H.—3l

IX

hess of the danger which lies in the apparently harmless practice of spitting anywhere but in a suitable vessel; he will learn that a reversion to a more natural mode of life means increased health ; that cleanliness and temperance are the greatest safeguards against diseases in any form. These lessons learnt he will go forth to the world again an apostle of fresh air, winning converts by that best of all agencies—example. In my last report attention was drawn to what the so-called minor infectious disease had cost the colony. Hear what a well-known American authority has to say with respect to what tuberculosis costs the people of the United States yearly : After a careful estimation Dr. Herman Biggs of New York places the expense of tuberculosis to the people of the United States at $330,000,000 (£66,000,000). He first calculates the loss to New York City by putting a value of $1,500 (£300) upon each life at the average age at which deaths from tuberculosis occur. This gives a total value of the lives lost annually of £300,000. But this is not all. For at least nine months prior to death these patients cannot work; and the loss of service at $1 a day, together with food, nursing, medicines, attendance, &c, at $1.50 a day results in a further loss of $8,000,000 (£1,600,000) making a yearly loss to the municipality of $23,000,000 (£4,600,000). For the whole country the 150,000 deaths from tuberculosis represent in the same way a loss of $330,000,000 (£66,000,000). He further points out that the total expenditure in the City of New York in the care of tuberculous patients is not at present over $500,000 (£100,000) a year —that is, it does not exceed 2 per cent, of the actual loss by death, &c. "If this annual expenditure were doubled or trebled, it would mean the saving of several thousand lives annually, to say nothing of the enormous saving in suffering." Further evidence of this is afforded by the fact that in the last twenty years the total number of deaths from tuberculosis in New York has decreased instead of increased, although there has been an increase of 70 per cent, in the general population. If we are to assume that the same value attaches to the individual units of our colony, and I see no reason to doubt it, and if we further accept Dr. Biggs's estimate of the cost of keep, nursing, medical attendance, &c, which a death from consumption has entailed, there is no difficulty in showing that the eight hundred deaths which took place last year cost New Zealand the appalling sum of £304,800. It could not of course be contended that even if we had abundance of sanatoria this sum could have been saved, but it is well to bear in mind that disease and death can be assessed in the language of the Stock Exchange. Nothing of the heartache, the sufferings of the patient and those dear to him, the slow-dying hope and the anguish which falls upon one who foresees he must soon leave a life he has but entered on, is to be found in the mighty debit balance set out. The time has gone by when we were wont to look upon the gradual disappearance one by one of families from consumption as a sacrifice to an outraged Deity. We are gradually learning the lesson so tersely put by Huxley that we never suffer but for some infraction of a natural law, that nature has no pity in her heart —if we affront her we may rest assured she will retaliate not in anger but in inexorable justice. The task of coping with tuberculosis in the older countries is fraught with difficulties which do not obtain in anything like the same degree in this chosen land. The individual has but to play his part, work in conjunction with the authorities, and join in putting down indiscriminate expectoration, and a very great advance will have been made in the work of lessening the awful toll which tubercle yearly demands at our hands. But for the appearance of small-pox in Christchurch the lecturing tour which I had contemplated would have been an accomplished fact; as it is, only a very small portion of the colony has been visited. It is to look back upon the regulations with respect to this disease which have been passed and placed on record. As far back as 1746 Ferdinand VI. issued to the medical men in charge of the various districts an instruction which ran as follows : — Experience having shown how dangerous is the use of linen, furniture, and articles which have been used by persons afflicted with, or who have died of hectic, phthisical, or other contagious diseases, we enjoin on all physicians to give notice of those persons who are sick with or who have died of phthisis, so that the Alcade may cause the linen, clothing, furniture, and other objects used personally by the patient, or which have been in his department, to be burned ; so that the Alcade may also order the apartment in which the patient died to be replastered and whitewashed, and the flooring or flagging of the room or above in which the patient's bed was placed to be changed. Besides, a registration must be kept of places from which clothing found in the shops of second-hand-clothes dealers comes, with information as to the names and residences of the vendors, as well as the persons who have used the linen and garments, and dealers in old clothes ordinarily doing business in infected clothes. The Alcade shall issue a paper attesting that the said goods are free from contagion ; this paper shall be the sole authorisation by which dealers in second-hand goods will be allowed to keep or sell such goods. Any physician who will not give notice of consumptive patients, or those who have died of consumption, to the Alcade of his quarter, shall incur, for the first offence, a fine of 200 ducats and suspension from the practice of his profession for one year ; and for repetition of the offence a fine of 400 ducats and the punishment of exile for four years. All other persons (infirmarians, domestics, attendants on the sick) who will not report the case shall incur a penalty of thirty days in prison for the first offence, and four

ii—H. 31.