HL Deb 15 April 1919 vol 34 cc337-43

EARL STANHOPE rose to ask the Under-Secretary of State for War—

  1. 1. Whether idleness or occupational work is considered to have the better curative effect on patients in hospital suffering from neurasthenia and shell-shock.
  2. 2. How many officers and other ranks have been discharged from the Army owing to neurasthenia.
  3. 3. How many officers and other ranks are at present in military hospitals suffering from neurasthenia and shell-shock, and how many of them are receiving vocational training.

The noble Earl said: My Lords, since I put these Questions on the Paper I see that the medical profession have been holding meetings in regard to the subject, and they say that only ignorant politicians ever refer to shell-shock. I plead guilty to the indictment, because your Lordships will see the word on the Paper, but it is a word that is very well known throughout the Army, and refers to trouble which is caused to men who are driven out of their minds. There are two methods of dealing with neurasthenia and men suffering from nervous trouble. One is called the Vienna method, by which a man is made to think about and to dwell on the actual cause which affected his mind. It is of course, obviously a very cruel method, and it is one which I understand is net now in favour with the majority of medical men.

The method far more generally accepted is that you should endeavour to occupy the man's mind, and the man's hands, and so on, in dealing with matters which interest him. It takes his mind off the war and off the experiences through which he has had to pass; and in many cases when that has been done by men with keenness and energy who are able to influence their patients, recovery has been quick and complete. I am sorry to say that in most military hospitals this policy has not been undertaken. It, I know, is difficult to do, and, as I said before, very largely it depends on the personality of whoever is in charge of the case. But I have no doubt in my own mind that where that policy is adopted, a very large proportion of patients recover as compared with patients where that policy is not put into effect. I have put on the paper a Question asking whether in the view of the. War Office idleness or occupational work is considered to be the better of the two. I think probably the reply will be that occupational work is considered the better. And then I ask to whom that is now being applied and how many have already been discharged from the Army without any knowledge of that system; and frankly I am prepared to say that in my view, which very likely will be disputed, many more men would recover from neurasthenia if the policy of giving them occupational work had been adopted very much sooner.

There is another point which is rather outside the scope of this Question, and of course I do not expect an answer from my noble friend, as it is not entirely in his department, but I am quite sure that he will be as interested in the matter as I am. It is this. When men are discharged from the Army for mental disabilities they are usually sent to the county lunatic asylums. They are supposed to be given different clothes, and to be given some money which they can spend as they like, but it is really intended to improve their diet and their feeding arrangements. I understand that in a good many cases the men have not received these clothes, and that in very few cases it is possible to give them a different diet from that of the pauper patients with whom they are arraigned; and what really happens is that men who have been in the Army, who have suffered in the service of their country, are put into asylums with pauper lunatics. I am quite sure there is nobody either at the War Office or anywhere else who would approve that policy; and it may be that at the moment, owing to the numbers, it is impossible to do anything else. But if my noble friend will inquire into it from the point of view of the soldiers he will find, I am afraid, that there is a certain amount of foundation for the statement., and I am sure when he does find that out he will do his utmost to rectify it. I beg to ask the Question standing in my name.

VISCOUNT KNUTSFORD

My Lords, before the Under-Secretary replies may I intervene for a moment? I ask to be heard on one part of the Question put by my noble friend where he asks which is the better treatment, occupational work or idleness. Is it not rather a new position that this House is being put into by this question—that the Government should be asked to subscribe for patients, or that they should intervene perhaps where doctors may differ? It seems to me that that puts the Government in rather a difficult position. But let that pass.

Without any claims to being a medical man, I can answer the noble Earl's question with absolute certainty. I happen to have been responsible ever since the war began for six hospitals for officers suffering from neurasthenia. At these hospitals we have treated no fewer than 3,000 officers all suffering from acute and less acute forms of neurasthenia; and I cannot help thinking that the noble Earl who has asked this question has been misled seriously by information which has reached him, because there happen to be a great number of people who have constantly misrepresented—I do not know why—the treatment of neurasthenic patients. I say emphatically that there can be no answer given to this question as to which is the better treatment. There can be no general answer given to it, because you have to treat each man according to the complaint he is suffering from, and according to the degree of the complaint. It would be just as sensible to ask which is the better treatment for indigestion, starvation or a blue pill, as to suggest one form of treatment as being universal for these various forms of nerve disorder.

Neurasthenia covers an extraordinary number of nerve disorders. There is a nerve disorder which conies from a bodily injury, where a man has been buried by a shell. There is a nerve disorder which comes from the actual concussion of high explosive shells. Then there are the very much more difficult cases of men losing nerve balance because of the strain of work carried on under different and varied conditions which they were not used to before. Then there are the nerve disorders which come from men constantly controlling and keeping down natural instinct, such as fear and other natural instincts which they had to keep down in the face of the enemy. All those are reasons for neurasthenia.

