COLONIAL MEDICAL SERVICE

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in the Air Force List will be determined at the endof the initial course by a system of marking andreports on the actual work done during theirinstruction.

Uniform and Equipment.Medical officers are required to provide themselves

with the uniform, service dress, and mess dress of theirrank and with the distinguishing badges of the RoyalAir Force Medical Branch. The provision of full dressis entirely optional at present. An allowance of 950towards the cost of uniform is made on joining tocandidates who have not had previous commissionedservice in H.M. Forces.

Emoluments.The emoluments of medical officers of the Royal Air

Force are given in outline above. The standard ratesof pay and retired pay were drawn up on the basisof the high cost of living in 1919, and 20 per cent. ofeach of the standard rates is detachable and subjectto alteration either upwards or downwards as thecost of living rises or falls. Under this provisionthe current rates now in force represent a reductionof approximately 6 per cent. on the standard rates.The next revision will take effect from July 1st, 1930,and subsequent revisions will be made at intervalsof three years.

RETIRED PAY.The minimum period of service qualifying for

retirement on retired pay is 20 years. Standard ratesof retired pay are as follows :-

Air Officers.Air Vice-Marshal .....8790 to <BIOIO per annum.Air Commodore .....8650 £950 11

The maximum standard rates of retired pay andthe compulsory retiring ages for the several ranksare :-

* Limited to five years.

Gratuities.-A permanent officer allowed to retirebefore having qualified for retired pay may be granteda gratuity provided he has not less than ten years’ commissioned service, namely :-1500 if he has 10 but less than 15 years’commissioned service.£2500 " 15 or more than 15 11 " "

Short-service officers will be eligible on passing tothe Reserve for gratuities on the following scale :£100 for each of the first two complete years of service,

£150 for each of the third and fourth complete years,and £200 for the fifth complete year ; that is :-

For three years’ service on the active list .. £350For five 11 " " " .. £700

These gratuities will not be payable to officers grantedpermanent commissions, but their service on a short-service commission will count towards retired pay. ,

COLONIAL MEDICAL SERVICE.

IN the self-governing Dominions (Canada, Australia,New Zealand, the Union of South Africa, and New-foundland ), and territories under their control, such asPapua and the Cook Islands and in the self-governingcolony of Southern Rhodesia, medical appointmentsare made concerning which information can be obtainedfrom the High Commissioners or Agents-General inLondon ; in North Borneo application should be madeto the British North Borneo Company, 17, St.Helen’s-place, E.C., for appointments ; and those inSarawak are in the hands of H.H. the Rajah. Muchvaluable information will be found in the " ProfessionalHandbook," Part II., issued by the Oversea Settle-ment Office, Caxton House, Tothill-street, London,S.W. 1, price 9d.As a general rule, each Colony or Protectorate has

its own public service distinct from that of everyother; and it is usually only the higher officers whoare transferred by the Secretary of State from oneColony to another. There are three exceptions tothis rule: (a) The West African Medical Staff, whichserves Nigeria, the Gold Coast, Sierra Leone, and theGambia, is one service. (b) The East African MedicalService, which serves Kenya, Uganda, Zanzibar,Nyasaland, Somaliland, and the Tanganyika Terri-tory is one service. (c) In practice the medical ser-vices of the Straits Settlements and the Malay Statesmay be regarded as one, as the officers may be andfrequently are transferred from the Colony to theStates or vice versa ; the two services are now calledthe Malayan Medical Service.The Colonies, Protectorates, and Mandated Terri-

tories to which medical officers are appointed by theSecretary of State for the Colonies are (a) the WestAfrican-viz., Nigeria, the Gold Coast, Sierra Leone,and the Gambia, with the Mandated Territories ofTogoland and the Cameroons ; (b) the East African-viz., the Kenya Colony and Protectorate, Uganda,Nyasaland, Somaliland. and Zanzibar Protectorates,the Tanganyika Territory, and Northern Rhodesia;(c) the Eastern-viz., Ceylon, the Straits Settlementsand Malay States, Hong-Kong, Mauritius, andSeychelles ; (d) the West Indian-viz., Jamaica,Trinidad, the Windward Islands, the LeewardIslands, Barbados, and the Bahamas ; (e) Fiji andthe Western Pacific, Cyprus, Gibraltar, St. Helena,British Guiana, British Honduras, Bermuda, and theFalkland Islands ; and (f) Palestine.

In Ceylon, Mauritius, Jamaica, Barbados, theBahamas, and Bermuda vacancies are practicallyalways filled locally by the appointment of qualifiednative candidates, or-in the case of some of thehigher posts-bv transfer from other Colonies.In the Bechuanaland Protectorate, Basutoland, andSwaziland appointments are usually filled locally.Appointments in Malta are all filled locally. Inaddition, certain medical appointments in the serviceof the Government of Iraq are filled with the con-currence, and normally upon the recommendation,of the Secretary of State. Vacancies occur mostregularly and frequently in the West African MedicalStaff, the East African Medical Service, and theStraits Settlements and Malay States.

