PUBLIC HEALTH.

Lyttelton Times, Volume CXVII, Issue 17878, 26 August 1918, Page 4

PUBLIC HEALTH.

ADDRESS BY HON G. W. RUSSELL. SUGGESTED STATE MEDICAL SERVICE. On Saturday evening, under the auspices of the Workers' Educational Association, tha Hon G. W. Russell, Minister of Public Health, delivered an address in the association's rooms, Trades Hall, on "Public Health." There was a crowded attendance, and Mr J. B. Struthers presided.

Mr Russell, who was frequently applauded during ithe delivery of his address, which occupied upwards of two hours, congratulated the promoters of the great movement which had resulted in establishing a series of educative lectures, and said he was proud to be the first* Minister of the Crown to address members of the association on pubho matters, particularly as he was speaking in the Trades Hall. In every country where the principles of representative government and adult suffrage were in operation, the ultimate control of the Government must rest with the workers. To realise tho difference between an educated and an uneducated democracy they had only to contrast Russia and the United States. Russia, with 75 per cent of her people unable to read, was in a parlous condition; America, where education was general, was a shining example to the world. Education, in order to attain the best results, should bo designed to tram-the whole faculties—the soul as well as the intellect. Germany was an educated nation, but tho teachers and professors had consistently inculcated into the minds of its youth the duty of obedience to the head of the State, and for years the education system had been designed to implant in tho minds of the people tho basic principle of tho divine right of kings—the policy of "blood and iron," as enunciated by Bismarck. Adverting to the Department of Public Health, over which he presided in the Mackenzie Government and m the National Cabinet, Mr Russoll said he considered it the most important of all portfolios, that of Education coming next. A country with a healthy and educated population had nothing to fear, as such a people must inevitably work out their own salvation.

RESPONSIBILITIES OF PARENTS. The serious decline in the Dominion's birth rate, said the Minister, was a very regrettable feature. In the period 1882-8 G the Dominion's birth rate was 3540 per 1000, but in 1919 it had fallen to 25.94. That was a very sad fact which must bo faced. It was a notable fact not only in New Zealand, but elsewhere, that with increased prosperity the birth rate invariably declined. Statistics showed that tho people of to-»day married later in life than those of earlier years, and were disinclined to assume the responsibilities of matrimony until they had reached positions which would secure comparatively large incomes. He referred to the deliberate limitation of families, and said that it was imperative that legislation should be placed on the Statute Book making it a penal offence to sell or trade in certain articles, which there was good reason to believe were largely used.' The State was deeply interested in its population, but at present accepted no responsibility in bringing up the family. With prices as they are at present the rearing of a large family involved considerable pressure. Should the State not act to some extent in loco parentis in, rearing the family? The time was not far distant, Mr Russell said, when the State would assist parents in their self-imposed responsibility, and he would support a proposal that parents earning 'less than £4 per week, with more than two children should require » State subsidy. To some extent the Dominions low death-rate compensated for the unsatisfactory birth-rate. If the New Zealand birth-rate had continued at the same rate as in 1882-86 to the end of 1915, there would have been an addition to the population of 240,000 or more than twice the total of the soldiers sent from the Dominion into the firing lino. New Zealand, with all her advantages, had a lower birth-rate than anv of tho Commonwealth States except Victoria. INCREASED NUMBER OF MAR-

RIAGES. Turning to marriage statistics, Mr Russell said that the number solemnised in 1916 was 8213, .the number showing a steady rise compared with the lbbi-Sb period,'but notwithstanding this tact, as he had previously pointed out, the birth-rate had steadily fallen. Referring to excess of spinsters over bachelors in certain districts, Mr Russell said the explanation could be found m the high prices ruling for land, which impelled the young men to seek their fortunes in districts 'where conditions were more favourable. He congratulated Mi- Holland (who was present) on the establishment of a Progress League in Christchurch, and hoped its activities would result in promoting rural industries. He was satisfied that there were great prospects for tne dairying industry in Canterbury, as by irrigation and the cultivation of lucerne great tracts of land could be made to produce much more than they are producing at present. At present Now Zealand was sending between onethird and one-half of all the cheese imported into Britaiu, and the Dominion was, he was convinced, destined to become the dairy farm of the Empire. The prospects for expansion in this direction were exceedingly bright.

THE CAUSES OF DEATH. Mr Russell then referred to the principal causes of death, and said that organic heart disease occupied first place, with cancer next. Through the improvements mado in dealing with tuberculosis, and as a result of research in many lands, considerable progress had been made, and this fell disease now occupied fourth place. At present tho work of the Department over whicn he presided was seriously handicapped for lack of funds. Already New Zealand had spent £45,000.000 in connection with tho war. arid her current expenditure was £2,500.000 a month. The time was approaching when it would be necessary to borrow for the development of the country, and he hoped that ere long more abundant funds would be placed at the disposal of his Department so as to enable something to be done' in investigating tho many, problems in which it was so deeply interested. DOMINION'S HOSPITALS. The question of the nationalisation of hospitals had been raised from time to time but he could not countenance such a suggestion. Ho was very thankful to the various hospital boards for their very fine work, and he had no desire to* see them wiped out and to assume the responsibility. Mr Russell then referred to the various consumption sanatoria under the control of the Department, and said that he hoped with tho coming of peace - that tho institutions now under the control of the Defence Department would again come .under the jurisdiction of tho Department which he controlled. The hospitals of the Dominion totalled thirtysix, with smaller institutions in the lesser centres, and cottage hospitals, most of which contained a maternity ward. The value of these hospitals, land and equipment was £1,650.000. The total number of people permanently employed in these hospitals was 1795. tho number of beds was 3761 4 and the average number occupied 2765. Last year 42,129 persons had received treatment in the Dominion hospitals and institutions. HOSPITAL BOARD FINANCE. Mr Russell then dealt with Hospital and Charitable Aid finance. At present the levies were on a basis of 1-Sd on the rateable value, and the Government subsidy was paid on .that basis. The system, however, was an unsound one, ho proposed to bring about a change at the earliest possible moment. Last

