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

Appendix to the Journals of the House of Representatives, 1947 Session I, H-31

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1947 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. M. B. HOWARD, MINISTER OF HEALTH

REPORT The Deputy Director-General of Health to the Hon. the Minister of Health, Wellington. I have the honour to lav before you the annual report of the Department for the year 1946-47. VITAL STATISTICS (The figures given include Maoris unless otherwise stated) Population.—The mean population of the Dominion for 1946 was 1,761,399, an increase of 66,685 over the figure for the previous year (European, 1,659,145 ; Maoris, 102,254). Births. —The registered live births numbered 47,647 (European, 41,871 ; Maori, 5,776), the highest ever recorded in New Zealand history. The birth-rate was 25-24 per 1,000 of mean population for Europeans and 56-49 per 1,000 for Maoris. The European birth-rate is the highest since 1917. Deaths.—Deaths numbered 17,720 (Europeans, 16,093; Maoris, 1,627). The respective crude death-rates were 9-70 per 1,000 mean population for Europeans and 15-91 per 1,000 for Maoris. Infant Mortality.—The infant-mortality rate was 26-10 per 1,000 live births for Europeans and 74-62 per 1,000 live births for Maoris. The European rate represents a new low record for European infant mortality.

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The following table shows details of infant mortality for the years 1940-46 inclusive :

Infant Mortality in New Zealand, 1940-46 (per 1,000 Live Births) (Europeans only)

Analysis of Deaths of Infants under One Month, 1945

Still-births.—The registered still-births were 21-75 per 1,000 total births for Europeans. The corresponding Maori figure is not available. The following table shows the death-rates for still-births and deaths of infants under one month of age for the years 1941-46 :

Rates per 1,000 Total Births (Europeans only)

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Year. Under One Month. One Month and under Twelve Months. Total under Twelve Months. 1940 1941 1942 1943 1944 1945 1946 22 03 20-00 18-73 21-27 20-60 19-59 19-08 8-18 9-77 9-98 10-10 9-52 8-40 7-02 30-21 29-77 28-71 31-37 30-12 27-99 26-10

Under One Day. One Day and One Week and Two Weeks Three Weeks Cause of Death. under One under Two and under and under Total. Week. Weeks. Three Weeks. One Month. Diphtheria Whooping-cough Influenza Syphilis 1 1 Convulsions 1 Broncho-pneumonia .. 6 6 1 2 15 Pneumonia 2 5 1 L 9 Diarrhoea and enteritis 3 1 1 5 Congenital malforma20 52 21 8 5 106 tions Congenital debility .. 5 9 1 1 16 Injury at birth 39 54 9 1 1 104 Premature birth 216 120 9 9 5 359 Other diseases of early 27 45 8 2 2 84 infancy Other causes 5 4 8 3 5 25 Totals— 1945 312 293 70 28 22 725 1944 289 270 76 43 14 692 1943 254 284 61 25 21 645 1942 260 264 54 26 25 629 1941 280 293 70 38 21 702 1940 288 318 72 26 18 722

Year. Still-births. Under One Day. One Day and under Two Days. Two Days and under One Week. One Week and under Two Weeks. Two Weeks and under One Month. 1941 26-92 7-76 2-49 5-63 1-94 1-64 1942 25-85 7-54 2-50 5-16 1-57 1-48 1943 26-25 8-16 3-53 5-59 1-96 1-48 1944 23-23 8-40 2-50 5-35 2-21 1-66 1945 22-84 8-24 2-43 5-30 1-85 1-32 1946 21-75 8-04 2-90 4-84 1-77 112

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Maternal Mortality. —Here again the Maori figures are not available. For Europeans the maternal-mortality rate, including deaths from septic abortion was 2*05 per 1,000 live births, as compared with 2-24 in 1945. After excluding deaths from septic abortion, the rate was 1-76 (1-94 in 1945). Summary oj Vital Statistics, 1946 ' European. Maori. Combined. Population, mean .. .. .. 1,659,145 102,254 1,761,399 Birth-rate per 1,000 population .. .. 25*24 56-49 27-05 Death-rate per 1,000 population .. 9-70 15-91 10-06 Infant-mortality rate per 1,000 live births .. 26-10 74-62 31-99 Death-rate, tuberculosis, all forms, per 10,000 population .. .. .. .. 3-38 39-04 5-43 This table shows at a glance the main differences between the European and the Maoris in respect of vital statistics. PRINCIPAL CAUSES OF DEATH (Europeans only) The following table gives the main causes of death for the year 1945, and the deathrates therefrom per 10,000 of mean population for that year and the preceding four years. Owing to the difficulty of obtaining detailed statistics so early in the year, no attempt has been made, as in previous years, to supply this information for the year immediately past. The corresponding figures for 1946 will appear in next year's annual report.

* 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 separately comparable with the figures for years before 1940.

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1945. Cause. 1944 : 1943: 1942: 1941: Rate. Rate. Rate. Rate. Number. Rate. Heart-disease (all forms) 5 ,655 35-48 33-49 33-68 36-41 31-55 Cancer 2 ,213 13-88 14-02 13-85 13-13 13-18 Violence 784 4-92 5-37 6-06 5-76 5-64 Pneumonia 222 1-39 1-32 j 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 181 1-14 1-14 1-40 1-36 0-94 Broncho-pneumonia 283 1-78 1-82 1-67 211 1-98 Tuberculosis (all forms) Kidney, or Bright's, disease 603 3-78 3-81 3-72 3-94 3-88 417 2-62 2-80 2-83 3-19 3-66 Apoplexy or cerebral haemorrhage 1 ,636 10-26 9-28 9-79 9-90 8-95* Diseases of the arteries 251 1-57 1-23 1-22 1-22 1-14* Senility 463 2-90 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 .. .. .. 60 0-38 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 0-33 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

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REPORTS OF DIVISIONAL DIRECTORS DIVISION OF PUBLIC HYGIENE Infectious Diseases Diphtheria. —During 1946 there were 1,683 cases of diphtheria (Europeans, 1,577; Maoris, 106), and since 1931 a yearly total of cases exceeding 1,000 has occurred on only one other occasion. . The distribution of the disease has been remarkable, in that the districts most seriously affected have been in the North Island, while the South Island, as in previous years, has largely escaped. The seven most northerly health districts, with a total population of approximately 914,282, had 1,451 cases, or an incidence of 15-87 per 10,000 population. The South Island, excluding Nelson-Marlborough, with a population of approximately 503,590, had 48 cases, or an incidence of 0-95 per 10,000 population. Central Wellington and Nelson-Marlborough Health Districts, ■ with a combined population of 277,401 and 178 cases, occupied an intermediate position both geographically and with reference to their diphtheria incidence rate of 6-42 per 10,000. Diphtheria among Maoris.—The notified cases of diphtheria among Maoris numbered 106, representing a rate of 10*6 per 10,000, compared with the rate of 15-87 per 10,000 for the Europeans in those parts of the Dominion in which the majority of Maoris live. It was previously thought that the Maori was relatively immune to diphtheria, but if this was ever so he would seem to be losing this immunity. In 1932, when 802 cases were notified among Europeans, there were only 3 Maori cases, and the respective rates were 5-51 for Europeans and 0-42 for Maoris. From 1932 onwards the incidence of diphtheria among Maoris has increased steadily, although during most of this period the diphtheria rate amongst Europeans was practically constant. The Maori rate has increased from 0-42 in 1932 to 1-81 in 1936, 3-22 in 1938, 4-37 in 1942, 8-10 in 1945, and 10*6 in 1946. So definite has this trend been that in the Wellington - Hawke's Bay District, in which the Maori population numbers 12,440, the diphtheria incidence in 1946 was actually higher among the Maoris than among the Europeans. It is evident that at the present time the Maori is as susceptible to diphtheria as the European. The History of Diphtheria in New Zealand. —Prior to 1901 the only authentic record of the incidence of diphtheria is to be found in the returns of deaths from diphtheria and croup. The death-rate in 1872 was 5-45 per 10,000 population, and increased to 8-47 per 10,000 in 1874. In that year the deaths numbered 270 out of a total population of 297,654, and despite a steady growth in population the number of deaths has since only once exceeded this figure. After 1874 the diphtheria death-rate dropped fairly steadily, with interruptions in the decline in 1882, 1888, and 1892. In 1892 the deathrate was 4-38 per 10,000 and the total number of deaths was 281 —the largest in New Zealand's history. Thereafter diphtheria mortality dropped steadily to reach the low rate of 0-47 per 10,000 in 1904. Diphtheria antitoxin was first used in New Zealand in the treatment of diphtheria in March, 1895, and thereafter its use became general. Probably its introduction coincided with a natural regression in the severity and incidence of the disease.

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The Department of Health came into being in 1901 at a time when the diphtheria death-rate was below 1 per 10,000, and, compared with other infectious diseases, notably scarlet fever, enteric fever, measles, and whooping-cough, it was regarded as of little importance. In fact, the table of principal causes of death published in the annual reports for several years omitted diphtheria altogether. In 1914 the incidence of diphtheria began to rise, and continued to do so for five years. The notifications in 1914 numbered 1,093, while in 1918 they were 5,539. The highest death-rate of this period was in 1917 with 240 deaths, or a rate of 2-18 per 10,000. In 1918 the deaths totalled 195, with a rate of 1-77. This was the year of the influenza pandemic, and for this reason very little mention of diphtheria is made in the Department's annual report. From 1919 onwards the disease receded and the incidence dropped steadily to reach a new low level in 1934, in which year the deaths numbered 26 only, with a •death-rate of 0-18 per 10,000. For the next ten years it remained low and the deathrate fluctuated between o*l and 0-2 per 10,000, but in 1943 the prevalence of diphtheria again increased, and in 1945 the notifications, for the first time in fourteen years, ■exceeded 1,000. This latest increase in diphtheria incidence is clearly part of a world-wide resurgence of the disease. This has been particularly marked throughout north-western Europe, as the following figures will show :

Notified Cases of Diphtheria

In comparison with these figures, it is interesting to note the trend of the disease in England and Wales and the United States over the same period :

Prior to the war, prophylactic inoculation against diphtheria was extensively practised in the United States, but it was not clear whether the low incidence of the, disease could be attributed to this or to the general epidemiological factors affecting the world as a whole. Incidence was also low in such countries as Norway, Sweden, and the Netherlands, where little systematic inoculation was carried out. The state of affairs during 1942-44 would seem to have supplied the answer to this question. Norway and Sweden have suffered an extensive epidemic, whereas in the United States the incidence has remained low. But the outstanding example of the value of large-scale inoculation

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Year. Denmark. France. Netherlands. Norway. Sweden. Eire. 1939 1,106 14,019 1,273 71 188 2,087 1943 2,527 46,539 58,603 22,787 2,496 4,650 1944 3,333 40,230 4,520 5,168

Year. England and Wales. United States. 1939 47,698 24,391 1943 35,944 14,943 1944 29,446 14,103

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is shown by the figures for England and Wales, where alone of all countries in northwest Europe there has been over these years a progressive marked reduction in the incidence of diphtheria. In New Zealand a considerable number of children have been inoculated, hut not sufficient to make us secure against the possibility of a serious epidemic. If anything, inoculation has been more actively carried out in the North Island than in the South Island, and yet, as has been shown, the incidence in the North Island has been sixteen times as high as in the South Island. It is clear that some other factors are at work, as was the case in Norway, Sweden, and the Netherlands before the war. Until at least 70 per cent, of the children under five years of age have been protected against diphtheria there can be no certainty that other factors may not combine to cause an epidemic. With the medical staff at present available to the Department this represents an impossible achievement without considerable help from private practitioners. For this reason the Department is concentrating on children of seven years and under, who are the most susceptible. The ideal to be arrived at is the inoculation of every child at six months of age, with a reinforcing dose on entering school at five. Scarlet Fever. —Notifications numbered 1,465 (Europeans, 1,454; Maoris, 11), compared with 5,081 for 1945. The last peak of scarlet fever incidence was in 1944 with 7,622 notifications. Enteric Fever.—There were 98 cases of enteric fever (Europeans, 49 ; Maoris, 49), and of these 15 were paratyphoid fever. Of the Maori cases, 18 were concerned in one outbreak at apa in the Rotorua district. The water-supply was from shallow wells that were probably polluted from pit privies in the close vicinity. Immediate steps were taken to obtain for the pa a piped supply of good water from the neighbouring borough. During June-July there was an outbreak involving -8 cases and 1 death in Southland. Two families only were concerned, and the source of infection was thought to be a woman who was a contact of both families and who had occasional attacks of diarrhoea. She was admitted to hospital for thorough bacteriological investigation, but it could not be proved that she was a carrier. Poliomyelitis. —There were 113 cases notified, including 1 case in a Maori. This was a considerable increase on the numbers for the two preceding years, and as the majority of cases occurred in the first five months of the year it appeared as if an epidemic of the disease might be impending. After May, however, the incidence declined and only sporadic cases occurred throughout the rest of the year. Tetanus.—A total of 25 cases were notified, and these included 4 cases of Tetanus neonatorum traced to the use of dusting-powders that were heavily infected with tetanus spores. The first two cases occurred in separate hospitals and were notified simultaneously to the Medical Officer of Health, Auckland. Inquiries were immediately set on foot, and the only common factor was a proprietary brand of baby powder that had been used in each case. The powder was traced back to the place of manufacture and found to be prepared from imported crude talc, nothing having been done during processing to render it sterile. A week later notification was received of a third case of Tetanus neonatorum, and in this case also the same brand of baby-powder had been used. Samples of the powder used —similar powder of the same brand —and samples of the crude talc were all examined for the presence of tetanus spores, and in all cases tetanus infection was found to be present. Steps were immediately taken to caution all midwives and maternity nurses against the use of unsterilized powders, but before the warning was issued a fourth case occurred, this time in Wellington. It is noteworthy that while the infected powder was used for the actual cord dressing in one case, it was only used as a general dusting-powder in the other cases. The infection therefore must have been a very heavy one. All 4 cases proved fatal.

