333

administrative officers, H.M. inspectors of mines, minemanagements, other Government departments, medicalbodies, and other concerned.The work of the mines medical officers is directed to

securing that the health of the mine-workers is main-tained at the highest level, particularly in relation tooccupational factors. They are therefore concerned withsupervision of medical arrangements (including first-aid)at mines themselves, and with ensuring that medicaltreatment and rehabilitation are available for mine-workers following injury or illness and that these facilitiesare used to the best advantage. Where the provision ofa necessary service falls short of need, it is their duty topropose improvements. They are also concerned withinvestigation and research into illness among -niners.During the war years, the Ministry of Fuel and Power’s

medical staff was necessarily concerned with certaintemporarv work, such as the medical aspects of recruit-ment and conservation of man-power. Certain per-manent schemes, however, were put into effect, prominentamong which is that whereby workmen who are injuredat the mines, where they are often not readily accessibleto a doctor, can have morphine administered to them byspecially selected certificated first-aid men employed atthe mines. Long-term policies were also developed, andsome of these are now well established, such as thearrangements for medical examination of all entrants tocoahnining below 18 years of age and the medicalexamination, including X ray, of all entrants, irrespectiveof age, to the South Wales coalfield. Another develop-ment of significance is the provision at certain mines ofmedical-treatment centres staffed by a State-registerednurse who will be under the direct supervision of adoctor. This scheme is already in operation at a number

of mines ; when it is functioning fully it will provideworkers with early treatment of a very high standard.

Since Jan. 1, 1947, the National Coal Board hasoperated the coalmines of the country in accordancewith certain statutory requirements, one of which is tosecure the health of the persons they. employ. Toimplement this requirement, the Board are in the processof engaging medical staff to advise them on matters ofhealth and to exercise medical supervision of theiremployees by continuing the development of the schemeinitiated by the Ministry of Fuel and Power. As thework of the National Coal Board doctors develops theMinistry’s Mines Medical Service will be freed to devotemore of its attention to additional constructive workwhich has had to be left in abeyance while temporary butimmediate problems were dealt with.

PRISONS AND BORSTAL INSTITUTIONS

AT the larger prisons whole-time medical officers areappointed, and at the most important ones principal medi-cal officers are assisted by one or more medical officers.Salaries are in accordance with the general Civil-Servicescales, and appointments are pensionable ; unfurnishedquarters are provided at most prisons, at a moderaterental. Candidates with a diploma in psychologicalmedicine are given preference, provided they have goodall-round experience. Appointments are made by theCivil Service Commission, 6, Burlington Gardens, London,W.1, to whom all inquiries should be addressed.At the smaller prisons no whole-time medical officers

are employed; local practitioners are usually appointed aspart-time officers. Further particulars of these appoint-ments can be obtained from the Prison CommissionersHorseferry House, Thorney Street, London, S.W.I.

Services Abroad

COLONIAL MEDICAL SERVICE

VACANCIES in the Colonial Medical Service occur mostoften in tropical Africa and Malaya. Medical officersare required, to replace normal wastage and to providestaff for expansion; they must be British subjectsholding a medical qualification registrable in the UnitedKingdom, with at least twelve months’ experience sincequalifying, preferably in hospital appointments. Candi-dates must have been born on or after Jan. 1, 1907,but, in addition, special contract. terms are available formen up to the age of 45 or for younger candidates whowould prefer to serve in the Colonies for a term of yearsrather than for their whole career.Medical Officers are appointed in the first instance for

general service or for health duties. There are oppor-tunities for field investigation, and posts are filled fromwithin the service for work in special branches ofmedicine and surgery and in public health. Medicalresearch departments exist in the larger Colonies.Specialist appointments are usually reserved for officersholding higher appointments who have shown out-standing merit in a particular branch of medical practice.A special grade of medical officers has been created inWest Africa for those holding higher qualifications, towhich direct entry is made. Opportunities to gainthese qualifications will be made available wheneverpossible, and selected candidates may be required toattend a course of instruction in tropical medicine andhygiene before proceeding overseas, or else to attendsuch a course during their first leave period. Vacancieswill occur in greater numbers in future for women withexperience in gynaecological and maternity work, schoolpublic health, and child welfare.Various government medical departments employ

about 700 European medical officers, including some 30women, and about 1200 locally appointed medicalofficers. Depending upon the territory, such diseasesas malaria, yaws, leprosy, sleeping sickness, plague,yellow fever, cholera, and other conditions associatedwith the tropics are encountered in addition to the usualdiseases experienced in any medical practice. An officerin the Colonial Medical Service has special opportunitiesfor the practice of preventive medicine, as well as

opportunities for teaching and research.

