18th Parliament · 2nd Session
The President (Senator the Hon. Gordon Brown) took the chair at 3 p-m., and read prayers.
page 759
– After living in a rented house for nineteen years, a returned soldier of “World War I., with a wife, two single sons, who are returned soldiers of World War II., and three other children, has been evicted by a returned soldier of World -War H. with a wife and one child, who bought the house from the owner. The evicted tenant had no more protection than an ordinary citizen under the Landlord and Tenant Regulations, and apparently the two returned soldier sons had no special claims because they were single and were not the lessees of the premises. I ask the Acting Attorney-General whether special provision could be made to cover similar cases in the future?
– As: the honor* able senator is doubtless, aware, the National Government considered that it still1 owed’ a duty to ex-servicemen and their dependants even after- it. handed aver to the States the administration of the landlord, and. tenant regulations, including the control of rents, and for’ that reason, it retained power to protect the rights of ex-servicemen and their dependants under the Landlord and Tenant Regulations.. My impression, without referring to the moratorium regulations, is that they apply not only to ex-servicemen of World War II., but also to those of World War I. ‘ However, I shall ascertain the position by referring to the: regulations, and- if they disclose any apparent injustice I shall take action to remedy it. I appreciate the difficulties which confront a tribunal which has’ to discriminate between the relative merits of ex-servicemen of the two world wars, and’ I should, think that the only criterion which a tribunal could apply in such circumstances would be to decide in favour of the ex-serviceman who appeared to be suffering the greater hardship in the particular instance. If the honorable senator will be good enough, to let me have particulars of the case to which he referred I shall inquire into the matter with a view to remedying any injustice. ~-
page 760
– In view of recent statements in the press- that Great Britain is. re-arming; and that grave difficulties have arisen in. Europe, will the’ Minister representing the- Minister acting for the Minister for External Affairs make a statement to the Senator oil- the course of the recent negotiations in’. Berlin, and’ on the present, situation in Europe- generally!
– I’ have had several’ discussions- with the Prime Minister in regard to the difficulties which have- arisen in Europe’ because of the -situation in Berlin, but I should not like to make a’ statment on the’ subject, without further reference’ to’ him. If it’ is practicable to’ make a statement on- the matter that’ will be- done in; the- near future. communism:
– T preface * question to-the-Minister for- Shipping and Fuel by directing his attention to a front-page story which appeared in. the Sydney Morning: Herald of the 13th September, in which the South, African Minister for the Interior, Dr. Donna is reported to have revoked the passport* of. two Communists who were, proceeding to the United Nations- Assembly in Paris. Dr. Donges is reported to have said thai the two Communists had “ a record of persistent law-breaking. - and un-South African activities at home and’ abroad, because of which the Government wa.<not prepared to accord them the privilege of the protection of Union passports “. In view of the firm action- taken by the South African Government, which is a member of the British Commonwealth, -will the Government consider adopting a similarly firm attitude and refuse to issue passports to known. Australian law-breakers, whether or not the are Communists, who seek leave- to travel overseas on missions- which are calculated to. damage Australia’s prestige? .
– i have, not seen the newspaper report referred to b? the’ Deputy Leader of the- Opposition. This Government has been elected bv a majority vote of the people, and determinations relating to the issue of passports can safely be left- in its’ hands. Obviously a’ government which successfully conducted, negotiations- in connexion with the conduct of the war, will be able to handle efficiently such matter? for the benefit of. the people during peacetime. i therefore suggest to the honorable senator that the matter of the issue of passports, or any other1 provision for the- safety of. this country, is one entirely for the Government, and is in capable hands.
– Has the attention: of. the Acting Attorney-General been drawn to a statement by the- Acting Premier of”. Queensland, Mr; Gair, tha* he. would refer, to the Prime Minister the traitorous comments, made by. the Queensland Communist Burns; If so, has- the Government’ received any, such representations from Queensland? What action is it; intended- to- take: against. Burns %
– No communication from the- Acting Premier of Queensland Has come to my notice, although it may have reached, the Prime Minister., t have given, consideration to the matter. [ received a1 report on the subject yesterday, and, moreover, I made a decision on it yesterday, hut I do not propose to announce- that decision- tar at few days,, for very good reasons.
page 761
– Will, the Minister, for Social) .Services inform the Senate what amount’s will be- refunded to Tasmania for the years- 1946-47 and 1947-48; including all social services payments.
– As the- honorable senator will realize- I have not- theinformation immediately available, but 11 4hall communicate it to. him>. as, soon. as. possible
page 761
– Will the: Minister for Social Services statewhether it is’ a fact- that overseasborn widows of ex-servicemen, are not entitled to- widows’ pensions, if: their husbands- die- from- causes- other- than theresult of war service, unless they have resided in, Australia, for five, years.?” If io, will the Minister take steps to overcome that anomaly as it now applies to such widows, to bring them into line with Australian, born, widows of exservicemen ?
– I have some recollection of having supplied an answer to a question in somewhat similar terms within the last few days. I forget whether I answered that question in the 3enate. As I have not exact details of she answer immediately available, I shall inquire into the matter and let the honorable senator have, a., reply, as: soon us possible,
page 761
– Can the PostmasterGeneral indicate what progress has been made in the provision of a post office and departmental residence in the- township of. Tullah.. Tasmania.?,
– I have not the information, available at the moment. I shall supply it to the. honorable senator as. soon, as possible.
page 761
– I ask the Minis:ter for Social Services whether any special benefits, other than, the- ordinary? pension, are paid to tuberculosis- sufferers, who- are compelled, to. enter- sanatorium?for treatment?:
– Under the Tuberculosis Act of 1945, as amended in1’946, the Commonwealth makes available the sum of £250,000 per annum for the purpose indicated by the honorable sena tor.. That money is made available with the objectives, first,, to persuade sufferers, to cease- working, in. order to, undergotreatment,, and,, secondly, to- ensure* that their dependants,, who ha.ve- been in close contact with: them,, shall be given, sufficient nutrition: .and that, their family ; shall be relieved, of the financial worry which usually arises in such, circumstances;. Those- payments have been effected through; the States- during thelast two years-, and” a measure now beforethe Senate- deals; with that particular matter in. another; way:.
page 761
– On the 15th September, the Deputy Leader of the Opposition: (Senator- O’Sullivan)’ asked questions regarding a- communication sent to. the Council of Foreign Ministers by the Australian. High Commissioner in. London concerning Italian colonies. The Prime Minister has advised me that he has looked into the matter and’ desires me to inform, the honorable senator that, in sending a» telegram to the Council, of Foreign Ministers requesting- that a report of the Ministers’ deputies should be transmitted to all interested governments and that the Australian Government should be given the opportunity to present its views direct to the council, Mr. Beasley was acting on the instructions of the Minister for External Affairs. The procedure adopted in sending this communication was the same as on previous occasions when the Government has communicated with- the- Council of Foreign Ministers or the deputies on. the subject of the Italian colonies. Those previous communications were also sent by Mr. Beasley on the authorization of the Minister for External Affairs. The Australian Government has received no formal reply to this communication to the Council of Foreign Ministers. It is understood, however, that no interested government other than the four major powers were given the opportunity to present their views to the Council of Foreign Ministers. The views of the Australian Government, however, were presented to the deputies of the Foreign Ministers during the meeting which preceded the Paris session of the Council of Foreign Ministers, [n authorizing the sending of this telegram, the Minister for External Affairs has followed the consistent policy of ensuring that our views on questions on which we have earned the right to speak shall be given full consideration. Australian forces made an important contribution to the allied victory in North Africa, and it is only right that full weight should be given to Australia’s views on the former Italian colonies in that area. Since the Council of Foreign Ministers has not reached an agreed solution, the whole question will come before the General Assembly for a recommendation.
page 762
asked the Minister representing the Minister for Commerce and Agriculture, upon notice -
– The Minister for Commerce and Agriculture has supplied the following information: -
The Commonwealth Government was approached by the Premier of Tasmania, Mr. Cosgrove, in respect of marketing the 1948-49 Tasmanian apple crop. Mr. Cosgrove stated chat the Tasmanian Government desired a voluntary pooling arrangement, provided, that SO per cent, of the growers participated, and that it would provide legislation necessary to enable the Australian Apple and Pear Marketing Board to market, the crop, with advances payable on a basis similar to that of the 1947-4S season. He asked if the Commonwealth Government would agree to make the State a grant equal to the amount of any loss incurred by his Government under its guarantee. This proposal was examined by the Government in the light of the fact that, due to shipping and other difficulties, the Tasmanian export apple and pear tradehad not returned to norma). I made a recom’mendation which the Government adopted and submitted to the Tasmanian Government. It was informed that, subject to (o) enablingState legislation, (6) agreement on details including Commonwealth approval of the formof contracts with growers and (c) limitation of the scheme to the season 1948-49 only, theCommonwealth would make a grant equal’ to the amount of any loss in which the Tas manian Government would be involved by reason of its proposed guarantee to Tasmanian apple-growers. It was stipulated that theguaranteed payment to growers, in respect of which the Commonwealth would reimburse the Tasmanian Government for any loss, would be at the same base rates as were advanced od apples and pears this year and would not takein to consideration any additional paymentswhich might he made this season as a result of a surplus on the pool operations. Should a profit he made on the 1948-49 pool, however, it would be distributed to growers as in thecase of 1047-48 pool. This proposal wataccepted by the Tasmanian Government, and: the plan is expected to operate in the next season. In view of the fact that Western Australia’s apple and pear export trade itsimilarly circumstanced I can undertake that the Commonwealth Government would sympathetically consider a request from theWestern Australian Government for applies tion of n plan on the lines to operate inTasmania.
page 762
PASTORAL Leases.
asked theMinister representing the Minister for tb> Interior, upon notice -
– The Minister for the Interior has supplied the followinginformation : -
Vestey’s have agreed to surrender approxmately 9,000 square miles from their leases, subject to certain conditions. Negotiations an-. still in progress. If the negotiations are successful it is intended to make the surrendered areas available for new settlers. The Legislative Council of the Northern Territory recently passed an amendment of the Crown Lands Ordinance providing for the establishment of a land board. This legislation has not yet been brought into operation, but will be examined as soon as copies are received from the Administrator. Ordinances in relation to Crown lands must be reserved for the GovernorGeneral’s pleasure. If the ordinance is assented to, steps will be taken immediately to create the land board.
page 763
asked the Minister representing the Minister for Transport, upon notice -
In view of the representations made, and recent consultations which have taken place between the Minister for Transport and Labour members from South Australia, relative to the northsouth railway, and the urgent need for the Government to improve the railway service from Leigh Creek to provide for the transport of a greater tonnage of coal necessary in the interest of South Australian industries, will the Minister inform the Senate of the result of the representations made and the intention of the Government to overcome the transport difficulties that now exist?
– The Minister for Transport has supplied the follow- ing answer : -
In response to repeated requests from South Australian Labour members, the Commonwealth Minister for Transport and the Minister for the Interior have agreed that the work of converting to standard gauge or re-locating on standard gauge that section of the northsouth railway between Leigh Creek and Port Augusta and Adelaide, needs urgent attention to cope with the present and future coal traffic from, Leigh Creek, and they have approved of an immediate preliminary survey being carried out to determine the correct route. When this has been done it is proposed to proceed with the construction of this line and the work upon the lines in the Peterborough division as the first phase of the general plan to convert South Australian railways to the standard gauge.
page 763
Secondreading.
Debate resumed from the 22nd September (vide page 640), on motion by Senator McKenna -
That the bill be now read a second time.
– On behalf of the Opposition, I have pleasure in commending the general prin ciples underlying this bill. Any legislation which has as its object the alleviation of suffering and the arresting of disease will naturally receive most cordial support from this side of the chamber.I regret that in the short time that has been available to me since the introduction of this bill, I have not been able to carry out the investigation and research that such an important measure warrants. However, it is gratifying to know that the bill is founded substantially upon the suggestions and recommendations of the Commonwealth Director of Tuberculosis, and, in general outline, meets with the approval of the various State Departments of Health and the State Premiers.
There are some phases of the bill on which I should like information. In his secondreading speech, the Minister for Health (Senator McKenna) said -
The Commonwealth will bear also the whole cost of the maintenance expenditure of the States approved by the Commonwealth in excess of the net maintenance expenditure incurred by the States in the diagnosis, treatment, and control of tuberculosis in the financial year J 947-48.
Sub-clause 4 of clause 5 reads -
For the purposes of this section, net main tenance expenditure by the State in any financial year shall not include any payment by that State by way of allowances to, or in respect of, sufferers from tuberculosis and their dependants. . . .
Yet clause 9 provides that allowances shall be payable to “such persons or classes of persons, subject to such conditions and in such manner as the DirectorGeneral, subject to the direction of the Minister, determines “. I ask the Minister to indicate in his reply to the secondreading debate whether the. States themselves may continue to make allowances to sufferers from this disease or whether the payments are to be distributed by the Commonwealth. If the implementation and administration of this measure is to be left to the States as it properly should be it is highly desirable that the States should not be hampered in any way in determining who shall receive allowances, and the terms and conditions under which allowances shall be paid. I may be quite wrong, but it would appear from sub-clause 4 of clause 5, and clause 9. that the Commonwealth wishes to retain completecontrol over, the payment of the allowances and will itself determine howthey shall be paid and towhom theyshall be paid. I submitthat ifthe administration of the scheme is tobe left to the States, powerto make such determinations will be vital to them. From my present reading of the measure, I take it that the States are not to be reimbursed by the Commonwealth for allowances paid bythem tosufferers from tuberculosis.
Although this is a highly commendable measure, I trust that it will notbe regarded as final and conclusive because the provision of hospitals and funds for the treatmentof the suffering sickI agree that we must do everything humanly possible to amelioratetheir conditions isnot sufficient. More important is theeradication ofthe causes of diseaseand, likethe Minister, I hope that we shall, in the processof time, eliminate the basic causes of tuberculosis by a general improvement of the standard of living and of working conditions. There is much truth in the old trite saying that prevention is better than cure. We look forward to the time when fewer and fewer hospitals will be necessary, because we shall have a more virile and diseaseresisting people.
I haveobserved the Minister’s remarks on the possible doubt about the Commonwealth powers to insist on compulsory notification of tuberculosis, and compulsory examination of suspected sufferers. It is gratifying to know that the States havepromised to introduce uniform legislation to maketuberculosis what in Queensland and in other places istermed a notifiable disease. If power to compel notification of the disease and the examination of suspected sufferers does not lie with the Commonwealth, it must reside in the States. In the prevention of the spread and the ultimate eradication of this disease, compulsory notification and examination wouldbe vital. Another matter with whichI should like the Minister to deal in his reply is the degree ofco-operation which is planned, or already exists, between the Repatriation Commission and the Director of Tuberculosis. According to this morning’s press there has been some discord at Concord, andthreesenior medical officers are reported tobe about to leave that institution, whichis conducted by the Repatriation Commission. Apart fromthe slightefforts made by the States to deal with tuberculosis, the only concerted attack which has been made on that disease has been made by the Repatriation Commission. It isof vital importanceto the whole community that the maximum co-ordination should exist betweenthe activities of the DirectorGeneralof Health, the Director of Tuberculosis and the Repatriation Commission. Proper co-ordination of those services would make available to sufferers the maximum. facilities and would eliminate unnecessary duplication.
