announced that a vacancy had occurred in the representation in the House of the electoral division of Johannesburg (West) owing to the resignation with effect from to-day of Mr. J. P. van der Spuy.

In view of the fact that this is the last day for motions by private members, I should like to move an unopposed motion—

Agreed to.

I should like to move the amendment as printed in my name—

This amendment has become necessary because in the draft estimates which have already been framed, money is not provided for the “Special Account”, but for “Secret services” on the Foreign Affairs Vote, as in the past, in other words, as matters stand at present Parliament is not going to vote funds for the “Account” as far as the 1967-’68 financial year is concerned, but for “Secret services”, as in the past. Because it is not certain when the Act will come into operation, Treasury cannot have funds voted for the “Special account” at this stage already, and it is advisable to make it clear that the funds that may be voted for 1967-’68 are to be credited to the “Account” once it has been established.

Amendment put and agreed to.

Clause, as amended, put and agreed to.

Remaining clauses and Title of the Bill put and agreed to.

Bill reported with an amendment.

Report Stage.

Bill read a Third Time.

I move—

1. (a) make a factual study of and investigate all existing psychiatric services in the Republic;
2. (b) make recommendations with a view to the co-ordination of these services in such a way that the best possible use may be made of them, bearing in mind the limited number of specialist psychiatrists and properly qualified nursing as well as other auxiliary staff, and having regard to accommodation; and
3. (c) make recommendations in regard to the future extension of these services so as to ensure the greatest possible benefit to the whole population of the Republic.

This motion expresses concern about the alarming increase in the incidence of mental illness in our country. When we talk about mental illness the question arises, of course, what we actually mean by that, and then we may say that it includes not only serious mental derangements, which are known as psychoses and which are mostly admitted to mental hospitals, but also the minor aberrations, neuroses and emotional disturbances encountered among human beings. If we are to determine the extent of this phenomenon of mental illness, I may mention to you that in 1964 the number of patients in our State psychiatric hospitals totalled 35,965, but the incidence was much higher than the figure I have quoted, because it is estimated that for every one person admitted to a mental disease hospital, there are ten mentally ill persons in society. If we take that figure, therefore, there would be from 300,000 to 400,000 people who need such treatment. That is borne out if we consider that doctors find that from 60 per cent to 70 per cent of the cases who visit their consulting rooms are not so much people with physical ailments as people who suffer from psychosomatic symptoms, mental ailments, mental derangements, which are manifested in physical symptoms.

We must also take cognizance of the statement made in a brochure published by the National Council for Mental Health in 1965—

If we add to these the large number of alcoholics, which is estimated at approximately 90,000, and more than 100,000 mental deficients who require care, we may say with certainty that we are here dealing with a problem of very great magnitude. Not only is it a great problem, but the motion also emphasizes that there has been a very conspicuous deterioration in the position and that we shall have great difficulty in making up the leeway; the figures have proved this to us. If we take the Weskoppies Hospital, for example, we find that in 1953 that hospital admitted 500 cases. In 1963 the number of admissions was no longer 500, but had increased to 2,000 in respect of that one year. In the 11 mental hospitals the aggregate admission figure is 10,000 a year, and if we compare that to the population increase, we find that there is a very large disparity. In 1918 the number of patients treated in all categories totalled 6,963; that was in 1918, and ten years later, in 1928. that figure had grown to 12,124, almost 100 per cent higher than ten years previously. In 1938 the figure was 17,027; in 1948 it had grown to 20,000: in 1959 it was 25,163; and in 1964 it was 35,965. According to census statistics the population increase from 1951 to 1960 represented 2.54 per cent a year, but the increase in respect of this particular type of patient over the same period totalled not 2.54 per cent but 19 6 per cent. If we inquire into the causes of this increase, it may be said that it is to be attributed to a certain extent to the population increase. It goes without saying that larger numbers must produce more patients. But another major cause is the fact that people are better informed nowadays and consequently report more readily for treatment; they are not as shy as in the past, and because of that a larger number of those patients now come to notice.

But if we furthermore consider the times in which we live, the particular character of our community, which may be typified as one of competition and constant tension and an increasing tempo, it is self-evident that there will be a larger number of people who are susceptible to neurosis and who are affected by this increasing tempo of life and conditions of living, and who then become deranged much more easily because they are susceptible to derangement. They would perhaps never have revealed it if they had been able to lead a quieter, more peaceful life. But whatever the causes of the problem, the fact remains that the problem exists and that it is a grave one, and that the problem is increasing in magnitude. It has therefore become time, as I ask in this motion, for consideration to be given to the appointment of a commission of inquiry which may go into this whole matter, which may put this whole matter in the correct perspective and which may indicate means of solving this problem. Not only is there an increasing problem, but there is also an increasing leeway as regards the services which are available and which have to be made available to these people. Close analysis of the figures has shown that although the number of patients increased from 10,000 to 20,000, i.e., doubled during the years between 1925 and 1950, the total number of doctors who had to treat them did not increase in proportion to that growth, and that also includes doctors appointed in a temporary capacity and on contract. During that period the number fluctuated from 40 to 50. There was no constant growth in the number of doctors who had to treat those people.

If we consider the doctor-patient ratio for example, we find that in 1918 there was one doctor to 387 patients; in 1964 there was one doctor to 460 patients; and if we add to those the out-patients, the number of patients to one doctor grew to 550. Not only did the magnitude of the problem increase, but the services to be rendered for curing these people decreased. In addition we have to bear in mind that not all these doctors were psychiatrists. Ten psychiatrists are employed, but one of them is the Mental Health Commissioner, who actually has nothing to do with these patients. There are therefore ten psychiatrists available to treat this mass of patients. This number is also showing a decreasing tendency, because in 1966 there were 13 to the present ten. If we analyse the nursing services in that hospital we find the same decreasing tendency. There are hardly any social workers and psychologists, and yet it is the modern approach in respect of psychiatry that there must be teamwork by doctors, psychiatrists, social workers and psychologists. There is not one psychologist on the staff of that hospital. Similarly, we find that the after-care for these people, which is of the utmost importance, is neglected deplorably. Apart from the inadequacy of the buildings, we find that there is a tremendous shortage of beds, so much so that at the annual meeting of the Mental Health Council it was emphasized that a considerable number of Indians, Coloureds and Bantu for whom no beds could be found and who had to be protected against themselves and against whom society had to be protected, had to go to prisons as a matter of necessity because there was a shortage of beds in the hospitals. But if we carry our analysis of this problem even further we find an ominous sign, namely that absolutely nothing is done in respect of child psychiatry. There is not one child psychiatrist in this country. The existing school clinics show us that there is a very grave problem. It was with great joy that we read in Die Vaderland of 16th February, 1967, that it is being considered in the Transvaal to establish child guidance clinics where there will be trained guidance officers, trained psychologists, sociologists, speech therapists, doctors and remedial groups to look after those children.

Now I say that the problem is not only one of great magnitude, but one which causes our country a great deal of harm and one which has become a most expensive problem. It is very difficult, of course, to determine the extent of the harm. It applies to various spheres, and in the first place to the national economy. As a result of the present inadequate services, the recovery figure is very low and a large number of these people have to be kept in hospital for a very long period, some of them until they die there. What is more, as a result of the protracted hospitalization they develop further aberrations which are peculiar to such hospitalization. It is an expensive business to keep a person there, and if we have to provide even more beds to keep those people there it becomes even more expensive. It is estimated that the mere building for a hospital for 2,000 patients cannot be erected at a cost of less than R11 million. Salaries and medicine cost R400,000 a year. Patient care at R1 per patient per day, will come to R730,000 a year. Apart from the buildings, it will therefore cost R1,130,000 a year to maintain such a hospital, which shows us how expensive it is if we have to put those people in hospital beds.

But much more serious than that is the loss of productivity on the part of these people. In a brochure published by the National Council for Mental Health in 1965, I read the following—

Even if this figure were exaggerated and we reduced it to a quarter of that amount, I would say that this decreasing productivity as a result of mental illness was costing the country more than R100 million a year. I say it is a tremendous loss which we are suffering as a result of the fact that there is still such a large number of people who have become mentally ill.

But this is not all. We cannot calculate this cost in capital alone; we are also paying the price in other fields. We think, for example, of crumbling homes where either of the parents became mentally ill or unbalanced, and of all the sorrow it entails for that family. We think of the inconceivable suffering of the mental patient and of the perils it holds for society. Who can testify to that more strongly than this House? If we think back a few months and recall the tragedy which was inacted here, when we were dealing with a person who in the judgment of the Court had become mentally ill, we appreciate the danger that may arise. Who can compensate for the loss suffered by this country?

I therefore say that the facts compel us to plead for a thorough inquiry into the problem because the magnitude of the problem, as I have outlined it here, proves that it is in the national interests that a thorough inquiry shall be instituted. But furthermore, statistics show that there is an increasing deterioration trend, and that we are not making up the leeway. Inadequate services and the fields which are still lying fallow, which are still to be exploited, reaffirm the necessity for the appointment of such a commission. We are forced to the conclusion that we are allowing this problem to continue to our own detriment and that somewhere there is something seriously amiss as far as this service is concerned. This is a reproach against ourselves, because the latest developments in the field of medicine show that it is possible to cure a very high percentage of these people if action can be taken immediately and if the correct means and techniques are applied immediately. If that is done, such people may recover to a large extent and lead useful lives in society. For that reason I maintain that there is justification for an immediate inquiry into this problem by a capable expert commission.

If you asked me what the commission should inquire into, I would say, as the motion indicates, in the first place a factual study of and an investigation into all existing psychiatric services in the Republic. It may be that such an inquiry will reveal certain things, and that it may be established, for example, that there is an unbalanced distribution between the services of the Central Government and the provinces in this field. Such an inquiry will be able to tell us why psychiatrists prefer to go and work in provincial hospitals rather than in the mental hospitals. In particular the terms of reference of the commission should be wide enough to enable them to deal fully with all our psychiatric services and their problems. The motion provides that such a commission of inquiry shall make recommendations on the co-ordination of the services to the benefit of all, and recommendations on the future expansion of services in order that the latest approach and treatment may be applied in our hospitals. If I consider, for example, that some time ago it was current usage to talk about those places, those hospitals, in terms which I should not like to mention here to-day, and if one considers the new approach, if one considers, for example, what is done in a hospital like Weskoppies, where fences have been removed and where the patients go about freely like normal people, we find that a new approach and technique is developing which may be applied most fruitfully in our country. I want to tell the Minister that in the circles of people who are interested in mental health, appreciative mention is made of the encouragement lent by him to pioneers in this field, to continue endeavouring to establish the best methods of treatment. The terms of reference should be wide enough to embrace all aspects of this problem. Not only should the inquiry give us an answer to questions such as where the services are inadequate, but also why this career is not so attractive to doctors and nurses; why it is that only such a small percentage is interested in psychiatry. Is this due to the remuneration, or does a stigma attach to this profession? Are the working conditions and the environment in which these people live and work rather unattractive? Is there something wrong with the status of those people in the medical world, or is it obsolete methods, etc., which no longer capture the imagination of the people or attract them to that work? Not only do we want replies to those questions, but we should also like to know whether the training and utilization of clinical psychologists are satisfactory. I say the commission should regard its task as urgent and exigent, because the country as a whole is in danger of suffering harm to an increasing extent, as pointed out at the beginning. If the Minister agreed, I believe that such a step would prove the greatest boon to the Republic of South Africa and its population, even if this inquiry did not mean that it would be possible to correct everything at once in one magic stroke. We know that it will demand a great deal of time and work and capital, but if such a commission can carry out this inquiry, which is of such great scope, I believe they will provide us with the blueprint for the future, in order that every stone laid in this field may be placed in accordance with a plan. For that reason, because this matter is so important and of such a serious nature, we want to plead that a very capable commission of inquiry be speedily appointed.

I must congratulate the hon. member for Kimberley (South) on his courage. Whether it is courage or foolhardiness I do not know, but we on this side of the House have for many years chided the Minister on the state of the mental health services of the country. But I do not think that even at my best I could provide a greater condemnation of the services which the Minister gives to mental health than that which has just been enunciated by the hon. member for Kimberley (South).

Those of us who work in the field of ill-health, and not necessarily mental ill-health, have known for many years that these services in this country were backward and that the problem was overtaking the limited services available to such an extent that it would soon lead to a breakdown. We have on many occasions asked the Minister to do certain things, and some of them he has carried out. I will mention them later. I hope that when I and my colleagues have finished speaking, the mover of the motion will withdraw his motion and accept my amendment, which reads as follows—

To omit all the words after “and” in the third line and to substitute “condemns the failure of the Government to take the necessary steps to keep pace with the problem and calls upon it to publish the relevant findings and recommendations of the commission of inquiry into the financial relations between the Central Government and the Provinces so that immediate action can be taken to provide sufficient and adequate services for the prevention of mental illness and the treatment and after-care of the mentally ill.”.

