TUBERCULOSIS.

Star (Christchurch), Issue 16748, 1 June 1922, Page 11

TUBERCULOSIS.

OR DLACKMORE’S CRITICISM REPLY BY DR VALINTINE. Ur T. H. A. Valintine; DirectorGeneral of Health has forwarded to tho ‘Star” on official reply to statements contained in a report to the North Canterbury Hospital Board on April 19, by Dr Blackmore, medical officer in charge of the Cashmere Sanatorium for consumption. l>i Blackmore’s statements, with the Departmental reply. are dealt with categorically as follows : 1 • Dr Blackmore’& statement:— That promises made to the public eight years ago with regard to tho erection ol a iresli air home for children have not yet been fulfilled, although the prevention of tuberculosis in children is a matter ot absolutely supreme importance. “ This is not true. The subsidy for tiie Home hits been promised by the Government since 1919 and will be paid, but ;lL the suggestion of tho -North Canterbury Hospital Board it was agreed by the Department that owing to the financial stringency it would be wiser to put off iho building < r the home for at least a year, as it was. not a mat tor of urgency. . 2. Dr Blackmore’s statement That as regards the campaign agmn.-t consumption in New Zealand generally no real progress Iras been mad© in the last twelve years. “This is not true. Jn place of one partly developed sanatorium at Otaki I lor thirty patients, and one unsuitable and generally unsatisfactory sanatorium I near Cambridge for sixtv-two patients, i we have now two well-found sanatoria in the North IsLand. Great improvements have been carried ©tit at the Otaki institution and recently a Resiaent .Medical Officer appointed. Owing to-th© establishment of the Pukoora Sanatorium it has been possible to close’ the obsolete and costly institution near Cambridge, which by the way, was not “erected’ 1 by the Department, as Dr Blackmore states. “ There are upw \175 beds for male patients a& Pukyowi.iuid forty beds for icmale ,puUtm/o4P ' Otaki, a total of. 210 as compared with sixtv-two foi> males at Te Waikato and thirty-five at Otaki, a total of ninety-seven, in 1911. And though Dr Bl^ckm orc^rais es the quibble that most at Pukeora are for soldi r parTmits there are at least seventy-iivo beds u-cd by and available for civilians, a'ud so tar we have been able to deal promptly with all tbo demands lor admission which come from the'hospital districts of the -North Island. Ihe fact remains we have in the North Island more than double the amount of sanatorium beds than v.e had in 1914. In. that number l am not including the special and excellent accommodation provided for T.B. patients by the Auckland. Waikato llawke’s Bay, Palmerston North and Wellington Hospital Boards. Apart from tljik accommodation in the North Island, til© Nelson, Timaru, Utago and Southland Boards in the South Island have provided special accommodation in connection with their hospitals for the treatment of patients suffering from tuberculosis.’ 1

3. —Dr Blriekmore’s statement : That th«?re is no definite national policy, no uniform and universal scheme lor dealing with tuberculosis in New Zealand, and that such nicasures as are being taken are carried out in a piecemeal and consequently inefficient fashion.

•'This is not true. Dr Blackmore knots the Departmental policy as to tho Hospital Boards. A conference < n * Tuberculosis in New Zealand and Methods for its Eradication, 5 wafe, as •suited, hold in Wellington eleven years back. At that conference much that should be effected in tho future was given voice. Dr Blackmore is one of the short niemoried people who forget the Great War and the peace—which is not yet—have actually occupied most of the years since that conference, and have dislocated many, too many, beneficial effects entered upon in pr v w ar years. Nevertheless tho"re has not been any such relaxation of efforts that the pre-war decline of the ‘death rate from tuberculosis lias not beou maintained. -No on© denies that the incidence of .phthisis was increased by v»ar activities. In 1915 the death rate from tuberculosis in New Zealand reached its lowest point, after that there was tho war-caused rise, and now it is satisfactory to record that in 1921 the death rate front tuberculosis was 0.65 per 1000 of the mean population, the second best figure yet recorded in the Dominion, or for that matter of any known country.

