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Thursday, 8 March 1928

Mr D CAMERON (BRISBANE. QLD) .- I have listened with the keenest interest to the speeches which have been made by honorable members upon the motion of the honorable member for Adelaide (Mr. Yates). I have always maintained - and the Leader of the Opposition and other honorable members have expressed the) same opinion - that party politics should play no part in a debate affecting repatriation. It seemed to me that the Government in accepting the recommendation of the royal commission which was appointed in 1925 to investigate matters affecting repatriation and pension payments - that ex-members of the Australian Imperial Force suffering from tuberculosis due to war service should be granted a permanent pension - fully appreciated the peculiarly distressing circumstances and conditions under which unfortunate men suffering from tubercular exist. I am sure that we all sympathize with the position of the returned soldier who is suffering from heart, kidney or other troubles mentioned by the Minister and the honorable member for Herbert (Dr. Nott) this afternoon; but the most tragic figure of all to me is the man who left these shores strong and healthy, and on returning from active service, and rejoining his family, was presently struck down by this dread disease. In many instances a man suffering from this disability cannot obtain employment even if he is able to work, and he is always oppressed by the nightmare that he is probably a menace - to the members of his own family. I know that the Government had that in mind when it accepted the recommendation of the royal commission. Not long ago, at the request of the T.B. Sailors' and Soldiers' Association of Queensland, I asked the Repatriation Commission to make the position quite clear in connexion with the pensions paid to certain ex-members of the Australian Imperial Forces, who are suffering from pulmonary tuberculosis, and I received the following reply: -

There is noact which provides for a permanent pension of £2 2s. a week for men suffering from tuberculosis. Cabinet, however, approved of such a pension being paid, but the 'provision is restricted to those who are definitely certified to be suffering from proved tuberculosis. Although the cases which have received sanatorium treatment, and have subsequently been paid a special rate of pension, are nearly always found to be " proved tuberculosis " cases, and are consequently entitled (under the Cabinet decision) to a permanent pension of not less than £2 2s. per week, there may still be rare cases, which, on the tests being applied, cannot be medically certified as " proved tuberculosis," and, therefore, may be liable to reduction below the £2 2s. rate, should the medical assessment of the disability be less than 100 per cent.

I should like also to quote from the report of the Repatriation Commission for the year ending 30th June, 1926, which I do not think has been circulated among honorable members. The commission in that report says: -

The Government decided that a permanent pension of not less than £2 2s. per week should be paid to all " members of the forces " proved to be suffering from pulmonary tuberculosis on or subsequent to 1st July, 1925, as a result of war service, or as a result of a preexisting condition having been materially aggravated by war service.

This important decision necessitated a review of all cases diagnosed as suffering from pulmonary tuberculosis and other chest complaints. On the advice of the medical advisory committee, the commission decided that, in order to establish proof or otherwise that the ex-soldier was suffering from pulmonary tuberculosis, each case was to be investigated on the following lines: -

1.   Brief clinical history (including all postwar illnesses, mode of life, habits, occupation).

2.   Signs and symptoms -

(a)   Cough.

(   b) Expectoration.

(c)   Night sweats.

(d)   Temperature variation - daily,

(e)   Temperature responses to exercise.

(f)   Effort response to exercise.

(g)   Pulse variation.

(h)   Response to diagnostic tuberculin. ( To be used with great discrimination, and focal as well as constitutional reaction noted. This test is not of paramount importance.)

(i)   Mental depression.

(j)   Appearance suggesting toxemia,

(k)   Sleep.

(l)   Weight (coat and vest off). State recent variations, if any.

3.   Sputum tests. Nature and number of tests to be stated. Repeated bacteriological examinations to be made, and concentration method is to be used where necessary. Animal injection (guinea pig) in cases of pleurisy with effusion.

4.   Inspection. Local evidence from physical examination.

5.   X-ray report - routine procedure.

(1)   Screen examination - to investigate -

(a)   Movements of diaphragm.

(6)   Normal clearness or otherwise of bases, presence of pleuritic adhesions (costo-phrenic symphisis), fluid, &c.

(c)   Presence and distribution of gross densities.

(d)   Appearance of heart and aorta.

(2)   Transverse 10 x 12 film of upper half of thorax includes essential parts, if fluoroscopy shows and basal abnormality an additional 10 x 12 film should be taken at upper border of clavicle on affected side.

