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LEPROSY !N W A

DR. COOK'S REPORT. DERBY LAZARET CON DEMNED.

ISLAND SEGREGATION - RECOMMENDED.

The Hony. Minister controlling the Me dical and Health departments (Mr. S.. W. Munsie') this morning made available the report of Dr. Cecil Cook, who, some time aco. visited the North-West of this State and reported to tie Federal and State Go vernments regarding the occurrence of lep rosy and treatment of lepers in Western Australia. Mr. Munsie stated that siaee

the report had been received he had been advised that it was intended Dr. Cook should make another visit to the .Northern Territory regarding the question of segre gation there, and at' the moment the posi tion was that it was impossible to act' in co-operation with the Commonwealth. Something had therefore to be done tem porarily to meet the position of the lepers in the .North, and in the meantime negotia tions would be continued with the Federal Government to see whether some sehTeme Cannot eventually be brought into opera tion. He had already held a conference with the Minister for the North-West .£Mr. J. M. Drew) and ofGeers of the depart ments concerned, and negotiations were now proceeding to see if sometEing could not be done in the direction of segrega ting the whole of the lejxsre. DR. COOK'S EEPOBT. After dealing with the questions of iu fectivity of loproay and various theqriea regarding infection, and also .the danger of the disease and the methods of treatment in other countries, Dr. Cook says: — POSITION OF WESTERN AUSTRALIA

To those conversant with conditions in North-Western Australia the desirability of immediate action against the spread of leprosy is made the more apaprent by the following facts: — (1) Amongst the whites 'the squalor of the far north camp will give ample op portunity for that' requisite intimacy of -5pntaet between leper and susceptible, that is believed to be necessary before infec tion can result. Moreover, the practice amongst whites of entertaining travellers all and sundry is a risky one once lepers commence to roam the country-side. (2) Amongst the blacks conditions are known to be ideal for the spread pf dis ease, in the camps, and require no elabora toin. (3) At the same time that the conditions are so favorable for the spread of dis ease, the sparseness of the 'population and the rarity of already infected cases ren der the present an ideal time for combat ing the disease. In a large population it is possible for a suspect to escape and be lost to sight for years, and during the period of his liberty perhaps thousands

of persons are exposed to the risk of in fection. On the other hand in the Kimber ley division it would bo impossible to Loae trace of a man unless he continued to avoid ail contact with whites, in which event his isolation would itself ensure his barmlessness. DERBY LAZARET. The building in use as a lazaret at De? by was at one time the residency. It ia an old wooden house in the same paddock as the general hospital and the native iso lation (venereal) ward. It stands about four chains from the hospital buildings, there being no fence or other obstruction to prevent aeeess from the one to the other or to the venereal hut. There is nothing to prevent or even to dissuade the in mates of any one of the buildings frater nising with those of the others. Inasmuch as the oecupants of the lazaret up to thg time of my first visit were all males, an-I the patients in the venereal ward all fe males, this is a matter of no little im portance from the standpoint of efficient segregation.

j.uc loiaiov uuiiuius '**? -lu {v-.t»i- (unre pair. On the northern side, the verandah with the exception of a narrow strip along the wall of the eastern room is completely floorless; Of the north-east verandah, only the concrete pillars remain, whilst of the nroth-west only the roof stiD stands. The south-east verandah is in similar condition to the northern. There are eight rooms and a hall very irregularly arranged, there being two large rooms at the northern end, two of medium size on western aspect, 3 small ones on the eastern side, and the skeleton of a porch on the southern veran dah. Whilst the walls are complete, the windows are for the most part missing and the doors — French lights — unhung. The inside is painted and kepi clean, but the outside is severely weather beaten. At the time of my visit, May 23, there' were four inmates — occupying the smaller rooms. I have since seen a white patient in Derby Hospital, a, camp gin at Yeeda, and a house gin (Derby police), who have since been admitted. The building was. -well ventilated, there being little glass in 3ny of the windows and few doors on thoir hinges. The lepers are fed from the Gen eral Hospital, one of Uieir number fetch ing the meals from a given point, with all necessary precautions. ISOLATION. Much publicity has of late been given to the alleged freedom, of the natives of the lazaret. The chief pointg of complaint are: — (1) The nath«s are permitteci free dom to leave the grounds on fishing excur sions, in this way coming into contact with town natives who bring the nsh back to their white employers. The creek wh^re

