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War Surgery and Medicine

CHAPTER 23 — Health of Maoris in 2 NZEF

page 734

Health of Maoris in 2 NZEF

IN certain features of the health of Maoris under active service conditions definite comparisons can be made with the European section of 2 NZEF serving under the same conditions.

The susceptibility of the Maori to tuberculosis is well known and this was the cause of rejection of a large number of recruits for the Maori Battalion. A report by the battalion's first RMO, Major W. B. Fisher, on the period 24 January to 1 May 1940, when the battalion was in camp at Palmerston North showgrounds, states that a total of 725 men had X-ray examination of the chest, of whom 120 were medically boarded down to Grades II, III, and IV and discharged. Of 140 men marched in as replacements, 60 were discharged as medically unfit.

The same report also states that a routine inspection of the men's feet on admission to camp revealed that 80 per cent had tinea and a large number had corns and callouses. It was noticed that most Maoris had flat feet and were very wide across the heads of the metatarsals, with a definite tendency to bunion formation of the big toe as well as a similar condition of the little toe, with the result that corns readily formed at these sites. No special care had been taken in the issuing of boots, and the recruits accepted the pairs they received, seeming to think they could make their feet fit the boots just as easily as make the boots fit their feet.

It was also noted that the incidence of venereal disease was high, especially in the North Auckland district and certain parts of the East Coast. A total of 80 cases of venereal disease were dealt with at Palmerston North, and of these, 60 were sent to the hospital at Trentham Camp.

Overseas, these particular conditions continued to be a cause of medical unfitness. Tuberculosis was not manifest among the Maoris in the incidence obtaining among the race in New Zealand, but it was the cause of a higher proportion of Maoris being invalided back to New Zealand than of Europeans.

Dr Macdonald Wilson of the War Pensions Department made a survey in 1949 of tuberculosis among Maoris in the services. He pointed out that for the first time in history a large group of Maoris was selected under the same conditions as European New Zealanders page 735 and went overseas and served under the same conditions. Official statistics show that the incidence of pulmonary tuberculosis in New Zealand is five times as high amongst the Maoris as in the Europeans. In the 3543 Maoris in the Army overseas, 48 cases of pulmonary tuberculosis were recorded from 1939 to 1949, equivalent to 13.5 cases per 1000, compared with an incidence of 7.4 per 1000 in the whole force of which they were part.

The periods in which the cases were diagnosed were: During service, 20 cases (41.7 per cent); at discharge, 16 cases (33.3 per cent); after return to civil life, 12 cases (25 per cent). Most of the original men of the Maori Battalion, unlike the rest of the Second Echelon, were chest X-rayed in 1940 and about 16 per cent were rejected for abnormal chest conditions. Radiology eliminates only those cases already showing parenchymal reaction to infection and does not eliminate those which have reached only mucosal infection. Thus with such a high percentage of cases amongst the Maoris picked up by X-ray examination it is only correct to assume that a higher percentage than normal of potential cases of tuberculosis already infected was accepted as fit for service. Seven of the 48 active cases were not X-rayed and 11 with X-ray evidence of past or inactive disease were considered fit for overseas service. One man rejected on X-ray re-enlisted and obtained a substitute for his routine X-ray, and no action was taken in another case recommended by the radiologist for boarding.

Included in the 48 cases were 10 cases of pleurisy with effusion. Of these, 8 were apparently cured or quiescent in 1949. Of the 48 cases the results of treatment in 1949 were: Apparently cured, 10; quiescent, 19; still active (domiciliary treatment), 7; in hospital, 5; died, 7. Four of the 10 cured cases followed pleurisy and 6 were cases picked up by X-ray but not requiring treatment. The quiescent cases were all working.

The annual incidence in New Zealand of new civilian cases per thousand population in 1948 was Maori 3.6 and European 0.77, and the average annual incidence per thousand in returned service personnel from 1945 to 1949 was Maori 1.73 and European 0.95. The figures of returned service personnel would be more complete, and in addition the personnel are in the age groups most susceptible to tuberculosis. By comparison with the annual civilian Maori rate of 23.5 per 1000, the rate of 13.5 per 1000 for a decade in Maoris who served overseas shows a remarkable reduction.

Dr Wilson sums up as follows:

Therefore the fact that a group of Maoris with this background in civil life, who were, like the Europeans, incompletely screened prior to going overseas, lived in a strange climate and underwent all the herding together and privations of campaigns, developed over the years a total of only 48 page 736 cases of pulmonary tuberculosis, definitely suggests the Maori is not unduly susceptible to tuberculosis—probably no more so than the average European if he lived under similar conditions to the European. With this has to be borne in mind the fact that the incidence of tuberculosis among Europeans in New Zealand is one of the lowest in the world.

In 2 NZEF there was always a higher incidence of venereal disease among Maoris than among Europeans. The happy-go-lucky nature of the race and lack of control, together with differences of social background, must be held accountable in part at least.

Difficulties with the feet also constituted problems, but many of the conditions were probably pre-enlistment disabilities, which were not assisted by the lack of right-fitting boots. The flat feet in themselves produced little functional disability, as flat feet are common to most native races.

On the other hand, Maoris overseas displayed an immunity, or decreased susceptibility, to certain diseases. The infective hepatitis incidence at certain stages was higher in 2 NZEF than in most other Allied forces in the same area, and yet the Maori incidence was consistently much below that for the Europeans. Detailed figures from the epidemics in the Western Desert in 1942 and Italy in 1944 amply support this point.

The skin condition of desert sores has also been stated to have been less troublesome in the Maori Battalion than in other units, but the evidence is less conclusive.

Turning to the psychological side, we find that the morale of the Maori Battalion was so high that there was a consequent reduction in anxiety neurosis and the allied disease of dyspepsia. Experience in the War Pensions Branch has shown that few Maoris are disabled for anything other than an organic disability, and that this is usually a gunshot wound. No unit probably suffered more in loss of personnel by battle casualty from gunshot wounds than the Maori Battalion. There was never any neurosis problem among the Maoris, who have not developed it post-war as have the Europeans. Since it is often stated that the Maori looks for every type of pension or grant he can get from the Government, it is significant that he has never developed the pension complex through ‘neurasthenia’.