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Dr. Blackmore thought that the institution for advanced cases should always be as near as possible to the chief centre that had to be served; otherwise patients would not go to it. Advanced cases should be encouraged to go to an institution of that kind to prevent them from spreading the disease amongst others, he also considered —for economic and administrative reasons, as well as in the interests of the patients —that the home for such cases should, whenever possible, be under the same administration as the sanatorium. If the institutions were under the same management cases could be transferred from the one institution to the other as appeared necessary. In his opinion, where a sanatorium was in the immediate neighbourhood of the town, it would be advisable to erect the institution for advanced cases in connection with it, but where the sanatorium was far removed then the institution for such cases should be in the immediate neighbourhood of the town. The only alternative suggestion he had to make was that, when the sanatorium was far removed from a centre, the advanced cases should be treated in the same place as other infectious diseases, and dealt with by the officer who was in charge of such an institution, though he did not think this altogether satisfactory. Dr. Lewis indorsed Dr. Blackmore's remarks with regard to the disinclination on the part of those patients in advanced stages of the disease to go any great distance from the towns for treatment. Dr. Blackmore moved, That in the opinion of this Conference it is advisable, where sanatoria are in the immediate neighbourhood of our chief centres, to erect institutions for advanced patients in connection therewith; but where the sanatoria are far removed from the centres the best means to provide for advanced cases would be by special institutions, to be erected as near to the chief centres as possible. Carried. It was agreed that in smaller places different arrangements would have to be made, such as the erection of annexes, &c. In reply to a question by Dr. Frengley as to the objection to consumptive cases being treated on the hospital grounds, it was stated that the chief reason was that in a general hospital they were looked upon as perfectly hopeless cases, and nothing much was done for them; but if they were put in institutions such as were suggested the patients were looked after by the medical officer in charge of the sanatorium, and thus got a much better chance. As a result of a discussion as to whether it was considered that actual danger resulted to other patients if cases were treated in general hospitals, the Conference agreed that the resolution in favour of separate institutions was passed in the interests of patients, and not from the view of there being any danger to patients suffering from other forms of disease, &c. Further discussion on this subject was deferred until later. The Chairman stated that as a general principle the Conference had decided that it was necessary to increase the accommodation for consumptives to 700 and he asked for an expression of opinion as to whether it would not be better to have the bulk of this accommodation erected in conjunction with our existing accommodation rather than have institutions dotted all over the country. In agreeing with a suggestion made by Dr. Blackmore to the effect that it might-be advisable to have one sanatorium for each Island —each local body to look after its own advanced cases — the Chairman pointed out that one great difficulty in the way of this would be the extreme parochialism so characteristic of New Zealand towns and townships —they would not combine. Then there was the difficulty, already referred to, with regard to the advanced cases objecting to go any distance away from their relatives. Dr. Blackmore advocated compulsion being put on local bodies to combine for the purpose of dealing with consumption in the best manner possible. The Conference was of opinion that the extra accommodation required should be erected in conjunction with existing sanatoria. After further discussion the following recommendation, moved by Dr. Frengley and seconded by Dr. Finch, was carried : That every Hospital Board in the Dominion that has not a special institution or institutions for consumption under its control should provide at its hospital or hospitals suitable, sufficient, and comfortable accommodation, by way of hospital annexes or otherwise, for the reception and treatment of consumptives in any stage of the disease, and until such time as the Medical Superintendent is of opinion that such patients can be treated with more advantage at special institutions suitable to the patients' condition. In moving this Dr. Frengley stated that he thought such a step was necessary because of a tendency on the part of Hospital Boards —in the past, not so much now —to regard consumptive patients as a danger, and an emphatic statement such as was suggested would remove the objection some Hospital Boards had with regard to putting up accommodation for consumptives in connection with their institutions. In connection with the question of limiting the number of sanatoria, Dr. Finch raised a point as to the effect on patients returning to a rigorous climate after having received treatment in a milder one. Dr. Lyth did not think that climatic conditions need be taken into account to any serious extent; it depended much more on the suitability of a patient for treatment. Proposed by Dr. Blackmore and seconded by Dr. Hardwick-Smith, That the multiplication of sanatoria is not desirable, because sanatorium treatment cannot be carried out to the best advantage in small institutions. At the most two sanatoria should be sufficient to serve the interests of each Island. Carried. The Conference was of opinion that it would be advisable to have resident medical officers at all sanatoria, and the following resolution was moved by Dr. Makgill and seconded by Dr. Lewis : That the sanatoria be of sufficient size to warrant the appointment of a Medical Superintendent in charge, whose duty shall be limited to the control of the institution and such duties in connection with the treatment of tuberculosis as shall be decided upon. Carried.
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