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operations on the dead subject—viz.. Amputation, Ligature of 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 threeexaminations seldom exceeds ten days, and is usually less. Candidates have the option of passing each part- separately, 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 viva 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 day preceding theexamination. 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 6)0 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 Secretariat, 14, Rue des Sols,Bruxelles.

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 1910, but the conditions ofmedical service in the Royal Navy have been modifiedwith the intention of making the Service compare morefavourably with the sister Services, as well as with thecircumstances under which much civilian practice iscarried on.A new Order in Council was made on August 8th,

1911, based, it is understood, on the report of Sir JohnDurnford’s Committee, appointed two years ago. ThisOrder appeared on Friday, August 18th, and will, wefear, be a disappointment to all but the senior officersof the Service. The old ranks of inspector and deputy in--spector-general become surgeon and deputy surgeon-general,as they used to be in the army. Pay is increased by Is.- daily every alternate year till 28 years’ service, when it is£1 15s. a day, and for fleet-surgeons does not rise anyhigher. Deputy Surgeons-General get a rise of 3s. daily.Senior medical officers of battleships and cruisers with

complements of 650 and upwards get 3s. 6d. dailycharge pay, which is very right and has often beenasked for. The fleet-surgeon at Shotley is given 5s.charge pay, and staff-surgeons there may get 2s. 6d. The

surgeon who after entry desires to take up a post of housesurgeon may perhaps be allowed to do so, but he cannotcount that time for promotion. The surgeon who passesthe staff surgeon’s examination at his first attempt maysecure 18 months’ earlier promotion by getting a special.certificate (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 £1000 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 £500.We doubt whether the added inducements are likely to com-plete the 10 per cent. shortage in the department, but, onthe other hand, the service is in many respects so gooda one, and the disabilities of civilian practice are justnow so much in evidence, that this surmise may be undulypessimistic.We would strongly urge on the authorities the advisa-

bility of removing legitimate grievances now; the reformscould 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.Allotment 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 arescarce and even junior partners are not to be found directlythey are wanted. The Services will therefore have to be

careful 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. With£20 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 £60for outfit. A private income is certainly not necessary. After20 years of service a naval surgeon is entitled to a pensionof £365 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 thatthough the Army and Indian Service are better paid,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. The

young surgeon, too, on board his vessel probably getsa better chance in the Navy than in the Army. So

long 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 quite recently. Formerly, candidateson passing the examination in London at once receivedtheir commissions as surgeons in the Royal Navy.They are now merely appointed acting surgeons.Then, after courses of instruction, they will be again

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examined, 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 pernapsthree 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-date, 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 importantinstruction in tropical diseases and naval hygiene theyreceive at Haslar. The relative proportions should bementioned if the best candidates are not to be frightenedaway. The entrance examination is also altered. Voluntarysubjects and hygiene are done away. The examination willdeal 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 the ’,Officers’ Training Corps. Nominated candidates, exceptthose nominated by colonial universities, are no longerallowed.

ROYAL NAVY MEDICAL SERVICE.

REGULATIONS FOR THE ENTRY OF CANDIDATES FOR COMMISSIONS INTHE MEDICAL DEPARTMENT OF THE ROYAL NAVY.

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 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 homeor abroad, as required; (5) whether he holds, or has held, anycommission or appointment in the public services; (6) that he is

registered under the Medical Act, giving the date of his registration as amedical student, or of his beginning professional study 1; and (7) whetherhe 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 candidates 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 he 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 ofthe exact date of this, as well as the number of commissions to becompeted for, will be advertised in THE LANCET. 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.

No candidate will be considered eligible who obtains less than 50 per Icent. 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 admit

annually not more than six candidates, according to requirements,specially recommended by the governing bodies of such colonial univer-

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

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 the 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. A fee of £1 will have to be paid by each candidate to entitle himto take part in the competition.Candidates who have served in the Officers’ Training Corps, and who

are in possession of the certificates laid down in the regulations for,

that 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 twoexaminations.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 he’has 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 this 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 will be allowed a second trial at thenext examination, the period between the two examinations not beingcounted as service for either promotion, withdrawal with gratuity, orretirement after 20 years’ service, and should he qualify he will beplaced at the bottom of his list; should he again fail his appointmentwill not be confirmed and he will be required to withdraw.A gold medal, a silver medal, and three navy regulation pocket cases

will be awarded as prizes in connexion with these examinations, and 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.Promotion.

An Inspector-General of Hospitals and Fleets will be selected fromamongst Deputy Inspectors-General who have in that rank three years’full pay service and who have not at any time declined foreign serviceexcept for reasons which the Lords Commissioners of the Admiraltyregard as good and sufficient.A Deputy Inspector-General of Hospitals and Fleets will be selected

for ability and merit from amongst Fleet Surgeons, but must haveserved in a ship of war at sea for two years as a Fleet Surgeon, or forfive years as Fleet and Staff Surgeon combined.

(a) Subject to the approval of the .LiVL’-l commissioners u 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 a ship of war at sea for three years,and have 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.

