In the face of these facts it may be not out of place to urge that the Director-General of the Army Medical Department should have a recognised position in the supreme councils which direct the administration of the Army; and that his representatives in the field should have such position on the Staff as would enable the medical aspects of the campaign to be effectively brought into notice. On the other hand, however, it cannot for a moment be said that the medical service has been in any way neglected by the generals in command in the present campaign. The report alone contains repeated evidence-if such were needed-of the constant and anxious regard Lord Roberts and those under his command had for the care of the sick in the hospitals; and, so far as the Natal part of the campaign is concerned, I can speak with gratitude of the continued and most solicitous interest which General Buller took in all matters connected with the sick and wounded, and of his eagerness to make perfect in every way the work of the medical depart

ment.

The recommendations of the Commissioners may now be considered in detail.

The first and third of these suggestions deal with the well-known fact that the Army Medical Corps is much below its necessary strength. The Director-General says in his evidence that the strength of the Army Medical Corps, both in officers and men, was completely exhausted in providing medical attendance for the first two army corps in South Africa.'

The Royal Army Medical Corps [says the report] was wholly insufficient in Staff and equipment for such a war, and it was not so constituted as to have means provided by which its Staff could be very materially enlarged or its deficiencies promptly made good. The deficiency in the staff of the Royal Army Medical Corps before this war was not the fault of the Director-General and the Staff of officers associated with him. They had, for a considerable time before the outbreak, urged upon the military authorities the necessity for an increase of the corps, but for the most part without avail.

It is, indeed, a fact that the paucity of candidates for the Royal Army Medical Service is such that vacant commissions cannot be filled up; and it is a further fact that the service has been for years seriously undermanned. Here, then, in spite of the undoubted popularity of the Army, in spite of the attractions of a military career, in spite of the fact that the medical profession is said to be overcrowded, or at least very amply stocked, candidates cannot be found to come forward for service in the Royal Army Medical Corps.

When this question was discussed some years ago, it was considered that the lack of a military rank explained the unpopularity of the service. This rank was granted, and the medical service was embodied as a Royal corps. In spite of a few opinions to the contrary, it would appear that this granting of military rank to

Army surgeons has been a wise and just movement, has been cordially appreciated, and has been the means of rendering more efficient the working of the department. Yet, notwithstanding this discreet action on the part of the Minister for War, the corps remains about as it was, still unattractive and undermanned.

The following appear to me to be the chief reasons why the Army Medical Corps fails to obtain a sufficient and regular supply of officers of good professional attainments':

(1) In the first place, the pay (or the allowance which is equivalent to pay) is not adequate. Subjoined is the present scale of pay, and it may seem to be ample enough until the expenses of living are inquired into. The gratuities and pensions may be said to be liberal, but it is to the initial scale of pay that most objection is taken.

Exclusive of quarters, fuel, servants, &c., or allowances in lieu.

The warrant upon which this scale was founded dates from some years ago from a time, at least, before the employment of unqualified assistants in medical practice was declared to be illegal. The assistant to the medical practitioner has now to be qualified, and the result is that the demand for young qualified men has greatly increased and the rate of remuneration has reached, in consequence, a high scale. The pay of the Army medical service is, in fact, based upon an obsolete market.

(2) The undermanning of the Service gives rise to serious complaints as regards holiday leave, leave for purposes of study, length of foreign service, and the like. These grievances are recognised as genuine. They have been very frequently emphasised in the medical journals, and they are specially enumerated in the present report.

(3) The amount of non-professional work thrown upon the Army

surgeon is considerable, and is very irksome to men who are anxious to practise their profession and to make advance in it.

In the present campaign the officers of the Royal Army Medical Corps, in some of the larger stationary hospitals, were kept constantly occupied with what may be termed office-work, the writing of reports and returns, and the checking of lists of supplies, &c. They were entirely prevented in several instances from attending upon the sick and wounded, that duty being undertaken by civil surgeons. This purely clerical work is a serious burden. It helps to extinguish interest in professional affairs, it does nothing to make an officer a more efficient surgeon, and it is from a business point of view exceedingly extravagant. The services of a specially qualified man are demanded and are paid for at a special scale, and yet when he enters the field of his work, he as often as not finds himself engrossed with petty concerns which could be as well or better disposed of by an ordinary clerk. It would seem anomalous if the senior surgeon of a civil hospital should be answerable for all reports and returns of patients, and should have to concern himself with supplies and with all details connected with stores, stretchers, blankets, utensils, and the like. In a civil hospital such work falls to the lot of a house governor or a house steward, and the surgeon is free to follow his special calling. In a military hospital in the field all this nonprofessional work should be in the hands of a quartermaster, whose responsibilities and duties should be so extended beyond their present narrow limit as to enable him to entirely relieve the commanding medical officer from this irksome and quite unsuitable work.

The Commissioners in their minor suggestions ask 'Whether the administrative and clerical duties of the Principal Medical Officers can be lightened; and, in particular, to what extent the reports and returns which have to be made can and should be shortened?'

