CONSUMPTION.

Dominion, Volume 6, Issue 1664, 3 February 1913, Page 6

CONSUMPTION.

DOCTORS IN CONFERENCE. PLAN OF. CAMPAIGN. ■ I IMPORTANT PROPOSALS. Tho report of the conference convened by tho Minister for Public Health (tho Hon. R. H. Rhodes) for tho purpose of inquiring into the prevalence of tubercular diseases in the Dominion, and particularly with regard to measures considered necessary to provent their spread, lias , just Leon issued. Tho conference, which sat on October 22 and 23, 1912, was thoroughly representatiye, consisting of medical men who have had special experience ,in the administrative control and treatment of tuberculosis. The conference was assisted by-. (he Chief Government Veterinarian (Mr. C. J. Reakcs) and the president and secretary of. tho Wellington Branch of the British Medical Association, the latter representing the views of members of the medical profession: engaged in private practice. Tubercular, diseases, the conference states, are not 'increasing in this country. Onthe contrary, there is evidence that during, tho last ten years there has been'a steady decline in the mortality rate from these diseases, particularly'pulmonary consumption. Much has been dono.in this country, it is added, to prevent ' the spread of tubercular diseaso, and'few, if any, countries, have so large a proportion of beds r.vailable to the population (one bed to every 3500 persons) for tho special treatment of these diseases. Moreover, legislative machinery has enabled the Public Health Department to initiate many measures essential in a campaign against consumption, and this machinery will bo the more effective when' tlie hospital boards and other responsible authorities' co-operate with the central Department in a campaign conducted on well-considered and uniform lines.

It was the opinion of • delegates-to the conference that the hospitol boards would enter the campaign with vigour. Little, however, can be accomplished, it is stated, unless the public aro thoroughly aroused as to the need for fhe measures which are outlined jn the report of tho conference. The central and local health authorities will bo powerless unless the public aro behind them, and in sympathy with their efforts. The conference was unanimous Ithat the campaign must be conducted on uniform lines throughout the Dominion, and that ruthless warfare against the diseases under review must be •accompanied by a due regard for private interests. The conference agreed with Dr. Blaokinore that "restrictive measures must not bo pushed too far," and that "tuberculosis is not a highly infectious disease." Tho home treatment of consumptive patients is an important factor in the campaign that has been.outlined.

Largo,as is the.existing accommodation for consumptives in special institutions, , the conference considered that it should be 'materially increased, and that some 700 beds (double the present number) should be provided. The increased accommodation should be provided in, connection. with existing institutions, or 'by means of annexes'attached to general hospitals. Opinions were unanimous to the effect thati little good could be Obtained by dotting the Dominion with small sanatoria. To bo 'of real use to the com.inunity, Such institutions should be large enough to engage the whole-time services of a medical man who has had specialexperience in the .treatment of tlie disease. The conference puts on Tecord its opinion that consumptives can be treated in general hospitals .without, detriment to other patientsv ■ Exception' is ■ taken, to alarming statements sometimes made even by medical men, that consumptive patients are a danger to others. General hospitals and annexes thereto, it is added, must be regarded as half-woy houses, so far as consumptive patients are concerned, where theso patients- can bo, treated until can be Admitted to special institutions. It is recommended'that institutions for the treatment of patients in different stages of pulmonary diseases should be situated on sites immediately adjoining one i another, so that tho various institutions could be under one medical and nursing administration./ Emphasis is laid on this decision in view: of contrary statements that have appeared in the public press. ■ Tho appointment of bacteriologists by the hospital boards of the four chief centres is strongly recommended, and the hope is expressed that the larger hospital boards will each provide at least one district nurse-to take a special place,in the campaign in connection with the following up of.those cases that are receiving, or have received, treatment in tho institutions controlled by tho board. Smaller boards might advantageously combine for this purpose.

