A HUMANITARIAN WORK.

Otago Daily Times, Issue 19239, 1 August 1924, Page 4

A HUMANITARIAN WORK.

(PLUNKET SOCIETY’S OPERATIONS. DUNEDIN’S FINE RECORD. LOW INFANTTLE DEATH RATE. The annual meeting of the Royal New Zealand Society for tho Health of Women and Children was held in the Town Hall yesterday afternoon. Tie Mayor (Mr IT. L Tapley) presided, and (hero was a good attendance, chiefly of women. Tho Mayor said it gave him great pleasure to bo invited by the society to again preside at their annual meeting. Ho had presided last year at the sixteenth annual meeting, and ho was with them again at Choir seventeenth annual meeting. t Ip to last year they had all recognised tho splendid work done by the society, but during the past year he had been more attracted: by tho work of the society, because ho had bad the opportunity of closely observing its operations. He wan more than ever convinced (hat tho people did not recognise the enormous value of the work of the society. Continuing, the Mayor referred to certain difficulties which had beset the society in regard to finance. If the society had more finance it oouhi do bettor work, and in this connect ion ho would _ like to draw their attention to tho financial campaign which was now being carried out in Dunedin by the society. Ho sincerely hoped that the results from the campaign would bo satisfactory. He would like to congratulate the society on the splendid work it had done during the past year, because they would see by the annual report that Dunedin still holds the distinction of enjoying the lowest infantile mortality death rate in tlie dominion and the rate for the past year was 4.3 per cent, for Dunedin, and for tho whole of New Zealand the percentage was 4.4 per cent. That was a fine record when they remembered that in ■ Dunedin in 1937 gast.ro enteritis and diarrhoea claimed 25 per 1000 births up to only two years of age. When they realised that for the last throe years hero had been no deaths in Dunedin from gastro enteritis and diarrhoea up to two years of age. they must recognise tho excellent work of the. society. Not only, lie might add, in their city, but in tho dominion, and he might say the whole world. Thoir work was extending right through tho world, and ho hoped that in time to come every country in the civilised world would adopt the methods of the society. Continuing the speaker said that they knew tho society was handicapped through tho inability to engage a larger number of nurses. 'They had four nurses hi Dunedin, and they carried out a tremendous amount of work every year. The visits paid by their Plunket nurses to homos totalled 8921, and the visits of adults and babies to the society's rooms totalled 12,726. The work of their .society could not, properly bo extended unless funds were provided. He noticed that tho society had nob only taken up tho question of the babies, hut. during tho past year it had taken up the vital question of maternal mortality. Ho was glad to see that Dr King was interesting himself in the matter. He noticed that Dr King had stated that these was no noce-sily for that mortality if mothers were only properly looked after before (he baby arrived. Dunedin was the birthplace of this great society, it was the training centre for all Ptluiket nurses, and he noticed that nurses came from different parts of the world to Dunedin to undergo Training. They wanted to retain* that prestige. The City Council had contributed £2CO to tho funds of the society, and he hoped this contribution would be mad© annually. If there was one body that should recognise the splendid work of tho society if was the Citv Council.—(“Hoar, hear.” He would like to make special mention of tho work of Airs Theomin (hon. treasurer) --.(applause)—Miss Patrick (director of the Plunket nursing). Miss R. A. Bulssin (matron Karitane-Hams Hospital), their 'four nurses, and thoir secretary, Miss G. ■Hoddinott. —(Applause). Dealing with the balance sheet, the speaker said that although tho strictest economy had been carried out by the society it bad gone back during the past year £973. Of course, they rtottld not afford to allow tho society to go , back like that, and he was glad to sc© that the society was aiming at securing jut endowment fund of £IO,OOO. so it would not need to worry as it had over these economical measures. Another regrettable point in connection with the balance sheet was that subscriptions had fallen from £271 8s 6cl in the previous year to £237 3s fid. This sum seemed a very poor one for a city like Dunedin. He hoped that this • amount would soon be considerably increased. Donations had also fallen from :(?1243 last year to £568. These figures 1./id been inducted in the balance sheet up To March 31 Since then they had started thoir campaign, and they had received some Tery substantial donations. They were deeply indebted to those citizens who bad given so freely, and b© hoped the campaign would prove most successful.