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PUBLIC RECORD OFFICE, LONDON

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19 January, 1920.]

LIBUTENANT-COLONEL

COLONIAL MEDICAL SERVICES COMMITTEE.

DR. E. E. MAPLES,

EIGHTH DAY.

Monday, 19th January, 1920.

[Continued.

19 January, 1920.]

PRESENT:

KINGSTON

D.Sc.,

SURGEON REAR-ADMIRAL STR HUMPHREY

ROLLESTON, K.O.B., M.D., F.R.C.P. MAJOR-GENERAL SIR W. B. LEISHMAN, K.C.M G.,

C.B., M.B., F.R.C.P., F.R.S, K.H.P., A.M.S. Mr. T. HOOD, Q.M.G., M.R.C S., L R.C.P. MR. A. FIDDIAN.

D.

SIA JAMES FOWLER, K.O.V.O., C.M.G., M.D., F.R.C.P., R.A.M.C. (T.), in the Chair.

LIEUTENANT-COLONEL SIR HARRY VERNEY, Bart.,

D.8.0.

Ma. J. E. W. FLOOD (Secretary),

Dr. E. E. MAPLES, called in and examined,

2223. Chairman: You belong to the West African Medical Staff; where are you serving now; what is your post now?-I am a Medical Officer, and I have been stationed at Calabar since 1915.

2224. Have you any points in connection with the Services you would like to bring before the Com- mistee? Yes, I have several points I should like to bring before the Committee. The first question you ask is: Brief general explanation of organisation of medical and sanitary services of the Colony with which you are concerned. I suppose it is hardly necessary for me to go over the appointments?

2235. No? There is the general branch and a sani- tary branch, but there are no specialist appointments in West Africa at all, beyond those connected with the Research Institute. Every day it is becaming more and more evident, I think, that these specialist appointments are necessary. For example, in Lagos there is a good deal of X-ray work; they have a very fine X-ray apparatus there, and the present Medical Officer in charge of the X-ray apparatus is a very competent radiologist, but I think there is need for specialist appointments in radiography. Another X- ray apparatus we have in Southern Nigeria is at Cala- bar. I work that myself, but I do not think there is any necessity for a specialist appointment there. I think there is a great necessity for Clinical Patholo- gists, at least in Southern Nigeria. To my mind, inedicine and surgery have made such large advances in the last 10 years that such appointments are necessary. In Calabar, I try and curry out Clinical Pathology. With overy patient that comes into the Hospital with a temperature I try to take a blood film; in fact I succeed in doing so. Any patient with fever is not diagnosed as malarial fever right off; I make it a routine to have the blood examined; in fact I have taught several members of the Native Staff to do that, some of the nurses in training can take films and stain them.

2228. Mr. Fidelian: The native nurses?--Some of the native nurses.

2227. The native women nurses?-No, the nurseB are mostly male in West Africa; there are a certain number of female native nurses. Of course, we baro a great advantage in Calabar, because we have a training whool both for Dispensers and for nurses also and therefore an adequate native staff. Every patient that comes into the Native Hospital there also has his stool examined as a routine. That routine examination, to my mind, reveals a very interesting phopomenon from a medical point of view. It has convinced me for many years that the most important

Perhaps

Possibly

disease in West Africa is Ankylostomiasia. I should not say the most important, but one of the most important diseases in West Africa.

