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

Appendix to the Journals of the House of Representatives, 1946 Session I, H-31

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1946 NEW 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 1945-46.

VITAL STATISTICS Population.—The mean population of the Dominion for 1945 was 1,691,520 (Europeans 1,593,513, Maoris 98,007). Births. —The total births were 41,651, representing a birth-rate of 24-62 per 1,000 of mean population. The number of European births was 37,007, with a rate of 23-22. This figure compares favourably with the rate of 21-59 in 1944. The number of Maori births was 4,644, which represents the high rate of 47-38. Deaths.—ln 1945, 17,686 deaths were registered, giving a crude death-rate of 10-46 per 1,000 of mean population. There were 16,051 deaths of Europeans, with a rate of 10-07, and 1,635 deaths of Maoris, with a rate of 16-68. Infant Mortality.—The infant-mortality rate was 34-79 per 1,000 live births. There was the usual marked difference between the European and the Maori sections of the community—the relative rates being 27-99 for Europeans and 88-93 for Maoris.

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The European rate compares favourably with that of 1944 (30-12), and, indeed, represents a new low record for infant mortality in the European section of our population. Still-births.—The rate for Maoris is not available. That for Europeans was 22-84 per 1,000 of total births which again is a record low r'ate for the Dominion. Maternal Mortality.—Here again the Maori figures are not available. For Europeans the maternal mortality rate, including deaths from septic abortion, was 2-24 per 1,000 live births, as compared with 2-71 in 1944. After excluding deaths from septic abortion, the rate was 1-95 (2-14 in 1944). Summary of Vital Statistics European. Maori. Combined. Population, mean .. .. .. .. 1,593,513 98,007 1,691,520 Birth-rate per 1,000 population .. .. 23*22 47-38 24-62 Death-rate per 1,000 population .. .. 10-07 16-68 10-46 Infant-mortality rate per 1,000 live births .. 27-99 88-93 34-79 Death-rate, tuberculosis, all forms, per 10,000 population .. .. .. .. 3-78 37-02 5-77 This table shows at a glance the main differences between the Europeans and the Maoris in respect of vital statistics. INFECTIOUS AND OTHER DISEASES Scarlet Fever. —Scarlet fever, with 5,081 cases (5,033 European, 48 Maori), shows a considerable decrease from the high incidence of 1944. Diphtheria.—There were 1,075 cases (996 European, 79 Maori) of diphtheria in 1945, as against 713 cases (693 European, 20 Maori) in 1944. In view of the extreme prevalence of the disease in Europe, "and the possibility of virulent strains of the causative organism being brought to New Zealand, the position has been watched closely. Unfortunately, owing to shortage of Medical Officers, the amount of immunization carried out in recent years has been limited, but endeavours are being made to do as much as possible. The policy of having diphtheria immunization done by District Nurses has been given an extensive trial in North Auckland, and has proved very satisfactory. It will be extended to other districts as soon as possible. Poliomyelitis. —Only a few sporadic cases were notified during the year ended 31st December, but early in 1946 there was a marked increase in the number of cases occurring in Otago. Restrictions were imposed on all gatherings of children and on children travelling from Otago and Southland to the rest of the Dominion. The schools also remained closed until the end of February. After the middle of February the incidence declined sharply, and since then cases have been sporadic, and have occurred throughout the Dominion. Food Poisoning. —Most of the cases of food poisoning were reported from one outbreak affecting the nursing staff of the Hamilton Public Hospital. The infection was not severe, and most of the nurses returned to duty within a few days. Beriberi. —The reported cases of beriberi occurred in prisoners of war from Japan, who were treated in hospitals in the Dominion while in transit to their final destinations. Puerperal Sepsis.—There were 75 notifications of sepsis following childbirth, with 4 deaths, a death-rate of 0-11 per 1,000 live births. Sepsis following abortion was notified in 100 cases, with 12 deaths, a death-rate of 0-29 per 1,000 live births. These figures are for Europeans only, as reliable figures for Maoris are not available.

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Tuberculosis. — The next table sets out the death-rate from tuberculosis for 1940-1945.

Death-rates per 10,000 Population

Venereal Disease.—The following tables summarize the work of the venerealdisease clinics in the. four main centres. Figures are given for the last pre-war years as well as for subsequent years. The reduction in the incidence of syphilis since 1941 has been maintained, and the figures now approximate the pre-war level: —

Number of Persons seen for the First Time at each 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 Gonorrhoea

Notifications of Disease. —Tables showing the notifications of infectious and other notifiable diseases are included in the section dealing with Public Hygiene.

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(Europeans only) RespiratoryNon -respiratory Tuberculosis Tuberculosis. Tuberculosis. (all Forms). 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 1944 3-12 0-69 3-81 1945 3-12 0-66 3-78

Year. Auckland. Wellington. Christchurch. Dunedin. Total. Grand Totals. 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 6 260 144 403 1942 70 78 53 71 18 11 20 6 161 166 327 1943 48 95 20 41 17 14 29 3 114 153 267 1944 21 48 14 26 14 10 27 4 76 88 164 1945 61 34 11 20 15 8 27 6 114 68 182

Year. Auckland. Wellington. Chiistehurch. Dunedin. Total. Grand Totals. M. F. M. F. M. F. M. F. M. F. 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 265 441 138 89 122 92 51 15 576 637 1,213 1944 215 470 140 59 139 86 50 22 544 637 1,181 1945 389 413 178 54 149 66 46 9 762 542 1,304

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THE PRINCIPAL CAUSES OF DEATH (Europeans only) The following table gives the main causes of death during the year, the actual number of deaths therefrom, and the death-rates per 10,000 of mean population for each of the last five years :

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1945. Cause. 1944: 1943: 1942: 1941 : Number. Rate. Rate. Rate. Rate. Rate. Heart-disease (all forms) 5,638 35-37 33-50 33-68 36-41 31-55 Cancer 2,212 13-88 14-02 13-85 13-13 13-18 Violence 785 4-93 5-38 6-06 5-76 5-64 Pneumonia 255 1-60 1-32 1-41 1-52 1-48 Pneumonia (secondary to influenza, whooping32 0-20 0-31 0-17 0-81 0-38 cough, and measles) Bronchitis 179 1-12 1-14 1-40 1-36 0-94 Broncho-pneumonia 249 1-56 1-82 1-67 2-11 1-98 Tuberculosis (all forms) Kidney, or Bright's disease 603 3-78 3-81 3-72 3-94 3-88 416 2-61 2-80 2-83 3-19 3-66 Apoplexy or cerebral haemorrhage ,1,640 10-29 9-28 9-79 9-90 8-95* Diseases of the arteries 239 1-50 1-21 1-21 1-22 1-14* Senility 459 2-88 2-94 3-17 3-02 3-13 Diabetes 319 2-00 2-10 2-16 2-28 2-22 Hernia and intestinal obstruction 125 0-78 0-74 0-65 0-74 0-73 Diseases and accidents of childbirth (puerperal 83 0-52 0-58 0-44 0-55 0-76 mortality) Appendicitis 59 0-37 0-50 0-47 0-44 0-55 Diarrhoea and enteritis 125 0-78 0-64 0-58 0-50 0-54 Epilepsy 45 0-28 0-30 0-46 0-53 0-43 Common infectious diseases — Influenza (all forms, including pneumonia) 53 0-31 0-40 0-42 1-61 0-49 Diphtheria 42 0-26 0-19 0-21 0-16 0-11 Whooping-cough 8 0-05 0-29 0-11 0-03 0-44 Scarlet fever 13 0-08 0-17 0-01 0-01 0-01 Typhoid and paratyphoid 3 0-02 0-02 0-02 0-05 0-05 Measles .. .. .. .. 10 0-06 0-05 0-20 0-03 * Owing to an alteration in the international agreement a s to the allocation of deaths to various causes, the figures for these two conditions are not separately comparable with the figures for years before 1940.

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REPORTS OF DIVISIONAL DIRECTORS DIVISION OF PUBLIC HYGIENE Quarantine At the end of the war the various emergency regulations governing medical inspection of overseas ships were revoked, and the procedure in force before the war has now been resumed. Ships are again sending wireless information concerning the state of health of those on board, and, if free from disease, the ship is berthed before being boarded by the Port Health Officer. During the year the New Zealand Government ratified its adherence to the International Sanitary Convention 1944 and the International Sanitary Convention for Aerial Navigation 1944. These Conventions, which are the work of the Health Division of UNRRA amend the corresponding Conventions of 1926 and 1933 and are of limited duration only. Dangerous Drugs and Poisons The Dangerous Drugs Regulations have been amended to include pethidine as a dangerous drug. The Poisons (General) Regulations were amended, with particular reference to prescription poisons. In addition, the new insecticide DDT was made a First Schedule poison, but by a later amendment the control of DDT was relaxed so as to permit, its sale subject to the necessary requirements as to the method of packing and labelling. Cemeteries Act Several municipalities have interested themselves in the establishment of crematoria. During the year crematoria at Hastings and Wanganui were built and are now in operation. Food and Drugs Milk-supplies.—With the coming into force of the Milk Act, 1945, and the consequent setting-up of Milk Authorities throughout the Dominion, there has been a further change in Government policy with respect to the supervision of milk-supplies. Under the new arrangement the Department of Agriculture will assume responsibility for the supervision of all milk-treating establishments, and the Department of Health is now responsible only for the sampling of milk as it is finally sold to the public. Each Medical Officer of Health or his deputy has been appointed to represent the Minister on each Milk Authority in his district. Regulations were enacted for the better control of milk-pasteurizing plants, and the high-temperature short-time method of pasteurization is now an approved method of pasteurization. Nitrite Poisoning.—Owing to several cases of accidental poisoning with sodium nitrite, used by butchers for the curing of meat, it has been found necessary to enact regulations providing for the special labelling of all meat-pickling preparations containing nitrites. Penicillin. —Regulations have been gazetted controlling the quality of penicillin and restricting its use to bona fide preparations containing a stated quantity of the substance. It is now an offence to sell any penicillin preparation that contains less penicillin than the quantity stated on the label. This is designed to prevent its commercial exploitation by manufacturers of patent medicines and toilet preparations.

