69
H.-31
Ambulance. An effort was made without success to induce the Hospital Board to take over the ambulance service. Nurses are now provided, however, to accompany special cases in the ambulance. Maori Hygiene. Opportunity has been taken to co-operate with Dr. Buck in his interesting and useful work among the Maori people. Inspections were made, together with the Matron of the Te Waikato Sanatorium and the Native Health Officer, of the Maori whares at Whakarewarewa and Ohinemutu, in order to award the prizes given by the Mayor of Auckland, the Health Department, and Mr. Leo Buller. Her Excellency Lady Plunket took an interest in this work, presenting certificates to the prize-winners. Dr. Pomare and I toured through the Bay of Islands, visiting Native schools and pas. Open Spaces. Newmarket initiated in this district the movement to remove the railings round open spaces. Sanitary conveniences are provided in the numerous Auckland parks. Quarantine. Thirteen ships were visited at the request of the Port Health Officer. In no case was it necessary to institute quarantine. An outbreak of measles on the N.Z.S. " Ainokura " was met by the isolation of three cases in the Auckland Hospital, and the subsequent landing of four cases at Motuihi, where the ship was disinfected and painted. Infant-life Protection. Auckland has been fortunate in having been the centre of a crusade to introduce a better system of artifically rearing children, the mothers of whom were unable to bring them up on the breast. Her Excellency Lady Plunket and the local committee, with Mrs. Parkes as secretary, have already done much good in educating the public on this subject. The lives of children have been saved. lam confident that as a result of Nurse Chappel's work as Plunket Nurse there will be a reduction in the infant mortality. Miss Jackson, District Agent under the Infant Life Protection Act, is doing excellent work. In a letter on her work Miss Jackson says, " I have only to say that I find naturally the great source of infant mortality is the substitution of patent foods and bottle feeding for the food which nature provides, and the substitution of the foster-mother for the natural mother with her instincts and sympathy for the child who is her own." Thus Miss Jackson, who has the supervision of the licensed homes, finds these, even when well regulated, but a poor substitute for that which unfortunately is denied to some children—a home with a mother's love and a father's care. Mrs. Hutchinson, with an experience of twenty-seven years in Melbourne, Sydney, and Brisbane, whose work at the Door of Hope is well known in Auckland, also states, '' That attention to details of cleanliness, and more especially the sterilising of feeding-bottles, prevented the loss of infant life." She thinks that the sale of bottles with tubes should be prohibited. Certainly I think the imposition of a prohibitive tariff on these death-traps would prevent their introduction into the country. The only reason why they are favoured by some mothers is that they are less trouble, and do not require holding up by the nurse. Mrs. Hutchinson's experience teaches her that a baby cannot be comfortably fed in a cradle —satisfactory bottle feeding can only be carried out with the modern boat-shaped bottle. Closure of Schools. As to the vexed question of closing schools owing to outbreaks of infectious disease, a subject to which much attention has been given of late years, public-health experience shows in New Zealand, as in older countries, that, with the exception of Native schools in isolated districts of the Dominion, the rules enforced by the -London County Council after consultation with the Society of Medical Officers of Health, in addition to the Memorandum to the Local Government Board issued in 1904, the latest authoritative ruling on the question, are in the main applicable to the schools under the control of the Auckland Education Board. The complement to exclusion is seclusion. The prohibition of exposure in the public way is intended to enforce the isolation of an infected individual in the house or hospital. As to the question whether an outbreak is best combated by closing the school or by excluding the children from infected households: If the cases are few and their origin known, the prompt exclusion of children from infected households often suffices in checking such diseases as diphtheria and scarlet fever. With regard to measles, however, the infective period is greatest during the pre-eruptive stage, which may last for four days before the appearance of the rash; it might seem, therefore, that my pronouncement against the closure of schools on the occurrence of measles was not advisable. Experience, however, has shown that in dealing with this disease the closure of a school has practically no effect in checking or mitigating an epidemic. Thus, in Auckland, to have closed any of the schools in which measles had broken out for a fortnight, as suggested, would have had no material effect, as in most cases the epidemic had already secured a firm hold on the children, and the opportunities for the spread of infection were so many that unless every sufferer could have been removed to an isolation hospital the risk of contracting the disease would have been minimised.
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