I move—

1. (i) instituting a thorough investigation into the factors causing these rising costsand the manner in which they can be combated; and
2. (ii) finding the most effective methods by which medical aid and provident schemes can help to lower these costs for the public,

At the outset let me express well-merited thanks and appreciation to the Government and the hon. the Minister for the attention they have given to, and the interest they have shown in this matter for appointing the Snyman Commission and also for the preference which has been given to this motion. It is quite clear that they consider it to be very important. I particularly want to tell the hon. the Minister that not only we but all those concerned in this matter are very impressed by the fact that he is sympathetically disposed towards this question and that he has been very active and diligent in this regard. I also want to tell him that since he has taken over this portfolio there has not been the slightest doubt that we have made very good progress in respect of health services in our country.

I am particularly pleased that we have already progressed so far. I spoke about this matter 10 years ago from the back benches, and on various occasions thereafter, and in 1957 I specifically asked for the appointment of this commission. My motives have always been the same, namely, that where in the past the patient or his next-of-kin paid the full costs of his illness in the form of a moderate amount to the family doctor, the seriously-ill patient to-day receives accounts from various quarters, from the hospital, his family doctor, from one or more specialists, from the laboratory, from the chemist, for the services of trained nurses, for radiological examinations and so forth. Every account represents a unique contribution towards his recovery, but the fact of the matter is that the financial burden of paying all these accounts has in the normal course of events become too heavy for the ordinary individual. The whole intention of this inquiry and also of the Government is to relieve this burden. It is the intention of the Government to put the recommendations of the Snyman Report into operation in such a way that we will achieve this aim.

As far as the Snyman Commission is concerned I want to congratulate and thank not only the Chairman, Professor Snyman, but every member of the commission for the valuable work they have done and the mass of information they have made available to us. Very hard work and study has gone into this matter. We also want to thank them for the positive recommendations which they have made. I want to say for the information of the House that this commission was appointed on 30 December 1959, and reported in the second half of last year. The commission was therefore busy with its inquiry for a full 18 months. I want to emphasize the fact that all those interested in this matter knew about it. It was publicized in the Press and over the radio and all interested parties, including the public in general, were invited to give evidence. In the second place, particular groups were specifically invited to give evidence. In the third place, this commission visited various centres in the Republic. There can therefore be no doubt that everyone had ample opportunity to put his views to this commission.

I think that it is also necessary for me to say at the outset that I am particularly grateful that this is not a party political matter. We cannot permit the health of our people to become a party political question. I have unshakeable confidence in the fact that not only each member of this House but everyone outside will give his full support to maintain this sound position. In the light of this and also in the light of the fact that this is a private motion I want to say very clearly that I am speaking for myself. The conclusion which I draw is my own with this qualification: I fully agree with and support these important principles which have been accepted by the Government, principles which I and others have advocated for the past 14 years. I make this statement unreservedly.

I also want to thank the hon. member for Odendalsrus (Dr. Meyer) in advance for having agreed to second this motion. He is not only a respected member of this House but, Mr. Speaker, he is highly thought of ip medical circles. That is why I feel privileged that he is willing to second this motion. I and all who have to deal with this matter are fully aware of the fact that confusion and uncertainty exists in the country in regard to what is actually going to happen in regard to health services. Let me state very clearly that no real reason at all exists for concern and a lack of confidence. You can be assured, Mr. Speaker, that there is no secret plan or sinister intent. On the contrary, the whole purpose of the Government is to safeguard the reasonable interests and requirements of all interested parties and to strengthen them in the future. Therefore I also want to express the hope that this discussion will assist in removing misunderstanding, ignorance and the unnecessary suspicion which exists, so that everyone will assist in making a success of this great undertaking with the greatest measure of goodwill.

I do not want to start with a parrot-like eulogy of the Snyman Report, although I agree with most of their views, but I want to start with one point in the Snyman Report which I think is a pity and which I feel is unfortunate. Surgeons, obstetricians and gynaecologists are the particular scapegoats mentioned in the report. I think that is a pity. It detracts from what is otherwise mainly a very comprehensive report. I always welcome frankness, on the part of a commission as well, but the specific findings in respect of surgeons, obstetricians and gynaecologists can only refer to individual members of the aforementioned groups. I consider it to be unfair; individual members of all branches of the medical profession do sometimes err as is the case in any other profession. I think it was unnecessary to pick on them. What has happened? In their hunt for sensation, and perhaps for other reasons, good reasons too because they simply do not have the space to do justice to a report of this nature, both the Afrikaans and English medium newspapers have grasped at this one fact and created the impression throughout the country that this has been the most important finding of the commission. I must say, space or no space, I take it amiss of the newspapers for having caused this harm and unnecessary antipathy by their report.

I want to mention another point and that is in respect of the wording of this motion. The original request which led to the appointment of this commission, the popular name which the Snyman Commission was then given, as well as the wording of this motion, is somewhat misleading. This motion refers to the rising costs of medical services and medicines. It is therefore misleading because many factors are involved in the health services which are performed in the country. On page 7 the commission states [translation]—

That is why I say the wording is somewhat misleading. It is also somewhat misleading because it has appeared very clearly from this report that of the total expenditure spent on health services, hospitalization amounts to 50 per cent, medical and dental services amount to 20 per cent and medicines to slightly less than 10 per cent, while sundries make up the rest. In respect of foreign countries, the commission’s findings was as follows [translation]—

this is referring to foreign countries—

The commission found further [translation]—

One gains the impression therefore that the emphasis was wrongly placed upon the rising costs of medical services and of medicines and that hospitalization was actually the highest factor. The commission came to this conclusion. They say the following [translation]—

I do not want to discuss this but I think that the obligations rest very heavily upon the provincial authorities to give careful attention to the finding of this commission.

A further interesting point, Mr. Speaker, is that the total cost of health services is not disproportionately high. The total expenditure in respect of health services amounts to from 4 per cent to 6 per cent of the national income. The commission found as follows [translation]—

It is interesting to note further that the increase over the past years has not been out of proportion to the rise in the cost of living in other spheres. I want to give a few examples. If we take the year 1951 as compared with the year 1959 and we take 100 as the yardstick, we find that in 1951 personal care and health was 100 and in 1959 it was 193, an increase of 93. Food rose to 170; fuel and light to 190; transport and communications to 205. We see therefore that the cost of health services did not rise disproportionately. I do not think that one can leave it there because it may be misleading. The figures I have just given are spread over the entire population. Our problem—and that problem remains—is that although these figures may sound good, the practical situation is that at a given time the individual has to pay a large account and this becomes a great burden to him. I must also say that one has to be reasonable and that progress in medicine must of necessity cause increased expenditure. If the community does not want to be deprived of the benefit of this progress, these rising costs will have to be met. The increase will therefore continue. In this connection the report states [translation]—

It ought therefore to be clear to all that no one must have the illusion that we are dealing here with a cheaper medical service but that an attempt is simply being made to give each one an opportunity of being insured against heavy expenses and secondly, to keep the rising costs as low as possible. We must realize this very clearly.

Mr. Speaker, I feel compelled to emphasize the next point strongly also and that is that we are not dealing here with a State medical service. I personally feel that a State medical service is a bad thing which we should not even discuss. I am also pleased to say that it is not the policy of the Government to establish a State medical service and the hon. the Minister of Health stated very clearly in this House last year that he was opposed to it. On page 106 of their report the Snyman Commission also states that it disapproves of a State medical service. In my opinion none of their recommendations embodies the establishment of a State medical service. If it were ever to develop in that way, or if it ever does develop in that direction, I want to say positively that I will oppose it most strongly. In contrast to a State medical service we have had a spontaneous development in South Africa in respect of the approach towards public health. I want to give the House a few figures. In private hospitals 80 per cent of the patients were private patients in 1950 and only 20 per cent belonged to sick funds. Ten years later, in 1960, the picture was reversed. Then 20 per cent were private patients and 80 per cent were sick fund patients. We have to deal here therefore with a spontaneous development of health insurance which is not, ought not and will not be administered by the State nor will it be financed by the State. The State will only act as co-ordinator to bring about uniformity and, where necessary, as mediator. I think that it ends there. The aim therefore is eventually to have everyone covered by health insurance. That is the aim of the State, as the hon. the Minister stated. As an ideal it is right and a good thing but I think in practice —and this is my considered opinion—there will always be a section, let us say 25 per cent, of the public who do not belong to sick funds. I base this standpoint on the experience of countries like Holland and other countries where they have had social medical services for many years and still find that 25 per cent of the patients are private patients. I want to add that I think that if we can reach the stage where 75 per cent of our people belong to sick funds we will already have completed a very great task and then the intentions of the Government and the hard work of the hon. the Minister will have been fully rewarded.

In this connection I also want to say that it would do a great deal of harm—and I know that this is not the intention—if these aims were to be achieved by compelling people to belong to sick funds. I refer now to an obligation which has been imposed by the Government. The conditions of service in certain private organizations are another matter completely.

In order eventually to achieve this global object, there are two things which in my opinion must be done and must be done fairly soon. The first is to give statutory power to a central board for medical schemes and in the second place to establish a board of control over medicines. I think that that principle is right and we must do so. In the implementation of its duties this board will have to deal with certain aspects and I think that it is as well for us to discuss a few of these aspects briefly. The first is the question of the level of income. The question arises whether a restriction must be imposed in respect of the income of the person when he is considered for membership of a sick fund. What is the present position? The present position is that the Medical Association has drawn up a preferential tariff, a tariff which is slightly lower than the usual private fee, but that preferential tariff is only applied to persons earning R4,600 and less per annum. Anyone earning more than that cannot belong to a fund and make use of this preferential tariff. Let me tell you that there is a history behind this matter. It may appear wrong—I am coming to it—but the Medical Association made this preferential tariff concession at the time with the specific purpose of assisting only those persons in the lower income groups. That was why they were prepared to do it and not include others having higher incomes. I want to say that I do not agree in principle with the present position, and I do not think that it should continue in this way. My standpoint is that everyone should be able to be members of a sick fund, irrespective of income, as is the case with other insurances. I also think that that is the aim of the Government. I want to give an example. The owners of large factories, large-scale employers with many employees from the nature of the case have large incomes, but they subsidize their sick funds to the extent of 33⅓ per cent and sometimes 50 per cent. The manufacturer subsidizes his employee’s sick fund but because he is earning a higher salary he himself may not belong to that fund. I think that that is unfair. We must of course also consider the doctors. This concession was made specifically with the purpose of helping the lower income groups and I feel that the tariffs which are fixed in the future, when everyone belongs to a sick fund, must not have as their basis the fact that a person has a reasonably low income, but that that preferential tariff should be determined on the sole principle that the doctor has the benefit of avoiding bad debts in that his accounts are paid in full.

The second point is the position of individual members. The position to-day is that individual members cannot become members of sick funds or obtain insurance. I myself for example would very much like to insure myself and my family, but as an individual I cannot do so because of a request from the Medical Association. I want to express the hope that this position will also be changed. In saying this, however, I want to make it very clear that from the nature of the case it must be so arranged that there will then be more than one premium payment, or whatever the case may be, because one cannot treat an individual on the same basis as one would a large group scheme. I feel that the principle that the individual should also have this opportunity must certainly be adopted. The idea is to take only three groups into account in fixing premiums, namely, the individual, the individual with one dependant and the individual with one or more dependants on the basis of 1:2:2½, or something of that nature. I do not want to elaborate in this regard, but with a view to what I said just now about the individual and with a view to the fact that old people must also certainly be covered, and also as a result of the experience of many sick funds and of some insurance companies, I take the liberty of emphasizing the fact that this matter should receive careful attention and should perhaps be reconsidered. From the nature of the case it is not a matter of principle, and therefore I take the liberty of making this request. I hope that careful consideration will be given to this matter.

There are two matters about which I feel very strongly and I do not think that anyone will disagree with me in this regard. The first is that if we want to avoid a State medical service, if we want to keep the relationship between patient and doctor on as high a plane as possible, if we wish to create a sense of responsibility on the part of the patient as well as to have quality service on the part of the doctor, we must at all costs ensure that in connection with all sick funds a free choice of doctor and dentist must be retained. That to my mind is a basic principle. The second point is that the cover in respect of the patient must be as wide as possible. I am referring to hospital expenses, doctors’ fees, dental expenses and all supplementary medical services. They must be as wide as possible. This can only be achieved if there is a register of sick funds which lays down minimum requirements and effects uniformity. For this reason a registrar of sick funds must be appointed. I do not know precisely what the position of insurance companies will be but it is very clear that a fund as such must be registered. Whether this must or can apply to insurance companies dealing only in insurance is another matter. This is a particular point which must be discussed. But when I advocate uniformity I do not want to create a misunderstanding. By this I mean one type of insurance. I am convinced that the circumstances and the requirements of our country, of individuals, of certain employers and employees, of old people and all these things, will result in there perhaps having to be more than one type of insurance and of benefits, on condition that the basic principles are not affected. That is also a matter of detail.

The next point is the fixing of fees, and I refer here particularly to the fixing of fees for doctors and dentists, but I want first of all only to speak about the fixing of fees in regard to sick funds and not private fees. When any fee is paid, the basic attitude is that it is a matter between the patient and the doctor or the patient and the representative of the medical profession or the dental profession. But we cannot allow disputes, the fact that they cannot reach agreement, perhaps because of unreasonable demands on one or the other side, to hamper or impede this great development of health insurance for everyone. That is why it is necessary for the State to act as mediator and it appears to me that in the event of a dispute the Central Board for Sick Funds will eventually itself have to decide, with perhaps an appeal to the Minister, but this is also a matter of detail which can be decided later. One has to be practical in this regard and the only practical manner is for people to negotiate. But eventually somebody must decide and in my opinion the statutory board is the board to fulfil that function. If anybody has a better idea I shall welcome it, but at the moment I cannot think of anything better.

In respect of private fees my humble opinion is that it is unnecessary and undesirable to want to fix those fees, and I will give you my reasons. When all have the opportunity of belonging to sick funds, and persons still prefer—they may form 25 per cent of the people—not to join and not to make use of the benefits, but to be private patients for reasons of their own, then it is not necessary to fix fees. They may have other claims and requirements; they may be people who are very wealthy and who for reasons of their own do not join a sick fund. Where a person does so voluntarily and where he is a private patient, it is not necessary to fix fees. Then the question of payment becomes a matter between himself and his doctor. We have experience of the type of patient who makes all sorts of claims which actually have nothing to do with his illness; he creates all sorts of problems for the doctor and demands much of his time which is something one cannot always express in terms of fees. We must also remember that any person has the right to appeal to the South African Medical Council if he is dissatisfied about any fees. I feel very strongly that this matter must remain a private one between the doctor and his patient. I want to mention another point in this connection. We talk about the fixing of fees but we have never heard about the fixing of hospital fees and I wonder whether one should not give some attention to this matter. I feel that it is our duty to make it possible for everyone in South Africa to belong to a sick fund and to have insurance to cover the expense which may be incurred in times of illness.

I want to say a few more words about the doctors in our country and I take the liberty of saying—because for some years now I have not been in active practice—that the entire world, our country included, owes a great debt of gratitude and appreciation to the medical profession and to doctors in particular, and particularly in the Republic of South Africa where the standard of our medicine—I do not want to exaggerate—is in any event equal to the best in the world. That is the evidence of foreigners, not even of our own people. A question now arises to my mind which I would like to air in public: Why is it that in so many cases the account of the doctor is always the last to be paid?

Because it is too high.

I do not think that that is correct. The hospital account is always much higher, but that is paid first because people are afraid of being taken to court, while the doctor is not so quick to take action. I think that there should also be an improvement in this connection.

