NOTE-In addition to the above there is a Subordinate Staff of Sorters and Letter-Carriers; and an Auxiliary Staff of Sorters is employed on Packet days to assort the Newspapers. GOVERNMENT MEDICAL SERVICE. FOR years the necessity of a Medical Service in Jamaica was pressed on the local Legislature and in opening the Session of 1852 Sir Charles Darling brought the subject prominently under their consideration. He stated that "the want of a sufficient number of Medical Practitioners was universally felt throughout the island by almost the entire body of inhabitants, whether high or low, rich or poor," and he strongly urged the Assembly" to make adequate provision" for such service. He assured them that "in some of the districts medical advice was not to be procured at all; in others only after a long delay and at a cost which virtually rendered it unattainable by the majority of the inhabitants." "The loss of life alone (and the consequent loss of labour) which annually resulted from this deficiency," added His Excellency, "was in itself a sufficient ground to justify any expenditure which it might be necessary to incur in placing the means of obtaining medical assistance within reach of the people generally." In the discussion of the question which ensued the honorable Mr. Westmorland stated that "the majority of the medical men were settled on the sea-boards, and those who lived in the country knew that for twenty to thirty miles no Doctor was to be found." Doctor Bowerbank assured the House that "the people died from preventable diseases for want of medical aid," and showed that "the whole amount then paid to the members of the medical profession in the different parishes amounted but to £2,300 per annum." This state of things continued until the year 1868 when Sir John Grant made provision to the extent of £3,000 for medical aid, and appointed on the 1st December fifteen Medical Practitioners as Government Medical Officers at salaries ranging from £200 to £300 per annum, chargeable partly to the poor rates and partly to the general revenue. At the close of the year there were forty medical districts defined and thirty-five Medical Officers appointed thereto, five being then vacant as no eligible Medical Practitioners were available. The Department thus organised was placed under a professional head designated the Superintending Medical Officer, who was also constituted the Adviser of the Government upon medical and sanitary questions. The duties of the Medical Officers are specified in the following rules which were framed by the Secretary of State for the Colonies, for the guidance of candidates for employment, and which contain the principles on which the service is regulated :— 1. The Colony of Jamaica is divided, for medical purposes, into districts of varying extent and population, to each of which, as a general rule, is attached one Medical Officer, who is held responsible for the due discharge of all medical duties within his district. 2. The District Medical Officers, who must reside within the limits of their respective districts, are required, in the discharge of their public duties, to undertake the medical charge of the paupers on the parochial rolls, and of any hospital, alms house or prison in their districts; to attend upon the Constabulary; to exercise a general control and superintendence over the Government Dispensaries of their districts; to vaccinate; and to advise the Government and Parochial Authorities on questions affecting the public health; and for such public duties no fees are receivable by them. 3. Medicines for the Public Service are supplied by the Government. 4. District Medical Officers are expected to provide themselves with a small case of surgical instruments of the best make. 5. The immediate control of the Medical Establishment is exercised by a Superintending Medical Officer. 6. The fixed salaries of the district appointments vary from £150 to £250 per annum. In some of the districts extra pay is receivable for attendance on the immigrants indentured to estates, and it is thought that additional remuneration may be derived from a successful working of the Government Dispensaries. 7. The District Medical Officers are at liberty to take private practice. The value of the private practice varies from £600 to £150, exclusive of Court and Inquest Fees and also Vaccination Fees, at a rate not exceeding 1s. for each certified successful case after the first 25 in each quarter. It must, however, be clearly understood that these figures are to be taken as only approximate, and that no guarantee as to the value of the private practice is given by Government, and that it rests entirely with the Medical Officers themselves to develop the private practice of the districts in which they are placed, by securing the confidence of the population with which they are brought in contact. 