The New Zealander has a bad record in regard to dental health, but whether this is due to some quality of the soil or water, or to faulty food habits, or merely to indifference regarding the care of the teeth, no one can say. At least it is not for lack of skilled dental services, as the standard of dentistry practised in New Zealand is unquestionably a high one. The amount of dental ill health found among recruits enlisted for military service in the 1914–18 War called for some action, and a School Dental Service was set up in the Department of Education and transferred to the Department of Health in 1921.
The first attempt at control of the practice of dentistry in New Zealand was in 1880 when the first Dentists Act was passed. This Act introduced registration of dentists, and specified the requirements as to training and qualifications necessary for registration. It also empowered the Senate of the University of New Zealand to appoint examiners to decide whether or not certain persons practising dentistry were entitled to be registered. This was followed by the Dentists Act 1904 which made provision for dental training in New Zealand. The first Dental School was opened in Dunedin in 1908 and had provision for 20 to 25 students. The cost of the building was largely met by donations from members of the dental profession, and the Government subsidy seems to have been provided somewhat reluctantly. During the next 10 years the number of dental students was small until steps were taken to encourage potential students by the provision of dental bursaries. This had the desired effect, and by 1923 the school was quite inadequate for the numbers offering, and a new Dental School to accommodate 60 students was opened in 1926. Finally, in 1957 the building of a third Dental School, much larger and more adequately equipped, was commenced, and this building was completed and opened on 4 March 1961. The new school has accommodation for the training of 240 dental students (60 in each of the four professional years of the course).
The first Dean of the Dental Faculty and Director of the Dental School was the late Dr H. P. Pickerill who achieved distinction as a plastic surgeon. He was followed by Dr R. Bevan Dodds (1927–45), and the present Dean is Sir John Walsh, K.B.E.
An amending Act of 1921 made it an offence for any unregistered person to practise dentistry, and a third Dentists Act passed in 1936 provided for the establishment of a Dental Council having disciplinary powers. The legislation was re-enacted in the Dental Act of 1963.
The New Zealand Dental Association watches over the general interests of members, and the ethical standards of the profession, and is governed by an Executive Council. It publishes a quarterly Journal which has existed since the early years of the century. There is also a Council on Dental Health Education. Affiliated with the New Zealand Dental Association are the following professional societies: the New Zealand Society of Dentistry for Children, the New Zealand Society of Periodontology, and the New Zealand Orthodontic Society.
The School Dental Service in New Zealand is unique in that it has successfully accomplished its task in a manner never before attempted, and one that was generally considered to be impracticable. For these reasons the Service for many years created no interest overseas – it was in fact ignored. In recent years, however, the success achieved has brought international recognition, and similar services have been organised in several other countries. The originator of the Service was Colonel (Sir) Thomas A. Hunter, Director of the New Zealand Army Dental Service in the 1914–18 War. In 1921 he proposed to select suitable young women, and to train them in a two-year course to provide an adequate service of preventive dentistry to school children. The dental profession was at first sceptical, but finally gave its approval, and has since then given full support to the undertaking.
The first Dental Nurses School was established in Wellington in 1921, with 35 students. The yearly intake of new students fluctuated around this figure, and by 1930 there were 93 dental nurses working in 147 treatment centres, and 60,289 children (approximately half the primary-school pupils in the Dominion) were receiving regular dental treatment. The onset of the financial depression in 1930 caused the Government to suspend recruitment, and for five years the rate of expansion was greatly curtailed. After 1935 a policy of rapid expansion was adopted. An auxiliary school was established in Wellington and the original school was replaced by a larger modern building. The Service continued to grow but in the post-war years staffing difficulties became acute, as the high birthrate rapidly increased the numbers of children needing dental care, while the dental nurses were recruited from the generation born during the depression of the thirties when the birthrate reached a very low level. Nevertheless by 1950 there were 226,350 children receiving dental treatment, including many pre-school children. At the end of 1951 a second school for dental nurses was opened at Auckland, followed by a third in Christchurch in 1956. One purpose of the new school was to tap a further supply of potential students who were unwilling or unable to come to Wellington for training.
In the post-war years the work of the Service began to attract overseas interest, and eminent dentists from other countries came to study it at first hand. In addition, several Asian countries began to send student dental nurses for training in this country.
The quality of the work of the school dental nurses has been commented on by visiting dentists, some of whom came prepared to criticise. They have, however, been unanimous in their praise of the quality of the work done by the nurses. In addition to the dental treatment given, the dental nurses are very active in dental health education, and much time is devoted to this valuable work.
The growth of the School Dental Service over the years is shown in the following table:
| Year | Dental Clinics | Dental Nurses | Children Treated | Total Operations |
| 1927 | 47 | 44 | 19,325 | 201,002 |
| 1937 | 252 | 161 | 89,803 | 725,069 |
| 1947 | 456 | 423 | 226,798 | 1,578,605 |
| 1957 | 783 | 700 | 321,219 | 2,476,473 |
| 1964 | 1,075 | 984 | 431,941 | 3,517,097 |
| 1965 | 1,116 | 1,045 | 456,049 | 3,603,988 |
Dental benefits for adolescents became available in 1947 under the provisions of the Social Security Act 1938, and provide for continuity of dental treatment after a child leaves the primary school and up to the age of 16. Treatment is given by dentists in private practice working under contract, and by the larger hospital boards. Each enrolled child is seen at six-monthly intervals and given any treatment necessary. In 1965 there were 179,109 children receiving this benefit.
The Dietitians Act of 1950 was designed to further the advancement of the knowledge of nutrition and dietetics, and to make provision for the training and registration of dietitians. A Dietitians Board set up under the Act determines courses of training, approves places of training, conducts examinations, authorises registration, and exercises disciplinary powers.
A person wishing to train as a dietitian must obtain one of the prerequisite qualifications, and then take a course of training of not less than 12 months at a Dietitians' Training School. Any such person must: (a) Hold a degree in home science; or (b) Hold a diploma of associate in home science; or (c) Being a registered nurse, and holding an endorsed School Certificate or some other certificate approved by the Board, spend two academic years at the School of Home Science.
There are Dietitians' Training Schools at the Auckland, Wellington, Christchurch, and Dunedin Hospitals. After completing the course of training, candidates must pass a State examination.
In 1964 there were 82 dietitians with practising certificates, and the majority are employed in hospitals.
The Department has advisory dietitians who are available to assist hospital dietitians and others requesting help.
The beginning of a hospital system may be said to date from the Colonial Hospitals built by Governor Sir George Grey in Auckland, New Plymouth, Wanganui, and Wellington. These hospitals were intended both for Maoris and Europeans, to be nursed in the same wards; in addition to the admission of Maori patients, many more were treated as outpatients.
The Auckland Hospital was a wooden building sited in the Domain. Building commenced in 1846 and patients were admitted before completion of the upper storey. It was criticised by the Colonial Surgeon, Dr W. Davies, in 1849, as being too far from the centre of the town, and without a satisfactory water supply, its well failing in dry weather. He also complained that wind and rain gained access to some of the wards, and that there were no adequate bathing facilities. The Wellington Hospital was built at Thorndon about the same time, and was admitting patients by September 1847. It was a two-storey brick building, and suffered considerable damage in the severe earthquake of 1848. It was replaced by a wooden building on the same site in 1855, and in 1881 a new hospital was erected on the Riddiford Street site where the hospital now stands. The first hospitals in Canterbury and Otago were built later, but by 1853 there was a hospital at Lyttelton, and the first Christchurch Hospital was built in 1862. The Dunedin Hospital was built in 1851, in the Octagon, and was transferred in 1865 to the Exhibition Building on the site of the present hospital in King Street.
