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Home , Alfred Keogh, Royal Army Medical Corps

rThu B- OCT. 5, 1901.] REORGANISATION OF THE . LMUDIOAL JOIU.AX. 1025

tReorganisation of tfie Ilrmy tedicat&ervices;O 4

REPORT OF THE COMMITTEE.

WE have received from the for publication the tion of the term of his appointment, but subject to the proviso report of the Committee appointed by the Secretary of State that he shall vacate his seat on the Board upon attaining the for War to consider the reorganisation of the Army Medical age of 6o years. He shall receive an honorarium of f200 per Services. The Committee was constituted as follows:-Right annum in addition to his out-of-pocket expenses for duties Hon. St. John Brodrick, Secretary of State for War, Chair- performed beyond a radius of 4 miles from Charing Cross. man; Sir Edward Ward, K.C.B., Permanent Under- Meetings. Secretary, Vice-Chairman. Members: -General Sir G. , 4. The Advisory Board shall usually meet at fortnightly de C. Morton, K.C.I.E., C.B.; Colonel Sir James Willcocks, intervals, and the necessary quorum for the transaction of K.C.M.G., D.S.O.; Sir Frederick Treves, C.B., K.C.V.O.; business shall be the Chairman (or in his absence the Vice- Sir William Thomson, C.B.; Surgeon-General Hooper, C.S.I., of Mr. G. H. Chairman) and two other members of the Board, whom I.M.S.; Lieut.-Colonel A. Keogh, C.B., R.A.M.C.; one must be a civilian. The Chairman (or in his absence the Makins, C.B.; Mr. A. D. Fripp, C.B., C.V.O.; Dr. H. Tooth, Vice-Chairman) shall have the right to vote, and, in case of an C.M.G.; Professor A. Ogston; Dr. E. C. Perry, F.R C.P. a vote. Secretary; Major H. E. R. James, R.A.M.C. The following equality of votes, shall have casting is the text of the Report: Duties. 5. The Advisory Board shall report to the Secretary of SCHIEME FOR THE REORGANISATION OF THE State upon all matters concerned with medicine, surgery, ARMY MEDICAL SERVICES. sanitation, and epidemic diseases as they affect the military services. Advisory Board. 6. The Board shall advise the Secretary of State upon the x. The Royal Army Medical shall be under the adequate provision of hospitals and upon the equipment of supervision of a Board, to be termed the Advisory Board for the same in full detail; upon the supply of drugs, appliances, Army Medical Services, and constituted as follows: diets, and medical comforts to the patients; and generally Constitution. upon whatever concerns the well-being of the sick an: The Director-General, A.M.S., Chairman. wo-anded. The Deputy Director-General, A.M.S., Vice-Chairman. 7. The Board shall prepare and submit to the Secretary of I , , with special State a scheme for the expansion of the Service to meet the knowledge of Sanitation. needs of war or serious epidemics, such scheme dealing with i Officer, Royal Army Medical Corps, with special questions of and transport, the equipment of all knowledge of Tropical Diseases. medical units at the base and front and on the lines of com- munication, the supply of drugs and medical comforts, the 2 Civilian Appointed by the Crown on the recommendation of the Secre- employment in the Service of civilian surgeons, nurses, and 2Civilian2CiiliaSureonsSurgeos [ tary of State. orderlies, and the utilisation of all voluntary effort for the the sick and wounded. I Representative of the War Office appointed by the relief of Secretary of State. 8. The Board shall have submitted to it, and shall report all for new and I Representative of the India Office appointed by the to the Secretary of State upon, plans hospitals of State for India. upon standard plans for barracks and standing camps. Secretary a list of civil The Matron-in-Chief, Queen Alexandra's Imperial 9. It shall be the duty of the Board to draw up Military Nursing Service (for Nursing Service hospitals recognised as places of study for members of the only). Royal Army Medical Corps. io. The Board shall also draw up a list of hospitals and Appointment of Civil Members. nurse-training schools recognised for the purposes of the 2. To be eligible for appointment upon the Advisory Board Queen Alexandra's Imperial Military Nursing Service. a Civilian or Surgeon shall be required to hold or iI. The Board shall arrange, so far as practicable, for the to have recently held a post on the acting staff of a leading annual inspection of each of the military hospitals by a Sub- Civil Hospital in England, Wales, Scotland, or Ireland, and committee consisting of at least one military and one civilian to be not more than 55 years of age upon first appointment. member of the Board, such inspection to be usually made 3. A Civilian Physician or Surgeon upon the Advisory Board without notice. shall hold office for a period of 3 years, renewable upon expira- 12. This Subcommittee shall ascertain and report to the 1025 MUDIaAL JOURNAL] REPORT OF THE COMMITTEE. [OCT. 5, 190I. Board whether the treatment of patients and the equipment shall be granted to candidates who have performed medical of hospitals inspected be in accordance with modern medical duties with troops on active service. and surgical requirements. 23. A candidate, having fulfilled the above requirements, 13. The Board may, with the permission of the Secretary of shall be directed to appear before the Advisory Board, who State, detail specially qualified Officers of the Royal Army will decide whether he may be allowed to compete for a com- Medical Corps or others to visit and report upon the army mission in His Majesty's Army. medical services of foreign countries. 