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War Surgery and Medicine

Second World War

Second World War

The original code of instructions for medical boards laid down the following regarding the acceptance of recruits:

Hernia (Inguinal): No case however slight, should be accepted for Grade I, even if well retained by a truss; if bilateral and not large and controlled by a truss, the man may be put in Grade II. If the hernia, either single or double, is large with patulous rings, but is retained by a truss, the man must be placed in a grade below the first, the precise grade being determined by a consideration of his general physical condition. If the hernia is irreducible, the man must be placed in Grade IV. Four months is the minimum interval after operation before a man may be placed in Grade I.

Hernia was the fifth most common disability (5 per cent) in all men graded II, III, or IV at their initial medical examinations in 1942 and 1943, when older men were in the majority among those examined. Of those called up for service, 1·62 per cent could not be placed in Grade I because of hernia.

When remedial treatment for minor surgical conditions was arranged in September 1940, hernia was definitely excluded from the list of conditions for which operation was authorised. Remedial treatment could only be given to cases which could be rendered fit for training in one month. The period of four months had been laid down as the minimum between operation for hernia and full duty. Suggestions were made by regional deputies that the period of one month be extended and that treatment for hernia should be included in the list, but the DGMS firmly adhered to his opinion that men with hernia should not be given remedial treatment to fit them for service.

In June 1943 all the Regional Deputies were asked their opinion with regard to the fitness of men with hernia for duty in camp or in page 407 the Home Guard. Nearly all the replies were to the effect that men who carried out their civil occupations without any trouble, particularly if this entailed physical work, were fit for duty both in camp and in the Home Guard. It was only the sedentary workers with particularly large hernias who would be unsuitable for these duties. It was pointed out that the number of otherwise fit and healthy men with hernia was surprisingly great, and many of them did strenuous labouring work without complaint.

The necessity for regulating the physical work required in the Home Guard was stressed, and it was pointed out that many men not fit for any strenuous physical work would be employed on lighter duties and they could be so graded by the Regional Deputies. The army authorities, however, for some inexplicable reason, had instructed that no differentiation was allowable.

It would seem that the ideal solution would have been to have given the Regional Deputies the power to determine whether these men were fit for duty in camp and in the Home Guard, and in certain cases sedentary work could have been stipulated. The Pulheems system, properly applied, would readily solve all difficulties.

Hernia is a common disability, and if all men, otherwise young and fit, are automatically excluded from the army, except as graded men, it means a definite limitation of manpower for the army. The three months' treatment needed to make a hernia case fit for active service would seem to be justified in a prolonged war, provided the operation is restricted to cases likely to be Grade I and not likely to recur. There would seem to be no justification for operation on men in the older age groups or on those with feeble abdominal musculature.