THE FIGHT AGAINST TUBERCULOSIS IN AUSTRALASIA.

III.

South Australia.

THOUGH it is only during the last few years that the crusade against consumption has had a a definite and specific character, yet it has, in reality, been carried on ever since the early days of sanitary reform. A new colony begins A new colony begins with Arcadian simplicity, only to find, in a few years, that it is accumulating the evils of "Civilization" common to older countries. In time there comes a period of awakening, and an effort is made to get rid of evils which ought not to have been allowed to exist. Now all these efforts have been attacks directly or indirectly against tuberculosis. Whether it has been Parliamentary enactment or local byelaw, whether it has been to improve drainage, prevent overcrowding or cause the erection of healthier buildings, all have united in reducing the mortality from consumption. The study of the mortality returns from phthisis in South Australia are interesting. Instead of being reduced by the various sanitary reforms, the death-rate slowly mounted up till in the year 1888 it reach its climax of 1.19 per thousand, then for several years it oscillated till in 1895 it began to go steadily down, and last year with only 84 per thousand it reached the lowest point for a great many years. It might be a matter of surprise that in England the phthisis death-rate began to decline as early as 1838, when the first efforts for sanitary reform were made, reaching in that year the enormous figure of 3.8 per thousand, it gradually fell till in 1895 it was only 1.4. But it must be remembered that consumption is a disease of "Civilization, with its attendant evils of overcrowding. The effect of over-crowding had been fully felt in England as early as 1838, and as slowly but surely sanitary reforms were put into force the death rate fell. But here, the evils of civilization increased at a greater rate than legislation was able to cope with, and it is only within the last decade that it has been possible to turn the tide. It is difficult to say how far immigration affects the death rate from phthisis, but I would say that at least ten per cent. of the fatal cases are imported.

The year 1898 was a memorable one in South Australia, for then the new Health Act, with clauses bearing directly on the subject, was passed. Dr. Borthwick, Medical Officer of Health for the City of Adelaide, states:

"The Health Act of 1898 contains certain sections which have a direct bearing on

tuberculosis. Sections 99 to 115 inclusive refer to tuberculosis in animals, and are known as the meat and milk clauses, while sections 128, 131, 132 and 133 refer to pulmonary tuberculosis in man, and are known as the Campbell clauses, in recognition of the special interest the late Hon. Dr. Allan Campbell took in securing their inclusion in the Act. The latter sections may be fitly considered first. The powers and duties imposed may be summarised as follows:

"It is compulsory on medical men to report every case of pulmonary tuberculosis coming under their notice to the local Board of the district in which the patient resides. The local Board has power to order and supervise the disinfection of the house, or part of the house, and also its contents, and it may defray the whole or part of the expenses as it sees fit. Articles may be removed from the house for disinfection elsewhere if necessary, and disinfecting apparatus may be provided by local Boards, acting singly or in combination; or, when such apparatus is otherwise available, its use may be arranged for. When a case of pulmonary consumption is certified by a medical man to exist in a building used for the storage of milk, or for the storage or manufacture of butter, cheese, or other article of human food, the local Board, with the sanction of the Central Board, may order the building to be closed if there is reason to believe that the milk or other products may be contaminated. The building remains closed until the patient is removed, and the Officer of Health certifies that all precautions have been taken to prevent contamination. Finally, local Boards have power to make arrangement with any laboratory to have the expectoration of patients examined for the tubercle bacilli. It should be noted that this disease is subjected to any of the other provisions in Part VIII., which refer to infectious diseases. That is, patients suffering from pulmonary consumption are not liable to isolation, nor are their movements in any sense restricted.

"While these powers are fairly comprehensive, their effectiveness must, of course, depend on the administration of the Act. It is impossible to speak for the State as a whole, but the following are the methods adopted in the City of Adelaide. When a case is reported, the first step taken is to enquire of the medical attendant whether he has any objection to the patient being visited by the Health Department's officer. This precaution was introduced to overcome any latent distrust in the policy of notification as leading to undue interference.

