WAR PENSION (MISS C. THOMSON) (Hansard, 30 April 1963)

§ Mr. John Strachey (Dundee, West)
I wish to raise the case of a constituent of mine, a Miss Charlotte Thomson, and the refusal of the Ministry of Pensions and National Insurance, under successive Ministers, to grant her pension.
I can describe the circumstances of the case very briefly. During the late war, Miss Thomson was passed A.1 for and joined the A.T.S. Comparatively shortly after joining, she showed signs of increasing invalidism, and there is a long and complex medical history of her troubles during service. She was progressively down-graded through the medical grades. She spent long periods in hospital and received a great deal of medical attention. She finally developed the unquestioned and obvious symptoms of the rare but extremely distressing disease which, I understand, is called Cushing's syndrome. She underwent two serious operations. The upshot is that she is a permanent and hopeless invalid and is quite unable to earn her living. She receives no war pension of any sort. That, prima facie, is the case which I put before the House.
During the course of a long correspondence and interviews the Ministry—and I use the term "the Ministry" because the case has come partly under the present Minister and partly under his predecessors—has been good enough to see me and to discuss the case with me. I have in my hand voluminous correspondence on it.
Summing the case up as it has developed between us, I think that it has two main aspects. The first is what I call the merits of the case. The Ministry has at various times, both in correspondence and in interviews with my hon.—and, in this instance, medically learned—Friend the Member for Greenock (Dr. Dickson Mabon), who has just come in, and myself maintained two things. It has sometimes maintained that the symptoms of this disease were apparent before Miss Thomson joined the Army, 1036 that the disease is a progressive one and constitutional, that it cannot be linked with her service and that it was apparent in its early form before she joined the Army. At other times the Ministry has said that the disease was unapparent when she joined the Army and that that was why she was passed A.1—it is difficult to believe that she could have been passed A.1 if it had been apparent—and that the symptoms developed during her service but were not attributable in any way to her conditions of service.
It is not my business to decide between these two views, nor do I think it very important to do so. If Miss Thomson had this disease, and if the symptoms of it were apparent before she joined the army, it was a most terrible tragedy and error that she should have been passed A.1. I would have thought that that mere fact, and the error of the military authorities in doing that, meant that she worked subject to conditions which were quite unsuitable for a person who already had this disease on her and that certainly she deserved a pension.
On the other hand, if the disease was not apparent when she joined, it was quite right, no doubt, to pass her A.1. In that instance, however, it would be common ground that the disease developed during her term of service, so that there would be a strong prima facie case, at least, that it was associated with the conditions of Service life. I will produce medical evidence to support that view. Therefore, in either case, in either of the positions which the Ministry has alternatively taken up, Miss Thomson is clearly deserving of a pension.
That is putting the merits of the case as briefly as I can. The Minister, however, like his predecessor, has relied rather on the legal position. In the last resort, he has brushed all these considerations aside and has said, "Be all that as it may, it is quite impossible for me to grant this lady a pension. It is legally impossible. We very much regret it, but she has been to the pensions appeals tribunal. The tribunal has turned her down and under Statute there is nothing I can do about it." That has been the Minister's last ditch of defence in this case.
1037 The Minister admits, as he has to do, that if fresh medical evidence on the matter could be produced, he would have the right to consider the case even though it had been before the appeals tribunal. Accordingly, I took the course of advising Miss Thomson to submit fresh medical evidence, and fresh medical evidence was submitted. I will put it before the House presently. The Minister states that it is not the right kind of fresh medical evidence and that what he means is disclosure of a totally fresh character which would throw a completely new light on the case.
I submit that fresh medical evidence in a case of this sort can only be weighty fresh medical opinion—because we are dealing with medical opinions. I do not pretend to be able to adjudicate on matters concerning Cushing's syndrome—they are extremely technical—and I am sure that the Minister would make no such claim. Therefore, it must be a question of the medical evidence.
I urge strongly upon the Minister that what has been submitted constitutes fresh medical evidence. I cannot give it all, or anything like all of it, to the House at this stage, but I should like to read certain extracts from a letter from Dr. Gordon Sprunt, of the Maryfield Hospital, in Dundee, who is a weighty authority on this matter, and show that there is at least weighty medical evidence which takes the same view as I do on the case and that this is not simply something which a layman like myself brings up in ignorance.
I will not read the whale letter, because it is long and highly technical, but I will read certain passages from it. It is a letter to Miss Thomson dated 17th July, 1962, and it begins: Dear Miss Thomson, There are several points which I think should be considered if you are making further representations with respect to your claim for a pension. First, Cushing's Syndrome is now known to be due to hyperfunction of the pituitary-adrenal axis. The pituitary gland is regulated in two ways, by the level of circulating hormone secreted by the adrenal and by the central nervous system"— That is underlined in the letter— via the part known as the hyperthalamus. It is well established that the secretion of the adrenal stimulating hormone … by the pituitary can be increased by various types of stress, both metabolic and psychological. 1038 The main point of the letter, according to the learned writer, is that psychological factors are germane and important in this condition. The letter goes on: Second, although the evidence of the literature is scanty, there is some showing that psychological factors can cause the activity of the pituitary-adrenal axis so as to cause pathological changes. The classical paper on this topic is that of Bush and Mahesh in the Journal of Endocrinology for 1959. I will leave out the extremely technical passages. The letter says later: It seems possible that some eases of Cushings Syndromed could arise in this way just as hyperactivity of the thyroid gland may be precipitated by psychological stress. Your service in the forces could well be constituted a stressful situation. Why was it that you entered the forces graded A.1 (although slightly obese and hirsute) but were eventually invalided out? Either your disease must have progressed during your service with the forces or the original medical assessment was wrong. Last, I agree with Mr. Strachey that you should have been given the benefit of any doubt as to whether service conditions aggravated the condition. I know a patient who had a pituitary adenoma treated while he was in the forces, and he now has a 40 per cent. disability pension for possible aggravation. I also believe that the two cases are so dissimilar on purely medical grounds as to justify your not having a similar pension. Of course, on the non-medical side that is an expression of opinion, like my own. But on the medical side it seems to me to be the production of new evidence—not conclusive necessarily but new evidence that the Minister can consider if he likes. I urge him most strongly to do so.
The simple fact to a layman like myself is that Miss Thomson entered the Services during the war fit enough at any rate to be graded A.1 by the medical authorities, and that when she left the Forces she was a hopeless invalid. She has no pension whatever. We can argue for ever about the exact degree of attributability—if there is such a term—to her service of her state of health, but her life has been ruined as a result of this breakdown in her health. It occurred substantially during her period of service, and I feel that she is due to a pension for her services during the war to Her Majesty.

