New Zealand Medical Services in Middle East and Italy
Medical Standards and Classification
Medical Standards and Classification
As the Medical Committee first directed its attention to standards of medical examination of recruits, it is apposite to refer to the position in the First World War. At the outbreak of war in 1914 the medical standards for acceptance of recruits for overseas service were low, being those laid down in 1904. Rules for the guidance of medical examiners were brief and vague and the form to be filled in was incomplete. The assessment of fitness, in fact, depended wholly on the experience of the medical examiner, with consequent great variation between the different examination centres in the percentage of recruits accepted or rejected. In many cases the percentage of acceptances was high owing to inexperience, and this was revealed later when a number of soldiers were discharged from the Army as a result of pre-enlistment disabilities. In 1916 the increasing numbers of men being returned to New Zealand for discharge after little or no service led to the formation of travelling medical boards. These full-time boards were staffed by specially-trained medical officers. The result was a rise in the rejection rates of recruits and a consequent fall in the percentages of soldiers page 11 breaking down later. (Up to 20 June 1916 the percentage of rejections at enlistment was 29·84, revealing, even on the low standard of medical examination, a permanent degree of physical unfitness of which the public generally was unaware.)
Later, in 1917, in an endeavour to meet the increasing demands on the depleted male population, the medical standard was again lowered, an action which drew vigorous protests from the Expeditionary Force headquarters in London. When drafts of soldiers arrived, a relatively large proportion of them required boarding and were returned to New Zealand without ever reaching France, while of the remainder many broke down after a short period of service.
One important consequence of the low medical standard was that the New Zealand Government became responsible for the payment of large sums in pensions for pre-enlistment disabilities held to have been aggravated by service in the Army. In order, therefore, that better standards should be adopted in any future war and that there should be conservation and better application of manpower, the Medical Committee was formed.
At the outset in 1936, the Medical Committee drew attention to the inadequacy of the system of medical examination laid down in the Mobilisation Regulations 1935. In the first place, the medical examination was to be conducted by the local doctor, upon whom rested the responsibility of deciding whether the man was fit to go into camp. This was held not to be satisfactory as the examination would not be very complete and, also, the possibility of pressure by interested parties could not be overlooked. Under the regulations a man would not be regarded as fit until he had been examined and passed in camp by a medical board. It was evident that this was totally unsatisfactory. A new system had to be devised. The principle of civilian medical boards was recommended by the Manpower Committee in 1935 and approved by Cabinet. This determined that recruits would receive a thorough and final medical examination before they left their own districts. The Medical Committee on this basis drew up a report, which it furnished in June 1937, on the detailed organisation and composition of civilian medical boards. Key men were the eleven Regional Deputies, who were later chosen by the committee from senior medical practitioners.
The committee, with the assistance of Lieutenant-Colonel Bull, also compiled a Code of Instructions for Medical Boards which was published in 1938 as a booklet of fifty-nine pages. This Code of Instructions was modelled on the very comprehensive Hill Report, prepared for the Imperial Defence Committee by a group of distinguished doctors set up in Great Britain in July 1924 to consider all medical aspects of national service in the light of the experiences of the First World War. The Hill Report had been revised and page 12 brought up to date in 1933. Among other points, it stressed the necessity for a thorough and properly-recorded initial examination on enlistment, and the tremendous cost to the State in pensions where this action was not taken. A medical examination form was also drawn up by the Medical Committee. This not only contained additional questions on the past medical history and illnesses of the candidate, but also required an examination of the urine and blood pressure, a cardiac-efficiency test, and a complete dental examination by a dental surgeon. (A later additional requirement was an X-ray of the chest.) The extra information supplied was of great value in the assessment of medical grading. That there was, after the outbreak of war, still an unduly large number of pre-enlistment disabilities discovered after the entry of men into camp was due in great measure to careless or insufficient examinations, or else to lack of experience and knowledge of army conditions on the part of medical boards, and not to any fault of the regulations laid down for their guidance. In addition, of course, men eager to enlist did not reveal their past medical history or else tried to cover up their disabilities. That unfit men did proceed overseas in some numbers, especially in the early stages, indicated insufficient check-up in training camps.
The Code of Instructions specified as its objects:
The medical classification of men to enable the Army, Navy, or Air Force to determine the type of duty for which they were most fitted.
The establishment of a standard system of grading.
It provided for a dominion organisation, under the Director-General of Health, with regional deputies in the eleven main centres controlling a total of twenty-five districts and with varying numbers of civilian medical boards in each district. Each medical board was to consist of two doctors and one dentist with supplementary staff. Later, an optician was added.
With Government approval the dominion organisation was set up early in 1939 and trial medical boards held for the examination of Territorials. These preliminary tests brought about a degree of co-ordination between boards and their staffs, and the organisation was in being and able to function smoothly when war broke out. Executive control rested with the Health Department. In June 1939 the Director-General of Health issued a circular to members of the medical profession giving details of the action to be taken by medical boards in the event of home-defence mobilisation.
The examination of recruits, therefore, was carried out not by the Army, but by a civilian organisation under the Director-General of page 13 Health with the advice of the Medical Committee of the Organisation for National Security. This was not generally realised by the public as the Army had been responsible for medical boarding in the First World War. (This procedure also applied in regard to soldiers who became unfit in camp and whose discharge became necessary. Upon receipt of the recommendations from the military authorities such soldiers were dealt with by the civilian medical boards.)