I move as an unopposed motion—

I second.

Agreed to, and the Bill accordingly withdrawn.

By direction of Mr. Speaker, the Marriage by Proxy Bill [A.B. 55—’45] submitted by the Select Committee, was read a first time; second reading on 9th May.

I move—

This little Bill is a simple one intended in Clause 1 to remove a redundancy and in Clause 2 to create machinery which will enable disciplinary action to be brought. An explanatory memorandum has been laid on the Table of the House. The law that was passed in 1923 provided if an objecter wanted notes of evidence he could get it by paying a fee of 1s. per 100 words. That was deleted, but in the Bill the clause I am amending was left in; it is pure redundancy. With regard to Clause 2, there is an absence of specific direction as to the manner in which notification is required, and the Public Service Commission had difficulty in the past in regard to serving a notice on people who had been absent and whom they have not been able to trace. The present clause makes provision in connection with the matter. In some cases lengthy periods have elapsed and they have not been able to get into touch and the particular post cannot be declared vacant. I would like to point out that if absence is due to the official being on military service he is protected by the Military Service Bill.

Motion put and agreed to.

Bill read a second time.

I move—

I object.

House to go into Committee on the Bill on 7th May.

I move—

Last year the Public Servants (Military Service) Act was enacted with the goodwill of all sections of the House, the object of it being to meet the case of ex-volunteers entering or re-entering the service of the State, including of course the railway service. This Bill is merely designed to remedy certain minor defects which have been revealed in putting the Act into operation. The Bill has the approval of the Railway Administration which is also affected, and has been considered by and received the approval of the Public Servants’ Advisory Council. All the necessary steps in the way of consultation have therefore been taken. An explanatory memorandum has also been laid on the Table dealing in detail with the individual clauses. Let me then briefly indicate what the effect of the adoption of this Bill will be. The first amendment proposed is in regard to the definition of whole-time military service, which has to be taken account of for the purposes of pay and pensions in respect of ex-volunteers in the service of the State. There are two changes which it is proposed to make in that regard. In regard to the first change we wish to meet a new situation created since the Act was passed. Up till the 1st of September of last year leave was granted to a soldier prior to discharge and therefore it fell into his period of whole-time service. Now we discharge him forthwith and make a cash payment in lieu of leave. Therefore it is only fair that the period in respect of which the cash payment is made should be regarded as part of his whole-time service. In the second place, it is proposed to make clear that certain periods of military service should not be included, that is, periods of absence without leave, or periods during which the soldier was deprived of pay under the provisions of the Military Discipline Code. That is dealt with in Clause 1 (a). Clause 1 (b) is designed to cover the case of certain members of the forces who may have to be retained in the army after the official date of the end of the war. We are thinking here of the Pay Corps which will, for obvious reasons, be employed longer than other sections, and we want to protect their rights. With that object Clause 1 (b) has been inserted. The next amendment is covered by Clauses 2 and 3. There are certain officials whose employment was terminated when they were released from military service. That happened in certain cases prior to the 1st February. 1941. The intention of last year’s Act was to restore to them their civil benefits. But we find that Section 2 of the Act does not have that effect, and so it is proposed to delete it and replace it by a new sub-section (3) in Section 3 of the principal Act which is contained in Clause 3 of this Bill. Then the following Clause 4 deals with some minor amendments that have become necessary as far as the Public Service section of the Act is concerned. Clause 5 of the Bill makes the same provision as far as the Railway Section of this Act is concerned. The next amendment, in Clause 6 of this Bill affects Section 10 of the principal Act. Section 10 of the principal Act safeguards the pension rights of ex-volunteers, but we find that under the wording of that Section the case is not covered of certain employees who were granted leave of absence without civil pay in order to enlist. We are treating them in the same way as other ex-soldiers and it is considered necessary, therefore, to amend the section in this way. Clause 7 contains quite a minor alteration in Section 11 of the principal Act so as to make sub-section (2) uniform with sub-section (1) of Section 1.

I have no objections to the provisions of this Bill as explained by the Minister. I however wish to point out to him special difficulties in connection with the application of Act No. 27 of 1941, the Act providing for re-employment of public servants who joined the army. Cases crop up of policemen who do not fall under that Act, as will be proved by the special case I shall mention. A person resigned from the police force for health reasons, but within six months thereafter he joined the army because his health was restored.

He bought his discharge.

Yes, owing to health reasons. He was ill for a long time, but when he had recovered he joined the army. He has now been discharged from the army and wishes to return to the police force. That was refused because according to Clause 2 (1) of the Act the requirement is that he should have resigned his post with the object of performing military service, and that he must have joined up within a reasonable period thereafter. Technically such a person does not fall within the provisions of that clause of the Act, because he did not resign in order to join the army. What he had in mind nobody can tell. But the fact remains that he resigned owing to health reasons and as soon as his health was good enough again he joined the army and saw service. He would now like to return to the police force but cannot. That seems to me a very strict application of the provisions of this Act. He will probably be given other work, but the work for which he is suitable and for which he was trained is not available to him according to this provision. There is a shortage of police. The Minister of Justice and the chief of police have told us that they cannot obtain enough police officials, but here we find that for a purely technical reason such a person cannot again be employed. I want to suggest that the Minister should rectify this matter in the Bill in the Committee stage, so that there can be elasticity in this provision which will make it possible to reinstate such persons in the service; in any case the principle should be laid down that every case will be dealt with on its merits and not necessarily according to the strict provisions now contained in the Act. The Act demands that he should have resigned with the object of joining the army. The fact is that he did join up, and for that reason the Act should not be so strictly applied that such persons are prevented from returning to the old sphere of activity, a sphere of activity where there is a demand for officials and for which the person is suitable. I hope that the Minister will reconsider the matter with the object of making this clause a little wider in the Committee stage.

I hope the Minister will give us sufficient time in which to consider the precise effect of the amendments in this Bill. There is one amendment which is open to some objection, and that is the one which aims at excluding from military service for pension purposes, on the man’s return to public service, the period of unpaid leave in excess of 21 days or any period of unlawful absence from active service. That seems to me to penalise the serving soldier by the loss of his pensionable service of a certain period of the time which he has spent on active service because during a certain number of periods, all too brief, he was granted unpaid leave or had to be defaulted for unlawful absence from military service. The same rule does not apply to those public servants who had no idea of military service and who never went; there is no such deduction in their case. But these deductions are going to affect the men who, perhaps in Egypt, enjoyed a short spell of leave. I think there is going to be very strong objection to that. If these men were entitled during their leave cycle to have a short spell of leave on military service, surely Parliament is not going to be so niggardly as to reduce that period from their aggregate for pension purposes. I think it is going to cause a very bad impression in view of the disparity that will exist then between the treatment of internees and soldiers. The internee—a public servant— who has spent his time in the internment camp, his family being supported by the Government, gets the full benefit of the period of his stay in the internment camp which is credited to him for pension purposes. Not so the soldier. Every little spell of leave he has had in excess of his total of 21 days is going to be reduced from the aggregate of his service for pension purposes. I want to mention that as one of the amendments to which objection will be raised. I hope the Minister will give us sufficient time to consider all the amendments carefully in relation to those whom we have a special duty towards at the present moment—the serving soldier.

Yes, Mr. Speaker, time will be given for further consideration of this Bill before the Committee stage is reached, although I must point out hon. members have had not only the Bill but the White Paper for some time. With regard to the point raised by the hon. member for Pinetown (Mr. Marwick), I would point out that in respect of the 21-day period to which he has referred the clause which we propose to insert would have, if adopted, the effect of excluding from whole-time military service any part of “a continuous period of more than 21 days during which such person was in custody, under detention in barracks, or undergoing punishment entailing, in each case, foreifture of military pay”. In other words, a period of not more than 21 days is still allowable, to be counted as part of whole-time military service. It is only therefore in serious cases of breaches of military discipline where the punishment is over 21 days where this is proposed. I certainly do not think it is unreasonable.

Will there be an equal penalty against the internees?

I am dealing with a Bill in regard to public servants who have been on military service.

†*The hon. member for Winburg (Mr. Swart) raised a point in connection with certain police officials who purchased their discharge from the police service, not with the avowed object of joining the army, but perhaps for health reasons; but who in fact later joined the army. He evidently wants to include them in the provisions of the Act. I do not think it will be possible to give the full privileges of the Act to all those persons.

But what about reinstating them in the service?

That is another question. Taking them back in the service without special privileges is something which I am prepared to consider.

There is already a shortage of police.

I will investigate that matter.

Motion put and agreed to.

Bill read a second time; House to go into Committee on the Bill on 5th May.

I move—

The Insurance Act was passed in 1943 and was brought into operation fairly early last year. Experience since gained has indicated the necessity of certain minor amendments. These amendments are contained in this Bill and explained in a Memorandum which has been before hon. members for some little time. Let me indicate what the effect of these amendments will be. The first amendment appears in Clause 1 and affects Section 4 of the Insurance Act. Section 4 of the Insurance Act deals with the registration of new insurers, and under that section an overseas company cannot be registered as a new insurer unless it has been carrying on business for more than twenty years. If it has been carrying on business at the commencement of the Act, although it has not had twenty years experience, it can continue in business in, South Africa, but the clause as drafted goes further than we had intended in so far as it prevents such a company which is entitled to carry on business from undertaking any new class of business. Now, there is no need for such prohibition. We have adequate financial safeguards in the Act, and the first alteration in this Bill, in Clause 1, therefore proposes to remove that prohibition, and therefore such insurers would be entitled to undertake new classes of business as well as those they carried on at the time the Act came into operation. Clause 2 removes an unintended hardship on certain local companies as compared with overseas companies. It is a common practice, of course, in insurance for a company to re-insure its liabilities. It may do that either inside or outside the Union. If it re-insures its liabilities with a company which does not carry on business outside the Union, that re-insurance, as far as that company is concerned, outside the Union, is not treated as a liability for the purposes of this Act. It would indeed be difficult to make such an overseas company comply with the Act. But where that re-insurance is effected with a company outside the Union which does carry on business inside the Union, that is regarded as part of its liability, and so the company carrying on business inside the Union is at a disadvantage in comparison with the company which does no business inside the Union. It seems only fair to remove that discrimination. The third clause deals with the provision in Section 17 of the Act which lays down certain requirements in respect of the deposit by companies of securities to cover liabilities during the transition period of 5½ years. Under the law as it stands, such companies are allowed to make such deposits or securities with the Union High Commissioners in London, Canada, Australia and New Zealand. We have no High Commissioner in Canada, but we have an accredited representative and we therefore propose to regard him, for this purpose, as being on the same basis as a High Commissioner. The fourth clause deals with the position of former insurers, or rather those who took over insurance from former insurers. A former insurer is a company which has ceased to carry on business in the Union but still has certain current policies in the Union. What happens in such a case is that another company takes over these current policies of the former insurer and Section 24 of the Act contains special provisions to cover such cases, the case that is of the company registered in the Union which takes over the business of a former insurer. But it has been found as a result of experience gained in the administration of the Act that Section 24 does not quite cover all such oases of the transfer of current policies from former insurers, and it is therefore necessary to extend the scope of Section 24 as indicated in the White Paper, so as to cover other cases of transfer than those already dealt with in that section. The principle, of course, is exactly the same. The position is merely that at present we have a hiatus and certain cases are not provided for. At the same time in Section 4 provision is made for the returns to be submitted by registered insurers in this connection. Finally there is a small amendment in Clause 5 to Section 60 of the principal Act, where it was found necessary to substitute for the word “class” the word “type”, in view of the fact that “class” is defined in the principal Act in such a way as to make it inapplicable. I think hon. members will appreciate from what I have said that there is no question of principle raised by this amending legislation and that we are really only dealing with certain points of difficulty which arose in administration, and that we are merely doing so with a view to making the Insurance Act a more workable instrument than it is at present.

May I venture to hope that we shall be given sufficient time to consider the effect of the proposed amendments? One would like to be satisfied because there are those among us who strongly objected to certain features of the Insurance Act of 1943 and if it is within the scope of the present amending Act one would like to have objectionable provisions eliminated.

I must apologise for not being present when the hon. Minister made his introductory speech. In any case, there are various aspects of so much importance that I personally would like to have information which I do not possess at the moment. If the Minister has already given that information, I must once again apologise. I however consider that I should raise these aspects in the execution of my duty. Perhaps the Minister can give the information. The Bill makes provision for certain concessions to insurance companies which have been registered in the Union for less than 20 years, and in order to meet them certain limitations which have been placed on their expansion have now been removed. In Clause 1 provision is made for their now expanding in new directions in which they were not active before. My information is that today there is really no sphere in which provision has not been made for insurance. In other words, the real insurance work for which there is a demand is performed by existing companies. The question therefore arises why there should now be an extension of the facilities of other companies, especially foreign companies, because the Bill makes provision only for foreign companies. Now my information is that there are quite a number of foreign companies while there is only a limited number of South African companies. And further my information is that there is no hiatus, but that all the requirements of insurance can be supplied. Why then is this concession made to foreign companies to perform certain work for which noprovision exists for them today? Seeing that the Minister wishes to extend this concession, we should like to know how many companies are affected hereby. How many foreign companies are now being enabled to operate on new terrain? Furthermore, I wish to ask whether it is not an obvious conclusion that where new concessions are granted there will as a matter of course be new competition, or rather whether opportunity will not be created for new competition. I understand that the number of companies operating in South Africa today is approximately 80, but all of them do not of course operate in all spheres. How many of these 80 are affected? I understand that of the 80 only a small percentage, not even 10 per cent., are South African companies. The remaining 90 per cent. are overseas companies. Now new terrain is opened for insurance work by overseas companies. A further question which immediately arises is what the position will be of those overseas companies who today have agencies in the Union. One special case was mentioned to me of a foreign company which only controls agencies and which evidently by the wording of the amendment in this Bill will be enabled to transfer some of its home funds to be available for the agency in South Africa and in this manner to be able to operate on a larger terrain. In how far will agencies of foreign companies for example be entitled to operate on a new terrain? Under the existing licence they will probably now be permitted to operate as a new company in South Africa. I regret that I have not had sufficient time to devote full attention to this Bill. There are a number of important aspects and I wish to ask the Minister whether he will not be so good as to postpone the discussion until Monday.

The Committee stage.

There are a few matters of principle in the issue.

They are really separate points which can be dealt with in Committee.

Cannot the second reading be postponed until Monday?

No.

The question then is what the practical effect will be, especially in connection with re-insurance. It is the practice to re-insure, and the matter of the locus standi of an insurance company is of importance here. A company which gives insurance in South Africa does not take all the risk. Usually the risk is spread, and another company is brought in for re-insurance. Under the old law that could happen either inside or outside the Union. Under the old Act the inland re-insurance company had to make available sufficient assets to cover its liability under the Act. We as a State cannot lay such an obligation on a foreign company which has no assets in South Africa with which to satisfy the requirements of the Act. We are now making provision for the deletion of this possibility, and foreign companies therefore also become liable. The practical difficulty however still remains that the Union has no locus standi in regard to foreign companies when re-insurance takes place. It is now laid down in this Bill that the foreign re-insurer’ will be subject to the same obligation as other companies in South Africa. I welcome this same requirement being put as is put to South African companies. If the Minister can inform me that that is the position, I welcome it.

I explained that.

I am sorry that I did not hear it. There are a number of other points with which I do not wish to deal now. But the chief aspect is that new terrain is being opened for companies who are today not entitled to operate in certain spheres, and the further question is whether agencies will not obtain a new status in South Africa by virtue of the provisions of this Bill.

As I have already said, I shall not take the Committee stage immediately. Therefore the hon. member for Ceres (Dr. Stals) will have more time to investigate certain aspects of the Bill. As regards the matter mentioned by him in connection with the re-insurer, I dealt with that in my introductory speech. It is clear that our object is to eliminate the discrimination which is at present operating against companies active in South Africa. We at least want to put such companies on an equal footing with companies which do not operate in South Africa.

I welcome that.

Another point raised by the hon. member is in connection with the first clause of the Bill. That deals with foreign companies which have less than 20 years experience. Our object here is only to give effect to what was the original aim of the Act. The original intention was only to limit such companies which started to operate in South Africa, not to prevent such a company from extending its business. The hon. member asks how many foreign companies will be affected by this clause. At the moment I cannot tell him that, but I shall obtain the information. He also raised the question whether the acceptance of this clause will mean that a foreign company which only has an agency here will now be able to operate in a new sphere. I do not think so, but I shall investigate it further and give the hon. member the information on a later occasion.

Motion put and agreed to.

Bill read a second time: House to go into Committee on the Bill on 7th May.

The danger to our public health is increasing. We have heard various expressions here about all sorts of diseases which rage amongst our people. We heard about circumstances which really make us feel very worried, and there are dangers which increase and become bigger by the day. If ever there was a time to take active steps against various diseases, it is now. We find that the position with regard to venereal disease, tuberculosis and such like diseases is alarming. They increase and do not decrease. We had another phenomenon in the past year, namely infantile paralysis. Infantile paralysis is one of those things which hangs like a sword over every house in South Africa where there are children, and we find that medical men are impotent against infantile paralysis. Even during the present year infantile paralysis increased to an alarming extent. Seeing that infantile paralysis is also serious in America, I wish to ask the Minister whether he made any attempt to get into touch with America in order to discover what the best means are of combating infantile paralysis. I however now come to another matter which has not yet been raised in the House. It is a matter referred to in the Annual Report of the Department of Public Health, namely with regard to the poisonous algae. We find that this plant is very poisonous indeed. It is regarded so seriously that the Rand Water Board, which exercises some authority over a portion of the water in Vaaldam, leaves no stone unturned to see to it that the water of the dam is cleared of this poisonous plant. The experience now shows that almost all the large dams, I believe without any exception, are contaminated by the algae. The report states here—

The Rand Water Board and the Irrigation Board work together in combating this plant. But unfortunately the population for all practical purposes remains ignorant in connection with the matter. Notices have been sent out but there has been no large scale action against the poisoning. The discovery of this plant only took place in 1942. I think the time has been too short to determine how many people have already lost their lives as a result of being poisoned by this plant. My constituency borders on the Vaal and there was serious contamination in my constituency, and deaths have already taken place amongst the natives which could not be explained by the medical men. They could not tell us what had caused the death of these natives. The time has been too short to determine whether deaths amongst humans have been caused as the result of this poisoning. This poisonous plant is spread by birds from one dam to the other and from one pond to the other. Last year attempts were made to eradicate the plant in the area of my constituency and adjoining districts, but they started too late. The rainy season was at hand and they could not do much. I should like the Minister seriously to consider the matter. I put a question as to which dams are contaminated. The reply of the department was that Vaaldam and the Bon Accord Dam were fairly seriously contaminated, while other irrigation dams, Hartebeestpoort, Loskop and Kraaipoort were slightly contaminated. They further stated that there was no possibility of the poisonous algae becoming a danger in the Mazelspoort Dam. A reassuring statement was thus made that there was no danger to the Mazelspoort Dam. But a few days after that we read in the Press—

As I have said, birds spread the plant, and it is sown everywhere. The municipalities have taken a serious view of the matter and they are cleaning the dams. But there are the farm schools. The children on the farm schools and practically every farmer on his farm is exposed to the poisoning, and I want to ask the Minister seriously to tackle the matter in co-operation with the Minister of Agriculture who has the machinery for eradicating the plant. There is a means of exterminating the plant completely, and today there is still opportunity to do so. I wish to give him the assurance that, as was done in my constituency, the farmers’ associations will assist in combating the plant. But a start should be made now. Why? The rainy season is passed. It is of no use repeatedly cleaning the dams if water from places higher up runs into the dam and contaminates it again. The difficulty must be tackled at the source, and the sources must be purified when the rainy season is over. I hope the Minister will devote his attention to it. They say here that the whole of the Free State practically is contaminated. How many of the hon. members whose constituencies border on the Free State know that their constituencies are also contaminated? There are hon. members here who do not know that, who do not know that the Hartebeestpoort’ dam, for example, is contaminated. It is a national danger and it can still be prevented from becoming a great problem because there is a means of eradicating the plant. We dare not allow it to spread further and contaminate the whole of the Transvaal and the Free State. What will be the position of our public health when we expose the nation to such dangers? Therefore I wish to ask the Minister seriously to tackle this matter, so that hundreds and thousands of lives may not perhaps be lost. The effect of the plant on certain animals is such that if they swallow 100 per cent. dose they die within ten minutes. But sometimes animals get a light degree of contamination, and they suffer and lose condition perhaps over a period of 18 months. The poison affects the liver. I myself examined an animal which died as a result of it. That animal died within quarter of an hour after drinking the poisoned water, and the whole liver was practically one jelly. There may be people today who have already been poisoned but who have not yet been poisoned to such an extent that they have died. Possibly they are steadily declining in health. For that reason I hope that the Minister will act without delay to exterminate this poisonous plant. [Time limit.]

