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1926.

THE PARLIAMENT OF THE OF AUSTRALIA.

REPORT

OF TH.E

ROYAL COMMISSION ON HEALTH;

TOGETHER WITH

A P P ENDI C ES.

P resented by Command ; ordered to be printed, 14th J anuary, 1926.

[Cost of Report :-:-Prcp::u·ation, not given; 900 copies; approximate cost of p r inting and publishing, 1;1(\[i.)

.Printed and Published for the GOVERNMENT of the COMMONWEALTH of AUSTRALIA by H. J. GREEN, P r inter for the State of Victol'ia .

No. 3.-F.IOSL-PRICE 2s. 9D.

1 247

., .)

COMMONWEALTH OF AUSTRALIA.

GEORGE V., J;ly the .Grace of God, of the United Kingdom of Great Britain and Ireland and of the British Dominions beyond the Seas, King, Defender of the Faith, Emperor of India.

To our trusty and well-beloved SIR lfEORGE A. SYME, K.B.E., M.B., M.S., F.R.C.S. (England); FRANK S. HoNE, B.A., M.B., B.S. ; RoBEitT HENRY B.A. (Oxon.), B.Ch., F.R.C.S. (l.), D.S.M., Barrister-at-Law ;

JANJ

GREETING:

KNOW YE that We do by these our Letters Patent, issued in our names by our Governor-General of our Commonwealth of Australia., and in pursuance of the Constitution of our said Commonwealth, the Royal Commissions Act 1902--1912, and all other powers him thereunto enabling, appoint you to be Commissioners to inquire into and report upon public health as a matt.er for legislation and administration by the Commonwealth, in conjunction with the States where n ecesf3ary, and more particularly with respect

(a) the · co-ordination of Medical Services of Commonwealth Departments in regard t o all matters affecting

public health ; (b) the co-operation of Commonwea.lth and State health authorities;

(c) the prevention of the outhreak, development, or spread of disease in the C?mmonwealth ;

(d) the prevention of vener eal disease and the exerciRe of control over, and thn treatment of, persm1s suffer·

ing from venerec1l disease ; (e) uniform legislation with r e!?:ard to purity of food and drugs; {f) maternity hygiene and child welfare ;

(f!) industrial hygiene ;

(h) the encouragement anq develupment of research work;

(i) the relationship which should exist between public health authorities and medical practitioners in regard to the prevention of dir;ease ; (j) the relationship whic·h should exist between public h ealth authorities and other public authorities rendering medical services ; and (k) the publication of information r elating to matters concerning public hPalth .

AND ·we appoint you the f:'ai d Si1· GPorge A. Syme to be the Chairman of t he said Commissioners.

AND We direct that, for the purpose of taking evidence, three Commissioi;erf': shall be suffi cient to constitute a quorum, and may proceed with the inquiry under these our Letters Patent.

AND vVe require you with as little delay as possible to report to our Governor-General of o u r .:-:ai el COJllll10llWCHlth the result of your inquiries into the mRtters entrusted to you by these our Letters Patent.

IN TESTIMONY WHEREOF We have caused these our Letters t o be made patent and the seal of om said Commonwealth to be thereunto affixed .

WITNESS Our right trust y and well-beloved HENRY WILLIAM BAR.0N FoRSTE R, a Member of Our Most Honora.ble Privy Council, Knight Grand Cross of the l\Iost Distinguished Order of Saint, Michael a.nd Saint George, Governor-General and Commander-in-Chief of the Commonwealth of Australia, this 7th day of Janua.ry, in the year of Our Lord One thousand nine hundred and

twenty -five, and in the fifteenth year of Our reign.

By His .Excellency' s ComnJa.nd, W. C. HILL, for PrimP- J.finister.

FORSTER, Governor-General.

Entered ou record by mc1 i!l F{,ng1ster of Pat.ent.s, No. 25, page 303, this 7th day of January, One thousand nine hundl'ed and twenty.five.

P. E. DEANE.

124 9

It I

/

ROYAL COMMISSION-LE1'TERS PATENT TABLE oF CoNTENTS

INTRODUCTlON

CONTENTS.

I. ILI,·HEALTH rn THE CoMliiONWEALTH IJ. MEDWAL SERVICES OF THE COMMONWEAL'l'H A.-Civil Departments B.-Defence Department

C.-Repatriation Department III. Co-OPERATroN OF AND STATE HEALTH AuTHORITCES

The Constitutional ABpect .International Obligations of the Commonwealth Co-operation in regard to 'Quarantine Co-operation in regard to other matters

Extension of Existing Co-operation Public Health Experts Chairs of Preventive Medicine and Tropical Hygiene Federal Health Council IV. PREVENTION OF DISEASE

A.-Action by Stat€s A Model Scheme Infectious

B.-Action by Commonwealth V. VENEREAL DISEASES · Effects of Legislation Venereal Disease Clinics

Commonwealth Subsidies VI. UNWORM I,EGISLATION WITH REGARD 1'0 THE PuRI'l'Y OL' F oon ,, N n Degree of Existing Uniformity Standards for Metric Svstem

Patent Medicines •

Infants' Foods Labelling .. Federal Standards Committee Legislation VII. MATERNITY HYGIENE

Maternal Mortality Puerperal Sepsis Causes and Prevention of Maternal Mortality Accommodation for Maternity Cases ..

Pre-natal Clinics Division of Maternity Hygiene Maternity Allowance Act VIII. Cmr.n WELFARE

The First Month of Life From the First Month t o the S.e cond Year From the Second to the Fifth Y ea.r· From the Fifth Yea.r to Adolescence Milk for Children Division of Child Welfare IX. I N DUSTRIAL HYGIENE ••

Present Conditions .. }}forbidity amongst W or kerR ..

Medical Services in Industry Standards of Health in Industry Division of Industrial Hygiene X. THE ENCOURAGEMENT AND DEYELOPMEN'l ' O F' RESEARCH WORK

Existing Facilities ..

PaguNo.

3

5

9

11

12 14 15 15 15 16 16 17 17 17 18 18 19 19 21 22

23 25 26 26 27

28 29

w 29 30 30

30 30 31 31 31 32 32 33 34 34

:16 36 :n 39 39

41 41 42 42

43 4 4

44.

4 5

45

Schemes for Developing Research 45

Constitut.ion of Resear ch Council 45

Research Fund 46

Need for Libraries . . 4!)

X!. THE RELATIONSHIP WHICH SHOULD EXIST llE'l.'WEEN PUBLIC HEALTH AUTHOR1'Il.ES AND M E DICAL PRAOTI'l'ION ERS ·t6 RPgistration of Medical Practitioners 47

XII. THE RELATIONSHIP WHICH SHOULD EXIS1' BETWEE N PUBLIC HEALTH AUTIIORITJES AND O ·rRER P UBLIC AUTHORITIE S RENDERING MEDICAL SERVICES 48

XIII. TnE PuBLICATION OF INFORMATlON RELATING ·ro P u BLIC HBALTH 4 8

Methods of Publicity 49

XIV. HEAL1'H EXPEN DITURE 50

XV. SUli1MARY O'F R ECOMMENDA:['IONS 5 1

XVI. EXPRESSION OF THANKS 54

XVII. CONCLUSION 54

/SEE. T 4llLE) 58

1 25 1

COMl\10N CfF AlJS'rRALIA.

REPOitT ()QMMISSIONEliS.

INTRODUCTION.

To His Exce{le?icy the Right Honorrable JoHN LA-WRENCE, BARON STON E -­ HAVEN, a member of His ll!laJ·esty's Mo st Honorrctble P1··i·vy Cmtncil ,

Knight G-rand Cross of the Most Order of Saint IVIichael

and Saint Georrge, Companion of the Disting·uished Service Orcle1··, Gove-rnor-General and in ancl mJer the Oorwnwnwea.lth

of Aust-ralia.

M.AY IT PLEASE YouH ExcELLENCY:

We, the C01nmissioners appointed by Royal Letters Patent to inquire into and report upon public health as a matter for legislation and adn1inistration by the Comn1onwealth, in conjunction with the States necessary, and n1ore particularly with respect to--

( a) the co-ordination of Medical Services of Commonwealth Departments in regard to all n1atters affecting public health; (b) the co-operation of Connrwnwealth and State health authorities ; (c) the prevention of the outbreak, development, or spread of disease in the

Cmnmonwealth ; (d) the prevention of venereal disease and the exercise of control over, and the treatment of, perRons suffering frmn venereal disec 1se · (e) uniform legislation with regard to purity of fo od and drngs ; (f) maternity hygiene and child welfare ;

(g) industrial hygiene ;

(h) the encouragem.ent and development of research work; (i) the relationship vvhich should exist between public heaJth authoritieR and medical practitioners jn regard to the prevention of disease ; (.i) the relationship which should exist b etween public he?J.th authorities

and other public. authorities r endering medica] services ; and (k) the publication of information relating t o rnatters eoneerning public health,

have th_ e honor to report as follows :-The 1natters referred to us for inquiry and report have involved. a,n exanunation of the legislation and administration ·with respect to public health by the Comnwnwealth and States, including the activities of local authorities and also of voluntary associations

and other bodies in the various States dealing with important Jnodern develop1nents in preventive medicine not covered by present h ealth legislation.

Evidence taken in all the Capital cities of Australia from responsible officials of Departments of Public Health, or of other Departments having functions related to public health; from Government Statisticians ; frol).1 officials of Local Health Authorities; from representatives of independent bodies discharging public health

functions as a ll1eans of . social welfare ; from lnedical practitioners in general practice or practising as specialists in various diseases within the scope of the inquiry ; .from University professors and lecturers who are recognized authorities on research a.nd other subjects Dt our inquiry from analysts and representatives of Con1merce: and from

many others with special _ kno·wledge or closely interested in various subjects referred to us.

Besides the various Capital cities we visited certain country centres in each State aud took evidence from the officials of 22 local health authorities (including those of 5 shires) with the view of ascertaining how the laws relating ·to public health are locally administered ; what degree of attention is paid to health services, and

provision is made for the isolation and treatment of infectious diseases, and for maternity rases, infant welfare, and industrial hygiene, by local authorities.

· We did not visit theN orthern Territory or the N ortherll parts of or ?f

·Western Australia. Valuable evidence was, however, taken on health and cli1natiC conditions in the tropical parts of Australia from Dr. J. S. C. Elkington (Di:ector, Division of Tropical Hygiene, Department of Health), Dr. R. W. Cilento (Duector of the Australian Institute of Tropical Medicine, Townsville), Dr. R. D. 1\'IcJntosh

(formerly Medical Officer at the Health Laboratory, To-wnsville), and Professor Griffith Taylor. Evidence was also taken with respect to Central Australia from the Rev. John Flynn, Superintendent of the Australian Inland 1\'Iission, Bush Department of the Presbyterian Church of Australia.

The number of public sittings for the examination. of witnesses, the number of witnesses exa1nined, and the places visited for the pltrpose of taking evidence were as follows:- -

---- , -Sta t P.. .Place . PubUc Sittings . Witnesses.

New South Wales Sydney 22 88

Newcastle 1 7

Grafton , . 1 3

South Grafton 1 3

I Lismore 1 6 Glen Innes 1 6 Lithgow ]_ 4 · Melbourne I 31 I - 76 Bendigo .. I ] I 6 Geelong ] i 3 . . I I I Mary borough 1 I 3 ! Amherst Sanatorium (Talbot) .. I 1 I 1 Brisbane I 5 2J Toowoomba I l I 6 .. I I I ., .. Adelaide . . 6 I 29 - Port Pirie 1 I 6 I Victoria

Queensland

South Australia

Port Augusta 1

I

2

l PeterborolJ-gh ]_ 5 Western Australia Perth 3 15 Kalgoorlie 2 8 Hobart 3 12 Tasmania Launceston 2 6 88 319 Evidence was taken at Grafton frmn the Shire Clerk of the Shires of Orara and Nyn1boida; at Lisinore from the Shire Clerk of the Shires of Gundurimba and Terania; and at Glen Innes from the Shire Clerk of the Shire of \V e also inspected a large number of public health and conditions in each State, including sanatoria -and for oases of tuberculosis, venereal diseases clinics, baby health centres or clinics, pre-natal clinics, schools for mothercraft, creches, kindergarten,-schools, hospitals arid infectious wards, health laboratories of the Conlmon)vealth and State, variop_s housing, industrial and mining COJ?-ditions, and major Quarantine Stations of the Cmnn1onwealth, at Sydney and Brisb&ne respectlvely. In :ve have .give.n consideration to many official memoranda an,d reports on the vanous subJects of mquiry, and have had numerous conferences with respect to evidence taken, and con,cerning the principles which have governed our decisions. 8everal of the headings of the reference embrace a large number of matters, an? they are therefore subdivided into subjects which are considered separately in this. Report. _ . The principal subjects are dealt with in the order set forth -in the but ihey overlap and are interwoven to a considerable extent. _ '

9

I,-=-ILL-H.EALTH IN THE In an inqujry into public health it seemed to us advisable, in first to make an investigation as to the extent and. character of 1ll-health ln. the Con1monwealth. -·

l, The Medical Officers of the Education Departments in the different States

1 25 5

stated that n.early all need attention for denfal defects, and that, large have AO$e and throat disease ?nd other defects, or are e1ther o:r Inentally. Reom;ds obta1ned as a result of rned1cal exam1nat1ons for nnbtary · purposes that a large number of both the adolescent and the adult malB pop11lation 1Vi1S below first standard. In the cadets annually examined from 1912 to ]9.20, 8 to 12 per cent, were rejected as unfit? and in the annual examination for Q.2o1os, 4978. the citizen forces from 1912 to 1925, from 13 · 76 per cent. to 29 per cent. were rejected. Of ·the examined for service abroad during War, 33 · 9 per cent. were rejec.ted. Q.2o6s2. Of men between the of 21 and 35 called up for medical examination by the prochuna·tiou of 1916, 42 per cent. rejected. 2. An attempt was n1ade to obtain deti1iled figure.s as to the causes of such low standard$D and as to the extent and causation of ill-health in ·the general population, but it - was impossible to gain exact infor.Plf1tion, because neither State nor Commonwe1:tlth administrations had developed machinery for the purpose. The. various State Statisticians who were examined said that comparatively little information could be given by them on this subject, because it had not been :regarded as within their field o£ activities, Even in regard to infectjous diseases, the Q. 3. Commonwealth Statistician stated : " The main vital statistics o£ importance are those which we do not collect because ours relate only to deaths." The Commonwealth and of Australia Conference on Industrial Hygiene, Sydney, 1922, stated-" Proper inquiry into the conditions under which the industrial classes carry on their ocoupation is alway$ hampered by the lamentable lack of statistical evidence of the experience of the workers engaged. No statistics exist of .the sickness e:xpe:rienced by the community at large corresponding to those of :mortality." The Commonwealth Royal Commisf3ion on · National Insurance, 1924- 2.5, endeavoured to obtain statistics as to morbidity in the Commonwealth, but did not sucoeed. The Comrnissioners .stated ; " The records of sickness experience of Friendly Societies First Progress would be of considerable value if a comprehensive $ystem of statistical tabulation and Report

Q. 33.

(l . 141 56.

Q. 1.4550 , Q. 14559.

l .. en.gu e c,f Natlom Health Organization Handbook,

No.8, 1925.

i)l,:m 5:1tlt.ut.lon Ar.t 51 (XL). Cen sus ancl 8t,,tistics A i'l 1906.

Q. 499?. .

10

The evidence of the Commonwealth Statistician indicated that valuabl e material on the subject of morbidity, which is now not used, might be made available. For instance, information could be obtained from records that might be collected by Friendly Societies, Charitable Institutions, Industrial Organizations, and others.

3. Under a lat er reference (p. 46) we shall deal with the relationship of medi cal practitioners to the prevention of disease, but we would observe at this stage that members of the medical profession are in posse.'lsion of a great deal of useful information as to the incidence and causation of disease which is not at present available to statisticians or health authorities. Memb ers of the medical profession sign death certificates and notify certain diseases, and in .. Western Australia furnish annual reports of cases of tuberculosis. It has been suggested that they should furnish particulars of all cases of illness that they nttend, or, ltt least, of such as the health authorities deem necessary .

4. In \ V" estern Anstralia the Stat e Statistician receives reports from hospital ::: and Friendly Societies, which include particulars of causation of disease . This improved procedure if't partl y due to the Statistician also being Registrar-General for Births and Deaths and Registrar of Friendly Societies, but it is also partly due to the

close association which exist ed years ago between the Sta t e H ealth Department and the Statistics Department. The procedure follo wed in Western Australia might, with advantage, be adopted by other States.

5. Exact and complete knowledge in regard t o morbidity is of fundamental importance in any jnquiry, or in any administration in regard to public health, and we are of opinion that the information indicated should be obtained. Certain increases in staff and in expenditure would be Tequired by the Commonwealth Statistician, but th ey would not be gr eat , and would he completely 1varra.nted by results.

In England the same difficulty and need have been felt for many years. As long ago as 1872 Dr. F arr, Registrar-General, said in his 'I'birty-fifth Annual Report-" The- reports of the existing medical offi.cers are of great practical value and will become more valuable every day. What is wanted is a st a·ff

offi cer in every county or great city, with clerks t o enable him to analyze and publish t he of weekly returns of sickness t o be procmed from eveq rlistrict. The thing t o aim at ultimately is a return of the cases o{

sickness in the civil population as complete as is now procured from the Army of England. lt will be an invaluable contribution to therapeutics, as well a:-: to hygiene, for it wi ll enable the tb erapeutist to <1 etermine the duration and the fat ality of all forms · of disease und er the several existing systems of trf\atment in the varion ii sanitary and social conditions of the people." In a recent official publication on this snbj ect, th e fo llmving st ate1neut is (referring to Bngland and vVales) :- ..

" At t he present moment there is no establisl1ed system for the regulnr eollectio:n and t abulation of cases oJ sickness other than for infecti011s disease.", hut the R t eps already ta.ken among hospitals and other instit.nti.ous, combined with the sp ecial research eff orts of public health workers, give gTO und for hope that the detai.]ed collection of Ln f\dical of gen.Pral siekness wi rJ

nltima telv be realized." ·-

We are of opinion that the :=;tage ])as been reached in our na.tional development when the Commonwealtl1 should exercise t o the full the powers given to it with regard to st atistics, and should arrange for the collection and classification of statistics of morbidity . The records of medical examinations by School Medical Officers, of

examinations of cadets, and other special records would afford most valuable information from the public health aspect if fu lly analyzed, classified, and tabulat ed. We are of opinion that , to do this sati,factorily, the services of a Statistician who is a m0dicaJ practitioner are essential. Dr. H arvey Sutton, Principal Medical Offtcer iu the

Department ot Public Instruction, New South \Vales, said, in evidence: " I n England they have Dr.' Brownlee in the St atistical Department, who has bee-n able to provide most valuable statistics. This work is quite outside the range of the ordinary statistician who collects vital statistics . I think the time is ripe in Australia when a

medical man should be appointed in the Statistical Department who really appreciates the value of causative influences. The present statistics do not give yon the full value in the study of causation . T think any one who has an ytl1 ing t o do with statistics will agree with me in tJmt regarrl."

11

RECOMMENDATIONS.

We recommend that------(1) Standardized statistical investigations into the extent and character of morbidity in the Commonwealth should be instituted and maintained . .

(2)

(3)

Definite , and formal co-operation should be established between the Statistician and the Health Department by associating a Medical Officer of the Commonwealth Depart!llent of Health with the Com­ monwealth Statistician's office to supervise the collection, tabulation,

and analysis of morbidity, mortality, and other vital statistics.

Legislation, where necessary, should be enacted to provide that such statistics as are required shall be furnished · by Government Departments, Friendly Societies, industrial and other bodies such as public hospitals, and by medical practitioners, to the Common­ wea-lth Statistician.

H.-MEDICAL SERVICES OF THE COMMONWEALTH. 1. The first particular reference in our Commission is " (a) T he co -ordination of medical services of Commonwealth Departments in regard to all matters affecting public health. " .

The evidence we have taken showed that the medical services are distributed among several Departments and under various Ministers. No single witness was able t o give a complet e aut hentic list of the whole of the medical services, but the foJlowing t able approximat ely shows the posit ion :-

Defence-­ Navy

Army

Air ..

Repatriation

Health

Department.

and Territories

Treasury­ P ensions

New Guinea

Prime Minister- -High Commissioner and Migration

Works and Railways

N umber a.nd Cha.ra c.:ter of Medical Officers .

19 permanent. 36 auxiliary

1 permanent whole-time 194 Militia part -time 38 Unattached 1,624 Reserv t>

2 whole-time Examiners and speciali sts (pft irl by

Minister.

Defence

44 whole-time Treasurer

90 part-time

32 whole-time H ck! lth

49 part-time Quarantine Offi cerx "-'2 whole-time Post Office and Public

Service

F ederal Capital, 1 whole-time t Northern Territory, 2 whole- 1 i mt · Norfolk Island, 1 whole-t;im t:' Papua, 5 whol e-time

tNew Guinea, 9 whole-time

Examiners (paid by fe es)

E xpropriation Board, 1 wbo! c-tinw

§1 whole-time

112 part-time

Treast1rer:

l)rime Minist er

Works and Railways

·------------ -----.!.-- ----- - · -- ·· --------------

• The t wo officers arc officers of the Healt h Department. t One acts as Quarantine ''fficer as well. t Dr Cilento is

loaned ':Y to act as Director of Health in New Guinea. § Tn Londou. !! Ad\1sory to the

on cxanunatlon of appli cants fm · employment, and testinn employees as to vision and liea.l'inn &c · also medical ofli ce:ro to a :R.A!lwA.y Medical Fund . Q e- ' • • · -

1 25 7

Q. 2112.

Q. 692.

Q. 631.

Q. 806, 809.

Q. 1308, 2402.

12

2. The evidence showed that each medical serviCe 1s quite distinct, and is practically a watertight compartment. \Vhile there is no systematic or routine .co-ordination between the services, they mutually assist and co-operate with each other to some extent, For instance, the Directm>·General, Army Medical Services, advises the Air Force Medical Services. The Department of Health loaned Dr. Cilento to the Home and Territories Depart1nent to organize medical services in New Guinea. The Treasury permitted the .Department of Health to make an analysis of medical records with regard to Invalid P-ensions, The Repatriation Department co-operated with 'bhe Department of Health in regard to inquiries as to bilharziosis and in dealing with tuberculosis, and with State Departments in treating mental cases and providing hospital accommodation. On the other hand, lack of co-operation also exists. For instance, the J\1edioal0ffioer.s of the Defence Department through their annual medical examinations of cadets and citizeu forces for many years have been obtaining information ·which would be useful to health administrators, but the information has not been made available for this purpose. is also true of the information obtained in the medical examinations for invalid pensions. As has previously been pointed out regarding morbidity statistics, the requirements of health administrators have not always been recognized by other Departments. Some of the want of co-operation in matters affecting health has arisen from the fact that the Department of Health of the Cmnmonwealth was established subsequently to the other Departments.

3. The Medical Services may be grouped into those of the Civil, the and the :Repatriation Depart1nents.

A.- MEDICAL SERVICES OF DEPARTMENTS.

Q. 693, 659. The evidence we have taken showed that all the Civil Services could be

co-ordinated by placing them under the :Minister for Health and under the sup@rvision of the Department of Hea1th.

Apart from the Department of Health itself; the problems of these medical services present themselves under various aspects-(a) Territorial Administration.- This includes the medical services of the Federal Capital Territory: Pa.pua, Norfolk Island, and the

Mandated Territories. The medical officers in these services are all whole-time officers acting as health officials. They are in most controlled by the Hmne. and Territories Depart1nent, hence where there is only one medical officer, as in Norfolk Island, he is not in official relationship with any other medical officer. But the close inter-relation of these services with the Department of Health is shown by the fact that one such officer in the Northern Territory acts a,s Quarantine Officer, by the laboratory at R,abaul being under the Departn1ent of Health a,:nd by the loan of Dr. R. W. Cilento from the Department of Health to re-organize the medical services of New Guinea. As

health oftl.oials these 1nedical officers $hould ha the training and status as other n1edical officers of the Comn1onwealth Depa,rtment of H ealth.

We are of opinion that the Commonwealth Department of Health should directly control all the Territorial Medical Services, and ·that the of these services

should be on the staff of that Depart1nent. One advantage of such an arrangement would be that the medical officers would have more opportunities of transfer . and pron1otion, and the service would then be attractive to a larger number of m.edical practitioners of good capability and training who would make public health thejr perinanent. work, and the service would be more efficient in consequence.

Q. 62o, 94oa. (b) Depa·rtmental includes the Pensions Branch of the

Treasury, the Postmaster-General's, and other Departments. The medical services of t.he Pensions Branch are performed by many part-time medical referees, who are paid by They are no medical supervision, and, ftS has beeP. pointed out ? no use

is made of the information obtained by them.

1259

13

The remaining medical services consist mainly of the medical examination of entrants to the Commonwealth Public Service, the re-examination of officers for extended sick leave, and the supervision of conditions of work, ;although the last has been very little developed. In the Postmaster-General's Department a whole-time medical officer has for some time been employed in Sydney. . This officer has recently Q. 1129, 9463•

been transferred to the Department of Health ; his ·duties have been extended to all 948 •

sections of the Public Service, and a similar appointn1ent has been made in Melbourne. The medical examination of entrants to the Public Service is made in practically all cases by medical practitioners specially appointed for the purpose. Certain of the medical officers in the larger centres are paid a s1nall . retaining fee, and in all cases, except the two whole-time officers in'"Sydney and Melbourne above-mentioned, the fee paid by the candidate is retained by the medical officer.

The Commonwealth is becoming a large employer of labour, and the services of the experts iu, the Industrial Hygiene Division of the Health Department should be officially utilized in supervision of the health and working conditions- of all Comnlon­ wealth employees .. In this way a standard would be set for other employers. Further, in the Co1nn1onwealth Railways, in connexion with the new. railways that are being planned, there wrll be need of expert sanitary supervision. vVe are of opinion that all

the medical services required by the various Departments of the Commonwealth should be performed by officers, whole-time or part-time, as the case may be, under the­ supervision and control of the Departlnent of Health, not only on the ground of economy and efficiency, but because the information acquired by such officers could

then be collated by the Department of Health and 1nade available for dealing with the subject of the prevention of disease in the community.

4. "The _ Commonwealth l\fedical attached to the High Commissioner's Office in I .. ondon is under the Prime l\finister. His chief work is in cortnexion with the medical examination of migrants, which is under the Minister for 1\figration. He has also Q. 21 sss, certain important duties in connexio:ri \vith the Department of Health, and all his duties

21382 .

are concerned with health. In our opinion, he should be under the Minister for Health.

RECOMMENDATIONS.

We recommend that-(1) The health administration of the Federal Territories (including Northern Territory, the Capital Territory, Papua, Norfolk Island, and the Mandated Territol'ies for New Guinea and Nauru) should be placed under the Commonwealth Department of Health.

(2) All work, for which the services of medical practitioners are required by the Commonwealth in any civil, as distinct from Defence and Repatriation administration, should be performed by medical officers, who should be either permanent whole-time or temporary whole-time, or temporary part-time officers as may be found advisable, of the

Commonwealth Department of Health.

(3) The present arrangement regarding the Commonwealth Medical Officer at Australia House, London, should be altered, and that the Principal Medical Officer in Great :Britain should be an officer of the Commonwealth Department of Health, whose duties should include--'-. (a) the control of the medical examination of intending migrants to Australia from

Great Britain- with power to select the Medical Referees ;

(b) the supervision of any arrangements which may, from time to time, be made for the medical examination of intending migrants from Europe ; -(c) acting as medical representative of the Commonwealth in all international health and quarantine questions, including those relating to animal and plant

quarantine ;

(d) taking steps to ensure that the Commonwealth Department of Health is promptly informed of all matters affecting or likely to affect health or quarantine administl.'ation in Australia ;

(e) regillarly supplying the Commonwealth Department of Health with authoritative · information in regard to health and disease ;

(f) adVising with respect to any medical questions which may be referred to him by . the High Commissioner or the Director-General of Health under the Comnierce Act or under any Legislative enactments dealing with food or drugs;

.. 2 7:2 7.

! I I\; .

Q. :2 21')(!. Q. l ?l H.

Q . 685:>.

Q . (j!)(jfi

1789.

Q . :?.21:16.

14

(g) acting as adviser to the High Commissioner, . London, on medical and health ' matters. (h) carrying out other duties as the of Health may from time to

time require .

.B.--..lVIEDICAL SERVICES O_F DE.PAR'l'lVLEiN'J'.

The evidence concerning the JVIedical ;-)ervices of the Defence JJ epartHwnt sorn.ewha.t contradictory . The Naval Medieal ·8ervices, according to Surgeon-Com­ Jn a.nder Gayer-Phipps, Director, Naval l\1:edical Servjees, nrust be kept separate aud distinct owing to their special organization and requirexnents, and particu larly t.he relation of the AustTalian to the British Navy. V\ ith this view Major-G eneral Fetherston, fonnerly Director-General, Medical Services, and Dr. Cumpston, Director-General of liealth: agreed. On the other hand, Major-General Barber, the present :Director-G eneral, lVIedical Services, Lieutenant-Colonel T. E. V. Hurley, Assistant Director, Medical Services, (temporarily carrying out the duties of Director-General, lVIedie;al Services) Colonel Nlaguire, Deputy Director, Medical SeTvices, New South Wales, a.nd Colonel .J. A. Dick said a sche1ne of co-ordination, and even of complete ainalgaJnation,

\Yas possible . Uolonel Maguire put the case as follows :-" As far as the

treatinent of the sick concerned there is no difference whether a n1an belongs to the Naval, 1\'Iilitary, or Air Forces, he is treated in the same ··way. From an achninistrative point of view, the three services might be combined, there are considerable difficulties in regard to each. The technical achnini-stration of each an11 of the service is so different that it would be neeessary to have three separate technical services . The 1nain advantages of fusion of the services would _be econo1ny and economical distribution of personnel. During peace time the Naval, l\1ilitary, and Air Forces could be easily administered by one head, but in war time it would be a difierent matter." Lieutenant-Colonel T. E. V. Hurley, in his evidence, said that at a conference held in 1922 an agreement was reached for a Common l\ieclical Service for the three branches. A copy of the report of that conference was furnished to us. It was signed by Sir N-eville Howse, Director-Genera], Medical Services; Surgeon-Com­ Inander Eames, Director, Naval l\fedical Services; and SquadTon-LeadeT A. P. Lawrence, Senior l\iedical Officer, Air Servic:es ; it recomn1ended a single service. JVIajoT-General Barber, Director-General, ]}fedical Services, in his evidence ;;;aid he had drawn up two sehemes, one for co-ordination and the other for amalgamation of tbe Army, and Air Medical Services. Amalga1nat.ion n1eant that there would be -

one service. Co-ordination meant keeping the three services distinct. The follo ·wing is his sche1ne for co-ordination :-co.oj: 1 ll i\AT 1 ux.

NAVAL, MILITAH,Y, AND Ail-:. S81:V! CES.

MlNlSTE

I I I

NAVAL BOAlJ,D MILITARY BOAR.D AIR :ROA H.D

------- --- 1 . . ------·------ D.G.l\1. 0 A .D. G.l\i.S. \Part 'J'itlle) i I I A.D.G.M.S (Navy) (Reserve) D.D's.M.S. (S t :t.t es) (Part Time) I (l'a.·L Timo 1 _ _ T_ __ 1 Ai<· Est,!bli>hments. NAVY Naval :\J e dical Otlicer :-o F xed Machinery 1 Aux . Services Military Naval E E.tablishme nts Citizen Naval Forces I M .. O's. i/c Permanent Field Troops P e r souuel (Navy I (Shore ' , Army, Air) Three of our n1em.be:rs (Sir George Syme, JJr. IIone, and Dr. 'lodd) have" when 1nen1bers of the Federal Coinmittee of the British IVledical Associatjon in Australia, considered the question o:f. a single 1nedical service for all the Defence FoTces, and agreed with the resolution of that Cmnmittee, of 9th February, 1922, to the efiect that there should be one 1nedical service to provide for the of the the Anny, and the Air Force. · Having carefully considered the evidence, and especially that of Surgeon Cmnn1ander Gayer-Phipps, ':Ve are all of opinion that the schen1e for co-ordination submitted bv 1\'Iajor-General Barber, Director-General, l\1edical SeTvices, is preferable to that for and is both practicable a.nd advisable, provided that the Sub­Director of each Service shall have power to act independently should en1ergency arise.

-.____.

15

C .- MEDIUAL SERVICES HEPATRIA'l'ION DEPARTMENT.

The Medieal Service of the Repatriation ])epartnlent is sorne·what peculiar. The Repatriation Con1mission is under the control of the Treasurer, bnt although the ex-soldiers are no longer under the control of the Defence Depart1nent, it is very advisable that the 1nedical officers dealing with thern sho ul< I have had military " experience . · ·we agree with t he opinion of Dr. Court ney, th8,t all whole-time medical Q. officers of the Com1nonwealth should have uniforn1 status, pay,

1 261

Suggestions have been 1nade that a Consultative Board, consisting of the · Directors of the :Medical Services of the Defence, Repatriation, and Health Department s, should be instituted to devise methods of co-operation between these services in Q. G os7. matters nonnected vvith public health in which all , or more than one, are interested. Such a Board could · render valuable services. It could, for instance, arrange for

securing records of 1p1fit recruits and the effective after-attention of the cause of unfitness, and for the of statistics; it could also deal with questions of hygiene in

the Defence Services. The protection of the civil population fron1 the effects of gassing in possible enemy air raids in tin1e of war is a n1atter that was brought to our notice, and is one requiring immediate attenti_on. We have not been a ble to consider it, but suggest that such· a Board as we propose n1ight take some initiatory steps in the 1natter. It should rneet at stated intervals, and elect its own chairn1an.

RECOMMENDATIONS.

We recom·mend that-/

(1) The Medical Services of the Repatriation Department should remain as at present. .

(2) The Medical Services of the Army, Navy, and Air Force should be co­ ordinated under one Director-General, with Sub-Directors in each Branch, keeping the three services distinct. (3) A Consultative Board should be established, consisting of the Director­

General of the Defence Medical Services, the Director-General of Health, and the Principal Departmental Medical Officer of Repatriation, to devise _ methods and means of co-operation between these medical sei·vices. III.- CO-OP ERATION- 0], COMMONWEALTII AND STATE HEALTI-I

ATJTHORITIES. Ti!E CoNSTITUTIONAL AsPECT.

-!, The second particular in our Co rnmission is " (b) The co-operation of Comn:tonwealth and State Health Authorities." This reference seems to us to i1nply that the respective functions of the Commonwealth and St ate Health Authorities should continue as at present, but, as several witnesses have expressed the opinion that the Constitution should be amended in order to give the Common,lirealth general legislative Q.6sio. pow ers in regard to Health, we feel called upon to consider the question as to the extent Q. 20188 · to which public health should be, in th_ e general terms of the reference, " a matter for legislation and administration by the Com1nonwealth." ·under the Constitution Act Q.2no-1.

the Commonwealth has no general legislative powers in relation to health, apart fro1n quarantine. Under some of its otheT legislative however, it can pass QAosi. legislation having a bearing on health. It can, for exan1ple, legislate on 1nigration, ;,orr· Act. trade an:d comn1eree, census and statistics, 1narriage and divorce, invalid and old -age Q.4o 5i .

pensions. It can also enact legislation providing for · the expenditure of public funds u.pon .purposes considered to be for the svelfare of the p\lblic, which has hitherto been accepted as including health. General powers to legislate on health could be conferred on the Conlffionwealth comt. Aet.

by an1en d1nent of the Constitution, through referendun1, or by the States voluntarily s. 128 . ;)Urrendering their powers by Acts of State Parliarnents. If such powers were conferred

by either of these n1ethods, a CominonVilealth Ministry of He9Jth could then be established which would control all · services relating to health in Australia, just as the lVIinistry of Health controls them in Great Britain. From our own experience and investigations while visiting all -.the States, we recognize that in a country so large, so diverse in climatic and other conditions, and so

sparsely po:pul.ated as of J-Iealth, similar

of Great Britain, could not effectively carr-y out Its functions except by devolVIng Its powers on local authorities in the several States. As many services in conne:xion with

Q. 72.

Q. 4042-9.

Q. 1 33.

Q .1 8402, Q.18406.

Q.20618.

Q.1:H64-88. Q.l6514-1G. Q.20679.

Q.21330-47.

Q.20618 . Q .66. Q.8997. Q.l8593.

Qnarant·i1w Act 1908-1924 . 8. 2A. (1.).

Q.20618.

16

health are under State Local Government Act s, difficulty would be likely t o arise, as a result of such devolution of powers, and we do not recomn1end that any action be taken by the Commonwealth to obtain general powers to legislate on health, unless approached by the States, provided by the

2. 1-Ia ving co1ne to this conclusion, we made an examination into the of co-operation between Common-vvealth and St at e Health Authorities under present Constitutional conditions. This examination showed that co-operation had taken place and had increased year by year; it revealed that failure to co-operate had also occurred, and indicated, further, some of the causes of failure, and the lines along which better co-operation could be about in the future.

INTERNATIONAL OBLIGATIONS OF THE COMMON"\VEALTH.

3. The emphasis on quarantine as the sole general power of the Commonwealth with regard to health has tended to obscure the fact that constitutionally the Commonwealth is the medium for dealing with health authorities overseas, and that as a signatory t o t \ e Paris International Sanitary Convention of 1912 and the Treat y of Versailles, and as

a member of the League of Nations, it has accepted international obligations with regarcl to health. These include the duty of forwarding inforn1ation on matters of international concern for the prevention or the control of disease. For the supply of such information the Commonwealth is at present dependent on the voluntary assistan.ce of the States. The information required has generally been supplied, but delay has sometimes occurred before it was given, and occasionally it has been insufficient. This has been due jn smne instances to the State Authorities not fully realizing the obligations of the Commonwealth, or in others to the powers of the State Health Departments being limited by their own statutes, while at times, as in the outbreak of plague in 1921, political considerations have been responsible. The first of these difficulties can be over­ come by the appointment of the Health Council we suggest later on (p. 18) ; the second

we will consider under reference (c) (" The prevention of disease," p. 19); the third will be liable to recur, if public health is subordinated to political exigency. In our opinion the Commonwealth should have power to enact any legislation necessary to enable it to carry out its above-mentioned international obligations.

Co-oPERATION IN REGARD To QuARANTINE.

4. The Constitutional powers of the Commonwealth with regard to quarantine were exercised by the passing of the Quarantine Act 1908. In the years immediately following, co-operation took the form of the State Departments of Health carrying out the provisions of the Quarantine Act under the direction of the Direct or of Quarantine, the Chief Medical Officer of the State Department of Health acting as Chief Quarantine

Officer in the State concerned. The State Governments were paid a certain sum for the services of the officers carrying out the work. Similar arrangements were made with respect . to anin1al and plant quarantine, and these, -vvith certain modifications, are stiJl in existence. Evidence before the Commission showed that with regard to animal

quarantine the Commonwealth could now be of greater assistance by providing an expert in veterinary science at the head of a Veterinary Quarantine Division of the · 9ommonwealth Department of Health, who, a1nong other duties, could advise its officers Ill the States. As these at present are also State officials, such an arrangement

wonld be an extension of co-operation between the Commonwealth and States. system under officers of the State Health Departments carried out

quarantine work has (except Ill the case of Tasn1ania) been discontinued for some years. The Act is now administered, so far as human or general quarantine is concerned, by a permanent Commonwealth officer and staff stationed in each State (except Tasmania) as a of the Commonweafth Depa:rtment of Health. Consequently, co-operation

has since had to proceed on different lines, and, on the whole, it has been successfully It however, failed the stress of epidemics as in that of small-pox

Ill 1913, Influenza m 1919, and plague ni 1921. Although the Commonwealth Quarantine J\ct. now been amended (s. 2A (1.) by the introduction of a provision which will the danger of a of some of such difficulties, the . necessity still

continnes for the most complete co-operation possible between the Commonwealth and the. Health Authorities in times of threatened epidemics. We think that the :pos1t1on _of the Co:inmonwealth Department of Health in regard to the perforn1ance of Its functions would be more clearly defined if the Quarantine Act were further amended by the addition to section 11 at the end thereof of the words "and in promoting public health."

1 263

17

CO-OPERATION IN REGARD TO OTHER MATTERS.

5. In those matters affecting health of which the States have sole co:r:trol, evidence has been submitted that a considerable degree of co-operation has existed between the Health Authorities of the Con1monwealth and States. They have Q· 5775• combined in an investigation into hook\vorm over the whole of Australia and in promoting measures for its eradicat ion where found to be present. They have similarly acted in .., co-operation in the campaign against venereal diseases, by the Commonwealth No.3 (a). subsidies to the States for expenditure on venereal disease. Conferences of Comn1on-wealth and .State I-Iealth and other officials have been held to devise uniform legislation and regulations with regard to purity of food and drugs, and to devise 1neasures for

uniformity in the action to be taken against tuberculosis. While these and other con-ferences have been of considerable value, great delay has frequently occurred in giving effect to their recommendations. In son:1e instances the recommendations have not been fully carried out.

The Commonwealth Department of Health has also co-operated with State Q.1 2222 . Departments in the fields of Industrial Hygiene and Sanitary Engineering, by providing Q. 76· experts. in these who have advised health m?nicipal in_various

States m regard to partiCular problems. It has also Instituted laboratones wlnchhave . been of great assistance, not only to State Health Authorities, but to 1nembers of the Q 4 '

medical profession in their activities in preventive medicine. F.urther reference to laboratories will be made under reference (c) (The prevention of disease, p. 25).

ExTENSION OJ!' ExiSTING Co-OPERATION.

. 6. The basis of these efforts at co-operation has been the tacit recognition of the fact that· the States / possess legislative powers necessary fo r health administration and the Commonwealth possesses financial and other resources that could materially help to make administra,tion effective. The instances of successful co-operation which we have given illustrate voluntary collaboration between States and Ooininonwea]th in the

exercise of their respective activities. :Future advance should be 1nade by the application of the same n1ethod to all departments of preventive medicine. With regard to co-operation between the Defence and State Departments concerning health supervision of boys and men, Colonel Maguire, Deputy Director of

1\!I:edical Services, New South Wales, and Dr. I-Iarvey Sutton, Principal Medical Officer of the Education Depart1nent of New South \/\Tales, have submitted a memorandum which will be found as Appendix No. 27. vVe are of opinion that this memorandum should receive the careful consideration of the Defence Department, as it seems to us to provide a very useful method of co-operation.

Evidence submitted to us showed that Health Adm.inistrations in the States Q.ssotHs. would welcome :further collaboration. The Order in Council which created the g. inc Commonwealth Department of :Health defined as son1e of its functions-investigation into disease, assistance with subsidies, and inspiration and co-ordination of all health

3 . 3 .

1 9 :..

1 .

activities. The Comn1onwealth should provide adequate funds and staff to the Q.Ho6o . Com.monwealth Department of I-Iealth to enable it to extend its activities in order to carry out fully the above-mentioned functions. Details of extension required will be given under reference (c) (" The prevention of disease ," p. 25) and under other references. ·

PUBLIC HEALTH EXPERTS.

7. That the success of health administration is more dependent on the personality and capability of the officers directing it than on any other single factor has been impressed on us very strongly during our inquiries. We are satisfied that a greater number of experts highly trained in public health is needed in Australia. It is essential that these should be provided and given such status and salary as would attract medical practitioners of exceptional ?.bility and efficiency. The appointment of highly- Q .14058 .

trained experts in public health by the Co1nmonwealth, in such numbers as may be. necessary, to advise and help local authorities when desired by State Health Administrations would give opportunities for further co-operation between Common­ weajth and States. Facilities for training these experts in Australia are very inadequate, . and ought to be increased.

The responsibility of the Commonwealth to the Mandated Territories 1nakes · it essentic1l.that adequate training should be provided by the Commonwealth for the medical officers who wHl be required for duty in these Territories. F.1081.-2

Q.815l. Q.8206. Q .960Q.

Q.l768.

Q. 273.

Q.l4065- 74.

Q .. 14060, Q.14072.

18

The Commonwealth could be of great assistance to State and local authorities by providing a training school where prospective medical officers of health could receive post-graduate training in different fields of health administration, and where the inspectorial staff and other personnel could also· be trained. At present there is a great lack of facilities for such training. ·

CHAIRS OF PREVENTIVE MEDICINE AND TROPICAL HYGIENE.

8. A scheme has been submitted to us for the endowment by the Commonwealth of Chairs and Schools of Preventive Medicine and Tropical Hygiene in the Sydney University. We are of opinion that these schools should be established, but consider that at the present juncture it would be sufficient to provide a Chair of Preventive Medicine with an adequate Department of Tropical Hygiene which, if necessary, could be later expanded into a Chair. The arguments put forward in favour of the selection of Sydney University for this purpose are to us convincing.

One feature in the work of Schools of Tropical Me.dicine or Hygiene should be the collection and condensation of the records of the medical administration of the Pacific Islands, with a view to their distribution. Valuable reports from the Pacific Islands are wasted, as there is no central place at which they can be correlated and collated .

