War Surgery and Medicine
Recommendations for Future Management
Recommendations for Future Management
Selection of Recruits: The utilisation of a psychiatrist for the medical boarding of recruits has been held to be impracticable and is probably undesirable. Some simple intelligence test is, however, desirable to eliminate the most dull and backward. This type made unsatisfactory soldiers as they gave considerable trouble and were very liable to be absent without leave, both at the Base and in the forward areas. The Pulheems system of boarding should help in this regard.
In camps the junior combatant officers and the RMO should evaluate the recruits and so discover any who are mentally inadequate. A check should also be made with records of the Division of Mental Hygiene of the Health Department to see that no psychiatric cases are accepted for the services.
The Psychiatrist: This specialist could be usefully employed as a consultant in the mobilisation camps in New Zealand to examine and report on any doubtful cases. He would also be of great value overseas in the same consultant capacity, both in the forward areas and at the base camps and hospitals.
Base Camps in New Zealand: Here the mentally abnormal and backward should be eliminated from Grade A units and utilised in labour groups or in other corps in conformity with their capacity. At the same time every effort should be made to counteract the influence of boredom and separation from home conditions which have such a deleterious effect on those constitutionally liable to anxiety states. Work should be made as interesting as possible and many other interests and recreations provided. The man should be made to feel responsible for the good of his camp and his unit.
Overseas: Morale and interest and activity must always be promoted as well as discipline and smartness. The soldier must be kept interested and informed concerning events and made to feel an important cog in the wheel.
The majority of the cases of anxiety neurosis at first arose at the Base, but later most were due to battle stress. Prevention is the page 654 best approach to the problem. This entails constant effort to keep men occupied and interested in useful work and the provision of healthy forms of recreation.
Repatriation should be arranged for all cases proving useless to the force and not reacting favourably to treatment.
The cases arising in the forward areas, many of which will be cases of physical and nervous exhaustion, demand different treatment. They should be treated in the first instance in the forward areas at the Field Ambulance level, thus retaining contact with their normal atmosphere and units. Sometimes a very short rest in an ADS will be sufficient, but normally these cases should be treated in a Divisional Rest Station set up by one Field Ambulance not otherwise actively employed. A psychiatrist could be stationed here during active periods so as to be available for the treatment of the cases and to give advice to the unit.
It is of the utmost importance that the cases should not be evacuated to the base hospitals unless they are considered to be of no further use as combatant troops. They should be rested and reassured and returned to their own unit and their own comrades. In the case of men with long service in the forward areas a transfer to base work, or even repatriation, may be advisable. This is especially applicable to Maori troops, who are normally unfitted for base duties especially after serving in combatant units for some time.
The treatment given at a Divisional Rest Station should consist essentially in rest and sedation. Adequate dosage of sedatives must be given to ensure sleep, but prolonged sedation was not found advisable. Narco-synthesis or the re-enacting of the experiences under sedatives was not held to be desirable in these cases. Patient discussion and explanation by the RMO, the medical officers at the Rest Centres or the psychiatrist, is held to be both preferable and sufficient. Dehydration should be counteracted and the diet should be liberal and appetising. A seaside location with swimming is ideal if climatic conditions are suitable. The mild cases should be ready for return to their units in less than a week.
From observation of convalescents with psychiatric disability passing through Base Reception and Convalescent Depots over a number of years, Major Blake Palmer is firmly convinced that provision should be made for a Psychiatric Unit with any future expeditionary force. This could be done in one of two ways:
By the formation of a Psychiatric Wing attached to the forward General Hospital. The unit could be modelled on those operating with 2 British General Hospital at Tripoli or 8 British page 655 General Hospital at Barletta. Such a New Zealand Psychiatric Wing should be so organised as to permit of a mobile team comprising one trained psychiatric medical officer, an NZMC assistant, and nursing personnel whose NCOs should preferably have state psychiatric nursing registration and rank appropriate to this qualification—on the analogy of the Sister with state general nursing registration or the physiotherapist. Minimum rank for such qualified nursing personnel should be staff-sergeant. This mobile team could be attached for service with Casualty Clearing Station, or could work in exceptional circumstances at a Divisional Rest Centre organised by a Field Ambulance.
A separate unit could be formed analogous to the Field Surgical Unit, Blood Transfusion Unit or VD Treatment Centre. There is much to be said in favour of the independent unit. It is indeed the method of choice. When working with a General Hospital the Psychiatrist, as CO of a unit, can better represent the special requirements of his organisation, which do not invariably find a ready acceptance as they differ from those of the Medical Division in many respects.