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May 29, 1895.
CHINA OVERLAND TRADE REPORT.
Answer.-We are of opinion--
(a) That the work required of the medical staff as at present distributed-falls to a certain extent on the Colonial Surgeon, and chiefly on the Superintendent of the Govern- ment Civil Hospital, and that the time of those officers is sufficiently occupied, more espec ally since the additional duty of daily inspecting the Tung Wa Hospital has been imposed on them.
(b) That the Medical Officer of the Gaol has not sufficient work, but that the present occupant of the post is not competent to assist at the Government Civil Hospital. (e) That the duties of the Health Officer of the Port fally occupy the time of one officer.
the railways I am discussing. Yet from begin. ning to end the local authorities have done no- thing but obstruct the Société in every way. The whole of the capital, with trifling exceptions, has been found by two British subjects in Hong. Long, Mosses, Chater and Mody, to whom and whose money the development of this Tonkin wealth is wholly dus.. Again and again have they tried to indues French capitalists to take a share of the burden. I believe this is now about to be accomplished, but I am speaking of the past. Moreover, the most childish restrictions have been enforced, of which one may be given as a speci men. No man not a French anbject may be employed by the Société in any capacity. That is, if the directors desired to obtain a report upon the value of their property, or upon the best means of developing it, from a distinguished
In view of the above it appears to us that British or American expert, they could not some re-arrangement of duties is desirable with charge his fee to the accounts of the Société,
a view to distributing the work more equally but would have to pay him out of their own among the officers of the Department. At pre- pockets as a purely private matter. Such are sent, chiefly owing to the reason given in (b) above some of the conditions and history of investment and to the fact that the services of the Health in Tonkin, while the country is starving for Oncer of the Port, owing to his being allowed want of capital, and ' pirates' hold possession of private practice, are not available for the general the greater part of it for want of opportunity work of the Department in time of great pressure to work for wages. I ask, therefore, what are or emergency, serious inconvenience is likely to the prospects of these tremendous railway con- arise should the Colonial Surgeon or the Su. cessions I have enumerated, or what reason is perintendent of the Government Civil Hospital there to think that they are bond fide com- or the Assistant Superintendent be incapacitated merviai investments? The reply is obvions.” for duty by sickness. Further, under the exist- There are many other subjects of interesting arrangements. it is difficult to provide for dealt with in Mr. Norman's book'; Siam, for leave due to officers of the medical staff without instance, and the relations of France with that outside assistance and this, we understand, is country, but for further soquaintance with these not readily available owing to the lapsing pay of we must refer our readers to the book itself, and the absent officer or officers being insufficient to we can assure them they will find it one of the induce doctors from ships, for instance, to place best they have ever read referring to the Far their services at the disposal of the Government. East. They may find reason to dissent from The result is that when either the Colonial some of Mr. Norman's conclusions on controver Surgeon, the Superintendent of the Govern sial subjects, but they will never fail to find him ment Civil Hospital, or the Assistant Super interesting.
intendent takes leave, his share of the work must necessary fall on the other two officers, the Health Officer of the Port and the Medical Officer of the Gaol for the reasons stated above not being available.
THE MEDICAL COMMITTEFS.
REPORT.
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405
the Government Civil Hospital. One of these officers to be available for attending the subordinate officers of the Goverument. and the Police. (b)—Health Officer of the Port. This officor would ordinarily not be available for other. duties, but in times of emergency should be at the entire disposal of the Principal Medi- cal Officer and at all time under his orders. (c)-Medical Officer in charge of the Gaol, whose duties should also include a daily in- spection of the Tung Wa Hospital. This officer should likewise be at all times under the orders of the Principal Medical Officer, and liable, when called upon, to assist at the Government Civil Hospital or available for any service at the discretion of the Principal Medical Officer.
Under the above arrangement we consider that many of the disadvantages of the present system would disappear. The Principal Medical Officer would have under his control a sufficient staff for the ordinary requirements of the colony, and in the event of an officer falling sick or taking leave it would be open to him to dis- tribute the duties of such officer amongst the remainder of the staff (taking his own share) without undue strain on any individual officer.
In addition to and independently of the above proposed medical staff proper, we recommend strongly the appointment of a Medical Officer of Health for the colony vis-a-vis the Medical Officer of Health for the Port; but, unlike the latter officer, entirely independent of the con- trol of the Principal Medical Officer, The Health Officer for the Colony should, in our opinion, have no connection whatever with the medical staff proper. His position should be quite distinct. He should be the medical advisor of the Government on all sanitary matters through the Sanitary Board, to which he should be attached (not necessarily as a subor. dinate officer of the Board) and on which họ should occupy a seat. He should, however, in our opinion, be entitled to no vote, his duties on the Board being purely of an advisory nature, and it being obviously undesirable that he should enter into any discussion upon points on which he is called upon to advise.
