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THE MUSTERING OF MEDICAL

SERVICE IN SCOTLAND
1914-1919

THE

MUSTERING OF MEDICAL

SERVICE IN SCOTLAND

1914-1919

BEING A RECORD OF THE WORK OF THE SCOTTISH

MEDICAL SERVICE EMERGENCY COMMITTEE

IN THE WAR

J. R. CURRIE

CAPTAIN R.A.M.C. MEDICAL OFFICER SCOTTISH BOARD OF HEALTH

SOMETIME MEMBER OF THE SCOTTISH MEDICAL SERVICE

EMERGENCY COMMITTEE

WITH A PREFACE BY

LIEUT. -GENERAL SIR ALFRED KEOGH, G.C.B., G.C.V.O., C.H.

LATELY DIRF.CTOR GENERAL OF ARMY MEDICAL SERVICES

PRINTED FOR THE

SCOTTISH MEDICAL SERVICE

EMERGENCY COMMITTEE

BY MORRISON & GIBB LTD.

EDINBURGH, 1922

PREFACE

THE Scottish Medical Service Emergency Committee
has wisely resolved to publish an account of its work
during the years 1914-1919. The story, as told by
Capt. Currie in the following pages, is not merely
interesting as a record of Scottish endeavour. It
possesses a special value to a profession awakened to
the important position it should occupy as an authority
in State affairs.

In 1914 the leaders of the medical profession in
Scotland assumed administrative and executive func-
tions for the purpose of safeguarding the interests of
the civil population, while at the same time arranging
for the provision of medical aid to the Military Services
of the Crown. The general mobilization of the Terri-
torial Force and of the Reserve had withdrawn from
civil avocations a large proportion of the Scottish
profession. It became obvious that, as events de-
veloped, larger demands would be made upon its
already diminished strength. At this crisis the pro-
fession in Scotland, with remarkably unanimity,
entrusted its leaders with plenary powers. This was
a voluntary submission to trusted authorities. The
movement, had it been official, could not have attained
the like success.

521700

vi Preface

As the world war developed, the difficulties which
the Emergency Committee had to meet necessarily
increased. The reader will learn, as he reads the
story, how these were often anticipated and always
surmounted. He will notice that, as the years rolled
on, there were periods of difficulty which at times
would almost appear to have endangered the success
of the Committee's efforts. This point should not be
lost sight of.

The provision of Officers for the rapidly expanding
Royal Army Medical Corps was one of the chief diffi-
culties which, from 1915 onwards, the War Office had
to encounter. While it is true that the Army Medical
Department was in some respects favourably situated
in regard to this matter, the constant pressure from
other Government Departments in their endeavours to
retain tneir medical personnel for public purposes was
often very embarrassing. In Scotland at least, the
opposing interests were quickly harmonized by the
leaders of the profession, as Capt. Currie lucidly ex-
plains, and from that time forward the anxieties of the
War Office ceased. In the end Scotland contributed
a larger proportion of Officers to the medical branch of
the Army than had been anticipated.

The methods of the Committee are profoundly inter-
esting. According to Tables I. and II. in the Text,
compiled when the mustering of the medical service
in Scotland began, the total medical personnel available
for all the purposes the Committee had in view was
three thousand eight hundred and twenty-two. Though

Preface vii

medical education continued to be carried on in the
Scottish Universities, the increase of personnel so
obtained hardly lightened the work of the Committee.
The new graduates with few exceptions immediately
joined the Royal Army Medical Corps. Medical re-
sources for civil purposes were constantly diminishing.
Despite such difficulties, the incessant demands of the
War Office were nevertheless always met ; and I feel
bound to record the fact that, while the reasons for
these demands could not of necessity be given, the
demands were never questioned by the Committee but
were complied with without a murmur. Great were
the sacrifices that were made, sacrifices which it was
the endeavour of the Committee to abate by a series of
measures recorded in this volume, not the least of the
achievements which can be put to the credit of Scottish
Medicine.

One almost regrets that the original purely voluntary
method could not continue beyond 1915. It was, how-
ever, inevitable under the circumstances that the
Emergency Committee should become involved in the
system which the difficulties of lay recruiting rendered
necessary. But the drawbacks were minimized as far
as possible. We find there is no abatement in the
efforts of the Committee : the enthusiasm and loyalty
of the profession are not diminished : the adjustments
between civil and military claims go on as before ; and
indeed under the Military Service Acts of 1916, as
Capt. Currie remarks, the special position of the pro-
fession is thrown into high relief.

viii Preface

Political changes in subsequent years altered the
relations of the Committee. The creation of the
Ministry of National Service broke its direct connec-
tion with the War Office, though the efforts of the
War Office to preserve, as far as possible, the autonomy
of the Committee were not by any means abated, were
indeed never relaxed. Dr. Norman Walker, the Con-
vener of the Committee, was appointed Scottish
Medical Commissioner to the Ministry, which thus
fell heir to the influential aid he had previously rendered
to the War Office.

If I have given a brief outline of the chief points in
the record of the earlier years of the Committee's
work when the Scottish organization was founded
upon a voluntary basis, I have done so because
I consider that this period reflects even more dis-
tinction on the medical profession in Scotland than
the subsequent or, as one may call it, the official
period.

The history of the part which Scottish Medicine
played throughout the War is worthy of careful study,
if only because of the lessons which can be learned
from its remarkable achievement. A graceful tribute
is paid on page 198 by Capt. Currie to the Scottish
profession. It is indeed abundantly clear that without
its unswerving loyalty, not even the Committee, com-
posed though it was of distinguished members of the
civil profession, could have successfully realized its
ideals of 1914. Even on Armistice Day Scotland was
prepared to contribute still more officers to the Royal

Preface ix

Army Medical Corps if the War had been further
prolonged.

Those of us who have served in the Royal Army
Medical Corps and have grown accustomed to the
struggle for medical autonomy in relation to military
affairs may conclude from the course of certain transac-
tions recorded in these pages that a not dissimilar
movement may one day be believed to be possible in
civil medicine. There can be no better example of how
much administrative ability and business capacity are
locked up in the profession of medicine than the
history of its voluntary work in Scotland. /•

I have already referred to Dr. Norman Walker, the
Convener of the Committee. From its earliest days he
was its mainstay. His sympathy with the difficulties
with which the War Office was faced and his obvious
desire to help were a never-failing stimulus to those to
whom questions of personnel were of the first import-
ance. By the close of 1916, which ended for a time his
direct relation with the War Office as Convener, Scot-
land had contributed 1800 officers to the Royal Army
Medical Corps. The figure had risen to 2200 at the
end of 1917, and to 2349 on Armistice Day.

In giving attention to the lessons which a study of
this book suggests one may perhaps regret that Capt.
Currie, who had himself served in the field and who
had thus in a twofold capacity peculiar opportunities
of studying the problems of the science and art of
medicine in relation to the science and art of war,
was precluded by the terms of the Committee's remit

x Preface

from setting forth in more detail his views on these
problems, which are at this moment of such special
interest. Unanticipated difficulties in the late War
were necessarily met by measures which, given time
for reflection, might have been different. Most of these
depended, and must always depend, on the organiza-
tion of the civil profession for the expansion of the
Regular Medical Corps for war needs. There is much
to be done if the errors of the past are not to be re-
peated : Capt. Currie's views, and those of Dr. Norman
Walker, on the procedure which should be adopted
would be of signal value.

ALFRED KEOGH.

FRANCE,

August 1922.

INTRODUCTION

THIS work, undertaken at the request of the Scottish
Medical Service Emergency Committee, is concerned
with the actings of the Committee during the Recent
War. It presents in addition, however imperfectly,
a view of the manner in which civilian Scottish practi-
tioners— as distinguished from regular officers of the
Navy, Army and Air Force — answered the call to
service for their King and their Country.

The Committee took up duty on 12 August 1914,
and dissolved on 31 December 1919. Founded
originally with the simple object of safeguarding civil
practice, it became, before long, the accepted authority
for medical recruiting in Scotland. Its field of activity,
narrow at the outset, widened with the course of events.
The narrative follows where the argument leads.

The things done or attempted during the period of
over five years are recorded for the most part in
chronological order. In tracing continuous movements
the time sequence is in some cases broken. The
substance of the Statutes, Regulations and other pro-
visions which mark changes in the position of the
medical profession and the Committee is embodied in
the Text.

The Minutes, Correspondence, Memoranda, Registers
and other documents of the Committee were placed at

xii Introduction

my disposal, and consulted. For the details of matters
transacted while I was furth of Scotland, I am princi-
pally indebted to Dr. Norman Walker, Convener of the
Committee.

The tabular records up to 1916 are derived from
contemporary counts employed or made by the
Committee for recruiting purposes. Of the remaining
tables most are based on an examination of the
Committee's New War Register, prepared by the
Committee in 1918 for its Recruiting Scheme of that
year, and employed after the Armistice in connection
with demobilization. In compiling the tables relating
to the deaths of Scottish practitioners, I have been
aided by Mr. T. H. Graham, Secretary of the Com-
mittee, now Branch Registrar for Scotland under the
General Medical Council.

Use has been made of official publications issued by
Departments of State, and of the lucid commentary
on current happenings contained in the pages of the
British Medical Journal.

J. R. CURRIE,

EDINBURGH,
June 1922.

CONTENTS

CHAPTER I
1914

PACK

CONFLICTING CLAIMS ...... i

SBRAJEVO ....... a

BRITISH MOBILIZATION ...... 4

MEDICAL POSITION IN SCOTLAND . . . -4

FIRST MEDICAL CONFERENCE ..... 5

EMERGENCY COMMITTEE . . . . .6

MEDICAL STRENGTH : i AUGUST 1914 ... 7

MEDICAL DISTRIBUTION: i AUGUST 1914 . • 9

EARLY TRANSACTIONS : First Memorandum — Attitude of Pro-
fession— Dependants of Men on Service — Response to First
Memorandum • • . • • .12

FORM OF UNDERTAKING . . . . 15

TERRITORIAL OFFICERS . . . . • 15

MEETING ........ *7

CLOSB OF 1914 ....... 17

CHAPTER II
1915. § 1

CLASSIFICATION OF PRACTICES : Second Memorandum . ig

ACTION IN ENGLAND ... . . 21

LETTER OF DIRECTOR GENERAL, A. M.S. . . . 22

VARIOUS RESULTS ENSUING : Third Memorandum — Applica-
tions for Commissions — Agreement — Organized Response —
Medical Bureau — British Medical Association . . 22

xiii

xiv Contents

PACK

SECOND MEDICAL CONFERENCE . . . .25

MEDICAL RECRUITING PROJECT . . . .26

EMERGENCY COMMITTEE IN CHARGE : Royal Navy — Territorial

Force ....... 28

MEDICAL STRENGTH : 15 MAY 1915 . . . -29

MEDICAL DISTRIBUTION : 15 MAY 1915 . . .32

CHAPTER III
1915, § 2

1915 RECRUITING SCHEME : INAUGURATION — Fourth Memor-
andum— Terms of Service — Organization . . -33
1915 SCHEME: NUMERICAL CONSIDERATIONS. . . 35
1915 SCHEME: OPERATION . . . . -37

SUNDRY PROCEDURE: Special Committee — Local Murmuring—
Fifth Memorandum — Terms of Service — Advice to Prac-
titioners ....... 38

PRACTICES OF SERVING OFFICERS: Help by Committee —
Disputes Sub-Committee — Arrangements — Notice Card —
Lay Press — Meeting . . . . . .41

1915 SCHEME: OUTPUT. . . . . .44

CHAPTER IV
1915. § 3

SURVEY OF ARMY RECRUITING : Normal System— Recruiting

Propaganda — National Registration Act 1915 . . 46

LORD DERBY'S SCHEME : Royal Proclamation . . .48

CANVASSING OF PRACTITIONERS: Conference . . 50

EMERGENCY COMMITTEE AND LORD DERBY'S SCHEME:

Tribunal for Medical Purposes . . . 51

WAR REGISTER: Sixth Memorandum . . . .52

MEDICAL STRENGTH : 31 DECEMBER 1915 . . -54

MEDICAL DISTRIBUTION: 31 DECEMBER 1915. . 54

CLOSE OF 1915 ....... 57

Contents xv

CHAPTER V
1916. § 1

PAGE

1916 SCHEME : INAUGURATION — Central Control— Local Con-
sultation ....... 59

1916 SCHEME: PROCEDURE . . . . .60

LETTER OF EXCUSE : Tribunal for Medical Purposes . .61

1916 SCHEME: OFFERS OF SERVICE . . . .64

1916 SCHEME: GENERAL CALL . . . .67

MEDICAL STRENGTH : 7 JUNE 1916 . . . .68

MEDICAL DISTRIBUTION : 7 JUNE 1916 . . .70

1916 SCHEME : CONCLUSION . . . . .70

CHAPTER VI
1916. § 2

CONCURRENT EVENTS: White Paper . . . .71

COMPULSORY SERVICE . . . . . .72

WAR REGISTER AND ATTESTATION: Transitional Period—
Certificate of Registration — Recruiting Authority — War
Office— A.C.I. No. 148 of 1916— Attestation . . 72

MILITARY SERVICE ACT 1916: A.C.I. No. 475 of 1916—

Certificate of Registration . . . . 75

A.C.I. No. 485 OF 1916: War Register— War Ojfice . . 76

FURTHER COMPULSORY SERVICE . . . -79

MILITARY SERVICE ACT 1916 (SESSION 2): Medical feature . 80
SPECIAL POSITION OF PROFESSION . . . . 80

QUESTION OF CONTROL: Conference . . . .82

MEDICAL CONTROL ESTABLISHED: Section 7— Professional

Committees Regulations . . . . -83

CENTRAL PROFESSIONAL COMMITTEE FOR SCOTLAND . 85

xvi Contents

CHAPTER VII

1916. § 3

DUAL SYSTEM : INAUGURATION ....

DUAL SYSTEM : CATEGORIES OF PRACTITIONERS
DUAL SYSTEM : PROCEDURE .....
EXEMPTIONS 1916 .......

OCCURRENCES: Recent Graduates — Suspension of Twelve

Months' Contract— Draft of Medical Officer*
MEDICAL MOBILIZATION .....

SCOTTISH OPINION: Emergency Committee — R.C.P.E. —
R.C.S.B.— Scottish Committee ....

POLITICAL CHANGE : Department of National Service .
ACTION BY EMERGENCY COMMITTEE ....
CLOSE OF 1916 .......

CHAPTER VIII

1917. § 1

MEDICAL MOBILIZATION : FURTHER PROGRESS— Conference
of Secretaries of War Committees — Director-General of
National Service — Interview .... IOO

ST. ERMIN'S CONFERENCE ..... 103

LIMITING RESOLUTIONS: R. P.P. S. G.— Glasgow and West of

Scotland— Edinburgh and Leith . . . .107

MEDICAL MOBILIZATION : DECLINE .... 109

GENERAL CALL-UP BY WAR OFFICE : Hospital Ships— Calling-
up Notices — Letter by Secretary for War — No* Contract —
View of Committee . . . . . .in

UNSETTLEMENT : A.C.I. No. 485 of 1916— Civil Community—

Conference . . . . . . .114

SETTLEMENT ..... . 117

58x11 GENERAL HOSPITAL . . . . .118

Contents xvii

CHAPTER IX

1917. § 2

PAGE

EMPLOYMENT OF MEDICAL OFFICERS : Criticisms — Conclusion
by Emergency Committee — Committee on Medical Establish-
ments in France . . . . . 119

DRAFT OF OFFICERS ...... 122

REVIEW OF EXCEPTIONS ACT 1917: Army Medical Boards —

Select Committee , . . . .122

MINISTRY OF NATIONAL SERVICE: C.M.S. Region of Scotland

— Advisory Medical Board ... . . .123

NATIONAL SERVICE MEDICAL BOARDS . . .125

RESUMPTION OF COMMISSIONS . . . . .126

MEDICAL MAN-POWER . . . . . .127

MEDICAL BUREAUX : Dundee — Edinburgh . . .128

EXEMPTIONS: 1917 . . . . . .128

CLOSE OF 1917 ....... 130

CHAPTER X

1918. § 1

MEDICAL VACANCIES : Local Government Board . .131

MILITARY SERVICE ACT 1918 ..... 133

CENTRAL PROFESSIONAL COMMITTEE FOR SCOTLAND . 133

EXEMPTIONS: 1918 ...... 134

GERMAN OFFENSIVE : 1918 . . . . .135

RESUMPTION OF COMMISSIONS . . . . .135

MEDICAL POLICY . . . . . .136

MILITARY SERVICE (No. 2) ACT 1918: Lay Community-
Medical Men . . . . . .138

MEDICAL PRACTITIONERS REGULATIONS 1918: Medical

Tribunal for Scotland — Procedure of Medical Tribunal . 140
Two CLAIMS ON PROFESSION: Military— Civilian . . 142

MILITARY AGE . . . . . . .143

xviii Contents

PACK

APPROVED CIVILIAN SERVICE: Relation to Substitutionary

Medical Practice — Relation to Non-medical Military Service 144

SITUATION REVIEWED: Substitution by Transfer . . 147

1918 SCHEME: INAUGURATION. —Eighth Memorandum —

Reconstitution of War Committees . . . .148

1918 SCHEME: OPERATION. —Medical Examination and
Grading— New War Register — Groups of Practitioners —
Substitute Practice . . . . . .150

FINANCIAL GUARANTEES . . . . .152

CALL OF GRADE I. PRACTITIONERS . . . .153

1918 SCHEME: OUTPUT. . . . . .157

ARMISTICE . . . . . . .157

CHAPTER XI
1918. § 2

DEMOBILIZATION PERIOD: Inter-departmental Committee of

Medical Services . . . . . 159

FIRST DEMOBILIZATION CONFERENCE . . . . 159

DEMOBILIZATION SCHEME . . . . .160

CLOSE OF 1918 . . . . . . .162

CHAPTER XII
1919

SECOND DEMOBILIZATION CONFERENCE . . . 164

DEMOBILIZATION EN MASSE : Established Practitioners . 165

MINISTRY OF NATIONAL SERVICE: TERMINATION. — Decision
of Committee to continue in Office as Emergency Committee
— War Office— Admiralty . . . . .166

DIRECT RELATIONS RESUMED : Nominated Scottish Practitioners 167
PRIORITY RELEASES . . . . . .168

CLOSE OF 1919: Dissolution of Emergency Committee. . 170

TERMINATION OF WAR : 1921 . . . . .170

Contents xix

CHAPTER XIII
GENERAL

PAGE

VOLUNTARY PRINCIPLE . . . . . .171

COMPOSITION OF EMERGENCY COMMITTEE . . .174

MEDICAL DUTY IN WAR-TIME ..... 178

CHAPTER XIV
GENERAL

WAR-CHANGES : New War Register . . . .180

MEDICAL STRENGTH: n NOVEMBER 1918 . . .181

MEDICAL DISTRIBUTION: n NOVEMBER 1918 . . 184

DEATHS OF PRACTITIONERS . . . . .186

PRACTITIONERS WHO SERVED ..... 188

DENUDATION IN CIVIL PRACTICE . . . .190

PRESSURE OF CIVIL WORK . . . . . 195

FURTHER DENUDATION . . . . . . 195

How SLEEP THE BRAVE . . . . .196

ACKNOWLEDGMENTS ...... 196

CONCLUSION ....... 199

APPENDICES

I. DIVISIONS OF BRITISH MEDICAL ASSOCIATION AS

ADOPTED BY EMERGENCY COMMITTEE . . 2OI

II. FIRST MEMORANDUM OF EMERGENCY COMMITTEE . 203

III. FORM OF UNDERTAKING BY LOCUM TENENS . . 206

IV. FOURTH MEMORANDUM OF EMERGENCY COMMITTEE . 207
V. NOTICE CARD FOR GUIDANCE OF PATIENTS . . 219

VI. REGISTRATION FORM ..... 220

VII. FORM K. UNDER 1916 SCHEME .... 221

VIII. LETTER OF EXCUSE ..... 222

IX. CERTIFICATE OF REGISTRATION . . . 222

X. INDIVIDUAL NOTIFICATION M.N.S.(M.) 5 . .223

XI. FINANCIAL STATEMENT ..... 224

INDEX ....... 225

xx Contents

TABLES

PAGE

I. CLASSIFICATION OF SCOTTISH CIVILIAN PRACTITIONERS

i AUGUST 1914 ..... 8

II. DISTRIBUTION OF ABOVE . . . .10

III. CLASSIFICATION OF SCOTTISH CIVILIAN PRACTITIONERS

ON, OR COMMITTED TO, WHOLE-TIME MILITARY
SERVICE AT 15 MAY 1915 . . . .30

IV. DISTRIBUTION OF ABOVE . . . .31

V. RESULT OF 1915 SCHEME — 15 MAY 1915 TO 8 NOVEM-
BER 1915 — SCOTTISH CIVILIAN PRACTITIONERS . 45

VI. CLASSIFICATION OF SCOTTISH CIVILIAN PRACTITIONERS

ON MILITARY SERVICE AT 31 DECEMBER 1915 . 55
VII. DISTRIBUTION OF ABOVE . . . 56

VIII. OFFERS AS AT 12 FEBRUARY 1916 UNDER 1916 SCHEME

OF EMERGENCY COMMITTEE . . .65

IX. DISTRIBUTION OF ABOVE . . . .66

X. CLASSIFICATION OF SCOTTISH CIVILIAN PRAC-
TITIONERS ON MILITARY SERVICE AT 7 JUNE
1916. . . .68

XI. DISTRIBUTION OF ABOVE . . . .69

XII. CLASSIFICATION OF SCOTTISH CIVILIAN PRAC-
TITIONERS LIVING ii NOVEMBER 1918 . . 182

XIII. DISTRIBUTION OF ABOVE . . . .185

XIV. DEATHS OF SCOTTISH CIVILIAN PRACTITIONERS . 187

XV. CLASSIFICATION OF SCOTTISH CIVILIAN PRAC-
TITIONERS WHO SERVED DURING THE WAR . 188

XVI. DISTRIBUTION OF ABOVE . . . .189

XVII. DISTRIBUTION OF SCOTTISH CIVILIAN PRACTITIONERS
SERVING AND REMAINING IN CIVIL LIFE AT 11
NOVEMBER 1918 . . 191

XVIII. POPULATION PER GENERAL PRACTITIONER IN

PRACTICE 1914-1918 . . . . 193

THE

MUSTERING OF MEDICAL
SERVICE IN SCOTLAND

CHAPTER I
1914

Conflicting Claims. — Serajevo. — British Mobilization. — Medical
Position in Scotland. — First Medical Conference. — Emergency
Committee. — Medical Strength : i August 1914. — Medical
Distribution : i August 1914. — Early Transactions : First
Memorandum — Attitude of Profession — Dependants of Men on
Service — Response to First Memorandum. — Form of Under-
taking.— Territorial Officers. — Meeting. — Close of 1914.

Conflicting Claims

THE Serb tribes which crossed the Danube in the era of
Heraclius erected themselves after the lapse of years into
the mediaeval Serbian Kingdom, a warrior state which, surviv-
ing for a time the disastrous field of Kossovo, fell at last in 1459
before the policy of Mohammed II. But the spirit of the nation,
unextinguished by Ottoman rule, revived in the nineteenth century,
and in 1878 the Treaty of Berlin affirmed the independence of
modern Serbia.

Renascent Serbia had aspired to reunion with the adjacent
territories of Bosnia and Herzegovina, which had been included
in the old Serbian Kingdom. The Treaty of Berlin committed
these provinces to the military occupation of Austria-Hungary.
They remained, however, a Turkish vilayet owning the sovereignty
of the Sultan.

2 Mastering oj Mr.dical Service in Scotland

fn 1908, putsu:r£ 'ier Balkan mission, Austria suddenly
announced her complete annexation of Bosnia and Herzegovina.
Serbia was aggrieved, and Russia, as the Protector of Serbia,
began to prepare for war : but Germany, fulfilling the terms of
her pact with Austria, ranged herself in shining armour beside
her ally. Russia then acquiesced in the annexation as a thing
accomplished, and Serbia renounced her attitude of protest. But
Bosnia and Herzegovina, although incorporated under the
Austro-Hungarian monarchy, were still the objects of Serbian
ambition, and — according to Austria— of Serbian intrigue.

Sarajevo

On 28 June 1914 the Archduke Francis Ferdinand,
Heir-Presumptive of the House of Hapsburg and
Commander-in-Chief of the Austrian Army, while
attending" military manoeuvres in Bosnia, came to
Serajevo, the capital of the province, accompanied by
his wife, the Duchess of Hohenberg. As the illustrious
visitors drove through the town two attacks were
made upon them. The first attempt was unsuccessful :
a native of Herzegovina threw a bomb, which exploded
but missed its mark. Later in the morning, however,
a Bosnian, having thrown a bomb which failed to
explode, fired thrice with a Browning pistol. The
Archduke and the Duchess — who tried to shield her
husband — were both mortally wounded. An Austrian
court of inquiry, held at Serajevo, traced the plot to
Serbian sources, and described the bombs as hand-
grenades from the Serbian Army Depot at Kragujeva6.
On 23 July the Austro-Hungarian Government
addressed a note to Serbia, prescribing steps to be
taken by her for the punishment of the persons
accessory to the crime, and for the general suppression
of Serb propaganda directed against Austria-Hungary.
A reply was expected by 6 o'clock in the evening of
25 July- Though the terms of the note were exacting,

1914] Course of Events 3

the Serbian Government, advised by Russia, returned
a conciliatory and timeous answer, reserving two
matters only. But Austria required an acceptance in
full. On 25 July her Minister left Belgrade. On
28 July 1914 the Austro- Hungarian Government
declared war on Serbia.

Russia had already made it known that in the event
of an attack on Serbia she could not remain indifferent.
On 29 July the Imperial Government ordered a partial
mobilization of the Russian Army. The prospect of
hostilities between Russia and Austria involved France
and Germany, their respective allies ; and exchanges
with a view to peace, in all of which His Britannic
Majesty's Government was untiring, took place between
the great European Powers. But on 31 July, when
Austria, after previous refusal, had consented to dis-
cuss the whole Serbian position, the German Emperor
decreed a state of war throughout his territories, and
issued an ultimatum calling upon Russia to counter-
mand her mobilization within twelve hours. On the
same day German patrols crossed the French frontier.
On i August the German Government declared war on
Russia, and France began to mobilize.

The cloud which had darkened Eastern Europe was
now imminent on the West. Two points were vital to
Britain, the protection of the northern coasts of France
against enemy attack by sea, and the territorial in-
tegrity of Belgium, safeguarded under Treaties of 1831
and 1839. On the former point Britain gave to France
a conditional promise of naval assistance. On the
latter point the British Government had asked the
French and German Governments, on 31 July, for an
engagement to respect the neutrality of Belgium. A
satisfactory engagement was given by France on the
day of asking, but Germany made no reply.

4 Mustering of Medical Sewice in Scotland

British Mobilization

On 2 August the British Naval Reserves were called
up. The Army Reserves were summoned to the
Colours and the Territorial Force embodied. On
4 August His Britannic Majesty's Government, re-
peating its request to Germany with regard to the
integrity of Belgium, asked for an answer before mid-
night. At 7 o'clock in the evening of that day
the German Secretary of State informed the British
Ambassador at Berlin that the safety of the German
Empire rendered it absolutely necessary that the Im-
perial troops should advance through Belgium.

From ii p.m. on 4 August 1914 a State of War
existed between Great Britain and Germany.

Medical Position in Scotland

An immediate consequence of the mobilization of the
forces of the British Crown was the sudden withdrawal
from civil practice in Scotland of some three hundred
medical men, mainly practitioners who held com-
missions as Surgeons in the Royal Naval Reserve, or
as Officers of the Royal Army Medical Corps, Special
Reserve and Territorial Force, or of combatant units.
Though the withdrawal was not in all cases complete,
and though many of those withdrawn were not in
general practice, the resulting gaps in the medical
service of the country were such as to offer a problem.

The situation was rendered more difficult by the fact
that the customary sources for the supply of vacancies
ceased to be available. The Admiralty had promptly
intimated that they required surgeons, whose age
should not exceed forty years, for temporary service
with the Royal Navy. The War Office had similarly
called for civilian medical practitioners who would be
granted the temporary rank of Lieutenant in the Army.

1914] Civil Practice 5

Their age was not to exceed thirty-five, but in excep-
tional cases gentlemen between thirty-five and forty
might be accepted. These opportunities were eagerly
grasped by the great majority of those younger
practitioners not yet in settled practice who could have
been secured in tranquil times as locum tenentes for
civil work, so that the inconvenience following the
abrupt departure of the Reserve and Territorial Officers
had to be met for the most part in towns and populous
places by ex tempore adjustments with neighbouring
practices. A number of country areas, however, having
lost their only doctor, were left defenceless, and the duty
of making provision for their needs presented itself as
urgent.

First Medical Conference

Under these circumstances it was aptly resolved by
the then Chairman1 of the Scottish Committee of the
British Medical Association to call a conference of
members of the medical profession in Scotland, in order
to consider what steps should be taken to relieve the
pressure of the hour. Representatives of the Scottish
Universities, of the Medical Corporations in Scotland,
of the General Medical Council, and the Scottish
Committee were invited to be present ; and the con-
ference met in Edinburgh on 12 August 1914. After
discussion, it proceeded to the appointment of a Com-
mittee "for the purpose of assisting to meet the
immediate difficulties in regard to medical practice
among the civil population which have arisen or may
arise owing to the departure of practitioners summoned
to take up military duty. " The Committee so appointed
received the designation of the Scottish Medical Service
Emergency Committee.

1 Dr. J. R. Hamilton.

6 Mustering of Medical Service in Scotland

Emergency Committee

The Scottish Medical Service Emergency Committee,
hereinafter referred to as the Emergency Committee or
the Committee, was composed, at its inauguration, of
fifteen medical men, seven of whom were appointed
ex officio, while eight were elected by the conference.
The seven ex officio members were the Presidents * of
the Royal College of Physicians, Edinburgh, the Royal
College of Surgeons, Edinburgh, and the Royal Faculty
of Physicians and Surgeons, Glasgow, together with
the Deans2 of the Faculties of Medicine of the Uni-
versities of St. Andrews, Glasgow, Aberdeen and
Edinburgh. Of the eight elected members, six, who
were engaged in general practice, included five office-
bearers3 of the British Medical Association, together
with the President4 of the Medical Guild. The two
remaining elected members were the Deputy Chairman 5
of the Scottish Insurance Commission and the Direct
Representative6 for Scotland on the General Medical
Council. The Direct Representative was the Convener
of the Committee. The Committee at its first meeting
appointed an executive sub-committee for the trans-
action of current business, and co-opted to membership
a Medical Officer7 of the Scottish Insurance Commission.

The headquarters of the Committee were at the
Royal College of Physicians, Edinburgh. The Secretary
of the Committee was the Librarian 8 of the College.

1 Dr. J. J. Graham Brown, Prof. Francis M. Caird, Dr. John
Barlow.

8 Prof. J. A. C. Kynoch, Prof. D. Noel Paton, Prof. J. T. Cash,
Prof. H. H. Littlcjohn.

» Dr. John Adams, Dr. G. C. Anderson, Dr. John Gordon,
Dr. J. R. Hamilton, Dr. John Stevens.

4 Dr. John Playfair. * Dr. John C. M'Vail.

• Dr. Norman Walker. T Dr. J. R. Currie.

8 Mr. T. H. Graham.

1914] Population 7

The field of enterprise entrusted to the Committee
covered the whole of Scotland. The population of the
country at the 1911 Census had been 4,760,904. The
estimates for succeeding years by the Registrar-General
for Scotland might under more normal conditions have
been turned to account by the Committee in reckoning
up the inhabitants of districts so as to compute their
medical requirements ; but mobilization and enlistment,
migration into munition areas and other abnormal
causes had from 1914 onwards a disturbing effect on
the numbers of local populations, the extent of which
the Registrar-General could not determine. The
Committee, therefore, adhered to the 1911 Census as
the standard for its calculations up to June 1916,
believing the Census figures to be as good as any
available, and sufficient for the practical objects in view.

Medical Strength : i August 1914

It was necessary also, for the purposes of the
Committee, to define, as soon and as closely as possible,
the effective medical strength of the country. The
number of persons whose names were contained in the
Local Register for Scotland, that is to say, the Scottish
portion of the Medical Register formed pursuant to the
Medical Act of 1858, was for 1914, 13,330; but many
of these were not resident in Scotland. The numerical
summary of the profession published in the Medical
Directory assigned to Scotland, in 1914, 4032 resident
practitioners.

The total figure of the Directory, however, did not
present a grouping of medical men according to the
nature of their work. For this information the Com-
mittee drew upon other sources. It obtained from the
Scottish Insurance Commission the number of Insurance

8 Mustering1 of Medical Service in Scotland

practitioners in Scotland in 1914. For facts regarding
the profession as a whole it was indebted to a count
made, as at July 1914, by the British Medical Associa-
tion. The count exhibited the number of members of
the profession resident in Scotland, arranged under
the classes of private practitioners ; insurance practi-
tioners ; consultants ; whole-time officials, including
teachers of medicine, medical officers of health, tuber-
culosis officers, institutional officers and Regular Naval
and Military Officers ; together with dental, retired
and unestablished practitioners. The delimitation ot
most of the classes did not present serious difficulty.
With regard to others, the boundary line could not, in
all cases, be clearly drawn. These complications,
which came before the Committee in the course of later
inquiries, were adjusted as the facts were ascertained.
The figures adopted as representing the main classes
of Scottish practitioners J — but excluding Regular
Naval and Military Officers — immediately prior to the
British mobilization were those stated in Table I.

TABLE I

CLASSIFICATION OF SCOTTISH CIVILIAN PRACTITIONERS:
i AUGUST 1914

Private Practitioners .... 376

Insurance Practitioners .... 1796
Consultants ..... 248

Whole-time officials . . . .514

Dental and Retired Practitioners . . . 269

Unestablished Practitioners . . . 619

Total . . . 3822

1 Unless otherwise indicated by the context the expression
Scottish Practitioner will be understood to mean a practitioner
medically domiciled in Scotland.

1914] Medical Personnel

Medical Distribution : i August 1914

The distribution of the medical personnel of Scotland
according to their place of residence was not less
important to the Committee than the classification set
forth in Table I., since the two factors, distribution
and classification, taken jointly with the estimated
population of areas, were to furnish the data for
determining whether the depletion of the medical
complement of a locality had for the time being
reached the limit of safety. The distribution areas
selected by the Committee were, as will be stated,1 the
Scottish Divisions 2 of the British Medical Association,
the four Glasgow Divisions being counted as one.
Particulars were derived, as before, for Insurance
practitioners from the Scottish Insurance Commission ;
for the profession generally, from an adaptation of the
count made by the British Medical Association. The
distribution figures, as at i August 1914, are shown in
Table II., which exhibits in column i the names of
Divisions; in column 2 the population at the 1911
Census adjusted for changes of boundary since that
date ; in column 3 the number of General 3 Practitioners,
comprising the first two classes of Table I.; in column 4
the number of Other4 Practitioners, comprising the
remaining classes of Table I.; in column 5 the total
number of practitioners ; and in column 6 the popula-
tion per general practitioner.

1 P. 29. a Appendix I.

8 General Practitioners include private and Insurance practi-
tioners. A Private Practitioner is a non-panel general practi-
tioner. An Insurance Practitioner is a panel practitioner.

4 Other Practitioners include consultants, whole-time officials
(excluding regular naval and military officers), dental, retired and
unestablished practitioners.

io Mustering of Medical Service in Scotland

TABLE II

DISTRIBUTION OF SCOTTISH CIVILIAN PRACTITIONERS:
i AUGUST 1914

MEDICAL PERSONNEL.

POPULATION

DIVISION.

POPULATION.

General

Other

PER

GENERAL

Practi-

Total.

PRACTITIONER.

tioners.

Aberdeen .

353,185

161

125

286

2194

Argyll

70,902

1364

Ayr ....

268,337

132

170

2033

Banff, Elgin and Nairn

114,148

102

1730

Caithness and Suther-

land .

52,189

2007

Dumbarton . .

136,233

2570

Dumfries and Gallo-

way
Dundee

143,190
281,417

101

134

I78

1746
2786

Edinburgh and Leith

400,806

232

473

705

1728

Fife ....

267,739

161

2704

Glasgow

1,008,487

461

395

856

2188

Inverness .

53.096

1713

Islands .

72,325

2679

Lanark

477,613

162

25 «

2948

Lothians

230,269

153

2399

Orkney

25,897

1295

Perth ....

124,342

2391

Renfrew and Bute

297,270

138

190

2154

Ross and Cromarty .
South Eastern

39,215
116,694

17
24

2307
2012

Stirling

199,639

127

2170

Zetland

27,9"

1994

TOTAL .

4,760,904

2172

1650

3822

2192

1914] Medical Personnel n

According to the Table the population per General
Practitioner in the twenty-two Divisions ranged from
1295 to 2948. Seven Divisions were below the 2000
level. In three of these, Argyll, Orkney and Zetland,
the estranging sea with its lochs and sounds restricts
the dimensions of practices and increases their number.
In three, Banff, Elgin and Nairn, Inverness and
Dumfries and Galloway, the spurs of the Grampians
and the Southern Uplands have a similar isolating
action. In Edinburgh and Leith medical practice is
actively carried on by both private and insurance
practitioners. Three Divisions, Dundee, Fife and
Lanark, had over 2700 persons per general practitioner.
All these are actively industrial.

The number of Other Practitioners, comprising con-
sultants, whole-time officials, dental,1 retired and un-
established practitioners, was relatively high in the
University areas of Aberdeen, Dundee, Edinburgh and
Glasgow, where 233 of the 248 Scottish consultants
resided and where whole-time officials abound. The
Edinburgh figure for Other Practitioners was further
augmented by the inclusion of 204 unestablished
practitioners, practically one-third of the total count of
such practitioners in Scotland.

The number of the profession medically domiciled in
Scotland as distributed in Table II. was taken by the
Committee as the high-water mark with reference to
which in the ensuing years of the war it observed, and
endeavoured to regulate, the changing aspects of the
medical situation. Gains to civil practice during the
period were few, as most young graduates entered the
Services. The dominant factor in the position through-

1 A Dental Practitioner means a Dental Medical Practitioner
— that is to say, a duly qualified medical practitioner engaged in
the practice of dentistry.

1 2 Mustering of Medical Service in Scotland

out was the steady decrease of the effective medical
strength of the country due to the withdrawal of
established civil practitioners from their districts in
order to take up military J duty.

Early Transactions

The early phase of the Emergency Committee's work,
extending from 12 August 1914 to the close of that
year, was in the civil sphere. It mainly related, in
terms of the inaugural remit, to the making of arrange-
ments for filling vacated general practices. In taking
action towards this end, the Committee pursued two
principal objects which, though not based on identical
grounds, were usually in practice inseparable. The
first was the maintenance of the efficiency of the medical
practice of areas so far as compatible with the require-
ments of the Army. The second was the safeguarding
of the home interests of practitioners absent on military
service.

The former object, that is to say, the maintenance of
medical practice, was the theme of the Committee's
First Memorandum* to the medical profession, which
was printed in the Scottish press on 19 August 1914.
The Committee in this document expressed its convic-
tion that the profession generally would recognize that
the needs of the civilian population must continue to be
met, and that whoever relieved a colleague summoned
to military duty was ipso facto also serving his country.
It held itself out as furnishing a clearing-house for the
dissemination of information, on the one hand regarding

1 Unless otherwise indicated by the context, the expressions
Army and Military ', when employed in a general sense, include
Navy, Army, and, later, Air Force.

9 Appendix II.

1914] Attitude of Profession 13

districts or practices deprived of qualified practitioners,
and on the other hand regarding- practitioners prepared
to undertake such vacancies. It accordingly invited
communications from practitioners desirous either of
obtaining or of affording help. It requested retired
practitioners who were able for duty to send in their
names for allocation to practices, recorded its view that
the fee offered to a locum tenens for a practitioner
absent on service should not exceed five guineas per
week, and proposed a reduction in the numbers of the
resident staff at large hospitals, infirmaries and asylums.

The Committee's reliance on the Attitude of the
Profession towards the problems arising for settlement
was already in course of justification in a number of
areas by the zeal of practitioners. On 7 August 1914
the British Medical Association had circularized
Divisions on the immediate claims of the war, and
meetings of medical men in many places in Scotland
had adopted resolutions to attend the patients of
practitioners called out on active service. On 17 August
1914, under the auspices of Dundee Local Medical
Committee, an emergency Medical Bureau was in-
stituted at Dundee with central office at the Royal
Infirmary. The patients cared for were both private
and insured, and the work was assisted by several
senior practitioners of the city.

Another spontaneous undertaking of the profession
in the early days of the war was the provision of
gratuitous medical attendance in Great Britain to the
Dependants of Men on Service. The scheme, which
originated in an offer made to His Majesty's Govern-
ment by the British Medical Association and the
Pharmaceutical Society of Great Britain, was cordially
received by medical men in Scotland. The Dumbarton-
shire Division of the British Medical Association,

14 Mustering of Medical Service in Scotland

meeting with the County Local Medical and Panel
Committees on 26 August 1914, made a pronouncement
in its favour. The Edinburgh and Leith Division,
meeting on 28 August 1914, resolved that the profession
should systematically co-operate for the purposes of
the scheme with the Soldiers' and Sailors' Families
Association and the Local Committees for the Preven-
tion and Relief of Distress. The general arrange-
ments were made public in a letter to the Press of
17 September 1914 by the President of the Board of
Education. As pharmacists, like practitioners, made
no charge for their work, and as the Executive
Committee of the Prince of Wales's Fund agreed ;o
defray the cost of medicines and appliances, the whole
service was free to approved beneficiaries. The
organization of this enterprise, on the medical side,
was begun and carried through by the Executive of
the British Medical Association, to whom, as well as
to the practitioners who took duty under the scheme,
much credit was properly ascribed.

The general alacrity of the profession in Scotland
made manifest in these activities was not less evident
in its Response to the request contained in the Com-
mittee's First Memorandum. A number of medical
men, of whom some had retired, placed themselves in
the Committee's hands as willing to take charge of
practices, and the most pressing difficulties in the
single-handed areas were by their help overcome. By
the end of the year relief had been afforded to a score
of places ranging from Sutherland to Roxburghshire
and Argyll, and in several instances substitutes were
provided in institutions for Resident Medical Officers
called up for military duty.

1914] Locum Tenentes 15

Form of Undertaking

In providing locum tenentes to maintain the medical
attendance of districts, the Committee at the same
time gave heed to its second principal object, the
protection of the interests of absent practitioners. It
drew up a Form of Undertaking1 for signature by
those who through its agency were introduced to vacant
practices. Unless it was otherwise arranged in writing
between the practitioners concerned, every locum tenens
acting under the Committee's arrangements was, by
the fact of his so acting, held to agree not to practise
as a Physician, Surgeon or Apothecary in the town in
which he was acting for the regular practitioner, or
within a distance of seven miles from such town or
from the regular practitioner's house, for a period of
five years from and after the date when the regular
practitioner returned to work or ceased to serve with
the Colours. Any question arising under the agree-
ment was to be submitted to the Presidents for the time
being of the Royal College of Physicians, Edinburgh,
the Royal College of Surgeons, Edinburgh, and the
Royal Faculty of Physicians and Surgeons, Glasgow,
as joint arbiters, whose decision should be final. The
agreement, though superfluous in most cases, for the
locum tenentes were above self-seeking, was much
appreciated by officers on service, who were enabled
by its means to dismiss the fear that the helper might
one day be a rival.

