DEPARTMENT OF HEALTH ANNUAL REPORT OF THE DIRECTOR-GENERAL OF HEALTH

Appendix to the Journals of the House of Representatives, 1944 Session I, H-31

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1944 NE W ZEALAND

DEPARTMENT OF HEALTH ANNUAL REPORT OF THE DIRECTOR-GENERAL OF HEALTH

Presented in pursuance of Section 100 of the Hospitals and Charitable Institutions Act, 1926

HON. A. H. NORDMEYER, MINISTER OF HEALTH

REPORT The Director-General of Health to the Hon. the Minister of Health, Wellington. I have the honour to lay before you the annual report of the Department for the year 1943-44.

Introduction The outstanding features of 1943 in comparison with the preceding year were a fall in the birth-rate and in the death-rate, a rise in the infant-mortality rate, and a still further improvement in the maternal-mortality rate and the death-rate from tuberculosis. There was a widespread outbreak of scarlet fever which still continues and an increased prevalence of diphtheria. There was an increased incidence of poliomyelitis, but, on the other hand, cerebro-spinal fever showed a marked decline. Vital Statistics (Exclusive of Maoris) Population.—The mean population of the Dominion in 1943 was estimated to be 1,538,651. Birth-rate.—There were 30,311 births in 1943, representing a rate of 19-70 per 1,000 mean population. The rate in 1942 was '21-73. Death-rate. —The death-rate in 1943 was 10-04 per 1,000 mean population, as compared with a rate of 10-60 in the preceding year. Infant Mortality.—The infant-mortality rate was 31-37 per 1,000 live births. In 1942 the rate was 28-71. Still-births.—'The still-birth rate was 26-25 per 1,000 live births, as compared with 26-54 in 1942. Maternal Mortality.—The maternal-mortality rate, including deaths from septic abortion, was 2-21 per 1,000 live births, as compared with 2-53 in 1942. When deaths from septic abortion were deducted, the maternal-mortality rate was 1-71 (1-73 in 1942). Infectious and other Diseases (Exclusive of Maoris, unless otherwise stated) Five thousand eight hundred and thirty cases of notifiable diseases were reported. This substantial increase on the previous year's figure of 4,372 is accounted for in large part by an extensive outbreak of scarlet fever and an increased incidence of diphtheria and poliomyelitis. Scarlet Fever.—Notifications of scarlet fever rose steeply from 457 in 1942 to 1,196 in 1943. This is the highest number of notifications since 1931, when 1,304 cases were reported. The indications are that 1944 will show a further marked increase in incidence. The last big epidemic of scarlet fever occurred in 1928 (6,123 cases) and 1929 (4,844 cases). The relative immunity of the Maori to scarlet fever is shown by the fact that in 1943 only 1 case of scarlet fever was reported in the Maori population. Diphtheria.—Diphtheria also showed an increase in 1943, 830 cases being notified, as compared with 542 in 1942. There were 32 deaths, giving a death rate of 0-21 per 1,000 of mean population. For twelve years notifications have been below a thousand each year, and in 1940 reached the low level of 367. The last major epidemic of this disease occurred in 1917 (5,458 cases) and 1918 (5,539 cases). It is to be hoped that parents will avail themselves of the opportunities for immunization of pre-school and school children offered by the Department. Experience in other countries) has shown that diphtheria can be controlled, if not, eradicated, in. this way. The chance of contracting the disease and of a fatal termination if the disease is contracted are markedly reduced by immunization,

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Influenza. —The outbreak of influenza in the Northern Hemisphere was watched with some anxiety, but did not reach our shores. Influenza in New Zealand in 1943 was at a low level and, indeed, the deaths attributed to this disease (65) were fewer and the death-rate from influenza (0-42 per 10,000) was lower than for some years. Lethargic Encephalitis.—Four cases of this disease were notified. Poliomyelitis,.—One hundred and twenty-seven cases were notified, in comparison with 30 in 1942. Fortunately, the condition did not become epidemic throughout the Dominion, but was mainly confined, except for a few cases, to the South Island. Enteric Fever.—There were 60 notifications (56 in 1942). The number of notifications each year remains fairly constant, the average for the past five years being 53. Cerebrospinal Fever.—Four hundred and ninety-eight cases of cerebrospinal fever (434 European, 64 Maoris) were notified in 1943, as compared with 932 (852 European, 80 Maoris) in 1942. Deaths numbered 72 European, 20 Maori. The rates for 1943 were: European 0'47, Maori 2-06 per 10,000 mean population. Whooping-cough and Measles.-—There were 17 deaths from whooping-cough and 7 from measles. Puerperal Sepsis.—Sepsis following childbirth was responsible for 9 deaths, a rate of 0-30 per 1,000 live births (0-47 in 1942). Sepsis following abortion, on the other hand, caused 15 deaths, a rate of 0-49 per 1,000 live births (0-80 in .1942). Tuberculosis.—Deaths from tuberculosis (all forms) were 572, as compared with 607 in 1942.

