702 PROCEEDINGS OF SECTION I. 



decision on each case also must rest ; they alone can say what kind 

 and extent of precaution is necessary in each case. 



The characteristic of this plan lies in examination into, and 

 consideration of, the circumstances surrounding each individual 

 case of phthisis ; and on no other principle can restraint of con- 

 sumption be attended with hope of success. Such, at least, is my 

 firm opinion. Consequently universal notification of all cases of 

 phthisis is the indispensable foundation. On the need for notifica- 

 tion I am confident there cannot be two opinions among us here 

 present, and therefore I say no more about it. On that foundation 

 a superstructure must be reared. Its general character, I think I 

 have sufficiently indicated already ; but the administrative factor 

 needs consideration. Two requirements involve legislation. The 

 first is universal notification ; the second is power to enforce 

 segregation in cases where it is clear that the safety of the healthy 

 cannot be otherwise ensured. This latter power would carry with 

 it power to make and to enforce regulations for the conduct of con- 

 sumptives allowed to remain at home. As regards the executive, 

 in the first place every member of the medical profession must be 

 enlisted — that is to say, every member must be employed, or be 

 liable to be employed, by Government on this business in his own 

 neighbourhood, and must be paid for his services ; and in the 

 second place, sanatoriums to accommodate the segregated must be 

 erected. You may consider, sir, and the members of this Section 

 may consider, that this proposal which I have sketched only in the 

 broadest outline, and merely so as to indicate a principal of action, is 

 arbitrary, would be distasteful, and might be oppressive. Very 

 likely. But it must be remembered that we are concerned with 

 natural phenomena. If we do not divert the forces, and alter the 

 conditions which lead to the dissemination of tuberculosis, they will 

 continue to take their proper effect, and relentlessly. Humanity is 

 one thing, and to be cultivated ; sentimentality is quite another. 

 When fear takes possession of the people as, for instance, in relation 

 to smallpox and plague, there is no proceeding so arbitrary, so 

 distasteful, and actually so oppressive, that they will not sanction 

 it, nothing, necessary or unnecessary, which they will not enjoin 

 and enforce, even in spite of the reasoned recommendations of well- 

 informed advisers. Why, then, should we be deterred by such 

 considerations from commencing to advocate a course in the case 

 of phthisis which is supported by all sound knowledge ? For my 

 own part, I must say clearly that I have formed a very definite 

 opinion that endeavours to reduce the prevalence of phthisis on any 

 01 her plan will drag on interminably, and in the end will be found to 

 have failed. 



Dr. W. G. Armstrong, D.P.H., Medical Officer of Health, 

 Sydney, said : — 



The point which I particularly wish to emphasise in this dis- 

 cussion is the importance of co-ordinating the measures, whatever 