14; The promotion of Officers or their retention in the Candidate: Entrance Examination. Service will be referred to the Board for consideration before 24. After having been medically examined the candidater submission by the Director-General to the -in- shall be submitted to a clinical and practical examination in Chief. medicine and surgery, the scope of which shall be defined by I5. The Board shall supervise the admission of candidates the Advisory Board. to the Royal Army Medical Corps, and shall arrange for the on Probation. examination of Officers for promotion, appointing examiners Lieutenant 25. gained a in this and recommending to the Secretary of State the amount of Having place Entrance Examination the successful candidate shall be appointed Lieutenant on proba- their remuneration, regard biing had as heretofore to the and shall English, Welsh, Scotch, and Irish medical schools. Except tion, proceed to Netley (until other arrangements have been made) for a 2 months' course of instruction in as specified in paragraph 25 every examinations shall be held hygiene and bacteriology, after which he shall be examined in 6 months at dates to be fixed by the Advisory Board. these Examiners shall be appointed annually by the Advisory subjects. He will then proceed to , where he will undergo a 3 months' course of instruction on the follow- Board, but no examiner shall serve continuously for a longer ing subjects: period than 4 years. A member of the Advisory Board shall Stretcher and ambulance drill. not be appointed examiner. Interior economy. I6. The Board shall exercise a general control over the Military law and hospital management. nursing service, and, in consultation with the Nursing Board, On the completion of the course he shall be examined shall submit to the Secretary of State a scheme to in develop these subjects. The marks gained at both these examinations the training of orderlies as attendants upon the sick and wounded. (provided they are not less than the 50 per cent. requisite to Director-General: Appointment. qualify), added to those at the entrance examination, shall decide his on the 17. The Director-General shal be appointed by the Secretary position seniority list of the corps, and he will thereupon be confirmed in his appointment as of, State on the Lieutenant. recommendation of the Commander-in-Chief, The mark ratio of each of these acting with the advice of the Advisory Board, and shall hold minor examinations to the entrance examination shall be as I to 8. office for 5 years. 26. A Lieutenant on probation who fails to obtain the Duties. qualifying percentage of marks in either of these minor I8. The Director-General shall be responsible for the administration of the Army Medical examinations shall be allowed a second trial at the termina- Service, the Militia tion of 6 months from entrance to the Service, and should he Medical Staff Corps, the Militia Reserve trained in medical qualify will be placed at the bottom of the list. If, however, duties, and Corps. the Volunteer Medical Staff He shall be he should again fail in either examination his appointment responsible for the distribution, promotion, discipline, and will not be and he will the general organisation of these services. confirmed, leave Service. 19. After reference to the Advisory Board as defined in Candidate: Re Resident Post in Civil -Hospital. paragraph 14, the Director-General shall bring forward to the 27. Should a candidate pass the entrance examination to Commander-in-Chief the names of may officers whom he the Royal Medical a judge worthy of promotion. Army Corps whilst holding resident appointment in a recognised civil hospital, or be appointed 20. The Director-General, in concert with the Advisory thereto at such a date as will permit him to take up his Board, shall draw up a scheme for the due provision of duties immediately after he has passed the entrance examina- medical aid for the Auxiliary Forces, Militia, Yeomanry, and Volunteers. tion for the Royal Army Medical Corps, he shall be seconded for the period of such appointment not exceeding one year, Candidate for Admission as Medical Officer. receiving, however, during such period no pay from Army 21. A candidate for admission to the Royal Army Medical funds, but counting his service towards pension or gratuity. Corps shall be a British subject of unmixed European blood, not more than 28 years of age, and shall possess a registrable Lieutenant: Regimental Duty. qualification to practise. He shall produce a certificate of 28. A Lieutenant, on completion of his course of instruction, birth or other satisfactory proof of age, and shall furnish to the will be attached for duty to a , , or other Advisory Board such evidence as may be required regarding unit, but while thus attached will also be detailed for duty character, conduct, professional ability, and fitness to hold a in a station hospital; but this provision shall not entitle commission in the corps. Special importance shall be any unit to claim that a medical officer shall be attached attached to a confidential report to be requested by the Board thereto. from the Dean or other authority of the school in which the Optionfor Three Years. candidate has completed his course as a medical student. 29. At the end of 3 years from the confirmation of his ap pointment as Lieutenant he will be permitted to retire, or if, Candidate: Previous Service. in the opinion of the Advisory Board (based on the reports 22. Subject to such arrangements as may hereafter be made, received from his Principal Medical Officer and the Command- opportunities will be given for civilian surgeons over age, ing Officer of the unit to which he has been attached), his who have served with troops in the field, to enter the corps. service has been satisfactory, he will be allowed by the Special marks, on a scale to be fixed by the Advisory Board, Secretary of State to adopt one of the following courss:s r T Ban= 0 OCT. 5, 19o011 REORGANISATION OF THE ARMY MEDICAL SERVICE. Lmi[z FJo=" 102 I (a.) To continue in the Service. Option after Nine Years' &ervie. (b.) To engage for a period of 7 years in the Reserve of 35. On the completion of 6 years' service as Captain, sub- Officers receiving the sum of £25 per annum while ject to such acceleration as he may have obtained under Para- so serving. An Officer who has been in the