w^lOfe __3^ COMMONWEALTH OF AUSTRALIA? QUARANTINE SERVICE. SERVICE PUBLICATION No. lO. Cornell University Library HD7106.A8A5 1916 An analysis of the causes of invalidity 3 1924 002 410 367 ,YSIS OF THE Causes of invalidity in respect of Claims under the Invalid and Old-age Pensions Act J. H. L. CUMPSTON, M.D., D.P.H., DIRECTOR OF QUARANTINE ISSUED UNDER THE AUTHORITY OF THE TREAaURER OF THE COMMONWEALTH L 0.1448. ALBERT J. MULLETT, OOVKRNMENT PRINTER, MELBOURNE ^W^ CORNELL UNIVERSITY LIBRARY NEW YORK STATE SCHOOL OF INDUSTRIAL AND LABOR RELATIONS THE GIFT OF The Family of Dr. I M. RuBiNOW 1875-1936 tJyufeatt, tS^iii'aua. The original of tliis book is in tlie Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924002410367 An Analysis of the 'Causes of Invalidity in respect of Claims under the Invalid and Old-age Pensions Act. By J. H. L. Cumpston, M.D., D.P.E., Director of Quarantine. The Invalid Pensions Act was proclaimed on tlie 18th ITovember, 1910, and came into operation on the following day. From that date to the 27th August, 1915, a total of 27,484 individual invalid pensions has been granted. As the Act had thus been in operation for nearly five years, and a considerable number of cases had been dealt with, it was thought that the information collected was sufficiently extensive to justify its examination, and it was considered that a unique opportunity was offered of obtaining some valuable information as to the distribution of disease throughout Australia. There is in existence no other administrative machinery offering so complete a means for the discovery of the extent of serious, or rather disabling, illnesses throughout the living community. The registration of deaths, with the accompanying certification of the causes of death, affords no information as to the distribution of disease throughout the living community. The compulsory notification of infectious disease does not cover nearly the same ground, as its application is limited strictly to communicable diseases. The examination of the evidence accumulated during the adminis- tration of the Invalid Pensions Act was therefore considered justifiable, and the Right Hon. the Treasurer sanctioned this piece of work. The evidence available consisted, so far as this investigation is concerned, of the medical certificates of the causes of invalidity given by the medical referees under the Act. These medical referees are medical practitioners of standing throughout the community, and are distributed at most of the large centres of population throughout Australia. The certificates, therefore, considered as statistical material, are free from possible error resulting from some factors of personality, and the fact that the examination of these certificates reveals a note- worthy uniformity of practice in dealing with applicants adds to the value of any results obtained. Almost the whole of the certificates were analyzed by Dr. P. O. Lord, Quarantine Officer, Victoria, and consistency in classification is therefore assured. 1.34.2 V C. l«9. It is necessary, before dealing witli the detailed analysis of 'tie results obtained, to indicate tbe scope of tbe Invalid Pensions Act. This is defined by section 22 of the Invalid and Old-age Pensions Act 1908-1909, the principal provisions of ■which are as follow : — 22. 'No person shall receive an invalid pension unless — (c) he has become permanently incapacitated whilst in Aus- tralia ; (d) the accident or invalid state of health was not self -induced nor in any way brought about with a. view to obtaining a pension; (/) his income or property does not exceed the limits prescribed in the case of applicants for old-age pensions ; Also by section 23 (2), which provides that — The Commissioner or Deputy Commissioner shall in all cases of invalidity, and also in cases of accident where the permanent incapacity, for work is not manifest, direct an exaniination of the claimant to be made by a duly-qualified medical practitioner, who shall certify whether in his opinion the claimant is permanenj;ly incapacitated for work, and shall state the grounds upon which his opinion is founded. The two important points are that pensions are only given to persons over sixteen years of age and only to persons permanently incapacitated from earning their livelihood. Basis of Classification. During the examination of medical certificates it became apparent that no good result would be obtained by carrying the detail of classifi- cation too far. As will be indicated at a later stage, a large proportion of the pensioners were over 50 years of age, and a very great number \ of the certified causes of invalidity were conditions of degeneration of ' the tissues. Very frequently a number of abnormal conditions were specified in respect of one person, and either the certificate was included under .the heading of senility, or the abnormal condition- to which the medical refereee attached