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PUBLIC RECORD OFFICE, LONDON

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9 February, 1920.]

COLONIAL MEDICAL SERVICES COMMITTEE.

MR. E. R. Darnley,

British Honduras, but that is only due to the abnormal rate of exchange. But I do not think the Windwards could afford to give £400 to £500 or £400 to £600; they might be able to give £400 fixed, or £350 to £450, Shall I go on to the Leewards?

2972. Yes, please.-In the Leewards, at present, the ordinary District Medical Officers are not pensionable.

2978. I do not think we are concerned with what a Colony can afford to pay. Our duty is to recommend what we think is reasonable to secure competent Medical Officers, and than it will rest with the Colonial Office to consider whether the Colonies can afford to pay these salaries or not? Perhaps the Committee will bear in mind that some Colonies have the alter- native of employing a greater number of Medical Officers of a medium class or a smaller number of B higher class, and that where communications are very difficult, there seems to be something to say in favour of getting a larger number of Medical Officers, although thereby you reduce the class of man, I have Dominica particularly in mind. It is an awful place to get about in, and a great part of the population live and die without medical attendance, That is the case in several other West Indian Colonies. 2974. There was a scheme for road-making in Dominica, but I don't know whether it has been carried out P-There is no prospect of it in the neur future; the Colony cannot afford it.

2975. Then the Colony cannot be helped. Well, the Leeward Islands ?-Many of the salaries are £300, and they will now, we hope, get an increase of 25 per cent.

2975. Making £375!-Yes.

2976. Have they any incremental scheme?-No. 2977. The man remains at £3757-Yes.

2978. And he has private practice?--Yes.

2970. In Antigua and St. Kitte the rate is only £250. That difference is accounted for because private practice in very much better, but in the rest of the Colony the salary is £300. Having regard to the means of the Loewards, I am inclined to suggest that £975 is about the limit that they can afford to pay.

2980. If a man gets £975, what does that make his aslary up to with private practice-Private practice varies so very widely. To take a few instances, some- what at random; private practice £100 at one place, £30 at another, £200 in a third, and in the beat districts of Antigua and St. Kitts it is £300 or £400. 2981. Only £400?-In Dominica the average private practice is probably smaller still. In many cases we have no information; such entries as "Some private practice" in two districts. That is all the information we have.

2982. Can you give information regarding Jamaica ? The Medical Service in Jamaica is recruited locally?— Yos, most of them are private practitioners, with a retaining foe; they get £200 a year from the Govern- ment now, They have 40 such District Medical Officers with a population of nearly one million.

2983. Forty Yes. I suppose the Committee realise that the number of Medical Officers in the West Indies is not such as to give effective medical attendance to anything like all the population. In Guiana, for example, the proportion of doctors to the population is small.

2984. Can you give some figures ?-It is 1 in 2,000 in Georgetown, 1 in 11,000 in the country, and 1 in 28,000 in the largest district.

2985. In Nigeria it is about 1 to a quarter of a anillion? That in more backward than the Went Indios, at least in that matter.

2986. Mr. Fiddian: There is one to 25,000 in Jamaica? That is the Government Medical Officers. 2987. There are others? There are others, but I do not know how many. Taking the example of Quians, the private medical practitioners are about half as many as the Government medical officers,

[Continued.

2988, Chairman: There are special reasons for that, as they are required for the sugar estates ?--Some of them koop their private medical officer, at least ir Trinidad.

2989. By law, the medical officer must visit the hospital on a sugar estate so many times a week; I think it is three times a week; so you must have a fairly large number of medical officers? Which Colony is that?

2990. Guiana P-I understand the Government take that responsibility.

2991. As I say, it is the Government Medical Officer ?-Usually.

2992. Sir James Fowler: How is it determined what a colony can afford to pay to its medical officers? -If, for example, Trinidad were in a better posi- tion financially than the Leeward Islands and could afford to pay higher salaries to the staff, we should naturally expect its doctors to participate and think that it was worth the Colony's while to pay higher salaries and to get better doctors.

