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9 February, 1920.]

COLONIAL MEDICAL SERVICES COMMITTEE.

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

than those of the West Coast. It is a more com- fortable existence facing the Indian Ocean; you get the Monsoon. It is not really very bad. Mombass has not at all a vile climate as climates go. A. regards health, I do not think there is very much to choose between them. In the Tanganyika territory you have another high region which may eventually Lo made into a magnificent health resort Iringa is in the middle of the Tanganyika territory, and the escarpment varies from five to seven thousand feet high. There was a German settlement up there, and in some ways it is delightful at Iringa. I was there during the war. You want fires at night and it is really a very nice climate, but the place is almost inaccessible at present. When the raine come on you cannot get near it, the whole country in the Rusha plains which lead to it are flooded for miles. Iringa

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place which might be made into a good hill tation; so you have the Highlanda in East Africa, and this place in Tanganyika Territory, and you have nothing comparable to either on the West Coast.

2942. Ware you referring to Buen in the Cameroons? -Yea

2943. Is it possible that that could be made into a health station f-Well, I doubt it, the men I have

poken to about it all say the rain 's so terrible.

2944. Chairman: It is very very wet; it is all right on the Coast? It is very wet and that I think detracts from its value. I think Bauchi might be Jundo into a very good hill station, but then they want good buildings there?--Yes, that is always an im- Fortant point.

2945. Sir James Fowler: You would be in favour of having several appointments so that a man should

[Continued.

continue in professional work to which he had devoted his life all his time in the Service?—Yes, I think these are very useful appointments.

2946. Has it not been a great disadvantage to the Services, generally, the necessity of providing in the administration for highest appointments?-It has For instance, it is specially so in the case of surgery. Men cannot develop the technique necessary if they are busy with administrative work. To be a good surgeon it strikes me you have practically to devote your life to surgery, at least to be a first-clas3 surgeon, and there is great need in these Colonies for first-class surgeons.

2947. I have been rather sorry you have not mentioned first-class physician?-Well, that is also a very important matter, I quite agree. I do not say all the medical officers are first-class physicians, but in some ways you are up against A more difficult proposition in surgery than in medicine, and nature will very often do a great deal for you in medicine, whereas this is not so commonly the case in surgery.

2048. Would you agree that a very highly equipped hospital medical, surgical and all the specialities would really affect the medical practice throughout a colony ?--You mean that it might give a man nex ideas.

2949. By setting a higher standard?-A higher standard. Yes, distinctly.

Chairman: Thank you very much.

(The Witness withdrew.)

Chairman: Colonel Balfour has just handed me the salaries of the medioal Service in the Sudan which I think it would be desired to put on our Minutes.

BUDAN MEDICAL OFFICERS.

First year £E720. £E120 war bonus.

£E60 every two years rising to £E1080 independ- ently of any war bonus.

Special posts £E1,200 and £E1,600.

Military allowance ££5 per month.

1/48th for each year of service. Pension regulation. 20 years' service.

No assisted passage.

Example: Under old conditions.

Senior Medical Inspector, at present serving.

12 years' service: £E1,100, including war bonus. Pay just over £E1,000.

Notes: Special posts to which reference is made above are:

1. Director Khartoum and Omdurman Civil

Hospital, £E1,200.

2. Director Sudan Civil Medical Department,

£E1,500.

£E = £1 0s. 6d.

Living is considerably more expensive in the Sudan than in the East or West Coast Territories.

The Northern Sudan is healthier than the East or West Coast Territories, but its climate is very trying --more especially to the nervous system. The summer is very long, March to November, the heat is often excessive and the dust storms abominable

MR. E. R. DARNLEY, called in and examined.

2950. Chairman: You are on the Colonial Office Staff in the West Indian Department?-Yes.

2951. I think you supplied us with a Memorandum relating to the position and emolumente of Medical Officers in the Government Medical Service of Trini- dad and Tobago ?—Yes.

2952. What further information can you give us regarding the West Indian Medical Service? What procedure would you like me to follow; would you like me to deal with particular Colonies first and then proceed to generalities, or to deal first with general questions anch the suggested Colonial Medical Service?

