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NOTES FROM SOUTH AFRICA.

(FROM OUR OWN CORRESPONDENT.)

The Parliamentary Session.THE first session of the first Parliament of the Union of

South Africa ended on April 25th. The work accomplishedduring the session has been of a disappointing character

generally, and remarkably little has been done towards con-solidating and bringing into line the divergent laws in forcein the different provinces of the Union. It was hoped thatamongst the first measures to be submitted by the Govern-ment to Parliament would have been an Act dealing withpublic health ; instead, however, of a comprehensivemeasure to deal with this important subject being broughtforward, an Act was introduced merely vesting in theMinister of the Interior the powers, duties, and functions ofthe medical officers of health of the former colonies. It istrue that it contemplated the appointment of a medical officerof health for the Union and of assistants, but the duties of theseofficers were merely to advise the Minister, and to performsuch services as might be assigned by him to them. Moreover,General Smuts, in introducing the measure, made it clear,in spite of his former promise, that he did not believe in thenecessity for a separate department being established todeal with public health, and that he considered the medicalofficer of health should not be the administrative officer incharge of public health. Largely owing to representationsmade by the different medical societies the measure metwith a hostile reception in Parliament, and consequently waspermitted to drop further and further down the order paper,and was one of the numerous measures abandoned whenParliament rose. Yet although the Government pleaded thatit had not had the time to prepare comprehensive publichealth legislation for the Union a satisfactory measure wasbrought forward, and after prolonged discussion finallypassed, dealing with diseases of stock. Weeks were

wasted in considering a Bill to provide for the union of theDutch Reformed Churches in the four provinces and othercomparatively petty measures. The only legislation passedof much interest to the profession was the Anatomy Bill,which was rushed through at the end of the session withoutdiscussion and practically without alteration.

Miners’ Phthisis Bill.

Early in March a Bill to provide for compensation to minerscontracting tuberculosis was introduced by the Minister forthe Interior. General Smuts, in bringing forward themeasure, stated that it contained principles to the carryingthrough of which the Government was pledged. Miners’

phthisis was to be dealt with as an occupational disease,and compensation was to be paid to any miner who contractedit. As the late Transvaal Government had failed to insist

upon adequate preventive measures the State was to defrayone-half of any compensation paid to a miner who hadminers’ phthisis and claimed compensation within two yearsafter the passing of the Act; the remainder was to be paidby the mine-owners. General Smuts stated that hehad considered very carefully the question of establishinga fund and of the miners contributing to such fund, but hehad rejected the idea on grounds both of principle and ofexpediency-of principle because, as he pointed out, thedisease was an occupational disease, and as such should bedealt with in the manner that accidents were dealt withunder Workmen’s Compensation Acts, and of expediencyowing to numerous obvious objections. Inter alia, GeneralSmuts stated that he defied any member of the House, be heever so learned in figures or economics, to frame a schemeby which he could establish any satisfactory fund for com-pensating miners contracting phthisis. He had gone intothe matter and had found it quite impracticable ; moreover,his object was to abolish miners’ phthisis, and if a fundwere to be established to which miners were required tocontribute he considered that mine-owners and the minersthemselves would come to regard the disease as a necessaryevil and as one that was not preventable. He expressed hisemphatic conviction that if the Bill as introduced became lawmine-owners would be compelled to place the mines in asanitary condition and to insist upon proper precautions beingtaken; while by providing that if a miner- were convictedof a breach of the regulations on three separate occasions he

would lose all right to any compensation that might other-wise become payable, he thought that the miners themselveswould be forced in their own interests to observe the regula-tions. In spite of the brilliant speech of the Minister, theBill was received very unkindly by Parliament, and criticismcame freely from all sides of the House. The financial

experts, led by the Right Hon. J. X. Merriman, pulled theBill to pieces; the medical members indicated to an

interested House the medical objections to the Bill as

drafted, and, with the exception of the Labour members,hardly a speaker expressed approval of the proposals. Themeasure was temporarily dropped, and it was not until themiddle of April that the second reading was proceeded with.Meanwhile, the Minister brought forward certain radicalamendments which entirely altered the position. Theseamendments purported to establish a fund to which minerswere to be compelled to contribute. General Smuts ignoredhis former contention, and frankly admitted that the reasonfor his change of front was because he could see no hope ofgetting the measure through the House in its original form.Again the measure came in for a storm of criticism, andon the motion for the House to go into committee a debateensued which lasted over several days. No sooner, however,was the House in committee than the Minister found thatMinisterialists and the Opposition alike were determined thatthe measure should be further altered, and it was accordinglywithdrawn by the Government. A few days later GeneralSmuts introduced a new Bill to deal with the matter, pro-viding for the establishment of a board to administer a fundto which the Government was to contribute £ 25,000 andthe mines an equal amount. General Smuts, in speakingon the second reading of this Bill, admitted that theGovernment had been trying to deal with a subject onwhich it had not complete information, and asked the

indulgence of the House to pass the new measure, whichwould enable relief to be afforded to urgent cases, andduring the year the board would, after the medical examina-tion of all miners had been carried out, be in a position toadvise the Government as to the exact prevalence of thedisease. A clause in the Bill empowers the board to havemedical examinations carried out, and it is also providedthat any miner who refuses to be examined will not beentitled to claim compensation. This Bill was somewhatreluctantly accepted by the House and was passed by theSenate without amendment. The vacillation of the Govern-ment in dealing with this question has alienated a consider-able section of its supporters, and General Smuts has notenhanced his reputation. If only he would be guided by themedical profession when dealing with medical subjects hewould make an admirable Minister of Public Health, for ofhis ability and capacity for work there can be no question.

