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22 December, 1919.]
COLONIAL MEDICAL SERVICES COMMITTEE.
Dr. E. LANGLEY-Hunt, G.M.G.
1252. Do you think a Service like the Ceylon Service, which largely consists of locally recruited men, could be affiliated with the Services of other Colonies, say the Straits Settlements and Hong Kong, satisfactorily ?—No, 1 should not think so.
1253. It would not do ?—No.
1254. Are the appointments made from home, or locally by the Government; the original appointments to the Service-As I mentioned, the Senior Officers, the Administrative Officers, are all from England, but local men are appointed and approved by the Governor.
1255. And then reported to the Secretary of State? -Reported to the Secretary of State.
1256. Afterwards?—Yes.
1257. And promotions in the same way?-In the same way.
1258. The higher officers, you say, that are re- cruited from England, are selected and appointed by the Secretary of State?—They are appointed by the Secretary of State.
1269. Are your Medical Officers required to acquire any native language?-All the locally appointed men speak Cingalese and Tamil. Of course, Tamil is greatly spoken in Ceylon from the fact that all the labour in Tamil, and we have a large number of Tamils in Ceylon; in fact, a large number of our Medical Officers are Tamils and, naturally, they all speak Tamil as their language. The Burgher too speaks Tamil.
1260. He learns it as a child f-Yoa, he learns it as a child; it is part of his education.
1261. Have you any suggestions to make regarding the Ceylon Service for the amendment of the condi- tions of the Service there?-Well, I do not think, air, that the Ceylon Medical Department is on anything like the same lines as the rest of the Colonial Medical Service, from the fact that, as I say, a very large majority of officers are locally recruited. With the exception of one officer that I know, I have never heard an officer express any wish to serve anywhere except in Ceylon, and he happened to be a man who did a considerable amount of very excellent war service. He one day was given an appointment, which he thought he should have, from the fact that he had come bere and had done very good service, and he asked that he might get one or two of the public appointments that we have to give in our own pleasure, or be transferred to some other Colony. The Indian Government approached us to get certain Medical Officers to work in India, and I was able to send them over 12 men, all locally recruited Officers, and the Indian Government were very glad to get them, and are paying them a very much higher scale of pay than they could ever hope to get in Ceylon. i have no doubt, indirectly, it will affect the Depart ment, because the men will begin to say they can get larger salaries than we can afford to give them. We start our Medical Officers at an extremely small salary, 135 Rupees a month; that is a very much smaller pay than that given to a Lieutenant in the B.A.M.C., which is £480 sterling.
1262. Is there any very marked line between what you call the apothecaries and the Medical Officers P- Yes. We were living, if I may say so, on the edge of a volcano with these apothecaries. The category that we call now the apothecary takes one or two years' tuition in Colombo,
1283. You have got a local school? We have got a local school.
1264. For the training of all apothecaries and Medical Officers-For the training of all apothecaries and Medical Officers, and the degree given there is registered all over the world.
1265. Can an officer qualified in Ceylon practice in England? Yes, and he does.
1288. An apothecary can practice sa a chemist P— I cannot say, because we have so many appointments for apothecaries out there. They have so many oppor tunities of getting a large salary by filling medical appointments where they get pensionable service; and, because of the fact that very often they are in the control of small districts where they have oppor
[Continued.
tunities of adding considerably to their incomes, they do not wish to leave Ceylon. They could not expect anything better elsewhere.
1267. You were on the Gold Coast, were you not?— For seven and a half years.
1268. Was the West African Medical Staff formed before that?--Yes, before then.
1269. Do you think any similar organization should be adopted in Coylon ?--I do not, sir.
1270. For the reasons you have already stated?- Yee.
1271. Sir James Fowler: How long is the curri- culum for the degree in the Colombo University P—— Seven years.
1272. And they become qualified? Yes; they then become Licentiates of the Ceylon Medical College.
1273. How is that written!-C.M.C., they are licentiates of the Ceylon Medical College,
1274. And as far as you could see, they are well qualified in medicine and surgery?—Yes, the standard is quite high. It is part of the duty of the Principal Civil Medical Officer and the Assistant Principal Medical Officer, and the senior R.A.M.C. Officer to see that the standard is maintained high, and I do not think I am wrong in stating that it is very high. 1275. They act as assessors?—Yes, the standard of aramination is extremely high.