£3

2953. Perhaps I might ask you a few questions first. Do you think it is feasible to amalgamate the Medical Services in the different West Indian Colonies; like the West African Medical Staff? Before I answer that question I would like to point out the nature of the Medics Service in the West Indian Colonies. In Barbados, for example, medical matters are very much on the footing that existed in this country before the introduction of panel prac tice. The General Hospital, is under a Board of Truste■.

The Government makes a contribution,

but the only pensionable Medical Officers in the Government employ are the Medical Officer of Health and the Medical Superintendent of the

That

Lunatic Asylum. The latter officer is not entitled to private practice, and the former is entitled to Then in Jamaica limited private practice only. there are 40 men on the Medical Staff in the dis- tricts, who depend mainly upon private practia: but receive small stipends from the Government. Accord- ingly, I do not think that Barbados or Jamaica would be likely to come into such a scheme. Ber- muda also is run practically by private practitioners, and it seems unlikely that Bermuda would come in. Strictly speaking, Bermuda is not a part of the West Indie. In the Bahamas there are only four Govern- ment appointments, apart from some posts to which only very small retaining fees are attached. seems to rule out all these Colonies. You have aft Guiana, Trinidad, the Windwards, Leewards and British Honduras, There would be considerable dif ficulty in getting even those into line, since each has been accustomed to its own entirely independent ser- vice, and in Guiana financial control resta with the Combined Court. I should not like to say, however, that inherently it was impossible for Trinidad, the Windward Islands, the Leeward Islands, and, per haps, British Honduras to amalgamate. Although the largest Colony of the group, Trinidad has not much to gain from the arrangement, the smaller Colonies would presumably gain by getting a better class of

9 February, 1920.]

MINUTES OF EVIDENCE.

MR. E. H. DARNLEY.

Medical Officer, but for that gain they would have to pay pretty heavily, probably more than they could afford, so that, on the whole, I am inclined to think that the proposal for a united West Indian Medical Service would not be advantageous. If the Com- mittee want to have it enquired into further, I think that they should appoint Sub-Committee to consider it and to prepare a scheme.

2954. A Conference in the West Indies? Well, there are many details to be worked out, and I think that it would be better that a preliminary scheme should be prepared in this country, using the experi- ence we have of the West African Medical Staff,

2955. If the scheme wore taken up, to have a West Indian Conference to decide whether such a scheme should be adopted, and then, if the Conference de- cided in favour, you could work out the details after. wards?-1 think it would be more feasible to refer that question out to the Colonies, to consult the Colonies by post rather than arrange a Conference in the first instance. The only way I can see a Con. ference can be arranged is to get together a meeting of Medical Officers, which would be rather a big business. It is quite likely that such a meeting might be required for other reasons, and it might take this as a part of the businces, but I do not think that the Colonies would be disposed to spare the principal Medical Officers merely to consider this; however, they might. I suggest that a com- bined Service would be likely to cost the smaller Colonies a good deal more, because at present they pay their Medical Officers very low rates, and, although those rates are being improved, I do not think they can afford to pay a rate calculated to attract the best class of men from this country.

2956. Would not one difficulty be the very different conditions in each Colony as regards private prac tice? Yes, that is another difficulty.

2957. It would be absurd to pay a man a high Balary in a Colony where he enjoyed lucrative private practice?-Yes, even in the same Colony there is a very great difference between the districte, but I understand that the difficulty existed in West Africa and has been overcome there,

2958. In Wost Africa there is a very small percent- age of posts where there is much private practice, I think. Do you think the Medical Service in the West Indies are generally contented now, the members of them ?-We have heard lately only one actual complaint which was referred to this Com- mittes, and that was in regard to payment for Venereal Disease cases in the Windward lalanda, but I think there is a feeling amongst them that their salaries are very low and ought to be improved, and to some extent they are being improved. I imagine that in British Guiana, Trinidad, and British Hon- duras, where the salaries have ben lately consider- ably increased, that the conditions as regards pay.