There is no need for a commission. The facts are known. The ideas which the profession has for the treatment are well known. Various methods have been evolved in other countries. We have a competent Commissioner for Mental Hygiene. We have services—although we should have more services—in the provincial hospitals for these people. There is no need to waste time by appointing a commission. The commission will just take time and it will give us no more knowledge than we already have. We know that the services for the Whites are sadly lacking, and for the non-Whites there are no services at all from their own people. Although a little is being done by the University of Natal, nothing is being done to train the Coloured and Indian psychiatrists, except this little that is being done in Natal. It is impossible for a psychiatrist to deal in a foreign language or with foreign people. He can do his best, but to go into the problems of mental health one must have grown up with the patient’s people. The shortage of psychiatrists is well known. The Minister has done a little. He has subsidized some 12 psychiatrists and psychiatric registrars in his own hospitals. The mover of the motion drew attention to the shortage of psychiatrists in the mental hospitals. It is even worse than he realizes, because the other doctors who are there, most of them, are retired men, and few are young men taking up psychiatry. The hospitals that provide first-class psychiatry do not fall under the Minister. They are Tara in Johannesburg, and Groote Schuur. These are modern psychiatric and neruological hospitals under the care of the Provincial Council. We do not need a commission. There is the Commission which has reported, apparently, but whose recommendations have not been released, and that is what we called for, because one of the things which the Commission was instructed to investigate and report on was the question of the relations, in regard to health services, between the provinces and the Central Government. What we really want to know is what that Commission recommended.

The problem is almost insuperable, and it will take years to solve, even at best. It is giving all the world trouble. Many of us who are old enough will remember that it was common at one time for patients to die of appendicitis. To-day that is almost unknown. This is not really due to any improved treatment; it is due to early diagnosis and treatment, and that is what we lack so much in this country in regard to mental health. It is true that there are numerous adults, whose numbers are increasing, who require hospitalization and treatment for mental health, but just as in the case of appendicitis, so in the case of mental health we must look to early diagnosis with its resultant prevention. It is better than appendicitis. We cannot prevent appendicitis, but if the Minister tries, he can create over the years, a service which will prevent the greater part of mental health and will keep these people in the community, in their families and at their jobs, living normal lives. In some cases we can even start treatment on the unborn child or prevent its birth. We now know the chromosome which causes the Mongol child. We can warn people so that they do not marry that man. That will come. Questions of diet have been found to cause schizophrenia, we believe. These things have not yet been worked out completely, but research is going on. The Minister must realize that his problem concerns the whole of human behaviour and he must not worry too much about training psychiatrists. They will come. What he must train now are the people who will find these children earlier. The naughty child has a reason for being naughty. The behaviour problem of the child in a nursery school has a reason. The health services at schools should be looking for these children to find out why they are that way. It may be due to a physical defect like hearing, but it is passed over. The Minister must have all the behaviour problems dealt with as they arise. It may be necessary, for instance, to teach a mother how to behave towards her child, because it is her fault and not the child’s. If these things are neglected, and a baby is always naughty and goes into a nursery school where he does not fit in, and he later goes to a school where he is backward, and later he becomes apprenticed to become an artisan because he is not fit for anything else, and he turns out to be a bad artisan and finally he becomes a delinquent, the cause should have been found out earlier. The Minister must see to it that he trains people to do this work. School nurses must be trained. Nursery school teachers must be trained, and all teachers must be taught to spot such cases, and people must be told where they can get help. That is where the Minister comes in. He should have health visitors who are trained in this work. He must also realize that after these patients have had expert treatment, he has to have a trained service—and I have told him this on many occasions—to go among the community and teach the community, the neighbours and the family what to do and how to help this behaviour pattern to fit in with theirs. The trouble to-day is that when patients come out of the hospitals they go to a home where they are misunderstood, where the neighbours walk on the other side of the street rather than come and chat with them pleasantly and make them feel at home; where the children are inclined to run away because their mother has said, “Keep away from him; he is mad”, and things like that. How can a man who is already upset, whose behaviour pattern is unusual, fit into an environment of that nature? What is the good of letting him leave hospital? Read the report of the Commissioner for Mental Hygiene and you will see that he says that while he has more than doubled the discharges from his hospitals, he has an immense rate of returns because he has not the staff in the community to fit that discharged patient into the community and to train the community to behave generously and kindly towards these people. These adult suffers have to be trained and treated, if possible, in their own environment, and if possible they should not lose their jobs. If they have to lose their jobs they should at least stay at home and receive treatment there. They do not need to go into hospitals for this sort of treatment, except perhaps for a very short period in order to get drug treatment and to get their balance. If possible, the man should not lose his community and home ties. What happened in the old days? Patients were put into mental hospitals and after they had been there three months they never came out alive again. Their families did not want them. Perhaps the mother did, but nobody else wanted them. The whole family regarded it as a stigma. If there were marriagable daughters in the family, they looked upon this person as a bar to their finding husbands. The mother of the prospective husband told him to keep out of that family because they had a madman among them. How can a man fit into such an environment? We must get rid of the stigma by training the community and by catching these patients so early that the stigma is never attached to them. The Minister must sit down with his Commissioner for Mental Hygiene and work out a plan, together with the Minister of Education, and subsidize those nurses who are willing to take up health visiting, and he must encourage the clinical psychologists and subsidize them. If sufficient clinical psychologists and health visitors and community nurses are provided, the admission rate or the morbidity rate in mental health will halve itself in a decade. The Minister must to it.

I do not want to reply to the hon. member for Durban (Central), but I do want to express my disappointment at the fact that he had nothing constructive to say in the first part of his speech, and was merely negative and even destructive because he used the word “condemn” in his description of this serious matter. I am not going to reply to him any further. I take it the hon. the Minister will also participate in this debate. But I should like to take this discussion further so that we may gather for ourselves what all is included in the concept of mental infirmity.

By that we understand any deviation in an individual’s mental condition or personality from the norm as laid down by the community of which he is a member. These deviations differ in degree from very slight to very serious. Man’s mental condition is so complex and irrational, and there are so many individual variations of personality and emotions, that it is difficult to determine where this mental deviation actually begins. In everyday conversation we so often hear the following: He is mad; he is not quite all there; he is not right in his head; he suffers from his nerves; his nerves are shot; he is dense; there is something wrong in his top storey; he is frustrated; he suffers from a psychosis; he suffers from neurosis; he suffers from delusions. When such a person is present these things are sometimes even described by means of certain gestures. We know how difficult this problem is, and even the psychiatrists, after years of study and experience, find it difficult to draw definite distinctions and make differentiated classifications of psychiatrical problems. They find it difficult to formulate these mental defects. I do not want to go into the problems of psychiatrists, but I can remember very well that as a student I spent a week at a mental institution, where I went to further my studies, and that for days after leaving that institution I found it very difficult to distinguish between what was normal and what abnormal. That is just to give you an idea of how difficult and complex this problem is.

With this introduction I have come closer to the central idea of the problem, as stated by the hon. member for Kimberley (South). The word “alarming” is the correct one. I quote from an article in the S.A. Medical Journal—

It has been proved by research workers that there is more mental infirmity, of whatever degree, that we are normally aware of. In this way the Commission on Chronic Illness made a survey in the state of Baltimore in 1957 and put the percentage at 10.8 per cent of the entire population of that state. In West Nigeria a survey was made in 1963 by Leighton and others, and they put the percentage at 23 per cent. Here in our own country a survey was made amongst the Coloureds in the Western Cape by Dr. Gillis and others in 1965. They found that 11.8 per cent of the Coloureds in the Western Cape suffered from some or other kind of psychical deviation. Do we realize what an enormous task this is? Are we aware of the fact that there are only plus-minus 24,000 beds in mental hospitals, and that these beds are required primarily for serious cases, those cases requiring hospitalization, which have been certified under the Act? Do we realize that of this 11.8 per cent of Coloureds, only one per cent come forward for treatment? A large number go to the out-patients clinics of hospitals and to the consulting rooms of doctors, while the rest get nowhere. When they come to the general hospitals they project their symptoms onto physical phenomena—appendices are even removed where a person shows psychical deviations. I have personal knowledge of a case where it cost the medical aid fund of a patient approximately R200 before it could be established that the patient was not physically ill but that he was not psychically unhealthy—he was maladjusted and had problems at his place of work. How are we going to tackle this problem? How are we going to try and solve or alleviate this problem? What are the means we have at our disposal and what can we achieve with them to, as the hon. mover of the motion asked, derive the greatest possible benefit for the entire population? I feel that we must in the first place give our attention to those outside factors which nourish a person’s mental defects and which are the cause of the slightest deviation in an individual becoming the worst kind of deviation, those factors which turn a sensitive person into a frustrated one, which make a psychopath of a depressive person; factors which lead the psychopath to suicide or mass-murder, factors which contribute to causing clashes between mental defects and the values and norms of society, etc. I want to mention a number of these factors and elaborate somewhat on them. In the first place there is our socio-economic welfare; in the second place there is the break-up of family life—more specifically the mother-child relationship and the instability of our married life; maladjustment to working conditions; defective training and recreation after leaving school; the collapse of our moral values; defective ties with the church; the influence of strong drink and drugs; and even the influence of alien ideologies, etc. All these factors have an influence on this plus-minus 10 per cent of our population who display some or other kind of mental aberration, or tendencies thereto. I want to dwell briefly on a few of these. It has, for example, been found that the incidence of schizophrenia is 11 times greater among the lower social classes than amongst the upper. Gillis and others who carried out an investigation amongst the Coloureds found that mental aberration amongst the lower social classes amongst the Coloureds was 17 per cent in comparison with 5 per cent amongst the upper social classes. In South Africa we are experiencing the highest divorce rate in the world—in Johannesburg in fact it is even as high as one out of every four marriages. Then we are not even taking into consideration those who simply separate. We must bear in mind the fact that in the case of 80 per cent of the children in orphanages and institutions one or both parents are still living—which means therefore that those children are, strictly speaking, not orphans. From that we must conclude that the mother-child relationship is at a very low ebb. Research workers who have carried out experiments with apes have found that apes which have been removed after birth from their mothers for periods of six months show a retarded development pattern. In addition their relationships towards their mothers and their playmates have been disturbed for the rest of their lives. And surely man is superior to the apes! Goldfarb made a study of children in a similar institution and he found that—

I want to state as hypothesis that every child who does not in his youth receive mother love, maternal care and paternal discipline will in later years show signs of some or other mental disorder.

Owing to the nature of society to-day it is often the case that it is not possible for each individual to do that kind of work for which he has an aptitude or in which he is interested. We must accept that as a fact. Many kinds of work are monotonous and boring. Nevertheless we cannot divorce ourselves from the truth that the attitude we reveal towards our work exercises a vital influence on our mental well-being. Why is it that the work which people do is in many cases unsatisfactory to them? One of the first reasons which comes to mind is the fact that people differ so much from one another, differences of psychical and physical energy. Many people must continually do more than they are capable of doing. This, unfortunately, makes them dissatisfied and ill. Then there is the nature and the implications of the work which people do. One result of modern industrialized society is that the work which has to be done often has no deep significance for the labourer himself. He is only associated with a small subsection of the entire scope of the task. Much has been said and many questions asked in regard to alcoholism, dagga and other drugs. Without elaborating on this I want to state the hypothesis that becoming addicted to these drugs is without exception a result of some or other underlying mental deviation, regardless of how slight the degree. If we go into the matter we shall find that every young boy who is addicted to dagga-smoking has come from a home where there was a weak parent-child relationship. He was therefore suffering from a mental disorder before he turned to dagga.

Unfortunately time does not allow me to go into the other factors. As far as the combating of this problem, this national problem, is concerned, there are two phases to which we must give our attention. In the first place there is prevention—in other words, the combating of factors which I have already mentioned. We must restrict them to a minimum, these outside factors which influence an individual and, for example, cause somebody who is only depressive to become a manic depressive and later even a certifiable person. It is of these factors which we must take note. We must in the first place restrict them to a minimum. In the second place, there are the methods of treatment. This aspect we must view in its entirety. We must not merely concentrate on hospitalization. Formerly the idea of a mental institution was that it was a place where mental patients are isolated away from the community. The standards were whether a person was a danger either to himself or to others. If he clashed with the mores of his community then he was declared to be a mental patient and was isolated in an institution. In the past these kinds of institutions were generally regarded as places of isolation. To-day isolation is no longer the most important aspect. Treatment is the most important aspect to-day. Now there is the question: Is a cure possible? In recent times tremendous progress has been made as a result of the application of new methods and new drugs. Often a cure is not possible but it is nevertheless possible to bring about a very great improvement, so much so that a person can be returned to the community where he is able to do useful work. Here I want to refer to the findings of a series of tests in which 400 cases in the Tara Hospital in the Transvaal were involved. There it was found that in the case of 87.2 per cent of this number of patients, patients who had suffered from all kinds of mental aberrations, an improvement could be brought about. The rehabilitation process is unfortunately a lengthy one. The first signs of improvement were seen only after 40 days, while the highest degree of improvement appeared after hospitalization for 100 days. It is therefore an arduous and lengthy process. It is important to remember that after hospitalization our task is not yet complete. When a patient is discharged and restored to the community, there has to be after-care. We know that with some diseases 20 to 30 per cent of the patients subsequently display a recurrence of the symptoms of that disease. But as far as the Department is concerned, these patients, as soon as they leave the institutions, are certified as healthy, and after that the Department is no longer responsible for them. What becomes of those people? Sometimes they go to doctors and sometimes to provincial hospitals where they are helped to some extent. However, the Department is no longer responsible for that patient, because he is not certified. Each one is then on his own. There is no co-ordination, whereas in other cases there is overlapping. That we can ill afford, in view of our already limited services. A patient, after he has been discharged, must be rehabilitated. Attempts must be made to place him in sheltered labour. We must take steps to see to it that those factors, factors which I have already mentioned, which pushed him over the verge in the first place, will not influence him again.

