accordance with the changing type of recruits and the rise in the cost of living. The scales of 1917 and 1918 were again considered in 1919 by a select committee of the newly elected House of Commons, which settled the rates governing payments till 1923. The principle of payment is that of compensation for disablement attributable to or aggravated by war service. " Disablement " is assessed by purely medical opinion, in terms of a percentage reduction from the stand- ard of a normal healthy man. The pension is on a flat rate graded from 20% to 100%; below 20% only a lump sum is awarded payable usually in weekly allowances. Pensions are in the first instance awarded temporarily usually for 12 months andremain temporary till the disability has reached its final and stationary condition, when they are made permanent. The patient is subject to periodical medical examination during this time, and at each " board " his disability is reassessed for the next period. In addition the principle was laid down in 1917 that no account was to be taken of the earnings of disabled men. The " alternative pension " was also provided whereby a man might obtain a pension (within certain limits) running up to his full pre-war earnings, which by the Warrant of 1919 were further loaded up by 60 % on account of the increased cost of living. Widows, also, may choose alternative pensions (husband's earnings plus 60%), and this right has been exercised in a large number of cases. The new pension scales were not to be subject to revision be- fore April 1923.
The following figures may be quoted from the Warrant of 1919 :
(1) Totally disabled (privates) :
Man 405.
( + attendance allowance up to 203. if helpless)
Man and wife 503.
Man, wife and one child 575. 6d.
Man, wife and two children .... 633. 6d. For each additional child 6s.
(2) Widows :
Childless 2Os.
(+ 6s. 8d. if aged 40).
With one child . 363. 8d.
With two children 443. 2d.
For each additional child .... 6s. Although the assessment of disablement is a purely medical matter, the question of entitlement (i.e. whether due to war service) is decided by medical and lay opinion combined. The claimant has an appeal against the assessment of a medical board to a medical appeal tribunal; he may similarly appeal against refusal of entitle- ment to one of eleven statutory pensions appeal tribunals set up under the 1919 Act. These are appointed by the Lord Chancellor and are independent of the Ministry of Pensions.
Constitution. In 1918 the Ministry consisted of the following branches: (i) Finance (including pensions issue office) ; (2) awards (men) ; (3) awards (men's widows and dependents) ; (4) awards (offi- cers and officers' widows and dependents, and medical treatment and training of officers); (5) local administration; (6) medical services; (7) vocational training; (8) artificial limbs; (9) surgical appliances; (10) chief inspector; (il) special grants committee. The only im- portant change in these divisions has been in the case of vocational training, which in 1919 was transferred to the Ministry of Labour (save for convalescent centres associated with medical treatment).
In April 1919 a scheme of regional decentralization was begun, and during the following 12 months II regions were set up. Each is governed by a director, assisted by a commissioner of medical serv- ices, a regional administration officer, an awards officer, a finance officer, a registrar, and staff. These regional offices carry on (i) medical examination; (2) awards of pensions; (3) control of Ministry hospitals; (4) supervision of the local war pensions committees. The Ministry itself, whose staff had numbered at its inception in 1917 2,296, expanded with its work to 5,754 in its first year, and in 1921 had reached 26,000, which included 8,000 hospital staff. (Of the male staff at this date 94 % were ex-service men.) The local war pensions committees then numbered 349, with nearly 1,000 sub- committees. They had 27,500 members and a paid staff of 6,200 in addition to many voluntary workers. Space precludes more than a mention of the special grants committee, the chief function of which is to make supplementary and special grants where need exists, under regulations approved by the Ministry of Pensions.
Duties. The machinery was great, but the burden was gigantic. By 1917 (when the Ministry came into being) 262,000 pensions in all had been granted. The number was doubled in the following 12 months. The increase continued rapidly ; at one time as many as 35,000 new awards were made in a week. The pressure was greatest in the first six months of 1919, when demobilization was at its height. It was estimated at the beginning of 1921 that the crest of the curve had been reached ; cessation or reduction of temporary pensions had begun to balance new awards, and medical treatment to be com- mensurate with the demand.
