THE TREATMENT OF CONSUMPTION.

Star (Christchurch), Issue 7923, 30 January 1904, Page 2

THE TREATMENT OF CONSUMPTION.

S!R J. G. WARD AT THE i SCIENCE CONGRESS. nTTERESTI-TG DI3CT73SIO_T. The Hon Sir J. G. Ward, Minister, of Public Health, read a paper before the Sanitary Science and Hyeienic Section of the Science Congress, orr " The Attitude of New Zealand as Regards Consumption." Sir Joseph, in opening, said : Mr Chairman, ladies and gentlemen, — 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 important matter very briefly, generally with the object of assisting in creat-ig public opinion in our own jcolony. It was with some slight misgiving that I allowed myself last night to be persuaded to enter an arena so crowded with scientific imen and women. I lay no claim to any special scientific knowledge, but the protection of the people against the ravages of this disease is, I submit, a very proper subject upon which la. _aen as well as scientists should be heard. Without the aid of the law, wliich, 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 bas done, and intends to do, in this war with the mighty bacillus. 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 whiclj. causes the disease, it took, as you all know, a long time before the people realised that there was danger of ifc spreading from one person to another. To his Majesty the, King no little credit is due for the efforts that are being made in the Old Land to Stem the onward progress of tS. 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 ifc 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 credit unfairly, but I do nofc hesitate to say that we have here a system of meat an<_ butter inspection thafc is equal to that of any other country. New Zealand has been the scene of some pioneer legislation, much of it good, though I dare say some of you may think otherwise — but in the crusad. against this disease we at least deserve credit. To place consumption in its proper position amongst infectious diseases was the first, important step. In this way the exact number of the poor sufferers is ascertained. Some hardship undoubtedly at first resulted, but by a careful and tactful administration of the regulations these have been greatly lessened. Possessed of the knowledge of the power of the enemy, so to speak, our riexfc step was to set about the erection of sanatoria for the treatment of those afflicted. One at least of these institutions is now in working order in the North Island. I had the great pleasure the other day to formally open the Waikato Sanatorium. There was a good gathering of men and women from many far-distant parts of the world. Some of th© visitors had seen and were well acquainted with several of the best-known sanatoria in the Old and New Worlds. Yet I wasvassured by not a few of these fartravelledi people that they bad never seen among their travels an' institution _ better fitted°ror its purpose than that situated close tq Cambridge. Certainly no fairer picture could have been asked for than what met the eye from that lone peak on the Maungakawa Range. It gave me the greatest pleasure to see among those gathered round on thafc 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. The es- ! tablishment of an up-to-date sanatorium • for the treatment of consumption on the Litest scientifio lines is another fact that must go to the- credit of this colony's pioneer legislation. To attempt to stem the tide with one such institution would be as hopeless as the efforts of the old lady with her broom. Realising this, I was able to convince my brother law-makers that further powers were necessary; and it is my intention at an early date to aak 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 cast upon them. In the course of my work as Minister of Public Health every day brings sad cases before me. The medical 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 suggestions 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 airthat 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, hut little expense, while the working cost would be small. Wifch 13 or 14 annexes capable of holding, say, 30 patients each, the colony would be enabled to house and oare for all those afflicted with thie 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 somewhere in the vicinity ofDunedin. More important even than the effect upon the patients themselves would be the safeguarding of the public at large. Within the walls of these, institutions every precaution would be taken to destroy the infected material, and thus the greatest of great dangers would be averted. Apart altogether frpm the humanitarian aspect of fche question, the course which the colony is now carrying out, and will, I hope, continue, is absolutely justifiable upon purely economic grounds. At the opening of the sanatorium at Cambridge I drew attention to some figures recently published by a well-known American authority. Calculating the value of , each individual at £300, he showed that the cost to New York City alone in on© year ..through this disease amounted to £4,600,000, while the total for the whole of the United States reached the appalling sum of £66,000,000. I have no wish to detain you longer, but I trust that this short sketch of what we are doing in this great work will at least convince you that politicians do— despite the criticisms occasionally levelled against them — take time and thought to eet 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. Among the many subjects upon which the scientific world has been engageo*) 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 medicine for the great discoveries they have been the means of unfolding, and by which an amelioration of the condition of people of all classes in all' countrie. has been brought. about. May I be allowed to congratulate the scientific men at present assembled in the City of Dunedin upon the good work that they and their a~socia>tions are doing for 'humanity at large? I congratulate also Dunedin upon having been