.A suggestion was made to us that in order to give .Australian graduates wider experience in quarantinable diseases and tropical medicine, the Commonwealth Government should ask the Colonial Office to nominate two or three or more young graduates for colonial service every year in Singapore, North Borneo, Hong Kong, Fiji, as well as in the Malay States where medical officers are appointed fro1n the Colonial

Office in London, and that application should also be made to the President of the Quarantine Board at Alexandria or to the Foreign Office, that one of the Commonwealth Medical Officers be appointed for three months to the Sinai Peninsula during the Hedjaz pilgrimage. It was stated that there is no place where better opportunity exists to gain experience in quarantinable diseases.

9. In our opinion the Commonwealth Serum Laboratories should be used not only for the training of professional and technical officers for Commonwealth laboratories, but also for the training of experts for State and other laboratories.

FEDERAL HEALTH CouNciL.

10. In our opin.ion a Federal Health Council should be instituted for the purpose of securing closer co-operation between Commonwealth and State Health Authorities. Conferences have been held in the past between the Chief Medical Officers of t he States and Commonwealth, and resolutions on various subjects relating to health, but in many cases the resolutions have .not been put into effect in all the States. If a permanent Council were established, 1neeting at regular fixed times, to devise n1eas u:res for co-operation of Comm.onwealth and States and of States with States, and to promote uniformity in legislation and ad1ninistration where advisable, we believe that the co-operation desired would be n1ore likely to be satisfactorily achieved.

With regard to the co1npositio:i1 of such a Federal · Health Council, most ·witnesses in referring to it have assumed that it would consist of the Director-General of Health of the Con1monwealth and tbe Chief Medical Officer of each State. We think that the Commonwealth Department of Health should have two additional representatjves on the Council. It is advisable also that the financial aspect of any proposal made by the Council should be very carefully considered, and we think that a financial expert of the Commonwealth Government should be available as a 1nember or as an assessor. The expenses of members att ending meetings of this Council should be paid by the Commonwealth Governn1ent, and legislation should be enact ed to provide funds for the establishment of the_ Health Council. If it should appear to the Government at any 'time that advantage would result from closer association between the Federal Health

Council and the medical profession, not more than two representatives nominated by . the Federal Committee of the British Medical Association could be appointed for a period of not n1ore than three years.

The question of the co-operation of Commonwealth and State Health Authorities will also be considered when dealing with subsequent references.

19

RECOMMENDATIONS.

We recommend that-(1) Section 11 (b) of the "Quarantine Act 1908-24 "should be amended by the addition of the words '' and in promoting public health '' ; ·

(2)

(3)

(4)

(5)

(6)

Legislation should be passed by the Commonwealth Parliament to provide funds for the establishment of a Health Council, on the lines we have recommended ;

Funds should be ntade available to provide for the extension of the Commonwealth Department of Health, in confor1nity with its functions ;

Legislation should be passed by the Commonwealth Parliament to provide University and other training for experts in public health ; also for the training of the technical personnel for aU public health services both in the Com1nonwealth and in the States ; ·

Legislation should be passed to provide subsidies to measures, approved by the Commonwealth Department of Health, which State or local authorities are unable to finance alone-with appropriate conditions attached in order to secure efficiency ;

Legislation should be passed to provide for the establishment of laboratories, or subsidies to State laboratories.

IV.- . PREVENTION OF DISEASE. The third reference in our Com.mission, is '' (c) The prevention of the outb1·eak, develop1nent, or spread of disease in the Commonwealth."

1. The existing legislation and administration of the Commonwealth and of the States is intended to achieve.t:this object. That of the Commonwealth is mainly to prevent the introduction of disease from overseas, by the operation of the Quarantine and Immigration Restriction Acts. These Acts appear to us to be all that is required in this connexion. In the adnlinistration, however, of the Immigration Restriction Q.720-7ss.

Acts,hwe aref odif.

grehater

1 dstrbictness, .bodth at the portshof anhd

at t ose o sem ar \:ation, s ou _ e exercise to prevent t e a nnss1on to t e

Co1nmonwealth of persons physically and n1entally defective.

It is necessary to bear in mind the possibilities in the near future of

increased transport by air. The duration· of transit from overseas will then be much shortened, giving opportunity for diseases, like small-pox, contracted by passengers in Eastern countries, to develop subsequent to their landing in Australia. Although Q.57S7. the Quarantine Act has been amended to include airships in the definition of the word

" vessel," the present system of quarantine will probably be insufficient to meet these new conditions. No procedure has been drawn up as to the respective parts to be taken by State and Commonwealth authorities once a quarantinable disease has broken through the quarantine cordon. Should a Health Council be established, as we have recommended (p. 18), this is one of the first subjects that it should consider.

The control of the :Mandated· Territory of New Guinea by the Commonwealth has added considerably to its responsibilities in this connexion. Evidence was given Q.t6oo. that the Ad1ninistration in New Guinea is constantly confronted with the possibility of the introduction of small-pox by the fact that that Territory is only ten days distant

from the infected coasts of the Orient. If srnall-pox once gained an entry into New Guinea, Australia would be n1enaced from New Guinea by the fact that it would be within only seven days' sail of an endemic area of small-pox. These facts furnish further Q.1691. reasons for placing the health adn1inistration of the Mandated Territory under the control Q.t86z::e.

of the Departn1ent of Health, as we have already recommended (p. 13).

A. Ac·rroN BY STATES.

2. With regard to the prevention of disease in the Comm.onwealth itself, we have, in dealing with reference (b) ("The co-operation of Commonwealth and S :·ate Health Authorities p. 15), recommended that the necessary measures should be carried out by the States, and indicated some of the ways in which the Commonwealth can best

'I

Appendix No. 30. Appendix No. 8(b).

Q.56 76 .

Q.l9175A­ Q.19499.

Q.20618.

20

co-operate and assist. A statement prepared by our Secretary shows that differences exist in the health legislation and administration of the different States, and in the efficiency of the methods adopted for the prevention of disease.

In New South Wales, health administration was at first wholly central. The Health Act of 1902 placed the administration under local authorities, and provided for the appointment of whole-time District Medical Officers of Health. Up to the present only two appointments of whole-time District Medical Officers of Health have been made outside Sydney. In the other States the administration was put in the hands of local authorities, who could appoint part-time local medical officers of health, ,;vith supervision by the Central Health Department which had power to act if the local authorities failed (as is also the case in New South Wales). In Victoria, under the H ealth Act of 1919 the State has been divided into districts, each under the supervision of a District Medical Officer of Health, and part-time Medical Officers of Health have also been retained acting for the local authorities, independently of the District _ Medica]

Officer of Health. In neither New South Wales nor Victoria is the District lVIedical Officer of Health in charge of all the health activities of the district.

Experience has shown that none of these systems is wholly satis­

factory. The prevention of the outbreak of disease depends partly on control of the environ1nent in which the community lives, and partly on the supervision of individuals themselves. The State Health Departments were formed at a time when the greatest emphasis was laid on control of the environment for the prevention of disease. Their activities have therefore been mainly directed to sanitation, especially of premises and food. Recent developments in the preve:p.tion of disease have been in the direction of greater supervision of the individual life; but the resulting health activities have no t, in most of the States, become a function of the Health Department, but have been assumed by other bodies, many of which are voluntary. Not only are these in many cases free from supervision by the Health Department, but control is frequently vested in laymen with no medical training, and therefore without a full appreciation of the problems involved. The result has been that health administration has often been made subservient to political, municipal, and vested interests, instead of being, as it should be, as of the utmost importance.

3. Local needs vary in different places and require local adjustments. For instance, the conditions in the north are different fron1 those in the south; campaigns for destruction of mosquitoes are much 1nore important in Queensland than in 'fasmania. Health requirements in densely populated differ from those in sparsely populated areas. It appears to us, therefore, that legislative enactments, and regulations made under thmn, dealing with health should be adn1inistered by local bodies of some kind. The tendency of those who have studied the . subject 1nost closely is to avoid undue

centralization of authority, and to devolve health administration on to local authorities. These should be developed to as high a degree of responsibility and efficiency as possible, and should utilize the knowledge and services of local medical practitioners in close co-operation with, and under the guidance of health experts. Inst ances have come under our own observation (of which Toowoomba is an excellent exan1ple) where, when the advantages of certain health measures have been fully explained to the local authority and the ratepayers by local medical practitioners, the local authority, after

obtaining advice from a Co1nmonwealth expert, has carried then1 out, and the people have willingly provided the funds, owing to a health conscience having been gradually developed in them. Success in any field of administration depends on the consenting attitude and goodwill of the people affected. Without such goodwill legal powers are almost valueless. But, with the best of goodwill, the local authorities require advice, assistance, and stimulus from skilled and trained experts. They may also need financial assistance to carry out recommendations which experts may make. Such help, in the form of a subsidy, may be used as an incentive to greater activity on the part of local authorities, and, by having conditions attached to the granting of it, may be utilized to ensure adequate and efficient service.

While, therefore, we do not consider that health legislation and administration should uniform in all the States, we are of opinion that the Commonwealth Depart1nent of Health should lay down certain general principles of health legislation and of administration. The Commonwealth could then give financial assistance towards the cost of health administration to such States as adopted the. principles in whole or in part.

21

A MoDEL ScHEME. .

4. In any principles so laid down we are of opinion that in each State the unit of health administration should be the local authority. The head should be the Minister of Health, who· should hold no other portfolio than that of Health. He should control all Government services connected with health, these, if necessary, being transferred to him for the purpose, in accordance with the way in which the Ministry of Health in

Great Britain cont:.:ols all health activities. He should. also regulate all voluntary organizations connected with health. The office of Permanent Head of his Depart­ ment (or State Director of Health, as he should be called) should be filled by a medical practitioner highly trained in preventive medicine. No lay official should be interposed him and the The Director should be provided with a trained whole­

time medical staff as well as with a secretary and clerical staff. He should be appointed for a term of years, and be paid a salary commensurate with the importance of his position and responsibilities. .

A State Health Council should be established to correlate all health activities, composed, according to the requiren1ents of particular States, of- . 1. The State Director of Health, who should be the Chairman. 2. The Commonwealth Health Official, if any, in the State.

3. Elected representatives, not more than two, of the medical profession. 4. , An elected representative of maternity hygiene activities. 5. An elected 1

representative of child welfare activities. 6. Elected representatives, not more than three, of local authorities, grouped for the purpose of electing them. 7. An elected representative of sanitary engineers.

8. An elected representative of the veterinary profession. The Council should meet periodically at fixed times. Each body represented should be entitled to bring before the Council through its representative any matter it may wish to have considered. Resolutions of the Council should be submitted by the

Chairman to the Minister. Each State should be divided into Health Districts, comprising actjacent local authorities, arranged chiefly by consideration of facilities for communication. A district generally should not be so large that the District Medical Officer of Health cannot visit any part of it and return to his centre in one day. In each district a District Health

Committee should be established, consisting of representatives elected by the local authorities fanning the district. The Committee should estimate the necessary expenditure, and arrange for the revenue required by fixing· the quota to be raised by each local authority. Each Health District should be under the control of a whole-time District Medical Officer of Health, who must be a medical practitioner specially trained

in preventive medicine. He should be responsible for the administration of all the health activities of the district, and be provided with an adequate whole-time and efficient inspectorial and clerical staff. He eould also perform certain duties for the Commonwealth, where necessary, such as examination of applicants for invalid pensions

and for the Public Service, and of cadets and militia, Quarantine Act functions, repatriation medical services, registration duties. In each Health District there should be established a Public Health Laboratory, an X-Ray equipment, and Baby and Child Welfare Centres. Hospital accommodation, adapted to the requirements of the District, should be provided for the isolation and treatment of persons suffering from infectious diseases, and for maternity cases. Pre-maternity and post-maternity clinics should be conducted as part of a Public Hospital service. Where necessary there should also be Public Hospital accommodation for persons suffering from tuberculosis.

The Minister of Health should determine the bounds of the district and appoint and pay the District Medical Officer of Health. The rest of the expenditure on health services should be met by the District Committee, but in special cases the Minister of Health might subsidize the Committee, subject to certain conditions. · The inspectorial staff should be appointed by the District Health Committee, subject to the approval of the Minister of Health, who should pay a moiety of the salary. No officer of the Health District should be dismissed without the sanction of the Minister. The system of part-time medical officers of health should be abolished, and in each Health District the local medical practitioners should have duties, prescril;led by law, in

co-operation ·with the District Medical . Officer of Health. For these services the medical practitioners should be paid by fees. The subject of the co-operation of the . medical profession in the prevention of disease will be considered in more detail under

1 26 7

22

reference (i) ("The relationship which should exist between pttblic health authorities and medical practitioners in regard to the prevention of disease, p. 46)"; while the subjects o£ other concerned with the prevention of the outbreak, development,

or spread of disease In the Commonwealth, and will be dealt with under their respective headings. Subject t? the sanction of the Minister of Health, a Health District might be formed voluntanly by one large local authority, or by several local authorities contiguous to. each combination, if at any time they so desired. The district so formed

might appmnt Its. own District Medical Officer of Health, provided that the l\1inister of Health a subsidy to the District Health Com1nittee towards its expenditure on health. No lVledwal Officer of !Iealth or any other officer of the Health District so formed should be appointed or dismissed without the sanction of the Minister of Health. ·

5. Satisfactory sanitation of individual homes, and of every community, however must be the basis of measures. From our own observations in country

absence of expert supervision seems to us the weakest part of their health

administration.. The scheme we have proposed would leave sanitary control in the hands of local authonties, but would provide for expert supervision sufficiently close at hand to act quickly and effectively. The schmne would also allow for the development of an educated and responsible local authority, and at the same time for the financial assistance being given by the central which our investigation has shown

to be frequently necessary. The elasticity of the sche1ne would enable varying emphasis to be placed, according to the situation and population of the Health District, on the problems of country or city, or of temperate or tropical climates. It would make all the problems throughout a State the responsibility of the Minister of Health; and,

while allowing and encouraging the assistance of voluntary organizations, would correlate them with the health administration.

INFECTIOUS DISE ASE S.

6. In connexion with the activities of State I-Iealth Administrations, reference may be made to those acute infections which have been their chief concern. Owing to its situation, and the activities of the quarantine administration, Australia has been comparatively free from severe epidemic diseases. such as sinall-pox, plague, and cholera.

This long-continued immunity has led to a danger to :which we are compelled to call Q. 12126. attention. Vaccination against small-pox has fallen into ahnost complete abeyance in

most of the States; yet successful vaccination and re-vaccination constitute the only

efficient protection against· small-pox, whether mild or severe.

Health ad1ninistration, especially in the larger centres, has reached a high development in the control of water supplies and the inspection of food, including milk. The statistics for those infections which become epidemic through contamination of water supplies and food . show that the death rate for typhoid fever in Australia has App. No. 2. steadily fallen from 148 per million in 1910 to 38 per million in 1924.

1

Satisfactory as these results are, they could be still further improved. Evidence has shown that there are still considerable defects in measures for the disposal of human and household waste. These defects are due in the larger centres, where organized systems of sewage disposal have been constructed, to the controlling authority being

independent of the central health authority. In smaller communities which possess water supplies, individual septic tanks have been installed, but theEte are not standardized, and in some places are controlled by local authorities insufficiently educated in sanitation. Q. 12247. The saine observations apply to many districts where pan systems are in operation. App. No.13(b)- Evidence was given that in the Murray Valley typhoid fever is especially prevalent, and

increasingly so as the stream descends. Such a position calls for increased administrative

activities in the field of sanitation both by States and Commonwealth. As regards the State, such activities would be provided for under the model scheme of health administra-tion which we have outlined. As regards the Comn1onwealth, the Division of Sanitary

in the Comn1onwealth Department of Health is already playing its part.

Evidence was given as to the stimulating effect on various local authorities of the operations of this Division. Its work should be extended, and increased opportunity given fot demonstration by its skilled staff of rrwdern methods of sanitation to country communities. The Division should undertake special research into problems of rural sanitation. ·

In diseases whose epidemic spread is but little influenced by improvements in sanitation, but depends mainly on direct infection, the record is much less satisfactory. App. No. 2. Diphtheria showed a death rate per million of less than 75 up ;'!ito 1910; it ranged from

23

155 to 168 from 1911 to 1921, and then suddenly dropped to less than 100 in the last th:ree years. Scarlet fever, though less fatal, showed the same irregular and uncontrolled curve of mortality-in striking contrast to feve!. and .

whooping cough _are among the most fatal of acute 1nfectwns In young children, no satisfactory attempt has been rnade to prevent their In to COJ?-trol such

infections, more intin1ate association -of the general mediCal practitioner w1th health administration is necessary, as proposed in the schen1e we have .out.lined. The knowledge gained in recent years in the epidemiology of these infections Indicates .tha:t they _can_ be controlled best by early diagnosis with the aid of laboratory methods; nnnlunization

o£ contacts; hospital isolation of patients and their treatment by inoculation; and by the detection, by bacteriological methods, of carriers in certain diseases. Such procedures require increased provision of ward accommodation for infectious diseases and of labora­ tories. Satisfactory preventive n1easures can only be effected by the practising medical profession. The system of terminal disinfection as at present carried out by health inspectors is of cotnparatively little use.

l ?6 9

7. Increased activity is also needed in dealing vvith son1e of the chief causes of death. Health Administrations do not deal with pneumonia, although it is notifiable in England, and is one of the four great causes of death in the Com1nonvvealth ; or with App. No. 2· heart disease, although it has caused over 1,000 deaths annually in Australia since 1910.

Among the various diseases that occur throughout the Commonwealt h, three are of especial and- national irnportance, viz., venereal disease, cancer, and tuberculosis. Venereal disease will be considered in detail and recomn1endations concerning it made under special reference (d) ( "The of vene1·eal disease," p. 26). It may be

observed here, however, that the causatwn, mode of spread, and treatment of venereal disease is thoroughly known, and its complete prevention would be possible and easy if every one in the community could be induced to put that knowledge into practice. Of cancer, on the other hand, very little is known, and consequently little can be done Q.21386-98. at present in the way of prevention. The death rate from cancer has steadily inereased from 733 per million of population in the Comnwnwealth in 1910 to 934 in 1924. Research into this disease is imperative, and should be the first measure directed App . 2. towards prevention. The grant of £5,000 by the Commonwealth Government for Cancer Research is a satisfactory step in this direction, and the University of Sydney Q. 7529.

has established a Cancer Research Committee, which is conducting work on the subject. The Cancer Research Scholarship founded by Sir John Grice in Melbourne Q. 44os. has also resulted in useful investigations.

Authoritative information should be more widely disseminated among the people Q . ! 1888• upon the subject of Cancer, advising that it is imperative that patients suffering from Cancer should seek treatment in the early stages of the disease, and explaining what are the early indications of its onset. The Commonwealth Department of I-Iealth should

publish reliable information on this subject, and arrange for its wide distribution to the public. ·

TUBERCULOSIS.

8. Pulmonary tuberculosis shows a steady fall in its death rate from 700 per App. No.\' ; n1illion of population in the Commonwealth in 1910 to 528 per million in 1924. Although further investigations in certain lirnited directions are required concerning tuberculosis in the Comrnonwealth·, its causation, mode of spread, and general treatment are well

known . . In all the States some measures have been taken for dealing with this disease, and much evidence has been submitted to us concerning their nature, extent, and efficacy. A Conference of the principal medical officers of the was held

in 1911, which made recommendations regarding tuberculosis. We find that these recommendations have not been carried out, that the measures taken are not uniform i.n the different States, and are, in all the States, incomplete and inadeq:uate. We have personally inspected a number of sanatoria hospitals for tuberculosis in different

States. We feel that it is necessary to call special attention to the conditions of these sanatoria. It must be borne in mind that patients are invited to enter these institutions for the safety of the community as well as for treatment. :Th1any remain there for long periods, but it is stated that it is difficult to induce a considerable proportion to stay

sufficiently long to obtain lasting benefit. It is therefore desirable that these institutions should be attractive, with a fair degree of com.fort and with adequate provision for recreation and occupation. We found that, except in one or two instances, these considerations have been overlooked. In many of these institutions we found that

24

patients in all stages of the disease were placed t ogether, which, in our opmwn, is extremely undesirable. Sufficient sanatoria should be provided to accommodate all patients in the early states of the disease, and this accommodation should be strictly reserved for such cases. It is equally urgent that separate hospital accommodation should be provided for advanced cases. The administration for dealing with tubercUlosis should provide for a proper classification of patients and for co -ordination between the different agencies that treat them. Common·wealth and State health officials should inspect all sanatoria and hospitals dealing with tuberculosis, vritha view of recommending to their respective Ministers a scheme for such co-ordination. As the Commonwealth Treasury pays a large amount per annum in pensions to invalids with tuberculosis, it is vitally interested and should take step to ensure that satisfactory means are provided 1l to reduce the number of cases of tubercula is in Australia. This involves concerted

and combined action by the Commonwealth and States ; but tuberculosis is such a national concern that the Commonwealth Government should realize its responsibility for placing the prevention and treatment of this disease on a sound and humane basis. 9. The prevention of tuberculosis, as in the case of venereal disease, is complicated by social and economic problems which are outside health administration as generally understood. For instance, congestion of population, bad housing, and insufficiency of proper food are factors in the causation of tuberculosis. The removal of affected individuals from unsuitable environment and the provision of suitable remunerative occupation for them in the country involve a difficult economic problem. The segregation of infected individuals until rendered non-infective by treatment is a most important measure of prevention of the spread of the disease. But in practice the necessary separation of such individuals from their families introduces a social difficulty, and also the economic question as to how the family, as well as the individual, is to be maintained while the breadwinner is segregated. Even if these problems be solved it may be difficult to compel tuberculous patients to submit to the measures considered Q.SQ7-91G necessary. The experience of the Repatriation Department is rather disheartening in

this connexion. It made admirable provisions for tuberculous returned soldiers, including complete and thorough diagnostic methods, sanatoria, farm colonies, suitable employment for improved, and hospitals for advanced and incurable cases, with ample pensions for the sufferers and their families. The measures adopted by the Department included most of the methods at present recommended and available in t he fight against tuberculosis, but the results can hardly be regarded as encouraging. The Commission of Public Health in Victoria has drawn up a scheme which would provide many essential App "- (

schemes in other States is want of funds . As to the respective shares of Commonwealth and States, it 'vill be seen that in the scheme of State Health Administration we have previously outlined as a model, tuberculosis would be primarily dealt with by the District Health Administration, which would provide a tuberculosis clii'ic with adequate means of diagnosis. The State Minister of Health should provide (1) a Central Tuberculosis Bureau, under a Director of Tuberculosis; (2) sufficient properly equipped sanatoria for early cases ; (3) occupational colonies ; ( 4) chest clinics at metropolitan hospitals ;

(5) hospitals for the care and segTegation of advanced cases. The Commonwealt h should increase the amount paid as invalid pensions in cases of tuberculosis, by gTanting adequate sustenance to their families while t he patients are in inst itutions; establish a Division of Tuberculosis in the Commonwealth D epartment of Health ; and grant subsidies to States for expenditure on tuberculosis, subject to the recommendations and conditions

made by t he Department. The Division should be available to give advice on tuber­ culosis matters whenever requested. We wish t o emphasize the fact that the facilit ies now existing for dealing 'vith cases of tuperculosis must be very greatly extended and improved. The cost will necessarily be considerable. The prevention of this disease further involves the general improvement of all sanitary conditions in large towns ; abolition of slums and congestion of population ; town planning and provision of public parks, gardens, and playgrounds, with adequate sunlight and fresh air to all dwellings ; sufficient proper food, especially abundant pure milk ; eradication of tuberculosis from dairy herds ; and . suitable conditions of employment , especially in mines. Some of these matters will be considered in more detail under other r-eferences.

10. More effective control of the infectious diseases mentioned above will a lso lessen the prevalence of many non-i nfectious conditions which are the direct or in­ direct results of past infection. Such a re-organization of State health administrations as we have proposed will assist in preventing many other diseases which are not regarded as infectious.

25

B.-AcTioN BY THE CoMMONWEALTH. 11. So far we have dealt with State activities in the prevention of disease, as we have pre-supposed the retention of State legislation on health. But in addition to the help which the Commonwealth could give to the States by inspiring and educating local

authorities through the instrumentality of its Divisional Directors, it could also give more direct assistance.

(a) It could directly subsidize States which take steps, to the satisfaction of the Commonwealth, to bring their legislation and administration into conformity vv-ith the we have outlined. A subsidy might be made towards the salaries of District

Medical Officers of Health; or a general subsidy to supplement State health expenditure, distinct from specific subsidies, such as those for the control of venereal disease, tuberculosis, maternity hygiene, and infant welfare, which could be provided by the Commonwealth even if a State did not adopt the proposed model administration.

(b) In the ]!ederal and Mandated Territories opportunity is given for the establishment by the Commonwealth of health legislation and services that would be models and object lessons for other Governments and administrative bodies. The Commonwealth Department of Health could establish a model Health Centre at

Canberra, which is an area already properly planned and suitable for the purpose. Model health ordinances could be made controlling all health services, including sanitary services, milk and meat supply, noxious trades, industrial hygiene, and smoke prevention. ·

The Commonwealth could also undertake the periodical medical examination of . all members of the Public Service and all employees throughout the Federal Territory, and make a systematic study of their illnesses.

(c) The wOTk already done towards the eradication of hookworm, the investigation Q.oo. into diphtheria at Bendigo, into silicosis in New South Wales, into plumbism at Port Q·76 · Pirie, and that which is now proceeding into miners' phthisis in Western Australia are

examples of Commonwealth health activity which can be widely extended without Q. 1 " 2

" 1 H".

interfering with State rights in regard to health. Special inquiries are needed into such matters as the prevalence of typhoid fever along the Murray Valley (which concerns three States), rural sanitation, the question of plumbism in children in Queensland, filariasis, the unclassified fevers of Northern Queensland, infantile paralysis in Australia, Q:1swo:

and many others. (d) By arrangement with a State a specially trained Commonwealth officer might from time to time be stationed in different localities to conduct model health Q.199. campaigns such as have been attempted in the United States of America.

(e) We have been impressed with the great value of the work being done by the Q.I 252G. Commonwealth Laboratories established in the different States. Medical practiti0ners and municipal authorities in such localities have been unanimous in their testimony Q.125n-4s. as to the assistance these laboratories have already given in the early diagnosis and control of infectious and other forms of disease. In addition, three of them (Bendigo, Q.I7553-6. Port Pirie, and Kalgoorlie) have been bases for special investigations. Evidence has Q.l?SOH5. shown that some of the States have had difficulty in procuring medical directors for their laboratories. The Commonwealth has had no such difficulty, as the directors of its laboratories have received training in the Commonwealth Serum Laboratories and Q:19404. · form part of the Commonwealth Service, which in so specialized a branch of medicine

is of great advantage to the individual. We are of opinion that the number of laboratories should be increased and so distributed that they would eventually be developed into centres of Health Districts, with which other branches of Health organization could be connected. It might be a matter for consideration by the

Commonwealth Health Council, if established as we propose, whether all diagnostic laboratories . should not be provided by the Commonwealth, and their Directors and staff made officers of the Commonwealth Department of Health. · (f) The Conferences of Divisional Directors and State representatives on industrial

hygiene and sanitary engineering that have been held during the past few years indicate a method of education and stimulation that can be applied to other health problems, such as diphtheria, tuberculosis, maternity hygiene, child welfare.

12. In connexion with the prevention of the development of disease it may be noted that the General Medical Council of Great Britain resolved in May, 1922, that "throughout the whole period of study the attention of the student should be directed

Q.20487- 96. Q.20497-·8. Q .20851-60.

Q.l3167. Q.13989.

26

by his teachers to the importance of the aspect of medicine." We are of

opinion that steps should be taken by the Faculties of Medicine in the Australian Universities to give the fullest effect possible to this resolution. The Faculties might also extend their usefulness by arranging for regular medical examinations of all medical students and sending in the result to the State Health Authority. Any financial assistance granted by the Con1monwealth to Universities for teaching preventive medicine should be given with the condition that arrangements be made for the above-mentioned purposes. . .

13. Evidence was submitted on the effect of alcohol on health, and on the influence of alcohol in t he spread of venereal diseases. Having considered the subject, we are of opinion that the excessive use of alcohol is both directly and indirectly respon­ sible for ill-health and disease to an extent which is very difficult to estimate.

14. We are of opinion that if the scheme of health administration we have proposed were adopted in all the States, many existing obstacles to progress in public health and in the prevention of disease in the Commonwealth would be removed. \Ve recognize that the Commonwealth can promote the adoption of such a scheme chiefly by indirect measures; also that change can only come gradually. Stat e health legislation will require amendment; methods will have to be slowly organized; money

will have to be provided; but we urge that in all new legislation and administration the ideal we have proposed should be kept in view.

RECOMMENDATIONS.

W e recommend that-(1)

(2)

(3)

((4)

(5)

(6)

(7)

The Commonwealth Department of 1-Iealth should formulate a model outline of general principles of Health Administration, along the lines we have suggested, and that the Commonwealth should subsidize States for expenditure on liealth, provided that their Health adminis-

tration sufficiently conforms to such model ; ·

In the Commonwealth Department of Health, Divisions of Epidemiology and Tuberculosis should be established to investigate problems of infectious disease, and advise generally in regard to all efforts to control infectious diseases ; ·

The Comrr10nwealth Department of Health should formulate the principles of a comprehensive campaign against the spread of Tuber­ culosis, and the Commonwealth should make conditional subsidies to the States for carrying out such a campaign, similar to those for venereal disease ;

The Invalid Pensions Act should be amended to allow of payment of pensions t o the dependants of patients suffering from infective tuber­ culosis while they are undergoing treatment in sanatoria or hospitals ;

The system of diagnostic laboratories should be extended, and that laboratories should be distributed in places that probably would be centres in health districts in the future ;

The system of inquiries into special infectious and other diseases, and of experiments concerning their control should be continued ;

The system of Conferences with State representatives on special aspects of sanitary engineering, industrial hygiene, and other problems of health should be continued.

V.- VENEREAL DISEASES.

EFFECT OF LEGISLATION.

1. With regard to reference (d) ("The prevention of venereal disease") the evidence showed that legislation dealing with this subject had been enacted and was in operation i.n all the States except South Australia, where an Act been passed but is

127 3

27

not proclaimed. These Acts have not been in operation long enough to enable definite conclusions to be drawn as to their effects. In 'Vestern Australia,, where the Venereal Diseases Act has been in force for the longest perio'd, and where the Comm.issioner administering the Act has taken a very keen personal interest in this subject, the Q .l4o R9 . statistics showed a reduction in the number of cases of venereal diseases reported. Owing

to the efficiency of the ad1ninistration, we are of opinion that notification in this State is satisfactorily carried out, and that the reduction is real and not due to cases not being reported. In Queensland the :figures showed some reduction, but it is not certain that Q.lsooo. all cases are reported. In. Victoria witnesses thought there was some reduction in the Q.515. number of cases of syphilis, but not of gonorrhoea. In New South Wales evidence was

conclusive that notification was not generally observed, and the figures were not reliable. Q.3496 · In South Australia venereal disease clinics have been established at the Adelaide I-Iospital Q.l34:37. for eight years, and the evidence was that the nu1nber of cases of syphilis treated was less. In Tasmania the figures did not give any indication of diminution in the disease. q. u225 . In all the States except Vlestern Australia witnesses stated that gonorrhoea was just as prevalent as ever. The evidence also indicated that the treat1nent of gonorrhoea in

women was most unsatisfactory, both as regards results and in the insufficiency of provision for treat1nent. Nearly all the witnesses vvere pessimistic on this subject. Q .183 29. Hardly any of the venereal disease clinics are capable of treating effectively, by Q .9642 . sufficiently frequent and personal attention, all the cases of gonorrhoea that present themselves, especially the cases in women. Several witnesses stressed the difficulty of Q.546 . preventing the spread of gonorrhoea without means for segregating, until declared non-infectious, the ·women who, while still infected, act as either regular or amateur

t 't t Q .. 3499. pros 1 u es.

VENEREAL DISEASES CLINICS.

2. In rnost venereal diseases clinics, the equiprnent is not in accordance with Q.20924. modern practice, the reason being lack of funds. Each State is spending two or three times as much as the Co1nmonwealth subsidy allotted to it, but it is questionable whether the money has always been spent in the w;isest way. In some clinics

syphilis is dealt with by a separate staff and in ependently of gonorrhoea, while in others the two diseases are treated together. The evidence submitted, and our own observations satisfied us that the former method is preferable, as the two diseases, though common in origin, are quite distinct in character and in methods of trea t1nent required. More clinics and better laboratory facilities are necessary in all the larger centres. The Government Laboratory in Sydney is overwhelmed with routine examinations. The Laboratory at Brisbane has had no Director for

eighteen months, and there is no one competent to conduct the complement· fixation test for gonorrhoea, which is laid down as one of the essentials for a certificate of cure ; in Launceston specimens have to be sent to Melbourne fo r examination; in Hobart there is no Medical Director of the Laboratory.

3. Our inspections of various venereal diseases clinics in the different States satisfied us that they are generally inadequate in accommodation and equip1nent, and so overcrowded that patients, with gonorrhoea especially, cannot be treated in a satisfactory manner. The inadequacy is chiefly due to lack of funds, but to some extent to imperfect administration. From what we have seen, as well as from the evidence submitted, we consider that venereal disease clinics are n1ore satisfactory when attached to hospitals than when separate establishments. More facilities for serological examination and for any treatment that may be necessary are available at hospitals, and the patients when attending them are not necessarily labeped as suffering from venereal disease.

4. As a signatory to the League of Nations Pact, the C01nn1onwealth is under an obligation to provide facilities for the treatment of sailors suffering fron1 venereal disease who come to its ports, also to supply a clinical record to each sailor thus treated Q.218. on a form, prescribed by the International Public Health Office, which can be taken by

the sailor to other countries .and kept up to date. Satisfactory provision for the treatment of sailors has been made by the Commonwealth Health Department at all Q.1so6s-1o. capital ports, except Melbourne and Hobart. In our opinion similar provision should be made at these two capitals and at· all other in1portant seaports in Australia, especially

if they are first ports of entry. 5. An inquiry by the International Public Health Office of Paris revealed the difficulty of obtaining exact information regarding the extent of venereal disease amongst

Q.l983.

Q.9649.

Q,20034.

Q.3012. Q .30l3. Q.3044. Q.398U.

Q.8908. Q.9675.

28

pregnant women. A number of married women are treated for venereal disease at women's clinics who are unaware of the nature of their illness. These and other facts have impressed upon us the importance of venereal disease in r:elation to marriage. e are of opini

CoMMONWEALTH SuBSIDIES.

6. One of the conditions of the Con1.n1onwealth subsidy of £15,000 on a £1 for £1 basis to the States for the expenditure they incur on venereal disease is that venereal disease clinics should be inspected by a Commonwealth officer to see that the conditions are carried out, but little seems to have been done in that direction, and it was admitted that there was no regular system of inspection.

To overcmne son1e of these difficulties we are of opinion that a Division of Venereal Diseases should be established in the Cmn1nonwealth Department of Health ; and that the Commonwealth subsidy should. be increased from time to time, but more strictly conditioned, and given not on the £1 for £1 basis to recoup the States for any expenditure they may incur, but for specific purposes approved and recommended by the Director-General of Health, such as establishing clinics, or providing them with equipment, and assisting . in propaganda and the publication of information regarding venereal disease and its prevention.

7. In regard to the prevention and control of venereal disease generally, it must be understood that the problem is complicated, and involves not merely medical or scientific, but economic, political, social, moral, and even religious considerations, consequently progress will be slow and gradual. Too much 1nust not be expected from legislation which is difficult, and in some respects impossible, to enforce. Thus we had it in evidence that the clauses of the Venereal Disease Acts with regard to treatment by

unqualified persons were practically useless, because patients would not give evidence in a court of law and publicly state that they had venereal disease. The same difficulty occurs in endeavouring to prove that prostitutes or others are spreading the disease. The Queensland Act is the only one that provides for the detention of prostitutes who are infected. It has been suggested ihat similar clauses should be introduced into the Acts in the other States, but it is doubtful whether they can be usefully put into operation. It is very necessary to provide hostels into ·which such women could enter voluntarily for treatment.

8. We investigated the value of the work of women police and consider that their usefulness has been fully proved, not only in the control of prostitutes, but of defaulters frorn treatment. \Ve consider that their services should be more fully used in connexion with venereal clinics.

RECOMMENDATIONS.

·we recmnmend that-(1) In the Commonwealth Department of Health a Division of Venereal Diseases should be established in charge of a whole-time Director ; (2) The Commonwealth should establish clinics for seamen at important

seaports ;

(3) The Commonwealth subsidy should be substantially increased, more strictly conditioned, and given for specific purposes approved by the Director-General of Health ; (4)

(5)

(6) (7)

(8) (9)

More clinics should be established in the larger centres, and more widely distributed in each centre ; The equipment and staff of each clinic should be such that patients can receive adequate individual attention ; Such clinics should be established preferably at general hospitals ; Clinics for female patients should be established preferably in

with women's hospitals, or women's departments of general hospitals ;

Clinics for syphilis and gonorrhoea should be separate ; Adequate laboratory facilities should be provided for dealing with venereal diseases, conveniently ,.to each clinic ;

29

(10) There should be greater co-operation between women police and authorities in charge of clinics ;

(11) The details of venereal disease administration should be made the personal responsibility of a medical officer of the State Department of Health ;

( 12) The Commonwealth . should undertake the establishment of clinics, or provision for the treatment of venereal diseases, when requested by a State ; '

(13) When the Co1nmonwealth passes legislation in the exercise of its constitutional powers regarding marriage and divorce, it should include clauses dealing with venereal disease, esp ecially-

1 27

(a) a clause similar to Section 13 of the "Venereal Diseases Act Appendix 1918," New South Wales, making marriage of any person No. s ::s. suffering from venereal disease in an infectious stage an indictable offence ;

(b) a clause providing that no marriage should be allowed' unless the parties make de clarations that they are not suffering from any contagious or infectious disease.

VI.-UNIFORM LEGISLATION WITH REGARD TO TI-IE PURITY OF FOOD AND DRUGS DEGREE OF EXISTING UNIFORMI TY

1. From the evidence submitted on this subject by a nu1nber of witnesses it wo uld appear that a considerable degree of unifonnity has been reached throughout the States in legislation with regard to the purity of food and drugs. Since 1909 several conferences of Commonwealth and State Health Aut horities, attended in some eases by Q 484- 6·

Government analysts and commercial representatives, have been held, notably those · of 1913 and 1922, at which recommendations -vvere made e1nbodying a complete series of regulations as to the use of preservatives and colouring matters and other foreign substances, and as to the labelling of packages, and prescribing standards for practically all foods and drugs. Owing to geographical and cli1n at ic conditions, the or

formulation of a st andard for fresh milk, and the question of preservative substances 1922 · in cream and concentrated milk, were left to each State.

2. All the States have adopted the regulations and standards reco1n1nended by these Conferences, with a few exceptions, concerning which there is still some difference of opinion. Some of these exceptions have been matters of special concern to manu­ facturers and importers, particularly the standard relating t o infants' foods,

portions of the labelling conditions, and the question of the declarat ion of the ingredients and their proportion in proprietary medicines.

3. Our attention was drawn by several vvitnesses to other matters dealt with under the regulations of the States concerning foods and drugs . Unifornuty was not to be practicable, for instance, with regard to bread, O\ving t o the fact that the wat er content varies according to the kind of wheat used. Several witnesses urged that the standard for milk should not be limited to its chemical constitution, but that provision

should be.n1ade for tests as to it s age and bacteriology. One witness gave evidence on the growing practice of using certain prohibited colouring substances in confectionery, and the mis-labelling of such fo ods. The question of preservatives in food was also referred to by several yyjtnesses, and attention was specially drawn t o the Final of the British Committee on the Use of Preservatives and Colouring Matters, which sat in England in 1924.

STANDARDS FOR METRI C SYSTEM.

4. Various other matters were discussed by a nun1ber of expert witnesses, such as the desirability of an Australian Pharmacopoeia or, as an alternative, an Addendu1n to the British Pharmacopoeia to meet Australian conditions with respect to certain drugs, and the question of the determination of standards for t he metric system of weights · and measures in Australia. The metric system, as distinct from the Imperial system, Q.5624-o636.

Q,J2897. Q.20158 . Q.20164 .

Q.20192 . Q.20193. Q.20 222 .

N o. 4 (cl.

Q.l 87 1i3.

Q.4468,

30

of weights and measures is in general use throughout Australia, as in other countries, in connexion with scientific subjects, and it is used to a large extent by medical prac­ titioners in the prescribing of medicines ; yet there are no standards established by law in Australia for the met re, the gmmme, the litre, or other metric measures of length or capacity. The Parliament has power under the Constitution Act to

legislate in this matter.

PATENT MEDICINES.

5. Hepresentations were made by several commercial witnesses in Sydney as well as in Melbourne with respect to No . 79 of the Victorian Hegulations for Foods and Drugs, which provides that every package containing a patent or proprietary medicine shall have attached thereto a label on which shall be inscribed the names of the drugs

therein which have any therapeutic action . These ·wi tnesses took the view that insistence upon this requirement would constitute an infringement of the trade mark rights of proprietors, and that there wo uld be nothing to prevent other persons from making the goods and selling them under the original trade name.

It may be pointed out that the Conference of Health Offi cials of the Common­ wealth and States of Australia of 1922 recommended with reference to pat ent or proprietary medicines, the disclosure of ingredient s and their proportion on every package, with a proviso t hat exemption be granted from this requirement on condition t hat particulars be confidentially deposited with the State Health Authority, that no

change be made \vithout notification, and that an undertaking be given that all goods sh ould comply with the particulars deposited. The evidence submitted showed that no State has adopted the proposed regulation, or has, as yet, taken control of such preparations.

INFANTs' FooDs.

. 6. Evidence was also given by several witnesses concerning the requirements of t he Victorian regulation No. 25, as to infants' foods. It was stated that the sale in Victoria of infants' foods which are allowed to be prepared and sold in all other States would infringe the requirement of the Victorian regulation with respect to lactose, and render the vendor liable to prosecution.

LABELLING .

7. The general question of labelling presents further It was asserted

that even i£ uniformity were reached with regard to standards, difficulty might arise in the interpretation of the regulation as to labels. For example, a food or medical preparation might be placed on the market of which the ingredients were fully set out on the label, with extensive and extravagant claims as to its value for the cure or

treatment of disease. The demands for the amendment of any such labels might vary in t he different St ates. One witness stated that considerably more trouble was caused in deali ng with the labelling of interstate foods than \-vith the difference in standards or wit h deliberate adulter ation, and he was of opinion that only by the clearest and

mos } explicit regulations could it possibly be realized by manufactm ers what was actually required on labels .

FEDEitAL STANDARDs CoMMITTEE.

8. It was suggested that it would be desirable to have a Federal Foods and Drugs Standards Committee under a Commonwealth Act for the purpose of making sta1;1dards and · regulations in regard to imported foods and drugs, and all foo ds and drugs of Australian origin subject to interstate exchange. To meet the serious labelling it was

considered that the proposed Federal F oods and Drugs Standards Committee should have the power of appointing a sub-committee for examining all labels, and deciding . upon the amendments which would be necessary in each case, and that administration of t he Conunomvealth Act should be left in the hands of the States as at present.

LEGISLATI ON.

9. It appears that the Commonwealth has power under the Constitution to legislate with-respect to in1ported foods and dru gs, and as t? f_ oods and drugs of Australian origin which are t.he subject of interstate trade, . but 1t 1s understood any such food or drugs after they leave the control of the Commonwealth (that IS, dter they have been released by the Customs, or have been transferred from one

31

State to another) are subject to State laws, and if they infringe the law of the State in which they are released or to which they are transferred, the vendor is liable. To overcome the difficulty now experienced by manufacturers and importers, and in order that uniformity may be accomplished with respec t t o foods

and drugs, we are of opinion that the Stat es should voluntarily transfer by legislation to the Commonwealth their powers of control of imported foods and drugs, and of foods and drugs of Australian origin, which are the subject of interstate trade, so as to enable the Commonwealth to legislate on the subject. The Commonwealth could then pass the necessary legislation, and appoint a Food and Drugs Standards Committee for the purpose of formulating uniform regulations as to standards and labelling. A sub­ committee of the Food Standards Committee or a body of experienced officers appointed

by the Foods and Drugs Standards Committee could deal with and decide upon details of labelling for such foods and drugs. To avoid duplication of machinery the regulations made by the Foods and Drugs Standards Committee so far as they concern the States should be administered by the State Health Authorities of the various States in conjunction with their own ]'oods and Drugs Acts and regulations. This body would be in a position to deal with the various difficulties to which our attention has been drawn.

RECOMMENDATIONS.

We recommend that-

1 277

(1) The Parliaments of the several States should refer to the Parliament of ConsL1 tutton the Commonwealth the matter of the control of imported foods and drugs and of such foods and drugs of Australian origin as are or may be the subject of interstate trade, and that the Parliament of the

Commonwealth should thereupon make laws for the control and regulation of such foods and drugs ;

(2) The Commonwealth Parliament should pass legislation for the establish­ ment of a legal standard for a metric or decimal system of weights and measures in Australia.

VII.--MATERNITY HYGIENE.