Reserve graph 3a, an Officer shall be allowed by the Secretary of State for & period of not less than i year or more than 3 to adopt one of the following courses: years may be permitted by the Secretary of State (a.) To retire with a gratuity of £x,ooo. on the report of the Advisory Board to return to (b.) To continue in the Service. the Active List, and if replaced on the Active List he shall be allowed to count one-third of his Examinatio for Major. service in the Reserve towards promotion, pension, 36. Should he elect to continue in the Service, an Officer, or gratuity. between his ninth and twelfth year of service (subject to such acceleration as he may have obtained under Paragraph 32), Lieutenant: Professional Instruction. shall be attached to a selected hospital at one of the military 30. Shouldthe Officer elect to continue in the Service, he shall centres, so as to enable him to attend the practice of a recog- be attached for a period of 6 months to a recognised hospital nised civil hospital for a period of 6 months, at the end of in a centre where he has opportunities of gaining further pro- which period he will be required to present himself for ex- fessional knowledge by attendance at a course or courses of amination in the following subjects: instruction in a civil hospital, or otherwise, as may be approved Medicine; surgery; hygiene and sanitation; bacteriology and by the Advisory Board. tropical diseases; military law, administration and interior economy; and one special subject from the subjoined list of Examination for Captain. optional subjects, to which additions may from time to timebe made by the Advisory Board: 31. At the end of 6 months of such instruction he shall Bacteriology, including the preparation of antitoxins. present himself for examination in medicine; surgery; Dental Surgery. hygiene and sanitation; and bacteriology and tropical dis- Dermatology. eases. In this examination the relative value of the subjects Fevers. Laryngology. expressed in marks shall be as follows: Midwifery and Gynaecology. Medicine, ICo; surgery, iOO; hygiene and sanitation, 70; Operative Surgery (advanced). bacteriology and tropical disease, 50. Ophthalmology. The percentage of the total number of marks necessary to Otology. Pediatrics. obtain distinction shall be as follows: Psychological Medicine. Special certificate of excellence ... 85 per cent. Skiagraphy. sit class ...... 8o ,, 37. In this examination the relative value of the subjects 2nd ,,7 .0. . . .. 70 expressed in marks shall be as follows: 3rd ,, ...... 60 Medicine, Ioo; surgery, Ioo; hygiene and sanitation, Ioo; The qualifying mark in eaclh subject shall be 40 per cent. bacteriology and tropical diseases, xoo; military law, 32. On the results of this examination an acceleration of administration and interior economy, Ioo; special promotion may be granted at the discretion of the Secretary subject, iOO. of State, provided that the Officer's conduct has been satis- The percentage of the total number of marks necessary to factory, in accordance with the following scale: obtain distinction shall be as follows: Special certificate of excellence ... 85 per cent...... 80 ,, Class in Examination. Acceleration of Promotion. ist class 2nd class ...... 70 ,, 3rd class...... 6o ,,

Special certificate of excellence ...... i months. The qualifying mark in each subject shall be 4o per cent. ist class...... I2 months. 38. On the results of this examination an acceleration of. promotion may be granted at the discretion of the Secretary 2nd class ...... 6 months. ... of State, provided that the Officer's conduct has been satis- 3rd class...... 3 months. factory, in accordance with the following scale:

33. An Officer who does not reach the qualifying mark in Class in Examination. Acceleration of Promotion. each subject shall be considered as having failed to pass the examination, and shall be placed on a supernumerary list for a period not exceeding 6 months, when he shall be required Special certificate...... s 8 months. again to present himself for examination in all subjects, and ist class ...... 12 ,, if he fail a second time he shall be compulsorily retired. Service on the supernumerary list shall not count for pension, 2ndclass ...... 6,,... increase of pay, or promotion. 3rd class ...... 3 Captain: On Promotion. 39. An Officer who does not reach the qualifying mark in 34. When an Officer has passed the examination specified each subject shall be considered as having failed to pass the in Paragraph 31 he shall be promoted Captain, and shall examination, and shall be placed on a supernumerary list for undergo a short course of instruction in Field Hospital work, a period not exceeding 6 monthg, when he shall be required Bearer drill, or allied subjects approved by again to present himself for examination in all subjects, and the Advisory Board, and on the conclusion of the course he if he fail a second time he shall be compulsorily retired. shall be posted to such station and duty as the Director- Service on the supernumerary list shall not count for pension, General may order. increase of pay, or promotion. TM,BuTi6 I -- 7LO281XMI"L Jouzx-AL I REPOILT OIP THIE COMMITTEE. rOCT- 5, 190t-

