9

H.—3l

the disease (notifications per million population) in New Zealand and in certain of the Australian States for the latest years for which figures are available, shows this clearly : —

Incidence Rate of Diphtheria in New Zealand and Australia.

Entekic Fever. Enteric fever shows a further marked decrease. If the present rate of progress is maintained it seems not unreasonable to hope that ere long this disease will cease to figure among the important causes of sickness and death in the Dominion. The position is extremely gratifying, and indicates the high and steadily improving standard of sanitation in New Zealand. The active policy of inoculation of the Maoris with anti-typhoid vaccine which has been carried oat in recent years has doubtless had a considerable share in producing a reduction of enteric fever in that section of the population. Tuberculosis. The notifications for 1920 show a considerable increase, although they do not equal the unsatisfactory record of 1917. In considering this disease, however, it must be remembered that information derived from returns of notifications alone is not accurate, as there is, unfortunately, a tendency on the part of the general practitioner to neglect to notify his cases. The returns of deaths are not so misleading, and the following table is therefore inserted as showing more accurately the course of the disease during the last decade : —

Deaths from, Tubercular Diseases. — Decennial Table, 1911 to 1920, showing for each Year the Rate per 10,000 living, and the Percentage of Total Deaths.

* All deaths. t Excluding deaths from influenza, October-December, 1918. It will be seen that the death-rate from tuberculosis reached its lowest point in 1915, but since then has shown a tendency towards, increase. This is doubtless due to the adverse influences of the war and the disastrous pandemic of 1918. The New Zealand rate, it should be added, compares very favourably with that of other countries. Cerebrospinal Meningitis. This again shows an improvement; it will bo seen that the notifications for 1920 are only onehalf of the number received in 1918. Poliomyelitis. Poliomyelitis showed an unmistakable tendency towards increase during the year under review. The Auckland Health District suffered in the autumn, while the rest of New Zealand was affected mainly in the succeeding spring. Twelve of the cases occurred in the Cook Hospital District during the months of September, October, and November. In this small outbreak there wore four deaths, and so far as is known three cases with varying degrees of permanent paralysis. It is a severe casualty list for so small an outbreak. Despite careful inquiry, no connection could be discovered between any two of these cases. The allied disease —lethargic encephalitis —it is interesting to note, was not influenced in the same direction as poliomyelitis. Ninety cases of lethargic encephalitis were notified in 1919, and only forty-two in 1920. The next two tables, showing the number of cases notified (A) by hospital districts, and (B) by months, are appended as furnishing more exact information concerning the incidence of infectious disease in the Dominion in 1920 :—

2—H. 31.

Country. Year. Notifications per Million of Population. New Zealand 1919 1920 1919 1919-20 1919 1920 3,079 2,092 1,412 3,917 3,001 4,130 >) ■ ■ New South Wales Queensland Western Australia Tasmania

Year. Mean Population. Number of Deaths from Tuberculosis.. Bate per 10,000. Percentage of Total Deaths from all Causes. 1911 1912 1913 1914 1915 1916 1917 1,014,896 1,039,016 1,068,644 1,090,328 1,099,394 1,099,449 1,099,117 738 716 812 728 693 742 755 7-27 6-89 7-60 6-67 6-30 6-74 6-87 7-74 7-77 8-02 7-17 6-95 7-00 7-17 (5-08* 17-64f 7-05 7-03 1918 1,103,022 832 7-54 1919 1920 1,136,389 1,179,619 762 851 6-71 7-21