New Zealand Medical Services in Middle East and Italy
In the early years of the First World War there was a system of dual control of the sick and wounded shared by the Public Health Department and the Defence Department. An important change in medical administration of sick and wounded came about in March 1918 following recommendations by the Minister of Defence. By resolution of the Cabinet the care and treatment of both discharged and undischarged disabled soldiers was made the sole responsibility of the Defence Department. Under the revised arrangements at the end of the war whereby the Minister of Defence assumed complete control over military patients, it was still necessary to make use of the hospital accommodation provided by the civil hospitals. In order to co-ordinate the work the Chief Health Officer, who had been Director of Military Hospitals with the honorary rank of colonel since 1915, was temporarily lent by the Public Health Department to the Defence Department and became a whole-time military officer under the DGMS. The King George V Hospital at Rotorua, the sanatorium at Hanmer, and all convalescent homes hitherto administered by the Public Health Department became military institutions. There had been a gradual change in opinion and, in effect, to the principle that the sick and wounded soldier was primarily the responsibility of the Defence Department; though it was necessary and indeed advisable to make use of the hospital accommodation provided by the civil hospitals, the soldier while an in-patient of the civil hospital was still the responsibility of the Army.
With the intention of benefiting from the experiences of 1914–18, the Medical Committee set about defining a policy for the future treatment of sick and wounded servicemen. At a meeting on 23 October 1936 it was agreed that the system of building temporary military hospitals adopted in the First World War was unsound and uneconomic, and that it was preferable to utilise the existing hospital facilities, with the provision of additional accommodation where necessary, and possibly provide separate military accommodation and staffs in the case of the larger hospitals.
On this basis, the Medical Committee made certain recommendations concerning the hospital treatment of sick and wounded service- page 14 men, for submission to the Organisation for National Security, and these were the subject of Cabinet decision on 7 February 1938. Cabinet accepted the principle recommended by the Medical Committee, though not approved by the Director of Medical Services, that ‘the local hospital facilities in New Zealand be utilised and adapted if necessary for the sick and wounded of the fighting forces in war’.
The policy approved by the Government was that all hospital treatment or investigation for sick and wounded servicemen, lasting more than twenty-four to forty-eight hours, was to be the function of the Health Department (through the Hospital Boards). It was thought that the Health Department was most favourably situated to review the facilities for medical treatment generally, to provide extensions to existing institutions, and to organise specialist treatment on a proper basis. In addition, where possible, the serviceman was to be treated in the institution nearest to his home.
It was laid down that the Army would hand over the sick or wounded soldier to the Health Department at the door of the civil hospital. From that point the Health Department would assume the responsibility for his treatment until he was fit to rejoin the Army. It was not fully realised, however, that the Health Department could act only in an advisory capacity to the hospital boards, which were independent and autonomous as regards the medical treatment and care of the patients in their institutions.
On this basis the army medical service arranged for only limited bed accommodation in camp hospitals. The function of these hospitals was to treat minor illnesses and lessen the call on beds in the civil hospital. To serve this latter end these hospitals did on occasion retain patients for more than forty-eight hours, many minor cases actually being retained up to a week.
There is no doubt that the policy limitation of the stay of patients in camp hospitals to forty-eight hours resulted in a number of cases of minor disabilities being unnecessarily transferred to civil hospitals. The direct result of this was that public hospitals, especially in Auckland and Wellington, which were chronically congested before the war and had long waiting lists, were still further congested and embarrassed by the daily admission of army patients with minor disabilities and mild infectious diseases which in civilian life would have been treated at home. These public hospitals, of course, had highly trained staffs, elaborate departments and equipment for dealing with the more serious diseases, and the overhead cost of a bed in one of these hospitals was very great by comparison with the requirements for hospitals dealing solely with minor diseases and disabilities.
On analogy with the system developed in 2 NZEF in Egypt, where page 15 there was no time limit for the retention of patients in camp hospitals, where transfer to a base hospital depended on the severity of the illness, and where minor cases of infectious disease and minor disabilities not requiring specialist attention were treated, it should have been possible to lay down a more flexible policy which would have enabled camp hospitals in New Zealand to be enlarged and to care for a larger proportion of patients.