I can only briefly deal with one or two matters under this vote. First of all I would like to say that I feel sure the House listened with appreciation to the personal statement of the hon. member for Yeoville (Dr. Gluckman) when he indicated that notwithstanding his undoubted feeling of frustration at the Government’s decision with regard to the National Health Service Commission’s report and the constitutional issue, he was nevertheless throwing in his full co-operation to assist the Government to carry out their declared policy of co-operation with the provinces. It was however, only what those of us who know him expected of him, and I personally am gratified that his very able services, advice and drive will be so placed at the disposal of the Government. Let me candidly say that many of us shared this feeling of frustration, because in many quarters it was felt that if the provinces stood in the way, that the moment opportune for a clean sweep of all provincialism had arrived. Whilst I personally have a good deal of sympathy with that view, I feel that we should face the reality of the existing constitutional position, and rather, therefore, accept the Government’s declared willingness to co-operate with the provinces, whereby it is hoped immediate and necessary steps will be taken to give effect to the commission’s report. There must, however, be no dilly-dallying. The public are impatient and it is up to the Government now that they have been given the strongest possible mandate by the country, as one of the chief means towards the goal of social security, to “get a move on and to do so speedily”. In this connection I wish to refer to the health centres proposal, which has also been accepted, and which is definitely a step in the right direction. The object of these health centres is self-evident in the commission’s report, so that I need not go further into their merits. In all, I understand, 400 health centres will be established in those areas, but I am not satisfied that there should be so much delay in coming to a decision where and in what rural places many of these health centres will be established in due course. I do not appreciate why the rural areas should be kept waiting, more especially those which have a large native and coloured community as well, whilst difficulties may arise with regard to the urban areas. The Minister in his earlier reply, stated that what was holding up matters was the question before the Advisory Committee as to whether there should be a means test or not. My own view is that there should be no means test but that it should be left to the individual to choose between going to the health centre for advice or to the private practitioner. There is bound to be a certain amount of competition against the private practitioner but I am satisfied, through my happy experience over many years and over a wide area, that the vast majority of medical men place the interests of the community they so ably serve before self. I contend strongly that if it is indicated as soon as possible where it is proposed to establish many of these health centres in the rural areas, local authorities can assist in making the necessary arrangements regarding suitable buildings and the like necessary services, and I stress this point and I hope that the Minister will follow out this suggestion. I am, of course, aware that they cannot actually be started now, as the medical and nursing personnel may not be available to any great extent just at present, but the fact remains, other spade-work can be done in the desired direction in the meantime, once the Government has indicated the places where such health centres are to be established in the rural areas, and the people could be gradually interested in and educated up to what services these health centres will pitwide. There are today many enthusiastic men and women already doing work which is envisaged will be done by these health centres, and whose activities support my plea that the Government should indicate with as little delay as possible, where these health centres are to be established. In this connection, I have in mind a small, but enthusiastic, body of men and women at Mortimer in my constituency, who as the chairman of the commission can testify, through self-sacrifice and keenness are doing very noble work, both as regard the general health of their community, and in the prevention sense, as well as other like services. Mr. Chairman, because these health centres will contribute so much towards prevention, which is really so essential, I wish to read a short paragraph from an interesting address given by Dr. H. J. van der Bijl at the Health Congress on the 29th November, 1944, when he stated, inter alia—

I therefore urge upon the Government the desirability of declaring where these health centres are to be etsablished in the rural areas in the fervent hope that they will be put into practical effect with the least possible delay. Then I should like to refer to the unsatisfactory position which appertains today with regard to the difficulties experienced by divisional councils in the Cape Province regarding their employment of a health officer. In the cases of the smaller divisional councils, they are expected to take all the necessary steps with regard to infectious diseases in their particular districts, and for such purposes the local district surgeon is employed, but it has been found that these services are a very heavy financial responsibility on these public bodies, even if they can claim a refund of two-thirds of the fees and expenses incurred by such district surgeon. It is grossly unfair that in the Cape Province where the divisional council system appertains—incidentally an excellent system— that this extra financial responsibility should be thrown on their shoulders, which in reality is that of the local ratepayers. In this way, the Cape Province is unduly penalised and I feel that the Public Health Act, No. 36 of 1919, ought very definitely to be revised as far as this financial responsibility is concerned, and which should be the sole responsibility of the Central Government. Indeed, I go further and I say that this old Act is definitely obsolete in many ways, and it is somewhat surprising that an amended Act to meet modern conditions has not yet been placed upon the Statute Book. I commend this to the Minister and hope that this will be done at an early date. Finally, the question of the spread of tuberculosis has been referred to by various speakers, and its extensive existence in the urban areas, and whilst I appreciate that the matter is also one of the major problems of the big cities; what about the rural areas with its large native population? There is practically no accommodation whatsoever for these unfortunate non-European sufferers, with the result that they are a potential danger to all with whom they come into contact. I am not unappreciative of the Government’s action and the assistance it has given to Lovedale in my constituency, for the benefit of these unfortunate non-European sufferers, but this is only a drop in the ocean, compared with even the minimum requirements of the rural areas. Take Lovedale, for instance, which caters so efficiently for the health of the non-European. The Governing Council there has been and is yearly facing deficiencies which notwithstanding the most careful management are growing to such a figure that they simply cannot carry on. I have already submitted to the Minister a memorandum in this connection, so that I will not go into the details thereof now but I would like the Minister to state definitely what the intention of his Department is regarding that memorandum. The Governing Council is anxious and alarmed, and unless assistance is forthcoming, they may definitely not be able to carry on. It is unfortunate that finance has to play such an important rôle in providing extended health services, and as the Minister of Finance has very rightly pointed out, the Government is asked and urged to spend and to spend liberally, but when it comes to the question of how to find that money, then there are shouts about the taxation necessary in finding that money. But, Sir, the health of the nation is fundamental to every plan for social security, and we must find the means, even if we have to pass it on to posterity, because they will eventually benefit by having a healthier nation in the future.

This important matter of a national health service naturally demands the attention of the whole nation. I must say that we on this side of the House are very disappointed because the matter has progressed so little in the past year. Already last year we expected that something would be done here in connection with that service which is so eagerly anticipated by the nation, but unfortunately after the statement of the Minister of Welfare and Demobilisation we feel disappointed. I just hope that that is not an indication of the manner in which social security for our nation will be dealt with. We hope that although the Minister now announces that in this matter he cannot do much this year, hard work will be put in in future in this regard in order to do something for the people. What appears strange to us is this. The nation asks for such a service; the medical profession is willing to perform the service. The nation goes so far even as to promise to contribute its financial share, if necessary, and provided it is a reasonable contribution. The health of the nation demands it, and therefore there is no hitch on the part of the nation, but why the Minister cannot carry on with this matter we cannot understand. The money is available. This matter can be tackled immediately, but in the meantime disease must continue to rage and take with it one victim after the other. It seems to me that we can only solve this problem when the Nationalist Party comes into power.

If that is the condition, it will never happen.

I think there is much more hope of that happening than that this Government will inaugurate such a service, because as I have said, there is not the least hitch. If the nation were unwilling and against this legislation, there would have been something to say in defence of the Minister’s actions but everybody welcomes it and yet it cannot be done. If it were a financial difficulty, it could be solved. In that respect the Free State set an example. It said: “Give us an amount and we will also ourselves tax the people in order to provide this service”. We in the Free State have to deal with thousands of natives whom we have to nurse without help from the Union Government. The Provincial Councils of all four Provinces are willing to provide this service. Just give them the money. When free medical treatment and also free hospitalisation are given, everyone will be prepared to put his hand deep into his pockets in order to promote this matter. There is a large portion of our nation today who are becoming the victims of disease because they have not the means to call in a doctor or to have hospital treatment. Others who maintain the health of their families sometimes become the victims of poverty. Afterwards they become discouraged because what they have saved for years is completely swallowed up by these hospital costs and the costs of medical treatment. Why cannot we solve this problem? Is the nation just being bluffed when these things are promised and not executed? I hope that there will now be action in this respect and that we will not receive promises only. The Minister said it was put down on paper, but we know this Government. We know that it is a Government of commissions which solves problems on paper, but as I stated just now, the only Party which will really solve the matter is the Nationalist Party. But in the meantime, until the Nationalist Party come into power, I would like to ask the Minister in the meanwhile to do something, and that is to see to it that the health of our children in the schools is cared for. Medical examination is done now and again in schools. There are medical inspectors who go round, and the services rendered by those inspectors to the nation are of inestimable value. But it sometimes takes four or five years before such an inspector again comes to the school, and I wish to ask the Minister to regulate the matter so that all schoolchildren will be regularly examined. It sometimes happens that a child has septic tonsils or a couple of bad teeth which undermine his whole health, and that inflicts irreparable damage to his health, just because the parent cannot afford to have the child regularly examined and because nobody knows about it.

Order, order. I think that matter falls under the Provincial Councils.

I thought it fell under national health. Another matter I wish to refer to is the danger in which our people are getting into in connection with tuberculosis and venereal disease. Take a place like Cape Town today. When one comes to the station and sees how many natives and coloureds are crowded together there, and one sees how they expectorate on the ground and one thinks of the number of consumptives in Cape Town, one is surprised that this disease does not spread faster in the Cape. Take for example venereal disease. Medical men have mentioned what the percentage of incidence is and how it is increasing. We on the platteland have on various occasions asked the Government to introduce legislation to force the natives working on the farms to be examined, and that they should receive injections if they suffer from that disease. They are very often engaged in dairying and often they are house servants, and yet many of them suffer from that disease.

May I remind the hon. member that this matter has been repeated ad nauseam.

But I am now coming to the point ….

Order, order. I wish to refer the hon. member to Regulation No. 90 which states that an hon. member may not repeat a matter ad nauseam.

I abide by that, but I should like to direct the Minister’s attention to this point in connection with it. The farmers want the district surgeons to be orderd to erect centra easily available to farmers in order that they may have natives working on their farms who suffer from venereal disease injected. I now have a case like that on my farm. My foreman has written to me that the disease has broken out on the farm again. The instruction of the doctor is that these natives must go to Ladybrand for injections, a distance of 70 miles every week. It is impossible for the farmer to send the native there. Hobhouse, however, is 32 miles from Ladybrand. Why cannot instructions be given that the doctor should inject these natives there? There are numbers of farmers who have this disease on their farms amongst the natives and they do not know how to have the natives treated, and I shall be very glad if the hon. Minister will give me a reply to the matter and if he will give me the assurance that the Government will do its best to have the problem solved. [Time limit.]

The answer lies in the health centres.

I think the House and the country is indebted to the Secretary for Public Health for the very excellent and valuable report that he has submitted this year, not only because of the information of a general character which helps to direct the attention of the public to the need for attending to public health in this country, but also because of the very important principles he indicates the Government have realised as necessary at the present moment. The public will, for instance, realise, I hope, that in the matter of health there is no such thing as colour bar and that the ill-health of the non-European population is not only a menace to the non-European population itself but, as the report states in the first paragraph, a menace to the people of South Africa as a whole. I hope that with the realisation of that position the Government will take more effective steps than has been the case in the past, even if it means emphasising the need for an improvement in non-European health. An improvement of their health conditions is not only important from the point of view of their health but also to safeguard the well-being and the health and industrial efficiency of South Africa as a whole. One of the things, I hope, that will emerge from this report is a realisation that our information in regard to national health is hopelessly inadequate and that the state of ill-health among the natives should at least be taken in hand and an organisation set up on the lines of that we have for the European population, and that we should ensure a complete record being prepared of the health position of the non-European population. I know that will again raise the question of lack of staff, and I trust in that connection the Minister’ will consider the utilisation to a considerable extent of the non-European soldier who will be demobilised and who will be capable of giving satisfaction in this respect instead of perhaps remaining unemployed. The other point I want to stress is the general question of social security under which this falls. For a number of years South Africa waited with bated breath for the report of the National Health Commission over which the hon. member for Yeoville (Dr. Gluckman) presided. We were told we would have to deal with social security as a comprehensive measure which would include public health for the people, and ultimately, when that report was issued —a very valuable report which everyone appreciated—we found ourselves placed in the position that the Government came to the conclusion we could not implement that report in the manner suggested. I happen to be one of those who agrees with the Government that it would have been a very wrong and dangerous thing at the present moment to have started a constitutional fight which, while it might nominally receive some support in this House, would nont receive adequate support in the country and from political parties to enable the Government to do away with the Provincial Councils in the matter of health. A fight of that kind might instead of improving the position and possibilities have delayed substantially the period when the recommendations of the National Health Service Commission will be given effect to. So I have no grievance against the Government for having decided not to embark on a constitutional fight at present. But I do want to emphasise this point that to the extent the Government is going to give effect to the recommendations of the report for the establishment of health centres, and to the extent that the Government is already in control of extra-institutional arrangements at present, that the Minister and the Government should definitely give us some assurance that these health centres, and that the extra-institutional arrangements that the Government has under its control, will be dealt with not on the basis of demanding a man to show what his means are before he can be attended but on the basis outlined by those who have been advocating social security, and that is health being a right and not being based on the means of the public. I hope the Minister will make it clear that any idea of a means test will be done away with entirely, and that any citizens in this country requiring attention in these institutions will be able to obtain that attention without their means being gone into in any way, and without the health centres being dealt with as pauper institutions instead of as they should be national institutions for all sections of the population.

I want to express my support for what the hon. member for Fort Beaufort (Mr. V. G. F. Solomon) said, and more particularly in regard to the importance which he attached to the establishment of health centres. The recommendations of the Gluckman Commission’s report in relation to health centres was really the whole basis, the whole kernel of that report itself. The hon. member for Fort Beaufort referred to the difficulties in this connection of establishing these health centres, difficulties relating to personnel, to the means test and so forth that the Minister mentioned yesterday. Those things were all dealt with by the commission itself in its report. The commission consulted the medical profession and the medical profession said on what terms it was prepared to co-operate in the scheme. What further difficulties have cropped up since then, in relation to personnel is therefore a matter, to my mind, which calls for some further explanation. The commission faced the question of shortage of personnel and it made recommendations on the basis of such personnel as did exist. It said that it would be necessary in the first instance for these health centres to cope with a very much larger population than it was hoped they would have to cope with when more personnel had been provided. In regard to the means test, that was not recommended at all; no means test was recommended by the commission and I support what previous speakers have said in that connection, that this scheme when it is brought into effect should really be administered with the absence of the means test. I want to ask the Minister also what plans he has initially for establishing these health centres. The commission recommended they should be placed in areas where the need is greatest. Last year the sum of £50,000 was placed on the estimates for the establishment of health centres, and this year £100,000 has been placed on the estimates—£150,000 in all. I want to ask the Minister how many health centres can be provided for that amount. How many health centres can be provided with this total sum of £150,000? That is the first thing I want to ask. Secondly, I should like to know where it is intended in the first place to establish these health centres?

At the present time it is not so much money that is the limitation but personnel.

I have dealt with the question of personnel. I still have not followed why the commission’s report in this connection cannot be adopted. Apparently the commission said that the medical profession was prepared to co-operate on the basis of a certain scale of salaries, and they also dealt with the total amount of personnel in the country, and they seemed to think it would be adequate provided each health centre had a certain population attached to it. But now there is another question which to my mind is even more important which I want to put to the Minister, and that is in connection with native hospitalisation. The Minister has explained to us that, due to constitutional difficulties, the Government have had to leave hospitalisation in the hands of the Provinces, but we want to know on what terms and under what guarantees that decision was arrived at; because as I emphasised yesterday, for years past the Provinces have explicitly repudiated any responsibility for the extension and development of native hospital services. They have said that over and over again and brought forward what I think is a very mean excuse, namely that they do not get the proceeds of the native poll tax. The result of the position has been this, that more particularly in the rural areas the Native Trust has been paying for a large proportion of these hospital services for natives. That was never intended to be a function of the Native Trust and it has not got the funds. The Provinces come along and put up constitutional arguments that they want to keep hospitalisation in their hands, and yet for years they have been repudiating liability for hospital services, which they say should fall under them, in spite of the fact that they have received funds for it from the Central Government. What funds have the Native Trust got? They have one-fifth of the proceeds of the poll tax, but that, explicitly in statutory terms, has to be spent on agricultural services. There is the local tax, which is spent by the local councils in the areas concerned, in the same way as rates, on roads and bridges and things like that. The Native Trust has a few small fees from grazing, afforestation, rents, etc., but they are very small and the Native Trust cannot afford this burden. I want to ask the Minister now whether, in view of the new financial arrangements made, the Provinces have resiled from the previous attitude they adopted that they could not afford to pay for hospitals for natives? Have they done so? The sooner we have a public statement on that point the better. For years there have been missionaries struggling away in the reserves without any help at all. They were very often foreigners, not even South Africans at all, and this country should be ashamed to leave to these people the duty of providing hospital services. We know what the Provincial attitude was in the past. We know that the whole question of the finance of native hospital services was pushed off from year to year, from one inter-Provincial consultative committee to another, and I do want to stress the importance of reasurring the native people on this point. I am asked about this wherever I go in the rural areas, and I ask the Minister to make a public statement as to whether the Provinces now definitely accept the responsibility. Now, there is another recommendation in the Health Commission’s report which I am very concerned about, and that is the provision of environmental services. If the full report had been accepted, if the constitutional difficulties had been got round, and the Government had assumed responsibility for the financial side of hospitalisation, £2,000,000 would have been set free for the assistance of local authorities in the provision of environmental services, sanitation, etc.—the provision of those services which are so essential in the preventive field. The result of the Provinces’ insistence in maintaining their hold over institutional services which they have so inadequately provided in the past, is that this £2,000,000 now will not be available for the essential services for which the commission intended it. And in this connection, therefore, I want to make this suggestion to the Minister that the time has now arrived to overhaul the whole question of local government in this country. I know that I cannot advocate any change in the law in this connection but I do feel that in future the serious lack of environmental services, particularly in small towns and in those large peri-urban areas which have grown up round big cities make it necessary to reconsider the whole question of financing the local sanitary and water services of these areas. The commission stresses more particularly that the small local authorities, with the best will in the world, are not in a financial position to provide adequately for environ-, mental services. The Government have obligations in the field of housing, but that does not and should not cover environmental services. The costs of drainage and sanitation and water, etc., should not be borne by tenants of national houses as part of their rents. That was an emphatic recommendation of the commission. The ordinary provision of environmental services from the proceeds of rates, and more particularly the rates of the smaller local authorities have not proved adequate to meet the demand. That is why I ask now, in view of the fact that this part of the commission’s report, the Gluckman Report, was not accepted, that the financial relations between local authorities, the Central Government and the Provinces be reconsidered by an independent Commission of Enquiry.

