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Military Service (Medical Grading)

Volume 107: debated on Thursday 20 June 1918

The text on this page has been created from Hansard archive content, it may contain typographical errors.

I wish to raise the question of the inadequacy of the system of medical grading. I make these observations with a strong sense of duty, in order to prevent the multiplication, especially among the older men, of those tragedies with which those of us who are identified with tribunals are now becoming daily familiar. At the time of the National Service Act we had a great number of very difficult cases to deal with where it was absolutely necessary that the proper medical grading of the men should be ascertained without any doubt. It was difficult enough then for tribunals to determine what should be done with the men under these conditions when they could absolutely rely upon the grading which the card disclosed. How much more so is it when we are dealing with men who, by reason of the extension of the age to fifty, are in a totally different class with regard to their commercial activity, with both domestic and business ramifications which make it absolutely necessary for us to be assured as to the genuineness and the completeness of the grading? I say with a full sense of my responsibility that unless something is done to put an end to the dissatisfaction which is daily growing a tide of discontent is rising throughout the country, and particularly in the southern part of the country, with which it will be very difficult to deal. I have watched the men who come before us, and I have been able, as I am quite sure other chairmen of tribunals have, who are giving up time which is generally valuable, and doing it continuously, to obtain after two years and three months some amount of experience and judgment, and one's own judgment in looking at some of these physical wrecks who come before you with grading cards marked 1 is that there cannot be a proper medical record of their fitness. In the hook issued in August, 1916, by the War Office, which is called Registration and Recruiting, the categories of medical fitness are set out, and on page 59 this is said:

"Category A men should be able to march, to see to shoot, and hear well and to stand active service conditions."
What is the meaning of active service conditions if it does not mean that they are physically fit for any military duty at the front and in the firing line which a man could possibly be called upon to undergo in this War?
"Category B, free from serious organic disease, able to stand service conditions on the lines of communication in France or in garrisons in the tropics and in addition, if classified under B1. able to march at least five miles, to see to shoot with glasses, and to hear well. If B2, able to walk to and from work, a distance not exceeding five miles, and see and hear sufficiently well for ordinary purposes. B3, only suitable for sedentary work. Category C, free from serious organic disease, able to stand service conditions in garrisons at home, and, in addition, if classified under C1, able to march at least five miles, to shoot with glasses, and to hear well. Category C2, able to walk to and from work a distance not exceeding five miles and hear sufficiently well for ordinary purposes. C3 only suitable for sedentary work."
It has been said again and again, in answer to questions within the last fourteen days, that there has been no alteration in the system of grading. I turn, therefore, to the memorandum which is lettered MNSR, 24, issued by the Ministry of National Service. I do not see a date to it, but it was about the time when the alteration was made, therefore, we may presume, in November last year. I turn to what is defined there to constitute the new grading. I find on page 1 of that circular letter:
"Grade 1 will comprise those who attain a normal standard of health and are capable of enduring physical exercise suitable to their age. Men must not suffer from organic disease with certain exceptions specified hereafter. Minor defects, such as teeth and eyesight, which can be removed or compensated for by artificial means, will not be regarded as a disqualification. Men who fulfil the conditions of Grade 1 will also be fit for general service in the Army."
I turn to a memorandum which was issued by the Ministry of National Service, No. 13 of 1917, which is signed E. A. Sandford Fawcett, secretary of the Ministry, a definite statement of the medical grades of the National Service medical boards—
"The MINISTER of National Service hereby directs as follows. These grades are four in number. Grade 1 is generally equivalent to category A."
I have shown that Category A men are able to perform any service in the Army—
"General service is the old classification. It includes those who attain a normal standard of health and strength and are capable of enduring an amount of physical exertion suitable to their age. They must be free from any serious organic disease or infirmity. Grade 2 is generally equivalent to Category B1 and C1, namely, garrison service abroad and garrison service at home in the old classification."
The old classification also comprises lines of communication and service in the Tropics—
"It includes those who, while not attaining the standard of Grade 1, are nevertheless able to stand a fair amount of physical strain and are likely to improve with training. Men in this grade should be able to march six miles with ease. They must have fair sight and hearing and must be of average muscular development Grade 3 is generally equivalent to the old categories B2 and C2 and B3 and C3. It includes those men who from any cause are not likely to be suitable to undergo military training for combatant service. As a general indication of the service for which they are required in the Army the following notes are published."
They give certain positions in which they may be occupied either in auxiliary service or labour or sedentary occupations, and there are in the memorandum M.N.S.R. 24 specific directions that the medical board in grading men shall, under the head of Grade 3, subdivide A, B, and C, so as to indicate whether a man should be put to auxiliary service or labour or sedentary occupations. It is the suppression of that fact by order, so I am informed, by the military representatives at tribunals that very considerably hampers the tribunals in determining whether Grade 3 men whose obligations in civil life are not very onerous, ought to be put in the Army as Grade 3 men. If we knew under which of the three sub-heads he would be found and we could safely assume that he would be kept there many Grade 3 men whose other circumstances would not keep them necessarily in civil life would be sent into the Army. It is the absence of that that very considerably makes difficulties in the tribunals. That is the position in which we stand to-day.

It is said that there has been no alteration in the grading. Grade 1 does mean and is in every respect equivalent to Class A. The Minister of National Service shakes his head. I cannot for the life of me understand after having read these two documents how it can possibly be contended that Grade 1 of to-day is not Class A. Merely saying it is not does not make it so. That is the reasonable interpretation of the language as printed in the books. It is said that our criticisms are unjustified. It is said that general figures have been given. I would like before passing from consideration of that to call attention to the Debates which took place in this House when the new Bill was introduced. It will be remembered that the Prime Minister made a statement distinctly saying that only 7 per cent. of these older men would find their way into the firing line. In other words, only 7 per cent. of them would be Class A men. There is no guarantee—and I hope the House will realise this—that once a man-is in the Army he will not be put to all the complete duties which fall upon the Service. There is no matter upon which there is a greater burden of complaint against the Army authorities to-day than this, that no matter what may be the category of the man when he is sent into the Army he can never be sure to retain that category for two days together. I know of my own knowledge that that is so. I have received letters so numerous that I think they would startle the National Service Ministry, though it has nothing to do with them, because the man leaves them the moment he is put into the Army.

