THE NAVAL, MILITARY, AND INDIAN MEDICAL SERVICES.

THE

NAVAL, MILITARY, AND INDIAN MEDICAL SERVICES.

635

Tobin, and Mr. D. J. Kennedy. Surgeon to Extern higher. Deputy Surgeons-General now get £25s. daily. Department : Mr. H. Meade. Gynaecologist and Lecturer on Senior medical officers of battleships and cruisers with comGynæcology : Mr. A. J. Smith. Pathologist and Lecturer plements of 650 and upwards get 3s. 6d. daily charge pay, on Pathology : Dr. T. T. O’Farrell. Surgeon-Dentist and which is very right and has often been asked for. Charge The surgeon who passes Lecturer on Dentistry : Mr. J. J. Murphy. Pharmacist and pay is now given more freely. the staff surgeon’s examination at his first attempt may Lecturer on Pharmacy : R. Shaw. secure 18 months’ earlier promotion by getting a special certificate (or 12 months’ if he only attains a first class), proUNIVERSITY OF BRUSSELS. i British and other practitioners holding registrable quali- vided the Admiralty thinks him deserving and the directorA surgeon who has teations are admitted to the examination for the Doctorate general does not reduce the period. of the University of Brussels without further curriculum. passed this examination before eight years may, as at present, It is essentially a practitioner’s examination and is separate retire with a gratuity of S1000 if he so choose ;but if he has from that intended for the Belgian students who take up the not passed at eight years he will be compulsorily retired on - medical curriculum of the University. The fees are-For any gratuity the Admiralty thinks right, not exceeding f:500. Wewould strongly urge on the authorities the advisability matriculation, Z88 12s ;for lst Part, B44 4s. ;for 2nd Part, ,;E44 8s. ;for 3rd Part, .644 8s. ;for legalisation of diploma, 8s. - of removing the still existing legitimate grievances ; the total, £22. Candidates who have paid in advance the fees for reforms could for the most part be effected at the expense of the three examinations, and are unsuccessful in the first, re- little but tact and a consideration of what is justly due to the naval medical officers. Every naval medical officer who cover the fees paid for the second and third ; those who fail in the second recover the fees paid for the third examination. has written to our columns, and this is not a small number, Unsuccessful candidates are allowed to come up again three has expressed dissatisfaction with the position in which months after rejection on payment of examination fees only, the cabin question has been left by recent regulations. officer of accommodation H. F.

AlIGtment to the medical cabin inferior to that to which he is entitled still takes place, and cannot, at any rate cannot always, be explained by the eramped space on that elaborate box of tricks, a modern man-of-war. Another innovation sadly wanted is a regulation to ensure that the senior medical officers in hospitals should have proper disciplinary power over and Morbid with of use Pathology Therapeutics; Anatomy, their subordinates and patients. Other points, such of the microscope ; Special Therapeutics and Medicine for example, of boats, Internal Diseases, including Mental Diseases; and Special as the supply and use Surgery. 3rd Part: Public and Private Hygiene; Medical might well be settled in accordance with the just examina- desires of the Naval Medical Service, for the Admiralty .Jurisprudence; Clinical Medicine; Clinical tion in Operative Surgery, consisting of some of the usual will be prudent to aim at making the Service more And the same may be said of all three operations on the dead subject-viz., Amputation, Ligature popular. that there is now no competition for comof an Artery, &c.; Ophthalmology ; examination in Mid- services. inFor the missions Naval Medical Service and no keen comthe mannikin on in obstetrical operation wifery, consisting (model of pelvis) ; and examination in Regional Anatomy petition for those in the Army Medical Corps or the Indian with Dissection. The time required for the three Medical Service seems undeniable, and this is the more un- examinations seldom exceeds ten days, and is usually fortunate a position since fewer men are now entering the less. Candidates have the option of passing each part medical profession as a whole. It is no longer easy for all separately, or of taking the three together, and the latter is hospitals to obtain suitable residents, while assistants are the usual course ; also of demanding a written examination scarce and even junior partners are not to be found directly on payment of an additional fee of one guinea for each they are wanted. The Services will therefore have to be part, a rule of which candidates rarely or never avail them- careful to increase their popularity, and the point is that selves. The examinations, which are vivd voce, begin on the it may be economical of them to do so now. By first Tuesday in November, December, March, May, and small concessions they may be avoiding having later middle June. Candidates should appear with their medical to pay a heavy price to attract men. We would also registration certificate or their diplomas at the Secretary’s suggest that it is unwise to let any of these departments Office not later than 2 P.M. on the dav preceding the run below the normal strength if it is possible to maintain ’examination. Most of the examiners speak English, and those them at par. who do not examine through the medium of an interpreter. Though reform may be wanted in the Naval Medical Great importance is attached to practical knowledge, but Service, its present state is not without material advancandidates must also possess sound theoretical knowledge, tages. At one time not so very long ago the Naval Medical the standard required varying with the subject. Pathological Service was not looked upon as one in which an educated and other specimens are not usually shown. There are gentleman could serve with dignity, while complaints were in England at present over 600 graduates holding this heard of many of the conditions of service. But the old degree, and a British Association of Brussels Medical order of things is giving place to the new, and a comGraduates has been in existence for many years. Appli- parison of the lot of the naval medical officer with cations should be made to the Secretary, 14, Rue des that of the civil practitioner will show that the trials Sols, Brussels; or to Dr. Arthur Haydon. Secretary of the of the civil branch of the profession are greater than Brussels Medical Graduates’ Association, 23, Henrietta-street, those of the naval branch, and probably when all things are considered the naval surgeon is in a far better posiCavendish-square, London, W. tion than the average lay professional man. In the junior ranks of the Service the pay is better than the average income of the lay medical man of the AND INDIAN THE and promotion is not always slow. same age, With MEDICAL SERVICES. Z20 a month the young naval surgeon can, if he is not extravagant, get along very comfortably, though he THE conditions of service in the medical departments of will require at the commencement of his career £50 or E60 the Army and Indian Army remain, with certain modi- for outfit. A private income is certainly not necessary. After fications, the same as for 1911; but the conditions of 20 years of service a naval surgeon is entitled to a pension medical service in the Royal Navy have been further modified, of k365 a year, which compares very favourably with the chiefly in regard to improved professional training. prospects of many medical men on the civil side of the proAn Order in Council was issued on August 8th, 1911, fession, and in case of illness there is the half-pay rate, based, it is understood, on the report of Sir John Durnford’s while pensions are provided for widows and children. Committee, appointed three years ago. This Order, we In this way the young naval officer is relieved of the most fear, was a disappointment to all but the senior officers I serious anxiety which can press upon a married man, but of the Service. The old ranks of inspector and deputy in- he ought not to marry young without due consideration, a spector-general became surgeon and deputy surgeon-general, warning which, however, applies to most medical men. as they used to be in the army. Pay was increased by 18. or With regard to the Medical Services of the Army and Indian 2:.daily every year or two till 26 years’ service, when it is Army, a comparison with that of the Navy shows that £115s. a day, and for fleet-surgeons does not rise any though the Army and Indian Service are better paid,

provided this second appearance be in the course of the same :academical year (Oct. lst to June 30th), otherwise they must renew the payment of the matriculation fee of E312s. The examination consists of three parts, viz.-1st Part: ’General Medicine; Materia Medica and Pharmacology; General Surgery ; and Theory of Midwifery. 2nd Part: General

Surgery ;

NAVAL, MILITARY,

636

THE

NAVAL, MILITARY, AND INDIAN MEDICAL SERVICES.

in the case of the army has been rendered the exact date of this, as well as the number of commissions to be for, will be advertised in THE LA.NCET. Candidates will be certain; in both services expenses are higher and competed examined in the following subjects: (a) Medicine, including Medical the work more fatiguing, while in the Indian Service Pathologyand Therapeutics ; and (b) Surgery, including Surgical Pathothere is a greater liability to disease and death. The logy and Clinical Surgery. The examination will be partly written and marks being allotted under the following scheme :young surgeon, too, on board his vessel probably gets partly practical, Medicine. a better chance in the Navy Surgery. than in the Army. So 400 400 Paper Paper long as the new surgeon is adequately good at his Clinical............ 400 Clinical......... ,.. 400 is kind and unselfish towards his patients profession, Oral 400 Oral 400 is not too self-assertive, and has any positive accomplishTotal ...... 1200 Total...... 1200 ments or skill at any sport or game, he should get on very No candidate will who obtains less than 5 per be considered if he is and And eligible well, especially good-humoured helpful. of marks in each subject. The examination will be held in London if a man has not these qualities and readiness where should cent. and will occupy four days. he be advised to practise ? The appointments announced for competition will be filled from the The conditions of entry into the Royal Naval Medical list of qualified candidates, arranged in order of merit; but should it to grant Commissions beyond those Service were altered in 1910. Formerly, candidates on at any time be considered expedient periodically competed for, the Admiralty have power to admit at once in London received examination the passing annually not more than six candidates, according to requirements, their commissions as surgeons in the Royal Navy. specially recommended by the governing bodies of such Colonial Universities as be selected and whose qualifications are recognised by the They are now appointed acting surgeons. More- General may Medical Council. Candidates so proposed are to be approved over, after courses of instruction, they will be again by the Director-General of the Medical Department of the Navy. candidates will have to pass a physical examination before examined, and if they pass this examination also will be aColonial board of Naval Medical Officers in their colony, and will be required to Their their on commissioned. is, seniority-that place duly register their qualifications on arrival in England. They will’be the list throughout their service-will depend on the marks allowed, if they wish it, to compete at the next examination for and take their position according to the order of merit ; should they get in both examinations. The standard of marking is entrance not disclosed, and proficiency in the second examination in they decide not to compete they will be placed at the bottom of the list. It will, however, be necessary in any case for them to pass a subjects which have been studied only through perhaps qualifying test at the time of the usual half-yearly examinations, when three or six months may avail as much in fixing.their places they will be required to obtain a minimum of 50 per cent. of the total as success in the first examination, which is the outcome of marks in each subject. In case of failure in this test examination the Admiralty will not undertake to defray the cost of the return journey the industry and training of at least five years. This pointto the candidate’s colony or other expenses thereby incurred. A fee of should be cleared up by the Admiralty, as the uncertainty:C1will have to be paid by each candidate to entitle him to take part in will operate to discourage application from the best candi- the competition. Candidates who have served in the Officers’ Training Corps, and who dates, the most highly educated, those most desired by the are in possession of the certificates laid down in the regulations for service, who will be rather shy to trust their hard-won pre- that Corps, will be credited at the entrance examination with additional marks as follows : Candidates in possession of Certificate A eminence to so doubtful a fortune. An extra 10 per cent. will receive 1 per cent., and those who possess Certificates A and B, for the second examination would give plenty of inducement 2 per cent. of the maximum number of marks allotted. to the acting surgeons to be attentive to the important inA candidate will not be allowed to compete at more than two struction in tropical diseases and naval hygiene they receive examinations. A candidate successful at the entrance examination will be appointed at Greenwich and Haslar. The relative proportions should be as Acting Surgeon in the Royal Navy and will be required to pass mentioned if the best candidates are not to be frightened through such courses of instruction as the Admiralty may decide. At the end of the courses the acting surgeon will be examined and after he away. The entrance examination was also altered. Voluntary has will be given a commission as Surgeon in the Royal Navy. subjects and hygiene were done away. The examination The passed commission will date from the day of passing the entrance deals with medicine and surgery only. In each subject examination. The number of marks gained at the final examination, there is a written, a clinical, and an oral examination, and together with those gained at the entrance examination, will decide a on the list for seniority. candidate’s An acting surgeon who fails 400 marks are given for each of the six examinations. This to qualify inplace the above examination (i.e., who fails to get 50 per cent. of scheme gives a material advantage in the competition to marks in each subject of the Greenwich and Haslar courses) will be

promotion less

............

............

............

