Medical Services in New Zealand and The Pacific
V: The Health of the Royal New Zealand Navy
V: The Health of the Royal New Zealand Navy
Although it is realised that the value of such information is limited owing to the small size of the RNZN, some of the more important items of vital statistics are necessary for any historical record. Special mention must also be made of some of the conditions met with in naval medical practice which are liable to reduce the efficiency of units, and those which result in serious loss to the service from permanent invaliding.
The material from which this data is compiled includes the quarterly journals and sickness tables rendered by each ship and shore establishment of the RNZN, which provide a complete picture, as far as those units are concerned, of all sickness and injury, both major and minor. In respect of those New Zealand personnel who served with the Royal Navy, information is lacking with regard to minor conditions but is complete as a record of casualties, hospitalisation, invaliding, and condition on demobilisation.
Including those whose service was for the most part with the Royal Navy, some 12,000 officers and ratings served in the Royal New Zealand Navy for varying periods from September 1939 to December 1946, during which time the strength rose from a peacetime figure of 1359 to a peak of 10,040, falling again to 1834 at the completion of demobilisation. It is customary in the Royal Navy to present statistical matter in the terms of incidence per thousand per annum of the serving strength, but on account of the small size of the force and the great variation in annual strength through these war years, it has been thought desirable after consultation with officers of the Census and Statistics Department to base New Zealand calculations on the mean annual strength for the whole period, a figure of 6157.
Deaths from all causes totalled 672 and comprise three main groups:
Losses from enemy action include killed in action, died of wounds, missing (presumed killed), and killed in air raids. This figure includes 151 lost in HMS Neptune and a very considerable number page 183 of Fleet Air Arm officers and ratings lost on operational sorties in various theatres of war. The accidental deaths also include a number of flying accidents during training and on non-operational flights.
The low incidence of deaths from sickness, 53 cases or 1·23 per thousand per annum, is noteworthy. Bearing in mind that it includes nine who died in Japanese hands as prisoners of war and all personnel dying in civil hospitals while still on service pay, and that some of the deaths occurred in men of older age groups than are usually employed on naval service, it can be regarded with considerable satisfaction, and compares very favourably with Royal Navy rates for a typical peacetime year, 1·4 per thousand in 1926.
The actual causes of death in these 53 cases are listed as under:
|Dysentery and enteritis||3|
|Coronary disease and other heart disorders||7|
|Cerebral vascular disease and other brain disorders||7|
|Intestinal obstruction, peritonitis, etc.||5|
|PWs in Japanese hands, full details not available||9|
|Wounds and injuries as result of enemy action||92|
Invaliding from the Navy
An important source of information as to naval health and fitness is provided by the records of invaliding. In peacetime everyone employed in naval service was expected to be fit for sea service in any part of the world. Any individual who fell permanently below this standard by reason of injury or disease was promptly invalided out of the service after examination and assessment by a medical board of survey. In the Royal Navy, for example, the invaliding rate in 1935 was 10–8 per thousand. A study of invaliding figures is of some importance, providing one means of assessing the suitability of those who have been entered, and indicating not only a permanent loss to the service from medical causes but a potential continued expense to the State by way of disability pensions.page 184
In war a somewhat different criterion may be applied to invaliding. Useful employment in shore establishments or in specified limited duties may still be available for trained men who have developed certain defects. Nevertheless, the invaliding rate in war can be expected to be very much higher than in peace, first, in consequence of increased injuries and accidents, and the effects of strain and lowered living conditions and, second, because the manning situation demands relaxed standards of entry and the extension of age limits beyond those of normal retirement. Such was the British experience in the First World War when the invaliding rate for the Royal Navy rose from 13 per thousand in 1913 to an average of 24 per thousand throughout the war years, falling again to previous levels with a return to peace.
From the outbreak of war until the end of 1946, by which time demobilisation was practically complete, 762 cases were invalided out of the RNZN, representing an approximate annual rate over the period of 17·7 per thousand. This figure covers all New Zealand naval personnel whether serving in New Zealand ships or with the Royal Navy, as all cases from the latter group were returned to New Zealand for final disposal. It also includes a small number of Royal Navy personnel whose invaliding was effected in New Zealand while serving on loan.
The principal causes of invaliding, some of which will later be discussed in detail, were:
|Neuro-psychiatric and mental disorders||182|
|Wounds and injuries||75|
|Gastric and duodenal ulcer||48|
|Miscellaneous general diseases and disabilities||343|
With regard to the last group, little comment is necessary. It represents examples of a wide variety of conditions, in effect the incapacitating disorders which might be expected in any large group of the population of similar age groups over a period of years. In none of them is the incidence of sufficient magnitude to suggest any particular relation to naval life. Some of them are conditions of relatively minor importance in civil life but necessitating invaliding because of reduced service efficiency. Others, such as the five cases of diabetes and seven of nephritis, were invalided in their own interests because they required a more sheltered life than the service could offer. Physical deterioration in older men is responsible for some of the cases. While there was a general upper age limit of 55 page 185 years for naval service, a number of experienced naval pensioners, retired officers and merchant seamen were employed in special duties up to the age of 65. Many of them served throughout the war, but the later years saw an increasing number invalided. In this group fall most of the cases of chronic bronchitis, myocardial degeneration, coronary disease, cerebro-vascular disease, osteo-arthritis and malignant neoplasms. Although forming only a small proportion of the total invalidings, these cases represent a section which is not encountered in the Navy in peacetime. Unsuitable entry accounts for a very small proportion of invalidings despite the fact that the only means of obtaining the discharge of those who could not stand up to the test of training, or who were found to have made false or misleading statements as to previous health, was by the full machinery of an invaliding survey. Such cases included epilepsy, asthma, eneuresis and some of the minor foot disabilities.
Various diseases of the eye, including the development of visual defects, were responsible for thirty-eight invalidings, while among the rare or unusual conditions may be mentioned single cases of actinomycosis of the lung, pancreatic cyst, sleep-walking and narcolepsy. Sea-sickness, though by no means uncommon and sometimes requiring drafting to specially selected employment, necessitated invaliding in one individual.