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19 January, 1920.]

COLONIAL MEDICAL SERVICES COMMITTEE.

Dr. E. E. MAPLES.

to the European lawyer, like Mr. Irving practising in Lagos; whereas formerly he went to the native barrister, he now goes to the European barrister because he is more trustworthy.

2311. With regard to continuity of service, do you think the tour of service might be increased ?--Well, that is very big question. I think it might be increased in certain places and under certain oon. ditions. I think in many places it cannot be increased at present. If you satisfy the Civil Service as regards their housing, their furniture, and their gardens, and make some interest locally, and especially if you could provide some sort of sanatorium at a place like Bamenda up in the Cameroons, where local leave could be taken, you would go far towards establishing There is another factor about an extended tour. making a long tour, and that is there is nothing in West Africa of any mental interest at all. It is simply country, after all, of savages; there is no civilisation, no art, nothing at all beyond your work. If from the point of view of tropical disease the country is healthiest, from the point of view of nervee it is ruinous. You may eliminate tropical diseases, but you will still have the effects of the sun on the nervous system, and a large number of men to-day are invalided from neurasthenia.

2812, Mr. Fiddian: A high proportion, do you think? Yes; there are a large number of men in- valided for neurasthenia to-day.

2313. Dr. Hood: Officials, or non-officiala? I am talking about both officials and non-officials. The first thing to settle is the housing before you can extend the tour, to settle the conditions which will enable a man to live and continue his tour. Another factor that comes in is the amount of work a man has to do in a day. I think some people are suffering in that respect from overwork, especially some medical officers and political officers. The medical officer is called up at night-time and may have to go off on a journey st a moment's notice. Another man who is often worked to death is the political officer in the Southern Provinces.

2314. With regard to retirement, do you think the retiring age ought to be postponed?—No, I think it should be rigidly enforced.

2315. After 18 years? Not necessarily; I thought you meant the age limit of 55 years.

2316. The age?—The age of the person; you mean length of service?

2317, YPG-I do not think he should be retired Only those people who have not been offered substan- tial promotion within a certain period of time should be retired, provided the failure to receive promotion was on grounds of inefficiency.

2918. You think the 18 years' service might be increased P-Before a man is entitled to retire?

2819. You?--I am afraid I have not thought about that. I think that is largely dependent too on im- proving the local conditions.

2820. Sir William Leishman: It has been suggested that in getting candidates for the West African Medical Service and other Services, in place of the present system of selection, a competitive examina tion might be a good thing. I should like to know your views about that? I am in favour of examina- tion myself, but I do not think you will get any candidates unless you can make the Service popular, and the popularity of the Service depends upon contented men. I think, if you can make the Bervice attractive both financially, and from a professional * point of view, and offer some outlets besides Adminis. trative posts, posts, say, like hospital appointments and that sort of thing, and satisfy, I do not say the requirements, but the aspirations of the Staff, and then get the British Medical Association to take it up, I think they would then probably advertise the staff a satisfactory. I see here, in this article in the British Medical Journal they say that the pay, and the conditions in the Indian Medical Service must now be looked upon as satisfactory.

2921, You read us

comparative tables of emoluments of posts offered in the Straits Settlements for a State Bervice, and also by a Rubber Plantation? --Yes.

Bome

[Continued.

2322. I suppose in the case of the State Service there is a pension attaching to the Service? Yes.

2323. And in the case of the Rubber Service there is a pension attaching there too? No.

2894. That makes a difference then?-Certainly it does make a difference, but the pay is very much better, and a man save money in a post like that where he could not in a Government appointment. I would like to mention if you compare what my salary amounts to with what this post offers, you must remember that my pay is for West Africa, which, after all, has more drawbacks in going to than any other Colony. There is no social life and there is no interest in the country apart from your work.

2325. I was very much interested in what you asid about improving the laboratory work, employing Clinical Pathologists and so on, and specialising in general in the West African Service. I would You rather like you to expand on that a little. mentioned X-rays as a subject on which men might apecialise? Although I have an X-ray apparatus in Calabar there is not enough work for one there. There is in Lagos. In Calabar you can com- bine that work with other work as is done at present, but I think a post could be created for a Radiologist in Lagos.

Fan

2926. For Clinical Pathology: was it your angges- tion that a man should do whole-time work in clinical pathology in connection with the hospital?--In Lagos a man could spend most of his time in Clinical Patho logy. In Calabar there are usually two medical officers doing what I call the technical work of the Station, although lately there has been only one, myself, we have been so short of men. That second man, does the health work and I think he might possibly do the Clinical Pathology and the health work as well.

2927, Mr. Fiddian: Surely the health work in Cala- bar is rather exacting, is it not?-Well, it is rather exacting. There are 16,000 people, and the second medical officer we have in Calabar not only does the health work, but the Barracks, the Lunatic Asylum, the European official outpatients and the Contagious Diseases Hospital. I do both hospitals, and the Pro- vincial Store. There are about 10,000 native out- patients in Calabar and 45,000 attendances in the course of a year. There are 56 beds in the Native Hospital, and eight beds in the European Hospital, and I may say a bundle of papers go up to my house every night from the Store; I have not got time to do them in the day-time.

