402 HEALTH PkOllLEMS IN COUNTRY DISTRICTS. 



years from July, 1902, to December, 1911, as follows: — In rural 

 districts of the Transvaal, total number of European deaths, 

 12,487, and of these 6,293. or more than half, had no medical 

 certificate as to the cause of death. Let us make an attempt to 

 realise something of the state of affairs concealed under those 

 figures. It is quite impossible to estimate the amount of sickness 

 that did not end in death. The physical suffering of the patient, 

 the mental anguish of the relatives, the haphazard and ill- 

 informed rusii to the powders and drops in the " Huis Apotheek," 

 even the })rayers of the Elders of the Church, and finally recovery, 

 partial or complete in some cases ; in other cases a wild rush to the 

 doctor after a hasty collection of all the available money in the 

 neighbourhood, or an agonising petition to the doctor to come, 

 with a promise to pay when the crops ripen. And the doctor 

 arrives just in time to see the patient in extremis. He can 

 recognise the cause of death and grant a medical certificate, and 

 that death is classified as certified, but I ask, how can that possibly 

 be described as proper medical attention? In my opinion it is 

 not. From a doctor's point of view there is no satisfaction in 

 being called in just in time to certify the cause of death, and too 

 late to be of any real heli> to the patient. A doctor does not 

 spend five, six, or seven of the best years of life in order to be in 

 a ix)sition to assist in the compilation of statistics. A doctor's 

 trite \york is to help people during life to recover health or to 

 case pain and anxiety when recovery is hopeless ; the writing of a 

 death certificate, which is of so much importance and interest to 

 the statistician, is to the doctor a mere irksome detail. I contend 

 that in many cases of certified deaths the patient has had no 

 proper medical attention because the doctor has been called in 

 too late to be of any real help. In other cases the doctor has 

 been called in, the diagnosis of an irrecoverable condition is 

 made, and no more is heard of the patient for perhaps weeks or 

 months, when the death occurs : whether these are classified 

 as certified or uncertified I am not in a position to say, but the 

 fact remains that such cases cannot be described as having proper 

 medical attention in the ordinary acceptance of the words. 



The health of the natives and coloured people in the country 

 should receive more consideration than it does at present, not only 

 for the purpose of easing pain and suffering and mental anxiety, 

 but also because of the close relationship between the white and 

 coloured inhabitants of the land. In the neighbourhood of towns 

 there is a continual stream going backwards and forwards. The 

 women and girls go up to do washing and cleaning, the men work 

 in town and return on Sundays, and infectious disease may 

 occur and be carried from place to place. If a death occurs, a 

 policeman asks a few questions and a burial order is given. If 

 there is any suspicion of foul play, then another state of affairs 

 occurs. This really is important. A cart and pair of horses is 

 sent down to remove the body to the mortuary, a fee is forth- 

 coming for a post-mortem, and money that is grudged to the 



