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In 1920 Sir Walter Egerton's Departmental Committee, to enquire into the Colonial Medical Services, reported in favour of a unified Medical Service to be re- cruited from recently qualified men who would be liable for service wherever the Secretary of State should appoint them.
In 1925 the Secretary of State Mr. Amery announced--We shall establish a Chief Medical Officer and at least the small beginnings of a Health Department, which will enable us to keep in far closer touch with the health and research work be- ing done all over the Empire and will give more direct guidance and assistance to the Medical Officers who are working often in great difficulties all over the Empire.
In 1926 a Chief Medical Officer was appointed with an Office in Downing Street. This Officer became the Chairman of the Colonial Advisary Medical and Sanitary Committee which up-to-date had a Civil Service Officer at its head. This was a recognition by the Colonial Office of a principle which had gained acceptance in most civilised countries that Medical Committees and Medical Services should be headed by Medical men.
This Committee, which scrutinises and comments on all the annual medical re- ports received from the Colonies and Protectorates, and which interviews Medical and Health Officers of the various services, is a body whose advice should be very valuable.
Service.
The Officer chosen for Chief Medical Officer, was Dr. Stanton of the F.M.S.
Since 1921 tours of inspection have been made by the Under Secretary of State for the Colonies to West Africa, to East Africa, to the West Indies, to Ceylon and to Malaya, and he has been able to see for himself what great difference exists between one Colony and another in the matter of medical organisation and progress in Public Health. The reports made show that while some are considered highly commendable, others are not so worthy.
*Report on MALAYA and CEYLON.
BY THE RT. HON. ORMSBY GORE. M.P. DURING THE YEAR 1928.
MALAYA.
There is no part of the Empire where the progress of medical and sanitary science can be studied with greater advantage than in British Malaya.
The many sided efforts that have been made to deal with the problem are commendable in the highest degree.
Though Palestine can claim credit for almost the most remarkable achieve- ments in anti-malarial work since the war the example of the Malay States is rightly held up among the countries of the world in this respect, and this is all the more notable as Malaya for climatic and ecological reasons is highly malarious. The slight- est relaxation of anti-malaria effort in Malaya is bound to bring retribution in its train.
Unlike the Agricultural, Education and Forestry Departments there is no single head for the Medical and Public Health Departments. They are two distinct Depart- ments miz,--The Medical Department and Service of the Straits Settlements and the Medical Department and Service of the F M.S. I feel that ultimately when an- other vacancy occurs in the headship, the merging of the two services and the two departments should be reconsidered. The existing dichotomy is difficult to justify in any technical or scientific service. Freedom of movement and transfer of per- sonnel is most desirable throughout the Peninsula.
*Published by His Majesty's Stationary Office, Adastral House Kingsway Lon- dlon. Price 4/6.
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Public Health and Sanitation require administrative as well as scientific quali- fications, and important as is this side of medical work in temperate climates it is doubly important in the tropics. It is to preventive rather than curative medicine that the increased expection of life in civilised countries is mainly due.
It may be necessary to reconsider the financial rewards that are available to the Public Health worker in comparison to those obtained in ordinary medical private practice if we are to attract the best brains of the profession to the preventive side.
The health of labourers on estates is well cared for.
In Singapore there are 8 special V.D. Clinies for males and three special ones for females.
I have one final suggestion. I think the number of qualified medical practition- ers in Malaya who are given facilities for or take study leave is inadequate.
Over and above the facilities and encouragement which should be offered to officers to undertake study leave from time to time during their careers, closer con- tact with medical work in Jaya, French Indo China, the Philipinnes and Japan seem desirable, and senior officers should be definitely urged to pay visits to these coun- tries to ascertain and report on recent developments that might be turned to use in Malaya.
CEYLON.
Though Ceylon possesses probably the most extensive hospital system of any British possession and has spent and is spending very large sums from public taxa- tion in re-equipping and staffing this system of clinical treatment of the sick, medical research, modern medical practice and preventive medicine in Ceylon are not up to modern standards and are below the public need.
Ceylon has concentrated all her energies on attempts to cure disease and al- leviate disease but is behind many other parts of the Empire in preventing the need
of such efforts.
The Bacteriological Institute at Colombo is hopelessly inadequate in staff and in accommodation. There is no medical research institute as in Kuala Lumpur. Such an institute is badly needed.
The future prosperity, progress and happiness of Ceylon are more bound up with the eradication of Malaria and anchylostomiasis than with politics, transport, agriculture or any other problems. So far from the incidence of Malaria decreasing it is increasing. Thanks to the charity of the Rockefeller Foundation some attacks have been made on anchylostomiasis with the result that while 90 per cent of the population is still infected the degree of infection has been considerably reduced in the treated areas.
Malaria. The main carriers of malaria in the low countries of Ceylon and es- pecially in the dry zones are A. Listoni and A. Culicifacies, and as in Malaya the most dangerous mosquito in the upland areas is A. Maculatus. A. Listoni breeds in wells and small irrigation channels particularly channels leading from tank irrigation. A. Culicifacies is found in considerable numbers in fallow fields in the drier coastal regions but is not uncommon in the small channels in the jungle regions. In the hill country districts A. Listoni and A. Maculatus are moderately abundant in fields under crops when the crop has become established, and are also prevalent in the associated irrigation channels. As in other countries the fresh cutting of jungle produces tem- porary conditions which make for the rapid increase in the numbers of the more dan- gerous species.
The eradication of the dangerous species will involve a long, patient, systema- tic and expensive campaign. It will involve a great deal of interference with the customary habits of the people, their wells, their minor irrigation channels, the treatment of crops, etc., etc. The spread of disease knows no arbitrary boundaries and there must be no differentiation between classes of landed property and the general powers given to the anti-malarial staff.
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