............

allowed a second trial at the next examination, the period between the two examinations not being counted as service for either promotion, withdrawal with gratuity, or retirement after 20 years’ service, and should he qualify he will be placed at the bottom of his list; should he again fail his appointment will not be confirmed and he will be required to withdraw. A gold medal, a silver medal, and three navy regulation pocket cases will be awarded as prizes in connexion with these examinations, and the gold medallist will have a distinguishing mark after his name in the Navy List. Surgeons on entry are only required to provide themselves with a REGULATIONS FOR THE ENTRY OF CANDIDATES FOR COMMISSIONS IN regulation pocket case of instruments. A candidate, who at the time of passing the examination for entry THE MEDICAL DEPARTMENT OF THE ROYAL NAVY.l holds or is about to hold an appointment as Resident Medical or for into the Medical of admission the candidate Department Every Surgical Officer in a recognised civil hospital, may be allowed to serve Royal Navy must be not under 21 nor over 28 years of age on the day in such civil provided that the period of such service of the commencement of the competitive examination. He must pro- after the date appointment, of entry into the Royal Navy does not exceed one year. duce an extract from the register of the date of his birth; or, in Pay from Naval funds will be withheld from officers while thus serving, default, a declaration made before a magistrate, from one of his parents but the time concerned will reckon for increase of full and half pay or other near relative, stating the date of birth. while on the active list, and retired pay or gratuity on retirement or He must be registered under the Medical Act in force, as qualified to withdrawal; except that no officar will be allowed to retire on a gratuity practise medicine and surgery in Great Britain and Ireland. until he has completed four years’ service, exclusive of the time spent He must declare (1) his age and date and place of birth ; (2) that he as Resident Medical or Surgical Officer. The eligibility of this appointis of pure European descent 2 and the son either of natural-born ment to count for time will be decided by the Medical DirectorBritish subjects or of parents naturalised in the United Kingdom; General. (3) that he labours under no mental or constitutional disease or weakThe seniority of surgeons on entry will be determined by the sum ness, nor any other imperfection or disability which may interfere total of the marks they obtain at the London examination and those at with the most efficient discharge of the duties of a medical officer in the conclusion of their probationary period as Acting Surgeon. Their any climate; (4) that he is ready to engage for general service at home names will then be placed in the official navy list, except in the case o abroad, as required; (5) whether he holds, or has held, any of candidates who hold, or are about to hold, a post as resident medical c mmission or appointment in the public services; (6) that he is officer or surgical officer to a recognised civil hospital. These candidates r mistered under the MedicalAct, giving the date of his registration as a will retain the position in the list which they obtained on entry, and m dical student, or of his beginning professional study; and (7) whether when their period of service as resident officer is over they will join the ne has previously been examined for entry in the Naval Service, and, next Acting Surgeon’s course and will be required to obtain qualifying if so, when. marks. entered without competition will take seniority next The certificates of registration and birth must accompany the declara- after the Surgeons last surgeon entered at the same time by competition. tion. which is to be filled up and returned as soon as possible, addressed It has been decided to establish a Naval Medical School at the Royal to the Director-General, Medical Department, Admiralty, London, Naval College, Greenwich.3 Two Fleet Surgeons have been appointed S.W., to permit of reference to the candidate’s medical school. The to fill the posts of Professor of Bacteriology and Clinical Pathology and Dean or other responsible authority of such school will be requested by Professor of Naval The latter will be in charge of the studies the Medical Director-General to render a confidential report as to the of Naval Medical Hygiene. Officers undergoing courses at this school. The candidate’s character, conduct, professional abilitv, and fitness to hold a course of instruction for Acting Surgeons will be six months in duracommission in the Royal Navy. The candidate will then be interviewed tion, two of which will be passed at Greenwich in the study of Tropical by the Medical Director-General, and his physical fitness will be deter- Medicine, Bacteriology and Clinical Pathology, Hygiene, and Skiaa board of Naval Medical Officers. The Medical Directormined by and the remaining four at Haslar in the study of Naval General will then decide whether he may be allowed to compete. If graphy ; Hygiene, Recruiting, Physical Traimng, Diving, Submarine Work, &e. candidate will to the be himself at the accepted, present eligible A Fleet Surgeon will superintend these studies at Haslar and fill the entrance examination, which will be held twice a year. Notification of post of Lecturer on Naval Hygiene. At the conclusion of the six months’ course an examination will be carried out as above mentioned. 1 To be obtained, together with the form to be filled up, on application to the Medical Director-General, Admiralty, London. S.W. 2 If 3 This school was opened on May 1st last by Admiral H.S.H. Prince any doubt should arise on this question the burden of clear Louis of Battenberg. proof that he is qualified will rest upon the candidate himself.

less broadly educated candidates. Confidential reports as to the character of a candidate are now to be obtained from the dean of his medical school. Certain additional marks are given to candidates who possess certificates from the Officers’ Training Corps. Nominated candidates, except those nominated by colonial universities, are no longer allowed. ROYAL NAVAL MEDICAL SERVICE.

THE

NAVAL, MILITARY, AND INDIAN MEDICAL SERVICES. Cape, Gibraltar, Shotley, Yokohama,

Poet-Graduate Iust1’ltction and Examination for the Rank of

will be

Staff Surgeon. The post-graduate instruction of Naval Medical Officers consists of two courses: (1) A six months’ course before promotion to Staff Surgeon; (2) a second course of three months for officers of not less than 14 years’ seniority. The first course is compulsory for all surgeons, and is followed by examination before the Medical Examining Board in London, in order to qualify for promotion to Staff Surgeon. The course

as

637

and Deal.

The

rate

of

charge pay

follows :0 7 6 50

Surgeon-General ........................ 10

Deputy Surgeon-General .................. of over 4 Fleet

a

day. "

" Surgeon years’seniority ...... Fleet Surgeon of under 4 years’ seniority and Staff Surgeon of over 4 years’ seniority ...... 26 " At Chatham, Haslar, and Plymouth charge pay is granted of 5s. daily to Deputy Surgeons-General, and 2s. 6d. to Fleet Surgeons in charge of sections. Also charge pay at 3s. 6d. a day is granted to the Senior Medical Officers of all seagoing ships with complements over 650. The hospital allowances for naval medical officers at home and abroad, in lieu of provisions, for themselves and servants, and for fuel and lights, are as follows :—

is to be taken when the surgeon has between four and a half and six and a half years’ seniority, as near the latter date as practicable. These place twice a year. There are six compulsory subjects : courses take Clinical Medicine and Surgery, Operative Surgery, Practical Anæsthetics, Ophthalmology. Chemical Pathology, and Hygiene; and three optional subjects: Bacteriology, Diseases of the Throat, Nose, and Ear, and Skiagraphv. A surgeon who fails to obtain a pass will be allowed a second trial; if again unsuccessful, he will be compulsorily retired on attaining eight years’ seniority, with such gratuity (not exceeding £500) as the Admiralty may see fit to grant. Instruction in bacteriology and clinical pathology, hygiene, and skiagraphy will be given at the Naval Medical School; the other subjects will be studied at the "Dreadnought" Hospital and other civil hospitals in London, as may be arranged by the Medical Director-General. The surgeons going through the course will be accommodated at the Royal Naval College, Greenwich, under the general control of the President; their instruction will be supervised by the Professor of Hygiene. The second course is not compulsory, but it is designed to afford These allowances are also granted to medical officers of marine divisenior officers an opportunity for refreshing their knowledge of surgery sions and dockyards at the Marine Rendezvous, and to the Inspecting and medicine, and making themselves familiar with modern advances. Officer of the Royal Navy Auxiliary Sick Berth Staff. There will not be any fixed syllabus, but arrangements will be made An allowance of 5s. a day, in addition to full pay, is granted to the to meet individual requirements. The officers attending the course senior medical officer, being a Fleet or Staff Surgeon, of a flag-ship will also be accommodated at Greenwich bearing the flag of a Commander-in-Chief. An allowance of 2s. 6d. a Voluntary classes for instruction of about six weeks’ duration is the to senior medical officer, being a Fleet or Staff granted held at the Naval Hospitals at the three home ports (Chatham, Haslar, day of the ship bearing other flags or broad pendants. The Surgeon, Plymouth’ for the benefit of medical officers, to whom every facility following charge allowances may be granted to medical officers will be afforded for the study and practice of bacteriology, clinical in charge of hospital ships: if above the rank of fleet surgeon, 5s. pathology, skiagraphy, &c., in the hospital laboratories. a day; and if of the rank of fleet surgeon or junior, 3s. a Promotion to Staff Surgeon. day. Medical officers conducting the courses of instruction will receive the following special allowances: At Greenwich, the Professor of (a) Rink as Staff Surgeon will be granted, subject to their Lordships’ Bacteriology, B150 a year; the Professor of Hygiene, £150 and 0250 for from at the of the date of to expiration years eight approval, surgeons charge of the studies of naval officers undergoing instruction. At entry, provided they are recommended by the Medical Director- Haslar, the Fleet-Surgeon, B150; the Junior Officer instructing sick General, have served at sea for three years, and have passed the berth staff, E50 ; at Plymouth and Chatham the same allowance of 0250 qualifying examination for this rank. (b) Special promotions will be is granted. Medical officers employed elsewhere than at a hospital, and made at their Lordships’ discretion to the rank of Staff Surgeon not victualled in kind, receive an allowance of 1s. 6d. a day in lieu of in cases of distinguished service or conspicuous professional merit. provisions, fuel, and lights. The travelling allowances, extra pay, Such promotions will be exceptional and not exceed the rate of lodging money, and compensation for losses are fixed for naval medical one a year. The total number at any one time of Staff Surgeons according to their relative rank in the service. ’ holding that rank by such special promotions will not exceed eight. The emoluments of the medical headquarters staff at the Admiralty These limitations do not apply to promotions for gallantry in action. are: Medical Director-General, 021800 per annum; Deputy Director(e) Acceleratecl Promotion.-Certificates will be granted at the General, £1100 per annum ; Assistants to Director-General, each B750 of for as follows :-50 cent. examination Staff Surgeon per qualifying per annum. marks for a pass; 75 per cent. for a first class, and 85 per cent. for a Half Pay. special certificate. An officer obtaining a first class is eligible for an advance of 12 months’ seniority, and one obtaining a special certificate for 18 months’ seniority; this acceleration will not be granted on examination results alone, and an officer must also be recommended as deserving of advancement.

are

6d.

officers

_____

Promotion to Fleet Surgeon. (a) Subject to the approval of the Lords Commissioners of the Admiralty rank as Fleet Surgeon will be granted to Staff Surgeons at the expiration of eight years from the date of promotion to. Staff Surgeon, provided they are recommended by the Medical DirectorGeneral, have served in that rank at sea for three years, and have not declined service except for reasons which in the opinion of the Lords Commissioners of the Admiralty are satisfactory. (b) Special promotions from the rank of Staff Surgeon to that of Fleet Surgeon will be made at their Lordships’ discretion in cases of distinguished service or conspicuous professional merit. Such promotions will be exceptional and will not exceed the rate of one in two years ; the total number at any one time of Fleet Surgeons holding that rank by such special promotions will not exceed six : these limitations do not apply to promotion for gallantry in action. Promotions to Surgeon-General and Deputy Surgeon-General will be made strictly by selection, and will be confined to officers who have proved themselves to be fitted, both professionally and as administrators, for these ranks. For advancement to Deputy Surgeon-General two years’ sea service in the rank of Fleet Surgeon will be required, or five years’ combined service at sea in the ranks of Fleet and Staff Surgeon. Fidt

Pay.

Candidates will do well to notice that the regulations issued to applicants do not put any limit on the amount of half-pay service which they may be compelled to undergo, also that time on half-pay counts only one-third towards retirement. Retirement.

will be as follows :’At the age of 60, or at any if he has had three years’ nonemployment in any one rank, or after four years’ continuous non-employment in any two ranks combined. Except that if in any particular case the Lords Commissioners of the Admiralty may consider that the interests of the public be retired service will be materially adirrespective of vanced by the further retention age if found of a Surgeon-General on the physically unfit for service. active list, the age for the tirement of such InspectorGeneral may be extended to 62.

