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THE FIGHT AGAINST TUBERCULOSIS tuberculosis. Sections 99 to 115 inclusive IN AUSTRALASIA.
refer to tuberculosis in animals, and are known
as the meat and milk clauses, while sections III.
128, 131, 132 and 133 refer to pulmonary South Australia.
tuberculosis in man, and are known as the Though it is only during the last few years Campbell clauses, in recognition of the special that the crusade against consumption has had a interest the late Hon. Dr. Allan Campbell took a definite and specific character, yet it has, in in securing their inclusion in the Act. The reality, been carried on ever since the early latter sections may be fitly considered first. days of sanitary reform. A new colony begins The powers and duties imposed may be sumwith Arcadian simplicity, only to find, in a marised as follows :
, few years, that it is accumulating the evils of “It is compulsory on medical men to report
Civilization common to older countries. In every case of pulmonary tuberculosis coming time there comes a period of awakening, and under their notice to the local Board of the an effort is made to get rid of evils which district in which the patient resides. The ought not to have been allowed to exist. Now local Board has power to order and supervise all these efforts have been attacks directly or the disinfection of the house, or part of the indirectly against tuberculosis. Whether it house, and also its contents, and it may defray has been Parliamentary enactment or local bye- the whole or part of the expenses as it sees fit. law, whether it has been to improve drainage, Articles may be removed from the house for prevent overcrowding or cause the erection of disinfection elsewhere if necessary, and disin. healthier buildings, all have united in reducing fecting apparatus may be provided by local the mortality from consumption. The study of Boards, acting singly or in combination; or, the mortality returns from phthisis in South when such apparatus is otherwise available, its Australia are interesting. Instead of being use may be arranged for. When a case of reduced by the various sanitary reforms, the pulmonary consumption is certified by a medical death-rate slowly mounted up till in the year inan to exist in a building used for the storage 1888 it reach its climax of 1:19 per thousand, of milk, or for the storage or manufacture of then for several years it oscillated till in 1895 butter, cheese, or other article of human food, it began to go steadily down, and last year with the local Board, with the sanction of the only •84 per thousand it reached the lowest Central Board, may order the building to be point for a great many years. It might be a closed if there is reason to believe that the milk matter of surprise that in England the phthisis or other products may be contaminated. The death-rate began to decline as early as 1838, building remains closed until the patient is when the first efforts for sanitary reform were removed, and the Officer of Health certifies made, reaching in that year the enormous figure that all precautions have been taken to prevent of 3.8 per thousand, it gradually fell till in 1895 contamination. Finally, local Boards have it was only 1.4. But it must be remembered power to make arrangement with any laborathat consumption is a disease of “ Civilization," tory to have the expectoration of patients with its attendant evils of overcrowding. The examined for the tubercle bacilli. It should effect of over-crowding had been fully felt in be noted that this disease is subjected to any of England as early as 1838, and as slowly but the other provisions in Part VIII., which refer surely sanitary reforms were put into force the to infectious diseases. That is, patients sufferdeath rate fell. But here, the evils of civiliza- ing from pulmonary consumption are not liable tion increased at a greater rate than legislation to isolation, nor are their movements in any was able to cope with, and it is only within the sense restricted. last decade that it has been possible to turn the “While these powers are fairly comprehensive, tide. It is difficult to say how far immigration their effectiveness must, of course, depend on affects the death rate from phthisis, but I would the administration of the Act.
It is impossay that at least ten per cent. of the fatal cases sible to speak for the State as a whole, but the are imported.
following are the methods adopted in the City The year 1898 was a memorable one in South of Adelaide. When a case is reported, the first Australia, for then the new Health Act, with step taken is to enquire of the medical clauses bearing directly on the subject, was attendant whether he has any objection to the passed. Dr. Borthwick, Medical Officer of patient being visited by the Health DepartHealth for the City of Adelaide, states :- ment's officer. This precaution was introduced
“ The Health Act of 1898 contains certain to overcome any latent distrust in the policy of sections which have a direct bearing on notification as leading to undue interference.
