PHARMACY

The registration of pharmaceutical chemists was first introduced by the Pharmacy Act 1880. This was followed by a succession of Acts until the present Pharmacy Act of 1939. Control of the training, examination, registration, and discipline of pharmacists is exercised by the Pharmacy Board, which consists of registered pharmacists who are proprietors, two pharmacists representing other members of the Pharmaceutical Society, and a barrister appointed by the Minister of Health. A Board of Examiners is appointed by the Pharmacy Board, and comprises six persons. Of these, one is nominated by the Minister of Education, two are nominated by the approved schools, and three by the Pharmacy Board. The training of a pharmacist includes two years at the New Zealand School of Pharmacy, followed by two years' apprenticeship to a master pharmacist.

The Pharmacy Board also appoints a Disciplinary Committee the chairman of which is the barrister member of the Board. Acting on the recommendations of this committee, the Board has certain disciplinary powers. All pharmacies must be under the control of a registered pharmaceutical chemist, and under the provisions of the Pharmacy Act, the Dangerous Drugs Act 1927, and the Poisons Act 1960, the retail sale of a large number of drugs and poisons is restricted to pharmacists.

The Pharmaceutical Society of New Zealand concerns itself with the ethics, status, education, and training of pharmacists, and protects the interests of the profession and of the public.

Provision has recently been made at the University of Otago for a degree of Bachelor of Pharmacy (B. Pharm.). In the case of the holder of this degree, the apprenticeship is of one year's duration.

PHYSIOTHERAPY

The Physiotherapy Act of 1949 is concerned with the training and registration of physiotherapists. A Physiotherapy Board is responsible for the control of the training, examining, registration, and discipline of physiotherapists. The New Zealand School of Physiotherapy at Dunedin is governed by the Otago Hospital Board. The physiotherapy course extends over three years, eight months of the final year being spent at a subsidiary school in the physiotherapy department of main hospitals in other centres. University Entrance Certificate is the required entry standard and the annual intake is over 60. There is a shortage of experienced teachers.

Post-graduate Courses

A two-year course conducted at the New Zealand School was introduced recently and leads to award of the Teacher of Physiotherapy Certificate. Entry requirements are physiotherapy qualification followed by at least two years' field experience. Courses of three months' duration are conducted a few times annually at the Physiotherapy Department, Public Hospital, Christchurch, in physiotherapy practice through influence of the neuromuscular system. The courses are open to all physiotherapists but limited to four at a time.

PUBLIC HEALTH

The Department of Health

An organised system of public health was first introduced in New Zealand by the Public Health Act 1872. By this Act a Central Board of Health was set up in each province, and power was given to each local authority to assume the functions of a Local Board of Health for its district. Of the Provincial Boards of Health, that of Auckland was the only one to carry out a sustained and constructive public health policy, and it was able to do this because it wisely appointed a salaried medical officer as its adviser. The Canterbury Board made a promising beginning, but soon lapsed into being solely a quarantine authority. Of the remainder some were entirely inactive, and others met from time to time but achieved little. Of the Local Boards of Health, that of Dunedin operated efficiently. It appointed a salaried medical officer, and, with his advice and encouragement, it was, for a few years, an active and enlightened board of health.

In 1876 the Provincial Governments were abolished and a new Public Health Act was passed setting up a Central Board of Health for the colony, and appointing each local authority as the Local Board of Health for its district. The Christchurch Drainage Board had been established in the previous year, and a special provision of the Public Health Act 1876 appointed the board as the Local Board of Health for the whole drainage district – that is to say, for the whole of the Christchurch metropolitan area.