I want to mention a few points concerning doctors. Firstly, the training period of a doctor is the longest of all the professions—7 years if he is fortunate enough to pass each year, and secondly, it is the most expensive. Thirdly, you have the position in many professions where a student earns a salary while he is being trained. In medicine he earns nothing during the whole of his training period, except in his last year when he may earn a small amount. The factor must also be considered—as appears clearly from the report—that at the start, a practice is always very small. I can well remember when I started. Fortunately, I always had at least one patient a day but there were many days when I had only one. A doctor can buy a share in a practice, but then he has to pay for it, sometimes a fairly large amount, in order to participate in that practice.

The next point I want to mention that I think is of importance is that it is being proposed that doctors should send their patients specified accounts for every service. I fully agree with that but it will also mean that the administrative expenses of the doctor will be greatly increased. He will have to employ more people and so forth. I refer to page 166 of the Snyman Report where it is stated

Has that report already been tabled?

No, but it was released some months ago. The report states [translation]—

I want to mention another point concerning doctors and that is that their earnings per hour, not only in our country but also in other countries, are lower than in many other professional callings. We all know that a doctor is on duty 24 hours of the day. In the days when I saw one patient a day, I was not tired from working but I was tired from waiting. A doctor has to be available and the fact that he must be available never gives him the opportunity to relax completely. I see that the hon. the Prime Minister is looking at me. Even though he may go to Betty’s Bay, he must always be available; he can never be completely relaxed. It is for that reason that we sympathize with him and I think that we ought to have the same amount of sympathy for the doctor who has to be available 24 hours of the day.

The next point that I want to mention is the question of pro deo work, the treating of patients gratis, the Robin Hood idea. It is quite true that pro deo work has decreased over the past years, chiefly because the Provincial Administrations decided some years ago to remunerate doctors for work which they had always performed free of charge. But there is still a large amount of pro deo work. I want to mention my own example. For 24 hours of the day, 12 months of the year, my partner and I were responsible for all the gratis treatment at the Vanderbijlpark Hospital. We were in the service of the Provincial Administration and therefore under an obligation, and we were remunerated. Do you know what the remuneration was? to-day it is more but then it was £84 per annum! It was only a nominal amount. But apart from that it is a fact that the scope of pro deo work is still considerable for all doctors. I want to say that more gratis work is done by doctors and dentists than in any other profession in South Africa. I welcome it and ask no reward for it; I merely state it as a fact. The report reads as follows [translation]—

I want to mention a further consideration in respect of doctors and dentists, particularly in connection with the fixing of fees. I do not think that it has previously been mentioned, nor do I think that it has been dealt with in the Report. What of the doctor, what of the dentist, who grows older, or shall we say more senior? He can no longer work as hard as he did when he was 30 years’ old and yet his family commitments are heavier at his more advanced age. As an advocate becomes more senior he becomes an S.A. and receives higher fees. An ordinary domestic servant receives wage increases as a result of seniority —and not because he does any more work— as he becomes older and more senior. In all spheres of life, in the Public Service as well, there is the prospect of an increase as the years go by. But what of the doctor? What of the old faithful family doctor when he is 50. 60 or 65? This must certainly be remembered and it is not an easy matter, when fees are fixed, to give consideration to this question. Should provision not perhaps be made in this regard? In England they have already done some work in this connection but I do not think it is a great success there. But should provision not be made for, senior or quality men, or whatever you want to call them, bearing in mind the older doctor or dentist? The older doctor can no longer do the quantity of work which he did in earlier years or should have done at any rate. We must not forget him when it comes to the fixing of uniform fees.

Now one final point and here I know that some and perhaps many of my colleagues differ from me, but it is my considered opinion that doctors should not have an interest in health insurance schemes and that the recent development where doctors have brought their own schemes into being and are administering them is unsound. That is not the function of a professional man, least of all of members of such a respected and honourable profession as the medical profession. This also holds good for chemists and dentists. But I want to go further and say that it is not in the interests of the profession or of the patient that the doctor should have an interest either in these schemes or in nursing-homes or in pharmacies or in the pharmaceutical industry. Here I am speaking about the man who is in practice. There is this exception that one sometimes finds in smaller places that a nursing-home is needed, or that a pharmacy is badly needed and so forth, and the only way to meet that need—and it is sometimes done on a very high level—is for the doctor to have a share in it. That is the exception, but generally speaking this should not be done. I want to congratulate the Central Board on having said already that it is not in favour of the proposition that doctors should administer their own schemes and on having tried to discourage this in a Press statement.

Just a word or two about dentists. What I have already said largely applies to them too. but there are also a few additional matters. The first is that South Africa has a great shortage of dentists and the second is that we must not lose sight of the fact that particularly in the case of a dentist the day-to-day expenses associated with the practice are very high as a result of the cost of material.

I come to my next point—the fixing of premiums in respect of sick funds. I am not very worried about this aspect because I think that the ordinary economic laws of competition and so forth will regulate this matter. I am very sure of one thing and that is that if the State wants to fix premiums, it must also accept the responsibility for losses, and obviously the State could not be anxious to do so. I think it is in this connection that the State or the Board can best give advice and assistance when funds are put into operation. We are all in agreement that the premiums should be kept as low as possible and I think that the State can give active assistance in connection with those things which will tend to keep insurance low. Part of the expenditure connected with such a fund or insurance company consists of administrative expenses, and this brings me immediately to one important factor which increases administrative costs, namely, the small claims. You yourself will realize that the smaller claims in respect of one visit result in tremendous administrative expenses for the fund, or whoever has to handle it. The position is that in the case of certain funds the first visit, a small amount at the start, has to be paid for by the patient himself and he is only insured in respect of the bigger amounts which are payable thereafter. In this connection one must not lightly adopt this standpoint and leave it at that, because the first visit is very important and one does not want to prevent the less-privileged man with a family of five or six children from calling the doctor for a first visit because he has to pay for that first visit himself because that first visit may perhaps prevent some serious illness. But is that so? I do not think so and I will tell you why. I do not think it would prevent the man from calling the doctor because he does not have to pay the bill immediately. It does apply to medicines which usually have to be bought for cash but as far as the doctor is concerned it is not an immediate factor because he is not paid immediately. In the second place, this difficulty can easily be overcome in respect of first visits by fixing a maximum for every person, for example: A man will pay for the first visit but if he has a large family and all eight children contract measles at the same time that man will not have to pay R30 or R40. We fix a minimum of R10 or R5 or whatever the case may be, and that is all he will have to pay. We must not forget that the man with the large family already receives a certain amount of benefit. In the first place the premiums are determined on a sliding scale, in other words, the smaller his income, the less he pays, although he may perhaps have a much larger family than a person with a larger income. You may ask why I emphasize this aspect. I do so because experience has always shown that the administrative costs in connection with these small claims greatly increase expenses which in turn result in loading the premium becoming unduly, something that we want to avoid. It is not the big claims which bring about heavy administrative expenses; it is the small claims which cause heavy administrative expenses and it is precisely in these cases that abuses take place, where the doctor is called for any reason at all, where he is called in the middle of the night or on a Sunday. The commission emphasizes this fact. Not only do they say that the patient should bear a share of the expenses, but they also ask that that share be increased. On page 308 they say this [translation]—

There are two ways in which to combat this abuse and the first is, to mention an example, that the sick fund should pay 75 per cent of all expenses and the patient 25 per cent, with a maximum to be paid by the patient so that he is not threatened with financial ruin if, for example, his whole family falls ill at the same time. The second way is that the first amount, once again subject to a maximum, should be borne by the patient himself, provided it is not too much, particularly if he has a large family. I believe that both methods should be applied to obtain the desired effect and at the same time, to help to keep the premiums as low as possible. This is the tendency in Canada, the U.S.A, and in many other countries and here too in South Africa our experience is that many sick funds specifically ask that the so-called principle of surpluses should be incorporated.

I want to deal with a further point, the question of subsidies. In terms of this Report the Government will quite possibly not be unwilling to give some sort of subsidy for the promotion of this scheme. Indeed, this opinion is clearly expressed in the Report but it is based on the fact that a subsidy must be given to funds whose administrative expenses are low. I cannot agree with this principle. I agree with the principle that there should be a subsidy but not that it should be based on low administrative costs and I will tell you why. We all know that it is the easiest thing in the world to manipulate administrative costs. Just put me in charge of a large business and I will manipulate my administrative costs in such a way that I will receive the maximum subsidy. There are so many facets of administrative costs and these are linked up with so many other things that they are easily manipulated to appear lower and therefore I think that this is an unsound basis. I would prefer to suggest another method and at the same time solve other problems which may flow from the application of these schemes while also providing a form of subsidy which fits in with the pattern of the present subsidies which the State provides in various spheres.

In the first place the commission draws attention to old people and pensioners. I fully agree that provision must be made for them and that we cannot neglect these old people. But it is also a fact that as a result of their needs the obligation to insure them or to absorb them in a fund must of necessity increase the premiums, and that changes the whole picture; in other words, it creates real financial implications. If a subsidy is considered, I wonder whether it cannot be given to two groups instead of being based on administrative expenses, so that firstly, in the case of the aged and pensioners, they will be specifically subsidized when they belong to a sick fund; secondly, a great deal is said about children’s allowances. It also has its drawbacks. Read about the experience of other countries, which has been anything but favourable. Would it not perhaps be a wise thing in respect of health assurance to subsidize the large family together with the old people and the pensioners and to use the subsidy in this way rather than to base it on low administrative costs?

While I am on the question of subsidies. I think we should refer to the employers of South Africa because they make a valuable contribution towards the sick funds which cover their workers. It is only right that they should do so but one is grateful for their cooperation and it is appreciated. The second point that I want to mention is the role of insurance companies. I think that South Africa is fortunate in that numbers of insurance companies have entered the field of this specific form of insurance. I cannot imagine that we are going to attain complete success in our aim to make health insurance available to all without having the assistance of the large insurance companies. Large sums of money are needed in this matter. I also think that the experience which they have gained and the problems which they have faced over the past years should be very carefully considered when we deal with the details of this matter.

A further point that I want to mention is the pharmaceutical industry. This is an aspect which has unfortunately received very little attention in this House over the past years. I am talking about the manufacture of medicines. Relatively speaking, this is a new industry in South Africa but it certainly has very great potentialities. We must make every effort to assist in making the Republic as independent as possible from the outside world in the sphere of the manufacture of medicines as well, and at the same time create great opportunities of employment for our own people. I want heartily to congratulate the firms which have already started production on what they have done and on the excellent standard of the preparations which they are placing on the market. In this sense not only do they merit the attention of the hon. the Minister of Health but also of the hon. the Minister of Finance and the hon. the Minister of Economic Affairs. There is no doubt that the pharmaceutical industry has made a very important contribution towards the combating of illness. In the Snyman Report they say the following [translation]—

This is most probably as a result of the efficaciousness of these medicines.

I want to mention another point in this connection and that is that in England, although the population has increased tremendously, one nevertheless finds that the number of prescriptions for medicines has not actually increased materially. In 1949 there were 202,000,000 prescriptions and notwithstanding the tremendous increase in the population, in 1959 the number was about the same, 214,000,000. I think this must be due to the greater efficaciousness of the medicines and, because of that, their more infrequent use. But I must also point out that in 1949 the cost per prescription was 30.05 cents and in 1959 it was 68.13 cents, which is also the picture in Canada and the U.S.A. The commission states. [Translation.]—

I would like to give the House this interesting information in respect of Canada, namely, that the per capita expenditure on alcohol is R20, per annum, on tobacco, R 12.50 and only R2.61 on medicines supplied on prescriptions. One finds further that all health services make up about 4 per cent of the national income but that medicines form 10 per cent of the total expenditure on health services. In other words, .4 per cent of the national income in England and in other countries is spent on medicines. In South Africa it is estimated to be about .6 per cent of our national income. But what is of importance is that over the past ten years the cost of medicines has only increased from 7.7 per cent to 10.1 per cent which is a small increase over ten years. In South Africa the position has been analysed a little further and we find that the public of their own accord buy medicines over the counter to the value of about R14,000,000, without prescription, whereas the amount spent on ethical preparations on prescription is R13.5 million. In other words, the public spend just as much money on medicine which they buy themselves as they do on medicine which they buy on prescription. In respect of the pharmaceutical industry I just want to say that there are about 80 manufacturing firms in South Africa. Of these only 15 are full fledged South African companies. All the others, in various forms, are overseas firms operating here. In other words, there are 15 South African firms and 65 non-South African or partly South African firms. This is one thing which disturbs me considerably. I feel that the local manufacture of medicines must be strongly encouraged and that these people must be given positive assistance. To avoid misunderstanding, I want to say very clearly that I do not underestimate or belittle the good services of foreign firms. I also realize that it is difficult in practice to manufacture certain medicines for a relatively small market in South Africa but nevertheless these foreign firms can make a far greater effort to manufacture locally and I want to bring this very pertinently to their notice.

Now, in respect of the local manufacture of medicines, the Report states as follows [translation]—

I want to emphasize a few of the ways in which we can assist the local manufacturers of medicine and stimulate this industry. As the law stands at the moment, the managing director of a pharmaceutical factory must be a chemist; the law requires that. I think this is an obstacle which should be removed. From the nature of things any pharmaceutical industry will employ a pharmacist or a well-qualified person, a chemist, to do that work, but I do not think that this specific legal provision that he should be the managing director is necessary. It is useless and merely increases costs. On page 241 the commission also emphasizes this point and states [translation]—

The second way in which we can help them is in respect of customs duties. The report states as follows [translation]—

I also feel very strongly that in the light of this finding there is no justification for the levying of import duties on raw materials which are needed for the manufacture of necessary medicines. A concession in this regard will greatly stimulate the industry.

In the third place we can assist the pharmaceutical industry by reviewing patent rights. I just want to say that I think that although this is a highly technical matter, it is true that in our new set-up 16 years is too long a period for patent rights to remain valid. I come now to the next point where we can be of great assistance to the industry and that is by using the generic name of a medicine as its main name. In this connection I want to say that under prevailing conditions many preparations having recognized standards are marketed under various patented names. Retail chemists are compelled to ensure that the same preparation can be supplied under any one of a large variety of names. Of course this in no way facilitates their work and this state of affairs must of necessity increase the cost to the public. These increased costs are due to the fact that chemists are compelled, for example, to stock six or more different patented antibiotic medicines containing identical chemical compounds each of which sometimes has to be opened to make up one prescription. This means that the original packing has to be broken, resulting in an additional fee of at least 10 per cent. A further result is that chemists have to invest far more capital in stocks, extra labour, in orders and the maintenance of stocks. The practical use of patent names for preparations which may only be supplied on prescription from doctors has resulted in a wide variety of prices, in some cases five or six times higher than when that same article was supplied under its generic name. In many cases manufacturers spend large sums of money on propaganda amongst the medical profession in order to influence doctors to prescribe an expensive variety of a general preparation. In most cases doctors are so overwhelmed by representatives and advertising material that they are not aware of the fact that a certain preparation is obtainable under its generic name at a very low price. In some cases the ordinary chemical formula is known but over and above this the formula is supplied as a long and complicated chemical compound. If it is possible therefore for the medical profession to use the generic names and the manufacturers are compelled to state that their preparations are the same as those sold under a particular generic name on a prescription, patients will save considerable sums of money, because a chemist will then be in a position to supply any preparation. The International Federation of Chemists is also in favour of the use of generic names in preference to patented names. It is felt that if it is made compulsory in medical propaganda to use the generic name together with the patented name, it will be a step in the right direction to make the medical profession au fait with the use of generic names. The Western Cape Branch of the Pharmaceutical Association has already discovered that where a local sick fund asked their doctors to use generic names, the cost of their medicines dropped considerably. If the generic names can be prescribed, open competition will certainly influence chemists to supply the most economic preparation which complies with a particular standard, for example, as approved by the South African Bureau of Standards. In view of the fact that chemists supply prepared medicines at a tariff approved by the S.A. Pharmaceutical Council, there can therefore be no question of chemists supplying a cheap article and charging for an expensive one. The Pharmaceutical Council is fully entitled to control this element. It may also be worth mentioning here that where there are large variations in the prices of medicines, we find practically without exception that the price of the South African product is lower than that charged by foreign firms. The use of generic names must necessarily stimulate our swiftly expanding local pharmaceutical industry which is already entering the field of basic manufacture. I think I have said enough in connection with generic names. The next point that I want to emphasize very strongly is that South Africa should establish her own pharmacopoeia. There are many good reasons for this. At the moment we are working on the British one but our climate here differs completely from that of England. Our prescription habits are also different and the clinical picture varies in many respects. With our disintegrated health service we also have a great need for standardization and furthermore our own pharmacopoeia will certainly link up with the growth and expansion which we are so anxious to have in our local pharmaceutical industry. The S.A. Bureau of Standards which is doing excellent work in so many spheres can easily undertake that work and they are also eminently suitable for the task. Indeed, my information is that they are already doing so. They already have a list. They are already making analyses and they are in close contact with the pharmaceutical industry. It appears from inquiries—and they have given me this assurance—that this service can easily be extended. If we do have our own pharmacopoeia, we will than have our own standards and we will have a full guarantee in respect of quality.

