CO885-(26N14) — Page 184

J

155

1 1 1 1 1 885/26

سيا

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-

PUBLIC RECORD OFFICE, LONDON

68

19 January, 1920.]

COLONIAL MEDICAL SERVICES COMMITTEE.

DR. E. E. MAPLES.

considered when you are offered promotion; remember, you lose the most interesting portion of your career, that is your medical practice, and practice holds out attractions for Medical Officers, people who are in- terested in their clinical work. I do not know that personally I would be very keen on promotion which would deprive me, after all, of the greatest interest in life.

7275. Mr. Fiddian: That is only when you are promoted above Senior Medical Officer?-Yes, but very often Senior Medical Officers act as Provincial Medical Officers for a good space of time; they have during the war.

2276. And they have no private practice during that period?They have not, no. That brings me to another question. I think those men might be given Staff pay. It would lead content. You may have man acting in the Provincial Office for a long time, and in the end he might not be promoted; you might make use of him for four or five yours, and then he might be passed over for promotion. Another thing I think is that men should have to undergo a course of instruction I will not lay down a law-may, every five years. At the present time, when they go on to the £500 to £800 grade, they have to undergo a course of instruction at home, and I think when a man has done 10 years, or before he goes on to the £800 to £750 grade, he might have to undergo a further course of instruction, because, if one does not, I think you lose touch with modern ideas in medicine. For myself, I find it difficult to keep pace with it. Then, another question crops up, and that is the system of distribution of stores. It is coming to an administra- tive question, but I have had a great deal to do with atore-keeping myself; I have been doing store-keeping for many years Central store-keeping. They are opening a new Central Stores at Port Harcourt, but I think, from a geographical point of view, as regarde the Southern Provinces, you want another Central Stores at say, Udì or Onitsha, Udi-Enugu is supplied from Warri, and I believe it takes six or eight weeks to get stuff from Warri up to Enugu.

2277. Chairman: These are medical and hospital stores of all kinds that you are speaking of?-I_am talking of all stores of the Medical Department. That brings me to another question: a medical district is not always of the same significance as a political dis- trict. When yon appoint officers to districts very often what is important from a political point of view is not so important from a medical point of view, be- cause doctors are required where the labour is concen. trated.

2278. Is your point that medical districts should co incide, or should not coincide, with administrative districts? They do not coincide at present as a matter of fact. I only say it should be recognised that they should not coincide.

Do you consider that conditions of service in your colony could usefully be assimilated to those in other neighbouring colonies? If so, in what respects?—No, I do not think so, not more than is at present done, and that practically amounts in the West African Staff, to assimilation on promotion. As a matter of fact, we are called the West African Medical Staff, but I think we are only a medical staff in naine.

2279. What changes do you suggest?--Personally I have a feeling against Senior Medical Officers being promoted au of their colony, but I do not see how you are to get over that at all. It all comes back to the same question of the individual and personal character of medicine, and the matter of establishing yourself in a place. I say that chopping and chang- ing does lead to discontent among the men, there is no doubt about that. If you do not promote the senior medical officers out of the Colonies, they loss their chance of promotion; at the same time, I do not think it is a wise thing to take a man out of his Colony, when the people know him.

2280. You would certainly not favour the intro- duction of a man from a colony, not amongst the West African Colonies?--At present I have not con- templated such an introduction. There is a certain amount of argument against oven the senior medical officers going out.

2281. That was the object of that question?—Yes.

-

[Continued

There is another thing that might be dons and that is to settle more definitely a medical policy as regards the Colonies, or the West African Colonies.

2282. What would you include in "policy "?—I think there should be a Director-General correspond- ing to the Inspector-General of the West African Frontier Force, and I think he would co-ordinate a definite policy, I mean as regards the future of the medical work in West Africa. I do not know very much about it, but it appears to me there is no con- structive policy as regards the staff.

2283. Would you have his sphere of influence in- clude all the Colonies of the West Coast? Yes, he would inspect like an Inspector-General of the Frontier Foros doen.

2284. How long do you think it would take him to inspect Southern Nigeria? You mean every Station? 2285. Where inspection was necessary.--He need not inspect every station each tour; if he spent eight months out and four months at home, or something like that it would suffice. I do not say he would inspect every Station every year.