I have evidence again and again of men who have been sent into the Army as C3 men, who have been posted to a battalion, and have been seen by the medical officer, who have had their categories altered. I know in many cases, from correspondence that has been sent to me for months past, that men who have been examined and who have broken down in service on the other side as well as here, have been before the medical travelling boards who should have been removed from Categories 2 and 3 in which the medical officers have placed them and have been put in Categoy A. That has happened again and again. I have known of cases, and I could turn up the whole correspondence which shows that there has actually been a conflict between the medical officer of the battalion and the travelling board, and the man has been treated as a kind of shuttlecock between them as to whether he should be Grade I, 2, or 3. If this uncertainty prevails when a man gets into the Army, then for Heaven's sake let us make sure what his category is before he gets into the Army! Seven per cent. was given to us as being the proper proportion of men between forty-two and fifty-one who would be going into the Army. The Minister of National Service, in the Debate on the 11th April, said:
"I cannot say the exact number of medical examinations that will be carried out on any one day, but we are arranging for a total number of medical examinations somewhere in the neighbourhood of 25,000 to be carried out daily. That is about the limit we can go to with the medical boards."
Then he said:
"I will undertake that there shall be no delay in getting the medical examinations of these men pushed on, and we will get it going as rapidly as we can to got a medical examination satisfactory to ourselves."
The burden of the complaint which we are hearing to-day is in respect of a district in London, where most certainly the examination has been speeded up under pressure, and that pressure is what I think this House will resent after the specific assurances that were given from time to time during the earlier Debate. During that Debate there was another speech to which I must call attention by the right hon. Member for the Rushcliffe Division (Mr. Leif Jones). He said:
"The right hon. Gentleman spoke of 35,000 eases a day. Therefore, however careful medical boards are, the weaknesses that find us out in our years after forty-five are not observable at once by a board which is a stranger to the man who comes before it for medical examination. They want to get the work done. They are being urged by the military authorities. I do not know what experience the right hon. Gentleman has had as yet of the hustling processes of the military authorities, who are anxious for men. The result will be that many men will be passed into the Army who ought not to be passed in. They will be in too high a grade and that will apply more and more as the age gets higher, for every year you go up the greater the danger is that more unfit men will be passed into the Army, and the greater will be the number of your breakdowns, and, therefore, the greater the burden which will have to be borne on your pension lists."—[OFFICIAL REPORT, 11th April, 1918, Vol. 104, col. 1760.]
Those were pregnant words, which ought to have been sufficient to ensure that the medical examination, especially after the Select Committee had made its Report and caused the whole system to be changed, and taken out of the hands of the War Office and put into the hands of the Minister of National Service, would be more satisfactory. We had every right to expect that, under these circumstances, and after this warning, they would have been most careful in what was done. I will not go further into details of the Debate at that time. The Minister of National Service stated the other day that the complaints only amounted to something less than 1 per cent., but it is no use dealing with percentages. We have no date with which to test them. We have not the period which they cover. One of my hon. Friends asked for data, but it was admitted that there was none. Therefore, there is no means of checking the percentage. What I do say is that in the course of something like three weeks—or, to be on the safe side, I will say four—no less than 400 applications have come up in the county of Middlesex alone to go from the medical boards to the medical assessors. I have a table showing the numbers received day by day for a certain period, which may possibly carry conviction if my general statement does not. On 30th May there were 12; on the 31st, 3; on 1st June, 11; Monday, the 3rd, 25; on the 4th, 21; on the 5th, 24; on the 6th, 44; on the 7th, 30; on the 8th, 29; on the 10th, 35, the day on which the question was raised in this House; on Wednesday, 11th, 28; on Thursday, 16; and on Friday, 17. Last Saturday it was 18, and Monday of this week, 12; and I am told that the tendency is an upward one now. I will show presently whether or not these applications are justified by the facts. I will deal with the cases which have come before the medical assessors, and which have been sent by the Appeal Tribunal. Since November, 1917, no less than 30.4 per cent. of those applications in Middlesex have resulted in reduction of the grading. That is a very serious state of things, having regard to the assurances that were given. I may refer briefly to some of the cases that have been so reduced. I am perfectly willing that the particulars should be put at the disposal of the Minister of National Service. They are put forward for the purpose of showing the cause of the rising indignation of the public outside, so that the matter may be put promptly in hand. I will give some of the cases, so that it may be seen how7 things have worked. A man of thirty-nine was examined and put in Grade 2, and was reduced to Grade 3. One of twenty-seven was reduced from Grade 1 to 2. A man of twenty-five examined at Watford was passed Grade 1, and on being sent to the medical assessors was rejected altogether. The next reductions are from 2 to 3, 1 to 2, 2 to 3, 2 to 3, 2 to 3, 2 to 3. Here is one who was put into Grade 2 with latent tuberculosis. Grade 2 was to include lines of communication, service in the tropics, and garrison duty abroad or at home. He was rejected entirely by the medical assessors. Another with a chronic deafness was put into Grade 3 and then totally rejected. These are illustrations of what is occurring.

9.0 P.M.

I pass now to give a few cases of men who have been had up again, who have been examined by the medical board, and whose cases are now waiting the decision of the assessors. There is a great number of these men. I take typical cases again. A man aged twenty-nine was put into Grade 1 by the City of London No. 2 Medical Board. He had been rejected. Then he was put in B1 by the Millhill people. Then he was rejected again by the medical board at Hampstead. Finally he was put into Grade 1 by the City of London Board. Here is another case. The man was put into Grade 2 by the City of London Medical Board. He served two years in the Army, until the 29th May, 1916, when he was discharged suffering from neurasthenia, insomnia, and gastritis. He had had trench fever and rheumatism, and yet he was regarded as being good enough for garrison duty and for lines of communication. Then there is a Grade 2 man with chronic pulmonary tuberculosis. What has become of all the directions that no man who a any time was suffering from tuberculosis should be allowed to go into the Army? I know that that was subsequently modified into the direction that the answers were to be scrutinised more carefully, and inquiries were to be made before rejection. How comes it that over and over again we find cases of tuberculosis passed by the medical board? It is a common thing for me to have to direct that the applicant for exemption should go in the first instance to the county tuberculosis officer, in order to save time, because I am only anxious to further the duties of my right hon. Friend, and think it best to have this question first definitely disposed of. Then there is the case of a man of thirty who was put into Grade 1 by a West London board. He was twice discharged from the Army for valvular disease of the heart, and he was afterwards rejected. He was X-rayed, and this showed that he had an enlarged heart, which was greatly displaced downwards, and was suffering from valvular disease of the heart, and had general symptoms of tuberculosis, which conceivably were still quiescent but might at any time become active. Yet this man was passed into Grade 1 for full medical service. It is almost incredible.

Another man of forty-four put into Grade 1 was suffering from cardiac degeneration and valvular disease, which was certified by an eminent physician of King's College Hospital. Then there is a case of a man with chronic gastritis, weak heart, lumbago, and sciatica. For some reason very little attention is paid to chronic gastritis and duodenal ulcer. Then there are two cases which I put in this House within the last few days. One is that of an excessively bad tumour extending from the neck to the shoulder, and when attention was called to it the man was told, "Oh, that does not matter. We will soon cut that out of you when we get you into the Army." That, surely, is not the way to recruit! That is not the sort of thing to bring before tribunals who are given the statutory duty of excusing a man on the ground of ill-health. Those are some of the cases which occur. I have also some special cases in which I have copies of the certificates. Here is a man put in Grade 2. He was a jobbing gardener, aged forty-four, and was examined by the medical board in Conduit Street. Seven years of all the directions that no man who at any time was suffering from tuberculosis since then, while cutting with a chaff machine. Five years ago he broke two of his ribs. In 1917 he had an epileptic fit and fell down in the garden, and since then he cannot move his wrist. Later on he had a second epileptic fit. That is certified by two of the doctors. Yet that man is put into the category for lines of communication and garrison duty abroad. Both his limbs are stiff and can only be moved with great difficulty. Then there is a Grade 2 man who is suffering from epileptic fits which are most severe and are recurrent every three weeks. The medical certificates go to prove that.