The Central Board of Health, which remained in being until the end of the century, proved to be a most ineffective body. It provided no leadership for the local boards of health, and never took the initiative in any public health activity. For long periods it never held a meeting – even for so long a period as 10 years. Without any encouragement from the central authority it is little wonder that with one exception the local authorities displayed an almost complete indifference to public health, the exception being the Christchurch Local Board of Health during the short period that it was a Committee of the Christchurch Drainage Board. This board appointed a salaried medical officer, and was fortunate in finding in Dr Courtney Nedwill a man of outstanding ability and energy, with the result that for a number of years it carried out a constructive public health policy which did a great deal to improve living conditions in Christchurch and its suburbs. Unfortunately it was short of money and received no assistance, but rather hostility, from the Christchurch City Council and the other local authorities which comprised the drainage board's district. By 1885 the drainage board was unable to continue administering public health, and the responsibilities in this field reverted to the local authorities.

For the next 15 years public health remained a legal concept only. The Central Board of Health, on the rare occasions when it met, interested itself in quarantine matters only and, as no local authority appointed a salaried medical officer to advise it, anything in the nature of preventive medicine was out of the question. The awakening came in 1900 when the world-wide pandemic of bubonic plague reached Sydney. It could be only a matter of time before the infection spread to New Zealand, and this stimulated the Government to take some effective action. The first case of plague occurred in Auckland in June 1900, while Parliament was in session, and after the enactment of a hurriedly drafted Bubonic Plague Prevention Act, a new Public Health Bill was introduced and passed towards the end of the session. By the Public Health Act 1900 a Department of Public Health was established to be staffed with medical men who had expert knowledge in public health, and who, moreover, were to be full-time salaried Government officers debarred from engaging in private medical practice. The local authorities continued to be responsible for the public health control of their own districts, but the country was divided into six health districts, each under the control of a District Health Officer armed with such effective powers that in matters of public health the local authorities had little scope for independent action.

The first Chief Health Officer was Dr James Malcolm Mason, and he was able to collect around him a small band of keen and competent medical men. That there were such men available whose specialised knowledge was not being used is a measure of the extent to which the larger local authorities had neglected their responsibilities as local boards of health. Not surprisingly the District Health Officers found much to do in improving the sanitary conditions of the larger towns. For some time the Department's chief function was to bring about healthy living conditions in our larger towns, and to bring under control the diseases which are caused by filth. Mason remained in office for nine years during which he showed himself to be an enlightened administrator. He concentrated on public health essentials, and displayed great judgment in regard to the speed with which successive reforms were introduced. He was succeeded in 1910 by Dr T. H. A. Valintine who held the post of Chief Health Officer and, later, of Director-General of Health up to 1930.

After the First World War and the influenza pandemic of 1918, a new Act was passed, and the Department which had become progressively more and more understaffed was reorganised. The Health Act 1920 restored to the local authorities a measure of their autonomy in public health administration, the over-riding powers of the District Health Officers being assumed by the Board of Health which was given authority to requisition local authorities to provide necessary sanitary works, or to compel them to take remedial action if they had failed to administer the provisions of the Act in their districts. After 1920 the functions of the Department began to expand rapidly, and in addition to maintaining a sanitary environment they came to include many activities which are now grouped under the term “Social Medicine”.

In 1930 Dr M. H. Watt became Director-General of Health, and he speeded up the forward move to cover all aspects of preventive medicine. Unfortunately his term of office coincided with the great financial depression of the thirties, followed shortly afterwards by the Second World War, and during both periods the Department of Health, like other Government Departments, suffered from grave shortages of staff, which not only hindered the necessary development of its activities but even caused some retrogression in the proper maintenance of public health. Dr Watt retired in 1948 and was followed in succession by Dr T. R. Ritchie, Dr J. Cairney, Dr H. B. Turbott, and Dr D. P. Kennedy.

Growth of the Department

At first responsible only for the maintenance and supervision of public health in a rather limited field, the Department of Health over the years has grown in size with the increasing magnitude of the duties entrusted to it. The first of these additional responsibilities was added in 1909 when the Department of Hospitals and Charitable Aid was amalgamated with the Department of Public Health, which then became responsible for the supervision of hospitals, charitable institutions, and private hospitals, and for the control of nurses and midwives. Dr Valintine, who had left the Department of Public Health in 1907 to become the Inspector-General of Hospitals, now became Chief Health Officer as well as Inspector-General of Hospitals.