I view with considerable alarm the attempt to whitewash the action taken by the Government. Especially do I view with alarm an attempt like that of the hon. member for Troyeville (Mr. Kentridge) to tell the world that this is the very best thing that could have happened and that the Government could have done nothing better than they did. I say I want one last word. This is a matter which has to remain a burning question before the public and before this House. There is division in control. At every turn there is divided control and the further divided control which has been introduced now appears to be working day by day against the best interests of public health in this country. We have to recognise it. I am aware that there will be some improvement, because there will be increased grants to the Provincial Administrations, but I am absolutely certain that the Provincial Administration is not the administration which should deal with hospitals for the whole of the Union and specialised services for the whole of the Union. That hon. member talks with his tongue in his cheek and says there is no colour bar in public health. No-one has ever dreamt of talking about a colour bar in public health, but he is personally prepared to introduce a geographical bar straight away, a geographical bar giving certain provinces which have large native populations and large European populations certain functions and putting them for the purpose of these essential services under the control of this province, yet that province is unable, in the nature of things, to make financial provision for carrying out this work as it had been hoped that it would be carried out. I do not wish to say anything more about it. The matter is finished, but I will not remain silent when an attempt is made to tell the world that this is the best thing that could have been done. It is only a very little better than the system we had before, and the question of the shortage of personnel, we know, exists today, but we also know that there will be many hundreds of medical men and thousands of nurses coming back from service overseas, and we know that in any case we were not prepared to put this scheme, or even a part of it, into operation in six months, but we could have begun within one year. Furthermore, it is in the power of the Government to begin to make plans for the provision of personnel, and we have not heard anything about that yet. I do not blame the Minister for that. All I want is that with regard to training personnel definite steps should be taken to investigate existing needs so that we will have medical nurses and training centres and begin to do something. I do not blame the Minister but I do want plans to be made immediately.

Would you tell the House what your views are about the means test at health centres?

I think that as far as concerns the health centres, people who are able to pay will not readily go to them. There are people who do go. We know that from our hospital experience today, that some people who can afford to pay go to free hospitals, but there again we have almoners to prevent them from going in if they are not entitled to free treatment. But that again is only because the service is not one which is accepted by the whole of the medical profession, and in which the whole of the medical profession can find a place if it wanted to. If it was like that, the whole of the public would have the fullest confidence and would readily come to the health centres and to the free hospitals and to the free services in the free hospitals. Today they will not have that feeling that they can get free services and free hospitals because it is obvious that provision has only been made for the indigent part of the population. That will not be remedied under conditions under which we are going for the next five or ten years. However, I believe that the time will come quite soon when different arrangements may be made and I only hope that there will not be attempts to paint the drooping lily which is dying. This divided control has become more intricate and impossible every day for the reason that the Minister has introduced new functions for the Provincial Administrations which they are entirely incapable of performing. There is one province which I look to to give us the best hospital service and where I think there are the best chances for the best specialist services, namely the Transvaal, but even there, although I had long talks with people in command there, I am very doubtful now whether specialist services can and will be so extended there that it will have any relationship to the large number of people, even indigents, who require specialist services in that province. We are going to do the best we can, but I hope that there will be no further attempt to make this appear to be anything like an ideal State. It is neither ideal nor good; it is bad. It is worse than it was because the Minister has introduced new factors into the provinces which should not have been there, but I believe that more will be done and more will be spent and more achieved than in the past. We will achieve more, especially if the Minister will accept the scheme where he will have special regional officers throughout the country and the country will be divided into twenty or twenty-five areas, each having a tuberculosis officer and a venereal diseases officer, etc., throughout the different areas of the country, so that we can at any rate do in that part of the scheme which we still have under the control of the central authorities far more than we were able to do in the past.

Business suspended at 12.45 p.m. and resumed at 2.20 p.m.

While I do not propose to discuss the provincial system I wish to associate myself with those members in this House who say that where the provincial system interferes with promoting the health of the people of this country let us do away with that system. I have no doubt that the Minister must have a very difficult task to fulfil. Everybody is looking to him today to set everything in motion, and with this provincial system we have today, with the prospects of free hospitalisation in the Transvaal while just across the Vaal we have not got it, we shall have no end of trouble, and the Minister will be blamed. If we want to look to the health of the people, and if provincialism is nothing but an obstacle in extending health services in the way the public are looking forward to, the public will not let provincial interests stand in the way of national interests. Dealing with the scheme enumerated by the commission, I can only say from a practical point of view I look upon it as idealistic. It is very beautiful on paper but it is quite impracticable.

Why?

There are two reasons. Let me mention one. In this House we have had no end of criticism of the Minister on account of the burden of taxation and if any hon. member will tell me where the money is coming from to finance an enormous scheme like this suggested by the commission ….

The commission tells us.

They talk in the air. If they think the same revenue the country derives today will be available in normal times, they will have to think again. Let us face it in a businesslike way. Let us not hold out hopes we cannot fulfil. However attractive the scheme may be if we cannot afford it we must cut our cloth according to our means.

You will only find money for destruction.

I say the practical thing is to go right ahead with something at once; and what is the best way—to put your existing machinery into motion. Your present machinery is practical and it can be extended and developed. We talk freely about social security, but where the Minister will get all the money required to carry out all the suggestions made by some hon. members I cannot say. With our limited means we must proceed on a programme within our means and adapt it to our existing machinery. At present free hospitalisation, free medical treatment and general provisions for improving social conditions are extended to paupers only. Instead of that we should have a systematic classification of our population, so that in every district there would be available a list of the residents who are entitled to free hospitalisation and free medical treatment. Then when a person who, though not necessarily a pauper, required treatment and deserves it, it will not be necessary for a visit to be made to the resident magistrate in order that the assistance of the district surgeon may be evoked. We should expand the district surgeon system; more of them should be made full-time officials, and their number should be increased. I am opposed to extending free hospitalisation and free medical treatment to people who can well afford to pay for it. That is a wrong principle entirely. I should like to mention one class in our community who, while they are not paupers, deserve and urgently require these free medical services; their health and well-being are suffering owing to the lack of these facilities which are at present beyond their reach. I refer to the small farmer; he lives from hand to mouth, he has a very small margin over and he may be living 40 miles away from the nearest doctor. He realises when illness overtakes the family that if he calls in the doctor it will involve him in an expense of £20 or £30. Therefore he allows the member of his family who is affected to remain without medical attention and for the illness to take its course before as is often of course necessary, he eventually does call in a doctor. There you have an instance of where help is denied a class of the community who really deserve to be assisted, but who are not assisted because they do not fall within the category of paupers. In fact, rather than be described as a pauper the small farmer will risk the health of his family by failing to call in a doctor in time. When he does call in a doctor, it may be a case, say, of enteric fever and the doctor calls five or six times, it may cost him £100, a sum which to him represents economic shipwreck. These men cannot afford to pay £150 or £100 for medical expenses all of a sudden. We have the district surgeon system now, and its extension should, as the Minister has indicated be started on. Not only is it in the country that the services of the district surgeons are required. In the towns it will often be found that there are people of the middle class who cannot afford to call in a doctor except in extremely urgent cases. Here again the salary earners could be classified and a list prepared of those entitled to free hospitalisation or free medical attention. The Minister has the machinery ready if he will only develop it and expand it. It is no good talking about a scheme which cannot be fulfilled because the country cannot stand the cost. Personally I take the stand that I refuse to extend these privileges to people who can afford to pay. Let us follow a practical policy that is capable of being put into immediate operation instead of holding out to the public the prospect of schemes that the country cannot afford to finance and so delay the matter.

I feel that before this debate concludes, I should intervene once again. I do this because it is quite clear to me that, in the minds of some hon. members, there is an impression that the Department of Public Health is floundering about in a bewildered attempt to muddle through the task which now confronts it. Criticisms have been made in respect of a number of matters. The House has been told that T.B. is rampant; that V.D. is undermining the stamina of our native population; that there have been outbreaks of smallpox in Natal and the Transkei; that typhus has flared up in alarming proportions in the native territories; and that malaria caused alarm in the Northern Transvai after abnormal rains. There is no dispute about these facts. I have never attempted, in the five and a half years I have been responsible for the administration of the Public Health Department, to conceal from the House, or from the country, the danger to public health from these major forms of formidable disease. The reports of the Department of Public Health have harped upon them with monotonous regularity year after year. But present discontents go further. We are told about the lack of health facilities, both preventive and curative, for large sections of the community. The plight of the middle-man—who is neither a pauper nor in a position to pay for specialised treatment—is stressed. We are told about the people on the platteland who, in times of emergency, are compelled to pay exorbitant sums for medical attention, or else go without. In dealing with these complaints, and these criticisms, I have pointed to the difficulties of the Department of Public Health as constituted at present. The explanations given, however, have either been misunderstood, or appear to have been expressed in such infelicitous terms as to make no impression on those who are anxious to see an improvement in our health standards and public health generally. In speaking of the future, it is urged that I should act, and not waste time on paper plans. Let me once again, Sir, try to put the position as I see it. My sympathies are entirely with those who feel that South Africa needs a New Deal in public health. But, as a shrewd, former mayor of Cape Town once remarked in the witness box: “You can’t discount no sympathy at the Standard Bank!” Sympathy, to be effective on occasions such as this, needs to be translated into action. What, therefore, is clearly wanted at the present time is some action— some action which will produce results. And those results must be the introduction of a health service, both preventive and curative, available to all sections of the Union’s population. Since 1919, and up to the present time, the Public Health Department has been limited in its activities by the powers conferred upon it by the Public Health Act of 1919. That that Act is out of date, and that it has served its purpose, was freely admitted by me when announcing the Government’s intention, in August, 1942, to appoint a Commission to enquire into national health needs. It was the realisation of this cardinal fact which prompted the Government to appoint such a Commission while still immersed in the prosecution of the war effort. When, therefore, hon. members complain now that the Department of Public Health should step in and compel local authorities to do this, or do that, I am quite prepared to agree with them. But they know, as well as I do, that I am prevented from doing so by the limitations of the Act. And, because the Department of Public Health has been acting under such grave statutory restrictions, and because it has, in many instances, had to bow to the exigencies of war demands, I have, on occasions, been driven to defend it and point Out that its record, in all the circumstances, is not entirely disreputable. In the five and a half years of war we have increased our vote on the ’estimates by nearly £1,000,000. We have more than doubled our expenditure on T.B., and nearly doubled our expenditure on V.D. We have actually spent £1,000,000 on providing hospital accommodation for T.B. patients during that period despite the fact that war needs have depleted our professional staff by 50 per cent., we have inaugurated a National Nutrition Council; opened a Nutrition Section in our head office; launched a National Housing and Planning Commission; built twice as many sub-economic houses as during the previous nine years of peace; combated typhus on an unprecedented scale in the Transkei; launched a mass attack on smallpox in the same territory and in Natal; initiated a new offensive on malaria in the winter breeding areas of the Transvaal; and established health centres at Polela, Natal, Bushbackridge, Transvaal, and Karatara, Cape, which may well prove to be models for the foundation of our future National Health Service in South Africa. Furthermore, as the House already knows, I intend introducing this Session a Bill to amend the Housing Act, which will give the Housing Commission drastic powers to meet our present housing emergency. That Act will have to be administered by the Housing Division of the Department of Public Health. In all these circumstances, I think it is legitimate to repeat one’s conviction that, in the face of difficulties sometimes apparently insuperable, the Public Health Department has in many conspicuous ways been able to make a considerable contribution to the advancement of public health during a period of abnormality. So much for the past five and a half years of war. What of the present? And what of the future? Last year the National Health Commission reported. Am I going to act on that report? And, if so, what action is to be taken? These are legitimate questions. The hon. member for Fort Beaufort (Mr. V. G. F. Solomon) seems to indicate that he considers the opinion of the House is that the Government was given the clearest possible mandate in this repott, and he thinks that we should have no means test, and that money should not be an obstacle. It is as well that the House and the country realised the implications. If the hon. member is correctly interpreting the feelings of the House and the country, if we are going to have our health services, we shall of course have to pay for it. What action will be taken? These are all legitimate questions, but I would suggest that it is not legitimate to expect a complete and full answer immediately. The Government has indicated that it is prepared to give the country a national health service within the framework of the Constitution. But before the scheme can be translated into reality there obviously must be careful co-ordinated and scientific planning. We cannot have a V-Day before there was careful planning. One cannot have a new order without proper planning. The Government announced that it will have the scheme within the framework of the Constitution. There are hon. members who feel that by allowing the provinces to remain in control of general hospital services we shall at the start be ruining any possible national health scheme. The Prime Minister has himself given this House the reason for the Government’s decision in the matter. I see no academic reason why such a national health service is not possible, allowing the provinces to run the health services, particularly in view of the fact that we have now evolved co-ordinating machinery which seems as if it will function well, and which is dealing with the problem like the training of nurses, the co-ordination of personnel, the transfer of personnel, wages and conditions, etc. That in itself is a big step forward, but of course, in the ultimate event, if the provinces do not deliver the goods, Parliament will have to review the position.

Hear, hear.

The Government considers that the scheme may work well, and if it works well we will be satisfied. We are within the Constitution. But if the scheme does not work well, and if the retention of general hospital services by the provinces results in a breakdown ultimately of national health services, it is for the people of this country to express their will, by constitutional means, in Parliament. The basis of the national health scheme, as contemplated by the National Health Commission, is this health centre. A number of questions have been put to me regarding health centres and how they should be constituted. To whom will these services be available? Will there be a means test? Will personnel be trained? I am not in a position today to give the House final decisions, but I can let hon. members know my own personal views on a number of matters, which will indicate the lines along which we are planning and the lines along which the Advisory Council are thinking, and the suggestions which are put forward which will come up for consideration. If we are going to carry out the report of the Gluckman Commission in so far as health centres are concerned—and I leave out now any question of hospital services—it seems that the Central Government which has already stated in its declaration to the provinces that it is accepting liability for non-institutional services, must assume 100 per cent. executive responsibility and 100 per cent. financial responsibility. This scheme then would represent national health services for all extra-institutional personal health services and some institutional services, namely mental hospitals, tuberculosis, venereal diseases and formidable epidemic diseases hospitals, which will be paid for entirely by Government funds, public funds including contributions from the accident fund established under the Workmen’s Compensation Act, and from employers liable to provide medical services for their employees under the Native Labour Regulation Act and administered entirely by the Government through health centres and regional organisation; in short, the national health scheme, as contemplated in the majority report of the Gluckman Commission, minus provincial-controlled general hospitals. Such a scheme would ensure health services for all according to their needs, and not their financial means. It would eliminate gaps, overlapping, and lack of co-ordination due to divided control. By way of unified national direction, it would ensure equitable distribution of the limited resources of medical and auxiliary personnel available in the Union. In order to bring it about, it will be necessary to enter into the discussions and negotiations contemplated on page 172 of the Gluckman Report, regarding the integration into a National Health Service of the many extra-institutional services at present conducted by public authorities and private agencies. Such will be the task, if this scheme is given the Government’s sanctoin, of the Advisory Council on National Health. I appreciate of course that since the Government’s decision not to proceed with the full report there is a very urgent necessity for the fullest co-operation between the Government and the medical and allied professions. There must be close consultation regarding various matters and the intention is that at the earliest possible opportunity, the hon. member for Yeoville (Dr. Gluckman) who is chairman of the National Advisory Committee should get into touch with his organisation and have the fullest possible discussions with them. So much for the conception of a health centre and the thoughts which are moving the minds of those dealing with the matter at present. I have already admitted that what the House, and the country expect me to produce is results. Anticipating this, and while therefore the necessary evidence was being assembled to’ enable a decision on Health Centres to be taken, I issued certain directives to the Advisory Council regarding priorities. These priorities have been listed as follows—

1. (a) The provision of a National Tuberculosis Scheme;
2. (b) The provision of a National V.D. Scheme;
3. (c) The establishment of an Institute of Hygiene;
4. (d) The establishment of a Central Department of Health Education;
5. (e) The Regionalisation of Health Services.

Let me indicate briefly what is contemplated under each of these priorities, recommendations in respect of which have already been submitted. These are matters which the Advisory Committee have been asked to advise the Department of Public Health upon as matters of piortiy. They are matters to which the committee has already given its attention and upon which they have already given me ah outline of schemes which are capable of consideration by the Government at the present time. I emphasise this in order to indicate to hon. members that in the two months since the formation of the Advisory Committee they have not been idle. In the two months since I last indicated to the House the Government’s approach to the matter, neither the Department nor the Committee were idle. The hon. member for Yeoville and the Secretary for Public Health and I took an opportunity recently of flying to Polela to examine the health centre there. The idea is that Polela should be used as a pilot plant for the training of personnel. Already an amount of £35,000 has been made available for this purpose. We have already personnel who will be approved of and will be diverted to the Polela centre for training. At a later stage we hope to have a training school which one hopes will develop ultimately into an institution of hygiene in Durban. Let me give the bold lines along which we are dealing as regards priorities. Take the question of the National Tuberculosis Scheme. It is all very well to say that we must make tuberculosis a national matter and make it a national scheme overnight, but what does that mean? It is just a matter of words. If it is to be national there will have to be planning. The suggestions which have already been put forward in tentative form are these. These suggestions will be considered by a number of tuberculosis experts who will view it each from his own standpoint but the suggestion is this, that if it is to be a national matter the provinces and local authorities should be relieved of their financial responsibility in regard to tuberculosis. Already the Central Government is responsible for from 75 per cent. to 90 per cent. in financial matters. The suggestion is first of all that it should be made an entirely national matter and that the Government should assume full financial responsibility. By relieving the Provinces of the limited contributions they do make at present, one would enable them, if they saw fit to do so, to apply the funds so released to improving nutrition, which is an anti-tuberculosis measure, and putting more ginger into the school feeding scheme, and it must be remembered that the Provinces at present have not undertaken responsibility for the school feeding of native children; that falls under the vote of the Minister of Education. If we would deal with tuberculosis on a national scale it is probably necessary to establish a national register of all cases of tuberculosis. The estimate given by the department for the number of tuberculosis cases at present puts it at 32,000 as against 8,000 lepers for whom the department keeps a register. Such a register would be in respect of the clinical condition, the stage of the disease, the economic circumstances, the dependants and the contacts. The next step in any national approach to the problem of tuberculosis involves radiography of entrants into industry, and a physical training battalion; also of adolescents in all native educational institutions and of known contacts, like for example all inmates of a native kraal where a known case of tuberculosis has died within the five past years. Already we have a system of mass radiography in Johannesburg in the case of the Witwatersrand Labour Association. This magnificent work has been carried on for some years there, and it is hoped to be able to secure at an early date mass radiography apparatus for Cape Town, Durban, Johannesburg and Stellenbosch. Under a full-blooded scheme these units, which are not available at the moment owing to war exigencies, will have to be instituted in various parts of the country. We will have to make provision for travelling clinics also. The department has already had an example of the type of mobile clinic used in America, fitted up in such a way that it will be suitable for the long distances to be covered in our country. There will have to be regular sputum surveys by medical aids in native areas, suspects and positives being brought along to travelling clinics. There will have to be provision for tuberculosis colonies, where cases can be isolated. We know that there are about 24,000 tuberculotics amongst non-Europeans, and if nothing is done they will infect the community among which they are scattered, and we also know that we can never arrange hospital accommodation for them within measurable time. That will take some time to bring about, but we can consider the matter along these lines, as an initial measure of having tuberculotic colonies where contacts can be placed in isolation. If we can get early isolation of contacts, that in itself is a major contribution towards eradicating tuberculosis. I saw an example of that while I was in Polela. A native left Polela to go and work in Durban and when he came back he had tuberculosis. The medical officer in charge wished to give him treatment but his reply was that he had had enough to do with the medicines of the white man and he went to his kraal. In the blunt language of the medical officer in charge, he pointed out to me that the man who had refused treatment had wiped out three children in that kraal before they eventually got him in to treat him again. There was no isolation and three children died in the kraal as the result. So quite obviously the emphasis to be placed on isolation is very great indeed. That is as regards tuberculosis. Hon. members will conceive the lines along which the expert advisers of the Department of Public Health are working. It is said that this does not represent final definitive decisions, but it shows that we are not being idle and that the material is being arranged so as to enable the Government to form an opinion and at no long distant date to enable it to take a decision in these matters. Similarly with venereal disease. There the National Advisory Council is going fully into the matter before a final plan is put forward and a similar conference of specialists in venereal disease will be called—not a conference, but simply a coming together of experts to give their views and to arrive at a plan. Plans for a future Institute of Hygiene have already been put down on paper, but of course one has to make small starts and the idea is that a commencement should be made by treating Polela as a pilot plant. Money has already been allocated for that purpose. One might be able to use Polela as a rural training ground for African health visitors and other workers in clinics. Wonderful work is being done there at present and there is much scope for using the experience gained there. Then there is the question of regionalisation. That is embodied in the report. One hon. member stressed the importance of having regional tuberculosis officers and the Secretary for Public Health has already worked out a plan for the regionalisation which will eventually enable us to have these expert officers in various parts of the country. As far as health education is concerned the idea is that just as in the last three or four years there was established in the Department of Public Health a section dealing with nutrition, so the time has arrived that we shall have a section dealing with health propaganda. There is an institution in Cape Town organised by Government, municipal and voluntary workers attempting to focus the attention of the public on health and welfare needs. There is the greatest need for this work at present. There is very much ignorance amongst cur people especially on matters such as nutrition. Take the incidence of diphtheria where hundreds of children die merely because their parents would not have them inoculated, although the Department of Public Health makes serum available which is almost 100 per cent. perfect in its effect. We have to make people alive to these health matters and plans have already been laid for doing so. These points indicate briefly what is contemplated under each of these priorities. Instructions in respect of each have already been given. These five priorities represent five methods of advance which can be undertaken in the next twelve months. I hope that the information which I have now given to the House will convince hon. members that these vast and intricate problems are being approached along scientific and realistic lines. A good scheme needs careful planning. But, what is most important of all we mean business and, given that measure of patience and encouragement one may fairly claim in present circumstances, the Government intends to deliver the goods.