6.   Summary and diagnosis. (Consultant opinion to be obtained, if required.) It is especially desired that ambiguity should be avoided in recording dates or periods, as well as in stating casuation of unemployment, absence from work and of medical attendance.

Out of a total of 2,160 cases suffering from diagnosed or suspected pulmonary tuberculosis, 1,140 cases had been reexamined up to the 30th June, 1926. Of this latter number it was found that 811 were suffering from "proved" pulmonary tuberculosis. The annual liability of the Commonwealth had increased by £20,000 in respect of the pension of 284 ex-soldiers, of the 811 cases, being raised to £4 4s. per fortnight, with resultant and corresponding increases to their dependants. But, of course, their pension could not be increased to £4 4s. until it had been proved that they were suffering from pulmonary tuberculosis on or after 1st July, 1925. These figures show that when the re-examination took place of the 1,140 sufferers, who up to that time had been diagnosed as suffering from the disease, about 300 cases were reported "unproved." As far as I can understand the amendment moved by the honorable member for Herbert (Dr. Nott), these 300 cases, some of which have, no doubt, since been proved to be suffering from pulmonary tuberculosis, would be met, since it could not be shown under the regulation as it now exists that they were entitled to receive a permanent pension of £2 2s. a week. It seems to me that the amendment, if acceptable to' the Minister, would meet the wishes of the honorable member for Adelaide.

Mr Yates - Oh no! That is practically the present law. What about those who would get no pension at all?

Mr D CAMERON (BRISBANE. QLD) - The present law is quite clear. It provides that those examined on or after the 1st July, 1925, and proved to be suffering from the disease, would be entitled to receive a permanent pension of £2 2s. a week. That does not include, for instance, the 300 out of the 1,140 exmembers of the A.I.F. who were reexamined after 1st July, 1925, and who were found to be not then suffering from proved pulmonary tuberculosis. But the amendment would bring them in, and I take it that they would be entitled to £2 2s. a week for life, and, if the medical decision warranted it, £4 4s. a week. If appears to me that there has been misunderstanding even in the variousbranches of the Repatriation Department throughout the Commonwealth in regard to the instructions about tubercular cases, and I doubt whether uniform action has been, taken in the various States. Apparently years sometimes pass before it can be established beyond doubt that an exsoldier is actually suffering from this disease. In one case that has come under my notice it is stated that the man was employed, on his discharge from the Australian Imperial Force in 1919, in the Accounts branch of the Repatriation Department. He had been ill since February of that year. I believe that he suffered a severe hemorrhage in the office of the department. He was examined by a medical officer in Brisbane and was sent on to a medical board. He -then had to go before another medical officer, and, finally he was examined by the " T.B " officer of the Queensland Government, who certified him to be suffering from pulmonary tuberculosis. He was sent to Kyoomba Sanatorium, near Stanthorpe, in March, 1919, and was discharged in the following July. He was in receipt of the full pension to June, 1921. He then had three-quarters, and half pension, which was subsequently increased to the full pension in 1923. He was accepted by the Repatriation Commission in December 1922, as suffering from tuberculosis due to war service. He was sent to the Kyoomba Sanatorium again in January, 1923, and was discharged in the following April at his own request. He received the full pension at each review since 1923. His disability was then disclosed by the Principal Medical Officer of Queensland as not proved pulmonary tuberculosis. That is the position of this man after five years of treatment. His malady is still regarded as not proved as being due to war service. I think that the Minister could do a great service to those unfortunate sufferers, if he would issue instructions at the earliest possible moment that all outstanding cases that were not accepted as " proved " be again examined without delay. The honorable member for Ballarat (Mr. McGrath) quoted what appeared to me to be an astounding case. I did not quite understand whether he said that he had asked the Minister to investigate it.

Mr MCGRATH - The Minister was away at the time.

Mr Yates - Why should the honorable member have to take the case to the Minister?

Mr D CAMERON (BRISBANE. QLD) - I feel sure that if it could have been shown to the Minister that there was any connexion between the man's disability and his war service, he would have received the pension long ago. I have had a number of cases under my personal notice, and one, in particular, to which the Minister referred. It was that of an unfortunate married man who never got as far as France or any theatre of war. He landed in England in midwinter, and had to remain in one of those camps which, as some of my friends know, imposed rather a severe test on the men, and there his trouble began. He did not hear a shot fired, because his health did not permit of his being sent into the field. For some years after his discharge he carried on in Australia without tubercular trouble appearing; but in the last two or three years he has suffered from it. The Minister investigated the case and personally interviewed this ex-soldier, who is now in receipt of a full pension. He has a wife and child, and he received a considerable sum as back payment for the years during which it was finally decided that he should have been in receipt of the pension.