All applicants for medical appointments in the giftof the Secretary of State for the Colonies should beunder 35 years of age, and must be doubly qualified ;preference will be given to those who have heldhospital appointments as house physicians andhouse surgeons ; testimonials to character and pro-

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fessional competence will be required, and everyofficer before being definitely appointed will be

medically examined by one of the consultingphysicians of the Colonial Office : Sir William Prout,C.M.G., O.B.E., and Dr. A. E. Horn, C.M.G., 104,Harley-street, London, W. 1 ; Major-General J. J.

Gerrard, C.B., C.M.G., the Royal Hospital, Kings-bridge, Dublin; Dr. Foster Coates. 22, College-gardens, Belfast ; and Lieut.-Colonel Glen Listen,C.I.E., I.M.S., 33, Comely Bank, Edinburgh, andDr. C. V. Le Fanu, 33, Hodney-street, Liverpool.Applications for such appointments must be addressedto the Private Secretary (Appointments), ColonialOffice, 2, Richmond-terrace, Whitehall, S.W. 1.

EAST AFRICAN MEDICAL SERVICE. The Medical staffs of the Kenya Colony and

Protectorate, the Uganda, Nyasaland, Somaliland,and Zanzibar Protectorates, and the TanganyikaTerritory form one service, the members of whichare liable to be posted or transferred to any of theDependencies as the exigencies of the service mayrequire. The preferences of individual officers are,however, taken into consideration as far as possible.

Selected candidates are appointed as medicalofficers on probation in the first instance for twoyears, at the end of which period their appoint-ments are made permanent if their service hasbeen satisfactory. Unless the Secretary of Statedirects to the contrary, they are required toattend a course of instruction at the Londonor Liverpool School of Tropical Medicine or theUniversity of Edinburgh before taking up theirappointments. If such a course is not takenbefore proceeding to East Africa, they are requiredto take it during their first leave of absence.Medical officers (but not sanitation officers) are

permitted to take private practice at some stationson the understanding that they give precedence totheir official duties. It must be understood thatadditions to their income from this source are notlikely to be substantial, and that the privilege isliable to withdrawal at any time.

Officers are provided with quarters free of rent orthe Government may provide temporary accommoda-tion, or an allowance in lieu of quarters may be paid.The salary of a medical or sanitation officer is 600per annum, rising by annual increment of 30 to840, and thence by increments of £40 to £920,subject to an efficiency bar at £840. Senior medicalofficers and senior sanitation officers are paid on thescale £1000 by annual increments of £50 to £1100.Officers who possess the Diploma in Public Healthon entering, or who acquire it while in the Service,receive two special increments in the scale.

Officers of the East African Medical Service are

permitted to retire with gratuity, if they wish, insteadof waiting to retire on pénsion as follows : (a) Afternine years’ service, of which at least six must havebeen spent in East Africa, £1000; (b) after 12 years’service, of which at least eight must have been spentin East Africa, £1250. If an officer elects to retirewith gratuity he thereby forgoes all claim topension.The grades and salaries (apart from ordinary

medical and sanitation officers) in the medical depart-ments are as follows :-

Kenya.—Director of Medical and Sanitary Services,;E1500; Deputy Director of Medical Service, 1200: DeputyDirector of Sanitary Service, £1200; Deputy Director ofLaboratory Service, 91200.

Uganda.—As Kenya. ’Tanganyika Territory.—As Kenya.Nyasaland.—Director of Medical and Sanitary Services,

£1200; Medical Entomologist. £1000-£50-£1100.Zanzibar.—Director of Medical and Sanitary Services,

£1400; Deputy Director of Sanitary Service, ,81200 : Rtsi-dent Surgical Officer. £1000- £50-£1100.

Somaliland.—Principal Medical Oilicer, £1000-£50-£1100.

There are also the following posts :- ResidentSurgical Officers (Kenya and Uganda), 1200 ;Specialist Officer, Sleeping Sickness (Uganda), £1150;

Medical Superintendent and Principal of MedicalSchool, Mulago Hospital (Uganda), £1150; SleepingSickness Officer (Tanganyika Territory), £1000-£50-£1100; Senior Bacteriologists (Kenya and Uganda),£1000-£50-£1100.

Sanitation officers are selected from the ranks ofmedical officers as occasion arises.

ASIA.Straits Settlements and Federated Malay States.-

European medical officers are appointed on thefollowing scale of salaries:$500 per mensem, rising to$550 per mensem during three years’ probation ;then, if they are placed on the pensionable establish-ment, rising to$575 per mensem, and thence byannual increments of$25 per mensem to$800 permensem, with a strict efficiency bar at$600 permensem. Officers possessing the D.P.H. receive anadditional allowance (non-pensionable) of$100 permensem.

