TUBERCULOSIS.

Otago Witness, Issue 3885, 28 August 1928, Page 7

TUBERCULOSIS.

THE COMMITTEE’S REPORT. DR LYTH’S CRITICISM. Dr C. E. W. Lyth, medical director of tuberculosis institutions under the Otago Hospital Board, forwarded an important report to last week's meeting of the board. Dr Lyth wrote stating that he wished co make some comments and suggestions on the report of the Committee of Inquiry recently appointed by the Minister of Health to consider the problem of tuberculosis in New Zealand. The committee had collected much valuable information and made important suggestions, but there would still be many differences of opinion on the question. One important factor brought to light . was that all those sanatorium superintendents who were unfitted in the admitting and discharging of patients were ■ keeping them under treatment much longer than was intended 20 years ago, when the- official policy "as “ a short educational course of treatment.” The ■olicy had been forced on the medical officers of sanatoria by the unsatisfactory results of brief educational treatment. Tn this connection he thanked the board for giving him a free hand in retaining patients as long as he considered necessary. The average stay of patients at Pleasant Valley was more than double that of 1912. The results of the change >f policy had been very gratifying in reducing the number of relapses. The improved prospect that was afforded to iatients by modern methods in treatment, and by more proonged treatment had led to the adopting of the definite >olicy of giving preference to them in selecting cases for admission. Many such eases commenced their treatment by ■ ipecial observation and rest at Wakari Hospital, and were transferred to Pleasant Valley Sanatorium for the more active convalescent treatment. “ Minimal ” cases were also accepted, and these when their home and working conditions were good, were the cases suitable for the “ short educational course of treatment.” The committee, in his opinion, was too optimistic about the possibilities of home treatment. There were 85 in-patients at Palmerston md Wakiri at the commencement of this nonth, and of this number only one was lying the full charge for maintenance, ipart from those receiving war pensions. It was admitted that some patients could be treated at home, and he had been engaged in the work for 16 years. In some cases the results had been successful, but the cases for home treatment must be selected with care, taking into consideration the following factors: The character of the patient, the character of the friends, the leisure and patience of a patient’s doctor, the patient’s financial position, the patient’s home and future occupation, and the probable duration of treatment. His experience of the difficulties of the work had led him to conclude that home treatment was best applied after an experience in the sanatorium in the majority of cases. There was in some quarters a feeling

that the official tuberculosis specialist was freely to admit all cases to his sanatorium.

This should not be the case

The hospital and sanatorium beds could not take all Che patients, and there

should be full confidence and co operation between the private practitioner and the

official to be sure that the right patient. was in the right place, whether in institution or at home. Such confidence and co-operation were largely a personal matter, and were of slow growth. It was sufficient at present to sav that the idea of co-operation was developing. Dr Lyth dealt with certain suggestions of the committee, which had special interest for the board:—(l) That the 12 beds now reserved for fever cases should be made available for tuberculosis patients. He had frequently urged this, and he took the... opportunity of urging it again. (2) That in place of a pooling scheme for the whole of the South Island, two groups should be formed by the hospital boards, one of which would consist of the districts at present administering the Waipiata Sanatorium, with the Otago Hospital district added. The main objection to such a scheme

was finance, and its many advantages in co-ordinating the resources of the different districts, and so increasing efficiency, and eventually effecting enonomies, were so great that serious thought should be given to overcome the financial difficulty. Under such a scheme Pleasant Valley Sanatorium would continue its useful work, and Wakari would increase in value. (3) The suggestion that relief should be given on a more liberal basis to the indigent consumptive. The committee expressed no opinion as to whether this should be by Government pension or through the board. (4) The need for after care is stressed and suggestions are made for the founding of voluntary care committees in the main hospital districts. He had frequently sought the assistance of social workers in Dunedin in this way. Much valuable help had been received, but difficulties fre- . quently presented themselves which only continued organised effort could overcome.. He suggested that the time • was ripe for voluntary effort on these lines. Such a committee would be invaluable in dealing with the problems that came within its scope, and its inquiries would reveal to what extent effort in the direction of working colonies for partially disabled patients was required, and to what extent some form of pension was needed. A member of the board might be permitted to act with him in.a voluntary effort to form such a committee.

The chairman said that the full report of the committe had been published. The secretary of the association had endeavoured to obtain a copy, in order to discuss it at the last executive meeting, but the report, he was informed, was in the hands of the printer, and it had been impossible to get a copy. Dr Lyth’s letter might be referred to the Sanatorium Committee, and Dr Lyth might have something to add to it when the report was available and the office obtained a copy of it. The suggestion made by the chairman was agreed to.