The outline of this case which I wish to bring before the House is simple to state. Mr. C. W. Harmar, of Goudhurst, is an ex-Gunner, and between February, 1942, and October, 1945, he was a prisoner in the Far East in the hands of the Japanese. Of this ordeal it is only necessary for me to say that he emerged weighing 4 stone, 9 pounds. He was X-rayed in October, 1945, and no abnormality was discovered. In January, 1947, he was discharged from the Service and re-enlisted for four years. At the end of that time, in December, 1950, he appeared before a medical board which passed him clear, so that really he had two examinations, one immediately after his return and the second five years after his return. I want to make that quite clear, because it stresses the nature of this problem.
In March, 1957, he contracted pneumonia and was treated for it. He is now at this moment suffering from pulmonary tuberculosis and receiving hospital treatment in Sussex. He may be out this month, but he has been told that he will not be able to work for twelve months. So he has had pneumonia nine years after leaving the prisoner-of-war camp and now, after 12 years, he has pulmonary tuberculosis. In those circumstances, the Ministry of Pensions and National Insurance has felt that it must refuse the request made on his behalf by many people for a war disablement pension. This was done after the most scrupulous inquiry—I should like to acknowledge that—and also after considerable correspondence, as my hon. Friend so informed me last October.
This is not a case about which anyone ought to use immoderate language. The refusal of the Ministry cannot be characterised as outrageous. But, unfortunately, it is not as simple as that. It involves the very difficult problem of assessing Mr. Harmar's disabilities in the light of his experience as a prisoner of war in the hands of the Japanese. My hon. Friend will have had far greater experience in these matters than I, but I fancy he will admit how difficult it is to assess fairly the consequences of that experience.
Unhappily, this is by no means the first case of its kind. I know of a case where tuberculosis occurred four years after the release of a man from a Japanese prisoner-of-war camp. In that case it was attributed to hardship and a pension awarded. There have been other cases which my hon. Friend will know about where the nerves of people have been permanently affected, and so on, and I think he will accept that scars can be left on a man as a result of these experiences which he will bear all his life. I am not blind to the difficulties of the Ministry. Where should the Ministry draw the line? Outside the category of prisoners of war we know that there are thousands of cases—many hon. Members have had to deal with such cases in their correspondence—and I accept that a line must be drawn after which it may be presumed that disability suffered by a man cannot be directly attributed to his service.
The Japanese cases present special difficulties. Because of the effect on the individual they vary in every case. I do not pretend as a layman to talk with any knowledge about tubercular causes or development. I think it is accepted that the rate at which it may make itself manifest is variable. In the case of Mr. Harmar, medical opinion is divided. Mr. Harmar's advisers and those looking after him sincerely believe this is attributable to his experience. The Minister's advisers, no less sincerely, believe otherwise.
I think I should quote from a letter I have from Mr. Harmar's chest physician, in which he states his grounds as follows:
When he was originally X-rayed, we thought there was evidence of old disease in
his lungs, and later we thought that there was some activity so he was admitted to a Sanatorium. I advised him originally to apply for a pension and was very surprised when he did not get it. In view of his past history of being a prisoner of war in the Far East, I think he undoubtedly contracted the disease whilst a prisoner of war and it has only just recently broken down again. Under these circumstances, I think he should be entitled to a disability pension.
It will be seen that there is a clear, sincere but, nonetheless, sharp difference of opinion between reliable medical evidence on the two sides. In those circumstances, a layman must speak with strict moderation. A terribly narrow line clearly divides knowledge and truth in cases of this kind. I think I am entitled to ask my hon. Friend what sort of term is set to the occurrence of such maladies in the case of the Japanese prisoner of war and whether this particular case is so far outside that term. I think that is doubtful, because I know how immensely careful the Ministry my hon. Friend represents is in such cases. Obviously this is not the only case of this sort. There must be others in which there is an honest division between the doctors.
Is there any way in which one can resolve such a situation? Where, as here, there is a scintilla of doubt, it seems to me that unless there are very convincing reasons otherwise, that scintilla of doubt should lead to the individual—in this case Mr. Harmar—getting the benefit of the doubt. That is all I ask my hon. Friend on behalf of Mr. Harmar.