If the medical attendant expresses no objection under these sections are (1) a Chief Inspector to the routine methods, the city trained nurse of Cattle, who shall be a veterinary surgeon, proceeds to the house, taking with her a copy appointed by the Governor; and (2) an of the printed instructions relating to disinfec- Inspector of Cattle, who shall be approved of tion and other precautionary measures which by the Central Board, appointed by the local she carefully explains to the patient or the Board. The appointment of the latter officer patient's nurse. She also supplies poor persons is optional on the part of the local Board. In with such disinfectants as are needed, and order to satisfy himself as to the presence of shows how to use them. Any insanitary disease an inspector of cattle has power to condition of the premises is noted and dealt apply all necessary tests, not only to suspected with. The nurse further maintains a more or animals, but to the whole herd. When he is less continuous supervision over the case from a satisfied that any animal is diseased, he shall public health standpoint, so
order the owner to kill the animal and destroy effective observation of the necessary precau- its carcase. The owner has, however, power to tions. On the other hand, should the medical demand that the inspector shall apply the attendant desire that his patient should not be necessary tests before the carcase is destroyed. visited, he is supplied with the printed If it be found to be free from disease its value instructions and requested to deliver them to may be recovered by the owner from the local the patient or some suitable person in the Board, the value of the carcase being deducted house. Experience has shown that when a from the compensation recoverable. In order medical man undertakes this responsibility, he to facilitate inspection of meat, public slaughterinvariably carries it out faithfully. Medical houses may be erected by individual or commen are encouraged by payment of a fee to bined local Boards, and provision is made notify removal of patients from one house to whereby other meat may be prevented from another ; so that every house vacated being sold in the district. It is also rendered a account of death or otherwise is disinfected by penal offence to sell for food a diseased animal the Department before it (or it may be only the or any meat from it. In regard to milk, the patient's room), is occupied by another person. same diseases apply to cows as to cattle, with The extent of disinfection depends on the the addition of ulcers or other diseases of the measure of isolation of the patient in the house. udders. The Act renders it illegal to supply It always includes the bedroom and frequently milk to any person from a diseased animal, or another room; and in the poorer classes of to mix such milk with other milk either for houses the opportunity is taken of thoroughly consumption as milk or for butter or cheeserenovating them."
making, or to give such milk to other animals “The numbers of deaths for the two years for food unless it has been boiled for ten ending 30th September, 1901, were respec- minutes, and the local Board notified of the tively 70 and 67, and of notifications for intention so to use the milk. The local Board the same periods 72 and 116. This may be has power to provide for temporarily prohibittaken to indicate that notification is increasing ing the sale of milk if the Officer of Health in favor; and it is gratifying to be able certifies that there are reasonable grounds for to record that no friction has occurred between believing that such milk is causing the spread the Department and the medical attendant or of infectious disease. It has also power to the patient. It need hardly be added that the make regulations for the protection of milk work would be much facilitated by the provision from contamination and adulteration, etc. of further isolation accommodation with power Finally, it is illegal to keep milk in a room to remove the poorer patients from small and used for sleeping purposes, or in any place or overcrowded houses.
manner likely to render the milk unwholesome. " The meat and milk clauses are, of course, “It must be admitted that very little has been supplementary to the Campbell clauses.
done in the direction of the construction of “The diseases of animals specified include abattoirs and the efficient inspection of meat. tuberculosis, and the following is a resumé of The city has a bill authorising the erection of the powers and duties :
abattoirs under consideration, and the various “ It is compulsory on owners to give a written local bodies of the metropolitan area have notice to the local Board as soon as they combined with the city to place the milk trade discover that their animals are diseased, and on a satisfactory basis. A fully-qualified to isolate such diseased animals pending the veterinary surgeon with special training in action of the local Board. The officers who regard to milk processes has been appointed, are charged with the execution of the work and already he has done good work in improving
the sanitary condition of the metropolitan the assistance of well-informed laymen, and for dairies.
this purpose a society, on the lines of the “Many tuberculous cows have been weeded National Society for the Prevention of Conout, and as time permits he will devote special sumption will shortly be inaugurated. attention to this disease among cows.
Another matter of prime importance is the Thus it will be seen that, notwithstanding care of incurable cases, especially those having Koch's dictum as to the small importance of no suitable homes. The Government have the this portion of the work, steps are being taken matter under consideration, and intend shortly to minimise whatever risk exists, at least to provide the necessary accommodation. within the metropolitan area.
When these various schemes are in full Already the Act has been fruitful, and working order, South Australia will be prepared the clauses compelling notification and disinfec- to carry on the fight against tuberculosis in tion will prove each year more fully their real earnest. inestimable value.
In the fight against tuberculosis we would place as of prime importance, sanitation and BRITISH MEDICAL ASSOCIATION legislation, and second to that we would place
NEWS. the institution of sanatoria. More than six years ago a home for consumptives was opened
PROCEEDINGS OF AUSTRALASIAN at Belair, seven miles from Adelaide. It was founded and endowed by the late Mr. and Mrs.
