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60

12 January, 1920.]

COLONIAL MEDICAL SERVICES COMMITTEE.

DR. J. H. CONYERS,

2081. Sir James Fowlor: Are medical men who are ailing ever sent on a sea voyage to recruit their health?--Oh no.

2082. There is no possibility of such a thing, is there? Well what happens is: If you are ill, if you canget get to England, you take a trip up to Bar- bados.

2083. Chairman: Yes, Barbados is the great health resort?—Yes.

2084. Sir James Fowler: How long would that taker To Barbados it may take two or three days, or it may take 36 hours; sometimes you get a direct connection. When you go by the Royal Mail it may take a couple of days; they go by Trinidad,

2085. You spoke of the difficulties of a General Medical Service. Had you in mind one on the lines, we will say, of the R.A.M.C.?--Yes.

2086. I do not think that any responsible person has over suggested that? Well, I rather took one of the questions sent to me to mean that; I think those are the words used" a General Colonial Service"- the last question "the formation of a General Colonial Medical Service," question D.

2087. You had some questions sent to you?-Yes. 2088. There are great differences between the R.A.M.C. and such a General Colonial Service?--The R.A.M.C. aro not called upon to treat the in- habitants of a place very much. They are treating soldiers; it does not matter very much where the man is. But what I was arguing for was, that it was an advantage to a Government to have a man there who had been some years in a place, not move him on too quickly; and it did not matter whether you moved R.A.M.C. man on, because the next man who came would be used to treating soldiers. It does not matter very much to the inhabitants of the place.

2089. Of course, I think you may take it that all who are interested see the difficulties very clearly, Have you opportunities for research there which are not ultilised-research in Medical Science in British Guiana P-A man can always make his opportunities; we have a well equipped bacteriological laboratory.

2090. In connection with the Hospital?--In con- nection with the Hospital.

2091. Chairman: And a bacteriologist ?-And we have a special bacteriologist who does nothing else but bacteriology.

2092. Sir Harry Verney: Do I understand that you do not know the terms of increased pay which the Governor turned down, or his own scheme --No.

2093. Can you give us some idea of what would be your notion of the commencing salary of a medical afficer ? What do you think he ought to get now?

Chairman: In order to secure satisfactory recruits, 2094. Sir Harry Verney: From our point of view, if we were recruiting here, what ought we to offer?

Nothing under £400,

2005. And rising to what?-I do not think the £600 is enough, Sir.

2006. What would you say?—I would say £400 to £800.

2097. You think if we offered £400 to £800 we could get good men?-I think so.

2008. Chairman: What increment?-Well, I think I would recommend

2099. What used it to be, from £400 to £900? That was a £25 increment,

2100. Every year? Yes, but it is graded now. Most of them, I think, are £20.

2101. But what would you recommend? I think

£25.

2102. £400 to £800, with an annual increment of £25 Yes; I think it would require some grading, but roughly speaking, I think it would be advisable to grade the men.

2103. Sir Harry Verney: So that he would get to nis £800 in about 18 years; that would be your iden, would it?—Not quite, no. The present scheme. is, that the men shall automatically go on with the £20 increment until they reach £800. It has been graded in classes, and I think there are some advan

[Continued.

It

tages in that. The classes graded bare are:-The £300 to £500 men, then the £500 to £600 men. gives an opportunity when the man gets his £500 there may be two or three of them waiting there -to reward merit; and that is one advantage of grading; I think, you are not making it purely a question of length of service and seniority.

2104. What I want to get at is this: If you have

■ really good Medical Officer, after how many years' service do you think he should reach his £800?— Well, I think he ought to go forward to his £800 a year in 16 years.

2105. A good man ought to go on to £800 after 16 years? Yes...

2106. There is nothing above that?—No.

2107. No further appointment? No further ap- pointment.

2108. No combination with other Colonies would give that good man in British Guiana a chance of something better? He could apply for promotion elsewhere.

2109. If it were one Service?-Oh, yes,

2110. Would that not be a possible advantage of the single Service? Yes; and the single Service has one vory great advantage-you would find it easier to recruit men.

2111. Would you have it apply to the West Indies as a whole? I do not think you can; the conditions are absolutely different; in most of the islands they are small district appointments, where the Govern ment pay very small salaries, and where the men rely on their private practice. The Demerara Ser- vice is absolutely different; the Government must have control of the men so as to supply the sugar plantations with doctors. By law they are bound to be visited once every 48 hours.

2112. Supposing this Committee recommended £400 to £800, what chance would there be that the Combined Court would approve of that? They seem to be in a generous mood lately; I fancy they would do it.

