Report on the proposed establishment of a Joint Lazaret at Darwin [EN2/25]

Cecil E. Cook M.B. Ch.M. D.T.M & H

Wandsworth Scholar

June 1925

Leprosy has been recorded in the Northern Territory since 1892, first in Chinese, and later in Aborigines from different localities. Until 1916 the practice appears to have been temporarily to isolate the former on improvised Quarantine grounds pending deportation to China, and to return the latter to their district of origin without restraint. About 1916 a Lazaret was established on a point of waste land on the Southern shores of Darwin Harbour. To this miserable locality Lepers have been sent to the number of twenty-one and twelve persons are now isolated there, include a healthy half-caste girl of four.

No effort has been made systematically to attack the disease with a view to its eradication. Notification has depended upon the diagnoses of bushmen and police, often erroneous, so that many are notified as suspect who are free from the disease, whilst others actually suffering from it are overlooked.

Such precautionary measures as have been taken appear to have been of the nature of expedients dictated by an exaggerated respect for Public criticism rather than by any humanitarian consideration for the unfortunate sufferer. Provided the known sufferers were banished from the society of their fellow men, the exigencies of the situation were deemed to have been met and no quest was undertaken to determine the possible origin of the infection in individual cases or to detect other Lepers. No useful records have been kept of admission, no histories filed, and apparently no treatment given. Conditions existing at the Darwin Lazaret, whatever may have been said in extenuation whilst it was used solely for the isolation of Aborigines, are inexcusable now that it has become necessary to provide accommodation for an increasing number of Europeans.

The wretchedness of the locality, the lack of suitable accommodation, and the neglect of treatment render the Darwin Lazaret a standing reproach upon the Health Services of the Territory. This is the more to be regretted in as much as the Ports of the Northern Coast are in regular communication with foreign countries where this medical problem has been met by all the resources of a highly organised service. The Commonwealth is likely by comparison to suffer loss of prestige in the matter of Tropical Hygiene as long as the present deplorable conditions exist under the very eyes of travellers from the East, and if for no other reason, the matter is deserving of immediate attention.

Research into the endemicity of Leprosy elsewhere in the Commonwealth reveals the important facts that

1. Leprosy amongst Aborigines, however originating has been a fruitful source of subsequent infections in Europeans.
2. Leprosy amongst Aborigines is more easily controlled by segregation than is the case amongst Whites, probably because the precautionary measure is more efficiently applied.
3. Whereas the public appear to be always on the look-out for such diseases in the Aboriginal, Leprosy is only too frequently overlooked, even by the Medical Profession, when affecting Europeans.

The usual course in the other States appears to have been

1. A series of infections confined to the Native Population.
2. Later a few sporadic cases amongst Whites in addition to those amongst the Aborigines.
3. Later still cases are recruited from the White Population alone.

Evidence is accumulating to show that whatever the eradication of the disease is attempted seriously during the first phase it is rapidly achieved. This has been the experience in certain parts of both Queensland and West Australia. On the other hand once the third phase has been entered – as at Rockhampton Q. – it is a matter of great difficulty under the system in vogue even to keep its spread in check.

Of recent years five white Lepers have been discovered in the Northern Territory, and three in West Australia. This is an important point demonstrating as it does that Leprosy is following a course in the North similar to that which it is seen to have taken in other parts of the Commonwealth. In view of the difficult experienced by other States in controlling the disease in the third phase of its endemicity, it is essential that in the Territory the work of prophylaxis should commence now. Moreover, if any progress in White Settlement is to be made in the North, it is highly desirable that an organised effort be made completely to eradicate the disease whilst cases are comparatively few and the population sparse.

The work will necessitate the provision of an efficient organisation for the detection of the disease and a modern Lazaret for the reception of patients. A system of thorough and regular examinations of Aboriginals must be maintained. This will no doubt be a matter of some expense, such it may be argued, as is not warranted by the present incidence of the disease as revealed by this survey. On the other hand the expedients hitherto in operation in the North have failed to control the disease even amongst the present small population. After a detailed study of Leprosy in Australia one is forced to the conclusion that precautionary measures are necessary both on humanitarian and hygienic grounds, and experience throughout the Commonwealth demonstrates that efficient prophylactic administration can control and even eradicate the disease. When on the other hand, as in Queensland, the system is imperfectly operated, the disease whilst kept in check, remains endemic, and a sequence of sporadic cases necessitate the continuance of the expenditure. It is therefore re-iterated, that the very paucity of cases that it likely to be advanced as an argument against incurring expense in an anti-lepra campaign, is in reality the most cogent reason for that expenditure, meaning as it does that the work can be undertaken now with the promise of comparatively early success, and the consequent saving ultimately of the many thousands necessary for the permanent maintenance of a Lazaret in the future.