they fish is a tidal one, and runs past the lazaret at the edge of the clay pan in flood springs. (2) The natives are able to leave the lazaret and go down to the town camp. Personal investigation into the second point elicited the following information-: — (a) The boundary fence is neither an ob stacle nor a deterrent to egress or ingress, and is in such a state of' disrepair as a result of termite activity as to be useless. (b) The bush comes sufficiently close to the fence and the fence to the. building on the side remote from the general hospital as to render it a matter of impossibility for the stall in the latter building to detect such egress or ingress, (c) The native camp and corroboree ground are very close to the quarantine area, and in such position that a native passing from oue to the other would be under cover and quite away from white, habitation throughout the .-journov. .Dr. Hodge has explained to me the con siderations that determine his attitude of liberality. It is manifest that the position and condition of the quarantine hospital fl VP. nP.vnTlfi life /-r\-nf ?*?/?*] T -,-,?,-, A ~-v~£ «*_ J i ?

eyer, that he has been attacked for permit ting visitors to patients and excursions to the creek. His reasons, with which I am entirely in accord? a-re as follow i^(a) A te-afeive js easily contented- with food? hoys ins (in 3 .a little company; biit i£ these arts laefeng he. will g6 in search oi them-, mxi be yeiy difficult 16 reip-fi to coaiiiieine^t. It is far better to gratify his wishes with precaution than to deny them without a possibility of enforcing the edict. vVlittsE he is permitted, like the white inmate oi most well-conducted lazarets, to fee Ills friends under the observation of the atf thonties, he is less likely to sneak away at night into the squalor and clandestine hugger-mugger of the camp, Certaiuly it may be objected that the black visitor, once permitted aeeess to the grounds, may fail thereafter to understand that he'musV not go there at will. Tliis, 'iTowever. is pure speculation, and must not -be con sin - ered too seriously, (b) The -position is' si milar in regard to the .fishing excursions. If unhappy, the native wiJl abscond, so. that it become politic, when he can terminate

his period of detention at will, to pennit I him this little liberty, on the ground -that, even if he should occasionally come into( contact with town natives, a leper under treatment and in segregation most of time is less menace than an eseapee secreted in the camp. There can be no doubt that efficient isolation is impossible there. With nothing in the lazaret to interest thera, with nothing to prevent their egress, it appears imbecility to suppose that the lib erty-loving- natives w31 voluntarily' deny themselves the society of their friends. As for the building itself, even conceding— as is bound to be. claimed — that it !s 'good enough for niggers,' it must be recognised that leprosy in Kimberley has occurred in a white man, and further cases amongst

Europeans may appear dunng the next few years. If the community arrogates to it self the right to deprive these unfortunates of their liberty, and to add to the horrors of incurable disease, the miseries of life long imprisonment, surely it also assumes the responsibility of housing them in com fort and endeavoring to ensure that their dragging years of decline shall, pass -with the minimum of suffering. Too long the leper has been an outcast, and the ebiect of public persecution, rather than ?practical sympathy. It is to be hoped that the laz aret of the future will be a haven of re fuge sought by the leper, rather than a loathsome prison to be avoided, if need be, by suixude. LAZARET CONDEMNED. In eo^elusiOrL, I -would suggest that the whole of the lazaret accommodation at Derby be condemned, and the site aban doned, on the following grounds : — (a) Derby, is an endemic area, and to that ex tent unsuitable fpr the treatment of lep rosy, (h) Elective isolation is impossible, (e) rhe btuldmg is unsuitable for tbe hous ing and' treatment of white cases

ALTERNATm; AOCOSOIODA'noW. In considering tbe provision of lazaret accommodation, attention should be erven to the follcmmg points:— (1) Isolation— The likelihood ot escape from and intru sion into the quarantine area should be re duced to a minimum. (2) Accessibility— Under- two aspects— (a) Cheapness of transport of patients and supplies; (b) pro vision of medical attention and of an effi cient resident staff. Hitherto the interests of patients have been crnelfr saci-ifieed to those of the com munity. Providedlepers were secured' re mote from the haunts of healthy 'meortt has been rmmateris/I that this very isola tion haspreclu^ed their receiving adequate care. Whilst this may have been of lSfctia moment when no satisfactory ''treatment was available, it is inexcusable now 'that modern methods of therapy can frequently return these people sound and well to the community. A direct result, moreover, of the provision of modern treatment will be to diminish the likelihood of attempts at escape, at least on the part of intelligent whites.