Then there is the question as to the meaning of the dissatisfaction which has arisen with regard to the categories. There was issued by the Director-General for the London region a circular letter, I think on the 3rd May. The writer states the conditions under which examinations were to be conducted by the medical board, consisting of four medical men and the president, and he describes the method of examination to be adopted. The number of the board was cut down to two members and the president, and the recruits were to be examined by one examiner, who was to refer all questions of doubt to his colleagues in order to avoid complaint that recruits were only examined by one doctor. The boards were to have five clerks each, and extra equipment that might be necessary was to be arranged. Anybody would think that these arrangements expressed on paper would at any rate be carried out, but I have in my hand a sheaf of letters which show that they have not been carried out. I have a letter from one of the examiners who was a member of two different boards and who was so disgusted at what was being done that he resigned and declined to take any further action. He states that when he was member of a board of medical examiners consisting of four and the president, different diseases were assigned to the various examiners, and after the recruit had passed from one to the other, cases of doubt were brought before the president, between whom and the examiners concerned there was a consultation. In this way a procession of recruits passed the examiners, each recruit taking one examiner about four or five minutes, and each was actually under investigation from fifteen to twenty minutes, which was ample time to find out his fitness for service in the Army. It was possible under this method, he says, to examine twelve to fifteen recruits an hour, and in his opinion that system was efficient and reduced the possibility of mistake; it worked as smoothly and rapidly as was compatible with a fairly exhaustive examination. About the middle of May that system was replaced by the present system of examination, when the board was reduced to the president and two examiners. The examinations were expedited and from thirty to forty recruits were examined in two and a half hours, each examination of a recruit taking from four to five minutes. On this change being made the writer declined to go on, and has not since been a member of any board. He was a man fully qualified and had large experience in these matters, and it was only from a strong sense of duty that he wrote me as to this system, to which he declined to be a party. I have a letter of the 12th June relating to a man who was examined on the 27th May, who had previously been graded, and he was asked to produce his grade card, which mentioned the complaints from which he suffered. He was graded though he had certificates from other doctors showing that his pulse was 120, that he suffered from enlarged heart, hernia, and rheumatoid arthritis in the knees. The man was in weak health and was unable to undergo exertion, yet he was put in Grade 2. Another man writes me and states that when he was examined he entered the building at two o'clock and was out again at 2.25. He had previously been examined three times by four doctors and rejected, suffering from disease of the heart. Ha was examined last Saturday and he was put into Grade 1. The next letter comes from a professional gentleman living in my own Constituency, but writing from his office. He says:
"I am forty-four. I was examined on Wednesday last, notwithstanding the fact that I have an affection of the heart which causes extreme faintness when I exert myself above normal; I can hardly see at all with my left eye. I have been graded 1. On my papers the affection of my heart was mentioned and also that I had a tendency to hernia…. I am willing to do my bit, but I do not think it is in the interests of the country that men who are likely to collapse under strain should be graded in the first-class—that is, men who under the previous grading would have been B2 or C3."
In a second letter to me he says:
"At Conduit Street I was examined by one doctor and partly by another, who devoted attention to my heart only."
Another man writes to me from Soho:
"I was called up for another examination at Camberwell on 29th May and after a brief examination by only one doctor I was put in Grade 1 (he was previously Grade 3). I have sent two letters to the Minister of National Service, asking if I will be accorded the privilege which I would have had if I had been in Grade 1 or Grade 2 on the occasion of my first medical examination, but I have failed to get any reply."
I may say that men who have been rejected or graded low and allowed to remain in civil employment and who have been brought up afresh and put in Grade 1 are now unable to obtain the position in the Army which they would have obtained if they had been passed Grade 1 before. They are now sent into the ranks as ordinary members of the military system. And so these letters continue. It is my duty to make it perfectly clear that these examinations are not now what they ought to be, and that it is mainly due to this attempt on the part of the authorities to speed up. I have not the least doubt that the Ministry of National Service has a tremendous task to deal with the number of recruits wanted by the Army, but at the same time I am sure that nobody could justify that the work should be done badly because of that. I saw it stated in the "Morning Post" of this week that a letter had been sent by the right hon. Gentleman to the Wallasey Tribunal, saying that the demand for men of the higher grades was so insistent that they must send every man they possibly could. That operates in the minds of some tribunals as being tantamount to an instruction, but other tribunals resent dictation of that sort and intend to go on the same as hitherto, ensuring, at any rate, that these men should have the same attention in the matter of their grading as had many of their sons, because that is what it comes to. Many of these men who are now being graded are the fathers of younger ones who have been taken under the old system. I hope the Minister will understand that I am making these criticisms upon facts which I can supply him with if necessary, and that they all come from one county. The figures reveal the extraordinary state of things that 34 per cent. show alterations in gradings, and that there are enormous numbers waiting and enormous numbers still to come in. This must show that there is something wrong, and I venture to think that no precaution is too great to take in order to restore the confidence of the public in the examination of these men, because everything depends upon these examinations. Only this very day have I written to the War Office about a man in the Army who has spent three years in hospital, and who again and again has implored the military authorities to send him back to civil life. I, therefore, hope the House will take note that matters are not as they should be.

I think the whole House will agree that it is very unfortunate that these repeated discussions should have to take place on the question of medical grading, especially after the Committee which sat some time late in the autumn. That Committee presented a most valuable Report, which was almost immediately acted upon by the War Office, and a new system of medical examination and appeal was set up which, on the whole, I most gladly acknowledge, effected a very great improvement in the medical examinations. I do not think I am at all exaggerating when I say that at the time of the introduction of the last Military Service Bill criticism of the medical examinations and complaints from the general public had sunk to a very low ebb. In the tribunal over which I have the honour to preside so much confidence had we in the medical board which was then sitting at Whitehall that often, instead of sending men to the special medical board, we sent them there for examination. In the course of twenty-four hours, often by the afternoon, they came back, and we were able to deal with them at once. That was the result of the new arrangements which were made, and undoubtedly they were acting on an established standard of medical fitness—A, B, or C, which subsequently became Grades 1, 2, and 3 which was roughly absolute; at any rate, it was quite stabular. I think it is not unimportant to go back to the condition of things which obtained when the last Military Service Act was before the House. I do not like to do it, but I feel that I must make some reference to a statement which I then made and questions I put to the Minister of National Service. We were discussing the question whether it was worth while to extend the age to fifty-one or fifty-six, and this was what I then said:

"That leads me to ask a question of my right hon. Friend who is responsible for the National Service Department, and it is this: 'Is it or is it not intended to lower the medical standard?'"
Then I paused, and as there was no response I went on:
"I assume that it is not so intended. After what happened with regard to the medical seandais, which revealed a condition of gross incompetence on the part of those responsible for them, I do not suppose that the Government would dream in the interests of the nation of reducing the medical standard."
I went on to say that that being granted, what did my experience justify me in suggesting that they could get out of the new class? They said they expected to get about 7 per cent., and I suggested, from my experience of the then existing medical standard, with which we were so satisfied by our continuous experience of some months, that they would not get more than 3 or 4 per cent., taking in, of course, the necessary exemptions for serious hardship and the claim of national necessity. The right hon. Gentleman (Sir A. Geddes) said he would get 7 per cent. But obviously the whole of our argument was based on the stabilisation of the then medical standard. Now it has been altered, and as a result you can get any proportion you like—7 per cent., 70 per cent., or 100 per cent., if you are going to juggle with your medical standards in this way; in fact, you will have your millions rolling in as a result. But I say here and now that if this House had had the slightest idea that the then accepted medical standard was going to be altered, it would never have passed that Act. It was on the assumption, of course, that the older men were going to be at least as fairly treated as the men of younger age that Parliament granted power to take men up to fifty-one. I think I may say I am speaking for the whole of the Members of this House when I assert it was on the understanding that there was to be no juggling with the medical standard, and that the old men were to be treated at least as fairly as the younger ones.

