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The New Zealand Medical Service in the Great War 1914-1918

Chapter XXII. Reconstruction in New Zealand

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Chapter XXII. Reconstruction in New Zealand

The New Zealand Defence Department had, by 1918, attained to a high level of organisation. The war policy of the Dominion, directed by a Coalition Cabinet, was administered by a Minister of Defence of marked ability and dominant personality, Colonel the Hon. Sir J. Allen, K.C.B., M.P., whose Ministry of Defence had grown from a modest and subordinate position to one of great strength and critical importance. The various branches of the Department, that of the General Staff, the Adjutant General, and the Quartermaster General, had been enlarged and reinforced by various active boards established for war purposes and concerned with munitions, supplies, transport and recruiting. The Medical Department of the Adjutant General, Col. R. W. Tait, C.B.E., had expanded with the growth of the other branches and at the end of the Dominion military year in June, 1918, was adequately staffed and had assumed full responsibility for all the duties normally allocated to such a department. The D.G.M.S, Surgeon General R. S. F. Henderson, C.B., K.H.P., A.M.S., had a staff of experienced officers which was composed as follows:—

D.M.S.: Col. J. R. Purdy, (D), N.Z.M.C.

D.M.H.: Hon. Col. T. H. A. Valintine, N.Z.M.C.

A.D.M.S. (Sanitary): Capt (tem. Lieut.-Col.) R. H. Makgill, N.Z.M.C.

D.A.D.M.S.: Hon. Capt. G. A. Gibbs, R.A.M.C. attached N.Z.S.C.

D.D.S.: Lieut.-Col. T. A. Hunter, N.Z.D.C.

The Consulting Surgeon in New Zealand at this date was Lieut.-Col. J. McN. Christie, N.Z.M.C., who had seen service with the Hospital Ship Marama in 1917, and had replaced Hon. Lieut.-Col. Hope Lewis, N.Z.M.C., deceased, whose first appointment as consulting surgeon dated from 1915. The appointment was directly under the control of the Director of Military Hospitals, the duties being: to inspect all returned soldiers in public hospitals and sanatoria, whether in or out patients, and to forward reports on these patients showing page 503whether they required further treatment or whether they should appear before a medical board. Besides the Staff at Headquarters there were: four A.D.'s M.S., one in each military district; the medical officers sitting on recruiting or invaliding boards; and the medical officers attached to various hospitals, camps, and depots. The New Zealand Army list at this period showed over 500 officers on the strength of the N.Z.M.C., of which nearly one-half with the N.Z.E.F. No serious difficulty, then, had arisen in supplying the necessary quota of officers to the N.Z.E.F., nor in filling the various appointments required to conduct the home services. From our Depot at Awapuni, in command of Lieut-Col. Gabites, N.Z.M.C., a constant stream of partly trained recruits was available to fill the ranks of the Corps, both in the Dominion and abroad.

An important change in medical administration came about in March, 1918. The dual control exercised by the Defence and the Public Health Departments over sick and wounded returned soldiers was, by resolution of Cabinet, abolished and the sole responsibility for the after care and treatment of both discharged and undischarged disabled soldiers was handed over to the Defence Department. The dual system in which the Chief Health Officer and the D.G.M.S. were co-equal failed, not in any way through lack of mutual understanding between the medical officers concerned, but because the arrangement was cumbersome, uneconomical, led to considerable delay in execution and was not productive of military efficiency.