“ 1 do not say that all that should be done has been accomplished. L entirely disagree that the problem has been neglected. Much lias been done, in the past twenty years, much before Dr Blackmore came to the Dominion, and much remains to bo done. The reduction in the death-rate in tuberculosis is a convincing certificate of the well intentioned deeds, not words, of the Hospital Boards and the Department. T have ample Powers to demand the establishment by Hospital Boards of an extensive programme in sanatorium buildings. What T do insist upon B that the present state of tuberculosis in this Dominion, financial state, does not demand any more to-day than sirn © the decline in tuberculosis started, drastic arid necessarily expensive measures for combatling tuberculosis. New Zealand i« itself well ahead of other countries in the number of hospital beds provided for consumptives ner head of population, and this despite the fact there is much loss tuberculosis in New Zealand than in same countries. This significant fact is conveniently overlooked by Dr Blackmore. Now Zealand’s tuberculosis rate is low. Its death rate is low.” f. Dr Blackmore*s statement:— That at the present time onlytwo Hospital Boards in New Zealand are provided with sanatoria, and that ‘ no Hospital Board in the North Island has a. sanatorium of its own for tuberculosis persons, although several have provided a certain amount of accommodation tor advanced cases.’ • “A half-truth There aro two sanatoria in the North Island They are not under Hospital Boards as Dili lackmore states they are under the direct control of the Department . Does it matter verv greatly by whom those institutions arc administered, so long as the beds aro available and the patients looked after prqoerly? That is the great point. In making his statement l can hardly believe Dr Blackmore deliberately meant to mislead the public. b. D Black more’s statement: — Xliat -North (’-aliter wry cannot rid

itself of consumption because as fast as it* own cases are dealt with others com© in from outside d-tricts in which no provision for dealing with them has been made. 1 ‘ i must take Dt Blackmore’s word for this, but, in face of his gross misstatements as to the position, I do o reluctantly. 'That a considerable numl>er of patients from outside districts arc attracted t-o Canterbury is undoubtedly true, and that attraction is due to the very excellent institution on the Cashmere Hills and the reputation Dr Blackmore deservedly holds as a skilful and conscientious medical superintendent. “ Now. as regards the other statements made against the Department I ddny absolutely tiwt there are fewer beds for T.B. patients in the North .Island than there were in 1912. On the contrary, as ! have already stated, tho .sanatorium beds amount to: Pukeora . . . .175 Otaki . . * . 40 215 As against: Te Waikato , . . 62 Otaki .... 35 97 in 1914. “ Tn.addition, in annexes attached to hospitals in the North lslaigl. there are the following bods available for the accommodation of patients from tuberculosis in th© ladge-r 1 'hospitals alone, the figures being t;u*eii from tho most recent returns available : 3i Auckland . . .18 Wellington . „ . 44 Napier . . . .10 Waikato .... 26 New Plymouth . . 6 Palmerston North . . 8 i Thames .... 8 Waihi .... 4 Total . . . .124 " The beds are used for the following classes of case:—(a) Those in the advanced stag© of th© disease; (b) those requiring observation with a view to determining their suitability for sanatorium treatment or otherwise ; (,c) cases waiting for admission to a sanatorium. Dr Blackmore’s statement :■— Some years ago the Auckland Hospital Board was very keen on providing a sanatorium of its own, and it proposed to spend quit© a large sum in building an up-to-date institution. Discussion took place for some time, then the matter dropped. Perhaps th© Auckland people will say whether they voluntarily abandoned their project. or whether they did so because th© Health Department wished the sanatorium to be built on an absolutely unsuitable site, at an Utterly impossible cost.—that is,' at a cost j which could not provide a proper institution. “ 1 absolutely deny that the Audi- | land Hospital Board has at any time } brought forward a definite proposal to I erect a sanatorium in the Auckland dia- I trict. 'fhe matter has been discussed by Departmental officers with the members of the board, and a site has been procured in the neighbourhood of Auckland for further hospital activities. But if I was naked to encourage the erection of a sanatorium in the neighbourhood of Auckland—or. for that, matter. :n th© Auckland province--! would not do so, the climate, in tho opinion of Departmental officers, not. being suitable; and in that opinion 1 believe I would have the support of the majority of th© Auckland members of the profession, and also of Dr Blackmore himself.”

Dr Blackmore’s statement:— the Timaru and Ashburton boards decided to build a sanatoriuW They bought a site at Fairlie. About a year ago they sold that site i in disgust, because, although in season and out of season they had pressed their claim for accommodation for their consumptives, the Government, acting on the advice of the Health Department, had consistently refused permission for the sanatorium to he erected. Timaru people are still asking for their sanatorium.