If the medical attendant expresses no objection to the routine methods, the city trained nurse proceeds to the house, taking with her a copy of the printed instructions relating to disinfection and other precautionary measures which she carefully explains to the patient or the patient's nurse. She also supplies poor persons with such disinfectants as are needed, and shows how to use them. Any insanitary condition of the premises is noted and dealt with. The nurse further maintains a more or less continuous supervision over the case from a public health standpoint, so as to secure effective observation of the necessary precautions. On the other hand, should the medical attendant desire that his patient should not be visited, he is supplied with the printed instructions and requested to deliver them to the patient or some suitable person in the house. Experience has shown that when a medical man undertakes this responsibility, he invariably carries it out faithfully. Medical men are encouraged by payment of a fee to notify removal of patients from one house to another; so that every house vacated on account of death or otherwise is disinfected by the Department before it (or it may be only the patient's room), is occupied by another person. The extent of disinfection depends on the measure of isolation of the patient in the house. It always includes the bedroom and frequently another room; and in the poorer classes of houses the opportunity is taken of thoroughly renovating them."

"The numbers of deaths for the two years ending 30th September, 1901, were respectively 70 and 67, and of notifications for the same periods 72 and 116. This may be taken to indicate that notification is increasing in favor; and it is gratifying to be able to record that no friction has occurred between the Department and the medical attendant or the patient. It need hardly be added that the work would be much facilitated by the provision of further isolation accommodation with power to remove the poorer patients from small and overcrowded houses.

"The meat and milk clauses are, of course, supplementary to the Campbell clauses.

"The diseases of animals specified include tuberculosis, and the following is a resumé of the powers and duties

"It is compulsory on owners to give a written notice to the local Board as soon as they discover that their animals are diseased, and to isolate such diseased animals pending the action of the local Board. The officers who are charged with the execution of the work

under these sections are (1) a Chief Inspector of Cattle, who shall be a veterinary surgeon, appointed by the Governor; and (2) an Inspector of Cattle, who shall be approved of by the Central Board, appointed by the local Board. The appointment of the latter officer is optional on the part of the local Board. In order to satisfy himself as to the presence of disease an inspector of cattle has power to apply all necessary tests, not only to suspected animals, but to the whole herd. When he is satisfied that any animal is diseased, he shall order the owner to kill the animal and destroy its carcase. The owner has, however, power to demand that the inspector shall apply the necessary tests before the carcase is destroyed. If it be found to be free from disease its value may be recovered by the owner from the local Board, the value of the carcase being deducted from the compensation recoverable. In order to facilitate inspection of meat, public slaughterhouses may be erected by individual or combined local Boards, and provision is made whereby other meat may be prevented from being sold in the district. It is also rendered a penal offence to sell for food a diseased animal or any meat from it. In regard to milk, the same diseases apply to cows as to cattle, with the addition of ulcers or other diseases of the udders. The Act renders it illegal to supply milk to any person from a diseased animal, or to mix such milk with other milk either for consumption as milk or for butter or cheesemaking, or to give such milk to other animals for food unless it has been boiled for ten minutes, and the local Board notified of the intention so to use the milk. The local Board has power to provide for temporarily prohibiting the sale of milk if the Officer of Health certifies that there are reasonable grounds for believing that such milk is causing the spread of infectious disease. It has also power to make regulations for the protection of milk from contamination and adulteration, etc. Finally, it is illegal to keep milk in a room used for sleeping purposes, or in any place or manner likely to render the milk unwholesome.

In the fight against tuberculosis we would

the assistance of well-informed laymen, and for this purpose a society, on the lines of the National Society for the Prevention of Consumption will shortly be inaugurated.

Another matter of prime importance is the care of incurable cases, especially those having no suitable homes. The Government have the matter under consideration, and intend shortly to provide the necessary accommodation.

When these various schemes are in full working order, South Australia will be prepared to carry on the fight against tuberculosis in real earnest.

legislation, and second to that we would place the institution of sanatoria. More than six years ago a home for consumptives was opened at Belair, seven miles from Adelaide. It was founded and endowed by the late Mr. and Mrs. James Brown. Originally built to accommodate 16 patients, it has been increased till at the present time there are 28 inmates, and when two new wings-one in process of construction and one contemplated-are complete, we will have a sanatorium to accommodate 50 patients, situated in one of the best climates possible, and constructed and equipped for the most part in the most approved manner, second to none in the Australian States.

A private sanatorium is contemplated, and will probably be opened by the end of the

summer.