Labour -Recruiting.Amongst the Government measures which have been passed

during the session is a Bill to regulate the recruiting ofnatives within the Union. This measure is on the whole anadmirable one, and will effectually check many abuses whichhave hitherto been prevalent. It has, however, one seriousdefect, in that it does not provide for the medical examina-tion of native labourers before they are sent away fromtheir districts. An amendment to provide for this was

proposed by a lay member, but was not rece’ved sym-pathetically by the Minister in charge of the Bill andwas eventually withdrawn. Had the medical Members

pressed for the amendment there is no doubt that it wouldhave been accepted. The medical examination of labourerson the recruiting grounds would appear to be essentialunder existing conditions. The work and conditions oflife on the mines are mainly responsible for the alarmingspread of certain diseases amongst the native races ofSouth Africa. Surely it would be one of the most practicalsteps that could be taken to provide that all labourers,before leaving their districts with recruiting agents, shouldbe examined by the Government medical officers-the districtsurgeons-with a view to ensuring that only the physicallyfit are recruited. It may be urged that the labourers areexamined by the mine medical officers on arrival at theirdestinations, but on the mines a labourer is medicallyexamined from the point of view more as to his capacityfor work than as to his freedom from disease. It is to be

hoped that this matter will again receive the attention of thelegislature.

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Baoteraologioal Research Laboratory for Sù1dh AfricaIt is understood that the Chamber of Mines is about to

hand over to the Government a sum of <E40,000 for theerection and equipment of a central laboratory at

Johannesburg for the carrying out of research work intohuman diseases, on the understanding that the Governmentwill maintain the same in a suitable manner. The Govern-ment will, no doubt, readily agree, as the need for such aninstitution has been recognised for many years.

Medioal Men and the Lay Press.There is an unfortunate tendency in South Africa on the

part of many medical men to use the lay press irregularlyfor the purposes of self-advertisement. One cannot but bestruck by the frequency with which newspaper announce-ments appear recording the arrival or departure of practi-tioners and a statement of their professional work or attain-ments. Reports of interviews with practitioners in whichtheir names appear as advancing opinions on diseases inwhich they are interested or on medical matters generally ofinterest to the public are not uncommon. The MedicalCouncils of the different provinces have endeavoured to

suppress these unfortunate practices, and with a fairmeasure ef success. It is by no means easy to do so com-pletely, however, as the arrival of a new practitioner in acountry village in South Africa is a matter of interest to thereaders of the local paper, and if a glowing account of sucha practitioner’s professional career does appear in the localpaper it is quite likely that the practitioner had no sharein publishing the article. Recently the whole subjectagain came before a meeting of the Transvaal MedicalCouncil, when the executive committee of the councilasked the council to record definitely their opinion thatthe practice is unprofessional and its authors liable tothe penalties of the Medical and Pharmacy Ordinance.The resolution drafted by the executive committee was basedupon an opinion obtained from the law officers of the Crown,but the council regarded it as too sweeping and referred it toa committee for modification. The profession is hoping thatthe Government may be induced to bring in a Medical andPharmacy Act for the whole Union next session, so as toestablish one Medical Council for South Africa. Many of therulings of the different Medical Councils are not in completeagreement, and therefore legislation to place all practitionerson the same footing is required. Moreover, there should beone law relating to the registration of practitioners, for thesale of poisons, and the like. At present the fee for registra-tion varies in the different provinces, and a medical manregistered in the one province is not permitted to practise inanother without registering also in accordance with the lawof that province. A draft Act approved by the differentMedical Councils was actually prepared and lodged with theGovernment some months ago, but nothing further has beenheard of it. The principles contained in that draft havenot yet been disclosed to the profession.

Death of a Well-kno7vn South African Practationer.On April 22nd a well-known practitioner in South Africa

met his death under unusually sad circumstances. Mr. H. L.Walcott settled in Cape Colony in 1880 and was for manyyears in practice at Oudtshoorn. About six years ago hewent to Vryburg, in Bechuanaland, and on the death ofDr. Nagent was appointed district surgeon and railwaymedical officer. On April 22nd, while on a holiday trip toCape Town, he was found in his room dead, and an inquestrevealed the cause of death as acute heart failure. Mr.Walcott leaves a wife and a young family. A memorialservice was held at Vryburg, which was largely attended bypatients and by the heads of the various Civil Service depart-ments and members of the Cape Mounted Police. Mr.Walcott was a sound practitioner with many sterlingqualities, which endeared him to a host of patients andfriends.May 2nd.

