CO885-(26N14) — Page 196

162

PUBLIC RECORD OFFICE

co

Reference :-

885/26

PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-

COPYRIGHT PHOTOGRAPH-NOT TO

82

2 February, 1920.]

COLONIAL MEDICAL SERVICES COMMITTEE.

SIR JOHN Rose Bradford, K.C.M.G.

the Colonial Medical Service is a thought out scheme of advancement-promotion. I think that is impor- tant. Then the opportunities alluded to a moment go for study leave; I think that is important. Well, then, of course, the status will no doubt depend to u certain extent on the character of the examination — the standard of the examination.

2612. Sir Humphry Holleston: Most of the ques- tions I thought of putting have really been touched upon before. From the point of view of the teacher, do you think it will benefit the status and salary, supposing there is a sufficient number of candidates, if an examination were instituted, such as is held in the Navy and the Army?—Yes, I do.

2613. Students would think that, if it is more difficult to obtain, it is more valuable?-Undoubtedly. 2614. Then there is the question of man who have had a certain term and tour of service coming back and having opportunity for refresher courses, do you think that those ought to be compulsory, or to be made potentially compulsory by a man having to pass some kind of examination to show he has benefited by having the special course, and his promotion depending to a certain extent on that, as it is in the Army before he can become Major?—I think they must either be compulsory or else there must be an advantage of some kind held out to the man for doing it. Whether that should be done by pro- motion, or by certain posts only being held by men who have gone through this, is question for Administrative officers to answer. I should have thought it might have been done under some schemo similar to that which the P.8.C. certificate are given. Either acceleration of promotion might be partly influenced by it, or the holding of certain posts might be influenced by it, but I doubt whether it would be very useful if it were made compulsory. I think probably it would be more useful if it were put in the other way.

A

2615. Do you think it would be fair to demand of man eventually that before he had been in the Service a certain number of years he should have a Diploma in Tropical Medicine and Public Health?- You mean, in addition to the Diploma they have to get now?

2616. They have a certificate now.-You mean in addition to that?

2617. Yes. Well, I think it would be as regards certain posts. You would get a better result by not making it compulsory, but by making it quite obvious that the men who had got these things got the best jobs.

2618. I believe in the Army a large number of men have the opportunity of becoming specialists-You.

2619. They carry on their ordinary work concomi- tantly with their specialist work?—Yes.

2620. Do you think this more satisfactory than making a man who is a bacteriologist, a Staff Officer say, from the time he entera till he ends up, in a position corresponding to Physician or Surgeon General? There is a misunderstanding sa regards one of my answers just now; I may be wrong; it is not quite carrect to say he does his ordinary work. Bo does, more or less, special work. A surgical specialist, for example, does not do quite the ordinary surgical work; he gets a better class of cases allotted to him, and so on, and he does not do the work just in the same way as an ordinary Medical Officer, who is not a specialist.

Sir William Leishman: That is quite the case in surgery and certain other special subjects such as bacteriology and hygiene; a man does no other duty; he does no ordinary duty.

2621. Sir Humphry Rolleston: So there is a very definite establishment, say, for a bacteriological and hygienic specialist? Well, of course, that does not always work out.

2622. So the bacteriologiat and hygienist would really be Staff Officers?

[Continued.

Sir W. Leishman: That is so; that is their status under ou now scheme,

2623. Sir Humphry Rolleston: I was asking Bir John whether he did not think that was a more satis- factory way than men specialising in addition to doing ordinary routine work?-Yes, provided it applies to all branches. It must apply to everything; it must apply to clinical medicine; it must apply to surgery; it must not apply simply to bacteriology and pathology.

Sir Humphry Rolleston: When you talk of broader subjects it seems to me the difficulty always turns up there of people who are not specialists getting appointed by favouritism. It is difficult to chooKe your man at a sufficiently early stage with a sufficient amount of justification, because they really have in many ways a much better time, do you not think? You objected in the Army that, in medicine, for example, there were no Specialists; I believe there are

now.