8. The District Medical Service of Jamaica is, in fact, to be regarded as a system in aid, the object of which is to diffuse medical assistance throughout the several parishes by inducing Practitioners to locate themselves in districts which, without some contribution from Government, would be altogether destitute of medical aid and advice, and the pay received by the Medical Officer from Government may be regarded as a retainer for professional services to be given as a Private Practitioner within the area in which he resides. 9. The gentlemen selected for these appointments must possess qualifications in medicine and surgery, and must be registered in England, and will be required to present themselves to a Physician, who will be named by the Secretary of State for the Colonies, whose duty it will be to report upon their physical qualifications for service in the tropics, and to approve the surgical instruments with which they propose to provide themselves. They will be provided by Government with a passage out to Jamaica, subject, however, to the customary agreement made with the Crown Agents for the Colonies, that the cost of the passage shall be refunded by the Medical Officer, should he within the period of three years from the date of his arrival in the colony quit it without leave, or relinquish his appointment for other cause than bodily or mental incapacity to continue the performance of his duty. 10. Gentlemen who have had no previous experience of the diseases of tropical climates will be attached, on their arrival in the colony, to the Public Hospital in Kingston as Supernumerary Medical Officers, for such a period as the Governor shall in each case direct, for the purpose of making themselves acquainted with the features and treatment of tropical disease. During this introductory service they will receive an allowance at the rate of £200 per annum, but will not be permitted to undertake private practice. 11. District Medical Officers will be entitled to leave of absence on half-pay for a period of not more than six months after each period of six years' service: it will, however, be left to the discretion of the Governor, looking to the exigencies of the service, to decide in each case the exact period at which such leave shall be granted. 12. Medical Officers will also be granted leave on half-pay on account of sickness duly certified by medical authority, in such manner and under such restrictions as the Governor may prescribe. 13. The District Medical Officers hold office subject to summary removal by the Governor for misconduct or for neglect of public duties, or for inattention to the wants of their districts in their capacity as Private Practitioners. They will be allowed pensions at the end of 20 years' resident service; the pension to be calculated at the rate of one-sixtieth of the salary, exclusive of any fees, for each year's service, provided that the total amount does not exceed two-thirds of the salary. In calculating the pensions of Medical Officers the Governor will make an addition of five years in respect of service in an intertropical colony, but no addition will be made in respect of professional qualifications. 14. It is to be understood that the full amount of pension, or indeed any pension, will not be claimable as a right; and that it will be in the discretion of the Governor to withhold a pension, or to award a reduced pension, if the circumstances of any individual case shall appear to him to warrant such a course. [Medical Officers joining the Department after the passing of Law 34 of 1885 (16th November, 1885), and holding appointment at the time of the passing of the Pensions Regulation Law 26 of 1892, (23rd May, 1892) or who may subsequently be appointed will be at liberty to contribute to a Pension Fund under the provisions of the last mentioned Law.] 15. Gentlemen appointed Medical Officers will be expected to proceed to Jamaica within two months from the date of their appointment. 16. Candidates for appointment should apply to the Secretary of State for the Colonies, who requires that all applications should be accompanied either by recommendations from persons known to himself, or by satisfactory testimonials from eminent members of the medical profession. During the year 1886-87 a medical tariff of fees was approved of by the Legislative Council, which it was decided should regulate the charges of all District Medical Officers who should be appointed to the service after their promulgation. The fees are as follows: 1. Advice and medicines at the District Medical Officer's residence or private or Government Dispensary-4s. For each subsequent visit as above in the same case -2s. 2. For each visit in Town from 6 a.m. to 7 p.m., within a radius of one mile from the centre of the Town -6s. 3. For each visit in the Country or within a radius of one mile from the District Medical Officer's residence -6s. 4. Mileage in addition to fee for visit for any distance over one mile and not exceeding five miles from District Medical Officer's residence, at the rate of 2s. per mile or