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126

1 March, 1920.J

COLONIAL MEDICAL SERVICES COMMITTEE.

DR. H. H. STEWART.

3761. You think as a general rule it would be wise and safe to take a man as soon as he had qualified? -Yes, as a general rule. I think there would be no need to make a hard and fast rule, because we would be losing candidates and very valuable men.

3782. I want to ask you a little more in detail about what you were saying of every officer having to stay at Headquarters. In your case that happen- ed? In my case that happened; yes, I did stay at Provincial Headquarters.

3763. Do you think it could be arranged for every officer to do the same under normal conditions ?-- Yes, every newly appointed officer; I do not think it would be difficult to arrange that he should go out a fortnight before he was due to relieve an officer and he should be kept a fortnight at

Head- quarter station.

3764. What was your own case; did you go out the moment you passed the Tropical School ?-No; I was kept here two months. I went out on the 24th September and the Course finished on or about the 23rd July.

3765. You could have gone out ?-At the ordinary fortnight's notice.

3766. Is that the case with most of your colleagues? That was the case with all the colleagues I have apoken to, and I have spoken to a great number on this point.

They simply came out and proceeded

direct to the station.

3767. And they could have come earlier if they had come as soon as they left the Tropical School?-- Yes. Two medical officers came out after I did, and they passed through the Tropical School practically at the same time. There have been those cases again and again.

3768. Is that the case now?-I am afraid I have no knowledge just now.

We have not had any candidates.

3769. But before the war you think the majority of the candidates had an interval ?-Oh! yes, there was a decided interval in normal times.

3770. You have quoted from Sir Frederick Lugard's Report. Have the other Governors taken the same view, or have you got rather a special case there in regard to the Medical Department?-That I am unable to say, or give any very definite information, because it would be outside, in another Colony, but I think is a special case,

3771. Presumably you have selected the worst case? -Well, I have not chosen this particular case from similar ones; the other Colonies have not been amal- gamated, and the Governors have been shifted.

3772. Is not that the Annual Report from which you were quoting? No, this is a special Report of seven years work by Sir Frederick Lugard.

3773. This is the Report where the suggestion is to reduce to £100,000 P-This is the one in which the principles are laid down.

3774. Sir Humphrey Rolleston: You are in favour of these Refresher Courses?-Yes, I am,

3775. How often ought they to occur?-Well, at present we have one at the end of the fifth year, and I should certainly advocate that there should be another one, say, at the end of the tenth or twelfth year. I do not want to lay down very accurate figures, because probably there will be some objection found on going through the matter, but to lay down only one Refresher Course is certainly not sufficient.

3776. Would you make it compulsory ?-They are compulsory at present; the fifth year one ia com- pulsory at present. I certainly think there should be another compulsory one, perhaps at the tenth or twelfth year.

3777. It would be a good thing to assimilate the officers, those who do administrative work ?-It would be an excellent thing, not perhaps on the same lines as a junior medical officer, but a definite course of instruction on hospital work.

3778. You want to know what the junior officer is doing?--Yea.

3779. Unies he has a course of that kind he can hardly know the bearings, or the demands which

[Continued.

junior men have made ?-I did not quite mean the compulsory element entering into it so much. He would not have to work for two months or two and a half months as a purely administrative officer.

3780. Are you in favour of making it not com- pulsory, but it should count towards promotion, so that to all intents and purposes it would be com- pulsory? More or less it would be compulsory.

9781. You are in favour of a, man showing some special bent for surgery or bacteriology being allowed to be a specialist I am very much in favour of that; I think that is very good.

the

3782. You would allow him to go up to equivalent of the higher ranks?-I would not allow him to go to the Director or the Principal Medical Officer's salary, but next to that.

3783. Supposing a man conducting research by himself-probably some men are able to do a certain amount what is your experience about that P-Of course, it is very limited; by yourself it is a very limited amount of research that you can do. You can do research probably in Bacteriology and Path- ology to a certain extent, examining blood and examining stools of various patients and natives. You can do a certain amount of that.