Having cleared the ground to that extent, I want now to say a word or two about a reply given in the House of Commons a couple of days ago. Again, I must trouble the House with what was said on that occasion, because it is important, and goes to the whole root of the matter. In reply to a question by the hon. Member for the Edgbaston Division (Sir Francis Lowe), with regard to the standard for Grade 1, the Minister of National Service said:
"I am glad to have this opportunity of stating that there has been no change in the standards of medical fitness required for classification in Grades 1 and 2. When introduced in October last the term 'Grade 1' was defined as meaning men 'who attain the normal standard of health and strength and are capable of enduring physical exertion suitable to their age.' This definition was at that time placed in the Library of the House. It has never been varied. Current statistics covering large numbers of examinations show that there is no increase in the proportion of men placed in Grades 1 and 2. I would add that there is no difference in principle in the grading of men above and below forty-three years of age."—[OFFICIAL REPORT, 18th June, 1918, col. 145.]
The right hon. Gentleman went on to say that there had been no alteration in the policy of the Government Department in this matter. This was challenged by a further question, and then the right hon. Gentleman said, with regard to a statement I made as Chairman of the House of Commons Tribunal, that I did not know what the meaning of Grade 1 was when I made that statement. He added:
"In view of the fact that Grade 1 is defined as meaning 'a man who attains the normal standard of health and strength and is capable of enduring physical exertion suitable to his age' that statement of the Chairman of the House of Commons Appeal Tribunal can have no meaning."
It does not matter whether I know anything about grading or not. The real point is, Has there or has there not been any change in the standardisation of the medical tests? In passing, it might be useful to say that I have some knowledge on this matter obtained as a result of two-and a-half years of hard work. The right hon. Gentleman referred to what was placed in the Library. Let me read to the House what was placed there:
"Grade 1 is generally equivalent to category A, general service, of the old classification."
Those words are from their own circular. The Minister of National Service when he gave his answer in the House omitted to quote this, the governing sentence—
"Grade 1 is generally equivalent to category A, general service, of the old classification."
That is just what it really amounts to. What it means is, You are going to have a classification of men in the age in which they are—thirty to forty, forty to fifty, or fifty to sixty. You are not testing them as to their physical fitness for the work of the Army. You are applying a physical test to ascertain whether they are in Grade 1 of, their particular range of ages. I am quite certain that is not what the Army wants. The whole thing is easily reduced to an absurdity. You will find the genial octogenarian coming up. You will have men of sixty-five, of seventy-five, and of over eighty, all graded according to their standing in those particular ranges. They will be wonderful old men for their age. That, I submit, is a new test for Grade 1. The proper test is the old A classification, which worked so admirably up to the passing of the last Act. It worked so admirably that we sent down without the slightest fear any number of cases to the ordinary medical board, and what really happened was this. In a period of about three months we sent down for re-examination from our Appeal Tribunal from 1,000 to 1,500 cases, and in no fewer than 70 per cent. of those cases the standard was either lowered, or the man was rejected altogather. I think I may say in 13 per cent. of the 70 per cent. the men were totally rejected. Let the House make no mistake. That was the standard for Class A, Grade 1, up to January last. It was the standard under which the whole of the tribunals of the country were working. Something must have happened since. We now know what it was. Grade 1 is not to be Grade 1, according to physical fitness, but it is to be Grade 1 of the age. I say that is trifling with the House of Commons. Is it any amusement to my hon. and learned Friend opposite (Sir H. Nield), to my hon. Friends here, or myself or others to be engaged in this constant strife on this question? Why, we want to work with the medical boards, not against them. But here this whole question is up again, and in a most acute form.

Let me carry the thing a little further. I say Grade 1 test was "fit for the firing line." It would be impossible for tribunals to work fairly, and with the rough justice which alone we can use unless you have what you may substantially term the rough, absolute, physical medical test. Of course, the other standards are varying in other things. I wish to show how this will operate between the two different classes of men—the young men up to forty-one, and the older men afterwards. Serious hardship is constantly arising against the appellant, and so is the measure of proof which is put upon him to prove the national interest which will justify him in remaining out of the Army. What was serious hardship and national interest sufficient to keep him out of the Army a year ago is no argument to-day. What was sufficient six months ago is not sufficient to-day. It is going up always against the appellant. What has happened has been this: We have been applying these standards of serious hardship and the weight of evidence of national interest to men up to forty-one, and in Grade 3, and we have been handing out to them almost automatically, when they have been usefully engaged, no matter what their age, for the last three or four months, exemptions for six months, with liberty to come again.

See what is going to happen with regard to men of the older age. A Grade 1 man, as he is at present being passed, I say, is purely a Grade 2 man of the old and proper standard, and a Grade 2 man of the new standard approaches nearly every time to a Grade 3 of the old one. If we are going to be forced to deal with a man of Grade 2 of forty-four, we shall be passing him into the Army because his standards of domestic hardship and national interest have been rising steadily against him. A man of thirty-four, Grade 3, would get his six months; a man of forty-four, nominally Grade 2, is sent into the Army. [An HON. MEMBER: "No!" That is what is happening all over the country to-day. We happen to know what we are talking about. We are in it. A most unfair differentiation is being made, and cannot help being made, by lots of tribunals. Perhaps they do not care to take the strong line which some of us feel bound to do in the national interest and in the interest of fairplay. That is what has happened. I say the only safe way to give us a chance to discharge our very difficult duties is to maintain the old standard. That is what the Army wants, anyhow. There can be no doubt about that—none whatever. To deal fairly between the older men and the young men—if we are going to be forced to deal with those men on these lines of Grade 1 and Grade 2, when we know they are really not Grade 1 and Grade 2—you must re-examine all the men of the other class, so that then we should be able to deal with them on a fair basis, and send them into the Army as well as men of forty-four, forty-six, and forty-eight. That is the fair thing to do. I do not suppose that it is at all likely to happen.

I want to draw attention for a moment to what happened to-day in the Tribunal sitting in the Committee-room upstairs. I do not hesitate to say it was a shocking and an appalling experience. My hon. Friend (Sir Charles Nicholson) came at my quite casual invitation yesterday. I said, "Well, come up and see for yourself," and he endorses what I say. A shocking and an appalling experience took place there to-day. We dealt with thirty-two appeals from men to go to the medical service. We granted twenty-four of them; we refused application in the case of five; and three were not entitled. What has happened? One hates to over-elaborate these examples, but it is the only way to show what is going on. I will be as brief as I can. A man for forty-four is passed in Grade 1. And this was the undoubted medical testimony from men not only of standing in general practice, but men who are well-known in Harley Street and in Cavendish Square. This man had double stricture of the uretha, was venereal, and he had to get the passage opened at regular intervals. This man also had acute sciatica. A man of forty-two had epilepsy, hernia, and middle-ear suppuration. Anyone with medical knowledge here knows what a terribly serious matter that is. He was passed in Grade 2. He had two seizures of epilepsy during eighteen months, the last seizure being about a month ago! And here was the evidence of a doctor testifying to this. A doctor at Charing Cross Hospital sent a certificate saying that the man had been admitted to the hospital and detained there four hours after the seizure in the street. Then there was the case of another man, aged thirty-seven, who had valvular disease of the heart, formerly C3, now passed into Grade 2!

I will take just one other case in eon-elusion. This man was forty-four. He had a very bad history of consumption. His father and two brothers died of it, and a very long and most careful examination by one of the senior physicians at the hospital says, "This man has active pulmonary tuberculosis." He was passed in Grade 2! That was the appalling spirit in which we passed men, and it was duplicated, I believe, all over the country. Some of these were men who were able to obtain either expert or professional assistance. Not only could they give the evidence of their own regular medical attendant, but a large portion of them went to specialists whose names are known all over the country. These specialists, naturally, do not work for nothing. I do not know to what expense these men I have mentioned must have been put. But there are thousands and tens of thousands of working men all over the country who had to fill up the form within five days—and it wants a bit of filling up—and who gave up the struggle. That, Sir, is the reason of the low percentage of appeals. Only men who have strength and wealth and opportunity to take these steps can protect themselves. The others have just given up the struggle all over the country—thousands of them, and have been passed into the Army. What can you do with Grade 1 or 2? The call upon the country-is so great that the men of forty-four, Grade 1, have to prove a very strong case to keep out of the Army. These are the sort of things which some of us, very regretfully, have felt it necessary again to bring before Parliament.

