Government which has been constituted to administer the pensions of, and provide medical treatment for, disabled exmembers of the Dominion's Expeditionary Force. In February, 1923, an Assistant Secretary of the Ministry visited Canada to confer with the officials of the Department of Soldiers' Civil Re-establishment in Ottawa and in other of the principal towns of the Dominion. Occasion was also taken to visit Washington to discuss with the officials of the Veterans. Bureau matters affecting Imperial pensioners resident in the United States. MEDICAL TREATMENT. 15. In-patient treatment.--Arrangements with civil hospitals for the admission of in-patients continued during the year. The number of special institutions for the treatment of war disabilities. not adequately provided for otherwise, declined from 95 to 73, and the total bed accommodation from 15,379 to 12,819.* Admission to in-patient treatment continued to be satisfactorily made through the regional medical staff. 16. The demand for accommodation for neurological cases which, during the preceding year, was increasing, reached a maximum during the year under review; and the requirements of the Ministry in respect of such cases were declining at the end of the year. 17. In the case of tuberculosis, the work of the whole-time medical officers appointed for England during 1921-1922 for specialist duties proved of the greatest value and the new arrangement was extended to Wales, Scotland, and Ireland. Special wards have been allotted in hospitals attached to the Ministry for investigation of cases in which there is an element of doubt, and the decisions arrived at by this means have been of great assistance. Through the activities of the specialist medical officers close co-operation has been maintained with the Ministry of Health and the local authorities responsible for the treatment of tuberculosis. 18. The treatment of mental diseases again received close and anxious consideration. The continuous and systematic inspection of all service patients in county and borough mental hospitals was maintained; and the necessity for certification under the lunacy laws was considered afresh in each case, and the possibilities of discharge from the institution on trial fully utilised. Various improvements in dietary and other matters concerning the patients as a whole and individually were effected. Arrangements were made towards the end of the year for the transfer, with the consent of responsible relatives, of certain suitable service patients under treatment in county and borough For particulars as to institutions see Appendix XIII. Information as to treatment provided is contained in Appendix XIV. See also para. 41. mental hospitals to the Old Manor Mental Hospital, Salisbury. In that institution the patients are accommodated as private patients in a special reserved wing, where they receive treatment in what is practically a hospital specially reserved and administered for them alone. It is hoped to obtain similar accommodation in the north of England. The Boards of Control for England and Scotland, and the Irish Inspectors of Lunacy, have continued to render all possible assistance to the Ministry in guarding the interests of ex-service patients in mental hospitals. 19. The use of special methods of diagnosis in the case of renal disease continued to give good results; and both efficiency of treatment and accuracy of assessments were thereby maintained. There was a slight falling off in the accommodation required for paraplegia; and the demand for in-patient and out-patient accommodation for the treatment of tropical diseases diminished considerably during the year. It was, however, found necessary to concentrate for further specialist treatment a number of cases of dysentery of a type specially resistant to treatment. 20. Clinics. As regards out-patient treatment, there was a decline in the number of special clinics for the treatment of aural, ophthalmic and cardiac cases, the numbers of such institutions at the end of the year being 18 for aural cases, 10 for ophthalmic cases and 5 for cardiac cases. There was also a decline in the number of surgical out-patients; and the number of clinics for the treatment of these cases decreased from 309 to 216, of which number 13 (excluding the special sections of general clinics), were under the direct control of the Ministry. The system of general, medical and surgical clinics under the Ministry's control, introduced during the preceding year, was further developed during the year under review, and the number of such clinics was increased from 35 to 96.. The arrangement has been fully justified by results. 21. Dental treatment.-The work of the Ministry's wholetime dentists in supervising and controlling arrangements for the provision of dental treatment has continued to secure a high standard of dental treatment at reasonable cost. 22. Concurrent treatment and training.-Facilities were continued for the concurrent treatment and training of those officers and men who, in consequence of their war disabilities, are unable to return to pre-war occupations, and who require to be trained in new occupations. During the year about 60 officers and 1,300 men successfully completed courses at convalescent centres. and were thereby enabled to pass forward for further training under ordinary conditions, or to take up employment. The demand for concurrent treatment and training began to diminish, however, towards the end of 1922, and by the end of March, 1923, it was found possible to close down the officers' centre at Bolton (32 beds) and the centre for men at Saltash (436 beds). 44999 A 5 The accommodation remaining at 31st March, 1923, was as follows: ... ... ... 288 Barry Accommodation to the extent of 165 beds also continued to be provided at Enham Village Centre, Andover, the Ministry paying an inclusive capitation fee. 23. Vocational training.-Arrangements were made with the Ministry of Health for the provision, at a number of sanatoria, of courses of vocational training for men suffering from tuberculosis. The courses of training comprise market gardening (including poultry and pig-keeping, etc.), rural carpentry, furniture repairing, house repairs, tin smithing, art metal work, etc., basket and brush making, and jewellery, watch, clock and china repairing. A course extends over a period of nine to twelve months, according to the particular type of training and the capacity of the patient to receive instruction; and the satisfactory completion of a course should enable a man to become an efficient workman and to earn a livelihood. The places available at the approved training sections numbered 510; and at the end of the year about 400 men had been admitted to one or other of the various courses. Those men who satisfactorily completed a course were eligible, subject to certain conditions, for training bonus and a grant of tools. Vocational training for tuberculous officers was provided at Matlock Sanatorium and at the East Anglian Sanatorium, Nayland, on a capitation basis. 