THE CUKE OF CONSUMPTION.

Otago Witness, Issue 2600, 13 January 1904, Page 21

THE CUKE OF CONSUMPTION.

THE ATTITTnJE OF NEW ZEALAND,

sir j. g. Ward at the science CONGRESS.

The meeting of the Sanitary Science and | Hygienic Section on Friday afternoon was j held in J room, the largest room at the | disposal of the association, and there was a large attendance. Dr J. M. Mason, vicepresident of the section, occupied the chair. , The Hon. Sir J. G. Ward, Minister of Public- Health, read a paper on "The Attitude of New Zealand as Regards Consumption." Sir Joseph, in opening, said : Mr Chairman, Ladies and Gre-ntlemen, — It is a little unusual for me to read a paper, but in the circumstances I trust you will allow me to put before you the views on this import-ant matter very briefly, generally with the object of assisting in creating public opinion in our own colony. — (Applause.) It was with some slight misgiving that I allowed myself last night to be persuaded to enter an arena so crowded with scientific men and women. I lay no claim to any special scientific knowledge, but the protection of the people against the ravages of this disoaee is, I submit, a very proper eubject upon which laymen as well as scientiste should be heard. — (Applause.) Without the aid of the law, which, after all, is only publio opinion crystallised, no great or permanent reform can take place. I make no apology, therefore, in occupying your attention for a few minutes in setting out what our colony has done, and intendg to do, in this war with the mighty bacillus. — (Applause.) A disease which yearly destroys between 60,000 and 70,000 people in England and Wales alone is one which everyone interested in the welfare of the race must carefully consider. Although the celebrated scientist Koch a good many years ago discovered the particular little body which causes the disease, it took, as you all know, a long time before the people realised that there was danger of it spreading from one person to another. To LJa Majeety the King no little credit is due for the efforts that are being made in tho Old Land to intern the onward progress of the disease. Great efforts have been put forth by the National Society, of which he was the founder, to bring the people to a proper sense of the importance of <the enemy and the methods by which it is spread. Roughly speaking, there are two ways in which consumption or tuberculosis is spread — to children by means of milk (though I have read that Koch has recently asserted that danger from this source is small), and to others by means of infected expectoration. Now, I have no wish to claim cretlit unfairly, but I do not hesitate to say that we have here a system of meot and butter inspection that is equal to that of any other country. — (Applause.) New Zaaland has been the scene of pioneer legislation, much of it good, though I daro say some of you may think otherwise — (laughter), — but in the crusade against th's disease we at least deserve credit. To place consumption in its proper position, amongst infectious diseases was ii'<? fin:t important step. — ("Hear, hear.") In this way the exact number of the poor suffe-rers is ascertained. Some, hardship undoubtedly at first resulted, but by a carofal and tactful administration of the regulations the^e have bee.n greatly les-ened. Po-is'°ssed of thp knowledge of the rowev of the enemy, so to speak, our n&xt step wai= to set about tho erection of sanatoria for the treatment of t!-o»o afflicted. One at least of these institutions is now in working order in tho North Island. I had the great pleasure the other day to formally open To Waikato Sanatorium. Thero was a gooclly gathering cf men e_nd worry n from many far-distent parts of the world. Some of the visitors hnd econ and wore well acquainted with several of tho best-known •^aua^oria in tho Old nnd New Worlds. Yet I wa* a&mrcd by not a few of th.'-o fartravelled people that tii-ry had never fceen

