CONSUMPTION IN THE COLONIES.

Press, Volume XLVI, Issue 7260, 21 January 1889, Page 5

CONSUMPTION IN THE COLONIES.

An interesting paper was read at tht recent meeting of the Australian Mediea) Congress by Dr. MeLaurin, President of the Board of Health of New South Wales, on "Australian Mortality." The follovrl ng remarks in reference to the position ot these colonies in regard to what is perhaps the most dreaded disease that human flesh is heir to will be read with interest:— ,

As in almost every other part of the world, consumption of the lungs figures in most of our returns as the greatest single cause of death. It is first in the colonies of New South Wales and Victoria for the whole period, and in South Australia for one year. In Queensland it occupies the second place, in Tasmania the third place, excepting for one year, when it is second; and in the sparselypeopled territory of Western Australia it is only the tenth in the order of fatality. In New Zealand it is at the head of ( the list for two years of the period, and. lot the third it is bracketed an equal first with accidental causes. Where I have been able to separate approximately the urban and rural districts (Le., in New South Wales and Victoria) it will be found to head the list in Melbourne and suburbs and in Sydney; in the country districts of Victoria and the suburbs of Sydney it is found to take second place, excepting one year, when it is third; but in the rural districts of New South.Wales it holds only the third place, being exceeded by old age and accidents. What is the relative prevalence of phthisis in the various colonies? To answer this, I have prepared the accompanying table for the year 1885, the latest common to all the colonies for which I had materials—excepting Western Australia, for which I have only materials for one year—viz., 1886. It gives tbe number of deaths per 100,000 living in each colony or district which X have Been able to separate. Table I.—l&Sj. Distriot or Colony. Per 100.0W New South Wales .. « .. 116-71 Sydney ....,»«. 232.37 Suburbs .. ... .. — lfii.'tGi. Country .. — ~.». 75.WVictoria .. „ .. 141,95' Melbourne and suburbs „ 239.13 ; Rest of Victoria.. .. « 88.6* Queensland ... „ .. w 18&SS ; Tasjnania .. „ ... ... 108438 South Australia .. .. *. 90.01 New Zealand .. _ „ 89.65 Western Australia (18S6) «. .. 63.21

It will be seen from this table that the districts under consideration divide themr selves into two classes, according to the prevalence of the disease. In the £rat, containing in order Melbourne, Sydney, suburbs of Sydney ana whole colony of Queensland, the percentage of cases if high, approaching to the average of the thickly-peopled countries of tbe old world. In the second division the percentage is low, the order being 'Tasmania, South Australia, New Zealand, Victoria outride Melbourne and suburbs, country parts .of New South Wales, and lastly Western Australia, in which there were only 27 deaths in all from phthisis, or at the rate of 68 per 100,000 living. In the last case-, however, we should most likely consider the numbers involved too emallto forman accurate standard, especially as the return is given for only one year. Dr. M'Laurin next estimated the ratio of deaths from phthisis to those from: aty causes. He continued :—

As in the former table Melbourne and Sydney head the list, in.Melbourne the ratio of deaths from phthisis to'"jthose from all causes being 11-87; and ih SVdnfcy 11 "00. These are followed by Queensland, 9*51; Victoria, as a whole. 9*63; NfeW Zealand, 8*45; suburbs of Sydney, 7'BQi and Sonth Australia, 770, and gradually in a descending scale untii we reach Western Australia With 3*35. Here I may mention as a curious fact that amination of the death returns of th&AU&i tralianM.P. Society for a periodof ibiCty years, and of the Mutual Life' Association of Australasia for a period of twenty years, I And. the ratio which claims arising from deaths by phthisis behr to claims from all other causes whatsoever to be almost exactly the same ia' both Societies—viz,, 12<4 per cent. When we consider the very great care taken by both of these Associations in examining persons who propose to them for assurancel and when we take into account' the identity of the' percentage of; loss to each Society from phthisis, I think we may infer that this ratio of 18.4 may- be takes* as the percentage of deaths from phthisis which may be expected among any,number of healthy adults, principally males, distributed over the greater' Australasia. At first sight, considering that the ratio of deaths from phtHisis':to deaths from all other causes'for the Wfiole colony of Victoria is only 9.63, and for the colony of; New South Wales is only 7.16, It would look as if the Life Insurance Com*panies cat, a very poor figure with their x 12.4, in spite of all the trouble they take to *~ exclude, i^nhealthy-lives. But this is only apparent,-for we must bear in mind that the Life Insurance Companies rarely accept proponents under the age of 15, and for tho most part their entrants are several .years older. They thus escape the very serious causes of death which operate, for the most part in infancy and early child* hood, and, therefore, phthisis, which is chiefly a disease of adult life, figures very highly among the de&tjty dealing causes in the assured population. In order to make this more clear, I have taken out the ratio which deaths from phthisis bear to deaths from all causes occuring above the age of fifteen in the colonies of Victoria and New South Wales* and the results are as follows:—iusVlcr toria, percentage of deaths from phthisis to deaths from all causes over elevenyears of age is 15,42, and In New South Wales 13.40. Hence we see that the assurance companies' result is rather better than-the average of Victoria, and a shade better than that of New South Wales; and - this confirms the opinion that most intelligent men have held, that the true use. /of medical examination for a life assurance company is not to provide a class of entrants much above the average in the ex* pectancy of life, but rather by thetfiSP elusion of diseased and unhealthy livesvto prevent the expectancy of the whole, class of entrants in any year falling below: the average. I have calculated a similar ratia for Queensland, and find it to be . When we come to compare the condJUSeiirs*, of Australia with that of the countries v - of the old world we cannot be but sfcruciE with the comparative immunity from consumption which a considerable proportion of this country enjoys. If we take the trouble to glance down the very elabaia£9 table given by Hirsch in the third volume of his "Handbook of Geographical ;&fld Historical Pathology," we shall beirieasp} to find that the rural parts at temtfM - Australia occupy a position with, reipiacfc " to this disease which will: comp&ed very favorably with most other conn* tries in the globe. Even Queensland* which is much the worst of our colonies as a whole, would stand very well, among European countries, being practically l the same as Switzerland, in which the death* rate from phthisis is very low for Europe, and to some parts of which phthisical patients are occasionally sent by medical advice. And the more favored colonies (at all events in the country parts) will com* • pare favorably with tbe rural portions «4 north-west Africa, which have. long; been celebrated for comparative immunity from phthisis. . •»:.,[. c. ■.-'•.'■:•'. It is but right, however, to hear mmmd* on the other hand, that the urban portions of Australia possess no < such immunity, and that Melbourne and Sydney shoe? a very considerable proportion of phthlsicai deaths—the former city, with- Its suburbs j showing 2.39 deaths per 1000 persona living, a proportion, which, according to Hirsch, is. nearly equal to that of man*. European cities, although, of course, much below many German and Austrian towns, in which phthisis seems to assume the proportions of a real plague. • It is useless to shut our eyes to the fact! that consumption has got a footing among as, and that it is now one of our most mv portant causes of death. How it is to bs checked in its advances, and, if possible, lessened in its prevalence, are &monsc>Cka most important sanitary problems of iha

