69

H.—3l

Infectious Diseases. The actual number of notifications in the two health districts shows a very decided decrease in the Wairarapa - Hawke's Bay Health District, but an increase in the Nelson - Marlborough Health District. This is mainly due to the decrease of scarlet-fever notifications in the former health district and to an increase in the latter health district. Two diseases, diphtheria and pneumonia (including pneumonic influenza), show an increase over the previous year. Scarlet Fever.—This disease, which had been epidemic in a mild form all through the previous year (.1928) and the early months of this year, began to wane in the late autumn. For the latter half of the year the graph shows about the same as the pre-epidemic incidence. The period of isolation, which, owing to the rush on the accommodation in the public hospitals, had been reduced to twenty-eight days for " clean " cases, has not been extended again to the regulation six-weeks period. The Medical Superintendents of most of the hospitals in the two health districts are satisfied that " clean " cases are quite free, from infection, even if desquamation has not quite finished. This shortening of the period of detention in hospital is a decided economic benefit. Although, however,. scarlet fever has declined rapidly in the Wairarapa - Hawke's Bay Health District, it shows now signs of becoming epidemic in the Nelson - Marlborough Health District, more especially in and around Nelson. The graph shows a decided rise since the middle of the year. The typo of the disease has. not changed ; it is still extremely mild, and there is no doubt quite a number of cases are not reported. Some are discovered when inquiries are made by the Inspectors on a notified case. Diphtheria.—There has been an increase of diphtheria notifications in both the health districts, but the cases have been scattered and not localized. The practice, which is being more generally adopted, of examining, wherever possible, the classmates of all notified cases who are contacts at school, is, I am satisfied, a very useful preventive method. Typhoid Fever. —Twenty-four cases were notified in the Wairarapa - Hawke's Bay District, and six in the Nelson - Marlborough District. For the first time in my experience the number of pakeha cxceeds the Maori cases. In the spring we had a series of cases in the Napier Hospital which were decidedly puzzling as regards origin of infection. Not one case, except familial cases, had, so far as could bo ascertained, any history of contact with another case. The cases occurred in and around the towns of Napier and Hastings. The majority of the cases were whites. Careful inquiry was made about the eating of oysters and shell-fish, which did not give us any clue that this line of infection was implicated. Fortunately, the mild epidemic, if such it could be styled, ended as abruptly as it seemed to begin. Dysentery.—The outbreak of this disease in the autumn in the South Auckland Health District fortunately did not spread to the Hawke's Bay District, although there were many Hawke's Bay Maoris at the big gathering at Ngaruawahia. There have been ten cases notified, but in the absence of any bacteriological confirmation of the diagnosis there is considerable doubt as to whether all the notified cases were true cases of bacillary dysentery. lam informed that the Flexner bacillus is not uncommonly found in routine feces examinations —e.g., clearance for typhoid fever, &c. Presumably it is when this particular causal organism becomes increasingly pathogenic that infection may be spread by " carriers." Pneumonia (including Pneumonic Influenza). —There were 1.83 notifications in the WairarapaHawke's Bay Health District, as against 131 in the year 1928, which also showed a decided increase on the previous year (1927). There were sixteen cases in the Nelson-Marlborough Health District. The mortality-rate on the 199 cases in the two health districts was 14-5 per cent. The distressing feature of these deaths is that nearly one-fourth of them (eight) were women in the last weeks of pregnancy. The woman advanced in pregnancy who contracts influenzal pneumonia has apparently little or no chance of recovery. In some of these cases death occurred within three days of onset of first symptoms. These unfortunate deaths come under the category of maternal mortalities, and, naturally, help to swell the maternal mortality-rate. It is, therefore, very important that the pregnant woman should receive ante-natal advice to the effect that if she should be unfortunate enough to contract influenza, or even a severe cold in her last months of pregnancy, she should take every care to avoid a complication like pneumonia. Apart from these unfortunate maternal mortalities, the mortality rate (11 per cent.) was not high. Pulmonary Tuberculosis. —Pulmonary tuberculosis shows a decided decline in the number of notified cases —73 as against 102 in the previous year —for the Wairarapa-Hawke's Bay Health District; but there has been a considerable increase in notified cases in the Nelson-Marlborough Health District. The deaths number forty-nine and seven respectively. Puerperal Fever.—There has unfortunately been an increase of notified cases, and also of deaths. In the two health districts there were nineteen notified cases and five deaths. Maternal Mortality.—The same applies to the maternal figures, which number twenty —ten more than last year. But eight of the twenty-one deaths were due, as already reported, to pneumonia in the last months of pregnancy. General Sanitation. No sanitary works on a large scale have been entered upon. After many years of negotiation the Hastings Borough has at last been prevailed upon to install some form of treatment for its sewage, which at present is being discharged in a crude state into the Ngaroruro River and is causing serious pollution. Plans have been prepared by the Borough Engineer and approved by the Board of Health. It is hoped this work will be completed during the course of this year.