In order that the necessary measures may be put in operation and at the same time the cost of doing so be used to best advantage, it is suggested that the organisation be used in connection with the control of other phases of Tropical Hygiene, which have hitherto been neglected in the less populated districts but which share with Leprosy an equal importance in their beating on the future health of the country. Such diseases are Ankylostomiasis, Granuloma, Beri-beri, Malaria, Framboesia, Dysentery, and the Enteric Diseases. The scheme appended is so devised that all these may be adequately dealt with by the Medical Organisation provided for the eradication of Leprosy and this explanation is stressed in case these proposals should be considered irrelevant to a Report on the Establishment of a Joint Lazaret for the North.

SUGGESTED SYSTEM FOR THE CONTROL OF LEPROSY AND
OTHER TROPICAL DISEASES IN NORTH AUSTRALIA

HYGIENE DISTRICT: The areas proposed to be brought under the campaign includes the Northern Territory, together with that portion of Queensland north of the 20^th parallel, and west of the Flinders River, and that portion of West Australia north of the 20^th parallel. These boundaries are selected on the basis of the endemic distribution of Leprosy and the provision of Medical Officers and take no account of any political sub-division of the Continent actual or proposed. Much would be gained if the control of Leprosy in Australia were entirely entrusted to an officer of the Commonwealth Service and removed from the inefficiency of State Health Departments, but this is not a matter for discussion here.

MEDICAL INSPECTORS. It is proposed that the Medical Officers at Camooweal, Burketown, Darwin, Wyndham, Derby and Broome be appointed Medical Inspectors with a view to the regular examination of Aborigines in their respective Districts and the notification and treatment of Tropical Diseases.

TRAVELLING INSPECTORS. Travelling Inspectors of Aborigines are suggested for the Inland area where no Medical Officers are stationed. These men should be qualified pharmacists with ambulance experience and should be trained in the technique of Intravenous Injection before being sent to their Stations.

Their duties would include:

1. Inspection at regular intervals of all aborigines in their allocated districts, with a view to the detection and isolation of Leprosy and the notification and treatment of other Tropical Diseases.

2. Rendering Medical Assistance to the White residents.

Such appointments to centres now unprovided with Medical attention are considered to be quite as satisfactory as and more economical than the appointment of Medical Officers. The Districts to be staffed will have to be re-determined from time to time. It is tentatively suggested that Halls Creek and Emungalan would be the most desirable centres under present conditions. From the former the Kimberleys could be regularly traversed, whilst for the part of the year at any rate the White settlement would be provided with Medical aid. From Emungalan, another white settlement in urgent need of some such assistance, especially if it is proposed to open a construction Camp in connection with the Railway Extension, the Roper and Daly Rivers and the Overland Telegraph Line could be traversed.

DIRECTOR. It is suggested that these Officers could be controlled and their work organised to the best advantage by the appointment of a Director with Headquarters in Darwin. Probably the services of this Officer could be dispensed with once the Service was thoroughly organised and put upon a sound working basis. On the other hand it would be advantage to retain his services for purposes of Research in the problems of Tropical Hygiene affecting the Territory. It is suggested that his duties should include:

1. The direction of the Anti-lepra campaign and the supervision of the Darwin Lazaret.

2. The supervision of the work and the control of the appointments of the Travelling Inspectors. In this connection it is suggested that the transfer of the duties of the Chief protector of Aboriginals to this Officer be seriously considered since it is impossible in the Territory to conduct a Hygiene campaign without arrogating to the Hygienist many of the functions of a Protector.

3. The inception and execution through the subordinate Officers of a campaign of Tropical Hygiene in the Territory.

4. The conduct of Research into prophylaxis and treatment of Tropical Diseases affecting the Territory, and into the problems of Entomology, Protozoology, etc. relating thereto.

It is preferable the appointee be prohibited the right of Private Practice, except in a Consultant capacity, for the following reasons:

1. Ample research remains to occupy the time left free from administrative work.

2. The nature of his duties as a Hygienist may frequently cause him to run counter to the prejudices of influential pastoralists and others, and it is desirable that personal interest in a valued patient should not colour his decision in a matter of policy.

