NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
Medical boards.
Paras. 429-35.
429. Matrons military family hospitals.—A matron of a military
family hospital who has, in the opinion of a medical board, become
unfit for full duty from any disability will be given notice under the
terms of her contract by the A. D. M. S. district or independent brigade
if he concurs with the findings of the board.
British other ranks.
430. Procedure for invaliding.—British other ranks will not as a
general rule be invalided ex-India as physically unfit for military service
but will be recommended for change to England, their cases being finally
disposed of on arrival in the U. K. When however a case is obviously
and unmistakably unfit for further service he may be recommended
for discharge as unfit for further military service, or if domiciled in
India, he may be discharged in accordance with King's Regulations and
Regulations for transfer to the Army Reserve and discharge. When it
is proposed to invalid a soldier ex-India the O. C. hospital will submit
A. F. B-179 (modified for India) with other necessary clinical documents,
to the A. D. M. S., who will, if he considers that the soldier should be
invalided, return the documents and sanction the man's appearance
before a medical board.
431. Special reports on cases.—If considered necessary, the
soldier's regimental conduct sheet and a statement regarding his effi-
ciency will be obtained from his O. C. Specialist's reports and photo-
graphs or radiographs bearing on the case will, if available, be attached
to A. F. B-179.
432. Documents for medical boards.—The O. C. hospital will be
responsible that all necessary documents are placed before the board
for each case and also current orders and instructions relating to medical
boards and invaliding.
433. Cases of epilepsy.—Before a diagnosis of epilepsy is accepted,
a certificate will be given by a medical officer to the effect that he has
seen the patient in a true epileptic fit, or, if the medical officer is unable
to give such certificate but is satisfied that the patient is suffering from
true epilepsy, he will state in writing the grounds on which he bases his
opinion. When the officer commanding the hospital is satisfied, on
the above information, that a soldier is suffering from true epilepsy,
he will arrange for him to be brought before a medical board with a
view to his discharge from the Army. The medical officer's certificate
or statement will be attached to the Medical Board proceedings.
434. Defects of vision.—Invaliding for defects of vision will, except
in special cases, be limited to men whose visual acuity has deteriorated
since enlistment. A statement will be obtained from the man's com-
manding officer stating what class shot he is. This will be taken into
consideration in deciding whether the man is to be invalided.
435. Disposal of special reports.—The special certificates required
under paras. 431, 433 and 434 above will in all cases accompany the
medical board proceedings when these are forwarded to Army Head-
quarters.
107
Paras. 436-43.
Medical boards.
436. Cardiac affections.—Cardiac cases will be admitted to hospital
for thorough examination and treatment and will not be brought before
a medical board unless treatment fails to remedy the condition within
a reasonable time.
437. Flat-foot.—If the joints of the tarsus are flexible, and the arch
re-appears when the man stands on tip-toe, flat-foot is no bar to
military service. Invaliding for flat-foot will be reserved for those rare
cases in which the foot is everted, the tarsal joints are stiff and the man
is unable to march.
438. Tubercle of lung.—In order that soldiers suffering from tubercle
of the lung may be afforded the earliest possible opportunity of obtain
ing suitable treatment in a sanitorium, etc., they will be invalided as
soon as possible.
439. Defects present on enlistment.—As a general rule men should
not be invalided for defects which were present on enlistment.
440. Change of climate.—As a rule, invaliding for " change of cli-
mate " should not be resorted to until change to the hills has first been
tried. This does not refer to special cases which would not be bene-
fitted by change to the hills.
Families of British troops.
441. Medical boards and invaliding.—When it is considered neces-
sary to invalid the wife or child of an officer or soldier, the procedure
for the invaliding of soldiers will be followed, the case being reported
on by a medical board on A. F. A-2.
442. Documents, disposal of.—The medical documents in connec-
tion with soldiers' families who are sent to the U. K. in consequence
of ill health will be disposed of in accordance with instructions on
trooping and invaliding as published from time to time in I. A. Os.
Indian troops and followers.
443. General.—Medical boards may be assembled at any time.
When a board cannot be assembled, the O. C. corps is authorised to
dispose of cases on the certificate of a medical officer. Men of the
Punjab Police may be brought before invaliding boards assembled
on Indian troops.
When Indian officers, non-commissioned officers or men, non-
combatant departmental and regimental employees or followers of
the supplemental services are invalided from the service, the board
will give an opinion as to whether the disability is or is not attribut-
able to military service, will assess the disability on a percentage
basis, vide Pension Regulations, India, para. 241, and will state
whether or not the disability is capable of improvement. A medical
board held to re-examine Indian troops or followers for re-assessment
of a disability pension will reassess the disability as above but will
express no opinion as to origin of the disability.