Matters which affect She general health of the Australian people, including the prevention, treatment and cure of disease, should notbe the subject of party politics, and if the measures proposedby the Government to improve thehealth of the community and to arrestthe spread of disease are sound theywill receive the cordial support of members of theOpposition.
– I compliment the Government on the introduction of thislegislation, which isof vital importance tothe people of Australia. Fromthe statistics of the incidence of tuberculosis quoted by the Minister for Health (Senator McKenna) in his secondreading speech it is obvious that people generally are ill-informed regarding thedisease. The Minister stated -
In the year 1946, the latestforwhichdetails are available,tuberculosiswasresponsible for 27.6 per cent, of deaths from all major individual causes among people from 20 to 30 years of age. It caused more than twice as many deaths in this age group as did cancerand tumours, and exceeded by more than 50 per cent, the total of deathsfrom diseases of the heart and circulatory system among people of those ages.
Thosestatistics arereallyalarming and should convince even the most sceptical of the really terrible position whichexists. The Minister also pointed out that -
There are still between 30,000 and 40,000 known tuberculosis sufferers in Australia. Theremay be many thousands more unsuspected cases.Thedisease in someforms is highly infectious.
Itrust thatI amnot doing an injustice to previous National and State governments,but I cannot help feeling thatthe mertia of those bodies was largely respon- sible for the present disastrousstate of affairs. Whilstwe do notknow the approximate number of undiagnosed ases, we do know that a great fear of the disease exists in many people in the community, and even at the present time most peopleare extremely reluctant to associate in any way with persons suspected of suffering from tuberculosis. Whilst that reluctance may be a very good thing from the individual’s point of view, it is entirely wrong from the national viewpoint, and I commend the Government for the initiative and energy which it has displayed in coming to grips with this problem.
The Minister explained some of the constitutional difficulties which had to be overcome in order to deal effectively with the disease. He stated -
Commonwealth entry into this field of health legislation is made possible by the amendment of section 51 of the Constitution at the referendum in 1946, which conferred power on the Commonwealth to legislate for the provision of medical services.
Honorable senators realize that constitutional difficulties prevented the National Government from making any effort to deal with the matter previously, and I think that the existence of those constitutional difficulties is in itself a condemnation of the Constitution. Subclause 1 of clause 8 of the bill provides -
For the purposes of this Act there shall be an AdvisoryCouncil, which shall consist of a Chairman and such other members, not exceeding eleven, as are appointed by the GovernorGeneral .
But it does not state from what field the membersof the Advisory Council are to be drawn.Because the measure will operate throughout the Commonwealth, I suggest in all sincerity that not only should the members of the Advisory Council be chosen from amongst the most eminent medical authorities on tuberculosis, but also that general medical practitioners who have had special experience in the treatment of the disease in certain areas where its incidence is unduly high should be appointed to the council. There area number of general medical practitioners in the State of
South Australiawhoare known tome, but whose names I do not intend to mention because they are so numerous, who have had to contend with all kindsof difficulties for years. Iconsider that recognition of their splendid efforts should be made by selecting someof them for appointmentto the proposed council.
I am pleased that the measureprovides for payments to be made to sufferers from tuberculosisandtheirdependants. The Minister pointed out that many family breadwinners are deterred fromseeking treatment because they fear that their families will sufferwant if they have to enter hospital and remain there for ; a long course of treatment, and, furthermore, that such anxiety retards the patients’ prospects of recovery. The Government intends toremove that disability, and I trust that in the administration of the measure the compensation paid to sufferers and their dependants will not be niggardly.
With regard to the administration of the scheme, the Minister stated -
The States will continue to administer, control and utilize their existing organizations and facilities, expanding them to provide adequately for growing needs.
The Commonwealth will bear the cost, by reimbursement ofthe States, of all new approvedcapital expenditure of the States from 1st July, 1948, for landand buildings, furnishings, equipment and plant for use in the diagnosis, treatment and control of tuberculosis.Estimates in this regard alone for the current year approach £500,000..
That is very good. In that paragraph there is contained more real information to the people of Australia, and a more definite plan for combating this disease than has been advanced during all of the years that we have had responsible government in the State and Federal spheres, and I commend the Government for so generously covering allavenues of expense for the treatment of tuberculosis.The Minister also said -
It will be noted by honorable senators that this bill, by reason of doubt asto Commonwealth power, makes no provision to require the compulsory radiological or other examinationof the public,nor does it attempt to make provision for the restraint of recalcitrant infectious patients, orfor the compulsory treatment of persons suffering from tuberculosis.
Once again, at the risk of earning the displeasure of the Senate, I drawattention to the almost impossible position in which this Parliament finds itself because of the limitations imposed by the Constitution. I repeat what I have said on many occasions before in this chamber, that if we are to legislate truly in the national sphere there must be provided some means of approaching the people, free from party politics, which has crept into such matters on every occasion in the past, aided and abetted by vested interests. It is deplorable that a Minister in charge of a department should find it necessary, when introducing a bill designed to do so much for the health of the Australian people, to draw the attention of the Senate und of the people of Australia to the fact that because of a doubt as to Commonwealth power no provision can be made to do certain necessary things for the checking and treatment of disease. I hope we shall not he confronted with this unsatisfactory position for very much longer.
The Deputy Leader of the Opposition (Senator O’sullivan) said that he noted with pleasure the promise of uniform taxation in this connexion. I agree with the honorable senator that that is something from which we must all derive pleasure. If we are to judge the possibility of uniformity amongst the States in respect of this or any other legislation on their performances in the past I am afraid that we are doomed to disappointment. This matter is too important to the Australian nation for the Parliament to lack the power to do everything necessary for the health of the people. It is gratifying to see introduced a bill of such a comprehensive nature limited only by the Constitution. We ask only for the full co-operation of the States, which in the past has not always been freely given, ft is pleasing to note that this Government has demonstrated to the Australian people its honesty of purpose and sincerity concerning the welfare of Australian citizens. I support the bill.
. -I desire to add my commendation of the Minister for Health (Senator McKenna) and the Government for introducing this hill to further the battle against tuberculosis. With so much war-mongering and talk of war, and the rattling of sabres in other parts of the world, it is indeed a pleasure te see that the time of the Senate is being devoted to a measure designed to attack disease and ignorance. In Tasmania this battle has been going on foi a considerable time, and a certain f measure of success against the scourge of tuberculosis has been achieved. During the last twelve months no fewer than 92,000 people were X-rayed. There are 170,000 people over the age of fourteen years in Tasmania, and of those approximately 55,000 have submitted themselves voluntarily for X-ra;v by the mass radiography unit thai the State Government is operating At the present time the mobile unit is making a second tour of the State. Dur ing last year 170 cases of pulmonary tuberculosis were detected. Since so mam of the residents of Tasmania have agreed that compulsory examination of all people for tuberculosis should be carried om. that this first survey of the State should have shown such results is interesting. It is a tribute to the people who have been responsible for organizing the mobileunit
Agreement has been reached between the Federal Minister for Health (Senator McKenna), the former State Minister for Health in Tasmania, Mi. White, the present Minister for Health in that State, Dr. Turnbull, and the Minister for Repatriation (Mr. Barnard) to establish hospitals in both the north and the south of Tasmania, for the purpose of providing better treatment for tuberculosis sufferers. In Hobart, it iintended that a hospital capable of accomm oda ting 200 patients shall be erected. It will be built as soon as the necessary materials are available. The Minister for Repatriation has arranged for the construction, subsequently, of an annexe to that hospital containing twenty beds, for the treatment of ex-servicemen suffering from this disease. In Launceston, also, it is proposed to construct a hospital to accommodate 100 tuberculosis sufferers. Another sanitorium is to bi built in the north of Tasmania. Indeed. Tasmania now claims to lead the Com monwealth in combating this scourge.
I wish to make an appeal to the numerous interested bodies throughout Austraia to redouble their efforts to educate the people of this country as to the wisdom of submitting themselves for examination at chest clinics which have been established in the State Health Departments, in an effort to check the spread of this disease. Excellent work in this field is being .carried out in all States by the Apex Clubs, of which there are 53 throughout the Commonwealth. These clubs, as a contribution to the national welfare, have set themselves the objective of eradicating tuberculosis. I compliment them upon the wonderful work they have accomplished during the three years they have bad the eradication of tuberculosis as their national service objective. Last March, the Apex Club at Launceston conducted a public opinion poll, in which three questions were submitted. The first of these was, “ Have you been X-rayed in the last twelve months ? “ Of the answers to that question, 41 per cent, were in the affirmative and 59 per cent, in the negative. To the second question, Do you know that sufferers from tuberculosis are entitled to financial assistance ? “, 41 per cent, answered in the affirmative and 58 per cent, in the negative. To the third question, “Are you in favour of compulsory X-ray examinations for tuberculosis ? “, 91 per cent, replied in the affirmative and 5 per cent, in the negative, whilst 4 per cent, were undecided. Those figures tell their own story. However, the point I emphasize at this juncture is that the Apex Clubs are doing much to awaken the public to the necessity to attack this disease. The facts they have gleaned are most informative, and their campaign is producing good results. I am sure that the figures which I have cited will be of great interest to honorable senators. I trust chat the work being done in Tasmania in this field generally will be emulated in other States.
I am a member of the Northern Tasmanian Sanatorium Committee, which is a voluntary committee set up for the purpose of providing after-care for tuberculosis sufferers. That committee has directed its efforts towards providing amenities for convalescents, and at pre.sent it is making a drive for funds for the purpose of establishing a seaside convalescent home. Similar schemes could be undertaken in the other States.
The objective of the co-ordinated plan embodied in the bill is to focus the efforts of governments and the medical profession on this dread disease. Such cooperation on the Dart of the medical profession is most gratifying, and I am very hopeful that its members will co-operate in like manner with the Government in other fields of preventive and curative medicine. The bill represents, a frontal attack by the Government upon tuberculosis, which, as the Minister and other honorable senators have pointed out, affects to a particularly vicious degree the most prolific reproductive age groups. The measure is typical of the social services which the Labour party aims to provide in the interests of the people. It is our party’s objective to combat squalor, ignorance and disease. At the referendum in 1946, the people agreed to alter the Constitution to give to the National Government full power to embark on steps to achieve that objective in the field of health and social services. Measures of this kind afford proof that the people’s confidence in the Government has not been misplaced. I commend the Minister upon the introduction of this progressive legislation which, I believe, represents an important step towards our goal of entirely eradicating the disease of tuberculosis.
– I compliment the Government upon introducing this measure, and I congratulate the Minister for Health (Senator McKenna) upon his second-reading speech. I note with pleasure that this legislation is being initiated in the Senate. As I have said on previous occasions, much more legislation should be initiated in this chamber. The measure is of momentous importance to the people, and I was pleased to hear the Deputy Leader of the Opposition (Senator O’sullivan) endorse it. He indicated that legislation of this kind is above party politics. ] agree with the Minister that the maintenance of national health is one of the greatest tasks which could be entrusted to any government. I listened attentively to Senator O’Byrne’s remarks. He claimed that the Government of Tasmania was leading the other States L its attack upon tuberculosis. I regret that
I cannot’ dispute that claim on behalf “ of “Western- Australia. So serious has- the position become in that State: during” recent years- that a body known as. the- Anti-Tuberculosis League has been formed for the purpose1 of combating it.. The- Minister said that tuberculosis is one of the most serious of all diseases. At the same time, however, he pointed out’ nhat it is readily curable in its early stages. The disease, if treated early, can- be entirely cured, or at least rendered! harmless. I do- not expect that the Government will experience any opposition from the British Medical Association In respect of this legislation. Given; that co-operation, I agree with the- Minister’s statement that it will be possible to eradicate the disease within our time. Although “within our time” might mean, any period, I assume that it refers to- the normal span of human life. For some of: tra, the period may be brief, but. for others it may be of long duration. However.,, if the scheme should be brought to at successful conclusion in my lifetime, it will be one of the greatest legislative monuments to the credit of a Labour government ever established in this country. The bill provides for the. initiation of a campaign- to secure greater1 cooperation from-, the people and from governments. The public mind must be educated about, this dread disease.. The need for such a campaign is stressed by the facts stated by Senator O’Byrne in relation to the Apex Gallup poll. The result of that poll was a. definite- inrdication that most people are still ignorant of what this Government has done to improve and extend social services. For example,, few people know anything about the Tuberculosis Act. We must teach tha people what they can do to. help in the eradication of tuberculosis..
Aru appalling fact stated by the- Minister is- that the disease’ strikes in Its most deadly form at men and women, in their most vigorous years,, when they still have the prospect of full and active lives before them. Those of us- who- have: come- in contact with victims of tuberculosis realize its insidious’ nature. The fact that it causes- more deaths: amongst: men and women between the ages of 20’ and 40’ years’ than in> any other- age group makes- it a. matte* of first-class importance to- the nation Such people are the- most active workers and the most fruitful. In spite of the ravages! of tuberculosis overthe years, very little- has. been done byprevious Commonwealth and State go.vernments to check its spread, and itf is very encouraging to’ realize that this Government proposes- to eradicate the scourge completely. Its- sincerity of pui’pose is shown by the fact that it has followed the enactment of the Tuberculosis Act, which I mentioned earlier, with further definite efforts. Most of the patients in tuberculosis sanatorium^ throughout Australia are- people who were youngsters during the depression. Their present ill-health is the result of the widespread unemployment of those days: Malnutrition is a concomitant of unemployment, and I understand that it is the greatest cause of tuberculosis in all countries. People who are well fed’ and comfortably housed’ are usually healthy whereas those who cannot afford to buy sufficient food and have to live in cramped accommodationbecome subject not only to tuberculosisbut also- to> many other serious diseases It appears to me that tuberculosis, result? primarily from malnutrition! and fear of the- future; That is why the incidence of the disease in Australia is so great to-day.. It i3 a legacy of the depression.
It is” a terrible fact that nr 1946’, 27.6 per cent, of the deaths from- all major individual causes’ amongst people between the ages of 20 and 39 years’ were caused by tuberculosis. It is even more alarming to notice that the disease has’ caused twice as many deaths in the same age group as have been caused’ by cancer and tumours. Tuberculosis fatalities exceed by more than 50 per cent, the number of deaths from diseases of the heart and the circulatory system. However, the death rate has declined in recent years, a fact which is1 almost entirely due to. the improved standard of living which Australians: now enjoy. With full employment” throughout: the Commonwealth, malnutrition is almost non-existent. Furthermore, although the. housing shortage’ is- still acute, the- situation, is steadily improving. This Government has’ done everything’ possible to> provide- bouses for the people. I shall not list all of its accomplishments, but people who have occasion to travel about the Commonwealthsee ampleevidence of the effectiveness of the CommonwealthStates housing scheme. Wherever one goes, one sees hundreds of new houses and many more under construction. We are still far short of our target but the shortage is gradually and surely being overcome. The solving of the housing problem will greatly assist in the eradication of tuberculosis.