The hospitals continued to be administered by the Government until 1854 when they were handed over to the Provincial Councils. From time to time as the need became apparent other hospitals were provided, being paid for as a rule by public subscription subsidised by Government funds. By 1884 there were 38 hospitals distributed throughout the country. With the abolition of provincial government in 1876, the Central Government resumed responsibility for the hospitals, and for the next 10 years they remained under the management of local committees with the Government bearing most of the cost. Successive governments sought for a solution of the hospital problem, but could reach no agreement with the local authorities as to the best method of controlling and financing them.
In 1880 Dr F. W. A. Skae was appointed as the first Inspector of Hospitals and Asylums, but died in the following year. He was followed by Dr G. W. Grabham, who had considerable knowledge of hospital administration. He was at first very critical of the condition of the hospitals and their administration, but his helpful advice was readily taken, and in his final report for the year 1886 he recorded very great improvement in most of the hospitals. His chief criticism was of their haphazard distribution, and of the extravagant method of financing them.
The first Hospitals and Charitable Institutions Act was passed in 1885 and set the pattern for our hospital system which in the main has continued up to the present. The country was divided into 28 hospital districts, each controlled by a board whose members were appointed annually by the local authorities of the district. The hospitals were to be financed by patients' fees, and, it was hoped, by voluntary contributions from the charitably minded, the balance being supplied by local rates with a Government subsidy. A number of “separate institutions”, which also received money from the rates as well as Government subsidies, continued in independent existence so that in effect there were two separate systems existing together. A new Act was passed in 1909 under which board members were to be elected by the electors of their district, and to hold office for three years. All the separate institutions which could not operate without assistance from the local ratepayers were taken over by the hospital boards, and the number of hospital districts was increased to 36.
By 1926, when the third major Hospitals Act was passed, the number of hospital districts had been still further increased, and the boards received approximately one-third of their income from patients' fees, one-third from local rates, and one-third as Government subsidy. The Act of 1926 remained in force for 31 years, by which time the method of financing the hospitals had undergone such great changes that the Hospitals Act 1957 became necessary. The introduction of hospital benefits under the Social Security Act 1938 relieved patients of the payment of fees, while in 1946 the maximum rate of hospital board levy on local authorities was stabilised at one halfpenny per pound of the rateable capital valuation. This was still further gradually reduced over a period extending from 1951 to 1957, by which time the hospital income from local rates was entirely abolished, and the Government became responsible for all public hospital finance.
During the thirties it also became evident that the continual subdivision of hospital districts had gone too far, and a trend developed for the amalgamation of districts in order to increase the efficiency of the service. A number of amalgamations has taken place, and while there were at one time 47 hospital districts, the number has now been reduced to 37. The Act contains machinery for a further reduction of districts.
The Hospitals Act 1957, as well as making the Hospital Works Committee a statutory committee, set up a Hospitals Advisory Committee of six members, three departmental and three from hospital boards, its function being to formulate a national hospital policy and to make recommendations to the Minister; and while local administration remains with the hospital boards, the Department, under the Minister, continues to be responsible for the general supervision and direction of hospitals, and all capital expenditure must be approved through the Department by the Minister.
Today New Zealand is well supplied with modern hospitals distributed throughout the country in proportion to the population. In 1965, excluding mental hospitals, there were 74 general hospitals, 99 maternity hospitals, 22 special hospitals, 22 old people's homes, and three Government hospitals. The number of beds, at 31 March 1965, available for patients or inmates in all public institutions and licensed private hospitals, together with the ratio per 1,000 of population, is shown in the table.
The total staff employed in public hospitals and other institutions controlled by hospital boards at 31 March 1965 was 28,421, of whom the largest groups were:
| Medical practitioners (full time and part time) | 1,668 |
| Other professional and technical staff | 2,266 |
| Nurses | 12,825 |
| Domestic staff, etc. | 9,964 |
| Other treatment staff | 431 |
| Administrative staff | 614 |
Salary scales for the different grades of hospital employees are determined by a Salary Grading Committee so that uniform salary scales apply in all public hospitals.
The largest hospitals, at Auckland, Wellington, Christchurch, Hamilton, and Dunedin, in addition to the ordinary hospital services, are able to provide a wide range of specialist treatment which is available also to patients from other districts. Some seven or eight other hospitals of moderate size provide limited specialist services which are available to patients from nearby districts. All but the smallest hospitals are equipped with laboratories and diagnostic X-ray departments.
A few public hospitals are classed as closed hospitals—that is to say, the whole of the medical staff are full-time salaried officers of the board, but in the great majority of hospitals a large portion of the senior medical staff are part-time officers engaged also in private practice.
The larger hospitals have specialist outpatient departments in addition to the usual casualty department for surgical and other emergencies, but the attendance of outpatients seeking services that can be provided by the general private practitioner is discouraged.
Hospital boards are required to operate their own ambulance services unless they enter into some arrangement with a subsidised voluntary agency. In 1965 there were 229 road ambulances operating from 130 stations – 47 stations and 93 vehicles being operated by hospital boards, and the majority of the remainder by the Order of St. John.
Thirty-six aircraft were available as air ambulances, and are operated by aero clubs and private operators. Air-ambulance facilities are also provided when necessary by the National Airways Corporation and the Royal New Zealand Air Force.
The special hospitals under the control of hospital boards in 1965 included:
1 tuberculosis sanatorium.
5 convalescent hospitals.
22 hospitals for elderly people.
2 hospitals for cripples.
8 hospitals for non-acute conditions.
1 children's home.
In addition, a large number of maternity hospitals are maintained by hospital boards.
The Department administers three hospitals – the St. Helens Hospitals at Auckland and Wellington and the Queen Elizabeth Hospital, Rotorua.
The St. Helens Hospitals were established in 1907, and 1905, respectively, in accordance with the Midwives Act 1904, as State maternity hospitals for the training of midwives, which function they still perform. Queen Mary Hospital was established during the 1914–18 War for service patients and later turned over to civilian use. It has 117 beds and provides treatment for patients suffering from the neuroses. Queen Elizabeth Hospital, with 135 beds, provides treatment for rheumatic conditions, and includes a unit of 20 beds for children suffering from cerebral palsy.
Details of the private hospitals, with numbers of licensed beds, are shown in the following table. The figures give the position at 31 March 1965:
| Type of Hospital | Number of Hospitals | Number of Licensed Beds |
| Maternity | 22 | 204 |
| Medical and surgical | 42 | 971 |
| Medical | 74 | 1,241 |
| Mixed | 4 | 474 |
| Psychiatric | 2 | 31 |
| Medical and children | 6 | 286 |
| Total | 150 | 3,207 |
Private hospitals are governed by regulations which set out requirements as to staff and equipment. Each is licensed for a stated number of patients, and they are under regular inspection to ensure that a satisfactory service is maintained.
To encourage the establishment of private hospitals the Government has advanced loan money on easy terms to licensees for capital expenditure.
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.
For some time after the founding of the colony no special provision was made for the mentally ill. If these unfortunates had no relatives to care for them, or if they were too great a problem to their family, they could be cared for only in the nearest gaol. For some years successive Governments were slow to make adequate provision for the mentally ill and subnormal. Public opinion, and the numbers requiring attention, led to the establishment in 1853–54 of asylums in Auckland and Wellington, largely financed by public subscription. In Dunedin, within three years of the Scottish settlement, three mental patients were the first to occupy the small hospital in 1851, and an asylum was established in 1863. A year later a similar institution was set up in Christchurch and 17 patients were transferred to it from the gaol.
