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COLONIAL MEDICAL SERVICES COMMITTEE.

9 February, 1920.]

DR. ANDREW BALFOUR, C.B., C.M.G., M.D.

[Curtinued.

ELEVENTH DAY.

Monday, 9th February, 1920.

PRESENT:

811 WALTER EGERTON, K.C.M.G. (Chairman),

Lieutenant-Colonel S HARRY VERNEY,

Bart, D.8.0.

Burgeon Rear-Admiral SIR HUMPHRY D. ROLLESTON, K.C.B., M.D., F.R.C.P. Major-General Sm W. B. LEISHMAN, K.C.M.G., C.B., M.B., F.R.C.P., F.R.S., K.H.P., A.M.8.

Lieutenant-Colonel BIB JAMES KINGSTON FOWLER, K.C.V.O., C.M.G., M.D., D.Sc., F.R.C.P., R.A.M.C. (T.).

MR. T. HOOD, C.M.G., M.R.C.B., L.R.C.P. MB. A. FIDDIAN.

MR J. E. W. FLOOD (Secretary).

Dr. Andrew BalFoux, C.B., C.M.G., M.D., Director-in-Chief of the Wellcome Bureau of Scientific Research,

London, called in and examined.

(Sir James FowLm in the Chair).

2822. Have you prepared any statement that you would like to put before the Committee?-I have not written out any statement, but my ideas on the subject are more or less crystallised.

2828. There has been a proposal, as you are aware, to appoint an Inspector-General of the Wost African Modical Staff, or a Director-General of the Weat African Medical Staff, and that has re-appeared on various dates since 1908-1914, and now.

Would you tell the Committee what you think of that proposal- I think, as regards the Inspector-General, that it would be a very excellent thing indeed; I believe it is rery much needed. I passed through the East African Colonies in 1917, and merely from the fact that I was associated with the Advisory Committee here (the African Committee) I was consulted on many points, not only by the medical staff, but by the Governors in East Africa, that is the Acting Governor of British East Africa, and the Governor of Uganda. They were all pleased to get the chance of talking to somebody who was associated with the Advisory Committee at home, and they, at that time, expressed the view that it would be a very great help if someone holding a post like that of Inspector-General, or a Travelling Commissioner, were appointed to get into touch with them. I should think that this also was true, from what I have heard as regards the West Coast territories.

2824. That suggestion has been before the Advisory Committee?-lt has.

2825. Such an officer would pay attention, I take it, more to general questions of sanitation and the good of the Service than to personnel?--I should think that would be his main function.

2820, What do you think is the reason for this con- staut re-appearance of the appointment of

an

Inspector-General? Do you think it is the desire that they should have someone through whom, as they say. they could make their grievances known, or that they feel there is an urgent need of inspection, or for any other reason I think both feelings are operative, but I think the first is the more insistent.

2827. That they should have some head of the Service Not necessarily a head, but someone who would act, as one might any, in loco parentis to them. as a sort of go-between between them and the lay officials of the Colonial Office.

2828. I quite agree; is it not possible that they have been perhaps more concerned, and very naturally, with their own Service, and may have overlooked the fact that there are officers serving in many other Departments, such the Straits Settlements, the West Indies, who would equally desire to have that means of communication P-Yes, I have no doubt that is the сдве.

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2829. That, and not the desire for inspection, is the real essence of the thing?-That, I fancy, is the chief point. I think they also feel the need of someone who could tell them what was going on in other places, ond keep them up-to-date, for they feel isolated and in need of information.

2830. In the memorial which was presented in 1914, this occurs:-"That facilities may be given them to "express, through adequate channels, feelings of "discontent should they arise at any time." That is an expression of the feeling, is it not?—Yes.

2831. You would be in favour of the appointment of one, or both, of the head of the Service as a whole, or of an Inspector-General of the West African Medical Service, or both-Well, I would be inclined to differentiate.

(At this stage SIR WALTER ECERTON entered the meeting and took 'the chair.)

2332. Chairman: Then, will you continue?—I think the Inspector-General or Travelling Commissioner would be exceedingly useful, not only in East Africa or West Africa,, but in other places. I have had tho

opportunity of visiting the West Indies, and, although this point was not discussed there in any way, I am quite sure that it would be a useful thing to hare someone with this office also visiting the West Indies,

9 February, 1920.]

MINUTES OF EVIDENCE.

DR. ANDREW BALFOUR, C.B., C.M.G., M.D.

because in some places the medical service labour under groat disabilities there. As regards the Director-General, that opens up rather a new point of view altogether. In order to have a Director-General, 1 take it you must have a more or less bomogeneous Barvice, Is the idos, may one ask, to unite all the medical services, the West Indian, the African, "and the Far East, into one great Colonial medical service? 2889. Sir James Fowler: No, certainly not?—No. 2834. May I read what is stated in a memorandum which I think you have read? "The desirability of "appointing a head of the Colonial Medical Service "has apparently been recognised by medical men "interested in tropical medicine and the Colonial "Medical Service for a long period, as several claim "the proposal as their own. That it has not made any progress is possibly owing to the fact that they "had in view a homogeneous servico, like the Royal "Army Medical Corps, under a director, who would have the power of appointment to and transfer from "each and every colony; the officers of the service "being interchangeable between the various Colonies. "A slight acquaintance with the theory and "practice of Colonial government tends to prove that "this is au impossible ideal, as in the case of some "Colonies the selection of candidates for appointment " is made by the Secretary of State, whereas in others "it is made locally; also the salaries and opportunities "for private practice differ very widely, and racial "disqualifications which obtain in some Colonies are "no bar to employment under other Govern- "ments"? That is in your memorandum, Sir James. Well, I agree with that. Of course, the appointment of a Director-General seems to presuppose consider- able change from the present form of administration. The medical officers at present serve under the governor of the colony in which they are acting, whereas if you had a Director-General-