Compulsory retirement

age,

SurgeonGeneral and Deputy Surgeon General, R.N.

*

I

To

at any age of 55. Atif the he has had three years’nonin or

Fleet

[

charge of the following hospitals and sick charge Day: Haslar, Plymouth, Chatham, Malta, Hong-Kong, Bermuda, Portland, Yarmouth, Haulbowline,

The medical officers in quarters will be granted

Staff and

reI age,

Surgeon

employment after four

or

rank,

any one continuous

years’ Surgeon. Surgeon. | non-employment in any ranks combined.

I

two

638

THE

NAVAL, MILITARY, AND INDIAN MEDICAL SERVICES.

In circumstances other than those specified in the last two paragraphs, The special attention of candidates is directed to the following rules a an officer retired under which officers are allowed to withdraw from the service after and other than misconduct, neglect of duty, &c., four years’ full pay service in the Itoyal Navy, with the advantage of with w less than 20 years’ service will not he allowed half pay or ro retired joining the Reserve of Naval Medical Officers:pay, but will receive a gratuity on the scale laid down in After four years’ service in the Roval Navy, an officer, if he wishes, the tl table above if he has eight years’ full-pay service, and on that prov in the last paragraph (b) should his full-pay service not amount may pass from active service to the Reserve of Naval Medical Officers, vided when he will reap the following advantages :t, eight years. The power vested in their Lordships of granting to He will be a r rates of half pay and retired pay in cases of misconduct is (1) granted gratuity of E500 on passing into the Reserve. reduced e to the award of gratuities on retirement, and the gratuity (2) His name will be retained in the Navy List; he will retain his extended naval rank and be entitled to wear his naval uniform under the regula- awarded a will be reduced to such an amount as is thought fit. An tions applying to officers on the retired and reserved lists of His Majesty’sofficer o retiring after 20 years’ full-pay service will be eligible, if recomn mended by the Medical Director-General for distinguished or Navy. n (3) If he agree to remain in the Reserve for four years he will meritorious service, to receive a step of honorary rank, such step to be receive a retaining fee of £25 per annum. If at the expiration of aawarded at their Lordships’ discretion, and not to confer any claim to this period he agree to remain in the Reserve for a further period of increase i of retired pay or of widow’s pension. All retired officers will four years he will continue to receive the same retaining fee. t liable, till the age of 55, to serve in time of declared national emerbe Should an officer prefer it, however, he may simply enter the Reservegency, in a rank not lower than that held on retirement. This for a period not exceeding eight years, with power to give six months’ liability 1 does not exist in cases of officers who withdraw from the notice of his intention to I Service receiving a gratuity after 8, 12, or 16 years’ full pay position at any time (in which case Naval he will receive no retaining fee). He may also adopt this method of service. Retired officers will receive special consideration as regards B Reserve service after the expiration of four years served under the appointments on shore connected with the Admiralty. e conditions referred to in (3), by renouncing his retaining fee for his last Widow’s Pension. four years’service in the Reserve. When an officer retires or withdraws on a gratuity his widow and No officer will be allowed to remain in the Reserve for a longer period ( will have no claim to pension or compassionate allowance. than eight years. Whilst belonging to the Reserve, officers must reportchildren In respect to other officers on the active or retired list, the widow’s any change of address to the Secretary of the Admiralty. Officers of the Reserve will be liable to serve in the Royal Navy in pension ranges from ,E50 per annum for a surgeon’s widow up to £120 j the widow of an Inspector-General; for each child an allowance is time of war or emergency. When called up for such service they will for I ranging from :B9to ,E20 per annum. Officers serving in the receive the rate of pay-viz., 17s. a day and allowances-to which they granted ’ reserve who during re-employment are injured on duty, or lose their would have been entitled after four years’ service on the active list. under the same Voluntary retirement and withdrawal will be allowed as follows:lives from causes attributable to theforservice, come or themselves, pensions and regards compensation (a) Every officer will have the option, subject to their Lordships’regulations as allowances for their widows and children, as officers of service on the scale ofcompassionate approval, of retiring after 20 years’

resign his

full-pay

retired pay provided in the table below, or with a gratuity on the the same rank on the permanent Active List. scale provided in that table if not eligible for retired pay. Miscellaneous. (b) At the expiration of four, eight, 12, or 16 years’ full-pay The medical officer of the senior flagship of a fleet is to be recognised service every officer will be permitted, subject to their Lordas the Medical Officer of the Fleet. He will be on the staff ships’ approval, to withdraw from the Naval Service, re- of the Principal Commander-in-Chief and will wear an aiguillette; he will ceiving a gratuity on the scale laid down in the table below. act as his principal adviser on medical and sanitary matters, and It is to be noted that the four years’ service is exclusive of time served report on such matters periodically to the Admiralty. He will as resident officer in a civil hospital. The name of an officer so withhave direct access to the and be in a position to drawing will be removed from the list of the Navy, with which all propose to him measuresCommander-in-Chief, for the efficiency of the Fleet’s medical connexion will then be severed, except in the case of officers who directly responsible to him for keeping him informed withdraw after four years, who are liable to serve in the Reserve. organisation, being A on these matters. limited number of active or retired medical officers (e) Applications from officers to retire or withdraw or resign their are appointed Honorary Physician or Honorary Surgeon to the King. commissions will receive every consideration, but no officer will, as are three There good service pensions of B100 a year; two Greenwich a rule, be permitted to resign under three years from the date of of £100 a year; and 13 of £50 a year awarded to pensions Hospital In order that arrangements may, as far as possible, be made Naval Medical Officers. The Gilbert entry. Blane gold medal is awarded every for the relief of officers who may wish to withdraw on a gratuity it is two years to each of two medical officers for the most approved journals desirable that six months’ notice of their wish should be forwarded for of their practice while in medical charge of a ship of war. Oncein the consideration of their Lordships. The Admiralty reserve to themevery five years a gold medal and 2100, the Chadwick Naval or Military selves power to remove any officer from the list for misconduct. Prize, is presented to a naval or military medical officer who has Gratuities and retired pay will be awarded on retirement and withspecially assisted in promoting the health of the men in the Navy drawal on the undermentioned scale :or Army. A special cabin will be appropriated to the Fleet or Staff Surgeon or the Surgeon in charge of the medical duties in each ship. Relative rank is accorded to medical officers as laid down in the King’s Regulations and Admiralty Instructions.

We recognise that the Admiralty has made a considerable effort to render the Medical Service attractive to men of a good professional stamp. By the regulations recently promulgated promotion has been accelerated, special promotion in the lower grades has been made possible in cases of distinguished service or conspicuous professional merit, and encouragement to enter the service, in the shape of earlier promotion, has been given to men who have held resident posts in recognised hospitals. A feature of the regulations is the permission to withdraw at the end of fouryears with a gratuity of S500 : a small increase of pay has been made to medical officers all round, and senior medical officers are put in a materially better position if they are serving in large battle-ships or cruisers. DeputySurgeon-Generals get the 3s daily that they did not get when pay was last re-adjusted. The rewards now offered to those who pass the examination for Staff Surgeon and the

penalties held before those who fail should ensure the medical officers of eight years’ service being men of ability and industry. But we regret that there is no mention of specialist pay which can be got by young officers of energy in the Army and Indian Service, nor is there any acceleration of promotion for scientific work. If pay has been increased, in respect of allowances, the medical officers of the Navy, up to the senior ranks, are not as well off as those of the Royal Army Medical Corps. There will also be discontent until the medical officers are unhampered in the performance of their important work by the executive officers. The medical officers should have control over the sick bay staff in ships, and over nurses and other attendants in hospitals, and executive officers should no longer figure as presidents of " medical surveys." The authority of the Director-General must be made adequate. More care must still be taken that medical officers are assigned fitting cabin accommodation. To make the service thoroughly efficient the medical officers must be given authority and position commensurate with their responsibilities, as has been done in the case of the Engineer department. severe

* Including time served as resident in civil hospital. t The gratuity will not exceed 2500 in case of a Surgeon retired for failure to pass for Staff Surgeon. 1To obtain this rate an officer must hold the commission of Fleet

Surgeon. An officer retired with less than 20 years’ service on account of discontracted in and attributable to the Service, will receive the half pay of his rank, or, with the consent of their Lordships, a gratuity on the scales given in the above table, but such officer will not be entitled to receive any special compensation for the disability in addition to the gratuity as above. An officer retired with less than 20 years’ service on account of disability, contracted in but not attributable to the Service, will receive(a) if he has over eight years’ full-pay service, either a gratuity on the scale given above or half-pay according as their Lordships think fit; (b) if he has less than eight years’ full-pay service, such gratuity as their Lordships think fit, not exceeding the rate of .E125 for each year of full-pay service. If the health of a surgeon breaks down before he completes 20 years’service, even if his disability be contracted in the Service or be due to climatic causes, he is liable at once to be only a gratuity. This point should placed on the retired list, receiving be well noted, as the position is a most unjust one. It should be clearly laid down what is to be understood by attributable."

ability,

THE

NAVAL, MILITARY, AND INDIAN MEDICAL SERVICES.

639

The dean, or other responsible authority, of the candiARMY MEDICAL SERVICE. school will be requested by the Director-General to date’s of the has service the medical recent Army During years as to his character, conduct, passed through many stages of evolution, and we consider render a confidentialandreport fitness to hold a commission in thu that in all essential matters the changes have been distinctly professional ability, in the direction of advance and improvement, not only for corps. A candidate whose application is regarded as satisthe officers composing this service, but in relation to the factory will be required to attend at the War Office a few Army at large. The formation of the Royal Army Medical days preceding the examination. It will then be decided if Corps by the Royal Warrant of 1898, when Lord Lansdowne the candidate may be allowed to compete for a commission. If approved, he will then be examined as to his physical was War Minister, marked the first great step ; then came a fitness in of the war South when the strain by a board of medical officers detailed by the DirectorAfrica, during period medical services were exposed to fierce criticism. The out- General a few days preceding his examination. The following is the order of the examinations :come of this was the appointment of a committee of inquiry 1. A candidate for a commission in the Royal Army Medical Corps in 1901 by Mr. Brodrick (now Lord Midleton), over which bodily health and free from any physical he himself presided. A Royal Warrant embodying the must be in good mental andwith the efficient performance of military defect likely to interfere recommendations of Mr. Brodrick’s Committee was issued in duty.

