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be more than a good physician; he must be an administrative officer of first-rate ability, because it is a business problem, and I think it is extremely important to get at the head of it a man who can administer the work effectively. We have found it extremely difficult to get what we call the State Director in the States, that is the man who is to be the administrative head of the work in a given State.
I hope you will bear in mind what I wrote to ought to be the very best we can get. the Colonial Office, that you ought not to have that made impossible by having your hands tied. We should get the best man we can get for that position in the service. It seems to be the feeling, in all these Colonies that I have visited, that if you could get the right kind of man at the head you will get a great deal of local hielp to do routine work. These microscopists are local people, but you want a good man, well trained, to be at the head of the service. It is much more important to have that man a man of first-rate ability, than, say, the second Medical Officer, where you would have more than one in a given Colony. I was talking to two or three men here who have had some experience in Ceylon, and they all seemed impressed with the very great importance of having the right kind of man at the head of the work in Ceylon, and they said that if you could get the right kind of man at the head of it you would find abundance of material there for subordinate positions.
SIR HENRY MCCALLUM: You would make the State Director, I presume, co- operate with the ordinary Government Service.
MR. WICKLIFFE ROSE: Yes; the work has to be under the direction of the
Government in every case. That seems extremely important that the work should take root, and grow up as part of the life and traditions of the people. That is why it seemed so advisable to have English medical men, because they are already at home. If you sent a man from any of the States it would take him a long time to find himself at home; these men know instinctively a great many things he would have to learn. It seemed to us important from that point of view.
SIR F. HODGSON: I suppose the experience you have gained in the United States has enabled you to establish a complete set of forms which these doctors will fill up. It is desirable to have uniformity, and I should like to know if the forms which have been adopted in the Southern States would be applicable to other places like the West Indies.
MR. WICKLIFFE ROSE: I do not know; I think in all essentials they will, but in the States, with respect to establishing a fixed form in the beginning, we first started our work, and then let the form grow out of the experience, and it seems to me extremely important in these Colonies that we do not tie the work down too rigidly by a fixed form in the beginning. I think we can have sufficient uniformity for the purpose of comparison, and we are sending to these Colonies the forms we use in the States, but not asking them to make themselves slaves to that form. hoping that out of the new conditions in the West Indies we are going to learn some new things, and I should like them to have a certain amount of freedom in developing their experience under those new conditions, and we will make the forms conform to that after the work starts.
I am
CHAIRMAN: We seem to have been practically drawn into the subject of the expense and nature of the administration, and I understand that estimates for the work at Trinidad, the Windward Islands, and Antigua, have been already referred to the members of this Committee who represent the profession, and especially Professor Haldane, Dr. Shipley, and Dr. Bagshawe, and that they would be perhaps in a position to give observations on these estimates, and let us then arrive at some definite conclusion upon this part of our work.
PROFESSOR HALDANE: About the first Medical Officer, I must say I rather agree with the observations of the Selection Committee that it would be difficult to get a very first-rate man at a salary of £400 a year. It would be difficult just I absolutely agree with Mr. Rose that it must be now, certainly in this country. very important to have a really good man at the head of things-the best man you can get. I mean not only from the administrative point of view, but from the You want a man with his head screwed on rightly, who medical point of view. will look at things in a sane way, and will not look at them simply from the view of finding worms in the intestine, but from the point of view of what damage this is doing, and what could be done by tackling it, and how it can be tackled, and so You want a good on, considering all the local conditions and all the difficulties.
all-round man, I think, and not merely a man trained as a specialist looking for worms in the intestine, which is only one thing to be considered among a great many other things.
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DR. SHIPLEY: Would it be advisable to have one tremendously big man at the head of the West Indies, and let him travel round, and then have some not such a good man in each island, or do you think there should be one good man in each island?
MR. WICKLIFFE ROSE: I hope that will be possible, and that it will come about-that in the course of time you would have one man who would have a sort of general administration of all the work done in those islands, and I have a sort of hope that out of the force we start to work from this man may develop. If not we will find him from outside.
SIR HENRY MCCALLUM: In considering the Eastern Colonies you would have to look to the fact that salaries in the Eastern Colonies and India are much higher than in the West Indies.
MR. WICKLIFFE ROSE: My attention has been called to that.
SIR HENRY MCCALLUM: That is a matter which the Selection Committee has overlooked, I think.
DR. SHIPLEY: We practically want now seven doctors for the West Indies. MR. WICKLIFFE ROSE: I am not quite sure how many they are to call for for British Guiana. We have sent one man to British Guiana.
THE SECRETARY: We only provide one for that scheme.
MR. WICKLIFFE ROSE: We will need three for Trinidad, and two for Grenada, but I think they are of opinion in Grenada that if they can find the right man to be made head of the work, they have local men who can be employed in a sub- ordinate position, so that I should say there would be one man for Grenada, that would be four, and one for St. Vincent, and one for Antigua, that is six.
DR. SHIPLEY: How do you propose to get them? Should there be a Committee to select them?
MR. READ: I think we must leave it to the Selection Committee to do their best; they are in touch with the schools, and they are constantly selecting doctors. I should think there would be no I imagine they will get them eventually. difficulty about that, although it might take some little time.
THE SECRETARY: Their view is that they will have a number of applications. MR. READ: Yes, that is all to the good.
DR. SHIPLEY: Is that the Committee mentioned in some of these documents? MR. READ: Yes, it is the Selection Committee here.
DR. SHIPLEY: Is that a Committee which acts for all sorts of posts, or only for ankylostomiasis?
MR. READ: It acts for Tropical Africa. It consists of our Senior Medical Officer, Sir John Rose Bradford; Sir James Kingston Fowler; two members of the Colonial Office, one of them being one of Mr. Harcourt's Secretaries, and the other the Secretary of our Tropical Medical Committee.
CHAIRMAN: Do they deal with all the Crown Colonies? MR. READ: Primarily they deal with Tropical Africa.
THE SECRETARY: They select all Medical Officers for all the offices under the Colonial Office.
SIR F. HODGSON: In fixing a salary for those officers you must not fix them so high as to cause dissatisfaction among the officers in the Government Medical
CHAIRMAN: That is an important point.
Services.
SIR F. HODGSON: Otherwise they will be wanting their own salaries increased, and give rise to a great deal of extra expense.
MR. READ: I take it that these men will be appointed on different terms and that we justify the difference in salary on that ground.
SIR HENRY MCCALLUM: I only speak for Ceylon, but I am sure there would not be dissatisfaction there.
MR. READ: We have problems of that kind-men sent out on special missions to Africa in connexion with sleeping sickness, and so on; they have been paid special rates of pay, and it has never given rise to any difficulty in the medical service. You will bear me out in that, Dr. Bagshawe, I think?
DR. BAGSHAWE: That is right.
PROFESSOR HALDANE: I think it would be much more attractive to first-rate men here if it were only temporary; the first-rate man would take it from the interest in it, and the experience it gives him at the time, and at the end of his three years, or whatever it is, he might go on, or he might not, but he would probably have got the thing into good working order by that time, and on good lines, so that it would go on.