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to come remain in its present form, though like all the hospitals it requires such addition to the nursing strength as can gradually

.be made.

While Moka was to be expanded, the other five hospitals were, according to the Chairman of the 1929 Commission, to be reduced to dispensaries or to be handed over to religious bodies, or according to Dr. Kirk's original scheme, to be abolished. We have seen some of these small hospitals and are glad that the Government has decided to retain them. The hospitals are not situated at the best possible centres which would serve their local area, in particular Poudre d'Or is badly sited, and Long Mountain, though in a far more healthy site than at Pamplemousses, is so inconvenient for access that most of the members of the 1929 Commission were pre- pared to recommend its abolition. The local hospitals are also far from being perfectly equipped or staffed, but they are very useful in relieving the major hospitals of the treatment of chronic local cases, and they are a real boon to the poor in the areas which are at some considerable distance from Port Louis or Candos. They have become all the more necessary with the gradual disappearance of the system of contract labour and estate medical relief.

The ordinary staff of a district hospital consists of a Medical Officer, and of a Dispenser who is also a steward or accountant.

11. The dispensaries are of much less obvious value than the district hospitals, apart from the dispensary which is attached to the Civil Hospital and which is really the out-patients' department of that hospital. There are two dispensaries in the suburbs of Port Louis, and 28 dispensaries situated in all the important villages where there is no hospital. Their distribution is shown on the accompanying map".

The qualifications of a country Dispenser are low and it cannot be expected that his medical work should be very effective, but we consider that most of these dispensaries have a real use which justi- fies their approximate annual cost of Rs.30,000. In the first place they serve as consulting rooms for the Government Medical Officers in charge of the country hospitals, who visit them at fixed times during the week; this is an excellent device for giving direct medical relief to the poorer classes. The Dispenser is at least able to ascertain the more serious cases of illness and to bring these cases to the notice of the doctor. Secondly, the Dispenser acts as a local chemist, who is able to provide simple remedies and to make up simple prescriptions on the doctor's orders; it must be remem- bered that in the country districts there are no chemists' shops, and though distances are small there are gaps sufficiently large to justify the provision of a Government chemist for the area. The

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Dispenser inevitably has much spare time, and we are anxious that his services should be used to a greater extent for Civil Status work, that is to say, the registration of births and deaths. The payment of small allowances for this purpose is far more economical than the maintenance of whole-time clerks in the district offices. The Dispensers are also utilized in the local administration of poor relief. În general we regard this dispensary system as a useful element in medical relief, but we have pointed out to the Director that a few of the dispensaries are either so near the hospitals or other dispensaries or else serve so few people that their retention is not necessary; they should either be transferred to a better - centre or abolished, with consequent savings in Dispensers, ser- vants and rent. Any resultant savings should be appropriated for strengthening the nursing staff in the hospitals.

12. For the understanding of the proposals which we make in part modification of the Director's scheme and, with his concur- rence, for the reorganization of the health work of the depart- ment, it is desirable now to turn to the accompanying statement which shows the sanctioned posts of superior medical staff, the actual arrangement, and the scheme which we recommend.

We need not refer at the moment to the beadquarters posts; we have discussed the three vacant specialist posts and have recom- mended that they should be filled in accordance with the Director's scheme the eight posts at the major hospitals, though at present not a little disorganized by leave arrangements, impose themselves and must be retained. The post of Radiologist will be abolished. The need for a Health Officer in Port Louis cannot be ques- tioned, but the Director has recommended that the Medical Officer of Health should also take the duties of Port Health Officer, which are at present being performed by one of the Resident Medical Officers of the Civil Hospital. The special post of Port Health Officer can

be abolished. We support this very reasonable proposal.

In our observations on the Prison Department we have recom- mended that in substitution for the post of Port Health Officer a new post of Assistant Superintendent of Prisons should be created, and that the officer holding it should be seconded to the Prison Department. It has been suggested that the Prisons Medical Officer should be a specialist in medico-legal work and should be in charge of all post-mortems, thus relieving local officers of attend- ance at Courts. Dr. Kirk, however, does not press this scheme, and we are strongly opposed to it, quite apart from the fact that we consider that the Prisons Superintendent should give his whole time to prison work.

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PUBLI

RECORD OFFICE

Reference :-

C.O.882/12

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ALLY WITHOUT PERMISSION OF THE REPRODUCED PHOTOGRAPHIC-

PUBLIC RECORD OFFICE, LONDON