New Zealand Medical Services in Middle East and Italy
Unfit and War-worn Men
Unfit and War-worn Men
The employment of graded men raised many problems. During October 1942 it had become apparent that there had been considerable accumulation in base depots of men who, while not requiring hospital or convalescent depot treatment, were unfit to be sent to rejoin divisional units. For instance, in the Infantry Training Depot, out of some 700 men it was found that only twenty-three were fit to go forward when a demand for reinforcements was made. Similar conditions obtained in other depots. Conferences disclosed that in a measure this was due to the necessity for clearing accommodation in hospitals and the Convalescent Depot for casualties from the Alamein offensive, and also to the lack of accommodation at the Reception Depot, where men discharged from hospital were received on their return to Maadi Camp. After a preliminary survey by experienced RMOs it was decided to board all men considered unfit to rejoin their units. Three special boards were assembled for this purpose, and consideration was given to the forming of a Standing Medical Board when there were medical officers available. (This was formed in March 1943.) A survey showed that between May and November 1942 1013 men had been medically down-graded at 1 and 2 General Hospitals and 2376 at Base Camp.
A detailed survey of the position revealed many reasons for the large congregation of ‘temporarily unfit’ men in Base Camp. Some men were attending the out-patient department at 1 General Hospital for specialist out-patient treatment; others were awaiting operations at 1 General Hospital, but these had been postponed on account of the rush of battle casualties; others had returned from Convalescent Depot but still suffered from general debility; others were mild cases of anxiety neurosis who would have been a liability in the field unless fully recovered; others with defective vision were awaiting new spectacles; some had painful scars from healed wounds, and there were some with foot complaints, including Maoris who, with their broad feet, found the ordinary army boot unsuitable.page 483
It was realised that this congregation of unfit men in Base, some for indefinite periods, led to deterioration. The long periods of idleness and ennui spent in base camps by all soldiers were multiplied in the case of the unfit, and few of these could submit to them without feelings of exasperation and frustration.
Appropriate measures were taken to remedy the position. Men who were permanently unfit but had never been graded as such were medically boarded, some for return to New Zealand. With the return to more normal conditions after the rush of battle casualties and the infective hepatitis epidemic, it was made a rule that 1 Convalescent Depot and the Rest Homes should not discharge cases until they were fit for depot training, and a more rigorous system of battle training was introduced at the Convalescent Depot with success. In addition, it was stressed that the processes of passing through Reception Depot should be expedited, but that Reception Depot should not pass on unfit men to unit depots. There was also a reduction in the waiting time for routine operations. The mild cases of anxiety neurosis and physical exhaustion continued to constitute a problem, but for the minor cases an effort was made to get these men back to their units quickly.
Then, again, there was a good case for the better management of a case where the constitutional breakdown was likely to be permanent as far as front-line service was concerned. For instance, suitable employment at Base was a paramount factor.
This matter of employment was given emphasis by the Consultant Physician 2 NZEF, who devoted much time to these cases. Men graded for nervous disorders were still maladjusted after arrival in Base Camp, and still required help and encouragement. The greater the care and common-sense attention devoted to them at this stage, the lesser would be the problem of final rehabilitation for civilian life. It had to be recognised that many of these men were disappointed in themselves, and very sensitive. It did no good to add insult to injury, and uncongenial employment, or an unbefitting occupation, was degrading and demoralising and aggravated the disability.
In this connection it was decided at a conference of senior administrative officers at Headquarters 2 NZEF on 13 January 1943 that a ‘Super-Employment Officer’ be appointed, with powers not only to settle graded men in jobs but also to act as an inspector and make sure that all men were as suitably employed as possible.
The Employment Officer no doubt provided some improvements in the employment of graded personnel in Maadi Camp, but it is just as certain that for many men with nervous disorders there was page 484 no adequate adjustment that could be effected in the circumstances, and their disorders remained in a semi-permanent state overseas.
To serve a double purpose—the useful employment of some of the graded men and the reinforcement of base medical units—it was approved in December 1942 that likely Grade II men in Maadi Camp should be attached as opportunity offered to general hospitals (including 23 Field Ambulance). If suitable, such men were transferred to the NZMC, and in the main were employed on ‘general duties’. In subsequent months a number were absorbed into the NZMC in this way.
