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PUBLIC RECORD OFFICE, LONDON

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23 February, 1920.]

COLONIAL MEDICAL SERVICES COMMITTEE.

Dr. Cox, Dr. Macpherson, Dr. van Somkhen, and Dr. GoodliftE.

he did not?--The inference from that being that one man was not sa good as another.

3517. Yes?--And I am free to admit that that will obtain sometines.

3518. (Sir Humphry Rolleston) You simply mean that the man has gathered that in conversation when he has come up hore? The leaflets given to him give him the impression that private practice is quite a factor.

3519. You think it would be better that that should be omitted? Well, if you omit it, unless you are prepared to materially increase the official salaries, it will not help you to get more men.

3520. (Chairman) The first thing an applicant asks,

I think, is, is there private practice?—Yes.

3521. Then he is given what information there is on the subject P-Yes. Well, if there is private practice we think the man should be restrained and restricted as little as is compatible with the good of the Service, and the example we have given of what we consider as the unreasonable restrictions is the kind of thing we are asking you to try to prevent. These tariffs have a nasty knack of fixing scales for other people. People who are quite able to afford to pay a decent fee, expect to get their service on the cheap.

3522. (Sir Humphry Rolleston) I see it says here in January, 1919, private practice does not exist in the majority of stations, and no guarantee can be given that an officer will be posted to a station in which he will be able to practise privately? Does that apply to the whole Service? That is West Africa, is it not? In West Africa you do pay the man what looks like

comparatively reasonable salary, but when you get a man taking on a job at £300 or £400

a

3523. (Sir Harry Verney) A man seeking for an appointment is always told the terms of the appoint- ment, and he is told that private practice is estimated at so much? I am not prepared to apportion the blame, but a good many men have the idea that they are given a more rosy idea of what the private prac- tice is than it turns out to be when they get out there.

(Chairman) I should have said just the opposite. A man is appointed, he is told there are certain appointments which have private practice, and he goes out hoping to get one of them. If he does not happen to get one of them, that is D great disappointment.

3524. (Sir Harry Verney) I think he is very muen discouraged at this Office? I am sorry we have not had an opportunity of bringing somebody from the West Indies where this complaint has been most frequent. There are difficulties in getting evidence from the spot.

3525. (Chairman) It is most difficult to get accurate information, therefore, I think the Office is very careful not to exaggerate the possibilities?—Yes.

3526. (Sir Humphry Rolleston) As to study leave. is that what you have heard, from your knowledge of Medical education, that study leave should be com- pulsory on the men, and that any man practically is obliged to take a course every five years? Yes. I think it would be a very good thing for the Service if it could be made compulsory.

3527. And he should show that he has benefited by it by getting a certificato by examination or some thing of that kind?—Yes.

3528. And he should be justified in counting that As a way on towards promotion P-I think he would If you did not make it compulsory, I think the man who did take it ought to have a special claim for pro- motion.

3529. 1 should rather like to emphasise the point Sir James Fowler put to you as to whether a man who is alministering in a Colony has to decide whether X-rays should be desirable or not, but he should have the opportunity of learning what that instrument is--How is he to spread himself out? He has to know everything. When he comes home and does his study leave, what is he to do; walk

[Continued.

the

round the hospitals and investigate_all specialities? I think it will be a little difficult. It seems to me when you get up to the top administra- live poste you have to pick up your knowledge by reading and personal interviews. I am talking now from my own experience. My knowledge of profes- sional matters is getting distinctly shaky in many respects, although I had 20 years of general practice. but still by constant association with men who are in practice, one doos pick up a good deal, and I rither think it would be a waste of time for my people to send me back to private practice, so that I could speak with first-hand knowledge. I have never been in any of the Services, so I cannot say how my experience would apply to men in the high administrative ranks.

3530. Your position at headquarters of the British Medical Association and so in touch with recent thought is not comparable with that of an adminis tiator somewhat isolated in a distant Colony ?—It seems to me that for a man to be able to advise with first-hand knowledge surgical specialists, patholo- gista, radiologists, ophthalmologists and specialists in venereal disease is rather a large order, and not to he compassed by six months' study leave. Still, I am open to conviction on the question, and you know far more about those things than I do.

