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NAVAL MEDICAL SERVICE.

THE life offered to officers of the Royal NavaMedical Service is one that ought to appeal to a largEsection of recently qualified medical men. There is ncintention in what follows, under this or the subse-quent headings, to pit one Service against the othelor to recruit in one direction more than in another,The particular regulations for each Service shouldsuffice to give each man the necessary impetus for adecision, but it is useless to disguise the fact that theattitude of the authorities in respect to the com-pulsory retirement at the age of 50 of a group ofsurgeon commanders who were under contract tobe employed until the age of 55 has produced anunfortunate impression. It creates a difficulty forthose who are in a position to advise young men asto their future careers when they give counsel basedupon engagements which may later be repudiated.The situation has evoked a formal protest from theBritish Medical Association, and although no specificaction was recommended to the Association by itsRepresentative Body, certain protests have foundtheir way into the public press and cannot havefailed to prejudice recruiting for the service.

In the Navy the young medical officer sees theworld in congenial company and with an assuredposition, the pay is good, the pensions are commen-surate, and the opportunities offered now forscientific work are real, while, if they are taken,promotion awaits the officer on grounds of professionalmerit.Rank of Surgeon Lieutenant-Commander will be

granted to surgeons at the expiration of six yearsfrom date of entry, and the point upon which stressshould be laid is that special promotion can be madein cases of conspicuous professional merit, which isthus placed on a par with general service. Six yearslater the period of promotion to Surgeon Commanderis reached, after having passed the qualifying exami-nation, when again special promotions can be madefor conspicuous professional merit as well as fordistinguished service ; but promotions are limited innumber, save, of course, for gallantry in action. Thisrecognition of professional attainment should provea very real incentive to progressive scientific work.The same principle prevails in the higher ranks.Promotions to Surgeon Captain and later to SurgeonRear-Admiral are made strictly by selection, but areconfined to officers who prove fitted, both profession-ally and as administrators, for this rank.Naval life may lead to opportunities for putting

into practice much of what has been learned in theclinical wards of a hospital. Further, the openingfor preventive medicine is large and many-sided,while appointments to the large shore establish-ments enable medical officers to keep their workmodern.New chemical explosives, as well as the extraordinary

behaviour of common articles under extraordinaryconditions of stowage, furnish perpetual problemsand surprises for the medical officer on board ship,and bring him into intimate connexion with hischarges in a way that is particularly necessary con-sidering the conditions of life. No medical officercan expect to succeed unless he secures the confidenceof those committed to his charge, and the healthlectures which he is bound to deliver will be muchmore fruitful if they are delivered to an audience Iwhich trusts him. Moreover, the delivery of officiallectures does not end this side of the medical officer’sduties. He must be ready to answer questions,sometimes of real acuteness, which are put to him bythe modern blue-jacket, and he will find that hislectures will often afford a starting point of work thatmay develop into great professional interest. Thus, Iwithout his being necessarily a psychologist, hisinfluence will be felt by both officers and men, untilthe well-being of the ship may be profoundly affectedby the extent of his tact and skill; for example,small matters assume undue proportion under stress

of confinement, and the medical officer should bequick to detect danger signs and warn his command-ing officer. Numerous changes have been introducedduring the last 20 years into the naval dietary, manyof which were the outcome of representations andresearch by naval medical officers. The work wantscarrying on, for much of it has gone to show that thefood problem is very complicated. Every medicalofficer on board ship should make himself acquaintedwith food values and the human powers of assimila-tion under varying conditions of work and climate,and here there is ample scope for research. Themodern requirements of gunnery and navigationnecessitate precision in their use and have madeophthalmology a valuable subject for study in theNavy. The physical training of both officers andmen is based on physiological axioms which are pecu-liarly the field of the medical officer ; this trainingshould be the subject of a watchful eye. There is nolack of scope here for professional work withoutmaking any reference to the vast problems whichhave to be faced when the medical officer has toarrange his particular department to the best advan-tage during or after an action. It is certain that hewill not be able to do this unless in times of peace hegets himself ready by study. Lastly, there is thewhole field of venereal and tropical disease.The young medical officer need not be afraid that

his work will be without scientific interest if he takesthe opportunities offered him.