There are between 30,000 and 40,000 known sufferers from tuberculosis in Australia today. But more astounding still is the statement that there may be thousands of unsuspected cases. That is a matter to which everybody should, give attention. At present there is no means of ascertaining the number of unsuspected cases. Only by a compulsory medical examination could we ascertain the total number of Australian citizens suffering from this disease. We have heard a lot about the undesirability of compulsion. We are told by our political opponents that this Government wants to order the lives of the Australian people from the time they rise in the morning until they go to bed at night. Such an extravagant statement, of course, will not bear analysis; but it may be thatcompulsion in this instance would be in the best interests, of the people. I cannot see any objection to every citizen of the Commonwealth being required to submit himself to a chest X-ray examination to ascertain whether or not this insidious disease is present. With mass radiography it would be possible more rapidly to arrest this scourge. However, the Government, so far as I am aware, does not intend to make examinations compulsory. I have before me some interesting information on the mass radiography carried out by the Navy, Army and Air Force on servicemen being discharged from the forces. Unfortunately the information is not right up to date, but it is not very old. It has come to me from a reliable source. The statement, which relates to Western Australia, is as follows: -
An illustration of the value of mass radiographyhas recently been afforded by the X-ray examination of all men and women discharged from the Army,Navy and Air Force in
Western Australia. The Deputy Director of Medical Services (Colonel Le Souef ) advises that, at the time of writing, of the 80 cases of pulmonary tuberculosis inService personnel at present receiving treatment there are -
Early or minimaldisease - 22 or 27.5 per cent.
Of these -
Discovered on reporting sick - Nil.
Discovered on routine X-ray - 22.
Moderatelyadvanceddisease - 54 or 67. 5 per cent.
Of these -
Discovered on reporting sick -22.
Discovered on routine X-ray - 32. 3.Far advanced disease - 4 or 5 per cent. Of these -
Discovered on reporting sick - 3.
Discovered on routine X-ray - 1.
It has been found possible to collapse successfully by artificial pneumothorax 15 of the 22 earlycases (the others being under observation, or collapse not necessary)or 68 per cent, of the moderately advanced group, in the 22 whose symptoms led to their discovery 10 or 45 per cent, have been successfully collapsed, compared with 20 out of 32, or63per cent, of those discoveredby routine X-ray.
In all 4 of the far advanced group, collapse was considered inadvisableor impossible.
Oncomparison with an analysis of the patients in the Wooroloo Sanatorium, almost all of whom have been diagnosed, because of symptoms which made them consult their doctor, it is found that only 4.5 per cent, have early disease, 47 per cent, have moderately advanced disease, and 48.5 per cent, have far advanced disease. It is tragic that all the moderately advanced and far advanced cases had at one time been early, andthat our failure to provide the means of early diagnosis in the past has rendered their prospects of recovery either poor or hopeless.
It is also interesting to note that in the Service figures it has been possible to collapse the lungs of 63 per cent, of the moderately advanced cases who had not reported sick but were discovered on routine X-rays, as compared with 45 per cent, of cases with a similar classification who had reported sick another point in favour of periodic routine X-ray examination. It is also to be noted that Service cases had their chests X-rayed only on entering the Services and on discharge. There can be no doubt that a periodic X-ray examination would have placed the great majority of all the 80 cases in the “early” group instead of the 27.5 per cent, found on discharge.
That information is most valuable, and would appear to be sufficient justification for the introduction of mass X-ray examinations. By educating the public, we might be able to secure the acceptance of a scheme under which a majority, if not all, of the people would, of their own volition, submit to such examinations.
As the result of the 1946 referendum, the Commonwealth Parliament was empowered to pass legislation for the provision of health services. Already there is on the statute-book the Tuberculosis Act which, in conjunction with the measure now before us, indicates that this Government, having secured a mandate from the people, is prepared to go ahead immediately with its national health programme. Bearing that in mind, I cannot refrain from drawing attention to the fact that in all the years since federation, it was not until 1946 that any government in the Commonwealth sphere sought to have the Constitution amended so that certain health services and benefits could be made available to the people of this country. Previous administrations failed badly to fulfil their duty to safeguard the health and well-being of the nation. Even in 1946, an endeavour was made to induce the people to vote against the Labour Government’s social service proposals.
This bill gives the Commonwealth authority to take action for the prevention, treatment, and control of tuberculosis and, as I have already pointed out, it envisages a campaign for a bold attack on the disease. The campaign has been mapped out after a survey in all States, consultations with the State Ministers for Health, and approval by the State Premiers. We can assume, therefore, that in passing this legislation we have the wholehearted co-operation of the States. In the course of the budget debate figures were given relating to expenditure by the various State governments on tuberculosis benefits. The total amount so expended can only be regarded as small in view of the period that has elapsed since the introduction of the scheme, but there may be some reason for that. It appears to me that, so far, the State governments have not done all that they could have done, in co-operation with the Commonwealth, to curb the ravages of this disease. If tuberculosis is to be eradicated early diagnosis is necessary. Provision must also be made for immediate isolation and medical treatment. Then of course there is after-care, and the restoration of the patient to normal life. That aspect is covered by the legislation already on the statute-book. An agreement has been reached between the Commonwealth Min- ister for Health and the State Minister for Health in Western Australia on sustenance payments to sufferers from tuberculosis and their dependants. Whether or not these payments are adequate, I do not know, but the fact is that they are available. However, it seems to me that, up to date, there has not been the call on this fund which would have been expected in view of the figures that have been compiled on the incidence of tuberculosis. So, it is proposed that adequate financial assistance to sufferers and their dependants, and after-care and rehabilitation, shall receive first consideration. Many people who suspect that they have tuberculosis in its early stages are afraid of a medical examination because they know that, should their suspicion be confirmed, they will have to go to hospital if they are to have a reasonable chance of recovery. Here, the economic factor enters. The young family man who finds that he is a victim of thi? disease knows that if he leaves work he will lose his income, and so he worries about the economic circumstances of hi> family. This measure represents » serious effort on the part of the Government to overcome the economic disabilities suffered by poor people who artafflicted with tuberculosis. When thimeasure becomes law I hope that thi payments to sufferers and their dependants will be sufficiently large to remove their financial anxieties.
The prevention of the spread of infection is an important part of any campaign to combat tuberculosis. Some time ago I mentioned in the Senate that it was known that there were 1,900 cases of tuberculosis in Western Australia but that only 300 could be isolated and treated in hospital. The remainder constitute a grave potential source of infection. Those people could not be treated because the State authorities were unable to provide sufficient hospital accommodation for them. The Repatriation Commission, whose, work I have recently had an opportunity to examine as a member of the Public Works Committee, is doing an excellent job for ex-servicemen afflicted with the disease. However, the Repatriation Commission is concerned only with exservicemen and does not provide facilities for the treatment of civilians. Since the number of civilians afflicted with tuberculosis is far greater than the number of sufferers amongs exservicemen, it is obvious that something aust be done for the treatment of civilian sufferers. It is estimated that for every death known to have been caused by tuberculosis, eleven other active cases were prevalent in which the disease had not been diagnosed. From recollection, L73 deaths from tuberculosis occurred in Western Australia in one year, and presumably many of the deceased persons infected other members of the community while they were alive. In addition, 1,900 people in that State were known to be suffering from the disease, as I have already mentioned. Of the 1,600 who were not given hospital treatment, it is quite possible that they were a source of infection to other persons. The disease is caused by the tubercle bacillus, which manifests itself in man by producing disease of the lungs, pulmonary tuberculosis, which is also known as consumption or phthisis, and of other parts of the body, bones, joints, glands in the neck, abdomen and intestines, kidneys, genital organs and meninges of the brain “. When we review the incidence of the disease it is obvious that any of us may contract it. By introducing this measure, the Government has given still further proof of its sincere concern for the welfare of the community.
I was pleased to hear the Minister for Health say in the course of his speech that -
The Commonwealth will bear the cost, by reimbursement to the States, of all new approved capital expenditure of the States from the 1st July, 1048, for land and buildings, furnishings, equipment and plant for use in the diagnosis, treatment and control of tuberculosis. Estimates of expenditure in this field alone approach £500,000 for the current year. [n outlining the Government’s plans the Minister also said -
The Commonwealth will encourage the establishment of thoracic wings, attached to teaching hospitals, for the investigation and treatment of diseases of the- chest, including tuberculosis. Medical students and trainee nurses will thus secure training in the early diagnosis of the disease. familiarity with its treatment, and experience in the care of tuberculous patients. In addition, the bill provides that the Commonwealth may pay subsidies to universities or other institutions to promote and assist investigation and research, and to develop courses of training in branches of medical science relating to tuberculosis problems. The Director-General of Health is empowered by the bill, subject to the direction of the Minister, to conduct, assist, and provide for research, investigations, experiments, studies and training, in relation to the detection and diagnosis of tuberculosis, and the treatment and after-care of sufferers from the disease. He may also arrange for the provision of scholarships for the post-graduate study of tuberculosis.
A healthy people makes for a happy nation, and I regard this legislation as a further step along the path of progress followed by the present Government.
– I have very great pleasure in supporting the measure before the Senate and I congratulate Senator Nash on his speech, in which he expressed most of the views that I hold. I do not intend to repeat the remarks made by the honorable senator, but I point out that the legislation for the control and treatment of tuberculosis which was passed in 1945 did not go far enough, otherwise it would not have been necessary to introduce the present measure. That legislation provided for the National Government, in co-operation with State governments to take certain action, but I am afraid that the State governments did hot co-operate as they should have done. My criticism applies particularly to the Government of South Australia, which could have made better use of the facilities provided by the National Government. It should certainly have made some attempt to inaugurate an effective scheme for the treatment of sufferers from tuberculosis in that State. Unfortunately, the successful implementation of the present measure will depend on the co-operation of the State governments.
Quite recently the Premier of South Australia made a public statement that the South Australian government proposed to spend £1,000,000 on a hospital for the treatment of sufferers from tuberculosis. Whether or not he made that statement in anticipation of receiving the necessary financial assistance from the National Government I do not know, but I suspect that he merely sought to gain some political advantage and was not genuinely concerned to provide treatment for sufferers from tuberculosis, in that State. The Repatriation, Commission intends- to expend a substantial amount of money in South Australia on the provision of facilities for the. treatment of ex-servicemen suffering from tuberculosis, and the Red’ Cross Society is also reported to be contemplating the expenditure of £100,00.0 on the erection of a special wing at Springbank Hospital, for the same purpose. Of course, not a word is- said about the National Government providing- the money.. Whilst it may be necessary because of our commitment to. those who fought- for this country in war, to have two sets of organizations for- the treatment of tuberculosis, I doubt the wisdom of having two sets of hospitals; In any event, the National Government will have to provide the finance for both organizations, although it will not receive any credit for its humanitarian action. Of course, [ realize that the members of the present Government are not greatly concerned as to who does the job, provided that it is done effectively, but I consider- that the National Government should- exercise vigilant supervision to- ensure- that the money which it provides for the State authorities is expended according to its directions. Whilst I congratulate the Government on taking a most practical step towards eliminating tuberculosis, no scheme can be completely effective until the National Government assumes sole responsibility for the treatment of this disease. The petty, political jealousies of State governments certainly do not tend towards efficiency in the administration of any comprehensive scheme.
An agitation is going on throughout the country for the erection of houses. The scarcity of proper accommodation must have a direct bearing on any scheme for the treatment of sufferers from tuberculosis. Unless decent housing accommodation can be provided for sufferers and their families the success of any scheme of treatment must be seriously retarded. I could furnish harrowing descriptions of families living in tenements and hovels in this country which would shock honorable senators. Many of the bread-winners of those families are suffering- from tuberculosa., but because of the inadequacy of their accommodation they have perforce to live in intimate- contact with the member* of their families. In such circumstance* the rapid spread of the disease’ i» inevitable. Hence one of the main thing* that should be done to accelerate housing construction.. South Australia has been let down because of lack of co-operation between- that State and the Commonwealth in the housing scheme. At some future time it may b« possible for the Commonwealth to brand out without the aid of the States-.
There is an agitation, for the expansion of industry. That necessitates the building of additional factories-. In various parts of Australia, factories are being built, but unfortunately the Commonwealth has no power to prescribe standards relating to lighting, space pe. unit, and hygiene. All such power i> vested in the States. In some of thi factories now being established, adequate provision is not being made to safeguard the health of the employees. That ‘it attributable to the inactivity of the State authorities. 1 shall refer now to the after-care oi tuberculous patients. Money is to be provided for the building of hospitals and I hope that convalescent homes, also, will be provided so that the patients- maj receive open-air treatment. Provision should be made for the maintenance of the individual sufferer and the- family group during- convalescence.. Patients should be relieved of worry about the welfare of their families during thai period. The allowance made to breadwinners whilst in hospital,, or during after-care treatment, should be adequate, so that they will not feel impelled te return to their places of employment before being completely cured, thu* spreading the disease.
In Great Britain, after-care training centres have been established for patient? suffering from tuberculosis.. When a person enters, such an institution he ittaught a light trade, and he receives an allowance for himeslf, together with an additional allowance for his wife and family, whilst so engaged.. If he- assist* with the- manufacture of goods for sale, he receives, in addition, a percentage of th* proceeds of his work.. A scheme: of- that nature could be- introduced in this country,, hut we should not defer action until State co-operation, is assured. A Long wait may be involved if the whims and. fancies- of the -States- have first to be satisfied..
Amounts; of payments to the people dependent on the patient should be considerably more- than are provided for in tha 1945” act, under’ which it was’ necessary for certain moneys te be paid by the Commonwealth, and others by the States, En the past, because the States have not always been able to provide the money necessary^ there- has been a somewhat niggardly approach to the matter, with, the result that adequate payment has not always been made to sufferers from tuberculosis. At times- such people have found, not long after their return home from hospital, that, because, of the small amounts provided, they must return to work.. In many instances, it has not been long before those patients have had to return to the sanatorium and go through the whole process again. They should be adequately provided for during the after-care period as well as during hospitalization, and they should be relieved of worry concerning the upkeep of their homes..
Another important phase of the matter requiring attention is the provision of establishments where scientific groups could’ study methods of treatment of tubercular diseases.. Senator Nash dealt with that aspect at length.. Very few men in the. medical field in Australia have made a comprehensive study of tubercular diseases. That is probably because arrangements have not been made whereby they could devote their full time to such study; they have to earn their living- and pursue’ their studies in whatever spare time they have. In- those circumstances’, their studies may extend over a period of years1, resulting in the benefits therefrom being neutralized. Although wonderful strides have been made in the past, if schools were established’ for the purpose of training such medical men in the treatment of tubercular diseases, far greater strides could be made in- the future. That would be a step in the right direction towards damping Out this dreaded, disease;
I contend that- arrangements- should-, be made for the States to introducer legislation to compel- every person to submit to a medical examination to* establish whether he- or she is infected with tuberculosis. In some- centres nearly 98 per cent, of the inhabitants have voluntarily submitted to- examination. Generally speaking; however; only a small percentage of the- people has submitted voluntarily; As Senator Nash pointed- out. that is mainly because of fear. In- many instances- such people are- told first thai they have consumption, which is the term generally- used, and they are then- afraid that people may shun them’ if it should become- known- that they are so infected. Ultimately; they cannot afford the* treatment necessary to arrest the disease-, because they would! not receive wages while undergoing treatment. Other members of the family are thus exposed to the disease. I do not know whether it is possible for the States to agree to son:1*form of compulsion in this matter, but J think that that would be most desirable. Frequently,, differences of opinion exist among doctors as to whether X-ray always detects the presence of the disease; some doctors contend that the only positive test is by an analysis of the sputum of persons suspected to be infected’.. In the Repatriation Department, also, controversy frequently arises as to whether a person is eligible for an allowance under the tubercular pensions scheme.
