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COLONIAL MEDICAL SERVICES COMMITTEE.
IV.
ANALYSIS OF REPLIES TO CIRCULAR SENDING OUT THE REPORT OF THE COLONIAL MEDICAL SERVICES COMMITTEE FOR THE OBSERVATIONS OF THE GOVERNORS.
I. GENERAL.
The Governor of Hong Kong sees no reason to take exception to any of the Committee's recommendations so far as Hong Kong is concerned, and the Commissioner of Wei Hai Wei agrees generally. The Governor of Uganda concurs in the Committee's recommendations, and Las no special comment to make. The Administrator of St. Vincent says his Executive Council concur generally in the Committee's recommendations. The Governor of Jamaica says the views of that Government will be forwarded after decision on the report of a Com- mission recently appointed to inquire into the local Medical Department. The Governor of Mauritius does not consider it advisable to make any report on the matter until after the arrival of the new Head of the Medical Department. The Governor of British Honduras thinks that candidates for the more isolated medical appointments should be obtained from Missionary Medical Schools; in fact, that Government should subsidise Medical Missionaries (say £500 a year); in return for this, they would be under the Director of Medical Services in the medical side of their work, and would not be allowed fees for private practice. He recommends the engagement of three for the Colony.
The Governors of Ceylon and Malta point out that their Medical Services are mainly or wholly recruited locally, and cannot usefully be considered part of any Colonial Medical Service. The Governor of Bermuda says they have only one full-time Medical Officer (the Medical Officer of Health), and local conditions are so abnormal that it is scarcely possible to offer any useful observations based on local experience. Moreover, local conditions of service will be affected by the eventual decisions only so far as the local Legislature chooses.
The Governor of Nyasaland says that his Executive Council advise that the Government should concur in the general proposals of the Committee if other African Governments do, lest they should be left out in the cold; but any revision of the conditions under which Medical Officers serve in Nyasaland should be based on those on which other public officers serve.
The Governor of Kenya saya that that Government agrees with the views of the Principal Medical Officer, who agrees with the Committee except in two points (noted in their place). The Governor of Somaliland thinks the recommendations both wise and practical."
The Principal Medical Officer of Zanzibar prefaces his observations on the report with a detailed discussion of the unsatisfactory condition of the Colonial Medical Services, more particularly in Zanzibar, and the causes thereof.
The Governor of Tanganyika agrees with the Principal Medical Officer in approving the recommendations generally. The Principal Medical Officer, however, urges the provision of a well-equipped permanent hospital, wherever & Medical Officer is to be stationed; the Governor thinks this can only be done gradually.
The Governor of the Gold Coast agrees generally with the report, except as to the proposed Director-General and Inspector-General. His Principal Medical Officer had consulted as many of his colleagues as he could get at before giving his views, but, after sending in his report, Dr. Alexander received the views of nine others; the chief thing about them being that they think the Committee's proposals will damage the status of the West African Medical Staff; it is not these changes that are wanted to make the staff more attractive, but an increase in pay to the level of what can be got in this country.
The Governor of the Straits Settlements has " consulted the Principal Chief Medical
· Officer, Straits Settlements, and the Principal Medical Officer, Federated Malay States," and Annexes a memo. with which "he is "in general agreement."
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Other Governors confine themselves to observations on points of detail. In order to sum- marise these, it will be convenient to take the report of the Committee by paragraphs.
II-DETAILS.
UNIFICATION of Colonial Medical ServICES.
Paragraphs 4, 5, 6 and 7.—The Committee realise that the full attainment of the ideal, which is a unified service, recruited from recently qualified men, liable to serve in any Colony, is not possible at present for various reasons; but they recommend that in future application should be made for admission to the "Colonial Medical Service."
The Administrator of St. Lucia agrees that a unified service is the ideal, but thinks the difficulties insurmountable. The Governor of the Windward Islands agrees. The Governor
COLONIAL MEDICAL SERVICES COMMITTEE,
of Ceylon points out that the local Medical Service is almost entirely locally recruited, and likely to be more so; it cannot, therefore, profitably be regarded as an integral part of any Colonial Medical Service. The Chief Medical Officer of Fiji quite agrees as to the advantages to the Medical Staffs of a unified service. The Principal Medical Officer of Tanganyika considers that a unified service is the ideal. The Governor of Trinidad considers that unification would offer many advantages, but that the difficulties are insuperable. On grounds of racial difficulties Trinidad would have to be excluded from any such unified Medical Service Scheme. The Governor of Nigeria deprecates any attempt to affiliate such services as those of the West Indies and Ceylon with those of the West African Medical Staff, and the Governor of Sierra Leone sees serious practical difficulties in the way of a unification of services, in view of the very great variations in local conditions.
