome any articles across important in increasing nuclear materials security the broader spectrum of military health� and preventing the export of nuclear material and related technologies�3 There are, however, serious Dr Andy Robertson, CSC, PSM challenges in these areas, with growing fissile material stockpiles in India, Pakistan, China and Commodore, RANR 4 Japan� Editor-in-Chief References: 1� Heslop DJ, Westphalen N� Medical CBRN Defence in the Australian Defence Force, J Military Veterans Health, 2019; 27(1): 66-73� 2� Department of Foreign Affairs and Trade, Australia’s Uranium Export Policy, Commonwealth of Australia, Canberra, 2018 (Accessed on 12 August 2018 - https://dfat�gov�au/international-relations/ security/non-proliferation-disarmament-arms-control/policies-agreements-treaties/Pages/australias- uranium-export-policy�aspx)� 3� Burt R, Lodal J� The Next Step for Arms Control: A Nuclear Control Regime, Survival 2011; 53 (6): 51-72� 4� Allison G� Nuclear Terrorism: Did We Beat the Odds or Change Them? Prism: Journal of the Center for Complex Operations 2018; 7(3): 2-21� 5� Kibaroglu M� The Threat of Nuclear Terrorism Requires Concerted Action� Strategic Analysis 2014; 38(2): 209-216� 6� Biswas S� Nuclear desire: Power and the postcolonial nuclear order� University of Minnesota Press; Minneapolis: 2014� 7� Gale RP, Armitage JO� Are We Prepared for Nuclear Terrorism? New England J Medicine 2018; 378(13): 1246-1254� Volume 27 Number 1; January 2019 Page 5 Short Communication Comparison of two co-located Infantry Battalions during the 1918 influenza pandemic with very different mortality experiences D Shanks, M Waller Abstract The 1918–1919 influenza pandemic was the greatest mortality event in recent history whose specific origins and mechanism remain largely unexplained� Wide ranges of mortality were observed in otherwise identical groups for unclear reasons� The 49th (n=1363) and 50th (n=1243) Battalions (BN) of the Australian Imperial Force (AIF) respectively had one of the highest and lowest influenza mortality rates of any Australian infantry unit� All non-combat mortality, specific pneumonia/influenza mortality and morbidity due to influenza-like illness were collected from both battalions 1916-1919� Mortality during the 1916-1917 epidemic of ‘purulent bronchitis’ was similar (8 deaths in both) whereas the 49th BN had 18 and the 50th BN had one pneumonia deaths during the influenza pandemic of late 1918-early 1919� Influenza morbidity was similar in both units except during mid-1918 when the 50th BN experienced more cases of a mild influenza-like illness (69 vs 103 cases in June)� The 49th BN had more recorded cases of influenza than the 50th BN during the late 1918 pandemic (116 vs 62 cases in October)