. Above the concluding figure of$800 per mensemthere are certain higher appointments, as follows :Principal Civil Medical Officer, Straits Settlements, andPrincipal Medical Officer, Federated Malay Stater,$1200 per mensem ; Director, Institute for MedicalResearch, Federated Malay States, Chief HealthOfficer, Federated Malay States, and PrincipalMedical College, Straits Settlements,$1100 permensem ; Senior Surgeon, Singapore,$1050 permensem ; 3 Chief Surgeons, Federated Malay States,$1000 per mensem ; Medical Officer and OphthalmicSurgeon,$1000 per mensem ; 6 posts at$1050 permensem ; and 17 posts at$850 per mensem, risingannually by$30 to$1000 per mensem. There arealso 14 medical appointments, including severalsenior posts, in the Unfederated Malay States.The following temporary allowances are at present

paid to all officers recruited from Europe in theGovernment Services of the Straits Settlements andFederated Malay States : unmarried officers, 10 percent. of salary; married officers, 20 per cent. ofsalary. Private practice by Government medicalofficers is not allowed, but consultation work withanother practitioner is permitted. Information aboutgeneral conditions in Malaya is obtainable from theMalay States Information Agency, 57, Charing Cross,S.W. 1.

Seychelles.-The chief medical officer receivesRs.700’0 per annum. There are four assistantGovernment medical officers, two receiving Rs.6500,the others Rs.3000 per annum.

Hong-Kong.—The present establishment of themedical department is : director of medical andsanitary services, £1200-£50-£1450; deputy director,£1125-£25-£1200; senior medical officer, £1025-£25-.81100 ; three medical officers of health, £740-£30-.81040 ; health officer of the port. and secondhealth officer of the port, .8740-JE30-81040 ; fivemedical officers, .8600-830-81020 ; bacteriologist,£800-£1100; assistant bacteriologist, £740-£30-.81040 ; radiologist, £740-£30-£1040; analyst, £625-.E25-JE900 ; assistant analyst, £400-£25-£700. Atemporary allowance on a scale varying with thesterling exchange value of the dollar is at presentpayable. Salaries are converted locally at the rateof 2s. =$1. Free quarters are not provided, but incertain instances a rent allowance is paid by theG overnment.

AMERICA.British Guiana.—There are the following posts in

the medical service of the Colony: one surgeon-general, £1000-£1200 per annum, with consultingpractice ; one medical officer of health, £900;ophthalmologist, £700; one bacteriologist and patholo-gist, £700; 37 medical officers at £500-£25-£700.Most of the senior posts in institutions carry dutyallowances (varying from £50 to £300 per annum)and quarters.

Trinidad and Tobago.—In Trinidad and Tobagothere are about 40 appointments. Governmentmedical officers receive salary at the rate of £400

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per annum, rising by annual increments of £25 to;8600. An officer appointed to a district receives,in addition to his salary, a travelling allowancevarying from 2100 per annum in a normal district to£150 per annum, and is allowed private practice,the value of which is estimated at from £50 to £800per annum. Officers employed in institution workreceive a duty allowance varying from £50 to £300.Medical officers having completed 10 years’ residentservice are pensionable at the age of 55.Windward Islands (Grenada, St. Lucia, St. Vincent)

There are over 25 appointments. The chiefmedical officer, Grenada, receives £750. The chiefmedical officer, St. Lucia, receives £600-£700 plusforage and subsistence allowances ; the post ispensionable, but private practice is not allowed exceptas a consultant. Most of the remaining appointmentsare district appointments with the right to privatepractice attached ; the salaries paid by Governmentare on the scale from £400-£500, except in St. Vincent,where the maximum is £450. The Governor hasthe power to transfer a medical officer from oneisland to another. Appointments are pensionable.

Leeward Islands (Antigua, St. Christopher andNevis, Dominica, Montserrat, Virgin Islands).-The appointments are similar in number and characterto those in the Windward Islands, and are pensionable.An officer when first sent out is not appointed to aparticular island but to the service of the LeewardIslands, with a salary of £350, and is later appointedto a definite district at a salary varying from £312to £400-£25-£450, and the Governor decides as tothe district which is to be allotted to him, accordingto station. He is liable to be transferred at theGovernor’s discretion, to any medical district in theLeeward Islands. The medical officers, except inSt. Christopher and Nevis, receive fees for successfulvaccinations, post-mortem examinations, evidence atcourts of justice, certificates of lunacy, and, in thelarger islands, for burial certificates. They are also,as a rule, allowed private practice. The chief medicalofficer, St. Christopher and Nevis, receives £700-£25-£750, but is not allowed private practice, except as aconsultant.

British Honduras.-There are seven medical appoint-ments (besides the post of principal medical officer)at a salary of$2430 per annum with incrementsof$120 to$3150. Unless they already possessa diploma of public health, medical officers are

liable to be required, before they join the colony,to undergo a course of instruction at a laboratory ofpublic health or analogous institution. The value ofthe dollar is the same as that of the United States- dollar.

OTHER OVERSEAS APPOINTMENTS.

