Sessional_Paper_1893 — Page 280

Table IX.

277

Report on the subject of securing more reliable returns of the real causes of death, and furnishing medical aid to the poorer classes of the Colony.

I have read and carefully considered the scheme of the Colonial Surgeon on which I have been asked to report.

So far as I understand the scheme it has two chief objects in view :--

1. To secure more reliable returns of the real causes of death.

2.-To furnish medical assistance and medicine to the poorer classes of the Colony.

As regards the first of these two objects, there can be no doubt that it would be highly advant- ageous to have the real causes of death certified by properly trained medical officers or practitioners. But in considering this matter, it must be remembered that the Chinese as a whole are not in favour of Western medical methods and that they would offer strong opposition to any system of improved registration of the cause of death which would necessitate anything in the nature of an invasion of the privacy of Chinese domestic life, on which they lay so much stress. If properly certified certificates of death are to be made compulsory, I do not see how interference with Chinese domestic life can be avoided. Such interference would, in my opinion, only tend to intensify the prejudice existing among the Chinese against Western methods and, so far from succeeding in accomplishing its object, would almost of a certainty defeat its own ends. The Chinese might be encouraged to procure properly certified certificates of the cause of death, but anything in the form of compulsion ought to be avoided, especially at the commencement of the attempt to introduce among them the benefits of Western medical science. At present many of the deaths occurring among the Chinese are accompanied by certificates. The attached Table (see Enclosure I,) shows the number of deaths in Victoria in 1891, and how many were accompanied by a certificate. If the deaths in the convents are included, and I think it is not unreasonable that they should be seeing that European doctors attend those institutions, this Table shows that 66% of the deaths in Victoria are accompanied by certificates. It is true that the majority of these certificates which were given by Native doctors in the Tung Wa Hospital are in many instances too general, but the Colonial Surgeon, who has the right by Ordinance to enter that Hospital at all times, might be able to suggest to the Native doctors how the certificates issued by them might be improved and made of more value for statistical purposes than they are at present,

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As regards the second object which the scheme has in view, the furnishing of medical assistance and medicines to the poorer classes of Chinese residents of the Colony, I think every one will agree that that is an object which should receive every encouragement. Indeed, I think that this Government is bound to help the Chinese in this direction, for the present medical service costs this Colony in round figures about $40,000 a year, and the Chinese who as rate-payers contribute the larger portion of that sum, derive comparatively but small benefit from that service. The expenditure involved in the scheme of the Colonial Surgeon would, I venture to think, be justified on equitable grounds alone; but however justifiable such expenditure might be, I am inclined to think that a less expensive plan than the scheme of the Colonial Surgeon should be adopted in the first instance as a tentative measure, for, as the Chinese are as a rule opposed to Western medical science, it cannot be foreseen with certainty how free Western medical attendance and drugs will be received by them. have institutions like the Alice Memorial Hospital to guide us to a certain extent, and, judging from the attached statistics (see Enclosure II,) with which Dr. THOMSON, the Superintendent of that Hospital, has kindly furnished me, it would appear that the Chinese are gradually overcoming their disinclina- tion to seek the help of Western doctors at the Alice Memorial Hospital. Instead of adopting the complete scheme drawn up by the Colonial Surgeon, I would suggest that, as a preliminary measure, two dispensaries be established, one in Victoria and one in Kowloon where, though the population amounts to over 25,000 persons, including the boat population, there is not a single qualified medical practitioner; that the two licentiates of the Chinese College of Medicine be placed in charge: that the two dispensaries be either affiliated with the Alice Memorial Hospital and subsidised by Government, the management of that Hospital being responsible for the supervision of the work carried on, or that they be entirely under Government control, the whole expense being borne by Government: that drugs and medicines be distributed free of charge and that medical advice be given gratis at the dispensaries to applicants whose inability to pay is undoubted: that, in addition to giving medical advice, dispensing medicines, and treating patients at the dispensary, the licentiates should attend without fee all cases where their services may be required: that no fee should be charged or accepted without the permis- sion of Government and then only in cases where no doubt exists as to the ability of the patient to pay, and that the Licentiates should give certificates of death free of charge in all cases in which they can certify to the cause of death.