—(Applause.) He had groat pleasure in moving the adoption of the annual report and balance sheet. The Rev. Dr Cameron, who seconded ■fho motion, said that any man would covet the honour of having a part in that afternoon’s proceedings. From the very commencement bo had regarded this as one of the most important organisations in the dominion. It, wa s certainly deserving of tho heartiest support of every individual in fho community. When it was considere.d that the saving of life was extending to pther countries all over the world it was impossible to estimate the value of work being done. Ho referred to what he hud seen of Plunket work in Canton, where Miss James was instructing Cbine-c mothers in things she had learned at the Karitano Hospital. It was not only a question of tho saving of lives, but there was the comfort of fathers and mothers. His own daughter had borne testimony to him of the great value of,the Plunket teaching in this respect. One of tho tragedies of our modern civilised organisation was that young mothers could not get tho help they required about the house. This society was an indication of tho value of a man with a great idea, with tho enthusiasm to make his idea live in (ho life of the community. and fortunate enough to get a hand of women such as had been connected with this society to carry on tho idea oneo ho luu! vitalised it. M'o honour that could bo given to Dr King could ho too great for tho work ho had carried on hero, and no honour could he too grout for the women who had supported him. The motion was carried unanimously. , ERECTION OF OFFICE-BEARERS. Tho election of office-bearers for the en»uiiig year wa-s moved en bloc by Air P. R. Sftrgood. and seconded by Dr L. E. Harriott. Dr Barnett assured the society that the great mass of the medical profession was heart and soul in support of this humanitarian effort*. T'hfv office-bearers are as follows: EPrisident, Mrs J. A. Johnstone ; vice-presidents—Lady Allen, Lady Rcea. Meadames Callaway, Jos. M'George. AV. A, Moore, J. M. Ritchie. T. K, Sidey; ci/mtriittee :—l.ady Sim. Mesdamcs A. Barftlrtfc, Peter Barr, Begg. Benson, Clapperton, L. F. Clog horn, W. Coleman, (Junniughame, Dove. Garth Gallavvay, J. L. Herbert, A. Isaacs, Jackson, J. C. M'George. M’Laren. Mandeno, Sydney Neill, O’Neill, C, W. Rattray. G. R. Ritchie, K. Ross. T. C. Ross, D. T. Shand, Solomon, John Watson, Commandant-Simp-Kon. tho Misses Gow, Joachim, and Dowrae Stewart, O.D.E. ; Advisory Board—Messrs Peter Barr, F. H. Can', P. L. Halsted, Leslie Harris, G. R. Ritchie, P. R. Sarpoo'l, T. K. Sidey, M.P., Dr Truhy King. Dr Herous; honorary surgeon. Dr L. E. Barnett, C.M.G.; honorary dental surgeon, Dr Piekorill; honorary analyst. Dr Inglis; lionorary bacteriologist. Dr C. U. Herons; honorary consulting physician, Dr Truhy King, C.M.G. ; honorary physicians (Kan-tanc-Harris Hospital)—Drs Ji. H. Williams, 8. B. W. Strain. F. S. Batchelor, K. Ross, s?n Ritchie, U. W. Carmalt Jones ; honorary phucitor, Mr George Mondy honorary foreign correspondent. Mr W. Jenkins; hC’orary treasurer, Airs D. E. Theomin. ADDRESS BY DR HERCUS. Dr Hercus said that a small boy in England, when asked by his Sunday school teacher to name the place where babies never died, without any hesitation replied. “New Zealand.” This ideal--the total abolition of foetal deaths—was beyond all dreams. Dr Fling, he noticed, placed the irreducible infantile mortality rate—i.e., tho number of deaths of infants under one vear of eg') per IMfO births registered, at <SO, and this rate was the objective towards which their society moved. Although, unfortunately, babies still died in New Zealand, it was a fact that it held the proud position of having the lowest infantile death rate in the world, and that it hold this proud position was duo in largo roWHitee to the work of this society and *t» distinguished founder, Dr Truby King. wore critics who said that there bar) been other factors operating in this reduction which had been as ~powerful as tjja -#ock of this society. They maintained that thoir salubrious climate, the virility oi , ih,3i> people, the great advances in 'jwL'Ho sanitation, and the falling birth rate