Fiji.—The Chief Medical Officer receives £1000-£50-£1100, with free quarters, unfurnished ; the MedicalSuperintendent, Colonial War Memorial Hospital;£800-£50-£1000, with £40 car allowance and freequarters ; the Medical Superintendent, Leper Asylum,£750-£50-£950, with completely furnished quartersand one servant; the Medical Officer of Health,£750-£25-£900, no quarters provided. There are 14District Medical Officers who receive £500-£25-£725,with partly furnished quarters or £50 house allowance(at the option of the Government) and duty allowanceof £50 per annum in districts where no privatepractice exists. In certain districts house allowancesor car allowances are granted. In others a medicalofficer is provided with a launch or boat. DistrictMedical Officers are allowed private practice on theunderstanding that their official duties are not-neglected. In five districts the Medical Officer is alsoDistrict Commissioner and receives an additionalallowance of from £175 to £275 and free partly-furnished quarters. In most districts there is privatepractice, the value of which has been estimated atfrom £100 to £600 a year.

’

Western Pacific High Commission.-The staff in the British Solomon Islands Protectorate consists of a.Senior Medical Officer (£650-£750), two District

Medical Officers (£550-£650), and one TravellingMedical Officer (£550-£650). Partly-furnished quar-ters are provided and a local allowance of £50 perannum is paid to the Senior Medical Officer and theDistrict Medical Officers. A local allowance of £50,consolidated travelling and subsistence allowance£200, and partly-furnished quarters are provided forthe Travelling Medical Officer.

In the Gilbert and Ellice Islands Colony there isa Senior Medical Officer (£650-£750), with partly-furnished quarters, and one Medical Officer (£600-£25-£650), with partly-furnished quarters or houseallowance. There is hardly any private practicein the British Solomon Islands Protectorate or the

Gilbert and Ellice Islands Colony.’ Cyprus.-There is a chief medical officer paid at therate of £750, rising by annual increments of £25 to

£850, and three district medical officers paid at therate of 2500 a year, rising by annual increments of JE20to £600 a year, all enjoying private practice (exceptthe chief medical officer and one of the districtmedical officers, who are allowed consulting practiceonly). There is also a post of consulting surgeon,£100-£20-£600 a year, with consulting practice.There is also a medical officer of health on £600,rising by C20 increments to £750 without privatepractice, and a specialist in venereal diseases with asalary of £700 a year and consulting practice ; theseare the only medical appointments open to Britishcandidates.

Gibraltar.—There is a surgeon of the ColonialHospital receiving £730, and private practice. Thereare also two assistant surgeons with a salary of :13600for 3 years and thereafter £650-£25-£700 per annum,who are allowed private consulting practice only.Free quarters, unfurnished, are provided for all threeofficers.

St. Helena.—The colonial surgeon at presentreceives £550 per annum, fees estimated at about £27a year, and £30 horse allowance. The assistant colonialsurgeon at present receives £500 a year and £30 horseallowance. Private practice is allowed, and suchpractice, together with the duties of non-Governmentappointments, is divided between the colonial surgeonand the assistant colonial surgeon in a proportionapproved by the Governor. The value of privatepractice and appointments is estimated at about£536 a year.

Falkland Islands.-There are two appointments.The colonial surgeon is paid at the rate of £600 perannum, with free furnished quarters. The assistantcolonial surgeon is paid at the rate of £500 per annum,with an allowance of £50 per annum in lieu of quarters.Private practice is shared between the colonial surgeonand the assistant colonial surgeon. The office ofcolonial surgeon is pensionable. The medical serviceof this colony is now under review.

Palest4ite.1-The grades and salaries of higherappointments in the Department of Health are:

Director, :6P.1200, plus £P.200 expatriation allowance.Deputy Director, £P.900-50-£P.1100, plus £P.150expatriation allowance. Assistant Director (Labora-tories), Specialist Surgeon,2 and five Senior MedicalOfficers, P.750-25-950, plus P.100 expatriationallowance. One Senior Medical Officer and Govern-ment Analyst, £P.550-25-750, plus £P.100 expatria-tion allowance. The remainder of the staff isrecruited locally. A temporary and variable cost-of-living allowance is at present payable in addition tothe salaries stated above.

Iraq.-The grades and salaries of the principalappointments in the Department of Health are:

Inspector-General of Health, Rs.1800-100-2800 a

month; Health Specialists, Directois of Hospitalsand Institutes, Chief Medical Officers in Mosul andKirkuk, Medical Officers of Health in Baghdad andBasra, Rs.1500-75-1800-100-2300 a month ; MedicalOfficers, Rs.1200-75-1800 a month. Posts in the

1 £P.1=£1 sterling.2 A certain amount of private practice is allowed.

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service of the Government of Iraq are not pensionable.Every officer (unless serving’on a 3 years’ contract)is required to contribute one-twelfth of his pay to aprovident fund, to which the Government makes acontribution equal to one-sixth of his pay.

LEAVE AND PENSIONS.

