Linking Cause of Death to War Service

[Neil Clark]

I found this thread very difficult to write in a clear concise and logical way but here goes -

Recently I have come across a few non-com cases where incorrect and conflicting advice has been given in relation to causation issues (determining whether the cause of death can be attributed to war service). This is very unhelpful and can result in good cases being aborted for no good reason.

A non com died of heart disease and it was decided there and then that his death couldn't possibly be attributable to his war service. WRONG!

I would like to try and clarify the situation here so as to try and avoid these mistakes being made in the future with regard to potential non-com candidates.

There seems to be 4 causes of death where errors are regularly being made on an on-going basis –

1. Heart Problems (including cancers) resulting in death.

2. Respiratory Diseases (including TB) resulting in death.

3. Mental Disorders resulting in death and suicide.

4. Simple Exhaustion resulting in eventual death.

Yes it's entirely possible for a man to be literally worked to death which manifests itself in the first instance as exhaustion.

Some people seem to think that if a non-com candidate expired due to respiratory illness, heart disease or suicide then the case can’t possibly go forward to MoD adjudication. In my opinion (for whats its worth) this is an error of judgement and one with shocking consequences for the non com.

I should now like to quote T.J Mitchell and G.M Smith in their 1931 publication “Casualties and Medical Statistics of the Great War” (page 349) –

CAUSES OF DISABILITY AMONG BRITISH FIRST WORLD WAR PENSIONERS

Wounds and Amputations 324,722 (38%)

Tubercolosis (TB) 65,370 (7.6%)

Respiritory Diseases 55,383 (6.5%)

Organic Diseases of the heart 31,502 (3.7%)

Functional Diseases of the heart 44,855 (5.2%)

Neurasthenia 58,402 (6.8%)

Malaria 44,749 (5.2%)

Rheumatism 33,908 (4%)

Ear Diseases 23,722 (2.7%)

Phychosis 13,030 (1.5%)

Dysentery 8,025 (0.9%)

Nephritis 15,837 (1.8%)

Other accepted causes 135,933 (15.9%)

TOTAL ALL DISABILITIES: 855,488

Remember here that the Medical Boards were convened in consultation with both the War Office, the service authorities and the medical services. Harsh decisions were often made which often resulted in widows going through the appeal process. The above figures represent all cases where a man or his family was eventually awarded a War Pension based purely upon disability. Long service Pensions were something entirely different. I often wonder how many men were denied a war pension based upon discredited evidence - hundreds of thousands probably!

Obviously hundreds of thousands of these men must have eventually expired due to these medical complaints attributable to their war service. Most must have died after the CWGC cut off date in 1921 (but that’s a different story and one which I don’t want to get into here).

So you see, the Ministry of Pensions guided by the Medical Services of the day fully accepted that men suffering from heart disease, respiratory illnesses and Mental disorders that the cause was linked (attributable) to war service.

The above official statistics clearly show that it is entirely possible for these cases (heart disease, respiratory illnesses and Mental disorders) to go forward to MoD adjudication. Researchers should NOT be throwing cases like this out based purely upon a few words on a Death Certificate (DC).

There is another aspect to this that needs clarification/consideration – In the 1920’s the medical authorities and doctors in particular often filled out D.C’s when they weren’t in possession of the facts. Families would often fail to mention a mans war service or the doctor concerned didn’t want to appear as though he didn’t know the cause of death and put something down to make himself look good. Don’t say this never went on because it even happens now in modern times. I recently read that an enormous amount of D.C’s wrongly list Pneumonia as the cause of death in hospitals. This is clearly not a modern day problem it’s been going on for donkey years!

Here are a few example non-com cases to support my argument –

REMEMBER THAT YOU NEED TO PROVE YOUR CASE ON THE BALANCE OF PROBABILITY NOT BEYOND REASONABLE DOUBT AS SOME PEOPLE SEEM TO THINK! The legal test “Beyond Reasonable Doubt” is only used in criminal cases. I often wonder if the person that makes the final adjudication in the MoD knows the difference between the two legal tests and that they should be using the lesser of the two when determining non-com cases. We too should be using the lesser of the two.

In 2003 I spoke to a member of the Naval Historical Branch about my non-com navy cases. During my conversation it became clear to me that adjudications were indeed being made using the criminal legal test and not the civil one which should have been used! When I pointed this out the chap was quite put out that I appeared to know more than himself, afterall I was a mere amateur wasn't I?

Here are a few examples -

1. A death certificate gives the cause of death as T.B or Pneumonia for a man we know was severely gassed in the trenches. The doctors in the 1920’s may not have been aware of a mans war service and medical science then was not very advanced compared to now. We can now safely make the assumption that the man dies as a consequence of his war service.

2. A death certificate gives the cause of death as Valvular Disease of the heart for a man we know served in the trenches under the most appalling conditions for the whole duration of the war. On the face of it the disease couldn’t possibly have been linked to his war service but wait. It is now known and accepted by the medical profession that diet is the most important factor when determining heart problems. Environmental factors also come into it. Men were expected to live in the most appalling conditions for days, weeks and months on end sometimes. In war service the food (rations) were often very poor quality or limited in terms of size. It is now safe to assume that his heart problems were caused by his war service.

3. A death certificate gives the cause of death as suicide. On the face of it there is no way that it can be attributed to his war service but wait. It is now accepted that men serving under war conditions often suffer from Post Dramatic Stress Syndrome and chronic depression. Remember that the medical profession in the 1920’s didn’t know about these mental diseases. Men suffering from mental disorders were often simply labelled weak-minded and treatment was refused. It is clear that in cases of suicide that it’s now entirely reasonable to link the cause of death with his war service.

4. A death certificate gives the cause of death as Exhaustion. On the face of it this seems a very unusual cause of death but wait. In the 1920’s life was very hard for the vast majority of people. People often died of exhaustion. Men serving in the armed services were often worked very hard resulting in exhaustion. It’s entirely reasonable to link simple Exhaustion with war service. A man could literally be worked to death! The death may have been slow but the final result was the same.