That the system was faulty was admitted by all parties early in the year. As evidence of the cumbersome nature of the existing scheme, the transfer of a military patient from one civil hospital to another is cited. On transfer of a military patient the medical superintendent of the civil hospital concerned communicated with the Public Health Department, whose chief, as D.M.H., if he approved of the transfer (in this he would be guided by the Consulting Surgeon), and if a bed was available in the hospital of destination, referred the matter to O.C. Base Records, who in turn directed the O'sC. military districts concerned: one, to issue the necessary rail warrants, the other, to warn the civil medical superintendent of the hospital of destination. At Rotorua Sanatorium and Military Hospital the system was to be seen in its most complex manifestation. The Sanatorium and Balneological Station was an institution controlled by the Tourist Department. The Medical Superintendent, Dr. Herbert, was an officer of the Tourist Department, his salary page 504being paid by them, but his sanatorium, in as much as it supplied the needs of the district as a General Hospital, came under the partial control of the Chief Health Officer; was in a sense one of the civil hospitals provided for under the Hospitals and Charitable Institutions Act. When military patients were first sent to Rotorua in 1915, it soon became evident that, if discipline was to be maintained, some military representation was necessary; as a compromise, the Medical Superintendent was given temporary rank in the N.Z.M.C. and Medical N.C.O.'s and O.R. were attached for duty. With the erection of the extension at Pukeroa Hill—at first two polyhedral wards—a combatant officer, Lieut.-Col. Newall, as we have seen, was attached as Commandant, when the new wards, now known as King George Vth Military Hospital were opened in 1916. The Medical Superintendent was now caught between many fires: the Tourist Department which paid him, the Public Health Department which controlled him, and the Defence Department by which he was disciplined. A more unworkable intolerable situation could hardly be imagined, yet compromised with and endured with singular fortitude by all concerned.

Public hospitals in New Zealand are supported by:—(1) Rates levied in the hospital districts; (2) A Government Subsidy proportionate to the amount levied by local taxation; (3) Fees payable by patients; and to a certain extent by voluntary contributions. The public hospitals are administered by the Hospital and Charitable Aid Boards, lay bodies and voluntary workers who employ a medical superintendent and a staff to administer the hospital and provide treatment for the patitents. In the working of the Hospital Boards the Inspector of Hospitals, also the Chief Health Officer of the Dominion, exercises an advisory and controlling function and has a certain prerogative in guiding the boards in in their selection of medical superintendents, assistants and nursing staffs. The medical superintendents are part time or whole time as is required by the size of the particular institution. But the superintendents, being officers of the Hospital Board, are-certainly more under the control of the Board than they are-beholden to the Public Health Department. Good will between all parties is essential for the smooth running of the Act and in the war period the best conditions prevailed. The boards animated by a real patriotism, co-operated most energetically with the Defence Department in providing accommodation and treatment for the returned soldiers. The link between the Defence Department and the Hospital Boards was the Chief Health Officer.

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Under the new arrangements whereby the Defence Minister assumed control over military patients, it was still necessary to make use of the hospital accommodation provided by the civil hospitals. In order to co-ordinate the work, Colonel Valentine was temporarily lent by the Public Health Department to the Defence Department and became a whole time military officer under the D.G.M.S. King George V Hospital at Rotorua and the Sanatorium at Hanmer, and all convalescent homes hitherto administered by the Public Health Department became military institutions. Another change in administration was necessary: discharges of returned soldiers still needing treatment had to be delayed indefinitely and, following the precedent of other Dominions disabled soldiers already discharged from the service required to be reattested prior to admission to hospital for treatment of recurrent disabilities due to wounds or war service. These measures essential to the maintenance of discipline were brought into force during the year.

Close consideration had been given by the D.G.M.S. to the necessity for providing adequate orthoepadic treatment for returned soldiers and provision for the special treatment of tubercular patients, and those suffering from the war neuroses. Public attention had been sharply focussed on these matters early in 1918, and shortly after the new arrangements came into force provision was made for the reception of the first orthopaedic team at Christchurch Hospital and for the erection of military sanatoria for the treatment of phthisis. In Dunedin, Lieut.-Col. Barnett, C.M.G., N.Z.M.C., who had now resumed the Chair of Surgery at the Otago University was instrumental in organising a preparatory scheme for the establishment of an Orthopaedic Centre at the Dunedin Hospital. At the instance of the D.G.M.S., Lieut.-Col. Mill, N.Z.M.C. recently returned from the United Kingdom, forwarded a report after a tour of inspection. The report which was later endorsed by Colonel Wylie, N.Z.M.C., advised that at least 3000 beds would be required; that at present there was a lack of accommodation, lack of trained medical personnel, and especially an inadequate equipment for physio-therapy. The establishment of two large central hospitals under military control, one for each Island, was recommended, and it was strongly urged, on the advice of Sir Robert Jones, who had personally interested himself in the matter, that none but trained military orthopaedic specialists should undertake the work of surgical reconstruction in New Zealand.