In conclusion I want, for a few moments, to give some attention to the other part of this motion, namely the shortage of psychiatrists. They are the people who have to do the work, who have to undertake the treatment. To ensure optimum treatment we need one psychiatrist for every 30 patients under intensive treatment; one psychiatrist for every 150 patients under lengthy treatment; one special nurse for every five to 40 patients, according to the degree of seriousness of their illness; one social worker for every 80 new cases; and one psychologist for every 200 to 400 cases. Now we find that we only have plus-minus 80 psychiatrists in this country. We can therefore forget about ever ensuring optimum treatment. Humanly speaking it is therefore impossible, but what we can do is to try to apply the few we have with improved co-ordination. To become a psychiatrist is an arduous process. He is expected to qualify as doctor first, and that takes seven years. Subsequent to that he must go into practice for a year or two and then go back for a further four years. It is therefore an arduous and lengthy study. The nature of the work is arduous and sometimes unsatisfactory. There is also the unsatisfactory aspect of treatment—one never knows whether one is going to be successful. He has no certainty such as that in the case of a patient’s hand which has been broken and put into a splint. In such a case the doctor knows that it will be well again after a number of weeks. But the psychiatrist is never sure. Every day he has to deal with the abnormal.

That is therefore the picture I want to sketch of our problems, and that is why I am glad that we could find time for this discussion. It is a serious problem—in fact, a national problem and not merely a problem for the Department of Health. I hope the hon. the Minister will give us an indication of what his attitude is towards this problem. In 1963 a national conference was convened, under the patronage of the South African National Council for Mental Health. There were 249 delegates to that conference, amongst which the director of the World Federation of Mental Health. Let me read something from the findings of that conference—

1. 1. That there is reason for grave concern about the increase in mental illness in the country;
2. 2. that there should be integration of all health services that are now under individual control;
3. 3. that the deteriorating psychiatric and paramedical services must receive priority for immediate attention;
4. 4. that the erection of large mental hospitals without having the necessary qualified staff should be discouraged;
5. 5. that psychiatric practice should be community orientated and not be wholly settled in the hospitals; and
6. 6. that the present Act governing mental health services should be revised drastically and that the positive approach in the modern outlook of psychiatry should be incorporated in the Mental Health Act.

It is not for me to say how this must be done, but in all sincerity I want to ask the hon. the Minister to-day to give his attention to these aspects. With that I want to lend my support to the motion moved by the hon. member for Kimberley (South).

I should like to compliment the hon. member for Kimberley (South) for having brought this question to the notice of the House. I should also like to tell him that although we differ from him in so far as his approach to the solution of this problem is concerned, we hope that from a discussion of this matter here something will be done at least to alleviate the deteriorating position of this important question. I think we must firstly recognize that mental disease is not in itself a specialized disease but that it is part of the general disease that occurs in man. We find that it is, perhaps, confined to one part of the body, i.e. the brain, but in very many cases, I would say in the majority of cases, there is in fact a tie-up between mental disturbance and the general health, environment and normal life of the person affected.

One wonders whether it is really possible to treat the mentally disturbed person as one who has only something wrong with the working of the brain. For this reason I feel that it is essential for us to agree immediately that those people who look after health generally should be allowed to look after those who are suffering also from mental illness. If we are going to do that, then there must be an immediate tie-up between the affairs of the Government and the affairs of the provinces in so far as health matters are concerned. I think that we have lost far too much time in separating hospitals which are under the control of the Central Government from provincial hospitals. If we are going to follow the steps suggested by the hon. member who introduced this motion, I foresee that the end of that road will be a final “yes” to the question of whether we should ask provincial hospitals to incorporate in their work the treatment of mental disease.

I do not know yet what the findings are of the Schumann Commission in so far as health matters are concerned, but I would hazard a guess that they are in favour of combining the activities of provinces and the Central Government in so far as health treatment is concerned. If that is going to be the recommendation, it becomes apparent that some of the shortages from which we are now suffering, will be alleviated. It is quite true that we have a grave shortage of psychiatrists in this country, but if we are going to allow the provinces to look after the mentally ill, and not only the mentally ill who are ambulatory and who are treated as out-patients, but also those who go into hospitals, the shortages there might be relieved to some extent by employing the doctors who are working in the hospitals.

One wonders why there has been such an increase in the numbers of mentally disturbed people or of the psychosomatic who find that they cannot, or fail to, appreciate what is offered to them in the field of health. One wonders why they are not educated to go to those who are trained to help them. One of the reasons is very often that they themselves do not have an insight in their own condition. I would say that where a person feels that he needs the help of a doctor, he should, firstly, go to a general practitioner, his own general practitioner, to seek help there, because it is the home doctor who knows, more than anyone else, what his environment is and what is lacking in his environment, and how he can be helped there. I wonder whether it is not because of the shortage of general practitioners and the haste with which general practitioners have to look after their patients that we find that those who are mentally disturbed in one way or another go and look for other sources of help. Sometimes they go further afield and they go beyond the bounds of the trained psychiatrist or psychologist, and they find succour or, perhaps, some imaginary relief by going to quacks and to certain institutions, of which we have been reading about lately; institutions and cults which are run by people who are not properly trained. There is danger in that, because I feel, and I think a lot of others feel, that instead of alleviating the position it could quite easily be aggravated.

If there was going to be a commission of inquiry, I am certain that another thing it would find was that our teaching hospitals are not adequately equipped to train a sufficiency of doctors, who could be encouraged, through other means, to take up psychiatry. I have pleaded with the Minister of Education to open up and allow those universities that wish to to train non-Whites to receive them. At Baragwanath we have the largest and best hospital for non-Whites in the whole of Africa. Baragwanath stands there with all the facilities to train the Bantu. It is adjacent to a very large town of Blacks. It is said that at least 750,000 Black people live in Soweto, right on the border of this hospital. The University of the Witwatersrand is not producing the number of doctors that it should to cater for our population. I say to the Minister that he should now consult with the Minister of Education so that he will open up the doors of Baragwanath hospital. He should allow the Black students to go there, train them as quickly as possible, and encourage them—only a small proportion of them can, but let that small proportion do so—to become trained in the treatment of mental disease. Because, as the hon. member for Durban (Central) has said in most cases a person has to be treated by one of his own for him to be treated successfully. There is the language difficulty, the environmental difficulty, the mode of life —all these things can best be treated by one of your own kind. We are wasting far too much time in looking for psychiatrists who do not exist. The sooner we learn to make use of the facilities that we do have, as soon as we open the doors for those people who want to enter our medical schools; and as soon as we find universities that are willing to teach these people, the better it is going to be for all sections of our population.

The Minister knows quite well what is happening to-day in the Transkei. There is not a single psychiatrist available for the 1,500,000 Blacks living there at the moment. He knows as well as I do what the position is outside magistrates’ offices and prisons. The hon. member for Kimberley (South) mentioned the position regarding the shortages of beds, and how we in this country, a civilized country, still have to make available prison cells for the treatment of those persons who should be receiving psychiatric treatment.

It is distressing to think that in a place like Johannesburg, a great city, one of the foremost—perhaps the most foremost city in Africa to-day—as many as 60 non-Whites—I do not say Bantu but non-Whites—mental patients are kept in cells at a police station awaiting certification and admission to mental hospitals. The fact that they are being kept there is as sad as the first part of that statement, because they are “awaiting” certification. They are not being examined. Whilst they are awaiting certification these unfortunate occurrences took place. As the Minister knows, supervision and accommodation at the cells where mentally ill patients are kept pending certification are totally inadequate. In Johannesburg to-day many police stations have been closed down, and I want to make the suggestion that some of the police stations that were closed down because of an alteration in police policy, could easily be converted into temporary homes to detain the mentally deranged, especially for those who cannot be accommodated in white hospitals. I know that one of the reasons that will be advanced for not using these places will be shortage of staff. Well, let us make a start. Let us say that we can only keep three or four in one establishment. It would be something. Let us get nursing aides. Let us train non-Whites to be nursing aides, how to look after these people temporarily, and have the ill certified as soon as possible. I feel that every district surgeon in the country should make it his business wherever there are cases of persons being detained because they are suspected of being mentally deranged persons to ensure that those persons should receive priority as far as examination is concerned. We should avoid, as far as possible, a rendition of the state of affairs that has existed. I hope that we have heard the last of mentally deranged persons being put together in large cells with the result that they cause one another serious bodily harm, and even deaths.

I do not want to elaborate. That is the one extreme. On the other hand we find people who should be able to get help, people who are on the verge of mental break-down, but who do not get such help. They are not getting it because it is not available, or it is not easily available. The Johannesburg hospital, for instance, is in the heart of the Hillbrow complex. According to statistics we find that the suicide rate in Johannesburg is more than double that of South Africa as a whole. We have this taking place in the main in an area which is in a hospital complex, where we have the general hospital, nursing homes, mental disease homes, and so forth. Yet, in this very area, we find that the suicide rate is higher than in any other part of Johannesburg, whilst the Johannesburg suicide rate is twice as high as any other part of South Africa. The feature of the central area is this. One finds the aged pensioner, the unemployed, the alcoholic, the homosexual or the jilted lover all suffering from a lack of social contact. They feel that life is not worth living, and in this area where these people are living we find this very high suicide rate. Persons who are not mentally deranged do not do this sort of thing. These potential suicides must be helped. There is a society called Suicides Anonymous which should receive every encouragement from the Minister. These people should be encouraged to go out and help, to be ready to help, all those who feel that for them the end of the world is coming.

I want to say to the Minister that in the South African Digest of last month there appeared an article at the end of the magazine in which it says, “Big expansion schemes for Transvaal hospitals.” It says—

We have the chance here, with the goodwill of the Minister and with good planning, to see that every one of those hospitals which is going to be built will have a part set aside for the treatment of those mentally ill people who need specialist treatment. Every one of those hospitals must have facilities set aside to train general practitioners to take an interest in mental disease. Every one of those hospitals must have facilities for training the Bantu, so that he, when he becomes a doctor, will have available the facilities for taking up psychiatry as a speciality. According to the figures given by the hon. member for Kimberley (South), one-eighth of our population are affected by mental disease in one way or another. Well, I think that we have been very lax in the way in which we have set about satisfying the needs of our population as far as this matter is concerned.

If we take the advice of the hon. member who introduced this motion we will encounter delays again. We will find that if the hon. the Minister appoints a commission of inquiry, they will have to sit for at least two years. Perhaps this Minister will be replaced by another Minister; the new Minister will have to go into the matter again, and probably nothing will be done again. I say that with the staff we have, with the present Commissioner of Mental Hygiene, with his help and determination—and, perhaps, with his persuasion—we will be able to change the ideas of our Minister. We must see whether or not from to-day onwards we cannot get something done along the lines that we have suggested year to year from this side of the House.

Mr. Speaker, fortunately I have become so accustomed to getting unbalanced ideas from the other side of this House, especially if they concern matters relating to health, that this morning’s discussion, and particularly the final words spoken by the hon. member who has just sat down, did not suprise me. The hon. member once again came along with the old complaint of 64 persons who were being detained in police cells because they had not been certified and were waiting to be certified in order to be admitted to mental hospitals. But only last year I pointed out to him so clearly that in practice this type of case proved to be stereotyped. It has been the experience in actual practice that most of the people who were caught and who subsequently hanged themselves in the cells, were either dagga smokers or skokiaan drinkers. Now, that does not mean that all dagga smokers who are caught to-day will be sent to mental hospitals to-morrow. It has been discovered that most of them could be discharged after having been locked up for a few days. The hon. member came along with the story that those poor people who could in any event be discharged after a few days had elapsed, should be certified and should then be taken to institutions only to be discharged after some weeks or even months had elapsed. That is the type of unbalanced outlook which we constantly come across in the speeches made by hon. members opposite. Equally strange is the hon. member’s suggestion in regard to the training of Bantu psychiatrists. The fact of the matter is that we hardly have 200 non-white doctors in South Africa. We know that our white doctors are working very hard. Amongst the thousands of white doctors we hardly find 100 white psychiatrists. We cannot get them to specialize in psychiatry. Now the hon. member wants us to go out of our way to get some of the small number of Bantu doctors we do have—people who find it difficult to pass their examinations—to follow the difficult course in psychiatry. One always expects these unbalanced proposals from that side. But let me come back to the hon. member for Durban (Central).