Territorial Officers

It is indicated above that at the outbreak of war the
withdrawal of medical men from civil practice was not
1 Appendix III.

1 6 Mustering of Medical Service in Scotland

in all cases complete. A certain number of Territorial
Officers, so long as the units to which they belonged
remained in their residential areas, were able in the
intervals of military duty to devote some attention to
their own or adjacent practices, and so help to relieve
the general shortage. When units, however, began to
be passed for overseas service their medical officers
became due to accompany them, and as these officers
were in most cases experienced practitioners, with a
long-standing knowledge of their districts, it was certain
that their places would be difficult to fill.

The Emergency Committee accordingly communi-
cated with the Director General,1 Army Medical
Services, placing these considerations before him, and
requesting that he would, as far as military claims
t srmitted, forbear to remove the single-practice men
when their Territorial units received marching orders.
In taking this course the Committee acted in consulta-
tion with the Scottish Insurance Commission and the
Highlands and Islands Medical Service Board.
Representations in a similar sense were made to the
Army Authorities at the instance of the Executive
Committee of the General Medical Council.

On 10 December 1914 a letter was issued by command
of the Army Council to General Officers Commanding-
in-Chief all Commands at home to the effect that when
a mobilized Territorial unit was moved from its own
locality in Great Britain steps should be taken, by
exchange, substitution or temporary demobilization, to
enable its medical officer to remain at home, if necessary,
in charge of his civil work ; and further, that when
a mobilized Territorial unit volunteered for Imperial
service abroad, its medical officer was to be permitted
the option either of accompanying it to the theatre
1 Sir Alfred Keogh.

1914] Hospitals and Infirmaries 17

of war, or of continuing in his own district with the
corresponding Reserve unit.

The action taken along these lines achieved a useful
purpose. Without impairing the medical attendance
provided for troops in the field, it lightened for the time
the burden of civil practice in outlying and depleted
areas.

Meeting

On 16 December 1914 the Convener1 of the
Emergency Committee addressed a meeting of practi-
tioners in the Hall of the Royal Faculty of Physicians
and Surgeons, Glasgow. He described the origin and
objects of the Committee, and spoke in support of its
recommendations to the profession as set forth in the
First Memorandum. He was in a position to state
that the Committee's advice to cut down the resident
staff of large hospitals and infirmaries had been most
faithfully given effect to. He adduced as examples a
Professor of Medicine who was taking duty as his own
house-physician, and a Professor of Anatomy who was
acting as house-surgeon in the hospital attached to his
medical school. The President 2 of the General Medical
Council, who attended the meeting, said that there had
been a danger of the breaking down of civil practice
in Scotland, and commended the efforts made by the
Committee to promote solidarity in the profession.

Close of 1914

Reviewing the medical situation in Scotland in
December 1914, the Committee ascertained that of
1796 Insurance practitioners on Scottish medical lists,
162 were on service with His Majesty's forces.
1 Dr. Norman Walker. 2 Sir Donald MacAlister.

1 8 Mustering of Medical Service in Scotland

Eighteen of these had departed from areas which, but
for arrangements made in relief, would have been cut
off from medical attendance, while 144 were derived
from places where the embarrassment was less acute.
With regard to the 376 private general practitioners
and the 1650 other practitioners who completed the
Scottish tale of 3822 medical men, the Committee's
information was at this date less precise ; but it was
satisfied, from facts communicated to it by its in-
dividual members and reported from other sources,
that a material shrinkage had taken place, affecting
all the classes of practitioners engaged in active work.
Antwerp had fallen in October, the Battles of Ypres,
1914, had now been fought and the period of trench
warfare on the Western Front had begun. It was
plain that the supply of medical officers for the armies
in process of formation to take their place in the field
would make still further claims on the medical personnel
of the country, and the Committee proceeded at the
close of the year to address itself to the question of the
nature and extent of the medical organization which
would be required to satisfy these impending demands.

CHAPTER 11
1915. § i

Classification of Practices : Second Memorandum. — Action in
England. — Letter of Director General, A.M.S. — Various
Results ensuing : Third Memorandum — Applications for
Commissions — Agreement — Organized Response — Medical
Bureau — British Medical Association. — Second Medical Ccn-
ference. — Medical Recruiting Project. — Emergency Com-
mittee in Charge : Royal Navy — Territorial Force. — Medical
Strength : 15 May 1915. — Medical Distribution : 15 May 1915.

Classification of Practices

IN January 1915 the Emergency Committee issued to
the profession its Second Memorandum^ dealing more
particularly with the Committee's second principal
object, the protection of the home interests of practi-
tioners serving with His Majesty's forces. In this paper
the Committee offered advice on the general principles
which should be followed in making arrangements for
carrying on vacated practices. It explained that the
supply of available locum tenentes was so meagre that
practitioners whose duty kept them at home must be
relied on to add the practices of absentees to their own.
The case as between military and civilian service was
stated in the following terms :

The man who is with the forces has the stimulus of fresh and
interesting work, and he has the satisfaction and honour of directly
serving his country. On the other hand, he may imperil the

2O Mustering of Medical Service in Scotland

position he has established perhaps after many years of hard work.
The man who remains to do the necessary work at home has a
more prosaic duty. He has to take on a large addition to work
which may be already considerable, and he has to do this without
the prospect of its being of any lasting benefit to him : for it is the
essence of these arrangements that they are only for the period of
the war, and that the absentee, when he returns, shall find his
practice as nearly as possible intact.

Proceeding to suggest a scale according to which the
remuneration derived from the added practices should
be shared between the absent holder and his vice-
gerent for the time being, the Committee took the view
that the distance requiring to be travelled in visiting
patients should be the ruling factor. It divided medical
practices into the three classes of Town, Town and
Country and Country practices, and proposed the
following allocations :

CLASS I. — Town Practices.— Including large towns. Half share
of all remuneration to absentee and half to deputy.

CLASS II. — Town and Country Practices. — Including towns with
considerable population, but with a large amount of country
work involving travelling expenses. Three-eighths share to
absentee and five-eighths to deputy.

CLASS III. — Country Practices. — Including single-practice
areas, other country places, and small towns with most of the
work in the surrounding country. A larger share * to deputy.

The Committee was aware that the distinction
between the three classes of practice, as defined,
could not depend entirely on geographical situation,
and that consideration of the facts and of local
conditions must determine the correct point of view
in doubtful cases. It held that the suggested alloca-
tions were applicable to both private and insurance
practice. It proposed a style for the rendering of

1 Made more explicit in Fourth Memorandum, printed as
Appendix IV.

1915- § J] Second Memorandum 21

accounts for private work on behalf of absentees.
It stated its confidence that no deputy acting* for an
insurance practitioner absent on war service would
wittingly endeavour to secure the transfer of the
absentee's patients to his own panel list, and it recalled
that for the due performance of the work such transfer
was not necessary, as the existing Insurance agree-
ments recognized the position of the deputy and
provided for his employment.

The principles and allocations suggested in the
Second Memorandum were accepted by Scottish
practitioners and formed the basis of a number of
settlements.

Action in England

On 27 January 1915, at a meeting in London of the
Council of the British Medical Association, a member
of Council, who was also a member1 of the Emergency
.Committee, made reference to the Committee's work
in dealing with medical difficulties in Scotland, and the
Council appointed a Special Committee to take such
corresponding action in England as might appear
advisable. The Special Committee drew the attention
of English Divisions and Branches to the Emergency
Committee's Second Memorandum, and recommended
that the whole question of medical arrangements
should at once receive their consideration. These
proceedings of the Special Committee, and the refer-
ences to the Emergency Committee on this and other
occasions, contained in the Journal of the Association,
reflect the friendly relations which subsisted throughout
the war between the Committee and its English
co-workers.

1 Dr. John Adams.

2 2 Mustering of Medical Service in Scotland

Letter of Director General, A. M.S.

On 10 March 1915 the Director General1 of Army
Medical Services addressed from the War Office to the
medical press the letter quoted hereunder :

I should be glad if you will allow me to explain through your
columns our position with regard to the employment of medical
men for the Army. It is briefly as follows : —

1. The need of medical men, both for home and foreign service,
is acute. We want every qualified man who is physically fit and
willing to serve.

2. We are in special need of general practitioners, and would
be glad to take on expert surgeons, ophthalmologists, radio-
graphers, etc.

3. We would give suitable men immediate employment.

4. At present we are not, except in special cases, sending men
of over 40 years of age overseas, but we should gladly take on
older men for home service.

5. We do not wish to denude the country of civil practitioners,
but every man who can arrange for his work to be done at home
should come forward as early as possible if we are to keep up an
adequate supply of medical attendance to our armies in the field.
This is really a national emergency, and we hope that the medical
profession, who have already done so much, will assist the
responsible authorities to meet it.

Should any qualified man wish to obtain a temporary commis-
sion in the Royal Army Medical Corps, he should apply to the
Secretary, War Office, Whitehall, S.W., for the necessary forms.

Various Results ensuing

The above important document, claiming in clear
terms, and on convincing grounds, the support and
service of the profession, prompted the Committee to
issue its Third Memorandum as a paving of the way
towards that co-ordinated effort for the supply of
medical officers which was now unmistakably fore-
1 Sir Alfred Keogh,

1915- § J] Third Memorandum 23

shadowed. In this memorandum the Committee drew
the attention of the public to the great strain imposed
upon practitioners, many of whom were working
15 to 1 6 hours a day, and requested patients and
their friends to send their messages for the doctor as
early as possible in the morning. It proposed to
School Boards and other Educational Authorities that
they should release entirely, or in part, those of their
medical officers who were willing to resume general
medical work. It again called upon retired doctors to
render such aid as might be possible, and it suggested
that the younger lecturers and assistants in the medical
schools should use the period of their holiday to lighten
the burden of country practitioners suffering from over-
work. It urged the need for the organization of all
professional forces.

Consequent on the publication of the Director
General's letter, it came to the knowledge of the
Committee that Applications for Commissions by indi-
vidual medical men had begun to increase in frequency.
The Committee in 1914 had approached * the War
Office with reference to single-handed practices : there
now came in sight the further risk that places in which
there were several practitioners might, through the
ardour of the local profession, sustain such a loss of
medical personnel as to fall below the efficiency level.
The Committee therefore joined in an Agreement with
the War Office and the Scottish Insurance Commission,
in virtue of which the names of all medical applicants
for military service issuing from Scotland were sent
by the Director General to the Commission, who con-
ferred with the Committee. If the two bodies, on
inquiry, were satisfied that arrangements could be
made to carry on a practitioner's civil work in his
1 P. 16.

24 Mustering of Medical Service in Scotland

absence, they intimated to the War Office that they
had no objection to his employment with the Army.
If they were not satisfied, they so informed the War
Office, and the practitioner's application was refused
or held up pending adjustment of the local position.
Later in the year, when the Committee had been
recognized by the War Office as a recruiting agency,
the Insurance Commission withdrew, and the negotia-
tions took place between the War Office and the Com-
mittee direct. Total rejection on the grounds specified
was rare, but a number of candidates were delayed for
short periods to the advantage of all concerned.

The above proceedings principally related to isolated
offers of service inspired by the Director General's
letter, but Organized Response to the stimulus which
he had applied was not slow to follow. In the front of
the movement for combined action was the Aberdeen
Branch of the British Medical Association, the acting
President of which was a member * of the Emergency
Committee. On 24 March 1915 the Branch sent
out a circular to the local profession, requesting civil
members to volunteer for whole-time or part-time
military service, and desiring them to intimate on a
schedule provided the particulars of their offer. A
Medical Bureau was established in Aberdeen for secur-
ing attendance on the private and insured patients of
practitioners absent with His Majesty's forces. The
Bureau had its headquarters in Aberdeen Royal
Infirmary, and was managed by an Executive Com-
mittee under the convenership of the member of the
Emergency Committee referred to.

On 8 April 1915 the Special Committee of the
British Medical Association, after an interview with
the Director General 2 and the Assistant Director
1 Dr. John Gordon. 2 Sir Alfred Keogh.

191S- § !] British Medical Association 25

General1 of Army Medical Services, addressed a letter
to all Divisions in the United Kingdom, urging upon
them that they should take action on the Director
General's appeal, by devising means to free for the
Army those medical men who were willing to apply
for commissions, and by making arrangements with
local military authorities for part-time work with
troops by civil practitioners. The measures proposed
in the Association's letter were promptly given effect
to in Scotland. The Ayrshire Division, for example,
meeting on 15 April 1915, appointed a Committee to
take all suitable steps. The Perth Branch, meeting
on the following day, chose a Committee with a
similar object. The Fife Branch, on 20 April divided
its county into seven districts, each of which was to
free medical men for service. The Glasgow Eastern
Division, also on 20 April, being informed of the
Scheme of the Glasgow Local Medical Committee for
carrying on the practices of absentees with the aid of
Bureaux,2 set up a Committee to make arrangements
for liberating practitioners for military duty. The
South Eastern Counties Division and the Lanarkshire
Division, meeting a little later, resolved that their
areas should be organized so as to permit of practi-
tioners joining the Army.

Second Medical Conference

While the work was thus advancing in the separate
areas of the country, it had in the meantime seemed
desirable to the Chairman 3 of the Scottish Committee
of the British Medical Association that a Second Con-

1 Lt.-Col. A. P. Blenkinsop.

2 Emergency Bureaux were in operation in Glasgow for about
three months.

3 Dr. J. R. Hamilton.

26 Mustering of Medical Service in Scotland

ference of representative members of the profession
should be convened, the purpose of the Second
Conference being to consider the need of the Royal
Army Medical Corps for the provision of officers.
Among those invited to attend, in addition to the
members of the Scottish Committee, were the Deputy
Director1 of Medical Services, Scottish Command;
the Presidents2 of the three medical corporations in
Scotland ; the Dean 3 of the Faculty of Medicine,
Edinburgh University; the Medical Member4 of the
Local Government Board for Scotland ; the Deputy
Chairman5 of the Scottish Insurance Commission ; the
Direct Representative6 for Scotland on the General
Medical Council; and the Medical Secretary7 of the
British Medical Association. The three Presidents,
the Dean, the Deputy Chairman, the Direct Repre-
sentative and five members 8 of the Scottish Committee
were members of the Emergency Committee. The
Second Conference was held in Edinburgh on 15 May
1915. Having heard explanations of various points
by the Deputy Director and the Medical Secretary, the
Conference, as a joint meeting, resolved to endeavour
to provide before 7 July 1915 at least 400 additional
medical men for the Army.

Medical Recruiting Project

In order to give effect to the above Resolution, the
Scottish Committee of the British Medical Association,

1 Surgeon-General Bourke.

a Dr. A. H. F. Barbour, Mr. J. W. B. Hodsdon, Dr. Ebenezer
Duncan. 8 Prof. H. H. Littlejohn.

4 Dr. W. Leslie Mackenzie. ° Dr. John C. M'Vail.

6 Dr. Norman Walker. 7 Dr. Alfred Cox.

8 Dr. John Adams, Dr. G. C. Anderson, Dr. John Gordon,
Dr. J. R. Hamilton, Dr. John Stevens.

1915- § !] Scottish Committee 27

on 21 May 1915, addressed to Scottish Branches a
circular in which each Branch was informed of its
share of the total 400 according to its medical strength,
and was requested to state how far it would be able
to meet the call. Branches were asked further to
indicate how many of their medical practitioners had
already joined the Royal Army Medical Corps, either
Regular or Territorial. Returns along the lines laid
down were duly made.

These measures of the Scottish Committee were
well-devised, but an anomalous position was develop-
ing. On one side the Scottish Committee was calling
on practitioners to join the Army. On the other side
the Emergency Committee was attempting to safe-
guard the home interests of practitioners who had
already joined, and to maintain, so far as military
requirements permitted, the standards of civil practice.
The objects ot the two Committees, though not
antagonistic, were different. It was vital to progress
that the Committees themselves should not seem to
be in opposition. This untoward possibility was care-
fully examined by both Committees in the light of
the national crisis, and as a result it was decided by
the Scottish Committee to place in the hands of the
Emergency Committee the records which they had
collected, and to ask the Emergency Committee to
undertake the duty of co-ordinating and organizing
the effort for the provision of medical officers for
the Army which had begun to be made throughout
Scotland.

At this time the Battles of Ypres, 1915, had been
concluded, the Battles of Helles were drawing to a
close, and the Battles of Anzac were over. Italy had
declared war on Austria.

28 Mustering of Medical Service in Scotland

Emergency Committee in Charge

The request put forward by the Scottish Committee
could not but claim the earnest consideration of the
Emergency Committee. In the course of an interview
at the War Office on 3 June 1915, the Convener1 of the
Committee and the President 2 of the Royal College of
Surgeons learned from the Director General 3 of Army
Medical Services that the War Office would welcome
with much cordiality any help which the Committee
could render. Immediately thereafter the Committee
met, reviewed its resources and decided to take up
the task.

In accepting the control of medical recruiting in
Scotland, the Committee was putting out on what was
to it an uncharted sea. Its original functions, by
this time familiar, of looking to the interests of
practitioners and the needs of the civil population,
would continue to be performed, and would require to
be carried on with increasing care as conditions grew
more stringent ; but it was now to engage in the wider
adventure of bringing to the notice of civilian medical
men their duty to the Army, and of offering them its
guidance and direction in answering the call to action.
The Committee recognized that, as a Committee, it
was a temporary creation. It had, however, the
approval of the War Office and the support of the
British Medical Association. It was by its member-
ship in touch with various branches, sections and ages
of the profession ; and, by means of problems already
dealt with, it had acquired experience which it was
ready to place at the disposal of any who, while eager

1 Dr. Norman Walker. a Mr. J. W. B. Hodsdon.

8 Sir Alfred Keogh.

1915- § i] Royal Navy 29

to give the most fitting service, might be in doubt
which way to walk.

The Committee in pursuing its undertaking had no
general agreement with the Senior Service. The
requirements of the Royal Navy and its Reserves for
qualified medical men had by this date been substan-
tially met, and the supply of undergraduates for
employment as Surgeon Probationers was being pro-
cured from the medical schools. From time to time,
however, a practitioner who desired to serve at sea was
directed by the Committee to the Admiralty, or a
Temporary Surgeon, at the Committee's request, was
released from his ship. These were friendly incidents,
and the Committee's dealings with the Naval authori-
ties were cordial throughout the war. Nor did the
Committee engage to supply the needs of the Terri-
torial Force. Its main endeavour, as will appear from
the narrative, was the provision of temporary medical
officers for the Regular Army.

Medical Strength : 15 May 1915

The Committee adopted as its local administrative
areas the Divisions * of the British Medical Association,
the four Glasgow Divisions being counted as one ; and
thought it essential, before making demands, to ascer-
tain how far the medical strength of Divisions was
already reduced, or was on the point of being reduced,
by withdrawals of Scottish practitioners2 for whole-
time service. It accordingly issued, on 15 June 1915,
a Circular to Secretaries of Divisions requesting them
to furnish in a week from that day information re-
specting their areas under three scheduled heads,
namely :

1 Appendix I. 2 Footnote, p. 8.

30 Mustering of Medical Service in Scotland

Schedule A. — Names and details of civilian practitioners1
accepted for whole-time service before 15 June 1915, and whether
called up on mobilization.

Schedule B. — Names and details of civilian practitioners com-
mitted to whole-time service by applications for commissions
before 15 June 1915, and whether before or after 15 May 1915.

Schedule C. — Names and details of civilian practitioners who at
15 June 1915 had not applied for commissions, but were ready to
do so if suitable home arrangements could be made.

This information was timeously supplied by most
Divisional Secretaries. The offers under Schedule C
were satisfactory. The facts under Schedules A and B
were as shown in Tables III. and IV., the balance being
struck as at 15 May 1915, and rejected applications for
commissions excluded.

TABLE III

CLASSIFICATION OF SCOTTISH CIVILIAN PRACTITIONERS ON, OR
COMMITTED TO, WHOLE-TIME MILITARY SERVICE AT 15 MAY 1915

Total by

On, or for,
Whole-

Re-

Table I.

time

maining.

Service.

Private Practitioners

376

306

Insurance Practitioners .
Consultants .....

1796
248

254
28

1542
22O

Whole-time officials

5*4

437

Dental and Retired Practitioners .

269

261

Unestablished Practitioners .

619

204

4iS

TOTAL .

3822

641

3181

1 The expression Civilian Practitioner excludes permanent
officers of the Royal Navy, Regular Army and, later, Air Force.
Unless otherwise indicated by the context, it will be held to
include officers of the Royal Naval Reserves, officers of the
Special Reserve of the Army, officers of the Territorial Force,
and temporary officers of the Royal Navy and Regular Army.

I9IS- §

Medical Personnel

TABLE IV

DISTRIBUTION OF SCOTTISH CIVILIAN PRACTITIONERS ON, OR
COMMITTED TO, WHOLE-TIME MILITARY SERVICE AT 15 MAY 1915

MEDICAL PERSONNEL.

DIVISION.

Total by
Table II.

On, or for,
Whole-time
Service.

Remaining.

Population
per G.P.
Remaining

(Col. 6).

G.P.

Others.

G.P.

Others.

G.P.

Others.

Aberdeen

l6l

I25

126

2803

Argyll ....

1541

Ayr

132

124

2164

Banff, Elgin and Nairn .
Caithness and Sutherland

66
26

36
IO

9
6

21
I

15
9

2003
2609

Dumbarton

2899

Dumfries and Galloway .

2075

Dundee ....

IOI

339 J

Edinburgh and Leith

232

473

'93

427

2077

Fife ....

3226

Glasgow

461

395

387

329

2606

Inverness

2413

Islands ....

3014

Lanark ....

162

141

3387

Lothians ....

2741

Orkney ....

...

J363

Perth ....

3°33

Renfrew and Bute .

138

«4

120

2477

Ross and Cromarty

245i

South Eastern

2483

Stirling ....

2349

Zetland ....

...

1994

TOTAL .

2172

1650

^324

317

1848

I333v

2576

GRAND TOTAL .

3822

~6^~

3181

3 2 Mustering of Medical Service in Scotland

Of the total of 641 practitioners referred to in
column 3 of Table III., and in the sum of columns 4
and 5 of Table IV. as on, or committed to, whole-time
service at 15 May 1915, 627 were already on duty with
His Majesty's forces, while 14 were awaiting commis-
sions which in the event they received. As Tables III.
and IV. relate to whole-time military service only, they
do not include Territorial Officers employed a la suite
of General Hospitals.

Medical Distribution: 15 May 1915

Comparing column 6 of Table II., dated i August
1914, with column 8 of Table IV., dated 15 May 1915,
the Committee observed that the ratio of population
per General Practitioner at the later date showed a
definite upward tendency, implying a corresponding
decrease of the General Practitioner strength of Divi-
sions. For Scotland as a whole the figure had risen
from 2192 to 2576. On i August 1914 no Division
reached 3000; by 15 May 1915, 5 Divisions had gone
beyond it. Of the remaining Divisions all but one
showed increases ranging from slight to appreciable.
Some Scottish Districts had already given much, while
others had reserves to draw upon.

CHAPTER III
1915. §2

1915 Recruiting Scheme : Inauguration — Fourth Memorandum —
Terms of Service — Organization. — 1915 Scheme: Numerical
Considerations. — 1915 Scheme: Operation. — Sundry Pro-
cedure : Special Committee — Local Murmuring — Fifth Mem-
orandum— Terms of Service — Advice to Practitioners. —
Practices of Serving Officers : Help by Committee — Disputes
Sub- Committee — A rrangements — Notice Card — Lay Press —
Meeting. — 1915 Scheme : Output.

1915 Scheme: Inauguration

ON 28 June 1915, with the facts before it, the Com-
mittee issued its Fourth Memorandum?- in which it
represented the great opportunity which had come to
the profession for rendering service to the Empire,
recalled the Director General's impressive appeal to all
who were physically fit and willing to serve, and stated
the Terms of Service 2 with the Army. The Committee
then proceeded to explain its plan for the Organization 3
of the profession, and set forth the Scheme 4 which it
proposed to carry out for the supply of medical officers.
Mindful at the same time of its former state, it recom-
mended practitioners going on service to make clear
and business-like arrangements for the conduct of
their civil work in their absence, and said that it was
prepared, if requested, to advise them on questions
1 Appendix IV. 2 P. 34. 3 P. 34. 4 P. 37

34 Mustering of Medical Service in Scotland

arising. It made the suggestions of its Second Mem-
orandum on the remuneration of deputies somewhat
more explicit, and it dealt again with various points
in finance, including transfers under National Insur-
ance. It concluded with an appeal for vicarious service
by those too old for the Army, requesting them to come
forward as locum tenentes for young practitioners
wishful to join.

The Terms of Service authorized by the War Office
to be intimated to the profession by the Committee
related to two classes : —

1. Practitioners under 40 whose services were due to be
accepted for a period of 12 months and who would be liable for
service at home or abroad : and

2. Practitioners over 40, who might offer themselves for a period
of 6 or 12 months, and who, if they desired it and had been found
serviceable, might be re-engaged at the end of 6 months. It was
not proposed to send those over 40 to France, but to employ them
either in this country or in such stations as Egypt, Malta, and
Gibraltar.

Practitioners engaging on a 12 months' contract were to re-
ceive temporary commissions in the Royal Army Medical Corps
with an allowance of .£30 for outfit and pay at the rate of 245.
a day with is. gd. for ration allowance and a gratuity of £60 at
the termination of the engagement, subject to satisfactory service.
Practitioners engaging for 6 months were to have the same terms
as for the longer period except that the gratuity was to be .£15
instead of ;£6o.

These terms were for whole-time service as temporary
officers of the regular Royal Army Medical Corps.
The question of part-time military service was not
dealt with at this juncture by the Committee, but was
left for adjustment in the different areas by those
familiar with their conditions.

The Committee, with a view to Organization , re-
quested that each of its local units should be placed
under the charge of a War Committee of medical men,

1915- §2] War Committee 35

to administer the Division for war purposes, and to
act as a link between the Emergency Committee and
the practitioners in each area. It was suggested that
a War Committee should consist of from three to five
members, and that it should be appointed at a meeting
of the profession of the area called by the Executive of
the Division. These recommendations were carried out.

1915 Scheme: Numerical Considerations

The Second Conference had resolved upon 400
medical officers as the number to be furnished by
Scotland. The Committee had reason to believe that
to this sum the graduates and licentiates of July 1915
would contribute about 100. There was left a balance
of 300 men to be provided by the rest of the profession.
As it was not possible to foresee with precision the
results of so considerable a withdrawal, the Committee
preferred, under its 1915 Scheme, to call up 280 practi-
tioners only. Thus the total call became 380, of whom
280 were to be practitioners.

In distributing the practitioner call among Divisions
the Committee attached importance to the population
per General Practitioner in column 8 of Table IV.,1
regarding this figure as an index of the further deple-
tion, if any, which an area might be able to suffer.
The Committee, however, was alive to the risks of a
purely numerical assessment. It did not adopt the
Procrustean plan of fitting all Divisions to one
standard. Rather it endeavoured by interview and
inquiry to ascertain their special circumstances and
temper the claims accordingly. It pressed lightly, if
at all, on sparsely peopled areas in which adjustments
with neighbouring practices would be difficult or
1 P. 31.

36 Mustering of Medical Service in Scotland

impossible : it made heavier demands on populous
centres which had facilities for organization. Where
most of the medical personnel was of the General Prac-
titioner class it was careful of approaching the limit of
safety : where the proportion of Other Practitioners
was considerable, it looked to them as a contributory
source of supply and asked for a larger contingent.

The General Practitioner strength of areas, as
recorded in column 6 of Table IV., was the base level
by which the Committee fixed the call of 280 practi-
tioners, but between 15 May 1915, the date of Table IV.,
and i July 1915, when the Committee launched its
Scheme, 42 practitioners had come forward spontane-
ously and applied for commissions in the Army. Of
these, the Argyll, Islands and Renfrew and Bute
Divisions provided one each ; Ayr, Dumfries and
Galloway, Dundee, Lanark and Perth, two each ;
Stirling, three ; Fife, four ; and Edinburgh and Leith
and Glasgow, eleven each. The 42 practitioners were
counted in as part of the total 280, and the Actual Call,
as intimated to Divisions, was adjusted at 238.

In another respect also the Committee modified the
findings of the Second Conference. The Conference
had named 7 July 1915 as the appointed day by which
the Scottish contingent should be in readiness, but in
view of the arrangements requiring to be made in order
to free so many doctors without dislocation of civil
practice the Committee came to the conclusion that
this date could not be adhered to.

On the same grounds, assuming a later date, the
Committee was averse to the project of calling up the
whole draft at one and the same time. It therefore
decided, with the concurrence of the War Office, to
conduct its 1915 Scheme by the method of three succes-
sive calls, which were made in the following manner.

IQ 1 5. §2] Successive Calls 37

1915 Scheme: Operation

As at i July 1915 the Committee issued to War
Committees a Preliminary Notice informing them of
the Actual Call, that is to say, the further number of
men whom it proposed to claim from their Divisions,
and requesting them to make such preliminary arrange-
ments as would expedite procedure when the successive
calls were presented.

On 20 July 1915 the Committee issued to War Com-
mittees its First Call, informing them of the number
required to make up the August contingents, calculated
at 50 per cent, of the total demand. The Committees
thereupon chose their tale of men, notified them to hold
themselves in readiness for service, and forwarded
their names to the Emergency Committee. The Emer-
gency Committee sent out to each practitioner the War
Office form of application for a commission. The forms
were filled in by practitioners, returned to the Com-
mittee, and transmitted to the War Office. The
applications of candidates known to the Committee
were vouched for by it, and accepted by the War
Office without further inquiry into credentials. Medical
examinations were arranged to be conducted through
the Deputy Director of Medical Services, Scottish
Command.

On 30 August 1915 the Committee issued to War
Committees its Second Call, asking for 25 per cent,
cf the claim on Divisions, to form the September
drafts.

On 22 September 1915, by means of the Third
Call, the October contingents were summoned, fur-
nishing the final 25 per cent., and completing the
total demand.

38 Mustering of Medical Service in Scotland

Sundry Procedure

Before summarizing the output1 of the 1915 Scheme
reference will be made to certain events and questions
which fell within its period.

In July 1915, at the annual representative meeting of the British
Medical Association in London, the Special Committee? which had
been composed of Association members and had done good ser-
vice, was replaced by a War Emergency Committee, appointed on
a broader basis. It was stated in reply to a question by a
member 3 of the Emergency Committee, who was present at the
meeting, that the new Committee would be empowered to organize
the profession in England, Wales, and Ireland. The War
Emergency Committee at its second meeting, on 4 August 1915,
co-opted to membership a member 4 of the Scottish Medical Ser-
vice Emergency Committee, who played an important part
thereafter in co-ordinating the work of the two Committees. On
20 October 1915 the War Emergency Committee changed its title
to the Central Medical War Committee.

Before the 1915 Scheme had completed a month of
life a Local Murmuring rose in Scotland. Statements
were made, and attained some vogue, that the needs
of the Army Medical Department were exaggerated,
that the War Office had already as many medical men
as were required, and that offers of service had been
rejected. It was clear that with such rumours flying
the mind of the profession would be divided, and that
War Committees in appealing to their practitioners
might be met with reluctance or apathy. The Con-
vener, at the request of the Scottish Medical Service
Emergency Committee, wrote to the Director General,
Army Medical Services, detailing the statements circu-
lated, and asking for an official rejoinder which could
be used to controvert them. The rejoinder came by

1 P. 44. a P. 21.

8 Dr. John Gordon. 4 Prof. H. H. Littlejohn.

1915- §2] Fifth Memorandum 39

return of post, on 8 August 1915, and on the same day
was issued to the Scottish profession, in the following
summary form, as the substance of the Committee's
Fifth Memorandum.

To outfit the new armies and to supply reinforcements for
6 months, it is estimated that at least 2500 more medical men of
military age (i.e. under 40) will be required.

During the last 6 months temporary commissions have been
granted in every case where the applicant was prepared to fulfil
all the conditions of the contract for service. In some cases where
the offer of service was accompanied by restrictive conditions, it
was not possible to accept it.

No Official in the Medical Branch of the War Office has ever
told anyone that more medical men are not required. Indeed, it
has been found necessary to make special provision to bring
medical men from Canada, Australia, and New Zealand.

It is specially incumbent on every young doctor who is physic-
ally fit to offer himself for military service. All will be needed,
and practically all will have an opportunity of serving with the
troops overseas.

The duty of the older men is to set free the younger men by
arranging to carry on their practices for them in their absence, or
by engaging for home service.

Any medical man preventing or dissuading his colleagues from
assisting the Medical Service of the Army 'during the War is
doing a serious disservice to the Empire.

The Committee added : —

These, then, are the facts. The Committee places them before
the Members of the Profession in Scotland, confident that, now all
doubts as to the needs are cleared away, the response from every
part of the country will be such as Scotland expects.

With regard to the offers accompanied by restrictive
conditions to which reference is made in the summary,
it is proper to say that in one typical case which
passed through the hands of the Committee the con-
ditions, while hampering to the War Office, were in
no sense shifty or overcautious. The practitioner on

4O Mustering of Medical Service in Scotland

the contrary required a guarantee that he would be
sent overseas. His offer was declined. Thereupon he
applied unconditionally, was accepted, and before many
days went on foreign service according to his desire.

On 3 September 1915 the Terms of Service were
altered. It was intimated by the War Office to the
Committee that as from that date a new policy would
begin with regard to the engagement of medical men
as temporarily commissioned officers in the Royal Army
Medical Corps :

1. No man under 45 years of age would be employed unless he
undertook general service obligations for a year and was found
to be physically fit for duty at home and abroad.

2. No man over 55 years of age would be accepted for home
service,

3. No man under 45 years of age would be re-engaged after the
expiration of his first contract unless he offered for general service.

The War Office announcement followed closely on
the issue of the Committee's Second Call, based on
the terms of the Fourth Memorandum, on the faith of
which a number of practitioners had already offered
themselves. The Committee asked the War Office
that those so placed might be permitted to come in on
the terms current at the time of their offer, and it was
accordingly agreed that Second Call candidates should
have the choice between the old terms and the new.
The Third Call was on the new terms.

The Committee had offered to give Advice to practi-
tioners who desired it on their duty towards military
service. Of those who approached the Committee,
seven appeared to be irreplaceable and were recom-
mended to remain in civil work. To practitioners
who consulted the Committee with regard to physical
defects or disabilities which they thought might bar
them from commissions or impair their usefulness if

1915. §2] Adjustments 41

appointed, the view was expressed that they should
offer themselves to the Army, leaving the question of
their fitness to be decided by the medical officer by
whom they would in due course be examined.

Practices of Serving Officers

Other practitioners sought the Help of the Committee
in arranging for the conduct of their practices during
their absence. The negotiations for replacing two
practitioners in a Stirlingshire Burgh by one locum
tenens were entrusted to a member J of the Committee,
who interviewed parties, visited the town and secured
an equitable agreement. Another adjustment in which
the Committee took interest was that arrived at
between the three practitioners in three townships of
the north-west of Fife, in accordance with which each
practitioner went to the Army in turn, the two at home
carrying on the triple practice during the absence of
their colleague.

Certain practitioners, who owing to the haste of their
departure had been unable to follow the Committee's
counsel and make businesslike arrangements for their
home affairs, consulted the Committee on matters at
issue between themselves and their neighbours. For
dealing with disputes and disagreements under this
head the Committee appointed a Disputes Sub-com-
mittee^ consisting of the President2 of the Royal
College of Surgeons, Edinburgh, the Dean3 of the
Faculty of Medicine, Edinburgh University, and the
Convener,4 who were to have, when required, the ser-
vices of the Clerk 5 to the Royal College of Physicians,
Edinburgh, as legal assessor.

1 Dr. John Playfair. 2 Mr. J. W. B. Hodsdon.

3 Prof. H. H. Littlejohn. 4 Dr. Norman Walker.

6 Mr. A. Gray Muir.

42 Mustering of Medical Service in Scotland

In issuing its calls to War Committees the Com-
mittee, alike in the interests of the public and of
officers proceeding on service, had asked War Com-
mittees to assure themselves that suitable Arrange-
ments had been made for the conduct of the practices
of all applicants for commissions. War Committees
had duly complied : but the Committee had abundant
evidence that in many areas the arrangements made
were not understood by the people. In the case of
insured patients, who were anchored for annual periods
by the Insurance contract, no immediate question
arose : but the private patients of absentees, adrift
between doctor and doctor, were omitting to intimate
whence they came, and were in consequence being
accepted as permanent patients by practitioners who
were unaware that their proper medical attendant had
gone to join the Army.

The Committee therefore printed a Notice Card1 for
the better guidance of patients, and issued supplies
to Secretaries of War Committees for distribution to
practitioners in their Divisions, with a request that
the card might be displayed in a prominent position
in waiting-rooms and consulting-rooms.

The Committee considered the further question of
utilizing the Lay Press for the intimation of arrange-
ments made for carrying on vacated practices. While
the profession itself, and the Council responsible for
administering the Acts which regulate it, are firmly
opposed in normal times to any advertisement by
practitioners, it appeared to the Committee that in
the emergency it would be legitimate to bring neces-
sary information to the notice of the public by inserting
announcements in local newspapers. The President2
of the General Medical Council, whose opinion the
1 Appendix V. 2 Sir Donald MacAlister.

i9I5- § 2] Announcements 43

Committee ascertained, expressed the view that under
the special circumstances the step proposed would be
permissible, provided that the advertisements were in
the name of the Committee, not of the individual
practitioners concerned. The Committee circularized
War Committees, indicating the importance of ac-
quainting patients that they could still remain in the
practice of their own medical man notwithstanding his
temporary absence, and drawing the attention of War
Committees to the exceptional procedure which the
urgency of the time seemed to warrant. The Com-
mittee stated to War Committees that it would be
prepared to assume responsibility for announcements
made in the press or drawn up for issue to patients,
subject to two conditions, first^ that before publication
or issue a copy was submitted to the Committee for
criticism, and, if thought necessary, for alteration and
correction, and, second^ that the announcement con-
tained these words or their equivalent — Approved by
the Scottish Medical Service Emergency Committee.

On 10 September 1915 the Convener1 of the Emer-
gency Committee attended by invitation a Meeting
of the Scottish Committee of the British Medical
Association at Perth. Addressing the meeting, he re-
ferred to the circumstance that, owing to the greater
complexity of the problem, practitioners in large towns
who desired to serve had found it more difficult to
arrange for the conduct of their practices, when
vacated, than doctors in some country places. He
recommended the use of the Notice Card and discussed
the methods of intimating arrangements which the
Committee could view with favour. He spoke of the
attitude of the War Office with regard to practitioners
whom the Committee put forward as possessing special
1 Dr. Norman Walker.

44 Mustering of Medical Service in Scotland

qualifications. All were required in the first instance
to take commissions as Lieutenants in the Royal Army
Medical Corps, but their special qualifications were
noted so as to be turned to account when the oppor-
tunity came. He acknowledged the valuable work
which was being done by the War Committees of
areas.

1915 Scheme; Output

The third and final draft of medical men, completing
the Committee's 1915 Scheme,1 was due to be forward
by the end of October. Eight days later the account
was cast with the result recorded in Table V.

Column 2 of Table V., Total Practitioners ; is the
same as column 5 of Table II., and is equal to the sum
of columns 2 and 3 of Table IV. Column 4, the Total
Call, takes in the 42 spontaneous applications already
noted. Column 5, the Response, includes 117 Gradu-
ates and Licentiates, of whom 20 were derived from
the University of Aberdeen, 6 from University College,
Dundee, 63 from Edinburgh University and the Con-
joint Board in Scotland, and 28 from the University of
Glasgow.

In Column 6 the plus sign shows where the response
outstripped the call : the minus sign where it fell short.
These figures are not commented upon excepting to
say that they should be read in conjunction with
column 8 of Table IV.,2 which states the population per
general practitioner in Divisions at the time when the
call was assessed.

The total output was 347 in lieu of 380 asked for.
The supply was close up to the demand. The response
of the profession in Scotland under the 1915 Scheme
was a material contribution to the Army.

1 P. 37- 2 15- 3i.

TABLE V

RESULT OF 1915 SCHEME 15 MAY 1915 TO
8 NOVEMBER 1915

SCOTTISH CIVILIAN PRACTITIONERS

Total.

On, or for
Service
at 15 May

Total
Call.

Response
at 8 Nov-
ember

Col. 5
minus
Col 4.

1915

1915.

Aberdeen

286

- I

Argyll ....

+ 3

Ayr ....

170

-7

Banff, Elgin and Nairn .

102

+ i

Caithness and Sutherland

...

Dumbarton .

'-6

Dumfries and Galloway

134

+ 2

Dundee ....

I78

- i

Edinburgh and Leith

705

+ 4

Fife ....

161

+ I

Glasgow

856

140

101

-39

Inverness

...

Islands ....

+ 2

Lanark ....

251

-3

Lothians . .

'53

Orkney ....

...

Perth ....

- i

Renfrew and Bute.

190

-4

Ross and Cromarty

+ i

South Eastern

~ 3

Stirling ....

127

•5

«s

Zetland ....

...

+ 2

Practitioners .

3822

641

280

230

-50

Graduates and Licentiates

...

100

117

+ 17

TOTAL .

...

380

347

-33

CHAPTER IV
1915. §3

Survey of Army Recruiting : Normal System — Recruiting Propa-
ganda — National Registration Act 1915. — Lord Derby's
Scheme : Royal Proclamation. — Canvassing of Practitioners :
Conference. — Emergency Committee and Lord Derby's Scheme:
Tribunal for Medical Purposes. — War Register : Sixth Memor-
andum.— Medical Strength: 31 December 1915. — Medical
Distribution : 31 December 1915. — Close of 1915.

Survey of Army Recruiting

WHILE the Committee's 1915 Scheme was running its
course, which covered the periods of the Battles of
Suvla and the Battle of Loos, and the execution of
Miss Edith Cavell at Brussels under the German
Military Code, a new recruiting organization came
into existence in Britain, comprehending within its
range all men of military age, including medical
practitioners. The attitude of the country towards the
duty of service with the Fighting Forces had, under
the shocks of war, been gradually but surely changing.
Medical and lay recruiting, which had hitherto pro-
ceeded along parallel but separate lines, now began to
touch and cross, and the medical demesne — for which,
however, be it said, protection had been neither desired
nor claimed — became liable to the inroads of the lay
recruiting agent.
Though new issues were thus presented which in the

19I5- §3] Army Recruiting 47

end affected profoundly both the Emergency Com-
mittee and the profession, the situation, as it arose,
was simply a result of developments in the methods
of Regular Army recruiting, which will be briefly
described.