But—I do not know why—everybody seems to think they can cure neurasthenia. I am the victim of a number of letters from all sorts of people suggesting marvellous cures. One lady wrote to me to say that when she played upon her guitar it had a most soothing effect—would I try it? I said it had been tried by David without great success when he played before Saul. Another man wrote to me to say that neurasthenia was a gas that was escaping from people, and that he was a mechanician and could at once stop the escape of the gas by means of a machine which he had patented and he was prepared to sell it at a reasonable price; he could stop the leak. Another man had actually a colony started for allowing these men to go and live in the woods in a state of nature with no clothes on and enjoy baths in the morning dew. Actually a colony of people was started by people who otherwise were quite sane and sensible, and the only reason the colony was closed was that the Highland dogs bit the patients and so the colony came to an end.

As I say, everybody seems to think that they can cure neurasthenia. But, speaking quite generally, the treatment for neurasthenia combines both the suggestions of the noble Earl. The first treatment is absolute quiet and rest where the patient is kept entirely away even from his relatives. That is the time we get most abuse. We receive letters from relatives of all-sorts asking, "Why am I not allowed to see poor John, who is so ill? It would comfort him very much," and so on. Then after that treatment, when a man has recovered his balance a little more, we give him what is called a sort of modified activity on a very, very carefully thought out plan, and a plan suited to each man's idiosyncrasies. But you cannot lay down a plan that would suit one man and say it would necessarily suit another.

Then the man is encouraged to associate with his fellow man, and there comes another time when we get into trouble because people who know all about it say that then he wants cheering companions and should associate with men who are quite well. On the contrary, if he were to do so he would be driven back to thinking how very much less well he was himself. Gradually he is taught to associate with other patients, and they talk about their improvements, and that does them good, and then they are induced and stimulated to take up occupations which they did before. If a man was an artist he is encouraged to draw, and we find that that is very much better for the patients than teaching them to knit stockings or other fancy occupations. We try to stimulate what was in the men before, and then they go to games, and so on, and I wish before I sit down to give some testimony to the extraordinary generosity of Sir Leicester Harms-worth and Miss Alexander, who gave up two most beautiful houses on Campden Hill and went away to live elsewhere. Those beautiful gardens are exactly suited for these! acidified activities. Then after that the patients have the advantage of going to the War Office and the Ministry of Labour and being sent to Oxford or Cambridge or other schools, where they can learn different employments.

In that way, my Lords, almost all these men have been cured. Really I have seen men, I do not like to say it, but they were hardly human, and almost all, and I think I might say all, have been cured. One can say it with pride and satisfaction and gratitude, because the very best neurologists in this country have given up the whole of their time with extraordinary devotion and single-mindedness to the study of this very difficult and complex disease. I do not know what answer the Under-Secretary of State for War is going to give, but I feel sure it would be misleading and mischievous if he were to say that any one treatment is better than another for a disease which has so many different causes and of which there are so many different forms.

VISCOUNT PEEL

My Lords, no one, I am sure, will criticise my noble friend Lord Stanhope for using the term "shell-shock," because I think it is only in the last few days or weeks that the doctors have decided that it does not exist, and therefore he was probably using the ordinary term. I must, however, say one word about the speech which has just been made by the noble Viscount opposite, who speaks of course with great personal experience on these matters and whose contribution to the discussion was, I think, greatly interesting to the House. May I say also that it is rather pleasant for a member of the Government to have the unique and refreshing experience of a noble Lord rising in his place and actually defending the Government. It does not often happen in these days. I have only one criticism, if I may make it, of the statement of my noble friend, and that was that surely he did scant justice to David, because I understood that the effect of the playing of David was that the gloom was removed from the brow of Saul, and therefore his playing had a useful and refreshing effect.

VISCOUNT KNUTSFORD

I understood he threw a javelin at David.

VISCOUNT PEEL

He missed him, and that was at the commencement of the treatment, I think. I cannot give myself so good an answer as was given to the first part of the Question by the noble Viscount. And may I say that I do take some exception to the phrase used by Lord Stanhope when he asks whether idleness or occupational work is considered to have the better curative effect. Surely idleness is rather a severe term to use. If a man is in sickness you do not say he is idle because he is not doing something. Idleness rather suggests a man who can get work and ought to work and is not working, and not a patient in a hospital. Of course I can only give a general answer—namely, that it must, depend entirely upon the particular case, and that it must be left entirely to the judgment of the doctors as to what, if any, form of occupation is good for the patient. It may well be that in the first stages in hospital a man may not be fit to do anything at all, and that rest may be the very best cure. Besides, as am sure Lord Knutsford would say, every case has to be most carefully studied, and therefore seine little time roust elapse before the doctors can make up their minds definitely what would be precisely the best kind of occupation to lead a man back into health. Of course generally speaking no doubt when any kind of occupation can be taken up by the man he will be more likely to recover rapidly than if he is left doing nothing.

The second Question is how many officers and other ranks have been discharged from the Army owing to neurasthenia? I will give my noble friend the figures. The number of officers suffering from shell-shock is 295, from neurasthenia 212, and from miscellaneous nervous diseases 441. The figures for the men are not quite comparable, because they are not analysed in the same way. Men discharged from nervous diseases number 34,592. A third question was how many officers and other ranks are at present in military hospitals suffering from neurasthenia and shell-shock, and how many of them are receiving vocational training? I have had a telegram sent to the different hospitals to try to get the figures together, but up to date, I am sorry to say, I have not been able to obtain them, and therefore my noble friend will see that I am equally unable to answer the Question of how many are receiving vocational training, because I have not the numbers of those suffering at present in hospitals.