Sept., 1913.] MEDICAL ATTENDANCE IN THE MOFUSSIL. 357

Jndian Jftcdical <?a3^ 11q. SEPTEMBER.

EUROPEAN DOCTORS IN THE

. MOFUSSIL.

The following letter from the European De- fence Association to the Secretary to the Govern- ment of India is a very important document and one which deals plainly with a very important question. It is recognised by all that the question of European medical attendance for the families

of European officials and non-officials is one

which will affect the various services in many

ways, and it cannot he denied that if European medical attendance is not conveniently provided this fact must naturally and necessarily affect the recruiting of Europeaus in all the branches

of the Civil Services. The services recognise this

fact, and it is hoped that this point of view will

be laid before the Public Services Commission when it reassembles in India in next cold

weather.

Medical men will not settle down in places where a livelihood is not to be obtained, hence as pointed out by Flexner (in his report on

Medical Education, etc ), it becomes the duty of Government to subsidise medical men in the

interest of the Government servants, a man so

subsidised becomes practically a Government servant, therefore, we say, let the Government of India continue to use the Civil side of the I. M. S. for this work. That service has never failed

Government in the past. Our special number last June showed what it had done for India

in the past^and \vhat it was still doing. Will

specially appointed medical men of equal standing be easily obtained for the Mofussil Civil Sur-

geoncies ? We doubt it. I- M. S. men are obtain-

able, and if the Government of India goes further it will only fare worse. We print in full the letter of the European

Defence Association : ?

" SirI am'directed to address you on a question gravely affecting Europeans in the mofussil or country districts of India.

Hitherto Europeans, both official and non-official, m

these districts havelusually .been: able to: obtain skilled

European medical aid. The advice and assistance of European medical officers

has been made available by posting officers of the Indian Medical Service to the different stations and districts

who, besides 'being in charge of the hospitals, attend

European officials and their families and are permitted to take private practice and attend non-officials.

It lias been brought to the notice of my Council that

for some time past there has been a tendency to remove the European Civil Surgeons from various districts.

This tendency, which appears to be not fortuitous but

the result of a systematic policy, has caused alarm and

dissatisfaction among Europeans residing in the country districts in India and among their relatives, friends, and employer's in the larger towns.

M3' Council have made enquiries as to the reasons for these changes and have ascertained that they are the re-

sult of a policy which is the outcome of a despatch No. 225, Military, from His Majesty's Secretary of

State for India, dated December 11th, 1908, in which the following passages occur expressing the final orders

of the then Secretary of State, Lord Morley of Black-

burn.

Paragraph 3. ' I have consequently decided that the

time has now arrived when no further increase of the

civil side of the service can be allowed, and when a

strong effort should be made to reduce it by gradually extending the employment of civil medical practitioners recruited in India.'

Paragraph 5. ' When it is found impossible to obtain

a man from outside the Indian Medical Service to fill a

particular new civil appointment, or one which has not previously been so filled, I will not object for the present to that service being drawn upon ; but the vacancy so

caused must be filled from outside it, i.e., no appoint- ment must be made in succession which would involve

an addition to the cadre of the Indian Medicaal Service."

My Council desire to point out that the effect of the policy indicated in this order has already been a

gradual but appreciable withdrawal of European Civil

Surgeons from mofussil districts.

It is clear that, as the demand for medical practi- tioners of high professional qualifications increases, as it continually is increasing and must increase, in the big cities, for the purposes of such great and developing in- stitutions as the Hospitals and Medical Colleges to say nothing of the posts which are constantly being created for bacteriological and scientific research and for

sanitary purposes calling for men of the highest scientific attainments, such appointments can only be filled at

the expense of the Civil Surgeoncies unless properly qualified independent practitioners can be found willing to accept them.

Unfortunately it is very evident that India does not

attract a supply of independent European practitioners of high qualifications, and the few such independent men who do seek to establish themselves professionally in India have no need to look beyond the private practice obtainable in the big cities and are not

attracted by the civil posts created by Government. The result, therefore, of the orders of the Right Hon.

Viscount Morley is that, in order to fill the posts above referred to, Civil Surgeoncies in the Mofussil are being surrendered to Civil and Military Assistant Surgeons or to independent practitioners of secondary attainments and that the highly qualified European members of the Indian Medical Service are being drawn more and more into the Towns for the purpose of their occupy-

ing the high civil positions and specialist appointments

358 THE INDIAN MEDICAL GAZETTE. [Sept., 1913.

which they alone are qualified to fill. There is nothing to prevent this process continuing under the existing state of affairs until such time as the Civil Surgeoncies in the mofussil areas are entirely in the hands of those who, it is submitted, are either professionally or racially unfitted to hold them.

A study of the various Provincial Civil Lists gives the following results. Out of a total of 246 Civil

Surgeoncies, 138 are at present held by European Officers of the Indian Medical Service, 17 by Indian Officers of the Indian Medical Service, 53 by European and Anglo- Indian Military Assistant Surgeons, 8 by European and Anglo-Indian independent practitioners, 29 by Indian Civil Assistant Surgeons and 1 by an independent Indian practitioner.

It is understood that the Military Assistant Surgeons form a reserve in case of war, but the fact remains, and

prominent attention is drawn thereto, that as a body they possess no registrable qualifications. The distribution of these appointments is as follows : Punjab 7, United

Provinces 11, Central Provinces G, Bihar and Orissa 3, Bengal 3, Assam 3, Madras 2, Burma 15, Bombay 3, while of the European and Anglo-Indian independent practitioners holding Civil Surgeoncies there are 3 in

Bengal, 2 in Madias and 3 in Burma. The Indian Civil Assistant Surgeons are, it is believ-

ed, qualified in the technical sense, but their employ- ment in Civil Surgeoncies opens up another aspect of the case which I am instructed to bring specially to notice. These appointments are distributed as

follows:?Punjab 6, United Provinces 5, Central Pro- vinces 2, Bihar and Orissa 2, Bengal 5, Madias 3

(including the one independent practitioner), Burma 4, and Bombay 3.

My Council wish to make it perfectly clear that they do not approach this question from a racial standpoint in the sense of any point of antagonism between the European and Indian races, but from the universal

racial standpoint as touching the most intimate and delicate side of private life. From this standpoint it

is no question as between European and Indian any more than between one European race and another.

It is a question of the intimate relations which must

of necessity exist between a doctor and a patient and

of the sacred right and privilege which every man

and more especially every woman seeks to exercise of

being professionally attended by a qualified practitioner of his or her own race, custom and ideas in life.

To force upon European ladies, more especially in

maternity cases, practitioners of secondary qualifications, or, as the case may be, practitioners of alien race and

customs, is to create a position which no British Govern- ment should tolex'ate for one moment, and yet this is the

situation which arises to-day, and which is being steadily extended, as the result of the operation of the orders

passed by the Right Hon. Viscount Morley. No Govern- ment would dream of attempting to force European male doctors on Indian ladies but, nevertheless, it has not

been considered improper to adopt the reverse attitude

and to issue orders which have the effect of forcing Indian doctors on European ladies.

It is not considered necessary to enlarge further on the subject. My Council trust that the Government

of India will view the matter in the light in which it has

been put forward, and that steps will be taken to remedy the evil complained of and to so alter the existing system that gradually the Civil Surgeoncies throughout India

may be placed in the hands of fully qualified European officers of the Indian Medical Service in the event of

equally qualified independent European practitioners not

being available for the posts. I am directed to request that the Government of

India will forward a copy of this letter to His Majesty's "Secretary of State for India."