part of a mile. 5. Mileage over five miles and not exceeding twelve 6. Mileage over twelve miles, 3s. per mile. For night visits from 7 p.m. to 6 a.m., one half fee and If asked to stay for a day or night according to agreement. Consultation as Physician or Surgeon, 21s. with mile- Every subsequent consultation on same case with mile- A medical certificate-21s. MIDWIFERY. Ordinary cases for attendance at delivery-£2 2s. and Minor operations-10s. 6d. ances extra. Capital operations according to agreement. Since the inauguration of the Department the number of medical districts has been increased to forty-seven, the whole being under the charge of 47 District Medical Officers, and the affairs of the Public Hospital have been entrusted to the direction of the Superintending Medical Officer, who has under him at that institution a Senior Medical Officer, whose duties are confined to purely professional work, assisted by two Resident Medical Officers. During the year 1886-87 the Lunatic Asylum was placed under the direction of the Superintending Medical Officer. A Medical Superintendent and Assistant Medical Officer are employed and reside at the institution. The accommodation that can be afforded in the Public General Hospitals, as far as room for beds is concerned, is as follows, namely :— Morant Bay Hospital 60 beds Lucea Hospital 22 beds 149 100 53 Annotto Bay Chapelton Dry River St. Ann's Bay Falmouth Montego Bay Spanish Town But the number of beds fully equipped in the several Public General Hospitals depends on the demand, and for the year ended 31st March, 1892, did not exceed a daily average of 776 beds occupied, though the equipment had necessarily to be kept somewhat in excess of this. Government Dispensaries have been established in the remote districts of Sandy Bay and Clark's Town, where medicines are dispensed and sold at fixed charges to all persons applying for them on the prescription of a Medical Officer, and where the Medical Officer in charge of the Dispensary attends on fixed days to give advice at a moderate rate of fees. The subject of medical attendance on poor persons who, although not paupers, are unable to pay the fee of four shillings, nominally considered the lowest charge by the Medical Practitioners, having been under consideration for some time, the Governor, pending the establishment of Government Dispensaries throughout the island, passed in September, 1880, certain rules for affording medical aid to them under a ticket system. These rules, as they now stand with subsequent amendments, are given below. The system has now been in operation for twelve years and is believed to work satisfactorily: 1. That the Chairman of a Parochial Board shall nominate to the Governor for appointment as Distributors of Tickets such gentlemen as he may select; and they will on appointment by the Governor be furnished by the Superintending Medical Officer with tickets of the respective values of 3s. and 2s. as respects all parishes other than Kingston, and of values of 2s. and 1s. as respects Kingston, and the appointment so made shall be subject to revocation on the advice of the said Chairman. 2. Any really poor person not on the pauper roll who is unable to pay the assumed minimum fee of 4s. will if considered deserving of the relief, receive from the gentlemen so selected a ticket which, on presentation at the Government Dispensary, or where there is no such Dispensary at the residence of the Parochial Medical Officer, will entitle the holder, on payment of the fee represented on the ticket, to medical advice and medicines. 3. A separate ticket must be presented on the occasion of each application to the Government Dispensary or Medical Officer's residence; but, in the event of a second or third visit being necessary during the treatment of the case, two-thirds only of the amount represented on the ticket first presented will be demanded, and half for subsequent applications during the continuance of the same illness. 4. Any person in receipt of a ticket unable to attend at the Government Dispensary, or at the Medical Offcer's residence, by reason of serious illness or infirmity, a note to this effect being made on the ticket by the gentleman making the recommendation, shall be attended at home by the Parochial Medical Officer of the district.* 5. Any such ticket presented to the Medical Officer of the district shall require him to attend at the home of the patient, for which service he shall receive an allowance for mileage at the rate of 1s. per mile going nd 6d returning.* 6. The fees represented on such ticket shall be paid by the applicant for relief, and the mileage by the Municipal Board of the parish out of the moneys provided by law for support of, and medical attendance on the poor.