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Medical Officer is abolished the Health services of the western division of the island can be maintained satisfactorily by the Health Officer, Plaines Wilhems; full medical relief is afforded by the Victoria Hospital. The Director also proposes to give a Health charge to the Government Medical Officer of the Moka Hospital. This is a hospital where serious operations are performed, and we desire to limit the Moka Health jurisdiction to the very small area which will give him no more than the dispensary of St. Pierre as his outlying consulting room, and in fact a charge con- sisting of little more than the well-to-do residents along five miles of road. The remaining area falls into two well-defined groups, the small southern area the upper portion of which contains only a small population, and a larger area on the east and north ex- tending from Quartier Militaire to Flacq and to Pamplemousses. In order to indicate the real facts about these areas our map shows the dispensaries, and the villages which have no dispensaries but which have been "* proclaimed.' If the whole of this area were divided among the Health Officers in charge of country hospitals some of the charges would be larger than we desire. On the other hand, as Dr. Kirk has pointed out, one Hookworm Officer cannot work throughout this area. We would add that no neces- sity is left for the appointment of a Sanitary Warden having juris- diction over the whole area; this post should be abolished

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15. Our solution of the problem is that two Hookworm Specialists should be appointed in addition to the present Hookworm Officer. One officer should be in general charge of hookworm and malaria treatment in the whole of the southern area, the other two officers, one of whom should be the assistant of the other, would have a similar charge in the rest of the island. But in addition to their special duties in the whole of these areas the northern officer and his assistant should be Health Officers in the lesser area which we have indicated between Flacq and Moka, an area for which there are natural boundaries in the hills to the south and the Nouvelle Découverte forest, the Fayences mountains and the 'Trou d'Eau Douce woods to the north. Similarly the southern officer based on Rose Belle should have full Health charge of the upper portion of the Savanne and Grand Port districts north of Rivière Dragon and Mare d'Albert Station and Cent Gaulettes. For the areas indicated there are four dispensaries along the main road in the northern area, and two dispensaries in the southern area; these would be the consulting rooms of the special Hookworm staff and the centres of their Health administration as distinct from their hookworm and malaria work. Their hookworm circles would not be large, and the area and population of their particular Health circles would be so restricted and so placed as to make it easy for them to do practical Health work in them as well as to con- duct their specialist campaign in the larger area. On the other hand the areas of the Government Medical Officers of Souillac, Mahebourg, and Flacq Hospitals would be very small indeed. There would hardly be any occasion for the officers to travel more

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than five miles from headquarters. We should make it quite clear that the Government Medical Officers will be in no sense under the control of the Hookworm Officers, but the latter will do their special work, but not any general Health work, in the circles of the former. We must also add that, though we have closely de- fiued the areas of the new circles in order to make the scheme clear, and to show that it is completely practicable, we feel that the Director should have power to modify these circles, provided always that the circles of Government Officers in charge of hospitals are not too much enlarged,

16. We find great difficulty in deciding whether we have been the more impressed by the facilities which the excellent roads and short distances in Mauritius offer for direct administration or by the way in which these resources have been squandered so that in many departments the real administration is in the hands of low-paid Inspectors and Guards. The Health Service is no excep- tion, and the result has been that the constant supervision of subordinate staff has come to be regarded as a primary essential of sanitary organization. This is a view with which we strongly disagree. The objective of the departinent should be for the Health Officer himself to see what is wrong and to see that it is put right, and we have made this possible by the small areas of the charges which we recommend. Direct action by the Health Officer himself is worth very much more than the supervision of Sanitary Guards. In our opinion no form of administration in a small, country is worse than that which gives a local range to an Inspector or Sani- tary Guard and makes him the officer really responsible for dis- covering and reporting defects. These are the men whom Dr. Balfour regarded as "little more than perambulating note-takers and entry-makers and whose popular reputation, according to the papers now before us, might be described in much harder terms. We doubt, however, whether we have been in any serious disagree- ment on this point of principle with either the Government or the Director, for the passages which we have quoted recommend- ing that the officers in charge of country hospitals should also be Health Officers would have no real meaning if the paternal doctor were to see nothing except through the eyes of a subordinate.

Dr. Kirk in his excellent conception of a Health Unit included a Sanitary Inspector amongst the staff of the centre. We fear that the full project will remain unrealizable for some time, not only on financial grounds, but also because suitable Health Visitors are not yet available. The Director does not, however, regard it as essential to the Health Unit idea to maintain a Sanitary Inspec- tor in a local charge, now that our modification of his proposals has reduced the Health charges to such manageable size. A glance at the map will show that the number of possible Health centres *Not reproduced.

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Reference

C.O.882/12

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