The results obtained at the Belair sanatorium cannot be compared with those of German sanatoria, for patients are taken in all stages, and many have been allowed to remain to the end rather than send them to unsuitable homes. Nearly 250 patients have been treated, the average stay being four months, only about 40 patients have been discharged as cured, the greater number of which have remained well ever since, while a great many more have been so much improved as to be able to return to their work. It is impossible to exaggerate the value of such a sanatorium. Not only are patients isolated and many cured, but it serves as a centre for the dissemination of knowledge concerning the treatment and prevention of consumption, not only the patients, but their friends also have firmly impressed upon them the value of fresh air and cleanliness, and have an object lesson as to the amount of exposure that the human body can endure with advan tage.

The medical profession cannot alone carry on the fight to a successful issue, they must have

NEWS.

PROCEEDINGS OF AUSTRALASIAN BRANCHES.

Victoria

THE annual meeting of the Victorian Branch of the British Medical Association was held at the Vienna Café on 20th December. The President (Dr. Neild) was in the chair.

The TREASURER (Dr. Cuscaden) read a statement of accounts, which showed a balance to the credit of the Society of £192 2s. 4d., with an increase of 20 new members.

The election of office-bearers then took place, with the following result-President, Dr. Macansh (Brighton); Vice-President, Dr. Weigall; Council. Dr. Neild, Dr. Willis, Dr. Dyring, Dr. Ramsay; Hon. Treasurer, Dr. Cuscaden; Local Editor Australasian Medical Gazette, Dr. Bryant; Hon. Secretary, Dr. Vance.

sented by the Secretary, and the business of the The report of Council for year 1901 was then premeeting concluded with the address of the retiring President (Dr. Neild). See page 1.

On the invitation of Dr. Neild, the members partook of a nicely-arranged supper, at which the healths of the retiring President (Dr. Neild) and the newly elected President were proposed and received with great good will. The healths of the other office-bearers were also honored in a similar fashion, and with the expression of feeling that all old troubles might pass away, and the profession, as a whole, might come into closer communion for their common good, the meeting

broke up.

REPORT OF COUNCIL FOR YEAR 1901.

"In presenting the annual report to the members of the Victorian Branch, your Council have very great pleasure in congratulating them on the very successful year which the Association has passed through. Not only have a large number of new members been elected, but several old members, who saw fit some time ago to resign their membership, have again rejoined the Branch.

"Many events of national importance have happened during the year, not the least of them being the visit of His and Her Royal Highnesses the Duke and Duchess of York to our shores. Your Council, on behalf of the

Branch, presented them with an address of welcome, which we learned was greatly admired by them.

"The Ballarat and Launceston Branches have had a most successful year. Their numbers are steadily increasing, and they are doing an immense amount of good.

"In July last a new sub-Branch was founded in the Western District. Some 14 or 15 members have already joined, and the Branch promises to be a great success. Your Council takes this opportunity of congratulating the medical men in the Western District on their spirit, and to wish them all success in their endeavour.

"Turning to the work proper of the Association, many matters of importance have engaged the attention of your Council. First, regarding medical ethics. Several unfortunate cases of this nature have been considered during the year. The decisions which your Council saw fit to give have in all cases, we have learned, given

satisfaction.

“A determined attempt was made by the proprietor of a so-called Drink Cure to sell the same to the Victorian

Government for a large sum of money. The prompt action taken by your Council in the matter not only prevented this, but at the same time caused a Board of Investigation to be appointed. Although the Board is not all that might be desired, we are sure it will enter upon its duties fully resolved to investigate the matter thoroughly, and not be deceived by 'humbug.'

"The opinion of the various medical societies throughout the States is to be asked at the next Congress in Hobart regarding the advisability of forming an Australasian Medical Association. As you are aware, the Victorian Branch has resolved to give a full measure of support to so desirable an object.

"Last October a request was received trom the medical men practising in Inverell, New South Wales, asking for the support of your Branch in the action they were taking against the clubs of the district. Your Council conveyed to them their sympathy, and at the same time resolved to do all in their power to assist them in their struggle.

"Coming to the internal affairs of the Association, we have great pleasure in informing you that the Branch is in a strong financial position, having close upon £200 to our credit. This desirable state of affairs is in a very large measure due to the great care exercised over the funds of the Association by your Hon. Treasurer. On the removal of the Austral Salon from their rooms, your Council made a most advantageous arrangement with the Architect's Society for the use of their premises for our meetings. These both, as regarding situation and convenience have given the greatest satisfaction. A large number of most interesting papers were read during the year. The attendance of members, however, was not as large as we should like to see. We well know that the time of medical men is fully occupied with professional duties; surely however, it is not asking too much from them to give only two hours once a month to the affairs of the Association. Your Council cannot close their report without referring to the valuable services rendered to the Branch by the retiring President, Dr. Neild. His time and advice have always been available to further the interests of the Association. and we trust he may be long spared to be a source of strength to the Council of the Victorian Branch. Your Council, in conclusion, trusts you will give to their successors the same measure of honest support as you have been pleased to accord to them during the year." (Signed)

"J. E. NEILD, President."

