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121

1 March, 1920.]

COLONIAL MEDICAL SERVICES COMMITTEE.

Da, H. H. STEWART.

FOURTEENTH DAY.

Monday, 1st March, 1920.

PRESENT:

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

LISUT.-COL. BIR HARRY VERNEY, BART., D.8.0. SURGEON REAR-ADMIRAL SIR HUMPHREY D. ROLLESTON, K.C.B., M.D., F.R.C.P. MAJOR-GENERAL SIR W. B. LEISHMAN, K.C.M.G., C.B., M.B., F.R.C.P., F.R.S., K.H.P., A.M.8.

[Continued

LIKUT.-COL, SI 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.S., L.R.C.P. MR. A. FIDDIAN.

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

Dr. H. H. STEWART recalled and further examined.

8712. Sir James Fowler: Do you think it would be possible to classify stations in relation to the number of successive tours to be spent at that station? You mean from the point of view of the individual Medical Officer?

3713. Yes? That you should classify stations into three or four categories?

8714. One-tour stations, two-tour stations, and three-tour stations?-Yee; I think in certain cases that would be quite possible; especially in the case of the more senior Medical Officers, it would be very desirable to have such continuity of policy.

3715. It is prima facie desirable, is it not, that an officer should stay at a station at least two or three tours; we have heard so; that he gets interested in his work, and the natives get interested in him? Yes, Sir; think that is quite correct.

3716. Are there any stations where you would say that a man should stay one tour only; I do not want you to name them?-Yes, those stations which have only recently been opened up and where the amount of medical work, and the amount of civiliantion among the natives is, you

may say, extremely

elementary. Under those conditions, it does not really very much matter whether a medical officer returns twice in succession to such a station.

3717. Then, there might be a station where he should certainly stay two years?-Oh! yea, certainly. 3718. What is the limit of tours which you would assign to any station, would you say that three tours were enough, or four? I think it is very difficult to lay down any hard and fast rule, because, in some cases, you might be dealing with officere who were specialists to whom any hard and fast rule could not apply.

3719. Put that aside?-Putting aride the case of a specialist officer, just the ordinary medical officer? 8720. Yes I should say not more than three tours in succession, as a rule. As I say, it is very difficult to lay down hard and fast rules for anything like that.

3721. Chairman: What do you call a tour?-The present tour is 12 months.

3722. 12 months East Africa?-No, Sir, West Africa.

3723. Sir James Fowler: Would you favour the retention of the gratuity at the end of nine years if a man likes to take it P-Yes, I would favour the retention of the gratuity.

3724. Would you consider the fact that few had taken it showed that it had had little or no in- Auence? No, from one point of view, probably the result of having that gratuity is to make the medical officer considerably more contented than he otherwise would be for instance, if he knows that, in his tenth year if anything happened to him his family would be entitled to £1,000 as part of his estate. I know it is a source of comfort to many medical officers when they reach that seniority.

3725. And the fact that he might take that at the end of nine years might influence him in entering the Service?--Yes, oh! certainly.

3728. Although he changed bis mind afterwards P- Certainly I think that would have a very beneficial effect, the retention of the gratuity.

3727. At what age do you think a man

ought

to get his pension P-Well, the age at present laid down, I think, is 50 years; you can retire with a pension, or after 18 years service.

comes

3728. Whichever comes first P-Whichever flat. If we take the average age of the medical officer as being 25, he is a comparatively young man when he retires with his pension. That again is a great attraction to many men, that they can get a pension while they are still fairly young men. 3729. Say, at 439-43, yes, in some cases 43; any way between 43 and the later forties.

3780. What pension do you think would satisfy men who retired after 18 years service?-Well, I am afraid that is a very difficult matter to give you uns figures about, because the cost if living is going up daily, and the general financial position is so difficult to ascertain.

3731. In the present situation P-In the present situation; if we were arguing on a pre-war basis it would be easier to state, but the difficulty is to state values from day to day.

3732. Were men satisfied with the pension in pre-war times?-Speaking generally, I do not think they were satisfied with the pension. I think they

1 Murch, 1920.]

MINUTES OF EVIDENCE.

DR. H. H. STEWART,

thought, even after 1914 they still thought, the pension erred on the small side.

3739. You spoke of the absanos of a policy towards the natives. Now, what policy -Polioy towards the natives, towards the medical staff, I think; towards the medical administration.

3734, I will take the policy towards the natives. Do you favour the policy of bringing the natives as ruuch as possible under the influence of modern medicine? Yes, Sir, most emphatically.

3735. You think everything shou.. be done to bring the native under the influence of modern medicine/ -Yes, Sir.

3738. That, broadly speaking, should be the policy? -Yes, I think that should be the principle which we should keep before us.