(a) Rank 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 in a ship of war for three years, and havepassed such examination as may be required after completionof five years from the date of entry in the rank of surgeon. (b) Specialpromotions will be made at their Lordships’ discretion to the rank ofStaff Surgeon in cases of distinguished service or conspicuous profes-sional merit. Such promotions will be exceptional and not exceed therate of one a year. The total number at any one time of Staff Surgeonsholding that rank by such special promotions will not exceed eight.No officer will be so promoted unless he passes the examination pre-scribed for other surgeons, but in such a case the requirement of fiveyears’ time in rank of surgeon will be dispensed with. (c) When a sur-geon’s promotion to the rank of Staff Surgeon has been retarded byfailure to pass the qualifying examination he will, should he pass andbe promoted, be dealt with as follows. He will be granted the seniorityas Staff Surgeon he would have received had he passed in ordinarycourse. He will reckon service for increase of full and half pay onlyfrom the date of appointment to full pay as Staff Surgeon. If on halfpay, or if placed on half pay when promoted, he will receive the lowestrate of half pay of the new rank from the date of passing the qualifyingexamination. Where delay in passing the qualifying examination maybe due to unavoidable circumstances special consideration will begiven. (d) The seniority of surgeons on entry will be determinedby the sum total of the marks they obtain at the London exa-mination and those at the conclusion of the Haslar course and 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 Haslar course and will be required to obtain qualifying marks.Surgeons entered without competition will take seniority next after thelast surgeon entered at the same time by competition. (e) The examina-tion for promotion to the rank of staff surgeon will be held by the Exa-mining Board, to which a naval medical officer will be attached to con-duct the examination in naval hygiene. The subjects of examinationwill be in writing and will include medicine, surgery, pathology,general hygiene, naval hygiene. (f) A candidate who at the timeof passing the examination for entry into the medical branch ofthe Royal Navy holds, or is about to hold, an appointment as residentmedical or surgical officer in a recognised civil hospital, will perhapsbe allowed to serve in such civil appointment provided that the periodof such service after the date of entry into the Royal Navy does not

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exceed one year. Pay from naval funds will be withheld from officerswhile thus serving, who will not be promoted earlier to staff-surgeon,if they have joined after Jan. 1st. 1910.A Surgeon who, on attaining eight years’ seniority in that rank, has

failed to pass the examination for the rank of Staff-Surgeon will becompulsorily retired with such gratuity as the Admiralty may see fitto award, but not exceeding :2500. This rule is not, however, to applyin cases where, in the opinion of the Admiralty, failure to qualify isdue to unavoidable circumstances, nor to surgeons who entered beforeJuly 1st, 1911, and who elect to receive pay at the old rates. Surgeonsare to be eligible for accelerated promotion to Staff Surgeon accordingto the class of certificate obtained in the examination for the rank ofStaff Surgeon as follows -.-Special certificate, 18 months ; first-class cer-tificate, 12 months. The above acceleration of promotion is only to begranted in the case of an officer considered to be deservingof advancement, and the Admiralty will have power toreduce the several periods if considered advisable, on the recom-mendation of the Director-General of the Medical Department.No surgeon who has failed to pass for staff surgeon will be grantedaccelerated promotion on the result of any subsequent examination,whatever may be the class of certificate obtained.No restriction is to be placed upon the number of special promotions

which may be made to the ranks of staff and fleet surgeon for gallantryin action.

- FMH Pay.

The medical officers in charge of the following hospitals and sickquarters will be granted charge pay: Haslar, Plymouth, Chatham,Malta, Hong-Kong, Bermuda, Portland, Yarmouth, Haulbowline,Cape, Gibraltar, and Yokohama. The rate of charge pay will be as

The hospital allowances for naval medical officers at home andabroad, in lieu ot provisions, for themselves and servants, and for fuel and lights, are as follows :-

* Except at Malta, where the allowance will be £70, but servants willbe provided at the public expense. These allowances are also grantedto medical officers of marine divisions and dockyards.

Charge pay at the Training Establishment at Shotley is to be grantedto Fleet and Staff Surgeons in charge of medical duties as follows :-Fleet Surgeons of four years’ seniority 5s. a day; Fleet Surgeons underfour years’ seniority, and Staff Surgeons, 2s. 6d. a day; the MedicalOfficer in charge of the medical duties of a ship-of-war at sea with acomplement of not less than 650 officers and men is to receive chargepay at the rate of 3s. 6d. a day.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. The Fleet and Staff Surgeons serving at the Admiralty and theMarine Rendezvous will be granted the Hospital allowance of £53 ayear in addition to the usual lodging money Medical officers con-ducting the courses of instruction at Haslar .Hospital will receive thefollowing allowances: two senior officers employed upon this duty,.S150ayeareach; the junior officer assisting, .S50 a year; and the juniorofficer instructing the Sick Berth Staff, 2,50 a year. The junior officerinstructing the Sick Berth Staff at Plymouth, 2,50 a year. Medicalofficers employed elsewhere than at a hospital, and not victualled inkind, receive an allowance of Is. 6d. a day in lieu of provisions, fuel,and lights. The travelling allowances, extra pay, lodging money, andcompensation for losses are fixed for naval medical officers according totheir relative rank in the service. -

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, Bif he has had three years’ non-employment in any one rank, or after four years’ continuous Inon-employment in any tworanks combined. Except that

IInspector and if in any particular case the Deputy In- Lords Commissioners of thespector-General Admiralty may consider thatof Hospitals the interests of the public To be retiredand Fleets. service will be materially ad- irrespective of

vanced by the further retention irrespective ofof an Inspector-General age if foundof Inspector -General of physically un-Hospitals and Fleets on the physically un-active list, the age for the re- fit for service.

tirement of such Inspector-General may be extended to 62.