There are one or two matters about which I feel very strongly in regard to what has happened since the passing of this Act. I will not say more about the matter than this: There have been two attempts made to reduce the rights of appellants. We only found them out after the Bill was on the Statute Book, after we knew what the Regulations were; and it required a very heated Debate in this House to get back to appellants the right of professional representation and an unclogged and unfettered right of appeal. Now we have the latest attempt, which is this alteration in the medical grading. I cannot see any answer to it. It is bad for the Army; it is bad for the State; it is unjust to the individual. My hon. Friend who sat with me to-day (Sir Charles Nicholson) has let me have a glance at some of the things with which he has had to deal with on the London War Pensions Committee.

I hold here the ghastly list of applications with which he has had to deal. The question was as to whether the men who made application for these pensions had their disease either caused or aggravated in the Army. Here are the figures. Out of 132 applications, in no fewer than 87 the reason for their discharge—sickness or physical disability—was not caused by or aggravated by the Army at all. They have no sort of appeal to the Government for any kind of monetary assistance, and they have no right to any pension. They ought never to have been in the Army. The Army has discharged them, and discharged them without any sort of claim, because their disease was not caused or aggravated by military service. Let me mention a few of the complaints from which they were suffering: Chronic bronchitis, deformed ankle, deformed foot, hernia, phthisis, tuberculosis, chronic suppuration of the ear, and so on through all the ghastliness of it! And all this is very largely preventable! That is the trouble.

I warn my right hon. Friend that if he persists in grading men according to the new standard—the standard of their age and not of their physical fitness in comparison with other men in the Army and with what the Army really wants—he is setting up a feeling of growing unrest in this country which is impairing the moral of tens of thousands of men who are the backbone of those who are fighting for freedom. Someone, it is said, must make the sacrifice. It is so easy to shed some body else's last drop of blood, or to spend somebody else's last shilling! How easy it is for us to talk about it here! What we want is not a card index system. What we want is more humanity in the machine. This must be attained. I say, in the interests of the country, in the interests of the State, and in the interests of the individual—which I put last of all—this medical grading must be done in accordance with the rules of ordinary common sense and simple fairness.

There are several points raised in the speeches which have been delivered which, really, are quite separate from one another. There is first of all the general principle which underlies the grading. That is a very difficult and intricate thing to discuss at such a time as this, because it is inevitably closely bound up with many technical and medical considerations. It is within the recollection of the House that the old system of categorisation was very unsatisfactory. I would like to explain to the House what, at all events, would have been one of the reasons for the great doubt which undoubtedly occurred in that old system. It was this: there was linked with the estimation of every man's physical fitness a strategic conception as to how he ought to be employed. That would have been all right with Royal Army Medical Corps officers, with real knowledge of the various classes of work required on service—I mean if the Regular Army were doing the grading. That categorisation might have been all right under those circumstances. It certainly was not all right when it became necessary to employ large numbers of medical men who knew nothing of the Army or of the type of work that various Army Departments were called upon to perform.

Are not the chairmen of these medical boards still Royal Army Medical Corps men?

The vast majority, I think, are not. Some are naval; most, I think, are civilians. They are all in plain clothes. I doubt if there are any Royal Army Medical Corps men regularly serving and acting as chairmen of the boards anywhere under the Ministry of National Service; my impression is that there are not. Anyhow, the old system of categorisation became impossible to work with civilian doctors. It will be remembered that A meant a man to do certain things, B meant a man to do something else, and C something else; and therefore the whole of that conception was swept away in order that we might present to the civilian medical men who were to do the work a problem which was really medical. That was the first general principle which was approved by the Medical Advisory Committee which is attached to the Ministry of National Service. I can assure you, Mr. Speaker, that there is no part of the work of the Ministry which has received greater care and greater thought than this very question of medical grading and of the principles which should underlie it. That principle, which I have just enunciated, and which I will repeat, that the problem presented to the medical board should be a purely medical problem, was the very first principle adopted, and from the moment of the adoption of that principle the whole of our work on the medical side has been looked at in relation to it. That principle was embodied and turned into a form which could be used by the medical boards in the various publications issued by the Ministry for the guidance of the medical boards.

The first instruction issued was National Service Instruction No. 3, of 1917, and that is the basis of the whole question of grading, and in that instruction the terms Grade 1, Grade 2, and Grade 3 are first introduced. They were introduced to convey a different meaning from categories A, B, and C, and they are defined absolutely different, but in order that during the period of transition there might be some linking up between the old system and the new, general equivalents were stated for the men of the ages then under consideration. This was last autumn. Those general equivalents have no bearing, and can have no bearing, in the case of men who have never been categorised. Men who have been graded are graded in accordance with the principles laid down, and the definitions of these grades have been most carefully drawn up and elaborated, and it takes no less than twenty-eight pages of instructions to give all the conditions which should exclude and what conditions should allow a man to be included in any grade. Whether those instructions are followed out or not is a separate question which we will come to in a moment, but for the moment the point is that the term Grade 1 was introduced with a definite meaning, and that meaning has never been changed. It was defined on its introduction as:
"This grade will comprise those who attain the normal standard of health and strength and are capable of enduring physical exertion suitable to their age."
Then it goes on as was read out to the House by the hon. Member for Ealing (Sir H. Nield). The men must not suffer from any organic disease with certain exceptions specified here.

Will the right hon. Gentleman read on in that paragraph, which reads, "Men who fulfil these conditions to be fit for general service in the Army"?

10.0 P.M.

That is quite true, and if we were merely trying to score debating points—[HON. MEMBERS: "Oh, oh!"]—and not dealing with a matter of the very gravest importance at the present moment, I might accept that argument, but the whole House knows that the instruction which governs the actual grading of the elder men carries out the principles, but excludes that last Clause, and puts in its place that the physical training of the men will be carried out under medical supervision.

Many hon. Members have misunderstood how the system is really working. Every man requires two indices to place him in the proper place on the posting chart. He requires his grade and then his age, and it is the combination of grade and age which settles a man's place in the square and the service he is to render. The actual posting charts are drawn up in such a form that that is visible to anyone who looks at it. The grades are along the top, the arms come up the side, and then the ages are placed in.

The actual posting of the arms must be a matter for the War Office, but the two Departments in this matter work closely together, and always have done. There is in every case the double consideration—what is the man's grade and what is his age? I cannot conceive of any system which civilian doctors could work which would be very different from that May I say, and on this point I am speaking with professional knowledge, that you cannot possibly take a great block of ages extending from 18 to 50, and pick out of them the men who are going to be suitable for Infantry in the trenches over the whole range. That is an impossible thing medically, and it is not intended. The only thing that medical men can do in the way of settling what is a man's physique is to judge upon the physical signs of disease and see whether he is reasonably fit for his age. It is exactly the same idea that underlies an examination for life insurance. I do not believe that you can get any other conception of medical grading when you are dealing with civil boards, because they have not got strategical knowledge, and, therefore, it is not attempted. I would like to assure the House that the cutting out of the strategical conception which underlay the old categories was done deliberately and after the most careful thought, for the very reason that it was far fairer to the men that they should be dealt with in relation to the physical fitness which they ought to have if they were properly fit for their years, and that the posting should be done on an age basis. That is the system which has been working since last autumn, and through all those months which the Deputy-Chairman of Ways and Means has told us were months when the medical arrangements were almost ideal, I think he said.