2993. Is it really a struggle over the estimates?— If it is necessary to get more money to pay doctors, increased taxation is usually involved, and that is very unpopular locally.

2994. Is there some definite relation between the pay of the medical officers and other officers? No, there is no definite relation, but when the salaries of one clams are raised the other classes are apt to think that their salaries ought to be raised also.

2995. Does it not practically come to this, that it depends who can put on most pressure?-Supply and 'demand is certainly an important factor. The scarcity of medical officers has undoubtedly put on some extra pressure, and, although salaries have been raised all round, the salaries of medical officers havo been raised more in proportion than those of other classes. That has been notably the case in Trinidad where the medical officers have had an increase of 60 per cent. and the rest of the staff have only been given 25.

2996. Supposing that the medical authorities of this country advised no one to take these salaries, I suppose that would be a form of pressure, would it not?--Yes.

2997. Which might be effective? Yes, it certainly might, particularly with the big Colonies, but there are some of the amaller Colonies where I am inclined to think the money would not be forthcoming. We should be pressed to allow them to employ doctors from the United States, or men from Canada who have not a qualification registrable in England.

2998. When the officers come home on leave, whom do they see? The Principal Medical Officers and Deputy Principal Medical Officers generally call at the Colonia Office and discuss the medical affairs of the Colony, but others might or might not call, according to whether they had any private affaira to settle. There is no system by which they are interviewed when they come over on leave, but I have seen all the Principal Medical Officers and a good many of the others, although but a small pro- portion of the whole staff.

2999. Do they take the opportunity of mentioning their grievances if they have any P-Yes, sometimes. I have heard some complaints of the rates of pay, but none at all recently. When Dr. Wise was here we told him that the question of raising salaries in Trinidad was under consideration, and they were raised.

*

3000. Chairman: They have not yet been raised? -Oh yes, they have been raised.

3001. The figures' you give in the memorandum are the enlarged salaries?-The enlarged salaries, £400 by £25 to £600, instead of a scale of £260 and rising much more slowly.

3002. Do you think, from your knowledge, that the cost of living in these islands has gone up greatly owing to the War, or not?-It has gone up a great deal, imported food has gone up at least 100 por

9 February, 1920.]

MINUTES OF EVIDENCE.

MR. E. R. DARNLEY.

cent., clothing a good deal more than that, while locally grown food has not gone up nearly so much. Rent varics, it has gone up in some places, not in others. On the whole, apart from income tax, I do not think that the increase of the cost of living here is very much greater than it is in the West Indies.

3008. They are very largely dependent on imported food, are they not?-Europeans?

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3001. Sir James Fowler: So that it would be ao- purate to state that in all of them the cost of living has increased enormously?-Well, greatly, at events. As regards the extent to which Europeans are dependent on imported food, I should have doubted whether they were dependent to any large extent.

3005. Chairman: Flour?-Flour, entirely.

3006. Biscuita, tea, coffee? Yes, but I should not think they wou'd eat the salt fish and the preserved beef which is imported for the labouring classes. Probably they would get a certain amount of fresh meat locally.

3007. And clothes?-For clothes they would be en- tirely dependent on imported stuff.

3008. You have heard that house rents have gone upf-Yes, in some places, in Port of Spain par- ticularly.

8009. Sir Harry Verney: When a doctor comes on leave from the West Indies is his passage paid? No.

3010. Neither way!--Neither way.

3011. If a man is transferred, say, from West Africa to British Guiana, is his passage paid?-Yes, if the salary of the appointment below the limit laid down in the Colonial Regulations which at pro- Eent is £800; it used to be £500.

3012 If the salary is below £800 his passage is paid? And that of his family.

2013 Would not the attractiveness of the West Indies be very much increased if the passage were paid to a man coming on leave; is not that a cheap way of adding to the attraction of the West Indian Medical Service?-I do not think it would be prac ticable to treat doctors specially, in that respect.

3014. We must confine ourselves to doctors. You think it would be a good thing that there should bo, at all events, assisted passages of doctors coming on leave? I should like to record my opinion that that should be decided as regards the whole West Indian Service, not merely doctors.