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It had been intended to send the first orthopædic team to King George V. Hospital at Rotorua, but as Christchurch was more central and offered superior accommodation, the unit was established at Christchurch Hospital in a new block known as the "Chalmers" Wards donated by the estate of the Chalmers family of Ashburton and appropriated to military uses with the consent of the donors. The local Hospital Board, whose medical staff was much depleted by the war, had early realised the advantages their institution would derive from the attachment of the orthopaedic unit more especially in developing their civil orthopaedic work and in the reorganisation of their departments. They agreed to do all in their power to make the conjoint work a success and in October, 1918, Colonel Wylie and his team were busily engaged in opening their various departments.

The close of the year 1918, was a disastrous period of failure for the camp sanitarians; statistics up to November had yielded a promise of a healthier year even than 1917, and encouragement in a belief in the efficacy of the very stringent preventive measures in force. But at the end of the year the results shown did not warrant any great assurance in the value of the sanitary measures adopted to exclude epidemic disease. The average strength of the camps in 1918 had been 9,181, with a total population of 24,434. Of this number 11,578 had been admitted to hospital; the hospital admission rate gave a figure of 36.81 constantly sick as compared with 12.49 for 1917. There were 295 deaths recorded in the camps, equivalent to a mortality of 12.07 per 1000 or 32.13 per 1000 on the average strength. These were the worst figures yet furnished in the annual health reports of the camps, but 73 per cent, of the sickness was due to influenza and of the deaths, 287 were caused by the later influenza epidemic.

There had been a preliminary wave of mild influenza in August and September, but in the first week of November a secondary wave of extraordinary severity swept over the camps. The first outbreak although it seemed to confer some slight immunity, was not attended by any marked incidence of pulmonary complications and it seemed to the medical officers that the throat swabbmgs were fully justifying their existence. But nothing could have warded off the explosive virulence of the main epidemic in New Zealand which so curiously coincided with that of the Division in France, the N.Z.E.F. camps in England and the world wide pandemic of late October and November. On the 11th and 12th of October troopships arriving in Auckland reported 80 cases of influenza on board. The page 507disease spread to small camps in Auckland and to the civil population and, by the 28th of October, was fully declared. Travelling southwards by coastal routes and troop trains it reached Wellington and the large camps between the 2nd and 4th November. Disseminated from the ports the pandemic affected the South Island a week later and strangely decreasing in mortality rate as it passed southwards, it died out at the end of November as suddenly as it had sprung into being. New Zealand had never suffered such a pestilence; records of previous epidemics of a wide spread nature were preserved, one in 1853 which affected the British troops and caused many deaths, and again in the years 1890 to 1894, there had been outbreaks of some severity but the total of all deaths from influenza in all the years from 1872 onwards was greatly exceeded by the mortality of the year 1918. Of 5,580 cases admitted to the civilian hospitals, 1,604 died; a case mortality of nearly 22 per cent, while it is estimated that over 6,000 deaths attributable to the influenza were registered during the short duration of the pandemic. Unprecedented in extent and virulence, the disease swept upon the camps striking down about one half of the population during the first 10 days. There was an incidence of 11 per cent. of serious pulmonary complications and in those so affected, a 42 per cent mortality. The deaths amongst the troops numbered 287. It was of brief duration, all was over in 18 days, but during the crowded weeks of the visitation the N.Z.M.C. staffs, depleted by sickness and death in their own ranks, wrought unceasingly with splendid 11devotion assisted by volunteers from the combatant ranks who displayed a quiet heroism, very honourable very praiseworthy, in their unwonted terrible and dangerous work. Five N.Z.M.C. officers, one sister, N.Z.A.N.S., and at, least 14 O.R. N.Z.M.C. gave up their lives in fighting the epidemic. Amongst the officers was one well known to us, Lieut.-Col. Mathew Holmes, N.Z.M.C. Invalided at the end of 1917, this officer, the first to embark a medical unit in the Great War, held the appointment of A.D.M.S. Wellington District after his return to New Zealand. He had given good services to the New Zealand Forces in Samoa, Egypt and in France, but constant ill health, ever militated against that full participation in the active work of the N.Z.M.C. which he so much desired. Bacteriological reports and pathological findings in the epidemic differed little in New Zealand from those compiled in European centres. The Bacillus of Pfeiffer was very prominent in the first wave, but not so frequently observed in the secondary page 508wave when the pneumococcus, a streptococcus and gram negative cocci seemed to be predominant. One interesting investigation made by Lieut. Waters, N.Z.M.C., Bacteriologist at Trentham, is worth recording. He exposed blood-agar plates in the wards and on the verandah of the hospital, others in the canteen and cinema hall of the camp. No cultures of pathological significance grew on the plates exposed in the hospital, but on plates from the picture theatre and more especially the canteen, copious growths of the characteristic organisms were identified. This promising inquiry into the vital question of modes of infection was most unhappily interrupted by the onset of influenza in the investigator. No preventive measures could control the spread of such an epidemic, but the despatch of the 43rd Reinforcements was cancelled; all movements of troop trains were stopped; the camps were rigidly quarantined, and a daily pilgrimage was made to the inhalation chambers. Shortly after Armistice demobilisation of the camps and home services commenced, but the epidemic delayed and lengthened the process and entailed an unusual amount of extra work on the medical service.