Captain: Provisional Promotion. 45. Should an Officer fail to obtain 50 per cent. of the total 40. An Officer who in the-opinion of the Advisory Board has number of marks, he will be allowed, after an interval of been prevented by the exigencies of the service, or by other 6 months and before he has completed his 20th year of actual very special circumstances, from presenting himself for ex- service, to present himself again for examination. Should he amination as required in paragraphs 33 and 36, may be pro- fail a second time, he will be compulsorily retired on a visionally promoted, subject to his passing the prescribed gratuity of £2,500, or he may, by special permission of the examination at the first available opportunity. Secretary of State, complete 20 years' service and then retire on a pension. Captain or Major: Specialist Appointments. Promotion. 41. In order to encourage the study of the special subjects 46. Promotion to the rank of Lieutenant-Colonel will be by enumerated in paragraph 36, appointments shall be made in selection from among those Officers who have passed the each Army Corps and in such other places at home and qualifying examination, and who have completed 20 years' abroad as may be approved of by the Secretary of State, of service, subject to such acceleration as he may have obtained Officers below the rank of Lieutenant-Colonel who shall under paragraphs 32 and 38. If not selected for promotion receive specialist pay according to the rank given in Ap- within twelve months from the completion of twenty years' pendix. To be qualified for appointment as specialist, an actual service, an Officer will be permitted to remain on the Officer must have gained at least 70 per cent. of the marks pay of a Major until he comnpletes twenty-five years' service, in the special subject taken in the examination mentioned in subject to acceleration, when he will be compulsorily retired paragraph 36. Specialists may also be appointed in Public on the pension of his rank (see Article 527, Royal Warrant). Health, if they have first qualified by obtaining a diploma recognised for registration by the General Medical Council. Lieutenant-Colonel: Special S3election. No Officer shall hold more than one specialist appointment 47. During his service as Lieutenant-Colonel an Officer may at the same time. be selected for a higher rate of pay under Article 362, Royal Svecial Study-leave. Warrant for Pay and Promotion, which rate he will retain 42. In case of an Officer desiring to engage in advanced until promotion to the rank of Colonel. professional study, it shall be open to the Advisory Board to Colonel and S5urgeon-General. recommend that special leave be granted him for a period 48. The promotion to the rank of Colonel and Surgeon- of 6 months. General shall be by selection. Service in India shall not be Major. necessary for to either rank. 43. An Officer, having completed 12 years' service (subject promotion to such acceleration as he may have obtained under para- Brevet Promotion. graphs 32 and 38), and having passed the necessary examina- 49. Medical Officers shall be eligible for brevet promotion tion, shall be promoted Major, and shall continue to serve in the Royal Army Medical Corps in the same manner as in that rank under the following conditions: Officers in the other branches of the Service; and such pro- (a) After 3 years' service from the date of his promotion motion may be given either for distinguished service in the to the rank of Major, he shall be granted a higher rate field, or for distinguished service of an exceptional nature of pay (see Appendix). other than in the field. (b) At the conclusion of 3 years from the date of his advancement to the higher grade (making 6 years in Medical Ofticers of Household Briyade. the he if his has been 50. Junior Medical Officers shall be gazetted directly to the rank), shall, service satisfactory, and not be attached be allowed by the Secretary of State to adopt one of of the Household Brigade, shall to them from the Royal Army Medical Corps as at present. the following alternatives: Medical (i) To retire on a gratuity of /2,500 (see Appendix). 5I. By special authority of the Secretary of State (ii) To continue in the service. Officers of the Household Brigade may be appointed Colonel in the Royal Army Medical Corps if they have complied with Examination for Lieutenant-Colonel. the conditions laid down in Article 362, Royal Warrant for Pay 44. Should he elect to continue in the Service, he shall, and Promotion, or as a reward for exceptional merit on active before he has completed 20 years' service (subject to such service. acceleration as he may have obtained under paragraphs 32 and Charge Pay. 38) be granted 3 months' study leave, and at the end of that time 52. When an Officer is in charge of a hospital he shall re- be required to undergo a qualifying examination for promotion ceive charge pay at the rate specified in Appendix. to the rank of Lieutenant-Colonel in the following subjects: Tenure ot (I) Hospital organisation, administration, and equipment in peace Appointments. and war, including the disposal of the sick and wounded. 53. The appointment to the charge of certain selected station (2) Organisation, administration, and equipment in war of. all hospitals, to be hereafter specified by the Advisory Board, medical units in the field and on the lines of communication. shall be for a term of not less than 3 years. (3) The sanitation of towns, camps, troop transports, and all places With the of Officers to likely to be occupied by troops in peace and war. 54. exception attached units, ap- (4) Epidemiology and management of epidemics, and the relations of pointments to a district shall, unless broken by a tour of civil law as regards infectious diseases. foreign service, be for a term of 2 years. (5) The medical history of important modern campaigns. 55. Should it be necessary to move an Officer from his (6) The administration, command, and discipline of the Royal Army station for other than temporary duty at an earlier date, a Medical Corps, and of other persons who may come under the circumstances shall be forwarded the Prin- J urisdiction of an officer of the corps. report of the by (7) The duties of all ranks in the Royal Army Medical Corps. cipal Medical Officer of the Army Corps to the Director- (8) Recruiting and invaliding, including a knowledge of civil law as it General. affects lunatics in the Service. Principal Medical Oficer, Artmy Corps. (g) The relation of the medical to all other branches of the Army as in each and defined by the various codes of regulations in force. 