Whilst there, is not much, chance of inducing, the older doctors to attend schools, or science, classes, because they do not. want to be bothered learning anything further,, it may be possible’ to- encourage the younger doctors to pursue diagnostic courses so that they may become, proficient in the detection and treatment of tubercular diseases.. I commend the Government for making, preparations in that direction. No doubt some years will elapse before the scheme will be operating smoothly. I do not think the States will co-operate fully for a long while yet, because they may consider that they will be able to make some political capital out of their own particular actions. I draw attention to- another aspect of this proposal. In respect of the funds to be provided under the measure, I urge the Minister to keep a close check upon expenditure to be incurred in the erection of hospitals. Past governments in South Australia wasted thousands of pounds in the construction of a tubercular hospital at Belair, in the hills district. That institution was originally known as a consumptives’ home. A similar institution was established beyond Springbank. Thousands of pounds were expended in the establishment of those institutions in spite of a serious divergence of opinion among medical men as to the. suitability of the rites on which they were erected. The Tuberculosis Society of South Australia also established a hospital at Angorichina where ‘treatment is provided for exserfice personnel convalescing after being discharged from repatriation hospitals. U that institution inmates have the opportunity to carry on light agricultural pursuits. I do not complain so much about the expenditure, which will be involved in the provision of similar institutions; the point I emphasize is that the most thorough investigation should be made by experts as to the suitability o’f sites for such buildings. Perhaps, the advisory body to be set up under this measure could collect the necessary data in respect of sites. The best possible treatment could then be made available to sufferers.
I congratulate the Government upon introducing this measure. It is doing a very good job in the social services field. As Senator Nash has pointed out, proposals of this kind were not even hinted at by past governments. It was not until 1945 that a serious attempt was made to provide social services. I trust that the Government will be able to extend its activities in this field. It should be possible to make similar provision in respect of diseases other than tuberculosis. Even under this legislation it might be possible to set in train investigations into rheumatic fever. So far as my knowledge goes the fever itself is not acute, but the after-effects of it are most serious. Schools of the kind to which I have referred might be employed to investigate whether there” is any relationship between rheumatic fever and tuberculosis. Measures of this kind will undoubtedly promote the health of the community. I wholeheartedly support the bill.
.- A pleasing feature of the bill, which I regard as a socialization measure, is. as the Minister for Health (Senator McKenna) has .stated, that it has the endorsement of State governments, both Labour and Liberal, whilst the Deputy Leader of the Opposition (Senator O’sullivan) has said that the Opposition supports it wholeheartedly. I always believed that, sooner or later, the Opposition parties would support legislation of this kind even to the degree of overcoming their prejudices agains socialism.
– I do not think that the Minister will be glad to hear the measure described as a socialists measure.
– 1 can only describe as socialistic any measure under which the Government with the cooperation of all parties establishes, and assumes full responsibility for, machinery to combat a disease. Measures dealing with the health of the community can be as much socialistic as measures under which a government assumes control of industries. This bill is part and parcel of the Government’s social service programme; and I am glad that at last the Opposition parties are prepared to sink their prejudices against socialism to a sufficient degree to support legislation designed to promote the health of the community. In my view this measure is a perfect example of socialism.
– Do not make the Minister for Health blush.
– The point the Deputy Leader of the Opposition overlooks is that the Government is entering this field because of the failure of the medical profession and the State governments to control tuberculosis. The disease has got beyond their control. It has been made clear that Tasmania has led the fight against tuberculosis. That State has made greater progress than any other State in dealing with the problem. In Tasmania a mobile X-ray unit travels throughout the State, and any person at any centre at which it stops may request to be X-rayed. I have seen that unit stationed ax the wharfs in Hobart when large numbers of waterside workers were X-rayed. The names and addresses of those examined were recorded, and they were advised later of the result of their examination. That service has been operating in Tasmania for some time, and it has played an important part in making a survey of the disease. Under this measure, the Commonwealth will relieve the Tasmanian State Government of a heavy financial burden. The latter has completed plans for the erection of a number of sanatoriums, and those buildings will now be financed by the Commonwealth. I do not agree entirely with the view expressed by some of my colleagues that this legislation should be administered solely from Canberra. Some of the State governments have already done a remarkably good job in this field, and having regard to varying conditions in different localities, this plan can best be implemented by the State governments.
There are several forms of tubersulosis Senator Nash mentioned miners’ phthisis. In the past, miners’ phthisis, which is caused through lungs becoming loaded with dust, was generally regarded as a form of tuberculosis. The most widely known form of tuberculosis is caused by a germ from which, I understand, very few people aro free. The germ develops only under certain conditions. However, other forms of tuberculosis are equally deadly diseases. One has only to read the tombstones in cemeteries in mining districts throughout Australia to realize that fact. Noting the years recorded on those tombstones one might be led to believe that wars had taken place in those districts at certain periods. Most of the miners buried in such cemeteries died at ages at which people are most susceptable to tuberculosis. Those miners, whose lungs were loaded with dust, died an agonizing death. Like the form in which tuberculosis is most widely recognized miners’ phthisis is a terrible disease involving a lingering death. I should like to know whether this measure provides for the treatment of forms of tuberculosis other than that in which the disease is most generally recognized. If not, can the bill be extended to embrace sufferers from all forms of tuberculosis? I understand that miners’ phthisis, consumption and tuberculosis are similar diseases. In each instance the lungs gradually decay, or are eaten out. To-day, a miner who is a victim of miners’ phthisis before being engaged at a particular mine is noi eligible for compensation should the disease subsequently preclude him from carrying on. On the other hand, a miner who is free from the disease upon being engaged at a particular mine is eligible for compensation amounting to £600 should he later contract the disease. That sum, of course, is poor compensation for premature death. I am reliably informed that miners’ phthisis can be checked in itsearly stages. The disease has practically been mastered in the United States of America. In that country, aluminium dust, which is circulated through all change houses counteracts any dust that may be in a miner’s lungs. I understand that several mines in Western Australia are installing that process in their change houses. I urge the Government to make that treatment uniform at all mines throughout Australia. Recently, a friend of mine who felt ill upon emerging from a mine, was found upon examination to have dust in his lungs. His doctor is now treating him with aluminium dust, and claims that, by thi? method, he can clean all the dust from the affected lung, which is in a bad condition. The doctor also claims that, when the cleaning process has been completed, the lung will not deteriorate again and the other lung will be protected as well. In other words, the doctor is able to prolong the man’s life, probably to normal old age, without any serious ill effects. This preventive and curative process has been mastered in the United States of America, and some mine offices in Western Australia are installing equipment to protect the health of the men whom they employ. This is such an important matter that I hope the Government will conduct a campaign against miners’ phthisis in conjunction with its campaign against tuberculosis. The disease is very prevalent amongst contract miners. The contract worker’s chief aim is to earn as much money as possible and, while he works norma] award hours, he works as hard as possible because “he is paid according to results. Sometimes a man has difficulty in using water to lay dust during drill i&g operations. If water gets into a “ down” hole, the drill often sticks. Sometimes earth and rock fall into the hole and -make the work very difficult. Naturally a miner may lose his temper when this happens, because he is not making progress and, therefore, is not earning -money. In such circumstances, if an inspector or deputy is not present, he -may put the -water on -one side and make a dry hole. “While doing this he becomes smothered in dust and inhales considerable quantities of it. This is highly dangerous. If all mines adopted the scheme which has “been put into operation in some mines in Western Australia and in the United States of America, a man could inhale the dust without risk because, in the change-house after finishing his shift, he would inhale aluminium dust which would not stick to his lungs and -would clear -away all traces of other dusts. The Government should investigate this method of treatment with a view to attacking miners’ phthisis on the same scale as it proposes to -attack tuberculosis. Miners contribute to compensation funds upon which they can draw if they become affected, but that has nothing to do with prevention and the disease is still prevalent in mines throughnut Australia.
Three terrible diseases .afflict the community .to-day. They are tuberculosis, miners’ phthisis and cancer. Great advances have been made in the treatment of cancer, which can be checked and cured if discovered at a sufficiently early staTe. From the information which the Minister for Health has supplied to the Senate in presenting the bill, it appears that tuberculosis can be prevented and cured and from the information which I have obtained, it appears that miners’ phthisis also can be eliminated. There is no need for miners to be affected by the disease in any way. That being so, T hope that the Government will extend its plans for the prevention and cure of tuberculosis to include the examination, together with treatment where necessary, of men who may be afflicted with miners’ phthisis. The States should make X-ray examinations, compulsory; I believe that the Government of Tasmania is already giving serious consideration to such a plan. On this point the
Deputy Leader of “the Opposition “and J are in complete agreement. Under such a system, miners’ phthisis could be detected and the victims could be provided with treatment by the same -doctors and in the same sanatoriums as those devoted to the care and treatment of tuberculosis. By -means of such a campaign wc could lift from the minds .of men throughout Australia the fear which pre vents them from working in the mines.
No objections have been raised ii , either the Senate or the House of Representatives to the principles of the Government’s magnificent social .services plan. Its national health scheme is applauded by -all political parties throughout Australia. The .scheme provides reasonable security for people who are receiving treatment for -various ailments. However, I know that many men .suffering from miners’ phthisis, which could be cured or .checked, cannot secure benefit* if they enter hospitals of their own freewill to undergo treatment. Therefore, .1 should like the Government’s scheme to be .extended in order that men who are affected by miners’ phthisis may be provided with the treatment necessary to save them from an early death. Although the Government seeks to cure all existing cases of tuberculosis, its main object if to eliminate the disease completely in the near future. If the disease can be prevented - and I can see no reason why that cannot be done - the huge expenditure that will be entailed in implementing the scheme .during the next few years wall be only a .temporary hurden. The need for certain hospitals and sanatoriums will cease to exist as the disease is defeated. Not only will thousands of people be mad© safe from the dread scourge, but ako taxpayers generally, who have to bear the cost of social services, will benefit financially. .1 am most delighted thai for once the Opposition has fallen into line and given its wholehearted support to a real socialization measure.
Senator ‘COOKE (Western Australia; [5.22]. - After many years of association with societies ‘which have fought for the elimination of the scourge of tuberculosis, a campaign in which the Labour party has always been in the vanguard, 1 have great pleasure in supporting the bill now before the Senate. It provides for the purchase of plant and equipment and the establishment of an administrative organization to deal with this frightful disease, which has been neglected by the States, probably not on account of apathy but on account of their inability to finance the necessary measures. In Western Australia, Dr. Henzell and Dr. King have worked continuously in studying the disease and developing methods of combating it. The Commonwealth took a great step forward when it made a grant off £250,000 for a survey to determine the incidence of the disease and for research equipment, and a further grant of £250,000 to provide for the relief of dependants of sufferers. Unfortunately, the States did not take full advantage >f these grants because they were afraid to become involved in an expensive campaign of such magnitude. They realized that, if they tackled the problem properly, they would be embarrassed in many ,ways. They knew that X-ray examinations of the population would reveal vast numbers of sufferers from tuberculosis for Whom they could provide neither the hospitals nor the equipment required for effective curative treatment. That -was a desperate situation.
This measure will repeal the legislation enacted by the Commonwealth in L945 and 1946, but it will, in effect, consolidate them. It will provide for the States, subject to certain conditions to be agreed upon, services and facilities for the diagnosis, treatment and control of tuberculosis. I am very pleased that the Commonwealth has entered wholeheartedly into the assault upon this disease. Now it will be able to call the tune, whereas previously it lias been expected only to pay the piper. The bill contains a very fine provision by which the Commonwealth may be required to reimburse the States for capital expenditure incurred after the 1st July, 1948, in the provision of land, buildings, equipment and plant for use in the diagnosis, treatment and control of tuberculosis. Furthermore, from ‘the same date, the Commonwealth may be held responsible ‘for maintenance and administrative charges incurred by the States in the campaign. In order to appreciate the portent of this measure, it must be realized that medical research in this field will be extended as far as i* physically possible. Great advances have already been made in Western Australia. In Perth, Dr. Henzell has already established the first tuberculosis clinic, in Murray-street, opposite the main Perth Hospital, where about 20,000 people have been examined by X-ray. Unfortunately, the State is able to accept for examination and treatment only those persons who are suspected sufferers from the disease although the scheme is being extended. The scheme is not able to embrace a full-scale test of the whole population Suspected sufferers are given a radiological screening, the result of which i* examined by experts. When shadows artdetected on the upper lobes of the lungs, the doctors are able to decide, with <a reasonable degree of certainty, that the subject suffers from pulmonary tuberculosis. At present only the most urgent cases can be treated. Other sufferers must stand down, after being warned of their condition. That should not be necessary. Dr. Henzell and Dr. ‘King do not wish to stop at that, but they have no option. They are bound by the limitations of finance and staff.
This Government now proposes to go one step farther and .provide for the thorough treatment of all sufferers. Patients will be sent to sanatoriums for treatment. Doctors believe that, if they can treat patients in the early stages of the disease, they will be able to eliminate it altogether. If the disease proceeds to a further stage of development, the lung is damaged and, although the germ may be latent, that damage cannot be repaired. A person suffering from the disease at that stage is not 100 per cent, fit for . employment in industry. Unfortunately, under present methods, such people cannot be employed. There b no room for men who lack the capacity to work normally. This Government will provide for the welfare of such persons
W arranging for the establishment of after-care sanatoriums. In company with Dr. Henzell, I have visited the Wooroloo Sanatorium in Western Australia, where the doctor has established workshops and facilities for light outdoor work with money subscribed by the public. Patients who have reached th, stage at which they show negative results in tuberculosis tests, but are still suffering from the disease, are allowed to remain at the sanatorium, where they are taught various trades. They are allowed to do as much open-air work as possible, [f they can work for two hours only, then they work for two hours a day. For the rest of the day they are resting or in bed receiving the usual hospital treatment. Some patients may work for as long as four hours a day in those workshops. Dr. Henzell and Dr. King agree that this system does more to bring a patient back to good health than the usual hospital treatment which requires him to remain in bed doing nothing. This lack of activity and interest, they say, produces morbidity in a large percentage of cases. These doctors are anxious that the Commonwealth should make available sufficient money to provide more after-care workshops and facilities so that patients may be completely cured, mentally and physically, and be able to return to industry knowing that their capacity is no less than that of healthy fellow workers. Mass radiography would require not only sufficient X-ray plants, but also the co-operation of the people, and an efficient records system. The administrative side of such a scheme would be nearly as great as the medical side. One examination of each person would not be sufficient. Examination would have to be continued at regular intervals. Special attention would have to be given to certain industries in which the incidence of tuberculosis is high. Under existing workers’ compensation legislation, many men who know that their health has been impaired refrain from seeking a medical examination. Anions; the most insidious of industrial diseases are silicosis, and tuberculosis, brought on by progressive deterioration of the lungs due to bad working conditions and dust. A worker may know that he has a pulmonary condition - not necessarily tubercular - but he may be afraid to have an examination because he cannot prove that the disease has resulted from his work. I know of one man who, knowing that he had a disease of the lungs, continued in his employment for ‘many years, because he feared that inability to prove that his condition was attributable to his work would deprive him sustenance and compensation Eventually, while working in excessive dust one day, he collapsed. His castwas argued in the courts, and the decision was that, regardless of his physical condition, because he was working in ai atmosphere overloaded with dust when he collapsed, he was entitled to compensation. Compensation was paid, but un fortunately the man died. He knew the fate that had been stalking him. Unless we have an equitable system of dealing with pulmonary tuberculosis, silicosis and other similar diseases, workmen will noi submit themselves to examination. 1 once worked with a young man who received hospital treatment for tuberculosis until the sick leave period prescribed in his award had expired. He was 28 years of age and had five young children. As soon as he came out of the sanatorium, he resumed his occupation and nobody could induce him to seel further treatment. He could not be forced to undergo treatment, and h« worked a one-man station, on the goldfields until he died. These things happened often before the Commonwealth took a hand in the matter. We must remove from the minds of sufferers from tuberculosis the fear that their families will starve if they seek hospital treatment. We must also ensure that when a patient registers a negative test, and is pronounced cured of this disease which has taken its full toll of his physical and perhaps mental strength, he shall have a period of rehabilitation during which he will be given after care. I suggest to the Minister that in his discussions with State authorities, consideration be given to the establishment of more workshops and facilities of the kind I have described so that during after-care patients can earn something, become re-acquainted with industry, build up their strength, and eventually go back to their occupation feeling that they have been completely cured and are competent to re-establish themselves in industry. There are, of course, forms of tuberculosis other than pulmonary tuberculosis, and they are to be feared just as much. For instance there is tuberculosis of the intestines, of the bone and of the brain. I believe that there should be an expansion of research in that wide field.