Were of equal importance. Concerning tho latter it was a fact that high infantile mortality rates wore generally associated with high hirth rates and vice versa, and it was a fact that, the birth rate in Mew Zealand had fallen from 41.21 per ICOO of mean population in 1880 to 14.40 in 1922, while their corespomling infantile mortality rates were 93.3 in 1880 and 41.9 in 1922. It was not necessary for him, however, to attempt, to refute such criticism- It was only necessary to refer to Franco, with one of the lowest, birth rates in the world—--15.s—but5 —but with an infantile mortality rate of 132. It was only necessary to study the graph on the cover of their annual report to show that- no such factors as those he had mentioned could account, for tho rapid fall in infantile mortality which commenced in 1907. Some new factor undoubtedly had commenced to operate at this period, and that factor had been the Royal Society tor the Health of Women and Children.

Before turning to tho subject of his address, ‘‘Some Thoughts on the Development and Future Activities of (ho Society,” h© would like to congratulate the Central Council on its annual renorl. It was an extremely ■■*, ■ T conceived and comprehensive document. Vital statistics op human bookkeeping was a subject, which was usually regarded as dry-as-dns**. In this report: it was presented In such a manner its to lx, of compelling interest to tho most casual reader. The solid achievement which the report presented demonstrated conclusively that, this societv stood in fho very front rank amongst the workers in preventive medicine in (his dominion. They were a guards battalion in the front lino trenches in this perpetual war against tho occurrence of preventable disease. All workers in this subject recognised fho society's unique (ontrihution. and congratulate it upon it.' Unfortunately for him, (he report was so complete that ho found most, of the ground that ho hail intended to cover that day had been covered. His thoughts on tho future development of tho society had not. only_ been already thought, but also expressed in print. IYFANTILE AIORTA TJTY.

He should think more had been written upon this subject than on any other in tho study of vital statistics. Birth rates, maternal and infant death rates, and foetal death rates were tho most delicate and fundamental indices which they possessed of tho health of a people. He had intended to remind them that, although their infantile mortality rate had fallen from 90 in 1331 to 44 in 1923, the decrease was entirely eonfied to the deaths occurring after tho first month of life. It was still as dangerous to bo a baby in New Zealand during the first month of life as it, was to be a soldier in (ho Now Zealand Fxpedifionnry Forco. Tho graph sliowing the infantile mortality rate during the first month of life was practically a straight, line. Nearly one-third of tho deaths under one month occurred within 24 hours of birth, and nearly three quarters within one week. Why should this be? Could they reasonably expect a reduction in this rate? Their report again answered those questions. The Municipal Health Service of Amsterdam in a recent, report showed that tho death rate of infants under one month was as low as 13 per 1000, as conrqxired with Now Zealand’s 29 per 1000 in 1923, although their total infantile mortality rate was more than double ours. He would point out_ that Amsterdam excluded those dying within 43 hours of birth from their infantile mortality returns, and included them under still births. The rate was. however, still capable of reduction A glance at the New Zealand Official Year Book for 1924 showed the principal causes of death in New Zealand during this first month. Premature births coma first with 423 deaths, or 34.8 per cent, of the total. Congenital debility came next with 165. or 13.6 per cent. Congenital malformations 136, or 11.2 per cent Other causes peculiar to early infancy, 128. or 10.5 per cent. Bronchitis and pneumonia, 99, or 8.1 per cent. Diarrhoea. 79. or 6.5 per cent. With the exception of the deaths due to congenital malformations, ail of these various operative causes • were capable of substantial reduction. It would be, in struetive to find out, for example, what percentage of His mothers whose babies died as a result of premature birth and congenital debility received ante-natal care throughout tho latter half of their pregnancy. One would like to know in more detail what exactly are “other causes peculiar to early infancy.” How many of the babies dying from diarrhoea were bottlefed How many dying from bronchitis and pneumonia came out of unhygienic and unsatisfactory domestic surroundings. Before proceeding to consider what further preventive measures could be taken by the society towards this end, they would glance for a moment* at another serious and largely preventable cause of annual loss to the child population. Foetal deaths, or still births, which statistically were not included either as births or aa deaths, had gradually increased from 679 in 1914, or 23.4 per 1000 births, to 842 in 1922. or 29.2 per 1000, a distinct rise in incidence. Recent investigations at Home by the Ministry of Health into this strangely neglected and important field of research showed that slightly more than half of the cases of infantile death investigated were preventable. More work on this subject should be done in New Zealand. By reducing this large annual wasting of infant life, they would also bo sparing the mother tho loss of much strength and energy which were expended to no purpose. PREVENTION.