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The public was warned to discontinue the use of any dusting-powders with young babies, and a large number of samples of different brands of dusting-powder were taken throughout the country and examined for tetanus infection. While the great majority were free from infection, it was found to be present in samples of three different brands. In some cases also, gas-forming bacilli were found to be present. As a result of these events, regulations under the Sale of Food and Drugs Act have been enacted to require that all talc or other mineral ingredients used in the manufacture of baby-powders must be sterilized by heat unless purified talc B.P.C. is used. The manufacturers of dusting-powders are introducing the necessary equipment for sterilizing talc, and already powders made from sterilized talc are on the market. Food Poisoning.—There were 248 cases of food poisoning notified, and of these 158 occurred in February-March and were concerned with one outbreak. The food in question was cooked ham and the infecting organism Staphylococcus aureus. The ham was all cured and cooked at a provincial factory and distributed over a wide area, .although the chief brunt of the infection affected Wellington. A cool store in Wellington in which the hams were received, and from which they were distributed throughout Wellington City and suburbs, was inspected on sth February and found to be in a dirty, neglected condition. The refrigerating mechanism was defective and the temperature■control unit out of action. It was also found that the cardboard cartons in which the •cooked hams were packed were being returned to the factory and used a number of times. After these unsatisfactory conditions were remedied further cases came to light, -and these were connected with hams despatched direct from the factory to country retailers. Investigations at the factory where the hams were cured and cooked showed that insufficient precautions were taken to prevent possible contamination of the hams after -cooking. Moreover, Staphylococcus aureus was recovered from the pickling-brine, from the pumping-pickle, and from racks in the cool chamber where the cooked hams were stored before despatch. Unfortunately, the lack of suitable laboratory animals prevented the confirmatory testing of these organisms for entero toxin. The actual source of the infection could not be determined. The hands and arms of all those handling the hams at the Wellington store were examined for skin infections but nothing abnormal was found. Similar investigations were made at the factory, .also with negative results. The heavy incidence in Wellington City as compared with other parts of the area supplied from this factory suggests that the infection arose in the Wellington cool store and was possibly transferred back to the factory by means of used cartons that were again used for packing hams. The refrigerators at the cool store were thoroughly cleaned out and disinfected with chloride of lime, while at the factory the pickling-brine was discarded and the brine-vats steamed out. Recommendations were also made that the wooden tables on which the Jhams were cut up, and on to which the cooked hams were placed to cool, should be covered with stainless steel. Most important of all, the use of second-hand cardboard cartons were strictly forbidden. The investigations revealed the very large traffic that takes place in cooked hams .sent out over a wide area from a central factory. Cooked ham is a very perishable product, and it is not well suited for despatch over long distances by ordinary methods of transport. From the hygienic viewpoint it is far preferable that hams should be transported in the raw, dry state and cooked locally as required.

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Venereal Diseases. —Tables I and II set out the number of persons seen for the first time at the venereal-disease clinics, and the total attendances at the clinics :

Table I

A. total of 1,049 males and 427 females also attended the clinics for examination and were found not to be suffering from venereal diseases.

Table II

For purposes of comparison with other years the following tables show first attendances at the various clinics since 1941 :

Table III. —Number of Persons seen for the First Time and found to be suffering from Syphilis

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— Auckland. Wellington. Christ-church. Dunedin. Total. M. F. M. P. M. F. M. F. M. F. Persons seen for the first time and found to be suffering from— Syphilis 77 26 20 25 25 13 30 4 152 68 Soft sore 5 4 13 22 Gonorrhoea 639 329 235 42 168 31 115 13 1,157

Auckland. Wellington. Christ church. Dunedin. Total. M. F. . M. > F. M. F. M. IP. M. F. Total attendances of persons suffering from — Syphilis Soft sore Gonorrhoea 1,808 6 6,157 3,101 2,993 2,604 14 4,850 1,914 1,555 3,028 140 3,506 547 421 1,110 833 428 i.94 8,550 160 15,346 5,990 5,m

Year. Auckland. Wellington. Christchurch. Dunedin. Total. 1 Grand 1 Totals, M. IT. M. F. M. ! »■ i M. F. M. P. 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 6 27 4 76 88 164 1945 61 34 11 20 15 8 27 6 114 68 182 1946 77 26 20 25 25 13 30 4 152 68 220

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Table IV.—Number of Persons seen for the First Time and found to be suffering from Gonorrhœa

It will be noted that in the cases of both diseases, while the incidence of infection among women has remained low, there has been a considerable increase in the number of men seeking treatment. It is not clear how far this represents a real increase, and how far it can be accounted for by the discharge of men from the Services. During the war a, large proportion of men between the ages of eighteen and forty were in the Army, Navy, or Air Force and under similar circumstances would be treated in Service hospitals. The tables at the end of this section of the report give details of the cases of notifiable diseases reported in 1946. Food and Drugs Food and Drugs Regulations. —During the year a new set of regulations under the Sale of Food and Drugs Act were gazetted. The existing regulations dated from 1924 and were badly in need of consolidation and revision. Some of the chief alterations in the new regulations were as follows : (i) The list of artificial colours permitted in foods has been completely revised so as to exclude a number of dyes that are now known to have toxic properties. (ii) The sale of artificial or imitation foodstuffs is prohibited, unless specifically permitted. (iii) The addition of synthetic vitamin preparation to foods is forbidden. (iv) If claims are made as to the presence of vitamins or minerals in foods, the amounts present must be stated in the label. (v) Standards have been introduced for table confections, milk-bread, arrowroot, suet, milk-shakes, rennet, milk-ices, lemon cheese, liqueurs, fish-liver oils, rose-hip syrup, penicillin, proprietary medicines, and dusting-powders. (vi) The provisions regarding disinfectants have been revised so that only those substances having a defined standard of disinfecting powers may be sold as disinfectants. (vii) The labelling provisions of the large class of non-alcoholic beverages have been revised to ensure that the customer may be able to know exactly what he is buying. Dusting-powders. —All baby-powders containing any natural mineral ingredient such as talc or kaolin must be made from purified talc B.P.C. or from talc or kaolin that has been sterilized by heating to 150° c. for not less than one hour. Fish-liver Oils. —As the manufacture of fish-liver oils is now an important New Zealand industry, a standard for fish oils has been adopted. The addition of calciferol is permitted, and the amounts of vitamin A and vitamin D present in the oil must be stated on the label. Imported halibut-liver oil is required to contain not less than 2,500 International Units of vitamin D per gram.

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Year. Auckland. Wellington. Christchurch. Dunedin. Total. Grand Totals. M. F. M. F. M. 1 F - M. F. M. E„ 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 4r3 178 54 149 66 46 9 762 542 1,304 1946 639 329 235 42 168 31 115 13 1,157 415 1,572

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Proprietary Medicines.—An important new regulation requires that all proprietary medicines sold must bear on the label a statement of the contained active ingredients and proportion of each that are present. This is supplementary to the provisions of the Medical Advertisements Act, 1942, and follows closely the provisions of the Pharmacy and Medicines Act, 1941, of Great Britain. Sampling of Foods and Drugs.—The following tables set out, by health districts, the number of samples of milk, other foods, and drugs taken and dealt with during the year 1946 :

Samples of Foods and Drugs taken and dealt with during 1946

The " other foods " sampled include bacon and ham (192), butter (122), cream (29), sausage meat and mince meat (265), milk-shakes (82), ice-cream (462), bread and flour (28), and pulped egg (34). Wrapping of Bread. —Regulations have been enacted to require that bread sold over the counter is wrapped in clean paper or other suitable material, but the regulation is not enforced in any district except when notice to that effect has been given by the Minister and published in the Gazette. The regulations also provide that after Ist January, 1948, all bread sold for human consumption shall be wrapped before it leaves the bakehouse.

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Milk. District. Number of Number of Samples not Warnings Prosecutions Samples. Vendors. complying. issued. recommended. North Auckland 207 75 5 2 Central Auckland 2,807 1,306 112 51 12 South Auekland 1,792 1,618 119 55 21 Thames-Tauranga 115 69 10 6 Taranaki 264 131 7 10 7 East Cape 569 489 36 33 2 Wellington - Hawke's Bay 2,093 1,016 184 33 14 Central Wellington 2,254 2,078 38 13 6 Nelson-Marlborough 155 72 4 '2 Canterbury4,826 1,096 480 97 21 West Coast 283 157 22 4 3 Otago 1,604 606 289 27 Southland 397 175 76 47 10 Totals .. 17,368 8,888 1,392 378 95 Other Foods and Drugs. District. Number-of Number of Samples not Warnings Prosecutions j Foods seized ' Samples. Vendors. complying. issued. recommended. and | destroyed. North Auckland 140 132 1 1 Central Auckland 213 133 32 16 48 South Auckland 82 78 8 4 5 Thames-Tauranga 23 1 19 1 Taranaki 3 3 1 1 i 5 East Cape 104 100 12 10 1 Wellington - Hawke's 156 102 7 3 4 22 Bay Central Wellington 135 112 10 4 4 22 Nelson-Marlborough .. 40 37 15 2 1 6 Canterbury 464 296 72 42 5 51 West Coast 30 28 4 3 Otago 568 337 74 1 7 Southland 115 26 9 Totals 2,073 1,385 255 86 15 178

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Nitrite Preparations.—To provide a further safeguard against accidental poisoning by sodium nitrite, butchers who used this substance are now required by regulation to maintain correct labelling on all containers in which nitrites are kept on their premises. In the past several fatalities have occurred through mistaking nitrite for salt or saltpetre. Food Premises and Eatinghouses.—The regulations controlling food premises and eatinghouses are now very out of date, and it is intended to. revise them as soon as staffing difficulties permit this to be done. Dangerous Drugs and Poisons Dangerous Drugs.—A disquieting feature in connection with dangerous-drug control is the increased consumption of heroin. This is one of the worst of the dangerous drugs, as far as addiction is concerned, and its manufacture and importation are both entirely prohibited in certain countries. While, therefore, it has a legitimate place in medicine, it cannot be regarded as indispensable. The following table will show how the importation and consumption of heroin has increased since 1944 :

Prior to 1944 the corresponding figures had remained remarkably constant. The supply of free medicine under the social security benefits began in 1941, but it was not expected that this would affect the quantities of dangerous drugs consumed. This assumption proved correct, and the consumption of morphine, cocaine, and heroin remained practically constant up to 1944. There was an increased consumption of codein, but this could be explained by the importation of codein that was used for manufacturing purposes within the Dominion. Previously tablets containing codein as an ingredient had been imported and the codein contained in them would not have been recorded as an importation of codein. As already stated, the consumption of heroin rose steeply after 1944 and the amount consumed in 1946 was nearly double that used in 1944. It is difficult to explain this rise, except as an example of a changing fashion in prescribing such as occurs from time to time. The attention of medical practitioners is being drawn to the matter, and the manner in which the drug is being used is being closely watched. Poisons Act and Regulations. —An amending regulation was enacted relaxing somewhat the restrictions on the sale of dichlordiphenyltrichlorethane (D.D.T.). This substance had come on to the Dominion market when our knowledge of its poisonous properties was very imperfect and before it was being sold to the public generally in any other countries. It was considered advisable, therefore, to class it as a First Schedule poison, which restricted its sale to pharmacists. When it was found that D.D.T. when used with reasonable intelligence is less toxic than was feared, the regulations were amended to allow for its more ready sale. Preparations containing less than 1 per cent, of D.D.T. may now be sold without any restriction; solutions of D.D.T. containing 1 per cent., but not more than 5 per cent., and dry preparations containing 1 per cent., but not more than 10 per cent, of D.D.T. are now classed as Fourth Schedule poisons and may be sold by any storekeeper, with certain restrictions as to labelling and packing. Preparations of D.D.T. in higher concentrations are still included in the First Schedule and their retail sale is restricted to pharmacists. A consolidation and revision of the regulations under the Pofeons Act, 1934, is now being undertaken.

