TUBERCULOSIS BILL

Press, Volume LXXXIV, Issue 25552, 21 July 1948, Page 6

TUBERCULOSIS BILL

PARLIAMENT

Plans Explained By Minister AIR DELIVERY OF VACCINE (P.A.) WELLINGTON, July 20. A review of what it was proposed to do to fight tuberculosis in New Zealand was given by the Minister of Health (Miss M. B. Howard) in the House of Representatives this evening when she moved the second reading of the Tuberculosis Bill. She said the bill was designed to give specific legal authority to the administrative activities of the Department of Health and hospital boards. The bill was also intended to provide a more uniform standard of control of the disease. The Minister said that new methods of treatment discovered in recent years in chest surgery and the use of drugs and substances gave , the tuberculosis patient considerable nope of recovery if the disease was found before it became too advanced. The newer methods of chest surgery had given the patient with moderately advanced disease a sure means of recovery.

To make an early discovery of cases mass miniature radiography was being introduced. This method of diagnosis, incomplete as it was alone, when combined with tuberculin testing and special bacteriological examinations and a careful clinical examination ensured that a majority of tuberculosis cases could be identified in a community and if necessary placed under treatment. National Health Institute The Minister said the finding of earlier cases from among presumably healthy groups of the population should be made easier if the bill was passed. The Government had already approved the establishment of a mass miniature X-ray training unit in Wellington. A medical director had been appointed end was expected to begin his duties in September. X-ray equipment of the most modern design had been ordered from England and should be installed at the end of the year in the prop osed National. Health Institute opposite the Wellington Hospital. After referring to the work of the Taranaki mobile X-ray unit, the Minister said the Government had approved in principle the establishment of seven other miniature X-ray units in various parts of the country, but these would not be provided until sufficient well-trained staff was available. Miss Howard said the suggestion that all school children under the age of 15 should be X-rayed every year was not only impracticable but, in the opinion of all tuberculosis officers, unnecessary and a waste of money, time, and effort. Tuberculosis of the lungs seldom showed itself in children under this age, except in Maori children. “As X-ray equipment of the modern type is available only in limited quantity and the trained staff is not yet available, an X-ray survey of the whole population, as requested by some people, must be limited in the main to special, presumably healthy, groups, wno are considered to come into close association over long periods with tuberculous infection known to be in existence,” said the Minister. Secondary school pupils in the leaving year would be tuberculin-tested and those who reacted positively wculd be X-rayed. Contacts of all known tuberculous patients would be X-rayed. It was useless at this stage to make the annual chest X-ray compulsory. Facilities could not be provided and the cost would be prohibitive for the results that could be expected. Vaccine From Australia It was hoped that much could be achieved by offering immunisation against the development of genuine tuberculosis with a special vaccine, said the Minister. The Australian Government had made plans to manufacture the vaccine and had agreed to supply New Zealand’s requirements by ah’ as the vaccine had to be administered fresh. The bill made provision to offer this vaccine on a voluntary basis to those people who of their own volition agreed to be’ immunised. It would be used on a limited scale at first.

A special committee ot tuberculosis officers and bacteriologists had been stet up to devise how the vaccine could be introduced into New Zealand next year. New methods of inoculation had satisfied all countries that it was useful and safe. “Since 1943 an average of 2385 new cases of tuberculosis in both races has been notified each year to the department,” said the Minister. “Deaths a year have averaged 940 persons, both European and Maori. *The trend of the death rate appears to be remaining stationary, and it is encouraging to note a record low mortality rate for 1947, when there were only 874 deaths from tuberculosis.” Cases Registered Miss Howard said the total number cases of tuberculosis registered alive on December 31. 1947. was 9821, an advance of 200 on the figure at the end of the previous year. Thirty-five per cent, of those cases were classified as being in an active, infectious state. Institutional accommodation was available for only half that number. The immediate contacts of registereed cases, amounting to 23,103, mostly children, were under regular supervision by chest clinics and district health nurses. In short, it could be stated that under existing methods of control an average of 40 to 50 new cases of tuberculosis were notified to the Department each week and two or three persons were registered as having died of the disease each day. The Minister said 112 nurses contracted tuberculosis last year and three deaths occurred. The majority of cases had. after a period of six to nine months’ treatment, been able return to duty. In the six-year period 1942-48. 556 cases had been reported among nurses and 400 had returned to duty or were deemed to have recovered and were in other occupations. The other 156 were in receipt of either sick leave on pay or were receiving a special grant of 25s a week in addition to the sick benefits to which they were entitled under the Social Security Act. Althoueh it was recognised that the chances bf contracting tuberculosis in nursing were possibly higher than

