Medical Services in New Zealand and The Pacific
III: The Medical Services of the Royal New Zealand Navy Ashore
III: The Medical Services of the Royal New Zealand Navy Ashore
Within New Zealand the naval medical service was responsible for a wide range of duties, which included the following:
Responsibility for all recruiting medical examinations and final examinations on entry.
Medical classification of personnel and their examinations for draft to sea and for foreign service leave.
Invaliding boards of survey and the examination and grading of all personnel on discharge.
Supervision of the hygiene of shore establishments and of the small ships based on New Zealand ports.
Training of the sick-berth staff.
Treatment of naval sick and injured in so far as this could be provided efficiently and economically with the available accommodation and staff.
Originally this work was confined to Auckland, which remained the main naval base and training centre throughout the war and where the refit of major war vessels was undertaken. The RNZN was never large enough to justify the establishment of a complete naval general hospital to cater for all its routine and specialist requirements, but the erection of Sick Quarters at Devonport in 1941, with 42 beds, X-ray plant and other equipment, a staff including nursing sisters, and the later addition of an operating theatre, enabled the Navy to provide full treatment for a very considerable proportion of its sick and injured. In addition, the training depot, HMNZS Tamaki, on Motuihi Island had its own sick quarters of 15 to 20 beds, with the result that in the Auckland naval district public hospital facilities were seldom invoked except for cases requiring specialist attention.
These facilities in Auckland not only helped to ease the difficult bed situation in the public hospitals but also proved of considerable advantage to the service. Without them it would not have been possible to provide the training and clinical experience for sick-berth ratings which was essential if they were to be efficient in their duties at sea. The retention of naval sick in their own hospital eliminated many of the problems of administration, discipline and disposal which are unavoidable when outside organisations are involved and enabled treatment to be undertaken with full consideration of the prospective service requirements. Service factors frequently determined the classification of ordinary routine cases as urgent. A naval vessel working to a strict time schedule for a refit might have a number of cases for operation or other treatment, page 176 none of which were clinically urgent but where immediate medical attention might obviate the necessity of leaving them behind when the ship sailed and of providing reliefs. Working in close association with the administrative officers of the Base and the Dockyard, the medical staff of Sick Quarters were often able to plan their work without adding to the difficulties of manning and despatch of ships.
With the exception of Wellington, and in the later stages of the war, Lyttelton, no other shore establishments were of sufficient size to justify the employment of naval medical officers and the provision of special treatment facilities. In Wellington the establishment comprised originally Navy Office and a small transit depot, limiting the work of the naval medical officer to examinations and recruiting duties, inspections of small ships and such out-patient treatment as could be afforded in a small sick bay without bed accommodation. Later, development of a base for small vessels, of special training depots and a number of small out-stations demanded fuller medical facilities, which had to await the completion of the barracks at Shelly Bay in 1944, but which eventually included a sick quarters of 13 beds in which a wide range of treatment, but no major surgery, was carried out. Similar developments on a smaller scale at Lyttelton were met by the erection of a sick bay with limited bed accommodation and the provision of sick-berth staff, working at first under the supervision of an army medical officer from the local coastal defences, but later with a naval medical officer.
Arrangements in other centres varied with the circumstances. The naval detachment at Waiouru, which included a sick-berth rating, came under the administration of a naval medical officer from Wellington, who visited the camp periodically, but the men received any necessary immediate treatment from the army camp hospital. In Whangarei, used for some time as a base for small patrol craft, cases which could not be conveniently transported to Auckland were treated by civilian practitioners or in the local hospital. Similar arrangements obtained in other ports for the occasional needs of the crews of small vessels requiring advice or treatment.
One of the most important duties undertaken by the naval medical service ashore was the examination of all naval recruits. Naval enlistment differed in several important respects from army recruiting, and the advantages to the service of retaining full control of the selection and classification of its prospective entries were so clearly apparent that, despite the shortage of medical staff, the practice was continued throughout the war.page 177
Certain points of difference between naval enlistment and army recruitment must be mentioned. In the first place, all naval entry was on a voluntary basis, though it must be admitted that most of those offering during the war were liable for some form of national service under the conscription regulations then in force. Again, overseas service was not restricted in the Navy to those over 20 years of age. A very large proportion of those sent to sea were between 18 and 20, and there was in addition the small but important class of continuous service seamen boys entered at fifteen and a half or sixteen and drafted to sea within a few months. Furthermore, all naval enlistment was for specific branches of the service, and it was necessary for the interviewing officers, and the medical examiners who worked in close association with them, to have a good knowledge of the requirements and conditions of all the various categories of naval ratings. Recruiting boards could, and often did, indicate to unsuccessful candidates for a particular branch other avenues of naval employment for which they might be suited, but no man could be arbitrarily transferred to a branch for which he had not volunteered.
Under these circumstances much more was required of examining medical officers than the assessment of a physical grade. Special standards of eyesight, colour vision and hearing applied to various types of employment, and the position became more complicated with the creation of new categories as the war progressed. Relaxation of the standard of full physical fitness was possible for a limited number employed in shore stations, but examining officers had always to bear in mind the remoteness and inaccessibility of some of the out-stations, which though classed as ‘shore or harbour service’ required active and agile personnel to man them.
Examinations were carried out at the bases where naval medical officers were stationed and by periodic visits of recruiting and selection boards to other centres. Chest X-ray examinations were done by the public hospitals, all suspects being referred to the specialist chest boards in the same manner as for army recruits. Candidates for the Fleet Air Arm underwent an additional special examination by Air Force boards to assess their flying categories. From 1944 onwards, considerable assistance in eyesight testing was obtained from mobile units of the Army Optician Service.
The selection of suitable recruits for war service, entailing the examination of some 14,000 candidates, was rightly regarded as one of the most important responsibilities of the naval medical service. Whereas in peacetime long training periods afford opportunities for reviewing new entries and re-assessing their suitability, many of the wartime naval recruits were shipped to the United page 178 Kingdom within a few days of joining, and it is to the credit of the examining officers that errors in selection were so infrequent.
No matter how carefully conducted, a single short physical examination cannot prevent the acceptance of some candidates who are subsequently found to be unsuitable under the test of training. In the RNZN this proportion was very small indeed and contained no instance of gross physical disability which should have been detected at the initial examination. Candidates with minor degrees of foot deformity were sometimes accepted on their assurance that they engaged in athletics and active pursuits, and a few of these were shown later to be unable to carry out arduous training. Most of the cases of unsuitable entry were psychological misfits, or instances of deliberately misleading statements in respect of past history of epilepsy, enuresis, or asthma.
Invaliding and Demobilisation
As with entry, so with discharge, all medical examinations were conducted by naval medical officers. It is particularly desirable that questions of fitness for retention in the service should be determined by persons possessing not only medical training but a good knowledge of naval life and conditions. Similarly, until the provisions of the War Pensions Act 1943 extended the interpretation of ‘attributability’ until it became practically synonymous with ‘service overseas’, assessment of attributability or aggravation could only be made by officers fully acquainted with the circumstances and with access to all the records.
It is true that the ultimate decision on matters of pension lay with the War Pensions Boards, but it was always the aim of Naval Medical Boards of Survey to provide them with carefully considered recommendations based on all the available facts.