The Normal System of recruiting for the Regular Army before
the war was one of voluntary enlistment. The Country was
divided into recruiting districts controlled by Army Recruiting-
Officers attached to the various Commands. The military age,
which varied slightly according to the arm of the service, ranged
between 18 and 35. Men were usually posted in the first instance
to their Depots.

With this system the medical man, as such, was not concerned.
If he desired to enter the Regular Army in his medical capacity
he applied in the prescribed manner for a commission.

On the outbreak of war there was a surge of recruits. The
Parliamentary Recruiting Committee and the Joint Labour
Recruiting Committee, through their local agencies, came to the
assistance of the military authorities by providing and equipping
additional recruiting offices. Later on, as the demand for men
continued, they helped further in conducting a Recruiting Propa-
ganda. Recruits were enlisted voluntarily for the duration of the
war and were passed direct to the colours. As certain civil
occupations were believed to be important in the national interest,
instructions were, from time to time, issued to Army Recruiting
Officers that men engaged in certain occupations should not be
enlisted. Of such men some were badged.

To this lay propaganda system there was a medical counter-
part. Medical men had the opportunity of taking commissions
for limited periods in the Royal Army Medical Corps. The first 1
offer made by the War Office to practitioners was open to those
up to 35 years of age or in exceptional cases up to 40, for a period
up to 12 months or till services were no longer required, which-
ever should first happen. The second 2 offer admitted practitioners
under 40 for 12 months, and over 40 for 6 or 12 months. The
third 3 offer excluded those under 45 from home service only, and
those over 55 from home service. These invitations were urged
upon the notice of practitioners by the British Medical Association

1 P. 5- 2 P. 34- 3 P. 40.

48 Mustering of Medical Service in Scotland

and its Scottish Committee, and by the Emergency Committee,
whose 1915 Scheme may be regarded as the climax of the
medical propaganda system in Scotland at this time.

The lay propaganda system, for a while, furnished as many
recruits as the War Office could handle. As the situation un-
folded, however, it was made known that more men still would be
required. Side by side with this call for soldiers a movement
began for mobilizing the whole nation on a war footing. To this
end the National Registration Act 1915 was passed on 15 July,
coming into operation on that day.

This was an Act for the compilation of a Register of the
population of the Country, both male and female, between the
ages of 15 and 65, excepting members of His Majesty's Forces
and certain other persons. The Register was so designed as to
record, among other points, ages and particulars of work. The
Central Registration Authority in Scotland was the Registrar
General for Scotland acting under the directions of the Secretary
for Scotland. The Local Registration Authorities were County
and Burgh Councils.

The Register was compiled as at 15 August 1915. Men of
military age were especially noted, and the names of a number
who were engaged in certain occupations were starred. Medical
men were included under the terms of the Act.

Lord Derby's Scheme.

The information in the hands of Local Registration
Authorities was the foundation of the new recruiting
organization, pointed to above, which came to be
known as Lord Derby's Scheme. The Director General
of Recruiting1 assumed office at the requesl of the
Secretary for War 2 on n October 1915. He secured
the assistance of the Central Recruiting Committee,
consisting of the Parliamentary Recruiting Committee
and the Joint Labour Recruiting Committee. It was
decided that Local Recruiting Committees should con-
duct a canvass of men of the military age, which was
now 1 8 to 40.

1 The Earl of Derby. * The Earl Kitchener.

I9I5- § 3] Royal Proclamation 49

At this important juncture His Majesty issued a
Proclamation containing these words :

In ancient days the darkest moment has ever produced in men
of our race the sternest resolve.

I ask you, men of all classes, to come forward voluntarily and
take your share in the fight.

In freely responding to my appeal, you will be giving your
support to our brothers, who, for long months, have nobly upheld
Britain's past traditions, and the glory of her Arms.

His Majesty ordered that men enlisted under the
Scheme might, with their consent, be transferred to
the Reserve, and Recruiting Officers were instructed
accordingly. Men so transferred were classified in
46 age groups, 23 of which were for single men and 23
for married men. The groups were to be called to the
colours in numerical succession, from the first, which
consisted of single men aged 18, to the forty-sixth,
which consisted of married men aged 40, except that
the first group was not to be called until the age of 19.

It was determined, as a feature of the Scheme, that
all men enlisted under groups, together with men who
had applied for service and had been rejected on medical
grounds, should receive a distinctive armlet to be issued
by Recruiting Officers.

Besides Local Recruiting Committees, whose areas
were Parliamentary, there came into existence by
appointment of the Local Registration Authorities —
who were County and Burgh Councils — Local Tribunals
whose function it was to consider claims for exemption,
postponement, or starring. War Office Representa-
tives were appointed for the purpose of addressing
Local Tribunals on the military aspects of cases coming
before them. They were assisted by Advisory Com-
mittees. There was in addition a Central Tribunal for
dealing with disputed cases.
4

50 Mustering of Medical Service in Scotland

Lord Derby's Scheme differed from the propaganda
system in several important particulars. Its canvass
was based on the National Register. It permitted
recruits who so desired to be relegated to the Reserve.
It empowered an investigation of doubtful cases.

Canvassing of Practitioners

In the course of October 1915 it came to the notice
of the Emergency Committee that Scottish practitioners
who had accepted the direction of the Committee on
their duty towards the Army had been canvassed by
Local Recruiting Committees under Lord Derby's
Scheme. It was vexatious to medical men who had
already expressed their wish to serve that they should
now be set upon from a new quarter ; and the Com-
mittee, surveying the position broadly, came to the
conclusion that medical recruiting, which had, so far,
with the cheerful co-operation of the profession, pros-
pered at its hands, would be likely to suffer if trans-
ferred to the management of lay authorities unfamiliar
with the conditions of medical practice and the medical
requirements of areas. It communicated these views
to the Director General, Army Medical Services, and
desired an early settlement.

On 5 November 1915, by request of the Director
General, Army Medical Services, a Conference took
place in London. The Convener1 of the Emergency
Committee and a member 2 of the Central Medical War
Committee met at the War Office with the Director
General,3 Army Medical Services, and the Director
General4 of Recruiting. The representatives of the
Central Medical War Committee and of the Emergency

1 Dr. Norman Walker. 2 Dr. James Galloway.

» Sir Alfred Keogh. * The Earl of Derby.

1 9 i 5- § 3] Lord Derby s Scheme 5 1

Committee explained the work which the two Com-
mittees had been carrying on. The Director General
of Recruiting intimated his approval, and expressed a
wish that the work should continue. He indicated
that any canvassing of medical men by his agents had
been by inadvertence. He requested that the two
Committees would undertake the whole of the arrange-
ments for procuring medical men for the Army, and he
agreed, on the recommendation of the Director General,
Army Medical Services, that they should be recognized
for this object.

Emergency Committee and Lord Derby's
Scheme

So the Emergency Committee became a Recruiting
Authority in Lord Derby's Scheme, with a status
equivalent to that of a Local Recruiting Committee, a
field which extended to the whole territory of Scotland,
and a duty to canvass all medical men of military age
within that field.

The question of a Tribunal for the area of the Com-
mittee's proposed activities, similar to the Local
Tribunals under Lord Derby's Scheme, was submitted
by the Committee to the War Office, who replied by
letter of 12 November 1915 that the Committee would
itself be regarded as a Tribunal for Medical Purposes.
As the Committee was closely in touch with the Head-
quarters of Army Medical Services it was not thought
necessary to appoint a War Office representative.

The Committee at this period, looking to its increasing respon-
sibilities, co-opted to membership the Professor of Pathology * of
the University of Glasgow and the Regius Professor2 of the Prac-

1 Prof. Robert Muir. 2 Prof. T. K. Monro.

52 Mustering of Medical Service in Scotland

tice of Medicine of the University of Glasgow. The Principal *
of the University of Glasgow, whom it invited to membership, was
unable, in view of his position as President of the General Medical
Council, to accept.

War Register

The Committee proceeded to the compilation of a
Medical War Register of Scotland, keeping in mind
that the military age for practitioners was up to 55, not
up to 40 as for the lay population, and, further, that
over 55 there were national services, other than service
in the armed forces, which medical men could render.
It was decided that the preliminary inquiries made for
the purpose of the Register should be such as to elicit
not only the service already given by each practitioner,
but also the service or services which each practitioner
who had not yet served would be prepared to render, if
called upon. Thus one process was to cover both
registration and canvass ; and the Register, besides
being a Register of names, was to be a Record of duty
promised. It was determined to calculate from the
Register the number of Scottish practitioners on military
service as at 31 December 1915.

The Medical War Register differed from the return
obtained of the medical strength of areas at 15 May
1915 in that it was to be founded on direct application
to the individuals concerned. It was to form the basis
of the Committee's 1916 Recruiting Scheme.2

With these objects in view the Committee on
18 December 1915, despatched to the addresses of
civilian medical practitioners in Scotland its Sixth
Memorandum^ announcing its 1916 Recruiting Scheme
and enclosing the two following forms to be returned
by 31 December 1915.

1 Sir Donald MacAlister. a P. ^.

- §3]

War Register

1. Intimation Form to be filled in by, or on behalf of, practi-
tioners on service. A practitioner holding- a commission but still
at home was to fill in the form himself. In the case of a practi-
tioner absent from home on service it was requested that the form
should be filled in by some person on his behalf.

2. Registration Form J to be filled in by practitioners not hold-
ing1 commissions. In this form practitioners were asked to state
their age and other particulars, and to offer for the service or
services appropriate to their age, according to three groupings,
namely—

Group.

Age.

Service.

Under 45

Lieutenant R.A.M.C., General Service.

45 to 55

Lieutenant R.A.M.C., Home Service.
Part-time home military work.
Locum tenens.
Part-time home civil work.

56 and upwards

Part-time home military work.
Locum tenens.
Part-time home civil work.

Offers made on the Registration Form were subject
to the condition that, in the event of the service
requiring the practitioner to leave his work, he would
be enabled to make arrangements for having it carried
on in his absence.

The Committee learned to its regret that, despite precautions
taken to scrutinize the casualty lists and employ all available
sources of information, the Sixth Memorandum had reached the
home addresses of several Officers who had lost their lives.

The Forms were duly returned in a large proportion

of cases. The services already rendered, as stated in

the Intimation Forms, and the services offered, as

stated in the Registration Forms, were entered in the

1 Appendix VI.

54 Mustering of Medical Service in Scotland

Committee's War Register. The services offered
belong to the Committee's 1916 Recruiting Scheme
and will be considered under that title. The count of
the services which had been rendered by 31 December
1915 was as presented in Tables VI. and VII.

Medical Strength : 31 December 1915

Table VI. is a classification of Scottish practitioners,
including officers a la suite, on military service at
31 December 1915. By comparison of Table VI. with
Table III.,1 which is dated 15 May 1915, it emerges that
the total number of medical men on service had risen
from 641 to 1290, that is to say, double the earlier figure.
The increase, while distinct in every class, is most
remarkable in the case of consultants and unestablished
practitioners.

For Consultants the increment must be ascribed, in
part at least, to the inclusion in Table VI. of a la suite
Officers who had not been included in Table III.

In the case of Unestablished Practitioners the
apparent increase is from 204 at 15 May 1915 to 471 at
31 December 1915. The view is taken that the earlier
count was below the facts. It was based on returns
accepted as approximate from Secretaries of Divisions.
The later return, being derived from information com-
municated direct to the Committee by Unestablished
Practitioners or their representatives, may be regarded
as nearer to correctness.

Medical Distribution: 31 December 1915

Table VII., which is a pendant to Table IV.,2 conveys
the distribution among Divisions of the practitioners
1 P. 30. f P. 3»-

1 9 J 5 • § 3l Medical Personnel

on service. The upward movement of population per
general practitioner remaining, noted in connection
with column 8 of Table IV., is continued in column 8
of Table VII. For Scotland generally the figure has
ascended from 2576 to 2892. The number of Divisions
above 3000 has advanced from 5 to 8. Of the 22
Divisions all but 3 reveal an increase of the ratio.

TABLE VI

CLASSIFICATION OF SCOTTISH CIVILIAN PRACTITIONERS ON
MILITARY SERVICE AT 31 DECEMBER 1915

Total by

Re-

Table I.

Service.

maining.

Private Practitioners

376

132

244

Insurance Practitioners .

1796

394

1402

Consultants ....

248

107

141

Whole-time officials

5*4

146

368

Dental and retired Practitioners

269

229

Unestablished Practitioners

619

471

148

TOTAL ....

3822

1290

2532

On a review of Tables VI. and VII. together, as
depicting the position at the end of 1915, it is observed
that one-third of the medical personnel of Scotland
was at this time on service with His Majesty's Forces.
The Aberdeen Division had contributed one half of its
strength. In certain towns within Divisions the
population per general practitioner was notably above
the Divisional average.

56 Mustering of Medical Service in Scotland

TABLE VII

DISTRIBUTION OF SCOTTISH CIVILIAN PRACTITIONERS ON MILITARY
SERVICE AT 31 DECEMBER 1915

MEDICAL PERSONNEL.

DIVISION.

Total by
Table II.

On Service.

Remaining.

Population
per G.P.
Remaining

(Col. 6).

G.P.

Others.

G.P.

Others.

G.P.

Others.

Aberdeen

161

125

107

3301

Argyll ....

1688

Ayr. ....

I32

2333

Banff, Elgin and Nairn .

2238

Caithness and Sutherland

2747

Dumbarton . .

3168

Dumfries and Galloway .

2310

Dundee ....

IOI

35»8

Edinburgh and Leith

232

473

213

169

260

2372

Fife ....

377 1

Glasgow

46,

395

127

174

334

221

3019

Inverness

24U

Islands ....

2893

Lanark ....

162

122

39*5

Lothians ....

3030

Orkney ....

i523

Perth ....

3188

Renfrew and Bute .

138

1 08

2752

Ross and Cromarty

»7

2801

South Eastern
Stirling ....

58
92

24
35

10
20

48
72

2431
2773

Zetland ....

...

2791

TOTAL .

2172

1650

526

764

1646

886

2892

GRAND TOTAL .

3822"

1290

2532

' §3l Episodes 57

Close of 1915

The record of 1915 may conclude with two personal
episodes of the year which illustrate the manner in
which the endeavours of the Committee were (i) cheer-
fully aided, and (2) as cheerfully outpaced, by the zeal
of the profession.

1. A practitioner, after a busy career in a Scottish
industrial valley, had retired at the age of seventy-two
to the quiet of his native village in a south-western
mainland county. In this pastoral setting he was
encountered by a member1 of the Emergency Com-
mittee in the course of an official interview which had
no connection with warfare. The practitioner, how-
ever, introduced the subject of the demand for doctors
and asked what he could do to help. It was suggested
to him that, if he felt physically fit, he might free some
young officer for the army by taking a vacant civil
appointment. He hastened to Edinburgh, offered him-
self, was accepted by the Convener2 and so

Forth out to Jura — Jura pictured high,
With lofty peaks against the western sky,
Jura that far o'erlooks the Atlantic seas,
The loftiest of the Southern Hebrides.

On this rugged island, 28 miles in length, he carried
on single-handed practice for close on four years.

2. A practitioner, who had determined to make sure
of his commission without risking the veto of the
Committee, proceeded from the West of Scotland direct
to Whitehall and offered his services to the Army.
Splendide mendax^ he described himself as a Works
Doctor, thus veiling the circumstance that he was
engaged in strenuous general practice in an important

1 Dr. John C. M'Vail. 2 Dr. Norman Walker.

58 Mustering of Medical Service in Scotland

Burgh. His age was thirty and his merit obvious.
He received his commission and was instructed to
prepare for duty forthwith. The Emergency Committee
however, which was not unwatchful, addressed an
enquiry to the War Office and, as a result — though not
by the Committee's request — the Officer's appointment
was suspended for further consideration. A member
of the Committee visited the town and examined into
the facts. On the one hand, the Officer had procured
his outfit, wound up his affairs and been the subject of
valedictory encomia in the Press. On the other hand
the Burgh had already provided four medical officers,
and the ratio of population per general practitioner,
which was normally 3500, had risen to over 5000.
But the local profession gave a cordial undertaking
so to arrange their work in the district that the
standards of medical attendance should be maintained,
and the Committee decided under these circumstances
that it would state no objection to the Officer's
employment.

CHAPTER V
1916. § i

1916 Scheme : Inauguration — Central Control — Local Consultation
— 1916 Scheme : Procedure. — Letter of Excuse : Tribunal for
Medical Purposes. — 1916 Scheme : Offers of Service. — 1916
Scheme : General Call. — Medical Strength : 7 June 1916. —
Medical Distribution : 7 June 1916. — 1916 Scheme :
Conclusion.

1916 Scheme: Inauguration

THE 1916 Recruiting* Scheme, announced in the Com-
mittee's Sixth Memorandum,1 came into effect as at
i January 1916 and continued in being for close upon
six months. It began as a medical branch of Lord
Derby's Scheme, by canvassing practitioners for a
voluntary undertaking to serve in the Army if called on,
and proceeded thereafter to speed the commissioning of
those by whom the promise had been given : but the
passing of the two Military Service Acts of the year
modified the working of the later stages of the Scheme
for practitioners of military age.

The object of the Scheme was the equipment of the
Army with medical officers under Groups A and B of
the Sixth Memorandum. Its principle where possible
was equality of sacrifice between individuals and areas.
Its administrative plan was central control combined
with local consultation.

1 P. 52.

60 Mustering of Medical Service in Scotland

Central control, as in the 1915 Scheme, was in the
hands of the Committee itself, which remained the co-
ordinating authority. The Committee was kept advised,
by direct communication from the War Office, of the
state and requirements of the Army. The medical War
Register, supplying the facts as to the number of
practitioners on service, enabled the Committee to esti-
mate what further contingent of medical men could be
freed in any town or district. The Register served the
additional purpose of acquainting the Committee which
practitioners were willing to serve, according to their
age, either as officers in the Army or as locum tenentes
for absent officers. For the assistance afforded by
Local Consultation the Committee relied on its local
War Committees, which continued in office.

The calls for applicants for commissions addressed
by the Committee to areas were usually covered, or
more than covered, by registered offers of service.
Under these conditions a choice had to be made
between rival candidates. The terms of service inti-
mated to the Committee by the War Office on
3 September 1915 were still in force. Practitioners
under 45 years of age (Group A of Registration Form)
were required to undertake overseas obligations :
practitioners between 45 and 55 (Group B of Registra-
tion Form) were eligible for home service. Practi-
tioners in the younger group were more valuable to the
army and were preferred by the Committee in deciding
claims otherwise of equal merit.

1916 Scheme : Procedure

A prospective applicant under the Scheme received
from the Secretary of his local War Committee the
appropriate Army application form ; and the Secretary,

1916. § i] Letter of Excuse 61

on the return of the form, transmitted it, if duly filled
in, to the Emergency Committee along1 with a covering
letter, Form K.1 Owing to the condition 2 attached to
offers of service made on registration forms, that
practitioners would be enabled to make arrangements
for having their work carried on in their absence,
Form K was so devised as to contain a statement by
the Secretary of the local War Committee of the
arrangements proposed to be made, and an expression
of opinion on behalf of his Committee that these
arrangements were satisfactory. The medical ex-
amination of candidates was conducted by the nearest
Recruiting Board. Other relevant procedure was like
that pursued under the 1915 Scheme.

Services proffered by practitioners, other than whole-
time service with the Army, such as part-time military
service at home or whole-time or part-time civil work
at the practitioner's home or elsewhere, were intimated
to the Committee by the Secretary of the local War
Committee on Form M, which, in the event of the
proffered service entailing absence from home, required
a statement of the substitutionary arrangements and an
expression of opinion on their completeness.

Letter of Excuse

A practitioner who had entered his name on a Regis-
tration Form as willing to serve if arrangements could
be made to free him might nevertheless have genuine
doubt whether such arrangements were practicable,
whether, if made, they were likely to be adequate, and
whether therefore it was in the public interest that he
should be withdrawn from his post or district. A
practitioner so bestead, who was desirous of having
1 Appendix VII. 2 P. 53.

62 Mustering of Medical Service in Scotland

his duty settled for him, was at liberty to submit his
case to the Emergency Committee as a Tribunal for
Medical Purposes ; and similar action might be taken
with respect to him, either with or without his concur-
rence, by any body, institution or group of persons
which claimed to have an interest or concern in the
continuance of his civil work.

The tribunician functions of the Committee at this
time were not, as later, statutory. They were exercised
in terms of the War Office letter J to which reference
has been made. The Committee appointed the President
of the Royal College of Physicians, Edinburgh ; the
President of the Royal College of Surgeons, Edin-
burgh ; the President of the Royal Faculty of Physicians
and Surgeons, Glasgow ; the Deans of the Faculties
of Medicine of the Universities of St. Andrews,
Aberdeen, Edinburgh and Glasgow ; and the Chairman
of the Scottish Committee of the British Medical
Association, together with the Convener, to investigate
claims submitted and report. The Committee's decision
that a practitioner, for reasons advanced, should not be
called on to undertake military duty was conveyed in a
Letter of Excuse.2

According to the procedure laid down for the pur-
pose by the Committee, a practitioner, or a person on
his behalf, desiring a Letter of Excuse was furnished
with Form Q (application for Letter of Excuse) by
means of which all applications were required to be
made. Applicants were reminded that questions of
physical fitness or unfitness would not be considered
by the Committee — which had already declared, as
above 3 recorded, that such questions could only be
decided by an officer of the Royal Army Medical Corps
after an application for a commission. Form Q, if
1 P. 51. 3 Appendix VIII. » P. 40.

I9i6. § i]

Letter of Excuse

duly filled in and returned, notified the Committee of
the practitioner's circumstances and of the grounds of
application by or for him, and might be accompanied,
if desired, by documents in support. The Committee,
if it thought fit, submitted the facts as alleged by the
applicant, and his contentions, for the observations,
in writing or otherwise, of persons considered com-
petent to advise it. A hearing, if deemed requisite,
was then given, and the Committee proceeded to a
finding. A Letter of Excuse, if decided to be issued,
was made valid for a stated period, not exceeding six
months. If the Committee decided not to issue a
Letter of Excuse it informed the applicant accordingly.
The Committee received in all 38 applications for
Letters of Excuse, the first on 25 January 1916 and the
last on 15 February 1916. Of the 38 applications most
were by Local Authorities or Boards of Managers of
Institutions, endeavouring to retain the services of a
medical officer : only a minority were by general
practitioners claiming on their own behalf. The figures
are shown hereunder.

Applicants.

Number
of Cases.

Universities

Town Councils

County Council

Parish Councils

Infirmaries

Asylums .

Other institutions

General practitioners for assistant or locum tenens
General practitioners on own behalf

TOTAL .....

64 Mustering of Medical Service in Scotland

Of the 38 applications, 33 were granted, 4 were refused
and i was withdrawn. The civil work of the practitioners
concerned, and the fate of applications, are set out.

•

||
<$

o
H

University teachers
Medical Officers of Fever Hospitals
Medical Officers of Health
Medical Officers of Parishes .
Medical Officers of Poor Law

2
2

...

6
7

2
2

Medical Officers of Infirmaries
Medical Officers of Asylums .
Medical Officers of other Institu-
tions ......
General Practitioners

2
IO

Total .

The Letter of Excuse, during its currency, protected
its holder against calls to service by the Emergency
Committee itself, and enabled him to answer any
uninformed local criticism of his persistence in a civil
station. It was introduced to meet a transitory phase
of the medical recruiting movement. Having served
its purpose, it was allowed to lapse.

1916 Scheme : Offers of Service

By 15 January 1916, as announced at a meeting of
the Committee at which the President 1 of the General
Medical Council and the Medical Secretary2 of the
British Medical Association were present, 75 per
cent, of the medical men in Scotland had returned
forms under the Scheme. The offers of service, both
1 Sir Donald MacAlister. • Dr Alfred Cox.

1916. § i] Offers of Service

whole-time and part-time, proved the general good-
will of the profession : but many practitioners who
had offered were in single-practice areas or else in
districts or towns too far denuded to justify further
demands at this stage of the war. Exceptional places
there were whose practitioners had not hearkened to
the charming of the Committee, or at least had made no
responsive movement. The Committee gave these Un-
registered Practitioners another opportunity, by issuing
on i February 1916 its Seventh Memorandum in which it
pressed them to send in their names as ready to undertake
service. The Seventh Memorandum was productive.

The offers of whole-time military service under the
1916 Scheme received on the Committee's Registration
Forms up to 12 February 1916 are recorded in Table
VIII., column 2 of which is a condensation of column 4
of Table VI.,1 and in Table IX., column 2 of which is a
reproduction of column 8 of Table VII.2 Offers of part-
time military service and of civilian service are not included
in the Tables.

TABLE VIII

OFFERS AS AT 12 FEBRUARY 1916 OF SCOTTISH CIVILIAN PRAC-
TITIONERS TO UNDERTAKE WHOLE-TIME MILITARY SERVICE

UNDER 1916 SCHEME OF EMERGENCY COMMITTEE

Number
Remaining at
31 December 1915.

Offers of
Whole-time
Military Service.

General Practitioners

1646

346

Other Practitioners

886

118

Total

2532

464

1 p. 55.

2 p. 56.

66 Mustering of Medical Service in Scotland

TABLE IX

DISTRIBUTION OF OFFERS AS AT 12 FEBRUARY 1916 OF SCOT-
TISH CIVILIAN PRACTITIONERS TO UNDERTAKE WHOLE-TIME
MILITARY SERVICE UNDER 1916 SCHEME OF EMERGENCY
COMMITTEE

Population
per General

OFFERS OF WHOLE-TIME
MILITARY SERVICE.

Practitioner re-

DIVISION.

maining at
31 December
1915.

General
Prac-

Other
Prac-

titioners.

Aberdeen

33° i

Argyll ....

1688

Ayr ....

2333

Banff, Elgin and Nairn .
Caithness and Sutherland

2238
2747

Dumbarton

3168

Dumfries and Galloway
Dundee ....

2310

20
29

Edinburgh and Leith

2372

Fife ....

377 *

3°

Glasgow

3019

Inverness

24*3

Islands ....

2893

Lanark ....

Lothians

3030

Orkney ....

1523

Perth ....

3188

Renfrew and Bute .

2752

»7

Ross and Cromarty

2801

...

South Eastern

2431

Stirling ....

2773

Zetland ....

2791

...

TOTAL .

2892

346

118

464

1916. § i] Offers of Service 67

Table VIII. exhibits that of 2352 practitioners
remaining in Scotland at 31 December 1915, 464 had
by 12 February 1916 made voluntary offers of whole-
time military service. Table IX. reveals that of the
divisions Glasgow sent in a total of 70 names and
Edinburgh and Leith 61. Among General Practitioners
the largest proportionate offers were those of Fife and
Perth, in both of which more than one-third of the
general practitioners remaining gave the promise.
From other divisions also, including those whose
medical strength was already much reduced, substantial
numbers came forward. No division is unrepresented
in the General Practitioner column.

1916 Scheme : General Call

In March 1916 the Committee warned local War
Committees of a General Call of 100 Scottish practi-
tioners. The Committee's War Register disclosed
that in the Burghs of Aberdeen, Dundee, Falkirk,
Greenock and Clydebank there were now over 4000
persons per general practitioner, and in Kilmarnock,
Dumbarton, Dunfermline, Coatbridge, Hamilton and
Motherwell, over 3500. On general practitioners in
these towns, and in the divisions of Argyll, Islands,
Orkney, Ross and Cromarty, and Zetland, the Com-
mittee at this time made no claim. With regard to
demands on general practitioners as a class, the
Committee by its Convener wrote to Secretaries of
War Committees in the following terms :

While it may not be practicable for your Committee to furnish a
further quota of applicants for commissions without including a
certain number of general practitioners, I am to urge that,
wherever available, young graduates and other unattached
medical men should be called on for service first, and that general

68 Mustering of Medical Service in Scotland

practitioners, whether in insured or private practice, should only
be asked to serve after the foregoing class has been fully drawn
upon.

The Committee had proposed that the 100 practi-
tioners of the General Call should be drafted in May
1916 ; but on pressing representations from the War
Office it began to claim them sooner. The pace, how-
ever, with the best intentions of all concerned, was
slower than in 1915, as the finding of means to fill
vacancies was becoming more difficult.

Medical Strength : 7 June 1916

The resulting position was tested by the Committee
as at 7 June 1916. The figures are summarized in
Tables X. and XI., of which Table X. relates to the
classification of Scottish civilian practitioners on service
under the two groups General and Other Practitioners.

TABLE X

CLASSIFICATION OF SCOTTISH CIVILIAN PRACTITIONERS ON
MILITARY SERVICE AT 7 JUNE 1916

Total by
Table I.

On Service.

Remaining.

General Practitioners

2172

563

1609

Other Practitioners .

1650

878

772

TOTAL .

3822

1441

2381

Table X., dated 7 June 1916, records 1441 practi-
tioners on service, an addition of 151 to the figure of

1916. § i] Medical Personnel

TABLE XI

DISTRIBUTION OF SCOTTISH CIVILIAN PRACTITIONERS ON
MILITARY SERVICE AT 7 JUNE 1916

MEDICAL PERSONNEL.

Division.

Total by
Table II.

On Service.

Remaining.

Population
per G.P.
Remaining

(Col. 6).

G.P.

Others.

G.P.

Others

G.P.

Others.

Aberdeen

161

104

3396

Argyll ....
Ayr ....

52
132

10
17

6
30

42
"5

2333

Banff, Elgin and Nairn .

2238

Caithness and Sutherland

2899

Dumbarton

3168

Dumfries and Galloway .

2347

Dundee ....
Edinburgh and Leith

IOI

232

77
473

24
60

43
229

77
172

34
244

3655
2330

Fife ....
Glasgow

99
461

62
395

28
I44

26
203

3i7

36
192

3771

Inverness

2528

Islands ....

2893

Lanark ....
Lothians

162
96

42
21

65
20

1 2O

3980
3070

Orkney ....

...

1523

Perth ....
Renfrew and Bute .

24
52

15
35

105

9
17

3272
2831

Ross and Cromarty .
South Eastern
Stirling ....

H
44

10
12
26

2801
2652
2852

Zetland ....

3101

TOTAL .

172

1650

563

878

1609

772

2959

GRAND TOTAL .

3822

1441

2381

70 Mustering of Medical Service in Scotland

Table VI.1, dated 31 December 1915. Of the total
1441, 563 were General Practitioners and 878 in the
remaining classes.

Medical Distribution : 7 June 1916

Table XI. relates to the distribution of practitioners
among Divisions. Collated with Table VII.2 it shows
that the increase during the period was mainly drawn
from the Other Practitioner group. The population
per general practitioner of Table XI. continues on the
whole the ascent of Table VII., but at a diminished
rate. By the departure of one more general practitioner
from Zetland the number of divisions with over 3000
persons per general practitioner was raised to nine.

1916 Scheme : Conclusion

To the sum of practitioners on service by Tables X.
and XI., there fell to be added 100 Scottish graduates
and licentiates who had passed to the Naval or Military
Forces of the Crown direct from their medical schools,
and whose names therefore had not at this time been
recorded in the Committee's Register. There were
besides in the Committee's hands, at the date of the
Tables, 95 applications for commissions by practi-
tioners, 19 of which were by general practitioners and
76 by others. These were transmitted in due course.
The Committee closed its Register to practitioners of
military age under the Military Service Acts8 1916, and
intimated to the War Office the names of the Un-
registered Practitioners of military age, less than
4 per cent, of the total. The 1916 Scheme, begun on
i January, was brought to a conclusion on 23 June 1916.
1 P. 55. » P. 56. » Pp. 75 and 80.

CHAPTER VI
1916. § 2

Concurrent Events : White Paper.— Compulsory Service.— War
Register and Attestation : Transitional Period — Certificate
of Registration — Recruiting Authority — War Office — A.C.I.
No. 148 of 1916 — Attestation. — Military Service Act 1916,:
A.C.I. No. 475 of 1916— Certificate of Registration. — A.C.I.
No. 485 of 1916: War Register— War Office— Further Com-
pulsory Service. — Military Service Act, 1916 (Session 2) :
Medical Feature. — Special Position of Profession. — Question
of Control : Conference. — Medical Control Established : Section
7. — Professional Committees Regulations, — Central Professional
Committee for Scotland.

Concurrent Events

THE 1916 scheme, in respect that its methods were
more rigorous at the close than at the outset, kept pace
with the system of lay recruiting, which had between
January and June 1916 undergone momentous changes.
Compulsory military service had been made the law of
Great Britain. Medical and lay recruiting, which from
the introduction of Lord Derby's Scheme had begun to
interlace at their edges, became under the Military
Service Acts completely fused in principle, so that the
same obligation as bound the layman rested on the
medical practitioner. The way by which these things
came, and the measures adopted, as the situation de-
veloped, to turn the special aptitudes of the profession
to the best national uses will be passed in review. The

7»

72 Mustering of Medical Service in Scotland

period to be dealt with coincides with the duration of
the Committee's 1916 Scheme.

On 4 January 1916 — to which date the narrative
must now turn back — there was issued as a White
Paper a Report by the Director-General 1 of Recruiting
on the results attained by his canvassers. The Report
showed that in 1915 between n October and 19 Decem-
ber 2,950,514 men had come forward and enlisted or
attested under Lord Derby's Scheme. The rejections
on medical grounds were already close on half a million.
Further, it was estimated that over half a million single
unstarred men in Great Britain had not responded to
the canvass.

Compulsory Service

These results, although numerically high, were con-
siderably below the claims of the hour. The purely
voluntary system could go no further. Steps were
taken to supplement it. On 5 January 1916 a Bill was
introduced in Parlament providing for compulsory mili-
tary service by single men of military age. By the
Royal Assent of 27 January it became the Military
Service Act 1916.2 Pending the appointed date of the
Act, which was 2 March 1916, attestation under groups
continued.

War Register and Attestation

During the transitional period up to and including
i March 1916 the position of unmarried medical practi-
tioners, of military age under the Act, was one of some
uncertainty. Those who had sent in their names for
entry in the Committee's War Register would, when
1 The Earl of Derby. f P. 75.

1916. §2] War Register 73

compulsory service came, be under the general bond
like eligible laymen : on the other hand, unlike eligible
laymen, they had by registering with the Committee
given an undertaking to accept a medical commission,
if called upon. Should they attest, to anticipate their
impending liability, or be content with the responsi-
bilities which they had already assumed ? The answer
hinged on the degree of recognition accorded by the
Recruiting Authority and the War Office respectively to
the Committee's War Register.

It should be noted that the Committee issued to the
practitioner of military age, as evidence of his registra-
tion, a Certificate of Registration,1 showing his willing-
ness to accept a commission in the Royal Army Medical
Corps if and when called upon to do so.

The Committee's undertaking to compile a War
Register, based on a canvass of the profession, had
excluded medical men from the normal operation of
the lay Recruiting Authority under Lord Derby's
Scheme. The Director General of Recruiting had in-
structed his agents that the medical profession was
to be exempt from their canvass. Any practitioner
who happened to be canvassed in error was requested
by the Committee's Sixth Memorandum to report the
circumstance to the Committee, which at once adjusted
with the Local Recruiting Authority of the area any
difficulty which had arisen. All practitioners, whether
registered with the Committee or not, were safeguarded,
so far as the Director General of Recruiting was con-
cerned, by the existence of the Committee's Register.

The disposition of the War Office to wards the Register

at this time is indicated by an official communication of

12 January 1916. The communication, as modified by

letter to the Convener of the Emergency Committee

1 Appendix IX.

74 Mustering of Medical Service in Scotland

from the Assistant Director General,1 Army Medical
Services, conveyed that every Scottish practitioner who
had attested and registered with the Emergency Com-
mittee should, when called upon, produce to the recruit-
ing officer his certificate of registration. He would then
not be posted to a combatant unit but would await
instructions from the Emergency Committee. The
communication declared also that no qualified medical
practitioner who was willing to accept, if offered, a
commission in the Royal Army Medical Corps should
be accepted as an ordinary combatant. Thus the Army
Council, according to the official communication, recog-
nized the efficacy of registration with the Committee
when combined with attestation.

The case of the attested practitioner was further
covered by Arniy Council Instruction No. 148 of 1916,
dated 19 January 1916, which directed that no qualified
medical practitioner who had been attested under the
group system was to be called up for service with the
Colours. If he had been called up for military service
under his group, he was to be sent back to his home,
and was to continue in the Reserve unless selected for
a Commission in the Royal Army Medical Corps.
Army Council Instruction No. 148 of 1916, made no
reference to the Committee's Register.

During the earlier part of the transitional period the
Committee had taken the view, which was shared by
the Central Medical War Committee in England and
provisionally acquiesced in by the War Office, that
registration in the Committee's register was equivalent
to Attestation, that practitioners of military age so
registered were due to be dealt with as if attested, and
that therefore they did not need to attest. As the
appointed date of the Military Service Act 1916
1 Lt.-Col. A. P. Blenkinsop.

1916. § 2] Military Service Act 1916 75

approached, however, the War Office reviewed the
position, and informed the Committee that it had
decided that medical men of military age should attest
in the usual way. Since most Scottish practitioners,
under the arrangement between the Director General of
Recruiting and the Committee, had not been asked to
attest, while others, being asked to attest and consult-
ing the Committee, had been advised to refrain from
attesting, the Convener inserted in the Scotsman news-
paper of 23 February 1916 a letter for the guidance of
the profession, to the effect that, while there were
some points still to be settled regarding the position of
medical men under the Military Service Act, all medical
men under the age of 41 must attest.

The closing words of the Convener's Letter were the
answer to the question x stated above with regard to the
position of single medical men of military age during the
transitional period which terminated on i March 1916.

Military Service Act 1916

As from 2 March 1916, under the Military Service
Act 1916, every British male subject ordinarily resi-
dent in Great Britain, and between the ages of 18
and 40 inclusive on 15 August 1915, who was un-
married, or a widower without a child dependent, on
2 November 1915 was, subject to scheduled excep-
tions, unless he had attained the age of 41 before
2 March 1916, deemed to have been duly enlisted in
His Majesty's regular forces for general service with
the colours or in the reserve for the period of the war,
and to have been forthwith transferred to the reserve.

The men affected were under the Army Act with a stated excep-
tion, and the Reserve Forces Acts 1882 to 1907, but while in the

1 P. 73-

76 Mustering of Medical Service in Scotland

Reserve were not liable to the death penalty for failure to obey a
call to the Colours.

The Act had provided for Local Tribunals in Local Registration
Districts, similar to the Local Tribunals under Lord Derby's
Scheme, for Appeal Tribunals and for a Central Tribunal. Appli-
cations for exemption on the ground of national interest, serious
hardship, ill-health, or conscientious objection to combatant service
might be made before 2 March 1916 to Local Tribunals and
appealed to Appeal Tribunals and the Central Tribunal. A Local
Tribunal for satisfactory cause shown might allow an application
after 2 March 1916. Certificates of exemption granted by
Tribunals might be absolute, conditional or temporary.

The scheduled exceptions included Regular Soldiers, Reservists,
certain members jof the Territorial Force, men serving in the
Navy or Royal Marines, discharged disabled men, men in
holy orders, regular ministers of religious denominations and
others.

In the administration of the Act the men affected were divided
into classes corresponding to the unmarried groups of Lord
Derby's Scheme.

On 2 March 1916 the Army Council issued Instruc-
tion No. 475 which, as applied to Scotland, bore that
medical practitioners who had registered with the
Emergency Committee for service with the Army and
were in possession of a Certificate of Registration,
might be considered eligible for Army duty irrespective
of their age.

The Emergency Committee, which prior to this time
had given Certificates of Registration to practitioners
of military age only, now proceeded to furnish such
Certificates^ on application, to practitioners of 41 years
or over.

A.C.I. No. 485 Of 1916

On 3 March 1916 the Army Council issued Instruc-
tion No. 485, which brought the official communication
of 12 January 1916 up to date and cancelled Army

1916. § 2] Military Service Act 1916 77

Council Instruction No. 148 of 1916. Army Council
Instruction No. 485 reiterated the view expressed in
the official communication that no medical practitioner
who was willing to accept a medical commission should
be accepted as a combatant.

Up to and including 31 March 1916, the Instruction
proceeded, no qualified medical practitioner who had
been attested under the Group System, or who was in
one of the classes under the Military Service Act 1916,
was to be called up for service with the Colours. Any
man called up and found to be a qualified medical
practitioner was to be sent back to his home.

After 31 March 1916 any qualified medical practitioner
who was attested under the Group System or was
classed in a class under the Military Service Act 1916,
and who was registered with the Emergency Committee
or provisionally accepted by the War Office, if he re-
ceived a notice paper calling him up, was to return the
notice paper to the Recruiting Officer together with his
Certificate of Registration or War Office letter. The
notice would then be cancelled, and the practitioner
would remain in reserve until selected for a commission
in the Royal Army Medical Corps. But any practitioner
attested or classed as above, who was not registered
with the Emergency Committee, or provisionally ac-
cepted by the War Office, would be dealt with in the
ordinary course.

By the terms of Instruction No. 485 the Army Council
assigned to the Committee's War Register a definite
function in the scheme of compulsory service, recog-
nizing it as the touchstone for the separation of
practitioners into two classes, the Registered who were
destined to join the army as commissioned medical
officers, and the Unregistered who were liable to be
posted to units as laymen.

7 8 Mustering of Medical Service in Scotland

It appeared to the Committee that any practitioner
who, by omitting to register, allowed himself to become
an enlisted man was inconsiderate of the national welfare,
inasmuch as he at once deprived the Army of a medical
officer and the civil community of a practising doctor.
A practitioner, on the other hand, who registered with
the Committee was turned to full account, either in a
military or a civilian charge, as the public need might
determine. The Committee therefore continued to urge
upon practitioners the claims of its War Register, point-
ing out that a full, and if possible a complete, Register
was necessary in order that the Committee might carry
out its undertaking to organize the profession for war,
and in order that the profession, co-ordinated under
its guidance, might throw its united weight into the
national effort.

The views of the War Office on the question, as con-
cerning alike the Central Medical War Committee in
England and the Emergency Committee, were expressed
by a statement given to the press in April 1916, in which
these words occur :

It is evident that all doctors of suitable age should have offered
themselves for service quite irrespective of their particular circum-
stances, whatever these may be, so that a proper selection may be
made by a body equipped with the requisite information from all
parts of the country, and thus competent to make the necessary
comparisons. The only alternatives are haphazard recruitment
and arbitrary demand.

At a meeting of the Emergency Committee held on

8 April 1916 it was announced that in many Scottish
Divisions over 90 per cent, of the profession had
registered as willing to undertake the scheduled ser-
vices, including whole-time and part-time military and
civilian service, appropriate to their age. In one large
Division where all practitioners but 9 had already

1916. §2] Recruiting Situation 79

registered in response to the Committee's memoranda,
the Divisional Secretary brought in 5 of the 9, leaving
only 4 unregistered, of whom 2 were over 60. In
another Division every practitioner under 45 either
held a commission or had declared his readiness to
take one.