Conditions of Service.For the time being the regulations for entry by

examination into the permanent service are in abey-ance, but a short service scheme providing for transferto the permanent service has been inaugurated. Theregulations for the entry of surgeon lieutenants underthis scheme provide for the usual qualifications ofregistration, good character, physical fitness, andage-the age not to exceed 30 years. The conditionsof service are a three years’ engagement with anoption of a further year, to serve when and whererequired under the general rules of the service as

regards discipline, and to rank with, but after,surgeon lieutenants in the permanent service, and toreceive two calendar months’ notice of services beingno longer required.The pay is 21 6s. 6d. per day, or B483 12s. 6d. per

year, while there is a gratuity on discharge of 28 6s. 8d.for each completed month of service. A gratuity toofficers invalided for causes not within their owncontrol is payable, while the same allowances arereceived as are payable to permanent officers ofsimilar rank, and lodging and provision allowanceswill be made and be subjected to revision from timeto time. The rates mentioned are j680 a year whenemployed on shore without quarters, and 260 a yearin lieu of rations when not victualled in kind, whilearrangements are made for officers in temporaryemployment on shore. No unemployed or half payis granted, but there are pensions for wounds or injuryon duty, and in the event of death the officer’s widowand children would fall under regulations applyingto officers on the permanent list. There is an equip-ment allowance for ordinary uniform of 250, but theofficer provides himself with a pocket case of instru-ments and a stethoscope.A short service surgeon lieutenant after six months’

service, on application to the Secretary of the Ad-miralty, may be considered for transfer to the per-manent service on a satisfactory report being receivedfrom the senior medical officer of the Squadron,Hospital or Depot in which he has served or is servingas to his professional ability, and a favourable reportfrom his commanding officer as to conduct. Suchcandidates must have been under the age of 28 onjoining for short service, and officers so transferredwill not be eligible for the gratuities provided. Theywill be permitted to count their seniority from dateof entry for short service for purposes of promotionand for increment of full pay, and similarly they willbe permitted to count their service from the date of

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entry for purposes of retired pay, but for purposesof retiring gratuity on the permanent officers’ scaletneir services will be reckoned only from the date oftransfer to the permanent list, this date being thatof receipt in the ship or establishment in which theofficer is serving of the order for his transfer to thepermanent list. Until that date he will retain histemporary rate of pay.

If a short-service lieutenant wishes to transfer tothe permanent service he will then come under thefollowing conditions of pay and pensions :

RATES OF PAY AND PENSION.

On first appointment to the Service, Medical Officers willreceive full pay -from date of appointment, but subject to theprovisions of Article 1347 of the King’s Regulations, 1913.

Flag Allowances.An allowance of 5s. Od. a day in addition to full pay is

granted to the Senior Medical Officer of a flagship bearingthe flag of a Commander-in-Chief. An allowance of 2s. 6d.a day is granted to the Senior Medical Officer of a shipbearing other flags or broad pendants.

Rates of Pension.Compulsory retirement will be as follows :-(i) Surgeon Rear-Admirals retire at the age of 60 with

retired pay at the rate of 2900 per annum plus 222 perannum for each year’s service over 27 years counting forretired pay, subject to a maximum rate of 21010 per annum.If, however, less than 27 years’ service counting towardsretired pay is rendered, a deduction of 222 per annum ismade for each full year wanting to complete that period,subject to a minimum of 2790 per annum.

(ii) Surgeon Captains retire at the age of 55. Maximumretired pay, 2900.

(iii) Surgeon Commanders retire at the age of 50. Maxi-mum retired pay, 2600.

(iv) Surgeon Lieutenant-Commanders and Lieutenantsretire at the age of 45. Maximum retired pay, :B450.

Subject to these maxima, the rates of retired pay forSurgeon Captains, Surgeon Commanders, Surgeon Lieu-tenant-Commanders, and Surgeon Lieutenants are as

follows :-

(p.a.) =per annum.

