PUBLIC HEALTH.

Dominion, Volume 4, Issue 1165, 28 June 1911, Page 4

PUBLIC HEALTH.

POWERS AND 11ESPONSIB1LITIES OP ISOAKDS. At the afternoon session/when the question of public health became the subject' of discussion, Mr. J. G. Wilson presided. Opening the debate Mr. Walker (chairman of the Otago Hospital Board) read a paper on the powers and responsibilities of Hospital Boards under- - tho Public Health Act, 1008. Mr. Walker sketched tho work done by his board in carrying out' the provisions of the new. Act. He said it liad been found that much better work was being done by a single central body than was possible under th'o old system of separate boards in' various localities. The board was given responsibility for the public health and the whole district aud it was a question whether the Act should not go still further and mako such bodies responsible as well for tho sanitation of the district with the aid of the Public Health Department'. The new system resulted in much greater harmony between the Department and tho boards, it was working very satisfactorily, the work was'more efficiently managed, considerable saving of life and property was effected, and generally was much preferable to the old stale of affairs. He moved: "That tho conference bo requested to express its views as to working of Section 5 of the Hospitals and Charitablo Aid Institutions Amendment Act, 1010, and to continuance or otherwiso of this duty being imposed upon Hospital and Charitablo Aid Boards. "That the conference consider tho question of it's being made mandatory on Hospital and Charitable Aid Hoards to take over the sanitary inspection in their respective districts, in addition to the inspection in connection with tho prevention of. infectious diseases." The motion was seconded by Mr. Eaton (Wairarapa) who said that the experienco in his district was similar to that in Otago. Tho work of the inspectors under the central controlling body was most satisfactory

Mr. Young (Waikato) expressed tho opinion that it was rather prematura to speak of tho working of somo of tho new provisions. He urged tho separation of the two. questions named in tho remit, and ho doubted tho wisdom of the second one.

Mr. D, JTLarcn, M.P. (Wellington), held that the matter of sanitary inspection should be left in the hands of tho City Councils, at any rate in tho chief centres. He moved that tho questions bo taken separately. ' This was.agreed to, the first' portion of the remit being adopted. Several delegates stated that tho sanitary inspection was being carricd out by boards in various districts with, satisfaction and benclit.

Mr. G. T. London (Wellington) considered t'hnt largo centres where efficient sanitary inspection was already being carricd out should bo exempted. Ho moved:

"That effect bo given to I'ho sug-

gestion only in so far ns it affects, centres where tho poptilatiou is less than 5000."

After consideration tho motion was withdrawn in favour of tho following ono by Mr. F. Bellringer (New Plymouth): "That the confcrencc is of opinion that it is an advantage to ; tho community .to have all matters relating to the administration of public health," hospitals, and charitable aid under the control of hospital boards, except in the case of boroughs ' having a population of more than 5000 which are ablo to appoint whole-time officers." Mr. Bellringer's motion was carried by 30 votes to 21. A TERRIBLE SCOURGE, FIGHTING CONSUMPTION. Opening a discussion on tho administrative control of tuberculosis, Mr. Horrell (chairman of tho North Canterbury Hospital District) said he doubted whether either tho district health officers or even Dr. Valintino himself could say hew many consumptives there were in the Dominion. Patients in the incipient stages of the disease were apt to be overlooked, and those in a more advanced stago sometimes neglectcd to call in medical aid.. Medical men should be asked to give notification fo the Health Department of all cases coming under their observation, and those suffering from the disease should be invited to present themselves for examination at public dispensaries. 'The treatment at these places should be free. Again, inspectors iu the employ, of tho boards should bo required to keep a lookout for cases of consumption, and, above all, there should be a system of inspection' of school children. The only way to check tho spread of the disease was to establish an efficient system of notification. If it were ones ascertained how many cases existed, a campaign could be inaugurated with some prospects of success. The reports of the medical superintendents at Christchurch and Wellington indicated tho lines upon which the campaign . must be conducted. These officers recommended_ that dispensai'ies, sanatoria, farm colonies, and homes for incurables should be established. The 30 boards of the Dominion could not be expected to. establish these institutions. The best way would bo for the Government to establish one sanatorium and one farm colony for each island. It was almost impossible for local boards to deal with the matter efficiently. The.boards might establish small dispensaries to act in conjunction with the larger ones, and could in other ways supplement the efforts of tho Government. Tho local boards should undoubtedly provide for advanced cases. Sanatoria now owned by tho boards could bo utilised as homes for incurables, or in many other ways. Concluding, Mr. ESrrell /moved:—

"That the Government should establish two well-foijnd sanatoria and. farm colonics, ono in either island."- - Tho motion 'was/seconded by ;Mr.;. Arm. strong (Marlborpugh).' '

