THE NAVAL, MILITARY, AND INDIAN MEDICAL SERVICES.

635THE NAVAL, MILITARY, AND INDIAN MEDICAL SERVICES.

H. F. Tobin, and Mr. D. J. Kennedy. Surgeon to ExternDepartment : Mr. H. Meade. Gynaecologist and Lecturer onGynæcology : Mr. A. J. Smith. Pathologist and Lectureron Pathology : Dr. T. T. O’Farrell. Surgeon-Dentist andLecturer on Dentistry : Mr. J. J. Murphy. Pharmacist andLecturer on Pharmacy : R. Shaw.

UNIVERSITY OF BRUSSELS.i British and other practitioners holding registrable quali-teations are admitted to the examination for the Doctorateof the University of Brussels without further curriculum.It is essentially a practitioner’s examination and is separatefrom that intended for the Belgian students who take up themedical curriculum of the University. The fees are-Formatriculation, Z8 8 12s ; for lst Part, B4 4 4s. ; for 2nd Part,,;E4 4 8s. ; for 3rd Part, .64 4 8s. ; for legalisation of diploma, 8s. -total, £22. Candidates who have paid in advance the fees forthe three examinations, and are unsuccessful in the first, re-cover the fees paid for the second and third ; those who failin the second recover the fees paid for the third examination.Unsuccessful candidates are allowed to come up again threemonths after rejection on payment of examination fees only,provided this second appearance be in the course of the same:academical year (Oct. lst to June 30th), otherwise theymust renew the payment of the matriculation fee of E3 12s.The examination consists of three parts, viz.-1st Part:’General Medicine; Materia Medica and Pharmacology; Gene-ral Surgery ; and Theory of Midwifery. 2nd Part: General

Therapeutics; Pathology and Morbid Anatomy, with use ofthe microscope ; Special Therapeutics and Medicine ofInternal Diseases, including Mental Diseases; and SpecialSurgery. 3rd Part: Public and Private Hygiene; Medical.Jurisprudence; Clinical Medicine; Clinical Surgery ; examina-tion in Operative Surgery, consisting of some of the usualoperations on the dead subject-viz., Amputation, Ligatureof an Artery, &c.; Ophthalmology ; examination in Mid-

wifery, consisting in obstetrical operation on the mannikin(model of pelvis) ; and examination in Regional Anatomywith Dissection. The time required for the three- examinations seldom exceeds ten days, and is usuallyless. Candidates have the option of passing each partseparately, or of taking the three together, and the latter isthe usual course ; also of demanding a written examinationon payment of an additional fee of one guinea for eachpart, a rule of which candidates rarely or never avail them-selves. The examinations, which are vivd voce, begin on thefirst Tuesday in November, December, March, May, andmiddle June. Candidates should appear with their medicalregistration certificate or their diplomas at the Secretary’sOffice not later than 2 P.M. on the dav preceding the’examination. Most of the examiners speak English, and thosewho do not examine through the medium of an interpreter.Great importance is attached to practical knowledge, butcandidates must also possess sound theoretical knowledge,the standard required varying with the subject. Pathologicaland other specimens are not usually shown. There arein England at present over 600 graduates holding this

degree, and a British Association of Brussels MedicalGraduates has been in existence for many years. Appli-cations should be made to the Secretary, 14, Rue desSols, Brussels; or to Dr. Arthur Haydon. Secretary of the Brussels Medical Graduates’ Association, 23, Henrietta-street,Cavendish-square, London, W.

THE NAVAL, MILITARY, AND INDIANMEDICAL SERVICES.

THE conditions of service in the medical departments ofthe Army and Indian Army remain, with certain modi-fications, the same as for 1911; but the conditions ofmedical service in the Royal Navy have been further modified,chiefly in regard to improved professional training.An Order in Council was issued on August 8th, 1911,

based, it is understood, on the report of Sir John Durnford’sCommittee, appointed three years ago. This Order, wefear, was a disappointment to all but the senior officers Iof the Service. The old ranks of inspector and deputy in-spector-general became surgeon and deputy surgeon-general,as they used to be in the army. Pay was increased by 18. or2:. daily every year or two till 26 years’ service, when it is£1 15s. a day, and for fleet-surgeons does not rise any

higher. Deputy Surgeons-General now get £2 5s. daily.Senior medical officers of battleships and cruisers with com-plements of 650 and upwards get 3s. 6d. daily charge pay,which is very right and has often been asked for. Chargepay is now given more freely. The surgeon who passesthe staff surgeon’s examination at his first attempt maysecure 18 months’ earlier promotion by getting a specialcertificate (or 12 months’ if he only attains a first class), pro-vided the Admiralty thinks him deserving and the director-general does not reduce the period. A surgeon who has

passed this examination before eight years may, as at present,retire with a gratuity of S1000 if he so choose ; but if he hasnot passed at eight years he will be compulsorily retired onany gratuity the Admiralty thinks right, not exceeding f:500.We would strongly urge on the authorities the advisability

of removing the still existing legitimate grievances ; thereforms could for the most part be effected at the expense oflittle but tact and a consideration of what is justly due tothe naval medical officers. Every naval medical officer whohas written to our columns, and this is not a small number,has expressed dissatisfaction with the position in whichthe cabin question has been left by recent regulations.AlIGtment to the medical officer of cabin accommodationinferior to that to which he is entitled still takes place,and cannot, at any rate cannot always, be explained bythe eramped space on that elaborate box of tricks, a

modern man-of-war. Another innovation sadly wanted is aregulation to ensure that the senior medical officersin hospitals should have proper disciplinary power overtheir subordinates and patients. Other points, suchas the supply and use of boats, for example,might well be settled in accordance with the justdesires of the Naval Medical Service, for the Admiraltywill be prudent to aim at making the Service more

popular. And the same may be said of all threeservices. For that there is now no competition for com-missions in the Naval Medical Service and no keen com-

petition for those in the Army Medical Corps or the IndianMedical Service seems undeniable, and this is the more un-fortunate a position since fewer men are now entering themedical profession as a whole. It is no longer easy for allhospitals to obtain suitable residents, while assistants are

scarce and even junior partners are not to be found directlythey are wanted. The Services will therefore have to becareful to increase their popularity, and the point is thatit may be economical of them to do so now. Bysmall concessions they may be avoiding having laterto pay a heavy price to attract men. We would also

suggest that it is unwise to let any of these departmentsrun below the normal strength if it is possible to maintainthem at par.Though reform may be wanted in the Naval Medical

Service, its present state is not without material advan-

tages. At one time not so very long ago the Naval MedicalService was not looked upon as one in which an educatedgentleman could serve with dignity, while complaints wereheard of many of the conditions of service. But the oldorder of things is giving place to the new, and a com-

parison of the lot of the naval medical officer withthat of the civil practitioner will show that the trialsof the civil branch of the profession are greater thanthose of the naval branch, and probably when all thingsare considered the naval surgeon is in a far better posi-tion than the average lay professional man. In the

junior ranks of the Service the pay is better thanthe average income of the lay medical man of thesame age, and promotion is not always slow. WithZ20 a month the young naval surgeon can, if he isnot extravagant, get along very comfortably, though hewill require at the commencement of his career £50 or E60for outfit. A private income is certainly not necessary. After20 years of service a naval surgeon is entitled to a pensionof k365 a year, which compares very favourably with theprospects of many medical men on the civil side of the pro-fession, and in case of illness there is the half-pay rate,while pensions are provided for widows and children.In this way the young naval officer is relieved of the mostserious anxiety which can press upon a married man, buthe ought not to marry young without due consideration, awarning which, however, applies to most medical men.

With regard to the Medical Services of the Army and IndianArmy, a comparison with that of the Navy shows that

though the Army and Indian Service are better paid,

636 THE NAVAL, MILITARY, AND INDIAN MEDICAL SERVICES.

promotion in the case of the army has been renderedless certain; in both services expenses are higher andthe work more fatiguing, while in the Indian Servicethere is a greater liability to disease and death. Theyoung surgeon, too, on board his vessel probably getsa better chance in the Navy than in the Army. Solong as the new surgeon is adequately good at his

profession, is kind and unselfish towards his patientsis not too self-assertive, and has any positive accomplish-ments or skill at any sport or game, he should get on verywell, especially if he is good-humoured and helpful. Andif a man has not these qualities and readiness where shouldhe be advised to practise ?The conditions of entry into the Royal Naval Medical

Service were altered in 1910. Formerly, candidates on

passing the examination in London at once receivedtheir commissions as surgeons in the Royal Navy.They are now appointed acting surgeons. More-

over, after courses of instruction, they will be againexamined, and if they pass this examination also will be

duly commissioned. Their seniority-that is, their place onthe list throughout their service-will depend on the marksthey get in both examinations. The standard of marking isnot disclosed, and proficiency in the second examination insubjects which have been studied only through perhapsthree or six months may avail as much in fixing. their placesas success in the first examination, which is the outcome ofthe industry and training of at least five years. This pointshould be cleared up by the Admiralty, as the uncertaintywill operate to discourage application from the best candi-dates, the most highly educated, those most desired by theservice, who will be rather shy to trust their hard-won pre-eminence to so doubtful a fortune. An extra 10 per cent.for the second examination would give plenty of inducementto the acting surgeons to be attentive to the important in-struction in tropical diseases and naval hygiene they receiveat Greenwich and Haslar. The relative proportions should bementioned if the best candidates are not to be frightenedaway. The entrance examination was also altered. Voluntarysubjects and hygiene were done away. The examinationdeals with medicine and surgery only. In each subjectthere is a written, a clinical, and an oral examination, and400 marks are given for each of the six examinations. Thisscheme gives a material advantage in the competition toless broadly educated candidates. Confidential reports asto the character of a candidate are now to be obtained fromthe dean of his medical school. Certain additional marksare given to candidates who possess certificates from theOfficers’ Training Corps. Nominated candidates, exceptthose nominated by colonial universities, are no longerallowed.

ROYAL NAVAL MEDICAL SERVICE.REGULATIONS FOR THE ENTRY OF CANDIDATES FOR COMMISSIONS IN

THE MEDICAL DEPARTMENT OF THE ROYAL NAVY.l

Every candidate for admission into the Medical Department of theRoyal Navy must be not under 21 nor over 28 years of age on the dayof the commencement of the competitive examination. He must pro-duce an extract from the register of the date of his birth; or, indefault, a declaration made before a magistrate, from one of his parentsor other near relative, stating the date of birth.He must be registered under the Medical Act in force, as qualified to

practise medicine and surgery in Great Britain and Ireland.He must declare (1) his age and date and place of birth ; (2) that he

is of pure European descent 2 and the son either of natural-bornBritish subjects or of parents naturalised in the United Kingdom;(3) that he labours under no mental or constitutional disease or weak-ness, nor any other imperfection or disability which may interferewith the most efficient discharge of the duties of a medical officer inany climate; (4) that he is ready to engage for general service at homeo abroad, as required; (5) whether he holds, or has held, anyc mmission or appointment in the public services; (6) that he isr mistered under the MedicalAct, giving the date of his registration as am dical student, or of his beginning professional study; and (7) whetherne has previously been examined for entry in the Naval Service, and,if so, when.The certificates of registration and birth must accompany the declara-

tion. which is to be filled up and returned as soon as possible, addressedto the Director-General, Medical Department, Admiralty, London,S.W., to permit of reference to the candidate’s medical school. TheDean or other responsible authority of such school will be requested bythe Medical Director-General to render a confidential report as to thecandidate’s character, conduct, professional abilitv, and fitness to hold acommission in the Royal Navy. The candidate will then be interviewedby the Medical Director-General, and his physical fitness will be deter-mined by a board of Naval Medical Officers. The Medical Director-General will then decide whether he may be allowed to compete. Ifaccepted, the candidate will be eligible to present himself at theentrance examination, which will be held twice a year. Notification of

1 To be obtained, together with the form to be filled up, on applicationto the Medical Director-General, Admiralty, London. S.W.