During 1919, important changes in administration took place. General Richardson on his return to New Zealand was appointed General Officer in charge Administration, an office not previously constituted in the Defence Department. Major General Henderson, having completed the term of his extended engagement with the Dominion Government, relinquished his appointment as D.G.M.S. at the end of March and on his departure received the public thanks of the Government for his valued services and was awarded the K.C.M.G. His duties were assumed by Brigadier General McGavin, C.M.G., D.S.O., N. Z. M. C., who returned to New Zealand in May. As the gradual return of medical officers, who had held important appointments in the N.Z.E.F. overseas, supplied the Director General with a staff of skilled and experienced subordinates, the senior officers on loan from the Public Health Department were returned to their civil duties. Dr. T. A. Valintine, C.B.B., D.P.H., relinquished his appointment as D.M.H., and returned to his duties as Chief Health Officer, and with him went Dr. Makgill, D.P.H., his director of Hygiene, who had been A.D.M.S. Sanitary. To both these medical gentlemen the Defence Department was much beholden for strenuous services during the war years. Dr. Makgill had directed the sanitary policy of the camps and had elaborated the ingenious preventive measures against epidemic disease already detailed, while his annual reports on the health of the troops are not only a testimony to page 509his industry and learning, but form a valuable commentary on contemporary sanitary and epidemiological knowledge.

The first and most important readjustment to be made by Brigadier General McGavin was the closing of a large number of small "war hospitals" or convalescent homes and the concentration of service patients in specialised military institutions. Owing to the over-crowding of the civil hospitals and the inadequate provision of military hospitals prior to 1918 the local Patriotic Bodies in the larger towns had established a number of small soldiers' hospitals and convalescent homes which by reason of their scattered distribution were almost impossible to administer or to control. The maintenance of discipline and the provision of special treatment were both considerations of urgent importance and there was also evident the necessity for a more accurate classification and sorting of the patients domiciled in these units.

Already in 1918 our orthopædic specialists sent out from England had reported unfavourably on the conditions existing in most of the larger hospitals, and this more especially as regards the facilities provided for physio-therapeutic and electrical treatments and the manufacture of splints and corrective appliances. It was noted, for instance, that many cases of functional paresis had been confused with the organic lesions and that both had been subjected to electrical treatments not suited to the respective conditions—many gun-shot injuries of peripheral nerves dating from 1915 and 1916 required treatment by nerve suture.

The first necessity was classification: with this object in view a travelling medical board was set up by the D.G.M.S. with Col. J. McNaughton Christie, C.B.E., N.Z.M.C., as chairman. The duties of the board were to visit all the outlying homes and recommend patients for transfer to the appropriate military institutions.

Owing to the fervour of local patriotic feeling, considerable opposition was offered to the closing of the smaller War Hospitals and Convalescent Homes. The Patriotic Bodies had many good reasons to advance for keeping their respective units open but the Defence Minister, Sir James Allen, was obdurate, he demanded efficiency at any cost and approved of a reorganisation of the military hospitals on the lines of similar formations in the United Kingdom. By means of the Travelling Medical Board the patients were ultimately sorted out and drafted to the now enlarged and specialised military hospitals; page 510but nearly two years elapsed before all the smaller units were finally closed.