It would be helpful to now discuss and debate what I have stated here. I feel that this aspect to non-com research is often brushed aside or forgotten. This results in the kind of bad advice I have seen being given by some individuals lately to inexperienced researchers who wish to go forward with their own non-com cases.

I honestly believe that WE here know more about these things than the so called experts making the decisions and adjudications. As an example all MoD (Army) cases are made by a Captain in Upavon Wiltshire. The officer serves in this appointment for a maximum of 3 years. It is quite likely that when the new officer arrives and the old one goes, all lessons learnt in the past 3 years are forgotten. I would mention in fairness that whoever is doing the work presently seems to be doing a superb job. I wish the same could be said for the RAF and Naval authorities too...

The non-coms should always be given the benefit of any doubt. It is clear that in the case of sailors this is not happening and that very harsh decisions are being made all the time.

In borderline cases where you think causation hasn't been entirely proven I would urge you still consider sending it onwards to the MoD for adjudication (via the CWGC in the first instance). I know that there are those of you out there who thrive on figures and league tables and that your approved percentages will suffer if a case is rejected. I am happy to admit here that out of about 50 or so non-com submissions since 2000 I have had only 33 approvals. I don't care because I'd rather the MoD reject a case than risk making the wrong decision myself. The worst that can happen is that a man will be rejected - BIG DEAL. Let these boffins do their job. Thats what they are paid (by us) to do...

I hope this thread will eventually assist a few people to make the right decision when determining causation issues. Please don't be too hasty with causation matters. Remember to judge them in the light of modern science not medical science of the 1920's.

Neil

[alanh]

Is my man included in this Neil?

[Neil Clark]

Hi Alan,

Sorry I don't follow? I'm not sure which case you are eluding too. The only case that springs to mind is YOUR superb submission - Lance Corporal Lawson Akehurst Smith which was approved a year or so back. I 'm not aware of any others.

I wanted to get in touch re VINE from Wye (RFC). Apparently his name appears on the Hempstead, London Civic War Memorial! I have photos of the plaque for you.

EDIT - Oh I understand now, the circumstances of his death. YES thats a good example Alan. A man that killed himself and the MoD APPROVED his case in light of modern medicine and knowledge about mental illness. This case concerns suicide others concern Heart Problems and Respiritory Diseases.

A good result in the end thanks to Alan's excellent work and persistance. Proof that it's worth giving it a go...

L.A. Smith

Age at death: 33

Born:

Full Name: Lawson Akhurst Smith

Service, Regiment, Corps, etc: London Regiment

Unit, Ship, etc: 9th Battalion (Queen Victoria's Rifles)

Enlisted: 1 January 1915, London

Rank: Lance Corporal

Decorations:

War (and theatre): WW1

Date of Death: 13 May 1918

Manner of Death: Died

Family Details:

Residence:

Home Department: Board of Trade - Patent Office

Civilian Rank: Second Division Clerk

Cemetery or Memorial: Plot C , Row A 15 All Saints Churchyard

Kent

Additional information and photographs

Some of Lawson Smith's Army medical papers have survived at the PRO.

From these, and from the Board of Trade files, it is possible to piece

together something of his tragic story.

For two years, Smith served at home with the 9th Battalion London Regiment (Queen Victoria's Rifles) before being sent to France on 2 February 1917. He was there only 5 months, returning on 24 July, having been wounded and shell-shocked. His file describes his military character as "very good, steady and well conducted"; at some stage he had been promoted from Private to Lance Corporal. He was eventually discharged from the Army and confined to a mental home. He died from the effects of throwing himself out of a window while in a state of coma. Lawson Smith was one of several borderline candidates for the Roll of Honour considered by the Board of Trade's War Memorial Committee in 1923. He had not died "on active service", though his death was very clearly a result of the war. The Committee decided that his name should be included, noting that it had already appeared on the Patent Office Memorial 1914-1918, now in Concept House, Newport (Board of Trade Rollof Honour, PRO, BT 13/111 and L A Smith, PRO, WO 364/3820). He is listed in the Medal Rolls WO 372/18 as Private 3919.

L A Smith is also commemorated on the Orpington War Memorial, the Roll of Honour at All Saint's Church, Orpington, the Roll of Honour at St Andrew's Church, St Mary's Cray and the Roll of Honour at St Paul's Crofton Photographs of these memorials (courtesy of John Pateman) Click on the images on the left of the page to view a larger version.

After a great deal of further research by members of the project, the Commonwealth War Graves Commission have now accepted Lawson Akehurst Smith for inclusion to the Roll of Honour, this will be followed by his grave being marked in the near future.

Best wishes

Neil

[truthergw]

I have nothing but praise and admiration for people who identify non commemorations but I think your net is cast too wide. If we assume that any one who served in the trenches, at Gallipoli, in the Middle East or as a seaman in the bowels of a ship's stokehold, was exposed to conditions which were unhealthy to a greater or less extent, then following your logic to its extreme, nearly any one who served is entitled to be commemorated as a war death. I think that everyone who served is entitled to respect for the service he rendered to his country but I think we should still differentiate between those who served and those who gave their lives. Your arguments tend to blur that distinction. As just one counter argument, TB was endemic until post WW2 . How can you say that it was contracted as a result of war service when children at school were being diagnosed with it as late as 1940s?

[Neil Clark]

Hi Tom,

In cases where a man died IN SERVICE he gets commemoration regardless of cause war or not. Is that a problem too?

Almost 70% of non coms which have been approved in recent years died as a result of TB. If you can prove a man was discharged from the service and that he eventually died of that SAME disease then it's a straightforward Approval.

The rules regarding who is and who is not entitled to commemoration is set in stone by the Government. This doesn't concern ME personally! I dont understand what you are suggesting, I and others simply work within a framework set by the service authorities and government...

With regard to proving a case, as I have mentioned above all you can do is try to prove your case using the test "On the balance of probability". You seem to be suggesting that any man who died of TB or Heart Disease or a Respiritory illness doesn't deserve his sacrifice to be commmemorated by the country they gave their lives for! Your argument is a little extreme but I accept you have a valid opinion on these matters.