Leave and Passages.-Lea,ve of absence in EastAfrica. The normal tour of service is 20 to 30months (less in Somaliland) after which leave is

granted with full salary for 2 to 3 days, accordingto the districts in which the officer has served, foreach month of service, plus the period of the voyageto England. If the officer is returning to EastAfrica for further service, he receives a further similaramount of leave, plus the period of the voyage toEast Africa. Extensions of leave with full salaryare given in case of sickness or in the case of officersattending approved courses of instruction. Inaddition to the above, local leave may be grantedup to 14 days a year. Officers serving in NorthernRhodesia are allowed four (or two) days’ leave inrespect of each month of service. Free first-classpassages are provided for the officer on first appoint-ment and on leave, and in certain cases assistancetowards family passages is given.

In the Malay Peninsula two months’ leave of absencewith full salary may be granted in respect of eachyear’s service, and this leave may be accumulated upto a maximum of eight months. Additional leave onhalf-pay may be granted on special grounds. Officersare provided with free passages on first appointmentfor themselves and their families (i.e., wife andchildren up to five persons, inclusive of the officer).Under temporary regulations at present in force,free return passages on leave to all officers (and theirwives and their children under the age of 10) irrespec-tive of salary.

In other Colonies outside Tropical Africa, subjectto the necessities of the service, leave of absence onhalf salary may be granted after a period of threeyears’ resident service without any special grounds.It may be given before the expiration of that period incase of serious indisposition, or of urgent privateaffairs. In the absence of special grounds, the leavemust not exceed one-sixth of the officer’s residentservice ; on special grounds it may exceed that periodby six months. In addition to the above, vacationleave on full pay may be granted, if no inconvenienceor expense is caused thereby, not exceeding threemonths3 in any two years. British Guiana, Jamaica,and Trinidad officers are allowed to accumulatefull-pay leave at the rate of six weeks for each year’sservice up to six months, exclusive of the period ofthe voyages to and fro, and no leave of absencemay (except in very special circumstances) exceedsix months in all unless the officer has served forfive years or more without leave. in which case twomonths on half-pay may be taken in addition tosix months’ full-pay leave.On first appointment an officer will, except in

the case of a few Colonies possessing RepresentativeAssemblies, be provided by the Crown Agents for theColonies with free passages to the Colony for himselfand his wife and children, if any, not exceeding fourpersons besides himself. The officer so appointedwill be required to execute an agreement binding himto repay the cost of the passage or passages so obtainedin the event of his leaving the Government servicewithin three years. An officer taking leave out ofthe Colony has in most cases to provide his own passages. ,

Pensions.—East Africa.-Officers on the pension-able establishment may retire (or be retired bythe Government) on attaining the age of 50 years ;but they may be retained in the service, with theirown consent, for such further period as the Govern-ment may recommend. Earlier retirement in theevent of ill-health is also provided for. Pension

3 Or, in the case of Fiji and the Western Pacific and theFalkland Islands 4½ months in any three years.

is computed at one-four hundred and eightieth ofpensionable emoluments—i.e., salary and value of freequarters 4 in respect of each month’s pensionableservice—at the time of retirement, subject to an

average of emoluments for the last three years beforeretirement instead of the actual emoluments at thetime of retirement being taken as the basis forcalculation in certain circumstances.

Other Colonies.-In most of the other Colonies anofficer holding a pensionable appointment may beallowed in the case of ill-health to retire on a pensionafter ten full years’ resident service ; otherwise hemust have attained the age of 55. For ten full years’resident service fifteen-sixtieths of the average annualsalary of the retiring officer’s fixed appointments forthree years prior to retirement may be awarded, towhich one-sixtieth may be added for each additionalyear’s service ; but no addition will be made in respectof any service beyond 35 years. For pension purposesabsence on vacation leave counts as full service, andleave on half-pay as half service. In a few cases theretiring age is 60 and the pension after ten years’service is ten-sixtieths instead of fifteen. In theStraits Settlements and Malay States, an.officer may,with the consent of Government, retire at age 50.Pensions are calculated on a basis of length of servicein months instead of years.

WEST AFRICAN MEDICAL STAFF.

Applicants for appointment as medical officersor medical officers of health in the West AfricanMedical Staff (the higher grades will usually befilled by promotion from the lower) must beBritish subjects of European parentage and between23 and 35 years of age ; preference is given to candi-dates who are over 25 years of age. Applicants mustpossess a complete double qualification, and must beon the Medical Register. Passages for wives andchildren are not provided by the Government, andhouses for the wives of junior medical officers are-

rarely available. Officers are not usually allowed to-take their wives and young children out with themuntil they have acquired experience of the localconditions and have obtained the sanction of theGovernor. When an officer has obtained permissionto be accompanied by his wife a grant of one-half the-cost of his wife’s’passage to and from West Africa is.made subject to certain conditions.