2 If any doubt should arise on this question the burden of clearproof that he is qualified will rest upon the candidate himself.

the exact date of this, as well as the number of commissions to becompeted for, will be advertised in THE LA.NCET. Candidates will beexamined in the following subjects: (a) Medicine, including MedicalPathology and Therapeutics ; and (b) Surgery, including Surgical Patho-logy and Clinical Surgery. The examination will be partly written andpartly practical, marks being allotted under the following scheme :-

Medicine. Surgery.Paper ............ 400 Paper ............ 400Clinical......... ,.. 400 Clinical............ 400Oral ............ 400 Oral ............ 400

Total ...... 1200 Total...... 1200

No candidate will be considered eligible who obtains less than 5 percent. of marks in each subject. The examination will be held in Londonand will occupy four days.The appointments announced for competition will be filled from the

list of qualified candidates, arranged in order of merit; but should itat any time be considered expedient to grant Commissions beyond thoseperiodically competed for, the Admiralty have power to admitannually not more than six candidates, according to requirements,specially recommended by the governing bodies of such Colonial Univer-sities as may be selected and whose qualifications are recognised by theGeneral Medical Council. Candidates so proposed are to be approvedby the Director-General of the Medical Department of the Navy.Colonial candidates will have to pass a physical examination beforea board of Naval Medical Officers in their colony, and will be required toregister their qualifications on arrival in England. They will’beallowed, if they wish it, to compete at the next examination forentrance and take their position according to the order of merit ; shouldthey decide not to compete they will be placed at the bottom of thelist. It will, however, be necessary in any case for them to pass aqualifying test at the time of the usual half-yearly examinations, whenthey will be required to obtain a minimum of 50 per cent. of the totalmarks in each subject. In case of failure in this test examination theAdmiralty will not undertake to defray the cost of the return journeyto the candidate’s colony or other expenses thereby incurred. A fee of:C1 will have to be paid by each candidate to entitle him to take part inthe competition.

Candidates who have served in the Officers’ Training Corps, and whoare in possession of the certificates laid down in the regulations forthat Corps, will be credited at the entrance examination withadditional marks as follows : Candidates in possession of Certificate Awill receive 1 per cent., and those who possess Certificates A and B,2 per cent. of the maximum number of marks allotted.A candidate will not be allowed to compete at more than two

examinations.A candidate successful at the entrance examination will be appointed

as Acting Surgeon in the Royal Navy and will be required to passthrough such courses of instruction as the Admiralty may decide. Atthe end of the courses the acting surgeon will be examined and after hehas passed will be given a commission as Surgeon in the Royal Navy.The commission will date from the day of passing the entranceexamination. The number of marks gained at the final examination,together with those gained at the entrance examination, will decide acandidate’s place on the list for seniority. An acting surgeon who failsto qualify in the above examination (i.e., who fails to get 50 per cent. ofmarks in each subject of the Greenwich and Haslar courses) will beallowed a second trial at the next examination, the period between thetwo examinations not being counted as service for either promotion,withdrawal with gratuity, or retirement after 20 years’ service, andshould he qualify he will be placed at the bottom of his list; shouldhe again fail his appointment will not be confirmed and he will berequired 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 thegold medallist will have a distinguishing mark after his name in theNavy List.Surgeons on entry are only required to provide themselves with a

regulation pocket case of instruments.A candidate, who at the time of passing the examination for entry

holds or is about to hold an appointment as Resident Medical or

Surgical Officer in a recognised civil hospital, may be allowed to servein such civil appointment, provided that the period of such serviceafter the date of entry into the Royal Navy does not exceed one year.Pay from Naval funds will be withheld from officers while thus serving,but the time concerned will reckon for increase of full and half paywhile on the active list, and retired pay or gratuity on retirement orwithdrawal; except that no officar will be allowed to retire on a gratuityuntil he has completed four years’ service, exclusive of the time spentas Resident Medical or Surgical Officer. The eligibility of this appoint-ment to count for time will be decided by the Medical Director-General.The seniority of surgeons on entry will be determined by the sum

total of the marks they obtain at the London examination and those atthe conclusion of their probationary period as Acting Surgeon. Theirnames will then be placed in the official navy list, except in the caseof candidates who hold, or are about to hold, a post as resident medicalofficer or surgical officer to a recognised civil hospital. These candidateswill retain the position in the list which they obtained on entry, andwhen their period of service as resident officer is over they will join thenext Acting Surgeon’s course and will be required to obtain qualifyingmarks. Surgeons entered without competition will take seniority nextafter the last surgeon entered at the same time by competition.

It has been decided to establish a Naval Medical School at the RoyalNaval College, Greenwich.3 Two Fleet Surgeons have been appointedto fill the posts of Professor of Bacteriology and Clinical Pathology andProfessor of Naval Hygiene. The latter will be in charge of the studiesof Naval Medical Officers undergoing courses at this school. Thecourse of instruction for Acting Surgeons will be six months in dura-tion, two of which will be passed at Greenwich in the study of TropicalMedicine, Bacteriology and Clinical Pathology, Hygiene, and Skia-graphy ; and the remaining four at Haslar in the study of NavalHygiene, Recruiting, Physical Traimng, Diving, Submarine Work, &e.A Fleet Surgeon will superintend these studies at Haslar and fill thepost of Lecturer on Naval Hygiene. At the conclusion of the sixmonths’ course an examination will be carried out as above mentioned.

3 This school was opened on May 1st last by Admiral H.S.H. PrinceLouis of Battenberg.


Poet-Graduate Iust1’ltction and Examination for the Rank ofStaff Surgeon.

The post-graduate instruction of Naval Medical Officers consists oftwo courses: (1) A six months’ course before promotion to StaffSurgeon; (2) a second course of three months for officers of not lessthan 14 years’ seniority. The first course is compulsory for all surgeons,and is followed by examination before the Medical Examining Board inLondon, in order to qualify for promotion to Staff Surgeon. The courseis to be taken when the surgeon has between four and a half and six anda half years’ seniority, as near the latter date as practicable. These

courses take place twice a year. There are six compulsory subjects :Clinical Medicine and Surgery, Operative Surgery, Practical Anæs-thetics, Ophthalmology. Chemical Pathology, and Hygiene; and threeoptional subjects: Bacteriology, Diseases of the Throat, Nose, and Ear,and Skiagraphv. A surgeon who fails to obtain a pass will be allowed asecond trial; if again unsuccessful, he will be compulsorily retired onattaining 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 othersubjects will be studied at the "Dreadnought" Hospital and othercivil hospitals in London, as may be arranged by the MedicalDirector-General. The surgeons going through the course will beaccommodated at the Royal Naval College, Greenwich, under thegeneral control of the President; their instruction will be supervisedby the Professor of Hygiene.The second course is not compulsory, but it is designed to afford

senior officers an opportunity for refreshing their knowledge of surgeryand medicine, and making themselves familiar with modern advances.There will not be any fixed syllabus, but arrangements will be madeto meet individual requirements. The officers attending the coursewill also be accommodated at GreenwichVoluntary classes for instruction of about six weeks’ duration are

held at the Naval Hospitals at the three home ports (Chatham, Haslar,Plymouth’ for the benefit of medical officers, to whom every facilitywill be afforded for the study and practice of bacteriology, clinicalpathology, skiagraphy, &c., in the hospital laboratories.

Promotion to Staff Surgeon.(a) Rink as Staff Surgeon will be granted, subject to their Lordships’

approval, to surgeons at the expiration of eight years from the date ofentry, provided they are recommended by the Medical Director-General, have served at sea for three years, and have passed thequalifying examination for this rank. (b) Special promotions will bemade at their Lordships’ discretion to the rank of Staff Surgeonin cases of distinguished service or conspicuous professional merit.Such promotions will be exceptional and not exceed the rate ofone a year. The total number at any one time of Staff Surgeonsholding that rank by such special promotions will not exceed eight.These limitations do not apply to promotions for gallantry in action.

(e) Acceleratecl Promotion.-Certificates will be granted at thequalifying examination for Staff Surgeon as follows :-50 per cent. ofmarks for a pass; 75 per cent. for a first class, and 85 per cent. for aspecial certificate. An officer obtaining a first class is eligible for anadvance of 12 months’ seniority, and one obtaining a special certificatefor 18 months’ seniority; this acceleration will not be granted onexamination results alone, and an officer must also be recommended asdeserving of advancement.

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 atthe expiration of eight years from the date of promotion to. StaffSurgeon, provided they are recommended by the Medical Director-General, have served in that rank at sea for three years, andhave not declined service except for reasons which in theopinion of the Lords Commissioners of the Admiralty are satis-factory. (b) Special promotions from the rank of Staff Surgeon tothat of Fleet Surgeon will be made at their Lordships’ discretion incases of distinguished service or conspicuous professional merit. Suchpromotions will be exceptional and will not exceed the rate of one intwo years ; the total number at any one time of Fleet Surgeons hold-ing that rank by such special promotions will not exceed six : theselimitations 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 haveproved themselves to be fitted, both professionally and as administrators,for these ranks. For advancement to Deputy Surgeon-General twoyears’ sea service in the rank of Fleet Surgeon will be required, or fiveyears’ combined service at sea in the ranks of Fleet and Staff Surgeon.

Fidt Pay.

The medical officers in charge of the following hospitals and sick quarters will be granted charge Day: Haslar, Plymouth, Chatham, [Malta, Hong-Kong, Bermuda, Portland, Yarmouth, Haulbowline,

Cape, Gibraltar, Shotley, Yokohama, and Deal. The rate of charge paywill be as follows :-

Surgeon-General ........................ 10 0 a day.Deputy Surgeon-General .................. 7 6 "

Fleet Surgeon of over 4 years’seniority ...... 5 0 "

Fleet Surgeon of under 4 years’ seniority andStaff Surgeon of over 4 years’ seniority ...... 2 6 "

At Chatham, Haslar, and Plymouth charge pay is granted of 5s. dailyto Deputy Surgeons-General, and 2s. 6d. to Fleet Surgeons in charge ofsections. Also charge pay at 3s. 6d. a day is granted to the SeniorMedical 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 fueland lights, are as follows :—

These allowances are also granted to medical officers of marine divi-sions and dockyards at the Marine Rendezvous, and to the InspectingOfficer of the Royal Navy Auxiliary Sick Berth Staff.An allowance of 5s. a day, in addition to full pay, is granted to the

senior medical officer, being a Fleet or Staff Surgeon, of a flag-shipbearing the flag of a Commander-in-Chief. An allowance of 2s. 6d. aday is granted to the senior medical officer, being a Fleet or StaffSurgeon, of the ship bearing other flags or broad pendants. Thefollowing charge allowances may be granted to medical officersin charge of hospital ships: if above the rank of fleet surgeon, 5s.a day; and if of the rank of fleet surgeon or junior, 3s. 6d. a

day. Medical officers conducting the courses of instruction will receivethe following special allowances: At Greenwich, the Professor ofBacteriology, B150 a year; the Professor of Hygiene, £150 and 0250 forcharge of the studies of naval officers undergoing instruction. AtHaslar, the Fleet-Surgeon, B150; the Junior Officer instructing sickberth staff, E50 ; at Plymouth and Chatham the same allowance of 0250is granted. Medical officers employed elsewhere than at a hospital, andnot victualled in kind, receive an allowance of 1s. 6d. a day in lieu ofprovisions, fuel, and lights. The travelling allowances, extra pay,lodging money, and compensation for losses are fixed for naval medical

officers according to their relative rank in the service. ’The emoluments of the medical headquarters staff at the Admiraltyare: Medical Director-General, 021800 per annum; Deputy Director-General, £1100 per annum ; Assistants to Director-General, each B750per annum.