juxua^uj .LAZARETS. This opens the question of the relative advantages of island and mainland laza rets. Whilst the former has the advan tage of making available a larger area, with greater security and less initial ex pense, it has the following manifest dis advantages: (1} Increased cost, of trans port; (2) increased cost of maintenance; medical officer's visits being reduced to periodical excursions, a special staff of management, resident with or near the lepers, will be necessary. In Western, Australia there are not sufficient cases to warrant a special expensive staff isolated with the lepers on an island. On the ojfcher hand, whilst the mainland offers every facility for efficient control and treatment by a part-time staff, and reduces transport expenses to a minimum, it is difficult to ensure the security of dis satisfied patients. An additional advan tage of the mainland is that it is pos-afole to select a locality of dry bracing cliriiaie, thus reducing the likelihood of sprend of disease and increasing the general hejiith of the patients. Choice lies then between an islan-3 — with sacrifice of medieaj. efficiency, and the mainland — ^wifn^saeriflce of the security of rigid isolation

Whilst the conditions of settlement in KYmberley are such as to minimise the dif ficulties of isolating white lepers on more especially - as given comfortable quarters, congenial oeeunation, good treatment and, possibly, hopeful prognosis, intelligent Europeans are unlikely to attempt escape, the reverse is true in regard to the black it .were convenient here to consider Cos sack leper island in tne light oi' tne re quirements outlined. ilie ijossaeK leper station^ at present ao ecajmooaiing but. two patients, is siiuatad on a point opposite the town of Cossack, 10 miles from Koeoourne, , whieh at hign. tide is an island, but wiiicn at low tide can ot» reacned on foot from tbe mainland. TJiart are no buildings on it apart ironi an lil venuiated Hut wmen tne natives do not appear to use. it possesses many aavan uages as a lazaret for natives, inasmucti as (1) it is easily accessible for thSe~medi eal oflicer from JioeDourne, thus adniiuiag or frequent and regular inedicaj attention^ l^) Cossack being practically deserted, tlie camp is remote xrom any wjiite or abori ginal population. Taere are no natives at uossacic. (isj Water is available on the island. (4) TJie natives axe tree to wau tlei over .the island at will, to build tutor own mias and to a limited extent live their own lives. Un tn.e other hand — (1) Esca-pe from thu island would be easy at low tides. This is not as serious a matter aa mignt appear, inasinucJi as the remoteness oi', the island from any aboriginal settlement and fche - lack of any attractions on .the mainland; eonipaxable to tnose'. actually v- ekiscmg-. on

tne isianu, ruuuer n uoiuceiy mat na rives wouJd venture tar and in any case their recovery should 'be 'easy. iNo iroirole as rar as 1 have been aD^e to ascertain has previously been recorded in this regard {%)' The^expense of transferring eases from Kimberie}, where new cases are ukeiy to be lound^^s an obvious disadvantage. . it would be necessary to erect . a trearment room on the island and to provide attan anxs who could be housed in Cossaclj. Coa sack is eminently more suitable as a sits for a lazaret than Derby; CO-OPBiJATiON URGED. Whilst recommending that Derby be abandoned, I cannot with equal assurance advise that the lepers be txansferred ? to (Jossack, although failing an alternative solution, the latter woujd be much the bet ter site for a lazaret. Unfortamatelyy'rthe Westraiian coast does not offer a suitable island convenient at ouee to the district involved and to medical attention, and 1 have endeavored to stress, the necessity for the use' of an island where any scheme of native isolation is contemplated. On the other hand, I believe that there is already an isolation island for ITerri tory lepers convenient to Port Darwin, and as it is manifestly desirable when lepers are so few in both Ivimberley, and North ern Territory to. save duplication in stati; and expenses, I would recommend to the West Australian Health Department thai they approach the Federal authorities wifcb a view to co-operation in the establish/ inept of- one iip-to-date .lazaiety convenient Qj iJarw'iny to' accommodate all lepers dis covered ihihe No.i!jrjj. ?

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