NOTIFIABLE DISEASES. The following diseases should be made notifiable to the Director within his district, and he should be vested in their regard with all the powers transferred from the Central Board of Health of Adelaide to the C.M.O. Darwin under the Infectious Diseases Regulations:

Leprosy.

Granuloma.

Framboesia.

Malaria.

Filariasis.

Enteric Fever.

Beri-beri.

Dysentery.

Ankylostomiasis.

Purulent Ophthalmia

Bubonic Plague.

Cholera.

Yellow Fever.

Other diseases at present notifiable in the States and Territory to the Commissioners of Public Health at Brisbane and Perth and to the C.M.O. Darwin respectively, should continue so. It is not considered desirable that the Director be responsible to any higher authority within the Territory, the best interests of the Service would be served only by his direct responsibility to the Minster for Home and Territories or the Director-General of Health for the Commonwealth.

Notifiable Disease should be reported to the Director by the Medical Inspectors and the Travelling Inspectors, and it should be the duty of the Director to issue instructions to these Officers as to Treatment and Prophylaxis.

ANTI-LEPRA PROCEDURE. 

The following is suggested as the basis of the Anti-Lepra Campaign, in conjunction with Aboriginal Inspection.

1. Compulsory Notification of Leprosy.
2. Compulsory Isolation of Lepers.
3. Regular periodical Re-examination of intimate contacts and Bacteriological Examination of their Serum. 

For this purpose the Director must keep a record of these persons and changes of address must be reported to him. 

It is suggested that the re-examinations should be at intervals of 6 months, for a period of 5 years and of 12 month for a further period of 5 years.

1. The criterion for Isolation should be different in the White and Aboriginal Races.
2. In the former who can be relied upon to report at any time and faithfully to carry out instructions, Lepers who do not give Positive results in the Examination for B.leprae should be permitted to remain at liberty until such time as a Positive result is obtained. During this time they must however comply with an order for modified isolation on the lines of the Norwegian Law, and must present themselves regularly for re-examination and Treatment as directed.

In the case of the Aboriginal whose careless and irresponsible habits render it impracticable to keep him under observation or to submit him to a course of Treatment unless he is under restraint, all patients presenting undoubted signs of Leprosy should be isolated at the Lazaret without resort to the arbitrament of Bacteriological Examination. In this way the danger of a Leper, who gives a Negative Smear at the time of Examination, disappearing into the Bush and becoming a menace to others during a series of exacerbations accompanies by the discharge of Bacilli, will be avoided.

3. Such suspects whether White or Aboriginal, as are not deemed sufficiently definite for committal to the Lazaret should be regularly re-examined under similar conditions to the stipulated (vide c) for Contacts. Manifestly it will be necessary to use considerable discretion in permitting freedom to an Aboriginal, under this provision.

4. Efficient Treatment of the Inmates of the Lazaret should be commenced. In this way a proportion of the cases may be returned as useful citizens to the community, no longer to be burden upon it. In addition the Lazaret will lose much of its terrors and becoming regarded more as a Hospital will probably be sought by patients rather than avoided, thereby assisting in the work of eradication. It is of the utmost importance that cases which for any reason are not admitted to the Lazaret should be put under treatment as systematically as those who are. It is apparent that a Leper outside the Isolation Grounds is an infinitely greater menace than one under restrain but this self-evident truth appears to have escaped the Queensland Health Authority. Undoubtedly lepers in that State who do not give a positive result in the examination for B.leprae are permitted liberty but afforded no opportunity of receiving treatment.

The practice, also in vogue in Queensland, of permitting suspects who give negative smears at the time of the first examination, to disappear from view, is undoubtedly largely responsible for the dissemination of the disease and the failure of the Prophylactic measures in that State.

The registration by the Director, of aboriginals requiring regular re-examination as suspects or as contacts, would be greatly facilitated by his appointment as Chief Protector, and this combined position would also be of considerable advantage in the execution of the necessary inspections, enabling the confidence of the natives to be gained by the timely issue of such rations and blankets as may be required.