Mr Yates - I have a similar case before me,, and the Minister will not look at it.

Mr D CAMERON (BRISBANE. QLD) - Speaking as a layman, I think that this case was finally proved because it was shown that before the man left Australia in 1917 he was in camp for two years on home service. He was not fit to go into the field; but, apparently, in 1917, when it was difficult to get recruits, he was accepted for service in the field. But the day before he went aboard thetroopship seventeen of his teeth were removed, and it was impossible for him to take the food provided. He was not provided with artificial teeth, and I think that it was agreed that owing to the hard time he had experienced in camp, together with the loss of his teeth, his general health was affected.

Mr Yates -i looked at the papers in that case, and the board indicated that the man was to be given the benefit of the doubt. I know another case identical with that quoted by the honorable member, but the Minister will not give the man the benefit of the doubt. The man's wife and child are now earning their own living.

Mr D CAMERON (BRISBANE. QLD) - I agree that that should not be necessary; but if it is possible to establish any connecting link between an ex-soldier's disability and his war service, there certainly should be no hesitation in granting the pension. I know that the members of the Medical Advisory Board that sits in Melbourne are eminent members of their profession, who give their services voluntarily, and in cases of tuberculosis, particularly, they are anxious to give exsoldiers the benefit of any doubt that may exist. Another case that I have under my notice is that of an ex-member of the service suffering from tuberculosis. Years after the war ended he developed this complaint, and he was not granted the pension until he was able to bring definite prpof, certified by two or three members of his regiment, that for three nights while serving with his unit in the field he had a most gruelling time, and suffered from a heavy cold; The honorable member for Adelaide has given us a vivid description of some of the nights that he experienced during his term in the Aus tralian Imperial Force, and this man had very similar trials. He spent nights in mud and slush, and that alone was sufficient to justify the granting of the pension, on the ground that his disability could be connected with his war service. I feel sure that every effort is being made by the Commission and the Minister to give the soldiers the benefit of the doubt whenever possible.

Mr Coleman - What benefit would result from the acceptance of the amendment?

Mr D CAMERON (BRISBANE. QLD) - It appears to me that it would cover the men referred to in the letter that all honorable members have received from the Tubercular Soldiers' Association in New South Wales.

Mr Coleman - Will the honorable member read that letter?

Mr D CAMERON (BRISBANE. QLD) - The letter reads -

Sir, -I have been instructed by my branch of the above association to get in touch with you and endeavour to enlist your sympathy regarding the matter of permanent pensions for tubercular soldiers.

There can be no doubt that when this act was passed, it was intended by members of the House to grant all men who have been proved by medical evidence to be suffering from tuberculosis due to war service, a permanent pension. The act now reads - "all men proved to be," which is a totally' different matter.

Under the present reading of the act, a soldier who is only proved once since 1st July, 1925, is eligible, while men who have been consistently proved for eight years prior to the passing of the act and have, through clean living, &c, become an arrested case though still unable to either follow or consistently follow any occupation, are not eligible. We appeal to you for your support in this matter, which requires immediate attention.

Our members look to you, sir, to right what we consider a grievous wrong, and give us what was first intended when this act was passed, viz., a permanent pension to all soldiers who have, since their return from active service, been accepted by the Repatriation Department as suffering from tuberculosis due to or aggravated by war service.

I take it that the amendment moved by the honorable member for Herbert (Dr. Nott) covers those men who, prior to 1st July, 1925, had been accepted as having contracted tuberculosis during war service. The motion, as amended by the honorable member for Herbert, will read -

That all ex-members of the Australian Imperial Force who served overseas and have since their return from active service been accepted by the Repatriation Department as suffering from tuberculosis due to or aggravated by war service shall be deemed to be suffering from a war disability. . . .

I should like to place on record the statements of the Minister for Repatriation made on the 21st August, 1925, to this effect -

We come now to the crux of the whole question. Honorable members, I know, are anxious to ascertain the views of the Government with reference to tubercular cases. The commission recommends -

A permanent pension in some degree be paid where tuberculosis has resulted from war service.

The Government has decided to accept this recommendation, and it will be given effect to from the 1st July last.

