Brief reports received from governments on the progress of their health activities

WORLD HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA SANT~

REGIONAL OFFICE FOR

THE WESTERN PACIFIC

BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL

REGIONAL C01,Jl"lITTEE Fourteenth Session Port JVloresby 5-10 September 1963 Agenda Item 9 B.i:liJ1:F H.EPORTS RECEIVED FROlvl GOVERNlVlENTS ON TBE PHOGBESS OF THEIR HEALTH AGrrvTIIES

5 September 1963

ORIGTNA1:

ENGLISH

Attached are brief reports received from the following governments in the Region on the progress of their health activities:

British Solomon Islands Protectorate Brunei China (Taiwan) Japan Korea *ll[alaya New Zealand North Borneo * Philippines *Sarawak Singapore Territory of Papua 8,nd New Guinea Viet-Nam .Western Samoa

* Au5tralia

* Available

in English only

AUSTRALIA Report on the Progress of Health Activities The following gives an outline of the more important matters in the 1962/63 Report of the Director-General of Health. l~

...

NATIONAL HEALTH SCHEME - HOSPITAL BENEFITS

During 1962/63 the National Health Act and Regulations were amended to simplify the payment of Commonwealth hospital benefits and at the same time provide for pensioners and patients in convalescent and rest homes. One aspect of the Hospital Benefits Scheme that had been a cause of some misunderstanding and difficulty had been the payment of Commonwealth benefit for insured patients in two separate stages, ordinary hospital benefit of 8/- a day being deducted from the patient's hospital account and the 4/- or ]2/. a day additional benefit being paid to the patient by his insurance organization with his fund benefit. A tendency had developed for pensioners to be required to pay hospital insurance contributions to meet charges for hospital treatment. As it has been the policy of the Commonwealth Government to provide free medical and pharmaceutical benefits for eligible pensioners under the Pensioner Medical Service it was considered desirable that arrangements should be made for the free treatment of these pensioners in public wards of public hospitals. It had been found that the existing hospital benefit arrangements had not been operating satisfactorily for patients in convalescent and rest homes and infir.mary sections of State benevolent homes and homes for the aged. Because many patients in these homes were pensioners and because they often remained in the homes for long periods the Commonwealth Government decided that they should not be obliged to join an insurance fUnd to qualify for Commonwealth benefits. The new arrangements, authorized by the amendments to the National Health Act and Regulation~have operated from 1 January 1963 and provide that qualified patients in approved hospitals and nursing homes are eligible for only one Commonwealth benefit in any one day, the amount of Commonwealth benefit payable being: In approved hospitals -

(a) (b)

for insured patients - 20/- a day (or 8/- a day during a waiting period or a period of unfinancial membership); in respect of pensioners enrolled in the Pensioner Medical Service and their dependants in public wards of public hospitals - 36/- a da~ for uninsured patients not included in (b) -

(c)

8/-

a d~

- 2 -

In approved nursing homes -

for all patients - 20/- a day. 2. 2.1

PUBLIC HEALTH Commonwealth Poisons Register

Work on the preparation of a Register of Poisons was carried out in 1962/63. The initial work has been directed principal~ towards the collection of information concerning all pesticide, insecticide and herbicide products marketed in Australia, the number of formulations for sale being in excess of 3000. Technical details have been assembled for the first 1200 of these preparations; collection of the required information for the remainder is proceeding and printing of the first batch of completed cards will commence before the ent3 ('If the calendar year. A sample card is shown below. Name WEEVIL-FUME Type of Product INSECTICIDE

MANUFACTUPER INGREDIENTS

John Smith Pty. Ltd., Sydney, N.S.W. TOXICITY Carbon bisulphide: From absorption through all portals; estimated oral fatal dose 1 to 2 ounces. Carbon tetrachloride estimated oral fatal dose 5 to 10 IDl. but as little as 2 mI. has caused death. CUtaneous absorption can cause toxicity.

Carbon tetrachloride Carbon bisulphide SUlphur dioxide

SYMPTOMS & FnmnmS

Nausea, vomiting and abdominal pain, visual disturbances, dizziness, confusion, central nervous depression, coma and death from circulatory collapse or respiratory arrest. Watch for kidney and liver injury, oliguria, albuminuria, edema, jaundice.

