Some Aspects of the Colonial Medical Services*

THE Glasgow Medical Journal. No. VI. December, 1924. ORIGINAL ARTICLES. VISTAS AND VISIONS: SOME ASPECTS OF THE COLONIAL MEDICAL SERVICES* By ANDREW BALFOUR, C.B., C.M.G., M.D., London School of Hygiene and Tropical Medicine. At this, the commencement of another session at the well-known extra-mural School of Medicine in Glasgow, I cannot help wondering how many of you students have in your own minds outlined your future careers. The French say "L'homme can no doubt that our propose mais Dieu dispose," and there be national poet was right when he told us in his homely doric " that the best laid schemes o' mice and men gang aft agley." Yet that need not prevent us, when young and sanguine, from speculating upon the future, harbouring our secret hopes, and even formulating our plans. Glasgow has ever been, and I suppose always will be, a Mecca for the men of the West Highlands, and it is at least very certain that those amongst * Address delivered at the opening of Session 1924-1925 at The Anderson College of Medicine, 14th October, 1924. No. a. Vol. CIL 354 Dr. Andrew Balfour?Vistas and Visions: you who hail from the lone sheiling or the misty isle, in whose veins courses the blood of the Celt, have dreamed dreams and seen visions. It would be discourteous to pry too closely into these cherished anticipations, but I take it that the majority look forward to the day when they will be let loose upon a confiding public and will practise, at first no doubt at that public's expense, employing the phrase in two senses, the lessons they have learned from a band of able and devoted teachers. The greater number also, I fancy, are content to envisage themselves as prosperous general practitioners, either here in Scotland or perhaps more especially within the confines of that southern kingdom which is so well disposed toward the peripatetic North Briton, and which, in many instances, benefits by his presence. It is a worthy ambition, and will be yet worthier when the general practitioner pays more attention to the preventive side of medicine than is the case at present and becomes, as he is bound to become, the unofficial, but none the less indispensable, ally of the medical officer of health. Still, remember that, as Sir Humphry Rolleston has pointed out, there will, in these islands, soon be one doctor to every 1,000 of the inhabitants. The outlook is alarming for the doctors, possibly also for the populace; and surely amongst a gathering which must contain many Scots there are some " blessed with the wanderlust," some who hear the call of that greater Britain which lies overseas, and especially those portions of it "where the palm, most gracious and marvellous of tropic trees, flourishes and bestows its bounties upon man. Yet I find that, speaking generally, there is a lamentable ignorance amongst medical students as to the prospects which the Colonial Medical Services hold out to those who think " of faring foreign," as the old phrase runs. To-day I thought we might profitably consider this point of " view, and I have termed my address Vistas and Visions," for I propose, as best I can, to give you some glimpse of what awaits those who seek the sun within the torrid zone, and to comment, not only upon the opportunities now afforded the Colonial Medical Officer in the practice of his profession, but to refer very briefly to some points regarding the possible future of Some Aspects of the Colonial Medical Services. ?S55 medicine, and of hygiene in our tropical possessions. I am not going to deal wiith the purely mundane side of the business. It is undoubtedly important, it is, and must always be, a powerful determining factor?pounds, shillings, and pence, paid monthly, to say nothing of pensions, will influence doctors like other men and women till the end of time. But particulars as to pay and financial prospects can easily be obtained, and I would only say that at the present period, in our larger and more important tropical possessions, these are fairly satisfactory, and may even in some cases be regarded as satisfying, if indeed, anyone, or should I say any Scot, is ever satisfied with his monetary remuneration. There is such a thing as divine discontent, and it has its uses. Let us, then, ignore the almighty dollar for the nonce. I would ask you rather to consider the question upon loftier and more romantic grounds. I would strive to attract you by portraying the interest and beauty of the setting in which the Colonial Medical Officer is often privileged to work, and by the opportunities vouchsafed to him for benefiting humanity, advancing the prestige of the Empire which he serves, and more especially for solving