Candidates whom it is proposed to select forappointment will have to be medically examined byone of the medical advisers of the Colonial Office (or,in the case of those residing in a Colony, by a medicalofficer appointed by the Colonial Government), andno appointment will be made unless the candidate isdeclared to be physically fit for service in West Africa.Candidates are allowed to express a preference forany particular Colony, and their wishes in thisrespect will be borne in mind and met as far aspossible, but they are liable to be posted in the firstinstance, or transferred afterwards if necessary toany other West African Colony at the discretion ofthe Secretary of State. Candidates who wish to beposted to Nigeria will probably find it useful to beable to ride. Transfers from one Colony to anotherwill be made as seldom as possible. Candidatesshould on no account apply for, or accept, a WestAfrican appointment in the expectation of ultimatelybeing transferred.

Those transferred to pensionable Crown appoint-ments elsewhere than in West Africa do not forfeittheir claim to pension in respect of their West Africanservice on final retirement, provided that they havebeen members of the staff for at least 12 months.Every officer selected for appointment is required tohave himself revaccinated before proceeding to WestAfrica, unless one of the medical advisers of theColonial Office certifies that this is unnecessary.

4 The value of free quarters for pension purposes is taken as15 per cent. of the minimum salary of the grade in which anofficer is serving at the time of retirement, subject to amaximum of £1 50.

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Instruction in Tropical Medicine.-Every candidateselected for appointment will, unless the Secretary ofState decides otherwise, be required to undergo a

course of instruction either at the London School ofHygiene and Tropical Medicine, Endsleigh-gardens,N.W.1, or at the Liverpool School of TropicalMedicine, Liverpool University, or at EdinburghUniversity. The cost of tuition will be borneby the Government, but candidates must make theirown arrangements for board and lodging ; an

allowance of £25 a month will be paid to themmonthly in arrear while they are under instruction.Payment of the allowance will be made subject tothe candidate signing an agreement by which he isbound to refund it (1) if he declines to accept anappointment in any of the Colonies for which hemay be selected ; (2) if he fails to obtain a certificateor diploma ; (3) if he relinquishes the Service for anyother reason than mental or physical infirmity, or

is removed for misconduct, within three years of hisarrival in West Africa.

If at the end of the session there exists no vacancyin the Staff to which a candidate can be appointed,he will be placed in a Reserve and granted an allow-ance at the rate of ;f;200 a year until the occurrence ofa vacancy.

Leave of Absence.-European officers in WestAfrica may be granted vacation leave on full salarynot exceeding in all one week’s leave in the UnitedKingdom for every completed calendar month oftotal residential service in West Africa, plus the time necessarily taken on the journey to the UnitedKingdom, and, if the officer is returning to WestAfrica for further service, the time necessarily takenon the journey from the United Kingdom to theColony. Vacation leave may be granted without anyspecial grounds after 18 consecutive calendar months ofresidential service in West Africa. An officer willnot be required to serve a tour of more than 24consecutive calendar months’ residential serviceexcept in special circumstances ; and the Governormay grant vacation leave to any officer at any timeafter he has completed 12 consecutive calendarmonths’ residential service within the above limits,the actual length of each officer’s tour will be at thediscretion of the Governor. Vacation leave on fullsalary may also be granted to an officer if he isinvalided from West Africa after less than 12 con-secutive calendar months’ residential service, andsick leave on full salary may be granted for anyperiod not exceeding six calendar months.

Appointments and Salaries.—Medical officers forthe West African Colonies and Protectorates-namely, the Gambia, Sierra Leone, the Gold Coast(including Ashanti and the Northern Territories), andNigeria (Southern and Northern Provinces)-areselected by the Secretary of State for the Colonies,and are on one list for employment and promotion.The grades and emoluments of the Staff are at presentas follows :-The Director of the Medical and Sanitary Service, Nigeria,

receives a salary of £1800 a year, with a duty allowance atthe rate of £360 a year. The Director of Medical andSanitary Service in the Gold Coast receives a salary ofJB1600 a year, with a duty allowance at the rate of £320 ayear. The Director of Medical and Sanitary Service inSierra Leone receives a salary of £1400 a year, with a dutyallowance at the rate of £280 a year. The DeputyDirector of Medical and Sanitary Service, Nigeria, and theDeputy Director of Sanitary Service, Nigeria, receive salariesof £1500 a year, with duty allowances at the rate of £300 ayear. The Deputy Director of Medical and Sanitary Service,Gold Coast, and the Assistant Director of Medical andSanitary Services, Nigeria, receive salaries of £1400 a year,with duty allowances at the rate of £280 a year. AssistantDirectors Medical Service : There are seven appointmentson this grade, five in Nigeria, two in the Gold Coast. Thesalary is at the rate of £1300 a year, with duty allowance atthe rate of £260 a year. The Assistant Director of SanitaryService, Nigeria, the Deputy Director of Sanitary Service inthe Gold Coast and the Deputy Director of Sanitary Servicein Sierra Leone receive salary at the rate of £1300 a year,with duty allowance at the rate of £200 a year. Specialists :The number of these appointments is not fixed, officers of

outstanding professional merit being eligible for appointment.The salary is at the rate of £1300 a year, with dutyallowance at the rate of £260 a year. After fiveyears’ approved service as such, the specialist officeris eligible to receive a salary at the rate of £1400 a y-’ar,with duty allowance at the rate of £280 a year. Tiereare at present five officers appointed specialists in Nigeria,three in the Gold Coast, and one in Sierra Leone. SeiiorMedical Officer : There are twenty appointments of thisgrade, with salary at the rate of £1000 a year, rising byannual increments of £50 to £1150 a year, and seniorityallowance at the rate of £100 a year. The Senior MedicalOfficer, Gambia, is allowed " staff pay

