H.—3l

(c) Tuberculin Testing of Special Groups of Children and Adolescents, followed by Diagnostic Measures in all Positive Reactors.—A positive reaction to this test indicates that the patient has experienced a tuberculous infection. A subsequent x-ray in the positive reactor may disclose evidence of tuberculosis disease. Negative reactors do not need an x-ray examination. Tuberculin testing is offered by the chest clinics and medical officers of the Department to the contacts of active tuberculous cases, and it is intended to introduce tuberculin testing to the pupils of secondary schools. (2) Classification. —This is becoming feasible with the recent reorganization and extension of hospital tuberculosis clinics. Many of the clinics could, however, do more work if their staff and x-ray and laboratory services were extended. (3) Segregation.—lt is considered that the segregation of active cases should be voluntary, except in a very small minority of recalcitrant cases : — (a) Hospital accommodation should be used, chiefly, for diagnosis, surgical treatment, and the segregation of " long stay " advanced cases. (b) Sanatorium accommodation should be reserved for cases with the most favourable prognosis—i.e., those that are approaching the " quiescent " or " inactive " state. In number of established beds, New Zealand compares favourably with other countries, but the accommodation here is mostly old and difficult to work. By virtue of the high Maori incidence in certain areas and the higher incidence of European cases in the larger towns, more accommodation is needed to provide adequate control. Many Boards have, plans in hand to improve and extend their hospital accommodation. In certain areas such as North Auckland, where there are relatively large numbers of Maoris, the Government has agreed to meet the cost of hospital accommodation for tuberculosis patients. During the past year the Boards of the western area and those of the eastern area of the North Island combined into two groups to administer Otaki and Pukeora Sanatoria respectively, and both groups plan to improve and extend the sanatorium accommodation in their areas. The Boards in the Auckland - Waikato - Bay of Plenty area are actively considering a combined sanatorium scheme for their area. Home segregation has been improved by an augmentation of the district health nursing service, and an attempt is being made to ensure that only those active cases who are willing to fully co-operate with the District Nurse and obey instructions be allowed to return to their homes. The Medical Officer of Health has power to order a non co-operative patient to return to hospital. It is realized, however, that better results are procured by obtaining understanding and co-operation of patients by teaching than by resorting to rigid compulsory measures, which tend to drive the disease underground. The success of home segregation will depend upon the completion of the housing programme, when recovering tuberculous patients on their discharge from an institution will be able to obtain homes readily and where they can sleep in their own rooms, have the usual home comforts, and have available essential sanitary conveniences. The improvement of housing for the Maori is recognized as an important factor in producing a decrease in the incidence of the disease in this race, and much can be expected from the increasing effort that is being made in this direction. As a temporary measure an increasing number of hutments are being supplied to suitable and co-operative Maori cases. The supervision of cases that persist in working at their place of employment is difficult. At the least hint of the possibility of tuberculosis in an employee it is found that undue fears are expressed by the healthy members of the staff, and often the patient, although declared by a doctor as quite safe in many instances to work, is forced to leave his employment and fall back on invalidity benefit in order to maintain his family. More understanding on the part of the employer and employees is necessary to prevent these unfortunate and too frequent incidents. The Medical Officer of Health has power to send a known active case to hospital for treatment, but has no power to force such a case to leave his work if the hospital is unable to admit the patient. The geographical features of New Zealand, with its sparsely populated areas, makes it impracticable for tuberculous patients to be segregated in " colonies," as is done in more populous countries. The Department considers that a combination of hospital treatment and adequate supervision of cases in the home will create the happiest solution for the patient and a minimum hazard for others. (4) Teaching Tuberculosis Control.—Hospital and sanatorium medical officers have been urged to teach patients the principles of preventive methods while they are in-patients so that on discharge from an institution they can reduce to a mininum any possible danger to others. (5) The Frequent Review of Out-patients.—The District Nurses see that patients attend tuberculosis clinics at prescribed intervals so that a relapse into the active state can be detected at the earliest possible moment and treatment prescribed. (6) Rehabilitation of the Quiescent and Arrested Patient.—No organized facilities are available for this purpose at present, but it is hoped that by the establishment of lay tuberculosis associations and the co-operation of the Rehabilitation Officers of the Rehabilitation Department there will be an agency in existence which can be called upon by the " arrested " case for help in vocational guidance and the chance of obtaining a graded form of sheltered employment. The plans for the future control of tuberculosis envisage— (1) Improved "case finding" by better notification, tuberculin testing, and x-ray surveys. (2) Better classification, and the identification of all active cases by more medical staff and improved diagnostic, laboratory, and x-ray facilities. (3) Efficient treatment and segregation in hospitals, sanatoria, or in the homes of these active cases until they are regarded as inactive. (4) Improvement and extension of institutional accommodation to provide more attractive and homelike surroundings in'which treatment and training can be given. (5) Improvement of housing conditions for European and Maori tuberculous families. (6) The education of the general public in tuberculosis control in order to create a humane understanding of the tuberculous patient's problems and to provide, assistance for his complete recovery and his return to normal standards of life. The war years have set back the full introduction of these plans by five to ten years, but in the meantime such control that the available staff, building, and equipment will allow will be exercised to the full.

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