I want to say a word about pharmacists. I think it would be wrong to have this discussion without saying something about them because they perform valuable and necessary services. We now have 1,500 of them. It is true that in certain cities there are too many pharmacists, but it is equally true that there is a general shortage of pharmacists throughout the country as a whole. They also have their problems because their practice has changed completely. In 1955 80 per cent of the medicines they supplied were medicines which they prepared themselves and only 20 per cent came from their shelves. But five years later, in 1960, they only prepared 20 per cent and 80 per cent comprised ethical medicines. Their dilemma is of course very great because of the fact that they have to stock a great range of ethical medicines, from 1,600 to 2,000. The Report states [translation]—

And so they go on. In the case of vitamin B12 there were 14. It is said that there are about 1,800 known ethical medicines in current use for which there may be a demand at any time and all of these are supplied on prescription only. I spoke about the generic names. I think that this will be of great assistance to pharmacists because as I have already indicated the compulsory use of the generic name will help a great deal.

Another sphere where we can be of assistance is in respect of the packaging of medicines. It appears to be quite unnecessary for expensive medicines to be made up in bulk. After all, the chemist has to charge extra when a small quantity is prescribed. This extra amount is recovered from the patient in order to make it an economic proposition for the chemist. The S.A. Pharmacists’ Association has already approached the Association of Ethical Manufacturers in this connection without success, and a specific and perhaps smaller quantity will therefore be welcomed in some cases and will be of great assistance to the chemist. There are other matters as well but I want to leave it at that with this thought that we should try to assist the chemists in such a way that it will not be necessary to have connections with wholesale chemists, because I regard that as an unhealthy state of affairs.

I have dealt with some aspects and everything that I have said, with certain exceptions, has referred in the main to Whites, because we must make a start somewhere. But I must add immediately that this sort of development also holds out great possibilities, and, from the nature of things, immediate benefits as well for all non-Whites, and in particular it holds out possibilities for future development when this is practicable, when their living conditions and their approach to the medical profession change. I feel very strongly about two things, firstly, that the principle that the patient should have a share in the responsibility for supplying health services should also be extended to the colossal gratis health services which are given particularly to the non-Whites. In other words, they should pay a small portion themselves for every service. Secondly, the commission recommends that a minimum amount be determined for every service and I full agree with it. Secondly, I feel very strongly that long-term hospitalization should be provided to the Bantu in their homeland for tuberculosis, mental diseases and chronic diseases and that this policy should be tackled with enthusiasm.

I want to conclude by saying that there is no doubt regarding the principles underlying these matters. We know precisely what we want to do. The details have to be carefully worked out and further studied but I do not think that we should hesitate to change them if it will lead to an improvement. It is the task of the Minister and his Department, and later of Parliament, to introduce legislation, and I want to encourage the hon. the Minister to set up at least two boards, the Central Board for Medical Schemes and the Board for the Control of Medicines, as soon as possible, or rather as soon as this can be done, by means of legislation. I feel that people who are in daily practice must be appointed to this board. This is a detail which we can discuss later. I want to mention one example. I feel that the board should have at least one chemist as a member, a man who has to deal daily with practical problems. These however are matters which we can discuss later. I am certain that under this legislation matters will be handled in such a way by the hon. the Minister of Health and his Department and also by Parliament with the machinery at its disposal that there will be a full opportunity as far as the details are concerned to make representations and to deliberate. Because it is in the interests of everyone and because this is a most important matter to every member of the population in South Africa, I want to make an appeal to all, in case there may be confusion or suspicion or fear—for which no real reason exists—to co-operate with one another with mutual trust and goodwill in order to establish a service of quality for the whole population.

I have very great pleasure in seconding the motion moved by the hon. member for Vanderbijlpark (Dr. de Wet) and I should like very much to congratulate him at the outset on the very capable way in which he introduced this subject. I think you will also permit me, Sir, to join him in thanking the hon. the Minister and the Government for the fact that they took the initiative in appointing this commission to investigate this important matter. It is fitting also that we should express our appreciation to the commission for the very comprehensive inquiry undertaken by it and for the very interesting, instructive report submitted by it.

As we all know, one of the objects of the commission was to see what could be done to bring about a reduction in the costs of medical services. I think that the public waited hopefully and believed that the commission would come forward with some sort of plan which, perhaps by a touch of the magic wand, would reduce the cost of medical services. Unfortunately, I personally believe that they will be disappointed because I believe—I have always believed—that we cannot expect any drastic reduction in costs. We must realize that the increase in the cost of medical services is a world-wide phenomenon which has been caused by quite a number of different factors, and we must bear in mind the fact that practically every year there is a steep rise in the cost of living and that that in turn affects the cost of medical services. We all know that 20 years ago one could get a tailor-made suit for R10 or R12; to-day it costs perhaps about R60. The fact remains that our standard of living has risen. The fact remains that salaries and wages, particularly of administrative clerks and nurses in hospitals and institutions and clinics and even in private practice where nurses and receptionists are needed, have increased. Salaries and wages have a very great effect on the increased cost of medical services, but better services are being provided to-day than those to which we had become accustomed in the past. We know that whereas in former years the patient was dependent on the services of one medical practitioner it is a general phenomenon to-day in dealing with difficult cases to find that a whole team of medical practitioners is called in to treat some particular illness or other. We must think of the more efficacious drugs which are being used to-day. These are expensive medicines into which an enormous amount of capital had to be sunk during the research years. All these things are inclined to push up the cost of medical services. And I want to mention another aspect in particular and that is the demands made by the public. The public is inclined, perhaps more than we realize, to make its own demands, which it is entitled to do—I admit that—but we sometimes forget that if we want to ride in a Rolls Royce we must not expect to pay the price of a Ford. What we find in our practice every day is that the patient comes along and demands certain drugs. He has no hesitation in telling you that he wants this, that or the other thing for a particular illness. We cannot blame members of the public because they read and hear about the tremendous strides made in medical science, and it is only right that they should demand that the results of this development should be placed at their disposal, but nevertheless it does mean that their demands, particularly if they are injudicious, bring about a very great increase in costs. We often find that certain sections of the public believe that all one has to do is to put the patient “under the lights” and then one can see immediately what is wrong with him, and that is why we constantly find that demands are made for X-ray plates which are sometimes quite unnecessary but the effect of which is that a hole is made in the patient’s pocket. In the same way patients demand a particular treatment or, contrary to what many people think, they demand operations which are unnecessary.

It very often happens, whatever the reasons may be, that in spite of the fact that the medical practitioner is not in favour of a particular operation, a patient nevertheless insists on it, even if only to be able to boast over a cup of tea at some future date about the expensive or intricate operation that he or she underwent. Talking about operations, I notice that the Snyman Commission also raises this objection that too many operations are performed nowadays. I want to emphasize this aspect that perhaps members of the public are partly to blame if too many operations are in fact performed. However, the commission alleges that far too many operations are performed nowadays, the underlying idea being that certain medical practitioners perform operations simply for the sake of financial gain. I do not know whether that has been properly established and I do not want to express an opinion in that regard. What I do believe is that if there are cases where medical practitioners operate just for the sake of the money, they will certainly be rare exceptions. I feel that this is an unfortunate observation in this report. But I do think that the commission is offering a wrong solution in suggesting that perhaps it will help if the fees charged for operations are reduced. The commission argues that if that is done, then perhaps there will be no tendency on the part of the younger family doctor lightly to decide upon an operation. I think that is perhaps an erroneous argument. I think that if there are people who operate for the sake of financial gain, a reduction in fees would in fact mean that they would perform more and more operations in order to keep their income stable. I do not believe therefore that that will prove helpful, nor do I think that if the family doctor performs fewer operations there will in fact be fewer operations because members of the public will still insist on operations and if the ordinary family doctor does not operate, the patient will go to the next medical practitioner and then to the following one until he eventually falls into the hands of the specialists, and even if the first, the second and the third specialist refuse to operate, he will still have the operation performed in the end by some specialist or other at a very much higher fee. If there are such cases then in my opinion the solution lies rather in educating the public to realize that unnecessary, injudicious demands are to their own detriment and that they should rather leave the decision in the hands of their family doctor in matters of this kind, and secondly the solution also lies in educating those few medical practitioners, if there are such people, whose character development may leave something to be desired. That would help, but not a reduction of fees. To come back to the question of costs, I think we must expect a gradual increase in costs and not a reduction. When we look at the present position we find, according to the Snyman Report, that the State spends about 2.4 per cent of the national income on medical services. We find that on an average the head of the family in South Africa spends R75 per annum on medical services. That means, on a percentage basis, that his costs in connection with medical services amount to something like 2.59 per cent of his expenditure. Generally speaking—and this is also the commission’s opinion—that is perhaps not an unduly high figure, but, as the hon. member for Vanderbijlpark has also stated, the trouble is that one may suddenly be presented with a heavy bill. That is what makes the position difficult for the patient. In looking for a solution it seems to me that the solution lies in two directions. In the first instance we should try to spread the costs over the longest possible period and the second solution is that we should make an effort, although we may not be able to reduce the costs, to bring about a saving and to check a further rise in costs. As far as the spreading of costs is concerned, this has often been suggested and there are various methods which are already being used. I have in mind the various sick funds, the medical aid funds and insurance schemes.

I do not want to deal with this in detail; I merely want to point out that already there are 169 medical funds of this nature in this country and that something like 40 per cent of the total White population already falls under one scheme or another. I do not want to enlarge upon this except that I want to mention this fact that while I am in favour of the proposition that we should get as many people as possible to join these schemes, I think it will be essential, if we encourage this, for the State to make sure that there is proper control over these various funds, because it will be of no earthly use if there is maladministration and the patient then finds that his monthly contribution is so high that he does not benefit at all, or conversely, that the medical practitioner will have to be exploited so that the balance-sheet will be able to balance ultimately. The question arises whether this medical fund system should be on a compulsory or a voluntary basis. Like the Snyman Commission I believe that to begin with at any rate, it should be an entirely voluntary matter, although it would perhaps be useful to exert pressure gradually so that we can give as many people as possible the protection of these funds. The other question is whether the whole nation should be drawn into this scheme, or would it be right to say that the upper layer, the very rich, should not fall under medical funds? This is an issue in regard to which there is a very great difference of opinion even amongst medical practitioners. The Snyman Commission recommends that everybody should fall under these medical schemes or insurance schemes, and it mentions certain reasons. The commission alleges that there is only a very small percentage of rich people and that it will make no great difference to the medical practitioner as such if they are excluded, but the commission’s main argument is that the so-called Robin Hood system should no longer be applicable in this country. This is a system which has been used throughout the world, and this is how it works: It is argued that because the medical practitioner has to do so much work free of charge, because he has to treat the poor man free of charge, he is entitled, when he treats a rich patient, to call upon him to pay a higher fee in an attempt to compensate him for the cases which he has to treat free of charge. The Snyman Commission alleges that there is no reason to-day why the medical practitioner should make use of that method because, so it argues, the State takes care of the poor man in this country. In my opinion that is an erroneous argument put forward by the commission because what it says there is only a half-truth. The State does not take care of the poor man. All the State does is to contribute to the costs, but the rest still has to be borne by the medical practitioner. Certain figures are given in this report. It is alleged that the State takes care of the poor through the medium of its district surgeon, but the commission mentions that the average district surgeon is paid at an average of 67 cents per hour. Here we find that an educated person who has taken an expensive course and who has to do highly responsible work is remunerated by the State at 67 cents per hour.

And he works day and night.

Yes, that is correct. And sometimes he has to run great risks. According to the report that we are dealing with here, the system is that the district surgeons themselves have to provide medicines to their patients. They are able to claim a refund from the State in respect of expensive drugs, but the ordinary medicines they have to provide themselves and they are given a monthly allowance. This report points out that on an average the district surgeon receives less than 10 cents per bottle for medicine given to his patients, which means that he is obliged to contribute the rest out of his own pocket. I want to mention just one further figure as far as operative work is concerned. The specialist’s fee for an appendectomy is R50. The general practitioner’s charge is R34. The district surgeon is paid R20 by the State. There was a time when it was only R10. But apart from this, the fact of the matter is that in certain provinces the district surgeon is still faced with two problems. If he sends his patient to the hospital for the operation then in many cases he loses all contact with the patient; he never sees him again; he himself does not perform the appendectomy. In other words, he derives no financial benefit from the fact that it is stated in his contract that he will receive R20 per operation. Another aspect is that even if he were to perform the operation himself, in certain provinces the Health Department says: “The patient is no longer my responsibility now; the matter falls under the province and the province will pay.” There are such provincial schemes—and here I speak from experience—where the district surgeon receives no more than R2 or R3 for his appendectomy. Reference is made in this report to the fact that the Railway medical officer works for about one-quarter of the fee of the general practitioner. In these circumstances I say that it cannot be contended that the State takes care of the poor man, and I can understand therefore why there is a large group of people who believe that there is still justification for employing the Robin Hood method.