BRANCHES. James Brown. Originally built to accommo
Victoria date 16 patients, it has been increased till at the present time there are 28 inmates, and when two new wings—one in process of The annual meeting of the Victorian Branch of the
British Medical Association was held at the Vienna construction and one contemplated—are com- Café on 20th December. The President (Dr. Neild) plete, we will have a sanatorium to accommodate was in the chair. 50 patients, situated in one of the best climates The TREASURER (Dr. Cuscaden) read a statement of possible, and constructed and equipped for the accounts, which showed a balance to the credit of the
Society of £192 2s. 4d., with an increase of 20 new most part in the most approved manner, second
members. to none in the Australian States.
The election of office-bearers then took place, with A private sanatorium is contemplated, and the
the following result :-President, Dr. Macansh will probably be opened by the end of the (Brighton); Vice-President, Dr. Weigall; Council, Dr.
Neild, Dr. Willis, Dr. Dyring, Dr. Ramsay ; Hon. summer.
Treasurer, Dr. Cuscaden ; Local Editor Australasian The results obtained at the Belair sanatorium Medical Gazette, Dr. Bryant; Hon. Secretary, Dr. cannot be compared with those of German
Vance, sanatoria, for patients are taken in all stages, sented by the Secretary, and the business of the
The report of Council for year 1901 was then preand many have been allowed to remain to the meeting concluded with the address of the retiring end rather than send them to unsuitable homes. President (Dr, Neild). See page 1. Nearly 250 patients have been treated, the On the invitation of Dr, Neild, the members partook average stay being four months, only about 40
of a nicely-arranged supper, at which the healths of
the retiring President (Dr. Neild) and the newly patients have been discharged as cured, the elected President were proposed and received with great greater number of which have remained well good will. The healths of the other office-bearers were ever since, while a great many more have been
also honored in a similar fashion, and with the so much improved as to be able to return to expression of feeling that all old troubles might pass their work. It is impossible to exaggerate the closer communion for their common good, the meeting
away, and the profession, as a whole, might come into value of such a sanatorium. Not only are patients isolated and many cured, but it serves REPORT OF COUNCIL FOR YEAR 1901. as a centre for the dissemination of knowledge
“In presenting the annual report to the members of concerning the treatment and prevention of the Victorian Branch, your Council have very great consumption, not only the patients, but their pleasure in congratulating them on the very successful friends also have firmly impressed upon them year which the Association has passed through. Not the value of fresh air and cleanliness, and have but several old members, who saw fit some time ago to
only have a large number of new members been elected, an object lesson as to the amount of exposure resign their membership, have again rejoined the that the human body can endure with advan Branch. tage.
• Many events of national importance have bappened The medical profession cannot alone carry on
during the year, not the least of them being the visit of
His and Her Royal Highnesses the Duke and Duchess the fight to a successful issue, they must have' of York to our shores. Your Council, on behalf of the
Branch, presented them with an address of welcome,
Queensland. which we learned was greatly admired by them.
“The Ballarat and Launceston Branches have had a most successful year. Their numbers are steadily
A GENERAL meeting of the Branch was held on increasing, and they are doing an immense amount of Friday, January 3rd, 1902, in the rooms, Treasury good.
Buildings, the following members being present :" In July last a new sub-Branch was founded in the
Dr. P. Bancroft (President), Drs. Hopkins, Taylor, Western District. Some 14 or 15 members have already Marks, Robertson, Wield, Sutton, Hawkes, Culpin, joined, and the Branch promises to be a great success.
Espie Dods, Eleanor Greenham, Flynn, Francis, Your Council takes this opportunity of congratulating
Lockhart Gibson, Wilton Love, Halford, Connolly, the medical men in the Western District on their spirit, Clowes and Brockway (Hon. Sec.).
Dr. HAWKES exhibited a uterus removed for fibroid, and to wish them all success in their endeavour.
shewing calcareous degeneration. “ Turning to the work proper of the Association, many matters of importance have engaged the attention of 460 grains when fresh, passed per rectum by a patient
Dr. FLYNN exhibited a large body, which weighed your Council. First, regarding medical ethics. Several unfortunate cases of this nature bave been considered
who had suffered from gallstones for eighteen months,
and who had been without symptoms for four months during the year. The decisions which your Council
since its passage. The treatment of the case had been saw fit to give have in all cases, we have learned, given satisfaction.