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Sale of Food and Drugs The next table sets out, by health districts, the number of samples of milk, food, and drugs taken and dealt with during the year.

Samples of Foods taken and dealt with during the Year ended 31st December, 1945

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Milk. District. Number of Number of Samples not "Warnings Prosecutions Samples. Vendors. complying. issued. recommended. North Auckland 140 38 3 1 1 Central Auckland 4,H6 1,816 264 127 5 South. Auckland 1,664 1,566 80 50 29 Thames-Tauranga 92 57 5 Taranaki 261 168 16 11 7 East Cape 325 245 31 26 4 Wellington - Hawke's Bay 1,629 431 25 6 12 Central Wellington 2,034 1,226 16 9 • 2 Nelson-Marlborough 128 55 3 Canterbury5,093 1,367 807 186 7 West Coast 207 168 13 8 1 Otago 1,750 667 253 97 2 Southland 372 186 47 25 17,811 7,990 1,563 546 70 Other Poods and Drugs. District. Number of Number of Samples not Warnings Prosecutions Samples. Vendors. complying. issued. recommended. North Auckland Ill 79 2 1 1 Central Auckland 365 175 143 12 11 South Auckland 90 80 14 5 Thames-Tauranga 20 8 15 Taranaki 7 6 4 i East Cape 68 68 12 10 Wellington - Hawke's Bay 273 195 15 6 Central-Wellington 179 141 22 6 Nelson-Marlborough 14 8 1 Canterbury 442 225 100 45 West Coast 65 38 8 2 Otago 373 238 14 1 Southland 137 42 8 6 2,144 1,303 358 95 16

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Notification of Disease The following tables give details of the cases of notifiable diseases reported in 1945 :

Table A.—Notifiable Diseases in New Zealand for Year ended 31st December, 1945, showing Distribution by Months

Enteric Tuber- * . Puerperal . Fever. culosis. > *7* Fever. S >> g 'B P ■ s 5 *- I » 1 I s 1 .1 Months. d j ■ fl§ 1 « f * 1* II 11 1 11! 11 ji 11 n 1 1 i i r 11 n i j i r i * i»fiSe-SeoP4iS 3 o hhMho S«!k»PQH January 387 76 .. 106 15 5 . . . . 18 13 9 4 1 3 7 2 3 .. 31 H . . .. 681 February .. 298 64 3 2 152 24 9 .. . . 17 2 7 5 1 1 10 23 618 March . . 598 74 1 . . 184 20 7 2 . . 28 7 10 2 1 3 2 1 3 26 . . 2 . . 9 980 April 579 90 2 . . 87 13 7 . . . . 21 5 7 2 2 1 2 1 12 35 1 1 1 9 1 . . . . 879 May 655 167 2 . . i.22 32 6 1 1 26 9 4 2 1 6 1 1 .. 17 3 1 .. 15 1,072 June 567 120 1 .. 115 17 4 2 1 21 6 8 8 1 5 1 .. . . 7 2 2 .. 19 .. 1 . . 908 July 540 86 1 1 117 30 13 1 1 25 9 3 2 . . 9 . . . . 1 12 . . 2 . . 24 877 August 491 92 2 . . 233 47 11 . . . . 26 3 3 4 2 3 . . 1 . . 7 3 1 . . 11 940 September 357 47 2 .. 133 31 6 1 1 22 6 8 4 .. 4 9 . . 1 .. 13 .. 1 1 647 October 246 62 3 5 181 40 8 1 1 20 6 11 4 . . 5 ... . 4 8 1 2 2 8 1 1 2 622 November 191 56 4 .. 179 38 16 2 .. 11 8 10 6 1 2 2 1 79 6 4 5 . . 9 .. 1 *50 681 December 124 62 2 .. 113 22 6 4 1 13 1 20 3 2 3 2 . . 8 7 5 5 .. 16 .. 1 .. 420 Totals — 1945 .. 5,033 996 23 81,722 329 98 14 6 248 75 100 46 12 41 10 5 ill 151 21 25 3 187 3 5 53 9,325 1944 .. 7,612 693 24 11 1,501 211 135 45 8 310 73 157 44 18 28 6 6 31 147 3 37 3 397 6 1 111,519 1943 .. 1,196 830 60 121,799 221 434 178 4 321 59 149 44 13 43 22 10 81 314 2 23 9 .. 1 4 1 5,830 1942 .. 457 542 56 101,418 239 852 30 3i 264 83 135 39 16 65 7 14 10 73 .. 18 5 .. 1 5 .. 4,372 1941 .. 338 383 47 91,197 241 163 4 6 374 101 123 73 17 42 6 19 93 348 1 21 8 .. 4 5 .. 3,623 * The cases of beriberi were among repatriated prisoners of war from Japan who were on transit through New Zealand.

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Table B.—Notifications of Cases of Notifiable Diseases by Health Districts for Year ended 31st December, 1945

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d s? to 1 g ■a S <3 a eg "So 2 Name of Disease. 1 3 pi 1 1 w q 1 O rQ 13 1 jg § 5 *4 1 § < ,g EH 1 i a OS 1 8 1 to . a >> I Co s 1 *- PI 1 -s 1 8 §> 1 1 s o pi o xn oS £ ft H "03 § £ g 0 !§ 9 0 1 J 0 0 0 m ■ "0. > H . Scarlet fever 20 638 643 207 235 250 893 737 37 649 83 240 401 5,033 Diphtheria 49 204 223 38 42 58 130 93 83 42 6 11 17 996 Enteric fever — (a) Typhoid 1 3 1 3 1 4 2 3 1 4 23 (b) Paratyphoid 1 5 1 1 8 Tuberculosis — (a) Pulmonary 23 369 73 25 54 29 167 412 61 248 37 145 79 1,722 (b) Other forms 5 64 5 8 2 16 83 14 57 1 66 8 329 Cerebro-spinal fever 4 22 6 5 7 1 3 23 18 1 5 3 98 Acute poliomyelitis 1 3 2 2 6 14 Influenza (pneumonic, &c.) 1 1 2 1 1 6 Erysipelas 4 59 18 "3 17 6 34 42 10 31 3 11 10 248 Puerperal fever — - Ordinary 1 12 4 2 3 7 4 7 28 3 4 75 Following abortion 36 1 4 17 42 100 Eclampsia Tetanus 11 1 3 4 7 2 12 *4 2 46 1 2 1 1 2 3 1 1 12 Hydatids Trachoma 4 2 1 9 7 15 3 41 1 3 3 1 2 10 Ophthalmia neonatorum _,. 3 1 1 5 Food poisoning 4 90 ' '2 3 1 4 ' 7 111 Bacillary dysentery 5 53 3 4 i5 38 22 4 7 151 Amoebic dysentery 3 1 6 7 4 21 Undulant fever 5 1 6 1 1 11 25 Chronic' lead poisoning 1 2 3 Malaria 1 49 i6 2 1 1 i6 47 4 30 1 "6 i3 187 Beriberi 53 53 Lethargic encephalitis 1 1 1 1 1 5 Actinomycosis 1 1 1 3 115 1,543 1,083 298 399 402 1,328 1,544 237 1,196 135 506 539 9,325

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Table C.—Notifiable Diseases in New Zealand for Year ended 31st December, 1945, showing Distribution by Age and Sex

