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9 February, 1920.]

COLONIAL MEDICAL SERVICES COMMITTEE.

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

deal? He travel, but he would not be in touch with the Colonial Office in the same way as the Travelling Commissioner would be, and he would not have the same status. A Travelling Commissioner of the kind indicated would have to be a man of standing with a good knowledge of conditions in the tropics, not necessarily only in Africa, but also in other countries.

2894. Such a Travelling Commissioner would be responsible to the Governor of the Colony rather than to the Colonial Office, I suppose?-No, Sir, I think he would be responsible to the Colonial Office. 2895. I see, independently?-Independently. He would be an independent Commissioner going out from the Colonial Office; that is my view.

2890. So that he would report to the Colonial Office and not necessarily to the Governor? Well, he might report through the Governor; I believe that is the usual channel. Besides, if he did not report through the Governor, in all probability, there would be a certain amount of friction. It depends a great deal on the type of man and the tactfulness with which he carries out his work. I think it would only be fair that any reports he makes should go through the Governor.

2897. Mr. Fiddian: There might be a Medical De- partment of the Colonial Office, but do you not think the Travelling Commissioner had better report to the Ministry of Health-I do not think the Ministry of Health has yet spread its mantle over tropical lands at all. If the Ministry of Health did spread ita man- tle over tropical lands, I think it is quite possible he might report to it, but I must say I never thought of the Health Ministry from that point of view.

2998. On this question of allowing man who had done well at research to be marked, so to speak, for promotion, have you ever found that men working in a laboratory are apt to be rather difficult to deal with from a general point of view?-Well, I find they vary like other people. There are some who are very difficult to deal with, and there are others who are delightful to deal with,

2899. Do you think there is anything in laboratory work in itself which puts a man rather out of touch with administrative methods in the Department?→→→ Yes; to a certain extent that is true.

2000. It is possible that a man who is quite a good head of a laboratory might make rather a poor head of a service, if he was suddenly translated from the one to the other?-Yes, the head of a large laboratory has a good deal of administrative work to do, but I think there is some truth in what you say. I would not lay a very great deal of stress on the man having done good research work, but I would allow it to count to a certain extent, though greater stress would naturally be laid on other matters, i.., the admin- istrative capacity he may have shown in other work, seniority, etc. I would give it a percentage of marks, to speak, but not perhaps a very high percentage. I think it should be considered, because the man has knowledge which would be useful to him in an administrative capacity.

2901. You would not keep a research man doing research the whole of his career?-Well, if he wished to do it and was a success in it, I do not see why he should not do it.

2902. The question is where he would come in for promotion? That would depend entirely on what facilities for research there are. At present, there is not very much hope for a man who devotes himself to research, but if something of the nature of what we were speaking came into operation, in other words if research was put on a better footing, then, there might be posta to which it would be well worth rising, and the man could with an easy mind devote himself to research altogether. It would be better that he should do so; I quite admit that.

2903. I think you said that in the Sudan the experiment of putting research work all under one hend, Medical, Veterinary, and so on, had been tried?

You

[Continued.

2004. It would depend, to a great extent, would it not, on the men selected, whether that arrangement would work. Medical laboratory men might find some difficulty working under the head of a man who was not a medical man?-Quite true, but these diffi culties, I am afraid, will always occur to some extent. It does not prevent the other Departments doing a certain amount of research, but the main Research Institute functions in a sort of consultative capacity. It does not debar a Medical Officer in his own hospital doing research, but you have a central place with experts at command as consultants as well as investigators, and that, I maintain, is distinctly useful whether they are concerned with entomology or chemistry, or some other branch of science. But that would rather be for a group of Colonies or Protectoratos. It could only be arranged if you - formed these groups; such a scheme could not be supported by a single Colony, it would be too ex- pensive.

2905. Dr. Hood: Do I understand you to say that, in your opinion, the men in the West African Medical Service are more content than the men in Ext Africa? That

distinctly Was

the impression I gathered from what I have seen of the men to whom I have spoken.

