A3 114.29rv

Urban i.re&3:-liip.st London. G-rafremstomi.

.rort Elizabeth.. Durban.

Covering ir'ages 5456 to 65£6«

j ast London Sitting* 18. j. 19.51.Mr. 0. A. Lloyd. Superintendent Municipal Locations,

says the large deathrate among infants is to be attributed, to a considerable extent, to the improper nursing of children.

(Page 5464.)

He says, apart from tuberculosis cases, infantile mortality, the deathrate oannot be complained of. The site on whioh the locations are situated is well u*ained and should be healthy.. The infantile mortality rate has, at one time per­haps, been over-estimated. The position is much improved.Still the mortality is large, death being aue to acute bron­chitis up to one year of age, with diarrhoea and enteritis responsible for a large number up to two years.

With the exception of 20 pails, which are removed twice weekly, the sanitary system, consisting of water-borne sewerage, removal of rubbish ana refuse, is effected twice weekly from each house anu from the public bins situated on the outskirts of tne locations. The streets and surroundings are cleaned up daily.

A bureau for the attention of children under the Ohilu Welfare is available. No organised meuical service had yet been arranges. A dispensary was about to be built, and was to come under the kedical Officer of Health.

The only infectious cases that might be regarded as serious are tuberculosis, occasionally a typhus fever case (usually importeu), with a periodical case of enterio.

The sewerage goes directly to the sea, and the water supply ana sanitation arrangements are quite satisfactory.

There is a large percentage of illegitimate births, consequently there are numerous mothers and children without support, which affects the wellbeing of the child and often is the flause of its death. (Page 5471/S.)

Mr. Lloyd says there is a good deal of venereal disease in the location. He oannoc give the percentage which will have to be obtained from the iieaical Officer of Health, but he knows there is a good deal of it. * (Page 5496.)

There is child welfare work in the location, and there are nurses on tne ilast Bank. The objects of the ohild welfare work are to teach the mothers how to bring up their children, and assist them where possible with a little food, nourishment and things of that sort. It is run by the Child Life Protection Association, this Association is European, and Mr. Lloyd does not think Natives participate at all. The nurses ere Natives, and are municipally paid. There is a third nurse, but she does not ao too much in connection with child welfare, her work is more attending at the hospital where the Native outpatients from the locations are seen. He does not think Natives have been asked to teke part in the work of the Association.

He thinks provision is made for a Native section in tne new hosi/ital. 5 500/1. )

Mr. Lloyd, does not consider that as far as Bast London is concerned, the physique of the town Natives is much inferior to that of the outsiae Natives. The Natives born there are just as svraray as those coming from the Transkei or elsewhere. One only need walk rouna the locations and see the/sturdy young girls growing up there. It is really remarkable, one will not find weeuy ohiloren and that sort of thing. These young girls are

«&9- fine

fine, robust healthy children, and so are the boys. They must undoubtedly be well fed. He is quite sure that there is no dif­ference in the physique of the town Native and the country Native extraordinary though it may seem. (Pa e 550.3.)

A Statement from che Public Health Department, of the Municipality of the City of Hast London, is includes in this box. This Statement is of a general nature ana covers a very wide are?.

It says that hospital attention is feee, also medical attention for seriously ill. The majority of the sick, ho.ever, rely on Native practitioners (unqualified.) (Page 3/4.)

Sanitary arrangements are referreu to in general terms in the Statement•

Under Uhild Welfare it appears that there are:-East Bank Area (East London Child Life.)y/est " " (Public Health Department.)Both. (Venereal Diseases Clinic - Municipal.)

Unuer Medioal Service it seems a dispensary was being built, and a, Doctor {-would be appointea during the year, to work under the direction of the edical Officer of Her1th.

There were three Native Health Visitors.(Pase 6.)

Erst London Sitting. 1S>. 3. 1951.i*r. R. H. Godlo. representing the East Bank Location

Advisory Board, says the Natives do not likfc the rondcvels on the West Bank, because they say they are not healthy, owing to the amount of conorete, they are too coibd in winter and too hot in summer. (Page 5577.)

Mr. C. Kadalie. representing the Independent Industrial and Commercial Workers’ Union of South Africa, speaks about me­dical treatment for farm labourers. He says in the majority of oases Native farm labourers suffer death because of the dire lack of meaical treatment through the stupidity of the position set up by the State in not mr.-ang proper provisions for adequate meaical service whenever desirable. He quotes Dr. Talbot, Bishop of Pretoria who had saiA. "Many of Is in South Africa have been "content to come here among the Natives and not bpther ourselves "about whether they are sick or poor or how they live or how "they die, but this attitude is unsound, even from a purely "business point of view. I think there is a kind of insanity "in South Africa that we waste so much Native life. Because of "the sheer laCit of reasonable meaical services, the mortality is "terrific.” Mr. Kadalie says this is the state of affairs exist­ing in the country with regard to meaicrl services end they ap­peal to the Commission to consider the necessity of establishing medical aepots for the large number of Native families serving on farms. (Page 55i.j . )

East London pitting. 20. j. 1 ^1.Mr. (j. LI. Lister. District Commandant, South African

Police, East London, says he thinks there is a lot of truth in the Statement of the Medical Officer of Health, that more than half of the Nrtive births are illegitimate. He cannot vouch for the figures but he thinks that there is a number of young women carrying their children about. (Pitee 5655.)

- 100-

lux. Lister, giving the figures of Police oases reported from the East Bank Location during 1930, includes one case of child stealing, and six of cruelty to and neglect of ohildren.

From the West Bank Location there were five cases under the Children Projection Act* (lances 5660/1.)

I>r. .V. B. Rubusana. Congregational minister, East London, dealing with conditions of Eative life in Urban areas, refers, inter alia, to unhygienic housing, unsatisfactory sani­tation, the absence of any form of recreation, and the want of provision for the treatment of diseases, and says these have increased the percentage of mortality among Eative adults and children.

He says that in the seaport of East London, sanita­tion services in the City are second to none ana the drainage system leaves nothing to be desired, the City^locations are the only places where these sanitation conveniences are not to be founder He also refers to the public l8trines in the locetion which are a menace to health. (Page 5567/8.)

Questioned with regard tp the infant mortality Lr. Hubusana says there is no reason to disbelieve the statement that of every five children born two die under the age of one year in his opinion what is wrong is the deeding of these children.He uces not think that the number of illegitimate children is so high as two out of every three births. (rage 5682/3.)

iilr. J. B. Cummins, referring to the deathrate and disease in the Location, says very ofteh children are brought to him and they receive medical treatment, and then never come back again until someone comes for a death certificate. In almost all these oases the children ere illegitimate and he does not thjfink the statement is much exaggerated that bbfo of the children born in the location are illegitimate. One of the principal reasons why so many children die is that nobody cares. In a great many instances the mothers do not care and in many instances the fathers do not care; they will not sujjply the money to procure medical treatment. He thinks it is possible that two ohildren out of every five may die, he does not think that statement is e great exaggeration. This is the figure over the whole population, not only over the illegitimate chil­dren. He aoes not say most of the illegitimate children that are born die, but the majority of the children that die under the age of one year, are ilxegitimate.

Mr. Gumming thinks that the natives have more or less settled, aown to the idea tnat a l8rge number of children is born to die. They do not appreciate that there is such e tremendous proportion as two out of «very five, there are child burials every day. He does not think that the Natives register all their births, so tnat the birth figure would be an understatement, and to that extent the infantile mortality rate might be an overstatement. A number of ohildren whose births are not regis­tered in East London might aie there. (PEKe 5695/5.)