I said that they were really satisfactory. Nothing is ideal in this world. I said that these medical arrangements were really satisfactory and that if that basis were continued there would be no cause of complaint.

Those were months during which this system was in operation. This system was introduced last autumn, and it has been in operation ever since. There has been no change in this system of double indexing in order to determine the man's posting. That is a system which, on the authority of the Deputy-Chairman of Ways and Means, has worked satisfactorily and that is the system which is in force now. I do not think it is that system of grading that is wrong. I admit freely that the results of the medical boards of the last few weeks have given grave cause for anxiety. I am not here to say that all is well in regard to everything that has been discussed. That would be foolish, and I will tell the House in a moment the action that has been taken, but I really cannot believe that a system which has worked thoroughly satisfactorily for months has suddenly gone wrong by itself, that the underlying principles have broken down or vanished and that the whole thing has become chaos as has been suggested. It would be absolutely fatal to satisfactory medical examination to go back to the old idea of categories A, B, and so on. It is not possible for any doctor to place a man absolutely into a pigeon-hole. All you can say is that a man is fit for his age or not fit for his age. That is the meaning which was attached by definition at the time of their introduction to the terms Grades 1, 2 and 3, and really it is far too serious for one to allow the accusation that there has been a breach of faith in this matter to pass unanswered. I can assure the House that we have not changed the meaning of those terms, and that we have not changed the principle upon which we are working. That is a fact. There has evidently been misunderstanding. This very night, speaking here, the Deputy-Chair man of Ways and Means has indicated—I think I may say it fairly—that he did not understand this double system which is in force, and which has been in force.

It is evident that there has been complete misunderstanding, and I welcome this opportunity of giving an explanation, which I hope will lead to complete understanding. We are not trying to conceal anything. We have nothing to conceal. I would not attempt to conceal anything in connection with this matter. That is the principle which is at work—that a man's physical fitness should be determined in respect of his age, that his age should be considered, and that the whole of his employment in the Army should be determined by the consideration of these two facts. The next point that I would like to refer to is the question of the medical boards throughout the country. As the House is aware, there are a very great number of medical examinations being carried out at the present time. I may say that the estimate which I gave to the House in the month of April that we would do 35,000 medical examinations a day has proved a wrong estimate. We have never been able to work up to anything like that number. We are at present employing a very large number of medical men—the figure runs into thousands—and we are allowing a quarter of an hour of medical time for every examination.

We are now allowing a quarter of an hour of medical time for every recruit that is examined.

I think the House is not treating the Minister quite fairly. He should be allowed to make his statements without so many interruptions.

We are allowing a quarter of an hour of medical time for every man examined, and the House ought to consider that the medical examination of every man costs for medical time alone 4s. 2d. It is not possible to complete every man's examination in a quarter of an hour, nor is it necessary to examine every man for a quarter of an hour. There are many cases which are dealt with in two or three minutes. [HON. MEMBERS: "Oh!"] Yes, and rightly so, because the man is either rejected or is obviously, for some reason or other, of the lowest grade which can become available for service. We are not calling up Grade 3 men of the new age period, and therefore it is not necessary to complete a very elaborate examination if the man is obviously not fit for one of the higher grades. In that way time is saved and longer time is obtained for the examination of men who require greater care. I do not think it is possible to obtain the services of more medical men than those now employed. They are about the maximum that we can obtain without serious detriment to the medical care of the civil community. Yet the demands for men for the force—Navy, Air Force, and Army—are so insistent that we cannot let down the number of examinations being performed daily. We, therefore, have to face the fact that about a quarter of an hour of medical time is all that we can afford nationally to provide for the medical examination of these men who are coming forward. We have, therefore, instructed them that they are, where the case is obvious, to push through the examination if the man is not going to be taken for service at all. It is now six or seven weeks since I first became alarmed as to what was happening at some of the medical boards. I would not like this House to consider that it has required stimulation from Members of this House before the Department took action. I myself have visited in the last few weeks no less than twenty-four places in different parts of the country, so that I could be absolutely certain that I knew what was going on, and I think I can say this: that throughout the country—as a whole the work that is being done is eminently satisfactory—[HON. MEMBERS: "Oh!"]—throughout the country as a whole; and we have had since this criticism of the medical boards began to appear very much in the Press the most extraordinary phenomena. We have received hundreds and hundreds of letters of thanks, of appreciation of medical examinations—literally hundreds; we have hundreds of them.

From men passed in Grade 1 and Grade 2, thanking us and saying that they consider the attacks unjust. These are men who are satisfied with their examination, and I would like to express here my deep and heartfelt thanks to the medical profession for the work they have done under enormous difficulties and pressure at the present time, on very inadequate remuneration. They are working under great strain in civil practice, and are helping us by taking two hours and a half, and perhaps five hours, in the course of the day examining recruits. The work that is being done on the whole is, to my certain knowledge, and from personal observation of hundreds of records, most satisfactory. On the other hand, I would be doing less than my duty if I did not admit that at certain places there have been breakdowns. I admit fully that the circular letter which was read by my hon. Friend the Member for Ealing (Sir H. Nield) was a most unfortunate letter—the one issued on the 3rd of May. But the story was not quite completed by my hon. Friend. That letter was issued from the regional headquarters, and a copy of it was sent to the Ministry, where it reached in the ordinary routine—because we have a check on these regional districts—the Chief Commissioner, who at once had it cancelled, and interviewed the Commissioner for London, who was instructed to summon, and did summon at once, the whole of the chairmen of the medical boards, got them together, and explained that a mistake had been made, that the instruction issued was cancelled, and reported within a week that that had been done. I know for a fact that it was done.

It was cancelled at once as soon as it was found. There was no instruction permitting second examination subsequently at all. This is the Report, but I will not read it as, if the hon. Members wishes to see it, it is in the Library in a similar binding to this one and has been placed there for the information of any Member who wishes to see it. The letter, which was an unfortunate letter, one which might quite easily be issued by any Government Department working under considerable pressure, was cancelled at once. One cannot do more than that. I have myself been to see these London boards at Conduit Street, and I would like to tell the House that the personnel of those boards is in large measure the same personnel that formed the eminently satisfactory Whitehall board. It was the Scotland Yard board, which the Deputy-Chairman of Ways and Means said was the board to which he used to send his cases. It is a most extraordinary-thing that that same personnel, reinforced, should be giving different results. [HON. MEMBERS: "Owing to the change in the instructions!"] That is exactly what I expected would be said. The reason is not a change of instructions. The reason is that here in London everyone has felt the pressure of the German offensive. Everyone here in London has felt acutely the need of the forces for men. It is all unconscious reaction of the pressure of the German offensive that is making these boards pass men who, under less pressure, they would not pass. They have received precisely the same instructions as other boards throughout the country. There is no other difference between the two. We have found it necessary to slow down the London board. There is no vice about these boards. They are not trying to push men through who are unfit; they are trying to do their work absolutely solidly, soundly, and well.

Another thing I would like to impress upon the House is that there is a great deal in this criticism of the boards which is not fair. It is not real. These things come in waves. Once criticism starts, criticism grows. Even if there is nothing to complain of, the neurotic complains. It will be within the recollection of the House that two nights ago the right hon. Baronet the Junior Member for the City of London (Sir F. Banbury), who I am sorry is not in his place, raised a case about an individual, a bleeder, who was examined at the Camberwell Baths. It is recorded in the OFFICIAL REPORT that the man complained that he was placed in a bath and made to go through the motion of swimming. That is a sheer bit of hallucination. The baths are floored over, there is no water in them. My hon. Friend the Parliamentary Secretary to the Ministry went down there the next morning, and I saw the chairman of the board. That was solemnly read out in this House, and there is not a shadow of foundation for it.