Further Compulsory Service

Scottish Medical recruiting was thus proceeding in
harmony, but on the lay side in both Scotland and
England there were certain audible discords. Married
men who had attested under Lord Derby's Scheme had
done so on the understanding that they would not be
called to the colours while single men remained un-
attested. This condition was in form complied with
by the Military Service Act 1916, which placed single
men in the reserve of the forces ; but in fact a number
of single men, by means of the exemption procedure of
the Act, had found sanctuary in civil occupations, and
the attested married men were so resentful that their
calling-up had to be deferred.

The military position, however, did not brook much
delay. It was true that apart from the righting on
the Tigris for the relief of Kut, the theatres of war
during the early months of 1916 had been comparatively
quiescent: but the armies on the Western front were
now making ready for the Somme offensive, to open on
i July, and the output of the Military Service Act 1916
was regarded as below their actual and prospective
requirements.

It was therefore decided that the duty of military
service, up to this time selective, should be extended
under statute to all men of military age.

8o Mustering of Medical Service in Scotland

Military Service Act 1916 (Session 2)

The Military Service Act 1916 (Session 2) received
the Royal Assent on 25 May 1916. Its appointed date
was 24 June 1916, as from which every British male
subject who at any time since 14 August 1915 or for
the time being was ordinarily resident in Great Britain,
and who for the time being was between the ages of 18
and 40 inclusive, unless he had attained the age of 41
before the appointed date, and subject to exceptions,
was deemed to have been duly enlisted for the period
of the war and to have been forthwith transferred to
the reserve. Provision was made to prevent as far as
possible the sending of men to serve abroad before they
attained the age of 19.

The provisions of the principal Act, as far as applic-
able, continued in operation, and other new provisions
were made. The principal Act and the Act might be
cited together as the Military Service Acts 1916.
Pending the appointed date of the Act attestation under
groups was permitted.

The Medical Feature of the Military Service Act
1916 (Session 2) was its Seventh Section, which pro-
vided that claims for exemption by medical men
should be dealt with by Committees of medical men.
The establishment of Committees so composed,
especially at a time of intense public feeling, may be
described as somewhat remarkable : and the circum-
stances which are believed to have inspired the section
and secured it a place in the Act are worthy of being
recorded.

Special Position of Profession

The Emergency Committee — together with the
Central Medical War Committee in England — in the

1916. § 2] Military Service Act 1916 (S. 2) 81

handling of medical recruiting, had been guided by
the view, which it had held from the first, that the
medical profession under war conditions had a twofold
duty to the country. Medical men in civil practice
were urgently demanded by the Fighting Forces, and
military claims had a clear priority to which civil
practice must yield. Civil practice, however, was an
essential service also, and could not be indefinitely
curtailed. The twofold duty of the profession was
first to man the Army with medical officers, and second
to keep civil practice in being. This twofold duty
placed the profession in a special position.

Civil medical practice in a number of Scottish
districts had already become far depleted. The
Emergency Committee in March 1916, when agreeing
to comply with the urgent request x of the War Office
to hasten the drafts then warned for service, had felt
it necessary to express the opinion that " future appeals
for more practitioners would require to be most
seriously considered in connection with the needs of
civil practice." A large proportion of the Scottish
practitioners of military age now remaining in civil
life were indispensable in the places where they were,
and could only be freed for the Army by the provision
of adequate substitutes. The special position of the
profession was thrown into high relief. Further,
recruiting under such conditions must involve precise
adjustment between civil and military claims, and any
persons placed in charge of the work, especially under
the compulsory powers of a Military Service Act,
would require to possess a knowledge of the conditions
of medical practice, sufficiently detailed to ensure that
no area was inadvertently denuded of practitioners,
and sufficiently extensive to furnish a standard for

^.68.
6

82 Mustering of Medical Service in Scotland

comparing area with area and preventing extreme
disproportion of sacrifice.

Question of Control

The point for consideration by the Government was
whether the lay Tribunals of the principal Military
Service Act possessed, or could acquire, the knowledge
above referred to, or whether it would be expedient
under the Bill of Session 2 to provide for medical
authorities. The question was open, but it was
understood that the Government inclined towards the
laity.

With a view to his information before arriving at a
decision, the President1 of the English Local Govern-
ment Board invited a Conference^ which met with him
at Whitehall on 29 May 1916. There were present
among others, the President z of the General Medical
Council, the Adjutant General,3 the Director General 4
of Army Medical Services, the Chairman5 of the
English Insurance Commission, the Principal Medical
Officer6 of the English Local Government Board, the
Chairman 7 of the Central Medical War Committee
and the Convener8 of the Scottish Medical Service
Emergency Committee.

The President2 of the General Medical Council
stated the case for the establishment of medical
authorities. Medical Committees already existed.
They had an organization. They were acquainted
with both local and general circumstances. They were

1 The Right Hon. Walter Long. a Sir Donald MacAlister.

• Sir C. F. N. Macready. 4 Sir Alfred Keogh.

• Sir Robert Morant. • Sir Arthur Newsholme.
7 Dr. T. Jenner Verrall. ' Dr. Norman Walker.

1916. § 2] Military Service Act 1916 (S. 2) 83

representative of the profession and enjoyed its con-
fidence. Their work in equipping the Army with
medical officers was highly valued by the War Office.
The medical position was quite exceptional, but the
Committees had shown their fitness to control it and
were worthy of further trust.

The Convener * of the Scottish Emergency Com-
mittee explained the situation in Scotland. The great
majority of the profession had undertaken services
appropriate to their age under the Committee's guid-
ance. The Committee's War Register was well filled
up. It contained the names of over 96 per cent, of
Scottish practitioners of military age. The Committee
had regulated Scottish medical recruiting in the past
and was able and willing to continue.

Medical Control Established

These and similar statements made at the Conference
were the means of convincing the Government, and
victory, which had hovered on the side of the laity, came
over to the profession. A clause was inserted in the
Bill of Session 2 to set up Professional Committees for
dealing with claims of practitioners. Their decisions
were to be binding on all concerned without the right
of appeal. This wide discretion proposed to be con-
ferred was queried in the House of Commons, but the
answer was given that if a special tribunal was ap-
pointed ad hoc there could be no appeal from it to
another body which had general powers and was
appointed to deal with general cases. The clause was
carried and became Section 7 of the Act.

Section 7 of the Military Service Act 1916 (Session
2) was in the following terms :

1 Dr. Norman Walker.

84 Mustering of Medical Service in Scotland

Regulations made under the Second Schedule * to the principal
Act shall provide for the establishment of professional committees
to deal with claims for exemption made by duly qualified medical
practitioners ; and any application made by such a medical
practitioner on any ground, other than that of conscientious
objection, for a certificate of exemption, shall be referred by the
tribunal to whom it is made to such a committee in accordance
with those regulations ; and the recommendation of the committee
on the application shall be binding on any tribunal constituted
under the principal Act.

On i June 1916 His Majesty by Order in Council,
entitled the Military Service (Professional Committees
Regulations) Order 1916, made Regulations for pro-
fessional committees in respect of medical practitioners
under the Military Service Acts 1916. The Professional
Committees Regulations prescribed for Scotland a
Central Professional Committee, and for England and
Wales a Central Professional Committee and a Com-
mittee of Reference.

The Central Professional Committee for Scotland was to consist
of not less than twelve nor more than twenty-five members,
appointed by members of the medical profession in such manner
as the Army Council might approve, and representative of the
profession, to which all applications for certificates of exemption
made to a tribunal in Scotland, by or in respect of practitioners on
any ground other than that of conscientious objection, should be
referred by the tribunal to which such applications were made.

The regulations prescribed further that if the Army Council
were satisfied that any existing Professional Committee which
had been recognised by them for the purpose of making arrange-
ments for the selection of practitioners for service during the war
in the Naval and Military Forces of the Crown had been appointed
by members of the profession and was representative of the
profession, they might if they thought fit, and subject to such
conditions as they might impose, approve such Committee for the
purpose aforesaid, and in that case the Professional Committee so
approved should be the Central Professional Committee.

1 Relating to constitution of Tribunals.

1916. § 2] Military Service Act 1916 (S. 2) 85

Central Professional Committee for Scotland

The members of the Scottish Medical Service
Emergency Committee, to which the Vice-Dean * of the
Faculty of Advocates of Edinburgh had been added
as Legal Assessor, were, on 15 June 1916, approved
by the Army Council in terms of the Professional
Committees Regulations, and so became the Central
Professional Committee for Scotland. So approved,
the Committee, though not at this time itself a Tribunal,
had for practical purposes the powers of a Tribunal,
inasmuch as its recommendation on any case, as already
noted, bound the Tribunal concerned. The Regulations
empowered the appointment by a Central Professional
Committee, with the approval of the Army Council, of
such Local Professional Committees as it might think
necessary : but the Scottish Central Professional Com-
mittee, in view of its own full knowledge of local
conditions, decided that it would not appoint Local
Professional Committees in Scotland. The Convener2
of the Scottish Medical Service Emergency Committee
was elected Chairman of the Scottish Central Pro-
fessional Committee.

The Review of Concurrent Events is completed.

1 Sheriff J. A. Fleming. 2 Dr. Norman Walker.

CHAPTER VII
1916. §3

Dual System : Inauguration. — Dual System : Categories of
Practitioners. — Dual System : Procedure. — Exemptions :
1916. — Occurrences : Recent Graduates — Suspension of Twelve
Months Contract — Draft of Medical Officers. — Medical Mobili-
zation.— Scottish Opinion : Emergency Committee — R.C.P.E.
—R.C.S.E.— Scottish Committee.— Political Change : Depart-
ment of National Service. — Action by Emergency Committee.
—Close of 1916.

Dual System : Inauguration

ON 24 June 1916, on the termination of the Committee's
1916 Scheme, the powers of the Committee as the
Central Professional Committee for Scotland came into
full operation. Since the statutory charge was super-
imposed on the voluntary recruiting which the Com-
mittee was still to carry on, the Committee had now
a dual function. Alike in its voluntary and in its
statutory capacity it had to condescend on the details
of individual cases, claiming for the Army every
practitioner who could be freed from civil work with-
out disaster to his area, and requiring that when any
practitioner returned from a term of military duty his
place as an officer should, if circumstances permitted,
be filled by a colleague from his district.

1916. § 3] Military Service Acts 19 1 6 87

Dual System : Categories of Practitioners

Under the Committee's twofold range of duty medical
practitioners fell into three categories :

A. Practitioners under 41 who had registered with the
Emergency Committee.

B. Practitioners under 41 who had not registered with the
Emergency Committee.

C. Practitioners over 41.

These age limits signified, in the case of a married
practitioner, that he was under or over 41 on 24 June
1916, and, in the case of a single practitioner, that he
was under or over 41 on 2 March 1916.

The courses open to practitioners were explained in
an Official Memorandum,1 issued by the War Office, to
be for each category substantially as follows :

A. Practitioners under 41 who had registered

A practitioner under 41, who had registered with the Emergency
Committee, was under Army Council Instruction 485 not called
up by the Military Authority for combatant service if, and so long
as, he was registered and undertook to serve and, if required,
served as a commissioned officer in the R.A.M.C., whenever this
might be found necessary in his particular case.

A practitioner registered with the Committee did not require to
make any application to a Local Tribunal for exemption, for the
reason that the summons to compulsory service, against which
alone he would have any occasion to appeal to a Local Tribunal,
did not reach him. He had no concern with any Local Tribunal
nor any Local Tribunal with him. If he was called up inadver-
tently by the Military Authority, all he required to do was to send
at once to that Military Authority a certified copy of his Certificate
of Registration, and the Military Authority then, in accordance

1 The National Organization of the Medical Profession in rela-
tion to the needs of H. M. Forces and of the civil population and
to the Military Service Acts. (War Office, 7 June 1916.)

88 Mustering of Medical Service in Scotland

with Army Council Instruction 485, cancelled the notice, and he
remained in reserve unless and until selected for a commission in
the R.A.M.C.

When selected by the Committee for a commission, he received
an opportunity, if he felt justified in claiming to be left in his civil
practice, of sending full particulars of his case ; and in due course
the Committee, after hearing him if he so desired, made a final
decision.

If it was decided that he was not to be taken, or not to be
taken till some specified later date, he was informed accordingly
by the Committee.

If on the other hand he was selected, he was offered by the
War Office, on the date indicated to him by the Committee, a
commission in the R.A.M.C., which he was bound to accept. In
that event his commissioned service was on that occasion for a
period not longer, unless he was willing, than twelve consecutive
months, and the terms and conditions of service were the same as
those hitherto obtaining for temporary R.A.M.C. commissions.

On his return to civil life it was necessary for him again to
register with the Emergency Committee so as to obtain the
conditional immunity conferred by Army Council Instruction 485 ;
otherwise he was liable to be called up for ordinary service by the
Military Authorities. It was clear, as regards the practitioner
under 41, that in virtue of the compulsory provisions of the
Military Service Acts, his statutory liability to military service
held good, as with other citizens, for the whole period of the war.

B. Practitioners under 41 who had not registered

A practitioner under 41 who was not registered with the
Emergency Committee was liable for ordinary combatant service
under the Military Service Acts. If on being called up he desired
exemption from ordinary service he applied to the Local Tribunal
for it : his claim, unless it was on the ground of conscientious
objection, was sent on by the Local Tribunal, under Section 7 of
the Military Service Act 1916 (Session 2), to the Emergency Com-
mittee, acting as the Central Professional Committee for Scotland,
which determined whether it was, or was not, necessary that he
should be allowed to remain in his civil practice.

If it was decided that he should so remain, whether for a time
or indefinitely, the Committee recommended exemption for such
period and subject to such conditions as they deemed suitable,

19 * 6. § 3l Military Service Acts 1916 89

and the Local Tribunal gave him a Certificate of Exemption
accordingly.

If on the other hand it was decided that it was not necessary
that he should be retained, the Committee so recommended, and
the Local Tribunal then, under Section 7, refused him exemption.
The Military Authority then called him up for ordinary service
under the compulsory powers of the Military Service Acts, and
the War Office then, unless they thought him unsuited for the
R.A.M.C., offered him a commission in the R.A.M.C. for the
whole period of the War and on the ordinary rates of pay, not
under the special arrangements as to pay and twelve-month
periods accorded to those who registered with the Emergency
Committee.

C. Practitioners over 41

A practitioner over 41 was not within the compulsory provisions
of the Military Service Acts, and could only be obtained for the
R.A.M.C. with his consent. If he was registered with the
Emergency Committee his undertaking pledged him to no more
than twelve consecutive months of service. Whether he served
for a second period after such interval, if any, as the Emergency
Committee might think applicable, was wholly in his option.

Dual System: Procedure

In intimating to a practitioner in category A that he
had, in terms of his registered obligation, been selected
for the Army, the Committee enclosed a form of applica-
tion for a commission. In its covering letter it wrote
these words, also in terms of the practitioner's registered
obligation.

If you are of opinion that your personal or professional circum-
stances or any other considerations justify your claiming to be left
in your civil practice, you must communicate in writing to that
effect at once to the Secretary of the Committee, when a form will
be sent you on which to state full particulars of your case.

The form referred to was the form entitled Applica-
tion for Exemption.

In intimating to a practitioner in category B that

9O Miistering of Medical Service in Scotland

his case had been referred by a Local Tribunal, the
Committee supplied him with the same form of
Application for Exemption.

The remaining procedure of the Committee in hearing
statements made by or for applicants, and in dealing
with their claims, was the same for practitioners in
both categories, except that the Committee's finding
in category A cases was intimated to the practitioner,
whereas in category B cases it was necessary to notify
it to the Local Tribunal concerned.

Conscientious objection being excluded from the
Committee's purview by Section 7 of the Military
Service Act 1916 (Session 2), applications for exemption
by category B cases were limited to the grounds of
national interest, serious hardship and ill-health. An
exemption recommended by the Committee might be
absolute, conditional or temporary.

Though authorized by Order in Council and heralded
by a War Office Memorandum the work of the Com-
mittee as the Central Professional Committee for
Scotland, strictly so called, was light. The cases
referred to it by Local Tribunals, as will be shown,
were infrequent and almost negligible. Its main
pursuit under the dual system continued to be, as
heretofore, to call on the practitioner to fulfil the
conditional promise of which his war registration was
the token, and then, having weighed the merits of
his case, either to allow him to remain in civil life or to
summon him to join the Army. The statutory powers,
however, though seldom required to be exercised,
strengthened and completed the Committee's control
over the channels of medical recruiting, inasmuch as
all practitioners of military age, except some few who
might pass to the Royal Navy or the Territorial Force,
were now brought by one path or another directly

. § 3] Exemptions 91

within its cognizance. Whether the practitioner came
forward betimes and registered with the Committee,
and then, being" called on to take a Commission, either
took it or stated his case for delay or exemption, or
whether, having refrained from registration, he tardily
sought exemption at the hands of a Lay Tribunal
which in turn referred him to the Committee, he was
guided to the Committee at last.

Exemptions: 1916

The first meeting of the Committee for the purpose
of considering claims by practitioners to be exempted
from military service took place on 26 July 1916. As
the Emergency Committee and the Central Professional
Committee for Scotland were composed of the same
persons, and as the Convener of the Emergency
Committee was the Chairman of the Professional
Committee, the Committee was able at its meetings
to deal both with claims by practitioners entered in its
War Register whom it had requested to take com-
missions, and with statutory claims referred to it by
Local Tribunals in respect of practitioners who had not
registered.

The claims heard between 26 July 1916 and the close
of the year were 47 in number. Of the 47 claims,
44 were addressed to the Emergency Committee by
registered practitioners, while 3 were referred to the
Professional Committee by Local Tribunals. Of the
47 claims, 16 originated from the Glasgow Division, 7
from Edinburgh and Leith, 4 from Renfrew and Bute,
3 each from Ayr, Fife, Lanark and Stirling, 2 each from
Aberdeen and Inverness, and i each from Banff, Elgin
and Nairn, Dumbarton, Perth, and the South-East.

Of the 47 applicants, i received absolute exemption,

92 Mustering of Medical Service in Scotland

12 conditional exemption and 12 temporary exemption.
To 22 of the applicants exemption was refused.

Occurrences

In July 1916 the Director General, Army Medical
Services, issued a decision with regard to Recent
Graduates, to the effect that all medical practitioners
who obtained their qualifications after the passing ot
the Military Service Act would be appointed to the
Royal Army Medical Corps, Special Reserve, and not
to temporary Commissions.

On 28 July 1916 at the Annual Representative Meeting of the
British Medical Association, the member1 of the Emergency
Committee who was a member also of the Central Medical War
Committee expressed to the Association the thanks of the
Emergency Committee for the help which had come to it from the
resources of the Association.

In terms of an Order now issued by the War Office
to certain Commands, medical officers of military age
holding temporary commissions in the Royal Army
Medical Corps under the Twelve Months* Contract —
authorized by the War Office in 191 5 2 and confirmed
in the Official Memorandum of 1916 — were required to
continue on service beyond their year. To a question
in Parliament on 31 July 1916 the Financial Secretary
to the War Office replied that temporarily commissioned
R.A.M.C. officers serving in Egypt, who would on
ceasing to serve as doctors become subject to the
provisions of the Military Service Acts, had been
retained beyond the termination of their year's con-
tract, but that their retention was necessary in order to
provide adequately for medical requirements. It was
hoped that they might be able to return to this country
at an early date when reliefs were available.

1 Prof. H. H. Littlejohn. 2 Page 34.

- §3] Suspension of Contract 93

The Secretary's answer was recognised as candid by
all who took account of the facts. The Somme offensive
was developing : at the date of the answer the Battles
of Delville Wood and Pozieres Ridge were in progress.
The claims of the Western front made the procedure
referred to inevitable. As most medical officers on the
twelve months' contract had spontaneously decided to
remain in the Army, and as the Order in any event
affected only those practitioners of military age whose
agreement was on the point of expiring, the number
practically concerned was small. In cases where
serious hardship threatened, or where the circumstances
were otherwise special, the War Office were prepared
to entertain proposals for release put forward by the
Emergency Committee.

On 6 November 1916 the War Office telegraphed to
the Committee asking for as large a draft of medical
officers as possible. They explained by letter that the
weekly wastage of R.A.M.C. officers in the British
Armies in France alone was considerably greater than
the number appointed week by week, that they were
failing to replace the casualties in that theatre of war
and that they were being urged besides to supply many
medical officers to forces in other fields. The Committee
in response called up 30 medical men and got 32. In noti-
fying the War Office of this draft it expressed its expecta-
tion that, if it found that it had depleted any area too
seriously, the War Office would favourably entertain
its request for the release of a medical officer or officers
to help the local shortage.

On 7 October 1916 the Emergency Committee lost by death one1
of its original members, formerly Chairman of the Scottish Com-
mittee of the British Medical Association, who had called together

1 Dr. J. R. Hamilton.

94 Mustering of Medical Service in Scotland

the First Medical Conference, which appointed the Emergency
Committee, and thereafter throughout his period of membership
had rendered conspicuous service.

Medical Mobilization

The Somme battles with their mounting casualties
and the losses at sea by enemy submarine action with
the consequent threat of scarcity, these and other
factors, while the year 1916 advanced towards its close,
left the country in no doubt as to the gravity of its
position, suggested that the time had come for a widely
concerted effort and so turned men's minds towards
that mobilization of the whole community on a war
footing which had been the remoter object of the
National Registration Act 1915.

The medical profession, continually under pressure
to make up to the Army its wastage in medical officers,
had this problem early before it. It saw the possible
usefulness of some co-ordinated plan which should be
inclusive of all its members. Alike in England and in
Scotland the situation was discussed among practi-
tioners, and a project began to take form for the
mobilization of all medical men in the national interest,
for both military and civil work.

Scottish Opinion

While medical Scotland as a whole was organized
with some completeness, and while in many districts
every medical man was either serving or pledged to
serve or was acting in relief of a colleague absent on
service, it was known to the Emergency Committee
that there were other areas where the burden was not
shared by all, and where the introduction of a compre-
hensive scheme would make for equality of sacrifice.

§3] Medical Mobilization 95

After careful consideration of the issues involved, the
Committee decided that there was a case in Scotland
for professional mobilization. It proceeded to reduce
to a definite formula the speculations current on the
subject: and on 15 December 1916 it unanimously
adopted the following resolution :

That the Committee approve of the principle of the complete
organization of the medical profession for the period of the war
and for 6 months thereafter, in order that every person whose
name is on the Medical Register shall be held bound, when re-
quired by the Government, to give such service as he or she is
competent to render to the country for naval, for military, or for
civil practice.

Rider : — The Committee have adopted the above resolution on
the understanding that the organization referred to shall be in
the hands of a Medical Committee appointed by the Government
for the purpose.

The Presidents x of the Royal Colleges in Edinburgh,
a Fellow2 of the Royal Faculty of Physicians and
Surgeons of Glasgow, and the Chairman8 of the
Scottish Committee of the British Medical Association
brought the resolution under the notice of their
respective bodies, and within a week from its adoption
by the Emergency Committee it had received the
cordial support of all but the Royal Faculty, whose
standing orders did not permit such expedition.

The resolution of the Royal College of Physicians,
Edinburgh, which was unanimous, was in the following
terms :

That this College, having considered the resolution submitted to
it by its representative on the Scottish Medical Service Emergency
Committee, endorses the policy of the resolution, on the under-
standing that the organization referred to shall be in the hands of

1 Prof. William Russell. Mr. J. W. B. Hodsdon.

2 Prof. T. H. Bryce. 3 Dr. John Adams.

96 Mustering of Medical Service in Scotland

a Medical Committee appointed for the purpose, and that this
College and the other Scottish medical corporations are adequately
represented on the Committee.

The resolution of the Royal College of Surgeons^
Edinburgh, also unanimous, was in the same terms as
the resolution of the Royal College of Physicians.

The resolution of the Scottish Committee of the
British Medical Association was in the following
terms :

That this Committee approve of the principle of the complete
organization of the medical profession during the period of the
war and for 6 months thereafter, in order that every person whose
name is on the Medical Register shall be held bound when re-
quired by the Government to give such service as he or she is
competent to render to the country for naval, for military, or for
civil practice, subject to the following riders :

1. The Committee have adopted this resolution on the under-
standing that the organization referred to shall be in the hands
of a Medical Committee appointed by the Government for the
purpose.

2. That at least one-half of the members of the Committee in
question should consist of general practitioners.

The four resolutions were all to the effect that for
the period of the war and for 6 months thereafter
every duly qualified medical man and woman should,
under an organized scheme, when required by the
Government, give such service to the country, for
naval, military or civil purposes, as he or she might be
competent to render.

The proviso, contained in the four resolutions, that
the scheme should be in the hands of a medical Com-
mittee to be appointed by the Government was war-
ranted by the recognition which had been accorded
to the then existing medical committees in both
England and Scotland.

The proviso by the Royal Colleges that they should

1 9 1 6- § 3] Medical Mobilization §7

be adequately represented on the Committee to be
appointed was justified by the high standing of these
bodies and by their public services.

The proviso of the British Medical Association that
at least one-half of the members of the Committee
to be appointed should consist of general practitioners
was warranted by the circumstance that the majority
of those whose destinies were liable to be decided by
the Committee to be appointed would be engaged in
the practice of general medicine.

Political Change

The Emergency Committee had proposed to |obtain
for the principles set forth in the resolutions the con-
currence of meetings of the medical profession in the
great Scottish centres, and thereafter to approach the
Government with a request for the legislative sanctions
necessary to transform the free-will offer into a work-
ing scheme.

But important events which had supervened modified
the Committee's intention. On 5 December 1916,
with the resignation of the then Prime Minister,1 the
First Coalition Government fell. The Prime Minister2
of the Second Coalition Government, who acceded to
office on 7 December 1916, created a number of special
departments for the special exigencies of the time.

One of these special Departments was the De-
partment of National Service. It was under the
charge of a Director General with the assistance of
a military and a civil director. On 19 December
1916 the Prime Minister announced in the House
of Commons that the Department of National

1 The Right Hon. H. H. Asquith.

2 The Right Hon, D. Lloyd George.

98 Mustering of Medical Service in Scotland

Service was in being: and stated further that if
volunteers under the Departmental Scheme fell short
of requirements, Parliament would be asked to grant
further powers.

Action by Emergency Committee

The organization of the country, as the Emergency
Committee concluded, was definitely under way. Any
proposals as to medical organization should be put to
the Government before its procedure in the matter was
finally settled. There was no time now for the Com-
mittee to secure, as had been proposed, a mandate
from the general Scottish profession. The views of
the Committee itself, however, and of representative
Scottish medical bodies, had been clearly declared ; it
was decided to make them known.

The Committee, therefore, standing for Scotland,
and acting in concert with the Central Medical War
Committee * and the Committee of Reference 2 in

1 On 30 December 1916 the Central Medical War Committee
addressed to Mr. Lloyd George, as Prime Minister, a letter in
which the following sentence occurs : " At a meeting on December
6th the Committee approved the general principle of mobilization
of the medical profession, apart from any question of the general
mobilization of the whole community, so that any individual whose
name is on the Medical Register shall give such service, whether
in a military or a civil capacity, as he or she is competent to give,
when required to do so by the State."

The letter closed with an intimation that the Committee was
prepared to place its services at the disposal of the Government in
any way which might be thought to be most useful.

* The Committee of Reference, writing to Mr. Lloyd George, as
Prime Minister, on 5 January 1917, expressed the wish to assist, in
such manner as might be determined, the mobilization of the profes-
sion, and gave the assurance that they were acting, as in the past,
in full sympathy and co-operation with the Scottish Medical Service
Emergency Committee and the Central Medical War Committee.

19 J 6. §3] Medical Mobilization 99

England, addressed by its Convener1 on 23 December
1916 a letter to the Prime Minister.2

The Convener's letter referred to the work of the
Committee from its appointment till the time of writing1,
stated the Committee's resolution of 15 December 1916
in favour of the complete organization of the profession,
quoted the supporting resolutions of the Royal Colleges
and the Scottish Committee of the British Medical
Association, and concluded with these words :

It was the Committee's intention to proceed by laying these
resolutions before meetings of the profession in the larger centres
of population in Scotland, and when they had received, as was
anticipated, an almost unanimous endorsement to ask you to
introduce the necessary legislation.

In view of your announcement the Committee is of opinion
that the information contained in this letter should be laid before
you at once so that you may place it at the disposal of whatever
authority is entrusted with the matter, and I am to add that the
Committee places itself and all the information at its disposal
unreservedly at the service of the country.

Close of 1916

Such was the position of professional mobilization in
Scotland at the end of 1916, a year which had wit-
nessed the introduction in Great Britain of compulsory
military service and the appointment in Scotland of the
Emergency Committee as a statutory body to decide
applications by practitioners. It was estimated by the
Committee that 1800 Scottish medical men, up to the
close of the year, had taken service with the Forces of
the Crown.

1 Dr. Norman Walker.

2 The Right Hon. D. Lloyd George.

CHAPTER VIII
1917. § i

Medical Mobilization : Further Progress. — Conference of Secretaries
of War Committees — Director General of National Service —
Interview. — St. Ermin's Conference. — Limiting Resolutions. —
R.F.P.S.G. — Glasgow and West of Scotland— Edinburgh and
Leith. — Medical Mobilization : Decline. — General Call-up by
War Office : Hospital Ships— Calling-up Notices— Letter by
Secretary for War — New Contract — View of Committee. —
Unsettlement : A.C.I. No. 485 of 1916 — Civil Community —
Conference. — Settlement. — 58th General Hospital.

Medical Mobilization; Further Progress

THE mobilization project, suggested in the Emergency
Committee's letter x to the Prime Minister of 23 De-
cember 1916, continued to engage the attention of
the Committee and of medical men in Scotland.

Mobilization, as applied to the medical profession,
was understood rather than defined. The President of
the General Medical Council referred to it later as a
temporary measure of general control, extending to
all practitioners and directing their distribution accord-
ing to the Nation's need for service. The Emergency
Committee's resolution of 15 December 1915, and the
supporting resolutions cited above,2 showed that the
services proposed to be exigible covered naval, military
and civil practice.

1 P. 99. f Pp. 95 and 96.

19 1 7« § xl Medical Mobilization 101

As touching naval and military employment, mobiliza-
tion was not against the inclination of Scottish practi-
tioners as a body. To many, debarred from commissions
on the ground that they were irreplaceable in their
areas, it seemed to open a way to the service to which
they aspired. As touching civilian work, however, the
question arose whether a practitioner under a mobiliza-
tion scheme could be ordered to leave his practice so as
to take charge of a medical bureau or central surgery
or of a vacated practice in another part of the country.
The answer could only be that such orders might have
to be given. This prospect was unattractive to many
practitioners and obnoxious to some, but most were
prepared to admit that the service would be of value,
and that under a scheme it would be their duty to
render it. Over Scotland generally, during the months
of January and February of 1917, as the Committee
had reason to believe, the medical profession, recogniz-
ing that its mobilization would serve the best interests
of the Nation, was prepared to be mobilized, subject
only to the condition that any plan of mobilization
should be under medical control.

On 26 January 1917, at a Conference of Secretaries of
War Committees, who were, on account of the office
which they discharged, in close touch with professional
opinion in their districts, the mobilization proposal was
discussed. All representatives present were agreed
as to the increasing difficulty of liberating practi-
tioners for military service : a number of Divisions
had reached the limit of voluntary achievement ;
under a compulsory regime, however, applicable to
both military and civil practice, adjustments could
be made, and more men freed. The following
resolution was carried at the Conference, nemine
contradicente ;

IO2 Mustering of Medical Service in Scotland

That this Conference of Secretaries of Local War Committees,
being informed that further substantial calls are likely to be made
on the profession, is of opinion that these calls can only be met by
mobilizing the whole profession.

On 6 February 1917 the Director General of National
Service J referred to the question at issue. In a public
utterance he said :

As for doctors, I have been in touch with the President of the
General Medical Council, and although my plans are not yet
completed I hope it will be possible for me to arrange something
with them. . . . What we have to do is to see that the doctors
are so mobilized and distributed that the needs of the civil popula-
tion and the army can be met, and that so far as possible
specialists shall be put to do work for which they have taken
pains to fit themselves in particular.

The interest of the Scottish profession, already alive,
was roused by the Director General's statement of his
intentions. Enrolment for national service was now
proceeding, and practitioners were wishful to know
whether it would be proper for them to enrol at once
or whether they should await developments. The
Convener of the Emergency Committee, who received
many inquiries, asked the Director General for a
decision. The Director General replied that Scottish
doctors should not enrol on ordinary forms as special
arrangements were contemplated. An announcement
to this effect was communicated by the Convener to
the profession through the Scottish press.

The Director General of National Service having
expressed a desire for an Interview with a represen-
tative of the Emergency Committee at St. Ermin's,
Westminster, the headquarters of his Department, the
Convener2 was appointed by the Committee to attend
at St. Ermin's, and attended. On the advice of the

1 Mr. Neville Chamberlain, » Dr. Norman Walker.

1917- § T] S/. Ermiris Conference 103

Convener, given at this interview, the Director General
resolved to call a Conference of representatives of the
Professional Committees, under the chairmanship of
the President of the General Medical Council, in order
to consider what steps should be taken with reference
to the organization of the profession under the scheme
for national service.

St. Ermin's Conference

The proposed Conference was announced by the
Director General in a letter, addressed to the Emergency
Committee on 22 February 1917, from which the
following passages are quoted :

The organization of the medical profession, with a view to
meeting1 the needs both of the military and civil population, is one
with which this Department is now concerned. . . . Accordingly
I have decided to call a Conference . . . and I should be very
much obliged if your Committee would be good enough to
nominate representatives from amongst their number who would
be prepared to attend. . . . For your information I may say that
the following will be among the subjects upon which it is desired
that the Conference should express an opinion.

1 whether the service to be given by members of the pro

fession should be compulsory or voluntary ;

2 what arrangements should be made for the collection and

distribution of fees or other form of remuneration in
cases where doctors leave their own practices or take
on the practices of others ;

3 what arrangements should be made :

(a) centrally, and

(b) locally

for redistribution of medical men ; and

4 what should be the relations between any central executive

or advisory body representing the profession and this
Department.

The Conference met at St. Ermin's, Westminster,

104 Mustering of Medical Service in Scotland

on 14 and 15 March 1917. The President1 of the
General Medical Council presided. There were present
three representatives 2 of the Scottish Medical Service
Emergency Committee, four representatives8 of the
Central Medical War Committee and two represen-
tatives4 of the Committee of Reference. There also
attended the Secretaries5 of the three Committees, a
representative 6 of the Army Medical Department, two
representatives7 of the English Local Government
Board and two representatives8 of the English In-
surance Commission.

The representative of the Army Medical Department
submitted to the Conference a statement showing that
close on 1000 additional medical practitioners were
required to make good the regular wastage of the
existing Army Medical Service, and to provide for the
necessary expansion of the service to meet new and
urgent demands.

In the light of the statement so submitted the Con-
ference proceeded to deal with the four heads of
reference set out by the Director General of National
Service in his letter of 22 February 1917, and found as
stated hereunder :

HEAD i. — Whether the service to be given by members of the
profession should be compulsory or voluntary.

Sir Donald MacAlister.

Dr. Norman Walker, Dr. John C. M'Vail, Dr. John Adams.

Dr. T. Jenner Verrall, Mr. E. B. Turner, Dr. C. Buttar,
D . Richmond.

Sir Rickman Godlee, Dr. Frederick Taylor.

Mr. T. H. Graham, Dr. Alfred Cox, Mr. Bishop Harman,
Mr. F. G. Hallett.

6 Sir William Babtie.

7 Sir Arthur Newsholme, Mr. H. O. Stutchbury.

8 Sir Robert Morant, Dr. J. Smith Whitaker,

I9I7* § Tl St. Ermiris Conference 105

The Conference held that the time for further appeals
for voluntary service was past, and that effective provi-
sion could no longer be made for the needs of the
Forces on the one hand, and of the civil population on
the other, without the institution of a system of com-
pulsory medical service for both men and women
practitioners. It recommended that steps for the
institution of compulsory medical service for members
of the medical profession should be taken forthwith,
apart from and independently of any measure for the
institution of compulsory national service applicable to
the civil population in general.

HEAD 2. — What arrangements should be made for the collection and
distribution of fees ; or other form of remuneration, in cases where
doctors leave their own practices or take on the practices of others.

The Conference agreed that the remuneration of
medical practitioners transferred by direction of a
Central Executive for substitute medical service of any
kind, other than service under a Military Authority,
should be secured by means of arrangements, as to the
allocation of professional fees, etc., approved by the
Central Executive concerned, and not by the payment of
professional salaries by the State : with the proviso
that it might be found necessary to institute a central
fund supplemented by state grants, from which the
Central Executive might draw in order to make good
unavoidable deficiencies of professional remuneration
in individual cases. The professional remuneration
secured to a medical practitioner, transferred by direc-
tion of a Central Executive for whole-time substitute
service from his own practice to another practice,
should not be less advantageous in its terms than if the
practitioner had been transferred from his own practice
to military service in the Royal Army Medical Corps.

io6 Mustering of Medical Service in Scotland

The Conference agreed further that the Department of
National Service should make such contribution towards
the necessary administrative expenses of the mobiliza-
tion of the profession as might be found necessary.

HEAD 3. — What arrangements should be made (a) centrally and
(b) locally, for redistribution of medical men.

The Conference adopted the view that for purposes
of central organization there should be Central Execu-
tives for England and Wales and a Central Executive
for Scotland, distinct and separate from one another,
the Central Executive for England and Wales being
the Central Medical War Committee with the Com-
mittee of Reference, and the Central Executive for
Scotland being the Scottish Medical Service Emergency
Committee. It considered that each Central Executive
should consist essentially of members of the medical
profession, and that provision should be made for the
inclusion in each of one or more women, representative
of women practitioners. The Central Executives should
be appointed or recognized by the Director General
of National Service for the purpose of carrying out
mobilization, and invested with the necessary powers ;
and provision should be made for the attendance at
their meetings of representatives of the Government
Medical Services concerned and for assistance of a legal
character when required. For the hearing of appeals
by practitioners with reference to mobilization, the
Central Executives should be empowered to sit in
several sections in different localities as might be
expedient, decisions by sections being issued in the
name of the whole Executive.

For purposes of local organization the Conference
was of opinion that the Central Executives should be
empowered to appoint or recognize, with the approval

I9I7- § J] St. Ermiris Conference 107

of the Director General of National Service, such local
professional committees as they might think necessary ;
and that such local professional committees should
forthwith be elected, or, if already existing, re-elected,
by the profession in areas, with a view to their appoint-
ment or recognition by the Central Executives.

HEAD 4. — What should be the relations between any Central
Executive or Advisory Body representing the profession and the
Department of National Service.

The Conference agreed that a small Medical Service
Advisory Board for Great Britain, representative of the
Central Executives and including the Chairman of each,
should be appointed for purposes of consultation with
the Director General of National Service or his Deputy,
and that representatives of the Government Medical
Services concerned should be invited to attend the
meetings. A Committee of the Medical Service
Advisory Board, consisting of the Chairmen of the
Central Executives, should be empowered to meet for
consultation with the Director General of National
Service or his Deputy in case of urgency.

The Conference embodied the foregoing opinions and
recommendations in a unanimous report which it pre-
sented to the Director General of National Service. By
request of the Director General, who desired to consider
the report, the proceedings of the Conference were not
made public at the time. They are now permitted to
be disclosed.1

Limiting Resolutions

In the meantime resolutions were adopted by practi-
tioners in Glasgow and Edinburgh, which limited in an

1 Letter of 24 December 1921 from Mr. Neville Chamberlain to
Dr. Norman Walker.

io8 Mustering of Medical Service in Scotland

important particular the suggestions of the Conference,
the Emergency Committee, the Royal Colleges and the
Scottish Committee of the British Medical Association.
On 6 March 1917 it was resolved by the Royal
Faculty of Physicians and Surgeons, Glasgow :

That the Royal Faculty of Physicians and Surgeons of Glasgow
approves of the principle of the organization of the whole Nation
to secure the successful and rapid conclusion of the war, so that
all fit persons shall be liable to be called on by the Government to
render such service in naval, military or civil departments as they
may be deemed suitable for, due regard being paid to age, train-
ing and circumstances : if and when this proposal is carried into
actual practice by the Government the Royal Faculty will be
prepared to render all possible assistance in the organization of
their own profession.

On 27 March 1917, at a meeting of medical practi-
tioners in Glasgow and the West of Scotland^ held under
the Chairmanship of the President of the Royal Faculty,
it was resolved, inter alia :

That this meeting, having expressed its opinion that the whole
Nation should without delay be organized for war, is nevertheless
strongly of opinion that to compulsorily mobilize the medical pro-
fession in advance of the rest of the community would be unjust
alike to the profession and the community at large.

This resolution was a more direct expression of the
second portion of the Royal Faculty's resolution of
6 March.

On 17 April 1917 the Edinburgh andLeith Division of
the British Medical Association passed the following
resolution :

That this meeting strongly protests against any measure of com-
pulsion being applied to the medical profession which is not at the
same time applicable to the whole community.

I9I7« § Tl Medical Mobilization 109

Medical Mobilization: Decline

The Glasgow and Edinburgh meetings, in resolving
that there should be mobilization but that the medical
profession should not be mobilized before the general
community, were at variance with the Emergency Com-
mittee, the Royal Colleges and the Scottish Committee
of the British Medical Association, which had favoured
medical mobilization simpliciter, and still more at
variance with the Central Medical War Committee * in
England and the St. Ermin's Conference, which had
declared for medical mobilization irrespective of the
lay population. They voiced a more careful and circum-
spect policy than had thus far animated the profession
on the subject. Nevertheless, had the Government
now been able to take legislative action in terms of the
report of the St. Ermin's Conference, and mobilize the
profession for all purposes independently of the rest of
the people, they would have received the effective com-
pliance of the great majority of Scottish practitioners.
A proposal, however, to lay a special obligation, includ-
ing civilian service, on a selected group was at this
time politically difficult ; and so the profession, which
had humbly begged the leading of the vaward, was not
suffered to take it. An Act 2 now ensuing, which was
passed in April, gave power to review the exception of
certain men from military service, but made no new
claim on practitioners.

Professional organization, as a topic, was referred to
at the session of the General Medical Council in May
1917. It was aimed at in the North of Scotland in June
when the Caithness and Sutherland War Committee
unanimously resolved :

1P. 98, Footnote i.

a Military Service (Review of Exceptions) Act, 1917. P. 122.

no Mustering of Medical Service in Scotland

That every fit man in the medical profession in Scotland irre-
spective of age should be conscripted and his services placed at
the disposal of the Emergency Committee, thus making possible
a scheme of redistribution of doctors, whereby more men of
military age could be released for the Army.

In July 1917 there was an approving" resolution
in London at the Annual Representative Meeting
of the British Medical Association, but the move-
ment over Great Britain as a whole had spent its
force.1

Complete mobilization, as proposed in the December
resolutions,2 remained at the last a plan not carried out.
It was, however, finely conceived and prompted by
high motives of public spirit, and even in its unsuccess
it stands as a distinguished episode of the medical
history of the war.

