Effect of Chest Clinics It is an interesting fact that, soon after the augmented Chest Clinic service became available, the Maori death rate from tuberculosis began to fall rapidly. In fact, when shown on a chart, it is most spectacular, an almost vertical drop. From 1920 till 1945 the figure had remained well over the 300 per 100,000. After 1945 the rate fell rapidly. By 1954 it was down to 78 which is less than the European rate for 1900. It looks as if the figure will continue to fall, though one cannot say if it will fall as rapidly as it has done in the last few years. However, this big drop in the death rate is a most hopeful augury. But the Maori death rate is still too high. It is still about seven times as great as the European death rate and the Maoris have still a long way to go before they catch up. There can be no slackening of the efforts to conquer tuberculosis. It is no use being satisfied with present results and resting on our oars. That can only lead to disaster. It is only by team work on the part of the doctors, the nurses and the Maori people that T.B. amongst the Maoris can really be brought under control. The doctors can supply the specialised advice and treatment, the nurses can help by home visits and guidance, but the Maori people themselves have a great part to play by seeking to attain better standards of living, and by co-operating with Chest Clinics and with the advice given by the doctors and nurses.

Importance of Early Treatment Though a very great deal can now be done for those who have tuberculosis, it is most essential to co-operate fully with the advice given by the doctors and nurses if the best results are to be obtained and if the spread of infection is to be checked as rapidly as possible. Sometimes the advice is not taken at all. Sometimes it is only half-heartedly carried out. In either case the results can be disastrous. Even within recent months, I have seen three tragedies occur because my advice about treatment was not carried out. Disease which could have been cured has become quite incurable. Furthermore infection for others is very likely to persist. Both of these circumstances need not have arisen if only advice about treatment had been accepted at the beginning. I want to say, and say it most emphatically, that the modern treatments for tuberculosis, faithfully carried out, can and do achieve absolute miracles of healing in the right kind of case. But it takes time; it requires whole-hearted co-operation; it means doing what the doctor thinks best. It is no use going into hiding or trying to put things off, or making some half-hearted compromise about treatment. The best time for treatment and the opportunity to use the best kind of treatment may be lost for ever. The only wise thing to do is to accept the doctor's decision about the treatment needed and the place where it is best carried out. When this is done we are very unlikely to see the sad tragedies I have mentioned. On the other hand, we are likely to see most marvellous healing of disease. This is especially true of early cases. When the disease is chronic and has been present for a long time before the patient is first seen, the results cannot be so good. But even then we can patch up somewhat. In early disease, however, the results are often amazingly good. In some cases the disease seems to disappear entirely. This leads me to my next point, the need for early discovery which is a very important factor in the control of tuberculosis. Now early discovery is really important because treatment of early disease is so very successful and because the risk of infecting others with tuberculosis is greatly reduced. A great part of this early discovery lies in two things. Firstly there is the use of X-rays. Secondly there is a need to pay heed to what I call the Warning Signals.

X-Rays It is very important to go for X-rays when asked to do so. The X-ray may be for a follow-up X-ray, for example, after a pneumonia, for an X-ray as a contact of some other case, because your doctor wants an X-ray done or because the District Nurse thinks you should have one. People with a chronic cough ought to ask for one to be sure there is nothing serious present. Your private doctor or the District Nurse can arrange this. An X-ray is actually a valuable form of health insurance. If nothing is found, you have an easy mind. If there is something wrong, the sooner it is seen to the better. I have an X-ray myself every year. I hope that in time this may be possible for everybody. It is certainly well worth while as a means of wiping out tuberculosis. There is one special form of X-ray I must mention, what is known as Mass Miniature Radiography, M.M.R. for short. Very small films are taken which sort out the doubtful chests. A bg film is then taken to get better detail and the person with the suspicious chest is referred to the Chest Clinic so that it can be decided if treatment is needed. The Taranaki Mobile X-ray unit has been working for quite a long time now and it has proved most successful in finding cases of tuberculosis and other chest diseases. This unit owed its inception to a gift of £1000 by the Taranaki Maori Trust Board. The Health Department is getting more of such X-ray units to go round the countryside. Now for a Mobile X-ray Unit to do its job properly EVERYONE in the settlement ought to roll up, including Grandma and Grandpa! I have seen quite a lot of T.B. in Maori children where the grandmother or the grandfather was the source of the trouble. If