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The Services.ROYAL NAVAL MEDICAL SERVICE.

Surg. Lieut. G. A. M. Anderson is promoted to SurgeonLieutenant-Commander.

--

ARMY MEDICAL SERVICE.Col. W. E. Hardy retires on retired pay. Temp. Col. Sir A. Chance relinquishes his commission and

retains the rank of Colonel.

ROYAL ARMY MEDICAL CORPS.Lieut.-Col. B. Forde is placed on retired pay.The undermentioned Lieutenant-Colonels retire on retired

pay: S. J. C. P. Perry, W. L. Baker, J. G. Churton,T. Biggam, H. A. Davidson.Major N. D. Walker to be temporary Lieutenant-Colonel

whilst specially employed.The undermentioned relinquish the acting rank of Lieu-

tenant-Colonel : Majors T. J. Potter and P. C. T. Davy; Capt.C. H. K. Smith.Major M. P. Leahy is placed on retired pay on account

of ill-health caused by wounds.The undermentioned relinquish the acting rank of Major :

Capt. A. E. Richmond ; Temp. Capts. C. D. Faulkner, B.Knowles, 0. R. L. Wilson, J. R. Griffith, D. Fisher.Capt. W. T. Hare resigns his commission and is granted

the rank of Major. --

A. L. Aymer, late Captain, R.A.M.C., to be Captain.Lieutenants (temporary Captains) to be Captains: G. H.

Barry, M. McG. Russell, F. G. L. Dawson.To be temporary Captains : G. Cock, late temporary

Captain; E. S. Joske, late Captain, A.A.M. Corps; H. Bell,late Can. A.M.C.

Officers relinquishing their commission :-Temp. Majorsretaining the rank of Major: W. S. Haughton, H. E. L.Canney. Temp. Capt. J. E. Ainslev, on transfer to the IndianMedical Service. Temp. Captains granted the rank ofMajor: H. N. Webber, S. E. Picken, N. E. Kendall, C. C.de B. Daly, R. Massie, J. H. Peek. Temp. Captains retain-ing the rank of Captain: J. S. K. Smith, S. W. H. Stuart,A. F. Sanderson, V. D. Pennefather, F. Shearar, G. B.Buckley, A. P. Mitchell, A. H. Holmes, J. F. O’Mahoney,R. G. Higgen, G. H. Winch, R. L. Hughes, C. R. Macleod,C. C. Brewis, A. Hines, S. Broderick, H. Hannigan, D. F.Brown, L. W. Evans, R. C. Poyser, R. B. Johnson, T. J.Cobbe, B. C. Haller, E. D. S. Heyliger, P. Black, W. Forsyth,W. N. H. Bell, D. J. Bedford, J. S. Williamson, J. Lascelles,T. D. Miller, J. L. Meynell, H. W. Hues, R. Hodson, E. G. B.Carpenter, E. R. Holborow, J. J. Robertson, W. S. I.Robertson, M. Dockrell, C. L. Spackman, J. H. Marshall,W. G. Hopkins, T. R. Fulton, S. W. Milner, A. C. Meek,J. M. Anderson, D. 0. Richards, H. S. Stockton, T. G.Elsworth, H. G. Parker, T. B. Vaile, W. J. F. Symons, N. B.Laughton, C. C. Okell.

SPECIAL RESERVE OF OFFICERS.

Capt. C. Nicholson relinquishes the acting rank of Major.Capts. J. P. Charnock (granted the rank of Major), P. F. A.

Grant, F. Griffith, L. K. Ledger, G. R. McRobert, E. W.Mann relinquish their commission.

TERRITORIAL FORCE.

