CAMPAIGN AGAINST DISEASE.

Dominion, Volume 4, Issue 1166, 29 June 1911, Page 4

CAMPAIGN AGAINST DISEASE.

HEAVY DAY AT HOSPITAL CONFERENCE. TREATMENT OF CONSUMPTION. THE NATIVE RACE. INCIPIENT MENTAL CASES. The Conference of Hospital Board delegates, opened by the Governor on Tuesday, resumed yesterday at 10 a.m. _Mr. J. G. Wilson presided. Members continued their debate on the administrative control of consumption. Several delegates having spoken, the Inspector-General remarked that the interesting discussion which had taken place in itself morn than justified the conference. Delegates were agreed that there must be united action, and, if this good spirit continued, there was every reason, to believe that in the course of a few decades, the disease would be stamped out in the Dominion. Common sense had ruled throughout the discussion, and not one note of hysteria had been struck. The speaker would fight tooth and nail against the proposition that the Government, instead of tho boards, should carry _on the campaign against consumption. It was absolutely opposed to tho hospital system which they were trying now to erect in New Zealand. The basic feature of that system was that each board should be responsible for the sick of its own district. The Government could do a great deal on the administrative side, and could help the boards in other ways. For instance, the Government might establish labour colonies. It would bo' difficult for the boards to provide for the detention of consumptives who should, in the opinion of the district health officer, bo detained. This duty could easily be carricd out by the Government through the district health officers. There had been some discussion as to the number of sanitaria required. ' At present there were two in each island, and a total accommodation for consumptives of IGO beds. The Auckland Board was about to erect a sanatorium with 50 beds. There would thus be accommodation for 210 patients, and this, the speaker maintained, was all that was required at the present moment, ot would ba required for somo time to come. They had, at tho present time, in his opinion, sufficient accommodation for' tho curable cases, but there was undoubtedly a deficiency of beds' for ' incurables. The boards must not be satisfied with providing rough shelters for consumptives detained for treatment. Tho accommodation must' be made as comfort'ablo as they knew how to mako it. Eosults at Frimloy Sanatorium, where patients were required to do a certain amount of graduated work, were much better than at institutions where patients were simply allowed to sit down and "swap" their own ideas as to symptoms and so forth.

Mr. Walker (Dunedin) considered that if tho Government attempted to mako tho boards provido an increased expenditure at tho present time it would be .up against a very hard rock indeed. It should lie with the Government to undertake the provision of a pure-milk'supply.: A solution would never : bo found for. the problom of cpnsumption until it was grappled with as a whole and-the only body l in New Zcalandi that, could do this'-was. tho Government. _ As ; : showing, that. the. present acconiinodaiiOn' for consumptives was inadequate Mf:' Walker stated that from Rakaia right down to the end of the South Island, only 28 consumptives were accommodated nt a sanatorium. Tho

Government' should bo asked to [five the matter their very serious consideration, with th'c idea of stamping the disease out; leaving details to their responsible officers. Pure Milk Supply. Dr. Faulkner (Duuodin) declared that tho spread of consumption would be.very soon prevented if provision wore made for taking caro of those advanced incurable patients who now* spread infection abroad. Tho second great causo of infection was milk. This was a delicate question to introduce, bccauso the financial considerations involved were so enormous. In the south the Farmers'. Union hart passed a resolution: "That the pasteurisation of milk and whey be made compulsory." In tho speakers' opinion the conference should certainly back up tho Farmers' .Union in this^natler.::^,

Mr. D. M'Larim, M.P., remarked that, in his judgment, the living, wad housing conditions of the people in inany. of ,our large centres were such as to make'for the existence of tuberculosis and its spread. The time was coming, the speaker believed, when municipalities would no more dream of allowing their milk supply to bo controlled under competitive condition? than they would now dream of allowing their water supply to bo so controlled.

