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PUBLIC RECORD OFFICE, LONDON

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19 January, 1920.]

COLONIAL MEDICAL SERVICES COMMITTEE.

DR. E. E. Maples.

increasing numbers. Other things we have lost. We ed to have gardeners in Warri. When I was in Warri the Government used to provide a gardener for each garden. That was provided out of some of the funds; I do not know which, but we had gar- deners. All these things have added expense to a

We now have to pay conservancy fees, and motor and bicycle licenseM.

2241. That would mean cleaning up, sanitary f Yes, and emptying your latrine pan and dustbin and similar things. They are only trifles, but they all add to a man's expense in the country. Another thing we used to get prison labour in our gardens. When you wanted a special job done there was no dificulty about getting prison labour. All these things lead to dissatisfaction, because a man, if he cannot afford to keep his garden up and take some 10terest in his home, is discontented. It not only spplies to the Medical Service; I think it applies to every Civil Servant. Then there is another thing as regards pay. The pay offered to-day for a Medical O our is £400 to £500, with duty pay. I think I am right that in the H.A.M.C. a Lieutenant gets £600 a year, with allowances.

2242. Mr. Fiddian: What about war bonus?--You want me to include everything; he starts at £400; add £100 war bonus, that is £500, and £80 Duty pay that is £580.

2248. Is it not £120 war bonus? Not for every- body. I draw £80 war bonus. I have done 14 years service, I am on £650 a year, and I draw £80 war bonus.

2244. Chairman: That is included in your £600- No, I have that in addition. £80 is the war bonus. I am pointing out that after fourteen years' service I draw £850 a year-£80 a year war bonus, and £100 year duty pay whilst on the Const; that in £890 a year whilst on the Coast. I see in the I was a year. R.A.M.C. they can start at £600 noticing to-day in the British Medical Journal" that in the 1.M.S. they start at £740 a year; at least it is equivalent to £740 a year; that is for the newcomers to the Indian Medical Service. This copy of the "British Medical Journal" is rather illuminating. I see the Government of the Straite Settlementa want 34 medical officers. Converting the dollar into pounds at 2. 4d.. they offer £616 a year to start with, rising by £35 year to £960. On the same page there 18 a rubber company offering £846 a year, rising by £140 a year increment to £1,260, providing a motor- car and motor-car expensed.

2245. That is also in the Straits Settlements? -That is in the Straite as well.

Would you care

to see this? (Paper handed in.)

2246. Are there any other points you have to bring forward P-That practically deals with all I have to cay, I think, about the material side. I have said something about the other side before. I think that medicine and surgery entail new and different forms of treatment.

2247. What is this side you are now speaking of? -1 have dealt with the discontent on the economic side, and now I am dealing with the professional side. I say there is discontent. I may say that the medical officers in Southern Nigeria have already petitioned the Governor about this discontent on

It the professional side. was signed by every medical officer on the staff in the country at the time. It is under consideration.

2248. What is the date of that?-That in 1919.

2249. You are referring to some memorandum which has not yet been presented P-It is an official paper; it is under consideration by the Governor at present. But the caacs of dissatisfaction I think are largely dependent upon the war. I think the thing is to realise them as they are to-day. One thing is that some medical officers have been greatly over- worked. If they want to do their work properly in an eficient way, to carry out their investigations properly, in some of these stations, they will have to have more medical officers. If the staff is to

[Continued.

conduct proper clinical investigations, spend time over their work, and not be a distributor of stock mixture, I think at some of the stations they will have to have more medical officers. If you would like me to give examples, I can. I think Port Harcourt has had only one medical officer, but ought to have two or three. I think Enugu-Udi needs two medical officers. There are other stations, but I think those are two of the most important, Port Harcourt and Udi. In Port Harcourt there is a prison with 10,000 prisoners, and in Udi district and Enugu there are prisons with at least 1,000 prisoners, besides much other work to do.

2250. Is there a medical officer specially detailed for the charge of the prison ?-No. At Port Har- court during the war one man has been doing every- thing. I do not want to take up a lot of your time, but Port Harcourt is the terminus of the railway; it has many Europeans there; it is the colliery port, with all the natives in connection with the Govern ment labourers who work on the loading of the ships. There is a prison with 1,000 people. There is & native hospital; it is not up to much at present, still there is going to be a large hospital built there; and there is now an established European hospital. Then he has the whole of the health work in connec tion with what they call the township to do, and

suppose he is liable to be called up the line. 2351. What is now about the population?-Well, it is an artificial town. I should think the popula- tion is over 5,000-the natives.