some of the problems which still perplex the student of tropical medicine?problems as fascinating as they are elusive. Knowing possibly the almost feverish activity which has characterised the study of tropical diseases, since the days when the problem of malaria transmission was " solved, some of you may be tempted to exclaim, Is there any- thing left to be discovered ?" Has not tropical disease become as hum-drum as, say, chronic bronchitis ? Well, in the first place, I cannot agree that chronic bronchitis is hum-drum. It may be so in the strictly clinical sense, but from the prophy- lactic point of view, it remains a most important disease. The same is true of most of our common respiratory complaints. They are cripplers of mankind, enemies of efficiency, foes to be fought. In the second place, though much has been done in the way of revealing the secrets of tropical pathology, there is still a great deal to be accomplished. Sir Alexander Houston, writing about a subject which might " well be considered stereotyped, namely, The London Water Supply," very truly says there is no limit to knowledge, no 356 Dr. Andrew Balfour?Vistas and Visions: . boundaries to the value of applied science, and no feeling but that of deep humility in the presence of so much that remains obscure and unexplained. If this can be predicated of the London Water Supply, what may not be said regarding the vast field of medical research in the tropics ? Let us discuss some of the lacunae which yet exist in our knowledge of exotic maladies, and consider where we still require light and learning in our efforts to preserve and better the health of tropical communities. Long ago, in Great St. Mary's Church, Cambridge, I heard that famous divine, the late Dean Farrar, deliver a missionary sermon. With the gift of vivid imagery which he possessed, and with those powers of oratory whereby he swayed the multitude, he proved most impressive. He began his sermon by picturing an angel of God sent forth to visit the dark places of the earth, and he described the flight of that angel, and the scenes which passed before the gaze of the heavenly messenger. There is no need to invoke the assistance of an angel in our survey. The aeroplane has appeared since Farrar's day, and it is easy to imagine ourselves speeding southward in a well-found Handley-Page, or perhaps, in view of a recent American exploit, " we should choose a Douglas World Cruiser." We pass speedily from the capricious weather and the gloomy skies of the north into balmier regions with a bright, strong sun above, and a vivid blue sea below, and ere long descry afar off a long coast-line, bordered by a ribbon of snowy surf. The low-lying littoral covered with scrub, bush and trees, amongst which the oil palm attains prominence, slopes inland to the higher forested ground, and to the distant heights which guard what used to be called the dark heart of Africa. That heart has been revealed, thanks, on this side of the great continent, to the labours and sacrifice of many pioneers from the days of Captain Richard Jobson, " the author of The Golden Trade," to those of that intrepid Scottish physician, Mungo Park, of his handsome, but equally ill- fated compatriot, Hugh Clapperton, of the indomitable Denham, and the remarkable Richard Lander. Yet, until comparatively recently, the whole coastal belt from the River Gambia to the Niger, comprising the British Colonies of the Gambia, Sierra Leone, the Gold Coast, and Southern Nigeria bore a most evil Some Aspects of the Colonial Medical Services. 357 " reputation, and was in very truth the White Man's Grave." It is, perhaps, due to a woman, to Mary Kingsley, more than to anyone else, that this opprobrious term no longer holds good, though it was Joseph Chamberlain, inspired by Sir Patrick Manson, who first took the steps necessary to remove the reproach, and it was the work of Manson, and of Ross, which made possible the transformation. The mere mention of the West Coast suggests malaria, and at once we are faced with possibilities. The uninitiated may " say, Surely we know all there is to be known about this common disease?" We have been acquainted with its cause since the time of Laveran, the researches of Ross and others have shown how its infection is conveyed, and how to cope with its vector, the mosquito, the Countess of Chinchon long ago introduced its specific cure, there is a huge literature, both lay and medical, regarding it. What, they may ask, remains to be accomplished ? Well, thirteen years ago Professor Stephens, of the Liverpool School of Tropical Medicine, set down some points upon which our knowledge was still defective.

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