1902, which regulates the existing conditions of service ; in 1907 free passages to India were granted for the wives and families of medical officers, whether employed on duty or not, an important concession, and one evidencing the liberal spirit of the War Office towards the medical service. Since 1907 several important changes have been made from time to time. Prior to this date promotion from the rank of Major to Lieutenant-Colonel was made by seniority after the passing of an examination on attaining 20 years’ service, the establishment of Lieutenant-Colonels being unlimited. Under a new clause introduced in the Royal Warrant the establishment of Lieutenant-Colonels was made Under present rules a fixed number and limited to 120. no promotion to the rank of Lieutenant-Colonel can take place unless three conditions are fulfilled-(I) there is a vacancy on the fixed establishment ; (2) the officer has passed an examination for promotion ; (3) he is selected as suitable for promotion. In the Colonel’s grade another important and far-reaching change has been made since Jan. 9th, 1907. An officer promoted to the rank of Colonel after this date will, on completing four years’ service in the rank, be placed on half-pay unless further promoted or retired from the service. Officers of the substantive rank of Colonel were also removed from the Royal Army Medical Corps, and have been since shown in the Army List as belonging to the Army Medical Service ; they have also a distinctive uniform. ADMISSION TO THE ROYAL ARMY MEDICAL CORPS ARMY ORDERS DATED JUNE 1ST, 1909). A candidate for a commission in the Royal Army Medical Corps must be 21 years and not over 28 years of age at the date of the commencement of the entrance examination, and must be unmarried. He must, at the time of his appointment, be registered under the Medical Acts in force in the United Kingdom. A candidate must complete the subjoined form of application and declaration and submit it to the Secretary, War Office, as early as possible before the date on which the entries are closed. APPLICATION OF A CANDIDATE FOR A COMMISSION IN THE ROYAL * ARMY MEDICAL CORPS.* (1 Candidate will not be permitted to compete oftener than twice.) 1. Name in full. 2. Address. 3. Date of birth.t 4. Nature and date of examination qualifying for registration. 5. Date of registration as a medical student. 6. Dates of passing medical examinations-First, Second, Final. 7. Qualifications. (Medical Registration Certificate, or, if not registered, Diplomas to be furnished.) 8. Academic and other distinctions. 9. Medical school or schools in which the candidate pursued his course as a medical student, and name or names of the deans or other responsible authorities. 10. Particulars of any commission or appointment held in the public services, including service in the officers training corps. 11. Date of examination at which the candidate proposes to present himself. Declaration. (N.B.-A mis-statement by the candidate will invalidate any suband cause forfeiture of all privileges for services sequent appointment

REGULATIONS

FOR

(ISSUED

WITH

rendered.) I hereby declare upon my honour that the above statements are true to the best of my knowledge and belief and further :1. That I am a British subject of unmixed European blood. 2. That I am not, as far as I know, at present suffering from any mental or bodily infirmity, or physical imperfection or disability that is likely to preclude me from efficiently discharging the duties of an officer in any climate. 3. That I will fully reveal to the Medical Board, when physically examined, all circumstances within my knowledge that concern my

health. 4. I also declare that my vision is good with either eye (with out the aid of glasses as the case may be).

Signature

or

with-

..........................................

Date..................................................

;,- All communications to be Whitehall. S.W. T A

addressed to the Secretary,War ,

certificate of registration of birth to be furnished.

great importance that the names given in the birth certificate should be correctly given on this form, and it is to be clearly understood that when they differ the names and date of birth given in the birth or baptismal certificate will be accepted for official record.)

(N.B.-It

is of

2. The attention of the board will be directed to the following That the correlation of age, height, and chest girth is not less than that which is given in the following table :—

points: (a)

Physical Equivalents.

(b) Measurement of height. The candidate will be placed against the standard with his feet together and the weight thrown on the heels and not on the toes or outside of the feet. He will stand erect without rigidity and with the heels, calves, buttocks, and shoulders touching the standard; the chin will be depressed to bring the vertex of the head level under the horizontal bar and the height will be noted in parts of an inch to eighths. (c) Measurement of chest. The candidate will be made to stand erect with his feet together and to raise his hands above his head. The tape will be carefully adjusted round the chest with its posterior upper edge touching the inferior angles of the shoulder blades and its anterior lower edge the upper part of the nipples. The arms will then be lowered to hang loosely by the side and care will be taken that the shoulders are not thrown upwards or backwards so as to displace the tape. The maximum expansion during deep inspiration will be carefully noted. (d) Weight. The candidate will also be weighed and his weight recorded in the proceedings of the Board. (e) The regulations regarding the examination of eyesight are as follows :Squint, or any morbid condition of the eyes or of the lids of either eye liable to the risk of aggravation or recurrence, will cause the rejection of the candidate. The examination for determining the acuteness of vision includes two tests: one for distant, the other for near vision. The Army Test Types will be used for the test for distant vision, without glasses, except where otherwise stated below, at a distance of 20 feet; and Snellen’s Optotypi for the test for near vision, without glasses, at any distance selected by the candidate. Each eye will be examined separately, and the lids must be kept wide open during the test. The candidate must be able to read the tests without hesitation in ordinary daylight. A candidate possessing acuteness of vision, according to one of the standards herein laid down, will not be rejected on account of an error of refraction, provided that the error of refraction, in the following cases, does not exceed the limits mentioned, viz.: (a) in the case of myopia, that the error of refraction does not exceed 2’5 D ; (b) that any correction for astigmatism does not exceed 2’5 D ; and, in the case of myopic astigmatism, that the total error of refraction does not exceed 2’5D. Subject to the foregoing conditions, the standards of the minimum acuteness of vision with which a candidate will be accepted are as follows :Standard 1. Right eye. Left eye. V = 6’6. Distant vision.-V = 6/6. Reads 0, 6. Near vision.-Reads 0, 6. Standard II. Better eye. Distant vision.-V = 6/6. Near vision.-Reads

0, 6.

Worse eye.

V. without glasses, = not below 6/60; and, after correction with

glasses,

=

not below

Reads 1. Standard III.

6,’24.

Better eye. Worse eye. vision. V, without V, without glasses, = not below 6/24; and, after correction with glasses, = not below 6/24; and, after correction with glasses, = not below 6,12. = not below 6/6. glasses, Near vision.—Reads 0, 8. Reads 1. Inability to distinguish the principal colours will not be regarded as a cause for rejection, but the fact will be noted in the report, and the candidate will be informed. The degree of acuteness of vision of all candidates for commissions (including preliminary examinations) will be entered in their reports in the following Distant

-

manner :-

Reads V = Reads V = Reads V= Deteetue Dpfpctivp Righteye... V= Reads ... " Lett eye... No relaxation of the standard of vision will ever be allowed.

Sufficientt

eye... (Right ......Lett eye...

......

......

......

......

......

......

......

......

640

THE

NAVAL, MILITARY, AND INDIAN MEDICAL SERVICES.

I

The following additional points will then be observed. (f That his or incapacity. (b) A detailed account of the subjective symptoms and hearing is good. (g) That his speech is without impediment. (h) That physical signs elicited by the candidate’s personal examination of the his teeth are in good order. Loss or decay of ten teeth will be con- patient, noting the absence of any which might be expected to be sidered a disqualification. Decayed teeth if well filled will be con- present in a similar case. (c) Where there is any reasonable doubt sidered as sound. Non-erupted wisdom teeth will not be counted in the mind of the candidate as to an exact diagnosis, he is to as deficient. (i) That his chest is well formed and that his heart give the alternatives, with his reasons for making the selection. and lungs are sound. (j) That he is not ruptured. (k) That he does A commentary upon the case as a whole, pointing out the not suffer from varicocele or varicose veins in a severe degree. symptoms which may he considered typical, and those which appear to A candidate who has been successfully operated on will be accepted. be unusual or only accidental complications. (e) Suggestions as to treatA definition of severe varicocele may be obtained from the Director- ment, both immediate and possibly necessary at a later date. (f) A General Army Medical Service, War Office, Whitehall, S.W. (l) That forecast of the progress and probable termination of the case. his limbs are well formed and developed. (nt) That there is free and Similarly the commentary on the report of a case submitted to the perfect motion of all the joints. (n) That his feet and toes are well candidate should discuss: (a) The family and personal history and formed. (o) That he does not suffer from any inveterate skin disease. other conditions preceding the development of the condition (p) That he has no congenital malformation or defect. (q) That he does described. (b) The relative significance of the physical signs, not bear traces of previous acute or chronic disease pointing to an symptoms, other indications of disease noted, and the genera) impaired constitution. (r) If the candidate appears to be not of pure clinical aspects of the case. (c) The diagnosis, with reasons for European descent this will be recorded by the board. If a candidate be selection of the most probable, when a positive diagnosis cannot be pronounced physically fit for service at home and abroad he will be attained. (d) The treatment, dietetic, medicinal, operative, &c., ineligible to present himself at the next entrance examination which cluding a criticism of the plan adopted, and alternative schemes of will be held twice in the year, usually in January and July. A candi- treatment in case of disagreement. (e) The morbid appearances and an account of the post-mortem examination (if any). date will not be permitted to compete oftener than twice. The Army Council reserves the right of rejecting any candidate The examinations are held at the Royal Army Medical who may show a deficiency in his general education. An entrance fee of ;B1 is required from each candidate admitted to College, London, and occupy about four days. the examination. The appointments announced for the competition are Candidates who have served in the Officers Training Corps will be credited at the entrance examination with additional marks as follows : filled up from the list of qualified candidates arranged in the those having Certificate A will receive 1 per cent., and those having order of merit, as determined by the total number of marks B 2 per cent. of the total. Service marks are also credited to a candidate who has been employed as an officer in consequence of a national each has obtained. Having gained a place in this entrance emergency, the number of marks depending on the period of employ- examination the successful candidates are ordered to proceed ment and the circumstances of the case. to the Royal Army Medical College, Millbank, S.W., for inA candidate successful at the entrance examination will be appointed struction in recruiting duties, at the termination of which they a Lieutenant on probation and will be required to pass through courses of instruction at the Royal Army Medical College, London, and at the will undergo two months’ instruction in Hygiene, Pathology, Royal Army Medical Corps School of Instruction, Aldershot, and, after Medicine, Military Surgery, and Military Medical passing the examinations in the subjects taught and satisfying the Tropical Director-General that he possesses the necessary skill, knowledge, and Administration, after which they are examined in these character for permanent appointment to the Royal Army Medical subjects. The maximum number of marks obtainable at this Corps, his commission as Lieutenant will be confirmed. The commis- examination is 700. At the present time the professors at the sion will bear the date of passing the entrance examination. A Lieutenant who, at the time of passing the examination for admission to Royal Army Medical College are Major E. M. Pilcher, D.S.O., the Royal Army Medical Corps, holds, or is about to hold, a resident F. R C. S , in the department of military surgery ; Major appointment in a recognised civil hospital, may be seconded for the W. S. Harrison, M.B., in the department of tropical mediperiod, not exceeding one ’year, of his appointment; he will not receive army pay, but his service will reckon towards pay, promotion, cine ; Lieutenant-Colonel Sir W. B. Leishman, M.B., F.R S., and retirement; he will retain the seniority obtained at the entrance in the department of pathology ; and Brevet-Colonel examination. H. C. Melville, M.B., in that of hygiene, Captain J. C. The precedence of Lieutenants among each other will be in order of merit as determined by the combined results of the entrance Kennedy and Major H. B. Fawcus being assistant proexamination and the examinations undergone while on probation, fessors. Colonel Erskine Risk, the commandant and except that the position on the list of a lieutenant on probation, director of studies, assisted by Brevet Lieutenant-Colonel seconded to hold a resident appointment in a recognised civil hospital P. Blenkinsop, instruct in hospital and corps will be determined by the place he has gained at the entrance A. examination. He will be required, at the conclusion of his hospital administration, in the duties of officers on transports, and appointment, to attend the courses of instruction at the Royal Army in the examination of recruits, and Major T. W. Gibbard Medical College and at Aldershot; but the subsequent examinations will be of a qualifying character and will not influence his position on lectures on Syphilology. The services of the following staff the seniority list of the Corps. of clinical teachers have been secured to give courses of Lieutenants when appointed on probation will receive instructions as instruction to the classes made up of 50 captains that now to the provision of uniform. an annual course for undergo promotion to the rank of On completion of his probationary training an officer is posted for duty to one of the military hospitals at home, his wishes being met as major :-Medicine : Major G. N. Pitt, M D., 2nd London far as possible in regard to the command to which he is posted. General Hospital; and Lieutenant-Colonel W. Pasteur, M.D., EXAMINATIONS. 3rd London General Hospital. Surgery : W. H. ClaytonSubjects for the Entrance Examination. Greene, M.B., F.R C S. ; and Major S. Boyd, M.B., F.R C.S., Candidates will be examined in medicine and surgery by a board 4th London General Hospital. Dermatology : T. 0. Fox, M. B., of examiners consisting of eight physicians and surgeons appointed Midwifery and Gynæcology : A. F. Stabb, M.B., from the civil hospitals and medical schools of the United Kingdom. F.R.C.1’. The examination will be of a clinical and practical character, partly M R.C.1. Ophthalmology: J. H. Parsons, M.B., F.R C.S. written and partly oral, marks being allotted under the following Otolopy with Laryngology and Rhinology : H. J. Marriage, scheme. M.B., F.R.C.S. Specific Fevers: F.F.Caiger,M.D.,F.RC.P. Maximum 3lediciiie (written). Besides these lecturers an honorary consulting staff has been marks. A. Examination and report upon a medical case 125 appointed by the War Office to Queen Alexandra’s Military 100 B. Commentary upon a case in medicine......... Hospital at Millbank. This staff comprises :-A. E. Barker, (Two periods of 45 minutes-total, one and a half F.R.C.S. ; Major Sir A. A. Bowlby, C.M.G., F.R.C.S., hours-for A, and one and a half hours for B.) lst London General Hospital ; Surgeon-Major-General Meclicizae (orao. 100 A. Clinical cases Sir A. F. Bradshaw, K.C.B., K.H.P. (retired); J. M. Bruce, 75 B. Medical pathology M.D., F.R.C.P. ; Lieutenant-Colonel Sir J. K. Fowler, (Ten minutes to examine case and ten minutes K.C.V.O., M.D., 3rd London General Hospital ; Surgeonviva voce-total, 20 minutes-for A ; 30 minutes Lieutenant-Colonel P. J. Freyer, M.D., Indian Medical to examine specimens and ten minutes viva voce -total, 40 minutes-for B.) Service (retired) ; W. S. A. Griffiths, M.D., F.R.C.P. ; Lieutenant-Colonel G. H. Makins, CB., F.R.C.S., 2nd Surgery (written). 100 A. Examination and report upon a surgical case London General Hospital ; and Honorary Colonel Sir W. B. Commentary upon a case in surgery ......... 125 Osler, Bart., M.D., LL D., FR.S., South Middlesex (Two periods of 45 minutes-total, one and a half Division, Royal Army Medical Corps. The course of hygiene hours-for A, and one and a half hours for B.) has hitherto comprised the examinations of water and Surgery (oral). air, the general principles of diet with the quality and A. Clinical surgery and pathology (including diseases adulterations of food and beverages, the sanitary requireof the eye) 75 B. Operative surgery and bandaging (including surgical ments of barracks, hospitals, and camps, the consideration instruments and appliances) 100 of the clothing, duties, and exercises of the soldier, and the (Ten minutes to examine case and ten minutes circumstances affecting his health, with the best means of viva voce-total, 20 minutes-for A, and about 30 minutes for B.) preventing disease, both at home and under the conditions of foreign service, also with particular reference to active Total marks 800 service in the field. The pathological course has up to the The following headings are published as a guide to candidates in1 time included bacteriology and demonstrations in drawing up their reports on cases :-(a) A brief history of the case as present such in the microscopic diagnosis, preparations of vaccines, &c., special the including points only (if family by patient, any) given s or personal history as have a distinct bearing upon the present illness attention being given to modern methods of research in the