After a discussion lasting almost two days, and after the Minister of Welfare has for the second time made a speech in which he eventually indicated the policy of the Government, I definitely believe that hon. members will agree with me that the public will be just as disappointed over the Minister’s reply as are members in this House.

No.

It appears to me that some hon. members do not agree. Let me then state the position shortly as I see it. We have before us two excellent reports, one from the Secretary for Public Health, in which he depicts the position today, and how diseases in South Africa are increasing, whether cancer, or venereal disease, or typhus, or smallpox, or whatever it may be. On the other hand we have the remedy as indicated in the excellent report of the Health Services Commission. Now the Minister has come and explained the Government’s policy. But what in brief, has he said? He has, in brief, said nothing more nor less than that the Government cannot accept this excellent report. He is accepting it only partially, and the Minister’s reasons why it cannot be accepted are twofold. In the first place the provincial system is in the way, and in the second place he asks where the money is to come from. If the Minister wants to tell us, as he has stated here, that the provincial system is now on trial I want to tell him it is not the provincial system that is on trial but the Government that is responsible for the health of the people. He is on trial. The nation will hold him responsible. Now the Minister wants to shift the responsibility of the Government as usual, whether it is housing or anything else, and to place it on the Provincial Councils. When the public note the prevalence of infantile paralysis, when they see how venereal diseases have become an insidious danger amongst the community, they do not ask whether it is the Provincial Councils or the Central Government under whom it falls. No, they will come to the highest authority and hold the Minister of Public Health responsible. Now the Minister states further that the people will not be prepared to find funds. That was also the argument of the hon. member for Vereeniging (Lt.-Col. Rood). I want to say that if the public were prepared to spend £100,000,000 a year during the last five years in destroying human lives, the public will also be prepared to devote a fourth of that amount to the health of the nation, to maintain the national life. This is obvious. Why does the Minister shift his responsibility on to the Provincial Councils? Why does the Minister use the argument that the people are not willing to vote the money? Here we have one practical example of the impotence of the Government. The Government have no self-confidence and when a man has no self-confidence he reaches the stage when he wants to shift responsibility on to others. We know about the prevalence of infantile paralysis, about the increase of venereal disease and how tuberculosis is raging in the country, how it is devouring people, and we feel that the public will be prepared to have a special health tax to finance a war against these things. The hon. member for Vereeniging has stated that we have a system, and that it is only necessary to expand it. But the system is hopeless. A system has been suggested by the Public Health Commission which is quite practical. I should like to dwell on a few aspects of it. We have an outbreak of infantile paralysis. During the first eight days it is a contagious disease. In other words, for the first eight days it has to fall under the Central Government, because contagious diseases fall in the first place under the Central Government. After eight days when it is no longer contagious, it falls under the Provincial Councils, because then they are responsible. Can the Minister state here today that this is a satisfactory state of affairs? Cases of infantile paralysis have occurred in Cradock. I would rather not say what happened there. But I should like to put this question to the Minister: If you get infantile paralysis, if children become life-long cripples, what provision has the State made for them? How is everything arranged? In the first eight days it is a contagious disease and it falls under the Central Government. After that it is no longer contagious and it falls under the Provincial Councils. Will the hon. member for Vereeniging say that such a system is satisfactory and practical, and that it should merely be extended? You can understand how the Department of Public Health is almost paralysed in the presence of such a system.

I stated that if the provincial system stood in the way it should disappear.

But the hon. member said at the same time that the system was right and should be extended. Does the hon. member want to blow hot and cold at the same time? Of course this arises because the hon. member is in a political dilemma in connection with the matter. The hon. member’s difficulty is that when in 1933 the United Party came into being they gave the promise that the provincial system would be maintained. Now the hon. member comes here and wants to blow hot and cold. But that will not go down with the people.

What does the Free State Say?

Let the Free State say what it wants to, and let Natal say what it wants to and let the Transvaal say what it wants to and let the Cape say what it wants to, but the people say that we should not tolerate the nation being destroyed by disease for the sake of the provincial system. We may not protect the system if the people are going to be wiped out under it. The people will not stand for that. The people will also be prepared to find the necessary funds to save us from self-destruction. It was peculiar that the hon. Minister should rise here, and all that he mentioned was that the Public Health Vote was doubled in respect of the amount of money voted. But the Minister must remember that in time of war disease does not stand still. War brings disease. It is one of the things that brings disease. Look at the position in the harbour towns of South Africa, how disease has increased. It is regrettable that the Department of Public Health, seeing we have such an able report as that of the Department of Public Health, is only getting £250,000 more than before the war, while £100,000,000 a year can be found to destroy people. The people will not stand for that. I want to come to something else. A commission was appointed to institute an enquiry into the bad condition of school children’s teeth. The commission that was appointed visited 78,563 European school children, and they confirmed the appalling fact that 67,000, that is to say 85 per cent. of the children’s teeth were affected and that 72 per cent. of them should have received treatment at that time. If you consider this on the basis of the 390,000 children who attend school in South Africa, it means that 280,000 children’s teeth should have received treatment. I want to say this afternoon that if it were not for the local authorities, then as far as dental treatment is concerned, the position in South Africa would be a farce. I do not say that I hold the Minister responsible and accuse him for this, for the existing laws, such as the Act of 1919, are of such limited scope that the Minister or his Department are unable to do very much. I do not know why the Minister does not introduce a new Bill which would satisfy these demands. Then he would not need to hide away behind these things. Dental treatment in our schools today is a farce. Every year a dentist pays a visit and teeth and examined. Treatment is prescribed. In some cases the children may perhaps receive treatment and ih many cases they do not. The following year he comes again to see what has been done. There is no continuinty. I am speaking of personal experience, and only a few years ago dentists, out of their humane feeling, treated the children free of charge. Many hon. members do perhaps doubt whether doctors and dentists do work gratis, but much work is performed free of charge. I can speak of personal experience. A ridiculously small sum is being made available to the Provincial Councils. If teeth are affected, it does not always take the form of a sickness, but it is a symptom of various illnesses in many cases. One knows, however, that every child whose teeth are broken and who suffers from toothache, cannot possibly attend school and benefit effectively from the education. There are many poor people who simply carry on and who have to manage. The Minister must realise that the machinery at his disposal is inefficient. Why does he not create efficient machinery as suggested by the Health Commission. [Time limit.]

It is not often I find myself in complete and absolute agreement with the hon. member for Albert-Colesberg (Mr. Boltman). But it is a feature of this debate that everyone has approached it with a deep and sincere concern for the health of this country. The provincial system has been attacked and as long as the provincial administrations are allowed to barter their services to the Union Government for a profit, so long will our constitutional position be unmanageable. To establish one particular point. Some while ago there was concern on behalf of the Central Government to hava uniform liquor fees throughout South Africa. The province was prepared to barter its liquor fees in return for charitable institutions. Every province that expended more in charitable institutions than was realised by the accretion to them of licensing revenue handed them over quite willingly to the Union Government, the charitable institutions as well as the liquor licensing revenue. Natal (which is always a law unto itself) was prepared by virtue of the fact that she got more out of liquor than out of charitable institutions to keep both

That was not he reason.

I am telling you that is the fact.

Order, order.

One must approach this question from the point of view of the hon. member for Albert-Colesberg. There is the question of medical inspection of school children. We know and the National Council for the Blind has known, one particular aspect of the medical inspection of school children. It disclosed in the Orange Free State no fewer than 7,000 cases of eye defects every year. There has been no attempt on the part of the provinces to institute services of a remedial character. They merely inspect the children, discover eye defects, say there are so many thousand children investigated, and leave it. In the Cape, Natal and the Transvaal it is exactly the same. There are thousands and tens of thousands of children whose physical defects are known to the medical inspectors, and nothing is done. Something must be done, and the concern with which this House is regarding this deterioration in public health is a very hopeful sign. We have heard from the Minister something which is extremely encouraging; the most encouraging part of his reply this afternoon has been that he has indicated to us the lines along which the Government is thinking.

But not acting.

At any rate, they are thinking, and it is very encouraging to know they are thinking. But this country demands something more than thinking. We want, as the Minister has indicated, that the next step will be action. We want action. It is all very well for the Minister to say he has instituted plans by which he hopes to establish a national approach to the question of venereal disease. Does the hon. Minister know that venereal disease in South Africa in certain areas is the highest in the world? Does he know, that the incidence of syphilis at a certain port in the Cape Peninsula is the highest in the world?

Which port?

I am talking about the port of Simonstown. The hon. member for Gardens (Dr. L. P. Bosman) yesterday gave an address and in his limited ten minutes dealt with the question of venereal disease. Today he gives figures to show that when he suggested 35 per cent. it was as a staggering criticism directed at this under-mining of the public health. He was told this morning that his 35 per cent. or 45 per cent., as stated later, bears no relation whatever to the port of Simonstown. It is something very much worse, and Suez and other places one has always heard of as cesspools of iniquity pale before the figures for Simonstown. These are facts. We are told that tuberculosis is rampant amongst certain sections of our people and the Minister today tells us—he has no national register—but he indicates there are 32,000 sufferers. He knows very well that his figures bear no relationship to the number of sufferers from tuberculosis. The figure of 35,000 is less than ½ per cent. of our population and it bears no relation to the number of victims. Yesterday when I spoke I said that the incidence of potential blindness in this country was very high and a very grievous problem. I said it was as high as in India. I read in today’s paper that Brig. Hoffe in opening a St. Johns conference stated—and I did not know his figures but they are correct— that in certain areas in the Union the incidence of blindness was higher than in any other portion of the world. Mr. Chairman, how many times have we heard how fortunate South Africa is, how it is the lowest taxed country in the world, how we are fortunate in having wonderful climatic conditions which ought to tend to elevate the social and health and physical conditions of our people. I associate myself 100 per cent. with the hon. member for Albert-Colesberg when he says if this country can afford £100,000,000 to fight, it can afford £100,000,000 to live. Let there be no suggestion that the Minister of Finance is the person who has effective control of these things. The public of South Africa demand that something be done. When we know, when we have an hon. Minister who says, “I know tuberculosis is rampant in this country, I know that South Africa compares extremely unfavourably with other countries in the world in regard to tuberculosis, I know syphilis and other venereal diseases are rampant in this country, I know ….” Well, he has to translate his knowledge into something more. He has to take steps to wipe out this disgrace. I mentioned figures yesterday on the authority of a Belgian ophthalmologist, who stated that 50 per cent. of ordinary native people standing on a railway platform at Germiston were suffering from trachoma. Are we going to do anythnig or are we not? Are hon. members going to stand up and like Cassandra make prophecies, while as in the case of Cassandra’s prophecies nobody takes action to remedy the evils? They ignore the prophecies, but Cassandra was always right. The prophecies she made always proved true.

She was a bit gloomy, wasn’t she?

She was a bit gloomy, so am I, and so South Africa ought to be. Let me say this, if my facts are wrong, if the facts of the hon. member for Gardens are wrong, if the facts of other hon. members are wrong then, Sir, we ought to be locked up as so many criminal lunatics. [Time limit.]

It is a pleasure for me to see that the vote “Public Health” is being kept outside politics, The health of the nation is a matter which stands above politics, and I am glad that this matter is not being approached from the political aspect. I hope that hon. members will not regard this from the political point of view if I accuse the Minister to a certain extent. The prospect of a national health service has actually been held out. It was a war promise to the nation that this service would be instituted. Today the war is running to a close, and I fear that the Minister and the Government are somewhat inclined to push this important matter into the background. Here and there you see some patch-work being done. Yesterday or the day before we heard the hon. member for Stellenbosch (Dr. Bremer) express the fear that with the little patchwork which is being done, the health centres will be very limited in scope. If they continue in this manner with the health centres, it will take years and years before they have expanded to the extent that everyone will be able to derive the benefit of them. It will take years and years, and for long years practically only the poorest of the poor will obtain the benefit thereof. We realise that the poor people are entitled to bettter health services, but we cannot forget another section of the population. The need is just as great with them as with the poorest people, and they are the middle class, the people who fall between the rich and the poor. This is the section of the population who practically form the nucleus of the nation, and I fear that that section is being neglected. The middle class do not want charity, but I can assure the Minister that they are having a hard struggle to keep their heads above water. If serious illnesses occur in a family, it means practically the ruination of such a family. For the middle class today there is no assistance or aid forthcoming, and I fear that the Government is not showing the necessary sympathy, actual sympathy, towards these people. In passing I want to point out that recently at the discussion of the taxation proposals, we endeavoured to obtain a certain amount of relief for these people so that expenses as regards medical treatment and hospital treatment could be deducted from the taxable income. But this as well was not granted. Think for a moment of the people living on the platteland who are 20 or 30 or 40 or even 50 miles away from the nearest doctor. Sickness comes. What happens? The man with moderate means feels that he has to wait to the bitter end before he calls in a doctor. If the doctor has to travel 30 miles or so from the town or the village, it will cost at least £10 or £15, and it is practically beyond him to pay. He waits and waits, with the result that he sees death approaching, and then calls in the doctor when it is too late. Then there are other cases. I am not an expert on medical matters but a doctor will tell you that when anyone contracts inflammation, inflammation of the lungs, and the patient has had it for two or three days, you cannot move such person. The choice open to that person is whether he should be moved to the village or whether the doctor should come out from the village. The costs of calling a doctor are high, and therefore a relation may perhaps come along and take him to the doctor, 20 or 30 miles, with fatal results. Instead of doing good, it simply results in the death of such person. This is the position in the remote parts of the country. Sometimes you also find unscrupulous doctors. I do not want to come too near the good ones. There are many good doctors, and I do not want to cast any reflection on them. But I know of cases where a doctor has travelled 20 or 30 miles out of a village. His neighbour may also perhaps need the doctor. He also has someone who is seriously ill and calls the doctor in. What do we find when the accounts arrive? That in both cases the doctor has charged the full amount. The conditions prevailing today are undesirable. These people do not want charity, but they want a good health service to be called into being and they are prepared, the nation is prepared to contribute towards such a service. They do not want charity. They are willing to contribute, but when the necessary contributions have been made, they also want to see it made financially possible for them to obtain essential health services there. The Minister may come along and offer the excuse—it has been repeatedly alleged—that it is a provincial matter. I do not want to say anything against my hon. friends from the Free State, but I cannot imagine how we can differentiate as between the Transvaal, the Free State, Natal and the Cape Province. You may perhaps have one province where 70 per cent. of the health services are put into practice and another province which neglects them. Is this in the national interest? A health scheme is not a policy which should be laid down by a province. It is a national matter and the policy must be laid down by the Union Government, and that is why I cannot accept the excuse that it is a provincial matter. Today there are hundreds of medical people at the front on active service. In the near future they will return, and they will be able to relieve the serious position. If they cannot do so in sufficient measure, we can apply the same system in this sphere as we have done in the spheres of education, namely to grant study bursaries to medical students so that they can be trained to satisfy that great need.

There is a shortage of 4,000 doctors.

Well then, give the facilities to those students to be trained, There are today hundreds of clever English and Afrikaans-speaking South Africans who are capable of being framed, but unfortunately they do not possess the necessary funds and for that reason they are being held back. It is no excuse that those people are not being trained.

The hon. Minister has just told us that if we have a comprehensive national health service as envisaged in the Gluckman Report, we shall have to pay for it. Well a still more important factor is that if we do not have it, we shall have to pay for it, and a very much more dreadful price. The hon. member for Vereeniging (Lt.-Col. Rood) who claimed to be a practical man, and is, in my opinion, also ran off the lines this afternoon. He wanted to know where the extra money for such schemes would come from. I would ask him if we let the people die—and at the moment we are letting the people die—where the money will come from which we get at the present time.

I did not say that.

If I have misrepresented the hon. member in any way, I am sorry, but I do not think I have gone very far from the sense put forward by the hon. member.

No, you have not.

I want to say a word to reinforce what was said yesterday by the hon. member for Green Point (Mr. Bowen) and others. Bishop Lavis, in pamphlet after pamphlet for year after year, has insisted on that same figure of mortality that the hon. member gave us yesterday, namely that one out of every two Bantu babies who are born die within two years. We have heard moreover at home and repeated here, that in Durban every day four people die from tuberculosis. We all know the steady advancement of the drowning waves of venereal diseases, and blindness too. We have got to stop these waves of misery and suffering. We ought to do it for humanity’s sake, but if that plea is not accepted as sufficiently realistic I would remind the House that being healthy is the minimum requirement and qualification not only of Europeans but those of other races who form the great basis of our workers. We cannot afford in that respect to hesitate any longer. We cannot afford any longer to pay in pounds, shillings and pence for the little that we already do, nor do we dare, Sir, to wait any longer and allow those diseases to stalk into our own households as they must do, and must continue to do, unless we make this, the greatest investment that we can make and that any nation can make at any time, in the setting of the great masses of the people on their feet, in giving the workers of the country strength and ability wherewith to work. We have got to do this thing. If the present plan—I thought it was an excellent one which the commission put before us—will not work for any reason we must make another plan, or find ways of making this plan work. We dare not dally any longer with this, and it is true, what many members have said, that the nation is losing its patience with the Government in this respect. The hon. Minister has a very attractive smile. He often beguiles me, and I think other hon. members, with it, but it is also true that the nation at large cannot see that smile and they are not impressed accordingly. I want to put this to the hon. member for Vereeniging who asked where the money will come from. When we have put the nation on its feet, when we have a healthy, strong nation—and we can have it; nature has given us all the essentials, unless perhaps unselfishness is also an essential— when we have built up our nation, when the people are no longer banned to the hospitals, by the thousands they will give us the money to pay for this service; they will produce the wealth of which the State stands in need. We cannot afford to have our workers, even those on the poorest standard, out of the industrial market. Bring them in, and they will more than pay their way. And if the House is worried at all, let me remind hon. members that at the present minute when our national wealth has been greatly increased, for the past five years the youngest and strongest of our workers have not been engaged in producing wealth at all. They have been engaged in defence of everything we hold most dear. But the fact remains that so far as the production of wealth is concerned, 250,000 of our youngest and strongest men and women have not been here to help us. If we can pay this extra taxation in war time when our strongest workers are not constructively employed, why should we fear for an instant that, when they come back to help us to build up South Africa, we will not be able to find the money to run this national health service? I suggest that we all are quite certain in our hearts, and in our heads too, that the money will be forthcoming if we have the will, and if we have the will we shall soon have a workable plan. I submit that we have such a plan, and further that we should go from this moment carrying out at least those parts of the plan that it is practicable to put into operation immediately. There has been a good deal of criticism of the provinces in what they have not done in this direction. It is largely the problem, I think that confronted Simple Simon a long time ago. He wanted to buy a pie when he did not have a penny; and I do not think that the provinces can give anything like satisfaction along those lines unless the money is first provided for them. I take it that the provinces are willing to “play”, that they are prepared to combine with the Government, that they are prepared to undertake the liability for full hospitalisation, they are prepared to do more than they have ever done in the past. For that reason I take it that they will have to tax the residents of the provinces by some form of hospital tax. May I suggesst before I sit down that the Government of this country might increase the amount for them, and at the same time increase central control over the provinces in respect of their hospitalisation activities, if we ourselves decided to have a national health tax, and paid it over to the provinces for this particular purpose. I believe the suggestion is that the provinces shall raise the money. They may be able to do that, or they may not, but the Government would have no difficulty whatsoever in raising vastly greater sums for this purpose in the form of a health tax; it would have no manner of difficulty in ensuring that in future the Provinces had a greater opportunity than any or all of us have had at our disposal in the past. May I commend to the Minister, as I did to the hon. Minister of Finance, that prevention is better than cure, and that therefore men should be trained in Durban, as suggested, in the new proposed Medical School, to go amongst the natives and even amongst the poorer of the Europeans, teaching them matters of health, detecting diseases in their early stages, and so preventing some of the very worst of the epidemics and diseases which at the present minute, in the opinion of many of us, threaten to sink the country.

