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17 November, 1919.)

COLONIAL MEDICAL SERVICES COMMITTEE.

ME. JOSEPH ARTHUR PICKELS, M.B., B.S. (Londan), &a.

184. Chairman: Is there any wish for change in the titles of these posts now, do you think?—I have not hoard it proposed or suggested by any one.

185. Sir Humphry Kolleston: There is no desire to have uniform? Only a certain few; ■ few would prefer uniform, and, of course, as regards expense it would be cheaper.

188. Mr. Fiddían: There is a certain uniform you can wear, if you like, now; a West African uniform? -There was something; I have not heard anything of it for a long time.

187. It is not popular?—I have not seen it worn by M.O.' for a long time.

188. Khaki is worn in the ordinary sort of way?— Oh yes, frequently khaki.

[Continued.

Sir James Fowler: Uniform was discussed at the Departmental Committee, and it appears that a good many officers objected to wear uniform.

Chairman: And a good many were not aware thas they were entitled to wear it."

Sir James Fowler: Others raised the point about wearing uniform at the reception of the newly- arrived Governor.

180. Chairman: As a matter of fact, at the recep- tion of the newly-arrived Governor, the persons present to represent the Medical Department would usually be very high officials?—Oh, yes.

190. At Lagos, for instance, they would wom the uniform appropriate to their rank?—Yes.

We are much obliged to you.

(The Witness withdrew.)

(Adjourned till Monday next, the 4th November, 1919, at 8 p.m.)

DIEUT.-COLONEL

SIR

SECOND DAY.

Monday, 24th November, 1919.

PABSENT:

SIR WALTER EGERTON, K.C.M.G. (Chairman).

HARRY VERNEY,

Bt., D.8.0.

SUROBON REAR-ADMIRAL SIR HUMPHRY D.

ROLLESTON, K.C.B., M.D., F.R.C.P.

LIEUT.-COLONEL SIR JAMES KINGSTON FOWLER, K.C.V.O., C.M.G., M.D., D.Sc., F.R.C.P., R.A.M.C. (T.).

MR. T. HOOD, C.M.G., M.R.C.§., L.R.C,P. MR. A. FIDDIAN.

MR. J. E. W. FLOOD (Secretary). Dr. JOHN CURRIE, called in and examined.

191. Chairman: You are senior medical officer in Northern Nigeria?—Yes, Sir.

192. You began your career in the Colonial Service in Southern Nigeria?-In Lagos Colony.

199. When was that P-In 1904.

194. And between going to your present post and Southern Nigeria, you went to East Africa?—My first service was in Lagos Colony, then in Southern Nigeria, and then I went to Northern Nigeria; from Northern Nigeria I went to East Africa.

195. Which part of East Africa?—I went first to Entebbe and then to Mwanza to the south of the Lake.

196. That is Uganda?—Yes, Uganda, and then to the South of the lake to German East Africa.

197. You have had a good deal of experience of Africa and the Tropics? Yes.

198. I think you have had a draft list of the head. ings under which ovidence of Witnesses in desired. Could you give a brief general explanation of the organisation of the Medical and Sanitary Services of Nigeria now? Yes, I think I could, Sir; well I have not been there, of course, since 1017.

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199. You have been on War service?—I have been on War service, but, in those days the Medical and Sanitary Services in Nigeria were under the control of the Director. He had a principal medical officer for the Southern province of Nigeria, and one for the Northern province; he also had a senior sanitary officer for the Southern province, and one for the Northern. The principal medical officer had his staff which dealt principally with station and district work, as apart from the purely sanitary work, although of course, very often at some stations he had to do both. The senior sanitary officer had charge of the matters more particularly from sanitary point of view. The medical officers below the rank of Principal Medical Officer were Deputy Principal Medical Officers, Provincial Medical Off- cers, Senior Medical Officers, Medical Officers first grade and Medical Officers second grade. The Senior Sanitary Officer has his staff of sanitary officers. The Principal Medical Officers were mostly concerned with administrative medical work, the other members of the staff with the professional side. The senior sanitary officers administered the sanitary part, and the sanitary officers did the more practical part of the work.