Your opinion although valid serves to demonstate the nature of the problem. This is why there is so much confusion out there. I don't understand what you mean by casting the net too wide, we don't make the rules...

[Stephen Nulty]

Neil

Thanks for the posting, which makes interesting reading.

As a result of this, I have decided to finally put forward to CWGC one of "my" Prescot men as a non-comm. I have his service record and death certificate. Would it be possible for you to PM me with details of the best way to take this forward.

[truthergw]

I believe we should be grateful to the men who served in the Great War. I also believe that men who laid down their lives in that war should be commemorated. I think that these form two groups. I do not believe that we should be making desperate efforts to prove that the death of every man who served is in some way attibutable to the war and that the two groups should be seen as one.

[Doc2]

I tend to agree generally with Tom, though in some respects I think Neil has made some good points--- While I respect greatly the people involved in getting the non-coms commemorated and fully support their efforts, it seems that they too often stretch the point to try to include cases in which the cause of death is only possibly tenuously related to service at best. TB is a prime example. If a soldier was not diagnosed as TB at the time of discharge, and was not discharged for TB, but later developed it (often many years later), on what basis can we claim that the death is due to service connection? If TB was documented to have been contracted in the service, and then the patient later died of it, I think this is pretty open and shut for a commemoration, but I am unaware of any proven correlation between the later development of TB and gas exposure, or of any evidence that TB ocurred at a higher rate in the trenches than in civilians at the time and post-war. As an epidemiologist who has worked (not in UK) on medical boards, I would find a claim for service connection of a TB death occurring many years after service, when TB was not documented to have been contracted or aggravated during service, to be invalid in the absence of other evidence. Another example of a possible problem case is the case referenced above with "valvular disease of the heart"-- Generally, valvular disease of the heart is either congenital or due to infection, not to diet or stress. If you can show a documented service-connected infection which could give rise to that condition (such as a case of Rheumatic Fever), then it could be determined to be connected, but otherwise it is only an assumption on your part which may or may not be justifiable, and a lot more proof would be needed.

In logic, there is something called a "post hoc, ergo prompter hoc" logical fallacy, which is the belief that if B happens after A, then there must be a causative connection between A and B. The argument often seems to be that "service in the trenches was bad-- diet, stress, gas, etc. (A)" and "ex-serviceman died of condition X (B )", and therefore the two are connected. This simply cannot be assumed in many cases, even under the "balance of probability" standard which Niel discusses (and with which I agree). The fact that the UK MOD accepted some cases of TB, or heart disease, or psychiatric disease, as being connected to service cannot be assumed to mean that all such cases were so connected, only that it was possible and each case needs to be looked at carefully. I agree with Niel that every case could be submitted for adjutication, but disagree that the medical evidence is quite as clear as he states regarding potential connections of diseases to service. This is simply not an easy issue to prove, under any standard. I only hope the UK office in charge of this has some medical expert assigned to review these cases rather than some line officer without knowledge of medical issues. (I would be happy to undertake this job for the MOD, if they wanted to hire me to do it).

Note: I am not familiar with the MOD rules on determining service-connection. The above comments are general in nature from a medical point of view, and do not purport to explain anything about how the UK manages this issue. Doc

[chrisharley9]

Could someone tell me what Nephritis is & how fatal it was at the time of the Great War

Chris

[truthergw]

Nephritis is a condition where the kidneys are inflamed, a symptom rather than a disease. If it was due to infection, it would be very hard to treat at the time, as was all infection.

[chrisharley9]

Tom

thanks for that - a couple of my cases had suffered from that condition

Chris

[Neil Clark]

Doc2,

An excellent appraisal of the situation from a medical professional - just what we really needed here.

TB cases will only ever be approved by the service authorities if the casualty was discharged suffering from TB and died of the SAME disease before the CWGC accepted cut off date of 1921 (deaths after this timeframe are never entertained).

I think it has been proven "on the balance of probability" years ago (that ole chesnut again) that the consequences of TB was increased when men were serving in certain poor conditions. I know from my experience that many many Naval Stokers contracted this disease whilst serving in engine rooms on board ships. There are probably other jobs where the incidence of TB was markedly increased but not being an expert in this area I'm not able to give an example.

Quite a few non-coms have been men who were actually Killed in Action (KIA) and I presume these cases are clearcut in respect of the current line of thought.

I am very interested in the connection between infection and valvular heart disease? This is something which needs clarification and may have enormous consequences for future non-com candidates who died from heart related problems.

Nephritis is yet another area which deserves more discussion and clarification. Perhaps there are others with a professional opinion able and prepared to enter the discussion?

As I have stated many times above, we (amateur non-com specialists/researchers) work within a tightly controlled framework. The service authorities themselves are the ones who decide who is entitled and who is not. As far as I know personally there are probably less than 15 researchers doing this type of work on an ongoing basis (literally a small handful of dedicated volunteers). Numbers are steadily increasing due mainly to the good work of Terry Denham and Co and in no small part this superb forum. But it must be stated that none of us can pre-determine how a case will be dealt with or adjudicated, we can only present our evidence and then hope for the best. Problems occur when the service authorities make harsh and unfair some would say preposterous adjudications (something which still goes on with sailors and airman).

I appreciate that there will be those out there who have a problem linking a casualty who was KIA with a casualty who merely died of a disease. What about incidents of Heat Stroke? In Mespot and Aden many many men fell ill and died with this. Are these men not entitled to be commemorated in the same way a KIA is?

Lastly I would point out (once more) that servicemen who died in service get a full entitlement for commemoration regardless of the circumstances. I have heard a few stories where men didn't really deserve this but the rules were rigid in this respect. I really don't think you can include men who died of illnesses and diseases in this category. The reason they get approved is that "ON THE BALANCE OF PROBABILITY" they contracted the illness or disease as a consequence of their war service. What is so difficult to understand about this? Who are we to question the rules...