2286. Or every Colony every year?-Or every Colony every year, but he would cover the ground in the course of a year or so, would he not? As far as I can see, the only way in which we are a Staff in upon promotion; I mean as regards different Colonies; the Colonies do not appear to work together in any

way.

2287. Your point is, you are called Staff and yet are not a Staff? Yes; at the same time, I do not think it is advisable that the practising Medical Officer, that is the man that is doing the actual clinical work, should be removed from his Colony. I think that is one factor that leads to discontent, one of the chief factors. It is a very curious thing, that men who have gone to other Colonies on promotion, usually come back to their original Colonies.

2288. Have you exhausted all the points; I do not want to stop you; now is the time? Then you say, do you consider the medical service of your Colony could be united or amalgamated with that of any other Oolony? 1 do not think it can be amalgamated, certainly not, unless the Administrations are amal gamated as well. The last question is, what steps, if any do you think should be taken towards the forms- tion of a general Colonial Medical Service? I say None because the factors of employment vary in different Colonies. Besides the duty to the Govern- There ment, a man has other responsibilities in life. is enough dissatisfaction in removal from Colony to Colony upon promotion; I ought not to say dissatis- faction, but men are not exactly pleased with it; if you are purposing to remove them from one part of the world to another, it would upset their social life; more than that it would entail great expense; the conditions are different, the climate, the pay, the duties and prospects are different.

2289. Wo have all those points in mind? Then I have nothing more to say. If you like to ask me anything, I will endeavour to answer.

2290. I am sure the Committee would like me to express our thanks to you for the care with which you have prepared your evidence, and the important information which you have brought before us, which 18 very valuable. Just to run through very briefly, and I will not touch all the points, I see your point about the specialists in charge of certain Depart- inente. You think their presence would raise the standard of clinical work-Oh1 certainly, yes.

2291. Would you be in favour of Staff appoint- ments, say, that of Staff Surgeons, man would continue as a surgeon for nearly all his service, and would go up pari passu with the man who undertook administrativo work; is that your idea?--Yes; it comes to this, that the Administrative Staff is at present the only putlet for a man, and every man has his peculiar abilities, and his particular choice in medicine. Personally, I have been doing hospital work practically most of my career.

2292. You would be in favour of such appointments as that, Staff Surgeon and Staff Physician and Specialist on a Staff It is not necessary to have both a Staff Physician and a Staff Surgeon for a man would be hospital. At the present time, one sufficient to do all the actual ward and similar work necessary.

19 January, 1920.]

MINUTES OF EVIDENCE.

DR. E. E. MAPLES.

2293. Do you think that there is an opening for a Research Service in the West African Colonies?—Do you mean independent research work, a service simply devoted to research and nothing else?

2294. To research, and partly to clinical pathology? -Yes, I think there is an opening, certainly.

2295. Say for a bacteriologist and a clinical patholo gist who could be promoted, after doing research work for some years, if they showed capacity? Yes, but 1 think those men should thoroughly understand that clinical pathology comes first. At the present time wa have a Research Institute, whose claim—I do not say they enforce it—is research work only, and I think the great thing to do now is to have clinical pathologista; say you give one to several districts in the same manner as you have Central Stores for certain parts of the country; you could have a clinical pathologist for each similar division. You cannot do diagnosis without clinical pathology. And that brings me to another point: There is no place in West Africa where & Wassermann test can be done, and I should any that about 25 per cent. of the people in Calabar alone are

acquired suffering from inherited or syphilis.

2296. You would be in favour of having a well- equipped Pathological Laboratory in connection with each Hospital, I take it Yes, practically every large hospital, and they could serve the surrounding districts. We have a good laboratory in Calabar, but we have nobody to do the work. I cannot do more than routine work myself, and that takes up all the time.

or

2297. Mr. Fiddian: Your Director-General, Inspector-General, would have to be chosen from the West African Medical Staff, I take it?--The men, of course, would prefer that.

2298. You do not think it indispensable?-Do you mean personally, or speaking for the Staff as a whole?

3299. No, personally.-Well, I do not know about that; I have not made up my mind; there are advan- tages and disadvantages.