I want to say a few words now about possible savings. I think that when we talk about savings we should turn our attention to the two places where the highest costs are incurred. and here I want to mention the hospitals and the overlapping of services. The Snyman Commission states—and I accept that that is correct—that hospitalization accounts for the biggest increase in the cost of medical services. Hospitalization accounts for 50 to 55 per cent of the costs, and if the figure is so high then the hospital is the first place where we should try to bring about a saving and on which we should concentrate our attention. We must bear in mind the enormous amount of capital which is tied up in hospitals and I am convinced that apart from hospitals attached to the medical schools, where it is necessary to have very expensive theatres and very expensive equipment, where important research is done, money is being spent unnecessarily on expensive buildings. There is no standardization of equipment in the hospitals. Expensive—sometimes unnecessarily expensive —equipment is purchased. Instruments are bought which are used only occasionally perhaps. I would not go so far as to say that they simply lie and rust there but in many hospitals they are practically useless and that is so simply because there is no standardization. We should try to save by making the duration of the patient’s stay in the hospital as short as possible, and good work is being done in this respect. to-day we are keeping patients for as short a period as possible in hospitals, but there is still room for improvement. Furthermore, all clinics should be built so that patients can be treated outside the hospitals, so that it will not be necessary for them to spend long periods in expensively equipped hospitals. I think that this applies particularly to the non-Whites. We could treat an enormous number of non-Whites in out-patient clinics and thus bring about a great saving. I have referred to the overlapping of services. Just think of the fact that we are providing medical services under the control, in the first instance, of the State where we have different departments providing different services. Services are being provided under the four different provinces and then we have a large number of local authorities each providing its own medical services. To mention an example, take the State for instance. The State has a chief regional medical officer with a full complement of staff that is responsible for medical services in that region. Then we have the provinces which have directors of hospitals, also with a full complement of staff. Then we come to the local authorities. We have the Health Boards in the Transvaal and Natal with their chief medical officers and their assistants and nurses and other staff. This also applies to the Provincial Council here in the Cape and also in the urban areas. Practically every town that is worthy of the name has its own medical officer with his district nurses, etc. and they provide all sorts of medical services. We find that there is no compulsory liaison between these very large groups; there is no co-ordination. Every group works independently and this causes enormous overlapping with resultant unnecessary costs. In our hospitals we have the same story. We have hospitals under the control of the State; we have hospitals under the control of the provinces; hospitals which are attached to medical schools and which work on a different basis, and then again we have hospitals which are purely provincial. We have hospitals under the control of the local authorities, mission hospitals, private hospitals, as well as other special hospitals such as SANTA and mine hospitals, for example. All these institutions are under separate control; they have their separate staff and their separate workers. Outpatients are also taken care of separately by these separate bodies. This overlapping must necessarily result in poorer services; it must result in greatly increased organizational costs. There should be a doubling of out-patient services—there is no alternative because to-day there is no proper co-ordination. There is no liaison between these various services. If each authority has to erect its own hospital it must result in divergent patterns and divergent control of hospitals. Just think of the fact that all these institutions purchase their supply separately instead of buying through one big channel. There is a complete lack of standardization. Another factor that we dare not overlook is the unnecessary and enormous waste of manpower. I am convinced that this country simply cannot afford to continue on this basis. We simply have not got the finances and the manpower. I say therefore that it is absolutely essential that we should try to cope with this question of overlapping without any waste of time and at the earliest possible date. I say that the time has come to do so not only because I consider it essential but it seems to me, after having read the commission’s report, that this is the opportune time because people are more or less ad idem. I just want to quote the opinion of one or two bodies. This is what the South African Nursing Council has to say in connection with overlapping—

In the same way I could also quote the Transvaal Hospital Department and the Free State Hospital Department. The Natal Hospital Department says—

I do not want to take up too much time but the fact of the matter is that all these persons and bodies have expressed themselves against this overlapping. The radiologists’ group of the S.A. Medical Association says—

I want to conclude by saying that I think that I have proved that the time is ripe, that this is a suitable time for us to concentrate as soon as practicable on the standardization of these various activities and that we should try to eliminate this overlapping.

I would like to congratulate the hon. member for Vanderbijlpark (Dr. de Wet) on his marathon effort but mostly on his quantity. Unfortunately for us on this side of the House we have not had either the report of the Snyman Commission nor the report of the Commission on Sick Funds available to us. I feel that it is wrong that a member should be able to come into this House and debate the reports of two commissions when the Opposition has not had the opportunity of seeing them. There have been odd extracts in the medical journals and odd comments, but in spite of all my efforts I have not been able to obtain a copy of the report of either commission. This make it extremely difficult to reply to the remarks of the hon. members for Vanderbijlpark and for Odendaalsrus. The machinery which is now suggested for the control of excessive medicines is, of course, of general interest to the Department of Health. But, Sir, it cannot be said under any circumstances whatsoever that their work was timeous. For the last two years this side of the House have urged action upon the Minister. During the last session the hon. member for Rosettenville (Dr. Fisher), seconded by myself, proposed that the hon. the Minister should at once undertake the introduction of a medical sick fund service. So the word “timeous”, I fear, is somewhat misplaced. As I have said, we are in a very difficult position in having to reply to the remarks of the hon. member for Vanderbijlpark.

My feeling about the Ministry of Health is that it is far from timeous and it is far from efficient. There are so many problems facing the health services of this country that I wish to propose an amendment to the motion of the hon. member—

1. (a) considers that one of the principal factors causing the rising costs of medical services and medicines is the Government’s general neglect of the real health problems of the South African population; and
2. (b) deplores the Government’s delay in establishing a voluntary national medical aid scheme.”

To start with this Minister is working under an Act which was brought in, I think, in 1919 and he is trying with an Act of 1919, which applied chiefly to a pastoral country, to maintain the health of a country the population of which has more than doubled and which has changed from a pastoral into a highly industrialized state; from a country where the non-Whites lived in their own areas into a country where the main cities are to-day surrounded by dormitory cities containing mostly non-Whites, with all the additional problems of the enlargement of cities which takes place. Whenever you aggregate people or animals or plants into large numbers you develop problems of aggregation. If you have an orange tree in your garden it is unlikely that it will develop disease. But if you have 30 to 40 to 50 orange trees together you can be quite certain that they will develop disease. The same thing happens in the case of human beings. If anything it happens more so. And the problems which face us to-day, to my mind, flow from an attempt to lower the cost of medical treatment and medicines instead of trying to avoid the necessity to use them. We should use our doctors to maintain positive health and not allow our people to contract illnesses and then try to get them better without paying for it. The duty of the Ministry of Health and of the Central Government is to maintain health positively.

How do you prevent appendicitis?

Even that, Mr. Speaker, can occasionally be prevented. It happens to be one of those diseases which is a disease of civilization. There are nations who live under certain conditions, the Chinese for example, who hardly ever get appendicitis. Appendicitis was almost unknown among the Bantu until he began to live in the White areas, until he began to eat the White man’s food. It was then that he started to develop appendicitis. He did not have it in the old days. That is my answer.

The hon. the Minister has in one instance, I must say, made an effort to meet what I believe to be the obligations of his Department and that it was he who introduced the universal vaccine for poliomyelitis. It was a sort of effort on his part to try to do something, to do something positive, but it was given a most exaggerated importance. In the health of this country poliomyelitis is not a very serious illness. The number of cases, even before the introduction of the vaccine, amounted to about 1,000 per annum. But this happens to affect children; it leaves people paralysed and because of that it is an emotional disease; the public consequently attached a great deal of importance to it. But the problem of poliomyelitis fades into insignificance in comparison with the problem of tuberculosis. Here we have a disease which costs the country seldom less than R8,000,000 per annum. That was what was spent last year. I think it was a little less the year before. This year it may be a little more. But the point is, Sir, that this is a preventable disease; this is a disease which could be brought under control, perhaps not eliminated. Few countries have succeeded in eliminating tuberculosis completely in the human but there are many things that can be done in order to help make this disease negligible.

I point to one thing: Firstly, the Public Health Act allows free radiological examination for tuberculosis subject to regulations which the Minister may make. What does he do? He charges them 2s. Now, tuberculosis is very largely a disease of the poor people; 2s. means something to them. In any case, they think that if they are well why should they go to be X-rayed? The ideal thing in this country would be to take miniature X-rays of everybody and to attempt in that way to discover the early cases, to isolate them from the other and prevent the disease spreading. What else should be done, Sir, to create a positive health in the country?

Take for instance the question of nutrition. Nutrition should be under the control of the Minister of Health. Nutrition is what we eat; it is the food we eat, but it is not under his control. He has passed it off on to somebody else. Take the control of pure water. We need control of pure water but it is not under the Ministry of Health. These things, when approached by a Ministry which is not the Ministry of Health are approached in general with an outlook of cost. Psychologically, Sir, there is only one Ministry which looks to the people, which looks to their health, which puts their health first. Every matter which concerns health should come under this Minister. Take the question of industrial health. This Ministry has abdicated completely from anything to do with industrial health. Inquire into industrial diseases. Take the Workmen’s Compensation Act; except for the compensation part of it, that should fall under the Minister of Health. How can you expect a Minister of Labour to be interested particularly in the health of the workmen? He is interested, as we saw last session, in the solvency of his compensation fund. In the case of industrial disease, what did I find when I looked into the matter? After a good deal of search I was able to find that there is a list of industrial diseases which changes a little from time to time. But the Ministry of Labour is not looking round to see what diseases are creeping into the factories. When there were enough people suffering from pneumoconiosis in the ordinary labour market it was then decided—I think during the last year or two —that pneumoconiosis should be regarded as an industrial disease. But it has never been anything else. Had the Government not abdicated from the medical side of pneumoconiosis to the mines it would have been detected many many years ago in the ordinary working man, those who work with cement, works where they make Vim, quarries, etc. All these things develop pneumoconiosis. But it was only recently, because people started to agitate, that pneumoconiosis sufferers have been regarded as coming under the Workmen’s Compensation Act. Had industrial health been taken over by the Department of Health they would have been looking for it. Even the outlook to-day, Sir, is unjustifiable. I wish to refer to two recent cases which are reported in the medical journals. In the Medical Journal of April 1962. I find a description headed as follows—

Now, Sir, what do we find? We find an article written by a doctor.

Business suspended at 12.45 p.m. and resumed at 2.20 p.m.

Afternoon Sitting

Mr. Speaker, when business was suspended I was trying to demonstrate how the whole health and industrial aspect is influenced by the psychological outlook of the observer. I want to say how important it is that in dealing with industrial health it is a great mistake to leave industrial health in the hands of the Ministry of Labour who is concerned only with work whereas the outlook of the Department of Health is that of looking after the individual worker’s health and welfare. Only they can deal with it.

I want to give the House some instances which happened recently in this country. The first is reported in the South African Medical Journal of 21 April, 1962. It refers to a case of “Anti-rust proofing by zinc galvanizing in Germiston ”. The first thing which is noticeable about this article is this. It starts like this—

It is noticeable, Sir, that this was a health inspector of the City Council. He was not an industrial inspector; he was not a factory inspector but he was a health inspector and he thought that things were not right. The matter was investigated and certain things were discovered. Firstly, “An investigation of the amount of zinc oxide would be costly. I lay emphasis on the word * costly ’ ”. We go on and we find that in this factory there is a turnover of labour of 50 per cent every year. It suggests that some of the workers were sick. I read further—

This is a doctor speaking—

Various methods were introduced into the factory. For instance a rail was put up. But it was found that it made the worker a bit slower so it was taken away. It was suggested that an exhaust system should be introduced to draw the fumes away. And what do we find? The manager said that he felt that an exhaust system would be too costly for the means of the company. So the only thing this factory suggested was that when any man got burnt—they frequently got burnt by splashing—he was fined because it was regarded as being careless. Here, Sir, we see the outlook of a factory, of an industrialist, who is not very greatly interested in his workers. He wants workmen Who can work but if any safety measures are going to cause a rise in the costs then he will resist them. It is only the State and only the Department of Health which will take sufficient interest to see that safety measures are carried out. I have discussed this matter with various health authorities, with various pathologists and chemists and people who analyse fumes and the general impression among most of them is that the industrialist will always resist anything extra that has to be put into his factory, such as a safety measure, on the grounds that it costs too much. Very often it is found subsequently that his recovering of the waste products changes the cost structure to such an extent that he is very glad to have saved it. However, that is by the way.

I want to draw attention to an article which appeared this week in a journal of the Medical School of the University of Cape Town— it is their Jubilee year—dated 19 January, 1963. Here we find that a large number of people in Cape Town are walking about with a fair amount of asbestos in their lungs. It sounds a most extraordinary thing, Sir, I want to remind the House that some two or three years ago I drew the attention of the Minister of Labour and the Minister of Health to the development of a cancer in people exposed to asbestos. This was a cancer which had been found very common in Kimberley. The general feeling was that it was due to asbestos though many other factors were involved. I know that the hon. the Minister has lent one of his staff to investigate this question but he has rather been investigating it in the mining area. I am now discussing the question of asbestos in the cities. I read from this article—

In other words, of 500 people who died consecutively—and it must have been in a hospital—there was evidence that these people had absorbed into their lungs sufficient asbestos to be found without great difficulty. There was no evidence that it had anything to do with cancer nor any evidence that it was doing them any harm but the fact remains that in the atmosphere of Cape Town there is apparently quite an appreciable amount of asbestos. The pathologist who did the work goes on to say—

I know, Sir, that some time back in Durban an inspector entered a factory which was dealing with asbestos and found that the men were working in a fairly dense atmosphere of dust, the dust, of course, being asbestos dust. He objected to it and what was done? The factory introduced an exhaust fan by which they sucked out the asbestos dust from the factory and blew it out into the street outside. Such a thing could not happen under a Department of Health. It can only happen under an industrial department. The outlook of the Department of Health should be and is that they must take over the industrial health so that when an inspector goes into a factory he will be a health inspector.

Let us turn to pneumoconiosis. Pneumoconiosis is a hardy annual in this House. It comes up as frequently as the group areas. I am not going to argue about the Group Areas Act and whether it is coming up again, but I do say that when an Act has to be constantly changed and constantly brought before this House, it is obvious that somebody is dissatisfied and that the Act is not working satisfactory. In my profession, Sir, if we are dealing with a sick person and we think we are right in our diagnosis and we think we are right in our treatment, and we know the treatment should be satisfactory, but the patient does not get better, we go back along our tracks and we try to see at what point we went wrong. I want to suggest that the Government should go back along its tracks in regard to pneumoconiosis, and even in respect of governments before the present Government. I know what is wrong with this Pneumoconiosis Act. It is that the men, the miners, do not have faith in the doctors of this Pneumoconiosis Bureau, and the reason for that is that these doctors are employed by the Department of Mines, that they are paid by the Department of Mines. I do not wish to say anything against them, but their outlook in general is not that of a health inspector, is not that of a doctor in practice, is not that of a man trying to get his patients better. These doctors in the Bureau have no responsibility to the man, to the patient. They have no responsibility to the patient; when they discover another disease, they do not even let the outside doctor know about it.

Why do you say that?

I will show you. They have no responsibility to the individual. They are employed to say various things: Is this man suffering from pneumoconiosis? If so, in what stage? If he is not, that is the end. They are not there to prevent disease, they are not there to cure disease, they are not there to help the man. They say: “Yes, you can go underground” or “No, you cannot go underground ”. No doctor worth his salt can stand that sort of work. No doctor can stand where he has no responsibility to the patient. I remember at one time I had a house surgeon, the son of a rich man, who I thought was a very good doctor, but he finally decided to work in his father’s business. I met him some months later and I said “Well, how is it in this rich industry in which you are working?” He said: “It is very nice; my hours are regular; but I cannot stand it any longer; I cannot stand not having responsibility.” It is that lack of responsibility, in respect of a sick man, that is causing the difficulty. The doctor is not responsible to the sick man, but to some committee, and as a result pneumoconiosis is a hardy annual in this House, and it will be so until such time as the Department of Health takes over the medical aspects of it and leaves the compensation point of view to somebody else. But this Government has in its department the biggest group, I might almost say the only group, of thoracic physicians and they never see a case of pneumoconiosis until it has been thrown out by the Bureau. If pneumoconiosis is to be properly dealt with, if the miner is to be satisfied, he must be satisfied, not only that he gets compensation—that has got nothing to do with me—but he must be satisfied that the doctor who sees him is a doctor who is interested in him and not interested in the Pneumoconiosis Act with all its various stages. Pneumoconiosis is the main industrial disease in this country. It occurs in other places than mines. It occurs in quarries, in cement factories, amongst those who live near to cement factories, those who live near asbestos mines. We know of a man who worked in the Johannesburg Tramway Company and who developed pneumoconiosis because the tram in which he either took the tickets or drove, passed near the City Deep Mine. We know that. All those things happen. But there are people in the Department of Health who can deal with these matters and they must not shirk their duty. The psychological outlook of the doctor looking after a sick man, whether he is a miner or a sailor, a working man, is different from the doctor who is looking after the interests of an employer or a Government Department. The hon. the Minister of Transport will tell the hon. Minister of Mines that he has very little trouble with his injured workers, very little. The reason is that the same doctors who attend to his railwaymen when they are sick, are the doctors that he can consult when he wants to know whether they are able to work, whether they should be given certain special work, and whether they should be compensated for injuries, etc., etc. The railwayman trusts those doctors and does not think that his doctor is merely serving the hon. Minister of Transport. There will be no peace among the miners until the Minister of Health takes over that department. So much for industrial health.