The subjoined figures have been taken as exemplifying the business of State pensioning at its maximum. (The figures are approximate and are taken from the estimates for 1920-1.) Cost of administration 19201, including medi- cal services, and local war pensions commit- tees 5,000,000
Cost of local war pensions committees (admin- istration) 1,150,000
Money disbursed through local war pensions committees 1920-1 (recoverable advances, treatment allowances, etc.) . . . 20,000,000 Estimated total cost of pensions including medical services and administration ex- penses 123,000,000
From these sums were treated or maintained, partially or wholly, both the World War and pre-war disability pensioners (the awards of these last by the Royal Warrant of 1917 had been levelled up to the corresponding war scale). The total number of awards had increased from 262,000 in 1917 to 1,849,000 at Dec. 31 1920, made up as follows :
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Disabled men 1,216,000
Widows 226,000
Dependents 384,000
Children 23,000
The pensions, temporary and permanent, actually in payment on Dec. 31 1920 were:
Disabled men 1,180,000
Widows 169,000
Dependents 362,000
Children 16,900
In addition the following first awards of disability retired pay or pension had been made:
Officers 56,487
Officers' widows 10,408
Officers' children 11,302
Officers' other dependents 7iO77
Nurses 2,045
Nurses' dependents 22
In payment on Dec. 31 1920 (approx.) : ,
Officers 38,850
Officers' widows 9.7OO
Officers' children 9,100
Officers' other dependents 6,500
Nurses 1,45$
Nurses' dependents 22
Including wives' allowances, and children's allowances the total number of beneficiaries was nearly 3,500,000.
Medical treatment was being carried on in 84 hospitals and con- valescent centres and 150 clinics. The Ministry controlled 14,000 beds in its own institutions and 10,000 in civil institutions (cf. the whole voluntary hospital system of the country, which has not more than 40-50,000 beds). There were under treatment at any given time 158,000 cases. The cost of this, including allowances to men under treatment, in excess of pension, amounted to 16,000,000 per annum. The doctors directly employed were 464, the hospital staff numbered 7,600; in addition, for assessment purposes, there were 450 medical boards, each of three members, examining over a con- siderable period from 21,000 to 25,000 men every week.
Special Features. In addition to the mere mass of the task, many most baffling problems demanded solution. The Ministry, in addi- tion to pensions work and medical treatment, had for example to undertake the supply and repair of artificial limbs and surgical ap- pliances (a special division of the Ministry was organized to deal with this). There were in Dec. 1920 23,932 officers and men pensioned on account of amputations of the leg, and some 64,000 cases of wounds of the upper extremity involving amputation of arm or part of the hand. There were 8,000 cases of epilepsy, 114,000 cases of "heart disease" and 69,000 cases of nervous disease (under which are included both "shell shock" and "neurasthenia").
There was no medical staff in existence to cope with such numbers. In the case of the "nervous diseases" a special training school for psycho-therapy and other forms of treatment was established in London, where a four months' course was given. The problem of "heart disease" demanded specialist attention; a system of special cardiological boards and clinics for examination and diagnosis was started in London, and extended throughout the country.
For the concurrent treatment and training of the broken men six large centres had been opened by Jan. 1921, and it was intended to open two more, giving accommodation in all to between 3,000 and 4,000. The effects of concurrent treatment and training upon the health and prospects of the patients were extremely beneficial. Difficulties were experienced in their absorption in industry, and efforts were made to overcome this by the institution of a national Roll of Honour by which firms pledged themselves to employ a cer- tain proportion of disabled men, while special treatment for the permanently unfit was being considered. (W. E. EL.)
PERCIN, ALEXANDRE (1846- ), French general, was born at Nancy (Meurthe) on July 4 1846. He entered the Ecole Polytechnique on Nov. 1 1865, and two years later was appointed a sub-lieutenant of artillery. He was promoted lieutenant in 1869 and captain in 1870. He took part in the Franco-German