selected for this meeting. It has much indeed to recommend it, for it has always been renowned for its interest in scientific research. This city, like its prototype in stern Caledonia, forms an appro prnte setting to a gathering of scientific men. That their labours may be fruitful and their enjoyments many is the wish whhh 1 have the very greatest pleasure in gi^.ng expiession to. y Dr Colquhoun said that the hearty thanks of the medical profession were due to Sir Joseph Ward and the Cabinet for the work they had done in connection with consumption in this country. He thought he might cay that th c measures the Government had taken and those it was about to take, as outlined by the Minister of Publio Health, amply fulfilled all that the medical profession ha_ asked the Government in the last eight or nine years to do. There might be «ome question ; as to details — as to the places where the hospitals should be — but tbe differences of opinion aonongsfc those concerned were exceedingly small. Whatever opinion in a general way might .be held as to the Government interfering with private enterprise, it must be perfectly obvious'tbat the .ombating of this disease was one of the things thafc they must look to the State for assistance in ; and the measures already inaugurated and to be inaugurated' by the New Zealand Governuienb would, he was sure, be th. means of .educing the spread of tubercular diseases, and increase the welfare of the whole of the inhabitants. What was good for consumptive patients was good for eveiybody else, arid he was strongly of opinion that one of the best lessons that will be spread abroad among the people by these sanatoria will be that everybody will be better by living more in the fresh air ait aU times. He looked forward to the movement raising the whole standard of health throughout the colony. He hadl much pleasure in moving a hearty vote of thanks to Sir Joseph Ward for Jus address. Dr W. Camac 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 Jor the good of the poor people who could not pay for treatment. The question of the prevention of' tuberculosis was ai very large and complicated one^^ and had) to be considered from- very many points of view. In the first place, it was not always an infectious disease. It only became infectious in its later stages, bub it was undoubtedly at the present time the most common infectious disease in any community. His opinion was thafc 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 not more tban 20 per cent of the cases that bad come under his notice in the best-organised sanatoria in the world! bad- the tubercular bacilli disappeared after treatment. That' meant tbat after treatment 80 per cent of the cases might Be a source of danger to the community. He held that the only cases of tuberculosis that should be treated in a public' sanatorium were those in which tbe tuberculajr bacilli were not found in the sputum at all. He did not wish to throw cold water on tho Government's action in this matter, bub still it was well that they should 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 among human beings they had one of the most powerful weapons for the prevention of the disease, or, at any rate, for detecting the disease afc 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 vs c of tuberculine immensely increased the value of sanatoria, and he therefore hoped that in New Zealand there would be no prejudice against it, as was the case in England ard Australia. It was ridiculous to suppose that the vs c of tuberculine was harmful to a person suffering in the early stages of the disease. That had never been proved by any scientific observations. It was the duty of the State to deal with infection at its source, and that source was to be found in the human sputum; containing the tuberculine bacilli, and that was to be found in those suffering from the later stage of the disease. Hia experience in Sydney proved to him that in • the poorer classes, if there was a case in a family and the rest of the family were treated by means of tuberculine, it wou.d be found that' in 50 per cent of instances another of the family was suffering in the early stage of the disease. Dr Wilkinson laid great stress on the important part played in the spread of infection by the invisible expectoration which was discharged by consumptives, and which was load-, ed with bacilli. Another thing was that the presence of tuberculosis in the poor was responsible for its prevalence in the community, and if we could deal with it in th 0 homes of the poor, we would be doing much more for the. 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 of city dispensaries and hospitals for advanoed cases. Germany favoured the hospitals, France favoured city dispensaries, whilst England disregarded both ' im favour of the. sanatorium. The sanatorium system must ■ not be judged by tbe work done in .th_ first two or three years, but rather after five or six years. From the statistics that had been collected, not in England, but in Germany, it was found that afc the end ot the first year there were splendid results, the number of cases fit to return to work being nearly 90 per cent, and the- mortality being under 1 per cent. At the end of the second, year, with the 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, ao that at the end of five, or isix years 65 per cent of those who 'had/be.n. treated by the sanatorium were dead.,. That wis i . one of the points of view that had tob®. considered in regard to the economic question. In conclusion, Dr Wilkinson congratulated New Zealand on having men in charge of its affairs who recognised that tuberculosis was a disease that had to be grappled with by .he State, and he congratulated them on having sanatoria and & system of notification ; but he hoped thafc before long there would also be established the simpler and more economic measures which he had indicated for prevention, which would certainly prove to be of still greater value to the community. Professor David (president of the Association) heartily seconded the vote of thanks proposed by Dr Colquhoun to Sir Joseph Ward for the interesting paper he bad contributed, and in the name of the meeting be would like to thank -.Sir Joseph for devoting so much of his time to the active work of the Association. They owed a great dear to the New Zealand Government for 'its great liberality to the Association oil the bccasion of this visit, and bethought they should take that opportunity of expressing to the .Government's representative their heartfelt gratitude for what had been done, and also lor bringing before the Association a question that was second- to none in its importance for the general interest of humanity at large throughout the world. Dr Jennings (Christchurch) said that twenty years ago the opinion of the medical profession, was that consumption was an-in-curable disease ; but to-day they had to give a message of hope inasmuch as consump bion was curable if treated in time. If that fact could be thoroughly understood by the people more good would be done than by I any legislative measure that could be adopted. • Dr P«. S. Stephenson combated the statement that consumption came principally from cities. As a matter ol fact quite as many casus came from the country as .from the towns. He did not think the system of city dispensaries would be suitable to New Zealand. Jt'nough was not done in the way ot 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 intp tbeir confidence as early as- J they should do. He thought there was a j future before tuberculine examination in a , modified form. Dr Mason said that Dr Wilkinson had given 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 after all the population from North Cape to the Bluff was only such as would stream along the Strand when the theatres came out. They wanted 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 that had to be carried out at the point of the bayonet was absolutely useless, and that was ■ why the Minister had been good enough to; come and talk to the people, and he (Dri Mason) hoped thafc during tne next year or so each one of them woulc_try to preach this gospel ef hope for the consumptive. On being put to the meeting by Professor David the vote of thanks was carried by acclamation, and . Sir Josepli Ward returned thanks. He congratulated Dr Wilkinson on his excellent speech, but continued that he was egotistical enough to say that if every other country in the world copied the New Zealand Health Act it would be for the benefit of the people in those countries. If Dr Wilkinson's argument* with regard to the results of sanitorium treatment was sound, I and no doubt it was, that in the sanatoria of the Old World they succeeded in saving 1 only 60 per cent,- all be could say was that in this country last year we lost 800 of our people through tuberculosis, and on a basis of £300 per head that meant a loss of fi24 0,000. If we were able to save by the use of sanatoria 30 per cent, that would mean a saving of 280 people, which would be/ doing a great work on the humanitarian Bide, and he would be very well pleased.