DISCUSSION ON TUBERCULOSIS. 711 



repeated at regular intervals. If milk from such a dairy could be 

 put up for sale tmder such conditions that it would not be mixed 

 with untested milk from other dairies, I think it would command 

 such an enhanced price that other dairymen would soon be induced 

 to adopt the same methods. 



With regard to our food supplies, I am of opinion that no 

 person affected with tuberculosis in an open form should be allowed 

 to work in an industry which requires the handling of food for 

 human consumption. 



A few words with regard to pulmonary tuberculosis. Koch 

 has stated that pulmonary tuberculosis is always caused by the 

 human type of tubercle bacillus, and those of you who have read 

 the publications on the work done, especially in Germany, during 

 the last few years will, I think, agree with him. Of thousands of 

 specimens of sputa examined by means of cultivation and inocula- 

 tion, in not one single instance could infection of the bovine 

 character be traced. 



Pulmonary tuberculosis in man is purely a disease due to the 

 human bacillus ; and in order to fight the spread of this form of 

 the disease we must treat patients already afflicted with it. To 

 my mind the first and most important step is compulsory noti- 

 fication. The bill which was lately before the Legislative Council 

 had two great drawbacks. If notification had to be made to Shire 

 Councils and municipal bodies it would be almost impossible to 

 ensure that strict secrecy which is so essential in such a delicate 

 matter. At present patients sometimes come to us in the earliest 

 stages of the disease. If these were frightened by the knowledge 

 that their ailment might be made public, I think that many of them 

 would prefer to remain ignorant of the exact nature of their disease 

 rather than run the risk of publicity. To my mind the Board of 

 Health is the authority to which notification of the existence of 

 the disease should be made. After notification no fui'ther steps 

 should be taken, provided that the medical attendant guaranteed 

 that all precautions had been observed to prevent the spread of 

 infection. Furthermore, only cases of open tuberculosis should be 

 notifiable. There does not seem to be any sense in notifying, for 

 instance, a case of tubercular knee-joint, seeing that there is not the 

 slightest danger of infection. 



With regard to tuberculosis dispensaries, so much has been 

 said lately on the subject, and the benefits of these establishments 

 are so apparent, that I shall only lay stress on one point. With 

 these dispensaries in existence poor people will be able to have 

 their disease diagnosed in the very earliest stages, and possibly they 

 may undergo treatment. Under present conditions persons suffer- 

 ing from commencing tuberculosis must go to a sanatorium for 

 some months at least in order to have a chance of recovery. But 

 what happens to their families in the meantime ? If in such dis- 

 pensaries we were able to diagnose the disease before there was any 

 actual breaking down of lung tissue, that is before the disease had 



