H.—3l

Enteric Fever. The number of notifications of enteric fever was 59, with 6 deaths, giving a death-rate of 0-04 per 10,000 mean population. To show the progress which has been achieved in dealing with this disease it may be stated that in 1921 the number of reported cases was 451 and the death-rate was 0-20. Bacillary Dysentery and " Summer Sickness." An epidemic of bacillary dysentery in the East Cape Health District caused some anxiety. There were 161 cases (36 Europeans and 125 Maoris), with 11 deaths (3 Europeans, 8 Maoris). Infection was traced variously, to contact with mild missed cases, swimming in polluted streams, eating shell-fish from doubtful sources, drinking water from polluted wells or streams, and careless preparation of food at tangis and similar gatherings. The prevailing organism was B. dysenteriae (Flexner). Dr. G. O. L. Dempster, Medical Officer of Health, North Auckland, in reporting on an outbreak of summer sickness, had this to day : — " A widespread epidemic of the so-called ' summer sickness ' occurred in the Whangarei area during October of 1940. This disease was no doubt due to a salmonella organism, although not recognized as such by the profession and hence not notified to the Department. The term ' summer sickness ' is an unfortunate one, as it allows the practitioners to hand a label to the disease without proper investigation. Further, the term conveys the idea that the disease is directly due to climatic influences and therefore something that is inevitable. .One typical case was fully investigated at the Whangarei Hospital and an organism of the B. enteritidis group isolated. There is no doubt that these outbreaks are more common than is recognized in the warmer parts of New Zealand and are conveyed by contaminated food. Unfortunately, until such time as the disease is notified promptly, little can be done from the preventive aspect." Influenza. The death-rate from influenza (all forms) was 0-77 per 10,000 mean population. In 1939 the rate was 1-10. Poliomyelitis. Twenty-two cases of this disease were notified in 1940, of which 4 were non-paralytic. Lethargic Encephalitis and Cerebrospinal Fever. Four cases of the former and 19 of the latter were notified. The low incidence of cerebro-spinal fever was gratifying, as this is a disease which is apt to flourish in times of war. The good record of 1940, however, did not long continue. In April-May, 1941, a localized outbreak resulting in 20 cases and 4 deaths occurred in the Bay of Islands County, while sporadic cases were reported from other parts of New Zealand. An account of this outbreak will be given in next year's report. Whooping-cough and Measles. Deaths from whooping-cough numbered 23, while only 1 death was reported from measles. Puerperal Sepsis. Sepsis following childbirth was responsible for 13 deaths (1.6 in 1939). The deaths due to sepsis following abortion number 14 (20 in 1939). Tuberculosis. There were 600 deaths from tuberculosis (all forms), as compared with 613 in 1939. The deathrate per 10,000 mean population for the past five years is set out in the following table : —

Tuberculosis is one of our major public-health problems, and measures taken to deal with it were outlined in previous reports. District nurses are now the agents for investigating tuberculous cases. The search for contacts and the supervision of patients living in their homes is now being much more effectively undertaken by these officers than by Health and Sanitary Inspectors. A refresher course was held for institutional and departmental nurses whose duties relate to the control of tuberculous cases. The course gave the nurses the opportunity of becoming acquainted with advances which have been made in knowledge regarding the disease. Cancer. Cancer is still one of the principal causes of death, and for this reason the educational work of the New Zealand Branch of the British Empire Cancer Campaign Society merits the highest support.

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Y _ Respiratory Non-respiratory Tuberculosis Tuberculosis. Tuberculosis. (all Forms). 1936 .. .. .. .. .. 3-63 0-94 4-56 1937 .. .. .. .. .. 3-28 0-63 3-91 1938 .. .. .. .. .. 3-17 0-73 3-93 1939 .. .. .. .. .. 3-39 0-59 3-98 1940 .. .. .. .. .. 3-24 0-64 3-88