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COLONIAL MEDICAL SERVICES COMMITTEE.

SPECIALIST APPOINTMENTS.

Paragraph 35.-The Committee deprecate the confinement of all senior and highly paid appointments to administrative work, and urge the creation of specialist appointments which would enable men to attain the highest rank and pay whilst continuing to practise their speciality (Medicine, Surgery, Gynecology, &c.). Specialist appointments should be given to of the service who have shown capacity at particular branches of work.

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The Chief Medical Officer of the Bahamas is strongly in favour of such appointments in the case of medical superintendents of institutions and medical officers of health, and he adds that the latter class should not be allowed private practice. Sir G. Haddon Smith says that in 1920 the post of Bacteriologist was created in Grenada. The Governor of Trinidad says that specialist appointments in bacteriology and public health are already in existence in the Colony. The Principal Medical Officer of Zanzibar urges the strengthening of the sanitation division, and that they should be paid at special rates; otherwise he thinks that Protectorate hardly affected by the recommendation, but urges the appointment of an Economic Biologist. The Resident thinks the appointment of specialists too ambitious for Zanzibar. The Principal Medical Officers of Tanganyika and Kenya think this recommendation most important. The Acting Senior Medical Officer of the Gambia is in favour of the appointment of specialists, especially in surgery, and of pathologists; and the Acting Governor observes that this can be done without appointing a Director General. The Acting Principal Medical Officer of Sierra Leone says specialisation to a moderate extent is practicable and desirable in that Colony, but equipment must be provided. The Principal Medical Officer, Gold Coast, says this will be kept in view; the estab- lishment of a fully equipped pathological department in the Gold Coast has been recognised. The Director of Medical and Sanitary Services, Nigeria, is in favour of creating these appoint- ments, but does not think specialists should be put out of the running for higher appointments eventually, when they get tired of their special work or less fit for it. The Governor thinks that the system should be adopted in Nigeria.

INCREMENTS AND PROMOTION.

Paragraph 36. The Committee disagree with the view that increase of pay by annual increment removes the incentive to effort. They regard the steadying of the flow of promotion as an important argument in favour of the amalgamation of services wherever possible.

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The Principal Medical Officer, Zanzibar, urges the adoption of the West African rule of advancing to a pay equivalent to the next senior grade any medical officer who has remained three years at his maximum without promotion. The Senior Medical Officer, Somaliland, points out that promotion prospects there are small and poor, but that the assimilation of the East African services would remedy this. The Governor of British Honduras is not prepared to recommend that assistant nedical officers should be given increments; the service is small, and promotion is viewed at present on the basis of a transfer to a pleasanter and more lucrative station. The Colonial Secretury of the Leeward Islands thinks that there should be a Chief Medical Officer (or if the new titles are adopted, Assistant Director of Medical Services) in each of the larger Presidencies, and that future appointments should be to the Leewards generally; at present he says promotion in the medical service of the Leeward Islands is nearly stagnant. The Governor of Trinidad says the recently adopted scales of pay provide periodical increments. The Governor of the Windward Islands says that the Governor would naturally bring to the Secretary of State's notice a specially good or specially qualified man, even if he were not European; promotion could be found, no doubt, in Trinidad, British Guiana or Jamaica. The Director of Medical and Sanitary Services, Nigeria, and the Governor entirely agree with the Committee. The Acting Principal Medical Officer, Sierra Leone, says the local medical officers had expressed themselves as satisfied with their new rates of pay only on condition that the senior posts were increased in numbers and pay. The Chief Medical Officer, Fiji, says the comparative absence of promotion prospects there is made up for by grunting to senior officers the stations with the best private practice.

TITLES.

Paragraph 37.-The Committee recommend by a majority the adoption of a nomenclature for the senior posts in medical services which would be uniform throughout the medical service. These titles are based on army style,

The Governor of Jamaica agrees to the change in the designation of the Superintending Medical Officer, which would require legislation. The Governor of British Guiana favours the new titles. Sir G. Haddon Smith opposes them. The Governor of Trinidad deprecates any change in the title of the head of the Medical Department of the Colony, and says the service is too small for the grading which is suggested. The Principal Medical Officer, Gold Coast, hopes the new titles will be adopted generally soon. The Acting Principal Medical Officer, Sierra Leone, makes some suggestions of his own, chiefly on the sanitary side. The Chief Medical Officer, Fiji, says that Colony should conform to the designations used in others. Nigeria has already submitted its own proposals.

