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128

1 March, 19:0.]

COLONIAL MEDICAL SERVICES COMMITTEE.

Da. H. H..STEWART,

it has been often the Provincial Medical Officer and Deputy Provincial Medical Officer. I know in some cases the Principal Medical Officer has not seen his own Modical Ofoers for years. For instance, the other day a Medical Officer who had been seven or wight years in the Service did not know a certain man; he had never met him.

3815. In the circumstances, calling for a special report from an officer on the officer's fitness for promotion would be of no value?-No; except that he would have to say that it came from the Pro- vincial Medical Officer under whom he was at present serving; but there have been many Provincial Medical Officers who have written reports on officers whose work they have never inspected. It simply comes down to the question of confidential reports as a

whole.

3816. Chairman: Surely the Provincial Medical Officer has seen the Medical Officer-He may have seen him, but he may not have inspected his work, except the returns which came to Headquarters, and, indeed, in many cases he has not inspected that man's work actually on the station when he was there.

3817. He is supposed to, is he not?-He is supposed to, Jes, Sir; but he cannot inspect if he is abort. handed and overworked,

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3818. Mr. Fiddian: You understand, when vacancy for a Senior Medical Officer occurs, it is not merely Medical Officers serving in the same Colony who are eligible for the appointment ?-Oh yes, I appreciate that.

3819. You think a special report should be called for on such an occasion from every Principal Medical Officer who has possible people serving under him?-- Yes.

3820. You do not think there would be any delay ? -I think there would be delay, but not any greater delay than there is at present.

3821. When you were here before, I think you rather objected to Sanitary Officers being treated an in the same grade for promotion, so to speak, as ordinary Medical Officers; you thought they were specialists, and should keep to their own line. Is that correct? Yes, Sir.

9822. You do not think a Sanitary Officer should be on the grade for promotion to Principal Medical Officer? No, I do not. Although there have been axceptions in the past which have worked very well, from the point of view of the principle of the thing I do not think it is correct.

3823. Is it not the duty of the Principal Medical Officer to administer the sanitation of the Colony P- That raises the question whether he should not dele- gate the entire sanitary work to the Senior Sanitary Öfficer, looking on the sanitary man as a specialist; he never interferes with the work of the bacteriologist and he never interferos with the work of the Director of Medical Research at Yaba.

3924. No. The Director of Medical Research instituted at Yaba does not issue orders to Medical Officers, does he P-No.

3825. Your Sanitary Officer does?-He does, and the Medical Officer has to carry them out.

3820. His general power of issuing those orders is subject to the Principal Medical Officer?-Oh! yes.

3827. Do you not think there is a certain difficulty, if you separate the two functions of the Principal Medical Officer and the Senior Sanitary Officer, of the Medical Officer being called upon to serve two masters?There is a theoretical difficulty. I think that could easily be surmounted. I think we would not have any difficulty in getting over that, any more than we have had in dealing with the far more difficult question of inter-departmental dealing with departmental officers.

3828. On what principle would you have a Principal Medical Officer selected; purely for administrative qualities? At present, it seems to me, the only effect of your arrangement would be to keep the promotion very nicely in the hands of the Medical Officers, and rule out anybody engaged in sanitation P-Yes, exactly. I think a Sanitary Officer should be a specialist pure and simple.

[Continued.

3829. Suppose the Sanitary Officer was to retort and say that the Medical Officer should be a specialist pure and simple, what then ?--He is a Sanitary Officer, specialist by choice.

3880. The other is a Medical Officer-Well, he is a General Medical Officer; he does everything; he does sanitation; he does everything.

3831. Would it not cause some difficulty getting him to put his heart into sanitation when he knows, however good the work he dues in sanitation, it will not enable him to get to the top of the Service?-I have spoken to junior Sanitary Officers, and those I have spoken to have all taken up sanitation work, I am glad to say, purely as sanitarians, and not as a short cut to promotion.

