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(3) As to whether another man should be sent at once to the Seamen's Hospital to take the place of a man selected for an appointment, and with regard to the number of men to be selected from the second half-yearly list, we must be guided by circum- stances, but I think that, knowing the number (roughly) of vacancies which occur in a year the vacancies which have already been filled, &c., and looking to the fact that doc- tors are always being required for special purposes connected with railways, surveys, expeditions, &c., we ought not to run much risk of having more doctors under instruc- tion than we can find places for.

(4) I think that all the men who are sent to the Seamen's Hospital should be re- quired to sign an agreement binding them to repay the cost of their instruction, if they eventually refuse to go to Africa.

(5) The eight Possessions should be required to contribute to the cost of training, the amounts of the contribution being settled on some reasonable basis. I think that this would be fairer than making each Possession pay for the cost of training of every officer which it took.

(6) The seventy-four appointments in the eight Possessions should be graded for promotion purposes.

In doing this it might be necessary to take into account the amount of private practice. Thus the Chief Medical Officer at Sierra Leone has an official salary of £500, but he probably makes as much, if not more, by private practice. We could then arrange the posts of Chief Medical Officer in the eight Possessions in order of value, and grade the rest of the doctors into two or more classes. On the occurrence of vacancies men would be moved up in order of seniority through the different classes, being transferred where necessary to the Possession where the vacancy occurred, until they came to the grade of Chief Medical Officer, in which they would be promoted, in due course, from the least to the most valuable. Some special arrangement would pro- the post of Chief bably have to be made with regard to one or two appointments, e.g., Medical Officer of Gambia, which is of small value, and the post of Colonial Surgeon, of the Gold Coast, which is as valuable as some of the appointments of Chief Medical Officer in the other Possessions.

(7) Every opportunity should be taken of transferring doctors from Group (a) to Groups (b) and (c), and vice versa. This will not only enable us to get a better stamp of man for Group (a), by being able to offer him a better prospect of promotion, but will tend to produce men with a wider knowledge of tropical disease, and therefore Dr. Manson has mentioned in conversation how very better fitted to grapple with it. desirable it is that men should have this all-round knowledge, and has given some recent instances in which very able men have gone astray through want of this general knowledge, e.g., by attempting to apply in (say) an eastern Colony the methods which had been found suitable in a West African Colony—or, by attributing malaria to cer- tain conditions which a knowledge of similar conditions in other Colonies would have shown to have nothing to do with the matter, &c.

As regards 3, this would no doubt form a useful supplement to the training which the men would get in this country, and we should urge the Colonial Governments to adopt the suggestion so far as possible.

There are one or two minor points to which I should like to call attention.

(a) European nurses are now being gradually introduced into our West African Colonies, and it is a question whether we should not organise a service of nurses for all the eight Possessions on lines somewhat similar to those proposed for the doctors.

(b) The medical and sanitary reports which are sent home from the West African Colonies are in great need of improvement. They are burdened with useless detail, they are incorrect, unsystematic, &c. My attention was first called to the unsatisfac- tory nature of our Colonial medical reports by the British representative at the recent Leprosy Conference in Berlin. He had the greatest difficulty in getting anything like satisfactory statistics regarding leprosy in the Colonies. The figures were given in one report and not given in the next; then the reports were made up for different periods in different Colonies, &c. I found that Dr. Manson fully corroborated this view, and That some uniform scheme he suggested, in his letter of the 15th of October, 1897,* for the medical reports of the various Colonies be devised, a scheme in which useless figures and tables, involving much labour and expense are omitted. Such reports should be sent in on a definite date and brought out as one volume, which should be

• 22442/97: not printed.

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freely circulated in the service, presented to the more important medical libraries, and placed on sale. Further, that the Colonial medical officers should be requested and encouraged to contribute to these reports special papers on the diseases of their respec- tive Colonies, which papers, after due editing, should appear as an appendix to the annual report.

By these means the value of the Colonial medical reports would be very much enhanced, the members of the Colonial medical service would be brought together in a measure, useful knowledge acquired one Colony would become quickly dissemi- nated, men would be encouraged to work and to vie with each other, and, doubtless, in time, important additions would be made by members of the service to medical science.

"The exact scheme of the reports might be devised by senior and experienced Colonial surgeons."

With regard to the settlement of this scheme, Dr. Manson has privately suggested that a small committee of ex-Colonial Surgeons, presided over by Sir Chas. Gage Brown, would be the most suitable. Sir C. Gage Brown, I know, would be willing to help, and we might add two or three ex-Principal Medical Officers, such as Sir W. Kynsey (representing Eastern Colonies), Dr. Crane (representing the West Indian Colonies), and Dr. McCarthy or Dr. Rowland (representing the West African Colo- nies). The scheme, as settled by this Committee, could then be submitted to Dr. Manson for any further suggestions.

(c) Dr. Manson also suggests, in the same letter, that, "The notes of the physical examinations of candidates for employment in the Colonial service, and of members of the service, made by the medical adviser of the Colonial Office, should be kept according to a special form, in a special book, and that this book be the property of the Government.

"The desirability of possessing a continuous record of the medical history of every member of the service, a record which could easily be referred to, is obvious. Accu- racy, continuity would be secured, and be independent of the tenure of office by any given medical adviser.

"In this connection I would suggest that every Colonial officer on his appointment should receive a health sheet, similar to those in use in the Army, in which illnessés, invaliding, leaves, and medical examinations should be entered by the Colonial surgeons from time to time."

This will, no doubt, be approved. The Crown Agents can then be instructed to supply the book, and the necessary steps can be taken to introduce the Army Medical Health Sheet.

H. J. R.

Enclosure in No. 1.

An Introductory Address on the necessity for Special Education in Tropical Medicine, delivered at St. George's Hospital at the opening of the Winter Session, October 1st, 1897, by Patrick Manson, LL.D., M.D. Aberd., F.R.C.P. Lond., Lecturer on Tropical Diseases at the Hospital.

GENTLEMEN,

I HAVE been asked by the authorities of this school to speak a word of welcome to those of you who to-day commence your systematic medical studies. I congratulate you on two things-one, your choice of medicine for your profession; the other, your choice of St. George's for a school. Though the medical profession is by no means a bed of roses, perhaps more than any other it is one which to him who follows it in the proper spirit is full of good things. It is intensely interesting; it is a recreation as well as a study; its influence on society is rapidly increasing; it is a fairly satisfactory means of getting a livelihood; and, above all, it is full of boundless opportunities for doing good. What reasonable man could wish for more? As regards your school, apart from its associations with the past-associations such as few can boast-I can con. fidently claim that of all the metropolitan medical schools none have shown of late years more energy, greater determination to keep with the times, or more far-sighted enter- prise. Nor have the students been unworthy of their school, for St. George's men are known all over the English-speaking world as accomplished physicians and sur- geons. More than this, and in a greater measure owing to the high tone of the school,