1276. Chairman: In Ceylon, the population is fairly well educated P-Well, educated in a sense.
1277. You have schools, and there are very few illiterates ? There is a large number of illiterates. In one place the trouble we had out there was to get the native to see the value of Western methods of
native doctor. treatment; they are so much inclined to appeal to the
1278. Sir James Fowler: Are the hospitals efficient? They are.
1279. And up to date?-And up to date.
1280. They are sanitary ?—I have no hesitation in saying that we have hospitals in Caylon that will favourably compare with any hospitals in the United Kingdom.
1281. You spoke of some Indian Medical Officers being there?--They are all men who have registrable qualifications, most of them Calcutta. We have not a very large number; it would work out, I suppose, to six or seven per cent. Our total hospitals in the Island number 22, and we have about 480 dispensaries. There are 50 estate hospitals, and a very large number, up to 650, dispensarios. We are responsible for all these institutiona, and they are all under our super- vision and inspection. We supply all the estates with 50 cents. worth of medicine per coolie par annum, and District Medical Officers, in charge of the District, all the death rates and birth rates come through our
into the Head Office and are checked by us.
As I say, the inspection is as complete as we can make it with the small staff that we have at our disposal.
1282. Is it part of your duty to inspect the hospitals? Yes; for the whole period of the war we have only had two Medical Officers recruited from England, the Principal Medical Officer and myself, as the Assistant, but for the last six months I was the only officer recruited from England in an executivo position. I carried on the whole work of the Depart- ment during that time.
1283. Any attempt to increase the number of Officers recruited from England at the expense of the Officers recruited locally would be resented P-It would. A Committee was formed with Sir Reginald Stubbs, who is now Governor of Hong Kong, and part of their finding was, that a very large number of the senior positions should be filled locally. For instance, the appointment I hold of 'Assistant Principal Medical Officer could be filled locally, and some of the other appointments, such as the Superintendent of the General Hospital, and the Superintendent of the Lunatio Asylum, could be filled locally. That now has given, the impression that local men are just as competent and just as capable of filling appoint. ments, up till now held by Europeans, as the Euro-
peans were.
22 December, 1919.]
MINUTES OF EVIDENCE.
Dr. E. LANGLEY-HUNT, C.M.G.
1284. And the Government of India Bill vill in- crease that?-Of course it will,
1285. The nursing; is that quite satisfactory?— Yes, sir.
1286. That is chiefly European?-Only in certain institutions; in most of our hospitals we have local
Of
nursed.
1287. Chairman: Male or female?-Female. course there are attendants who are capable of looking after the sick under direction, but we have our own oursing institution there, where we train our nurses, under English supervision and training.
In our
hospitals in Colombo, Kandy and Nuwara Eliya the nurses are all European; all our nurses in the General Hospital in Colombo are European, except that they have a large number of natives, of course, subordinate to them. We have a very large number of religious sisters who work in the pauper wards.
1288. Roman Catholics P-Roman Catholics.
1289. You still have those Roman Catholic religious sisters? We still have thosa; they also look after the Lunatic Asylum. We have a matron and two nurses in Kandy, and a matron and one nurse in Nuwara Eliya with a subordinate native staff under them.
1290. Sir James Fowler: You mentioned the salary being higher ?--Yes.
1291. He geta a higher salary than could be afforded by the Ceylon Service. What does that mean exactly; do they come on the Estimates P-At the end of every year we have to make out an estimate of the expendi- ture for the coming financial year; we estimate for the number of Medical Officers, and through that make additions to the Department. The scale of salary that we offer was fixed considerably before the war; it is a pre-war scale. We have recruited our locally qualified officers on the old scale. At the time that scale was formed, when Dr. Perry WAA Principal Medical Officer out there, the Medical Officer was quite satisfied to take a small salary, because he knew that he could considerably augment his salary by private practice. But there is a very large number of private practitioners existing there, men who have never joined the Department, or who have resigned from what appointments they held, and whatever private practice there is has been taken up by the private practitioners. The mistake we made when we started the Medical Register there was there was a large number of apothecaries-that they only had to show proof that their living depended on the money they could make as Medical Officers to be allowed the privilege of private practice. They were called certified medical practitioners, and they are scattered all over the Island. Men who had no qualification at all beyond that of apothecary were not only competing with our locally qualified men, but with our men who were qualified in England.