Dr. Frengley stated that as to notification. the principal difficulty had been hitherto that very few boards had provided places for tho reception of consumptives. Tho only way to tako up the work effectually was to establish" the necessary institutions, an annexe to the general hospital in each district for the reception of incipient ea'es, o sanatorium, and a home for incurables. Pasteurisation, said Dr..Frengley, was no remedy. The effort, should bo to eradicate the disease in tho herd?, and should not be confined to an.' attempt' to minimiso its ravages. Pure milk, and not pasteurised milk, was wanted foi- tho proner feeding uf babies. - * Sources of Infection, A delegate: "Is not tho Native race one of the most fruitful, sources of infection of this complaint, and would not tho Government bo more successful in controlling it than any local institution:-" ' Dr. .Frengley said thero was a great deal of truth in what was inferred by the delegate. Steps were being taken to bring tho health conditions of tho Native race into lino with those required from Europeans. Another delegate asked whether tho inspection of immigrants regarding this disease was satisfactory. Dr. Frengley replied that at present as much was being dono as very well could Ise dono by tho port health officers. It was impossible to delay a ship long enough to enable an exhaustive examination of immigrants to bo made. Tho Department could not do anything more at this end, but it was hoped "that something would be dono at the other end before people got aboard the ships. Dr. Valint.ino said ho might not bo diplomatic, but, so far as lay in his power, he would oppose tho suggestion that the Government should take over tho whole control of this matter. The Government and the Department could not do it so well as tho Hospital Boards. Dr. Faulkner said he quite agreed that pasteurisation was a very secondrate concern as compared with tho testing of tho herds. Pasteurisation, kowovcr, would lessen the immediate incidence of the disease. Children were being fed with pasteurised milk iu the south at the present time and doing well on it. Replying to another question, Dr. Yalintino said that'.in. some areas iu Wellington thero was a population of 72 persons to the; acre,.- In Tory Street thero wero places carrying SO people to the acre. Consumption returns from these districts were certainly larger than in less thickly ■populated areas. In one part of the city the speaker had been informed there was uctunlly an area carrying 200 peoplo to the acre.

Mr. London's amendment', "That sanatoria for the treatment of consumption bo established in suitable districts near to the four most important cities in the Dominion. That the boards of the districts cmbracing such cities control these sanatoria, and that patients from all tho other districts in tho Dominion bo available for treatment in these sanatoria, and that the expense incidental to tho treatment bo paid b.v the respective districts," was carried by lit voles to 21. Mr. Young (Waikato) moved as a further amendment— "That this conference looks upon tho spread of tuberculosis in Ihc Dominion as a source of danger to the whole State, and believes that it is tho duty of tho General Government, rather than of the local boards, to take in

hand tho treatment and eradication of tubercular diseases. Or, in the event of the Government declining to undertake the work, then the necessary sum should ba placed upon the Kstimates f-o that the work may'be carried out by the local boards without cast to the ratepayers." Tho amendment was ruled out of order. Decision of Conference. The original amendment (Mr. London's) was rejected when submitted lo tho conference as a substantive motion. After some discussion on points of order the following further amendment proposed by llr. W. H.-ilaslin (South Canterbury) was adopted: — "That this conference fully recognising what' a scourge consumption is to humanity and the laudable efforts of the Health Department to cope with this disease begs to assure the. Department of its readiness to co-oper-ate in any scheme of preventitive or curative character that the Department may desire." On the motion of Dr. Faulkner (Ot'ago) it was agreed:— "That the Government bo requested to introduce further amending legislation to give the various llospitaUand Charitable Aid Boards power of detention over inmates of benevolent homes, hospitals, sanatoria, or other institutions under the boards' control . in all cases where the Health Department considers it necessary in the interest's of the community." The motion was carried. Need tor Trained Nurses. Mr. Powell (Waipiro Hospital Board) read a paper on the 1 health of t'he Native race. Ho referred to the necessity for training young Maoris, both men and women, for service as nurses in the Native townships and settlements. If the Government and the hospital boarus had a genuine desire to improve tho health of the Natives and prevent, t'he spread of infectious disease among them the services of nurses to aid in their work would be accepted gladly, 'i'lie authorities should not be so sentimental in dealing with t'he Native. Their customs and prejudices should be respected, but where the Maori would not conform to tho rules of health no sentiment should be allowed t'o interfere with prompt action. Ho moved: (1) That legislation be passed as soon as possibie, transferring the control of contagious diseases directly from the Department of Native Affairs to the Public Health Olhcers. (2) That in order' to conserve the Maori race the. question of maternity and infant mortality should bo dealt with directly by tho responsible officers of the hospital and charitable aid boards, and as a further guarantee of this the Native race should bo brought into conformity with tho Europeans under the Registration Act, and this should be applicable not. only to death, but also to births and marriages(,,'S) That nurses should work among the Maoris in order to instruct them in accordance with tho European way of living both in sanitation and health. As Dr. Valintine said that tho transfer asked for had already been made, tho first resolution was withdrawn. Some objection was raised to tho second proposal, on the ground that tho Maoris paid no rates, and made no direct contribution to hospital expenses. Dr. Valint.ino said that tlie Department was able to prosecute a Maori offender against the law of sanitation just as readily as a European. It had been found that tho results for the system of subsidised medical officers among the Natives were not wholly satisfactory, and consequently the Department proposed to appoint nurses to iook after sanitation and tho health of-tho Natives generally. Theso nurses would be paid by tho Do--partment, but would bo placed under the control of' tho district hospital boards. In some districts tho nurses would bo wanted almost immediately, but the Department would do all it could to meet tho demand. Ono difficulty would be to get. suitable women, as tho work required a tremendous lot of devotion and selfsacrifice. The dut.;e,s ( of the nurses woiOd include:—(l) TJe'p;>rtin<r upon tho 'condition of tho kainga and the prevalence of sickness therein: (2) .making recommendations for improvement: (3) pavinrr snecial attention to flic- feeding of children; (H -idv'sing expectant mother?; (5) recording. as far as possible, all;births and deaths in.the district; ((>) nominally instructing tho Natives in .Hygiene: (7) paying visits of inspection to Native schools.