Half Pay. _____

Candidates will do well to notice that the regulations issued to appli-cants do not put any limit on the amount of half-pay service whichthey may be compelled to undergo, also that time on half-pay countsonly one-third towards retirement.

Retirement.Compulsory retirement will be as follows :-

’At the age of 60, or at any age, if he has had three years’ non-employment in any one rank, or after four years’ continuousnon-employment in any two ranks combined. Except that

ISurgeon- if in any particular case theGeneral and Lords Commissioners of theDeputy Sur-

*

Admiralty may consider that geon General, the interests of the public To be retired

R.N. service will be materially ad- irrespective ofvanced by the further retention age if foundof a Surgeon-General on the physically un-active list, the age for the re- fit for service.tirement of such Inspector- IGeneral may be extended to 62.

At the age of 55. or at any age, Fleet

Surgeon if he has had three years’non-Staff employment in any one rank, Iand Surgeon. or after four years’ continuous and Surgeon. | non-employment in any two

ranks combined.


The special attention of candidates is directed to the following rulesunder which officers are allowed to withdraw from the service after a

four years’ full pay service in the Itoyal Navy, with the advantage of w

joining the Reserve of Naval Medical Officers:- ro

After four years’ service in the Roval Navy, an officer, if he wishes, tlmay pass from active service to the Reserve of Naval Medical Officers, vwhen he will reap the following advantages :- t,

(1) He will be granted a gratuity of E500 on passing into the Reserve. r

(2) His name will be retained in the Navy List; he will retain his enaval rank and be entitled to wear his naval uniform under the regula- ations applying to officers on the retired and reserved lists of His Majesty’s oNavy. n

(3) If he agree to remain in the Reserve for four years he will n

receive a retaining fee of £25 per annum. If at the expiration of a

this period he agree to remain in the Reserve for a further period of ifour years he will continue to receive the same retaining fee. tShould an officer prefer it, however, he may simply enter the Reserve

for a period not exceeding eight years, with power to give six months’ 1notice of his intention to resign his position at any time (in which case Ihe will receive no retaining fee). He may also adopt this method of B

Reserve service after the expiration of four years served under the e

conditions referred to in (3), by renouncing his retaining fee for his lastfour years’service in the Reserve.No officer will be allowed to remain in the Reserve for a longer period

than eight years. Whilst belonging to the Reserve, officers must report (any change of address to the Secretary of the Admiralty.

Officers of the Reserve will be liable to serve in the Royal Navy in time of war or emergency. When called up for such service they will j

receive the rate of pay-viz., 17s. a day and allowances-to which they Iwould have been entitled after four years’ service on the active list. ’

Voluntary retirement and withdrawal will be allowed as follows: (a) Every officer will have the option, subject to their Lordships’approval, of retiring after 20 years’ full-pay service on the scale ofretired pay provided in the table below, or with a gratuity on thescale provided in that table if not eligible for retired pay.(b) At the expiration of four, eight, 12, or 16 years’ full-payservice every officer will be permitted, subject to their Lord-ships’ approval, to withdraw from the Naval Service, re-

ceiving a gratuity on the scale laid down in the table below.It is to be noted that the four years’ service is exclusive of time servedas resident officer in a civil hospital. The name of an officer so with-drawing will be removed from the list of the Navy, with which allconnexion will then be severed, except in the case of officers whowithdraw after four years, who are liable to serve in the Reserve.(e) Applications from officers to retire or withdraw or resign theircommissions will receive every consideration, but no officer will, asa rule, be permitted to resign under three years from the date ofentry. In order that arrangements may, as far as possible, be madefor the relief of officers who may wish to withdraw on a gratuity it isdesirable that six months’ notice of their wish should be forwarded forthe consideration of their Lordships. The Admiralty reserve to them-selves power to remove any officer from the list for misconduct.Gratuities and retired pay will be awarded on retirement and with-

drawal on the undermentioned scale :-

* 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.1 To obtain this rate an officer must hold the commission of Fleet

Surgeon.An officer retired with less than 20 years’ service on account of dis-

ability, contracted in and attributable to the Service, will receive thehalf pay of his rank, or, with the consent of their Lordships, a gratuityon the scales given in the above table, but such officer will not beentitled to receive any special compensation for the disability inaddition to the gratuity as above.An officer retired with less than 20 years’ service on account of dis-

ability, contracted in but not attributable to the Service, will receive-(a) if he has over eight years’ full-pay service, either a gratuity on thescale given above or half-pay according as their Lordships think fit;(b) if he has less than eight years’ full-pay service, such gratuityas their Lordships think fit, not exceeding the rate of .E125 for eachyear of full-pay service. If the health of a surgeon breaks down beforehe completes 20 years’service, even if his disability be contracted inthe Service or be due to climatic causes, he is liable at once to beplaced on the retired list, receiving only a gratuity. This point shouldbe well noted, as the position is a most unjust one. It should be clearlylaid down what is to be understood by attributable."

In circumstances other than those specified in the last two paragraphs,and other than misconduct, neglect of duty, &c., an officer retiredwith less than 20 years’ service will not he allowed half pay orretired pay, but will receive a gratuity on the scale laid down inthe table above if he has eight years’ full-pay service, and on that pro-vided in the last paragraph (b) should his full-pay service not amountto eight years. The power vested in their Lordships of grantingreduced rates of half pay and retired pay in cases of misconduct isextended to the award of gratuities on retirement, and the gratuityawarded will be reduced to such an amount as is thought fit. Anofficer retiring after 20 years’ full-pay service will be eligible, if recom-mended by the Medical Director-General for distinguished or

meritorious service, to receive a step of honorary rank, such step to beawarded at their Lordships’ discretion, and not to confer any claim toincrease of retired pay or of widow’s pension. All retired officers willbe liable, till the age of 55, to serve in time of declared national emer-gency, in a rank not lower than that held on retirement. Thisliability does not exist in cases of officers who withdraw from theNaval Service receiving a gratuity after 8, 12, or 16 years’ full payservice. Retired officers will receive special consideration as regardsappointments on shore connected with the Admiralty.

Widow’s Pension.When an officer retires or withdraws on a gratuity his widow and

children will have no claim to pension or compassionate allowance.In respect to other officers on the active or retired list, the widow’spension ranges from ,E50 per annum for a surgeon’s widow up to £120for the widow of an Inspector-General; for each child an allowance isgranted ranging from :B9 to ,E20 per annum. Officers serving in thereserve who during re-employment are injured on duty, or lose theirlives from causes attributable to the service, come under the sameregulations as regards compensation for themselves, or pensions andcompassionate allowances for their widows and children, as officers ofthe same rank on the permanent Active List.

Miscellaneous.The medical officer of the senior flagship of a fleet is to be recognised

as the Principal Medical Officer of the Fleet. He will be on the staffof the Commander-in-Chief and will wear an aiguillette; he willact as his principal adviser on medical and sanitary matters, andreport on such matters periodically to the Admiralty. He willhave direct access to the Commander-in-Chief, and be in a position topropose to him measures for the efficiency of the Fleet’s medicalorganisation, being directly responsible to him for keeping him informedon these matters. A limited number of active or retired medical officersare appointed Honorary Physician or Honorary Surgeon to the King.There are three good service pensions of B100 a year; two GreenwichHospital pensions of £100 a year; and 13 of £50 a year awarded toNaval Medical Officers. The Gilbert Blane gold medal is awarded everytwo years to each of two medical officers for the most approved journalsof their practice while in medical charge of a ship of war. Onceinevery five years a gold medal and 2100, the Chadwick Naval or MilitaryPrize, is presented to a naval or military medical officer who hasspecially assisted in promoting the health of the men in the Navyor 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 ofa good professional stamp. By the regulations recentlypromulgated promotion has been accelerated, special pro-motion in the lower grades has been made possible incases of distinguished service or conspicuous professionalmerit, and encouragement to enter the service, in the

shape of earlier promotion, has been given to men whohave held resident posts in recognised hospitals. A featureof the regulations is the permission to withdraw at theend of four years with a gratuity of S500 : a small increaseof pay has been made to medical officers all round, andsenior medical officers are put in a materially better positionif they are serving in large battle-ships or cruisers. Deputy-Surgeon-Generals get the 3s daily that they did not getwhen pay was last re-adjusted. The rewards now offered tothose who pass the examination for Staff Surgeon and thesevere penalties held before those who fail should ensure themedical officers of eight years’ service being men of abilityand industry. But we regret that there is no mention ofspecialist pay which can be got by young officers of energyin the Army and Indian Service, nor is there any accelera-tion of promotion for scientific work.

If pay has been increased, in respect of allowances, themedical officers of the Navy, up to the senior ranks, are not aswell off as those of the Royal Army Medical Corps. There willalso be discontent until the medical officers are unhamperedin the performance of their important work by the executiveofficers. The medical officers should have control over thesick bay staff in ships, and over nurses and other attendantsin hospitals, and executive officers should no longer figure aspresidents of " medical surveys." The authority of theDirector-General must be made adequate. More care muststill be taken that medical officers are assigned fitting cabinaccommodation. To make the service thoroughly efficientthe medical officers must be given authority and positioncommensurate with their responsibilities, as has been done inthe case of the Engineer department.


ARMY MEDICAL SERVICE.

During recent years the medical service of the Army haspassed through many stages of evolution, and we considerthat in all essential matters the changes have been distinctlyin the direction of advance and improvement, not only forthe officers composing this service, but in relation to the

Army at large. The formation of the Royal Army MedicalCorps by the Royal Warrant of 1898, when Lord Lansdownewas War Minister, marked the first great step ; then came aperiod of strain during the war in South Africa, when themedical services were exposed to fierce criticism. The out-come of this was the appointment of a committee of inquiryin 1901 by Mr. Brodrick (now Lord Midleton), over whichhe himself presided. A Royal Warrant embodying therecommendations of Mr. Brodrick’s Committee was issued in1902, which regulates the existing conditions of service ;in 1907 free passages to India were granted for the wivesand families of medical officers, whether employed on dutyor not, an important concession, and one evidencing theliberal spirit of the War Office towards the medical service.

Since 1907 several important changes have been madefrom time to time. Prior to this date promotion from therank of Major to Lieutenant-Colonel was made by seniorityafter the passing of an examination on attaining 20 years’ service, the establishment of Lieutenant-Colonels beingunlimited. Under a new clause introduced in the RoyalWarrant the establishment of Lieutenant-Colonels was madea fixed number and limited to 120. Under present rulesno promotion to the rank of Lieutenant-Colonel can takeplace 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 assuitable for promotion. In the Colonel’s grade another

important and far-reaching change has been made sinceJan. 9th, 1907. An officer promoted to the rank of Colonelafter this date will, on completing four years’ service in therank, be placed on half-pay unless further promoted or

retired from the service. Officers of the substantive rank ofColonel were also removed from the Royal Army MedicalCorps, and have been since shown in the Army List as

belonging to the Army Medical Service ; they have alsoa distinctive uniform.REGULATIONS FOR ADMISSION TO THE ROYAL ARMY MEDICAL CORPS

(ISSUED WITH 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 com-mencement of the entrance examination, and must be unmarried.He must, at the time of his appointment, be registered under theMedical Acts in force in the United Kingdom. A candidate must com-plete the subjoined form of application and declaration and submitit to the Secretary, War Office, as early as possible before the date onwhich 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. t4. 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 otherresponsible authorities.

10. Particulars of any commission or appointment held in the publicservices, 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 sub-sequent appointment and cause forfeiture of all privileges for servicesrendered.)

I hereby declare upon my honour that the above statements are trueto 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 thatis likely to preclude me from efficiently discharging the duties of anofficer in any climate.

3. That I will fully reveal to the Medical Board, when physicallyexamined, all circumstances within my knowledge that concern myhealth.