most importance was taken as the basis of classification. Occasionally also the certificate, while certainly definite enough for the purposes of the Act, was so worded as to make a precise pathological or clinical classification difficult. Moreover, had a classification in detail been attempted, there would have been produced a table of considerable length, in which a large num- ber of headings, with a total number of cases under each, so small as to be negligible, would have appeared. The lowest total appearing in the table given is spinal curvature, of which there were 31 cases — this is given because it appeared possible that some significance might be attachable io it, but if the item " digestive disorders " had been subdivided into its component parts there would have been a large number of small items to which probably no significance of importance could be attached. The general rule adopte'd throughout the classification was to include any individual certificate under the appropriate heading according to the pathological condition primarily causing the disability. For example, iasanity due to epilepsy, when the insanity was clearly stated to have been due to epilepsy the certificate was included under " Epilepsy," and not under " Insanity." Difficulties were, however, constantly encountered, e.g., although it is definitely accepted that spinal degenerations are mostly syphilitic in ■ origin, yet it was rarely so stated on the certificates, and the general rule was adopted of classifying solely within the limits of the actual text of the certificates. As avoidable confusioji would have occurred had the few cases in which spinal degenerations were stated to have been syphilitic been included under the heading Syphilis, all spinal degenerations were included under the one heading. On the other hand, defective vision was occasionally stated to have been the direct result of some definite cause, e.g., accident or chronic nephritis. In such cases the certificates were classified under the primary condition and not under Defective Vision. The general results of the methods of classification adopted is to group the causes of invalidity under these , primary pathological causes, and to classify all cases under definite, rather than under indefinite, headings. It is recognised that the classification could not be exact by reason of the nature of the material dealt with, but the interpretation of the information given by the medical referee has been as exact as possible. The following detailed remarks will serve to indicate the detail of classification which was adopted uniformly throughout. Acciciewf.— Incapacitation following injury. There was no reason for doubt as to classification under this heading, as the certificate requires a definite statement whether the invalidity was the result of disease or accident. Senility.— This general term has been adopted as indicating a general bodily degeneration, rendering the subject incapable of supporting him- self In many of the medical certificates the term " senility " is actually used- in all others grouped under this heading the description of the patient's condition was such as to leave no doubt as to the appropriate- ness of the classification. Rheumatism and Arthritis. -Vniev this heading have been mcluded acute and chronic rheumatism, gout, rheumatoid arthritis arthritis defonnans, &c.; but valvular disease of the heart resulting from acute rheumatism has been included under Disorders of the Circulatory System. A 2 Disorders of the Circulatory System includes " valvular disease " and its various synonyms, myocarditis, angina, endocarditis, aneurism, arterio-sclerosis, &c. Phthisis.— It would have been desirable to have differentiated between tubercular and non-tubercular " phthisis," as in this way some indication of the effect of occupation upon pulmonary conditions would have been obtained, but owing to the various terms adopted and the impossibility of exactly interpreting their significance, it was inevitable that such conditions as " pneumokoniosis," " fibrosis of the lung," and "miners' phthisis" should be included under the general term " phthisis." This also includes " tuberculosis of the lungs." Hemiplegia and Paralysis includes the paralytic conditions resulting from embolism, thrombosis, haemorrhage ; also . paraplegias resulting from pressure on the cord. Spastic paraplegias have been placed under " Spinal Degeneration," paraplegias from tubercular spine, under " Tubercular disease of bones and joints." Defective Vision. — The causes of this disease were varied, e.g., glaucoma, trachoma, cataract, ophthalmia, optic atrophy, &c. As stated above, in certain instances cases of defective vision were classified under the primary cause. Disorders of the Digestive System include gastric ulcer, pyloric stricture, chronic diarrhoea. Female Disorders. — This somewhat unsuitable term has been adopted to include abnormal conditions peculiar to the female, e.g., prolapse of the uterus, myomata, &c. Congenital Imbecility. — All the certificates under this heading were clearly expressed,- and definitely stated that the cause of the invalidity was lack of intellectual development resulting from congenital causes. This comment applies also to the next heading " Congenital mal- formations." Syphilis.