The following table shows the course of the disease for the past five years:—

The number of deaths and the death-rate from all forms of tuberculosis in 1943 were the lowest ever recorded in New Zealand. Venereal Diseases.—The following tables summarize the work of the venereal disease clinics in the four main centres for the past five years.

Number of Persons dealt with for the First Time at the Venereal Disease Clinic and found to be suffering from Syphilis

Number of Persons seen for the First Time at each Venereal Disease Clinic and found to be suffering from Gonorrhœa

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Death-rate per 10,000. Year. Respiratory Non-respiratory Tuberculosis Tuberculosis. Tuberculosis. (all Forms). 1939 .. .. 3-39 0-59 3-98 1940 .. .. 3-24 0-64 3-88 1941 .. .. 3-19 0-69 3-88 1942 .. .. 3-18 0-75 3-93 1943 .. .. 3-09 0-63 3-72

«/ L'J. Auckland. Wellington. Christchurch. Dtinedin. Total. Total. M. F. M. F. M. F. M. F. M. F. 1939 .. ..59 43 18 25 19 11 12 5 108 84 192 1940 .. 63 37 77 58 12 8 22 8 174 111 285 1941 .. .. 102 57 96 63 29 17 33 6 260 143 403 1942 .. ..70 78 53 71 18 11 20 6 161 166 327 1943 .. ..48 95 20 41 17 14 29 3 114 153 267

Auckland. I Wellington. Chriatchuroh. Dunedin. Total. — r Total. M. F. M. F. M. F. M. F. M. F. . ; I 1939 .. .. 399 141 333 53 328 88 91 90 1,151 372 1,523 1940 .. .. 474 118 310 53 286 79 78 89 1,148 339 1,487 1941 .. .. 410 183 373 42 271 72 81 79 1,135 376 1,511 1942 .. .. 312 286 236 63 181 69 75 73 804 491 1,295 1943 , J 265 441 138 89 122 92 51 15 576 637 1,213

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The figures are incomplete, as they represent only cases treated at the venereal disease clinics in the four main centres and in particular do not include cases occurring amongst members of the Armed Forces, who normally are treated by the Service medical departments. The position, however, can be regarded as showing a definite improvement. Male civilians treated for venereal disease in 1943 are fewer than in any of the preceding war years, while the Armed Forces also report a lower incidence. The increase since 1939 in females attending the clinics is an indication of the active steps which have been taken to follow up known contacts and to bring them under treatment. Cancer-. —The cancer clinicsi established in the larger hospitals by Hospital Boards in conjunction with the New Zealand Branch of the British Empire Cancer Campaign Society record a steady improvement in the number of successful treatments. These clinics are available for hospital and private patients alike. Under arrangements with the New Zealand Branch of the British Empire Cancer Campaign Society, the Radio Physicist of the Society visits all treatment centres for the purposes of calibrating plants and clinical dosimeters against the portable standard of the laboratory, and for advising upon measures for the protection of patients and staff from electrical and radiation risks.

Principal Causes of Death The following table gives the main causes of death, the actual number of deaths therefrom during the year, and the death-rates per 10,000 mean population for each of the last five years:—

"Owing to an alteration in the international agreement as to the allocation of deaths to various causes, the figures for these two conditions are not separably comparable with those of earlier years. Reports of Divisional Directors Public Hygiene.—There has been elose co-operation with the Armed Forces in enforcing measures aimed at preventing the introduction of disease from overseas. In particular, active steps have been taken to deal with the risk of importation of mosquitoes not present in the Dominion. A Mosquito Control Committee has been set up and two officers have been appointed whose duties are to collect specimens of mosquitoes for identification and to carry out surveys of mosquito-breeding places in Wellington and Auckland and in the vicinity of aerodromes and elsewhere. Following their reports, steps are being taken to eliminate all potential breeding-grounds for mosquitoes in and about our ports and aerodromes. In collaboration with the Army Medical Service, a booklet has been printed to instruct hospital medical officers and medical practitioners in the detection and treatment of cases of malaria that may occur among men arriving from malarious areas overseas.

