War Surgery and Medicine
Treatment: At the Base
Treatment: At the Base
The more severe cases from the forward areas were sent back to the base hospitals for further treatment. They included the exhaustion cases not responding to the four or five days' rest, and the more severe anxiety states. The cases, though not severe, deemed no longer suitable for front-line service were sent for grading direct to the base camp.
The hospital cases were given further sedation and rest, followed by reassuring interviews. Adequate dosage of sedatives was necessary. There was a tendency always to give too little: 3 grs. of phenobarbitone soluble intramuscularly was necessary for severe anxiety states and morphia in doses of ½ gr. with .01 gr. of hyoscine. Such dosage would in most cases ensure rest where repeated smaller doses might have little effect, and repetition was often unnecessary.
Cases evacuated to hospital were considered very largely to be cases unlikely to return to combatant duties. At the same time it was just as necessary for these cases to be reassured and built up. Frank discussion was most necessary at this stage, and it was found that a large proportion of cases, in discussing their condition, did fully appreciate it and, realising that they were unable to face battle conditions, wished to do what they could. Any indication of such page 641 desire was grasped with both hands by the examiner and encouragement given. In the absence of any such indication by the patient it was explained to the patient how his particular breaking point was reached, and he was shown how just as good and useful a job in many ways could be done in other units not actually in the front line. It was surprising the number of patients whose immediate response was: ‘The last thing I'd like to do is to go back to New Zealand like this. If I could only do a decent job I'd do it.’ The rest was easy. A large proportion of cases of neurosis were satisfactorily placed in suitable employment at Base and on the Lines of Communication and presented no further problem. Quite a proportion of them were not even graded, but were transferred to non-combatant duties on personal application along with a medical recommendation.
In the management of cases of war neurosis the building up of the patient's self-respect was one of the most important therapeutic measures. A person might be an inferior type of individual, he might have broken down earlier than a normal person should have done; but if that person was to be reconditioned or rehabilitated, he had to be led to see that it was no fault of his own and that he could yet show how he could overcome his difficulties and still do a good job. The soldier's self-respect was in this way preserved, which was all-important.
Under war conditions overseas the problem was a very impersonal one. Fighting troops were the first necessity. If a man proved he was of no use in a combatant unit then a decision had to be made whether he could be of use in another unit overseas. If he was not to be of use, then he was returned to New Zealand. On the whole it seemed to work out in a reasonably successful manner. (The Consultant Psychiatrist MEF, Brigadier James, stated that 40 per cent of psychiatric casualties could have been prevented by the careful selection of recruits, and that 35 per cent of all cases were caused by actual battle conditions. Of the total British cases 75 per cent were retained in the Middle East, and at a late period both armed and unarmed pioneer units were formed so as to utilise these men.)
No special organisation was set up within 2 NZEF to deal with psychiatric casualties. Use was made of British psychiatric units for the more serious cases.