— No case was included under this heading unless the cause of the invalidity was specifically stated to have been syphilis. Insanity. — Included any condition certifiable as insanity. Varicose Veins.— This included only certificates in which the primary cause of the invalidity was stated to have been varicose veins or varicose ulceration. Spinal Degenerations included all organic degenerations of the spinal cord. Epilepsy included only cases so certified. Indefinite.— In several instances the medical referees have been satisfied that the applicants deserved pensions, but were not able to ascribe any very definite cause for the disability. Miscellaneous includes several diseases for which pensions have been granted, but the numbers of such are so few that a separate classification would not have been justified. Examples are hydatids, cystitis, , &c. Cancer includes sarcoma, carcinoma, epithelioma, rodent ulcer. Asthma and Bronchitis. — These two conditions have been included together as a common heading, as the occasions upon which they appeared on the one medical certificate were so frequent that they could not he individually classified. Infantile Paralysis.— The paralysis and deformity resulting from ■ acute anterior poliomyelitis. Tuberculosis of Bones and Joints.— All cases so certified. Nephritis includes all inflammatory conditions of the kidneys, including chronic nephritis. Neurasthenia.— Several pensions have been granted for this as the specified cause. Hernia.— These were chiefly inoperable inguiaal hernia, also ventral hernia following laparotomy. ArhCBmia.—These were chiefly cases of pernicious anajmia. Secondary anaemias occasionally occurred, and when no primary cause was stated these were included as " anemia." When the primary cause was given the classification was adopted. The total number of certificates examined was 22,979. These were .distributed throughout the various States, as follows: New South Wales Victoria South Australia Tasmania Queensland Western Australia 6,952 8,191 2 249 1,770 2,674 1,143 The cases have been tabulated according to both age distribution and the causes of invalidity. Age Distkibittiow. The first interesting point which emerges from a study of this table is that of the age distribution of the persons in respect of whom certifi- cates have been given. These are as set out hereunder :- Totals . . Percentages 16- 20. 1,280 5-57 20- 30, 2,553 11-11 30- 40. 2,686 11-68 40- 50. 4,197 18-26 50- 60. 8,191 35-64 60- 70. 3,496 15-21 70- 80- Over 80. 90. 90 497 75 4 2-16 0-32 0-01 It will be seen that the percentages show that the age distribution is well graduatedj and, having respect to the fact that the standard if eligibility for pensions is permanent inability to earn a living, the various age-periods are represented very much in the proportion that experience of disabling sickness generally would lead one to expect'. N"ot that the distribution is that which should be considered in any way the most satisfactory, for, as will be seen, that is far from being so, but it is in accord with what is known of the distribution of the diseases dealt with from other sources of information. By far the largest proportion is the 50-60 age group, which accounts for 35.64 per cent., or more than one-third, of tiie total. The next in. order of magnitude is the 40-50 age group, which contains 18.26 per cent., or approximately one-fifth, of the total. It will not be inappropriate at this juncture to direct attention to the possibility, by well-directed means, of transferring a large propor- tion of these cases to later age-groups, and so giving large numbers of individuals several more years of active life, as well as saving the nation considerable expense. This aspect will be more completely discussed when the detailed diseases are being discussed. It is, moreover, an unsatisfactory feature of this table that no fewer than 6,519 individuals between 16 and 40 years of age are in receipt of a pension. This number is 28.36 per cent, of the total, and when it is recalled that permanent inability to earn a livelihood is the basis of eligibility for a pension, the result is far from pleasing. Mpre than one-fourth of the total pensions are granted to persons under 40. Causes of Invalidity. The list of disorders included in the table is not perhaps as extensive as might Lave been expected, but the very fact is at once sufficient to arrest attention. The following is the list of the disorders of which there were more than 500 cases. — Eheumatism. Phthisis. Disorders