3784. Entomology?-Entomology too.

There are certain things which need more elaborate instruments and apparatus than there are at one's disposal or that one can get at what is called a "bush station." It is rather difficult for a man; it depends upon whether a man prefers to specialise in Bacteriology or go in for Venereal Disease or Ophthalmology or other subjects.

3785. Would it not be justifiable to make any work which a man manages to do on his own initiative count to a certain extent in regard to the question of promotion? You mean from the point of view of original research?

3786. Yes P-No, I do not think it would be very fair to do that, because some men at the larger stations have practically, as you may say, the work of a busy general practitioner, and really have very little chance for research work, and it would, be rather hard to penalise that man who is working from early morning till late in the afternoon merely because he is not one of those at an out-station who can do research.

3787. Then with regard to the question of pro- motion, I think you mentioned the occurrence of instances in which the Principal Medical Officer's Report has not always been accepted with regard to promotion; have you not? Yes, that is the general idea among the Staff.

3788. Perhaps it is rather a difficult question to answer, but on what basis then is promotion popularly supposed to depend upon seniority?-I think it is largely on seniority. I believe I am correct in saying that when a question of promotion comes up for Principal Medical Officer or Provincial Medical Officer all his recorda are gone through by the Medical Advisory and Sanitary Committee, carefully gone through, his confidential reports, and other matters; that is my assumption. But I am not quite sure of my ground when I speak of Senior Medical Officers,→ whether he also is considered by the Sanitary and Advisory Committee; and I think it is really the Senior Medical Officers who should be sifted-if I may use the word-most carefully, because that ought to be the most definite scrutiny the selection of your Senior Medical Officers. After all, if you got the

right Senior Medical Officers, the question of efficiency of the Principal and Provincial and Deputy Pro- vincial Medical Officers is a matter which more or lena will right itself; the important step is to select the right man from the medical officers, and we have the idea that when a man's name comes up for promotion he is not considered specially for promotion, and special reports are not called for from the Principal Medical Officer; they simply take his general confidential reports for ten, twelve, or fourteen years into consideration,

1 March, 1920.]

MINUTES OF EVIDENCE.

DR. H. H. STEWART.

3789. Then is it really that the report of the man on the spot ought to be, in a way, more important than the complete survey of a man's record ?-1 think it would form a very good guide. At the same time, I do not intend that the complete survey of his work should be neglected; but if a special report were called for, that ought to be taken in con- junction with the complete survey. I am specially speaking about Senior Medical Officers, because I know the idea that Senior Medical Officers are not subjected, perhaps, to such a close scrutiny as they might well be.

3790. Would you, on general principles, think they ought to be surveyed by a Medical Board sitting in London? Yes, I think that is the fairest and most impartial way.

3791. You are in favour of the Advisory Medical Board? Oh yes, emphatically.

3792. What do you think about the question of there boing a Director-General-1 mean a man who would be very much in the position of the Board, and perhaps would have more bowels of compassion than a Board; a single man?-He might be to a certain extent er officio a member of the Advisory Board. It would be possible for him to meet Medical Officers.

I

3793. Do you agree with the existence of such an officer P-Yes, I do. I brought that up before. very much prefer the existence of a Director-General of the West African Medical Staff,

A

3794. We are talking of two different things. Director-General is a man who would be here perhaps the head of the Advisory Board. He would be an official to whom your officers might come and make any reporta that they thought desirable ?-You mean after visiting the Colonies in person.

3795. Oh no. I should call that an inspector?- No; I would not be in favour of that, unless he made himself personally acquainted with what was going on in the Colonies, knew all the men who were working, and the conditions under which they were working, and could speak with first-hand information of the country. I do not think it is at all advisable to have a man, simply one man, to deal with pro- motions, I would much rather have a Committee.

3796. These inspectors would be a kind of Travelling Commissioners, who would go round pretty constantly. To whom would they report? Would they report to the Governor, or to the Colonial Office through the Governor? They would report to the Colonial Office through the Governor.