1. Whatever the intention of the Commonwealth Parliament may have been when it passed the Maternity Allowance Act in 1912, the public expected that the Act would enable all mothers to pay for proper medical, nursing and other attention during childbirth. That expectation appears to have been realized to a considerable degree.

In the last financial year 79 · 3 per cent. of t he 134,000 mothers who were paid maternity allowances were attended by medical practitioners, while in 1913 the percentage was only 63 · 2. In Victoria, the only Stat e for which figures were supplied, an examination of 35,700 maternity allowance claims -during the t welve months ending 30th June, 1924, showed that 60 per cent. of the births occurred in hospit als, private and public.

We think, however, that the public expected further that as a consequence of this presumably better attention the mat ernal mortality would be proportionately reduced. Unfortunately it has not. The figures submitted by the Commonwea1th Statistician showed that the number o:E deaths o:E mothers per 1,000 births was 5 ·1 in 1910, and 5 ·5 in 1924. In 1915 it was as low as 4 · 3, and in 1917 it rose to 5 · 6.

MATERNAL MoRTALITY.

2. A comparison of statistics for the periods 1909-16 and 1917-24 shows that the average maternal mortality rate has increased from 4 · 87 to 4 · 98, while t he average infantile mortality rate :for the same periods has fallen from 70·9 to 61·0. The average death rate for the same periods has fallen from 10 · 68 to 10 · 15. Dr. E. S. Morris, in his prize essay, "On the Causes and Prevention of Maternal Morbidity and Mortality," states that in the year 1923, regarded by him as a fairly normal year, 5,839 Mcd . J our, women, of whom 3,861 were married, between the ages of 15 and 49, died, and of this Allst., l!l.ll.!5• number 691 died in what ought to be the normal physiological process of childbirth, or

approximately one-sixth of the total deaths of married women. Tuberculosis and cancer, recognized as very fatal morbid conditions, caused respectively about one-fifth and less than one-eleventh of the total deaths of women, married and single.

Q .6l 14-i.

Q.95l.

Jnu. 1925 .

Q .!H6.

Such figures must arrest the attention of every one, and urgently demand investigation into the conditions that allow such results. In addition, numerous cases occur of illness and subsequent morbidity and invalidity which are the result of non-fatal sepsis, and of accidents of childbirth, regarding which no figures are available. The evidence submitted to us showed that the resulting disability arising from such illnesses is very considerable. ·

PuERPERAL SEPSIS.

3. N·o reliable figures are available as to the frequency with which puerperal sepsis occurs. It is not notifiable under the Public Health Act of New South Wales. Although cases occurring in private hospitals are reported to an official of the Health Deparhnent, cases in public hospitals are not reported. In the other States puerperal fever or septicaemia is a notifiable disease under the Health Act, but no satisfactory definition of puerperal fever has been drawn up. It is recognized both in Australia and in England that the present system of notification of puerperal sepsis is valueless as a true record of morbidity. There is no means of determining how many deaths notified under the term septicaemia originate in puerperal conditions. In Victoria puerperal fever is notifiable; septicaemia is not. Numerous cases of septicaemia must follow abortion, but there are no figures to show how many.

CAFSES AND PREVENTION OF l\iATERNAL MORTALITY.

4. The above facts indicate a grave national danger, greater even than official figures reveal, but its existence has not caused any Health Department to take steps, by a conference of those interested, or by any other course, to determine the extent of the dllnger, or suggest means to combat the evil. Such inactivity on the part of Health Departments illustrates a serious defect in existing health administrations, and of the necessity, previously mentioned, of obtaining statistics of morbidity.

5. At present no official investigation is made as to the circumstances under which 1naternal deaths occur in connexion with childbirth. In our opinion it should be a duty of a Medical Officer of the Health administration to make a thorough inquiry into the causation of each individual death in childbirth, with the object of obtaining data fo r the irnprovement of 1naternity hygiene.

6. All the witnesses we have examined concerning this subject agree that, up to the present, the conditions of maternity hygiene have not been satisfactory. It is admitted t hat the results of. obstetric practice have not improved proportionately to the scientific advances that have been made in general medicine and surgery ..

7. P.t.I1 analysis of the causes of maternal mortality shows that about one-third of the deaths occurred from sepsis, one-third .from the toxaemias of pregnancy, and one-third from other complications of childbirth. No improvement has occurred under any of these heads. Sepsis is, n1ost frequently, the outcome of faulty conditions at or about the ti1ne of childbirth either in the professional attendance or in the private h01ne or hospital where the patient is attended; the other complications can, in the 1najority of cases, be prevented by routine supervision of the health of expectant mothers, which procedure also lessens the risk of sepsis in certain cases. At the time the l\1aternity Allowance Act -vvas passed emphasis was placed on proper attendance at

childbirth ; t he n1ain change in 1nedical thought on this subject since that -date has been the shifting of t he emphasis to pre-natal supervision. The evidence submitted to us by obst et ric authorities indicat ed t.ha t pre-natal supervision was one of the most in1portant measures for prev enting a great deal of ma.ternal mortality and n1orbidity. Although this fact is not sufficiently recognized as yet by administrative authorities and the general public, the medical profession in Australia, as elsewhere, has realized in the past few years the necessity for reform in the obstetric practice of its members and in the methods of training 1nedical students in practical obstetrics. The Victorian Branch of the British Medical Association has instituted an inquiry into this subject, and drawn up a report, which was submitted to us. It

stated that the time and opportu_nities given to obstetrics are insufficient to train properly the average student for this important branch of general medical practice; that the standard of work should be raised; that the teaching should be extended in time and amount; that the standard of examination should be r&ised ; and that a

1 27 9

whole-time Director 0£ Obstetrics sht:Juld. be appbitlted. As a result of this inquiry the Wilson 'rrust has .made a grant to t~e University of Melbourne. providing for the appotlJ.tment ~fa D~rector o~ dbstetric Research, and it i~ expected. that his inve~tigatiop_ ":'Pl lead to irhpefta:rit and valuaple reforms. In Sydney a whole-t~me Pro£es,sor of Q.6049, Obstetrics has been appointed, and -tM curriculum amended to provide more efficient ~eacfµing in tp.e subject, including a covrse .of pre-na~al hygiene. At Adelaide rri~ternlty Q.13449. wards, ate being erect~a at the Adelaide Hospi~~l, where stude~ts wi11 rec~ive additional special .. traJri.ing ih obstetric practice. The Yictorian Post-Graduate C01;nmittee has

Mltl, :Mffesher cop.~ses 11,1 obstetrics for medical practitioners, and post-graduate classes are being formed in other States.

. . 8. , Women r~ceive attention during .childbirth not only from medical.practitioners, but alsb f!oin mi4~ives. In all the Stat~s legislation has been en~cteci for the registration of mitlW~ves, with provision for :registration in future only after training and examination. Thes~ Acts, however, permitted the registration of women who had been acting as midwives prior to the passing of the .Acts; and. who were not necessarily properly .trained. Sever::tl y~afs must elapse before this cl3:ss of ini:rse can be replaced ·by th~se who Etre efficiently . ,t:r_ained in modern :l:neth9ds. Tµe facilities for training midvyifery riutses are insufficient; and there is difficulty in meeting the

demaiid for efficient nurses.

9. The -shortage of nurses has resulte~ in untrained ,nurses, who are registere,d Q.13670-1. under the Midwives Act, adopting the practice of atteriill:hg several patients in their own homes for a . few hours each day. As ?, result apparently of the passing

of the Maternity Allbwance Act, a large fl.timber t>f sinitll private :maternity homes have s:P.ftttig into existehce, conducted by 1iUrsef4 whd, although te~isteretl, are riot always effici~nt in their methods, and are not cftpable. of trainihg others. Efforts at~ made in most of the ~tates to supervise thes~ hthries, hiit with varying success. No stantla:ttl procedure exists. Iii sdme States supervision i~ l~ft to tlie lbcal atithoi'ity, in others th~ cent.:r~l authority carries it out; soi.n~tirries, in reitidbe country tlistricts, by th~ aid

of the police ot bth~t uhtpialified deputies. In st>:rne cities when septic cases 6bcur in such mat~rnity homes ov~rlappi11g of authority occurs. ·

AccoMMODA'.tION ·FOR MATERN11,y CASES:

10. The figures furnished to us bv the Commissioner of Ma.ternitv Allowances as to the per~entag: of case~ attended in hospitals, public or private, for \he year ended 30th June, 1924, w~te as fbllows :-New South "\Vales

Victoria Queensland South Australia Western Australia Tasmania .. Australia. · . ;

• •

41 60 61 57

62 51 52

Q.682.

One ,vitness stated that ther~ were not enough maternity beds in Melbm~rne or in Q. 20766 · country districts in Vidona. ln 13:obart it was stateclthat a·~ least 40 per cent. qf m0th¢r~ Q.no 9o. were attended in hospibal, , and that ~here was insufficient hospital as:co117-m~dation for maternity cases in Tasmania. In South Australia all subsidized couptry.hospitals possessed Q.13466· maternity wards. ·western Australia had only private maternity hospitals outside Perth. In New South Wales no public maternity hospitals were in existence outside Sydney, but Q. 5o71 . there were maternity wards connected wit]:i general hospitals and also private hospitals.

In .some country di~tricts maternity wards have been provided, which were n

nurses; in remote distritts. F.1081.-3

34

PR.E-NATAL CLINICS.

11. At the request of their medical staffs most of the large public inaternity hospitals in the States have instituted natal clinics. Most of these are comparatively recent, and are not yet quite on a proper footing, but they are increasing in number and efficiency. Medical practitioners are giving pre-natal care to their private patients ]n

increasing numbers. At many baby health centres throughout the Commonwealth some pre-natal advice has been given to expectant mothers. The educative value of these centres in inculcating on women the necessity for such sup ervision is undoubted. But the work is done by nurses, wherea::; examination and advice by a medical practitioner are required in all cases.

12. We canuot lay too mucll etres::; on the necessity of providjng increased facilities for pre-natal care and supermsion. All the medical witnesses examined testified to the great value of such me:>,sures as a means of preventing maternal mortality and morbidity. For example, the stavistics of the Queen

Victoria Hospital fot Women, Melbourne, though dealing with a few cases, are very striking. All women confined in the hospital must attend the pre-natal clinic. During the three years the maternity department has existed 1,031 cases have beeu confined, with two maternal deaths. In 1924, 429 women were confined and no

maternal death occurred. Further, there were no cases of eclampsia, and, owing to the early detection of venereal disease in the mother and its treatment, no grossly syphilitic infant was born in the depa.rtment.

13. All the evidence submitted indicated that one of the most important measmes that should be undertaken for improving maternal mortality and morbidity is the adequate provision in populous centTes of properly equipped and efficiently staffed maternity hospitals, either public Ol' intennediate, with a pTopeT ambulance

service. These would not only give betteT accommodation fOT mateTnity cases, but would affOTd the much needed facilities for training obstetric nmses and medical students. Pre-natal and post-natal clinics, as well as obseTVation waTds, should be a:;;sociated with all such hospitals, as well as rest homes for expectant mothers, and an exteTne department where considered necessary. In less populous districts maternity wards should be attached to every general hospital. In dealing with reference (c) (The prevention of disease) we have already recommended that such measmes should be provided at District Health Centres by the State Health Administrations (p. 21).

14. \\Te do not consider it is iucumbent ou us to lay down, in detail, ideal method .':l of teaching students and nmses in obstetrics, of hospital arrangements, or of pre-natal supervision. . These must be left to -the bodies concerned.

DIVISION OF MATERNITY HYGIENE.

15 . 'Ve are of opinion that the Commonwealth can best assist in Maternity Q.sss6-ssa7 . Hygiene by granting subsidies to States which provide such facilities for attention to pregnant and parturient women as are considered necessary by the Commonwealth Department of Health. A Division of Maternity Hygiene should be established in that

Department, under a trained Director, who should advise as to the directions which State activities should take, lay down the conditions under which subsidies should be granted, and see that they a11e observed.

Q.II00 5. Q.6025. Q,6046. Q.6066. Q.6280. Q.7816. Q.579. Q.591-2. Q.2362.

Q.8865. Q.l6154 .. !i. Q.l7137.

M..<\.TERNITY AcT.

16. Many suggestions were made by witnesses as to ways in which t he money now expended under the Maternity Allowance Act could be better used for the promotion of maternity hygiene. The majority of such witnesses advocated its abolition and the devotion of the money thus made available to the provision of clinics and hospitals. It is doubtful whether the Maternity Allowance Act had any object other than the provision of comfort to the mother in childbirth. The evidence of the CommissioneT

of Maternity Allowances showed that the primary object was humanitarian, and not the promotion of health. Evidence was submitted that the allowance was a benefit from this aspect, and should not be superseded by any scheme less universal in its application. No increased saving of maternal or· infant ilfe in the first month has occurred

35

since the passage of the Matermty Allowance Act, and it does not seem to be the highest form of humanitarianism merely to provide comfort which does not lessen the risk of death or disabilitv to the mother or her unborn infant. We consider that no scheme of maternity allowance or motherhood endowment can be regarded as satisfactory

which does not attempt to secme adequate care, in conformity with the best medical experience, for the hr.alth of mother and child both in the pre-natal period and at the time of childbirth. If the Maternity Allowance Act be continued, we are of opiuion that the Act should be amended to provide for payment of the allowa.nce only on the conditions that the expectant mother should make application for the benefit at least five months before the date of the expected birth, and that a medical cert ificate be produced that the mother has had satisfactory pre-natal supervision. The granting

of maternity benefits could in this way be utilized to secure satisfactory pre-natal C'ate , and, thereby, a reduction of maternal and infantile mortality and morbidity. Such procedure · would involve the provisiou of increased facilities for pre-natal treatment, the necessity for wfiich we have already advocated.

We are of opinion that when adequate facilities for pre-natal and post-nata] care and medical attention at confinement have been provjded, and the public has been educated to recognize that every expectant mother must make use of them, the Maternity Allowance Act should not be universal in its application, but payment of the allowaPce

should be restricted to cases where special difficulties exist, either finarcial or otherwise. We are of opinion, also, that ally maternity benefit under a National Insurance scheme should be payable only on the conditions we haye suggested above regarding the maternity allowaiJ.ce.

If the scheme of State Health Administration we have recommended (p. 21) were established, application for maternity benefit or allowance could be made to the District Medical Officer of Health, who could perform this service for the Common­ wealth, and arrange with the patient's medical attendant or with a maternity hospital

and clinic for the necessary attevtion. Pending the passing of legislation, the Commouwealth Department of Health should issue a booklet, as has been done by the Canadian Govemment, to be given to each applicant, with necessary information as to precautions to be taken during pregnancy.

17. In connexion with the Maternity Allowance Act it may be pointed out t hat no standard of viability is laid down in the Act when payment is claimed for a child not born alive. We suggest that the child must measure at least 35 em. (approximately 14 inches) in length.

RECOMMENDATIONS .

We recommend that-(1) In the Commonwealth Department of Health a Division of Maternity Hygiene should be established;

(2) Conditional subsidies should be granted by the Commonwealth to States in order to provide facilities for attention to women before, during, and after childbirth, according to standards approved by the Common· wealth Department of Health ;

(3) The Maternity Allowance Act should be amended-

(4)

( a) to provide that the application for the allowance shall be made at least five months before the date of the expected childbirth, and that the allowance be not paid unless a medical certificate be produced to the effect that the mot.h er has had pre­ natal supervision ; and (b) by the addition to Section 5 (2) of the words, "No child shall be

deemed a viable child which measures less than 35 em. ( approxi­ mately 14 inches) in length;

Conditional subsidies should be granted by the Commonwealth to assist in the education of medical students and nurses in obstetrics in accordance with conditions approved by the Commonwealth Departmeni of Health.

1 28 1

Appendix No. 31.

Q .26 . Q.29. Q.3l. Q.1623l.

Q.10570. Q.l4535. Q.l4544. Q.501 6.

Health (;ommlttee of

Nations, Recommenda­ tions of April, 1925.

of Health on Causation of Freta! Deaths.

Practire of Prcv. :Med. 1923. Fitzgerald .

Q.6083.

Q.95l.

Australian Demography, 1922,

36

VIII.-CHILD WELFARE.

1. Schemes for child welfare have been chiefly concerned with the health of the infant and of the school child. For the consideration of all the of children's

health it is necessary to deal with the subject under four divisions. corresponding to special age periods, viz.- (1) The first month of life; (2) from the first month up to two years; (3) the period from two years to five years; (4) the period from five years to adolescence. ·

THE F IRST Mo;NTH o:F I ... I FE.

2. Although infantile mortality, that is, the death-rate in the first year of life, has been substantially and steadily reduced in Australia in the past 25 years, investigation shows that this reduction is confined to the later months of infancy. The mortality for the first month of life has been almost constant for the past ten

years, at about 30 deaths per 1,000 births, amounting to between 40 to 50 per cent. of the infantile mortality each year. Two-thirds of the deaths occurring in the first month of life take place in the first week of life ; they iue mostly due to

such causes as prematurity, congenital debility, atid malformations. Consequently, their causation must be regarded as being connected with conditidns arising before ot during birth rather than with conditions arising after birth. Intimately bound up with this question is that of still-births. Such births are registrable only in Western Australia, where, accordin g to the evidence of the Statistician of that State, they are registered bot h as births and deaths. In other States they are not registered by law. The Tasmanian Statistician said that in that State they have generally been registered since the passing of the Maternity Allowance Act. No registration of death is requited before the burial of a still-born infant in any State except Western Australia. This variation of procedure in the different States necessarily introduces confusion ihto the statistics of infantile · mortality. We consider it desirable that the Commonwealth

Government should take at once the necessary steps to bring about uniformity of procedure in the different States. Investigation showed that different metJ?.ods have been followed in difierent countries, and the Health Organization of the League of Nations has this year issued a memorandum, with suggestions for uniformity. They suggest-(1) A birth is to be deemed a live birth, if an infant breathes; (2) a dead birth

(or, as we term it, a still-birth) is the birth of a foetus after 28 weeks' pregnancy measuring at least 35 em . in length, in which pulmona.:r:y respiration does not occur ; such a foetus may die either (a) before, (b) during, or (c) after birth, but before it has breathed; (3) every live birth should be inscribed in the Register of Births ; an infant born alive, but dying before registration of its birth, should be entered both in the Register of Births and in that of Deaths, certificate of cause of death being produced; (4) every dead-birth be entered in a separate Register of Dead-Births, the person responsible for the

registration being required to produce, wherever possible, a certificate of the cause of death, signed by a registered medical practitioner. Rates of infantile mortality will be based on the numbers of live births and of deaths of infants under twelve months.

3. The above deals only with the statistical side of the question. There is also a preventive aspect to be considered. I n England, although still-births are not registered, the body cannot be buried without a medical certificate or a declaration by a midwife that such child was not born alive. The birth of a still-born child must also be notified to the Medical Officer of Health of the District. Investigations in England by Dr.

Eardley Holland, published by the Ministry of Health in 1923, showed that 50 per cent. of still-births are preventable; 20 per cent. by pre-natal methods alone (15 per cent. of these being due to syphilis) ; 12 per cent. by a combination of pre-natal and intra-natal methods ; and 20 per cent. by intra-natal methods alone. Gallie, working in the Toronto General Hospital, arrived at similar conclusions. Evidence showed that in the Royal Hospital for VVomen in Sydney a pre-natal clinic has been at work since 1912. A comparison of 4,000 births since that t ime with 4,000 births before pre-natal supervision was introduced showed a reduction of about thirteen still-births per 1,000 births. This experience, coinciding as it does with investigations in E ngland and Canada, suggests that at a low estimate, 1,500 still-births could be prevent ed every year in Australia by the adoption of pre-natal supervision. Evidence also showed that of the 36,288 live births in Victoria in 1922, 1,065 did not survive the first month of life- roughly, about 29 per 1,000. In the whole of Australia 3,955 infants in the first month of life died in 1922. As has been said, the majofity of these deaths are due to pre-natal or intra-natal causes. The same measures of prevention that have reduced the number of still-births should bring about a corresponding reduction in the number of deaths in the first month of life. At a low estimate, 1,500 of these 3,955 deaths could

37

.bee;n saved by proper pre-natal supervision and proper treatment of the mother

m childbrrth. · Such a saving in still-births and of lives in the first month of life would approximately 3,000 lives annually to the community, in addition to the maternal

that would be saved. This presents a strong additional reason for Commonwealth

assistance being given to schemes for the improvement of obstetrics, which include pre-natal supervision .

···".[.

1 283

. 4. In times past occurrence of still-births was regarded as unavoidable. In the of recent knowledge, an investigation of each still-birth should be made by the District Medical 'Officer of Health. For this to be done, registration or notification to will be required as in England. The time allowed for registration

of m most of the States at present is too long, although the operation · of the Q.os2H . Allowance Act has reduced the period that elapses between birth and Q.roo611-7o.

registration. In some of the States a Notification of Births Act. has been passed, compelling notification to 'the health authority within 36 or 48 hours. This can only be applicable in towns or closely-settled districts, but we consider it would be advantageous to make it applicable in all such districts. We are also of opinion that the boundaries of registration districts should correspond with those of local authorities, as is the case in Tasmania. The Commonwealth Statistician gave reasons why this would be an

advantage. If this were done, at some future date, whenever a scheme of District Q.6 . Medical Officers of Health is introduced, arrangements could be made for registration to be made ·at the office of the District Medical Officer of Health, and passed on by his clerical staff to the Commonwealth Statistician's office, thus ensuring the closest

co-operation between the Departments of Health and Statistics. 5. We recognize that there are difficulties in the way of similar notification of earlier foet al deaths, but the loss to the nation through the foetal and maternal deaths due to abortion is so considerable that the question should be faced by health authorities.

The memorandum of the League of Nations which we have quoted states that registration as a dead-birth is reguired in the case of a shorter gestation than 28 weeks in Switzerland Health c om. (six calendar months) and in Japan (four months). It is suggested in the memorandum that the registration of births of such non-viable foetuses should be entered in a separate record, with such information as to duration of pregnancy, cause of miscarriage and

1925 .

other particulars as may be prescribed by a competent authority. vVe consider that with a scheme of District Medical Officers of Health in personal relationship to local medical practitioners, it will ultimately be possible to introduce some system of confidential notification of miscarriages that will help to check the present waste of life.

FRoM THE FrnsT MoNTH TO THE SEcOND YEAR.

6. Infancy is generally understood to last until the end of the second year, but records of infantile mortality deal only with deaths in the first year. The infantile mortality in Australia has been steadily reduced during the past twenty Appendices years, until it is now the second lowest in the world, that of New Zealand No. 2 a nd st.

being the lowest. As has been stated, this fall in mortality has occurred wholly in the period between the second and twelfth month. The causes of illness in this period are ahnost wholly post-natal. They are chiefly nutritional disorders, due to improper feeding, or illnesses characterized by vomiting and diarrhrna, which are now recognized as being chiefly due to infections of the digestive tract. Improvement has been brought about by the careful instruction of mothers in the importance of breast feeding. Nearly all mothers can breast-feed their babies if properly instructed, and if sufficient care is taken. Should a mother, as exceptiomiJly happens, prove unable to feed her baby naturally, careful training in correct methods of artificial feeding, supplies of pure fresh milk, and regular supervision of the baby, have prevented the occurrence both of nutritional disorders and of infections. This has been achieved by the establishment of baby health centres, which are rapidly increasing in number and influence in every State. Those we visited were, except as regards methods of

of administration, all conducted on the same general principles. Premises have been provided, centrally situated, and easily accessible, at which mothers attend weekly, with their babies, whose general condition, weight, diet, . are carefully recorded by the nurse in attendance. Babies are also visited in their own homes. There is a certain ·

amount of medical supervision in most of the centres. Medical advice is not given to sick babies, who are referred by the nurse to medical practitioners or hospitals. In Q,l879L Brisbane we found that some treatment for minor ailments was given by nurses or by Q.Iss46-7. the visiting medical adviser. In two of the States (New South Wales and South Australia) special hospitals for babies suffering from gastro-intestinal disorders have been established.

Q.OIIl2 .

Q.AN9.

Q.3303.

Q.6494. Q.83SO . Q.8336-47. Q.3303. Q.l4443 . Q.l809-l. Q.1876U.

Q.2788.

38

7. It has been recognized that the nurses at baby welfare centres need special experience, and schools for training nurses in mothercraft have been established in Sydney and Melbourne, and arrangements are being made for mothercraft schools in other cities. We found three types of such schools-(a) The Tresillian School of Mothercraft, in Sydney, established by the Royal Society for the Welfare of Mothers and Babies. It provides residence for trainees, who must be certificated nurses, and are trained for three months, and for nursing mothers with their babies, especially those who are having difficulty with breast-feeding. A few premature babies are taken in, but, except for these, no babies are admitted without their mothers. The are instructed in methods of inducing breast-feeding, and of feeding babies artificially during the process, and in food values. The institution is under the control of a medical practitioner, assisted by an honorary medical staff. A course of lectures is given to the trainees on the care of the nursing mother and her baby, and the mothers receive instruction on the same subject. The trainees are examined at the end of their course, and, if successful, receive a certificate. They are then eligible for appointment to baby health centres. (b) The Tweddle Hospital for Babies and School of Mothercraft, at Footscray, Victoria, was established by the Society for the Health of Women and Children of Victoria with :funds provided by the generosity of Mr. Tweddle. It has accommodation for four mothers with babies, for twelve babies without their mothers, and for eight residential trainees. The trainees are all certificated nurses, either general, who train for four months, or maternity, who train for six months. They are given a theoretical and practical knowledge of the normal baby, and of the nursing, care, and treatment of babies suffering frQm malnutrition, also of food values ; and of the care and dieting of premature infants. They are also instructed in the technique of breast-feeding and in dealing with the nursing mother and her baby, and the difficulties arising out of failing lactation. They are examined at the end of the course, and given a certificate if they pass. (c) The Victorian Baby Health Centres Association has established a training school at South Melbourne for certificated nurses, who are given a three months' course in the care and feeding of infants. These nurses are not in residence, but attend daily at the Training School or at the Foundling Hospital, where mothers and babies are in residence. Systematic lectures and teaching are given in this course by the Medical Officer and the Matron. At the end of three months' training an examination is held, and a certificate awarded to those who pass. Only certificated nurses with a special certificate in infant welfare..,_are appointed to baby health centres.

8. The organization of infant welfare work in Australia has been mainly initiated by voluntary associations, who have taken a great and increasing interest in the subject. They have been assisted by subsidies from Governments, from local authorities, and by private benefactions. Where voluntary efforts cause the establishment of baby health centres, and local committees are charged with some responsibility, we found that they

bring into the work an element of enthusiasm which serves the useful purpose of arousing the interest of the mothers in the district. This greatly assists the nurses, and not only combats prejudice and ignorance, but spreads knowledge on this subject. In New South Wales and Queensland baby health centres have been established and maintained entirely by the Government. In tbese instances uniformity and continuity of standards and maintenance have been brought about, and the results in these respects have been advantageous, but as an educative influence in the community, they are probably not so satisfactory.

9. It is highly desirable that Local Authorities should take their share in responsibility and maintenance. When they do so general interest is aroused, in the same way as by the activities of lay committees. Their contributions would relieve the heavy charge on the Central Administration, and assist in providing for increase in the number of centres and for expenditure, which it is evident must shortly be undertaken. A generous spirit in this direction should be a matter of civic pride.

10. We consider it imperative that all such centres and all schools of motherc:raft should be under responsible medical supervision. Efforts should be made to secure the sympathetic co-operation of local medical practitioners, and to encourage them to make use of the facilities offered at baby health centres. It has been found in practice that

women medical practitioners are specially interested and capable in this branch of work, and their services should be utilized as much as possible. 11. We are of opinion that the Commonwealth should subsidize States for expenditure by them on infant welfare, provided that the methods adopted conform to standards approved by the Commonwealth Department of Health. Baby health

39

centres should be established in all large towns. They should be supported by funds raised partly by voluntary effort, partly by local authorities, and partly by subsidy from the State Government. The details of working each centre should be entrusted to a local committee, provided that such details conform to certain standards laid down by the State Health Administration which should also appoint a medical officer to direct infant welfare throughout the State. Special subsidies should be given to

schools of mothercraft, which are approved by the State Administration. The work of the Commonwealth Divisional Director of Maternity Hygiene should include infant welfare until a special Division of Child Welfare is established. He should assist in correlating the work of State Health Administrations in regard to infant welfare.

FROM THE SECOND TO THE FIFTH YEAR.

12. Up to the present this period of a child's life has received little attention from health authorities. Its importance, however, in regard to the subsequent health of the child has of recent years been increasingly recognized. Statistics show that more than half the deaths from diphtheria occur during this period. Deaths from

tuberculous and other fm:ms of meningitis during this period form a large part of the

1 28 5

total deaths from meningitis. Whooping cough and measles are not only more fatal under five years of age, but in many cases leave permanent after effects. The evidence of Q.so1s. school medical inspectors showed that in a large proportion of children nose and Q.2ooall. throat disease and dental defects had developed in the pre-school period and were

revealed by the first medical examination at school. Evidence was given as to the need in cities for more adequate supplies of pure milk for children of this age.

13. In large centres creches, day-nurseries, kindergarten-schools, and Montessori schools deal with a small number of children between two and five years. But these are not primarily or principally concerned with the health of the child. They may indeed act detrimentally in times of epidemic. A special risk to children of this age Q.ts7so.

is the contraction of illness which is conveyed by infection from child to child. Some baby health centres are extending their work to include children over two years old. These children need inspection only two or three times a year to see that development is proceeding normally. It has been suggested that chndren of this age period should Q.:.o21

be supervised by a department of child hygiene which should extend the operations of Q-20547 the baby health centres to deal with children from two to five years old.

14:. Under the scheme of health administration we have outlined in reference (c) (The prevention of disease), direct infections would probably be much diminished, and the risks of this age-period would probably be lessened. If healthdistrictswereinstituted, arrangements could be made for the periodical inspection of these children by a District

Medical Officer of Health (p. 21.). ·

15. We consider that the Commonwealth Department of Health should make :m investigation into the health problems of children fTom two to five years of age . With the 'information thus gained the Commonwealth could assist State Health Authorities by a.dvice and in other ways in promoting the health of children of thiR age-period .

FROM THE FIFTH YEAR TO ADOLESCENCE.

16 .. Most of the children of this age-period are dealt with by the school medical inspection service which is in operation in each State, although with varying efficiency. In New South Wales a principal medical officer superintends fomteen Q.ao:l9-tl7, medical inspectors, eleven travelling dental clinics, an ophthalmic travelling clinic, and a staff of nurses. An effort is made to examine each school child three times during his school life. Special investigations have been made into such questions

as endemic goitre, and valuable records are being accumulated. An admirable example of co-operation between medical practitioners and the school medical inspectors has been set by the principal medical officer notifying the British Medical Association of intended visits of medical inspectors to any district. The Association then

circularizes the medical practitioners in that district asking them to assist by giving treatment for defects found at the inspection. In Victoria a staff of eight whole-time Q.2o5su. medical officers, five dentists, and two school nurses is at work. In addition, four District Medical Officers of Health make some inspections of school children in the country. The arrangements provide that the child is examined three times

during school life. In South Australia there have been one medical inspector and Q.IS75s. one dental officer and one school nurse for many years. This year four additional

Q.l4218.

Q.l8522. Q.l9131.

40

medical inspectors have been engaged, with more school nurses, and provision made fot systen1atic examinations throughout the State. In Western Australia one whole­ tirne medical officer has been working under the Health Department with assistance from school nurses. In Queensland all the rnedical· inspectors are part-time officers; there is no medical director or medical supervision. Several full-time nurses n1ake the arrangements for medical inspection of different schools. A chief dental officer Q.Io9z7-11069· and several dentists on his staff do dental work. In Tasmania one whole .. time

medical officer works in the south, another in the north, and there is one part-time Q.ll56l-:-u'z4. medical officer in Hobart and one in Launcestion. All work independently of one

another, with no rnedical superviswn. They are assisted by school nurses and two travelling dental clinics.

Q.3743-7. Q.12414. Q.5551-7.

Q.5043. Q.20539.

Q.l0772A

Q.lG384.

Q.10767.

Q.10773 •.

17. The school 1nedical service deals with the school life in four different ways. . (a) School environment. - The medical inspector in most cases has little to do w1th school environment. Lighting, ventilation, and other working conditions are

generally left to the State Works Department. The sanitation of school premises is generally under the local authority, and in ·some of the States this is

non-effective, because Government buildings are judged to be exempt from such authority. -

(b) Outbreaks oj·injectious diseases in a school.--Owing to the area each medical inspector n1ust cover, the preliminary steps for preventing such outbreaks rest with the head teacher; consequently, an infection often secures a footing in a school before definite action is taken by medical. authorities. Subsequent procedure varies. In some St.ates control is left wholly to the local health authority; in others the medical inspection staff deal with the outbreak. In some States, regulations still exist regarding terminal

disinfection and closure of schools during an epiden1ic ;. in other States such procedure is discouraged. The valuable work done in New South Wales and in

den1onstrating the possibilities of control of diphtheria in schools by Schick tests and toxin-anti-toxin injections has been mainly performed by officers of the Health Department.

. · (c) Inspection for physical disease, including dental defeats.--Inspection for physjcal disease constitutes the chief, and perhaps the most valuable activity of school medical officers. They not only discover defects and provide .records of sickness, but also send notification to parents advising them to obtain treatment for such defects in their children. The procedure varies. In metropolitan areas medical treatment for all defects is easily procured through private medicaJ practitioners, lodge medical officers, general or special hospitals, but in cou11try towns and rural districts, treatment sometimes becomes difficult, · nartieula.rlv as reo-ards defects of the eye, ear, nose, L v 0

and throat; as in very few con!ltry to1vns are medical specialists dealing with these diseases to be found. In the ease of. dental defects, while private dentists are now distributed throughout most country districts, no dental hospital or facili-ties for _ free dental treatment existed, except in capital cities, until the appointment of SGhool dentists. In some States the travelljng school dentists treat school children of all ages; in others, the school dentists limit their attention to children under eight years of age, but, on the whole, the provision for the dental treatnlent of children is insufficient to meet all requirements.

(d) Inspection for 1nental dejects.-An endeavour is 1nade to discover mental defects early in the child's school life by the application of special tests so that suitable instruction may be given. In many cases the testing is done by the teacher, because the 1nedical staff is not sufficient to cope with the whole of the work. In Tas1nania a very complete systen1 of intelligence testing has been instituted, by which a psychologist supplements the medical inspection and determines the grade of the child. A psychologist has lately been appointed to the South Australian staff under the school medical director. In New South \Vales intelligence testing is done by the l\1edical Staff. We consider that the necessary staff for such skilled intelligence testing should be appbinted to the school medical service in each· of the States.

Increased· faci1itiefl for teaching children below norrnal n1ental standard are urgently required, and should be provided by means of schools err

classes. Residential jnstitutions also should be provided -for cases of mental deficiency which are not suitable for education in either ordinary or special Cases which are not certifiable as idiots or imbeciles, but of whose

.1 28 7

41

eondition the diagnosis is unquestioned, should be in such institutions. In Q.to77s. Tasmania a Mental Deficiency Act was passed in 1920, and under provisions a Mental Deficiency and a Psychological Clinic have been established. The Act gives pqwer to establish separate institutions for mental defectives, but none have been provided owing to want of funds. As the Pensions branch of the Comn1on.wealth Treasury Q .5062•

pays invalid pensions to mental the Commonwealth should be interested in any 1neasures that may be taken to prevent their reproduction and multiplication. Segregation is one such measure, and the Commonwealth might subsidize States who wish to provide institutions for the segregation and care of mental defectives.

The duties of medical inspectors of schools in some States include instruction in hygiene to the teachers who, . in many schools, are required to give short lessons in this subject to the children. We would stress the importance of in.Btructing children in hygiene and of keeping the teaching in accord with the most recent developments

in preventive medicine.

18. In Western Australia school medical inspection is under the Health Department; in all the other States it is under the Education Department, although originally in Tasmania it was under the Health Department. There must be advantages, presumably, in placing it under the Education Department, or this would not have become the general practice. It was that there might be difficulty of access to schools under any other arrangement, and that the work would not proceed so smoothly. But Q.l1623. the work is directly connected with health, and all such activities should come under a Minister of Health. With such an arrangement public and private schools could be

officially medically inspected in the same way as State schools. Provision should also be made for the medical examination and control by the Health Department· of wards qf the State who are under the care of special Departments.

MILK FOR CHILDREN.

19. We have been greatly impressed, during our investigation into the question of child welfare, with the important part that an abundant supply of pure milk plays in the well-being of the child from early infancy to adolescence. Several witnesses insisted on the necessity of quantity as well as quality of milk in the dietary of the Q .919.

child, not only in improving its nutrition, but in lessening the risk of its developing Q.2oss. tuberculosis and other diseases. Evidence was given both in Adelaide and Sydney of Q- 6356· the satisfactory results of experiments made during the past year, in which half a

pint of milk was added daily to the diet of children at school. The evidence showed Q.ts7ss. that in the capital cities much attention is being given to the difficult problem of Q .s5as. providing a satisfactory milk supply. Experiments have been made in various directions, but nowhere has the difficulty been met of supplying a large city with Q.I4373-tH2I

milk that is pure, both chemically and bacteriologically, at a price that enables the Q-12147-62. poorer classes to buy it freely.

We consider that if a Divisional Director of Veterinary Quaravtine is appointed in the Commonwealth Department of Health as suggested by us (p . 16), he should pay special attention to this problem, and that he should, by investigation and advice, stimulate efforts to deal with the question in every State.

DIVISION OF CHILD wELFARE.

20. The foregoing analysis of the problems of child welfare makes it clear that under present conditions the health of the child is safeguarded only by State activities, voluntary and official. The health of the child determines the future health of the adult, g,nd on the health of the adult depends his capacity to discharge the obligations of citizenship, including those of defence and parenthood. The care of the health of the

child ought therefore to be a national duty of the Commonwealth. It is evident that the problems of of infant life sho.uld be a respo!lsibility of .a

Director of Maternity Hygiene. When we the ever-Increasing activities In · regard. to the ?f. the penod two to five of age, tJle

necess1ty for co-ordination of the activities of the different States regardJng the child of age, the complexity of the situation as we are

convinced that the Commonwealth should also appcnnt a Divisional Drreetor of Child Welfare. His duties should include investigation of the health conditions of children. of all ages, especially mental hygiene. He should advise State .authorities of the of his and generally as to all- q_uestions in connexion

with child welfare.

Q , 7(} .

rve recommend that-- -

42

RECOMMENDATIONS.

(1) The Commonwealth should take the necessary steps to secure the uniform registration of still-births in Australia in accordance with the recom­ mendations of the Health Organization of the League of Nations of April, 1925, with reference to dead-births; .

(2) In the Contmonwealth Department of Health a Division of Child Welfare should be established, whose Director should investigate and advise on the health problems of child life;

(3) The Commonwealth should subsidize States to provide additional facilities for child welfare, especially schools of mothercraft, provided that they conform to standards approved by the Commonwealth Department of Health ; and also to provide institutional care for mental defectives ;

(4) It should be the duty of the Commonwealth Department of Health to promote and assist any activities of State Departments that have n1 view an increased supply of pure milk to infants and children.

IX.- INDUSTRIAL HYGIENE.

1. The phase of public health work referred to by the term'' Industrial Hygiene'' on1braces action taken for the prevention of sickness and accident in industry, and aims at the guidance of the development of industry along hygienic lines and at improving generally the health conditions of the workers. Until recent years the action taken in Aus­ stralia with respect to industrial hygiene has been limited to legislation concerning space, sanitary accommodation and ventilation of factories and workshops, with some restrictions on the age of employees; ventilation and safety in niines, and the mitigation of the larger risks of certain occupations. As a result, however, of the increase of knowledge as to the causes of ill health, the subject of industrial hygiene has received greater

attention. Numerous investigations which have been made in various countries have shown that the dangers and risks of certain occupations are in many cases preventable, and it is gradually being recognized that not only can a large proportion of disease, ill health and accidents be eliminated, but that production can be greatly increased by the provision of means for the protection of the worker.

PRESENT CoNDITIONs.

2. Conferences on the subject of industrial hygiene between officials of t he Departmenti'i of Health of the States and Cornmonwealth, with representatives of St at e Departments of Labour or Factories, were held in 1922 and 1924 respectively, .at which t he i'iU bject was considered with the view of arriving at uniformity of practice

in certain respects. A number of resolutions were passed by the conference of 1922 having as their object the securing of uniform action in each State, as to the ex am.ina­ tion of employees, keeping of records, minimum age of employment, collection and publication of information, appointment and qualification of factory in.spectors, legislation,

morbidity statistics, and provision of medical services by employers. Although it is too soon yet to expect any material change, certain recent developments have been noted. Among them may be mentioned the following :- In New South Wales a Medical Officer of Industrial Hygiene was appointed in 1923 to the Department of Health for the purpose of investigating working conditions and making examinations of Q.B634. employees in industries ; and regulations under the Public Service Act were

•• issued in 1924 governing the appointment of cadets and factory inspectors, and

24: P · 177· outlining the educational and technical qualifications necessary for appointment and promotion. In Victoria regulations under the Health Act were issued in 1923 requiring Q. 568.

notification .of certain occupational diseases. In the same State a Medical Officer of the Department of Health was, in 1923, placed for a portion of his time at the disposal of the Labour Department for the purpose of investigation of any medical condition;

and in October, 1925, a female medical inspector of .was appointed to the latter

21.1o.2s . Department for the purpose of exercising closer supervision over female and child

w. A. workers collectively and individually. In Western Australia an amendment of N o. 41 o n gz :J. the Factories and Shops Act was passed in 1923 in which provision was made for

the regulation of factories where lead, . mercurial, or arsenical preparations are manufactured. In the same State the Workmen's Compensation Act was amended in 1924 to provide that where workers are affected by certain specified industrial dis eases

43

(23 in number) , they shall be entitled to compensation as if ,the disease were a personal injury by accident. At the same time the diseases referred to were made notifiable. Arrangements have recently been made by the Co1nmonwealth Department of Health with a number of firms for the keeping of records on prescribed lines; and information is being accumulated for future use. .

MORBIDITY AMONGST WORKERS.

3. A. considerable number of witnesses. was examined by us on this subject. It appears from the evidence that comparatively little information is available as to morbidity amongst workers, owing to the fact that no legislation is in force requiring the notificati9n of sickness other than certain infectious diseases, or the recording of illnesses by the companies or firms concerned. An i.J+quiry made by Dr. D. G. Robertson, Director, Division of Industrial Hygiene, Commonwealth Department of Health, into the sickness experience of 95,244 officers in various Departments of the Government

services of the Cornmonwealth and the States of Victoria and New South Wales for the years showed that during those years"' the total number of days lost by male officers, of whom. there were 70,741 , was 479,685, or an average of 6 ·8 days per annu1n per employee. Of the female officers, 24,503 in number, the total number of days lost was 277,677, or an average of 11·3 days per annum per employee. The average Q.743 . loss of time by male and female employees was 7 ·9 days per annum. The loss of time

due to epidemic or infectious diseases was 24 per cent., injuries 21·3 per cent., digestive diseases 21·5 per cent., respiratory diseases 12·3 per cent., and diseases of the nervous system 8·8 per cent.

MEDICAL SERVICES IN INDUSTRY.

1 2 9

4. With regard to the provision of medical services by employers, the evidence submitted by Dr. D. G. Robertson showed that fron1 inquiries made, one company Q .776_7s6 . engages a full-time medical officer, 21 companies each employ a part-time medical officer, 5 companies have the services of a medical officer through medical funds, and 21 other firms have physicians available in cases of emergency. At least 22 firms

employ qualified nurses to look after the workers, and 6 other firms employ unqualified nurses for this purpose. It was further stated that 15 firms provide both an ambulance room for the treatment of injuries and a dispensary where the usual remedies are kept, and that 32 other firms have an ambulance room, and 5 provide

dispensaries. In all, 52 firms are known to have made some provision for the medical care of their employees. The activities of the co-operative council of the Electrolytic Zinc Company of Australasia Lhnited, in endeavouring to i1nprove the health of the en1ployees of thP­

company, illustrate what can be acco1nplished in this direction, and especially by the H ealth bl. h • d 1 }' . rrh . '} f } .. 'd a· Septeml•r. l, esta IS ment of a enta c 1mc. _ e co-operative coun.c1 o : t 1e con1pany cons1 ere 1925. that this clinic has undoubtedly resulted in. i1nproved health conditions, aud, concun:·ently, has also promoted happiness and efficiency".

5. ]from the evidence given by various industrial xnedical officers it would appear that their duties vary considerably. In so1ne cases applicants for en1ploy:rnent Q.24n -2 r. w . are not exan1ined before engagernent ; . in others the conditions under which e:tnployees work are not supervised. In all cases, however, small ailments and accidents and Q. 5565-5622. illnesses occasioned by the employment are attended to, and in some cases measures

are instituted to prevent the recurrence of ill-health. In some instances the by medical officers and nurses include advice to the employees to consult their medical attendants or a dentist, or to go to a hospital, and as every case of ill-health is reported the conditions of the work are examined, and defects as far as possible remedied. In some firms a transfer to some other section of the establishment is arranged if ill-health

is the result of standing, or is due to some other special cause of fatigue. 6. Most of the Witnesses on this subject were agreed that · there was need for Q.7s4-7. training of medical practitioners who propose to engage in industrial medical work. The majority of those now engaged in this work have gained their knowledge fron1

experience, and the suggestion was supported by several witnesses that industrial 1nedical training should be included among the subjects dealt with by the Chair of Preventive Medicine, which we have recommended should be established (p.18-19). Several witnesses advocated propaganda among persons engaged in industrial occupa-tions. It was proposed that, among other methods, short and suitably-worded notices

might be displayed ·in. all industrial is aJ:ready done in some,

pointing out-the necessity for care, and how to ·avoid riSks and dangers

Q.4882.