The bill provides that payments to sufferers shall be made at such rates as the Director-General, subject to the direction of the Minister, determines. That will have to be considered carefully, but [ am confident that the Minister, as usual, will administer these provisions with the utmost sympathy for the sufferer and will in all cases make generous payments.
In years gone by, while tuberculosis was solely within the province of the States, many workers could not get treatment, and most of them worried about the economic position of their dependants. Members of the medical profession like Dr. Henzell and Lr. King, who, long before the days of government encouragement, contributed so much to the alleviation of suffering from tuberculosis, should be brought into consultation with the Commonwealth authorities in the administration of this scheme. The Chief Medical Officer in Western Australia has made a very serious report, and I agree with every word of it. From time to time, the Labour movement drew public attention to existing conditions, but, unfortunately, authority was vested in a nonmedical man, who consistently opposed the recommendations of fully qualified doctors and refused to sanction expenditure, believing that he was doing a good job. If a doctor bucked against this man, he was penalized. That civil servant is no longer in his former position, but conditions have not changed very much. The Chief Medical Officer in Western Australia is one of the most competent medical men in the Commonwealth. He is an authority on tropical diseases, and his record is excellent. However, he is meeting with strong opposition, and I hope that when this scheme becomes operative, State medical officers who have given many years of service to the health of the people will be called into consultation frequently. I recall that Dr. Roy Mueke of Perth, applied himself so strenuously to medical services for the good of the community, that he sacrificed his life.. He was a fine young man. He battled against the parsimony of a government, and the short-sightedness of a public servant who would not expend sufficient money to provide the facilities necessary for the medical service to which Dr. Mueke con sidered the public to be entitled.
I commend the bill to the Senate. It La great step forward. I congratulate the Minister on the straight-forward and clear drafting of the measure, and the full consideration which has obviously been given to all aspects of this important matter.
– This measure will co-ordinate all the intellectual and material resources of medicine in an effort to stamp out tuberculosis. The statement that there are 30,000 or 40,000 tuberculosis sufferers i» the Commonwealth reveals a regrettable state of affairs which becomes even worse when one considers that probably many more thousands are unsuspecting sufferers. It is a grim thought that 27.6 per cent, of the deaths occurring in the Commonwealth are due to tuberculosis I fear that unless remedial action is taken soon that figure will become even greater, because, according to one eminent medical authority, almost every person in the community comes in contact with the tuberculosis germ before he reaches the age of five years. The germ lies dormant while the person maintains resistance to it, but immediately resistance is diminished, the germ becomes virulent. Whether or not that theory is sound 1 am not in a position to say, but it has wide support. Until now, in our efforts to curb the ravages of tuberculosis, we have been dealing with effects rather than with causes. Certainly the effects must be countered, and everything possible done to minimize the suffering of victims. The Minister for Health (Senator McKenna) put his finger on the real trouble spot when he said -
The fall in the morbidity and mortality rates of tuberculosis may be related to the general rise in the standard of- living, of nutrition and housing*. In fact, an eminent doctor has suggested that when every one has enough room in which to live, enough to eat. and enough room and proper conditions in which to work, the incidence of tuberculosis will diminish to vanishing point.
That is what I mean when I say that we have been dealing with effects and not with causes. We should not be human if ve ignored those effects, but I believe :hat with adequate nutrition, housing and slothing, the people of this nation, prosperous &s it is to-day, will hare a much Setter chance of fighting the scourge of tuberculosis. In the capital cities thou<an?ls; ?? people live in slums, which are haughty, d’amp and cold in the winter. These conditions are due in some measure o. the opportunity that has been given to private enterprise in the past to- force lown the wages of workers. These conditions are one of the prime causes of tuberculosis. The Government proposes *;o summon to its aid all the authorities concerned in the treatment and prevention of tuberculosis, the germs of which ire said to be present in every human body and it has undertaken to finance my undertaking which has the approval >f the Minister for Health. In Tas.mania, the medical practitioners have jo-operated freely with the State Government to combat the spread f the disease, and a. genuine and determined effort has been made. The financial and other assistance which the National Government is prepared to. provide will make the task of -he Tasmanian Government much easier :f accomplishment. “Whilst, the efforts nada by the present Government, to combat tuberculosis are deserving of high praise,, I believe, that much, more could he. done if the people of Australia were properly housed and adequately nourished *tad. clothed. The, present Government n,as, done its utmost: to> bring about such a state of affairs,, hut,, unfortunately, rite people- frustrated its, attempts when they rejected, the Government’s: proposals to. exercise control of wages, and conditions and prices, at the recent referendums. Although science’ has proved that the human body can subsist on very little, it should be realized that the resistance to disease of the human body decreases proportionately with the. decline of living standards.
Until now many unfortunate sufferers from; tuberculosis, and their families, have undergone considerable hardship because the family bread-winners have been compelled to continue working in order to maintain their families instead of entering a hospital to undergo treatment. Even those who enter hospitals must ex- perience considerable financial anxiety . which undoubtedly retards their recovery The Government now proposes to relieve such people from a great deal of their financial worries. It will also pro vide facilities for persons who sirpect that they are- suffering from tuberculosis- to- undergo radiological examination in their homes or at their places of work: *Although radiologics facilities to detect the presence of tuberculosis have been provided in some small measure in the past only a comparatively few people have availed themselves ofthose facilities. Modem radiologics1 examination- does; not involve pain or discomfort. All- that one has. to do when undergoing- examination is to remove hi* tap clothing and stand in front of the radiological* instrument for a> few moments.
– It is not necessary to disrobe now.
– I am pleased t< hear that,, because it indicates, the degree of technical improvement which- ha> taken, place. People should! take advantage of the facilities, offered to then by modern science to- protect, their health I am convinced that, if State instrumen-talkies- scientists’ and the- medical professions, co-operate enthusiastically with the National Government we can expect, te- accomplish a great, deal in the, forthcoming campaign, against tuberculosis At the- same time I again stress, the need for improving the living conditions) oi our- people, and I commend that, portion of the Minister’s- speech, in- which he said -
All governments in- Australia are. interesting themselves increasingly in the matter o) housing1. The Commonwealth is concerned also, in the raising of nutrition standards, and there is increasing recognition of the need for im-p.novem.ent of factory and workshop conditions.
-This measure, which will- provide facilities for sufferers from tuberculosis. should1 command the support of all honorable senators’, and, therefore, I wa* pleased to hear- the rem arks of the Deputy leader of the Opposition- (Senator 0’ Sullivan). The health of the community should’ be the first consideration of any government. If our people an neal (bv- they will necessarily be efficient, which means that we can proceed with
The development of the country in order -o provide decent housing and living conditions for our’ people’. I was pleased to learn from the speech made by the Minister for Health- (Senator McKenna) that tuberculosis is not-, as many- of us thought, an hereditary disease. The Min.eA. also pointed out that although the disease is highly infectious sufferers can “be cured in the early stages of infection. However, it is obvious- that if we are to arrest the incidence of the disease- there must be co-ordinated action by the various governmental authorities and medical interests concerned. When I was a boy a young and pretty girl used to sit on the verandah of a house in the same street as that in which I lived, and we- used to wave to her- as we passed the house1. That unfortunate girl was stricken with Con.sumption and although we knew nothing about the disease we were all obsessed by the idea that- we had to avoid’ the girl for fear of contracting- it. Because prevention is better than cure, the present measure provides not only for the treatment of tuberculosis but also for’ its prevention. Medical authorities +tate that one of the essential factors in. preventing the occurrence of the disease- is the provision of adequate housing accommodation and the supply of proper- food, which should include vitamini A, animal fats and the other chemical elements: necessary to strengthen the human body.. We also know that hygiene plays an important part in preventing the spread of the disease. Many modern factories are designed to admit plenty of. sunlight: and fresh air,, and to provide sufficient room for the employees. In many instances open-air recreational facilities are also provided, and in such places the risk of tubercular- infection is reduced to a minimum.
Tuberculosis should not be> a major cause for concern in this country, because <ve have plenty of sunshine and beautiful parks and beaches whore our people are accustomed to spend their leisure. Those healthful conditions contrast with those in older countries where the incidence of tuberculosis- is very high. Medical statistics show that the disease afflicts many people in the most vigorous and reproductive years- of their lives, and 1 was- amazed’ when the Minister informed us- that- more young women die from tuberculosis- every year than from conditions associated with pregnancy The- implementation of the Govern ment’s- plan to combat disease should increase our birth-rate and assist us toovercome the difficulties’ inherent in out small population. I often think that wido not emphasize sufficiently the importance of human life, and that- thi slight- value placed upon human life in some countries-, particularly those ii Asia, is the reason why they have noi developed as they should have. I waiastounded to learn that 27.6. per cent, of deaths of people aged between 20 and 3£ years- in 1946 were attributed to tuberculosis. Undoubtely many others were condemned to- spend the remainder oi their lives in ill health and misery: W( should not treat sufferers- from tuberculosis as outcasts, but should encourage them- to visit hospitals and medical, centres for special examination. While: 1 was taking- part in the recent- Federal referendum campaign in Tasmania. a mobile radiological unit visited a small, town where we were- conducting a meeting The officer in charge of the mobile unit way present at our meeting, and at. it its conclusion I invited him traddress the gathering- in order to. explain the importance of his: work. He waigood enough to- do so, and strongly advised his audience to submit them selves to, radiological, examination. tb,following morning.
Sitting suspended from 5.58.. to 8 p.m.
Senator- MURRAY. - In the bill th. sum of £500,000 is being allocated foi the purchase of land, erection of buildings, the furnishing of those buildings, and the provision of equipment. Whilst all that is- very desirable, I should like to have seen a considerably greater sum allocated for the saving of human life. Unfortunately, we are apt to place too cheap a price on life and the saving of life, yet anything of that kind should have the hearty approbation of every right-thinking person.
We must seek the co-operation of thi people. It is of no use our providing expensive X-ray and other equipment and luxurious sanatoriums, unless the people are educated in the object of the Government and the authorities to wipe >ut this disease. I notice with pleasure “hat the incidence of tuberculosis is steadily declining in Australia. That is in direct contrast with the older countries. In war-torn Europe are large a urn bars of people who have lost their homes and are now herded together in refugee camps and displacedpersons areas. The incidence of tuberculosis in Europe is gradually increasing. Deficiencies in diet, and many other local conditions have brought about an increase there. In Australia we are gradually evolving a social conscience which is not only determined to combat tuberculosis but also is making it much easier for the health authorities to adopt the various measures envisaged in this bill. While in Japan, the members of the parliamentary delegation were amazed to see the manner in which the people were herded together. Medical authorities have stated that, whilst tuberculosis is not hereditary, it is very infectious. When speaking with officials on the staff of the Supreme Commander of the Occupation Forces in Japan, who are charged with the responsibility of safeguarding the health of the Japanese people, the members of the delegation were told that the worst menace they have to combat is tuberculosis. That is true also of China and other Asiatic countries, where about 50 per cent, of the people are affected. When one sees the conditions under which the people are living and working that is no cause for wonder. The average dormitory allotted for sleeping to the young girls who work in the factories is only 6 feet by 3 feet, which is the size of their straw tami mat. Twenty-five to ‘thirty girls lay herded together in an area approximately 15 feet by 15 feet, lt is no wonder that the incidence of tuberculosis there is very high. The same applies to the native people in New Guinea. For the sake of warmth, security and protection, there is a great tendency for them to huddle together, and that is one of the main factors in the spread of the disease. It is not hereditary, and is not necessarily passed down from father to son or from motherto daughter. There are several means, of treatment, some of which are very expensive. An ex-soldier friend of mine, who suffered from tuberculosis, was treated with gold. ] have heard of several other forms of treatment which have achieved varying degrees of success. Whilst I do noi know what the medical people think of the use of mutton bird oil, which is produced in Tasmania, it is certainly favoured by the miners in South Africa, who work at very great depths extracting diamonds. It is very good for the treat ment of any pulmonary complaint and is very keenly sought. A considerable quantity of this oil was shipped to South Africa before the .war. The inclusion of vitamin A tablets and cod liver oil in the diet plays an important pan in combating the disease. People should be educated regarding diet deficiencies and what they should provide for their children. A hardy race cannot be built on a diet of cream puffs and mince pies. The children should be given good nourish ing food which is available in abundance in Australia. -
The plan envisaged in this bill is to be directed by the Commonwealth Director of the Division of Tuberculosis, in consultation with Ministers of Health, held recently at Canberra. That cooperation is very necessary and most heartening. Provision has also been made to overcome the financial difficulties thai arise when persons contract tuberculosis. Very often people, particularly breadwinners, who have a suspicion, or definite knowledge that they have the disease, conceal it because of the economic factor. The provision which is made in this bill to assist such people financially is to be commended.
When visiting sanatoriums, particularly one in Tasmania, I learnt of the acute shortage of nurses. That State is more advanced than the other States in the matter of facilities for the treatment of tuberculosis. Steps should be taken to encourage the enlistment of suitable personnel to be trained as nurses and nursing orderlies. The training of competent male nursing orderlies is a matter in connexion with which the Minister for Post-war Reconstruction and the
Minister for Repatriation may be able to assist. There is available quite a large number of men who had wide experience and good training during the war in the Australian Army Medical Service. There is an acute shortage of competent nurses who have been fully trained in the treatment of tuberculosis.