by olive oil. “ A determined attempt was made by the proprietor of
The SECRETARY exhibited, for Mr. Rands, Governa so-called Drink Cure to sell the same to the Victorian
ment Geologist, specimens of edible clay from New Government for a large sum of money. The prompt Guinea, and read the following notes :action taken by your Council in the matter not only Notes on CLAY EATEN AS A RELISH with FOOD BY prevented this, but at the same time caused a Board of
THE NATIVES OF THE BETURA RIVER, BRITISH Investigation to be appointed. Although the Board is not all that might be desired, we are sure it will enter
NEW GUINEA. upon its duties fully resolved to investigate the matter In the annual report on British New Guinea for the thoroughly, and not be deceived by “humbug.'
year 1899 to 1900, Mr. Robert Bruce, who resides at “ The opinion of the various medical societies Gebaro Island, at the mouth of the Fly River, reports throughout the States is to be asked at the next to His Excellency the Lieutenant Governor on this Congress in Hobart regarding the advisability of subject as follows :forming an Australasian Medical Association,
“I got a curious thing here this time. There was are aware, the Victorian Branch has resolved to give a hanging from the roof what looked like a string of full measure of support to so desirable an object. white sausages. I asked by signs for them and they
" Last October a request was received from the were brought to me. I found they looked like pipemedical men practising in Inverell, New South Wales, clay, moulded, with a string running through their asking for the support of your Branch in the action centre, which joined a lot together. After a lot of they were taking against the clubs of the district. inquiries as to its use, I found that it was scraped down Your Council conveyed to them their sympathy, and at with a shell and used as relish to food. I tasted it, the same time resolved to do all in their power to assist and fancied it contained arsenic. They gave me one, them in their struggle.
which, unfortunately was lost in the boat. Lots of the “ Coming to the internal affairs of the Association, natives of Torres Straits and New Guinea eat red-fat we have great pleasure in informing you that the earth, which contains iron. The women of the Straits Branch is in a strong financial position, having close eat it when pregnant so as to make the child light upon £200 to our credit. This desirable state of affairs skinned, etc. This is the first time I have seen white is in a very large measure due to the great care clay eaten in New Guinea." exercised over the funds of the Association by your The Betura River is a tributary of the Fly River, Hon, Treasurer. On the removal of the Austral Salon
and joins the latter on its southern side, opposite from their rooms, your Council made a most advan
Canoe Island, between thirty and forty miles up from tageous arrangement with the Architect's Society for the mouth. It is situated towards the south-west of the use of their premises for our meetings. These British New Guinea in latitude 8° 20' S., longitude, both, as regarding situation and convenience have 148° 45'. The earth was analysed by the Government given the greatest satisfaction. A large number of Analyst, and it proves to be practically a silicate of most interesting papers were read during the year. iron and alumina. The following is the analysis :The attendance of members, however, was not as large We well know that the time
Silica (SiO2) as we should like to see.
62.0 per cent.
Iron and Alumina (Fe,O3, A1,03) 30-7 per cent. of medical men is fully occupied with professional
Traces duties ; surely however, it is not asking too much from
Lime (Ca 0)... them to give only two hours once a month to the
1.8 per cent.
Moisture at 1000 U... affairs of the Association. Your Council cannot close
2.4 per cent. Loss at a dull red heat
4:3 per cent. their report without referring to the valuable services rendered to the Branch by the retiring President, Dr. The clay evidently contains very ltttle organic matter Neild. His time and advice have always been in its composition—under 2 per cent. The sample was available to further the interests of the Association specially tested for arsenic, but none was found. and we trust he may be long spared to be a source of sample of the so-called “red fat” earth forwarded to strength to the Council of the Victorian Branch. Your me consists of steatite, which is a hydrous silicate of Council, in conclusion, trusts you will give to their magnesia. successors the same measure of honest support as you
The Secretary was instructed to thank Mr. Rands have been pleased to accord to them during the year."
for the very interesting specimens and notes. (Signed)
The SECRETARY announced the resignations of Drs. “ J. E. NEILD, President."
Comyn and Dixon, in consequence of these gentlemen " W. B. VANCE, Hon. Secretary.” having left the State.
It was proposed, in reply to a letter from the collector that the officials of the Institute did not wish it to be of the Queen Victoria Memorial Fund, that the Branch known that their medical officers were not met in do not subscribe to the fund.
consultation by other members of the profession. Drs. TAYLOR and SUTTON thought that a sum of He thought that to have been medical officer to the five guineas should be subscribed by the Branch, and Institute was sufficient slur upon a man, and that mored to that effect.
further ostracism after he had severed his connection
with the lostitute was unnecessary. Dr. HOPKINS questioned the right of the Branch to devote its funds to any such object.