The undermentioned officers to be Lieutenant-Colonelsand to command the Field Ambulance: Majors J. M. G.Bremner (2nd East Anglian), D. Rorie (Bt. Lieut.-Col.)(2nd Highland), E. B. Bird (Bt. Lieut.-Col.) (3rd Wessex),A. E. Kidd (3rd Highland), A. Callam (2nd East Lancashire),E. H. Cox (3rd East Lancashire), J. W. Leitch (lst Lowland),J. W. Eeay (3rd Lowland), T. A. Barron (lst North Midland),D. L. Fisher (2nd Northumbrian), P. R. Ash (3rd North-umbrian), F. Whalley (2nd West Riding), T. Donovan(1st Welsh), C. L. Isaac (3rd Welsh); Capts. J. F. MacIntosh(lst Highland), A. T. Falwasser (lst Home Counties), H. G. G.Mackenzie (3rd Home Counties), C. S. Brebner tlst London),R. E. Bickerton (2nd London), R. M. Vick (3rd London),J. MacMillan (5th London), H. K. Dawson (6th London),J. F. Dixon (2nd North Midland), J. Miller (3rd North Mid-land), R. A. Broderick (2nd South Midland), T. A. Green(3rd South Midland), W. Lister (1st West Riding).Major W. G. Mitchell is restored to the establishment.Capt. F. R. Humphreys to be Major.1st Western General’ Hospital : Capt. T. P. McMurray is

restored to the establishment.

ROYAL AIR FORCE.Medical Branch.—Lieut.-Col. G. N. Biggs (Major, R.A.M.C.,

T.F.) relinquishes his temporary R.A.F. commission onreturn to Army duty and is permitted to retain the rank ofLieutenant-Colonel. ICapt. C. E. Thwaites is transferred tp the unemployed list.

Parliamentary Intelligence.HOUSE OF LORDS.

WEDNESDAY, APRIL 28TH.EXPERT INQUIRY ON SHELL SHOCK.

Lord SOUTHBOROUGH called attention to the differenttypes of hysteria and traumatic neurosis, commonly called"shell shock," from which many soldiers suffered duringthe war, and referred to the death penalty inflicted uponmen by courts-martial on the charge of "cowardice" "

(without inviting any reopening of the evidence in suchpainful cases); and moved that the Government shouldmake inquiry either by a Select Committee of the Houseof Lords or by a Departmental Committee into theexpert knowledge derived by the army medical autho-rities and the medical profession with the object ofrecording for use in time to come the experiences ofthe war, and to advise whether by military education orotherwise some scientific method of dealing with such casescould not be devised. He said this was a vast and com-plicated subject which must be approached with care andcircumspection. The subject of shell shock could not bereferred to with any pleasure. All would desire to forget it-to forget the cases, extraordinary and mysterious, with whichwe had been confronted; to forget the roll of insanity, suicide,and death ; to bury our recollections of the horrible disorder;and to keep on the surface nothing, but cherish the memoryof those who were the victims of the maligmty. But theycould not do this, because a great number of the cases ofthose who suffered from shell shock and its allied disorderswere still upon our hands and deserved our sympathy and care.

The Identification of Shell Shock.It was aiso our duty carefully to record all the knowledge

and experience acquired by our medical and administra-tive authorities. He was inclined to think that thedisorder now called "shell shock must have occurred insome of the fierce and bloody battles of the past and thatamong its victims were many whose condition was neverproperly understood, and who suffered the penalty of death.He believed that he was right in saying that whatevermight have been the diagnosis at the beginning ofthe war there was now a fairly general consensus ofopinion here, in France, and in America, that theywere cases of varying and differing types of hysteriaor traumatic neurosis common and well known in civillife, well understood by medical practitioners, and fre-quently met with in railway and other violent accidents. Ifit was a fact that a true identification of the disorder waswanting in the early months of the war he feared that throughinadvertence and want of knowledge dreadful things mighthave happened to unfortunate men who had in fact becomeirresponsible for their actions.

Shell Shock and Hysteria.It was clearly not long, however, before our army medical

authorities, in common with the French, fully realised thegravity of the disorder and appreciated that if one under-stood hysteria they were well on the way to understand" shell shock." This was all for the good, but it did not infact lighten responsibility, for hysteria was a very seriousand dangerous malady, and not only did it present itself invarious forms and types, but it became in a sense con-tagious, because men became open to suggestion throughexpectation. And only too often such expectations wererealised. If it might be assumed that shell shock wasnow recognised to be a type of hysteria differing but littlefrom the traumatic psycho-neurosis observed in civil life,then it should be amenable to the same therapeuticmeasures both for prevention and cure. These andother matters relating to treatment offered an interest-ing field for inquiry, evidence, and records. There wasevidence that " shell shock " or hysteria was not confined tothe untrained soldier. This meant, no doubt, that in somecases after wear and tear the nervous system refused to domore. But it also meant that the seasoned soldier hadprobably suffered already from shell shock," had beeninvalided, and then returned to the front. Was it not worthwhile to inquire whether, when a man had been badlydamaged by " shell shock," it was safe either for himself orhis colleagues to allow him to return to the fighting line ?There were many thousands of cases of shell-shocked mendischarged to pension or invalided out of the service.Some investigation, not of individual cases, but ofclasses of cases, might be expedient. In quasi-mentalcases he could imagine no more miserable fate fora patient than a continued course of absolute idle-ness, and the health and condition of a large numberof men doing nothing but draw their pension mightbe greatly improved by an organisation designed to givethem a little work as a beginning. He feared there were anumber of cases of mental type so severe that the hope of

