garded as unfit and not accepted. In short, the army accepted for service only the best human material.
At the outbreak of war in Aug. 1014, there was a tremendous rush of recruits to the colours, and perforce attempts were made to deal, on the same simple plan, with the tens of thousands of men who besieged the recruiting offices. The need for soldiers was clamant, irresistible, and there was no time to devise another method. The result was inevitable the army was flooded with men who after a few weeks or months of service broke down and proved useless. The authorities then saw that in this war they were confronted with a new problem men had to be provided on a scale never before contemplated and the man- power resources of the country were to be strained to the ut- most. The army needed would have to employ men of different degrees of physical fitness, since the available number of per- fectly fit men would not be adequate for all the needs of the country. It was therefore necessary to classify recruits accord-* ing to their fitness for the very varied duties for which the army required men the old simple division into " fit " and " unfit " was no longer sufficient: recruits must be classified or graded so that as far as possible every man called up for service should be allotted to the particular occupation in the army for which he was fitted by his training and degree of physical fitness. Ac- cordingly, a system of categories was introduced whereby recruits were classified by medical boards as being fit for general service, field service at home, garrison service, labour or seden- tary work; as experience of this system accumulated various modifications and sub-divisions of these categories were subse- quently introduced to meet the difficulties which arose in their application in practice.
Meantime, on Jan. 27 1916, the first Military Service Act, which provided for the compulsory service of unmarried men between the ages of 18 and 41, came into operation, and on May 26, a like obligation was imposed on the married between those ages. By this time, the difficulty of categorization was becoming painfully evident; it consisted essentially of the fact that the category was not a purely medical classification but rather a kind of administrative shorthand founded upon medical informa- tion. In other words, medical boards were required to perform the functions of a posting board, as well as their proper medical function of assessing the degree of physical fitness of the men examined. The attempt to combine these functions failed, as in the light of experience we can see it was bound to fail, and was in fact the cause of the growing volume of dissatisfaction which became steadily more general and more emphatic during the latter half of 1916 and the early months of 1917. The examina- tion of men called up under the Review of Exceptions Act in April 1917 caused a storm of hostile criticism; this led to the appointment of the Shortt Committee, which, in Aug. 1917, recom- mended to the House of Commons that the whole organization and administration of examination should be transferred from the War Office to civilian control. Accordingly, the Ministry of National Service the Department entrusted with this work assumed these duties as from midnight Oct. 31 1917.
The immediate medical duties of the Department were: (i) To introduce a new system of grading the grade of each man to be determined by physical considerations alone to replace the system cf categorization in which administrative as well as medical considerations were taken into account; (2) to lay down ' definite standards of physical efficiency for the guidance of members of examining boards; (3) to establish National Service Medical Boards for the examination of men of military age.
As regards the personnel of the boards, great care was taken to select suitable chairmen who were generally whole-time medical officers. Members of the boards (i chairman and 4 members constituted a board) were drawn from a panel of local civilian doctors of good standing a system which made for efficient work, economized the medical man-power of the country and was at the same time elastic. These boards were established at convenient centres all over Great Britain. At first they numbered 97 and were soon examining some 80,000 men per month. The number of boards steadily increased to cope -with
the increasing work. In April 1918 285,631 men were examined, in May 456,999, and in June 475,416; by this time the number of boards was 209. After this the pressure relaxed somewhat, and the numbers in succeeding months were July 371,923, Aug. 158,544, Sept. 97,694, Oct. 110,255.
From the outset instructions were issued to boards that they were to grade all men brought before them according to their physical fitness at the time of examination in conformity with the following standards:
Grade I. Those who attain the full normal standard of health and strength and are capable of enduring physical exertion suitable to their age. Such men must not suffer from progressive organic disease, nor have any serious disability or deformity. Minor defects which can be remedied or adequately compensated by artificial means will not be regarded as disqualifications.
Grade II. Those who for various causes, such as being subject to partial disabilities, do not reach the standard of Grade I. They must not suffer from progressive organic disease. They must have fair hearing and vision, be of moderate muscular development, and be able to undergo a considerable degree of physical exertion of a nature not involving severe strain.
Grade III. Those who present marked physical disabilities or such evidence of past disease that they are not considered fit to undergo the degree of physical exertion required for the higher grades. Examples of men suitable for this grade are those with badly deformed toes, severe flat-foot, and some cases of hernia and of varicose veins (others are indicated later under the headings of the various diseases and disabilities). The third grade will also include those who are fit only for clerical and other sedentary occupations, such as tailoring and bootmaking.
Grade IV. All those who are totally and permanently unfit for any form of military service.
In order to assist the boards in their task of grading, and to insure uniformity as far as possible through the country, instruc- tions were also issued to them indicating the effect of some 60 common disabilities and diseases upon the grading. Thus, in the Ministry of National Service, a department was created with the administrative machinery requisite not only to supply the armed forces with recruits, but also to survey the physical fitness of the male population of military age and so provide a physical census of the human material at the disposal of the country for all its needs. It is evident that, until categorization with its administrative factors was abandoned and grading by physical considerations alone introduced, true inferences as to the health and fitness of the male population could not be drawn from the statistical returns of recruiting. With the introduction of the new system on Nov. 1 1917, the statistical returns at once became of great value, and provided for the first time a physical census of part at least of the population.
The number of examinations completed during this last year of the war with the numbers placed in each grade is shown in the accompanying table:
Medical Examinations (Period Nov. I 1917 to Oct. 31 1918). No. of Examinations and Reexaminations.
Grade 1 871,769 (36-0%)
Grade II 546,276(22-5%)
Grade III 756,859(31-3%)
Grade IV 250,280 (10-2 %)
Total
2,425,184
It will be noted that of the 2,425,184 examinations 871,769 resulted in the man being placed in Grade I., 546,276 in Grade II., 756,859 in Grade III., and 250,280 in Grade IV. In other words 36% were placed in Grade I., i.e. were judged to have attained the full normal Standard of health and strength, and to be capable of undergoing physical exertion suitable to their age; 22 % were placed in Grade II., i.e. were judged to be capable only of undergoing such physical exertion as did not involve severe strain ; 32 % were placed in Grade III., i.e. presented marked physical disabilities or such evidence of past disease that they were not considered fit to undergo the degree of exertion required for the higher grades; 10% were placed in Grade IV., i.e. were judged to be totally and permanently unfit for any form of military service. This result may be summarized by saying that of every 9 men of military age in Great Britain in the year under review 3 were perfectly fit and healthy, 2 were definitely below the normal standard of health, 3 were unfit to undergo any^
