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the merits and conduct of the two classes. I consider," says Dr Andrew Smith," that the danger to which an officer is exposed during a severe epidemic in the West Indies, is greater than the danger that a man is exposed to in war." Who can doubt the large fund of courage, both active and passive, that is to be found in the medical profession? But is there only one form of reward for every kind of courage? St Francis, Thomas-àBecket, Luther, Latimer, Howard in the dungeons, and Mungo Park among the Africans, all showed a courage of which it were difficult to define the bounds; but would any of them have thought that all its aims were lost because they are refused a pair of epaulets, and the distinction of so many shots over their coffins? We cannot conceive that it would do justice to the courage with which a man of experience and learning deliberately devotes health and life to the fulfilment of the noble duty of saving the lives of many others, that his merit should be weighed in the same balance with that of the high-spirited, thoughtless youth, who is the first to leap into the ditch or mount the parapet. The spot where the soldier's glory can be gained, is often far from that where the zealous military surgeon is reaping his. The Commissioners, referring to those honours which can only be conferred for service in the face of the enemy, say: "But the most arduous and the most dangerous services of medical officers are not always, even in war, rendered before the enemy. They have to strive with an enemy more dangerous than man. In the almost pestilential wards of Scutari, the exertions were more continuous, the dangers were greater, and the honours and rewards to be obtained were fewer, than at the front before Sebastopol. The mortality of the medical officers at Scutari was not much exceeded by that of the combatant officers in the army of the Crimea; but the survivors are debarred from receiving those honours which, fortunately for the country, are prized more than either rank or emolument."

In fact, there are some grounds for thinking that the medical depart

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ment is already cramped by too close an analogy to the combative in the gradation of ranks. Look at the difference of natural function between a superior and inferior officer, and a superior and inferior physician. In the former case the captain commands his company of one hundred, the colonel commands ten companies, making his thousand, and so upwards to the commander-in-chief; the character and responsibility of the functions rapidly rising with the rise in rank. In the medical world the family physician or the apothecary attends to the teething of the children, to the coughs and stomach-complaints, to the occasional sprains and cut fingers. When a critical case of typhus or erysipelas occurs, the superior officer is called for in the shape of the eminent consulting physician; if some critical operation in trepanning or amputation is necessary, he comes in the shape of a celebrated operating surgeon. But in the army service, where the established function of each rank is to have command over those of inferior rank, the adaptation of the several grades in medical and surgical science to their proper exigencies is entirely lost. The physician's progress upwards in his profession must all be through practice; but when he rises above the position of regimental surgeon in the army, he virtually leaves this test of progress behind him. Thus the performance of the most critical operations falls to the regimental surgeon and his assistant, the youngest members of the medical hierarchy--many of those in the Crimea, according to the evidence on the point, were mere boys; while it is the function of some dignified and veteran inspector to notice whether a bit of orange-peel is left on an hospital floor, or whether the requisitions are accurately recorded, and the case-books rightly kept. Thus, under the present system, it seems extremely difficult to find functions and rewards for professional talent in the army. A man there may be a great physician or surgeon, and a blessing to his regiment, but he cannot rise from his humble sphere but to undertake functions on which his talents are wasted, or for which they may not be suited. In the permanent

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military hospitals there are opportunities for men of professional ability, but these can absorb but a small number. And even the inspecting and other work of the ordinary seniors can, we would suppose, give work to but a small proportion of those who rise in rank by seniority. Where elevation is virtually a removal out of the true theatre of usefulness, of course there will be no strong case for breaking through the easy and natural gradation by seniority. If, indeed, a man has talent enough for the performance of his regimental duties, it would be scant justice to deny to him that rank which he can also fill as well, because there is some other person who could perform some higher professional function still, were there any such in existence. How this must all tend to depress military talent and energy in the army, may be too easily seen. On the difficulty of bringing promotion by selection to bear on professional merit, we take the following remarks by a surgeon of hussars, Dr Henry Mapleton-they look like truth and good sense. "No man deserves promotion more than the quiet unassuming man who will get up at night and go to the sick, readily and without murmur, with kindness and humanity in all his acts, but who will not perhaps write a good report : and my experience of the profession is, that in nine cases out of ten, the best practical men are the worst at making reports. Yet this man will rarely be brought to the special notice of the Director-General for promotion out of his turn; but another, who writes well and practises badly, will." (Q. 4568.) There has hitherto, however, been but slight occasion for considering the best criterion for special promotion, since there seem to have been but rare infringements on the seniority system. A considerable portion of the Report before us is occupied with explanations how the promotion by seniority is adjusted to practical possibility, since army surgeons die all over the world, and the man next to the vacated place may be fifteen thousand miles away from it. The arrangements made for adjusting the claims of all, may be in reality simple, like those of the great bank and railway clearing houses in