On the subject of unfit or war-worn men the OC Medical Division 1 General Hospital, in his report for the quarter ended 31 March 1943, made the following comment:
The most trying and certainly the greatest part of the work has consisted in trying to assess and dispose of the large numbers of men who are chronically ill with minor complaints, such as vague pains, backache and dyspepsia. In many it is the natural combination of prolonged field service, age in the late thirties, and a general weariness. To be fair to all is very difficult as many have not given really useful service at any time and are very introspective and health-conscious. There is practically no malingering but many make the most of what are really minor complaints. There are those also who are really worn out and unfit for any further field service. Fibrositis is a common diagnosis which covers vague backaches, and pains in and around joints when there is no external evidence of disease. These men often fail to respond to any form of therapy and are frequent callers at RAPs wherever they are. Functional dyspepsias are more common than organic gastric diseases and often date from some unpleasant battle experience. They also fail to respond to any form of therapy. All these cases receive considerable care and attention and frequently have a prolonged stay in hospital before being placed in what is considered their correct grade. Men with three years' service are frequently not fit for further service overseas.
In an investigation the Consultant Physician, Colonel Boyd, found that from 1 September to 31 December 1942, 139 cases of functional neurosis had passed through the Reception Depot from medical units: of them 63 (44·6 per cent) were graded I and returned to their units, 61 (42·6 per cent) were graded II or III for base duties, and 14 (10·8 per cent) were graded for return to New Zealand. From May 1941 to December 1942, 920 cases of psychoneurosis had passed through hospital, and they necessitated 1204 medical boards, which resulted in the following gradings: I and IA 8·2 per cent; II and III 50·9 per cent; and NZ Roll 40·7 per cent. In his report Colonel Boyd said:
It is obvious that nothing can be done to diminish the precipitating causes which are the very essence of active service, though it is a well known fact that the better disciplined the troops the fewer cases of nervous upset. It is clear too that the more careful the selection of recruits, and the greater page 485 the prophylactic care shown in the case of the man who proves unstable, the less the incidence of neurosis will be. This latter duty is primarily the function of the unit medical officer and his diligence in this respect may be reflected in the relative incidence of neurotic breakdowns in different battalions exposed to equal stress and strain.
In an investigation at 3 NZ General Hospital at Tripoli from 10 April to 31 May 1943, it was found that 72 NYD N1 casualties and 478 organic battle casualties were admitted from units of the Division. The final diagnoses of the NYD N cases were: Anxiety neurosis, 55 cases; physical exhaustion, 11 cases; effects of concussion, 4 cases; hysteria, 1 case; and psychosis, 1 case. Their length of service in the Middle East was: Less than six months, 19 per cent; six to twenty-four months, 26 per cent; over two years, 51 per cent; not stated, 4 per cent. The 72 cases came from 19 units but there was no very marked difference between units, except for one group of 12 who had been subjected to continuous shelling for forty-eight hours. Long-service men suffered a gradual deterioration whereas recent reinforcements often broke down rapidly. Of the cases of physical exhaustion, 10 were returned to their units and 1 downgraded. Of the others 22 were returned to their units and the other 39 down-graded, including 3 for return to New Zealand.
After the conclusion of the Tunisian campaign it was found necessary to board medically for physical and/or mental exhaustion a number of men who had been through a succession of heavy battles. A number were returned to New Zealand, including some from the Maori Battalion who were exhausted and whose condition was not expected to improve on base duties. (In the Maori Battalion the incidence of psychoneurosis was low, just as among returned servicemen in New Zealand the number of Maoris claiming war pensions for neurosis was comparatively much lower than the European rate.)
All the hospitals had developed occupational therapy for cases of anxiety neurosis and found it of benefit for surgical patients as well.
At 31 July 1943 there were 53 officers and 2197 other ranks down-graded in 2 NZEF, the most common disabilities being: Functional nervous diseases 676; battle wounds 406; foot disabilities 217; accidental injuries 151; ear 104; cardio-vascular 76; eye 75; fibrositis 72; arthritis 72; gastro-intestinal 157.
1 Not yet diagnosed (nervous).