Remove patient to fresh air; if swallowed induce emesis or gastric lavage with water and instill sodium sulphate cathartic. Remove contaminated clothes and wash skin well for cutaneous exposure. See card on Carbon Tetrachloride. Avoid: Epinephrine, danger of ventricular fibrillation; fats and alcohol. DATE

6/63 Commonwealth Information Centre for Poison Control

- 3 -

2.2

Poliomyelitis

The incidence of poliomyelitis in the year was low in all States, only 35 cases being confirmed by the Poliomyelitis SUrveillance Committee compared with 572 in the previous year. Although the number of cases was small; this does not mean that the danger of future outbreaks has disappeared. For use in any future emergency 1 000 000 doses of each of the three poliovirus types of Sabin vaccine were imported during the year and are held at the Commonwealth Serum Laboratories. The recommendation of the National Health and Medical Research Council that a fourth dose of Salk vaccine should be given a minimum of one year after the third dose was implemented and an average of 31 000 doses of vaccine were issued to the States each week since January 1963. 2.3 Australian Drug Evaluation Committee

Because of the recent revelations of the harmfUl side-effects of some hitherto widely used druC'" . . . nd the rapidi ty with which many new and potent remedies are being introduced into therap~IJ a committee known as the Australian Drug Evaluati on Committee lTas established in June 1963. This Committee, whose members are eminent in the fields of clinical medicine and pharmacology, will report on the safety of drugs generally, evaluate specific drugs referred to it for opinion by the Director-General and act as an independent arbiter in cases where an importer or manufacturer of drugs desires a review of a prohibition imposed by the Department of Health.

2.4

Northern Territory Health Services

ThQ further development of the Survey Section has made possible the extension of the effectiv~ coverage by triple-certificated sisters to the whole of the Northern Territory. These sisters will soon be in the position to see every Aboriginal in the Territory at least once every year. Although particular emphasis is placed on infant health and the well-being of the vulnerable groups, the: isters playa vital part in the leprosy control campaign and assict materially in the control of communicable disease. A special expedition of the Senior Survey Sister into Eastern Arnhem Land resulted in contact being made with 105 Aboriginals, 40 of whom had not previously been in contact with any European and their existence was unsuspected. 2.5 National Fitness Movement

The National Fitness Movement in Australia will benefit from the activities which will follow the introduction on a large scale of the Duke of Ed nburgh I s Award Scheme. Originated by His Royal Highness, the Duke of Ed riburgh in 1954 the scheme, which is intended to assist the development of character and citizenship in young people, involves a personal challenge to the young participant to attain a certain standard of proficiency in leisure time activities of a purposeful

- 4 -

•

kind. Because of its link with National Fitness the Commonwealth Minister for Health approved in May 1963 a grant of £500 from the National Fitness Fund to assist in the establishment of an Australian office of the scheme. The scheme is, however, in no way subject to governmental control. 2.6 Institute of Child Health

The Director-General of Health and the University of Sydney have agreed to a joint appointment between the Commonwealth Department of Health and the University of an Associate Professor of Child Psychiatry in the Departments of Child Health and Psychiatry in the University of Sydney. It is believed that this will be the first appointment of a professor or associate professor of child psychiatry in the British Commonwealth.

•

2.7

National Health and Medical Research Council

As part of the general reorganization of the council activities, all committees of council were reformed. Three main advisory committees were appointed which will report direct to council. These are the Medical Research Advisory Committee, composed of persons with specialized knowledge and experience in medical research appOinted by the council, the Medicine Advisory Committee composed of the members of Council representing the Australian colleges and medical associations, and the PUblic Health Advisory Committee, composed of the State Directors of Health.

The Antibiotics, Nursing, Nutrition, Radiation Health and Radio Isotopes Committees were reformed with new terms of reference and will report to council in future through the Medicine Advisory Committee. The Dental Health, Epidemiology, Food Additives, Food Standards, Maternal and Child Health, Medical Statistics, Occupational Health, Traffic Injury, Tropical Medicine and Health and Veterinary PUblic Health Committees were also reformed with new terms of reference and will report to Council through the PUblic Health Advisory Committee. Sub-committees were formed to deal with the Training of Personnel Using Radio Isotopes, Poisons Schedules, Poliomyelitis, Preventive Medicine in General Practice, Health Advertisements, the Labelling of Hazardous Substances, Dental Data Standardization, Virology, Food Irradiation, Food and Cosmetic Colours, Pesticide Residues in Food, the National Morbidity Survey, Radiation Technical Matters and Policy and Pesticides. 2.8 Leprosy

The Council accepted the detailed report by the special Leprosy Committee as a general principle for control of leprosy in Australia. It was considered that it sho,lld be possible to eliminate leprosy in Australia during this century and that it is now possible to define and clinically recognize non-infectious states of leprosy.

I

- 5 -

Among the more general reco~endations it was considered that the terms "leper", "lazaret" and "leprosarium" should no longer be used and that the curable nature of the condition should be stressed by referring to people with leprosy as "leprosy patients" or "patients with Hansen's Disease" and to special leprosy isolation establishments as "leprosy hospitals", "hospitals for the treatment of Hansen's Disease ll or simply "isolation hospitals".

