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to the Department's proposal as to the appointment of whole-time Medical Officers. In the sanitary government of some of our larger cities there is certainly room for improvement. As far as the present health districts are concerned, the work of tho Department has been to some extent decentralized, inasmuch as the Medical Officers of Health have been given more direct powers of supervision and control over departmental activities within their districts. During the past year Dr. Wilkins resigned his position as Director of the Division of School Hygiene, and Dr. Ada Paterson, who has been closely associated, with the School Medical Service for many years, was appointed in his place. Now that the economic outlook is brighter and the personnel of the Department has been somewhat strengthened, we can look forward with a certain degree of confidence to increased activity and better results in the cause of preventive medicine in this Dominion. However, the evolution of a healthy race can only be achieved when each citizen of the State bears his or her share of the responsibility ; and here I may well, quote a statement by Sir George Newman, Chief Medical Officer of the Ministry of Health, who wisely says, " The changes of disease, their effects on mankind, and the strengthening of the national physique to resist them are movements which are secular ; and prevention is also a matter of long periods of time. Preventive medicine is an aspect of social evolution which involves wide and deep apprehension and practice in society as a whole. It concerns individual habit and communal custom. It must not only follow in the wake of growing knowledge and await that knowledge, but it is dependent on the readiness of the great mass of the people to accept, understand, and apply that knowledge, at least in substance and principle. AM wise government no doubt depends on the assent of the governed, but in public and private medicine an even fuller assent is needful if the individual, is to reap his full advantage, and at the same time act loyally as a member of the community. In fact, he is under obligation to cultivate his own health and capacity, and so to conduct himself as not to conduce to the hurt or risk of his neighbours. Hence the progress of preventive medicine depends in extraordinary degree upon the enlightenment and education of the people. There is no doubt that owing to the national system of education, to voluntary educational movements and societies, and to the valuable agency of the Press and public opinion, such enlightenment is proceeding apace; yet it has to go far." Dr. M. H. Watt, Director of the Division of Public Hygiene, draws attention to certain features affecting the public health, which may be regarded as disquieting, chief of which is the very low birthrate. It is to be regretted that little more, can be said about this than has been said on previous occasions. It is, indeed, very hard to impress on mothers the fact that child-birth is not a disease, but a normal, physiological process. However, more will be said on this subject in another portion of this report. The high rate of still-births and the mortality-rate of infants under one month is also a matter for concern. On the other hand, the crude death-rate of 9-03 places New Zealand in a more favourable light, as does indeed its infant mortality of 43-8 per thousand births. In this connection all thanks are due to the Plunket Society for its untiring efforts to make this infantile-mortality rate the lowest in the world. Tuberculosis. —It is satisfactory to note that the death-rate from tuberculosis—6-21 per 10,000 — still shows a tendency to decline. The gradual fall of this death-rate is certainly satisfactory. The value of early sanatorium treatment cannot be too strongly urged, and. in this respect it is gratifying to read the remarks of Dr. H. Short, Medical Superintendent of the Pukeora Sanatorium. Dr. Curtis, of the Otaki Sanatorium, on the other hand, does not report so favourably as to the admission of female patients. It is early yet to speak of the results of Professor Dreyer's vaccine treatment, which has been tried at Pukeora. We look forward to speaking more definitely as to the results of this treatment in the course of the ensuing year. The Department awaits with great interest the report of the special medical committee set up to consider the Spahlinger treatment. During the year there has been circulated to all medical practitioners copies of a revised issue of the departmental leaflet on " Consumption," for distribution where they might consider profitable. As members of the International Tuberculosis Union we have been kept advised of the most recent advance's in the treatment and prevention of this disease. The opening of tuberculosis clinics in connection with the public hospitals of the chief centres, on similar lines to the Anti-Tuberculosis Dispensary at Sydney, should prove an invaluable aid in the fight against this scourge. In answer to a questionnaire the Office of the League of Nations has been supplied with information as to tuberculosis in New Zealand. It is hoped that reliable international statistics will be available in the immediate future which will be most valuable for comparative purposes. Puerperal Fever. —The remarks of the Director, Division of Public Hygiene, under this heading and that of " maternal mortality " are of special significance. Maternity—when two lives are at stake—should certainly be free from all reasonable danger. Evidently with the realization that many of the deaths from puerperal fever are preventable, the General Medical Council have taken steps in Great Britain to improve the education provided in the medical schools as regards obstetrics. I quite agree with Sir George Newman when he states " There has been an unfortunate tendency to regard practical midwifery as a subject inferior to medicine or surgery and scarcely worthy of the personal, attention of a senior teacher." I have no doubt that the attention the medical profession are giving tliis question of maternal mortality will result in an appreciable lowering of the death-rate, and also the high rate of still-births and infant-death rate under one month, to which it bears so close a relationship. The reports of the Medical Officers of Health show that the Department has been giving this question very careful attention. The regulations gazetted for the conduct of private maternity hospitals should, if reasonably carried out, have a good effect.