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I 1943. - 1042 : 1941 : 1940: 1939 : Cause. Rate. Bate. Bate. Bate. Number. Bate. Heart-disease (all forms) .. .. •• 5,183 33-68 36-41 31-55 29-52 27-80 Cancer .. .. .. .. • • 2,191 14-24 13-07 13-18 12-02 11-79 Violence . .. • • • • • • 933 6-06 5-77 5-64 5-68 5-72 Pneumonia .. 217 1-41 1-52 1-47 1-60 2-02 Pneumonia (secondary to influenza), whooping-cough, 27 0-17 0-81 0-38 0-28 0-58 and measles Bronchitis .. .. •• •• 214 1- 39 1 - 36 0-94 1*12 1 • 36 Broncho-pneumonia .. .. •• •• 257 1-67 2-11 1-96 1-79 2-00 Tuberculosis (all forms) .. •• •• 572 3-72 3-93 3-88 3-88 3-98 Kidney or Bright's disease .. .. .. 413 2-68 3-19 3-66 3-18 3-47 Apoplexy or cerebral haemorrhage .. .. 1,506 9-97 9-90 8-95 8-45* 5-77 Diseases of the arteries .. .. •• 187 1-21 1-22 1-14 0-98* 3-46 Senility 488 3-17 3-03 3-13 2-63 2-16 Diabetes 332 2-16 2-28 2-21 1 -98 2-23 Hernia and intestinal obstruction .. .. 100 0-65 0-74 0-73 0-78 0-70 Diseases and accidents of childbirth (puerperal 67 0-44 0-55 0-77 0-62 0-68 mortality) Appendicitis .. .. .. • • • • 73 0-47 0-44 0-55 0-58 0-69 Diarrhoea and enteritis .. .. • • 90 0-58 0-50 0-53 0-50 0-45 Epilepsy .. .. .. ■■ 71 0-46 0-53 0-43 0-34 0-26 Common infectious diseasesInfluenza (all forms, including pneumonia) .. 65 0-42 1-61 0-49 0-77 1-10 Diphtheria 32 0-21 0-16 0-11 0-10 0-16 Whooping-cough .. .. .. •• 17 0-11 0-03 0-44 0-15 0-01 Scarlet fever .. .. .. •• 2 0-01 0-01 0-01 0-01 0-01 Typhoid and paratyphoid .. .. .. 3 0-01 0-05 0-05 0-04 0-02 Measles 7 0-9 0-20 0-03 0-01 0-05

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The Health Act, 1920, was amended to give more adequate control of breeding-grounds of flies, mosquitoes, mites, or ticks capable of causing or transmitting disease. Malaria has also been made a notifiable disease under this same Act. Supervision of the production, processing, and distribution of all foodstuffs has received attention. A general tightening up of the standard required before a license is granted or renewed has been carried out by both local bodies and departmental inspectors. The report of the Milk Commission should stimulate interest in the production of an ample and safe milk-supply. Hospitals.—During the year a modern hospital of 300 beds and all necessary staff quarters and services was commenced at Otahuhu, near Auckland. This hospital, which is being built at the cost of War Expenses Account, was primarily to deal with Service patients, who were expected to arrive in such numbers that the civilian hospital system might be unable to deal with them. When no longer required for Service patients, it will form a valuable part of the Auckland Hospital Board's institutions. Clearing-hospital facilities were established at Ellerslie in order to deal with returning Service patients who may arrive at Auckland. The average number of occupied hospital beds substantially increased during the year. The figures will be given in the Appendix to the annual report published at a later date. The number of beds available in some districts is still considerably less than the demand for them, but some Hospital Boards are showing an increasing unwillingness to embark upon the expenditure necessary to provide adequate facilities. In 1942 a pamphlet on " The Prevention of ' Hospital Infection ' of Wounds " was reprinted by the Department and circulated to all hospitals. Some of our better hospitals have made a most commendable attempt to achieve the ideals of safety for their patients as set out in the pamphlet, while others have not reached the same standard. Another pamphlet, on the prevention of cross-infection in hospitals, has been compiled by an authoritative committee in England. It is hoped to circulate this pamphlet also, as there are too many cross-infections in some of our hospitals. Arrangements have been made for a limited regular supply of penicillin from Australia. It has been found necessary to subject penicillin to a control order to ensure that the restricted amount available shall be kept for cases who need it most urgently and because the Australian authorities desire that it be available to our population on the same terms as it is to their own. In the meantime the pathologists in the main centres act as local representatives of the Department in the control and distribution of penicillin. School Hygiene.—This year of the war the health of the school-child is beginning to show the effect of the times. Malnutrition is showing a decided rise. There is a conneetional slight rise in skin troubles and external eye-diseases which are probably reflections of the nutritional state. On the other hand, there are bright spots in the lessened incidents of dental caries and goitre. This would seem to be the result of the widespread dental clinic care and response to propaganda for the mox*e common use of iodized salt. Diphtheriaimmunization work was carried out steadily, there having been given during the year 23,466 complete courses of protective material. Division of Tuberculosis. —Active steps continue to be taken in fighting this disease. Contact has been made with district staffs, facilities in the main hospitals for treating tuberculosis have been inspected, and visits have been made to all sanatoria. Conferences which were held at Palmerston North and Auckland have stimulated Hospital Boards to appoint Tuberculosis Officers, to institute hospital chest clinics, and to provide better accommodation for tuberculosis cases, including facilities for surgical-collapse therapy, occupational therapy, and education of the patient. In Auckland a lay Tuberculosis Association has been formed on similar lines to those established in America and England. It is hoped that this will lead to the formation of a national association, whose main concern will be the rehabilitation of the tuberculous patient. The first step in a tuberculosis-control programme is case-finding, and progress in this connection has been made possible by the appointment of additional district health nurses. These nurses have contributed largely to the compilation of the New Zealand Tuberculosis Register. The magnitude of the problem is shown in the following table, which sets out the number of cases of tuberculosis at present known to the Department:-—