I want to turn now to the hon. Minister’s own Department. The Minister’s Department is chronically short of personnel. In fact it is in a bad way in certain very serious aspects. It has almost no pathologists; it has perhaps four or five; so far as I know the Minister has no virologists, although he can call on Dr. Kipps of the University of Cape Town. Sir, these are very serious deficiencies. Many parts of this country are sub-tropical or almost tropical. We have been fortunate up to the present in having on our northern borders countries which were controlled by modern civilized departments of health, and we have been able therefore up to a point to stop disease coming down from the north. It is easy for the Department to control the seaboard. But we are faced with changing factors in this country, changing factors in that our northern borders will need a great deal of protection and we know that protection is not sufficient. We know that the Asiatic flu which came down some three or four years ago, did not come in through the ports—it came down from the north. We have the example of the introduction of rabies in 1960 in the north of Zululand. Now that was actually foreseen. The Department of Veterinary Services told me that they knew that it was coming, that they could see it coming down, and yet they were unable to prevent it, and the Department of Health had the misfortune of being faced almost at the same time with three epidemics at a time. There was the outbreak of rabies which made demands on their staff, there was the outbreak of foot-and-mouth disease which called on their staff and they had an outbreak of typhus in Port Elizabeth. They were very hard pushed to have sufficient staff to deal with these problems, and I feel that it is time that the hon. the Minister with all the dangers that we face to-day should have a mobile team. He should have somewhere, as should the department of veterinary services—but that is not for me to say here—have a mobile team which is available and can be called upon at any time to deal with an outbreak of disease. It does not exist. The district surgeons are very much below the required number. I have already drawn attention to the pathologists and the virologists. The importance about virology and pathology is that they serve the purpose of diagnosing diseases, but in addition to that they serve the purpose of manufacturing the antidotes. In the case of rabies we had an example of a breakdown. Temporary it is true, but nevertheless there was a breakdown and had we been dependent solely on the human side of it, we would have been in great difficulties. It came out that the only laboratory capable of manufacturing virus anti-bodies is that which belongs to the Poliomyelitis Research Institute and we had enough stocks of poliomyelitis vaccine to be able to offer their services to the hon. the Minister and to help prepare sufficient rabies vaccine. But what was the quantity they could produce? It was shocking that in the whole of South Africa from the human aspect virus preparations, anti-bodies, were reduced to 900 doses per week. Now, Mr. Speaker, virus diseases will not wait until these vaccines are prepared, and here again I emphasize the deficiency of pathological manufacturing departments in this country. Those of us who take an interest in the scientific aspect of the spread of viruses know to-day how near the edge we are moving when there could be an outbreak.

Let us look at the point of view of what this Minister’s Department has done in regard to research. Medical research was put under the care of the Council for Scientific and Industrial Research. Now the hon. the Minister must not come and tell me that the Du Toit Commission recommended this. The Du Toit Commission did not recommend it. I have made a close study of the recommendations of the Du Toit Commission, and I find that the Du Toit Commission, while it recommended that there should be close cooperation between this Council for Scientific and Industrial Research and medical research, nevertheless recommended that they should not be amalgamated. But they did say: Establish a Council for Research in Medical Science and in that council place research in medicine, in human pathology, in human research, in animal research, and also research into dental diseases. Had that recommendation been implemented, great benefit would have come to the Department of Health and to the Department of Veterinary Services. Because more and more is medical science and veterinary science learning that there is very little difference between the human animal and other animals when it comes to disease. But diseases which have one name in veterinary services are not recognized in the human services as being the same disease, and it is only by the identification of the actual virus that we will be able to appreciate what is happening to us when new viruses appear and what is happening to the animals when new virus diseases appear among them. I regard it as a most urgent matter that medical and veterinary and dental research should be put under one control, and that control, I believe, should be the Minister of Health. There is a country which does this to some extent and that is the Commonwealth of Australia, where all quarantine has been placed under the care of the Minister of Health. He is solely responsible for all varieties of quarantine and the quarantine outlook of the Commonwealth of Australia has been magnificent. It has of course the advantage that they are an island, an island under single control, but it is one of the few countries which has been able to keep itself free of rabies. Very few other countries are free of rabies. Scientists believe that these viruses can be changed and the research into this aspect is so essential to this country. Even the hon. Minister’s own farm at Claremont where they manufacture the vaccine for smallpox is not controlled by a virologist. So short are we of these particular scientists. I feel that every effort, no matter at what cost, should be made by the Minister to train more virologists and pathologists and to get them into his Department. I don’t want the hon. Minister to think that I am not appreciative of what he has done with these two commissions. I am not in a position to criticize, to approve or to disapprove of them. Their reports are not available. I feel that when they are available I shall try to consider them with an objective mind, but it is not possible to criticize or even to discuss something which one has not seen. I do feel, however, that in the diversion of his attention as far as these matters are concerned, which in their way are trivial matters compared with the large problems of poverty and health, the large problems of prevention, when you see the country as a whole and the people as a whole, the Minister cannot do justice to his task. If he wants to know one of the main reasons why medical costs are high. I can tell him. I am not running politics, but if you will realize that a hospital like our Durban hospital has to run a European section, has to run an Asiatic section, has to run an Afro-Asiatic and a Euro-african section, and has to run a Bantu section, you can well see how all this adds to the cost structure. We have to face that fact.

One or two things, however, the hon. member for Vanderbijlpark did mention which I still want to refer to. He spoke about our having our own pharmacopoeia. I don’t think the hon. gentleman has given that all the thought it needs. The cost of a pharmacopoeia is colossal. It is a highly technical book of many pages, running into thousands. It is like a dictionary. It would mean that it would have to be translated, which under the technical circumstances probably would be impossible. To ask that the Bureau of Standards should be prepared to undertake this task is, I do not want to say absurd, but certainly far beyond their capacity. They have not got the time to do it.

The great thing that we have to realize is that medicine is universal. Whether you learn to be a doctor in Cape Town, or whether you learn to be a doctor in Berlin, it does not make any difference, and the countries whose pharmacopoeia we use in general are Britain, where the pharmacopoeia has been compiled probably over 50 or more years, and where it is constantly kept up to date, and the United States, and that is quite enough for us, and there is no lowering of our dignity because we use someone else’s pharmacopoeia.

I never said so.

I know, but I see no reason to make this change.

Another matter to which the hon. member drew attention was the shortage of dentists. My own feeling is that we must try to find a way of lowering the cost structure of dental treatment. The unfortunate dentist has only so many half-hours per day; he can deal with one patient in half-an-hour as a rule. In addition to this he is a human being and he has to stand on his feet while he works; few people can stand on their feet for more than about eight hours a day, especially as they increase in years. Furthermore, during much of his work his position is twisted, his body is twisted, and it is not unusual to find that dental surgeons tend to break down as a result of the condition of their legs or their backs rather than that they get old mentally. So in America, while they have a lot of quacks, nevertheless they have introduced a system of dental aids who are trained to the extent that they can prepare a cavity. We must face the fact that the bulk of the dentist’s work is the preservation of the teeth which are carious and in which cavities are appearing, by clearing out the cavities and by filling the cavities, the dentist saves your teeth. So there are now being trained in America, and used, dental assistants who prepare a cavity under the supervision of a qualified dentist, who then if he decides that it is satisfactorily done, proceeds himself to fill the cavities. They employ two or three of these aids, and in that way the cost structure of dental treatment may be reduced. But if we carry on as we are, Sir, there is not the slightest hope of lowering the cost structure of dental treatment. The man, as I say, has only so many hours and only so many years that he can work; he has to spend five of his years to learn his work. It is a fallacy to think that he makes money out of selling teeth. He does not. His cost structure is very carefully controlled so that you have to find some way by which he can treat more patients in a given time than is possible under our present system.

I beg the hon. Minister again to try and see his Ministry from a wide point of view. I would suggest that he should resign his portfolio of Posts and Telegraphs, because I believe that it is not within the capacity of any human being to be Minister of Health in this country unless he devotes his full time to it. I would further suggest to him to see that research work in the university medical schools is helped, that they do not have to go cap in hand to the C.S.I.R. and ask for funds. Why should the Minister of Economic Affairs control medical research, because that is what it amounts to. The Department of Health has ceased to take an interest in it. The universities are hard up, they cannot keep their research workers. Medical research workers are going. None are coming in. There is always an interchange of men between universities, but if we could only find out the number of topgrade doctors who have left this country— not for political reasons generally, but because unsatisfactory conditions of work and research, and lack of chances for their children to be themselves doctors and research workers, we would be alarmed. The hon. the Minister should see the size of the problem that he is faced with, and he should not waste his time tinkering with the little committees that he appoints.

I second the amendment.

At the outset I should like to say that I share the concern expressed by the hon. member for Durban (Central) (Dr. Radford) of the fact that this side of the House has not been made aware, nor has had copies made available to it of the report of the Snyman Commission. Only this morning an application was made to have sight of and reference to this report and the reply was given that copies are not yet available. I think it is most regrettable that this side of the House has been deprived of that courtesy.

There are some points arising out of the speech of the hon. member for Vanderbijlpark (Dr. de Wet) I should like to touch on. I followed the information he gave with the greatest interest, and I feel that some of the points he made are worthy of comment. One of the salient points in the recommendations of the hon. member for Vanderbijlpark was that the manufacture of drugs and chemicals in South Africa should be undertaken primarily in this country, and I understood him to say, primarily by South Africans. With that remark, I think, we can all agree. But if we take that position to its logical conclusion, we find that we need skilled people to perform the tasks necessary to manufacture drugs. I’ll go into greater detail a little later on regarding the position in the labour market in so far as skilled pharmaceutical services are concerned. I hope the hon. member for Vanderbijlpark will take cognisance of the danger that is facing us in that direction. Another reference was made to a disability that is inherent in the provision that a manufacturer of medicines has to appoint a chemist to be the managing director of the body corporate which manufactures the particular medicines. I believe that the absence of a chemist and druggist from the commission was the cause of a misunderstanding of the position, and I believe the difficulties which led to the conclusions in the report of the commission of inquiry, are more hypothetical than real. I believe that an amendment of the Medical and Pharmacy Act, could easily overcome that difficulty. I am certain the hon. the Minister is aware of the position and that he knows of the solution which will be forthcoming that will overcome this difficulty. But I would like to put a hypothetical case to the hon. member for Vanderbijlpark so that he can appreciate the danger if the control of the manufacture of medicines passes outside the scope of the Medical, Dental and Pharmacy Act. If such control were only enforced in terms of Section 37 of the Act, which lays down certain acts which may be performed by certain individuals such as chemists and druggists, if those are the only conditions applicable to the manufacture of medicine, you could reach a position where six small manufacturing organizations could engage one chemist and druggist who would operate on a rota and go along to these various manufacturers and supervise the manufacture of a particular medicine and then pass on and give his services to another member of such a combine. I believe that such a practice would not be in the interest of the public. The hon. member for Vanderbijlpark referred to the rising cost of medicine, but I think we must put this in its true perspective. He referred specifically to medical services and to medicine. I believe from figures, which are accurate, that in comparatively recent times many of the expensive preparations which form a large proportion of the prescriptions which are dispensed under present circumstances have undergone a considerable reduction in price. I make bold to say that antibiotics, taking the whole field of antibiotics, the various cortisone preparations and their derivatives, would possibly represent 20 per cent to 30 per cent of a chemist’s dispensing turnover, in the number of prescriptions, and from figures which I have— and they are authentic—it is pleasing to note that various antibiotic capsules have enjoyed a considerable reduction in price. I do not propose to refer to them by name, but a well-known capsule which retailed not so long ago, in 1961, at R7 for 16 capsules was reduced last year to R4.35. A similar preparation in liquid form, which was originally R3.08, is now R1.71. In regard to cortisone preparations there has also been a reduction. I believe the original price of some of these preparations was as high as R15 for 30 tablets. to-day the price is R1.85. I believe that is something of which this House should be made aware.

The hon. member also referred to the question of the South African pharmacopoeia and I would like to enlarge briefly upon what the hon. member for Durban (Central) said. This matter has exercised the minds of those who are responsible for the use of the pharmacopoeia in South Africa, and for seeing that it is the medium of teaching in the colleges. As late as 1961 the Secretary for Health said that the question of the translation of the British Pharmacopoeia and other official reference books had been considered by the Department in 1958, when they came to the decision that as Che Union still had to import most of the drugs used for medicinal purposes, the compilation of a South African pharmacopoeia might result in a drug shortage, as the larger overseas manufacturing houses might not be willing to manufacture drugs which comply with the specifications for a relatively small market. The enormous cost of translating and producing Afrikaans versions would be prohibitive. But I know that a suggestion has been put to the Minister and I am sure it enjoys his consideration, that the establishment of a South African formulary should be proceeded with as soon as practicable and that it should be in both official languages. Reference was made by the hon. member for Durban (Central) to the expression “timeous”, which the mover of the motion included in his remarks. I would like to endorse that. This matter is not being done timeously; it is long overdue. If one goes back just a little into the past, one realizes that some of the things the hon. member has in mind when he moved his motion came to the attention of this House as early as 1937. It was not actually discussed by the House, but the matter did receive the attention of a Select Committee. I am referring to the Proprietary Medicines and Appliances Bill of 1937, almost 26 years ago. Now we have a call for positive action and I feel that there is a strange anomaly. No one will deny that there is urgency in supplying health and welfare services to the people, but it seems to me at this stage that to stress the urgency of the question is premature. We have the report of the Snyman Commission. I have explained that it has not been made available to all of us who are interested in it, and it would appear that legislation may be introduced without many people who are vitally concerned in such legislation being able to give the matter the full benefit of their consideration.

In regard to medical aid schemes, progress has been made. A council has been appointed. I have in my possession—I doubt whether many members of the House have—the rules which Dr. Reinach’s Council has produced in regard to these schemes. But this, too, has come late, and in my opinion does not go far enough. The real problem has been the failure of the Government in the past to recognize the need to assist people in so far as the establishment, co-ordination, maintenance and operation of medical aid schemes are concerned. The people most affected and who need help most urgently are those in the middle income groups which comprise the largest proportion of our population. I feel that there are certain provisions under the existing legislation which there are to protect and help poor people. The wealthy people, although they might find the cost of medical services excessive, are in a position to meet that cost, but it is mainly for the middle income groups that the demand for assistance exists. While I realize that there are numerous medical aid schemes in existence, as far as I know they operate only for White people, and I feel that the ultimate aim should be to include all the citizens of the Republic in some form of medical aid scheme. I am not suggesting a form of national health insurance, but I believe that the Government and the Department of Health must accept a greater responsibility in assisting the members of the public to combat this great fear of sickness. We know that a great variety of schemes are in existence. I believe that the Reinach Council will try to co-ordinate all those schemes. There are numerous disadvantages in the operation of these schemes. Many of them have expensive and top-heavy management structures resulting either in an excessive contribution by the members or a reduction in the benefits enjoyed. Other schemes operate on a restricted list of medicaments, and it means that the members are deprived of access to a wide range of drugs which the modern physician regards as necessary. In any case, I do not believe that all schemes cater for all the basic essentials which are so necessary in the eyes of the people. I submit that any scheme should include medical care, surgical care, the provision of medicines, hospitalization, facilities for X-rays, pathological examinations, dental services and maternity benefits, and it should be the immediate aim to co-ordinate a scheme which would provide the citizens of our country with all these services.

