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The Defence Services

Royal Naval Medical ServiceThe Medical Service of the Royal Navy affords, t,o

medical practitioners who are attracted by the prospectof sea service and work with the Royal Na,vy, a wideopportunity to practise their profession in an attractiveenvironment. A background of naval tradition naturallypermeates the Royal Naval Hospitals and Naval TrainingEstablishments, as well as Her Majesty’s ships. Officersserving on the permanent list are encouraged to specialisein all branches of medicine, and they are given fullfacilities to obtain higher qualifications. Courses of post-graduate study are carried out not only in naval hospitalsbut also at civilian teaching centres. There is a widevariety of subjects comprised in the title " navalmedicine," and it might often be claimed that certainof these subjects are unique. They include aviationmedicine, the physiology of diving, the physical aspectsof service afloat and ashore, commando service, tropicaldiseases, and last, but by no means least, industrialhygiene. Furthermore, a naval medical officer is nolonger concerned with the care of the sailor alone, butmust also have up-to-date knowledge of the diseases ofwomen and children so that he may attend the needs ofthe W.R.N.S., members of the Q.A.R.N.N.s.. Naval v.A.D.s,and the wives and children of Servicemen and Admiraltypersonnel serving abroad.The Royal Naval Medical Service offers a life career

with service on the active list up to 55 for all to57 for surgeon captains, and to 50 years of age forsurgeon rear-admirals. Provision is made in the regu-lations for counting previous experience, both serviceand professional. All previous commissioned service as amedical officer in one of the Armed Forces is allowed tocount in full, and all non-medical commissioned serviceis allowed to count as half. (’ivilian hospital experi-ence, and also experience of a special nature in privatepractice which is recognised by the Medical Director-General as warranting additional seniority, may beallowed to count up to a limit of seven years in all *The additional seniority will be reckoned as service for

pay and promotion but not for retired pay or gratuity.Leave is granted to officers at the following scales : inthe United Kingdom, 42 days a year ; when appointed toH.M. Ships on general service, at the rate of 3 days a

RATES OF PAY OF MEDICAL OFFICERS IN THE ROYAL NAVAL

MEDICAL SERVICE

The married rates shown a.pp]y to officers over 25 years of ageonly. When the officer is not accorumodnted or messed, additionalallowances are paid.

month ; when on foreign service, 14 days local leave ayear with a further 2 days for each month abroad onreturn to the United Kingdom.

Entry in the first place is for a short-service com-mission of either three or four years which may beextended. During this time application may be madefor transfer to the permanent list. Medical practi-tioners who undertake their National Service in the RoyalNavy are also eligible to apply to transfer to the per-manent list. ’I’he normal career for a medical officerprovides for promotion to the full rank of surgeonlieutenant after one ye<ar’s service, and to surgeonlieutenant-commander after a further seven years’service. Surgeon lieutenant-commanders are promotedto surgeon comrnander by selection at about their 15thyear of total service and surgeon commanders are

promoted by selection to surgeon captain about their23rd year of total service. Subsequent promotion tosurgeon rear-admiral is by selection.

Hates of pay are shown in the accOlnpanying table.Medical officers are also eligible for allowances, in additionto the basic rates of pay, on the same scale and underthe same conditions as for other officers of equivalentrank. These include travelling expenses, subsistenceallowance, and passages for wives and families. Officerswho transfer to permanent commissions after a minimumof one year’s service will be paid a permanent commissiongrant of t1500 (taxable).The maximum rates of retired pay in addition to

terminal grants are payable to officers who completecertain specified periods of service. Officers allowed towithdraw who are ineligible for retired pay will be eligibleto receive gratuities.

Further information may be obtained from theMedical Department, Admiralty, Queen Anne’s Mansions,St. James’s Park, London, S.W.I.

ROYAL XAVAL DENTAL SERVICE

Dental officers are entered for Naval service under similarconditions to those applying to medical officers. Information

concerning conditions of service can be obtained from theMedical Department of the Navy, Queen Anne’s Mansions,St. James’s Park, London, S.W.I.

Royal Army Medical CorpsThere is, at the moment, a limited requirement for

trained specialists, particularly ophthalmologists, oto-laryngologists, and radiologists. In the main, however,the R.A.M.C. seeks applications from young recentlyqualified practitioners.