Cases of Tuberculosis in New Zealand (inclusive of Maoris)

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Pulmonary. Non-pulmonary. Total. Nortli Island .. .. .. .. .. 4,698 386 5,084 South Island .. .. .. .. .. 1,398 181 1,579 6,663 Not stated and presumed mixed forms .. 109 Total .. .. .. .. .. .. 6,772

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Group x-ray examination of certain sections of the community lias been undertaken, but the work has been limited because of the inability of the x-ray departments of public hospitals to cope with it. When sufficient radiologists and equipment are available, a more general use of this method of examination will be possible. In the meantime, efforts are being concentrated upon family contacts and other groups exposed to infection, such as nurses in public hospitals, dental nurses, training college entrants, school-teachers, medical students, and laboratory workers, A limited number of factory employees have also been examined. The following reflects the work done by the district nursing service and school medical officers: — New tuberculous homes brought under control .. .. •• 2,050 Total number of homes under control .. .. .. ■ ■ 6,865 Number of new contacts examined and brought under control .. 4,611 Total number of contacts under supervision to be brought up for revision .. .. .. •• ■■ •• •• 18,094 Number of Mantoux tests .. .. • ■ • • • • 1,822 Number of positive reactors .. .. .. • • • ■ 474 (26 per cent.) Number of contacts x-rayed .. .. .. ■ • • • 5, 522 Number of cases found amongst contacts as active from Mantoux testing and x-ray examination .. .. .. • • 377 (6-8 per cent.) The routine examination of contacts yielded 377 active cases. An improvement in housing, both for the Maori and the European family, will be one of the main factors in effecting the hoped for decline in tuberculosis in this country. The source of infection of every case must be traced, and, in turn, when discovered should be brought under treatment and placed under institutional or domiciliary control. Improvement in housing should be far less costly than the provision of new tuberculosis institutions. Nursing.—The work of the Nursing Division has been influenced by two factors during the current year, the first being the increasing difficulty which is being experienced with hospital staffing, and the second the rapid expansion of the Department's public health nursing service owing to the extension of the tuberculosis, immunization, and health education programmes. The following measures were undertaken to relieve the hospitals staffing difficulty(l) Man-power regulations were gazetted which laid down that the staffing of public and private hospitals, of any State Department, and the Plunket Society should rank as an essential service. The movements of all nurses leaving training schools and of all married nurses were controlled. (2) The Civil Nursing Reserve was extended, and now consists of 28 registered nurses and 280 voluntary aids helping a very large number of hospitals for varying periods. (3) The Nursing Division was used as an advisory body in regard to hospital vacancies. (4) A nursing recruiting campaign was carried out. Towards the cost of this the Government granted the sum of £1,000. Hospitals used as training-schools for nurses during the last five years show an increase of 2,271 in the average number of occupied beds. These employ an additional staff of 1,462 nurses, of whom 557 are registered nurses. The district nursing staff has been increased to cope with the intensified public health programme, and authority was obtained to appoint an additional 50 nurses over a period of eighteen months. With the establishment of a Tuberculosis Division, more detailed reporting and visiting of this type of patient has been required. New houses and equipment have had to be provided for the additional nurses. A difficult problem has been the provision of motor-cars, and many areas have been handicapped by lack of transport for the nurse. _ . Matters of special importance dealt with by the Nurses and Midwives Registration Board were: (1) The gazetting of regulations to allow Voluntary Aids to sit for the State examination for nursing aids if they have carried out 0,000 hours of duty in approved hospitals. This will give voluntary aids who have given valuable wartime service a reduction of one year in the period of training they must undergo if they wish to seek registration as nurses. (2) The Mental Hospitals Department asked that the training and registration of mental nurses should come under the authority of the Board. The necessary authority is now being sought. (3) A special committee of tutor sisters from different hospitals under the Chairmanship of Miss Bridges was set up to prepare a report on a preliminary course to be taken at secondary schools, with the possible provision of bursaries for those taking the course, and the revision of the Nursing Syllabus in the light of presentday medical science. . The new school provided for the post-graduate nurses is now m use and the number of students has been increased. A short course for nurses, entering public health district service is now held twice a year and has been of much service in providing standard introductory instruction. During the months of July and August Miss Lambie visited Fiji tor the purpose ot reporting on the development of a South Pacific Nursing Service. Maternal Welfare.—The occasion of the retirement of Dr. Paget makes it opportune to refer to the progress which has been made in the saving of lives of mothers. In 1923 the maternal-mortality rate from all puerperal causes was 5-11 per 1,000 live births. In 1943 it was 2-21.