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the restoration of the mind had practically been abandoned.Were these to be permanently kept in homes, and was thetreatment there the most desirable for them ? Again, was itwise that various classes of the disorder should be mingledtogether ? The real question in cases of dereliction of dutywas whether there was loss of will-power. What power hadthe courts-martial to make inquiry into the condition ofthe man’s mind ? It was obvious that in cases of hysteriato ascertain truly the condition of the prisoner’s men-tality and will-power was of the first importance.He gathered that where a plea of insanity was

entered at a court-martial the medical officers were notallowed to report generally on the prisoner’s state of mind.The man, possibly one with a low order of mentality, mighthave entirely lost his wits on the day of the battle, and a fewweeks later might have practically recovered. In recentyears, through the humanity of the judges and the establish-ment of the Court of Appeal, the rules in McNaughton’s case-the case of the murderer of Drummond, Sir Robert Peel’ssecretary-had been relaxed and the judges had approachedthe position that responsibility might be abrogated by lossof control if arising from mental disease or infirmity and notthrough the accused person’s own conduct. But it wouldappear to be otherwise under military law, under which, if thedefence of insanity was raised, it could only be resolved bya rigid application of the McNaughton rules.

Military and Civil Considerations.Inquiry might fairly be made as to whether the military

and the civil law should not be put upon the same footing.Was it possible, the noble lord asked, to prepare the mindsof soldiers against the disasters of hysteria and neurosis ?Dr. Morton Prince, a distinguished physician of Boston(Massachussetts), had given great attention to the subject athome, at the base, and in the hospitals of France andEngland. He was of opinion that it might be driven into asoldier’s mind as part of his ordinary training that "shellshock" was a form of hysteria, due to his own thoughts andfears, and external suggestion arising from the condition ofthe modern battlefield, and that as long as he received nophysical injury there was little danger to be apprehendedfrom the disasetr. The efficiency of the army and of futurearmies might well be impaired by shell fear (as they calledit in America), and it was worth considering whether somemethod of giving confidence by training and educationmight not be devised by a committee. Upon the committeeof inquiry it would be important to have the best armymedical representation that could be found, and he suggestedthat their lordships’ House might be represented by LordDawson of Penn, until recently Sir Bertrand Dawson. Two

representatives of the House of Commons would also be

important. A naval medical officer might be put on thecommittee, as the results of shell fighting at sea were

distinctly different from those of shell fighting on shore.Lorcd Horne’s I’iears.

Lord HORNE, as a general officer who had commandedlarge forces in the field, cordially supported LordSouthborough’s motion. He was convinced from his ownpersonal experience that there was a tremendous field ofresearch open to any committee established with the objectreferred to by the noble lord. In the later part of the war ifthere was the shadow of a suspicion that a man’s crime mighthave been caused by any of the forms of hysteria which were eincluded under the term "shell shock" he could confidentlystate that the sentence was not confirmed until the accused hadbeen under the observation of medical authorities or detainedfor a time at one of the detention establishments and givenevery opportunity of allowing those in authority to arrive ata decision, whether his mental balance had in any way beenaffected or not. He was much struck by the suggestion that aninquiry by a competent committee might lead to some formof mental exercise that would enable them to train soldiers toendure the nerve-shattering conditions which led to thisform of "shell shock." Personally, he thought it was ex-tremely probable that some methods might be devised whichwould lead to that end. But the term "shell shock shouldnot occupy people’s minds too much, because many of thosewhose mental balance gave way during the war did not losetheir self-control from anything to do with a shell, but fromthe general effects of extreme tension on a highly organisednervous system. It was those, possibly, of the lower men-tality and lower organisation ; those whom nature hadendowed with a more easy-going temperament, whowere less likely to suffer from any form of "shell shock." Fear, after all, was met by whatever effort was necessaryto control the nerves. Under the novel conditions of amodern battlefleld there was no man who did not sufferfrom fright. The man who got through was the man whoretained the power of controlling his nerves.