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Under 1-5 " 5-10 10-15 15-20 20-25 25-30 30-35 35-40 40-45 disease. i Year. Years. Years. Years. Years. Years. Years. Years. Years. Years. M. 3?. M. !. M. I\ M. F. M. F. M. F. M. 'P. 31. F. M. F. M. F. Scarlet fever .. .. .. 23 16 578 547 837 1,146 381 573 122 244 35 152 15 76 21 81 16 50 23 29 Diphtheria .. .. .. 22 19 111 106 170 143 81 71 30 46 16 43 20 29 10 17 8 13 8 8 Enteric fever — (а) Typhoid .. 2 2.. 1 1.. 1 2 1 2 3.. 1.. 1 (б) Paratyphoid .. .. 1 .. 1 .. .. .. 1 1 1 1 .. 1 .. .. .. .. .. .. 1 Tuberculosis— (a) Pulmonary .. .. 1 3 11 8 15 9 21 20 65 91 143 150 183 125 135 75 76 52 65 42 (&) Other forms .. .. 4 1 20 17 16 15 8 14 12 16 13 30 20 11 23 14 12 9 8 8 Cerebro-spinal fever .. 13 11 18 12 6 4 6 2 3 1.3 1 3 1 1.. 3.. 4 1 Acute poliomyelitis .. .... 1 3 2 1 1 1 2.. .. .. 1.. 1 1.. Influenza (pneumonic, &c.) .. .. .. 1 .. .. .. .. .. 2 .. .. .. 1 1 Erysipelas .. .. 3155234 3' 6245594 11 7 14 8 16 Puerperal fever — Ordinary .. .. 3 .. 19 .. 24 . . 12 .. 12 .. 5 Following abortion .. .. .. .. .. .. .. .. .. .. .. 4 .. 24 .. 33 .. 19 .. 13 .. 5 Eclampsia .. .. .. .. .. .. .. .. .. .. .. .. 3\ 19 .. 6 .. 9 .. 6 .. 3 Tetanus .. .. .. .. .. .. 1 4 1 1 .. 2 .... .. .. .. .. .. 1 .. 1 Hydatids .. .. 2 1.. 3.. 1 4.. 1 1 4 J 3 2 1 1 1 5 Trachoma .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 2 .. 2 2 1 Ophthalmia neonatorum .. 1 4 Pood poisoning i. .... .. 1.. .. .. 3.. 1 23 5 56 2 2 8 2 1 1 1 1 Bacillary dysentery .. .. 4 7 20 14 11 5 6 2 2 6 3 11 6 7 3 6 6 1 1.. Amoebic dysentery .. .. .. .. .. .. .. .. .. .. .. .. 3 .. 7 .. 1 1 1 2 3 Undulent fever .. 1 1 1.. 1 2 1 1 3 1 4 1.. Chronic lead poisoning .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 Malaria .. .. 1 1 1 2 4 38 61 47 23 8 Beriberi .. .. 6 .. 14 .. 8 .. 6 .. 6 Lethargic encephalitis .. .. .. .. .. 2 1 .. .. .... 1 Actinomycosis .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 72 63 771 715 1,063 1,335 517 693 252 445 274 516 346 328 270 255 165 178 140 125

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Table C.—Notifiable Diseases in New Zealand for Year ended 31st December, 1945, showing Distribution by Age and Sex— continued

Name of Disease. 45-50 Years. 50-55 Years. 55-60 Years. 60-65 Years. 65-70 Years. 70-75 Years. 75-80 Years. 80 and over. Totals. M. F. M. F. At. F. M. J?. M. F. M. F. M. F. M. F. M. F. Scarlet fever 10 10 5 12 3 12 2 8 1 2 3 2,073 2,960 Diphtheria 2 3 5 5 2 3 1 ' 2 1 ' 1 490 506 Enteric fever —• . (a) Typhoid 1 2 1 1 1 8 15 (b) Paratyphoid 5 8 Tuberculosis — (a) Pulmonary .. ... .. 75 31 62 18 58 21 56 17 44 10 17 6 9 5 ■ 1 2 1,037 685 (6) Other forms 8 5 6 5 8 5 6 2 1 4 4 1 3 170 159 Cerebro-spinal fever 1 1 1 1 1 62 36 Acute poliomyelitis 6 8 Influenza (pneumonic, &c.) ' 'l 4 2 Erysipelas 7 21 ' '8 "9 'io 13 ' '7 "i4 "3 13 ' 6 ' 6 ' '4 ' 5 "2 ' 3 95 153 Puerperal fever — Ordinary 75 Following abortion ' '2 100 Eclampsia.. 46 Tetanus ' 1 'io 2 Hydatids ' '2 ' 'l "l ' '2 2 "l ' 1 24 17 Trachoma 1 3 7 Ophthalmia neonatorum 1 4 Food poisoning "l "l "l 1 24 87 Bacillary dysentery ' 'l ' '2 1 2 2 ' '4 ' '4 ' 3 4 ' 1 ' '2 ' '2 ' 1 ' 1 72 79 Amoebic dysentery 1 1 1 17 4 Undulent fever 4 "3 1 18 7 Chronic lead poisoning "l 3 Malaria ' 'l 180 7 Beriberi 2 ' '4 ' 1 ' '4 ' 1 ' 'l 53 Lethargic encephalitis "l j. ' '4 Actinomycosis ' 1 3 114 79 94 55 90 57 79 48 60 34 31 19 17 12 4 9 4,359 4,966

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Table D.—Maoris: Notifications of Cases of Notifiable Diseases for Year ended 31st Decenber, 1945

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Months. Scarlet Fever. Diphtheria. Enteric Fever. Tuberculosis. Cerebro-spinal Fever. Acute Poliomyelitis. Influenza (Pneumonic, <ftc.> Erysipelas. Puerperal Fever. Eclampsia. Tetanus. Hydatids. Trachoma. Ophthalmia Neonatorum. Food Poisoning. Bacillary Dysentery. Amoebic Dysentery. Undulant Fever. Actinomycosis. Chronic Lead Poisoning. Phosphorous Poisoning. Malaria. Beriberi. Lethargic Encephalitis. Totals. o ft K H 2] s © ■a K 1 ce S* S o (S J o 5 O S" >> M C6 a 3 O a tto st g s 0,0 PR January February .. March April May June July August September .. October November .. December .. 1 6 2 23 4 4 3 3 1 1 5 9 5 7 7 4 7 5 3 10 9 8 4 2 1 1 3 1 3 6 6 10 5 51 45 35 35 27 29 20 36 39 39 48 50 7 3 5 9 4 5 3 6 4 8 5 12 2 3 2 2 2 1 4 1 2 1 1 1 3 1 2 1 1 1 1 1 1 1 1 1 1 2 1 3 4 1 1 1 6 1 2 i 5 1 6 1 11 7 3 11 3 2 1 1 74 63 64 55 70 60 47 60 73 73 84 84 Totals — 1945 .. 48 79 42 1 450 71 20 2 8 3 1 1 6 19 2 7 45 2 807 1944 .. 10 20 50 476 66 20 i 9 7 1 4 11 39 1 2 14 1 2 1 735 1943 .. 1 15 27 521 62 65 i 9 2 1 6 42 1 12 37 2 3 1 1 809 1942 .. 3 41 52 *2 416 50 80 l 3 4 10 3 1 1 7 26 5 6 27 3 1 742 1941 .. 3 14 55 486 65 47 2 14 1 1 5 10 3 1 207 1 1 916

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DIVISION OF HOSPITALS Hospital Beds At 31st March, 1944, there were 16,613 hospital beds, public and private, in the Dominion, which gave 10*2 beds per thousand of population based on the estimated mean population under the old census. At 31st March, 1945, there were 16,976 beds, which gives 10 per thousand of population based on preliminary 1945 census figures. Many Hospital Boards have a considerable deficiency in the number of beds required to treat the public adequately. The North Canterbury, Otago, and Southland Hospital Boards, for example, have in hand plans for the addition of over one thousand beds in new buildings. The Auckland Hospital Board has opened between three hundred and four hundred beds at Cornwall Hospital, and will shortly open three hundred beds at Middlemore. A feature of the year has been the closing of a number of private maternity hospitals because of shortage of domestic and nursing staff, and because, as elderly licensees give up the private maternity hospitals that they have conducted for many years, younger nurses are unwilling to undertake the burden of taking over or establishing maternity hospitals. Hospital Boards have, in many cases, had to purchase or lease the private maternity hospitals until such time as permanent maternity accommodation can be built. A serious shortage of domestic staff has been almost universal. Some hospitals have had little difficulty in maintaining an adequate nursing staff, while others, especially those in country districts or the infirmary type of hospital, have been unable to maintain adequate nursing staffs. This has resulted, in some cases, in the closure of sections of the hospital or in the refusal to admit non-urgent patients, and, in a few cases, in inadequate care being given to patients. Architectural Many overseas authorities have expressed the opinion that hospital architecture is one of the most specialized types of architecture. The following quotation is from a recent American publication : We have repeatedly pointed out that the designing of a hospital is unlike any other design problem, and that successful experience in planning factories or schools does not ensure success in planning a hospital. A hospital is the most complicated type of building that is planned with any frequency. The Department has had great difficulty in attempting to exercise adequate supervision of the plans of Hospital Boards, as it has had only one Architect for some years. It appears desirable that the architectural staff should be considerably strengthened in order that the Department should itself undertake the provision of sketch plans for all hospital building. This would enable a greater measure of standardization than is possible at present. Anaesthetic Deaths It is usual to review the deaths that have occurred under anaesthesia each five years. The following table is therefore appended : Return of Deaths under Anaesthetics, 1941-45 Total,deaths under anaesthetic for year ending—31st December, 1941 .. .. .. .. 28 31st December, 1942 .. .. .. .. 23 31st December, 1943 .. .. .. .. 25 31st December, 1944 .. .. .. .. 35 31st December, 1945 .. .. .. .. 31 Total deaths for five years .. .. .. 142