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In 1927, when statistics were first available for deaths from septic abortion, the maternal-mortality rate exclusive of such deaths was 4-41. In 1943 it was 1-71. In 1927 the death-rate from puerperal sepsis (excluding septic abortion) was 2 per 1,000 live births. By 1943 it had fallen to 0-30. The work of Dr. Paget and of his former associate, Dr. Henry Jellett, contributed largely to the favourable turn of affairs shown by these figures. The measures planned by these officers and subsequently adopted by the Department under the direction of Dr. Paget included the introduction of a thorough antiseptic and aseptic technique, a revision of the standard of training of obstetrical nurses, and closer supervision of maternity hospitals. Dental Hygiene.—The activities of the Dental Division have continued on a steadily increasing scale during the year under review. The School Dental Service in particular has been further expanded. It now operates at 413 centres, as compared with 387 at the end of the previous year. The staff has increased to 618 (including 150 student dental nurses). The number of children under regular treatment is 168,588, an increase of 22,092 during the year. Additional schools to the number of 83 have been brought within the scope of the service, making the total number of schools now receiving treatment 2,203. There has been a further substantial increase in the number of pre-school children enrolled for regular dental supervision. The number now stands at 18,122, as against 12,993 at the end of the previous year, an increase of 38 per cent, during the year. The total number of operations for the year was 1,462,404. This number included 779,534 reparative fillings in both permanent and deciduous teeth, 201,232 prophylactic fillings, and 81,524 extractions. Evidence of improvement in the dental condition of new school entrants over a period of nine years is afforded by statistics that are now available. While it would not be justifiable on such limited evidence (it refers to seven centres in various parts of New Zealand) to assume that there has been any significant improvement over the whole Dominion, the figures nevertheless reveal a satisfactory trend. The statistics in question relate only to children who had not been under dental treatment prior to entering school. Stated briefly, they reveal that whereas the average caries index for the 1934 group of new school entrants at the seven centres was : 11-4, the 1943 group of new entrants at the same centres showed an average caries index of 7-3. Dental health education received added emphasis during the year through the appointment, in a temporary capacity in the meantime, of a senior dental officer to work in close collaboration with the Departmental Committee for Health Education and to direct this work within the Dental Division. A school dental nurse experienced in this work is already attached to Head Office staff, and the appointment of a second nurse lias been approved. The field staff of the School Dental Service has been active during the year in the endeavour to implant the idea of positive dental health in the minds of parents and children. This work culminated in a Dominion-wide Dental Week in February, 1944, when a- week's intensive campaign was conducted by the whole staff. The dental health educational activities recorded for the year numbered 7,246. The further development of State dental services has received close attention during the year. Additional University bursaries for dental students were granted at the beginning of 1944 to the number of 36. Owing to the increased responsibilities arising from new emergency regulations, the Dental Sub-committee of the National Medical Committee was reconstituted in November, 1943, as the National Dental Committee. Its functions are to ensure the orderly recruitment of dental personnel for the Armed Forces, and to advise the Controller of Man-power on dental man-power problems, more especially those concerned with the control of practising locations of dentists and the direction of dental graduates to employment. A representative Dental Advisory Committee was established during the year to collaborate with the Education Committee of the Rehabilitation Board in connection with problems arising from the rehabilitation of dental personnel serving with the Forces, and of other ex-service personnel who may wish to pursue dental studies. The organization established and administered by the Department as part of the military medical boarding system for the dental examination and treatment of all Army personnel on return to New Zealand has continued to operate satisfactorily during the year. Both the boarding and the treatment are carried out by private dental practitioners under arrangement with the Department. The routine administration of the affairs of the Dental Council of New Zealand has been continued throughout the year, and matters arising from the administration of dental legislation have received attention. Maori Hygiene.—The mean Maori population was estimated to be 96,984, as against 94,473 in 1942. The following table enables a comparison between Maori and European vital statistics:— Maori. European. Birth-rate per 1,000 of population .. .. .. .. 45-78 19-70 Crude death-rate per 1,000 of population .. .. 17-27 10-04 Infant-mortality rate per 1,000 live births .. .. .. 90-09 31-37 Maternal-mortality rate per 1,000 live births .. .. 2-25 2-21 Death-rate, tuberculosis (all forms), per 10,000 .. .. 36-91 3-72