BELFAST OPHTHALMIC INSTITUTION.-Themedical report submitted at the recent annual meeting ofthis charity showed that during 1910 in the extern depart-ment there had been treated 1728 new eye cases and 1000patients suffering from diseases of the ear, nose, and throat,while in the wards 146 more serious cases were received.

IFinancially, the treasurer said they would require an additionalZ60 annually to keep them entirely free from debt. J

THE GENERAL MEDICAL COUNCIL.THE ACTION OF THE COUNCIL IN RELATION TO

THE NATIONAL INSURANCE BILL.

The PRESIDENT of the General Medical Council, at themeeting on Monday, May 29th, submitted to the Council thereport of the National Insurance Bill Committee, which wasin the following terms :-The committee has considered the National Insurance Bill now

before Parliament in so far as its proposals relate to the provision of" medical benefit" for a very large proportion of the population. TheCouncil, in the exercise of its statutory functions, has necessarilybecome familiar with the conditions under which medical practice hashitherto been carried on in this country. Having regard to these con-ditions, it has in the public interest endeavoured, both by educationaland by disciplinary methods, "to secure the maintenance of suchstandard of proficieucy" as shall sufficiently guarantee, on the part ofregistered practitioners, "the possession of the knowledge and skillrequisite for the efficient practice of medicine, surgery, and midwifery"(Medical Act, 1886’. The Council cannot fail to recognise that under theorganised system proposed in the Bill the existing conditions will beprofoundly altered. The alterations will affect the relations of themajority of the members of the profession to the State and to thepublic. The manner in which they conduct their practice will inimportant respects be controlled by new authorities, which need notpossess any professional character or experience, and which are notrestrained from imposing conditions that are inconsistent with profes-sional efficiency and freedom. The voluntary hospitals and othercharitable institutions, which are now largely supported by thecontri-butions of both employers and employed, have hitherto afforded thoseopportunities for clinical study that are indispensable for efficientmedical education. There is danger that, under the new conditions,the resources of these institutions will be diminished and theirusefulness for this purpose impaired. Changes, whose full effectit is impossible to forecast, will take place in the sanitary andpreventive departments of public health administration.As a result of these and other consequences of the legislation pro-

posed it may well happen that the prospects and attractions of medicineas a professional career will be so far depreciated that the numbers whoenter upon it will no longer be sufficient for the necessities of thecountry. Already the steady decline in the number annually admittedto the Medical Register, which has fallen from an average of 1455 duringthe period 1891-95 to an average of 1117 during the period 1906-10, givescause for some misgiving. Any considerable reduction below thepresent rate of supply would be of serious import to the public.For these reasons, which specially concern the General Council of

Medical Education and Registration of the United Kingdom, the com-mittee think it highly expedient that steps should be taken to impressupon the Government the necessity of introducing into the Bill suchamendments and additions as will safeguard the important interests inquestion. In particular, the committee desires the support of theCouncil in making representations to the following effect :-

1. That (a) the Insurance Commission, (b) the Advisory Committee,(c) every Local Health Committee, should include members who areduly qualified medical practitioners.

2. That "medical benefit" and "maternity benefit" should beadministered by the local health committees, and not by "approvedsocieties." "

3. That in respect of the administration of "medical benefit," the" arrangements with duly qualified medical practitioners " made by thelocal health committees should be such as to admit of free choice of themedical practitioner on the part of the insured person; and that inrespect of the administration of "maternity benefit" the like freechoice of the medical practitioner or midwife on the part of the personreceiving " maternity benefit" should be admitted.

4. That in respect of the grant of subscriptions and donations tohospitals and other charitable institutions, contemplated in Clause 17of the Bill, the governing conditions should be assimilated to those setforth in Clause 15 (1) with regard to the administration of " sanatoriumbenefit."

5. That in respect of the provision to be made for "the supply ofproper and sufficient drugs and medicines" under Clause 14 (2). thesupply of proper surgical dressings and appliances should be included;and further, that steps should be taken to ensure that the drugs andmedicines are of the standard required by the British Pharmacopoeia,and that the dispensing of prescriptions is carried out by qualifiedpersons.

6. That medical benefit" should include provision for consultationsand for operations when these are necessary.

7. That, in the case of an insured woman, it should be made clearthat sickness benefit "accrues in addition to "maternity benefit"; andfurther, that in cases attended by a midwife the local health committeeis empowered to pay for the attendance of a medical practitioner,should such attendance be called for by the midwife in accordance withthe rules governing her practice.

8. That in Clause 59 (7), applicable to Ireland, it should be madeclear that "deposit contributors" are not limited in their choice ofmedical practitioners to the medical officers of health for dispensarydistricts.

The report was received and entered upon the minutes.The PRESIDENT moved that the following recommendation

of the committee be adopted as the finding of the Council :-That the Council instruct the committee to press upon the Govern"

ment the importance of amending the National Insurance Bill in thesense of the suggestions contained in this report, and to make repre-sentations on such other matters relevant thereto as may arise whilethe Bill is under the consideration of Parliament.

He said that the points dealt with in the report werewithin the province of the Council, and it was incumbentupon it to see that the Government was duly impressed