Non-specialist Career66% of medical officers will be employed on general-

practitioner duties. After attending the junior officers’course at the Royal Army Medical College, they starttheir career as regimental medical officers where theybecome conversant with the soldier and his environment,the objects of the Army, and the requirements from itsmedical service in peace and war. They will, later, serveoverseas where, as a regimental medical officer or incharge of a medical reception station or small hospital,they will be able to study the causation, prevention, andtreatment of tropical diseases, the effects of climate, &c.On their return to the United Kingdom, they attend thesenior officers’ course ; the first 21/2 months are spent instudy at the Royal Army Medical College, Millbank, andthe next 3 months in a special postgraduate course atselected teaching hospitals. At this stage officers mayopt to remain at general medical duties or take up fieldtraining or junior staff appointments. For the moresenior appointments the requirements are a sound back-ground of clinical and preventive medicine to meet theiradvanced responsibilities in the administration of theArmy Medical Services in peace and war.

Specialist CareerSpecialists are, subject to professional proficiency,

employed on specialist duties up to the rank of colonel.Thereafter they may serve in this rank up to the retiringage of 57 or may be selected for promotion to brigadiereither in a specialist or non-specialist capacity. Theprocess of selection for specialist training is carried outafter the junior officers’ course, those applicants who are

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most successful in the course examination being accepted.Those accepted are provided with excellent opportunitiesto obtain higher qualifications and specialist experience.There is at the moment a particular need for ophthalmo-logists, otolaryngologists, and radiologists.

Postgraduate TrainingThere are liberal arrangements for specialists and non-

specialists to undergo postgraduate training throughouttheir career.

Employment after RetirementAll suitable medical officers (specialist or non-specialist)

may be employed up to the age of 65 in appointmentsspecially set aside for retired officers. Non-specialistsare employed on general practitioner or medical adminis-trative duties and specialists on specialist duties.

Conditions of ServiceAs conditions of service greatly affect a wife, married

practitioners considering an army career are advisedthat their wives should discuss these conditions witharmy wives who have served at home and overseas.The overseas tour is of 3 years’ duration. Families

of officers aged 25 or over can, in the case of most over-seas stations, accompany the officer by sea or air. Localallowances are paid in certain overseas areas where thecost of living is greater than in the United Kingdom.Schools are normally available locally, and in the caseof those with children between 11 and 18 years left inthe United Kingdom a tax-free education allowance ofup to -f!-75 per year is paid if they attend boarding-school, or -f!-26 a year if they attend day school and areplaced in the care of a guardian. In addition specialair flights, sometimes free and sometimes at reducedrates, are available to bring school-children to jointheir parents for the holidays. The facilities for sportand leave travel vary but are usually very good.A home tour, spent in U.K. or North-West Europe,

lasts at the moment 4-5 years. As a rule there is nodifficulty in obtaining family accommodation or arrang-ing schools. The education allowance referred to aboveis, however, subject to income-tax in the case of thoseserving in U.K., but not in North-West Europe.

It is the Army policy that all ranks should be givensome months’ warning of an impending move. Thisis done as much as possible but cannot always beachieved-for example, the posting of an officer afterthe senior officers’ course may be influenced by hisperformance on the course and cannot be decided before-hand, and emergencies may necessitate a sudden chainof appointments and reliefs.For those over 25 years of age, travel of families from

duty station to duty station is, subject to certain condi-tions, at public expense. If serving on a commission of3 years or over refund of furniture and removal expensesis payable and disturbance allowance of either jB40 orf:20, depending on the type of accommodation occupied,is issuable to cover incidental expenses for such moves,providing the period of duty at the new station is for atleast 6 months. Furniture of those over 25 years ofage, and serving for 3 years or more, who go overseaswith their families, may, subject to certain conditionsbe stored at public expense. Family accommodationprovided by the Government is at a reasonable rent-furnished accommodation for a major is, for example,<6100 per year.The comradeship of the Army extends to wives and

children, but the wives of those interested will find outabout this and the advantages and disadvantages ofan army life far better from other army wives.

Conditions of CommissioningThe normal maximum age is 33 but allowance is

made for those who have previously held commissionedrank in H.M. Forces on full pay. An antedate, countingtowards pay and promotion, may be allowed for 2 yearsspent in civilian practice or hospitals. An additionalperiod of up to 5 years may be allowed for specialistappointments held. An allowance is also made forprevious commissioned service on full pay. This antedatecounts towards the " reckonable service " mentionedbelow.

Promotion and PayDetails are given in the accompanying table, In

addition the following are payable :On appointment to a permanent connnission, a taxable grant of

.81500.An initial outfit allowance (in addition to certain free issues of

clothing) so that officers may provide themselves with the authorisedscale of uniform without expense to themselves.

