War Surgery and Medicine
[A War Pensions Survey by Dr D. Macdonald Wilson]
IMMEDIATELY following the First World War the outpatient departments of our New Zealand hospitals were thronged by ex-servicemen suffering from either neurasthenia or disordered action of the heart. The neurasthenia or ‘shell shock’ case, as he was called, was there with his restlessness, lack of ability to concentrate, worries over trifles, insomnia, headache, tremors, and increased superficial reflexes. Beside him stood the man whose heart beat rapidly without any exertion, the pulse rate often only counted with difficulty, whose distress resulted from the pounding of his heart and discomfort in the chest. On examination he was found perspiring in the armpits and fingers, the apex beat of the heart diffuse and flapping. In a search for some organic changes in the heart by palpation and percussion the heart was sometimes described as dilated, with the apex beat outside the nipple line and with a systolic apical bruit.
With the discharge of these men from the Army and their rehabilitation they disappeared from the clinics like the snow in summer. In a very short time the vast majority of these ‘DAH’ cases had settled to normal, a few had become definitely neurotic and developed other protean symptoms, while a few others have continued to suffer from functional tachycardia, or neuro-circulatory asthenia as it is now called. Following the 1914–18 War came the investigation of the heart by X-ray and the electrocardiograph, which brought home to the profession the limitations of percussion and the stethoscope.
The modern medical graduate in examining a patient records the blood pressure as routinely as he does the pulse rate. But this was not always so. In New Zealand as late as the year 1930 physicians often examined and reported upon the cardiovascular condition of a war pensioner without recording or referring to the blood pressure. Amongst military files of the 1914–18 War routinely examined, a few records are found of the blood pressures observed at general hospitals of the 1st New Zealand Expeditionary Force in England page 659 in 1918. However, there was no general use of the sphygmomanometer, and indeed often the systolic pressure only was recorded. Also there are a few files with the blood pressure recorded at the Trentham Military Hospital in 1922. From 1918 to 1922 the Army treated service patients at Trentham in what was one of the best organised hospitals New Zealand has ever known. It was not until about 1924 that the general hospitals began to use the sphygmomanometer, and at that time the aneroid type was used, but only to record the blood pressure of cases suspected of hypertension and not as a routine procedure. During the year 1924 only one case diagnosed as hypertension was admitted to Wellington Hospital, while in 1930 the number had risen to ten, three of these associated with another condition, namely pregnancy, diabetes, or syphilis. In 1936 some 56 inpatients were treated. Therefore, when any investigation is made into the possible longevity of people suffering with what is considered an abnormally high blood pressure, it must be remembered that few records exist in New Zealand prior to 1930.
The War Pensions Branch of the Social Security Department has a complete ‘follow-up’ of its patients from the date of enlistment until death. If placed on a satisfactory permanent pension, the pensioner may be lost sight of for a time, but if he enters hospital or applies for increased pension because of any worsening of his condition new medical reports are added to his file. Should any ex-serviceman, not a pensioner, enter hospital or apply for a sickness benefit, his service file is consulted to see if his disability might be related to his war service. Again, on the death of every ex-serviceman his service file is referred to the War Pensions Board for a decision regarding the attributability or not of his death to service.