" of B150 a year, inaddition to duty allowance, but he is debarred from privatepractice. Senior Sanitary Officer : There are nine appoint-ments of this grade, with salary at the rate of £1050 a year,rising by annual increments of £50 to £1200 a year, and aduty allowance at the rate of £210 a year. Possession of theDiploma in Public Health is usually required for appoint-ment to this grade. Special facilities are granted to study forthe diploma during leave. Medical Officers of Health:There are at present 24 appointments of this grade. Thesalary scale is the same as that of Medical Officers. exceptthat Medical Officers of Health are granted an initialsalary at the rate of £800 a year, together with seniorityallowance at the rate of £72 a year and staff pay at therate of £150 a year, half of which is payable during leave.After three years’ service on the maximum of the scale,viz., £960 a year, and on undergoing an approved course ofstudy, Medical Officers of Health are eligible, if unpromoted,subject to the recommendation of the Governor, to be placedon the scale £1000 a year rising by annual increments of£50 to £1150 a year, together with seniority allowance atthe rate of £100 a year and staff pay as before. The holdersof these appointments are not allowed private practice.Candidates selected for service as Medical Officers of Healthmust obtain the Diploma in Tropical Medicine and Hygieneof Cambridge, London, or Liverpool as a condition of appoint-ment, or must be in possession of the Diploma in PublicHealth. They are appointed subject to the condition that,if after a period of service in West Africa they are consideredunsuitable to serve in that capacity, they may be called uponto transfer to the medical side. In such cases the officeisare given the rate of salary which they would have reachedif they had been appointed to be Medical Officers instead ofMedical Officers of Health in the first instance. MedicalOfficer : The salary attached to this grade is at the rate of 660a vear, rising by annual increments of £30 to £720 a year.Then, if confirmed in the appointment, £720 a year. rising byannual increments of £40 to £960, with seniority allowance atthe rate of £72 a year. Before passing £800, medical officersare required to take a special course of study for three months.If they obtain satisfactory certificates at the end of thecourse they draw their further increments up to £960 a year.

A medical officer who has served for three years onthe maximum salary of this scale (£960) withoutobtaining promotion is eligible, if recommended bythe Governor, to be placed on the scale £1000-£50-£1150, with £100 seniority allowance (as for SeniorMedical Officers).

Special Appointments.—The Director of the MedicalResearch Institute, Lages, and the Director ofthe Medical Research Institute, Accra, receive a salaryof £1300 a year, with a duty allowance of j6260 ayear, rising after five years’ approved service to asalary at the rate of £1400 a year and duty allowanceat the rate of £280 a year. There are a number ofappointments for pathologists and bacteriologists inNigeria and the Gold Coast. The salary and otherconditions attached to these posts are similar to thoseof Medical Officers of Health. Duty allowances,seniority allowance, and staff pay are not pensionableemoluments.

Increments.-Increments to salaries are payableonly when the service of an officer during the periodof employment qualifying for increment is approved.Payment of Salaries.-Information as to the pay-

ment of officers’ salaries or of monthly remittances topersons in England may be obtained from the CrownAgents for the Colonies, 4, Millbank, S.W. 1. Allallowances are paid locally.

All officers of the staff, except directors, deputydirectors, assistant directors, senior sanitary officers,medical officers of health, research officers, and afew other officers holding special appointments,are at present allowed to take private practice,provided that it does not interfere with the faithful

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and efficient performance of their official duties, butit is within the power of the Governor to withdrawor suspend the privilege in such places and forsuch periods as he may consider desirable. Private

practice does not exist at many stations, and noguarantee can be given that an officer will be postedto a station in which he will be able to practiseprivately. As a general rule, and subject to theexigencies of the service, stations where there is privatepractice are allocated to senior members of the Staff.Pensions and Gratuities.-Pensions and gratuities on

retirement are granted in accordance with the law andregulations of each individual Colony.

Fuller information can be obtained from the PrivateSecretary, Colonial Office, 2, Richmond-terrace,London, S.W.I.