those m any other occupation, a considerable degree of care was exercised by all hospitals in preventing this, Miss Howard said. Opposition’s Support The Leader of the Opposition (Mr S. G. Holland) said any bill for the improvement of the nation’s health must have members’ whole-hearted approval. but the bill, like too many from the Government, did not go far enough. It dealt with the effects of tuberculosis rather than with its detection and causes. The bill conferred wide powers on^those charged with controlling and curing the disease, but in the main those powers were warranted. The bill placed an obligation on hospital boards to treat tuberculosis patients, but it was an obligation they could not fully discharge to-day for lack of buildings, a condition for which the Government alone was responsible, said Mr Holland. It was useless to ask boards to erect buildings when, largely because of the Government’s wages and hours policy, materials were not available. The Minister should have, explained how the Government would assist boards to carry out the duties it was placing upon» them. Mr Holland said tuberculosis was the fifth highest cause of deaths in New Zealand and the highest single cause of deaths among females in the 20 to 30 age group. It was also the highest single cause of deaths among Maoris. Between one-sixth and onefifth of all hospital patients to-day were suffering from tuberculosis, and yet hospital accommodation was available for only one-half of those suffering from the disease in a contagious form. Was the treatment of the disease to suffer for an indefinite time a lack of facilities?* Was New Zealand to go £long always suffering from shortages? Mr Holland said the Maoris were the greatest sufferers in. the country from tuberculosis, yet when a group of North Island hospital boards chose a site in Levin for a tuberculosis hospital they were refused the land because it was under Maori ownership. He could not believe that the decision expressed the real wish of the Maori people, and challenged the Maori members in the House to say that the land would be made available for this most deserving purpose. Mr Holland said great caution was needed on the clause of the bill virtually empowering a magistrate to commit a person to an institution for treatment. However, after full consideration, he felt the clause was justified.

Discussing the portion of the bill providing for financial assistance to sufferers from the disease, Mr Holland said he was sure the House would not be niggardly. The value of this section would depend on the vigour with which the measure was administered. There wis Vital need for public enlightenment on the dangers ofc overcrowding in homes, schools, and factories, and of bad ventilation. Recruits to certain occupations should be examined medically before taking jobs.

Voluntary Workers Mr Holland commended the work of voluntary visitors in tuberculosis institutions. They exposed themselves to considerable risks and he suggested that benefit provisions made available to nurses should also be offered to these volunteers if they contracted the disease.

The Prime Minister (Mr P. Fraser) returned to the House at this stage, and when Mr Holland referred again to the Levin site for a special hospital, Mr Fraser interjected that the Direc-tor-General of Health (Dr. T. R. Ritchie) had informed him there was plenty of other land available. Mr Holland said malnutrition was a condition likely to lead to infection and the department’s reports showed that nutritional standards had declined since 1940, both among European and Maori school children. There was a sharp increase in malnutrition from 1940 to 1945, with a slight improvement in 1946. . Sufferers from tuberculosis in New Zealand were 5.5 in 1000 over the whole population. 'This could be analysed as 4.32 in 1000 Europeans and 24 in 1000 Maoris. The death rate was 3 1-3' in 1000 for Europeans, but 39 in 1000 for Maoris. After reading this report, which showed all too clearly that Maoris suffered more from the disease than the rest of the population, his feelings were outraged at the report that Maori owners were withholding land wanted for a tuberculosis institution.

Interjections by Mr Fraser drew from Mr Holland the reply that it was impossible to refer in the House to the Maori people without the Prime Minister’s getting up in arms and declaring that the Maoris were being unfairly attacked. “Too Much Sickness”

Mr Holland said there was far too much sickness in New Zealand. It was costing £10,000,000 a year. One cause was that children to-day ate too much rubbish, because they had too much money to spend on buying rubbish in shops. Too many New Zealanders enjoyed their games from the sideline instead of playing themselves. The Opposition welcomed the bill as far as it went and would vote for it. Mr T. E. Skinner (Government, Tamaki) said the lack of adequate hospital facilities was largely the fault of previous Governments This Government was the only one which had tackled sickness in a positive way. Too many people thought it was something to be ashamed of to suffer from tuberculosis and tried to hide it, but by doing that they were helping to spread the disease. As more money had been spent by this Government than any other on recreation, lack of sport and games could not be held responsible for the increase of tuberculosis.

Mr Skinner said an X-ray should be made of every school child and on entry into industry every person should be medically examined. In those industries where there were likely to be dirt and dust there should be periodical examinations Mr E. P. Aderman (Opposition. New Plymouth) said the Government in its 11 years of office had not built one sanatorium for tuberculosis sufferers. The bill did promote matters which were all for the good of the community and the bill set out to benefit persons who were sufferers. There would still be a backwash from bad houses and infected dairy cows. The Maori member of the Executive Council (Mr E. T. Tirikatene) said tuberculosis was never *found among the Maori people before the advent of the European, but the change of environment and different food and clothing might have assisted materially in making the physique of the Maori more susceptible to the disease. He said the Maori owners of the land at Levin would have no objection, to the use of it for a sanatorium provided other suitable land was made available to them.