"W. B. VANCE, Hon. Secretary."

Queensland.

A GENERAL meeting of the Branch was held on

Friday, January 3rd, 1902, in the rooms, Treasury Buildings, the following members being present:Dr. P. Bancroft (President), Drs. Hopkins, Taylor, Espie Dods, Eleanor Greenham, Flynn, Francis, Marks, Robertson, Wield, Sutton, Hawkes, Culpin,

Lockhart Gibson, Wilton Love, Halford, Connolly, Clowes and Brockway (Hon. Sec.).

Dr. HAWKES exhibited a uterus removed for fibroid, shewing calcareous degeneration.

Dr. FLYNN exhibited a large body, which weighed 460 grains when fresh, passed per rectum by a patient who had suffered from gallstones for eighteen months, and who had been without symptoms for four months since its passage. The treatment of the case had been by olive oil.

The SECRETARY exhibited, for Mr. Rands, Government Geologist, specimens of edible clay from New Guinea, and read the following notes:

NOTES ON CLAY EATEN AS A RELISH WITH FOOD BY THE NATIVES OF THE BETURA River, BRITISH NEW GUINEA,

IN the annual report on British New Guinea for the year 1899 to 1900, Mr. Robert Bruce, who resides at Gebaro Island, at the mouth of the Fly River, reports to His Excellency the Lieutenant Governor on this subject as follows:

"I got a curious thing here this time. There was hanging from the roof what looked like a string of white sausages. I asked by signs for them and they were brought to me. I found they looked like pipeclay, moulded, with a string running through their centre, which joined a lot together. After a lot of inquiries as to its use, I found that it was scraped down with a shell and used as relish to food. I tasted it, and fancied it contained arsenic. They gave me one, which, unfortunately was lost in the boat. Lots of the natives of Torres Straits and New Guinea eat red-fat earth, which contains iron. The women of the Straits eat it when pregnant so as to make the child light skinned, etc. This is the first time I have seen white clay eaten in New Guinea."

The Betura River is a tributary of the Fly River, and joins the latter on its southern side, opposite Canoe Island, between thirty and forty miles up from the mouth. It is situated towards the south-west of British New Guinea in latitude 8° 20' S., longitude, 148° 45'. The earth was analysed by the Government Analyst, and it proves to be practically a silicate of iron and alumina. The following is the analysis :Silica (SiO2) 62.0 per cent. Iron and Alumina (Fe2O3, Al2O3) 30.7 per cent. Lime (Ca O)... Magnesia (MgO) Moisture at 100° C... Loss at a dull red heat

...

...

...

...

Traces 1.8 per cent. 2.4 per cent. 4.3 per cent. The clay evidently contains very ltttle organic matter in its composition-under 2 per cent. The sample was specially tested for arsenic, but none was found. A sample of the so-called "red fat" earth forwarded to me consists of steatite, which is a hydrous silicate of magnesia.

The Secretary was instructed to thank Mr. Rands for the very interesting specimens and notes.

The SECRETARY announced the resignations of Drs. Comyn and Dixon, in consequence of these gentlemen having left the State.

It was proposed, in reply to a letter from the collector of the Queen Victoria Memorial Fund, that the Branch do not subscribe to the fund.

Drs. TAYLOR and SUTTON thought that a sum of five guineas should be subscribed by the Branch, and moved to that effect.

Dr. HOPKINS questioned the right of the Branch to devote its funds to any such object.

He

Dr. LOCKHART GIBSON thought that individual members might be deterred from subscribing privately if a subscription were sent from the Branch. urged the importance of the fund, and stated that the medical profession was already very well represented in the subscription list.

Dr. WILTON LOVE considered that if any subscription were sent it should not be less than 25 guineas.

Dr. BROCKWAY thought it would be a good plan to collect private subscriptions from members, and to donate the sum thus collected as coming from the Branch.

It was resolved, after discussion, that a sum not exceeding £12 be devoted to the purchase of journals and periodicals for the library, provided that the journals were not removed from the room.

Dr. FRANCIS gave notice of motion to change the rules of the library to that effect.