Responsibility for the asylums was vested in the Provincial Governments whose surgeon, as a rule, was the visiting medical officer. By good fortune the Otago Provincial Surgeon, Dr Edward Hulme, had studied mental diseases at the well-known Salpêtrire Hospital in Paris. Others were less well qualified. In 1876, with the abolition of the Provincial Governments, responsibility for the asylums reverted to the Central Government who appointed Dr F. W. A. Skae, Inspector of Asylums and head of the Asylum Service. By that time asylums were established at Auckland, New Plymouth, Napier, Wellington, Nelson, Hokitika, Christchurch, and Dunedin. By that time also the population was rapidly outstripping the capacity of the buildings which, in consequence, lacked space and many essential comforts and amenities. Whilst deploring this very serious difficulty, Dr Skae conceded that the wards were scrupulously clean and the patients treated humanely. There was, however, an unevenness in the standard of skilled medical treatment at the various asylums. In 1881, after Skae's death, Dr G. W. Grabham took over the duties of Inspector-General of Hospitals and Asylums until 1886. His successor was Dr Duncan MacGregor, until then Professor of Mental and Moral Philosophy at the Otago University, and one-time visiting physician to the Dunedin Asylum.
During his long and distinguished tenure of office, MacGregor had to face many serious problems arising out of the very heavy demands on the accommodation of the asylums, which in part he attributed to “the strong tendency which has risen to throw every case that can be brought within the definition of insanity off the local rates onto the general taxation of the Colony”. He was constantly urging Governments to increase the accommodation available, and as late as 1897 he referred to “the terrible conditions to which our asylums have been allowed to lapse owing to the overcrowding”. MacGregor was responsible for some remarkable improvements, both in the quality of medical treatment and the consideration given to the essential needs of rehabilitation. His superintendents were hampered in some institutions by overcrowding; his junior medical staff were poorly paid; and the regular and systematic instruction of the attendant staff was not provided for by any system of State examination. Yet, in his term of office, many far-reaching and important developments were pioneered. An obligatory course of lectures for nursing staff was instituted, meagre in the extreme by modern standards, but remarkable at the time, and even thought by some to be excessive.
In 1904, following upon the success of “The Cottage” and “Simla” wards at Seacliff, MacGregor authorised the newer development at Seaview Hospital, Hokitika, of what was to become the villa hospital pattern. MacGregor's successor in 1907, Dr Frank Hay, continued the development of the idea of the villa hospital, and since the early 1900s all new mental hospital development in New Zealand has been on villa lines. By 1924 New Zealand could show what was probably the only complete villa mental hospital in the world.
In 1908 a Mental Hospital Department was set up under its own Minister. The service continued as a separate Department until 1947, when it became the Mental Hygiene Division of the Department of Health with which it was joined. This union has proved fruitful.
In the intervening years a very great change has come about in the general attitude towards the mentally ill, and some corresponding improvement towards institutions devoted to their care. The present mental hospitals have developed a largely open policy. Restraints are minimal, and there is a major emphasis on treatment, rehabilitation, and development of abilities and assets. The institutions for the mentally subnormal have been differentiated from the mental hospitals, and are developing an advanced form of training programme. In addition to qualified nursing staff, many new categories of professional staff are included in the therapeutic team. Occupational therapists, whose training school was founded by the Division, social workers, clinical psychologists, and recreation officers – not to mention teachers and training officers in the hospitals for the mentally subnormal – have augmented the therapeutic agencies. There still remains in some areas, and in categories of accommodation, a residuum of the former problems of overcrowding. It is, however, confidently anticipated that this will be resolved within the next few years; for fewer patients are nowadays becoming chronic, and the length of stay in hospital after treatment is rapidly falling. Even more remarkable is the rapidly rising ratio of voluntary patients admitted. In 1954, 1,178 were admitted voluntarily and 1,928 admitted subject to reception order. In 1962 a Mental Health Amendment Act came into operation, which provided for the formal admission to mental hospital of certain types of patient who previously would have been admitted under a reception order. The procedure by which these patients are admitted is very similar to that for admission to public hospital on the recommendation of a medical practitioner. In the main these patients are mentally defective or mentally infirm (senile) patients. In 1964, the most recent year for which final figures are available, there were 4,244 voluntary admissions, 1,290 informal admissions, 1,429 formal (committed) admissions, and 351 Part IV admissions. (Part IV cases are referred from the Court or from prison. Some are eventually committed – some are referred back to the Court.)
There has been a progressive and steady reduction in the length of stay in hospital for first admissions. The latest available returns show that some 83 per cent of all patients admitted, including the mentally subnormal and the elderly and infirm, are discharged within less than one year: 57 per cent or more are discharged within less than three months. It is the aim and policy of the Mental Health Division to return the patient to his family and to the community as soon as the best interests of all concerned are served by so doing. In 1964 the average number of occupied beds was 10,489, including the hospitals and training schools for the mentally subnormal. During that period 7,314 patients were admitted and 7,273 were discharged.
The Division is alive to the need for developing close and intimate links with the community. For the past 30 years or more outpatient consultation services have been operated by mental hospital medical officers – many of them at nearby public hospitals. Out of this service has arisen the establishment of psychiatric wards in public hospitals, as part of the general hospital services, and the further development of psychiatric outpatient clinics at several of the larger public hospitals. Various patterns and ways of extending these services by way of psychiatric units and psychiatric wards in public hospitals are currently under examination, and further extension in this direction may be expected in the near future.
by Geoffrey Blake-Palmer, M.R.C.S., L.R.C.P., D.P.M., L.D.S., R.C.S., L.R.C.S., Director, Division of Mental Health, Department of Health, Wellington.
Founded in 1890 at Auckland, the New Zealand Foundation for the Blind has as its purpose the well-being of blind persons of all ages, and aims to teach them not only to tolerate their affliction but also to rise superior to it.
The services provided by the Foundation include the following:
Accommodation for blind persons of all ages. The Sunrise Home accepts blind babies and young children up to the age of seven years. The children are given kindergarten and pre-school training. Other homes are Bledisloe House for elderly blind men and the Hutchinson Home for elderly blind women.
Education. The Foundation has a residential primary school, from which selected pupils are able to proceed to ordinary secondary schools. Those not able to do so are transferred to trade training in the workshops. Some blind children even go on to the University, and obtain degrees in arts, law, and music. The Foundation has a Music Department, and maintains its own brass band.
Library Services. The library has books in Braille and Moon script and talking books, which are issued on loan to blind subscribers.
Trade Training and Employment. The Foundation has its own workshops, and provides hostel accommodation for blind employees.
Welfare Activities Including Occupational Therapy, Social Clubs, and Hobbies. These activities come within the scope of morale builders, particularly for the large group of blind persons over the age of 50. The blind are helped to help themselves, to accept their disability, and to rise above it.
The Foundation relies on the generous support of the public and is subsidised by the Government.
The New Zealand branch of the British Empire Cancer Campaign Society was formed in 1929, and soon received sufficient financial support from the public to enable it to undertake a programme of research into the causes of cancer. In January 1964 the Society attained autonomous status under the name of the Cancer Society of New Zealand (Inc.).
In addition to its Executive Committee, the Society functions through six divisions in Auckland, Wellington, Christchurch, Dunedin, Palmerston North, and Hamilton. Each division has a large degree of autonomy and controls its own finances. The financial resources of the branch and of the divisions come from members' subscriptions, donations and bequests, and street-day collections.
The activities of the Society and its divisions include research into the causes and treatment of cancer and the allied diseases; the operation of consultation clinics, either themselves or in cooperation with hospital boards, to which patients can be referred for consultation and diagnosis; and health education to inform the public about cancer and to stress the supreme importance of seeking early medical advice in suspected cases of the disease.