2906. Do you happon to know whether the East African Medical Staff have ever memorialised the Secretary of State over their conditions?.-Yes, they have done so.

2907. You know that the West African man have memorialised twice?-Yes.

2008. And now I hear there is another memorial from Nigeria on the way?--I do not suppose the West African men are absolutely content with their con- ditions, but I certainly think they are in a better frame of mind' than the East African, I consider the initial salary, for instance, is still on the low side in both places. It compares very unfavourably with that of the Sudan Medical Servic..

2909. Sir William Leishman: On the subject of specialisation, on which several other members have spoken, do you not think it is a good thing if a man took a special subject and became highly qualified in it that he should continue in that subject for his service if it were possible to arrange so rather than change over to administration as he became more senior?-Apart from the question of research laboratories, you mean, for example, the man who takes up surgery?

2910. Yes, I am speaking of the man who takes up surgery, &c.—Yes.

2911. You think it would be a desirable thing that a good specialist should continue a specialist in h's service as long as he possibly could? Yes, I think that would be wise.

2012. So if some arrangement could be come to by which such men should have well-paid posts available to them, that might be a means of securing content- ment in such a Service?-Yca,

2913. They should have, in other words, a higher scale of pay in such special subjects? It would make for efficiency, of course.

2914. What subjects would you include besides; we will take it that laboratory work, pathology and bacteriology, would be one, State medicine would be another; and surgery you mentioned; how many of these special subjects would you like to see treated in that way, opening a career to a man which he might follow to the end of his service?-There are surgery, State medicine, and laboratory work, that

is three.

2915 These are the three? These are the principal three which occur to me 'just now.

2916. On the point of interchangeability of officers, of such a specialised department, if it were created, from one Colony to another, I should like to know your views on that, not only from the point of view of the comfort of the officer concerned, but for the benefit of the health of the Colony he was serving in general, and to extending his experience; do you think after a

9 February, 1920.]

MINUTES OF EVIDENCE.

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

man had held a bacteriological post in West Africa, it would, or would not, be a good thing that he should be transferred, either voluntarily or compulsorily, to East Africa, or possibly to the West Indies, or possibly elsewhere? Yes, I think that would be distinctly

beneficial.

2917. So that he could carry his experience into a new field where it would probably be usefulF--Yes.

2918. It would enlarge his own ideas, and generally help forward the progress of the health of the Colony concerned?--Certainly.

3919. So you think that question of interchange of officers between the Colonies, at any rate, would be a good thing as concorns specialists, do you?__ Specialists; I do not know about surgery, I am not able to speak about that, but as regards hygiene and as regards Inboratory work, I am sure of it."

2920. Do you think, from the same point of view, a certain degree of interchange would be desirable in ordinary Executive Medical Officers that they too shoull extend their experience and carry fresh interest and fresh experience into another Colony?--- Yes, I think it would.

2921. To a certain extent, you think it would?__ It would have to be done with care and discretion. I think it depends a great deal on the personality of the man, but I believe it would, as a general rule, be a good thing.

2922. From the point of view of improving the health of the Colonies?-The health of the Colonies, certainly.

2923. Do you think the same principle might apply to transfers, interchangeability between adminis- trative officers, which might also throw open greater prospects of promotion, administratively; but the chief point is the same point of increased efficiency?→→→ This is not quite on the same footing, because what you gain in some ways you may lose in others. The man does not know the new conditions under which be comes; if he is very adaptable, he will soon pick up the ropes; if he is really a good man he will quickly got at the root of matters, and then such a change will be helpful, but it is a more difficult question in the case of administrative officers.

2024. You think it is possible that he might bring into a Colony, the Colony to which he went, certain new ideas that he found worked satisfactorily in his old one? Yes, that is true, but, of course, it depends so much on the man; he might want to introduce things which, while quite good in the country where he had previously served, might be wholly unsuitablo elsewhere. Still, anything that furnishes new knowledge and widens experience is helpful, and the main problems are much the same everywhere. least that has been my experience in many parts of the tropics.