among their travels an institution better fitted for its purpose than that situated close to Cambridge. — (Loud applause.) Certainly no fairer picture could have been asked for than what met the eye from that lone peak on the Maunga.kawa Range. It gave me the greatest pleasure to see among those gathered round on that occasion several who had been inmates of the institution, and who had gone back to the " workaday world" very greatly improved, if not absolutely restored to sound health. Tho establishment of an up-to-date sanatorium for the treatment of consumption on the latest scientific lines is another fact that must go to the credit of this colony's pioneer legislation. — (Applause.) To attempt to etom the tide with one euch institution would be as hopeless as the efforts of the old lady with her broom. — (Laughter.) Realising this, I was able to convince my brother law-makera that further powers were neoessary ; and it is my intention at an early date to ask the hospital boards in those districts whose climates are known to be beneficial in chest ailments to undertake the new responsibilities which the law has east upon them. 'In the course of my work as Minister of Public Health every day brings sad cases before me. The medioal profession has, I understand, decided that cases of consumption should not, for the sake of other patients, be treated in a general hospital. Now, while we laymen must be guided by expert advice, there is one aspect with which we alone must deal — that is, the monetary one. Willing as a Government may be to carry out the sxiggestions of the -scientific man, they often find themselves confronted with an expenditure which, if incurred, would seriously hamper other necessary works. Now, in the schemes which I intend to have carried out we shall, I think, be able to obtain all that the experts ask for, and yet not make an unfair demand upon the colony's general funds. The addition of a few shelters to each of these country hospitals would entail, in most cases, but little expense, while the working cost would be Email. With 13 or 14 annexes capable of holding, say, 30 patients each, fche colony would be enabled to house and care for ail those afflicted witli this fell disease. I propose to have these institutions established at the following places — viz., Auckland, Hamilton, New Plymouth, Masterton, Otaki, Nelson, Christchurch, Naseby, Lawrence, Queenstown, and some- , where in the vicinity of Dunedin. — (Ap- 1 plause.) More important even than the effect upon the patients themselves would be the safeguarding o-f the public at large. Within the walls of these institutions every precaution would be iaken to destroy the infected material, nnd thus the greatest of great dangers would be averted. Apart altogether from the humanitarian aspect of the question, the course which the colony is now carrying out, and will, I hope, continue, is absolutely justifiable upon purely economic grounds. — (Applause.) At the opening of the sanatorium at Cambridge I drew attention to some figures recently pub- • lished by a well-known American authority. Calculating the vaJue of each individual afc £300, he showed that the cost to New York City alone in one year through this disease amounted to £4,600,000, while the total for the whole of the United States reached tho appalling sum of £66,000,000. I have no wish to detain vcu longer, but I trust that this abort sketch of what we are doing in this gr«it work will at least convince you that politicians do — despite the criticisms occasionally levelled against them' — take time and thought to set aside from the hurly-burly of everyday questions, and not only think but legislate for the unborn millions which we trust may inhabit this fair land of ours. — (Applnuse.) Among the many subjects upon which the scientific world hns been engaged, it must be admitted that sanitary science occupies a foremost place, and the wide world is indebted to an unpayable extent to students in preventive rrKvlirinc for the preat discoveries ihey hay" been tbo mep.ns of unfolding, and by which an amelioration of the condition of people of all classes in all countries has been brought about. May I be allowed to congratulate tho Fciwitifjo men at present assembled in the City of Diinpclin upon tbo good 'work that they pnet their associations are do'nc; for humanity at large? I eon- ! orratula^o also T}un ri dm upon having been selpotod for this mr-ot.inc. It has much indoerl to reeommmrl it. for it has n'vjivs been r^nownrri far its interest in poientiPc re-soar^K TJrs pity, liko iU profntvop in stfrn Paled'^iii. forms an anpronriptc. <=pttinfr to n erf he fir °> of scientific r-on That iheir Mx'urs iibv h* fruitful and <'i->ir r>nioymcr>t<; rr.p-<-" i- the wi=h whidi I have the "vry Qreate=t pl"n«urp in Riving oxpresc]nn t,-v — 'Jj~vc\ npr;]au=P.)

