463

years’ service and receive gratuities on the followingscale :-

Gratuities will be awarded on retirement and withdrawalon the undermentioned scale.

ARMY MEDICAL SERVICE.

ROYAL ARMY MEDICAL CORPS.

THE publication of anew Royalu’arrant on June29th,1926, has gone a long way towards removing thealleged grievances of officers of the Corps, and thisService can again be recommended as a career toyoung medical men. Competitive examinations forregular commission, which have been in abeyance forsome time, will again be held half-yearly in Januaryand July. These examinations in medicine andsurgery are entirely of a clinical and practical character,partly written and partly oral.The regulations for admission giving full details

should be obtained from the Under Secretary of State(A.M.D.1), War Office, Whitehall, London, S.W.1,and carefully studied. A personal interview with arepresentative of the Director-General, Army Medical ’,Services, is readily obtainable. ’

The rates of pay and allowances are good; theopportunities of post-graduate study are generous,and the work is varied, responsible, and interesting.The gratuities after certain periods of service enablean officer should he so desire to leave the Service witha capital sum large enough to go a long way towardsre-establishing himself in civil life, and, further, theknowledge of the world and the comradeship of hisfellow officers that he has gained in the Army will beof no small value to him.New entrants are commissioned in the rank of

Lieutenant, and the first six months of service arespent on probation, during which time they undergo,in addition to their Military training at the RoyalArmy Medical Corps Depot at Aldershot, a pro-bationary course at the Royal Army Medical Collegein London in Hygiene, Pathology, Tropical Medicine,Military Surgery, Recruiting, the prevention andtreatment of Venereal Disease, and the elements ofArmy Administration. At the end of this course,and after qualifying at the necessary examinations,their commissions are confirmed, and they take theirplaces in seniority according to the total marksobtained at all examinations up to that date. OfficersTraining Corps service with possession of Certificates" A " or " B " (Medical) carry a definite value inmarks in this total.An entrant who is holding or about to hold at the

time of the entrance examination a resident HouseAppointment at an approved Civil Hospital may beseconded while holding such an appointment up to amaximum period of 12 months. A candidate whohas held such an appointment within six months ofentry may be granted an antedate up to 12 monthsin respect of the period the appointment was held.This secondment and antedate counts in all respectsas commissioned service, except that pay will not beissued for that period.

After a total period of one year’s service at homethe young officer goes abroad, probably to India, forhis first tour of foreign service. Here he gains hisflist practical experience of tropical disease andtropical hygiene, and possibly his first experience ofactive service on the frontiers of India. His tour

abroad lasts five years, with probably six months’leave home during that time. On returning home theR.A.M.C. officer has the opportunity to decide whetherhe will remain in the Corps or accept the gratuity of.61000 after seven years’ service, and try his fortunein civil life. If he elects to remain, he will, betweenhis eighth and twelfth year of service, undergo a courseof post-graduate study at the Royal Army MedicalCollege and the London Hospitals of five months’duration, followed by a course of study of a specialsubject selected by himself, provided he has shownspecial aptitude in the post-graduate course or duringhis previous service. During this period of study heremains on full pay, and the fees for the courses arepaid by the State. When qualified in his specialsubject, the officer becomes entitled to specialist payat 5s. per day when holding a specialist appointment.After this post-graduate course the officer probablyproceeds abroad again and promotion to Majorrapidly ensues, and from that time onward the officerreceives regular successive increases of pay, and is

eligible for additional and charge pay as well. TheDirectorates of Hygiene and Pathology and theappointment of two serving officers as Consultants inMedicine and Surgery have been instituted and haveproved a marked success, all these appointments beingof the rank of Colonel or Major-General.Under these conditions the possibilities for good

workers are very great in the Royal Army MedicalCorps. There is scope for original research in tropicaldisease, in preventive medicine, and in bacteriology,as well as in the large clinical field open to the specialistin Medicine, Surgery or Gynaecology, in VenerealDisease, and in Ophthalmology. Child welfare is alsoundertaken systematically by officers of the RoyalArmy Medical Corps.At the same time instruction in administration is