It would appear, moreover, that the Government was
not forgetful of the willingness which Scottish and
English practitioners had expressed to come under
special obligations. Though the original scheme of
statutory organization for both military and civil
purposes did not materialize in the manner intended, it
was not all lost. The discerning eye will detect its
influence in the Military Service (No. 2) Act8 of 1918,
which fixed a higher military age for medical men than
for the lay community, and empowered the application

1 In July 1918 the Annual Representative Meeting implied its
adherence to the doctrine of special war service by the profession.
An amendment, referring to the Military Service (No. 2) Act, 1918,
and declaring that "any conscription extended beyond the age
limit determined for the rest of the nation and moreover different
in character and of the nature of an industrial conscription, which
has constantly been repudiated by the Government, is totally
unnecessary and unwarranted," was moved, and on being put to the
meeting was lost.

* Pp. 95 and 96. »P. 138.

1917. § 0 Call-Up by War Office in

to civilian practitioners, under prescribed conditions,
of a measure of vocational control.

General Call-Up by War Office

Hospital Ships had been assailed by the enemy on
several occasions before the end of 1916, but in 1917
these attacks assumed a more intense and determined
form. The hospital ships Asturias and Gloucester Castle
were torpedoed in March 1917 ; Donegal and Lanfranc^
hospital ships also, were sunk on one day in April ; and
the conveyance to Britain of sick and wounded from the
theatres of war began to be seriously threatened.

It was therefore decided that it would be necessary
to institute many hospitals overseas. The War Office
was aware that the staffing of the proposed establish-
ments would make large demands on the remaining
medical man-power of the country, and it set out with
impetuous vigour to secure the personnel required.

The I7th of April 1917 had witnessed the loss of
Donegal and Lanfranc. On 18 April the Director of
Recruiting instructed all Recruiting Officers to issue
immediately Calling-Up Notices to all medical practi-
tioners of military age on their registers to report in
seven days. On 19 April a direction was sent to
Commands and Groups in Great Britain that Recruit-
ing Officers were to compile an accurate list of all
medical practitioners in sub-areas, and that Army
Council Instruction No. 485 of 1916 was to be regarded
as cancelled in individual cases seven days after issue
of the calling-up notice, unless the practitioner con-
cerned had appealed his case to the Emergency
Committee and had not received a reply.

Commands and Groups were directed to issue to

H2 Mustering1 of Medical Service in Scotland

each practitioner of military age a Letter from the
Secretary of State for War J couched in the following

terms :

WAR OFFICE, 21 April 1917.

I am desired by the War Cabinet to ask your earnest con-
sideration of the following matter :

The enemy, in total disregard of the accepted tenets of civilized
warfare, have deliberately instituted a submarine campaign
against hospital ships.

It has therefore become essential that a large number of
hospitals should be established overseas in the various theatres
of war for the treatment of the sick and wounded.

In order to allow of this being done, and done with great
rapidity, it has become essential to secure the services of every
member of the medical profession who can possibly be spared
from this country. The figures in the possession of the Govern-
ment make it plain that the number of doctors who could be
spared from this country are more than are needed to supply the
military requirements if adequate steps are taken, by the doctors
over age or by other means, for doing the work in this country
of the men who must now be taken for medical service overseas.

For these reasons the War Cabinet have decided, as the first
step in this process, that every medical man of military age must
be called up at once under the Military Service Acts, in order that
he may thus be made available at once, and that, if he cannot be
spared from his locality without arrangements being made for
carrying on his work, his case may be immediately investigated
and decided upon and steps taken for securing a substitute for
that work.

Every medical man thus summoned must, therefore, communi-
cate immediately to the Central Medical War Committee (or the
Scottish War Emergency Committee), if he is of opinion that
circumstances (personal or public) make it impossible for him to
go — e.g. that he can only be spared from his present duties when
some arrangements have been made for doing his present work.

May I express the earnest hope that every doctor over military
age will immediately offer his services to the local Medical War
Committee of his area as willing to undertake any substitution
work within his capacity which would help to release any man of
military age who cannot otherwise be spared ?

1 The Earl of Derby.

1917. § i] Call-Up by War Office 113

The War Cabinet recognize to the full the great services that
the medical profession has rendered during the present war, and
regret that the barbarous action of the enemy compels a further
call on their services, and a resort by the Government to measures
which the Army Council had intended to avoid, and could still
have avoided, but for this new phase of German outrage. They
recognize that the new procedure must involve additional sacri-
fices for the people of these islands, and must fall heavily on the
medical profession. But the War Cabinet trust and believe that
this call will be met in the same splendid spirit with which
previous calls have been met, and that members of the medical
profession and the public whom they serve will ungrudgingly
make whatever sacrifices may be necessary in order that our
soldiers abroad may have the same attention and care which
medical science provides for their comrades at home.

Again on 21 April a further instruction was issued to
Commands and Groups in Great Britain. Practitioners
who applied for commissions or who had been ex-
empted by the Emergency Committee on or before
19 April 1917 were to be sent home to await instruc-
tions to join for service at 48 hours' notice on or after
6 May. Practitioners who appealed to the Emergency
Committee after being called up were to be dealt with
in a like manner, subject to the Committee's decision.
Practitioners exempted by the Emergency Committee
after 19 April were to remain exempted. Practitioners
who refused to apply for commissions were to be
posted as privates to the R.A.M.C. and dispatched to
the Blackpool Depot.

For these engagements there was announced a New
Contract which principally differed from the twelve
months' contract1 previously in force by requiring
service from the day of commencing duty until the
termination of the emergency then existing or until
service was no longer required, whichever should first
happen.

1 Pp. 34, 40 and 88,
8

1 14 Mustering of Medical Service in Scotland

The ends to be served by the courses outlined were
not fully apparent. In the View of the Committee
the lists of medical practitioners to be compiled by
Recruiting Officers would be less complete than its
own War Register. While acquiescing wholly in the
grounds of urgency as advanced by the Secretary of
State for War in his letter to practitioners, it looked
with concern on the virtual extinction of its exemptions
granted up to 19 April. It agreed that the posting
as privates to the Royal Army Medical Corps of prac-
titioners who rejected the offer of a commission was
warranted as a penal measure, but it doubted, as here-
tofore, the expediency of a plan which deprived the
civil population of a doctor without providing the army
with a medical officer. It observed, with regret, that
the new procedure destroyed its initiative. It recog-
nized, however, that through the right of appeal it
would retain some power of control. It approved of
the new contract.

Unsettlement

When Recruiting Officers, in accordance with their
nstructions, issued their notices to report, practitioners
of military age still remaining in Scotland were thrown
into an agitation. While some of those registered
with the Emergency Committee were pleased by the
near prospect of military service which had hitherto
been denied them, and others were indignant at the
departure from the conditions under which they had
undertaken to serve, the general feeling was one ot
unsettlement mingled with anxiety, and the Committee
foresaw that without some remedy there would be
dislocation of civil practice.

Seeking a remedy, the Committee turned to the

1917- § i] Call-Up by War Office 115

recruiting direction of 19 April 1917, which continued
Army Council Instruction No. 485 of 1916 in operation
beyond seven days after notice issued, if the practitioner
concerned had referred his case to the Emergency
Committee and had not received a reply. As every
practitioner registered with the Committee who re-
ceived the calling-up notice had referred, or would
refer, his case to the Committee, the resulting position,
in the view of the Committee, for practical purposes
was that practitioners registered with the Committee
were still under the Instruction. The Committee there-
fore, in order to allay the turmoil in the mind of the
profession, caused to be published in the Scottish press
of 21 April 1917 a statement setting forth the current
provisions of Army Council Instruction No. 485 of
1916 with regard to (a) practitioners of military age
registered with the Committee, and (b) practitioners of
military age not so registered, as follows :

(a) If a qualified medical practitioner who is attested under the
group system, or is in one of the classes under the Military
Service Act 1916, and who is enrolled1 under the Scheme of the
Central Medical War Committee, or the Scottish Medical Service
Emergency Committee, or has been provisionally accepted by
the War Office, receives a notice paper calling- him up, he should
return it to the Recruiting Officer, together with his certificate of
enrolment or W.O. letter. The notice will then be cancelled, and
the practitioner will remain in reserve until selected for a com-
mission in the Royal Army Medical Corps.

(b} If a medical practitioner has attested under the group
system, or is in one of the classes under the Military Service Act
1916, but has not enrolled under the scheme of the Central
Medical War Committee, or the Scottish Medical Service
Emergency Committee, nor been provisionally accepted by the
War Office, he will be dealt with in the ordinary course.

1 Enrol was the term employed in England. It was equivalent
to register.

1 1 6 Mustering of Medical Service in Scotland

Apart from their temporary disturbing effect on the
medical profession, the War Office instructions had
raised the question of the Committee's obligations to
the Civil Community in Scotland. Deprived of its
initiative in the choice of practitioners for military
service, the Committee could no longer accept responsi-
bility for maintaining the general standard of civilian
medical attendance. The measure of control still
remaining to it, by virtue of the appeals competent to
be made by practitioners after receipt of the call-up
notice, might give it the power to intervene in in-
dividual cases, but the broad supervision which it had
exercised was taken out of its hands. The Committee
held it essential to preserve the understanding hitherto
existing between itself and the War Office, in accord-
ance with which the War Office had agreed to refrain
from commissioning any medical man if the Committee
considered him irreplaceable in his area.

The Convener1 of the Committee at a Conference
at the War Office with the Director General,2 Army
Medical Services, informed the Director General of the
feeling of the Committee on the whole position. The
Committee did not propose to cease from its activities.
On the contrary, it would continue to render to the
War Office every assistance in its power. If, however,
a medical breakdown occurred in Scotland through the
withdrawal by calling-up notices of indispensable
practitioners, the Committee would be blameless, and
the War Office itself must be held responsible for any
untoward results. The output under the new method
would in any case be no higher than under the old.
If the War Office would inform the Committee of the
complement of officers expected from Scotland in order
to meet the existing emergency, the Convener was

1 Dr. Norman Walker. » Sir Alfred Keogh.

1917- § 0 Call-Up by War Office 117

satisfied that the Committee, if its initiative and control
were retained, would at once set out to secure the
number required, with every prospect of success.

The Director General informed the Convener that the
Army required 900 additional officers. The Convener,
subject to confirmation by the Committee, accepted
responsibility for one-fifth of the total, that is to say,
180, on the understanding that the War Office would
call off its Recruiting Officers and leave the selection
of practitioners to the Committee.

Settlement

Returning to Edinburgh the Convener acquainted
the Committee of the acceptance which he had given.
The Committee concurred, added 20 to Scotland's
share, and undertook in ten weeks' time to raise 200
officers in levies of 20 per week. The War Office
thereupon cancelled the orders which had been pro-
ductive of discontent, and the unrest in Scotland
gradually subsided. In June 1917 the Committee had
to ask the Military Authorities to restrain the zeal of
Recruiting Officers, who were again preparing to make
a call on practitioners of military age. But in the end
the procedure current before 18 April was re-established
for a time.

The arrangements of the Central Medical War Committee in
England, being necessarily more complex than in Scotland, had
suffered a still more serious upheaval ; and the Central Committee
had on 25 April 1917 represented to the War Office that, failing
adjustment, it could not take any further part in the selection of
doctors for military service. On 25 April 1917 the Secretary of
State for War replied to the Central Committee that the former
procedure with regard to the selection of doctors would be
continued, and agreed not to give a commission to any doctor
except on the recommendation of the Central Committee.

1 1 8 Mustering of Medical Service in Scotland

58th General Hospital

One of the Hospitals established overseas in con-
sequence of the German campaign against hospital
ships was the 58th General Hospital. Owing to the
depletion of the Territorial Hospitals in Scotland
difficulty was experienced in supplying it with its full
number of officers. The Emergency Committee, by
request of the Deputy Director1 of Medical Services,
Scottish Command, nominated practitioners for appoint-
ment to the vacant posts.

The further progress and decline of the movement
for the mobilization of the medical profession, together
with the course of the events which ensued on the
issue of the calling-up notices to practitioners of
military age, filled the first half-year of 1917. The
principal operations of the British armies included
in the period were the advance to the Hindenburg
Line and the Battles of Arras and Messines 1917, the
First and Second Battles of Gaza, the occupation of
Baghdad and the Tenth Battle of the Isonzo. Other
momentous occurrences of the time were the abdication
of the Emperor of Russia, and the declaration of war
between the United States of America and the German
Government.

1 Surgeon-General J. C. Culling.

CHAPTER IX
1917. § 2

Employment of Medical Officers : Criticisms — Conclusion by
Emergency Committee — Committee on Medical Establishments
in France. — Draft of Officers. — Review of Exceptions Act,
1917 : Army Medical Boards — Select Committee. — Ministry of
National Service: C.M.S. Region of Scotland — Advisory
Medical Board. — National Service Medical Boards. — Re-
sumption of Commissions. — Medical Man-power. — Medical
Bureaux: Dundee — Edinburgh. — Exemptions 1917. — Close of
1917.

Employment of Medical Officers

IN the pursuit of its endeavours to secure for the
army a sufficient supply of medical officers, the
Emergency Committee from time to time had been met
by Criticisms that the Military Authorities, if they
would use their existing medical officers, would have
no need to ask for others ; and that the Emergency
Committee, so long as medical officers already in the
army were not turned to account, had no justification
for making further calls on civilian practitioners. The
contention put forward was usually founded on a stated
instance of a medical officer on service either waiting
for work, or inadequately employed, or holding an
unsuitable medical charge, or engaged on non-medical
duty.

The Committee, in frequent communication with the

War Office both by correspondence and by interview,

119

1 20 Mustering of Medical Service in Scotland

was able to obtain from that Department its observa-
tions on the general question and on any particular
cases adduced ; and on an occasion in 1915, as above1
narrated, it requested and received a definite official
pronouncement which it intimated to the Scottish
profession. The Committee accepted on the one hand
that the processes of war, as waged, were to some
extent wasteful of medical officers, inasmuch as the
medical establishments of armies required to be main-
tained in excess during the times of quiet in order
that there might be no shortage in the times of stress.
It believed, on the other hand, that many of the stated
instances of redundancy were authentic, and capable of
remedy ; and it had drawn the attention of the War
Office to alleged examples of uneconomical use of
medical personnel. The Committee's Conclusion on
the whole subject was that, while certain intervals
of comparative idleness for medical officers were
inevitable, it should not be impossible for the Military
Authorities, with suitable organization, to ensure that
most medical men, when employed, were employed on
medical duty appropriate to their experience. The
Committee was aware — and had informed 2 the profes-
sion— that it was the desire of the War Office that
suitable medical work should be provided. It appeared,
however, that under field conditions there was risk of
misappropriation of effort.

Balancing these considerations one with another, the
Committee saw no occasion to deviate from its policy
of urging upon medical men in Scotland the pressing
claims of the Army. It did not disguise that there
might be defects in the military machine, but it held
that no surmised imperfection should stand between
the practitioner and his duty to apply for a commission.
1 P. 38. 2 Pp. 43 and 44.

1 9 1 7- § 21 Establishments in France \ 1 \

The public, however, depending for its information
on hearsay and on tales which it could neither verify
nor disprove, became first suspicious and then con-
vinced that the Military Department was not making
adequate use of the medical practitioners who were
being withdrawn from their practices in such numbers.
Questions were asked in Parliament, and the feeling
generally became so strong that the War Office on
22 August 1917 appointed a Committee entitled the
Committee on Medical Establishments in France, with a
remit to proceed at once to France for the purpose of
inquiring into various matters connected with the
personnel and administration of the Army Medical
Services in that country, and on its return to carry out
similar investigations in the United Kingdom. The
Chairman of the Committee was a distinguished
soldier.1 Of the six remaining members one was
the Convener2 of the Scottish Medical Service Emer-
gency Committee ; and another was a distinguished
Scottish surgeon.3

The Report of the Committee on Medical Establish-
ments, which was duly presented, was not published
by the Army Council. It is understood that the
general sense of the Report was favourable to the
dispositions of medical personnel made by the Army
Authorities in France. Approbation, however, was
seasoned with judgment, and certain improvements
were suggested. It is believed that the recommenda-
tions of the Committee, excepting some regarded as
impracticable, were carried out. The Committee on
Medical Establishments did not investigate home
conditions, which were dealt with by another Com-
mittee in 1918.

1 Sir Francis Howard. 2 Dr. Norman Walker.

8 Mr. H. J. Stiles

1 2 2 Mustering of Medical Service in Scotland

Draft of Officers

Reference has been made to the circumstances under
which the Emergency Committee was reinstated in its
place as the civilian authority for medical recruiting in
Scotland. So reinstated, the Committee proceeded, in
accordance with the offer1 which it had made to the
War Office, to call up further practitioners, and was
able within the stipulated time to produce the two
hundred promised. Pursuing these and similar activities,
it renewed for a space that collaboration with the War
Office which had dated from the inception of the 1915
Scheme. This tie was now to be formally severed.

Review of Exceptions Act, 1917

The Military Service (Review of Exceptions) Act,
1917, which received the Royal Assent on 5 April 1917,
had given power, as already indicated, to review the
exception from military service of certain men excepted
under the Military Service Acts 1916. The men affected
were members of the Territorial Force not suited for
foreign service, men who had been discharged from the
Navy or Army in consequence of disablement or ill-
health, and men who had been previously rejected on
any ground. The Army Council, in terms of the Act,
called them up for medical re-examination.

The Army Medical Boards, which conducted the
examinations, were, with or without reason, dis-
trusted. Public confidence was not restored by the
creation of Special Appeal Boards, and a Select Com-
mittee2 of the House of Commons was appointed to

»P. 117.

1 Select Committee on Military Service (Review of Exceptions)
Act, 1917 (Mr. E. Shortt's Committee).

I9I7- § 21 National Service 123

inquire into the working of the Review of Exceptions
Act, with special reference to medical re-examination.
On 2 August 1917 the Select Committee advised that
the whole organization of Recruiting Medical Boards,
and of the medical examinations and re-examinations,
should be removed from the War Office and placed
under civilian control.

Ministry of National Service

The recommendations made by the Select Committee
were acted upon by the Government. The Department
of National Service, which had been inaugurated in
December 1916, was reconstituted under a Minister,1
entitled Director of National Service, to whom authority
was given to control not only the medical aspects of
recruiting, but also the whole question of man-power.

On i November 1917 the Ministry of National Service
assumed effective charge. Its status was civilian. Its
Departments included a Medical Department under a
Chief Commissioner2 of Medical Services. The prin-
cipal object of the Medical Department was the medical
examination by National Service Medical Boards of all
men of military age called up for such examination
under the Military Service Acts. Great Britain was
divided into ten areas, known as Regions, of which
Scotland was one. Each Region was under a Director 3
of National Service, and in each the Chief Commissioner
of Medical Services was represented by a Commissioner
of Medical Services, whose function it was to manage
and maintain the medical work of his Region.

The creation of the Ministry of National Service ter-
minated the original method of direct communication

1 Sir Auckland Geddes. 2 Sir James Galloway.

3 In Scotland, Mr. C. D. Murray.

1 24 Mustering of Medical Service in Scotland

between the War Office and the Emergency Committee.
The Medical Department of the Ministry now became
intermediary, being informed by the War Office of the
need of the Army for medical officers, and advised by
the Emergency Committee of the ability of areas to
supply them. In assuming office the Minister agreed
to honour existing arrangements between the Com-
mittee and the War Office, undertaking in consequence
not to call up for service, or sanction the grant of a
commission to, any medical man practising in Scotland
without reference to the Committee. These changes
touched the medical recruiting side of the Committee's
work only : its powers as the Central Professional
Committee for Scotland were, subject to necessary
adjustments, unaffected.

The cordial relations which had subsisted between
the Emergency Committee and the War Office con-
tinued between the Committee and the Ministry of
National Service. At an early period the Committee
had expressed to the Minister its readiness to make
itself useful in any way in its power under the new
arrangements for recruiting ; and the Minister, taking
the Committee at its word, had invited the Convener *
of the Committee to the position of Commissioner of
Medical Services for the Region of Scotland. The
Convener left the question of the action which he
should adopt entirely in the hands of the Committee,
which decided after careful consideration that it would
on balance be an advantage if he became Commissioner,
provided that he retained the office of Convener. The
Minister agreed to these terms, and the Convener ac-
cepted appointment. A member of the Committee, who
was in the Army but home from overseas sick, was,
pending full recovery, placed by the War Office at
1 Dr. Norman Walker.

1917- §21 National Service 125

the Convener's disposal, in order to assist him at the
outset in organizing Scotland under National Service.
When the Medical Department of the Ministry was
being shaped for the ends which it was to serve, the
Emergency Committee was consulted on the proposed
arrangements. In order to keep the Medical Depart-
ment in intimate contact with medical opinion, an
Advisory Medical Board was formed, being selected
from among distinguished medical men on the Pro-
fessional Committees, or otherwise of high standing.
The President1 of the Royal College of Surgeons,
Edinburgh, who was a member of the Emergency
Committee, was appointed to membership of the
Advisory Medical Board. Through all these channels
— but especially through the appointment of the Con-
vener as C.M.S. Scotland — there was close co-operation
by the Emergency Committee with the Ministry of
National Service.

National Service Medical Boards

A National Service Medical Board under the Medical
Department of the Ministry consisted at first of a
Chairman and four other members. The Chairman
was a whole-time officer of the Ministry, taken over
from the Royal Army Medical Corps to act in a civilian
capacity. The four other members were civilian
medical men, engaged in general or other practice and
employed by the Ministry on a part-time footing, a
plan which obviated the complete withdrawal of any
practitioner from his normal work, and so conserved
as far as possible the dwindling medical man-power of
the country. The practitioner members of Scottish
National Service Medical Boards were medical men of
1 Mr. J. W. B. Hodsdon.

1 26 Mustering of Medical Service in Scotland

recognized skill and standing whose names were con-
tained in rosters drawn up by the Emergency Com-
mittee for each Board at the request of the Ministry.
They were appointed by the Ministry. A man dis-
satisfied or aggrieved after examination by a Medical
Board might appeal to an Appeal Tribunal. The
Appeal Tribunal might order his examination by
Medical Assessors, who were appointed by the Secre-
tary for Scotland.

Resumption of Commissions

In December 1917 the following circular letter,
signed by the Secretary of the Ministry of National
Service, was sent to practitioners in Scotland, named
by the Emergency Committee to the Ministry :

I am directed to inform you that, with a view to maintaining
the required number of Officers in the Royal Army Medical Corps
consistently with the least disorganization of medical service
throughout the country, it is necessary to call upon all medical
practitioners of military age who have resigned, or may resign,
their temporary commissions on the expiry of an annual contract
on and after October 3ist, 1917, to resume their commissions.

This decision has not been arrived at without a very full con-
sideration of the medical needs of the civilian population on the
one hand and of the urgent requirements of the Army on the
other, as well as of the services which such officers have already
rendered. This proposal will not affect the customary privilege
which has hitherto been accorded to the profession, of laying any
difficulties, which individual practitioners may have in accepting
or resuming service, before a Committee of their professional
colleagues.

The Minister of National Service therefore urgently requests
that you will immediately place yourself in the hands of the
appropriate Central Professional Committee in order that within
the next fourteen days the Professional Committee may be put in
possession of the facts, which will enable it to determine whether
your services may again be placed at the disposal of His Majesty's
Government.

1917- §2] National Service 127

It was recognized by the profession that the military
situation furnished ample ground for the call issued
by the Minister. Scottish practitioners, who were
requested to place themselves in the hands of the
Emergency Committee, appreciated the consideration
shown for any difficulty in which they might be placed.
The terms of the letter were conform to the under-
taking of the Minister not to call up any Scottish
practitioner without reference to the Committee.

Medical Man-Power

In connection with a general survey of the man-
power resources of the Nation, it was necessary that
the Minister of National Service should be provided
with an Index showing the physical fitness of medical
practitioners of military age in England and Scot-
land, irrespective of whether they had or had not
already served in the Royal Army Medical Corps.
The Minister therefore decided that such practitioners
should receive notice to attend for examination and
grading by National Service Medical Boards. When
consulted by the Minister on this decision, the Com-
mittee represented that a certain number of practitioners
of military age in insular and remote areas of Scotland
would find difficulty in making arrangements to attend
for examination at a distance and, if found fit when
examined, would be unable, owing to local needs, to
be withdrawn from civil work. It advised that these
practitioners should not receive notices. The Minister
concurred, and the notices relating to Scotland were
accordingly addressed, as at December 1917, to
practitioners in a selected list, prepared by the Com-
mittee, from which the names of practitioners situated
as described had been excluded.

128 Mustering of Medical Service in Scotland

Medical Bureaux

An account J was published during 1917 showing
the continuous successful working of Dundee Central
Bureau which had been inaugurated as an Emergency
Medical Service in August 1914. Dundee, prior to the
outbreak of war, was numerically under-equipped with
general practitioners, and the withdrawal of those who
had subsequently joined the Forces had aggravated the
initial shortage. Under these conditions the Bureau
would appear to have proved itself of special value.
The account set forth that the proportion of work per
patient was less than in normal times, and referred to
the generous provision of accommodation by Dundee
Royal Infirmary. It concluded with these words:

The doctors in Dundee have no doubt as to the economy in
the working power of the doctors which has resulted from the
establishment of the service.

In consequence of the reduction which had taken
place in the medical strength of Edinburgh, it was
decided by local organizations in 1917 that centres
should be set up for medical purposes. Emergency
Bureaux were established in the city, each with two
practitioners in attendance. Consultations were given
and messages received in respect of insured persons.

Exemptions 1917

Of the 107 claims for the exemption of practitioners
from military service which were dealt with by the
Emergency Committee during 1917, two were put
forward by Local Tribunals and the remainder by
practitioners whose names were included in the Com-

1 Dr. R. C. Buist in British Medical Journal, 1917, vol. i.
Supplement, p. 134,

1917- § 2] Exemptions 129

mittee's War Register. Of the 107 practitioners, 30
were in the Glasgow Division, 17 in Lanark, 8 in
Renfrew and Bute, 7 in Dundee, 6 in Ayr, 5 each in
Edinburgh and Leith and the Lothians, 4 each in
Aberdeen, Dumbarton, Fife and Perth, 3 in Dumfries
and Galloway, 2 each in Caithness and Sutherland,
Stirling and Zetland, and i each in Argyll, Banff,
Elgin and Nairn, Ross and Cromarty and the South-
East.

Fifty-six of the 107 applicants were exempted, one
absolutely, 49 conditionally and 6 temporarily. Ex-
emption was refused to 51.

During- 1917 certain changes of personnel were experienced by
the Emergency Committee. A practitioner1 resident in Musselburgh
was appointed to the vacancy created by the death of the former
Chairman2 of the Scottish Committee of the British Medical
Association. The President3 of the Scottish Association of
Medical Women was co-opted to membership of the Committee.
It was resolved that the President4 of the Royal College of
Surgeons, Edinburgh, on the expiry of the term of his Presidency
and therefore of his ex-officio membership of the Committee,
should, in view of the value of his services to the Committee,
become a co-opted member.

On 8 December 1917 the Convener5 of the Emergency Com-
mittee submitted to the Committee that his tenure of the appoint-
ment of Commissioner of Medical Services for the Region of Scot-
land in the Ministry of National Service, in which capacity it
would be his duty, where necessary, to enforce the provisions of
the Military Service Acts against medical practitioners of military
age, rendered it undesirable that he should at the same time con-
tinue to hold the position of Chairman of the Central Professional
Committee for Scotland, which adjudicated on claims advanced by
practitioners for exemption from the statutory provisions referred
to. He therefore tendered his resignation of the Chairmanship of
the Central Professional Committee, which the Committee, on the

1 Dr. A. D. R. Thomson. 2 Dr. J. R. Hamilton.

8 Dr. Laura S. Sandeman. <Mr. J. W. B. Hodsdon.

8 Dr. Norman Walker.

130 Mustering of Medical Service in Scotland

advice of its Legal Assessor, accepted. The ex-President1 of the
Royal College of Surgeons, Edinburgh, co-opted to membership
of the Emergency Committee as at 18 October 1917, was elected
Chairman of the Central Professional Committee for Scotland.
The Convener remained Convener of the Emergency Committee.

Close of 1917

The year 1917 saw the Emergency Committee de-
tached from its intimate association with the War
Office, and linked, but not fettered, for administrative
purposes, to the Ministry of National Service, which
fully accepted the status of the Committee as a
voluntary and independent body. The Committee
computed that at the close of the year — by which time
the Cambrai operations of 1917 were concluded, the
twelfth Battle of the Isonzo was past and Jerusalem
had been taken — Scotland had contributed to His
Majesty's Forces about 2200 medical men.
»Mr. J. W. B. Hodsdon.

CHAPTER X
1918. § i

Medical Vacancies : Local Government Board. — Military Service
Act 1918. — Central Professional Committee for Scotland.
Exemptions 1918. — German Offensive 1918. Resump-
tion of Commissions. — Medical Policy. — Military Service
(No. 2) Act 1918 : Lay Community — Medical Men. — Medical
Practitioners Regulations 1918: Medical Tribunal for Scot-
land — Procedure of Medical Tribunal. — Two Claims on
Profession : Military — Civilian. — Military Age. — Approved
Civilian Service : Relation to Substitutionary Medical
Practice — Relation to Non-medical Military Service. — Situa-
tion Reviewed : Substitution by Transfer. — 1918 Scheme :
Inauguration — Eighth Memorandum — Reconstitution of War
Committees. — 1918 Scheme : Operation. — Medical Examina-
tion and Grading — New War Register — Groups of
Practitioners — Substitute Practice. — Financial Guarantees. —
Call of Grade I. Practitioners.— 1918 Scheme: Out-put.—
Armistice.

Medical Vacancies

IT had been a principal object of the Emergency Com-
mittee, from its origination, to safeguard the home
interests of serving medical officers by trying to keep
their Civil Practices in being during their absence.
This end was sought to be promoted by the aid of
neighbouring practitioners, or by the employment of
locum tenentes under bond not to start independent
work in the locality. As the war continued, however,
and the depletion of areas increased, openings were
created in a number of districts where unestablished

132 Mustering of Medical Service in Scotland

medical men might settle. In certain cases such a
settlement might be proper enough ; in others it would
have been opposed to the general welfare and unjust to
officers with the Army. The Committee in 1918 caused
intimation to be made that no doctor should set up
practice in Scotland without previous consultation
with it.

Medical posts in the Public Services, vacated by
officers on duty with the Forces, were filled at first on
a provisional basis by the Local or other Authorities
concerned ; but with the lapse of time a tendency
developed to make such appointments substantive.
Especially in the case of new posts, or posts finally
relinquished for any cause, the temptation to Authori-
ties to make permanent settlements was strong, despite
the fact that this course was inconsiderate of serving
officers who might otherwise have been suitable
candidates. The Committee deprecated procedure on
these lines, and was opposed in particular to permanent
appointments being given to practitioners of military
age, unless in special circumstances. Early in 1918,
by its Convener, it placed its views before the Local
Government Board for Scotland as the Central Depart-
ment most influential in the matter.

The Local Government Board were cordial to the
representations made. The question of temporary
public appointments had already engaged their atten-
tion. Prior to the war, grants in aid of the salaries of
medical officers appointed by Local Authorities to
certain posts had not been sanctioned by the Board
unless on a permanent footing. Under war conditions,
however, the Board had decided that this plan should
be departed from, as not being in the public interest,
since it held out inducements to Authorities to make
permanent appointments from an abnormally limited

1918. § i] Military Service Act 1918 133

field. The Board had accordingly announced by
Circular of March 1915 that contributions would be
paid in the case of interim appointments for such period
as the Board might sanction.

The Board were prepared to take such further steps
as might be competent for them, in order to secure that
medical officers serving with the Army should not be
prejudiced during their absence, in respect of posts
for which, on their return to civil life, they might be
held eligible.

Military Service Act 1918

The Military Service Act 1918, which received the
Royal Assent on 6 February 1918, was an Act to pro-
vide for the cancellation of certificates of exemption
from military service granted on occupational grounds.
Subject to its provisions it gave power to the Minister
of National Service to withdraw any such certificate at
any time by Order. The operation of the Act greatly
augmented the work of the Ministry of National
Service, especially in the examination of coal miners,
munition workers, and other classes now called up for
military service, and made correspondingly increased
demands on the practitioners of the country, who
manned the National Service Medical Boards. The
Emergency Committee co-operated with the Ministry
in arranging for the additional Boards required, while
making at the same time reasonable allowance for the
needs of medical practice.

Central Professional Committee for Scotland

Under the Military Service (Professional Committees
Regulations) Order1 of 1916, and the Amending
'P. 84.

134 Mustering of Medical Service in Scotland

Order1 of 1917, the appointment of a Central Professional
Committee for Scotland was by approval of the Army
Council, and the Emergency Committee held office as
the Central Professional Committee for Scotland under
the recognition of that body. Owing to the transfer-
ence to the Ministry of National Service, under the
Ministry of National Service Order 1917, of certain
of the powers and duties of the Army Council, the
Military Service (Professional Committees Regulations)
Orders of 1916 and 1917 were no longer applicable,
and an adjustment of the position of the Central Pro-
fessional Committees was required. The necessary
adjustment was made by the Military Service (Pro-
fessional Committees Regulations) Order 1918, dated
22 March 1918, which placed the appointment of a
Central Professional Committee for Scotland under the
approval of the Minister of National Service, and em-
powered the Minister to approve as the Central
Professional Committee for Scotland any existing
Professional Committee which had been recognized
and approved by the Army Council. The Minister
recognized the Emergency Committee as the Central
Professional Committee for Scotland, conveying his
recognition to the Committee by letter of 25 March
1918.

Exemptions: 1918

Between i January and 18 April 1918 the Committee
disposed of 23 claims for the exemption of practitioners
from military service. None of the claims was sub-
mitted by a Local Tribunal to the Committee as the

1 The Military Service (Professional Committees Regulations)
Amendment Order 1917, which permitted an increase of member-
ship above 25, allowed sectional sittings and empowered the
election of a vice-chairman,

19 1 8. § i] British Casualties 135

Central Professional Committee for Scotland ; all were
advanced in respect of practitioners registered in the
Committee's War Register, and were dealt with by the
Committee as the Emergency Committee. Seven of
the applications were derived from Glasgow, 6 each
from Edinburgh and Leith and Lanark, and i each
from Ayr, Dumbarton, Dundee and the Lothians.
Six of the practitioners received conditional exemption,
and 3, who were duly qualified medical practitioners
engaged in the practice of dentistry, were referred to
the Dental Service Sub-Committee, appointed by the
Minister of National Service. To 14 practitioners
exemption was denied.

German Offensive: 1918

The German offensive in Picardy began on 2 1 March
1918, and the British Armies, facing it with stubborn
heroism, sustained heavy casualties. The treatment
and disposal of large numbers of wounded made
exacting demands on the Royal Army Medical Corps,
itself suffering from many losses. On 22 March the
Ministry of National Service advised the Emergency
Committee that there was urgent need for medical
reinforcements, and the Committee at once called up
50 practitioners from Scotland.

Resumption of Commissions

On 27 March the Ministry intimated to the Committee
that all practitioners who had relinquished medical com-
missions during the war and who could, in the opinion
of the Committee, be spared from civilian practice should
be requested to report at the War Office for service at
the earliest possible date. The Committee immediately

136 Mustering of Medical Service in Scotland

notified those Scottish practitioners who were eligible
under, the conditions stated, urging that they should
straightway render the assistance which the Armies in
France had need of. Out of 15 practitioners notified,
9 were posted in April 1918, 2 in July and i in August.
Three do not appear to have reported for service.

Practitioners volunteering at this hour of special
crisis, as distinguished from the practitioners circular-
ized J by the Ministry of National Service in December
1917, were accepted on the understanding that they
would not necessarily be held as contracting under the
current Terms of Service.2 Their engagements would
be subject to review, either on personal grounds or in
consideration of local requirements, at the end of the
special crisis or in six months' time at the latest ; and
they would then, if possible, be released. They would
not, however, assume that they had received an uncon-
ditional promise of release. If the Ministry of National
Service, after consultation with the Emergency Com-
mittee, should come to the conclusion that the situation
warranted an extension of their military service, they
would remain for a further period in the Army. The
offer to take medical officers on emergency terms was
open in Scotland for thirteen days. It was withdrawn
as from 9 April 1918, the day on which Germany turned
aside to deliver an offensive in Flanders.

Medical Policy

By means of a Military Service Bill now in course of
preparation it was the purpose of the Government to
call upon the medical profession of the country to serve
in the Army at a higher age than laymen, and, under
given conditions, to carry on civilian practice, when and
>P. 136, aP. 113.

1918. § i] Policy 137

where directed. On 5 April 1918, before the Bill had
been presented to Parliament, the Ministry of National
Service invited the opinion of the Emergency Com-
mittee on the medical aspects and policy of the Bill.
The views of the Committee on points placed before it
were as undernoted :

The Committee agreed with the Ministry that, in the event of
many practitioners hitherto exempt on the ground of age being
made liable to military service, the policy of the Government in
utilizing them should be directed to two main objects, (i) to set
free the young and fit for service as medical officers in the Forces,
and (2) to maintain the efficiency of the medical care required for
the civilian population. It had been the practice of the Committee
itself, throughout its existence, to act in accordance with this
policy.

With regard to the methods by which it might be possible to
provide for both military and civilian work, the Committee was
averse to the commissioning of practitioners as military medical
officers, to be redistributed under orders by the military authorities
for the purpose of undertaking military service together with
such civilian medical practice as might be thought expedient.
It favoured, on the contrary, a plan of agreed action by the
medical men concerned, with a view to co-operation and substitu-
tion, subject to any compulsory powers to be furnished by the
Bill.

The Committee concurred with the Ministry that, as the medical
problem for the Government was the proper distribution of the
medical personnel of the country, the establishment of substitu-
tionary medical practice appeared to be unavoidable.

The Committee was of opinion that in all cases of substitutionary
medical practice there should be a guarantee against financial loss
to the practitioner acting as substitute. Such a guarantee would
materially lessen the difficulties which had so far stood in the way
of effective substitution.

Asked by the Ministry whether it would be possible, in areas
where there were known to be numbers of young practitioners fit
for general service, rapidly to establish a scheme of co-operative
or organized rearrangement of civilian medical practice having for
its object the liberation of the young practitioners for the Army,
the Committee said tha.t such a. scheme could be made a success if

138 Mustering of Medical Service in Scotland

it received the support of the medical profession in the area in
which it was set up.

The Committee suggested to the Ministry that legislative pro-
vision should be made for dealing with medical practitioners whose
applications for commissions in His Majesty's Forces had been
rejected on grounds of health or on other considerations, or whose
commissions had been terminated by discharge. It should be so
enacted that practitioners in these groups should be at the disposal
of the Professional Committees in order that they might be held
liable to render such civilian medical services as might be con-
sidered within their power. The Committee was satisfied that the
services which could be so rendered would be of considerable value,
since many of the practitioners in question were capable of doing
a full day's civil work.

The foregoing expressions by the Committee were
general pronouncements on a Bill which was expected
to apply to the whole of Great Britain, and possibly
Ireland. In Scotland, so far at least as military service
was concerned, the great majority of suitable practi-
tioners, irrespective of age, were either already in the
Army, or were, in terms of their War Registration,
awaiting the summons to serve.

Military Service (No. 2) Act 1918

The Military Service (No. 2) Act 1918, which was
passed on 18 April of that year, made certain provisions
for the military service of the lay community, and cer-
tain differential provisions for the medical profession.

For the Lay Community it was laid down by
Section i (i) that every British male subject who had
at any time since 14 August 1915 been, or who for the
time being was, in Great Britain, and who at 18 April
1918 was between the ages of 18 and 50 inclusive, or
who at any subsequent date attained the age of 18 was,
subject to exceptions, as from 18 April 1918 or subse-
quent appropriate date, deemed to have been duly

1 9 1 8. § i ] Military Service (No. 2) Act 1918 139

enlisted in His Majesty's regular forces for general
service with the colours, or in the reserve for the
period of the war, and to have been forthwith trans-
ferred to the reserve.

For men generally, or any class of men, the military
age by Order in Council might be raised to any age up
to and including 55 (Section i (i), proviso («)).

His Majesty might, by Proclamation declaring that a
national emergency had arisen, direct the withdrawa
of certificates of exemption, with certain specified
exceptions (Section 3(1)).

The Secretary for Scotland might make regulations
for the constitution of tribunals to receive applications
for or relating to certificates of exemption, including
appeals, and for the establishment of special tribunals,
committees or panels for dealing with particular classes
of cases (Section 4(1)).

Every man exempted by a tribunal after 30 April
1918, unless the tribunal otherwise directed, was liable,
under prescribed conditions, to join the Volunteer
Force and remain an effective member of that Force
during the currency of his certificate of exemption
(Section 4 (6)).

The differential provisions for Medical Men hinged
on Section i (i) proviso (#), by which the medical
military age was fixed as up to and including 55, as
contrasted with 50 for men generally. While the
additional burden, or part of it, might be imposed on
the layman by Order in Council — which required
to be placed in draft before each House of Parlia-
ment, and which might only be submitted to His
Majesty if each House presented an address to His
Majesty praying that the Order might be made — a
duly qualified medical practitioner was directly liable
under the Act,

140 Mustering of Medical Service in Scotland

Medical Practitioners Regulations 1918

The medical profession, thus disjoined by the Act
from the general body of citizens, formed one of the
particular classes of cases to be dealt with by specia'
tribunals, and the Secretary for Scotland,1 as em-
powered by Section 4(i)(£) of the Act, proceeded
accordingly to make regulations, which were sub-
mitted in draft to the Emergency Committee and
generally approved. The Military Service (Medical
Practitioners) Regulations, 1918, replacing as from
23 May 1918, the Military Service (Professional Com-
mittees Regulations) Order 1918,2 prescribed that there
should be a special tribunal for Scotland, entitled the
Medical Tribunal, for dealing with applications for the
granting, renewal or review of certificates of exemption
to practitioners in Scotland.

The Medical Tribunal was to consist of members
representative of the medical profession, appointed by
the profession in a manner approved by the Director
General of National Service. Any existing Professional
Committee, recognized under the Military Service
(Professional Committees Regulations) Order 1918,
might, if the Director General of National Service so
decided, be a Medical Tribunal.

The Director General 3 of National Service, by letter
of 19 June 1918, conveyed to the Emergency Committee
his decision to constitute the Emergency Committee —
recognized by him by letter dated 25 March 1918 under
the Military Service (Professional Committees Regula-
tions) Order, 1918 — as the Medical Tribunal for Scot-
land. The Convener4 of the Emergency Committee
was appointed Chairman of the Medical Tribunal.