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Heroin (Kilograms). 1944. 1945. 1946. Importations 41 3-6 7-4 Consumption 4-0 6-3 7-8

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Notification of Disease Table A.—Notifiable Diseases in New Zealand for Year ended 31st December, 1946, showing Distribution by Months

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Enteric Fever. Tuberculosis. <3 > 0 Puerperal Fever. Ophthalmia Neonatorum. E? I •g Months. 1 PR "§ CO "S ,g a o ■d | T) I i 8 P4 S" jjj g 1 1 O - £• PR :l m 1 0 1 >> a 1 <*3 1 S I P 1 1 .& 1 3 0 fl •sl !| pq ai ! 1 H I H 1 ■f w ! | g £ O O 1 t» '« 5 M 1 m a .0 8 a ■4 & & Ph 1 1 1 O | O 1 1 "1 .2H 1 g 0 a 0 % © H January February March April May June July August September October November December 118 98 138 138 158 128 139 132 120 119 86 80 64 65 65 155 264 267 248 137 114 80 63 55 2 3 4 "4 3 8 4 2 2 1 3 1 4 ' '2 1 1 "4 102 116 128 132 141 120 104 141 118 180 116 132 21 30 23 21 21 29 23 26 32 36 18 10 7 5 4 4 12 14 5 17 8 3 5 3 26 23 9 22 14 8 5 4 "l 2 ' 'l 19 11 19 27 21 12 18 13 9 11 19 14 8 6 3 5 6 2 8 9 10 8 8 3 8 9 2 11 10 2 6 3 3 7 1 4 4 5 4 2 5 3 4 1 11 10 5 1 2 2 5 5 1 2 1 3 1 1 1 3 5 6 1 2 7 4 5 8 3 7 ■ '2 "1 2 1 1 2 2 ' '2 "l "l ' 1 18 132 23 7 9 "i2 2 28 4 10 5 7 6 11 12 6 15 5 2 1 4 4 5 2 12 4 1 1 "1 2 "1 2 "2 3 3 "1 3 2 1 2 6 3 "2 13 7 3 4 3 4 6 4 4 1 1 1 2 ' 1 "1 429 530 457 558 690 606 605 517 514 . 498 346 333 Totals 1,454 1,577 36 13 1,530 290 87 112 3 193 76 66 55 23 52 9 7 245 78 31 26 2 50 3 2 6,020

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Table B.—Notifications of Cases of Notifiable Diseases by Health Districts for Year ended 31st December, 1946

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Name of Disease. North Auckland. Central Auckland. South Auckland. Thames-Tauranga. Taranaki. Bast Cape. Wellington - Hawke's Bay. Central Wellington. .a so I 1 1 £ Canterbury. West Coast. Otago. Southland. Totals. Scarlet fever 7 152 50 21 73 35 294 285 42 286 7 95 107 1,454 Diphtheria 25 486 352 74 122 49 243 104 74 26 1 11 10 1,577 Enteric fever — (a) Typhoid 8 3 2 3 1 5 5 9 36 (b) Paratyphoid 2 5 "l 4 1 13 Tuberculosis — (a) Pulmonary 23 367 73 34 51 21 147 269 52 279 31 123 60 1,530 (b) Other forms 1 41 8 4 6 2 23 71 4 63 8 40 19 290 Cerebro-spinal meningitis 16 7 6 8 2 5 23 2 7 2 6 3 87 Acute poliomelitis 7 7 1 9 9 1 7 61 10 112 Influenza 1 1 1 3 Erysipelas 5 64 16 5 5 3 21 39 "3 22 "l 6 3 193 Puerperal fever — (a) Ordinary 1 4 8 9 8 8 10 14 1 9 4 76 (b) Following abortion 26 1 1 14 22 2 66 Eclampsia 12 1 1 1 5 5 "2 19 9 55 Tetanus *2 7 5 1 4 2 1 1 23 Hydatids 1 3 2 *3 15 7 20 "l 52 Trachoma "l 4 2 2 9 Ophthalmia neonatorum 3 "l 1 1 "l 7 Food poisoning 5 1 2 32 35 139 16 io 5 245 Bacillary dysentery "l 39 2 "l 2 14 12 5 2 78 Amoebic dysentery 4 1 1 5 4 2 14 31 Undulant fever 3 • 1 *3 2 . 6 1 10 26 Chronic lead poisoning 2 2 Malaria i7 4 5 *4 8 4 ' 7 1 50 Lethargic encephalitis 1 1 1 3 Actinomycosis •• 1 1 2 Totals 66 1,263 542 161 293 171 844 997 197 826 62 372 226 6,020

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Table C.—Notificable Diseases in New Zealand for Year ended 31st December, 1946, showing distribution by Age and Sex

Name of Disease. Under 15 510 10-15 15-20 20--25 25-30 30--35 35-40 40-45 1 Year. Yea rs. Years. Years. Years. Years. Years. Years. Years. Years. M. P. M. F. M. P. M. P. M. P. M. P. M. P. M. P. . M. P. M. P. Scarlet fever 3 6 168 189 266 326 69 136 38 80 12 57 6 24 6 18 6 16 6 7 Diphtheria 33 32 172 188 260 215 108 132 42 92 42 71 26 33 14 25 9 20 6 12 Enteric fever — (a) Typhoid 4 2 1 5 1 2 1 1 2 1 1 1 3 2 (b) Paratyphoid ' '2 3 1 1 2 1 Tuberculosis — (a) Pulmonary 2 3 10 3 11 12 23 24 49 82 161 148 115 99 97 83 76 66 47 48 (b) Other forms 1 3 18 12 16 15 8 14 15 12 13 26 18 13 13 15 6 8 10 6 Cerebro-spinal meningitis 9 10 10 10 11 5 2 3 3 3 3 2 1 1 2 1 2 Poliomyelitis 1 1 14 8 20 11 9 8 7 7 5 7 ' '4 "3 "3 1 1 2 Influenza 1 Erysipelas "5 "2 "5 "6 2 "l "6 ' "l "3 "3 "2 5 "2 "5 5 "3 5 'io ' 3 ' 'l3 Puerperal fever — (a) Ordinary 3 21 22 11 13 6 (6) Following abortion 4 19 21 11 7 4 Eclampsia "l 4 16 17 13 2 2 Tetanus ' '4 ' 'l ' 'l 5 "l ' "l ' '2 1 1 ' 1 1 "l Hydatids 2 2 6 1 ' 'r 4 5 ' '3 "l ' 6 ' 2 ' 1 4 Trachoma ' 'l 2 1 2 1 Ophthalmia neonatorum ' '3 ' 4 Pood poisoning 1 2 ' '7 5 ' '7 'i6 ' '9 i7 ' '8 15 "7 ' '9 i.4 ' '9 ' '6 ii "6 ii "8 ' 'l2 Bacillary dysentery 4 3 11 7 5 3 2 1 1 3 1 2 3 5 3 2 2 2 1 1 Amoebic dysentery 6 8 1 5 7 2 Undulant fever ' '2 ' 'l "l '' 2 "3 4 ' 'l 2 2 3 "l Chronic lead poisoning 1 Malaria ' 1 15 11 io "l "4 "l Lethargic encephalitis "l "l ' 'l Actinomycosis "l Totals 68 67 424 438 605 618 239 344 173 317 278 391 211 253 170 198 132 161 95 118

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Table C.—Notifiable Diseases in New Zealand for Year ended 31st December, 1946, showing distribution by Age and Sex— continued

Name of Disease. 45-50 50-55 55-60 60-65 65-70 70 i-75 75-80 80 Totals. Years. Years. Years. Years. Years. Years. Years. and over. M. P. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Scarlet fever 3 ' 2 3 1 1 3 1 1 587 867 Diphtheria "2 6 1 7 3 6 2 3 4 "4 ' 3 "3 "l 727 850 Enteric fever — (a) Typhoid 3 2 1 1 1 1 17 19 (b) Paratyphoid 1 ' "l "l 6 7 Tuberculosis — (a) Pulmonary .. 66 28 52 14 58 14 47 9 32 11 16 6 13 3 1 1 876 654 (6) Other forms 8 3 6 5 4 4 3 4 2 4 1 3 1 143 147 Cerebro-spinal meningitis 1 2 1 1 1 1 1 1 45 42 Poliomyelitis 61 51 Influenza ' 1 "l 1 2 Erysipelas *8 "7 ' 5 12 "8 12 io "i6 "9 ' 6 ' '3 "3 "2 "2 "3 83 110 Puerperal fever — (a) Ordinary 76 (b) Following abortion 66 Eelampsia.. 55 Tetanus "2 "l 12 11 Hydatids 1 ' '2 ' 1 "l "2 "3 "2 ' 1 ') ' "l 30 22 Trachoma 2 8 1 Ophthalmia neonatorum .. 3 4 Food poisoning 'l2 "6 'ii 12 ' 3 "4 "4 "4 "2 "l ' 'l ' '3 "l ' 'l 107 138 Bacillary dysentery 1 1 1 2 1 2 1 2 1 "l "l 2 41 37 Amoebic dysentery 1 1 29 2 Undulant fever 2 ' 'l ' 1 18 8 Chronic lead poisoning ' 1 2 Malaria "3 48 2 Lethargic encephalitis 3 Actinomycosis "l "2 Totals 113 59 81 61 81 46 75 41 53 30 25 18 17 7 6 6 2,846 3,174

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Table D.—Maoris: Notifications of Cases of Notifiable Diseases for Year ended 31st March, 1946

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Enteric Fever. Tuberculosis. .23 Puerperal Fever. i i M £ Months. S3 > 4> fe 8 CO •a 1 H 5 S *o 1 H J S "o £ P3 s e 0 1 3 fi 'e" 6 fR <u .g O S 1 PH *cs .s •g. 2 ! o & J iS c "§ < '3 o 3 § i b § & s ci I 1 O SCO It £ o 0,0 PR # c8 ft a H 1 CS "S H £ "§ u W • CS a | 1 1 jl 1 o Is ft <D f 1 <L> t-2 .S 1 (§ % f§ g 1 M 1 ft 0 3 1 -J! i +3 a £ "3 13 a (3 OS 1 .23 1 a J 1 H January FebruaryMarch April May June July August September October November December 3 1 2 2 2 1 6 6 6 7 21 16 15 7 10 7 2 3 5 1 3 20 5 1 6 3 1 1 1 31 35 30 44 24 38 32 31 31 55 53 45 7 5 4 3 5 3 6 9 2 3 4 1 2 2 1 2 3 1 1 1 1 1 1 1 1 1 2 2 1 1 1 1 1 3 1 1 1 2 1 1 1 1 I 1 2 6 1 2 i I I 3 2 1 1 ~2 1 2 4 5 2 2 1 3 2 3 1 1 1 1 1 57 58 55 65 79 72 60 60 65 75 66 55 Totals 11 106 47 2 449 51 13 1 10 6 1 1 2 12 16 6 3 25 2 1 1 1 767

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DIVISION OF HOSPITALS Hospital Board Finance The provisions made in section 15 of the Finance Act (No. 2), 1946, limiting the rate of Hospital Board levies on local authorities are regarded as involving increased responsibility on the part of the Department for the supervision of Hospital Board expenditure. Under the old provisions, which had operated since 1923, levies for maintenance purposes had been subsidized at rates ranging from a minimum of 14s. per £1 to a maximum of 265. per £l, but averaging £1 for £1 over all districts. Levies for capital purposes were subsidized at a uniform rate of £1 for £l. Under the new provisions, which became effective from Ist April, 1947, the amount to be levied by any Board in each financial year is " an amount equal to one half-penny for every one pound of the capital value of the rateable property in the district of the Board or an amount equal to one-half the net estimated expenditure of the Board, whichever is the less." The " net estimated expenditure "is the amount that, according to a Board's annual estimates, is required to be found by levy and subsidy together. The new provision means an assured minimum rate of subsidy on levies of £1 for £l, with no fixed maximum. It is expected, however, that the highest rate of subsidy payable for 1947-48 will be that payable to the Whangaroa Hospital Board —namely, about £l7 per £l. The actual total of levies on local authorities will not be available until all Boards' estimates have been approved. Details will be published in a later Appendix to this report. In the meantime a provisional estimate of net expenditure for both maintenance and capital purposes is £4,950,000. Of that sum, approximately £1,340,000 will be found by levies on local authorities and £3,610,000 by subsidy. Under the old subsidy scheme now superseded the local authorities would have been called on to find £2,475,000, so that the new provision limiting the rate of levy means relief to the local authorities to the extent of approximately £1,135,000.. Building Proposals The following table gives the Ministerial consents to capital expenditure on hospital buildings extensions over the past twelve years : £ 1935-36 .. .. .. .. .. .. 140,368 1936-37 .. .. .. .. .. .. 189,996 1937-38 .. .. .. .. .. .. 209,738 1938-39 .. .. .. .. .. .. 164,739 1939-40 .. .. .. .. .. .. 236,516 1940-41 .. .. .. .. .. 457,357 1941-42 .. .. .. .. .. .. 542,963 1942-43 .. .. .. .. .. .. 912,002 1943-44 .. .. .. .. .. .. 809,295 1944-45 .. .. .. .. .. .. 1,017,012 1945-46 .. .. .. .. .. .. 1,066,463 1946-47 .. .. .. 1,004,941 Average per year for last ten years .. .. £642,103

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It will be accepted that the total Ministerial consents or approvals for a year would roughly approximate the expenditure in that year, as the carry-over from year to year would not vary greatly, except when the graph alters quickly. For 1947-48 the 'proposed amount of capital expenditure on building extensions by Hospital Boards approximates £2,900,000. It is naturally impossible to estimate the consents for the year until the year is nearly complete, but the figure of £2,900,000 represents the completion of works consented to previously, and the expected expenditure during this year on works to be completed perhaps over the next one, two, three, or four years. Plans Apart from building-works in progress, there are Hospital Board building plans in existence for some £10,000,000. Some of these plans await approval or are approved in the sketch-plan stage. Others are nearly completed or are completed and await approval or are approved as working-plans. In addition, the Department knows of further proposals representing at least £3,000,000 which have not yet reached formal sketch-plan stage. The fees payable to private architects for the £10,000,000 plans represent perhaps £150,000 for the sketch plans alone. Hospital architecture is one of the most highly specialized and difficult forms of architecture. It is obvious that, had an adequate departmental staff been built up over recent years, the above-mentioned sketch planning could have been done at a fraction of the above-mentioned cost and, in many instances, more efficiently than has been done. Apart from the delays which are inevitable with a shortage of staff, one of the most disappointing features to those concerned is that there is great scope for research in planning standards, materials of construction, sound-prevention, efficient mechanical appliances, and in other directions if only staff had been available. The position with regard to building-material and labour shortages is well known and has caused extreme delays in the completion of some hospital buildings with, in some cases, astonishingly high tendered prices. The needs of buildings for housing, hydro-electric development, education, transport, industry, and other services are such that it is obvious that there must be some restriction and rationing of Hospital Boards' building proposals. The annual report of 1945 showed that New Zealand already had over 10 beds per 1,000 of population, which is higher than any other country in the world had —or had hitherto stated as an ideal. Several hundred beds are closed because of lack of staff. It is not unreasonable, therefore, to ask for a planning holiday while a survey is made to see which buildings should go on first. This survey was commenced, but is at present in abeyance through further deterioration in the staff position. Hospital Board Salaries For many years Hospital Boards have decided what salaries should be paid to senior professional officers, often without reference to the Department, but lately subject to stabilization. Certain anomalies have resulted. The Budget announcement of 1946 stated that it is the view of the Government that a greater measure of control of Hospital Board expenditure should be exercised. Subsequently, amendments were made to the Hospital and Charitable Institutions Act giving power to make regulations prescribing the conditions of employment of employees of Hospital Boards not under any award and setting up advisory committees in relation thereto.