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Age-groups

Location of Deaths under Anaesthetics

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Nature of Anaesthetic. 1941. 1942. 1943. 1944. 1945. Total. Chloroform .. 1 2 3 6 Chloroform and ether 3 5 6 *2 6 22 Ether 3 3 4 7 2 19 - Ethyl chloride and ether 11 7 5 8 4 35 Gas and oxygen 5 2 2 4 1 14 Gas and oxygen with ether 1 1 1 3 Cyclopropane .. i i 1 3 6 Pentothal sodium 2 6 9 17 Avertin with gas and oxygen 1 1 Cocaine hydrochloride 1 1 Pecicaine 1 1 Percaine .. ,. 3 1 2 3 9 Evipan .. .. .. .. 2 2 Novocaine i 1 Nature of anaesthetic not stated 1 1 i 1 1 5 Total .. ... 28 23 25 35 31 142

Age. 1941. 1942. 1943. 1944. 1945. Total. 0-5 6 7 5 5 4 27 6-10 2 1 1 2 6 11-20 1 3 2 3 2 11 21-30 2 3 5 4 7 21 31-40 1 2 4 2 2 11 41-50 1 3 4 6 4 18 51-60 5 2 2 10 5 24 61-70 1 1 3 4 9 Over 70 7 i 1 2 11 Age not stated 2 ■ I i 4 Total 28 23 25 35 31 142

Total Deaths Place. under Anaesthetics, 1941-45. Dental surgeries Doctors' surgeries 6 1 Private hospitals 21 Private house 2 Maternity hospitals 1 Public hospitals— Auckland 17 Wellington 16 Christchurch .. 12 Dunedin 6 Hamilton 7 Palmerston North 6 Wanganui 5 New Plymouth 3 Southland 2 Waipukurau 2 Hastings 2 Hawera 2 Northern Wairoa 2 Green Lane, Auckland 2 Ashburton .. 2 Napier 2 Buller. Wfstport .. 1

Place. Total Deaths under Anaesthetics, 1941-45. Public hospitals—continued Taumarunui 1 Timaru 1 Grey River 1 Raetihi Waihi 1 Tauranga Burwood, Christchurch Rotorua 1 Gisborne 1 Westport 1 Lower Hutt 1 Waipukurau 1 Masterton 1 Patea 1 Kaikoura Whakatane 1 Taihape 1 ■ Blenheim 1 Military Camp, Waiouru 1 Sick-quarters, H.M.S. 1 " Philomel" 142

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DIVISION OF SCHOOL HYGIENE Medical inspection of children continued throughout the year to the extent possible with the limited medical personnel available. The Department was unable to recruit additional medical officers, and operated at approximately half the authorized strength. Much work was accomplished nevertheless.

The Medical State of Primary-school Children, 1945

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(European and Maoris) European. Maori. Number. Percentage. Number. Percentage. Number of children examined 70,387 5,207 Number of children found to have defects 28,158 40 00 2,403 46-14 Number of children with defects other than dental .. 22,422 31 85 1,697 32-59 Children showing evidence of — Subnormal nutrition 6,682 9 49 414 7-94 Skin-diseases 1,425 2 02 541 10-38 Heart— Organic disease 282 0 40 13 0-24 Functional disease 544 0 77 12 0-23 Respiratory disease 388 0 55 34 0-65 Posture — Slight impairment 19,370 27 51 875 16-80 ' Gross defect 2,154 3 05 40 0-76 Deformities of trunk and chest 846 1 20 25 0-48 Mouth — Defect of] aw or palate 3,284 4 66 73 1-40 Dental caries 6,513 9 25 969 18-60 Extractions of permanent teeth .. ... 790 1 12 71 1-36 Fillings 54,677 77 68 2,498 47-98 Perfect sets of teeth 2,107 2 99 335 6-43 Gums : Gingivitis or pyorrhoea 135 0 19 65 1-24 Nose and throat — Nasal obstruction 2,890 4 10 83 1-59 Enlarged tonsils 9,639 13 69 514 9-87 Enlarged glands 4,515 6 41 166 3-18 Goitre — Incipient 6,545 9 29 223 4-28 Small 1,207 1 71 17 0-32 Medium or large 64 0 09 2 0-03 Total amount of goitre 7,816 11 09 242 4-63 Eye — External eye-disease 445 0 63 21 0-40 Squints 280 0 39 10 Defective vision— Uncorrected 1,390 1 97 y3 1-78 Corrected 1,020 1 44 12 0-23 Ear — Otorrhoea 59 0 08 49 0-94 Defective hearing 204 0 28 52 0-99 Defective speech 274 0 38 10 0-19 Mental— Retardate 221 0 31 6 0-11 Feeblemindedness 56 0 97 Epilepsy 8 0 01 0-07 Other nervous defects 100 0 14 4 Digestive system defects 65 0 09 8 0-15 Phimosis 50 0 07 4 0-07 Undescended testicles 133 0 18 14 0-26 Hernia 112 0 15 7 0-13 Number of parents present at the medical examination 18,741 26 62 642 12-32 Number of children notified as defective 19,117 1,943

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Points worthy of notice in the above findings : The level of nutritional defect remains high, practically the same as last year's high figure—viz., 949 per cent, in 1945, 9-53 per cent, in 1944 in Europeans. The Maori figures have deteriorated a little, 7-94 per cent, in 1945, 6-33 per cent, in 1944. Poor posture shows a definite increase in both Europeans and Maoris in its minor grades, though the level of gross defect is much the same. 19-47 per cent, of slight European impairments in 1944 became 27*51 per cent, in 1945, the corresponding figures for gross defect demanding remedial treatment being 3-05 per cent, in 1945 and 2-53 per cent, in 1944. In Maoris the 10-26 per cent, of 1944 became 16-80 per cent, slight impairments last year, but gross defects were 0-88 per cent, in 1944, reduced to 0-76 per cent, in the last year. This preponderance of poor posture in our schools is probably another indicator of unbalanced dietaries in the homes,"also evidence of parental carelessness in ensuring that children obtain sufficient rest and sleep. Too many of our young children in towns are allowed out at nights when they should be in bed asleep. The Maori children continue to show up unfavourably as compared with Europeans in skin-diseases, dental caries, and pyorrhoea, but seem, as always before, to have superiority in posture, in perfect sets of teeth, in rounded normal jaws, and show less deformed trunks and chests, less adenoids and tonsils or enlarged glands, and less goitre. Health Camps foe Primary-school Children The scheme begun last year of keeping certain health camps open all the year round to take only tuberculous contacts was tried cut, but did not prove successful. The idea has therefore been abandoned, and health camps will continue to admit tuberculous contacts with other children, provided they are shown by physical and x-ray examination to be free from tuberculous disease. Health camps functioned all the year round, some permanently, and some in the summer only, for children selected by the school medical and nursing staff. The Medical State of Pre-school Children, 1945 There has been an improvement in pre-school child nutrition, which was subnormal in 10-34 per cent, in 1944 and in 8-86 per cent in 1945. There is also less dental caries, 9-90 per cent, in 1944 falling to 7-48 per cent, in 1945. These are the only significant changes in the figures from the previous year. It is disappointing to find 10 - 3 per cent, of mothers voluntarily admitting their children get insufficient sleep, and a further 7-4 per cent, not bothering to put toddlers down for a daytime rest. Pre-school Medical Inspection Summary Number of children seen .. .. .. .. .. .. .. .. 7,357 Number of defects found— Number. Percentage. Anaemia .. . . .. .. .. .. .. 298 4 • 05 Uncleanliness .. .. .. .. .. .. 24 0-32 Subnormal nutrition .. .. .. .. .. .. 652 8• 86 Protuberant abdomen .. .. .. .. .. 320 4 • 34 Posture defective .. .. .. .. .. .. 192 2-60 Deformities — Chest .. .. .. .. .. .. 155 Legs .. .. " .. .. .. .. 324 Feet .. .. .. .. .. .. 665 1,144 15-54 Skin-diseases .. .. .. .. .. .. 316 4-29 Heart: organic defects .. .. .. .. .. 74 1-00 Lungs .. .. .. .. .. .. .. 82 1-11 Dental—■ Gums and soft tissues .. .. .. .. .. 32 0-43 Dental caries .. .. .. .. •• .. 551 7-48 Nose and throat— Adenoids .. .. .. .. .. .. 321 4-36 Tonsils .. .. .. .. .. •• .. 994 13-51