Do you know, Mr. Speaker, the more I see of the hon. member, and the longer he remains here, the more he astonishes me. According to him the result of all these evils is a tremendous increase in the number of mentally ill persons in South Africa. That is the case throughout the world and not only in South Africa. He wants to burden the Department of Health with everything. The Department of Health must approach the schools. The Department of Health must cater for the mental needs of children in schools in order that they do not develop abnormalities. The Department must educate the mothers—the Department must, as it were, educate the entire community. Well, the hon. member does not astonish me in the least any more.

On the other hand, the hon. member for Brentwood to my mind gave one of the most balanced surveys of this matter. What he said, is indeed the truth. If the hon. member for Rosettenville wants to laugh about it …

I am laughing at you for not taking his advice.

The hon. member for Brentwood gave the facts of life. It is said that one out of every three persons in America suffers from some mental disorder or other. I do not know whether that is in fact true, because, as the hon. member for Brentwood asked: “Who can really be regarded as being normal?” [Interjections.] Yes, I think many people in this House would perhaps fall into that category.

What is the reason for this abnormality, this lack of mental balance? Is it not a fact, as psychiatrists tell us, that many people in our society lead an unnatural existence in our cities? Surely people and children are leading an unnatural existence when they are herded together in flats which do not have gardens. They find themselves locked up between four walls. If they go out into the streets they are surrounded by the walls which enclose the streets. They then have to be taken to the parks to play. Is that not one of the main reasons? Is one of the reasons not the fact that at present we have a way of life characterized by an artificial sense of urgency in which every person wants to be better than the next, in which every person wants to be richer than the next? Is that not a fact? Is it not a fact that most people do not get any recreation? Just think of the children and young people of Sea Point and the accusations which are made against those poor young people. What is the cause of that if it is not our society? Are domestic circumstances not also to blame, domestic circumstances in which the parent has no time to spend with his child? Is that not one of the reasons?

Yes.

I agree with the hon. member. Do parents not neglect their children? Is it not a fact that our young people are the ones who are the most adversely affected by the disintegration of family life? Under those circumstances those poor young people do not receive the necessary guidance and they run wild. Should we therefore be surprised if they eventually land in prison and in mental institutions? Does liquor not also play a major role? Are our young people not being taught to drink by our older people to a larger extent? Is that not also a major factor? Is the misuse of narcotics and other drugs not also a major factor? Surely it is not the duty of the Department of Health to teach parents how to educate their children. It is not the task of the Department to tell town planners how to develop their towns. It is not for the Department to say that there should be more recreational facilities for young people in the cities. It is not for us to see to it that families do not disintegrate. The Department of Health does not have anything to do with that. Why then do we also find this type of attack being made on the Department, attacks which are always unbalanced and never have sound bases? I say there is no justification for doing so. The hon. member said that perhaps there were many people in this House who also needed psychiatric advice!

The Department of Health, apart from social circumstances with which we do not have anything to do, tries to make and keep the public as healthy as it possibly can and as far as it is within the ability of the Department of Health to do so. There are two prerequisites for doing so. In the first instance there must be hospitals and clinics for the treatment of people. The other aspect is the people who provide the treatment, the psychiatrists. In the past hon. members spoke a great deal about accommodation, about our hospitals. I think I furnished figures in this regard last year, figures which indicated that we had hospitals and similar accommodation on such a scale that complaints could no longer be made, because we were very close to the ideal. However, Sir, the major problem of the shortage of psychiatrists still remains. A psychiatrist’s training is a specialized training which has to be received after the completion of the medical training. Only after a person has practised as a doctor, does he specialize in psychiatry.

We know that it is extremely difficult to get doctors to proceed from ordinary medicine to psychiatry. Over a period of many years our Department has been doing everything within its power. We have removed the stigma attaching to these hospitals to such an extent that hardly any stigma remains. We have succeeded to a very large extent. We have called in the assistance of our best medical leaders in South Africa. They have assisted us. We have nearly removed that stigma. We have integrated that with the system of medical training. We award bursaries to our students who have not even completed their studies in order that they will be able to study psychiatry after the completion of their studies. We have created special clinical training posts in our hospitals so that our young people may receive a salary while they are being trained in the hospitals. All these things are done on a large scale.

But, Mr. Speaker, the tragedy of all these things is that even if we do train our young people with all the power at our disposal, they simply do not remain with us. Whereas we train all those young people, they simply do not remain in our service. Over the past five years we have trained 20 persons at Sterk-fontein and of that number of 20 only seven are still in our service. At Weskoppies we have trained 13 people over the past five years and at present not one of them is in our service. That is the problem. One trains psychiatrists with the greatest effort and at enormous costs, but they do not remain in one’s service. What is the reason? There may be many reasons for that. The first reason is that private practice is very profitable and many of them go into private practice. But there is a second factor and that is that many of them go to the provincial hospitals to which they are drawn by pleasant and favourable circumstances—not that I begrudge anyone pleasant circumstances in life.

Mr. Speaker, let me just mention the facts to you: We have in our hospitals more than 35,000 patients suffering from mental illnesses in a serious degree. In many of those cases we have achieved wonderful results through protracted treatment over a period of many years. But in addition we have more than 22,000 outside patients. At present we have a clinic for out-patients at virtually every hospital which people attend on a voluntary basis and where they receive the best treatment free of charge. Treatment which sometimes costs people thousands of rands, patients at our hospitals receive free of charge. The results which are being obtained at present are so good that people from the best families visit these clinics for treatment because a stigma does no longer attach to these clinics and the services which are being provided there are wonderful services. More than 22,000 people receive treatment as out-patients every year. For this enormous number of people who have to be treated in the hospitals until they are cured and for this tremendous number of out-patients which we have to treat, we only have 22 full-time and part-time psychiatrists in all our services. We only have 22 and I have already said that we have trained 20 in one of our hospitals over the past five years. I now want to tell you what the position is in three provincial hospitals without mentioning the names of the hospitals. Those three hospitals have a total number of approximately 175 beds. The number of patents they treat in a year is between 1.000 and 1,500 at the most. Do you know how many full-time and part-time psychiatrists they have in their service? They have 25. In order to treat 1,000 to 1,500 people the provincial hospitals have 25 full-time and part-time psychiatrists in their service, and we, with the enormous task which we have of treating 35,000 bed patents and 22,000 outside patients have 22 full-time and part-time psychiatrists. That is our problem.

Whose fault is that?

Whose fault is that? I shall tell the hon. member what the circumstances are. When one is in the service of the State, one has to treat every patient; one cannot select patients; one cannot say that it would take years to cure any particular patient and that one does not want him; one cannot say that one is only going to treat the less serious cases; one cannot say that one is not going to take patients unless one will be able to obtain results within a short period. In the provincial services, on the contrary, patients are selected and the more difficult cases are left to the central hospitals, those cases of schizophrenia, which are always difficult cases, the cases of senile psychosis, the difficult epileptic cases, the low-grade mentally deficient; for those cases the State has to care. The provinces only select the cases which can be treated easily. They merely select the cases of neurosis and similar nervous conditions. What is the result of that? The result is that the psychiatrists in the provincial hospitals have easy and fruitful tasks. Everyone of us, whatever we do, would like to achieve good results. If one is able to treat a person and to cure him, it gives one tremendous satisfaction and the psychiatrists in the provincial hospitals get that satisfaction but the psychiatrists in our central hospitals only get that to a partial extent. The result naturally is that they prefer to work in the provincial hospitals. With the large number of patients we have in South Africa, the services of the psychiatrists in the employment of the State are not restricted to one place only; the psychiatrists have to serve in various places. The person who is at Komani has to assist in Port Elizabeth; the person in Grahamstown also has to render assistance in Port Elizabeth or in East London; he has to render assistance everywhere. Our task is an enormous one as a result of the fact that we have such a small number of psychiatrists in South Africa.

Give the provinces more work.

Is the hon. member now really being serious? Do we have to classify him under the category of people to whom he referred a short while ago? These services must be performed and if one is going to leave the treatment of all these cases to the provinces, what is going to happen? Who will then be left to treat the serious cases? That is the problem. There is only one solution and that is that these services in South Africa must be co-ordinated. It must not be possible for the provinces to say, “The cases in the provincial hospitals can be cured easily; come to my hospital”. And that is what the psychiatrists are saying amongst themselves at present; they regard the provincial service as being an easy service, where circumstances are pleasant and where they achieve good results within a short time. They regard the service in the State institutions as being a second-rate service, because there they have to work harder and they have to deal with more difficult cases. The problem is, in the first place, that there is insufficient co-ordination. In the first place, one must get better co-ordination.

Why then do you not bring that about?

That does not depend on me alone. The Minister of Health does not determine the relations between the provinces and the Central Government. Why does the hon. member always have to be unfair in his arguments and in the facts he mentions? Surely it is not right to do so. He does not, after all, achieve anything by doing so. Every person who wants to achieve something must be fair and balanced in his judgdment. I appreciate the attitude which hon. members adopted here to-day but this discussion merely confirmed once more the view the Government has held for a long time, and that is that better co-ordination between the provincial services and the State services is absolutely essential. I cannot say when a decision will be taken in regard to the recommendations contained in the Schumann Report; they are being considered by the provinces at present, and I want to express the hope that we shall find a solution before long. As regards the relations between the provinces and the Central Government as far as psychiatric services are concerned, I do think that that is a subject which requires even more thorough study. We shall have to investigate this matter even more. There the Government supports the view that we have to institute further investigations in order to assist in achieving even greater co-ordination between the services being rendered by the provinces and the State in this regard.

I rise to support the amendment moved by the hon. member for Durban (Central). I believe that the subject raised in the motion before the House has been the subject of a previous investigation, and to the best of my knowledge the information obtained by that commission has not filtered through to us. I feel that we are entitled to know what the findings of that commission were. Sir, so much is known about the subject and the Minister has had so many good suggestions from this side of the House that I doubt whether it is necessary to appoint a further commission to investigate this matter, but at the same time I do want to commend the hon. member for Kimberley (South) for raising this particular subject because it is, as he has said, a subject of vital concern to the whole of the country. For that reason I think we must commend him for focusing attention on this matter, and if what he and other members have said in this debate will activate the Department into taking definite steps that can alleviate the situation, then I think that only good can come from the fact that he has moved this motion here to-day.

Sir, I am surprised to hear the hon. the Minister say that to the best of his knowledge we are very well supplied so far as hospitals and clinics in this country are concerned and that the real trouble lies in the fact that there is a shortage of psychiatrists. In Port Elizabeth, where we have a population of over 100,000 Whites, 90,000 Coloureds, and 150,000 Bantu, we have no mental hospital whatsoever, except at Grahamstown which is some 80 miles away. I know for a fact that the fact that this mental hospital is 80 miles away from Port Elizabeth is definitely creating a great deal of hardship. I feel that we in Port Elizabeth or in the Eastern Cape have a very definite claim that further hospital facilities should be created there. The hon. the Minister has raised the question of co-ordination. If greater co-ordination between the Department of Health and the provinces is going to improve the situation, then I would say that we are all in favour of a greater degree of co-ordination. I know from my own experience in Port Elizabeth that it is the lack of co-ordination there that is perhaps making it more difficult to treat the mentally ill. Sir, I think it is appropriate that the hon. member for Kimberley (South) raised this particular subject at this particular time, because the Council for Mental Health is having a conference in Port Elizabeth at the present time. It is interesting to read in the Eastern Province Herald of the 8th of this month what Dr. Stander, Director of the National Council for Medical Health has to say. He confirms that there is a very big shortage of psychiatrists in this country. He said that there was a desperate need for more trained mental health personnel at all levels, both in mental hospitals and for voluntary mental health services. He said that the most important discussion at the three-day conference of the Council which would be held at Port Elizabeth was what positive steps could be taken in conjunction with the Government departments and training institutions to relieve this shortage. Sir, I do hope that there is going to be the fullest co-operation from the Government side, because we support the hen. member for Kimberley (South) when he says that there is this urgent need.