24. Occupational treatment.-Facilities for occupational treatment in workshops and grounds were provided at further hospitals. At the end of the year there were about 3,000 men receiving treatment of this character, which has proved to be of great value. 25. Artificial limbs and surgical appliances.-The arrangement introduced in the preceding year, by which a large part of the work of renewal and repair of artificial limbs was decentralised to limb-fitting centres, proved satisfactory. During the year under review 7,589 artificial legs were supplied, of which 3,733 were of the new type of metal limb, which is now available for issue where supply is recommended by the surgeon in charge of the case. The number of artificial arms supplied was 1,230. Of these issues 366 legs and 96 arms were a first supply, necessitated by post-discharge amputations; 836 legs and 273 arms were duplicates, and the remainder were issued in renewal of limbs previously supplied. With the exception of a comparatively small number of post-discharge amputations the issue of duplicate limbs was practically completed at the 31st March, 1923. Repairs to artificial legs and arms were carried out in 33,489 cases. 26. During the year, 17,758 pairs of surgical boots were issued and in 14,640 repairs were effected; and 13,520 surgical appliances of other kinds, such as leg and arm instruments, belts, trusses, spinal supports, etc., were supplied, repairs being carried out in 2,639 cases. 27. Spectacles and artificial eyes.-Artificial eyes, totalling 6,217, were supplied through the Ministry's optical appliances depôt to 3,770 pensioners. From the same source 1,197 pensioners were supplied with spectacles, 257 pairs being of a special type for cases of facial injury or of greatly injured vision. 28. Hand-propelled tricycles and invalid chairs.—A first issue of 202 hand-propelled tricycles and 115 invalid chairs was made during the year to pensioners who have lost both legs or who, on account of paralysis or other disabilities, are unable to walk; and 101 issues of tricycles and 14 invalid chairs were made in renewal of those previously supplied. Since the establishment of the Ministry 3,912 bicycles and invalid chairs have been supplied, including 2,649 tricycles, 859 Merlin chairs for indoor use, 275 bath chairs, 98 spinal carriages and 31 chairs or machines of a special nature. It is estimated that 2,482 pensioners are in possession of hand-propelled tricycles supplied by the Ministry, 126 of whom are officers. 29. As a result of an arrangement made with the Joint Council of the British Red Cross Society and the Committee of the Lord Kitchener National Memorial Fund, motor attachments for use with the Ministry's hand-propelled tricycles have been supplied in about 80 cases where, because of the hilly nature of the country, or the distance at which the man may reside from his work, the possession of one of these attachments is a real boon if the man is competent to use it. No financial responsibility attaches to the Ministry in the matter. Applicants accept liability for the increased wear and tear which may arise from the use of an attachment; and arrangements for supply are made by the Society only on the recommendation of a medical officer of the Ministry that the man has the aptitude, and that his temperament and condition generally are such as to justify a grant. 30. Medical boards.--During the year medical boards were held on 22,840 officers and 346,049 men; and there were also 17,240 domiciliary examinations, made necessary because the pensioner's condition did not permit of his attendance before a board. About 7 per cent. of the assessments of these boards were challenged, on account of which there were examinations by medical appeal boards in the cases of 2,050 officers and 26,372 men. These figures, making a total of 414,551 examinations. represent a considerable decline on those for the preceding year, when the total examinations was 888,026, and a still greater decline from the total of 1,260,900 for the year ended 31st March, 1921. During the year under review, however, the specially constituted boards set up to make examination with a view to the grant of final awards commenced operations, and between May, 1922, and March, 1923, these boards had examined. 2,101 officers and 196,519 men. It is of interest to note that, of the appeals to medical appeal boards, 58 per cent. of the original decisions were confirmed, 32 per cent. were raised, and the remaining 10 per cent. lowered. 31. Medical referees.—The number of medical referees holding appointments at the end of the year was 1,627, as compared with 1,702 at the 31st March, 1922. The number for England was 1,080; for Scotland 288; for Ireland 184, and for Wales 75. Over 80 per cent. of the medical referees are practitioners who have seen service in the Great War. Altogether, they made 143,000 examinations during the year, as compared with 604,000 during the preceding twelve months. 32. Supplies to institutions, etc.-At the end of the year 44 hospitals and other institutions were obtaining food supplies and laundry and transport services in respect of about 13,334 individuals through contracts arranged by the Ministry centrally. Supply services to pensioners for the provision of artificial limbs, surgical boots, appliances, stump socks, crutches, etc., were also met by central contracts. All contracts for supplies of metal and wooden legs now require from the makers a guarantee to maintain the limbs in good order and repair for a period of five years, at a flat-rate maintenance charge per limb. Supplies of medical and surgical stores were issued from the Ministry's central depôt to 47 hospitals, 5 convalescent centres, 133 clinics, and to medical boards. Stump socks, arm mitts, gloves, crutches and walking sticks were supplied to areas and individuals as required, and various component parts of artificial limbs were also distributed to limb makers from the central depôt. Arrangements were continued with the British Red Cross Society for supplies of games and comforts. SPECIAL GRANTS COMMITTEE. 33. Amendments to Regulations.-The original purpose of the Regulations of the Special Grants Committee was to make special or supplementary provision for cases where, under the Royal Warrants, assistance either could not be granted at all or was less than the merits of an exceptional case appeared to require, and, following a recent review of the Regulations in the light of the altered position which arose mainly from extensions and improvements in the provisions of the Royal Warrants, certain modifications were made to which effect was given during the year. |