THE WHITE SCOURGE.

Press, Volume L, Issue 14907, 4 March 1914, Page 7

THE WHITE SCOURGE.

CAMPAIGN OF ELIMINATION.

CO-OPERATION WANTED

CONFERENCE OF HOSPITAL

BOARDS

AN IMPORTANT DISCUSSION

A very important conference between representatives of most of the Hospital Boards of Canterbury was held yesterday at the Cashmere Hills Sanatorium to discuss the question of co-operation between the Boards in fighting consumption. The Boards represented were:—North Canterbury: Messrs F. Horrell (chairman)- J. D. Hall, "W. McMillan, Orton Bradley. G. Scott, and Dr Fenwick; Ashburton: Mr. H. Friodlander; Bullcr: Mr Greenwood; Grey: Mr. Fletcher: South Canterbury: Dr Paterson and Mr Gillingham; Westland: Mr. Clif-j ton. CO-OPERATION NEEDED. The conference assembled at the Hospital Board's rqoma at 11 a.m., when Mr. F. Hbrrell (chairman of the Board) extended a very hearty welcome to the delegates, and trusted that their conference would bo of benefit to those suffering from tuberculosis. Their object in arranging tho conference, ho said, was to endeavour to come to some arrangement whereby those afflicted in tho visiting representatives' districts might have the benefits of sanatoria treatment. As the North. Canterbury Board had spent thousands of pounds of their own ratepayers' money in combating the disease they naturally were not eager to tako patients from outside districts, although in isomi; crises the rule had been broken. They recognised, however, tho impossibility of the smaller Boards incurring the enormous expense of establishing; sanatoria, etc. Personally he did not think this would be necessary, provided some , mutual arrangement could be arrived at with the larger Boards. All would agree that it was almost futile to attempt to stamp out the disease unless there was some uniformity of action throughout the Dominion. It was. for example, useless for this Board to attempt cures while other Boards were propagadng the disea.se by doing r.otliii g.

At «i conference of Hospital Boards hold in Wellington somo few years ayo, he had moved that it was desirabJe that the Government should establish two sanatoria, farm colonies, etc. —one in each Island—but this Mas not agreed to, as tho Inspector-General was against it. It was then suggested that the four large centres .should cany the work on. Tho North Canterbury 13oaru took the matter up in earnest, and, although they lacked the farm colony, they were endeavouring to carry oiu the recommendations of the conference of medical experts who met last yt>nr They prided themselves on having secured the services of one of tho most expert medical gentlemen in the Dominion if not in Australia, and this led to many applications coming from outside sources which had to be refused. A VISIT Or INSPECTION. After this welcome the whole party Ittbtored to the Sanatorium and there entered upon a thorough inspection-oi the buildings and tho treatment carried out. there. Dr. Blackmore, superintendent of the sanatorium, personally conducted the visitors over the buildings and showed how the accommodation had been extended from time to time. The visitors were greatly interested in tho structure of the shelters and the general administration of the institution. One of the most interesting portions of the trip was an inspection of the King George V. Coronation Home which Ks now almost ready for occupation. This institution is designed to serve as a stepping stofle to admission to the Sanatorium when tho case is discovered by the "dispensary, and also as an establishment for the reception of chronic cases. Tho Sanatorium is designed to give active remedial treatment, and till a patienfis able to undertake that treatment he or she will be placed in tho hospital at the foot of the hills. There will be some "forty-five beds in this and when it is opened it is confidently hoped that there will be ample room for the admission of all the consumptive cases of Christchurch. In the Sanatorium at present there are lifty-eight shelter beds and four emergency beds. A SCHEME PROPOSED. In conference, tne cuanman said that tho yeariy cool per beu oo lur iius beta X.160 10s eacn, Out au- tviiartou U"t* secretary; naci piepared estimates, aor next year making vue cost JUiud Is Ou. iuu suggested uuic eacn uistnct snouid provide its own shelters at the banaLonuiri, containing us many oeos a≤ they tiiougiic wouxd be necessary , ior tiio needs or their locality. Mr Uillingham eaid ttiat the South Canterbury JJoard had entered into an agreement with the Otago Board for seven years to eend its patients to tne Pleasant. Valley banatoriura. Ashburton had joined in that plan and lie thought tnat for the present their district should he omitted trom any arrangement. ' Mr Clifton, chairman of the Westland Board, stated that because of climatic reasons no sanatorium could be set up on the Coast, so that his Board was anxious to effect some reasonable arrangement with the Canterbury Board. Ho could see that the initial cost would be fairly heavy, but'he would like somo particulars as to the cost of maintenance. Hie Board would be prepared to discuss any proposal favour.ably, and would endeavour to fall in with ;t. Mr Horrell eaid that he believed the North Canterbury Board would not expect anything from the other Boards in the way of share in the cost of ground or administration. All that would be expected would be the cost of erecting the shelters and the cost of maintenance THE USE OF DISPENSARIES. j In response to an invitation from tho chairman Dr. Blackmore made some remarks as to tho institution and operation of dispezisaries. If was, of course, necessary, lie said, in dealing with tuberculosis, to try to get rid ot it altogether. To do tnis it was necessary hist of all to know where the cases were, and to deal with them. This information was derived from notification or from the tubercular dispensary. This latter was used for detecting early cases of disease, and it then took immediate charge of them. If tho case was fit for cure it was removed to the Sanatorium, or, if too advanced, to a special hospital. Having dealt with the cases, the next step was to deal with the bouse and make it impossible for it to distribute the disease further. This was done |>y the dispensary, which farther acted as n medium for dispensing information. Corr?<try, the dispensary should be looked upon as one of the agents in a preventive scheme. The aim was to send all cases out in an uncontagious condition. In an ideal form tho nex: step would be the removal of

