CONSUMPTIVES.

Timaru Herald, Volume XIIC, Issue 13558, 31 March 1908, Page 2

CONSUMPTIVES.

ANNEXE XI) BE riiOVIDED.

SITE TO BE LOOKED FOR

At a special meeting of the South ' Canterbury Hospital Board yesterday, die question of making somo provision for the treatment of consumptives was dealt, with.

As a means of obtaining some expert advice on the subject for the guidance of the Boaid, the chairman had written to Dr. Unwin us representing the local Medical Association, proposing the- following questions, answers to which he thouguo would be of assistance to the Board : " (1). Il is desirable to prececd with the fraction of sanatorium buildings in the hospital district? " (2). If so, should the Board's duty, and consequent provision by way of buildings, etc., be limited to dealing with hospital cases only?

" (3). Or should +l<« Board 'aim at providing sanatorium treatment for all who mar desire it, on payment of such charges as may be imposed? . " (4). In the foregoing, what is the approximate number, in either case, that 'it would be necessary to provide for? *' (51. What is the greatest distance from the general hospital that an institution could be placed and worked as an annexe thereof. " (6). Is there any objection, except on the score of the cost of conveyance to and fro, to the hospital laundry being utilised for the proposed sanatorium? " (7). Should the object of treatment be curative mainly?- " (B'j. Vfould' there'be. any objection to the buildings other than the shelters, being ■builtl"'"of 'timber?; i : " OK It' has' been stated: that: in iNort h Canterbury there are probably or five hundred cases'of consumption.; ■: Is this an_apprbximatibn to "the truth,, and; if so, haß,:Sputh 'Canterbury anything Jifce such an .average of-cases per 1000 of'"population? ,' v : '■'■"' -';•"■ "'■'■• '. •'' '■[' .'V. . "In connection with question' ■ 5 the Boariiias '.oir.offer"a.-piecev of. :land, : . some 28 acre? 'in- : area, -. adjpinihg-:'the. fever hospital site.' .It is Suggested ;"*.hab if this land were acquired a cheap style 6f buiiding might be erected in sufficiently close proximity to .this.-hospital'' to alloiy of the cooking being carried out at .the present kitchen. ' The site on which this hospital stands is about eight acres, arid'the idea ,is:to erect in the .near future.' other bu~u.ings thereon for on Old People's Home. " n nestion .6.—The ' laundr- at : the general hospital is well; "equipped rand ca-"»b!o of putting through ' double or treble'tbe work it is now doing:' . •..., "T assume that the initial cost of the necessary buildings ywould be -much the ;araewhetbererected one., site near Timaru or at any other place (an inland site wonld be the cheaper for the land itself), but that medical attention and maintenance thereafter, would be much more costly in the case of the latter, and in ' considering this matter, the view of nob only -what we ought to do, but what we can do, must be borne in mind.:- ••-. What I mean by hospital • cases,' aro' persons who would be admitted to the general hospital as being_ unable to jpay, for medical .attendance, or. who have unsuitable, or no homes, or' who. on account of the foregoing, or other causes, .are ' unable to obtain, proper nursin<r and-attention." Dr. W. H. Unwin, oh'behalf-of the medical men of South Canterbury, reported that in accordance with the Board's request a meeting of the; South Canterbury Medical Association had been held in Timaru on Friday, last.; , Thp Health Department was represented by Dr. Finch, illness preventing Dr. Mason "from being present: Dr. Valintine, Inspector-General I of Hospitals, was' present in an unofficial | capacity:,, • The following, answejs .to quesby the • chairman of the Board m-writing, were decided upon:—- .; ; ■'Yes.vit was,- desirable to proceed -.with the erection-of sanatorium buildings': iii this districts ..- • >" The sanatorium should be for all classes of She. cpmin unity. . " " " - _ '''lt should be.'built to accommodate 25. "No ■. site .which.' was not at. a considerable altitude arid at.a considerable distance from-the ,sea could' be recommended. "In addition to the above ,answers to, questions, the following resolutions Twere passed:-—.'* 1 '" •■-., . ".....'."■■'..'• v: " " ... •■" That the South Canterbury Board be asked to build a sanatorium at -a suitable

altitude, or failing their' ability to do so, to make arrangements for curative cases to be sent to the Cashmere Sanatorium." ■ "That the Board. b» requested to: put up shelters to accommodate 10 ' patients, for observation purposes only, near the Timaru..hospital, to be worked as an annexe thereof." -

"That the matter of the .distance from the Thnaru hospital be left,to the resident medical officer and the Board. :

"There was no objection, except the cost :qf conveyance to and fro, to the hospital laundry: being nsed or the ; proposed' sanatorium. ; :

"Yes, the object of treatment should be uirative - • "No, there would be no objection to the buildings, other than the shelters, being built of timber.

"The estimate of the"Health Department was 2 to '2.5 per thousand of population, of cases of consumption for the whole of Canterbury." The chairman explained to the Board that he had heard that the medical men were to a meeting regarding the consumptive sanatorium question, and he had written his letter in order to put before them certain ideas that the Board had. discussed.