Research, sponsored by the Society, is being undertaken in Dunedin in the Society's research laboratory at the Medical School, at Auckland, and at Christchurch.
The New Zealand Crippled Children Society was founded in 1935, and its aims and objects, expressed briefly, are to see that every crippled child has the earliest possible treatment, followed where necessary with the most effective continuous care; to assist parents to a true understanding of the child's special needs, and to inspire hope and confidence both in parent and in child; to help each crippled child to obtain a sound vocational training, and so take his or her place in the community; and to encourage in employers an attitude favourable to the employment of cripples.
A crippled child is defined as a young person under the age of 21 who, as the result of bodily defect, either congenital or acquired, causing deformity or interference with the normal functions of the bones, muscles, or joints, is handicapped with respect to movement, the performance of work, and/or social adjustment. The main scope of the Society's activities lies in the following fields – orthopaedic disabilities, hare-lip and cleft palate, heart disabilities in marked degree, and crippling neuro-muscular disorders.
The Society has 18 branches in New Zealand, and one in the Cook Islands. Each branch society is autonomous with full control of its own finances. The Society has considerable accumulated funds derived from bequests and donations, and its affairs are controlled by an Executive Council. Each branch society obtains its income from members' subscriptions, from interests on invested funds, from lottery distributions, and from such sources as street collections, rag drives, etc.
The total membership of all the branches at March 1964 was 18,102, and the total income from members' subscriptions for that year was £11,235. In the same year the branches raised some £51,200 through donations, appeals, and special efforts. The total number of cripples registered with the Society at March 1964 was 7,438, of whom 6,071 were children of 15 years and under.
The functional activities of the Society in relation to crippled children are all carried out by the branch societies, and in addition to keeping in touch with each registered child and securing adequate treatment they include the following:
Provision of travelling orthopaedic clinics.
Visits to crippled children in home or hospital.
Making grants where necessary for purchase of surgical footwear, surgical appliances, etc.
Making available on loan tricycles, wheel-chairs, etc.
Organising parties and entertainments, and providing Christmas gifts.
Arranging for occupational training and employment.
Providing transport to and from hospital and for outings.
Although a School for the Deaf was established by the New Zealand Government as early as 1880, a long time was to elapse before anything was done for the hard-of-hearing adults – that is to say, those who are handicapped by impaired hearing in varying degrees. In 1922 the Government established lipreading classes for adults, first in Wellington, and later in the other three main centres, but the work was little known and few people profited by it.
During the years following 1926 a movement started by Mrs G. A. Hurd-Wood, of Hamilton, gained momentum and culminated in the formation, in 1932, of the New Zealand League for the Hard of Hearing. By 1945 the League had 10 branches throughout the Dominion, and by 1960 there were 20 branches and 11 sub-branches. The aims and objects of the League are to help totally or partially deafened adults by encouraging them to realise and face their disability; to assist them to pursue their accustomed means of livelihood with a minimum of inconvenience to their employers, the public, and themselves; to eliminate quackery as it concerns deafness; and to cooperate with the Government in dealing with the prevention of deafness in children.
The League conducts lip-reading classes, and assists deaf people to obtain the full benefit from their hearing aids. It organises social activities and entertainments for the hard of hearing, and fosters “clubs” to provide recreational activities and a spirit of companionship.
The Government assists the League by paying the salaries of their lip-reading tutors.
The originator of health camps was Dr Elizabeth Gunn who, as school medical officer at Wanganui, organised small summer camps for undernourished children in 1919 and the years following. By 1929 public interest had been aroused sufficiently for summer health camps to be held in various localities by voluntary organisations, funds being raised by voluntary subscriptions, supplemented by the sale of health stamps which first appeared in 1929. The first permanent health camp was established at Otaki by the Wellington Children's Health Camp Association. This camp was opened in 1932, and was soon in continuous use, each group of undernourished children spending a minimum of six weeks in the camp. By 1936 so many health camp associations were organising camps that a National Health Camp Federation was formed, and in the following year the King George V Memorial Appeal raised a sum of £176,000 which was devoted to the establishment of five permanent health camps.
This valuable work has continued up to the present time, although, fortunately, the proportion of undernourished children to be provided for is far less than it was when the movement started. The emphasis now is on non-physical disabilities, home difficulties, and children who are not making adequate progress at school.
With the cooperation of the Post Office, health stamps have been placed on sale during the spring of each year, and the resulting proceeds defray much of the cost of operating the camps. Undoubtedly the health camp movement has played a useful role in the campaign against tuberculosis.
The Royal New Zealand Society for the Health of Women and Children, more commonly known as the Plunket Society, is unique in that it was founded for the express purpose of filling a gap in the country's health services, and the success achieved, combined with its strong appeal to the public, has brought Government approval and support, and enabled it to maintain itself as an integral part of our public health services. The Society's founder, Dr (Sir) Truby King, while superintendent of the Seacliff Mental Hospital, became concerned at the avoidable loss of infant life, and he considered that the chief causes of infant mortality were maternal ignorance, the decline in breast feeding, the use of unsuitable artificial foods, and a faulty regimen generally in the nurture and care of infants. In 1905 Truby King began a pioneering campaign of education in baby welfare among the mothers of Dunedin, and at a large public meeting held in Dunedin in 1907 the Society was formed. It received enthusiastic support from the public and the press, and was very greatly assisted by the active personal interest of the Governor and Lady Plunket.
The principal aim of the Society, the education of mothers in the proper feeding and care of their babies, was to be achieved by the establishment of Plunket Rooms throughout the country, staffed by nurses specially trained in all aspects of baby welfare, where advice and assistance were to be made freely available. While the Society's general activities were from the first guided and controlled by a central Council, local branches were formed and given a large degree of autonomy and responsibility, acting under the general advice and guidance of the central Council. Undoubtedly it is this distribution of authority and responsibility that has proved to be the foundation of the Society's strength.
In 1907, also, the first Karitane Hospital was established in Dunedin for the reception and treatment of sick and ill-nourished babies, for whom the ordinary hospitals are unsuitable. It serves also as the training school for Plunket nurses, all of whom are registered nurses seeking post-graduate training in mothercraft. Later, Karitane Hospitals were established in Christchurch, Wanganui, Wellington, Auckland, and Invercargill, and while the training of Plunket nurses is restricted to the Truby King – Harris Karitane Hospital at Dunedin, the other hospitals train Karitane nurses – that is, girls with no previous training who undergo a 20-month course in baby care.
In the year of the Society's foundation, branches were set up in Auckland, Wellington, and Christchurch, and by 1914 twenty branches had been established and 27 Plunket nurses were at work. By 1962 there were 106 branches and about 500 sub-branches, employing 220 Plunket nurses. There are also upwards of 250 mothers' clubs whose members meet regularly for social and educational purposes.
The Society has itself raised the larger portion of its income and its services are free. In recognition of their value, Government subsidies have been made available on an increasing scale. At the present time these amount to approximately £150,000 a year.
The teaching of the Society stresses the supreme importance of breast feeding, and urges the use of humanised milk as a supplement to, and if necessary a substitute for, breast feeding, with proper hygienic precautions in its preparation and handling. As a result of this teaching there has been a marked reduction in the infant deaths from the diarrhoeal diseases which used to be a major cause of infant mortality. In addition to the correct feeding and nurture of the baby, mothers are instructed in the proper clothing of infants and young children, and their protection from avoidable accidents. When children are a little older, the Society cooperates with the Department of Health in arranging for periodic medical examinations. The activities of the Plunket Society have been largely instrumental in reducing the infant deaths that occur between the second and twelfth months inclusive from a rate of about 40 per 1,000 live births in 1908 to the present low figure of less than seven per 1,000.