of the Circulatory System. Hemiplegia. Accident. Senility. Defective Vision. Congenital Imbecility. Epilepsy. Degenerations of the Spinal Cord. ' Tubercular Bones and Joints. Cancer. Varicose Veins. Rheumatism. — The high figure under this heading is a surprising feature of this analysis, aiid a perusal of the certificates led at times to the suspicion that the term was not always used by the medical referees with strict clinical accuracy. ITotwithstanding this possibility, however, the fact that chronic inflammatory conditions of the joints plays the largest part in the invalid pensions list must be accepted as indicating the undue predominance of such conditions. The graduated incidence of these conditions on the various age groups increasing from the 16-20 period to a maximum at the 50-60 period, and then again declining, is quite in keeping with the familiar features of the " rheumatic " group of joint disorders. Still, the fact that 28 per cent, of the total number of cases under this heading occurs under 50 years of age invites attention to the possibility of improving the position in this regard. While the rheumatic group of disorders is not to be included in that class commonly referred to as preventable disorders, yet it is obvious that appropriate treatment applied at the time of the first appearance of symptoms will in many cases entirely remove the trouble, and if it does not succeed in aborting the trouble will in most cases very materially delay the arrival of that stage in the disease when the patient has to confess his inability to earn his own livelihood and has to apply for assistance. Almost all, if not quite the whole, of the cases under 50 should be so susceptible to medical treatment that their illnesses could have been delayed to a later period of life, and, bearing in mind the " permanent incapacity " standard, the majority figure might well be removable from the 50-60 period to the 60-70 period. This is an aspect of the invalid pension scheme which might well receive consideration for three reasons — (1) Many persons would be entirely saved the humiliation of having to apply for assistance; (2) the period of inevitable necessity would be delayed ten, twenty, or possibly thirty years, and just as many years of suffering avoided; (3) the Conunonwealth would be saved so much expense. Phthisis. — As has been pointed out, it was found necessary to include in this group both the tubercular • and non-tubercular affections of the lungs, to which are usually applied the term " phthisis." In reality, only two groups have been so included, viz., tuberculosis of the lungs and that non-tubercular condition frequently called " Miners' Phthisis," which is attributable to the effect on the lungs of dust inhaled during working. It is much to be regretted that these two groups could not be separated, as the . information in respect of each would have been of great value; but, inasmuch as each of the conditions is entirely preventable by appropriate means, the total figure may be discussed as being amongst the " preventable " group of diseases. The total number 8 of phthisis cases were 2,532, or 11.01 per cent, of the total number of pensions granted. This is an unduly high figure, and of itself shoui arrest attention. When it is further considered that of the total 2,53 cases of phthisis 42 per cent, were less than 40 years of age, and 21.1 per cent., or more than one-fifth, were less than 30 years of age, it adds to the already abundant evidence of the excessive amount of preventable lung disorders in the community and its special incidence upon young adults. Tuberculosis of Bones and Joints accounted for 749 individuals, or 3 per cent, of the total. ISTearly half of these cases were under 30 years of age, and 68.3 per cent, under 40 years of age. This amount of disablement of yoimg adults in the community will be referred to later in this report. Disorders of the Circulatory System. — These comprised a total of 2,280, or 9.92 per cent, of the total. It is difficult to discuss this group on any general lines, as the causes of the disorders were various, e.g., rheumatic fever was the cause of many heart disorders, syphilis produced many aneurisms, and so on, and the age distribution of the cases was such as might be expected on these grounds. Hemiplegia, which, in practically all the cases, was the uncomplicated paralysis of muscles on one side of the body resulting from a haemorrhage in the brain, accounted for a total of 1,555, or 6.76 per cent, of the total number of certificates examined. Such hemiplegias occur as the result of degeneration of the blood vessels of the brain, the causes of which may be varied. Such causes include general degeneration of the small arteries, syphilitic degenera- tion, &c. Accident. — The disablements mentioned in the certificates were naturally of all kinds, but the reflection frequently occurred during the examination