In considering the feasibility of any housing scheme, the question of cost is a very important factor, and we know from past experience that municipalities, especially the smaller municipalities, have demurred because they fear that the financial implications might be beyond the capacity of their powers. I admit that very generous changes have been made, and their responsibility for any possible loss has now been so reduced that many municipalities are induced to embark upon schemes which they otherwise would not have tackled. Nevertheless the cost of any building is still a very important consideration, and it is for that reason that I feel constrained to offer the House and the public in general the results of an experiment which is now being carried out by Ermelo. The municipality of Ermelo has embarked upon a sub-economic scheme for non-Europeans under which, as an initial instalment, they propose building a matter of 150 houses. It will interest hon. members …

Are these for Europeans?

No for non-Europeans. It will interest hon. members how these houses are constructed. This house consists of three rooms, a living room, which is ten feet by twelve feet, and the other two rooms are each ten feet by ten feet. The house is built entirely of burnt bricks, lime, cement, under a pitched roof, with steel windows and ordinary door frames. The National Housing Board was invited to send a representative to Ermelo, and we have had the privilege of a visit from the chairman. When we showed him a token house that had been erected he was very pleasantly surprised, and he could hardly believe when we showed him what it cost that it was possible to erect a building of that nature for the cost entailed. The houses are being constructed in two sections. One section is being built by native labour and the other section is built by European labour. The cost of building a house with native labour, complete, including a stove and including sanitary conveniences, comes to less than £113. I have the figures of the cost of some of the houses in various stages of erection.

What kind of floors have they got?

They have a composition floor. I can give the hon. member the composition of the floor. It is made of some composition containing ash and concrete as well. The concrete floors will he just as cheap but especially in a climate such as the high veld has, it is very cold in the winter.

Was money advanced by the commission for this purpose?

It is now a sub-economic scheme.

Built with money advanced by the commission?

Yes. That is why the commission was interested. This house would adorn any countryside. I think that the finished product is sufficiently attractive to stand comparison with many houses I have seen in the Peninsula. These houses afford a very comfortable abode and they are certainly attractive in every possible shape and form. As I said before, they have a pitched roof; they even have cement slabs which could serve as a pantry where the native woman can put in her provisions, such as she has, and where she can also put her cooking utensils. The cost of the complete house, including sanitary conveniences, including a stove, is only a matter of £113 with native labour and £120 with European labour. I do not wish to weary the Committee by giving hon. members details of the materials used in the construction.

What is the roof made of?

It is made of iron. There is no ceiling in these houses. There are two partition walls but there are no partition doors, but that can easily be overcome. The woman could simply hang up a bit of material or tapestry, according to the size of her purse, and by that means ensure privacy. As I have said the cost with native labour is £113, the cost with European labour is just slightly more, i.e. £120. The number of bricks used is 8,000 and the cost of the stove is £5 17s. 6d., but that is all included in the total cost. The scheme is under the direct supervision of the town engineer and the works foreman. The municipality is able to erect these houses, and to let them to the natives at an overall charge of 12s. per month, which includes rates, sanitation and water. I make bold to say that nowhere else in the country has a scheme been undertaken where the cost involved is so small. I want to say this without wanting to draw disparaging comparisons with schemes, the details of which have been published in other localities—I have in mind the case where a municipality boasted that they could put up a similar house for £300, but the difference between £300 and £113 is very considerable indeed. Admittedly we do not pay union rates of wages. In the case of native labour, the cost of labour is £23 5s. 0d.; in the case of European labour it is £30. But when one bears in mind that a European labourer who has any skill at all can put up a house such as this within fourteen days, one realises that the rate of remuneration is not too inadequate. As far as this scheme is concerned, therefore, I feel that it is one that can stand the closest examination, and the example set by Ermelo is one worthy of emulation. The National Housing Commission felt that before they could finally approve of our scheme, they should require us to erect at least one token house. That was done and the costs were carefully checked up, and the National Housing Commission was satisfied as we were, that the figures which we gave were not any way beyond the mark, that they reflect and reflect accurately the actual cost involved in erecting houses of that nature. I say therefore if it can be done at Eermelo, it can be done elsewhere, and we issue an open invitation to any members who are interested to inspect these houses. Several members who were given details of this scheme have evinced a lively interest and have promised to visit our location to see that these houses are in point of fact attractive and that they lend grace and dignity to the locality in which they stand. Not only have we started on a native housing scheme but we have also started on a European housing scheme, and we are able to erect a five-roomed house, including a stove and bathroom, kitchen sink, and with all floors in the living rooms constructed of wood, with a little verandah, ceiling boards and all other modern conveniences, for a matter of £460. That is done entirely with European labour, also under the supervision of the town engineer and the works foreman. That, I submit, in all modesty is also a very commendable effort. I do not want to seem unnecessarily parochial in blasting the trumpet of Ermelo, but I feel that we have broken ice and we have shown the Union that it is practicable, even under the exorbitant prices today, to put up decent houses at a very low cost. We concede that the prices one has to pay for building material today are very much in excess of the prices that obtained before the warf

What is the actual cost of this house?

The actual cost of the house, excluding ground, is £460. It is a five-roomed house with a kitchen, pantry and bathroom.

Is there no wage determination there?

No, I said just now that there is no wage determination, but those people are paid a living wage. The European labourers get about £1 a day.

Not 4s. an hour?

No, not 4s. an hour because they are not so highly skilled. But nevertheless all the bricks are neatly laid; all the walls are plastered inside and outside. The house is lime-washed outside and muraloed inside, and it is an abode in which any respectable person can reside with comfort and without loss of dignity. I feel that I have not detained the House unnecessarily in giving the House these details. I would be interested to learn of any other municipality which can boast of as good a result, and even at enhanced prices. I feel that this is an example which can be followed and followed with success by other municipalities. It is one thing to have a scheme in theory; it is another thing to translate that scheme into bricks and mortar, to construct the edifice and to prove that the cost is no more than your original estimate.

I want to draw the Minister’s attention to a matter which in my opinion, is of very great public interest, and it is in connection with the South African Pharmacy Board. According to the report of the Secretary for Social Welfare, during the year under review 55 chemists, 32 managing directors in the business of pharmacy and 111 apprentices were registered. I want to refer to this statement because the whole position of pharmacy in our country today is unsound. Pharmacy is in the hands of just one or two big companies, a monopoly is being formed in pharmacy, and you find here that 32 managing directors who are registered as chemists are directors of companies. The question arises in how far these people are the deciding factor in regal’d to ordinary pharmacy work. Today the small chemist in the country has no longer a chance.’ A monopoly is being formed. We have even gone so far this year as to establish a faculty or department at the Potchefstroom University College for the training of chemists. First and second year education is already being given there. But what is the general experience? It is that as soon as a student has completed his course, when he must serve as an apprentice for a certain number of years, it is impossible to get him placed. There ought to be many more than 111 apprentices. I will tell you for example what took place at the local technical college last year. A chemist visited the Jan van Riebeek School and told of the good chances that exist of making a living as a chemist. Twelve of the scholars there who had completed their matric and done well, went to the technical college to be trained as chemists. The first year they followed an ordinary scientific course; for example chemisty is one subject which they have to study very thoroughly. The principal of the college informed me that they were the best students that he had had there for years. Now we are confronted with the enormously great difficulty of getting those students placed; and why is it? For the reason that the closed shop principle has been created here. There are one or two big companies who control the chemists throughout the country. They have a chain of chemists through the country. Here in Cape Town you know yourself that there were three big wholesale chemists who also did retail business. Today they are all in the hands of one Or two big companies. It happens throughout the country. They do not need any longer to take on apprentices. They are not out to serve the country. They are out to make personal profits, and if they want a chemist, they import a man. I want the Minister to give his consideration to this; he is also a lawyer; he knows that today no attorney who is the head of a trust company can practise as an attorney. His name is scratched off the roll. He cannot practise. He may not take on any legal work. He is a director of a trust company who comes into competition with the ordinary attorney in his routine work. Now I want to suggest that the Minister should give the same advice to this Pharmacy Board that precisely the same principle should be applied to pharmacy, that these 32 managing directors who are not out to make their livelihood as ordinary chemists, should be eliminated from the profession. They are people who are big business men; they are not there to train chemists who will be able to serve’ the nation. Let them then be ordinary traders. ’Then matters should be taken further. When a chemist can indicate that he has a certain turnover in the year, then arrangements ought to be made for him to take on an apprentice. At the big companies who for example have big departments, where they manufacture medicines, the same obligation ought to rest on them to take on a few apprentices. We must take this aspect of our health services into serious consideration. Nothing less than a monopoly for commercial purposes is being allowed to develop, a monopoly in the hands of just a few big companies, and we as a nation ought to ensure that we have independent small chemists established over the whole country where they can serve in the interests of the nation. At present that is not the case; and I trust that the Minister will give his attention to this matter and that this Pharmacy Board will furnish him with advice on this matter, so that these needs can be satisfied.

I will give my attention to the matter.

I shall be glad.

It is a gratifying phenomenon as well as a pleasure, that this House, the highest assembly in the country, has been seen at its best on this particular occasion when discussing such an important national matter, and has undoubtedly treated this matter on its merits with all the earnestness which it deserves. The debate which has been held on this matter is in my opinion a credit to this House as well as to the members who have conducted the discussion on the high level in which they approached this exceptionally great national matter. The question occurs to me after having listened to the gravity of the situation, where each one has endeavoured to depict the problem as he himself views it and feels it, on the basis of the merits of the case—whether we are not dealing with a position which demands that there should be an extra portfolio created for this one department to deal with the matter. Let us for a moment pause and consider a few aspects of this matter. Take the dental treatment of school children alone; take the case, as it has been put here today, of venereal diseases; take the case of tuberculosis which has been very clearly explained here, and take the case of general health; if we include the shortage of hospitals, the shortage of doctors and nurses and the general unsatisfactory position with which the Minister is confronted—if we remember in addition that he has another important portfolio to cope with, and if we regard the matter from this viewpoint, then I feel absolutely convinced in my mind that the Minister of Welfare and Demobilisation is endeavouring to do his best in exceptionally difficult circumstances. It is very easy to evolve a theory, to formulate schemes out of the air as it were and to criticise and to suggest what should be done. But when we put those theories into practice and are confronted with hard facts, we often find that we are dealing with quite another state of affairs than that which confronted us in theory when we formulated our propositions. When we consider the matter from the point of view that we are dealing with a question of the utmost gravity and of enormous scope our serious thought evokes the question whether we are not dealing with a matter which justifies the creation of an extra portfolio in order to be able to cope with the matter efficiently. I want to suggest, Mr. Chairman, whether the Minister should not give serious consideration, in view of the shortage of hospitals, to the possibility of equipping some of our military camps which will be disbanded and become useless, as hospitals for these cases which at the moment we cannot care for owing to the fact that hospital accommodation is not available.

We are already considering it.

But I want the Minister to give serious consideration to the matter. If at a later stage I have the necessary time, I will indicate to the Minister how private bodies, who have nothing to do with the matter, are already working in that direction on their own. The position may become worse after the war. At the moment we are dealing with people which in the ordinary course of events we would always have to care for. But after the war we will care for thousands whose health has been impaired during the war, and who as a result thereof will have to have the necessary treatment at an early stage in life, which they would not have needed had it not been for the sufferings they have endured on the battle-fields. We know that under present circumstances we have a system whereby paupers receive treatment free of charge. But I cannot help reverting at this stage to a matter which I brought to the attention of the Minister last year when his vote was under discussion. It is the question of the responsibility and humane obligations which are thrown on to local bodies such as municipalities and divisional councils. While paupers are exempt from payment or receive free treatment, we have at the same time the position that local bodies must accept responsibility for contagious diseases, and that half the expenses are paid by means of the health department to the divisional council or the municipality concerned, after the account has been rendered. We are very grateful for that. But does it suffice to say that where the matter is one which is really the responsibility of the State, it should be thrown in this way on local bodies and that they should have to contribute half of the costs in respect of contagious diseases? You can understand what the outcome is. The result is that those diseases, as far as the local authorities can dodge their responsibility, do riot receive the treatment which they ought to. Not only this, but there is the transport of the patients to the hospitals for which the local authorities, the municipalities or the divisional councils are also held responsible. There is the burial of each pauper who dies in the district, where again the poor divisional council must pay up. Then there is the treatment of tuberculosis sufferers which is a very big question with many of the local bodies. If anybody shows signs of tuberculosis, it is requested that such person should be sent to Nelspoort, and the divisional council is called upon to accept responsibility for such a case if accommodation is obtained there. The divisional council must bear the costs of transport as well as the costs in connection with the nursing. If the person is discharged from there and comes to the institution at Stellenbosch for the necessary further treatment at a very high tariff, then it is also the responsibility of the local authority. The result is that in some of the cases where a divisional council has sufficient humane feeling to meet its obligations, these cases cost it hundreds of pounds each until eventually the person is healed or is dead. I am speaking of single cases which cost so much. It is actually a fact and I know of cases where the person has not been cured and where for several years the divisional council has had to bear the expenses on account of the treatment being its financial responsibility, and where practically a sigh of relief was heaved when they heard that the person was dead. It is an absolutely unsatisfactory state of affairs. We realise well enough the gravity of the situation. There are cases where the local authorities cannot get the people away. The local authorities cannot get them away to a nursing institution, although they are prepared to pay for them, with the result that those bodies are called upon to bear the costs of local treatment. There are several cases where those bodies have to provide the necessary milk and rations where persons are treated in private homes or where they are cared for in houses which the local authorities have for that purpose. When sickness breaks out, it matters not what the occasion is, but the divisional council is expected to provide the vaccine. Take the case of diphtheria. It is a contagious disease, and when it breaks out, the divisional council has to make the necessary arrangements for the vaccination of hundreds and sometimes thousands of people, as was the case for instance recently with an outbreak at the missionary station at Genadendal and at Grabouw. Vaccine is dear, but the financial responsibility is left to the divisional council of the district. The divisional council must appoint its own doctor to deal with the cases in the district. Apart from the district health officer the divisional council which wishes to meet its obligations must appoint a doctor and pay a nominal amount for such work. I take it that this is also done by other divisional councils. It is done by my own divisional council. And then the doctors take up the attitude—perhaps justifiably—that as soon as anybody has the slightest ailment, that person becomes the responsibility of the divisional council and the divisional council must accept that responsibility, or otherwise be exposed to public condemnation. But it goes still further. We find that even people who are able to pay try on occasions, where they are in need of the necessary treatment, to dodge the financial responsibility by asserting that they are unable to pay, and once again the divisional council is called upon to accept the financial responsibility or a portion thereof. These councils undoubtedly fulfil a useful purpose. The divisional council is certainly an instrument which can be used in connection with public health conditions. But we must also admit that the divisional councils were never called into existence with a view to dealing with public health. [Time limit.]

There are just a few points I want to touch on under this vote, and the first is the position of the South African Health Practitioners’ Society. I was asked to broach the matter here so that the public can find out what the Minister intends doing in connection with this society, with these people who, as I understand from them, can be of effective assistance in restoring people to health, and who perhaps could be used very efficaciously in a national health plan. I must honestly admit that I do not know much about the society, but a voter from my constituency wrote to me. I do not know whether they do the medical professional harm or good or whether they oppose them. But in a free country such as ours all people ought to have the opportunity of making a living, and they are looking forward to a statement from the Minister. The second point is with regard to a question which I put to the Minister concerning the position in connection with rivers which run through towns or the platteland and where those rivers are freely used for swimming and washing, and for all sorts of other purposes which do not tend to the promotion of health.

Provision is made therefor.

I was at a place where free use was made of such a river for swimming and washing. The water from that river is used later by farmers for drinking water and domestic purposes.

If it is declared a public stream, control can be exercised.

In this particular case in one week there were not less than 20 cases of gastric fever. I feel that we should compel such towns to have swimming baths so that the people do not need to go and swim in the river. I think we all realise the dangers attaching to such a position, and I hope that this matter will receive the Minister’s attention. In connection with the evacuation of slum areas and national housing, I understand that it is the Minister’s intention to go into the question of housing in more detail when he moves the Bill to amend the Housing Act, and for that reason he does not wish to discuss the matter at any length at this stage. We will have an opportunity at a later stage of going into the matter further, but in view of the Bill which the Minister is compiling, I want to urge him to demand a stricter observance of the Act in connection with the evacuation of slum areas. As the proverb says, he must take the bull by the horns. The position is becoming worse and worse. We always approach this matter from the point of view of expenditure. But if we were to give more attention to the laying out of townships and consider the matter in its true perspective, then those slum area difficulties could be solved without cost to the State or the municipalities concerned, by tackling a system of cross-planning. Where one section of the town has sunk to the level of a slum area, we ought to declare that to be a factory area, and to lay out another section as a township. This will mean that the slum area in that past will disappear and small factories will develop there. The people themselves will disappear from that area without any expenditure to the State, for they will receive money for those areas which will enable them to go and build at another place. Take Johannesburg. I am certain that if the lowest portions of Vrededorp and the north-western area were transformed into an area for small factories, it would cost the State nothing to clear those places. They will solve their own problem. I do not want to go into the matter very deeply this afternoon, for the Minister will afford us a further opportunity of discussing it in detail, but I hope that he will take this aspect of the evacuation of slum areas into consideration. It is one of the most dangerous sources of the spread of disease which one could find. Take 17th or 18th Street—look at the Malays and Asiatics who live there. There is such a conglomeration of them that one wonders that those people do not die. I do not want to detain the House for long, but I would like to refer to an item of £5,000 on page 129 in connection with the Red Cross Society. The amount is apparently for a special purpose, and I do not believe that it is the total amount which the South African Red Cross obtains from the Government. I presume that it is in connection with research and educational work. But I still think that it would be a good thing if the Minister made use of this opportunity of expressing a special word of gratitude for the work which that society has done, especially during the war. I think that, especially now that the war in Italy is at an end and the war in Western Europe is almost at an end, that this is an apt occasion for the Minister to pay tribute to the work of this society, for it has contributed in a magnificent manner to easing the lot of our soldiers. It has been told to me by prisoners-of-war that they would never have been able to exist in prisoner-of-war camps had it not been for the packages of food stuffs provided by this society. We know that that society is dependent in large measure on charity, and I think that where a society has performed such noble work as the South African Red Cross Society, particularly where it has been done during the war, we should ensure that it is not dependent on charity and that the State should grant it adequate assistance. Apart from the foodstuffs which this society has provided for our prisoners-of-war, we know the enormous investigation organisation they have maintained during the war. In view of all these things, I think that the Minister of Welfare and Demobilisation ought to avail himself of the opportunity this afternoon of expressing gratitude to those people, and also to declare that they will be afforded the opportunity of continuing their work as they deserve. As regards tuberculosis we have had speeches from members who know more about that matter than we laymen do. But it is clear to us that there has not been sufficient done in that direction by a long way. Allow me to say in regard to this matter that I think that more use should be made of the natural health sources in the country to combat that disease in the first stages, apart from the work which is performed by means of hospitals. We know of the natural health sources which exist in the country. There are for example the midlands and the Karoo. When we journey through the Karoo, we perhaps do not think very much about it, but we can make use of the Karoo in the commencing stage of this disease for bringing relief to our people. Perhaps we can even at a later stage go so far that in the later stages of the disease as well people’s lives can be lengthened there. I would also like to see miners’ phthisis sufferers who leave the mines in the first stage of the disease, being able to go to a settlement in such a vicinity. I am convinced that it will contribute in a large degree towards easing the lot of those people and combating such diseases.