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

Signature ..........................................Date..................................................

;,- All communications to be addressed to the Secretary,War ,Whitehall. S.W.

T A certificate of registration of birth to be furnished.(N.B.-It is of great importance that the names given in the birth

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

The dean, or other responsible authority, of the candi-date’s school will be requested by the Director-General torender a confidential report as to his character, conduct,professional ability, and fitness to hold a commission in thucorps. A candidate whose application is regarded as satis-factory will be required to attend at the War Office a few

days preceding the examination. It will then be decided ifthe candidate may be allowed to compete for a commission.If approved, he will then be examined as to his physicalfitness by a board of medical officers detailed by the Director-General a few days preceding his examination. The followingis the order of the examinations :-

1. A candidate for a commission in the Royal Army Medical Corpsmust be in good mental and bodily health and free from any physicaldefect likely to interfere with the efficient performance of militaryduty.

2. The attention of the board will be directed to the followingpoints: (a) That the correlation of age, height, and chest girth isnot less than that which is given in the following table :—

Physical Equivalents.

(b) Measurement of height. The candidate will be placed against thestandard with his feet together and the weight thrown on the heelsand not on the toes or outside of the feet. He will stand erect withoutrigidity and with the heels, calves, buttocks, and shoulders touchingthe standard; the chin will be depressed to bring the vertex of thehead level under the horizontal bar and the height will be noted inparts of an inch to eighths.

(c) Measurement of chest. The candidate will be made to standerect with his feet together and to raise his hands above his head.The tape will be carefully adjusted round the chest with its posteriorupper edge touching the inferior angles of the shoulder blades and itsanterior lower edge the upper part of the nipples. The arms will thenbe lowered to hang loosely by the side and care will be taken that theshoulders are not thrown upwards or backwards so as to displace thetape. The maximum expansion during deep inspiration will be care-fully noted.

(d) Weight. The candidate will also be weighed and his weightrecorded in the proceedings of the Board.

(e) The regulations regarding the examination of eyesight are asfollows :-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 rejectionof the candidate.The examination for determining the acuteness of vision includes two

tests: one for distant, the other for near vision. The Army Test Typeswill be used for the test for distant vision, without glasses, exceptwhere otherwise stated below, at a distance of 20 feet; and Snellen’sOptotypi for the test for near vision, without glasses, at any distanceselected by the candidate. Each eye will be examined separately, andthe lids must be kept wide open during the test. The candidate mustbe 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 errorof refraction, provided that the error of refraction, in the followingcases, does not exceed the limits mentioned, viz.: (a) in the case ofmyopia, that the error of refraction does not exceed 2’5 D ; (b) that anycorrection for astigmatism does not exceed 2’5 D ; and, in the case ofmyopic astigmatism, that the total error of refraction does not exceed2’5D.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.Distant vision.-V = 6/6. V = 6’6.Near vision.-Reads 0, 6. Reads 0, 6.

Standard II.Better eye. Worse eye.

Distant vision.-V = 6/6. V. without glasses, = not below6/60; and, after correction withglasses, = not below 6,’24.

Near vision.-Reads 0, 6. Reads 1.Standard III.

Better eye. Worse eye.Distant vision. - V, without V, without glasses, = not below

glasses, = not below 6/24; 6/24; and, after correction withand, after correction with glasses, = not below 6,12.glasses, = not below 6/6.

Near vision.—Reads 0, 8. Reads 1.

Inability to distinguish the principal colours will not be regardedas a cause for rejection, but the fact will be noted in the report,and the candidate will be informed. The degree of acuteness ofvision of all candidates for commissions (including preliminaryexaminations) will be entered in their reports in the followingmanner :-

Sufficient t (Right eye... V = ...... Reads ......

Sufficient ...... Lett eye... V = ...... Reads ......

Dpfpctivp Righteye... V= ...... Reads ......

Deteetue ... " Lett eye... V= ...... Reads ......

No relaxation of the standard of vision will ever be allowed.

640 THE NAVAL, MILITARY, AND INDIAN MEDICAL SERVICES. I

The following additional points will then be observed. (f That hishearing is good. (g) That his speech is without impediment. (h) Thathis teeth are in good order. Loss or decay of ten teeth will be con-sidered a disqualification. Decayed teeth if well filled will be con-sidered as sound. Non-erupted wisdom teeth will not be countedas deficient. (i) That his chest is well formed and that his heartand lungs are sound. (j) That he is not ruptured. (k) That he doesnot suffer from varicocele or varicose veins in a severe degree.A candidate who has been successfully operated on will be accepted.A definition of severe varicocele may be obtained from the Director-General Army Medical Service, War Office, Whitehall, S.W. (l) Thathis limbs are well formed and developed. (nt) That there is free andperfect motion of all the joints. (n) That his feet and toes are wellformed. (o) That he does not suffer from any inveterate skin disease.(p) That he has no congenital malformation or defect. (q) That he doesnot bear traces of previous acute or chronic disease pointing to animpaired constitution. (r) If the candidate appears to be not of pureEuropean descent this will be recorded by the board. If a candidate bepronounced physically fit for service at home and abroad he will beeligible to present himself at the next entrance examination whichwill be held twice in the year, usually in January and July. A candi-date will not be permitted to compete oftener than twice.The Army Council reserves the right of rejecting any candidate

who may show a deficiency in his general education.An entrance fee of ;B1 is required from each candidate admitted to

the examination. - - - 0 - 0-- -

Candidates who have served in the Officers Training Corps will becredited at the entrance examination with additional marks as follows :those having Certificate A will receive 1 per cent., and those havingB 2 per cent. of the total. Service marks are also credited to a candi-date who has been employed as an officer in consequence of a nationalemergency, the number of marks depending on the period of employ-ment and the circumstances of the case.A candidate successful at the entrance examination will be appointed

a Lieutenant on probation and will be required to pass through coursesof instruction at the Royal Army Medical College, London, and at theRoyal Army Medical Corps School of Instruction, Aldershot, and, afterpassing the examinations in the subjects taught and satisfying theDirector-General that he possesses the necessary skill, knowledge, andcharacter for permanent appointment to the Royal Army MedicalCorps, his commission as Lieutenant will be confirmed. The commis-sion will bear the date of passing the entrance examination. A Lieu-tenant who, at the time of passing the examination for admission tothe Royal Army Medical Corps, holds, or is about to hold, a residentappointment in a recognised civil hospital, may be seconded for theperiod, not exceeding one ’year, of his appointment; he will notreceive army pay, but his service will reckon towards pay, promotion,and retirement; he will retain the seniority obtained at the entranceexamination.The precedence of Lieutenants among each other will be in order

of merit as determined by the combined results of the entranceexamination and the examinations undergone while on probation,except that the position on the list of a lieutenant on probation,seconded to hold a resident appointment in a recognised civil hospitalwill be determined by the place he has gained at the entranceexamination. He will be required, at the conclusion of his hospitalappointment, to attend the courses of instruction at the Royal ArmyMedical College and at Aldershot; but the subsequent examinationswill be of a qualifying character and will not influence his position onthe seniority list of the Corps.Lieutenants when appointed on probation will receive instructions as

to the provision of uniform.On completion of his probationary training an officer is posted for

duty to one of the military hospitals at home, his wishes being met asfar as possible in regard to the command to which he is posted.

EXAMINATIONS.

Subjects for the Entrance Examination.Candidates will be examined in medicine and surgery by a board

of examiners consisting of eight physicians and surgeons appointedfrom the civil hospitals and medical schools of the United Kingdom.The examination will be of a clinical and practical character, partlywritten and partly oral, marks being allotted under the followingscheme.

3lediciiie (written). Maximummarks.

A. Examination and report upon a medical case ...... 125B. Commentary upon a case in medicine......... 100

(Two periods of 45 minutes-total, one and a halfhours-for A, and one and a half hours for B.)

Meclicizae (orao.A. Clinical cases ..................... 100B. Medical pathology .................. 75

(Ten minutes to examine case and ten minutesviva voce-total, 20 minutes-for A ; 30 minutesto examine specimens and ten minutes viva voce-total, 40 minutes-for B.)

Surgery (written).A. Examination and report upon a surgical case ...... 100B. Commentary upon a case in surgery ......... 125

(Two periods of 45 minutes-total, one and a halfhours-for A, and one and a half hours for B.)

Surgery (oral). ,

A. Clinical surgery and pathology (including diseasesof the eye) ................ 75

B. Operative surgery and bandaging (including surgicalinstruments and appliances) ............ 100(Ten minutes to examine case and ten minutesviva voce-total, 20 minutes-for A, and about30 minutes for B.)

Total marks ......... 800

The following headings are published as a guide to candidates indrawing up their reports on cases :-(a) A brief history of the case asgiven by the patient, including such points only (if any) in the familyor personal history as have a distinct bearing upon the present illness

or incapacity. (b) A detailed account of the subjective symptoms andphysical signs elicited by the candidate’s personal examination of thepatient, noting the absence of any which might be expected to bepresent in a similar case. (c) Where there is any reasonable doubtin the mind of the candidate as to an exact diagnosis, he is togive the alternatives, with his reasons for making the selection.(d) A commentary upon the case as a whole, pointing out thesymptoms which may he considered typical, and those which appear tobe unusual or only accidental complications. (e) Suggestions as to treat-ment, both immediate and possibly necessary at a later date. (f) Aforecast of the progress and probable termination of the case.Similarly the commentary on the report of a case submitted to the

candidate should discuss: (a) The family and personal history andother conditions preceding the development of the conditiondescribed. (b) The relative significance of the physical signs,symptoms, other indications of disease noted, and the genera)clinical aspects of the case. (c) The diagnosis, with reasons forselection of the most probable, when a positive diagnosis cannot beattained. (d) The treatment, dietetic, medicinal, operative, &c., in-cluding a criticism of the plan adopted, and alternative schemes oftreatment in case of disagreement. (e) The morbid appearances andan account of the post-mortem examination (if any).

The examinations are held at the Royal Army MedicalCollege, London, and occupy about four days.The appointments announced for the competition are

filled up from the list of qualified candidates arranged in theorder of merit, as determined by the total number of markseach has obtained. Having gained a place in this entranceexamination the successful candidates are ordered to proceedto the Royal Army Medical College, Millbank, S.W., for in-struction in recruiting duties, at the termination of which theywill undergo two months’ instruction in Hygiene, Pathology,Tropical Medicine, Military Surgery, and Military MedicalAdministration, after which they are examined in thesesubjects. The maximum number of marks obtainable at thisexamination is 700. At the present time the professors at theRoyal Army Medical College are Major E. M. Pilcher, D.S.O.,F. R C. S , in the department of military surgery ; MajorW. S. Harrison, M.B., in the department of tropical medi-cine ; Lieutenant-Colonel Sir W. B. Leishman, M.B., F.R S.,in the department of pathology ; and Brevet-ColonelC. H. Melville, M.B., in that of hygiene, Captain J. C.Kennedy and Major H. B. Fawcus being assistant pro-fessors. Colonel Erskine Risk, the commandant anddirector of studies, assisted by Brevet Lieutenant-ColonelA. P. Blenkinsop, instruct in hospital and corpsadministration, in the duties of officers on transports, andin the examination of recruits, and Major T. W. Gibbardlectures on Syphilology. The services of the following staffof clinical teachers have been secured to give courses ofinstruction to the classes made up of 50 captains that nowundergo an annual course for promotion to the rank of

major :-Medicine : Major G. N. Pitt, M D., 2nd LondonGeneral Hospital; and Lieutenant-Colonel W. Pasteur, M.D.,3rd London General Hospital. Surgery : W. H. Clayton-Greene, M.B., F.R C S. ; and Major S. Boyd, M.B., F.R C.S.,4th London General Hospital. Dermatology : T. 0. Fox, M. B.,F.R.C.1’. Midwifery and Gynæcology : A. F. Stabb, M.B.,M R.C.1. Ophthalmology: J. H. Parsons, M.B., F.R C.S.Otolopy with Laryngology and Rhinology : H. J. Marriage,M.B., F.R.C.S. Specific Fevers: F.F.Caiger,M.D.,F.RC.P.Besides these lecturers an honorary consulting staff has beenappointed by the War Office to Queen Alexandra’s MilitaryHospital at Millbank. This staff comprises :-A. E. Barker,F.R.C.S. ; Major Sir A. A. Bowlby, C.M.G., F.R.C.S.,lst London General Hospital ; Surgeon-Major-GeneralSir A. F. Bradshaw, K.C.B., K.H.P. (retired); J. M. Bruce,M.D., F.R.C.P. ; Lieutenant-Colonel Sir J. K. Fowler,K.C.V.O., M.D., 3rd London General Hospital ; Surgeon-Lieutenant-Colonel P. J. Freyer, M.D., Indian MedicalService (retired) ; W. S. A. Griffiths, M.D., F.R.C.P. ;Lieutenant-Colonel G. H. Makins, CB., F.R.C.S., 2ndLondon General Hospital ; and Honorary Colonel Sir W.Osler, Bart., M.D., LL D., FR.S., South MiddlesexDivision, Royal Army Medical Corps. The course of hygienehas hitherto comprised the examinations of water andair, the general principles of diet with the quality andadulterations of food and beverages, the sanitary require-ments of barracks, hospitals, and camps, the considerationof the clothing, duties, and exercises of the soldier, and thecircumstances affecting his health, with the best means ofpreventing disease, both at home and under the conditionsof foreign service, also with particular reference to activeservice in the field. The pathological course has up to the