It was unknown at the time that he suffered from hallucinations. That has since appeared. That is an example of a not infrequent type of complaint. I have here another rather extraordinary case, of a letter, written to a Member of this House who, very courteously sent it on to me, in which bitter complaint was made about the medical boards and about the inferior standard of work, giving actual cases. I wrote back to my hon. Friend in the House, and he sent the letter on to his correspondent, who wrote back and said:

"It did not occur to me when I wrote you that my letter would be passed on to Sir Auckland Geddes; otherwise I would have endeavoured to make myself more clear. I should not like it to be thought that there was any complaint as to the treatment of the men (hiring examination."
Which was what the whole letter was about, so I sent off the Deputy-Commissioner of the Medical Service concerned to go and see this gentleman, who is a responsible citizen and a prominent man. He now writes that he is sorry that he wrote that letter. He was suffering from neuralgia, and it was written on the spur of the moment without due consideration. You cannot take all these complaints at full face value. Listen to this. The hon. Gentleman (Sir H. Nield) put down yesterday or the day before a question to ask me whether I was aware that a man who is blind in one eye, partially paralysed, and suffering from hæmorrhage of the lungs, on 5th June, was placed in Grade 1 by the medical board in Northampton Street, W.; whether such a decision is in accordance with the instructions issued to medical boards by the Department; and whether it is proposed that a man suffering from those disabilities should be taken in the Army in Grade 1 or in any capacity? This case caused me, as many cases do, a feeling of sinking, wondering what the medical board would do next; so the Parliamentary Secretary wrote to my hon. Friend and asked him if he could give any information about the case. The reply struck me as most extraordinary. It was received to-day:
"Dear Sir,—I am directed to acknowledge the receipt of your letter of 15th June to Sir H. Nield, K.C., M.P., and to say that the information was furnished by a man who was examined at the same time as the man in question, but unfortunately he was unable to obtain the man's name and address."

Does the right hon. Gentleman appreciate that the information was sent officially to the office of the Middlesex Appeal Tribunal by a man who claimed to have been in the examination room at the moment that man was passed by the doctor?

I say there had been no communication to the Department in this case. Here is a case, for which I do not think there is any evidence, brought forward, discussed, and brought out in evidence against the Department because a man said to someone at the tribunal—

No address, no name. Someone saw a man with one eye who was passed medically fit. Really if that is the sort of stuff that is going to be brought forward it is perfectly hopeless. I am now, and always have been, absolutely willing and anxious to receive every bit of assistance I can from every Member of this House who will help us to get this difficult, unpleasant and very important work done properly, but really we do not get much help. In one region I asked the regional director to issue invitations to every Member of Parliament for a constituency in that region to come and see the work of the Recruiting Department at any time he liked. Fifty-one invitations were issued. Forty Members have not replied. Ten have acknowledged and have done nothing. One only has come. The right hon. Gentleman (Mr. Samuel) came and saw the medical board, and said it was satisfactory. He is, so far as I can gather, the only Member of the House out of that fifty-one who has done anything in the way of satisfying himself that our actions are either wrong or right by direct observation. At a time like this, if hon. Members feel that we who are trying under great pressure to meet the demands of the Army and Navy and the Air Force for men are doing wrong, would it not be better in the country's interests and in the interests of confidence throughout the country if they came to me, or wrote to me, or spoke to the Parliamentary Secretary any time he is here, and said, "Look here; we think you are making an awful mess of this. We are sure you are. What are you doing it for?" Then we could explain. It would be so much better. Would it not be much better to assume that we really are trying to do this thing right than that we are trying to go wrong through some sheer natural inborn vice? For months I have been working at these medical boards, and yet the sort of case I have referred to is put down as a question here without any evidence at all. It really is hardly fair to the country. I do not mind a bit for myself. I do not mind for the Department, although they are working absolutely up to the hilt. The staff has worked splendidly. It has stood up to the pressure of the German offensive in a way that is absolutely first class. No Department in this country has had to bear the load that the National Service Department has had to bear recently. The way the staff has stood up to the strain is absolutely magnificent; but, naturally, with the new classes of men coming in, there are difficulties. We cannot avoid them. We had a mistake made in London, but we cancelled the bad order at once. You cannot do more than that. You cannot stand over every official's shoulder day and night and see what he is writing. These things will happen.

We had a few bad cases at Conduit Street. I quite admit that. We then got a wave of criticism which has carried the neurotic along with it, and we have got now a big volume of neurotic criticism added to the real criticism. I know perfectly well the class of case that were up before the House of Commons Tribunal to-day. They are a small group of cases; at any rate, I hope they are a small group, which got through during that time, when there was, I will not say a breakdown, but a wobble, in the organisation. The machine as a whole is the same machine that gave satisfaction throughout all the winter months. It has been described by our most severe critic, the Deputy-Chairman of Ways and Means (Sir D. Maclean) as having been satisfactory during the winter months. It is the same machine working on the same principle. The whole of the arrangements for grading men are exactly the same as they were. The whole thing is the same, but criticism has started. No recognition has been made of the amount of work that has been done to put the break right, and it is now, I think, completely right. It was not a real break, it was only a wobble. The results did not show themselves at the moment, but they showed themselves weeks afterwards, and once they start then the same case comes up and up.

I would appeal to this House at this time when we have the greatest possible difficulty in maintaining the supply of men for the forces that we should receive all the help of private criticism sent to us, and we will always pay attention to it, before the questions are put down in the House and before statements are made in public, which will be recorded and published throughout the whole country as statements of policy when the statements are in fact based, as we now know for certain, upon a misunderstanding. We have had these statements, and I can assure the House that there are at the present moment an enormous number of men held up from getting into the forces as a result of the statements that have been made. I would like to appeal to the House to try to understand the policy which is being followed in regard to taking men for the Army. It would be absolutely unsound in the national interest to take all young men together. You would disorganise everything. If you take all the young men now, where will the recruits come from months hence? Where is your money going to come from to keep things going if you take all the men engaged in production? [An HON. MEMBER: "You are taking the men of business!"] The older men who are being taken into the Army are a mere handful. How many men of the new military age who have already joined up—I am not talking about being called to join up, or be medically examined, but who have already joined up—are known to any individual Member of this House? Not many. It is one thing to have a lot of talk about the people who are called up; it is another thing to watch the figures of the men who are joining. There is many a ditch and many a fence for the man to be stopped by before he joins the Service after he is made liable under the Military Service Acts; and the numbers of men of the older age that are being taken into the Army in the main are the men who can be better spared than their juniors. There have been one or two exceptions, but in the main I am convinced that this policy which we are following is absolutely sound. There are definite needs at this present moment in the Army for men who for that age are physically fit, who will not in all probability—I can give no guarantee, obviously, with regard to a soldier—will not be required actively to fight. There must be units, there must be forces present in certain distant theatres throughout the months to come, and really at the present time anything that delays the legitimate flow of the older men to the Colours is hampering our forces in France.