200. The Nigerian service is recruited entirely by supointment from England, is it not?—Yes, Sir; the European staff is appointed by the Secretary of State. The subordinate staff are native,

201. They are native? They are native.

202. Do you think the native elements could be in- creased, or not with advantage?-I think the Native. of Africa is capable of doing a great deal more than perhaps he is allowed to do; that is my experience, I do not think that any native would make such a Batisfactory officer as a European, but there are cer- tain posts, I think, in certain districts which could be filled by a native medical officer; I think he would be capable of filling them.

209. If you had natives would you train them in a local Medical school, or would you let them come home to England? They would have to come home to England at present.

204. Would you give them appointments on the same footing as Europeans, or would they be quite a separate service?--A subordinate service at present.

205. Do you not think if they came home to England, and qualified in England, they would be discontented if when they went out they were not put on the same footing as Europeans?--I think very likely they would,

206. Yet you think it preferable to train them in England? We have not opportunities of training them out there, Sir.

207. I know you have not, but they might be created, might they not?—Yes, I think they might be. 208. In Hong Kong, they have a local medical achool, and in the Straits too, I think?I think it is quite possible if one had a very busy centre they might be trained.

209. Would you put them in posts where they would have to attend on Europeans as well as natives?- -] think it depends on the size of the post. A post, for example, like Epe I think could be run by a native medical officer.

210. You mean posta where there are only two or three Europeans?—Yes.

211. And all the others are antives?—Yes.

▼

212. It is unnecessary to have a European medical officer just for those two or three Europeans?--Well. I do not say that: you have rather got me in a corner; I would much prefer to have a European medical officer, because the work would really be better done, but if you are busy the native could do it.

213. Would you pay them less, and therefore the Government would have more men? I do not think

we have yet arrived at the stage when they should he put quite on an equality, Sir.

214. Do you consider the conditions of service, salary, private practice, leave, pension, etc., are

24 November, 1919.]

MINUTES OF EVIDENCE.

Dr. John CCRRIE,

generally satisfactory in Nigeria now? Well, not with the rise in prices and the depreciation in the value of money; certainly not.

215. Had you left Nigeria before the position of medical officers was improved P-No, I left in 1917 to go to East Africa. I am speaking now of the im- mense depreciation of the value of money; our salary is only worth half what it was.

216. And you think further improvement is re- quired? I am sure of it.

217. What amendments would you suggest?-As far as Nigeria is concerned?

218. I think we might speak of West Africa, might we not? The Services in the various Colonies have been more or less affiliated?-Well, we must have an increase of salary, and that increase of salary must be extended to the pensions and to the gratuition.

219. Do you think the gratuity is good? Do not look

at it from

A personal point of view, but generally from the point of view of the Servicn. You are becoming now rather a senior medical officer; do you like the idea of your best men going away after a short time of service?--I do not think they do go away; it does not encourage a man to remain a very short time, because he cannot get that gratuity until he has been nine years in the Service. 220. Then, after nine years, is he not just at his best? He ought to be most useful to the Service then, but I really do not know how many men have left the Service at that particular age in their ser- vice; I do not think very many have; I do not remember any.

Secretary: Very few since 1 took over the work. Sir Harry Varney: Two or three is the outside. 221. Mr. Fiddian: About half-a-dozen, I should think, is the whole thing?—That has been going for many years.

222. Chairman: If very few take advantage of it, is it worth while offering it? Yes, because, you see, I am not pensionable after 9 or 12 years' service, but if I die after having done 12 years' service, my next of kin gets my £1,200.

229. It is always dormant there? It is always dormant; you can take it at any time.

224. If you die? Yes.

225. Otherwise, then salary and pension prospects. Do you think the Service needs improvement in any way? How are quarters now?--It depends on where you are, Sir. The ordinary officers' quarters want improvement; they are not so good as the Medical officers' quarters, and those are not all that could be desired. They have improved very greatly during my service and are fairly good generally.

226. In there any other point that you think ro. quires attention to make the Service more attractive? As far as I personally can see, I think if our pay were made equivalent to what it was before the war we should not have very much to grumble about.

