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COLONIAL MEDICAL SERVICES COMMITTEE.

appointments. The Acting Principal Medical Officer of Sierra Leone prefers the selection for Appointment to the West African Medical Staff of men with previous tropical service, especially in preventive medicine. The Principal Medical Officer of the Gold Coast and the majority of his staff favour the institution of an entrance examination with preliminary interview. The Director of the Medical and Sanitary Services, Nigeria, ia in favour of the appointment of young men, and of the institution of competitive or qualifying examinations as soon as the supply of candidates warrants such a measure.

The Colonial Surgeon of Gibraltar puts forward a very interesting proposal for utilising the Gibraltar Colonial Hospital for training Surgical Specialists. The Governor points out the difficulty of finding accommodation. The Straits Settlements and Federated Malay States memo. thinks the Medical Appointments Sub-Committee should be composed of men with practical experience of tropical life.

ADMISSION BY EXAMINATION.

Paragraph 15.-The Committee express the view that if the principle of admission by examination is accepted the Secretary of State should reserve the right to appoint by selection to certain posts of a special character, for which admission by examination is unsuitable, and expressly apply this reservation to research appointments.

On this the Director of Medical and Sanitary Services, Nigeria, comments that he thinks there are as good men in the Colonial Service as out of it; and the Principal Medical Officer, Tanganyika, also thinks that special investigators might well be sought for in the Colonial Medical Service rather than elsewhere-as, for example, in the Royal Society. Indeed, if the Colonial Services cannot furnish suitable candidates, he thinks the Schools of Tropical Medicine should be brought in. The Governor disagrees; for many years to come the Colonial Service will not be self-sufficing in this respect.

GROUPING OF COLONIES.

Paragraphs 16-17.-As a completely unified service is not at present possible, the Com- mittee point out that candidates must present themselves for service in those colonies for which they are eligible according to the regulations in force; and they recommend that the Colonial Medical Service should be organised on the same lines as the Departments of the Colonial Office —that is, by groups; and that candidates should apply for admission to the service in one or more of those groups.

The only comments on this come from the Acting Principal Medical Officer of Sierra Leone, who cannot agree that candidates should be expected to apply for admission into one or other of such very mixed departments," and the Director of Medical and Sanitary Services, Nigeria, who sees no reason why the Colonial Medical Service should be organised in the same way as the Colonial Office.

ASSIMILATION OF NEIGHBOURING SERVICES.

Paragraphs 18 to 25.-The Committee urge that the Medical Services of the Straits Settle- nents and the Federated and Unfederated Malay States should be formed into one Malayan Medical Service, with one roster for promotion, and point to the assimilation of the Medical Staffs of the four West African Colonies as a conspicuous success. They recommend a similar staff for East Africa, and the gradual assimilation of conditions of service, pay, pension and gratuity in East Africa to those in West, so as to facilitate the ultimate formation of one medical staff for British Tropical Africa, which they think may be possible as intercommunication improves. They think, however, that the assimilation of the conditions of service between East and West Africa presents difficulties, and that the question cannot be re-opened at present, though they favour the interchange of senior officers. These are, in their opinon, the only Medical Services that can be assimilated.

The Chief Medical Officer of the Bahamas thinks that the formation of a unified West Indian Medical Staff is the ideal; officers to be capable of being freely transferred after three years in one colony; but the variations in the value of private practice would create difficulties in the way of transferring officers, especially senior men. The Governor agrees generally, and thinks that the Colony should have the opportunity of considering whether it should be included in any unifying scheme that might be adopted for the Medical Service of the West Indies. The Principal Medical Officer of British Honduras says that assimilation of the Medical Service of the West Indies is impossible; local conditions differ too widely, and many medical men regard their Government salaries as retaining fees simply. The Governor agrees. The Administrator of St. Lucia agrees that a unified service is the ideal, but thinks the difficulties insurmountable. It might, however, be possible to have a grouped Medical Service. Acting Surgeon-General of British Guiana says that to all intents and purposes that Colony and the West Indian Islands are already treated as one Medical Service, except in the matter.of pay. The Governor of the Windward Islands fears that the difficulties are insurmountable, and points out that many local candidates for medical appointments in the West Indies have no wish to serve away from the immediate neighbourhood of their homes; nor will the Wind- ward Islands be able to pay on the same scale as Trinidad or British Guiana. The Straits Settlements and Federated Malay States memo. says the unification of the Malayan Medical Service is desirable. The Government of Nyasaland think that the Protectorate Medical Service might gain by the creation of an East African Medical Service. The Principal Medical Officer