56. The Principal Medical Officer Army Corps (to) The Army Medical Services of othei Powers. in each district shall be the Staff Officer of the General Officer 1 0 9 ,OC. 5,19. ] REORGANISATION O-F TILE ARMIY MEDICAL SERVICE. ousuaAa Commanding for all medical and sanitary services, and shall taken-by the Advisory Board to present a detailed scheme for be responsible to him for the administration of all hospitals the establishment of such a hospital and staff college for the and medical stores. consideration of the Secretary of State. 57. The Principal Medical Officer shall deal with all matters ST. JOHN BRODRICK. in his district, and shall only refer to the Advisory Board in E. W. D. WARD. cases of serious doubt or difficulty. C. D}; C. MORTON, Major-General. 58. Every Army Corps shall have a completely equipped JAMES WILLCOCKS, Colonel. bearer company and field hospital and a proportion of other FREDERICK TREVES. medical field units at its headquarters, in order that the *WILLIAM THOMSON. Officers and men of the Royal Army Medical Corps may re W. R. HOOPER, Surgeon-Generalt ceive instruction and gain practical experience in the per- G. H. MAKINS. formance of field duties. HOWARD TOOTH. ALFRED D. FRIPP. Convalescence. , Lieut.-Colonel, R.A.M.C., 59. With the view of reducing the number of slight cases of *ALEX. OGSTON. illness in hospital, and thus providing accommodation for E. C. PERRY. those of a serious nature, convalescent homes shall be estab- H. E. R. JAMES, Major, R.A.M.C., lished in each district to which soldiers recovering from Secretarty. severe illness may be sent. These homes, which are intended for men who are so far recovered as to be able to dispense Exceptions by Sir William Thomson, C.B.: with the services of nurses, shall be visited daily by a Medi- i. Having regard to the important functions and powers of" cal Officer. the civilian members of the Advisory Board, as set Trivial Cases. out in the report, I am strongly of opinion that-it, 6o. Medical Officers in charge of units should be instructed should be composed of representatives of the medical to retain in barracks cases of injury or illness of a trivial schools in the several divisions of the Kingdom. character, which are likely only to interfere for a few days The sum proposed to be paid would practically ex- with thq soldier's performance of his duties. clude other than teachers, although 70 per 6r. For the reception of such cases a barrack room shall be eent. of the Medical Officers come from schools out-- set aside, when available, in which they will be attended by side England. the Medical Officer in charge of the unit. The Medical Offi- 2. It is inadvisable to fix an age limit for civilians oni cers will, however, as far as possible, treat light cases of illness appointment. as out-patients. This is not done in the case of the other representa- Hospitals in Small Stations. tives. for can 62. In small stations where no military hospitals are avail- The Secretary of State War always protect able, arrangements may be made with the authorities of the himself in this regard when making selections. local civi] hospital for the admission thereto of cases requiring WILLIAM THOMSON. treatment as in-patients. Exceptions by Professor A. Ogston: Clerical Work. I consider that the scheme falls short of what is requisite 63. With the view of relieving the pressure of clerical work among other things in the following matters, viz.: now experienced by the Officers and men of the Royal Army not a Medical Corps, the Secretary of State has directed that steps i. It does provide for the formation of Sanitary shall to simplify the returns rendered by Medical Corps, consisting of Officers specially charged wit be taken the duty of carrying out proper sanitary measures in Officers, and the forms of accounts used in hospitals. peace and war, and a staff of men trained to ensure the requisite measures being carried into effect. Civilian Conmultants. 2. It does not provide such study leave as the advancing 64. Consulting Physicians and Surgeons from the acting state of medical science now demands, and is likely staff of recognised civil hospitals shall be appointed by the in the future to demand even more, nor such liberal Advisory Board to attend when required at military hospitals privileges in this direction as have been found neces- at such times as may be desired by the Medical Officers in sary in the armies of other great European Powers. charge. Members of the Advisory Board shall not be eligible 3. It makes no provision for placing at the disposal of the for appointment as consulting physicians or surgeons. many Medical Officers serving in remote and isolated stations abroad such information as will enable them Concentration of Serious Cases. to familiarise themselves with the advances of medical 65. In order that opportunities for instruction and special science, and as is called for in the interests of those advice may be obtained, serious cases will be concentrated who are placed under their care. whenever practicable in the larger military hospitals, for 4. It fails to provide for Medical Officers being trained by example, Woolwich, Millbank. attendance upon civilian patients in all the branches of their profession, so that they may become equally Medical Staff College. skilful with their civilian brethren, and may avoid 66. The Committee is strongly of opinion that the estab- the narrowing influences which act so injuriously lishment of a Military Hospital and Medical Staff College for upon Medical Officers who have to deal only with the the training of Officers of the Royal Army Medical Corps treatment of soldiers and military officials. would very materially conduce to the efficiency of Army ALEX. OGSTON. Medical Service. It recommends that immediate steps be * Subject to remarks printed below. 1030 KVDTCAL JOAl l REORGANISATION OF ARMY NURSING SERVICE. [OC. 5, 1901. APPENDIX. PROPOSED RATES OF PAY, ETC., FOR MEDICAL OFFICERS. Allowances, Pay Servants', Per Annum. Lodging, Fuel, Total and Light.