This debate has already proceeded for a considerable time and it is with reluctance that I intervene again, for that reason, but I feel it is my duty to do so in order to repeat the question which I put to the Minister today and on which I asked him to make a public statement. The Minister has no doubt overlooked the matter. The Minister said in his speech earlier this afternoon that he had requested the Secretary for Public Health to answer by correspondence certain points which members had raised, but this is not a matter which permits of being dealt with in that manner, because it is a matter of considerable importance in the field of policy. I have not raised it for the first time this year. I have raised it on the Public Health Vote year after year, and it concerns the responsibility for native hospitalisation. The provinces in the past, certainly ever since 1938, have been contending that they are not in a position to finance the maintenance or the proper development, especially in the rural areas, of hospitalisation for natives, and they give as their reason what I regard as the mean one that they are not entitled directly to tax the natives as such. Every time I have raised the question I have been referred to interprovincial consultative committees. Then we had the investigation by the Health Commission. That Commission has now reported that hospitalisation should be provided by the State. Now the Minister has told us, and the Prime Minister has told us, that that will not be done but that hospitalisation will remain under the provinces. That makes it necessary again to raise the question of who is responsible for native hospitalisation. I am not the only member who has raised this point. It was also raised by the hon. member for Tembu-land (Mr. Payn) who is a member of the Native Affairs Commission and who said that the Native Trust is not in a position to subsidise native hospitalisation. They have been doing so, as a matter of fact, for years. Every year they spend £75,000 of their meagre reserves, which mostly come from native sources, but these sums are quite inadequate. However, they made an attempt to deal with the situation. What I want to ask the Minister is this. In the discussions which took place between the Central Government and the provinces as the result of which this decision was come to, that the provinces should retain control of hospital services, have they or have they not given the Central Government the assurance that they will in future be responsible for both the maintenance and the development of native hospital services? In other words, have they or have they not resiled from their standpoint taken up previously in this matter? It is a matter of high public importance and it is necessary that it should be dealt with by way of a public statement in this House in order that the native population of this country may be reassured, and also that reassurance may be given to the small band of men and women, those missionaries of various denominations, who have been battling desperately in the reserves to try, out of their own meagre funds, unassisted by the public authorities of the country, to run the hospitals. The Minister said that some of the questions put to him in this debate involved planning and therefore it was hot fair to press him to answer these questions. But this question does not fall into that category. It is simply a question of fact as to whether the provinces have now undertaken this responsibility which they repudiated for so many years, and it is more particularly important in view of the direct finding of the Gluckman Commission which I have quoted before and which I make no apology for repeating again—

It was evident from this report that the Commission recommended the transfer of control of native hospitals from the provinces to the Central Government because of the experience we have had of their inability to cope with native health in this respect. I would be obliged to the Minister if he could tell the House and the public whether now the provinces have explicitly accepted responsibility for native hospitals. The shortage of beds is notorious. There is a shortage of beds in the European field, but in the native field it is more serious still. I know of a case in my own constituency, in the district of Mafeking. I do not know whether the position has changed now but a few years ago there was a native population of 40,000 and beds for six. There are probably districts where there are no beds at all and it is a matter of the very greatest importance. We want to get this quite clear that the provinces accept the responsibility. We do not want to be told when we approach the provinces again for assistance, particularly in the native reserves, that it is not a matter they can cope with.

I am sorry I did not deal with that question earlier; it was not deliberately overlooked. A clear-cut line of distinction has been drawn between the Government and the provinces in regard to responsibility for general hospital services and hospital services in respect of infectious diseases. The effect of the Government’s decision is that the provinces are responsible for general hospital services. They have accepted that responsibility. General hospital services must be available to natives as well as to Europeans. The provinces have asked for that responsibility, and they have been allowed to retain it in terms of the Constitution. It is theirs and they cannot evade that responsibility. The Government has insisted it should retain responsibility for tuberculosis, venereal disease and all formidable epidemic diseases. I was attempting to show earlier this afternoon that it seems to me the logical effect of that decision on the part of the Government is it should accept full financial responsibility for these particular services. If that is so, in practice what will happen is the Government will make available accommodation for native tuberculotics and for natives suffering from venereal disease. The Government accepts the responsibility for the capital expenditure that will be involved. But we have in view the taking over of military camps like Springfield at Durban and Baragwanath at Johannesburg. It is the Government that will have to bear the financial responsibility of these native patients, just as it bears the responsibility for coloureds or Indians or Europeans. So far as formidable epidemic diseases are concerned, the Government accepts full responsibility. So far as concerns general hospital services it is the responsibility of the provinces, and theirs alone.

I think that after having listened to all the representations directed to him from all quarters of the House the Minister will now realise that the country in general is not satisfied with the steps the Government is proposing to take in connection with national health. The people ask for something more, as has been rightly stated even by members on the Government benches. The public now want action. It is of no avail holding out nice plans for the distant future. Steps must be taken and taken quickly. The hon. minister will agree that the position of national health as such—he only needs to read the reports of his own Department— is deplorable, that we are rapidly approaching the edge of the abyss; and if the position is as revealed by his Department I think, bearing in mind the future, even the Minister must agree that the few measures he has suggested are not adequate. We have had the report of the National Health Commission. It is certainly one of the best reports which has ever seen the light of day. The Government has now given its reactions to that report and has announced its alternative scheme. In a nutshell it is tantamount to the creation of certain health centres in the country, a clinic for every 25,000 souls. With all respect the clinics will by no means be able to handle 25,000 people effectively. It is impossible. And how long will it take before these clinics are spread over the whole country? The difficulty now indicated by the Government is the constitutional difficulty in connection with the Provincial Councils. I want to put this question to the Minister: Should the Government resolve that it will follow a fixed policy, a uniform policy in respect of certain diseases prevalent in our country— should it once take this decision and allocate funds for the purpose and should it then come to the Provincial Councils and say: Here is £100,000 or £200,000 to devote to combating this or that disease but you must act according to the prescribed regulations; if the Government said this to them would a single Provincial Council be unwilling to accept the money on these conditions? If one Provincial Council had the nerve to refuse the money just because the money must be applied in conformity with certain prescribed regulations as determined by the central authority, the province would deal with such a Provincial Council. We should like to know what the Minister’s objection is to that course. We do not want to abolish the Provincial Councils, but let us utilise the Provincial Councils; let us provide them with the necessary funds and let them make their contribution to carrying out the great plans for public health. I have before me the balance sheet of a hospital in one of the outlying districts in the North. This hospital has an annual expenditure of £2,200 and the measure of support it receives from the Provincial Council is only £450. This means that the small community must bear the tremendous burden of collecting £1,800 a year for the health of the whole area with about 15,000 people. Is that right? This case I have mentioned is the case of a hospital which unfortunately is not situated in the principal town of my constituency, and just because it is not in the principal town it is not registered as a provincial hospital. We thus see the difficulties we are confronted with when we work on the basis of centralisation. This poor group of people are obliged to carry the burden which the Government should bear on its own shoulders, whether through the provinces or through the Central Government. Is that right? How can we expect that a small community should contribute £1,800 for the health of the whole district? We should be glad if the Minister would go into this sort of case and if he is really in earnest let him propose measures to eliminate the difficulties now in existence. As has been indicated by various speakers, and as is illustrated by the reports that are available, we have all these formidable diseases prevalent in the country today, but numerous difficulties are in the way. Let me mention two instances of which I have personal knowledge. In a certain village the doctor was called into a case. It was a fairly large family; there are five children. When the doctor came back that night he said: “It is one of the worst cases of venereal disease; the child is suffering from it.” He took away a blood smear and the test showed “absolutely positive”. What is the position? Neither the doctor nor the magistrate nor the man had the right to keep the child away from school. And that while the whole family, the mother and the five children, had the disease in the severest form, and in this case, so the doctor assured me, the patient was just in that stage when the disease was most contagious. Yet they were all powerless to keep the child away from school, and the child sat on the school benches with the other children and drank soup and other things with the other children.

Why is that?

Because the regulations are there and the doctor has not the right to prevent the child from attending school.

He has the authority.

No, that is not the case. If the hon. member goes into it he will find that this authority does not exist. Although the blood smears indicated it was a positive case the child remained in the school. I want to mention another instance. A friend of mine is living in an hotel here in Cape Town. He knows something about these things. A servant in the hotel came along and he saw that it was a typical case of consumption. This servant came with a tray full of cups, and coughed over the cups. My friend had a sore throat which made him very susceptible to tuberculosis germs in the circumstances. Fortunately he had the knowledge, but I and others who have not the knowledge would quite innocently have drunk from those cups. Look at the danger we are running.

When I was interrupted by the time limit on Wednesday morning I had just then touched on the importance of health propaganda in connection with the national health scheme. I am gratified to learn that since then the hon. Minister has shown that he appreciates the significance of health propaganda as an integral part of a sound national health scheme. On the estimates there is an amount of £5,000 given to the South African Red Cross for the dissemination of health education propaganda. I do know that in the Transvaal the society has been active in the dissemination of a health propaganda, but I doubt very much whether in the other parts of the Union the South African Red Cross has functioned adequately in this connection. The Minister has, in his five priorities, instructed the Action Committee of the National Health Advisory Council to put forward a scheme for a central health education council; and I feel in relation to this suggested council they should subsidise also other organisations in this country, and I would like to stress this particular point. During the war many voluntary associations have arisen inspired by a very strong sense of public duty, and they have played a noble part, showing initiative and enthusiasm in connection with the war effort. I do feel that an approach to these organisations with their very strong sense of duty would have the result that their activities could be harnessed to a mass attack on health ignorance in this country, and ignorance is a fundamental factor in the creation of disease. The harnessing of all those voluntary forces would have a great effect in bringing home to the public of South Africa the necessity of sound health knowledge. I would put this to the Minister. I feel that the harnessing of those voluntary helpers in the various war-time organisations in this country who have displayed energy and enthusiasm, would be a very potent factor in enabling sound healthy education propaganda to permeate the length and breadth of the country. The point in that connection is this, that a number of these organisations have branches in the rural areas of the country, or units of some kind, and through them one could get propaganda to the people in the areas where health education is most needed-. I should like now to deal with the question of tuberculosis. The hon. Minister has mentioned that he intends, under the national health plan to create mass radiography measures in some of the major centres of the Union. I feel it would be much more important, in view of the influx of disease into the urban areas, to associate with these health centres radiological measures such as the screening of natives, so that one could secure early detection of these contagious cases. Quite apart from diagnosis, contagious cases in the incipient stage one would detect tuberculosis in its earliest form; and, in view of the fact that the detection would take place in respect of the whole of the natives, in the rural areas and home environment, one could the more easily follow up contacts and initiate investigation into family conditions. I feel this would be a constructive step, though I am not condemning mass radiography in the urban areas.

I thought I had made it clear that health centres would have to have these instruments for mass radiography.

The point I want to make is this. Under the Native Urban Areas Act local authorities have the power to frame regulations for the medical examination of natives, and I feel that with the institution of radiological measures associated with the health centres, quite apart from tuberculosis, there could be a detection of other contagious diseases, and in this way a clearance certificate could be given to the native to enable him to come into urban areas. By such means you would check the big influx of natives into the towns in contagious stages of disease. I feel this is an important point. In relation to the discussions which have centred round this debate I have been struck with the fact that most members have discussed tuberculosis, venereal disease, smallpox, typhus and other diseases, but, with the exception of the hon. member for Jeppes (Mrs. Bertha Solomon) who dealt with the National Nutrition Council, little or nothing has been said about what is the most vital and fundamental factor in introducing disease. It has been said, and quite rightly, that the one single item which is more important than any other in the preservation of health is food, and in this connection the report of the National Health Council for the year ending 1943 indicates that that council appreciates the significance of sound feeding in relation to health. Some of the members of the council felt a Ministry of Food was necessary, and this apparently was put to the Cabinet. The Cabinet found that it was impracticable, but arising out of this suggestion a modified form of food administration was created in the appointment of an executive, an executive consisting of the Secretary for Public Health, the Secretary for Social Welfare, the Secretary for Agriculture, a nutrition officer and a professor of economics. I do feel, and I would urge on the Minister, in so far as the priorities he has just mentioned are concerned, to instruct the Action Committee to present a report dealing with the nutritional problem, so that the National Health Council could function to the full on this vital aspect of health.

School feeding has resulted from the Nutritional Council.

I should like, when the Minister answers my queries, if he would answer the question centring round the activities of this National Nutrition Council, because, quite apart from the report ending 1943, one has heard little or nothing of their activities. It is most important, because we have got to do something relative to the promotive aspect of disease. The Minister in his reply referred to the curative and preventive aspects, but the promotive aspect is extremely important in dealing with those factors which help to build up the resistance of the individual, and in building up the resistance of the individual so lessen his susceptibility to disease. I do trust the Minister will, in addition to those priorities already mentioned, include one associated with the activities of the National Nutrition Council, and a scheme for the sound production’ and distribution of essential foods.

It is with extreme regret I am speaking now, but I cannot allow to pass unnoticed the fact that this debate has been seized upon by a section of the House to prosecute a denunciation of Provincial Councils and of the provincial council system. I do not want to raise the constitutional issue on the floor of the House, but I cannot allow these attacks by various members to pass without a protest. We had the assurance of the Prime Minister, and we had the assurance of the Minister that the constitutional position would be observed; but member after member has come forward with a proposal that in this matter of public health the Provincial Councils should have general hospitalisation taken away from them and administered by the Central Government. It is not only members of the House who have taken that line. In the statement made by the Minister this afternoon he also stated that he would in certain circumstances, take hold of the general hospitalisation services, that he would take them over from the jurisdiction of the provinces.

If the provinces failed.

The hon. member says if they failed. I am reminded by that of a practice in the old Cape Civil Service; if they wanted to get rid of a man they took his work away from him and so made him redundant. That is the procedure that is constantly being used. I am not blaming the Minister, but it is a fact there is a tendency to undermine the Provincial Councils and to use national questions of this sort to support those attacks. I hope that for the remainder of this debate the question of the authority of the Provincial Councils will not be questioned. As a matter of fact,. I would remind members that the Provincial Councils are not the creation of this House. The Provincial Councils were constituted under the Act of Union. They are not the creation of this Parliament, and in the relevant section of the Act of Union it states that Parliament shall not except on the petition of the Provincial Council concerned, do anything to abolish it or to circumscribe it in any way.

I should like to direct the attention of the Minister and of the House to the danger of bubonic plague. It is endemic in South Africa and there are outbreaks from time to time in various parts of the country. Particularly in my constituency, Hoopstad, there are outbreaks every year. There is practically not a single year without cases of mortality from the disease. The last report of the Public Health Department informs us that in the 12 months ended June, 1944, bubonic plague was present in no fewer than five districts of the Cape Colony and it extended from Kuruman to Uitenhage. In the Transvaal there were two outbreaks, and in the Free State there were outbreaks in no fewer than four districts, two of them being in my constituency. We see moreover that in the Cape Province there were 31 cases. 19 fatal; in the Transvaal two cases, both fatal; and in the Free State there were 29 cases, of which 18 proved fatal. In the whole of the Union there were 62 cases, of which 39 proved fatal. Bubonic plague is an exceptionally dangerous disease. It is transmitted by rodents. Lice that infest the rodents are communicated to human beings, who then contract bubonic plague, which may in the first case not be fatal and not contagious. The first patient develops the lung type of plague; it is a deadly disease, while the germs are contagious 100 per cent. The Department is actually doing something in this connection. In the Free State there are four officials who drive around in those areas where there are rodents suffering from the disease, and in the Transvaal there is one official. I feel, however, that it is such a great potential danger that more attention should be devoted to the disease. Otherwise it might under one circumstance or another develop to a terrible extent and become a great menace. A few years ago there were within a month eight fatalities from the disease in my constituency on a couple of adjoining farms, and the circumstances under which these people died were so tragic that I feel we should pay much more attention to combating this disease. In the first instance the person who is affected contracts the lung type of plague, and after it has been ascertained that the individual is suffering in this way he has to be isolated in the house. He cannot be visited because at this stage the disease is so contagious and dangerous that no one dare enter the room without wearing a mask, and if you do enter it is almost 100 per cent. certain that you will also die from the disease. So one person after the other dies in the house. Their last hours have to be spent alone in the sick chamber. The officials who were sent to attend to them lived in tents outside and only now and then could an official enter to give the absolutely necessary attention to the patient. But what made such an unforgettable impression in my constituency is that amongst the patients who succumbed there was a woman who had contracted the disease and in her last hours she gave birth to a child. In the circumstances she had to lie in the room alone and people could only see through the window what was happening. On account of the danger of the spread of the disease the woman had to spend her last hours in these circumstances and went to her death with her child. We feel that when such cases occur in connection with bubonic plague the Department should give more attention to this matter and that it should be regarded as a national matter. Efforts should be made on a large scale to eradicate the rodents. When the disease is not occurring in our immediate neighbourhood, and we only hear of incidents such as I have related, they do not make a deep impression on us, but when it touches our own people, people we know, or our own families, then we see what this disease really is and then we all feel that it is a matter that should receive the earnest and immediate attention of the Government. We have seen that it is virtually spreading throughout the whole of South Africa. We have to make war against the rodents, and we have to begin particularly in those parts that I represent, which are sandy regions. We shall appreciate it if there is an effort on a big scale by the Government to exterminate these rodents that carry the disease. Apart from this danger, we know that these rodents, especially the mice, cause great damage to our grain. They destroy a great quantity of food which is a consideration during this war, and which perhaps in the years that follow with peace will be a still greater consideration. As I have pointed out here, there were two cases in the Transvaal, and both were fatal. I should therefore like to make a further appeal to the Minister to make an effort on a big scale to eradicate the rodents, first and foremost in those sandy areas, and then perhaps it will be easier to clean up the rest of the Union.

I was rather interested in the picture that the hon. member for Ermelo (Mr. Jackson) put before us just now in connection with housing. I want to say at the outset that I am not saying there is anything wrong with the figures quoted by him, but what struck me is that I thought these houses were being built very cheaply indeed. In order to get a comparison I took the quantities from what he told me of the size of the rooms and worked out a quotation of the amount of material required, and compared it with what those prices would be in Johannesburg. I will take his figures as regards bricks. He says there are 8,000. That is £32, at £4 a thousand. He did not say anything about the foundations of the house, but I took all the material in a very neat way. There is roughly five yards of concrete foundation in the building, allowing for a wall 15 inches wide and one foot deep. No foundation should be less than one foot deep, and I know that well because I have done it all my life. That would cost £7 10s. We know today that limesand in Johannesburg would be £7 10s. and I want to tell you that he is slightly wrong about the roof. He said it was a pitch roof, but looking at the plans it is a lean-to roof, which is a very cheap roof. I worked that out at £60. I am talking about prices of material only and not labour, because I want to have a fair comparison of what it would cost in Johannesburg. Then he said that the house was plastered inside and out and according to the size there would be 200 yards of plastering inside and outside, which would cost 1s. a yard in Johannesburg, making it £10. I also accept that there are four doors in the house, and with locks and hinges that would cost £10. There should also be four windows and the very cheapest price in Johannesburg would come to £12 for the windows. The hon. member said it was an ash floor. I think he means a concrete floor which is very cheap and would come to 25s. He also said there was a lavatory. I do not want to take quantities for a lavatory, but it cannot be built for less than £7 10s., and the whole lot totals £111 10s. without labour. The hon. member got that house built, labour and all, at Ermelo, with native labour for £107 and with white labour for £120. The reason why I do this is that I hardly think it is a fair comparison to compare what can be built in Johannesburg with what can be built in Ermelo. But there is one point I wish to make. I think it is only right to tell the House that you can build at house which will last five years, and one which will last 100 years, but the house which the hon. member for Ermelo referred to this afternoon will blow away with the wind within a few years.

