April
SERVICE NOTES.
1898.] THE COLONIAL MEDICAL SERVICE.
A meeting was held under tlie presidency of Sir Joseph Fayrer, Bart., K.C.S.I., in the Bast Conference Hall of the Imperial Institute, on Wednesday, March 2nd, 1898, and Mr. James Cantlie gave an address on the Organisation of the Colonial Medical Department. The scheme which was proposed for consideration was based upon that contained in a paper on the organisation of the Colonial Medical Service hy Surgeon-Lieutenant-Colonel Evatt, published in the British Medical Journal of September 26th, 189(5. The main points in this scheme were that all appointments for the service should be made after a competitive examination to be held in London at stated intervals; that successful candidates should undergo a special training in tropical medicine before taking up their duties; that fixed titles, periods of service, and pay proportional to such periods of service should be arranged, and that a Director-General should be appointed to control the Colonial Medical Service. It was suggested that a medical officer on appointment and for two years after joining, should have the grade and title of Assistant-Surgeon, for the next ten years that of Surgeon, from twelve to twenty years of service that of Staff-Surgeon, after twenty years that of Senior Surgeon, after twenty-five years that of Deputy Inspector-General, and after twentyeight years that of Inspector-General. It was further suggested that distinguished officers of the service should be privileged in proportion to their number, and, in turn with naval and military medical officers, to be nominated honorary surgeons and physicians to the Queen. We take the following account of the discussion of Mr. Cantlie's paper from the British Medical Journal of March
5th.
Sir Joseph Fayrer, Bart., K. C. S. I., who occupied the chair, in introducing the lecturer, expressed the hope that the outcome of the reading and discussion of the paper would be that a great Colonial Medical Service, analogous to the Indian Medical Service, would be established. The matter was in embryo at present, but advantages should be held out that would encourage the best men to enter the
service. Mr. Cantlie then read his paper, a short epitome of which is given above. Sir William des Veaux (late Governor of Hong-Kong), in opening the discussion, expressed the opinion that it would conduce very largely to the improvement of the- medical service in the colonies if a general service were established, and if there were a hope that those who were appointed to .
.
the smallest colonies at the smallest salaries could rise to the higher positions where better salaries were paid. The expense of preparation in England would be considerable, and in the case of small colonies which could not afford to pay more than a certain sum, it would be a little hard on them to be obliged to take the very youngest men with the least experience. The general principle, however, of giving a young man who entered the service every right to suppose that if he did his duty he would rise to a higher position in the general organisation of the medical service was most
acceptable. Dr.
Hillier
thought
there was a
possibility
of
pressing
for
appointments by the Colonial Office to an injudicious extent. Many of the appointments must necessarily be small in nature, both in work and pay. The appointment of officers
in such cases would be better filled if left in the hands of the local authorities than they possibly could be by the authorities at home. A certain amount of work in the colonies should in the interests of the public and the profession and the Government itself go to the private practitioner. Dr. Manson remarked that many of the colonies were peopled by aliens subject to the British Crown. In Mauritius the majority of the settlers were French by sympathy and extraction, and would not care to have an English surgeon nominated by a board in London thrust upon them. If any good well-thought-out scheme which could be worked economically were shown to the Government, they would certainly jump at it. The question of education in tropical diseases was an important one. For a young man practically untrained in diseases of tropical climates to be plunged into a tropical country in which the diseases peculiar to it were acute, was extremely undesirable and reprehensible. He knew that the Government was not indifferent to the subject of the Colonial Medical Service, and that the sympathy of the authorities was very much in the direction of Mr. Cantlie's wishes. The difficulties were to find a good plan which would reconcile everybody, and the lack of funds. There was a splendid opportunity for a millionaire philanthropist to establish a tropical medical school and a school for the education of men who intended in future to practise in tropical countries. Brigade Surgeon Lieutenant Colonel McLeod (Netley) was strongly of opinion that instruction in tropical diseases ought to be post-graduate and not part of the curriculum of the students It would be better and cheaper that men select-
