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23 February, 1920.]
COLONIAL MEDICAL SERVICES COMMITTEE.
DR. Cox, Dr. Macpherson, Dr. van Someren, and Dr. GOODLIFFE,
have brought one down, if I had thought it was not known to you. We have had a lot of legal points arising on the interpretation of the contract, and 1 am quite sure a great many men in the Army felt that it was a distinct protection, to them to have a contract.
3406. (Sir James Fowler) Were not these tem porary appointments during the War, contracts of appointment during the Wai P-Yes, they were.
3407. We are now speaking of the relations of a Service apart from the War, to the Government?— That is what we do not know about. We knew all those contracts, but no permanent officer has a con- tract, I think.
3408. (Sir Harry Verney) It is only the temporary officers? You may be right.
3409. (Chairman) Whether they are doctors, or engineers, or civilians, or lawyers?-You may be right on that, Sir. I saw large numbers of these contracts during the War, but, now I come to think of it, they were with meu on temporary contracts. But the permanent man has the advantage of a much more elaborate reference to Regulations than any Colonial man haa.
3410. The permanent man comes in under the Colonial Regulations. He sees those and he knows exactly what the conditions of Service are then. He is given the pension and all? Well, I do not try to excuse a man who does not make sufficient enquiries to find out what his pension is going to be. I can only say we have abundant evidence that a good many men are discontented, because they went in believing that their total emoluments were going to be a good deal higher than they are. It is the private practice I am thinking about there. And it is quite evident that some of them did not realise that the pensions are as small as they have turned out to be. I agree that is due to their own carelessness.
3411. It is very difficult to safeguard a man who is so careless as not to enquire? It is.
3412. Then, as regards private practice, can you give any instances where they have been misled at all? You see what they are generally told is-say, there are 50 appointments in a Service, and at certain posts there is a remunerative private practice, but in the majority there is none at all?--Well, Sir, whatever they are told it is quite obvious to us that many of the men, particularly I think those coming from the West Indies, have been very badly dis- appointed in the amount of private practice that has come their way. You have evidence that came from Grenada. It is mentioned" opportunities for private practice" in paragraph 14.
3413. Of that, you have details in the Memo- randum? Yes, more or less details.
3414. Private practice depends a good deal upon the individual, does it not?-1 take it it does.
3415. One man will make a good practice where another man will fail?-Yes, and men will not take much trouble about making a good private practice if they find that they are hampered by having to get permission of the Governor, or other people before they can take private patients, or that some unreasonable control, they may think, is going to be exercised over the fees that they charge to people who have no claim on the Government at all.
3416. That complaint we have set out here?-It seems fairly obvious that some of the salaries that are offered could never be accepted by a man who was any good at all unless private practice was going to pan out fairly well, and when a man finds, in addition to a small salary, the most he can make in private practice-a reasonably good man-is some- where about £150 to £200 a year, he begins to wish he had not gone. That kind of thing will never attract really good men.
3417. What were you thinking of as an adequate salary on first appointment for a Medical Officer in the Colonial Service?-Well, judging by the kind of
[Continued.
salaries that are going now in England, I do not think you could expect to get a man under £700 a year.
3418. That is just after he is qualified? Yes, to go abroad and to give up any chance of getting a practice at home; to go abroad and take his riska in a tropical climate. Judging by what he is making at home, you would not get him to look at it undor £700 a year, in my opinion.
3419. That seems very high for newly-qualified students P-That is what the Indian Medical Bervice is offering, anyway, and they are very glad to get them.
3420. Permanent men ?-Temporary men; they are doing this because they cannot fill up their permanent ranka.
3421. Only for temporary appointments P-The temporary man is being offered practically the same salary as they are prepared to give to their per- manent men. It is not exactly fixed yet, to be per- fectly frank with you about that. The India Ofic is considering, and has been for some few months. what salary they shall offer. We told them some months ago they could not expect to get a man under a 50 per cent. riee, and they find that is so.
They cannot get the men. They have now offered, in order to relieve the tension, £700 a year for temporary men to go out on a two years' contract, and they have considerable difficulty in getting sufficient; in fact, they are not getting sufficient of them.