2118. Sir Humphry Rolleston: Do you think there would be any advantage if there was an entrance examination instead of the present method of selec tion, as regards the benefit to the Service?--It is so difficult to get men, I do not think I would put any difficulties in the way.

2114. It would be a disadvantage then?--Yes. 2115. You were speaking about the difficulty of men getting to a post graduate course, do you think they ought to have periodic study leave at five years' interval or oftener?-You find that it is not every man who will devote his time to studying when he comes to England. For instance, a man who geta keen on surgery would take the opportunity to develop surgery, and it is very much to the advan- tage of the Government, obviously, to have a good surgeon there, or there may be some other line. A good many of them I think would take up some line; some of them would take up mid-wifery to help improve the general standing of mid-wifery in the Colony, because, you see, at the hospital, where they are all practically trained in their work for the districts, the better men you have there, the better information becomes generally diffused in the Colony. I do not think every man will take up post graduate work.

2110. Would it not be to the advantage of the Service if it were made compulsory every five years? -I do not think it is practicable.

2117. Would it not improve the man's ability?— Unless he wants to do it, I do not think it is the slightest good trying to force a man to do it.

2118. Would it not be possible for them to get thoir post graduate course in North America, say a place like Baltimore, with loss waste of time and money involved in a journey, to England?-I forget how many days it takes to get to Baltimore, quite twelve days.

2119. As long as that?-Oh, yes, quite twelve days. There will be improvements in a year or so; the

12 January, 1920.]

MINUTES OF EVIDENCE,

Du. J. H. Conyers.

Royal Mail steamers will do the trip to England in 14 or 15 days, I think; there is nothing in it; some of them go to Canada.

Chairman: It used to take longer to get to Canu da than to England before the war.

2120. Sir Humphry Rolleston: You have a good Medical Society in British Guiana; you have a ceṛ- tain amount of books coming out there? Yes, there is a branch of the British Medical Association.

2121. Where you publish proceedings, and so on? Yes, we have published for a good many years.

2122. Mr. Fiddian: A certain proportion of your Medical Officers come from West Indian families?- Yes,

2123. Do you find those men are more contented than the others with the existing rates of pay?—No, I do not think so.

2134. And the Chinese?-I do not think the Chinese need enter into the consideration, really.

2125. By missionaries?—No; the Government have, up in the Interior, certain posts which are manned by diapansera.

2120 Men of colour?-Black dispensers.

2127. They do work?—Yes.

2128. And it is successfulP-I think they do it very successfully, these men in the outlying districts, such na Pomeroon and the North West, &c.

2129. You spoke of the low to the Government when a man who understood the local needs Was moved to another colony. I suppose there would always be a certain disadvantage in moving a man of average ability in the district-Yes, I think so.

2130. You think it rather important? Very important.

2191. The extension of the leave terms you spoke of would require the consent of the Combined Court, would it not?-No, the Colonial Office, not the Com- bined Court. They have nothing to do with the leave terma.

2132. Chairman: I think indirectly, because there would have to be more salary?—Indirectly.

2133. You could do without it, of course, if you could manage with fewer doctors?--Do without what? 2134. You could give officers more leave on full pay, if you got the officers, who remained in the colony, to do their work? Well, that is the con- ditions under which we get leave now, Sir. As it is now they are working five men short,

2135. Mr. Fiddian: Is there any medical officer in charge of sanitation ? Yes, but I am afraid there is very little sanitation in Demerara. That is rather an important point, the sanitary point. There is a medical officer of health for the colony generally.

Aro

2136. One? One; he is alw the port officer of the Port of Georgetown; he does work in connection. with quarantine and so on. He has under him a staff of sanitary inspectors; I cannot tell you the number. 2187. Modical men?—No, no, sanitary inspectors. One of these is an Englishman. I do not know that he is at present, but he was appointed from England, and the others native inspectors. All these sanitary inspectors have passed some examination, I think hald under the auspices of the Royal Sanitary Institute, and the policy has been to send a Sanitary Inspector into a district, and he cleans up that district, supervised by the English Sanitary In

The iden of Dr. Wise has been to spector, and so on. proceed very slowly and only employ a certain number. But it is recognised that a greater push must be made in sanitary matters, and it is now under the serious consideration of the Governor to appoint a second Medical Officer of Health, if not a third, as it is found that one man cannot carry out the duty.

2138. He is a little bit tied to Georgetown ?-Ho is a little bit tied, although he is relieved of the Port duties by the hospital men, The policy of the Govern- ment, under serious consideration at the present moment, is to increase the staff of Medical Officers of Health, and also the staff of Sanitary Inspectors. I

[Continued.