continuous. The Royal Army Medical Corps isessentially organised for war, and one of the lessons ofthe Great War was that trained administrators mustexist to enable the fullest benefit to be obtained fromprofessional talent. Many appointments carryingadministrative responsibility are open to those officerswho display capacity for this duty. All officers mustbe prepared to undertake command and to have aknowledge of Army administration, especially in war.Equally important is the technical training of theNon-commissioned Officers and men of the Corps insuch " trades " as Trained Nurse, Nursing Orderly,Masseur, Radiographer, Operating Room Assistant,Laboratory Assistant. Hospital Cook, Dispenser, &-c.This training is carried out by the Officers and NursingSisters, and opens a large field for those who haveability in lecturing and teaching as well as the powerof influencing men.

Promotion.Promotion takes place automatically to Captain

after 3 years, and to Major after 12 years’ service,provided the officer is qualified and recommended forpromotion. Promotion to the higher ranks is byselection from those senior in the rank below, butspecial promotion by brevet or otherwise is’open toofficers of the Royal Army Medical Corps.

Additional Pay and Charge Pay for Officers ofthe R.A.1v1.C.

(1) Officer not above the rank of lieutenant-colonel, whileacting as specialist in a post considered by Our Army Councilto merit the grant of additional pay, according to subjectsor groups of subjects as under.

Operative Surgery, advanced ; Medicine ; Ophthalmology ;Gynaecology and Midwifery ; Dermatology, and VenerealDisease. Otology, Laryngology, and Rhinology ; Radiology ;Anaesthetics ; Mental’ Diseases ; Hygiene ; Pathology ;subjects other than above, at the discretion of Our ArmyCouncil, 5s. daily.

(2) (a) Officer in charge of a hospital.-If the number ofequipped beds, as certified by the Deputy Director of MedicalServices, exceeds-

50 beds.. 2s. 6d. daily. 300 beds.. 7s. 6d. daily.150 " .. 5s. Od. " 500 .. 10s. Od. "

Officer in charge of a medical or surgical division of ageneral hospital with not less than 300 beds-half the aboverates.

464

Daily. Bs. d.

(G) Senior medical officer, RoyalArsenal,not exceeding 10 0

(c) Officer in command of the dep6t, Royal ArmyMedical Corps .......... 5 0

(d) The senior officer of the Army Medical Serviceswith an army in the field : A rate to be fixed bythe Army Council according to the magnitudeof the charge.

(e) The officer, if under the substantive rank ofcolonel, holding the appointment of senior medicalofficer in a command abroad, or of assistantdirector of medical services, if the number ofsoldiers is 1500 or upwards ...... 5 0

(f) Adjutant R.A.42.C. Depot ...... 5 0(g) Adjutant R.A.M.C. (Territorial Army) .... 2 6 I

PAY AND ALLOWANCES.

c.s. =commissioned service.’ Pay Warrant rates as amended by A.O. 196/26 less 5t per cent. from July 1st, 1924, vide A.O. 93 and 204 of 1924. The

Pay Warrant rates are subject to revision to an extent not exceeding 20 per cent. according to variation in the cost of living. Thenext revision takes place from July 1st, 1927.

t Rates of allowances vary from time to time and issues are subject to conditions laid down in the Allowance Regulations.

Retirement and Retired Pay. IThe following are the rates of pension and retired ’Ipay :— 1. Retired pay will consist of two parts : (a) a service

element based on the officer’s total service ; (b) a rank Ielement for the rank from which the officer retires. Anofficer with less than 20 complete years’ service will not beeligible for retired pay. I

2. The scale will be as follows, subject to the reduction z,of 5t per cent. referred to below :- I

(a) Service element.-215 a year for each completedyear of service as a medical officer.

(b) Rank element.-

The retired pay of an officer retiring with less than one If,complete year’s service in the rank from which he retires will i

be assessed as though he had retired from the rank below.- I

Maximum rates of retired pay (a)

and (b) together :— £ £

Captain and Subaitern .. 300 Colonel .. .. 800Major 450 Major-General . 1000Lieutenant-Colonel .. 600 Lieutenant-General 1200 1

The above rates are those laid down in the Pay Warrant.Thev have been reduced by 5 per cent. as from July 1st, 11924.