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now reasonably satisfactory, but I could not say the same for the Windward or the Leeward Islands generally, although there are exceptions as regarda particular appointments.

2959. Are you able to get enough recruits for the West Indies now?-No, we have had very great diffi- culty in getting a good class of Medical Officer, and particularly in getting sufficient European Medical Officers. But the salaries have now been raised, only very recently in British Guiana and British Hon- duras, and it is rather too soon to say what effect that will have on the supply.

2960. What is the commencing salary now in these Colonies?-In Guians £400 by £25 to £500 and subse- quently to £700, in British Honduras $1944 to $2430 by $121.50c.

2961. Are these American dollars?-Practically. The salaries are at par £400 to £500, but more like 600 to £750 at the present rate of exchange. Trinidad, as you will have seen from the memoran- dum, is £400 by £25 to £600.

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[Continued.

2962. Has that been raised recently ?-Yes, it used to be £250,

2963. Do you think you will be able to get suffi- cient recruits of a satisfactory character at those salaries I think that remains to be seen. Perhaps

it is more a question for Mr. Cooke than for myself. We have had a definite complaint from Guiana that there are beginning to be too many coloured men in the service. The Governor has asked for more Euro- pean practitioners. That would be one of the diffi- culties, of course, if it were proposed to combine the West Indian medical services with those of any Colonies outside the West Indies, that they are full of coloured men.

2964. Have you any other points you wish to bring to notice-Would the Committee care to consider tho case of the individual Colonies; either all of them or some to which I have specially drawn attention? The conditions in the Windwards and the Leewarda are certainly, in some respects, unsatisfactory.

2965. Will you give the conditions of the Wind- wards and Leewards?-Regarding the Windwards, in Grenada and St. Vincent the ordinary rate of salary is £250, which is likely to be be increased by 10%, making £275. In St. Lucia most of the appoint- monts are at £300, soon to be £390. Private practice is allowed.

But

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2966. What is that private practice worth, do you kuow; have you any idea?-I will come to that in a minute; it varies greatly in amount. But AS regards Government emoluments I might add that, in Grenada, each Medical Officer gets an allowance of £100 a year, which is a temporary allowance for duties imposed under the new Venereal Disease Ordi- nance, so that actually they receive £350.

2967. Sir Harry Verney: £375?-£950 at present; if the 10% is sanctioned they will get it on the £250. 2969. Chairman: Is that allowance pensionable?— No, it is not. The salaries are pensionable. regards private practice, the Governor reports that, 10 Grenada, he has been informed that, including the salary, there is not a Medical Officer who makes under £1,000 a year, 19

that the Grenada people seem to be pretty well off in regard to private practice. is not so in St. Lucis and St. Vincent, gener- ally speaking. In St. Lucia private practice was estimated for six districts at rates varying from £60 to £211, but in regard to one district no information was given, In St. Vincent private practice is estimated at about £100 in four districts; £150 in the fifth and £200 in the sixth, so that the total pro- fessional incomes of four Medical Officers in St. Vincent were only £350, plus a few small fees.

2969. Were these men appointed from England?— Not all of them. During the war it was almost impossible to get men for these small posts from England, and the Governor appointed anybody he could get on the spot; coloured men, men with Canadian qualifications not registrable here, and in some cases men with United States' qualifications who are only eligible under temporary war ordinances, These are being replaced as opportunity offers. That is the state of affairs as regards the Windwards. Would the Committee be in sympathy with an effort to raise the salaries of the men in St. Lucia and St. Vincent, and what do they think would be a reason- able standard? I am omitting Grenada because the private practice there is quite good.

2370. What is your opinion as regards the salaries? -I think that they are very low, and that the Colonies could afford to pay rather more, and that if they were willing it would be worth while to pay it.

2971. Independently of what the Colony can afford to pay, what do you think is the salary which should be offered to ensure getting competent men?-That is, I think, a question more for Mr. Cooke, but the heat scales we have been able to arrive at in the Wert Indies hitherto start at £400 and rise to £500 and £600 or more. There is an exception in the case of