day.. - .-■' *■' .'• '.'•' It would take too long if I were here to go into this question. I would venture; however, to draw your attention to, twU matteis—lst, that phthisis is essentially a disease of towns, especially of great towns, and that, consequently, improvement at the; hygienic conditions- of great towns,- more especially in ventiksttaa, free. space, and, not least, in good morals, will necessarily tend to the diminution of the phthisical death-rate; 2nd, the di* coveries of the last few years with respect to the bacterial origin of phthisis surely to awaken, the puolic- tonriiw apathy with which they continue to consume the flesh of tuberculoU» nxen and the milk of tuberculoua eowai That these tuberculous animalaado present the characteristic bacilli at ia no doubt. I supposerl must admit fau* I cannot point to a case in wMcartsne transfer of the bacillo* from the ox orgrm bo the human, actually demonstrated; but the identity aft the morbiflc cause in the ox and the human

being is quite suffideutJy probable to raise a suspicion strong enough to justify us in preventing any risk of the kind, and I suppose no one would knowingly allow his family to be fed on tuberculous beef or tuberculous «p»'Uf- There is, however, a good. Ho*; of trf ,ffiMHl "? in tuberculous cattle—at least, in New South Wales— whether for slaughtering or dairy purposes, and one measure winch is most urgently required in that colony is a law rendering penal all trafficking in such unlrmtlq for any purpose whatsoever. I believe that such a law would De of great (service in preventing the spread of consumption among our population. Thiaview will, I think, be strengthened If we inquire how the Jews in Australia Bare in regard to phthisis, and I am indebted for some valuable information on on this head to my friend the Rev. A. B. Davis, the learned and much respected Jewish clergyman in Sydney. It is well known that the greatest care if* taken by the Jews to avoid the consumption of meat which is in any way tainted by disease. As Mr Davis says in his letter to mc:— *' The slightest speck on the lungs (which are blown out to their full extent) or blemish of any kind would be sufficient to condemn the carcass, and the butcher accredited by the Jewish community would not .be permitted to dispose of it." Wbw, just as I should expect, the Jews is Australia show a great immunity from phthisis. Mr Davis states that in the Jewish population of New South Wales, numbering 4000, be can only call to mind one death from phthisis in three years. Taking the average for the whole colony of New South Wales, the expected deaths in 4000 persons for this period would have been 13.68, and as Jews for the most part lhre in cities we might fairly expect the death rate to be higher than for the whole colony. Instead of the rate expected we find, however, only one death, and a consequent saving of (say) twelve lives in this number of persons in three years. I do not Say that this saving of life is entirely due to the avoiding the use of tuberculous meat, but I take leave to maintain that I am justified in crediting this cause With a good deal of the beneficial result. Perhaps it will be still mere striking if I point out the saving of life in the Colony which would ensue if the Jewish average were maintained for the whole population. In 1885, 1095 parsons died ot consumption in New South Wales, being at the rate of 115-51 for each 100,000 of the population. If the Jewish rate had been general only 79 .would have died, being a saving of over 1000 lives in one year. It may, of course, be alleged that this death rate among the Jewish population ought nut to be taken as being absolutely a&urate, and that, therefore, it is hardly lair to compare it strictly with the general death rate of the colony. Possibly this may be so, but even after making every allowance for mistaken diagnosis, and for atiy other probable source of error, I cannot but feel convinced that the alleged immunity of the Jews from phthisis does, onthe whole, really exist, at all events in •New South Wales, and that their condition with respect to this disease contrasts very favorably with that of the general population. Aattor Melbourne, I cannot give you exact figures; but I learn from Mr Davis, on the authority of Mr Meyer and Dr. Brownless, thte respected Chancellor of the Melbourne University, that little or no phthisis exists among the Jews in that city. It might be worth while to notice that tbe country districts of New South Wales, where the phthisis rate is low, are for the most part devoted to the rearing of sheep; while Queensland, where the rate is high, Is, at all events in the coast divisions, almost exclusively devoted to the raising .Surely there is sufficient energy among ns to lead us to try to reduce the general de&th-rate to that of the Jewish community, and the first step in this direction Is in my opinion to put an absolute end to tbe ,uSe of meat torn tuberculous oxen and of milk from tuberculous cows.