War Surgery and Medicine
The incidence of hysteria in eye cases was not marked. Lieutenant-Colonel Coverdale, through whose hands went all these cases in 2 NZEF, reported only 95 cases seen during the three-year period page 433 from March 1941. The total New Zealand troops during that time was 59,000. It was found that the cases were limited to susceptible individuals with an incapacitating loss of function. The incidence was highest during periods of stress, though the large majority of cases arose at Base shortly after arrival in the Middle East. After Greece and Crete there were 32 cases, 24 arising at the Base. At the second Libyan campaign period there were 17 cases, and after Minqar Qaim 13 cases. On the other hand, at the time of the advance from Alamein to Tunis only 6 cases were seen—only 1 of them from the Division, but 3 from recent arrivals in Egypt.
A high percentage of the cases had had some pre-existing ocular defect dating generally from childhood, many such cases being missed at the medical examinations of recruits in the early period of the war before the institution in New Zealand of mobile optician units. The main symptoms complained of in the series were:
|Main Symptoms||Severe Cases (50)||Mild Cases (45)|
|Pain in or behind eye||9||8|
|Contracted fields of vision||43||39|
|Defects of accommodation||2||2|
|Conjunctivitis (presumed self-inflicted)||3|
Of the 50 severe cases, 42 were invalided to New Zealand and 8 were graded for Base. The 45 mild cases were retained in their units. Of the 53 cases retained in the Middle East, 20 were subsequently sent back to New Zealand and 7 were graded for Base, while 3 were killed in action and 1 died of disease. At the end of the period 15 were still in the Middle East, while 12 had returned to New Zealand on furlough or for non-medical reasons.
Forty-two men judged to be hopeless cases of hysterical amblyopia were sent back to New Zealand, as their influence would have been unfavourable at all times and their presence even at Base a source of weakness and disquiet. It can be said that few of these were even Grade II at enlistment, but, in regrading them, it was anticipated that some would be able to give useful service at home. Post-war investigations have shown, however, that this view was optimistic. In March 1949 the medical files of 41 of these 42 page 434 men were examined and it was found that 37 had been pensioned for varying periods, 11, it seemed, permanently. Only 3 had had pensions refused and only 1 had made no application.
The problem of hysteria, therefore, was not a serious one, and with the elimination of susceptible men in New Zealand in the later years of the war few cases were seen.
Every grade of intensity of functional disorder, from trivial asthenopia to total uniocular blindness, was met with. The chief difficulty was in deciding what degree of incapacity was necessary to justify the serious yet only permissible diagnosis of hysteria.
This clinical embarrassment was appreciated by the DMS, who called a conference of some senior medical officers to contrive a solution, though it cannot be said that the problem was solved. The fact that when hysteria was diagnosed the man could not thereafter be convicted of malingering is sufficient to indicate that the difficulty was not mere pedantry.
The letters NYD (Not Yet Diagnosed) were allowed in our hospitals, but they often had the obvious disadvantage of being untrue. After having brought a long and exhausting investigation to a successful conclusion, to write NYD seemed unreasonable and destroyed the usefulness of the designation for cases where it was really required.