A succession of speakers apreed upon the necessity of educating the Natives on health matters, and the' second motion was earned unanimously. In view of Dr. Valintine's statement, tjie.- third motion was withdrawn. \ INCIPIENT MENTAL CASES, • ■ PAPER BY THE INSPECTOR- ' GENERAL. "The incipient, mental and deliriun'i tremens patient," was tho subject on which a paper was read by Dr. Valintine. lie said that it could scarcely be claiiued that, much as New Zealanders prided themselves on being abreast of modern thought, thev had done all that could bo accomplished for the treatment of patients with incipient mental aberration. The hospital system could never bo regarded as peTfrct so long as there was not accommodation in the principal hospital for this particular class of patient. Rcom for twelve patients should bo attached to the four chief hospitals, and so .arranged that the patients would not intnrfero with the ordinary class of iumato of tho institutions. It was to be hoped that the boards would accept this additional responsibility. Proposal Strongly Opposed, Mr. YS'alker (Dunedin) moved "That it bo a recommendation to the Government that provision should be made in those centres where required for a receiving houso in connection with tho Mental Hospitals Department, for the treatment of incipient mental and D.T. patients." Mr. Walker said he was quite aware that his motion was opposed to the view expressed by Dr. Valintine in his opening address. The responsibility of caring for m=ntal patients should "rest solely with the Government. If the InspectorGeneral's proposal wero adopted the principal board of the Dominion would be let in for an expenditure of a magnitude which they had' not yet realised. The Government had offered to subsidise a mental annexe to the Duiicdiu' Hospital to tho amount of i£soo, but this would not meet tho view of the boards. It would cost .£3OOO or '.£IOOO to croct such a ward in Dunedin. If tho Government insisted that tho board must undertake, this work it must bear tho whole, cost, not only of tho buildings, but of maintenance as well. Tho best plan, however, would be to establish a receiving home for tho mental hospitals in each centre where it was required. Seconding tho motion, Mr. Horrell (Canterbury) said the position of his board was similar to that of Otago. The area of ground at the disposal of the board was limited, and tho reception of incipient montal patients would entail a serious nuisance and a considerable expenso. Other delegates agreed that while provision should be mado for the reception of incipient mental patients in places other than the mental hospitals, this provision should bo made by the Government, and should nut be made a charge upon any ono locality. Mr. Mackay (Auckland) contended (hat D.T. rases could not any longer bo treated at tho general hospitals in places like Auckland.

Mr. I'riedlandcr (North Canterbury) said he failed to see why the Government should ask the local bodies to undertake this extra dutv without providing the ,£.s.d.

Dr. Hardwick Smith said tho delirium tremens ease required trained nursim:. whether by male or female nurses and should bo treated at hospitals. ,-\t; present most hospitals lacked the special accommodation required. A difficulty arose from tho fact that a hospital could not afford lo keep special (rained attendant for cases that sometimes were few anil far between.

Dr. Faulkner agreed with Dr. Hardwick Smith that a number of D.T,cases needed hospital treatment. . The incipient mental cases would give the boards much more (rouble. If the Mental 'Hospital 'authorities could devote tho same attention to early cases as to those of more pronounced development', great good would result.