Amongst the first of the specialised units to be constituted in 1919 was a neurological centre for the treatment of the war neuroses. Queen Mary's Military Hospital at Hanmer Springs, in the South Island, had been used as a Convalescent Home since 1915. At first a balneological station under the Tourist Department, possessing a hot sulphur spring, a resident medical officer and a small sanatorium, it admitted convalescents of all categories; but during the war, until 1918, it was under the control of the Public Health Department. Later it assumed a more military character and in 1918 had a combatant officer as commandant, with N.Z.M.C., N.C.O.'s and orderlies and a military medical officer. Major Bernau, N.Z.M.C., had followed Captain Hendry, N.Z.M.C., and was succeeded by Major Brewis, N.Z.M.C., but on the opening of the hospital as a neurological centre, it was commanded by a medical officer, Lieut.-Col. D. E. Fenwick, N.Z.M.C., recently Registrar and Chief of the Medical Division of No. 1 N.Z.G.H. An objectionable feature in the disposal of "shell shock" cases in New Zealand prior to 1918, had been the treatment of the more serious cases in convalescent homes adjacent to and controlled by the Mental Hospitals Department. Public opinion was very sensitive to the removal of alleged "shell shock" patients to mental hospitals, so much so that after certification, the soldier mental patients were accommodated in separate "military" wards where they received the same gifts and minor attentions as the inmates of other hospitals as far as was permissible. But at Hanmer none of the more serious cases were to be admitted; it was from the first clearly determined that the hospital was not to be a "borderland" home nor a place for the treatment of the milder psychoses but a centre for dealing rapidly and effectively with the many cases of hysteria, neurasthenia and psycho-neurosis which had accumulated during the war. Hanmer was well organised in its new work when Major Chisholm, N.Z.M.C., one of the officers specially trained in England under Sir James Mott, took command of the Hospital in 1920.

The proposal outlined in March, 1918, for the formation of military orthopaedic hospitals in the four centres, included an Orthopaedic Hospital at Rotorua. The Convalescent Home known as King George V. Hospital had been in existence since 1916. Lieut.-Col. Herbert, N.Z.M.C., Superintendent of the Sanatorium, had enlarged the Physio-therapy Department and had installed page 511Vocational Workshops during 1917. A new Hospital had been erected at Pukeroa Hill overlooking Lake Rotorua and the hot pools at Ohinemutu in 1916, and as it was decided to separate the new hospital from the Sanatorium an extensive building scheme was embarked on late in 1918, when Lieut.-Col. Mill N.Z.M.C., assumed command. He was succeeded by Lieut.-Col. Bernau, N.Z.M.C., the following year, and in 1920 the unit received all the patients from the Military Annexe at Auckland, becoming a fully equipped military orthopædic hospital of 300 beds.

At the Civil Hospital in Auckland, additional wards for military patients had been established at the end of 1915. The buildings where these patients were accommodated, known as the Annexe, were controlled by the Superintendent, Lieut.-Col. Maguire, N.Z.M.C., who had served with the New Zealand General Hospital in Egypt, but had been recalled to the service of the Civil Hospital. In the March, 1918, proposals, the Annexe was destined to be expanded so as to form a military orthopædic hospital. The institution was inspected and reported on by Colonel Wylie, then Inspector of Military Orthopædies, and it was decided that the Defence Department should assume control. Lieut.-Col. Mill, therefore, in June, 1919, took command of the military unit and was later succeeded by Lieut.-Col. Murray, C.M.G., D.S.O., N.Z.M.C., in September.

The Annexe was closed in March, 1920, and the military patients transferred to Rotorua where the new buildings were now available. The change of site was fore-shadowed in the original policy of 1918, the building scheme had been in part, completed at Rotorua and economy in medical officers and in administrative expenditure in a great measure dictated the change. Ultimately the Annexe was available as a physio-therapy department of the Civil Hospital and a portion was appropriated as a Venereal Clinic for males and females, controlled by the Hospital but supplied by the Public Health Department with a medical officer: Major Brown, N.Z.M.C., late Officer in charge of the V.D. Section of No. 3 N.Z.G.H., Codford, was appointed, while the other officers of his staff who had received special training in England were attached to the Civil Venereal Dispensaries at the chief centres.

In June, 1919, the Camp Hospital at Trentham was enlarged and organised as a general hospital of 500 beds. Colonel Wylie, following Lieut.-Col Mills, had command, and supervised page 512the necessary alterations and additions. The existing hutments were adapted by means of a connecting corridor with sanitary pavilions attached. Special departments, for physiotherapy, X-ray and plaster work, were provided for and extensive splint shops, curative and vocational training workshops, and gymnasia were established. The Surgical Division at Trentham, mainly orthopædic, was in charge of the second Orthopaedic Team under the direction of Lieut-Col. Stout, D.S.O., late Surgical Specialist at No. 1 N.Z.G.H.