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The first regulations made under this amendment are dated 14th May, 1947, and entitled Hospital Board Employees (Conditions of Employment) Regulations 1947, and state that the Minister may appoint advisory committees to advise him on the conditions of employment of employees, conditions subject to which leave of absence may be granted, rates of salaries, wages and other emoluments and increments payable, and on complaints or disputes that may arise. The committees are to consist of a Chairman and up to five employees and an equal number of other persons, of whom at least half are members of Hospital Boards and the remainder of whom are officers of the Public Service. Steps are being taken to select the personnel of these committees, which should be functioning in the very near future. Other Controls The above-mentioned amendments also gave power to make regulations to provide for the determination by the Minister of the maximum amount which a Board may spend during the then current or next ensuing financial year on any specified item or class of expenditure. Powers were also taken to regulate the purchase, custody, issue, or other disposal of stores. Steps are being taken to prepare regulations implementing both these powers. General The above-mentioned controls are more than justified by the profound change in the system of finance. Moreover, it would seem that adequate departmental staff is very necessary. With some Hospital Boards more than others there is undoubtedly evident a tendency to incur or to seek authority for expenditure which would not have been contemplated had not the rate been stabilized. It is likely that this tendency will increase. Total Hospital Board Expenditure The actual payments by Hospital Boards last year (1946-47) were : £ Maintenance .. .. .. .. .. 5,916,438 Capital .. .. .. .. .. .. 812,925 Total revenue payments .. .. .. .. 6,729,363 Loan .. .. .. .. .. .. 386,818 £7,116,181 The receipts were £1,889,209 from levy on the ratepayers, almost all of the remainder of the receipts being from subsidy from the Consolidated Fund or amounts received from the Social Security Fund. The above-mentioned figures do not include any expenditure on mental hospitals or on Government-controlled hospitals at Hanmer, Rotorua, and the St. Helens Hospitals, nor do they include the £251,581 paid from the Social Security Fund to private hospitals.

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DIVISION OF CHILD HYGIENE Medical oversight of the health of pre-sehool- and school-children was maintained through medical officers and District Nurses of the Department:—

The Medical State of Primary-school Children (European and Maori)

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European. Maori. Number. Percentage. Number. Percentage. Number of children examined Number of children found to have defects Number with defects other than dental Children showing evidence of — Subnormal nutrition Skin-diseases Heart — Organic disease Functional disease Respiratory disease Posture— Slight impairment Gross defect Deformities of trunk and chest Mouth — Defect of jaw or palate Dental caries .. Extractions of permanent teeth Fillings Perfect sets of teeth Gums : Gingivitis or pyorrhoea Nose and throat—Nasal obstruction Enlarged tonsils Enlarged glands ., .. Goitre — Incipient Small Medium or large Total amount of goitre EyeExternal eye-disease Squints Defective vision— Uncorrected Corrected Ear — ' Otorrhcea Defective hearing Defective speech Mental — Retardate . Feeblemindedness Epilepsy Other nervous defects Digestive system defects Phimosis Undescended testicles Hernia .. .. • • • • Numbep-of parents present at the medical examination Number of children notified as defective 76,266 26,005 19,778 6,159 1,478. 351 915 . 518 28,155 2,702 1,237 2,817 7,331 1,711 57,195 3,149 177 1,823 9,012 4,576 4,923 584 66 5,573 34-09 25-93 8-07 1-93 0-45 1-17 0-68 36-91 3-54 1-62 3-69 9-61 2-24 74-99 4-12 0-23 2-39 11-81 6-00 6-44 0-74 0«06 7-24 7,295 3,027 1,814 539 915 21 13 25 1,713 116 54 35 1,231 180 3,781 491 90 121 664 117 273 17 5 295 4i-49 24-87 7-38 12-54 0-29 0-17 0-33 23-48 1-58 0-74 0-47 16-87 2-46 51-83 6-73 1-23 1-65 9-10 1-60 3-73 0-23 0-06 4-02 458 314 1,555 1,126 77 242 289 162 66 17 60 67 35 228 102 18,891 20,551 0-60 0-41 2-03 1-48 0-10 0-32 0-38 0-21 0-06 0-02 0-07 0-09 0-04 0-29 0-13 24-77 13 9 145 15 38 45 6 5 1 1 4 8 114 1,931 0-17 0-12 1-98 0-20 0-52 0-61 0-08 0-06 0-01 0-01 0-05 0-10 1-56

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There is a slight improvement in nutrition, the subnormal nutrition for the last three years being 9-53 per cent, in 1944, 9-49 per cent, in 1945, and 8-07 per cent, in 1946. The Maori figures for the same period are : 1944, 6-33 per cent. ; 1945, 7-94 per cent. ; 1946, 7-38 per cent. The posture of our school-children is poor, 36-91 per cent, failing to carry themselves well. The Maori figures are better than the European, but still 23-48 showed poor posture. This amount of postural defect has some relation, undoubtedly, to the insufficient rest and sleep common to a considerable proportion of our children. In some cases unbalanced dietaries will be helping the bodies to droop. It is pleasing so see more perfect sets of teeth being recorded in European children —• 4-12 per cent, this year, against 2-99 per cent, last year. The Maori figure, 6-73 per cent., against 6-43 per cent, in 1945, steadily maintains the racial superiority here. In spite of all the work of District Nurses, there is much educational work yet to do. Goitre in European children is at a very satisfactory level, 7-24 per cent., when one remembers that three or four times this amount was being recorded less than ten years ago. As the use of iodized salt has increased in the same period, it would seem that making good the iodine deficiency has reduced simple goitre incidence in our land. The Medical State of Secondary-school Children Our medical staff do not visit secondary schools as a routine. However, for one reason or another a few schools did have a medical inspection, 902 children being seen. Of these, approximately two out of three had medical or dental defects. Eliminating dental defects, approximately one out of three had some physical defect. The total of children seen was so small that detailed figures and percentages are not being given. The picture in this small group is one of unsatisfactory nutrition, prevalent skin troubles, poor posture, and unhealthy throats. It is planned to do more medical inspection in this adolescent group as staff becomes available, a commencement as a routine next year being a possibility in a limited way. Our medical staff is still at half the necessary strength. The Medical State of the Pre-school Children Number of children seen .. .. .. .. .. .. .. 7,352 Number of defects found— Number. Per Cent. Anaemia .. .. .. .. .. .. 93 1-26 Uncleanliness .. .. .. .. .. 15 0-20 Subnormal nutrition .. .. .. .. .. 647 8• 80 Protuberant abdomen .. .. .. .. .. 264 3-59 Posture defective ... .. .. .. .. 347 4*71 Deformities— Number. Chest .. .. .. .. .. 187 Legs .. .. .. .. .*. 279 Feet .. .. .. .. .. 581 1,047 14-23 Skin-diseases .. .. .. .. .. .. 373 5-07 Heart: Organic defects .. .. .. .. 75 1-02 Lungs .. .. .. .. .. .. 77 1-04 Dental — Gums and soft tissues .. .. .. .. 20 0-27 Dental caries .. .. .. .. .. 503 6• 84 Nose and throat— Adenoids .. .. .. .. .. 229 3-11 Tonsils .. .. .. .. .. .. 722 9-82 Enlarged glands .. .. .. .. .. 282 3-83 Goitre .. .. .. .. .. .. 38 0-51 Eyes— External eye-disease .. .. .. .. 87 1-18 Defective vision .. .. .. .. .. 51 0-69

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The Medical State of the Pre-school Children —continued Number of defects found —continued Number. Per Gent. Ears— Otorrhcea .. .. .. .. .. 29 0-39 Deafness .. .. .. .. .. 17 0-23 Phimosis .. .. .. .. .. .. 38 0-51 Undescended testicles .. .. .. .. .. 67 0-91 Hernia .. .. .. .. .. .. 33 0-45 Habit abnormalities — Bad food habits .. .. .. .. .. 736 10 • 01 Other bad habits .. .. .. .. .. 496 6-74 Bowel action abnormality .. .. .. .. 91 1-23 Eneuresis .. .. .. .. .. .. 421 5-73 Insufficient daytime rest .. .. .. .. 371 5-04 Insufficient sleep .. .. .. .. .. 326 4-43 In these pre-school children subnormal nutrition remains practically at the same level as last year (8-86 per cent, in 1945). Poor posture, showing a lack of body tone, with which sleep and diet have much to do, appears in 4-71 per cent. Much the same percentage have too little sleep and rest —not enough daytime rest in 5-04 per cent, and too late to bed at night in 443 per cent. Ten per cent, of the toddlers give trouble at meal-times, showing the need for more education of parents in child-management. Immunization against Disease Whooping-cough : Complete course of vaccine, 1,082. Diphtheria : Complete course of vaccine, 66,533.

DIVISION OF NURSING The year presented many adjustment difficulties so common throughout the world as a result of the war. However, the nursing service of the Dominion has been maintained through the close co-operation of those responsible. The outstanding fact this year has been the very great increase in New Zealand's birth-rate, which has made considerable demands on hospital beds and staff. At the same time, there has been a wastage of nurses due to a large increase in the number of marriages with the return of our servicemen, the number of married nurses employed decreased, and with the lifting of Man-power Regulations and travelling restrictions a large number of nurses have left New Zealand with the desire to see something of the world. Over a period of six months no less than 88 nurses notified my office that they were leaving New Zealand, so that probably the number who have actually left is considerably larger.

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Health District. Babies, 3-12 Months. Pre-sehool, 1-5 Years. School, 5-15 Years. Total. North Auckland 929 1,343 497 2,769 Auckland 1,013 10,441 5,697 17,151 South Auckland • 183 2,928 4,640 7,751 East Cape 37 1,609 1,638 3,284 Taranaki 475 2,161 446 3,082 Wellington - Hawke's Bay 1,519 3,218 1,614 6,351 Wellington-Wairarapa 614 4,093 1,970 6,677 Nelson-Marlborough 161 665 822 1,648 Canterbury - West Coast 991 3,913 3,934 8,838 South Canterbury 16 565 991 1,572 Otago 159 1,938 2,691 4,788 Southland 159 1,379 1,084 2,622 Totals 6,256 34,253 26,024 66,533

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For the past three years the Civil Nursing Reserve, made up of registered nurses and voluntary aids from the Order of St. John and the New Zealand Red Cross Society, has assisted the staffing of our civil hospitals, particularly the small country hospitals. However, the factors already mentioned affected this Reserve so materially that only a very small number was left by the end of 1946. The Hon. Minister of Health therefore agreed that this Reserve should terminate at the end of this financial year. The Registers Due to lack of clerical staff and the fact that nurses have failed to notify changes in their occupation and address, it has been very difficult to have an accurate practising register. This year a new method was introduced and the co-operation of all matrons of both public and private hospitals was enlisted to ensure that all registered nurses employed filled in the form of application for their practising certificates. The result of this is as follows, and will be used as a basis for guidance in the future : Practising Certificates issued as at 31st March, 1947 Nurses (one certificate) .. .. .. 1,398 Nursing aids (one certificate) .. .. .. 49 Psychiatric (one certificate) .. .. .. 418 Nurse and psychiatric (two certificates) .. .. 22 Total, non-obstetrical .. .. .. 1,887 Nurse, midwife, and psychiatric (three certificates) .. 2 Nurse, maternity, and psychiatric (three certificates) 6 Maternity and psychiatric (two certificates) .. 1 Nurse and midwife (two certificates) .. .. 768 Nurse and maternity (two certificates) .. .. 1,406 Midwife (one certificate) .. .. .. 250 Maternity (one certificate) .. .. .. 180 Total obstetric .. .. .. 2,613 4,500 Percentage obstetric (excluding psychiatric and nursing aid), 6*85 per cent. Legislation Following on the consolidation of the Nurses and Midwives Act, new regulations governing the training and examination of the various classes of nurses were gazetted. In the case of male nurses, the course of training covers a period of two years and the subject material follows the course of training for nursing aids, only that it pertains to the worjc of the male nurse. The regulations governing the practice of obstetric nurses were also altered, particularly in regard to the use of chloroform as an anaesthetic. Section 18 of the Finance Act, 1946, gave the Hon. Minister of Health power to set up certain Advisory Wages Boards which would prescribe wages and conditions of work for those employees of a hospital not covered by an award. The Government has approached the New Zealand Registered Nurses' Association to nominate five members of the profession who will represent the various ranks of nurses employed by Hospital Boards to represent them on the Nurses' Board.