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The Medical Officer of Health, Hamilton, states that the district nurses continue to spread the gospel of good health amongst the Maori people wherever possible, and to attend to the greater part, at any rate, of their medical needs. He reports a considerable improvement in the general sanitary conditions of the Maori people. That there were only three Maori cases of typhoid in his district for the year, the lowest figure recorded, is a tribute to this improvement. The Medical Officer of Health, Gisborne, reports that the housing conditions of many of the Maoris cause great anxiety. The spread of disease, and particularly tuberculosis, the prevalence of scabies and other similar conditions, are maintained by the poor circumstances in which people have to live. He is convinced, by personally visiting the Maoris in their homes, that given decent facilities they can maintain as high a proportion of satisfactory houses as Europeans of equal economic status. Nutrition. —Dr. Muriel Bell has maintained close collaboration with other Departments interested in nutrition and the food-supply of our people. The booklet, " Good Nutrition," lias been revised, and a wartime edition is now in course of printing. The services of Dr. Bell and Miss Frengley, Dietitian, have been used for advice on dietaries of various institutions and authorities, and for teaching dietetics in training colleges. Nutrition charts were designed and made available to nursing training-schools, district health nurses, and others concerned in the teaching of dietetics. Industrial Hygiene.—Dr. J. M. Davidson, on loan from the Ministry of Labour and National Service, London, arrived to take up duty as Industrial Hygienist to the Department. He is now engaged in making a survey of industry and their possible hazards. Health, Benefits. —No new health benefits were introduced during the year under the Social Security Act. Cost of Benefits : The following is a statement of the expenditure on the various classes of benefits during the year, the figures for the previous year being shown in parentheses:— Maternity benefit — £ Hospitals .. .. .. .. .. 324,769 Medical practitioners .. .. .. .. 167,272 Nurses .. .. .. .. .. 12,027 St. Helens hospitals .. .. .. .. 9,870 Total .. .. .. .. .. £513,938 (£505,224) Medical practitioner services— £ Capitation fees .. .. .. .. .. 55,612 General medical services .. .. .. .. 1,026,449 Special arrangements .. .. .. .. 3,2,669 Mileage .. .. .. .. .. 60,39.1 Total .. .. .. .. .. £1,175,121 (£1,016,052) Hospital benefits—• ===== Public hospitals— £ In-patients .. .. .. .. 1,571,192 Out-patients .. .. .. .. 73,138 Private hospitals and approved institutions .. 283,065 Mental hospitals .. .. .. .. 182,829 Other institutions .. .. .. .. 55,184 Total .. .. .. .. .. £2,165,408 (£1,546,959) Pharmaceutical supplies benefits — £ Chemists and medical practitioners .. .. 722,172 Institutions .. .. .. .. .. 40,027 Total .. .. .. .. .. £762,199 (£563,247) X-ray diagnostic services .. .. .. .. £109,435 (£88,588) Massage benefits .. .. .. .. .. £27,333 (£8,836; 6 months only) Maternity Benefits: The existing scale of fees agreed to between the Hon. the Minister and the British Medical Association was intended to remain in force for two years. It has now been operative for four and a half years, and it was felt that a revision was expedient. Discussions are taking place between the representatives of the British Medical Association and officers of the Department. General Practitioner Services : There has been a slight reduction in the number of persons receiving medical benefits (capitation scheme), but in general the medical practitioners who undertook to supply medical benefits have continued to do so in spite of the introduction of the fee-for-service scheme. Inquiry from capitation practitioners shows that individually they consider this type of medical practice to be superior to any other, and. patients generally do not abuse their right to receive free medical attention on request,

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The cost of general medical services shows a slight increase on that for the previous year. The shortage of civilian doctors and the long hours they are working in many cases makes it unlikely that the cost of general medical services will increase further under present conditions. Pharmaceutical Supplies Benefits: The cost of this benefit continues to increase and represents an expenditure of 9s. per head of the population, exclusive of the medicines supplied to in-patients of public hospitals. Part of the increased cost is due to extensions of the Drug Tariff following extensions of the British Pharmacopoeia and Pharmaceutical Codex. The increasing costs of drugs also has an important influence on the cost of the benefits. Apart from, these two factors, the number of prescriptions written is constantly increasing, and it is hard to resist the impression that many unnecessary bottles of medicine are prescribed. A new Drug Tariff was issued in November and came into force on Ist January, 1944. While a few proprietary substances of proved merit were included in the new Drug Tariff, its main purpose was to define more clearly the substances which do not involve a claim on the Fund. It is considered that pharmacists now have a more ready appreciation regarding what does and what does not involve a claim on the Fund. Hospital Benefits: The amount of the hospital benefit was increased from 6s. to 9s. a day as from Ist April, 1943. This increase accounts for the increase of over £600,000 in the total amount paid. Advisory Committees: Considerable assistance has been given by the various advisory committees which help in the administration of the benefits. The Central Pharmaceutical Committee, which comprises private medical practitioners and contracting pharmacists, was instrumental in the revision of the Drug Tariff, while the Drug Committee considered applications for the inchision in the Drug Tariff of a large number of proprietary remedies. The Radiological Advisory Committee held a number of meetings for considering application from radiologists for recognition and made appropriate recommendations to the Hon. the Minister. _ /' A Disciplinary Committee was also set up under the provisions of section 83 of the Social Security Act, 1938, to consider the case of a private-hospital licensee who had charged her patients fees in excess of those which she had undertaken to charge. In this case a recommendation was made to the Hon. the Minister that a fine of £10 be imposed. Neurological Surgery: Dr. Murray Falconer took up his duties in July, 1943, as lecturer in neuro-surgery at the Otago University. By arrangement with the University his salary is being paid from the Social Security Fund and his services are to be available to any patient from any part of New Zealand. Dr. Falconer has in his charge a number of beds in the Dunedin Hospital. He pays visits to Christchurch and Wellington at approximately monthly intervals in order to examine selected patients, who are transferred to Dunedin hospital for surgical treatment. Later it is hoped to include Auckland in his itinerary. General Milk-in-schoolf! Scheme,—The total number of pupils in the milk-in-sehools scheme in 1943 was 235,361 (an increase of 523 over the previous year), representing some 84 per cent, of the school population. The totals for pasteurized bottled milk, milk for cocoamaking purposes, or malted milk are made up as follows:— Pupils. Pasteurized bottled milk . . . . .. . . 222,098 Malted milk .. . . .. . . .. 8,234 Milk for cocoa .. . . .. . . . • 5,029 235,361 Apples-in-schools Scheme.—Apples free of cost were supplied during the apple season to pupils attending all types of schools. The scheme continued for eight weeks, during which time approximately 92,000 cases of apples were supplied. Health Camps.—Recommendations received from the medical officers and social workers indicate an increasing need for permanent and secondary health camps to enable understandard children to have a course of treatment in one of these institutions. It is anticipated the present shortage of health-camp accommodation in the North Island will be overcome by the early return to their normal functions of three camps in the Wellington Province at present being used for war purposes, and the establishment of a permanent institution in the Auckland District. In the South Island summer camps have functioned to capacity, while the permanent camp at Roxburgh has continued to care for children not only from Otago and Southland, but from other districts, including Chatham Islands. Notwithstanding other appeals, the sale of health stamps received generous support throughout the Dominion. Sums raised from the sale of these stamps and donations to the movement amounted to £26,511, which is just over three times last year's record total. A special donation from the J. R. McKenzie Trust and the subsidy from art-union funds will also be distributed to executives for the maintenance of children. Health Education,.—The budget for health education provided for an expenditure of some £15,000. Of this sum £8,000 was set aside for a special campaign by newspapers,