2928. I gather there are not enough whole-time appointments possible, or justifiable in Clinical Pathology? In the Northern Provinces as well? I cannot talk of the Northern Provinces, but I should think round the Udi-Enugu-Onitsha Districts it would be possible to employ a whole-time Clinical Patholigist-I mean for the Division, not for one Station alone. Also in Lagos and Calabar.

2329. Looking at it from the point of view of principle, if you were to employ men in the way you suggest, to go on year after year doing that class of work, what is their future? I think the posts should be sufficiently remunerative and go on by incremental scale, to make it worth their while remaining in the post.

2330. Up to what sort of grade? Well, I have not thought about that; to correspond to the Deputy Principal Medical Officer, or Provincial Medical Officer.

2331. And would you have the same principle apply- ing, if you appointed surgical specialists?—Yes; to hospital specialists. As a matter of fact, I have not thought of the actual pay of the officer, but if he is to retain that appointment as a career, I think ho should be given adequate pay.

2332. If these specialist appointments are graded, you think that men should continue in that line of work throughout their service, and be adequately rewarded, by increase of pay from time to time, just as in the Administration? That is a very difficult question to answer.

2399. Otherwise you would create considerable dia- content, would you not, if a man serves for ten or

19 January, 1920.]

MINUTES OF EVIDENCE.

DR. E. E. MAPLES.

twelve years in this way, and sees his contemporaries promoted to better positions and higher pay, and he in kept at this work P-When you come to the sanitary work, he has opportunities of promotion. That would be one objection to the specialist posts, if the men were

confined to them.

2334. That is already legislated for, the sanitation, but not in these new openings of pathology, possibly surgery and hospital work. In the majority of cases, if men on hospital work got adequate pay, I think very few of them would prefer to take up the ad ministrative branch--that is, men interested in their clinical work.

2335. They would be content to stay?-If the pay was sufficiently good. I do not know; I am not cer tain about that; one is rather inclined to speak according to how you feel yourself.

2336. You mentioned the fact that there is no place in West Africa where the Waterman reaction could be done; not even in the Central Institute?—In the Central Institute the plea is that they are for research and not for routine clinical pathology. As a matter of fact, the Research Institute bave done many Was serman reactions for me, but I am not satisfied that the method carried out there is a reliable one, because they do not lay themselves out to do a Wamerman re-

action.

2387. Apart from that, in other hospitals, have they opportunities for doing dark ground work?...-In Cală- bar you have a good laboratory. Calabar is a very up-to-date place because it was the centre of the Government before the amalgamation. They always had a laboratory there, and in 1904 they had an X-Ray apparatus, and that has been continued. There are facilities there for doing dark examinations, but we have not the time to do them. I do not do auch routine work myself. I have not the time to do it. Native work is not reliable, but it is some help towards getting to the bottom of your diagnosia. One thing for which a Wasserman test is required is this. Many children come into the hospital with enlarged livers and spleens. For several years I have been interested in these cases, but I do not know what they are suf fering from. I strongly suspect it is syphilis. Not only do the children come in with liver and spleen, but adults come in with it also, and I think most probably they are specific cases. Another thing comes into this hospital question; take the question of gonor- rhoes, which must be treated by modern methods; you must have urethroscopes. Gonorrhoea is one of the

[Continued.

most prevalent diseases in Calabar. It is partly due to the prevalence of polygamy. A native gets gonor. rhwa and does not trouble about it. He takes a new wife and infects her; you get a man sometimes wit four young wives, every one of them infected with gonorrhina. It makes you almost think the normal state of the Epik woman is to have a chronic vaginal discharge. Your work is scamped unless you have got time to undertake investigatione properly.

2398. When you advocate that a Medical Officer should do certainly one, possibly two tours, in the same station, what is your chief point of view there,

because surely the diseases which he has to treat do not differ so widely as that; if he went to another. station he would hnd the same class of disease?--

Every class of native patient is averse to coming to you until they know you, and you gain their con- fidence; it does not matter whether he is a pauper, a prisoner, or from any other class of the community.

2389. Chairman: Have you seen anything of yellow fever in your experience? Yes, I have seen two cases of yellow fever in the course of my career; at least, there were Seidelin bodies in the blood, and presumably it was yellow fever; it was diagnosed as yellow fever.

2340. Have you seen many cases of hyperpyrexia; hyperpyrexia of doubtful origin?-Yes, I have, but the cases of hyperpyrexia are gradually decreasing. If you talk to an old Sister like Miss Graham, in Calabar, she would tell you they formerly had a series of cold baths round the hospital in which they put the hyperpyrexia casce, and they used to die like flies. That does not happen nowadaya. You very seldom see hyperpyrexia. I saw a case about eighteen months ago, on one of the ships, in a man that had come

round from Bakana.

2341. A great many of those cases have occurred on board ships? Yes, but sometimes they occur among natives; you find the malarial parasite in the blood in many of these casos.

2342. How do you think they began in those case? -Some of them are undoubtedly malarial fever cases. The child that comes in with hyperpyrexia, when you take up a syringe and inject quinine in the buttocks and place phenacetin ou the tongue, these are cases of malarial hyperpyrexia. So also in many cases the adult, but I strongly suspect some of the cases were yellow fever in the old days. Practically, you do not often ace hyperpyrexin, only very occasionally. Chairman: We are very much obliged to you for the evidence you have given us. Thank you.

(The Witness withdrew.)

(Adjourned till Monday next, the 26th instant, at 3.30 p.m.)