the most important diseases are venereal diseases. That is by the way. Blood examination reveals alan that in most cases of pneumonia there are malarial parasites in the blood. Whether it is the toxin of the pneumococcus that brings them in or not to the peri- pheral blood stream from the spleen, I do not know. I only want to point out that to carry out your work efficiently in a tropical country there is a good deal of Clinical Pathology necessary in the form of routine examinations. And then, I think there is another kind of specialist appointment necesary in West Africs, and that is what I call a Special Hospital Medical Officer, a man that is used to doing hospital work alone, and to concentrating himself on that work. I may say, myself, I have done nothing practically but hospital work since 1909. I was in charge of the Warri hospitals for several years, and I have been in charge of the Calabar Hospitals since 1915. I think these special hospital appointments are a very urgent necessity indeed for the staff. There is another point that crops up here, and that is the question of the function of the Medical Officer. I do not think the function of a Medical Officer is clearly deter- mined. It appears to me that since the war thin has been more apparent because of the shortage of staff and the amalgamation of Northern and Southern Nigeria. I think I am right in saying that before the amalgamation of the Northern and the Southern Provinces one of the functions of the Medical Officer in Southern Nigeria was towards the general public. especially the native community. With shortage of staff it has not been possible in all cases to perform this function, and I do not think that it has ever been carried out in the Northern Provinces as much as in the Southern Provinces. I suppose that was largely a question of funds. But what I am getting at is this, that this point materially affects the prospect of the Medical Officer as regards the quality of the work he undertakes. If he is to be confined to Government officials and dependents and there is to be no work among the general population, it deteriorates, to my mind, the attractiveness of the work that is done in West Africa. I consider the most interesting work in West Africa lies among the general native community. That is the work which is interesting

2228. Chairman: That is not only purely private praction; that is public work?—No question of private practice.

MINUTES OF EVIDENCE.

DR. F. E. MAPLES.

I

2229. Mr. Fiddian: You are thinking of the estab- lishment of dispensaries and native hospitals?—Yes. It also affects us in another way. If you confine this function to all Government dependents, let us put it in that way, you can compel him to travel a great deal more and I think he loses interest in his work by constant travelling, and he loses also what I call diversity of experience. have always felt that there should be some definite constructive policy for the future. I realise we have passed through a transition stage during the war, when you have bad to do the best you could. As regards function, if you are to do your work properly it entails to-day different and more difficult inethodA of investigation for diagnosis, and it entails more expensive methods of treatment. It involves more time, if you are to do routine blood and stool ex- aminations, and that sort of thing. To do your work efficiently, you have to spend time doing it. I may say that I myself work 14 hours a day; I get up at a quarter past five and I never go to bed till ten at night; I have always work to do at my house. The second question is: How recruited, whether by appointments from England or locally P From England in all cases, as regards the West African Medical Staff. There are a few appointments of Native Medical Officers, but they do not belong to the West Alfrican Medical Staff, they belong to the Native Medical Officers of Nigeria, or, as they prefer to call themselves, the African Officers. Then you have some races who have no objection to European methods of treatment. The Hausas, for example, in the Northern Provinces, are much disinclined to European methods; they have their own native doctors. I think possibly in the Northern Provinces it has also been a question of the Medical Officer not having the means to practise European methods of medicine, mean hospitals and instruments, appliances and similar facilities, and I think that is dependent upon a lack of funds. The Northern Provinces have never had the funds that The Southern Provinces have had in the past.

2250. Chairman: You think, briefly, that if the European medicine were more thoroughly up-to-date, it would educate the native medicine? That is exactly what I mean. I ought not perhaps to point it out, but it appears to me to be a function--a duty— of Government to encourage European methods of medicine.

2231. Anything else?—In my own case the Efiks in Calabar are very difficult people to practice medicine amongst at all; they are very great believers in what they call Ebok," that is, native medicine. They believe in native medicine, and it is not until you have been in the station a long time that they are inclined to come to you. You have, in a manner, to establish yourself to gain their confidence.