I referred in my opening remarks to the question of the limitation in the number of skilled people and I believe that the implementation of any scheme as envisaged by the Reinach Council or by the Department, or by the hon. member for Vanderbijlpark, for that matter, will need an increased number of skilled personnel. Let us look at the personnel which will be required to administer such a scheme. Primarily it will consist of medical men, dentists, chemists and druggists and the nursing services. I should like to take this opportunity to draw the attention of the Minister to the very serious position which may well arise in regard to the provision of pharmaceutical services, and I should like to quote briefly from the report of the National Bureau of Educational and Social Research published in 1960 and which, in the chapter dealing with chemists and druggists, refers to what is known as the Bremer Commission or Committee of Inquiry into the training of chemists and druggists, which was appointed in 1951. This is what the report says—

It might be well to look at the position then. In 1947 to 1950,545 chemists and druggists trained and qualified in the Republic. The Committee appointed in 1951 suggested that the annual increase in the number trained should be 30 per cent, and that at least 200 per annum would be needed to make up for the expansion envisaged in the country. But what are the facts? Taking the figures for the three years from 1959 to 1962,197 new chemists and druggists were added to the register, or 66 per annum. The ceiling fixed in 1960 was 200.

Reverting to the question of medical aid societies, I feel that the need for the establishment of such societies has been due to the fear of the population of sickness and the expenses arising therefrom, but I believe that one of the factors which aggravates the whole position is the question of self-medication. I believe that self-medication in this country is something which cannot be ignored continually. I believe that ultimately it enormously increases the cost of the treatment of people. I believe that one has to analyse the whole position of what can be called the cost of being sick. Let us just take a very simple example of the man who has a cough and decides, after reading a tempting advertisement in the newspaper, that he will try a certain cough mixture, and having done so, he tries another and another, and finally he is convinced that he should see his doctor, and the doctor diagnoses tuberculosis. The expense involved in treating the patient at that stage is a terrific drain on the resources, of the State and it is a tremendous financial loss to the individual concerned. That is also a factor which deserves very careful consideration. Self-medication leads to the injudicious use of many drugs, and many of the drugs which are available can be used injudiciously with harmful results. It was with this in mind that I tabled a question to the Minister in an attempt to get information concerning the injudicious use of drugs. I asked the Minister whether he had any information about the tragic consequences of the injudicious use of drugs by the public, and if so, how many cases, and what drugs were concerned, and also whether his Department had found the existing method of control adequate for the protection of the public. The reply given by the Minister indicated that, firstly, no reliable statistical information existed, but— “in the light hereof, and having regard to the recommendation of the Commission of Inquiry into the High Costs of Medical Services and Medicines, that legislation should be introduced to provide more effective control over the importation, advertisement and sale of drugs, the Department is satisfied that better control measures are urgently required in the interests of the public ”. I do not believe that one can gainsay that remark lightly, but I think we have to consider the position as it exists to-day and we must ask ourselves whether this matter is so urgent that it cannot wait for the full consideration of the report of the Snyman Commission. This Commission has been given a very high status by the Minister and it has conducted an extensive investigation—up to the present it has cost the State about R24,000—and yet the findings are not available to the House, although information has been released to various bodies which have a direct interest in the matters under consideration. But it is quite obvious from Press reports received from the bodies which have had access to the report that not only is the question of medical aid to receive priority, but also the question of legislation to establish a board to control various aspects of drugs and medicines. As I see it, this board will control formulation, manufacture and standardization, and it will even play a part in co-operation with the S.A. Bureau of Standards in the examination and testing of drugs. I want to quote from the S.A. Pharmaceutical Journal the impression which certain sections of the public have gained in regard to the power and purpose of this Board—

That statement was apparently issued to an organization which had the courtesy of a visit from Mr. Kempff, the Secretary of the commission. While no one who is interested in the welfare and health of our country will deny that a board with such objects would serve a very valuable purpose in South Africa, I feel that before it is established it must be put on a sound foundation and it must enjoy the support and the co-operation of every single facet of the whole aspect of the distribution of drugs and the treatment of sickness. It might be as well just to investigate what the position is at present and to see whether this position has broken down so badly that the need for the appointment of this board becomes one of such great urgency. Sir, we have had control. At present the control of what might be called drugs which may have unpleasant side effects is vested in a conjoint committee comprising members of the S.A. Medical Council and of the S.A. Pharmacy Board. I think few people would admit that the functioning of that body is perfect or adequate, but I would point out that South Africa has fortunately not had to suffer the tragedies of the Thalidomide cases which have been prevalent in so many of the Western countries of Europe. So it would seem, therefore, that there is control and that it operates with a fair degree of success. It might be interesting to investigate briefly how the system works.

In so far as habit-forming drugs are concerned, they are under very strict control. The amount of habit-forming drugs which can come into the country is settled by negotiation with the World Health Organization and the handling of habit-forming drugs all along the line of manufacture and distribution is safeguarded by the provisions of Section 65 of the Medical, Dental and Pharmacy Act. I believe this position is perfectly satisfactory because the control insists on the keeping of registers by anyone who has the power to dispense habit-forming drugs, and I would say that among the pharmaceutical outlets there must be some 2,000 registers kept. As far as medical men are concerned, those who do their own dispensing are also obliged by law to keep a habit-forming drug register. But how often are these registers inspected? I know cases where five years have elapsed before the register was inspected, and that is not an isolated case. I believe that is the crux of the difficulty which will arise after the establishment of this Board of Control, the question of policing the requirements of the Board of Control and seeing that its recommendations are carried out. It is quite obvious that at present the Department lacks the necessary personnel to effect the number of inspections necessary to safeguard the welfare of the public.

We also have the question of potentially harmful drugs. There again, ample legislative control exists in the form of Section 65bis, but I say advisedly that paragraphs (5) and (6) of Section 65bis are seldom, if ever, adhered to, and there has been no attempt by the Department, to my knowledge, at any time since the Act was promulgated in 1954 to implement those provisions which the Minister himself said last year in this House he felt were necessary. He was asked to withdraw this control, but he said he could not see his way open to doing so, and yet these provisions are not enforced; and I submit it is primarily due to the fact that the Department of Health has too few inspectors and is involved in the implementation of too many Acts. It has to deal with the Public Health Act, the Food. Drugs and Disinfectant Act, the Therapeutic Substance Regulations, the Medical, Dental and Pharmacy Act, to mention but a few of the major Acts, and I think the Department has shown that due to its lack of staff it is incapable of implementing all these Acts as they should be implemented. I have dealt with the question of the distribution of drugs by people who are trained by their profession and calling to handle drugs, but what is the position in regard to the distribution of potentially harmful drugs, which is permitted in certain cases by people with little or no training at all? I am referring to those people who are granted permission under the Medical, Dental and Pharmacy Act to hold poison licences, and certain of whom are empowered to handle potentially harmful drugs which are registered under the Farm Feeds and Fertilizers Act. There were in 1961 5,616 poison licences. It would be interesting to know how often these registers have been inspected and whether the Department can say with any degree of certainty that every one of these dealers in poisons is carrying out the rigid provisions of the law to safeguard the public. The sad feature of all this is that when contraventions are discovered, which would appear to be to the detriment of the public, there are cases when the police have been reluctant to act. There are many other aspects of the report which will in due course receive the serious consideration of this House, I believe, but I feel at this stage that in view of the fact that so many of the members of this House are not aware of the contents of the report of the commission it would be unwise to deal with it in great detail. I believe it is the wish of all of us that the question of the health and welfare of the people of South Africa should be dealt with expeditiously, but I believe that when we create something which will have to go down in history, something which will deal with all sections of the population and which will help them to overcome their dread of sickness and its attendant expenses, we should do so on the firmest possible foundations. The only way we can do that is for this House to be fully acquainted with the facts of the matter and the decisions made when legislation is put before it. Then I believe it will be possible to produce legislation which will be in the best interests of the people of South Africa and which will stand the test of time.

Mr. Speaker, I should like to begin by thanking the hon. members for Vanderbijlpark (Dr. de Wet) and Odendaalsrus (Dr. Meyer) for their contributions not only to this discussion but also towards the appointment of the Commission of Inquiry and really also for what will be achieved, which to a large extent will be the result of their efforts and their interest. I know the hon. member for Vanderbijlpark has certain doubts about the report of the commission, more as the result of what the commission, according to him, was perhaps not tactful enough to avoid saying. His objection is that the commission dared to make certain statements and to reveal certain facts which may perhaps embarrass some of our medical friends. I should like to point out to the hon. member that when a commission like the Snyman Commission is appointed, it is its duty to reveal everything, even things which are not always pleasant for everybody. If such a commission fails to reveal certain facts it would mean that doubt would be cast on it, and that its report would be much reduced in value. That is unfortunately the position if one wants to be impartial and thorough, because then one must also say things which perhaps one’s friends do not like to hear. Unfortunately that is something we just have to accept, and the medical profession also.

The hon. member for Odendaalsrus had one objection which is particularly important, namely that we will perhaps not be able to control these medical schemes, and that is a real danger. Fortunately control over all these organizations was introduced some years ago, in 1956, by the Mutual Aid Societies Act. All these medical schemes and sick funds are subject to that control, which is mainly financial control. I think the hon. member can therefore be assured that financial control already exists, and in so far as health control is concerned, this will now be introduced as soon as the Central Council is clothed with legal authority.

The hon. member for Durban (Central) (Dr. Radford) is one for whom I have great respect. I always regard him as a man who has good and clear ideas, but it is a fact that the best of us sometimes lose the road and I am afraid that this afternoon he did so during the first portion of his speech. That hon. member and the hon. member for Durban (Berea) (Mr. Wood) have perhaps connived because they supported each other in their attack on the Government by saying, “This thing is long overdue “you are always too late, you are always too slow ”. Just let me remind hon. members of how fast things happened in fact. In the 1959 session, immediately after I was entrusted with this task, there was a discussion on this subject in this House, and I at once promised the House that I would do my best and said that the Government was so interested in the matter that a commission of inquiry would be appointed. That commission started functioning in the beginning of January 1960. The commission completed its investigation and its report, consisting of three volumes, in approximately two years, a really great and magnificent piece of work. I do not think that we have ever in our history had a commission which submitted such a report in a shorter period than this one did. I think it is an outstanding achievement that this commission could complete such high-standing work within two years, together with a report which stands four-square and which can withstand any criticism. But I know what the hon. member’s difficulty really is and why perhaps he has not done what his sober self would have let him do, namely that the hon. member for Rosettenville (Dr. Fisher) moved a motion last year asking that the State should introduce a medical scheme for everybody. They calculated that it would cost the State R48,000,000 every year. We on this side explained why we thought that although it would be a feasible solution it would, however, be too expensive and less effective than our solution. We gave all the reasons and I do not want to go into them again. Thereafter this commission submitted its report and shortly after that the Central Council for Medical Funds was put into operation, and whilst we are gathered here and the whole of the report has not even been printed yet, that Central Council has already set to work and is doing very good work. I do not think the hon. member can accuse us of having wasted any time. I think that when he is calm again he will probably get up during the next session and apologize for having so unfairly accused this side of the House. The hon. member unfortunately was not his old reasonable self, because do you know what he did? In his attempt to belittle everything that was done, he launched an attack on the energetic way in which the Department combated polio throughout the country. South Africa is one of the first countries in the Western world which combated polio on a national scale and it is now taking the next step in order to eradicate it finally in South Africa. [Quorum.] The hon. member will remember that other great countries of the world have already tried to tackle the problem but that they were faced with such problems that they became afraid and ceased their attempts, but that South Africa is one of the first countries in the world on this side of the Iron Curtain which has really managed to achieve so much success in combating polio. The hon. member then said: “Oh, how many polio victims are there? There are only a few and you are just becoming emotional because you see that these people are crippled; it does not make so much difference.” But the hon. member must remember that in some years there were over 3.000 cases of polio—3,000 people who could have been crippled for the rest of their lives and would have been of no use, or of very little use, to society. But this he regards as being of little importance; it is just a trivial matter. He says that we are concerned with trivialities instead of tackling such great problems as tuberculosis. But the hon. member should not forget that ever since the time of Dr. Bremer we have been tackling tuberculosis seriously. The hon. member forgets that in South Africa we are faced with a problem in connection with tuberculosis which one does not find in other European countries, namely that the people who contract tuberculosis are mainly the Bantu, a large percentage of whom do not submit themselves for investigation or treatment. Our problem in combating tuberculosis is not to make a man healthy when once he has tuberculosis. We can do that, and we do everything in our power, but the problem, as the hon. member for Middelland (Mr. P. S. van der Merwe) said, is first to discover this man, and we have endless problems because we have many mountains and valleys and there are many millions of Bantu who hide themselves there.

I find it peculiar that the hon. member on the one hand condemned the Department and us, but soon thereafter he became himself again and pleaded that nutrition should be placed under this bad Department, this Department of Health which has really done nothing, and which was asleep the whole time. Nutrition must now be placed under this Department and it is wrong to put it under any other department, and industrial health must be put under this Department because it is wrong to put it under any other department, and the same applies to asbestosis and pneumoconiosis because the Mines Department cannot handle it as well. Research must be placed under this Department and should no longer be under the C.S.I.R. On the one hand the hon. member condemned this Department …

May I put a question to the hon. the Minister? Is it not a fact that you spent R80,000 on polio and that you allowed only R5,000 for the use of B.C.G. for a much more serious disease, B.C.G. which is almost as effective in combating tuberculosis as vaccine is in combating polio.

The hon. member has again spoken too hastily. Let me just remind him of the problems of B.C.G. The hon. member will know that we started the new B.C.G. only very recently. The old B.C.G., as he knows, could only be injected after the man had been tested. If one now tests the Bantu, one knows only in five days’ time whether B.C.G. can be injected, and by that time he has disappeared completely. Then the hon. member should also remember that the new B.C.G. is only about 80 per cent effective. It is not as effective as the polio vaccine by far. The polio vaccine is 100 per cent effective. B.C.G. is only a preventive measure, and even though we use it we still do not reach those hundreds of thousands of Natives who hide in the mountains and hide their children in their homes. That problem still remains.

The other problems referred to by the hon. member for Durban (Central) unfortunately have nothing to do with the one under discussion to-day, namely these medical schemes and the Snyman Report. Therefore the hon. member should not blame me for not replying, but I want to ask him to be so good as to raise the matter again under my vote when the House is in committee on the Estimates, when I will give him the standpoint of this side of the House.

There was one complaint with which I have sympathy, namely that the printed report of the Snyman Commission is not available yet. Just let me inform hon. members what has been done. On 31 October—really on 1 November—this report was released for publication. Various copies of the report were then studied in roneoed form. The Press, the medical Press and all the other interested bodies could then peruse it, and the main contents of the report were announced generally. About 40 copies were also made available to the Medical Council, of which the hon. member is a member, and to the Pharmaceutical Association, of which the hon. member for Durban (Berea) is a member, and quite a number of other persons and bodies. There were always roneoed copies available for those who were sufficiently interested in the matter, but the hon. member for Durban (Berea) has just told us that this morning, shortly before this debate began, he went to the Department and that the Department could not provide him with a copy. But surely he asked for it a little late. I think if he had taken the trouble to ask for a copy a little earlier, I myself would have been able to assist him. Now let me just say this. The Afrikaans copy of the report has already been printed; the first proofs have been passed and we are just awaiting the final proofs. The English translation has almost been completed, after which it will of course also go to the printers. At the latest we hope that both will be available in the beginning of April, but I still hope that long before that date we will be able to make printed copies available, at least in Afrikaans, to hon. members who are interested in it.

