War Surgery and Medicine
Later Experiences in 2 NZEF
Later Experiences in 2 NZEF
The problem as seen by the Board of Inquiry was one solely associated with the reactions to change of environment and mode of life. When the Division was involved in actual combat other factors came into play, associated with the stresses and strains of bombing, shellfire, and exhaustion.page 635
At a conference of New Zealand medical officers in August 1943 Major Caughey summed up the position: predisposing factors were a lowering of individual morale (noise, near-escapes, and anything lowering resistance, such as infective hepatitis, dysentery, and desert sores), or a lowering of group morale. In this latter regard the progress of the campaign was all-important. In the static period at Alamein cases were numerous, but after the breakthrough there was a progressive decrease in incidence.
In July 1942, during the hard fighting at and after Minqar Qaim and Ruweisat, the psychiatric casualties were 334. In August and September, when the Alamein Line was being held in the heat of summer with the added trial of flies, the numbers were 155 and 66. In October, with the added stress of the Battle of Alamein, the number rose to 106, but fell rapidly during the victorious advance from 57 to 25 a month till with the Mareth battle it rose again to 134. In May and June there were sharp drops to 27 and 8 respectively. The 4th Field Ambulance, in 3000 battle casualties passing through the unit from June to October 1942, had 300 nervous cases, 10 per cent of the total.
Confidence in the higher command and in equipment lowered the incidence of neuroses. Unit morale depended on the CO and the MO to a surprising extent. Age and rank were found not to have any significance. Length of service was of some importance, and prolonged service in the forward area tended to lower the resistance to psychoneurotic illness. In this regard it was of importance for the RMO to ensure that men showing any early signs of neurosis, such as slight changes in personality and behaviour, minor psychosomatic illness or loss of weight, should be rested and given leave from the forward areas.
Major J. Russell stated that 5 per cent was the average figure for psychiatric casualties, and this was the figure for the Division during the North African campaign in 1942–43, over half the cases arising during the withdrawal to Alamein in the first two months. There were great unit differences, sometimes depending on the MO or the CO being taken prisoner, killed or lost. (Of seven battalions equally engaged from 26 October to 30 November 1942, the incidence of nervous breakdown varied as follows: 24, 23, 0, 8, 22, 16, 12.) If a unit got a bad name there was a great collapse of morale, evidenced by frequent desertions and rise of nervous disorders.
Every individual has his eventual breaking point, and continued battle stress produced both physical and mental exhaustion. In the Tunisian campaign in April 1943, of 400 battle casualties 40 per cent were nervous disorder cases (NYDNs). The types seen page 636 included those with panic state occurring usually during battles, those with somatic symptoms as well, e.g., gastric symptoms; but a number were cases of pure physical exhaustion, just ‘done in’, with no nervous system involvement.
A survey at 3 NZ General Hospital at Tripoli, covering the period of six weeks ended 31 May 1943, showed that neurotic casualties totalled 72, while wounded admitted to the hospital numbered 478. Most of the nervous cases were of anxiety neurosis; half the admissions had long service of two to three and a half years. In these long-service men a gradual deterioration had been noted, with several diverse factors as causes. The precipitating factor in one group of twelve was a period of forty-eight hours' constant shelling.
As regards disposal, 10 of the 11 physical exhaustion cases were returned to their units; of the remaining 61, 22 were returned to their units, 3 were boarded for New Zealand, 36 were graded for base duties. The men suffering from physical or nervous exhaustion in the forward areas usually reacted more favourably to treatment because of their more stable personalities.
The Maori Battalion had the excellent custom for a man in his first battles to be closely attached to experienced campaigners to give him confidence, and it had a proud record, but by the end of the North African campaign some of the men of the unit, and of other units, had become exhausted.
In August 1943 a special board was set up to examine 22 Maori soldiers of 28 Battalion, the board having as its chairman Major Russell, consultant psychiatrist to 2 NZEF. Of the cases:
One man was so mentally dull and backward that his return to New Zealand was recommended.
Two men with least service had been nervous in action, the first after severe bombing on his first day, and the other after wounding.
Nineteen cases had experienced strenuous service, 11 having been through Greece and Crete. Quite a number had been wounded on at least two occasions, one man three times, and some had nervous incapacities remaining. They had all been good soldiers, but had eventually broken down. All were worried and were mentally and physically tired and certain of their inability to go into action again. Emotional incidents played a part in some cases, but extended strenuous service was the main cause in all. They all required boarding and an extended period of rest.
In the Italian campaign no fresh problems arose, but the majority of cases were due to nervous and physical exhaustion. The incidence varied considerably according to the stress and, particularly, page 637 according to the morale and success of the campaign. As at the time of the breakthrough by the enemy to El Alamein in 1942, the period in Italy in early 1944 after the remnants of the first three echelons had returned from furlough was the second occasion when the morale of the Division was below its usual high level, and a noticeable temporary increase in the incidence of neurosis occurred. It has also, of course, to be appreciated that the fighting at these periods was also the most severe. The ADMS 2 NZ Division, Colonel R. King, took a keen interest in the problem and encouraged his RMOs in the weeding-out of personnel and in the resting of soldiers showing signs of exhaustion.
Prevention was of the utmost importance, and the RMO was in the key position in this regard. While his battalion was at the Base it was his duty to comb through his men and eradicate all those who were obviously constitutionally unfitted to be fighting soldiers. This culling was necessary at all times and could be readily carried out in the quieter intervals. Opportunities for holding neurosis cases in battle were very small, either in advance or in retreat, but it was advised that in static periods such casualties be held at least for a day or two, treated by the RMO with sedatives and rest, then assessed. Questions to be considered were: Is the soldier going to be of use in forward areas again? Will his presence affect unit morale? Is he in a constitutional group predisposed to neurosis? It was advised that reasons for sending a soldier back from his unit should be recorded, giving the opinion of the MO and CO as to whether the man would be of further service in a forward area.