(d)

-

-

-

0

-

0--

......

.....................

..................

......

,

................

............

.........

-

THE

NAVAL, MILITARY, AND INDIAN MEDICAL SERVICES.

causation of tropical disease. The surgical course consists of lectures and demonstrations in military surgery and X rays and lectures on errors of refraction from a military point of view. On completion of the above course Lieutenants on probation join the Royal Army Medical Corps School of Instruction at Aldershot for a two months’ course in the technical duties of the corps, including a course of gymnasium drill and stretcher drill, and at the end of the course A Lieutenant on are examined in the subjects taught. probation who fails to qualify in either of these examinations will be allowed a second trial, and, should he qualify, will be placed at the bottom of the list. Should he again fail in either examination his commission will not be confirmed. Illiteracy on the part of a candidate as evinced by inaccurate spelling, poor composition, or grammatical errors in the oral examination, at the entrance examination, or at the examinations undergone while on probation, will be regarded as disqualifying for appointment.

641

receives daily charge pay at the rate of 2s. 6d. for charge of 50 beds, 5s. for 100 beds, 7s. 6d. for 200 beds, and 10s. for 300 beds. An officer under the substantive rank of colonel. if holding the appointment of senior medical officer in a command abroad, or administrative medical officer, if the troops number 1500 or upwards, receives 5s. charge pay. At the Royal Army Medical College the professors receive JB200 and the assistant professors E80 a year in addition to pay and allowances of their rank. There are sundry other appointments also carrying extra emolument. Reserve of Officers. An officer of the Royal Army Medical Corps with at least three, but not more than six, years’ service may be permitted to become an Army Reserve Officer for a period of seven years, and while so, serving he will receive a retaining fee of 225 a year. With the’ sanction of the Army Council such officer may be allowed to return to the active list, and if the period he has been in the Reserve of Officers amounts to at least one year, and not more than three years, he shall be allowed to reckon one-third of such period towards promotion, gratuity, and pension.

Seconded Service.

Officers may be permitted to accept employment under the Foreign or Colonial Office, when it is desirable in the interests of the public service. An officer so seconded is not eligible for pay or allowances from army funds, but his service reckons towards promotion, increase of EXAMINATIONS IN THE ROYAL ARMY MEDICAL CORPS. towards pension. The Lieutenants are required to pass two examinations before their pay, gratuity, and, under certain circumstances, Egyptian Army, the sanitary service of the: commissions are confirmed; at the termination of the course at the medical service of the and the medical services of various Foreign and Government, Royal Army Medical College they are examined in military surgery, Egyptian Colonial Governments are mentioned as capacities in which Army tropical medicine, hygiene, pathology, and the organisation of military Medical Officers may be employed. hospitals and the medical charge of troops; after the course at AlderOfficers may also be seconded at entrance into the Corps when holding. shot, in regimental duties, drill and field training. at civil hospitals, as already noted under Before promotion to captain lieutenants have to pass in (1) map- resident appointments for Admission." reading and problems in practical tactics ; (2) military law; (3) organi- Regulations PROMOTION. sation, administration, and equipment; (4) military medical No promotion of a medical officer shall be made without the administration, the duties of executive officers, and the terms of the Geneva Convention; those subjects may be taken up separately and at approval of the Secretary of State. An officer shall be eligible for promotion to the rank of Captain on any time after completing a year’s service. The examinations are held the completion of three and a half years’ service, and to the rank of locally. A captain for promotion to major must qualify in the following Major on the completion of 12 years’ service, provided that in each subjects, the examination not being taken until he has at least case he has passed the necessary examination, and is recommended five years’ service : (1) map-reading and practical tests; (2) military for promotion. Promotion to the rank of Lieutenant-Colonel to complete an establaw; (3) organisation, administration, and equipment; (4) drills and exercises of the Royal Army Medical Corps; (5) medicine; (6) surgery; lishment shall be made by selection from Majors who have qualified in (7) hygiene; (8) bacteriology and tropical diseases; (9) one special such manner as may be prescribed by the Army Council. If an officer has passed with distinction the examination qualifying subject from the following: bacteriology and the preparation of antitoxins, dermatology and venereal diseases, midwifery and gynzeco- for promotion to the rank of Major, the 12 years’ service required tor advanced logy, operative surgery, ophthalmology (including rhinology render him eligible for that rank may be reduced by 18 or 12 months,. and laryngology), physical training (including clothing and food of the according to the standard of marks obtained. soldier), State medicine. The examinations in subjects (1) to (4) are Promotion to the rank of Colonel to complete an establishment held at local centres; the rest of the examination is held after a shall be made by selection from Lieutenant-Colonels. An officer prospecial course of instruction during nine months. Officers are per- moted to the rank of Colonel shall, unless retired, be placed on half-pay The on completing a period of four years’ service in such rank. A Lieutenantmitted as far as possible to choose their own special subject. instruction in hygiene and bacteriology and in the special subjects is Colonel may also be promoted to the rank of Colonel if specially given at the Royal Army Medical College and in civil hospitals in recommended for distinguished service in the field. Promotion to the London. The examination in subjects (1) to (4) is qualifying only; in rank of Surgeon-General shall be made by selection from Colonels. the remaining subjects special proficiency qualifies for accelerated A Colonel may also be promoted to the rank of Surgeon-General for promotion and for employment as specialist officer with extra pay. distinguished service in the field. An officer of the Royal Army The examination for promotion to lieutenant-colonel maybe taken Medical Corps is eligible for promotion to brevet rank. A Captain by a major at any time after three years in that rank, and is held at after at least 6 years’ service, a Major or Lieutenant-Colonel, may notified times in the military district where the officer is serving. The be promoted to the next higher rank by brevet for distinguished: subjects are: (1) army medical organisation in peace and war; service in the field or for meritorious or distinguished service of (2) sanitation of towns, camps, transports, &c., epidemiology, and the an exceptional nature other than in the field. If the officer diea management of epidemics; (3) (a) medical history of the more before the date on which the notification of his promotion for disimportant campaigns, and the lessons to be learned therefrom; (b) a tinguished service in the field appears in the London Gazette the knowledge of the army medical services of the more important Powers ; promotion shall bear the date which it would have borne had the (c) the laws and customs of war so far as they relate to the sick and officer not died. Distinction in original investigation or research wounded; (4) a medical staff tour. may, in the case of officers of the Royal Army Medical Corps, be PAY AND ALLOWANCES, ADDITIONAL PAY, AXD CHARGE PAY. regarded as "distinguished service of an exceptional nature other The rates of pay and allowances are as follows, the allowance rates than in the field." An officer who may in the opinion of varying slightly from time to time. Specialist pay and charge pay are the Army Council have been prevented, in very special ciralso given under certain conditions. cumstances, from qualifying for promotion, or who. having failed

-

These allowances are not issued when quarters are provided. Additional and Charge Pay.-A captain holding the brevet of major I to qualify, may have been debarred from receives an additional 2s. per day; an officer under the rank of lieu- i qualifying, may be provisionally promoted. on the first available opportunity tenant-colonel holding a specialist appointment receives 2s. 6d. per day. The officer in charge of a hospital, or of a division of a general hospital, cancelled and he shall be retired from the

! qualify

further

opportunity

of

If, however, he fails t&

his promotion shall be service. An officer may

642

THE

NAVAL, MILITARY, AND INDIAN MEDLCAL SERVICES.