3832. I am not talking of the ordinary Sanitary Officer, but the ordinary Medical Officer, who has to do sanitary and medical work; would be not put all his money

on the medical-That would be an argument against specialisation in any form whatever, and that argument might also be carried into any profession; into the Indian Medical Service, where they have Inspectors of Jails, and those are debarred. They are purely specialists. I do not think it would hurt the Service, because we want to make the position of specialist so attractive that he gets almost as high as the Principal Medical Officer; it would be a matter, probably, of a couple of hundred pounds difference. We do not mind the more empty title: I do not think wo mind that at all. As a matter of fact, the specialist would be a great deal better off.

3833. I cannot understand why you think that a man who does his work as a Medical Officer all right, but is not fit for promotion, should be made to retire after completing 18 years or attaining the age of 50. If he is capable of going on doing the work of 1 Medical Officer, why should he retire?-When you get a man like that, who has been passed over repetedly, he is a source of weakness to the Staff, because, very naturally, he is always grumbling; he is, in fact, reducing the general morale of the Staff. You have to look at it purely from the Staff point of view. A man who is repeatedly passed over is not a source of strength to the Staff. I am not taking it from the point of view of the individual.

3834. You would retire people after a term of years? Either that, or an uge linit if he has not got promotion. I would not apply that, of course, to the specialists.

3835. What is the pay of a native nurse?-A third- class nurse, I think, gets £60 a year, plus a war bonus. I am not quite certain what the war bonus

amounts to.

3836. You spoke of it being difficult to get rid of these men P-That is when you have first-class nurses.

3897. What

first-class aro

nurses ?--First-class nurses receive £120, second-class nurses receive £90, and third-class nurses receive £60.

8898. Surely by the time a man has got to be a first-class nurse he has been effectually sifted -No, once a nurse is promoted to be a second-class nurse, he goes on automatically. Reference to the Lagoa Hospital would show that to be the fact.

3839. Do you know what happened to the School for training Government Dispensers; there was such a school, was there not?--No, I do not know what happened to that scheme.

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3840. At any rate, it is not now in force?-I do not want to mislead you'; there is an amended scheme; the Chief Dispenser at Lagos Hospital, who is native, trains natives who are apprenticed to the Government. He is a good man, but he has not got the education, bold and the general pratige over the natives that a European would have.

3841. I am not quite clear as to the position that you want to assign to the West African Medical Staff Association. You said something in your evidenco about enabling that body to guide and direct things. What sort of guidance and direction do you mean?— Public opintok..

MINUTES OF EVIDENCE.

1 March, 1920.]

DR. H. H. STEWART,

public opinion ?—Merely

public

3842. Merely opinion.

3843. Could you just enlarge a little more on the functions of the Association? The functions of the Association are to correspond with the various Colonies, the Gold Coast, Sierra Leone, and we hope to bring out some form of a paper to which individual members of the Staff on the West Coast could con- tribute as a whole, and it would be purely a matter. of course, effecting the West African Staff. I know there are many men on the Staff at the present day who would be quite willing to contribute articles and descriptions of operations, and work of that sort, to a magazine of that kind, who would not at the present day dream of writing, say, for the "Lancet," or some other paper. You quite understand the feeling that they would have with regard to that. I say that we would be able to keep in touch the Medical Officer who is stationed in out-stations, and let him know what is going on generally in the profession, what we are doing na regards professional matters, and what we are doing with regard to the other matters which may, from time to time, crop up which would be of interest to the Staff.

3844. It would be a sort of combination of trade union organ, and a scientific journal, then?--Hardly trade union.

3845. You do not object to the phrase "professional association "?-Professional association I prefer, I think.

3846. On much the same lines as the "British Medical Journal "P-Oh! you, much more humble.

3847. On much the same lines?-Well, on much the same lines as to the news, local news, and things like that. It is only an ideal which has been put before us; I do not know that we will be able to accomplish it, 3848. Dr. Hood: With regard to the classification of stations, do I understand you would classify various stations with the various grades first, second and third ?—Yes.

3849. You mean the stationa would be first-class stations ?-Yos.

at Headquarters

3850. The third-class station would be right in the bush? Yes.

3851. Do you not think it would be rather invidious if you had them classified like that; men would object being sent to a third-class station ?-Well, I think they are, more or less, classified like that at the present moment, although it is not definitely states. I believe I am correct in saying that there exists at the present moment in the Medical Department.. roster of Medical Officers, a list drawn up of men to go to certain stations, according to their seniority, and other Medical Officers go temporarily to any station which happens to be allotted to them.