of these certificates that some at least of the cases need not have resulted in permanent disablement if early and suitable tre?it- ment could have been obtained. The total number of cases classified under t^is head was 1,481, or 6.44 per cent, of the whole number. Senility. — This general term was used in connexion with all cases where the incapacity for work resulted from general breakdown in health, associated with advancing degeneration of the body tissues. For every human individual a time arrives when the balance between waste and repair is disturbed and the processes of degeneration proceed at a greater rate than the processes of repair. This is a purely natural phenomenon, but the time of its onset varies considerably according to individual constitution. It m9,y occur at an earlier or a later stage, and no fixed point can be determined for any group of individuals. IsTotwitli- ^tanding the inevitability of the onset of old age, however, much can be 'done by appropriate measures to delay the onset and progress of the changes, or, at the least, to postpone that point at which the breakdown becomes so complete that the person is obliged to apply for assistance in order to support his existence. The total number of cases certified under this heading was 1,367, •or 5,94 per cent, of the total, and no considerable number of oases was -SO certified under the age of 50. The number certified between the ages •of 50-60, however, provokes the query whether means could not be devised of delaying the onset of this " senile " condition to a later age period. Defective Vision. — This group included all persons whose vision was considered to be sufiiciently defective to prevent their earning their own livelihood. In many cases the person was completely blind. An endeavour was made ,to classify the causes of the blindness, but the information given was not sufficiently complete to enable this to be done with any degree of accuracy. The total number of cases was 1,40.3, .or ■6.1 per cent, of the total. Such information as was given as to the •causes of the defective vision indicated that in some of the cases the cause was syphilis. A noteworthy feature in the figures under this heading is the number of cases of defective vision under the age of 40 years. Of the total cases of defective vision, 26.5 per cent., or one-fourth, were in persons under 40 years of age. Having regard to -the frequency of gonorrhoeal infection at birth as a cause of blindness in young persons, these figures must be regarded as having a possible ;significance. Congenital Imbecility. — The total number of cases of congenital imbecility was 1,136, or 4.94 per cent. This figure is not perhaps large, but it is sad enough. The causes of congenital imbecility have frequently leen discussed by authorities. It is obvious that the cause must be some defect or disease in one of the parents. Sir Greorge ISTewman, who analyzed carefully the question of infant mortality, summarizes the position as follows : — " But though declining, there is still abundant evidence that syphilis is one of the most active of all maternal infections in the production of congenital weakness and degeneracy in the offspring." Other authorities are in accord with this statement. Congenital Malformation may be grouped with " Congenital Imbecility." They totalled 378, or 1.64 per cent. The remarks concern- ing syphilis made in connexion with congenital imbecility apply also to -the group of congenital malformations, although probably to a consider- ably less extent. C.1449.— B 10 Epilepsy.— Th,e total, under this heading is 947, or 4.12, per cent. It is difi(icult to arrive at, any, exact estimate, of the essential, causes of epilepsy,, a,A^ s|;iU, mora, 4ifEcult, obviously: to assess , the . relative import- ai^ce of, ea,ch qf , such causes, Two references may, however, assist towards the elucidation of this subject : — Dr. Carl Browning, the Director of Pathological Laboratories,. Glasgow University, recently carried out observations upon 3,000 cases. Amongst 331 unselected cases of children attending hospital as outdoor patients, syphilis was present in a proportion of 14 per cent. Out of 204 cases of mental deficiency and epilepsy in young children, syphilid was present in 95 cases, i.e., 46 per cent. Dr. Kate Eraser and Dr. H. Fergason Watson examined 204 cases of mentally deficient children under eight years of age. Of these, the presence of syphilis was detected, by the Wassermann test, in no fewer than 60 per cent. . It would appear to be legitimate to say that a considerable part of this group of congenital imbecility, congenital malformations and epilepsy is syphilitic in origin. Degeneration of the Spinal Cord included 7?7 cases, or 3.46 per cent, of the total. The significance of these conditions is that they are almost certainly largely syphilitic in origin. ISTothing further need be said to indicate their importance