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PUBLIC RECORD OFFICE
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9 February, 1920.]
COLONIAL MEDICAL SERVICES COMMITTEE.
DR. ANDREW BALFOUR, O.B., C.M.G., M.D.
nie to be depressed, and they were feeling their griev ancou at the time. The Native Hospitals, generally, were, I do not think, up to standard; some of them were fairly good.
2848. With what other administrations are you comparing them-tropical administrations?—I was comparing them with the Sudan administration. I know the Sudan administration and 1 do not think they compare very favourably with certain of the Sudan Civil Hospitals. I have also seen better hospitals in the West Indies.
2849. I do not think it is fair to compare Tropical Africa with the West Indies-old colonies that have been established hundreds of years ?-That is true. It any not be quite fair. I realise the difficulties of the situation, only it did strike one that the native in Uganda, at any rate, was not being looked after so well as he might have been, and some of the Medical Officers admitted that this was the case. The Principal Medical Officer, Dr. Wiggins, spoke to me about the question of hospital accommodation for the natives. He thought it was very bad, and that larger funds should be forthcoming for improving the conditions in this direction. Of course, one contrasts, and, perhaps, wrongly contrasts, the Mission Hospital at Kampala with the Government Hospitals. The Mission Hospital is a very good hospital indeed.
2850. Supported from Mission Funds subscribed in England? Yes, precisely.
2851. Have you anything else you would like to say on this Inquiry generally. The impression of the conditions of the Medical Service? I think it would be a good thing if the Eastern Territories could be united on somewhat the same lines as has been done on the West Coast. I believe that would be a very good step to take. Uganda, British East Africa, Zanzibar, and, although I do not know it, probably Nyasaland. I take it Somaliland would probably be left out because in Somaliland the condi- tions are rather difficult.
2852. And communication is difficult too P-Com- munication is very difficult. But these four I think, and, of course, the Tanganyika Territory, five in all. I think it would be a very good thing to consolidate them and make an Esat African Medical Service. I believe it would lead to esprit de corps, which is, to Bome extent, lacking at present, and do away with the jealousies which are present. I would also like to Bay something about the pay and status British Sanitary Inspectors in the East Coast territories. This has a distinct bearing on the question at issue, for unless the Sanitary Inspectors are contented the Medical Officers of Health will not find it easy to have the sanitary work properly supervised. At the present time the British Sanitary Inspectors are by no means contented; indeed I understand that in 1916, they presented a petition as regards their So far as know, nothing has been grievances, done to remedy these, and from inquiries I made when I was in East Africa I am quite certain that they should be remedied. It is chiefly a question of pay, position and opportunities for promotion and I hope that something may be done for these men, who have difficult and often dangerous work to perform and who should be the backbone of sanitation in British Tropical Africa.
2853. At what age would you recruit Medical Officers for Tropical Service?-I should say 25 or 26, not younger.
2864. How would you recruit them, by selection or examination?--Well, I, myself, rather believe in
Belection.
2855. Purely selection?--I think so, on the whole, Sir, because there are so many other qualities that go to the making of a good Medical Officer in the Tropics; I mean quite apart from his mere know- ledgo of his profession.
2856. Would you select an officer and send him out at 'onco, or would you select him young and let him improve his training in England?—I would select him younger and give him a course Medicine and Hygiene before he went to the country. in Tropical
[Continued.
2867. Would it be necessary to pay him whilst be was studying in England, or would you expect him to pay? I think it would be advisable to give him so much pay; I do not know that he would draw his full pay, but I think he should be given a certain amount during his study; I consider that would be fair.
2858. Do you think it is advantageous to transfer Medical Officers from ous Colony to another, or is it better to keep them in the same Colony till they be come fairly senior?—I can see advantages and disad vantages, it is rather a difficult question. If you take East Africa, of course, one must admit there are great differences in climate. You have Uganda and you have East Africa; the highlands of East Africa are very different, of course, from any habitable part of Uganda. Again, you have the Coast Balt and, naturally, men would like to get, I should think, to the highlands of East Africa where the life is totally different from that in the other parts. Hence, changing_men about, might give rise to a little trouble. But, apart from questions of this kind, I am sure it is a good thing to change mon about. I think it quickens their imaginations, gives them new ideas, and helps them greatly, but it should not be done at too early a period. I think they should get a thorough grip of the place to which they are first posted, but as soon as they have got that, then I think it would certainly help them to move them about. They seo new diseases and new sanitary conditions.