(4) The Army medical service offers very little encouragement for advancement in professional work. It must be assumed that the majority of those who enter the profession of medicine do so because that particular occupation interests them. It cannot be denied that the Army medical service does little to foster this interest and still less to encourage a continued advancement in purely professional work. When once a young surgeon has obtained his commission he need trouble himself but little about medicine and surgery. He will be advanced to the position of a colonel if he lives long enough and behaves decently, but his advancement will be rather by years of service than by professional merit. The Service encourages its officers to live long and give no offence, but it does very little to help them to progress in their profession and to become more able surgeons and physicians, and, as a consequence, more able officers. Promotion, indeed, in the Service should be by professional merit rather than by years. The Commissioners allude to this when they

urge 'the necessity of employing in the higher posts men selected for their merit rather than by seniority.'

To go more into detail it may first be noted that the entrance examination of the Army medical service is not popular, nor is it of notable utility. It deals-as regards its compulsory subjects -with the same topics of examination as form part of the usual tests for a qualifying degree or diploma. The recently qualified candidate has just had his knowledge satisfactorily tested in these subjects, and he is not impressed with the need of going over the same ground again merely for the purpose of being ranged in a list. The optional subjects-which embrace modern languages, physics, zoology, geology, and botany-do not appear to be particularly germane to his future career, except perhaps as regards the firstnamed item.

It would be of greater value to the candidate and to the Service he is joining if the entrance examination were to concern itself with such subjects as tropical diseases, gunshot wounds, hygiene, camp sanitation, and the like, and possibly also with modern languages. The candidate has already shown himself qualified to practise, and is probably not a little weary of five years' study in the subjects required by the qualifying examinations. The subjects just detailed open up new fields and new interests, and are of direct service in the future; and as the entrance examination has little real object beyond that of being a means of classifying competitors, it is well that it should be as practical as possible.

The successful candidate becomes a lieutenant, and after three years' service on full pay, a captain. After twelve years' service on full pay-including at least three years abroad-he may become a major, provided he meets certain requirements. The chief requirement is that he pass an examination in those very subjects which are prominent in the entrance examination, and also display a knowledge of hygiene and of the administrative work connected with the medical service. He has to write a report on some professional subject and to supply certain certificates.

There is no evidence that this examination is other than a somewhat lenient affair, and, be that as it may, it is not of a character to encourage the best type of professional work in a man who has already held a commission for twelve years. In the place of this questionable test it would be well to institute an examination in certain special subjects, and to supplement that by a moderate general examination.

The special subjects should be such as ophthalmic surgery, laryngology, nervous affections, tropical diseases, operative surgery, and others. The result of such a test would be this-that officers before promotion to the rank of major would have to furnish evidence of having kept up their general knowledge of medicine and

surgery, as at present, and of, moreover, possessing a sound knowledge of some one special branch of practice. The individual officer would be thus encouraged, from the time of obtaining his commission, to follow up his professional work, and to make himself proficient in a particular branch of it. By such work he would secure his promotion. The Director-General, on the other hand, would gradually acquire the services of men who had made themselves proficient in special branches of medicine and surgery, and who could be located where their particular qualifications would be most valuable. Some such course is more or less inevitable, for so wide now has become the art and science of medicine that it is almost impossible to expect an individual to possess a thorough and practical knowledge of all the subjects embraced by that science.

Two minor matters incidental to the encouragement of professional work in the Royal Army Medical Corps may here be alluded to. Firstly, it is natural that those who seek a commission in the Service should endeavour to obtain it as soon as possible after they have become qualified. It thus happens that few who enter the Army can afford to hold the exceedingly valuable offices of house surgeon or house physician in a large hospital. It would be well if such especial leave could be given to officers who have just joined as would enable them to hold these appointments without loss of seniority.

Secondly, the purely professional side of the Army Medical Service could be materially helped if some mutual arrangement for the carrying out of certain hospital work could be entered into between the civil and military hospitals.

The second recommendation of the Commissioners deals with a matter of pressing importance, viz. the obtaining of a sufficient number of surgeons to be added to the Staff of the Royal Army Medical Corps in the event of a great war. It is obvious that no medical establishment in the Army could be maintained perpetually on a war footing. Unfortunately, the demands upon the Service during the times of peace and during the progress of a great war present differences so enormous that they cannot be met by any reasonable compromise. It is a little unsatisfactory to maintain the Army medical service on a peace footing, and then to trust to the services of casual volunteers in the event of a war. The civil surgeons who filled up the ranks of the Royal Army Medical Corps in the present campaign did adinirable work, but they had no knowledge of the routine of military duties, nor of military methods and discipline. They were consequently ineffective except when accompanied, and to some extent controlled, by officers of the Service.

This obvious difficulty could be met by the establishment of an Army Medical Reserve upon the lines of the Military Reserve. For the first two or three years after a student has obtained his qualifi