* 7. In the ease of prescription prepared at the Government Dispensaries, or with Government drugs, onethird of the fee roceived with the tioket shall be credited to the Government to cover the cost of the medicines, and two-third to pay the Medical Officer; when made up by the Medical Officers from their own drugs the entire sum represented on the ticket shall be their fee. The payment of mileage from poor rates has been discontinued as it has been held to be, under Law 6 of 1886, an improper appropriation of the money derived from those rates, and the attendance of Medical Officers at the houses of patients is no longer required. 8. Medical Officers having charge of Government Dispensaries will attend to the holders of tickets between the hours of 9 and 11 o'clock a.m., on two days in the week, which will be fixed by the Medical Officer. 9. Prescriptions to be made up at Government Dispensaries will be attended to daily, Sundays excepted, between the hours of 11 a.m. and 4 p.m. A Dispensing School has been established at the Public Hospital for the purpose of training efficient Dispensers for the several medical institutions of the colony; there are at present thirteen students undergoing a course of instruction, and, were it not for the limited accommodation, a much larger number might be enrolled. During the first year of the constitution of the Government Medical Service its officers received no concessions from the Government by way of pension or leave of absence. If a Medical Officer required to quit the island on the ground of ill-health he had to forfeit all his subsidised salary in order to provide a substitute, but in the year 1877 the arrangements set forth in the 11th, 12th and 13th sections of the Regulations given above in respect to leave of absence and pensions were sanctioned by the Secretary of State. Section 24 of the Pension, Law 34 of 1885, preserves the right to pensions to those District Medical Officers who entered the service before the coming into operation of that law. The Lepers' Home situated in the neighbourhood of Spanish Town is under the direction of the Superintending Medical Officer. This institution contains 168 beds, and during the year 1891-92, 124 cases of leprosy, 12 cases of framboesia, and cases of other kindred diseases were treated there. Below is a statement showing the amount expended from general revenue for the working of the Medical Department from the period of its inauguration to the close of the financial year 1890-91 : As an outcome of the Report of the Royal Commissioners instructions were issued that District Medical Officers are not to be allowed to engage in any business unconnected with their profession; or to occupy land except in cases where the occupation of the land necessarily accompanies that of the house. QUARANTINE. THE practice of Quarantine in this island has been considerably modified since the official investigation into its working in 1851. The laws now in force are 37 of 1869, modified by 32 of 1872 and Law 10 of 1892. The Governor in Privy Council is authorised to declare any port or place to be an infected port or place within the meaning of the Quarantine Law of 1869, and vessels arriving from such port or place are liable to quarantine, the duration, &c., of which depends upon the circumstances of each case, and is left to the discretion of the Quarantine Board. Whenever a vessel arrives at any port in this island, not coming from any place declared by the Governor in Privy Council to be "infected," and not having at the time of arrival any infectious disease on board, or not having had any death from such disease during the voyage, the Health Officer is authorised to admit her to pratique. If a vessel on arrival is not provided with a bill of health from the last port touched at, the Visiting Officer shall, under the provisions of Law 10 of 1892, order such vessel to hoist a Quarantine Flag and anchor at the Quarantine Ground until released. There is power to the Governor to appoint lazarets and to frame rules for the same. The following Rules were made in 1874 for carrying out the Quarantine Law :1. Ships placed in quarantine by the Health Officer are to hoist the yellow flag at the fore-top-gallant mast head and are to take up an anchorage without delay in the quarantine ground where they are to remain until released by order of the Quarantine Board. 2. The quarantine ground shall be pointed out by the Visiting Officer. 3. A Constable is to be placed on board each ship in quarantine and is to see that all Rules and Regulations in respect of quarantine are strictly carried out. 4. No personal communication is to take place between vessels in quarantine and the shore. No boats from the shore or from other boats or vessels, whether in quarantine or not, shall be allowed to have personal communication with a ship in quarantine. 5. No ship shall be allowed to make fast to the quarantine buoy placed to mark the quarantine ground or to anchor within 100 yards of that buoy. 6. Lighters or boats conveying cargo or coals or other supplies to ships in quarantine may be towed to the quarantine buoy; and to prevent personal communication with the ships in quarantine all persons on board such boats or lighters must then quit them and return outside the limits of the quarantine ground. 