With regard to diseases in the Location, the pre­valence of tuberculosis is very serious; there are a great many cases of tuberculosis in the location and, of course, it is a danger to the town. These people are in service and, in many cases, they ere nursing children end they are suffering from tuberculosis of the luhgs at the time. In many cases they get the infection from lung-sick cattle - by eating them end by drinking the milk. He cannot mention a specific case.

-1 0 1 -

He suspects that on account of the European experience*Mr. Cumming gays the Municipality hes spent a lot

of money in providing houses for the Natives, “but there are still most undesirable dwellings, and he does not think the local authorities oen possibly carry out the regulation as to overcrowding.

The sanitation of the location has very much im­proved, the conveniences are possibly rather far apart, but the Hatives are very careless in their use. This refers to tne new location, there does not appear to be much sanitation in the old location* (Pase 5693/6.)

Grrahamstown Sitting. 23. 3. 1931.Dr. F. A. Saunders, prior to giving evidence, puts in

a Statement. On the subject of sanitation he says that in the looations it is altogether inadequate,- there are all too few latrines provided for the number of;lpeople, and such as are provided are far from efficient and savoury. He had noticed several some weeks previously (in December) without doors snd that right on a public roadway. The pail system was employed but the uails were not changed sufficiently frequently, the odour was revolting and the flies a pest. On account of the absence of domestic latrines conditions around the houses were very bad, and it is in tnis manner that such diseases as Dysentery and Typhoid fever are spreed*

It was a matter of the most urgent importance that there should be some provision made for the segregation, in comfortable surroundings of persons suffering from such dis­eases as Tuberculosis, Plague and Small-pox. At the time there were no facilities for this - the infectea person must lie in his or her miserable hovel, surroundeu by his or her fellows, possibly in the same apartment as the household food and water.He instances a case whioh had recently caught his attention, of a man dying from Tuberculosis, expectorating on the mud floor of a miserable hut in which slept his wife and two chil­dren, and next to the room in which stood the family supplies of -e- food. In such circumstances it is impossible to eradicate the menace of Tuberculosis.

Dr. Saunders recommends a general re-organisation of the housing of the locations,- there should be provided either adequate domestic latrines on the pail system, or better still a number of oentrally-placed communal closets operated on the water-borne-sewage system.

Proper drains should be provided in the streets for the carrying off of domestic water.

Well covered refuse bins for household debris should be provided for a selectea number of houses. These bins should be emptied several times per week and the refuse incinerated.

iinpty tin s, broken bottles and other articles holding water and likely to serve as breeding sites for mosquitoes eto. should not be allowed to lie about but should be thrown into the garbage pits. This would reauce the risk of the spread of Malaria aj.d otner tropical diseases.

The water supply to the locations was not sufficient, there were several so-callea "cent»el tanks" supplied but these were neither truily convenient, nor were they filled sufficiently often. There should also be provided water receivers that would be covered and periodically inspected. The tanks likewise should be cleaned.

Daily street defining should be carried out, and quarters should be inspected to see that proper rubbish receptacles are kept, and that material is not left to rot in the open eir*

When and where meat is disposed of in the locations, there should be proper facilities for protecting the food from pollution, especially flies; frequent inspections should be made

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l)v ooixiijofc out# offiodr#In the case of death, there should be a reoognisedprocedure for the removal, rapidly, kyx of the corps®; where necessary, corpses should be removed to a properly built mor­tuary to await such examination as may be requisite. . . . . .

Infectious and contagious diseases should be notified bv the responsible Medioal Officer, end adequate precautions against spread of the disease taken; prophylactio treatment against Typhoia Fever; delousing, ana vaccination agsmsljbmall- pox being efficiently done; Natives living in contact or in proxi­mity to such cases should be instructed as to their behaviour, and a house provided for "contacts" in Cerebro-spinal Meningitis and other infectious diseases, properly guarded.

A simply explained account of the advantages to De derived from the observance of the elements of sanitation and hygiene, should be printed for the guidance of all teachers and all Natives able to read. Teachers and others in authorityshould be encouraged to explain the basis of sanitation to their pupils. The older persons should receive such instruction, either through tne location inspector, missionaries, or others capable of giving it. In Tanganyika Territory the teaching of elementary sanitation to the Native teachers, and their impart­ing it to their pupils, is having a beneficial effect upon the Native compounds and villages.

Dr. Saunders suggests that Municipal and other autho­rities - Churches, Missionary Societies, Native Welfare Socie­ties - could do much good by offering prizes as well as lucid instruction.

Advice should be given on Diet - the value of vita­mins, orange juice, fats, milk; the danger of white bread and polishea rice, ana irellagra, Scurvy, Beri-beri ana causes ejfc- plainea.

He urges the appointment of several intelligent Na­tive "boys" who rpight be trained in elementary sanitary work; these boys would from day to day inspect public ways, domes­tic grounds and the like, would see that the water-supply is kept from pollution, and generally report to the Inspector upon all matters connectea with the sanitation of the locations.That Native boys could be trained to do this very satisfactori­ly is evident from the success that is being obtained in iiast Africa. (From Pages

9/l2 of State­ment .)

Referring to the Mortality among Adults and Children Dr. Saunders says it is not surprising, in the circumstance* in which they live, tnet it is high.

He gives the following figures for Grahamstown.

EUROPEANS. NON4.SU ROPEAtlS .Year ended Deaths under Deaths under30 June. Births 12 months. Births 12 months.

1927 211 11 676 2091928 201 14 660 2201929 186 5 644 1751930 226 10 662 176

He gives the following striking figures for Infant Mortality per 1,000 under the age of twelve months:-

- 10 3-

Year. Europeans. Coloured. Natives

1923. 76.6 227.91924 39.41 159.71925 79.6 314.51926 86.9 193.51927 52.1 298.7 312.21928 64.68 265.3 325.91929 26.9 281.8 268.81930 44.2 169.6 299.4

These figures are from official sources.The following statement by Professor. V7.M. MacMillan,

(Complex South Africa) is quited:-"as long ago as 1916 I examined the birth and death

"registrations in the pleasant and quite normal city of Gra- "hamstown, demonstrating (to the satisfaction of a challenger •‘who checked my results) that in the twelve preceding years "the average infantile mortality was tt 1 in 3, over 333 per "1,000,births exceeding the total of deaths in only two of the "twelve years. About the same time East London made a return "for quite an ordinary year of over 400. Johannesburg, for "reasons of sex-distribution already suggested, may fee rather "sbnormal, with an even higher proportion tnan usu8l of "un- "wanted" illegitimates. But there, in 1922/3 and 1923/4 the "infantile death-rate was 'enormously high,’ 571.12 end 565.12 "respectively."

Dr. Saunders' Statement continues es followe:-"Perhaps the fact that there is but one ’hospital bed'

"to every 2,231 l*on-Europeans in the Union, may enable us to "understand more readily why the Native mortality should be "so high* It is authoritatively stated (Memo. 7, p. 11, "Johannesburg Joi£t Council of Europeans and natives) that to "one hospital beu there are 334 Europeans - the standard in "’civilise*' countries being one bed per 200 of population.