It has been stressed previously that throughout the North the official attitude hitherto has been to satisfy the Public demands for security from Leprosy, and this done, to go to no further trouble or expense in making the patients happy or alleviating their condition. Under suitable circumstances, the Lazaret may be made of haven of refuge to the sufferers and only under these circumstances is it justifiable for the State to deprive them of their Library by compelling them to enter and remain in the Institution. Condemned to years of suffering and progressive invalidity, shunned by their fellows and banished to strange sad company, theirs is already an unhappy lot and for the Community thus protected from similar fate to intensify their misery by parsimony and neglect is a terrible reproach. Apart altogether from Prophylactic aspect of the provision of Leper Hospitals, there are still cogent reasons for this action in districts where Leprosy occurs, which would be none the less urgent were the disease admittedly not contagious. Such are:

1. It is a chronic, usually progressive, intractable affection, dragging on through years of exacerbation and remission until the victim may become crippled and helpless but still survive in parlous state until some intercurrent infection gives him his coup-de-grace. When any number of poor and indigent individuals reach this stage it become desirable that the community establish a Home for their reception.

2. Where Aborigines are concerned it should be remembered that these people at best lead very simple lives. It should be a matter of no great difficulty in a Lazaret suitable situated and directed to make these patients more comfortable and happier in confinement than they would be at large, in view of the fact that their infirmities prevent them from providing for themselves under conditions of Bush life.

3. Treatment along modern lines occasionally results in arrest of the disease if not actually in cure. In order that Aborigines be afforded this opportunity of relief, it is essential that they be under restraint, since their fear of the technique will otherwise induce them to avoid it by disappearance.

4. Treatment is highly specialised one, requiring for its proper administration not only a thorough knowledge of the therapeutic properties of the drugs employed and of the correct technique in administration, but also a complete comprehension of the significance of the various reactions to the treatment manifested by individual patients. Impossible of administration in the Bush, even Hospital conditions require the supervision of a skilled and experienced attendant. This specialised attendance cannot in this sparsely populated and wide-flung district be permanently provided at the many centres where Leprosy is endemic e.g. Roper River, Alligator River, Adelaide River, Daly River and West Kimberley, so that the interests of the patient demand that he be brought to a central Leper Hospital where these advantages are to be found.

5. Much still remains to be discovered in regards to the treatment of the disease, which can only be satisfactorily studied in a well-equipped Hospital for lepers. It is the interest of Research and therefore of the patient that all cases be available for study.

That there should be a Lazaret, is then, in the interest of the patient himself – that this Lazaret should take the form of an Isolation Hospital is solely in that of the Public. Whereas in previous years the latter alone has been considered, it must be insisted that no scheme of Leper Isolation is justifiable which ignores the points previously mentioned to show how it may meet the patients of interests. If the comfort and adequate treatment of the inmates be provided for, Isolation can be recommended on the following grounds:-

1. Leprosy is a very terrible disease for which there is no certain cure. It is believed on good grounds to be contagious and in the absence of a satisfactory curative method the community can only be protected by segregation of the afflicted.
2. Amongst the more civilised aboriginals the disease constitutes a menace to White Settlement. In Queensland for example some years ago lepers were mainly recruited from the Black races, but today it seems firmly established amongst the Whites, these now producing the bulk of admissions to Peel I.
3. The practice amongst the tribes of allotting young gins to old helpless male lepers is a very probable origin of leprosy occasional appearing in whites habitually co-habit with Black.
4. Even amongst Whites it is difficult to ensure that the desirable degree of Isolation be attained when the patient is left at home. In the case of the Native it is hopeless to expect it in the Camp, whilst the nomadic habits of the tribe will render each case a constant source of infection to new districts.

Reasons for advocating the concentration of all lepers found in the North into one Central Lazaret may be summarised thus:

1. The number of lepers so far known is not large and can be conveniently and efficiently managed by a small staff.
2. Were more than one Isolation Camp established, each to be adequately administered would require a staff as large as would be required for the Combined Lazaret – duplication therefore means increased expense without additional efficiency.
3. The larger the number of cases under one authority, the better are the opportunities offered for Research.
4. No suitable site was found in West Australia convenient to Medical aid, and no other than one proposed (vide infra), near Darwin. Since only one suitable site is available throughout the North it should be utilised for the care and isolation of all lepers in that part of the Continent.

SITE FOR THE COMBINED LAZARET

PRELIMINARY CONSIDERATIONS. In selecting a site for a Lazaret the following points come up for consideration.

1. Nature of Surroundings. It cannot be too often repeated, platitude though it appear, that Lepers are not isolated for their individual benefit but for the protection of the community. It is incumbent then upon those to whom falls the duty of selecting the locality in which these unfortunates are to end their days, to choose a congenial and healthy one.

White patients compulsorily removed from their homes where they may have enjoyed a high standard of living are entitled to expect from the Community that in their isolation and confinement, they be provided those comforts to which they have been used. The necessary loss of liberty should be made bearable as possible by permitting patients the freedom of a large area rather than confining them within Prison Walls.