3852. You must be aware of the fact that the senior of the Medical Officers are sent to the stations where there is, more or less, nbre private practice. That is looked upon as their due to be sent to stations where there is private practice?-Yes, I quite realise that.

3853. Do you not think the stations would have to be classified according to the amount of private practice there was, to give satisfaction to the Staff P I think it could be done; I think it would work. As as rule, the stations which have a large amount of private practice, or a fair amount, are the stations which have a lot of very important Government medical work.

3854. But, on the other hand, there are a lot of them which have not very much medical work from the Government point of view, are there not?-From purely the Government point of view.

3856. Purely official P-There are one or two, but only around the creeks. I think you refer to them there; yes.

3856. Where there is a lot of Government work in an out-station and no private practice, if you were to send a Senior Medical Officer, one of the older Medical Officers, to that station, would you not get him complaining ?--Yes, ho would.

3857. He would complain bitterly? Yes, he would. 3858. He would prefer to get to a station where

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[Continued.

there was a lot of private practice and very little Government work?--Yes, possibly, but there are very few of these stations, not really very many, taking the Gold Coast and Sierra Leono into consideration. 3859. There are more in Nigeria ?-There are more in Nigeria than elsewhere.

3860. You admit then, that private practice is a great cause of discontent?—I frankly admit that; I do not wish to quibble on that point. To my mind, one of the great difficultios in dealing with the West African Medical Staff is the difficulty of private practice; I quite realise that.

3861. Then, with regard to pension, you think a man ought to be allowed to retire, say, at 43 years of age, after 18 years' service? Yes, he should be allowed if he wishes to, certainly.

3862. Do you not think it is rather unfair for the Government for an experienced man rather young in years to be allowed to go? He can at the present time, I know. He can.

3883. It does not strike you as a little unfair on the Government that a comparatively young man should be allowed to go on pension ?—I think he has done the work he contracted to do; he has done good work for the Government. The question is, how many men we know have stayed on for two or thres years longer and never left the country; there is always that point of view.

3864. Then you make a comment about Medical Officers remaining at Headquarters a short time before going into the interior. You know that, before the war, that was quite a common thing; that was done?—It was an accident, as a rule.

3865. Pardon me, and even during the war, with regard to the nurses, the same thing occurred. In the case of the nurses, they were nearly always kept at Headquarters ?-It was a question of the accident of coming into Lagos, not to Calabar; the communica- tion beyond Lagos was bad.

3866. They were nearly always kept at Lagos for two or three months?-I think that should be extended to the Medical Officer in a lesser degree.

3867. Only on account of their being sufficient nurses to do the work?-I know, from my own point of view, and those who came out after me, all were sent direct to their stations.

3868. That may be an accident; the man in the interior telegraphs down that he is sick, what can you do but relieve him at once, they are much overdue?— I do not think that applies to the general principle involved.

3869. Now, with regard to the courses. Is it not your experience that the majority of medical mon, when they come home on leave, go to some hospital to do some kind of work, almost every leave?--Bome do; I do not say all.

3870. Surely the younger men moatly go to the hospitals, do they not?-Some of them go for a few days.

3871. Not seriously†-1 am afraid they do not go seriously.

3872. 1 think the bulk of them do really. Then, you complain about the equipment of the various out stations; have you ever directly examined the equip. ment ?-Oh yes, and used it.

3873. Does your experience coincide with "mine, that in most of the stations the equipment which is there is never, woll, hardly ever used?--I think, as far as it is capable of being used, it is used. think we have had in the past the wrong type of equipment.

I

3874. Take a modern microscope, for instance; have you ever been to a station where the microscope han never been used P-No.

3875. It is kept locked up?—I always kept mine locked up under lock and key, because I was respon- sible for it; it was a very valuable instrument, but I used it.

3876. You know with regard to the training of a subordinate native staff in Lagos, the difficulty has

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