•

2.9

Traffic Injuries

The scheme to provide a standardized medical report form for traffic accidents was supported. These forms are being printed and will be used initially by over thirty general practitioners interested in the traffic accident injury problem. The Council provides a research grant to support an accident injury investigation in Brisbane and supported a proposed extension of this project. It was noted, however, that very little of the information available on the prevention of traffic accidents has be p ,., applied and that other countries' successe in preventing traffic accidents has been due to action at the political, social and educational levels.

J

COMMONWEALTH

OF

AUSTRALIA

REPORT OF

THE DIRECTOR-GENERAL OF

HEALTH

JUL Y 1. 1961 - - - JUNE 30, 1962

CENTRAL OFFICE, PARKES, CANBERRA, A.C.T.

•

COMMONWEALTH

Director.General: F.R.C.O.G. Assistant

Major-General W.

D. Refshauge,

C.B.E.,

M.B.,

B.S.,

Directors~General:

Dr. H. E. Downes, M.B., B.S., D.P.H. Dr. G. M. Redshaw, M.B., B.S., D.P.H. R. H. D. White, O.B.E.

Senior Medical Officers: Dr. W. F. H. Crick, M.B., B.S. Dr. A. M. McArthur, M.B., Ch.B., D.T.M. & H., M.C.P.A. Dr. R. C. Webb, M.B., B.S., D.T.M. & H. (Chief Commonwealth Medical Officer at Australia House, London). Dr. C. W. Phillips, M.B., B.S., D.T.M. & H. (Chief Commonwealth Medical Officer, Immigration Service, The Hague, Holland). Division of Public Health: Director, Dr. A. Johnson, M.B., B.Ch., B.A.O., B.A., D.P .H. (Belfast). Division of Tuberculosis: Director, Dr. Alan King, C.St.J., B.Sc., M.B., B.S., F.C.C.P. National Health and Medical Research Council: Medical Secretary, Dr. R. H. C. Wells, M.D., B.S., B.Sc., M.R.C.P., D.T.M. & H. Pharmaceutical Division: Director, R. M. W. Cunningham, Ph.C., M.P.S. Division of Plant Quarantine: Director, Dr. T. H. J. Harrison, D.Sc.Agr. (Sydney). D.I.C. (London). Division of Veterinary Hygiene: Director, K. S. McIntosh, B.V.Sc. Division of Nursing: Principal, Matron F. M. Peterson. Medical and Hospital Benefits Division: Dil-ector, A. A. M. Kelly, D.P.A.. A.A.S.A.

STATE OFFlCES Sydney: The Commonwealth Centre, Elizabeth-street, Sydney, N.S.W. Commonwealth Director of Health, Dr. L. J. Wienholt, M.B., B.S.

Melbourne: Commonwealth Offices, Spring-street, Melbourne, C.I, Victoria. Commonwealth Director of Health, Dr. H. M. Franklands, M.B., B.S., D.T.M. Brisbane: Commonwealth Government Offices, Anzac Square, Adelaide-street, Brisbane, Queensland. Commonwealth Director of Health, Dr. A. H. Humphry, M.B., B.S.,. D.T.M.&H.

DEPARTMENT

OF

HEALTH

Adelaide: C.M.L. Building, 41-47 King William-street, Adelaide, South Australia. Commonwealth Director of Health, Dr. C. S. Barbour, M.B., B.S. Perth: 473 Wellington-street, Perth, Western Australia. Commonwealth Director of Health, Dr. I. B. Mathieson, M.B., B.S., D.T.M. Hobart: Commonwealth Offices, Stowell-avenue, Battery Point, Hobart, Tasmania. Acting Commonwealth Director of Health, Dr. B. W. Royall, M.B., B.S., D.T.M.&H. Darwin: Department of Health, Darwin, N.T. Commonwealth Director of Health, Dr. I. D. Byrne, M.B., B.S., D.T.M. & H. LABORATORIES AND RESEARCH ORGANIZATIONS Commonwealth X-ray and Radium Laboratory, Surry-place, Melbourne, C.l. Director, D. I. Stevens, O.B.E., B.Sc. Commonwealth Acoustic Laboratories, Commonwealth Offices, 5 Hickson-road, Miller's Point, Sydney, N.S.W. Director, N. E. Murray, O.B.E., B.E., B.Sc. Institute of Anatomy, Canberra, A.C.T. Medical Officer-in-charge, Dr. E. H. Hipsley, M.B., B.S. Institute of Child Health, University of Sydney, N.s.W. Director, Professor Thomas Stapleton, M.A., D.M., M.R.C.P. School of Public Health and Tropical Medicine, University Grounds, Sydney, N.S.W. Director, Sir Edward Ford, O.B.E., M.D., D.P.H., D.T.M., F.R.A.C.,P., F.Z.S. Commonwealth Bureau of Dental Standards, 18 Lonsdale-street, Melbourne, C.l. Officer-in-charge, A. R. Docking, M.Sc. National Biological Standards Laboratory, Canberra, A.C.T. Director, Dr. L. F. Dodson, M.B., B.S., Dip. Clio.Path., D.Phil. (Oxon). Commonwealth Health Laboratories are located at the following centres:Townsville, Cairns, Rockhampton, Toowoomba, Lismore, Tamworth, Albury, Bendigo, Launceston, Hobart, Port Pirie, Kalgoorlie, Darwin, Canberra, Alice Springs. The names listed above are those of the officers occupying the various positions at the time of publication of this Report. In several instances the officer concerned assumed the position either during or since the period covered by the Report, the officer formerly occupying the position having either retired or taken up other duties.