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

if he has had three years non-

IStaff Surgeon, employment in any one rank,

and Surgeon. or after four years’ continuous and Surgeon. ’ ) non-employment in any tworanks combined.

The special attention of candidates is directed to the following rulesunder which officers are allowed to withdraw from the service afterfour years’ full pay service in the Royal Navy, with the advantage ofjoining the Reserve of Naval Medical Officers :-After four years’ service in the Royal Navy, an officer, if he wishes,

may pass from active service to the Reserve of Naval Medical Officers,when he will reap the following advantages :-

(1) He will be granted a gratuity of B500 on passing into the Reserve.(2) His name will be retained in the Navy List; he will retain his

naval rank and be entitled to wear his naval uniform under the regula-tions applying to officers on the retired and reserved lists of His Majesty’sNavy.

(3) If he agree to remain in the Reserve for four years he willreceive a retaining fee of JE25 per annum. If at the expiration ofthis period he agree to remain in the Reserve for a further period offour years he will continue to receive the same retaining fee.Should an officer prefer it, however, he may simply enter the Reserve

for a period not exceeding eight years, with power togive six months’notice of his intention to resign his position at any time (in which casehe will receive no retaining fee). He may also adopt this method ofReserve service after the expiration of four years served under theconditions 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.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 willreceive the rate of pay-viz., 17s. a day and allowances-to which theywould 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 Lordshipsapproval, 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.The name of an officer so withdrawing will be removed from the listof the Navy, with which all connexion will then be severed, except inthe case of officers who withdraw after four years who are liable toserve in the Reserve. (c) Voluntary retirement and withdrawal at thediscretion of their Lordships will be allowed, as a rule, only when anofficer is unemployed or serving at home. Under special circum-stances, however, it may be permitted in the case of an officer servingabroad, provided he pays his passage home, and, if necessary, that ofhis successor. (d) Applications from officers to retire or withdrawor resign their commissions will receive every consideration, but noofficer will, as a rule, be permitted to resign under three years from thedate of entry. In order that arrangements may, as far as possible,

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be made for the relief of officers who may wish to withdraw on a

gratuity it is desirable that six months’ notice of their wish should beforwarded for the consideration of their lordships. The Admiraltyreserve to themselves power to remove any officer from the list formisconduct.Gratuities and retired pay will be awarded on retirement and with-

drawal on the undermentioned scale:-

* To obtain this rate an officer must hold the commission of FleetSurgeon.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 and in the paragraph followingthis under (b), but such officer will not be entitled to receive anyspecial compensation for the disability in addition to the gratuityas 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 £ 125 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.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 be 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 ,c50 per annum for a surgeon’s widow up to Q120for the widow of an Inspector-General; for each child an allowance isgranted ranging from ,c9 to ,c20 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.A special cabin will be appropriated to the Fleet or Staff Surgeon or

the Surgeon in charge of the medical duties in each ship. Specialregulations have been made as regards the mess expenses of medicalofficers appointed to the several divisions of Royal Marines for limitedperiods.Every medical officer will be required to undergo a post-graduate

course of three months’ duration at a Metropolitan Hospital oncein every eight years (should the exigencies of the Service permit),and this as far as possible during his Surgeon’s, Staff Surgeon’s, and

Fleet Surgeon’s period of service. While carrying out this course the,medical officer will be borne on a ship’s books for full pay and willreside at the Royal Naval College, Greenwich. The repayment oftravelling expenses to and from his home or port will be governed bythe King’s Regulations ; the fees for each course (not exceeding .E25)will be paid by the Admiralty on the production of vouchers at theend of the course. The medical officer will be required to produceseparate certificates of efficient attendance in the following: (1) themedical and surgical practice of the hospital, including instruction inanaesthetics; (2) a course of operative surgery on the dead body ;(3) a course of bacteriology ; (4) a course of ophthalmic surgery,particular attention being paid to the diagnosis of errors of refrac-tion ; and (5) a practical course of skiagraphy.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 promulgatedin 1903 promotion was accelerated, special promotion in thelower grades was made possible in cases of distinguishedservice or conspicuous professional merit, and encouragementto enter the service, in the shape of earlier promotion, wasgiven to men who have held resident posts in recognisedhospitals. A feature of the regulations is the permission towithdraw at the end of four years with a gratuity of £ 500.The new Order in Council, founded, it is presumed, on therecommendations of Sir John Durnford’s Committee, grantsa small increase of pay 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 mustalso 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 a

period 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 Waarant 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 e-tablishment 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—(1) 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 Colonels grade another

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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 Director-General, A.M.S., in sufficient time to permit of refer-ence to the medical school in which the candidate completed hiscourse as a medical student.