year subsidies were,paid on the following basis:—Dunediii £1 Os Bd, Auckland 19s 3d, Wellington 16s Bd, and Christchurch 15s 3a. He held that the subsidy should be based on the rate levied. If a district chose to rate itself at a high rate in order to secure tho greater efficiency of the- institutions under its care, it should, as a matter of common justice, get a higher subsidy. He knew of one districtl where the rate was 2Jd, which received a smaller subsidy than others where the * lowest rate was levied. This was a gross and flagrant injustice, and he would strive to have' remedial measures passed. The revenue received by the hospital boards from the Government amounted to £221,000, and tho total income reached £672,000. Only about 25 por. cent of fees earned were received, as pressure was never exerted in cases where there was evidence to show that patients were not in a position to meet the charges.

HOSPITAL SATURDAYS URGED AFTER THE WAR.

Referring to means of securing additional revenuo, Mr Russell pointed out that last year contributions amounted to £IB,OO0 —a very small sum indeed, considering tho wealth of the After tho war ho hoped to see a Hospital Saturday inaugurated to raise funds. Such money would draw a subsidy of 24s for every 20s raised. At present the only hospital district where money was raised by this means was Hawke's Bay, where recently such an effort brought in £709. At present tho Dominion was divided into four health districts. Those were much too large, and nothing but the shortage of money prevented them from being broken upAt present there* were in numerous centres lay health inspectors who should be replaced by trained medical men, the former being placed in,charge of smaller centres. The control of public health could not be dealt with in generalisations; it was necessary to get down to detail. IMPORTANCE OF DENTAL TREATMENT.

On thing which they had learned from the war was the large number of unfit men in their midst, and he had no doubt that if similar tests were applied to women like results would be obtained. In a healthy country like New Zealand more than 54 per cent should have come up to the standard required by the military authorities. He was satisfied that one of the principal causes of medical unfitness was the absence of the proper dental treatment of _ children. Some time ago the Wellington Education Board undertook the dental examination of between 700 and 800 children and it was found that only two had perfect teeth. This was a shocking state of things. Science had abundantly demonstrated that bad teeth were responsible for many of tho ailments to which the flesh is heir. The matter had caused the speaker much concern, and ho was satisfied that if the teeth received proper treatment it? youth the Dominion would have a much more healthy race of men and women in future. The Department was prepared to give 75 per cent of the cost of treatment if tho nospital boards would do the rest, such subsidies being confined at present to extractions; filling? and stoppings. At present there was a scarcity of trained dentists, but the Government was prepared to give assistance in the shape of bursaries, conditionally on students undertaking to devote •three or four years after attaining proficiency to public work. The same policy had been followed with regard to medical training, bursaries being provided for students conditionally on their undertaking to go into the public hospitals for two years on obtaining theii degree, at a salary of £2OO per annum and fre« board.

Mr Russell next touched on the work of the Department regarding pure foods, and said that the law was being strictly enforced without fear or favour, anc only a few davs ago substantial fines had been inflicted in Wellington in connection with milk adulteration. MATERNITY HOMES. Speaking of maternity homes, Mr Russell paid a tribute to the memorj of the late Right Hon R. J. Seddon, who was responsible for the establishment of the first four homes. Without douht they had been responsible for reduced infantile mortality, as evidenced by the fact that whereae the rate per 1000 in 1907 was 88, in 1915 it was 50. the lowest in any country in the world, and less than one-half of that of Britain. The battle of the future would bo lost not through casualties on the field, but on account of empty cradles. LIVES LOST THROUGH FEAR OF MEDICAL FEES. The question of the cost of medical services was one which caused anxiety to many people, and there was nc douht that many people refrained from calling in medical assistance in case oi illness because they could not see then: way to find the wherewithal to pay the doctor. This had undeniably resulted m tho losa of many valuable lives. Some doctors did not make money a first consideration, but others did. He believed that if doctors could be relieved of fintmcial worry they would be able to devote their attention to their patients much more efficiently than under existing conditions. He hoped the time would come when there would be a State medical service, when the services of the profession would be absolutely free to all. To-day there might be cases where there' were sick children, but the parents feared to approach the doctor because of the cost. That was a fearful commentary on tho system and called aloud improvement. The greatest asset which any country could possess was a healthy, virile people, and during his occupancy of his present position the people of tne country could rest assured that -he would do everything with the means at his disposal to effect improvements which he hoped would prove of lasting good tc the country. (Loud applause.) Mr E J- Howard moved a hearty vote of thanks to Mr Russell! foj his very fine address. He urged that the Department should concentrate its attention on free maternity tomes, and dwelt at some length on the heavj charges now incurred bv ■ Mr F. Oartwright. who seconded the motion, brought under the notice of the Minister the services which were beins rendered to the community by 'the association, and that it was deserving of financial assistance. # The motion was carried unanimous!.' amidst loud applause.