The Curator of the library and museum (Dr. HAWKES) reported that seven journals had been promised by members of the Branch.

It was resolved that a sum not exceeding £10 be devoted to the purchase of necessary jars and material for the museum.

Dr. HAWKES suggested that a special effort should be made during the year to obtain specimens of intestinal parasites.

Dr. CULPIN introduced the subject of meeting in consultation the medical officers of the Brisbane Associated Friendly Societies' Medical Institute, and asked the Branch to endorse the resolution passed by the Queensland Medical Society in 1896, which was as follows: "That the Queensland Medical Society views with disfavour any of its members meeting the medical officers connected with the Brisbane Friendly Societies' Medical Institute in consultation, in view of the degrading conditions imposed upon their medical officers by this body." He said that he had asked the Secretary of the Brisbane Associated Friendly Societies' Medical Institute to supply him with a copy of the agreement between them and their medical officers, but had not been granted one, as the Secretary stated that a new agreement was in course of preparation, which would not contain the terms objected to by the profession.

Dr. TAYLOR pointed out the difference between the Brisbane Associated Friendly Societies' Medical Institute and that of Toowoomba, to the advantage of the latter. He thought that, if medical officers of the Medical Institute were not met in consultation-and he refused to meet them-they should not be met after they had left their service with the Institute, until some number of years had elapsed.

Dr. WILTON LOVE reviewed the circumstances of the foundation of the Institute, and stated that its formation had enabled the Friendly Societies to dictate terms to the medical profession, and that many Friendly Societies were seceding from "private societies to the Institute. His chief objections to the Institute were (1) that the sum paid per member to its medical officers was less than that paid to medical officers of societies not connected with the Institute, (2) that no one was excluded from membership of the Institute, whatever his income or position. He said

that the officials of the Institute did not wish it to be known that their medical officers were not met in consultation by other members of the profession. He thought that to have been medical officer to the Institute was sufficient slur upon a man, and that further ostracism after he had severed his connection with the Institute was unnecessary.

Dr. CONNOLLY thought that some years should elapse before an ex-medical officer of the Institute was met in consultation by the profession, and that, in order to give every member of the Branch an opportunity of stating his views on the question before the Branch, the resolutions passed at the meeting should not be put into effect until they had been ratified at the next meeting; and was inclined to think that it might be wiser to defer any action until the new agreement spoken of by Dr. Culpin had been formulated by the Institute.

Dr. LOCKHART GIBSON agreed originally to the resolution of the Queensland Medical Society because of the degrading nature of the agreement, and thought that it might be wise to approach the Medical Institute in order to lay before them the views of the Branch. He thought that-(1) The agreement should be so framed that it could be signed without loss of dignity by any member of the profession; and that (2) there should be a wage limit; and that, if ostracism were decided upon, it should be carried out by every member of the Branch, and was personally of the opinion that a medical man should not agree to act upon the medical staff of a Hospital which had upon its staff a member of the profession who was in the habit of meeting in consultation medical officers connected with the Institute.

Dr. HOPKINS considered that the resolution passed by the Queensland Medical Society was not sufficiently stringent, in that no penalty attached to members who disregarded it. He emphatically thought that men who met the Institute men should themselves not be met. His great objection to the Institute was that money was being made by the Institute out of the work done by its medical officers, and he thought that there should be a time limit before an ex-medical officer of the Institute was met in consultation by other members of the profession, if, indeed, they should ever be so met.

Dr. SUTTON remarked that the objections to the Institute were (1) that the agreement was degrading, (2) the medical officers were exploited for the financial benefit of the Institute. He thought that the medical officers of the Institute should be ostracised by the profession, and this ostracism removed in each case only by a special resolution of the Branch.

Dr. HAWKES agreed with Dr. Hopkins, and related a similar condition of affairs as having existed in Rockhampton.

Dr. HALFORD thought that in fairness to the medical officers at present under agreement with the Institute a date should be fixed after which the resolution should take effect, in order that they might have an opportunity of severing their connection with the Institute if they wished to do so and if they were ignorant of the light in which their appointments were held by the profession.

Dr. BROCKWAY thought that it would be unwise to defer action until the Institute had framed a new agreement, but rather that it would be well to pass a stringent resolution and forward a copy of it to the officials of the Institute, since such pressure from the profession might produce real alterations in the present agreement. He cordially agreed with the suggestion that no ex-medical officer should be met in consultation