The hon. member for Durban (Berea) had one objection to this commission, namely that there was no chemist on it. It is very difficult to appoint to a commission all the people who may possibly be interested in it directly or indirectly. The only principle to adopt in appointing a commission is to appoint honourable and efficient persons who can listen to all the evidence and then give their decision as honourable, intelligent and trained men, on the basis of the evidence submitted to them. May I point out to the hon. member that evidence was given before this commission by the S.A. Pharmaceutical Association itself by the S.A. Pharmaceutical Manufacturers’ Association, by the Wholesale Drug Trade Association, by the Retail Chemists’ Association, etc. In other words, ample evidence was submitted to the commission by all the various interests represented by the hon. member for Durban (Berea). Therefore I do not think he can for one moment accuse the commission of not devoting its attention thoroughly to all the problems affecting the chemists’ profession.

Unfortunately I have not much time at my disposal, but perhaps I should say a few things with reference to what was stated here to-day. The hon. members for Vanderbijlpark, Odendaalsrus and Durban (Central) all pointed out that medical costs are steadily increasing in South Africa and that this is something which severely affects every citizen. For years already the State has been asked to take action. Let me give the history of the matter as it started in 1959, when this matter was entrusted to me for the first time. After the Snyman Commission was appointed in the beginning of 1960, in order to speed up the matter, we appointed a departmental committee under Dr. Reinach to make a study, apart from medical schemes, with a view to including the population in such schemes in order to safeguard them from high medical costs. This departmental report, an excellent piece of work, was later handed to the Snyman Commission which accepted it with only slight changes. I think this report of the Snyman Commission is an excellent one. It is a well considered document and the findings and recommendations of the commission are all based on facts and figures, and I think this report will for many years still be accepted in South Africa as a standard work on conditions here. The commission found what we had so often said in this House in the past, that practically the greatest proportion of the non-White population and the less privileged section of the White population are already well covered medically in South Africa by free hospital services and by the services of district surgeons, but it pointed out that the great majority of Whites are very heavily burdened by the high cost of medicine, which is steadily increasing, and it also pointed out that in order to protect themselves this middle class established medical aid schemes and sick funds for themselves. This idea, says the commission, has particularly come to the fore since the end of the Second World War. When the commission reported there were already 245 schemes in operation, apart from insurance schemes. They point out that already 48 per cent of the population is served by such schemes. These schemes have, in other words, shown that they fulfil the need. They have shown that they were effective, and what we now have to do is simply to expand those systems to cover the whole population. The advantages of that are much greater than the advantages of the scheme suggested here by the hon. member for Durban (Central). In the first place, the State will save that enormous amount of R48,000,000 per annum which the hon. member himself estimated, and in fact the State will have a service which is much more effective at a much lower cost. It is a service which promotes the self-respect of the members of the scheme, because the people participating in the scheme organize it themselves; they elect their own executives; they build up those associations themselves. Everywhere we find that those associations’ executives consist of inspired people who mostly do the work in their spare time, selflessly, simply in order to render a service to their fellowmen. We find that the administrative costs are low, because these are voluntary services and because the members of the executive are so unselfish that they often do not even claim travelling expenses for themselves. We also find that the costs are low because in most cases the employer co-operates. One finds that the employers are willing to bear the administration costs of those schemes, often not only to the extent of 25 per cent, but even up to 100 per cent. In addition, one finds that those schemes promote a good spirit between employers and employees. Surely it would have been most unfair and most unreasonable to destroy that splendid system and to replace it by a State scheme such as suggested by the hon. members for Rosettenville and Durban (Berea).

The Snyman Commission then went further and as positive steps it recommended that a Central Council for Medical Schemes should be established, a special body in the Department of Health which can then persuade the rest of the population of South Africa, that 52 per cent of people who are not yet organized in medical schemes and sick funds, to join such associations or to establish new ones. But that Council will in the second place try to improve the existing schemes, as far as possible, to remedy their defects and to straighten out their difficulties, because hon. members will remember that many of these schemes have certain shortcomings, Some of them, e.g., do not provide for dental services, for childbirth and for treatment by specialists. All these are matters which the Snyman Commission regards as essential for any good medical scheme. But we also find other shortcomings in these sick funds. The Snyman Commission found, e.g., that there are certain sick funds or medical schemes which do the following: As long as a man is ill but still alive they do very little for him, but the moment he dies they assist in regard to medical expenses, death benefits and disability allowances. In other words, they first allow the man to die and then they render assistance, whilst the object of the sick fund is in the first place to assist a man during his lifetime and the other things are secondary. If one can make a man healthy, one indeed assists him.

There are still other problems arising in connection with these medical schemes and sick funds, and that is their relationship with medical men and the medical profession, because in every sick fund it is the doctor who renders the services. Every sick fund really revolves round the medical profession, and sound co-operation with the medical profession is absolutely essential if one wants to place these schemes and sick funds on a sound basis. Therefore the Snyman Commission says that one of the main tasks of this Central Council should be to establish sound co-operation between the medical profession and these schemes.

I move—

This Bill deals with a very small subdivision of our marriage laws in general and in particular with our divorce laws. I want to say right in the beginning that our divorce laws in South Africa have become antiquated to a large extent and that they should be investigated on a national basis, and if this Bill of mine to-day focuses the attention of the public on the abuses created by one of the provisions of our divorce laws, I will be very happy.

By way of introduction I also want to say that I am aware that this Bill I am introducing to-day contains quite a few defects which can be eliminated at a later stage, but I want to ask hon. members who participate in this debate at this stage to concentrate on the question of principle as to whether the institution known as judicial separation should be abolished or not. Before I explain the Bill as such I think it is necessary to give particularly the lay members in the House a brief exposition of the legal rules concerned in a judicial separation. This term means that although a married couple are still joined by marriage, the spouses no longer live together and cannot demand conjugal rights from each other. In other words, this couple remain married but do not live together as man and wife, nor do they have a common household. Hence the term “skeiding van tafel en bed”, or separation.

The institution of judicial separation can come about in two ways. The first is by way of a bare agreement between the parties neither to live together nor to demand conjugal rights from each other, but without dissolving the marriage. These agreements entered into by spouses can of course be put into the form, as is usually done, of a notarial deed entered into before a notary public, hence the term “notarial judicial separation ”. Where such a notarial judicial separation exists between a man and his wife, the one cannot demand marital privileges from the other before the court has cancelled that agreement.

The second way in which it can be done is by means of an order of a competent court, hence the second name of the other type of separation, namely judicial separation. Such an order is issued on the same grounds as for a divorce, but also on other grounds with which I shall deal in a moment. I just want to draw the attention of hon. members to the fact that Clause 1 of this Bill provides for the abolition of the institution of judicial separation. Spouses are, however, not prohibited from entering into a notarial deed providing for separation. It is only the judicial order for separation which is sought to be abolished.

Clause 2 deals with existing orders of court or deeds of separation, and provides that they may be set aside. Clause 3 deals with notarial deeds of separation which remain in force but which will also be subject to the rule that they can be cancelled by a court, by a divorce order or other order of a competent court. I just want to point out that I am not asking for the abolition of the institution of separation on the basis of the many grounds on which a separation may be obtained. I do not really want to go into those grounds, because I base my submission that this institution should be abolished not on the multiplicity of grounds on which such an order may be obtained, but rather on the abuses flowing from it.

I just want to mention these grounds so that hon. members, and particularly the lay members of the House, may see how easy it really is to obtain a separation. According to the English sacrament a marriage is an institution “for better or for worse ”. But it happens so often that if the “worse” happens, one party or the other takes refuge in a separation. I want to quote from Prof. Hahlo’s book, “The South African Law of Husband and Wife”, page 314. These are the grounds on which a separation may be obtained—

Then he gives 17 different grounds. I want to mention them briefly—

There are an enormous number of grounds on which a separation may be obtained. Now what is the object of a separation? What is the object of an institution in terms of which a couple remains man and wife but do not live together? It is generally admitted that the object is for the parties to become reconciled; a reconciliation must take place. In other words it is to give the parties a period of time in which to get rid of their ill-feeling towards each other and of all their inhibitions. But it is a fact of which all the welfare workers and all the organizations dealing with broken marriages, and all legal practitioners in the country, are aware, viz. that this reconciliation which is supposed to take place as the result of a separation takes place only by way of the greatest exception. I have been practising as an attorney for 25 years already and I have not come across any case in my practice where a reconciliation took place. If the matter goes further at all, it only results in a divorce. It is almost incomprehensible, with the knowledge we have to-day, that we can still think of letting a man and his wife live separately in order that they may become reconciled. It is incongruous. If one looks at the object of this institution one must declare unequivocally that it is really useless. It does not comply with its object, viz. to obtain the desired reconciliation. What is more, in some cases those laudable objects do not exist at all. Because if there is a separation, e.g. on the ground of adultery, there need not and there cannot be a later reconciliation. I again want to quote from Hahlo on page 333, where he says this—

So if a poor man has always lived a chaste life, an irreproachable life, he still cannot get rid of the order of judicial separation between him and his wife. In other words, in that case there can never be a reconciliation. Now one asks oneself: Why have an institution with that object if the object cannot be attained? This is not the case only in regard to adultery. It says, “certain other matrimonial offences of enormity ”. There can be other such offences also. I think, for example, of homosexuality. Also in that case, even though he lives a very chaste life thereafter, he will not be able to escape the order of court.

It is particularly in cases where “matrimonial offences of enormity” were committed that we get the many tragic cases we come across. I have a thick file of correspondence which I have received from people all over the country in this regard. Most of the tragic cases are due to that type of contravention. My proposition is that this institution simply does not serve its purpose. It is an unnecessary institution and ought to be abolished.

I want to draw your attention, Mr. Speaker, to the consequences of a separation. There are firstly the personal consequences, and secondly the legal consequences. Both these consequences are legal consequences, but there is also a third, the social consequences affecting the children. The personal consequences are briefly, that the marriage is really suspended. It remains in existence but in so far as the parties are concerned it is really suspended. In other words one has a marriage, but no consequences flow from it. What one retains is nothing but an empty shell. The pith and essence of the marriage have been removed. All the obligations of the marriage remain, but not a single one of the rights remains. Dr. A. van der Merwe said the following in his thesis on marriage—

By this yardstick, in so far as the personal consequences are concerned if there is a separation, that personal enrichment simply cannot take place. Nothing is left of the marriage. The other one, the procreation of children, cannot take place either. In other words, the good things of a marriage, the objects with which the marriage really took place, are suspended and only an empty shell remains. My submission is that it cannot be said that if the whole essence of the marriage is removed a reconciliation can take place so that a full married life can be resumed.

I now come to the other consequence, the legal consequences flowing from a marriage. Also these are suspended to some extent. In this regard I want to say that we have enough legislation in South Africa to provide for a man paying for the maintenance of his wife and children. Both the common law and the Children’s Act make ample provision for the maintenance of children. An order of judicial separation, therefore, does not contribute to, or derogate from, the proper maintenance of the children. That is also true in so far as the wife is concerned. I admit that there was a time in the past, before our legislation was amended, when an order of judicial separation was a very useful institution for enabling the wife to retain her maintenance. That, however, is no longer necessary because we passed an Act in 1953, Act No. 37 of 1953, the Marriage Act, in which the whole position is set out very clearly. I want to quote it very briefly. I again quote from Hahlo’s book. I do not have the Afrikaans version at my disposal—

That is what I want to stress—

Therefore this Act also provides for the maintenance of the wife, in spite of the fact that the spouses are no longer married. My submission is therefore that also from that point of view, in so far as the legal consequences of such an order are concerned it has become an unnecessary institution and that it should be abolished.

In regard to the other legal consequences, they are the same as in the case of any divorce and they vary from case to case. Those also will not be affected, even though this institution no longer exists. That then brings me to the other consequences of a separation in so far as the children are affected. This is not a legal consequence, but a social consequence which we have to bear in mind. A legal separation, Mr. Speaker, is perhaps a temporary solution for the ill-feeling, the malice and the enmity existing between the parents, but in so far as the children are concerned it is no solution at all because the deleterious effects are precisely the same as in the case of a divorce. The children are in fact the victims, and even to a greater extent. What they lose can never be restored to them. In the case of a divorce there may perhaps be a measure of restoration because the parties may perhaps re-marry and have a good marriage, and those children may again have a father or mother. But in the case of a separation the children will always lack the parental care of the one parent. This is an aspect of this institution which should not be lost sight of. It may assist the parents, but it is very harmful to the children. Sir, I can also quote from my correspondence to show what these unmistakable effects are. I can quote from numerous letters I receive where women, e.g., complain about their sons who had no fathers, and about what has happened to them as the result. On this aspect social workers have expressed some opinions to me. There is another group of children I wish to discuss, and those are the children born illegally as the result of this institution of judicial separation. Their fate is really a tragic one. Therefore separation not only negatives the objects of a marriage …

Have you any statistics about the number of separation orders granted?

Unfortunately I do not have those statistics, Mr. Speaker, but I am able to quote the statistics of the Rand Supreme Court of last year. Unfortunately I do not have the statistics for the whole of the country because in our statistics—I have ascertained that—divorces and judicial separations appear under one heading. It is a great pity, but statistics unfortunately are of no assistance to me in this case. I have said that these separations are contrary not only to the objects of a marriage, but are contrary to the whole of human nature. We dare not lose sight of that. More is expected from spouses who have become a prey to this institution than flesh and blood can bear. Because a couple remains married but have to forfeit al) marital privileges, it happens in almost every case that one or other of the spouses succumbs to the temptation to commit adultery. Unfortunately it is particularly the male sex which succumbs to that temptation. I know the weakness of my sex, but it is also obvious that the man is seeking affection, that he seeks the companionship of the opposite sex. One finds in most cases where a separation has lasted for some years that the man commits adultery and that children are born. Let me quote one case to you, Sir, from the voluminous correspondence I have had in regard to this matter. This is a letter from a woman in Johannesburg. She writes—

Mr. Speaker, this is typical of all the cases that have come to my notice, the type of spite which exists; people who have never learnt the Christian virtue of forgiveness. Who suffers as the result? Not the parties who have to be punished, but the innocent, illegitimate children who have to live their whole lives as such. I know cases where those poor children could not even be christened. That becomes known at school and the child is told: You have not even got a name. All this is the result of the fact that we think we can make a man and a woman live separately whilst married and imagine that they will become reconciled. We do not think of all the consequences it can have, not only for them but also for the next generation.

Mr. Speaker, I regard the continued existence of this institution of judicial separation as the direct cause of the birth of such children because, as I say, it is unnatural to expect a man or a woman to remain celibate for the rest of their lives. We are not all priests and nuns. Why should we expect it of these people?

What new grounds for divorce do you propose in the Bill?

I will come to that in a moment, Sir, I want to quote a few instances from this correspondence dealing with this aspect and to show how people act from spite. I received the following letter from a man in Milnerton. He writes—

Mr. Speaker, if we do not want to undermine the sanctity of marriage, we should not create an institution which in fact undermines that.

I now come to the abuses. The abuses are not only that the opportunity is taken to act spitefully; there is also a financial aspect, and it has become a sort of method of extortion. I do not think I am going too far when I say that judicial separation has become nothing but a sort of instrument of extortion, particularly in the hands of unscrupulous spouses. Firstly it is asked for, as I say, out of spite, and thereafter it is used by the so-called innocent party to extort more financial benefits than she is entitled to. The one party knows that the other would rather dissolve the marriage, and that fact is then used as a sort of bargaining factor to obtain more than is justified. I want to read a further letter in this regard, from a person in Johannesburg. I may say that most of the persons I am quoting here are very prosperous and prominent members of society. They are people holding high positions in the country, and not just nobodies. But, as the hon. member has pointed out to me. that makes no difference. This person writes—

Then it continues—

I fully agree with that. Here is a letter from somebody in the Eastern Province. I may say he is a medical specialist and a prominent man in the community. He writes—

So it goes on, Sir. People are continually using this weapon. Because she knows that the other spouse would rather have a divorce, because they realize that the marriage is irrevocably ruined and nothing can save it, she uses it as a method of extortion to get more maintenance than she is entitled to. The other person always gives in, thinking: If I do this, she will give me a divorce. In this way I can mention numerous cases, Sir, instances of this type of extortion. In all the correspondence I have had I have come across only one woman who did not welcome this legislation, and that is a woman who is separated and receives maintenance. She is not concerned about the institution itself; she is only concerned about her maintenance. When I wrote back to her saying that in terms of the 1953 Act she can enjoy all the protection she wants, she was also satisfied.