2624. Sir William Leishman: There are now?—Yes. But it is only recently. During the greater part of the War, for example, there were none. I think that is quite wrong. I think you ought not to select bacteriology, or pathology, or surgery; you ought to have an opportunity for a man to become a specialist in any one of the branches. I do not see any greater difficulty in doing it in medicine than in bacteriology. There was in the Army no inducement for a man to do it in medicine; there were considerable induce- ments offered as regards bacteriology. I think they should all be treated in the same way. It is not the province of any particular branch of medicine, whether it be bacteriology or pathology, to arrogate to itself that that is the only branch in which there is research or specialisation.

2625. Nir Humphry Rolleston: Supposing there was * Medical Director-General now, would you take that man out of the Service, or would you take a distin- guished man out of the profession generally and put him in? I would take a man out of the Service, if possible, unquestionably.

2626. Mr. Fiddian: You prefer the Colonial Medical Service should be entered by examination P-Yes.

2627. Do you apply that to all medical men serving under the Colonial Office P-Yea,

2628. Take the case of the West Indies; in Jamaica there is a medical qualification to be obtained which entitles a man to be put on the local Register, and if the Governor recommends him for a Colonial appoint- ment would you suggest he should be sent over here to be examined?-I will try and answer your question; I quite see the difficulties.

2629. Sir Harry Verney: It is a special case?—I know the West Indies is a special case.

2630. Mr. Fiddian: Do you know that a great majority of the medical men serving in Ceylon are Cingalese? Yes.

2631. Although they have a Colonial qualification you do not suggest that they should be put on the General Service? My answer would be that those exceptional cases would have to stop outside.

2632. They would be Medical Officers of Ceylon or the place in which they served, but they would not belung to the Colonial Medical Service?-Yes.

2633. It might be rather difficult to explain that?— It might.

2634. To their satisfaction P-Yes.

2635. And perhaps to the Local Government ?--Yes. 2636. You realise that there is a certain distinction in this matter between the Army and Navy, on the one hand, and the Colonial Service on the other, owing to the existence of a certain class domiciled in the Colony acquiring a medical qualification and looking for employment in that Colony. Their domicile is constantly making a difficulty?—I quite realise that. I do not know whether the thing is at all comparable, I have not sufficient knowledge to say whether it is

2 February, 1920.]

MINUTES OF EVIDENCE.

BIR JOHN ROSE BRADFORD, K.C.M.G.

or not, but it seems to me it is rather comparable to the state of affairs which exists in India where they have a subordinate Indian Medical Service.

2637. The subordinate Indian Medical Service, as I understand, has not the usual registered British qualification, a qualification registered within the United Kingdom; these people az officio have?—Yes. The difficulty that you propound is as regards the West Indies and Ceylon. These men would either have to be in a Service that was not the Colonial Medical Service, or, for a certain length of time, they should perhaps be allowed to be admitted, on the nomination of the Governor, it being distinctly understood that this arrangement would come to an end after & certain time, and they would then have to be exam. ined like the others. I do not know whether you want my opinion on the thing, but if that is the funda- mental difficulty against the thing, the question of the West Indies and the case of Ceylon, I think with great Colonial Empire like ours, with the tremendous possibilities there are for medical work and medical research, and for making a magnificent Colonial Medical Service, difficulties of that kind would have to be brushed aside and got over somehow. 2638. I quite see they would have to be got over?→→ Got over in one of the two ways I have mentioned.

2639. Every new School in one of the Colonies would intensify the difficulty P-I do not think so, because if you have a Medical School in one of the Colonies, a really good Medical School, there would be no difficulty about holding the examinations.

2640. The examinations would be held locally P

ล

I see no difficulty as regards that.

2641. You think one of the chief things required is to put up the pay of the Colonial Medical Ser- vice P-Yes, I think that is one of the things.

2642. You are thinking of that with special refer- ence to what is paid to medical men at the present time elsewhere?-I am only thinking of what is being paid in the Services.

2643. The present difficulty is the supply of medical men; there are not enough medical mon to go round. Is not that so?-I cannot answer questions as regards that. I have been away too long to know exactly what is the state of the Medical Schools at the present time; I have not got any accurate information.

2644. Some of the Colonios might conceivably say they can get medical men cheaper who have not got British qualifications?—Yes.

