H.—3l.

Vital Statistics. (Exclusive of Maori.) Death-rate. The death-rate was 9-25 per 1,000 mean population, as compared with the rate of 9-20 in the preceding year. Infant Mortality. The infant-mortality rate was 30-21 per 1,000 live births, a new low record for the Dominion. In 1939 the rate was 31-14. Still-births. The still-birth rate per 1,000 live births was 29-45 (31-21 in 1939). Birth-rate. The total births in 1940 were 32,771, representing a rate of 21-19 per 1,000 mean population. This was the highest rate since 1925. Maternal Mortality. The maternal-mortality rate, incltiding deaths from septic abortions, was 2-93 per 1,000 live births, as compared with 3-64 in 1939. When deaths from septic abortion are deducted, the maternalmortality rate was 2-50. Infectious and other Diseases. (Exclusive of Maori, unless otherwise stated.) A total of 2,929 cases of notifiable diseases were reported in 1940, as compared with 3,260 in 1939. Scarlet Fever. Three hundred and fifty-seven cases, with 1 death, were reported as due to scarlet fever. The corresponding figures for the previous year were 480 cases and 2 deaths. The death-rate per 10,000 mean population was 0-01, the same as in 1939. Di-phtheria. Three hundred and sixty-seven cases of diphtheria were notified, as compared with 517 in 1939. There were 15 deaths, giving a death-rate of 0-10. In 1939 there were 24 deaths and a death-rate of 0-16. Attempts to control the spread of this disease by compulsory notification, and the removal to hospital of cases and the control of carriers, have reached the practical limit of their usefulness. On the other hand, it is now accepted that diphtheria can be prevented by active immunization with toxoid or toxoid-antitoxin mixtures. Several countries have passed legislation making immunization against diphtheria compulsory for all young children. New York City was early in the field in diphtheria immunization, and is now reaping the benefit. In the decade 1920-29 there was an annual average of 10,685 cases of and 684 deaths from diphtheria in New York, but in 1939 there were only 543 cases, with 22 deaths. This excellent showing is credited to the extensive immunization of children against diphtheria. In New Zealand the campaign against this disease by means of active immunization was continued, and the results have been encouraging where it has been carried out for an extended period. In the East Cape Health District, for instance, a programme for the immunization of children was begun in 1930. In 1929 the case rate per 10,000 mean population in that area was 18-11, while in 1940 it had fallen to 1-82. The Medical Officer of Health for the South Auckland Health District again gives convincing evidence of the value of active immunization. He writes as follows :— " There was an increase in the incidence of diphtheria amongst the uninoculated. A total of forty-eight cases were recorded. With the exception of two cases which had received partial immunization, all the cases occurred amongst those who had not received the benefit of immunization, whilst the two partially immunized cases had received one injection only. There were four deaths, three of which were Among children of pre-school age. These deaths among young children point to the necessity for continued efforts to arrange for the immunization of as many as possible of the pre-school population. It seems fairly evident now that the campaign for the protection of children against diphtheria is proving a success, and it is hoped that, with further extension of the programme, this satisfactory position will be maintained." The immunization of children of school age will not in itself suffice to reduce the incidence of diphtheria. Children of pre-school age must also be protected. It is hoped through the co-operation of parents to reach in growing numbers this group of children. Parents of children entering school will be invited to have them protected against diphtheria when the School Medical Officer carries out the medical examination of the school. Steps have also been taken, in co-operation with the Plunket Society, to make this protective measure available to pre-school children attending the Child Welfare Clinics conducted under the auspices of that body.

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