3. Officers with seven and less than 20 years’ service asmedical officers may be permitted to retire with a gratuity inaccordance with the following scale :-

After 7 years’ service as a medical officer .. B1000,,3 3 " ., " in therank of Major ...........82800

,. 6 vears’ service as a medical officer in therank of Major 23500

THE ARMY DENTAL CORPS.

The Corps is administered by the Director-General,Army Medical Services. It is a joint service for theArmy and Royal Air Force and personnel is requiredto serve under either force and be interchangeable.Officers and other ranks posted for duty with theRoyal Air Force will perform their duties under theRegulations of the Royal Air Force for the employ-ment of dental personnel, but the conditions in thefollowing tables apply equally in either force. Pro-motion is carried out on one general list. The regula-tions for admission to the Army Dental Corps shouldbe obtained from the Under-Secretary of State, WarOffice, and carefully studied.

OFFICERS : Appointment ance Prontotion.1. Commissions as Lieutenants in the Army Dental Corps

may be given to persons duly qualified under regulationsapproved by the Army Council.

2. An officer shall be eligible for promotion to the rank ofCaptain on completion of three and a half years’ service and tothe rank of Major on completion of 12 years’ service in theCorps, provided he has previously qualified in such manneras may be prescribed by the Army Council.

3. Promotion to the rank of Lieutenant-Colonel andColonel to fill the establishments laid down from time to timefor those ranks, shall be made by selection of the ArmyCouncil, provided the officer has previously qualified for

promotion to those ranks in such manner as may be pre-scribed by the Army Council. 4. Appointments are in the rank of Lieutenant, except incases where service of three and a half years or more has been

given as a temporary dental officer when the rank of Captainwill be given. Service as a temporary dental officer willcount towards the three and a half years for promotion toB Captain, and the 12 years for promotion to Major.

These rates are 5 per cent. below those shown in thePay Warrant, 1926, as amended by Army Order 196/26.The latter are subject to revision to an extent not exceeding

465

20 per cent., according to variation in the cost of living.The next revision takes place on July 1st, 1U27.

Charge Pay.The officer in charge of the Dental Laboratories, Aldershot,

receives charge pay at the rate of 5s. a day if holding the rankof Captain, or 2s. He!, a day if holding the rank of Major.

Allowances.The allowances for officers of the Army Dental Corps are

at the same rates as for officers of the Royal Army MedicalCorps.

Retiren.ent and Retired Pay or Gratuity.(1) The rates of retired pay will be the same as for officers

of the Royal Army Medical Corps.(2) Voluntary retirement on retired pay will not be allowed

until after twenty years’ service.(3) Earlier retirement on gratuity may be allowed :—

After 8. years’} service as a Deiatal{ gratuity of £1000." 15

,, Officer, £2000.18 £3000.

(4) Retirement will be compulsory at the age of 55 years.(5) A lieutenant who does not qualify for promotion

within three and a half years’ service in the Corps will beretired ; and a captain who fails to qualify for promotionto major within twelve years’ service in the Corps will beretired on any gratuity for which he may be eligible underparagraph 3.

The aim of the Corps is the prevention of wastageof man power on account of dental disease or dentaldeficiency, and, to enable this to be carried out, everyrecruit is inspected by a dental officer immediatelyafter joining and all necessary treatment carried out.The soldier will be re-inspected at least once a yearand his dental efficiency maintained at the beststandard possible. As recruits are not now enlistedunless they have sufficient natural teeth to enable themto masticate efficiently it is hoped that the conserva-tive nature of the treatment they will receive willreduce considerably the percentage of artificialdentures required.

INDIAN MEDICAL SERVICE.