€1

prepared a schema; I do not know what they have done with it, showing how it might be done and the numbers that I recommended. When that came on it was pointed out that the question of emigration was a very important one, and that it was very de- sirable that they should devote some attention, con. siderably more attention, to the sanitary work of the Colony, especially in the outlying districts. To addi. tion to that there is a special officer for the town of Georgetown, a Medical Öfficer of Health for George-

town, who is partly paid by the Government and partly paid by the municipality.

2139. What salary does he get? The one in George- town?

2140. Yes? I think he gets £900 or £1,000 a year. 2141. He has no private practice, of course?—No, he has no private practice.

2142. What about the Health Officer of the Colony? I think he gets about £700

2143. Chairman: Is that Dr. Wishart? Dr. Wishart is for the city of Georgetown; he is partly paid by the Government and partly by the munici- pality.

3144. That is the £900 a year man?. He gets £900

and travelling allowances, which they have raised. He gets £1,100 or nearly £1,200. He is a well-paid man; he gets the post-mortems of Georgetown; they must amount, from bills I have seen, ta £200 or £300 a year.

2145. There are a great many of them?- There are a great many of them in Georgetown.

2146. Mr. Piddian: The Medical Officer of Health for the whole colony is not paid so much?—He is not paid so much. I think the next man in Georgetown will never get that salary; I do not think the Govern ment will agree to it.

2147. Do you see any advantage in the appointment of a Director-General, or an Inspector-General, for the whole Colonial Medical Service?-I bave not con- sidered the point; I really could not answer the quee tion.

2148. Dr. Hood: Who performs your duties when you are away?-My particular duties are performed by one of the senior officers,

2149. Is there a Deputy Surgeon-General ?--No. It is usually one of the senior officers. It is not necessarily the second man because very often you have a district officer who has devoted himself entirely to district work; he is hardly in a position to do my work.

2150. Would it not be an advantage to have a Deputy Surgeon-General?—Well, of course, it has always been a difficulty for the Burgeon-General not having a Deputy. I do not know what the Deputy would do when the Surgeon-General was not on leave. I have frequently been Deputy Surgeon- General, but then I had had a considerable knowledge of the Service, a considerable amount of administra- tive work. It is not every Officer who has that ex- perience. I have never considered the point of the appointment of a Deputy Surgeon-General, because I see great difficulties in the way. They generally use the man at the Hospital. Dr. Rowland used to act; I have acted on several occasions. The present man at the Hospital is Dr. Craigen; he is not acting at the present time

2151. It struck me as rather curious that you have no stop between the ordinary Medical Officer, and the Surgeon-General. With regard to pensions, has a man to retire after 60 years of age?—After 60 I think it is; it used to be after 65.

925. Chairman: After 60, I think now, is it not?— Possibly after 60 now; I think it is after 60.

2153. I do not think you have the model Pension Ordinance in British Guiana, as far as I remember?— I think it is 60; it used to be 65.

Dr. Hood: Do you think 60 too old for a man to remain in British Guiana?

2154. Chairman; I am not sure that it is not 65; it used to be 65. I know no Medical Officers, but other officers well over 60, Professor Harrison ?—He is over 60; Mr. Crook in older still, Sir; I had an uncle there who retired, I think, at 67.

Į

Page 180Page 181

62

12 January, 1920.]

COLONIAL MEDICAL SERVICES COMMITTEE.

Da. J. H. CONTERA.

2155. Dr. Hood: It seems hardly worth while re- tiring then at 60, does it?-You must increase the pension then.

2156. Sir William Leishman: These European officers, with British qualifications, that you have at present, what about their average age; are many of them young men who have recently joined you, or have most of them been a good long time in the Service? Oh some of them a long time.

2157. In the last five years how many fresh re- cruits have you had?-I am not quite certain.

2158. Would they average one or two a year?—I do not quite know. Oh yes, the year I went there two men came; two came immediately before. It varies very much according to the retirements. At the present time the retirements are taking place rather quickly. All these men at the top of the list here are of the same age; they will all retire about the same time.

2159. Have you had any retirement recently of the younger men, who have only served a small number of years in British Guiana? Oh no, there have been no retirements. They would not be retirements, they would be leaving the Service.

2160. Leaving the Service? One man applied to go to West Alfrica. It is really on account of domestic reasons. He has applied to go, and I believe he has got an appointment. There is one other man who has applied to go.

2161. Are the majority of the officers married? Yes.

2162. On the question of leave, or sick leave, if they have to go home, nothing is allowed for passage, they have to pay their own way? They pay their own passage. He gets three months' leave and the rest on half-pay.