Dr. CONNOLLY thought that some years should Dr. LOCKHART Gibson thought that individual elapse before an ex-medical officer of the Institute was members might be deterred from subscribing privately
met in consultation by the profession, and that, in if a subscription were sent from the Branch. He order to give every member of the Branch an opurged the importance of the fund, and stated that the portunity of stating his views on the question before medical profession was already very well represented the Branch, the resolutions passed at the meeting in the subscription list.
should not be put into effect until they had been Dr. Wilton LOVE considered that if any subscription ratified at the next meeting; and was inclined to were sent it should not be less than 25 guineas.
think that it might be wiser to defer any action until Dr. BROCKWAY thought it would be a good plan the new agreement spoken of by Dr. Culpin had been to collect frivate subscriptions from members, and formulated by the Institute. to donate the sum thus collected as coming from the Dr. LOCKHART Gibson agreed originally to the Branch.
resolution of the Queensland Medical Society because It was resolved, after discussion, that a sum not of the degrading nature of the agreement, and thought exceeding £12 be devoted to the purchase of journals that it might be wise to approach the Medical Institute and periodicals for the library, provided that the in order to lay before them the views of the Branch. journals were not removed from the room.
He thought that-(1) The agreement should be so Dr. FRANCIS gave notice of motion to change the framed that it could be signed without loss of dignity rules of the library to that effect.
by any member of the profession ; and that (2) there The Curator of the library and museum (Dr. should be a wage limit; and that, if ostracism were HAWKES) reported that seven journals had been decided upon, it should be carried out by every promised by members of the Branch.
member of the Branch, and was personally of the It was resolved that a sum not exceeding £10 be opinion that a medical man should not agree to act devoted to the purchase of necessary jars and material upon the medical staff of a Hospital which had upon for the museum.
its staff a member of the profession who was in the Dr. HAWKES suggested that a special effort should babit of meeting in consultation medical officers be made during the year to obtain specimens of connected with the Institute. intestinal parasites.
Dr. HOPKINS considered that the resolution passed Dr. CULPIN introduced the subject of meeting in by the Queensland Medical Society was not sufficiently consultation the medical officers of the Brisbane stringent, in that no penalty attached to members who Associated Friendly Societies' Medical Institute, and disregarded it. He emphatically thought that men asked the Branch to endorse the resolution passed by who met the Institute men should themselves not be the Queensland Medical Society in 1896, which was as met. His great objection to the Institute was that follows : " That the Queensland Medical Society views money was being made by the Institute out of the with disfavour any of its members meeting the medical work done by its medical officers, and he thought that officers connected with the Brisbane Friendly Societies' there should be a time limit before an ex-medical Medical Institute in consultation, in view of the officer of the Institute was met in consultation by degrading conditions imposed upon their medical other members of the profession, if, indeed, they should officers by this body.” He said that he had asked the ever be so met. Secretary of the Brisbane Associated Friendly So- Dr. SUTTON remarked that the objections to the cieties' Medical Institute to supply him with a copy of Institute were (1) that the agreement was degrading, the agreement between them and their medical officers, (2) the medical officers were exploited for the financial but had not been granted one, as the Secretary stated benefit of the Institute. He thought that the medical that a new agreement was in course of preparation, officers of the Institute should be ostracised by the which would not contain the terms objected to by the profession, and this ostracism removed in each case profession.
only by a special resolution of the Branch. Dr. TAYLOR pointed out the difference between the Dr. HAWKES agreed with Dr. Hopkins, and related a Brisbane Associated Friendly Societies' Medical similar condition of affairs as having existed in Rock. Institute and that of Toowoomba, to the advantage of hampton. the latter. He thought that, if medical officers of the Dr. HALFORD thought that in fairness to the medical Medical Institute were not met in consultation-and officers at present under agreement with the Institute he refused to meet them—they should not be met after a date should be fixed after which the resolution should they had left their service with the Institute, until | take effect, in order that they might have some number of years bad elapsed.
opportunity of severing their connection with the Dr. Wilton LOVE reviewed the circumstances of Institute if they wished to do so and if they were the foundation of the Institute, and stated that its ignorant of the light in which their appointments were formation had enabled the Friendly Societies to held by the profession. dictate terms to the medical profession, and that many Dr. BROCKWAY thought that it would be unwise to Friendly Societies were seceding from “ private defer action until the Institute had framed a new societies to the Institute. His chief objections to the agreement, but rather that it would be well to pass a Institute were (1) that the sum paid per member to its stringent resolution and forward a copy of it to the medical officers was less than that paid to medical officials of the Institute, since such pressure from the officers of societies not connected with the Institute. profession might produce real alterations in the present (2) that no one was excluded from nembership of the agreement. He cordially agreed with the suggestion Institute, whatever his income or position. He said that no ex-medical officer should be met in consultation