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The General Hospital Service Last year I remarked that the occupied-bed rate of our hospitals used as trainingschools was still increasing and that there was a decrease in our nursing staff which I hoped was a temporary condition. The following table shows that for the first time since 1944 there has been a decrease in hospital occupancy. This is partly due to deliberate closing of wards owing to shortage of staff and partly due to the decreased demands of service patients :

The return shows the greatest decrease is amongst registered nurses, the reason for which I have already explained. The present figures give a total nursing staff of 4,402 for 7,812 occupied beds, which is 1 nurse to 1*77 occupied beds. This percentage of nurses to patients is slightly better than last year (1 to I*9) because of the occupied-bed rate having decreased by approximately 700 beds. The proportion of registered nurses to pupils, 3tol, is too low. For satisfactory staffing, the proportion of nurses to patients should be 1 to I*s and 2 pupil-nurses to 1 registered nurse. It is important that every effort should be made to build up staffs to this ratio if possible, otherwise conditions within the hospital become difficult and detract from recruitment. Registered Staff. —Points which will have to be considered in retaining registered staff will be not only reasonable salaries and hours, but also conditions of service so that young registered nurses are given responsibility according to their ability. This means adequate staff education, careful selection of nurses for the various types of duty according to aptitude, and encouragement of development, together with a happy atmosphere of pooled experience of the whole registered nursing staff. Some hospitals have made use of the married registered nurse, who may be only able to work a few hours of the day, by paying her on an hourly rate, and have found this worker of great assistance over busy periods of the day for routine nursing duties. This system might be much more widely used than it is. Student Nurses.—All employing authorities have now realized that the reservoir of potential young woman-power is limited owing to the drop in birth-rate between 1926-33, therefore every effort needs to be made to recruit carefully and make the conditions for student nurses those which are really for students and not just employees. At the recent Hospital Boards' Conference it was decided to set up a Joint Recruiting Board of the Hospital Boards and the Department, to which the Boards would subscribe as well as the Government, to carry out a more extensive recruiting scheme and to prevent if possible, some of the overlapping which had taken place when the Boards were carrying out extensive individual schemes.

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— 1941. 1942. 1943. 1944. 1945. 1946. 1947. Number of occupied beds 6,040-0 6,285-7 6,808-5 7,603-2 8,493 8,550-05 7,812-1 in training schools Number of registered 922 984 1,172 1,366 1,500 1,347 1,199 nurses Number of pupil-nurses .. 1,575 2,798 2,974 3,124 3,390 3,280 3,203

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A Joint Committee of the Education Department, Secondary School Inspectors, and nursing officers of the Department has been outlining a curriculum which might be taken at secondary schools subsequent to the general School Certificate for those girls who are too young to enter for training and yet who are interested in nursing as a career. It is hoped to have this curriculum ready by the end of this year and to use it to recruit girls with the right educational background. All our hospitals provide class-rooms and instructions, but if a hospital is to be a school as well as a hospital it must provide the real educational background of general interest by all members of the staff, and conditions of work must be such that the student can really study not only the theoretical course outlined for her, but the rich clinical field in which she is working. There is no doubt that where a Hospital Board has an adequate staff and can provide a block or study-day system of teaching the results are far reaching, and in the end, because of the conditions attracting girls, the hospital is able to give a better service to its patients. Domestic Staff. —In spite of the fact that a new award with an increase in wages and a universal forty-hour week has come into being, there is still a marked shortage of workers in some hospitals. Housing is a definite difficulty. The majority of hospitals depended on obtaining domestic staff who lived out, but now this is impossible, and it would appear that those Boards who can house this staff are in a position of advantage. If only it were possible to obtain more workers with a little instruction they might be given a wider range of duties, which, in turn, might make their work more attractive and would certainly assist the nursing staff to a much greater degree. There is no reason why they should not be taught to assist convalescent patients, feed helpless patients, and many other simple nursing duties. Obstetrical Nursing Service As already stated, this year has been marked by a very large increase in New Zealand's birth-rate, 47,647 births, of which an additional 4,618 took place in the maternity hospitals which are training-schools. This was largely because many of the private maternity hospitals closed owing to the age and infirmity of the licensees, difficulties over staff, and rising costs. This meant that the beds and the staffs in the training-schools had to be increased. To assist with the recruitment of registered maternity nurses and midwives, in addition to appeals in the nursing journal and through broadcasts, a personal circular letter was sent to every registered maternity nurse and midwife. A survey of the position was made for every hospital in the Dominion every quarter to see which district and hospital required help most urgently, and, in addition to every pupil midwife completing her training being interviewed as regards her future, which has been done for some time, every pupil maternity nurse has been interviewed as well. These personal interviews have been carried out by the nursing officers of Head Office, together with the Nurse Inspectors of the District Offices. The result has been that for 759 beds with an occupied bed rate of 614 and a total of 15,226 confinements there has been a staff of 139 midwives and 92 maternity nurses —that is, 231 registered obstetric nurses and 437 midwifery and maternity trainees —which is equal to a staff of 668, or more than 1 nurse to 1 patient, or 1 registered obstetric nurse to 1 nurse to 3 patients, or 1 registered obstretric nurse to 2 trainees. This result can be regarded as very satisfactory under the circumstances.

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At times it has been said that the St. Helens Hospitals might have carried more of this increase, but the annual returns show: — 1947 St. Helens Hospital, Auckland .. .. 646 1,026 St. Helens Hospital, Wellington .. .. 549 706 St. Helens Hospital, Christchurch .. .. 313 409 St. Helens Hospital, Invercargill .. .. 204 330 The number of midwives was increased by affiliating Alexandra Home to St. Helens Hospital, Wellington, half-way through the year, and this is being extended.

Public Health Nursing With the introduction of a visiting-nurse benefit through the Hospital Board system there has been a very rapid expansion of the Hospital Board district nursing scheme. Originally it was estimated that 1 nurse would be required for 4,000 of population, but it would appear as though 1 nurse to 6,000 will be sufficient, although the demands vary according to the conditions. For instance, in two adjacent districts where the type of hospital case varies because of scarcity of chronic beds the demand is just double ; also, a small country town of 7,000 people which has an adequate hospital has found it can hardly keep a District Nurse employed. This is largely because there are so few people in homes who can care for a bed-ridden patient between the visits of a nurse. Now that the number of doctors has increased in the community it is most important that nurses should only pay an initial visit without the patient seeing a doctor and that every patient should be under medical care where at all possible. The following is a summary of work of 80 Hospital Board District Nurses for the period Ist January, 1947, to 31st March, 1947 : Number of nurses (including 1 part-time only) .. .. 80 Total new cases referred from — Hospitals .. .. .. .. .. 591 Private practitioners .. .. .. .. 1,325 Patients own home .. .. .. .. 3,488 Total number of cases seen at — Nurses' centres .. .. ... .. .. 2,365 Patients own home .. .. .. .. 9,615 Total number of visits at — Nurses' centres .. .. .. .. .. 2,376 Patients own homes .. .. .. .. 33,208

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— 1941. 1942. 1943. 1944. 1945. 1946. Number of nurses qualifying as maternity 228 261 293 316 335 410 nurses Number of eighteen months' trainees 53 76 59 61 62 56 qualifying as maternity nurses Number of midwives qualifying 57 66 51 55 61 76

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In the case of the Department's staff there has been a minor expansion only, as it was considered advisable, while there was such a shortage of nurses, to delay expansion of services. The district staffs, particularly the Nurse Inspectors, have worked under great disadvantages in many instances owing to scarcity of Medical Officers of Health, and it has meant a great deal of thought and effort to maintain and carry on the work, particularly in rural areas. The expanding diphtheria immunization campaign, the expansion of the school health service, and the increased emphasis on Maori infant welfare and tuberculosis control all required well-prepared nurses to carry out their programme. The better results are an encouragement to further effort. The following table shows a year's work for 18 Nurse Inspectors and 174 District Health Nurses (of whom 19 have been on leave for special courses) : School work— Mapri. European. Hours spent in school work .. .. .. 5,767 35,132 Number of schools visited with S.M.O. .. .. 57 2,113 Number of schools visited alone .. .. 3,785 13,169 Number of visits to homes of school-children .. 29,442 23,432 Number of visits to homes of pre-school children .. 30,970 8,749 Tuberculosis control— Number of visits to homes .. .. .. 17,361 17,581 Number of cases seen at home .. .. 12,332 9,444 Number of contacts seen— Adult .. .. .. .. .. 16,491 12,801 Children.. .. .. .. .. 25,991 9,825 Maternal and infant welfare— Ante-natal cases seen .. .. .. .. 9,803 1,971 Confinements attended .. .. .. 165 42 Number of visits during puerperium .. .. 1,950 202 Infants seen at home or clinic.. .. .. 40,917 8,191 Attendances and treatments — Number attended at cottage or office ... 19,608 15,955 Number in own home .. .. .. 48,721 20,179 Total number of homes visited for any purpose .. 133,063 65,560 Number of inoculations .. .. .. 18,858 28,121 Social-welfare cases .. .. .. .. 2,398 715 Pas or settlements visited .. .. .. 19,492 3,933 Lectures given— To school children .. .. .. ~ 2,089 6,206 To other groups .. .. .. .. 520 351 Complete immunizations (six-monthly period, April to September, 1946) : Diphtheria .. .. .. .. .. 24,235 Whooping-cough .. .. .. .. 789 Typhoid .. .. .. .. .. 6,363

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The staff-education programme as outlined last year has been followed this year and many of the district meetings have been attended by Miss McNab or myself. By the use of nurses' own cases and problems in group discussion much useful information has been illustrated. Industrial Nursing Miss Ryan has now visited all factories where nurses are employed several times and also some where nurses could be employed. Group meetings have been held in all centres. For this coming year the first course in connection with the Post-graduate School will be held, and 4 students are enrolled. In addition, a correspondence course, which will be conducted with the assistance of the Correspondence School, is to be held for those nurses who are already in positions and who have had no previous training. Conferences The Department has had a great deal of assistance from the voluntary organizations — the New Zealand Red Cross Society and the Order of St. John are continuing to train voluntary aids and to assist hospitals in this manner; the Registered Nurses' Association has worked most closely with the Nursing Division throughout the year in several pieces of research, one of which was carried out by means of a questionnaire concerning the wastage of pupil-nurses. Post-graduate School The Post-graduate School has had an exceedingly busy year, with a record number of students, 50. In addition, refresher courses, each of a week's duration, have been held for theatre and tutor sisters and two groups of nurses have been taken for the Introductory Course. Additional class-room accommodation is urgently required. This could be done by taking away the residential rooms, although it has been useful to have these, in view of the shortage of accommodation in Wellington. Staff The Department's institutions, like others, have had a most trying time with staff changes, particularly at Queen Mary Hospital, Hanmer Springs, which, being a country hospital a long distance from a town, finds it particularly difficult to maintain staff. All of the staffs of these hospitals have given excellent and devoted service in order to maintain their hospitals' standard of service. To the other executive officers of the Department and to the nursing staff of the Department as a whole, as well as the Hospital Boards and their staffs and the Hospital Boards' Association, the Director is extremely grateful for continued co-operation and assistance, and, in particular, mentions the clerical staff of her own Division, who have carried out a great deal of additional work involving overtime.

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DIVISION OF MEDICAL BENEFITS This section of the report mainly concerns itself with an account of the expenditure involved in administering the health-benefits section of the Social Security Act. Some remarks are, however, necessary regarding the functional side of medical care in New Zealand. A perusal of the statement regarding the various benefits to follow will demonstrate that the people of New Zealand have benefited considerably since the introduction of the various benefits. It is true that under the present system there is an ill-balanced distribution of medical practitioners and that the services provided in many cases may be difficult to obtain and sometimes of indifferent quality because of excessive demands on practitioners. Nevertheless, a great majority of the population are receiving services which they were unable to afford in the past. There is still, however, much to be accomplished. A better distribution of practitioners is necessary. The present shortage of specialists should be overcome and specialist services of all kinds be readily available wherever required at the cost of Social Security Funds. The merging of curative and preventive medicine, now known as social medicine, should be achieved, and health centres which are necessary for this type of service should also be provided. From the functional side there is therefore much to be achieved in improving and extending the various types of medical care that are necessary for New Zealand. Regarding the cost of benefits, the total expenditure for the past year, as well as that for each section, with its equivalent percentage of the whole, is tabulated below : Amount. Percentage. £ (1) Maternity benefits .. .. .. 672,989 10*8 (2) Medical benefits .. .. .. 1,760,574 28-3-(3) Hospital benefits .. .. 1,986,288 32 • 0 (4) Pharmaceutical benefits .. .. 1,439,686 23 • 2 (5) Supplementary benefits .. .. 352,043 5• 7 £6,211,580 (1) Maternity Benefits This section accounts for 10-8 per cent, of the total expenditure. The expenditure under this section has increased by £72,780 since the last report. As this increase is undoubtedly due to an increase in the birth-rate, it is the most comforting feature of this report. It is to be noted that the increases Apply to attendance in public hospital maternity annexes and to the professional services of medical practitioners only. The present difficulties of private maternity hospitals is reflected in a reduction of expenditure in this section, due, no doubt, to the reduced number of beds available in such institutions. (2) Medical Benefits This section accounts for 28-3 per cent, of the total expenditure. Apart from payments to medical practition'ers for professional services to maternity patients, this section represents all the remaining expenditure involved in payments to general medical practitioners. Capitation.—The expenditure under this subsection has again decreased. This is not due to any inherent defect in the capitation system, because, for obvious financial reasons, a capitation system cannot survive in contact with the alternative fee-for-service system.

