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War Surgery and Medicine

War Pensions Survey

War Pensions Survey

A survey was made in May 1952 of the records of all ex-servicemen who had applied for pension or had been graded below Grade I on discharge, and including those in whom hernia was diagnosed at discharge, although the man himself may have had no prior knowledge of any abnormality and certainly of no disability. In all there were 562 cases, including those whose hernia had been repaired but who complained of minor symptoms. The records available for these cases revealed that there were 666 herniations in men whose theatres of service were:

Overseas New Zealand
Army—2NZEF MEF and CMF 261 186
2 NZEF IP 84
Navy 22 4
Air Force 46 63
—— ——
413 253

Of the 261 men with service in 2 NZEF MEF the herniations were: (a) present before going overseas, 14; (b) operated on prior to enlistment with recurrence overseas, 18; (c) originated overseas, 154; (d) discovered on discharge in New Zealand, 65; page 415 (e) occurred after discharge, 10. An actual herniation was not present in all the cases in groups (a), (b), and (c)—some men who had been operated on successfully complained of minor symptoms.

The types of hernia noted in these men were: inguinal hernia—right, 85; left, 64; bilateral, 78 (i.e., 39 men); femoral, 8; incisional, 12; umbilical, 6; epigastric, 7; diaphragmatic, 1.

The 227 cases of inguinal hernia were dealt with as follows:

No operation (hernia persists) 60
Operated in MEF 41 25
Operated in UK 8 4
Operated in Germany 11 7
Operated in NZ 107 17
227 53

Of the recurrences 35 were repaired satisfactorily, mostly with one operation, but 18 were unrelieved, four of whom had one further operation, and one had four further operations.

Of the 25 recurrences from MEF, 2 were repaired satisfactorily in the Middle East and the majority of the remaining 23 in New Zealand. The 23 cases represented about 3 per cent of the 725 cases dealt with in 2 NZEF in the Middle East, a very satisfactory result which can be attributed to a wise selection of cases for operation, and also to adequate surgery. Of the 725 cases, only 41 were graded below Grade I on discharge.

A total of 84 cases was recorded from the Pacific Force, to which some Grade II men were sent and from which relatively more men were invalided to New Zealand.

A total of 186 hernias were recorded in homeservicemen, and of these 49 were present on enlistment; 14 recurred after a pre-service operation; 110 developed during service; 12 were discovered at discharge; and 1 developed after discharge. Some 104 were operated on, with 32 recurrences, of which 12 remained unrepaired, 7 after one, 3 after two, and 2 after three operations. The recurrence rate was thus 30 per cent, and 11 per cent of the total cases were eventually unrelieved. The poorer results naturally arose from the higher age groups and lower-graded men who composed the Home Service force. The 135 men who had served overseas, but who had their only operative treatment subsequently in New Zealand, had 26 recurrences (only 20 per cent), and only 7 (5 per cent) were finally unrelieved. Altogether the results appear satisfactory, though in some cases several operations were required, with a consequently long period of recovery from disability. The overall picture is, firstly, of the rejection by the page 416 army of nearly 2 per cent of recruits because of the presence of hernia; secondly, that of the men sent overseas 1 per cent developed hernia, of whom the majority were operated on with success so that they continued to serve overseas, as also did many who were graded without receiving any operative treatment. Only a very small number were invalided back to New Zealand because of hernia, and most of these had other disabilities or were in the oldest age group. Operation overseas was largely restricted to younger men with good musculature, the older men being graded for lighter work, generally at the Base. This resulted finally in only 3 per cent of the operated cases showing up as recurrences on arrival back in New Zealand. This was in contrast to overseas cases first operated on after their return to New Zealand when 20 per cent had an initial recurrence, but of whom only 5 per cent remained unsatisfactory after further operation. In all primary operations in New Zealand (201 cases) the recurrence rate was 19 per cent, while in the 342 cases operated on in 2 NZEF MEF to March 1943 the recurrence rate was under 6 per cent.

Of the 163 hernias occurring in all services where the interval times between operation and recurrence were given, 77 recurred within one year, 31 within two years, 13 within three years, and 42 after three years. There was only an odd case of recurrence after eight years.

The position in 1952 with the 531 herniations in army cases coming in the purview of the War Pensions Boards was that 351 had been operated on, and of these, 104 had had recurrences, which were all repaired except for 33. Many of the 33 declined further surgery after the first operation. Hernia was still present in 180 cases which had not been operated on.

Of all cases, relieved and unrelieved, only 46 (18 from the Middle East and 21 homeservicemen among them) were receiving a pension in 1952, and of these, 36 were receiving 20 per cent or under. Some of the pensions were for weak or painful scars, and only one was for atrophied testis. The final pension liability is remarkably low, and shows that the army can use men with the abnormality of hernia without the State eventually being required to pay any large amount in pensions.