The Tuberculosis Associations, of which there are 15 throughout the country, came into being in 1945–46. Each Tuberculosis Association is autonomous, but coordination is achieved by the New Zealand Federation of Tuberculosis Associations which operates through an Executive Council.
The purpose of the Tuberculosis Associations, in broad terms, is to work for the comfort and welfare of tuberculous patients and their families, dealing with problems, domestic and otherwise, that are outside the scope of medical treatment. They provide amenities for hospital patients, arrange entertainments, assist with grants for clothing, etc., arrange for Christmas parcels, and in other ways aim to alleviate the boredom and hardship caused by the disease. The associations also disseminate information about tuberculosis among members of the public.
The Tuberculosis Associations derive their income from members' subscriptions, donations, and bequests, lottery grants, and profits from the Christmas Seal campaign.
An organised Blood Transfusion Service has come to be regarded as a normal function of every general hospital, but a little over 30 years ago no such service existed, and special arrangements had to be made for any necessary transfusion. The first attempt in New Zealand to organise such a service was made in Wellington in 1928, due to the initiative of the late Sir Fred Bowerbank and Clarence Meachen. The latter was leader of the First Wellington Rover Scout Troop, and 30 members of this troop volunteered as blood donors, and so formed the first association of voluntary blood donors in New Zealand.
The demand for blood increased, and by the end of 1931 there were approximately 100 active donors, and some more comprehensive organisation became necessary. The cooperation of the British Medical Association was sought, and in 1932 the Wellington Blood Transfusion Service was set up with an expert medical committee to guide its activities. Similar blood transfusion services were set up in connection with the other major hospitals throughout the country in the following years. In 1956 the Wellington Blood Transfusion Service was taken over by the Wellington Hospital Board, and has since been operated by the medical staff of the Wellington Hospital. The number of transfusions given in Wellington rose from 367 in 1939–40, and 3,254 in 1949–50, to 4,440 in the year ended 31 March 1956.
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.
Since the earliest days New Zealand seems to have had an attraction for medical men. The planned Wakefield settlements made provision for the inclusion of doctors among their settlers, and the flow of emigration brought into the country a number of medical men from time to time. As early as 1838 Dr Joseph Crocome settled at Waikouaiti, and worked among the scattered whaling stations and settlements along the Otago coast until his death in 1878. The gold rush of the sixties attracted many medical men, certain of whom devoted their first energies to the search for gold, some later returning to the practice of medicine. Before the discovery of gold in Otago there were five doctors practising in Dunedin; by 1862 there were 13, and in 1864 twenty-nine practitioners were attending to the needs of the rapidly growing town.
Medical practice in the early days – particularly in country districts – was an exhausting and strenuous calling. Patients were scattered over a wide area, and because of poor roads the country doctor could travel only on horseback or on foot. Writing of one such practitioner who settled at Tuapeka among the gold miners, Fulton refers to “the miles he had to travel by night and by day; the tedious ascent of precipitous mountains on horseback or on foot; the rivers to be forded, or if in spate to be swum across; the journeys in brightest sunshine or in blinding snow storms; the nights he had to camp with no place to lay his head, or in shepherds' huts or small shanties, awaiting the arrival of the long looked for son and heir; these were but a few of the trials that Ebenezar Halley had to face”.
Dr John Wait, who practised during the sixties in Oamaru and the country around and beyond it, “for many years led a very hard and strenuous life, riding long journeys into the back-blocks to attend patients, swimming rivers, and often, when he lost the track, camping in the tussocks until daylight. One of his long journeys necessitated his riding to Lake Ohau about 150 miles from Oamaru. The latter part of his journey he rode through snow piloted by a back-block shepherd… On his return to Oamaru he had to go immediately to Hampden. When he got home again he found some friends waiting to have a game of whist. He therefore sat down and played most of the night although he had been in the saddle for several days and nights”.
If life in the early days was hard for the average colonist, it was doubly so for the country doctor who conscientiously did his duty and answered every call. This country has good reason to be grateful to such men. By 1868 the Medical Register contained the names of 133 medical practitioners to serve a population of about 228,000. Specialism had not developed, and the absence of antiseptics and anaesthetics prevented all but the most urgent surgery. During the eighties, however, medicine, and particularly surgery, made great advances. Louis Pasteur had established the bacterial origin of infection, and Lister had supplemented this by the introduction of antiseptics, while anaesthesia was coming into general use. By 1885 the leading surgeons in Dunedin did not hesitate to open the abdominal cavity when necessary, and in 1891 Dr F. C. Batchelor published Notes on 100 Cases of Abdominal Surgery – a remarkable achievement at that time.
Further great advances in medical science were made after the First World War, and this hastened the development of specialism. It also led to an increase in the number and size of hospitals, and a demand for more medical men. This need was amply supplied both by an increased output from the Otago Medical School, and also by the continual arrival of highly qualified doctors from overseas; indeed, there can be few countries that have been so well provided with adequate numbers of well-trained and competent medical practitioners. The numbers of registered medical practitioners in New Zealand in proportion to the population at different periods are as follow:
| Medical Practitioners Registered | ||
| Year | Names on Register | Population |
| 1868 | 133* | 227,810 |
| 1890 | 427* | 672,750 |
| 1910 | 810* | 1,002,679 |
| 1930 | 1,382 | 1,438,239 |
| 1950 | 2,313 | 1,812,946 |
| 1960 | 3,396 | 2,371,746 |
| 1964 | 3,832 | 2,590,787 |
*Excluding those registered with addresses outside New Zealand.
The Medical Register includes the names of many practitioners who have left the country, either permanently or temporarily, and many others who have retired, or for other reason are not practising their profession. A survey of the distribution in New Zealand, during 1963, of the active members of the profession produced the following figures:
Public Hospitals: Whole time, 576; part time, 637. Department of Health – Mental and other hospitals: Whole time, 75; part time, 40. Others: Whole time, 72; part time, 36. In Private Practice: 1,738.
Of the doctors in private practice in 1965, 432 were specialists and 1,287 were general practitioners, of whom 152 had some specialist interest.
The ratio of doctors in private practice to population was one active private practitioner to 1,478 population, and one general practitioner per 1,974 population. These are overall figures, but there is a greater concentration of private practitioners in urban than in rural areas, and some urban areas are better supplied than others.
The first legislation for the registration of medical practitioners throughout the whole country was the Medical Practitioners Act of 1867, although previously, both in the Wellington and in the Otago Provinces, Ordinances had been passed setting up, in each case, a Medical Board to undertake the registration of doctors within the province. The Otago Ordinance even made provision for the deregistration of any medical man deemed by the Board to be “guilty of disreputable or infamous conduct in any professional respect”. The Act of 1867 also set up a Medical Board which was empowered to compile a Register and to purge it as necessary. The Board had power also to remove a name from the Register if the practitioner concerned was found guilty of any crime or misdemeanour, or was deemed to be guilty of discreditable or infamous conduct in any professional respect. This Act was unpopular with the profession on account of the composition of the Medical Board, which included the Director of Geological Survey, the Comptroller of Public Accounts, the Secretary for Crown Lands, and the Auditor-General. Consequently in 1869 a new Act was passed and the Medical Board abolished. Under the Act of 1869 the registration of medical men was undertaken by the Registrar-General. He had power to remove a name from the Register in the event of false registration, or after conviction of felony or misdemeanour, but the Act made no provision for removal for discreditable or infamous conduct in any professional respect.
