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Rh etc.) for which the cross was awarded are denoted by a bronze laurel branch or different kinds of stars attached to the ribbon, which is green with narrow red stripes.

VI. PERSONAL DECORATIONS OF OTHER COUNTRIES

The revolution in Russia, Germany and Austria-Hungary closed the history of many of the older orders; but both those still existing and those which have ceased to exist were given largely for war services during the World War, and they are hcjre briefly dealt with as decorations.

Italy. The most important of the Italian service orders and deco- rations are as follows:

(1) Medals for military valour. These medals are awarded for special individual acts of bravery to both officers and men of the army and navy. The medals are of three classes, gold, silver and bronze, but the first is rare.

(2) Cross for merit in war. A bronze cross bearing on one side the words " Merita di Guerra " surmounted by the royal crown and initials. Reverse: a star surrounded by rays. Awarded to those whose conduct has been meritorious for some considerable period d'jring war, but who have not performed some exceptionally gallant action deserving of the medals for military valour.

(3) Military Order of Savoy. Instituted in 1815, consisting of five classes. Awarded for specially distinguished services in war and for exceptional services in times of peace. The decoration consists of i cross resting on a wreath of laurel.

(4) Order of the Crown of Italy. Established in 1868 to com- memorate the annexation of Venetia and the unity of Italy. There are five classes. The badge consists of a gold cross patee convexed enamelled white, edged gold, with gold love knots between the limbs. In the centre on a blue enamelled plaque, edged gold, is a golden representation of the Iron Crown.

(5) Order of Saint Maurice and Saint Lazarus. Founded in 1434. There are five classes. The badge consists of a Maltese cross, placed saltirevvise, vert edged gold, with gold knobs on the points for St. Lazarus; surmounted by a cross botonei enamelled white, edged gold, for St. Maurice. The badge of the first four classes has the royal crown above it.

Russia. (i) The Order of St. George, probably the best-known of all Russian decorations, was founded in 1769 by the Empress Catherine II. for rewarding distinguished bravery in action. It consists of a gold, white enamelled cross, patee, with, in the centre, a representation of St. George fighting the dragon. There are four different grades and the ribbon is orange and black. (2) Order of St. Anne (three classes and various medals); the cross is of crimson enamel and the ribbon carmine with narrow gold edges. (3) Order of St. Stanislas (three classes) ; cross, ribbon red and white. (4) St. Vladimir (four classes) ; cross, black enamel, ribbon red and black.

Serbia. (i) Order of the White Eagle. Instituted in 1883, con- sisting of five classes: knight grand cross, grand officer, commander, officer and companion. The badge consists of a gold double-headed eagle surmounted by a crown. (2) Order of St. Sava. Instituted in 1883, consisting of five classes. Awarded principally in recognition of valuable sanitary and medical services with the army. (3) Medals for bravery. These are in gold and silver according to class.

Greece. (i) Order of the Redeemer. Instituted in 1829, consisting of five classes: e;rand cross, grand officer, commander, officer and knight. (2) Military Cross. This is the highest award for services in the field. It was instituted in 1917 and consists of three classes.

Rumania. (i) Order of the Star of Rumania. Instituted in 1877 to commemorate the participation of Rumania in the Russo- Turkish War. There are five classes: knights grand cross, knights commanders, commanders, officers and chevaliers. (2) Order of the Crown. Instituted in 1881. There are five classes as above.

Belgium. (i) Order of the Crown of Belgium. Instituted in 1897 for honouring those who distinguish themselves in artistic, literary or scientific work; in industrial or commercial activity or by their devotion in works of African civilization. There are five classes of the order and a medal. (2) Order of Leopold. Instituted in 1832, consisting of five classes. This order is sometimes conferred upon military officers for service in the field. (3) Croix de Guerre. Insti- tuted in 1915 for award to those who are mentioned in despatches and for acts of courage, devotion and valour on the field of battle.