Under the Health Act 1920 the Department became the Department of Health, in recognition of its wider functions, and shortly afterwards it assumed control of the Pukeora Sanatorium, King George V Hospital, Rotorua, and Queen Mary Hospital, Hanmer. These institutions, first established for the treatment of service patients, were gradually converted to civilian use. In 1921 the School Medical Service and the School Dental Service were taken over from the Education Department. The former has expanded greatly over the years, while from the latter there developed the very efficient School Dental Service operated by dental nurses, all of whom have been trained in the Department. By 1965 there were 1,045 dental nurses supplying regular dental treatment to 456,049 children in 2,502 schools.

The enactment of the Social Security Act 1938 introduced a whole range of treatment benefits, the organisation and control of which became a function of the Department, and in 1946 supervision of health hazards in factories and other places of work became an additional responsibility.

Finally in 1948 the Department of Mental Hospitals was amalgamated with the Department, and later the X-ray and Radium Laboratory was taken over from the British Empire Cancer Campaign Society, and the National Health Institute was established. With all these numerous responsibilities, it is not surprising that by 1965 the Department had a staff of nearly 7,000, and a yearly expenditure of over £67 million.

Functions of the Department

The Department of Health is required to promote and conserve health; to prevent, limit, and suppress infectious and other diseases; to advise local authorities in matters relating to public health in so far as they are charged with the care of public health; to promote or carry out researches and investigations concerning public health and the prevention or treatment of disease; to publish reports, information, and advice concerning the public health; and to organise and control medical, dental, and nursing services so far as such services are paid for out of public money.

The manner in which these functions are performed are set out under the following headings: (1) Public Health Services, which include the prevention and suppression of infectious diseases, and measures taken for the promotion and conservation of public health; (2) Supervising Services relating to public hospitals; and (3) Laboratory Services for the prevention and treatment of disease.

Other departmental functions, namely, administration of mental hospitals and other special hospitals, administration of the health benefits under the Social Security Act 1938, and the operation of the School Dental Service, will be described in the sections relating to Hospitals, Social Security Health Benefits, and the Dental Profession.

PUBLIC HEALTH SERVICES

The first function of the Department, namely, the prevention of disease, and the promotion and conservation of health, derives its authority from the following legislation: the Health Act 1956, the Tuberculosis Act 1948, the Food and Drugs Act 1947, and various regulations under all three Acts. To enable these functions to be carried out, the country has been divided into a number of health districts, each in the charge of a Medical Officer of Health, a medical practitioner with special qualifications, and he is assisted by nurses, inspectors of health, and other professional, technical, and clerical officers. The Health Act is concerned with the control of infectious diseases; the operation of an adequate quarantine service to guard against the introduction of disease by ship or aircraft; the maintenance of a sanitary environment with safe water supplies, sewerage systems, and adequate provision for the removal and disposal of refuse; the control of healthy conditions in homes and other buildings, including places of work; the maintenance of proper hygiene in the preparation, storage, and sale of food; the control of nuisances and offensive trades, of the pollution of rivers and streams, and of the air; and the maintenance of child health.

Control of Infectious Disease

A large number of infectious diseases are required by law to be notified by medical practitioners to the local authority and to the Medical Officer of Health. Every case so notified is promptly visited by a health inspector who gives instructions about the quarantine measures necessary for contacts who attend school or are food handlers. He also sends a report to the Medical Officer of Health who decides what further action, if any, is necessary. By these means possible epidemics are prevented or cut short. These control measures to limit the spread of infectious disease are supplemented by more positive preventive measures such as vaccination and inoculation for the prevention of tuberculosis, typhoid fever, diphtheria, whooping cough, tetanus, and poliomyelitis. Some of this is done by private practitioners with vaccine supplied free of charge, while much of it is done by medical officers and nurses of the Department.