1 The Rig^ht Hon. Robert Munro. ' P. 134.

1 Sir Auckland Geddes, 4 Dr. Norman Walker,

1918. § i] Medical Tribunal for Scotland 141

He was still Scottish Commissioner of Medical Services
in the Ministry of National Service, but in the changed
circumstances he agreed to accept office. The Regius
Professor1 of the Practice of Medicine of the Univer-
sity of Glasgow was appointed Vice-Chairman of the
Tribunal ; and the Secretary 2 of the Emergency Com-
mittee, Clerk.

The Procedure of the Medical Tribunal for Scotland
was prescribed by the Medical Practitioners Regula-
tions to be substantially as follows :

Subject to the Regulations, an application to the Medical
Tribunal for a certificate of exemption might be made by a medical
practitioner himself or in respect of him, but if made by some
other person on his behalf might not be entertained by the
Tribunal unless the practitioner joined in the application.

By Regulation 13 an application for exemption might be made
to the Medical Tribunal on any of the following grounds :

(a) On the ground that it was expedient in the national interests
that the practitioner should, instead of being employed in military
service, be engaged in other work in which he was habitually
engaged, or in which he wished to be engaged, or if he was being
educated or trained for any work, that he should continue to be
so educated or trained.

(b) On the ground that serious hardship would ensue if the
practitioner were called up for Army Service, owing to his
exceptional financial or business obligations or domestic position.

(d) On the ground of a conscientious objection to the under-
taking of combatant military service.

Ground (a) was defined as the occupational ground, and grounds
(i), (c) and (d) as personal grounds. The occupational ground
and the first two personal grounds, but not the ground of con-
scientious objection, had been due to be considered by the
Emergency Committee as the Central Professional Committee for
Scotland.

By Regulation 17 an application for exemption might not be
entertained by the Medical Tribunal until after the dispatch to
the practitioner concerned of an individual notification by the

1 Prof. T. K. Monro. 8 Mr. T. H. Graham.

142 Mustering of Medical Service in Scotland

Director General of National Service, specifying the time for
making- the application.

By Regulation 24 a certificate of exemption granted by the
Medical Tribunal might be absolute, conditional or temporary.
A certificate granted on occupational grounds was required to be
subject to the condition that the practitioner should undertake
such professional service, and under such conditions, as the
Director General of National Service might, after consultation
with the Medical Tribunal and in concert with any Government
Department concerned, from time to time deem best in the national
interests. The same condition might, in the discretion of the
Tribunal, be applied to a certificate granted on personal grounds.

By Regulation 25 it was competent to the Medical Tribunal to
direct that an exempted practitioner should not be liable to join
the Volunteer Force.

In occupational cases, by Regulation 29, the decision of the
Medical Tribunal was final. In personal cases the Medical
Tribunal might give leave of appeal to the Central Tribunal.
The decision of the Medical Tribunal with regard to leave of
appeal was final.

The Regulations in general applied to voluntary
attested practitioners, and practitioners registered in
the War Register of the Emergency Committee, as
well as to other practitioners.

Two Claims on Profession

Thus the Military Service (No. 2) Act 1918 and the
Medical Practitioners Regulations, taken together,
made two claims on the medical profession, each of
which went beyond what was exacted from the general
body of citizens. The military claim was for service
up to 55, instead of 50 ; this was a difference in degree.
The civilian claim introduced a new provision, that of
vocational control ; this was a difference in principle.
On the other hand, the concession made by the War
Office in 1915, and renewed under the Military Service
Act 1916 (Session 2), that medical destinies should be

1918. § i] Five Added Years 143

under medical charge, was continued and extended by
the appointment of a Medical Tribunal for Scotland to
deal with all claims by medical men.

Military Age

The military claim for five added years was viewed
askance by a few Scottish practitioners. Before the
Bill became law two resolutions had been adopted by
medical men in Edinburgh, disapproving of the apparent
intention of the Government to treat the profession on
a different age-footing from other classes. An Edin-
burgh correspondent l writing to the medical press in
May 1918 suggested that it would have been better, as
involving less strain on the profession, if the War
Office had offered commissions for a limited period to
practitioners up to 60 or 65. Another Edinburgh
correspondent2 writing at the same time, maintained
that it would have been wiser to refrain altogether
from lixing an age-limit as applied to doctors. But
the attitude of Scottish practitioners in general was
unconcerned. To most the age of compulsory military
service was of no practical interest. They had long
since registered with the Emergency Committee their
willingness to join the Army ; and up to 55 — or any
higher age — they held themselves in readiness, when-
ever called upon, to fulfil their undertaking.

There was some speculation whether the claim for
five added years injured medical prestige. One of the
correspondents referred to above looked upon it as a
slight. To a medical Member of Parliament,3 speaking
in the House of Commons, it seemed an honour. The
Emergency Committee in its Eighth Memorandum4

1 British Medical Journal, 1918, i. p. 520. z Ibid.

8 Sir W. Watson Cheyne. 4 P. 149.

144 Mustering of Medical Service in Scotland

thought the new provision honourable. The question,
which was essentially one of feeling, was not to be
settled by argument. It was disposed of, in so far as
it was possible to dispose of it, by the following words
of the President1 of the General Medical Council, spoken
in May 1918 :

The particular mode of meeting the situation, now adopted by
Parliament, may not be that which all would favour. But we
shall do well to accept it as an honour that, as we are held
capable of a unique form of service to the State, so we are charged
with a heavier responsibility than others.

Approved Civilian Service

The civilian claim, for such approved civilian medical
service as the Director General of National Service
might deem best, was discussed, in the medical press
and elsewhere, as a form of vocational compulsion. It
is true that it involved the application to civilian
practitioners under prescribed conditions of a measure
of vocational control. Strictly, however, it was not
compulsion, since it could not be enforced.

If a practitioner, being called for military service,
was prepared to join the Army, no question of his
rendering approved civilian service could arise. If, on
the contrary, being called up, he applied to the Medical
Tribunal for exemption on occupational grounds, he
received exemption only on the condition that he under-
took approved civilian service. To an exemption on
personal grounds also the same condition might be
attached. If, being exempted on the condition in-
dicated, he failed to comply with the condition, his
exemption lapsed and he again became subject to
military service under the Military Service Acts. But
1 Sir Donald MacAlister.

1918. § i] Alternative Courses 145

he could not be compelled to give approved civilian
service. He had the Army as an alternative.

Military service under the Acts was general service
with the colours. A practitioner called to serve could
not demand as of right, and expect to receive, a com-
mission in the Royal Army Medical Corps. He might be
posted to any unit as a private soldier. In the view of the
Ministry of National Service, expressed in a statement1
of May 1918, it could no longer be said, in the existing
national emergency, that the service of doctors could
not economically be utilized in the Armed Forces in
other than a medical capacity, and that doctors not
required in the Army in that capacity must therefore
always be retained in civil practice. If some of the
doctors in a particular district could in fact be spared
without substantial detriment to the population of that
district, it might be that such of them as were not
needed for commissioned medical service in any of the
Armed Forces could better serve the country at the
existing juncture in some non-medical capacity in the
Army than by continuance in the civil work in which
they were engaged at the time.

It was to be presumed that the Government, being so
minded, in dealing with a practitioner called to military
service as surplus to the needs of his area, would, if he
did not receive a medical commission, expect him
to serve without one. While, therefore, it was open to
any practitioner who had a general antipathy to
approved civilian service, or who found himself set
to some disliked civilian task, to turn to the Army
for refuge, he would take this course with a clear
understanding that he might be consigned to the
ranks.

1 Ministry of National Service. Statement to Members of the
Medical Profession. M. N. S. R. 6 1 ,
IO

146 Mustering of Medical Service in Scotland

Approved civilian service included, and was for
most purposes equivalent to, Substitutionary Medical
Practice undertaken with the view of liberating1 for
military service young and fit practitioners who were
otherwise indispensable in their districts. It was rated
by the Ministry of National Service, in the official
Memorandum, as intermediate in national importance
between commissioned medical service in the Royal
Army Medical Corps and non-medical military service
by practitioners. Its utility had been recognized before
this time by the Emergency Committee, which had
described the coming forward of older practitioners to
free their juniors for the Army as vicarious military
service.1 The Committee had concurred2 with the
Ministry in regarding substitute practice as a necessary
factor in any scheme of medical reorganization which
might now be projected under the stress of war.

On the subject of Non-medical Military Service by
practitioners, however, the Committee did not share
the views of the Ministry. The Committee had pre-
viously 3 had the question under notice and had come
to the conclusion that, while the posting of a medical
practitioner to the ranks might be warranted in some
cases as a penal measure, it had at the same time the
grave defect that it deprived a civil area of its doctor
without adding a medical officer to the Army. To this
conclusion, so far as its own territory was concerned,
the Committee still adhered, believing that over Scotland
generally, owing to the reduction of medical man-power,
the public interest would be better served by permitting
practitioners to carry on their own practices than by
forcing them into the ranks of the Army. The fact
that non-commissioned service could be demanded in
the last resort might be utilized as a compulsitor in
I p. 34, «P. 137. » Pp. 78 and 114.

1918. § i] 7^ransfer 147

special cases where there was a special duty to under-
take substitute practice.1

Situation Reviewed

The Committee in the past, proceeding on a voluntary
plan, had succeeded in equipping the Fighting Forces
with Scotland's full share of medical officers. It had
every confidence still, that, continuing on a voluntary
plan, it would once more be able to meet the require-
ments of the Army. Its War Register contained the
promise of every suitable Scottish practitioner that he
would take a commission when offered. Substitutionary
arrangements, in the increasing stringency, would pre-
sent a more serious problem, but with the co-operation
of its War Committees and of the profession the Com-
mittee believed that such arrangements could be
adequately made.

Practitioners were by this time well accustomed to
local substitution in the conduct of vacated practices by
neighbouring colleagues in the same area. Substitution
by Transfer of a medical man from one area to another
was a new expedient. It would as a rule require to be
put in operation for the relief of country practices
involving attendance on insured persons under the
National Insurance Acts, and it was on that account

1 This paragraph conveys the collective feeling of the Emerg-
ency Committee on various points arising in connection with
the somewhat difficult subject of non-medical military service.
At the Annual Representative Meeting of the British Medical
Association held in London in July 1918, Dr. John Stevens, a
Member of the Emergency Committee, moved, as an amendment,
that no medical man should be conscribed into the ranks unless he
had refused to take a commission. The amendment, which was
seconded and discussed, was lost.

148 Mustering of Medical Service in Scotland

regarded with disfavour by Scottish practitioners, not
engaged in Insurance practice, who were opposed to the
contract basis of the current Medical Benefit arrange-
ments. The Committee noted the point at issue and its
bearing on the problem of the hour.

To the Scottish profession as a whole substitution
by transfer was not attractive ; it was the prosaic duty
of the Committee's Second Memorandum,1 as con-
trasted with service in the field ; the Committee,
however, felt assured that, when the need was realized,
practitioners would resign themselves to be transferred,
and that the Committee itself, if entrusted with the
task, would be able to procure from among the pro-
fession, especially in the large towns, a sufficiency of
substitutes for all purposes.

1918 Scheme: Inauguration

To achieve this object the Committee desired to act
on a selective plan, calling up practitioners, some of
whom would pass into the Army, while others, seeking
and receiving exemption, would undertake the duty of
approved civilian service. It appeared to the Com-
mittee that a Scheme of personal selection would be
better suited to Scotland than the more comprehensive
methods to be adopted in England.2 At a meeting of
the Committee on 13 May 1918, at which were
present the Chief Commissioner3 of Medical Services
of the Ministry of National Service, the Commissioner4
of Medical Services, Region of Scotland, the Director 5

1 P. 20.

8 The Standard Exemption under the English procedure, and
the Certificate of Protection, identical in terms and effect with it,
were not current in Scotland.

9 Sir James Galloway. 4 Dr. Norman Walker.

6 Mr. C. D. Murray.

1918. § i] Eighth Memorandum 149

of National Service, Region of Scotland and a repre-
sentative l of the Secretary for Scotland, the Chief
Commissioner indicated to the Committee that it was
intended to leave the selection of doctors for the Forces
in the Committee's hands. The Committee in these
circumstances approached the Ministry with proposals
for its 1918 Scheme under which the Committee would
be responsible for the recruiting" of the medical pro-
fession in Scotland, for both military and civil pur-
poses. The Scheme was approved by the Ministry.

As a preliminary step to the 1918 Scheme the
Committee issued to the members of the medical pro-
fession in Scotland its Eighth Memorandum^ of date
22 May 1918, on the Reconstitution of War Committees.
The Memorandum recalled the changes which had
taken place in the position of the Emergency Com-
mittee, War Committees and the profession since 1915
when War Committees came into being. It referred
to the passing of the Military Service (No. 2) Act 1918,
and to the extension of the age of compulsory military
service for lay citizens to 50, and for medical men —
thus honourably placed on the right of the line — to 55,
as well as to the question of civil substitution, raised
by the Medical Practitioners Regulations. And it
proceeded :

In 1915, when local medical War Committees were first
appointed, the position was, as already noted, different from that
now existing, and it cannot be assumed that the Committees then
chosen will be the best for present requirements. Yet the work
which falls to be carried out in the immediate future by these
Committees will be most exacting and most important, and
before they proceed to take it up it is essential to ensure that they
are, beyond question, fully representative of the professional
interests in their areas. Committees at this juncture therefore

1 Mr. A. H. B. Constable.

150 Mustering of Medical Service in Scotland

should go back to their constituents, and should be reconstituted
in such a manner as to make it certain, in the light of the present
crisis, that all local shades of opinion which need representation
have in fact been represented. This is the view of the Minister
of National Service, with whom the Emergency Committee as a
portion of the war machine now works in co-operation.

The Secretary of the local medical War Committee of your
area has accordingly been instructed to call a meeting of the whole
profession in your area in order to reconstitute the local medical
War Committee along the lines above suggested. ... It is your
duty to attend.

The local War Committees of important and
populous Divisions were reconstituted in terms of the
Memorandum. In the more sparsely inhabited
Divisions no change of personnel was necessary or
practicable.

1918 Scheme; Operation

The first step in the Scheme proper was the Medical
Examination and Grading of medical practitioners of
military age under the Military Service (No. 2) Act
1918. The examinations were carried out by Special
Medical Boards of the Ministry of National Service,
working under arrangements intended to obviate un-
necessary delay or inconvenience for those called up to
be examined. Practitioners who had already pre-
sented themselves for examination by ordinary National
Service Medical Boards were not, except in special
circumstances, required to be re-examined. Any
practitioner dissatisfied with his grading by a Medical
Board of the Ministry might apply to an Appeal
Tribunal J for permission to be medically examined
by the Medical Assessors. On the right of appeal of
a medical practitioner on a question of grading there
were no prescribed restrictions like those laid down
1 P. 126.

1918. § i] New War Register 151

by Regulation 29 of the Medical Practitioners Regula-
tions with regard to a decision of the Medical Tribunal
on an application for exemption from Military service.

The Committee, in accordance with an understanding
arrived at with the Ministry of National Service, pro-
ceeded to rewrite and in some respects to elaborate its
War Register begun to be compiled at the close of
1915. The New War Register exhibited for every
Scottish practitioner his name, age, medical qualifica-
tion and date, address, area, medical class, details of
civil work, physical grade, war service record and other
relevant particulars.

On the basis of the New War Register the Committee
divided Scottish practitioners not already in the Fight-
ing Forces into three Groups with respect to their
age and circumstances. In the matter of age the
dividing line was the upper limit of the medical military
age as determined by the Military Service (No. 2)
Act 1918. In the matter of circumstances — regarding
which the Committee consulted the War Committees
concerned — the criterion was the standard of local
depletion in its relation to the estimated utility of the
practitioner as a medical officer in the Army or as a
transferable substitute for civilian work. The three
groups were as noted hereunder.

GROUP A.— Practitioners up to, and including 55 : able to be
spared and deemed likely to be useful as medical officers or
civilian substitutes. Eligible under the Scheme.

GROUP B. — Practitioners up to, and including- 55 : unable to be
spared or deemed unlikely to be useful as medical officers or
civilian substitutes. Ineligible under the Scheme.

GROUP C. — Practitioners over 55 : not liable to military service.
Ineligible under the Scheme.

The Committee resolved that calls to service
should be issued to practitioners in Group A. only,

152 Mustering of Medical Service in Scotland

and notified the Ministry of National Service to that
effect.

The position of practitioners under the 1918 Scheme
with respect to Substitute Practice was kept in mind by
the Committee. By the Medical Practitioners Regula-
tions the duty of civilian service enjoined by the Medical
Tribunal as a condition of exemption on occupational
grounds was not open to appeal ; but, in order that
every consideration might be extended to practitioners
with regard to the class of civilian service which they
might be instructed to render, the Committee adopted
a resolution that, in the event of a practitioner who
had been granted temporary exemption on occupational
grounds being subsequently called upon for service of
any kind, he would be afforded an opportunity of
stating his circumstances to the Committee if he so
desired. The Committee confidently expected that
any arrangements for transfer which might be
necessary would be able to be made by voluntary
agreement.

Financial Guarantees

The Committee had already expressed its opinion
that the provision of financial guarantees to practi-
tioners called upon to undertake substitute practice
was a proper condition of any scheme involving
approved civilian service. The question, in relation to
the Committee's 1918 Scheme, was the subject of a
meeting between the Committee and the Liaison
Officer1 of the Ministry of National Service, who placed
before the Committee a scale of payments for sub-
stitutes, ensuring to them in general a rate of re-
muneration equivalent to that of officers in the Royal
1 Mr. S. P. Vivian.

1918. § i] Treasury 153

Army Medical Corps. The Treasury was disposed to
cover liabilities where the fees derived from a practice
did not provide a sufficient sum to meet the approved
rate. The Lords Commissioners stipulated, however,
that the standard arrangement should only come into
force where the two practitioners were unable to come
to any private arrangement, and they laid down the
further condition that the introduction of substitutes
should, in the first instance, and for some considerable
time, be practically limited to the case of practices
of considerable magnitude, the receipts from which
should suffice to defray the proposed remuneration
of the substitute, without recourse to the Exchequer
guarantee.

While the Emergency Committee was favourably
impressed by the Liaison Officer's scale of payments,
it considered that the limitation of the Treasury
guarantee to practices yielding a substantial return
should not be made applicable to Scotland, since most
of the Scottish practices for which transferred sub-
stitutes would be required were country practices in
the remoter areas and therefore comparatively unre-
munerative. The point, however, was left in suspense
as the scale of payments was not put to the test of
experience.

Call of Grade I. Practitioners

By the first week of June 1918 the main German
offensives in Picardy, Flanders and Champagne had
been checked. The War Office now required to provide
for the medical casualties of the impending general
British advance, though the losses incurred by the
Royal Army Medical Corps during the enemy offensives
had not yet been repaired. The special need was for

154 Mustering of Medical Service in Scotland

medical officers physically fit, graded in Grade I.1 by
National Service Medical Boards.

On 29 June 1918 the Emergency Committee received
a communication from the Ministry of National Service
inquiring whether the Committee would be able to
produce at least 50 Grade I. men, of age 45 or under,
before the end of the year. The Committee answered
in the affirmative, and proceeded in conference with
War Committees to make assessments on Divisions
which would produce a total of 50 practitioners belong-
ing to Group A. of the Scheme, of the grade and
age specified. The conditions as to grade, age and
grouping narrowed the range of selection, and War
Committees reported difficulty in making adjustments
with a view to release. Three members2 of the
Emergency Committee, including the Convener, inter-
viewed the Chief Commissioner8 of Medical Services in
London on the position. They drew his attention to
the hindrances occasioned by the requirements as to
grade and age, and to the desirability of demobilizing
low category medical officers in order to facilitate the
release of Grade I. practitioners from civilian work.
On the former point the Chief Commissioner was
unable to hold out hopes of concession ; on the latter
point he informed the delegation that their representa-
tion would be given effect to.

In July 1918 the Committee accepted with regret the resignation
from its membership, on health grounds, of the then Chairman 4
of the Scottish Committee of the British Medical Association. It
co-opted to membership the Vice-Chairman J of the Scottish Com-

1 Grade I. men were men who attained the normal standard of
health and strength, and were capable of enduring physical
exertion suitable to their age.

1 Prof. H. H. Littlejohn, Prof. Robert Muir, Dr. Norman
Walker.

1 Sir James Galloway. 4 Dr. John Adams.

1918. § i] Fifty Practitioners 155

mittee, together with a member 2 of the Scottish Committee resident
in Bothwell. The co opted Medical Officer » of the Scottish Insur-
ance Commission having been for some time on military service,
the Committee approved the appointment of the remaining
Medical Officer 4 of the Commission, who had made many visits at
the Committee's request regarding the circumstances of practi-
tioners, to the office of Visitor. On the representation of the
Secretary for Scotland8 the Committee agreed to invite to all
meetings of the Medical Tribunal for Scotland the Medical
Member6 of the Local Government Board for Scotland and the
Special Commissioner7 of the Board of Control, in order that they
might act as assessors in matters affecting their respective
Departments.

The Committee resumed its negotiations with War
Committees and reached a settlement. In the course of
September it approved, and passed to the Commissioner
of Medical Services for the Region of Scotland in the
Ministry of National Service a list containing the
names of 50 Grade I. and Group A. practitioners of
age 45 or under. Of the 50 practitioners 2 were private
practitioners, 37 Insurance practitioners, i a con-
sultant, 4 whole-time officials, 4 of the dental and
retired class and 2 unestablished. Each of the 50
received from the Scottish Commissioner an individual
notification,8 pursuant to Regulation 17 of the Medical
Practitioners Regulations, to the effect that any original
application for the grant of a certificate of exemption
must be made to the Medical Tribunal on or before the
fourteenth day from the date of notification.

Of the practitioners notified n did not exercise
their Tribunal rights and so became liable for military
service in or outwith the Royal Army Medical Corps

1 Dr. J. R. Drever. 2 Dr. John Goff, in lieu of Dr. G. C.

Anderson now on military service.

3 Dr. J. R. Currie. 4 Dr. G. M. Cullen.

0 The Right Hon. Robert Munro. 6 Dr. W. Leslie Mackenzie,
7 Dr. John Macpherson. 8 Appendix X.

156 Mustering of Medical Service in Scotland

and with or without commissions. Had the fighting-
continued they would have been recommended by the
Committee for commissions in the Royal Army Medical
Corps.

The remaining 39 applied to the Committee, as the
Medical Tribunal for Scotland, to be exempted from
military service. Of the 39 applicants, 20 were granted
temporary exemption on occupational grounds, and
were therefore liable to undertake approved civilian
service as the Minister of National Service might deem
best. Four medical practitioners who practised dentistry
were referred to the Scottish Dental Tribunal, appointed
by the Minister of National Service. One case was
outstanding on 24 October 1918, the date of the last
meeting of the Medical Tribunal for Scotland. To
14 applicants exemption was refused.

The 50 Grade I. practitioners were selected by the
Committee as the Emergency Committee, notified as
to their Tribunal rights by the Scottish Commissioner
of Medical Services who was the Convener of the
Emergency Committee, and, in respect of those who
applied for exemption, adjudicated upon by the Com-
mittee as the Medical Tribunal for Scotland.

The figures are summarized hereunder:

Available for
Military Service.

Available for
Civilian Service.

Others.

Exemption not applied for
Exemption applied for : —

...

Granted .

...

Refused .

Referred and Out-

standing

...

Totals .

1918. § i] Cessation of Hostilities 157

1918 Scheme: Output

Thus the 1918 Scheme created a reserve of 45
Scottish practitioners, available to render public service
when requested. Twenty-five — of whom n had not
sought exemption and 14 had been denied it — would
have been destined, had the fighting" continued, to
receive commissions in the Royal Army Medical Corps.
Twenty would have been due to act as substitutes in
civilian practice, either locally or by transfer, for other
practitioners called to the Army.

Judged by earlier standards these results were
meagre. But the 1918 Scheme did not come to full
maturity. It was cut short by the general cessation of
hostilities.

Armistice

The Advance to Victory by the British Armies on the
Western Front opened in Champagne on 20 July with
the Battles of the Marne 1918. The advance in
Picardy began on 8 August with the Battle of Amiens,
and was continued by the Second Battles of the Somme
1918. By 12 October the Hindenburg Line of the
German defence had been broken. The final British
advance, in Flanders, Artois and Picardy, began on
28 September with the Battle of Ypres 1918, and
closed with the Capture of Mons on 1 1 November.

On 30 September the Bulgarian Army had laid down
its arms. Turkey had surrendered on 30 October and
Austria-Hungary on 3 November. On n November
1918 German delegates accepted the terms of an
armistice imposed by the Allied Plenipotentiary,1 with
whom was associated the British First Sea Lord,2 and

1 Marshal F. Foch. 2 Sir Rosslyn Wemyss.

158 Mustering of Medical Service in Scotland

hostilities ceased on the Western Front at n a.m. on
that day.

The New War Register of the Emergency Com-
mittee showed that when the Armistice was granted to
Germany 2349 Scottish civilian practitioners1 were
serving, or had served, in the Navy, Army, or Air
Force.2

1 P. 188.

3 The Air Force had been established under the Air Force (Con
stitutiori) Act 1917, passed on 29 November 1917.

CHAPTER XI
1918. § 2

Demobilization Period : Inter-departmental Committee of Medical
Services. — First Demobilization Conference. — Demobilization
Scheme. — Close of 1918.

Demobilization Period

THOUGH the general armistice brought to a necessary
close the work of the Emergency Committee as a medical
recruiting agency, the Committee had still its duty to
the civil community and to medical practitioners on
service. During the period of demobilization, which
now began, it concerned itself with the medical needs of
the most depleted areas and with the personal claims ot
medical officers, as grounds for priority of release.

The Inter-departmental Committee of Medical Services
set up by the Ministry of National Service for the purpose
of considering questions involved in the provision of
the necessary numbers of medical officers for the Forces,
consistently with the maintenance of adequate medical
provision for the civilian population, had been approved
by the War Cabinet in October 1918 for the supervision
of the demobilization of all medical officers serving with
His Majesty's Forces.

First Demobilization Conference

On ii November 1918 the Inter-departmental Com-
mittee met in London. There attended from Scotland,

160 Mustering of Medical Service in Scotland

by invitation, the Convener1 and Secretary2 of the
Scottish Medical Service Emergency Committee, the
Medical Member8 of the Scottish Local Government
Board and the Deputy Chairman4 of the Scottish
Insurance Commission. There were present also the
Medical Director General of the Navy, the Director
General of Army Medical Services, the Medical Director
of the Air Force, representatives of the Ministry of
National Service, the English Local Government Board,
the English Insurance Commission and others. It was
agreed at the meeting that there should be in Scotland
a demobilization scheme, under the supervision of the
Emergency Committee, in accordance with which the
Emergency Committee would collect and send to
the Ministry of National Service, for transmission to
the departments concerned, the names of practitioners
for demobilization arranged in the following order of
priority of release.

On public grounds :

(1) Practitioners drawn from communities where the shortage of
medical service was most severe ;

(2) Practitioners in the public services, including those employed
in, or attached to, hospitals and infirmaries ;

(3) Practitioners on the staff of teaching schools of medicine ;
On personal grounds :

(4) Practitioners having claims on the ground of long military
service ; and

(5) Practitioners having claims on the ground of personal
hardship.

Demobilization Scheme

The Convener of the Emergency Committee undertook
that the Committee would take charge as agreed at the

1 Dr. Norman Walker. « Mr. T. H. Graham.

•Dr. W. Leslie MaQk.e.n.zic. *Dr. John C. M'Vail.

1918. § 2] Demobilization 161

meeting. The representatives of the Scottish Local
Government Board and the Scottish Insurance Com-
mission expressed their concurrence. Returning to
Scotland, the Convener visited War Committees, ex-
plained to them the demobilization scheme, and noted
at each meeting the names of practitioners whose return
to civil work was most urgently demanded. Public
intimation was made of the arrangements proposed,
and the Scottish Local Government Board, the Scottish
Insurance Commission, the Board of Control, the Uni-
versities, Managers of Hospitals and Infirmaries, County,
Town and Parish Councils and others sent in to the
Emergency Committee, as the demobilization authority,
the names of the practitioners whose services they most
required.

Acting on its knowledge of local conditions and on
the representations made by local War Committees
and the Departments and Bodies above enumerated,
the Committee, between 14 November and 31 December
1918, forwarded to the Ministry of National Service
lists containing the names of 188 practitioners in the
classes (i), (2) and (3) above, desired to be released
from military service on public grounds. The localities
concerned, and the number of practitioners desired on
behalf of each, were as follows :

Glasgow 32, Edinburgh 24, Aberdeen 8, Dundee 7, Dumfries
and Paisley each 4, Dumbarton, Dunfermline, Hamilton, Leith,
Lenzie and Port Glasgow each 3, Ayr, Elgin, Falkirk, Gourock,
Greenock, Kilmarnock, Kirkcaldy, Lanark, Perth, Prestwick and
Wishaw each 2, and Alexandria, Alloa, Annan, Arbroath, Ardersier,
Armadale (West Lothian), Auchterarder, Banff, Barrhead, Beauly,
Beith, Blantyre, Bothwell, Brechin, Burntisland, Cambuslang,
Cardenden, Castle Douglas, Chryston, Coldstream, Crocketford,
Cupar-Fife, Denny, Douglas, Dunblane, Dunkeld, Duns, Forfar,
Fraserburgh, Galashiels, Giffnock, Glenluce, Haddington,
Houston, Innerleithen, Irvine, Jedburgh, Johnstone, Kilwinning,
II

1 62 Mustering of Medical Service in Scotland

Kirkliston, Kirkwall, Lairg, Langholm, Leslie, Lochgilphead,
Melrose, Millport, Moniaive, Morven, Munlochy, Nairn, North
Berwick, Newburgh (Aberdeen), New Deer, Oban, Overtown,
Portsoy, Renfrew, Rothesay, Rutherglen, Stevenston, Stirling,
Stonehouse, Taynuilt, Thornton (Fife), Tiree, Whitburn, Wigtown
and Winchburgh each i.

Most of the Officers so recommended by the Com-
mittee for release were urgently needed at home owing
to the epidemic prevalence in Scotland at this time of
a fatal type of influenza. There was, however, great
destitution among the civil population in the recently
occupied regions of France and Belgium, and numbers
of Medical Officers with the British armies in these
areas were required for the work of relief. The con-
sequence was a temporary check to medical demobiliza-
tion. Nevertheless, by the close of the year, progress
had been made.

In November 1918 the Emergency Committee co-opted to
membership the Medical Member1 of the Local Government
Board for Scotland and a medical practitioner 2 resident in Aber-
deen. In December 1918 the late Dean3 of the Faculty of
Medicine of Edinburgh University, who, in consequence of his
resignation of the Deanship, had ceased from ex-officio member-
ship of the Committee, became by invitation of the Committee,
which highly appreciated his services, a co-opted member.

Close of 1918

The year 1918 experienced the coming into operation
of two Military Service Acts. Under the latter of these,
special claims were made upon the medical profession
and the Emergency Committee was recognized as the
Medical Tribunal for Scotland. In the course of the
year the Committee initiated its 1918 Recruiting Scheme,

1 Dr. W. Leslie Mackenzie. a Dr. George Williamson.

» Prof. H. H. Littlejohn.

1918. § 2] Demobilization 163

which was closed by the general Armistice. After the
Armistice the Committee devoted itself to the demobil-
ization of Scottish medical officers on grounds of public
interest. Throughout the year the Committee remained
in official relations with the Ministry of National Service.

CHAPTER XII
1919

Second Demobilization Conference. — Demobilization en masse :
Established Practitioners. — Ministry of National Service : Ter-
mination— Decision of Committee to Continue in Office as
Emergency Committee — War Office — Admiralty. — Direct Rela-
tions Resumed : Nominated Scottish Practitioners. — Priority Re-
leases.— Close of 1919 : Dissolution of Emergency Committee.

THE Emergency Committee continued to send to the
Ministry of National Service lists of practitioners for
release on public grounds, and by 25 January 1919 had
made enough recommendations to raise the civil medical
service of Scotland to 80 per cent, of pre-war strength.

It now felt that it might properly nominate cases of
long war-service and personal hardship, and it requested
the War Committees to prepare and transmit to it
lists of the absentees from their districts, who were
qualified for consideration on these grounds, arranged
in order of priority.

Second Demobilization Conference

But on 24 February 1919, at a meeting in London of
the Inter-departmental Committee of Medical Services,
which was attended by the Secretary * of the Emergency
Committee — the Convener and several other members
being ill at the time with influenza — the announcement

1 Mr. T. H. Graham.

164

1919-] Demobilization 1 6 5

was made that the Director General of Army Medical
Services had received instructions from the Secretary of
State for War to release medical officers from the Army
as and when they became surplus to requirements.
From the Army point of view, it was explained, the
release of officers by nomination for priority had been
found impracticable. The new plan of mass demobi-
lization would liberate practitioners in batches of 400
to 500.

Demobilization en masse

The Emergency Committee perceived that mass
demobilization could take no account of age, length
of service and civil needs. Some depleted areas would
perforce remain short-handed. Territorial officers and
other practitioners who had left established practices to
join the Army would be liable to be retained with the
Forces, while recent graduates, who had no settled
occupation, would be freed. Older practitioners, who
had remained at home, and who, under the weight of
years, had been looking forward to the early return of
their assistants or partners, would be called upon for
a further term of endurance. The Committee, at the
same time, appreciated the military complications in-
volved in demobilization by priority. Many of the
officers recommended, or due to be recommended, by
the Committee were in Base Hospitals holding im-
portant charges. Others were in distant theatres of
war or attached to scattered posts in occupied country
nearer home. They could only be freed by the pro-
vision of substitutes, who might themselves in turn be
nominated for release.

These things being so, the Committee considered
that a certain measure of priority of release should
be combined with the mass demobilization. It desired

1 66 Mustering of Medical Service in Scotland

in particular to secure this concession for Established
Practitioners > that is to say, practitioners established
before the war as general practitioners or as teachers
in medical schools, together with a few younger practi-
tioners who, though not themselves established, were
urgently required as assistants to general practitioners.
It proceeded, therefore, to forward to the Ministry of
National Service — for favourable notice by the War
Office — a series of lists which would ultimately include
all practitioners of the classes referred to.

On 22 March 1919 the Committee lost by death another of its
original members, formerly Vice-Chairman 1 of the Scottish Com-
mittee of the British Medical Association, who, although residing
at a distance from Edinburgh and busy with other duties, re-
gularly attended the meetings of the Committee, to the Com-
mittee's profit.

Ministry of National Service : Termination

In the course of March it was made known that the
Ministry of National Service was approaching the close
of its tenure of office. The duties of the Committee,
as advisory to the Ministry, would terminate simul-
taneously. These changes modified the Committee's
position in certain respects, but they could not affect its
general responsibilities towards the civil community
and the medical profession, which it had accepted in
1914 as the Emergency Committee, and had reaffirmed
in subsequent years. The Scottish public now regarded
the Committee as the proper authority for dealing with
grievances occasioned by the shortage of doctors. The
personal interest which the Committee had been allowed
to take in the affairs of Scottish medical men placed
upon it a compelling duty to keep on trying to do what
1 Dr. John Gordon.

1919-] Demobilization 167

it could in the work of their demobilization. With the
general practitioners of the country it had a special
concern. They could not, like doctors in the Public
Services, look to corporate bodies to speak for them.
Meeting on 19 March 1919, the Committee resolved that
it would continue in office as the Emergency Committee.
This Decision of the Emergency Committee was inti-
mated by one * of its members to the Central Medical
War Committee at a Conference held in London on
21 March. A few days later the Emergency Committee
received a letter from the War Office expressing the
hope that the Committee would forward its lists of
nominees for release direct to the War Office, so re-
viving the association between the Committee and the
War Office which had necessarily been in abeyance
since November 1917. The Committee was approached
by the Admiralty also, desiring to be informed at the
earliest possible moment whether the Committee would
be prepared to carry on its functions with regard to
the demobilization of Officers for civil purposes. On
31 March 1919 the Ministry of National Service, with
which the Committee had been on terms of cordiality,
and in which the Convener of the Committee had held
office, came to an end.

Direct Relations Resumed

On i April the Committee resumed direct touch with
the naval and military authorities. Though demobili-
zation en masse ensued as ordered, the priority lists
submitted by the Committee were kept in view by the
War Office, which made every effort to free the officers
named, especially those serving in France. Consider-
able numbers of the Committee's nominees obtained
1 Dr. John C. M'Vail.

1 68 Mustering of Medical Service in Scotland

release in April. May, however, was less productive.
On 24 May 1919 the position was as follows :

NOMINATED SCOTTISH PRACTITIONERS

Nominated for release up to 31 March 1919 . . . 594
Released up to 24 May 1919 . . . . . . 403

Outstanding at 24 May 1919 191

These figures were submitted to the Director General J
of Army Medical Services in London by a delegation 2
of the Committee. The delegation pressed upon the
Director General the claims of established practitioners,
and urged the expediency of a proposal already mooted,
namely, the granting of medical commissions to young
graduates in order to free older men from service.
The Director General stated in reply that he was bound
by the instruction 3 to demobilize en masse, but that he
was prepared, as heretofore, to give every attention to
the urgent cases. The Committee's suggestion as to
recent graduates was given effect to. It failed, how-
ever, to provide the increase of personnel desired.

Priority Releases

From June 1919 onwards the Committee concentrated
on the cases of practitioners qualified for consideration
by long service or personal hardship. Many had joined
the Forces at various crises of the war on the Com-
mittee's suggestion or advice. To those who had thus
entrusted themselves to its hands it was conscious of a
definite obligation, which it endeavoured to discharge
by urging on the War Office their claims to early

1 Sir T. H. J. C. Goodwin.

»Prof. H. H. Littlejohn, Mr. J. W. B. Hodsdon, Dr. John C.
M«Vail, Dr. Norman Walker.
•P. 165.

1919-] Demobilization 169

liberation. The Committee's representations were, as
far as possible, accepted by the military authorities,
and a number of Scottish officers asked for at various
times continued to be set free.

Pari passu with priority releases, general demobili-
zation was proceeding. It freed automatically a
proportion of the practitioners included in the priority
lists of the Committee, and in this respect was of
medical value. It tended on the other hand to injure
the prospects of priority cases still on service, as the
general reduction of the forces decreased the total
number of officers and accentuated the difficulty
experienced by the War Office in providing reliefs
for nominees.

There followed in consequence a progressive diminu-
tion in priority releases. At last, on 25 November
1919, the Assistant Director General1 of Army Medical
Services wrote as follows to the Convener2 of the
Emergency Committee :

. . . The General Officers Commanding-in-Chief all Expeditionary
Forces and Commands have embodied in a roster the names of
all medical officers who desire early release, and . . . the names
have been arranged in the order of priority decided after con-
sideration of the claims of individuals as represented by the
officers themselves.

This order is adhered to as far as possible in releasing medical
officers, and I am therefore to say that it is regretted that no
further orders regarding the release of individuals can be issued
from this Office.

I am finally to say that in cases of extreme hardship the facts
may be brought to the notice of the General Officer Commanding-
in-Chief, when the case of the individual officer will receive con-
sideration and his position on the roster be amended accordingly.

These sentences presaged the close of the Committee's
association with the work of medical demobilization,
1 Sir E. Worthington. 2 Dr. Norman Walker.

170 Mustering of Medical Service in Scotland

but it is proper to record that the War Office proved
better than its word, and ordered two releases in
December at the Committee's request.

Close of 1919

Partly in virtue of the Committee's applications for
release by priority, partly as a result of the mass
demobilization which had restored many officers to
civil life, the number of Scottish practitioners remain-
ing in the Army, for whom the Committee was re-
sponsible, had by December 1919 been brought to a
figure, which, although not capable of being ascertained
with precision, was believed to be unsubstantial. As
touching the practitioners still on service, the military
authorities, owing to the progressive reduction of
establishments, had been forced to prescribe that future
releases must conform strictly to military procedure,
and could no longer be influenced by those civil con-
siderations which were now the sole remaining concern
of the Emergency Committee.

There was no further service which the Committee
could render. It took the view that it was rude
donates^ and entitled to quit the arena. It dissolved
accordingly as at 31 December 1919.

Termination of War : 1921

At Buckingham Palace, on 10 August 1921, ratifications of
treaties of peace with Germany, Austria, Hungary and Bulgaria
having been deposited, His Majesty in Council ordered that
31 August 1921 should be treated as the date of the termination
of the war, the relations between His Majesty and the Ottoman
Empire remaining unaffected.

CHAPTER XIII

GENERAL

Voluntary Principle.— Composition of Emergency Committee. —
Medical Duty in War-time.

THE particular transactions of the years 1914 to 1919
being recounted, it is proposed in two concluding
chapters to consider certain questions of general
interest. ChapterXIII. will treat of the principle which
guided the work of medical recruiting in Scotland
during the recent war, and of the steps by which
the range of professional duty became formulated.
Chapter XIV. will be concerned, among other topics,
with the changes in the total strength and distribution
of Scottish civilian practitioners, with the number who
died and the number who served, and with the extent
of the denudation which took place in civil medical
practice owing to war conditions.

Voluntary Principle

The original sanction for the existence of the
Emergency Committee to meet immediate difficulties
in medical practice was derived from a resolution of
the First Medical Conference.1 The selection by the
then Chairman of the Scottish Committee of the British
Medical Association of the persons to attend the Con-

JP. 5.
171

172 Mustering of Medical Service in Scotland

ference, though wholly judicious, was arbitrary. The
resolution could only take effect in so far as it might
be agreed by the general body of Scottish practitioners.
The Committee, however, on setting to work was well
received by the profession.

The sanction for the enlargement of the Committee's
field by the inclusion of medical recruiting was drawn
indirectly from the Second Medical Conference 1 which
closely resembled the First Conference in the manner
of its calling together. The resolution of the Second
Conference, that there should be a medical recruiting
campaign, became operative through the action taken
by the Scottish Committee of the British Medical
Association, which, having started the movement,
expressed a desire to hand on its charge to the
Emergency Committee. The Emergency Committee,
after ascertaining that the War Office would welcome
its co-operation, inaugurated its 1915 Recruiting
Scheme, the sanction for which was thus derived by a
form of delegation from an arbitrarily selected body,
and could only, as before, become valid through the
consent of practitioners. Employing the organization
of the British Medical Association the Committee asked
that War Committees should be appointed, in the
areas of Divisions, to be its local outposts. The
appointments were immediately made. Acting through
its War Committees, it issued to the profession a
series of calls to service. The drafts required came
cheerfully forward. It was clear to the Committee
that in its recruiting work it had the support of the
Scottish profession.

The Committee's 1916 Recruiting Scheme, which was
the medical section in Scotland of Lord Derby's Scheme,
was announced on the same plan as the 1915 Scheme.
1 P. 25.

Voluntary Principle 173

The response of the profession was again satisfactory.
Every Scottish practitioner from whom any service
could reasonably be expected registered himself with
the Committee as ready to undertake the duty, whether
military or civilian, appropriate to his age. The
functions of the Committee under the Scheme as a
Tribunal for Medical Purposes were exercised at the
instance of those who had already expressed their
willingness to serve. Prior to, and during, the 1916
Scheme, up to the operation of the Military Service
Act 1916 of Session i, every transaction of the Com-
mittee, in its relations with the medical profession, was
on a voluntary basis.