Aboriginals will quickly become contented under comfortable conditions especially if they are permitted occasionally to wander about and hunt. Whilst this is impossible in a small confined Lazaret, it can easily be arranged on an Island.

2. Isolation. If the Lazaret is situated on the Mainland the opportunities for escape are many, unless considerable expense is incurred in the erection and maintenance of Barb-wire entanglements or Iron fences.

On an Island one must consider the use of canoes swimming and wading at low tide. Few sites in Port Darwin or along the coast of W.A. otherwise suitable are sufficiently separated from the mainland at low water to be useful as Isolation Camps.

3. Accessibility. It is desirable that the Station be convenient to a Centre of Population for the following reasons:

1. Facility for transport of Stores and Meat;
2. Medical Supervision. The more accessible the Station to Medical Attention the greater will be facilities for frequent and regular visits by the Medical Officer.

THE PRESENT LEPER STATION. At the present time Lepers are detained on the Northern extremity of the point of land separating East from Middle Arm. The site is three miles or so from Darwin, the journey across occupying about half-an-hour in a launch under favourable conditions. Nominally the Reserve for Lazaret purposes comprises forty-eight (48) acres but in reality much of this is unavailable being mangrove flat. The buildings occupy a narrow strip of foreshore which is low and sandy and exposed to North-west weather. Two miles of sandy ridge runs southward to Peaked Bush, but this although accessible is separated from the reserve by Mangrove Swamp. The buildings consist of one Iron Hut (14 x 12) with veranda all round, and two small unoccupied humpies. In the larger building which is comparatively new, the floor of the room is flagged but that of the veranda is of sand.

Two one thousand gallon tanks constitute the source of water during the dry season. During the Wet Season additional open tanks are used to catch water for immediate use.

The natives at present on the Station appear contented and as game is abundant and the supply of food regular there appears little reason why they should attempt escape. However, they are not receiving treatment and were they compelled to undergo a course of Chaulmoogra Oil with its nauseating properties and its unpleasant after-effects there is little doubt they would utilise the many opportunities for escape.

On the other hand the site is eminently unsuitable for the accommodation of White patients being a depressing and unhospitable locality, haunted by plagues of mosquitoes (C.vigilax & C.sitiens) at certain seasons.

The present Water Supply is quite inadequate if any addition to the number of patients on the Station is contemplated. If therefore cases are to be brought from W.A. it will be necessary to make some extra provision, either by sinking a well or by considerably increasing the catchment surface and the number of storage tanks.

Isolation: On the chart this point is show as Mainland, but it is popularly regarded as an Island. Whether this latter view is correct is very doubtful but there can be no doubt that south of the hill known as Peaked Bush, it is all mangrove swamp intersected at flood tide by a network of deep creeks.

Owing to the high rise and fall of the tide at Port Darwin – it is given as 27 ft. – much that is apparently insular at high water actually communicates with the mainland at low Springs. Whilst therefore escape would not be easy on foot from the present Lazaret at flood tide on account of the mangrove jungle, by walking & wading at low water escape would be comparatively easy. Of the twenty one natives from time to time isolated here, six have escaped – two by canoe built on the Isolation grounds. The majority of these escapes have never been re-captured.

Accessibility. The landing is at the Northern extremity of the point and can only be used at high tide. No other landing is available unless a track be cut from the beach on the Eastern side of the Point to the Lazaret through from 200 to 300 yards of mangrove swamp, & would remain un-surmounted.

The disadvantages of the present landing are:

1. Exposure to North-west weather. There is no protection during the latter part of the year from the squalls blowing from the North-west and it is occasionally impossible for the launch to effect a landing with stores for days at a time. At the latter end of the dry season it is usually necessary to take water to the Station from Darwin and this disability, apart from its possible serious consequences to the inmates will stimulate them to attempt escape.

2. Whilst the station is dependent for supervision and direction on visits from Darwin its distance from the town across the water is too great. Were monthly or weekly visits sufficient, the place would be convenient enough, but for a regular daily attendance such as will be necessitated by an increase in the number of inmates and the inception of treatment, it is too far from Darwin. A permanent resident orderly would therefore be necessary so that the locality loses what advent it may have had in being nearer to Darwin than other suitable sites whose comparative remoteness required the appointment of a resident attendant.