NOTE.—In regard to cases, where awards of disability pensions are concerned, a
medical board is always necessary and the certificate of a single medical officer will
108
Medical boards.
Paras. 444-49.
not be accepted, except in the case of Gorakhpur(Karaghat), Laheria Sarai and Nepal
where, if it is not possible or feasible to assemble a medical board for such purpose,
the opinion of the officer commanding Indian military hospital, Karaghat or Laheria
Sarai in the case of the two former and of the Legation Surgeon, Nepal, or in his absence
the certificate of the military sub-assistant surgeon of the Legation hospital, Kathmandu,
countersigned by the Legation Surgeon in the case of the latter, will be accepted in lieu
of the opinion of such a board.
444. Procedure for invaliding.—When it is considered that an
Indian officer, trained soldier or follower should be invalided from
the service, a statement of the case with the medical history sheet
will be forwarded by the O. C. hospital to the A. D. M. S.
If the A. D. M. S. concurs he will return the documents and direct
that a medical board be held. The O. C. hospital will then inform
the O. C. the individual's unit and request him to forward I. A. F.
Y-1948.
Recruits will be dealt with as laid down in Regs. for the Army in
India, paragraph 190. As a general rule recruits should not be
invalided for defects that were present on enlistment.
445. Finding of the board.—The medical board having recorded
their opinion on I. A. F. Y-1948 will return all the documents to the
O. C. hospital, for transmission to the A. D. M. S. If the A. D. M. S.
concurs in the opinion of the board he will endorse I. A. F. Y-1948
accordingly and return the documents to the O. C. hospital who will
then proceed in accordance with the instructions on I. A. F. Y-1948.
If the A. D. M. S. does not concur in the opinion of the board the pro-
cedure will be as laid down in last sentence of para 417 ( a).
446. Tubercle of lung and other diseases.—Care will be taken that
cases suffering from tubercle of the lung are brought before medical
boards for invaliding as expeditiously as possible and that their early
return to their homes is facilitated.
The principles laid down in paras. 432 to 439 will apply to the
invaliding of Indian troops and followers.
447. Amputation cases.—A soldier or follower who has lost a limb
will not be brought forward for invaliding until the stump is com-
pletely healed and ready for the fitting of an artificial limb.
448. Invalids unfit to be moved.—When the condition of an Indian
soldier or follower, whose discharge as an invalid has been approved,
is such as to prevent his immediate removal from hospital, he may
be retained as a free patient for further treatment at the discretion of
the O. C. hospital.
Mental Disease.
449. Responsibility of the medical services towards cases of mental
disability.—(i) Any person subject to the Army Act showing symp-
toms of mental disability will at once be admitted to a British mili-
tary hospital and placed under observation and treatment. If no
military hospital exists in the station, he will be transferred to the
nearest station in which one is situated.
(ii) The same procedure will be carried out in the case of persons
subject to the Indian Army Act, who will be admitted or transferred
to an Indian military hospital.
109
Para. 450.
Mental cases.
(iii) If any person residing in a Cantonment and entitled to medi-
cal attendance under para. 271, shows symptoms of mental disability
the authorised medical attendant will report the case at once to the
O. C. station and invariably state in his report the amount of control
which in his professional opinion should be exercised over the said
person and whether the said person is likely to be dangerous to him-
self or others. In the event of the medical attendant reporting that
the person concerned should be placed under control, the O. C. station
will be responsible that steps are forthwith taken to place the said
person under proper and suitable control either in a military or civil
hospital. If for any reason the O. C. station considers it undesirable
that the said person should be placed in a military or civil hospital
or if the relatives or friends of the said person object to his or her being
so placed, the O. C. station will report the case at once to the civil
authorities so that action may be taken under the provisions of the
Indian Lunacy Act, 1912.
(iv) If any person in a Cantonment not subject to the Army Act
or to the Indian Army Act and not entitled to medical attendance
under para. 271 shows symptoms of mental disability, the case will
be dealt with by the civil authorities.
450. Procedure on admission of a case of mental disease to a mili-
tary hospital.—(i) When a person suspected to be suffering from mental
disease is admitted to a military hospital for observation a consulta-
tion will if considered necessary, be arranged with the military specia-
list in mental disease. If a consultation with a military specialist
cannot be arranged a consultation with the superintendent of a civil
mental hospital will be arranged if there is one situated in the station
or adjacent thereto ( vide para. 266(a)).
When applying for the services of a mental specialist the medical
case sheet and A. F. B-183 will be forwarded ; the mental specialist
will then decide whether it is necessary for him to see the case.
(ii) If a definite diagnosis of mental disease (lunacy) is made or if
so diagnosed at any time while under observation, the case will be
brought before a medical board and dealt with as laid down in para.
452 et seq.