2645. Then we will have to measure in terms of money, the value, so to speak, of a British Medical degree with a Colonial degree. These men have a qualification in the United States, and are not registered in this country?-Then you could not em- ploy them, could you?

2646. Yos we can; we have such medical men em- ployed in the Colonies that is regulated in each case by the local law? Then my answer to that is that the local Colonial authorities have to be educated.

2647. They have to find the money? They have to find the money, but they have got to be educated to the fact that they are not going to get proper and efficient medical service by cheap doctoring.

2648. You know the money comes out of the pocket of the local taxpayer, not out of the pockets of the taxpayers of the United Kingdom F-Yes.

2649. The local taxpayer might say he was being mulcted for the benefit of the British Medical Ser- vice?—I see; I think that would have to be faced.

2650. Respecting the value of having a Colonia! Medical Service, do you think a man really would belong to a service which might include black men ? --The Indian Medical Service includes black men.

2651. I have heard that the prestige of the Indian Medical Service was suffering?-Now, but 30 years ago the prestige of the Indian Medical Service was exceedingly high.

2652, Chairman: There was no black mau in it then? Oh yes; I speak from absolute knowledge of them.

26218

[Continued.

83

Sir William Leishman: I can confirm that, Sir. 2653. Mr. Fiddian You have spoken of an Inter viewing Committee before examination; you said you did not think any Department should be with- out that? That was said to me in the form of that question, and I assented to it.

2654. Entrance to the Civil Bervice in this country is without the candidates being seen P-I do not know.

265-5. And I think the Indian Civil Service is re- cruited in the same way ?-May be so; I am not familiar. I am still of opinion that it was of great value to the Army Medical Service, and I think other officers will bear me out in that.

2656. You suggested that research work is better done in some other way than by sending out missions from time to time from schools of Tropical Medicine. You do not agree with that. I take it the sugges tion is that that is better dona than by keeping a permanent staff say in West Africa?--I really cannot express an opinion about that. The question as to whether research is well done or not is entirely. dependent upon the people who do it.

You may have one period in which a Tropical School may have a number of brilliant people who go out and solve the problera; another time they will not, and there will be some brilliant people in West Africa who will do it. I think the point is that the Service ought to afford opportunities for the men in the Service to do this work. That is the fundamental thing, that if research is not encouraged inside the Service, wall, then the Service will starve and you will get ultimately a very indifferent type of men in the Bervice, so that if you ask me whether I think, as a policy, it would be wise for all research work to be done by expeditions sent out from home, I should answer unhesitatingly, "No; not as a policy but in individual instances it may be a wise thing to do."

2657. You say the Service would be starved?-- Starred in intellect.

2658. You say the ordinary machine does not eu- courage intellect?-You can twist it round to that if you like, but it is not what I said. What I say is, to go back to my words, that the status of a branch of knowledge or of a profession ultimately depends upon the research work turned out by that branch. or that profession. That is what I mean, and that if a Service is known publicly to be one where no eliconragement is given to work of that kind, then I say an inferior type of man would enter that Service, and if the policy were adopted of the whole of the research work in our Colonial possessions being done by expeditions sent out from home and not by Dien in the Service, I think that would be disastrous. 2659. Dr. Hood: Men take up house appointments after passing their examinations; do you not think that would bo rather a dead letter; do you think many would get house appointments?-Oh, yes; if the better class of men went into the Service they would,

2660. How are house men generally chosen at the teaching schools? They are chosen at different. schools in different ways. In some schools they are chosen by a clinical examination; in other schools they are nominated by the Physician or Surgeon; in others they are appointed by their record in the school.

2661. Do you think, if they knew a man was going out to West Africa, they would be likely to give him a house appointment?-Oh, yes; it is quite a common thing. It is quite a success in the Army.

2662. But do you think it would be for the Colonial Service? The thing is like this: Mr. Smith at a certain hospital thinks he would like to go into the Colonial Medical Service, but he wants to be a resi- deut. If he goes into the Colonial Medical Service he cannot be a resident under present conditions, and so he does not enter the service.

2663. Why should not a man do a house appoint- „ment in, say, a Bucks hospital, rather than not do one at all? You said he is confined entirely to

L. 2