We on this side of the House believe that there are some steps the Government could take to help the situation. He also pointed out this very matter that I have raised. He said there was a need for more mental health clinics and treatment centres in the country. He also raised this question of Port Elizabeth which I am emphasizing, a city with a population of half a million which has no mental hospital for Whites or non-Whites within a range of 80 miles. What I say this morning is in respect of this problem as it affects the Eastern Cape. We have very good mental health societies there that are doing all they can to alleviate this serious problem, but because of the shortage of facilities they are being very seriously handicapped in their work. So I would make a very special plea this morning that the Department consider very seriously the establishment of a ward in both the Provincial Hospital and the Livingstone Hospital where people who are not so seriously mentally affected that they have to go to Fort England can go for treatment for a short period. I am thinking particularly of the short-term mental patients. Such patients could be admitted to these new wards built on to these hospitals for a brief period of treatment, and then they could either be discharged, or if they have to undergo prolonged treatment they can then be transferred to Fort England in Grahamstown. But the problem has arisen that this facility we ask for cannot be provided because the Livingstone Hospital and the Provincial Hospital are controlled by the province and mental health is under the control of the State. I feel that if better coordination can be arranged, then surely we have a very strong claim to this in Port Elizabeth, that these wards should be subsidized or assisted in some way by the State, although they would form part of the provincial system. Those wards should be provided there both for Whites in the Provincial Hospital and for non-Whites at the Livinstone Hospital.

In conclusion, I wish to make a very urgent appeal to the Minister to give this matter his most serious consideration, because I can give him the assurance that this matter is causing great hardship in our community.

I think that we had a very fruitful discussion on this important matter this morning, and I am grateful for what we were able to learn from the contributions made by various hon. members. We also feel very reassured by the reply of the hon. the Minister that the Government was aware of this problem and was giving it its attention. For that reason I think that this motion has served its purpose and, with the leave of this House, I should like to withdraw it.

With leave, amendment and motion withdrawn.

I move—

1. (1) instituting mass screening of persons of all races in the affected areas;
2. (2) assisting affected persons to meet the cost of treatment; and
3. (3) giving top priority to further research into the disease by the Council for Scientific and Industrial Research and other appropriate bodies.

The history of this disease can be traced back for many centuries. Apart from traces that were found in mummies in Egypt, the first recorded history of it appears in manuscripts of mediaeval Arab physicians. It is also referred to by Portuguese doctors working on African trading stations furing the 16th and 17th centuries. However, the parasite which causes the disease was only discovered in 1851 by one Dr. Bilharz, whence the name of the disease. The eggs of this parasite, which is also found in South Africa, were first identified in South Africa only in 1846. Since then many researchers have worked on this problem and much is known about its life cycle and the treatment of the disease. During this period Dr. Charles Nicholle described bilharzia as a disease “whose destiny it was to be born, to live and to die”. Unfortunately, however, despite its hoary age, it still displays a remarkable vitality and, in fact, the disease is still spreading, insidiously but definitely. The World Health Organization has estimated that at least 500 million people throughout the world are affected by this disease. It is estimated that in South Africa alone 3 million people are affected. The persistence and the spread of this disease have been favoured by various factors, the most important of which are, firstly, the impossibility of ensuring strict personal hygience amongst the inhabitants of the endemic areas; secondly, the inadequacy of the drugs available for curing the disease; and thirdly, the impracticability of measures devised for controlling the vectors, which in South Africa are the Bulinus snails.

Dealing with the first factor, we have the problem in this country of the inhabitants of the infected areas. These areas include most of the Bantu Reserves, in which it is almost impossible to ensure strict hygiene among the people. Although the Bantu are a naturally hygienic people, they do not understand our methods of hygiene. Their primitive methods of sanitation do not provide for the use of proper latrines or for the proper disposal of excreta. Two years ago the hon. member for Koedoespoort introduced a motion in this House, urging the Government to prevail upon these sections of the population to ad-just their customs and way of life so as to fit in with the requirements for the effective prevention and combating of this disease. With all due respect to the hon. member, from my personal knowledge of the Bantu people I would say that this is impossible. Their very nature is such that they do not appreciate our methods of hygiene. They are taught hygiene in schools. In practice, we find that what they are taught in schools and apply while they are there, and much as they apply it while they are under the influence of the white man, immediately they return to their kraals these things are forgotten and they go back to their traditional way of life. In fact, this has been found to be the case throughout the world. Only in Japan has this means of preventing the spread of the disease been effective. Japan is a small country, densely populated by people of a certain level of intelligence, and they are winning this battle against bilharzia after many years of strictly enforced hygienic control. I believe that it is enforced there by law, and many things which are taken as natural not only by the Whites in South Africa, but particularly by the non-non-Whites, are offences punishable by the courts. But when you consider the vastness of South Africa and the nature of the population, which is very sparsely spread over these areas, and who are largely illiterate and only semi-civilized, this is an impossible task.

Another factor operating against the implementation of these methods is that the Bantu people have lived with this disease so long that they have come to accept it as part of their ordinary way of life. They accept it as something which is there and that they have not been able to do anything about. The nature of the disease is such that a person suffers from it for many years before it really becomes chronic and before he really feels the bad effects of it. There is, however, I am glad to say, a growing awareness among the Bantu of the existence of this disease, and they are becoming increasingly aware of the way in which it affects their lives and their productivity, and more and more of them are seeking treatment, but unfortunately, in many cases only after the disease has become chronic.

The answer to this problem, I submit, lies in Part 1 of the motion, and that is to introduce mass screening of all persons in all the affected areas. I understand that in the past testing for bilharzia has been a lengthy and costly business and that it has involved the use of a particular material which is not readily available in large quantities. However, I want to quote from a report in the S.A. Digest of 23rd December. 1966, where, referring to the achievements of a Pretoria team of pathologists, they say this—

This, to my mind, is a fantastic break-through. Now we will be able to do something about it. One of my colleagues, however, will deal further with this aspect.

The second factor I mentioned which has favoured the advance of this disease is the inadequacy of the drugs available for the treatment of this disease and, of course, the drastic nature of the treatment and its unpleasant side-effects. However, recent advances in research have produced drugs which are claimed to be efficient and which can be produced cheaply in large quantities, which are easy to administer and which act rapidly with few or no side-effects. These are the claims made by the manufacturers and by various researchers. It is not for me to say whether it is correct or not. One such drug which is administered orally and which has been tested in Natal at the King Edward VIII Hospital is claimed to be 97 per cent effective. A total of 150 patients were treated. They were all non-Whites. Unfortunately, in the case of non-Whites, it is often difficult to trace these patients after a period, but of the 150 treated 97 were traced after two months. Of the 97 traced, only three were not cured. This gives a fantastic percentage cure of 97 per cent. The report goes further on this particular test. It is claimed that only two of the 90 cases that were traced showed signs of a minor intolerance to this particular drug, and none of them showed any significant toxicity. I am sure that the hon. the Minister of Health will understand the implication of this. As I say, it is not for me to verify these claims; it is up to the Department, and particularly up to the C.S.I.R. to do so, but it does appear that there has been a breakthrough in the research in this field, and it does open up the prospect of not only mass screening, as I suggested earlier, but also the mass treatment of people in those areas where bilharzia is endemic.

What is most significant to me in reading these reports is the claim made by the manufacturers of some of these drugs that they interrupt the life cycle of the bilharzia parasite. It is generally accepted that the only way to combat this disease is to interrupt that life cycle and to prevent the propagation of the parasite which carries this disease. This life cycle, briefly, is that when the millions of eggs which are laid by the female parasite in the human host are excreted and reach water, they hatch into larvae or miracidia. They then seek out a snail and penetrate its body, where they develop into cercariae. These then go back into the water and on contact with a human or animal host, they penetrate the skin and develop into these parasites and the cycle begins again. As a matter of interest, I believe that these parasites can penetrate the skin in as little as 20 seconds. That is all the time that it takes for these parasites to penetrate the human skin. It means that a person does not necessarily have to bathe in infected water for any length of time. He only has to dip his hand into the water to wash off a bit of sand and he can contract a disease like that.

This brings me to the third factor which favours the spread of bilharzia. That is the impracticability of measures devised for controlling the vectors. So far these measures have been ineffective for various financial and practical reasons. The problem in attacking these snails is not just to kill them—that is easy—but not to affect the insect, fish and plant life which is also in and around the water which is infested. Much research and experimenting have been done in the field of molluscicides for the treatment of these snails. This must be co-ordinated and extended. This is one way of breaking this life cycle. An interesting report appeared in the Sunday Times of the 18th December, 1966, which claims that a method of sterilizing bilharzia-infested waters has been perfected. I have endeavoured, but unfortunately have been unable to get any further information on this claim. Perhaps the hon. the Minister knows about it and perhaps he could advise us on it. But it appears that this new process attacks the cercariae, not the snail. This, to my knowledge is a new field and certainly bears further investigation.

Over 100,000 square miles of South Africa are infested by this snail. This area stretches from the Sundays River east and northwards through the Transkei, Natal, Zululand, Swaziland to the Eastern and Northern Transvaal. It was, until a few years ago, considered that the disease had been confined to that area of the Transvaal north of the Witwatersrand watershed. But snails have now been found as far west as Schweizer-Reneke. The snails have also been found in the Vaal Basin, as well as in the Orange River. The old belief that these snails were only found in east-flowing rivers which flow into the Indian Ocean has been disproved. Similarly the fallacy that catchment dams that are not fed by rivers or streams, were free of infestation. Infected snails have been found in such dams in the Natal Midlands. This means that the spread is continuing further.

But, Sir, I want to deal with the implications of the infection of the Vaal and Orange Rivers. This is serious. With the vast irrigation schemes which are now in progress and which have been planned, there is a distinct possibility, in fact, the probability, that this dreadful disease will be spread to the whole of South Africa. I know of the precautionary measures which the hon. the Minister’s Department is taking, which those other departments which are involved in the construction of these schemes are taking. But they, I submit, are not enough to ensure that this disease is not going to be spread into the western half of the country. I must warn the Government of this and that urgent, immediate action must be taken to combat this disease at its source. Research must be done and we must get on with the job, because it will only take one person, one infected person, who might not even know that he has the disease, to come from one of the infected areas to one of these enormous irrigation works and the whole of the area can be set alight. Therefore it is a matter of urgent, national importance that further research into this disease and its eradication be given top priority.

I have given instances of claims by various bodies of success in the various fields of research. What I want to know, is: What is being done to co-ordinate, to advance and to improve this research? We have the South African Council for Scientific and Industrial Research, which is doing a tremendous amount for the benefit of South Africa in many spheres. I want here and now to pay tribute to the work which is being done by this body in this particular sphere. However, when I look at the pitiful amounts that it has been able to allocate to this research, I wonder how they have been able to accomplish anything at all. During the year 1963-’64 they were able to allocate R39,100. During 1964-’65 it was R40,376. In 1965-’66 it was R50,730. In the 1964 Annual Report of the C.S.I.R. this fact was mentioned. It is said that as the amount that they have been granted for research has increased at the rate of only 7½ per cent per annum, they have been able to allocate only such an increase in this field of research. They pointed out that with the voracious demand (I think that was the term they used) for grants for research in this country, they find it impossible to keep on. These sums are woefully inadequate when one thinks of the magnitude of the task that the C.S.I.R. faces and the importance thereof. I know that there is a divergence of opinion as to the effect of this dreadful disease. It is not a spectacular disease, such as poliomyelitis, tuberculosis or malaria, which kill and maim thousands of people every year. In fact the 1965 Annual Report of the C.S.I.R. has this to say:

Is that not a terrible indictment, that there is no consensus of opinion of the effects of a disease which has been known for centuries? Does it not show that surely more research is required? I would go further and say that surely this supports the plea which has been made by this side of the House (I have found it on the records) for a number of years that bilharzia should become a notifiable disease, so that we can at least get a picture of what is happening and where it is happening.

However, I want to say from my own observations and my own experience that I am satisfied that bilharzia is an insidious disease that does affect the sufferer. Nobody will tell me that the person who is infected does not suffer and that his productivity and his work do not suffer. This is a debilitating disease. It causes anaemia, pain and suffering and it can, in certain cases, be fatal. It affects the efficiency and productivity of the sufferer. Ask any farmer in the Natal Midlands. Citrus farmers in the Eastern Transvaal admit that they cannot get as much work out of an employee who is infected as from a healthy labourer.