Q,l 9947.

Q.76.

44

STANDARDS OF HEALTH IN INDUSTRY.

7. The inquiry co nduct ed by Professor Chapman into the Broken Hill miillng industry, where over 7,000 miners were examined, convinced him t hat t he hygienic standards of Europe and other countries are not applicable to persons in this country, and that there is a need for an Australian standard of healt h. For this purpose a complet e physical survey of every individual in certain industries is necessary. Up to the present, medical examination has taken place only in certain industries in which there is a special risk. It would help greatly if a similar examination could be made

of workers engaged in industries in which there is no special risk. Another witness, Dr. S. A. Smith, also expressed the opinion that a survey of industrial groups in Australia is essential in order to lay down standards of healt h in Australia. He was of opinion that the investigation should be made by a staff including an expert physiologist . Such an investigation would be a favorable starting point for a proper system of indus­ trial hygiene in Australia, and would point the way to modifi cations in working co nditions

which would t end t o improve t he health of men engaged in dangerous industries. . . 8. Comparatively little attention has so far been paid in Australia to the question of industrial hygiene. Wit h the exception of the Broken Hill R oyal Commission , and of certain investigations into the health ot stone masons, quarrymen, sewer miners, and some branches of the clothing industry, there have been few well-defined or complete

invest igat ions to determine the industrial conditions in any . industry or to correlate them to the health of the workmen. DIVISION OF INDUSTRIAL HYGIENE.

9. The Division of Industrial Hygiene of the Commonwealth Department of Health was initiated in 1921, when the Rockefeller Foundation loaned an expert medical officer in industrial hygiene to the Commonwealth for the purpose. This Division has been active in several direct ions, and has published the following valuable Service publications-The Scope of Industrial Hygiene, Health I-lazm·ds in Industry, I nd1.lstr·ial Accident Prevention, which have been widely circulated. The conferences of Common­ wealth and State Health officials with leading officials of the State Department s of Labour or Factories, alreadv referred to, were held at the instance of this Division . The Director of the Division of Industrial Hygiene is a member of the Advisol'J Committee on Industrial Hygiene of the International Labour Office, and in this way close t ouch is kept with all development s in the field of industrial hygiene in other countries . Expert advice is available to employers and employees, and t he work of the Division is likely to be of great value in guiding the development of industry along hygienic lines, and improving generally the conditions of the workers. A.'3sistance has been given to State Governments in connexion with several inquiries and investigations.

10. VVe are of opinion that the Division of Industrial Hygiene in the Department of Healt h has been organized on right lines in carrying out the follo·wing activities :--(a) the publication of Service Reports and information; (b) the collection of data on mortality and morbidity;

(c) t he encouragement of the organization of industrial welfare services, medical, dental, and nursing, among industrial companies or firms; (d) the encouragement of routine medical examination of employees ; (e) the organization o.f uniform methods of records by industrial establish­

ments;

(f) assisting State Health Industrial Authorities and other bodies in investi­ gations and inquiries into problems or difficulties in connexion with industrial hygiene; and that its work in these directions should be extended.

RECOMMEND ATIONS.

We recommend that-( 1) The work of the Division of Industrial Hygi ene in the Commonwealth Department of Health should be extended in th e directions above indicated ; (2) Provision should be mad e at Universities for the training of medical

practitioners in industrial medical work ; {3) A physical survey of individuals engaged in various in dustries should be made for the purpose of establishing Australian standards of health, and that this should be carried out under the contr ol of the

Commonwealth Department of Health by a trained staff including an expert physiologist.

(4)

45

The periodical conferences Commonwealth and State officials with representatives of Labour and Factory Departments should be continued for the purposes of insuring uniformity with respect to records and further action on various other subj ects of .industrial hygiene.

_X,-THE ENCOURAGEMENT AND DEVELOPMENT OF RESEARCH WORK. 1. Nearly all the witnesses we have examined on the subject of Research have emphasized its fmportance and the necessity for encouragement an9. development, as underlying all advancement in public health. _ They deplored the lack of recognition of this fact and the consequent inefficiency of provision for investigation and the acquisition of new knowledge.

EXISTING FACIDITIES.

2. The evidence indicated that limited facilities for research have been provided by both Commonwealth and State Governments; by universities, by hospitals, and by the generosity of public-spirited private citizens. Many of the existing facilities in the way of laboratories, however, are so much engaged in carrying out purely routine

examinations that little opportunity is afforded for research work being done in tbeJ?. It must not be thought, however, that research work in health problems is limited to wltat can be carrieq out in laboratories. Much of it must necessarily be done outside Q.4231. laboratories, involviq.g as it does clinical and personal study of disease in the individual, Q.7453.

as well as the so-called field and communal investigations of disease and mortality. Evidence was submitted that very valuable original research in preventive medicine cari be done, and has in fact been done, by private individuals acting on their own initiative Q.7444_9. and quite independently of laboratories or special equipment. We wish to emphasize Q.75ss. aspect of the question, we t hat special

g1ven to research that may be carried out mdependently of well-eqmpped laboratones.

ScHEMEs FOR DEVELOPiNG REsEARCH.

3. While agreeing as to the need for research, witnesses differed as to details

1291

of the methods that should be adopted to develop it ; as to how much money wquld Q.7564. be required for the purpose ; and as to how t he expenditure should be controlled. Q.75so. of ?Pinio? _ were. to resea:rch in s.hould be

out m connexwn with with hospita ls, or m specral Ihstltutes, or at all Q.7529.

three ; as to whether workers should devote their whole time to research, or should Q.2o6ts. engage .in well; whether teachers fr.om teaching

for vanous penods m order to carry out soine specral mvestigatlbn, or whether Charrs Q.tS95t. wholly for research should established at universities . Opinions also differed as Q,47o5. to whether endowments should be provided for research in general with or without special institutes for the purpose ; or whether grants should be made to assist special ' " · inquiry into particular subjects only, proposed by individual investigators, to be carried

on with facilities already existing, or augmented, if necessary, by funds from the special grant; and as to the value of research scholarships and the conditions under which they· shbuld be established. 4. Professors MacCallum and Berry submitted an elaborate and detailed scheme

for the development of research, the result of a conference with research workers and Q.92G!i--7J. pathologists in Melbourne. The general principles of the scheme were similar to those which had been advocated by previous witnesses, ahd these principles were also approved Q.74s5. by subsequent witnesses. Difference of opinion was expressed as to some of the details, Q·9550· and some of them do not appear to us to be altogether practicable. We approve of the main pr;inciples and consider that the Commonwealth Government should prQvide a Fund in aid ofresearch in health questions, and should establish a Council to administer it. Such

Council, if properly constituted, would itself decide the best methods of utilizing the

f11nd and of promoting research. Among its duties would be- to control and allocate the money; to provide facilities for research workers in existing laboratories, or extend t hem where necessary; to assist individuals in investigations on which they are engaged or which they propose to carry out; to co-ordinate the activities of research worker:s in different States, or to combine workers in teams ; to advise as to directions in which researcli is indicated, and even to initiate 1t:

CoNSTITUTION oF RESEARCH CouNciL.

5. As regards the constitution of the Research Council, the proposal of Professors Q.9971 • MacCallum and Berry that it should consist of nineteen members, with an Executive Committee of six members, does not seem to us t o be satisfactory. We would suggest

Q,l6277. Q.1.6293. q.Z0620.

Q.lOOlO.

Q.7405, Q.7518.

Q. 7407-7425, 7521.

46

one srnall body, on which should be a representative of the Government, who should be a business or financial authority appointed by the Governor-General in Council. The Director-General of Health should be a member, ex officio. The other members should be- ( a) representatives of the Universities of Sydney, Melbourne, and Adelaide, one each, nonlln.ated by their respective Faculties of Medicine; (b) three representatives of the n1edical profession, nominated by the Federal Committee of the British Medical Association in Australia, one of whom should be or have been engaged in research_ ; (c) a scientist nominated by the National Research Cotmcil. members should be appointed for a period of five years.

6. A Sub-Committee should be appointed in each State, consisting of the lVIember of Council residing in that State, and two Men1bers co-opted by him and approved by the Council, to consider local researches, and advise the Council concerning them. If no member of Council be resident in any particular State, the Council should have power to appoint a State

RESEARCH FUND.

7. It is difficult to estin1ate the amount of money that should be made available for the use of the Council. The Commonwealth Government granted an amount of £5,000 for the year 1924- 25 for research into one particular subject-Cancer. In view of the wide field covered by research in connexion with health and its immense national importance, we are of opinion that the Commonwealth would be justified in providing at least £30,000 per annum for this purpose. As it is essential that the work should be continuous, the amount should be in the form of a special appropriation or an endowment

and not an annual grant. NEED FOR LIBRARIES.

8. In connexion with research work, several witnesses drew attention to the need in Australia of better library facilities. Existing libraries are incomplete, and the distances between them make it difficult for investigators to consult literature that is wanting in places where they are working, but may be available in some distant library. · Various suggestions were made, including the establishment of a comprehensive library at Canberra. In our opinion this proposal would involve a very large and continuous expenditure, and would not meet the requirements of workers in distant parts of the Commonwealth.

9. One of the functions of the Research Council should be to provide some means whereby research workers could study the literature of the subjects they propose to investigate. The Council might appoint an official, who, among other duties, should compile an index of available literature, giving information as to where it can be and, with the approval of the Council, employ local agents to make excerpts and digest8 where necessary. The Council might also make grants to libraries.

RECOMMENDATIONS.

We recommend that-The Commonwealth, by Act of Parliament should--(1) Establish a Health Research Council constituted as detailed above ; (2) Provide a Special Appropriation or Endowment of £30,000 per

annum in aid of Health Research.

XL-THE RELATIONSHIP WHICH SHOULD EXIST BETWEEN PUBLIC HEALTH AUTHORITIES AND MEDICAL PRACTITIONERS. L The relationship which should exist between public health ·authorities and 1nedical practitioners in regard to the prevention of disease has been considered when dealing with previous references. We have also, when referring to morbidity statistics

(p. 10), stated that medical practitioners are individually in possession of information concerning the nature, extent and causation of disease, that is not made available to public health authorities or to statisticians. We have recommended that legislation should be enacted to provide that such statistics as are required should be furnished by medical practitioners to the Commonwealth Statistician (p. 11).

2. Medical practitioners are among the first to come into relation with those who are affected with illness. They have the first and, consequently, generally the best opportunity o£ taking or advising steps for prevyntion, especially when the illness is infectious. In this regard certain legal obligations are imposed on medical practitioners. Under the Health Acts of the various States they must notify to the Health Department

•

47

or to the Local Authority, as soon as it is diagnosed, any case that is "infectious" in the terms of the Act. In all States but one they are required to notify cases of venereal disease. In Western Australia they are required to furnish annually to the Health Department a list of all cases of tuberculosis they have seen. By the Regulations- under the Quarantine Act, if the infection is a quarantinable disease such as smallpox, they are required to notify the Commonwealth Department of Health. In

some of the States the Local Authority accepts a medical certificate that terminal disii1fection of a sick room has been performed. In Queensland they are required to certify that a typhoid convalescent is not a carrier. Under the Vaccination Acts they vaccinate against smallpox for the State Health Departments. In some States they are required to notify eases of industrial poisoning and industrial illnesses. A large proportion of medical practitioners also recognize obligations, other than those imposed by law in this connexion and fulfil them voluntarily and gratuitously, in the interests of their patients and of the community. But, as the Federal Committee

of the British Medical Association in Australia stated, in a report on the co-operation of the medical profession in public health, FebTuary, 1925, " in no State is the service Q.2076. of the practising practitioner officially utilized for the prevention of disease to any degree consistent with his knowledge and opportunity " and " any scheme to rectify existing conditions must have as its immediate ideal the linking up of the general practitioner into active participation in the administrative scheme."

3. The Federal Committee stated further that the medical practitioner "should be the unit of the medical side of the administration and should- · (i) Notify to his District Health Officer on prescribed forms-(a) all births and still-births; (b) all deaths; (c) all cases of communicable disease

by the regulations (d) all cases of mineral or organic

pmson1ng.

(ii) Order iri ·writing, ' methods, prescribed by the Health authority, of concurrent and terminal disinfection in infectious cases. (iii) Carry out the methods, prescribed by the Health authority, for the prevention of the spread of infection by contacts or carrieTs. (iv) Carry out medical inspection of school children in particular districts

by arrangement with the District Health Officer and Education authorities. (v) Carry out other health duties as pTescribed from time to ti1ne by regulations, or as requested by the District Health Officer. (vi) Be entitled to receive adequate fees." In our opinion all the above should be included in the duties of the medical practitioner. Among the other health duties to be prescribed he should, when a _ d_eath occurs in his practice in connexion with childbirth, immediately forward to the District Medical Officer of Health a special report, particulars of the case. He should also furnish such returns of cases of illness attended by him as may be required by the District Medical Officer of Health. -

4. In the proposal we have suggested under refe;ence (c) (" The prevention of the spread of disease," p. 21) , for a model State Health Administration, n1edical practitioners would have definite prescribed duties in connexion with public health and preventjon of disease, to be carried out under the supervision of, and in co-operation 1vith the District Medical Officer of Health. As already stated the model . scheme ·

\i'i!e have proposed probably will not be brought into operation for some time and then only gradually. We are of opinion, however, that much could be done under existing circumstances by mutual agreement, to bring the medical practitioner into greater participation in health administration. Evidence showed that an arrangement exists jn Hobart between the Medical Officer of Health and n1edical practitioners, by which the local authority in a case of diphtheria pays the medical attendant a fee for each

REGISTRATION oP MEDICAL PnAC'J'ITlONER8.

5. The position of medical pTactitioners, as persons recognized by law for the performance of particular public duties, and, generally speaking, entitled to practise Inedicine, and in that capacity having Certain obligations imposed upon them essential in public health administration, is one which, we think, calls for considera-bion in this connexiqn in respect of their registration. The registration of medical practitioners is a function of the several States ; and there are six Medical Practitioners' Acts in

Australia, each . operating wl.thin the confines of the State enacting it, and all differing

Q.1s611.

Q.20620

•

48

irom ohe another in some as to who is and who is not entitled to be registered. Apart from the in health administration generally, arising from the

anbmalies indicated, the evidence given to the Conttitission showed that difficulties have experienced by the Commonwealth Department of owing to its officers;

appointed to carry out the work of the Departmeht within the area of a State; having to be registered there as legally-qualified medical practitioners according to the require­ :tnents of the Act in operation in the State; and having, on their removal to anether State, tq be again registered in that State.

Evidence was given that it would be an advantage if the registration of medical p1•actitioners could be carried out by the Commonwealth instead of as at pr_esent by the several States ; and we would strongly urge that the steps be taken to allow

of this beirtg done. B. The deterrllinatioh of the which should exist between public

health authorities and medical practitioners is alniost entirely a matter f6r abtion by the States. We cannot make a direct recommendation with regard td action to be taken by them, but as far as the Commonwealth is concetneu our are as follows :-

RECOMMENDATIONS.

We recommend that-(1) Legislation where necessary should be enacted to provide that such statistics as are required he turnlshed by medical practitioners to the Commonwealth Statistician ; {2) Comtrtortwealth should. . as a to States

for general health administration; that their should provide £or the active participation of medical in local health

administration on the lines we have suggested; {3) The bonimonwealth shouitl to arrange for the transfer to the

Commonwealth from the . States of their pdwf!rs with regard to registration df practitioners.

XIi.-THE RELATIONSHIP WHICH SHOULD EXI$T BETWEEN PUBLIC HEALTH AUTHORITIES AND OTHER PUBLIC AUTHORITIES RENDERING lVIEDICAL SERVICES. 1. As regards the Commtn:iwealth we have, Under reference (a) (n The co-ordination of medical services df Commonwealth Depd:f·tments ,in regard io . all _matters affecting public health ")-previously made that provide for the to-brdination

of all its departments as regards medical services (p. 13), and we are ntit aware of any other Com.rnonwealth public authorities that medical se:tvices. ' 2. As regards State public rendering medical they. .are,

in the widest interpretation of tp.e ter,inl3 of so numerous, and the conditi?fis under which they carry on their functions in the . s.everal States ate so vaned that we find it impossible to make any recoi':riihendations on the for ariy

"legislation and administration by the Comnionwealth in conjunction with States," to which we are limited by our terms · of reference. 3. Under reference (c) ("The prevention of disease," p. 21), we hilive otitlified a model scheme of State health administration in which all activities coriileBted With "health would be under a State Minister .of Health, such as hospitals, maternity liygiene,

child welfare; medical inspection of schools, water supply and If such a

scheme were established, the relationship between health authorities aD:d 6ti1ier public authorities tendering medical services in the States would be by the State

Minister bf Health.

XIII.-THE PUBLICATION OF INFORMATION RELATING TO PUBLIC HEALTH. 1. Evidence on this subject was given by several They were

unanimous in the opinion that the education of ther public in the principles of public health and personal hygiene was of impbrtance. Nbhe of them, however, suggested of teaching or of publication which have not already more le§s utilized.

In order that the educative effect of publicatibns mfiy he as goeu pp§silHe, it h1tist be borne in mind that two purposes have to be servea; nftmely, the 5£ lli©re or

less technical informatioh to those engaged in health Work\ w1iich i§ fiecel:l§a#ly limited, and the dissemination of popular information to nlie public, Whlcli to

be as wide as In seeking to educate the ge:rleral pti.bli6 ¥t mattefs; it is

important that the irrlormatioli should be accUrate and of so si:diple a oliaftitJCer ·us te be

UJ!.derstood. tt is important at the same time to bear, in mind that, where Q.425 t> .

information IS sl!pplied in regard to care should taken to avoid arousing

in the minds of persons who are, or who may believe that they are

suffering from them. ·

ExiSTING METHODS oF PuBLICITY

2. Commonwealth Department of Health has published several valuable Service publications oh particular public health subjects or bearing on special investigations which it undertatken. It also the Commonwealth Journal

of entitled Health (intended ptirriarily for the information of the officers of Q.54• Health Departments) which is circulated among public officials of the Commonwealth and States and other_ persons and bodies interested ifl health organization. Of the Service publications, _ 1,500 cbpies are ptinted and sent to different groups of official persons and others. Health is issued every two months, and 2,500 copies are distributed to civil authorities, various departments; members of Parliament, medical practitioners, and associations with objects bearing on health; but only 180 copies to other persons with interests bearing on health.

3. Certain of the State Departments of Health publish valuable annual reports, but their distribution is limited. All the State Departments issue booklets, posters, Q.S95L leaflets, and_ wa_ llsheets_ of warning, advice arid in_struction in reference to Q.1321s-s1. infectious diseases an.d 9ther health subjects, which reach a fairly large section of the public. Similar publicity is given by tnany local health attithorities, varying according

to the needs of their districts. 4. Numerous voluntary associations, societies and other bodies contribute to the propaganda work by the distribution of literature; and some of them organize lectures Q.10047· and classes for instruction. is also made by them of the press and the platform for

health publicity purposes., The campaigns held £tom time to . time i:n the several States are Q.7344 ·

notable ex-amples of special efforts made by the Pub)ic Health of Australasia and its branches to create a health consCience in the people and to interest the people in CD:n:lfilunity health and the prevention of disease. During these Health-weeks public meetings are held, numerous lectures are tleliveted by pt'ominent public and Q.s(1oL

professional men; health exhibits are shown, displayed and a general .effort made to reach the public by these methods of publicity. _ 5. In recent yea:ts the cinema; has, been utilized for the direct teaching of hygiene an4 for stirring the imagination .P.eople to !1 more of

problems 0f health ,; and the posfnbilitles of a's a channel for health Q.uo u-ss.

propaganda work, have to be rea-lized. 6. We are of opinion that aH these methods of publicity are fo:t;

advancement oi public health and the preventiofJ of _ djse.ase; and that they sho-uld be continued and .. . The British 1\-linistry of H e:;alth publishes an annt1al report which furnishes valua-ble information regarding _ the state of the public health .. Funds should be provided for the issue of a similar report for Australia by (he

Commonwealth Department of Health, and for _ a more frequent issue and \1\'ider distribution of all its publications; also for procuring a central library of cinem.a films which could be hired by State, municipal or other activities. 7. A Division Publicity should be established in the Commonwealth Department

of Health which sh:ould correlate and advise as to all publicity activities, and which Q-6262 • might take into its cunsideration the advisability of publishing or assisting in publishing a popular journal on health. 8. Wliereas a certain an1ount of information in regard to health and .diseas-e is published in the Australian newspaper s as news cabled from it is occasional;

only, frequently of a se-nsational character, and sometimes even misleading. We are of opinion that arrangements should be made for authoritative information to be regularly and systematically supplied by the medical officer attached to the High Commissioner's Office in London, for publication in Australia.

9. A number of suggestions worthy of consideration have been made by witnesses in to the publicatiop: o(.?latters concerning pub-lic health·, and may, we think, With advant-age be recorded. These ma-y be bri;efiy indicated as follows: ..;;.;;... Newspapers should employ medical m.en as correspt>nd.ents in public health Q .954 7'

matters.

Reports of congresses on hygiene or on 1neclicine in newsfta.per-s shottld be tusH. written by competent medical practitioners. F.l081.-4

l-t .H 54 7.

.954

q .73 4·1.

A [Jpemli x No . 29 . Q .l1204.

1J,.l40911 .

\{ .1651 8.

q,.l8!J4U .

Appendix zs.

50

Th e Australian Medical Publishing Con1pany Limited, in addit ion t o publishing the 1J1 ediaal .J otcrnal of A should publish a popular health journal or magazine, the columns of which could be 1nade ava1laJble fo r publishing information supplied. by the Commonwealth Departrnent ot Healt h and the several State Health Department s. The children in schools should. be given teaching in hygiene weekly or even

daily. . . . .

The results of 1nedical research should be popularized by publications 111 n1agazines or newspapers in a simple and interesting form. . Legislation should be passed for compelling the observance of recognized rules of industrial hygiene in all places where large or even small numbers

of persons are employed. Bureaux of Public Health education should be established by the several Stat e Govern1nents, which should carry out all the necessary -publicity work for the health administration.

RECOMMENDATIONS.

lV e reamnmend that-(1) In the Commonwealth Department of Health a Division of Publicity and Health Education should be established with adequate funds t o provide for a wide extension of publication of information relating to

public health ; (2) An Annual Report should be published by the Commonwealth Depa1tment of Health ; (3) It should be a function of the Commonwealth Medical Officer in London

to supply the Commonwealth Department of H ealth regularly and systematically with information on health matters in the United Kingdom and elsewhere, suitable for publication in newspapers or otherwise in the Australian States ; ( 4) Subsidies and other fo rms of assistance should be given to the States in

furtherance of their health publicity activities.

XIV.- HEALTH EXPENDITURE. }1Jvidence was submitted by various officials as t o expenditure on healt h services,

but we were unable to obtain satisfactory and complete statements as to the tot al expenditure on health in t he several States. The nature of t he services administ ered by I-Iealth Departments differs considerably in each State. For instance, in one Stat e the Health Department Inaintains a number of hospitals and asylums; in another, t he department 1naintains several hospitals and subsidizes many others not under its control. In the remainder of the St at es expenditure on hospitals is borne by other departments. The medical inspection of State schools is a function of the H ealth Department in one State ; in two others this work is partly carried out by medical officers of the Health Department, but; rrmirJ.y by t he :Education Department, while in t he remainder it is wholly carried out by the Education Department. In five Stat es the JiealtlJ Departments incur considerable expenditure in the treat ment and prevention

of venereal disease. In South Australia t his work is a function of another Department. In several States subsidies are made t hrough the H ealth Department to various voluntary associations for work in connexion with infant welfaJre; in others the expenditure js cha.rged t o a different department. .

In these circumstances it would be of no value to endeavour to compare t he ·ost. of the health activities of t he various St ates. 2. With regard to'the expenditure of local authorities, evidence ·was not available from any official source as to t he total .an1ount spent on healt h adrninistn1t ion by these

bodies in any St at e. Inquiries made in twelve of the country centres visited by us showed t hat the total amount expended in healt h work wa £79,982, or approxi1nately 22 per cent. of the aggregate revenue of £364,325. The districts of these local authorities included six of the largest country centres in t he States; and in t he evidence relating t o

three of them, the annual cost of sewerage was not included. The remaining six were to·wns of moderate size. The figures , not represent the average amount

spent by local authorities in health work From the st at ement s of the officials of t he shires visited by us it is evident that the expenditure in sparsely populated district s is very small and t otally inadequate for the needs of the residents.

51

\iV e consider that all the expendit ure on Health in the several Stat es should be classified on a uniform system, so that reliable information on the subj ect could be easily supplied . '

. 3. We have not attempted t o esti.mate the expenditure that would be necessary to give effect to our recommendations. We· do not expect that all of thern could be brought into operation at once, but even if introduced gradually, a very large expenditure be incurred. VVhile such expenditure would not be directly revenue-producing

hke that in postal services for instance, it ·would be reproductive directly and indirectly. We have referred to the large amount which the Con1monwealth spends annually on invalid pensions for diseases that are preventable (pp. 9 and 24 ). We believe that a large proportion of this could be saved by the adoption of Ineasures such as \Ve have

recon1mended. The States of the Commonwealth spend, it has been estimated, Q.l>u 7v £6,250,000 on hospitals, benevolent institutio·ns and asylums and other activities for the purpose of relieving conditions, many of which could and should be prevented. If they were prevented, much of the money thus spent could be For instance, we had evidence that in Bendigo in 1923, a catmpaign against diphtheria was instituted. The daily nun1ber of patients· in the infectious ward of the Bendigo hospital had been . as high as 90 and averaged fro1n 20 to 40 . Subsequent to the campaign the nunJ.ber was reduced to almost nil in a period of 18 months, and the diphtheria wards were closed,. which had not happened fo r 25 years. Again, it Inust be obvious that a reduction of n1ent al defi ciency would r esult in diminished expenditure on courts, gaols,

and lunacy institutions. E xpenditu:re in preventive measures means an incalculable saving of life and i1nproven1ent of general healt h and efficiency, a return that is none the less real although it cannot be expressed in financial terms. We have already drawn attention to the lo w standards revealed by medical exa1ninations for Inilitary purposes. Improvement in maternity hygiene and child welfare would result in impToved standards of the adult 1ater on, and so provide men of ".A.l " class for

defence purposes.

X V. - SUJYllVIARY OF HJL COM l\fENDAT10NS.

We recmnr;nend as f ollows with r respect to th e subJ.ects mentioned :­ I. ILL-HEALTH IN THE

(1) That standardized statistical investigations into the extent and character of morbidity in the Commonwealth should be instituted and maintained. (2) T'nat definite and formal co-operation should be established between the Statistician and the Health Department by associating a Medical Officer of the Commonwealth Department of Health with the Commonwealth Statistician's office to supervise the collection, tabulation, and analysis of morbidity, mortality, and other vital statistics. ·

(3) That legislation, where necessary, should be enacted to provide that such statistics as are required shall be furnished by Government Departments, Friendly Societies, industrial and other bodies such as public and by medical practitioners, to the Commonwealth Statistician.

II. CO-ORDINATION OF THE ME DICAL SERVICES OF THE COMMONWEALTHo

A.---IV!ed ica l Services of Civil Departments.

(1) That the health atiministration of the Feder-al Territories (including Northern Territory, the Capital Territory, Papua, Norfolk Island, a nd the l'dandated. Territories of New Guinea and Nauru) should be placed under th e Commonwealth Department of Health.

(2) That all work, for which the services of medical practitioners are required by the Commonwealth in any civil, as distinct from Defence Repa triation a..1ministration, sllould be peliormed: by medical officers, who should be either permanent whole=time or temporary wnole=time, or temporary part=time officers as may ibe found advisable, of the Commonwealth Department of Health.

(3) That the present arrangement regarding the Commonwealth Medical Offi.cer at Housej London, should be altered, and that the Principal lVIedical Officer j_n Great 13rit'l;in shoul,d be an officer of the Commonwealth Department of Health, whose duties should include-(a) the control of the medical examination of intending migrants to Australia from Great

Britain-·with power to select the Medical Referees ; (b) the supervision of any which rn.ay, from time to time, he made for the

medical examination of intending migrants from Europe ; (c ) acting a s medical representative of the Commmnvea.,lth in all international health and quarantine questions, including those relating to animal aud plant qua,rantine ; (d ) taking steps to ensure that the Commonwealth Department of Health is promptly informed

of all matters affecting or likely to affect health or quarantine administration in Australia ;

1 297

52

(e) regularly supplying the Commonwealth Department of Health with authoritative information in regard to health and disease ; (f) advising with respect to any medical questions which may bei referred to himT;by tlie High Commissioner or the Director-General of Health under the Commerce Act or under

any l egislative enactments dealing with food or drugs ; (g) acting as adviser to the High Commissioner, London, on medical and health (h) carrying out other duties as the Director-General of Health may from time to time require . .

B.-1\iedical Services of Repatriatiop. and Defence Departments. (1) That the IVIedical Services of the Repatriation Department should remain as at present. (2) That the Medical Services of the Army, Navy, and Air Force should be co-ordinated under one Director-General, with Sub-Directors in each Branch, keeping the three services distinct.

(3) That a Consultative Board should be established, consisting of the Direetor.-General of t}le Defence Medical Services, the Director-General of Health, and the Principal Departmental Medical Officer of Repatriation, to devise methods and means of co-operation between these medical services.

III. CO-OPERATION COMMONWEALTH AND STATE HEALTH AUTHORITIES.

(1) That section 11 (b) of the "Quarantine Act 1908-24 " should be amended by the addition of the words " and in promoting public health ". (2) That legislation should be passed by the Commonwealth Parliament to provide funds for the establishment of a Health Council, on the lilies we have recommended.

(3) That funds should be made available to provide for the extension of the Commonwealth Department of Health, in conformity with its prescribed functions. ( 4) That legislation should be passed by the C.ommonwealth Parliament to provide University and other training for experts in public health ; also for the training of the technical personnel for all public

health services both in the Commonwealth and in the States. (5) That legislation should be passed to provide subsidies to measures, approved by the Commonwealth Department of Health, which State or local authorities are unable to finance alone-with appropriate conditions attached in order to secure efficiency.

(6) That legislation should be passed to provide for the establishment of laboratories, or subsidies to State laboratories.

IV. THE PREVENTION OF THE OUTBREAK, OR SPREAD OF DISEASE.

(1) That the Commonwealth Department of Health should formulate a model outline of general principles of Health Administration, along the lines we have suggested, and that the Commonwealth should subsidize States for expenditure on Health, provided that their Healih administration sufficiently conforms to such model.

(2) That in the Commonwealth Departmfmt oi Health, Divisions of Epidemiology and Tuberculosis sh.ould be established to investigate problems of infectious disease, and advise genera1ly in regard to all efforts to control infectious diseases.

(3) That the Commonwealth Department of Health shouid formulate the principles of a C'6mprehensive campaign against the spread of Tuberculosis, and the Commonwealth should make conditional subsidies to the States for carrying 9Ut such a campaign, similar to those for venereal disease. ( 4) That the Invalid Pensions Act should be to alloW ()I payment of pensions to the of patients suffering from infective tuberculosis while they are undergoing treatment in sanatoria or hospitals.

(5) That the system of diagnostic laboratories shoH.ld be extended, and that laboratories should be distributed in places that probably would be centres in health districts in the future . . That the system of inquiries into special infectious and other diseases, and of experiments concerning their control should be continued.

(7) That the system of Conferences with State representatives on special aspects of sanitary engineering, industrial·hygiene, and other problems of health should be continued . .

V. THE PREVENTION AND CONTROL OF VENEREAL DISEASE.

(1) That in the Commonwealth Department of Health a Division of Venereal Diseases should be established in charge of a whole-time Director. (2) That the Commonwealth should establish elinics for seamen at important seaports. (3) That the Commonwealth subsidy should be .substantially increased, more strictly conditio ed) and given for specific purposes approved by the Director-General of Health.

( 4) That more clinics should be established in the larger centres, and more distributed in each centre. (5) That the equipment and stafl of each clinic should be sueh that patients can receive adequate individual attention.

(6) That,such elinies should be established preferably at general hospitals. (7) That clinies for female patients should be establiShed preferably· in connexlon with women's hospitals, or women's .departments of general hospitals. (8) That clinics for syphilis and gonorrhoea should be separate.

53

(9) That adequate .laboratory facilities should be provided for dealing with Venereal Diseases situated conveniently to each clinic. (10) That there should be greater co-operation between women police and authorities in charge of clinics.

(11) That the details of Venereal Disease administration should be made the personal responsibility of a medical officer of the State Department of Health. (12) That the -Commonwealth should undertake the establishment of clinics, or provision for the treatment of venereal diseases, when requested by a State.

(13) That when the Commonwealth passes legislation in the exercise of its constitutional powers regarding marriage and divoree, it should include clauses dealing with venereal disease, especially-( a) a clause simllar to Section 13 of the '"Venereal Diseases Act 1918 ",New South Wales, making marriage of any person su1lering from venereal disease in an infectious stage an

indictable offenee ; (b) a clause providing that no marriage should be allowed unless the parties make declarations that they are not suftering trom any contagious or inteetious disease.

VI. UNIFORM LEGISLATION WITH REGARD TO THE PURITY OF FOOD AND DRUGS.

(1) That the Parliaments of the several States should refer to the Parliament of the Commonwealth the matter of the control of imported foods and drugs, and of such foods and drugs of Australian origin as are or may be the subject of interstate trade, and that the Parliament of the Commonwealth should thereupon make laws for the control and regulation of such foods and drugs.

(2) That the Commonwealth Parliament should pass-legislation for the establislunent of a legal standard for a metric or decimal system of weights and measures in Australia.

VII. MATERNITY HYGmNE.

(1) That in the Commonwealth Department of Health a. Division of Maternity HygUme should be established. (2) That conditional subsidies should be granted by the Commonwealth to States in order to provide facilities for attention to women before, during, and after according to standards approved by the Commonwealth Department of Health.

(3) That the Maternity Allowance Act should be amended-( a) to provide that the apylication for the allowance shall be made at least five months before the date of the expected childbirth, and that the allowai\Ce be 11ot paid umess a metlical certificate be produced to the effect that the mother has had pre--natal supervision ; and

(b) by the addition to Section 5 (2) of the words " No child shall be deemed a viable child Which measures less than 35 em. (approximately 14 inches) in length." ( 4) That conditional subsidies should be granted by the Commonwealth to assist in the education of medical students and nurses in obstetrics in accordance with conditions approved by the Department of Health.

VIII. CHILD WELFAltE.

(1) That the Commonwealth should take the steps to secure the uniform registration of still-births in Australia m accordahce with the recoliimendations of the Health Organizati

(3) That the Commonwealth should subsidize States to provide additional facilities for child welfare, especially schools of mothereraft> provided that they conform to standards approved by the Commonwealth Department of Health ; and also to provide institutional care for mental (lefeetives. (4) That it should be the duty of the Commonwealth Department of Health to promote and assist any activities of State Departments that have in view an increased supply of pure milk to irtfants and

children.

IX. INDUSTRIAL HYGIENE

(1) Tliat the wor:k of the Divisioh of Industrial Hygiene in tlie Cofflitionwealth Department ot Health should be extended in the following directions :-(a) tile pubiicaitbil of Service Reports and information ; (b) the collect1otf of data on mortalitY and morbidity ; - · ·

(c) -, the encouragement of the orgahization of industrial Welfare services, medical, and nursing, among industrial companies or firms ; . . (d) the of ro:utine medical examination ?f ; • . . _ ..

(e) the organization of uhiform methods of records by md¥strml , • . ...

(f) assistma- state Health Industrial Authbrities and other bOdies· in ittvestigations antl into 0 proolems or diffictUties in cOiifiexioh With Iht1ustrial Hygiene. · (2) That provision should be made at t1nivers!ttes for the teaching and training ·of medical practifionet•s In industrial metl.imu work.

· (3) Tha:t a, physical survey uf indhriduals engaged in various sho?ld be made for purpose

of-establishing Australian standards of health, and that this- be earned tne control

of; the Commonwealth Department of Health, by a trained staff including an . ..

(4) That the periodical conferences between Commonwealth and State officials , With

of tabour and Factory Departments sh()Uld be continued for the purposes of -in rsutihg u!lifotlhity wi th respect t'o records and acti()rt on various ·othet• subjects of. ifidustriM hygietl.e. . . . - .

1299

t;rit is i t "Med . . co nrnal of .':<

54

X. THE ENCOURAGEMENT AND DEVELOPMENT OF RESEARCH WORK.

That the Commonwealth , by Act of Parliament, should-(1) Establish a Health Research Council, constituted as detailed above (p. 45). (2) Provide a Special Appropriation or Endowment of £30,000 per anmun in aid of Health Research.

XI. THE RELATIONSHIP WHICH SHOULD EXIST BETWEEN PUBLIC HEALTH AUTHORITIES AND MEDICAL PRACTITIONERS IN REGARD TO THE PREVENTION OF DISEASE.

(1) That legislation, where necessary, should be enacted to provide that such statistics as are required shall be furnished by medical practitioners to the Commonwealth Statistician.

(2) That the Commonwealth should require as a condition of subsidies to States fo r general health administration, that their legislation should provide for the active participation of medi cal practitioners in local health administration on the lines we have suggested.

(3) That the Commonwealth should endeavour to arrange fo r the transfer to the Commonwealth from the States of their powers with regard to registration of medical practitioners.

XII. THE RELATIONSHIP WHICH SHOULD EXIST BETWEEN PUBLIC HEALTH AUTHORITIES AND OTHER PUBLIC AUTHORITIES RENDERING MEDICAL SERVICES.

(Dealt with under other headings. )

XIII. THE PUBLICATION OF INFORMATION RELATING TO MATTERS CONCERNING PUBLIC HEALTH.

(1) That in the Commonwealth Department of Health a Division of Publicity and Health Education should be established, with adequate funds to provide for a wide extension of publication of information relating to public health.

(2) That an Annual Report should be published by the Commonwealth ·Department of Health.

(3) That it should be a function of the Commonwealth Medical Officer in London to supply the Commonwealth Department of Health regularly and systematically with information on health matters in the United Kingdom and elsewhere, suitable for publication in newspapers or othenvise in the Australian States.

(4) That subsidies and other forms of assistance sh ould be given to the ·states in furtherance of their health publicity activities. ·

XVI. EXPRESSION OF THANKS.

We cannot conclude our Report without expressing our t hanks for t he courteous manner in which officials of Con1monwealth Departments, State Go er nn1ents and t heir offici als , as well as those of local authorities and voluntary organization. · have r endered aRfiistance to ouT inquiries . Especially are we greatly indeht erl to t he able

and willing St:r vineR of our ir tclefat igable Secretary, 1\ir. Trathen.

XVII . CONCLUSION.

The rnatters referred to us in our Comrnission cover so w jdc a :field oJ ing urr·:y t hat son1e aspect s may appear to h!1ve received less consideration than 1night be expected. On n1ost of t he subjects investigated by us, our re·co mmendations have necessarily been Jimited by t he fact that they wer e not 1natters for legislation and adnlinistration by t be

Co:mmonwealth or by the Commonwealth in conjunction w!th the States, but for legislation and administration by States only. I n regard t o t hese subject s, therefore, our recmnmendations, apart fro1n an amencLment of t he Constitution, could only be f o1· indirect action on the part of the Co1n monwealth, · which should consist for t he rnost in encouraging voluntary co-operation on the part of the States. I n efforts to

prevent disease it is almost an axiom t hat voluntary co-operation between t he individual and the administ ration is more effective t han attempts at compulsion, especially when t he individuals have an intelligent comprehension of what is necessary . To secure intelligent. voluntary co-operation, individuals n1ust be educated, . not spasmodically but continuously. One 1neans of education is a model healt h

administration in full operation, and t his the Commonwealth could supply in the Capital Territory. The present position is one in which " the immemorial contest is going on between Stat e control and volunt ary effort . If every human being aimed at the ideal there wo uld be no need for control. _ If everyone was controlled the human being would beco1n e a machine progress would stop." We have endeavoured to make

55

such recon1nwndations as would provide what we hope may form a satisfactory basis for co-operation between Conm1onwealth and States. The successful result of any scheme that may be devised vvill depend not so 1nuch on its adoption by the Comrnonwealth as on the degree to which States and individuals who constitute the

Comn1onwealth co-operate in an endeavour to carry it out.

We believe that the citizens of the Common\vealth will realize the need for . co- operation in n1easures for pron1oting public health and individually and collectively conf?rn1 to and support such rneasures as may be adopted, recognizing the truth of the old H,o1nan saying, Salus populi suprema lex esto.

We have the honour to be,

' /our Bxcellency's most obedient servants,

YV, TRATHEN, Secretary, lVIelbourne, 30tb November, 1925.

G. A .. SYME, Chainnan.

FRANK S. HONE .. H. TODD.

JANE S. GREIG. S. R,. INNES-NOAl).

1 30 1

1 30

57

APPENDICES.

::::;:=:=================;:===== -

•

Appendix No. Question No. in Evidence.

58

TABLE OF APPEND ICES.

Snbject.

--------j-------------1

1

2

3(a) 3(b} 3(c) 4(a)

4(6}

4(c)

4(d) 5(a) 5(b) 6

7

8

9

9A 10 ll(a) ll(b)

ll(c} ll(d} ll(e) ll{f} ll(g) 12 13(a) l3(b) l3(c) l3(d)

14 15 16(a} l6(b}

17(a) .l7(b) J7( c} 18

L9(rL) l9(h) 20

2 J 22(a) 22(b) 23(a)

23(b) 24 25 '21-i

'27

28 29 :30 3]

33

Q.l Q.68 Q.l45 Q.215 Q.509

Q.466

Q.466

Q.322 Q.2542 Q.2542 Q.2912 Q.4583

Q.4922 Q.6105 Q.8403 Q.958l Q.l2l04 Q.l2104

Q.l2l04 Q.l2104 Q.l2l04 Q.l2082 Q.l2106 Q.l2l48 Q.l2283 Q.l2247 Q.l2222 Q.l2220

Q. 13437 Q.l6249 Q.16249 Q.l8360 Q.1 8360 Q.l8360 Q. l9064 Q.l674G Q.1 6753 Q.1 9212

Q.206ll Q.20714 Q.207 14 Q.20968

Q.20968 Q. 2l724 Q,.l8087 Q.20556

Q.6980

Report, p. 50 Report, p. 50 Report, p . 20 Report, p . 35 Report, p. 43 Report, 'p. 29

List of Witnesses Death Rates from Various Diseuses (fourteen Tables) Co-ordination of Commonwealth and State Powers with respect to Quarantinable a.nd Other Diseu.se Range of Health L egislation in the Australian States Conditions governing the payment of Subsidies to the States in com1exion with Venereal Disease Venereal Diseases in Victoria (s even Tables) ; Cost of Venereal Disea.se Clinics; and Observations ancl

Recommendations Table of Prosecutions in Victoria under the H ealth Act by the Commission of Public Health for the years 1921 to 1924 Memorandum on Labell ing of P ackages, R.nd showing all Prosecutions under the H ealth Act, Victoria, from

1920- 21 to 1923- 24 Scheme of control of Tuberculosis by the Commission of Public H ealth, Victoria Statement showing Health Activities of the Cit y of Prahra.n H ealth Centre, Malvern-road, Prahran Statistics relative to the Venereal Diseases Clinic of the Victorian Department of Health, Melbourne Memorandum on the esta.blishment of a Board of Control, Clinic, and Laboratory concerning Mental Defec ti \ '<: "

in Victoria Proposed Form of Agreement between Physician and Company in connexion with Industrial Hygie:w Chart of Maternal Mortality in Childbirth in New South Wales, from 1890 to 192:3 Organization Chart, Department of P ublic Health, N.S.\V. Estimate of Cost of Pathological L a boratory for Hospitals Chart of Tuberculosis Mortality (all forms) in Australia, 1870 to 1924 Table of Comparison between cases of Pulmonary Tuberculosis reported and Deaths, from Hll IJ t0 I

Victoria Children living with Tuberculosis parents receiving Boarding-out Allowances, Victori a. Invalid Pensioners and Bad Home Surroundings Misbehaviour of Patients at Sanatoria, Victoria Statement showing number of cases awaiting admission to Sana.torium, Victoria Legal Enactment in Victoria concerning Tuberculosis Bacterial Counts of Samples of Milk (three Tables) Questionriaire to States, with replies, as to responsibility for various phases of Sanit

Health Expenditure on Health Administration for five yea,rs (1920-24) by City of Bendigo Statistics r elating to Venereal Diseases at Night Clinic Department , Adelaide Hospital, from 1917 to 19 24 Diagram showing the Present Distribution of P ark and Recreation Areas of Adelaide Metr opolitan Area Proportion of Population to 1 acre of Park Land of Corporations and District Councils of Adelaide Work performed at Venerea.l Diseases Clinic, Brisbane, during eleven months ended 31st July, 192f\ Oases notified from Departmental Male Clinic, Brisba.ne, from l st July, 1924, to 31st May, 1925 Statistics of Female Clinic, Brisbane, for eleven months ended 31st May, 1925 Analysis of Industrial Disease Claims, Queensland, 1918- 19 to 1923-24 Chart of Death Rates from Tuberculosis i n Hunter River District, New South Wales, 1901-23 Chart of Infantile Mortality, 1901-23, Hunter River District, Sydney, and New Zeala nd Chart of Typhoid Fever, Diphtheria, and Scarlet Fever reported from 1910 to 1924 in Grea.ter T onwuom ba.,

Queensland Chart showing Typhoid Fever rates in Towns situated on Murray and Goulburn Rivers Citizen Forces : Statisties of Medical Examinations of Senior Cadets for Service in Citizen Forces Senior Cadet Training: Stat.isti cs of Medical Examinations carried out for Rervice in the Senior UaJ(,Ls Experience of Colonial Mutua l Assurance Society Limited under Poli eies providing Sickness i n

the event of sickness from any cause for 1923 and 1924 (Australia only) Details of Sickness for 1923- 24 of Colonial Mutual Life Assurance Society Limited (A nstmli a only) Infectious Diseases, North-Western Health District of Victoria (two Tables) Maternity and Child Welfare, and Maternity Hospitals, Queensland Goitre in Victoria Practicability of co-operation between Defence Department a nd Dt>partment (Rc lt ill)l .\fE'd ieal

Service) concerning Health Supervision of Boys and Men Health Expenditure in certain Country Centres Expenditure.by State Hea lth D epartments 8

Outline of H ealth Legislation and Organization in the Australian States Analysis of Infantile D eath Rates: and Death Rates for England a nrl Austra.lia An Industria l Den tal Cl inic Ser.tion 13 of the V ene1·eal Diseases Act 1918 of New South Wales

--- - ------------------- - ·- ----- - ------ -----

Name.