It would appear that INFECTION could and DID often result in HEART PROBLEMS AND NEPHRITIS. I had a man REJECTED a few years ago because according to the idiots at the Naval Historical Branch in Portsmouth, it was impossible to link this condition to war service! Well in the light of what has been said here by someone who knows what he's talking about that was a load of cobblers! Perhaps I need to get that case back out and do some background research into infection resulting in heart failure etc...

With regard to MENTAL CASES and SUICIDE - I'm reading a very informative book at the moment - Forgotten Lunitics of the Great War by Peter Barham I can recommend this book to anyone looking to submit a case of suicide. The Book was published in 2004 by Yale University Press. ISBN NO: 0-300-10379-4 Cost £20 I'm willing to lend it out if it helps...

This infection thing resulting in heart problems is really quite BIG news... It's a pity we have taken so long to find this out. Perhaps it may be a good idea to search the various medical related websites for precis on infection and such like? Anyone care to help me out?

Stephen,

I'm glad you found this thread helpful. That was the general idea when I sat down this morning in the early hours and wrote it. It suddenly dawned upon me that these aspects to non-com work are never really discussed in any real detail...

Please PM me with your email. My email is clarkneil@hotmail.co.uk

Neil

[Neil Clark]

Here is 2 of my past REJECTS which I now intend to re-submit. He died of Heart Failure. I will look into arguing that this was (on the balance of probability) caused by infection and his war service. You will note that the local authority and locally based service units accepted his death was directly linked to the war and went ahead and gave him a military funeral with full honours (including a guard of honour and trumpetors). His name was then placed on the towns civic tribute. Despite this the Naval Historical Branch in Portsmouth insisted it was impossible to link valvular disease of the heart with war service! In light of recent developments it seems this was incorrect - a link can be made in some circumstances.

Able Seaman 202829 Herbert Frederick HOSKINS. HMS “Royal Arthur”. Royal Fleet Reserve (R.F.R). Died 20th January 1915 aged 31 years. Died at 23 Christchurch Road, Ashford, Kent. The given cause of death on the death certificate was heart disease. Husband of Mabel H Hoskins (nee Pilbeam) of Ashford, Kent. Brother of Caroline May Wilkins of 23 Christchurch Road, Ashford, Kent. Herbert normally resided at 66 Lower Denmark Road, Ashford, Kent. Buried locally 23rd January 1915 in the Ashford Cemetery, Canterbury Road, Ashford. Grave reference - 7004.

There is a Mabel Harriet Pilbeam buried in the same burial plot. Mabel was buried here on 2nd February 1966 aged 79 years.

Death Certificate reference – West Ashford/ASH28/171.

Before the outbreak of war Herbert was the Licensee of the Wheatsheaf Public House, Lower Denmark Road, Ashford. Herbert’s death certificate states that he was a sailor.

The Ashford Absentee Voters List for 1918 gives –

51, Beaver Road, Ashford

Driver 234110 Frank HOSKINS. Royal Field Artillery (RFA).

The 1901 census gives –

23, Christchurch Road, Ashford

Charles HOSKINS 57 Labourer Baddeley, Hampshire

Mary 54 Bungay, Suffolk

Arthur 23 Carpenter Joiner Stepney, London

Catherine 21 Stepney, London

George 19 Hawker Stepney, London

Frank 12 Stepney, London

Herbert joined the Royal Navy in 1899 for 12 years service. He served on the following ships during this period – St Vincent (1899), Argincourt (1900), Galatea (1900), Empress of India (1900/01), Caesar (1901/02), Wildfire (1903/04), Northampton (1904), Hawke (1904/05). Herbert left the navy on expiry of his service engagement. On the outbreak of war Herbert answered the call of his country and rejoined the navy. He was posted to HMS Royal Arthur on the 2nd August 1914 and remained with this ship until 26th November 1914. On the 27th November 1914 he returned to HMS Pembroke in Chatham and was subsequently invalided on 21st December 1914. Herbert died only 1 month later of heart disease. His death was therefore attributable.

The local papers reported his death as follows “Saturday of Herbert Frederick HOSKINS, Royal Navy, the licensee of the Wheatsheaf Public House, Denmark Road, South Ashford who passed away on the previous Wednesday aged 31 years. The deceased who leaves a widow and a baby girl had served 12 years in the navy, and upon the outbreak of war re-joined serving on HMS Royal Arthur and on one of the naval trawlers. He was invalided home in December, and died from valvular disease of the heart. His coffin was covered with the union flag and following the mourners was the funeral party in khaki uniforms of members of the 5th Buffs (East Kent Regiment) under Private Cowell who was wearing the Chitral ribbon. At the conclusion of the impressive service, Trumpeters Wells and Wilkinson of 458th Battery, Royal Field Artillery sounded the last post”.

7% of men who were awarded war disablement pensions were as a consequence of heart problems. The case for Herbert is extremely strong taking into account he died only 1 month after being invalided.

________________________________________________________________________________

This man was rejected a few years ago again on the grounds that DIABETES could not be linked to war service under any circumstances. Perhaps it's now possible to argue on the grounds of diet during war etc. Note he died from the SAME disease that he was medically discharged with 18 months later. On the grounds of this fact alone perhaps I should now re-submit him to the MoD? What do you lot think?

I admit this case isn't as strong as HOSKINS above -

Stoker 1st Class 278041 William Robert PAGE. HMS “Pembroke”. Royal Naval Barracks, Chatham, Royal Navy Reserve (RNR). Died 11th September 1917 of diabetes aged 38 years at 28 Postmans Row, Ashford, Kent. Born 15th March 1879 in Willesborough, Ashford, Kent. Son of William and Caroline Page of 28 Postmans Row, Ashford, Kent. Buried 15th September 1917 in the Old Ashford Cemetery, Canterbury Road, Ashford, Kent. Grave reference – 7286 (paupers grave unmarked). His mother Caroline was present at William’s death.

William’s death ceritificate reference – West Ashford/ASH29/205. His death certificate states his occupation as (Late) Stoker, H.M Navy Pensioner.