from, the point of view of the practical appli- cation of the results of an inquiry such as the present one. Cancer. — The number of cases of cancer is comparatively small, being 737, or 3.2 per cent, of the total. The other disorders classified in the table need not be minutely dis- cussed, as they do not occur in. sufficiently large proportions to give them any special significance. Generally, however, they suggest the same remarks as were made upder the heading of " Eheumatism," to the effect that probably much more could be dq^^ejthan is being, done to prevent these disorders progressing, to the stage when the patient becomes unable to earn his own living. Digestive disorders, varicose veins, female disorders, hernia, are largely susceptible to treatment,, and could, as a general rule, be kept sufficiently unde;r control to admit of the person earning a reasonable wage. The result? obtained from this analysis of certificates give food for reflection in several,. directions, but in none mo^'e striking tl^an in the results obtained in respect of persons under 40 years of age. 11 The Table of the certificates" in respect of i persoHS-under 40 years of age i8.,givenihiereunder : — Senility Rheumatism . . Asthma .and Eronchitis . . Chronic Nephritis Hemiplegia Begeneratioa^f Spinal Cord Insanity Epilepsy Gengenital Imbecility . . Congenital Malformations Infantile Paralysis Diabetes Cancer Syphilis Phthisis Tuberculosis of Bones and Joints Disorders of Circulatory System Aneurism Varicose Veins Defective Vision Plumbism Digestive Disorders Female Disorders Spinal Curvature Accident Indefinite Miscellaneous Hernia Aneemia Goitre Neurasthenia Neuritis 16-20. 43 7 6 75. 30 6 135 288 91 120 1 6 3 87 143 59 56 1 2 1 3 66 15 33 1 2 20-30. 1,280 103 16 20 113 62 30 299 433 113 108 ► 12 8 14 448 215 118- 1 142 3 13 17 10 139 20 74 6 8 6 2 30-40. 2,653 5 208 31 34 156 115 69 179 240 78 46 13 29 20 534 154 164 1 24 175 2 28 28 7 165 60 95 2 4 6 13 1 Total. 2,686 6 354 64 60 344 207 105 613 961 282 274 26 43 37 1,069 512 341 1 25 373 6 43 46 20 370 95 202 2 11 16 19 3 Per- 6,519 ■076 5-430 •828 •920 6-276 3 175 1:610 9 •403 14-741 4-325 4-203 •398 •659 •567 16-398 7-853 5-230 ■015 -383 5-721 -092 -669 •705 -306 5-675 1-457 3^098 -030 -168 -245 -291 -046 99-983 It is inevitable that a point must be reacbed by every individual at ■wbicb be becomes, -wbetber by advancing age or by disease, incapable of earning sufficient to support bimself. While tbe advent of tbis stage may be contemplated with a certain amount of complacency in respect of tbe 16,460 persons over 40 years of age, it is impossible to con- sider tbe 6,519 persons under 40 permanently incapacitated ■without very serious questionings concerning tbe necessity for such, or the possi- bility of eliminating! entirely from, future tables all age groups under 40 years of age. The outstanding feature of this list is the item " Phthisis." At these age groups the non-tubercular affections -would not .appreciably affect the total, and, consequently, the -whole number may be considered to be tubercular. The fact for consideration is that 16 per cent, of the 12 pensions under 40 were given for tuberculosis of tiie lungs, and if, as is quite equitable, tuberculosis of bones and joints be added, the . high figure of 24 per cent, is obtained. It should be remembered at this point that tuberculosis is considered as a preventable disease. The item next in importance is "Congenital Imbecility," which accounts for 14 per cent, of the total cases under 40. One-seventh of the pensions under 40 years of alge are paid for a condition which, as has been shown above, is very often, if not generally, syphilitic in origin. The next group to arrest attention is the group of affections of the nervous system, including hemiplegia, degenerations of the spinal cord, insanity, epilepsy, which, together, include 19 per cent, of the total group under 40 years of age. Defective vision accounts for about 5 per cent, of the cases under 40 years of age, and it has been. pointed out that this defective vision is in such young persons frequently the result of gonorrhoeal infection from the mother at the moment of birth. The analysis of the causes of permanently incapacitating invalidity in persons under 1^0 years of age is, therefore, sufficient to arrest attention. Tuberculosis, syphilis, and gonorrhoea play the most prominent part, and these diseases may with suitable measures be kept under control. It remains now to return to the figures in general for a moment, to consider two groups of diseases, namely, those diseases in which syphilis, either inherited or acquired, plays some part, and those diseases which are generally considered to be preventable diseases. The first group comprises — Degeneration of the Spinal Cord . . 797 Insanity 415 Epilepsy 947 Congenital Imbecility . . 