7

H—3l

It is both expensive and inadequate to send State medical officers and nurses from twenty to one hundred miles or more to introduce children from school or home to medical practitioners living in close proximity to those children. National insurance for sickness and invalidity is one method already in operation in England, and throughout Europe and Asia, of partnership with the general medical practitioner for the purpose of disease-prevention, and I recommend advocacy of its adoption by New Zealand to your favourable consideration. The Birth-rate.—Reference should be made to the steadily decreasing birth-rate. (1) Actual Reduction in the Number of Births in the -past Three Years. Year. Births. Reductions. 1926 .. .. .. .. .. 28,473 1927 .. .. .. .. .. 27,881 592* 1928 .. .. .. .. .. 27,200 681* 1929 .. .. .. .. .. 26,747 453* (2) Actual Reduction in Infant Deaths for the same Period. , - Infant Deaths ~ , Year. , , „ „ . Reduction. (under One Year). 1926 .. .. .. .. .. 1,132 1927 .. .. .. .. .. 1,080 52f 1928 .. .. .. .. 984 96| 1929 .. .. .. .. 912 72f Quite a good way of increasing a population is the direct method. Early marriage induces large families. If by more and earlier marriages the birth-rate can be increased the infant-death rate will tend automatically to rise, but there will be a considerable net gain in population. The Principal Causes op Death itemized. Heart-diseases (all forms) . . .. .. .. 2,533 Apoplexy or cerebral haemorrhage .. . . .. .. 634 Diseases of the arteries .. .. .. .. .. 428 3,595 These diseases of the heart and arteries account for 3,595, or nearly one-third, of the deaths. In the last half-century the death-rate from each of these three causes has increased very greatly —e.g., that from heart-disease (all forms) has trebled, and that from apoplexy more than doubled. Quite a proportion of these deaths apply to persons under sixty years of age. Habit, environment, and infection are important causative factors. In the report for 1928 I discussed several causes of the various forms of heart-disease. Cancer, 1,467. The following table, taken from the " New Zealand Official Year-book," shows the cancer deathrate in the Dominion for the last ten years.

Number of Persons who died from Cancer, the Proportion per 10,000 Persons living, and the Percentage of all Deaths, 1920-29.

We know not the cause of cancer. It is increasing in prevalence at a slow, not rapid, rate. Being a disease of late life, and having in the past often missed detection or registration, its apparent increase is in considerable measure accounted for by our longer span of life and greater skill in diagnosis. The real increase is slight, and can be checked if advice and treatment be sought early in the disease. Recent results show that the proportion of actual cures from the treatment of early cancer is very high indeed. It has always been an important cause of death, but results show that nowadays submission to skilled treatment at an early stage is worth while. Particularly after the age of thirty-five we should seek medical examination for any unusual condition which might be cancer.

* Despite an increased population. f Contributed to by reducing birth-rate.

„ ,, . m j. 1 tv it. Deaths from Deaths from „ Deaths irom Total Deaths, „ . A AAA n , AA Year. „ 11 n Cancer per 10,000 Cancer per 100 Cancer. all Causes. of Living Persons. of all Deaths. 1920 .. .. .. .. 1,029 12,109 8-72 ' 8-50 1921 .. .. .. .. 1,044 10,682 8-53 -9-77 1922 .. .. .. .. 1,066 10,977 8-52 9-71 1923 .. .. .. .. 1,115 11,511 8-75 I 9-69 1924 .. .. .. .. 1,245 10,767 9-59 1 11-56 1925 .. .. .. .. 1,207 11,026 9-08 10-95 1926 .. .. .. .. 1,341 11,819 9-91 11-35 1927 .. .. .. .. 1,324 11,613 9-63 11-40 1928 .. .. .. .. 1,374 11,811 9-87 j 11-63 1929 .. .. .. .. 1,467 12,314 10-43 11-91