Visiting Tuberculosis in Dunedin District

Kai Tiaki : the journal of the nurses of New Zealand, Volume XVI, Issue 4, 1 October 1927, Page 202

Visiting Tuberculosis in Dunedin District

A great deal is heard nowadays on the subject of tuberculosis, and to the ordinary layman so much publicity conveys the idea that the trouble is largely on the increase. From a graph recently compiled by Dr. Shore, our late Assistant Medical Officer of Health, from statistics covering the past decade, it has been proved conclusively,, and this graph shows that such is by no means the case. On the contrary, the mortality rate has fallen consistently and steadily. For the benefit of those who may not already know, under the Health Act, 1920, pulmonary tuberculosis is a notifiable infectious disease, and as such, all reported cases are investigated by the Public Health Department. On a notification being received m the office the procedure is as follows : — The home is visited and a report on the patient first made. This is done m triplicate forms. Particulars are noted, such as patient's age, occupation, duration of disease, present condition of health, whether clinical or positive case, treatment received and treatment recommended, also the patient's past illnesses, if any, especially pleurisy and pneumonia. The history of the patient's family and antecedents is also inquired into. The patient's bedroom is then inspected and suggestions perhaps made which may be carried out for the benefit of the patient. Even a change to a sunnier room may be advised, when such chance can conveniently be made. Much advice can be given, but the Health Department issues excellent pamphlets which contain all possible information for both patient and contacts. I shall be glad to hand these out at the end of the lecture should any present desire them. One really requires to lay stress on the most important facts only. These pamphlets give the cause of consumption and how to prevent it, also precautions to be observed by the patient and precautionary measures against pulmonary tuberculosis to be observed by the contacts. Names of all members of the family are noted, also their various occupations, and any illnesses they may have had, especially

pneumonia, pleurisy, or any other chest complaint, and m the case of children, measles and whooping cough as well. The names of school children are handed on to the school medical officer of the district, along with a short history of each child, and these children are closely watched throughout their school career.

Dealing with adult contacts is a little more difficult, as the majority are at business during the day, making it almost impossible for one to get into personal touch with them. When strongly advised that they should be examined as a precautionary measure, one invariably gets the answer that they are either quite fit or have recently been passed for a lodge, and therefore must be fit. They fail to see often the necessity for being examined periodically by a doctor, if they have no symptoms of disease. However, the public are gradually waking up to the importance of such a step, and we hope people will soon submit to a periodic examination of the body as they do now, many of them, to a periodic examination of their teeth.

The patient and contacts finished with, a survey is now made of the home. From the exterior the size, aspect, elevation, underfloor ventilation, exposure to or obstruction from the sun, etc. From the interior the number of rooms, rough dimensions of same, ventilation, number of occupants of each bedroom, whether m single beds or sharing beds, etc. As a rule, conditions are satisfactory, but one occasionally comes across cases with very poor environment. On visiting one home, which Avas attached to a modern shop, situated on one of our main streets m Dunedin, and passed by some of you probably every day, the patient, a girl of 17, was found m an unlined washhouse lying on a mattress supported by four boxes, with room for a chair only, apart from the copper and built-in tubs. This state of things, m spite of a large airy, unoccupied room, facing north, with fireplace and casement windows. The mother's only excuse was that her daughter was too infectious to be nursed m

the home. Another case, a returned soleldest five years, was living m one room, m a house m Filleul Street. These two dier with his wife and five children, the cases are mentioned to emphasise the necessity for a thorough investigation when tubercular cases are reported. When making initial visits to cases it is not possible to make many improvements right away. Suggestions can be made and advice freely given, but it is not until the confidence of the people is won that much progress is made. When the public once realise that the Health Department is striving to assist and not to interfere then much more effective work will be done. The patients are usually well cared for, the majority transferring to the various sanatoria for treatment, and those remaining at home, looked after under suitable conditions ; but it is essential that all homes be visited from time to time for more reasons than one. Apart from the contacts requiring supervision, patients are often found migratory. They are apt to move from one home to another without notifying the Department of any change of address, and it is only through constant visiting that one is able to keep m touch with them and at the same time be able to make necessary arrangements for disinfection of premises. Disinfection,

of course, is done by the Department free of charge when a positive case is moved to an institution, or even if a patient be transferred from one room to another m the same house. District visiting m connection with pulmonary tuberculosis absorbs most of my time, but I supervise and assist at Dunedin Hospital final State examination, and also inspect from time to time the premises of chiropractors, masseurs and beauty specialists. However, to my mind, tubercular work is by far the most interesting and important, and much help is obtained by cooperation with the T.B. Out-Patients' Department, Dunedin Hospital. May I conclude with an extract from a recent address given by Sir Robert Phillip, President of the British Medical Association, m Edinburgh. It appeared m our papers a few days ago, and is as follows : — " I am prepared to believe that 30 years hence tuberculosis will be largely a memory of the past, and the time will come when hospitals for advanced disease and settlements for tubercular wrecks will be regarded as anachronisms." To read such a statement is at least encouraging, and one only hopes that his prophecy may come true.