Dr Co'rjul'omi *.rjA fhpt the henH-,- thp^ks rf fh" -moriioal ■pvn c i>-.^ion w'Ptp duf* to Sir .Tosep'i Wrrd ard rhc Cahinrt for tho v.ork tliev ' a'l rlono in connection with co'iPiimution iii i lsi 5 cciiritT- TTo thought ho m!s>h< «ay thi., th" '■nf.p'uto-? tho Government had takfn and tho^ tlir>v wpre p^rm<- 1o tiVe. as outlmfr' h-* I" Minuter of PuHip Health, srapV f'i'fil' l "d ?11 thai the ir.rdicil profes<=;on had fioTcpd the Oovprmrppnt in t^p la«t eisrht or nir-i rrai" to do. Th°ro might b^ n--.rnp f;uo-tio'i as to clotnils — n=i 1o the rOar"" 1 " - i-~r" i!ie i-cTil^a's should h« — H"t the diffearurca of opinion among-.!; those coa-

• I cerned were exceedingly small. Whatever , j opinion in a general way might be held as • to the Government interfering with private . enterprise, it must be perfectly obvious that i the combating of this disease was one of the "things that they must look to the State ; for assistance in ; and the measures already ; inaugurated and to bo inaugurated by the New Zealand Government would, he was i sure, be the means of reducing the spread • of tubercular diseases, and increase the wel- , fare of the whole of the inhabitants. What was good for consumptive patients was good for everybody eke, and he was strongly of opkuon that one of the beet lessons that 1 will be spread abroad among the people by these sanatoria will be that everybody will bo better by living more in the fresh air at all times. He looked forward to the movement raising the whole standard of heal,th throughout the colony. He had much pleasure in moving a hearty vote- of thanks to Sir Joseph Ward for his address. , Dr W. Camae Wilkinson, of Sydney, congratulated New Zealand on being ahead of the other colonies in the matter of some ' system of notification of infectious disease, and also of having already started sanatoria for the good of the poor people who could f cot pay for treatment. The question of the { prevention of tuberculosis waa a very large j and complicated! one, and had to be con1 sidered from very many points of view. Iv the first place, it was not always an infectious disease. It only became infectious in its later stages, but it was undoubtedly at the present time the most common infectious disease in any community. His opinion y/as that sanatoria, valuable as they are, indispensable as they are, were very often a poor means of preventing the spread of disease in the community. Turban, of Davos, had shown that in mot more than 20 per cent, of the cases that had come under hia notice in the best organised sanatoria in the world had the tubercular bacilli disappeared after treatment. That meant that after treatment 80 per cent, of the cases might be a source of danger to the community. He held that the only cases of tubercvilosis that should be- treated in a public sanatorium were those in which the tubercular bacilli was not found in the sputem at all. He did not wish to throw cold water on tho Government's action in 1 this matter, but still it was -nell that they ' ehould look at the more important measures , of dealing with the prevention of this disease. He was one- of those who could state , from personal experience that in tuberculine i among human beings they had one of themc^t powerful weapons for the prevention < of the- disease, or at anyrate for detecting . the disease at such an early stage that it could be treated successfully in 80 or 90 per cent, of the cases by means of the sanatoria. ' The use of tuberculiaie immensely increased the value of sanatoria, anu he therefore hoped that in New Zealand there would be no prejudice against it, as was the case in , England and Australia. It was ridiculous to suppo-e that the use of tuberculine was harmful to a person suffering in the early stages of tho disease. That had never been , . proved by any scientific observations. It was the duty of the State to deal with infection at its Gourco, and that souice was to bo found in the Iruman sputem containing ' , the tuberculine bacilli, and that was to bo , found in those suffering from the later stage ; of the disease. His experience m Sydney ( proved to him that in the poorer classes, ; if there was c. case in a family and tho , ' rest of the family were treated by means . of tuberculine. it would be found that < iai 50 per ce-nt. of inetances another , of the family was suffering in the ] early stage of the dis-oaso. Dr Wilkinson | laid great stress on tho important part , played in the spread of infection by the ; invisible expectoration which wae discharged -, by consumptives, and which was loaded with , bacilli. Another thing wais that the presence ] of tuberculosis in the poor was responsible : ■ for its prevalence in the community, and . if we could deal with it in the hemes of tho ' poor w© would be doing much mere for the J prevention of 'the disease than any work < we could do in the way of sanatoria. The \ principle of sanatoria was in no sense an economical way of dealing with the disease. < ■He strongly advocated the establishment o ( '. city dispensaries and hospitals for advanced cases. Germany favoured the hospitals, France fayouied city dispensaries, whilst ; England disregarded bo^h in favour of the ■ sanatorium. The sanatorium S3'fitem must net be judged by the work clone in the first two or three yoars, but rather after five or six years. From tho statistics that had been j collected, not in England, but in Germany, j it was found that at the end of the first year there were splendid lcsults, the number of ca=cs fit to return to work being nearly ' 90 per cent., and the mortality being und^r 1 per --exit. At the end of the second year with tho same number of cases taken the deaths were 10 per cent., and the number fit for work 75 per cent. In the third year , there were 30 per cent, of deaths, and 60 per cent, fit for work ; and so on, so that | : at the cud of five or six years 65 per cent. . i of thcee who had been treated by the sana- '. toria were dead That was one of the points of view that had to be considered in regard , '■ to the economic question. In conclusion, | ; Dr Wilkinson congratulated New Zealand j on having men in charge of its affairs who j rcooem'-pcl that tuberculosis was a disease that had to be grappled with by the State, t and he congratulated them on having sana- (