reckon towards his promotion anytime, not exceeding one year, during 2. In very special cases, such as loss of health due to tropic al which he may have been on half-pay on account of ill-health caused service or to active operations, the period may be extended, but it shall not exceed 18 months in all. by military service; and also any time not exceeding two years during which he may have been on half-pay on reduction. An officer while When a medical officer is absent from duty on account of sickness, seconded shall continue to be eligible for selection for promotion as if up to a period of 30 days, if duly certified by a medical officer. this he had remained on the establishment, and his service while seconded period shall not be included in the period of absence on leave to which I shall reckon towards such promotion. the issue of pay is limited, provided the general officer commanding at the station considers that the circumstances of the case warrant RANK. The Director-General of the Army Medical Service shall hold thesuch a concession. Any excess of 30 days will be included. When an officer has exhausted the periods of sick leave permissible, substantive rank of Surgeon-General and shall rank in relation to for a combatant officers as a Lieutenant-General if recommended by theas above mentioned, and is still unfit, he is placed on half-pay not exceeding five years, and under certain conditions as to the ] Army Council. All other Surgeon-Generals shall rank as Major-period of his illness is eligible for the following daily rates : Generals in relation to combatant officers. Officers of the Armycausation ’, £ 1. Medical Service above the rank of Colonel shall hold the substantiveSurgeon-General, £2; Colonel, £19s. 6d. ; Lieutenant-Colonel, with three years’ service as such, £1 7s. 6d. ; Major. Captain, or Lieurank of Surgeon-General. 10 tenant. under five years’service, 6s. ; after five years, 8s. ; after years, RETIREMENT. 10s. ; after 15 years, 13s. 6d. (a) Voluntary Retirement. SERVICE ABROAD. An officer of the Army Medical Service may be permitted to retire in When an officer’sturn arrives for foreign service he is duly warned cases in which such retirement may be deemed expedient by the some months beforehand, and as far as service exigencies permit his Army Council. wishes for any particular station abroad are complied with. A Scale of Retired Pay. Lieutenant is usually sent abroad during the second year of his service. ;The tour of Yearly. foreign service is 5 years for India, the Mediterranean, and 2 Director-General after 3 years’ service in the appointSouth Africa, and 3 years for other stations. 1125 ment (with 30 years’ service) SERVICE ON THE WEST COAST OF AFRICA. Daily. .6 s. d. An officer volunteering for, or ordered to, the West Coast of Africa 2 00 shall receive double pay while actually serving on the coast, and for Surgeon-General Colonelany time spent at Madeira or the Canary Islands on sick leave, or on Under 4 years’ service as such, but with 30 years’ ordinary leave not exceeding 61 days in a year. total service 1 10 0 A medical officer after 12 months’ continuous service on the West After 4 years’ service as such............ 1 15 0 Coast is entitled to full pay during leave at home for one day for every If not qualified as above the rate for two days served on the coast. Each year or portion of a year served on the West Coast of Africa by a lieutenantan officer of the Royal Army Medical Corps shall reckon double towards colonel. Lieutenant-Colonelvoluntary retirement or retired pay, provided that he has served 12 1 0 0 After 20 years’ service months on the coast. In ordinary cases the 12 months may be made 1 26 25 " up of two separate periods of not less than six months each; and if an 1766 officer leaves the coast on account of sickness he may reckon any period 28 " 1 00 of service on the coast, however short, in order to make up the 12 Major, after 20 years’ service months’ coast service which is required to entitle him to count his Gratuity. service double. Except when the officer has been invalided, no period P, Major or Captainof less than six months’ of service on the coast shall reckon double After 5 years’ service in the rank of captain ...... 1000 under this article, or count towards the required period of 12 months, 1800 "3 " " major ...... 6 2500 " " " WIDOWS’ PENSIONS. Except in the case of a Colonel, or a Lieutenant-Colonel, an officer Widows’ pensions and compassionate allowances for children of in who, on voluntary retirement, has served for less than three years deceased officers are given under certain conditions specified in the the rank from which he retires, is entitled only to the gratuity Royal Warrant for Pay and Promotion. There is also an Army Medical retired or pay assigned to the next lower rank. Officers’ Widows’ and Orphans’ Fund on mutual assurance principles. (b) Retirement on Account of Age or Limitation of Period of Service. PAY IN INDIA. The retirement of officers of the Army Medical Service is compulsory There has been an improvement of late vears in the pay and conat the following ages: Surgeon-General, 60; Colonel, 57; and other ditions of ,ervice of army medical officers in India, as elsewhere. The officers, 55. A Major shall retire on completion of 25 years’ service pay and allowances (which are combined in India) of a lieutenant are if he has been superseded for promotion; or, if he fails to qualify for 420 rupees per mensem ; for captain’s rank, the pay and allowances are promotion, on completion of 20 years’service. A Captain who fails to from 475 rupees to 530 ropees after seven, and to 650 rupees after ten pass for promotion may present himself at the next examination; if he years’ service. Majors receive 789 rupees on promotion and 826 rupees again fails he is retired at once on any gratuity for which he may be after 15 vears’ service. Lieutenant-Colonels, 1150 rupees ; after three eligible, or if not so eligible as soon as he completes 5 years’ service as vears 1250 rupees. In addition, charge pay is given, ranging from 60 to Captain. A Lieutenant who does not qualify within 3g years of appoint- 240 rupees according to the number of beds equipped in a hospital. ment must resign if he fails at the next examination unless there are Specialist pay, 60 rupees monthly. There are also various appointspecial circumstances for consideration. Special employment in a ments, cantonment hospitals, &c., carrying extra pay, that are shared national emergency as an officer, or in a position usually filled by an between the Royal Army Medical Corps and the Indian Medical Service. officer, before entry into the corps is reckoned towards retired pay or The value of the rupee is fixed at 1s. 4d. ............

..................

..................

...............

...............

...............

...............

............

"

......

gratuity.

Account of Medical Unfitness. (c) Retirement on Account An officer placed on the half-pay list on account of medical unfitness shall, if not previously retired, be retired from the Army at the expiration of five years from the date on which he was placed on the half-pay list, or, if reported by the regulated medical authoritv to be permanently unfit for duty, on the officer’s application, at such earlier date as may be decided by the Army Council. The scale of retired pay on account of age or medical unfitness is the same as under voluntary retirement, except that the condition of three years’ service in the rank is omitted.

INDIAN MEDICAL SERVICE. The grades of officers in the Indian Medical Service are the same as those of the Army Medical Service and Royal Army Medical Corps The Director-General will rank either as Major-General or Lieutenant-General as may be decided in each case by the Secretary of State for India in Council.

EXAMINATION OF CANDIDATES FOR ADMISSION INDIAN MEDICAL SERVICE. Ratesfor Officers not qualified for Retired Pay or Gwetzcity on Candidates must be natural born subjeots of His Majesty, of Voluntary Retirement. European or East Indian descent, between 21 and 28 years of age at If the unfitness was caused by military service retired pay equal to the date of the examination, of sound bodily health, and in the the half pay of his rank. If not so caused, provided the officer has at opinion of the Secretary of State for India in Council in all respects least 12 years’ service, retired pay equal to the half pay of his rank suitable to hold commissions in the Indian Medical Service. They for such period only, not exceeding five years from the date of the may be married or unmarried. They must possess under the Medical officer’s retirement from the Army, after five years on half pay under Acts a qualification registrable in Great Britain and Ireland. No candiArticle 435, as the Army Council shall determine according to the date will be permitted to compete more than three times. Examinations for admission to the service are held twice in the year, usually merits of the case. in January and Julv. Candidates for the January examination must KING’S HONORARY PHYSICIANS AND HONORARY SURGEONS. be between 21 and 28 years of age on Feb. lst, and those for the July of on the most meritorious officers of the Army Medical Service Six examination must be between 21 and 28 on 1st. The exact date the active list shall be named Honorary Physicians and six Honorary of each examination and the number of August with appointments, Surgeons. On appointment as Honorary Physician or Honorary Surgeon the latest date at which applications will be received, willtogether be notified in an officer under the rank of Colonel in the Armv Medical Service may THE LANCET. be promoted to the brevet rank of Colonel. A Lieutenant-Colonel apThey must subscribe and send in to the Military Secretary, India or shall receive at pointed Honorary Physician Honorary Surgeon pay Office, Westminster, so as to reach that address by the date fixed in the the rate laid down for a Colonel of the Royal Army Medical Corps advertisement of the examination. a declaration according to the when qualified for promotion to that rank. An officer shall relinquish annexed form, which is procurable from the Military Secretary. the appointment of Honorary Physician or Honorary Surgeon on Declaration and Schedule of Qualifications to be Filled ecp by retirement. Candidates. LEAVE OF ABSENCE. Full pay may be given during ordinary leave of absence for 61 days I, ........................................................................ , a candidate for in each year at home stations ; in the Mediterranean, Bermuda, and employment Majesty’s Indian Medical Service, do hereby attest West Indies leave for two years, and in China, Ceylon, Straits Settle- my readiness to engage for that service, and to proceed on duty immediately on being gazetted. ments, and South Africa leave for three years may be accumulated. I declare that I labour under no mental or constitutional disease, SICK LEAVE. nor any imperfection or disability that can interfere with the most An officer of the Army Medical Service may draw full pay for the efficient discharge of the duties of a medical officer. undermentioned periods during sick leave granted on the recommenI hereby declare upon my honour that the above statements are true dation of a Medical Board, provided there is reasonable probability that to the best of my knowledge and belief. he will ultimately be fit to return to duty :I inclose. in accordance with Paragraph 4 of the Regulations. 1. In ordinary cases for a period not exceeding 12 months. (a) proof of age; (b) two certificates of character; (c) certificate of ’

REGULATIONS

FOR THE

TO THE

in His

.

THE NAVAL. MILITARY. AND INDIAN MEDICAL SERVICES. a course of ophthalmic instruction, showing that the included instruction in errors of refraction; (d) evidence of a registrable qualification; (e) in case of natives of India or others ed1!cated in that cozintry only, a certificate from the Director-General, Indian Medical Service.

having attended course

Signature............................................................ Date ................................. , 19 . 1. Name in full. 2. Address. (Any alteration to be notified to the Military Secretary, India Office, London, S. W.) 3. Date of birth. (This must be supported by a certificate or stat2t<0!’
Marks. 1. Medicine, including therapeutics.................. 2. Surgery, including diseases of the eye 3. Applied anatomy and physiology.................. 4. Pathology and bacteriology ..................... 5. Midwifery and diseases of women and children 6. Materia medica, pharmacology, and toxicology ............

1200 1200 600 900 600 600

643

signs elicited by the candidate’s personal examination of the patient, noting the absence of any which might be expected to be present in a similar case. (c) Where there is any reasonable doubt in the mind of the candidate as to the exact diagnosis he is to give the alternatives, with his reasons for making the selection. (d) A commentary upon the case as a whole, pointing out the symptoms which may be con-

which appear to be unusual or only accidental as to treatment, both immediate and possibly necessary at a later date. (f) A forecast of the progress and probable termination of the case. After passing this examination the successful candidates will be commissioned as lieutenants-on-probation, and will be granted about a month’s leave. They will then be required to attend two successive courses of two months each at the Royal Army Medical College, Millbank, and at Aldershot. The candidate’s commission as a lieutenanton-probation will bear the date on which the result of the entrance examination is announced, but his rank as lieutenant will not be gazetted until he has passed the final examination, held at the conclusion of his period of instruction. The course at the Royal Army Medical College will be in (1) hygiene, (2) military and tropical medicine, (3) military surgery, and (4) pathology of diseases and injuries incidental to military and tropics} service. The course at Aldershot will include instruction in (1) internal economy, (2) Army Service Corps subjects, (3) hospital administration, (4) stretcher and ambulance drill, (5) equitation, and (6) map reading. Lieutenants-on-probation will receive an allowance of 14s. per diem, and during the period of instruction they will be provided with quarters (where quarters are not provided they will obtain the usual allowances of a subaltern in lieu thereof), to cover all costs of maintenance, and they will be required to provide themselves with uniform ; a detailed list of the uniform and articles required will be sent to each successful candidate. A lieutenant-on-probation who is granted sick leave before the completion of his course of instruction and final admission to the service will receive pay at the rate of 10s. 6d. a day for the period of his sick leave. Candidates will be required to conform to such rules of discipline as may from time to time be laid down. At the conclusion of each course candidates will be required to pass an examination on the subjects taught, and in order to qualify each lieutenant on probation must obtain 50 per cent. of the total marks. If he fails to qualify in either of these examinations he will be liable to removal from the service, but if specially recommended he may be allowed to undergo the course or courses again under certain restrictions as to pay and position. A lieutenant’s commission dates from the day on which the result of the examination is announced. Officers appointed to the Indian Medical Service will be placed on one list, their position on it being determined by the combined results of the preliminary and final examinations. They will be liable for military employment in any part of India, but in view to future transfers to civil employment, they will stand posted to one of the following civil areas :-(1) Madras and Burma; (2) Bombay with Aden ; (3) Upper Provinces-i.e., United Provinces, Punjab, and Central Provinces; and (4) Lower Provinces-i.e., Bengal, and Eastern Bengal and Assam. The allocation of officers to these areas of employment will be determined upon a consideration of all the circumstances, including, Officers transferred to as far as possible, the candidate’s own wishes. civil employment, though ordinarily employed within the area to which they may have been assigned, will remain liable to employment elsewhere according to the exigencies of the service. A lieutenant who, within a reasonable period before the date at which he would otherwise sail for India, furnishes proof of his election to a resident appointment (or to a preliminary appointment leading in due course to a resident one) at a recognised civil hospital,2 may be seconded for a period not exceeding one year from the date on which he takes up such appointment, provided that he joins it within three months of passing his final examination and that he holds himself in readiness to sail for India within 14 days of the termination of the appointment. While seconded he will receive no pay from Indian funds, but his service towards promotion, increase of pay, and pension will reckon from the date borne on his commission. In special cases permission may be granted to lieutenants to delay their departure for India, in order to sit for some further medical examination. Lieutenants remaining in England under such circumstances will receive no pay for any period beyond two months from the date of termination of the course of instruction, unless the period elapsing before the day on which the majority of the lieutenants of the same seniority sail to India exceeds two months, in which case lieutenants allowed to remain in England will receive pay up to that day. In such cases pay will re-commence on the day of embarkation for India. All the provisions of this clause are subject to the general exigencies of the service. Before the commission of a lieutenant-on-probation is confirmed he must be registered under the Medical Acts in force at the time of his appointment. Candidates who have been specially employed in consequence of a national emergency, either as an officer, or in a position usually filled by an officer, will be allowed, under certain circumstances, to reckon such service towards pension. sidered

typical and those

complications. (e) Suggestions

2 The following is a list of recognised Civil Hospitals.—England and Wales.-London: St. Bartholomew’s Hospital, Charing Cross