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radio, and screen advertising. Newspaper advertising formed the basis of the scheme. Health advertisements appeared regularly in thirty-five daily metropolitan and country newspapers with a circulation of approximately a million, and a quarter people. Radio and screen advertising was also used extensively. In the routine programme, weekly health articles continued to be supplied to twenty-eight daily papers, and magazine articles to various journals. A number of new pamphlets were issued, and several others are now being printed. Supplies of leaflets relating to venereal disease, tuberculosis, arid sex education were obtained and distributed. New stocks of posters were received from Ihe Health and Cleanliness Council, London, National Tuberculosis Associations of Great Britain and the United States of America, and Department of Health, Union of South Africa. These have been widely distributed. The available 16mm. sound-films and film strips now cover a wide range of subjects. Among these are films dealing with venerealdisease problems, some of which have been supplied to the Army authorities. The Department's mobile health exhibit, illustrating the facts of healthy living and good nutrition, visited a number of centres. Libraries were instituted 'at each district office for the purpose of supplying all district health nurses with literature and information on health education. Information has been supplied through the Library to overseas organizations and health authorities, and co-operation maintained with departmental and other libraries. The Library is now affiliated with the Canterbury Medical Library, Christchurch Hospital, with regard to loan of the wide range of their journals and reference material. Medical Advertisements Act.—The personnel of the Board established by the Medical Advertisements Act, 1942, were appointed early in the year. The earlier meetings were concerned with the preparation of the Medical Advertisements Regulations (Serial number 1943/63). The Medical Advertisements Procedure Rules 1943 were also, prepared for the guidance of those wishing to make applications to the Board under the provisions of the Act and regulations. The Board has considered numbers of applications under section 6of the Act. In some instances notices have been served, and in others further inquiry has been recommended. Labelling matters have been widely considered, and exemption applications under Regulation 4 dealt with. The Department has taken an educative rather than an oppressively legal line in its administration of this new legislation. Boards associated with the Department.—The Board of Health, Medical Council, Medical Research Council, Nurses and Midwives Registration Board, Opticians Board, Masseurs Registration Board, Medical Advertisements Board, Plumbers Board, King George V Memorial Fund Board, and Dominion Advisory Board of New Zealand Federation of Health Camps continued their work during the year. Medical Research, Council.—A list of the special Committees set up under the Council, and some information regarding the researches carried out by the Committees, is set out below:— (1) Nutrition Committee— " 'Vitamin C Status of Personnel in Two Military Camps and Investigation of Vegetables cooked in Hospitals" (McLeod, McLaughlan, and Bell). " Nutritional Aspects of Prospective Meat Rationing in New Zealand." "Estimation of B, in Foods" (McLaughlan and Wilson). " Peameal versus Meatmeal in Rat Feeding " (McLaughlan and Wilson). " X-ray Preventive!, Methods for Assay of Vitamin I)." " Summarized Results on Tests for Vitamin C in Foods and in Blood Plasma" (McLeod, McLaughlan, Wilson, and Bell). " Wholemeal versus higher extraction flour " (Bell). " Effect of Baking-powder on the B, Content of Wholemeal " (Wilson). Published in New Zealand Journal of Science and Technology, Vol. XXIV, 1942. "Vitamin B, Content of Wheat-germ and Germ Bread" (Wilson). Published in New Zealand Journal of Science and Technology, Vol. XXIV, 1942. (2) Committee for the Study of the Physiology and Pathology of the Thyroid Glands— Studies of Goitrogenic Agents " (Kennedy). " The Significance of the Basophil Changes in the Pituitary in Thyroxine-deficiency States" (Griesbach and Purves). " The Significance of the Acidolph.il Changes in the Pituitary in Thyroxine-deficiency States " (Griesbach and Purves). " Pituitary Function in relation to the Action of Allythiourea and lodine " (Kennedy, Griesbach, and Purves). " The Relative Activities of I- and r-thyroxine and certain Thyroid Preparations" (Purves).