1 present time included bacteriology and demonstrations inmicroscopic diagnosis, preparations of vaccines, &c., special

s attention being given to modern methods of research in the


causation of tropical disease. The surgical course consists oflectures and demonstrations in military surgery and X raysand lectures on errors of refraction from a military point ofview. On completion of the above course Lieutenants on

probation join the Royal Army Medical Corps School ofInstruction at Aldershot for a two months’ course in thetechnical duties of the corps, including a course of gym-nasium drill and stretcher drill, and at the end of the courseare examined in the subjects taught. A Lieutenant on

probation who fails to qualify in either of these examina-tions will be allowed a second trial, and, should he qualify,will be placed at the bottom of the list. Should he againfail in either examination his commission will not be con-firmed. Illiteracy on the part of a candidate as evinced byinaccurate spelling, poor composition, or grammatical errorsin the oral examination, at the entrance examination, or atthe examinations undergone while on probation, will beregarded as disqualifying for appointment.

EXAMINATIONS IN THE ROYAL ARMY MEDICAL CORPS.Lieutenants are required to pass two examinations before their

commissions are confirmed; at the termination of the course at theRoyal Army Medical College they are examined in military surgery,tropical medicine, hygiene, pathology, and the organisation of militaryhospitals and the medical charge of troops; after the course at Alder-shot, in regimental duties, drill and field training.Before promotion to captain lieutenants have to pass in (1) map-

reading and problems in practical tactics ; (2) military law; (3) organi-sation, administration, and equipment; (4) military medicaladministration, the duties of executive officers, and the terms of theGeneva Convention; those subjects may be taken up separately and atany time after completing a year’s service. The examinations are heldlocally.A captain for promotion to major must qualify in the following

subjects, the examination not being taken until he has at leastfive years’ service : (1) map-reading and practical tests; (2) militarylaw; (3) organisation, administration, and equipment; (4) drills andexercises of the Royal Army Medical Corps; (5) medicine; (6) surgery;(7) hygiene; (8) bacteriology and tropical diseases; (9) one specialsubject from the following: bacteriology and the preparation ofantitoxins, dermatology and venereal diseases, midwifery and gynzeco-logy, advanced operative surgery, ophthalmology (including rhinologyand laryngology), physical training (including clothing and food of thesoldier), State medicine. The examinations in subjects (1) to (4) areheld at local centres; the rest of the examination is held after a

special course of instruction during nine months. Officers are per-mitted as far as possible to choose their own special subject. Theinstruction in hygiene and bacteriology and in the special subjects isgiven at the Royal Army Medical College and in civil hospitals inLondon. The examination in subjects (1) to (4) is qualifying only; inthe remaining subjects special proficiency qualifies for acceleratedpromotion and for employment as specialist officer with extra pay.The examination for promotion to lieutenant-colonel maybe taken

by a major at any time after three years in that rank, and is held atnotified times in the military district where the officer is serving. Thesubjects are: (1) army medical organisation in peace and war;(2) sanitation of towns, camps, transports, &c., epidemiology, and themanagement of epidemics; (3) (a) medical history of the more

important campaigns, and the lessons to be learned therefrom; (b) aknowledge of the army medical services of the more important Powers ;(c) the laws and customs of war so far as they relate to the sick andwounded; (4) a medical staff tour.

PAY AND ALLOWANCES, ADDITIONAL PAY, AXD CHARGE PAY.The rates of pay and allowances are as follows, the allowance rates

varying slightly from time to time. Specialist pay and charge pay arealso given under certain conditions.

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 underthe substantive rank of colonel. if holding the appointment of seniormedical officer in a command abroad, or administrative medical officer,if the troops number 1500 or upwards, receives 5s. charge pay. At theRoyal Army Medical College the professors receive JB200 and theassistant professors E80 a year in addition to pay and allowances oftheir rank. There are sundry other appointments also carrying extraemolument.

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 anArmy 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 returnto the active list, and if the period he has been in the Reserve ofOfficers amounts to at least one year, and not more than three years,he shall be allowed to reckon one-third of such period towards pro-motion, 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 publicservice. An officer so seconded is not eligible for pay or allowances fromarmy funds, but his service reckons towards promotion, increase ofpay, gratuity, and, under certain circumstances, towards pension. Themedical service of the Egyptian Army, the sanitary service of the:Egyptian Government, and the medical services of various Foreign andColonial Governments are mentioned as capacities in which ArmyMedical Officers may be employed.Officers may also be seconded at entrance into the Corps when holding.

resident appointments at civil hospitals, as already noted underRegulations for Admission."

PROMOTION.No promotion of a medical officer shall be made without the

approval of the Secretary of State.An officer shall be eligible for promotion to the rank of Captain on

the completion of three and a half years’ service, and to the rank ofMajor on the completion of 12 years’ service, provided that in eachcase he has passed the necessary examination, and is recommendedfor promotion.Promotion to the rank of Lieutenant-Colonel to complete an estab-

lishment shall be made by selection from Majors who have qualified insuch manner as may be prescribed by the Army Council.

If an officer has passed with distinction the examination qualifyingfor promotion to the rank of Major, the 12 years’ service required torrender him eligible for that rank may be reduced by 18 or 12 months,.according to the standard of marks obtained.Promotion to the rank of Colonel to complete an establishment

shall be made by selection from Lieutenant-Colonels. An officer pro-moted to the rank of Colonel shall, unless retired, be placed on half-payon completing a period of four years’ service in such rank. A Lieutenant-Colonel may also be promoted to the rank of Colonel if speciallyrecommended for distinguished service in the field. Promotion to therank of Surgeon-General shall be made by selection from Colonels.A Colonel may also be promoted to the rank of Surgeon-General fordistinguished service in the field. An officer of the Royal ArmyMedical Corps is eligible for promotion to brevet rank. A Captainafter at least 6 years’ service, a Major or Lieutenant-Colonel, maybe promoted to the next higher rank by brevet for distinguished:service in the field or for meritorious or distinguished service ofan exceptional nature other than in the field. If the officer dieabefore the date on which the notification of his promotion for dis-tinguished service in the field appears in the London Gazette thepromotion shall bear the date which it would have borne had theofficer not died. Distinction in original investigation or researchmay, in the case of officers of the Royal Army Medical Corps, beregarded as "distinguished service of an exceptional nature otherthan in the field." An officer who may in the opinion ofthe Army Council have been prevented, in very special cir-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 majorreceives an additional 2s. per day; an officer under the rank of lieu-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,

I to qualify, may have been debarred from further opportunity of

i qualifying, may be provisionally promoted. If, however, he fails t&

! qualify on the first available opportunity his promotion shall be

cancelled and he shall be retired from the service. An officer may

642 THE NAVAL, MILITARY, AND INDIAN MEDLCAL SERVICES.

reckon towards his promotion anytime, not exceeding one year, duringwhich he may have been on half-pay on account of ill-health causedby military service; and also any time not exceeding two years duringwhich he may have been on half-pay on reduction. An officer whileseconded shall continue to be eligible for selection for promotion as if he had remained on the establishment, and his service while seconded Ishall reckon towards such promotion.

RANK. The Director-General of the Army Medical Service shall hold the

substantive rank of Surgeon-General and shall rank in relation tocombatant officers as a Lieutenant-General if recommended by the Army Council. All other Surgeon-Generals shall rank as Major- ]Generals in relation to combatant officers. Officers of the Army ’,Medical Service above the rank of Colonel shall hold the substantiverank of Surgeon-General.

RETIREMENT.

(a) Voluntary Retirement.An officer of the Army Medical Service may be permitted to retire in

cases in which such retirement may be deemed expedient by theArmy Council. Army Council.

Scale of Retired Pay. Yearly.Yearly. ;

Director-General after 3 years’ service in the appoint- 2ment (with 30 years’ service) ............ 1125

Daily..6 s. d.

Surgeon-General .................. 2 0 0Colonel-Under 4 years’ service as such, but with 30 years’

total service .................. 1 10 0After 4 years’ service as such............ 1 15 0If not qualified as above ............... the rate for

a lieutenant-colonel.

Lieutenant-Colonel-After 20 years’ service ............... 1 0 025 " ............... 1 2 628 " ............... 176 6

Major, after 20 years’ service ............ 1 0 0

Gratuity.Major or Captain- P,After 5 years’ service in the rank of captain ...... 1000" 3 " " major ...... 1800" 6 " " " ...... 2500

Except in the case of a Colonel, or a Lieutenant-Colonel, an officerwho, on voluntary retirement, has served for less than three years inthe rank from which he retires, is entitled only to the gratuityor retired pay assigned to the next lower rank.

(b) Retirement on Account of Age or Limitation of Period of Service.The retirement of officers of the Army Medical Service is compulsory

at the following ages: Surgeon-General, 60; Colonel, 57; and otherofficers, 55. A Major shall retire on completion of 25 years’ serviceif he has been superseded for promotion; or, if he fails to qualify forpromotion, on completion of 20 years’service. A Captain who fails topass for promotion may present himself at the next examination; if heagain fails he is retired at once on any gratuity for which he may beeligible, or if not so eligible as soon as he completes 5 years’ service asCaptain. A Lieutenant who does not qualify within 3g years of appoint-ment must resign if he fails at the next examination unless there arespecial circumstances for consideration. Special employment in a

national emergency as an officer, or in a position usually filled by anofficer, before entry into the corps is reckoned towards retired pay orgratuity.

(c) Retirement on Account of Medical Unfitness.(c) Retirement on Account of Medical Unfitness.An officer placed on the half-pay list on account of medical

unfitness shall, if not previously retired, be retired from the Army atthe expiration of five years from the date on which he was placed onthe half-pay list, or, if reported by the regulated medical authoritv tobe permanently unfit for duty, on the officer’s application, at suchearlier 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 threeyears’ service in the rank is omitted.

Ratesfor Officers not qualified for Retired Pay or Gwetzcity onVoluntary Retirement.

If the unfitness was caused by military service retired pay equal tothe half pay of his rank. If not so caused, provided the officer has atleast 12 years’ service, retired pay equal to the half pay of his rankfor such period only, not exceeding five years from the date of theofficer’s retirement from the Army, after five years on half pay underArticle 435, as the Army Council shall determine according to themerits of the case.

