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H.—3l

i • GENERAL SANITARY MEASURES. Infectious Diseases. The evidence obtained from our inquiries into_the outbreaks of infectious disease, more particularly scarlet fever, showed that there is a great deal of carelessness on the part of persons suffering, or in charge of those suffering, from infectious complaints, as regards the use of trams, cabs, trains, and other public vehicles. Accordingly, the Inspectors have been on the look-out for breaches of the Public Health Act in this respect, with the result that we have instituted proceedings on eight occasions, six being for breaches of the law re travelling in public vehicles. In all but one we were successful. This one case occurred in Wellington. The notifying medical man had diagnosed diphtheria, but the case failed owing to a second medical opinion having thrown doubt on the accuracy of this diagnosis, the Magistrate holding that this doubt did not enable one to say that the patient "to his own knowledge was suffering from the disease." As, however, the patient had travelled in a public vehicle (a tram) before this second opinion was obtained, there was evidently a moral breach of the Act if not a legal one, for the patient travelled in the vehicle immediately after being told by the medical man she was suffering from diphtheria, and before she was in a position to cast any doubt on this opinion. It would seem necessary that there should be an amendment in the wording of section 32 of " The Public Health Act, 1900," so as to prevent this sort of thing being repeated, as it is evidently not desirable that where two medical men differ as to diagnosis the patient should be able to voluntarily adopt the view that his case is not infectious, and travel about immune from punishment. If the words " to his own knowledge " were omitted it would strengthen the hands of the Department in such cases; and it would make the matter more clear if a clause were added somewhat as follows: " Any person concerning whom a registered medical practitioner has issued the notice in section 26, subsection (4), of this Act, shall be deemed to be suffering from the infectious disease specified, until he can produce satisfactory medical evidence to the contrary." Such a clause would also make the position more definite when dealing with convalescent patients. Infectious Diseases Hospitals: At Mastertov the necessary legislation to enable Hospital Boards to build on lands held by Hospital Trustees unfortunately was not enacted, thereby occasioning more delay in the necessary provision of accommodation for infectious cases in some of the country districts. During the recent epidemic of scarlet fever at Masterton the cottage which the Trustees had secured some time before for use as an infectious-disease hospital was dangerously overcrowded for considerable periods, and the need for better provision was amply demonstrated. It is satisfactory to report that the Hospital Board has found the necessary funds, and a beginning has been made on the erection of an infectious ward, in brick, in connection with the new hospital. At Pahiatua the lack of legislation has caused much vexatious delay. A site has been chosen and approved by Dr. \ 7 alintine (the Inspector-General of Hospitals) and myself, in the grounds of the present hospital. It has been proposed to make this a brick building, but this I consider would be a most unnecessary waste of money, as a small four-bed building of the type erected last year at Greytown, at a cost of £400-.£500, would serve amply for a long time. At Wellington the present epidemic of scarlet fever is straining the accommodation for such diseases to the utmost, and it has been necessary to refuse admission to some cases. It is reasonable to exercise a good deal of care in selecting the cases for hospital treatment during an epidemic of scarlet fever, for the evidence in English towns goes to show on the whole that no great benefit to public health is to be gained by an attempt to provide hospital isolation for all cases ; indeed, some hold that, from the point of view of the patient, such segregation is undesirable. However that may be, in the majority of cases in Wellington sufficient isolation ami suitable medical attention can be secured in the homes of the patients; and the cases where such home treatment cannot be secured are, during an outbreak, always sufficient to more than fill the thirty to forty beds available at the district hospital. On these grounds the Department is endeavouring to exclude any but the more necessitous cases, in accordance with the representations of Dr. Ewart, the Medical Superintendent, who finds the present accommodation for infectious cases unsatisfactory. Indeed, considering the position and aspect of the present isolation wards, the safety of the general hospital wards must be a matter requiring the exercise of much anxious supervision, and it is very evident that a properly equipped fever hospital is urgently needed. There is some difficulty in finding a suitable site near enough to the General Hospital to allow of economy in administration, indeed, excluding part of the Asylum grounds, the only available spot is the Old Men's Home, and it would be a desirable matter for the Trustees to enter into negotiations for an exchange. It should not be difficult to find a spot equally suitable for the old pensioners, whereas it is well-nigh impossible to get any other place for the infectious wards. Quarantine. Nothing of the nature of dangerous infectious disease has occurred in the district during the year, and no infectious cases from overseas have arrived, with the exception of one or two cases of tubercle, for which suitable bonds have been received and provision made before a landing was permitted. Some attention has been paid to the question of the excessive cost to the Department of the tender used by the Port Health Officer in his work. Investigation has shown that a much more economical plan would be to obtain an oil launch. The interest and sinking fund, on the initial cost, together with the working-expenses, would be very greatly under what is at present paid yearly in steamer-hire. If the Customs Department were to co-operate, the expense would be very small for the two Departments. This matter has been the subject of a special report.