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" Pituitary Function in the Hyperthyroid State" (Grieisbach and Purtes). " The Absence of a Thyroid Inhibitor in Eat Pituitaries " (Griesbach and Purves). " Studies on Experimental Goitre.—lV: The Effect of Di-iodo-tyrosine and Thyroxine on the Goitrogenic Action of Brassica Seeds" (Purves). Published in the British Journal of Experimental Pathology, Vol. XXIV, 1943. (3) Hydatid Committee: Farther work has been carried out on the natural history of the hydatid parasite. Research work on animals has opened up new lines of thought and investigations that have an important bearing on hydatidprevention. Linked up with the work of the Department of Hydatid Research and Prevention, Medical School, Dunedin, are the clinical investigations on hydatid incidence published annually in the New Zealand Medical Journal and the clinical records of the Hydatid Registry of the Royal Australasian College of Surgeons. These records now relate to 1,715 cases. Both of these lines of study are in the hands of the Chairman of the Committee, Sir Louis Barnett. One of the important conclusions reached by a study of the data is that the initial hydatid infection in human beings occurs almost exclusively in juveniles, although the clinical manifestations of the hydatid cysts may not reveal themselves for many years. Miss Batham, M.Sc., the Research Officer, has been engaged, in addition to other lines of research, on testing the efficiency of arecoline and other anthelmintics. (4) Committee of Clinical Medicine— " Circulatory Effects of some Iso-thiourea Derivatives, with Special Reference to Sensitization of Animals to the Pressor Action of Adrenalin" (Pastier and Smirk). Published in Journal of Physiology, Vol. 101, 1943. "Control of Radium for Gastric Acidity" (Jenkins and McGeorge). Published in the Archives of internal Medicine, Vol. 70, 1942. "Casual and Basal Blood Pressures": (i) "In British and Egyptian Men" (Alam and Smirk) ; (ii) "In Essential Hypertension" (Alain and Smirk) ; (iii) "In Renal Hypertension" (Gatman, Nassif Amin, and Smirk). Published in British Heart Journal, Vol. V, 1943. (5) Tuberculosis Committee: A programme of area surveys, where the form and degree of activity of the disease will be collated, has been planned. Culture media research has been proceeding in Dunedin under the Travis Bequest Fellow, Doctor Edson, and his staff in the hospital laboratory at Auckland under Dr. Gilmore. Occupational hazards in regard to the development of tuberculosis have been briefly surveyed. (6) Obstetrical Committee-: Owing to war conditions the work of this Committee has been very much curtailed during the year. Staff It is with deep regret I record the death of various members of the staff. Messrs. C. Hayes, J. Gambrill, R. V. P. Hopkins, and E. R. Strang lost their lives while on active service overseas. Dr. R. A. Shore, Deputy Director-General of Health, died after a short illness. Dr. Shore ably served the Department for twenty years as Medical Officer of Health, Director of the Division of Hospitals, and in his final capacity as Deputy Director-General of Health. His long association with hospital adimhistration brought him into touch with hospital authorities throughout the Dominion, and in this sphere his sound judgment and kindly personality will be greatly missed. In the sudden death of Dr. T. McKibbin, Dunedin, the Department lost a valued officer with many years' experience in public-health administration. Mr. Gordon S. Reid, Architectural Inspector in the Department, died suddenly while in London. Mr. Reid joined the Department in 1932 and was well known throughout the Dominion by public-hospital authorities. Dr. Telford retired from the post ol: Medical Officer of Health for the CanterburyWestland Health District after a period of twenty-four years with the Department. Throughout his tenure of office he administered the district under his control with oustanding zeal and ability. In conclusion, I wish to express thanks for the support rendered by my officers during the year. ' M. H. Watt, Director-General of Health.

Approximate Cost of Payer.—Preparation, not given ; printing (930 copies), 61!).

Authority: E. V. Paul, Government Printer, Wellington.—l 944.

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