toria and a system of notification ; but he hoped that before long there would a'so bo established the simp! or and more economic* measures which he had indicated for prevention, which would cc-rtaiuly prove to bo of still greater value to the community. — (Applause.)

Professor David (president of the association) heartily seconded tho vote of thanks proposed by Dr Colquhoun to Sir Joseph Ward for the interesting paper he had contributed, and in the name of the meeting re would like to thank Sir Joseph for devoting so much of his time to the active work of the aesoeiation. They owed a great d&al to the New Zealand Government for its great; liberality to the association on the occasion of this visit, and he thought they should' take that opportunity of expressing to the Government's repreeentative the-ir heartfelt" gratitudo for w hat had been done, and also for bringing before the association a question that; was seoond to none in its importance ior the general interest of humanity at largo throughout the world. Dr Jennings (Christchurch) eaid that £0 years ago the opinion of the medical profession was that consumption was an incurable disease ; but 'to-day they had to give a message* of hope inasmuch as consumption was curable if ti-cated in time. If that fact could be thoroughly understood by the people more good would be- done than by any legislative measures that could be adopted. Dr R. S. Stephenson combated the. statement that consumption came principally from cities. As a matter of fact quite as many cases came from the country as from the towns. He did not think the system of city dispensaries would be suitable to New Zealand. Enough was not do'ie in t'r.e- way of diagnosing consumption by the ordinary methods of clinical examination. Another thing was that medical men, afraid of alarming their patients, did not perhaps take their patients into their confidence as early as they should do. He thought there was a future before tuberculine examination in a modified form.

Dr Mason said that Dr Wilkinson had! Hven expression to one or two opinions with which he concurred and some with which he> did not. He quite agreed that if New Zealand had a population closely gathered together a scheme of city dispensaries would be of value, but afte-r all the population from North Cope to the Bluff wa3 only such as would stream along the Strand when the theatres came out. They wanteel to bring home to the people the dire effects of consumption, because, after all, legislative enactment went for nothing if the people paid no heed to it. Every enactment thafc had to be carried out at the point of the: bayonet was absolutely useless, and that was why the- Minister had been good enough ie come and talk to the people, and he (Dr Mason) hopeel that during tho next year or to each one of them would try to preach thi3 gospel of hope for the consumptive. On being put to the meeting by Professor David tho vote of thanks was carried by acclamation, and Sir Joseph Ward returned thanks. He congratulated Dr Wilkinso.i on his excellent speech, but continued that ho was egotistical enough to say thai if every other country in the world copied the New Zealand Health Act it would b& for the benefit of the people in those countries. If Dr Wilkinson's argument with regard to the results of sani + orium treatment was sound, and no doubt it was, that in th<* sanatoria of the Old World they succeeded in paving only 60 per cent., all he could «£>* ~vas thafc in tins country last year wo lost cOO of our people- *hrough tuberculosis, and on a, basisof £300 pp* head that meant a of £24-0,000. If wo were able to sa\e by the use of sanatoria 30 per cent., thafc would mean a saving of 2fO peoiile, which _ would! be doinc; a great work on the humanitarian side, and he would be veiy well pleased.