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121 THE ARMY: PROJECTED CHANGES, MATERIAL AND MORAL. building. But how many lives have been thrown away by there being no hospital accommodation, which is almost universally the case, and how many people have been invalided for the same reason one cannot say, but the number of European officers who die on the way home and in the first three l1wnth8 after their arrival in England must be added to the Government death-rate to get an idea of the reality. How can a medical man do his ordinary work and nurse a couple of serious cases day and night-one very likely in his own bed-and do the work properly ? It is impossible, even leaving out of the question the danger to his own health and life, but it is done out here constantly and "economy" is supposed to justify it. I know of a case where a European hospital was down and passed in the estimates for 1906 and the building was not started till the middle of October ; the reason given-I cannot vouch for the truth of it-was that the governor wished to choose the site on the occasion of his annual visit, and some colour is given to this by the fact that he did choose it and a different site from that pre- viously selected by the medical officer of that station. Another instance of economy in.connexion with that hospital is that the balcony verandah was originally designed 10 feet wide all round and economy in the shape of the governor cut this down to 9 feet at the sides and 6 feet at the ends. And now as to the pay. A medical officer gets .6400 a year, rising to £500 by yearly instalments of .S20; a small percentage pass on if they survive to the giddy height of £600-£700 a year as a senior medical officer, of whom there are three or four, while £800-£900 is given to the deputy principal medical officer and £1O00- .S1200 to the principal medical officer. Considering the importance of the medical man in this climate let us contrast this with the pay of other professional and non-professional men. Senior district commissioners, £600-£700 ; ordinary district commissioners, £500-£600; police magistrates (professional), £500-£600; puisne judges (professional), £1000; Solicitor-General (professional), £700-£900 ; super- intendent of telegraphs, £500-£600 ; marine super- intendents, .&500-.S600; superintendent engineer, .E600- £800; engineers, .MOO-.&500; assistant conservators of forests (recruited from anywhere), £500-£700 ; provincial engineers, .E600-E800, and so on ; somehow the medical man does not rank very high, but this is not all. Up to May lst, 1906, the medical officer as a second class officer (a matter of size of salary) was entitled to a travelling allowance of 15s. a day in common with all officers of his standing. In connexion with the amalgamation of Southern Nigeria and Lagos travelling allowances have been cut down to 5s. a day for officers of that grade, but a compensating allowance called "duty allowance varying in amount from £80 to .f.300 has been granted to every officer of that or higher standing except the medical officer. The excuse for this "economy" is that the medical officer is allowed private practice. Private practice in the majority of stations does not exist, and where it does has not a medical man the right to money earned after Government work is done in the exercise of his profession without a deduction from his salary being made ? Much of the work would have to be done whether the Government liked it or not. Up to last year medical officers had an allowance of Z50 a year for doing public health work and many of them took a course in public health and a diploma to enable them to do the work well. Last year an attempt was made to remove this shocking piece of Government extravagance altogether, but a few men were not to be bluffed and finally the allowance was con- tinued in the case of men who had joined the service before Jan. 1st, 1905. Medical officers appointed after this date do not get the allowance, but are, of course, expected to do the work, and equally, of course, they have to submit to having their work criticised and in some cases altered by political or even by army officers or other laymen who, of course, know much more of sanitation than does a medical man. Practically, then, the medical officer is the only person to suffer by this economy, certainly the only pro- fessional man, and this surely ought not to be. Can your influence, exerted perhaps in Parliament, alter, or help to alter, this condition of things ? At all events, will you try for the good of the pro- fession ? If nothing else can be done, a warning to medical men contemplating joining this service to get a definite contract with everything down in detail in ’, black and white (economy is still going on, " rigid " is now prefixed in official documents) should do good, so that if I they join at all they do so with their eyes open, knowing that their living wage cannot be further reduced. Moreover, we think that if they have a full knowledge of the state of things the better class of medical man will not offer himself for this service, which will make the Government treat us fairly, as if the class of medical officer goes down the class of other employees will go down too, the best class of men not caring to risk their lives unnecessarily. I am, Sirs, yours faithfully, A WEST AFRICAN MEDICAL OFFICER. THE ARMY: PROJECTED CHANGES, MATERIAL AND MORAL. To the Editors of THE LANCET. SIRS,—In a leading article in THE LANCET of Dec. 15th, 1906, p. 1673, you criticised Mr. Haldane’s recent address to the members of the committee which he has called into being to advise the Army Council in matters affecting the spiritual and moral welfare of the army. As you observed, Mr. Haldane’s meaning was occasionally elusive and there was much that was nebulous and indefinite in his speech, but at the same time none can deny that Mr. Haldane is probably more capable of clear reasoning and definite expression than the majority of his colleagues in the Cabinet. Perhaps as a philosopher accustomed to the guidance of pure reason he felt a little uncertain as to the terms in which an audience com- posed principally of ministers of various religious denomina- tions should be advised and as to what topics should be especially recommended for their consideration. Possibly he may have felt that, as you expressed it in your article, " the committee is cut off from a valuable source of information by not containing a medical member." His words when read care- fully seem to suggest this, for he said among other things, "nowadays it is realised that you cannot save men’s souls without attending to their bodies, and, conversely, it is considered that all cannot be well with their bodies unless it is so with their souls also." In another passage he referred to the importance of inculcating temperance, as a work demanding the cooperation of all interested; and in yet another he said, "Religion is not morality but morality and religion go together ; you cannot divorce religion from its surroundings, but if the surround- ings become better then the awakening of religious life becomes easier." The moral and religious aspects of a soldier’s possible mental training Mr. Haldane naturally found to be inseparable, and he seemed to have on the tip of his tongue admissions that the consideration of his physical circumstances and conditions of life was also in- volved. Indeed, as has been said above, he referred directly to the evils of alcoholic intemperance and he also made allusion to the opportunity for moral instruction which might be found when the soldier lies sick or injured in a military hospital. At the same time the fact remains that Mr. Haldane has placed no medical man’s name in the list of his committee, although it does not consist exclusively of ministers of religion, and although upon it one or more army surgeons of experience in their branch of the profession and one or more physicians of wider experience in some directions than army surgeons may have the opportunity of enjoying would have been of considerable service. In the various circumstances of barrack life, in the feeding arrangements and in those connected with the supply of alcohol and other refreshments, in the provision of sleeping accommodation, and in sanitary matters there is much which affects physical and moral conditions simultaneously. In connexion with morality, one particular and obvious phase of the question, that of sexual morality, involves physical considerations almost impossible to eliminate from any dis- cussion primarily devoted to the religious bearings of a difficult subject. All the above points and many others need to be ventilated and discussed not only by teachers of religion, and not only by eminent leaders and organisers of soldiers as fighters in the field, but by others whose acquaint- ance with the soldier is more intimate than that of the general or the bishop (or even the chaplain), and by those whose knowledge of their subject is increased and supple- mented by scientific training. The medical man would have his prejudices like other members of the committee. His prejudice, for example, would lead him to oppose any move- ment which had as its probable result the hindering of the soldier from seeking medical advice at the earliest possible opportunity when infected with venereal disease. In a recent paragraph Truth informed us that a very