Adams, E. vV. . .

Alderson, Col. F. J., Director,

Universal Training Administration Allen, J., Shire Clerk, Shires of

Gundurim ba and Terania Anderson, Dr. Margaret H. Arm it, Dr. H. W. Armstrong, Dr. G.

Arthur, M.L.A., Dr. R. Atkinson, Dr. R. C .. E. Commis­

sioner of Public Health

Badham, Dr. C. Ball, Dr. L. H.

Barber, Maj.-Gen. G. W., Director­ General Medical Services (Army) Barret t, Sir J. W.

Barrington, Dr. Beale, 0. C. Beare, . Dr. F. H. Bedford, Miss M. J.

Bell, Miss Jessie, Matron, Hospital Bellamy, H. E., Hydraulic-Engineer Bennett, S., Go vernment Statistician Berry, H. Vv. Berry. Professor R. J . A.

Bett, H. D.

Birks, Mrs. Lucy Blackburn, C.M.G., Dr. C. B. Boelke, Dr. Grace F. Bowman, Mrs. Eliz. H., President

Nat. Council of Women Boyes, Mrs. I: C. Boyle, J. V. Bradshaw, A. C., Chief Inspector

F actories Brain, W. A., Town Clerk Brandt, E. W., Secretary Hospital Brennand, Dr. H. J. W . . .

Brooke, Dr. A . (Analyst) Brouff , R. A., T own Clerk Br owne, Dr. J . \V. Browne, Dr. Marie J3rownell, E. Buchanan, Dr. A. L.

Buckley, Dr. Emma A. Bull , De. L.B .. .

Bull, Dr. R. J . . .

Burkitt, Dr. ,LA.. N . Bt . G.

"Burnell, Dr. G. H. Hutchers, C. L ., Secret ar y l'harmaey Board

Uarnegie, Dr. W. D. Chapman, Profe::;sor H. G. Chapple, Dr. A. '1'. Cherry, Flight-Lie ut. G. )i'., 1VIedi ea l

Officer, Air Forces Cherry, Dr. P . T. S. Chuter, C. E., Assistant Under

Secretary, Home Department Cilento, Dr. R. \f•l., Acting Director, Public Health, New Guinea Clemons, Dr: G E .

Clubbe, Dr. C. P. B.

Coen, Dr. J .

Cole, Dr. G. E., District Health

Officer Collett, A. H. Collins, C. M.G., J. R. , Secretary Commonwealth Treasur y Corlis, Dr. P. E. t.;ourtenay, Alderman I ,. F .

LIST

Pla ce.

Sydney

Lismore, New South Wales Melbourne Sydney

" Perth

Sydney Melbourne

Sydney

" Adelaide Brisbane Peterborough Adelaide

P erth Melbourne

" Adelaide Sydney

" Adelaide Launceston .. Sydney Perth

Hobart Peterborough Sydney Melbourne Lithgow Adelaide

" Sydney

" Adelaide Melbourne Rydney Adelaide Melbourne

Lithgow Melbourne

Adelaide Brisbane

Melbourne

Launceston .. Sydney

Lismore. New South \li,T ales Gee lon g

Sydney Melbourne

Grafton Sydney

59

APPillNDtx No. l.

OF WITNESSES.

Minutes of Evidence Question Number.

8606-8632 20704- 20752

17737-17756

2471-2540 9534-9569 6283-6347 6414-6493 13979- 14095 14138- 14210

8633-8677 21230-21284 22136- 22219

4085- 421 6 4399-4408 6004- 6063 20222-20259

13543- 13643 18887- 18925 13933- 13952 15972- 16032

14514- 14612 12896-12992 4264-4338 4693-4704 13710-13757

8567-8605 8861-8948 16120-16165

11725-11790 20260-20275 14721- 14774

10856-10913 13966-13978 G917-6964 20753- 20762 20277-20348

16439-16453 13670-13676 9747-9825 7616-7699

9613-9675 16468- 16517 22077- 22099 7405- 7485

15846- 15939 10181- 10195

12993- 12994 4798- 4946 20349- 20439 2098- 2144

4080-4084 13275-13381 18061- 18268

1686- 1782

11791-11840 6348-6413 9892-9923 17539- 17673

21975- 22023

20115-20139 578- ()82

17099- 17167 9676- 9746

Name.

Courtney, Dr. A. C., Principal

Medical Officer R epatriat ion Com­ mission Cox, F. A. Cox, Dr. F. E., Chief Quarantine

Officer Craig, Dr. F. B. Croll, Dr. D. G. Cumpston, Dr. J. H. L., Direct or­

General of H ealth (Common ­ wealth)

C'uscaclen , Sir George

DnJe, Dr. J., Medic:JJ Officer H ettlth, Public Health Department D arling, Mrs. Ethel F . Davey, Dr. Constan ce lVI.

Davies, H. C., Superintendent

H obart Gaol de Crespigny, Dr. C. T. C. de Mon chaux, Dr. C. F. A. de :Morton, Sister M vrtle I.

Dick, Dr. J . A. .

Dick, Dr. R., Director-General .of Public Health, N.S.W. Dimelm.v, T., Secretary Department of Public Health Dow, W. Duhig, Dr. J. V. Dumbrell, A.

Duncan, J. Dymock, S. J., Shire Clerk, Severn Shire

Eadie, Dr. J .. Mel. Medi cal Offi cer of Health Earp, M.L.C., The Hon. G. F. E celes, C. E ., Town Clerl;;:

Edwards, H. J., Town Clerk Dr. J·. S. C., Director,

Div. Trop. H ygiene (Common ­ wealth) Elliott, Mrs. Kat herine Ellis. Dr. Constance Ellis, Dr. L. E. ..

Every-Burns, VI ., Town Clerk ..

Fairfax, Dr. E. W. F eat onby, Dr. H. N. , Medical

Officer, Public Hea lth Departmen t Fehlberg, W. J . Fetherst on, Maj.-Gen. R. H., Officer of Heal Lh, Prahran

Fiascb, Dr. P ...

Firth, F. W. }11tzgera.ld, Dr. .J., Medi cal

Officer, Education Department Flynn, Revel. c T., Superintendent, Australian Inland Mi ssion Fowler, Dr. R . Freshney, Dr. R., Medical Offi cer

of Health

Gall, W . J., Under Secretary, Hom e Department Garrett, E. E., To vv·n Clerk Gault, Dr. R R.u t h Gayer-P hippf?, Surgeon Commander

C. · A., Direct or, Naval Medical Servi ces Giblin, L. ]1' ., Government St at­

istician

Place .

:Melboul"ne . .

Glen Innes . .

Perth

Sydney Brisbane Melb0urne

Sydney lVIelbomne

P ert h

Hobart Adelaide H obart

Adelaide Brisbane Bendigo Sydney

Melbourne

Sydney Brisbane Newcastle Grafton Glen Innes . .

Bendigo

Sydney K aigoo rli c

Boulder Sydney Brisbrw e

K algoorlic lVIelbounw Sydney GraJton

Sydney Melbourne

Brisbane Melbun:·nc

Sydney

lVIelbonrne

Adelaide

1\'lelbourne

Too woo mbn,

Port Pi ri e Adela.icle lVIei bonrne

H oba.rt.

Minutes of Evidence Question Number.

798- 936

19647- 19736 14341- 14367

6184- 6263 19082- 19116 62- 279 1598- 1685

1981- 2035 3384- 3472 8151- 8203 20611- 20680 2764- 2880

14372-14458

ll484- ll5:i3 16383- 16431 10914-1092(:;

15940- 15971 18327- 18361 12726- 12765 6839-6916

5660- 5874 8246- 8325 12766- 12857

14268- 14294 18497-18508 16609- 16707 17168- 17209 Hl737- l980(1

12403- 1250()

14775- 14887 15128- 15]5(; 15055-15127 8204- 8221

18587- ]8fi8li

11H 5(i- 15l8 (i 3877- 3981

l70l4- 1709S

8002- 807!:) 12075-12128

!8087- 18752 2541- 2763 10038-10102

20192

20539- 20()]0

1 04:32- 164:\S

1263- l:3ut 19381 -1938:{ 19387--1947'7

15408- 1547 ";:1,

lSR!l- 19Stl

60 •

LIST OF

Name.

Gibson, Dr. J. L. . . . .

Gillies, Dr. S. . . . . . .

Gla.ssop, J., Town Clerk . . . .

Golding, H. G. . . . . . .

Goode, Dr. A. . . . . . .

Green, M.H.R., A. E . . . .

Green, Dr. T. E . . . . .

Griffiths, W. S., Government To,vn Planner Gutteridge, A. G., Directo r, Div. Sanitary Engineering (Common­

wealth)

Haenke, E. W., Chief Dental

Inspector, Education Department Halley, Dr. Gertrude, Medical

Officer, Education Department !Ialloran, H. C.. . . . . .

p:aniilton, Dr. G. R. . . . .

Hannah, Sister Margaret ..

Hargreaves, Dr. W. A., Government Analyst Harper, Dr. Margaret H. . .

Ha rkness, C.M.G. , E. B., Under I

l:leoretary, Chief Secretary's De­ partment Harris, C. D., Garden Suburb Com-missioner Harris, Dr. :May . . . .

Haste, Dr. R. A. . . . .

Hawkins, Dr. Ethel M., Medical

Place.

Brisbane ..

Sydney ..

Newcastle . . Kalgoorlie .. P eterborough )lelbourne ..

Bendigo ..

Adelaide ..

Melbourne ..

Brisbane

Adelaide

Sydney

" Port Pirie .. Adelaide

Sydney

Adelaide

Newcastle .. Adelaide Hobart

Minutes ot Evidence Queslion Number.

18517- 18521 8222-8245 16548--!6608 15044-15054 13874-13932

4654-4692 12507-12579 16237-16264

12220-12307

19 130--19175

13758-13828

8949-8983 5875--5956 15673-15725 16033-16ll9

649-!--6631 8326-8406 20140-20152

16265- 16272

16960- 17013 16166-16210 10927-11069

Officer, Education Department Hawthorne, W. J ., Shire Clerk,

Shires of Orara and Nymboida. South Grafton 17376-17432

Henderson, J. B., Government

.A..nalyst

18753-18768

Herlitz, Dr. H., Medical Officer, Heatherton Sanatorium Melbourne . . 21002-21121 Henry, )!a-., Chief Veterinary

Officer, Agricultural Department Hill, Dr. J. G. W. . . . .

Hinder, 1\fiss E. M.. . . . .

Hislop, Dr. J . G. . . . .

Holdsworth, J., Town Clerk ..

Hooper, Dr. J . W. D. . . . ·1

Horsfall, Dr. A. H . . . . .

Huelin, F. J., Secretary Depar tment of Public Health Hughes, Dr. W. K. . . . .

Humphery, Dr. E. l\'1. . . • .

Hunter, P., Director of Migration Hurley, IA-Col., T. E. V., Acting D.G.M.S. Hurley, Col. L. J., Deputy

Director Migration

Tngleton, H. C., Town Clerk •.

Inglis, Dr. W. K. . . . .

Ireland, Dr. E. W. J. . . . .

Irvine, Mrs. Emily M., Organizing Secretary, Countrywomcn's As­ sociation 1 rwin. Dr. H. A.

Sydney

,, ..

Perth ::

Port Augusta Melbourne ..

Sydney Perth

Melbourne .. Sydney Melbourne ..

Bendigo ..

Sydney ..

Launceston . . Sydney ..

Ka lgoorlie . .

J 'ackson, Dr. E . S. . . . . Brisbane

J ohnson, Dr. C. H., Medical Officer, Melbourne .. Venereal Diseases Clinic J ohnson, Dr. E. Angas, Medjcal Adelaide Officer of Health .Johnston, Dr. L. P. . . . . Sydney

Jones, Dr. W. E., Inspector-Genera,! Melbourne .. of the Insane · !

Jordan, F. G. 0., General Secretary, ,

::I

Healt h Inspectors' Association, 1 Australia J ull, Dr. Roberta H. M., Medical I Perth I nspector of Schools

Kellaway, Dr. C. H. • • • •

Kenny, Dr. J. P. • . . .

Kidger, E. H . • • • . . .

Knowles, G. S., Assistant Secretary Attorney-General's Department (Commonwealth) Knox-Read, Mrs. Constance M. • . Korff. A. J., Registrar-General ..

Melbourne . . Perth Sydney Melbourne . .

Glen Innes ..

.Adelaide ..

8764-8787

7793- 7850 9225--9298 14613-14626 15249-15288

927-10()5 10103-10109 73 89-7404 14096-14137

2145--2288 7751-7792 21348-21385 1783-1888

1514-1597

12308-12402 7582-7614 11841- 11894 R788- 8860

15l87- 15210

18509- 18516 2881-3095 20851-20952 13493-135<12

7066-7111 4567-4653

14211-14239

4217-4263 14647-14720 20164-20185 4041--4079

19840-19853 16211-16236

Name.

Lane, Dr. Mary, Medical Oilioer, E ducation Department Laughton, A. M., Government Statist Lawes, Dr. C. H. E . . . . .

Lendon, Dr. A. A. . . . .

I.eonard, .A. R . D. W. . . . .

Lipaoomb, Dr. T. W. . . . .

Love, . R. J ., Secretary Charities Board

MacCallum, Professor P . .. • .

Ma oCartie, MiBB Thelma. . . . .

MacGilliouddy, Dr. M . P. . .

MacGowan, Dr. E . T. . . . .

Maguire, Col. F . A., D .D.M.S.,

Second Military District Macinnes, L. T., Dairy Exper t,

Agricultural Department Macintosh, D r. C. L. S .. .

Mackeddie, Dr. J . F. . .

Mackenzie, Dr • .A. J . . . . .

Markell, A. M. . . . . . .

Matthew, Dr. R. Y. . . · ·

Matthews, Dr. S. . . . .

Mayo, Dr. Helen . . . .

Merri!Iees, Dr. C. R ., Medical Officer, Public Health Department Merritt, F. H., Town Clerk Millard, Dr. R. J., Medical Super­

intendent Coast Hospital

Phtee.

Launoeston ..

Melbourne . .

Sydney Adelaide Port P irie •.

Sydney Melbourne . .

..

Lismore Melbourne .. H obart Sydney

Melbourne : :

Glen Innes .. Sydney . .

P ort Pirie . .

K algoorlie . . Adelaide ..

Melbourne ..

Toowoomba Sydney ..

Miller, Professor E. M. . . . . Hobart ..

1r!iller, Dr. W. F., :Jfedical Officer Maryborough, of H ea.lth Mills, Professor A. E . . . . .

Mitchell, D r. P. W., Quarantine Officer Molesworth, Dr. E . H. . . . .

Montgomery, A., State 11-Iining En· gineer l\foore, Dr. K. R. . . . .

Moore, D r. E . Brettingham . .

Thfoore, Dr. J . I., Commissioner of Public Health Morris, Dr. A. E. . . • .

Morris, Dr. B . H ., I nspector-General of Hospitals Morris, Dr. E. S., Medical Officer, P ublic Health Department Morris, Dr. J . N . • . . .

Moseley, Dr. A. H . . . . .

Munro, :Or. A. W. . . . .

Murphy, H . M. . . . . . .

Muscio, Professor B . . . . .

McClelland, T. C. . . . .

McColl, Dr. D. S. . . . .

McDowall, Dr. V. . . . .

l\fclntosh, Dr. R. D. . . . .

McLaren, J. G., Secretary, Home and Territories Depar tment McLean, Dr. J. B ., General Medical Superintendent, Brisbn.ne and

South Coast Hospitals Board MoLorinan, Dr. Margaret H. MacPherson, Dr. J . . .

Nash, M.D., M.L.C., The Hon. J . B . Neely, T. H., Secretary, Board of Health

Nelson 1 J . W., Town Clerk Nelson, Dr. W . T. . .

Newland, Dr. H. S. . .

Noble, Dr. R. A. . .

O'Connor, J. A., Deputy Commis­ sioner Queensland State Govern­ ment Insurance Office Osborne, Dr. E thel E . . .

Osborne, Professor W. A. Owen, D. .. . .

Page, Dr . W. S. I Palmer, :Or, A. A,1 Government

I

Medical Officer Pardey, Dr. J. Mel., Medical Officer of Health

1 Victoria

Sydney Newcastle . .

Sydney Perth

Melbourne . . Hobart Brisbane

Melbourne .. .

Adelaide

Sydney

Melbourne .. Sydney

Melbourne : : Sydney · Melbourne ..

Bendigo Melbourne ..

Brisbane

Melbourne . . Sydney

Lismore Knlgoorlie . . .Adela ide Sydney

Brisbane

Melbourne . .

" Lithgbw Brisbane Sydney

Launceston . •

Minutea o! !evidences Question Number.

11561- 11724

12858-128!)5

7930-8001 16454-16467 15479-15541 7860-7921 20763-20850

9969- 10037 17757-17800 1362--1513 11353-1141 7

6965--7065

20202--2022 1

8080-8150 12189-12219 20487-20496 19854-19940 20153- 20163 15641-15672 14888-14946 13644-13669 I 11992--12074

19157a--19223 7184--7273

10765-10855 21484-21604

9570-9609 16809-16838

5292--5371 14240-14267

10196-10232 11070-11 203 17856- 18060

3473-3597 13382-13492

5081- 5291

3598-3696 9461-9532 6268-6282 11895-11991

8678-8G97 20497- 204!)8 22100-2213(} 18442-1849G

125 0-12607 683- 7:3G

18269- 18326

22024-22076 7365-7388

7922-792!) 20076-20114

17433-17538 15211-15248 13248-13274- 8698-8763

19060-19081

4409-4467 4705-4797 20440-20478

18926=-1893(1 5957-6003

10302- 1042-J

61

LIS'f OF WITNESSES-continued ·

Name .

Park, Dr. C. L ., Direct or, Div.

M:arine Hygiene (Commonwealth) Parker, W . R., President Dental Board Paton, Dr. R. T. . .

Penrose, J. S. . . . . .

Phillips, H. N., Town Clerk

Pike, Capt. E . R. B., -Ron. Secretary Queensland Ambulance Transport Brigade Plunkett, P. J. . . . .

Por ter, G. Registr ar-General ..

Price, ·Dr. T. A. . . . .

Priestley, Dr. H. . . . .

Pullar, J, . . . . . .

P urdy, Dr. J. S ., Medical Officer of Health, Sydney

Purnell, D r. K. C., Medical Officer of Health

Rankin, A. A., Chairman}Board of Directors, Newcastle Hospital Rees, W. D. . . .. . .

Reid, D1·. C. W., Chief Quarantine Officer, Sydney Richards, Dr. E. A. . . . .

Robertson, Dr. D. G., Director,

Div. Indus. Hygiene (Common­ wealt h) Robertson, Dr. E., Chief Health Officer and P ermanent Head,

Department Public Health l'to bertson, Professor T . Brailsford Robertson, W. A. N., Chief Vet­ erinary Officer, Departmen t of

Agriculture R odley, H . B. . . . . . .

Rowan, Dr. G. P., District Health Officer Russell, A. C., Secretary, Royal North Shore H ospital Ryan, M.L.C., The Hon. J.

Sandes, Professor F . I' ...

Soantlebury, Dr. Vera . .

Schafer, Dr. C. H. . .

Scholes, Dr. F. V. G. . .

Scott, Dr. B. C., Medical Officer, Greenvale Sanatorium Selwood, Dr. J. L. . . . .

Sliarley, F. E., Town Clerk . .

Shoo bridge, Miss M. C. . . . .

Shrimpton, F. G. . . . . I

Simms, E ., Secretary Commonwealth Railways Sinclair, Dr. E rio, Inspector-General Mental Has pit als Sinclair, Dr. T. vV., Medical Officer,

Health, Melbourne Smith, Dr. S . .A. . . . .

Smith, Dr. W. Ramsay, Chairman Central Board of Health Sommarlad, lVIrs. M . .A. . . Spencer, Nurse-Inspector, L. M. . . Springthorpe, Dr. J. W •. .

Sprott, Dr. G., Medical Office r of Health Stacy, Dr. V. 0 .

Stanton, Dr. B.

Place.

Melbourne

Brisbane .. I

Sydney ..

Launceston .. Mary borough, Victoria Brisbane ..

South Grafton Brisbane ..

Toowoomba Sydney ..

1 1

Melbourne .. Sydney ..

Geelong

Newcastle ..

Toowoomba Sydney ..

Lismore Melbourne ..

Melbourne . .

Adelaide Melbourne ..

Adelaide Bendigo

Sydney

Lithgow

Sydney . .

Melbourne . . Peterbmwugh 1 Melbouxne . .

Brisbane ..

Peterborough Hobar t ..

Sydney . .

Melbourne ..

Sydney

Melbourne . .

Sydney Adelaide

Glen Innes .. Newcastle ..

Melbourne .. Hobart . .

Kalgoorlie .. Melboume ..

-----------------·----- -----

l\linutes ol Evidence Question Number .

Name.

191 29

5425-5622 10233-10301 21399-21483

I

Stenning, H . R., Town Clerk . .

Stenning, S. C., Secretaty Central Board of Health Stephens, Dr. H. Douglas ..

Stewa>·t, J. . . . .

19029-19059

17271-17375 18950-18995 19478-19"499 7486-7528

20953-21001 7274-7344 8518- 8566 20276

21903- 2i 974

I

Stewart, Dr. J. E. F. . .

Stirling, Miss Harriet .A •. . Stokes, Dr. E. S. . .

Stopford, M.L.A., Dr. R. Story, J. D ., State P ublic Service Commissioner Stroud, S, H. . . . . . .

Suckling, Dr. F. M. . . . .

Sulman, Sir John . . . .

Sutton, Dr. Harvey, Principal

Medical Officer, Education De­ partment Sykes, l\bjor G. E. Symons, Dr. E. L .

Tassie, D1·. L. G. . . . .

Taylor, Dr. G. H ., Chief Medical Officer, Railway Department Taylor, Professor T. Griffith ..

16908-16959

19224-19307 8984-9071 I Taylor, Dr. W. F. . . . .

'faylor, W. I. . . . . . .

1 Telford, Dr. R. W., District Health 17801-17855 737-797 I

Officer Thompson, A. . . . . . .

Thomson, H. . . . . . .

280-577 4468-4566

16273-16316 12129-12188

16318-1 6346 12608-12725

9610-9612

20479-20486

7529-7554 3300-3383 13953-13965 10110-10180 21122-21229

18-522-1 8586 138-29-13873 11 417- 11483 20193-20201

2289-2361

5372-5424

3697-3876

1994J-20006 13071-13247 I 16317 19807-19839 16839- 16907

4339-4398 10430-10678

i4947-15043 3245-3299

Thwaites, Dr. A. H. . . . .

Tidswell, Dr. F. . . . .

Traylen, W. .. . . . .

Tudor, E. J., Secretary Department of Health Turner, Dr. A. J .

Venness,- A. A., Town Clerk Vickers, Dr. W. . .

Wade, Dr. R. B. Waites, 1'., Acting Government Statistician Walla ae, Dr. H. G., Medical Officer,

Health, Hunter River Combined Sanitary District Walsh, Matr on Agnes· Mc.L. . .

Walsh, R. H., Acting Secreta1·y Dep:utment of Public Health Walter, A. L., Town Clerk Wardell- ,Johnson, Dr. P. H. Wardla.w, Dr. H . S. H . ..

Warner, Dr. Beatrice A. Waterworth, Mrs. E. A ...

I

Watson, Dr. H., Medical OtF.cer Greenvale Sanatorium Welsh, Professor D. A. . . Wheatland, Dr. F. T . . .

'\Vickens, C. H., Commonwealth Statistician Wilkinson, P., Federal Analyst .. 1 Williams, Assistant Nurse-Inspector

I.

Wilson, Dr. A. M. . .

Wiudeyer, Professor J. C. Wood, Dr. A. J. . .

Woodruff, Professor H. A. Woods, W. E . . . ..

Yeates, H. Yeatman, Dr. U., of Health Medic11l Officer

Place.

1 30 7

U inutes ol Evidence Questiou Number. !

South Graft on 17210-17270 Adelaide . . 16518- 16547

Melbourne .. Lismore Perth Adelaide Sydney

Sydney

Melbourne .. Port Augusta

Adelaide Sydney

: :

Sydney ..

. Maryborough, Victoria Sydney Melbourne . .

Perth Hobart

2362-2470 17674-17736 14459-14513 16347-16382

9368-9460 7615

18996-19028

5623-5659 9310-9367 9299-9309 4947-5080

20 681-20703 15289-16407

15726-15845 7112-7155

7345-7364 19117-19128 982&-9891 21605-21751

6773-6838 20499-20538 21386-21398 7700-7750

14368-14371 11204-11352

Brisbane ..

Glen Innes . . 19500-19646 Sydney . . 6632-6646

Sydney 6647-6772

20007-20075

Newcastle . . 16708-16808

Perth Brisbano

Gee long Perth Sydney Me lbourne . .

Hobart Amherst, Victoria Sydney . .

Toowoomba Melbourne ..

Melbourne .. Sydney Mclbouruo .. ..

Sydney

Toowoomh:• Port Pirie ..

14627-14646 18940-18949

21 853-21902 14295-14340 8503-8517 3982-4040 11534-11560 21752-21852

7555-7581 19308-19357 1-61

3096-3244 9072-9224

1096- 1262 6064-6183 2036-2097 21330-21347 20186-20191

19358-19380 1!1!542- 15640

62

No. 2.

(Qttestion No . l.)

Year. N .S.W.

- - --

1910 5 ·1

1911 5·2

l912 5·4

1913 5 · 7

1914 5·0

l915 4 · 6

1916 5·7

l917 6·2

1918 5·0

1919 't · 7

1920 4·9

1921 4 ·2

l!.l22 4·6

l923 5·6

924 5· 9

U n M MO .N WJ t; AL'l'l{ OF' A.rrs·rH.A LI A.

L'LH1R l'IM{A L

JJi.; Anrs PER 1,000 Bm:rB:s, 1910 - 1924.

Territories.

Vi c. Qld. S.A. W.A. Tas.

Capt t al.

- - - - - - -- - ---- - - -

4 ·8 5·9 4 ·8 4· 4 5·4 . . ..

4·5 5 ·8 5 ·8 3 · 7 4·6 30·3 . .

4·5 5 · 3 4 ·0 4 · 3 3·4 .. ..

4 ·7 4·2 4·6 3·6 4·2 . . . .

4·1 ,1. 6 4·8 4 · 7 4 · 3 . . ..

3· 7 -!·7 4·6 3·4 4 ·4 . . . .

4·3 6 · 2 5·7 5· 4 3·2 13·5 ..

4· 8 6·3 4·2 5·3 5·6 29·0 ..

4 ·3 4·6 4·1 4·6 5·5 . . ..

4 ·6 4·9 5·0 5·6 2·6 .. ..

5 ·5 4 ·2 4·8 6·3 4·9 . . . .

5·1 5·3 6·1 2·8 4·7 . . . .

3·8 5·2 4 ·2 5 · 3 5·7 14·3 . .

4·1 6 ·4 4 ·9 4·1 ;{·9 . . ..

5· 5 '

5•0 5· G 4·3 I 4 •6 . . . .

c mwth.

'

'

5·1 5·0 4·8

4 ·9 4·6 4 · 3 5·3 5·6 4·7 4·7 5 ·0

4·7 i·5

5·1 )•5

UF!ATK RA'rE OF 01-JILDRE!< WHO DIED O N E }lONl ' LI

1,000 Bmms, 1910- 1924.

Teiritories.

\ r ea l". N.S.W. Vi c. Qld . t; .A . W.A. 'l'a.s. Cmwtl1.

Ca p•t· tl.

--- - - - - - - - - - - - - - - - - - -1910 30·48 31·65 29·32 26·19 29 ·80 33·83 .. . . 30· 35 1911 32·19 31·70 30·62 25 ·05 31·64 30 ·16 .. 33 ·33 31· 0(j 1912 29 ·81 32· 38 31 · 38 28·64 32·57 33·15 90·91 51· 26 30·96 1913 32· 19 32· 83 30·51 29·30 29·07 33·81 38·46 22·73 31 ·71 l914 32 ·01 34·02 30·93 31·31 32·38 30·91 34·48 .. 32 ·29 1915 31 ·97 34· 31 30·25 30·60 28·83 35·24 32·79 21·28 32·36 1916 31 · 37 33· ;!6 31·41 29·18 30·95 31 · 90 27·78 15·87 31 · 68 1917 29·84 30·:JO 28·81 27· 81 27·78 27·90, 28·99 45 · 45 29 ·42 1918 32 ·85 32· 57 2\1·02 29 ·76 29 · 97 29·36 19 ·05 20· 41 31 ·58 1919 34·86 3() · ()2'30 ·75 30·!56 28 ·25 38·61 37·74 74·07 :H· :to l920 31· 89 34 ·9.6 2t> ·59 29 ·8i) 29·94 29· 79 ll·ll 66 · ()7 31·82 1921 30·44 34 · /(j 27·1j5 29 ·23 30 ·87 32·84 l2 · 66 . . :n·l5 !922 29·04 29. 2fl·77 28 · 51-l 28 ·781 29· 57 28. !57 :{]· 25 28 ·71 i l923 30·18,33·73 29 ·08 26·231 34·47 . . . . ::)(l ·(i / 1924 30 · 59 32· 10 27 ·50 25·53 24 · 70 33·251 17· 54 24·3[1 21)· 85 DBA'r.El RATE b'IWM '£ UBEROIJLOSI S OF 'rliE RESP!RA'rO!

DJ•:A'rll. B.ATES T u BE !{C vLOSlS ( o TH E K THAN OF 'J' R>;

I{BSPIRATORY i)Ys'l' EM) P ER lVbLLIOX PoPULA'rrO!< ,

Hll0-1924. ------ ---- ------- --- I Territories . Yea,. N.S.W. Vic. Qld . S.A. W.A. Tas. North' n Federal Capital. C'mwth. --- --- - - - - - - ----:-,-.-.--- 1910 11 5 165 76 1911 98 163 91 l912 95 142 93 l913 120 132 50 l914 89 123 49 191 5 83 123 51 l91 6 91 128 51 191 7 68 144 43 1918 84 H4 42 191 9 76 113 50 1920 87 us 40 1921 74 124 38 1.922 66 100 27 1923 56 95 19 1924 50 135 47 1 16(; 85

151 140 189

137 llO 178

126 83 154

103 62 107

152 103 112

161 70 22 1

154 82 12(1

100 84 161

130 66 166

107 73 138

123 69 103

103 85 196

83 40 121

96 66 16::!

. .

. .

277 ..

. .

210 206 ..

..

. .

. .

..

. .

. .

.. I . . . .

..

. .

..

..

..

..

. .

..

. .

. .

.. I

.. I

128 127 11 6 114

94 99 !Of! 97

99 90 95 88 80 66

D .mATH g ATI!l MLLLIO.'< t

Territories.

Year. N.S.W. Vic. Qld. S.A . W.A. Tas. Cmw t h.

Nortll'n F ederal Capital.

- - --- - --- - - - ----- - - -

191 0 714 835 659 810 498 633 .. .. 733

1911 735 828 641 731 617 689 302 561 739

1912 739 896 622 767 598 692 600 491 760

1913 727 834 651 832 568 741 554- 408 747

19 14. 729 832 646 831 505 745 1,356 75G 71! 3

1915 706 819 632 885 685 708 694 . . 743

1916 770 926 688 797 751 788 210 . . 804-

1917 772 925 733 862 1 666 814 412 401 Sl ;{ 1918 816 941 825 840 714 732 ·H1 .. 8-14 1919 853 861 787 942 794 864 859 433 85] 1920 815 905 788 904 / 815 732 1, 187 460 842 1921 844 952 792 917 848 83 5 1,280 .. 874 1922 859 998 857 953 1 886 866 274 .. 907 1923 I 845 1,017 827 949 I 761 771 554 .. 892 1924 930 1,01 2 791 965 904 I 922 1,110 . . 934 DEATH RATE FROM Dll'HTHBRIA J'E & MILLION OF PoPULATION, . 1910-1924.

Year. N .S.W . Vic. QJd . S.A. W.A.

1910 1911 1912 191 3 1914 191 5 1!)1 6 191 7 1918 1919

1920 1921 1922 192 3 1924

70 147 153 176 139 158 173 131 120

69 121 143 95

78 95

78 181 186 173 149 142 192

lll

147 143 186 179

87 54 69

96 65

150 155

155 135

128 174

166 130

107,137 118 315

120 201 105 184

134 175

172 179

145 249

77 121

49 91

62 53

66 126 11 6 147 . 121 1 1091 109 104

881 103 152 135

.65 57 39

Territories.

T as. Cm wth

42 105 236 196 163 148 201

19 6 101 102 15 7 281 270 I 149

93

N orth'n Federal Capital.

.. i

554

74 155 162 168 145 141 18

13 128 112 155 168

98 69 75

Year.

l910 911 912 913 91 4 915 916 917

63

DlllATH RATE PER MIL LION .FROM. TYPHOI.D, 1910-1924.

N.S.W. VIc. Qld. S.A. I W.A. I

---- - -------

178 110 167 63 188

108 71 145 56 286

131 70 223 92 329

125 69 191 112 201

132 75 187 128 174

11 5 55 222 112 140

105 52 229 109 121

50 44 75 66 95

I

Tas.

---

215 105 84 82

56 76 72 88

Territories.

North'u ]'edera Cap it" I

I.

---

. . ..

302 . .

.. ..

.. ..

.. ..

.. ..

. . ..

.. ..

Cmw th.

148 109 133 11 9 122

11 3 107 57

1 30

AUSTl{ALlA.

P UERI:'.I£ 1tA L .\:IO .Ril'ALITY At.JC URDING TO AGE, 1923 AND 1924.

.Nnmber of Confinements resulting I in lA ve Births.* Dea ths Nun11Je r of from Deaths !rom Age of Mother. Puer- Puerperal Cause• fier Sing le Births Births peral 1,000 Con- Births. of of Total. Causes . finem ents. Twins. Triplet s . -I - - - - I I 1-923 . l l l l 1 1 1 1 l l l 1 1 l 918 55 34 77 22 71 50 . . .. 50 Under 20 6,423 35 6,458 28 4·34 919 61 22 95 36 63 54 .. .. 52 20 and nnde1· 25 30,302 220 30,522 112 920 61 35 97 35 85 77 .. .. 58 25 and under 30 38,510 357 l 38,868 169 4·35 921 59 44 77 68 126 117 .. .. 64, 30 and under 35 30,683 417 2 31,102 166 5·34 922 45 19 51 37 77 70 .. .. 41 :15 and under 40 19,073 274 3 19,350 153 7·9l 923 45 34 57 25 52 60 . . .. 43 40 and under 45 6,793 86 6,879 57 8·29 924 44 20 56 26 56 37 . . - .. 38 45 and ove1· Unspecified 629 5 19 634 6 9·46 19 l-tA'l'Jo: !IROM 80ARLE'l' PER MiLLION OF POPULATION, 1910-1924. I Terri Yea r. N.S.W. Vic. I Qld. S.A. W.A. Tas. Cmwth . , orth' 0 , • Cnpt ta l. l -- . 1910 14 13 2 5 7 l G I . . . . • 13 ! 3 i · i 7 · 21 :: : : 1 1913 12 4 2 Hi 3 15 . . . . I 8 1914 ll l 3 4 3 10 . . . . (i 1915 46 8 1 2 . . 25 . . . . 21 Hll6 50 19 10 2 3 15 .. .. 27 1017 14 23 '1 2 .. .. .. .. 13 19 18 8 28 7 20 32 ii . . . . Hi 1919 1920 8 2-l G 17 9 15 . . . . 13 10 21 s 47 12 . . . . . . 1 ' 11 l !J2l "" 1-l 4 8 3 19 . . . . 8 _ ! .. : H I :: ; : I J D J;A'fH i:C N l'E n:oM DL':i EASES 011 THE HEAH1' (INc LUDING PEI\!CAILD lTIS, ENDOCAitD!TIS, :n-fYOCARDI'l'IS '"-'fD ANGINA PER MILLION OF POI'ITLATION, 1910-1924. Territories. Year. Vic. Qld. S.A. W.A. Tas. em ll' tlt. North' u J!'ed era l Cap ital. - - ---- - ------- ----------l010 979 1, 318 996 1,194 734 806 . . . . 1,077 l!)l l 1,079 1,424 1,201 1, 154 851 1,141 604 . . 1,189 H.ll2 1, 168 1,475 1,214 1,175 774 1,179 .. 491 1,238 19 13 1,024 1,324 1,121 1,157 728 1,152 83 1 1,633 1,126 1914 954 1,316 1,058 1,138 747 959 2,442 756 1,077 19 15 973 983 1,034 1,008 697 1,238 1,388 810 981 1916 1,021 1,109 1,168 795 1,055 1,892 . . 1,037 19 17 842 1,022 875 1,052 819 1,015 825 . . 923 l918 865 1,041 976 1,017 733 984 411 824 940 10 19 1,138 1,363 1,251 1,306 1,213 1,444 1,289 . . 1,249 l()20 1,035 1,226 1,176 1,233 964 1,250 1,425 .. 1,131 1921 1,032 1,182 1,025 1,187 812 1,224 512 .. 1, 108 19'22 1,060 1,165 1,001 1,093 942 1,131 1,095 710 1,080 1923 966 1,200 963 972 861 1,277 . . 302 1,037 1924 I 1,020, 1,238 1,024 995 904 1,336 .. 1,039 1,084 'l'otal 132,432 1,394 --;I -- 5 - · lG

1924.

Under 20 .. 6,9451 36 .. 6,981 29 4 .Iii ?O a nd under 25 30,348 194 .. 30,542 137 4•4\l 25 a nd u ode1· 30 37,614 374 .. 37,988 167 ·i·4{1

30 a nd under 35 30,806 395 5 31,206 199 6•37

35 and under 40 19,251 266 5 "19,522 132 6 · 76

40 and under 45 6,666 68 2 6,736 68 10· 10

: 6 and o ver 4 .. 588 4 .. 592 6 10 ·14

Unspecified .. 16 .. .. 16 .. . .

- ----------- - - - --

Total .. 133,234 1,337 12 133,583 738 5·52

* Tn Western Australia, where the registration of still- births is carried uttL , the number of still births for mothers of all ages represents approximately 3 per of t.h c n um,ber of Ji ve births on the basis of the experlenec nf ten y ca'rs.

1914- 23.

IJ EA'l 'H R A'l 'E S Pi;R 100,000 F'ROM ' l'YPHOID, DIPRTHEftiA , CANOitH ; .\[ATERNAf, JYlOHT;ILI'I'Y AND lNFA:'o/TTLE M:ORTALT'l'Y, 1909-1923 .

-

Death m tc5 per 100,000 frot H-· D ea th rates pel' 1,00 births . 0

Year .

I '" '"'"''" I ,.,,, .,. T .v ph o id . Puerpcrnl lnfatlfi Ca nses . -------------·---I·'· 190ll .. ti

I

15 gr; 3 ·87 109

1910 . . 5 12 97 a·5ti l Oii

1911 . . 7 I 14 99 3·67 130 1912 .. 4 I

l 2 102 3 ·78 91>

19 13 . . 4 12 106 3·71 108

19 14 . . ij 16 107 3·95 105

19 15 .. 4 17 .ll2 3·94 110

1916 .. 3 16 117 3 ·87 91

1917 .. 3 13 121 3 · 66 96

1918 .. 3 14 122 3·55 97

1919 .. 2

I

13 115 4·12 89

1920 .. 1 15 11 6 4·12 80

1921 .. 3 13 122 3 · 71 83

1922 .. 2 11 123 3•58 Ti

1923 .. 2 7 127 3·82 I ti9

I

SCOTLAND.

DEATH H. A'i'ES PER 100,000 FROl\£ T'YPHOID, DIP.H•rHERIA, CANCER; MA'l'ERNAJ" AND INFANTILE MoRTALITY PER 1,000 LIVE BIRTHS, 1909-1923.

Death rates per 100,000 from- Death rates per 1,000 live births. Year.

Typhoid. Diphtheria. Cancer. Puerperal Infantile. Causes.

1909 .. 6 20 102 * 108

1910 .. 6 20 103 * 108

19ll .. 6 20 104 * 113

1912 4 17 110 * 106 .. 1913 .. 4 17 110 5·9 110

1914 .. 5 19 113 6· 0 Ill

1915 .. 4 18 111 6·1 127

1916 .. 3 17 113 5·7 97

1917 ..

I

2 13 115 5·9 108

1918 .. 3 16 114 7·0 100

1919 .. 2 15 117 6·2 102

1920 .. 2 15 119 6·2 92

1921 .. 2 13 122 6·4 90

1922 .. 1 11 125 6·6 lOi

1923 1 I 10 130 6·4 79 .. I

I I

* Not available.

UNITED STATES OF AMERICA. D EATH RATES PER 100,000 FROM TYPHOID, DIPHTHERtA, CANCER; MATERNAL AND INFANTILE MORTALITY PER 1,000 LIVE BIRTliS, 1909-1921.

Death rates per 100,000 from- Death rat es pet 1,000 live births. Year.

Typhoid. Diphtheria. Canc-er. Puerperal Infantile. Causes.

1909 21 20 74 * * .. 1910 24 21 76 * * .. 1911 21 19 74 * * .. 1912 . . 17 18 77 * *

1913 18 19 79 * * .. I

1914 .. 16 I 18 80 *

:;:

1915 12

I

16 81 6·1 * .. 1916 .. 13 15 82 6·2 101

1917 .. 14 17 82 6·6 94

1918 .. 13 14 80 9 ·2 101

1919 .. 9

I

15 81 7·4 87

1920 . . 8 15 83 8 ·0 86

1921 .. 0

l

8 86 u·s 7o

* Not readily available.

NEW ZE ALAND.

D E'A'l'II R ATEI:l PER, 100,000 FROM DIPH'l'H"Gltlk, CANCER; M A'l'ERNAt AND INFANTILE MORTALJTY PER 1,000 LIVE BIRTHS, 1909-1923 . - .

Death rates per 100,000 from- Death rates per 1,000

Iivo birtlls:

Year.

'l'yphold. Diphtheria. Cancer. Puerperal Cat1ses. lnta-Hliil•. --

1909 .. 6 7 73 5·09 62

1910 .. 6 8 75 4· 50 68

1911 . . 7 6 80 4· 53 56

1912 . . 4: 78 3·64 51

1913 .. G 6 80 3 ·58 59

1914 .. 4 7 83 4 · 16 51

1915 .. 5 9 82 4·70 50

1916 .. 3 15 83 5·86 51

1917 .. 4 22 87 5·98 48

1918 .. 3 17 85 5·98 48

1919 . . 3 13 90 5·06 45

1920 ..

I

3 8 86 6·48 51

1921. . . 2 8 86 5·08

I

18

1922 .. 5 6

I

86 5 · 14 4:2

1923 ..

I 2 I 5 88 5 · ll 44

I -

64

APPENDIX No . 3 (a).

(Question No. 68. )

Co -oRDINATION oF Co:r.n.mNWEALTH AND S TATE vnni.

RESPECT TO QUARANTINABLE A N D OTHER DISEASES.