2869. Do you think a Senior Medical Officer ought to be called upon to learn something of the language of the natives where he is stationed ?--I think it is most useful; it is the rule in the Sudan; Medical Officers must learn Arabic, and on the East Coast, of course, you have almost a lingua franca in Swahili, which is in very general use almost everywhere except in the more remote parts of Uganda. I certainly think it is of importance. I have not been on the West Coast, but I believe there are so many different languages and dialects there that it is rather difficult unlea Hausa were considered sufficient to carry a man through.
2860. Do you think it is desirable to offer any special facilities to officers on leave to study?--Cer- tainly,
2881. In what way would you encourage them to study when on leave?—I would give them extra study kave in addition to their ordinary leave.
2882. On full pay? I am rather inclined to give it them on full pay. It is true that they benefit them- selves from study leave, but still I think such study leave is mostly for the benefit of the Bervice, there fore, I am inclined to think that they might be given full pay, I forget what the rule is in the Indian Medical Service, but I rather think officers of that Service get their full pay when they are actually on study leave.
2863. Sir William Leishman: They get full pay?- I think it is the wisest plan.
2864. Chairman: If you gave a man extra have on full pay, would you expect him to pay all the expenses of the course, or would you help him pecuniarly? I would be inclined to help him there
too.
2865. In paying the fees as well-Paying a pro- portion of the fees, at any rate.
2866. What branches of study would you specially encourag: I would encourage Tropical Medicine and Hygiene, Operative Surgery, X-ray work, and also diseases of the special organs, such as eye, ear, nose and throat. If men wished to take up Mid- wifery or Gynaecology, they might have courses on those aubjects, because some of them have a good deal to do in those directions, but the others would be the
important subjects of study.
Of course, General Medicine would be included and Clinical Laboratory Work could be taken along with the Tropical Modicine and Hygiene. It would be a prac- tical as well as a theoretical course.
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2967. Sir Humphry Rolleston: Venereal Dis eases? A course on Venereal Diseases for those men, at any rate, who wished to specialize in this line. İ think it would be a good thing; yes; at any rate, as
9 February, 1920.]
MINUTES OF EVIDENCE.
DR. ANDREW BALFOUR, C.B., C.M.G., M.D.
regards the treatment of Venereal Disenso. I think most of the Medical Officers should have a course in up-to-date methods and improved technique in the actual treatment of Venereal Disease. I do not say they should all make an academic study of Venereal Disease, but they should be well versed in ita treat- ment, certainly-f forgot that this should be a part of their studies. It is very important in these countries.
2888. Chairman: In all Tropical countries, I think?--In all Tropical countries, yes.
2860, What local provision do you think our Gov. ernment could make for study, giving facilities for study in the Colony? You mean study in the country itself?
2870. By establishing a Laboratory and a Research Institute? As a matter of fact, every one of them has a Laboratory.
9871. Adequate? The one in British East Africa is very badly housed, and is in a very bad position. There is a very marked contrast there. The Veterinary Laboratory is a magnificent institution, it would bear comparison with any place of the kind I have ever seen, whereas the Laboratory of the Medical Service in Nairobi is very badly housed indeed. It is fairly well equipped, but it is in a low- lying, dusty locality, and it certainly compares very unfavourably with ths Veterinary establishment. Then the one at Uganda is not much of a place; that is the only way I can put it. I believe it is to be im- proved. There is an excellent Laboratory at Dar-es- Salaam the old German Laboratory.
2879. Has that been kept up? That has been kept ap. A West Conat man has gone there, I believe Dr. Butler-a very good man from Sierra Leone. It is rather interesting, if I may mention it in this con. nection, that, so far as the climate of the Coast area gos, it seems to be the consensus of opinion that the East Coast is rather better than the West Coast, not so much as regards actual health but as regards com- fort. Climatic conditions are, on the whole, rather better. For one thing, you have the benefit of the monsoons, That is one reason why you find that West Coast men rather like to go to the East Coast. However, that is really by the way; it occurred to me at the moment, and so I mentioned it. I do not know about the Laboratory in Nyasaland. In Zan- xibar there is quite a good Laboratory, but it is chiefly devoted to Economic Entomology. However, there is other work done there, and it is housed in a good building.