At

29-25. Is there any point that has not been touched on by myself or the other members of the Committee, which you might like to mention as likely to improve the general status of the Medical Service? Not only the status of the Service, but improve the conditions in general? There is the question of possibly uniting the East and West Coast Services some day, but I do not think that could be done for some time. I think the first thing to do, so far as I can see, is to consoli- date the East Coast, and note if that proves & success. If it is a success it might be possible later on to form one African Colonial Sorvice. I see some difficulties as regards transport and communication, and there are also the climatic differences, but it is clearly the kind of idea which ought to be entertained.

2928. If these difficulties could be surmounted, beginning by first co-ordinating, linking up the East African Protectorates in one, subsequently linking up East and West, do you think, with experience gained, that is a desirable ideal, linking up all the Colonial Medical Service and making one Colonial Medical Service? I think it is a fine ideal, but I do not think it is feasible.

2927. You see great difficulties ?-I see great diffi culties indood unless you kept the Services in different parts of the world in distinct groups. I think if they

[Continued.

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were kept in distinct groups it might be done some day. in the West Indies the conditions are very different from what they are in Africa; in the Far Exat they are also markedly different, so different that I do not think you could

make one Colonial homogeneous Service; I do not believe that is fonsible. 2928. If it were feasible, you think it would be a good ideal to work for?-I think it is.

2938. It would tend to introduce, and produce, Cuprit de corps, would it not P-Yes, 1 think it is quite a good idea.

2020. And quite feasible in the light of the knowledge and experience gained in other parts of tha world; it would all be gain to the State?All that part of it would be distinctly so. It is a fine ideal and an ideal to press for, but I doubt very much whether it can ever be realised. The only part I can seo that can possibly be realised, at least at present, is the African part.

the

2930, Sir James Fowler: Therefore, with regard to African part, there is, as you say, great esprit de corps in the Wout African Medical Service? -I think there is.

2931. And we hope that with unification there might be so in the East African Medical Service?--Yee.

2939. You would not like, would you, that the W.A.M.8. should disappear? Well, it depends upon what would replace it.

Chairman: Leave out the "W."

2033. Sir James Fowler: The African Medicat Service; the West African Medical Service and the East African Medical Service have both those names.

I suggest there is good reason they embrace the whole of the Colonies on the East and West Coast, respectively? Would you not call it the Tropical

African ?

2934. You agree they embrace all the British Colonies on the East and West Coast?-They do.

2095. Now, take the African Medical Service, there are, are there not, enormous areas in Africa which neither of those Services is in the slight.st degree connected with, and never could be?Quite

trus.

2996. Do you think they have the right to take the African Medical Service as a British Service when you are not including an immense Brea under Britain? I think, quite apart from other countries, the fact of South Africa has to be considered. I do not think you have the right to adopt such a title from that standpoint alone. There is also the Sudan and Egypt.

2937. And Rhodesia P-And Rhodesia, and South Africa, but I think a solution might be found per- haps in the term Tropical African Medical Service.

2938. You do not know very much about the Weat African? I have never been on the West Coast.

3930. Still, you have read and hoard a good deal?_ Yea,

2940. Do you think with the climatic conditions pre- vailing in the East and the West, ao far as you know, that the difficulties are so great as to justify a con siderable difference of the pay and leave in West and East? I have inquired into this matter from the men whom I have met. I was rather interested in it, and, as far as I can make out, Uganda and certain portions of the Tanganyika territory are a bud na anything on the West Conat.

·

2941. Possibly worse?-In some cases possibly worse. Undoubtedly the conditions are rougher in parts of what was German East Africa, a country which I know fairly well. On the other hand, you have not got on the West Coast anything comparable, os far as I know, to the Highlands of East Africa. and I do not think you will ever have it even if the mountain region in the Cameroons is brought in because I understand the rain fall there is very heavy end although you get a coolish atmosphere von hare such terrible rains that they do away with the good of the change in elevation. Then, as I said before, taking the respective littorals, the East African climatic conditions are on the whole, I think, better