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General Medical Services. —The increased expenditure under this subsection was £309,153, which, is an increase of 23-9 per cent, for the year. During the same period the number of medical practitioners claiming on the Social Security Fund increased from 965 to 1,121 —e.g., 156—a 16-per-cent. increase. The shortage of medical men is therefore to some extent being overtaken, but not yet at the rate necessary to meet current demands for medical services. The approaching restoration to normal standards of medical personnel affords an opportunity for the examination in more correct perspective of the merits and demerits of the general medical services system. It is accordingly hoped that some of the shortcomings arising out of the serious doctor shortage during the war will of themselves disappear with the return of practically all medical men to civil practice. It cannot be gainsaid, however, that the conditions prevailing over recent years have in some cases brought about a serious lowering of the quantum and quality of medical services. Every attempt should be made to rectify this position as early as possible, and to this end it is proposed to arrange a conference with representatives of the British Medical Association shortly, and that one of the subjects of discussion will be the present fee for service system. Special Arrangements.—The expenditure under this subsection has increased slightly, but this is due to an increase in the number of such districts. The service provided in these areas has again been very satisfactory. (3) Hospital Benefits This section accounts for 32 per cent, of the total expenditure. This section alone shows a diminution in expenditure in comparison with last year. This is probably due to the shortage of beds in most public hospitals. It is to be particularly noted that there is not a compensatory increase in out-patient expenditure and that there is a slight decrease in expenditure for private hospitals. The expenditure under this section is not the full cost of public-hospital expenditure —to it has to be added the subsidy from the Consolidated Fund plus the ratepayers' contribution. (4) Pharmaceutical Benefits This section accounts for 23-2 per cent, of the total expenditure. The expenditure for the year amounted to £1,439,686 in a population of 1,705,550—e.g., a rate of 16s. lid. per head of the population. Since the inception of this benefit the number of prescriptions supplied each year have been as follows : Financial year ending 31st March — ' Number. 1942 (11 months only) .. .. .. .. 2,170,000 1943 .. .... .. .. .. 3,500,000* 1944 .. .. .. .. .. .. 4,250,000 1945 .. .. .. .. .. .. 4,900,000 1946 .. .. .. .... .. 5,400,000 1947 .. .. .. .. .. .. -5,882,000f * Average cost per prescription, 3s. 3d. j Average cost per prescription, 4s. 8 Jkl. The year-by-year increase in expenditure is therefore due to an increased number of prescriptions, as well as to a general increase in the average cost of each prescription. It is to be noted in connection with these rising costs that many expensive new drugs have been introduced during recent years, and that in the absence of health-benefits legislation the majority of them would not have been available to most patients on account of their cost.

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(5) Supplementary Benefits This section accounts for 5*6 per cent, of the total expenditure. At the moment the proportional cost of this subsection is low, but with the further development of those services already in operation and the introduction of additional benefits it is to be expected that the costs of this subsection will rise considerably. Table The following table shows expenditure since commencement of the benefit.

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Table I.—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. 1946-47. Subdivision 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 Sche: 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 I : Matern £ 74,780 139,602 45,938 1,031 16,022 6,440 ity Benefits £ 106,834 216,086 161,638 5,663 21,101 7,653 (commence £ 113,276 227,315 176,973 6,215 18,940 7,151 d 15th Maj £ 110,217 207,575 158,208 5,089 15,089 9,046 % 1939) £ 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. £ 223,914 202,928 232,088 4,825 9,234 283,813 518,975 549,870 505,224 513,939 530,734 600,209 672,989 me introduc ed, 1st Marc] fi, .1941 ; G' 114,608 21,166 69,898 eneral Medic 71,149 64,039 831,397 49,468 )al Services i 55,610 60,392 1,026,073 37,256 Scheme intr 42,400 59,442 1,161,326 23,855 oduced 1st Nove 38,084 68,965 1,291,448 27,495 1,317 mber, 1941) 31,187 90,289 1,600,601 35,428 2,673 396 205,672 1,016,053 1,179,331 1,287,023 1,427,309 1,760,574

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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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* £lO,OOO estimated for year ended 31st March, 1947, but not expended. t These are mainly iff respect of hospital benefits. { 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 Security Fund. This should be taken Into account when comparing published figures relating- to Social Security Fund expenditure.

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Treatment in.public hospitals .. .. .. 514,254 893,251 953,794 1,020,319 1,564,315 1,689,233 1,767,874 1,593,367 Out-patient treatment .. .. .. .. .. .. 47,162 70,720 73,137 83,412 98,972 97,287 Treatment in private hospitals .. .. .. 82,980 141,737 146,953 191,647 238,772 259,489 264,865 251,581 Treatment in approved institutions .. .. 1,459 37,873 28,155 38,819 43,908 56,504 41,749 44,053 Contribution to Consolidated Fund for — Mental Hospitals .. .. .. .. 166,000 171,000 181,451 181,869 182,830 187,942 Queen Mary Hospital .. .. ... 6,835 10,060 11,705 22,872 28,691 28,032 I oontrioution Rotorua Sanatorium .. .. .. .. 2,707 4,712 4,985 4,563 5,932 6,425 j , Rotorua Soldiers' Hospital .. .. .. . .. .. .. 10,150 20,561 19,663 J aDollsnea - 774,235 1,258,633 1,374,205 1,540,959 2,158,146 2,330,700 2,173,460 1,986,288 Subdivision IV : Pharmaceutical Benefits (commenced 5th May, 1941), (11 months) Drugs supplied by— Chemists .. .. .. .. .. .. .. 261,845 530,695 716,080 933,490 1,082,342 1,389,638 Medical practitioners .. .. .. .. 1,527 5,891 6,092 6,231 6,030 5,879 Institutions.. .. .. .. .. .. .. 16,326 26,661 40,026 40,516 44,994 44,169 279,968 563,247 762,198 980,237 1,133,366 1,439,686 Subdivision V : Supplementary Benefits Radiological services (commenced 11th August, 1941) .. .. 27,962 88,588 109,426 128,842 132,806 175,420 Laboratory services (commenced 1st April, 1946) .. .. .. .. .. . . . . .. 61,453 Massage services (commenced 1st September, 1942).. .. .. .. 8,836 27,331 32,152 35,569 43,028 Specialist services (neuro surgery) .. .. .. .. .. .. 1,066 1,324 2,260 1,485 District nursing services (commenced 1st September, .. .. .. .. .. 7,717 58,880 68,614 1944) Dental services Domestic assistance (commenced 20th December, 1944) .. .. .. .. .. .. 456 2,043 Ambulance benefits* .. .. • • • • • • •. •. • • • • •. Artificial-aids benefits* .. .. .. .. .. .. .. .. .. .. .. 27,962 97,424 137,823 170,035 229,971 352,043 Grand totals .. .. .. 1,058,048 1,777,608 2,437,407 3,722,907 4,751,437 5,298,729 5,564,315 6,211,580 Recoveries! .. .. 1: 1,350 923 1,819 1,728 24,757 64,015 27,751$ 20,384 'Net totals .. •• .. 1,056,698 1,776,685 2,435,588 3,721,179 4,726,680 5,234,714 5,536,564 6,191,196

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DIVISION OF TUBERCULOSIS The general activities of the year have been mainly concerned with improving the accuracy of the district registers notified cases. Planning of hospital and sanatorium accommodation have occupied much time, and a chest-surgery policy for New Zealand hospitals has been defined. The Director visited the South Pacific in September, and in special reports has advised the Government of Fiji and the Island Territories Department on tuberculosis control in their respective areas of administration. The returns for the year 1946 as obtained from the notifications by general practitioners, hospital clinics, and the Department's case-finding scheme disclose the known position as at 31st December, 1946, as under : Stated Morbidity of Tuberculosis, Maori and European, in New Zealand, as.at 31st December, 1946, compared with the years 1944 and 1945 :

The increase in morbidity during the last three years is more likely to be due to intensified case-finding and better notification than to a marked increase in prevalence. New cases (actual or suspected) notified during 1946 numbered 2,320, as compared with 2,572 in 1945 and 2,254 in 1944. Of the 2,320 notified cases, pulmonary cases numbered 1,973, (1,530 Europeans, 443 Maoris) and non-pulmonary 347 (Europeans, 290, Maoris, 57). The known incidence rates for all forms of tuberculosis are : European, 4-32 per 1,000 ; Maoris, 24-56 per 1,000 ; and combined cases, 5-48. Of the 9,617 cases on the register at 31st December, 1946, 3,304 were returned as being in the " active " state, " infectious," or " potentially infectious." The 1946 mortality returns for tuberculosis, as supplied by the Government Statistician, are scheduled as follows

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Pulmonary. Non-pulmonary. Total, 1946, all Forms. 1944. 1945. 1946. . 1944. 1945. 1946. North Island South Island .. .. 5,038 1,722 6,116 2,055 6,234 2,315 507 259 546 360 653 415 6,887 2,730 Totals for New Zealand 6,760 8,171 8,549 766 906 1,068 9,617* * Total Maori morbidity for 1946 in the above total = 2,485.

M —- ■ Pulmonary Forms. Other Forms. Total Deaths, 1945. European. Maori. Totals, Pulmonary. European. Maori. Totals, other Forms. M. F. M. F. M. F. M. F. E.. M. North Island South.Island .. Total, New Zealand 159 97 128 75 124 4 160 4 571 180 33 25 29 15 51 49 3 162 43 376 225 358 15 256 203 128 164 751 58 44 51 52 205 601 373

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Deaths from tuberculosis, pulmonary forms : 1944. 1945. 1946. Europeans .. .. .. .. 485 496 459 Maoris .. .. .. .. ..285 292 292 770 788 751 Deaths from tuberculosis, non-pulmonary : Europeans .. .. .. .. 106 105 102 Maoris .. .. .. .. 87 81 103 193 186 205 Death-rates, all Forms

District Nursing Staff Altogether, 7,874 outpatients are now being supervised by 217 District Nurses employed either by the Department or by Hospital Boards. These nurses have also been responsible for finding 323 new cases of tuberculosis during the year. Tuberculosis Research Improved methods of control, diagnosis, and treatment as reported from overseas have been closely followed. During the course of a short visit overseas in June, the Director hopes to investigate the B.C.G. vaccine immunization now being used in Canada and Scandinavia. Reports of results achieved with this vaccine suggest that this form of immunization could now be introduced into New Zealand. Dr. W. Gilmour, research worker at Auckland for the Tuberculosis Committee of the Medical Research Council, has submitted a summary of his work with the bovine type of infection in human beings for the period 1942 to 1947. From specimens derived from 165 non-pulmonary tuberculosis lesions he has discovered 13-3 per cent, which were caused by the bovine type of infection. Specimens from 294 pulmonary lesions yielded only 1 that was caused by this type. This form of research is being pursued in other parts of New Zealand, and all results so far received support the impression that tuberculosis infection from cattle has been responsible for only a very small number of the cases now registered. The chief cause of tuberculosis in this country undoubtedly is the human type of infection. The urgent need to provide adequate and suitable hospital accommodation, together with suitable homes, for the tuberculous is necessary not only in the interests of individual patients themselves, but also in the interest of improving the general health of the country. Tuberculosis to-day is— » (1) The fifth highest cause of death in New Zealand. (2) The highest single cause of death in females in the age group 20-30 years, both for Maoris and Europeans. (3) The highest single cause of death amongst the Maori people. One-fifth to one-sixth of the total hospital population in New Zealand is suffering from tuberculous disease. Over one-third of the registered cases are known to be in an active infectious or potentially infectious state, and Institutional accommodation is available for only one half of these.