No substantial amendment to these provisions was made until 1914, in which year a new Act provided for a Medical Board of seven medical practitioners including the Inspector-General of Hospitals (in effect the Chief Health Officer). In addition to the powers formerly held by the Registrar-General, the Board, in any case of grave misconduct in any professional respect, could apply to the Supreme Court for the removal of the name of the practitioner concerned. In 1924 the Medical Board became the Medical Council, and the Director-General of Health continued to be an ex officio member as well as becoming Registrar. The Council was also empowered, after due inquiry, to fine a medical practitioner an amount not exceeding £50, or to suspend him from practice for a period of 12 months. With minor amendments the system of registration has remained the same up to the present time.
With the introduction of health benefits, under the Social Security Act 1938, it was deemed necessary to provide further disciplinary powers to deal with irregularities in respect of claims for remuneration from the Social Security Fund. This led to the setting up of District Disciplinary Committees controlled by a Central Disciplinary Committee which has the power to censure or to fine any practitioner if a complaint, made against him by the Minister of Health, is found, after due inquiry, to be substantiated. All the members of these committees are themselves medical practitioners. This system of disciplinary procedure is controlled entirely by the New Zealand Branch of the British Medical Association, except that the Minister may appoint one member of the Central Disciplinary Committee. The Medical Practitioners' Disciplinary Committee also has a lesser jurisdiction over offences termed “professional misconduct” and breaches of contract between bursars and the Department of Health.
It will be seen that, for offences concerned with a practitioner's practice of his profession, all disciplinary powers are exercised by the profession itself.
For the first 50 years or so of settlement, the New Zealand population relied entirely on doctors who had been trained overseas. Today the majority of medical practitioners in this country have received their basic medical training in New Zealand.
The University of Otago was established by 1870, and in 1875 the embryo medical school was in existence. This was a very ambitious project for so small a community, and many difficulties arose before the school was firmly established. It was proposed at first to provide only the first two years of a medical course, students having to complete their studies and obtain their medical qualifications at some other school of medicine. Even this modest undertaking met with difficulties, as for a time most of the medical authorities overseas hesitated to recognise this preliminary training. It was not long, however, before the required recognition was granted by the University of Edinburgh, and it became the custom for New Zealand medical students to study for two years at Dunedin, and to complete their course with a further two years' study at Edinburgh. From 1885 onwards it became possible to complete the whole medical course in Dunedin, and the first student to do so was William Ledingham Christie who qualified in 1887. The first woman to complete the medical course at Dunedin was Emily Siedeberg, later Dr Emily Siedeberg McKinnon, who entered the school in 1891. She later specialised in obstetrics and was medical superintendent of the Dunedin St. Helens Hospital for 33 years.
Round the turn of the century the Medical School went through a difficult period. The University was in serious financial straits, and the Council had no choice but to reduce the salaries of the teaching staff, while money was lacking for necessary extensions and improvements, both as regards buildings and equipment, and for the appointment of an adequate staff. It was impossible to keep the school and the hospital up to date, and there was a serious falling off in the number of students. After 1905 the University's finances improved, and during the years leading up to the outbreak of the First World War conditions at the Medical School showed a slow but steady improvement. The salary cuts were restored, additional appointments were made, and new departments were established. By 1912 the number of students was 120, and it was coming to be realised both by the Government and by the general public that the Otago Medical School was a national institution and one worthy of support. During this period Dr (later Sir Louis E.) Barnett, Professor of Surgery, on returning from a visit to America, was able to say: “Our Medical School, with all its limitations and imperfections, compares favourably with the American Schools”.
With the outbreak of war in 1914 intending medical students could no longer study overseas, and the demands of the services for medical officers added a further stimulus to the training of doctors in this country. Between the years 1914 and 1919 the annual entries of students increased from 30 to 90, and the total numbers of students from 155 to 340. The existing buildings were quite inadequate for these numbers, and during the war years the first of the Medical School buildings adjacent to the hospital was erected, and served to accommodate the Pathology Department and the newly created Bacteriology Department. A portion of the cost of this building was met by public subscription.
With the end of the war the numbers of students continued to increase. Many returned servicemen sought to enrol, and the majority of medical students now wished to train in New Zealand rather than overseas as had previously been a common alternative. An additional building became necessary, as well as increases in staff and equipment. The Government was unsympathetic, and having its own financial difficulties was not disposed to be generous. However the Medical Faculty, ably led by the Dean, Dr (later, Sir Lindo) Ferguson, and supported by the Chancellor, maintained such pressure on the Government that successive grants were reluctantly made, and the building proceeded with, to be finally completed in 1927. This provided adequate accommodation for the Anatomy and Physiology Departments. During the twenties the medical course was extended to six years and, later, in 1937, arrangements were made for sixth-year students to undergo clinical training at one or other of the four metropolitan hospitals, thus taking advantage of the large amount of clinical material available in the other three major centres.
By 1923 there were 870 doctors in active practice in New Zealand, and 297 of these were Otago graduates. In point of size the Medical School was one of the most important in the British Commonwealth, and Otago graduates had proved that they could more than hold their own in securing and holding appointments in Great Britain and elsewhere. Undoubtedly the wisdom of the school's founders, and the exertions and devotion of its teaching staff during the early years of struggle, had been amply justified. About this time the need for better training in obstetrics became evident, and this required the establishment of a chair of obstetrics and gynaecology, and the provision of an up-to-date maternity hospital with facilities for the adequate training of medical students. The Government agreed to provide the cost of the new hospital, and the New Zealand Obstetrical and Gynaecological Society, stimulated by their energetic secretary, Dr Doris Gordon, succeeded in raising by public subscription the money necessary to endow the new chair. The new Professor of Obstetrics and Gynaecology, Dr J. B. (later, Sir Bernard) Dawson was appointed in 1931, but the Queen Mary Maternity Hospital, to take 28 patients, and with living accommodation for six students, was not opened until February 1938.
After the post-war rush of students, the numbers became stabilised at a slightly lower level for some years, but the introduction of health benefits under the Social Security Act, from 1941 onwards, increased both the need and the opportunities for medical practitioners, and the numbers increased once more. After the end of the Second World War, in 1945, it was found necessary to limit the yearly intake of students to 120, and to establish a system of priorities for admission to the school. This intake ensures a yearly output of approximately 100 doctors.
The quality of a medical school is greatly influenced by the calibre of its Dean, and in this respect the Otago Medical School has been very fortunate. Over a long period of 68 years the position has been held successively by three men only, and each played a significant part in building up and maintaining a high standard of efficiency. Dr J. H. Scott was Dean from 1890 to 1914, Dr (later, Sir Lindo) Ferguson from 1914 to 1937, and Dr C. E. (later, Sir Charles) Hercus from 1937 to 1958. The present Dean is Dr E. G. Sayers, C.M.G., F.R.C.P. (LONDON). Both Sir Charles and Dr Sayers are Dunedin graduates.
Besides the basic medical degree, the Medical School provides instruction and conducts examinations for the following degrees and diplomas:
| Degrees: | Doctor of Medicine: | M.D. |
| Master of Surgery: | Ch.M. | |
| Bachelor of Medical Science: | B.Med.Sc. | |
| Master of Medical Science: | M.Med.Sc. | |
| Diplomas: | Diploma in Public Health: | D.P.H. |
| Diploma in Microbiology: | Dip.Micr. | |
| Diploma in Diagnostic Radiology: | Dip.D.R. |
In addition to the facilities provided at the Medical School, Postgraduate Committees based on the larger hospitals have been active for a number of years in providing facilities for post-graduate instruction in different branches of medicine and surgery. For some time these committees worked independently, but recently they agreed to bring about closer integration by forming the New Zealand Post-graduate Medical Federation Incorporated. The objects of the Federation are the encouragement, advancement, and integration of all aspects of post-graduate medical education in New Zealand.
At present the Federation includes eight Post-graduate Committees based respectively on the Otago Medical School, Auckland University, and the hospitals at Hamilton, Napier, Palmerston North, Wellington, Christchurch, and Invercargill.