!55
eel for the colonial service should be sent to Netley, than that imperfect and meagre arrangements should be made for them elsewhere. Dr. Manson objected to the existing institute at Netley being used for the education of men in tropical diseases, as it was entirely devoted to English soldiers, whereas the colonial service was particularly devoted to natives and their diseases. Dr. Thin was astonished at the accuracy and extent of the knowledge of tropical diseases which students acquired at Netley, but it was impossible to obtain that knowledge from only a short course of study. Dr. Simpson (Calcutta) suggested that a committee should be appointed with'tlie object of advancing Mr. Cantlie's views Mr. Cantlie, in reply, thought that a school dealing with tropical diseases was absolutely necessary outside any existing institution. Malaria and dysentery were not the only diseases of which a man had to have knowledge before going to the tropics. There was more experience to be gained in the London docks on that subject than in any other place in Europe. It was a capital plan to provide that private practitioners in the Colonies should be made visiting surgeons to the hospitals, and called outside-surgeons, but they should not be treated as part of the covenanted staff of the medical department, and participate in the rank, benefits, and pensions to which the regular surgeons were entitled. The Chairman had hoped that the meeting would have furnished an opportunity for doing justice to what had always seemed to him to be a very grossly neglected branch of the service. He wished to see the great and important Colonial Medical Service given the same standard of position as the medical services of the Army and Navy. It was true there was a Colonial Medical Service at the present moment, but it was not organised ; it was disunited and not bound together by any bonds. He thought the school at Netley was most complete for education in the particular subjects that were required, and advocated its extension. He thoroughly endorsed the proposition that the Government should be solicited to construct the Colonial Medical Service upon the same, basis as its other medical service, having an exactly analogous position. It was resolved that a committee should be formed to deal further with the question, to formulate a scheme and bring it before the notice of the Government, and to consider the best means of constituting a public Colonial Medical Service.
SERVICE NOTES.
1898.] THE COLONIAL MEDICAL SERVICE.
A meeting was held under tlie presidency of Sir Joseph Fayrer, Bart., K.C.S.I., in the Bast Conference Hall of the Imperial Institute, on Wednesday, March 2nd, 1898, and Mr. James Cantlie gave an address on the Organisation of the Colonial Medical Department. The scheme which was proposed for consideration was based upon that contained in a paper on the organisation of the Colonial Medical Service hy Surgeon-Lieutenant-Colonel Evatt, published in the British Medical Journal of September 26th, 189(5. The main points in this scheme were that all appointments for the service should be made after a competitive examination to be held in London at stated intervals; that successful candidates should undergo a special training in tropical medicine before taking up their duties; that fixed titles, periods of service, and pay proportional to such periods of service should be arranged, and that a Director-General should be appointed to control the Colonial Medical Service. It was suggested that a medical officer on appointment and for two years after joining, should have the grade and title of Assistant-Surgeon, for the next ten years that of Surgeon, from twelve to twenty years of service that of Staff-Surgeon, after twenty years that of Senior Surgeon, after twenty-five years that of Deputy Inspector-General, and after twentyeight years that of Inspector-General. It was further suggested that distinguished officers of the service should be privileged in proportion to their number, and, in turn with naval and military medical officers, to be nominated honorary surgeons and physicians to the Queen. We take the following account of the discussion of Mr. Cantlie's paper from the British Medical Journal of March
5th.
Sir Joseph Fayrer, Bart., K. C. S. I., who occupied the chair, in introducing the lecturer, expressed the hope that the outcome of the reading and discussion of the paper would be that a great Colonial Medical Service, analogous to the Indian Medical Service, would be established. The matter was in embryo at present, but advantages should be held out that would encourage the best men to enter the
service. Mr. Cantlie then read his paper, a short epitome of which is given above. Sir William des Veaux (late Governor of Hong-Kong), in opening the discussion, expressed the opinion that it would conduce very largely to the improvement of the- medical service in the colonies if a general service were established, and if there were a hope that those who were appointed to .