3797. Would the kind of man whom you would recommend for that appointment be a man who had been Senior Medical Officer already, or would he be outside it?-Oh! no; I think it should be looked upon in the case of the West African Medical Staff as the highest rank in the Staff, and seid lust time I think it would be the rule that the highest posts in the Service should be taken from the Ser- vice, as in the case of the Army and the Navy and the Indian Medical Service. They never go outside and bring men into the Army Medical Service; they always promote from their own Corps, and I think that is a very sound principle,

3798. I gather that you think that the personnel is very inadequate?—Yes.

3799. And that that is really false economy ?—Yes, absolutely. A man cannot do good work if he is simply a travelling pillman, and goes from place to place in a motor-ear, and has a large district and sub-districts to look after; he cannot do really good work; he is tired out travelling continuously, He cannot do good work, and districts, generally speak. ing, are really far too large for one man to adequately luck after.

3800. You think that there is evidence that it is had economy from the point of view of the adminis trator P-Yes. You mean, from the point of view

of running auch a

3801. Well, running the Colony?-Yes, very dis- tinctly. There is one very serious question which

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[Continued.

will have to be dealt with in Nigeria, and I think on the West Coast generally, and that is venereal disease. It is absolutely impossible for any one nedical officer with a population of 400,000 or 500,000 natives to get at, or examine, or instruct in any way adequately, the natives in what venereal disenso is and what it means. You cannot combat venereal disease if you only have the staff you have at the present day. I know it is becoming a very serious problem in Northern Nigeria; the result is diminution of the birth rate.

A

3802. So that the prosperity of the Colony is dia tinetly impaired by the inadequate Medical Service? -Oh very distinctly; although, of course, it is a difficult thing, possibly, to bring home to the layman -the Governor; but that is the fact.

3803. It is an important thing to bring home, if you could, as an argument in favour of having an efficient medical service?--Yes, Sir, it is a very important thing. We have tried to do that already in a Memorandum which we have presented to the

Governor in Lagos. We have pointed out that it would be very false economy to cut down medical estimates and medical personnel merely because they do not produce revenue. It produces an enormous revenue in health and prosperity among the com- munity.

3804. Mr. Fiddian: You said a moment ago that you thought the highest posts in the West African Medical Stuff should be reserved to members of the West African Medical Staff?--I did, yes.

3805. Are you prepared to adopt the corollary to that, that members of the West African Medical Staff should never be given posts anywhere else?-- Yes, I am perfectly prepared to do so.

3806. Do you think that all your colleagues would accept that proposition?-I do not like to speak for all my colleagues, but I have spoken to a number of my colleagues, and they desire me to say that they go into the West African Medical Service with the intention of serving in West Africa, not with a view to making it a stepping atone to another Service of another Colony on promotion.

3807. A very strong sense of the West African Medical Staff, and a very weak sonse of the Colonial Medical Service ?--Yes.

3808. How far would they carry on the principle? Supposing they are invalided from West Africa, are they prepared to take their pension and never apply for employment anywhere else? That, of course, I cannot say.

3809. About this question of promotion: I under- stand that your difficulty is chiefly about the promotion to Senior Medical Officer?-That is a very important point.

3810. We know the Principal Medical Officer is called upon to report always on the men serving under him? Yes.

3811. Among the details, his fitness for promotion? -Yes.

3812. Do you not think it would be rather-I will not say insulting, but invidious to ask a Principal Modical Officer, when the time comes up for a man to be considered for promotion, to report specially on his fitness, as if he had never thought of it before? -No, I do not think so, knowing what I know generally about confidential reporta, the fay that confidential reports as a rule are drawn up.

3813. What do you think the Colonial Office would be justified in doing if it found a Principal Medical Officer whoso special report under those circumstances differed from his annual report on a man's fitness for promotion? Do you not think it would be a matter to take rather serious notice of P-Yes, I quite agree. 3814. Do you not think the Principal Medical Officer -if there are such persons-who had been rather careless about his annual reports might remember that, when he is called upon for his special report. and might look back to see what he had reportedl on an officer-Unfortunately it is not always the Principal Medical Officer who reports. In the past