H.—31

56

Private Hospitals. The efficiency of these institutions is steadily improving. A new maternity hospital was opened at Dannevirke at the beginning of the year. The Soldiers Memorial Maternity Hospital at Hastings, which is under the control and management of the Hawke's Bay Hospital Board, was opened in July. Siijce its opening the number of admissions amply justifies the building of this public institution. Nurse Inspectors. The work carried out by the two Nurse Inspectors, Miss Broad and Miss Lea, in my health districts is excellent. In addition to the periodic inspection of all the private hospitals, the Nurse Inspectors visit the local midwives, maternity nurses, and masseuses, and inspect " beautyparlours," &c. All this work is carried out in addition to the large amount of office and correspondence work which their duties entail upon them. SECTION 7.—'TARANAKI HEALTH DISTRICT. Dr. Mbcredy, Medical Officer of Health. Infectious Diseases. The year was noteworthy for an extensive epidemic of scarlet fever, which was responsible for 583 cases (corrected figures) out of a total of 940 notifications received for all notifiable conditions. Pulmonary tuberculosis, pneumonia, pneumonic influenza, erysipelas, and puerperal fever all show a considerable increase in notifications over the previous year and also over the average for the previous six years. Diphtheria, showed a slight increase on the previous year, but the sixty-eight notifications are far below the average for the preceding six years. The majority of the cases were sporadic, and in no part of the district was an epidemic experienced. The type of the disease was mild as a rule, but two deaths were reported. No " carriers " were discovered, but this may have been due to the fact that swabbing of case contacts was only exceptionally resorted to. Scarlet Fever. —As predicted in my annual report for 1927-28, an epidemic of scarlet fever was experienced, and still continues into 1929. The epidemic reached its peak in July, 1928, when 156 cases were reported, as against sixty-seven in June and 107 in August. Owing to the large number of cases, it was necessary to arrange for treatment at home for a considerable proportion in order to relieve the congestion in the hospital isolation wards. This was only done where the home circumstances permitted of adequate isolation and nursing. As a result, only just over 50 per cent, of the cases were admitted to hospital. Of 221 of these cases whose history was gone into, 17 per cent, suffered with some complication, which, as a rule, delayed discharge from hospital. Nephritis was found to be present in six cases, and otitis media in eleven of the series. Only two deaths were recorded in the 583 cases notified. On the whole, it would appear that the epidemic was of low virulence, and few cases of permanent injury should result. It is, however, probable that some of those cases nursed at home or not seen by a doctor will require hospital treatment for complications recognized only some time after the febrile attack. So far as could be ascertained, the discontinuance of terminal fumigation as a routine played no part in the spread of the disease. Fumigation by formalin was desired and carried out in only thirty-four cases. The shortening of the standard period of isolation to four weeks had a marked effect in obviating overcrowding of the isolation wards. Enteric Fever.—Only eight sporadic cases of enteric fever were reported during the year, as against sixteen for 1927. This is very satisfactory in view of the large number of Maoris in the district, together with the relatively unprotected state of the water-supplies to the boroughs. Pulmonary tuberculosis was notified as present in thirty-six patients, as against thirty-two for the previous year, and an average for the preceding six years of nineteen. This rise is probablv due to the presence of a Medical Officer of Health in the district and the consequent prompter and more regular notification of all cases of the disease. Owing to the extent of her other duties and district, organized following-up of all child contacts of the cases was not carried out by the school nurse during the year. There are fifty-six school-children and fifteen pre-school children now on the roll of contacts. These children are the contacts of fortytwo cases. Puerperal fever was responsible for seventeen notifications, as against an average of eight for the preceding six years. Five of these proved fatal, including three cases which occurred in a private hospital in New Plymouth. The circumstances of this happening were fully investigated by Dr. Paget, and steps taken to prevent, as far as possible, a recurrence. Pneumonia and Pneumonic Influenza. —One hundred and sixty-three cases of pneumonia were notified, and twenty-eight of pneumonic influenza. The notifications of influenza from the schools suggested that there was a fairly widespread epidemic in the district, causing a considerable amount of absence from school. The maximum incidence was reached between June and August in most of the larger schools.