Z a. d. £ s. d. d. ILieutenant on Probation and Lieutenant ...... 250 0 0 73 10 0 323 10 0 Captain, i.e., after 3 Vears' service ...... 287 0 0 92 15 2 379 15 2 Captain, after 7 years' total service ...... 307 4 10 92 15 2 400 0 0 Captain, after io years' total service ...... 385 0 0 92 15 2 477 15 2 Major, i.e., after 12 years' total service ...... 430 0 0 157 12 10 587 12 10 Major, after 3 years' service as such. 475 0 0 157 12 10 632 12 I0

Lieutenant-Colonel, i.e., after 20 years' service ...... 547 0 0 i66 15 4 .713 15 4 Lieutenant-Colonel selected under paragraph 362 of the Royal Warrant (establishment of 50) ...... 638 O O i66 15 4 804 15 4

Colonel...... 730 0 0 233 10 10 953 10 10

Surgeon-General ...... Consolildated 1,500e 0 0

Director-General ...... 2,000 0 0

The pay of Officers of the Royal Army Medical Corps below amalgamated the existing Army Nursing Service and the the rank of Major while serving in India shall be increased so Indian Nursing Service. as to bear the same ratio to the above rates for non-Indian President. service as at present exists. 2. Her Majesty Queen Alexandra shall be requested CHARGE PAY (see Paragraph 5o). graciously to assume the Presidency of this Service. S. d. Hospitals of 3oo beds or more ... IO o per diem. Constitustion of Nursing Board. 200 ,, 7 6 3. The Nursing Service shall be under the immediate con- 100 ,, 5 0 trol of Her Majesty Queen Alexandra as President, and of a 50 ...... 2 6 Nursing Board constituted as follows: SPECIALIST PAY (see Paragraph 41). President.-Her Majesty Queen Alexandra. Medical In Public Health and in any subject mentioned in Para- Chairman.-The Director-General, Army Service, or an graph 36, 28. 6d. per diem. Officer nominated by him. Two members of the Advisory Board, Army Medical Ser- RETIRED PAY AND GIRATUITIES. vice, of whom one shall be a civilian. As already existing, with the following exceptions (see The Matron-in-Chief, Queen Alexandra's Imperial Military Paragraphs 29 and 35); Nursing Service. Pay on the Reserve, £25 per annum. Three matrons of large civil hospitals with medical Gratuity, after 9 years' service, £i,OOO; £2,500 after 18 schools. years' service. One representative of the India Office to be appointed by the Secretary of State for India. Two members to be nominated by Her Majesty the Presi- SCHEME FOR THE REORGANISATION dent, and holding office for three years. OF THE ARMY AND INDIAN Mode and Term ofAppointment of Certain Members of the NURSING SERVICE. Nursing Board. 4. Upon this Nursing Board the civilian members of the THE same Committee has presented the following report on Advisory Board, Army Medical Service, and the matrons of the reorganisation of the Army and Indian Nursing Service: civil hospitals shall be appointed by the Crown, on the advice of the Secretary of State, and sball hold office for a period Title. of 3 years, renewable on expiration of the term of appoint- i. There shall be one Military Nursing Service for His ment. Majesty's Army in the , India, and the A matron of a civil hospital shall receive an honorarium of Colonies, to be designated "Queen Alexandra's Imperial Mili- £26 58. per annum while serving on the Board. tary Nursing Servike" (Q.A.I.M.N.S.). In this service shall be 5. The Nursing Board, of which three shall form a quorum, OCT. 5, IgOI,] REORGANJSATION OF ARMY NURSING SERVICE. r Tu BoumNA 1031 a shall usually meet at fortnightly intervals. The minutes of Io. The Matron-in-Chief shall be the medium of com- the proceedings of the Nursing Board shall be laid by the munication between the Director-General and the Queen Matron-in-Chief before the.Advisory Board. It shall be in Alexandra's Imperial Military Nursing Service, in all matters the power of the Advisory Board to refer back any point to connected with that Service. the Nursing Board for reconsideration, and in case of a ii. The Matron-in-Chief shall be responsible for keeping divergence of opinion between the Boards, the matter in the Service records and confidential reports from the matrons question shall be referred to the Secretary of State. of the various hospitals regarding the character, conduct, and Functions of Nursing Board. efficiency of the sisters and nurses under their control. 12. The Matron-in-Chief shall keep herself acquainted with 6. Subject to the general control of the Advisory Board the the various shall be responsible for- the administration of the nursing service in Nursing Board military hospitals. (I.) Advising the Secretary of State upon the strength of 13. She shall submit to the Nursing Board recommendations the Nursing Staff of various grades requisite in and each military hospital (including the hospitals for for the appointment, promotion, retirement, dismissal, distribution of members of the service. women and children attached to military stations), I4. She shall be responsible for maintaining a sufficient having regard to the character of the cases admitted, staff of special nurses, detailing them for duty in cases of and subject to the proviso that as a general rule hos- pitals containing fewer than IoO beds will not be emergency, or for service in smaller hospitals. 