THE entry of European medical candidates into theIndian Medical Service practically ceased with thelast open competitive examination held in 1915, andit is an open secret that recruitment for the Servicehad for many years previous not been brisk, withthe result that at the present time the Service is wellofficered in its higher ranks and notably deficient inthe ranks of those who will be called to succeed them.Among the senior and retired officers are many whosework in medicine and the allied sciences has becomea household word, for a generation ago the conditionsof service were such as to attract men of the greatestpromise in the medical schools who were rarelydisappointed in a career which, without producingwealth. gave unlimited opportunity for the display oftalent in research and administration unfettered byirksome restriction. We may suppose, and it is theview of many senior officers in the Service, that theperiod of depression is now passing and that theprospect is again bright for those who are fitted inphysique and disposition for a medical career in India.But the new outlook involves frank acceptance of

the Indian reform scheme, the essential of which isincreasing participation of Indian-born subjects inthe government of the country, although, so long asEuropeans are employed in the various departmentsof the Indian Civil Service, nothing is more certain Ithan that there will and must remain Europeandoctors to attend them. Entrants must also beprepared to face the fact that more time will elapsebefore they can hope to get into civil employ andthat opportunities for private medical practice arenot what they were. On the other hand. it is reasonablycertain that the social effect of Indianisation will notpress hardly on the medical service for the reason thatEuropean doctors will be chiefly requisitioned in

stations with considerable European communities.In these communities the equipment and organisationof hospitals has been steadily improving and men withprofessional ambition will find positions which willsatisfy their aspirations. On the military side thestation hospital system has rendered the position ofmedical officers more independent by making team-work possible and permitting of specialisation invarious departments of medicine and surgery. Lastly,those who join now will have unequalled prospect ofadvancement in a Service which has been so depletedfor 10 or 15 years or more, and the new terms ofservice announced by the Secretary of State for India,last month assure conditions of pay, pension, andfurlough much superior to those recently offered.

Special Recruitment.To meet the immediate need the offer has been

announced of special terms for permanent commissionsto a small number of medical men of Europeandescent free to sail for India within the next fewmonths. Candidates, who must be well qualified andbetween 21 and 32 years of age, will be appointed onthe nomination of a selection committee before whomthey will appear in person. The special advantageoffered is the option of retirement on a gratuity atthe end of a short specified period of service—£1000after six years, £2500 after 12 years-and if theoption is not taken up the officer will continue inthe Service on the ordinary pensionable footing. Theywill be eligible for the concessions granted in the newprovisional regulations and for free passage if invalidedhome on sick leave during the first 12 years. Militaryemployment only is guaranteed, but they will enjoythe benefits of any conditions regarding civil employ-ment applicable to officers appointed later to theService as a result of decisions taken on the LeeCommission report.

The New Pro2isiozzcel Regulations.Competitive examination remains suspended for

the present and admission to the Service is on

written application to the India Office. As soundbodily health is a first essential candidates may, ifthey wish it, undergo a preliminary examination bya Medical Board which meets weekly at the IndiaOffice.

Candidates must be under 32 years of age at the timeof application and possess qualifications registrablein Great Britain. Up to the present time officers havebeen employed both in civil and military departmentsand have been interchangeable between the two. Atthe beginning of his career an officer was employedon the military side, which has medical charge of theIndian Army. If he remained in military employ heheld a post on the staff of a station hospital, or aspecialist post, or a post on the administrative staffof the army, promotion being on a time-scale up to therank of lieutenant-colonel and by selection to the ranksof colonel and major-general. He could, however, ifhe chose, apply, after two years’ Indian militaryservice, to be registered as a candidate for transfer tothe civil side, from which appointments are made tocivil surgeoncies, established at the principal civilcentres to provide for the medical needs of civilofficials and for general medical administrative pur-poses and to the specialist services (for example,public health, bacteriological and research depart-ments, and the professorships at the medical schools).Such transfers normally took place after aboutseven years’ service in military employment.

In view, however, of the recommendations of theLee Commission only military employment can beguaranteed to officers entering at the present time,although they will be eligible for such civil employmentas may become available as a result of the LeeCommission report. Executive medical officers inboth civil and military employment may attendpersons unconnected with Government serviceprovided their duty admits of it. On the militaryside, however, the opportunities for private practiceare not great. Service during the war as a medical