London, but the details appear to the uninitiated very complicated.

How very necessary the system of promotion by seniority is in the army medical department, and how very heavy a burden this necessity is, are both illustrated in a remarkable form by promotions made upon other grounds in the Russian war-promotions which could not be avoided without scandal. It appears that these promotions upheaved a stratum of other medical officers away from the scene of action, who would have reason to complain that they had not an opportunity of competing for the prizes. It is explained that when such promotions were made, the Director-General, following a practice which had perhaps been established when instances of special promotion were extremely rare, took the earliest opportunity to promote the medical officers who had been passed over, as it is termed, by the special promotions. "Thus many medical officers who had distinguished themselves by their zeal or skill during the war in the East, or who had served continuously through all the hardships and dangers incidental to those campaigns, were rewarded by promotion, irrespective of seniority; and their seniors, who, being in Australia or elsewhere during the same period, had had no such oppor tunity of distinction, would likewise be promoted, to compensate them for their ill fortune."

It is clear that the Commissioners are at a loss to solve the difficulties in the way of the adjustment of the medical department of the army; they think " a limited number of good-service pensions to the officers most distinguished by their zeal and efficiency is due to the department, and will act as a wholesome stimulus to its members." Pensions and retiring allowances are useful and valuable things; their special usefulness is the inducement they give to broken-down and superannuated public servants to retire, and let the public business go on unburdened by their troublesome adhesion to functions which they cannot perform. But these are not the stimulants which guide aspiring young men in the choice of a profession, or urge on earnest and energetic adepts to seek

its higher distinctions. On one substantial point only do the Commissioners appear to find a way of benefiting the army surgeon in his present position; it is the simple unequivocal alternative of raising his pay. No one will deny that he fully deserves this. It will make him more comfortable and respectable during his years of monotony or drudgery; but it will not induce him to cultivate his capacities for the higher departments of a service which affords him so faint a chance of finding exercise for them. Coupled with this suggestion is another, which casts a melancholy shadow on the future of the army medical officer. "We must also add," the Commissioners say, "that we consider compulsory retirement at sixty-five years of age for the inspectorial ranks, and fifty-five years of age for the executive ranks, is absolutely necessary for the efficiency of the service." So that, at the age when the aspiring members of other professions often only begin to strive for its highest honours, the medical officer must leave the field, and either recommence the world again, or content himself in half-pay obscurity and uselessness.

It may sound like the extremity of Utopianism, but we cannot help, as at present advised, launching the opinion, that it would be better for the medical profession and all others concerned, if, instead of medical officers being created and continued asan appendage to particular branches of the public service, there were a separate medical department, consisting of all the medical men in the public service, from which each branch might be supplied according to its needs. The army and the navy surgeon could thus have the whole medical promotion in the public service before their eyes. When scientific professional men of very considerable standing have been tempted out of the lucrative walks of professional life, into some public office where their knowledge is required, it has often been noticed that their want of business aptitude or experience almost neutralises their scientific skill. But if they had spent their early years in the army or navy, and gradually found their way up to the more lucrative civil

appointment, they would probably have been competent men of business as well as of science. During the last quarter of a century, many new medical offices of more or less importance have been connected with the boards of lunacy, the poorlaw, the administration of prisons, the collection of national vital statistics, and the inspection of factories and mines. There are other Government departments in which medical science would be valuable, and in some of those where it is already employed it ought to have a higher place and a more influential voice than it has. Respectable members of the profession have lately been complaining that it has not its legitimate influence in the legislation and administration of our country. Instead of such organic changes for the special benefit and distinction of the profession as they sometimes demand, we think their aid will be more legitimately obtained if the State draw liberally on the profession for all those members whom it can effectively employ in the public service: then by degrees would the profession grow into its legitimate influence and usefulness.