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Total Deatlis, 1946. Crude Death-rates per 10,000. V 1944. 1945. 1946. European^ 561 3-81 3-78 3-39 Maoris 39£ 37-40 37-02 39-04 Both races 956 5-96 5-77 5-43

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DIVISION OF MATERNAL WELFARE Births The increased number of births during 1946 imposed a considerable strain upon maternity services. Accommodation As materials and labour for building purposes were scarce, administrators and licensees in most cases had to make the best of existing accommodation, so that facilities did not always reach the standard laid down for maternity cases. After internal discussions, the Department temporarily* waived the full-scale standards where necessary to ensure that this essential service be maintained. Nevertheless, thanks to a high standard of medical and nursing cafe, the maternal-mortality rate of 2-05 per 1,000 live births was the lowest ever recorded in New Zealand. The still-birth rate of 21*75 was also the lowest on record, and the neo-natal deaths compare favourably with previous years. During 1946-47, Auckland, Wellington, and Christchurch Hospital Boards' opened maternity wards for normal cases wherein patients were allowed own-doctor attendance. Other Hospital Boards in some cases provided overflow accommodation within the general hospital. The Department recognizes the necessity for this temporary overflow accommodation, but realizes that safer facilities for confinement cases must be provided. At this date it is estimated that 400 to 500 new beds are required to provide an adequate maternity service throughout the Dominion. Some of these beds would be in replacement of sub-standard accommodation. Staffing The 'Department thanks the many retired midwives and married nurses who relieved during 1946, also Plunket nurses who gave up week-ends to relieve charge sisters. In October, 1946, the Director of Maternal Welfare and the Matron of St. Helens, Wellington, represented the Department on a committee of inquiry into short-term and long-term remedies for staffing of obstetrical hospitals. Field Survey The Directorship of. Maternal Welfare was vacant for two years. During 1946 the present Director travelled over the greater part of New Zealand in order to assess maternity hospital needs. Post-graduate Centre During 1946, negotiations were furthered between the University of New Zealand (and its Auckland University College), the Auckland Hospital Board, and the Department of Health for the founding of a post-graduate obstetrical and gynaecological teaching centre in Auckland. It is envisaged that this centre will have far-reaching effects upon medical, nursing, and research obstetrical interests throughout the Dominion

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Table No. I.—Number of Births P.A., Birth-rates, Neo-natal Death, Still-birth, and Maternal Death-rates

Table II. —Puerperal Mortality, 1946 (European), showing Number of Deaths and their Proportion to Live Births

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(Average rates for each quinquennial period from 1926 to 1945 and rates for 1946) *1926-30. 1931-35. ,1936-40. 1941-45. 1946. Number of live births per annum E. 27,420 24,825 27,941 33,918 41,871 M. 1,843 2,847 3,935 4,411 5,776 Live-birth rate E. 19-76 16-98 18-36 . 21-81 25-24 M. 28-40 38-06 45-17 45-56 56-49 Total .. .. 20-13 . 18-00 19-81 23-20 27-05 Still-birth rate per 1,000 total births .. E. 30-68' 28-95 28-49 25-02 2,1-75 Neo-natal death-rate per 1,000 live births E. 24-82 22-34 22-51 20-04 * M. * 20-58 26-07 22-08 * Total * 22-16 22-93 20-25 * Still-birth rate and neo-natal death-rate comE. 54-72 50-64 50-36 44-56 * bined, per 1,000 total births .Maternal-mortality rate (including septic aborE. 4-80 4-47 3-59 2-61 2-05 tion) per 1,000 live births M. * 7-16 5-44 3-18 3-81 Total * 4-75 3-80 2-68 2-27 | Maternal-mortality rate (excluding septic aborE. 4-14 3-29 2-87 2-04 1-76 tion) per 1,000 live births M. * 6-60 4-93 2-73 3-64 Maternal death-rate from septic abortion per E. 0-66 1-18 0-72 0-57 0-29 l',000 live births M. * 0-56 0-51 0-45 0-17 E. = European ; M. = Maori. * Not available.

— Number of Deaths. Death-rate per 1,000 Live Births. Puerperal sepsis following childbirth Accidents of labour— Placenta praevia . Post-partum haemorrhage Puerperal embolism and thrombosis without puerperal sepsis Other— Obstetric shock and heart failure Ruptured uterus > Toxaemia of pregnancy— Eclampsia Puerperal toxaemia (pre-eclamptic) i.. Acute yellow atrophy of liver Accidents of pregnancy— Abortion (non-septic) Ectopic gestation .. .. .. ... Ante-partum haemorrhage, without delivery Puerperal psychosis Total maternal deaths (excluding septic- abortion) Septic abortion — Married Single women ... 5 5" 6 13 >33 4 5 16 y28 4J 51 1 7 1J • 1 0-12 0-79 0-67 0-17 0-02 74 1-76 12 5 J 12 0-29

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Table III. —Maternity Hospital Statistics, 1935, 1939, 1943-46

Cesarean Section The steady increase in the percentage of deliveries by Csesarean Section is indicated by the following figures : Percentage of Csesarean Sections to Total Deliveries. 1940 .. ... .. .. .. .. 0-71 1942 .. .. .. .. .. .. 0-77 1944 .. .. .. .. .. .. 0-84 1945 .. .. .. .. .. .. 0-93 1946 .. .. .. .. .. ..1-15 DIVISION OF DENTAL HYGIENE The year ended 31st March, 1947, has been notable for the introduction as from the Ist February, 1947, of the dental service for adolescents. This represented the culmination of a long period of planning and negotiation with the dental profession. It is gratifying tp be able to record that this new service has been launched with the complete approval and full co-operation of the profession as represented by the New Zealand Dental Association. Following is a detailed review of the • activities of the Dental Division during the year.

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1935. 1939. 1943. 1944. 1945. 1946. Number of hospital^ 274 272 297 •287 275 26a Number of beds * 1,680 2,108 2,078 2,066 2,249 Admissions for ante-natal treatment * 1,299 2,403 2,448 2,741 2,930 Admissions for delivery- * 27,083 32,287 34,621 38,360 42,641 Confined at full term 18,175 25,521 30,549 32,629 36,405 40,416 Confined 7-9 months 859 1,285 1,696 1,881 1,955 2,005 Per 1,000 confinements 45-1 47-9 52-6 54-5 51-0 47-a Total confined 19,034 26,806 32,231 34,533 38,360 42,421 Per bed * 16-0 15-3 16-6 18-6 18-9 Abortions 118 165 196 243 194 165 Per 1,000 confinements 6-2 6-2 6-1 7-0 5-1 3-9 Instrumental deliveries.. 1,690 2,672 3,149 3,248 3,634 4,602 Per 1,000 confinements 88-8 99-7 97-7 94-1 94-7 108-5 Manual removal of placenta 166 187 185 217 243 279 Per 1,000 confinements 8-7 7-0 5-7 6-3 6-3 6-6 Haemorrhage : Accidental 66 91 113 108 167 153 Per 1,000 confinements 3-5 3-4 3-5 3-1 4-4 3-6 Haemorrhage : Placenta previa 93 113 166 172 194 ,216 Per 1,000 confinements 4-9 4-2 5-2 5-0 5-1 5-1 Haemorrhage : Post-partum 256 330 431 463 436 539 Per 1,000 confinements 13-4 12-3 13-4 13-4 11-4 12-7 Eclampsia 77 81 84 78 86 92Per 1,000 confinements 4-0 3-0 2-6 2-3 2-2 2-2 Infant deaths 303 414 462 491 487 53a Per 1,000 confinements 15-9 • 15-4 14-3 14-2 12-7 12-6 Still-births 545 749 746 709 801 824 Per 1,000 confinements 28-6 28-0 23-1 20-5 20-9 19-4 * Not available..

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Adolescent Dental Service The second or adolescent phase of the National Dental Service was inaugurated on the Ist February, 1947. The policy that was adopted, after consultation with the New Zealand Dental Association, provides for the development ultimately of a Statesalaried service to deal with the adolescent group, with, in the meantime, a privatepractitioner service under which enrolled patients receive treatment as a dental benefit under the Social Security Act. The scope of the service, eligibility for enrolment, the responsibilities undertaken by contracting dentists and by enrolled patients, and administrative details are set out in the Social Security (Dental Benefit) Regulations 1946. Fundamental features are : (i) previous regular dental care, or, failing this, a high standard of dental health at the time of application, is a necessary qualification for enrolment; (ii) the system is designed to ensure preservation of the natural teeth in a sound and healthy condition. Extraction of teeth is not included in the normal schedule of treatment, and must be specifically approved; (iii) contracting dentists undertake to provide examination and necessary treatment at six-monthly intervals at fees specified in the regulations ; (iv) it is planned to continue this system until patients attain their nineteenth birthday, but in this first year of operation only those under sixteen years of age are eligible for enrolment; (v) there is free choice of dentist. In effect, the inauguration of this service marks a further step in the development of the system of controlling dental disease by means of regular examination and treatment at half-yearly intervals from pre-school age to the age of nineteen years. The invitation to dental practitioners to undertake service under the scheme met with an immediate response, and by the 31st March, 1947, two months after the inauguration of the system, approximately 70 per cent, of the private practitioners had offered to accept patients, and offers were still being received. It had been a matter for speculation as to what extent the public would wish to avail themselves of the purely conservative dental care offered, but the thousands of applications for enrolment that poured into the District Offices as soon as the inauguration of the service was announced made it clear that full advantage would be taken of the facilities that were being provided. By the 31st March some 18,000 applications had been received and were being examined to determine the eligibility of the applicants for enrolment. School Dental Service The number of centres at which the School Dental Service operates shows a further increase to 456 treatment centres, as against 447 at the end of the previous year. At the 31st March, 1947, the staff numbered 679, including 206 student dental nurses in training. The shortage of school dental nurses in field clinics, a legacy of the war years, continues to be a major problem, and is likely to remain so until the greater numbers now being trained become effective in the field. So far the half-yearly output from the Training School has been sufficient to make good current wastage, but the position will not be satisfactory until there is sufficient staff to overtake the accumulated arrears of treatment and resume normal expansion. The number of children under regular treatment is 226,798, an increase of 15,878 during the year. The number of schools receiving treatment is 2,313, as compared with 2,348 at the end of the previous year. The reduction is due to the consolidation of schools in various areas. The total number of operations for the year was 1,578,605. This included 906,553 reparative fillings in both permanent and deciduous teeth and 173,447 preventive fillings, a total of 1,080,000 fillings. In contrast with this figure, which represents

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approximately the number of teeth preserved for useful service, the number of teeth removed as unsaveable (or in some cases to relieve over-crowding) was 68,663, a ratio of 6-3 extractions to every 100 fillings. Health Education A very gratifying amount of dental health education work has been performed by school dental nurses, the total number of activities amounting to 7,593. A specialist officer from the divisional staff has made a start on an intensive programme entailing the visiting of every school dental clinic and providing direction to the school dental nurses' efforts. The production of still further new film-strips, posters, and pamphlets has been undertaken, and the field staff make good use of the material that is available, including sound films and a wide variety of display material. Radio talks on dental subjects, integrated with "talks on other aspects of health, have continued to be a feature of the educational work. Dental Research During the year arrangements have been put in hand for the resumption of research work under the Dental Research Committee of the Medical Research Council. This work was commenced in 1939, but was interrupted by the war. The plans have been revised, and the work will now be undertaken on a wider and more scale. Of special significance in this connection is the appointment of Dr. R. E. T. Hewat, D.D.S. (N.Z.), as Field Research Officer attached to the Division of Dental Hygiene. It is expected that Dr. Hewat will take up his new duties in June, 1947. Dental Bursaries Health Department bursaries to the number of 23 were granted to dental -students at the beginning of 1947. Of the bursaries granted in previous years, 65 were renewed and 5 were suspended temporarily. The total number of bursaries held as at the 31st March, 1947 (including those temporarily suspended), was 93. Of 4 holders of bursaries who graduated in 1946, 2 are now on the staff of the Dental Division and 1 was granted permission to accept a Demonstratorship at .the Otago University Dental School for one year. The fourth failed to undertake the service prescribed in the bursary agreement, and the penalties provided for in the agreement were duly imposed in this » Shortage of Staff The work of the Dental Division has suffered during the year from shortage of staff at all levels. Numerically the staff has remained almost static during recent years. Any slight upward trend in numbers has been negligible as compared with the rapidly expanding school rolls. As a result, not only has extension of dental services in the schools been restricted, but there has been increasing difficulty in maintaining existing commitments. An interesting point arises in this connection, in that it has become evident that the public have developed a very keen appreciation of the value of regular halfyearly dental care for children, and become concerned when the interval between inspections extends beyond the customary six months. This is most gratifying as evidence of an awakened interest in the importance of good dental health, even if it tends to be embarrassing under present conditions. The outlook, however, is bright as far as the staffing of school dental clinics is concerned. The Dominion Training School for Dental Nurses and its annexe are full to capacity, and when once the field staff is adequately •reinforced it will be possible to commence on the task of overtaking the accumulated arrears of treatment.

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The prospects in regard to dental surgeons are less- promising.i The general shortage of dental surgeons in the Dominion is reflected in the service, and it is found to be increasingly difficult to secure or even to retain the services of such officers. The depletion of staff at this level is causing concern, and there is need for the strengthening of the senior ranks by the appointment of dental surgeons of senior standing and suitable qualifications and experience. Dental Treatment of Returned Servicemen With the return to New Zealand of the Forces overseas, the volume of work in ■connection with the Department's organization for providing dental treatment for returned personnel of the Armed Forces has steadily declined during the year. By the ■end of the year under review it was found possible for the duties of the dental supervisors (private dental practitioners who organized the examination and treatment of returning drafts) to be transferred to departmental officers, and it was arranged that this would be done as from the 15th April, 1947. The purpose of the system was to ensure that Service personnel were returned to •civilian life with a standard of dental fitness not lower than when they enlisted. On .arrival in New Zealand all personnel were dentally examined as part of their medical bearding, and the necessary treatment was authorized by the dental supervisor in accordance with the policy laid down. The authority for treatment was posted direct to the dentist nominated by the serviceman, and the dentist later submitted his claim to the Department in accordance with the approved scale of fees. The system worked smoothly and effectively, and its operation over the period of the war years was notable for the entire absence of any serious complaint. The Department takes this opportunity of acknowledging the work of the dental supervisors and of the private dental practitioners, by whose sustained efforts this service for returned personnel was made possible. ' GENERAL Industrial Hygiene In Dr. Davidson's report published in the 1944 annual report he suggested " that •consideration be given to the formation within the Department of Health of a Division of Industrial Hygiene to include the factory inspectorate, relieved of all other duties and to administer those parts of a new Factories Act and such other legislation as is concerned with*the health, welfare, and safety of the industrial worker." The principle of a Division of Industrial Hygiene is now accepted, and the Factories Act, 1946, section 78, gives to Medical Officers of Health or other authorized officers of the Department of Health the same powers and authorities as Inspectors of Factories under the provisions of the Act. The first medical appointment to the new Division was made during 1946, and the appointee, Dr. Garland, arrived in the Dominion to take up his duties in January, 1947. Nutrition Dr. Muriel Bell and the Nutrition Research Committee of the Medical Research Council continue to/give considerable attention to matters relating to the nutrition of our people. In May, 1946, the rate of flour extraction in New Zealand mills was raised to 80 per cent. This was done in response to the request of the Emergency Food Council to all countries that they should save wheat by this method during the world wheat shortage. In New Zealand the 80-per-cent. extraction meant an extra 7 tons of flour per 100 tons of wheat, and it was calculated that New Zealand would thus be able to