cases when recovering to a farm where perfect health would be restored.

SMALL SANATORIA CONDEMNED

So far as email districts were concerned, it was not possible for them to run a sanatorium satisfactorily. For it to be satisfactory it must bo in charge of a man with a good deal of experience and special knowledge, and suyh men were scarce. In a scattered country like ihis it was better to Have two or three sanatoria properly run and properly equipped. J3y starting a small one in the country failure would be courted—that it ad been the experience everywhere—and therefore it was necessary for smaller places to club together and establish a proper place. It was,' above all, essential, however, that a dispensary should be established in the smaller districts to detect the cases and send them on to the Sanatorium for proper treatment. It was also necessary that those districts should make some preparation for treating the advanced cases by putting up a few shelters. 'A HOPELESS TASK." Mr GiUingham (Timaru) said that, there was no hope of stemming the tide so long as immigration went on the way ifc did. It was like trying to stem a flood. They had had immigration cases in advanced stapes before their Board. I>r. Blackmore admitted that some cases wero getting through, but not so many as was said. The last Health Department report said that only eight or ten had got through. No "flood , ' was taking place, and while it might he desirablo to have all excluded, this could bo done only by so-strict an examination that the public would not stand it. Dr. Fen wick counselled that they should not listen to the voice of despair. It was true that cases were being brought in, but they would have to just fight on. He had examined hundreds of immigrants and knew the conditions. That afternoon they had something practical they could do. Surely Westland cotfftl raise some £2-10 to "put up four shelters. and Ashburton could easily do more by public subscriptions. PRACTICAL QUESTIONS. Mr Greenwood (Buller) s-aid he was quite sure his Board would be prepared to do its part. He congratulated Canterbury on the stejw it had taken to fight the disease, but deplored that tho public did not really know just how dreadful a thing the disease was. Mr I'Viedlanrlqr (Ashburton) said his Board had already recognised the value of promptitude. But the medical men themselves would not report *asc6 as speedily as they should, and they had actually complained to the Inspec-tor-General, and asked him to tho I'iw. As soon as tho caso was reported the Board would investigate and take- all necessary steps. Tho scheme proposed by Mr Horrell was a very good one. but an important question was: Was there room at the Sanatorium for all the shelters which would bo required by the different Boards. If it was found that there was not room the position would bo awkward, because at present Ashburton had an arrangement with Ota go which ehould not be lightly broken.