’• I admit that I discouraged the idea, and am glad 1 did so. In my opinion, it would have been absurd to have two sanatoria within about 120 miles of each other, and in practically the same climate. Dr Blackmore knows very well that I tried to get South Canterbury and Ashburton to join with North Canterbury in th© extension and maintenance of the institution on the Cashmero Hills. 1 bad hopes, and still iujpe. that this scheme may be brought about. It may be said here that for years past Departmental officers have been very

anxious to establish a sanatoriuirl in Central Otago, the climate being considered particularly suitable for tho treatment of consumptives. A site was selected near Waipiata, and a year ago certain boards were circularised as Ic* the proposal, but only a few board* agreed to contribute their quota towards the erection and upkeep of such an institution. It is to be hoped that the forthcoming meeting at Timaru will bring about the fruition of a scheme that has been in th© minds of those who have long had the scheme at heart “ There L, however, a most disquieting aspect revealed by Dr Blackmore’s contentions. Everyone can see on page 102 of the 1921-22 Year Book, a chart, in the form of an X on its side; the falling line since 1875 represents the decline in tuberculosis, the rising line, the increase in deaths from cancer. In 1875 there were approximately sixteen deaths per 10,000 of mean population, in 1921 there were 0.5 deaths per teu thousand. Notwithstanding this the North Canterbury Hospital Board basing it- views on the generally acknowledged unreliable figures ol notifications, refers to the undoubted increase in the number oi tuberculosis cases. My Department lias always been ready Jo admit and has held up to praise and for example to other boards the very extensive, indeed almost complete, measures that board has provided—in sanatorium and hospital equipment, in its tuberculosis, dispensary, and its specialists and nurses—for the prevention, combating and treatment of tuberculosis. Now if de-pit© all these measures there- is, ns apparently Dr Blackmore- wishes to

emphasise, no improvement in the tuberculosis state in that area, the question before me and my officers must I>© : “Are all these measures of little or no avail ? Must we not

search for some alternative and better means for coping with this scourge? ” Laymen arc not all fools. Hospital board* in general are more anxious than Dr Blackmore gives them credit for, to do *whnt they can to curtail tuberculosis. Tt is not sufficient to pool all our thought* and movements oil the opinion of just one professional man. Before the public and hospital board will agree to a costly outlay I must satisfy them that more than a scintilla of satisfactory results is obtainable for their afflicted patent?., and for the control of the disease. Of what use asking other districts to do ;,& North Canterbury has done if the incidence of the disease in their less fully ©quipped districts at present is no greater than in Canterbury with its plentitude. Dr Black more’s pronouncement if it was in accordance with facts, and coming from that very place where the anL-i-

i tuberculosis programme is most comi plete and well administered, would | make the Department’s hopes for pro- : gross still less realisable. Anyhow it ! must set all Hospital Boards and medi- ! cal men thinking. ! “ Neither myself, nor my officers, intend to be misled by Da- Blackmore’s illfounded judgment. Th© proof that the ( measures so far taken have had the desired effect is in the satistical figures I hove quoted. To remove the uneasy feeling created Dr Blackmore i would be more helpful to other boards ( «and the Department if he will give dcj finite facts and figures showI ing ‘ that the full measures jin North Canterbury have had | n beneficial result. If h© cannot ! do so then for the sake of the sufferers. let him hold liis peace. Unless they ' arc by way of merely abusing his professional colleagues of the Health Department, it is difficult to understand Pr Blackmore’s strictures in view’ of: — (1) Th© proved declining death rat© from tuberculosis in New Zealand. (2) The exceptionally low death rate from this disease in New Zealand in comparison with other countries. (3) The fact' that the campaign against tuberculosis is by no means discontinued. “ In conclusion may T say that in my twenty-one years of acquaintance with activities in th© prevention of disease I in this dominion 7 have never known : any good results arise from an overstatement of the case. Dr Blackmore’s sweeping generalisations and insufficient particulars are just the kind of propaganda /which retard rather than help on the good cause he and the board and th© Department have so ; much at heart.” DR BLAC K OR E’ S REPLY. I>r YalintincTs statement was shown to J>r Blackmore last evening. Dealing first with Dr Yalintine’s remarks on the children’s home suggestion. Dr Blackmore said that if what/ Dr Valintine said was true it meant, of course that the building had been erected. It had j not. It meant that the subsidy which I the Government promised towards the erection of the building had bgen paid. Tt had not. Dr Valintine said that the subsidy was promised by the Government so far back as 1919, and would b© paid, but that at th© suggestion of tho North Canterbury Hospital Board ;t was agreed by the Public Health Department that it would bo wiser to put it- off for a year. “ I know nothing at all about the board making such a suggestion. It must be remembered that my report was mad© to the Hospital Board, and if anyone was to blame I was blaming tho board as much as anybody,” said Dr Blackmore. The plans of the building were altered because of th© cost of building having gone up. It could not have been put up as originally designed under about £20,000, but the original estimate was about £SOOO or £6OOO. “ Quite v a number of meetings had to be held With tho architect and Public Health Committee to tr>’ and devise plans which would enable us to put up a building for something like the originally intended cost. We finally designer! a building, not anything like the original one. costing about £7OOO. When the- plans had been prepared the Public Health Department said that th© subsidy would not be forthcoming that year. I was. present when Dr Wylie made that statement to the Public Health Committee. He said nothing whatever about the Hospital Board having suggested that tho erection of the building should be postponed.” As to Dr Valintine’s reply concerning thq Cambridge Sanatorium. Dr Blackmore did not know wlrat was meant in the assertion that it was not erected «»y them. The second sanatorium referred to was the one for soldiers at W aipukurau. It was not erected by the Public | Health Department at all, but by the Defence Department for the exclusive use of soldiers, and tho Public Health Department, had no right at all for taking credit for having provided that sanatorium.