Before the outbreak of war William was working as a Baker in the Ashford area. In 1908 he was working in the Ashford Railway Works. His name appears on the Ashford Railway Rolls of Honour and on the South Eastern & Chatham Railway Dover Marine War Memorial.

William joined the Royal Navy on 3rd October 1894 and signed up for 12 years service. He served on the following ships between 1894 and 1900 – Victory II, Hallabar, Fearless. Most of his service was spent on HMS Victory II. On the 8th August 1903 William left the navy and was posted onto the reserve list. He returned home to Ashford. On the outbreak of war in August 1914 William was re-activated and was posted to HMS Pembroke in Chatham, Kent where he trained sailors. William was obviously an “old hand” and highly regarded by his superior officers. William remained in Chatham until 29th February 1916 at which time he was invalided out of the navy.

The Ashford 1881 Census gives –

Hinxhill Lane, Willesborough, Ashford

William PAGE (Father)

William R Born 1879

William is not recorded as a war casualty by the Commonwealth War Graves Commission. He was INVALIDED from the navy on 29 February 1916 suffering from Diabetis. He died of the SAME disease on 11 September 1917. We have taken medical advice regarding his symptoms and the known causes of Diabetis. It is documented that Diabetis can be bought on by poor diet, stress and a hard working life. On the balance of probability we feel that this case should be Approved. It is extremely harsh to make the assumption that this man’s disease was NOT as a direct consequence of his war service. He contracted the disease whilst on active service and died of the SAME disease 18 months later…

[Guest geoff501]

thanks for that - a couple of my cases had suffered from that condition

Chris, one of my cases died from nephritis. I got nowhere looking for his service papers and had not heard of the condition before. Not even on LLT who have only just discovered the relevance of TB, so I started to dig around for info. I found a couple of (1916) papers and discovered it was responsible for 10% of hospital admissions at one time (not sure if 1915, or 1916). It was also said to have a very low mortality rate. The real cause was not determined at the time. There were a few other papers that I found, some quite recent studies on WW1 diseases, but you need subscription access to the medical journals to get hold of these. Might be the sort of stuff Neil is looking for.

[Doc2]

Here is 2 of my past REJECTS which I now intend to re-submit. He died of Heart Failure. I will look into arguing that this was (on the balance of probability) caused by infection and his war service. You will note that the local authority and locally based service units accepted his death was directly linked to the war and went ahead and gave him a military funeral with full honours (including a guard of honour and trumpetors). His name was then placed on the towns civic tribute. Despite this the Naval Historical Branch in Portsmouth insisted it was impossible to link valvular disease of the heart with war service! In light of recent developments it seems this was incorrect - a link can be made in some circumstances.

Able Seaman 202829 Herbert Frederick HOSKINS. HMS “Royal Arthur”. Royal Fleet Reserve (R.F.R). Died 20th January 1915 aged 31 years. Died at 23 Christchurch Road, Ashford, Kent. The given cause of death on the death certificate was heart disease. Husband of Mabel H Hoskins (nee Pilbeam) of Ashford, Kent. Brother of Caroline May Wilkins of 23 Christchurch Road, Ashford, Kent. Herbert normally resided at 66 Lower Denmark Road, Ashford, Kent. Buried locally 23rd January 1915 in the Ashford Cemetery, Canterbury Road, Ashford. Grave reference - 7004.

There is a Mabel Harriet Pilbeam buried in the same burial plot. Mabel was buried here on 2nd February 1966 aged 79 years.

Death Certificate reference – West Ashford/ASH28/171.

Before the outbreak of war Herbert was the Licensee of the Wheatsheaf Public House, Lower Denmark Road, Ashford. Herbert’s death certificate states that he was a sailor.

The Ashford Absentee Voters List for 1918 gives –

51, Beaver Road, Ashford

Driver 234110 Frank HOSKINS. Royal Field Artillery (RFA).

The 1901 census gives –

23, Christchurch Road, Ashford

Charles HOSKINS 57 Labourer Baddeley, Hampshire

Mary 54 Bungay, Suffolk

Arthur 23 Carpenter Joiner Stepney, London

Catherine 21 Stepney, London

George 19 Hawker Stepney, London

Frank 12 Stepney, London

Herbert joined the Royal Navy in 1899 for 12 years service. He served on the following ships during this period – St Vincent (1899), Argincourt (1900), Galatea (1900), Empress of India (1900/01), Caesar (1901/02), Wildfire (1903/04), Northampton (1904), Hawke (1904/05). Herbert left the navy on expiry of his service engagement. On the outbreak of war Herbert answered the call of his country and rejoined the navy. He was posted to HMS Royal Arthur on the 2nd August 1914 and remained with this ship until 26th November 1914. On the 27th November 1914 he returned to HMS Pembroke in Chatham and was subsequently invalided on 21st December 1914. Herbert died only 1 month later of heart disease. His death was therefore attributable.

The local papers reported his death as follows “Saturday of Herbert Frederick HOSKINS, Royal Navy, the licensee of the Wheatsheaf Public House, Denmark Road, South Ashford who passed away on the previous Wednesday aged 31 years. The deceased who leaves a widow and a baby girl had served 12 years in the navy, and upon the outbreak of war re-joined serving on HMS Royal Arthur and on one of the naval trawlers. He was invalided home in December, and died from valvular disease of the heart. His coffin was covered with the union flag and following the mourners was the funeral party in khaki uniforms of members of the 5th Buffs (East Kent Regiment) under Private Cowell who was wearing the Chitral ribbon. At the conclusion of the impressive service, Trumpeters Wells and Wilkinson of 458th Battery, Royal Field Artillery sounded the last post”.

7% of men who were awarded war disablement pensions were as a consequence of heart problems. The case for Herbert is extremely strong taking into account he died only 1 month after being invalided.

________________________________________________________________________________

This man was rejected a few years ago again on the grounds that DIABETES could not be linked to war service under any circumstances. Perhaps it's now possible to argue on the grounds of diet during war etc. Note he died from the SAME disease that he was medically discharged with 18 months later. On the grounds of this fact alone perhaps I should now re-submit him to the MoD? What do you lot think?