: Medical inspectors of schools! it is stated, are expected to take a prominent paTt in the discovery of "early cases." Openair schools are recommended for children ipredisposed to consumption. The conference also. recommends that special dispensaries for the'treatment of chest diseases should be established in the chief centres, .and whero possible in other hospital districts. "The dispensary, iyith its attendant officers—the medical superintendent of the sanatorium, the bacteriologist, the;district : nurse, and the sanitary inspector—should be. regarded as the headnuarter's of the campaicn in each hosnital district." The establishment of farm colonies for the : treatment of patients who. though cured of tho disease, would not be well advised in going back to indoor occupations, is mentioned as « very essential m_atter._ It is stated that these farm' colonies will' with advantage be in close proximity to the sanatoria. Mention is' made of the necessity of correcting an impression on tho part of ex-sana-torium patients to consider that they have done their life-work and that 'the State should keep them. Graduated. work by patients is defended as being in their interests, and not solely .for the benefit of the institutions. •. Regarding-milk supply, it is stated that unfortunately; so long as the public exhibits such r apathy with regard to tho ■quality., of- the milk supplied for human consuhtption, : it will , bo/difficult to effect atiy> very drastic reforms with regard to the control of this industry. If tho public really wants, clean milk of good quality, it must-be, prepared to pay for it. What tho pubic demands tho trado will supply. In the meantime tho recommendation of

tho conference—that Hospital Boards should obtain milk for their institutions only from those suppliers who submit their herds to periodical tests by responsible officers of the veterinary branch of tho- Agricultural Department—should have somo effect. The enforcement of

the regulations under the Salo of Food and Drugs Act, 1 which oro now before Cabinet, will give the central Department an opportunity of effecting reforms in connection with our food supplies that are much needed. "You will note," tho report continues, "that, though a resolution was carried to tho effect that tho milk factories should bo pasteurised, tho conference'' did not mako any' recommendation with regard to the pasteurisation of jniilk intended for human consumption, the monibcrs being of tho opinion that such pasteurisation would largely minimise its food-value, and would engender a feeling of false security that would be of more real danger to the public that a milk supply which was subject to a careful and regular supervision by responsible officers. If tho public considers that tho question can be settled by pasteurisation of milk intended for direct human' consumption— which it cannot—it will not be likely to insist on those reforms in the trade l.'tlmt wo so earnestly dosirp." . The only quostion on which the conference was not unanimous was that with regard to the restriction of immigration. Though the members wero as ono with regard to the restriction of immigrants in the advanced stages of disease, much sympathy was expressed for those immigrants in the, early stages-of the disease who might be denied the advantages of our climate and social oonditions. It was urged by more than ono speaker that snch persons wero British subjects, and should not bn demied the advantages thnt wero avnilalilo to their more robust fel-

low-oanotrymen.; "The question is, indo?d. a vory vexed one.'" runs the. report, "and wo feel sure, that it ninv bo left to your clemenoy'to decide whether it may mot ba possible to permit the immigration "f persons in the earlv stages of the disease, provided that they can ehow that they aro willing to submit to certain conditions compatible with the inWests of tho countrv where they hnpa to beoomo effect! to citizens, Tha oonferv

once was, howevor, unanimous in its approval of tho measures about to bo taken by tho Government to prevent persons in advanced stages of the disease from lauding on these shores, and was confident that tiio most effective means to this end could .bo brought about by rigid inspection prior to immigration and during the voyage, it being contended that more responsibility might with advantago be thrown on the shipping companies.'' Attached io the report is a series of summarised resolutions presenting in detail the recommendations'of the-confer-ence. Tho last two resolutions ■ run as follow:— That it is of vital importance to tho success of tho movement that tho campaign against tuberculosis should bo carried 011 by uniform and concerted action throughout the whole Dominion; that with a. view to secure such action, the local authorities to combine wherever necessary to enablo the chief measures which have been recommended by this conference to Tie earned into effect, vit. :— The search for early cases; the proper treatment of cases amenable to treatment; the removal from their homes to suitable institutions of those persons suffering from consumption who are unable to take the precautions necessary to prevent the spread of the disease; the education of the public; the after-care of persons who have been under treatment for consumption. . ■ That in the event of failure to secure such unit)- of action, the Government be urged to take over, complete control of the tuberculosis campaign, and,' if considered advisable, to recover the cost of administration from the various Hospital Boards.