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of Kenya sympathises strongly with the scheme, but thinks that the inclusion of Nyasaland and Somaliland would be a disadvantage. The Senior Medical Officer of Somaliland thinks that the assimilation of the East African Medical Service, which, he says, has practically been effected already, would make it easier to get Medical Officers for Somaliland, where the outlook is at present so poor that Somaliland cannot expect to get them. The Governor agrees, and assumes that if the East African Medical Services were unified transfers would be compulsory. The Principal Medical Officer, Zanzibar, thinks it very important that neighbouring services should be grouped as soon as possible; but the Resident, agreeing generally, doubts whether free inter-change of Medical Officers would make for efficiency, owing to the differences of local conditions, languages, private practice, &c. The Governor of Trinidad thinks that the establish- ment of a unified Medical Service for the West Indian Colonies alone would be difficult, owing to differences in salary, rates and conditions of service and pension. The Governor of Cyprus sees no advantage in linking the Medical Service of Cyprus with that of any other Colony, even if it were practicable. The Governor of Malta thinks association with an organised Medical Service would be of advantage to the local service, but it is inadvisable at present to alter exist- ing arrangements. The Chief Medical Officer of Fiji seems doubtful us to the amalgamation of the Medical Services of the Colonies included in the Western Pacific High Commission. The Commissioner of Wei-Hai-Wei thinks that the Medical Service of Wei-Hai-Wei should be amalgamated wth that of Hong Kong, medical officers being seconded from Hong Kong for service in Wei-Hai-Wei, His Senior Medical Officer agrees. The Chief Medical Officer of Seychelles sees the difficulty of amalgamating the medical service of that colony with any other. but points out that medical service in Seychelles is very much less attractive than elsewhere. The Acting Principal Medical Officer of the Gold Const thinks the West and East African groups would have to be kept apart; unification, his staff agree, is only practicable to the extent of grouping neighbouring services. He adds that nine of his staff have informed him that they doubt whether the West African Medical Staff would gain by unification. The Director of Medical and Sanitary Services, Nigeria, favours ultimate amalgamation of the medical services of the East and West African Colonies, and prefers the transfer of seniors to that of juniors.

INSPECTORS.

Paragraph 26.-The Committee recommended the appointment of Inspectors of Medical Services for East and West Africa respectively. For other parts of the Empire they said occasional visits by medical men of authority would be sufficient.

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The Straits Settlements and Federated Malay States memo. says that visits by experts are advisable for special ends, but routine inspections by travelling Deputies of the Director General are unnecessary there, and might interfere with the functions of the local heads. The Principal Medical Officer of Kenya expresses the opinion that the appointment of an Inspector for the East African Medical Service would result in increased efficiency. The Senior Medical Officer of Somaliland says that Inspectors should be appointed, and that Somaliland should be regularly inspected and brought up to date in medical" inatters. The Governor agrees. The Principal Medical Officer of Zanzibar would welcome the visit of Inspectors. The Governor of Tanganyika is not satisfied as to the wisdom or necessity of such appointments; inspection is essential, but it should be done by Heads or Deputy Heads of Medical Departments. The Chief Medical Officer of Fiji regards the appointment of travelling inspectors as very important, and thinks such an appointment the only one likely to be of advantage to the Western Pacific High Commission. The Governor of Trinidad concurs in the Surgeon General's suggestion that the appointment of & Sanitary Commissioner for the West Indies would be a good thing; he should visit, confer, report and advise, but have no executive authority or control. He would be an officer of the Imperial Government. The Governor of the Windward Islands thinks an experienced man from the Colonial Service might visit and report on the different colonies, but he is against an Inspector General. The Acting Principal Medical Officer of Sierra Leone advocates the appointment of one or more Inspector-Generals, and the Principal Medical Officer of the Gold Coast favours the appointment of Inspectors (though some of his staff dissent). The Governor disagrees, on the ground that they are unnecessary and expensive. A similar difference of opinion is revealed in Nigeria, where Dr. Rice advocates the appointment of un Inspector General for the West African Medical Staff and thinks that inspeeting officers should be members of the Colonial Service, not outsiders; whereas Sir Hugh Clifford thinks that the appointment of an Inspector General for the West African Medical Staff would be unnecessary and mischievous. He holds that the heads of the Medical Departments would do the inspection work better, and that their authority would be undermined by the appointment of an Inspector General. Dr. Rice's idea of the function of an Inspector General is, in Sir Hugh Clifford's opinion, entirely opposed to the principles on which the government of Crown Colonies is based. He regards the analogy of the Inspector General of the West African Frontier Force ay misleading.

PAY.

Paragraph 28.-The Committee are of opinion that Colonial Governments, if they desire to obtain the services of competent medical men from this country, must increase considerably the present scale of salaries, and that an initial salary of at least £600 will be required.

The Straits Settlements and Federated Malay States memo. says that £600 should be the minimum, but it should be supplemented by a scale of local allowances to ensure approxi- mately equal purchasing power. The salary should be enough for a married man.

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