Medical Services in New Zealand and The Pacific
IX: Rehabilitation of the Disabled
IX: Rehabilitation of the Disabled
The vast majority of servicemen who had had limbs amputated overseas required no further surgery in New Zealand. Long below-the-knee stumps were purposely left in some cases at the original page 403 operation overseas so that, when sepsis had subsided, amputations could be made at the sites of election under the best hospital conditions. This led to some confusion of thought among men who did not understand the surgical complications. Amputees were normally evacuated to New Zealand without delay so that the fitting of artificial limbs could be carried out at the appropriate time.
There was, therefore, a big demand in New Zealand for the supply and fitting of artificial limbs. At the beginning of the war there was very little training in the country in artificial limb making. The manufacture of artificial limbs was largely in the hands of private firms. In 1943 the limb manufacturing and fitting equipment and plant of a large firm in Wellington was taken over by the Rehabilitation Board. It was entrusted to the Disabled Servicemen's Re-establishment League to operate as part of the new vocational training and recreational centre erected by the board in Wellington. From then on, this centre performed the bulk of limb manufacturing and fitting work on behalf of ex-servicemen.
To expand production modern plant and tools had to be obtained and limb-makers trained. The manufacture and fitting of artificial limbs made considerable scientific advance during the war years. To ensure that New Zealanders were able to benefit from the advances in technique, the Director-General of Medical Services and the War Pensions authorities arranged for an experienced orthopaedic surgeon to be sent overseas in August 1944 to the United States of America and Great Britain to study modern methods and then apply them in New Zealand.
The service to amputees in respect of treatment and the fitting of artificial limbs was at first concentrated in Wellington, where a large and well-equipped limb factory was developed and where the services of an orthopaedic surgeon familiar with modern practice were available. Later part-time orthopaedic surgeons were appointed at Auckland, Christchurch and Dunedin, where facilities for the fitting and repair of artificial limbs were also established. All fittings and major repairs to artificial limbs were supervised or recommended by the orthopaedic surgeons.
When an amputee returned to New Zealand he was examined by an orthopaedic surgeon, who instructed the Supervisor of Artificial Limbs in the procedure to be followed in each case. The Supervisor interviewed each amputee and followed up each case until an artificial limb had been satisfactorily fitted. In numerous cases it was found that owing to the condition of the stump further operative treatment was required. Progress reports were made to the War Pensions Department, which had control of the provision of artificial limbs. When the orthopaedic surgeon indicated that the amputee page 404 was ready to be fitted with a limb, the Army's Sick and Wounded Branch arranged for the amputee to be admitted to a suitable convalescent home during fitting.
At one time all amputees were taken to Mowai Home, Wellington, for fittings as no facilities existed elsewhere. Later, facilities were provided in Auckland and amputees were accommodated in the Evelyn Firth Convalescent Home. An attempt was made early in the war to manufacture and fit artificial limbs in Christchurch and Dunedin, but this system proved unsatisfactory. Later, artificial limbs made in Wellington were fitted in Christchurch and Dunedin under War Pensions Department supervision.
The demand for artificial limbs increased steadily from 1942, and owing to the difficulty in obtaining trained operatives, and also materials and parts, there were some delays in the provision of limbs. Amputees were instructed in the correct use and maintenance of their artificial limbs and were retained on army pay until a limb had been satisfactorily fitted, when a certificate to that effect was given by the orthopaedic surgeon in charge of the case. The artificial limbs provided were of a high standard.
By the beginning of 1948 some 461 out of the total of 491 Second World War amputees had been fitted with artificial limbs. The remaining thirty were fitted with limbs shortly afterwards. Of the 461 who had been fitted, 285 had also received duplicate limbs – an excellent achievement.
In 1942 the Disabled Servicemen's Re-establishment League was appointed by the Rehabilitation Board as the agent of the board responsible for the training of disabled servicemen in new trades and occupations, in order to enable these men to utilise their remaining earning ability and take their place once more in civil life. (This League was inaugurated in 1931 by the New Zealand Returned Soldiers' Association to provide training and employment for disabled servicemen of the First World War.)
The headquarters of the League was in Wellington and there were training centres at Auckland, Wellington, Napier, Christchurch, Dunedin and Invercargill. In each of these centres, disabled servicemen who were unable to return to their pre-war occupations on account of war disabilities were trained in new trades and occupations, payment being made during the training period.
Disabled Servicemen's Re-establishment
Any ex-servicemen disabled to the extent of 40 per cent or more was considered for such training. The League was financed largely by the Rehabilitation Board by way of free grants for administration costs and plant and machinery, interest free loans for working capital, free premises and by training subsidies on a sliding scale.page 405
The League had a training farm at Milson, Palmerston North, at which those disabled ex-servicemen who sought their future on the land were able to obtain training in dairy and pig farming, poultry keeping, bee-keeping and market gardening. The following table indicates the occupations taught in the League centres and the number of ex-servicemen of the 1939–45 War who were training and had completed training at 31 March 1948:
|Trade or Occupation||In Training||Employed||Completed Training Established in Own Enterprise|
|Artificial limb making||8||3|
|Boot repairing and surgical boot-making||11||31||42|
The aim of the board was to train seriously disabled men in a suitable occupation up to normal industrial standards so that on completion of training they might be able to take their place in private industry. However, some were precluded by the nature of their disability from undertaking outside employment, and to these the League's facilities offered a sheltered occupation on completion of training or an avenue of disposal for the products manufactured in their own homes.