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Pre-school Medical Inspection Summary —continued Number of defects found—continued Number. Percentage. Enlarged glands .. .. .. .. .. .. 386 5 ■ 24 Goitre .. .. .. .. .. .. .. 80 1-08 EyesExternal eye disease .. .. .. .. .. 106 1•44 Defective vision .. .. .. .. .. .. 52 0-70 Ears— Otorrhoea .. .. .. .. .. .. 16 0-21 Deafness .. .. .. .. .. .. 34 0-46 ■ Phimosis .. .. .. .. .. .. .. 28 0-38 Undescended testicles.. .. .. .. .. .. 96 1-30 Hernia .. .. .. • • •. •. .. 30 0 • 40 Habit abnormalities — Bad food habits .. .. .. .. .. .. 778 10-57 Other bad habits .. .. .. .. ... .. 497 6-75 Bowel-action abnormality .. .. .. .. .. 100 1-35 Eneuresis .. .. . • •• •• .. .. 474 6-44 Insufficient daytime rest .. .. .. .. .. 546 7 • 42 Insufficient sleep .. .. .. .. .. .. 760 10-33 Preventive immunizations — Whooping-cough —Complete course of vaccine : Number of children.. .. .. 990 Diphtheria—Complete courses, either three doses of formol toxoid, or two of alum precipitated toxoid : Number of children — Pre-school ages .. .. .. .. .. .. 9,445\ 1R Primary school .. .. .. .. .. .. 8,768/ ' DIVISION OF NURSING Legislation The Nurses and Midwives Act and Amendments were consolidated in 1944, and provisions were included in the new Act for the training, examination, and registration of male nurses and for the awarding of post-certificates for special courses approved by the Nurses and Midwives Board. Under this legislation the certificate awarded by the Royal New Zealand Society for the Protection of Women and Children (Plunket Society) will, from April, 1946, be recognized as a State certificate. Hospital Service The following table shows that, although the occupied bed rate of hospitals used as training schools is still increasing, there is for 1946 a decrease of some 250 in nursing staff. This is largely due to the large number of marriages which took place during the year with the return of servicemen, and to the lifting of the man-power restrictions. The table shows a total of 4,627 nurses for approximately 8,600 occupied beds. If the staff was on the basis of 1 nurse to 1-5 occupied beds as recommended, it is estimated the requirements would be a total of 6,450 nurses. However, the reduction in the numbers of registered nurses should be only a temporary phase. A certain number of nurses who have been attached to the Services will return to practise, and the number of nurses registering each year has been steadily increasing, from 450 in 1940 to 665 in 1945. At present the position in some of the country hospitals, particularly those where the amenities are not good, or where little improvement has been made to equipment, is most difficult owing to staff shortages. The Hospital Boards controlling these hospitals will have to improve conditions if staff is to be retained.

Nurses in Training Schools

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— 1940. 1941. 1942. 1943. 1944. 1945. 1946. Number .of occupied beds in training schools Number of registered nurses Number of pupil nurses .. 5,331-8 908 2,219 6,040-0 922 1,575 6,285-7 984 2,798 6,808-5 1,172 2,974 7,603-2 1,366 3,124 8,493-0 1,500 3,390 8,550-05 1,347 3,280

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Recruiting Campaign For the past three years the Department has been spending £l,OOO a year on pamphlets, newspaper advertisements and articles, broadcasts, and film material in campaigns for the recruitment of nurses. In spite of this, the number of applicants of the right type is not sufficient to meet the demand, which has meant that many unsuitable girls' have been accepted. This is reflected again in the wastage which takes place during training, as from returns it would appear that at least 25 to 30 per cent, of those who commence training do not finish. A study will be made to endeavour to obtain information which can be used to reduce this wastage of human energy, time, and money. The position in regard to the supply of domestic staff has considerably deteriorated, particularly with the lifting of the Man-power Regulations. Nursing Education The Nursing Education Committee of the New Zealand Registered Nurses' Association, of which the nursing officers of the Nursing Division are members, conducted two inquiries during the year through the Department. These inquiries were made by means of questionnaires, the subjects being : (1) the incidence of septic fingers, and (2) teaching in the wards by the ward sisters. The results of these studies were compiled and circulated to the Matrons of all hospitals. Essay competitions were judged for the general, maternity, and midwifery training schools, the winning hospitals being Masterton, Waikato, and St. Helens The Civil Nursing Reserve After serving a most useful function for a period of nearly three years, the Civil Nursing Reserve has dwindled considerably. During this time some 50 registered nurses and 500 voluntary aides have served in the Reserve. Practically every hospital Board in the Dominion has received some assistance. Salary Scale During the year the officers of the Department were called into consultation by the Hospital Boards' Association and the New Zealand Registered Nurses' Association regarding the introduction of a new salary scale for nurses. Later the new scale was approved by the Stabilization Commission with retrospective effect from Ist April, 1945. Obstetrical Nursing Service The increasing number of private maternity hospitals reverting to public-hospital control has brought about a marked change in obstetrical nursing service of the country. This development is steadily increasing, and the Hospital Boards concerned have had to cope with many difficulties. Public-health Nursing There has been a fairly rapid expansion of the district bedside care being given by Hospital Boards as a result of the introduction of the district nursing benefit. The service has been greatly appreciated because of the very small number of nurses engaged in private nursing. A number of Boards instituting this service for the first time arranged for the nurses to attend the month's introductory course for district nurses in Wellington, and this has been a definite advantage. There has been a further expansion of the Department's district staff as several new districts have been created, and in a few instances where Boards have been unable to appoint nurses to isolated areas the Department has taken over the area, the nurse so

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employed being responsible for the entire programme in that area. The advantage of this system for isolated areas has been that with a large staff it is possible to change these nurses fairly frequently. There has also been an extension of the amalgamation of the Plunket Society and the Department's nursing staffs in some areas. In Otago the Plunket Society with four of its nurses doing departmental duties, is responsible for the entire public-health nursing duties, while the Department's nurses at Lake Tekapo, Otira, Porangahau, Mokau, and Great Barrier Island will undertake the duties usually carried out by the Plunket nurses. Post-graduate School The work of the school is steadily expanding. Forty-two nurses took the course in 1945, and fifty have enrolled for 1946, and there are many inquiries for 1947. This year the syllabus was reviewed and certain subjects made compulsory examination subjects. The Director of the Division of Nursing is of the opinion that the content of some of the subjects requires further consideration with a view to courses in clinical supervision being added to the curriculum, and the introduction of such specialties as. orthopaedics, tuberculosis, and obstetrics. Island Nursing Service The Director, Division of Nursing, visited Fiji, Samoa, Rarotonga, and Aitutuki. A conference was subsequently held in Suva, attended by the Chief Medical Officers of the various administrations, at which the Island Nursing Service was fully discussed, and decisions arrived at as to its future development. Occupational Therapy Meetings of the Selection Committee, consisting of Dr. Buchanan, Miss Inman, and the Director, Division of Nursing, were held. A large number of candidates were interviewed, and two classes of six were selected for training as occupational therapists. DIVISION OF TUBERCULOSIS The activities of the Division during the year have been directed in the main towards the keeping of the Tuberculosis Register in a more accurate manner, with the result that the prevalence of the disease in its many forms is better understood by all workers. The returns for the year 1945, as obtained from the notifications by general practitioners, hospital clinics, and Department's case-finding scheme, disclose the known position as at 31st December, 1945, as under: — 1. Stated Morbidity of Tuberculosis, Maori and European, in New Zealand as at 31st December, 1945, compared with years 1944 and 1943 :

The increase in morbidity during the last three years in more likely to be due to intensified case finding and better notification rather than an increase in prevalence.

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Pulmonary. N on-pulmonary. Total, — 1945. 1943. 1944. 1945. 1943. 1944. 1945. North Island 4,698 5,038 6,116 386 507 546 6,662 South Island 1,398 1,722 2,005 181 259 360 2,415 Totals for New Zealand 6,096 6,760 8,171 567 766 906 9,077* * Total Maori morbidity for 1945 in the above total = 2,387.

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2. New Cases notified as Tuberculous to the Medical Officer of Health during 1945 are scheduled and compared with cases notified in years 1943 and 1944:

Total new cases, both races, notified: 1943, 2,603 ; 1944, 2,254 ; 1945, 2,572. Some of these cases have been found to be non-tuberculous and consequently deregistered. 3. Incidence Rates, all Forms: — Rates per 1,000 Population. The known incidence for Europeans— 1945. 1944. North Island .. .. .. .. 4*17 3-47 South Island .. .. .. .. 4-20 3-47 The known incidence for Maoris — North Island .. .. .. .. 24-13 23*24 South Island .. .. .. .. 27 • 35 25-48 The known incidence for combined races — North Island .. .. .. .. 5-84 4-98 South Island .. .. .. ..4-35 3-59 The known incidence in New Zealand for Europeans — Both Islands .. .. .. .. 4-19 The known incidence in New Zealand for Maoris — Both Islands .. .. .. .. 24-24 The known incidence in New Zealand for combined races .. .. .. .. .. 5-35 Rate of " Activity" : Out of a total of 9,077 cases on the register at 31st December, 1945, 2,321* were returned as being in the " active " state, " infectious "or " potentially infectious " 25-57 per cent. The European incidence is 11-13 times the annual deaths. Figure for 1944, 9-7. The Maori incidence is 6-4 times the annual deaths. Figure for 1944, 5-7. The combined race incidence is 9-3 times the annual deaths. Figure for 1944, 8-0. The incidence of the combined races is approaching the figure 10 that is usually accepted as the ratio of cases to deaths in other countries. The New Zealand European incidence is higher than this figure. 4. The 1945 Mortality Returns for Tuberculosis, as supplied by the Government Statistician, are scheduled as follows

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Europeans. Maoris. — Pulmonary. Non-pulmonary. Totals. Pulmonary. 1945 Total, Maoris. 1943. 1944. 1945. 1943. 1944. 1945. 1943. 1944. 1945. monary. North Island South Island .. 1,292 507 1,027 474 1,152 570 131 90 140 71 183 146 1,423 597 1,167 545 1,335 716 442 8 64 7 506 15 Total for New Zealand 1,799 1,501 1,722 221 211 329 3,020 1,712 2,051 450 71 521

— Pulmonary Forms. Other Forms. Total Deaths, 1945. European. Maori. Totals, PulmoEuropean. Maori. Totals, other Forms. M. F. M. F. nary. M. F. M. F. M. F. North Island South Island Total, New Zealand .. 203 111 110 73 128 7 150 7 591 198 28 23 35 20 47 1 33 143 44 376 227 358 15 314 183 135 157 789 51 55 48 33 187 603 373 * As 2,614 other cases have yet to be classified this is a low figure.

