DISCUSSION ON TUBERCULOSIS. 703 



they may be, which are now in operation, or which are I hope about 

 to be put into operation against tuberculosis. No one wishes to 

 decry the work which has already been done, nor the fine results of 

 which it has been productive. Of these results, confining oneself 

 for the moment to New South Wales, it is only necessary to point 

 out that the death rate from tuberculosis in this State has fallen 

 over 33 per cent, since Koch's announcement of his discovery of the 

 tubercle bacillus in the year 1882, while in the other Australian 

 States approximately similar reductions have taken place. 



But successful as these measures have been, it is impossible 

 to deny that they have been to a large extent desultory. There 

 has been little or no co-ordination ; and when one says this one 

 does not speak of Austraha only, but of the whole English-speaking 

 world. Private benevolence and private enterprise have stepped 

 in here and there and done a great deal. Large municipalities, 

 and even the State itself, have come forward, but hitherto nearly 

 all the work done has been disjointed. Here in Austraha, for in- 

 stance, our special means of fighting consumption consist in brief 

 of a few sanatoriums controlled by charitable societies for the 

 poorer sick, and by private enterprise for the better-to-do ; in some 

 of the States there are State hospitals for the more advanced cases ; 

 but everywhere the accommodation in both these classes of in- 

 stitutions is notoriously inadequate for the numbers who need them. 

 Then we have some localised systems of notification. In the city 

 of Sydney, to take a case in point, notification of consumption is 

 compulsory within the city boundaries only ; while throughout the 

 whole of the suburbs, which contain four fifths of the population 

 of the metropolitan area known as Sydney, consumption is not 

 notifiable, and this statement is equally true of the rest of New 

 South Wales. The results of this localised system of notification 

 are sometimes rather absurd. A consumptive patient residing on 

 the north of Cleveland Street will be notified ; he will be visited 

 from the city health office ; he will be instructed in all the pre- 

 cautions he ought to take to avoid the spread of infection, and his 

 domicile will be visited from time to time to observe that he is 

 carrying out the advice which has been given him. Finally, when 

 he moves away from liis house, a trained staff of disinfectors will 

 visit the place and thorov:ghly disinfect the rooms he has used. If, 

 on the other hand, our consumptive lives just south of Cleveland 

 Street and so outside the city boundaries, he will not be notified, 

 though the neighbourhood he is hving in is quite as populous, and 

 the conditions existing in it essentially the same as those in the 

 city just across the street. 



Finally, we have in each State a public health service with 

 generally very inadequate powers to deal specially with consump- 

 tion, and insufficient funds allotted to them for that special purpose. 



It may be asked, if our past measures have been inadequate, 

 how is it that the mortality from consumption has diminished so 

 greatly as it has ? I believe the answer to this objection is that 

 the great decline in the death rate from consumption has been due 