1,136 Congenital Malformation 378 Syphilis 102 3,775 It must be here distinctly pointed out that it is not stated that syphilis is the cause of all the above cases. It is not known what proportion of them is so caused. Together, however, they form 16 per cent, of the total number of certificates examined, and it may not be denied that if syphilis could be eliminated from the community this total would b& materially reduced. 13 The next group worthy of consideration is that group which may be called the Preventable Diseases group. These include diseases wholly or partly preventable, although naturally the extent of the prevention actually attained depends upon the completeness of the measures instituted. The group may be taken as comprising- — Degeneration of the Spinal Cord Y9Y Congenital Imbecility . . 1,136 Congenital Malformation 378 Syphilis 102 Defective Vision . . 1,403 Infantile Paralysis . ■ .. 347 Phthisis . . 2,532 Tuberculosis of the Bones and Joints . . 749 7,444 The total in this group is, therefore, seen to be 7,444, or 32.3 per cent, of the total. The deduction from this figure is tha^, with appropriate means, the health of a very large proportion now drawing pensions might have been preserved. But it is noteworthy that the diseases principally concerned are Tuberculosis, Syphilis, and Gonorr hcea. The outcome of this inquiry has been to bring into prominence two main points : — (1) That pensions are being given to large numbers of people who are entitled to such pensions by reason of certain ailments which are susceptible to treatment in their earlier stages. Could any system be devised whereby large numbers of the community could have ready access to early medical treatment a large proportion of future pensioners (estimating on the present basis) could be saved iriany. years of suffering, and the nation would be saved much unproductive expen- diture. In my opinion, a comprehensive scheme of national insurance offers such a means of alleviating distress as has been indicated. (2) That many pensions are being paid on account of diseases which are, with proper measures, preventable — notably tuberculosis and syphilis — and the results obtained indicate the advisability of more effectively- attacking these diseases. Here it may perhaps be permissible to repeat that a comprehensive scheme of national insurance offers the most promise in this direction also. Finally, the investigation has indicated that a properly controlled and co-ordinated system of scientific research into the causes of disease, and the conditions which favour the development of disease, might effect a considerable economy both in public money and in human life. 14 COMMONWEALTH— ALL STATES. 16- 20- 30- 40- 50- 60^- 70-. 80- Ove r Total. 20. 30. 40.. -50. 60. 70. 80. 90. 90. Senility 5 16 448 598 243 56 1 1,367 Rheumatism . . 43 103' 208 432 1,250 601 74 3 2,714 Asthma and Bronchitis . . 7 16 31 100 337 170 12 1 674 Chronic Nephritis 6 20 34 68 222 79 4 1 434 Hemiplegia 75 113 156 324 621 224 38 3 i 1,555 Degeneration of the Spina] Cord 30 62 115 232 277 77 3 1 797 Insanity 6 30 69 116 156 37 1 415 Epilepsy 135 299 179 172 131 31 947 Congenital Imbecility . . 288 433 240 108 62 5 1,136 Congenital Malformations 91 113 78 50 38 8 378 Infantile Paralysis 120 108 46 39 30 4 347 Diabetes 1 12 13 37 78 20 i 162 Cancer 6 8 29 159 393 133 7 '2 737 Syphilis- 3 14 20. 25 33 7 102 Phthisis 87 448 534 656 651 153 3 2,532 Tuberculosis of Bones and Joints 143 215 154 112 110 15 749 Disorders of the Circula- tory System 59 118 164 337 1,042 502 56 1 1 2,280 Aneurism . . 1 1 2 3 7 Varicose Veins 1 24 116 420 105 6 "i 673 Defective Vision 56 142 175 295 518 196 19 2 1,403 Plumbisni 1 3 2 11 21 8 46 Digestive Disorders 2 13 28 65 141 45 . , 294 Female Disorders 1 17 28 55 133 19 '2 255 "Spinal Curvature Si , 10 7. 7 ,4 31 Accident i 66 139 165 330 510 253 is 5 1,481 Indeiinite 15 20 60 99 104 26 / . . 324 Miscellaneous . . 33 74 95 113 227 85 9 636 Hernia 2 21 104 65 5 197 Anaemia i 6 4 33 38 7 89 Goitre 2 8 6 22 29 2 69 Neurasthenia . . . , 6 13 35 42 7 103 Neuritis 2 I 11 19 11 i 45 1,280 2,553 2,686 4,197 8,191 3,496 497 75 4 22,979 15 iVTEW SOUTH WALES. 16- 20- 30- 40- 50- 60- 70- 80- Over Total. 20. 30. 40. 3 50. 60. 70. 80. Ill 90. 13 90. Senility- 10 209 283 629 Rheumatism . . io 30 57 131 361 259 38 886 Asthma and Bronchitis . . 2 11 9 35 101 66 224 Chronic Nephritis 2 5 10 18 60 32 i 128 Hemiplegia 16 17 38 70 171 92 17 i 422 Degeneration of the Spinal Cord 13 29 34 68 95 45 2 1 287 Insanity 2 10 20 22 50 11 1 116 Ejfflepsy 45 88 52 38 29 10 262 Congenital Imbecility . . 