H.—3l

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There were eighty-six licensed private hospitals in Auckland Health District. The majority of these are well equipped, and are found on inspection to be in excellent order and well managed. Several private hospitals in the country districts, however, arc not up to the standard required by this Department, but these are being gradually improved and the necessary requirements are beingadded. The improvements effected are specially in regard to sanitary conveniences, labour-rooms, and nurseries in maternity hospitals. SECTION 2.—WANGANUI AND TARANAKI HEALTH DISTRICT. Dr. H. G. H. Monk, Medical Officer of Health. Diphtheria. This complaint has only a Blight reduction to be noted, and the same remark may be made as in scarlet-fever cases —the cases were of the mild variety. Thanks to the almost universal use of diphtheria anti-toxin as soon as the case shows itself, the illness is cut short, and the lives of many persons saved. The earlier the treatment is commenced with the anti-toxin the better. The controversy as to how many units should be given seems to have more or less died out, and doses of six thousand to eight thousand are now freely given. When the very large doses of sixteen thousand to twenty thousand were given we frequently heard of the reaction that followed. Eight or ten days after the injection enlargement of the lymphatic glands and. erythematous rashes appeared. First doses may be given without these reactions, but if a second dose is given the reaction may occur. These reactions are supposed to arise from antigen bodies in the scrum and not from the anti-toxin itself. I have noted the above facts, as in two cases during the past year I saw the glandular enlargement which was put down to the diphtheria, but which was undoubtedly due to the two large doses of anti-toxin administered. At one time we received rather frequent notifications from the Hawera district, and I visited the school and obtained swabs from the throats of about one hundred and fifty children. This proceeding was effectual in spotting the carriers, who were isolated. The result was quite successful, and the cases ceased. Cases of diphtheria were reported from New Plymouth (all parts of the town), Inglewood, Waitara, Stratford, Tuna, Mahoe, Wharehuia, Hawera, Eltham, Kaponga, Waverley, Wanganui, Ohingaiti, Marton, Turakina Valley, Taihape, Bull's, Rata, and Raetihi. Of the above-named places the incidence of diphtheria was heaviest at New Plymouth. The sewerage arrangements at New Plymouth require a new system altogether to abolish the high number of so-called septic tanks at present in use, which are a danger to the health of inhabitants and visitors. The need of new sewers is well known to the New Plymouth Council, and I have been informed that as soon as the new hydro-electric works are finished the sewers are to be taken in hand. Enteric Fever. The total number of cases of enteric fever keeps low, and the cases are about equally divided amongst Maoris and Europeans. Tuberculosis. The number of cases notified during the past twelve months was thirty-eight, as compared with fifty and fifty-six in previous years. This is a very satisfactory condition, especially when the fact that a very great part of the district has very heavy rainfall and there is also an abundance of clay subsoil throughout. More use has been made of the sanatoria than in previous years, and the increased knowledge of precautionary measures thus disseminated must prove of value to relatives. Puerperal Fever. During the year nine cases were notified of this disease, as compared with seven and twenty-one in the two previous years. Out of these nine, four certainly cannot be considered true puerperal fever, as there were causes other than puerperal to account for the rise in temperature. In one case, where the temperature was noticed within forty-eight hours of the time of confinement, it was exceedingly difficult to find a cause. The patient came from a clean home and was well cared for, and nothing out of the usual was noticed at the time of confinement. The home in which the birth took place is one of the most carefully run and cleanest in the district. The only clue that I could find, after asking a number of questions from the nurse, was that the husband had had to go home in a hurry, as he had a cow with milk-fever, which he had been attending for several days, and he had been coming into the house for ablution purposes. Ido not know whether there could be any connection between the two cases, but it struck me as possible. In none of the cases notified did a second one occur in the same hospital. In another connected with farm life a patient was brought into a nursing-home in a most filthy condition, and had to be cleansed thoroughly as quickly as possible before the birth of the cliild. From the description given to me by the nurse, the wonder would have been if no trouble had followed the confinement. An inspection of the house from which the patient came proved it to be of the dirtiest description. This was the only fatal case in the Wanganui-Taranaki District during the year. The occurrence of a case of puerperal fever is a most serious happening in a nursing-home, as if it gets to be known it means the avoidance by expectant mothers of that home for months. For this reason medical men and nurses are very reluctant to notify a case until they are absolutely sure of their diagnosis, with the result that serious trouble probably follows. As a rule there is no isolation ward in-any ordinary nursing-home, and the staff is not numerous enough to allow of a nurse being set apart for a special case. Hence the cases are sent to the public hospital. This always seems very