2163. Does the climate suit British born women and children? I think, as far as a tropical climate goes, it suita them very well.

2164. What is the average class of work of the Medical Officer; has he a large district over which he has to travel?--Yes.

2165. Chairman: What is the size of a district; what amount of road would he have to travel over in an ordinary district! I suppose in a month something like 500 miles.

2166. I do not mean that; he lives somewhere near the centre of his district; how far would it be to each end of his district-10 milos?-Not more; the rough travelling is about, I suppose, 500 to 600 miles a month.

2167. Yes, but it is all backwards and forwards, a short stretch of road?—Yes, it is not very wide.

2188. And I think from the sea inland, it is never more than three or four miles? That is so.

2169. British Guiana is just a strip along the coast? -Or up the river.

2170. Sir William Leishman: This private practice, which hulks so largely in his remuneration, does he obtain that chiefly in the centre in which he is living, or does that apply to the out district where he visits; is the private practice all over his district?--In his district; he is not supposed to go outside his district because he poaches then on the next man, do you

nee.

2171. The amount that he would get from private practice, I suppose, varies considerably ?-In the dif- ferent districts, yes.

2172. Does that give rise to any discontent ?--No, because a man waits to apply for a hotter district, if he is not entitled to it by his seniority; when there is a vacancy in a better district he makes an application for it.

2173. He looks forward to getting more and more from private practica?-Generally speaking, he looks forward to getting nearer Georgetown, i.c., the dis- tricts round Georgetown, I think, really on account of the private practice; they are more populous,

2174. And the private practice, of course, is of a ¿eneral nature; he has to do surgery and medicine and export diagnosis of disease? Yes.

[Continued

2175. You said there was a well-equipped Labora- tory at Georgetown P-Yes.

2176. With a bacteriologist attached?--Yes. 2177, How long has he been there-some years?— Some years, not very long; about three or four years. 2178. Chairman: About five or six years, 1914 or 1915, I should think P-You.

2179. Sir William Leishman: Have the Medical Officers any opportunity of taking courses at this Laboratory under the Government bacteriologist P—— No, there are no such courses.

2180. Would you say that on the whole they are well equipped to carry out modern methods of diagnosis;

Officers your Medical

the microscope practically themselves f-Oh yes; they come out with that knowledge.

can

Use

2181. That knowledge, of course, is not very full; it wants experience, does it not?--Yes.

2182. They have no opportunity then of learning more modern methods of diagnosis, and so on ?--- Most of the Medical Officers use the microscope in the districts.

2183. Have they all their own microscopes? Are microscopes provided for them ?-Most of them have their own microscopes, but the sugar plantations provide microscopes. The districte practically mean the sugar plantations.

2184. Is the necessary equipment provided at the Medical Officers' own expense, or provided by the Government P-Tho Government provide nothing.

2185. Would you say that the quality of your latest recruits has been quite satisfactory, from the point of view of medical qualifications ? From the point of view of qualifications, yes.

2186. The point has been raised by one or two others; do you think, there being no administrative posts, except the one at the top which you hold, that that causes any discontent in the junior ranks? If there were intermediate posts between the Medical Officer and the Head, would that be welcomed, or otherwise?-Most Medical Officers do not like to

touch administration.

2187. That is, assuming they are not remunerated for it. They would, if they were paid for it, would they not? They mostly fight shy of administration. Administration means responsibility quite outside their line, really. I do not think they are keen on administration; they would like to put that quite on one side, and stick to their own medical businesg entirely.

3188. As far as your experience goes, when a man has got to British Guiana he is likely to become content to spend the whole of his professional life there and would not prefer the option of moving to another Colony in the West Indies or elsewhere ?→→→ If the other Colony offered him better terms he would be delighted to move.

2189. He would like to go on botter terms-pro- motion P-Y.

2190. Mr. Fiddian: Even if he were a West Indian Ly birth Oh yes, I do not think the patriotism for British Guiana goes very deeply.

2191. Chairman: Do you insist on all your Medical Officers going through a course at one of the Tropical Schools of Medicine?-No, Bir.

2192. Do you not think it would be a good thing if every new Officer did go through that course, either before appointment or on the first occasion of his visiting England ?-It has never been done. We have always had such trouble about getting Medical Officers. Certain of our Medical Officers have, of their own free will, done it.

2188. Would you offer them any inducement ?— Undoubtedly I think it should be done.

2194. What form would you make the indue ment? --Pay them full salary while they were doing it and pay their fees.

12 January, 1920.]

MINUTES OF EVIDENCE.

DR. J. H. CONY KEN,

2195. Sir William Leishman: You spoke of the very different conditions in the West Indian Colonies so being against the possibility of affiliation or amal- gamation.

