I. Guiding Principles for Direct Repatriation or Accommodation in a Neutral Country
A. ' Guiding Principles for Direct Repatriation'
The following shall be repatriated directly:
1. Sick and wounded whose recovery within one year is not probable according to medical prognosis, whose condition requires treatment, and whose intellectual or bodily powers appear to have undergone a considerable diminution.
2. Incurable sick and wounded whose intellectual or bodily powers appear to have undergone a considerable diminution.
3. Convalescent sick and wounded, whose intellectual or bodily powers appear to have undergone a considerable diminution.
B. ' Guiding Principles for Accommodation in a Neutral Country. '
The following shall be accommodated in a neutral country:
1. Sick and wounded whose recovery is presumable within the period of one year, which it appears that such recovery would be more certain and more rapid if the sick and wounded were given the benefit of the resources offered by the neutral country than if their captivity, properly so called, were prolonged.
2. Prisoners of war whose intellectual or physical health appears, according to medical opinion, to be seriously threatened by continuance in captivity, while accommodation in a neutral country would probably diminish that risk.
C. ' Guiding Principles for the Repatriation of Prisoners in a Neutral Country. '
Prisoners of war who have been accommodated in a neutral country, and belong to the following categories, shall be repatriated:
1. Those whose state of health appears to be, or likely to become such that they would fall into the categories of those to be repatriated for reasons of health.
2. Those who are convalescent, whose intellectual or physical powers appear to have undergone a considerable diminution.
II. Special Principles for Direct Repatriation or Accommodation in a Neutral Country
A. ' Special Principles for Repatriation '
The following shall be repatriated:
1. All prisoners of war suffering the following effective or functional disabilities as the result of organic injuries: loss of a limb, paralysis, articular or other disabilities, when the defect is at least the loss of a foot or a hand, or the equivalent of the loss of a foot or a hand.
2. All wounded or injured prisoners of war whose condition is such as to render them invalids whose cure within a year cannot be medically foreseen.
3. All sick prisoners whose condition is such as to render them invalids whose cure within a year cannot be medically foreseen.
The following in particular belong to this category:
(a) Progressive tuberculosis of any organ which, according to medical prognosis, cannot be cured or at least considerably improved by treatment in a neutral country;
(b) Non-tubercular affections of the respiratory organs which are presumed to be incurable (in particular, strongly developed pulmonary emphysema, with or without bronchitis, bronchiectasis, serious asthma, gas poisoning, etc.):
(c) Grave chronic affections of the circulatory organs (for example: valvular affections with a tendency to compensatory troubles, relatively gave affections of the myocardium, pericardium or the vessels, in particular, aneurism of the larger vessels which cannot be operated on, etc.);
(d) Grave chronic affections of the digestive organs;
(e) Grave chronic affections of the urinary and sexual organs, in particular, for example: any case of chronic nephritis, confirmed by symptoms, and especially when cardiac and vascular deterioration already exists; the same applies to chronic pyelitis and cystitis, etc.;
(f) Grave chronic maladies of the central and peripheral nervous system; in particular grave neurasthenia and hysteria, any indisputable case of epilepsy, grave Basedow's disease, etc.;
(g) Blindness of both eyes, or of one eye when the vision of the other is less than 1 in spite of the use of corrective glasses. Diminution of visual acuteness in cases where it is impossible to restore it by correction to an acuteness of 1/2 in at least one eye. The other ocular affections falling within the present category (glaucoma, iritis, choroiditis, etc.);
(h) Total bilateral deafness, and total unilateral deafness in cases where the ear which is not completely deaf cannot hear ordinary speaking voice at a distance of one metre;
(i) Any indisputable case of mental affection;
(k) Grave cases of chronic poisoning by metals or other causes (lead poisoning, mercury poisoning, morphinism, cocainism, alcoholism, gas poisoning, etc.);
(l) Chronic affections of the locomotive organs (arthritis deformans, gout, or rheumatism with impairment, which can be ascertained clinically), provided that they are serious;
(m) Malignant growths, if they are not amenable to relatively mild operations without danger to the life of the person operated upon;
(n) All cases of malaria with appreciable organic deterioration (serious chronic enlargement of the liver or spleen, cachexy, etc.);
(o) Grave chronic cutaneous affections, when their nature does not constitute a medical reason for treatment in a neutral country;
(p) Serious avitaminosis (beri-beri, pellagra, chronic scurvy).
B. ' Special Principles for Accommodation in a Neutral Country. '
Prisoners of war shall be accommodated in a neutral country if they suffer from the following affections:
1. All forms of tuberculosis of any organ, if, according to present medical knowledge, they can be cured or their condition considerably improved by methods applicable in a neutral country(altitude, treatment in sanatoria, etc.).
2. All forms necessitating treatment of affections of the respiratory, circulatory, digestive, genito-urinary, or nervous organs, of the organs of the senses, or of the locomotive or cutaneous functions, provided that such forms of affection do not belong to the categories necessitating direct repatriation, or that they are not acute maladies (properly so called) susceptible of complete cure. The affections referred to in this paragraph are such as admit, by the application of methods of treatment available in the neutral country, of really better chances of the patient's recovery than if he were treated in captivity.
Special consideration should be given to nervous troubles, the effective or determining causes of which are the effects of the war or of captivity, such as psychasthenia of prisoners of war or other analogous cases.
All duly established cases of this nature must be treated in neutral countries when their gravity or their consitutional character does not render them cases for direct repatriation.
Cases of psychasthenia of prisoners of war who are not cured after three months' sojourn in a neutral country, or which after that period are not manifestly on the way to complete recovery, shall be repatriated.
3. All cases of wounds or injuries or their consequences which offer better prospects of cure in a neutral country than in captivity, provided that such cases are neither such as justify direct repatriation, nor insignificant cases.
4. All duly established cases of malaria which do not show organic deterioration clinically ascertainable (chronic enlargement of the liver or spleen, cachexy, etc.), if sojourn in a neutral country offers particularly favourable prospects of final cure.
5. All cases of poisoning (in particular by gas, metals, or alkaloids) for which the prospects of cure in a neutral country are especially favourable.
The following are excluded from accommodation in a neutral country:
1. All cases of duly established mental affections.
2. All organic or functional nervous affections which are reputed to be incurable. (These two categories belong to those which entitle direct repatriation).
3. Grave chronic alcoholism.
4. All contagious affections during the period when they are transmissible (acute infectious diseases, primary and secondary (syphilis, trachoma, leprosy, etc.).
III. General Observations
The conditions stated above must, in a general way, be interpreted and applied in as broad a spirit as possible.
This breadth of interpretation must especially be applied in neuropathic or psychopathic cases caused or aggravated by the effects of war or captivity (psychasthenia of prisoners of war), and in cases of tuberculosis in all degrees.
It is obvious that camp doctors and mixed medical commissions may find themselves faced with many cases not mentioned amongst the examples given under Section II above, or with cases that cannot be assimilated to these examples. The above-mentioned examples are only given as typical examples; a similar list of surgical disabilities has not been drawn up because, apart from cases which are indisputable on account of their very nature (amputations), it is difficult to draw up a list of specified types; experience has shown that a list of such specified cases was not without inconvenience in practice.
Cases not conforming exactly with the examples quoted shall be determined in the spirit of the guiding principles given above.