At Featherston, in the Camp Hospital, a centre for D.A.H. and C.P.D.I. had been formed; the latter designation a nomenclature including all undiagnosed cases of chronic pulmonary disease of indeterminate character, a class like D.A.H., in need of further sorting. A Venereal Division was associated with this Military Hospital which was commanded by Lieut.-Col. McLean, C.B.E., In 1920, Featherston Military Hospital was closed, the cases transferred to Trentham with a proportionate staff and the officer commanding took up the appointment of A.D.M.S. Central Command.

A sanatorium for the treatment of tubercular soldiers had been under consideration since 1918. Situated near Waipukurau, in the Hawkes Bay District, in an ideal climate, and on a hill named by the Defence Department "Puke Ora," the hill of health, the institution was opened late in 1919, and command was taken by Major H. Short, O.B.E., one of the officers specially trained in England for this important work. About 130 beds were available, of which the greater part in individual shelters, but additions were in progress and it was not until 1920 that the institution was fully developed. Similarly in the South Island, a Military Annexe to the existing civil sanatorium at Cashmere Hills, near Christchurch, had been provided where Major Aitken, M.C., N.Z.M.C., also a trained specialist, took command. By January, 1920, the number of soldiers of the N.Z.E.F., who had been returned to New Zealand with a diagnosis of Pulmonary Tuberculosis, positive or suspect, was 987; of these, 504 had received treatment in sanatoria, while 483 had been discharged. It had been found that a high proportion of the soldiers returning from England with the diagnosis P.T.B. had so improved by the sea voyage as to present neither symptoms nor physical signs of disease on arrival, and the fact that so many had not required treatment suggested the probability that the original condition was not tubercular. On the other hand 25 per cent, of the cases designated C.P.D.I. presented signs of tubercular infection of the page 513lung and were drafted to the military sanatoria where there was ample accommodation for all suitable cases. The advanced cases were treated in other hospitals or shelters at their own homes, while the Repatriation Department undertook the after care of the convalescents at a special farm colony where training could he acquired in outdoor occupations suitable to this class of invalid. No problem was more beset with difficulties than this, the repatriation of tubercular soldiers; the chief difficulty—not appreciated by the layman—being diagnosis.

At the Chalmers Military Hospital, Colonel Wylie was thoroughly established early in 1919. All orthopædic departments were well organised and indeed served as a model for the other similar institutions. At Timaru, South of Christchurch, a small military hospital was established in 1919, under the command of Major Ulrich, N.Z.M.C. At this centre, military orthopædic work was developed by the commandant, who had in 1917 been chief of the Surgical Division of the New Zealand Stationary Hospital, and Major Unwin, N.Z.M.C., who held a similar appointment at No. 2 N.Z.G.H., Walton. At Dunedin Hospital, during 1919, the military wards acquired a greater degree of efficiency on the arrival of the New Zealand Section of the "Jaw" Hospital, Sidcup, under Major Pickerill and his assistants, and the attachment to the staff of Major Renfrew White, N.Z.M.C., late of the R.A.M.C., a graduate of Otago University, whose, post graduate training in England had been orthopædic surgery. Under these officers a military surgical unit, with a full range of orthopædic departments, was organised, capable of undertaking all classes of reconstructive work.

