TUBERCULOSIS MENACE

Evening Star, Issue 17953, 26 April 1922, Page 10

TUBERCULOSIS MENACE

DR LYTH'S VIEWS. DISPENSARIES AND CO-ORDINATION SANATORIUM TREATMENT THE IDEAL. 1! everyone responsible for tuberculosis in-patients made an attempt to ton ml under observation a great deal• ™ 0 progress would bo made. It m the continuous observation of these cases tM helps to secure thorn from a. relap..o ana from infecting their families. This waa a statement made by Dr C. B W Lyth, medical director of the Otago Hospital Board’s institution at Pleasant Valley in the course of an interview with a ‘Star’ representative tht* m °™ln K ’tho first place,” continued Dr Lyth, “I wish to say that the report, furnished by Dr Q. J. Blackmorc, medical director of tho North Canterbury Hospital Board’s institution on tho tuberculosis menace is to tactDr Blackmore lias spoken fearlessly on, tho subject, and bis report may stir tho Government to take some action. One occasionally felt, said Dr Lyth, that one was not cel ting results ns one should, and tho difficulty _ appeared to bo increasing instead of diminishing, as the disease was such a tricky one to deal with. He would not say that a great deal had not been done with regard to treating tho disease in New Zealand. When ho came to tho dominion ten years ago lie was struck with the fart that this country was in a particularly favorable position. The climate was salubrious, and it was an isolated country. It was also a small country, with a centralised Health Department which was efficient, and it had a homofeneous hospital .system. 'lhia was a great elp to start with, and it was merely a question of making use of those advantages. He was favorably impressed with J.ho opportunities offered ; but it was apparent that it was time the Health Department had: a definite policy based on the Edinburgh system of dealing with tuberculosis. The' idea was that it was necessary to catch, tho patient, in the early stages of the disease, and also those with whom he or she came in contact. The system earned out hero was for patients to bo treated at a dispensary, which was in turn linked up with a sanatorium for early cases. The more, serious cases were treated at the hospitals in co-operation with the Health Department, with working colonies for ex-patients. The whole was linked together by dispensaries or out-patient departments, andi the idea was for hospital boards to carry out a systematic campaign against consumption on those lines. The North Canterbury and Otago Hcsptial Boards both carried out a, large part of this programme. The. Wellington Hospital Board made a start, but gave it up. This meant that outsido of two districts tho work was quite unsystematic. There were tuberculosis .sanatoria, in the North Island, hut there was no system in use for trying to secure the right class of patients. In Otago at the present time there were empty beds for male patients, but not for female patients. Tho sanatorium at Pleasant Valley was full of women patients, and also the balcony at the Dunedin Hospital. There were, however, numerous vacant beds for men at both tho Wakari and Pleasant Valley sanatoria. One block to accommodate sixteen patients had been opened at Wakari. which left a block of thirty-six beds unopened, owing to financial reasons. It was probable that Wakari when in full use would prove rather largo for their needs; hut the present number of empty beds was duo to the military sanatoria, taking so many soldier patients. When they had thought out a proper method they would harm no difficulty in filling the beds at Wakari. At Clyde there was only one patient under shelter; so that whilst patients in some parts of the country were clamoring for beds, there were empty beds in other parts. CO-ORDINATION NEEDED. What was needed was more co-ordina-tion of existing efforts. After this had been accomplished it would bo possible to decide whether much more accommodation would be required. It was quite certain that the Government could not afford to build a sanatorium in Central Otago at tho present time, and it was apparent that a greater effort should be made than at present to get the best value out of tho existing accommodation. It did not pay hospital boards to keep beds empty when patients were asking for treatment. On the other hand, hospital boards could not afford to treat outsido patients unless the outside boards contributed to the maintenance of such patients. It will be remembered that Dr Blackmore expressed himself satisfied that tho work had not been without result. Dr Lyth also concurred with this view. Although the number of patients who had recovered under treatment had not been what they expected, there was no doubt in his mind that the efforts which had been made had led to the saving from the disease of a large number of children. This had been accomplished oven without the provision of a homo for predisposed children. In addition to the homo at Kew, and such organisations, there was the summer school for children recently carried out by tho school medical officers—all theso factors helping to a considerable extent. Tho military patients must become less, and many empty beds would be available for civilian patients. They were already being accepted, in fact, in the Waipukurau (Hawke’s Bay) Military Sanatorium. OUT-PATIENTS. ’ If tho large block containing thirty-six beds at the Wakari Sanatorium was opened he could enter into residence there, and thus bo able to undertake additional outpatient work at the Dunedin Hospital. It would then bo necessary to have an assistant at Pleasant Valley Sanatorium, but this institution would' probably bo closed when a sanatorium was opened in Central Otago. Tho efficiency would bo much greater if the large block at Wakari waa opened. Most people had a fad in regard to the best site for a sanatorium, but he was quite sure that tho Wakari institution was going to bo one of the best of its kind. It certainly had some advantages over the sanatorium at the Cashmere Hills. Christchurch. AFTERMATH OF THE WAR. Statistics had shown that there, was a steady fall in the death rate from tuberculosis up to the outbreak of tho war, but there had been a slight rise since then. The war conditions had apparently aggravated the disease. There was no doubt that during the last three years tho effects of the influenza epidemic had been responsible for an increase in tho tuberculosis death rate. If a person had tho disease influenza invariably hastened the onslaught of tho germ. Tho war and other disturbances had no doubt prevented tho authorities from taking steps to complete any schemes for combating tho disease more effectively. What was wanted now, moro than increased accommodation, was the. provision of qualified officers in charge oi tuberculosis dispensaries on Edinburgh lines, in order to co-ordinate with tho existing institutions. The dispensary was a place where suspected patients were examined, including contact cases (such as members of the patient’s household), and which cooperated with, the institutions in such a way as to make tho best possible use of the beds. This could bo efficiently carried out in tho Otago district if tho whole of tho Wakari sanatorium was opened. SANATORIUM TREATMENT. In regard to the treatment of patients, Dr Lyth said that ho was more than over convinced that sanatorium treatment waa the most efficient way to deal with tho disease. , Where this -treatment appeared to fail it waa often due to the prolonged neglect of the proper treatment before the patient entered the sanatorium, or te the patient’s return to unfavorable conditions after an

apparent recovery had been made In the institution. The sanatorium statistics, therefore, improved when the patients were recognised and in tho early stages of the disease, and in proportion to efficiency in after ca-ro. Talcing everything into consideration, fair progress had been made in coping with tile disease, and tho system as laid down hid worked well. This system, however, had been somewhat deviated from as a result of tho war and for other reasons. It would bo necessary, therefore. .for- the department to devise a new programme with which to grapple with the disease.

One of tho most, urgent needs was for some system to bo brought into force so aa to keep tuberculosis patients under strict observation-after they left the sanatoria. and for tho best rise to bo made of all empy beds. As an instance of tho urgent need of the authorities keeping in close touch with patients and contacts, Dr Lyth cited a case where a brother and sister were under treatment in a sanatorium, and another brother instuicted to come along and be examined. There was no sign of the complaint on this young man at the time. Ho went away into tho country, and tho doctor had no chance of locating him for future examinations. Some twelve or eighteen months later tho man returned, and- ho_ was admitted to the sanatorium suffering from the disease. It was in a very advanced stage, and he died in a few months.