Hospital, Guy’s Hospital, King’s College Hospital, London Hospital, Middlesex Hospital, St. George’s Hospital, St. Mary’s Hospital, St. Thomas’s Hospital, University College Hospital, and Westminster N.B.-The examination in medicine and surgery will be in part Hospital. Birmingham: General Hospital and Queen’s Hospital. Bristol: and will include on the the dead practical operations application Royal Infirmary and General Hospital. Cambridge: Addenbody, of surgical apparatus, and the examination of medical and surgical brooke’s Hospital. Cardiff : Cardiff Infirmary. Leeds : General Infirpatients at the bedside. No syllabus is issued in the subjects of the mary. Liverpool: Royal Infirmary and Southern Infirmary. Manexamination, but it will be conducted so as to test the general chester: Royal Infirmary. Newcastle-on-Tyne: Royal Infirmary. knowledge of the candidate in all subjects. No candidate shall be Oxford: Radcliffe Infirmary. Sheffield: Royal Infirmary and Royal considered eligible who shall not have obtained at least one third of Hospital. Scotland.—Aberdeen: Royal Infirmary. Dundee: Royal the marks obtainable in each of the above subjects and one half of the Infirmary. Edinburgh: Royal Infirmary. Glasgow: Royal Infirmary and Western Infirmary. Ireland.—Belfast: Royal Victoria Hospital. aggregate marks for all the subjects. For the clinical examinations each candidate should provide himself Cork: North Infirmary and South Infirmary. Dublin: Adelaide with notebook, pencil, stethoscope, and ophthalmoscope. In drawing Hospital, City of Dublin Hospital, Jervis Street Hospital, Mater up reports on cases the following points should be observed, viz.: (a) A Misericordiæ Hospital, Meath Hospital, Mercer’s Hospital, Richmond, brief history of the case as given by patient, including such points in Whitworth, and Hardwicke Hospital, St. Vincent’s Hospital, Sir the family or personal history as have a distinct bearing on patient’s Patrick Dun’s Hospital, and Dr. Steevens’ Hospital. Galway: The A of I case. detailed account the subjective symptoms and physical County Hospital and the Union Hospital. (b) ......

......

THE NAVAL,

644

MILITARY, AND INDIAN MEDICAL SERVICES.

PAY AND ALLOWANCES. Officers on appointment are, when possible, provided with The rate of pay drawn by Lieutenants of the Indian Medical Service passage to India by troop transport; when such accommodato arrival in India is 14s. a day, but a Lieutenant (1) who has tion is not available passage at the public expense is pro- previous been permitted by the Secretary of State to hold a hospital appointvided by steamer, or a passage allowance granted if pre- ment will receive no pay while holding it; (2) who is detained by illness ferred. Wives of married officers are entitled to passage in this country will be paid at the rate of f:250 a year from the date on he would otherwise have embarked until the date of embarkation, by troop transport, if available. Any officer who may which and at the rate of 14s. a day during the voyage to India. neglect or refuse to proceed to India under the orders Pay at the above rate is issued in this country up to the date of of the Secretary of State for India within two months embarkation, and an advance of two months’ pay at the same rate is made prior to embarkation, which is adjusted in India. from the date of terminating his course of instruction, also The following are the monthly rates of Indian pay drawn by officers of or within 14 days of the termination of his hospital the Indian Medical Service from the date of their arrival in India appointment if the Secretary of State has permitted him to , (N.B.-1 rupee ls. 4d.):hold one, will be considered as having forfeited his commission unless special circumstances shall justify a departure from this regulation. A course of instruction in sanitary methods, rules, and regulations as carried out in Indian cantonments has recently been instituted for young officers of the Indian Medical Service and the Royal Army Medical Corps on first arrival in the country. The nature of the diseases to be comand prejudices customs and bated, the social and religious customs of the various races, and the limited resources of money and material make large modifications from European methods necessary. Lieutenants of both services are now posted on arrival either to Rawal Pindi, Poona, Lucknow, or Bangalore for one month for this course, which is carried out under the supervision of the senior medical officer and sanitary officer. The instructors are medical officers nominated by the principal medical officer, India, and demonstrations on various subjects are given by other officers, staff, engineer, and medical. The course consists of demonstrations and inspections in all parts of the NOTES.-(a) Unemployed pay is drawn by officers of less than seven lines of British and Indian troops, bazaars, Government years’service who are not holding officiating or substantive charge of regiments prottided they have passed the examination in dairies, bakeries, slaughter-houses, trade premises of dairy- native Hindustani known as the " Lower Standard." Officers of more than men, bakers, butchers, and aerated water manufacturers seven years’ service draw grade pay alone when unemployed. Staff pay and dhobies’ houses, market and water-supplies, methods of is the pay of certain special appointments and is drawn in addition to pay. washing clothes, surface drainage, removal and disposal grade (b) Horse allowance is granted to officers in charge of cavalry regiof sewage and refuse, antimalarial measures, disinfection, ments at the rate of Rs. 90 a month to Lieutenant-Colonels and Majors, cantonment hospitals, control of venereal diseases, plague and Rs. 60 a month Captains and Lieutenants. The Exchange compensation. -Under present arrangements, officers of the prevention, methods of hospital administration, &c. are not statutory natives of India receive officers under instruction thus have an opportunity of Indian Medical Service who compensation allowance to compensate them for the fall of exchange learning something of native customs and are encouraged the value of the rupee. The allowance consists of an addition to their to learn the vernacular, so as to be less dependent salaries (subject to certain limitations) equal to half the difference between their salaries converted at ls. 6d. the and (2) the upon their subordinates when first put in responsible standard Government rate, which has(1)been fixed atrupee, ls. 4d. the rupee =

__

the socialand religious

prejudices

positions.

PROMOTION.

A Lieutenant is promoted to the rank of Captain on completing three service from the date of first commission, provided he passes an examination in military law and military medical organisation. Captains are promoted to the rank of Major withont examination after 12 years’ full-pay service; this promotion may be accelerated by six months in the case of officers who fulfil certain specified conditions. A Major is promoted to Lieutenant-Colonel withoict examination on completion of eight years’ full-pay service in the rank of Major. All promotions to higher grades are given by selection for ability and merit. In case of distinguished service a medical officer may receive special promotion. The ages for compulsory retirement are 55 for Lieutenant-Colonel and Major, 60 for Surgeon-General and Colonel, and 62 for the Director-General. In special cases an officer may be continued in employment, for the good of the service, with the sanction of the Secretary of State.

years’ full-pay

until further notice. No officer, however employed, can draw more than the grade pay of his rank until he has passed the " Lower Standard." Officers holding the principal administrative appointments and substantive military charges of the Indian Medical Service receive the following consolidated salaries :Rs. per mensem. 1800 to 2500 Colonel, 16 (some in civil employ) from .........

Surgeon-General, 1 @

.....................

2 @

.....................

"

2200 2500 3000

(the Director-General I.M.S.) 1 @ Specialist pay at the rate of Rs. 60 a month is granted to officers below the rank of Lieutenant-Colonel who may be appointed to certain posts. Except in the administrative grades and in certain special appointments officers are not debarred from taking private practice as long as "

it does not interfere with their proper duties.

POSTS IN MILITARY EMPLOY. LEAVE RULES. half the highest administrative posts in military Approximately Officers of the Indian Medical Service below the rank of Colonel may medical employ are allotted to the Indian Medical Service. These be granted: 1. Privilege leave under such regulations as may from time include the appointments of Deputy Principal Medical Officer of His to time be in force. 2. Leave out of India for no longer period than one Majesty’s Forces in India and Secretary to the Principal Medical Officer of year, capable of extension to two years’ absence from duty, on the His Majesty’s Forces in India. Half the appointments of Principal following pay for officers in military employment (officers in civil Medical Officers are to Divisions and Brigades, the other half being filled employment are entitled to higher rates) : After arrival in India, onby Royal Army Medical Corps Officers. In the junior ranks half the first appointment, B250 a year; after the commencement of the tenthappointments to military staff surgeoncies, the medical charge ot year’s service for pension, L300 a year; after the commencement of the! cantonment hospitals andStaff Officers for medical mobilisation stores in fifteenth year’s service for pension, f:450 a year ; after the commence- each of the nine divisions of the Army are allotted to the Indian Medical ment of the twentieth year’s service for pension, f:600 a year ; and afterService and the other half to the Royal Army Medical Corps. The the commencement of the twenty-fifth year’s service for pension, JE700appointments’ of Medical Storekeepers to Government, which supply the a year. 3. Leave in India, but for the period of one year only, on fullneeds of the Civil and Military Departments, are reserved for the Indian military pay and half the staff pay of appointment. No extension ofMedical Service alone. leave involving absence from duty for more than two years, whetherr POSTS IN CIVIL EMPLOY. taken in or out of India, can be granted except on specially urgent grounds and without pay. An officer unable on account of the state ofA large number of posts in civil employ are ordinarily filled up from his health to return to duty within the maximum period of two years’;’ officers of the Indian Medical Service. Officers are required to perform absence, unless he is specially granted an extension of leave withouttwo years’ regimental duty in India before they can be considered pay, is placed on temporary half-pay or the retired list, as the circum.L’ eligible for civil employment. The principal appointments, together stances of the case may require. An officer is also liable to be placed 1 with the salaries attached to each, are stated in the accompanying on half-pay or the retired list should his health require an undue table (p. 645). amount of leave, whether in or out of India. Leave may be granted att An allowance of Rs. 100 per mensem is also granted, in addition, to s the chief plague medical officers in certain provinces. any time, but solely at the discretion of the civil or military authorities in India under whom an officer may be serving. Officers of the3 There are also six Chemical Examiners with Rs. 800-1650 per mensem t and a number of Port Health Officers with Rs. 750-1950 per mensem. Administrative grades may be granted leave not exceeding eight months, besides privilege leave. during their tenure of appointment.. Other appointments of Resident Surgeons and Physicians at hospitals, s Extra leave (known as study leave) may be granted to officers desirous &c., are on salaries ranging from Rs. 700 to 1650 per mensem. There

’

e of pursuing special courses of study at the rate of one month’s leave for each year’s service up to 12 months in all. An officer on leave is being recalled to duty unless certified by y required to join at onceto on do so. a medical board as unfit

also a certain number of appointments under the Political Department on salaries ranging from Rs. 450 to 1450 per mensem, exclusive of local allowances. Qualified officers of the Medical Service are also eligible for

are Ii

THE

NAVAL, MILITARY, AND INDIAN MEDICAL SERVICES. Officers of the Indian Medical Service

645 are

liable after retirement

on

pension before completing 30 years’ service to recall to military duty in case of any great emergency arising up to 55 years of age. All officers of the rank of Lieutenant-Colonel and Major are placed on the retired list at the age of 55, and all Surgeons-General and Colonels at the age of 60, but the Director-General is allowed to serve until he has attained the age of 62 years. In any special case, where it would appear to be for the good of the Service that an officer should continue in employment, he may be so continued, subject in each case to the sanction of the Secretary of State for India in Council. Officers placed on temporary or permanent half-pay are granted halfpay at the following rates.