I agree with the Minister’s statement that attack is the best means of defence. We are attacking this problem in a big way. Our object is the eradication of this disease in our time, and I consider that that is a very worthwhile objective, which can be achieved. This bill provides for an all-out attack on tuberculosis. In my opinion we should give it the greatest amount of publicity possible. Last evening in the Senate Clubroom honorable senators viewed a screening of a very fine animated colored cartoon depicting Britain’s social services programme. I see no reason why something of that nature could not be provided by our Department of Information, to assist the Minister with his campaign. No doubt other honorable senators have noticed the vast amount of publicity given to the necessity for the eradication of venereal disease. We should do more than merely exhibit notices; we should campaign actively against people who spit indiscriminately, and do other things which result in the spread of tuberculosis. [ am not a medical man, but I have been told that the tuberculosis germ is present in our organisms at all times and that only under certain conditions does it develop. I consider that a great deal of money and time should be expended in tuberculosis research. New methods to combat many of the terrible scourges which afflict humanity may be discovered. There may be potential Louis Pasteurs and Lord Listers in Australia. Every effort should be made to discover the organisms that cause tuberculosis, then to isolate them, and develop the attack on that basis. As the Minister for Health very aptly reminded us -
Peace hath her victories. No less renowned than war.-
If we can knock this scourge out in our time, let us do so. It may take a decade or two to accomplish but if Australia is the first country to do it, that will be numbered amongst the most important of this country’s achievements.
.- In dealing with this subject one must allow his mind to recall events in early childhood in order to comprehend fully what the ravages of tuberculosis have mean not only to the people of Australia but to the whole world. In the middle of last century the word “ tuberculosis “ was unknown. The name of the disease was then “ consumption “. The diagnosis of the medical men at that time was thai “ so and so is suffering from consumption “. During the latter half of the century the disease was known as the “ white plague “. The medical men of those times knew little more about tuberculosis than the ordinary laymen of to-day knows. The method of treatment of consumption in those days was to plug up all the keyholes and build a big fire in the room. In many instances that resulted only in hastening the death of the patient. This Government has benefited by experiences of the past, as also has the medical profession. It has been stated, publicly, that we have people who. given the opportunity, could wipe out tuberculosis in approximately 25 years. It is interesting to note that Denmark has done more than any other country to eradicate tuberculosis. The Danes have made such progress in this field thai they estimate that the disease will be eradicated in their country within the next decade. Even ten years ago these proposals would have been described as purely fanciful. Under this measure subsidies will be made available to the States subject to the approval of the Minister for Health. Whilst the State health authorities are to administer the scheme, the Commonwealth will finance it, a provision with which, I believe, most honorable senators will agree. It is obvious that without financial assistance the States would not be able to make much progress in the fight against tuberculosis. The Minister in his secondreading speech referred to the approximate numbers of people suffering from tuberculosis. He said -
Although improvements in living, housing and working conditions have been brought about there was still between 30,000 and 40,000 known tubercular sufferers in Australia.
Asone who hasrepresented theworkers for many years in different phases of community social activities, I have to admit that much of the prevalence of tuberculosis in this country during the past century was due to bad housing, lack of proper ventilation in homes and lack of correct foods. Every medical man agrees that bad housing conditions encourage the spread of tuberculosis baccili. However, the provision of proper foods is equally as important as the provision of hygienic housing conditions. The Government commenced its attack upon this courge by taking the practical step of calling into conference the State Ministers of Health. The very fact that such a conference was held, has helped to create a social conscience upon the subject and enabled the people to realize the seriousness of the disease. Many of us can recall the practice prevalent among our acquaintances in our younger days when young men and women, after staying out late at a ball the preceding night, would rush off to work the following morning without having anything at all to eat. That would happen two or three times a week; and so those young people became easy prey to tuberculosis.
Apart fromthe State health authorities, local governments are doing much within their limited spheres to check the spread of the disease. The council for the municipality in whichI reside has already made provision for the X-ray examination of local residents, both young and old, in a survey of the prevalence of the disease within its area. The proposals now before us are a logical continuation of the policy implemented by the Government during the war years. The Department of Labour and National Service, so far as it was able to do so under national security regulations, made available officers, including medical officers, to supervise and improve the ventilation of war factories. As a part of its programme, steps were taken wherever possible to provide hot lunches and correct foods for factory workers. This measure, therefore, is in keeping with the Government’s general policy of safeguarding the national health. Generally speaking, the State health authorities have co-operated to the fullest degree with theGovernment in this field.
Officersin charge of this particular phase of the Government’sSocial legislation have gone into this problem thoroughly Senator Murray referred to the provision of adequate nursing staff for the cart of patients suffering from tuberculosis. Our health authorities have asked the immigration authorities to increase the quota of female nursing assistants and female domestics to be made available for training in hospitals and sanatorium in the nursing profession or domestic field and that such nurses or domesticsbe brought to Australia under the nomination of hospital and sanatorium authorities who would be able to guarantee them adequate accommodation Thus, the Government is leaving no stone unturned in its attempt to eradicate tuberculosis. In addition, it has agreed to make provision to enable medical officers of tubercular services to attend post-graduate courses to study thoracic diseases. In that way, the medical pro- fession will become more conversant with the latest developments in the treatment of tuberculosis. The medical profession has advanced with the times. When I was a young man, the view of the medical profession was that tuberculosis was a hereditary disease. The profession has since revised that diagnosis. Medical science has established that tuberculosis is nota hereditary disease. In view of that fact it is well within the bounds of possibility that a government can, by progressive legislation, ultimately eradicate the disease from the community. Untila few years ago, when the Government provided sickness and employment benefits, a breadwinner who contracted tuberculosis retained his employment as long as possible, because otherwise his wife and family would practically be obliged to starve. That outlook was not surprising when we realize that economic conditions in the past did more to spread than to check the disease. About 80 per cent, of the people really believe that tuberculosis is a hereditary disease, whereas it is infectious and contagious. No tag will be attached to the sum of £250,000 which will be made available annually under this measure to the States for the purpose of combating tuberculosis.
Le effect,, the Commonwealth now says that: it. will finance the construction of: any building which a State may require: for- that’ purpose,, the only condition being: that all grants must be approved, by the. Minister:.
– That is socialization.
– It may be;, but the family of & man who is- suffering from, tuberculosis, will, not be concerned, whether- this. proposal i& socialistic in. character.. That man will grasp the opportunity afforded to him under thislegislation to recover his health. Apart altogether- from the benefits which will be made available- under this bill, a married’ man who is1 now suffering from tuberculosis is- eligible to receive, in addition to child endowment, a minimum benefit of £4- a> week. That provision hasalready helped’ to check- the practice-, so prevalent in the past, of sufferers from, the. disease remaining- in- their employment as- long as* they could possibly carry on for fear- that their families would, be deprived of- their earnings! These, PrOposals are* not based, on mere theory; they have been evolved and endorsed by the medical experts1 in- the employ of. the Government who specialize, in the treatment of tuberculosis. Under this bill, the Government seeks, to ensure thai men. who. are only 40 per1 cent, or 50 per cent, fit for work after being treated shall be given opportunities to- help themselves. The shortage of trained staffs will be overcome largely by malting available to the- various sanatoriums the services of many people who, having been treated for tuberculosis, are unfitted for more strenuous occupations. Furthermore, the Government will ensure that, the wives and. children of victims shall not want for anything: Invariably, tuberculosis sufferers who become despondent surrender all chance of recovery. A man who has no hope cannot be saved by any means on earth. Hope is the one saving feature. The Government’s scheme will remove from patients and their dependants the burden of worry which so much prejudices chances of effecting cures.
The Government realizes that. Australia needs a. larger population, but the advice of experts, both here and overseas, is that -‘Ut numbers cannot be raised by natural increase within the next quarter of a century to- the leveL necessary for. survival. Therefore the Government, if encouraging, immigration,, but it provides that all migrants must pas.’ a health test. I believe that, ii. the- near future,, we shall have a system of diagnosis, by which tuberculosis infection can be discovered in the early stages, and cured. That would be a monumental achievement: I have very great pleasure in supporting the bill. Such a measure should be removed from all considerations of politics and sectarianism. Wa want, to ensure that every person who suffers from tuberculosis in any- form shall be able to rid himself of the complaint immediately. I believe that the measures being taken by this Government will lay the foundations for a future state of society in which it will be impossible for. tuberculosis to survive.
– I join, with, my colleagues ingiving a very warm welcome to the- bill Some time ago* the Minister for Health (Senator McKenna) cheered the people of: Australia by announcing that, he would soon introduce a measure to establish n national health scheme. I. hope that this bill will fit into, the plan that, he. has in mind. To me, it, is one of the first concrete signs of the Government’s intention to tackle the problem of preventive medicine as. well as that of curative medicine. In the past, a great deal of attention has- been paid to the curative aspect of medical research, but little has been done to organize preventive medical services;, a work which I believe, to be of the first importance. The results: tha* can be achieved by prevention are exemplified, by the success of the campaign against diphtheria. That disease may not be. so difficult to eradicate as tuberculosis, but amazing results- have, been gained by attacking it on a national scale-. By means of propaganda made available to schools and institutions, people have been made conscious of the dangers: of diphtheria and have learned of the correct methods of combating it. This. has led to the almost complete eradication of the disease in Australia. Few parents have not been advised at some time of the necessity for having their children- immunized against diphtheria. The result i* that to-day the disease is under control and almost completely eliminated.
The Minister has submitted to the Senate a skeleton plan for the campaign against tuberculosis. We all know that this is a much more serious complaint than diphtheria and presents more difficult problems to medical science. Senator Katz has ‘emphasized what I have often heard, namely, that tuberculosis is a disease of poverty. It is a result of bad housing, ill nourishment and lack of sunlight and fresh air. It flourishes in the slums of our cities. The Minister hopes that, by means of this bill, tuberculosis will be stamped out within a measurable time, but I admit to a feeling of scepticism. I am not a medical scientist, and therefore 1 am prepared to accept the advice of professional experts. However, for, many years I have believed that the best way ro combat tuberculosis is to clear our slums and provide the people with adequate nourishment and proper houses where they can have sunlight and fresh air. Perhaps the desired result can be achieved in some other way which will be more effective. I realize that the task of housing our people and giving them r-he attention that they need is a difficult me and cannot bo accomplished quickly. Therefore, I shall be very happy if the Minister’s hopes are realized. Attempts to eradicate tuberculosis have been very haphazard up to the present. Various State governments have given some attention to the task, but with very poor results. A few years ago I had the opportunity to travel around Australia as a member of the Social Security Committee. Medical experts in all States impressed upon the committee the seriousness of tuberculosis. A very prominent doctor in Sydney declared that at least 70 per cent, of the people in that city were infected with the tuberculosis germ every month but that most of them were strong enough to throw off its effects. A doctor who was in charge of the State tuberculosis sanatorium in South Australia described the shocking conditions under which patients were housed. The wing which they occupied was situated between the main wing and the mortuary of the hospital to which it was attached. Senator Katz has stressed the importance of preventing patients under treatment for tuberculosis from becoming despondent. The doctor told the committee how bodies were wheeled every day along a corridor in the sight of patients in the tuberculosis ward. The procedure became so commonplace that the patients conducted a daily sweepstake on the number of bodies that would be taken to the mortuary. That was due to lack of finance. The Government has a big task to perform in providing for more sympathetic methods of treatment’, of sufferers.
We have been told that the entirepopulation of Australia oan be submitted, to a thorough radiological examination, quickly and cheaply, and with beneficial results. A few years ago about 1,000,000 young men and women whoenlisted in the armed forces were submitted to chest examinations. At tb al time it would have «been possible to extend the system to all age groups and thus secure valuable information about the state of our national health. Such a series of tests would probably have disclosed many incipient cases of tuberculosis which could have been checked.. However, I see a danger in carrying out such an investigation to-day. Our hospitals are hopelessly overcrowded. In the district where I live, people waiting toundergo surgical operations have to wait for six months or longer to obtain hospital accommodation. The same state of affairs prevails everywhere. What would be the effect of conducting a nationwide chest survey and pointing out to thousands of people that they were in the early stages of tuberculosis but, unfortunately, could not be treated because of the lack of facilities and would have towait until new hospitals were built and extra staffs were trained ? I do not know what attention the Minister has given to that aspect of the problem, but it wa> the subject of a great deal of earnest thought by members of the Social Security Committee, which made somerecommendations on the matter. Hospitals cannot be erected and stafftrained overnight. In order to stamp out tuberculosis, many more hospital.and much more equipment must be pro vided. T urge the Government to give- very serious consideration to this problem before proceeding with any largescale measures for examining the chests of the people. I had intended to stress the economic aspect of the tuberculosis problem, but that has been dealt with adequately” by Senator Katz. Doctors confirm that many patients who have tuberculosis in its incipient stages, will not leave their employment and rest for ray nine or twelve months as they must lo if they are to be cured, because they cannot make adequate provision for the sustenance of their families. Those patients generally say that they are not very ill, and will carry on a little longer. Unfortunately, only too often they carry on until they are forced to give up their work, by which time it is sometimes too late to be cured. The Government has contributed towards a solution of this problem by providing benefits for the dependants of sufferers from tuberculosis. In Great Britain the treatment of this disease has been tackled in a new way. Special workshops have been established at tuberculosis treatment centres, and as patients improve they are allowed to work for one, two or perhaps three hours a day at suitable occupations. They are paid for their work, and the interest that chey take in it assists the cure. This rehabilitation progresses as the cure nears completion, until finally the patient is quite ready to go back into industry. That experiment could well be studied by the Australian Government with a view to providing similar establishments in this country.
X am pleased that the Commonwealth Parliament has at last decided to tackle the tuberculosis problem on a national basis, and, that it will be no longer bandied in a haphazard fashion as it’ has been in the past by the States. I believe that if a concerted attack is made on this disease, it will be possible to stamp it out within a measurable period. [ compliment the Minister on the intro.duction of the bill.
.- The introduction of this measure is further evidence of the Australian Government’s desire to safeguard the health and welfare of the people of this country. The main problem that has confronted the.. States in- dealing with tuberculosis has been that of providing sufficient finance. In Western Australia, quite a lot ‘of thought has been given to the matter, and some years ago an anti-tuberculosis committee wa> formed to consider methods of combating this disease. Unfortunately the lack of finance hampered progress-. Tuberculosis must be tackled as a national problem. With the assistance of the State governments, the Commonwealth hopesto be able to stamp out the disease entirely before many years have passed. J am confident that all State governmentirrespective of their political colour, will co-operate to the best of their ability. The task confronting the Commonwealth is difficult. Throughout the Commonwealth there is a shortage of hospital accommodation for sufferers from tuberculosis. In Western Australia, there is the Wooroloo Sanatorium and the McMillan Home, but the latter is mainly for exservicemen, and in both institution* accommodation is limited. If the Commonwealth will finance the erection of new buildings in all States, it will he making a worthwhile contribution to the solution of the tuberculosis problem. Senator Murray mentioned the operation of mobile X-ray units. These units are doing excellent work. I believe that s start should be made with the school children because if tuberculosis can be eliminated from the younger generation, we shall be well on the way towards itcomplete eradication.