"Inaeed, the more the lack of medical facilities is "considered, the more is it realised that South Africa is in- "finitely behind the Colonial Office in her Kative-medical "policy. In East Africa, for example, the medical and hospi­tal facilities grantea even the tribesmen in far flung por- "tionsof the country are excellent. In Tanganyika Territory, "which has not been tinder British rule more than ten years,"the Colonial Office already has built up a large and effi­cient Medical Department, one of the prime functions of "which is to extend the blessings of European healing to the "Natives. In each district of any importance there is a "fully qualified Medical Offioer, with usually an assistant "Medical Officer (Indian), and with a staff of trained Native "dressers and hospital hands. Travelling clinics move about "freely in the remotest portions of the country. How different "a state of affairs from that obtaining in South ifrical In "the country Natives are expected to pay for the majority of "the medicines supplied them - these often being purchased "through chemists a.d druggists without any special knowledge "of human medical treatment. The upshot of this national "neglect - and no softer term adequately conveys the truth - "is that we are not only breeuing disaffection for the European "but also are unwittingly assisting!in the development of "disease. Unfortunately there sre indications, too, of a "spreading among Europeans of that insane complex of callousness "towards the iiative so often expressed in the phrase: 'the "'more Natives that die the lesser the risk of a Native "'dominance.'

-104- "Retional

"Rational lines to follow in an attempt to decrease "the adult and infantile mortality are the following:-

"(a) Provision of better hospital facilities for ^etives; "accommodation within such a hospital should either be entirely "free, or in the instance of the better educated, better waged "Natives, granted on very low terms, at the discretion of the "Medical Officer.

"(b) Provision to each large location (e.g. those "larger than the location at Grahamstown) of a whole time "Medical Officer, whose function wotild be to deal exclusively with "the health, hygiene, sanitation of the locations, and with the "health of the Natives resident within the European township. "Naturally such an officer would have to be responsible for "natives in the township district: this could be arranged by "the appointment of Native dressers at different centres with- "in each district, these dressers being supplied with drugs "and materials for treatment of minor ailments: they would be "inspected by the Medical Officer according to programme.

"(c) Special arrangements for treatment of infantile "troubles, '.Tuberculosis, Venereal diseases (it is estimated "that at least 80 > of the Native population of the Union is "infectea - vide .Report of European-Bantu Conference, p. 118; "Lovedale, 1929.)

"(a.) Training of Native women as midwives, these "trained assistants being placed at suitable centres within "locations and within districts. A central bureau giving ad- "vice and help to Native prospective and actual mothers is "an urgent necessity for each large location. Mothers not "only require treatment, but advice as to the best maimer in "which to bring up their children; they should be taught the "elements ef cleanliness and health-coriiinonsense. In this way "alone can the mothers* superstitions, and the powers of the "traditioiial midwives (often creuited with powers of witch­craft), be overcome.

"(e) Appointment of a sanitary staff for locations:"this staff being a Motive one, working under the direction of "the Aieuical Officer, or in the absence of such an official,"the location inspector.

"(f) Provision of isolation hospitals for infectious "and contagious diseases of serious nature - e. g. advanced "Tuberculosis, rlagne and Small-pox; these hospitals to be "free to the average Native, or to extend very light, nominal "terms to the better waged classes.

"(g) Encouragement of the work of Welfare Societies "interested in the health and well-being of Native mothers and "children.

"(h) The gradual training of an African Sub-assistant- "surgeon type of medical man - for employment in Native dis­tricts end locations, under the guidance of the Medical Offi­cer. It is estimated (Report National European-Native Gonf. "Capetown, 1929; 176) that 900 medical men are needed in S. A."for the datives. For professional, ethical and business reasons "these men should receive the full training of a medical man;"these students could be trained in South Africa, e. g. at the "Universities of Capetown and Johannes ourg.

"It is to be hoped that Government will take up this "matter seriously at en early date: representations made in "1928-29 had no effect, and it is regrettable to have to record "that Government actually refused the proposal of the Carnegie "Trustees to allot a large sum for buildings to be used for "the medical training of Natives (vide Memo 7, Johannesburg "Joint Council of Europeans and Natives, p. 12.)

(Prom Pa^es 16/19 of Statement.)

Note. Included in the file is a lecture by Dr.Saunders, which has no special bearing on the subject of native health,- also a Statement of an Illustrative case of

-105- Pulmonary

Pulmonary Tuberculosis which is covered by his evidence which follows.

Dr. P. A. Saunders. Fellow of the College of Surgeons of Edinburgh, refers to the Statement which he has put in, and says that in addttion, he wishes to accentuate tne deplorable condition of tuberculosis in South Africa. He points out that there is a vicious circle, a case is discovered to be a case of tuberculosis, and the man, immediately he consults a doctor is certified as having tuberculosis ana the result is that he is immediately unable to be employed any more and it is practi­cally left for his wife and family to starve. It is a serious thing from the local point of view that these cases should go on. Dr. Saunders endeavours to get them into the local hospi­tal, but is told t at that is quite impossible, the local autnority cannot allow tubercular cases to go into the local hospital, and that the question of tuberculosis remains with the Union Government and has nothing to do with the Provincial Government. The next thing that the Missionaries or the friends of the patient attempt to ao is to apply to the Prince Albert Infirmary, and there Che uoor is shut in their faces and they are told "This is an Union business; it belongs to the Union "Government; we ere a Provincial Government; keep outside."

The next tning is,tnis man having been certified — he has perhaps been working somewhere or otner in the town and his master shoves him out because he is spitting and is a danger to the community. The next thing is he goes back home; there he lias miserable surroundings. The Government says "Your customary food is kaffir beer; you cannot drink any." Anybody who knows anything about kaffir beer knows it is one of those things - natural foods - which contain a large a- mount of vitamins which are absolutely necessary in order to build up the body, so as to be able to resist the infection of tuberculosis. They are not allowed to have this kaffir beer, although kaffir beer only contains about 3j*> of alcohol.But there is worse to follow; this man, efter a time, has only got a hut to live in, is wretchedly housed; has nowhere to spit - spits on the floor; presently it dries up; children play about the floor and the sun, having dried up these things to a certain extent, a child inhales it and becomes infected. 'There have been dozens of these cases. When tuberculosis gets into a kaffir hut the whole family is doomed, it is only a mat­ter of time, liotning is uone to help these people. One would think some provision would be made by the town authorities, the Provincial authorities or the Government, to prevent this vicious circle.

His suggestions which he had previously maue to the Government were as follows:t- The Town Council should rent a small cottage or some sort of shelter somewhere convenient to the location with facilities for removing the roof by turning a handle or tnrowing open the whole thing to the sunlight or daylight and, bjr turning another handle, enable the wall to go down. These things used to be available at home; there is no reason why we should not have them here.

In lilo when he was Medical Officer of Health he hod drawn up a plan whicn he had submitted to the Mayor of Gra­hams town, but it had been turned down by the Provincial Autho­rities who said it was a Government matter. If there were only a sort of cottage or house or special shelter erected within the vicinity of the location it would be possible to help these unfortunate people,- these men who are a menace to their wives and families. Dr. Saunders is referring to "end" cases, not commencing cases; they are not so important.

He stresses the manner in which infection is carried by nurse-giiii, or by employees in stores or buildings where tney have to handle food.

In 1^13 he had suggested that the Town Council should -106- rent

rent a cottage on the outskirts of the town arid, that a care­taker should he obtained and a suitable nurse provided. To appoint a suitable nurse is a very important thing. Any other woman who just goes to look after them is just as big a danger as the patients themselves, because she knows nothing about the importance of the care necessary in looking after tuber­cular cases.

He had made a suggestion which was very kiidly re­ceiver by the Government - that tney should allow him to hrve a small hospital to be put in the grounds adjoining tie Prince Albert Infirmary, on only the one condition, that is that the nurses woulu be kept distinct from the other nurses end would be trained in the treatment of tuberculosis esses. Although the tneu Administrator was most sympathetic ana said he would do his utmost this had to be turned down as he could not touch it because it belonged to the Union Government.

This woulu only be a temporary makeshift, if there were a hospital or infirmary to take casual cases, and it would help those lat-ies who go down to the infirmary if cases had somewhere to go, if they remain at home they are a danger to everybody.