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Deaths from tuberculosis, pulmonary forms, 1945 and 1944: 1945. 1944. Europeans .. .. .. .. 497 485 Maoris .. .. .. .. .. 292 285 789 770 Deaths from tuberculosis, non-pulmonary (other forms), 1945 and 1944 : 1945. 1944. Europeans .. .. .. .. 106 106 Maoris .. .. .. .. 81 87 % 187 193

Death-rates, all Forms

It is of interest to note that—(l) European male deaths from all forms (365) exceed the female deaths (238): (2) Maori female deaths from all forms (190) exceed the Maori male deaths (183): (3) The crude death-rate of the combined races (5-77) is slightly lower than for last year (5-96) : (4) The total number of deaths in 1945 exceeds the deaths for 1944 by 13 : (5) The European death-rate is slightly reduced and the Maori death rate is slightly increased over the 1944 rate. Further Register details (31st December, 1945) show a New Zealand incidence as follows: — (1) Sex incidence — 1945. 1944. Males, both races .. .. .. ..4,951 4,230 Females, both races .. .. .. .. 4,136 3,501 (2) Disposition of notified cases — 1945. 1944. 1943. Supervised in hospitals .. .. 1,116 1,114 954 Supervised in sanatoria .. .. 706 661 - 577 Total in institutions .. .. 1,822 1,775 1,531 Supervised in own homes .. ' .. 6,535 5,308 4,707 Supervised in hutments (Maoris) .. 181 182 106 Supervised in boardinghouses, or nomadic 539 466 428 Totals .. .. .. 9,077 7,731 6,772 5. Progress of Notified Cases : (a) Returned as disease " deteriorating" or " sta- 1945. 1944. tionary ".. .. .. .. .. 1,068 1,445 (b) Number returned as disease "improving" .. 1,253 1,321 Total (a) and (b) regarded as'' active " .. 2,321 2,766

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Total Deaths. Crude Death-rates per 10,000. 1945. 1944. 1943. North Island 734 6-43 6-81 South Island 242 4-36 4-31 Both Islands — Europeans 603 3-78 3-81 3.72 Maoris 373 37-02 37-40 ' 36-6 Both races 976 5-77 5-96 5-62

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5. Progress of Notified Cases—continued (c) Number returned as disease " quiescent" or 1945. 1944. "arrested" .. .. .. .. 3,654 2,374 (d) Number returned as disease " apparently cured " (252 have been deregistered) .. .. 488 381 Total (c) and (d) regarded as " inactive " .. 4,142 2,755 (e) Number of cases whose accurate classification has yet to be determined .. .. .. 2,614* 2,201 6. " Infectious " or Bacteriological Status of Notified Cases at 31st December, 1945 : 1945. 1944. {a) With discharge Tubercle bacilli positive .. .. 1,045 708 (b) With discharge Tubercle bacilli negative .. .. 1,504 1,323 (c) With no discharge or sputum available .. .. 3,099 \ . _ 9C . (d) Cases not investigated .. .. .. .. 3,429f J ' 7. Service Personnel returned at 31st March, 1946, from World War 11, with tuberculosis and receiving pensions (as submitted by the Medical Officer in Charge of Treatment, Pensions Department): — Overseas New Zealand Service. Service. Total. Tuberculosis, all forms .. .. .. 593 346 939± Hospital and Sanatorium Accommodation Activities of the Division have also been directed towards the provision of adequate institutional accommodation for tuberculous patients. As a result — (1) Hospital Boards in the Western Area, North Island, are searching for a site where a modern sanatorium to accommodate 120 patients can be built: (2) The Auckland and South Auckland Hospital Boards have agreed to combine to erect a sanatorium of 150 beds at Hamilton: (3) The Auckland Hospital Board has submitted to the Department sketch-plans of a 276 bed Chest Hospital to be built at Green Lane : (4) The Waikato Hospital Board has purchased a site of 102 acres at Hillcrest, Hamilton, where a new sanatorium will be built, and also a chest hospital of 200 beds for the'Waikato Hospital District: (5) The Western Districts Sanatorium Committee is finalizing plans for the improvement of the Otaki Sanatorium : (6) It is regretted that a fire at the Waipiata Sanatorium last year destroyed 8 beds. Plans to replace these with other improvements are being prepared : (7) The Wellington Hospital Board is planning to improve the facilities at Ewart and Victoria Wards and contemplates building sanatorium accommodation for 120 patients. Hospital Nursing Staff The incidence of minimal tuberculosis in nurses in hospitals has been carefully watched during the year, and representations have been made to all Hospital Boards during the year to reduce to an absolute minimum the disease in nurses by improving facilities arid nursing technique. The general shortage of female nursing staff in tuberculosis institutions is acute, and in many instances the shortage has had to be remedied by the employment of male nurses.

* This figure is too high, and efforts will be intensified to have these cases classified during the year. f This figure is too high, and efforts will be intensified to have these cases investigated during the year. J This is very much lower than what was quoted at end of World War I.

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The augmentation of the departmental district nursing staff by 41 specially trained ■district nurses to a total of 205 nurses will allow better control of " tuberculous households " and should further improve " case-finding." All departmental staff have been most conscientious in taking part in the tuberculosis control programme. The North Auckland Hospital Boards have agreed to appoint a whole-time Tuberculosis Officer to be based at Whangarei. All tuberculosis areas will then have adequate specialized medical officers to supervise diagnosis, treatment, and after care, with the exception of the eastern districts, North Island, who should have one Assistant Tuberculosis Officer. Dr. C. E. Lyth, after twenty-five years' faithful service to the Otago Hospital Board, has resigned. Dr. Brian Thomson, of England, will take up his appointment in July, 1946. Tuberculosis Research Improved control and new methods in diagnosis and treatment as have been reported from overseas have been diligently followed, and all new methods have been or are being investigated with a view to their introduction into New Zealand. Plans for the Future Control of Disease The plans for the future control of tuberculosis in New Zealand envisage : (1) A further intensification of " case-finding " by better notification, tuberculin testing, and x-ray surveys. (2) Better identification of " active " cases so that necessary measures of control can be instituted. (3) Further improvement and extension of tuberculosis accommodation in hospitals and sanatoria. This accommodation is regarded as a very necessary factor in the preventive control programme : (4) The improvement of housing conditions of European and Maori patients who are able to live in their own homes : (5) The further education of the general public in tuberculosis control per the medium of tuberculosis associations, as well as by the publicity afforded by the Department. Further details and full statistical tables are available in the comprehensive report prepared for submission to the next Tuberculosis Officers' Conference in October, 1946. DIVISION OF HEALTH BENEFITS Cost of Benefits The attached table gives a statement of the expenditure on the various classes of benefits since their inception. The table also indicates the nature of the various benefits and the dates of their coming into operation. The following comments are made with respect to each of the five classes of benefits: — Subdivision I: Maternity Benefits. —The actual increase in expenditure, shown in the total since 1940, is due mainly to an increase in the birth-rate. The birth-rate was relatively high in 1941-42 and also during the past year, when there were 3,400 more European births than in the previous year. Subdivision II: Medical Benefits. —The important item in this subdivision is that of " General Medical Services " or, in other words, the fee-for-service system of remuneration of medical practitioners. As mentioned in last year's report, costs have risen steadily following the commencement of this benefit in 1942. Since last year 100

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additional practitioners have commenced or recommenced practice, and this is reflected in the increased expenditure during the past year of £130,122. The problem remains of stabilizing expenditure in a fee-for-service system, as also of ensuring quality and quantity of service in all parts of New Zealand, but it is hoped that measures now under consideration to ensure co-operation with the medical profession will lead to the desired r&sult. Special Areas.—Expenditure in this class of benefit is for the provision of medical practitioners in various isolated parts of New Zealand not able to obtain them under ordinary conditions. All of the special areas are functioning very satisfactorily, except that in some difficulty has been experienced in securing continuity of medical service, but it is anticipated that permanent appointments can soon be made for all these areas. It is pleasing to record that, despite the salaried nature of these appointments, the services provided have been satisfactory. Subdivision III: Hospital Benefits. —In this subdivision, particularly that of in-patient treatment in public hospitals, the increase of expenditure since the inception of the benefit has been marked. The increase has been due not only to an actual increase in the "number of patients, but also to the 50 per cent, increase in maintenance fees which became operative in 1943. Subdivision IV: Pharmaceutical Benefits. —The total expenditure in this subdivision for the past year was £1,133,366, which is almost as great as that for medical practitioner services over the same period. The drugs dispensed by chemists were responsible for the greater part of this sum, the increase during the past year having been £148,852. Most of the increases have been due to costly prescribing by doctors. This is exemplified by the number of prescriptions costing £1 or more, which were very rare in the days before social security, but now amount to 1 per cent, of all prescriptions or 7 per cent, of the total cost of all prescriptions. Remedies for this situation now under consideration will, it is hoped, secure stabilization or even reduction in the cost of drugs. Subdivision V: Supplementary Benefits. —The total indicates the benefits now in operation, as also those which will come into operation during the ensuing year. It is hoped that satisfactory arrangements can soon be made so that specialist services can be made available to all.