Treatment. Up to the time that the responsibility for the Lazaret was taken over by the Commonwealth Quarantine Officer, it appears that the frequency of visits to the Camp was determined by the necessity or otherwise of transporting stores of water. Sometimes a month or much longer elapsed between these visits so that sufficient stores for that period had to be left on the Station in charge of one or other of the Lepers – latterly a half-caste boy of 12 years. The obvious disadvantage of this neglect is the facility it offers for escape. Whilst one may expect that a native would hesitate to undertake the arduous journey across the Mangroves to the mainland when he is more or less incapacitated for hunting, the provision of stores sufficient to maintain him for a month or longer might be the deciding factor.

Medical visits were not even as frequent as these of transport. No treatment being undertaken this was not surprising. As previously remarked, the policy seems to have been to get the lepers out of the community and if possible leave them there, but to take no action to alleviate their condition. This is readily to be understood, however in view of the fact that under the conditions of Isolation treatment of the natives would probably have led to their absconding. The only practicable method under existing conditions is to leave each a supply of Chaulmoogra Oil with simple instructions as to its use. There can be no doubt that this would never be taken whilst there was no supervision.

To summarise then, the present site is not favoured for the establishment of a permanent Lazaret for the following reasons:

1. There is no suitable landing.
2. It is a depressing locality and much of its apparent area on the Chart consists of Mangrove Flats, so that the Inmates are unnecessarily confined.
3. Escape is easy even without the provision of canoes.
4. The water supply is inadequate.

ALTERNATIVE SITES. The following alternative sites were inspected and exhaust the possibility of Port Darwin, viz:

The Shell Islands.

Buchanan Island.

Point Emery

Talc Head.

Channel Island.

The Shell Islands. These are a pair of small islands situated in East Arm to the North-east of the present Lazaret. They are too small to be of any use, very low-lying and exposed and at low tide in direct communication with the Mainland convenient to Darwin. They are useless as sites for Lazaret accommodation.

Buchanan Is. This island is situated in the southern mouth of Apsley Strait, between Melville and Bathurst Islands. Apart from the aquatic habits of the Natives of these Islands and their frequent visits in canoes, the island is at low tide too convenient to the Bathurst Island Mission.

Point Emery. At Pt. Emery there is a reserve for Quarantine purposes having an area of sixteen acres. This is situated about two miles from Darwin but is very convenient to the Kahlin Beach Native Compound. The apparent advantages of this site are as follows:

1. It is convenient to Darwin, facilitating daily visits by the Medical Officer and thus rendering the appointment of a special permanent staff unnecessary.

2. It is an elevated site bordered on three sides by cliffs 75’ high. It is flat and stony, lightly timbered and well-grassed. It would therefore be a healthy and congenial locality for the purpose. Water is available at the Compound. It was proposed that by fencing with barbed wire across the narrow isthmus the point could be rendered secure as an Isolation area.

The disadvantages however are great, and it will be seen that in reality the apparent advantages are non-existent.

1. Although the cliffs are rocky, it is easy for canoes of which there are several at the Compound, to land on the Point at high tide, and for natives to ascend or descend the cliff. At low tide the Point is in direct communication with Kahlin Beach by an unobstructed sandy spit. To ensure security therefore it would be necessary completely to enclose the Isolation area with a barbed wire entanglement or an iron fence. This would be a very costly matter, more especially as the wire would have to be set in concrete to prevent successful burrowing and an attendant would be necessary to prevent attempts at escape. The hoped-for economy in the latter regard therefore in the latter regard would not be effected.

2. The proximity of the town and compound with their many attractions to the isolated natives would be a constant stimulus to escape.

3. The confinement of the patients within prison walls is the very practice which has been deprecated throughout this Report.

4. Unless lepers are landed in Darwin and conveyed by road over the two miles to the Lazaret, it would be a difficult matter in rough weather to arrange for their landing at the Point. Pt. Emery is exposed, its cliff steep and its foreshore rocky. Although these features would offer no serious obstacle to a native attempting escape, they would be sufficiently formidable unless special provision were made, to constitute a serious inconvenience in the landing of patients.

Point Emery therefore is not favoured, it being regarded as having no real advantage to recommend it, and many drawbacks, which discredit it as a site for a Lazaret.

Talc Head. Talc head is situated on the western side of the Harbour, a little over six miles from the Darwin jetty. It consists of a Bluff 80’ high connected to the mainland by a narrow isthmus of low-lying sand. It is accessible at all tides from the South-eastern aspect where there is a good landing in North-west weather, and at full tides from the North-western aspect where there is a good landing in South-east weather.