9015. Chairman: The cost of a passage has doubled in the last five years, has it not?--Yes, about doubled, 8016. Sir Harry Verney: One more question on Fassages: Assuming a man is going to a responsible post in British Guiana, say, from West Africa, ought le to pay his own passage, a post of over £800 or whatever it is? A man going on a public service, not a question of lease; being transferred; ought he to pay his own passage? That is the decision which has lately been arrived at in connection with the revision of the Colonial Regulation in question. It is a case where my opinion does not matter because

decision has just been taken.

3017. It matters to us if we are recommending something if we can get responsible opinion to agree with us?--I see nothing unreasonable in a man who is getting promotion to a post with a salary of over £800 being required to pay his own passage. In fact, Colonial officials are very seldom transferred except upon promotion.

3018. Chairman: Why should the more senior official be called upon to pay his passage, and the junior not?—He has more mouey to pay it with.

3019. Has he; be is probably married with several children while the junior official is perhaps unmarried?--It is impossible to take account of that; some of the officials marry very young.

3020. Sir Harry Verney: I understand that, on the whole, a unified service for the West Indies is an impossibility; you demonstrated that clearly? If it

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is to include all the West Indian Colonies, yes, think so.

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3021. Do you think there is anything possibly to be said for a Colonial Medical Service as a whole, even if doctors were only nominally in the Service; do you think there is anything in the suggestion that you should have a body called the Colonial Medical Service in which people are seconded to a particular Colony under particular conditions P-I should like a little more information as to what that suggestion would imply. It seems that it would be little more than nominal,

3022. Yes, well, if it were little more than nominal, would it have any value?-It could not affect salaries and pensions, and that sort of thing.

3023. NoP-At present ar officer will describe himself, quite correctly I think, as belonging to the Colonial Medical Service if he holds A medical appointment under any Colonial Government,

3024, Mr. Fiddian: Do you see any advantage in having an Inspector-General or Director-General for the Colonial Medical Services which would include the West Indies in its sphere ?-I think not; it would detract from the sense of responsibility of the Princi- pal Medical Officers. But it seerns desirable that there should be occasional Conferences of the Principal Medical Officers, and at those Conferences there should also be present some gentleman of high medical authority from this country.

3025. Do you think you would got the West Indies to pay his expenses in such cases?-I could not say for certain, but I should think it was probable.

3026. Allusion was made, I think, by one of the witnesses that there should be a couple of Medical Inspectors of all the West Indies to go all round?- les, I saw that.

3027. Do you think that suggestion practicalF-No. Not for a general enquiry, apart from missions of definite and restricted scope.

3028, The money would not be forthcoming?-It would not.

3029. There would be quite a possibility of friction? Yes. It would be feasible to send a travelling Medi- ral Officer with a special mission, but he would have to co-operate faithfully with the Principal Medical Officer and the other Medical Officers if he is to be of any real service. This scheme for occasional Confer- oncos of Principal Medical Officers is one I have had in mind for some time, and it seems to me it would be helpful in bringing Colonies into touch as regards medical matters.

3030. I think there have been two such Conferences in West Africa? Were they successful P(Dr. Hood): A lot of things were discussed,

3031. Mr. Fiddian: The Principal Medical Officers of the various Colonies meet one another much more seldom than those of the West African Medical Staff, is not that so?-They hardly ever meet except at an arranged conference.

3092. Chairman: It all depends. Barbados, Trini- dad and Guiana often meet. They are bound to, because they pass through each other's Colonies. The Principal Medical Officer at Guiana must pass through Trinidad? With a few hours in Port of Spain and other friends to see, I do not think there a very much opportunity for a discussion on medical matters.

3033, Mr. Fiddian: Sanitation is not much observed in the West ladies, is it?-In some aspects a great deal has been done.

3034. It is rather left to chance, is it not ?-Sanitary measures to prevent the entrance of yellow fever have been, on the whole, conspicuously successful.

3035. External and internal measures, so to speak? -Both measures for the reduction of Stegomyia in the ports and quarantine measures.

3036. They have been kept up? Yes, fairly well. I would not like to say that there are not weak spots.

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