227. Is the Service generally contented, do you think? It is hardly fair to ask me that question, because I have not been there since 1917,

228. When you left was it? I did not hear much grumbling then.

229. Do you think the type of medical officer that was being recruited when you left satisfactory--the new comers? All the new men that I met, I think I can any, without exception, were energetic and cap- able, and I think they were very excellent men for the Service, very excellent indeed. I did not strike anyone who was an undesirable, either professionally or otherwise.

290. And in East Africa, did you find the same?-- I found a very nice type of man, an extremely nice type of man, quite as nice as you have on the West Coast.

231. How do you think conditions in East Africa compare with the West-I would not go to Enst Africa for anything.

The place is 232. Why? For various reasons, under-staffed; the people have been tricked ont there; it is an unhealthy climate, and they are under- paid.

233. They think they are going to a healthy climate? And they are not. There is not very much to choose between that and West Africa. There is a

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very nice, beautiful spot in the Highlands, but that is only a very small portion of the Čolony.

234. You say they are underpaid?--Well, I do not know whether anything has been done recently in the matter of their pay, but certainly they ought to be on exactly the same footing as regarda pay and everything else as the West African staff. They deserve it; their work is good, such work as they can do, considering their small numbers.

235. How did you find the cost of living compares there? Perhaps you can hardly say, because you went there in an exceptional time; but pay has to have some relation to the cost of living, has it not ?— The cost of living in Nigeria varies tremendously.

236. According to where one is According to where you are. Take Calabar, for example. I know when I was stationed at Calabar, if I could get an African chicken for 2s. 9d. I was lucky, but in Zaria I could get them for 8d. And you could not get aggi in Calabar; you expect your boy to bring you back five or six for a penny in Zaria. And the same thing, I think, holds good in East Africa; in some places the living is much cheaper.

237. As far as life goes, are conditions in East Africa better than in West Africa? You know the sort of bush station a man has to live at in West Africa P-Yes.

238. In East Africa, are the conditions better at an ordinary bush station, or much about the same? Perhaps I have not the right to speak about that; I was stationed for two months at a place called Mbale in the Eastern province of Uganda; I have been at Entebbe; the rest of my time was spent down at Mwanza on Lake Victoria. The quarters 1 had there were filthy beyond description. We had a tennis court there; we spent much money in trying to get it right. We did eventually get it right, and We that was all we had in the way of amusement.

had not the time to go out shooting, though there is plenty of shooting, I believe.

239. The conditions were not normalf-They were not normal; the comparison is hardly fair.

240. The medical services of the different West African Colonies are not quite amalgamated, but they are affiliated? They are affiliated.

241. Do you think a closer union could be effected with advantage P-To the West African P

242. Yea? I do not see what advantage would

accrue.

243. You think the present arrangements are quite satisfactory ?-One may move from one Colony to another on promotion; very likely one has done so, and I believe it is possible to effect an exchange by agreement from one Colony to another.

244. And you think that is better than the former system under which each Colony's service was quite separate? I do not think each Colony's service could be quite separate.

245. It has been proposed that there should be one general Colonial Medical Service for all the Crown Colonies; do you think that would be advantageous; do you see any difficulties ?-I do not think that would do at all. I think you could have a tropical African service, the Eastern service, and a Weat Indian service; but I do not think you could have them all lumped up together.

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246. For any particular reasons? Well, we not want the West Indians over there, for one thing. 247. Mr. Fiddian: You mean white or black Weet Indiana? Well, they are mostly mixed, are they not? I think we had better he without them.

248. Chairman: Do many of your medical officers in Nigeria learn anything of the languages of the stations P-I think you will find that every man in the northern province can speak Hause, which I think there is no difficulty in learning; in fact, I am sure it would be a very good thing to make every medical officer learn a language. Some have done it. In spite of obstruction put in my way at headquarters at Lagos, I did it, and I think that no gratuity should be given for it; I think it should be made a sine qua

non.

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24 November, 1919.]

COLONIAL MEDICAL SERVICES COMMITTEE.