Dr. Saunders points out that kaffir beer is an essen­tial food of the Native, the alcohol contentis The vita­mins are important in building up and strengthening ell these people; it is most important that these cases should have food enabling them to resist the disease. They are also deprived of their milk because the urban Natives have not sufficient ground upon which to keep cattle, neither can they get maize, tney have not the facilities for making bread so buy wnite bread which is uevoid of vitamins.

There is a lleaicaa Officer of Health and District Surgeon but it is impossible to attend to ell these matters.

With regard to tuberculosis, its spread in very many instances is aue to the t^hod by which milk is provided, but tha£ is a very difficult thing to prove, because, as far as he is aware, the milk that the patients themselves get in the locations is not examinee.. They get milk from their own goats and from cows, but they have hardly any, it is conspicuous by its absence.

One can see babies of two or three weeks or a month old ana the mothers unable to suckle them. They give the chil­dren flour ana water, they could do nothing more detrimental. The deathrate there is appalling, it is over 8 ., it is four times the amount of that of any town in Great Britain.

The natives have not been made immune to infection, it is virgin soil, "the result is, these Natives here have ’’only to get a chance of getting a microbe near them, and it "kills them."

Vitamins are very strong in kaffir beer, they are not found in anything else, they are so important in prevent­ing tuberculosis, Beri-beri and other things.

The deathrate there is simply a .palling, under the age of 12 months the figures are most striking. In 1930 there were 299 deaths among the Natives per thousand; that is one fifth of the population are dead in one year, (l-age 5697/COa.)

Ur. E. Ifl. Vambo stresses the need for further edu­cational facilities, and says that more than half the Native children of school-going age in that province ere not obtain­ing any school facilities whatever. (Page 5726.)

Hr. D. R. Llovcke dealing with urban Native areas says that in Port Alfred in return for rents of £1. 10. per annum for plots only, no water, lights, roads or sanitary arrangements are afforded. No medical assistance is given to

-107- cope

cope with, the ever-increasing infantile death rate.(I-age 5729.)

A Statement by the tieverend G. H, P» Jacques is included in the file. In it he says:-

"If_ there is one fiB4d which crlls urKently for co­operation that is in Jrublic Health, The mortality among "Natives in certain centres (Vide Joint Council’s Report Johan­nesburg has reached thefysnormous figure of over 900 out of "1,000. The average European mortality is somewhere In the "region of 50 per thousand. While this case quoted is an ex- "treme one, infant mortality mounts up to an alarming figure "among Natives.

"Health Societies can materially help by teaching the "home and mothercraft so readily learnt when taught by those "willing to impart it with understanding and sympathetic minds,

"Municipalities have established Health Centres In "the Locations where informed and progressive policy holds "sway. It is greatly desired that this excellent work should "be common to every community where Locations exist. Native "Nurses should be fcrcinea to attend to the ..ative Centres for "the treatment of burns, sores, ophthflmia caused by flies,"ana those minor ailments which deplete Native health so "severely in most places.

"If these Native Nurses could v/ork under, and with "a small Committee of Europeans and Natives they would increase "their effectiveness tremendously. In most towns there are "such good women workers who would guide and assist the Native "Nurse, and count it a part of the duty they owe to the com- "munity life." (Page 3 of

Statement.)

The Reverend* S. H. H. Jacoues is cross-examined on his statement and it appears that the figure of 900 deaths per 1,000 refers to infant mortality, rnd is an extreme case.

He considers that the death rate is mounting.(lJage 5739/40.)

Dr. Ella Miriam Britten, a medical practitioner, in private practice, says a lot of her work is in the locations. After ten years' work as a general practitioner in Grahamstown she can unhesitatingly testify to the appalling poverty and its attendant overcrowding and disease to be found in the Native location. The houses are badly built and many are mere hovels. There are a few decent houses belonging to the better class Natives, and the Municipality has built a few houses, but the rent of tnese is too high considering the current wages. Wages are inadequate to meet the expenses, and to make up the deficiency a Native either lets a room or rooms and crowds his own family into a quite inadequate space, or the wife has to go to service or do charring and neglect the children.

The day a Native goes off ill, his wages stop, so that illness is a real tragedy, and not only is there no money for medical aid, but sometimes not even for food, so that often a doctor is not sent for until it is too late.

Diet at the best is poor - bread, mealies, beans and a little meat, that is, very little proteid and vitamins.Little children are the chief sufferers here, especially in the critical year that follows weaning. Infant mortality is high - in 1930 it was 299 per 1,000 - and mortality in the second year is also high. It is difficult to get the exact figures for the second year, but Dr. Britten does not think

-106- that

that more tnan three out of five babies born reach thejlthird year. Dental Caries, almost unknown among children in the Territories, is common and the resisting powers to disease are low,

Kaffir beer, which would supply the vitamins defi­ciency is prohibited, but Gape brandy always finds its way to the location and, where food is scarce and legitimate amuse­ment almost nil, alcohol is an attractive way of escape from difficult conditions.

Tuberculosis is common ana there is no attempt made to control it, and cases in the last stages of this disease are often found sleeping in an unventilated room withihalf a dozen other people. At the time there was a great deal of unemployment, especially among the men.

Regarding tuberculosis, Dr. Britten could verify what Dr. Saunaers had said; there were no means whatever for treat­ing it; there was the difficulty in the location that the men go away to work and as soon as they have any trouble they re­turn there, so that the tuberculosis rate seems high* Men go to Port Elizabeth or to Johannesburg and the moment they are not well they come back to their home, into a hut which is al- reaay very overcrowaed, ana settle down end spread tne disease.

Another trouble with low wages is that the illegitimate rate increases. The lobolo system is such that the men have tP P&y so many cattle, and with low wages they are not able to do so; the girl has a baby, the man is not legally tied to her and he removes himself. Dr. Britten finds quite a number of women in the location have a series of illegitimate babies and it is very aifficult to deal with these cases. She thinks, in the few years she has been there, the illegitimate rate has definitely increased. (Page 5741,4.)

Mrs. Olive Cuvier ■ ylme says:-"Unaer paragraph 4 of Section 7, I see that infor­

mation is sought about "Inuistrial ana other aiseeses and "provision for their treatment". As a voluntary worker in "the Grahamstown locations, under the Child Welfare Society, "one of my duties is to discover and keep in sight children "who are suffering from malnutrition and starvation. Now, "there are very many starving children in this location and "the chief, anu. almost the sole cause of these sad cases "is illness in both or one of the parents who are thus pre­sented from supporting their families. Mow, in sn over­whelming majority of cases, this illness is pulmonary tu­berculosis and one is simply appalled by the prevalence of "this disease for which there is no provision or treatment "whatsoever.

"The regulations of our hospital prohibit the admis- "sion of sucn cases, with the result that men and women and "sometimes young children lie dying for months in overcrowded "one-roomed huts. During the last few months of life, these "oases have constant haemorrhages ana the consequent spread "of the infection is dreadful to contemplate. In such cases "it is a common occurrence to find these dying people"sleeping in a room with five or six children and sharing "blankets with them.

"The food is kept in the same room."The following oases, all of which have come under

"my notice during the last six months, are typical examples "of tne conditions which I have attempted to describe.