A committee of the Board of Health – the Epidemiology Advisory Committee – assists the Department in consultation on matters concerning the control of infectious diseases.

Tuberculosis Control

Measures for the discovery and treatment of early cases of tuberculosis have been greatly intensified since 1954, with a resultant great reduction in the incidence of tuberculosis and the number of deaths caused by it. This has made it possible to close several sanatoria that were full a few years ago, with other persons awaiting admission.

The chief methods of detection are Mantoux testing, and mass X-ray examination of selected groups. During 1964 chest X-ray examinations were made of 351,743 persons, and 93,608 were Mantoux tested. BCG vaccination was given to 33,034 persons, mostly children between 10 and 14 years of age.

Child Health

The purpose of the School Medical Service is the early detection of abnormality or ill health in pre-school and school children. This work is carried out by school medical officers and public health nurses, and they aim to see each pre-school child at the age of two, and again during the fourth year. Arrangements are made with private doctors for necessary treatment, and advice is given to mothers for the benefit of their children's health.

Children attending the primary schools are examined by a school doctor in their first school year unless they have already been seen during the preceding two years. Other children are examined by nurses twice during their primary-school life, and referred to a medical officer if any defect is found. Every effort is made to persuade mothers to be present at these examinations. Audiometric surveys are made also to detect deafness.

Child Health Clinics

Six Child Health Clinics have been established throughout the country for the investigation and treatment of emotionally disturbed and psychologically maladjusted children. Each clinic is staffed by a specialist paediatrician, a psychiatrist, an educational psychologist, a play therapist, a social worker, and a secretary. There is close liaison between the clinics and the schools, and the social worker investigates the children's home conditions.

Occupational Health

Oversight of the occupational health risks in factories and elsewhere is a responsibility of the Medical Officer of Health working in cooperation with the factory inspectors of the Department of Labour. To assist in this work an Occupational Health Unit, staffed by specialists, is to be established in the National Health Institute. Medical practitioners are required to notify cases of industrial disease seen by them, and this indicates where health hazards exist and preventive action is needed.

Control of Food Standards

The administration of the law governing the quality of food and drugs is exercised by each Medical Officer of Health whose officers take numerous samples for analysis which is carried out by the Dominion Laboratory and its branch laboratories. In addition to maintaining the quality of food, the Food and Drug Regulations specify how food in packets should be labelled so that the purchaser is fully informed as to what he is buying.

Dental Health

Preventive dental treatment for pre-school and school children is an important public health undertaking, and is described more fully in the section dealing with dentistry.

Health Education

Preventive medicine has advanced far beyond the stage when the provision of a healthy environment is the sole aim of the public health authority. Much ill health is caused by errors and indiscretions on the part of the individual, and to correct this, and to teach people to feed themselves aright and to live an active, temperate, and well-balanced life, are important functions of the Department. Newspaper advertisements, booklets and leaflets, posters, films, health talks, and radio broadcasts all play their part in the campaign. Much health education is given in personal day-to-day contact, with individuals and small groups, by dental nurses, public health nurses, inspectors of health, and other field officers.

Medical Statistics

The maintenance of a Medical Statistics Branch is a most important feature of public health administration. The collection and examination of statistical data relating to the causes of morbidity and mortality form an essential foundation on which to build an effective public health policy.

Services for Maori Health

The Maori people, though enjoying equal political rights with their fellow citizens, present certain problems which have their origin in heredity, the lingering effects of old tribal habits and customs, and a sense of values which differs from that of Europeans, and all these pose a problem in the field of public health. The innate vigour of the Maori race is shown by their high birthrate of 46 per thousand population, compared with the European rate of about 25, and a correspondingly more rapid population increase; but the morbidity and mortality statistics of the Maori show higher death rates at all ages, and a greater susceptibility to many types of disease as compared with those of the Europeans.