The following is the report of the Committes Being satisfied from the evidence before as appointed by H.E. the Governor to inquire into that the present numerical strength of the the Medical Department and other matters re-medical staff, although not too large, is quite lative thereto;-;. -
suficient for the ordinary requirements of the We, the undersigned, were appointed by his colony, it remains to us to suggest such Ire- Excellency the Governor to be members of ■ distribution of the duties as may, if not effec-proposed new officer; they must necessarily de- Committee of Inquiry into the Medical Depart-tually overcome, at least considerably minimise, ment of the colony and other relative matters the disadvantages of the present system of ad- embodied in a list of subjsote which socompanied |ministration in the department. In consider- our letters of appointments:
2.We have accordingly proceeded on the lines laid down by the Government and have con- ducted our inquiry with special referencs to the subjects upon which we were asked to report. In the course of that inquiry, with a view to mak- ing ourselves thoroughly soquainted with the working of the Medical Department generally, we have had occasion to pay a personal visit of inspection to the Government Civil Hospital, and have examined several servants of the Go- vernment, to whom we are indebted for much valuable information and many useful sugges- tions, which we have adopted and embodied in our recommendations.
The following is a list of the officers who have appeared before us in thecourse of our inquiry:--
The Colonial Surgeon..
The Superintendent of the Government Civil Hospital.
The Buperintendent of the Gnol.
The Assistant Superintendent of the Govern- ment Civil Hospical,»
The Secretary of the Sanitary Board.
The Health Offloor.
The Medical Officer of the Gaol.
The Government Analyst.
Dr. Chung of the Alice Memorial Hospital. Honourable Dr. Ho Kai, and the Matron of the Government Civil Hospital.
A copy of the evidence given by them forms an appendix to the report which we beg to submit below for the consideration of his Excellency the Governor. ・・
ing what re-arrangement is necessary for this purpose we have been guided by the following facts which have been brought to our notice :- (1)-That much of the Colonial Surgeon's time is occupied at present in attending subordinate omcers of the Government and Police Officers and their families. Also that he is charged with the duty of inspect ing the Tang Wa Hospital. This work we consider should not be ordinarily performed by the Principal Medical Officer of the Government, and we shall accordingly re- commend the performance of these duties by a junior officer.
(2). That the Health Officer, although nominally under the control of the Colonial Surgeon, is not absolutely at his disposal in an emergency, owing to his being allowed private practice.
(3)-That the services of the Medical Officer of the Gaol are not at present availed of when assistance is required in the Govern ment Civil Hospital.
In view of the above facts, we beg to make the following recommendations for the re-constitu- tions of the medical staff and a general re-dis-. tribution of the daties pertaining to them.
We consider that the title of Colorial Surgeon is a misnomer and should be abolished, and that in his place a Principal Medical Officer of the Government, whose duties should be both ex- soutive and administrative, should be appointed. Such officer should be the recognised head of the medical staff proper, but should, in our For facility of reference we have drawn up our opinion, also perform the duties of the Superin- report in the form of answers to the various tendent of the Government Civil Hospital in so questions submitted to us and corresponding | far that he should superintend and be respon- numerically thereto.
sible for the satisfactory management of that institution.
BEPORT. Question 1. The present distribution of work and the hours of duty of each member of the medical staff. What rearrangement of duties gif any, is desirable with a view to securing the
more efficient working of the Department ?
We are not prepared to lay down definitely the specific duties that should be assigned to the
pend to a great extent on local conditions aud circumstances, which are perhaps better known to the Government than to ourselves, but we consider that the duties performed by similar officers in some of our large towns at home should, mutatis mutandis, be assigned to the Health Officer for the Colony, and we append for the information of the Government a copy of the duties laid down by the Bradford Cor- poration for their Medical Officer of Health, and an abstract of those performed by similar officers in the City of London, which it may be found desirable to adapt to local requirements.
With regard to the qualifications requisito for the proposed office, we are strongly of opinion that the selected candidate should possess a public health diploma in addition to his ordinary medical degree, He should, in short. be au ex- pert in all matters affecting the public health.
Question 2.-Whether the existing staff is sufficient to meet the ordinary requirements of the Colony, and what special arrangercuts, if any, should be made in case of emergency?
Answer-We have already dealt with the first part of this question and expressed our opinion that under the re-arrangement proposed abovə the numerical strength of the staff is sufficient for the ordinary requirements of the Colony.
With regard to the latter half of the question, we have also provided above for cases of moderate emergency in recommending that the services of all members of the medical staff proper should, be available for other than their ordinary duties, when necessity arises, and that the Principaĺ Medical Officer shall have the power of appor, tioning and allotting such special duties. In cases of emergency we are unable to recommend any definite course of action, seeing, that tho proper steps to be taken on such occasion must necessarily depend on the circumstangs and conditions and must be decided accordingly. We, however, venture to suggest that in agro QË The Principal Medical Officer should have any grave emergency arising liberal-ladnooront under bis control and at his disposal the follow be offered to outside medical practitioners (local ing staff ****
or otherwise) to place their services at the dis- (a)-Two medical officers who should or-posal of the Government, and that such tem- dinarily perform the duties of assistants at porary officers should be under the orders of the
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