2873. The Laboratory at Dar-es-Salaam, is that purely a Medical Laboratory? Yes.
2874. No economic work done?-Not there.
2875. Do you not think it would be advantageous to have under the same roof or in the same block of buildings the Economic, the Medical, and the Veterin- ary, all the scientific research work carried on ?—Yes. I do think that. I saw that in the Sudan where it was all under the Department of Education.
2876. The differont staffs could, more or less, assist each other? Yes. There are difficulties because one department is apt to pull against another. The Department of Agriculture is often up against the Medical. It is rather interesting, in this vory con- nection, that the whole question of the future of the Laboratories at Khartoum is up for discussion just now, because they will have to leave the Gordon College, which is the headquarters of the Education Department. There is now no room for them in the College and the question is, what is going to happen to them? The Department of Agriculture want them because of their Entomological and Economic side. The Medical Department want them because of the Medical side and the Hygienic side, and personally I think the only way out of it is to establish a separate Department of Science and Research, of which the Laboratories would be the nucleus.
2877, Have thenr under one head?-Raise it to the status of a Government Department; it is quite im- portant enough; ■ Department of Science and
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Research. My own fealing is that all these Colonies should have such Departments of Science and Re- search with scientists at the head of thom. I think it would help very greatly.
2878. Sir James Fowler: I was just going to ask you whether you were in favour of that step being taken, that is the institution of a Department of Research P-Yes.
2879. And a Research Laboratory Department in every Colony?--Certainly, or at least a large Institute for each group of Colonies or Protectorates.
2880. And, if Economic Research were added to it, do you think that would be an advantage?—I think it would; the subjects dovetail into each other.
2881. From the point of view of, we will say, Scientific Reasearch in Medicine, would it not be a great advantage that that Institute should be close to the best equipped hospital in the Colony?—Yes, that is true.
2882. Next door, almost?-Yes, if it can be ar ranged, it is an advantage to have it so.
2883. They mutually help each other; they affect each other's work, I take it? Very much so.
2884. The Chairman: I am afraid the Agricultural man would say the same thing as regards his Labora- tory, that it must be near the Chief Agricultural Station in the Colony ?--These are just the difficulties that arise; it might be possible to have the different Laboratories under one chief and place them in differ- ent places; I think that is perhaps the ideal scheme. 2885. You have not the same elasticity of staff?- Yes, and it costs more too, Sir. This question of combined research is a difficult matter, but it was done in the Sudan, and it is only now, I think, that they are beginning to have any trouble over it.
2886. Sir James Fowler: At any rate, you would be in favour of having the Medical Research Institute in close association with the best equipped hospital? -You, I think that is essential.
2887. Whatever happens to the other?—At least very desirable.
2888. Sir Humphry Rolleston: In regard to the question of research, do you think it would be just fi. able to make it a claim for promotion-You mean. Sir, if a man has done specially good research work that it would be considered?
2889. It should be recognised as being a claim for promotion; he is the better man probably, but whether he is a better administrator? I think it should carry weight, though only along with all tho other points; his administrative capacity, his seniority, and all the different things that count.
2300. With regard to study leave, should that occur at intervals of five years?—I should say yes. I think that about twice in the course of their ser- vice the man should have study leave.
2801. Do you think it would be advisable to make
it compulsory?—I think it would be a good thing to make it compulsory; I do not know whether it is feasible to do so, but if so I would recommend it at least as regards the first study leavo.
2893. With regard to the question of a man's showing that he has really taken advantage of such a course, would you make it obligatory that he should receive a certificate, or if he has not already got it, attain the Diploma of Tropical Medicine, or the D.P.H.? I think he should have a certificate to show he has carried out his course of study properly, and I feel that some consideration should be shown to men who desire to take the Diploma of Tropical Medi cine and Hygiene, or the D.P.H. I think it indicates a desire to get on and to do their work properly, and I consider it is advisable that men should take one or other of these diplomas. Such diplomas would be very useful to them, whatever branch they may pro- foss a knowledge of hygiene is always of value to them.
2893. I am not quite clear in my mind as to how the appointment of a Travelling Commissioner would differ really very much from what the Senior Medical Officer of a Colony does; does he not travel a good
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