15. She shall present every year to the Nursing Board a provided with a regular female nursing staff (vide nurses, paragraph I4). scheme for the annual leave of matrons and special and shall report to the Board the arrangements made by (2.) Defining the conditions under which nurses may and nurses. enter the Service, the terms of their appointment, matrons for the annual leave of sisters i6. Amongst the duties of a matron, to be defined in detail and the duties to be performed in the several grades by the Nursing Board, shall be the following: of the Nursing Service. (i) To recommend suitable candidates for admission to (3.) Dealing with all questions relating to the uniform in accordance with the prescribed and clothing of the Nursing Service. the service reports from Matron-in- regulations. (4.) Receiving and (onsidering (2) In conjunction with the Medical Officer in charge of Chief and the matrons of the various hospitals. Matron-in-Chief such Recommending to the Commander-in-Chief, for the the hospital to forward to the (5.) confidential reports with regard to the work and approval of the Secretary of State, the appointment, and retention, promotion, retirement, dismissal, and conduct of the nursing staff as may be required, distribution of the members of the Nursing Service. to make recommendations for retention, promotion, (6.) Arranging for the selection and engagement of addi- retirement, and dismissal. (3) To be responsible for the general nursing arrangc- tional nurses, the organisation of the requisite for due of nursing staff, and the appointment of Principal ments of the hospital, the performance their duties by the sisters and nurses, and for the case of war or epidemic. Matrons in maintenance of good conduct, efficiency, and dis- (7.) Advising the Secretary of State upon the formation Alexandra's cipline amongst all members of the female nursing of the Nursing Reserve of the Queen in Imperial Military Nursing Service. staff. In conjunction with the Medical Officer (8.) Arranging for the periodical inspection of military charge of the hospital to report upon these matters intervals to the Nursing Board through hospitals as regards nursing efficiency. at stated (9.) Submitting to the Secretary of State, through the the Matron-in-Chief. Advisory Board, a scheme for the organisation and (4) To exercise similar functions as regards the hospital development in India of the Queen Alexandra's for women and children in a station where rsuch Imperial Military Nursing Service, which shall allow hospital exists. for adequate local control, subject to the general (5) In urgent cases to provide, where practicable, for the authority of the Nursing Board. nursing of women and children on the married establishment. Grades in the Queen Alexandra's Imperial Military Nursing (6) To engage and dismiss the female servants appointed Service. to attend upon the nursing staff, and to be respon- 7. The Queen Alexandra's Imperial Military Nursing Ser- sible for their discipline, good conduct, and vice shall consist of- efficiency. (i.) A Matron-in-Chief and Principal Matrons. (7) To undertake the daily inspection of the nurses' (2.) Matrons. quarters to ensure that they are clean, well venti- (3.) Sisters. lated, and kept in good order. (4.) Nurses, to Officer in of Badge. (8) To be responsible the Medical charge the for sufficient supply, good condition, 8. All matrons, sisters, and nurses of the Queen Alexandra's hospital and cleanliness of the bedding and linen in the Imperial Military Nursing Service shall be entitled to wear nurses' quarters and the wards under her nursing an appropriate badge which, by special permission only of charge. Her Majesty the President, may be retained by the wearer after leaving the Service. (g) To see that proper medical and nursing attendance is provided without delay for sick members of the The Matron-in-Chief. nursing or female domestic staff. 9. The Matron-in-Chief shall have a seat on the Advisory (io) To arrange the annual leave of sisters, nurses, and Board, acting as a Member of the Board whenever matters female domestic staff, reporting thereon to the concerning the Nursing Service are under discussion, and in Matron-in-Chief. her absence a Principal Matron shall take her duties. I7. A Principal Medical Officer shall report annually to the Txx BiLiTrim I 1 0-7'2 MZDICA.L JOUILNAI I REORGANISATION OF ARMY. NURSING, ERVICE. [C.[OCT. -,5, ICOI.-(! Nursing Board, through the General Officer Commanding, Nursing Board. Should any question arise as to their status upon the conduct and efficiency of the matrons of hospitals in the Queen Alexandra's Imperial Nursing Service, the witliin his district. Nursing Board shall report thereon to the Advisory Board, i8. Amongst the duties of a sister in charge of i ward, to be and the recommendation of the Adcvisory Board shall be sub- defined in detail by the Nursing Board, shall be the following: mitted to the Commander-in-Chief, whose decision shall be (i) To be responsible for the cleanliness, ventilation, and final. good order of her ward and its annexes. 