The Need for Special Medical Advice.Viscount HALDANE said he agreed with the grounds stated

by Lord Southborough, but lie was not quite sure that theremedy he proposed by his motion was right. It was nowknown that want of mental control was in a good many

cases the result of an actual physical cause. For instance,the shock of an explosion might physically inhibit the actionof the nerves which controlled breathing; the supply ofoxygen to the blood, and therefore to the brain, might beimpaired. The result was that the individual was for thetime being, and perhaps for some time after, a differentpersonality. There was much more than a question for theordinary experts. All that could be done, he thought, was tocollect the very valuable body of evidence which had beengot together lately. There were investigations at the TaplowHospital, under the direction of the War Office, which wereof the utmost value, and others had been going on all overthe country. He agreed that the matter required theclosest investigation. It had too often, however, been thecustom because a man was a very eminent medical man toask him to investigate a branch of a very great sciencewhich had ramifications with which he was not familiar. Ina matter of this kind they ought to get together a smallbody of picked men of the highest eminence in thisparticular branch of investigation. A small investigatingcommittee of this kind brought together by the War Office,could, roughly, at all events, lay down certain standards.

Expert Inquiry Granted.Viscount PEEL (Under Secretary for War), replying for

the Government, said that the instructions to courts-martial during the war were that where the soldierin his defence or in mitigation of punishment urgeda substantial plea on medical grounds a medical witnesswas invariably to be called either to substantiate or

rebut the case before the finding, if it was in defence,and afterwards, if it was urged in mitigation of punish-ment. In practice the court adjourned and a medicalboard was held ; and on the adjourned hearing one or moremembers of the board would be called to give evidence as tothe facts observed and their conclusions on these facts. Amental specialist was always included if their was anysuggestion of " shell shock " or any other kind of mental ornervous derangement. A medical board was always heldbefore any action was taken to confirm a death sentence.The number of cases in which such sentences were carriedout was exceedingly small. For cowardice 18 death sentenceswere carried out and 266 for desertion. The total number ofdeath sentences carried out was 343, whereas the total numberof such sentences passed on officers and men was 3076. Asregards the request for an inquiry, the view of the Governmentwas that great advantages might be obtained from such aninvestigation. Many of the nervous and mental conditionsencountered were entirely new to many of the medicalofficers concerned, and there had been a great many expres-sions in different medical journals of their individual viewson the subject. It was thought that it would be of greatvalue if these different views could be gathered togetherand thoroughly investigated by such a committee as hadbeen suggested. The composition of the committee was amatter for consideration later. Besides experts in theparticular subject, it might be considered whether fromthe discipline side a lawyer and a soldier might also beincluded.—The motion was agreed to.

HOUSE OF C O M M O N S.

. WEDNESDAY, APRIL 28TH.Indian ilediclcl Service Pensions.

Colonel YATE asked the Secretary for India if he could nowstate what increase was to be made in the pensions of thewidows, children, and dependents of deceased officers of theIndian Army, the Indian Medical Service, and the RoyalIndian Marine.—Mr. MONTAGU replied : I am still awaitingthe views of the Government of India. I have againimpressed on them that the matter is urgent.

Contaminated and IPtfcctious Stores.Mr. Jumrr DAVISON asked the Minister of Health whether

lie had received any resolutions of protest from the varioustrade-unions and other organisations in the district of Bowand Bromley strongly protesting against the dumping ofinfectious and contaminated surplus stores of Governmentwar materials in that district, and demanding that all suchstores deposited there should be destroyed at once and nofurther quantities allowed to be landed in this country as, intheir opinion, this dumping was responsible for the,outbreakof small-pox in that district; and whether he could statewhat action he proposed to take in the matter.-Dr. ADDISONreplied: I have received a resolution of protest from the Bowand Bromley Local Labour Party in regard to this matter.The stores referred to are in course of removal, and it isexpected that the removal will be completed by the end ofnext week. These stores will be thoroughly disinfected anddeposited in premises which have been secured for thispurpose outside London. The disinfection is being carriedout under the supervision of one of the medical officers of theMinistry of Health. I am informed that no stores belongingto the Ministry of Shipping which are known to be infectedare allowed to be placed in store until they have beenadequately disinfected,

