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26 January, 1920.]

COLONIAL MEDICAL SERVICES COMMITTEE.

Lieut.-Colonel W. T. PROUT, C.M.A.

great blocks of Colonies, like the whole of tropical Africa on the one side into a group, and the West Indian Colonies into another, and the East Indian Colonies into a third, your three conditions are ful- filled in the separate groups?--You might get groups of Colonies where you have the conditions approxi- mately, certainly.

2450. Those three groups tropical Africa, the West Indian Colonies, and the East Indian Colonies ?- Yes, you have them in West and East Africa. The West Indian Colonies form a group which conceivably might have & more or less homogeneous Medical Bervice.

2451. Anyhow, which would fulfil your three con- ditions?-No.

2452. Do they not?-They do not, because Jamaica for example, does not have a common portal and a common standard of entrance, while British Guiana does. Then again, you will find an Eastern group where conceivably a certain amount of co-ordination could take place.

2453. Sir Humphry Rolleston: I should like to ask you about the age of entry; what do you consider the best age for a man to enter for a tropical Service? - think, on the whole, about 26.

2464. And you would wish that he should have a course of tropical medicine?-Oh! certainly.

2455. What about his having periodic study leave; would you make that compulsory?—I think it most important.

3456. Do you think you woud be justified eventually in determining that man's promotion by showing evidence, such as obtaining a Diploma in Tropical Medicine or Public Health ?-For promotion?

2457. I will not say determine it entirely on those grounds, but play a considerable part?—He gets that course in Tropical Medicine before appointment, does be not?

2458. Very few get the Diploma before their first 18 months, do they, of preliminary education?—They are all compelled, I think, now to go through the course at the Tropical School.

2459. Do they get a diploma for that? No, they get a certificate; they get a diploma at Liverpool and a diploma at Cambridge.

2460. Mr. Fiddion: There is a London diploma ?- Yes, there is a London diploma. I am rather re- luctant to suggest examinations for promotion at a middle stage of a man's career.

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2461. Sir Humphry Rolleston: I suppose there is a dangor that a man waiting for promotion might be overlooked? I think, on the whole, that is provided for by the reports about a man that come from the Principal Medical Officers and the Governors, series of Confidential Reports are always being made, and I think one can size up the work that a man does, pretty well, by those personal reports. I am very much against promotion by mere seniority, and always have been.

2462. You would promote by selection ?--I would promote by selection. giving due weight to seniority. I think that, on the whole, is the view the Advisory Committee have taken in recommending promotions, 2463. To return to the subject of the hypothetical Director-General, do you think, if the Service were as homogeneous as the Navy is, for example, there would be no objection to it?—I do not think there would be any very great difficulty about it.

2464. Mr. Fiddian: You said, in reply to several members of the Committee, that it might be advisable to amalgamate groups of Colonies; do you see any difficulty in amalgamating, say, the Medical Service of Hong Kong, the Straits and Ceylon?-I do, great difficulty. I say it might be possible. It might be possible to do it in the West Indion, but I see great difficulties, owing to the Loval Governmente raising great objection.

Continued.

2465. Promotion in the Colonial Medical Bervice generally means being given an Administrative post, does it not?--Yes.

2466. Not to a scientific or professional post ?—No, that is right.

2467. Do you think that the fact of the man's having taken, way, the D.P.H. since he joined the Service, or having taken a post graduate course, is a necessary indication of his fitness for promotion to an Administrative appointment?—No.

2468. It may even have nothing to do with his fit- noes?-Oh! quite.

2469. You have mentioned the case of Mauri- tius: I suppose you agree it would be impracticable to insist that every Medical Officer appointed in Mauritius should hold the qualification for registra- tion in this country ?-I think it would. I think, in practice, many of them are qualified.

2470. It would be impossible to change that?—I am afraid there would be a great outcry on the part of the Creoles of Mauritius.

2471. A similar difficulty might arise in Jamaica, for instanceP-Yea; I fancy that the Jamaica diffi- culty is not quite the sumo as that in Mauritius; it is more economio, I think, than anything else.

2472. But there is a considerable difference They would object very strongly to after their local methods of appointment.

2473. It is much more expensive for a black man, say, to come home from Jamaica to this country and qualify than it is to go, say, to a coloured college in the United States and qualify there?-So far as I know, it is.

2474. As regards the amalgamation of the Services of East and West Airica, 1 think one of the reasons the amalgamation of the West African Staff has been such a success is that there is a great deal of inter- communication between the Colonies, is there not?— There is a good deal.

2475. The Colonies are close to one another, men see a good deal of each other, there is frequent leave? - do not think the men see much of one another.

2476. You do not think that has much to do with it? I do not think so.

2477. I was about to suggest that there was no intercommunication whatever between Mast and West Africa P-Yes, that is so.

2478. Do you not think that might make some diffi- culty in creating an esprit de corps in this Tropical African Service ?They would meet to some extent nt home.

2479. To a very limited extent ?-To a very limited extent.

2480. The Sports' Club is the only medium?—It is not to be recommended.

2481, Thuc is about the only place where they meet? Oh no, the West African Staff Dinner.

2482. You do not see any reason why this Director- General, for the combined Tropical African Service, should be the cause of friction with the Governors?- I do not think so; I do not see why he should.

2487 Have you ever had it suggested that the existence of the Advisory Medical Sanitary Com- mittee for Tropical Africa had caused some friction?

I have heard that the Governors do not like it. 2484. Chairman: Do not like what? The Advisory Committee.

Chairman: I never heard that.

Mr. Fiddian: I have; I seem to remember some enquiry directly.