Under our migration scheme, we are admitting to this country many thousands of Europeans, some of whom come from displaced persons’ camps and former concentration camps in which they were underfed, badly housed, and ill clad for seven or eight years. I should like an assurance from the Minister for Health (Senator McKenna) that these people are being thoroughly examined for tuberculosis before being permitted to embark for this country. Every tuberculous migrant who reaches this country will cost the Commonwealth many hundreds of pounds. The medical officer at the Hollywood hospital in Western Australia told me that after World War ]. quite a number of people who migrated to this country were found to bo suffering from tuberculosis. . He told’ me also the cost to ‘the State of .every patient who passed through the Wooroloo hospital.
I .believe too, that closer attention ‘could be given to conditions in shops and factories as a means of .minimizing tuberculosis. Inspectors appointed under the shop and factory legislation ‘of the various : States should be empowered to insist upon the improvement of conditions which they .consider to be conducive to tuberculosis. In moulding foundries, for instance, dust and fumes are prevalent, and in the “ dressing “ shops of these “plants there is a high percentage if emery dust in the air. Such ;conditions aggravate tuberculosis. The authority to inspectors should be sum.cient to enable them to insist upon the elimination of dangerous working conditions.
One of the most serious problems that she Commonwealth will encounter in implementing this scheme is the shortage of trained hospital staffs. Not long ago, the staff at “Wooroloo Hospital, “which normally is 80 -or 90, fell to approximately .20. Fortunately the institution secured the ‘services <of 30 or 40 migrant girls who, according ito information that I have received from Dr. Henschall, are doing excellent work. I believe that we .can look to our migrants to assist -us to solve our hospital staffing problem, because hospital employees to-day enjoy conditions “which aTe undreamt of in the countries from which many of these people have migrated. With proper selection and tuition, T am sure that migrants will make excellent attendants ind wardsmaids.
According to medical authorities, tuberculosis requires not only medical treatment but also psychological treatment. It is most important that a patient should .have ‘complete rest and freedom from worry. There is, of course, a prescribed diet, but rest and contentment are most important. For this reason it is essential that a married man who enters an institution for treatment should be assured that his dependants shall be adequately cared for. Sometimes men who cannot help worrying about their families are permitted to go borne provided they observe certain conditions, and take the required periods of rest. Adequate provisions for -the dependants of sufferers from tuberculosis if necessary,, therefoi:e, if a .rapid -cure iwto ,be effected.
E.very member <of the Senate, I am sure, will take a .keen interest in the progress of this scheme. As I have said, the main trouble in all States in the past has been the shortage of money. Medical men have not had the funds that they required to deal with this ‘diseasein an adequate manner. Now the Commonwealth is coming into the field, and 1 hope that within a few years -we shall see a great improvement in tuberculosisstatistics.
Senator SHEEHAN (Victoria) [8,58 J - -The debate on this measure has beer, most interesting and I regret very much that it ‘has not been broadcast, because 1 believe that it would have done much tobring home to the people -of this country the necessity for a concerted -attack on this dread disease. It is appropriatethat this legislation should have been, introduced by a Labour government, because, although tuberculosis is no re- spector of persons ‘and is not confined entirely to any one section ‘of the community, conditions in our factories and workshops and also in some Australias, homes, render -working people more susceptible to the disease.
– What, after seven .years of Labour rule!
– After 49 year* of federation for most of which, antiLabour parties have occupied the treasury bench in this Parliament. Because the validity of the Pharmaceutical BenefitsAct was challenged in the High Court in order the prevent the Parliament from doing something for the people, the pre sent measure had to be introduced. Unfortunately, the Parliament is nandi capped by a written Constitution, and ob every occasion that a Labour Government has sought to extend the powers of the Parliament to grapple with great national issues the present Opposition parties have taken advantage of technicalities in the Constitution in order to frustrate the attempt. When specific issues have been referred to the people by way of referendum, those parties have done their utmost to persuade the people not to extend the powers of lit; Parliament. The result of the referendum which was held some time igo and which conferred some power on (he Parliament to legislate in respect of social services was an outstanding exception to the general rule, but even now he powers of tho National Parliament to legislate in regard to social services is not complete. Whilst the Government s prepared to go a long way in order to achieve its humanitarian objectives it must be borne in mind that it has to overcome the obstacles presented by the necessity to obtain the consent and cooperation of six State governments. The National Government is not empowered to build, hospitals and sanatoriums for the relief of sufferers from tuberculosis in the States, and when it seeks to do so it has to solicit the co-operation of the States. [n the -course of this debate an important point was made in regard to the necessity for obtaining uniform legislation for the protection of the health of factory and other industrial workers. For many years I spent a considerable time inspecting -conditions in factories and industrial undertakings, and any one who lias had similar experience must have been shocked by the primitive conditions under which so many men have to spend most of their working lime. Faulty sanitation and complete lack of sanitation are not uncommon in many plants. After all the efforts which have been made over a great number of years to induce or to compel employer* to provide ordinary decent conditions for their employees, it is most depressing to realize that even to-day the National Government cannot legislate directly in
Mich matters, but must seek the cooperation of State authorities. If the National Parliament were equipped with adequate powers how much easier it would be for us to organize a campaign to eliminate tuberculosis and some of the other frightful diseases which afflict so many people! There are many other humanitarian objectives which the National Government is prevented from achieving because of the distribution of legislative powers in this country. Nevertheless, it is our duty to do everything we can to exercise our limited powers in the interests of the people.
The present measure is designed to combat the spread, of tuberculosis rather than to prevent it. We must go further, and plan to overcome the incidence of tuberculosis just as we should prepare to defend ourselves against attack by « hostile army. We must go into the schools ;and impress upon the children the menace to their health presented by tuberculosis. During the course of hit second-reading speech the Minister foi Health (Senator McKenna) reminded us of the large number of tuberculosis victims with whom each of us wa> acquainted in his youth. What was th» attitude adopted by. the community to wards sufferers in those days, and what is its attitude to-day? Many people stil! adopt the attitude that the sufferers are somehow responsible for their condition and they treat those stricken with th* disease as though they were outcasts. W* must change the general attitude of th* community towards the afflicted, and 1 am, therefore, extremely pleased to learn that provision is to be made, through the Department of Social Services, for the payment of allowances and sustenance to sufferers and their dependants.
Excellent speeches have been made h> honorable senators who have taken part in the debate, and I do not want to re peat what many of them have said. However, I impress once more upon th* Senate the difficulties which confront th* National Parliament when it has to deal with matters of such importance. I trust that the constitutional difficulties which have obstructed the National Government in its efforts to combat tuberculosis will impress upon honorable senators the necessity for conferring upon the National Parliament adequate legislative powers. I commend the Government for introducing the measure, with the provisions of which I entirely agree, and 1 express the hope that its passage will be a forerunner of continuous cooperation between the National and Stat* parliaments to .stamp out the scourge of tuberculosis.
– in reply - I express my gratification at the reception accorded to this measure by all honorable senator* who have taken part in the debate, and
L compliment them on their contributions, which have .been most interesting. Their speeches were all the more meritorious because of the very short notice which .they had of the Government’s intention to introduce the measure. Senator Arnold was quite right in stating that the provisions of the measure and the contents of the speech which I delivered merely outlined the plan of campaign to be waged against tuberculosis, without furnishing much detail, The Government does not consider it desirable at this stage to develop full details of the plan. However, many interesting features of the situation in regard to tuberculosis aro referred to in the measure now before us and in the second-reading speech which I delivered. A number of other important aspects has been mentioned by honorable ‘ senators who have taken part in the debate <md 1 propose now to deal with them.
The unqualified support given to the measure by the Deputy Leader of the Opposition (Senator O’sullivan) was most welcome. The honorable senator referred to sub-clause 4 of clause 5 of the bill, and pointed out that in determining the net expenditure of a State for the year ended the 30th June last, which is to constitute the base year, any allowances paid by the State from moneys provided by the Commonwealth should be disregarded. However, the Commonwealth is already paying moneys to the States under different heads towards the cost of the attack on tuberculosis, and the present measure provides that all moneys expended after the base year 1947-48 for capital and maintenance purposes in excess of those incurred in that year by the State concerned are to be paid by the Commonwealth. For that reason it will uo longer be necessary to make payments under the Tuberculosis Act and other acts passed for the purpose of combating the disease. We shall ascertain the amounts spent by the States apart from moneys provided by the Commonwealth, and having determined that sum, we shall in future pay all amounts expended in excess of that sum.
The honorable senator also referred to clause 9 of the measure, which provides for payments to be made to sufferers from tuberculosis and their dependants, and expressed the fear that the distribution of the allowances’- referred to in the clause might be removed from the supervision of the State governments. That may or not prove to be the case. Sub-clause 2 of clause 9 provides that-
Allowances under the last preceding sul/ section -
shall be payable to such persons oi classes of persons, subject to such conditions and in such manne* as the Director-General, subject to the direction of the Minister determines ;
That provision is an optional one, whereby the Government can, if it wishes, arrange for the present procedure to continue, or may discuss with the States the necessity for making a change. After experience of the operation of the measure, and discussion between the Commonwealth and State Governments, it may be considered advisable for the Department of Social Services to assume sole responsibility for the distribution of allowances to sufferers from tuberculosis Many of those sufferers are receiving invalid pensions, and their affairs have been investigated by that department. For another reason, which I shall explain presently, it might also be considered preferable that one department should distribute the allowances, invalid pensions and any other payments to which sufferers and their wives and children may be .entitled. The other consideration which I had in mind is that the social services consolidation measure imposes a means test on applicants for invalid pensions. They are not permitted to draw invalid pensions if they are capable of earning more than 15 per cent, of the normal wage.
Other honorable senators referred to the acute shortage of nurses and hospital staff, but it may be possible to modify the application of the means test to hospital and sanatorium patient* so as to encourage those who are physically fit to do so to offer their services, in return for payment, to the institutions in which they are patients. If that suggestion is practicable the shortage of staff will be overcome to a considerable degree. At present many patients who are able to perform light duties would offer their services in return for payment nut for the operation of the means test. Of course, it is not contemplated that patients who offer to work would be permitted to do so unless their medical advisers approved. The Deputy Leader of the Opposition expressed concern that the treatment of patients suffering from tuberculosis might be removed from the control of the State authorities, but I point out to him that there are certain considerations, such as those which I have outlined, which may favour a change of control. The honorable senator also stressed the need for ensuring that there would be no duplication of the functions of the Repatriation Commission and the Department of Health. I acknowledge the need to exercise care to prevent such duplication. However, the Minister for Repatriation has been most co-operative, ±nd he recognizes the need for complete collaboration between all the authorities engaged in that field. A very good instance of such goodwill was given by Senator O’Byrne, when he pointed out that already the repatriation authorities in Tasmania, in conjunction with my department, have agreed that the two tuberculosis institutions proposed to be built at Hobart and Launceston respectively, shall not be planned on the basis of separate institutions for civilians and for ex-service men aid women. There will be a wing or floor reserved for ex-service people, who have a very real reason to be together following associations during the war. They have a community of interest. The hospital to be built at Hobart will house both ex-service men and women, and civilians. The ordinary services of the institution will he available to both types of inmates. The ex-service personnel may have their own resident medical officer, but the honorable senator can rest assured that the repatriation authorities are most co-operative and have. generally speaking, made available throughout Australia, at my request, beds in tuberculosis institutions under the control of the Repatriation Department tor civilians. I do not think that honorable senators need have any misgivings about this matter; a full degree of cooperation will be forthcoming from the Repatriation Department.
asked a question about an aspect which was not dealt with in my second-reading speech and is not covered by the bill, namely the personnel of the Advisory Council. What is in mind is that the Advisory Council shall be presided over by the Director-General of Health. The Commonwealth Director of Tuberculosis, another nominee of the Commonwealth, and the six directors of tuberculosis in the States will also be invited to attend that council. Only three of the States have full time directors ‘ devoting the whole of their time and services to tuberculosis, but all States have agreed to make permanent appointments of whole- time directors. Each of them will be invited to attend the Advisory Council. The Director of Tuberculosis for the Repatriation Department will be a member. In addition, certain medical experts in tuberculosis will be members. I suggest that that is an ideal organization which will provide a perfect liaison between all bodies interested - the Commonwealth Department of Health, the States, the medical profession, and the Repatriation Department. Standards can be evolved and plans discussed and agreed upon.
Another matter referred to by Senator Critchley was that of the compulsory radiological examination of the people. Our lack of power in relation to compulsory radiological examination and the detention of recalcitrant infectious patients, and the necessity for ensuring treatment of certain rare cases . arises rather unexpectedly. The power conferred upon this Parliament at the referendum held in 1946 to provide medical services was cut down by the addition of the words -
But not so as to authorize any form of civil conscription.
At the time it was thought that that would effectuate the intention of the Government not to nationalize the medical profession. Unfortunately those word? have a wider connotation than the original intention of the Government. They raise real doubts as to whether the Government can compel people to undergo radiological examination or enter sanatoriums. There is, however, an agreement between the States and the Commonwealth. In the rare cases where it will be required, there, will be the element of compulsion, which is necessary for the protection of society. My own belief, after canvassing the field, is that resort will be required to that power in. very few cases indeed. I deplore the publicity which has been given, not only in the press but over the air, to the small element of compulsion that will be necessary in an approach to this disease.
The States have agreed that the Commonwealth shall draw model legislation, which they have undertaken to submit to their respective Parliaments so that compulsion, where it is necessary, will be available on an even basis throughout the Commonwealth. Some States already have the necessary power. Tasmania is about to introduce legislation to ensure that there shall be compulsion where it is absolutely necessary.
I entirely agree with Senator 0’Flaherty regarding the training of doctors ‘in the treatment of tuberculosis, [n my second-reading speech I contended that more adequate training of members- of the medical profession should be embarked upon and that training hospitals, and institutions should be developed in a way that would permit both undergraduates and nurses, undergoing training courses to become familiar with the symptoms of the disease, its diagnosis, and treatment.
The really great problem which faces anybody seeking to attack tuberculosis ia the great dearth of specialists and trained personnel in this country - chiefly radiologists and radiographers - without whom the attack cannot be directed effectively or intelligently. Senator O’Flaherty referred also to the subject of rheumatic fever, but be acknowledged that it does not come within the scope of this measure. I agree that rheumatic fever has bad after-effects and that, togetherwith its allied troubles of rheumatoid arthritis and other arthritic complaints, it takes a very heavy toll in this country in human suffering and misery. That is a matter which, may properly be considered by the National Health and Medical Research Council which the Australian Government set up. and io< which it provides the sum of £50,000 per annum- for purposes of research.. T assure, the honorable senator, that- the capital expenditure to be incurred by th,States after the 1st July, 1.948, will bt thoroughly surveyed in advance by the Commonwealth, and that the machinery I have already indicated for the Advisory Council to. provide full collaboration on a very excellent basis between Commonwealth and States .will ensure uniformity as to sites and types of buildings. The Commonwealth, in its Division of Tuberculosis, is building an expert group of persons comprising not only medical men but also architects who an specialists in hospital construction. Those experts will be able to furnish advice or the latest and most effective developments. As the Commonwealth is committed to finding not only the whole of the additional capital expenditure, but also the whole of the extra maintenance expenditure that will be incurred from the 1st July this year, we shall keep a watchful eve upon the maintenance ex:penditure of the States as well as upon capital expenditure.
Senator Aylett in the course of a very interesting contribution to the debate, born of broad experience-
– The honorable senator’s remarks were very interesting.