In saying that there were now 215 sanatorium rods in the North Island as compared wth97 in 1914. Dr \ alintine was evading Dr Blackmore s statement, the latter continued. That statement was that there were not as many beds foi civilians in the North Island as there were in ‘Most of those 175 beds that Dr \ nlintine ‘■peaks of are mad© use of for soldiers, and the whole institution was erected, as I have, said, for soldiers. “ He says. • We have been able to deal promptly with th© applications for admission that come from th© hospital districts in the North Island.’ About two weeks ago a male patient was sent to me. from a dqctor in the North Island. I recommended that the patient should apply fur admission to the Pukeora Sanatorium, but the patient told me that ho had already made application and had received word from the Sanatorium that lie could not he admitted for two months. “ As to my remarks that there lias been no definite national policy for dealing with tuberculosis in New Zealand. .Dr Vaiiintin© says ‘ that a conference was held eleven years ago in Wellington.’ Tn the period between the time the conlerence was held and the outbreak of the war. what steps did th© Public Health Department take to giro . effect to the recommendations that were mad© at* that conference? They had nearly three years in which to do something, and so far as I know they did nothing at all.

“ Dr Yalintiue says that ‘ What I do insist ♦on i- that the present state of tuberculosis in this Dominiop does not demand any more to-day than since th© 'decline in tuberculosis start-

ed drastic aid necessarily expensive measures for combating tuberculosis.’ That simply means that Dr Vabntino is content to go on seeing between 7IX) and 800 people die every year of tuberculosis . n New Zealand without making any further effort than he is

making at present to prevent these deaths. And jf this is the view of the head of the Public Health Department. I am afraid it is rather hopeless trying to convince him that something really ought to be done. He says that 1 have overlooked the fact that there is much less 1 überculosis in Now Zealand than in any other country, and that its death-rate is low . I have not overlooked either fact. 1 have repeatedly mentioned them : but that does not seem to be any reason why we should net try to stamp it out altogether. The fact that we have a low death-rat© arid less tuberculosis puts us in a much more favourable position than most other t countries for dealing with this problem. “I said that at ih© present time only two hospital boards in New Zealand are provided with sanatoria, and that no hospital board in the North Island has a anatorium of its own to treat tuberculosis.. In mentioning this Dr Valintine gdes on to say that l am telling half-truths But it is the whole truth. Dr Valintine is noi able to d£tiy that no hospital board in .(he North laland has a sanatorium of if* own. I was talking about hospital boards and not the Public Health Department. * There are- two in the North Island.’ says Dr Valintine. It dees not matter in th© least hv whom they are administered, but I was drawing attention to the fact that the hos pj ta 1 boards in the North Island do i ot provide accommodation for their