I admit this case isn't as strong as HOSKINS above -

Stoker 1st Class 278041 William Robert PAGE. HMS “Pembroke”. Royal Naval Barracks, Chatham, Royal Navy Reserve (RNR). Died 11th September 1917 of diabetes aged 38 years at 28 Postmans Row, Ashford, Kent. Born 15th March 1879 in Willesborough, Ashford, Kent. Son of William and Caroline Page of 28 Postmans Row, Ashford, Kent. Buried 15th September 1917 in the Old Ashford Cemetery, Canterbury Road, Ashford, Kent. Grave reference – 7286 (paupers grave unmarked). His mother Caroline was present at William’s death.

William’s death ceritificate reference – West Ashford/ASH29/205. His death certificate states his occupation as (Late) Stoker, H.M Navy Pensioner.

Before the outbreak of war William was working as a Baker in the Ashford area. In 1908 he was working in the Ashford Railway Works. His name appears on the Ashford Railway Rolls of Honour and on the South Eastern & Chatham Railway Dover Marine War Memorial.

William joined the Royal Navy on 3rd October 1894 and signed up for 12 years service. He served on the following ships between 1894 and 1900 – Victory II, Hallabar, Fearless. Most of his service was spent on HMS Victory II. On the 8th August 1903 William left the navy and was posted onto the reserve list. He returned home to Ashford. On the outbreak of war in August 1914 William was re-activated and was posted to HMS Pembroke in Chatham, Kent where he trained sailors. William was obviously an “old hand” and highly regarded by his superior officers. William remained in Chatham until 29th February 1916 at which time he was invalided out of the navy.

The Ashford 1881 Census gives –

Hinxhill Lane, Willesborough, Ashford

William PAGE (Father)

William R Born 1879

William is not recorded as a war casualty by the Commonwealth War Graves Commission. He was INVALIDED from the navy on 29 February 1916 suffering from Diabetis. He died of the SAME disease on 11 September 1917. We have taken medical advice regarding his symptoms and the known causes of Diabetis. It is documented that Diabetis can be bought on by poor diet, stress and a hard working life. On the balance of probability we feel that this case should be Approved. It is extremely harsh to make the assumption that this man’s disease was NOT as a direct consequence of his war service. He contracted the disease whilst on active service and died of the SAME disease 18 months later…

Neil, you have to be very careful medically, as there are some things you still don't seem to understand from a medical perspective. Heart failure is NOT the same as Valvular Heart Disease. Heart failure is a much broader issue, and may be due to many medical conditions (including valvular heart disease), most of which would have little to do with service. ONLY Valvular Heart Disease is normally considered due to infection, not other kinds of heart disease. And to show that it was due to an infection during service rather than as a child, when it was most common in this period, you really need military medical records. Do you have access to medical records on these non-coms? Without them, you are often going to have a very difficult time proving your case, even by a preponderance of evidence. As an aside, technically, most people who do not have cancer or an infectious disease or a genetic disease or trauma die of "heart failure"-- the issue is, what caused it?

I don't know the UK rules-- do they commemorate only "service-caused" diseases, or do they also consider "service-related"ones? Or even "service aggravation of pre-existing disease"? Can you obtain and let me see a set of the rules you are working under? I will be happy to review individual cases for you if you can provide detailed information, and I can either recommend submission or more digging for proof. Let me know if I can help. I'm on your side and have no axes to grind (I'm not even a Brit), but proving service connection is not quite as simple as some would like it. (as an example, Diabetes can be aggravated by diet, but not normally by a poor diet as in the trenches-- it is usually aggravated by too much sugar and carbohydrates in the diet and obesity, not a lack of food-- basically, it is a congenital disease which you get from your parents, in the vast majority of cases, complicated by poor eating habits. Other cases are due to a diet overly plentiful in worthless calories and carbohydrates. There are other causes, including infection and trauma, but these are more rare-- "stress and a hard-working life" would be very rare as causes.) Given the incidence of trench fever and leptospirosis in the trenches, nephritis would be possibly a more clear-cut connection, but still not an open and shut case, as there are also many non-military related causes, shown by the number of civilians who die with that diagnosis. Doc

[Neil Clark]

Doc2,

That is a very kind gesture and one I would very much like to take you up on! YES you're right, when it comes to Medical matters I'm a bit thick! (indeed some would say I'm thick most of the time). I'm certainly quite outspoken at times but I mean well and I'm always fiercely loyal to those I respect.

I imagine that a few others may also want your advice every now and again. I shall leave them to PM you regarding this. Don't worry there are very few of us - Terry Denham, our chief co-ordinator, the true pioneer of this work John Morecombe (peace be upon him), J.H's mate Neil York, Shropshiremad, Horachio2 my good mate Chris Harley, Jimmy james, Alan Humpries the official hon government DTI researcher, Geoff501of search engine fame and a few more besides all of whom do a wonderful job. We all seem to do our own thing and none of us has an idea on the odd sounding diseases we often come across!

You have already been of immense help and I thank you for taking the time to reply the way you have.

You will be pleased to learn that we are all volunteers and that we pay the full costs of this work from our own pockets. Between us I imagine we account for in excess of 250 or so non-coms all of whom have now been approved. Terry Denham does a HUGE amount of footwork and he co-ordinates everything we do on here regarding non-coms etc. John Hartley & Co are doing some sterling work with their very own non-com project. Together we probably all account for the vast majority of non-com cases that the CWGC receives each year (80% at least I'd imagine)...

Not only do they get their names recorded on the CWGC Casualty Index but more importantly they all get new war graves or in the case of men with no known grave, their names are placed on a memorial to the missing. I personally have had a few cases where they had no grave marker at all! It was particularly pleasing to see a new headstone erected for these forgotten men. It's really worthwhile work and I can already see you agree.

I'd be interested to learn of anyone elses experiences regarding non-coms where it was decided not to submit their cases on the grounds that they died of a non specific cause and one which couldn't easily be put down to war service. Has anyone any views on TB cases?