In attempting to correct this disparity, the Department provides a District Health Nursing Service in all districts where Maoris are numerous, and special attention is given to maternal and child welfare and control of acute infectious diseases and of tuberculosis. These services are additional to the ordinary public health, medical, dental, and hospital services which the Maori shares equally with the European. Much of the increased incidence of ill health in Maoris arises from poor housing, overcrowding, and lack of suitable employment, which are perhaps an unavoidable accompaniment of an extremely high birthrate. The problem is clearly much more than a public health problem, and is closely bound up with education, incentive, occupational training, and suitable employment.

Quarantine Services

Legal provision for the necessary quarantine measures affecting ships and aircraft from overseas is contained in the Health Act and Quarantine Regulations, and this legislation has been drafted to comply with the International Sanitary Regulations adopted in 1951 by the Fourth World Health Assembly. Responsibility for administering the quarantine provisions rests with the Medical Officer of Health of the district, and a port health officer is appointed for each port to act as his deputy. For each international airport a medical practitioner is appointed to act in a similar capacity.

The only diseases for which special quarantine precautions may be taken are set out in the International Sanitary Regulations, and are smallpox, plague, yellow fever, cholera, typhus, and relapsing fever. These are legally known as the “quarantinable diseases”, the only one presenting any danger to New Zealand being smallpox. If any infectious disease other than a quarantinable disease appears on a ship or aircraft, it is dealt with in the same manner as would apply if a case of such disease arose within the country. If a case of a quarantinable disease is present on a ship or aircraft, the procedure to be carried out is set out in the appropriate regulation, the same procedure being followed in all countries.

Since about 1935 the quarantine stations, which were formerly maintained ready for use, have been done away with, it being possible to control the spread of quarantinable diseases by other means, namely, by hospitalisation, vaccination, and isolation or surveillance of contacts.

Control of Air Pollution

The Health Act 1956 provided the Department with additional powers for preventing pollution of the atmosphere. This is not a serious problem in New Zealand, but with the development of the country's industries it could become so unless preventive action were taken in time. Chemical inspectors have been appointed whose main function is to advise industry how to operate with the minimum pollution of the atmosphere, and they are armed with adequate powers to be used when necessary to reinforce their advice.

SUPERVISING SERVICES

Supervision of Hospitals

The public hospitals are completely financed from Government sources, and the Department is responsible, under the Minister of Health, for seeing that the hospitals are adequate in number and efficient in operation. While the detailed administration of hospitals is the responsibility of individual hospital boards, new hospital buildings, or extensions of existing buildings, come within the purview of the Department which must consider the need for the building in question and the overall requirements of the country, and keep expansion within the available resources of finance and the building industry. In this connection a large measure of responsibility rests with the Hospital Works Committee, a statutory committee consisting of the Director-General of Health, a Public Works engineer, and a Treasury officer. The Department maintains an Architectural Section and undertakes both detailed planning for the smaller hospital boards, and examination and modification or approval of plans prepared by private architects for the larger boards.

Another important function of the Department is that of providing inspection and advisory services for hospitals. This keeps the Department fully informed as to the developmental needs of hospitals throughout the country, and provides knowledge as to the quality of the treatment given by hospital staffs. Regular inspections are also carried out by nurse inspectors concerning the proper functioning of nursing services, including the training of student nurses, while an inspecting dietitian and an inspecting physiotherapist give advice within the scope of their particular specialties. Finally, the administration of the hospitals is assisted by the visits of advisory officers and advising house managers.

Private Hospitals are required to be licensed by the Department, and are under regular inspection to ensure that they are adequately staffed and equipped, and properly conducted.

LABORATORY SERVICES

The Department carries out its function of research and investigation through its two laboratories at the National Health Institute, and the Dominion X-ray and Radium Laboratory.