*

Officers cannot retire in India

on

half-pay.

An officer of less than three years’ service, although he may be transferred to the half-pay list under the general conditions of transfer, will not be granted any half-pay unless his unfitness has been caused by service. INVALID PENSIONS. An officer who has become incapacitated for further service in India on account of unfitness caused by duty may be granted an Invalid Pension on the following scales Per annum. After 16 years’ pension service ............ P,272 15 " 252 ............ " " " 14f! 232 9f ............ " 13 212 ............ " " " " 12 192 ............ " " " "

"

WOUND PENSIONS. Officers are entitled to the same allowances on account of wounds received in action and injuries sustained through the performance of military duty as are granted to combatant officers of His Majesty’s Indian Military Forces holding the corresponding military rank. in the

appointments these appointments

Assay

are

and Mint

Departments.

from Rs. 600-2250 per

The salaries of

mensem.

OFFICE IN ADMINISTRATIVE GRADES. TENURE The tenure of office of Surgeon-Generals and Colonels is limited to five years. Colonels, if not disqualified by age, are eligible either for employment for a second tour of duty in the same grade or for employment in the* higher-grade of Surgeon-General by promotion thereto. Absence on leave in excess of eight months during a five years’ tour of duty involves forfeiture of appointment. Surgeon-Generals and Colonels, on vacating office at the expiration of the five years’ tour of duty, are permitted to draw in India an unemployed salary of Rs. 1350 per mensem in the former, and Rs. 1000 in the latter case, for a period of six months from the date of their vacating office, after which they are placed while unemployed on the following scale of pay :OF

FAMILY PENSIONS. The claims to pension of widows and families of officers are treated under the provisions of such Royal Warrant regulating the grant of pensions to the widows and families of British officers as may be in force at the time being. The widows and families of officers are also entitled to pensions under the Indian Service Family Pension Regulations, for the benefits of which all officers must, as a condition of their appointment, subscribe from the date of their arrival in India, except in the case of natives of India, for whom it is optional. HONOURS AND REWARDS. Officers of the Indian Medical Service are eligible for the military distinction of the Order of the Bath and for other Orders, British and Indian, and for good service pensions. Six of the most meritorious officers are named Honorary Physicians and six are named Honorary Surgeons to His Majesty. On appointment as Honorary Physician or Surgeon an officer below the rank of Colonel is promoted to that rank, remaining supernumerary until absorbed.

PROSPECTS IN THE Two MILITARY SERVICES. The Royal Army Medical Corps is at the present time, we believe, on the whole, a thoroughly contented service, although for some time back there has been a feeling of uneasiness and uncertainty, more especially in the senior ranks, as to their future prospects by the adoption of a system of promotion by so-called selection. It is felt that the spirit of the Royal Warrant for promotion has been departed from, A Surgeon-General or Colonel who has completed his term of service thereby causing a block in promotion affecting all ranks. The and has reverted to British pay may reside in Europe, at the same time limitation of the tenure of the colonel’s appointments to four qualifying for higber pension. years has caused heartburnings in this grade, as after this RETIRING PENSIONS AND HALF-PAY. Officers of the Indian Medical Service will be allowed to retire on the following scale of pension on completion of the required periods of service :After 30 years’ service for pension... f:700 per annum + f:350 after three years’ active employment in India as a Surgeon-General, or + E250 per annum after five years’ active employment as a Colonel, or £ 125 after three years as a Colonel. Eight months’ absence on leave is allowed to count towards actual service in those grades. " ;B600 per annum. 27 ,, ,, " JE500 25 " " f:400 " 20 " " -B300 " 17"" x x 11 Service for pension counts from date of first commission and includes all leave taken under the leave rules. Time (not exceeding one year) passed on temporary half-pay reckons as service for promotion and pension, in the case of an officer placed on half-pay on account of medical unfitness caused by duty, military or civil.

unless promoted, men are now placed on half-pay. the reduction of the cadre establishment of lieutenant-colonels has adversely affected a large number of majors who are well worthy of promotion to the next rank ; and it is felt that the rules recently introduced allowing of accelerated promotion from the rank of captain to major have not worked as fairly as it was intended they should have. The improvements that were introduced by Sir Alfred Keogh, K.C.B., the late Director-General, have, however, been so substantial, both as regards emolument and as affecting the professional and military status of medical officers, that it would be ungracious to refrain from acknowledging the generous spirit that has actuated the War Department authorities in their attitude to the medical service. We feel sure that the good results of this are being, and will continue to be, manifested in an improvement in the health and efficiency of the army at large.

period, Again,

646

PUBLIC HEALTH DIPLOMAS.

In the Indian Medical Service the recent introduction of of c health devoting his whole time to Public Health the increased pension (.6600 per annum) after 27t years’ vwork ; or (b) in Scotland, a medical officer of health service has been an important concession ; there is still, of c a county or counties, or of one or more districts however, a block in promotion, administrative rank, which thaving a population of not less than 30,000 ; or (0) in used to come after 26 or 27 years’, being now generally Ireland, I a medical superintendent officer of health of a deferred until over 30 years’ service ; limitation of the period district c or districts having a population of not less than of service in administrative rank, as recently adopted in the30,000 :: ; or (d) in the British Dominions outside the United I a medical officer of health of a sanitary district Royal Army Medical Corps in the case of the colonel’s grade, Kingdom, would probably be an improvement. The order issued that an 1having a population of not less than 30,000, who himself officer of the Indian Medical Service must refer the question holds 1 a registrable Diploma in Public Health; or (e) a of his fees when above a certain low limit to the civil medical i officer of health who is also a teacher in the Departauthority was most objectionable: it might necessitate the Iment of Public Health of a recognised Medical School; or violation of professional secrecy and it is professionally (f) a sanitary staff officer of the Royal Army Medical Corps ( in 1 the rules were Revised having early degrading. promulgated charge of an Army Corps, District, Command, or l recognised for this purpose by the General Medical part of 1911, which, if -there is really necessity for any Division, regulations at all in these matters, need not be objected ICouncil ; or (g) an assistant medical officer of health of a I or of a single sanitary district having a population to. The neglect of the rule that the office of prin- county cipal medical officer to His Majesty’s forces in India Iof not less than 50,000, provided the medical officer of 1 of the county or district in question permits the may be held by an officer of the Indian Medical Service is health still felt to be a grievance. On the whole it can hardlyiassistant officer to give the necessary instruction and to be said that the Indian Service at the present time offersissue certificates ; or (ii.) that he has himself held for a the advantages over the Royal Army Medical Corps, either period of not less than three years an appointment as professional or pecuniary, that it formerly possessed,medical officer of health of a sanitary district within the while changes are foreshadowed that make it inevitable that British Dominions, and having a population of not less than the status, prospects, and influence of the Indian Medical 16,000. The certificate for the purpose of Rule 3 (1) must Service will be affected injuriously. The objections to include testimony that the candidate has attended under the many proposals recently made are, however, we venture to supervision of the person certifying on not less than 60 think, so serious on the grounds of general policy that we working days. Provided that if the candidate has (i.) proabstain from any criticism on their effect on the duced satisfactory evidence that he has attended a course prospects of the Indian Medical Service ; there is, or courses of instruction in sanitary law, vital statistics, indeed, no concrete proposal to criticise. The difficulties epidemiology, school hygiene, and other subjects bearmet with in attempting to carry the proposed reforms into ing on public health administration, given by a teacher practice appear to have been much more considerable than or teachers in the department of public health of a re-

expected by the highest authorities, though neither cognised medical school; or produce evidence (ii.) unknown to, nor ignored by, those having local experience. that he has been a resident medical officer in a hospital It is, moreover, a dangerous thing to introduce a feeling of for infectious diseases containing not less than 100 beds distrust and uncertainty into any public service ; if the during a period of three months,-the period during duties hitherto performed by the Indian Medical Service are which he has been engaged in acquiring practical in future to be shared with other medical men not of that knowledge of his duties under this rule may be service, then the privileges and emoluments of the Indian reduced to three months, to include an attendance on at Medical Service will inevitably be diminished, with the least 30 working days. 4. Every candidate shall produce evinatural result that men of the highest class will come dence that after having obtained a registrable qualification forward in fewer numbers to compete for the service, and he has during three months attended at least twice weekly the service generally will deteriorate. Such a result would the practice of a hospital for infectious diseases at which he has received instruction in the methods of administrabe disastrous. tion. (Methods of administration shall include the methods of dealing with patients at their admission and discharge, as well as in the wards, and the medical superintendence of the PUBLIC HEALTH DIPLOMAS. hospital generally. In the case of a medical officer of the Royal Army Medical Corps a certificate from a principal INSTRUCTION FOR DIPLOMAS IN SANITARY medical officer under whom he has served, stating that he SCIENCE, PUBLIC HEALTH, STATE MEDICINE, has during a period of at least three months been diligently AND TROPICAL MEDICINE. engaged in acquiring a practical knowledge of hospital a view of ensuring "the administration in relation to infectious diseases, may be RESOLUTIONS, designed with a of distinctively high proficiency, scientific and accepted as evidence under Rule 4.) 5. The examination possession shall be conducted by examiners specially qualified; it shall practical, in all the branches of study which concern the have extended over not less than four days, one of which been at various times have the by public health," adopted General Medical Council from 1902 to 1911. The rules shall have been devoted to practical work in a laboratory, to practical examination in, and reporting on, require that : 1. The curriculum for a Diploma in Sanitary and one which fall within the duties of a medical officer of subjects Public or State Medicine shall extend over Science, Health, 2. Every health, including those of a school medical officer. a period of not less than nine calendar months. The regulations in question as to study may be procured candidate shall produce evidence that after obtaining a at the office of the General Medical Council in London. received he has instruction registrable qualification practical in a laboratory or laboratories, British or foreign, approved University of Oxford. -An examination, conducted partly in which the in the writing, partly vivii voce, and in each subject partly practical, by licensing body granting diploma, chemistry, bacteriology, and the pathology of diseases of is held in Michaelmas and Easter Terms in the following animals transmissible to man are taught. (The laboratory subjects :-General Hygiene, General Pathology (with instruction shall cover a period of not less than four special relation to Infectious Diseases), the Laws relating to calendar months, and the candidate shall produce evidence Public Health, Sanitary Engineering, Vital Statistics. The that he has worked in the laboratory for at least 240 examination is in two parts, which may be taken together or hours, of which not more than one-half shall be devoted to separately ; but Part I. must be passed either before or at Practical Chemistry. The laboratory course should be so the same examination as Part II. The fee for admission to arranged as to lay special stress on work which bears most the examination is 5for each part. Successful candidates directly on the duties of a medical officer of health.) are entitled to receive the Diploma in Public Health. Any 3. Every candidate shall produce evidence either (i.) that, person whose name is on the Medical Register is admissible after obtaining a registrable qualification, he has during six as a candidate for this examination provided (1) a period of months been diligently engaged in acquiring a practical not less than twelve months shall have elapsed between knowledge of the duties, routine and special, of Public the attainment of registrable qualification and the Health administration under the supervision of : (a) in time when he presents himself for either part of the England and Wales, the medical officer of health of a examination; (2) he produce evidence of having, after county or of a single or combined sanitary district having obtaining a registrable qualification, attended during a population of not less than 50,000, or a medical officer three months the practice of a hospital for infectious was