The guidance you refer to is actually non existant! The CWGC did produce 1 A4 piece of paper in 2007 which was given to the service authorities but nothing has ever been given to any of us. If we have a CWGC query we normally ask our widely acknowledged resident CWGC expert Terry Denham who always trys his best to help. If he doesn't know the answer from memory, he has ways of getting to the truth quite quickly. When the Commission produced that A4 piece of paper I remarked at the time my 8 year old son could have done better - it really was quite embarrassing for the person that produced it! No wonder the Naval Historical Branch in Portsmouth was making so many idiotic adjudications!

I will try and locate the thread which concerns this. I remember posting the guidance on it (it didn't take up much hard disk space)! FOUND IT - http://1914-1918.invisionzone.com/forums/i...showtopic=85123

I have full size versions for those who want a copy.

Prepare to have a good laugh! This is actually THE document that the CWGC provided to the Naval Historical Branch when they requested some sort of guidance and training.

My personal email is - clarkneil@hotmail.co.uk

Neil

[Doc2]

Neil, I'll be glad to help if I can-- anyone can PM me for input, and I will be happy to provide medical input on documents. If you can send me the large copy of the 2005 reference document you have, that will be helpful (I must be getting too old for this-- I really can't read the one you posted on the other thread.) What is the UK law on the subject? Somewhere this should be defined-- or is this whole commemoration/non-com issue based solely on CWGC policy without governmental guidance? Just don't get upset if I don't answer immediately-- I have a full-time job, and spend about 1/2 of my time on travel, so don't always have access to the web--- but I will get to it eventually. Doc

[Neil Clark]

I had no idea what Epidemiology was so did a Wiki search -

Epidemiology

From Wikipedia, the free encyclopedia

Epidemiology is the study of factors affecting the health and illness of populations, and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine. It is considered a cornerstone methodology of public health research, and is highly regarded in evidence-based medicine for identifying risk factors for disease and determining optimal treatment approaches to clinical practice.

In the work of communicable and non-communicable diseases, the work of epidemiologists range from outbreak investigation to study design, data collection and analysis including the development of statistical models to test hypotheses and the documentation of results for submission to peer-reviewed journals. Epidemiologists may draw on a number of other scientific disciplines such as biology in understanding disease processes and social science disciplines including sociology and philosophy in order to better understand proximate and distal risk factors.

AND I STILL DON'T HAVE A BLOODY CLUE..... ha ha.

Joking aside, I'd say you are very very well qualified to provide the kind of advice we all so badly need. I couldn't imagine a better medical discipline to have available to us.

Thank you kindly.

[Doc2]

Basically, Neil, epidemiology is the study of the incidence and spread of medical conditions on a population basis rather than as individuals. It plays a great role in epidemic preparedness and response, as well as in evaluation of the treatment and outcomes of disease. We tend to break people up into groups, separated by exposure or disease or treatment, and see how the groups can be compared. This is very useful if you are determining what treatment is best for a disease or injury. Thus, epidemiology has been described as "the study of people, broken down by age and sex...". I'm also a real clinician, by the way. Doc

[Neil Clark]

Doc, - Look who must have done all their homework! ha ha...

_______________________________________________________________________

How about this example I have just thought of -

Private Joe Bloggs was serving overseas on active service (with the best infantry regiment in the British Army - The Buffs!). His unit went forward on a fighting patrol at night and came under heavy gas attack. Joe "copped" a huge load of the stuff whilst he was laying in an old bomb crater in no mans land trying to shelter. He eventually managed to get back to his own trench when the gas had disipated during darkness. Joe was immediately recovered through the medical evacuation chain back to the UK. After 3 months treatment it was decided he could go home. He was at this stage medically retired and awarded a war pension. Joe moved away from his town of birth and lived the life of a hermit alone and in poverty. 1 year later poor Joe's lungs finally started to give out! He refused to seek medical help and eventually expired (died) from lung failure. The doctor certifying his death didn't know anything about Joe's war service, in fact no one even knew where he came from. The Doctor took it for granted that Joe had died of Pnuemonia or TB and put this down on his Death Certificate. He was buried in a paupers unmarked grave.

Years later one of us finds his service papers and decides to find out more about him. We establish he served overseas on the frontline from 1914 to 1917. His service papers record the fact he was severely gassed in 1917. We establish he finally died in 1920. His D.C gives the cause of death as TB. and Pnuemonia. His Service papers are now so faded that we can't possibly make out the reason he was discharged and awarded a war pension.

We then find a newspaper article listing Private Joe Bloggs as being gassed and recovered to the UK wounded in 1917.

Do we go forward with this case or BIN IT? His DC doesn't support the gas theory... (I have seen some people telling inexperienced researchers to abort at this point). I dis-agree.

It's quite possible even probable that doctors in the early 1900's were filling out DC's and giving an incorrect cause of death. This isn't entirely surprising given the standard of medical treatment then before anti-biotics had been invented. They did the best they could in the circumstances. I don't blame any doctors either, they were trying their best and meant well.

Non-com cases should be looked at NOW using modern day medical knowledge and medicine. It should be acknowledged by the service authorities that mistakes were often made on D.C's. Why do they rely so heavily on these things when it is obvious they are not to be relied upon or indeed trusted? In my opinon they should be making their judgments based upon ALL circumstances NOT just by what it says on a DC. Using the "On the Balance of Probability" principal properly and treating the DC with the SAME degree of consideration as other factors and documents, so many more men would get the tribute they deserve.

My argument is this basically - a DC is something that should be taken into account when determining an adjudication but not relied upon to the extent that they currently are. As I have stated above, medical practitioners not in possession of the full facts often record an incorrect cause of death. I know this to be the case because I have in my work attended many sudden deaths (where the police must be informed). Doctors will often list Pnuemonia as a cause of death if the exact cause can't be established. Coroner Inquests will also do the same thing sometimes if they are unable to properly explain a sudden death. They make their asumptions by using the civil legal test "On the balance of probability" (there it is again). The point I wish to make is that this practice is still widespread in the UK.