DR. JOHN OURRIE,

249. You think it is a great advantage to a medical officer to understand the language of his district?—— You, I do; I think the medical officer should be made to learn these languages just as much as the political. 250. Do you not think he ought to have a gratuity for it? Look at it from the Government point of view; say the Government want their medical officers to qualify to learn a language; they offer a gratuity; surely that might be an incentive?--Would it not be fairer to the Colonial Service generally if he had to pass a progress examination before his appointment was confirmed?

251. You would have to put that in the conditions of service, when you were asking for recruite?--Yes. 252. Would not that rather deter some people from joining -I should not think so; it would not have deterred ma,

258. For many years, the difficulty has been to get enough recruits, has it not?—I do not know; I can- not way. I think they should learn the language. I am all out for the medical officers getting as much money as they can; I have no objection to their having a language gratuity; if they can have it, so much the better; but I was thinking of the whole of the service at the time. I think the medical officers should have a gratuity for learning languages if not compulsory.

954. I think in Nigeria and West Afrion now tho medical officers are all allowed private practice, are they not P-Yos, medical officers are, and senior medical officers; provincials, I think, are debarred.

255. Do you think that is a good thing?—You must have it; you cannot help it; it is a good thing; you really cannot help it.

258. One reason why you cannot help it is that there are no other medical officers?—Quite so, and you cannot refuse patients. I am certainly not going to see a sick man die for want of medical service.

257. Sir James Fowler: A proposal has been made that there should be a Colonial Medical Service, not oge Service for the whole of the Colonies, but a Ser- vice which would be divided into sections, depart- menta?—Yes, Sir.

258. A West Indian Department?—Yes.

259. A Ceylon, Straits, and Eastern Department P Yee.

260. A West African and Mediterranean Depart ment, the West African Medical Staff being under that; an East African Department The Mediter- ragean, what does that mean-Cyprus?

281. Cyprus, Gibraltar, and Malta? That, I do not think, ought to come into the tropical.

202. No; it is simply that appointments to those services are in that department of this office ?~~That is an office business, yea.

209. And an East African Department P-No, 1 think the East African and the West African should form one Department, that is to say, Gambia, Sierra Leone, Gold Coast, Nigeria, Uganda, the East Africa Protectorate, Nyasaland, and Somaliland should be one service with German East Africa.

264. Mr. Fiddian: And Zanzibar?-Zanzibar; I think, the rest should go under the Eastern.

265. Sir James Fowler: But, under these condi- tions, admission to each should be governed by certain regulations, such as those now existing, till they are changed. Do you see any objection to a Colonial Medical Service of that kind P-As long as the com- partments, or Departments, are well defined, I think it is all right; but I am quite sure that the best way out of the thing, as far as tropical Africa is con- cerned, is what I say.

208. Yes, as far as tropical Africa is concerned ?— Tropical Africa.

267. But, suppose there was an advantage in hav- ing a general service under these conditions we are discussing, do you see any reason why the West Indian Department should not share those advan. tages?—I do not see why they should not share these advantages at all.

268. Would you not be in favour of having a Head of the Department of the Colonial Medical Service, supposing there was one?-It is too big for one man. 289. It is too big for one man?--Yes; you might

[Continued.

have a Director-General of the tropical African Ser- vice, but he could not do the whole lot, East and West Africa, and the West Indies.

270. Chairman: I do not think you quite under- stand the proposal. It is, I think, that the Director- General should be resident in London P-Quite so.

271. In this office, and generally supervise from this office the Medical Service.

272. Sir James Fowler: There is no suggestion that in each Government the autonomy of the Government should be interfered with P-No.

273. That could not be.-Of course not.

274. You see the great difference in that is that in Nigeria the Governor of Nigeria or the Director of Medical Service in Nigeria would be supreme, as he is now. There is no auggestion that the Director should be in the same position as the Director of the Army Medical Service is Would you agree that there is any advantage under those circumstances ?→→→ It does not acem to me that he would be doing any- thing. What would he do? He would not have any control or say in the matter of Nigeria. That is a question which people higher up in the administra- tive work of the staff would be able to answer much better than I can.

