9

EL—lB

or where such conditions as injuries of nerves, ununited fractures, or involvement of joints, are still undergoing treatment with a prospect of improvement. Amputations. —During the year the supply of light-metal (duralumin) artificial limbs has been arranged. Extensive inquiry in London has shown the superiority of these over the old wooden limbs. These limbs are very much lighter, which is a matter of great importance, particularly to men with an amputation above the knee, especially if their occupations entail their moving about a good deal. The limbs are also much stronger, and require repair less frequently. These repairs also most often take tho form of replacement of wearing-parts, and can be effected by posting the limb to the workshop. Their fife is at least twice that of wooden limbs, and probably much more. As these limbs are not yet made in New Zealand, it has been necessary to arrange for their importation from England. Tho only part requiring actual fitting (tho bucket) is made in the Government Artificial-limb Workshop, and fitted to the limb when received. A cable code has been arranged with the manufacturers so as to avoid delay. As, however, these limbs vary little from a standard, it is anticipated that by keeping a stock of several sizes on hand the delay entailed in cabling the measurement will in most cases be avoided. In any case, however, every amputee is alreadyprovided with a duplicate limb, so that he may always have one available, and he would therefore suffer no hardship in waiting a month or two for the replacement of one limb. Arrangements have been made to have all amputees measured, so that it will not be necessary for them to attend the factory for that purpose. This will leave only one attendance (for fitting) necessary, and it is thought that in many cases, by the taking of plaster casts, even this attendance will not bo necessary. An expert was brought from London to instruct the employees in the Government Artificiallimb Workshop in the working of the metal and in the repair of these limbs. Amputees who have already been supplied with duralumin limbs have expressed their satisfaction with them, and apparently have no doubt of their superiority to the wooden limb. Pulmonary Tuberculosis. —It is not at present clear that the incidence of pulmonary tuberculosis has been increased by the war; an endeavour is being made to ascertain if this has been the case. The concentration of patients in sanatoria has tended to emphasize the prevalence of this condition, especially among returned soldiers. Ample sanatorium accommodation is available for tuberculous ox-soldiers at Pukeora (in the North Island) and the Upper Sanatorium, Cashmere (for South Island patients). Cases not suitable for treatment at these institutions are accommodated in the Wakari Sanatorium, Dunedin, in shelters connected with the public hospital at Auckland, and at other public hospitals throughout the Dominion. Each patient on leaving the sanatorium is provided with a specially constructed tent, or an allowance wherewith to build a shelter or makeapproved structural alterations to his house. The object of this provision is twofold :in the first place, it ensures that the patient will continue to live under suitable conditions after his discharge ; and, in tho second, that he need not then come into such intimate contact with members of his family or other associates as to endanger them by infection. A certain amount of furniture is also provided with this accommodation. By regular medical examinations by chest specialists the progress of each of these cases is carefully followed. Functional Nervous Disease (Neurasthenia and Hysteria). —lt will be noted that there are 857 of these cases in receipt of pension ; their proportion to all other pensioners is 1 : 16. The treatment and pensioning of these oases 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 familiar where compensation is sought under the Workers' Compensation Act. An intense desire, often (perhaps generally) subconscious, to secure financial consideration for their disabilities leads to the development of a train of nervous symptoms which are -generally not difficult to recognize. Under tho Workers' Compensation Act, however, when the case is settled, these symptoms disappear, often with dramatic rapidity. Unfortunately, in the case of pensioners the course is different. Tho worse the patient becomes the greater is his pension up to a certain limit. To maintain the pension at tho 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 of their condition these patients are defective in selfreliance and especially susceptible to suggestion. That in a considerable proportion of these pensioners tho 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 transports, in England, at the overseas base in France, or, commonly, very shortly after reaching the front. An extremely common cause of the persistence of these conditions is tho undiscriminating solicitude of well-meaning associations and individuals. It is this cultivation of the nervous disorder by such- individuals (perhaps not always disinterested) which renders the obvious course of the grant of a final gratuity futile. This course, if it were possible, would complete the 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 if some organic disability has actually previously affected it; for instance, such symptoms not uncommonly group themselves in tho 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 (" hospitalization "). These patients are treated at the neurological centre at Hanmer Springs, which is admirably suited to tho purpose. The patients generally leave the institution greatly improved, with increased, self-reliance. Unfortunately, they constantly relapse whenever exposed to any anxiety or strain such as may arise in their domestic or business life. Tho returned soldier is just as likely to suffer in this way as the person who did not go to the war (and in some cases more so, not because of the strain to which ho has been subjected at the war, but because on his return to New Zealand he has dropped behind a little in tho struggle for existence). The clerk takes up land ;he has no knowledge of farming; his farm fails ; he and his family are in grave financial difficulties, and ho immediately develops neurasthenic symptoms. His failure he attributes not to his lack of knowledge, but to the fact that his health was ruined at the war, and his proof to himself and his family of this is the present state of neurasthenia. Domestic troubles are just as common. Tho civilian patient will admit these domestic troubles. The service patient blames the war and his condition for his altered

2—H. 18.