War Surgery and Medicine
Overseas Experience of 2 NZEF
Overseas Experience of 2 NZEF
Some 700 men developed hernia during service overseas with 2 NZEF. The great majority were young men in whom operative repair was eminently suitable, and comparatively few were of an age at which permanent success could not be hoped for. However, all cases in the older group were carefully evaluated with regard to the prospects of future satisfactory military service. They were graded for base duties, or sent back to New Zealand without operation, if full operative success was not expected.
The practice of discouraging operation for the older group of men (those in their late thirties and forties) proved satisfactory. It was felt that these men could carry on at the Base if suited for light employment, and, if not, it was better policy for them to be employed in New Zealand.
Even if operation were successful in these cases they were unsuited for front-line duty, and the period of six months on light duty following operation was not warranted for a man fit to be employed only in Base Camp. The younger men, on the other hand, could in three months be made fit for front-line service with a very slight liability to recurrence, so operation was well justified.
In December 1943 recommendations were made by the Consultant Surgeon 2 NZEF that ‘cases with definite herniation should be referred to hospital for operation. Cases with weakness of abdominal musculature, producing some indefinite bulging of the inguinal region, should carry on. After operation care should be taken to prevent undue strain for a period of three months, after primary operation, and at least six months after operation for recurrence. The cases will automatically be graded for this period, but even so care must be taken to see that strain is eliminated as the reason for the grading is apt to be forgotten.’
Grading: Cases were graded following operation in difficult cases, in the older men, and because of recurrence. At May 1942 only nine cases of an average age of thirty-seven years were graded for base duty.
By March 1943 seven graded men had been sent back to New Zealand for non-medical reasons and seven of an average age of thirty-five were at that time graded for base duties. Two had refused operation, for one an operation was not advised, one was awaiting operation, one was a recurrence, and two were graded as a precaution. Details were as follows:
Umbilical Hernia and small R. Bubonocele. Refused operation. Age, 38 years.
Operation Bilateral in New Zealand, 1940. Recurrence of small bulge, one just outside ring, other in ring. Refused operation. Age, 42 years.page 409
Large Indirect Hernia. Operation September 1942. Temporarily graded for rest. Age, 23 years.
Bubonoceles bilateral, also osteoarthritis knees, fat, poor subject. No operation advised. Age, 40 years.
Bilateral operation in New Zealand. Operation NZEF November 1941. R. side. In November 1942 recurrence noted size of pigeon's egg. Sac small and difficult to find. Cord displaced in front of aponeurosis. Also has syphilis. Age, 41 years.
L.I.H. Operation advised recently. Not yet performed. Age, 37 years.
Operation in New Zealand (1932 R.I.H., 1935 R. & L.I.H.). Operation in NZEF, R.I.H. September 1941. Silk repair, satisfactory result but graded as a precaution. Age, 26 years.
The conclusions reached in May 1942 after a review of the cases sum up the position satisfactorily: ‘The results show clearly that inguinal hernia, except for the period of disability consequent on the performance of the operation and the convalescence therefrom, is not of any serious importance in 2 NZEF’.
There were about 10 men graded for hernia every month, including cases graded temporarily following operation. There were normally about 30 men on the graded list at one time, 23 actually in the last list of men graded for all conditions, a very small proportion of the whole.
Invaliding: Older patients were often sent back to New Zealand, especially if they had some added disability. Up till March 1943 only seven cases had been sent back to New Zealand, their ages being 29, 39, 42, 49, 50, 52, 52. During the rest of the war in the MEF and CMF another 24 cases were invalided back to New Zealand—a total of only 31 in 2 NZEF for the whole period of the war.