War Surgery and Medicine
Treatment in the Forward Areas
Treatment in the Forward Areas
In the forward areas management was concerned more with physical and nervous exhaustion. At first all these cases were evacuated to the Base. It was then found that this resulted in very few ever getting back to the forward units. The farther they went back the longer they stayed and the less likely were they ever to be fit to return to their units. Then some were held in the Field Ambulances for a few days and returned to their units direct. It was found that this was satisfactory in many cases, especially in those men suffering from exhaustion and not specially prone to psychological upset.
At Alamein a Rest Centre was established by 4 Field Ambulance in an ideal situation on the coast, and exhaustion cases were sent there. Of 33 admissions, 11 were evacuated to hospital and 22 went back to their units; nearly all of these men were working in their units three months later.
In Italy these cases were normally retained and treated in the Field Ambulances if conditions were satisfactory, and considerable numbers were thereby saved to forward units.
The essential preliminary treatment was rest, and this was generally ensured by adequate doses of sedatives. Luminal up to gr. iii daily was usually given. If possible hot showers were provided and ample nourishing food. Enemas were given and purgatives as required, as constipation was common. When adequate rest had been obtained, occupation was essential and strict discipline was enforced. The days' timetables were carefully arranged so as to balance rest and healthy occupation.
Interviews were arranged by the medical officers and the condition of the patient discussed fully and explained and all reassurance given. Normally in four or five days' time the man was fit to return to his unit. Cases not responding were evacuated to the base hospital. It was realised that few of the cases sent to Base would return as front-line troops. The best results were obtained in cases not psychologically unstable who were suffering from temporary exhaustion.
In the 2 NZEF there were never any special exhaustion centres, such as the British Army instituted, where psychiatrists undertook the treatment of cases referred from the forward units. The page 640 same type of treatment, however, was carried out in the divisional area by the utilisation of the Field Ambulances, generally the resting Field Ambulance, being employed as a Rest Centre for this purpose. There are no records of the percentage of cases sent back to the combatant units. A considerable percentage, probably the majority, were referred to the Base for grading and then placed in some suitable occupation.
More elaborate forms of treatment were carried out in the special British forward centres, but not in the New Zealand units. Continuous sleep treatment for three to five days was utilised at one time, but the results were not very satisfactory. Narco-synthesis was also used extensively in some centres, the patient re-enacting his experiences whilst under sedation. Lieutenant-Colonel John Russell, who acted as psychiatric adviser to 2 NZEF, was not in favour of this form of treatment and thought that the purpose could be better served by frank and dispassionate discussion with the patient. He did not believe that the patients forgot their experiences, but that they tried to hide them. Lieutenant-Colonel Russell was quite satisfied with the results obtained in the Division by simple methods, particularly the early treatment of exhaustion by adequate sedation and supportive measures.