F.—3l

8

Ohinemuri County suffered to the extent of twenty-five cases, chiefly in Waihi and Paeroa, in both of which places the school was disinfected during the winter holidays. At Kamo, in Whangarei County, also, an outbreak occurred among the children, and the school was closed for disinfection. A great deal of infection might be avoided if parents took the ordinary precaution of keeping their children from school during convalescence, or while there is infection in the house. But, through ignorance or selfishness, they neglect to do this, and the local bodies often are not sufficiently alive to their duties to see that such precautions are taken. In two instances it was found advisable to suspend the milk-supply from dairy farms. DIPHTHERIA. One hundred and fifty-one cases have been notified, of which 68 arose in the city, 49 in the suburbs, and 34 in country districts. Twelve deaths occurred in 1902 in Auckland and suburbs from diphtheria, a very large proportion considering the population. Only seven are recorded in the rest of the great towns. Comment was made in last year's report on the outbreak which was started by the turning-up of the soil polluted by a carelessly constructed stable belonging to the Tramway Company. A fair number of the sixty-eight city cases can be traced directly or indirectly to this source. Inquiries were made systematically into each case, and it was noticeable that many instances occurred where the connecting-link between one case and another was found in some person or family considered to be suffering from "tonsillitis" or "croup." I have no doubt a number of cases escaped notification thus. It would be well were the medical attendant to regard with suspicion all eases of sore throat while a diphtheria epidemic is in progress, and to take precautions accordingly. One school was closed for disinfection owing to this disease. Another stable with the same faulty construction as that at Bayfield was pulled down, but on this occasion the contractor was directed to use lime and other disinfectants when the filth-saturated soil was opened. Only one case —a man working in the stable —resulted. As in enteric, so with regard to diphtheria, a certain number of cases may be traced to the sewer-outfalls in the harbour. Parnell suffered must heavily of the suburban districts, thirteen eases being notified here— three, at least, of those were contracted by children playing -about the foul spots in St. George's and Mechanics' Bays. Mount Eden, with ten oases, shows up badly. They arose in much the same parts of the districts as the typhoid cases, and are directly traceable to lack of drainage. Arch-hill and Eden Terrace, with five and four cases respectively, have a high proportion for their population. Doubtless the foul open sewer running through these districts is largely responsible for this. Of the country districts, Cambridge, with seven cases, shows too high a proportion—comment on which was made last year. Two of these arose in one of the Bailway Department houses, where a direct connection between cesspit and untrapped house-sink was the means of carrying the infection. Thames Borough. —Seven cases arose, most of them being in one road, where the water-table carrying the sewage is less well flushed and more faulty in construction than in most of the streets. MEASLES. A very severe epidemic of measles has swept over the district, 3,544 cases being notified—l,392 being in the city, 1,526 in the suburbs, and 626 in the country. It was usually accompanied by an outbreak of whooping-coupli, and together these diseases caused 58 deaths in 1902, of which 40 were from measles. Doubtless many other cases occurred not notified, since parents frequently do not send for a medical man for this disease. I found it necessary to advertise the fact that the householder was under legal obligation to notify the Department of the cases. The removal of measles from the list of notifiable diseases also makes the return incomplete, though by the time this was done the outbreak was abating. There is every reason to believe that the return of the troops from South Africa in August was responsible for the epidemic, which began in September, reached its height in October and November, and diminished in January. Previously only a dozen or two cases were reported month by month. The spread was largely due to the utter disregard for all precautions which marked the attitude of the public to the disease, and the schools became veritable hotbeds —Wellesley Street, in the city, and Newton East more especially suffered. These were disinfected during the holidays, as also were Newmarket, Northcote, and Pakuranga schools, which had to be closed on account of the numbers afflicted. As an example of the indifference with which people regard measles, it was found that at Northcote a baker's boy was distributing bread within a week of the time the rash faded. This, of course, was stopped. I suggested that advantage should be taken of the holidays in October to make a general disinfection of all schools, but this was not carried out. Since measles is no longer on the schedule of infectious diseases, precautions are difficult. Several complaints have reached me from schoolmasters regarding parents sending infected children to school. But I cannot now take any measures towards preventing this. TUBEECULOSIS. One hundred and nine cases have been reported—3l in the city, 27 in the suburbs, and 51 in the country. These probably only represent the more pronounced cases of phthisis, and little can be gathered as to the prevalence in various districts, as medical men differ in their ideas of what constitutes a notifiable form of the disease. Thames County, 16; and Manukau County, 13, seem out of proportion to the other districts.