H.—3l

3

Maori epidemic of 1912 was comparatively mild and innocuous, in this latter manifestation it had reverted to the type which long ago caused it to be regarded as one of the scourges of mankind. Out of a total of four cases from the ' Willochra ' two died, while a third was critically ill for several weeks, and then made a slow and tedious convalescence. These three cases were all of the type known as ' confluent,' and were characterized by a very extensive skin-eruption and a profound toxasmia. None of them had been successfully vaccinated at any time, either in childhood or in adult life, consequently the disease ran its ordinary severe course uninfluenced in any way. The fourth case, which shows up in marked contrast to the three just mentioned, was that of a man aged thirty, who had been successfully vaccinated as a child. He had a very mild attack of ' discrete' smallpox, the skin-eruption was not extensive, and his symptoms were few. He was feverish for only three days, and thereafter entered 011 his stage of convalescence, making a rapid and uneventful recovery. Here the effect of the old vaccination is noticeable, and while not altogether immune, owing to the time which had elapsed since the vaccination, yet he was afforded a very considerable degree of protection, and was affected by the disease in an appreciably modified form. "As evidence that vaccination affords absolute protection against smallpox is the fact that of the five people in constant attendance upon these patients not one acquired the disease, although living continually in an atmosphere and amongst surroundings which were absolutely impregnated with the contagion of the disease. These five people were all protected, one, it is interesting to note, by a former attack of smallpox when a child, the remaining four by recent successful vaccination. They adopted no special precautions to safeguard themselves, being confident that tliey were absolutely immune against the disease, and such proved to be the case. " These observations, then, confirm the claims that have been made in favour of vaccinaton " (1.) Recent successful vaccination is an absolute protection against smallpox. " (2.) Successful vaccination in the past will afford some degree of protection, depending on time which has elapsed since the vaccination was performed." Leprosy.—Of the three cases in quarantine at the commencement of the year the Maori case was discharged, having for two years been proved negative to the disease by bacteriological examination. He was allowed to return home, where he shortly afterwards died from natural causes. A case was admitted during the year, the patient being a returned soldier. The history of the case showed that in boyhood he was in India, and probably contracted the disease there. There is nothing special to report in regard to the condition of the other two cases. Maternity Hospitals. Attached is an excellent report by Miss Maclean, Assistant Inspector, 011 the above-mentioned hospitals and the administration of the Nurses and Midwives Acts. There is no doubt that as a result of the appalling wastage brought about by the war it will be necessary to afford every facility to mothers with a view to maintaining the population by liatural means. Several reports on this important matter have been submitted, and as a result all Hospital Boards have been circularized as to the necessity of erecting maternity wards in connection with their hospitals. By this means it may be possible to afford mothers all the advantages of modern treatment at a very much reduced cost. Already several Hospital Boards have intimated their decision to erect maternity wards at their hospitals at an early date. Napier has, through the generosity of Mr. L. H. McHardy, secured a building, which has been converted into a maternity home. A movement is also afoot in Hastings to provide a similar institution. Buildings for the same purpose have also been acquired in Invercargill and Blenheim. In the latter place an epidemic of puerperal septicaemia showed to the Board the necessity of providing such an institution. I am certain that it is only a question of time when all the country hospitals will be provided with suitable maternity wards, which will not only allow patients to be treated therein at a greatly reduced rate, but will also allow increased facilities for the training of midwives, for whom "there is a great want in the more remote country districts. Infantile Mortality. Without doubt every effort should be made in the direction of still further reducing the infantile-mortality rate, which has been very apparent during the last decade, and shown that the results of the efforts of the Plunket Society, the St. Helens Hospitals, and the Department have not been in vain. It is hoped that during the ensuing year special measures will be undertaken in this direction. Pre-natal clinics have been established at our St. Helens Hospitals with a view to encouraging expectant mothers to consult as regards their condition of health before confinement, and these clinics have been fairly well attended. Arrangements are also being made for nurses to visit the newly born so that the mother may receive the best of advice as regards the treatment of her infant. To this end also it is hoped that the district nursing scheme will be very much extended during the ensuing year. Private Hospitals. A summary of private hospitals appears as an appendix to this report. It will be noted that licenses have been given to 260 private hospitals, of which 165 are for maternity patients only. It is pleasant to note that some of these maternity hospitals encourage their patients to report from time to time on the progress made by the infants born in the institutions, thus following on the lines of our St. Helens Hospitals, where much good has been derived by these means.