3531. My impression was that men got qualified not quite so quickly as you suggested. Is not the average time a man takes to qualify seven years ?--- Well, I have seen it variously stated. He cannot do it in less than five years; I should imagine most men manage to do it in six.

3532. The number of men who have qualified at 21 years, and gone into the profession at 15, must be very small?-Qh! yes; a five-year man you cannot get at 21; I was thinking of my old days when it was four years, 17 to 21, but between 23 to 24 is about the average time at which men qualify now.

3533. Dr. Hood: Have you come across many men from West Africa ?-Yes, I have come across a good many.

3534. Are they more or less content, more content than the other Services? They are more content than the other Services, I am safe in saying that.

3535. Have you ever hoard the suggestion made about pooling private practice?-No, I cannot say I have.

3536. For instance, take Nigeria; you find along the littoral private practice is worth anything up to £2,000 a year, but in the stations 100 miles inside it is nothing at all, and, as a matter of fact, there is a good deal of discontent among men who, for so many years, have been kept out of the stations where the large private practice is. Do you think that it would be feasible at all to pool the private practice, and then divide it: there would not be such a desire among the men to go to the stations on the Coast where the private practice is, if the private practice were pooled?-Unless you moved the men about a good deal, it would hardly be fair to give the money to the men who did not do the work.

3537. Still, it seems rather unfair to some men who have to live in the outside stations nut to be able to make anything by private practice?-It is unless you can give them their fair share of the work where there is private practice to be obtained. The only remedy would be to give the men who go to the stations where there is no private practice a higher salary.

3538. With regard to the increase in the salaries, do you think the mongy expended on the Medical Department in each Colony should bear some propor tion to the revenue? Well, I really do not think that is a question which I am competent to answer. All that I can say is that, from my experience, you will not get men of a certain type unless you pay a certain salary, but I hardly think, as an adminis trator, a question of that kind is one that I am com- petent to answer.

MINUTES OF EVIDENCE.

23 February, 1920.] DR. Cox, Dr. MACPHERSON, DR. van SOMEREN, AND DR. Good..IFFE.

3539. But if you increase the emoluments of the Aledical Service by 50 per cent, you would have to increase all the other Departments?—I daresay you would. It seems to me you can either have a cheap Service or you can have a more expensive one, and it is up to the people who have to find the money to say what kind of Service they can afford.

3540. Does that introduce the question of the sub- ordinate Service like they have in India? They have a aubordinate Service in India, have they not?—Yes, they have.

3541. That in really a cheap Service, is it not ?— It is believed to do its work fairly well inside its own limits.

3542. Do you think any of the other Colonies could introduce a subordinate Service; do you think in West Africa there could be a University established to train men for the subordinate Medical Service ?-- Men who are partially trained?

3543. They would not be so highly trained as they are in England?—No, obviously, Well, I am afraid I cannot say we have ever considered that; it cer tainly has never been put up to us by any members of the Service.

3544. Chairman: Are you familiar with the con- ditions of the Indian Subordinate Service? Well, I know something about it; I cannot say I am familiar with it, but I know something about it.

3546. They are not fully qualified men, are they ?--- No; they have a training a little more than half what the property qualified man would have.

3546, And they are not called upon to perform the full duties of a Government Medical Officer P Not there is a fully qualified doctor anywhere near, but as a matter of fact, they do a good deal of work in some of the areas which certainly in this country. would only be allowed to be done by a man who was fully qualified.

3547. Is the qualification in Coylon such that a man can practice in England with it, do you happen to know 7-1 am not certain about that.

3548. r. Fiddian: As to your suggestion for the expansion of the grouping system. For example, there might be a West Indian group; I put it to you that there are certain differences between the West Indian Colonies and the West African which make it much more difficult to group in the West Indies than in West Africa P-I agree.

