694 PROCEEDINGS OF SECTION I. 



contributory causes, chief of which, is general improvement in sanita- 

 tion ; but in Germany, during the last decade, the death rate has 

 diminished by 25 per cent, without any marked improvement in sanita- 

 tion, but during that period £10,000,000 have been spent by insurance 

 societies on the erection of sanatoria, to say nothing of large sums spent 

 privately in the same way ; and it is admitted that the diminished 

 death rate has been brought about in great measure as a result of the 

 sanatorium treatment. In France during the same period, where few 

 sanatoria have been erected, the death rate has remained practically 

 stationary. During the same period in the Australian States, which 

 have been slow to adopt the sanatorium treatment, there has only been 

 a slight decrease ; whereas in South Africa the mortality from con- 

 sumption seems to be on the increase. 



The conclusion is that the greater the number of patients who can 

 be cared for in sanatoria and special hospitals, the sooner will this 

 disease be stamped out. But it must be remembered that the patients 

 in these institutions are not quarantined ; we cannot restrain their 

 movement, nor do I think we are called upon to do so. The importance 

 of these special institutions is that they educate the patients in those 

 principles which prevent the spread of the disease. It is high time 

 that we thoroughly understood the nature of the infectiousness of 

 consumption. It was an immense advance when we recognised that 

 it was really an infectious disease, and due to a specific organism, but 

 a great deal of unnecessary hardship is entailed upon the sufferers from 

 the popular misjudgment of the nature of its infection. You must 

 remember that the tubercle bacillus is one of the most difficult of all 

 pathogenic germs to cultivate, and that it does not maintain life very 

 long outside the human body. It is very easily destroyed by fresh air 

 and sunlight. It is admitted that in not more than 20 per cent, to 

 30 per cent, of cases can we trace any definite source of infection, and 

 the contraction of the disease seems to depend much more on suscepti- 

 bility, either inherited or acquired, than on exposure to infection. 



The precautions adopted in a sanatorium are ample, and if these 

 are carried out with scrupulous cleanliness we are convinced that a 

 consumptive need not be banished from society. I could point out 

 that old standing chronic cases are the greatest menace to the safety 

 of the public. Such patients grow weary of taking precautions, or are 

 too weak to pay attention to the demands of cleanliness. For such, 

 the provision of such hospitals as we have on North Terrace is the only 

 satisfactory safeguard. 



4.— SCHOOL HYGIENE IN TASMANIA. 



By J. S. C. ELKINOTON, M.D., D.Ph., Chief Health Officer and Permanent 

 Head of the Defartment of Public Health of Tasmania. 



[The substance of this paper has been included in an article under the same 

 title published by the author in the " Journal of the Royal Sanitary Institute," 

 London, vol. XXIX. (1908), pp. 285-290.] 