KING’S HONORARY PHYSICIANS AND HONORARY SURGEONS.Six of the most meritorious officers of the Army Medical Service on

the active list shall be named Honorary Physicians and six HonorarySurgeons. On appointment as Honorary Physician or Honorary Surgeonan officer under the rank of Colonel in the Armv Medical Service maybe promoted to the brevet rank of Colonel. A Lieutenant-Colonel ap-pointed Honorary Physician or Honorary Surgeon shall receive pay atthe rate laid down for a Colonel of the Royal Army Medical Corpswhen qualified for promotion to that rank. An officer shall relinquishthe appointment of Honorary Physician or Honorary Surgeon onretirement.

LEAVE OF ABSENCE.Full pay may be given during ordinary leave of absence for 61 days

in each year at home stations ; in the Mediterranean, Bermuda, andWest Indies leave for two years, and in China, Ceylon, Straits Settle-ments, and South Africa leave for three years may be accumulated.

SICK LEAVE.An officer of the Army Medical Service may draw full pay for the

undermentioned periods during sick leave granted on the recommen-dation of a Medical Board, provided there is reasonable probability thathe will ultimately be fit to return to duty :-

1. In ordinary cases for a period not exceeding 12 months.

2. In very special cases, such as loss of health due to tropic alservice or to active operations, the period may be extended, but itshall not exceed 18 months in all.

When a medical officer is absent from duty on account of sickness,up to a period of 30 days, if duly certified by a medical officer. thisperiod shall not be included in the period of absence on leave to whichthe issue of pay is limited, provided the general officer commandingat the station considers that the circumstances of the case warrantsuch a concession. Any excess of 30 days will be included.When an officer has exhausted the periods of sick leave permissible,

as above mentioned, and is still unfit, he is placed on half-pay for aperiod not exceeding five years, and under certain conditions as to thecausation of his illness is eligible for the following daily rates :Surgeon-General, £2; Colonel, £1 9s. 6d. ; Lieutenant-Colonel, £ 1.with three years’ service as such, £1 7s. 6d. ; Major. Captain, or Lieu-tenant. under five years’service, 6s. ; after five years, 8s. ; after 10 years,10s. ; after 15 years, 13s. 6d.

SERVICE ABROAD.

When an officer’s turn arrives for foreign service he is duly warnedsome months beforehand, and as far as service exigencies permit hiswishes for any particular station abroad are complied with. ALieutenant is usually sent abroad during the second year of his service.The tour of foreign service is 5 years for India, the Mediterranean, andSouth Africa, and 3 years for other stations.

SERVICE ON THE WEST COAST OF AFRICA.An officer volunteering for, or ordered to, the West Coast of Africa

shall receive double pay while actually serving on the coast, and forany time spent at Madeira or the Canary Islands on sick leave, or onordinary leave not exceeding 61 days in a year.A medical officer after 12 months’ continuous service on the West

Coast is entitled to full pay during leave at home for one day for everytwo days served on the coast.Each year or portion of a year served on the West Coast of Africa by

an officer of the Royal Army Medical Corps shall reckon double towardsvoluntary retirement or retired pay, provided that he has served 12months on the coast. In ordinary cases the 12 months may be madeup of two separate periods of not less than six months each; and if anofficer leaves the coast on account of sickness he may reckon any periodof service on the coast, however short, in order to make up the 12months’ coast service which is required to entitle him to count hisservice double. Except when the officer has been invalided, no periodof less than six months’ of service on the coast shall reckon doubleunder this article, or count towards the required period of 12 months,

WIDOWS’ PENSIONS.Widows’ pensions and compassionate allowances for children of

deceased officers are given under certain conditions specified in theRoyal Warrant for Pay and Promotion. There is also an Army MedicalOfficers’ Widows’ and Orphans’ Fund on mutual assurance principles.

PAY IN INDIA.There has been an improvement of late vears in the pay and con-

ditions of ,ervice of army medical officers in India, as elsewhere. Thepay and allowances (which are combined in India) of a lieutenant are420 rupees per mensem ; for captain’s rank, the pay and allowances arefrom 475 rupees to 530 ropees after seven, and to 650 rupees after tenyears’ service. Majors receive 789 rupees on promotion and 826 rupeesafter 15 vears’ service. Lieutenant-Colonels, 1150 rupees ; after threevears 1250 rupees. In addition, charge pay is given, ranging from 60 to240 rupees according to the number of beds equipped in a hospital.

Specialist pay, 60 rupees monthly. There are also various appoint-ments, cantonment hospitals, &c., carrying extra pay, that are sharedbetween the Royal Army Medical Corps and the Indian Medical Service.The value of the rupee is fixed at 1s. 4d.

INDIAN MEDICAL SERVICE.The grades of officers in the Indian Medical Service are

the same as those of the Army Medical Service and RoyalArmy Medical Corps The Director-General will rank eitheras Major-General or Lieutenant-General as may be decidedin each case by the Secretary of State for India in Council.REGULATIONS FOR THE EXAMINATION OF CANDIDATES FOR ADMISSION

TO THE INDIAN MEDICAL SERVICE.Candidates must be natural born subjeots of His Majesty, of

European or East Indian descent, between 21 and 28 years of age atthe date of the examination, of sound bodily health, and in theopinion of the Secretary of State for India in Council in all respectssuitable to hold commissions in the Indian Medical Service. Theymay be married or unmarried. They must possess under the MedicalActs a qualification registrable in Great Britain and Ireland. No candi-date will be permitted to compete more than three times. Examina-tions for admission to the service are held twice in the year, usuallyin January and Julv. Candidates for the January examination mustbe between 21 and 28 years of age on Feb. lst, and those for the Julyexamination must be between 21 and 28 on August 1st. The exact dateof each examination and the number of appointments, together withthe latest date at which applications will be received, will be notified inTHE LANCET.They must subscribe and send in to the Military Secretary, India

Office, Westminster, so as to reach that address by the date fixed in theadvertisement of the examination. a declaration according to theannexed form, which is procurable from the Military Secretary.

Declaration and Schedule of Qualifications to be Filled ecp byCandidates.

I, ........................................................................ , a candidate foremployment in His Majesty’s Indian Medical Service, do hereby attestmy readiness to engage for that service, and to proceed on duty imme-diately on being gazetted.

I declare that I labour under no mental or constitutional disease,nor any imperfection or disability that can interfere with the mostefficient discharge of the duties of a medical officer.

I hereby declare upon my honour that the above statements are trueto the best of my knowledge and belief.

I inclose. in accordance with Paragraph 4 of the Regulations.(a) proof of age; (b) two certificates of character; (c) certificate of ’ .

643THE NAVAL. MILITARY. AND INDIAN MEDICAL SERVICES.

having attended a course of ophthalmic instruction, showing that thecourse included instruction in errors of refraction; (d) evidence of aregistrable qualification; (e) in case of natives of India or othersed1!cated in that cozintry only, a certificate from the Director-General,Indian Medical Service.

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!’</ declaration. See Paragraph 4 oj the jEeg’ttKoKs.)4. Profession or occupation of father, and whether, at the time of

candidate’s birth, his father was a British subject of European or EastIndian descent.

5. Statement as to whether the candidate is married or single.6. Colleges and Medical Schools at which the candidate has received

his medical education.7. Medical School in which the candidate completed his course as a

medical student, and name of the Dean or other responsible authority.8. Degrees of B.A. or M.A.; details as to any prizes, university

honours, &c.9. Registrable qualifications.10. Date of examination at which the candidate proposes to present

himself.11. Date of any previous occasions on which the candidate may

have presented himself for examination for admission to the IndianMedical Service, or other examination for the Public Services.

12. Particulars of any commission or appointment held in the PublicServices.The declaration must be accompanied by the following documents:—

a. Proof of age either by Registrar-General’s certificate, or, wheresuch certificate is unattainable, by the candidate’s own statutorydeclaration, form for which can be obtained at the India Office,supported, if required by the Secretary of State, by such evidence ashe may consider satisfactory. A certificate of baptism which does notafford proof of age will be useless. In the case of natives ofIndia it will be necessary for a candidate to obtain a certificateof age and nationality in the form laid down by the Govern-ment of India which is obtainable from the Director-General ofthe Indian Medical Service, Simla. A candidate of East Indian descent,not born in British India, must produce a certificate of age and nation-ality from the Government of the country where he was born, showingthat he is the son or grandson of a person born in British India. b. Arecommendation and certificate of moral character from two responsiblepersons-not members of his own family-to the effect that he is of

regular and steady habits and likely in every respect to prove creditableto the service if admitted. c. A certificate of having attended a courseof instruction for not less than three months at an ophthalmic hospitalor the ophthalmic department of a general hospital, which course shallinclude instruction in the errors of refraction. d. Some evidence ofhaving obtained a registrable qualification. e. Any European educatedin India and every native of that country will be required to produce acertificate signed by the Director-General, Indian Medical Service, thathe is a suitable person to hold a commission in the Indian MedicalService. A candidate should apply to the Director-General, IndianMedical Service, for the necessary certificate at least three monthsbefore the date on which the declaration is to be submitted under Rule 3.The Secretary of State for India reserves the right of deciding

whether the candidate may be allowed to compete for a commission inHis Majesty’s Indian Medical Service.The physical fitness of each candidate will be determined by a Board

of Medical Officers who are required to certify that his vision issufficiently good to enable him to pass the regulation tests (see underArmy Medical Service). Every candidate must also be free from allorganic disease and from constitutional weakness or other disabilitylikely to unfit him for military service in India. The physical examinationis otherwise in all respects the same as that detailed under Royal ArmyMedical Corps. Candidates who pass the physical examination willbe required to pay a fee of f:1 before being permitted to compete.No candidate will be permitted to compete more than three times.More detailed regulations as to the physical requirements can beobtained on application to the India Office.Candidates for the Indian Medical Service may, if they like, undergo

a preliminary examination by the Medical Board which meets at theIndia Office every Tuesday by applying to the Under Secretary of State,India Office, inclosing a fee of two guineas. They must pay their owntravelling expenses. The decision must be understood, however, not tobe final. It may be reversed in either direction by the ExaminingMedical Board immediately prior to the Professional Examination.On proving possession of the foregoing qualifications the candidate

will be examined by the Examining Board in the following subjectsand the highest number of marks attainable will be distributed asfollows:-

Marks.1. Medicine, including therapeutics.................. 12002. Surgery, including diseases of the eye ............ 12003. Applied anatomy and physiology.................. 6004. Pathology and bacteriology ..................... 9005. Midwifery and diseases of women and children ...... 6006. Materia medica, pharmacology, and toxicology ...... 600

N.B.-The examination in medicine and surgery will be in partpractical and will include operations on the dead body, the applicationof surgical apparatus, and the examination of medical and surgicalpatients at the bedside. No syllabus is issued in the subjects of theexamination, but it will be conducted so as to test the generalknowledge of the candidate in all subjects. No candidate shall beconsidered eligible who shall not have obtained at least one third ofthe marks obtainable in each of the above subjects and one half of theaggregate marks for all the subjects.