The National Health Institute

The National Health Institute was opened in 1954. It carries out research and teaching, and provides specialised laboratory and epidemiological services. An Occupational Health Unit, also, is now being developed.

Laboratory: The Institute has a number of laboratories whose work includes research, and the provision of services in general bacteriology, virology, bacteriophage typing, and chemistry. Though the work of the laboratories is primarily directed to public health ends, the services are available to and much used by hospitals and medical practitioners generally. Particular use is made of bacteriophage typing, the leptospirosis and toxoplasmosis diagnostic facilities, and of the salmonella and shigella reference services, for which latter the Institute is the national centre. The virus laboratories provide a general diagnostic service for virus diseases, and as national influenza centre serve as one of the world-wide chain of influenza laboratories organised by WHO.

Teaching: Teaching is an important function of the Institute. In association with the Wellington Technical College, it conducts a full-time training course for health inspectors, attended by departmental, local body, and Colombo Plan students. Refresher courses for more senior health inspectors are organised, and special short courses for hospital bacteriologists. Lectures also are given to post-graduate nurses, midwife trainess, and hospital staffs.

Epidemiology and Research: The work undertaken is directed to solving immediate practical problems, and recently great attention has been paid to those involved in cross infection within hospitals. This work has covered a very wide field ranging from architectural design, and ventilation, to small details of cleaning, laundering, and housekeeping, including the use and effectiveness of various disinfectants.

Smallpox Vaccine: All the smallpox vaccine used in New Zealand is prepared at the Institute.

Occupational Health Unit: The Occupational Health Unit, which is envisaged, will be concerned with the whole range of problems that arise in this important branch of public health.

The Director of the Institute is Dr J. D. Manning who succeeded the late Dr J. H. Blakelock.

Dominion X-ray and Radium Laboratory

This National Radiation Laboratory was established by the Department in 1950 to administer the Radioactive Substances Act 1949, and regulations enacted thereunder. The Act is designed to protect the people of New Zealand from unnecessary exposure to harmful radiation, and this purpose is achieved by:

1. Restricting the use of ionising sources to those qualified and competent persons who hold a current licence issued by the Laboratory.

2. Providing for the notification of all sales of irradiating apparatus, and establishing the Laboratory as the sole importing authority for radioactive substances.

3. Regulating against the gross misuse of radioactive substances and irradiating apparatus.

4. Providing, through the Laboratory, a radiation measuring and advisory service.

An essential feature of the working of the Laboratory is the provision of a field service. Trained physicists, equipped with a wide range of instruments, make periodic visits to all places where radiation sources are used. X-ray therapy units and hospital dosemeters are calibrated bi-annually. These field measurements are augmented by reports detailing physical data and giving guidance for protective measures. Monitoring of radiation workers is provided by the postal film service. The effectiveness of New Zealand radiological protection can be judged from the results which show clearly how the present very low doses have been progressively approached since national coverage was achieved in 1952.

The Laboratory supplies radon seeds and needles from its radon extraction plant, and also makes available Strontium-90 superficial applicators used principally for ophthalmic treatments.

An unusual feature of the organisation of radiation protection in New Zealand is that the services provided are available free to the licensees.

The Laboratory services are backed by development and research projects. In recent years the Laboratory has been actively engaged in investigating the degree of radioactive contamination from fall-out, and assessing what damage, if any, to the general public has arisen.

THE BOARD OF HEALTH

A Board of Health having advisory functions only was first established under the Public Health Amendment Act 1918, but was quickly superseded by the Board of Health set up by the Health Act 1920. This Board's functions were partly advisory, but it was also given statutory powers to compel local authorities to fulfil their duties under the Act, and where necessary to requisition them to provide sanitary works (water supplies, sewerage, etc.). The Board in fact assumed many of the powers wielded by the District Health Officers under the Public Health Act 1900.