The chairman's letter and -Dr. Unwin's leply were read, and the Board approved of the chairman's action in writing. " Some correspondence relative to tlie subject was, read.

The Ashburton Board wrote that as there was\a likelihood of their district beir- merged into North Canterbury, they thought it best to take no further steps in regard to a consumptive 'sanatorium. From the secretary of the Christcburch Consumptive .Sanatorium Executive. The Executive expressed considerable surprise at the action of this Board in withdrawing from the arrangement they had been working for. The consideration 'shown by North Canterbury had in no way. been reciprocated by South Canterbury and much valuable time had been wasted in consequence.

Messrs Perry, Perry and Kinnerney advised that a Government subsidy of £ for £> would ba paid on contributions levied from local authorities for the purpose of providing a consumptive sanatorium. The' Act of 1907 provided for this. The chairman said the doctors seemed to object to a sanatorium being established near Timaru. He understood that they were unanimous on that point. Their idea seemed to be that when people were sent to a sanatorium they should go to a place where they would have the best possible chance. Members themselves knew that people suffering from lung diseases did better inland than on the coast, and apart from that, if they were going in for the curative treatment, it would be unwise to fly in the face of the unanimous) medical opinion. It was better to know this beforehand, than to put up a place to which' tho medical men would not send patients because it was unsuitable for them. They, however, recommended an annexe for cases that must bo provided for. It wa.s a pity that, this could not. be put on the hospital grounds—an acre would do, but there was not the acre.

Mr Talbot went on to express his opinion that a mistake had been made in withdrawing from the combination with Christchurch, and to suggest that that step should he retraced.

Mr Gillingham asked whether the sanatorium treatment. had been sufflcient.lv well tried to have proved superior, and whether inland situations had been proved to be the best.

Dr. Belt, in reply to Mr Oai<»ie. *»id that the experience of I ho race had shown, before sanatoria were thought of. that high altitudes were best for people suffering from lung 1 complaints, and that experience

was not to Llj knocked oil the head by the statistics of sanatoria for a few years. Mr Ctaigie said he had known of eases iTiat were better near the sea than inland. - Dr. Beti- gave (in committee) some information regarding the motives influencing the'medical nun to make the. recommendations "that Dr. Unwin had put in writing. ' ' ' , Mr Craigie said the medical men deserved the best- thanks of the Board for the.attention .they had given .the matter* : L ,, : for their dis-inteiestedne.ss, for tlu ; -•(.">-• lislimellt of a sanatorium must le. ;| to their losing -patients. Mr Craig-1 then read the following extracts .fronyifr xadms article iui the London •'*"*« 'J" 31st. January, on a report prowntedto the British Government by Dr Bulstrode, who had been instructed to investigate the lesults, of consumptive sanatorium treatment, and spent some-years in-doing

"■ "Dr. Bulstrode has first had to show that the magnitude of the evil has been greatly overrated, and that, eoiisump ion, or tuberculosis of the lungs, instead of threatening to become a cause of increased mortality, has for many years -been steadily/declining.. In the year 1838_it destroyed, in England and Wales, 59.025. lives, a mortality equal to 39.9 for each 10,000 persons living. In 1906 it destroyed 39,746 lives, a mortality equal tc- 11.5 for each 10,000 persons" living. From 30 in 10,000 in 1885, the mortality .fell to 26 \ in 1865, to' 22 in 1875, to 18 in'4Bßs, to 14 in 1895,. and to 11.5 in 1905. The descent has been irregular, and occasionally interrupted, but, on the whole, continuous/ Four significant periods are noted by Dr. Bulstrode during its course—the passing of the Public Health Act in 1875, the discovery of the bacillus in 1882, the passing of the Housing of the Working •Classes Act' in 1890, and the commencement of .the sanitorium movement in 1890; but none of these appeals to have materially accelerated a change which had made good progress twenty years- before the earliest of them -. The mortality of 1905 was precisely equal to the decrease of the" preceding thirty years; and hence if .the rates of decrease of those thirty years were to be continued for another, thirty years more, the disease would 'totally disappear and be extinct at. the end of. the period, following -in- this respect the histories of some others which have preceded it, such, for example, -as leprosy, relapsing and typhus fevers, and, the fevers communicated by the mosquitoes. "It would appear, from this aspect., of the general question, that .the.,establish'-', 'ment of sanatoria\fpr the reception pf de-' blared cases' of consumption, iri which the may be taught how to live, and how, to'? avoid the .dissemination, of infec : tive material, was a proceeding which, however admirable as a benevolent provision for suffering individuals, was hardlylikely to fulfil the;-expectations which: it had at first occasioned in many quarters, although these expectations!, as Dr. Bulstrode carefully points out, were not encouraged by pathologists: It has not been found, so far, that the existence of theise sanatoria, the history of Which has been followed in detail by Dr. Bulstrode for seven years, has produced any perceptable .effect upon the ;.rafcs of decline of consumption mortality, "either in England and Wales generally, or in the countries possessing such institutions as compared with those which aie destitute of them; and their own .records, when carefully examined, seem; to indicate that, in, the case of a very large proportions of .the patients received, they have done little more than postpone the fatal issue. , "The report seems to lead to the. conclusion that the sanatorium treatment of the lung affection can at best form only » part pf the. means'that :should be employed .in lany,,.national' endeavour .to' arrest: the ravages of tuberculosis generally.'''. ''.': m< Mr Craigie said- .these •" exWts w'-eie generally encouraging, and he'attached; a :good deal of importance', to ; was said regarding situation. He did,not' believe situation or altitude were of so much importance,- thougiriie. was willing to admit that altitude .suited better the majority i/f cases. But if so, why was Cashmere Hills selected? ' That was.riot'an ideal site either as regards altitude or distance from the .'seas. • .Soriie ,;of the doctois had told him that they did not approve of'it as 'a. site;' and he was sure that within five miles of Timaru they could get an equal , altitude and a much better climate.