For the clinical examinations each candidate should provide himselfwith notebook, pencil, stethoscope, and ophthalmoscope. In drawingup reports on cases the following points should be observed, viz.: (a) Abrief history of the case as given by patient, including such points inthe family or personal history as have a distinct bearing on patient’scase. (b) A detailed account of the subjective symptoms and physical I

signs elicited by the candidate’s personal examination of the patient,noting the absence of any which might be expected to be present in asimilar case. (c) Where there is any reasonable doubt in the mind ofthe candidate as to the exact diagnosis he is to give the alternatives,with his reasons for making the selection. (d) A commentary uponthe case as a whole, pointing out the symptoms which may be con-sidered typical and those which appear to be unusual or only accidentalcomplications. (e) Suggestions as to treatment, both immediate andpossibly necessary at a later date. (f) A forecast of the progress andprobable termination of the case.After passing this examination the successful candidates will be

commissioned as lieutenants-on-probation, and will be granted about amonth’s leave. They will then be required to attend two successivecourses of two months each at the Royal Army Medical College,Millbank, and at Aldershot. The candidate’s commission as a lieutenant-on-probation will bear the date on which the result of the entranceexamination is announced, but his rank as lieutenant will not be gazetteduntil he has passed the final examination, held at the conclusion of hisperiod 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) patho-logy 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 providedwith quarters (where quarters are not provided they will obtainthe usual allowances of a subaltern in lieu thereof), to cover all costsof maintenance, and they will be required to provide themselveswith uniform ; a detailed list of the uniform and articles required willbe sent to each successful candidate.A lieutenant-on-probation who is granted sick leave before the com-

pletion of his course of instruction and final admission to the service willreceive 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 eachlieutenant on probation must obtain 50 per cent. of the total marks. Ifhe fails to qualify in either of these examinations he will be liable toremoval from the service, but if specially recommended he may beallowed to undergo the course or courses again under certainrestrictions 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 thepreliminary and final examinations. They will be liable for militaryemployment in any part of India, but in view to future transfers tocivil employment, they will stand posted to one of the following civilareas :-(1) Madras and Burma; (2) Bombay with Aden ; (3) UpperProvinces-i.e., United Provinces, Punjab, and Central Provinces;and (4) Lower Provinces-i.e., Bengal, and Eastern Bengal andAssam. The allocation of officers to these areas of employment willbe determined upon a consideration of all the circumstances, including,as far as possible, the candidate’s own wishes. Officers transferred tocivil employment, though ordinarily employed within the area towhich they may have been assigned, will remain liable to employmentelsewhere 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 electionto a resident appointment (or to a preliminary appointment leading indue course to a resident one) at a recognised civil hospital,2 may beseconded for a period not exceeding one year from the date on which hetakes up such appointment, provided that he joins it within three monthsof passing his final examination and that he holds himself in readinessto sail for India within 14 days of the termination of the appointment.While seconded he will receive no pay from Indian funds, but hisservice towards promotion, increase of pay, and pension will reckonfrom the date borne on his commission. In special cases permissionmay be granted to lieutenants to delay their departure for India, inorder to sit for some further medical examination. Lieutenants remain-ing in England under such circumstances will receive no pay for anyperiod beyond two months from the date of termination of the courseof instruction, unless the period elapsing before the day on which themajority of the lieutenants of the same seniority sail to India exceedstwo months, in which case lieutenants allowed to remain in England willreceive pay up to that day. In such cases pay will re-commence on theday of embarkation for India. All the provisions of this clause aresubject to the general exigencies of the service. Before the commissionof a lieutenant-on-probation is confirmed he must be registered underthe Medical Acts in force at the time of his appointment. Candidateswho have been specially employed in consequence of a nationalemergency, either as an officer, or in a position usually filled by anofficer, will be allowed, under certain circumstances, to reckon suchservice towards pension.

2 The following is a list of recognised Civil Hospitals.—Englandand Wales.-London: St. Bartholomew’s Hospital, Charing CrossHospital, Guy’s Hospital, King’s College Hospital, London Hos-pital, Middlesex Hospital, St. George’s Hospital, St. Mary’s Hospital,St. Thomas’s Hospital, University College Hospital, and WestminsterHospital. Birmingham: General Hospital and Queen’s Hospital.Bristol: Royal Infirmary and General Hospital. Cambridge: Adden-brooke’s Hospital. Cardiff : Cardiff Infirmary. Leeds : General Infir-mary. Liverpool: Royal Infirmary and Southern Infirmary. Man-chester: Royal Infirmary. Newcastle-on-Tyne: Royal Infirmary.Oxford: Radcliffe Infirmary. Sheffield: Royal Infirmary and RoyalHospital. Scotland.—Aberdeen: Royal Infirmary. Dundee: RoyalInfirmary. Edinburgh: Royal Infirmary. Glasgow: Royal Infirmaryand Western Infirmary. Ireland.—Belfast: Royal Victoria Hospital.Cork: North Infirmary and South Infirmary. Dublin: Adelaide

Hospital, City of Dublin Hospital, Jervis Street Hospital, MaterMisericordiæ Hospital, Meath Hospital, Mercer’s Hospital, Richmond,Whitworth, and Hardwicke Hospital, St. Vincent’s Hospital, SirPatrick Dun’s Hospital, and Dr. Steevens’ Hospital. Galway: TheCounty Hospital and the Union Hospital.


Officers on appointment are, when possible, provided withpassage to India by troop transport; when such accommoda-tion is not available passage at the public expense is pro-vided by steamer, or a passage allowance granted if pre-ferred. Wives of married officers are entitled to passageby troop transport, if available. Any officer who mayneglect or refuse to proceed to India under the ordersof the Secretary of State for India within two monthsfrom the date of terminating his course of instruction,or within 14 days of the termination of his hospitalappointment if the Secretary of State has permitted him tohold one, will be considered as having forfeited his com-mission unless special circumstances shall justify a departurefrom this regulation.A course of instruction in sanitary methods, rules, and

regulations as carried out in Indian cantonments has recentlybeen instituted for young officers of the Indian MedicalService and the Royal Army Medical Corps on first arrivalin the country. The nature of the diseases to be com-

bated, the social and religious __

customs and prejudicesbated, the social and religious customs and prejudicesof the various races, and the limited resources of moneyand material make large modifications from Europeanmethods 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 iscarried out under the supervision of the senior medicalofficer and sanitary officer. The instructors are medicalofficers nominated by the principal medical officer, India,and demonstrations on various subjects are given by otherofficers, staff, engineer, and medical. The course consistsof demonstrations and inspections in all parts of thelines of British and Indian troops, bazaars, Governmentdairies, bakeries, slaughter-houses, trade premises of dairy-men, bakers, butchers, and aerated water manufacturersand dhobies’ houses, market and water-supplies, methods ofwashing clothes, surface drainage, removal and disposalof sewage and refuse, antimalarial measures, disinfection,cantonment hospitals, control of venereal diseases, plagueprevention, methods of hospital administration, &c. Theofficers under instruction thus have an opportunity of

learning something of native customs and are encouragedto learn the vernacular, so as to be less dependentupon their subordinates when first put in responsiblepositions.

PROMOTION.

A Lieutenant is promoted to the rank of Captain on completing threeyears’ full-pay service from the date of first commission, provided hepasses an examination in military law and military medical organisa-tion. Captains are promoted to the rank of Major withont examinationafter 12 years’ full-pay service; this promotion may be accelerated bysix months in the case of officers who fulfil certain specified conditions.A Major is promoted to Lieutenant-Colonel withoict examination oncompletion of eight years’ full-pay service in the rank of Major. All

promotions to higher grades are given by selection for ability andmerit. In case of distinguished service a medical officer may receivespecial promotion. The ages for compulsory retirement are 55 forLieutenant-Colonel and Major, 60 for Surgeon-General and Colonel,and 62 for the Director-General. In special cases an officer may becontinued in employment, for the good of the service, with thesanction of the Secretary of State.

LEAVE RULES.

Officers of the Indian Medical Service below the rank of Colonel maybe granted: 1. Privilege leave under such regulations as may from timeto time be in force. 2. Leave out of India for no longer period than oneyear, capable of extension to two years’ absence from duty, on thefollowing pay for officers in military employment (officers in civilemployment are entitled to higher rates) : After arrival in India, onfirst appointment, B250 a year; after the commencement of the tenthyear’s service for pension, L300 a year; after the commencement of thefifteenth year’s service for pension, f:450 a year ; after the commence-ment of the twentieth year’s service for pension, f:600 a year ; and afterthe commencement of the twenty-fifth year’s service for pension, JE700a year. 3. Leave in India, but for the period of one year only, on fullmilitary pay and half the staff pay of appointment. No extension ofleave involving absence from duty for more than two years, whethertaken in or out of India, can be granted except on specially urgentgrounds and without pay. An officer unable on account of the state ofhis health to return to duty within the maximum period of two years’absence, unless he is specially granted an extension of leave withoutpay, is placed on temporary half-pay or the retired list, as the circum.stances of the case may require. An officer is also liable to be placedon half-pay or the retired list should his health require an undueamount of leave, whether in or out of India. Leave may be granted atany time, but solely at the discretion of the civil or military authoritiesin India under whom an officer may be serving. Officers of theAdministrative grades may be granted leave not exceeding eightmonths, besides privilege leave. during their tenure of appointment.Extra leave (known as study leave) may be granted to officers desirousof pursuing special courses of study at the rate of one month’s leavefor each year’s service up to 12 months in all. An officer on leave is

irequired to join at once on being recalled to duty unless certified by I

a medical board as unfit to do so.

PAY AND ALLOWANCES.The rate of pay drawn by Lieutenants of the Indian Medical Service

previous to arrival in India is 14s. a day, but a Lieutenant (1) who hasbeen permitted by the Secretary of State to hold a hospital appoint-ment will receive no pay while holding it; (2) who is detained by illnessin this country will be paid at the rate of f:250 a year from the date onwhich he would otherwise have embarked until the date of embarkation,and at the rate of 14s. a day during the voyage to India.Pay at the above rate is issued in this country up to the date of

embarkation, and an advance of two months’ pay at the same rate isalso made prior to embarkation, which is adjusted in India.The following are the monthly rates of Indian pay drawn by officers of

the Indian Medical Service from the date of their arrival in India, (N.B.-1 rupee = ls. 4d.):-

NOTES.-(a) Unemployed pay is drawn by officers of less than sevenyears’service who are not holding officiating or substantive charge ofnative regiments prottided they have passed the examination inHindustani known as the " Lower Standard." Officers of more thanseven years’ service draw grade pay alone when unemployed. Staff payis the pay of certain special appointments and is drawn in addition tograde pay.

(b) Horse allowance is granted to officers in charge of cavalry regi-ments at the rate of Rs. 90 a month to Lieutenant-Colonels and Majors,and Rs. 60 a month Captains and Lieutenants.Exchange compensation. -Under present arrangements, officers of the

Indian Medical Service who are not statutory natives of India receiveexchange compensation allowance to compensate them for the fall ofthe value of the rupee. The allowance consists of an addition to theirsalaries (subject to certain limitations) equal to half the differencebetween their salaries converted at (1) ls. 6d. the rupee, and (2) thestandard Government rate, which has been fixed at ls. 4d. the rupeeuntil 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 sub-

stantive military charges of the Indian Medical Service receive thefollowing consolidated salaries :-

Rs. per mensem.Colonel, 16 (some in civil employ) from ......... 1800 to 2500Surgeon-General, 1 @ ..................... 2200

" 2 @ ..................... 2500" (the Director-General I.M.S.) 1 @ 3000

Specialist pay at the rate of Rs. 60 a month is granted to officers belowthe rank of Lieutenant-Colonel who may be appointed to certain posts.Except in the administrative grades and in certain special appoint-

ments officers are not debarred from taking private practice as long asit does not interfere with their proper duties.

POSTS IN MILITARY EMPLOY.

Approximately half the highest administrative posts in militarymedical employ are allotted to the Indian Medical Service. Theseinclude the appointments of Deputy Principal Medical Officer of HisMajesty’s Forces in India and Secretary to the Principal Medical Officer ofHis Majesty’s Forces in India. Half the appointments of PrincipalMedical Officers are to Divisions and Brigades, the other half being filled

by Royal Army Medical Corps Officers. In the junior ranks half theappointments to military staff surgeoncies, the medical charge ot

! cantonment hospitals and Staff Officers for medical mobilisation stores ineach of the nine divisions of the Army are allotted to the Indian Medical

Service and the other half to the Royal Army Medical Corps. Theappointments’ of Medical Storekeepers to Government, which supply theneeds of the Civil and Military Departments, are reserved for the IndianMedical Service alone.