"The

3787. The Medical Department in relation to the Government; was that a point on which you wished to say something--I think I brought up that before on the question that there had been no definite policy with regard to the Medical Department. The attitude of the administrators in the past towards the Medical Department has been extraordinary and I think nothing will show it better than this. This is Sir Frederick Lugard speaking, he says: British staff of the Medical Department, though re- duced by 45 per cent, during the war, bas, with the aid of motor-cars, and additional native staff, worked very successfully. The pre-war cost in 1914 was £128,800, and I think the cost in 1919 for a somewhat depleted staff is £127,000. The normal cost should not I think exceed £100.000." That is a reduction of £23,000 on the pre-war 1914, and that is practically Sir Frederick Lugard's speech to the Nigerian Council, in which he foreshadowed great outting down of the Medical Department's expenditure generally, despite the fact that instruments, drugs and equip ment cost roughly double what they did in 1914; yet none the leas he was prepared to reduce our estimates from £123,000 in 1914 down to £100,000 at the present day. I think that shows the point of view far better than any words of mine.

3738. That would reduce your efficiency by 50 per cent. Yes, Sir, that is practically what it means. 3739. Do you think that there is room for a college for the training of a subordinate staff ?-At the present moment, no, I do not think the time is ripe yet for a venture of that description, because the natives as a whole are not educated up to that standard yet.

3740. Do you know other Colonies on the coast ?--- I have been just ashore at Acora, Sekondi, and Sierra Legne and Gambia. I have been in all these Colonies. 3741. Assuming they are all to be taken in, is there a personal element amongst the natives sufficient to produce a fair number of students at a college of that kind?--Yes, I think you would attract a certain number of natives purely from the novelty at first of such a college; it would attract a great many natives from the novelty, because nativos are sttracted, no doubt, by any novel, or new proposal; it has a great influence upon them, but I do not think, as a serious proposition, they would take up medicine. There are only a few of the professional men's sons who go to England to be educated; there are very few medical men in proportion to the natives. 3742. Would there be enough to produce twenty students a year?-No, I do not think there would be enough natives to produce twenty students a year, considering what the cost of education would be for those students.

8743. Chairman: You do not think you could find 20 youths in Lagos who would be suitable for training for the medical profession P-I daresay we should find them, but whether they would be suitable in all respects from the point of view of personality, and the general point of view of medicine

3744. I thought you were talking from the educa tional point of view?-Yes, from the general point of view of medicine I am speaking; whether it would be desirable to introduce such a college or such a school at the present moment.

125

[Continued.

9745. The material is there if you wish to institute a college? Yes, but I think you would admit that any medical college must be based on sound education first of all.

8748. Yes, what I was asking you was, would it not be possible to find sufficient youths in Lagos alone to study at such a college properly educated? -As far as I know I do not think you would get natives to the number of 20 a year possessing the standards which are laid down by the British Medical Council for a medical student to posSEAS.

The stan- dard of Latin, French, Mathematics; the general educational standard is not up to that of the English medical student.

3747. Sir James Powoler: We are discussing a sub- ordinate Medical Service; I should not like to have to say exactly what subordinate meant? Would it not necessitate giving them a degree!

8748. A qualification?—A qualification. 3749. A license to practise in A subordinate capacity; analagous to the Indian Subordinate Ser- vice ?--Yes.

8750. Chairman: The senior Cambridge local

examination; is that sufficient for training for a subordinate Service?-Looking at it purely from the point of view of a subordinate Service.

9761. Similar to the Indian Subordinate Medical Service? Just now I am afraid I was taking it from the point of view of the English medical standard.

3752. No, taking it from a subordinate service point of view -I think for a purely subordinate service you probably would find sufficient candidates. 3759. Sir Harry Verney: I want to ask your views about recruitment. Do you know the present system of recruiting for the West African Medical Staff?- The present system of recruiting, as far as I know, is purely through the various medical schools and through the medical Press by notices when vacancies occur in the various Colonies.

3754. Do you think that is satisfactory ?-Well, I do not think it is satisfactory, because I do not think the West African Medical Staff is brought promin- ently enough before the various training schools, and schools which supply candidates.

9755. How do you think it could be improved P Well, that rather depends on the general improve- ment of the West African Staff pay and prospects. 3768. Assuming for the moment that your recom- mendations were adopted for the improvement of the Staff, how would you set to work to improve the recruiting?—If the recommendations were adopted for the West African Staff, the greatest asset from the recruiting point of view is the contented man in the Service. He ro-visits his old medical school and gets in touch like that. And then there is the question of bringing forcibly bafore the Heads of the various Schools the question of putting it to their men. Just now, if a Service career is thought of by a medical student, it generally resolves itselt into the Navy, the Army, or the Indian Medical Service. They never think of the West African or the Colonial Service, because it has never been brought to their notion.

3757. Do you think an examination would be help. ful? Well, that would be very desirable, if we could get the number of candidates. It is pure a question of supply and demand. During the war, when the demand exceeded the supply, they had to drop the examination for the Indian Medical Service.

3758. You know now that the age is between 27 and 35 preferred. Do you think that ought to stand?

No, I do not think so.

9759. Do you think it ought to be lower, or higher! -It certainly ought not to be higher, but I cannot see any objection at all to a man, say at 23, going out to the tropics.

9780. In fact, as anon as he is qualified ?-He might just qualify, if he were lucky, at 21, but as a rule you will find the average age is about 24 or 25 before they qualify,