Japan. The principal Japanese military decoration is The Order of the Golden Kite, instituted in 1891 and awarded solely for acts of very distinguished bravery performed in action by officers and men of the army and navy. There are seven classes. It'consists of an eight-pointed star edged with gold or silver according to class, upon which is placed a species of St. Andrew's cross in blue enamel. On the top of the decoration is a golden kite with wings spread. Ribbon : green, with a white stripe at each edge. The chief remain- ing decorations are The Order of the Rising Sun and The Order of the Sacred Treasure (women), but these are not confined to naval and military persons.

Germany. While the orders of the various states (which were numerous) were conferred on individuals for war service, the principal decorations were, with one exception, Prussian decorations conferred by the emperor, in his capacity as king of Prussia, upon

Germans of all federal states. These Prussian decorations which became in effect German were: the order Pour le Merits and the Iron Cross. The ribbon of both is black with white edging (the Prussian colours). The Iron Cross of the higher class was worn with- out a ribbon. One award was made of the Iron Cross with gold star, perhaps the rarest of all military decorations. This was to Field- Marshal von Hindenburg, and the only previous recipient had been Prince Bliicher. Awards of the Iron Cross of 1914 were not made to those who held the Iron Cross of 1870, who received a bar instead. A decoration given for auxiliary war services, both to military and to civil personnel, was the Verdienstkreuz fiir Kriegshilfe. This, which though Prussian was regarded from the outset as purely a German decoration, is a cross in silver-grey metal with a ribbon of the German national colours silver, with narrow black stripes and red and black edges. (R. E. F.) MEDICAL EDUCATION (see 18.23). To the reformer's zeal an impetus was lent by the World War in various fields, and in the domain of medical education it was still by no means easy in 192 1 to estimate how far the changes that had been effected in the few preceding years had the quality of permanence. Of those changes two overshadow the rest, namely the introduction in 1920 of the Clinical Unit system into England, and the admis- sion of women students to a number of London medical schools, which in that respect came into line with the practice of the great majority of provincial universities. Though these events were actually the outcome of many years of preparation, yet they partook more of the nature of tentative experiments than changes effected and wearing an air of finality. There was a desire to test in practice views long rooted in theory.

Great Britain. The decision of some of the London schools to admit women students was largely in the nature of an emer- gency measure planned to meet the exigencies of the moment. These schools, deprived by the war of most of their male stu- dents, were led to look elsewhere for recruits. The experiment was first tried in a very tentative way by St. George's hospital, but early in 1916 St. Mary's hospital was thrown open to both sexes. In 1921 the London hospital, St. Mary's, University College hospital, King's College hospital, Charing Cross hos- pital, Westminster hospital and St. George's hospital all ad- mitted women students. Some of these schools regarded this innovation as an experiment while others were committed to the policy of coeducation.

The Clinical Unit organization undoubtedly constitutes a fundamental modification of the system of medical education, which, arising out of the apprenticeship system, had come to be accepted as a sound and practical course of instruction. In the early days of the medical schools all the teaching, including chemistry, physics and biology, was carried out by the medical and surgical staff. The first subject to break away was chem- istry, and in 187080 many of the schools engaged chemists to train their students in this subject. Later physics, and later still biology, followed suit. During 1900-20 the same change oc- curred in the teaching of physiology and anatomy, so that by

1921 the preliminary and intermediate subjects of the curric- ulum were taught by workers who devoted all their time to that purpose. This change has spread to the later subjects of the medical course, in response to the growing demands which developments in knowledge and technique make upon the time and equipment of teachers. In these proposals to create units there is therefore no rude break with tradition, but rather a step forward in the evolution of medical education forming a logical outcome of the whole trend of contemporary medical teaching and an inevitable sequel to the advances that have taken place in medicine and the allied sciences.

In 1908 grants in aid of medical education were made for the first time by the Board of Education, and with their general acceptance the autonomy of the schools, based on their financial independence, disappeared. It was clear from the first that schools which received a grant must submit to the policy of the Board of Education, and it was on that bedrock fact that the Royal Commission on University Education in London built. The report, published in 1913, indorsed the views of Mr. Abraham Flexner, set forth in his survey of " Medical Education in Europe " (1912), and was in substance, so far as it concerned medical education, an argument for the creation of clinical