By the Health Act 1956 the composition of the Board was slightly altered but it retains its statutory powers affecting local authorities, and also is required to furnish to the Minister of Health, on request, advice relating to:

1. The adoption of a general health policy for the promotion of health, the prevention of disease and disability, and the adequate and effective treatment of disease, and the proportion of the available resources that should be allocated for each of these purposes.

2. The relationship of the control and management of hospitals to the general health policy.

3. The operation of the health benefits under the Social Security Act 1938, and their relationship to the general health policy.

4. The coordination of the activities of local authorities under the Health Act, and of the activities of voluntary associations in respect of public health with the activities of the Department of Health.

By a new provision, the Board is empowered to appoint committees, of two or more persons, to inquire into and report to the Board on such matters within the scope of its functions as are referred to them by the Board, or to exercise on behalf of the Board any of its powers or functions. Any such committee may include persons who are not members of the Board.

This is a most important and far-reaching provision as the Board is enabled to appoint to such committees persons having special knowledge or qualifications suitable for the purpose for which a committee is appointed. Since 1957 a number of committees have been appointed, to investigate and report on certain matters, and concerned with local authority affairs, fluoridation, services for the deaf, air pollution, epidemiology, maternity services, and Maori welfare. The combined membership of these committees represents a large fund of expert knowledge on a variety of subjects. As a rule the chairman of each committee is a member of the Board, and is able to report personally to the Board on the activity of the committee. Reports of special committees have been printed and made available to the public. These deal with Outpatient Services in Public Hospitals, Psychiatric Services in Public Hospitals, Services for the Deaf, the Medical Examination of Young Workers, Grading of Public Water Supplies, Occupational Deafness, the Employment of Dental Technicians, the Introduction of the Metric System in Pharmaceutical and Medical Practice, and the Training of Health Inspectors, the administration and servicing of Public Water Supplies, and the Health Responsibilities of Local Government.

CONTROL OF HYDATID DISEASE

Hydatid disease is now receiving greatly increased attention, both on account of the ill health it causes, and also because of the great economic loss associated with it. The disease is due to a parasite which may occur in dogs as an intestinal tape worm, and during the cycle of its development it exists as a cyst in the organs of human beings or sheep and other animals. Dogs become infected by eating raw offal from an infected sheep, and the cystic stage is caused in man or sheep by ingestion of the tape-worm ova that are passed in the dog's excreta. Eradication of the disease aims to rid the dog of the infection by drug treatment, and to guard against reinfection by preventing the dogs eating raw offal. For very many years the Department of Health issued posters and leaflets setting out the method of eradication of the disease, while supplies of the necessary drug for the effective treatment of their dogs were supplied to dog owners at the time of the animals' relicensing. These measures proved ineffective owing to lack of the necessary stimulus, although by degrees groups of farmers have shown increasing awareness of the problem.

By the Hydatids Act 1959 a National Hydatids Council has been set up and charged with the function of controlling, preventing, and eradicating hydatids. Local authorities, under the general direction of the Council, are empowered to appoint inspectors, and to prepare plans for the prevention and eradication of hydatids in their districts. Inspectors have power to call on owners of dogs to make their dogs available for treatment at specified times and places, and to require them, where necessary, to provide disposal units or treatment units for the disposal or treatment of raw offal. Owners of dogs are required to pay fees for the treatment of their dogs. A great reduction in the hydatid infection of dogs has already been brought about, but some years will pass before complete eradication can be expected. This will show itself by the disappearance of the infection from sheep.

It is estimated that the economic loss to the farming industry through hydatids in sheeps' livers has exceeded £2 million per annum, while in human beings the disease has caused some loss of life and much unnecessary suffering.

PUBLIC HEALTH RESPONSIBILITIES OF LOCAL AUTHORITIES

Local authorities are required by the Health Act to maintain healthy conditions within their districts, and they carry out these functions with the general advice and oversight of the Medical Officer of Health.