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lower her annual wheat importation by 500,000 bushels. The United States has adopted a compulsory 80-per-cent. extraction rate, while in Britain the very high rate of 90 per cent, is in force. Papers were prepared by Dr. Bell for the British Empire Scientific Conference, the International Assembly of Women, New York, and for the Royal Society's delegate to the meetings of the American Philosophical Society and the National Academy of Sciences in Washington. Information has been freely supplied to improve the standard of dietaries of boarding institutions, hospitals, and on the subject of school lunches. Articles have been contributed and addresses given for education of the public and special groups on the subject of nutrition. Milk-in-schools Scheme As a check on the extent to which the scheme has operated, a " census " was taken on 25th September, 1946. Of the 231,103 children in the various types of schools at which pasteurized milk was available on that date, 159,588, or 69 per cent, accepted the £ pint ration. Malted milk was available to 9,493 children, of whom 8,280 accepted the ration. Raw milk made into a cocoa drink was taken by 398 children in schools having, an attendance of 883 on that date. Apples-in-school Scheme Apples 'free of cost were supplied to pupils attending all types of schools for fourweeks during the apple season. A total of 45,260 cases of apples were supplied. Health Camps Health camps have continued to operate successfully, the majority being permanent camps open throughout the year. Although some 1,800 children were admitted during the period under review, all camps, have long waiting-lists of children who have been selected for admission by the school medical and nursing staff. Reports show that the majority of the children receiving health-camp treatment benefited to such a degree that they returned-to their homes fully restored to health. The health-stamp campaign was again very successful, and [sales, approximately £90,000, were £15,000 in excess of last year's record. Health Education The budget for health education provided for an expenditure of £26,000, on similarlines as given in previous reports. . Further sets of posters were designed and supplied to schools and organizations. There was experienced a strong and growing demand for health educational films, and a number of accessions were made to the film library to intensify the campaign against diphtheria, tuberculosis, venereal diseases, dental caries,, and in the interest of good nutrition, child welfare, and industrial and public hygiene. , The health advertisements, which have been favourably commented upon by overseas, authorities, appeared regularly in newspapers and journals. District, institutional, and Head Office libraries have been kept supplied with reference works, journals, and health educational material, including a special set of books for a correspondence course on industrial nursing which has been initiated. In collaboration with the New Zealand Trained Nurses' Association, literature and posters were issued for the nursing;

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recruitment campaign. In the forthcoming year new ground will be broken and new methods tried to reach the public. The mobile health exhibit will go on tour, and an itinerary has been arranged for this purpose. A campaign has been planned to renew the attack on the hydatid-disease menace. Industrial films for the training of nurses are being provided, and the production of our own films has been forecasted. 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. International Health Conference As delegates from the New Zealand Government, Dr. H. B. Turbott and I attended the International Health Conference, convened by the Economic and Social Council of the United Nations, and held in New York from 19th June to 22nd July, 1946. As a result of the deliberations of the Conference the following instruments were drawn up and separately signed : Constitution of the World Health Organization. Arrangement for the establishment of an Interim Commission of the World Health Organization. Protocol concerning the Office International d'Hygiene Publique. South Pacific Health Service An agreement for the establishment of a South Pacific Health Service was made between the Government of New Zealand (in respect of the New Zealand island territories, including Western Samoa), the Government of Fiji, and the Eastern Pacific High Commission. This agreement regularizes and extends an arrangement for co-operation in health matters which has for nearly twenty years existed in the island territories administered by the Government of Fiji, the Western Pacific High Command, and the Government of New Zealand. Medical Research Council Thyroid Research Committee.—Three papers published during year : —- (1) " Observations on the Acidophil Cell Changes in the Pituitary in Thyroxine Deficiency States —(1) : Acidophil Degranulation in relation to Goitrogenic Agents and Extrathyroidal Thyroxine Synthesis " (Purves and Griesbach). British Journal of Experimental Pathology, 1946, Vol. XXVII. (2) " Studies on Experimental Goitre —VII: Thyroid Carcinomata in Rats treated with Thiourea " (Purves and Griesbach). British Journal of Experimental Pathology, 1946, Vol. XXVII. (3). " The Effect of Thyroid Administration on the Thyrotropic Activity of the Rat Pituitary" (Purves and Griesbach). Endocrinology, Vol. 39, No. 4, October, 1946.

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Also a paper entitled •• Studies on Experimental Goitre —VIII: Thyroid Tumours in Rats treated with Thiourea " (Purves and Griesbach) accepted for publication in the British Journal of Experimental Pathology. A paper entitled " The Thyroid Gland and Recent Research " (Hercus) published in the N.Z. Medical Journal, August, 1946. Virus and Immunology.—" Reports on Research into Control of Air-borne Infection, Growth and Pathogenicity of Viruses,, Effect of Temperature on the Virus—Host Relation, Viable Virus Counts and Poliomyelitis " (Richardson). Papers:— (a) " The" Nature of Resistance to Poliomyelitis as evidenced by the Incidence of the Disease " (Richardson). (b) "A Simple Method of Preservation of Stock Cultures " (Kirschner). (c). " Isolation and Typing of Group-A Beta Hsemolytic Streptococci " (Kirschner). Neurophysiology and Neuropathology.—Publications : " Myelography in Lumbar Intervertebral Disk Lesions : A Correlation with Operative Findings " (Begg, Falconer, and McGeorge). British Journal of Surgery, October, 1946. " Sensory Disturbances occurring in Sciatica due to Intervertebral Disk Protrusions : Some Observations on the Fifth Lumbar and First Sacral Dermatomes " (Falconer, Glasgow, and Cole). Journal of Neurology, Neurosurgery, and Psychiatry (in press). " Acetyl Choline and Neuromuscular Transmission" (Fillenz and Hanafin). Journal of Neurophysiology, May, 1947.. " Acetycholine and Synaptic Transmission in the Spinal Cord " (Eccles). Journal of Neurophysiology, May, 1947. " Electrical Investigation of the Mono-synaptic Pathway through the Spinal Cord" (Brooks and Eccles). Journal of Neurophysiology July, 1947. "An Electrical Hypothesis of Central Inhibition " (Brooks and Eccles). Sent to Nature, 1947. Dental Research.—Reports submitted by Professor Walsh and Mr. J. LI. Saunders. Paper'given at the Science Congress in Wellington on 20th to 23rd May, 1947, on in the Attack on Dental Caries " (Walsh). Psychiatric Research. —Published during the year :- # (1) "A Report of Similar Mental Disorders occuring in Identical Twins " (Palmer). J. Ment. Sc., October, 1946, 92, 817. (2) "The Use of Curare with Convulsion Therapy" (Palmer). J. Ment. Sc., April, 1946, 92, 387. (3) " The Diagnostic Use of Ether in Neuro Psychiatry" (Palmer). Proc. R. Austr. Coll. Phys. (in press). Nutritions— < y (1) " Preliminary Note on Calcification in Rats treated with Thiourea " (Weeber). (2)." Preliminary Note on Fluorine Content of New Zealand Teeth " (Harrison). (3) "• Topical Application of Fluorine " (Harrison). (4) " Estimation of the Floufine Content of Urine " (Harrison).

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(5) " Study of tlie Excretion of Fluorine with and without Tea Ingestion" (Harrison). (6) " Summarized Report on Riboflavin and Thiamin Status of Pregnant Women " (Olemow and Macfarlane). (7) " Further Note on the Inferiority of Pea-meal as compared with Meat-meal in Stock Diets for Rats " (Connor and Weeber). (8) " Thiamin Excretion in Normal Subjects (Macfarlane). (9) " Assay of Riboflavin in Higher-extraction Flour : Riboflavin Content of Wheat. and 80-per-cent. Extraction Flour Six Months after Change" (Clemow). (10) " Assay of Riboflavin in North Island Fish " (Clemow). (11) " Progress Report on Thiamine Content of some New Zealand Fish" (Macfarlane). Printed (1) " Report on Incidence of Rickets in New Zealand " (Malcolm). N.Z. Medical Journal, October, 1946. (2) " Nutritional Factors affecting the Teeth " (Harrison and Bell). ' N.Z. Dental Journal, January, 1947. (3) " Wholemeal versus White Bread " (Bell). Dental Journal, January, 1946. Hydatids Research. —Reports on research submitted, including " Incidence of Hydatid Disease in New Zealand," " Styx Experiment Returns," and " Graph of Cultivation in vitro of Hydatid Scolices." Results of last-named embodied in paper submitted to Parasitology Journal. During the year an article entitled " Hydatid Disease " was published in Journal of N.Z. Association of Bacteriologists giving summary of diagnostic and brief outline of lines of research. " Testing Arecoline Hydro bromide as an Anthelminthie for Hydatid Worms in Dogs " (Batham). Parasitology, Vol. 37, Nos. 3, 4, August, 1946. Clinical Medicine Research. —Publications (1) " The Spread of Infective Hepatitis and Poliomyelitis in Egypt " (Van Rooyen and Kirk). Edinburgh Medical Journal, 53, 527. (2) " Pathogenesis of Pleurisy with Effusion " (Thompson). American Review of Tuberculosis, 54, 349. Papers in press : (1) " Circulating Properties of ■iso-Thioureas, Guanidines, iso-Ureas, and Amidines 1 (Fastier and Smirk, with successive collaboration of Crawford and Strang). Journal Pharmacology and Experimental Therapeutics. (2) " Some Observations on High Blood Pressure " (Smirk). New Zealand Medical Journal. (3) " The Functional Pathology of Essential Hypertension " (Smirk). Transactions of Royal Australasian College of Physicians. (4) " Observations on the Classification and Renal Function Changes in* Nephritis " (Smirk). Transactions of the Royal Australasian College of Physicians.

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(5) " Preparation of,Alkyl iso-Ureas " (Ongley). Transactions of Royal Society of New Zealand. (6) " Urea Alkyl Sulphates " (Carter and Ongley). Journal of American Chemical Society. Reports on research. : (1) " The Precordial Electrocardiogram, with Special Reference to Difficulties in Interpretation of Suspected Coronary Infarction and the Meaning of the T-wave " (Antonoff-Lewis). (2) - Some Problems concerning High Blood Pressure in New Zealand " (Alstead and Smirk). (3) " Nature of Ventricular Flutter and Ventricular Fibrillation" (Smirk and Fastier). (4) " Control of Gastric Hyperacidity by Radium " (McGeorge). (5) " Factors influencing Prognosis in Pneumococcal Pneumonia " (Alstead). (6) " Perfusion Experiments on Rats " (Restall and Woodhouse). (7) " Potentiating Effects of Amidine Derivatives " (Fastier and Reid). Enterobius Vermieularis.—Further report submitted by Professor Richardson. Tuberculosis Research.— (1) Report furnished by Dr. Johnson. (2) Summary of report by Dr. Gilmour on typing of Tubercle bacilli from 1942-4 7 to be published in N.Z. Medical Journal this year. (3) Report of experimental work by Travis Laboratory. Obstetric Research: — (1) Report submitted by Professor Dawson. (2) Articles on " Research in Pelvimetry," by Dr. Allen, published in February and March issues, 1947, of British Journal of Radiology, Vol. XX. Further papers to be published in April and May issues. Cancer Research. I—Reports 1 —Reports submitted by Sir James Elliott, President of New Zealand British Empire Campaign Society, and Mr. Roth, Physicist in Charge, Dominion X-ray : and Radium Laboratory. I regret to record the deaths of two retired officers who faithfully and ably served the Department, Dr. R. H. Makgill and Dr. T. L. Paget. Dr. Makgill joined the Department in 1901 and he held many responsible positions, including at various times those of Medical Officer of Healthj Auckland and Wellington, and Acting Chief Health Officer. Dr. Makgill was keenly interested in health legislation and was responsible for the drafting of the Health Act, 1920, and the Nurses and Midwives Registration Act, 1926, to quote two major pieces of legislation to which he turned his attention. Dr. T. L. Paget, who served the Department for twenty years, played a most prominent part in the campaign for improved maternity services. As an outcome of his - co-ordinating efforts he contributed largely to the progress which has been made in the saving of t&e lives of mothers, as shown in the favourable trend of the New Zealand maternal-mortality rates.

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A Timaru Health District was created and Dr. G. L. McLeod appointed Medical Officer of Health. The following medical officers have been appointed : Dr. E. W. Kinsey (New Plymouth), Dr. A. W. S. Thompson (Auckland), Dr. Miriam K. McAllum (Wellington), and Dr. F. J. G. Lishman (Gisborne). Dr. H. B. Turbott visited overseas to study the latest trends in public-health work in America and England. It is only fitting that I should conclude this report with a brief expression of the Department's sincere appreciation and esteem of Dr. Watt, who, after many years of onerous and faithful service, has retired from the position of Director-General of Health. To him is due a great deal of the credit for the marked development which has taken place in public-health administration in this country within recent years. He carried with him into his retirement the good wishes of his former,colleagues. In conclusion, I desire to express my thanks to members of the staff for their loyal support. T. R. Ritchie, Deputy Director-General of Health.

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