Mr IJorrell replied that it was hoped eventually to stamp the disease out. At tho present thfy thought they had reached the maximum requirements for the Canterbury district, and now had wncp for an additional twenty-five or thirty beds. That should be sufficient for the present needs of the district. They could answer tho question only by ascertaining what would be the needs of the districts.

sln reply to Dr. Fenwick, Br. Blackmore said that he would strongly advocate a third institution in the r>:ape of a farm somo forty miles from the city. An expert would not bo required there, but a junior would' do. DISPENSARIES RECOMMENDED. Mr Fletcher (Grey) said he was strongly improved with the value of a dispensary, and ho would report to his Board very strongly in favour of one. That wcnld bo necessary to know just how many ensos they would have. If anything practicable evolved from the conference tho Grey Board would be perfectly willing to join in with it Dr. Blackmore said that/he believed he was correct in saying that the dispensary was responsible'for the notification of fully four-fifths of all the cases discovered in Chiis-tchurch. He had not found the "doctors lax in sending patients to tlio dispensary, which he believed got over the chief difficulty of formal notification. They sent the patients to the dispensary to have their suspicions confirmed, becauso in private practico they might not be sure of the disease. One great difficulty in notification was the attitude of the general public, who always regarded with excessive suspicion anyone known to be suffering from tuberculosis or one who took tho desired precautions. It would tako years to educate the public to a proper comprehension of the disease.

Dr. Paterson enquired what would be the cost of a dispensary in a provincial town. If there were to be dispensaries they would have very largely to be run by the local medical men.

Dr. Blackmore said that the best plan would be to get a man on the honorary staff who took a special interest in the disease to run the dispensary. A sii all honorarium would be necessary ir. M>mo cases. The other expenses ■would be a nurse at up to £120 a year, and the provieion of a room and some furniture. MOTIONS CARRIED. Mr J. j>. Hall said they would have to indicate to-the smaller Boards just what accommodation for shelters they could give. Because of the support Canterbury had given the- institution, the Board should be very jealous of the provision for Canterbury's requirements. By duly safeguarding that he would be willing to* set .aside twenty of the prospective thirty beds for the couutry Boards. It would be necessary to guard against the sanatorium being made a dumping-ground for tHe country, and it would be wise to ensure that each of the smaller Boards established dispensaries. Mr Hall also referred to the need for strict examination of school children for tuberculosis.

Dr. Blaekmore isaid that' dumping was prevented by the stipulation that the final decision as to the admission of a patient must rest with the medical superintendent. It would also be necessary for all patients to remain in the home as long as the superintendent required. On the motion of Mr J. D. Hall, seconded by X>r. C. Fenwick, this resolution was carried: —

"That in the opinion,of this conference it is desirable to establish tubercular dispensaries in 'all districts for the purpose of detecting tuberculosis, of educating people in methods of treatment, and of preventing the disease." Mr Hall also moved, and it was agreed : — ..--■ 'That the inspection of the health of school children be proceeded with as soon as poseihle, and that a copy of the resolution be sent to the Ministers of Health and Education." HOSPITAL BOARDS' ASSOCIATION. Mr Greenwood (Buller) drew attention to the position of the law in making Boards responsible for the maintenance of patients in other hospitals who have been residents of the district. Ho said this was a heavy burden on the small Boards, as they frequently received these heavy bills completely as a surprise. There emerged from a desultory discussion on this subject the suggestion that a Hospital Boards' Association •should be formed to discuss very many important subjects affecting the different Boards.