2300. There is another point; you have laid great emphasis on the importance of continuity in · station?—Yes.

2301. But some stations have considerable private practice; others have comparatively little?—Yes, that is quite right.

2302. Are there no men who would object to being left tour after tour, or even two tours, in the same station, not having private practice? I have not suggested that they should be left tour after tour in a station, but I say they should be there a certain time, and they should be given a chance to show their ability, or what they can do in a place. If you are to chop and change them about, you cannot form any opinion of their capacity at all." Replying to that question about objecting because there is no private practice, I think, although the private practice does not amount to very much, even in the bush stations, there is a little to be done, if a man takes enough interest in his work. For example, I mean he can always work among the natives; although he will never be recompensed for his loss of nerve energy. Most often I get nothing for my work. I do not suppose more than a dozen times in fourteen years I have had more than a fee of five guineas.

For a splenectomy, if I had a fee at all, I should not get more than that. The bulk of the population in Nigeria are poor people. It is only in Lagos I think, where the native is rich, and that is because he is able to sell or lesse his land to a European. I think that is what is at the bottom of the prosperity in Lagos to a large extent; it is an unearned increment I think. There is another thing, as the men are promoted to Senior Medical Officer it gives the men in the Bush stations an opportunity to come into a better station; and when the senior man goes home on leave it gives a junior man probably six months at least in a fairly good station.

[Continued.

69

2303. Sir Humphry Rolleston: With regard to the question of post-graduate courses, you said you would have them every five years, so that a man might have a refresher course. Would you make them compul sory, or largely optional? I think they should be made compulsory. Thoy should be approved courses of study. A man should be able to select one, but he should be compelled to undertake some course. 2304. Would you test him afterwards, and make any promotion, or increase of salary, dependent on his showing that he has taken due advantage of the course? Yes, in the same way that you do at present. You do not go on the £500 to £600 scale unless you undertake this approved course of study. A certifi- cate should be produced to show that you have under- taken it and that you have performed it satisfactorily.

2306. If a man fails to show that he is a keen officer, you would be inclined to retire him after eighteen years' service?—The difficulty is to decide who is the able officer and who is the inefficient officer, but I think an inefficient officer should be retired after eighteen years' service,

2306. Supposing a man is notoriously incompetent, or drunken, w there any way of getting rid of him, except through the Governor of the Colony-It comes back to what was said in connection with the nationalisation of the mines; it is almost impossible to get rid of an honest but inefficient officer.

2307. I have heard of it being done?-I think, in connection with the nationalisation of the mines, a former Post Master General said that. The difficulty is to decide who is efficient and who is inefficient. But the feeling about the matter is this, that the men who would retire to-day cannot afford to do so on their present pensions That is the feeling of the men in the senior posts. I suppose it is possible that there are people on the Staff whom it would be better to have retired. I am not prepared to go further than that. I think in the R.A.M.C., unless you pass the examination and get your Majority within a certain number of years, you have to retire That is the idea I have at the back of my mind.

2308. You would have an examination test, rather than a certificate after a refresher course?-I would not be prepared to say an examination.' It would depend on what sort of an examination it would be. Some people have a certain facility in passing examin- ations. It is very difficult to decide such a matter, but the idea is that unless the man comes up to certain standard, I think he should retire after 18 years' service. How you are to decide that matter, I could not tell you, or who should be retired and who should not.

All

2909. Dr. Hood: Do you think a subordinate Medical Staff would be useful in West Africa?—Yes, I do think so; I think there are many posts they could fill. But that would involve, I take it, creating a local university and giving local diplomas. that, to my mind, is connected with future policy, and what the function in the future of the Medical Staff is to be. If you want a Medical Staff in large towns, to do the health work and the medical work there I think it will be a necessity; it depends on what your ultimate aim is. At present you are only providing for districts and groups of districts. you are to provide for towns and the native com- munity, in the near future it will be necesdary to have a Native Medical Service, with either whole or part time appointments.

It

2310. You do not think the nativeB would resent going to their own colour; would they prefer to go to an European Medical Officer, or to a native? ---In the present state of civilisation as regards medi. cal matters-I am not talking about surgical matters -they usually prefer to go to their native, what they rall their Bush doctor-the native Medicine Man. They do not come to you from a medical point of view, until they have spent all their money on the native Medicine Man, and then they come to you as a last resort. I think the educated nativo however, in most instances, does prefer to come to the European Medical Officer, the same as to-day he prefers to go