3422. How long do you think this scarcity of medical men will last?-I think about another three years at least.
3423. And after that time what should you think would be an adequate salary P-Of course, it will all depend on prices. People will have got accustomed by that time of talking about £700 as they used to talk about £400,
3424. You say something about specialista here, the necessity for specialisation. I think the Committee quite agree that it is desirable to have specialists, but, except in the larger Colonies, you could hardly have many-No, sir, I agree. We think, possibly, our suggestion about grouping might help there. You might have men who would travel about a group and have fired times at which to turn up in certain places and have cases brought to them.
3425. Sir James Fowler: Would you be in favour of the appointment of a Director-General of the Colonial Medical Service; a medical man at the head of the Service, not having the powers of the Director- General of the R.A.M.C., or the Navy, but mainly to act as a channel by which the feelings of discontent could be carried to the Colonial Office? That seems to be bound up with the possibility of forming one general Colonial Medical Service, and that, we think, although an ideal is an impossibility. If you have not got your one Service, it seems to me rather diffi cult to suggest the appointment of one Head. Ono would rather press the point of having these Inspectors, men of high rank in the Service-instead of having one man, have two perhaps who could act as the channel between the periphery and the centre. 3426. Chairman: If you had Travelling Inspectors, you would have to have three or four at least, would you not, assuming that they were to make annual visits to the Colonies-I think you would, Sir.. You could not start with less than two, or perhaps three. 3427. You could not do it in a year?—No. In trying the experiment you might try, say, a visit to East Africa one year, and a visit to West Africa another, with the six months at home in the interval.
3428. Sir James Fowles: You are aware that on many occasions the West African Medical Staff have dveired the appointment of an Inspector-General; are you aware of that? Yes, I have heard of it.
3429. They have also desired that facilities may be given them to express, through adequate channels, feelings of discontent should they arise at any time?
Yes.
23 February, 1920.]
MINUTES OF EVIDENCE.
Dr. Cox, Dr. Macpherson, Dr. Someren, and Dr. GoodlIFFE,
3430. Do you think that a Hoad of the Colonial Medical Bervices would meet that wish; that facilities might be given them, through him, to express feelings of discontent should they arise at any time?-Oh! undoubtedly.
3431. The duties of such a Director-General would be very various, no doubt, but is it not possible that such an appointment would lead the Colonial Medical Bervice to feel that there was someone in their own profession through whom their views could be cou- veyed to the Colonial Office?-Yes, indeed it would. 3432. Are not the functions of such an Officer, per- manently resident in London, entirely different from those of an Inspector travelling through various Colonies? Yes.
3433. Supposing such an appointment as you desire. were made, would it not be part of the duties of one of those Inspectors to report, say, once a month, to the Colonial Office, to the Secretary of Stato, sending A copy of his Report through the Governor of the Colony in which he was travelling?—I suppose it might be.
3434. Supposing the Advisory Board had such Reports, would they not be in a better position to aci than if they saw only Medical Reports which were 15 or 18 months old?-I quite agree.
3435. Would not that keep the Advisory Board, whose purview you desire to enlarge, much more closely in contact with what was going on in the Colonial Medical Services than any other which could be devised I think it would, and that is why wo have suggested it.
OF
3436. So that you agree that the functions of Director-General at home and Inspectors-General travelling, are essentially different? Yes, Sir. course, the ideal thing, we believe, would be A Colonial Medical Service with a Director-General,
3437. Might I just point this out to you? Would it not be the function of those travelling Inspectors to bring to the Colonies the result of the ripest ox- perience that you could obtain in all matters of tropical medicíno and sanitation ?—Yes.
3438* Would not that probably be welcomed by the Officers of the Service?—I am sure it would.
3439. That would be something quite different from expressing grievance through adequate channels ? Yes; I do not see why the same man should not do both.