2282. Mr. Fiddian: What do you mean by a "long time;" so many months, or so many years? Well, it would take at least a tour for a man to gain their confidence, I am sure.

a

man

2233. It would be all the better if you wont back to the same place the second year-Yon. In my opinion, it leads to a great deal of dissatisfaction; not only lack of continuity of colony, but of station. Unless there is some degree of continuity of station, never seen the fruition of what he has at- tempted to do. I feel that very much myself. If Jou go into a hospital and try to organise it, you cannot do it in 12 months. For example, the new X-ray apparatus I erected myself in Calabar in 1915 is only now in perfect order this year, in 1920. The organisation that we have there of examining bloods and the routine clinical pathology, cannot be ostah- lished in a short time. If a man is in a station only 12 months, or if he is chopped and changed about, I m quite certain he losce the interest in his work, because it in no use making an effort unless you are going to sea some result from it. It all comes to this that medicine is an individualistic calling.

2234. Chairman: I think we take that point; what is your next point? My next point, on which you ask a question, is linguistic. They are gradually talking more and more English. I do not think the

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[Continued.

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language question in West Africa is a great diffi culty; with education they are beginning to speak English almost everywhere. The next question is No. 4: I would rather answer No. 5 first: Is the Medical Service generally contented? Well, I think it is discontented in certain ways, but I think that is largely the result of the war. No. 4: Do you consider conditions of service (salary, private prac tice, leave, pension, &c.) generally satisfactory? If not, how would you suggest amendment, bearing in mind the conditions of service of other Government officers? I think the discontent lies in two direo-

tions, one is an economic question, and the other is a professional or an administrative one. I think the economic question is bound up with the same question which affects the whole of the Civil Service, that is the increase of prices since the war, occasioned by the war. In 1914, when the Colonial Office re-or- ganised the pay, I think the pay was adequate and I think the men were contented too. It gave an outlook; whether promoted or not, you still got on, and you got a certain size of pension after 18 years. That pension to-day, I might say, is almost ludicrous, The native food in the Calabar Market has gone up 950 per cent., that is in taking a series of articles, and we are dependent on that market for our fresh food. The tinned food in the factories has gone up 150 to 200 per cent. Now, I can say, having the hospital accounts in Calabar, a fowl, which used to cost la. 9d. or 28., that is big enough for one meal for one man, now costs 5s. But more than that, for two months we have had no fresh meat in Calabar at all. Of course, in that respect, stations differ; it is very difficult to draw any conclusion from one station. In some of the stations in the bush they are very much better off; food is very much cheaper than at the stations on the coast.

2235. What is the increase in the price of eggs?— I am

very sorry I cannot tell you; I have been keeping my own fowls.

2236. Go on in your own way, please?-Not only that, but when you have establishments at home to keep up, they have had a corresponding increase in expensos. My expenses in Calabar last year have come to almost my salary; it costs me £600 a year to live by myself in my house, and I may say I have practically no extravagances.

2237. Are you married?-I am married, yes.

2288. You have a wife who is over here?—Yes. I have other sources of income, and my people contri- bute to my home. When I went to Calabar it used to cost me £900 a year to live there. That shows the increase. I have perhaps one extravagance, that is I keep good servants, and it is necessary, because I am away from the house so long; I am practically out all day. I perhapa pay rather high wages to boys. I have the Rocounts, because I pay everything by cheque; tho Bank is next door, and if the cook wante market money, he takes a cheque and changes it. I work out my expenses. Warri and Calabar are two of the dearest stations in Nigeria. If I had not other sources of income, I could not possibly do it. The economic position of every Civil Servant in Southern Nigeria has gradually become worse with cach amalgamation. Everybody wanted the mess system abolished, but it led to increased expenses. You lost Government Servants, you lost the pay of the Mess Servants, and the kerosine that used to be provided free. Of course, this is old history! In the old days you used to have rice for your servanta, or 3d. a day instead. Everybody wanted the Mess System abolished, but they were not compensated; they did not receive a corresponding benefit.

2239. The mess system was replaced?—By the single house system. must say, of course, on this economic question I do not know that it really comes into it here that the housing question affecte the whole of the Civil Service, The housing is totally inade quate to-day.

2240. The accommodation ?—The accommodation is not adequate, and there is always heart-burning about quarters, especially as wives are coming out in