In the early 1900's most people held Doctors in very high regard indeed. Whatever a doctor said or wrote was considered almost godly. Things have now changed, the truth is out - Some doctors probably kill more people than they save. We no longer look up to doctors as gods which is a good thing. Why then now are we taking so much notice of DC's which were filled out nearly a hundred years ago when medicine was still in the dark ages? We are relying too heavily upon discredited documents.

How many former WW1 servicemen have TB or Pnuemonia listed as the cause of death when in truth they died of gassing or some other war induced death? TENS OF THOUSANDS PROBABLY...

I wonder if these factors have ever been taken into account by the service authorities charged with making adjudications? I doubt it personally. They haven't ever even considered speaking to us (the individuals that provide them with their work). I have often wondered why the CWGC and service authories have NEVER invited us to get together and discuss these matters. If they did then we could all make a contribution and perhaps come up with a better Standard Operating Procedure (SOP) than the one I got hold of in 2007 (refered to in another thread).

Am I the only one starting to feel a little bitter about the way I'm treated by these people?

[Neil Clark]

I have found these links which may be of interest. It looks as if the UK has very lax laws with regard to doctors filling out DC's compared to the US, Australia and a few other first world countries. The point I'm making here is that if it goes on now then it's likey to always have gone on (during the Great War too).

I found what I was looking for here - This article appeared in the Observer on Sunday June 25 2006 on p5 of the News section. - http://www.guardian.co.uk/society/2006/jun...dicineandhealth It backs up my story about incorrect causes of death being issued by doctors in the UK.

And here - http://www.dailymail.co.uk/news/article-50...infections.html

Surely if Death Cerificates have been discredited like this the service authorities should take notice and stop treating them with the reverance they so plainly do.

And some other helpful links -

http://www.dogpile.co.uk/uk.dogpl/clickit/...for_Doctors.pdf

http://www.dogpile.co.uk/uk.dogpl/clickit/...docs/2008_2.pdf

Chris Harley - You might find this one useful, I know I will - http://www.antiquusmorbus.com/ and this - http://www.videojug.com/interview/death-basics it has reference to the incidence of Nephritis in the USA.

According to this forum, doctors in the UK are deliberately hiding incidents of MRSA and C.Diff on D.C's. - http://www.mrsa-forum.com/

let's not let the discussion turn into a general slagging match for doctors in the UK who it must be said on the whole do a very good job. We need to confine discussion to DC's and non-coms.

I'd like to look into this suggestion of infection causing heart disease/failure. It has enormous relevance to the subject matter here. I wonder how often cases have been aborted in the past when the researcher finds out that Heart Problems were listed on a DC?

NAMES ON CIVIC WAR MEMORIALS AS EVIDENCE

How often do I hear people saying this - "the fact a name appears on a civic war memorial isn't very good evidence and doesn't prove that the man is entitled to an official commemoration". Well once more I completely dis-agree -

The fact that a name appears on a civic tribute like this is a good indication that the casualty died from a war related cause. Of course there are always going to be cases where this isn't so but in the vast majority of cases the local authority or memorial trustees must have carried out there own enquiries and found in favour of the man. I can confirm that the service authorities don't ever seem to take this into account when determining their cases. This is wrong in my view, the fact a mans name appears on a tribute is good evidence not on it's own but alongside other supporting documents such as service papers or newspaper articles. In 95% of cases I have dealt with where a mans name appears on a civic war memorial, it has turned out the casualty was entitled to a commemoration and was eventually approved. At no time did the service authority take into account the FACT the name appeared on a civic tribute. It's about time that due consideration was given to a mans name appearing on a civic war memorial. Before anyone challenges this line of thought, when it comes to civic war memorials I know what I'm talking about. In Kent at least I (and Dave Hughes) have researched over 400 of them some in very fine detail. It annoys me when I hear people telling people to more or less ignore REAL documentary evidence like this. I can tell you that during a criminal investigation ALL evidence is given the SAME value and that the CPS makes it's decisions based upon all provided evidence. The service authorities should be doing exactly the same thing with non-coms. If the names appeared on paper somewhere then they would consider it but for some odd reason civic war memorials don't count. It's CRAZY and it's about time it stopped!

This line of thought is widespread because WE all allow it to be. STOP telling people that a name on a civic tribute counts for nothing IT DOES! I have a 95% success rate with the things. Personally I trust this evidence more than a Death Certificate which relys upon pure conjecture most of the time.

I get nearly all my non-coms from civic war memorials in Kent and most end up getting approved.

[jim_davies]

Neil,

Thank you for posting this. Very interesting and informative.

I have a couple more lads that I will try to get to over the next month or so.

jim

[Neil Clark]

Jim,

I'm glad you found my personal rantings of some interest. I thought the time had arrived to vent my spleen and liven things up a bit!

To be perfectly honest I was expecting a few more desenting replies, but it would appear my findings have had the desired effect - to encourage others to look carefully at cases which have been aborted on the grounds of illness and diseases like - Heart Problems, Respiritory Diseases and mental illness. Also, the question of how reliable are old Death Certificates and names on civic war memorials, all of which tend not to be discussed in any great detail.

In the past I have seen posts from newbies asking about a name on a war memorial only to be told by someone (who really should know better) that this means NOTHING and that it is well known most civic tributes contain incorrect data ect... Instead we should be telling them that this is pretty good evidence to start with (useful REAL evidence and a reasonably reliable indication the casualty died as a consequence of war) and that more needs to be done to establish the truth.

Neil

[chrisharley9]

Neil

I have just been researching the Melton Constable M&GN Railway Memorial in Norfolk - a lad who was not on CWGC so I checked his service record which states that he was discharged due to exposure & breathing difficulties - it looks like he was dead withing weeks of his discharge - when the DC arrives I wonder what the cause of death will be

Chris

[Neil Clark]

Poor sod was probably severely gassed or had an industrial railway accident in the field! His DC will in all probability give (wait for it).... Pnuemonia or TB or perhaps Upper Respiritory Disease!!!!!

Goes to prove what I'm trying to get over here...