These are things which those of us who are in daily contact with people affected by this disease, know. It is estimated that at least 70 per cent of the people of all races, in the rural areas of Natal, are infected. In fact, almost every adolescent admitted into the King Edward VIII Hospital, no matter for what reason, is found to be suffering from this disease. South Africa cannot afford this loss of man hours. For years many people, including hon. members on this side of the House, have been urging that more should be done in this field. The Government, Sir, must stop running away from the problem. Many Ministries are involved—it is not only the responsibility of the hon. the Minister of Health and his Department. Therefore I am very sorry to see that no other Ministers are here, particularly the Minister of Water Affairs, the Minister of Bantu Administration, the Ministers of Agriculture—because agriculture is affected. The disease is attacking cattle and we have already had cases of death amongst cattle in Zululand. Commerce and industry and provincial administrations are also involved. As a matter of fact, this is such a clouded issue that it is impossible to get a true picture of what is being done or exactly how much is being spent in this sphere. The new Minister of Planning is himself a medical man and therefore I should like to appeal to him to make a plan to co-ordinate all efforts to control this disease. My appeal is that Ministers should stop passing the buck. Rather, they should get down and help our research units to fight this dreadful disease. We have the facilities in this country and we have the men with the capabilities of beating this disease. All these are asking for is that red tape should be eliminated and that they should be given the funds and they will conquer this disease.

The hon. member has brought up a very important problem for discussion. I feel, however, that before mass screening and mass treatment are undertaken we should first try to get some idea of everything that is involved here. In the first place we have to contend with a too complacent attitude on the part of our people as a result of the fact that bilharzia infestation usually does not have fatal consequences. Although it does affect the sufferers and makes them less fit for work, it is not fatal. That is the line of reasoning that is followed. I say that in the first place we should regard bilharzia as a common problem in tropical and sub-tropical countries. It affects approximately 400 to 500 million people, that is to say, about one-eighth of the population of the world. It may therefore be said that one out of every eight people in the world either suffers from or is exposed to bilharzia. After malaria and hookworm, bilharzia is the most important parasitic disease.

In South Africa it is endemic in the tropical and sub-tropical regions and, as the hon. member said, an area of approximately 100,000 square miles with a population of between 2 and 3 millions is affected by it. While bilharzia occurred only in the northern parts of our country at first, it has also spread to the south now. In fact, as the hon. member said, the Vaal River Basin is also infected now. Infected snails have recently been found at places where there had been no infected snails before. I think that the disease was brought there by Bantu who were brought to the Free State gold fields to work there, Bantu who came from the endemic regions and were therefore infected with bilharzia germs. If we do not attempt to check the spreading of this disease, it will simply continue to spread in this way. It is difficult, however, to control the movement of people from one part of the country to another. The development of the Low Veld and the building of dams such as the Josini Dam and others with their irrigation canals favour the development of and provide a favourable habitat to the snails which are responsible for the spreading of bilharzia. It therefore seems that we must expect a greater spreading of bilharzia in South Africa in the next few years. To see the seriousness of a disease in its right perspective one must be able to determine fairly accurately the number of deaths and the morbidity caused by the disease. For example, what do we know about the incidence of this disease? As I have said, about one-eighth of the population of the world is affected by this disease. It is also known that this particular disease has been with us for at least 30 centuries, because bilharzia ova were found in uroliths and tissues of mummies of the 20th Dynasty —that is to say, of the years 1200 to 1090 B.C. Even so, our knowledge of the symptoms, the treatment and the prevention of this disease is still very incomplete.

Is the incidence of this disease very high? In this regard we find that the authorities differ with one another. Elsdon Dew, for example, maintains that virtually all boys in Natal are infected, while Bhagwandien, on the other hand, thinks that only between 20 and 30 per cent of them are infected. Why then is it difficult to determine beyond any doubt whether or not a person suffers from bilharzia? We find that open cases undoubtedly harbour live worms when worms or their ova are to be found in tissues or secretions. Then there are the “closed” cases where one can merely assume that a person is harbouring worms or harboured worms previously if the patient had been exposed to bilharzia-infected waters at some earlier stage and if each or at least three of the following laboratory tests have a positive result: The complement fixation test; the fluorescent anti-body test; the bilharzia skin test; and an abnormal eosinophile count in the blood. Then it also depends on whether the patient’s symptoms are the characteristic ones indicating the presence of the worm or its ova. Before proceeding to administer treatment, one must determine whether the symptoms caused by the worm or its ova will be more harmful than the possible harmful effects caused by modern therapeutic treatment.

It should be noted that (1) infested persons can carry live worms in their bodies for decades without any noticeable harmful effects or any demonstrable disease process; (2) the most effective therapeutic agents available today, namely emetine and antimony preparations, can be dangerous and even lethal; (3) there is no preparation available on the market today with a proven rate of cure of more than 70 per cent; and (4) the new bilharzia remedy, Ambilhar, has not yet been proved or accepted at international level. Its real properties as far as safety and reliability are concerned still have to be confirmed. In fact, certain harmful side-effects are already known. Deaths as a result of bilharziosis and acute fulminating bilharziosis occur very rarely in South Africa.

From what I have said here my hon. friend for Pietermaritzburg (District) will see that the mass screening and treatment he has called for is almost an impossible task. It should also be noted that a person who has been treated can be infected again, particularly the Bantu who live in unhygienic conditions in the endemic areas. I do not want to suggest in any way that bilharziosis is a minor disease. I am saying this on the grounps of (a) the wide spectrum of clinical-pathological images produced by it—as a matter of fact, there is almost no organ, gland or tissue of the human body in which the worm or its ova have not yet been found; (b) the mechanical complications of granuloma and consequent fibrosis; and (c) the carcinogenic part it plays in the bladder and cervix. I therefore maintain that the main control points as far as bilharziosis is concerned must be the following: (1) Group treatment of infected individuals; (2) control of snails; and (3) health guidance to all population groups, that is to say, in environmental hygiene and sanitation. If these three cannot be undertaken simultaneously, one has no hope of stamping out this disease. There are three research centres in Africa at the moment, namely (1) the Bilharzia Research Institute in Egypt; (2) the Bilharzia Chemico-Therapeutic Centre in Tanzania, which is run by the W.H.O., the British Medical Research Council and the Tanzanian Government; and (3) the C.S.I.R.’s research unit at Nelspruit in South Africa.

I agree with the hon. member that a great deal of research into the morbidity, diagnosis and treatment of this disease is still necessary. However, I am pleased to be able to pay tribute to research workers in South Africa. Here I refer among others to Dunston and Pepler for their modification of the bilharzia complement fixation test. Previously the test material was prepared by means of parasites washed from mice livers. It took many infected mice to make one test possible. It can therefore be understood that there was a shortage of the antigen everywhere, and even the W.H.O. was unable to supply it. Dunston and Pepler decided to use the antigen from the parasites of cattle livers (Schistosoma Matheei). There is no shortage of cattle livers. In some parts of the Eastern Transvaal there is a 100 per cent infection. The tests yielded satisfactory results, and now we have plenty of material, and for the first time it is possible to apply this valuable test on a large scale throughout the world. This single discovery can greatly increase the knowledge about bilharzia everywhere, and a great deal of credit is due to these two research workers for this valuable discovery. It may be interesting to mention here in passing that the animals in the Low Veld such as monkeys, baboons, pigs, crocodiles and hippopotami that were examined showed bilharzia infection. I am also glad that the C.S.I.R. decided to make R 10,000 available for research in connection with the treatment of bilharzia—in other words, the effect which the new remedies are having.

I hope and trust that we shall have more knowledge of and control over this disease before long and that it will be possible for our Government to vote even more funds for research, control of snails and health guidance.

In conclusion I want to thank the hon. member once more for again bringing this rapidly spreading disease to the notice of this House, and of the Minister in particular.

Mr. Speaker, when the House adjourned I had just commenced to express the appreciation of the hon. member for Pietermaritzburg (District) and myself to the hon. member for Geduld who as a medical man had taken part in this debate. Mr. Speaker, I think that you know that neither the hon. member for Pietermaritzburg (District) nor myself have medical training. We are not known as Dr. Webber or Dr. Sutton. We therefore bring to this matter an approach which is outside the realm of medicine and we hope to bring it home to the hon. the Minister, to this House and to the country the very real problem that we face and the magnitude of the problem which I feel in many cases tends to be overlooked. It is a growing problem and that really is the point of the motion introduced by the hon. member and seconded by me, namely that we are attempting to bring home the magnitude of the problem, the fact that it is growing and the threat that it poses to the people of South Africa. I believe that this is a very sound motion of immediate interest to the people of South Africa. I think that the hon. member who introduced it is to be congratulated for introducing it in a serious and constructive manner. This matter enjoys the support of both sides of the House. It has been the subject of motions in this House before. It has been the subject of great concern to hon. members here and in the Senate where I remember that two years ago Senator Sutter introduced a motion on this very subject to which the Minister at that time made a reply.

The reason why it is brought up again to-day is that we believe that progress has been made in attempting to find a solution and attempting to nut the Department of Health which is the department to which we look for protection against this particular disease, in a position to take active steps to benefit the population as a whole. I cannot stress enough the necessity for attempting some measure of control. This is something which we cannot allow to escape out of the control of the Department of Health. It is something which is insidious and is creeping into all sorts of places where it has never been before. I believe that we must take very serious cognizance of this fact and attempt to establish first of all the incidence of the disease. That is really the point of the first portion of the motion introduced by the hon. member namely to introduce a process of mass screening whereby we can pinpoint the incidence of the disease and new areas into which it may be moving. The great difficulty is that it can move into a new area almost undeteced. This is not a disease which causes spots on people which enables you to see that they have got it. It is a most difficult disease to detect. I want to ask the hon. the Minister whether he has any plans in mind of making a positive effort to pinpoint the incidence of bilharzia. We know that there are certain areas in which it is endemic but we have found in the Midlands of Natal that this is something which is continually encroaching on new areas. The motion asks for a mass screening of the people in these areas. The question was raised whether it was practical because it was not thought practical in the past because of the fact that the test had to be carried out with material gathered from the livers of mice. As the hon. member for Geduld said, it takes quite a few mice to test one person. Now a new breakthrough has been made by the experts in Pretoria and this material is now more freely available. I believe that the time has come for the Department of Health to start such a scheme of mass screening.

It can now be done and I believe that it is important for various reasons. One of them is the question of farm labour. Those of us who employ Bantu labour and in particular those who have to employ Bantu migrant labour, are faced with this problem. I do not believe that any thinking farmer would employ Bantu migrant labour on his farm if he knew that they were infected with bilharzia because it carries the immediate threat that the whole water supply, namely the dams, streams, etc., and all else on that person’s farm, can be contaminated. I think that for people who are interested in agriculture this is something which can be of the utmost concern. It is something which the Department of Health should be encouraged to investigate and to take positive steps to solve. It is not only a threat to the Bantu community, but to the white community and all rural areas, and not only farm families. It goes far beyond the bounds of the farmer and his own family and reaches out to members of the public living in the smaller rural communities to whom a Sunday picnic has become a tradition. If the cost of that relaxation is going to be bilharzia, then it is going to affect thousands of our people who have a right to demand that every effort should be made to protect them against this particular scourge. This process has now become available. I think that it enables us to take the first fumbling steps towards attempting to control bilharzia and attempting to limit its incidence.

I am particularly concerned about this matter and we, in Natal where the disease has been endemic in the hotter areas for a long while are particularly concerned because we have in our province a vast chain of State dams being built which provide a magnificent source of relaxation for the whole of our population. I have spoken about this before in this House—and hon. members from those parts of Natal where these dams are being built will support me—that these dams offered to our people an undreamt of source of relaxation and the chance to participate in water sports, such as boating, sailing and fishing. These are things which they have never had before and they are now available on a scale which we have never dreamed of. The plans of the Natal Provincial Administration, the Department of Tourism and other interested bodies to exploit these areas are going to have the effect that they are going to bring more and more people into contact with the water. This comes very close to the situation described by George Bernard Shaw when he spoke of marriage. He said that marriage was an ideal institution because it combined the maximum of temptation with the maximum of opportunity. I may add that George Bernard Shaw was a bachelor when he made this statement. This comes perilously close to that kind of situation because you have State dams and opportunities for relaxation and provision is made by State authority for people to come into contact with the water. I believe that there is a very great need for a scheme to provide some sort of protection by the State in these particular cases. This is one of those diseases which, as sometimes happens in history, has suddenly taken on a new urgency. It happens every now and then in history, when a sudden change of events takes place such as this new system of dams that suddenly brings this to the forefront. This is to-day taking on an increased importance throughout South Africa because it concerns not only the dams in Natal but the whole Orange River scheme and the Western Cape. Everywhere where there is today stored water, there is a threat to the people that this disease may spread.

Suddenly in 1917 there was a world epidemic of influenza which followed the war, the deprivation suffered in the four years and the massacre of the people. To-day this threat of bilharzia is posing us with a crisis. I do not put it at anything less than that. It is a crisis which is being brought into the very homes of the people of South Africa. This is the nature of our problem. We want to find out what we can do to lay the foundation for an attack on this disease. Obviously, if we want to mount an attack, we must have information. This is the first requirement.