2252. It is a place likely to be of great import- ance?--Yes, of great importance. As I say, I do not think these things could possibly have been avoided. If you have not got the staff you cannot send them there. I could give you some facts about Udi if I could find the papers. 1 am afraid I have not the papers with me. In Udi there in ■ colliery— there are 3,000 people employed in it; in the prisone In the surrounding districts there are 1,000 prisoners, and, I think, four or five prisons. Then there are a lot of second-class officials, and they take a great deal of looking after; they are always inclined to call the doctor in for trivial things.

2258. Natives-No, I am talking of Europeans. 2254. The Public Works Department P-Yes, and railway. There are 40 Europeana at Enugu, all Government except one, and two wives. The Euro. peane do not all live in Enugu proper, but some on the hilltop, 1,200 ft. up, and others at Iva, four and a half miles away. Many of them are second- class; they do manual work, and are often ill. In addition, there are three Europeans and 170 troops at Udi, 17 miles away by road, and very hilly. There are 45 miles of railway to Afikpo Road, where Then comes the native there are more Europeans.

staff and employees in the colliery. There are 3,000 employees in the colliery. Many accidents occur on the railway. There are also colliery and railway clerks. There is a prison staff of 100. There is a police and court messenger staff. The accidents are serious and frequent. The medical officer who has written to me saya "he had two compound frac tures on two men last week from a fall of stone in the colliery." Then he goes on to prisons. He has four prisons in this district-one at Enugu (that is where he is stationed), one at Iva four and a half miles away, one at Emene ten miles away, and one at Udi, which is 17 miles away. There are 1,000 prisoners altogether; some of them are long-sentence men. He says the prisons are a veritable nightmare. Sanitation; there in B second-class township de- veloping, also a native town. Then be says there is survey party, cqnsisting of four Europeans, 30 troops, and a number of native staff, who have just gone to Emene, 10 miles away, with no medical officer. Railway construction is about to start, and they are going to send 450 additional prisoners. Lengwe, 43 miles away in the hills, is to be handed over to Onitsha Province. He visited the place last week to see it, and has reported on it. There is European military-political officer, 60 troops and other stuff there already.

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now one

19 January, 1920.]

MINUTES OF EVIDENCE.

DR. E. E. Maples.

2255. All this that you have been stating lately is the work of one man? That is the work of one man and that man has written to me; I cannot vouch that it is true, it is only a letter. He has also said what is wanted.

2256. I think we should like to hear that?-He says that we want a European Sanitary Inspector at once, or a Medical Officer of Health alone. He says the Medical Officer should have a motor car. Udi will always have to be visited, and there is plenty of running about to be done in Enugu. Then he asks for adequate buildings, but I understand that is a queation of time

2257. Just ene moment would you put your finger on Enugu here?-(Witness pointed out Enugu and Udi on the map.)

2258. All this relates to a small area about here? -Yee.

2259. It does not include Onitsha?- No, there is a Medical Officer at Onitsha. He goes on to the native staff. He says: "I want a really first-class dispenser, two hospital boys, a good nurse and a nurse-in- training." Then in the prison he says he wants a good nurse, and a nurse-in-training. Sanitary Inspectors: he says he wants one second-class Sanitary Inspector and two Vaccinators and one third-class Sanitary Inspector, and he hopes there will be a Medical Officer soon in Udi who will also do Longwe. I have spoken about Port Harcourt. Of course there is the health work in connection with the shipping-bearding and that sort of thing. The man there has had to do that As well. Several men have got complaints, but in my opinion it is simply due to shortage of staff. The man at Ikot Ekpene, for example, says his life is spent travelling up and down roads on a motor lorry, up to Aba, Itu Arochuku, Uyo; he says he has five places to travel up and down to. There is another place down here close to the Calabar District, Abak, where there is an A.D.O. Then at Ikot Ekpene itself he says he has got a hospital with 30 beds, and fre- quently extra cases on the floor. It is also a

place where the natives are always cutting each other up so that many post mortoms are performed. I forget how many post mortems he does in a month, but it mounts into figures.

2260. The natives are constantly fighting? Con- stantly fighting, and they are constantly heing killed. The bodies are brought for post mortems and he has to set to and do a post mortem, and then perhaps ge off to Abs and bark again; he has got the hospital to do, and there is a prison with 400 prisoners in Ikot Ekpene as well; of course he gets tired of it.