Under the Military Service Act 1916 (Session 2)
the Committee attained a statutory position. It be-
came a Professional Committee for dealing with claims
for exemption from military service by medical prac-
titioners referred to it by Local Tribunals. In the
main, however, with little modification, it continued in
its voluntary courses, calling to service those prac-
titioners who had registered in its War Register and
granting postponement, under the name of exemption,
to such as could not be freed from civil employment.

The voluntary principle was endangered in April
1917 by the action of the War Office in issuing a
general calling-up notice to practitioners of military
age. The Committee, however, made an adjustment
with the War Office, and matters were restored to a
voluntary footing. The position so established was
fully recognized by the Minister of National Service
with whom the Committee came into official relations
in November 1917.

In June 1918, under the Military Service (No. 2)
Act 1918, the Committee was constituted the Medical
Tribunal for Scotland, and, as such, exercised the

174 Mustering of Medical Service in Scotland

powers entrusted to it by the Military Service (Medical
Practitioners) Regulations 1918. But the Committee's
1918 Scheme, which received the approval of the
Ministry of National Service, was founded on voluntary
lines, since practitioners called to service in terms of
the Regulations had already expressed their willingness
to serve by registering with the Committee.

Thus the voluntary principle, and the voluntary
status of the Committee, survived in substance to the
date of the Armistice. That the voluntary method
would have sufficed to provide for the redistribution of
the civil work of the profession, as would have been
necessary had the war continued, is on the whole un-
likely. That it supplied with some completeness
Scotland's share of Medical Officers from 1914 to
1918 is borne out by this narrative. That a Com-
mittee which was composed of medical men, and which
for the purpose of its principal activities had no
electoral machinery, no formal constitution and no
statutory or chartered authority, but derived its
sanction solely from the tacit or expressed approval of
the medical profession, should have been accepted by
Departments of State and by the Scottish people as
competent to meet the medical requirements of the
Fighting Forces during the national struggle, is
evidence of the confidence reposed in the profession by
the general public, which must be presumed to have
taken the view that no lay body could exact more from
the profession in war-time than the profession was
prepared to exact from itself.

Composition of Emergency Committee

Having regard to the recognition accorded to the
Committee as representative of the profession, the

Emergency Committee 175

question of its composition is of more than personal
interest. As a professional Committee its number was
prescribed at first to lie between 12 and 25 inclusive.
A later Order permitted an increase. The names of its
original 15 members are indicated1 in Chapter I., but
its original composition was altered during its tenure,
as the following list reveals.

EX-OFFICIO MEMBERS

P.tf.C.P.E.—Dr. J. J. GRAHAM BROWN, succeeded by Dr. A. H. F.

BARBOUR, succeeded by Prof. WILLIAM RUSSELL, succeeded

by Sir ROBERT W. PHILIP.
P.K.C.S.E.—Prof. FRANCIS M. CAIRD, succeeded by Mr. J. W. B.

HODSDON, succeeded by Dr. R. McKENZiE JOHNSTON, suc-
ceeded by Dr. GEORGE MACKAY.
P.R.F.P.S.G.—Dr. JOHN BARLOW, succeeded by Dr. EBENEZER

DUNCAN, succeeded by Dr. A. FREELAND FERGUS.
University of St. Andrews— Prof. J. A. C. KYNOCH.
University of Glasgow — Prof. D. NOEL PATON, succeeded by

Prof. T. H. BRYCE.
University of Aberdeen.— Prof. J. T. CASH, succeeded by Prof.

THEODORE SHENNAN.
Edinburgh University. — Prof. H. H. LlTTLEJOHN, succeeded by

Prof. J. LORRAIN SMITH.

ELECTED MEMBERS

Dr. JOHN ADAMS, Glasgow: Vice-Chairman, Scottish Com-
mittee, B.M.A. Member 1914-18.

Dr. G. C. ANDERSON, Methil : Secretary, Fife Branch, B.M.A.
Member 1914-16 and 1919.

Dr. JOHN GORDON, Aberdeen: President, Aberdeen Branch,
B.M.A. Elected 1914. Died 1919.

Dr. J. R. HAMILTON, Hawick : Chairman, Scottish Committee,
B.M.A. Elected 1914. Died 1916.

Dr. JOHN C. M'VAIL, Edinburgh : Deputy Chairman, Scottish
Insurance Commission. Member 1914-19.

Dr. JOHN PLAYFAIR, Edinburgh: President, Medical Guild.
Member 1914-19.

'P. 6.

1 76 Mustering of Medical Service in Scotland

Dr. JOHN STEVENS, Edinburgh : Secretary, Edinburgh Branch,

B.M.A. Member 1914-19.
Dr. NORMAN WALKER, Edinburgh : Direct Representative for

Scotland, General Medical Council. Convener 1914-19.

CO-OPTED MEMBERS

Dr. J. R. CURRIE, Edinburgh : Scottish Insurance Commission.

Member 1914-15 and 1919.
Prof. ROBERT MUIR, Glasgow : University of Glasgow. Member

1915-19.
Prof. T. K. MONRO, Glasgow: University of Glasgow. Member

1915-19.

Dr. A. D. R. THOMSON, Musselburgh, B.M.A. Member 1917-19.
Dr. LAURA S. SANDEMAN, Aberdeen, Scottish Medical Women,

1917: succeeded by Mrs. BEATRICE RUSSELL, Edinburgh.
Mr. J. W. B. HODSDON, Edinburgh : ex-President R.C.S.E.

Member 1917-19.

Dr. J. R. DREVER, Glasgow : Scottish Committee, B.M.A. Mem-
ber 1918-19.
Dr. JOHN GOFF, Bothwell : Scottish Committee, B.M.A. Member

1918-19.
Dr. W. LESLIE MACKENZIE, Edinburgh : Local Government

Board for Scotland. Member 1918-19.
Dr. GEORGE WILLIAMSON, Aberdeen. Member 1918-19.
Prof. H. H. LITTLEJOHN, Edinburgh : ex-Dean of Medical

Faculty, Edinburgh University. Member 1918-19.
Legal Assessor: Sheriff J. A. FLEMING, Vice-Dean, Faculty of

Advocates. 1916-19.
Visitor: Dr. G. M. CULLEN : Scottish Insurance Commission.

1918-19.
Secretary: Mr. T. H. GRAHAM, Librarian, R.C.P.E., and later

Branch Registrar for Scotland under General Medical

Council. 1914-19.

The 23 members of the Committee on 31 December
1919, the date of its dissolution, were:

Dr. G. C. ANDERSON, London : Deputy Medical Secretary, B.M.A.,

formerly Methil.
Prof. T. H. BRYCE, University of Glasgow.

Emergency Committee 177

*Dr. J. R. CURRIE, Scottish Board of Health.

*Dr. J. R. DREVER, Edinburgh : Scottish Medical Secretary,

B.M.A., formerly Glasgow.

Dr. A. FREELAND FERGUS, Glasgow, R.F.P.S.G.
Dr. JOHN GOFF, Bothwell, B.M.A.

*Mr. J. W. B. HODSDON (now Sir JAMES HODSDON), Edinburgh.
Prof. J. A. C. KYNOCH, University of St. Andrews.
*Prof. H. H. LITTLEJOHN, Edinburgh.
Dr. GEORGE MACKAY, Edinburgh, R.C.S.E.
Sir LESLIE MACKENZIE, Scottish Board of Health.
*Dr. JOHN C. M'VAIL, Scottish Board of Health.
*Prof. T. K. MONRO, University of Glasgow.
*Prof. ROBERT MUIR, University of Glasgow.
Sir ROBERT W. PHILIP, Edinburgh R.C.P.E.
*Dr. JOHN PLAYFAIR, Edinburgh, Medical Guild.
Mrs. BEATRICE RUSSELL, Edinburgh.
Prof. THEODORE SHENNAN, University of Aberdeen.
Prof. J. LORRAIN SMITH, Edinburgh University.
*Dr. JOHN STEVENS, Edinburgh, B.M.A.
Dr. A. D. R. THOMSON, Musselburgh, B.M.A.
*Dr. NORMAN WALKER, Edinburgh, Convener.
Dr. GEORGE WILLIAMSON, Aberdeen.

* Member of Executive Sub-Committee.

The 23 members may be divided geographically into
those representing the North, East and West of Scotland,
the North being demarcated by the River Forth and its
estuary, and the East separated from the West by a
line drawn south from Stirling. Of the 23 members
4 were of the North, 13 of the East and 6 of the
West. The preponderance of the East was due to two
principal causes, first the presence in Edinburgh of
three of the seven Scottish Schools of Medicine, and
second the fact that, when the Committee was formed,
Edinburgh practitioners were intentionally selected
as being conveniently available for meetings to be
held in the Royal College of Physicians. Later the
inequality was adjusted to some extent by co-opting
members from the West. The interests of the West
12

178 Mustering of Medical Service in Scotland

were competently secured by the Western represen-
tatives.

Every member of the Committee was registered in
the Committee's War Register as prepared to under-
take the service appropriate to his age.1

Medical Duty in War-Time

Though the voluntary principle, owing to the circum-
stance that the Committee's War Register was begun
during the period of voluntary enlistment, inspired the
policy of the Committee in its subsequent relations
with the profession, the statutory position of the pro-
fession itself underwent during the war a far-reaching
process of change.

Up to the appointed dates of the Military Service
Acts 1916 the medical man joined the Forces as a free
agent in the eye of the Law. He had no constraint
other than his own sense of duty, or the general opinion
of his fellows that every practitioner who was able to
loose himself from the ties of civil employment ought
to apply for His Majesty's Commission. After these
dates, subject to specified safeguards, he was, if of
military age, under compulsion to serve. By the
Military Service (No. 2) Act 1918 he was liable to serve
at a higher age than laymen.

By the Medical Practitioners Regulations made under
the Military Service (No. 2) Act 1918, a medical practi-

1 Eight members of the Committee held His Majesty's Com-
mission : Lt.-Col. John Barlow, R.A.M.C. (T.) ; Lt.-Col. Robert
Muir, R.A.M.C. (T.); Major J. W. B. Hodsdon, R.A.M.C. (T.);
Major H. H. Littlejohn, O.T.C. ; Major T. K. Monro, R.A.M.C.
(T.); Major A. Freeland Fergus, R.A.M.C. (T.); Captain
G. C. Anderson, R.A.M.C. (Temporary Commission), and another.
Captain Anderson served in Egypt and Palestine ; the other in
France and Italy. Mr. T. H. Graham, Secretary, who made six
attempts to enlist, was rejected by the Army for visual defect.

Claims of War 179

tioner who sought and obtained exemption from military
service on occupational grounds, or in some cases on
personal grounds, came under the requirement to
render controlled civilian service. This last was not
actual compulsion, since it could not be enforced
against a practitioner who elected to serve in the ranks
of the Army, but in the majority of cases, in view of
the nature of the alternative, it would have had the
effect of a compulsitor. The application of the Dilemma
as an instrument for procuring controlled civilian ser-
vice conveyed a suggestion of indirectness, and was
adversely criticized in consequence by members of the
profession. It may be presumed that the method
adopted was intended to operate as the equivalent of
compulsion, or else as the initial step towards direct
legislation placing civilian service on the profession as
a general obligation.

It would thus appear that, finding expression in a
military enactment of the war, the principle became
established that this Country, when belligerent, may
properly require from its medical men national services
both greater in extent and different in quality from
those due by its lay citizens. It may claim medical
men for the Forces at a higher age. It may expect
them, under conditions, to take part in civilian work.
Both these provisions were covered by views stated in
course of the mobilization movement by representative
professional bodies, though not in the end accepted
by all. Since both provisions, during the recent war,
came late in the course of hostilities, neither was put
to full trial. There can, however, be no doubt that,
had the fighting continued, and had the additional
duties been fully imposed, medical men would have
risen to the occasion, as in the past, and acquitted
themselves with credit.

CHAPTER XIV

GENERAL

War-changes : New War Register. — Medical Strength : 1 1
November 1918. — Medical Distribution : u November 1918. —
Deaths of Practitioners — Practitioners who Served. — Denuda-
tion in Civil Practice. — Pressure of Civil Work. — Further
Denudation. — How Sleep the Brave. — Acknowledgments. —
Conclusion.

War Changes

THE principal record open to the writer for the purpose
of ascertaining the changes which took place in the
number and distribution of the civilian medical profes-
sion in Scotland during, or as a result of, the war was the
New War Register prepared by the Emergency Com-
mittee in the course of 1918. This compilation in-
cluded all practitioners, whether surviving or dead,
reported to the Committee as medically domiciled in
Scotland on or after i August 1914.

Deaths of practitioners intimated to the Committee
were checked by comparison with the notices of deaths
of practitioners received, and made accessible to the
writer, by the Registrar1 of the Branch Council for
Scotland under the General Medical Council. The
Branch Registrar's notices supplied information with
regard to both service and civil deaths. Service deaths
were further confirmed from Official Lists, and from a
Roll of Honour accompanying the Report of the Pro-

1 Mr. T. H. Graham, Secretary of Emergency Committee.
180

Medical Personnel 181

ceedings of the Clinical and Scientific Meeting- of the
British Medical Association held in 1919.

It is not claimed that the Committee's New War
Register is correct to a unit ; as will appear, it reveals
anomalies. Further, the majority of the practitioners
named in the Local Register1 for Scotland of the
General Medical Council are not medically domiciled in
Scotland, and in the case of those dying during the
war the information supplied sometimes left the
question of domicile undecided. The Official Lists of
Officers dying and the Roll of Honour of the British
Medical Association covered a wider field than Scotland,
and the attempt had to be made to identify Scottish
practitioners by collating these returns with the Local
Register. This part of the work was carried out by
the staff of the Branch Registrar. Founded on these
data, many of which required careful interpretation
before use, the succeeding Tables are subject to limita-
tions ; and had there been any assurance of particulars
such as they contain becoming available from other
quarters, the writer might have felt it his duty to leave
to some more dexterous hand the task of setting forth
the position of the Scottish profession at the close of
hostilities. In the absence of such assurance the Tables
may assume the merit of being the best obtainable in
the mean time. They are presented accordingly.

Medical Strength; n November 1918

The number of civilian medical practitioners, in civil
life and on service, medically domiciled in Scotland
on Armistice Day is shown in column 3 of Table XII.
As compared with the figure of column 2 of Table XII.
for i August 1914 — which is reproduced from Table I. —

'P. 7.

1 82 Mustering of Medical Service in Scotland

private practitioners show a decrease of 34, of whom
the larger proportion had died,1 while some had retired
from practice or left the country. Insurance practi-
tioners had fallen from 1796 to 1612, a loss of 184, of
whom most had died, while others had retired from
practice or resigned from the panel. Consultants

TABLE XII

CLASSIFICATION OF SCOTTISH CIVILIAN PRACTITIONERS
LIVING ii NOVEMBER 1918

Living
i August
1914.

Living
ri November
1918.

Loss or Gain
1914 to 1918.

Private Practitioners

376

342

-34

Insurance Practitioners .

1796

1612

-184

Consultants .

248

230

-18

Whole-time Officials

5!4

374

- 140

Dental and Retired Practi

tioners
Unestablished Practitioners

269
619

1416

+ 38

+ 797

TOTAL .

3822

4281

+ 459

were less by 18, of whom the majority were dead.
The figures of these three classes may be regarded
as near to accuracy.

Whole-time officials had declined from 514 to 374, a
difference of 140, which is not explained by the 1 6 deaths
recorded for this group. The view is taken that a
number of whole-time officials included in the count of
the British Medical Association, who were in temporary
addresses in 1914, had joined the Navy or Army from
these addresses before the Committee compiled its First
1 Table XIV., p. 187.

Medical Personnel 183

War Register, and so were either untraced or merged
in other classes. The accretion of 38 dental and retired
practitioners is probably genuine, despite 70 deaths.
The abnormal increase of the unestablished by 797 is
partly authentic owing to the fact that young Scottish
graduates and licentiates, who would in peace have
entered general practice or taken whole-time civil
appointments, passed direct into the Fighting Forces
as unestablished practitioners. The increase is on the
other hand believed to be partly fictitious since certain
young graduates and licentiates, not belonging to
Scotland but trained in Scottish medical schools, who
would under ordinary conditions have returned at once
to their country of origin, joined the Navy or Army,
immediately on graduation or licence, from addresses in
Scottish University towns, and so figured in the Com-
mittee's War Register as medically domiciled in
Scotland.

The total number of civilian practitioners medically
domiciled in Scotland on i August 1914, according to
the count reproduced in column 2 of Table XII., was
3822. Had this number increased between that date
and ii November 1918 at the same rate as the total
number of practitioners registered in the Local Scottish
Register of the General Medical Council, the total
number medically domiciled in Scotland on n Novem-
ber 1918 would have approximated to 4011. The
number recorded in the Committee's new War Register
and stated in column 3 of Table XII. is 4281, represent-
ing an excess of 270. The apparent increase is to be
explained as an inflation of the Committee's Register,
principally due to the inclusion of the unestablished
practitioners not belonging to Scotland.

While Table XII. exhibits over the period of
hostilities a clear diminution in the numbers of private,

184 Mustering of Medical Service in Scotland

insurance and consultant practitioners, its information
on the remaining classes and on the total strength of
the civilian profession as affected by the war is in
some respects inconclusive.

Medical Distribution: n NoYember 1918

The distribution of medical personnel among Divisions
of the British Medical Association, together with the
estimated population of each Division on Armistice Day,
is set out in Table XIII. The populations, supplied to
the writer by favour of the Registrar General1 for
Scotland, are the arithmetical mean between estimates
prepared for, and used in, the Annual Report of the
Registrar General for Scotland for 1918, and figures
derived from a statement of revised rationing statistics
dated October 1919. The resulting numbers are put
forward as approximate only, being probably over-
stated in some Divisions and understated in others.
General 2 Practitioners in the Table include private and
insurance practitioners, and Other3 Practitioners the
remaining classes.

A comparison of Table XIII., dated n November
1918, with Table II., dated i August 1914, reveals a
reduction in the total number of General Practitioners
from 2172 to 1954. A corresponding decrease is
observed in all Divisions except Perth, which exhibits
an accession of 9, and Zetland, which shows no change.
The total number of Other Practitioners has risen from
1650 to 2327. All the Divisions share this ascent.
The total increase for practitioners of all classes, which
is shown by Table XII., may be traced also in the total
figures of Table XIII. for all Divisions but Ross and
Cromarty and Stirling.

1 Dr. J. C. Dunlop. 2 Footnote 3, p. 9. 8 Footnote 4, p. 9.

TABLE XIII

DISTRIBUTION OF SCOTTISH CIVILIAN PRACTITIONERS
LIVING ii NOVEMBER 1918.

MEDICAL PERSONNEL.

ESTIMATED

DIVISION.

POPULATION
ii NOVEM-

General

Other

BER 1918.

Practi-

Total.

tioners.

Aberdeen

344.753

145

236

Argyll ....

60,572

378

Ayr ....

269,652

103

184

Banff, Elgin and Nairn .
Caithness and Sutherland

105,774
47,626

52
25

105

Dumbarton

I47.536

102

Dumfries and Galloway .

135.224

137

Dundee ....

274,075

106

198

Edinburgh and Leith

409,586

189

567

756

Fife ....

292,276

I64

Glasgow.

1,105,505

421

521

942

Inverness

Islands ....

Lanark ....

500,041

*53

158

Lothians ....

235,530

161

Orkney ....

23,279

Perth

126,346

I05

Renfrew and Bute .

316,790

126

224

Ross and Cromarty

South Eastern

108,653

Stirling ....

200,669

118

Zetland ....

24.753

TOTAL

4,881,692

1954

2327

4281

The total population of the Inverness Division, together with
the Islands and Ross and Cromarty, is estimated as 153,052.

Figures for the three Divisions severally are not available.
185

1 86 Mustering of Medical Service in Scotland

Deaths of Practitioners

Table XIV. records the number and class of civilian
practitioners medically domiciled in Scotland who died
on service or in a civil condition. Column 2, entitled
Service Deaths, presents up to 31 December 1919 the
deaths of Officers, other than permanent Officers of the
Regular Forces, who were killed in action, lost at sea
by enemy action, or died of wounds or disease con-
tracted on service. Column 3, entitled Civil Deaths,
submits up to n November 1918 the deaths of practi-
tioners engaged in civil practice. The extension of
time in column 2 enables account to be taken of deaths
of Officers occurring after the Armistice from wounds
sustained or disease contracted prior to that date.

The total deaths among practitioners were 362, of
which 133 were service deaths and 229 civil. Service
deaths confer their distinction on every class of the
Table. The weight of civil deaths was greatest on the
dental and retired practitioners, of whom most belong
to the latter category. Among whole-time officials and
unestablished practitioners civil deaths were relatively
few. Private, insurance and consultant practitioners
occupy an intervening position, nearer the lower limit.

Had the British Empire been at peace from 1909 to
1918 inclusive, and had the average annual death-rate
among all practitioners registered in the Medical
Register, which is the aggregate of the three Local
Registers for England, Scotland1 and Ireland, for the
five years ended 31 December 1913 continued unaltered
during the five years ended 31 December 1918, the
deaths of practitioners medically domiciled in Scotland
during the 4^ years ended n November 1918 would
have been at the average annual rate of 15*4 per 1000.

1 Separate figures for the Scottish Register were not available.

Mortality in Profession 187

In so concluding it is necessary to make the assumption
— which may or may not be warranted — that all
registered practitioners and practitioners medically
domiciled in Scotland are normally exposed to the same
risks. If the average annual rate of 15*4 per 1000 be
applied for 4^ years to 4051, the mean of 3822, the
count of i August 1914, and 4281, the count of
ii November 1918, the deaths among civilian practi-

TABLE XIV
DEATHS OF SCOTTISH CIVILIAN PRACTITIONERS

Service Deaths 2 August 1914 to 31 December 1919
Civil Deaths 2 August 1914 to u No\ ember 1918

Service

Civil

Total

Deaths.

Private Practitioners

Insurance Practitioners .

117

146

Consultants ....

Whole-time Officials

Dental and Retired Practitioners

7°

Unestablished Practitioners .

TOTAL ....

133

229

362

tioners medically domiciled in Scotland may be esti-
mated at 265. The total recorded deaths, in column 4
of Table XIV., exceed this estimate by 97.

The 229 civil deaths similarly calculated on the mean
number of practitioners at risk of civil death during
the 4j years are equivalent to an approximate average
annual war death-rate of 18*3 per 1000. This rate is
higher than the general average peace death-rate of
15-4 per 1000, but the class at risk of civil death during

1 88 Mustering of Medical Service in Scotland

the war years — a class which excluded the youngest
practitioners and included the oldest — was of a notably
unfavourable age constitution, so that the whole differ-
ence between the two rates cannot be set down as
a measure of the effects of war. The general pro-
position, however, that the pressure of the war bore
heavily on the civil profession requires no support from
figures.

Practitioners who Served

The Scottish civilian practitioners who served in His
Majesty's Forces are classified in Table XV. Officers
surviving and Officers who died make up the total who
served. The total who served were 2349, of whom 158
were private practitioners, 599 insurance practitioners,
151 consultants, 219 whole-time officials, 66 dental and
retired practitioners and 1156 unestablished. These

TABLE XV.

CLASSIFICATION OF SCOTTISH CIVILIAN PRACTITIONERS
WHO SERVED DURING THE WAR

PRACTITIONERS WHO SERVED.

Surviving.

Died on, or
of, Service.

Total
Served.

Private Practitioners

'S3

158

Insurance Practitioners

5?o

599

Consultants ....

148

IS*

Whole-time Officials

211

219

Dental and Retired Practitioners

Unestablished Practitioners .

1074

1156

TOTAL .

22l6

133

2349

Medical Officers

189

TABLE XVI

DISTRIBUTION OF SCOTTISH CIVILIAN PRACTITIONERS
WHO SERVED DURING THE WAR

DIVISION.

GENERAL
PRACTITIONERS.

OTHER

PRACTITIONERS.

TOTAL.

Aberdeen

202

266

Argyll ....
Ayr .

12
6l

27
QI

Banff, Elgin and Nairn .
Caithness and Sutherland

40
13

Dumbarton

Dumfries and Galloway .
Dundee ....

45
65

66
99

Edinburgh and Leith

354

438

Fife

Glasgow ....
Inverness

183
10

360
23

543
33

Islands ....

Lanark ....
Lothians ....

177

Orkney ....

Perth ....

Renfrew and Bute . .

112

Ross and Cromarty
South Eastern

3
*9

16
38

Stirling ....

Zetland ....

Total .

757

1592

2349

190 Mustering of Medical Service in Scotland

figures, on the mean of the numbers of each class
living on i August 1914 and u November 1918, in-
dicate that there served of private practitioners 44 per
cent, of insurance practitioners 35 per cent., of con-
sultants 63 per cent., of whole-time officials 49 per cent.,
and of dental and retired practitioners 22 per cent.
The number of the unestablished who served overtops
the mean. Of the mean total strength of the civil
profession in Scotland, including the unestablished,
58 per cent, were on service during the recent war.

The distribution among Divisions of the practitioners
who served is presented in Table XVI. The largest
totals are those recorded for Glasgow and Edinburgh
and Leith. Aberdeen has a figure of over 200, and
Lanark and Renfrew and Bute over 100. Dundee,
Fife, Ayr and the Lothians have over 90. Every
Division sent its contingent.

Denudation in Civil Practice

Table XVII. portrays the areal distribution of Scot-
tish General and Other Practitioners surviving on n
November 1918, according as they were serving, or
alternatively had already served, on that day, or re-
mained in civil life. Thus the General Practitioners in
column 3 include not only those who were on service
on ii November 1918, but also those who, having given
service, had returned to the charge of their practices.
Few, however, had so returned, and most who had
returned had again gone on service, so that the General
Practitioners of column 5, who represent the balance of
column 3, may be taken as broadly equivalent to the
number engaged in civil practice on Armistice Day.
The figures of column 5 are therefore employed in
fixing the population, in column 7, per general practi-

TABLE XVII

DISTRIBUTION OF SCOTTISH CIVILIAN PRACTITIONERS, SERVING
AND REMAINING IN CIVIL LIFE AT n NOVEMBER 1918

2 3

PRACTITIONERS.

*;*

O j

ESTIMATED

Serving, or

DIVISION.

POPULATION having Served,
ii NOVEMBER at n November

Remaining.

1918.

H 5

G. P.

Others.

G. P.

Others.

§1

Aberdeen

344,753

194

4009

Argyll. . .
Ayr ....

60,572
269,652

37
77

1637
35°2

Banff, Elgin and Nairn

105,774

3111

Caithness and Suther-

land .

47,626

2802

Dumbarton .

I47,536

4098

Dumfries and Gallo-

way ....

135,224

5°

2704

Dundee

274,075

4645

Edinburgh and Leith .

409,586

330

108

237

3792

Fife ....

292,276

573 i

Glasgow

1,105,505

174

247

ISO

4476

Inverness, Islands, and

Ross and Cromarty .

153,052

2888

Lanark

500,041

109

5435

Lothians

235,530

4529

Orkney

23,279

1552

Perth ....

126,346

3082

Renfrew and Bute

316,790

4061

South Eastern

108,653

2937

Stirling

200,669

3859

Zetland

24,753

2750

TOTAL

4,881,692

723

'493

1231

834

3966

191

192 Mustering of Medical Service in Scotland

tioner remaining, which furnishes an index for each
area of the denudation in civil practice. For reasons
stated under Table XIII., Inverness, the Islands and
Ross and Cromarty require to be grouped together.
The remaining areas are the same Divisions as in
previous distribution tables.

Of the ten Divisions whose population exceeded
200,000, two, Fife and Lanark, had over 5000 persons
per general practitioner remaining ; five, Aberdeen,
Dundee, Glasgow, Lothians, and Renfrew and Bute,
had over 4000 ; while three, Ayr, Edinburgh and
Leith and Stirling, had over 3500. Of the less
populous areas, one, Dumbarton, exceeded 4000.
For Scotland as a whole the population per general
practitioner remaining was 3966, a notable increase
on 2192, the corresponding figure for i August 1914.

That this attenuation should have been reached
without a general breakdown of the civil medical
service, and the popular unrest which would have
ensued, was the result of several causes. There are
grounds for the view that the total demand on the
profession from civilian sources, though latterly over-
whelming to the practitioners left at home, was less
during the war than under peace conditions. Enlist-
ment reduced the number of the persons qualified to
obtain civil medical attendance. The abundance of
employment promoted mental and physical well-being.
The rationing restrictions in certain cases were probably
beneficial to health. Before the high purpose and the
grave issues of the war valetudinarianism withered.
People, when genuine illness overtook them, complied
with requests made on behalf of the profession and sent
their summonses to their doctor by a stated hour of the
morning. At the Emergency Bureaux the amount of
work requiring to be done was in general below ex-

Denudation

'93

TABLE XVIII

POPULATION PER GENERAL PRACTITIONER IN PRACTICE
1914-1918

1914
i Aug.

'9?5
15 May.

1915

31 Dec.

1916
7 JuneJ

1918
ii Nov.

Aberdeen ....
Argyll
Ayr

2194

1364
2033

2803

J54i

2164

3301
1688

2333

3396
1688

2333

4009
1637
3502

Banff, Elgin and Nairn
Caithness and Sutherland .
Dumbarton

1730
1007
2570

2003
2609
2899

2238
2747
3168

2238
2899
3168

3III

2802
4098

Dumfries and Galloway
Dundee ....
Edinburgh and Leith .

1746
2786
1728

2075

3391
2077

2310

35^8
2372

2347
3655
2330

2704
4645
3792

Fife
Glasgow ....
Inverness ....

2704
2188
1713

3226
2606
2413

3771
3019

24'3

3771
3l8l
2528

5731
4476

2888

Islands ....
Lanark ....
Lothians ....

2679
2948
2399

3014

3387
2741

2893

39'5
3030

2893
398o
3070

2888

5435
4529

Orkney ....
Perth
Renfrew and Bute

"95
2391

2154

^63
3033
2477

1523
3188
2752

'523
3272
2831

1552
3082
4061

Ross and Cromarty .
South Eastern
Stirling ....

2307
2OI2
2170

2451
2483

2349

2801
243 i
2773

2801
2652
2852

2888

2937
3859

Zetland ....

1994

2791

3101

2750

Total

2192

2576

2892

2959

3966

The figures in black type are for Inverness, the Islands, and

Ross and Cromarty taken together.
13

194 Mustering of Medical Service in Scotland

pectation. As may be deduced from Table XVIII. the
change from a full supply to a scarcity of practitioners
was effected by gradual stages.

Excepting the influenza epidemic1 of 1918-19, which
cost Scotland 17,575 lives, and which would have over-
taxed the medical profession even at its normal strength,
the standards of medical practice, in their essentials,
were preserved intact through the war period, and if
practitioners were less accessible than in the days of
peace, the hardship so entailed was not more than
people, to their credit, accepted as unavoidable.

While such was the general position, there was in-
equality in the local incidence of the shortage. The
differences between Divisions have been stated. In a
number of areas within Divisions the proportion of
persons per general practitioner was much in excess
of the Divisional average. In a part of Glasgow
which was normally cared for by seventeen general
practitioners, ten of these in February 1918 were
absent on military duty. Of the seven remaining,
two were ill and one was totally incapacitated, leav-
ing only four effectives for a population of 55,000.
This was equivalent to 13,750 persons per general
practitioner. The Emergency Committee obtained
from the War Office the discharge of one of the ten
officers on service, so that the number of persons per
general practitioner fell to 11,000.

Complaints from Districts, put forward by local bodies,
as to the lack of medical attendance were received by
the Committee in a number of cases towards the close
of hostilities. While sympathizing with the requests
made, the Committee, owing to the requirements of
armies in the field, was seldom able to grant them.

1 The maximum intensity of the outbreak was during de-
mobilization.

Denudation 195

Pressure of Civil Work

The maintenance of a medical service in the country
despite the conditions prevailing was only made
possible by the strenuous and unremitting efforts of
the medical men in civil practice. Their self-denial and
devotion were worthy of the best traditions. The
strength of many was overpowered by their burden.
Instances occur to the minds of all of doctors whose
lives were cut short by the strain of their war-time
duties. In a district of Glasgow in the course of one
week two elderly practitioners died on their rounds,
one while seated at the bedside of a patient, the other
in the street.

Further Denudation

It thus emerges that by Armistice Day the number
of general practitioners in civil practice in Scotland
had been reduced far below the pre-war level. It is
shown, however, that the loss of personnel was
unequally shared among Divisions and parts of
Divisions.

If the war had continued, and the Fighting Forces
had demanded further drafts of Scottish medical officers,
further drafts could have been provided. From the
remote and insular areas further withdrawals could
have been made by means of substitution, and an
increase in the denudation of populous areas, accom-
panied by a smoothing of the inequalities between
them, would have liberated substantial numbers. It
is probable, however, that the voluntary system of
arranging for the carrying on of vacated civil practices
would have required to be replaced by a co-ordinated
scheme under statutory powers. It was happily never

196 Mustering of Medical Service in Scotland

necessary to compute the ultimate degree of denudation
of the medical service which, had the fighting on the
Western Front in the Autumn of 1918 proved indecisive,
would have had to be imposed upon the nation ; but
the opinion is hazarded that, as long as Britain could
maintain Armies in the field, so long, at least, the
Scottish profession would have been able, and willing,
to supply medical officers.

How Sleep the Brave

It would have extended the range of this admini-
strative account beyond its proper limit, if the attempt
had been made to depict any of the great events to
which the work of the Emergency Committee was but
the prelude. The naval and military actions in which
Scottish medical officers played a distinguished part
belong to larger history.

To the Officers who gave their lives for their country
Scottish Medicine will owe and pay a tribute of grateful
remembrance. They attained the crowning honour of
war and ennobled the profession which counts them in
its number. No term of praise can add lustre to their
name. They rest, whether by sea or land, secure of a
special place in the memory and affection of their
colleagues.

Acknowledgments

From the date of its entrance upon medical recruiting
until March 1918 the Emergency Committee was in-
debted to the unwavering support of Sir Alfred Keogh,
D.G., A. M.S., whose far-sighted appreciation of the
twofold responsibility of the profession, for both the
military and the civil purposes of war, lightened the

A cknotuledgments 197

labours of the Committee at various critical stages and
in a wider field determined a medical policy which
conduced to the success of the British arms. To Sir
T. H. J. C. Goodwin, who became D.G., A.M.S. in
succession to Sir Alfred Keogh, the Committee was
obliged for much consideration especially during the
difficult period of demobilization. The Committee's
relations with Lt.-Col. A. P. Blenkinsop, A.D.G.
(personnel), Sir William Babtie, D.M.S., and Sir
E. Worthington, A.D.G. (personnel), at the War
Office, with the officers of the Scottish Command, and
with the Medical Department of the Admiralty, were
of the most cordial character.

Throughout its tenure the Committee had the ad-
vantage of receiving the advice, on problems arising,
of Sir Donald MacAlister, President of the General
Medical Council, who, although unable to accept
membership of the Committee J placed his wide
experience of medical questions entirely at its
disposal.

From the Right Honourable Robert Munro, Secretary
for Scotland, and the officials of the Scottish Office,
from the Earl of Derby as Director General of Re-
cruiting, from the Department of National Service
under Mr. Neville Chamberlain, from the Ministry of
National Service under Sir Auckland Geddes and, for
medical services, Sir James Galloway, from the Local
Government Board for Scotland, the Scottish Insurance
Commission, the Highlands and Islands Medical Ser-
vice Board and other Public Departments, and from
the Central Medical War Committee and the Committee
of Reference in London, the Committee received
effective co-operation in all matters of mutual interest.

To the members and officials of Town and County

198 Mustering of Medical Service in Scotland

Councils, District and Insurance Committees, Educa-
tion Authorities and Parish Councils, to the Scottish
Universities and Medical Schools, to Managers of
Hospitals and Infirmaries, Employers of Labour,
Miners' Associations, and others concerned in the
question of medical supply, the Committee was in-
debted for clear statements of cases submitted to it,
and a reasonable acquiescence in its decisions.

The Committee owes a cordial acknowledgment to
the British Medical Association, which made its or-
ganization available to the Committee in the appoint-
ment of War Committees. The War Committees
rendered important service. They proved themselves
zealous, efficient and worthy of every confidence. The
names of their original Secretaries are recorded in
Appendix I.

By courtesy of the Royal College of Physicians,
Edinburgh, the College, as already noted,1 was utilized
as the Headquarters of the Committee, and Mr. T. H.
Graham, the Librarian of the College, acted by per-
mission of the Council as Secretary of the Committee
during its period of office. For these facilities, which
were much prized by the Committee, its special thanks
were presented to the College.

The Committee's most extensive obligation was to
the medical profession of Scotland, whose constant
support in times of stress was both a stimulus and an
encouragement. The confidence of practitioners in
entrusting their destinies to its hands was deeply
impressive to the Committee. The Committee recog-
nized, in the fullest degree, that any success which
followed its work in medical recruiting or in maintain-
ing the standards of civil practice was due not to its
own unaided effort, but to the public spirit which

'P. 6.

Conclusion 199

actuated the Scottish profession throughout the
national struggle.

A statement of the financial transactions of the
Committee is contained in Appendix XI. Contributions
were received towards the Committee's expenses from
the Royal College of Physicians, Edinburgh, the Royal
College of Surgeons, Edinburgh, the Royal Faculty
of Physicians and Surgeons, Glasgow, the British
Medical Association, and, later, the Exchequer.

Conclusion

It appears to be demonstrated, or convincingly
suggested, by the experience of the Emergency Com-
mittee, as told in the tale now closing, that in Britain
at war it is administratively easy, owing to the bent
of the profession, to equip the Fighting Forces with
medical officers. To secure an effective distribution of
practitioners for civil practice, according to the varying
needs of different localities in war-time, is compara-
tively difficult.

In war, when waged by the modern highly organized
state, military and civil medicine are seen to have inter-
associations. In large-scale war, after a certain point
is reached, military and civil medicine are found to
be inseparable, and of nearly equal importance, since
difficulty arising on the civil side, through the with-
drawal of civil practitioners for military service, acts
indirectly as a drag on the further medical equipment
of armies. If the question of civil denudation is well
handled in early stages, the operation of the drag will
be delayed. If the question is well handled through-
out, the operation of the drag will be reduced to a
minimum.

Any arrangement or preconcerted scheme for

2OO Mustering of Medical Service in Scotland

supplying the Fighting Forces with medical officers,
drawn up or to be drawn up by the Military Depart-
ments of this country in anticipation of a future war,
should, if it is to serve the purposes of a large-scale
war, include means to hold and adjust the balance
between military requirements and the claims of civil
practice from the outbreak of hostilities.

APPENDICES

APPENDIX I

(PP. 29, 198)

DIVISIONS OF BRITISH MEDICAL ASSOCIATION
IN SCOTLAND AS ADOPTED BY EMERGENCY
COMMITTEE

NAME OF DIVISION.

DESCRIPTION.

SECRETARY OF WAR
COMMITTEK 1915.

Areas named are Civil Counties
unless otherwise indicated.

Aberdeen

Aberdeen. Kincardine.

Dr. F. K. Smith.

Argyll .

Argyll.

Dr. J. A. Clarke.

Ayr ....

Ayr.

Dr. W. F. Brown.

Banff, Elgin and

Banff. Elgin. Nairn.

Dr. T. A. Sellar.

Nairn.

Caithness and

Caithness. Sutherland.

Dr. A. Bremner.

Sutherland.

Dumbarton

Dumbarton.

Dr. J. Young.

Dumfries and Gallo-

Dumfries. Kirkcudbright.

Dr. J. D. Robson.

way.

Wigtown.

Dundee .

Forfar.

Dr. R. C. Buist.

Edinburgh and Leith

Edinburgh Burgh. Leith

Dr. J. Stevens.

Burgh.

Fife.

G. C. Anderson.

Glasgow .

Glasgow Burgh.

Dr. J. Wishart

Kerr and Dr. J.

R. Drever.

Inverness

Mainland of Inverness, ex-

Dr. J. Murray.

cept Glenelg and Arisaig

Parishes.

2O2 Mustering of Medical Service in Scotland
APPENDIX I.— continued.

NAME OP DIVISION.

DESCRIPTION.

Areas named are Civil Counties
unless otherwise indicated.

SECRETARY OF WA«
COMMITTEE 1915.

Islands .

Lanark .
Lothians .

Orkney .

Perth

Renfrew and Bute .

Ross and Cromarty

South Eastern .
Stirling .
Zetland .

In Inverness, Glenelg and Aris-
aig Parishes, Harris District
and Islands ; in Ross and
Cromarty, Gairloch, Apple-
cross, Lochcarron, Lochalsh,
Kintail, and Glenshiel
Parishes, and Lewis District.

Lanark, except Glasgow
Burgh.

Midlothian, except Edinburgh
Burgh and Leith Burgh.
East Lothian. West Lothian.

Orkney.

Perth.

Renfrew.

Bute.

Mainland of Ross and
Cromarty, except Gairloch,
Applecross, Lochcarron,
Lochalsh, Kintail, and Glen-
shiel Parishes.

Berwick. Peebles. Rox-
burgh. Selkirk.

Stirling. Clackmannan. Kin-
ross.

Zetland.

No appointment.

Dr. H. Miller and
Mr. W. M. Mar-
shall, Solicitor.

Mr. J. Burnet
Mackie, S.S.C.
(Midlothian);
Dr. W. R. Mar-
t i n e (East
Lothian) ; Dr.
A. Scott (West
Lothian).

Dr. W. Park.

Dr. J. H. Lyell.

Dr. W. Clow and
Dr.W.E.Tellet.

Dr. E. K. Mac-
kenzie.

Dr. M. J. Oliver.

Dr. D. Yellow-
lees.
Dr. S. Bolton.

APPENDIX II

(P. 12)

FIRST MEMORANDUM OF EMERGENCY
COMMITTEE

THE Scottish Medical Service Emergency Committee
has been constituted for the purpose of assisting to
meet the immediate difficulties, in regard to medical
practice among the civil population, which have arisen
or may arise owing to the departure of practitioners
summoned to take up military duty.

It is understood that some 300 Scottish practitioners
have been thus called away from their practices, and
more are liable to be called for at short notice.

In large towns these difficulties are little felt, for the
practitioners remaining have willingly undertaken to
attend to the work and to safeguard the interests of
their absent colleagues. But in smaller places and in
rural districts such friendly arrangements are less easily
made. Locum tenentes are not numerous, and the rate
of remuneration they expect tends to become pro-
hibitive.

To cope with the emergency, the Committee suggests
that the following steps should be taken : —

(1) That it should be generally agreed that the fee
offered to a locum tenens taking the work of a prac-
titioner engaged in military duty should not exceed
five guineas a week.

(2) That retired practitioners willing to relieve their
professional brethren, and so to enable them to serve
their country in the field, should send their names to
the Emergency Committee forthwith for registration
and ultimate allocation to temporarily vacant practices.