Mr Coleman - What will be the basis of the permanent pensions?

Sir NEVILLE HOWSE - I am about to explain. Ex-members of the forces proved to be suffering from tuberculosis as the result of war service will be paid a permanent pension of not less than £2 2s. a week, but will be required to present themselves for periodical medical examination in order that they may be advised as to the progress of the disease and the necessary treatment. There will be no right or authority for the pension to be reduced at any time, but it can be increased if the disability has become worse.

Mr Coleman - Are they to receive two guineas for life whether they are cured or not?

Sir NEVILLE HOWSE - Am I not speaking clearly enough? Each of these men will receive at least £2 2s. a week independent of his condition as disclosed on re-examination.

He will only be re-examined for his own benefit, so that he will know what progress he has made, and be told the line of treatment he should pursue. The pension will not be reduced under any circumstances.

I also wish to quote the following passages from a report of the Repatriation Commission for the year ended 30th June, 1926:-

The remarks published in former reports regarding treatment in sanatoria can be reiterated, but it is noted that patients are now more willing to return for treatment when occasion warrants. There is a definite improvement in the attitude of patients to graduated work, and a vast increase in the amount of useful work performed. On the whole, the majority of -patients who enter sanatoria now are really desirous and willing to co-operate with the medical officers in their treatment. There has, of course, been considerable interest provoked by the reported " cures " for tuberculosis. Numbers of individual patients have approached the commission's medical officers for information on the subject, and on being informed that there was no proof as yet that any of the cures had definite value, seemed quite satisfied to let it rest at that and carry on with slow routine treatment.

The following portion of the report relates to the difficulty experienced in diagnosing tuberculosis : -

The provision of a permanent minimum pension of £2 2s. per week for ex-soldiers suffering from proved pulmonary tuberculosis since the 1st July, 1925, has not been in operation for a sufficient length of time to enable any dogmatic statements to be made concerning the results. It has certainly emphasized the difficulty of establishing a diagnosis be- - yond doubt in many cases of pulmonary disability. The diagnosis of clinical tuberculosis on which many patients have been admitted to sanatoria for treatment has, in several cases, required revision after a period of treatment, and observation in such institutions has failed to establish proof that the tubercle bacillus was the infecting agent. It is recognized that the associated signs and symptoms justify the diagnosis of clinical tuberculosis.

If the Minister would immediately issue the definite instruction that all cases which are still outstanding as doubtful should be re-examined, including particularly those cases which prior to the 1st July, 1925, had been accepted as suffering from tuberculosis due to war service, much of the anxiety which now exists would disappear. These unfortunate men in many instances have lived in hospitals for long periods, and suffer great anxiety and uncertainty about their condition. We have the assurance of the

Minister that it takes a long time to decide whether a person is actually suffering from tuberculosis. As an ordinary layman I must express amazement that it should take years to arrive at any definite diagnosis in such cases.

The Minister referred to the request of those who advocated the appointment of a federal appeal board. I must plead guilty to being one who advocates such a board. I believe thata federal appeal board, constituted on the lines of the appeal boards appointed in Great Britain and Canada, would advance the interests of ex-soldiers incapacitated through war service. I agree that while the present Minister for Repatriation remains in that office individual cases will probably receive better treatment than they would get from any appeal board, but after considerable study of the subject I am convinced that, speaking generally, an appeal board would be most advantageous for the men concerned. Once that board was appointed it would be improper for any ex-member of the Australian Imperial Forces to apply to his parliamentary representative to take up his case; the decision of the board would be final. I do not desire to cast any reflection upon the Medical Advisory Board which now sits in Melbourne. That board has rendered excellent service, but after all it is an advisory board, and the Repatriation Commission is prone to qualify a number of its decisions by stating that the board was consulted, thus throwing the onus for the rejection of an appeal on the board. The Canadian Pensions Act provides that -

There shall be a board known as " The Federal Appeal Board " consisting of not less than three nor more than seven members appointed by the Governor in Council on the recommendation of the Minister of Justice.

The , majority of the members shall be persons who served in the naval, military or air forces, of Canada during the war.

Each person shall devote the whole of his time to the performance of his duties under this act, and shall not accept or hold employment inconsistent therewith.

At present much of the trouble and distress is attributable to doubt, and to the long delays to which many cases are subjected, and I am confident that a similar board in Australia would best meet the needs of our returned men.

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