.
the smallest colonies at the smallest salaries could rise to the higher positions where better salaries were paid. The expense of preparation in England would be considerable, and in the case of small colonies which could not afford to pay more than a certain sum, it would be a little hard on them to be obliged to take the very youngest men with the least experience. The general principle, however, of giving a young man who entered the service every right to suppose that if he did his duty he would rise to a higher position in the general organisation of the medical service was most
acceptable. Dr.
Hillier
thought
there was a
possibility
of
pressing
for
appointments by the Colonial Office to an injudicious extent. Many of the appointments must necessarily be small in nature, both in work and pay. The appointment of officers
in such cases would be better filled if left in the hands of the local authorities than they possibly could be by the authorities at home. A certain amount of work in the colonies should in the interests of the public and the profession and the Government itself go to the private practitioner. Dr. Manson remarked that many of the colonies were peopled by aliens subject to the British Crown. In Mauritius the majority of the settlers were French by sympathy and extraction, and would not care to have an English surgeon nominated by a board in London thrust upon them. If any good well-thought-out scheme which could be worked economically were shown to the Government, they would certainly jump at it. The question of education in tropical diseases was an important one. For a young man practically untrained in diseases of tropical climates to be plunged into a tropical country in which the diseases peculiar to it were acute, was extremely undesirable and reprehensible. He knew that the Government was not indifferent to the subject of the Colonial Medical Service, and that the sympathy of the authorities was very much in the direction of Mr. Cantlie's wishes. The difficulties were to find a good plan which would reconcile everybody, and the lack of funds. There was a splendid opportunity for a millionaire philanthropist to establish a tropical medical school and a school for the education of men who intended in future to practise in tropical countries. Brigade Surgeon Lieutenant Colonel McLeod (Netley) was strongly of opinion that instruction in tropical diseases ought to be post-graduate and not part of the curriculum of the students It would be better and cheaper that men select-
!55
eel for the colonial service should be sent to Netley, than that imperfect and meagre arrangements should be made for them elsewhere. Dr. Manson objected to the existing institute at Netley being used for the education of men in tropical diseases, as it was entirely devoted to English soldiers, whereas the colonial service was particularly devoted to natives and their diseases. Dr. Thin was astonished at the accuracy and extent of the knowledge of tropical diseases which students acquired at Netley, but it was impossible to obtain that knowledge from only a short course of study. Dr. Simpson (Calcutta) suggested that a committee should be appointed with'tlie object of advancing Mr. Cantlie's views Mr. Cantlie, in reply, thought that a school dealing with tropical diseases was absolutely necessary outside any existing institution. Malaria and dysentery were not the only diseases of which a man had to have knowledge before going to the tropics. There was more experience to be gained in the London docks on that subject than in any other place in Europe. It was a capital plan to provide that private practitioners in the Colonies should be made visiting surgeons to the hospitals, and called outside-surgeons, but they should not be treated as part of the covenanted staff of the medical department, and participate in the rank, benefits, and pensions to which the regular surgeons were entitled. The Chairman had hoped that the meeting would have furnished an opportunity for doing justice to what had always seemed to him to be a very grossly neglected branch of the service. He wished to see the great and important Colonial Medical Service given the same standard of position as the medical services of the Army and Navy. It was true there was a Colonial Medical Service at the present moment, but it was not organised ; it was disunited and not bound together by any bonds. He thought the school at Netley was most complete for education in the particular subjects that were required, and advocated its extension. He thoroughly endorsed the proposition that the Government should be solicited to construct the Colonial Medical Service upon the same, basis as its other medical service, having an exactly analogous position. It was resolved that a committee should be formed to deal further with the question, to formulate a scheme and bring it before the notice of the Government, and to consider the best means of constituting a public Colonial Medical Service.
