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While no hard-and-fast rule can be made, it is considered that, in view of the fact that no known overseas authority has ever recommended more than 10 beds per 1,000 of population as an ideal to be aimed at, those hospital districts which already exceed this figure should be required to present a very strong case before consent is given to further extensive building programmes (except where private maternity homes go out of business and have to be replaced), at least during the present acute shortage of houses, labour, and building-materials. Hospital Board districts in this category include Wellington, Palmerston North, Cook, Marlborough, South Otago, Dannevirke, Waipawa, Vincent, Westland, and possibly one or two others. On the other hand, some Hospital Boards have too few beds to treat the population adequately. In some cases this appears to be due to inability of the ratepayers to afford the necessary accommodation, and in other cases it appears to be due to lack of public conscience. Penicillin In March, 1944, American penicillin began to be available at the rate of about 5,000,000 units a week, and at a cost of £6 per ampoule of 100,000 units. In June, 1944, regular supplies of Australian penicillin were imported at the rate of 10,000,000 units a week and at a selling-price to hospitals of 335. per ampoule. The price to hospitals has now' fallen to 10s. 6d. per ampoule, and the quantity imported is at the moment 61,000,000 units a week. It is proposed to increase this quantity immediately and, as the demand increases, to increase it further to 100,000,000 units a week, which should be almost sufficient to treat all patients who need penicillin. At first the distribution was controlled by the pathologists of the four main centres, who, at considerable inconvenience, generously gave of their time in supervising the administration of penicillin and restricting its use to those patients who needed it most. In March, 1945, distributing depots were established at the hospitals at Hamilton, Gisborne, New Plymouth, Wanganui, Napier, Waipukurau, Palmerston North, Nelson, Blenheim, Greymouth, Timaru, lnvercargill, and the four main centres. It is hoped that, in the near future, the Control Order restricting the use of penicillin will be revoked and all hospitals which have refrigeration will be able to order penicillin as they need it, just as they order other medical supplies. The visit of Sir Howard Florey, who gave two lectures in each of the four main centres and one at Nelson, was a most stimulating experience and of great benefit to those who were privileged to hear him. DIVISION OF SCHOOL HYGIENE Nutritional State of School-children A significant fact evident from the statistics of the medical examination of school-children is that there has been a distinct falling off in their nutritional state since 1940. Percentage of Children ivith Subnormal Nutrition European. Maori. 1940 .. .. .. .. .. .. 4-23 1-36 1944 .. .. .. .. .. .. 9-35 6-33 The effect of the war was scarcely felt in 1940. Thereafter rationing, official and unofficial, has had a cumulative effect. At first, substitute foods were available, but as the war has progressed milk, eggs, cheese, liver and kidney, bacon, green vegetables, and potatoes have been subject to periods of shortages or, in the case of vegetables, to periods of high prices as well. It is not easy for the housewife to maintain a balanced diet. She is often unable to follow the simple dictum, " Make up with milk and vegetables," because of the shortage and price factors. As soon as milk becomes scarce, as it has done the last three winters, school milks are stopped or rationed. In 1944 school milks reached less than half the children in the winter months and in some districts the supplies ceased earlier in the autumn term. Confirmation of the unsatisfactory child nutrition is found in the pre-school figures, where 10-34 per cent, were found malnourished. Dental State op School-children As the school-children have become completely serviced with dental clinics, both dental caries and extractions of permanent teeth have diminished and fillings have increased. This is a curative service that has succeeded ; the preventive side is not apparent yet, for perfect sets of teeth are getting fewer and fewer. Goitre In the period 1920-30 goitre in school-children was a problem ranging from 20 per cent, to 30 per cent, in certain areas and giving a New Zealand average over 20 per cent. The opening year of the "forties" found goitre established at: Europeans, 13-74 per cent.; Maoris, 8-68 per cent. This 1940 figure has been further reduced in 1944 to 9-71 per cent, in Europeans and 5-73 per cent, in Maoris. This would seem to be a success for preventive medicine, as in the two decades and a half concerned the use of iodized salt has steadily risen till most of the population now take the iodized variety of salt. Immunization There were 31,210 children given the complete immunization course against diphtheria. Of this number, 15,456 were of pre-school age. Using Phase I Type C Commonwealth of Australia vaccine, 1,460 pre-school children were given the full course of inoculations against whooping-cough. This latter work is being done on request only and is limited to the age group six months to two years. The Pre-school Child A total of 8,645 pre-school children were medically examined, but the work of the pre-school clinics is being seriously handicapped by the shortage of staff. DIVISION OF NURSING Shortage op Nurses There has been a general shortage of nurses due to the demands of the Armed Forces and the increase in the hospital-bed rate. However, we may expect some improvement in the position as larger classes

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