"October 1930. Annie Ntshana - at 12 S. Street, a "woman in the last stages of consumption was lying on the "floor with practically no beuding. The weather was cold."The husband (too ill to work) and four children, were sharing "this woman’s scanty blankets. Another child had aied four "days before I visited the house and the woman died two days

-10S later

"later. There was no food in the house."December 19,50. Nofaite Ngani - 25 1 Street. An

"old men in the last stages of consumption. So ill that wife "cannot leave him to go ana work. The wife ana five children "all sleep in contact with the patient. Another baby "expecteu shortly. These people are kept alive by rations "from the Magistrate. The house is swarming with flies "and the patient expectorating on the floor,

"January 19.31. Tom Ngeleza - 28, R. Street, iin old "man of 70 has had Tuberculosis for 11 years. His third "wife, a young woman, was compelled, under Native custom to "marry him about seven years ago. By this wife he has four "ohilcLren, whom he will never be able to support.

"Now, my object In quoting these individual oases, of "which there are many more, is to bring to the notice of the "Commission, the need of sanatorium treatment for such cases "as these.

"To the lay mind, it would not seem an impossible "venture for some sort of primitive open-air hospital to be "constructed in every municipal location - a place where these "people could lie in bed in the open air, be visited by their "friends, but be so segregated from their families as to "prevent the appalling spread of this disease. Naither "the construction nor the staffing of such sanatoria as I "suggest would be heavy, one European or Native Nurse could "look after very many beas, for these is little nursing to "be aone. With even slightly better food and fresh air,"many of these cases might recover, but even if they all "uied, the greatest problem of all would still be met, for "the spread of the uisease would be arrested.

"In conclusion, I woula suggest to the Commission "that a proportion of the general tax aolleoted in eeoh "municipal location be returnable to that municipality for the "purpose of erecting a consumptive sanatorium if that munici- "pality so desire."

Mrs. My line uoes not know whether there is a higher inciaence of the disease there, or whether the people are more alive to it. She says she woula like to contradict Dr. Saunders who attributed the high Native mortality to tuberculosis; it is not due to tuberculosis. She works in the location for the Child Welfare Society. They have epiaemics of diarrhoea; they always have uiarrhoea with them; they have flies; they get epiaemics of whooping cough ana measles and then the babies get pneumonia ana aie; they lose a tremendous number like that. They have the tuberculosis. The ohilaren do not get enough food ana they they contract other diseases and aie.

She believes the births that take place in the location have to be regularly registered, but is not in a position to say whethar they are. She thinks the Natives know that they have to bo registerea. The moment the babies are really bad they rush off to a doctor to diagnose the illness so as to save them trouble at the end - just to say what it is so that there is no inquest. The Chila Welfare Society pays the salaries of two Native Nurses who work in that location.The Society cannot affora it, one member of the Society generously guarantees the salary of the second Nurse, and when** ever the Society is short he pays.

She thinks they Municipality has to pay so much to help the Society, but it does not provide any nurses.

What she would like to see, of course, is this sanatorium in the location. She does not think it possible to compel these people to go into it when they are dying, but if it wire in the location she thinks they could be compellea. She mentions a case unaer her notice atjthe time. A girl of 20 has turned consumptive, and her mother would do anything

-110- * to "

to get that girl out of the house, she ssys "I know what it means; my husband died in 1918 from the same disease and I am afraid my other children will getjit from her." She does not know what to do. She cannot take the girl sway from her job because she knows she herself cannot support the family.

Mrs. Mylme says a lot of the Natives in the loca­tion are underfed. The wages ere very low indeed and she thinks it most essential that there should be a hospital where these cases oould be put. "When Mr. Jansen cam© here, we "asked if he could not possibly help us and pay us a very "small amount of £150 a year to pay the nurses’ salaries, but "I am afraid we have not met with much success.”

There are women in all three locations. The Coloured and the others ell go to the bureau. At the time she thought the mortality was not quite so high among the Coloured as among the i.atives. She attributes that to their higher earning capacity. She has not had muchlexperienoe with the Coloured people, she deals principally with the ftstive people. The bureau - of the Child Welfare Soaiety - is for Natives and Coloured, but they are not very keen on mixing, and the work deals really with the Katives.

The Society cannot afford to pay fully qualified nurses, it has not the funds. The one is a fully qualified maternity nurse, trained at Cape Town and she is doing mostly maternity work, and excellent work. The other one had a train­ing at St. Cuthbert’s Mission, where they do not give certifi­cates; she has had quite a lot of experience. These nurses go out working every day.

The Katives in these locations under the conditions in which they live are not able to keep their mouses clean; they only get water three times a week; early in the morning they oen be seen queued up 20 in a row, waiting for water; they oannot oarry more than two petrol tins of water up the hill; if they want more they have to go back and av/ait their turn.They have not the pots and things to boil chat water.

There is a Native -affairs Committee on the Town Council, and she thinks that Committee visifci the location and meets the Natives. They are very sympathetic to the Society. The Society opens the clinic on Thursdays and deals with anything up to 30 mothers and babies a week. The previous week there had been 33 new babies on the books, so they were increasing steadily, (Page 5745/50.)

Mr. G. F. Heathcote. Medical Officer of Health, says everyone admits that tuberculosis is rife in Grahamstown, as he supposes it is in any other Hative community in South Africa. At any time he can lay his hands on any number varying from 12 to 18 known consumptives in the location; it varies from time to time. The deaths ar^round about 30 per 8nnum.The difficulty with tuberculosis is largely the fact thrt these Natives do not have a doctor until they are practically dying; the case is not known to anybody until a man is in extremis.Very often the first Mr. Heathcote hears of it as M. 0* H., in the way of notification is after the man has already died.The doctor in attendance in the last stage notifies the death of the case; so that the actual known cases in a location do not conform strictly to the amount of tuberculosis there, and the only fair test of the amount of tuberculosis is the annual aeathrate and that is, as he says, round about 30 per 1,000 which is high. That was a slip of the tongue, it is 30 total deaths, it is about 4 per 1,000. The total aeathrate is round about 50 per 1,000, that includes all deaths, infantile as well.

A lot has been said about hosjjitals and these tuber- -111- cular

tubercular cases. The procedure there was that when a oase was notified it was investigated and some attempt made at home isolation. The Council possessed a hut which was movable and which could be put up in any man’s plot where home isolation was impossible. One is at once up against a reel difficulty in all this preventive work, and that is the ignorance of the Native and his real unwillingness to leern; he will not just believe what he is told. A hut is put up for a man and he will not live in it. They are given spittoons anu are given dis­infectant and cod liver oil, but Mr. Eeathcote agrees with a good many people that the spittle usually lands on th® floor instead of in tne receptacle provided. In his own mind he quite admits that hospitals for these advancea cases is a step in the right direction; it is an educative step. He does not believe that isolating these known consumptives woulu have any lerge effect in reducing the amount of consumption among the Native people, but it w ula relieve a great deal of poverty and woulu help individual cases. It would educate a Iiative as to how a siok man ought to deport himsalf in relation to hia neighbours and family. Mr. Heathcote believes the trouble about such an isolation hospital is a very obvious one - the cases are all going to die and, once a Native knows that, the place is no longer called a hospital but a "dead house", or something to that effect. (P h k c 5750/4.)

irort Elizabeth Sitting. 24. o. lbol.

Dr. D. L. Ferguson. Medical Officer New Brighton Location, Assistant M. 0. H. for the City of Port Elizabeth, deals wicn tne question of venereal diseases, and confines his remarks, to begin with, to the new Brighton Location. He is in charge of tne venereal disease clinics in Port Slizabeth, as well as being Medical Officer at New Brighton. As fer as he can make out venereal diseases may be said to be common at New Brighton but it is impossible to say what percentage of the people are affected. Prom what he can hear of figures quoted by other authorities, it would appear to him that those figures are on the high side. They have there, as far as he can make out, about 270 new cases occurring per annum in a populrtion of approximately 8,000. He thinks that figure is high because he has no evidence that cases are concealed from him at all.He takes it that all the Natives come to him for treatment.