3549. For instance, a very large proportion of the West Indian men are what I might call domiciled in the West Indies; they were born and brought up there in a particular island, and they are really n number of private practitioners receiving Govern- ment subsidies. I think that applies, to some extent, in Barbados and Jamaica. Do you not think that constitutes rather a difficulty in this grouping?-It is, I agree, and then you have the additional diffi- culty that some of these West Indian Islands are. some more, some less, independent bodies, having, their own Government, and so on, but I think there are advantages in grouping.

3550. They all have; you are rather under a mis apprehension about the Government in the Colonies; you know the administration is run by local Govern- ments, is it not?—Yes.

3551. Not by the Colonial Office?-No; I quite understand that.

3553. The funds come from the Colony, not from the Imperial Government ?-I quite understand that. 3553. In the West Indies there are something like fourteen Governments? Yes,

3554. Those would all have to be persuaded, except some few extreme cases?-Wo quite appreciate that; the doctors who have been advising us; the men who have been in the Service all appreciate the difficulty. but we do put it forward as an idea to be worked towards, and we believe these Governments can be persuaded to see the advantage of it.

3555. You said you thought the people who found the money should decide what kind of Service they would have?—Yes,

119

[Continued.

3556. That is you would leave it to the West Indian Colonies to decide; if they could not have a highly paid medical man at £700 a year, you would let them go where they liked to get that medical man-As long as they know, as long as the British Government, which has more responsibility, knows that the standard of Medical Service in these dis- tricts would fall.

3557. Does that follow, that it would fall ?—Yes. 3558. The United States?-The best men in the United States would not be attracted.

3559. It might be quite a good jub for the average man P-It is an experiment, like another, which might be tried, but I was under the impression that we were rather anxious to keep up the bond between British Dependencies and the Old Country, and that a good deal of sacrifices oven would be made in order to keep that bond up.

3560. But it is a West Indian Colony you were aaking to make a sacrifice ?—I understand they are part of the British Empire.

3561. They have had to make some sacrifices, and they are the least wealthy parts of the British. Empire? I do not want to minimise the financial

and other difficulties, but it is a question that has to be faced. We want a certain standard of Medical Service; if so, it has to be paid for.

3562. And you think that standard of Service can be given by any man who has got a British Medical qualification rather than a man trained elsewhere?— Generally speaking. One knows there are greate. differences between the American degrees that. between the British degrees.

3563. No matter whether the man is black or notí --No distinction at all.

3564. The second group was the Mediterranean group? Let us say at once that is a mistake. It is not big enough to form a group; the Mediterranean people would have to come in with the minor Colonies. 3565. You mention an Eastern Asian group that would comprise Hong Kong. Straits Settlements, Malay States, anything else; Ceylon ? And China, Wei-Hai-Wei.

3566. Do you take Ceylon? I am rather puzzleȧ to know what position you give Ceylon in those arrangements?-Do they come under the Service at

3567. Certainly, in so far as there is a Colonial Service. Yes,

present?

3568. I wondered where you would put them; how you would put them in a grouping system? Subject to what I have already stated, we realise this group- ing is not a very simple matter, but it does not soun to us to be insuperably difficult to group, for the purpose of the Advisory Committee at home.

3569. You say the advantages of such grouping are great, particularly as bearing on leave and pro- motion. I cannot see how the question of leave comes into it? The bigger the Service, the more easy it is to give leave. It is not a question of grouping it: it is lending an advantage to the West African Medical Service. I do not know that the question of leave from the Gold Coast, and leave from the West African Medical Service comes into it; it is true they have the same leave conditions?-If it does not affect it, think it ought to, because one of the advantages of grouping is you have a larger area; you can keep a reservo.

3570. You mean

could be fent from Mauritius to Ceylan to let a man go on leave, or something of that sort P-Yes; I see no objection to that,

man

3571. You do not see any difficulties in a man being sent from Mauritius to Ceylon P-There is the distance, but the distance can be got over.

You would take a man from a nearer place if you could get him more easily; I imagine there are places nearer Ceylon than Mauritius from which he might be got.

3572. There are not many other minor Colonies left the Falklands. You said something about private practice which I did not understand. You said medical candidates coming here had been tacitly