(iii) If a definite diagnosis of mental disease has not been made,
and if the patient recovers before he has been under observation for a
continuous period of thirty days, he may either be discharged from
hospital as fit to return to duty or to resume his usual occupation,
or he may be brought before a medical board for the purpose of being
granted sick leave or being invalided.
(iv) If a definite diagnosis of mental disease (lunacy) has not been
made and if the patient has not apparently recovered after having
been under observation for a continuous period of thirty days, he
will, without further delay, be brought before a medical board for
examination and report. In all such cases A. F. B-183 will be attached
to the Board proceedings.
110
Mental cases.
Para. 451.
The medical board may recommend that the patient
—
(a) be discharged to duty, or to resume his or her occupation,
if the board considers that the patient has recovered.
(b) be granted sick leave or invalided ex-India.
(c) be referred for further observation and treatment.
(d) be disposed of as in para. 452 et seq.
( v) If a definite diagnosis of mental disease (lunacy) is not clearly
established during this second period of observation, the patient will
be brought before a second medical board for examination and report
as soon as considered advisable by the O. C. hospital but, in any case,
not later than thirty days after the date of assembly of the previous
board. This second board will decide how the patient should finally
be disposed of, that is, that the patient—
(a) be discharged to duty, or to resume his or her occupation,
if the board considers that the patient has recovered.
(b) be granted sick leave and or invalided ex-India.
(c) be disposed of as in para. 452 et seq.
NOTE.—(i) No patient who has been kept under observation on the recommenda-
tion of a medical board in the circumstances described in this paragraph will be dis-
charged from hospital or removed from the sick list except on the recommendation of
a second medical board.
(ii) Whenever a medical board is held on a case of mental disability or of suspected
mental disability, the officer in medical charge of the case will prepare a statement of
the case on A. F. B-183 (modified when necessary) for the information of the board.
451. Management of cases of mental disability.—( a) Cases of
suspected mental disability and certified insanity, when practica-
ble, will be accommodated apart from other patients.
(b) Os. C. hospitals will be responsible that special instructions
are issued in writing regarding the management of each case, and they
will be responsible for the general bearing and conduct of subordinates
and medical attendants towards these cases.
(c) The medical officer in charge of a mental case will be responsible
that a careful and accurate statement of the appearance, demeanour,
conduct and conversation of the patient is recorded daily by the atten-
dants. He will invariably verify these statements and record regu-
larly his own observations on those points immediately after each
visit.
(d) Mechanical restraint will be restricted to the use of the straight
jacket and bed sheet. Orders for attendants on insanes are given on
I. A. F. M-1202 and these should be supplemented, if necessary, in
any special cases by the O. C. hospital ( vide sub-para. ( b) above).
(e) When guards are placed on duty over mental cases, they should
be fully cognisant of their duties and responsibilities, definite and
adequate orders in writing, type or print being delivered to the guard
commander on mounting. The O. C. hospital should satisfy himself
that all instructions and orders are rigidly carried out.
111
Paras. 452-53.
Mental cases.
(f) When a case of mental disease (soldier) is transferred or dis-
charged from hospital, he will invariably be removed in the presence
of a medical officer who will be responsible that he is dressed with
due regard to health and comfort and will instruct the escort as to
the peculiarities of the patient, particularly as. to whether he has
displayed suicidal or homicidal tendencies. Whenever possible in
the case of British ranks suffering from mental disease a mental
nursing orderly will be detailed as one of the conducting party.
(g) Before transferring a case to a mental or other hospital it will
be ascertained that accommodation is available.
Disposal of cases of mental diseases.
452. General.—In addition to the preceding rules in regard to
medical boards and invaliding the following special instructions will
be carried out in dealing with cases of mental disease.
Persons subject to the Army Act.
453. Certification and disposal .—(i) After the individual has been
kept under observation in the manner prescribed in para. 450(i) and
a definite diagnosis of mental disability has been made, the officer
commanding the military hospital will arrange for the patient to be
again examined by two medical officers separately and at different
times. If each medical officer is satisfied as to the patient's insanity,
he will complete and sign a Lunacy Certificate on India Army Form
M-1244. The officer commanding the hospital will then arrange for
the patient to be brought forthwith before a medical board, before
whom the Lunacy Certificates and Army Forms B-179 (modified for
India) and B-183 will be laid. Neither of the medical officers who
signed the Lunacy Certificate shall ordinarily be a member of the
Board. If the Board is satisfied as to the patient's insanity, he shall
then be formally declared to be a lunatic for the purpose of the
Indian Lunacy Act, 1912 and these regulations.
(ii) The completed medical board proceedings and lunacy certi-
ficates will be forwarded to the D. D. M. S. or A. D. M. S. concerned
who will decide whether the patient should be sent to a mental hospital
or be detained at his station pending embarkation for the U. K.