The hon. member for Gordonia (Mr. J. H. Conradie) made a complaint against the South African Pharmacy Board, suggesting that certain big companies, chemists and druggists, in this country have formed a monopoly to control pharmacy, and that one of their initquities is in refusing to employ apprentices. He further stated that the total number of apprentices in South Africa was 111. I would like to point out to the hon. member that the position is not as he said. Pharmacy is not dominated by big companies in this country. There are roughly 1,000 chemist shops in South Africa.

To whom do they belong?

Does my hon. friend suggest that there is a tied house system?

I said so.

I may point out that the tied house system does exist, but not in the same form as in the liquor business, where a house is tied to a brewery or wine merchant for ever. The small chemist is tied to the wholesaler by a bond only until he pays off the bond.

The liquor people are bound in the same way.

I admit that it is not a good system but the fact that they are tied to a wholesale house does not take away the individual freedom of action of the chemist. I would like to see the system removed, but it is not so bad as the hon. member suggests. I think one can say this, that I will be surprised if more than 20 per cent. of chemists in this country are tied to a wholesale house or to anyone else, and that system is in no way responsible for the lack of apprentices. I may tell the hon. member that whilst a few years ago there was a shortage of apprentices, last year the position improved and today it is much better and there are more than the 111 he speaks about.

The report mentions that.

The report was published for 1944, but I can tell the hon. member that the improvement in the registered apprentices during this year has brought up the figure to over 200, and that is because the Pharmacy Board and the various pharmaceutical societies pointed out, particularly here in the Cape, which was the worst culprit in this respect, that chemists were not doing their duty to their profession by refusing to take apprentices. The Cape people made the complaint to me personally that they could not take apprentices because under the wage determination they had to pay a boy who was no good to them for the first 18 months something like £9 a month and still had to teach him and allow him two afternoons a week off to go to the Technical College.

And that is why they employ girls.

Yes, but they are just shop girls who sell over the counter. But the point is this that as regards the Transvaal and Natal and the rest of the country apprentices are coming in fairly freely now and the position is better than in 1944. I quite agree that the apprenticeship system requires revising and the Pharmacy Board at present is considering the whole question of the revision of the apprenticeship regulations. Apprentices can be trained in the country too. Every country chemist can take an apprentice. About three years ago there was objection to that but now they have to get their training, and if the chemist does not get prescriptions in the ordinary way, so as to teach the apprentice how to make them up, he must give the apprentice prescriptions to make up not silly prescriptions to be thrown down ’the drain, but things which can be used. If he is a good chemist he will train the apprentice properly. However, I only got up to point out that the position is not due to a conspiracy on the part of the big companies or on the part of the chemists themselves, because that would be a most foolish thing for them to do. They require apprentices and they themselves complain that they cannot get the assistance they want.

Do you say there are 1,000 chemist shops?

Yes.

But there are only 87 chemists registered.

No, there are 1,600. You can accept that as being correct. Therefore the position is this, that with the position of difficulty that has arisen, the Board is now reconsidering the whole question of apprenticeship in order to secure a steadier flow of apprentices into the business. The board is also interested in a system for the assistance of returned soldiers. There are a large number of apprentices on active service, unregistered assistants, and a scheme has been evolved whereby these men will have special attention and special examinations, and also they will encourage a certain number of other returned soldiers to go into the business. The Pharmacy Board is not keeping out apprentices. They are anxious to have the best apprentices and to train them properly.

This afternoon at the commencement of his reply, the Minister seemed to wish to convey the impression that he really felt the responsibilities of his Department very acutely. He admitted there were many defects and shortcomings, and he created the impression that he was going to do his utmost to put things right. He stated that the Secretary for Public Health would write to members in connection with the requests that we have made. That gave me hope. But in the same speech the Minister comes and he does not only reveal his weakness but he also reveals his powerlessness to tackle the problems that exist today in our country. He said that we should now go on with the scheme, and if it is not a success we can go back to the people. What more does he want from the people? He has here received a clear reflection from the representatives of the people in this House. He knows very well that the public do not mind what it costs to give a proper health service to the country.

And what about Natal?

The representatives of that province spoke clearly on behalf of the inhabitants of that province. The Minister now takes up the same position as the Government took up when the report of the National Health Services Commission was presented to him. The Minister should not be so pessimistic.

No, I am not pessimistic.

He clearly created that impression. I should like to associate myself with the policy pleaded for in this debate by the hon. member for Pietermaritzburg (City) (Col. O. L. Shearer) and the hon. member for Aliwal (Capt. G. H. F. Strydom). I accept that the Department of Public Health as it stands at present should have as its principal function the prevention of disease; its function must be to prevent diseases and epidemics coming in from outside, and its further great function is to combat the spread of contagious diseases. Those are its principal functions. Now the question arises whether the Department of Public Health is capable of discharging that function. When I ask myself whether it is qualified for this task it is definitely my impression that the Department is not qualified for it. In the first place, I should like to mention this argument. We have had the smallpox epidemic. The Minister has told us that vaccination has taken place on a large scale in Natal and in the Transkei. I know that this is so. I know that the Minister’s task is rendered very difficult by the way natives move throughout the Union, on account of the Minister concerned refusing to turn off the tap at their reserves. But what avails it to inoculate a section of the natives here and another section there? Is it not possible to get a mass and compulsory inoculation over the whole Union? What has happened now? This contagious disease has gradually spread into the interior. When it broke out in Johannesburg everyone wanted to be vaccinated. I myself went to my doctor and there was no vaccine. If that is the case with a disease such as smallpox, that there is not enough vaccine, the Minister must admit that his Department is not up to its job. It is not in the interests of South Africa to allow the natives to die in numbers from epidemics. Apart from that, if this is happening today in the case of the natives tomorrow it can happen to us. Accordingly, I say that we should exert our utmost efforts to prevent such diseases. We have the means to do so. I also want to draw the attention of the Minister to the way in which the vaccinations were carried out. When the school children and the students were being vaccinated I saw the vaccine standing there in a bowl. This is unhygienic. Sometimes, too, the skin was not scratched well enough, with the result that the inoculation did not take. Certain parents went with their’ children to private practitioners and there was no vaccine. When vaccination occurs the Minister’s Department should see to it that it is hygienic and properly carried out. Then I come to another matter. I have spoken here about the prevention of disease, and I should like the Minister to make a statement as to what steps the Government have taken in connection with the prevention of infantile paralysis in South Africa. I may be wrong, but according to newspaper reports that disease comes from America. If that is so, the Minister should give us an explanation of what precautionary measures he is taking in our harbours to ensure that diseases are not transmitted to South Africa. The Minister should know that as a result of this disease little boys and girls in our country will be crippled throughout life. After the war we are going to have epidemics; that is admitted, and I think the Minister should make a reasurring statement in respect of the precautionary measures that are being taken to prevent the spread of disease by means of aircraft and ships or in any other way. The English motto is: “Prevention is better than Cure.” It is the sacred duty of the Government to preserve eternal vigilance. The public have an uneasy feeling that they cannot absolutely rely on the Department of Public Health. That Department must be competent to combat epidemics from outside. The Prime Minister has himself stated that he fears disease and epidemics after the present war. That is a natural phenomenon we get after wars. The Minister owes it to the House and to the country to make a reassuring statement to the effect that he and his Department are alive to taking the necessary precautionary measures.

As a member of Parliament, I believe in courtesy and justice, but today I learned a new lesson from some old members of Parliament—that we can tie up a person and gag him and that we can then attack him as the hon. member for Langlaagte (Mr. Bawden) did. I think that the hon. member owes the hon. member for Ermelo (Mr. Jackson) an apology for his attack on this occasion. I wanted to stop him in the course of his speech, but he would not allow himself to be stopped and as a result he very probably will have to put the matter right with the hon. member for Ermelo.

The matter has already been settled.

When my time was up I was showing what a useful instrument the Minister had in the divisional councils of the Cape Province, and I want to suggest that the Minister should make further use of that instrument he has in the form of divisional councils and develop them in the direction of public health services. They have not got just the right machinery, but the Minister’s experience with the divisional councils will no doubt have taught him that from feelings of humanity they consider it their sacred duty to go as far as can reasonably be expected from them in connection with the assistance regarding public health. I am perfectly certain if they had the funds at their disposal they would be prepared to go very far in assisting the Minister in connection with public health, nothwith-standing the fact that it is a new task that is being placed on their shoulders, and one for which they were not exactly intended. Every month there appears numbers of cases in connection with public health demanding the attention of the divisional councils, that they are obliged to keep an eye on and to deal with and that imposes financial as well as humane obligations on them. Let us bear in mind that the divisional councils have only limited sources of income. They have no unlimited sources of assistance into which they can dip for finance in order to look after these matters. And very often we have poor divisional councils who are really too poor to discharge their real duties in connection with roads, bridges etc. In addition to that, there are additional burdens in respect of public health, as I have already shown on a previous occasion, and these are placed on their shoulders with the obvious result that as they are looking after this aspect of public health, and as they are incurring obligations in connection with it, their other duties must suffer in certain respects. I should like to repeat that I consider this an extremely unsatisfactory state of affairs. I should like to hear from the Minister what is being done in the other provinces. I am not entirely conversant with the position in the other provinces where there are no divisional councils. But as the divisional councils are called upon here to play such a leading rôle in connection with public health and to accept so many financial responsibilities in connection with it, I am extremely desirous to learn from the Minister what the position is where there are no divisional councils and where the provincial council or any other authority has to accept the financial and the humane responsibility in respect of public health. My experience is that despite these facts there are today people dying amongst us as a result of the lack of treatment. People walk along the road, they become sick and die. You do not know where they are going; everyone tries to evade his responsibility. That poor person remains in want of the necessary hospital attention. We were obliged in our constituency to go to the length of constructing our own tuberculosis hospital; it was built with our funds, assisted by the Department of Public Health, and that tuberculosis hospital is today administered with our own funds. But where it was possible for our divisional council to build its own tuberculosis hospital, it is not possible for every divisional council to do so, and if we want to meet urgent requirements it is necessary for every divisional council to take up all the T.B. cases that are today not taken up by the larger hospitals in the country. The urgent need exists, and we are asked to make provision from divisional council funds and to bear this expenditure ourselves in connection with the administration and maintenance of the hospital that we have established from a feeling of humanity towards these people. We have in our divisional council district many people who can only pay their property taxes with difficulty, taxes that are required by the divisional council for their financial needs. But notwithstanding this we also have to oblige them to accept this responsibility on their shoulders as an auxiliary matter. I want to suggest that the Minister should use the divisional councils as far as possible, and they will be prepared to help in any reasonable manner. Then I also want to suggest that at the same time we should be prepared to accept the financial responsibility to a further degree than merely paying the half in respect of contagious diseases. In many cases they have to keep their own doctor in order to ascertain whether the diseases are contagious, and I want to suggest that an amount should be decided on by the Department of Public Health for necessary attention of this character. We are aghast when we see that in this enlightened century in which we are living animals are receiving better attention than many sick people. When a valuable horse or sheep or beast becomes sick the owner will do everything in his power to obtain a veterinary surgeon, even if he has to travel 100 miles to treat that horse or sheep or beast properly. Here we have people virtually dying under our eyes without them enjoying the attention that today a valuable animal enjoys at our hands. We cannot argue that fact away. It is better we should look it in the face and institute a system under which the necessary provision can be made for rendering medical and hospital services available with a view to meeting the position as it appears to be. Today it is that man’s turn, but tomorrow or the next day it may be our turn. In the case of a pauper who cannot afford these services it is the duty of the State to see that the necessary attention is given. Today it is the man who has not the necessary funds to look after himself, but tomorrow or the next either you or I may find ourselves in that position. I admit that the Department of Public Health has made more provision in recent years. I also admit that the need was so great that it was difficult to make effective provision for all, but at the same time the question arises whether the demands have not increased more rapidly than the provision that has been made to fulfil these requirements. We can only be satisfied with ourselves when we are convinced that our needs are not developing at a greater pace than the provision we are making to satisfy and surpass those needs in respect of hospitalisation, nursing services and medical treatment.

For my part I maintain that if the health services of the country are suffering partial shipwreck owing to a lack of the necessary doctors, steps can be taken in this connection similar to those taken in connection with education. When I spoke just now I suggested that study bursaries should be granted to medical students in the same way that study bursaries are granted to teachers. I want to suggest that those bursaries should be given on condition that the students, when they are qualified, should repay them so that the State should suffer no actual loss. Now I may be told that the universities are today absolutely full. Today we have to deal with an emergency. In the past five years we have had this same emergency. I think the position is just as serious in this respect as it has been in other respects in the past five years, and if it necessary we can adopt emergency measures to provide the necessary facilities in the universities for the training of staff. If we do not take action today we shall have the same position after five years as we have today. Today we cannot have 100 per cent. perfection, but we can in any case, as one hon. member stated, take the bull by the horns and get to grips with the matter. Today there has been no opposition in the House to the proposals of the Health Services Commission. That commission was comprised of doctors, people who have a thorough knowledge of the matter, and their recommendations are the recommendations on which we have to decide today and by which we shall have to stand. Another excuse that is being made is that we have not enough nurses. When we think about nurses we are almost compelled to compare the position with the position prevailing in the commercial world. It seems curious to make the comparison, but when you offer certain articles for sale there is such a thing as supply and demand. When the supply is greater than the demand the price has to go up; in other words here you have a shortage of nurses, and one of the ways to prevent it is to create more attractive conditions for those nurses.

I agree.

I mention this as a solution to remedy this defect. I for my part would go further and say that if we cannot get enough European nurses we should train non-European nurses.

The difficulty is that our friends marry all the good nurses.

You should not be personal.

Then our people get the benefit of it, when you marry a woman who can look after the children properly. The hon. member almost put me off. I want myself to suggest if we have not sufficient nurses we have capable coloured women in the country and even natives. Educate them also on the principle of separation. This is another method to remedy the defect that exists today. Another question that can easily be solved is the question of funds. The Minister says we have not got the requisite funds. I can give the Minister the assurance that if we have the necessary services the Europeans and the coloureds and the natives in the country do not mind paying the necessary taxation, but on condition that they have the necessary services. There is no one in the House who is opposed to that, so we shall not have any opposition from the public. In this respect no apology is required. One of the principal foundation stones of the nation is health. It is a factor that we must not lose sight of. We must be prepared to pay for it, and we are prepared to pay for it. If we take the past five years we shall find that thousands and thousands more people have died in everyday life for lack of the necessary attention than have even died on the battlefield. If we were prepared to find the funds in the last five years for war we should also be prepared to find the funds for a national service.

But you must have a national income.

The hon. member for Vereeniging (Lt.-Col. Rood) is a big financier. It is a poor thing if he cannot solve this problem of augmenting the national income. I wish to associate myself with the resolution recently taken by the Afrikaner Christian Women’s Association, which runs as follows—

The resolution goes on to say—

I shall be very brief. I wish to bring only two matters to the notice of the Minister the first being in connection with district nurses, especially in our smaller towns. The allowances received by district nurses are far from adequate. The smaller towns find it difficult to get doctors, but when these doctors are appointed as part-time district surgeons and their salaries are made attractive by the Department those smaller centres will have a better chance of obtaining doctors. Consequently I want to plead with the Minister to increase the scale of payment for these part-time district surgeons. The second matter I wish to bring to the notice of the Minister is the system, commenced about five or six years ago, of the district surgeon touring the various wards in his district for the purpose of inoculating or injecting people suffering from venereal disease. I think the Carnarvon district was the first where this was done, and it was a success. But what we ask is that the district surgeons should visit the wards regularly to give injections. We ask that this should be continued throughout the year and that the district surgeon should not only make one visit during the year to a ward. Then I feel that that examination should be made compulsory for all persons, including members of Parliament. There are so many persons who are not prepared to allow themselves to be examined. You get resolutions by congresses all over the place asking that those engaged as servants should be compelled to have injections. But you cannot limit it to one class. Those people have the same rights as we have. They have the right to say to us: “We are working but the home in which we work may not be healthy.” Accordingly I say that we should all be willing to have a compulsory examination.

Vote put and agreed to.

On Vote No. 27.—“Mental Hospitals and’ Institutions for Feebleminded”, £960,000.

I should like briefly and forcefully to direct the Minister’s attention to the state of affairs in the mental hospital at Bloemfontein. Provision is made here for that. Last year they budgeted for 1,850 patients, but this year there are 1,800. I understand that the number varies between 1,800 and 1,900. My information is that the institution was established for only 1,200. The institution, together with its staff, as it exists today has been designed for 1,200 patients, and in those circumstances it is evident that the conditions are unsatisfactory, when you have an institution occupied by 1,800 patients when there ought to be not more than 1,200. I do not want to say that fewer patients should be admitted, and besides I understand there are patients who cannot be admitted but the State ought to make provision to enable these patients to be admitted. It is almost humanly impossible for a staff intended to look after 1,200 patients to deal with 1,800, and I hope that the Minister’s Department will devote its attention to this matter with a view to affecting a speedy improvement.

I hope that this vote will not pass without some statement of policy by the Minister on the future of the mental hospitals. I think a statement of that kind is long overdue. The simple fact about our mental hospitals is in general the point that the hon. member for Winburg (Mr. Swart) put to the Minister in particular terms. It is that the whole provision for the mentally sick in this country is completely inadequate. That is not a new position; that is not a position that has arisen out of the war. It is a very old story in South Africa. The report of the National Health Services Commission which only touches upon this side of the question of health services, reveals the fact that the lack of adequate facilities goes right back at least to 1913. At that time a Select Committee of this House reported on the deficiency of the accommodation that was provided under this heading. Since then,. there has been some extension of the facilities that the country offers, but it has been remarkably slow. It is natural that in a young country like South Africa, there should be a gap between the facilities offered and the needs of the community. In all directions we are faced with the same problem, but in most other directions we are catching up on the demand for services much more rapidly than in respect of this particular service. The position, as revealed by the National Health Services Commission itself, shows that there is an enormous deficiency in the beddage for patients in this country. The report states—

The report states further that at the end of December, 1942, the total number of mental hospital beds available was 11,735 for the whole country and that the number of patients in residence was 13,356. That in itself is a reflection of the conditions under which those who are working in this service are struggling against terrific odds. The figures of the Commissioner for Mental Hygiene show an even greater discrepancy. The figures which he submitted to the National Health Services Commissoin showed that 400 Europeans were accommodated in the hospitals provided for Europeans in excess of the number for whom basic facilities were provided, and that the over-crowding of nonEuropeans amounted to 2,300, that is to say, the mental hospitals are accommodating 2,300 more non-Europeans than they have facilities for, 2,300 in excess of the number basically provided for. That is a situation that must undermine efficiency lamentably. This terrible overcrowding that was the worst feature of the situation discovered by the commmission which investigated the position in 1937, is one which makes it completely impossible to get an efficient service out of the money that is being spent. This shortage of accommodation which leads to over-crowding of this kind also makes it impossible for us to take into our mental hospitals acute cases which should not be left at large to the detriment both of themselves and of the community as a whole. But the overcrowding of the hospitals is only one aspect of the seriousness of the situation. In addition to overcrowding there is apparently the extremely serious problem of under-staffing. I know that this problem of staff is one which affects all our medical services, but the under-staffing of this service is not only particularly acute, but it is peculiarly difficult. It makes’ the position of those who are in the service peculiarly difficult. The memorandum submitted to the National Health Services Commission by the South African Trained Nurses Association showed that out of a female nursing staff of 740 which was apparently budgeted for, there were 383 vacancies in March, 1943. The memorandum also records that in 1939-40, while there was an increase of 527 patients, there was actually a decrease of 38 in the number of nurses. All these facts reveal an extraordinarily unfortunate situation, and I feel that there ought to be some plan to remedy the position in both these regards. I know only too well, that there is an all-over shortage of nursing personnel. We are as has been reported on the Publier Health vote, engaged in efforts to increase the trained staff for the ordinary hospitals, but that provision does not at the moment cover this question of training personnel for mental hospitals. I do not know why it should have been so difficult to staff the mental hospital, apart from the question of the war, but it would appear that the mental hospitals do not normally attract an adequate number of recruits to their service. The situation that has been put to me in authoritative circles, that the reason for that is that the housing and living conditions under which this staff is called upon to work are totally inadequate, that in many cases the nurses have to be accommodated amongst the patients, which means an enormous strain both on the mental and physical resources of the nurses themselves; that they work for long hours, that they are hopelessly overburdened by what ought to be house work and not nursing service, that in many cases they are doing the work of domestic servants, which means that they are completely incapable of doing the very exacting work for which they are supposed to be trained, and which the community requires. If these allegations are correct, then the whole situation ought to be reviewed immediately, and some provision made to relieve the nurses in these hospitals of all but their essential duties which are sufficiently exacting to make it imperative that no extra burden should be imposed upon them. Now one matter I want to put to the Minister is this, and I would like to know what his department is doing in that regard. When the pressure upon the nursing services in the mental hospitals became so acute, the proposal was made— I think again by the Trained Nurses’ Association—that African girls might be trained as mental nurses or as assistant mental nurses to look after their own people. That seems to me a perfectly sound proposition. We have large numbers of African girls who could be trained for this purpose, and I think with careful training African nurses ought to be a very useful adjunct to the hospital staff. But I am told that the department was not in favour of that proposal, that their response to the situation was simply to reduce the educational quali-fications of the entrants to the service. The qualification was reduced from Std. VII to Std. VI. That seems to me an extremely unwise move. It does not strike me as the direction in which to seek any remedy of the serious difficulties under which our hospital staffs labour. I should have thought that, even as a temporary measure the training of African nurses would have been a far more satisfactory proposition. Now I am putting up an old case; it may have a few new figures to it to bring it up to date, but the essentials of this case are long established. [Time limit.]