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The Supply of Midwives.Mr. BRIANT asked the Minister of Health if he would state

the number of practising certified midwives in the UnitedKingdom and the approximate number required for theproper care of maternity cases; and what steps, if any, theMinistry proposed to take in order to secure that an adequatesupply of midwives should be available.-Dr. ADDISONreplied in a written answer : According to the last report ofthe Central Midwives Board the number of women entitledto practise as midwives on March 31st, 1919, was 44,166, butthe number who gave notice of their intention to practisein 1918 was only 11,298. No useful estimate can bemade of the total number of midwives required. Theshortage which exists in some districts is due tothe fact that the number of cases within reach istoo small to enable a midwife practising indepen-dently to make a living. The Ministry have con-

tinued the policy of the Local Government Board ofurging local authorities and nursing associations to sub-sidise midwifery in the more scattered districts and of

paying grants in respect of such subsidies. By this meansthe proportion of the rural population served by trainedmidwives has increased since 1917 from 51 per cent. to 65 percent., and steady progress is being made. Nearly all thecounty councils and county nursing associations have framedschemes for extending the midwifery service of their counties.A number of local authorities in urban areas have also, withthe assistance of the Ministry, subsidised the provision oftrained midwives in parts of their districts in need of thisservice. A grant in aid of the training of women as mid-wives has been authorised, and is being administered by thePresident of the Board of Education.

After-Care of Consumptives.Major ENTWISTLE asked the Minister of Health whether

his attention had been drawn to the report issued by theKingston-upon-Hull Insurance Committee dealing with theadministration of sanatorium benefit for the year endingDec. 31st, 1919, in which it was pointed out that a largeproportion of the number of persons who applied forsanatorium benefit died within a comparatively short periodafter treatment where such treatment was not followed upby effective after-care; whether he was aware of the strikingimprovement which had taken place in Hull since theestablishment of an after-care committee; and, if so,whether it was the policy of the Minister in his schemefor combating tuberculosis that after-care would form anintegral part thereof and receive liberal financial encourage-ment from Imperial sources.-Dr. ADDISON replied: Theanswer to the first three parts of the question is in theaffirmative. As regards the last part, the financial arrange-ments in connexion with the scheme for combating tuber-culosis are under consideration.

Diet and Clothing for Tuberculous Ex-soldiers.Mr. RUPERT GWYNNE asked the Pensions Minister whether

his attention had been drawn to the fact that it was notgenerally known among ex-Service men suffering fromtuberculosis that they were entitled to extra diet allow-ance, and special bedding and clothing -where necessary;and if he would give instructions to local War PensionsCommittees to have this information more widely circulated.- Major TRYON replied: Inquiries which have been made donot support the suggestion contained in the question.Moreover, the conditions under which special diet andclothing can be provided are fully set out in the LocalWar Pensions Committee Handbook, copies of which havebeen supplied gratis to the headquarters of the variousex-Service men’s associations. The handbook is now beingplaced on sale, and the local branches will thus be enabledto obtain copies for the information of their members.Mr. RUPERT GwYNNE asked the Pensions Minister

whether he could see his way to issue instructions forextra clothing and bedding to be given from time to time toall ex-Service men certified to be suffering from tuber-culosis instead of providing it on loan in certain cases.-Major TRYON replied: Where open-air home treatment isordered extra blankets which are certified to be necessaryare supplied, but not on loan, nor is the cost recovered.Extra clothing is provided as an incident of treatment andnot in supplementation of pension, but in certain cases menhave expressed the wish to purchase clothing on thetermination of treatment, and the question whether thiswould be practicable is being considered.

THURSDAY, APRIL 29TH.Insanitary Pertsians Offices nt Hastings.