7. The boats or lighters so left may then be towed alongside the ship in quarantine by her crew and unloaded, but no packages are to be returned to the boats or lighters from the ship. When the boats or lighters are empty they are to be towed back by the crew of the ship to the quarantine buoy, and after the men so em. ployed have left them the persons who may be in charge of such boats or lighters may proceed to the quarantine buoy to fetch them away. 8. All boats belonging to ships in quarantine are to hoist a yellow flag in the bow when absent from their ships. 9. Passengers in ships that are placed in quarantine may, with the sanction of the Visiting Officer, be landed in the ship's boats at such Lazaretto or place as may be pointed out by the Visiting Officer and subject to his instructions and supervision. 10. Cases of sickness among the crew or passengers of ships in quarantine may, with the sanction of the Visiting Officer, and under his instruction and supervision, be landed in the ship's boats at the Lazaretto. 11. No articles of clothing or bedding that have been used in cases of disease shall be permitted to be landed. 12. The mail bags from a ship in quarantine shall, before being landed, undergo such process of fumigation as the Visiting Officer may consider necessary. 13. Any person who may have died on board a ship in quarantine shall be buried in such place as shall be pointed out by the Visiting Officer. 14. In case of a ship in quarantine proceeding to sea the Constable shall be previously landed at the Lazaretto. The Pilot, who accompanies the ship to sea, shall proceed on his return to the Lazaretto, and both Constable and Pilot shall remain there in quarantine for the same period as the ship would have been kept if she had remained at anchor. 15. In the cases where the Quarantine Board may think that the nature of the contagious or infectious disease is such as to render it unnecessary to keep the ship in which any case of such disease shall have occurred in quarantine for so long a period as fourteen days, or if there be other circumstances to justify any shortenIng of the period of fourteen days of quarantine, the Quarantine Board may, if they shall think fit, admit a vessel to pratique at an earlier period than the period of fourteen days provided in section 15 of Law 37 of 1869. 16. Any person who may be found guilty of any infringement of any of these Rules and Regulations shall be subject to a penalty not exceeding ten pounds. The following further Rules were approved by the Governor on the 2nd April, 1884, for carrying out the Quarantine Law: "If at any time by reason of the failure to comply with any Rule of this Board, or for any other sufficient reason, it should be found impracticable to receive passengers that are on board a ship placed in quarantine into the Lazaretto, or other place that may be approved of by the Quarantine Board, such passengers will be required to remain on board until the ship is released from quarantine or until arrangements can be made for removing them from such ship. No passenger or other person on board a ship in quarantine will be allowed to leave the ship for the purpose of being landed at the Lazaretto, or other place that may be approved by the Quarantine Board, before payment has been made to the Visiting Officer of the amount payable, in accordance with the following scale, for the maintenance of such passenger during the period of detention in quarantine: For first class passengers at the rate of 6/ per day. Children, according to class, charged as under : 8 years of age and under 12 years-half rates. The following rule was made by the Officer Administering the Government in Privy Council on the 16th November, 1888: Should the Master of any vessel that has been ordered into quarantine in any port of the island desire to proceed to any other port of the island before such vessel has performed, and been duly discharged from, quarantine, he should give notice of such desire to the Visiting Officer of the port at which his vessel is in quarantine, and shall in such notice name the port to which he desires to proceed, and it shall be the duty of the Visiting Officer to furnish to such Master a certificate showing the number of days the vessel has been in quarantine, and the number remaining to complete the quarantine term; and thereupon it shall be lawful for him to proceed to such last mentioned port; but he must enter such port flying the quarantine flag, and proceed straight to the quarantine g round at such port. The Master of any vessel neglecting or contravening any of the provisions of this rule shall incur a fine or penalty not exceeding ten pounds. The following Rules for the government and direction of the Lazaretto at Green Bay are binding on the officers, servants and inmates of the Quarantine Establishment: |