3440. Have you thought of the possibility of admitting Officers to the Service by examination on the lines of the R.A.M.C.. and the I.M.B. P—Well, some years ago we did consider this in connection with a proposal to have a general Colonial Service. but we very reluctantly came to the conclusion that it was not a feasible proposition, therefore we have not troubled about it lately.
3441. Supposing the object of it were to obtain a personnel consisting of men who had recently taken their qualifications, and perhaps had been seconded for house physician and house surgeon, would it not be likely that their attention would be fixed on the Service, through an examination botter than in nuy other way?—If the attractions of the Servico were otherwise good, I think it would be an excellent iden. It has proved to be so in the Indian Medical Service, which has always been looked upon as one of the inost distinguished Medical Services under the Crown, and the entrance examination to which has always been looked upon as being pretty stiff, and appointment to it has been prized, and the same thing might be done as regards the Colonial Medical Service.
3442. Supposing there were different Regulations for admission into the Colonial Services in different parts of the world, as to the Colonies, for example, it would be necessary, would it not, that the candidates <hould sit, so to speak, under the Regulations of the Department of the Service which they desired to enter? That is, a man desiring to enter the West to the Indian Service would apply for admission West Indian Department?—Yes; that soems rens6|| able.
115
[Continued.
3443. For the West African Service to that Depart- ment; for the East African Service, to that Depart- ment. Do you think it would be a desirable thing if the Government Medical Services, Army, Navy, India, Air Force, and possibly Colonial, held one single qualifying examination, the candidates sitting as candidates from the various Departments and approved by the ends of the various Departments as candidates?-The same examination; I suppose from that would follow the same rates of pay and other conditions.
3444, Oh! not at all, surely, they would be candi- dates from the Army, the Navy, India, the Air Force," and the Colonial Office, sitting under the Regulations of the Department that had approved their candidature, and subject to the Regulations of those Departments, but all examined at one time for the purpose of administrative convenience? And the same examination, the same tests?
3445. Yes. I do not quite see how you could expect the same tests to be passed by men at varying rates of salaries.
3446. (Chairman) You have that at present, have one examination for the Home, the Indian, and the Eastern Government Services P-Not Medical.
3447. No; they are not Medical, but it would apply in the same way as for the Administrative Service?— Yes.
You
3448. (Sir James Fowler) Do you not think that it would be an advantage, in the work of the Medical Schools, if there was one single examination instead of each Department holding a separate examination P
The idea is new to me, but I can
see obvious advantages in it.
3449. Specialist appointments; you think that the existence of a very highly qualified staff at the principal hospital of the Colony would influence the clinical work of those who came in contact with that HospitalP-Yes.
3450. Would you be in favour of giving a man who had shown special capacity in some Department of the Service, an opportunity to remain in the Service and continue to work in his own special Department: not to come in BA an Administrative Officer eventually, but rising to the rank and pay of an Administrative Officer?-Undoubtedly, Bir. I think it is a great defect in many Services I have had a knowledge of that the only way to get to the higher posts and the higher salaries was to drop your clinical work and become an Administrator. I think the suggestion you make is an excellent one.
3451. What do you think is the amount that would be attained by a man holding consecutive appoint- ments as a locum tenens at the present moment?- Eight guineas to ten guineas a week, depending on the nature of the practice. I do not think you will get one under eight guineas, and many men are getting ten guineaa.
3452. Would you be in favour of assimilating the Litles in the various Colonies to those that have been in use during the war; for instance, that the Head of the Service should be the Director of the Medical Service; that his Deputy should be the Deputy Director; that according to the extent of the Colony there should be Assistant Directors constituting the staff of the Medical Service of the Colony ?—Yes, I think that would please the Service and would be helpful.
3453, Would you agree that those titles are now fairly well understood--Woll, I am afraid I have not sufficient direct knowledge of that.
3454, Still, there have been a great many men in the Service during the war?—Yes,
3455. You have naturally come into contact with them. Would you be in favour of a Research Service for the Colonics, that is in the larger Colonies, a Research Institute, say, on the lines of the Lister Institute? Where the Colony could run to it, un. doubtedly.
3456. Supposing it were possible to associate that with Economic Research, do you think that would
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