In a Hopeless Minority. Dr. Valintine remarked that evidently ho was in a hopeless minority in the waiter, but he was quite satisfied (hat, as tiino went on, the hoards would recognise that flic speaker's proposals wore ba-ed 011' humanitarian considerations. Mr. Walker said the whole position was that tho caro of incipient mental eases devolved upon the Government and that' the Government should bear tho ".ost of earing for them, if Iho Gov;rnn. ,'iit: offered lo bear the whole cost of building and maintaining wards not a board in tho Dominion would object. . Mr. Walker's motion was carried on the voices. THE BLIND AND THE FEEBLEMINDED. ADDRESS BV MR. lIOGBEN. Mr. W. Shrimpton (llawke's Bay) moved "That homes for indigent adult imbeciles and de.-titute iiiind persons, mentally able to benefit by being taught' "to read under tho Braille or other systems, be provided by tho State." Mr. Maslin (south Canterbury) seconded the motion. In the course of an address on llio treatment of the feeble-minded persona and imbeciles, Mr.. G. Hogben (inspec-tor-General of Schools) stated that feebleminded children capable of being educated were under the care of tho Education Department. Some attempt was mado to educate them, even though they were semi-imbecile. So far, only boys had been dealt with'by the Education Department in the institution at Otekaike, but the oslato was largo enough to afford room for an institution for girls, sufficiently isolated. There were at present 50 boys at Otekaike. Plans were now under consideration for cotlagc homes on tho estate, each ono to accommodate a particular kind of case. The prospect of admitting feeble-minded qirls to Otekaike was very ne,ir realisation. As soon as some of the cottago homes had been erected it would bo possible to accommodate some of tho girls. Mr. Shrintp'on's motion was carried. Mr. Wilson (North Canterbury) moved: "That tho conference affirm tho necessity of founding a State school for defective girls similar to that, established for boys at Otekaike, and a State home, with powers of detention, for women of feeble character, ■whose proclivities are a source of danger to tho community, both from a physiological and moral point of view." Mrs. Wilson remarked that there was at present no provision mado for tho care of defective girls in New Zealand. Mr. Gillingham (South Canterbury) seconded tho motion. A number of subsequent speakers supported it. A delcgato (addressing Dr.' Valintine): "AVoukl you be prepared lo recommend to the Government, the desirability of providing some place where these moral weaklings could "bo kept in restraint and prevented from propagating their species?" .Dr. Valintine: "Certainly." Tho motion was carried on tho voices.

DUTIES OF NURSES. EIGHT-HOUR SYSTEM. A paper on this hours of work and duties of hospital nurses was road by Mr. W. Shrimpton (Hawke's Bay). Anion* ether suggestions for improving the standing ot members of the staff was one for. a post-graduate course of training for all mines who desire to qualifv tor the higher position. No nurse should be allowed to look for promotion simply on account of length of service. Addressing the conference 011 tho' subject of the eight-hour system for nurses, Mr, R. 11. Nolan (Hawera) dealt at some length with the difficulties of securing an obscrvanco of regular hours in connection with the employment of hospital nurses. Matrons and nurses of the higher grades could not possibly l?o included in au eight-hour scheme. Mr. D. M'Laren, M.P., supported the eight-hour-day system. " Mr. R. C. Kirk (Wellington) moved: "That, in.-the opinion--,of this con•.yferincfe, the'eight-hour'systeiu in connection with nurses is not in the best interest's of either the nursing profession or the 1 patients in the public ■hospitals." He was satisfied tliat tlio. cight-liour system had not'turned out as good nurses as did the old ten or twelve-hou:*. system. Tho givls themselves, in many cases, would prefer the old system. The motion was seconded and heartily supported by Mr. li. 11. Nolan (Hawera), Mrs. M'Lcan, Assistant-Inspector of Hospitals, said that, to train a nurse thoroughly in. her work it, was far better for lier liot to be hurried in what 6hc was .doing and not. to be obliged to leave a patient at a set hour. Mr. Young (Waikato) ,and other delegates claimed that better results were to .be secured by tho eight-hour system generously interpreted. 'Mr. M. Coyle (Auckland) moved as an amendment: , "That this conference recommends that t'hc Inspector-General of sJosj)i- . tals circularise all tho hospitals in the Dominion with regard to tho successful working of the eight-hour system, or otherwise." Dr. Hardwick Smith (Wellington) stated that against the eight-liour system there were' to be cited tho difficulty in obtaining nurses and the fact that nurses working under the.system had to work hard all the time they were on duty. As n result there was some injury to tho ideals and refinements of nursing. A better system, in the speaker's opinion (than the eight hour), would be to extend tho hours somewhat, anil let tho nurses study at the bed-sides .of patients. At present many nurses worked so hard that they were too tired to study when off duty. Tho speaker would propose a schemo under which nurses would nominally work twelve hours per day. Time allowed for meal hours would reduce this to. Ifl.l hours, and on every other day the nurses should be allowed two hours off duty. This would involve just 21 hours' extra work per fortnight, as compared with tho system in vogue. The speaker would propose, however, that, once a fortnight, nurses should lie allowed a clear 2-1 hours off duty. This would bring down the extra time worked in a week to four and a half hours, and in a fortnight to nine hours more than nt present. lh- adopting this system it would be possible to have three nurses in a ward instead of two. 'This meant a great deal. It meant quietness instead of rush and hurry in the wards, and it meant that patients would be properly attended to. Mr. Kirk withdrew his motion, and the amendment, having now become (he motion before tho conference, was carried on tho voices.