13

H.—3l

" Some of the post-mortems held on very acute cases in young adults showed septic lobular invasion of both lungs, intense inflammation of the whole of both lungs breaking down in patches into pus ; and an interesting point was that in some of these cases wherein practically the whole of both lungs was intensely congested the medical attendant was confident prior to death that the base of one lung only was involved. Percussion and the stethoscope indicated to him one-sided lobar distribution. " The Government Bacteriologist informs me that bacteriologically the outstanding feature was the presence of the mixed infections of which a hsemolytic staphylococcus aureus was the most constant finding. Several of the fatal cases showed staphylococcal septicaemia before death, apparently in pure culture. During the period April to August, 1923, also, there were indications of a general exaltation in virulence of the staphylococcus, causing, for example, virulent osteomyelitis and fatal septicsemia following boils, <feo. " The Pfciffer bacillus was a very constant finding, always associated with staphylococcus aureus, pneumoooccus, streptococcus, and micrococcus catarrhalis in this order of frequency. Pneumococcus plus Pfoiffer was much less common than staphylococcus plus Pfeiffer. Of those which occurred type I was the commonest, but the other types occurred. " In view of recurrences in the future, the disturbing feature is the absence of any vaccine or serum prophylaxis or treatment of proved value, excepting type 1, pneumococcus serum, in the few oases in which this bacillus predominates." Acute Primary Pneumonia. The notifications for this disease show a considerable decline. In 1923, 788 cases were notified as compared with 946 cases in 1922 and 1,029 cases in 1921. It is difficult to say to what extent this lessened number of notifications represents a real decline in the disease. It may be that cases which in ordinary times would be called acute primary pneumonia were in an influenza year notified as pneumonic influenza. Pueiu'ebal Fever. The following table shows the course of this disease for the quinquennium 1919-1923:—

Puerperal Fever in New Zealand, 1919-23.

It is well known that the returns of notifications in puerperal fever are, as a general rule, far from complete, and that for this reason the returns of deaths provide a more accurate presentation of the position. The position disclosed by the above table is not satisfactory, and indicates the need for review and overhaul of the present methods. The Department has prepared and proposes to issue more stringent regulations in regard to midwives and private hospitals, which it is hoped will exercise some influence in reducing the undue incidence! of this disease. Fuller information concerning the distribution of the above diseases, together with details of the remaining notifiable diseases, is contained in the subjoined tables.

Table A. —Notifiable Diseases in New Zealand, 1923, showing Distribution by Months.

Year. Notifications. Number Rate P er 1 ' 000 JNumbei. Live Births Di ?,aths. Number. Rate per 1,000 Live Births. 1919 1920 1921 1922 1.923 79 3-23 124 4-14 178 6-23 262 9-03 176 6-93 52 67 48 52 52 2-12 2-22 1-68 1-79 1-86

Month. 4) 3 a A 5 & o I A I 3 C 9) .O H .a •g "So 9 •a |S| CC d 03 I 4) >. a O 1 i ° j rt rt i g 5 3 I § 6 s ; 3 0, rrj C Ph HH Ph a • -a I •f 1 -3 « a 11 I I I i | 11 9 3 -a £ ; 2 ££ eq H M Eh | H O ■™ 5P in 1 « I O'S . .3 >• Sro rfj Ph S <« a a r- a ~ £rH HH O 3 5 u flow o -5 <S fH B 2 419 .. .. 1 1 401 2 506 500 2 560 1 639 2 1,119 1 1,013 4 489 12 .. 10 .. 499 8 458 3 ..2 .. 374 January .. j 62 February .. 64 March .. 114 April .. 133 May .. 137 June .. 136 July .. 120 August .. 86 September 99 October .. 93 November 88 December 69 125 163 175 192 199 240 233 141 107 129 120 121 44 33 21 20 20 20 18 18 11 22 19 24 89 70 93 79 88 75 88 95 75 103 83 04 1 1 5 1 2 4 3 1 2 0 7 3 5 1 4 3 1 14 5 45 17 4 23 16 6 48 8 7 20 20 7 54 23 34 56 11 473 138 10 487 145 10 72 86 11 18 62 13 27 62 17 4 43 18 .. 3 1 .. 5 11 .. 4 3 14 15 .. 3 2 2 .. 18 .. .. 2 2 6 18 3 3 .. 13 29 10 5 1 2 2 27 4 1 1 .. .. 15 5 2 .. .. 1 12 4 2 2 . . 2 19 4 3 3 .. 2 17 2 2 2 .. 2 14 0 1 3 .. .. 1 2 2 1 2 5 4 6 3 2 .. i 1 2 1 2 2 2 16' '.'. 2 .. 13 2 ! Totals, 1923 1,201 1,951 270 1,002 36 17 176 1144 788 213 38 29 20 8 27 8 27 36 ..13 2 6,977 Totals, 1922 1,449 1,989 539 1,129 42 98 262 216 946 271 .. 36 22 7 26 7 20 36 2 4 1 7,075 2 4 1 Note.— -Eela a first became noi itifiable in May, 1923. tmpsii May, I.