THE WHITE PLAGUE.

Otago Witness, Issue 3111, 29 October 1913, Page 10

THE WHITE PLAGUE.

ITS PREVENTION AND TREATMENT.

DUNEDIN MEDICAL OPINION

At the meeting of the Otago Hospital and Charitable Aid Board on Thursday afternoon lengthy correspondence wan road from tho Dunedin Medical staff and the board’s medical superintendent (Dr Falconer) in answer to a request for their opinions as to the future policy of the board in regard to the treatment and prevention of consumption. Appended are the answers received :

Sir, —I "beg to inform you that a special meeting of the staff Vas held on Monday, October 13, to consider the letter from the board requesting the opinion of tho staff as to the future policy the board should pursue in regard to the treatment and prevention of consumption. • After full discussion, the following suggestions, drawn up by Dr Colquhoun, in consultation with tho other senior physicians, were approved of by the staff, and I was instructed to forward them to the board. These suggestions include:

(1) The institution of a tuberculosis dispensary, with trained nurses to visit and attend patients in their own homos, and to report to tho dispensary medical officers upon other occupants of tho home, and to procure the attendance of “contacts” at the dispensary for medical examination. (2) Accommodation at tho Hospital for the preliminary observations ami classification of consumptive patients, (3) Sanatorium accommodation at Pleasant Valley, and the erection, without further delay, of accommodation for advanced arid incurable consumptives at Pine Hill. Tho staff is strongly of opinion that the erection of the latter is a much more urgent matter than any increase of sanatorium accommodation at Goodwood, in order to provide for those advanced cases which cannot benefit by sanatorium treatment, and which, in their own homes, arc often a menace to their families —such cases as at present are occupying the balconies at tho Hospital, to tho exclusion of the patients for whom these balconies were erected. (4) The securing by tho board of land where the work of an outdoor colony can be carried on. The staff made no recommendation regarding the inspection of echools, factories, machinery, etc., as those aspects of tho pievention of tuberculosis were not thought to fall within the domain of the board. 1 am, etc.. W. Newlands, Secretary Honorary Staff, Dunedin Hospital.

Dr Falconer wrote as follows: Sir, —In reply to your letter of October 7 1913, I beg to report concerning “ the future policy tile board should pursue in regard to the treatment and prevention of consumption.” ~ 1 can see no reason why the board should not carry out as its future policy the general plan of campaign which has already been adopted by the board, and which is set out in detail in the reports collated m the chairman’s minute. In regard to the general principles of this policy, I do not find any difference of opinion in the mind of any member of the board’s medical staff. Where, however, there may be room for difference of opinion is in the relative importance of the several measures to bo adopted and the details in carrying out the policy. This aspect I shall now consider. The cucstion of the preventive measures in connection with tuberculosis lies chiefly with the Public Health Department, and the role delegated to hospital boards is limited mainly to the prevention of “home infection.” This is done by domicibary ■v isitation by the district nurse in connection wth the out-patent department for tuberculosis attached to the Dunedin HospitalProgress in this direction was necessarily slow 1 at first. In initiating this new scheme I thought it imperative not to alienate the sympathy and active co-operation of tne general * medical practitioners of the district, without whoso assistance no headway can be made in any medical campaign. I think this was successfully managed. The work in t.iis department has grown in volume since the appointment of a medical director, ab.e to devote his whole time to the care of tubor•culosis. It will require to go on developing. At present domiciliary visits to the town patients are undertaken by the district nurse, while country patients arc supervaod by tho -health inspectors. There are lit prosent 88 patients in our own hospital district under supervision in their own homes. The nurso’e services should he avaihiblc Jilso when necessary for country cases as originally intended, while visitation bv med'cal officers in certain cases will also be necessary in both town and country. Tho policy of extending the Pleasant Valley Sanatorium, which now consists of 46 beds (less four occupied by nurses), has been called in question. When in direct charge of the sanatorium I reported a deficiency of bods to supply the demand, and also pointed out the administrative nursing difficulty encountered from the want of a sick bay, and also.the necessity for a nurses’ home. This was referred to the medical director on his appointment, who, in connection with the architect, recommended the erection of a sick bay of 16 beds, making 52 beds. . The sanatorium was originally built, I understand, for 30 patients, to serve the Otago district alone. By the inclusion of outside districts the area to be catered for lias doubled, so that 62 beds are no more than the proportion that was originally thought necessary. The administrative re quirements for these extensions necessitate practically the remodelling of the sanatorium at a cost estimated by the architect of £6OOO, which sum the Otago Board asked tho Government to put on the Supplementary Estimates for that purpose, holding the Government responsible for all further capital expenditure. In answer to this tho Inspector-general asked for an alternative estimate of the cost of providing a sanatorium of 100 beds, on the higher site, which was planted with shelter belts soon after the opening of the sanatorium. Tho Block plan (estimated to cost £12,000) was forwarded to him “as a basis for discussion,” not as the policy of the board. There has practically been very little money expended at Pleasant Valley in administrative requirements, the old homestead serving, that purpose. Now that tho institution has grown, serving double the district, and acting, as a private sanatorium in addition (there being no private sanatorium now in Now r Zealand available), administrative quarters, which ought probably to have been built at the start, are now rendered absolutely necessary. Tho

capital cost at Pleasant Valley has been about £SOOO. To form a 100-bedded sanatorium would thus cost £17,000, which compares favourably with the cost of about £50,000 for the same number at Cashmere Hills. No one has yet suggested that a 100bedded sanatorium, be immediately built at Pleasant Valley, only that in remodelling the institution the Inspector-general quite rightly suggests that the minimum administrative block should bo designed to accommodate that number, should it bo found eventually necessary to do so. In regard to the chronic ward, the policy of the secondary hospital at Pine Hill, adopted by the board, meets the requirement laid down by the Tuberculosis Conference. It is fair comment that, apart from a sick bay, no future shelters be built at the sanatorium, until it is seen by experience how much the secondary hospital will relievo the necessities.

In regard to the farm colony, the Otago Board has adopted the policy of extending the scop® of the institution to meet the requirements of an “industrial sanatorium.” But they require all capital expenditure to be met out of the consolidated revenue. A difference of opinion exists as to the necessity of purchasing further land for apple and pear culture, etc. I have already reported on the necessity of a resident skilled gardener. If the Government decided on this policy, I believe good use would he found for sub-stations, say, at Dunback or elsewhere, supervised from the sanatorium, but financially under the control of a private philanthropic body, with initial assistance from the Government. I drew attention in the second annual report of the Pleasant Valley Sanatorium to tli/o fact that the post-sanatorium conditions were more important as regards ultimate recovery than even the stay in the sanatorium proper, and that our present system signally failed at that point. In regard to the care of pre-phthis : cal children, which I originally suggested might bo undertaken by the Patients and Prisoners’ Aid Society, the Tuberculo« : s conference has since recommended their oare by the education boards. I think private philanthropic bod;es better suited to carry out certain aspects of this Work.— Yours faithfully,

Allen R. Falconer, Medical Superintendent.

It was decided to refer consideration of the questions raised in the correspondence to the Sanatorium Committee, it (acting with the medical director) to draw tip a report for submission to the board.