§ Dr. J. Dickson Mabon (Greenock)
I intervene at the invitation of my right hon. Friend the Member for Dundee, West (Mr. Strachey) who has done such 1039 a tremendous amount of work on behalf of Miss Thomson, because I also was invited by him to meet the previous Minister of Pensions and National Insurance on this very important matter. My right hon. Friend has been very dogged in his persistence in raising this case. Miss Thomson herself seems to me to be an admirable lady in many ways and she has shown great courage in allowing this matter to be raised publicly in this House. There is involved here a very important point of substance in the administration of pensions.
Her case reveals that certain facts have emerged as a consequence of the advance in medical knowledge, and it would be wrong of the Ministry, in its interpretation of the Regulations as they presently are, to disregard this new advance. I concede that it is possible perhaps that in the exercise of justice the Minister might seem to offend against a Statute, but in that case, it would be an argument for amending the Statute, not an argument for penalising individuals. I realise the difficulties here, but I think that it is important to try to do justice to people like Miss Thomson.
Sticking strictly to her case, it seems to me quite clear that though the initial medical opinion, which is now in retrospect seen to be wrong, could be forgiven, what cannot be forgiven is what happened while she was in the Forces, in some of the instances of medical examination, in hospitalisation, and so on. It seems difficult to say that it is only by hindsight that we can now be wise about these events. I think there was neglect here, perhaps understandable neglect, but, nevertheless, not neglect which excuses the Ministry from honouring its obligations to this lady. I do feel there is a very strong case for giving special consideration to her in this matter.
Miss Thomson's does represent a very strange case in that the argument is that her initial constitutional disease has been aggravated by consequences for which medicine did not allow. It is now pretty clearly established in medical opinion that psychological stress can play a part in precipitating this disease. This was not medical opinion in the nineteen-forties, say, but unless the Ministry is to defy and controvert medical opinion now, I cannot see how the case for Miss Thomson fails. I would earnestly plead 1040 with the hon. Gentleman tonight willingly to consider what the position is so that—let us hope—there are no more Miss Thomsons. In the case of this courageous lady, I hope he will not give a definite refusal tonight, but will leave the door open, so that, in retrospect, we can do justice to her.