We have not mentioned the sanitary department as among those which already absorb medical science, because, as yet, it is but partially and imperfectly developed. That a thorough system of sanitary organisation will be extended to the army, after evidence so overwhelming, both of the good it is capable of accomplishing, and of the disasters which our troops have endured in its absence, cannot be doubted. Having before us the great object of pleading the soldier's claim for whatever aids to health and vitality science has given to the world, we have not thought it necessary at present to enter on the details of sanitary science, reserving it for an early occasion to offer to our readers a succinct account of its established results, and a description of the shapes in which these may be come available, whether to the soldier or to the rest of the community. In the mean time, we think that both in the army and in other departments, the chief instrumentality in sanitary organisation must fall to the medical profession. True, they are not

the authors of the science, and are not reputed to have given it any cordial welcome or assistance. The functions to which the physician and surgeon have hitherto been trained, have been those of curing diseases and healing wounds. No one feels a natural prepossession at first sight for something that is to supersede his science, and accomplish the object of his labours by other means. With out any ill feeling to the world, the votary of the curing art has his heart's affections on difficult and instructive "cases ;" and the humane hospital-surgeon will feel a private sorrow in contemplating an array of empty wards. The medical department of the army has endured some obloquy, because its surgical officers have not also been sanitary officers. But the function was out of the routine of their duties, and there was no warrant or authority for the undertaking if they desired it. No doubt, as Sir James Hall explains it, the regimental or inspecting surgeon would have something to say about the salubrity of quarters or the site of an intrenchment, yet these are functions merely incidental to the staple duty of such an officer among the sick and wounded. They are not functions in which he has either power or responsibility; and it depends on his relations with the officers in command, whether any suggestions he makes will be listened to. In private life, indeed, the consulting physician, whose patient calls him in for an opinion on the drainage of his house, or an analysis of the water in the pump, or even for his views about the neighbouring fen or graveyard, might not feel gratified by the compliment so paid to his enlightened views, and his advancement with the spirit of the age. The sanitary function has yet to be defined and adjusted. How readily it may come to the hands of the medical officer, was shown some years ago, through an ingenious adjustment which at once created the transformation on shipboard. The mortality among Government emigrants to distant colonies, and among penal transportees to Australia, had become alarming. It was suggested that the shortest remedy was to pay for their passage, not by the number

shipped, but by the number delivered alive. The contractors now took an altered view of the terms of their contract: formerly it had been to supply so much ship room and provisions, now it was a contract to keep people alive, fortified by a penalty on each death. The surgeon, instead of merely physicking the sick and treating sores and wounds, was converted into a sanitary officer, who looked keenly to the ventilation of the ship, the salubrity of the food, and even the habits, generally, of the passengers, as promotive of health or of disease. They were not to be permitted to deteriorate their condition; it was equivalent to allowing them to cheat the contractor. signal decrease in the mortality of such passengers was the result.

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The practical conclusion of the Commissioners on this point is well put in the following short statement:

In civil life, sanitary science as yet is neither much studied nor widely spread, nor has the value of its practical application to the ordinary conditions of life obtained any very general acquiescence. While the tendency to fuse together the practice of medicine and surgery has thrown almost the whole practice of the country (except that of the great towns) into the hands of the general practitioner, a subdivision of labour of another kind has simultaneously been gaining ground in the medical profession. The study of sanitary science has been taken up as a specialty, and the field has been abandoned by the mass of the profession, to be exclusively occupied by those who so study it. The names of those eminent in either branch are perfectly well known to the public, who employ the one or the other according as they want individual sickness treated or public sickness prevented. It is rare to send for the health officer to treat sickness, or to employ the eminent practising physician or surgeon to drain a town or to guard a district against the approach of cholera. The fusion between the medical and surgical specialties is in the army medical department_even more complete than in the civil profession; and if efficient sanitary officers are to be obtained, it will be by the encouragement offered by Go