On the medical side, as we have noted, the tubercular soldier and the "neurological" type had been provided for. As a further development a convalescent camp was established at Narow Neck, Auckland, whereto many doubtful cases of lung infection and D.A.H. were drafted. This unit, under the command of Lieut.-Col Maxwell Ramsay, N.Z.M.C., was visited periodically by the Tuberculosis specialist, Major H. Short, N.Z.M.C., and a final disposal of this troublesome class was ultimately made. Many of the D.A.H. cases passing to Trentham were disposed of to Hanmer after close investigation. Lieut.-Col. Fenwick, N.Z.M.C., was appointed Consulting Physician to Trentham in 1920. The Medical Division then was organised by Major G. H. Robertson, N.Z.M.C., who had specialised in cardiology in England, To this Division all cases of D.A.H. and war neurosis were sent from the page 514North Island and very large numbers drafted thence to Hanmer for psycho-therapy, or otherwise disposed of. The Medical Division at Trentham became a diagnostic centre and in a sense filled the place of the special Boards in England. Periodical visits by the tuberculosis specialist ensured adequate co-ordination of the work of sorting the doubtful chest conditions and selecting eases for sanatorium treatment. In June, 1919, the number of service patients under treatment was 4,831, of these, 1890 were in-patients, but by May, 1920, the number had fallen to 3,057, a reduction chiefly noticeable amongst the out-patients. The number of returned soldiers at this time hospitalised was 1,581. The outpatients were provided for in the large centres by garrison dispensaries and massage departments associated with the office of the Command A.D.M.S., and in the provincial towns by the local hospitals, many of which had returned N.Z.M.C. officers on the staff.

Final demobilisation of the N.Z.M.C. was practically completed by the 30th April, 1920, but the medical personnel retained by the Defence Department was transferred to a new formation, the New Zealand Army Medical Department, drawing the same rates of pay as existed in the N.Z.E.F. with which almost all the medical officers retained and nearly 50 per cent, of the N.C.O.'s and men had served overseas. The Department in 1920 numbered 40 officers, 8 commissioned quartermasters or other non-medical officers, 459 N.C.O.'s and other ranks, 210 N.Z.AN.S., or 900 in all—including male and female assistants.

In the process of reconstruction we are now chiefly concerned with the military hospitals alone, which from 1920 onwards were: King George V., Rotorua, with 300 beds; Trentham Military Hospital, 500 beds; the two Military Sanatoria at Pukeroa and Cashmere Hills; the Neurological Centre at Hanmer; and the Convalescent Camp at Narrow Neck, Auckland. The Civil j Hospitals at Dunedin, Timaru and Christchurch absorbed the military staffs in 1920, and developed their civil orthopædic work; there was ample material as a serious outbreak of poliomyelitis in 1916 had left us many crippled children for the full treatment of whose deformities there had been up till now no adequate provision. At Wellington Hospital, which had closed its Victoria Military Ward when Trentham was organised in 1919, there was as yet no provision for establishing an orthopædic division. With the gradual disposal of ex-service patients, the two military hospitals opened their wards to civilians, children mostly. King George V. Hospital had soon over 100 beds occupied by crippled page 515children and Trentham Hospital provided for similar patients in the Wellington district. The association of the crippled children with the disabled soldiers proved a very happy one, helpful to morale, promoting discipline, but above all a stimulus for the orthopædic teams already surfeited with the military reconstructive work and not a little despondent at the results attending their efforts, which in 1918, in the first vehemence of orthopædic ardour, had promised such splendid achievements. The crippled child, an emotional problem, and one offering an altering promise of better and speedier results, did much to energise the war weary workers. In stimulating interest in civilian orthopædic work, 'Colonel Wylie, who on demobilisation, was appointed Director, division of hospitals in the Public Health Department was a principal mover, and his zeal in reorganising the civilian hospitals and furthering their development were everywhere productive of progress.

In the work of medical reconstruction, the voluntary aid societies and patriotic bodies gave valued assistance. The Red Cross Society, ever indefatigable in its activities, on behalf of disabled soldiers, assisted in the hospitals, the sanatoria, and convalescent homes in providing recreation rooms and a wealth of comforts for the patients. No less active in peace than in the field, the New Zealand Y.M.C.A. supervised the picture theatres, and institutes attached to the hospitals, which did so much to relieve the tedium of prolonged orthopædic treatment. And, again, the Salvation Army gave willing help in a like manner. The district patriotic bodies were ever ready to relieve the temporary hardships that beset the disabled soldier in his transition from convalescence to civil employment; and on the concerted efforts of these bodies aided by the vocational training staffs and the Repatriation Department, much of the success of the work was dependent.