We have to have accurate up-to-date information in regard to its incidence, where it is to be found, of new areas into which it is spreading, and of the areas in which it can be easily controlled before it can take hold. This is the old military axiom. First of all you have to find your enemy. You have to establish his whereabouts. Then you have to drive in his outposts. When you have driven in his outposts you can concentrate your attack on his main concentration. That is what we are asking for in this motion. The primary object in asking for mass screening is not to establish the presence of this disease in an area in which we know it is endemic. We know that there are certain areas where it has always been. We want to know where the disease is now becoming established, where it was not found before. I believe that this can be done. We want to know where it has recently penetrated and to see that the most urgent action is taken in those areas to check its spread. I believe it can be done. Perhaps in that way we shall be able to create a cordon sanitaire-—a belt—around the incidence of bilharzia, where we can manage to clean it up and then mount a major attack on the areas in which it is endemic.

This is obviously not an easy problem to get hold of, because of the fact that man, who is the carrier of the disease, is so innately mobile. He can come and go as he pleases, but we believe that a careful and regular use of the screening process and careful treatment, particularly where there are concentrations of people in schools and clinics and other institutions and organizations of the Department of Health, will give the most valuable results.

Spot checks can be made in a particular district. I think it is quite fair to say that in the school you will find, perhaps sooner than anywhere else, the incidence of this disease, because of the natural affinity that young boys seem to have for water. When one considers the great campaign that has been mounted by the department in the past against malaria, and the continual battle we have against tuberculosis, the fight against polio and even the battle which took place in Zululand against nagana and the tsetse fly, one realizes that it is within the capabilities of this department to mobilize the resources of the State and to take this action. What is necessary is the realization of the growing seriousness of this problem. I do not for one minute accuse the hon. the Minister of not being aware of the seriousness of the position. I have heard him speak on this matter before in the Senate, but we have to realize that this is a growing problem. It is something which is creeping up on us. It is growing into new areas where it ought to be contained. That is why we believe that the use of this process of screening, the use of new drugs, the attempt to limit the incidence of the disease and the attempt to prevent the disease breaking out into the whole of South Africa is something of the utmost urgency and something which ought to be undertaken right now. I came across an article in the Sunday Tribune of the 22nd January this year, dealing with the position in South-West Africa. The headline reads as follows: “Bilharzia invasion fear from canal scheme”. I should like to quote a few excerpts from this article. It states:

and this is only too true, Sir,

Is that not also the case of the rest of South Africa, where we have these enormous State schemes to bring water to these areas? Is it not important that we should exclude bilharzia from these areas? The article continues and mentions the Okavango territory, to the east of Ovamboland, which is the area to which the water is being brought. It says that the Okavango territory is riddled with bilharzia, while Ovamboland is free. The plan is to bring the water from the Kunene River into Ovamboland through canals, but the Kunene’s upper reaches have been known for many years to harbour bilharzia. The article continues:

The department is receiving advice on the engineering aspect of the problem. The article continues:

This is in fact what is happening in our country. We have exactly the same challenge. As the hon. member for Pietermaritzburg (District) so clearly said, it is not only the Department of Health which is concerned. This Minister is the first and the most directly concerned because it is a matter for the Department of Health to treat and to attempt to control, but there must be some co-ordinating authority. I believe that the intention of this motion is to ask that the hon. the Minister should take the most urgent steps to ensure that the co-ordination takes place so that any new processes available are used as soon as possible to limit this disease, which, I say again, is becoming a threat to the whole of Natal, and which can be a potential threat to the whole of South Africa. It is in that spirit that we move this private member’s motion, asking the hon. the Minister to give the most urgent attention to this particular problem.

Mr. Speaker, after having listened to Dr. Webber and Dr. Sutton I must say I almost feel like Saul among the prophets to-day. The problem of bilharzia is to be found all over the world. I can only congratulate the hon. members for Pietermaritzburg (District) and Mooi River for the manner in wich they have dealt with this matter. They did not try to make political capital out of this major problem. Bilharzia is a world-wide problem which has been known for a number of centuries. The disease was described by a certain Wilhelm Bilharz as long ago as 1851; hence the name “bilharzia”. The first case of bilharzia in South Africa was recorded in 1869. Since then a great deal has become known about bilharzia and the area of distribution of the disease has become fairly well known; as has been indicated by the hon. member for Pietermaritzburg (District) the area over which the disease is spread has not changed much. As is stated in general terms, this disease occurs in those areas served by the rivers in South Africa which flow into the Indian Ocean. As hon. members have mentioned here, we have the particular problems in connection with the infestation of these waters to contend with. If one is acquainted with the life cycle of this disease, this schistosoma which causes bilharzia, one knows more or less where to tackle this disease. This disease is spread by human beings whose excreta finds its way into the water; there the miracidium develops, which then affects the various species of snails. After a period of four to six weeks the snails secrete the so-called cercariae, which in turn can affect humans and animals by simply penetrating the skin. The logical way of treating this disease would be to break this life cycle by applying the principles of normal hygiene as advocated by the Department of Health and by every enlightened person, but, as the hon. member for Pietermaritzburg (District) has pointed out, with our large Bantu population this aspect presents us with a particularly difficult problem.

There are five methods of tackling this problem; firstly, by preventing the water from being contaminated, as has been pointed out by the hon. member; secondly, by preventing human beings from becoming contaminated— in other words, by teaching them to observe normal standards of hygiene. The third and fourth methods of tackling this disease are two ways of treating the water; there are two aspects which have to be considered in this regard. Attempts can be made, firstly, to destroy the snail and, secondly, to destroy the miracidium. The problem in connection with exterminating the snail is that the snail is one of the lowest forms of life so that, when poisonous substances are applied to the water, all the other forms of marine life are killed before the snail itself is killed. That is the problem we are up against here. The spreading of bilharzia in these endemic areas is a direct result of the balance of nature having been disturbed, in that when, owing to research work carried out by the famous Dr. Anecke. malaria was stamped out in large areas of the Eastern Transvaal Low Veld in particular, where malaria was prevalent, the agents used for exterminating the malaria mosquito, namely oil, ordinary oil which was sprayed on the water, also killed many of the parasites which normally feed on the snails. We also find that people are exterminating birds on a large scale to-day, and here I have in mind the African coot in particular, which is one of the greatest eaters of snails. This problem has arisen as a result of nature having been disturbed. We find that areas which used to be sparsely populated are now being occupied by large numbers of farmers, industrialists, and so forth, and we are exultant about that because our country is developing, but meanwhile bilharzia has spread more and more as a result of this migration of people. Mr. Speaker, these then are the problems we are up against.

We now come to the fifth method by which this problem can be tackled, and this seems to me to be the most practical method of tackling the problem, namely by destroying the parasite where it has affected humans, in other words, by treating the humans themselves. We find, however, that there are problems involved in treating human beings. In the first place they have to be diagnosed for the disease. The most common method of diagnosing the disease is to ascertain whether there are any ova in human excreta. There is another test, namely the so-called complement fixation test. Mention was already made this morning of the breakthrough achieved by certain gentlemen in connection with this problem of bilharzia in South Africa. In discovering and making available the antigen for this complement fixation test these gentlemen—I am referring to Dr. Dunston and Dr. Pepler in Pretoria—also made, inter alia, the following findings—

That is the one which usually infects cattle—

Where we find in certain parts of the Transvaal that almost all the cattle are infected this problem is aggravated by the fact that the same schistosoma may infect humans as well. The problem we are faced with, therefore, is how to treat the people themselves. There are various methods of treatment and that is where our problem lies. The problem is that none of these methods of treatment are completely safe. There are a few methods of treatment which have been developed in the course of time. Firstly there are the antimony derivatives, secondly the thioxanthone derivatives and thirdly the so-called Ambilhar, which was mentioned by the hon. member here this morning and with which particularly good results have been obtained. The gentlemen who carried out these tests in Durban had the following to say in the S.A. Medical Journal of 8th October, 1966, in which they gave an exposition of the use of this Ambilhar—

This remedy too, therefore, is not the solution we are seeking. Any remedy for destroying this parasite must fulfil certain requirements. The ordinary treatment is available to the individual, but where the Department of Health comes into the matter, where mass treatment has to be applied, we have to lay down certain requirements. Firstly, the remedy must be safe; secondly, it must be reasonably simple to administer and to control; thirdly, it must be effective and not too expensive. We cannot treat this disease in any other way. I can see no reason for launching a major campaign at this stage in order to ascertain who are infected, because there is no need for that. A person may be found to be cured within a week and before you have finally dealt with him he may be infected again. There is no sense in that. There is only sense in trying to determine the extent of this mass infection if a mass remedy is available to combat that infection. I think this hon. House will under no circumstances raise any objections if a plea is made here for research work to be undertaken in any field, and for that reason I am very grateful for the way in which the hon. member for Pietermaritzburg (District) has raised this matter. I therefore want to associate myself with him in his pleas for research work to be carried out, but I want to add that research work is, in fact, being carried out on a large scale. I do not regard it as the duty of the Department of Health to carry out research. I regard it as the duty of the C.S.I.R. to see that research is properly co-ordinated and that such reason is then carried out, as it is in fact being carried out. Research work is being carried out at various places in the country, such as at the Research Station at Nel-spruit. Research work is also being undertaken by the S.A. Institute for Medical Research, and by Professor Elston-Dew in Durban. I want to say that the research work which is being carried out in South Africa is highly thought of, so much so that this country is receiving large amounts of money from the U.S.A, for the purpose of carrying out this research. I therefore consider it a privilege to associate myself with the hon. members in pleading for research to be undertaken, but at the same time I say that we are very grateful for what is being done by the Department of Health and by our scientists in this connection.

I am very pleased to have the opportunity to associate myself with this motion. I think it is a very important one indeed and that it has come very timeously. I would also like to say that I feel that other speakers in the debate have made a good contribution by giving their views on the subject. Particularly the hon. member for Fauresmith has dealt with the matter in the most eloquent terms. He has dealt with the technical aspect of the disease and its implications, and he has told us how difficult it is to control bilharzia.

We on this side of the House, although we are appreciative of what is being done in the field of bilharzia, feel that there is room for more extensive research work and that also in the field of publicity much can be done in order that the public may become fully informed of the effects of this disease. The problem is obviously a public health problem, and the control measures that should be instituted rest squarely on the shoulders of the Department of Health under the control of this Minister. Because bilharzia is such a slow-acting and insidious disease, it has little public impact. It does not frighten people like cancer or polio, or even tuberculosis or the more spectacular epidemic diseases. The public possibly does not realize that some 3 million of our Bantu population are affected by this energy-sapping disease. I do not think it would be wrong to say that their labour potential, as the result of having contracted this disease, is halved, and that in a period when we are deeply concerned about manpower and productivity. I therefore think it is appropriate to focus attention on this disease which is causing this loss in productivity of our labour force. Because this disease acts quietly and undramatically, there is not much about it in the press and there is no public clamour that an urgent campaign should be mounted to control it, and possibly that is the reason why our campaign that we have launched, sponsored by the Department of Health, is perhaps moving, if I may use the expression, at a snail’s pace. Because the disease does not frighten people they do not study the problem and do not properly acquaint themselves with the control measures, and so quietly the disease spreads from one area to another.

I think the hon. member for Pietermaritzburg (District), who is just a layman like myself, in most eloquent terms showed how the disease is affecting the whole of our labour force. Therefore the hon. member enjoys my full support for having raised this matter at this particular stage of the development of our country when we anticipate, in the years that lie immediately ahead, a great expansion in our water conservation programme. If one could look into the future, one would see canals all over the country where at present there are none. You will see waters diverted from one river system to another; you will see fertile valleys which are at present not being cultivated due to a shortage of water. They will become cultivated and will become highly productive, and therefore we will see a great increase in the population of those areas. In other words, we will see conditions created that are indeed most favourable for the expansion of this disease. Therefore I think it is right and proper that at this stage of our development we should discuss control measures to make quite sure that we are able to contain this disease which obviously at present is affecting the productivity of our labour force. Sir, I speak mainly on behalf of the Eastern Cape in this debate. I listened with great interest to the way the hon. member for Mooi River described the great water resources they have in Natal, the beautiful lakes, the holiday resorts, and the swimming and yachting. But we in the Eastern Cape have exactly the same potential, and that potential I believe will be extended when the waters from the north flow down to the Fish River and the Sundays River. Then we will have exactly the same conditions that prevail in Natal. But at present I am glad to be able to say that we are free of the disease. There are no cases at present being reported in the Port Elizabeth area. But although we are free of the disease now, I pointed out that circumstances favourable to the growth of the disease are going to be created, and therefore we are particularly interested in raising these matters in the House at the present time. I agree with the hon. member for Mooi River when he says that measures must be taken to make quite sure that the disease is contained and does not spread into other areas which will provide a favourable habitat for the snail and thus for the spread of the disease. Our plea here this afternoon is that a campaign, more dynamic than the one we have at the present moment, be launched in order to make quite sure that this disease is contained. If we look at what is going on, it is somewhat alarming to find that at the present time we are spending, as far as I can ascertain—if I am wrong I hope the hon. the Minister will correct me—R 100,000 per annum on research, publicity, etc. Now, this seems a very small amount if we remember that we are spending something like R18 million on a disease like tuberculosis. Of course, the one disease is more serious than the other but despite that there seems to me a tremendous disparity. We have got to ask ourselves the question whether we are spending sufficient money, whether we in this House are voting sufficient money, to enable a campaign to be mounted, a campaign to get bilharzia under proper control. This is a question we ask most sincerely and we hope the hon. the Minister will give us his views. We realize that this is not a disease which can only be controlled by the Department of Health because in the very nature of the disease it cuts across many departments—for instance, the Department of Bantu Administration, the various departments of agriculture, the Department of Water Affairs and the Department of Planning. However, we believe it is the Department of Health which must take the initiative. At its door rests squarely the main responsibility for seeing that this disease is not only contained but entirely eliminated. What is the position in Rhodesia? I have here a newspaper clipping reporting—

So often in South Africa we say that we are giving the lead in many things, but here little Rhodesia is teaching us a lesson or two. I say let us reverse the position so that we would be able to say that we are ahead also in so far as research into bilharzia is concerned.