consumptives. He goes on to say that North Canterbury cannot rid ttself of all its consumptives, on account of others coming in nil the time, and then he proceeds to confirm my own statement by saying that the statement that a .onsiderable number of patients are attracted from outside districts to Canterbury is undoubtedly tiue. “ Dr Valintine then proceeds to give the number of beds for tuberculosis cases that aro attached to the various general hospitals in the North Island T had said in my report that several hospital boards did provide- a certain are used: (a) for those in the -advanced cases. Dr Y r alintine says that ihe total of these beds in th© North Island is 124. and he says that they are used : (a) fo rthose in the ad vanned stages of the disease; (b) those requiring observation with a, view to determining suitability for sanatorium treatment dr otherwise: and (c) cases waiting • for admission to sanatoria. If there is ample accommodation in the sanatoria in the North Island to meet the demands made on I hem by the hospital boards, as Dr Valintine says, why is there a necessity for shelters attached to the hospitals for cases waiting lor admission to a sanatorium? Why are the patients not sent- in direct to Hie sanatoria? Will Dt Valintine also say how many patients are really transferred from these shelters attached to hospitals to the sanatoria, end how many of th© patients who go into them ever leave them again except to go to die ? And bow j many of the beds that are provided atj teehed to these hospitals does he really I consider arc beds suitable for the | proper treatment of consumption? The | only beds be mentions that I nfn perI snnaTlv acquainted with are those—o: seme of them attached to the Wellington Hospital, and I should be verv sorry indeed to see anyone that 1 knew condemned to undergo so-called treatment in buildings of that description.” “ As to the Auckland hoard’s intentions Dr Valintine absolutely denies that that board has at any time "brought forward a definite proposal to j erect a sanatorium in the Auckland district. At the time the matter was under discussion there were several articles in the newspapers about this proposed sanatorium for the Auckland Hospital Board and at either the Jftos- ! pital Boards Conference held about j 1910 or the Tuberculosis Conference. held the following year Dr Valintine | himself told the delegates that the | Auckland Hospital Board was just about to erect a sanatorium- for fifty j patients. J read this statement in the ! report only a few days ago, and yet he says that ‘ fio definite proposal to erect the sanatorium has been brought before me.’ “ Dr Valintine says in connection with the provision of a sanatorium for T imaru and Ashburton that his 3>e- : partment ha.s been very anxious for years past to establish a sanatorium in Central Otago, and that the sito was selected near Waipiata and also that a year ago certain boards were circularised as to the proposal. This statement appears td bear out pretty wed my contention tl(iat the Public Health Department has not been particularly active in its campaign against consumption For several years past, as l3r Valintine says, they have been anxious to establish this sanatorium and yet ic is only a year ago that they circularised cliff© rent boards about it and up to the present absolutely nothing at all has been done. , “ A notion attributed to me by Dr Valintine is that in spite of all that has been done in North Canterbury for dealing with tuberculosis there : s | no improvement in the tuberculosis I state in that area. And lie asks | whether, if this is so. must we not •search for some alternative and better means for coping with this scourge. I have not anywhere said, or suggested., that there has been no improvement- in the tuberculosis state in North Canterbury. I did not make th© •statement that there is an undoubted increase in the number of tuberculosis cases. It was made bv members of the board at their meeting jn Aprtl witliout reference to me, and I have contradicted it. “ If Dr Valintine wants refutation of his own statement—not mine—that only 21 scintilla of satisfactory results is obtainable by the means at present adopted in this district, lie will find it in my annual report to the Hospital Board either last year or the previous year, when I gave particulars of tire first 1000 cases treated in this institution. and was able to show that, in spite of the fact that numbers of advanced cases of the disease hail been admit te 1 to the Coronation Hospital, there were still over 700 of those patients known to me t-o be alive and well. If this is not a result which Air Valintine considers to be satisfactory, perhaps he will quote* better results from some other sanatorium elsewhere. I doubt whether he will be able to do so even if he searches the records of both America and Europe. ” Dr Valintine assumes that the declining death rate from tuberculosis ; n New- Zealand and the exceptionally low death rate from that disease are due to measures that have been taken against the disease in this country, and he appears to be quite satisfied with the effect of these measures. He does not, however, make the public aware of tho fact that the death rate from tuberculosis is declining in nearly all countries. Tt declined to a most marked extent in Great Britain when there were practically no active tuberculosis measures being taken. Tt is well known that tho decline was clue to the better housing and better living conditions oi the people. But that active tuberculosis measures .are worth adopting is shown bv the case of Ireland. A\ bile tuberculosis was declining in England, Scot

land and Wales it was still increasing in Ireland, but began to fall in quite a marked way ns soon as a definite tuberculosis campaign was instituted. u Tn no part of his statement does Dr Valintine combat my statement that there is no uniform and universal srliem© for dealing with tuberculosis in New Zealand. T slated that the measures taken now are piecemeal apd Dr Valintine’s statement bears that out. “I do not car© to *ay anything about Dt Valintine’s personal attack on me—that may- go for what it is considered to be worth. The matter of trying to reduce th© amount of tuberculosis in New Zealand is not a personal one, and personal abuse is not. T think, quite tho right way of answering the complaint T. have made that, thorough measures are not being taken. Nor Trill anything in tbo nature of personal abuse serve to hid© th© fact that the Department is still very much in arrears in the measures that ought to he taken to suppress this disease.”