DISCUSSION ON TUBERCULOSIS. 707 



required for cure is lengthy ; minimum has been stated to be two 

 years. 



In regard to the first of these, every case of pulmonary tubercul- 

 osis may be a source of infection, unless supervised. Our best means 

 of prevention is to get all cases as early as possible — in fact do 

 everything we can for the early detection of cases ; a great help to 

 this would be to urge self notification. 



For the second, whilst we recognise and want to impress the 

 fact that the disease is curable, we must remember that tuberculosis 

 is curable only in proportion to the extent of the disease. This 

 usually means the duration of the disease. Whilst probably all 

 early cases are curable, only a very small proportion of advanced 

 cases respond to treatment. This is again a reason for getting cases 

 as early as possible. 



Thirdly, a very special feature of cure in tuberculosis is the 

 length of time required, the usually accepted minimum being two 

 years. It is this length of time that makes treatment so expensive, 

 on account of the cost of living for so long under special conditions 

 and without earning anything ; likewise we might add that the 

 length of time required for treatment is really proportionate to the 

 stage of the disease in which it is started ; so that for economy we 

 should try to get cases at their earliest onset. In fact, instead of 

 getting early detection with its valuable effect on prevention and 

 cure, at the present time exactly the opposite state of things exists 

 amongst State School teachers and Civil servants ; the tendency 

 is to hide the nature of the illness and remain at work ; in this way 

 infection may be disseminated amongst those with whom they 

 are associated, and when the true nature of the condition is dis- 

 covered the cases are frequently too far advanced for permanent 

 cure. 



In consideration, therefore, of the necessity of prevention of 

 infection, of the difficulty of obtaining early detection of tubercul- 

 osis, together with the value of the lives to be saved, we have made 

 the following recommendations : — 



That teachers suffering from tuberculosis shall be referred to 

 the Government Medical Officer. 



That on the certificate of the Government Medical Officer the 

 Education Department be empowered to grant leave of absence in 

 favourable cases, irrespective of the length of service of the teacher 

 concerned, for a minimum period of six months, and a maximum 

 period of two years, on the terms and conditions as follows : — 



That full pay be allowed for the first six months, and, if ex- 

 tended leave is necessary, half-pay be allowed for a further period 

 of six months. 



That in favourable cases in which leave of absence under 

 special conditions is recommended, treatment in an approved 

 sanatorium is compulsory, and that supervision by the Department 