APPLICATION OF A CANDIDATE FOR A COMMISSION IN THE ROYALARMY MEDICAL CORPS.* *

(A Candidate 1vill not be permitted to compete oftener than twice.)1. Name in full.2. Address.3. Date of birth. fi4. 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 presenthimself.

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 Tne 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 Office,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 thecorps. A candidate whose application is regarded as satis-factory will be directed to appear before the Director-General,Army Medical Service, a few days preceding the examina-tion. The Director-General will decide if the candidate maybe allowed to compete for a commission. If approved, hewill then be examined as to his physical fitness by a boardof medical officers detailed by the Director-General a fewdays preceding his examination. The following is theorder 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, weight, and chestgirth is not 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 eyeliable 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 I.

In Standard III., the standard for the test for distant vision, withoutglasses, for officers of the Special Reserve, will be not below 6/36.

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 :-

No relaxation of the standard of vision will ever be allowed.The following additional points will then be observed. (f) That his

hearing 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. (m) 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 is not of pure Europeandescent the fact should 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 Pl is required from each candidate admitted to

the examination.Candidates who have been specially employed in consequence of

a national emergency, either as an officer or in a position usually filledby an officer, will be allowed to reckon such service towards retired payand gratuity, and if over the regulated limit of age at the date of com-

mencement of the competitive examination will be permitted todeduct from their actual age any period of that service if suchreduction will bring them within the age limit. The duration of

service is to be reckoned from the date on which the candidate com-menced such service, except in the case of candidates who have served

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for two or more periods at short intervals. In such cases the totalperiod of service to be considered in granting marks at the entranceexamination will be specially determined.Candidates who have served in the Officers Training Corps, and who

are in possession of the certificates laid down in regulations, will becredited at the entrance examination with additional marks as follows :those having Certificate A will receive 1 per cent., and those havingA and B 2 per cent. of the maximum marks allotted.A candidate successful at the entrance examination will be appointed

a Lieutenant on probation and will be required to pass through suchcourses of instruction as the Army Council may decide and, after

passing 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.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 hospitalshall be determined by the place he has gained at the entranceexamination. A lieutenant cannot be so seconded for more than 12months, and during this period he will not draw pay from Army funds,but his service will reckon towards promotion, increase of pay, gratuity,and pension. 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.EXAMINATIONS.

Sttbjects for the Entrance Examination.Candidates will be examined by the examining board in medicine

and surgery. The examination will be of a clinical and practica:character, partly written and partly oral, marks being allotted underthe following scheme.

Medicine (written). Maximum

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 illnessor 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 thecandidate 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 generalclinical 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 in 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 Lieutenant-ColonelC. H. Melville, M.B., in that of hygiene, Captain J. C.Kennedy and Major C. F. Wanhill 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 Captain J. Galloway, M.D., F.R.C.S.,4th London General Hospital. Surgery: W. H. Clayton-Greene, M.B., F.R.C.S. ; and Captain H. S. Collier, F.R.C.S.,3rd London General Hospital. Dermatology : A. Whitfield,M.D. Midwifery and Gynaecology: G. F. Blacker, M D.,F.R.C S. Ophthalmology : J. H. Parsons, M.B., F.R.C.S.Otology with Laryngology and Rhinology: H. Tilley, M.D.,F.R.C.S. Specific Fevers: E. W. Goodall, M.D. Besidesthese lecturers an honorary consulting staff has been

appointed 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-GeneralA. F. Bradshaw, 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, C.B., F.R.C.S., 2ndLondon General Hospital ; and Honorary Colonel Sir W.Osler, Bart, M.D., LL.D., F.R.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 thepresent time included bacteriology and demonstrations inmicroscopic diagnosis, preparations of vaccines, &c., specialattention being given to modern methods of research in thecausation 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 onprobation 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. The maximum numberof marks obtainable at this examination will be 100.A Lieutenant on probation who fails to qualify in eitherof these examinations will be allowed a second trial, and,should he qualify, will be placed at the bottom of the list.Should he again fail in either examination his commissionwill not be confirmed. Illiteracy on the part of a candidateas evinced by inaccurate spelling, poor composition, or

grammatical errors in the oral examination, at the entranceexamination, or at the examinations undergone while on pro-bation will be regarded as disqualifying for appointment.

EXAMINATIONS FOR PROMOTION IN THE ROYAL ARMY MEDICALCORPS.

These examinations are intended to test the progress and proficiencyof officers in those branches of knowledge which are essential to theircontinued efficiency.Lieutenant before Promotion to Captain.-This examination may be

taken at any time after completing 18 months’ service and will beheld in the military district in which the officer is serving. Thesubjects of this’examination, which are detailed in the King’s Regu-lations, are as follows: (1) squad, company, and corps drills andexercises; (2) (a) the terms of the Geneva Convention; (b) a generalknowledge of the administration, organisation, and equipment of the

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army in its relation to the Medical Services; (3) the duties of ward-masters and stewards in military hospitals, and the preparation ofreturns, accounts, and requisitions connected therewith; (4) duties ofexecutive medical officers ; and (5) military law.