§ The Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance (Lieut.-Commander S. L. C. Maydon)
I can only agree with the right hon. Gentleman the Member for Dundee, West (Mr. Strachey) and the hon. Gentleman the Member for Greenock (Dr. Dickson Mabon) that this is a most tragic case, but I think that, unwittingly, they have both disregarded a part of the unfortunate story. The right hon. Gentleman said that the Ministry based its case on two conflicting arguments, first, that the disease was apparent before she joined the Services. This is perfectly correct. Secondly, although her case was that the disease was not apparent before she joined the Service, we still disputed that it was attributable to her service in the forces.
This is not the case.

§ Mr. Strachey
Oh, yes.

§ Lieut-Commander Maydon
Whether or not the original medical examination which graded her before entry into the forces was correct is not for me to say. I cannot, of course, comment on this, which, in any event, took place a long time ago.
The fact is that Miss Thomson joined the A.T.S. in June, 1943, after medical examination in May, 1943. In July, 1943, she first went into Bruntsfield Hospital, Edinburgh, with a diagnosis of some form of endocrine disturbance. In August, 1943, she was sent to another military hospital. Part of the symptoms which she described to the doctors were pains which had begun five years previously. After barely two months in the Services, she was in hospital under treatment for complaints of which she said there was evidence some five years previously. Another fact is that in the three years immediately before her service, it is reported, she gained 2 stone 12 lbs. in weight, and a gain of weight is one of the symptoms of this very unpleasant disease. During the 1¾ years 1041 of her service she gained only a further 6 lbs.
I say all this not in an attempt to show that her life in the Service had any arresting effect on the disease, but merely to show that, whatever her military grading when she entered the Service, this disease undoubtedly commenced long beforehand.
The second point which the right hon. Gentleman made was that the Ministry was sheltering behind the decision of the pensions appeal tribunal. He may call it sheltering, but Parliament in its wisdom has decided that in cases like this, the final arbiter shall be an independent tribunal. It is not a question of the Ministry's trying to take shelter behind a device, but of its faithfully following the procedure laid down by Parliament.
Lastly, the right hon. Gentleman argued that fresh medical evidence had been produced by Dr. Gordon Sprunt in his letter to Miss Thomson. With the greatest respect, I differ from that. Dr. Gordon Sprunt appears to me—and I have read this letter most carefully several times—to have quoted hypothetical examples, taken from medical works, of what could happen in such cases, and to have tried to relate them to the case in point.
What is needed to constitute fresh evidence, however, is not an opinion, which, after all, is only an interpretation of undisputed evidence. The only matter about which there might be dispute is why Miss Thomson was ever graded A.1 in the first place. Fresh evidence means a new fact which had not previously been disclosed—for instance, that Miss Thomson might have been in a road accident in military transport, which might have had some effect upon her physical condition, or a new fact of that nature. Nothing of that sort has been produced.

§ Mr. Strachey
The hon. and gallant Gentleman brushes aside Dr. Sprunt's letter and calls it hypothetical. Does he disregard the fact that Dr. Sprunt says 1042 that psychological factors are now recognised as being conducive to this disease and its aggravation, and that this was not so at an earlier period? That is the new factor.

§ Dr. Dickson Mabon
Surely the hon. Parliamentary Secretary does not want to mislead the House. What has been said in the fundamental papers on this matter is not based on hypothetical cases, but on medical fact, If the hon. and gallant Gentleman looks at the case of Miss Thomson he will see a number of entries showing the degree of psychological stress which culminated in her discharge after a number of years. I have read the papers, and I am impressed by the number of records by medical men of the effect of psychological factors.

§ Lieut-Commander Maydon
I appreciate what the right hon. Gentleman and the hon. Gentleman have said, but the fact remains that there is nothing in Dr. Sprunt's letter which adduces a fact not previously known and directly related to this case. There are new facts relating to other reports and cases referred to in the letter, but no new fact relating to the unfortunate case of Miss Thomson. This is why we cannot accept this letter as fresh evidence.
Lastly, the hon. Gentleman for Greenock said that he would like us to look at the case again, in justice to Miss Thomson. I must tell him that we have looked at it time and time again. The right hon. Gentleman has most faithfully represented the interests of his constituent in this matter and there has been lengthy correspondence and there have been many reviews. But we are unable to accept that Miss Thomson could be granted a pension on the grounds that her complaint is attributable to her service, or that it has been aggravated thereby.