Junior specialist pay...... P73 per yearSenior specialist pay 219 per yearQualification pay (for Staff College

graduates) ........ 63 to ,1;127 per year

PROMOTION AND RATES OF PAY OF R.A.M.C. MEDICAL OFFICERS

The marriage allowance for officers aged 25 or over is JJ55 a I

year less when family accommodation is provided or the family iaccompanies the husband at an overseas station. i

Retired Pay, &c.For less than 20 years’ qualifying service, there is a

tax-free gratuity rising from ael000 at 10 years’ serviceto .S2800 at 19 years’ service.

Pensions are payable as follows on retirement at the Bages and with the reckonable service stated: 1Major.... P625 for 22 years’ reckonable service at 53 years, j

plus lump-sum grant of <&bgr;1875. ,

Lieut.-colonel.. &pound; 8U0 for 24 years’ reckonable service at 55 years,plus lump-sum grant of 2400.

Colonel.... P1000 for 26 years’ reckonable service at 57 ’

years, plus lump-sum grant of ;63000. lBrigadier .. 1150 for 28 years reckonable service at 59 years, t

plus lump-sum grant of .83450. ’

Major-general .. &pound; 1400 for 30 years’reckonable service at 60 years,plus lump-sum grant of .84200.

Lieut.-general ...61600 for 30 years’ reckonable service, on

completion of appointment, .84800..

Deductions are made in the case of an officer whose J

reckonable service is less than stated above or whoretired voluntarily 2 or more years before his compulsoryretiring age.

Retired-officer AppointmentsThese may be held from the date of retirement until

the age of 65. The annual salary ranks from .8880 to.61107, in addition to pension.

Further information may be obtained from theAssistant Director-General, The War Office (A.M.D.2),London, S.W.I.

ROYAL ARMY DENTAL CORPS

IRegistered dental surgeons of British nationality or citizens !

of the Irish Republic who are liable for service under the iNational Service Act may apply for short-service commissions Ifor not less than 3 years on the active list, with a reserve ,

liability up to 8 years from the date of their appointment,Those (both men and women) who are not liable for servicemay apply for short-service commissions for varying periodsof between 2 and 8 years on the active list. An antedate ofseniority counting towards increments of pay and time pro-motion may be granted for postgraduate civil professionalexperience ; previous commissioned service in the ArmedForces is also taken into consideration. A tax-free gratuity is

payable. Officers or dental surgeons (male) may be appointedto permanent commissions direct or at any time during the rshort-service or National-Service engagement. Until further

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notice, those so appointed will be paid a special grant offl250 (taxable) after one year’s satisfactory servico as dentalofficers. The period of their short-service commissions willreckon towards ultimate retired pay and service gratuity,but will not entitle them to short-service gratuities. Dental

surgeons who are eligible to apply may obtain full particularsand application forms from the Under-Seeretary of State,The War Office (A.M.D.6), London, S.W.I.

Royal Air Force Medical BranchThe Royal Air Force offers an attractive career to fully

registered men and women medical practitioners who areBritish subjects or citizens of the Irish Hepublic. Nor-mally, the upper age-limit for applicants is 33, but olderapplicants may be considered. Appointment is usuallyto short-service commissions for three, four, five, or sixyears in the first instance, each of which may be extendedto complete a maximum period of eight years’ service.Exceptionally, suitable candidates may be appointed topermanent commissions direct from civil life. Short-service officers may apply for permanent commissions atany time during their service.Medical officers come into contact with flying and air

evacuation of sick and wounded, as well as the clinicalspecialties and the treatment of Service families. Thereare, in addition, opportunities in aviation medicine,hygiene, and industrial medicine.For regular officers, antedates of seniority may be

admissible for recognised civil experience. These ante-’ dates reckon towards pay, seniority, and promotion.The normal rank on appointment is flying-officer, withpromotion to flight-lieutenant after one year’s reckonableservice, and to squadron-leader after eight years’ reckon-able service. Officers recognised as R.A.F. specialistswill be promoted to the rank of wing-commander afterseven years’ satisfactory service in the substantive rankof squadron-leader, to group-captain on completion ofeight years’ satisfactory service in the substantive rankof wing-commander, and to ranks above group-captainby selection. Non-specialist officers can expect promotionto wing-commander after about seven years’ satisfactoryservice in the substantive rank of squadron-leader ;promotion to the rank of group-captain and above beingby selection.

Officers serving on permanent commissions may beallowed study-leave with full pay and allowances to takeapproved postgraduate courses, for which tuition feeson an approved scale may be granted. Officers havingexperience or aptitude in a specialty may be employedon specialist duties and subsequently earn recognitionas senior trainee specialists with additional pay of 4s.per day and as Royal Air Force specialists with additionalpay of 12s. per day. Non-specialist medical officers belowthe rank of group-captain will be awarded additional payof 4s. per day on gaining a registrable diploma in publichealth, industrial health, or tropical medicine, providedthat in each instance the prescribed period of studyoccupied an academic year.