Many come in the initial stages, and they do so be­cause they have heard that the treatment is effective. They are very quick to learn that a treatment is effective and they are not possessed of that false shame which the European has, and, as a matter of fact, the European is more likely to conceal the disease than the Native is. He has 3een many more cases of gonorrhoea in Europeans then in Natives.Gonorrhoea in Native baby girls is very uncommon, whereas among the European baby girls it is not at all infrequent.

He says "baby girls" because that is just one of the instances of the way in which gonorrhoea is spread. Baby girls are often infected innocently with gonorrhoea and they always have under treatment several cesses of European baby girls, whereas, as far as his memory goes, he does not know of a single case of Bative baby girls getting gonorrhoea. For that reason it seems to him that gonorrhoea is less common among Natives then among Europeans, although syphilis is more common amongi|NatIves. It must be distinctly understood that there ere these differences between syphilis end gonorrhoea.It seems to him that the common hebit of mar ied Native men co-habiting with other women during the period that their wives are nursing their babies or during the period when they are pregnant, is a greet cause for the suread of the disease.

-112- It

It appears to him thet that habit is a common source of infec­tion among the families of such men. It will be found that when that man’s wife is pregnant or is nursing her baby, that man goes to another woman who is suffering from venereal dis­eases and he comes back to his own home and brings the disease to his healthy wife anu family.

Dr. Ferguson had no difficulty st all in persuading his patients at New Brighton to come for treatment which is perhaps due to the spectacular effects of the treatment of venerealjdiseases or rather syphilis. Gonorrhoea is not so effective and it takes a long time to cure, but syphilitic treatment is very spectacular now and the resii}.ts are appre­ciated by the Natives. He has had very few oases where these diseases have been deliberately concealeu.

He now comes to errors in diet, quality and quantity, which to his mind account for much 111 health. .Among a certain class of Native there is a genuine concern in this matter and an attempt is made to prevent the onset of disease. It is among the more euacsted Native people that they try to remedy this and he has evidence that they are appreciating the posi­tion ana thet they are trying to feed themselves and their families morelrationally than they have done hitherto. Of oourse, the comparatively low wages and inability to spend money wisely rather tend to aggravate the position. It is a fact that very often Natives do not spend their money wisely, and one will understand how that affeots the whole position.

The next point about which Dr. Ferguson speaks, is the question of infantile toortality. Infantile mortality at New Brighton Location the previous year had been 532.6 per thousand births. Now that is high, of course, on an European Standard, but within the previous year they had instituted a system of child welfare in New Brighton, not on the same lines as conducted in European communities, but the four nurses there nave been trained in child welfare work and they have been told to advise Native mothers with regard to the feeding of tneir babies, and this had been in operation approximately eight or nine months and the conditions were such that he did not think that there were many babies who had not been influenced by this method, with the result that the death rate had now fallen from ooZ to 171.3. That was for the eight months end­ing 28th. February 1931 and for those eight months the infantile mortality rate was 171.3 per annum.

Asked if some of that might not be due to better registration Dr. Ferguson says as far as he knews the re­gistration had not differed within the previous eight months from what it nad been the year before. O^course it is very difficult to come to a definite conclusion in so short a time, but what seems to him to bear out this 171 is that the Co­loured population of Port Elizabeth seemed to have improved greatly in its attention to this question and he thinks thet the mortality will, by the mfchhods which they were applying, be kept down to under 200. But he does not think it will be possible to decrease it very much more than, that, without a change in the housing and economic conditions of the Natives generally.

Dr. Ferguson thinks that the Native is definitely showing a reasonableness in the manner of this life, that is to say that, when he sees he can be cured of a disease like syphilis, he comes for treatment and, when the mothers know that their babies can be benefited by being weighed every week, they will come in large numbers. They have the vision to see and to realise what is goodjfor them and that undoubtedly is most encouraging in the work that is being undertaken.

Dr. Fergosun's next point is tuberculosis, which is very common, in fact it is more common among the Natives than it is among any other section of the community in that city.

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The death rata in J)930 from tuberculosis among the Natives at New Brighton was 7.5 per thousand of population and the Euro­pean death rate from tuberculosis was .62 in the city, and the Joloureu. aeath rate was 2.8j, so that a Ooloureu person showed a very much larger rate than the Europeans aid.

The Coloureu persons were in between the iiuropesns and the natives.

There is, however, evodence that che Native is aeveloping an immunity to tuberculosis, just the same as the iSuropeans developed an immunity to tuberculosis after the industrialisation of iiingland in the year 1850 or thereabouts.The figures which justify that in Hew Brighton are these.In 1929, the tuberculosis death rete was 8.11. In 1930, the figura was 7.5, ana for the nine months of the current year - the health year ends on the j Oth. June - it was 5.9, showing an actual and very considerable decline.

Also to bear out the fact that the Native is deve­loping immunity to tuberculosis Dr. Ferguson says he had gone into the figures of notifications within the previous two years. For the two years ending December 30th. 1930, (with regard to notifications) he had found that there were 144 notifications and, of these 144 notifications, two cases occurred in each of six houses. nThat is to say, there were 144 individuals affected and of these 144, there were 12 which occurred at the rate of two per house in six houses. There were no households where there were more than two cases.

He submits that that shows the IJative is developing immunity to tuberculosis and it is known, of course, that the chronic type of tuberculosis is more common than it used to be. Professor Lyall Cummings went into the question on the Witwetersrand on the Mines and he also bears out the contention that the Natives are developing immunity to tuberculosis, and Dr. Ferguson considers that it is definitely established that tuberculosis is not going to make th® Native inefficient, nor is it going to make it impossible for him to take his place in modern industrialism.

There is evidence, not only locally, but on the mines as well, that the Natives are developing an immunity apart from economic conditions. It seems to have nothing to do with economic condition*. It is a natural immunisation.

As far as Dr. Ferguson knows Natives do not develop scarlet fever, but it is a common disease among Europeans.

They get measles, not as badly as Europeans, but he has had cases where they have developed pneumonia from measles, and he has actually had cases of death from it.

Dr. Ferguson goes on:- "Now, perhaps, I may deal •'with an old belief among Natives. You probably know that "a Native does not look upon disease in the same way as we "do, he looks upon it as some sort of intangible spirit from "the outside ana, so long as he holds that view, that"it is an intangible spirit, so long, I am afraid, there ia "no hope for him, but I do really feel that that belief is "dying out, and he is now well established, for instance, in "regard to the unuerstanuing that there are certain diseases "whioh are infectious and that the only way to deal with "them is by isolation end by treatment of the sick."

As far as Dr. Ferguson oan ma^e out liquor does not play any important part in the health of the people of New Brighton.

Y/ith regard to industrial diseases, in that area the authorities are really not particularly concerned; the only industrial disease which they ever see there is anthrax, whioh is owing to the wool and skin trade. They deal with that and the treatment is satisfactory, it is dealt with at the Infectious Diseases Hospital. He makes it clear that he is really only dealing with New Brighton. There are outside areas which are not so fortunate and where diseases at various

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times ere rampant, so he is given to understand. Any resident of Mew Brighton can obtain hospital treatment ana also the services of certain medical specialists and, incidentally, these specialists, such as the specialists in ear, nose, throat and eye complaints, give their services gratis, Just as they do to any other poor person in the City of Port Elizabeth*

There is, therefore, no considerable hardship in this regard, so far as the sick natives of New Brighton are conoerned. There is, however, hardship frequently when the head of the family is off work for some time through sickness or other causes, as many of the Natives have nothing in reserve.

There are facilities for recreation which^are being improved, but large numbers of young Natives take no interest whatever in sport, which leaxjds to practises which are harmful to themselves and to the race* He thinks, speak­ing from his own personal experience, that the young urban Native is physically not so virile as the country Native.