(A) Addition for each full year’s service in excess of thatspecified in column 3 or deduction for each full year wantingto complete that period of service-addition or deductionlimited to five years in each case.

DENTAL BRANCH.The Naval Dental Service offers similar opportuni-

ties to qualified dental surgeons except that higherrank than that of Surgeon Commander (D) is notopen to them. They are provided with suitablesurgery accommodation equipped with modernappliances and supplied with all material requiredfor their work, and there is every opportunity forthem to maintain a high standard of professional skill.Entry is by competition, the Competitive Entrance

Examination being similar in scope to the FinalQualifying Examination. Candidates are required toproduce the usual certificates of birth, registration andof character, and must be physically fit for serviceanywhere. They must not be more than 28 yearsof age on the day of commencement of the entranceexamination. An outfit allowance of 250 is payableto officers finally entered.

Provision has been made for candidates who, atthe time of passing the examination, hold or are aboutto hold an appointment as Dental Officer in a recog-nised Civil Hospital. The time concerned, providedit does not exceed six months, may reckon for increaseof full pay while on the active list. It is also proposedto allow a three months’ Post-graduate Course toSurgeon Lieutenant Commanders (D) of over twoyears’ seniority. The rates of full pay are as follows :-

Pay and Alloivances.NOTE.-20 per cent. of these rates of full pay, half-pay,

and retired pay are considered as due to the present high costof living, and are subject to change on or after the lst July1924, and thereafter every three years, either upwards ordownwards, according as the cost of living rises or falls.

F1111 Pay.

On first appointment to the Service, Dental Officers willreceive full pay from the date of appointment, but subjectto the provisions of Article 1347 of the King’s Regulations,1913.

Dental Officers are eligible for the same rates of lodgingand provision allowances as other officers of equivalentrank and are entitled to the same privileges. The rates ofhalf-pay are :-

- H6f<f-f<t?/.&mdash;In the case of Dental Officers, a distinctionis to be drawn between (a) Officers awaiting employment, and(b) those who are permitted, for private reasons, which theAdmiralty regard as satisfactory, to refuse an appointment orto have their appointment cancelled, or who are unemployedat own request or in consequence of misconduct.

In the former case, (a), Officers are to receive unemployedpay, as follows :-For the first six calendar months, full pay of rank (without

allowances). For the next six calendar months :-

I Thereafter :-Half the full pay of their rank and seniorityon the Executive Officers’ scale, viz. :- _

I Unemployed pay will not, however, be granted in cases,where an Officer is undertaking continuous professional workfor which payment is made.

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In the latter case, (b), Officers may receive half the fullpay of their rank and seniority on the Executive Officers’scale.

Periods during which unemployed Full Pay or UnemployedPay are received will only count as half-pay time.An Officer who is permitted, for private reasons, to decline

an appointment, or to have his appointment cancelled willnot be entitled to any Unemployed Pay. In such cases,Officers may be placed on Half-Pay, and the conditions ofretirement, Widows’ Pensions, Leave, are the same asfor medical officers of equivalent rank and seniority.

Arrangements are also made whereby officers maybe allowed to withdraw from the Service after fouryears’ service and receive gratuities on the followingscale :-

(a) Gratuities will be awarded on retirement andwithdrawal on the undermentioned scale.

ARMY MEDICAL SERVICE.

THE recent alterations in the conditions of service Iin the Royal Army Medical Corps, which constituted,as we said at the time, the greatest reform that hastaken place in that Service for a generation, havewell fulfilled their promise. For many reasons

which are obvious and have been detailed on previousoccasions, the Service can be thoroughly recommendedto young medical practitioners. Competitive exa-minations for commissions into the R.A.M.C. are held Itwice a year, usually in January and July. The

Regulations for admission to the R.A.M.C. should beobtained from the Army Medical Department, WarOffice. London, S.W. 1, and carefully studied.

