5

H.—3l

The Otago Hospital Board's Sanatorium at Pleasant Valley, near Palmerston, with accommodation for forty-six early cases, having proved too small for requirements, quarters for an additional eight patients have been erected. Cases from the hospital districts of Waitaki and. Maniototo are still being admitted to Pleasant Valley by arrangement with the Boards concerned, but owing to the lack of accommodation cases from Southland and other hospital districts are to be excluded. The Southland Board has built a small sanatorium of twenty beds on its Kew property, near Invercargill. Advanced cases will continue to be treated at the various local hospitals throughout the health district. The Otago Hospital Board is proceeding with the erection of a large hospital for consumptives on its Waikari property, on the outskirts of Dunedin, including provision for thirty-six cases, and sixteen in emergency wards, to relieve the Dunedin Hospital of such cases as quickly as possible. General Sanitary Conditions. The reports of all the District Health Officers go to show that there has been little tendency on the part of local authorities to undertake works of any magnitude during the war, and the extension of existing sewerage schemes and the institution of new ones has had to be delayed in any but minor undertakings. Sanitary Conditions of the Maoris. The notifiable epidemic; diseases to which the Maoris are in any degree prone are enteric fever and tuberculosis. Enteric fever is more or less endemic, but during the year there were seventeen outbreaks, fifteen being in the Auckland Health District and two in the Wellington. In six of the cases is was necessary to establish temporary hospital camps under the charge of the local district nurse for Maoris. This was followed by a house-to-house inspection by the District Inspectors of the settlements concerned, with the result that a large number of old and dirty buildings were pulled down and many insanitary conditions remedied. Out of the total number of cases of typhoid (351) occurring in the Auckland Province some 155 cases are known to have occurred amongst the Natives or half-castes. In the Auckland country districts a total of 219 cases were reported : only about sixty-six of these occurred amongst Europeans. The work of the Inspectors and nurses to Natives in dealing with outbreaks of disease and supervising the sanitation amongst the Natives is bearing fruit, although in some districts it is still a most difficult matter. In many parts the provision of. proper privies has been enforced, and the supervision of water-supplies has been carried out. The Maoris are showing themselves more amenable to carrying out instructions and advice of nurses and Inspectors, but still require constant supervision. The nurses have assisted greatly in impressing upon the Natives the need for cleanliness and the enforcing of ordinary rules of hygiene. In the parts under constant observation of Inspectors and nurses the general sanitation of the Natives has improved considerably. As regards the Bay of Islands District, it is interesting to compare the infectious diseases occurring this year with 19.1.6. They are as follows : Diphtheria—number of cases in 1916, 18 ; in 1917, 5 ; enteric fever- number of cases in 1916, 258 ;in 1917, 18. The constant supervision of the Native pas and kaingas in the Native settlements by the departmental nurses and. Inspectors has no doubt greatly assisted in obtaining these results, and bettering the sanitary conditions under which the Natives now live. Climatic conditions have also, no doubt, had their influence in connection with typhoid. The rainfall has been SO heavy during the past twelve months that streams, springs, &c, have been thoroughly cleansed. The Natives will always make use of small streams, even one which there is reason to believe is infected, but the great increase of rainfall has benefited these by giving them a thorough washing-out. Hotel-inspection. The usual annual inspection of licensed hotels was undertaken before the annual licensing meetings, with the exception of the Otago District, in which the work was not able to be specially undertaken. In all 563 hotels were inspected by the Department's Sanitary Inspectors in conjunction with the police, and in 201 cases alterations were recommended and carried out. Offensive Trades. Various applications for permits to establish offensive trades were considered, and in those cases where no nuisance was likely to result were granted. The usual inspections wore also made of existing promises, and any nuisances arising therefrom remedied. These industries generally will always be a source of justifiable complaint when conducted in closely settled localities. The only remedy, even thus late in the day, is to set apart restricted areas in each district within which all now offensive trades must be. established, and to compel the older'works in and near towns to conform to strict regulations made uniform throughout the Dominion. To this end reports were obtained from the District Health Officers on the advisability of proclaiming a special area in or near each of the four chief centres, wherein all offensive trades should be located. Port Health Inspections. During the year 520 oversea vessels were inspected, as follows : Kaipara, 1 ; Auckland, 227 ; Onehunga, 3 ; Tauranga, 3 ; Napier, 6 ; New Plymouth, 8 ; Wanganui, 22 ; Wellington, 147 ; Picton, 1 ; Nelson, 1 ; Greymouth, 1 ; Westport, 4 ; Lyttelton, 39 ; Timaru, 7 ; Oamaru, 1 ; Port Chalmers, 25 ; Dunedin, 9 ; Bluff, 15. Fortunately no quarantining of vessels was necessary, as three of the four quarantine-stations are temporarily occupied by the Defence Department on condition that they shall be vacated if required.

Insert M. dl.