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Social Security fund Medical Benefits: Statement showing Expenditure since Commencement of Benefits

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1939-40 (10$ Months). 1940-41. 1941-42. 1942-43. 1943-44. 1944-45. 1945-46. Subdivision I: Matern Public-hospital fees Private-hospital fees Medical practitioners' fees Medical practitioners' mileage-fees Obstetric nurses' fees St. Helens Hospital fees Subdivision II: Medical Benefits. (Capitation Scheme introduce Capitation fees Capitation and general medical services mileage General medical services Special arrangements under section 82 Purchase of sites and erection of residences for Medical Officers appointed under section 82 Remuneration, allowances, and expenses of medical practitioners in areas other than those covered by section 82 ity Benefits £ 74,780 139,602 45,938 1,031 16,022' 6,440 (commenced £ 106,834 216,086 161,638 5,663 21,101 7,653 1 15 th May, £ 113,276 227,315 176,973 6,215 18,940 7,151 . 1939)' £ 110,217 207,575 158,208 5,089 15,089 9,046 £ 114,930 209,841 162,227 5,044 12,027 9,870 £ 133,946 210,675 158,409 5,647 11,117 10,940 £ 160,870 222,669 201,633 4,572 10,465 Contribution now abolished. 283,813 51.8,975 549,870 505,224 513,939 530,734 600,209 d 1st March , 1941; Gei tieral Medics 1 114,608 21,166 69,898 il Services S 71,149 64,039 831,397 49,468 Icheme intrc 55,610 60,392 1,026,073 37,256 iduced 1st I 42,400 59,442 1,161,326 23,855 November, 1941) 38,084 68,965 1,291,448 27,495 1,317 205,672 1,016,053 1,179,331 1,287,023 1,427,309

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* These are mainly in respect of Hospital Benefits. f Prior to Ist April, 1945, these recoveries were treated as credits in reduction of expenditure. For 1945-46 they are included in Miscellaneous Receipts, Social This should be taken into account when comparing published figures relating to Social! Security Fund Expenditure.

Subdivision III: Hospital Benefits (commenced 1st July, 1939); Out-patient Benefits (commenced 1st March, 1941) Treatment in approved institutions includes Ashburn Hall, Knox Home, Auckland, and Karitane Hospitals, payments to latter being introduced in 1940, but dated back to 1st November, 1939

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Treatment in public hospitals Out-patient treatment Treatment in private hospitals Treatment in approved institutions Contribution to Consolidated Fund for — Mental Hospitals Queen Mary Hospital Rotorua Sanatorium Rotorua Soldiers' Hospital Subdivision IV : Pharmaceutical i Drugs supplied by— Chemists Medical practitioners Institutions Subdivisk Radiological services (commenced 11th August, 1941) Laboratory services (commenced 1st April, 1946) Massage services (commenced 1st September, 1942) Specialist services (neuro surgery) District nursing services (commenced 1st September, 1944) Dental services Domestic assistance (commenced 20th December, 1944) Grand totals Recoveries* Net Totals 514,254 1,459 166,000 6,835 2,707 893,251 141,737 37,873 171,000 10,060 4,712 953,794 47,162 146,953 28,155 181,451 11,705 4,985 1,020,319 70,720 191,647 38,819 181,869 22,872 4,563 10,150 1,564,315 73,137 238,772 43,908 182,830 28,691 5,932 20,561 1,689,233 83,412 259,489 56,504 187,942 28,032 6,425 19,663 1 l 1,767,874 98,972 264,865 41,749 Contribution )- now abolished. 774,235 1,258,633 1,374,205 1,540,959 2,158,146 2,330,700 2,173,460 benefits (com menced 5th May, 1941); 261,845 1,527 16,326 , (11 monthf 530,695 5,891 26,661 0 716,080 6,092 40,026 933,490 6,231 40,516 1,082,342 6,030 44,994 279,968 563,247 762,198 980,237 1,133,366 m V : Sujr plementary j Benefits 27,962 88,588 4^836 109,426 27 j 331 1,066 128,842 32 j152 1,324 7,717 132,806 35,569 2,260 58,880 456 27,962 97,424 137,823 170,035 229,971 1,058,048 1,777,608 2,437,407 3,722,907 4,751,437 5,298,729 5,564,315 1,350 923 1,819 1,728 24,757 64,015 27,751f 1,056,698 1,776,685 2,435,588 3,721,197 4,726,680 5,234,714 5,536,564

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DIVISION OF DENTAL HYGIENE School Dental Service The School Dental Service now operates at 447 centres, as against 428 at the end of the previous year. As at the 31st March, 1946, the staff numbered 641, including 183 student dental nurses. The field staff of school dental nurses remains approximately the same as at the date of the previous annual report —viz., 390, as against 389 twelve months previously. Resignations of married nurses on the return of their husbands from war service overseas have continued during the year, with the result that the staffing problem has become acute. Consideration has been given to the question of adopting expedients to bridge the period until the increased output from the Training School becomes effective. As recorded in the last annual report, the entry of student dental nurses has been increased to one hundred per year. The number of children under regular treatment is 210,920, an increase of 19,580 during the year. This includes 24,364 children of pre-school age. The number of schools now receiving treatment is 2,348, as compared with 2,321 at the end of the previous year. The total number of operations for the year was 1,572,156. This number included 871,450 reparative fillings in both permanent and deciduous teeth and 194,667 preventive fillings, a total of 1,066,117 fillings. In contrast with this figure, which represents approximately the number of teeth preserved for useful service, the number of teeth removed as unsavable (or in some cases to relieve overcrowding) was 68,656, a ratio of 6-3 extractions to every 100 fillings. The Dental Health Education Officer, to whose appointment reference was made in the last annual report, has continued to develop this important phase of the work of the Dental Division. The appointment of a school dental nurse experienced in this work to assist the Dental Health Education Officer has been authorized and will take effect shortly. The field staff of the School Dental Service has continued to show commendable enthusiasm for health education work throughout the year, as is shown by the fact that their activities under this heading number a total of 8,279. The School Dental Service Gazette, which is edited by the Dental Health Education Officer, continues to fulfil a most useful function in keeping the widely dispersed staff in close touch with the activities of the Service as a whole, and as a medium for the dissemination of information and instructions. Proposed Dental Service for Adolescents The further development of State dental services to the adolescent section of the community has continued to receive close attention during the year, with a view to the inauguration of such a service in the near future. An attempt to recruit dental surgeons to the Department for this work proved disappointing, but the possibility of doing this will be further explored. Administration During the year Mr. A. D. Brice, 8.D.5., Assistant Director (Training) and Principal of the Dominion Training School for Dental Nurses, resigned in order to enter private practice. This necessitated a number of staff transfers and promotions. Increasing difficulty is being experienced in securing and retaining the services of suitably qualified and experienced dental officers. Dental Bursaries Additional University bursaries were granted to dental students at the beginning of 1946 to the number of 23. Of the bursaries granted in previous years, 45 were renewed for 1946 and 9 were suspended temporarily. The total number of bursaries held (including those temporarily suspended) is 76.

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The National Dental Committee The National Dental Committee continued to function throughout the year in connection with the control of dental man-power, the release of dental personnel for service with the Armed Forces, and associated problems. With the cessation of hostilities and the return of most of the dental personnel from the Forces, man-power control of dentists was discontinued as from the 31st March, 1946, and the National Dental Committee ceased to function as from that date. The Department of Health, as the convening: authority, takes this opportunity of acknowledging the ready co-operation of the representatives of the New Zealand Dental Association and of the Armed Forces Dental Services (and at a later stage of the dental technicians' organization), who, as membersof this Committee, devoted much time to its deliberations over a period of some six years. Rehabilitation of Dentists The Dental Advisory Committee on Rehabilitation has continued its work in collaboration with the Rehabilitation Board. Numerous cases affecting the rehabilitating of ex-service personnel in dentistry have been referred by the Board for the Committee's recommendation. The Department is indebted to those members of the dental profession who voluntarily give their time to the work of this Committee. Dental Treatment op Returned Servicemen The Department's organization for providing dental treatment for returned personnel of the Armed Forces has continued to operate, smoothly and satisfactorily throughout the past year. The work imposes a considerable strain upon the already busy private dental practitioners who undertake the boarding and the treatment, but, nevertheless,, the response is good, and there is general satisfaction with the treatment that is given. A particularly heavy burden falls upon those private dental practitioners who act as dental supervisors in the various districts, and during the year under review it was found possible to arrange for these dentists to be granted financial remuneration for their services. GENERAL Industrial Hygiene The visit of Dr. J. M. Davidson, from the Ministry of Labour and National Service,. London, and the publication of his review of industrial hygiene in New Zealand* stimulated interest in this important sphere of public-health work. Largely as the resultof his visit, it is hoped shortly to establish the Division of Industrial Hygiene within the Department. Nutrition Dr. Muriel Bell and the Nutrition Committee of the Medical Research Council have given continuous attention and research to matters relating to the nutrition of our people. Milk-in-schools Scheme The total number of pupils participating in the milk-in-schools scheme was 235,941 made up as follows : Pupils Pasteurized bottled milk .. .. .. .. 222,678 Malted milk .. .. .. .. .. 8,234 Cocoa-making .. .. .. .. .. 5,029 235,941

