South Australia among first in 1899 to make it compulsory for doctors to notify about cases of pulmonary TB/phthisis
Prominent public health campaigner Dr Allan Campbell, who pushed for compulsory notification of pulmonary tuberculosis cases by doctors. At right: The garden in the Consumptive and Cancer Home opened in 1902 in the former lunatic asylum annexe in the original Adelaide Hospital building near Hackney Road in Adelaide's inner east.
South Australia was the first place in Australia, and among the world’s first, to make it compulsory in the 1899 for cases of pulmonary tuberculosis – or phthisis as it was more commonly and fearfully known – to be notified to authorities.
But this came only after a long debate that brought out the unresolved state of knowledge and attitudes towards the disease. In 1891, pulmonary tuberculosis deaths almost doubled other major killers: diphtheria and influenza. In 1891-97, diphtheria deaths declined by 87% after a antitoxin in 1895. But pulmonary tuberculosis only went down 6%.
In 1896, during a debate in South Australia’s Legislative Council, Dr Allan Campbell, prominent in public health, proposed including tuberculosis in the list of infectious diseases. But he was opposed by central board of health president Horatio Whittell who saw tuberculosis control as regulating the meat and milk industry, believing that food intake, rather than airborne particles, was the main cause.
Campbell persisted in trying to convince members of parliament that the new science of bacteriology confirmed tuberculosis passed through human contact and he called for tuberculosis to be notifiable by doctors as the basis of control. He was up against opponents such as Ebenezer Ward, not a medical practitioner, who declared that tuberculosis was not a communicable disease and the colony “would be making itself a laughing stock”’.
More pragmatic opposition, from government chief secretary James O’Loghlin, and the central board of health, centred on the cost and complexity of notifying such a pervasive and long-lasting disease. In 1897, the Legislative Council recognised tuberculosis as a contagious disease and agreed to local boards of health disinfecting premises after a tuberculosis death.
In 1898, Campbell got enough support in parliament to make tuberculosis notifiable. But a proposed payment of two shillings and sixpence to doctors for each notification took on class dimensions. Some members, notably Labor’s Egerton Batchelor and William Archibald, argued the payment would allow the unscrupulous in the medical profession to notify the disease for profit and it was likely doctors would notify only the poor for fear of losing wealthy patients.
Archibald was the only one in the debate to argue the best means of eliminating consumption was to improve workers’ conditions.
In 1899, when notification of tuberculosis by doctors was made compulsory, local boards of health had to send a nurse or health officer to instruct the householders on disinfecting, hygiene, and how the consumptive should behave. In a measure that protected wealthier South Australians, this procedure wasn’t pursued if the notifying doctor advised against it.