What f nrther contribution could the society make to the reduction of these death rates? Tho same measures which would reduce the number of still births would also reduce the death of infants under on© mouth and in addition would reduce the maternal mortality rate. It was therefore a most fruitful field of endeavour. The answer to the question was fully realised by Dr Truby King. It was given bv Dr Russell Ritchie during last Health Week. It was being continually urged by the medical profession. As was so often the case in preventive medicine, it was a simple common-sense answer, and it was summed up in one word —ante-natal hygiene. Let, thorn continue to urge upon the general public in season and ont of season the tremendous importance of this subject. Concentrate on this problem with all the tenacity of purpose which had characterised their assault upon (ho neglect of breast feeding. He would quote a statement recently made by Dr Watson. Professor of Midwifery in the University of Edinburgh : “It has long been recognised that most of the complications arising in pregnancy, in labour, and after labour are preventable. If they are detected early they can easily bo cured. In tho case of most of them it is only when they have progressed, unrecognised and untreated, that they are dangerous.’' There was a certain fatal weakness in human beings which refused to recognise danger until it presented itself in a dramaito form. The men at the front were not easily convinced that the insidious silent Anqthclinc mosquito could be as deadly as high explosive. The danger signals in pregnacy were frequently so slight, a.s to require expert detection, If they succeeded in this purpose, which they most certainly would do, it would be necessary to consider what facilities for ante-natal care could be offered. In Dunedin at present there were at least two excellent ante-natal clinics, one at ho Batchelor Hospital under Dr Ritchie, and one at, St. Helens * under Dr Siedeborg, but he understood that 60 to 79 per cent, of tho mothers did not report until pregnancy was far advanced. But further provision throughout the city would be necessary, Certainly the* consulting room < every practitioner was an unto-natal clinic for his district., but ho thought this society could most, profitably extend its activities into this fie hi.

Ho would propose, therefore, for their consideration that their Plunket centres might ho expanded to provide ante-natal centres. The ante-natal clinic should be available, for all expectant mothers who desired to attend. The staff, which _should include a medical man. would recognise and anticipate probable difficulties, and when necessary refer potienls to their own doctors, or to maternity hospitals. Pairing now to tho death rate from one month until the end of tho first year, the period in which their efforts had shown such remarkable success. Could more he done? Unfortunately in Now Zealand they had not yet corrected their death rales lor town and country, and_for various districts of the same town. This had been done at Home, and had shown conclusively the important (influence of environment. The medical offiior of Bradford, for instance, had recently grouped the infant mortality in the town according to the rateable value of (heir homes. He found (hat in houses rated at £6 a year and under the infant mortality rat© was 165, while in those rated at £l2 or over, the rate of mortality was onlv 88 por 10C9. The commonest: causes of death from one month to 12 months* were—Diarrhoea, bronchitis, and pneumonia, and though tubercle did not bulk largely they knew that a.)I too often tho seed wa-s laid at this period. To a large extent these were environmental diseases. They would not reduce these diseases appreciably until th©y seriously grappled with the lion,sing problem. There was no single measure of which ho was aware which would produce a greater reduction in the,-;© diseases than the removal of tho condition of overcrowding, insanitation and flirt, which woro all too common jn certain areas in this town. He refused to