Mr MasUn: There could be no doubt' about that. ', Mr Craigie: On a hot day they will be suffocated, and on a cold one "wrapped in fog.' "Proceeding, lie said he. feared the cost of an ideitl site would be prohibitive: . v lhe Government selected ■■ Cainbridge as an ideal ' site, - and now faults were found with it, and the results were riot too encouraging. The patients ought to have a hill to climb for exercise, it was said, but at Cambridge the place was on top of a hill, the patients must first walk, downhill, and when exhausted climb np again. , He contended that South Canterbury could make excellent provision, and he hoped to hear no more regrets that lhey had given up;the idea of sending their patients to the. Cashmere. Hills He was pleased at the-doctors proposal to make gome provision at the hospital on a small scale, and hoped, that some benevolent person would give;them a site for a sana-

torium on a .larger scale, and in the meantime they should be content with small annexes. If they went inland they could put np cheap wooden buildings, and treat their consumptives under better condv tions than at Cashmere Hills. The doctors pub in Cashmere Hills as a side thrust; they were not asked for that. Dr Bett explained that this was because there would be experts in charge there; not because of its situation. . Mr Maslin suggested''getting a Kit of ;'and from the park for the annexes. lie believed it would be done if Mr Craigie would support it. ' Mr Craigie said it could not ,be done. Messrs Lyall and Gillingham approved of the annexe proposal of the doctors. , Mr Buxton thought Mr Craigie's arguments went to show that anything they could do would be likely to result in failure. Dr Bulstrode's report seemed to say that there would have been a reduction of the disease, without any treatment. Ho held that if they were going to spend public money at all for this purpose, it should be spent where it would produce the best results, no matter where it was. He approved of the annexes in the meantime, as a means of helping the Board to arrive at a final decision. Mr Buxton suggested that a very suitable situation and climate could be found in the upper totara Valley. The chairman described some of the cases that had" to be provided for—persons who could nob afford attention at home, persons who had no home, and persons; even some well-to-do who could not get proper attention at home, and would not conform to what was required of them there. The report of Dr Bulstrode did not seem to cover this ground. He was pleased that the doctois had been disinterested and had not considered their own pockets in their recommendations. Mr Talbot defended the Cashmere Hills from some of the- objections raised against the site. He llun said that no harm could be done by doing at once what the- doctors recommended in the. .way of an an- i nexc. There could bo no mistake in taking that step, as the annexe would be ( wanted, as explained, if they had an ideal sanatorium •somewhere else. .

Mr Maslin inquired whether the annexe could be attached to the Talbot hospital and worked from this. They would not be erecting a new old men's home immediately. (It. had been agreed that both could nob bo undertaken in one- year.)

In reply IoJMr l,yall, Mr KUidliolmc >;iid the Waimate "shelter.*" were only 30 or 40 yards from the hospital, and there were four patients in them now. The trustees had let a contract) for increasing the number of shelters. .Mr Maslin drew attention to the neces-

sitr for two' annexes, to separate the sexes, and this was recognised m Hie. subsequent discussion. ; . Mr Butler lieliev*d that the decision that South Canterbury should stand alone was approved by the majority of the people. He pointed out that in feimth Canterbury they could not go to high attitudes without getting into a colder elfmate. He believed there were good sites to got convenient to tk* railway,, and they need not- tie themselves to Timaru. So far as he could ascertain, there was not the high proportion of consumjitives that there was in North Canterbury. As to the Talbot hospital, there-"would not bs room there for a, sanatorium and old men s home too. . Mr Maslih had heard of an excellent site near the railway in the Waihai Downs district. '

The following resolutions were carried unanimously : Mr Craigie moved—"That a committee consisting of tlie'-'chairman and ■ Messrs Maslin, Butler, Gillingham and; the mover, be set up to act in conjunction with, the chairman and secretary of the late medical conference, to enquire into site, buildings, etc., for the proposed annexes feline treatment; of consumption.',' Moved by Messrs Studholme and: LeCren —"That the committee;, endeavour to ■secure a suitable site for: a consumptive sanatorium for the whole of South Canterbury." Moved by Mr Craigie—" That a hearty vote of thanks he accorded to the medical men of South Canterbury for - the prompt and candid way they treated the request of this Board for answers to questions put before them." ' This concluded this section of the business of the day.