1292. Have there been any attempts made to raise the salaries? There have been attempts made with a view to having an increase of their salary. They have had small bonuses, not very much, but they have had a certain amount.
1293. Do you see much opportunity for research in medicine and the allied sciences in Ceylon!-Yes, sir; we have at the present moment à Bacterio logical Institute with a European officer in charge. Professor Castellani, of the Pasteur Institute, ran a Hospital for Tropical Research, but that has been in abeyance during the War. That is available at any time, but the opinion was that simply to rely on the private venture of Professor Castellani was not right. He was brought out as Director of the Bacteriological Institute, and Medical Super- intendent of the Research Department.
1294. And that Department is, so to speak, in abeyance temporarily?-Now we have another man out there. Dr. Nicholls came to us from East Africa; he runs the Bacteriological Institute, and he is also responsible for the Pasteur Institute, which we have only recently started.
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1295. Is there much rabies?--Yes; we have treated enormous number of cases. Before we had to Bond on all our cases to India. I could not give
[Continued.
39.
you the exact numbers, but we have treated hundreds of cases. I do not say that necessarily they were al infected by rabies, but they were certainly bitten by dogs, and the results were examined,
1298. Have you seen any case of hydrophobia-I saw seven cases before I came home; two men dieu in the Hospital in Colombo; I saw one of them.
1297. You never want to see another?--I had seen uthers before that, sir.
1298. Bir Harry Verney: I hope I will not go over the same ground too much, but you have seen the effect of assimilating neighbouring Medical Ser- As regards the Gold Coast. You think that was a success, asimilating the Medical Service on the Gold Coast with that of the rest of the West Coast of Africa?-1 do.
vices.
1299. As far as the assimilating of these Medical Servicos went, do you think it would lead you to suggest the establishment of a single Medical Service for the whole of tropical Atrica I think, Sir, that would depend on the inducement offered.
1800. Presumably on promotion. If the Service were asimilated for the whole of tropical Africa, in the same way that it was for the whole of West Africs, would that be acceptable to the Gold Coast! I only speak from my own feelings; I should cer- tainly, from my own feelings, go to East Africa on promotion from West Africa; I should go now.
1301. If that were done, could you give me any opinion as regards the West Indies, in regard to the same thing being done?-No, I know nothing about the West Indies.
1302, You are quite definite that if a general Colonial Medical Service were formed, Ceylon abould not come within it?—Yes.
1303. It must be a Service by itself? Yes. 1301. What can we do to secure contentment within the service? All that we have been able to do has only been fairly successful at present, both as regards recruitments and standard P-Personally, I think a discontented officer is a bad officer. Until you give your men what they regard as a living wage, I do not think you will get satisfactory work.
1305. Do you think it would be possible to have H certain number of Officers who had no private prac tice-Private practice in Ceylon is a myth. They have the privilege of private practice, but you can only take Colombo. Kandy is practically a washout,' as far as private practice goes, because there are so many private practitioners. In Nuwara Eliya, a District Medioal Officer makes quite a good thing. A District Medical Officer who has to compete with the apothecaries in private practice, and they are qualified men, in his immediate neighbourhood, gets very very little.
I do not think I exaggerate when I say I could count on the fingers of both hands the men who make a living by private practice, and they are mostly Colombo men Some of them make very arge incomes. The income of the Senior Physician in the General Hospital in Colombo would compare probably with some of the men in Harley Street.
1306. How would it be, supposing private practice were forbidden and a decent wage paid?-How are you to deal with sickness amongst the European community and the wealthy natives?
1307. If there is an equivalent salary paid- although we could hardly get that I suppose supply and demand would do it? If a wealthy native can get free medical attendance, he thinks by paying a fee that he will get considerably better medicine and considerably better attention; you have always to deal with that in the wealthy native's mind. The thing the native can get for nothing is of no value; when he has to pay for it he thinks it is of some good.
1308. Chairman: You say that the apothecaries have been granted certificates to practise?—Yes, sir. 1809. I suppose it is known that there were not enough qualified Medical Officers? No, they started in 1907, I think.
1910. Quite recently?-Yes, when we had our Medical Registration Ordinance brought out. At that time there was a very large number of apothe caries who were in charge of District Hospitale and Dispensaries all over the island, and it was pointed out that it would be a very great hardship to these