TRANSFERS.

Paragraph 38.-The Committee express the opinion that transfers from one Colony to unother should be facilitated, and that when an officer is transferred to another Colony or moved

COLONIAL MEDICAL SERVICES COMMITTEE.

from one station to another in the same Colony he should be allowed all reasonable expenses involved, and that transfers should not be allowed to affect adversely the ultimate pensions of the officers transferred.

The Straits Settlements and Federated Malay States memo. says caution will be needed in transferring officers where the conditions of the two Colonies differ greatly (e.g., West Indies and Malaya). The Chief Medical Officer, Bahamas, points out the difficulties in consequence of the variations in the value of private practice, though he favours a system of free transfer after three years in one Colony. The Acting Surgeon General of British Guiana says that transfers are not uncommon between that Colony and the West Indies. The Governor of the Windward Islands thinks most of the Grenada medical officers would not accept transfer, being local men; and most of them he would not recommend. The Governor of Cyprus knows of no local transfers which involve loss of pay: reasonable expenses are reimbursed. The Principal Medical Officer, Kenya, says that the question of transfer is one considerably exercising the minds of medical officers; that it is generally held to be most unwise to refuse any offer of transfer on promotion, but that such offers not infrequently mean a reduction of pay. The Resident of Zanzibar is doubtful about interchange; and the Principal. Medical Officer thinks it would be easier with the senior grades: junior men would have to be kept within local groups; languages would be a difficulty, and the continuation of pension rights must be provided for. The Governor of the Gold Coast thinks that the grievances in connection with the question of transfers should be put right. The Director of Medical and Sanitary Services, Nigeria, favours the transfer of seniors rather than juniors.

HOUSING.

Paragraph 39.-The Committee recommend that the attention of local Governments be called to the fact that the very defective condition of the housing in many colonies is one of the causes of discontent.

The Senior Medical Officer, Somaliland, dislikes the doubling-up of officials (i.e., that two or more officials should occupy the same quarters), but he thinks that houses should be provided at the larger and more permanent stations. The Colonial Secretary of the Leeward Islands implies that houses are not provided for medical officers there. A Committee has been appointed in Trinidad to enquire into the provision of quarters for officers. The Governor, Cyprus, says that some progress has already been made in the provision of suitable houses, and that he hopes eventually to provide good houses for all medical officers. The Acting Principal Medical Officer, Sierra Leone, says that housing in Sierra Leone is particularly bad. The Principal Medical Officer, Gold Coast, says that that Government recognises the necessities of the case, and is doing all it can. The Director of Medical and Sanitary Services, Nigeria, regards the satisfactory solution of the housing question as vital.

CONFIDENTIAL REPORTS.

Paragraph 40.-The Committee refer to the objections expressed to the system of con- fidential reports, more particularly in respect of the failure to acquaint the individual officer with the nature of the report. They add, however, that they understand that it has recently been decided to introduce important modifications into the system, which they think would go far to remove the objection.

The only comment is from the Director of Medical and Sanitary Services, Nigeria, who is wholly opposed to the idea of disclosing the reports to those reported on. The reports, collec- tively, of many years, should give the authorities a just estimate of the man, He thinks it is usual to warn officers of their faults. But in the absence of a Director General at the Colonial Office, and an Inspector General, West African Medical Staff, the undeserving are too often promoted.

POSTING TO STATIONS.

Paragraph 41.-The Committee think it very desirable that when a new medical officer arrives he should be stationed for at least a month at headquarters, and that a man who has been doing good work in a station should be kept there for several years.

The Principal Medical Officer and Resident of Zanzibar agree. The Principal Medical Officer, Kenya, agrees that newly joined officers should not be sent straightway to out-stations, and that men who do good work in particular posts should be kept there; but he adds that it should be made worth their while to stop. The Governor of Cyprus says that English medical officers are always stationed in the chief town of their district. The Director of Medical and Sanitary Services, Nigeria, says the proposal is entirely commendable, but impracticable, owing

to the want of accommodation.

REFERENCE LIBRARIES.

Paragraph 42.--The Committee recommend the provision of at least one medical reference library in each colony, and the insertion in the annual medical report of a paragraph dealing with such libraries.

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