’ r

POSTS IN CIVIL EMPLOY.

A large number of posts in civil employ are ordinarily filled up from;’ officers of the Indian Medical Service. Officers are required to performtwo years’ regimental duty in India before they can be consideredL’ eligible for civil employment. The principal appointments, together1 with the salaries attached to each, are stated in the accompanyingtable (p. 645).t An allowance of Rs. 100 per mensem is also granted, in addition, tos the chief plague medical officers in certain provinces.3 There are also six Chemical Examiners with Rs. 800-1650 per mensemt and a number of Port Health Officers with Rs. 750-1950 per mensem.. Other appointments of Resident Surgeons and Physicians at hospitals,s &c., are on salaries ranging from Rs. 700 to 1650 per mensem. Theree are also a certain number of appointments under the Political Depart-is ment on salaries ranging from Rs. 450 to 1450 per mensem, exclusive ofy local allowances.

Qualified officers of the Medical Service are also eligible for


appointments in the Assay and Mint Departments. The salaries ofthese appointments are from Rs. 600-2250 per mensem.

TENURE OF OFFICE IN ADMINISTRATIVE GRADES.The tenure of office of Surgeon-Generals and Colonels is limited to

five years. Colonels, if not disqualified by age, are eligible either foremployment for a second tour of duty in the same grade or for employ-ment 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 anunemployed salary of Rs. 1350 per mensem in the former, and Rs. 1000in the latter case, for a period of six months from the date of theirvacating office, after which they are placed while unemployed on thefollowing scale of pay :-

A Surgeon-General or Colonel who has completed his term of serviceand has reverted to British pay may reside in Europe, at the same timequalifying for higber pension.

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 ofservice :-After 30 years’ service for pension... f:700 per annum + f:350 after three

years’ active employment inIndia as a Surgeon-General, or+ E250 per annum after fiveyears’ active employment as aColonel, or £ 125 after three yearsas a Colonel. Eight months’absence on leave is allowed tocount towards actual service inthose grades.

" 27 ,, ,, " ;B600 per annum.25 " JE500 "

" 20 " f:400 "

" 17"" x x -B300 11

Service for pension counts from date of first commission andincludes 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 placedon half-pay on account of medical unfitness caused by duty, militaryor civil.

Officers of the Indian Medical Service are liable after retirement onpension before completing 30 years’ service to recall to military duty incase 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 Colonelsat the age of 60, but the Director-General is allowed to serve until hehas attained the age of 62 years. In any special case, where it wouldappear to be for the good of the Service that an officer should continuein employment, he may be so continued, subject in each case to thesanction of the Secretary of State for India in Council.

Officers placed on temporary or permanent half-pay are granted half-pay 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 causedby 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 InvalidPension on the following scales

Per annum.After 16 years’ pension service ............ P,272" 15 " " " ............ 252" 14 f! " 9f ............ 232" 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 ofmilitary duty as are granted to combatant officers of His Majesty’sIndian Military Forces holding the corresponding military rank.

FAMILY PENSIONS.The claims to pension of widows and families of officers are treated

under the provisions of such Royal Warrant regulating the grant ofpensions to the widows and families of British officers as may be inforce 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 ofwhich all officers must, as a condition of their appointment, subscribefrom the date of their arrival in India, except in the case of natives ofIndia, 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 andIndian, and for good service pensions. Six of the most meritoriousofficers are named Honorary Physicians and six are named HonorarySurgeons to His Majesty. On appointment as Honorary Physician orSurgeon 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, althoughfor some time back there has been a feeling of uneasinessand uncertainty, more especially in the senior ranks, asto their future prospects by the adoption of a system ofpromotion by so-called selection. It is felt that the spiritof the Royal Warrant for promotion has been departed from,thereby causing a block in promotion affecting all ranks. Thelimitation of the tenure of the colonel’s appointments to fouryears has caused heartburnings in this grade, as after thisperiod, unless promoted, men are now placed on half-pay.Again, the reduction of the cadre establishment of lieu-tenant-colonels has adversely affected a large number ofmajors who are well worthy of promotion to the next rank ;and it is felt that the rules recently introduced allowing ofaccelerated promotion from the rank of captain to majorhave not worked as fairly as it was intended they shouldhave.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 medicalofficers, that it would be ungracious to refrain from

acknowledging the generous spirit that has actuated the WarDepartment 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 inthe health and efficiency of the army at large.

646 PUBLIC HEALTH DIPLOMAS.

In the Indian Medical Service the recent introduction of c

the increased pension (.6600 per annum) after 27t years’ v

service has been an important concession ; there is still, c

however, a block in promotion, administrative rank, which tused to come after 26 or 27 years’, being now generally Ideferred until over 30 years’ service ; limitation of the period cof service in administrative rank, as recently adopted in the ::Royal Army Medical Corps in the case of the colonel’s grade, Iwould probably be an improvement. The order issued that an 1officer of the Indian Medical Service must refer the question 1of his fees when above a certain low limit to the civil i

authority was most objectionable: it might necessitate the I

violation of professional secrecy and it is professionally (degrading. Revised rules were promulgated in the early 1

part of 1911, which, if -there is really necessity for any l

regulations at all in these matters, need not be objected I

to. The neglect of the rule that the office of prin- I

cipal medical officer to His Majesty’s forces in India I

may be held by an officer of the Indian Medical Service is 1still felt to be a grievance. On the whole it can hardly ibe said that the Indian Service at the present time offersthe advantages over the Royal Army Medical Corps, eitherprofessional or pecuniary, that it formerly possessed,while changes are foreshadowed that make it inevitable thatthe status, prospects, and influence of the Indian MedicalService will be affected injuriously. The objections to

many proposals recently made are, however, we venture tothink, so serious on the grounds of general policy that weabstain from any criticism on their effect on the

prospects of the Indian Medical Service ; there is,indeed, no concrete proposal to criticise. The difficultiesmet with in attempting to carry the proposed reforms intopractice appear to have been much more considerable thanwas expected by the highest authorities, though neitherunknown to, nor ignored by, those having local experience.It is, moreover, a dangerous thing to introduce a feeling ofdistrust and uncertainty into any public service ; if theduties hitherto performed by the Indian Medical Service arein future to be shared with other medical men not of thatservice, then the privileges and emoluments of the IndianMedical Service will inevitably be diminished, with thenatural result that men of the highest class will comeforward in fewer numbers to compete for the service, andthe service generally will deteriorate. Such a result wouldbe disastrous.

PUBLIC HEALTH DIPLOMAS.

INSTRUCTION FOR DIPLOMAS IN SANITARY

SCIENCE, PUBLIC HEALTH, STATE MEDICINE,AND TROPICAL MEDICINE.

RESOLUTIONS, designed with a view of ensuring "thepossession of a distinctively high proficiency, scientific andpractical, in all the branches of study which concern thepublic health," have been adopted at various times by theGeneral Medical Council from 1902 to 1911. The rules

require that : 1. The curriculum for a Diploma in SanitaryScience, Public Health, or State Medicine shall extend overa period of not less than nine calendar months. 2. Everycandidate shall produce evidence that after obtaining aregistrable qualification he has received practical instructionin a laboratory or laboratories, British or foreign, approvedby the licensing body granting the diploma, in which

chemistry, bacteriology, and the pathology of diseases ofanimals transmissible to man are taught. (The laboratoryinstruction shall cover a period of not less than fourcalendar months, and the candidate shall produce evidencethat he has worked in the laboratory for at least 240hours, of which not more than one-half shall be devoted toPractical Chemistry. The laboratory course should be soarranged as to lay special stress on work which bears mostdirectly on the duties of a medical officer of health.)3. Every candidate shall produce evidence either (i.) that,after obtaining a registrable qualification, he has during sixmonths been diligently engaged in acquiring a practicalknowledge of the duties, routine and special, of PublicHealth administration under the supervision of : (a) in

England and Wales, the medical officer of health of a

county or of a single or combined sanitary district havinga population of not less than 50,000, or a medical officer

of health devoting his whole time to Public Health

work ; or (b) in Scotland, a medical officer of healthof a county or counties, or of one or more districtshaving a population of not less than 30,000 ; or (0) inIreland, a medical superintendent officer of health of a

district or districts having a population of not less than30,000 ; or (d) in the British Dominions outside the UnitedKingdom, a medical officer of health of a sanitary districthaving a population of not less than 30,000, who himselfholds a registrable Diploma in Public Health; or (e) amedical officer of health who is also a teacher in the Depart-ment of Public Health of a recognised Medical School; or(f) a sanitary staff officer of the Royal Army Medical Corpshaving charge of an Army Corps, District, Command, orDivision, recognised for this purpose by the General MedicalCouncil ; or (g) an assistant medical officer of health of acounty or of a single sanitary district having a populationof not less than 50,000, provided the medical officer ofhealth of the county or district in question permits theassistant officer to give the necessary instruction and toissue certificates ; or (ii.) that he has himself held for aperiod of not less than three years an appointment asmedical officer of health of a sanitary district within theBritish Dominions, and having a population of not less than16,000. The certificate for the purpose of Rule 3 (1) mustinclude testimony that the candidate has attended under thesupervision of the person certifying on not less than 60working days. Provided that if the candidate has (i.) pro-duced satisfactory evidence that he has attended a courseor courses of instruction in sanitary law, vital statistics,epidemiology, school hygiene, and other subjects bear-

ing on public health administration, given by a teacheror teachers in the department of public health of a re-

cognised medical school; or produce evidence (ii.)that he has been a resident medical officer in a hospitalfor infectious diseases containing not less than 100 beds

during a period of three months,-the period duringwhich he has been engaged in acquiring practicalknowledge of his duties under this rule may bereduced to three months, to include an attendance on atleast 30 working days. 4. Every candidate shall produce evi-dence that after having obtained a registrable qualificationhe has during three months attended at least twice weeklythe practice of a hospital for infectious diseases at whichhe has received instruction in the methods of administra-tion. (Methods of administration shall include the methodsof dealing with patients at their admission and discharge, aswell as in the wards, and the medical superintendence of thehospital generally. In the case of a medical officer of theRoyal Army Medical Corps a certificate from a principalmedical officer under whom he has served, stating that hehas during a period of at least three months been diligentlyengaged in acquiring a practical knowledge of hospitaladministration in relation to infectious diseases, may be

accepted as evidence under Rule 4.) 5. The examinationshall be conducted by examiners specially qualified; it shallhave extended over not less than four days, one of whichshall have been devoted to practical work in a laboratory,and one to practical examination in, and reporting on,

subjects which fall within the duties of a medical officer ofhealth, including those of a school medical officer.The regulations in question as to study may be procured

at the office of the General Medical Council in London.

University of Oxford. -An examination, conducted partly inwriting, partly vivii voce, and in each subject partly practical,is held in Michaelmas and Easter Terms in the followingsubjects :-General Hygiene, General Pathology (withspecial relation to Infectious Diseases), the Laws relating toPublic Health, Sanitary Engineering, Vital Statistics. Theexamination is in two parts, which may be taken together orseparately ; but Part I. must be passed either before or atthe same examination as Part II. The fee for admission tothe examination is 5 for each part. Successful candidatesare entitled to receive the Diploma in Public Health. Anyperson whose name is on the Medical Register is admissibleas a candidate for this examination provided (1) a period ofnot less than twelve months shall have elapsed betweenthe attainment of registrable qualification and thetime when he presents himself for either part of theexamination; (2) he produce evidence of having, afterobtaining a registrable qualification, attended duringthree months the practice of a hospital for infectious

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THE NAVAL, MILITARY, AND INDIAN MEDICAL SERVICES.

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