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War Surgery and Medicine

Observations in a Base Hospital

Observations in a Base Hospital

In October 1941 Colonel Spencer, CO 2 NZ General Hospital furnished a long and thorough report on anxiety neurosis based on a year's experience at the base hospital. Recognising that a large number of men had become psychiatric casualties before ever they came under enemy action, he had endeavoured to assess the nervous and physical make-up of a large number of soldiers regraded for return to New Zealand. One problem he dealt with, amongst others, was the association of nervous symptoms with organic abnormalities. In the Army the chronic neurotic revealed himself by his constant attendance at the medical inspection room on account of his recurrent headache, backache, painful feet, gastric complaints, and other psychosomatic symptoms. He was tense and over-anxious and did not concentrate on his work on account of his preoccupation with his disabilities.

Men complained of minor organic malformations such as foot deformities and varicose veins, which were normally ignored in civilian life. The man's mental attitude was the deciding factor in the disability. The condition was fastened on as a way of escape from the danger and boredom of army life and it was difficult page 634 to deny some disability. It was wrong policy for an MO to draw attention to any presumed abnormality of the feet.

Men played on past illnesses. A common illustration was the persistent headache complained of by men with a previous head injury (often many years before), sometimes associated with concussion. In most cases the man had carried on with his civil occupation. The cases proved an encumbrance and were best sent to New Zealand for Home Service.

In relation to old operative scars, symptoms complained of could not be assessed and the scars acted as an excuse to the soldier. In dyspepsia an underlying nervous factor was very frequently present. When ulcer was suggested to the patient it was difficult to effect any improvement.

It was recommended that constant reminders should be given to medical officers that all suggestion to soldiers parading sick must be positive, i.e., towards feeling well; and that they should rarely be given a diagnosis, or peg, on which symptoms could be hung and added to until a full-grown complex was evolved, which meant down-grading or invaliding.