(3) That it be suggested to the educational authori-

203

204 Mustering of Medical Service in Scotland

ties that school medical officers should be permitted to
give at least part of their time to general work.

(4) That the visiting staffs of large hospitals,
infirmaries, and asylums should consent to a reduction
of the numbers of their medical residents and clinical
assistants, and should themselves undertake a propor-
tion of the work usually assigned to these junior
officers.

(5) That in the larger towns young practitioners,
whose practices are not yet extensive, should in pairs
make an arrangement whereby one undertakes the
whole town practice for (say) two months, while the
other acts temporarily in the country for a third
colleague absent on duty ; and so alternatively for
successive periods.

In these and other ways the Committee has reason to
believe that a sufficient supply of practitioners for the
present need could be provided ; what is still required
is to bring the workers and the work together.

The Committee is convinced that the profession
generally will recognise that the needs of the civilian
population must continue to be met, even in the
presence of an imperative call for an adequate service
in the field ; and that whoever relieves a colleague
summoned to military duty ipso facto is also serving
his country in this time of stress.

The ordinary agencies for the supply of qualified
assistants and locum tenentes are in active operation,
and they should in the first place be resorted to by
practitioners requiring such assistance. The Com-
mittee does not propose to assume the functions of
such agencies. But by furnishing a bureau or " clear-
ing-house " for the collection and dissemination of
information, on the one hand, regarding districts or
practices deprived of qualified practitioners to work
them ; and, on the other hand, regarding practitioners
prepared to undertake the duty of supplying such
vacancies for a time, the Committee is satisfied that a
valuable service may be rendered to the profession and
the public,

Appendix II 205

The Committee is now ready to receive communica-
tions from medical practitioners in Scotland who are
desirous either of obtaining" or of affording1 professional
help in the circumstances above indicated. All such
communications should be addressed to

THE CONVENER, MEDICAL EMERGENCY COMMITTEE,
ROYAL COLLEGE OF PHYSICIANS,

EDINBURGH.

APPENDIX III
(P. 15)

FORM OF UNDERTAKING

SCOTTISH MEDICAL SERVICE EMERGENCY
COMMITTEE

ROYAL COLLEGE OF PHYSICIANS,
EDINBURGH

DEAR SIR,

In asking you to agree to act as locum tenens for
Dr. I feel sure that you will not misunderstand

the request that you should give the undertaking referred to
below. It is obviously the duty of the Committee to take all
reasonable steps to prevent any difficulties arising later
Unless it is otherwise arranged between the practitioners con-
cerned in writing, each locum tenens acting under the present
arrangements shall, by the very fact of his so acting, be held to
agree not to practise as a Physician, Surgeon, or Apothecary in
the town in which he is acting for the regular practitioner, or
within the distance of seven miles from such town, — or from
the regular practitioner's house where it is not in a town, — for a
period of five years from and after the date when the regular
practitioner returns to work or ceases to serve with the colours
from whatever cause ; and to join with the regular practitioner
or his representatives in submitting all questions that may
arise in connection with the practice to the Presidents for the
time being of (a) the Royal College of Physicians of Edinburgh ;
(£) the Royal College of Surgeons of Edinburgh ; and (c) the
Royal Faculty of Physicians and Surgeons of Glasgow, as joint
arbiters ; and to abide by their decision.

If you agree, please sign the docquet below and return this
circular to me, when I shall have it stamped as a binding
Agreement.

I am, Yours faithfully,

I confirm the terms above set forth in con-
nection with the practice of Dr.
of which I agree to take charge as locum tenens.

Sign as follows :—

"Adopted as holograph, >•

JOHN SMITH, M.D." signature ,..*^*» .._,

Date..,,

APPENDIX IV

(P. 33)

FOURTH MEMORANDUM OF EMERGENCY
COMMITTEE

THE WAR

Opportunity of the Profession

I. — To the Medical Profession of this Country there
has come a great opportunity. Theirs is to be the
distinction of rendering services to the Empire greater
than those which any of the other peaceful professions
can offer. They will have hardships in the field and
sacrifices at home. To make these sacrifices and
endure these hardships will be their duty and privilege.

II. — Scotland has provided her full proportion of the
medical men required for Army work up to the present
date. But a fresh call has gone forth for more
volunteers to meet the needs of the new armies and to
make good the losses of those now at the front. The
call, in the words of the Director-General, is to all
" who are physically fit and willing to serve."

Position in Scotland

III. — Various organizations, in particular the British
Medical Association through its Branches and Divisions,
have taken steps to bring this fresh appeal to the notice
of the profession in Scotland, and an encouraging
response has begun to be made.

IV. — It is, however, the unanimous opinion of those

who are in touch with the War Office on the one hand,

207

208 Mustering of Medical Service in Scotland

and with the working members of the profession on the
other, that a single central body should, in Scotland,
undertake the general direction of the arrangements
to supply the needs of the nation. After conference
and negotiation with the various professional executives
it has been agreed to entrust this responsible duty to
the Scottish Medical Service Emergency Committee,
which was constituted in August 1914 for the purpose
of dealing with the problems that called for solution
at the beginning of the War.

Emergency Committee

V. — This Emergency Committee is a temporary
body, and it possesses no right of control ; but it has
already acquired much useful experience, and it places
its counsel and help at the disposal of all members of
the profession, whether they volunteer for active service
or remain at home to fulfil civil duty and carry on for
those who are absent.

VI. — The Committee do not think it necessary to
dwell upon the Director-General's impressive appeal.
It is printed in the British Medical Journal of i3th March
last, and is already well known to all. The devotion
of the medical profession in Scotland is unquestioned.
Guidance and direction only are now required to ensure
a response worthy of the high occasion.

Offer* for Whole-Time Service

VII. — The attention of the Committee will, in the
meantime, be specially directed to offers for whole-time
service. This is the more pressing problem. The
number of men for whole-time service which it is hoped
to raise in Scotland is 400. The Committee believe
that arrangements regarding part-time service will be
best made, and where necessary readjusted, by those
possessing a close knowledge of the circumstances of
each individual area.

Appendix IV 209

VIII. — Offers for whole-time service may be divided
into two classes : —

1. Men under forty, whose services will be accepted

for a period of twelve months, and who will
be liable for service at home or abroad.

2. Men over forty, who may offer their services

for a period of six or twelve months. These
will not be sent to France, but will be em-
ployed either in this country or in such stations
as Egypt, Malta, and Gibraltar. If they
desire it, and have been found serviceable,
they may be re-engaged at the end of six
months.

Men may enrol their names with the Emergency
Committee, declaring their readiness to join
after a certain date on receiving thirty-six
hours' notice from the War Office that their
services are forthwith required. If they en-
gage on a twelve months' contract they will
receive temporary commissions in the R. A. M . C. ,
with an allowance of ^£30 for outfit, and pay
at the rate of 243. a day, with is. gd. for
Ration allowance, and a gratuity of £60 at
the termination of the engagement, subject to
satisfactory service. If the engagement is for
six months the terms are the same as for the
longer period, but the gratuity would be ^"15
instead of ;£6o.

Organization of the Profession

IX. — In directing the work of enabling men to apply
for these appointments the Emergency Committee, as
already indicated, is to be the Central Body. It is
proposed that the area of each Division of the British
Medical Association shall be the local administrative
unit, looking for co-ordination, and help if desired, to
the Emergency Committee. The area of each division
should be in charge of a War Committee, the formation
14

2 io Mustering of Medical Service in Scotland

of which should, if necessary, be carried out by the
Executive of the Division calling a meeting of the
Members of the profession in the area for the purpose.
The membership of a War Committee should be small,
say three or five. In some cases it may be found that
the area of a division, owing to the detailed adjustment
necessary to meet varying circumstances, is too large
for effective control by the Divisional War Committee.
In these cases it will be convenient to subdivide further
into such areas as Counties, districts of Counties, or
populous Burghs, appointing a War Sub-Committee
for each. The work devolving upon War Committees
will be considerable, and it is suggested that their
members should be men who, despite other pressing
claims on every hand, are prepared to make time to do
the work.

X. — Before detailing the procedure by which the
Emergency Committee will keep in touch with the
War Committees, reference must be made to two
matters of practical importance. The first of these
is the extent to which certain areas have already con-
tributed to the needs of the Army. The second is the
question of the dates by which the fresh drafts must be
available.

Service already given

XI. — It is known that there are districts in Scotland
which have already made notable sacrifices, while in
others, for reasons which have up till now been adequate,
there are considerable reserves to draw on. Steps
have been taken, with the co-operation of the British
Medical Association, to ascertain the facts with pre-
cision, with the result that the Emergency Committee
will have in their hands a Muster Roll of the profession
in Scotland. In considering the question of approach-
ing areas with a further call upon their men, the Com-
mittee will keep before them, for their guidance, this
Scottish Muster Roll.

Appendix IV 211

Fresh Drafts

XII. — With regard to the dates by which the fresh
drafts will be wanted, the Emergency Committee have
arranged with the War Office to be informed upon this
particular. To the total of 400 men referred to in
paragraph VII. there is reason to believe that the
graduates and licentiates of July will contribute about
100. Of the remaining 300, some will be expected to
be ready for duty, if required, in August ; an additional
number will be due in September ; and a further con-
tingent in October. In advising War Committees of
the incidence of these claims upon their respective areas,
the Emergency Committee will make successive calls
upon them in order that disorganization of civil practice
may, as far as possible, be prevented and time allowed
for devising adjustments to meet the new conditions.
These calls, which will be three in number, will be
preceded by a preliminary notice.

XIII. — As briefly as possible, the following are the
main steps in the procedure which it is proposed to
follow.

Procedure of War Committees

XIV. — Preliminary Notice. With the Muster Roll
of each area before them, and with knowledge of the
requirements of the Army, the Emergency Committee
will early in July intimate to each War Committee the
total number of men from their Division who will be
required for service, and thereupon it will be for the
War Committee to make such preliminary arrangements
as will expedite procedure when the three successive
calls are presented.

XV.— First Call. On or about 2oth July the Emer-
gency Committee will intimate to each War Committee
the number of men from their Division who will be
required to form the August contingent. Thereupon
the War Committee, acting in subdivided areas through

2 1 2 Mustering of Medical Service in Scotland

its War Sub-Committees, will select those practitioners
on whom the honour shall fall, and will request them to
hold themselves in readiness for service as and when
called upon. The War Committee will also, at the
earliest possible moment, forward the names of these
practitioners to the Emergency Committee. The Emer-
gency Committee will then send to the practitioners the
form of application issued by the War Office. These
forms, duly filled in, will then be returned by the practi-
tioners to the Emergency Committee, to be transmitted
by the Emergency Committee in due course to the War
Office, with whom the remaining steps will lie.

XVI.— Second and Third Calls. On or about 2Oth
August and 2oth September the Emergency Committee
will similarly intimate to each War Committee the
number of men from their Division who will be required
to form the September and October contingents respec-
tively. The further procedure for each of these months
will be precisely the same as for August.

Civil Practice

XVII.— It will be the duty of War Committees to
assure themselves that proper arrangements can be
made for carrying on the practices of those who are to
go on service, and the Emergency Committee will look
to War Committees to see that names are not sent in
until this is ascertained. It is clearly undesirable in
the public interest that any area should be denuded of
medical practitioners.

XVIII. — In populous centres special schemes for
carrying on civil work will have to be devised, or
bureaux established as in Dundee and Aberdeen. Such
schemes may be specially organized for the purpose, or
it may be found convenient to employ the organization
of existing bodies. In any case, the schemes should be
capable of dealing, where necessary, with both private
and insurance practices.

Appendix IV 213

Practitioners on Service

XIX. — Turning now to the questions which fall to be
considered by individual medical men, the Committee
would urge upon every practitioner who leaves his
practice on being chosen for military service the import-
ance of making clear and business-like arrangements
for the conduct of his work with the colleague or
colleagues who take charge of it. The Committee
suggests that such arrangements between practi-
tioners should be communicated to it ; and it is
prepared, when desired, to advise as to their
suitability. This suggestion is offered because,
during the past months, the Committee's advice has
repeatedly been sought in cases where arrangements
proposed or made have been found deficient either in
definiteness or in equity as between the parties. When
a misgiving as to equity exists on either side the Com-
mittee will be ready to advise on the arrangement with
a view to its reconsideration if thought necessary. It
is better to seek a satisfactory readjustment than to
leave doubts unsettled, and so kindle a sense of injustice
on one side or the other.

XX. — As a result of its experience, the Committee
strongly recommends every practitioner who joins the
Army to nominate some person, preferably a business
man, with power to act on his behalf in those matters
of business concerning his practice which may emerge
during his absence.

XXI. — Members of the Committee are constantly
being asked by their medical friends or former pupils
to advise them as to the direction in which their duty
lies in the circumstances of the time. The Committee
is now prepared to assume the responsibility of giving
such advice to enquirers. Its composition and experi-
ence justify it in believing that its collective opinion,
formed after due consideration of each case on its merits,
will be received by the profession and the public as

214 Mustering of Medical Service in Scotland

definitive. Correspondence from those who desire the
support of such an opinion is accordingly invited.

Practitioners who remain at Home

XXII. — Practitioners who remain at home may be
counted upon to safeguard loyally the interests of
colleagues absent on military duty ; but it is necessary
to urge upon all who assume this responsibility that in
making arrangements for such an object co-operation
on a recognized plan is of supreme importance, and is
indeed essential to the efficiency and repute of the pro-
fession in the present emergency. The Committee will
always be prepared to facilitate such co-operative
arrangements, and, if necessary, a member of the Com-
mittee will visit the locality concerned in order to assist
negotiation.

XXIII. — In January last the Committee issued a
circular containing suggested arrangements for carry-
ing on the practices of men then absent on duty with
the King's Forces. While the principles therein em-
bodied still hold good, the problem has grown so as to
make it desirable to reiterate the more important of
these principles and to formulate others.

Glasses of Praotioe and Financial Arrangements

XXIV. — While the medical man who is with the Forces
has the honour of serving his country directly, he may
at the same time imperil the position which he has
established after many years of hard work or in which
he has sunk his capital. The man who remains to do
the necessary work at home has to take on a large
addition to work which may be already considerable,
and he has to do this without the prospect of its being
of any lasting benefit to him, for it is the essence of
these arrangements that they are only " for the period
of the war." Bearing these considerations in mind the
Committee commends the following arrangements for
three classes of practice : —

Appendix IV 215

CLASS I. — Town Practice. — Large towns where the
question of mileage is not a very important
consideration. Here it is suggested that an
equal division of the remuneration should be
agreed upon, this to apply both to private and
insurance practice. Where a bureau is in
operation the plan should be to deduct the
expenses of working from the receipts and
divide the balance equally.

CLASS II. — Town and Country Practice. — Towns
with a considerable population, but with a
large amount of country work, necessarily in-
volving the question of travelling expenses.
It may be possible to ascertain these with
more or less exactness, but as a general rule
probably a division of all remuneration on the
basis of three-eighths to the absentee and five-
eighths to the man who is doing all the work
and paying all the expenses is the nearest to
equity.

CLASS III. — Country Practice. — Smaller centres or
Single Practice Areas where the question of
travelling expenses and consumption of time
becomes still more important. In such, three-
fourths at least should be allotted to the man
who is doing the work.

XXV. — It should be noted with regard to the three
classes of practice that the difference between, say, a
town practice (Class I.) on the one hand, and a town
and country practice (Class II.) on the other, is not
entirely one of geographical situation. Practices in
large cities will in general offer no difficulty ; they are
town practices pure and simple. For practices in towns
of moderate size, however, much will depend on the
character of the town. In industrial burghs many
practices will suitably be classed as town practices
(Class I.) ; while in a market town of the same popula-
tion all practices will probably be of the town and
country class (Class II.). In the same town again,

216 Mustering of Medical Service in Scotland

some practices will belong to Class I. and others to
Class II. Lastly, in many small towns where the bulk
of the work lies in the surrounding country, the town
element may be practically non-existent, and the
practice would fairly be counted in the country class
(Class III.). Consideration of the facts and of local
conditions can alone determine the correct point of
view in doubtful cases.

XXVI. — The foregoing considerations are thought
to be applicable both to private and insurance practice,
including under private practice all fees for medical
attendance, operations, midwifery, and the like, and
under insurance practice all capitation fees, mileage
and dispensing allowances, and other charges, if any.
The sum total of such amounts would be divided
between absentee and deputy in the proportion of half
and half: three-eighths and five-eighths: and one-
quarter and three-quarters — according as the practice
falls under Class I., Class II., or Class III.

Aooounta

XXVII. — In private practice the treatment of cash
payments will be simple. As regards the rendering of
accounts for private work on behalf of absentees, these
should be sent out by the deputy at the same time as he
sends out his own, and it is suggested that they should
be sent by Dr. A. "on behalf of Dr. B., absent on duty
with the King's Forces."

XXVIII. — In insurance practice it will probably be
found convenient that the Insurance Clerk should pay
directly to the absentee and to his deputy the propor-
tional amount agreed upon between them. Formal
authorization would require to be given to the Clerk
with this object.

Question of Transfers

XXIX. — The Committee are confident that no medical
man remaining in civil practice at home will endeavour

Appendix IV 217

to secure the transfer to himself of patients of a practi-
tioner absent on War Service. Alike for private and
insurance work they feel sure that this rule will hold.

XXX. — With reference more particularly to insurance
work the Committee think it useful to say that, save in
very exceptional circumstances which are dealt with in
paragraph XXXII., it is not in the general interests of
the profession that transfers should be made from the
Insurance lists of doctors absent on War duty. Nor is
it necessary. The position of Deputy is clearly recog-
nized by the Agreements under the Medical Benefit
Regulations. Insured persons do not need to be on
the list of the deputy ; they remain on that of the
doctor for whom the deputy acts. In the course of a
year transfer can ordinarily take place only with the
consent of the doctor whose list contains the name of
the insured person. At the end of a year such consent
is not required ; the insured person may then give notice
that he desires to change his doctor, and having done
so he is at liberty to make a fresh choice. In some
areas doctors remaining at home have passed a self-
denying ordinance, by which they refuse to accept any
such transfers for a period of twelve months from the
return home of the doctor absent on War Service. If,
however, an insured person were to persist in his deter-
mination for transfer notwithstanding such refusal by
the doctor to whom he applies, then the Insurance
Committee would be required to assign him to some
doctor in their area, and that doctor would be bound
to accept. It seems to the Committee that it is the
proper course for the doctor to whom such persons are
assigned, to hold them in trust for the absentee, sharing
the capitation and other allowances on the principles of
paragraph XXVI. Further, it is open to the profession
in any area to agree that, at the end of the year during
which such assignment holds good, the doctor will refuse
to continue the insured person on his list, so that it will be
necessary for the insured person to make a fresh choice,
and he will naturally revert to his original doctor.

2i8 Mustering of Medical Service in Scotland

XXXI. — The Committee is satisfied that the adoption
by the profession of an arrangement on these lines will
give very full protection against loss of practice through
acceptance of War duty ; but even if any loss were to
occur, it would amount only to this, that the doctor,
in respect of his own work, is sharing in the burden
which every individual in the Nation will have to
bear on account of the War. The Committee knows
that that burden, and greater burdens, will be borne
unflinchingly.

XXXII. — The Committee recognizes that a certain
number of applications for transfer from the lists of
practitioners absent on service may be due to circum-
stances which have nothing to do with the War.
These cases should be considered on their merits,
and the decision may sometimes be difficult ; but the
Committee is of opinion that no practitioner should
accept such an application without having previously
consulted some local body representative of practi-
tioners in his area. The facts should be laid before
the Panel Committee or the Local Medical Committee
or similar Medical Association, and the practitioner
should take their advice into careful consideration.

Vicarious Service

XXXIII. — Those who cannot serve the Country
directly with the Forces can do so indirectly by
placing themselves at the disposal of the Emergency
Committee as locum tenentes. There are young men
in remote districts eager to join the R.A.M.C., who
are prevented from doing so because they can get no
substitute, and can find no neighbour near enough to
do their work. If a man who is himself too old to
serve will take the place of one of those young men,
and thus allow him to go, he will indirectly contribute
one to Scotland's four hundred.

EDINBURGH, 28/7; June 1915.

APPENDIX V

(p. 42)

NOTICE

DOCTORS SERVING WITH H.M. FORCES

PATIENTS

whose ordinary medical attendant is serving
with the forces should during his absence
intimate his name to any other doctor whom
they may consult or call in.

BY REQUEST OF

THE SCOTTISH MEDICAL SERVICE EMERGENCY COMMITTEE.

219

APPENDIX VI

(P. S3)
To be filled in by Practitioner not holding a Commission

REGISTRATION FORM
MEDICAL RECRUITING SCHEME— 1916

Name of Practitioner (Surname). . . .

(Christian names in full).

Qualifications). .

Present work

Address.

State here whether general
practitioner and if so whether
panel or non-panel : consultant :
whole-time officer (public health
officer, tuberculosis officer, hos-
pital resident, pathologist, etc.) :
recent graduate living at home,
etc.

Age as at \st January 1916.

GROUP.

AGE.

Mark with a X the service or services which
you are prepared to render.

Under 45

Lieut., R.A. M.C. (general service).

45 to 55

Lieut., R.A.M.C. (home service).
Part-time home military work.
Locum tenens.
Part-time home civil work.

56 and upwards

•:::::.

Part-time home military work.
Locum tenens.
Part-time home civil work.

At the call of the Local War Committee for my area, as in-
structed by the Scottish Medical Service Emergency Committee,
I am prepared to render the service or services marked above.
This offer is subject to the condition that, in the event of such
service requiring me to leave my present work, I am enabled to
make arrangements for having it carried on during my absence.

(Signature)

(Date)

To be returned to

THE SECRETARY,

SCOTTISH MEDICAL SERVICE EMERGENCY COMMITTEE,
ROYAL COLLEGE OF PHYSICIANS,

EDINBURGH,
before 31 st December 1915.

APPENDIX VII

(P. 61)

Form K

DEAR SIR,

I enclose herewith Application Form for a
Commission in the Royal Army Medical Corps by the
following practitioner : —

Address.

I have ascertained that in the event of the practitioner
obtaining1 a Commission, the following arrangements
will be made for carrying on his work during his
absence: —

My Committee is of opinion that these arrangements
are satisfactory.

Yours faithfully,

Secretary of the Local War Committee for the
Division.

THE CONVENER,

SCOTTISH MEDICAL SERVICE EMERGENCY COMMITTEE,

ROYAL COLLEGE OF PHYSICIANS,

EDINBURGH.

APPENDIX VIII

(p. 62)

LETTER OF EXCUSE

Dr.

Address

THE SCOTTISH MEDICAL SERVICE EMERGENCY COMMITTEE
is of opinion that it is meantime undesirable in the public
interest to call on the above-mentioned medical practi-
tioner to undertake Military Service.

This Letter is valid until,

Secretary. Convener.

ROYAL COLLEGE OF PHYSICIANS,
EDINBURGH, 19

APPENDIX IX

(P. 73)
CERTIFICATE OF REGISTRATION

SCOTTISH MEDICAL SERVICE EMERGENCY
COMMITTEE

This is to Certify that Dr.

has registered his name with this Committee as one 'who
is willing to accept a Commission in the Royal Army
Medical Corps, if and when called upon to do so.

Convener.

Secretary.

ROYAL COLLEGE OF PHYSICIANS,
EDINBURGH.

APPENDIX X

(P. 155)

INDIVIDUAL NOTIFICATION

M.N.S. (M)5
MINISTRY OF NATIONAL SERVICE

MEDICAL PRACTITIONERS

Notification pursuant to Regulation 17 of the

Military Service (Medical Practitioners)

Regulations, 1918

Surname

Christian Names.
Address

You are hereby notified that any original application
to be made by or in respect of you for the grant of a
certificate of exemption must be made to the Medical
Tribunal in accordance with Regulation 17 of the
Military Service (Medical Practitioners) Regulations,

1918, on or before the day of 191 ,

being the fourteenth day after the sending of this
notice.

Dated this day of. 191 .

Signature , ,,,.,

for the Minister of National Service,

Issued by the Ministry of National Service,
Westminster, London, S.W. x,

Ai/Form/55.

223

APPENDIX XI

(P. 199)

SCOTTISH MEDICAL SERVICE EMERGENCY
COMMITTEE

STATEMENT OF INCOME AND EXPENDITURE
FROM JANUARY i, 1915, TO DECEMBER 31, 1919

INCOME

CONTRIBUTIONS RECEIVED—

Royal College of Physicians, Edinburgh .
Royal College of Surgeons, Edinburgh
Royal Faculty of Physicians and Surgeons,

Glasgow

British Medical Association

War Office Grant-in-Aid ....

Ministry of National Service

EXPENDITURE

PAYMENTS DISBURSED —
Printing and Stationery
Typing and Materials .
Postages, Telegrams, and Telephones
Travelling Expenses .
Salaries and Gratuities
Advertising ......

Miscellaneous .

£200

10
150
750

100

Balance in hand .

^1285 o o

^203 10 3

14 15 o

164 18 8

306 5 8

494 II 8

9 14 9

23 o 6

;£i2i6 16 6

68 3 6

£1285 o o

The balance in hand of £68, 35. 6d. is applied towards the
cost of production of The Mustering of Medical Service in
Scotland.

T. H. GRAHAM.

EDINBURGH, June

INDEX

A.C.I., No. 148 of 1916, 74
„ No. 475 of 1916, 76
„ No. 485 of 1916, 76, 115

Act, Air Force Constitution, 1917,

158

,, Military Service, 1916, 72, 75
,, Military Service, 1916 (Ses-
sion 2), 80, 83

,, Military Service (Review of
Exceptions), 1917, 109,
122

,, Military Service, 1918, 133
,, Military Service (No. 2),

1918, no, 138
,, National Registration, 1915,

48,94
Adams, Dr. John, 6, 26, 95, 104,

154, 175
Admiralty, 4, 167

,, Medical Department, 197
Advertisement, 42
Advisory Committee. See Com-
mittee
,, Medical Board. See

Board

Age, medical officers. See Ser-
vice, Terms of

,, military, 47, 48, 75, 80, 138
Air Force, 158

America, United States of, 118
Amiens, Battle of, 157
Anderson, Dr. G. C., 6, 26, 175,

176, 178
Antwerp, 18
Anzac, Battles of, 27
Appeal Board, Special. See Board

,, Tribunal. See Tribunal
Armistice, 157
Armlet, 49

Army Council. See A.C.I, and

Council

,, Recruiting, 46
Arras, Battles of, 118
Artois, 157
Asquith, Right Hon. H. IL,

Assessors, Medical, 126
Association, British Medical, 13,

21, 24, 97, no, 172, 181, 198,

199

Associations, Miners , 198
Attestation, 74
Australia, 39
Austria, I, 27, 157

Babtie, Surgeon-Gen. Sir William,

104, 197
Baghdad, 118

Barbour, Dr. A. H. F., 26, 175
Barlow, Dr. John, 6, 175, 178
Belgium, 3, 162
Blackpool Depot, 113
Blenkinsop, Major-Gen. Sir A. P.,

25, 197
Board, Advisory Medical, 125

,, Army Medical, 122

,, Control, 161

,, Highlands and Islands
Medical Service, 16, 197

,, Local Government, Eng-
land, 82

,, Local Government, Scot-
land, 132, 161, 197

,, National Service Medical,

125, 133

„ Special Appeal, 122
„ Special Medical, 150

226

Index

Bosnia, I, 2

Bourke, Surgeon-General, 26

British Medical Association. See

Association
Bryce, Professor T. H., 95, 175,

176

Buist, Dr. R. C., 128
Bulgaria, 157
Bureaux, Medical —

Aberdeen, 24

Dundee, 13, 128

Edinburgh, 128

Glasgow, 25
Buttar, Dr. C., 104

Cabinet, War, 112, 113

Caird, Prof. Francis M., 6,

175

Caithness and Sutherland, 109
Call-up by War Office, in
Calls to Service, 37, 67, 93, 153
Cambrai, 130
Canada, 39

Canvassing of Practitioners, 50
Card, Notice, 42
Cash, Prof. J. T., 6, 175
Cavell, Miss Edith, 46
Census, 1911, 7
Central Medical War Committee.

See Committee
Central Professional Committee.

See Committee
Central Recruiting Committee. See

Committee
Certificate, Protection, 148

„ Registration, 73, 76
Chamberlain, Mr. Neville, 1 02,

107, 197

Champagne, 153, 157
Cheyne, Sir W. Watson, 143
Circular, June 1915, 29
Civilian Service, approved, 144
Command, Scottish, 197
Commission, Scottish Insurance,

16, 23, 161, 197
Commissioner of Medical Services,

Scotland, 124, 129, 156

Commissions, Resumption of, 120

!35
Committee, Advisory, 49

„ Central Medical War,

38, 98, 117, 197
,, Central Professional,
for Scotland, 84,
85, 124, 129, 133,

173

,, Emergency. Sa? Emer-
gency

,, Medical Establish-
ments in France,
121

,, Medical Services,
Interdepartmental,
159, 164

„ Professional, 83, 84

,, Recruiting, Central,
48

,, Recruiting, Joint
Labour, 47

,, Recruiting, Local, 48

, , Recruiting, Parlia-
mentary, 47

,, Reference, 84, 98, 197

,, Scottish, British
Medical Associa-
tion, 5, 26, 43, 96,
97

,, Select, on Military
Service (Review of
Exceptions) Act,
1917, 122

„ Special, British
Medical Associa-
tion, 21, 38

, , War Emergency, Eng-
land, 38
Committees, War, 34, 44, 101,

109, 149, 172, 198
Compulsory Service, 72, 79
Conference, Demobilization, First,

159
,, Demobilization,

Second, 164

,, Derby, Earl of, 50
,, D.G., A.M.S., 116
,, Local Government

Board, En gland, 82

Index

227

Conference, Medical, First, 5, 171
,, Medical, Second, 25,

172

,, St. Ermin's, 103
,, War Committees, Sec-
retaries of, 101

Conscientious Objection, 84, 90
Constable, Lord, 149
Contract, Suspension, 92
Convener. See Walker, Dr. Norman
Council, Army, 16

,, General Medical, 5, 16,

109

Cox, Dr. Alfred, 26, 64, 104
Cullen, Dr. G. M., 155, 176
Culling, Surgeon-Gen. J. C., 118
Currie, Dr. J. R., 6, 155, 176, 177

Deaths of practitioners, 186

Definition, Civilian practitioner,

General practitioner, 9
Insurance ,, 9

Military, 12
Other practitioner, 9
Private , , 9
Scottish , , 8

Delegation, D. G., A.M.S., 1919,
168

Delville Wood, Battle of, 93

Demobilization, 159

„ en masse, 165

Dental Service Sub- Committee,

135

Dental Tribunal, 156
Denudation of Practice, 190, 199
,, „ further, 195

Dependants of Men on Service, 13
Derby, Earl of, 48, 50, 112
Directory, Medical, 7
Disputes Sub-Committee, 41
Distribution, Medical, 1914, 7

,» 1915,32,54
„ 1916,69,70
„ „ 1918, 184

Divisions, British Medical Asso-
ciation, 9, 29

Drag on Equipment of Armies, 199
Drever, Dr. J. R., 155, 176, 177
Duncan, Dr. Ebenezer, 26, 175
Dunlop, Dr. J. C., 184
Duty, Medical, in War, 178

Edinburgh, 143
Edinburgh and Leith, 108
Egypt, 92
Emergency Committee —

Accounts, 199

Appointment, 5

Dissolution, 170

Medical Mobilization, 94

Personnel, 6, 175
England, 21, 98, no, 117, 148
Enrolment, 115
Episodes, 57

Established practitioners, 166
Exchequer, 199
Excuse, Letter of, 61
Exemption, Medical Men, 84, 90

,, Occupational, 141

,, Personal, 141

,, Standard, 148

Exemptions, 1916, 91

„ 1917, 128

„ 1918, 134, 156

Fergus, Dr. A. Freeland, 175, 177,

178

Fife, 41

Financial Guarantees, 137, 152
Flanders, 136, 153
Fleming, Sheriff J. A., 85, 176
Foch, Marshal F., 157
Form, Intimation, 53

„ K, 61

„ M,6i

„ Q, 62

,, Registration, 53
France, 3, 162

Francis Ferdinand, Archduke, 2
Fund, Prince of Wales's, 14

228

Index

Galloway, Sir James, 50, 123,

148, 154, 197
Gaza, Battles of, 118
Geddes, Sir Auckland, 123, 140,

197
General Medical Council. See

Council
GEORGE V, His Majesty King,

49, 139, 170
German Emperor, 3

,, Offensive, 1918, 135
Germany, 3, 118, 136, 157
Glasgow, 17, 194, 195

„ and West of Scotland,

108

Godlee, Sir Rickman, 104
Goff, Dr. John, 155, 176, 1 77
Goodwin, Lieut. -Gen. Sir T. H.

J. C., 168
Gordon, Dr. John, 6, 24, 26, 38,

166, 175
Grade I, 154
Grading, 127, 150
Graduates, 35, 44, 70, 92, 183
Graham, Mr. T. H., 6, 104, 141,

160, 176, 178, 180, 198
Graham Brown, Dr. J. J., 6, 175
Groups, Lord Derby's Scheme, 49

,, 1918 Scheme, 151
Guarantees, Financial, 137, 152

Hallett, Mr. F. G., 104
Hamilton, Dr. J. R., 5, 6, 25, 26,

93, 129, 175

Harman, Mr. Bishop, 104
Helles, Battles of, 27
Heraclius, i
Herzegovina, I, 2
Highlands and Islands Medical

Service Board. See Board
Hindenburg Line, 118, 157
Hodsdon, Sir James, 26, 28, 41,

95, 125, 129, 168, 175, 176,

177, 178
Hohenberg, Duchess of, 2

Hospital ships, 1 1 1

,, 58th General, 118

Hospitals Resident staff, 17
,, Territorial, 118

Howard, Major-Gen. Sir Francis,

121

Influenza, 162, 194

Interview, Chamberlain, Mr.

Neville, 102

Interview, D.G., A.M.S. 1915, 28
Isonzo, Battles of, 118, 130
Italy, 27

Jerusalem, 130

Joint Labour Recruiting Com-
mittee. See Committee
Jura, 57

Keogh, Lieut.-Gen. Sir Alfred, 16,
22, 24, 28, 38, 50, 82, 116, 196

Kitchener, Field Marshal Earl,
48

Kossovo, I

Kut, 79

Kynoch, Prof. J. A. C., 6, 175,
177

Lay Press, 42

Letter, D.G., A.M.S., 1915, 22

,, Excuse, 6 1

,, Secretary for War, 1917,

112
Littlejohn, Prof. H. H., 6, 26,

38, 41, 92, 154, 162, 168, 175,

176, 177, 178
Lloyd George, Right Hon. D.,

97, 98, 99
Local Government Board. See

Board
,, Recruiting Committee. See

Committee
,, Tribunal. See Tribunal

Index

229

Locum tenentes, 13, 15

Long, Viscount, 82

Loos, Battle of, 46

Lorrain Smith, Prof. J., 175, 177

MacAlister, Sir Donald, 17, 42,
52, 64, 82, 104, 144, 197

Mackay, Dr. George, 175, 177

Mackenzie, Sir Leslie, 26, 155,
160, 162, 176, 177

M'Kenzie Johnston, Dr. R.,

175

Macpherson, Sir John, 155
Macready, General Right Hon.

Sir C. F. N., 82
M'Vail, Dr. John C., 6, 26, 57,

104, 167, 168, 175, 177
Man-power, Medical, 127
Marne, Battles of, 157
Married Men, 1916, 79
Medical Assessors. See Assessors
„ Establishments in France,

121

,, Man -power, 127
,, Mobilization, 94, 100
,, Practice. See Practice
,, Services, Interdepart-
mental Committee of.
See Committee

Memorandum, First, 1914, 12
Second, 1915, 19
Third, 1915, 22
Fourth, 1915, 33
Fifth, 1915, 39
Sixth, 1915, 52, 73
Seventh, 1916, 65
Eighth, 1918, 143, 149
Memorandum, War Office, 1916,

Messines, Battle of, 118

Military Age. See Age
,, Definition, 12
,, Service Acts. See Act
,, Service, Compulsory, 72,

,, Service, Non - medical,
145, 146

Miners' Associations, 198
Mobilization, British, 4

Medical, 94, 100
Mohammed II, I
Monro, Prof. T. K., 51, 141, 176,

177, 178

Mons, Capture of, 157
Morant, Sir Robert, 82, 104
Muir, Mr. A. Gray, 41
Muir, Prof. Robert, 51, 154, 176,

177, 178
Munro, Right Hon. Robert, 140,

I55» J97

Murray, Right Hon. C. D., 123,
148

National Register, 48

National Service —
Department of, 97
Medical Boards. See Board
Ministry of, 123, 166

Navy, 29

New Zealand, 39

Newsholme, Sir Arthur, 82,
104

Notice Card, 42

Notification, Individual, 1918,
I5S

Objection, conscientious, 84, 90

Offers of service, 65

Officers, employment of, 1 19
„ Territorial, 15
,, who died, 186, 196

Operations, military, 18, 27, 46,
79, 118, 130, 157

Order, Military Service (Profes-
sional Committees Regulations),
1916, 84, 133

Order, Military Service (Profes-
sional Committees Regulations)
Amendment, 1917, 134

Order, Military Service (Profes-
sional Committees Regulations),
1918, 134

230

Index

Order, Ministry of National Service,

1917, 134
Organization of Profession, 34

Parliamentary Recruiting Com-
mittee. See Committee.
Paton, Prof. D. Noel, 6, 175
Pharmaceutical Society of Great

Britain, 13

Philip, Sir Robert W., 175, 177
Physicians, Royal College of,

Edinburgh, 6, 95, 198, 199
Physicians and Surgeons, Royal
Faculty of, Glasgow, 95, 108, 199
Picardy, 135, 153, 157
Playfair, Dr. John, 6, 41, 175, 177
Policy, medical, 1918, 137
Population, Scotland, 7, 184
Pozieres Ridge, Battle of, 93
Practice, Medical —
Civil, 131

,, Classification, 19
,, Country, 20
„ Denudation, 190, 195
,, Pressure, 195
,, Public Service, 132
,, Town, 20
,, Town and Country, 20
Practitioner, Civilian, 30
,, General, 9

„ Insurance, 9

„ Other, 9

,, Private, 9

,, Scottish, 8

Practitioners Established, 166

,, Mortality among, 186

„ Registered, 77, 87

,, Rejected, 138

,, Unregistered, 65, 70,

77,88

„ who served, 188

Press, Lay, 42
Proclamation, Royal, 49
Profession, Scottish Medical, 198
Professional Committees. Set

Committee
Protection, Certificate of, 148

Reconstitution ol War Com-
mittees, 149

Recruiting Committees. See Com-
mittee

Propaganda, 47
,, Regular Army, 47
,, Schemes. See Scheme
Reference, Committee of, 84, 98,

197

Region, Scottish, 123
Register, Medical, 7, 181
,, National, 48
,, New War, 151, 180

War, 52, 73, 77, 78, 83,

142

Registered Practitioners, 77, 87
Registrar-General for Scotland, 7,

48, 184

Registration, Certificate, 73, 76
Regulations, Professional Commit-
tees, 1916, 84, 133
,, Professional Com-

mittees, 1917, 134
,, Medical Practitioners,

1918, 140

Rejected Practitioners, 138
Releases, Priority, 161, 168
Report, Lord Derby's, 72
Resumption of Commissions, 126,

'35

Review of Exceptions Act, 109,

122

Review of Exceptions, Select

Committee, 122
Richmond, Dr., 104
Royal Navy, 29

,, Proclamation, 49
Russell, Mrs. Beatrice, 176,

177

„ Prof. William, 95, 175
Russia, 3

,, Emperor of, 118

St. Ermin's Conference, 103
Sandeman, Dr. Laura S., 129, 176

Index

231

Scheme, 1915, 33, 37, 44
,, 1916, 59
„ 1918, 148, 157
,, Demobilization, 160
,, Lord Derby's, 48
Scotland, Local Government

Board for. See Board
Scotland, National Health In-
surance Commission. See Com-
mission
Scotland, Registrar-General for.

See Registrar-General
Scotland, Secretary for. See Secre-
tary for Scotland
Scottish Command, 197

,, Committee, British Medi-
cal Association. See
Committee
Secretary for Scotland, 48, 126,

139, 140, 149, 155, 197
Select Committee on Review of
Exceptions Act. See Committee
Serajevo, 2
Serbia, I, 2
Service, Compulsory Military,

72, 79
,, Non-Medical Military,

146

Offers, of, 65
Service, Terms of—
1914, 4

I9i5> 34, 40, 53

1916, 60, 87

1917, 113

1918, 136, 138, 142,

143
Shennan, Prof. Theodore, 175,

177

Ships, Hospital, ill
Smith Whitaker, Dr. J., 104
Somme, 79, 93, 94, 157
Special Committee. See Committee
Statement, National Service, 1918,

145

Stevens, Dr. John, 6, 26, 147,

176, 177

Stiles, Sir Harold, 121
Stirlingshire, 41
Strength, Medical, 1914, ^

„ .1 1915,29,54

Strength, Medical, 1916, 68
1918, 181

Stutchbury, Mr. H. O., 104

Substitution, Financial guarantees,
J37, 152

Substitution, Medical practice, 146

Surgeon Probationers, 29

Surgeons, Royal College of, Edin-
burgh, 96, 199

Suspension of Contract, 92

Suvla, Battles of, 46

Taylor, Dr. Frederick, 104
Terms of Service. See Service
Territorial Force, 15, 29
Thomson, Dr. A. D. R., 129, 176,

177
Transfer of patient, 21, 34

,, of practitioner, 147
Treasury, 153

Tribunal Appeal, 76, 126, 150
,, Central, 76, 142
,, Dental, 156

Local, 49, 76
,, Medical, for Scotland,

140, 173
,, Medical Purposes, 51,

62, 173
Turkey, 157
Turner, Mr. E. B., 104

Unregistered Practitioners, 65, 70,

77,88
Universities, 161, 198

Vacancies, Medical, 131
Verrall, Sir T. Jenner, 82, 104
Victory, Advance to, 157
Vivian, Mr. S. P., 152
Voluntary Principle, 171
Volunteer Force, 139, 142

232

Index

Walker, Dr. Norman, 6, 17, 26,

28, 41, 43, So, 57, 82, 83, 85,

99 102, 104, 107, 116, 121,

124, 129, 130, 140, 148, 154,

160, 168, 176, 177

War Committees. See Committee

„ Emergency Committee. See

Committee
„ Office, 4, 23, 73, 78, 92,

121, 167, 172, 173
,, Office Representative, 49

War Register. See Register

,, State of, 4
Wester Wemyss, Admiral of the

Fleet Lord, 157
White Paper, 72
Williamson, Dr. George, 162,

176, 177
Worthington, Col. Sir E., 169,

197

Ypres, Battles of, 18, 27, 157

WHERE persons named in the Text or Foot-
notes are differently styled in the Index, the
style of the Index is later or more complete.

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