There are three objections to the Bill at the moment. The first is that there are people who on religious grounds do not want a divorce or cannot get it, in terms of their religious faith. I have in mind particularly Roman Catholics, who recognize no divorce. They now have objection to this Bill. my reply to them is threefold. Firstly, if their religion or religious convictions are so strong then those people ought to have the courage of their religious convictions and preserve their marriages, and they should not seek legal measures by means of which they retain only the empty shell of their marriage whilst violating the whole spirit and essence of the marriage. My second reply to them is that such people who do not really want a divorce can still in terms of this Bill, and by means of private agreements, have a separation; they can even have a notarial deed of separation, because that is not abolished in terms of this Bill. Thirdly, my reply to them is this: If they cannot arrive at an agreement to separate and the one spouse makes living together dangerous and intolerable, the other spouse can leave him. She need not live with him. She still has all the protection she desires in terms of the law; she can get all the maintenance she wants. It is not necessary for them to obtain a judicial order of separation. If the one spouse then wants to institute an action for the restitution of conjugal rights, the fact that she can prove that life became intolerable and dangerous can always be advanced as a defence to that action, and that person’s action will fail.

The second objection raised to this Bill is one which was raised by Professor Hahlo, whom I may say is regarded as an expert in this sphere. He is a professor at the Witwatersrand University. I can best explain his objection to the Bill as it stands now by giving an example. Clause 2 of the Bill in its present form, says Professor Hahlo, really leads to a contradiction in terms, and I concede that he has good reason for saying so because as the Bill reads now it says that in cases where there is separation either of the parties can apply to court for an order of divorce, or rather an order for restitution of conjugal rights. Supposing a person who lives in adultery sues his wife for restitution of conjugal rights and the court then, as the Bill now reads, has to issue an order for restitution of conjugal rights, it would amount to the court ordering that woman to return to her husband who is already living in adultery and may still live in adultery, which would of course be a ridiculous position. She can then only come back to court and say: I was willing to restore conjugal rights, I was willing to obey the order of court, but this is the position I found. What is the court’s position then if she comes to court on the return day and informs the court to that effect? Then the court can only grant a divorce. But it would then be a condonation of adultery and it would be placing her, who is really the injured party, in the wrong. That is a difficult position. I think that in the committee stage, if the Bill reaches that stage, I will try to amend the position to give the court the discretion in that case to act as it thinks fit, which I think will be the best solution.

The hon. the Minister of Justice asked a moment ago whether in terms of this Bill there would be additional grounds for divorce. My submission is that no additional grounds for divorce are being added, because by abolishing this institution I think we are really limiting the scope of divorces. If we were to adopt the course suggested by certain of my colleagues, that we should make the Bill read that after a period of one, three or five years these people can then come to court and ask for a final order of divorce, it would be providing an additional ground for divorce, because it would mean that this judicial separation which exists would be regarded as grounds for divorce. My submission is that by merely abolishing it there will be no additional grounds for divorce. If there is now a notarial deed of separation in terms of Clause 3 as it reads now, and divorce is asked for, the grounds for divorce must still exist. There must still have been desertion or adultery. If those grounds are not there, the court will be entitled to say that it cannot grant a divorce. In my opinion no new grounds for divorce are created by this Bill.

I am aware that in the committee stage certain defects in this Bill will have to be amended. To send the matter to a Select Committee before the second reading will of course mean that the divorce laws which are not relevant as a whole now can then be discussed. I want to say that I think the time has arrived when our divorce laws should be investigated, and I would even welcome it if some of my colleagues suggest that the matter should be referred to a Select Committee, even before the second reading, so that the whole matter may be discussed. I feel that my task to-day is not to try to have this Bill passed in the face of all opposition. That would be a Pyrrhic victory. I want to say that we should merely direct public attention to the matter, and try to remedy the position. Therefore I myself will welcome an amendment to this effect later.

Let me sum up my standpoint. I firstly say that separation totally fails in its object of bringing about conciliation between the spouses. I say further that separation is actually in conflict with and is contrary to the objects of a marriage. My third submission is that separation and its consequences have a cruel effect on the parties themselves and an even more cruel effect on their children, and that separation is abused by people who use it as a method of extortion to get more money than they are entitled to from the other party who wants a divorce. Finally, I say that separation has really become a superfluous institution, because we already have other methods of dealing with these matters.

In June last year it was announced in the Press that I would introduce such a Bill. I may say that I heard nothing from the Bar and the Side Bar officially; I received no official intimation in regard to their attitude. But I spoke to as many members of the Bar and the Side Bar as I could in regard to the matter and all of them are agreed that at least something should be done to improve this state of affairs. They are not all in favour of this form of abolition, but all are agreed that here we have an institution which should be adopted to modern circumstances. Nor did the Churches express an opinion. I may say that this Bill appeared in the Government Gazette as early as December. I have watched the Church periodicals “Die Kerkbode”, but have not seen anything to intimate that they were opposed to this Bill. I have discussed the matter with social workers and other people, and they are all agreed that at least a change should be made in regard to this matter. In those circumstances I feel at liberty to ask hon. members to support the Bill.

The hon. member for Heilbron (Mr. Froneman) spoke with obvious feeling here this afternoon, and I appreciate that he did so in order to put the cases of many people who undoubtedly have suffered in certain ways, due, in the opinion of the hon. member, to the institution of judicial separation or notarial deeds of separation. But I shall try and show that their position would have been very little different under the new dispensation should this Bill be passed. I think though that it was the considerable feeling which he brings to bear on this point which perhaps caused the hon. member to rush in where angels would fear to tread; because I must remind him that this institution has been part of the antecedents of our law for very nearly 1,000 years, indeed since the time of the Canon Law and its effect upon the developing Roman Dutch Law in the Middle Ages.

A thousand years don’t make it right.

I may say that in Holland in the Sixteenth Century when the law became secularized and shook off the Canon law, the Hollanders of that time retained the institution which is now being debated. I feel that in this attack on this ancient institution, the hon. member for Heilbron has not even had the support and comfort of many important institutions in pressing with him for this reform. He very candidly admitted that he has not heard from any church quarter, that he has not heard from the Bar or Side Bar, and I don’t think he would have heard from either the Vrouefederasie or the National Council of Women, nor indeed from, the Law Revision Committee or any other bodies. This of course is no bar to him raising the matter, but I think that it suggests why there are several substantial reasons why one should not accept this Bill and which I shall attempt to touch upon.

The hon. member made a reasonable case on the basis of the spite which has motivated some parties to institute judicial separation proceedings and not divorce actions. It is perfectly true that there have been cases of that kind, but I want at once to say to him that if he does away with this institution, people who are spiteful can still achieve the same object by simply refusing to take a divorce. Consequently people who wish to be spiteful can simply allow the marriage to continue, take no steps to approach the court for a judicial separation or enter into a notarial agreement, simply let the position remain that they are man and wife not living together. Therefore I think that the main evil which the hon. member sees will not be removed.

I think too that the reason why one has had the cases that one has had of judicial separation being taken are easily explained. It is this, that in the old days, until the Act of 1953, it was not possible on divorce, without the consent of the two parties, for the plaintiff, the so-called innocent spouse, to claim maintenance money. It was, however, possible where the claim was judicial separation. This led people to seek and take the remedy of judicial separation. That consideration no longer obtains, and I suggest therefore that the number of cases where judicial separation is in fact taken, will diminish further.

Let me immediately try and put this whole matter in perspective. The hon. member very fairly said that it is only a minor portion of our law. But let me put the figures of judicial separation in perspective. As he says, there are not so far as I know separate figures kept in South Africa between divorce and judicial separation. Certainly they were not available in any publication that I was able to consult.. But there are figures appearing in the Report of the British Commission on Marriage and Divorce of 1951-5, and they are astonishing. They show that in 1954 in England there were only 74 decrees of judicial separation compared with 27,353 decrees nisi of divorce. That is a proportion of approximately one to 370, and my own experience is that in our country too the proportion is probably not dissimilar. I would have thought that it is certainly in the region of one to 200 or more. And I say, for the reason I have already mentioned in regard to maintenance, that it is probably getting less.

Mr. Speaker, I think that it can be accepted then that the number of cases where judicial separation is taken to-day is relatively small and among those cases there must surely be certain cases with which the hon. member for Heilbron would not quarrel, namely where people have a religious or conscientious objection to divorce. In such cases there is no question of spite. There are those cases where the marriage is not broken, but temporarily ended by this means where a reconciliation is hoped for. Admittedly as the hon. member very fairly said, there is probably not a large number of cases where that is the result, but they do in fact happen and they should not be under-estimated.

As I said at the outset, I believe that any benefit flowing to these people in cases of spite is more imaginary than real, because, as I say, you would simply get the spiteful party adopting the course of taking no action Whatsoever. In such a situation, the innocent party so-called would still be entitled to pledge the credit of the other party for necessaries and thereby obtain maintenance. They probably could approach the court and obtain maintenance without taking a divorce, and in addition there is the Destitute Wives’ and Children’s Act. which would be available to them.

But I suggest that there are very great disadvantages in accepting this measure, and I think there are some that the hon. member would not have intended. May I in the first place remind him of a number of people who are in the position that they have had to put up with wrongful and unlawful conduct on the part of their spouse in circumstances in which our law does not give them a divorce. That is an important class of case and the courts have repeatedly said that that distinction must not be blurred. May I read to the hon. House a passage from the judgment of the Chief Justice in 1949, in the case of Feldman v. Feldman—

If this Bill were accepted and the institution of judicial and notarial or voluntary separation done away with, the position would be that there would be quite a number of persons who would be assaulted, and, in other words, obliged to put up with wrongful conduct from their spouse and would be without any remedy at all. There would be many in that category, and the fact that that remedy does lie to hand is undoubtedly a factor in ensuring the continuation of marriage and a cessation, to some extent, of misconduct.

There is another important disadvantage this Bill brings. It upsets many arrangements of longstanding, and I suggest leaves the matter very much up in the air. If Clause 2 of this Bill is regarded it will be seen that the court is obliged to set aside any order of judicial separation or any voluntary separation when it is approached, after the passage of one year from such order or agreement. What may then occur? You may well get the position that the so-called guilty spouse approaches the court, obtains an order setting aside the judicial separation order, and you are then faced with this position that the so-called innocent spouse advances that the grounds upon which judicial separation was granted still operate; in other words, the other spouse is perhaps still drinking to excess, is still perhaps prone to assaulting him or her, and consequently this presumably would be advanced by that spouse. What then must the court do? It no longer may issue an order of judicial separation, and I suggest that you would then probably be in a stalemate position in which the parties are simply not divorced, living together, and the orders in regard to the children and maintenance are probably thrown into doubt.

I think there is a further serious disadvantage of this measure, and it is this, that it opens the door to divorce even wider than it is to-day. In South Africa it is very easy to obtain a divorce. I am not arguing the merits or demerits of that. But I think that compared with other countries it is certainly much easier to obtain a divorce in South Africa, than in almost any country. I think it is fair to say that it is perhaps easier here than in other countries. Now in my submission this Bill virtually introduces a new ground for divorce, namely wrongful conduct, which cannot be said to be done intending to bring the marriage to an end, and which has been followed by a judicial separation or notarial agreement, followed in turn by a further year’s lapse of time. That constitutes a new ground, because having regard to Clause 2 it is clear that after a voluntary separation has been entered into, and has been in existence for one year, the party may approach the court and have it set aside and call upon the other party to restore conjugal rights; and it is clearly expected by the hon. member that the result of that will mean divorce. So you get the position that substantially a new ground is introduced if this Bill is accepted, a ground which to a large extent is in conflict with the true position. I say that for this reason: If wrongful conduct had been indulged in intending to bring the marriage to an end, the party could have taken divorce in the first place. But we are dealing with cases where the wrongful conduct was not done intending to bring the marriage to an end. One knows that type of case. A man perhaps is not able to control himself and is extremely inconsiderate, not to say brutal with his wife, but in fact he cannot live without her, and he loves her very much. It is quite a common position in these cases. Such an injured wife will not be entitled to a divorce as our law stands, but she would be entitled as the law would stand to negotiate a voluntary separation, wait a further year and use this machinery to obtain a divorce.

That is a very good idea.

I would rather say that most authorities feel that one wishes to endeavour to strengthen the ties of marriage, not, I may say, by legal means, but rather to encourage and strengthen the institution of marriage. One point which has been mentioned in this regard is that people should wish to see that their marriage lasts. If I may diverge slightly, I would quote a passage from the British Commission on “Marriage and Divorce”, which is relevant to the whole question. They say at page 10, in paragraph 51—

The point I wish to emphasize is that this passage, with which I agree, suggests that one of the roads along which improvement may be achieved is “in strengthening his resolution to make marriage a union for life ”. Now if a person is encouraged at the first sign of liquor, or the first knocks that occur which the law holds to entitle one to judicial separation, if a person is encouraged then to approach the court for a judicial separation, it may indeed substantially weaken the resolve of the parties to fight through the battle and make a successful marriage.

That argument of course is not quite correct, because according to this Bill no further orders can be made.

That is true. No further orders of judicial separation could be made. That is perfectly true and that does undoubtedly weaken the argument I make here.

It destroys your whole argument.

I am not so certain about that, because for one thing it relates to notarial deeds only.

However, Mr. Speaker, passing on, it has been suggested by the hon. member for Heilbron that this Bill could usefully be sent to a Select Committee, and I think he said that he would welcome such a suggestion. I would suggest that in dealing with an institution of this kind, where we have had no call from the persons most closely interested, one would be very loath to set up a committee or commission of any kind; but I would in any case suggest that a Select Committee would not be the proper body to tackle such a task. I would suggest that one cannot tackle this matter piece-meal. One would need, as did the British Commission, to go into the whole question of marriage and divorce and possible defects in the law in respect of those institutions. I do not think, with respect, that a Select Committee would be the best and most convenient body. If the British Commission is any guide, it lasted for four years, it produced a report running to about 350 pages, with a further schedule with a further 50 pages. I think one would want to draw widely on people who are even more expert in this field than perhaps we are here. Equally with a commission, I do not think that in view of the numbers of cases involved, in view again of the absence of a request for a commission of this kind, I do not feel that it would be justified. I must say that in the absence of the recommendation of any such commission, and in view of the objections, some of which I have sketched to-day, it is impossible for us to support this measure.

I am very glad that the hon. member for Heilbron (Mr. Froneman) has introduced this Bill into this House. Not that I quite agree with the hon. member, just as little as I agree with the hon. member for Pinelands (Mr. Thompson). But at least I agree to the extent of about three-quarters with the hon. member for Heilbron, whereas I do not agree with the hon. member for Pinelands at all. The first argument advanced by the hon. member for Pinelands was that judicial separation has existed for more than 1,000 years already. But the fact that it has existed for more than 1,000 years still does not mean that it should continue to exist. The hon. member’s second argument was that in England judicial separation takes place in one out of 300 cases. What about that? I think that is one of the arguments which can be advanced in favour of the abolition of judicial separation. Mr. Speaker, in view of the importance of this matter, I think we should first give thought to it, and I therefore want to move—

I second.

Agreed to; debate adjourned.