These differences are not, 1

take it, medical differences, that in to say, an Officer going to another district would not meet diseases that he was not accustomed to deal with ?—No.

2196. It is quite irrespective of that? Yes. 2197. Chairman: Do you think it would be a good thing to recruit Medical Officers directly after they bave passed their examinations and then keep them at home, to gain further experience, for, say, eighteen months or two years ?-Not so long; you might let them go through a take very long.

[Continued.

63

an appointment of House Surgeon at home for a per- tain time? I do not think that is a great advantage. 2209. You can give them the experience in the Colonies?It used to be so in my time. I would rather they took their experience out there.

2209. Sir James Fowler: Do you not think it makes Bu enormous difference in the man's career whether he has held a house surgeoncy, and house physiciancy under highly qualified teachers?—Quite so." I quite agree.

2110. Do you not think it lasts all his life?-But will he have highly qualified teachers? Many of the men in my time used to go to lunatic asylums, placés

like that. Tropical School; that does not

2198. There is great difficulty in getting candi- dates? That is the great difficulty at present.

2199. And if you selected them after they had passed their examinations, offered them a selection then, would you not be likely to get more candidates? That is the time you could select them through the Medical Schools. I know in my own time I never thought Colonial appointments were sufficiently ad- vertised in the Medical Schools; it Was not prominently brought before our notice, just as got through, that there were appointmente vacant; we really could not find out the terms of these appointments.

We

2200. Students are always discussing what they are to do? Yes; what you are to do, what about a Colonial appointment; what do you know about it? It was not brought prominently before your notice. I remember one man saying to me, "What about British Guiana?" "I know very little about it." He said: "The great objection is the place has not gut a pension." That was by the senior man of his year, quite the best man; he had read up the con- ditions and informed me that there was no pension allowance. Luckily for himself he did not go to

British Quiana.

2201. Those were the conditions when you were studying; how are they now; do you think they are sufficiently advertised nowP-I could not say.

2202. What is your impression ?-I should imagine

not,

2203. That students are still ignorant?-They are not brought to their notice at the time of their pass- ing their examination. At the Edinburgh Univer- sity, just as the examinations are over and the men are to be capped; that is the time to bring it forward.

2204. You think they are still unfamiliar with the conditions of how to get into the Service?—I do not know, but I imagine they are.

2205. What was the lower limit of age that you would fix for new recruits for the Service; would you fix any lower limit, or would you say directly a man has passed his examination? Oh, we would like to get them as young as possible.

2208. Would 21 be too young?-Well, they will not give you your diploma under 21. I do not think they would he too young, Sir. Some of our very beat men have gone out at that age.

2207. Would you not stipulate that he must hold

That was held to be fulfilling the Regula- tions of the Colonial Service. That was of no value. He had very much better have come out to George- town Hospital where he would have had the advant- age of consulting with the man in charge of it daily, and in six months picking up a tremendous lot from such a man.

2211. ('hairman: How many beds have you in the hospital? It has been changed so often that I have really forgotten. I think they have got it up to 500 now.

2212. Nir James Fowler: Would it not be one of the Regulations of the Service that a man should take an appointment at a lunatic asylum, or anything of that kind?-He should hold a hospital appointment; that

a regulation for the British Guiana Service when I went there; bold the position of an assistant in a hospital. It has been so.

was

2213. Is that so now?—No,

2214. How are your Medical Officers recruited; you say sometimes you ask for one from home-Yea 2216. But not always?—No, not during the war, was hopeless.

Chairman: Before the war.

it

2210. Sir James Fowler: Before the war; we will speak of normal times P-Well, most of the men caine appointed by the Colonial Office; others came out to the Colony who were connected with the Colony, and took acting work at the Hospital, and so got into the Service.

2217. And then were appointed by the Government? -Appointed by the Government.

2218. Chairman: Came out for private practice? Most of them went to the hospital. There were

usually vacancies; men going on leave; there was a little money to pay them, and then they ultimately got into the Service in that way; they were found useful, and got in in that way.

2219. Sir Humphry Rolleston: Who is the man in charge of the hospital; is that a local practitioner in Georgetown?—Őb, no; he is one of the Government officers; and he does nothing else but look after the hospital, and he has plenty to do.

2220. When you speak of senior Medical Officers you mean men senior in appointment, they are not called senior Medical Officers.

2221. Chairman: You mean senior in service?-I mean senior in service.

is all.

2222. Sir Humphry Rolleston: That is all? That

('hairman: Thank you.

The Witness withdrew.

(Adjourned till Monday next, at 3 p.m.)