Captains before Promotion to Major.-Captains will be examinedunder the following rules, and will be eligible for acceleration intheir promotion to the rank of Major under Article 303 of the PayWarrant. An officer who gains accelerated promotion will be placedfor precedence after the last officer (whether subject to accelerationor not) promoted approximately 3, 6. 12, or 18 months before him.This examination, which may be taken at any time after completing

five years’ service, will be held on the termination of a period ofspecial study at such times and under such arrangements as theDirector-General A.M.S. may determine. The examination will consistof written papers, essays, oral and practical examinations in thefollowing subjects, which are detailed in the King’s Regulations:(1) medicine; (2) surgery; (3) hygiene; (4) bacteriology and tropicaldisease ; (5) one special subject from the subjoined list: (a) bacteriology,including the preparation of antitoxins; (b) dermatology, includingvenereal diseases; (c) midwifery and gynaecology ; (d) operativesurgery, advanced; (e) ophthalmology; (f) otology, including laryn-gology and rhinology ; (g) State medicine ; (6) military law.Majors before Promotion to Lieutenant-Colonel.-This examination,

which may be taken at any time after three years in the rank ofMajor, will be held in the military district in which the officer isserving at times which will be duly notified. The subjects of this exami-nation, which are detailed in the King’s Regulations, are as follows:1. Army medical organisation in peace and war. 2. Sanitation oftowns, camps, transports, and all places likely to be occupied by troopsin peace and war; epidemiology, and the management of epidemics.3. (a) Medical history of the more important campaigns and thelessons to be learnt therefrom ; (b) a knowledge of the Army MedicalServices of the more important Powers; and (c) the laws and customs ofwar, so far as they relate to the sick and wounded. 4. A tacticalproblem in field medical administration.

PAY, ADDITIONAL PAY, AND CHARGE PAY.The following are the rates of pay, additional pay, and charge pay

of the Army Medical Service and Royal Army Medical Corps :—

Pay.

A Captain of the Royal Army Medical Corps, holding the brevet rank Iof Major, shall receive pay at 2s. a day, in addition to the pay of hisrank.

Additional Pay.An officer not serving on the Headquarters Staff appointed a member

of the Advisory Board, £ 150 a year. An officer under the rank ofLieutenant-Colonel holding an appointment as specialist, 2s. 6d. daily

Charge Pay.(a) An officer in charge of a general or other hospital, or of a division

of a general hospital- Daily.

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 soserving he shall receive a retaining fee of .E25 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 Officers.A Lieutenant on probation who at the time of passing the examina-

tion for admission to the Royal Army Medical Corps holds, or is aboutto hold, a resident appointment in a recognised civil hospital may beseconded for the period not exceeding one year during which he holdsthe appointment. While seconded he shall not receive pay from armyfunds, but his service shall reckon towards promotion, increase of pay,gratuity, and pension.

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 previously qualified in such manner as may be prescribedby the Army Council.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 torender him eligible for that rank may be reduced as follows :-

Promotion to the rank of Colonel to complete an establishmentshall 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 distinguishedservice in the field or for meritorious or distinguished service ofan exceptional nature other than in the field. If the officer diesbefore 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 failedto qualify, may have been debarred from further opportunity ofqualifying, may be provisionally promoted. If, however, he fails toqualify on the first available opportunity his promotion shall becancelled and he shall be retired from the service. An officer shallreckon 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 ifhe had remained on the establishment, and his service while secondedshall 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 theArmy Council. All other Surgeon-Generals shall rank as Major-Generals in relation to combatant officers. Officers of the ArmyMedical Service above the rank of Colonel shall hold the substantiverank of Surgeon-General.

RETIREMENT.

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

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

Scale of Retired Pav.

Except in the case of a Colonel, or a Lieutenant-Colonel, an officerwho, on voluntary retirement, has served for less than three years in

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the rank from which he retires, shall be 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 Director-General of the Army Medical Service shall, unless his

service has been specially extended to complete 30 years’ total service,retire on completion of the term of his appointment, and the retire-ment of other officers of the Army Medical Service shall be compulsoryat 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.

It shall be competent to the Army Council to place a medical officeron the retired list after 30 years’ service.

(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.An officer, whether on full pay or half pay, who, to the satisfaction

of the regulated medical authority has been pronounced insane,shall be retired from the Army.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.

Rates for Officers not quadified for Retired Pay or Gratuity 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 Army 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.

MEDICAL OFFICERS OF THE REGIMENTS OF HOUSEHOLD TROOPS.Commissions as surgeon-lieutenants in the Household Cavalry shall

be given, on the nomination of the titular colonels of the regiments, topersons approved by the Army Council. The conditions governing payand promotion are similar to those laid down for the Royal ArmyMedical Corps.

EXCHANGES AND TRANSFERS.An officer of the Royal Army Medical Corps shall be permitted to

exchange with another officer of such corps, or with a medical officerof the Household Cavalry, under such conditions and regulations asmay from time to time be made.Exchanges between officers of the Royal Army Medical Corps under

the rank of Major and medical officers of the Indian Army, andtransfers of such officers from either of the above services to the other,shall only be permitted subject to the approval of the Secretary ofState for India in Council and on the following conditions : (1) Thatthe officers have less than seven years’ service; (2) that the seniorofficer exchanging takes the place of the junior on the list and shall notbe promoted until the officer next above him has been promoted;(3) that the junior officer exchanging is placed for seniority next belowall medical officers whose commissions have the same date as his own;and (4) that the officer transferred is placed for seniority below allmedical officers holding the same rank at the time of his transfer andshall not be promoted until the officer next above him has been

promoted.An officer of the Royal Army Medical Corps who has exchanged or

been transferred from the Indian Army shall reckon, subjectto the above conditions his previous service with the said forcestowards promotion, increase of pay, gratuity, and pension.

