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H.—3l

Another point which is of the greatest interest from a preventive point of view is the almost universal recognition by all and sundry of the infectivity of consumption. Now that it is recognised that the disease is spread, principally through the agency of the billions of bacilli which are daily coughed up by the sufferer from consumption, the sphere of action—the arena, so to speak—is more defined, and consequently it becomes easier for us to defend ourselves. The inclusion of consumption amongst the list of notifiable diseases is an important step in the right direction, because through this we are enabled to gauge accurately the number of cases which yearly occur in the colony ; and, most important of all, we are empowered to require every landlord in whose house a person suffering from consumption has lived to have it properly disinfected before it can be relet to another tenant. It has come to the knowledge of this department that cases have occurred where, through the non-disinfection of rooms which had been occupied by persons suffering from consumption, tenants have contracted the disease. Under the new law this evil will be greatly lessened. I look upon this as one of the most important weapons granted us with which to combat the spread of the disease. Another point which is worthy of the most serious attention of the Government is the great number of people suffering from consumption who yearly land in the colony in the search after health. It has been urged by some that we ought to exclude every one suffering from consumption. This attitude has the support of many, but I think in most cases it comes of ignorance or nonappreciation of the true facts of the situation. If the colony were.as free from consumption as it is from small-pox or rabies it would still be a matter for careful consideration as to whether it is wise—reckoning on the lowest of bases, namely the monetary one —to prohibit the sufferers from incipient phthisis, who are able to pay for their keep and attendance, from coming to New Zealand in order to avail themselves of the benefits of our climate. Viewed from the point of international equity, it seems to me it would be as unfair as it would be unchristian to deny any fellow-creatures the privilege of sharing the beneficent effect of our climate. On the other hand, there need be no hesitation whatever in pointing out to the world at large the unfairness to us, as well as the inhumanity to the sufferers, of consigning a person in an advanced stage of consumption to the irksomeness of a long sea-voyage, and the divorcement from all he holds dear, in the vain Will-o'-the-wisp pursuit of the recovery which can never be his. But, when we add to this impossibility of cure the fact that the sufferer is next door to penniless, there need be no hesitation on the part of the State to interfere and say, " We shall not permit the importation of such unfortunates." Any medical man in practice in the colony could, from his case-books, collect many cases of people who when they landed had no possible chance of recovery, and the only part of New Zealand they ever saw was the inside of a ward in a general hospital. That the exclusion of such cases can be justified on humanitarian as well as economic grounds I have not the slightest doubt. Another point, more perhaps pertaining to the outside world than to ourselves, but still sufficiently proximate to justify our paying it attention, is the indiscriminate way in which the sick and the hale are mixed up on board ship. Picture, for example, the condition of affairs on board, say, a sailing-vessel, which invites first-class passengers desirous of availing themselves of the recuperating effect of a long sea-voyage. One such ship I knew well. Of the ten saloon passengers three were suffering from phthisis in an advanced form, one was a dipsomaniac, and one was practically insane. All the cabins, in addition to the two water-closets, ventilated into the saloon. Two of the passengers were perpetually surrounded with an atmosphere of creosote and its allied smells. Cabined with one of these sufferers, who was constantly expectorating large quantities of the tubercle bacilli, was a gentleman who was travelling because of a bad family history and a slight sore throat. Had he of his own free will wished to select an experiment whereby his power of resistance to tuberculosis could be determined, I can honestly say he could not have chosen a better set of conditions. Constant companionship in a close stuffy cabin with a man suffering from consumption, coupled with the disgust and consequent want of appetite owing to the inhalation of second-hand creosote, were just that congeries of factors which would try a man's power of resistance to that disease. The abolition of such conditions—the precluding of the possibility of such sources of infections—is, I consider, justly within the range of practical politics. Sanatoria. While I have dwelt at some length on the removable factors of consumption, and while prevention is indeed better than cure, it is certainly not both. The purely medical treatment of consumption is now almost a thing of the past. The recognition of the great value of fresh air, sunlight, and judicious feeding have replaced the hundred-and-one vaunted specifics for the disease. The so-called open-air treatment has almost universally been adopted. I must not be taken to mean by my insistence upon the value of fresh air and sunlight that drugs ha\e no place in the management of such cases; in all cases of consumption they have a value, but whatever value they may have is greatly enhanced by the conjunction of plenty of fresh air. The establishment of sanatoria for the treatment of consumption has, on the Continent of Europe and in America, been accepted as a legitimate tax upon the general public, and I think justly so. Becognising, as we must, that tuberculosis is a common disease among our people, and bearing in mind the great infectivity of the disease, it profits us from every point of view to, firstly, use every means in our power to prevent its spread; and, secondly, to adopt the best and cheapest method of curing those who are suffering from the disease. There are in New Zealand many situations where such institutions might be erected with the greatest possible benefit, but 1 would suggest that we move with caution in this matter. For that reason I recommended that a sanatorium capable of accommodating twenty males and twenty females be established by way of experiment. Bearing in mind the beneficent effects of fresh air