Post-graduate education has varying functions and methods:
Training of Young Specialists: To assist in the further study of the basic medical sciences weekly viva-tutorials are held from March to the end of July at both Dunedin and Auckland, and in August a month's concentrated course is held at the Medical School in preparation for the various primary examinations for higher qualifications.
Courses of General Interest: All Post-graduate Committees, at least annually, hold up to a two-week course for medical men in their area. The subjects of these courses, over a five-year period, will cover many aspects of medicine, surgery, and obstetrics.
General Practitioner Training: Each Post-graduate Committee holds short courses for general practitioners lasting for a weekend, or for several spaced afternoons during one month. This enables practitioners to benefit from additional study without interference with their ordinary work.
Post-graduate courses benefit greatly from the stimulus provided by the visits of eminent professional men from other countries, such as are provided by the Sims Visiting Professorships, the Sims-Black Professorship, and the Pfizer Lecturer. In addition, most committees bring visitors from abroad to strengthen their courses.
The aim of post-graduate education is to assist young men to study for higher qualifications without being obliged to leave New Zealand, and to offer all medical men the opportunity to continue their medical education throughout their professional lives.
The first recorded attempt to form a medical association was made in Dunedin in 1873 by Dr T. M. Hocken. It aroused little interest, however, and lapsed after a few months. In 1876 Dr Coughtrey, the first Professor of Anatomy in the University of Otago, succeeded in forming an Otago Medical Association, which two years later changed its name to The New Zealand Medical Association. Its influence, however, does not seem to have extended beyond Otago. In 1879 an attempt was made by the profession to have set up a General Medical Council which would appoint medical boards in the various provincial districts to undertake the registration of medical practitioners, to adjudicate on all matters relating to medical ethics, and to consider matters of public importance requiring professional consideration. Provincial district associations were also envisaged. A Bill along these lines was introduced in the Legislative Council and passed, but was rejected by the House of Representatives.
During the eighties local medical associations were established in Auckland, Wellington, and Christchurch, and in 1887 a New Zealand Medical Association came into being, the first meeting being held at the Dunedin Hospital on 12 April 1887. At a later meeting held in Wellington a Code of Medical Ethics was adopted. In 1896 the New Zealand Medical Association became the New Zealand branch of the British Medical Association, and has continued as such up to the present time. To enable it to hold its own property the branch, in 1927, was registered as a limited liability company.
In addition to the British Medical Association there are smaller societies and associations formed by groups of medical men having a common interest. Some of these are peculiar to New Zealand, while some have originated overseas, and have branches in this country. The aim of these societies and associations is to foster an interest in some section of medical practice, and to bring about and maintain a high standard. These groups may be classified according to their different characteristics:
The Royal Australasian College of Physicians and the Royal Australasian College of Surgeons each has a New Zealand Committee, and in each case membership is obtained by examination. Fellowship of the Royal Australasian College of Physicians is obtained by election, and of the Royal Australasian College of Surgeons by examination.
The Royal College of Obstetricians and Gynaecologists has a Regional Council in New Zealand. It grants a diploma by examination, and membership also is granted by examination. Fellowship is awarded only by election.
The College of Radiologists of Australasia is derived from an earlier body – The Australian and New Zealand Association of Radiologists. The college has a New Zealand Committee, and conducts examinations for diplomas and certificates. Membership is obtained only by election.
The College of General Practitioners of the United Kingdom has a New Zealand Council, and four faculties in New Zealand – in Auckland, Wellington, Canterbury, and Otago. Any registered medical practitioner may become an associate if he undertakes to continue approved post-graduate study, and to uphold and promote the aims of the college. To obtain membership a practitioner must be qualified for seven years (with five years in general practice), and must be sponsored by two members of the college. He must submit evidence concerning practice, experience, and academic achievements. If required, he must submit to interview by the Board of Censors.
The Australia and New Zealand College of Psychiatrists has a New Zealand Committee. Membership is granted by election, and requires at least five years' specialised practice in psychiatry and approved postgraduate qualifications.
There are also a number of specialist and other societies which are peculiar to New Zealand, and which are affiliated with the New Zealand branch of the British Medical Association. The aim of some is primarily to foster some branch of medical or surgical practice, while others provide the opportunity for consultation and association between groups of practitioners having a common interest. They fall into several groups:
Specialist societies. Membership of these is obtained only by election, and indicates recognition of competence in the specialty:
The Ophthalmological Society of New Zealand;
The Oto-laryngological Society of New Zealand;
The New Zealand Dermatological Society;
The New Zealand Orthopaedic Association;
The New Zealand Society of Pathologists.
Specialist societies open to any registered medical practitioner:
The New Zealand Obstetrical and Gynaecological Society;
The Paediatric Society of New Zealand;
The New Zealand Society of Anaesthetists;
The New Zealand Rheumatism Association;
The Neurological Association of New Zealand.
Associations of hospital officers:
The Psychiatric Medical Officers' Association;
The Medical Superintendents' Association of New Zealand;
The New Zealand Association of Part-time Hospital Staff;
The Whole-time Senior Medical Officers' Association of New Zealand.
Other societies open to any registered medical practitioner:
The General Practitioners' Society;
The Association of Medicine in Sport.
There are four medical libraries under the charge of full-time librarians, and five smaller libraries:
Otago Medical School Library: This is the largest of the medical libraries, and has about 50,000 volumes, and receives about 700 current periodicals. It has two branch libraries concerned with anatomy and physiology.
Department of Health Library: This library, with its branch libraries distributed throughout the country, contains about 35,000 volumes. It specialises in the literature of preventive medicine and public health, and receives about 500 current periodicals.
The Marion Davis Memorial Library: This library was established in 1961, in Auckland, through the generosity of Sir Ernest Davisa who built, equipped, and endowed it in memory of his wife. The previously existing Auckland Hospital Medical Library has been integrated with this library, which subscribes to some 500 periodicals. There are about 5,000 modern textbooks and 11,500 volumes of journals.
The Canterbury Medical Library has some 14,000 volumes and 350 periodical subscriptions.
Smaller medical libraries, not in charge of full-time librarians, have been established at the Wellington, Palmerston North, Cook, and Masterton and many other hospitals, and at the headquarters of the New Zealand branch of the British Medical Association.
A New Zealand Medical Journal was first published in September 1887, shortly after the formation of the New Zealand Medical Association, and was edited by Dr D. Colquhoun, the first professor of medicine at the Otago Medical School. It ceased publication in October 1896 when it was amalgamated with the Australasian Medical Gazette.
In August 1900 the present New Zealand Medical Journal commenced publication, the editor being Dr J. M. Mason who shortly after became Chief Health Officer. For many years the Journal appeared six times a year, but since January 1960 it has been published monthly. Other editors, in succession, have been Dr J. W. Fell, Sir James Elliott, Dr S. D. Rhind, and the present editor, Dr J. O. Mercer.
Annals of University of Otago Medical School, Carmalt-Jones, D. W. (1945); Medical Practice in Otago and Southland in the Early Days, Fulton, R. V. (1922); Handbook of B.M.A. (New Zealand Branch (1947–60); The Otago Medical School Under the First Three Deans, Hercus, C. E., and Bell, F. G. (1964).
From its earliest years the Otago Medical School adopted the Edinburgh tradition of research, and for some 50 years the only medical research undertaken in New Zealand was that carried out at the Medical School.
The Health Act 1920 converted the Department of Public Health into the Department of Health, and one of the new functions it was charged with was to promote or carry out research and investigations concerning the public health, and the prevention or treatment of disease. For several years the Department sponsored research on such subjects as poliomyelitis, still births, and goitre. Over the last 35 years, also, departmental officers have carried out field studies, mostly concerning various aspects of epidemiology.