LEAVE OF ABSENCE. Full pay during ordinary leave of absence for 61 days in each year at

home stations and generally longer periods abroad may be granted to amedical officer provided that no additional expense is incurred thereby.When the period of leave has been exhausted or exceeded in con-

sequence of sickness no further pay during ordinary leave shall remaindue.

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 the regulated medical authority, provided there is reasonableprobability that he 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 tropical

’ service or to active operations, the period may be extended, but itshall not exceed 18 months in all.

When a medical officer is sick at his station, whether in hospital,quarters, or lodgings, his absence from duty on account of sickness,up to a period of 30 days, and if duly certified by a medical officer,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. Anv excess of such leave of absence on accountof sickness at an officer’s station beyond the period of 30 days shallbe deducted from his ordinary leave.

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 for

any 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 andother relatives of deceased officers are given under certain conditionsspecified in the Royal Warrant for Pay and Promotion. There is alsoan Army Medical Officers’ Widows’ and Orphans’ Fund on mutualassurance principles.

PAY IN INDIA.

There has been an improvement of late years in the

pay and conditions of service of army medical officers inIndia, as elsewhere. The pay and allowances (which arecombined in India) of a lieutenant are 420 rupees permensem ; for captain’s rank, the pay and allowances are from475 rupees to 530 rupees after seven, and to 650 rupees afterten years’ service. Majors receive 789 rupees on promotionand 826 rupees after 15 years’ service. Lieutenant-Colonels,1150 rupees. In addition, charge pay is given, rangingfrom 60 to 240 rupees according to the number of beds

equipped in a hospital. There are also various specialistappointments, cantonment hospitals, &c., carrying extra

pay, that are shared between the Royal Army Medical Corpsand the Indian Medical Service. The value of the rupee isfixed at Is. 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 borq subjects 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 Januarv 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 theadvertiseTne2it of the examination. a declaration according to theannexed form, which is procurable from the Military Secretary.

Declaration and Schedule of Qualifications to be Filled up 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; (e) certificate ofhaving attended a course of ophthalmic instruction, showing that thecourse included instruction in errors of refraction; (d) evidence of aregistrahle qualification; (e) in case of natives of India or othersed1wated in that country only, a certificate from the Director-General,Indian Medical Service.

1. Name in full.2. Address. (Any alteration to be notified to the Military Secretary,

India Office, London. S W.)3. DM,e of birth. (This must be supported by a certificate or statu-

tory declaration. See Parngraph 4 of the Regulations.)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 merlical education.7. Medical School in which the candidate completed his course as a

medical student, and, name of the Dean or other responsible authority.

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8. Degrees of B.A. or M.A.; details as to any prizes, universityhonours, &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. b. A recommendation and certifi-cate of moral character from two responsible persons-not membersof his own family-to the effect that he is of regular and steadyhabits and likely in every respect to prove creditable to the serviceif admitted. c. A certificate of having attended a course of instructionfor not less than three months at an ophthalmic hospital or the oph-thalmic department of a general hospital, which course shall includeinstruction in the errors of refraction. d. Some evidence of havingobtained a registrable qualification. e. Any European educated inIndia 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.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 servicein 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 ;E1 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.

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 physicalsigns 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 he con-sidered typical and those which appear to be unusual or only accidentalcomplications. (e) Suggestions as to treatment, both immediate andpossiblv 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

granted about a month’s leave and will then be required to attend twosuccessive courses of two months each at the Royal Army MedicalCollege. Millbank, and at Aldershot. The candidatf,’s commission as alieutenant will bear the date on which the result of the entranceexamination is announced, but his rank will not be gazetted until hehas passed the final examination, held at the conclusion of his period ofinstruction.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 tropicalservice.The course at Aldershot will include instruction in (1) internal

economy, (2) Indian military law, (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 W711 be providedwith quarters (where quarters are not provided they will obtain

the 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.

Officers appointed to the Indian Medical Service will be placed on onelist, 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 employluentelsewhere according to the exigencies of the service. -’.-:""ÍA lieutenant who, within a reasonable period before the date ar,

which he would otherwise sail for India, furnishes proof of his electionto a resident appointment at a recognised civil hospital,2 may be secondedfor a period not exceeding one year from the date on which he takesup 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.

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 voung 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 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 is

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. Newca,st]e-on-Tyne: Royal Infirmary.Oxford: Radcliffe Infirmary. Sheffield: Royal Infirmary and RoyalHospital. Scotland.-AberdeeD: Royal Infirmary. Dundee: RoyalInfirmary. Edinburgh : Royal Infirmary. Glasgow : Royal Infirmaryand Weqtern Infirmary. Ireland.-Belfast: Royal Victoria Hospital.Cork: North Infirmary and South Infirmary. Dublin: AdelaideHospital, City of Dublin Hospital, Jervis Street Hospital. MaterMisericordi2e 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.