APPOINTMENT OF DIRECTOR-GENERAL,
Paragraphs 8 and 9.-The Committee recommended the appointment of an officer of stand- ing in the medical profession as a member of the Colonial Office Staff with a suitable title (the majority recommended the title of Director-General of the Colonial Medical Services); his functions generally to be advisory and consultative, rather than executive.
The Governor of Bermuda thinks the appointment of a Director-General sound. The Governor of the Windward Islands thinks it unnecessary, or even a change for the worse. The Straits Settlements and Federated Malay States memorandum says the Director-General should, as a rule, be himself a member of the Colonial Medical Service. The Governor of Nyasaland is of opinion that good results might accrue, if the status of the Principal Medical Officer as head of the Medical Department is not disturbed. The Principal Medical Officer of Kenya agrees with the recommendation, but he thinks, in opposition to the Committee, that the Director- General should visit the Colonies. The Principal Medical Officer, Zanzibar, regards the appoint- ment of a Director-General as essential; but the Resident, while agreeing, deprecates anything in the nature of dual control, and welcomes the limitation of the Director-General's functions indicated in the report. On the other hand, the Acting Governor of the Gambia, in opposition to his Acting Benior Medical Officer, is against the appointment of a Director-General, holding that the West African Staff are already too apt to regard themselves as imperium in imperio, and that the Committee's proposed safeguards would be illusory; he thinks the appointment would be subversive of discipline, and that the same arguments could, and would, be used for the creation of distinct Colonial Engineering or Educational Services. The Heads of the Sierra Leone, Gold Coast and Nigeria Medical Services favour the appointment of a Director-General, but the Governor of the Gold Coast thinks it subversive of all discipline for individuals to refer their grievances direct through the Principal Medical Officer to the Director-General, and nine of the local Medical Staff are against it. The Governor of Nigeria, in presuming that the Secretary of State does not wish for the observations of Colonial Governments on the appoint- ment of a Director-General as a member of the Colonial Office Staff, may be taken to indicate that he himself does not favour the idea. Indeed, he criticises the suggestion that the West African Medical Staff have not found an adequate channel for their discontent.
RBCRUITMENT.
Paragraphs 10 to 13.-The Committee favour the selection of medical men fresh from the Medical Schools, and they suggest that they should be seconded for service as House Physician or House Surgeon before going out, as well as attending in all cases a School of Tropical Medicine. They recommend that admission to the service should be by competitive or qualify. fying examination. They advocate, however, a system of preliminary sifting by interviews.
The Principal Medical Officer of British Honduras thinks that until a fresh crop of post-war graduates is available, at least £1,000 a year would be required to get men of the type suggested. The Governor says they have had to recruit three Medical Officers from Canada, one of whom has resigned. He is against examination, and prefers the present method of selection, with six months' probation at a School of Tropical Medicine. But if an examination is set up, he thinks suitable Medical Officers could be found among those who failed to get posts in East Africa or West Africa. The Administrator of St. Lucia agrees that young men should be recruited for the service, and as soon as possible after qualifying. The Governor of the Windward Islands is against any change in the present system, owing to the claims of local men. The Straits Settlements and Federated Malay States memo. says that even specialists should take a course and examination at a School of Tropical Medicine; course to be free, and half pay (at least) given; the seconding suggested is valuable, and should extend to work for higher degrees and specialist courses. The Principal Medical Officer of Zanzibar favours selection of candidates by examination after interview, and seconding them for the post of House Surgeon or House Physician before going out; he adds that he regards training in Surgery as the more important. The Resident agrees, but lays stress on the importance of retaining a probationary period. The Governor of Tanganyika expressly favours the appointment of young men; so does the Principal Medical Officer of Kenya-adding, however, that an examination is impracticable until there are more candidates than there are vacancies, but that the preliminary interview with and approval of the candidates should be essential. On the other hand, the High Commissioner of Cyprus urges that medical posts for the Island should be filled by the selection of officers whose health has given way in the tropics, but who are still capable of service. The Acting Senior Medical Officer of the Gambia says that competitive examinations for entrance into the service would help to increase its prestige, and attract young medical graduates after hospital