Officers appointed to permanent commissions willreceive a grant of .S1500 (subject to income-tax) afterone year’s satisfactory service and they will be entitledto retired pay and other benefits after completion ofservice. Short-service officers will, on completion of theircommissions, be paid a tax-free gratuity at the rate of?00 for each year of satisfactory service. Arrangementsexist to preserve their superannuation rights under theNational Health Service (Superannuation) Regulations,1950.Further information can be obtained from the TJnder-

Secretary of State for Air, Air Ministry, M.A.I.p., 2/8,Richmond Terrace, Whitehall, London, S.W.1 (Trafalgar8811, ext. 6674).

ROYAL AIR FORCE DENTAL BRANCH

Commissions are available in the Royal Air Force DentalBranch to candidates of either sex who possess a degree orlicence in dental surgery of a British university or liconsingboard, and who are registered under the Dental Act in forcein the United Kingdom. Dental officers in the Royal AirForce have plenty of scope for all the aspects of dentistry in abranch which trains its own technicians and maintains its ownlaboratories under senior dental officers. Dental officers

servmg on short-service or National-Service commissions may

apply at any time for appointment to permanent commissions.The Inngth of the poriocl on a short-service commission andthe period required in the reserve on its completion is thesame its for medical officers. Similarly, dental surgeons maybe granted permanent commission!-! if they can complete atleast twenty years’ service qualifying for retired pay. Proviouscommissioned service counts for antedate of seniority rank onappointment, and terms of promotion the same as for medicalofficers. while antedates for civil oxperience in a recognisedprofessional appointment are given on the following basis, sub-ject to a maximum antedate of seven years for such experience :first four years, in full; any later experience, in half. Candidateswho hold specialist appointments may be allowed to have theircivil experience assessed on a different basis, but within the samemaximum of seven years. A tax-free gratuity, at the rate ofJE170 a year for each year of satisfactory active-list service, ispayable to short-service officers on transfer to the reserve.Dental officers appointed to permanent commissions are

encouraged to pursue their studies in postgraduate researchand may be allowed up to seven months’ study leave on fullpay and allowances to take approved postgraduate courses.Until further notice, a grant of ;E1250, subject to income-tax,will be made after one year’s satisfactory commissionedservice in the dental branch, to officers appointed to per-manent commissions. Short-service or permanent-commissionofficers who have the appropriate higher qualifications and therequisite experience may be recommended for specialistappointments. Further information may be had from the

Under-Secrotary of State, Air Ministry, M.A.6, 2/8, RichmondTerrace, Whitehall, S.W.1 (Trafalgar 8811, ext. 6669).

Health Services at Home

PUBLIC HEALTH

Among the divisions of the nation’s health services,public health ranks next in size and importance to thegeneral-practitioner and hospital services and it offers asatisfactory career to the young doctor keen to work forthe welfare of the community as well as for the individual.Under the National Health Service Act of 1947,

councils of counties and county boroughs were designated" local health authorities " and had conferred upon them,and through them upon their medical officers of health,wide responsibilities for the provision of personal healthservices. These include a duty to provide clinics andother services for mothers and young children, domiciliarymidwifery, home nursing, domestic help, health visiting,immunisation, vaccination, and ambulance services.Wide powers are also given to these authorities to prepareand administer schemes for the prevention of disease andfor the care and aftercare of sick persons. Recently,new concepts have been developing in the mental-healthservices and there will be considerable expansion inlocal-health-authority responsibilities as the result of therecommendations in the report of the Royal Commissionon the Law relating to Mental Illness and Mental Defici-ency. In most counties and county boroughs the medicalofficer of health is principal school medical officer and isthus responsible for the preventive health services cover-ing children of all ages. In some areas further co&ouml;rdina-tion has been secured by placing the authority’s socialwelfare services also under the medical officer ofhealth.

In county boroughs, boroughs, and urban and ruraldistricts, the medical officer of health is responsible forenvironmental hygiene. In contrast to the early daysof public health when the medical officer of health waspersonally concerned with the execution of many sanitaryduties, health departments are now organised to free himfrom much of the detailed work, which is performed bytrained lay officers, or even transferred to the care ofother departments-as in the case of water-supply andsewerage disposal. Naturally, the extent of this devolu-tion of responsibility varies widely, and in rural areasproblems of water-supply and sanitation are still a majorconcern of the medical officer of health. The supervisionof housing conditions is also a responsibility of the healthdepartment. All this work remains under the generalcontrol of the medical officer of health, and he mustsupervise the purity of water-supplies even though theirproduction is not his concern. Though less concerned