63

H.—3l

Auckland City, Devonport, Mount Eden, Onehunga (11 cases, against nil last year), Eden Terrace, Mount Albert, Remuera, Coromandel County, Manukau County, Rodney County are localities chiefly responsible for the increase, though various other portions of the health district contribute their quota. Of the 19 cases in Manukau County, 13 lay within an area of some five square miles, a triangle lying between Pokeno, Paparata, and Pukekohe. Noticeable decreases are observable in Grey Lynn, Parnell, and Whangarei (from 7 cases to nil). Domestic pets, more especially cats, are carriers of the disease. In one street in Auckland two cases in all probability arose from a cat having become infected and having introduced the disease to a household. Tuberculosis. The cases notified for the five years are—l9o3-4, 92; 1904-5, 86; 1905-6, 86; 1906-7, 96; 1907-8, 198. As has been remarked in reports from this office in previous years, notifications of this disease are an imperfect indication of its prevalence, and perhaps the increase this year is due almost entirely to more perfect notification. Lack of accommodation has nullified to some extent the benefits of compulsory notification. The various Hospital Boards in the district, however, now have either provided, or are at present providing, consumptive annexes. Thanks to the initiative of the Auckland Hospital Board, and the willing work of Dr. King and Mr. Bannerman, the medical attendant and manager of the Costley Home, shelters have been erected there to accommodate twenty-four cases. The opening of the Karere Tree-planting Camp provided a home for six Auckland cases which had improved at Te Waikato Sanatorium. Blood-poisoning. Cases notified during the past five years are—l9o3-4, 21 ; 1904-5, 16; 1905-6, 15; 1906-7, 19; 1907-8, 76. The increases over last year are, — £ [1906-7. 1907-8. *ST Auckland City ... ... ... ... 4 34 +30 Suburban boroughs ... ... ... ... 5 10 +5 Suburban road districts ... ... ... 1 7 +6 Country districts ... ... ... ... 9 24 +15 Hospital ... ... ... ... 1 +1 Increase ... ... ... ... ... ... ... 57 Noticeable increases have occurred in Auckland, Devonport, and Manukau, while cases have been distributed over almost the whole of the district. This increase may in some measure be attributed to the stringent measures taken to enforce notification. The 76 cases reported are to be classified thus: — Septicaemia (unclassified) ... ... ... ... ... ... 23 Erysipelas ... ... ... •■■ ••■ ••■ ... 23 Tetanus ... ... ••• ■■• •■■ ■■■ • ■• •■■ 7 Puerperal ... ... ••• ••■ ... ••• ... 23 76 Only 3 cases of puerperal septicaemia were reported in 1906-7. Septicaemia. —Septicaemia, erysipelas, and puerperal fever may all be classed as preventable or " dirt " diseases. They originate from specific micro-organisms which enter the body either by abrasions, wounds, or contact with'"' mucous membranes. People whose resisting-power has been lowered through living under insanitary conditions, from accident, or women after parturition, are especially prone to these diseases unless minute attention is given to scrupulous cleanliness and the details of disinfection. To attempt in some measure to prevent the spread of infection, all registered midwives in attendance on such cases have been suspended, whilst monthly nurses have been prohibited from practice for one month by arrangement with the Inspector-General of Hospitals. Although no doubt such a seemingly arbitrary proceeding may in some cases appear severe, more especially where the nurse was in no way to blame, yet, in the interests of lying-in women, this precaution was deemed necessary. In Johannesburg even more drastic precautions were taken. "In all notified cases the hands of midwives or other female attendants were as far as possible disinfected in the presence of the Inspector, by cutting and cleaning the nails, soaking the hands in ether after a preliminary wash, then scrubbing vigorously with yellow soap and veryhot water for five to ten minutes, and finally soaking in 1 to 200 of izal or cyllin for five minutes. Clothing and other possibly contaminated articles were also disinfected, and the persons in question were required to bathe." In Auckland some midwives have voluntarily brought their baskets or kits for disinfection.