The medical and health services will be considerablyexpanded in order to fulfil the schemes for public-healthdevelopment already planned. Full particulars of termsand conditions of service may be obtained from theDirector of Recruitment, Colonial Office, 15, VictoriaStreet, London, S.W.I.

SOUTHERN RHODESIAN MEDICAL SERVICE

The government of Southern Rhodesia maintains amedical and public-health service with an establishmentof 18 whole-time administrative, specialist, or public-health officers and 49 government medical officers.

Rates of pay for the whole-time officers are :Annual Salary

Medical director ...819002 assistant health officers......1 1School medical officer (man) ... e IField officer3 radiologists .....2 directors of laboratories £ 1450- £ 50- £ 1600Government pathologistGovernment psychiatristMedical superintendent, mental hospitalMedical superintendent, leprosy hospital JAssistant medical superintendent, men-

tal hospital .........81100-850-81250School medical officer (man) .... B £935-£33-£11002 school medical officers (women).. Government medical officers are graded as follows :

2 senior government medical officers .. £1450-£50-£160047 government medical officers .....8660-827 10s.-S990

In addition to the salary scales shown, cost-of-livingallowances at the rate of 10 % of salary up to a maximumof 2100 are paid at present.

’Whole-time medical officers and the two seniorgovernment medical officers are not permitted privatepractice but are allowed consultant practice. Govern-ment medical officers, except those stationed at Salisburyor Bulawayo, are allowed private practice, the value ofwhich varies from £100 per annum upwards, accordingto the station. The duties of government medicalofficers include supervision of the 18 governmenthospitals and 74 native clinics, and attendance onpolice, boarders in government schools, and prisoners.They also undertake medicolegal work and public-healthduties. Leave may be granted at the rate of one-eighthof service, and may be taken in periods not exceeding184 days at a time. Study leave may also be granted.

After two years’ service medical officers under theage of 45 can be appointed to the fixed establishment.

334

and contribute to a pensions’ scheme. The retiring ageis 60. On appointment government medical officers areusually stationed at Salisbury or Bulawayo where theyare paid an allowance of £200 per annum in compensa-tion for not being allowed to undertake private practice.They are usually required to do relieving duties atvarious out-stations. until a permanent vacancy occurs.Appointments in Great Britain to the service are madethrough the High Commissioner for Southern Rhodesia,Rhodesia House, 429, Strand, London, W.C.2, who willsupply further details on request.

SUDAN MEDICAL SERVICE

The Sudan Medical Service aims at providing a com-plete health service for the Sudanese peoples, forgovernment officials, and for the Sudan Defence Force.The area of the Anglo-Egyptian Sudan is about a millionsquare miles-almost one-tenth of the African continent-and the total population is probably still less than8,000,000. In accordance with the terms of the Anglo-Egyptian Agreement of January, 1899, the country isunder the joint administration of Great Britain andEgypt, and its connexion with the British Government isthrough the British Ambassador in Cairo and the ForeignOffice.The country is embarking on a new period of develop-

ment in every sphere, and it is the policy of the govern-ment that Sudanese shall film all government posts whenthey are fitted to do so by personality, ability, andtraining. It is therefore necessary that newly appointedBritish officials should be sympathetic to this policy andshould be ready and willing to play their part in assistingtowards its achievement.The personnel of the Medical Service on the British side

consists at present of about 40 doctors, 32 nurses, andsome public-health inspectors and laboratory and X-raytechnicians. On the Sudanese side there are more than80 doctors-trained at the Kitchener School of Medicinein Khartoum-some of whom have had postgraduateexperience in London, as well as public-health officersand sanitary overseers, medical assistants in charge ofdispensaries, and a large number of hospital orderlies,nurses, and midwives.The headquarters of the service are in Khartoum ;

and here, and in the adjacent town of Omdurman, arethe central hospitals and specialist services, the KitchenerSchool of Medicine, the Stack Laboratories, and mid-wives’ and nurses’ training schools. The project foran entirely new hospital of over 400 beds for Khartoumhas been initiated, and construction will be startedas -soon as circumstances permit. Outside Khartoumthe country is divided into seven provinces, and inthe principal town of each there is a large and well-equipped hospital. In the smaller towns there are otherhospitals, each in charge of a Sudanese doctor; and thereare some 400 dispensaries serving the still smaller townsand rural areas. British medical inspectors are attachedto the main hospitals and may also supervise the areasin which they serve.As there are hardly any private practitioners in the