I would like also to say a few words about mental hospitals. I can back up the view that the staff is having a very bad time in the mental hospitals, and as far as accommodation is concerned in my part where I come from, where there is a big institution, the housing conditions leave a very great deal to be desired. These nurses are called upon to do a great deal of overtime, especially during the war. In Potchefstroom we have a big area where the department can extend its building activities in so far as the mental hospital is concerned. I understand that at Valkenberg, which I believe it is now proposed to extend, you have to pay about £200 per morgen for ground. Well, there is plenty of room for extension in Potchefstroom. There is another point I would like the Minister to consider. I have heard from quite a number of medical men that we have no provision in South Africa for neurotic cases, not mental cases but temporary mental cases. A man or woman who is temporarily upset mentally has to go to a mental hospital. People do not like doing that and I am informed by medical men that in other countries neurotic people are treated in a neurotic hospital. Doctors tell me that over 50 per cent. of the ordinary cases which require attention are probably due to some form or other of neurosis, and we have no accommodation to permit of the treatment of these people. I have been asked also by people in my neighbourhood to suggest to the Government that it consider the possibility of establishing a neurosis hospital, preferably near a mental hospital.

There is another point I should like to mention. Provision is made here in reference to certain hospitals for what is described as religious work. Some of them get £100 and some get £160. I should like to know from the Minister what is the character of the religious work that is done in the mental hospitals. By whom is it done? Is it done by certain denominations? I should like to have a little information from the Minister on this point.

I understand that the answer to the last question put to me by the hon. member for Winburg (Mr. Swart) is that facilities are given to the representatives of all denominations to provide religious services in the mental hospitals.

But to whom are these amounts paid?

One pound per service is given to the official conducting the service. The hon. member for Winburg has spoken about the difficulty at Bloemfontein. There is overcrowding. The hospital is scheduled to take a given number of beds and in actual fact the authorities have been forced through circumstances to place more patients than was provided for originally. The position of our mental hospitals is not something of which we can be proud. I must frankly admit that. That is one of the matters which has been even more troublesome and difficult than many of the other difficult problems attached to the Department of Public Health at the present time. We have a shortage of beds. At the end of 1943 European overcrowding was to the extent of 376, or 8.4 per cent., and over-crowding of non-Europeans was 2,447 (37 per cent.). In his latest report which I tabled recently in this House the Commissioner for Mental Hygiene said—

The Commissioner has put the position there. I say it is not a matter of which we can be proud, nor is it a matter in which one can attribute blame to any particular government. It so happens in the past our mental hospitals have been the Cinderella of our medical services. In fact, it is only in the last 18 months that the administration and control of mental hospitals has been placed under the control of the Public Health Department. Formerly it fell under the Ministry of the Interior. I am not suggesting for a moment that there was maladministration by the Department of the Interior. But it is certainly more in conformity with modern ideas of health that a department dealing with persons afflicted with mental disorders should be under the control of the department dealing with public health as a whole. That change has taken place. But in the meanwhile we are faced with this tremendous shortage of buildings. We have a similar shortage of nurses. The position in September, 1944, was as follows: Out of a total female nursing staff of 740 below the rank of Sister, no less than 305 posts were vacant, and that is virtually the position at the present time. Out of an establishment of approximately 740 there are roughly 300 vacancies. We cannot get the girls to fill the positions. I agree with the hon. member for Cape Eastern (Mrs. Ballinger) that once again in respect of this shortage of nurses there would appear to be some relation between the shortage of nurses and the conditions under which they work and the general conditions of employment. I think I should let the Committee know that a special ad hoc committee will be meeting in Bloemfontein early in May to discuss the question of the nursing shortage generally. That meeting was convened as a result of consultations which took place between representatives of the Nursing Council and the Co-ordinating Council a week or two ago. Arising out of that it was decided to have a representative of each of the provinces, and a representative of the Government to meet at Bloemfontein to go into the whole question of salary scales and treatment of nurses generally. I shall ask the conference to ensure that the question of recruitment of nurses for mental hospitals shall be dealt with at the conference. So far as the future is concerned we have laid our plans for building. The Government has already entered into negotiations with the City Council of Cape Town in terms of which it will sell Valkenburg and the ground on which the Valkenburg Mental Hospital is situated, to the City Council. That transaction will take place at a time when other accommodation is made available in the Cape Peninsula for our mental patients, who are accommodated now at Valkenburg and may need accommodation in future. The proposal at present is to build a mental hospital for 1,500 European patients at Bellville. It is proposed to have two mental hospitals. At present Valkenburg accommodates both Europeans and coloureds. The proposal is to have one mental hospital at Bellville for Europeans, to accommodate 1,500, and there will be built another hospital to accommodate 1,500 coloureds. That also will be built in the Cape Peninsula, but the site has not yet been fixed. Then there is the completion of the Krugersdorp Mental Hospital. We hope when that is completed to have accommodation for 300 additional Europeans. We also have our plans to build two new hospitals each for 1,500 natives, one in the Transvaal and the other in Natal. These are the proposals we have on paper. We are already taking in hand the additions at Krugersdorp, and that will certainly give relief next year. I hope that next year, 1946, it will be possible to make a start ’with the building of the new hospital in the Cape Peninsula, though I cannot give a final undertaking in this regard.

Neither of these will help the pressure on the natives.

I agree with my hon. friend. Some four or five months ago I asked the Secretary for Public Health and the Commissioner for Mental Hygiene, to ask the Quartermaster-General the question of obtaining military camps for the purpose of using them temporarily as mental hospitals. So far no firm proposition has resulted from those discussions and negotiations. I understand it is not at all an easy matter to convert an existing building of that type under present conditions for the purpose of accommodating mental patients. You may have a very good camp, which is very useful for accommodating persons under certain circumstances, but, as hon. members know, a mental hospital has to be run on a system of various keys, and it is not possible to obtain keys and locks at the present time. I do not myself profess to understand the complexities of the system, but apparently it is quite an essential feature.

Keys or locks?

Both. That is one of the difficulties that confronts us at the present time. I am not able to hold out any more hope than that. I agree that this is a blot on our Health Department, and the sooner we can get the buildings and the trained staff the better. No doubt next year with the situation changing and with the position in regard to materials changing, and an improvement in other directions, we shall be able to make a start.

Do you think you could give me the figures for European and non European patients respectively? The report gives the total number, but could it in future show Europeans and non-Europeans separately?

I can arrange for that to be done.

When we are dealing with the Minister, the saying applies “we live in hopes”. He admits that the condition is critical and very bad. I wonder whether he realises how bad it really is. I am informed that hundreds of patients are awaiting admission to the mental hospitals.

I recently helped you to secure an admission.

Certainly, and I am very thankful for that. But it should not be necessary to secure your assistance to get someone admitted to the hospital. I understand there are hundreds awaiting admission. They cannot receive the treatment that is necessary in the places where they are. As this is the position it is not sufficient for the Minister to say: I think it will be next year, but I cannot be definite. We cannot go on like that. I am grateful the Minister assisted me in that one case, but there ought to be adequate accommodation. I do not blame the Minister and the department. He only recently took over this department for the first time. But apparently the mental hospitals have always been shabbily treated. The people are just as entitled to treatment as other persons. On the platteland and even in the towns the professional men are not available to treat these patients. They have to come to these institutions for scientific treatment. Consequently it is necessary to act energetically and not only to make promises. Action must be taken as rapidly as possible. It is not sufficient for the Minister to say that he understands the position is bad, that he agrees that it should be improved, but that he does not know whether this will happen the following year or in 10 years. I think we should let the Minister understand that it is an urgent matter and that it is necessary to make provision.

I am pleased to hear the Minister’s statement that a committee will meet in Bloemfontein to go into the question of shortage of mental hospital nurses. I realise from the information he gives that there is a shortage of over 300 nurses, but the position in Pretoria has been very acute indeed; so much so that native girls employed on domestic duties have had to assist the ordinary European nursing staff. I appreciate the difficulties of the Department, but at the same time I would be failing in my duty if I did not point out that one of the major reasons for not being able to kee a normal staff in the mental hospitals is the low wage paid these girls. In Pretoria one finds that probationers only remain a month or so, and then they go elsewhere to get better remuneration. Since a committee will be meeting in Bloemfontein this month, I would like the Minister to ask the committee to go into the question of a proper diet for the nurses. I know from a number of them, since they are in my constituency, that not merely once a week but possibly four or five times a week supper is comprised of a plate of soup, monkeynuts, bread and butter—and possibly not butter but jam. I know that the nurses have very arduous duties to perform and there is something wrong when a diet on those lines is given to the nurses. I would ask the Minister to take a note of this and to arrange to prescribe a decent diet for the nursing staff.

I am glad the Minister admits that the position in the mental hospitals is by no means rosy. I had the opportunity to visit the mental hospital in Pretoria on one or two occasions, and it is pitiful to see how the people there are treated. This is solely to be ascribed to the shortage of staff. The number of nurses in the hospital is too small. They work harder than any nurses in the world, but because they do not get adequate remuneration the nurses are not to be obtained. But that is not all. There is the dress of the mental patient. Apparently no notice whatever is taken of their complaints. Because they are mental no notice is taken of their complaints and they do not know whom to approach. It is sad to see the clothing of the Europeans, a loose garment. When it is cold they shiver. In a number of cases they have caught pneumonia as the result of lack of proper clothing. I regard this as nothing less than a scandal. Then their boots are in a sad state. I should like the Minister to see for himself what the position is. They are running around barefoot on the gravel, the boots have no soles. I think it is one of the most scandalous things in South Africa the way these mental patients are treated. Then there is the question of food. One person who spoke to me told me that they were starving, they could not get enough food. As the hon. member for Pretoria (West) (Mr. Hopf) has stated, they get pitiable food bread and jam. They have to live on that. The treatment is scandalous. I have myself seen how many of them have extremely bad teeth, but no dentist is sent to them to have their teeth attended to. Are these then, just wild animals that we let loose in these places. Why are we spending money year after year to maintain these hospitals? We are obliged to give them good treatment and I make an appeal to the Minister to go and see for himself and be convinced of the codifions; then he will be more sympathetic in the future.

Last Session whilst we were discussing the amending of the Mental Disorders Act, I brought to the Minister’s notice the unhappy plight of some of our mental patients who happen to have a small estate. I also brought to the Minister’s notice the fact that mental hospitals follow the practice of making these patients pay maintenance charges. I told the Minister that I thought it was time these unfortunate cases were made a charge on the public purse, and that a small estate, such as I have in mind, should not be made to bear these charges from time to time. I think I was supported by the hon. member for Pinetown (Mr. Marwick). The Minister’s answer on that occasion, as far as I can remember, was to suggest that as the national health scheme was to be brought into being that I should not press the point. It was suggested that the national health scheme would probably afford relief on the lines I was asking for. We have had the national health scheme brought before us, but so far, no relief has come from that quarter. I want to ask the Minister whether it would not be possible to do something in this respect. It is hardly fair to expect a small estate of a mental patient to bear maintenance charges. I have a case in mind where I have already paid out considerable sums from the funds of a very small estate of a mental patient; and the other day I received a further account for between £70 and £80 which I have been called upon to pay. I can quite understand that heads of departments concerned have to carry out the law as it stands, but I appeal to the Minister again that something should be done to afford relief in cases of this description.

There is one point of considerable importance I should like to refer to the consideration of the Minister of Public Health, and that is, before we can get any improvement in the strength of the nursing staff in these institutions we must try to introduce a better type. Many potential candidates for these posts have got it firmly into their minds that as a rule the staff in these mental hospitals is of a very hostile type. They are people who have not been proving suitable. I am not condemning them because of the class, but there are numbers amongst them of strong character who dominate the others, and to a certain extent bully them. The bullying element among the staff are responsible for the fear that possesses possible candidates when they are asked to join the staff of these mental hospitals. I should like to see that side of the matter made the subject of enquiry by any committee that sets out to improve the conditions. I am satisfied it will be a long time before you get adequate staff unless suitable action is taken on these lines. My conviction is there is quite a big element in the staff of the hospitals who practically lay down the conditions. The Minister may in theory lay them down through his department, but the unpleasantness or otherwise of the actual conditions is determined by a coterie of nurses who dominate the others and intimidate them. I know of cases, I have been spoken to by the patients in these hospitals, by men I have known for years who are patients there. There is one man who is suffering from locomotor ataxia and who is in perfect possession of his senses. He confided in me to a considerable extent in this matter. He said: You will never make an improvement unless you can improve the tone of the personnel themselves; they are the people who really control the situation and other nurses, persons of the best possible type, are fraid to come forward. It is a pathetic thing that men and women out of their mind should be in the hands of people not suited for that kind of work. I think whoever solves this question of finding and keeping the right type of nurse in these institutions will have solved a great difficulty. I hope the Minister will not disregard that. I was glad to hear the hon. member for Wakkestroom (Mr. J. G. W. van Niekerk) support it. All of us who are concerned in cases that enter mental hospitals from time to time realise that that is a sad defect in these institutions, and I am sure it is one the Minister would like to put right, and with his energy I am sure in the end he will succeed.

I entirely agree with the hon. member who has just spoken that in providing staff and amenities in our mental hospitals we should be just as anxious to do the best we can for these patients in the same way as we do for the inmates of general hospitals. The old idea that a stigma attaches to a mental patient is dying out or ought to die out. No stigma attaches to a mental patient, just as no stigma attaches to a person who is ill in the physical sense. I shall certainly follow up the suggestions made by the hon. member and see they are brought to the notice of the Nursing Council, who are the statutory body to deal with matters affecting nurses and the nursing profession. The hon. member for Pretoria (West) (Mr. Hopf) referred to the standard of feeding amongst patients and amongst the nursing staff. Recently the Department of Public Health instituted an enquiry into the dietary scales for patients in our mental hospitals. That enquiry will have to be extended throughout the length of the Union, and it is already clear, I think, from the results that have flowed in, there is room for considerable improvement. I think the hon. gentleman is correct in what he says. So far as concerns the question of maintenance fees payable in respect of municipal institutions, they aggregate £120,900 a year, and the hon. member for Pretoria (East) (Mr. Clark) is quite correct when he says that on the last occasion when he raised this matter in the House I told him that the question of free hospital services for mental patients was necessarily bound up with the national health scheme. I cannot give a final answer in regard to that, because it is one of the questions involving Government consideration at the present time. But it would certainly seem logical that if free hospital services are given in the case of ordinary patients we should also give free hospital services for mental patients. In the administration of the law regarding mental hospitals, I should like to assure my friend, the Commissioner for Mental Hygiene has been most sympathetic in individual cases. I know of instances where he has agreed to waive his legal right to a claim for charges, but I quite agree in what the hon. member said that it will be very much better if we had this matter on a fixed basis; and if we could remove the necessity for fees it would do away with that difficulty once and for all.

Vote put and agreed to.

On Vote No. 28,—“Social Welfare”, £2,198,000,

I notice that an article in the “Cape Argus” on the 20th April states that the Treasury has refused to give authority to the department to subsidise the Cape Town Social Welfare Organisation. The article reads—

I hope that this does not mean that the Central Government is going to carry on social welfare on its own, or that the municipalities should play only a very indifferent part. I suggest that social welfare is as much the responsibility of the State as it is the responsibility of the local authorities. I feel that an efficient Social Welfare Department in all municipalities would prevent a great deal of the diseases we have been listening to in the House for the last few days. I happened to be chairman of the committee that was responsible for the Social Welfare Department of the Johannesburg Municipality being established and on the occasion of our first meeting a number of chairmen of different charitable institutions who appeared before the committee, expressed the feeling that they found that by themselves they could not give the services they wished to give to our less privileged citizens and there was much overlapping of their services in different ways. The Johannesburg Municipality formed its own Social Welfare Centre under the directorship of Mr. Murray and since then we have gone on and on to very much increased activity. Cape Town followed the same policy. But no sooner has it got itself established firmly, than there is this change of policy by the Treasury Department towards Social Welfare. This is all the more surprising when one remembers that Cabinet Ministers themselves have time and again recommended that municipalities should establish their own Municipal Welfare Departments, and in every country the tendency today is to encourage their social services. There is not a big city in America or Great Britain that has not got its social centres. In Britain they call them the Public Assistance Department and in America the Public Welfare Department. I think that this blow that has been dealt by Treasury to the Cape Town Welfare Department is a sad one. The Johannesburg Social Welfare Department has grown so much since it was started that we have had to acquire adjoining ground to enable us to increase our accommodation. Some of the activities that we and the State co-ordinate in and do is the distribution of butter, eggs and other commodities and investigating cases of people requiring help, often immediate help. I would like to give an illustration of one case which came to my own observation, where a soldier had left a wife and children. They were left without food or care. It was brought to my notice and I telephoned to the Welfare Department and within one hour we had that wife and her children under the care of the Department, who were able to provide food and shelter. Another thing we have is a training centre for the working classes where we teach them to do sewing and the repairing of different articles, and to sell them, thereby augmenting their small earnings. We have a number of nursery schools which are becoming very popular nowadays and something very much needed for the children. Another aspect of our activities is the crèches. In the whole of the Transvaal we have only seven non-European and 15 European crèches. I am quite sure that in Johannesburg with its large native population alone we can do with 15 non-European crèches. We all know that married native women are often compelled to go out to work and leave their children to the care of someone, often not too desirable, and it is very necessary that these crèches should be increased in number. I think it is very wrong of the Treasury to stultify any city’s social welfare work. It is very necessary for the municipalities to have their own social welfare departments and to co-ordinate their work with that of the Union Department of Social Welfare. I hope that the Minister will see his way clear to see that the municipalities are not hampered but helped in their social welfare work.

We feel very sorry for the Minister of Welfare and Demobilisation on account of the flogging he has had for two days on this vote. We now want to begin with a new whip.

If you were really sorry for him you would now let the vote go through.

I said that there is another flogging we want to start with.

Well, move.

I move—

Agreed to.

House Resumed:

The CHAIRMAN reported progress and asked leave to sit again; House to resume in Committee on 5th May.