– I thought thai Senator O’sullivan would find them so. That was the only occasion on which the honorable senator interjected. I gauge from that fact that Senator Aylett really did stimulate his interest.
Senator Aylett referred to difficulties in the field of silicosis. Whilst that does not come within the ambit of the National Health and Medical Research Council, much consideration has been given to the new process of treatment with aluminium dust, to which the honorable senator referred. The council investigated that method of treatment but hat not yet accepted it as a proven remedy, although it is still under consideration. Honorable senators will be interested to learn, however, that silicosis is to be the subject of the pneumoconiosis conference to be held in Australia, conducted under the International Labour Organization. In the School of Public Health and Tropical Medicine,, early in 1949. silicosis will be a subject for consideration. The fact that this world conference is tobeheld in Australia is a tribute to Australia for the initiative it has already displayed in an approach, to that particular problem. Arising from those thoughts, too, the Government has recently authorized the establishment of, a unit of industrial, hygiene at the Sydney University and in the School of Public Health and Tropical Medicine. That unit is designed for postgraduate study by medical practitioners, to enable them to specialize in the treatment of all types of industrial diseases. They will investigate causes, of, and devise remedies for noise, dust, fumes, vibration, fatigue, light, and all other problems affecting men working in industry under difficult conditions.
Senator Murray, in the course of his remarks, referred to the capital expenditure of £500,0 00. That is the estimate for new capital expenditure to which the Commonwealth will be committed in 1948-49. Thereis no limit laid down in the bill as to the amount which may be expended by the Commonwealth on either capital or maintenance expenditure. When the Australian Government embarked on an approach to this problem it considered first, not the expense but the need, the amount of human suffering involved and the vast economic loss to the nation that this disease has caused and will continue to cause unless arrested. It is estimated that at the peak of the development of the plan, the Australian Government will be providing approximately £2,000,000 per annum. The amount will taper off in the later stages of the campaign. Throughout Australia today there are in hospitals vacant beds for patients suffering from tuberculosis, despite the large number of people who are in need of such beds. That arises from difficulties connected with staff, and indicates the acute shortage of nurses and of domestic staff, who are not readily available. The Minister for Immigration (Mr.Calwell) is helping appreciably by directing to tuberculosis hospitals, displaced persons arriving in this country. He is following a policy of directing them to institutions and to activities throughout Australia that, in our policy of full employment, ourown people are not so ready to undertake. Those institutions in the States are very grateful to the Commonwealth,and to the Minister for Immigration in particular, for the great helphe has given to them in providing, them with those displaced persons.
Senator Harris referred to the necessity to examine displaced personsto ensure that they do not bring infection in with them. I can assure the Senate that very special precautions are taken.Not only are the displaced persons X-rayed before embarkation but,on arrival in Australia, they go into a camp and are X-rayed again and thoroughly examined. The Senate may rest assured that adequate safeguards are exercised.
Senator Arnold referred to the possible damage resulting, from X-raying all of our people and locating all those who may to some degree be infected with tuberculosis, when we know that the full facilities for treating them are not available. My view, and the view of my department, is that we should not postpone our case finding until, we have available all necessary facilities. It is infinitely better to attack this disease in persons, at an early stage, when it can be arrested far more easily, than at a later date. In the early stages it is not so infectious ; there is not a vast danger to the community if the sufferers are properly instructed in methods of hygiene, and told, how to prevent the spread of the disease. So, the important thing, from, the, viewpoint of those who advise me, and my mind runs entirely with them, is that one of the earliest phases of the attack will be to locate the persons who are infected and ascertain the extent of the problem. Even if we cannot immediately accommodate them in institutions, we can so instruct them that they will not be a source of danger to others and will be able to embark on domicilary treatment in their own homes and to their own advantage, and so speed up the arrest of their disease and the consequences of its development.
In conclusion, this approach by the Government to tuberculosis is just one more step in the field of preventive medicine which has marked the course of the Department of Health during the last two years. I should require quite a time to tell honorable senators about all the activities of the department, which make for public welfare and public health. I simply draw attention to the fact that for some time we have been training pathologists at the School of Public Health and Tropical Medicine, at Sydney. They will be drafted to pathological laboratories throughout Australia. Several new laboratories are to be established in the near future. Recently, we established a Division of Child Health within the department. Authority has been given for the establishment of an Institute of Child Health at the Sydney University. A new chair will be established, and it will be an adjunct of the Commonwealth school there. Under the Acoustic Laboratories Act we have established acoustic laboratories to investigate the incidence of noise. We have approved of dental standards ; and some time ago I made a statement to the Senate announcing the free issue of diphtheria and whooping cough serum, or vaccine. Those activities show that the Common wealth is fully alive to the development of preventive measures in its approach to the problem of the national health. What we are doing tonight will be not only a mercy and a help to sufferers from tuberculosis and a safeguard to the great bulk of the people, but also a basic contribution, as I said in my second-reading speech, towards the protection of the health of young Australians not yet born. As one honorable senator said to-night, this measure will be a potent factor in building sound, healthy bodies in Australians.
Question resolved in the affirmative.
Bill read a second time.
In committee:
Clauses 1 to 4 agreed to.
Clause 5 (Arrangements with States).
– Can the Minister for Health (Senator McKenna) give the Senate some idea, in terms of figures, of the financial commitment involved under the clause f I understand that the Commonwealth will not reimburse the States in respect of allowances now being made bv them; that the Commonwealth will meet only expenditure in excess of that incurred in the base year, and that in the calculation of the excess expenditure allowances paid by State governments to sufferers from tuberculosis will not be taken into account.
– I suggest that the Deputy Leader of the Opposition (Senator O’sullivan) should start with the proposition that the Commonwealth wishes to ascertain what tuberculosis is costing a State actually from its own resource? without any aid from the Commonwealth. Having ascertained that figure, the Commonwealth will meet all additional capital and maintenance expenditure. The honorable senator will agree that if we are to do that, there is no need to pay again amounts which the Commonwealth is already paying under these various heads to the States which they then dis burse. We are already paying those amounts at the present time. In respect of beds occupied by patients suffering from tuberculosis the Commonwealth is paying 6s. a day for each bed. We have not yet paid a great deal to the States under the TuberculosisAct. That act contains a provision whereby the Commonwealth is prepared to con tribute up to £50,000 on a £1 for £1 basis, towards the maintenance of new diagnostic facilities and another sum of £b0,00i> per annum, again on a £1 for £1 basis towards the maintenance of after-cart facilities. Those moneys were directed solely to the maintenance of new facilities established at the expense of the States in the diagnostic and after-care fields. The purpose of those grants, which were made when the Commonwealth lacked the power it possesses to-day, was to stimulate the States into activity, because the on’ contribution the Commonwealth could then make in the field of tuberculosis was financial. We were not in a position to give any other lead, or assistance; but very few States have availed themselves of any portion of those grants. Some of them have-not availed themselves at all of those grants. Such States have noi built’ new diagnostic, or after-care, facilities. Their failure to do so is due to a good reason, namely, the more urgent need to provide housing. Thus, there iivery little involved under that heading. In respect of pharmaceutical benefits for the treatment of tuberculosis, we have not yet resolved an agreement with the States as to the basis of payments for outpatients and in-patients in intermediate and private wards. That is all that is involved under that heading. The assistance provided by the Commonwealth in that respect i3 either non-existent, or negligible. The provision under paragraph (d) of sub-clause (4) relates solely to State budgets, and it operates so as to exclude from calculation, when we are determining what a State itself expended from its own resources, the income it collected from patients, amounts it may have had or which its institutions may have received by way of donations. The only reasonably large sum which might be involved under the clause is in respect of payments under the Hospital Benefits Act, that is, the payment of 6s. a day for each bed. I regret that I cannot inform the honorable senator of the total amountinvolved under that heading.
. -I am not aware of what amount, if any, is paid by the States to sufferers from tuberculosis. It may be more, or less, than the amount which the Commonwealth contemplates paying. Is there any likelihood of any anomaly arising? In the event of the Commonwealth being prepared to pay sufferers an allowance, the States may desist from paying such allowances in the future. Can the Minister say what amounts are being paid by the States to persons suffering from tuberculosis.
– The amounts being paid by the States are those agreed upon with the Commonwealth, and they are paid from the annual Commonwealth grant of £250,000 which is distributed by the States at rates determined by the Commonwealth. There are a few. exceptions. For instance, in Victoria, in addition to the amount paid by the Commonwealth, that State until recently - I am not informed as to recent developments - was paying an additional 10s. by way of rental allowance. The new rates under these new proposals will be determined and gazetted in the near future, and it is desirable that there should be uniformity throughout Australia, because we do not desire to encourage the States to pay any amounts in excess of those which we shall be paying, whether we distribute them through the States, or pay them direct to sufferers.
– Will all sufferers from tuberculosis in all States be treated on the same basis?
– Yes.
Clause agreed to.
Clause 6 (Powers of DirectorGeneral).
– Can the Minister for Health (Senator McKenna) indicate whether the Government contemplates taking over any particular institutions? Under the clause, the Director-General, under the direction of the Minister, is empowered to acquire hospitals, sanatoria, laboratories, diagnostic centres, after-care, radiological, and other units and clinics for the diagnosis,’ treatment and control of tuberculosis. Does the Government contemplate taking over any institutions which are conducted or controlled, privately?
– The answer to the question just asked by the Deputy Leader of the Opposition is, “No”. He will realize that the Commonwealth has direct responsibility in the Australian Capital Territory and the Northern Territory. We need powers of the kind set out in the clause to cover those two territories. However, as I have already indicated, probably one of the greatest contributions the Commonwealth can make, and might make, directly will be in the field of training personnel. We may need establishments for that purpose. It is desirable that there should be uniformity in the training of nurses in tuberculosis. There should be a uniform curriculum in that sphere. I say without reservation that we have no thought at the moment of taking over any particular institution ; but we need such power in the event that we may require to use it.
– Are there any privately-controlled tubercular sanatoriums in the. Commonwealth at present ?
– Not that I am aware of.
Clause agreed to.
Clauses 7 and 8 agreed to.
Clause 9 (Payments to sufferers from tuberculosis and their dependants).
– Will the Advisory Council be the authority to determine the allowances to be paid? If not, what body will authorize the payment of these allowances ?
– The Advisory Council will have only advisory powers, in accordance with the provisions of subclause 4 of clause 8. It will not have any executive power at all. It will merely advise the Minister. Paragraph (a) of sub-clause 2 of clause 9 provides that allowances - shall be payable to such persons or classes of persons, subject to such conditions and in such manner as the DirectorGeneral, subject to the direction of the Minister, determines :
That will be a matter for determination by the DirectorGeneral with the approval of the Minister. In short, the Government will determine the rates of the allowances.
– The same sub-clause provides that allowances “shall be at such rates (but not exceeding such rates as are prescribed) “ as the DirectorGeneral determines. Have the rates yet been prescribed, or are they to be prescribed?
SenatorMcKENNA (Tasmania - Minister for Health and Minister for Social Services) [9.46]. - In the terms of the bill, they have not yet been prescribed. Certain rateshave been established under the legislation of 1945 and 1946 and there is a provision in this bill that those acts shall not be repealed until a date to be proclaimed. The Government wants the existing law, which provides certain rates of allowances, to remain in force until new regulations are promulgated after this hill has received the Royal Assent. The rates are being revised at present.
– They are to be revised ?
– Yes. There will be a new scale.
Clause agreed to.
Clause 10 (Delegation).
– This clause provides that the DirectorGeneral of Health may delegate all or any of his powers and functions. Why is the right to delegate power not made subject to the direction of the Minister? Clause 6 provides that the DirectorGeneral may do certain things subject to the direction of the Minister, but there is no such qualification in this clause. I am very chary about allowing the Director General to delegate any of his powers without the direction or consent ofthe Minister. We have an excellent Director General, and some splendid officers work under him, but it is possible that his powers will be delegated to somebody; who will not exercise them in accordance with, thewishes of the Government.
– I subscribe to what the honorable senator has said about the excellence of the DirectorGeneral and his staff, but I point out that all powers of substance conferred upon the Director General under this bill will be subject to the direction of the Minister. He will be allowed to delegate only such powers as he possesses, and all of those power s will be exercisable subject to the direction of the Minister. The most thathe can do will be to delegate a power which is liable to control in this way. Then will be full ministerial control. I may reassure the honorable senator by pointing out to him that the only likely exercise of power by the DirectorGeneral under clause 10 will be in relation to selecting the authorities for the payment of tuberculosis allowances. These authorities may vary from place to place in order to meet the convenience of institutions and individuals. The terms of this clause appear in many acts of parliament and they appeared also throughout the National SecurityRegulations.
– Yes, and the provision has been abused too !
– The powers thatthe Di rectorGeneral may delegate willbe subject entirely to the direction of the Minister.
SenatorO’Flaherty. - I am satisfied of the Minister is sure about that.
– I am happy about the position.Full ministerial responsibility will be preserved.
Clause agreed to.
Clauses 11 and12 agreed to.
Title agreed to.
Bill reported without amendment; report adopted.
Bill read a third time.
page 797
Motion (by Senator Ashley) agreed to - .
Thatthe Senate, atits rising, adjourn to Wednesday, the6th October, at 3 . p.m.
page 797
The following papers were presented: -
Commanwealth Bank Act - Appointment - I. A. Butler.
CommonwealthConciliationand Arbitration Act - Regulations-Statutory Rules 1948, No. 117.
Customs Act - Regulations - Statutory Rules 1948, No. 120.
Customs Act and Commerce(Trade Descriptions) Act-Regulations - Statutory Rules 1948, No. 99 (Substitute copy).
DiaryProduce ExportControl Act - Regulations - StatutoryRules 1948, No. 118.
Defence (Transitional Provisions) Act-
National Security (Enemy Property) Regulations - Order- Areas ceasing to be enemy territoryor persons ceasing to be enemy subjects.
National Security(FoodControl)Regulations Order - No. 34.
National Security( Prices)Regulations - Orders- Nos. 3392-3408.
National Security (Rabbit Skins) Regulations Order -Returns.
National Security- (Rationing)RegulationsOrder - No. 155.
National Security (Tea Control) Regulations - Order- No. 9.
Regulations - StatutoryRules 1948, Nos. 114, 121, 122.
Income Tax Assessment Act - Regulations - Statutory Rules , 1948, No. 115.
Navigation Act - Regulations - Statutory Rules 1948, No. 112.
Port and Telegraph Act - Regulations - Statutory Rules 1948, No. 113.
Seatof Government Acceptance Act and Seat of Government (Administration) Act -
Regulations - 1 948 -
No. 2 (Education Ordinance). No. 3(Building andServices Ordinance).
Seat of Government (Administration) Act - Statement of Receipts and Expenditure for the Australian Capital Territory, for year 1947-48.
Services Trust Funds Act - Regulations - Statutory Rules1948, No. 110.
Trade Marks Act - Regulations - Statutory Rules 1948, No.111.
WineOverseas Marketing Act - Regulations -Statutory Rules 1948, No. 119.
Senate adjourned at 9.53 p.m.
Cite as: Australia, Senate, Debates, 23 September 1948, viewed 22 October 2017, <http://historichansard.net/senate/1948/19480923_senate_18_198/>.