2I. Any present member of the existing Services who is not (2) To atteind the Medical Officers in their visits to the retained in the Queen Alexandra's Imperial Military Nursing ward, and carefully to carry out their orders with Service, may be recommended for a gratuity of one month's regard to the diet and treatment of patients. payfor each year of service, if she is not entitled to a pension; (3) To see that the nurses and orderlies perform their and any member who may decline to accept the new terms of duties punctually and efficiently, reporting any employment shall be allowed to serve upon the terms of her breach of discipline or neglect of duty on the part present engagement. of a nurse to the Matron, and on the part of an 22. PAY. orderly to the Medical Officer in charge of the ward, or in his absence to a warrant or non-com- (a) Nursin.q Staj- Matron-in-Chief, /250 a year, rising by annual incre- missioned officpr of the Royal Army Medical Corps. ments of o10to /300, and lodging allowance. (4) To take part in the nursing of all patients seriously in a ill. Principal Matron India, /230 year, rising by (5) To be responsible to the Matron and Medical Officer annual increments of /io to £280, and lodging of the ward for sufficient supply, good condition, allowance. Principal matrons, £1IO a year, rising by annual and cleanliness of the bedding and linen, and for increments of £5 to £i6o. the personal cleanliness of the patients. according to size of hospital, /70 to /ioo a 19. Amongst the conditions under which nurses may enter Matrons, /120 the Service, and the terms of their appointment (to be de- year, rising by annual increments of 65 tV fined in detail by the Nursing Board) are the following: to £150. Sisters, ios. a year, rising by annual increments (I) A candidate must be of BritUsh parentage, be between /2/37 25 and 35 years of age, and possess a certificate of of 1s. to /5o. Nurses, /25 a year, rising by annual increments of not less than 3 years' training and service in medical /2 and surgical nursing in a Civil Hospital recognised lO8. to 635. the Board. She shall to (b) Female Servants. by Advisory be required a annual increments of / /20. satisfythe Nursing Board that as regards education, /15 year, rising by to character, and social status she is a fit person to be admitted to the Queen Alexandra's Imperial 23. ALLOWANCES. Military Nursing Service. (a) Nursing Staf. (2) If provisionally accepted she shall be placed on pro- Home station, board and washing, x5s. a week. bation for a period of 3 months, at the end of which Station abroad, board and washing, 2IS. a week. time, if her work and conduct are reported to be Station abroad. washing, 38. 6d. a week. satisfactory by the matron of the hospital, she may, Home station, uniform, /6 per annum. after having been medically examined, enter into Station abroad, uniform, /7 per annum. an agreement binding herself to 3 years' service in Home and abroad, cloaks, /2 per annum. the Queen Alexandra's Imperial Al ilitary Nursing (b) Female Servants. Service, and undertaking to conform to the rules Board and washing, ios. 6d. a week. and regulations of the Service. The agreement 24. Allowances at the recognised scale shall be given for shall be dated from the time at which the nurse was Indian and Colonial service. provisionally accepted, and may, on the recommen- dation of the Commander-in-Chief, be terminated Annual Leave. at any time by 3 months' notice from the Secretary 25. The regular annual leave of members of the Queen Alex- of State, or in case of grave breach of discipline or andra's Imperial Military Nursing Service in Home Stations misconduct, without notice. shall be as follows: (3) On the expiration of her three years' term of service Matrons, 6 weeks. a nurse may be permitted- Sisters, 5 weeks. (a) To retire from the Service. Nurses, 4 weeks. (b) To continue, in the Service as a staff nurse, abroad shall be on the with an agreement terminable at any time by Leave at stations granted military one month's notice on either side. system. (c) To join the staff of special nurses under the orders of the Matron-in-Chief, with an agree- Pension. ment terminable at any time by one month's 26. It is desirable that all members of the Queen Alex- notice on either side. andra's Imperial Military Nursing Service should be eligible To offer to apply for a pension at the age of 50 years, and should be (d) herself for promotion to the post of ac- sister, undertaking to serve for at least one retired at the age of .55 years. Rates of Pension shall be year, and afterwards under an agreement cording to the scale laid down in Article I,233, Royal Warrant terminable at any time by one month's notice for Pay and Promotion. on either side. ST. JOHN BRODRICK. (e) To enter into a fresh agreement for service, as E. W. D. WARD. nurse or sister in India or elsewhere abroad, G. DE C. MORTON, Major-General. for a period of three or five years, according to JAMES WILLCOCKS, Colonel. climate. FREDERICK TREVES. WILLIAM THOMSON. W. R. HOOPER, Surgeon-General. Conditions applicable to present members qf the Army and G. H. MAKINS. Indian Nursing Service, and members of the Army HOWARD H. TOOTH. Nursing Reserve. ALFRED D. FRIPP. 20. All present members of the Army and Indian Nursing ALFRED KEOGH, Lieut.-Colonel, R.A.M.C. Service, and members of the Army Nursing Reserve who have ALEX. OGSTON. been in military employment during the war in , E. C. PERRY. shall be eligible for appointment in the Queen Alexandra's H. E. R. JAMES, Major, R.A.M.C., Imperial Military Nursing Service, if recommended by the Secretary.