helievo that the problem was an insoluble one. It was only necessary for public opinion to be amused am! some solution would he found, and he knew no agency which could exert more influence in this direction than the Royal New Zealand Society for the. Health of Women and Children. Would they do it? Ho would now like to turn for a moment, to consider the child from one year to five years, i.he little runabout, as* the Americans called him. He was pleased indeed to sec that their charier embraced this important time of life, for while attention had been focussed on the baby under twelve mouths tho little runabout had been somewhat neglected. It was true that the death rate fell rapidly after tho first year of life, and that. Ibo child who had safoly reached its first birthday had passed the’mast perilous months of its life. bat. there were still various dangers to bo avoided anti overcome before the child came under the care of the school medical service.

Examination of children entering the schools revealed a number of physical detect which were directly preventable. Dr irwia had kindly supplied him with the following figures' relating to 958 entrants (aged live to six years) entering school during the last 18 months: — Fix hundred and sirty-three, or 69.2 per cent, had untreated dental caries. One hundred and ninety-seven, or 20.6 per cent., presented some nutritional defects—subnormal nutrition, manifestations of rickets, otc. One hundred and seventy-three, or 18.1 per cent,., had enlarged tonsils and adenoids. One-hundred and fifty-seven, or 16.4 per vent., had enlarged glands. Fifty, or 5.2 per cent., had goitre. it was unnecessary for him to point out how many of those, departures from lieatlh wore directly preventable. Continued supervision at reasonable intervals at the Plunket centre would in many oases have prevented tho disabilities. General instruction in domestic hygiene would have gone a long way to prevent 860 of the disabilities — namely, the decayed teeth and the nutritional defects. Of coarse, much of this knowledge should have been given to the older girls at school, but the curriculum was already overloaded, the teachers said. Ho would like to see motherrraft and domestic hygiene receiving increasing recognition in their schools, and in the primary schools he would go so far a£ to suggest the addition of an additional compulsory year which would bo hugely devoted to these basic luibetences. There was also an appreciable death rate to consider amongst the little runabouts. In 1922, 380 died, bat unfortunately tho Govern merit Statistician did not analyse the cause of death. This was always done in England, and assuming that the causes of death in New Zealand were more or less similar they found that infections diseases were responsible for tho majority of tho deaths. Pneurponia. of all forms and tuberculosis came first. The prevention of these depended largely on general health measures, proper housing, an adequate provision cf fresh air, sensible clothing, good and regular meals, enough soap and water and provision for using them. etc. Measles, whooping-cough, and diphtheria came next, but time would only permit him to refer to diphtheria. In tho period 1930-1922, there were 137 deaths in Now Zealand between birth and five years of age. Tho disease was largly a. disease of childhood. Little progress had been made in tho last 20 years to contest it. The disease was actually more fatal to-day than it, was 20 years ago, and this in spite of tho tremendous scientific advance in the knowledge of the disease which had been made. The economic tors? from tho disease, worked out by the Department of Health on tho basis of the average stay in hospital ever all ages, was over £20,000 per annum. And yet it was largely preventable. In the method of immunisation with toxin antitoxin mixtures they had a means of prophylaxis against diphtheria which was comparable to the value of vaccination against smallpox. And yot tho public would not take advantage of it. Diphtheria, they know, had recently been epidemic in Pert Chalmers, and, steps had been taken to find out those children susceptible to tho disease, arid protect them from it. Tho Department of Health urged the importance cf the measure, the school committee enthusiastically supported the proposal, the medical profession of Port Chalmers also actively advocated it; but the result had been disappointing in the extreme. Only a trifle over ICO children were permitted to be tested and to receive tho injection, and only six out of this one to five year period, although parents were urged to bring children of this ago period. Again, tho only remedy was education, and again (be most powerful organisation of which he knew which could remedy this matter was this society. ORGANISATION AND DEVELOPAIENT. Ho would like to see one Plunket centre to every square mile of their cities. The Plunket nurse he regarded us on© of the most important links between the homes of the people and the office and administration