(Extract from Report of Premiers' Conference, January, 1919.) Tlz,e Ghairman.-The Dir·ector of Quarantine has addressed to the Commonwealt h Government, through the ordinary officia.l channels, the following r ep ort:- ·

The question of pubHc health is at the present time of the gi'eatest importance. Not only is there the quite rea:l danger of importation oi disea se consequent upon .the resumpt ion of international trade, but there is also the supr·eme necessHy fo r

raising the standard of health throughout the . comn:imity to the highest practicable level and maint aining it at t hat leveL 2 . .At the health of the public is not the subject of

exact study by Governments, but , if d.t were con sider ed from the stand-point of national economy by

ture of money along Joines would be a pro­

fitable investment. It would be possible to make an ami n al report showing _Joss and pr,ofit j,o the Commonwealth each year by death and disease, and ,by their prevention. 3. It is merely a truism to say that the increase in human capital and human efficiency is of supreme importance to t he

Commonwealth at the present .time. 4. The reports of the Committee a ppointed by t he Common· wealth Government reveal possibilities in t hese directions iu respect of several diseases, and they a lso reveal in a very strik­

ing manner the necessity for systematic investigation into the immediate and remote causes of disease and death in Aus­ tralia. Examples may be dted as follow:-

In the :Army there has been an appreciable n umber of cases of typhoid fever, diphtheria, or sd.milar preventable diseases. The methods of control in the Army are, with modifications, applicable te civil conditions, and a con· certed attempt can be made towards the eradication of such diseases in the Commonwealth with the prospect of very profitable results in preventing death and improving effi· ciency. In Victoria alone, during the first nine months of

HH8, 6,500 cases of diphtheria were reported, some of which will almost certainly become a charge on the Invalid Pension Vote. There is every reason why a serious attempt should be made to discover' by field and lwboratory investigation why this disease persists, and this could be followed by a con ­ certed attempt toward.s its reduction.

There are indications that tubeTculosis in Aust ralia fol ­ lows definite lines which differ somewhat both in age and distribution, and in the character of the bacillus of

tuberculosis as seen ·in other Investigation of

t his disease is required, and a definite attempt to r·educe its preva lence by the applicat ion of measures proven su c­ cesssful in other countries ought to be made. A very large number of deat hs occur every year from d iseases due to high blood pressure. Many of t hese can be prevented, but it is first necessary t o a scertain by con ­ certed investigation what are t he local AustraHan causes of these diseases, and what a r e the means necessary to prevent them.

The campaign against venereal disease has been launched in Australia by five of t he S t a tes, with the g uar a ntee of fi nancial subsidy .from the Commonwealth. This venereal legislation is a social experiment, in which all the w orld has shown marked inter est, and it should be vigor·ously and en:erge-t ically pushed. Hitherto it has been r ather h a lt­ ingly whereas it should be ready to deal n ot

only wit1i local cases, but also with the 55,000 men en ­ listed in the Atrs'tralian Iinperial Force who have had venerea,l disea;se, and who will presently be dis·charged. With thes_ e diseases, especially with regard· to the in­ vestigation and attempts at their control, State boundaries cannot _be considered. For example, the investigation of tuberculosis amongst miners should include a

between the- a011ditiofi s at K algoorlie, Broken Hill, B en · digo, Mount Lyell, and Newcastle. Typhoid fever cannot be adequately s-tudied unless conditions in several states at the same time be compar ed .

Hookworm is known to be prevalent i:ri Queensland · but , t hough it i's suspected at New·cast le, Bendigo, and other places, no a t these has yet been made .

This is a disease which,. if not eradicated, will effective-ly prevent succes'sftil development of tt'opical coastal Aus­ tralia by Europeans. It is already sufficient ly prevalent to justify this statement. _

Much more miglit be said, but sufiicient indica­

tion has be-e1l given o:f the necessity for organized research :;md effort of a national kind to-wards the investigation and a.tte:mpted control Of disease ju Australia . 5. Disease no . state bo-undaries, and tns of

state may be nullified by the negl'en-t of anotlier. Huma11 health contr'ols the defence capabilities of ;the Commonwealth,

65

it . tleti'rmine s the working effi ciency, a n,d, t herefore, the uat_ iona) wealth of the Commonwealth, and as, in .the final test, all national emei·g·encies are matters foi· the Coiiimon­ ll '.ealth as , a whole, the liumii n pcipuiation, which detef·mii1cs tJ;e capabi!ity of the CoinmoriweiiJth fo m eet t he·se emei-genci~s , shuulcl surely be a matter for· {he earnest attefrtion of the Comnion:wealth Govei .. nmen't.

6. 4 .lr eady the Commonwealth Goveruruent has ~ecome coin ­ rnitt_ecl. .to <:!ertain matters• of public hea ith wit hin the Coiiunon­ ,10ealth. Its prirrcipal constitutional function in preverifo,e 11;edici ne is maritime quarantine . . '.l)i e_ appiicatiqn, _ of qiiafa1(

t me has, however, by t he expressed desire of the State Gove5u­ ments, become extended, so that . the Co=onwealth lias .iie­ come responsible for t h e coiitr6I of ceitaiY1 diseases wb'foh thr eaten to spr ead from State to S t ate.

7. Uncler the invalid Pens,ions Act, paymen t s .. a re made t o persons suffwing from disabling condit ions. T{ie system i s unbusinesslike in tha t p'ay.ine11 ts are . made fo1' many coildi­ t ions due to pr eventable diseases, and actuaity lo niany per ­ sons suffering Hom ti-an smissible' disease in an fofectfoll's form, without any attempt to preve'nt n ew case·s aril f.ntf, or to' c0:0:­ trol tl1e sprea d of infection by tli'e' i'.nfectfous p'i!'ns ion'.ei-:I. S'.o'ine State Gov·ernments have ali·eady maae representation'.~ on this aspect.

~- '.!'he mafei'nity bonus system is, .nforeQ_ ve'i', an uriec'oiiotilica l atteirrp t .at a measm'e of pubiic fiearth. The amount of ri10ney expended_ is sufi?.'cient to pi-oyi'de a system of n ~tional car'e for women before, diuing, and after confin en'lent, wh'ich wo'uiil: vei-y greatTy i mprove t he health of tr1e child0beai'i'ng ,v6'm~n of the community, would prevent many deaths, woMd i.ns ur~ lieartMer

cl:/iidr en, would: pr event many wo'm'err from suffering for years frciin clll'on'rc i'll- nealfh. This' ,'i•ould be do'i'ie by estab'J:ishiirg· ti iid maintaining a: system of mit e-nat al dinics ancl Iying-in \Yards thro't1ghout the s'ettred po'r°tio ns· of Australia:, and com­ petent visiting nurses in t h e country districts.

9. Tli'~ Co'illni01:i\veait1~ G'ove·rniileiii, iinpetied by the revela­ qo·u·s: of vener eal disease dii'ring ine ,var, actively iritere'stecf itself .in the ca nipaigrr against tb'ese disease' ' i nd is now de­ fiii'ite1y co'in'i;ni tted to· the policy of' a ssts·ting State efforts in

thes e a'fre'c tions. 10. Similarly, the ravage:s ·Of li:ooR:~ortn h'dve been sno,\iii: to lie oI } o,~::eaf, a ~ational i~~·o1' ~a'fl'ce'_ tfra\ the. ()_o~~'.O'l'l;Vealth, recogmzmg 1.t cannot permit tne presen't- cond1tron'S' to con­

ti1ii1e~ ]:\'as o'ffe1' ed to hecome' ail active par ficip'an't in' the cam-pa ign agafo,st. t h'.i's dise'a se'. . . '

I 1. The Commoriwealtll'. Govern'inent Iias a:1 so offered:- t 6 the s tat e of Victoria t o undertake a joint can'ip'aigxi oi ilivestiga­ t i'o'n a'nd coiitrol into tu-mdculosis· ai :Be ncl-igo, with: th'e ex­ p1'essed int ention of p1:ov>icl'i1 i'g for aJ1 A11st i·afia: accurate in­

fci ririatio'n ~ohce·rning this disease, and its' methods of spread ,md contror. !2. TM re'turn of troops :from abroad·, a'nd theft rep'atriation, will open up a large· Ii.trmbef of giresfioi'is' of public hetlth, in r esp~ct of wli'icn t h e r·e·spon~bility of th-e Coimnon\vealth can ­

no t oe igno'i- ed. There are a large nu:mbei- of mt'ses of t ub'e'r cu los-is, a ve r)' l>i.1'ge n umher of q 1.se's oI v-enereaI d'f sease, m.a-i.ry carrier~ of ,lysenfer:i,' and typhoid, ca s-es of bilharz.fos is; and' cit h el' para­

' i Li e disea ses. .irrrl) ii_d.1 . repre_ seiifati ~11~ ~re ?e.i'i!~ _ m~de by . state officia1 s and J\I m1ster s that the respons1b1hty for the proper care of these cases res t s with the Commonwealth.

13. Many problen1s of a public healt'h kind are bound to a dse in t he future in connexio·n with the sett lement .and occu­ pation o·f r etu rned soldie:rs. An illustr·ation is afforded by the danger of . settling soldier s who l;iave had malaria in some of t he _ irrigation districts, where the proper species of mos­ cjuTfo abound.

14. There appears to be some' pos1r{hility that the terri'torial resp6nsilii1ities· of the Commonwealth' will be incr·eased in tbe nea r futm•e. If this occm ·s, ma11y ne\\' dangers• aud problems in _preventive medicine will be presented.

15. All of the above poi nts strongly to the necessity for a

cohesive po,licy, under ,the direction of a Minister, to pl'epare f,, r t he difficulties before t hey arise, and i t is submitted that the pr·esent is' now an opportune time for co nsideration of the manifest responsi•bility of the Commonwea:lth in respect o,f

pnb lie heal th. · Hf. 'l\vo alternative policies have been su:ggested:-( a. ) TlJ..at the Commonwealth sli"ould assume control of the Publfo Health functions· throughout Au str alia:. This

,fould involve the tran sfer of t h\( necessary powe1;s by _the States -to the Comm'onwea1tn. This would not involve e::derisive ()l' radical

ehanges. It might be dealt ,vit'n efthe'l' by' a dual s.ysfom of genernl control by the" Commo:ri~ealth, and power s of local administration by tbe State Govern ­ ments. This· system is very liable t o prove un­

wor1fable. On the other hand·, a cojnpletely unified, system wou}1\ be p ossible, and <·o·u]d lie '\Y Orked Oll the samr. a dmiJ 1·st rative systew as fli e Defence Department, wfth R de1foty a elm in is'tfri:ri:g _ each sta~e, and e!!,cl, state ;ubdivided into administr ative di&t'r icts, plac-F.1081.-5

1 31 1

ing upon every r egisterea medical practitioner de­ finite dut ies and responsibilit ies iu ,coiine:rion ,vith £lie pi·evention of a'isea se, and on iiacb: iocal govefn­ \llg body responsibilities for municipal s'anitictioft. ( /; ) The otlier· sys£em-whicn is the' Ai'neHcau systen1-

would be one in which the CommMnveaTth Dep'art­ rnent o.f Public Health wo{1ld, in addition to it s quarai1tine functio11 s, concern itself with tire ili ­ vestigation of causes of clisease and death, rn:ethod!:t of prevention df disease, /fo'Hec'tion of s'anitary dat.t, educat ion ~f ,the p'iiblic iir ii1att.ers of p'ttbric health, I ri addition to .t his, the Con'un'on,vealth Go'vernmeilt could s1ibsiclize any well clit-ecte d effor t made by an'y state t o,v a rds

the era dication o'r control of a ny clrse::tse, co'i:i.kl con:duct cart1-pa1g ns of p1'evention hi which rno'te than orie sf.ate was in­ t er ested, and could genefall'y, as is done in th'e United States, ii1spife and co·-01"dinate public l\.ealth measures generally wit1i­ ou£ infringement 01' tr'ai1sfer ,of t he sovereign: powers o'f sta:tes.

T he ~ai lure of preventive medicine tinder -the p'resent system in Australia tb a cHieve r esults wl'iic h ::ire eas'ily p·ossible; and, ~1i ;i/a}'~ic11'.l a_r-, clisc~uragin:~ s_l'owness i1 ins_ titu'ting effective venereal disease measures, md1cates •strongly the need for more eafoisi a:tten'.ti:on being given to j)reveiltive' medicine- in .Aus­

tralia. Dr. Cumpston then goes on to po1'6.t out tll::it the two Com­ mohwii:ilth laboratories-the Seru m Institute at Melhourne, ~itd the 1nstitU:te of Tropi:c'al Diseases at Townsville-consti­

tute t wo great and efficient centres a;t which . r esearch· work fan be effectively carried out- wotk that will be inevita:l'>le, a:ltd vitally neces s'ary in the event of atry e'pidemi:c o·ccurdng in t he Com'mbnwealth. He alludes in other memor anda t o

th:e' fact tlrn:t eYer since th'e tertnrna tiotl of hostiliti.es• he has oeen m'itking prepar a tio'n s agains t the inti'oduction of some o'l th'e diseases that are ptevale:n t in Europe and Asia. He p:rearcited' an outbreak of ,cholera: , vhich has' since occurred iii eastern' .Asia, and ha:ii 1:a,>agecl B'ombay. He war ns and ur·ge.s tt:1e· Cotiiinoriwealth a:utl:/orit ies-to whom he owes· primary; if not sole, responsibility-o.f the necessity of getting ready, fir st df aH, from the purely quarantine point of view, and,. secondly, from t he }!J'Oint of view of the co-operation of _t he States, .to

prevent the spr ead of any of these. disea;ses that .may enter our ga tes. He warns u s t o get ready to prevent the devas.t a­ tion' Which such epidemics ham caused· in other •countr_ies. Without any definite proposition from yo\l; gentlemen, at th.i~

stage; I t hink it advisa ble t ha t you should c'onsider with

t he Commorrwealth the ver y important ru a ttei;s _ which have been brought before 1,1 s by our Chief Medical Adviser.

APPENDIX No. i (li). ( Question 145) .

S TA'J'Ell!ENT BROWING THE RANGE OF HEALTH L EGISLATION IN >i:HE AUSTRALIAN S'r,\'IES, A ND CER'L\IN I'OI N'fS OF D0IFFERENCE OR IN WJUCH THERE 1S A,BS E NCE Ob' Uiri:ironill' t Y. 1n .Austra lia public lie itttl:t faw a1\d p1ibli c heal t h a dmin'isfra­ tion a re not quite identical ; ~p-e'akii:ig 1n a gener ar way, fh'~i ¢ ,fre stafotory powers -ivMcTi are no"t exer cised, iii'id the He:iltli De_pai·iments ai·e ci_ iscl.'i'arging adniini.sH ative fiinctio1iii f6'r which there 18 110 slatiito'i·v pi-o'vf/i foi1.

Oii ,ina ly sing public . Jieaith f~gisl atici11, tis embodied ll'r tfte 1 -:]:ealt}i .. Act~ of _, t~e d-ifl' ercJ~~ .. S~iites·, .the }_qll o\Hng are th'e fo nct10ns with wh;ch su ch B:ealth Act s cleat: ....:.... (

( b) Sewers iuicl drn.ins a nd cli:s]_Jo'sal o'E sg,va:ge; ( c ) Nigh't-soi! removal And dispos al; (d) Scavenging, n\moval of fefuse, cl~aiis'iflg of slire~ts, &c.;

( e) Dwellings, b.oarding ho'uses, and' l' ottging l'iou Ms; (fl J'.ublic buildfogs ; (gY Nuisances an d offe nsive trades; (Ti ) Fo·od anci ,1 i·sii1 fee l anis; ( i) Infectious c'ii sea.ses;

(j) Venereal disea ses; (k) Vaccination; ( l) Private aria pub He J,o·spitals;

( n) Re·gist:ratfon . of 1iurses ;' midwi'ves, a'ifc1' ge'nedtl :ni'd mental nurses. The above list is a composite one representlng . t he ,,,-1r6'1'e range of activities, but in no' .one state does t he Health AcL

inciucie all of the above functions . . For ex.ample, in Tasinania public buildings . a r e no,'v dea lt with uiider a S ;Pecia l act. In Western .Australia, da:frfo s a;!'c provided for In .th~ sections _re1aH:n'g fa conH~1. 9 1 f.~g~'s,_ # n4,

m Queensland and New South Wales; are dealt with: under separate acts. Queensland is the . only state wliicn . Ji-as nrn:­ chinery for the' reg istration of general nurses imder flte Heitltli Act, And _Ne'Y South Wales Ji.as P.:? .'f?r_c>'v!,sio:n fo:r. . t'-!ie rfgi~tr·a ­

tion of m1dw1ves. In T asmama, m1dw1ves· aTe c-ontroll'ed under a1i act separnt e from the H ealth fret. In Vi. cforia the ins pe"­ ti:o n of r11Mit for humafr u se is pr ovid·ed under r.h e H eal-th A e1'. wher eas in South .Atistr alia and other states rt is prrn>itl e,l

under ,speoial acle,

\ 'v itlt regard io those statutory function s which are de­

::; igned to secur e for m a.n a h ealthy envir onment, suclJ a.s

those relating to sewage, nightsoil, ga.rbage, houses, and n uisance::;, there is an increa::;ing tendency to fi n d the::; e statu­ tory prov isions r emoved fr om the Health Act::;, and ·placed 1.111der local government or special a.cts.

In Queensland. uud VVes t ei·n Au::;t r alia , are defini Le

jJrovisions in the Health Act guverning the eoutroi of sewer::; and sewuge works, and eomplcte eont1·oi of nightsoil and garbage services. Iu Victoria., the control of ::;ewer s ;.md drains has beeu definitely relegated t o local a uthorities, with a pro­ viso that all sewers and drains shall be kept by the council so as not to be a nuisance or dangerous to health, while nigh tsoil servi ces remain still under the jurisdiction of the Health Act. ln New South Wales, a ll of these service s have been defL."litely tran sferred to local a uthorities under the Local Government Aet, and supervi.sory control only is r eser ved u ncler section 3 of the Public Health A.ct 1915. It is interesting to see the

of function::; which are defi n itely t:ipecifl ed in the

Pttblic Health Amen dmen t Act Ull5, as t hose functions exer­ eised by the local government authori ti(.!s, in relation to which Lhe Central Health Department m ay exer ci ::;e the jJ UW€rs of :-;ection 3 of the Public Health Amendment Act, giving the Hoard of Health power to act in (1,]] respects a::; a cuuncil in

Lhe case of default by any com1 cil. In t h e Local Government .Act o:f f.i ew 8uui h W.ales, the

powers eontempla.ted under the He

L lefinitely BP'ecified, but statutory power i also gi T en .to con ­ t rol mortuaries and cem eteries, the sale of meat and fish, t h e eontrol of public ·buildings, and this act has a specified power which does not exist ·in any of the H ealth Acts or other acts of the other states, viz., the establishment , con trol, m ain ­

tenance, and regulation of infant s' milk depots. Reference might a lso be made to .the impotence of the Health Depart­ m ent as eA.']>ressed in New Sou th Wales Health Act 1902, Ji1 (3) .

There is here an anomaly of a serious and significant kind, vi z:., that the Local Government Act provides for such an im­ portant function of health a s infant welfare, whereas the Hea lth Act of the same state does not deal in an y way w it h

thi :s· it em. This, therefore, represents the fir·st important

pha.se of inquiry in respect of public h ealth, viz., t he in­

creasing devolution of local responsibility with the increas­ ing population in any State from the central health autho­ rity to the local authorities, and, also, the increasing separa­ tiou of certain public health functions fr·om t he Health De­ partment, as evidenced by the L ocal Government licts, which are administered by a department entirely separate from the H ealth Department, and such other A cts a s the Sewage Dis ­ tricts Act -of Victoria, or the vVater-courses Pollution Act of South Australia .

Th e next important aspect for consideration may be indi­ cated briefly as follows:-A perusal of the above list, which gives the ·statutory limita­ tions of the power s of the Hea lth Department, shows that,

with the exception of infectious diseases a nd registration of HUr l:l es, the whole sphere of h ealth leg islation deals exclusively wltlt the environment in which a man lives and the food which h e eats, but does not deal i n any way with the man himself

ur t he supervision of his individual health. It ma.y, therefore, be said that health a dministration has xeached a stage at which the statutor y health authorit y is

rapidly .being divested of its · powers of control over t he en­ vironment, and is not being provided with any powers to meet the new developments' in the science of public health which have relat ion to the man's individual health as distinct from

the conditions under which he lives. Even in the sphere of infectious d·iseases, a lthough excepted from the above general rule, this same genend principle ap­ plies. F·or' example, each of the Hea lth Acts has elaborate provisions prohibitino- the letting of a house in which a case of in fectious d isease

0

has occurred w ithin six ( 6) weeks, un­

less disinfection has been performed-a measure now recog­ nized to be of very doubtful u tility, whereas no Health A ct has . a provision the from of . a

typhoid convaleseent by exammatwn, be

has been proved to be mfectlve or otherwise. Queenslancl

mak es this ·p r ovision under· regulations. An absolutely essential porti on of public health machinery is an efficient laboratory system, with precautions against t he spread of disease ·by in fective material. Four state health Departments have bacteriologica l laboratories, and the Com­ monwealth H ea lth D01partment is establishing a series of these for cou ntry d i st ricts; also, an enormous part is being played in

t he control of infectious diseases by sera, vaccines, &c., and yet, nowhere in the whole ran&'e legislation can there

be fou nd a ny reference to bactenologiCal methods of control or bacteriological laboratories. The part p layed by insects in the spread of infectious

diseases is now universally re.cognized, but, except in the Queen sland Health Act, n o ·provision is made wh ich in any way recognizes the existence of t hi s factor.

66

lt is now a commonplace of p u blic hea lth knowledge that, iu t he transmission of infectious tJie spread of in­

fection from human to human, or from animal to humall,

is of infinitely g rea t er impor tance t han the condition ::; od' environment, but , whereas there a r e extensive legal pro­ relating t o water-cours es n.nd sewers, houses a.nd

defects generally, based upon the old conception of

t he origin of infectious diseases, t!J ere is, pract ically spea king .. uo lega l code vvhich contemplat!!s expeditious detailed

investigation of the human sour ce of infection, and admini;;­ tra tive provision whereby medical offi cers of health shall a et in a ccordance with modern 'Prin ciples is not in any way

general. In the important field of infant w elfare, as ha s been stated above, no legal provisions exist--except ht t he New South

\Valen Local Government A ct - and in only one state is infcw t ' ''elfa:re a function of the Health and, in t he

single state r eferred to, the control by the H ealth Depart m ent is partial and incomplet e. Sch ool hygiene is a most import ant fu n ction of public lt ee:.dLit which, in almost every State, is administered by the E due: a,t!P JI

Department, and that w it hout lega l powers or sufficient a p ­ preciation of the opportunities provided f or nationa l wo1 k and for the furthering of scientific know ledge by t his work. Industrial hygiene bas hardly yet r eceived a.ny atteut ion, but, where it has, it is an ill-defined composite of statu tor.r powers under the Health .Act which are not exercised, ; J nrl statutory powers under Factories a nd similar aets wLicl1 are exercised with very great diversity of practice amongst t he d ifferent States.

The control of tuberculosis is attempt ed in only an ineoru­ plete way; only one state h as a t u berculosis clinic admiui;;­ terecl by the Health Department, and only one other state ha::; a tuberculo is clinic which i s under the control of. a volun­

ta1·y body. T he import ant field of maternal welfare, in associatit>n witl1 child-bearing, is not in any state a function of the Healt lt

Departm.ent, except in so far as the supervision of midwives is concerned. An ela,borate system of maternal hospitals and their control is being developed in Queensla nd without asso­ ciation with the state Health Department.

Military Service.-The magnificent opportunities f or obtain­ ing available information as to the physical condition of the Australian male youth, afforded by the compulsory tr·aining scheme, were not sufficiently utilized, the whole scheme being under t he Defence Department without co rrelation with the Health Departments.

Even in the field of g:eneral sanitation, supervision by the Health Department of small sewage ins tallations, or purity of water catchments and of public bUildings is incomplet e where it exists at all; the control of such important sou r'ces of food supply as abattoirs and dairies has become largely disassociated from the Health Departments, and is now con­ trolled by Agricultural so that. the Health J? e­

partment does not, generally speakmg, exercise any effective control over these phases of public health. Town planning is proceeding in a desultory way in the

different s't ates, but, ,so far as i s known, the valuable advice wh>i,ch could be given by t h e Health Departments in matters such as the pollution of water supplies, the reservation of a site for hospitals and similar matters, is not taken advan ­ tage of.

The sections a:b ove represent a discussion on-( a) Gen eral sanitation ; and (b ) Functions which are now bein g discharged either by Health Departments or· other agencies; but there is still anothBr field in which much can be d one

beyond what is at present being attempted. M ental Hygiene.-There is a n enormou s field of work in the direction of the study of means for preventing mental and ner­ vour d i,sorders.

Hegistration of births and death s is now carried out by the statistical executives, and a gr·eat mass of information which could be of extreme value i s riot available for' public health application. For example, if births ,could be notified to an

effi cient health office within 24 hours after registration, then etfective ·infan t care measures could be applied where they appeared to be necessary, and, if confidentia l certification of cases of death wer e sent to the Health Depa1·tment instead of t he Registrar, not only would accurate certification repla ce much inaccu rate certification and t h e value od' statistics be

enhanced, but early action could be taken in instan ces

where effective measures for the prevention of further cases of disease could be applied. It is, howevei·, in the erlension of t he s p her e of p·ublin

health to embrace any m easur e which may be taken t o

render t he healt h o,f any individu al better· than it is, or to

reduce the ,sum t otal of i·.dividua l ill-healt h that the pr omise for the future is offe r ed. I n fectious diseases hospitals dis charge patient s convalescent from diphtheria and scarlet fever, and there is no machinery for obser ving the future history of those patients who h ave had n ephrit is or card iac pa r a lysis.

Geueral hospitalr.:; discharge patients convalescent from _pnen ­ rnonia or typhoid fever, and there i s no machineTy for ensur­ Jug tlmt these patients a re restored to their·- ful1 a nd normal ltea,lth befo re they resume a ctive work.

There is an enormous mass of disease which passes_ through L lte general hospitals every y ear, but no a t tempt is made t o thi,s rich fi eld fo r investigation with the object o£

a::;c eTtaining whether any pr acticable measu r·es could be a.p­ [Jlied ··which w ould reduce the sum total of individual in the comrp.unity. The invalid pensions are paid merely on the basis of the

fact of invalidity; and no attempt i s made to ascertain whether any of this vast bulk of illness i s preventable ; similarly, the resources of the Char ity Organization Society and similar 1Jodies could, d oubtless, offer field s for· investigational work which would give much pr omise. Correlation between P·ubl·ic H ecdth lJep.cwtrnents, H os­

pitals, and the .Lvl edical P1·otession. Under the e:x:isting system a v ery u ndu e proportion of mouey spent on the health of .the people i s devoted to t he cure of

the sick, and there is little, if a ny, attempt to utilize the

knowledge in the possession of hospitals' staffs, and of Health Department stafi's f or the common purpose o,f reducing the Lotal quantity of disease or· disability. It is worth con sidet·­ i ng whether public hospitals might not be placed under the control of local a u t horities, ·whether individual Jo ca.J autho­ r ities or t he conjoint administration .or several local autho­ rities, and whether either the Health· Department's staff ,should not be a ssociated ·with the control of hospitals or the hospital

contr'ol board a ssociated with .the H ealth Department adminis­ t r ation. This applies particularly in r espect of infections

diseases hospitals, but a pplies also t o maternity wards, mental wards. and children's wards . The' medical profes·sion in its intimate contact with the family life of the community is in a u nique position for ap­ plying the prin ciples of ·public health at the point at which

t heir application ·would be m ost proiitable. The Health De­ partment may exercise legal cont r'ol, mor·e or less complete, and may endeavour t o educate the public, but, without the informed co-oper ation of the m edical pr actitioners, t hese mea;sures w11l fa ll short of complete su ccess. There is u o

reason why the medical profession, in r eturn for the legal pro­ tection of their' professional interests which the State affords, should not be required to do considerably more in the way of control of infectious and other diseases tha n they are now call-ed upon to do. The directions in whicp. t be medical prac­ t itioner can be an ,organic pormon of t he public hea lth system without surrendering his in dependence are multiple, and the public h ealth legal code should be extended to include an in­ cr·ea'Sed n:mge of public service from individual medical men.

For this also, it is essential that Government should recog­ nize its ovvn obligations t o provide laboratory aids at points acceptable to medical practitioners, as the medical men can­ not >be expected to discharge the duties now suggested unless

the public laboratory facilities are available. Co'l"rela;tion with Statis-tical W is now recognized

that in public healt h work all effor ts' should be controlled by the application of ma_ thematical results, order to analyse the material available for the deduction of general principles, aud to estimat e the degree of success attending the effort s

ma de. In mor tality statistics, hospital statistics and infec­ tious disea;ses work, a constant analysis of the figures available from month t o month is necessa-ry for accurate deductions as t o the behav iou r of disease, and for the indication of the

proper m ethod s of c.ontro1. Outhrea.k s of i11fectious diseases or u ndue mortality from non-infect io1ls cli seas€s jn any district requil·e scientific de­ tailed investigation actu a ll y in t he field by tra·ined staff, if

full knowledge is to be obtained of t he best methods of con­ trolling these diseases. A con s iderably wider :field of investigation of r esearch shoulol be cover·ed in Australia than has hitherto been possible.

Finally, in the administrative field, there is room for con ­ siderable discu ssion; there is legal conflict persi sting as is in·· dicated, for example, in sections 136-137 of the Queensland Health Act; there are also the dissociation between· Common­

wealth Tcrrit.or iR-1 Services a nd t he Central Health Depa1·t­ me11t, and the r os:::;i.bility of impr ovement in the association be t ween local govern ment authorit ies ancl state hea1th depart­ nt entP .

APPENDIX No. 3 (c) . (Question No. 215. )

GONDITIONtl G OVERNING T H E PAYMENT OF ANNUAL 8UBSIDY B'! 'rHE C o lVHviONWEALTR GovERN.d:ENT To T H E STA'l'ES IN CONNEXION WITH THE CON'l'ROL OF VENEREAL DIS EASES .

New South Victoria Queensland

A.mownt o f A.·nnnal 8ubs1 ·dy. £

Wales 4,500 a s

3,500 as 3,000 aN

Western Au stralia 2.600 as

Tasmania J.:ooo as

from _920 from 1917 from 1917 from 1917

from 1918

1 31 3

CONDITIONS.

( 1 ) T hat t l1e subsidy shall be on a £1 for £1 l;

i he nmx imum above stated. ( 2) That n otifi ;;atiou of cases by medical prac. btioncr::; i.te compulsory.

( 3) That all practicable weas ures lJe taken for traci ug tlte source of. infe.ction . ( 4) That the treatme11 t sh all be on r ecognizeJ. m oderH lineB , "ncl a.clequate precautions tal<::en ao""aiust the snreacl of iH -

fection. <=>

( 5) That arrangements be made a s soon as possible for tlic -of examinations for microscopical examinatio11

fo r dmgnos,Is and for blood examinations, and tha t arrange ­ ments be made, wher'e practicable, for such examinations t o t lt madt: at the time of the examination of the patient ; abo

t lmt such arrangements a s are possible be made for the

examination of s:pecimens fwm all extra met rop-olitan di;o­ Lricts. · ( 6) That clinics be established, where oracticable for t>p_ecia l treatment of venerea l disease, and that patieu'ts be ad­

mitted on first appearance, on the same basis as all other

patients. ( 7) That patients admitted to such clinics be entitled to

free treatment; any patient desir·ous of 1nakirw a contril>u­ t:on to the hospital funds t o be permitted to do 0

so.

( 8 ) That inspection be made h;y a Commonwea1t h cle puted by the Commonwealth Government, for the of seeing that the above conditions are carried out. ( 9 ) That ret urns be furnished on prescribed lines.

( 10) That spe0ial facilities be afforded to any medical olliecr nom inated from time to time by the Commonwealth Govern­ ment. ( ll ) That the hospital concerned will agree to undertake to arrange for a serries of lectures or practical demonstration"

each year to under graduates and graduates on some su ,b jGct or subjects connected vvith venereal diseases for attendanoe at which no fees will be charged.

( 12) That the claim for payment of the subsidy be aecom­ paniecl by a statement, certified a s co r rect by the State Auditor­ Gen eral. setting out full details of service paid for.

AI?PENDIX No.4 (u ) .

(Quest:Wn No. 509.) 1

VENEREAL DISEAS I£S . Victoria.

TABLE I.

Dis TIUC'r DIS'l'RIBD'J'ION o F CAsEs, 1s'l' JoLY, 1Ul7, To 318'1' DECEMBER, 1924.

--D-is _t_ri_c_t·--1 Gono"h"'"·l SyphiHo. I I i Tot"'' ·

I

31,4551 10,935 I 1,1851 787 I H,362 Metropolitan Ballarat Bendigo Gee long Rest of State

107 22 I 2 I 131

125 1 58 2 185

1,146 197 ; 22 < .!: 1,369

----_____ [ _____ ----- - -----304 1 67 I 12 1 38

4,

Whole S-t-at- ·e ___ _

'l'ABLE H .

MONTHLY INCIDENCE .

___ --1-"'.:':J 1018. 191U Jmo.i 192':_110:3.

Januarv · 555 596 84611 402 460, 307 395

F ehruai.·y I 627 556 700 469 504

1 1 335 516

March · 457 434 594 593 545 474 57P

April . . I 455 598 545 426 , 329 331 , 376

: :1! . . I

.Tuly . . l ,129 676 723 664, 577 364 312 502

August 71 61 608 472 ! 254 477 353 1 418

September , 714 654 559\ 56lj 461 477 429 408

October i 669 G26 9G9 53 11 567 5141 374 468

November : 539! 5281 714 463 5441 4661 359 4.51

December I 4851 492 698 600 426 490

,4,252,6,929 7,559 6,88815,41415,5841 4,54115,264

--------'---

TABLE Ill. SEX l NCIDJTIN.CE .

Si_ng le infections.

I

Se X. ll' IOlTI m oOl 1 Ja.

I

Sy I

Soft Chancre. I

COI1iJ . Sy_pl)ilis .

Male ..

JJ'emal.e ..

..

Sex.

MaleJ ..

B:em.,ale ..

Tqyals ..

- -

0-5 year& 6-10. years , ll-15 years 16-20 years 21-25 years 26-30 years 31-35 years 36-4:0 years 41-4:5 years 46-50 years 51-55 years 56-60 years 61-65 years Over 65 ye

I 30,536

Gonorrlirea and SyJ!h.il is _.

1,428 134,

1_,562

I

- 7,867 1,189 ; 11,27.9. 1_,22.1 M_ixed

Gonorrhcea Syphilis 'and Soft ana· Soft

Ch;m,c[e ..

..

95 113

9 5

104 118-

-

I:V..

AGE INCIDENCE.

Males.

0 •81 0 ,·25,; 0•44 7 •65 21 •09 23 ·80.

12·84 7 •31 4:43 .

I

2 ·81 '

I o.-76 .

I 0 •4.7 I 0•25

I

362

I

7.94

1:

IGononhrea, Syphilis, .

aJ+:Q S9f.t ·

-

261· 2-, 28 r

Females.

0·96 0·62 ' 1•53 2·53 2•85 2 •06 1•25 0•78 0•44 0 .•26 0 .•34 0·03 0·03

3,9,954 6,_ 477

46,431

Totals.

1,662 150 -1,812

T_etals.

2-•03 i •21 1•06 9 •18 23•62 26•65 14·90

8•56 5•21 3•25 2·45

l ·10

0 •50 0·28

'l'ota.J s

I

85 ·IO 14·90 100•00

TABLE v .

The Table . following slwws_ th.e relative Humbers aL

uertain institutions and by private practit1oner.s dtu{JJ g i.l1 e [ eriod 1st July, 19F, to 31-st_ December, 1924 :-4,327

Childrens' H9spital . . . 1,034

Departmental Clinic . . . 12,663

Melbourne ... 5,137

Queen Victoria 827

Other institutions 1,450 -

Private 20,99;)

Total 4§,43.}

H will be noted that of the 46,431 case:; notified 25,4::18 h ave beeu treated at special •linics o · instituti on s and 20,993 by

1. rivate practitioners.

The number of priv:at,e practitioners who have reportf\ d : , is _ 528. .._ ·

TABLE VI;

CO.N'l'll.AV.M OF 'l'RI> AC1', AND HEGULA1'10N<:).

,)'un,t'lnfk"rlJ .. 1st , Jnly,._ 1917, to_ 31st , U euernber, ll::l24.i

(n) Defaulters (i.e., persons who have failed to co n ­ tinue medical keatment until cured) ( b} . Defaulters traced Defaulters not traced . . ..

(c). Orde1::s. issued re.quiring persons to attend for . treatment . . . . . . . . ..

(d) _ Pro.secution s for disobeying order (e), Pros(3Jc}.ltions. fm; illegally treating cases (f): Warr

Males. Females

(h) Infectin g . persons with veue rea l di seases, prose­ cutions · for

7,85.9-3,625' 4,234

75 8

2

3

219

2

68

N a;ncl of persons who fa;il ed to con·

treatment at the prescribed were furmshed b y

clinics and private practition ers. T hree thousand: six hundrcrl and twenty-fi ve def::mlte1;s ·we:J;e t raced. These, the ex­

c.eption ot '76, attendance by su (tsion ..

I n ' 6_ 5 orders to. re-attend wer e $-Ufficien-t. In

eight prosecutions had to be proceede(t to secure r e·

n,ttendance. · Four- hundred and for-ty-three p6scners· (224 males· and> 2l!J females) were detained in gaol for treatment afte:J?. the expira-tion of their sentence. ·

'Ilwo ine·n suf:£e ring' from vene:t:eal disease convicted· fol· having su bjected w.omen. to the. risk of infection. One re.ceived a sentence_ of two mon.ths ;. the other of twelve months (the maximum. und;e · the. Act). ·

·*Proceedings are pending in the case of ::mother m an for a

silllila.r ..

* Case tried at Court on Rebruary, 1925. Accused was convicted

and sentenced to one imprisonment.

'r-AB}?E

F in.'l.ncial Year . . - .

1917-1& 1918-19· 1919-20, 1920-21 1921-22· 1922-23. 1923=24

Totals

Tota l

£

5, 175 18,327 ll,461-ll,624 12,628. 11,917 11,817

82,949

CGMPARATIVE oF V.D. 1923.-24.

Item.

Depa.r.t : ment_ al:

CLINIG.

I

Melbourne, I A-lfred. Queen Victoria.

Salaries Wages-·-

£ '

1,255-1 777 1 ;

75& 625 26.9

I

Drugs ..

Other 'chargf?s

'l'otal c

I Reve _ n.ue_ fr.·om Patients. ! Patients treated .. N t:) . of:a£tep.dances . . . Cost per attendance- . . Cost of drugs per dance .. · . . Uost of wages per atten- danc€l. · . . . . - 324

379

aj735 1

£235 · 1,89? 82, 182 11d.

1d.

3d.

5d.

201

1,343

£362 -1,-120 2:3,-892-l s.

I

2<1.

2-!d.

7-!d.

738 88

1,464

£944· 1,059 --16,244 1s. 9td:

10-fd.

I

I

103 l-13·

538-

£177 552' 7,98 • l s. 4d :

3d.

8d- ..

Nf)-r;m.-The , comparative cost- of· drugs at- the- Alfrec! is ten than that at the Clinic-, and -five

times-greater than at the ·Melbcmrne. The above _figur51_ s do nqt include the cost of _Salvarsa.u Substitutes. 'l'hese are suvpi!ed to alLclinics.by the

0-BSE.RVA'l'IONS· AN:D RECOMMENDATIONS. Notification.-The Act provides that notification shall noiJ disclose name. patient, however_,· does not· continue trea,t ­ JU ent n ame and address are · notified. In the period under

review 7,859 persons, ou·t of 46,4Q l notified, failed to continue treatment, and were consequently reported by name. Of this­ number 3,625 were traced,. leaving 4,234· undiscovered. The principal cause of failure was due to the giving of false

names and addressel'). On -of of _name and address,. particulars

arc sent to the_ officer in of the .. plain clothes pglice.

This officer causes inqu_ iry to be made, and ·when the defa:ulter is found he is instructed to re-attend. If · he does not do so,.

legal proceedings are instituted. Where suasion is sufficient, r:oercio:rL is .not: used. The practical utility of notification baR· been by pe1·sons competent t o judge,

Trevathin Committee. •. expressed · the view i.hat " compu.lt>ory r otificati.on . of. · vener.eal.. ·disease would tend ·· to con_ cealment:, n,nd wou)d prove ' a ' backward step." This committee<. COD · siders that secrecy plus provision of facilities for treatment

I, . . .

nre preferable and more effective than any compulsory mea­ sm·es . It is t o bo noted that in Victorian experience notifica.-1 ion by name had the eff ect of causing ap p r oxima tely on e-h a.lf (I I' the defaulters to r esume treat m ent. Of those wh o CO I11 cl

be traced, a fa,ir proportion followed itinerant callings,

and probably secured treatment in another State . Many other s who could not b e tmced probably continued treatment under another name and wit hout furnishing the new medical attendant with history of case. This causes

duplication of notifications. The d ata are not Stlfficiently acct1rate to definitely state

what are the r esults of notification in securing treatment. It is ver y clear, however, t hat infected perso.ns are coming up for treatment at an earlier stage than heretofore. It is

becoming increasingly difficult to obtain cases- in the secondary st ages for clinical demonstration. Ther e is n ot sufficient evidence to enable an ac.cnrate esti­ mat e of the p ercentage proportion of infected persons in the

Rta.t e to b e given .

The number of notifications received was in 1919,

wh en 7,559 cases were r enorted. In 1920, the notifications nnmbered 6,888; in the following year the n umber was 5,414; in the n ext year 5,584; and in 1923 the notifications were

4,541. ln 1.924 there a,n inci'ease to 5,264.

It is known that some of the notifications are duplicated b y p atients giving different names when they change their medical n,ttendant s. In recent years a fair number of infected

has been instrument.al in inducing others to attend. This

applies more particularly to married men. Many of these

·eases at@ ch:ronics, ·so that increased notifications does not n ecessarily m ea,n new i:p.fections. Provisidns for Accommodation.- All hospitals reee1vmg Go­ vernment aid are r equired to provide for treatment of pe:iiSons \'m:ffering from venereal disease . Special clinics are providefl

>t.t the Alfred, ::M:elbotlrne. and Queen Victoria Hospitals and

at t he Depar tmental Clinic in Lonsdale-street . Special pro­ vi sion is made at the Children's Hospita l for both Otlt--p atient n,n cl in-pat ient cases .

Beds (sixteen) are p1•ovided at the Queen Victoria Hospital for fern ales. There are no available beds males. It is

hi ghly desirable that a vrai'd should be available for ti'eatment flf men in the acute stages. As a vety small proportion of· in ­ fect ed persons require to be k ept in b ed £or . any length of time comp aratively few hospital b eds are r equired.

'l'he est ablishment o£ a ven er eal sanatorium for males a:nd one for f ew l't:les . is stron gly urged. Such pla ces can be main­ tained at a lower cost than hospitals, as the inmates can do

a gteat d eal of the necessaty lab our.

As no places of detention h av e b een provided, it h as been

n ecessar y to d et ain prisoner s suffering from vener eal disease in gaol. ! t is v ery d esirable that when sentences of prisoners

h ave expired there . sho1.1ld be some suitable place to detain th em un t il t ender ed n on-infective or r eleased on certain con­ d itions. "('l'able VI. gives p 1tr t ieulars as t o detained

prisoners.) I nt er-m ediute Olinics.- Th ere is a f airly large number of per­ sons w ho are able and willing to p.ay "intermediate" fees for treatment, but more privacy t h an obtains at a public

clinic. '!'his is an aspect of the question that d em ands considera­ ti on. S ecn'e.g ation of lrtfec_ied Person-$ .- H is not pra cticable under the Venereal A 9t- f3 ecu r e segregation of infected

p er sons who are known to be snr eadin g the rlise ase. Prosti­ tntes k nown to be in fect ed solicit cu st om either op enly or

dandestin elv. No action can b e t aken un der t'b e V en er ea l

Diseases. Act provided they ar e under m edical treatment. As 1'L gen er al rule. prostitutes. ar e good attenders. As long

t-his source of i 11fection exists, vene.real disease will b e spread . It is recommended that Jegaf pr6visi0..."1 be made for the estab­ li shment of private court s for the b earing of su ch cases, n,nd

that the court should h a.ve power . wli ere it is sa t isfied that

the accused p erson is spreRJding -infeetion, to dehdn such p.er­ son until r endered nen-inJect ive. Many persons ar e p r epared t.o :lri privat e, but they

will not face a public court. .. ·

Prophyla.'Xis .- Provision is a.t a, U the c]jnics fm· dis­

infection of per son s exposed· to risl<. Speci a l arrangemeptR wer e m a d e for ke-eping· the · Depart m ental Cl:tntc open until 111.idnight f'or t he convenien ee of ap p liea:nts f or disinfecting

t re atment. 'rhe experi m ent continued for thr ee monthR.

D uring this p e l.'ied not Ofl'e app-hlcant appeat·ed afte1'' the ordi­ ll ary hour of elos·1:1re. (Clinic is open from n o0..rr t o 9 p.m.)