91 110 58 21 14 1 295 Congenital Malformations 30 30 24 11 7 102 Infantile Paralysis 45 26 9 8 5 93 Diabetes 1 2 2 12 21 9 47 Cancer 1 3 7 59 114 61 4 249 Syphilis 1 2 4 4 1 12 Phthisis 14 100 115 119 116 50 3 517 Tuberculosis of Bones and Joints 47 39 42 26 22 5 181 Disorders of the Circula- tory System Varicose Veins 18 30 1 42 6 86 29 316 106 225 48 32 1 749 191 Defective Vision ii 32 46 66 150 71 b 382 8 100 88 8 513 190 163 71 4 Plumbism 1 1 3 3 Digestive Disorders Female Disorders i 7 9 15 8 18 22 45 40 15 8 Spinal Curvature Accident Indefinite Miscellaneous . . Hernia 2 24 10 11 3 49 6 25 1 47 24 16 2 94 55 23 7 2 3 6 5 2 176 78 49 32 2 5 4 4 'ii6 17 32 29 5 '7 1 '2 Anaemia 11 Goitre Neiirasthenia . . , , i 3 2 "l 1 13 11 Neuritis ' ■ • 396 664 1 695 229 17 1,068 2,391 1,491 1 6,952 16 VICTORIA. 16- 20- 30- 40- 50- 60- 70- 80- Over Total. 20. 30. 40. 50. 60. 70. 107 80. 45 90. 11 90. Senility 1 4 144 312 Rheumatism . . 20 39 86 171 456 131 10 1 914 Asthma and Bronchitis . . 1 1 9 36 109 52 6 214 Chronic Nephritis 3 6 32 94 22 2 159 Hemiplegia 23 41 59 146 223 68 6 566 Degeneration of the Spinal Cord 8 14 45 104 99 11 281 Insanity 3 14 32 42 49 13 .153 Epilepsy 44 103 13 78 58 13 369 Congenital Imbecility . . 93 142 77 46 33 1 392 Congenital Malformations 26 38 28 22 17 2 133 Infantile Paralysis 33 34 23 12 8 1 111 Diabetes 7 2 15 30 3 1 58 Cancer 2 2 9 53 141 37 1 i 246 Syphilis 2 8 14 14 20 4 62 Phthisis 39 199 242 346 327 56 1.209 Tuberculosis of Bones and Joints 53 92 62 51 51 8 317 Disorders of the Circula- tory System 17 39 56 135 382 131 5 765 Varicose Veins 8 50 152 21 1 232 Defective Vision is 57 62 122 182 50 4 2 497 Plumbism 1 1 5 12 3 , , 22 Digestive Disorders 1 7 21 42 7 78 Femade Disorders 5 6 13 42 4 . , 70 Spinal Curvature 2 2 2 2 8 Accident 13 44 61 125 150 65 4 452 Indefinite 4 10 29 37 18 2 100 Miscellaneous . . 7 23 42 52 88 22 i 235 Hernia , , 7 32 17 2 58 Ansemia 4 1 20 24 5 .. 54 Goitre 1 4 1 ■ 13 13 1 33 Neurasthenia . . . , 4 8 18 25 5 60 Neuritis 408 2 932 6 12 10 862 1 89 15 31 1,052 1,798 3,035 •• 8,191 '17 SOXTTH AUSTRALIA. 16- 20- 30- 40- 50- 60- 70- 80- Over Total. 20. 30. 40. 1 50. 60. 19 70. 16 80. 9 90. 6 90. Senility 51 Bheumatism . . 6 11 23 38 119 35 2 234 Asthma and Bronchitis . . 1 2 4 6 36 1 1 51 Chronic Nephritis 4 9 29 6 i 49 Hemiplegia 14 18 21 34 84 17 . 4 1 193 Degeneration of the Spinal Cord 4 5 14 16 25 3 67 Insanity 2 11 19 34 5 71 Epilepsy 15 39 23 17 17 2 113 Congenital Imbecility . . 27 51 42 17 5 142 Congenital Malformations 9 11 6 5 3 2 36 Infantile Paralysis 9 15 4 3 6 37 Diabetes . , , , 2 3 7 i 13 Cancer 2 1 3 18 44 4 2 75 Syphilis 1 2 2 5 Phthisis 21 83 67 51 50 6 278 Tuberculosis of Bones and Joints 22 33 21 9 18 , . 103 Disorders of the Circula- tory System 4 16 26 32 128 21 3 1 1 232 Varicose Veins 3 10 40 4 1 58 Defective Vision 4 11 19 32 66 6 3 141 Plumbism 1 4 6 Digestive Disorders 1 1 6 14 2 24 Female Disorders 5 6 13 3 1 28 Accident 9 i4 18 29 45 11 126 Indefinite 1 4 1 3 2 11 Miscellaneous . . 5 4 7 9 26 3 i 55 Hernia 3 11 2 1 17 Aneemia 1 1 2 4 8 1 17 Goitre 2 1 1 4 Neurasthenia . . 5 5 10 Neuritis 153 322 331 386 3 865 153 28 9 3 2 2,249 18, WESTERN AUSTRALIA. Senility Rheumatism . . Asthma and Bronchitis . . Chronic Nephritis Hemiplegia Degeneration of the Spinal Coj^d rnsanity Epilepsy Congenital ImbeoUity . . Congenital Malformations Infantile Paralysis Diabetes Cancer Syphilis Phthisis Tuberculosis of Bones and Joints Disorders of the Circula- tory System Aneurism Varicose Veins Defective Vision Plumbism Digestive Disorders Female Disorders Spinal Curvature Accident Indefinite Miscellaneous . . Hernia Anaemia 16- 20. 10 20- 30. 50 4 1 1 1 8 1 11 19 6 5 13 30- 40. 99 9 11 2 2 1 2 3 24 40- 50. 119 19 3 21 5 9 6 3 1 S 3 43 9 1 4 21 1 2 3 5 18 2 6 1 1 201 50- 60- 70- 80- Over 60. 70. 64 80. 35 90. 7 90. 24 1 58 39 9 13 10 3 7 7 , , 9 16 6 1 20 7 . 1 3 1 5 1 •• •■ "l ' * ' " 1 , , 5 1 26 7 '36 is .. 2 .. .. 25 20 2 2 3 17 6 3 24 14 1 5 •,• 5 2 3 1 1 •• 37 25 3 3 2 5 8 5 4 3 i 337 256 69 11 1 Total. 131 141 31 18 45 64 10 39 49 13 16 8 41 6 124 33 68 7 31 77 2 12 10 15 101 13 28 9 1 1.143 19 QUEENSLAND. 16- 20- 30- 40- 60- 60- 70- 80- Over Total. 20. 30. 40. 50. 1 60. 37 70. 109 80. 38 90. 16 90. Senility 201 Rheumatism . . 11 15 47 166 99 15 1 354 Asthma and Bronchitis . . 6 7 51 37 2 103 Chronic Nephritis 3 11 10 6 22 8 1 61 Hemiplegia 16 27 20 41 70 14 4 192 Degeneration of the Spinal Cord 4 3 6 10 23 6 52 Insanity 1 3 5 17 13 6 45 Epilepsy 22 37 15 13 15 3 105 Congenital Imbecility . . 35 71 19 8 5 1 139 Congenital Malformations 11 11 11 8 5 2 48 Infantile Paralysis 17 23 3 5 4 3 65 Diabetes , , 1 4 2 9 3 19 Cancer 1 2 18 31 14 66 Syphilis 1 3 4 P ithisis ■ 3 23 48 64 87 16 241 Tuberculosis of Bones and Joints 4 18 9 9 8 1 49 Disorders of the Circula- tory System 12 16 20 33 105 57 11 254 Varicose Veins 2 13 55 18 88 Defective Vision 11 25 18 35 69 43 1 202 Plumbism 1 2 3 2 1 9 Digestive Disorders 3 1 13 18 10 45 Female Disorders 1 2 5 22 3 33 Accident 8 12 19 39 58 29 i 166 Indefinite 1 1 3 3 8 Miscellaneous . . 5 8 15 15 25 is 83 Hernia , , . , . , 19 10 29 Anaemia 1 3 1 5 Goitre , , 1 1 3 5 Neurasthenia . . 153 310 2 254 6 425 5 934 508 73 17 13 •• 2,674 13127 Cornell University Library HD 7106.A8A5 1916 An analysis of the causes of invalidity 3 1924 002 410 367