Widespread and Deadly. I Dr. Blackmore (South Canterbury) said that consumption was one of the:.most deadly and widespread diseases existing-at. tho present day; It -attacked;'young, middle-aged, and old. It was said that.no one over 41/ years of agfi was entirely-free from any trace of consumption. ■ The most valuablo asset owned by a.' community was its labour. It might be computed that if. 650 labourers died of consumption tho Stato incurred a loss -of .£200,000. Apart from tho monetary loss, consumption gave rise to incalculable misery_ and suffering in the community.. This disease which created so much havoc 1 " was p'reventible. Wherever it existed, it was due,, broadly speaking, to iSfection from milk, or from consumptive human beings. Amongst -.tho predisposing causes to consumption, Dr..; I3lackmqro ...jiained inherited weakness, -overwork, indulgence in alcohol, and insufficiency of food. .'ln dealing with the disease, it was necessary to try to stop the production of the germ, and to try to increase the resisting power of thoso who were susceptible to tho disease, or had rendered themselves artificially susceptible to it. Tho first necessity v.as notification of cases; advancod cases must he removed from amongst the healthy. The disease must be prevented from attacking people predisposed to it. Consumptives must be educated so that they might not give .the disease to .other people.. People must be educated gener-' ally as to tho means of avoiding tho disease, and a miro milk supply must bo ensured. Dr. Blackmore described in dotail the scheme outlined by Mr., Horrell. It had been urged, he remarked, that tho cost of destroying tubercular cows would bo prohibitive, but as a fact it would handsomely pay. this country to destroy, every tubercular cow and pay compensation to the owner.. .

. Dr. Hardwick ' Smith (Wellington) agreed that the methods described by Dr. Blaciitnoro must ,be adopted in any attempt to deal with the scourge'of consumption. In addition it would bo necessary to provide for tho segregation of refractory patients who would not submit to necessary rules and treatment. It had been stated that every patient who -died ot consumption dragged two other people' down at least. These people, at any rate, could bo saved. Jleans must be provided for separating early, intermediate, and late cases. The -work of carrying on the campaign - should be entrusted to specialists. State or Board Control? i- M i r 'i ?i" l'l, (Wellington) contended that the boards, in their economiccil administration of affairs compared not unfavourably with the Government. In tho speaker's opinion, a better'plan than hat advocated by Mr. Horrell' would bo to establish a limited number of sanatoria districts under the control of boards He would move/as an amendment: "That sanatoria for the treatment of consumption bo established in suit- * able districts, near to the four most important cities ■in the. Dominion. That the boards of tho districts embracing such cities control these sanatoria, and that patients from all the other districts in the Dominion bo available for treatment in these sanatoria, and that tho expense incidental to tho treatment be paid by the respective districts."

Mr., Eraser (Oamaru) . said everyone listening to the addresses of the "two medical officers who 1 had spoken must have been impressed with the fact that consumption, an infectious disease, had ■ not been treated as an infectious disease in New Zealand in'the'past; A great deal more might bo done than at present to cure sufferers and stamp out the disease. The scheino outlined by Dr. Dlackmore would never be carried out. efficiently by tho boards. It must bo taken up by the Government. It would bo best to refer the whole question to tho Government, making no mention of details.

Mr. R. C. Kirk (Wellington) said he disagreed with the last speaker in his pessimistic view of what could be accomplished by the board. The speaker was a littlo tired of continually hearing it suggested that the boards, though vested with amplo powers, should run to tho Government at every difficulty. Consumption should bo dealt with by tho boards from the. beginning. Mr. Kirk quoted extensively from tho recommendations contained in a report pre.sented to (ho Wellington board by Dr. Hardwick Smith, as showing that much ground might bo usefully covered by the boards. It was a pity, he continued, that there was not a greater measure, of co-operation between the different boards. At present treatment was apt to be a littlo haphazard. If this conference, or a sub-committee of the conference, could-devise a scheme providing for a uniform treatment of consumption,' a very great benefit would result. Concluding, Mr. Kirk movedi

/'That the notification of consumpiiou and its allied diseases lie mado compulsory. Further, (hat it be a recommendation to the Government that Hospital Boards be given power to detain for treatment in these institutions persons who are suffering from tubercular diK/ase, if, in tho opinion of the health officer or medical superintendent of the hospital, such detention is necessary in tho interests of public, health."

'Replying to a question. Dr. Yalintine stated that consumption was an infectious disease, and it was mandatory upon medical practitioners to notify cases. The trouble was that a case might last for three years and medical officers who dealt with advanced patients always took it for granted that the case had been previously notified. What was wanted was notification and renotification. Tho law was not at present being carried out. Dr. Valintino stated, in concluding, that last year there were over 700 deaths from consumption and only 550 notifications of cases. ■

After- some further discussion Mr. Armstrong (Marlborough) suggested that the amendments should be withdrawn and that the conferenco should unanimously ask tho Government to fissunie control of the campaign against consumption. The conference adjourned shortly after 5 o'clock, without bringing tho debate to a conclusion. It will be continued today, when the conference is to resumo at 10 a.m.'