The Trevathin Committee h as considered t h e prophylactic :<,spects of ven ereal disease, rmd, af_ t er weighing the pros, and

con s, m akes t h e f ollowing suggestions :- - .

(l} Qu ali:fi,ecl chemists should l;>e to seU disinfect­

ants, provided such disinfectants so1d in a form

with _ instructions for .u se ap p roved by

sqme ..

(2} C ommerci§.l adve,rtisements r elati:n,g t o su ch disinfect­ i'J.nts should b e prohibitec1 ,

1 3 5

(0) The instruction by medical officers of venereal disease clinics of male p ersons attending such clinics in the p:reventh'e lise of disinfect ants would affor d a. useful means of educatin g the community . . (4) Our view is that m oney spent on a. general' system oli

providing facilit ies for self-disinfection would eel'" t ainly b e less profitable than spent either 011 '

treatment or on m easures of ech1cation and improve­ ment of social conditions. No official steps have been taken to extensively educate on· prophylactic lines, but it is a question that demand's earnest; con sideration.

Statutory Declarations re Alleged Infected Persons.-Since the· coming into force of the Act twenty statutory declarations have, been made relative to the existence of infected persons who · were not under treatment. Twelve were made by men and' eight by women. In all cases the declarants were actuated b y malice or from pe1·sonal motives not related in any way t(, ·

th e welfare of the public. Hos.tels.-The question o.f the establishment of hostels for wom en should receive consideration . Dr. W . H. Hamer,

)\'[edical Officer . of H ealth, London Coun ty Council, speaks ver y favorably of the results n.chieved in r egaril to hoste-IR

('"t.fl,hliR rl ed in L annon.

APPENDIX No.4 (b). (Question No. 466.)

Prosecutions, &c., by Commission of Public Health 1921, 1922, 1923, and 1924. ----------- ------ ------ ---- -

__c

No. of prosecu-tions, ..

No. of Cautions

Fines ..

Costs and Ex-penses ..

(1) (2)

(3)

l}o,ildinu

F ood Laws . Sanitary f, aw. R egulations.

532 144 31

699 78 2

£ 8. d'. £ 8. d .. £ 8. d.

1,705 9 0· 377 5 0 128 5 0

1,403 7 6 232 14 0 43 9 10

APPENDIX No. 4 (c).

{Question No. 4468.)

Total.

707 779 £ 8.

2,210 19

,1,679 11

Public Health Department,

d.

· 2'95 Queen-·street, Melbourne, 9th March, 1925.

MEMORANDUM.

0

4

W rhen giving evidence !before the Royal Commission on Health, I expres sed the opinion rthat, if a Federal Fo.od

Standards Committee were a,ppointed, there should be m ­ cluded in ,i.ts powers the p ower of giving decisions in respeot of la be1s, such de.ci•sions t o be wp;plicable to the whole of Aus­ tra lia. Under exis.t ing circumstances, labels have to be sent to each St-at e. for arp:p.roval. T his involves a of

correspondence, and frequently long delay1 s a\1\::utmg demswns of In !'lowe c:;tsea the decisions differ a.s to what

may or may not appeax .in the. is, of oourse,

no difficulty ,as- rto .presc:n:bed particulars; It JS the of

the cont.ents. o.f the label tha t cau ses trouble. In addition to the prescribed: p.artieula,r:s, t he label may include any descrip­ tive matter, pro'Vided SlJCh matter is true. The Bur eau .o-f Ohem ist:vy o.f .the, United Sta.tes D epartment

of Agriculture issues notices of judgment under the Foo.d and Drugs Act. Many of the notices Jtefer to misbra nding. I

a m, hoovever, not d eax- a,& to the 'lY3:rt-t.aken by the D epartment in 1!'egard to securintS Gorrect la'b<;lllmg m so far as the separUJte Stat es are concerned. In of pr·o-secut:i:on.s u :nde1· the Health . Act, a return

wa.s supplied, hut this :retur11 <'5n1y. with the of

the Commission. 1'·he t fLb le fo llowmg m clucles all prosecutwns in Victoria, u nd er t he Act :-

Year. P r osecutions.. Fines.

1920-2'1 416' £1,298"

1921-2 604 1,.6.53

1922-3 650 1,892

1923-4 48.4- 1,714

(Sign ed } ·. E. ROBERTSON.

'!'1 1e Secret"a;ry , 'Royal Com mission on li!ealth-, 51 Melbo-qrne,

/I.PPEN DJX 1o . 4 (d) .

(Q11 "Stion 322. )

C0 M'MfSflTON OF P U BLIC 1-TEA lit'H, \' 1.0'1' 01UA.

TUBERCULOSIS.

(1) SCHEME OF CONTROL.

The table following shows the actu a l number of dea ths

rmd t h e do:Lth r ate per million in t h e State of Victo ria f or tl1e porions m pntioned :-Tube1'cu losis (A.ll Fo1· ms) . Death R ftt c

Year. 'J.'ota.l Death s. per mill ion .

Average-1886-1890 1,932 1,834

1910 1,307 1,006

1911 1. ,354 1,025

1912 1,296 957

J913 1.,269 911

1914 1,230 864

'1915 1,135 796

1915 1,239 879

1917 1, 181 840

1918 1,198 84!)

19 Hl 1,267 865

1.920 J ,208 80:1

Hl2l 1,235 804

1922 1,076 68:l

'i 1,195 743

'1924 1,169 71 2

(2) FINANCIAT, RESPONSIBHI'fY.

B (·foro entering on any extensive camp aign fen· t h e control etf' tnhercuJosis it is very d esirable that t h e q u Psti on of finan­ r·i 1.l r esponsibility sh ould b e definitely settled. The Health Act m·ovicl.es that it is the d11ty of councils to with a n infectious diseases, including tuberculosis.

Councils are entitled to half of t h e total net cost of pro­

Yicling· accomm od ation, nu intenance. am1 treatment of per son s <=nffe ring from infectious c1isense from th e Government.

Under existing condition s Greenvale an d A.mherst Sana­ toria a r e m aintained b y the State. H eatherton S anatorium

is j ointly bv the State and metropolitan councils.

1\ special sub sidv of £800 p er annum granted t o t h e Allstin

H 0spitaJ for maintenance of cases of tuher cu losis. As tuher­ enlosis is a chronic disease, and as suffer ers therefrom fre­

rru ently m ove from one municipal district to another, it is not comparable to the acute infectious diseases. In any case, how­ r·ve r. as men.sures of control ar e taken in the interests of th e nnh1ic welfare, they should not be dependent on charity for flwir cn rrving out. The question appears to b e narrowed

rlnwn as to wh ether the expenditure sh ould be imposed on th P !!Pn eral taxpa,yer or part ly on t h e taxp aver and p artlv on the 1·at ep avPr. It may be r eason ably ar gued that the control of

i·nlwrcnlosis is a n ation al m atter r ath er than of municipal co n­ This q11estion. h owevAr, is a mnttPr of poli cv anrl few

llw G0vPrnm e nt to cleci.rl e .

(3} CoNTRoi.LING BODY.

The r e should be a centml controlling body endowed with th t' n ecessary powers tn direct all m atters r elating to accomrnocl n. ­ f i•1n , mainten:wce, and t r eatm ent. (Local p r eventive measm·ps m i !!hi r ea.son ::1 bly be imposed on councils.)

Th e cont rollin g b ody should consist of p ersons having special qu a lifi cations for the work to be carried out. Th0 a. ppointment of the members of the controlling body 'VOulcl cl epencl to a great extent on the sources of the fnnd s .

H th e g(mer nl taxpayer is to provide all the funds the Minister ,.f H eal t h 'vould appropriately make the appointment s; il'. l1 owever, the councils contribute; they would b e entitl ed to

r P]wesentntion proportionate to their contributions. Th E' fnnctions of this body will include-(l) control of admissions, discharges, and transfers in r e­ lation to any sanatorium or institution suh sidizei! h y

t h e State;

(2) control of all clinical matters; control of educational propaganda.

(4) D IRECTOR OF TUBERCULOSIS.

For the efficient cn,rrying out of the policy of controlling l.od,v it is essential that a specially qualified practitiOner shoulcl i,e appointed as director. . .

functions of the director w1ll mclude-

(1) the direction of . .

(2 ) t h e direction of san atoria, and aclm1sswns, dischal'ges, and tran sfer s; examination and diagnosis of all cases referred to him;

the dir ection of educational propaganda; th e· rl irection of the r egistration clepot.

70

Tlre controlling body would settle a ll prillcipks ancl Lhe !

di r ector would execute the details. The director should be directly associated with t h e co n­

I rolling body--preferably chairman .

To secure a practitioner with the necessary qualifications a sa.lary of at least £1,000 would have to be offered. If circumstances do not justify such an app ointmen t t ill'

question of a par t time dir ector would n eed to be con sid(' r ed .

(5) REGISTRATION DEPo T .

The director would be in charge of the depot. Tht: work ur

lh e d epot would include--(1) record of n otifi cations; · (2) admissions, discharges, and tnm sfers in r ela tion t o

sanatoria;

(3) r ecords of clinical histories; (4) surveillance of pat ients in col ln,borntion with conn ci ls .

(6) DISPEKSARY AND SPECIAI.· CLINICS .

The question of the establishment of a speci a.l dispen snr:,' has been car efully considered, but after weighing the pros and con s it is not considered aclvisa.ble to establish sam e . It is r ecommended that each general hospital sh ould p r ovidf· n. tuberculosis clinic. P ersons having symptoms of tubercn losis

will not atten d a specia l disp en sar y, but usually h ave no ob­ jection to a.ttending a general hospital. If sympt oms are su s­ picious, patien ts would b e drafted from t h e O .P. p hysi cians' dep artment to t he clinic. From the clinical educational poi1ii

of view it is desirable that tuberculosis clinic8 should be es­ tablished at hospitals associated with the Medical School. These clinics sh ould b e linked up with the R egistration D epot. Notification, of course. is a direct link, but general co-opera­ tion is n ecessary, particularlv in r elation to n.dmissions a.nd f1is char ges from s an atoria an d survei llance of patien ts.

Early diagnosis is of great importan ce. P1· ovision should h e made at the clinics and at the Registrati,)n D epot f or tlw

necessary a dj uncts to enable this to be done. To be et'fective t h ere sh ould be, in addition to the 0 .P. cle ·

par t m ent. a small spe e;i Rl ward associated with each h cspit •• l clinic .

The Commission is of the opinion that it would be advan ­ tngeous to provide a tuberculosis wing of 20 b eds or so, having provision for the sexes. The Alfred Hospital has been mention Nl in this regard, chiefl y because it was considered t hat it was t h e

onl _v metropolit.c·w hospital that h ad sufficient ar e :-1. < 1.vai lahl0 for t h e er ection of a suitabl e tuberculosis wing.

(7) SCHEMATIC DIAGRAM.

The diagram attached shows the procedure :v JvnraL Nl bv Lh P Commission for the cont rol of tubercnlosis. (The lPttei· s ;1L ma.rgin refer to letters in diagram)-!\. R Ppresen ts the controlling b ody whose fn n cl;ions n r e

inrlica.tecl in paragr aph 3 n. R ep r esentR the home of t he patient . The arrows indicate th at the pati ent n1av eithn direct t o the R egistrat ion D epot ( rl ) or 1 n "

hoRp ital (c) . In the f ormer case th e ywtient. wonlrl h e r eferred b v his medical a.ttendant cl irer:t to f.lll'

depot. -

C' . R.Ppresents r. public hospital having an O.P. fl r:> pa.rl·­ l!tent and a special ward. The patient in t his Cfi S!'

is sent h y the hospita.l to the R egistration

He may b e either an in-patient or an out-pa.tien t. D . R.ep.resents the Registration Depot, the functi o,1 s of which ar e set out in p ara.gr aph 5.

After examinlJ,t.i or1 :otnrl recording of particular s, r.rrangemen i' ,.: wonl c( b e made to send the patient to the receiving sanatori n 111 or the advanced sa,natorium, or the intermediate san a.torin111. or the sa.n 3,torinm for non-pulmonary cases, or to the h ost el .

(a) Receit,ing Sanatorium.-,.-All cases not properly environe

Th e purposes served by the r eceiving sanatorium inolude-­ (a) hygienic ecluca.tion re curative and preventive m e a­ sures ; (b) observation of case with a view to definitely ascerta.i.11

condition,

(a)

(b)

(c)

borne, if the domestic and fi n ancial conditions nr,,

favorable; or to an industrial san atorium if cure or considerable im ­ provement m ay reasonably be expected; or to a sa.natorium for advn,nced cases w h er e prognos1:>

is unf:1.v••rn.IJfc

A. receiving san atorium should preferablv b e n ear the

metropolis, as the fp:eatest number of case s come from the

rentre of populati on. It also permits of securing the best

clinical advice in cases of doubt.

At pr esent 150 beds ar e available for early cases. Owing,

however, to lack of b eds f or advanced cases, unsuitable cases have to b e adm itted pending vacancies at n/lva,nced sa,natoria. In the meantime they may become so vre ttk that thev cannot with safety he removed. It is very undesira,ble for deaths to

occur at a sanatorium for· early case·s.

It is desin.ble to h:we a separate sanatorium for e

At the present time 146 beds are provided at the Austin Hos­ pital and 124 at the Heatherton Sanatorium . This accom.m oda­ tion does not suffice :for dem a nds. In addition, there are cases eking out an exi stence on the invaiid pension who sbonld , in t he inter ests of contacts, b e in an institntion.

(c) Intenned·iate S anatorium.- There is a ra1r number of p atients who can afford to ·pay <.t moderate amount for their maintenance and treatment, but who cannot pay the charges of a private sanatorium. Experience shows that the mixing

together of free and paying p at ients is very

U nder presen t conditions patients admitted to n sn. natorimn <.tre asked to pay what they can affor d. Pri<'r t o admission

man y ap pear to be willing to pay, after (presumablv

aft er conferring with free patients) all sorts n[ i' G< l sons are a dvanced for discon t inuing payment·s . vVhile it is quite f e a­ sible for paying a n d free patient s to be trea t e d a gener al

l1osnital , conditions are quite different at amttoriPm wh ere ]1::ttients freely mix. (d) S anatorium .fo1' Non-.Pulmona?'Y Oases.-Non -pulmon­ ary tuberculosis occur s most frequen tly in children, ::mel usually

requires surgical attention. It i s desirable th a t t h ere should he a separn.te institution f or this class of case--pr eferably in

rh e form of an op en-r.ir hospital with S'..litable grounds. Such an institution should be situated within e r. sy r e 8. ch of the city , so as to permit easy access of parents. (e) H ostel for .Persons Affected with is :1 con sicleTabl e number of persons affected with tuberculosis who ar e able to carry on a produ ct1ve occupa.tion. Under

prec;ent conditions some of these persons, having no h omes. ftre compelled to live in boar ding-houses or hotels, where, if th ey ob serve tuber cul osis hygiene, their condition would be noterl and t hey woul d r eceive notice to quit. In addition to

:1 ecommodating such peT sons a h ostel could b e utilized for

1>ntit-nts a dmission to a sanatorium, for p atients who

;1·e being transferred from one sanatorium to another , and f or nfltiPllts on leave to atten d a dentist or to transact i.mpor t8,nt ·s .

R. R ep resents the municipal counciL which will b e in

d irect communication with the Registration Depot. The council w ill be informe cl of a dmissions to and rlischarges from the sanatorium so that the •lisinfection of premises mav be d o11e and the patient kept under sanitary surveillance. P. H epresents the sanatorium f or non-pulmonary cases .

'The functions of this are set out in paragraph

7D (d) .

( .

' ·

TT .

Hflp r esent;s the receiving sanatorium, the fu nctions of w hich are set out in paragraph 7 (d) .

All pati e11ts received

h ome he retn rns there after receiving the necessary instruction in personal hygien e a nd general pre­

f'an tionary measures. If t h e p atient i s able to carry oo p r oductive work

:-mel main tain himself, and h as no h0me, he may go

to t h e nost el. If t h e pvtient is able to carry on

nrnductive worl;;: in a small vv ay

further improve, h e will be sent t o the industrial

sanatorium. If, on the oth er hand, the patient m ak es no pro­

gress and the. prognosis is nnfa.vor ab!e, the p atient will be sent to the advanced sanat ormm . R <:>presents the hostel, the functions of which a.re set out in paragraph 7D (e) . T. R.epresents the int ermediate sanatorium, the functions

of which are set out in p aragraph 7D (c) . .J . R epr esents the in dustrial stmatorium .

•' Industrial s an atorium " connotes :=t place where produ ctive indust ry i s car ried on under the best

hv P"ienic conditi ons. Each patient should be pro­ vi cl'ed with work suitable · t o his aptitude and

strength. D uring the whole of t he time the p atients would b e under medical supervision . Sm8Jl open-air industries. such pou ltry raising, bee k eeping. pig r r,ising, &c .. should be t aught as

well as such productive cr afts as d o not require

::nuch strength and which can be carried out under the best h :vgi.enic conditions i pra.cti€e .

,..,, I 1.

1 317

When p:=ttients have r ecovered sufficiently to en­ a ble thew to r e:;ume their old work or to take up

a new rwocn,tion, t hey would r eturn h om e or go t·.r1 the hostel . K. Represents a p lace of occupation attend ed by a p erson Jiving at the hostel. L. Represents the advanced sanatorium. Ed-u cational Propaganda.-It is very desirable that patients and the public should be educated in regard to tuberculosis, l:nl.t such edu cation should b e carried out in such a way as not to scare people . Indiscreet propaganda has the effect of causin g

persons who may be suffering from early symptoms to refrain from seeking medi cal a dvice until it is too late. P ersons suffering from early symptoms and contacts shoulcl be encouraged to seek medical a dvice, an d provision should b e

made for same . ·

Health visitors, preferably specially tndned nurses, can b e of service in preventing the spread of the disease bv

visiting the homes of infected per so.ns and giving

arlvice, and inducing contacts to be clinically ex amined.

(9 ) GENERAL SANITARY MEASURES.

The existence of t uberculosis is closely associated with in ­ sanitary hom es, insufficiency of proper ·food, depressing su r­ roundings, and unhygienic w orking p laces. Undoubtedly, especially during recent years, great improve­ ments been made in the living conditions o:f the poor er

peopl e, ftn cl the ffl,ct of such imp roved conditions is reflected in the diminishing tuberculosis dAath rate. B ut good living conditions in t h emselves are not suffick nt to cop e with tlw

disease. The infective unit must be dealt with; h ence t ilt<

n8cesl'litv for the speciflJ measnres outlin 10 cl ir1 this scheme.

· FINANCIAL AsPECTS.

Registrat-ion Depot.- The exp endit ure in co11 nexion t iw i! ep6t will p robr.b1 v Am ount to abont £2,000 pPr ::mnum, ma,d,; n p as follows :-

Director 'l'wo nurses Clericn.l staff . travelling expen sfl s,

prin ting, nni! prop:=tganda

£ 1,000 .£400

.-£60 0

£2,000

Recei1;inq Sanatoriurn .-H nn industrial samLt orium is prn­ vided , about 60 . bedf: will be required for the r eceiving sa.nn­ torium. It is estimated th at a new sanatorium will co::;t abont £30,000 .

The annual maintenance cost is estimated at about £4,500. I ndustrial San•atoriurn.- It i s estimated tha,t a 200-hecl san a ­ torium will cost abo11t £ 40,000. It is very d esirable t hat t h er e should be a separate sana­

t orium for e ach sex. If two san atoria are provided tl1 e caRt

will be about £60,000 . The m ainten:=tnce cost of a n industrial sanfl,torium would b P less per h ead that a receiving sanatorium, as the nursing staff would b e less, and the patients conld be utilized for produe­ t ive work.

The mainten ance cost for 200 beeTs is estima.ted at abr)lt f, £ 9 ,500 p er annum. I n t ermediate Sanator'ium.- An in termediate s n.natorium fol' 50 beds w ould cost n,bout £ 20,000. The fees r eeei.ved shou1(l cover the cost of maintenance.

Advanced Sannto1'ium .- T he Austin Hospita l (l46 beds) and the H ea.th erton (124 b eds) provide fl.ccommodation

for advanced cases. It is calculated th:=tt another 100 beds ar e necessary. Sa.n atorimn .frw Nnn-Pulmon ary Cases.-Da.ta are not avail­ able as to number or cases for which it i s d esirable t o

provision. Hostel.-It is desirable to provide one h aRte] for femal er-; one f or males. Each would probably cost. about £ 10,000 .

Charges shon1cl cover cost of m aintenance .

ACCOMMODATION .AVAILABLE .

Be(l s.

Jnst.it.ntion. - - ------ - Totn.l. Rem:uks.

Male. Female.

Greenvale 90 no For early cases

Amherst . . 60 60

cases Heat h erton 87 37 12-J.

Austin 100 46 146

H

72

.... t .,.

A l ~,on rour:g

L_

\ .

\ \

\

NOT[ : Arrow5 in_d.icole the movements Patienls.

F

\

L

D.=>.£.

A\PPE:WPI ¥- Nq. q

(Questiop }'fo. 2542.)

OI'fY OF PRAHRAN, V1CTORIA.

COMPILED TO SHOW HEALTH AC'l'IVI'l'Itt;S.

R.oughly, 2 m iles square. Populatiop., 51 ,500. Town Cler k chief executive officer -of th# cjty.

S taff.

[.Ie alt h officer (one) . Male inspectors (three). A in spector (one).

Tr amed nurses (three) . Offic e work, general statl'. ,City Engineer and his sta.ff .

Health Officer.

Attend at office d aily . R.eceive and dispatch correspondence . Recei,ve reports from staff ,and directs work of staff. Attends Health Committee m eetings and conferences on health matter s.

J?oes swabbing and inocculation.

lnter.vi!'lws ratepayers and receives complaints. Adm1msters depamm ent and a dvises generally on the follow­ ip.g :-Wor k of H ealth S ect'ion.

(In conju nction with the Town Clerk.) Estimates . Reports and ret urns. Advise Council. Medical charit ies.

Complaints. Distress of r esiden ts. B:ousing. &c . Arrange admission to Infectious Diseftses Hospital and gen er al hofOpitals. -

(In .CQ:fijunction with t.he City Collection of garbage. Street cleansing. Drainage. Night-soil collection (pan system). Septic tank. R.efnse destruct or . Garbage tips. Disposal and collection trade refuse. Subdivi8ion of P't'Operty. Erection _ of bujldings, sanitary of.

Streets and r .o w's; form ation ft nd maintenq,11ce of, sanitary sicle of.

A.dmin·istration of Acts and Regulations. Administration of Health Act and R egulations. Factories Act, sanitar y constru ction and working conditions. Theatres and amusement places. Barbers' shops. Lodging houses. Restaurants and eating h ouses. Examination, ::j,:p_alyzing food and drugs.

HonsinQ. Noxious trades, Marine ::>toxes and c .1l eotors' Rmoke and nuisance. Cem eteries Act (Sunday burials).

Buildings.

N ew, sanitary of con stru ction .

Old, r ep air and insa,nitary side of . Yards, clrainagf') of. Market shops, stalls, inspection of. Butcher and fish sh ops. les, inspection arid r epair, hor ses in the mty.

l•'o·wl-houses and yards, position and inspection. H nnseR , closin g against habitation and d emolition.

Birti1s. Deaths.

Sta-tistics and Retur1lS of

Tnfeeti01 1S di sease l· eports.

Butchers' shop s. Fish shops.

Inspection.

All nuisa.n ces anc1 9f previous mentioneil work. Fellmongers car ts in the city. Manure carts in th e city . .

W ater supply, purity of. Food and milk sup,ply, pu,rity Sewerage, defects in.

73

Sch.ools.

Sanit{try inspection of. Swah i;hro&ts, diphtheria ctunptLign . Nn'rg __ -See Nm:se 3rcl,

Not'i;fiable Di seases.

I nspection of prRmises. Cleanina and disinfection . Isola.tion and .contacts. Swabbing throa ts. . epidemics.

Vaacination Distributipn of treatmept for.

Emergency hospitals.

1 31

and Pathologic[Ll specimens, examination oF .

Infant welfare work. Child welfare ·work.

Health Oentn1.

'{ oung people welfare. Pt·e-materni.t;v a.dvi.ce and welfal'e.

APPENDIX No. 5 (b).

HEALTH CENTRE, MALVERN-ROAD, PRAHRAN. NEAR CHAPEL-STREET-CONVENIEN'r OF AccEss TO CrrY.

Built 1923. Cost £ 6,50.0 (land and building).

Entirely paid by the Council.

Single-storied brick building. Walls built to carry second :;tory fot' Museum and Exhibition. Heated electricity. Gas Cooking.

Accommodation.

(1) Small lecture h all, seat about 200. (2) Dressing room. (3) Two examination Pooms. (4) Kitchen and scullery. (5) Nurses retiring room·s. (6 ) Two sets sanitary .Jonveniences. !7) Small grass lawn for playground. (8) Large verandah as shelter shed. Buildings were erected not only for infant welfare work, but ,Ls a centre for all sorts of health activities, the object being to arouse the interest of ::mel develop an health conscience in citizens bv lectures, demonstrations, domicilliary visits and interviews; to try to improve the h eftlth of or keep in good

health citizens from infancy to adult life. Ho-pe ultimately to bring round centre a staff of enthnsiastic health workers em-oracing phase of preventive service.

Health. Officer, Three trained nurses. Sisters i and 2 do-

Staff.

In) Infant welfare work. (b) Pre- m at ernit y welfare. (c\ Correspondence._

(Children from infancy to two yem·s.) .Sister 3 does childr en and adult welfar e. Takes children over age for Sisters 1 and 2 , and h as all other activWes . rrhis nosition was first started some four months a.go, and r,he Sister is already overloaded with work. When the system

is fullv est abli shed a.ncl Sister in charge is trained,

anot her Sister will be appointed. Sta.ff of six and other helpers chosen by Sisters. The Rervices of the Sisters n.re at t h 0. disposal of Ll!e eity

fo r· welfare other work.

Oont,rol.

Bv H ealth Officer, and through him to T own Cl erk and City C'ounc:il. No ontsicle committees .

Finance .

From f!ity funds, except that Government give £125 per annum each for two Sister s. ( See attached Not a charitable institutif-.n. No voluntary subscriptions. No payment by attendees.

It is hoped ultimately that some system of museum and

exhibition of health plant and appliances may b e organized in the second story of building when built. No medical or dental treatment i s undertaken .

Hall.

Bodies doing anything io prouwte h eal·& h may use i;hP l1. Jl free. :For instance, St . John Ambu lance, Ministerin g- Clri I­ !lren>s League. F'ree lectur es to public are gi.wm b y m ed ieftl men

T-Te ::l,lt.h Officer on eqncative lines.'-

ltelat'io·n with V ictorian Baby H ealth A.ssoc'iation. Quite indep enden t of a n y other body. v\Tork with V .B .H .A . generally follow their practice. Distribu te their literature and k eep simila1; records . P rahran Sisters attend their lectures, and Dr. Ver a S cantlf\-bu.ry visits the .Centre o0c a sionally, an d is welcome.

P ass and receive names o f infants whose p a r en ts move from nne r1istrict to a.nother.

T a lbot M -il k.

Spe ci a l m ilk is fLdvised . Mothers unable t o p ur ch ase sam e n.re either given free su pply or pay only propor t ion of cost .

(See balance-sh eet.)

vVork of Sisters.

I nfant welf2re work is done in much the same way <1S in

,)th er centres. But work of the Third Sister is new. and is

r,nlv being arr anged and deve loped, so t o speak (page 2).

Par·.::nts with .childr en after leaving Baby Centre are encour aged f·o nome to her. She takes measurements and advises as to

food feeding and home life . She attends schools and kind Pr ­ gn,rtens, fo llovvs up sick children to home and ttbsentees often :L way fr om school, tries to get th ese children car ed for m1fl

s!mt to M .O . She lectures to elder school gi 1·ls. Accompanies Health Offi cer to schools and assists him.

Sch ool teachers welcome her, particularly in younger cla.sses. visits f actories whe1·e t h ere are young womon, and tries

t o inter est them . I n a u t u m n a n d \v-inter thel'e will be lectures and d emonstrations f or t h ese women on h ealtl! a,ncl matern iLy :mhiects, and, later, l ect11 r es to youths. At present Health Officer an d Sister ar e learning tho work, simpl.v feeling t h eir way, and w ill open n 11 t if' H ,ny enC(JUr fl,ge­

'nent anrl r esp on se is given.

Pr e-ma tm·nity.

Exp ectant mot hers are encourr.ged to come i.o t h e Cen tre for a.dvice--100 came last year . Up t o t h e present only seen

hy Senior S ister . P rimipfl.ra.e, sick women, sent t o h ospital s for medica,] advice. r.t is proposed to open a maternity clinic iH ch a r ge of medical man to go far ther- (pre )-th an S ister s !!;O if Alfred Hospital does not open one sh ortly .

C orT espondence.

A v ery la r ge bran ch of t h e infant welLu'e '"or k h as d o­

v e" 1 np e cl b y gi infm·n1 a.ti U I J h y e n cA to motlt c· rs

;Ll l uvt:H· th0. .Sta.tc. The Sisters writ e a.ho u t GOO lett er -s year ly <11 1 f,IJis suJ, jeC't . 'l'hei r wo rk i s Yer_,- 11111 !' 11 a.nd I

f h i ilk rn.u st he; procl ucti ve of good.

'l 'o h nprove W m·l.: .

l . P re-rn.u.ternity i.s importance. vVe w a n t i.o

l1i r ti1 r eports earli er :md of r esidents nut of t h e city.

Better control of materni ty lwspitals n,n fl nur ses.

:L Mon: well-equipped m aternity hospit:tls Hear er to city . 4 . System of domesti c i1 el 11 so t. hat m o ,·e pa.tients could g

to l1 uspit n. ls, particn lnrly sick wonl P'I! . ·n· f·hnse who may aJ t­ i.ic·iJl c!TI' h ·o 11 ldes o rn e C'onfinement.

Hetutns.

I . Cost of welfare work.

2. \Velfn,rc Contre (baby) . ., W elfat·e ( ehild ) .

4. Dea.tl t:-i unrle1· yea r .

74

1922-23 .

Oapitr£l Cos t , £ 6,!100.

State contribut i on Milk paym ents Felt on b eauest Coun cil contribntion

Sal ar ies Milk G en er a l

State Mille Refunds Counci l con rr ibution

Sal ar ies M ilk _ Labour cten er aJ

R. eceiptM.

B x p enditur.·P. .

J 923-1 924.

H.e ceiptfl .

Ex.penditun .. .

£

250

29 40o

84(j

£, 45()

65 287

J,384

on capital cos t 110t included i 11 a.b(lve.

charge made fo r use of ci't.y services to Hoalt h Cen t r.·.

R.etn r n No. 3.

CI1,Y OF P R AHRAN. C H ILD \ i\TELl<'A R E CffiN'l'RE.

One Nur sing S ist er working three month-s- 1st Octob e l: to 31st D ecember, c

!-Iom es visit e d. 302. Children a,t Cent r e, 90. Referred to medical .

H.eferred to den t ist, Jt ll.

H.Pt.ll i' l1 0 . 2.

CI TY OF PR.A HRAN. WORK 01<' VVELFA1-tJ·; CENTRl•; 'l'wo Nvn·ing S istP1'S.

Total att endances, 8,811. Visits t o homes by Sister s, 1,7:::17 . SeDarate babies clealth with, not inclurl i11 g cun t> spo nde iH :<-' , 7!14.

Outward cor respondence, estimates re 100 babies, 600. Pre-maternity , 100. Dea,thR nf w!111 ha.d a ttenrlt ·d Cen t r e- P nHllliL1llitJ,, ·1 ;

1.

CITY OF PR. AH RAN.

R.eturn N o. 4 .

U:ours.

lfi

Total under 1 day 1

Hi I

I

- - - - -

Days.

1 2 4 5

2 r. 4 2 2

D RA'l'HS OF CHIL D REN UNDER 0 NB YEAR OLD .

Da.ys.

7 8 9 10 11 12 13 14

0 = 16 . .

Total under 7 days

31

Tot.al tmder 14 daysl 31

Total .Birt hs in City-1,281.

Days.

1 5 16 17 18 19 20 21

1 = 1

Tot a l under 21 days

32

Popul a tion -·51,000 .

I

Days.

23 24 25 26 27 28 29 30

Total under 1 mouth

32

'l'otal Deaths, All Ages-4:24.

ltfonths.

2 4 6

= lO

Total unde r 1 year

75

CITY O.F PRAllRAN.

DEA.T.HS OF UNDJUt 0 N l!1 Yl

1924- Days. Months.

Hours. 2 3 4 6 7 I

Days.

8 \:) 10 11 12 13 14

I

Days.

15 16 17 18 19 20 21

Days.

22 to 30 2 3 4 s 9 10 11 1 2

---- ----12 2 '1 3 = 22 2 0 0 1 3 1 3 = 10 1 = 1 N il. 1 1 2 1 1 u 2 1 1 .... = 11 Total nuder 1 year Total under 1 day 12 Totai under 1 week 1 34 1 Total under 14 days 44 Total under 21 days 45 Total 1mder 30 days 45 Tota l Births in City- 1 ,218 . Total Deaths, All Causes-38r,. Populati.on-51,500. DEATHS OF CHILDREN UNDER ONE YEAR OF A GE.

Reported by 25 Medical Pmctitioners.

One medical practitioner reported 13 deaths , One medica.l practitioner reported 6 deaths . On e medica l practitioner reported 5 deaths. One medical practitiQner 4 deaths.

l"':i e ve n me clic a. l pr1t ctitioner s each r eported 2 d eat h s .

Fo u rteen medi cal pra;Ctiilioner s ea ch r eported 1 deat h .

API'JiJN"nix No. 6.

(Que!'ltion No .

------·- --·-- --

ADMISSIONS TO CLINIC, 440 LONSDALE-STREET, MELBOURNE. NEW lNFBCTIONS IN EACH YEAR. MEN's CLINIC.-From 17.6.18 to 31.12.24.

P1·oved

Total Non-venereal Year . Admissions. after Examination. 7.6.18- 3] .1.2.18 1,459 37

91 9 . . .. 2,303 60

.920 . . .. 2,288 85

92J . . .. 1,665 63

922 .. .. 1,428 81

923 .. .. 1,592 118

924 .. 2,205 145

Totals . . 12,940 589

Infected Infected During During Previous Year or Year as Years. Under. - --- -381 1,04] 574 1,669 598 1,605 359 1,243 258 1,089 302 1,172 299 1,761 ----- 2,771 9,580 M:tllN'S CLINIC.

Year.

17.6 .18- 31 . 21 .18 1919 . 1920 1921 192,2 1923 1924

Totals

Gonorrhoea. Ch a ncroid .

902 1,264-1,178 959

894 994 1,621

25 99 I7fl 113

96 72 46

Syphilis.

206 681 432 335 302 298 303

Total New lnfectlonR.

1,133 2,044 L,78H 1,407

1,292 1,364 1,970

----------7,812 630 2,557 I 10,999 - ------ ---· ----. --·-·----·---·-

DISEASES CON1'RACTED D OlHNG T'HR Y EAR

M.KN' s OLIN ru .

I

Sin gle Infections.

Ye:tr.

Gon orrh oea .. I I

I Gonorrhoe;t (' lw nc10id. Primary secondar y Tertiar y and I --- 1 Syphilis. Syphilis. Syphilis. Chancroid.

I7. 6 . 1 s- -:n . 12. 1 s 81 3 20 I 67 51 .. 2

]919 . . . . 910 70 269 48 .. 8

]920 .. . . ] ,012 143 219 51 .. 18

1921 .. .. 820 78 134 49 .. 10

1922 .. . . 705 64 84 31 .. 15

1923 .. . . 810 56 84 31 .. 8

1924 .. . . 40 65 35 . . 5

- ----

Totals ..

I

l\ ,483 4:71 922

I

296 .. 66

Patients with one Venereal Disease Pa.tients w:itb two or more VenereaJ Diseases

Total

:Mixed Infections.

Gonorrhoe:o. Sy philis and and

Syphilis. Cha ncroid.

85 343 144 127

173 175 202

1,249

.. 8,172

.. 1;408

. . 9,580

l

18 14 23 16

7

..

79

Gononhoea, Chancroid I a nd Syphilis. ------ -

2

3

4

2

1

1

l

..

14

-

'L'uLal s.

- --- --

1,041 1,669 1,605

1,24:3 1,089 1,172 1,761

9,580

---

rAPPENDIX No. 7. (Question 4583.)

lV(F.NTAL DEJ<'ECTlVES, VICTORIA.

Acting as < t sub-committee, Professor Berry, Mr. McR&e, and Dr. Jones beg to offer the following :-

. (1) The est:;tb l_i shment of a clinic and laboratory within, or close pro:x:n m ty to, the Tea chers' College and University.

( 1 h e commencement of this work has already been authorized by the former Minister for Education.) . (2) That a n euro-pathological la boratory should be estab ­ h s? ed later on within the University of Melbourne, and that

this shonld b e jointly administ ered a nd financed by the

Gover nment and University. .

(3) That the public or public charities, such as the Walter and Eliza Hall Trust, b e invited to subscribe to the establish­ ment of the clinic and laboratories. (4) That a b oard of control shall be appointed, which will be entrusted with the administration of all matters concern­ ing the notification, inspection , care and maintenance of all mentally deficient persons, as well as with t he establishment :in stitution s, other than day schools, which may be t.stab­

h Rhed for the t r aining and segregation of mental d efectives. The board of control should consist of five individuaJs : one should be appointed by the Gover nment of Victoria, one by the Department of Education, one by the Faculty of Medicine, one from the Chief Secretary's D epartment, and the Inspector­ General of the Insane. · One member of the board shall be

appointed as chairman, with a casting, as well as a delibera­ tive, vote. (5) The board of control should h ave power to co-opt two a.dditional members for any period of time, or for any special purpose, and such members shall have, during the period of their appointment, equal rights and powers with the other members.

(6) The board of control should be consulted with r eference to th e appointments of the staff of the clinic, and, further, to have power to appoint a medical advisory committee and an nftPl' care committee. ·

(7) The board of con trol is to b e directly responsible for

th e expenditure of all moneys which may he from time to

time voted for the purpose of the 'clinic and laboratory, the r esidential schools, or a ny similar institution. (8) The board of should take steps to provide for

a. census of all mentally defective p er sons and children, especi­ allv with referen ce to those children who may be considered suitable cases for housing and education in special traini.ng schools . That, so far as possible. this census should b e under­ taken by the existing State instrumentalities, and tha.t it

should be especially directed to the classification into educable anil non-educable sub-normal children, &c The sub-commit tee visited on Friday, 31 st October,

and. c fter inspect ion of this property, begs to offer the fol­

lowing r ecommendations :-(a) The school should, at th e outset, be restricted

t o m n.le and female children b elow the a ge of 10 years, and t o the tvpe known as high grade m ent ally defective children. (b) As these inmates at varying ages attain their pube.scence, thev slJOul d b e subdivided for further classification.

(c) Up to 20 year s M age, there is some hope of establish­

in<;{. under careful supervision, such h abits of control as

might the p atient to be able to r eturn to the com­

rnunity under the watchful -eye of an after-care committee. After that age. there is very little hope of improvement, and i·.he h nnat e will probably require permanent segregation in some other institution. 'The hopeless idiots and imbe ciles and

;:;pxual pervcrfs will become th e sole care of the State and b e pl:wcr1 in other suitable institutions, and on the S t ate th e

wl1 ole charge of maintenance of such cases will fall. (d) The training sch ool sh all b e under the management of th e bof"l.rd of cont rol referred to in cla use 4, assisted b y the

medical an d after-care committee m entioned in cla use 6.

'This scheme will secure the necessary unity of purpose

through out the whole design . (e) 'The staff of the training school shall include an expert superintennent and a matron and such other officers as are

r1e em ed necessary. (f) The tra ining sch ool shall b e provided with a small r e­

search laboratory, which should b e worked in a,ssociation with lh P clinical laboratory a.lready refr:rred. to . An duty

will be to provide an expert class1ficatwn of the mmates of

i he school or schools. (IJ) 'T he fullest provision shonld be made in the training

sc·hool for the edncation, as well as the manqal traming, of

the inmates. So f ar as possible, no individua.ls shall "tle idle, :Lnd tl1e occupations provided sho11ld inclu de wood. carving, basket m aking, sewing, garden farm work, worl;:,

and household work, and so on. Each ch1ld's capa­

bilities' should b e studied, and used to the best advantage ;

hence the importance of an expert staff. (h) As r egaTC1s the finance of the t r aining school. this must necessarily be a fi r st charge on the Government,.

ho ard of control should be instructed to make the mstitut.wn n.s self-supporting as is possible, as is the. case wit l; -'{in_eland : To this end, provision should be made ror the aam1sswn of

private paying . . . .

(i) a1ves ample famhhes for the establishment of n

colony which include residential schools and separate

blocks for the train ing and segregation of various classes of

76

mental. defectives of both sexes, together with ample oppor­ t nnity for farming, dairying, and other indnst rial occup ations flllrl training. ·

The existing temporary buildings, erected by the Red Cross S ociety for the training and in struction of arrested ca:

APPENDIX No. 8.

(Qu12stion 4922.)

FORM OF AGREEMENT.

MEMORANDUM OF AGREE1ri:ENT made the d av of

One thousanrl nine hundred ::md twent y- .. between of ,

in the State of (hereinafter caJled tht>

Company) of the one part and of ,

physician (hereinafter called the Physician) of the oth er part, wher eby it is a;.greed as follows :-Term of Engagement. - 1. The company will emplov the physician a nd the physician will serve the companv for the period of t welve months from the " · as its medical

officer at upon the terms ani!

conditiens h er einafter appearing. Salary.

2. The salary of the said physician shall h e day of p er annum pa.vab1e monthlv on t he every month during th e continuance of this agreement. aiJ CI the first payment to b e m ade on the clay of

n ext. Travelling Expenses .

3 . The company will pav to the ph ysici a n his r eflSO!Hlh1 (' n.nd proper fares and travelling expen ses 'Nhilst he is

from engaged upon the bnsmess

of the company.

Drugs.

4 . The company will supply all dressin.gs. a nd m edic:1l

nnc1 surgical eq nioment and also all office nccommod ntion . st:1.tionerv. and offi ce sundries r equi ite for t.hr ca.rryi n;:, ont of the p hysician's duties under this agreem ent. Duties of the Physician.

5. The physician during the continuance of thi s agr ee ment---Residence. (a) Shall reside at

No Private Practice.

(b) Shall ncL engage in private practice.

Da.ily Attendance.

(c) Shall attend at. th e works of the comn n.nv at such stated h'mrs d ai.lv as mn;y be fixe r1 by the f!Pnerf\1 superintendPnt of the cornmiTJ v. a:rd «hall carrv out such duties as the general

superintenden t shall prescribe, which mav include-Examination, of ftpvlicants fqr Employment. (i) ThA gener ?..l examination of every applicant

for employment by th e comp any. Periodica l E:r arnination of Rmvloyees (i i) The m edical examination at stated p eriod s of all em­ ployees of the

o f Sick and Granting o f Certificat es.

(iii) The medical exandn ation of any person -em ployed r c­ norted tn be sick a.nd the giving of a certificn.te as

to th e fitnesR t o resume of any ernployees

absent throl.ll!h illness. Medical Trea tment of Employees. (iv) T b0 symptomatic treatment of employees suffering from indisposition of a temporary ch aract-er. (ivA) The disposal of oat ients when treatment at t h e worb;

is not undertaken. Accidents.

(v) 'The attendanc0 upon any employee injur ed by accid eul at the company' s works. Sanitation and Hygiene . (v i) The periodical of all buildings_ and wo;k­

ing -pl aces wit h. a view to t _h e . promotion. of h1gl1

st andards of samt!:',r y and hyg1em c surroundmgs. Occ-upational Diseases . (vii) The · of occupa.tional diseases existing

amongst the company's employees and of their cause and their r emedies. Pirst; Aid Ambulan ce Roorns , R es t Rooms, Dent al Clinics. &c. (viii) The s.uper-0,sion and adininistration of. aid, ambu­

lance rooms. rest rooms, dental chmcs, &c. The

specification , of the duties of nurses, first-aid at­

tendants, dentists, &c .

1 32 3

77

Advising Good Beha'Vionr.

(ix) The advising of employees as to the obser vance of

rules of health at the cornpanv's works in their

homes. "

Certificates for Accident J.i'und (x) The supplying of certificates to injured or sick em­

ployees claiming benefits from accident or sickness funds. Preventive Med'icine. (x i ) The performance of such duties as shall b e agreed

b et ween the general superintendent and the

physician with regard to experiments in the princi­ pals of appli(;)d preventive medicine. To Keep Bec01·ds and Make RepoTts. G. 'Fhe physician shall keep proper records of all work done by hun, and shall from time t o time make reports to the

superintendent _upon the following matters, togethel'

w1tlt any recommendat iOn which the physician shall think proper to make.

