11

H.—3l

as a result of child-birth in this country than in many other countries which have not the advantages that we possess. The following table shows the position clearly : — Maternal-mortality Rates. Country anrl Year. Maternal Rate Country and Year. Maternal Bate per 1,000. per 1,000. Denmark, 1921 .. .. .. 2-0 Germany, 1918 .. .. .. 4-9 Netherlands, 1921 .. ..2-3 New Zealand, 1923 .. ..5-1 Sweden, 1917 .. .. .. 2-5 Spain, 1915 .. .. .. 5-2 Italy, 1917 ~ .. .. 3-0 Ireland, 1920 .. 5-5 Norway, 1917 .. .. ..3-0 Switzerland, 1915 .. .. 5-5 Uruguay, 1920 .. .. .. 34 France, 1914 .. .. .. 5-7 Japan, 1921 .. .. .. 3-6 Scotland, 1919 .. .. .. 6-2 England and Wales, 1922.. .. 3-8 United States Birth-registration Area, 6-8 Union of South Africa, 1919 .. 3-9 1.923 Hungary, 1915 .. .. .. 4-0 Belgium, 1919 .. .. .. 7-2 Finland, 1918' .. .. ..44 Chile, 1920 .. .. ..7-5 Australia, 1921 .. .. .. 4-7 Again, while New Zealand is justly proud of its record that it possesses the lowest infant-mortality rate in the world, a close inspection of the figures shows that there is still much to be done. The reduction in the infant-mortality rate in New Zealand has been wholly due to the saving of infant life after the age of one month, an accomplishment due in no small measure to the excellent work inaugurated and directed by Dr. Truby King. The death-rate of infants under one month in this country, however, is still 29 per 1,000 live births, and has shown practically no reduction since the Plunke.t Society commenced its work in 1907, when the rate was 30 per 1,000. In a recent report which the Health Department received from Dr. C. J. Brenkman, Chief of the Medical Statistical Department of the Municipal Health Service of Amsterdam, it is shown that the death-rate of infants under one month in that city has fallen from 23 per 1,000 births in 1905 to 13 per 1,000 births in 1.922. Differences in the methods of compiling the figures forbid any strict comparison between the two countries in regard to first-month mortality. The fact remains that in Amsterdam the first-month mortality is a rapidly falling quantity, while in New Zealand it is practically stationary. Closely allied in its causes with the death-rate under one month is the mass of still-births which occurs annually in the Dominion. Still-births have been notifiable since 1915. The rate of still-births for the year 1923 was 32 per 1,000 live births, a higher figure than any previously recorded. These three groups of figures show New Zealand in a most unfavourable light. It is obvious that present methods are not effective and do not provide the solution of the problem. New measures must be devised. The problem is one which concerns primarily the general public and the medical and nursing professions, and the remedy would appear to lie rather in their hands than with the Department of Health. It can be reasonably expected that better treatment of the expectant mother and higher skill on the part of the attendants at the time of birth and immediately afterwards would reduce these rates very materially. SECTION 2.—NOTIFIABLE DISKASKS. The outstanding feature of the year under review was a widespread but comparatively mild prevalence of influenza during the winter months. In other respects the year was exceptionally favourable. The death-rate from tuberculosis (all forms) was lower than in any year previously ; scarlet fever, diphtheria, and enteric fever were less prevalent than they have been for many years. Scarlet Fever. The course of scarlet fever in New Zealand during the last five years is briefly shown in the tables below. The notifications for 1923 reveal a satisfactory decline as compared with the previous year ; the death-rate, however, while low, shows a slight increase over the preceding year.

Scarlet Fever in New Zealand, 1919-23.

, , Ox— , Diphtheria. As the next table shows, there is a continuing decline in diphtheria. Both incidence-rate and death-rate from this disease are now lower than they have been since 19.12. The disease, however, is much too prevalent. The lack of staff has militated against the adoption to any extent of methods of control based upon active immunization with toxin-antitoxin mixtures. It is hoped, however, that it may be possible to push on with this very important measure during the coming year.

.919 .920 .921 .922 .923 Year. Notii Number. 1,521 1,248 1,845 1,449 1,201 ieations. Rate per 10,000 of Mean Population. 13-31 10-46 15-07 11-58 9-42 Number. 23 15 24 10 13 Deaths. Rate per 10,000 of Mean Population. 0-20 0-13 0-19 0:08 0-10