SUDAN MEDICAL SERVICE.This Service is responsible for carrying out civil,

medical, and public health duties in the Sudan.The staff consists of : (a) A Director, pay £1500-

22000. (b) A Senior Physician and a Senior Surgeonto the Khartoum and Omdurman Civil Hospitals,each with a pay of £1200-£1750. (c) An AssistantDirector and Medical Officer of Health, KhartoumProvince, pay £1200-£1750. (This latter post istemporary, and the terms and duties are subject toalteration). (d) 31 British " Senior Medical Inspec-tors " and "Medical Inspectors," whose pay com-mences at £720 and rises, subject to the recommenda-tion of the Director, by five biennial increases to£1080, and after 13 years’ service to £1200. TheSenior Medical Inspectors are eligible, by selection,for the four senior posts. All Medical Inspectors areappointed, in the first place, on probation for twoyears, and if at the end of that time they are acceptedfor permanent service under the Sudan Government,the first increase of pay is subject to their passingan examination in Arabic.In addition to the above there are (e) a number

of Medical Officers trained at one of the SyrianMedical Schools, besides (f) Sudanese Medical Officerstrained at the School of Medicine at Khartoum.There are several native ((j) Assistant Medical Officers,who have been given a purely practical training inone of the larger hospitals in the Sudan.Amongst the attractions of the Service are : The

great variety of the work met with among manydifferent races of the Sudan ; leave of 90 days,which is granted every year after the first 18 monthsof service ; study-leave, which may be given for somedefinite purpose, whilst two years towards pensionableservice may be granted to those who have specialqualifications and experience. The pension forMedical Inspectors who retire after 20 years’ serviceis not less than EE.500 a year. If, however, heserves for a longer period, or is appointed to one ofthe higher posts, he will receive a larger pension.Private practice is allowed, but is limited to a fewof the larger towns, and may be carried on so longas it does not interfere, in any way, with officialduties. These duties include acting as consultantto the principal hospitals and the supervision ofmedical and public health work, the inspection ofschools, the examination of candidates for Governmentservice and pension, and the training of AssistantMedical Officers and native Sanitary Overseers.The Khartoum Medical School is staffed, mainly bymembers of the Medical Service, who receive anadditional remuneration of £250 a year for theirwork as teachers. A Registrar of the Medical Schoolis also selected from the Service, who receives £250 avear extra pav.The country is developing rapidly, and the Medical

Department is being increased to meet its growingrequirements. Vacancies are always advertised inTHE LANCET as they occur.

Candidates must be single and under 30 yearsof age. and they must have held a resident post,preferably that of house surgeon, in a large generalhospital. As a rule they are required to take out acourse in Tropical Medicine before they leave England

for the Sudan. The f ves for this course are paid bythe Sudan Government, and in addition, an allowanceof £4 15s. per week is made, under certain circum-stances, to each selected candidate who attends it.

Inquiries for further information should be madeto Dr. Acland, 19, Bryanston-square, London, W. 1,or to the Deans of the principal medical schools.

WOMEN’S MEDICAL SERVICE FOR INDIA.AMONG careers open to medical women abroad the

Women’s Medical Service for India deserves honour-able mention. This service is open to fullyqualified medical women of British or Indiannationality, and with the present amount of Govern-ment subsidy the number of medical officers islimited to 44. Medical women proceeding to Indiato join the Women’s Medical Service receive a

sufficient sum for a first-class passage to India. Onlanding they are posted to one of the larger women’shospitals to gain Indian experience and to learn thelanguage. During this period (from six months to twoyears) private practice is not allowed. For a furtherperiod they are appointed to act temporarily formedical women on furlough, during which timeprivate practice is allowed. They are then definitelyappointed to the charge of hospitals. Private prac-tice is always allowed after the first two years, pro-vided it does not interfere with official duties. Theonly exception is in administrative or educationalposts, when an allowance in lieu of practice is given.The amount obtained from practice varies accordingto the station, but in most cases it forms a fair additionto the salary, varying from £150 to £1000 a year.

Excellent opportunities for surgery-especiallygynæcological—are found in the Women’s MedicalService. To those who are not keen surgeons oppor-tunities are likely to open in the future in connexionwith maternity and child welfare ; medical womenwith administrative ability are also needed for theinspection of women’s hospitals and other medicalinstitutions.

Rates of pay are as follows :—

Furnished quarters are provided, representing anadditional Rs.150 per mensem.The cost of living in India is much higher than

formerly, but it should be possible for a medicalwoman (with house provided) to meet actual householdexpenses for about Rs.200 per mensem, leaving theremainder of her salary for dress and personal expenses.To this must be added the necessary saving to meetadditional expense for furlough and leave spent inthe hills.One month’s privilege leave on full pay is granted

each year. Furlough on half-pay at the rate of twomonths for every year of service is granted after everythree years. Study-leave on two-thirds pay is grantedto the extent of 12 months in the total service. Thereis a provident fund to which members of the servicecontribute 10 per cent. of their pay. The servicecontributes another 10 per cent., which accumulates atinterest and is repaid on retirement.

Admission to the service is made by selection. Can-didates in the United Kingdom should apply to theHon. Secretary, United Kingdom Branch of theCountess of Dufferin’s Fund, care of Major-GeneralJ. B. Smith, India Office, Whitehall, London.

Documents

COLONIAL MEDICAL SERVICE