About 1928 a New Zealand branch of the British Empire Cancer Campaign Society was formed, and in 1929 began to carry out research into the causes of cancer.
In 1937 a Medical Research Council was set up as a committee of the Board of Health with the Director-General as chairman. The Council selected nutrition, goitre, tuberculosis, hydatid disease, and dental caries as subjects in which research should be carried out, and a corresponding number of committees were appointed, each concerned with one of the subjects, and responsible to the Council for bringing forward suggested programmes of work with estimates of the costs involved. The Medical Research Council depended on a yearly grant from the Government and its financial resources were small.
In 1950 the Medical Research Council Act was passed by which the old Council was dissolved and a new Medical Research Council came into being as an independent body corporate. The Council consists of 10 members nominated respectively by the University Grants Committee, the Royal Society of New Zealand, the Royal Colleges of Australasia, the British Medical Association, and the Board of Health, with three ex officio members, the Director-General of the Dept. of Scientific and Industrial Research, the Dean of the Medical Faculty, and the Director-General of Health, who continues as chairman. The financial grant from the Government has been increased and is made triennially on an increasing scale, so that there is more opportunity to plan ahead, and more security for those working for the Council.
The new Council has continued the policy of the previous Council, and is extending into other fields of research as research workers and the necessary finance become available. The Medical Research Council has always cooperated closely with the Otago Medical School, and with the Medical Research Councils of the United Kingdom and Australia.
In 1955 a Medical Research Foundation was incorporated in Auckland to sponsor local research, and has been successful in raising considerable funds from local sources. Similar foundations have been established more recently in Wellington, Christchurch, Palmerston North, and Hawke's Bay, and each has received contributions from private individuals and business firms.
Mention should be made of some of the notable contributions made towards medical research in New Zealand. In 1940 the Travis trustees of Christchurch contributed funds towards fundamental research in tuberculosis, and in 1954 the Life Offices Association of Australia established a fund to promote and assist research on diseases of the heart and blood vessels. In both cases the grants are supporting research carried out at the Otago Medical School. In 1957 Dr J. S. Phillips bequeathed to the Medical Research Council a substantial sum for the eradication of filariasis in Western Samoa. In recent years, also, the New Zealand Dairy Board, the New Zealand Meat Producers' Board, and the New Zealand Wool Board have been jointly contributing a large amount annually towards research in hydatid disease.
The early New Zealand hospitals had no provision for skilled nursing, the only attention received by patients being that of untrained male attendants or uneducated and untrained women. The advances in surgery in the eighties, and the development of the Nightingale tradition suggested the need for more skilled nursing and pointed the way. A system of probationer nurses who were young women with a better education and a sense of vocation was instituted at the Wellington and Auckland Hospitals in 1884, but at first no attempt was made to give any formal teaching. Organised teaching for probationer nurses was first introduced at the Wellington Hospital by Dr Truby King in 1888 during the short time he was medical superintendent, and the hospital issued a Nursing Certificate after a four months' course. The recruitment of educated probationers, and the provision of organised training, soon spread to other hospitals.
In the late nineties Mrs Grace Neill, who had been trained at Charing Cross Hospital, was appointed an Assistant Inspector of Hospitals, and after a few years she realised the need for introducing and maintaining a definite standard in the training of nurses. As the result of her representations, the Nurses Registration Act 1901 was passed, and provided for a course of three years' training and a State examination followed by registration. This was a revolutionary achievement, and thereby a firm foundation was laid on which to build the future high reputation that came to be enjoyed by New Zealand nurses. In 1904 the Midwives Act was passed and provided for the registration of midwives. This Act also gave authority for the establishment of one or more State maternity hospitals for the training of midwives, and under this provision the St. Helens Hospitals were set up.
In 1925 the Nurses and Midwives Board was formed. Its function is to determine courses of training for nurses and midwives and maternity nurses, to approve hospitals where training is undertaken, to hold examinations, and to receive applications for registration. The Board also has disciplinary powers.
At the present time 41 hospitals are approved as schools for the education of general and maternity nurses, three (St. Helens Hospitals) for midwives, two for male nurses, 10 for psychiatric nurses, three for psychopaedic nurses, and 11 for nursing aids. In 1964 there were 5,927 student nurses in training, of whom 252 were Maoris, and 10,218 qualified nurses on the practising register.
Post-graduate nursing courses commenced in 1928 in Wellington where the New Zealand Post-graduate School for Nurses is still operated by the Department of Health in cooperation with the Victoria University and Teachers' Training College. In 1965 four courses are offered: Administration and Teaching for Schools of Nursing; Administration and Teaching for Public Health Nursing; Administration of Hospital Nursing Service; and Principles and Practice of Health Education.
In recent years a number of nurses from overseas have attended the course under the Colombo Plan or with WHO Fellowships. In 1965 a total of 55 nurses, 13 of them from overseas, completed the course. The post-graduate school also holds introductory courses for ward sisters and public health nurses, and refresher courses for all categories of staff.
The pioneer of district nursing in New Zealand was Nurse Maude, of Christchurch, who organised a district nursing service in that locality in the early years of the century. The Department first began to employ district nurses for work among the Maoris in 1910. At first their work was mainly bedside care, but an early recognition of the need for health education among the Maori people brought about a generalised public health nursing service which has extended throughout the length and breadth of the country.
Hospital boards also employ large numbers of district nurses, their main function being bedside care in the home to relieve pressure on hospital beds by keeping patients out of hospital, and permitting earlier discharge.
Two of the larger hospital boards provide three-year courses for the training of male nurses. The armed forces also provide courses for male nurses needed in military, naval, and air-force hospitals. In 1964 there were 253 names on the Male Nurses Register.
The Occupational Therapy Act of 1950 controls the training and registration of occupational therapists by the establishment of an Occupational Therapy Board which is responsible for the training syllabus, and the examining, registration, and discipline of occupational therapists. The training course is a three-year one, and only women are accepted for training. The training school is at the Oakley Hospital. In 1964 there were approximately 360 registered occupational therapists, all except 63 of whom were trained in New Zealand. Occupational therapy is in great demand for the treatment of a number of conditions, and there is a considerable shortage of occupational therapists.
An advisory occupational therapist is employed by the Department of Health.
Provision for the training and registration of opticians is contained in the Opticians Act 1928 and regulations thereunder. The Opticians Board consists of three registered opticians, a medical practitioner, and the Director-General of Health, or his representative, as chairman, and the Board conducts the qualifying examinations, controls registration, and exercises any necessary disciplinary action.
The course of training for an optician extends over four years. The first year is taken at any New Zealand university studying Chemistry I, Zoology I, and Physics I. The following two years are taken at the University of Auckland studying Optometry I and II and Psychology I and II. When the student has completed this course he is awarded a Diploma in Optometry. However, before he may be registered he is required to spend a further year gaining clinical and practical experience, following which he sits the Opticians' Board examination.
The Optometrical Association of New Zealand watches over the general interests of opticians, and aims to encourage a high standard of ethical practice, and to promote educational facilities for students of optometry.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 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.
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:
Restricting the use of ionising sources to those qualified and competent persons who hold a current licence issued by the Laboratory.
Providing for the notification of all sales of irradiating apparatus, and establishing the Laboratory as the sole importing authority for radioactive substances.
Regulating against the gross misuse of radioactive substances and irradiating apparatus.
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.
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:
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.
The relationship of the control and management of hospitals to the general health policy.
The operation of the health benefits under the Social Security Act 1938, and their relationship to the general health policy.
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.
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.
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).
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.