They are empowered to make health bylaws, and are required to appoint a sufficient number of health inspectors to investigate cases of infectious disease, and to report on them to the Medical Officer of Health. They are required also to carry out inspections for the detection and removal of nuisances and conditions injurious to health, and to inspect food shops, food premises, and eating houses to ensure that they comply with regulations under the Health Act and with the local bylaws.

Healthy conditions in dwellings and places of work and entertainment are a responsibility of the local authorities who must provide and maintain safe water supplies as well as adequate sanitary services for the removal and disposal of refuse. They must also exercise control over offensive trades.

Challenge for Health: A History of Public Health in New Zealand, Maclean, F. S. (1964).

SOCIAL SECURITY HEALTH BENEFITS

Part III of the Social Security Act 1938 provides for the operation of a variety of health (treatment) benefits. The benefits introduced, and the years from which they have operated, are as follows:

1939, Hospital Benefits. Free maintenance and treatment in all State mental hospitals. Free maintenance and treatment in any public hospital. Payment of a portion of the fees charged for treatment in a private hospital

1939, Maternity Benefits. Services of a medical practitioner during pregnancy, confinement, and puerperium.

Free treatment in any public maternity hospital, and part-payment of fees payable to private maternity hospitals.

Payment of nurse's fees if confined at home.

1941, Hospital Outpatient Benefit. Free outpatient treatment in any public hospital.

1941, Medical Benefits. This provided free general practitioner services on a capitation basis. Few practitioners agreed to supply this service.

1941, Pharmaceutical Supplies Benefit. This provides for a wide range of drugs to be supplied free on the prescription of a registered medical practitioner.

1941, X-ray Diagnostic Services. These services are available free at a public hospital, and a portion of the fee of a private radiologist is payable by the Department of Health.

1941, General Medical Services. This is a general practitioner service on a fee-for-service basis. A fee of 7s. 6d. per consultation (12s. 6d. on Sundays and at night) is payable by the Department. Milage also is payable in country areas. The practitioner may claim direct on the Department, or may charge the patient in the ordinary way, the latter then claiming a refund. The practitioner may charge the patient an additional fee. General Practitioner Services in Special Areas. To meet the needs of special areas where the population is too small to support a medical practitioner, or for some other reason, the Minister may declare a special area, and engage a practitioner to supply a medical service for an inclusive annual payment.

1942, Physiotherapy Benefit. Massage treatment at a public hospital is free. A fee of 5s. from the Department is payable to a registered physiotherapist who may charge the patient an additional amount. The treatment must have been recommended by a medical practitioner.

1944, District Nursing Benefits. This provides free district nursing services if afforded by a nurse, midwife, or maternity nurse employed by the State, a hospital board, or any subsidised association.

1944, Domestic Assistance Benefits. Domestic assistance may be provided during a mother's incapacity, or in cases of hardship. The services are supplied through some approved organisation.

1945, Extension of Outpatient Benefits. Hospital boards may make payment to specialist surgeons in respect of operations for hare-lip or cleft palate at some place apart from the hospital.

1946, Laboratory Benefits. Free laboratory diagnostic services may be provided by any hospital laboratory, or by a pathologist in private practice.

1947, Extension of Outpatient Benefits. Provision has been made to pay the whole cost of contact lenses in certain deficient cases. Some types of hearing aids are provided at the cost of the Department, and a subsidy of not more than £13 is paid towards the cost of the more expensive hearing aids. The full cost and repair of artificial limbs is payable by the Department.

1947, Dental Benefits. Free dental treatment is available to hospital outpatients, and dental treatment is provided for adolescents up to the age of 16, provided they previously had enrolled with the School Dental Service.

by Francis Sydney Maclean M.B., B.CHIR., M.D.(CAMB.), M.R.C.S.(ENG.), L.R.C.P.(LOND.), formerly Director of Public Hygiene, Department of Health.