472 SCIENCE IN AFRICA 



trol of the Secretary for Public Health of the central government, 

 Sir Edward Thornton. There is a full account of existing medical 

 facilities in the Official Year Book (1937), and an interesting article 

 by Dr. J. A. Mitchell, late Secretary for Public Health, on the 

 history and development of the health administration in the coun- 

 try before and after the constitution of the Union, was contributed 

 to earlier issues. It is difficult to give an adequate summary of the 

 medical staff because private practice has grown to such a degree 

 in South Africa that the hospitals, etc., rely, as in Great Britain, 

 to a large extent on part-time work by practitioners and specialists. 

 For certain purposes, such as the control of sanitation and out- 

 breaks of infectious disease, most municipalities and some other 

 local authorities have health officers and health departments 

 attached, but the scope of these organizations varies so much, in 

 the absence of uniform legislation, that it cannot be summarized. 

 In most districts of the Union medical officers, mostly part-time, 

 known as district surgeons, are employed by Government. In 

 June 1936 there were in all 357, of whom 339 were part-time. A 

 port health officer is appointed by the government as resident 

 at each port of the Union for the inspection of vessels. In 1935-6 

 the Union government expenditure on public health, medical 

 services, lepers, and mental diseases was ^(^1,106,168 out of a 

 total ordinary expenditure, excluding provincial services, of 

 ^£"30, 1 35, 791; general hospitals are controlled by the Provincial 

 Administrations, which also administer poor relief. 



The introduction of National Health Insurance in the Union 

 has recently been under consideration by a Committee of Inquiry 

 appointed by the Minister of Public Health (Union of South 

 Africa 1936). Its principal recommendations are that compulsory 

 health insurance should be instituted in urban areas; the number 

 of district surgeons in rural areas should be increased, using where 

 possible the services of local residents, and in the native areas, 

 where medical services are quite inadequate for the needs of the 

 population, a general extension is required, including a larger 

 staff of doctors, the inauguration of a native nursing service, and 

 a staff of health visitors. 



Hospitals in the Union are numerous: details are shown in the 

 following table, and in addition there are eleven institutions for 