Sanitation is controlled by the Municipality and well adapted to the present needs of the people of the lo­cation. The low incidence of intestinal disease, suoh as enteric fever, points to the efficiency of the system. The water is good. Municipal water is laid on at intervals and, as far as he knows, the water is of excellent standard.

Some of the houses in the older parts of the loca­tion ere far from desirable, and in his opinion the construc­tion of new houses without a corresponding increase of the population would increase the health of the location.

Dr. Ferguson imphasizes the question of infantile mortality. He feels that, if facilities were given for the treatment of infantile diseases and if the mothers were edu­cated, then it would be possible to expect a definitely lower deathrate.

There is another point of importance which he thinks might be of some interest to the Commission, in view of the fact that a medical service fcr Natives was at the time being discussed by the Medical Association of South Africa. For

years he had been Medical Officer to the Simmer & Jack Mine in Johannesburg, and during that time had been in con­stant touoh with Bstive orderlies. The Medical Association recommend that the work of training medical orderlies should be taken up under a scheme of medical services. For the previous two years Dr. Ferguson had had under him four fully trained Native nurses. It seems to him that these Native nurses and Native orderlies are efficient; they are keen and they are applying considerable energy and zeal in dealing with the Native people.

The Native nurses at New Brighton are fully quali­fied. They hold the Colonial Medical Certificate, but it seems to him that, with the present state of development, it is ab­solutely necessary for the success of any scheme, that ade­quate supervision by a trained meaical man should be provided for, because meaical knowledge, of course, places a tremendous power in the hands of people, and he feels, from the experience which he has had, that supervision is still necessary over the work of these lvative nurses, and he feels that any scheme which the Government may think fit to bring in in regard to the health service to)the Natives, should contain as an integral part of it that the work of every nurse, male or female, shall be personally ana constantly supervised by a qualified medi­cal man. Daily supervision of every case is necessary by a medical man, Black or WEite, but a fully qualified man and of the European Standard of course. Any scheme not involving this control would, in his opinion, be of doubtful value and he is afraid that it would be open to abuse*

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In the Native mortality statistics there is a higher rate among illegitimate children, the illegitimate mother has not a husband to look after the child, and, secondly, very often she/is ashamed of it, and furthermore the child is very often diseased. Dr. Ferguson thinks thelf illegitimate child is more frequently diseased than the legitimate one.

The mother very often tries to get rid of it before it is born,- there are many factors which favour a higher death- rate among the illegitimate than among the legitimate children.

He does not quite reoollect the percentage of il­legitimate births, but the proportion is far higher than among the Europeans. (Page 5755/64.)

LIr. J. P. McNamee. Superintendent of New Brighton Location, says the death registrations must be complete be­cause a burial order is necessary, end he thinks the birth registration is fairly oomplete. He cannot give a guarantee that it is absolutely complete, but he can see that it is fairly accurate. There are nurses in charge of the various districts, and there are headmen in charge as well. The Natives know quite well that it is necessary to register a birth and that they are liable to punishment if they do not do so.There is a registration offioer at the location, and Mr.McNamee would say that the registration is correct to about oxie per cent.

The Natives occasionally come from outside for medical treatment. Without being inhuman, the authorities try to prevent that, because there is naturally e tendency for them to come into the town where they can get free medi­cal attendance, but the doctor does not give attendance to anyone unless they present their residential oard. There are exceptions, of course. Sometimes there are persons who simply must have attention. Only a few small children are brought in under such conditions. (jrcge 5765/7.)

Dr. Ferguson thiiiks that in making up the vital statistics, it is possible, in a certain number of cases, to transfer out deaths that take place under such cir­cumstances. If it comes to his notice that a case has oome in on account of sickness of a baby, he always notes it on a card. Records are kept of every clinical case and if a case comes in particularly to get medical attention it is shown on the record.

That correction has not been made in the vital statistics he has given so that this is still a crude death-­rate against the locally registered birth rate. It is the relation between the number of actual deaths of Natives recor­ded and the number of actual births recorded.

It is not common there for Native women to go baclt to their homes, or to their kraals, for, at least, their first confinement. He has only come across it very infrequently, and can only remember one case* He sees such a large number of people every month that he thinks it would come to his notice and he has no reason to think that it is so. (Page 5767/8.)

Dr. Ferguson thinks that the Native ages more rapidly than the European and probably the child-bearing age is commensurntely decreased. He thinks the Native women stop bearing children earlier than European women do, because they age more rapidly. He has not sufficient experience to say whether the age of the Native woman for bearing children is lower than that of the European woman. His impression is, though it is very difficult to get reliable information on

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this point, that the Native women are not so fertile as they used, to be. Under present circumstances he thinks that, in a period of normal fertility, the Native woman gives birth to more children than the European woman does, but he does not think that she has more surviving children.

Referring to better housing for the Natives, he mentions as one of the principal objections to the old houses that they cannot be properly de-verminised. When there is a case of typhus fever, it is practically impossible to fumi­gate a house which has a number of cracks in it. It is im­possible to kill the lice when the wall has all kinds of cre­vices in it.

Kaffir beer, from the point of view of the vitamins, is good for the Eative, but, of course, he can get these vitamins, too, from other sources. Dr. Ferguson does not know whether he can get them cheaper, but he can get them. Cn the mines it has been proved that the beer which they give there is of value to the aiet of the Natives. They are given certain quantities of beer and it is held that that is of value to their diet.

Dr. Ferguson thinks the Native is suffering perhaps more from the lack of ordinary milk in town, than from the lack of ketffir beer.

Mostly Vitamine B. was found in kaffir beer. It depemas on the way in which it is prepared, and this question of vitamines is really still sub judice.

There is a very noticeable lack of milk in the location, and he considers that it has a serious effect. The Natives cannot buy milk at an economio rate. Taking the Natives with whom he deals as a whole, he would say that as a general rule they are under-nourished. That applies to parents as well as children - to male as well as female. Under-nourishment is a considerable feature in the location.

(Page 5770/5.)

Hr. H. Relton. Chairman, Village Management Board of Korsten, says that in Korsten, over twelve months, the deaths were 910 of ell races, the births were 1,1S1 and stillbirths 157. Infantile mortality in Korsten, according to the figures in his summary was 428.56 per 1,000. This was for Natives alone, and the figure for I ew Brighton was 319.08. He had obtained these figures from the Secretary of the Village Management Board. He does not have separate figures in respect of the number of Native deaths. He does all the registration of births and deaths at Korsten himself, so by his figures there is a deathrate of 45 per 1,000.

(Note. Korsten appears to be a mixeu. community ofEuropeans, Asiatics, Coloured and Natives.)

(Page 5659.)

Head Constable L. 3. van der Walt. South African Police, referring to E Co-habitation without “H^rriage says a very bad factor in assisting this form of living is the misuse w which is made of the provisions of the Childrens' Protection Act. During his stay at New Brighton he has observed that unmarried females do their utmost to entice men wi-fcb to co­habit with them with the object of being in a position to de­mand support for the maintenance of a child. As soon as the child is born, the woman comes to the Courts and complains that the father of the child is failing to give proper support to his child; the man is ordered to pay 5/— per week towards the support of his illegitimate child. This enables the mother to give up her employment and she then leajds an im­moral life. (Page 5843.)