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Apple-in-schools Scheme Apples free of cost were supplied to pupils attending all types of school for four weeks during the apple season. A total of 44,481 cases of apples were supplied. Health Camps The number of children requiring health-camp treatment has increased to such an extent that most camps have long waiting-lists for admission. Despite staffing difficulties, health camps have continued to operate successfully, and the opening of a further permanent camp at Maunu, Whangarei, has done much to meet the need of North Auckland, especially of the Maori population. The construction of a large permanent camp near Auckland has also been put in hand, but some considerable time will probably elapse before the project can be completed. Three records have this year been established in the sale of Health Stamps—firstly? all available stamps were sold ; secondly, the campaign lasted only four months instead of the usual five months ; and thirdly, sales, approximately £75,000, were £13,000 in excess of last year's record. Health Education For this purpose a sum of £26,000 was allocated and expended on similar services as given in the previous report. There was an increased demand for advice and information, including requests from overseas and from research workers. By permission of the Controller, H.M. Stationery Office, London, copies were printed of the Medical Research Council, London, War Memoranda " The Prevention of Hospital Infection of Wounds " and " The Control of Cross Infection in Hospitals." These were distributed to hospitals in conjunction with a departmental pamphlet, " Suggested Nursing Technique for Tuberculosis and other Infectious Diseases in Hospitals." The pamphlets, " The General Principles of Maternity Nursing " and " The Technique of Isolation " were revised, printed, and widely distributed. To meet demands for information as to scope and nature of the Department's work and for educational staff purposes, a pamphlet giving an outline of head administration in New Zealand was printed. Many additions were made to the Head and District Office libraries. Co-operation has been maintained with University and departmental libraries and assistance rendered to research workers and accredited persons. The 16 mm. sound-film library now contains over one hundred and thirty films, which have been extensively used by departmental officers for lectures to various groups. Boards associated with the Department The Board of Health, the Medical and Dental Councils, the Medical Research Council, the Nurses and Midwives Registration Board, the Opticians Board, the Masseurs Registration Board, the Medical Advertisements Board, the Plumbers Board, the King George V Memorial Fund Board, and the Dominion Advisory Board of the New Zealand Federation of Health Camps continued their work during the year. Medical Research Council The following statement sets out the names of the members of the Medical Research Council established in 1937 and of the Committees set up under the Council, and gives some information about the researches carried out by the Committees : Medical Research Council.—Muriel E. Bell, M.D., Member of Board of Health; N. L. Edson, M.8., Ch.B., representing Travis Bequest trustees ; Sir James Elliott, Kt., M.D., Member of Board of Health ; E. J. Fawcett, M.A., Director-General of Agriculture ; Professor C. E. Hercus, 0.8. E., D.5.0., M.D., Dean of the Faculty of Medicine, University of Otago ; P. P. Lynch, M.D., representative of the New Zealand Branch of the British Medical Association; E. Marsden, C.M.G., C.8.E., M.C., F.R.S., D.Sc., Secretary of the Department of Scientific and Industrial Research; Sir Donald

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McGavin, Kt., C.M.G., D.5.0., M.D., F.R.C.S., Member of Board of Health ; Professor F. H. Smirk, M.D., M.R.C.P., representing Royal Australasian College of Physicians; The Director-General of Health, Member of Board of Health, Chairman {ex officio). Nutrition Research Committee. —Professor John Malcolm (Chairman), Professor 0. E. Hercus, Professor Elizabeth Gregory, Sir Theodore Rigg, Dr. Muriel Bell. " Summary of Final Report on the Incidence of Rickets in New Zealand Children " (Malcolm). " The Present State of the Science of Nutrition, with Particular Reference to the Special Problems of the Empire, including the Nutritional Status of the Indigenous Peoples of the Colonies." Paper by Dr. Muriel Bell to the Royal Empire Conference, London, 1946. " Hypervitaminosis A : Induced by New Zealand Fish Liver Oils " (Moore). " Serum Phosphatase Levels in Hypervitaminosis A " (Weeber and Moore). " Vitamin D Estimations, 1945-46 " (Weeber). " Further Interim Report on a Rickets Survey " (Weeber and Deem). " Note on the Keeping-power of the Buffer Substrate Solution used in the Determination of Serum Phosphates by the King-Armstrong Method " (Weeber). " Vitamin C Determination in Rose-hip Syrup and Rose-hip Jelly Crystals" (Weeber). " Interim Report on the Estimation of Fluorine " (Harrison). " Estimation of Riboflavin " (Clemow). " Thiamine Determination of New Zealand Fish " (Macfarlane). Thyroid Research Committee. —Professor C. E. Hercus (Chairman), Professor J. Malcolm, Dr. N. L. Edson, Dr. J. A. D. Iverach. Continuation of study of the goitrogenic activity of derivatives of thiourea and related compounds. Hydatid Research Committee. —Sir Louis Barnett (Chairman), Dr. C. S. M. Hopkirk, Dr. T. R. Ritchie. " Testing ' Caprokol' Hydrobromide as an Anthelmintic for Hydatid Worms in Dogs " (Batham). " Testing Arecoline Hydrobromide as an Anthelminthic for Hydatid Worms in Dogs " (Batham). Tuberculosis Research Committee. —Dr. T. W. J. Johnson (Chairman), Dr. Chisholm McDowell, Dr. W. Gilmour, Dr. H. B. Turbott, Dr. C. A. Taylor. Tuberculosis Research at Auckland Hospital (Gilmour). Clinical Medicine Research Committee. —Professor F. H. Smirk (Chairman), Dr. M. McGeorge, Dr. N. L. Edson. Publications—- " Renal Function and Prognosis in Benign Hypertension " (Murray McGeorge) Quarterly Journal of Medicine, sth July, 1945. " Effect of the Initial Level of the Blood-pressure upon the Response of the Human Subject to Blood-pressure raising Reflexes " (Bruce Martin and Smirk). Journal of Physiology, 1945, Vol. 103, No. 4. " Spread of Infective Hepatitis " (R. Kirk). The Lancet, Jan. 20, 1945. " Control of Gastric Hyperacidity by Radium " (Murray McGeorge). Proceedings Royal Australasian College of Physicians in Christchurch, February, 1945. " Ventricular Rhythm " (Smirk). Proceedings of a meeting of the Royal Australasian College of Physicians in Christchurch, February, 1945.

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Publications in Press—- " Ulcerative Colitis " (Iverach) Proceedings of a meeting of the Royal " Infective Hepatitis " (R. Kirk) J> Australasian College of Physicians in " Some New Pressor Drugs " (Smirk) J Wellington, February, 1946. Virus and Immunology Research Committee. —Dr. N. L. Edson (Chairman), Professor E. F. D'Ath, Professor J. C. Eccles, Professor C. E. Hercus, Dr. J. 0. Mercer. Committee not yet in active work. Neurophysiology and Neuropathology Research Committee. —Professor J. C. Eccles (Chairman), Professor F. H. Smirk, Professor W. E. Adams, Dr. M. A. Falconer. A clinical team investigated all cases of sciatica admitted to the Dunedin Hospital, and, in addition, has held a weekly out-patient session for the purpose of seeing new cases and of the following-up of old cases. Dental Research Committee—Professor J. P. Walsh (Chairman), Mr. J. LI. Saunders* Dr. R. E. T. Hewart, Mr. H. S. Wilkinson. Committee not yet in active work. Obstetric Research Committee. —Professor J. B. Dawson (Chairman), Dr. F. CBennett, Dr. Sylvia Chapman, Dr. T. R. Plunkett, Dr. T. F. Corkill, Dr. G. J. S. Fisher {ex officio), (President of the Obstetrical Society). " Progress Report on Pelvimetry Research " (Allen). Enterobius Vermicularis: Report by Professor L. R. Richardson. STAFF I regret to record the death of Dr. R. B. Robb, who held the position of School Medical Officer, Auckland, for five years. Dr. Thos. J. Hughes retired after thirty-two years' service. Since 1920 Dr. Hughes filled with distinction the responsible position of Medical Officer of Health, Auckland. Mr. F. J. Fenton, Inspecting House Manager, and Mr. G. Laurenson, Architect, retired after long and valuable service in their respective spheres. Dr. Doris Gordon was appointed Director of Maternal and Infant Welfare, a position that has been vacant since the retirement of Dr. T. L. Paget in 1944. Dr. Gordon is well known for activities in the cause of infant and maternal welfare. In conclusion, I desire to express my thanks to the members of the staff for their loyal support during the past years. M. H. Watt, Director-General of Health.

Approximate Cost of Paper.—Preparation, not given ; printing (1,033 copies), £125

Price. 9d.]

By Authority: E. Y. Paul, Government Printer, Wellington.^l946.

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