2261. These are all officers who have volunteered their information?-Well, this is simply information that they have written to me; I am friendly with a lot of men on the staff.

2262. Have you any other points that you would like to mention, because no doubt other points will crop up on which other members of the Committee will ask you questions; but do not let me stop yun at all? There is another question that some people feel and that is that the native staff is not adequate. 1 think that is a question largely of the manner in which you wish your work to be carried out, whether the native staff is sufficient or not.

2263. For instanco, the native hospital staff, aro you 'speaking of them, or the sanitary stuff?--For example, some people want clerical staff, and some men do not want clerical staff. The man at Ikot Ekpens thinks he should have a clerk. Personally I think, in each bush station, if there is a hospital at All, there should be a nurse; apart from a dispenser, there should be nurses: there are not always nurses. in some of the outstation hospitals.

2964. Malo native nurses?-I am thinking of male native nurses now. One fault in the staff too, in my view, is that the Administrative Medical Officer the Provincial Medical Officer does not travel enough. I think men would like it better if they were more frequently inspected by the man in charge of the Province.

2265. It encourages them ?--You, it encourages them; they can see what the men are trying to do.

2266. How often is inspection carried out? Well, sometimes it is very seldom. I am not talking about the heads of the department inspection, I am

26743

[Continued.

67

talking of the man who does the local administrative medical work. We are divided up into Provinces and there is a Provincial Administrative Medical Officer in charge of the Provinces. They do very little travelling at all, that is my experience.

2267. It was not the Medical Officer you were talk- ing of just now?-No; I was talking of the Provincial Medical Officer. I think one of his functions should be largely travelling, if he wishes to know his men. and to see what work they are doing. I have already said that think that a continuity of station for A certain period is a desirable thing in the staff, if they are going to be contented. In fact I know one. man who said last year he had seven changes of station in his tour.

2268. If you had to put that into tours how many consecutive tours would you recommend for one station-Personally, I should think a man ought to do two tours in a station, at the very least. I do not think there is very much else I want to say. There are

a lot of other minor points that I do not think it necessary to bring up here. You now ask, do you consider the type of medical officer who is being re-

cruited at present generally satisfactory? I say it is impossible to answer that, because most of the junior men have been away, during the war, over in France, or in East Africa. Their qualifications appear to be better, but I do not think qualification is the sole factor in a man's capacity; I think his character is very much more important. Well, I think I have spoken about the economic side. I MAY say I understand-I have nothing to do with it myself that the other Civil Servants are in accord with the Medical Officers as regards their ideas in the way of promotion, and other matters. But coming to the staff itself. I think improvements can be made in the staff.

First of all, as regards this function towards the general public-in the Northern Provinces in the past, Medical Officers had very little to do medically with the Hansa Community at all. As I said, Hausas like their own native doctors, but i think perhaps it is also partly because the Medical Officers have not had proper facilities for carrying out their work. There is one thing that attracts a native. If you want to work among the natives the Arst thing is surgery. I am quite sure until you can show them you can do some surgery they are not inclined to trust you in medical matters.

2200. We shall probably want to ask you a good many questions if you think you have exhausted all the important pointa?—I do not want to detain you. but I should like to make one or two anggestions.

2270. Oh yes?-There is one thing, I think, might help. I understand it is the same in the R.A.M.C., when you come to the question of appointing Prínci pal Medical Officers, they might be selected from all officers of a certain standing. It seems a revolutionary iden, but I believe it is the same in the R.A.M.C.; T think they take them from the rank of Lieut.-Colone! upwards when selecting for the highest appointments. 2271. Sir William Leishman: Quite exceptionally; that has been done in the case of our present Director. General? What I was getting at is this: it gives an opportunity for the able man to be selected if a larger range of meu is considered for promotion than in the past. I know it is promoting men over the heads of other people. but if you want efficiency there is a certain argument in favour of it.

2272. Chairman: I think one might say now that when promotion is in question there is a very large number of names brought forward?- I am not conver sant with what names are brought forward, but the promotion has been largely according to seniority, according to the list of the staff.

2273. Sir William. Irishman: You would advocate them going down several steps, and grades, if necen- sary Yes. Say every Provincial Medical Officer and upwards, something like that, and not take only from the Deputy, and no lower rank, Another thing t suggest is that an officer who is not offered sub- stantial promotion, because of inefficiency, should be retired on pension after eighteen years' "service.

2274. Chairman: If he had not attained a certain rank? If he is not offered promotion. He might elect not to be promated. There are factors to be

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