275. 1 quite agree with you. Another administra. tive point. Do you think that, merely from the point of view of climate, there is practically no difference between East and West Africa?—I think the climate in Uganda and East Africa, leaves a very great deal to be desired. You have in British East Africa a large area of what we might call nice coun try, the Highlands, but it is only a very mall pro- portion of the Colony, and that is the "part of the country where you least want medical officers. That In the part which is baing exploited now. Uganda you have no beauty spots like you get up in the Highlands or Mount Kenia and some of these places; you cannot roam about on the shores of the lake on account of Tsetse. You have quantities of black-water fever and malaria there, besides dysen tory and all the rest of it. I do not think Uganda has very much to boast about in the way of climate, it is certainly higher up than Nigeria and has picturesque country.

276. You would agree generally that there are parts of East Africa which are quite as bad, if not worse, than many parts of West Africa. You would agree to that? I would quite agree with that.

277. You said, and I agree with you, there is an impression that East Africa in a better climate. You agree that there is that impression abroad? Yes.

278. That is reflected in the candidates coming for appointments who are prepared to go to East Africa, and are not prepared to go to West?Yes, I dare- say. There is also the prospect of shooting. It is not generally known that in West Africa there is very fine shooting.

279. If you joined the two Services, you might lose all those candidates, might you not?-Some of these people, if they are uninstructed and are allowed to go away with the idea that East Africa is a fino climate. If they have been persuaded it is, and they find it is not, you might lose those candidates.

280. Their friends might be adverse to their going? -Quite possibly.

281. Do you think the pay, and all the other con- ditions of service should be the same?—I think so.

282. Sir Harry Perury: I have only one point: Did you find that the medical officers of East Africa wished to go to West Africa?--I met one or two who cursed the day they took up East Africa rather than West Africa; I can give you the names, if you like.

283. You think, if the two Services were merged into one, that quite,« number would be glad if they were transferred to West Africa-I think they would. Mind you, I am speaking now of the con- ditions under which they joined. If you get equal conditions, I do not suppose, at this time in their career, that they would change.

284. I do not know whether it is a fair question. Do you think that the class of medical officer that you met, or that go to East Africs, is better socially or professionally, than those who go to West Africa? --Not a bit.

24 November, 1919.]

MINUTES OF EVIDENCE,

DH. JOHN CORRIE.

285. You think there is nothing in it?-Not a bit. 256. And, as far as your opinion goes, the two services could be perfectly merged in one with the same rates of pay and conditions in every respect P Quite so.

287. Chairman: The leave conditions are not the same? Are not the same.

288. Sir Harry Verney: The pay is not the same? The pay is not the same; the gratuities are not the same; I do not think they have got any gratuition at all?

289. Chairman: The difficulty in East Africa, in the matter of leave, is that, if you had to rule that the man should have leave for 12 months, it would be rather absurd relieving a man at Nairobi for a yourf-You cannot legislate for a Colony by the best spot in it.

Bome

200. I mentioned Nairobi, but there are healthy hill stations?-Nairobi is not such a healthy place as people ima place as people imagine; but I quite see your point;

291. I was reading Sir F. Lugard's evidence about Nigeria this morning, and I noticed that he says for certain periods, even in Nigeria, a man could stop out much longer?-Both you and I know that sonie men have done so without harm to themselves. There are in all those places nice spots. Buea, for example, Is a place where a man could stop for quite a long time. We know Butes is a pleasant place and Oyo is not too bad.

292. Sir Harry Verney: But, then you would say that perhaps 10 per cent. of the appointmenta in East Africa are better than anything in West Africa from the point of view of health?I do not know about that I cannot put it into figures.

293. You say you cannot judge much by the best places; I do not know whether East Africa is half and half, good and bad?-I should not put half of East Africa as good.

294. Much less than half?-Considerably less than

balf.

296. Would the effect of having the recruits, of having the whole service in one, be detrimental?—1 do not see why it should be.

296. The effect that a man might be sent to West Africa without choice would not doter him from coming forward?What effect has it in India? If you join the Indian Medical Services you have to go where you are sent. If you join the African Medical Service, the same holds good.

207. I quito agree?-I do not say it ought to make any difference at all. When a man takes up a Government appointment, he has to abide by the con ditions.