The bluff itself is about two acres in area and covered in jungle. Across the isthmus, a ridge similar in height and general features runs to the South, and to the West of this an extensive Mangrove flat stretches out to Woods Inlet. Along the East, part of the Coast is cliff and part flat, and on the latter water is available at shallow depths.

Talc Head in common with all the Mainland to the west of West Arm, is part of a large peninsula cut out by West Arm and the upper reaches of Bynoe Harbour, and connected to the mainland by a very narrow isthmus at Slate Cliff. In the event of escape from Talc Head considerable difficulty would be experienced in traversing this isthmus without some knowledge of the locality. It is not suggested that Natives would encounter much trouble but in view of certain recommendations in regard to Quarantine later to be made this point is mentioned now.

The advantages of Talc Head as a site for a Lazaret are:

1. Its congenial features as a locality for permanent confinement.

2. Its comparative Isolation from Darwin coupled with its accessibility by launch.

3. The existence of sufficient water supply for use in the Dry Season and the facility for the pasturing of live stock and gardening.

4. The provision of good landings in all weathers.

On the other hand, this point in common with every other site in this country is accessible to and liable to visits from Native canoes. The holding of a Lease a little to the South of the Point, where Natives are employed renders this a consideration of no small importance. Otherwise, even were escape effected, the escapees would not be likely to come into contact with the White Settlement at Darwin. Owing to the extensive Mangrove Flat on the Western side of the Point and the sand-bank exposed at low tide on the North and West, it becomes impossible, narrow as the Isthmus is, to isolate it by a barrier thrown across the ridge.

As a locality for a Lazaret, Talc Head, though eminently suitable in some respects, is not favoured on account of the accessibility to the Mainland at the South, which however forbidding it may be as a journey to Europeans is not likely to offer a serious obstacle to Natives more especially as their fellows in the vicinity of the Lazaret would in all probability facilitate their escape by means of their canoes.

Channel Island. The present Maritime Quarantine Station is situated on Channel Island about eight miles from Darwin. The Quarantine Buildings are situated on the northern of the three hills which form the Island and comprise an administrative block, two wards and a ‘drying’ shed. The Island whilst to a certain extent easy of access to the swampy Mainland on the Eastern side, is the only situation in the immediate neighbourhood of Darwin to which Lepers could be taken with a reasonable prospect of successful isolation. It may be approached with ease by canoes but the land in its vicinity is low-lying, swampy and unfrequented by Blacks so that unlike Talc Head it is not likely be visited in this way.

The island itself consists of three hills covered with jungle and running down on the Eastern side into mangrove flats but on the West rising steeply from the sea and edged by a rocky beach. The present landing is not satisfactory as it is difficult to negotiate in North-west weather but in its immediate vicinity a small creek runs out which with a little work could be covered into a good all-weather landing.

Fresh water is obtainable on the island by shallow boring or from surface wells. At present 25,000 gallons of rain water is stored in tanks at the Station but this would be inadequate to maintain the Staff and Patients of a Lazaret through the Dry Season. This is estimated on the basis of the admission to the Darwin Lazaret of the twelve (12) Westralian Lepers and the two Territory patients at present at Little Bay (N.S.W.) in addition to those already in isolation at Darwin.

Whilst Channel Island is further from Darwin than the present Leper Station, the necessity for the appointment of a resident Orderly whatever site be selected, renders this a matter of little consequence. Daily treatment can be administered by the trained orderly and the Medical Officer attend at regular bi-weekly intervals.

Being 48 acres in area the inmates would be afforded ample opportunity for the exercise of that limited liberty considered so desirable. The facilities for escape would be few. Provided conditions on the island were made reasonably congenial, there is little reason to expect that natives would wish to leave. In the event of their deciding to do so, it would be necessary to find a canoe or to swim at low tide. On a small island it should be possible to prevent both methods, when an official is permanently in attendance since visiting canoes are not to be expected here and consequently the natives on the island would have to build their own. If necessary the precaution could be taken of confining the natives to a compound at night. It is repeated, however, that the facilities for escape and the prospects of its success are so unattractive that the attempt is not likely to be made. Nevertheless it must be admitted that the locality is not proof from escape but it is the only one that nearly approaches the ideal and is therefore recommended. The alternatives provided the Quarantine Department offers the use of the island are as follow:

1. Securely to fence off by an effective barb-wire barrier the actual Quarantine Buildings, thus preventing the Lepers otherwise permitted the freedom on the island, from haunting them. It is important to remember that no large number of contacts is likely to be isolated in the Quarantine Station at Darwin, inasmuch as it is the practice for ships to proceed in Quarantine to Eastern Ports, landing at Darwin only the sick and those whose destination is the Territory Port. As the sick are unlikely to wander at large, the only difficulty is likely to rise in the management of a large number of convalescents. Strictly speaking, there can be no objection, provided adequate precautions are taken, to the housing of lepers on an island set apart for Quarantine purposes. On the other hand the popular attitude towards this procedure is likely to be coloured by ancient prejudice. It will not be said that lepers are confined at the Quarantine Station but that the subjects of Maritime Quarantine are sent to the Lazaret. To that extent therefore it is undesirable that the two Departments should share a single Island.

2. The second alternative with the consent of the Quarantine Department is to remove the Maritime Quarantine Hospital and leave Channel I. free for the Lazaret. It is understood from the Director-General of Health that his Department is prepared favourably to consider this, provided a suitable new site is made available to him. The requirements of such site must of course be decided by the Quarantine Department, but one ventures here to draw attention to the possibilities of Talc Head for this purposes. Its advantages have already been outlined and the only objection to its use as Lazaret does not seriously affect its utility as a Quarantine Station. Provided the precaution is taken of depriving the natives on the lease previously referred to, of their canoes whilst the station is in use, or more preferably, having them removed from the vicinity altogether at such a time, the only danger to be considered is escape overland. Aboriginal natives are unlikely to be the subjects of Maritime Quarantine and only to these is Talc Head deemed insecure. Many miles must be traversed through jungle and mangrove swamp before the mainland proper can be gained and this once reached is un-populated and very remote from habitation. When it is considered that the bulk of the persons quarantined will be either ill or convalescent it is improbable in the extreme that the feat will be attempted or be successful if it were. Talc Head is to be regarded as quite as proof against escape on the part of the Quarantined as is the present Station. Whether its other features compare sufficiently well to justify the rouble of transfer is a matter for the decision of the Department concerned.

Deep water exists close to the shore and as already mentioned there are good landings on either side of the Point. The flat isthmus connecting the Bluff to the peninsula would enable cot-cases to be landed with a minimum of difficulty. Both Channel I. and Point Emery are inferior to Talc head in this respect.

Whatever be the ultimate decision in regard to a site it will be necessary for the Lazaret to have the use of a launch or lugger in order that patients and stores may be expeditiously carried and it is further desirable that this vessel should be sufficiently sea-worthy to travel up and down the coast of the Territory and Western Australia thus facilitating Medical Surveys and providing transport for cases in the latter State.

It will also be desirable that the Resident Orderly at the Lazaret be provided with a companion and quarters remote from the Leper Huts. The second man could be employed as an assistant or Cook. Alternatively the appointment could be given to a married man.

In conclusion it is re-iterated that a greater error cannot be made than the assumption that because cases are at the present time comparatively few there is no need for energetic action or the disbursement of funds in an Anti-lepra campaign. If the Department is not prepared itself to undertake the expense it is strongly urged that the British Empire Leprosy Relief Association be invited to do so. After a lengthy study of this disease in other parts of Australia, one becomes convinced:

1. That if neglected now it will in future year constitute a serious problem in the health of the community and will be very difficult to eradicate.

2. That if attacked now on a scientific plan designed on the lines suggested by experience elsewhere, it could be so successfully dealt with as to be got under control within a decade.

Finally, consideration for the unfortunate patients, more especially those Whites whose pioneering in this country has exposed them to the disease with resulting infection, demands that this serious matter so long neglected or spasmodically attended to, should at once receive attention. In this way it is hoped not only that the disease will be prevented from reaching other residents of this country, but also that those unfortunates who have become its victims will receive the case and treatment necessary to the alleviation of their suffering. Under existing Laws in Australia only the Government through the Lazaret can provide this care and treatment. The fact that is has so long been unobtainable in the North is a grave reflection on the responsible authority.

APPENDIX

At the time of the commencement of this Survey there we nine (9) Lepers isolated at Darwin. The following have since been admitted:

Jimmy Ah Cup (Roper Valley); Alick (Pine Creek); Judy (Pine Creek); Billy (Maranboy).

In addition Victor a Café proprietor in Darwin of Greek origin was isolated in his own home pending other arrangements, it not being considered justifiable to condemn him to exile in a Lazaret of the nature of the one at Darwin.

The Survey is not complete and it is considered that several more will be detected in the Roper River and Alligator River Districts.