of the Health Department. She was doing a magnificent work, and had the satisfaction of knowing that her work was pre-eminently constructive. By increasing the numbers of Plunket nurses, by reducing the size of their areas, he could seo her in tho future taking over tho duties of other nurses at present working on other specialised health problems. He could see tho Plunket centre becoming a veritable health centre around which other voluntary organisations engaged in health work would rally. Tho St. John Ambulance Association, the Home Economics Association, the Red Cross, the* Girl Guides, Free Kindergarten, ere., etc., would al] have their place in the work of such centres, and the Medical Officer of Health would keep a friendly and advisory eye upon the whole. CO-OPERATION. Finally, he came to the all-important question of co-operation. He noticed that under the aims and objects they specifically mentioned that one of their chief aims was to co-operate with other ogacisations working in the interests of health. This was absolutely essential for efficient working, but before co-ordination could he close and intimate there should be, ho considered, some administrative machinery by which the co-ordination could bo effected. In the army, before any advance was contemplated, and. indeed, while in the field, weekly conferences were held between the various arms of the service. Such conferences were no less desirable and essential, ho suggested, in this perpetual war against “the captains of the men of death.” Ho would like to see the society approach, all other societies which were engaged m health work, with a view to appointing delegates to what they might term a City Health Council—a Health General Headquarters. They had already seen an approximation to such a body in the Health Week Council. This council, however, would be a permanent one, with the Medical Officer of Health a.s permanent chairman, and would meet at regular intervals. From its headquarters it would launch offensives against such problems as defective housing, tuberculosis, cancer, dental caries, diphtheria, etc., etc. —(Applause.) If would promote mutual understanding, co-ordination, and co-opera-tion between many societies working towards the same ideals to prevent the occurrence of disease and to secure for all the best possible conditions of living. Might the society long continue in its beneficent work.—(Applause.) REDUCING MATERNAL MORTALITY. Dr Truby King wa© called on to express the thanks of the meeting to Dr Helens for his address. He first of all thanked the Mayor for the splendid part he had taken in advancing the. work of the. society, and the City Council for its liberality m voting the society £2OO. Tho society had always desired to reduce maternal mortality, and could not consider a.s alien a subject so intimately concerned with the health of women and children. He admitted that much could yet, he done in this direction They should all be grateful for the splendid support and assistance lliey hat! received from the press cf the dominion. Ho had said before, and could not repent 100 often, that no press in any part of the world compared with tlic press of this country. In America the papers would not give such help aa was given here, not with any view to pecuniary gain, but at an actual loss. They locked to something higher than profit, and without that support the society could never have attained its present position. No one had helped them more in this way than (he late Mr Charles teaser, editor of the 'Witness, and in his death the society had sustained a grout loss. lie was glad that the editorship was now in the hands of a man who had always taken a great interest in their work. He argued that a good midwifery service would be of tho greatest assistance to the doctor, whoso proper sphere in confinement cases was diagnosis and the determining whether (he case wa« normal or not. There was nothing so damaging to mother and child as precipitate delivery There was now practically no danger in child birth, not even in specially difficult cases if medical skill were available. Without a doubt ICO lives of mothers could he saved every year in tho dominion. For every ICO mothers who lost their lives in childbirth ICOO mother,*; were more or less gravely damaged and 1000 babies were more or less gravely damaged. Dr Truhy King spoke also of the way in which children from the age of from one to five were ruined through insufficeint Cairo and attention. At present the atton-

< ion tho fociely could give was inadequate owing to tho insufficiency of Plunket nurses to cover (ho ground. ILO invited JJr Ifercus to luv’orno a mombor of iho Advisory Hoard of tho Dunedin branch, and moved a motion to (hat- effect. The motion was seconded by Mr Sacgood. and carried unanimously. On Dr King’s motion Dr Herons was accorded the hearty thanks of the meeting by acclamation. The meeting concluded with the customary compliment to the chair and (he singing of a verso of tho National Anthem.