298. It is a man's relations who object?-Oh! well. Chairman: It might work the other way too, for one service you might get more people willing to go. than you would now, to West Africa; they would all come forward knowing they might go to East Africa, hoping they would.

299. Mr. Fiddian: It is worked in that way. There used to be a system by which the men put down their names for Northern Nigeria. In practice they went, and it worked very well; very few people seem to be discouraged in practice by the fact that they cannot be sure of going to Nigeria; they can now go to the Northern provinces-We were always allowed to put down our names for the Colony we pre- ferred.

300. And still are?-And still are. If there was a vacancy we went there.

301. Nine out of ten put their names down for Nigeria.

302. Sir Humphry Rolleston: Do you think there is any persistence of the old prejudice of the stigma against West Africa, or whether it has improved 7- What sort of stigma, professional stigma?

303. I was coming to that; I was going to say against going to West Africa; we had been informed that it applied particularly to the medical staff? Because they have to scrape the gutters of the profession to get medica! men to go out there; is that what you mean?

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904. As to whether you thought there was still a stigma expressed by 3 d's about going to West Africa? - have never heard anything about it. I must say this is the first that I have heard of it. to say the place is not a health resort, and the man who goes into the tropics-it does not matter where he goes--must be prepared to take such risks as there are, but, over and above that I am not aware that there is any stigma.

305. It certainly does not apply; well, if it does not exist the specific question falls to the ground. We

were rather given to understand that there was a general prejudice against people who went to the West Coast, and particularly against the medical staff? And that the result was, you got a poor

quality of man, socially and professionally, for that is what it boils down to.

306. That would explain that?—I do not know. 307. If that exists? I am not aware that that does

exist, but I do know this, that the constant cry amongst the men fighting in German East Africa was, "For God's sake send us a West African doctor."

308. Well, that is very satisfactory. The other question I was going to ask you was about the ques- tion of the hypothetical Director-General. Suppose there was a man in the office now, whose function across the sea was to get in touch with all the Colonial medical men, what style of man do you think would be best suited for the post? Suppose there was auch a man, would he be a man who had had a certain amount of experience, as one of yourselves, or a man in such a good position in the profession in England that his name would carry weight?-I do not think the West African Medical Service would tolerate s R.A.M.C. man to start with, or an I.M.S. man; I should prefer myself one of our own selves; I think far better one of our own Heads.

309. The choice in my mind was between one of yourselves, and, say, one of the men whom you might call the Heads of the profession in London?—No, we do not want them, we would rather they did not come; I would rather have one of ourselves.

310. You understand the conditions when you have been out there in the tropics. There are very few of the Heads of the profession who have been, and really understand tropical conditions?-Very few.

311. Mr. Fiddian: Supposing you got a man for this post who always had served in West Africa, obviously his usefulness, as regards other parts, say, East Africa, would be limited? Of course it would, 312. He would be better than a man who had never been out, but he might misjudge a West Indian ques- tion that came before him?—That was one reason why I said I think you had better separate the West Indian business entirely from the African and the Eastern.

313. But, the idea of having a Director-General, or Inspector-General, for each of them, at the Colonial Office, would be rather impracticable; you could not have a little Department composed exclu- sively of Directors-General ?—It would be rather awkward if you had three Directors-General, I know.

314. You expressed yourself strongly in favour of extending, if i may say so, the Medical Service to cover East Africa, to have a tropical Africau Medical Service?-Yen.

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315. Do you think the same freedom of movement would be possible; if a man is promoted to be senior medical officer, he may be sent, he would be sent, just where the vacancy occurred; a man in Northern Nigeria might be sent to Gambia; it would not be so easy to send him to Somaliland or Zanzibar?--Why. 316. Because he would not know so much about it? -I do not think there is much he would not be able to pick up easily.

317. He would be perfectly willing to go?—If it is known he may be transferred on promotion, as we are now, I do not think he would have any objection; I should think he would be rather glad. Ho has at least a basis of tropical knowledge, and he would be able to fill in gaps.

318. Chairman: Except on promotion, men do not like transfer to another Colony P-I do not think they usually ask for it.

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