These are the things which the man who contem-plates joining the Service should bear in mind. Therates of pay and allowances are good; tht- chancesof seeing the world and the opportunities for post-graduate study are generous, and the work is nowadaysvaried, responsible, and interesting. At certain periodsthe young officer is relieved from all other duties forfive months for the purpose of post-graduate study.During this period he is on full pay and the fees forhis courses of instruction are paid by the State. Histime is devoted to post-graduate work, and theleading clinical and scientific institutions are co&ouml;perat-ing to secure that this post-graduate work shall bereal and fruitful. Officers who show a markedaptitude for special subjects and have had previouspractical experience in them are now selected toundergo a specialist course lasting for a further fourmonths, thus giving these officers a post-graduatecourse of nine months. At the same time, in districts Iwhere the privilege would be of the most practical Ivalue, opportunities are forthcoming for youngofficers to attend the clinical practice of large localgeneral hospitals.By a Royal Warrant issued in September, 1919,

medical and combatant officers were placed on thesame footing as regards retired pay, and the fact thatmedical officers enter the Service after a long andexpensive training some five years later in life than,combatant officers was overlooked. This inequalityof treatment has now been rectified, with the resultthat a medical officer of 20 years’ service or over gets975 per annum more pension than a combatantofficer with the same number of years’ service.Once again let us deal with the most frequently

repeated criticism of the Service-namely, that iadministration eternally takes the pas of science. IThe Directorates in Pathology and Hygiene which

were recently created in the R.A.M.C., and whichwe may say have proved a marked success, form acomplete answer to such criticism, however just itwas in the past. This scheme of creating Directoratespermits specially selected men to rise from all ranksto Major-General on the strength of their scientificwork. Hitherto, a few notable men being excepted,the rule in the R.A.M.C. has been that, whatever aman’s qualifications or abilities, on attaining the rankof Lieutenant-Colonel, he must be prepared to go offinto administrative work and leave his scientificduties to his juniors. If he preferred to remainworking in bacteriology, in preventive medicine andhygiene, or in tropical diseases, for example, he coulddo so, but, except in extraordinarily fortunatecircumstances for himself, he would find that hisdevotion to science had cost him all chances offurther rise in his Service, promotion being reservedfor the administrative billets. This now has all beenchanged, and the change has its expression in theseDirectorates. All ranks up to and including the rankof Lieutenant-Colonel can draw specialist pay andhold appointments carrying allowances. The follow-ing is the scale of additional pay and charge pay :&mdash;

Additional Pay and Charge Pay for Officers ofthe R.A.M.C.

(1) Officer not above the rank of lieutenant-colonel, whileacting as specialist in a post considered by Our Army Councilto merit the grant of additional pay, according to subjectsor groups of subjects as under, within a limit of 5s. a day :-

Operative Surgery, advanced ; Medicine ; Ophthalmology;Gynaecology and Midwifery; Dermatology, includingVenereal Disease, 5s. daily. ’

Otology, Laryngology, and Rhinology; Radiology;Anaesthetics ; Mental Diseases; Hygiene; Pathology ;subjects other than above, at the discretion of Our ArmyCouncil, 2s. 6d. daily.

Officers granted temporary higher rank while holdingappointments in the services of hygiene and pathologywill not be eligible for additional pay as specialists whileholding such temporary rank.

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

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

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

Daily.s. d.

(G) Senior medical officer, Royal Arsenal not exceeding 10 0

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

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

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

(f) Adjutant R.A.M.C. Dep6t ...... 5 0

(g) Adjutant R.A.M.C. (Territorial Army) .... 2 6

Further, an officer, graded as a specialist, andappointed to the charge of a medical or surgicaldivision of a general hospital may be allowed toretain his additional pay and to draw the rate ofcharge pay laid down for the officer in charge of amedical or surgical division of a general hospital,provided that the total of additional and chargepay so drawn does not exceed the rate of charge paydrawn by the officer in charge of the hospital. Withthis exception charge pay and additional pay asspecialist wiR not be issuable concurrently. It maybe here pointed out that the distinction betweenscientific and administrative work is largely verbal.Take the conduct of a large hospital-is it possibleto separate the scientific routine which is designedto ensure progressive therapeutics from the adminis-trative work which provides and maintains thepremises and service, and selects and oversees thepersonnel ?