'1 . If d ur in,g tlle said term of one ye<1r, or a.ny extensiou

thereo! which may be mutually arranged, the physi cian shall be gmlty of any personal misconduct or of any wilful bi·each or ?ontinue? neglect of t_he t erm s of this agreement or of the d_ubes h e.rembefore any. duties which may from

to hme b e propeny ass1gneu to hm1 by the general super­

mtendent in m anner aforesaid (of which neglect, breach, or misconduct the board of dire.:;tors for the time being of the c?mpany shall be the sole judge) the company may by resolu­ tiOn of t h e board of directors (a copy of which resolution

shall be sent or delivered to the physician) for thwith and

without any previous notice ·or payment in lieu of notice put an end to and . determine the e m i_>loJ::n::ent of t he physician hereunder, and m such case the p11ys1cum shall be paid the amount of salary as aforesaid which. may be due to him

down to date of the said r esolution, and such amount shall be received by h im in full satisfaction and discharge of all claims an_d demands ·w·hatsoever against the company ]n respect of tlus agreement or the subject matter thereof.

W 01·king C ond'i tions .

(a) 'I'he working conditions in existence at the company's works in their relation to the h e alth of employees. Sanitation and Water. (b) Sanitation and water supply at t he company's works.

Health of Employees.

(c) The of employees medically examined especi­

ally havmg regard to the suitability of each em­

ployee's work to his physical condition. Accidents.

(d ) The condition of persons injured at the company's

works, stating, so far as ascertainable, the cause of such injury and making recommendations for the avoidr.nce of future accidents.

· Not to C harge Employees. 8. The physician shall not make any charge to any em­

ployee.

Question of Renewal Hereof.

9. The question of the renewal of this agreement in the

same or different conditions shall be considered by the partie;; hereto at the end of nine months from the date hereof. In witness whereof the said company hath hereunto set its common seal and the said physician hath hereunto set his hand

and seal the day and year fi rst above written. The common seal of the was hereto

afiixed in the presence of-

Signed, sealed, and delivered by the said tlte presence of-

D irectors. Secretary. in

APPENDIX No. 9.

(Question No. 6105.)

NEw SouTH WALES.

IVIA'l'ERNAL MORTALITY IN CHILDBIR'rH. 1890 TO 1923.

1 1 I I : , 'T I : -H , · :

I I ! I I 1 +r I I 1 I -++ I

1 -t--1-+-ll-1-+· I I i I I Li . I L-t . --1-1

1

! T++-t-H --i-+L . 1 I 1 I : i 1 , 1 J-_ j=fF -+-r+t' .l:t± L..L_

: I I

I I I I . I l I

+ ' , i

1 1/ 1 H_l l ' Tf-f-l=ttF j f-f- + -f I m -j 1 1 rr r--r- · I ' -t 1 !§.H!...J..2l0 J s

-1-·. ! I ilft§ltt- -t-1- - -t±-,-

l-+- u_ I l l/\r--r-!1 +-f- -f-1 H.+·++ .-+-+-;

f-l- 1--rl f-l 1 1 ;"' ' rrr 1 1 1 -h-Ilt' -r __ i1·_-J

1 ,-rf£l-Jt _j I i I II I i I I ·-r- t I I .l. _L.J_ I I 1 - . 1. 1 ; - : I I 1\ l ' 1 1 1 l.L =i#,+rri .:=i=f ·-'- W--1.-LJ rJ __ A tl -j \1 1 1 -fl+T · 1- H H tW--t+-1-. ·j ··+· f--j H+ 1 cH ' 1 1 1 I 11 I\ 1 , • 1 1 1 ++-T'_j J+- ' \ -ft+-! j I l I i f i=i t- 7 I ·-r'-, . • t/ 1 -H· i I i I I v I -t+-- I I I -- -tt+R --1- ,Lr- ' ! I , ' , 1 -+t+-4-i--1-+\ 1 II 1 1:[1 f + __J_ _ ±±:::..: 1- ft+- -l-t-- &. 1-H++-t- , , Ff+J , 'r1 +qr .+ +-,-t-!-1 lfEfffii-+ ·-f .t l :U·:-I t-H 1 -+-(T It I 1 f-+- c-- +\+ tJTbt t_LL I.LI J · It Jt 1 , 1 1 H 11 · l· - _ _ i=R./i\ft-, r-·1 1 H - j-t·-- l-:--1-f I i l l--+ H-L-+ I ! I . [--j-- 1-- - - ll- -p- -. 1-t- -1 - n- Hitt-t - I Tl-1 +tl +·r- H-± ! _ _ 1 f:,_ 'iTt+ I ·r I r..,. --1 I !=it ! 6 I I I . ml I :R- r--LI _LI --l.J' li 1,-·j -i -1 .I I H---, 1 H---+-,f-_ ti -·--\ -rr---r-'1 J i _ r±f--j-i-·---+-' t--j ij--t---r-· . .J-J-i-f-_[_L.L , 1L-"-t--+Im1-,--·. -_, __ , __ --'1-i +-i tl f-- -· ·- -r+ L -- - - , -+11-+ .L +--i -1-+ jli +· ··-,·--!· ·l,s r i- 1 1 1 1 t- · - l=r r - ·H-r-+--Tl_f±. -tlJlff+:+r ' tfti;j-- -!- -TL+· ·-·! l .. t--1 1- I -iT+-· I -I - - i-+-1- ....... --- --H-TILLLl_r-t i-,1--' I I I -1 ll - 'r- +1- L -· I- T I I ' 1-1-- f-r· -+- =t= +-+-1-H+l-' I -+-r- - -7"-;- ++ r-1 -LJ L= -·It· - 1- -r-1-f-]--i l i l I =r_+· ... - - --[-+=fl: II_, r t-ril-+ri·-f-+-e-+-.+-+ - +-r-t-1- -l-+J - i r-t t-l 1 I I , I I I ,- I I t -"u+i.= -t+H+ r·-rJ __ -u-1=1 1 1' . 1 I 1 _Lu_u 1 1 1 1 1 I lJ1. 1890 \ \) 1895 1900 1905 1910 1915 1920 1925 Chart sh owing maternal mortality i.n child-birth according to the New South Wales Statistician's reports feom 1890 tilll923. 'l.1he chart shows deaths p er 1,000 births, During the yea,r 1893 th.e Statistician's Office commenced to wribe to the medical a,ttendant for furt her details in cases where tho death certificat e did not state that the death was of pu.erpera.l origin. This is still done in New South Wales but not elsewhere, hence the N ew South Wales figures a1·e higher than the :F'edeml St atistician's, J. L . WINDEYER,

(,

I\.

Aw.e:NDIX No. 9A. (Question No. M03.)

ORGANIZATION CHART Dep;;;Jrfrnent or Public Hed/th N. s. W.

r:::.: or \ Public He~fth '\:.o~;:;/ £x~ndure ~~7

- -----~

----- ------ ·--- - - --- . -~

. ..,.µ..,,,,.,. , ,:Y Ct:,rr,,,,.,/l"f'w:C ,

A.,,-y;. Food.G Ac:r,

(,..,.,,..,.,,,,.,

~~/

~ / We/F;,.-e Sccie

~ repre.senr expenditure Frof77 Con.solldz,fec/ Rev~~ dunng_ye-::lr /,32:3- 1:324, bur eX"clude, C;;;,p/f;;,/ Expendirure.

78

79

APPENDIX No. 10 .

PATHOLO GI CAl, .LA BORA TOR Y :FOR H OSPITAT,S .

180 S y.dney,

2:3rd .l925.

The Dea11 of the F aculty of l\fedicin e , Uni oi' Sydney,

Da rlin gton.

!J ea1· MiJls-

.AL veTy Bhort notice 1 have endeavo ured ;to vi sualize the

problem y ou have l::l et m e. I have had hme t o interview only one rmedical ·offic er -connect ed with .the hospitaJ s for ·women ir1 Sydney , and that w as necessarily very rbrief, and my only otheT authorities a.re the annual repor t s of t l1e Benevolent Socie;ty of New Sou t h vVa les for 1923 ::.md of the W·omen's Hospital, CrowJl-street, a l so for 192:3.

NLA.I N DATA.

J. P op ulr-vtion for ·whic h la,boratory investigat ions are re­ quir ed:-

In-patients (Obstetric and Gyne­ cological) ..

District Patients ( 0 bstetric)

Out-patients (Gynecological and Prematernity)

T otal number of beds

Average number of beds occupied

II Royal. Crown-street.

Wom

i

3,131 1,721 1,622 1,024

289 290 239 200

3,165 2,425 1 467

9:4: I 82

(_ l: J JbL IJ P.Gernuer, .l922, t lJ ere were 13 3 !WO'l1).en and 52 ibed s wt the Royal:-

Deaths (Gynecological and Ob­ stetric)

Still-born

Royal. Crown-street.

Women. Children. Women . Children.

44 65 15 33

105 52

2. E a;·isting Laborator y Facilities.-I must plead personal ignorance, but the

an honorary patholog,i,st and a 'path ological department, and 7 44 specimens were examined durillJg 1923, but w hether a 1l were examined in the hospital labora tory or n ot I camiot sa y . Thi s t ot a l is very small !Per bed co mpa,r e cl with that for a

gen eral hos:pital (-at .the Royal Prince Alfr ed Hospital t here were a ppr ox imately 13,000 examinations fo r 500 ibe cls) . At i. !J c Cr own-street Hospital there is an honora r y pathologist ,

:1nd t h e p a thologica l depar;tment is m entioned in the a nnua l

reuort for 1923 but there i s nQ informa,tion as to its a ctivities. Apparently are t ·aken to the Board of Health and t o

other laboratories. I cannot find any sta.tement that post­ mortem examinations have ibeen made in either hos·pitals.

3. Morbi d conditi()n s jn w.h. i. ch ' kvbo r a t or y in;vestig a t ions r: :ig.ht r eason.a,bly ·be es:peded , and i u some a r c e sc:entin1,

bo th fo r dja gnosis a u d fo r ixoa tmon t :-(11.·) Prematerna l ooD di,LioJi s, e.g., alhuminuri <-:,, llcpl tr.i.tjs,

h y peremJ3Sis, e-l:la.tn ps i:-t, p yel.itis, \ren ereal d i >4f)a ses, endocrine disorders, m ental aberration ,.; , log ic::d ex am ination s in ::;u s·pect ed septic coudit iowo of the genita l t r ad.

( 7J) Accidents of childbirth, e.g., blood gro upi ng· of

mother and donor s in cases wher e h :oe Jnunlw,gc 1:' ex:pected or has oc-curred.

( o) Postpart um conditions of mother and ch ild, e.g ., a s above, a l so ;septicwmia s, ,p;yromias, a menYia s , 'pneu ­ rmonias in far ctio ns, mast it i.s, er;ysipe1u ::;, enclom c­ t ritis, salpingit i s, peritonit is, vaTi ous trm: o ;· "·

COivll\H_;N T A:N JJ tl UG HESTlO.N .

J .l:uwe no .hel::litatiou iu giv ing an opinion, whir:l t is qu it. o disint er ested, tlmt ea ch of t hese ];l,l'f\'C and ;;1,dmi r ab!e in s titu tions :would Jind that a medica l gn vdua-te specia lly trai n ed .i u pathology and bio-cherruistry would have his vdw le t ime f u l ly occupied from t ·he ii r.st d-ay of his ap:pointment. To get tl1 c work done as it should be done, it is essential to have-

( l) Adequa,te laJbor.atory buildings and equipment.

( 2 ) A full-time s,pecially trained ,pathologist and 1.io­ chemist, a. man or woman who is prepa-red to :find in this work his or her career, a graduate in medicine who has spent not less than two years in some

larger lwb oratory, and is both .a bacteriologist a;nd a. bio-chemis.t , and it seems t o me to be prefer.a,ble, in these srpecial conditions, to have one full-time

graduate than a half-time pathologist and a half­ time bio-:chemist . I only budget, of cours e, for

.init i a l condjtions, and m ore staJI might be required

when all the clinical staff wanted to know thin g;.:.

BUILDINGS AND l i: QU IPMENT.

'ro build lwborat ories rus a solidly constructed cott age a nnexe woukl ·cost ver.y a:p p roxima,tely £ 2,500, and equirpment £1 ,0 00. Alteration of or a dd-ition to existing buildings might b e

cheaper. In addi tion to laboratories, and apart from

them, a chilled m ortua Ty l:md a, well-ventilated post-mor tem room are also essential. These facilities do not exist I und< ;r ­ stand at Crown-street. These buildings would co l::lt < i.pprox i­ mately. another £800. A small animal house and l 'LHl a rc ai CJ

)ViAIN'l'll:N AN CID.

Sala-ri es, l!Vag es, cLn d Mate-rial.

Initial salary of pathologist and bio-chemist Trained laboratory attendant £600 250

65 200

Charwoman (}1alf time) Ma teria l

£1,11 5

In conclusiou, I must repeat tha t t h is repor t t o y un h < ts beeu , uf ne.cessity, hurriedly prepared, bu t I have n ot missed the ·wood for the trees. I am satisfied tha t -( 1 ) T.bere is a bun dant ''vork for a full-time paJthologist

a nd bio-chencist in ea,ch hos:pital. ( 2)

( 3)

T:hi's arran gement would be t he most economical ai'i r egards the serv ice obta.inecl and results achieved. . The iben eflts t hat wou ld a ccrue, bot h t o the clinical staff, and, above a ll, to the pa tients, would be im-

mense.

(Signed) A. W. 'TEBBUTT.

80

AI' IJJ<;N DI::\ No. J 1 (a) .

((Jn estion 1 · 0. f2l0'4.)

T U JN

DJ.;.A.'l ' JJ H.A.'l'JLi::i ,\I IU,I ON OF J>OPl ' L A'I'ION.

.. L . 1 . · r J 1- 1 I I I I 1 '

+- r-++--i, j-+--+--+---ii-+-+--j---1----- -+---l--1--+-+--+- i -·r-'· +--i,--+--t--+-1-1:--+- 1 +.,-+ ; I

+- I !

! I

\

1500 ' I/

/

I

It'\

I I

I

\ I '1ll

\

• I

\ I )

\!/ '\--

\, 1\.

IJ \

l \

I ,

\ /i'

I .

. I

0 I

t870 188 0 1890 1900 1910 1920

APPENDIX No. 11 (b).

(Question No. 12104.)

PULMONARY TUBERCULOSIS.

A COMPARISON BETWEEN NU111:BER Ol!' CASES REPORTED AND THF. Dl!;A';t'HS.

Year. Cases R eported. Deaths.

1910 1,457 1,078

1911 1,407 1,108

1912 1,327 1,087

1913 1,376 1,056

1914 1,410 1,031

1915 1,509 942

1916 1;653

1917 952

i9i8 1,480 937

1919 1,297 1,084

1920 932 990

1921 1,302 1,025

1922 1,158 887

1923 1,088 997

1924 1,060 960

81

The number of cases of clinical in a community

can be estimated by multiplying the number of deaths from tuberculosis by 10. (Rosenau.) The provision of one bed for. 2,500 of population is the stan-

dard recommended in the Astor report. Victoria under this standard would require 650 begs. .

APPEND!]\: No. 11 (c) .

(Question No. 12104.)

CHILDREN LIVING WITH TUBERCULOUS PARENTS RECEIVING BOARDING-OUT ALLOWANCES.

Collingwood.-Sleeps in same room as two children, for one of whom she is receiving assistance from the State. Richmond:-Five children. All receiving State aid. Eldest child 12, has tuberculosis hip, sleeps in sv,me room as father

mother, and child of 4. State aid granted for

children.

APPENDIX No. 11 (d).

(Question No. 12104.)

INVALID PENSIONERS AND BAD .HOME SURROUNDING. Prahran.-Visited 18.9.24. Had not been reported to Prahran Council. Conditions-4-roomed cottage. Inmates, 4 adults, 5 children. Patient lodger living in small, totally unventilated room in back ya,rd.

Collingwood.-Husband died of tuberculosis. Lives in 3-roomed house. On€ room let to married couple with 3 chil­ dren. Mother and father of children at work, and Mrs. D. look s after children. Room very dark. Collingwood Council in­ formed Mrs. D. now an inmate of an institution.

South Melbourne.- (Female)-Ill 2 years. 4-roomed house; occupants 10, including 7 children; says she sleeps in front room on sofa. Attendit1g Melbourne Hospital as an out­

patient. House dirty and squalid. B1·unswick.- (Deceased)-Inmate Greenvale 8.1.23; discharged 9.1.24. Slept in room with wife and 2 children. Child aged 2 years died of tuberculosis. 23.4.24. Invalid pension

granted 17.10.24. Died 27.11.24. Sleeping apartment badly ventilated; one small window. Melbourne,-(Returned sgldier)-Refused to go to a sana­ torium. Died 24th May. Daughter aged years

T.B. 7.8 .24. Son aged 28 reported : T.B. 7.8.24. Son marned with 2 children;, all sleeping in one room. Son and both receiving invalid pensions. Williamstown.-(Invalid pensioner)-3-roomed house. Fo,mily

consists of wife and 6 ehildr.en, ages 3, 4, 7, 12, 15, 17.

Another child €Xpected in a few weeks, and wife. is to be fined at home, Husband sleeps in kitchen. Children receive allowance from a charitable fund.

APPENDIX No. 11 (e).

(Question No. 12104.)

MISBEHAVIOR OF PATIENT$.

Ma.le.-Dismissed from Militarv Sanatorium; dismissed from Austin Hospital. Admitted Heatherton, 30.6.22; dismissed for misconduct on 25.7.24. Admitted Greenvale, 26 .2.24; dis­ charged, 10.3.24.

F.IOSI.-6

Male.-Greenvale, 5.7.21 to 31.10.21; 16.1.23 to 4.9.23; 16.10.23 t o 5.11.23. Dismissed from Austin and H€atherton, which institutions both refuse re-admission. Has now been ad­ mitted to Amherst.

Mal-e.-Admitted Austin, 30.8.21; discharged for drunkenness, 25.9.21, and refused re-admission. Has been a patient at Dalby (Queensland), Watt;Jrfall (N.S.W.), and also in Male.- Absconded from Heatherton; refused re-admission.

Undesirable; no means of support. ·

Male.-Greenvale, 31.5.21 to 6.9.-21; 8.2.22 to 2.4.22; 18.1.23 to 12.4.23. Has been in Heatherton; refused re-admission. Male.- Heatherton, Mar ch, 1919, to September, 1919; Green­ vale, 21.6.21 to 28.6.21. H.e-appli€d for Heatherton; refused

admission. Has been serving sentence in gaol. Now in

country. Living on invalid pension. Male.-Admitted Heatherton, 29 .7.24; absconded, 5.2.25; re­ fused re-admission. Alcoholic. Male.-Dismissed Amherst, 1924. Dismissed Austin, 1924. Now at Austin. If dismissed from there1 no place available.

AJ>PENDIX No. 11 (f).

No, 12082,.)

CASES AWAITING ADMISSION TO SANATORIA.

Month. Year. Mal€. Female. Total.

March 1923 10 8 18

April 1923 10 9 19

May 1923 14 7 21

June 1923 8 10 18

July 1923 6 10 16

August ... 1923 3 7 10

September 1923 1 1 2

October 1923 12 3 15

November 1923 9 2 11

Deoomber 1923 11 2 13

January 1924 6 2 8

February 1924 13 9 22

March 1924 1 3 4

April 1924 8 8

June 1924 16 16

July 1924 5 37 42

August ... 1924 3 48 ... 51

57 September October November December January February March ...

1924 1924 10

1924 8

1924 7

1925 8

1925 3

1925 6

APPENDIX No. 11 (g).

(Question No. 12106.)

57 58 68

45 53

44 51

39 47

37 40

38 44

LEG/\ L ENACTMENTS CONCERNING TUBERCULOSIS. Tuberculosis is a. notifiable infectious disease, and therefore the general provisions of the- Infectious Diseases Regulations are applicable to this disease. .

Special Regulations have been enacted m regard to tuber­ culosis, and are as follows :-(1) Every person suffering from pulmonary tuberculosis shall expectorate into a special receptacle, and

receptacle and the contents thereof be dism­

fecte{l or destroyed by heat by such or by

the person in nursing attendance upon or m charge of such patient. (2) The Medical Ofilcer of Health shall keep every patient under surveillance by inquiry and inspection ':"'ith a

view to ascertaining whether the precautwnary measures are b eing observed. (3) If the Medical Officer of Health is of the opinion that any patient is so helpless or so· n egligent as to be a

danger to the health of others, he shall take action in accordance with the provisions of section 109 of the Act. Section 109 of the H€alth Act is as follows :-

On the order of a Medical Officer of H.ealth, any person who is suffering from any infectious disease may be re­ moved to a suitable hospital or place of isolation, and there detained until such Medical Officer of Health or any

medical practitioner (authorized in writing by the Commis­ sion or the Council) certifies in writing that such person is free from infection or can be discharged without dangel" to the public health.

82

APPENDIX No. 12 .

(Question No. 12148.)

BACTERIAL COUNTS OF SAMPLES OF MILK FROM DAIRY FARMS AND DAIRIES FROM 151'H FEBRUARY, 1923, TO 17TH - JULY, 1924.

Microscopic Count per

Dairy Farms.

Number of Samples.

.Percentage of Total.

Number of Samples.

Dairies.

Percentage of Total.

Equivalent Plate Count 1/4.

10,000 and under 10,001 t o 20,000

20,001 , 40,000

40,001 , 80,000

80,001 " 100,000

100,001 " 250,000

250,001 ,

500,001 " 750,001 ,.

1,000,001 .. 1,500,001 ,

2,000,001 , 3,000,001 ,

500,000

750,000 1,000,000

1,500,000 2,000,000

3,000,000 4,000,000

4,000,001 .. 5,000,000 5,000,001 " 10,000,000

10,000,001 " 20,000,000 Over 20,000,001 . .

Totals ..

14 508 145 190 107 391 -1,355 333 - -1,688

153 117 -1,958 116

76 --2,150 84 47

35 76

40 50

2,482

·56

5 ·84 7·65 4 ·31 15·75 ---54

13·41 --68 6·16 4·71 -79 4·67 3·06 -86 3·38 1·89 1·41 3·06 1·61 2·01

13 69 30 34 17 104

120

67 72

267

- 526

138 73

110 77

50

737

924

172 -1,146 85 152

1,383

•!:13 4·98 2·16 2 ·45 1·22 7·51 --19

8·67

4·85 5·20 -38 9·97 5·27 - -53 7·95 5·56 - - 6G 3·61 12·43 - - 82 6·14 10·99

2,500 and under 2,501 t o 5,000

5,001 " 10,000

10,001 , 20,000

20,001 " 25,000

25,001 " 62,500

62,501 "

125,001 " 187,501 "

250,001 " 375,001 "

125,000

187,500 250,000

375,000 500,000

500,001 " 750,000 750,001 , 1,000,000

·1,000,001 " 1,250,000 1,250,001 " 2,500,000

2,500,001 , 5,000,000 Over 5,000,001

BA CTERIAL COUNTS OF SAMPLES OF MILK F ROM DAIRY FARMS AND DAIRIES FROM 18TH JULY, 1924, TO 31 sT JANUARY, 1925.

i\licr osc•.l )Jic Count. ver c.r. .

Dairy :warms.

Number of Samples.

Percentage of Total.

Dairies.

Nnmber of Samples.

Percentage of Total.

Equivalent Plate t:o un1. 1/4.

--------- ----------- -------------------l------------·1-----------·l------------l- -----------l------------- -

lO,OOO and under 10,001 t o 20,000

20,001 , 40,000

40,001 " 80,000

80,001 " 100,000

100,001 " 250,000

250,001 ,

500,001 ,. 750,001 "

1,000,001 ,. 1,500,001 ,

2,000,001 " 3,000,001 ..

500,000

750,000 1,000,000

1,500,000 2,000,000

3,000,000 4,000,000

4,000,001 " 5,000,000 5,000,001 " 10,000,000

10,000,001 " 20,000,000 Over 20,000,001 ..

Totals ..

471 149 188 f68 305 - 1,181

268 -1,449 105 77 ---1.631 81 .

44 - 1,756 47 31

19 45

18 13

1,929

24·42 7·72 9·74 3·52 15·81 - -61·22

13·89 --75·11 5·44 3·99 - -84·55

4·15 2·28 -91 2·43

1·60

·98 2·33 ·93 1

·67

97 26 37 17 99 - 276

124

106 72

96 73

578

- 747

81 51 - 879

35 116 -1,030 67

73

1,170

8·29 2·22 3·16 1·45

8·46 --23·58 10·59

9·05 6·15 - - 49·4

8·20 6·23 --63·84 6·92

4·36 --75·12 2·99 9·91 -88 5·72 6·24

2,500 and under · 2,501 t o 5,000

5,001 " 10,000

10,001 " 20,000

20,001 " 25,000

25,001 " 62,500

62,501 "

125,001 , 187,501 "

250,001 .. 375,001 "

125,000

187,500 250,000

375,000 500,000

500,001 , 750,000

750,001 " 1,000,000

1,000,001 " 1,250,000 1,250,001 " 2,500,000

2,500,001 " 5,000,000 Over 5,000,001

______ __________________ _:_ _____ ...;._ _____ .;__ ____ _,.!. _____ . ···- - ----

1 33

83

BACTERIAL COUNTS OF SAMPLES OF MILK FROM DAIRY FARMS AND DAIRIES FROM l5'rH FEBRUARY, 1923, TO 31sT JANUARY, 1925.

Dairy Farms. Dairies.

Equivalent Plate Count _ Microscopic Count per c.c. 1/4. Number of Percentage Number of Per<'entage Samples. of Total. Samples. of Total. 10,000 and under .. .. . . 14 ·32 13 ·51 2,500 and under

10,001 tQ .. o . 20,000 .. .. . . 979 22·19 166 6·50 2,501 to 5,000

20,001 "

40,000 .. .. .. 294 6·66 56 2· 19 5,001

"

10,000

40,001 "

80,000 . . .. . . 378 8·57 71 2·78 10,001

"

20,000

80,001 "

100,000 .. . . .. 175 3·97 34 1·33 20,001

"

25,000

100,001 "

250,000 .. . . .. 696 15·78 203 7·95 25,001

"

62,500

-2,536 --57·49 - · 543 -21·26 250,001 " 500,000 .. .. . . 601 13·62 244 9·56 62,501 " 125,000 -3,137 --71·11 500,001 " 750,000 .. .. .. 258 5·85 173 6 ·77 125,001 " 187,500 750,001 .. 1,000,000 . . . . .. 194 4·40 144 5 ·64 187,501 " 250,000 - 3,589 - 81·36 -1,104 ----43·24 1,000,001 " 1,500,000 .. .. .. 197 4·47 234 9•16 250,001 " 375,000 1,500,001 " 2,000,000 .. .. .. 120 2·72 146 5·72 375,001 " 500,000 -3,906 - 88·55 -1,484: - -58·12 2,000,001 " 3,000,000 .. .. .. 131 2·97 191 7·48 500,001 " 750,000 3,000,001 " 4,000,000 .. .. .. 78 1•77 128 5·01 750,001 " 1,000,000 -1,803 --70·62 4,000,001 " 5,000,000 .. .. .. 54 1·22 85 3·33 1,000,001 " 1,250,000 5,000,001 " 10,000,000 ... .. .. 121 2·74 288 11·28 1,250,001 " 2,500,000 -2,176 --85·23 10,000,001 " 20,000,000 .. .. 58 1·31 ·152 5·95 2,500,001 " 5,000,000 Over 20,000,001 .. .. . . .. 63 1·43 225 8·81 Over 5,000,001 Totals .. .. .. .. 4,411 .. 2,553 . .

Who is officially responsible in the State-1. For determining that any community shall be pro­

vided with a water supply

2. For determining that any community shall have ex­ tensions or changes made in its water supply

3. For the preparation of plans for water supply works

4. For approval of plans for

water supply work

6. For carrying out construc­ tion work

6. For operation and main­ tenance of works

APPENDIX No. 13 (a).

(Question No. 12283.)

QUESTIONNAIRE TO STATES AS TO RESPONSIBILITY FOR VARIOUS PHASES OF SANITARY ENGINEERING WORK.

New South Wales.

In Metropolitan, Hunter, and Grafton Districts, the Minister for Works. Outside these Districts the local Council

The Minister for Public

Works, Boards, or Coun­ cils, as case may be

,

Water Boards or local

Councils

Victoria .

State Rivers and Water Supply Commission, Municipal Councils

State Rivers and Water Supply Commission, Municipal Councils, Water Works Trusts

" "

,

Queensland.

Metropolitan Water and

Sewage Board, so far as re­ lates to City of Brisbane, South Brisbane, and

suburbs. Local Authori-ties and Water Authorities so far as relates to country towns and shire areas

JJ

State Rivers and Water I Bdsbane and suburbs, the I Supply Commission, Minister of Public Works.

Local Authorities Country towns, &c., where

works are carried out from loan money advanced by Treasury, the Commissioner of Irrigation

State Rivers and Water Brisbane and suburbs, Metro-Supply Commission, politan Water and

Councils, Trusts, Local Sewage Board. Country

Authorities towns, the Local Authority,

supervised by Commissioner of Irrigatio.n

JJ , , 1 Brisbane and suburbs, the

Metropolitan Watf:lr Sup}Jly and Sewage Board. Country toWILS, the Local Authority l

South Australia.

Ccmmissioner of Water

\\- orks recommends, and Cabinet decides

"

,

Workat

,.

,

,

,.

,

,

"

of Water

,

,

,

Western Australia. Ta"mani:t.

None •. Local Authority

I

,

···j ,; ;·â€¢

.. 1 ..

"

None. except as originate I Public Works Departmelilt with Water Board• where money is lo!:med by

,

1

Government ; also Public Health Department

..

·"""'· lft •jl

In Metropolitan · Area, I Local Authority Metropulitan Sewerage Department. On gold-supply, Gold-fields

Water Department. In Water Board Areaa, ·the Boards

I • " , ,, "

a::.

Who is officially responsible in the State-ce>ntimwed'.

7. For the prevention of pollu­ tion of the water· supply­ (a) at its source or in its catchment area ·

(b ) in channels,, service reservoirs, and other points

8. For inspection of works with reference to conditions· which may affect the· public health

9. For examination of tJhe

quality of at public water supply

10. For determining the need 1 for t he puTification of a water supply

n. Fbr tho- definition of re- I quirements as to aJnd which are t·o· be· ceptedl as fudicatirrg a safe arrd! puir.e' wateT'supply

12. Fbr Mre· enf0rcement of these nequirements·

New South Wales.

Water Boards Councils ,

Department Health

"

u

..

"

"

,

,

or local

..

of Public

)1

'

$

REsPoNSIBILITY FOR V ARm us PHASEs oF SA.NITARY ENGINEERING Wo&K--comanvad.

l

I

Victoria.

The Commission of Pu blio Health, any Municipal Council, St ate Rivers and Water Supply Commis-sion, or Water Trusts

The Commission of Public Health

,,

" "

,.,

li

I!

I

l Local Authorities(?) •• I

i

i :r li n " " I I 'i. :! :I. l

Queensland.

I

I

South Australia.

Com missioner of Public I Commissioner of Water

He3.lth has power to make ' Works; also Local Boards regulations in an of Health

for the protection from pol- r lution of water used for

domestic purposes-(a) In a ny water-course or lake, the Commis­ sioner of Irrigation.

On catchment areas, the Metropolitan Water Supply and Sewage Board as regards Brisbane, and Local Authori­ ties as regards

country towns (b) The Metropolitan

Water Supply and Rewage Board and Local Authority respectivt

The Commissioner of Public Health

, , ..

,,

" "

·-

10 ,.

, , ..

,

Specifie responsibility not placed. Commissoner of Water Works. Local

Board of Health ; in Ade­ laide, Central Board of

Health

Specific responsibility not placed, probably the Com­ missioner of Water Works

None specifically defined.

j ..

Matter of judgment pro­ oa oly on part of Director of Chemistry

Western Australia.

Where a. Water Supply

comes under one of the Water Authorities spec­ fled in No. 6, then such Authority has power;

otherwise, power

to Health Authorities

No specific Authority. but general authority under Health Act

The respective Water

Authority, subject only to the limited power

given to the Health Com­ miS'sioner and Local

Health Authorities to close polluted supplies , IP ,

u , ..

TaSDlM;ll&.

(a) Local Authority and

Public Health Depan­ ment (b) Public Health Depart­ ment paramouni

Local Authority and Publio Health Department

,

, u "

In new supplies the Public Health Department. In long-established suppliea (?}

Local Authority and Public Health Department, which is paramount under or­ dinary circumstances. In

case of serious water­

borne diseases, certainly the Public Health De­

pa:rtment

co Ot

P-1 w w

Who is officially responsible in the State- continued. 13. F or foreseeing the need for reservation and resump­

tion of catchment areas which must come into

future use, and for t aking appropriate action

14. For exercising a control with reference to condi­ tions of furnishing, of

storage, and of handling over the quality of drink­ ing water furnished-( a ) on trains and in rail­

way restaurants (b) at hotels which do not draw from the Municipal Water

Supply

(c) on board ships in

Australian waters

15. For exercising a control over the quality of water for domestic use in rural areas not furnished with a

public supply

Sewemge.

Who is officially responsible in t he State-1. For determining that any communiby shall be pro­

vided with a sewerage sys­ tem

2. For determining that any community shall have ex­ tensions or changes made in its sewerage system

3. For the preparation of plans for sewerage works

4. For the approval of plans of sewerage works

New South Wales.

Department o£ P ublic

Health and Railway

Commissioners Department of Public

Health and local Coun­ cils (?)

Department of Public

Health and local Coun­ cils

In the Metropolitan,

Hunter and Grafton Dis­ tricts, the Minister for Works. Outside these Districts the local Coun­ cils

The Minister for Public

Works, Boards, or Coun­ cils, as the case may be

R:ms:PONSIBILITY FOR VARIOUS. PHASEs OF SANITARY ENGINEERING W aRK-continued.

Vktoria.

Very partial control only by Governor-in-Council (aerat ed waters and co r­ dials)

Very partial control by

Commission of Public H ealth in respect of water supply of buildings occu­ pied by cow-keepers and dairymen ; also by Coun­

cils

Local Authorit y (Council or Trust,)

Local Sewerage Authority

State Rivers and Water Supply Commission, Commission of Public Health indirectly and in advisory capacity

Queensland .

Brisbane, the Metropolitan Water Supply and Sewer­ age Board ; country towns, the Local Authority

The Commissioner of Public Health exercises a genern,l cont.rol over all water used for domestic purposes

Country areas, Local Autho­ rity. Brisbane, Metropoli­ tan Water Supply and

Sewerage Board

On loan money, Treasurer. On loan money without a poll, Commissioner of Pub­ lic Health and Minister of

Public Works

South Australia. Western Australia.

None specifically defined. l None . .

Commissioner of Water Works exercises this func­ tion to a certain extent

(a) R.ailway Commissioner responsible for the fur­ nishing of water on

t rains and refreshment rooms . No respon­

sibility stated re quality (b) No responsibility speci ­ fi cally stated (c) Director-General of

Health for Common­ wealth

Local Board

Co mmissioner of Sewers in Metropolitan Area and in Special Sewerage Districts

(a) Commissioner of Rail-ways (b) Local Health Authori-ties (c) Navigation Authority

(Federal)

Health Authorities

None . .

None -·

Tasmania.

Local Authority

(a) Local Authority and

P ublic Health Depart-ment (b) " .. ..

, (c) .. ..

Local Authority and Public Health Department

Local Aut horit y

Public Works ·Department, where money loaned by Government ; also Public Health Department

00 0')

RESPONSIBILITY FOR VARIOUS PHASES OF SANITARY ENGINEERING WORK-continued.

-- New South Wales. I Victoria. I Queensland. I South Australia. I West;em Australia. I Tasmania. --·-· I I Sewerage-continued. Who is officially responsible in the State-continued.

5. For oarryffig out construe·! The Mmister for Pnblie I Local S.werage Authority I Country areas, Looal Commissioner of S.wers in I Outside the Metropolitan I Loeal Authority tion work Works, Boards, or Coun- ity. Brisbane, Metropoli- Metropolitan .A,rea and in Area, Local Health

cils, as the ca.se may be tan Water Supply and Special Sewerage Districts. Authorities

6. For operation and main­ tenance of work

7. For the control of surface drains

8. For prescribing the details of plumbing and house connexions-(a) In sewered areas not

under the juris­ diction of the

Metropolitan Boards

Used with small sew­

age tanks or

" septic " tanks

for residences, hotels, &c.

9. For inspection of works with reference to condi­ tions which may affect the public helath

10. For the examination of the characteristics and quality of sewage and sewage ef-fluents

11. For determining the need for treatment of sewage

Water or Sewerage Boards or local Councils

,

Se" enge Board

ot

Municipa,J Councils

Local Councils, subject to. ,. (a) Local. Sewera.ge Autho- I· (a) Looal Authority Ordinances of Local Go- rities

vernment Act 1919

Department Health of Publio (b) Municipal Councils

Governor-in-Council on recommendation of the Commission of' Public Health

(b)

Local Authority and Commis­ sioner of Public Helath

Local Board, with Cenvral Board- having concurrent jurisdiction. Commissioner of Sewers for those com­ munities connecting with sewerage systems

(a) None specifically stated

(b.) Lo cal Board of Health, with Central Board of Health concurrent juris­ diction

Commissioner of Sewers in Metropolitan Area. Local Board of Health or Central Board of Health

.. .. " Sewerage Authority . ·1 Loeal Authority .. ... I None specifically stared. 1 Commissioner of Sewers I does some of this

.. J , ., :;. "' .. ., .. '"I "

, .. I'

I I !

Loca.) Health Authorities

..

In the Metropolitan Area, the controlling engineer of the Metropolitan

Warer Supply Depart­ ment, subject to inter­ vention by the Public Health Commissioner if conditions exist which may cause a nuisance

.. , rr

. , " , ..

(a) Local Authority, Cor· poration of Hobart ; Corporation of Laun­ ceston (b) Local Authority and Pub­

lic Health Department. All septic tanks are

subject to approval

by Public Health De­ partment

Local Authority and Public Health Department

,,

00

.....

00 (.]l

tin ued.

Who is offici-a.lly responsible in the State-continued. 12. For determining what

means shall be taken for the treatment of sewage

13. For the definition, of re­ quirements- as- to quality and q uantit;y of· sewage or sewage effluent discharged into a body of water

14. For enforcement of those requirements

III. Night -soil Disposal.

Who i&wfficially _responsible ia the State'-1. For determining that any community shall be pro­

vided with facilities for the systematic collection and disposal of night-soil

2. For decision as to the

methods, to be used

3. For the preparation of plans i] any are required

4. For the approval of plans and methods to be used

5. For operation and main­ tenance of the service

6. For definition of the require­ ments which the service shall meet

:New South Wales.

Public Works Department and Department of Pub­ lic Health, in combination

Department Health of

,

Public

Local Council, under super­ vision of Department of Public Health

Department of Public

Health.

"

Local Councils ..

Department ·of Public

Health and Local Go­ vernment Department

RESPONSIBILITY FOR VARIOUS PHASES OF SANITARY ENGINEERING W ORK-contin'iUd.

Victoria.

Sewerage Authority. The Commission of Public Health in case of outfall into sea

The Governor-in-Council on recommendation of the Commission of Public Health

Already determined by Par­ liament in case of " any city or town." Com-

missioner of Public

Health may determine it in case of borough or

, shire

The Commission of Public Health as regards col­ lection, the Governor­ in-Council as regards dis­ posal (optional) ( ?)

(?)

Queen l>land.

Local Authority

Governor-in-Council by Order in Council. Commissioner of Public Health

Commissioner Health of Public

The Local Authority may. If required by the Commis­ sioner, it shall

Commissioner of Public

Health

Local Authority

South Australia.

None specifically Commissioner of does some of this

stated. Sewers

.,

Local Board of Health

Commissioner Health of Public I Central Board of Health. Ad­ . vice, inspection, direction

in certain cases

The Council of every city I Local Authority or contractor or town, and, in certain Local Board of Health in case of complaints circumstances, of every · borough· or shire

The Governor-in-Council Commissioner Health of Public Local Board of Health,

Central Board of Health

Western Australia.

In the Metropolitan Area, th('l controlling engineer of the Metropolitan

Water Supply Depart­ ment, subject to inter­ vention by the Public

Health Commissioner if conditions exist which may cause a nuisance

None ••

The Local Health Author­ ity, or,in event of failure, the Commissioner of

Public Health

,

"

,

"

"

"

,

Tasmania.

Local Authority and Public Health Department

Public Health Department and possibly Marina

Board; former paramount

Local Authority and Public Health Department

"

Local Authority

Public Health Department

Local Authority

Public Health Department

00 00

Ill. Night-soil D·isposaT:­ continued.

Who is officially responsible in the

7. For inspection of the service with refe·rence to conditions which may affect the

health, safety, and con­ venience of the community

8. For the enforcement of such req ui'rements

9. For exercising control which will prevent seepage from a night-soil depot polluting a public water supply

IV. Poll'ution of Natural Waters.

Who is officially responsible in the State-l. For securing and recording information regarding

physical conditions of natural waMrs which liave a direct relation to the

problem of pollution of these waters, such as'--(a) Volume of stream flow- maximum,

minimum, and average

New South Wales.

Department of Public

Health and local Coun­ cils

, , ,

, ,., ,,

(a.) Water and Sewerage Board, Water Conser­ vation and Irrigation Commission

(b) Frequencyanddura-1 (b) tion of various

small flows

(c) Volumes and Ievels of tidal move­ ments in ·tidal

estuaries

Navigation Department .•

2. For securing and recording j Local Councils, Public information regarding all , \Yorks Department, Pub­ discharges of liquid wastes · lie Health Department into natural waters, their

quality, and

quantity

RESPONSIBILITY FOR VARIOUS PHASE(OF SANITARY ENGINEERING WORK-continued.

Vic!torla.

The Municipal Council, but possibly the pistrict

Health Officer, under the Chief Health Officer

1

The Council, or, in default, the Commission of Public Health

1 The Commission of Pu blio

\

Health or the Council

\

Possibly the Commission of Public Health, but

very great doubt, as

terms of Statute are very general

(a) State Rivers and Water Supply Commission

(b).

(c) (?) ••

(?)

I

I

Queensland.

Local Authority, Inspector and Officer of

Health.

South Australia.

Local Board lfo£ Health. Central Board supervisory

Western Australia.

'l'he Local Health Author­ ity, or, in event of failure, the Commissioner of Public Health

Local Authority .. •. ) Local Board of Health. I The, Commill8ioner of Pub· j

Central Board of Health lie Health

Prohibited ..

.. .. . .

· · I No known cases in South Aus- I " tralia. Local Board would act ; Oentral Board I

concurrent

'l

specifica.lly st&ted, but I None . .

Commissioner of Water Works does some of this

None specifically stated, but Commissioner of Water ' Works does some of this on catchment areas

None . .

,

"

I

I

I

Taamani14

Local Authority and Public Health Department

" "

. ,

" " "

'

(a} No specific authority

(b)

"

(c) Marine Board

No Authority specified, but within the domain of Local Authority

00

t-1

-..J

-- New South Wales.

TV. Pollution of Natural Waters--continued.

'Yho is of!icially responsible in I

in the State--continued. I

:

3. For determining whether an Department oi. P ublic existing dischargeofliquid Health and Water and wastes should be per- Sewerage Board (prac.

mit t ed to continue, or

whether it should be sub. tically none permitted)

jeoted to suitable treat·

I ment

4. For determining whether a Department oi P ublio prospective new discharge Health and Water and of liquid waste should be Sewerage Boa.rd permitted 'ffithout treat-

mentor whether treatment should be required

I i !

5. For determining what me!llllS Department of Public shall be adopted for the Health

treatment of liquid wastes

' if required

6. For the preparation of plans Public Works Depart,menlo, if required for the treat- Water and Sewerage

ment of liquid wastes Board

7. For the approval of such Department oi Public

plans Health and Public

Works Department con-jointly

8. For carrying out construe-tion work :. n accordance Public W orks Depm-t.ment, with such plan

9. For operation and main- Local Councils .. . .

tenance of such works

l 0. For inspection of industrial Department. of Pu.blic wastes and of works for the Health; Watei" and

treatment thereof and of Sewerage Boards waters into which such wastes flow, with reference to conditions which may affect the health, safety a.nd convenience of the community

R:&SPONSIBILITY li'OB. VARIOUS PHASES OF SANITARY ENGINEERING WORK-continued.

I

Victoria. Queen•land. South Australia. Western Ans t.ralis.

I

and Water Governor . in . Council, by Local Board re nuisance. Cen- The Looa.l Hea]t.h Authority State Rivers Supply Commission Order in Council tral Board or Commis-

' and Commissioner of sioner of Water "Vorks re l Public Health pollution of water supply. 1 i Irrigation Commission rP. i of streams "

. , , .. . . . . .. Local Board. Central Boa.rd The Stare Department of

might act under Health Health, if approached by Act , but no procedure t-ht> individual conc-erned e.xists for assuring that all cases of pollution will be

brought t.o official atten-tion. The spirit of enforce-ment is remedial, not pre-,-ent.i,·e. Also aims to put onns entirely on individuai

(?) .. .. .. Governor.in-Counctl, by None .. . . . . I The Stat.t> Department of

Order in Council Health

I

(?) .. .. . . Private owners or the Local .. . . .. . . Pri>a.te en!,oi.neers . .

Authority, as the ease may be

.. I

!

of I (?) .. .. .. The Local Authority .. . . . . .. \ St ate Department

I Hea.lth

I j.