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A Statement by Mr. A. Linton, representing the Native

Welfare Society of Port Elizabeth and District, composed, of Europeans and Natives, is included in the file, the following

is an extract:-"Nearly £2,0C0 was expended in 1929 on the Medical

"Service provided. There are four qualified Native nurses."The Assistant M. 0. H. visits the Location every day. A Child "Welfare clinic is in operation. New water mains have been "laid assuring an ample supply of water, roads have been con- "structed and the main streets lighted. A Native Advisory "Council on the lines of the Native Urban Areas Act is in

"operation."The rents include, among other things, medical

attention, i. e. Doctor, hospital and district nurse.A monthly ©ten** course of high class lectures (per­

haps too high class) had been inaugurated by the Native Wel­fare Society. The 'Wayfarers were strong, and their activities, joined to those of a Native Red Gross Soaiety, had been re­ducing the infant mortality rate considerably since the issueof the last official statistics. (Page 3 of

Statement.)

N# B. This refers to the New Brighton Location.

Mr. Linton’ s Statement contains the following:-

" 4 5 . traAJ.TW.

"The only medical services provided especially for "Natives are those referred to in paragraph 9 (the paragraph "quoted above) in Mew Brighton Location belonging to P . E. "Municipality. It is under the control of the Medical Officer "of Health, Dr. P. H. Scroggie, M. B ., Ch. B ., D. H ., and "is directly under Dr. D. L. Ferguson, M. B«, Ch. B ., D. P. H., "whose knowleuge pf the Native language and of Native ways has "gained the confidence of the inhabitants. He visits the "Location daily, and on special occasions when called upon by "the nurses. There is a hospital in the Location containing "twelve beds, but it is being used more as an observation "hospital, all the serious oases being transferred to the "Infectious Diseases Hospital (under the Gity Council) if "required, or to the Provincial Hospital (under the separate "Hospital Board.) There ere four fully qualified Native nurses "engaged in the location, mostly in visiting work.

"46. The following are the figures for the year ending

"JO June, 1930:"New Brighton*

"Attendances by Medical Officer at dispensary 8,336 n n «i »» " in hospital 594*» ii »• " " in patients’ homeslt154

"Visits by nurses to patients' homes 3,140•«Patients admitted to location hospital 99" " " " General Hospital 131

"47. For year ending 30 June, 1930, the number of "births among residents of the Location was 310, equal to "42,30 per 1,000, and the deaths 279, equal to 38,08 per "1,000. Of these 279 deaths, 55 were due to Tuberculosis,"58 to Pneumonia, and 39 to Diarrhoea. Of the deaths 103

"were those of infants undeifone year, giving a rate of "332.26. A Child Welfare Committee of the New Brighton "Bantu Improvement Association holds weekly clinics, and "it is expeoted that by this, and other means, the infant

"mortality will be reduced.-118~ "48.

"48. All the other public medical services in the town "are open to Nativas equally with Europeans. Under the control "of the Medical Officer of Health of the Port Elizabeth Munici­pality there are a City Infections Diseases Hospital (shortly "to be transferred to the supervision of the Provincial Hospi- "talj, Maternity and Child Welfare Clinics, and a Dental Clinic. "There are no figures relating to Natives, as apart from non- "Europeans, given regarding these. There is also a Venereal "Diseases Clinic, and out of 1,338 oases dealt with during the "past year, 989 were non-Europeans, and over 700 of these were "of individuals between the ages of 15 and 35. While these "figures are alarming, it must be remembered that it is only "very recently that a Venereal Diseases olinic has been esta­blished here. As compared with the previous year the atten- 11 dances at the clinic have increased nearly threefold, from "9,354 to 26,455.

"45. The foregoing Infectious Diseases Hospital and "the Clinics deal with cases from all the bodies administering "Native Affairs in this District.

"50. It has been found impossible to secure figures of "Native Birth and Death rates for comparison over a series of "years before the P. E. Municipality in 1923 took over the Na- "tive Location at New Brighton. Almost the whole of the Native "population lived outside the P. E. Municipal Boundary, and "half of them still do so. The following figures taken from "the yearly reports of the Port Elizabeth Municipal Medical "Officer of Health's Report, may, however, be of assistance:

"Year 1917. Europeans. Non-Europeans.

"iropuletion. 19,824 13,232- 33.056.

"Birth Hate 29.56 48.89

"Death Rate 12.71 36.72

"Infantile Mortality 85.82 261.20

"Ysar 1922.

"Population 23,875 12,789- 36.664.

"Birth Rate 27.89 42.38

"Death Rate 10.80 28.47

"Infsntile Mortality 91.79 250.40

"Year 1926. {New Brighton Location taken over.)

"Population 27,338 12,955- 40.293

"Birth Rate 25.26 _ 45.47

"Death Rate 9.7 27.93

"Infantile Mortality 61.47 213.06.

"51. For the year 1926, New Brighton Location (not in- -119- eluded

"included in above figures) containing 2307 married adults,"1384 single adult males, 577 single adult females, and 2654 "children under 16, a total of 6,922 , had 179 births (69 "legitimate and 110 illegitimate) a birth rate of 25.22; and deaths " 280, equal to 40.50 The«e figures are published in the re-

"turn without comment by the previous K. 0. H. In 1927 the "births were 296, (115 legitimate, 181 illegitimate) a birth "rate of 42.49, and the deaths were 280.

■ 1930. Euronean. Non-Eurooean.

'^Population. 33,550 15,200 - 48,750

"Birth Rate 25.45 39.01

"Death Rate 11.14 21.38

"Infantile Mortalityul03.44 178.75

"In the same year, Hew Brighton location, not in­cluded in above figures, with a population of 7,327, had a "birth rate of 42.30 end a death rtte of 38.08, and an infant "mortality of 332.26. This last figure in the opinion of the "M. 0. H. is not reliable. For the eight months ending 28 "February, 1931, I am informed that the infantile mortality "rate in New Brighton has been 171.3 per 1,000. The only "explanation that oan be made is t'iat the four Native nurses "attended s year ago x special lectures on Child Welfare."Such a phenomenal drop cannot be regarded as permanent."The Provincial Hospital for the year 1929, admitted as in­patients 2,203 Europeans, and £» 1,386 Coloured and Native "patients, and 1,607 Europeans and 5,448 Coloured and Native "out-patients were treated. In the Coloured and Native figures, "Eatives constitute the larger proportion.

"53. The iledicsl Officer of Health for P. E .,"Dr. F. H. Scroggie, M. B., etc., has kindly furnished me "with the following observations relating to the i'.ew "Beighton Location:-

" ’New Brighton Location.

" 'Mortality among Adults." ’Figures in the Annual Reports are not reliable for

" ’ comparison with locations of different population composition.

" ’Venereal Diseases.

" ’Venereal diseases are common. Here ag*An it is " ’ impossible to say what percentage of the people are affected. " ’Children are often infected, when their parents suffer from " ’ syphilis, probably owing to their occupying same beds, etc. " ’with their parents. The common habit of married Native men " ’ co-habiting with other women during their wives' lactation " ’periods appears to be a common source of infection to other- "'wise healthy families.

" ’ I have no difficulty whatever in persuading my " ’patients at New Brighton to come for treatment, this being " ’ due to the spectacular results, particularly of anti-syphi- " ’ litic treatment. I have had very few cases where these dis- " ' eases have been deliberately concealed.

" ’Errors in diet, quality and quantity, account for " ’much ill-health, but among a oertain class of Native there

" ’ is a genuine concern in this matter and an attempt to pre- " ’vent the onset of disease, tow wages end an inability to " ’ spend wisely aggravate the position.

- 120-

Collection Number: AD1438

NATIVE ECONOMIC COMMISSION 1930-1932, Evidence and Memoranda

PUBLISHER: Collection funder:- Atlantic Philanthropies Foundation

Publisher:- Historical Papers Research Archive

Location:- Johannesburg

©2013

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