The treatment of servicemen who had been completely blinded in both eyes, or whose sight was seriously impaired, fell into two categories. First, there was medical or surgical treatment, which was the responsibility of the Department of Health. Second, there was page 406 the matter of training in a suitable occupation, which was a function of the New Zealand Institute for the Blind, Auckland. Servicemen requiring both treatment and training could either be admitted as in-patients to the Auckland Public Hospital or could attend the hospital as out-patients while in training at the Institute for the Blind.
The responsibility for the training of blinded ex-servicemen was assumed by the Rehabilitation Board.
In 1945 the Blinded Servicemen's Trust Board was formed. The purposes of the Trust Board as set out in its deed of constitution were, inter alia, '… to acquire and maintain a hostel to be named NZ Saint Dunstan's and such other hostels (if any) as it thinks fit for the training of persons who have been servicemen, as defined by the Rehabilitation Act, 1941, and its amendments, and who have become wholly or partially blind, and to promote the well-being of any such person whether within a hostel or not.'
The Trust Board comprised three members appointed by the Rehabilitation Board and five members nominated by the New Zealand Red Cross Society, the St. John Ambulance Association, St. Dunstan's (England), the New Zealand Institute for the Blind, and the Commercial Travellers' and Warehousemen's Association of New Zealand. This enabled the public to be represented on the Trust set up to provide for the general welfare and re-establishment in civil life of blinded servicemen.
Following the incorporation of the Blinded Servicemen's Trust Board, a suitable property at Maungakiekie, Auckland, which had been used as a rest home by the United States Forces, was acquired and reconstructed to provide suitable living quarters and training facilities. This training centre, appropriately named New Zealand St. Dunstan's, was officially opened in November 1945.
The aim of St. Dunstan's training was to provide blinded servicemen with a basic source of training in braille, typewriting, etc., to enable them to take their place in the civilian community again, and where possible to provide them with an interesting and remunerative occupation. In some cases these men had been able to engage in industry on the completion of their training, but the majority were precluded from doing so by the nature of their disabilities. Thus, although the original aim of the Rehabilitation Board was to train these ex-servicemen for re-absorption into industry, experience proved that in the majority of cases this was impracticable.
At 31 March 1948 there were 21 blinded men in training at St. Dunstan's, while 13 men had completed their training at that date. While St. Dunstan's trained the visually disabled ex-servicemen, page 407 the Blinded Servicemen's Trust Board concerned itself with the settlement of the men in civilian life, if possible, after the training period was completed.
Applications by ex-servicemen for pensions were considered by a War Pensions Board, which consisted of a chairman and two other members, one of whom was a medical practitioner and the other was nominated by the New Zealand Returned Services Association. Appeal could be made against the decisions of the War Pensions Board to the War Pensions Appeal Board, which was usually presided over by a senior member of the judiciary, and on which there were two medical members, one of whom was appointed as a representative of the returned servicemen and the other by the Government. The general administration of the enactments providing for pensions and allowances in respect of war service and the carrying out of the decisions of the War Pensions Boards and the War Pensions Appeal Board were the functions of the Secretary for War Pensions of the Social Security Department.
The War Pensions Boards visited various centres in New Zealand, which enabled them to see ex-servicemen in person. In addition, part-time district medical officers were later attached to the Social Security Department to assist and advise locally on problems of treatment.
A disability pension was payable to a serviceman in the following cases:
Where the disablement occurred while on service overseas.
Where the disablement was attributable to service with the forces.
Where the condition which resulted in the disablement was aggravated by service.
The following is a summary up to 31 March 1950 of the disabilities from which ex-service personnel were suffering at the time of application for pension:
|Type of Service|
|Class of Disability or Disease||Overseas||New Zealand||Total|
|Infections and infestations||1,878||112||1,990|
|Eye, ear, nose||6,433||1,317||7,750|
|Circulatory and blood system||1,926||985||2,911|
|Generative system||316||119||435page 408|
|Gunshot wounds and accidental injuries to bones, joints, and soft tissues||6,020||1,183||7,203|
|Diseases of bones, joints and muscles||5,007||1,807||6,814|
|Tumours and neoplastic growths||149||48||197|
There was a basic weekly rate of disablement pension and, if the serviceman was only partially disabled, the War Pensions Board determined the proportion of this rate at which the pension was to be paid, having regard to the extent of disablement, except for certain specific disabilities for which definite proportional rates of pension had been laid down.
Where the serviceman was suffering from two or more serious disabilities, or was in receipt of a pension for total blindness, the War Pensions Board might also grant an additional amount over and above the basic disablement pension.