A gradual dispersal of the medical personnel of the N.Z.A.M.D. proceeded in step with the reduction in the number of ex-service patients under treatment. At the close of the military year in June, 1922, the total number of in-patients was 920; while the out-patients numbered 756; or 1,676 ex-service patients in all During the year the following military medical institutions had been handed over to the Department of Health: Pukeroa Sanatorium, on 13st July, 1921; King George V. Hospital, 20th October, 1921; Queen Mary's Hospital, 19th January, 1922; Trentham Military Hospital, 31st March, 1922; Cashmere Hills Sanatorium, 31st May, 1922. The treatment of out-patients at page 516the garrison dispensaries, previously controlled by the A.D.'sM.S, was now undertaken by the civil hospitals. Trentham Hospital was finally closed at the end of 1922. The Wellington Hospital organised an orthopædic division, took over the few remaining civil and military patients, and absorbed a proportion of the Trentham staff and equipment. Already several of the medical officers, who were part time at Trentham, were on the staff as honourary surgeons and physicians at the Wellington Hospital so that there was no lack of continuity of policy and direction in the work of reconstruction. The two military sanatoria became civil institutions, their staffs being absorbed into the Public Health Service, and the same course followed in the case of King George V. Hospital and Queen Mary's Hospital which became the first civil institution established in New Zealand for the treatment of functional nervous diseases.

At each of the four centres, homes were established for very chronic or incurable ex-service patients. The Evelyn Firth Home at Auckland; the Rannerdale Home at Christchurch, and the Montecillo Home at Dunedin, each controlled by the D.G.M.S. subsidised by the Defence Department but administered and aided by the Red Cross Society. At Trentham the small cottage hospital with 20 beds remained open as the Red Cross Home pending transfer of patients to a new site in Wellington. Surgical treatment was provided by the local civil hospitals and the surroundings and amenities of the homes were made attractive and agreeable by the known zeal and generosity of the Red Cross Society.

The workshops for the manufacture of artificial limbs and surgical appliances which had been established by the Defence Department at Dunedin, Christchurch and Auckland, were handed over to private firms constituted by returned soldiers who, in the. majority of cases, were limbless men specially trained under the vocational schemes, or, in the case of the splint shops, to the respective Hospital Boards. At Wellington the artificial limb factory remained under the control of the Defence Department The Military Medical Stores branch, under Major Gibbs, continued to supply not only the military wants but the requirements of various Government departments and many of the civil hospitals.

Finally arrangements were made and became effective in July, 1922, whereby the medical treatment, and the other medical activities in relation to service patients should be carried out by the Pensions Department so that co-ordination of medical treatment and pensioning might be more completely and economically page 517effected. The D.G.M.S., Major General Sir Donald McGavin, C.M.G., D.S-.0., in addition to his military duties, was appointed Medical Administrator of War Pensions, so ensuring continuity in administration and freeing the Defence Department from all farther responsibility with regard to ex-soldiers.

So, in one way or another, the N.Z.M.C. officers were repatriated: many returned to private practice; some took up whole or part time service with the Pensions or the Public Health Departments or other medical branches of the Civil Service; a few became superintendents of civil hospitals; many were attached to the staffs of these hospitals and continue to supervise the after care of disabled soldiers. In the organisation of the New Zealand Medical Services for the Great War, able help had been given by the civil medical officers of other departments of the State, by the hospital boards and their hard worked staffs, and by the civilian practitioners recruited into or co-operating with the Army Medical Department. How, in a measure, these services were repaid I have attempted to show. Each trained medical officer of the N.Z.E.F. brought back with him from overseas some special knowledge or skill which was of immediate avail to the civil population and so the profitable lessons taught by the war became a powerful uplift to the civilian medical organisations of the Dominion. Not alone the officers of the N.Z.M.C. but the rank and file also played an important part in the after war medical reorganisation, as radiographers, laboratory assistants, male nurses, masseurs, and as employees of the civil hospitals or the state departments engaged in medical work.

Of the N. C. O.'s and men of the N.Z.M.C. who served in the Great War much more could have been written that is honourable and worthy of all praise: of their devotion to duty in the field, at the bases, at sea in the hospital ships, and in New Zealand. Of their individual brave deeds but little has been reported—I think they would have it so. But this at least must be said: whatever praise the New Zealand Medical Services may have won in the Great War was, in greater part, earned by the soldierly conduct of the non-commissioned officers and the men of our Corps.

Of our comrades who are dead, whose names are here inscribed, those killed in the field or by disease, our common foeman, it is our hope that their sacrifice may shine forth if but dimly in this book, for those who coming after—perhaps engaged in a like adventure—may read this, their faltering epitaph.

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