country, most medical, surgical, gynaecological, and public-health and preventive work is carried out by membersof the service. There is also a varying amount of adminis-trative work to be done : medical boards must be held,and school-children examined. Though it may bepossible for work in the out-stations to be arranged sothat a man who is keen either on medicine or on surgerymay be able to devote himself more to the branch heprefers, all junior members of the service should becompetent to undertake whatever comes their way. Atpresent most specialist appointments are filled by selec-tion from the more senior medical inspectors, and suchpromotion, which depends on the occurrence of vacancies,is rare before 12 or more years of service. All specialistappointments are held in the Khartoum-Omdurmanarea, and the holders may be called upon to act also aslecturers and teachers in the Kitchener School of Medi-cine, receiving fees in addition to their pay for theirservices in this capacity.The Sudan Government having decided to suspend, for

the present at least, all appointments on probation forpension, medical inspectors will now be appointed on

probation for a provident-fund contract or on short-term contract. If appointment is on the former, thetime-scale applicable starts at £E.840 per annum (£E=20s. 6d.) and rises by five biennial increases to .EE.1270,followed after three years at that rate by an increase to£E.1400, the grant of increases of pay being subject tosatisfactory work. If appointment is on a short-termcontract, the salaries will be approximately 6% higherthan the equivalent provident-fund rate. Appointmenton a provident-fund contract provides (subject to aninitial probationary period of two years) security for aminimum period of seven years or up to the age of 38,whichever is the later date. Subscription to the provi-dent fund is at the rate of 7 t % of salary, the officialqualifying on reaching the age of 38 or completing sevenyears, whichever is the later date, for a governmentcontribution equivalent to his own, accumulated at 4%compound interest. Service under short-term contract isinitially for two years, but may be renewed. A cost-of-living allowance at the rate of £E.225 a year is beingpaid at present. Medical inspectors have prospects ofpromotion to posts carrying higher maxima. Noincome-tax is at present payable in the Sudan.

Private practice is permitted, provided that it doesnot interfere with official duties,; but except in a few ofthe larger towns opportunities for private practiceare few. A doctor is not allowed to charge private feesfor work "performed in a government hospital.Annual leave of 80 days per annum in the United

Kingdom is now being granted after the first tour ofservice, with free air passages from and to the Sudan.Full pay is drawn during leave periods. No free quartersare provided. Government houses can usually beobtained on payment of rent and other charges. Thesevary according to the station and the accommodationavailable, but are usually between £E.40 and .SE.80

per annum. -

The service provides good professional work combinedwith an open-air life. Work may mean travelling oninspection-tours by rail, steamer, air, car, or animaltransport. The climate varies from the hot dry northernzone, through the central area which has a 3-4 months’rainy season, to the southern zone, in which conditionsbecome increasingly tropical as the southern border ofthe Sudan is approached. The general level of thecountry rises from 1200 feet at Khartoum to 2000 feetabove the sea at Nimule, on the Uganda frontier. Thereare good opportunities for exercise-tennis, golf, andpolo being the main afternoon games. There are swimming-pools in the larger towns. In the southern zone there isplenty of shooting, and in many places very good fishing.

Applicants in the United Kingdom must be British-born and should preferably be under 35 years of age,with a good general experience. Special experience inmedicine or surgery, and possession of a higher quali-fication will be regarded as an additional asset. Anofficial is allowed to take his wife out to the Sudan after

reaching the age of 27 or on completing four years’service, whichever happens first, though it is not usuallypossible to provide family accommodation during thefirst tour. Candidates selected for appointment will asa general rule be required to undergo a course of instruc-tion at either the London or the Liverpool School ofTropical Medicine before sailing. The tuition fees areborne by the government, and a subsistence allowanceof not less than £25 a month is paid during the course.

Candidates selected for appointment are given freetransport from their homes to their station in the Sudan.Salary becomes payable only from the date of arrivalat the Sudan frontier, but candidates are granted anallowance of half-pay up to a maximum of £20 permonth for the period of waiting in the United Kingdomfor a passage until the date of sailing, and a furtherallowance up to a maximum of £E.40 to cover travellingexpenses and Sudan customs dues and to compensatepartly for the period of the journey during which pay isnot being earned.The conditions of service given here are liable to

alteration in accordance with government regulations.Further particulars and information about vacanciesmay be obtained from Dr. H. C. Squires, C.M.G.,consulting physician to the Sudan Government, 93,Harley Street, London, W.I. (Tel. : Welbeck 3423.)