I am glad my hon. Friend the Member for Ashford (Mr. Deedes) has raised this case, because it is one to which I have given a great deal of thought. I was glad of the firm yet moderate way in which he discussed it.
All cases of ex-Japanese prisoners of war are cases we are bound to look at—all of us—with a great deal of sympathy. It is as, my hon. Friend said, very difficult in these cases where a man has been a prisoner of war for any length of time, to decide what connection there is between his experiences in the prisoner of war camp and his subsequent illness. I do not think my hon. Friend needs reminding that like him I am a layman. I shall, therefore, take his advice to try to look at this problem with, in his own words, strict moderation.
My hon. Friend has talked about the history of this case and has rightly said that when Mr. Harmar was X-rayed in 1945, after his return from the prisoner of war camp, his chest was found to be normal. He had several medical boards at the end of that year which pronounced that his general condition was good and his nutrition was good. I have some difficulty in understanding the figures which my hon. Friend gave about Mr. Harmar's weight. I looked carefully at the report of the medical board and found that his weight was very considerably more than the 4 stone 9 lb. my hon. Friend quoted.
Mr. Harmar served until the beginning of 1951, and I think it significant that in those five years the only illness from which he suffered was a cold, which lasted only four days. At the end of his military service, in December, 1950, he had another medical board which found his physique fair and, again, found nothing abnormal at all in his lungs. From his discharge from the Army until fairly recently he was working in various employments, until in 1954 he had his first attack of pneumonia. That was the first of three attacks. He also had an attack of influenza one December.
Apart from the words which my hon. Friend has already quoted from Mr. Harmar's medical adviser. I think it would be fair if I underlined this opinion by another quotation, from, I think, the same source, which reads:
This man has in my opinion not yet fully recovered from the hardships he suffered during his time as a prisoner-of-war. He has had three attacks of pneumonia in three years, more than most people get in a lifetime. Hic resistance to disease, especially respiratory infection, is below that of an average man of his age.
That is from Mr. Harmar's doctor.
After the third attack of pneumonia in 1957 his doctor referred him to a chest clinic and at that time, which I think was in February of this year, it was diagnosed that he had quiescent tuberculosis. In May, 1957, he claimed a pension for pneumonia. In the following month, in June, he was admitted, as indeed are the great majority of ex-prisoners of war, into Roehampton Hospital for a thorough investigation to see what was the position in relation to any tropical disease. It was discovered that he suffered from some effect of malnutrition.
The medical board this summer advised him to go to a chest clinic, and it was there that X-rays of his chest were not found satisfactory and the tuberculosis to which my hon. Friend has referred was suspected.
The question which my hon. Friend has raised is whether Mr. Harmar's experiences as a prisoner-of-war had the effect of lowering his resistance to infection, thus pre-disposing him first of all to pneumonia, which in its turn made more likely the onset of a tuberculous infection. I hope that I put that correctly. I am bound to admit, having looked very carefully at this case, that I think that this chain of causation is extremely unlikely.
First of all, there is the evidence of his last five years of service in which he suffered only this small cold of short duration. Secondly, there is the evidence of the medical board, first when he left the prisoner-of-war camp and secondly, when he left the Army, that his lungs were clear. Thirdly, there is the fact that he did not have pneumonia until eight or nine years after he left the prisoner-of-war camp. I think that it is reasonable to expect that if his experiences as a prisoner-of-war had had the effect of lowering his resistance to infection, he would have suffered before the eight or nine years had elapsed.
I would, however, make this reservation. Although I am still of the opinion that the connection between malnutrition on the one side and pneumonia and tuberculosis on the other is extremely improbable, there is the fact that he has had these three attacks of pneumonia, which, as his doctor says, are as much as most people get in a lifetime—and I hope more than a great many people get. The second fact is that in this case there is a sincere difference of medical opinion. Where a difference of medical opinion exists, my right hon. Friend is able to refer the matter for a decision to an independent medical expert.
I suggest that such a course would be appropriate in this case. I will give my hon. Friend an undertaking now to issue directions to this end, so that Mr. Harmar's case can be re-examined and the conflict of opinion—the very genuine and sincere conflict of opinion—between Mr. Harmar's doctor and the medical advisers in the Ministry of Pensions and National Insurance can be resolved.