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War Surgery and Medicine

Experiences in British Army in United Kingdom 1

Experiences in British Army in United Kingdom 1

A statistical review of cases of hernia in the British Army in the United Kingdom from mid-1943 to mid-1944 has disclosed much of interest which is partly comparable to 2 NZEF experience. In terms of man wastage among males, hernia contributed more to hospitalisation in the army in the United Kingdom than any other single diagnostic category, and indeed more than the entire class of psychiatric disorders. In addition, refusal of operation entailed wastage of manpower in the higher categories as these men had to be down-graded. In the one year there were 6874 first hernia operations and 846 operations for recurrence, an annual rate of 5 per 1000 strength. The period in hospital was protracted, the mean stay in hospital and convalescent depot being three months. Practically all cases were returned to full duty. The relative incidence of operation at different ages varied little, but the incidence of discharge increased with advancing age and very steeply in the terminal age groups.

The relative incidence of the different types of hernia was indirect 86; direct 10; femoral 4.

Recurrences were much more common following simple removal of the sac and less frequent following repair by fascia. A majority page 414 of the recurrences following indirect hernia were still indirect and resulted from failure to excise the sac, and more commonly followed the simpler form of operation. The majority of the recurrences occurred within one year.

The final conclusion arrived at by the reviewers was that ‘(a) after about one out of every eight primary operations the original condition reappears within twelve months; (b) the overwhelming majority of such recurrent cases are the result of an operation for the performance of which a relatively modest level of professional skill is perhaps too commonly deemed to suffice.’

The review throws valuable light on the problem. It confirms our New Zealand experience in the Middle East that operation in suitable cases can be relied on to make a man fit for front-line duty. The opinion is also given that many recurrences are due to inability to find, or satisfactorily deal with, the sac—a sign of poor and inexpert surgery.

The 2 NZEF period of three months before return to full duty following operation is also shown to have been the standard in the United Kingdom. Multiple recurrences were shown to be fairly common. This upholds the 2 NZEF routine of grading and invaliding such men, generally in the older age group, instead of subjecting them to operation, thus enabling their manpower to be better utilised and saving hospital accommodation overseas.