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carried 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 oflearning something of native customs and are encouragedto learn the vernacular, so as to be less dependent upontheir subordinates when first put in responsible positions.

PROMOTION.A Lieutenant is promoted to the rank of Captain on completing three

years’ 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 without examinationafter 12 years’ full-pay service ; this Ipromotion may be accelerated bysix months in the case of officers who fulfil certain specified conditions. IA Major is promoted to Lieutenant-Colonel without 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.

LEAVE RULES.Officers of the Indian’Medical Service below the rank of Colonel may

be 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, :E250 a year; after the commencement of the tenthyear’s service for pension, jE300 a year ; after the commencement of thefifteenth year’s service for pension, JE450 a year; after the commence-ment of the twentieth year’s service for pension, jE600 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 isrequired to join at once on being recalled to duty unless certified bya 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 .E250 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 ol

the Indian Medical Service from the date of their arrival in India(N.B.-l 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 rovided 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 z

Rs. per mensem,Rs. per mensem,

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 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 consideredeligible for civil employment. The principal appointments, togetherwith the salaries attached to each, are stated in the following table :-

An allowance of Rs. 100 per mensem is also granted, in addition, tothe chief plague medical officers in certain provinces.There are also six Chemical Examiners with Rs. 800-1650 per mensem

and a number of Port Health Officers with Rs. 750-1950 per mensem.Other appointments of Resident Surgeons and Physicians at hospitals,&c., are on salaries ranging from Rs. 700 to 1650 per mensem. Thereare also a certain number of appointments under the Political Depart-ment on salaries ranging from Rs. 450 to 1450 per mensem, exclusive oflocal allowances.

Qualified officers of the Medical Service are also eligible forappointments in the Assay and Mint Departments. The salaries ofthese appointments are from Rs. 600-2250 per mensem.

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 Prihcip’tl Medical Officer of HisMajesty’s Forces in India and Secretary to the Principal Medical Officer of

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His Majesty’s Forces in India. Ilalf the appointments of PrincipalMedical Officers areto Divisions and Brigades, the other half being filledby Royal Army Medical Corps Officers. In the junior ranks half theappointments to military staff surgeoncies, the medical charge otcantonment hospitals and Staff Officers for medical mobilisation stores ineach of the nine divisions of the Army are allotted to the Indian MedicalService and the other half to the Royal Army Medical Corps. Theappointments of Medical Storekeepers to Government, which supply theneeds of the Civil,’3nd.Military Departments, are reserved for the IndianMedical Service alone.

TENURE OF OFFICE IN ADMINISTRATIVE GRACES.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 duly in the same grade or for employ-ment in*thehigher,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 expirationof the five years’ tour of duty, are permitted to draw in India anunemployed salary of Yes. 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 service Iand has reverted to British pay may reside in Europe, at the same time !,Qualifying for higber pension.

RET]IRING PENSIONS AND HALF-PAY.Officers of the Indian Medical Service will be allowed to retire on

the following scale of pension on completion of the required periods of

Service 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..Officer of the Indian Medical Service are liable after retirement on

pension 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 betransferred 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 PEWSIOWS.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 scale :-

-

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.

The Royal Army Medical Corps is at the present time, webelieve, a fairly contented service, although for some timeback there has been a feeling of uneasiness and uncertaintyamongst all ranks, but 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.We had reason to refer to this condition of affairs in anannotation on the appointment of the present Director-General (vide THE LANCET, April 2nd, 1910, p. 936). 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. Dissatisfaction is also caused by the inconveniencecaused to officers under 12 years’ service having to remain inmilitary hospitals on orderly duty as often as every fourthnight for night duty and carry out their day work as well.The improvements that have been 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 medicalservice. 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.

In the Indian Medical Service the recent introduction ofthe increased pension (.E600 per annum) after 27 yearsservice has been an important concession ; there is still,however, a block in promotion, administrative rank, whichused to come after 26 or 27 years’, being now generallydeferred until over 30 years’ service ; limitation of the periodof service in administrative rank, as recently adopted in theRoyal Army Medical Corps in the case of the colonel’s grade,would probably be an improvement. The order issued that anofficer of the Indian Medical Service must refer the questionof his fees when above a certain low limit to the civil

authority was most objectionable: it might necessitate theviolation of professional secrecy and it is professionallydegrading. Revised rules were promulgated in the early partof the present year (see THE LANCET, March lltb, 1911,page 682), which, if there is really necessity for anyregulations at all in these matters, need not be objectedto. The neglect of the rule that the office of prin-cipal medical officer to His Majesty’s forces in Indiamay be held by an officer of the Indian Medical Service isstill felt to be a grievance. On the whole it can hardlybe said that the Indian service at the present time offersthe advantages over the Royal Army Medical Corps, eitherprofessional or pecuniary, that it formerly possessed.If the changes foreshadowed by the Secretary of State (seeTHE LANCET, May 29th, 1909, p. 1537, and July 10th, 1909,p. 91) be carried out, it seems to be inevitable that thestatus, prospects, and influence of the Indian MedicalService will be affected injuriously. The objectionsto these proposals are, however, we venture to think,so serious on the grounds of general policy that we

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abstain from any criticism on their effect on the

prospects of the Indian Medical Service; there is,indeed, no concrete proposal to criticise. It is, moreover,a dangerous thing to introduce a feeling of distrustand uncertainty mto any public service ; if the dutieshitherto performed by the Indian Medical Service are

in 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 INSTATE MEDICINE.

