HEALTH AND MEDICINE — GENERAL 5O5 



problem arises in areas, such as Uganda, where salvarsan has come 

 to be regarded as the cure for all ills. It is unfortunately a frequent 

 practice for certain African medical attendants to make illegal 

 profits by the sale of salvarsan which is either stolen or collected 

 by giving doses less than those ordered. A system of supervision 

 close enough to prevent these defalcations is practicable, but if free 

 treatment were recognized as a right acquired by the payment of 

 poll-tax, the African himself would probably insist on his rights; 

 the danger would then more probably come from demands for 

 salvarsan for every ailment. 



The development of health insurance in England based on the 

 part-time employment of private practitioners has not proved 

 satisfactory from every point of view, and the arguments against 

 it apply more forcibly to African conditions. Therefore, the pro- 

 vision of free treatment by a state service might well prove a more 

 satisfactory line of development for Africa. 



MEDICAL EDUCATION OF AFRICANS 



The improvement and maintenance of health in Africa depends 

 largely on the provision of trained African assistants who can un- 

 dertake routine v/ork at hospitals, and can take medical aid direct 

 to the rural areas while working under the supervision of European 

 medical officers {see Chapter XVII). The training of dispensers, 

 nurses, dressers, and midwives has been established for some years 

 in most African territories, but recently the lack of a more highly 

 trained auxiliary staff capable of efficient diagnosis and treatment 

 has been seriously felt. The medical service, as other services, can 

 be envisaged in the form of a pyramid, in which the base is formed 

 by a large number of nurses, dispensers, etc., the apex by the Euro- 

 pean medical officers, and the central part by auxiliary doctors 

 or medical aids. This intermediate class exists in East Africa in 

 the form of Asiatic assistant and sub-assistant surgeons and in 

 Uganda of African medical assistants, but in West Africa, although 

 there is beginning to be a supply of African auxiliaries, and African 

 doctors qualified in Europe already fill some senior posts, nearly 

 all the work of routine diagnosis and treatment has to be done by 

 Europeans. 