2835. Chairman: They serve under the Governor; but there is a Chief Medical Officer, is there not?- There is the Chief Medical Officer, yes; but the Governor, I take it, sir, is the supreme head in the colony.

2836. Yes P-I do not quite know how the Director- General would work in under these conditions.

2837. Sir James Fowler: Perhaps I might just read to make this quite clear; this is also from the same document: "The Director-General would have "no control over officers whilst actually serving in any colony; such matters as appointment to stations, "leave, discipline (oxcept when the action of the "Secretary of State might be necessary), etc., would "be under the control, as at present, of the Governor "and Principal Medical Officer of the Colony "P-I think if it could be done without friction it would be a very good thing, but I am rather inclined to think a post of the other kind, the Inspector-General, or Travelling Commissioner, as distinct from a Director- General, might, at any rate, at the present time, until one saw how the scheme worked, be the better plan.

2838. Chairman: You mean an officer like the Inspector-General of the West African Military force? -Bomething of that kind, someone who would go out, say, for perhaps six months in the year, tour those districts, gather information, find out what the men were thinking and saying and doing, and help them as far as possible.

2839. You would have to have one Inspector-General for West Africa, another for East Africa, and another for the West Indies?-It might be possible to have one both for East and West Africa. It might not be nocessary to have the visits paid quite so frequently. The West Indies would require a separate man. know he would be welcomed in Trinidad and British Guiana,

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2840. Once every two years?-That might be quite sufficient; I think it probably would be.

2941. What would be the use of having an Inspector- General of that Hind P-Well, I think he would find out what was going on much better, for instance, than

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the Advisory Committee can do here; he would get into touch with local conditions, the men would more readily come to him and explain their difficulties. Before you came in I was explaining that I happened to come through British East Africa and Uganda in 1917 and, knowing that I was member of the Advisory Committee here in the Colonial Office, not only the medical officers but the governors were very anxious to talk things over and just get some idea of how things were viewed in other places and so on, and it struck me very forcibly that someone who could carry on that work regularly would certainly be of great use, and the men themselves told me it would be mdat advantageous. He would act as a kind of go-between between the medical services there and the lay officials in the Colonial Office, and grievances could be brought before him and he himself could

suggest methods of remedying faulty conditions. The conditions were undoubtedly very bad in East Africa and Uganda. I have no hesitation in saying that, and I feel that this would be one of the methods of remedying them to some extent, and probably also

act as a preventive measure in the future. That is another important point.

2842. One of our duties is to see how the conditions in the Medical Service in the different colonies could be improved. Can you give us some examples of how the conditions are pretty bad in East Africa?-Well, at the time I was there, I do not think the conditions of pay were good. Opportunities for study leave were non-existent, there were faw facilitios for scientific work, there was a lack of necessary information, there were not enough medical officers, and I think, in Uganda at least, the wants of the natives were not properly attended to. There were not nearly enough medical officers to deal properly with the native pupulation, and sanitary oflicers were practically non- existent. In Uganda there was really only one officer, whose sole duty was sanitation. The territory is an enormous one, and the prevailing diseases are Small pox, Plague, and Cerebro-Spinal Fever.

2843. To what extent do you think all that was due to the war?--I think it was in part due to the war, but I know it also existed before the war. It is not by any means wholly dependent upon war conditions, although the war aggravated it very much and brought matters to a head.

2844. Of course, you know that East Africa and Uganda are poor administrations?—I know that.

28-15. East Africa, until very recently, and I believe Uganda still is helped from the Imperial Government? -Yos.

2846. The quarters which Medical Officers have there are they satisfactory?-Those that I saw word, I think, on the whole satisfactory. Yea. I saw, for instance, the Medical Officer's quarters at Masindi, which is one of the outlying districts in the centre of Uganda. He had quite a good house. There was nothing to complain of there, nor at Kisumu, where I stayed in the Medical Officer's house; but I have heard that in some parts the quarters are not very satisfactory in some of the districts in British East Africa, I believe, but I am not perfectly certain on this point.

2847. The hospital buildings and equipment?-The hospital buildings varied very much. The Infogtique Diseases Hospital at Bombo, when I was there, was exceedingly bad. It was a hastily put-up hospital and chiofly used for military purposes; but even so, it was a very bad hospital indeed. I remember it contrasted very greatly with one which has been put up at Kisumu by a West African Medical Officer who was serving on the East Coast; and he, without any more help than they had in Uganda, had put up quite a remarkably good ward for smallpox. It seemed to me, if one may say so, that the men from the West Coast, as a whole, were keerter on their work. I do not think they were a botter class of men, or anything of the sort, but they seemed more contented and more energetic. Many of the East Court men appeared to

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