Mr. JOHN DAVISON asked the Pensions Ministry whetherhe had received any complaints from the staff of theHastings War Pensions Committee and Medical Refereesprotesting against the insanitary condition of the officesoccupied by that staff and committee; whether he wasaware that the medical referees who had held examinationsof disabled men in the building unanimously condemnedit on account of the unhealthy atmosphere, and on someoccasions refused on that account to examine men suffering

from open wounds; that these premises were for someyears occupied by a department of the Corporation, butthat, in consequence of excessive absences through sicknessof the members of their staff, the Corporation decided tovacate them; and whether, in view of the unsuitability ofthese premises as offices and their general unhygienic condi-tion, he would make inquiries into the matter, with a viewto securing accommodation in a more healthy situation.-Major TRYON replied: The answer to the first part of thequestion is in the affirmative. The suitability of the accom-modation now in occupation by the Hastings War PensionsCommittee has been under the consideration of the FirstCommissioner of Works, who is, I understand, endeavouringto secure other accommodation.

.

MONDAY, MAY 3RD.Orthopœdic Cases in Birmingham.

Mr. HALLAS asked the Minister of Health whether he wasaware that the Discharged Soldiers’ Committee of theCitizens’ Committee of Birmingham was finding difficultyin dealing with orthopædic cases in consequence of themassage staff being too small; and whether he could providethe necessary relief.-Major TRYON (Parliamentary Secretaryto the Ministry of Pensions) replied: There are a number ofvacancies in the Ministry of Pensions Massage Service, butit is expected that these will shortly be filled. The necessaryadditions to the staff at Birmingham will be made as soonas possible.

Blind Vlerrabers of Advisory Blind Committees.Viscountess ASTOR asked the Minister of Health whether

instructions had been issued to all local Advisory BlindCommittees to have among their members one blind personelected as a representative of the blind in the committee’sarea; and whether, if a local committee failed to complywith these instructions, or, while appointing a blind repre-sentative, failed to summon him to meetings of the com-mittee, any steps could be taken by the Minister to enforcehis wishes on the local committee.-Dr. ADDISON replied:In reply to the first part of the question I gave instructions,on the advice of the Central Advisory Committee, thatwherever practicable vacancies occurring in these localcommittees should be filled by blind persons until at leastone-third of the committee (excluding representatives fromlocal authorities) were blind persons, and this proportionhas not been reached in nearly all cases. As regards thelatter part of the question, the final appointment of membersrests with me, and if the honourable Member will furnishme with particulars of any case in which a person so

appointed has not been summoned to meetings I will havethis matter looked into and dealt with.

TUESDAY, MAY 4TH.Foreign Service Roster for Medical Officers.

Lieutenant-Colonel BUCKLEY asked the Secretary for Warand Air if he would state what method of selection wasadopted in detailing Royal Army Medical Corps officers forduty in India; whether a roster of previous service at homewas maintained; and whether consideration was given toservice in the theatres of war in detailing officers for India.-Sir A. WILLIAMSON (Financial Secretary to the War Office)replied: A foreign service roster for officers of the RoyalArmy Medical Corps is kept. Officers are detailed forservice in garrisons overseas in accordance with this roster,except in the case of any officer who, on account of specialqualifications which he may possess, is required for specialduty in the United Kingdom. When an officer who hascompleted a tour of service in India again becomes due forforeign service every endeavour is made to post him to acolony, but this must necessarily depend on the demands forreinforcements and numbers of officers available. With regardto the last part of the question, due consideration is given toservice in theatres of war other than France and Italy.

Medical Men OM Sessional Engagements.Mr. ROBERT YOUNG asked the Pensions Minister if he

would state the number of pensioned retired regular navaland military medical men employed by the Ministry on asessional basis besides those employed at a salary ; howmany sessions could be put in in a day; whether this wasoften the most lucrative method of payment for the afore-said medical men; and whether, on account of the shortageof work, many demobilised civilian doctors were only gettingthree or four sessions per week which in many casesrepresented their whole income.-Major TRYON replied: Thenumber of retired regular officers employed by the Ministryon a sessional basis who are drawing pensions is 152, being5 per cent. of the total number of medical men so employed.The maximum number of sessions is 11 per week, but owingto the number of medical men available for the work theaverage number of sessions per week which can be given toeach man is considerably less.

Darageroics Drugs Bill.Mr. SHORTT (Home Secretary) introduced a Bill to regulatethe importation, exportation, manufacture, sale and use ofopium and other dangerous drugs, which was read a first time.