RESOLUTIONS, designed with a view of ensuring "thepossession of a distinctively high proficiency, scientific andpractical, in all the branches of study which concern the

public health," have been adopted at various times by theGeneral Medical Council from 1902 to 1910. The rules

require that-" 1. A period of not less than twelve monthsshall have elapsed between the attainment of a registrablequalification in Medicine, Surgery, and Midwifery and theadmission of the candidate to any examination or any partthereof for a diploma in Sanitary Science, Public Healthor State Medicine. 2. Every candidate shall produceevidence that after obtaining a registrable qualification hehas during six months received practical instruction in alaboratory or laboratories, British or foreign, approved bythe licensing body granting the diploma, in which chemistry,bacteriology, and the pathology of diseases of animals trans- Imissible to man are taught. 3. Every candidate shallproduce evidence that, after obtaining a registrable qualifi-cation, he has during six months (of which at least threemonths shall be distinct and separate from the period of

laboratory instruction required under Rule 2) been diligentlyengaged in acquiring a practical knowledge of theduties, routine and special, of Public Health administra-tion either under the supervision of : (a) in Englandand Wales, the medical officer of health of a countyor of a single sanitary district having a populationof 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 health of a

county or counties, or of one or more sanitary districtshaving a population of not less than 30,000 ; or (0) in

Ireland, a medical superintendent officer of health of a

district or districts having a population of not less than

30,000 ; 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. (The certificate of an assistant medical officer ofhealth of a county or of a single sanitary district having apopulation of not less than 50,000 may be accepted as evi-dence under Rule 3, provided the medical officer of healthof the county or district in question permits the assistantofficer to give the necessary instruction and to issue certifi-cates. Provided that the period of six months may be reducedto a period of three months (which shall be distinct and

separate from the period of laboratory instruction requiredunder Rule 2), in the case of any candidate who producesevidence that after obtaining a registrable qualification hehas during three months attended a course or courses ofinstruction in sanitary law, sanitary engineering, vitalstatistics, and other subjects bearing on, Public HealthAdministration, given by a teacher or teachers in the

Department of Public Health of a recognised medicalschool. A candidate who shall have produced evidencethat he has himself held for a period of not less than threeyears an appointment as medical officer of health of a

sanitary district within the British Dominions, and having apopulation of not less than 15,000, may be exempted from

the requirement of Rule 3.) 4. Every candidate shall

produce evidence that after having obtained a registrablequalification he has attended during three months the

practice of a hospital for infectious diseases at which oppor-tunities are afforded for the study of 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 special outdoor duties of amedical officer of health."

i The regulations in question-as to study may be procuredat the office of the General Medical Council in London.

University ./ of -London.-State Medicine is one of the subjectswhich candidates for the M.D. degree may offer (Branch V.).Certificates must be produced showing that a course of prac-tical instruction has been attended for the prescribedperiod, and that the course has included such chemical,microscopical, and meteorological work and exercises asmore especially relate to sanitation. The attendance in-cludes six months’ practical instruction in a laboratory andsix months’ instruction in public health administration underthe supervision of a medical officer of health, and threemonths’ attendance on the practice of a hospital for in-fectious diseases. In connexion with this degree the variousmetropolitan medical schools hold regular classes underteachers of Public Health and Sanitary Science, such in-struction being also used to obtain the various diplomas ofother Universities and of those Royal Corporations whichgrant them.

University of Oxford. -An examination, conducted partly inwriting, partly vivi 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 .S5 for each part. SU0cessful 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 the

examination; (2) he produce evidence of having, after

obtaining a registrable qualification, attended duringthree months the practice of a hospital for infectiousdiseases at which opportunities are afforded for the

study of methods of administration; . (3) he produceevidence of having, after obtaining a registrable qualifica-tion, attended during a period of six months on one or morecourses, approved by the Syndicate, of practical laboratoryinstruction in Chemistry, Bacteriology, and the Pathology ofthose diseases of animals that are transmissible to man ; and(4) he produce evidence of having, after obtaining a regis-trable qualification, for six months (of which at least threemonths shall be distinct and separate from the period oflaboratory instruction) been associated day by day in theduty, routine and special, of public health administrationunder the supervision of : (a) in England and Wales eitherthe medical officer of health of a county or of a singlesanitary district having a population of not less than 50,000or a medical officer of health devoting his whole time topublic health work ; or (b) in Scotland or Ireland themedical officer of health of a county or of one or moresanitary districts having a population of not less than

30,000; or (c) a medical officer of health who is a teacherin the department of public health of a recognised medicalschool; or (d) a sanitary staff officer of the Royal ArmyMedical Corps having charge of an army corps or district;