CO885-(11-12) — Page 349

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institutions than the Mental Hospital, so that a large increase is contemplated; but we are so impressed with the general modera- tion of Dr. Kirk's scheme that we are not prepared to regard his minimum demand as unreasonable. It is clear, however, that it cannot be realized in the present conditions. So far as the increase of cost, amounting to Rs.62,366 on the minimum of the scale of pay proposed, would result from raising the pay of the nursing staff, we are not sure that the scales which the Director has adopted from the Commission would be justified; rates of pay must be com- pared with the general rates of pay prevailing and we have dealt elsewhere with the general aspects of the present emolu. ments of Government servants. So far also as numbers are con- cerned it is obvious that the additional nursing staff is not avail- able, even if there were money to pay for it, nor do we understand that Dr. Kirk presses for the immediate adoption of his standard, although it remains a clear indication of what will be necessary in the future. One comparatively small increase should, however, be faced immediately. We strongly support the view of the Govern- ment that it is of primary importance in the administration of the hospitals to attach Nursing Sisters to the staff; it is unquestionably necessary to make sure that the professional level of the nursing staff does not decline with the gradual increase in numbers which we anticipate; and Dr. Kirk urges, and we concur, that action should be taken at once to recruit two more Nursing Sisters from Great Britain. The two Sisters now employed have to face an almost intolerable burden of work. We have suggested to Dr. Kirk certain economies in the stores administration which would provide for this recruitment without increasing the total cost of the department. The item of Rs.9,000 for allowance to students in nursing is already being used in effect to provide additional nurses.

6. Another item to which we draw attention with the same object is the allotment of Rs.30,000 for "extra assistance, medical and otherwise." A vague item of this type is always open to objection, and the Chairman of the 1929 Commission recognized this by reducing the allotment to Rs.1,000. This drastic reduction is not justified, for the fact of the seasonal work on the hospitals cannot be ignored; hard work combined with bad nourishinent brings many extra patients to the hospitals at the end of the harvest, and, some relief must then be given to the staff. But this extra assistance must be defined. We suggest in the first place that a retaining fee of Rs.1,000 to Rs.2,000 in each case should be given to three doctors selected by the Government, in order to secure their services at the busiest time. Should it prove more practical and economical simply to make payments for the services actually rendered we have no strong objection, provided that the allotment for this purpose does not exceed Rs.3,500, to which must be added Rs.1.500 for refund of fees to anaesthetists. The remaining

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Rs.25,000 should be appropriated for the pay of additional permanent nurses, warders, and attendants, the sum so used being transferred to the appropriate items of the budget. It will not be possible at once to recruit the additional nurses, warders, and attendants for whom there would be funds available. The balance should be used on carrying out the proposals which we make for the X-ray branch.

7. It follows from these observations that we agree generally with the view that has been taken by the Government that no substantial economies can be made on the present allotment for the staff and maintenance of the three major hospitals; and we consider further that it will be essential for some years to come gradually to increase the number of nurses, warders, and attendants while at the same time facilitating the training of the staff and keeping up their standards by the recruitment of a few more Nursing Sisters. For the present the new expenditure can only be met by savings such as we have indicated.

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8. Before passing to the examination of the country or district hospital system, we think it will be convenient to refer to the specialist officers whose work would be for the most part in close connexion with the work of the major hospitals. One of the posts included in the budget provision for Medical Officers, Item 9 of The officer this Head, is the post of Radiologist on Rs.10,000. who holds that post is at present acting as Superintendent at Victoria Hospital while the Assistant Superintendent of the Mental Hospital is in temporary charge of X-ray work. radio plant at the Victoria Hospital is described by the Director as far too elaborate and it has never been worked to its full capacity. There is a smaller plant at the Moka Hospital which was installed by the late Dr. Leclezio and is quite suitable for ordinary work. There is also a very old plant at Port Louis,

Two alternatives which is only used for bone cases. possible: the present plant should be improved and should case an Assistant remain in charge of a specialist, in which Radiologist must be obtained, the risks of X-ray work being too great if one doctor is employed solely on radiology; or on the other hand the plant at the Victoria Hospital should be replaced by a smaller portable plant, and the X-ray work should be divided among the medical staff of the hospitals, who should by means of assisted passages be given an opportunity for special training. The Director, while preferring the former, has himself suggested the latter course to us, as being the most practical means of deal- ing with radiology when the financial resources of the Colony are restricted. We agree and recommend that the post of Radiologist should be abolished. Dr. Dupré should be employed as Resident Medical Officer at Victoria Hospital and should receive as duty

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