PENSIONS.

Otago Daily Times, Issue 19269, 5 September 1924, Page 8

PENSIONS.

SIR DONALD MGA YIN’S COMMENTS. NEURASTHENIC AND HYSTERICAL SUBJECTS. (Fbom Ope Own Coeeespondent.) WELLINGTON, September 3. The report of the Pensions Department shows that there are 50,025 pensioners in New Zealand, drawing pensions of an annual value of £2,325,603. The war pensioners number 23,166, the annual value of their pensions being £1,215,126. There are 21,453 old-age pensioners, drawing £780,664. and 5526 widow pensioners, draw ing £209,739. The Medical Administrator of Pensions, Major-general Sir Donald M’Gavin, dealing with the medical administration, makes some very interesting observations regarding functional nervous disease (neurathbnia and hysteria). There are 857 of these cases in receipt of pensions. Their proportion to all other pensioners is 1.6. Sir Donald says:— “The treatment and pensioning of these cases present the most difficult problems with which the medical administration has to deal. The genesis of many of these cases is similar to those which have become familar where compensation is sought under the Workers’ Compensation Act. An intense desire, often—perhaps gonerallv—subconscious to secure financial consideration for their disabilities loads to -.ie development of a train of nervous symptoms which are generally not difficult to recognise. Under the Workers’ Compensation Act. however, when the case is settled these symptoms disappear, aften with dramatic rapidity. Unfortunately in the case of pensioners the course is different. The worse the patient becomes the greater is his pension up to a certain limit. To maintain the pension at the maximum the disability has also to maintain a certain standard. It is difficult to conceive conditions better calculated to perpetuate functional nervous disease, especially when it is remembered that in the very nature ot their condition these patients are defective m self-reliance and especially susceptible to suggestion. That in a considerable proportion of these pensioners the nervous system was originally less able to resist the disturbing effect of external impressions than normally appears clear from the fact that many of these cases developed in camp in New Zealand, on the transports, in England, as the overseas base in Franco, or commonly very shortly after reaching the front. “An exactly common cause of the persistence of these conditions is the un- . discriminating solicitude of well-meaning associations and individuals. It is this cultvation of the nervous disorder by such individuals —perhaps not always distintrested —which renders the obvious course of tho grant of a final gratuity futile. This course, if it were possible, would complete tbe analogy with cases under the Workers’ Compensation Act. and achieve its happy results. It is to be pointed out that the symptoms complained of by these patients are often concentrated on a particular organ, especially in some organic disability has actually previously affected it. For • instance, such symptoms not uncommonly group themselves in the abdominal region when the individual has suffered a previous attack of dysentery which may have been quite slight and > transient. If it has been necessary to retain patients in hospital for some considerable time such symptoms not uncommonly develop shortly before or after discharge (“hospitalisation”). These patients are treated at the neurological centre at Hanmer Springs, which is admirably suited to the purpose. The patients generally leave the institution greatly improved and with increase! selfreliance. Unfortunately they constantly relapse whenever they are exposed to any anxiety or strain such as may arise in their domestic or business left.

“The relumed soldier is just as likely to suffer in this way as tbe person who did not go to the war. and in some cases more so because of the strain to which ho has been subjected at the war. On his return to New Zealand he has dropped behind a little in the struggle for existence. The dork takes up land. lie has no knowledge of farming. His farm fails. He and his family are in grave financial difficulties, and he immediately develops neurasthenic symptoms. His failure he attributes not to his lack of knowledge, but to tho fact that his health was ruined at the war, and his proof to himsetf and his family ot this is his present state of neurasthenia. Domestic troubles are just as common. The civilian patient will admit these domestic troubles: the service patient blames the war and his condition for his altered state of feeling. The wife also blames the stress of war. It is quite obvious that neither party would in any way consider that anything else was tho cause because it is natural to blame something and also because ' that to which they lay the blame will bring in monetary assistance. It is difficult to know to what extent such relapses should be accepted as entitled to further treatment for pension when it is so clear that in the majority of cases the condition is constitutional, and no reasonably attributable to service. “It is clearly to be understood that the preceding remarks do not refer in any sense to malingering. Pure malingering is rare, altnough tho partial form which consists in an exaggeration of existing symptoms is undoubtedly common.”