Chairman; I left soon after it was formed,

2485. Mr. Fiddian: I think it was formed in 1914? -No, before that. They have never raised any objec tion when they have come up to see us,

26 January, 1920.)

MINUTES OF EVIDENCE.

Lieut.-Colonel W. T. PROUT, C.M.G.

2486. What sort of man would you have for a Director-General? That is a difficulty,

2487. Could you do without a man who had know- ledge about East and West Africa?-Oh yes, I think

60.

2488. A man who had knowledge of West, but not of East P-1 think so; I think, with a knowledge of the conditions of either of these, he would very soon assimilate the other

2489. How frequently would he visit them?-He would visit them periodically, but the frequency would have to be determined later.

2490. You would not advocate a man being chosen from outside the service for that appointment?—I do not think I should have any objection to it.

2491. You would want a man who had some know- ledge of tropical medicine, or experience of the tropics, and such a man from the Colonial Medical Service, the Indian Medical Service, the R.A.M.C., or the Egyptian P--I do not think I, personally, would object to a man of outstanding personality being appointed from outside.

2492. But he would have to be of outstanding personality?—I certainly think he wants to be a man who was known a little.

2493. Dr. Hood: With regard to the Staff in those Colonies, would you approve of Staff-Officers being appointed, rising with regard to salary like officers who were promoted in the ordinary way?—I do not quite understand.

2494. For instance, in large centres like Lagoa, Acors and Sierra Leone, would you approve of Staff- Burgeons being appointed who would be mainly Staff- Surgeons for the whole of their career? You mean professionally trained. I understood you to use the term" on the Staff" in an administrative sense.

2495. Not to do any administrative work?—I do, certainly. I think it would be a very good thing to have specially trained men, to allow men to specialise in certain branches, keep them to these branches and pay them adequately, to make up for their non- promotion to administrative posts.

2496. What sort of Staff appointment, say, in the large centres, would you suggest?-Surgery chiefly, possibly midwifery and gynecology, and a physician.

2497. Do you not think it would be rather too expensive to have too many of them?—Yes.

2498. Which is the one you would give preference to?--I think surgery, on the West Coast of Africa, is perhaps one of the main things, and gynecology.

2499. And research? Well, I was not thinking of that, because it is already there.

2500. Well, it is in Nigeria to a certain extent?- Bacteriology, certainly.

2501, Sir William Leishman: On that subject of specialisation, which Dr. Hood has raised, do you not think that a greater interchange would be advisable there between different laboratories and different Colonies, to extend the experience of a man?—Yes; I had not thought of that, but I think that would be a good thing.

2502. A witness wo had the other day spoke of the necessity, in his opinion, of a larger use of clinical pathology, that is bringing the work into the wards. As I gather, the Central Research Institute has very little touch with the actual wards ?-That is so.

2503. Could you suggest any means by which that could be extended more widely, so that the advantage of modern methods of diagnosis should be more utilised P-I think the Institute WAS more for research; I do not think it was in connection with clinical work so much. I think, so far as clinical pathology is concerned, you want more laboratories connected with the different clinical centres.

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[Continued.

2604. And in the case of this specialisation, do you not think it would be a good thing if higher places were open to men, so that they could go up to as high rank as Administrative Officers, perhaps not to the very highest grade, but the highest but one in bacteriology ?-Certainly, I do.

2505. They do not exist at present-I do not think they do.

2506. You think it would be of advantage?—I do. I certainly think that a man who specialises ought to be just as well paid as an Administrative Officer.

2507. And you would apply the same principle, to

made other subjects, if surgery were

A special subject ?-Yos.

2508. On the question of study leave, do you think it would be desirable to have more than one course

of study leave, or would you have another at an interval of, say, five years, or any other period? Do you think it is sufficient that an Officer should only have ono refresher course during his service? Well, I do not think I should care about making two com- pulsory.

2509. Not even in view of the very rapid advance of knowledge?—It is advisable, I agree with you, but whether it should be made compulsory is another matter. In the West African Medical Staff most of the men do brush themselves up; a good many do.

2510. That is only as a voluntary measure?- Voluntary. It is a matter that might be considered. I would not like to give an off-hand opinion as to the value of compulsion.

2511. If an extra course were insisted on, would you think it right that not only should the fees be paid, but some extra leave given or extra pay, so that the man himself should not suffer from having to go through such a course P-No, I think that extra leave I should might be given, but pay I do not know. like to consider that. It is as much for his advantage as it is for that of the Service.

2512, I have heard a great deal about the varying conditions in different Colonies, and the subject of private practice constantly crops up. In your ex- perience, does that give rise to a certain amount of discontent in the Bervice, inequalities of oppor tunity I do not think in, West Africa it does, because I think the junior men recognise that they will not get much, and the senior men are naturally appointed to places where there is private practice. 2513. We have heard of instances where officers, apparently, clung to a certain station because of the opportunities for private practice and someone in a different station does not get it. It is a difficulty, is it not? It is, but I think, as a matter of fact, it is the senior men who are sent back to these stations.

2514. Have you ever thought of any way by which that could be equalised?—I do not think so, except by way of seniority; the senior men get the better places.

2515. Private practice is an absolute necessity in most Colonics?-1 think it is advisable.

2516. Advisable and necessary?—Yes.

2517. There is a suggestion I should like to make to you, to know what your opinion would be. You have told us you think the conditions of service vary so much in different Colonies that you cannot fully encourage one big Colonial Service of a homo- geneous character. The suggestion is this: Would it not be possible that we should recognise the different conditions in even groups of Colonies for officers up to a certain stage, what you might class, roughly, as executive officers; above that, that that officers might be recognised as eligible for, say, the administrative, the higher posts, and then; conceivably, these officers in this administrative service might be liable, at the disposition of the Colonial Office to go to any other Colony, That