With these words I should like to say again that I have much pleasure in supporting the motion of the hon. member for Pietermaritzburg (District) and I should like to associate myself with the views also of the other hon. members who spoke so ably to this motion.

Mr. Speaker, bilharzia is a disease which has occurred in Africa for thousands of years. We have probably had bilharzia in South Africa since the time the white man arrived here. Bilharzia is, of course, not only found in South Africa, but is spread throughout Central and North Africa as well as other parts of the world—India, for instance. In spite of this, people have not yet succeeded in conquering bilharzia anywhere. Attention has been focused on this disease from all sides, and from all sides and in all sorts of ways investigations have been carried out and attempts have been made to stamp out this disease, but so far nobody has succeeded in doing so.

This matter has been discussed in this House as well as in the Senate on several previous occasions. I do not think that this discussion would have taken place to-day if it had not been for the fact that one of the hon. members on the other side of the House had seen an article in the S.A. Digest entitled “Bilharzia break-through in South Africa”. The following was said in connection with this breakthrough: “An important break-through which greatly assists in the speedy diagnosis of bilharzia”—in other words, neither curing it nor stamping it out, but diagnosing it. As a result of this, one gains the impression that some hon. members want to give out that the Department itself did not know about the various forms of diagnosis, and also that this problem could be combated easily because a new method of diagnosing had now been found. I just want to tell hon. members that the Department of Health is one of the most alert Departments, and that it is merely because people do not always know what the Department knows and does that they judge it wrongly.

Bad publicity.

Let me point out to the hon. member that the field which the Department of Health has to cover is divided into extensive regions, regions in which this disease is to be found. Every division specializes in combating this disease in the best possible way. Schools, the Bantu and the Whites are continuously being provided with guidance by means of which they are informed about how to avoid this disease. As a matter of fact, the Department is always out in front—for example, surveys are being made all the time to determine where these snails and especially the contaminated snails are to be found. That is an easy method of determining the extent of bilharziosis and it can be done without examining the people themselves—a method which is in any event very precarious because of the fact that people move from place to place so quickly. The easiest method, therefore, is to determine where the snails are to be found and in which areas they are carriers of parasites. If the snail is not contaminated, one may rest assured that there is no bilharzia. The Department is continuously carrying out these investigations. The moment there is talk of a dam being built, the Department arrives there first to investigate everything in order to determine whether bilharzia is perhaps present there, and, if so, whether it can be stamped out. Mention had no sooner been made of the Orange River scheme, than the Department sent its workers to carry out investigations throughout the length and breadth of the Orange River to try to determine whether there were snails which carried or could carry bilharzia germs. It should be borne in mind that these germs are not carried by all snails. The Department even went further and examined every worker, and it is still doing so to-day, in order to determine whether or not he had bilharzia. If it is found that a worker suffers from bilharzia, he is no longer permitted there. Then he is removed. Therefore it is wrong to say that the Department is not infinitely alert and does not know an exceptionally great deal about this problem. But it should be remembered that this is a disease which has existed for thousands of years. It is therefore not possible to solve it at once. There are many problems.

The hon. member for Fauresmith referred to the cycle in regard to this disease. In the first place, human beings are responsible for leaving the eggs of this parasite in the veld and from there they land in our water; in the water the snails are contaminated and after 40 days or so the snail leaves new parasites which, in turn, affect human beings when they come into contact with such water. It is possible to solve this problem in several ways.

In the first place, it can be done by starting with human beings themselves, by curing human beings, but in this respect it should be borne in mind, as the hon. member for Fauresmith rightly remarked, that at the moment we do not have a remedy which makes mass treatment possible. We only have remedies which can be applied to individuals and which can effect cures under strict medical supervision. But it is impossible to apply this remedy on a large scale. As yet we do not have an effective remedy which makes it possible to treat thousands of people simultaneously. Besides, we are not a police state which simply uses force to subject people to treatment, irrespective of the consequences. We have to leave it to those people to go on taking those pills voluntarily, subsequent to having felt what effect those pills have on them. Research in this field does not rest with us. The amounts spent by the large pharmaceutical firms of the world on conducting research into such remedies, runs into millions of rands. Those firms are doing more research than the State can hope to do or has done in the past, and they are gradually coming closer to a solution. I think it is very clear that they are gradually coming closer to a solution, but so far the cure has not yet been found. That new remedy of which mention was made by a few of the physicians in this House and which is probably the best remedy for bilharzia and is being publicized by their own firms as being revolutionary, is not without aftereffects, side-effects and other unpleasant effects. The moment that remedy is taken, it causes nausea in many people. It causes severe and protracted headaches. In many people it affects the nervous system; in some it causes heart spasms. That remedy is still not the final cure. One will not and one cannot succeed in making the large majority of the population take that remedy. I am convinced that we may be close to an actual breakthrough, but it is certain that such a remedy has not at all been found as yet.

That is why I want to say in the first place that research in the field of pharmaceutical remedies does not fall within our province, and that we cannot hope to attain approximately the same success those large, rich pharmaceutical firms are attaining. What other fields of research are there? Other possible research we may conduct is to change the habits of these people, and especially to change the habits of the Bantu population, so that they will not allow those eggs of the parasites to land in the water. As was said by the hon. member who introduced this motion-—and I should like to compliment him on that—this is not a field in which we can hope to have success. We cannot hope to make those Bantu change their habits and their hygiene within a generation. Therefore, that field does not afford us much scope for research. The only remaining field of research is to try to combat the snail. That is the only alternative. But in this field that which is humanly possible is already being done in South Africa. Merely pouring money into research is of no use. One should have planned research. In doing research one should have an end in view. One should know what one is investigating. A few years ago we made our research in South Africa more effective by placing everything under the control of the C.S.I.R. If my figures are correct, the C.S.I.R. receives from the State an annual grant of R10,800.000 in respect of research projects. It is assisted by a medical pilot committee which consists of experts of the C.S.I.R. and the South African Medical Institute which is probably one of the best institutes in any country. In that committee it has the scientific research to help it to determine what course such research is to take.

I just want to remind this House of the field in which that research was conducted. This pilot committee directs all research which is being done in the Johannesburg divisional unit, the Potchefstroom research division and the Nelspruit research division, and another pilot committee, which is linked up with it,, directs pathological research. In other words, this problem concerning these snails and everything which is connected with these snails, is now being tackled from four different angles. Of late they have been doing research by means of one project, namely the physical damage bilharzia causes to the constitutions of experimental monkeys which serve as guinea-pigs. The object of the second research project was to investigate the pathological effects bilharzia could have on human beings. The object of the third project is to conduct research into the spread of bilharzia-carrying snails and to see to which areas they are spreading.

The next project was to study the snail itself and to see how it could be combated. The next project was to study all the preparations which are snail-killers or which could be used as potential snail-killers. Other research undertaken was in connection with the spread of snails in order to see whether there were methods of preventing snails from spreading from one area to another. The object of yet another project was to see whether the spread of the parasite could not be prevented. This research is being conducted in a large number of spheres. But, as the hon. member for Florida explained so well, biologically speaking the snail belongs to one of the lowest forms of life, and any remedy which is discovered tends to destroy the higher forms of life before it destroys the snail. For that reason it is so much more difficult for us to fight the snail itself. The most promising way of combating this disease is by being able to cure it in human beings. However, let us remember that almost every person who has been to the Low Veld and washed himself in that water, used that water, drunk that water or swam in that water, has had bilharzia at some stage or other. You must accept the fact that in South Africa the Low Veld population and the major part of all the inland areas are infected with bilharzia. If I look at hon. members, I am sure that there are many of them who either have or have had bilharzia. I myself have had it, but I have been cured of it. Fortunately I have not suffered any after-effects. But the way I had it, any hon. member can have it. Many of us have probably had it at some time or other. At present it is so common that when one visits a specialist in internal diseases in the north, one is automatically examined for bilharzia. That is how widely the disease has spread. But what is the use of tackling any method while one is unable to cure human beings, because if one is unable to cure human beings, what is the use? We know that the entire population of South Africa, and especially the Bantu population, criss-crosses the whole of South Africa. As long as we do not cure them and as long as they criss-cross South Africa, they spread that disease wherever they go.

If that disease is stamped out at a certain place and a few snails are left there, it will eventually occur there again. We shall therefore be saddled with that disease for as long as we have bilharzia sufferers, for as long as we are unable to fence off contaminated water and for as long as we are unable to see to it that animals are kept away from such water, because, as the hon. member for Fauresmith pointed out, it is now being presumed that the parasite which is found in cattle and in other animals, is the same as the parasite which is found in human beings. In other words, even if one were to cure human beings, it would still be possible for animals to contract the disease again. Unless you are prepared to exterminate all forms of animal life as well, you will still be saddled with that problem until you will be able to cure human beings. In other words, it appears that there will not be much to be gained by tackling this disease in any way other than trying to cure it in human beings. One has to tackle it by trying to cure it in human beings. As I have said, I hope that with the latest developments—and we still have a long way to go—we are infinitely closer to finding the solution to this problem than we were before. The hon. member for Mooi River said that there was a breakthrough in the diagnosis of people who have this disease. The best test for this is the complement fixation test. That is the best test for finding out whether a person has bilharzia. But to test a person by that method costs R1.40. In other words, it is an expensive test.

What will one achieve by paying R1.40 per person in this area where there are so many people who probably have bilharzia—a number which probably runs into millions—if one has no real purpose in doing so? What does one achieve by merely determining whether a person has bilharzia, when one does not have a remedy with which one can cure that person? We do in fact have a remedy with which we can cure a person who is very sensible and very civilized. However, the large majority of people say, “No, those pills made me feel so sick yesterday that I simply cannot face them any more”. It is not a question of one pill that has to be taken, nor is it a question of a few pills. A few courses of pills have to be taken. One does not achieve anything by trying to track down people who have bilharzia.

There are areas where this disease has come in only recently.

Yes, but what is the use? The hon. member for Mooi River used an example. He said that we should look upon bilharzia as if it is an enemy in time of war. One corners the enemy and then destroys him. But how are we going to corner bilharzia? Bilharzia has spread. How are we going to get at it? One day when we are able to cure this disease in human beings, we shall succeed in cornering it. Once we have cured human beings so that they can no longer infect snails, this disease will probably disappear. It will be impossible for us to corner this disease before that happens. Let us suppose that the hon. member for Mooi River is correct and that we succeed in cornering this disease. Then we shall have a large corner into which this parasite has been driven. What would be the use of that? How can one conquer that parasite? From the nature of the case—with these three methods we have briefly outlined here—this will remain an impossible task until we have the cure.

Sir, it is always a good thing for us to discuss these problems in this House. It ensures that all of us remain awake to the problems of South Africa. It always encourages us to take an intelligent interest in these problems and to seek for the solutions to them. However, I think that we are in the unfortunate position to-day, even though I wish hon. members were right, that we are still as far from a solution as we were before. When the solution has been found and when the remedy has been found and perfected and can be administered to the masses so that they will not object to it and take it willingly, then we shall virtually be on the point of stamping out bilharzia once and for all. But until then we shall be saddled with these problems as they exist today. Until then we can merely try to enlighten children as well as adults, and to erect notices at swimming baths from time to time—even if they are continually being pulled down by campers—and to teach the Bantu to be more hygienic in their habits, and to go out of our way to use all remedies, knowing that they are, alter all, only partial remedies. We shall never really be able to break the back of this disease until we have the cure for it.

Mr. Speaker, I am very grateful to hon. members who have participated in this debate to-day. I am grateful for the attitude that has been taken up by those hon. members who have participated and for the positive contributions they have made to this debate. However, I feel that the motion has now been aired. It has served its purpose, and with the permission of the House, I wish to withdraw the motion.

With leave, motion withdrawn.