(iii) Should the D. D. M. S. or A. D. M. S. concerned decide that
the patient is to be sent to a civil mental hospital, he will make a re-
ception order on I. A. F. M-1246 under the authority of Section 12,
Indian Lunacy Act of 1912—the reception order will be made out not
later than seven clear days after the earlier of the two examinations on
which the lunacy certificates are based. The A. D. M. S. should send
as early as possible a certified copy of the reception order to the
person in charge of the mental hospital into which the lunatic is to
be admitted.
Ordinarily the reception order will be made out for the admission
of the lunatic to the mental hospital at Yeravda, Poona, but in urgent.
112
Mental cases.
Paras. 454-56.
cases an order may be made for admission to the mental hospital at
Lahore, Ranchi, Madras or Rangoon. However, mild cases will be
sent to the B. M. H., Deolali.
(iv) Officers and other ranks domiciled in U. K. who are in-
valided for mental disease will be sent to the United Kingdom as soon
as possible. Those admitted to asylums or mental hospitals in India
under the provisions of Section 12, Indian Lunacy Act will, as soon
as a passage is arranged, be handed over to the military authorities
under the provision of Section 32(2), Indian Lunacy Act of 1912, on
the application of the D. D. M. S. or A. D. M. S. who originally
signed the reception order. Those domiciled in countries other than
the U. K. will be sent to their country of domicile as soon as arrange
ments can be made.
(v) In the case of officers and other ranks domiciled in India, the
officer commanding station will apply to the magistrate for a recep-
tion order under Section 5 of the Indian Lunacy Act of 1912. The
application will be made on I. A. F. M-1245 (Form 1, Schedule 1,
Indian Lunacy Act of 1912) supported by two Lunacy Certificates
on I. A. F. M-1244A (Form 3, Schedule 1, Indian Lunacy Act of
1912).
If the magistrate makes a reception order, steps will be taken to
obtain the retirement or discharge of the lunatic, under the provisions
of the Royal Warrant and the King's Regulations.
When a reception order has been made by a magistrate for the
reception of an individual into a mental hospital, the individual
may either be handed over with the reception order to the civil autho-
rities for disposal or sent under military arrangements to the asylum
or mental hospital to which he is to be admitted.
454. Cases of mental disease to be invalided from the army. —An
officer or other rank who has been diagnosed as a case of mental disease,
even though he may have recovered, will be retired or invalided out
of the service as permanently unfit.
Persons not subject to military law.
455. Definition. —Under this heading are included officers' wives
and children, Lady Nurses, Q. A. I. M. N. S., Q. A. M. N. S. I. and
I. M. N. S. (except when on active service), wives and families of
N. C. Os. and men and all other persons residing in Cantonments who
are not subject to military law but who may be admitted to a
military hospital under the authoraity of the G. O. C. District if
accommodation is available.
456. Disposal.—(i) If domiciled in the U. K. or other country
outside India, they will normally be brought before a medical board
and invalided to the country of domicile.
(ii) If domiciled in India, they may be admitted to a mental hos-
pital or asylum under one or other of the several sections of the Indian
Lunacy Act of 1912 (excluding Section 12).
113
Paras. 457-60.
Mental cases.
Or (iii) in either case they may be handed over to the care of rela -
tives or friends who will arrange for their disposal and take full res-
ponsibility in accordance with the instructions in para. 459.
If admission into a mental hospital is considered desirable in the
case of persons in (i) above while awaiting passage to the country of
domicile, or in (ii) above, an application for admission will be made
to a Magistrate on I. A. F. M-1245 accompanied by two lunacy certi-
ficates in accordance with para. 453(v).
457. Relatives to accompany mental case invalided ex-India.—In
the case of women and children suffering from mental disease it is
most desirable that the husband of a woman or in the case of a child,
one of the parents should accompany the patient to the U. K. in order
to arrange for the patient's disposal on arrival.
Indian troops and followers.
458. Disposal.—Cases of mental disease in Indian troops and
followers will be dealt with as laid down in Regs. for the Army in
India, para. 194.
If admission to a mental hospital is considered necessary applica-
tion for admission will be made to a Magistrate by the man's O. C.
on I. A. F. M-1245 accompanied by two medical certificates I. A. F.
M-1244A. See para. 453 (v).
Responsibility of relations or friends.
459. Whenever an individual suffering from, or under observa-
tion for, mental disease, is handed over to his relations or friends
they will be required to sign a certificate accepting full responsibility
for his care. (See Appendix XIII).
460. Documents—disposal of.—The medical documents in connec-
tion with soldiers' families who are sent to the United Kingdom in
consequence of ill-health will be disposed of in accordance with ins-
tructions on Invaliding as published from time to time in India Army
Orders.
114