He would be a brave man who, because of some personal disagreement with the policy that has been followed, would say that he would not allow these men to pass through to the Forces. They are required and urgently required. It was announced to the House two months ago that 7 per cent. of the total block of men of the new age were going to be required to be posted this year. That has been twisted and turned as if it meant that only 7 per cent. of them will be fit for service. The statement stands—I have repeated it on many occasions in the House—as true to-day as it was then, that it is absolutely necessary, if we are not to dislocate our arrangements for maintaining the forces in the field, that we should have 7 per cent. of the total number of men of the new age before the end of this year and that they should come in a steady flow. It is a fact that at the present rate we shall not get them. It is absolutely necessary, therefore—and I wish to be quite clear on this—that we should increase the pressure of the call for these men, and instructions will be issued to the tribunals that it is important that more men of these ages should be obtained. That is absolutely necessary if we are not to disorganise the arrangements for maintaining our forces in the field. That is all I wish to say on that subject. But there were some points raised to which I might possibly be permitted to refer for a moment. There was a definite statement made by the right hon. Member for Dewsbury, about the swollen staff, and the gigantic organisation, priding itself on its own size, I would like to take this opportunity of telling the House that we are now so administering the recruiting service that recruits are costing less each month than the month before, and that the staff engaged in the work is being steadily reduced, in spite of the fact that the cost of the medical examination is going steadily up, and we are paying more money for the medical examinations. It is only just to the staff at this time to say that, in view of the work they have been doing and the hours and hours of overtime they have worked. Many of them are volunteers without pay or reward, and yet they hear a lot of criticism hurled at them, and it is only right to remember that they are volunteers who in many cases are giving their services free to the State.

The right hon. Gentleman stands up in defence of the War Office and recruiting, and I can sympathise with the right hon. Gentleman in the position in which he finds himself to-day. I can assure him that the appeal he has made to us to do nothing to stop the flow of recruits to the forces does not fall, in my case, on deaf ears. I came down to the House endeavouring to put myself in the place of the right hon. Gentleman, and I can assure him that his position is one with which I have great sympathy. Toward the end of my authority at the War Office it had been decided that the business of getting recruits for the Army was a business which ought not to be any longer in the hands of the War Office, and ought to be the business of a civil Department, and accordingly a Civil Department was set up for that purpose, and the right hon. Gentleman was appointed to his present office. The Army Council and the military authorities ought to have time in which they can use their energies for the conduct of the War, and they ought not to be embarrassed with the trouble and difficulty of securing troops. And when that decision was taken it was undoubtedly equally decided that after a recruit had been obtained it was not the business of the Civil Department to place him in the Army but the business of the Army to put him in the position and unit in the manner they thought best. I do not think the Minister of National Service has sufficiently fully appreciated that. My right hon. Friend the Deputy-Chairman has been told by the Minister of National Service that he did not understand the situation. I cannot help thinking that the Minister of National Service has made a muddle in that matter. At any rate, my right hon. Friend the Deputy-Chairman knows the practice pursued in consequence of the instructions given, and he knows the results. My right hon. Friend the Deputy-Chairman gave some extraordinary illustrations, and I thought the fact which emerged most strongly from them was how exceedingly unfair it is that in order that a man should be able to obtain redress for being wrongly graded he should have to consult privately a medical practitioner. How many of these men are there who can afford that amount of money? It is a very infinitesimal proportion. The right hon. Gentleman said that the change in the name of the grades was intended to convey a different meaning, and yet the actual leaflet itself says, "Grade 1 is generally equivalent to category A."

That is not the leaflet which officially gave the definition of the new grades.

It is a leaflet issued from his Department, and it explains what Grade 1 is. I do not know why on earth there was any alteration made. It is true we had our difficulties in the old War Office days, when I worked in conjunction with the right hon. Gentleman when he was Director of Recruiting. Our difficulties were mainly due to medical boards, due to the fact that the majority of doctors at that time had been sent out of the country and were serving with the forces in France. I understand that the right hon. Gentleman has not had those difficulties with the medical boards except in one or two instances, such as the Conduit Street Board, where there was, he said, not a breakdown, but a wobble in the machinery. It is quite true that he has to get recruits for the Army, and we greatly sympathise with him in that most difficult and onerous task, but it is no use getting recruits for the Army that are not going to be of value to the Army, and that is the main proposition which my right hon. Friend brought before this House, and that is really the fact of which the House is most seised. It is not a single, a double, or even a treble disadvantage to the country to take bad recruits, but it is a quadruple disadvantage. You not only do a grave injustice to the man himself, but you take him away from work which may be of great national importance, and you deprive the nation of that work; you increase the charge to the Army for hospital accommodation and treatment; and you increase the charge for pensions. The right hon. Gentleman told us that everything had worked well until quite recently, when his attention had been called to certain breakdowns by medical boards, and he said he thought, in part at any rate, this was due to a sort of subconscious action on the part of doctors who were speeding up the flow of recruits to the Army owing to the pressure on the Western Front. It is a most mysterious suggestion that doctors should so lose their balance of judgment as to place a man in a group for which he is wholly unfit, and I hope that that particular medical board which the right hon. Gentleman has in his mind's eye will at any rate be informed that they must not pursue that course any further. It is impossible for the Minister of National Service to direct on what particular duties a man shall be employed once he gets into the Army. The right hon. Gentleman will admit that. He cannot issue instructions to the military authorities to say that A. B. is a person who shall only be employed on a particular duty. Once a man is put into the Army it is the business of the Army to use him in the way that they think best. We cannot clearly interfere with the military authorities in that matter. It must be within their discretion to utilise the men in the best possible way. That being so, surely an instruction ought to be issued to these medical boards to exercise the greatest care, so that these terrible mistakes which have been brought to the notice of the House by the Deputy-Chairman shall be avoided in the future. I hope I have said nothing which will do anything to make it more difficult for the right hon. Gentleman to carry on his most difficult task. I fully appreciate the great difficulty he has to face. When he made the alteration in Grade 1 a, b, c, and d, he did so, as he informed the House, because categorising was not a desirable policy to pursue. Indeed, we did find in the days I was at the War Office that this policy failed because the Army invariably put a man in another category. I do not blame the Army, but, that being the case, surely it is imperative that the medical boards and the National Service Ministry should only choose men who are fit for positive duties in any part of the field in France, unless they are specially car-marked for work behind the lines or are not allowed to go to the front at all. I imagine from what the right hon. Gentleman said that he has been working in great cordiality with the War Office. No doubt there are certain grades in the Army—those for butchers, dispensers, and so on—which do not require men to be in Grade 1, and he might ask the Army in such cases to be content with men from Grade 2. I know the right hon. Gentleman cannot, of course, issue any such instructions to the military authority. Having been at General Headquarters in the Adjutant-General's Department, he knows that very well; therefore, it behoves him, as the head of the National Service Ministry, to issue instructions to the medical boards to exercise the utmost care not to pass men who are unfitted for the duties to which they are likely to be put, because it is encumbering the Army with sick men, it is encumbering the pension service, and at the same time it is taking away a source of national wealth, none of which things we can afford now.

I rise to make a suggestion, if I may, to the Government. This is a matter in which the House takes a very great deal of interest. The explanation of the Minister of National Service, I think, has not been regarded in all quarters with satisfaction, and I understand that there are several Members who desire to take part in this Debate. The Debate only began at nine o'clock, and it is now a few minutes to eleven. Supply for next Thursday has not been fixed, and the Vote for the Ministry of National Service has not yet been taken this Session. I would suggest, if agreeable to the House and acceptable to the Government, that this Debate should now be discontinued for the time being, that the Vote for the Ministry of National Service should be put down for Thursday next, and that then there should be a full opportunity for discussion.

I think there is no doubt whatever that it can be arranged to take the Vote next Thursday, and I hope the House, therefore, will now take the Second Reading.

Question put, and agreed to.

Bill accordingly read a second time, and committed to a Committee of the Whole House for to-morrow (Friday).