'v "f.

CONTENTS PAOE.

Introduction .. National Health Benefits Hospital Benefits Medical Benefits .. Pensioner Medical Service Phannaceutical Benefits Tuberculosis .. Public Health Immigration Medical Service National Fitness .. Nursing Institute of Anatomy Nutrition Therapeutic Substances Epidemiology Broadcasting and Television National Health aud Medical Research Council Medical Research aud Teaching Institutions School of Public Health and Tropical Medicine Institute of Child Health •• Quarantine .. Animal Quarantine and Veterinary Hygiene Human Quarantine and Marine Hygiene Plant Quarantine Territory Health Australian Capital Territory Northern Territory Commonwealth Laboratories Commonwealth X-ray and Radium Laboratory Commonwealth Acoustic Laboratories National Biological Standards Laboratory " Commonwealth Bureau of Dental Standards Commonwealth Health Laboratories World Health Organization Commonwealth Grants Red Cross Blood Transfusion Service Royal Flying Doctor Service of Australia Home Nursing Subsidies Free Milk for School Children Mental Institutions

7 9

10 13 15

18 37 44 45 46 48 49 50 50 51 55 57 60 60 67

.-r

71

71 75 78

81 81 86 94 94

108 112 116

117 118

119 119 119

120 121 121

COMMONWEALTH DEPARTMENT OF HEALTH REPORT FOR THE PERIOD FROM 1st JULY, 1961, TO 30th JUNE, 1962. HIS report deals in detail with the activities of the Commonwealth Department of Health during the year ending 30th June, 1962. No major outbreak of communicable disease occurred during the period, although 572 confirmed cases of poliomyelitis were notified, compared with 191 in the previous twelve months. There was, however, a fall in the number of cases of infectious hepatitis from 12,847 in 1960-61 to 11,557 during the year under review. The National Health Scheme continued to expand, the Commonwealth providing substantial financial assistance towards meeting the cost of medical and hospital treatment, and the provision of drugs prescribed by doctors, both for private patients and persons receiving treatment in hospitals. The Commonwealth provided medical treatment and drugs free to pensioners and gave financial assistance to State Governments which facilitated the provision of hospital treatment to pensioners without charge. In the case of both hospital and medical treatment, Commonwealth assistance to patients took the form, principally, of payment of a substantial part of the benefit accruing to persons insured with the hospital and medical insurance funds; also to their dependants. In addition, the Commonwealth met the cost of deducting 8s. a day from the accounts of all patients, insured or otherwise, treated in public and approved private hospitals. In the case of uninsured pensioners treated in public hospitals, the Commonwealth's contribution was 12s. a day. Membership of the Hospital Benefits insurance scheme at 30th June, 1962, covered 73 per cent. of the population, including members and dependants, and Medical Benefits Scheme membership covered 68 per cent. of the population. In addition, 'a large section of the community is protected by the Pensioner Medical Service (the cost of which is met by the Commonwealth), Commonwealth Repatriation benefits, and other provisions. As a result of higher charges for hospital treatment, which in most States have applied in recent years, most hospital fund organizations now operate tables providing a combined Commonwealth and Fund benefit of 80s. a day, while a few organizations operate tables providing 'combined benefits as high as 1208. a day. No amendments were made in 1961-62 to legislation governing the operation of these schemes. Under the Pharmaceutical Benefits Scheme the Commonwealth meets all but 5s. of the cost of dispensing by chemists of a wide range of prescriptions written by qualified medical practitioners. No charge is made to eligible pensioners for the supply of these prescriptions. No legislative changes were made in this scheme during the year under review, although the range of benefits was extended. Restrictions were placed on the prescribing of tranquillizer drugs. Expenditure under the scheme increased during the year by £7,308,662 to £35,189,883 (including £9,097,498 for pensioners and £3,776,141 reimbursed by the Commonwealth to approved hospitals, Bush Nursing Centres, &c.). Payments by patients, at 5s. per prescription amounted to £6,503,888. Approximately 37,700,000 prescriptions were handled under the scheme, 11 ,700,000 of them for pensioners. The average price per prescription was 208. Id.

T

·:/ ,

8

The increase in the cost of the scheme was due, principally, to the increasing volume of prescriptions. This resulted from the expansion in the list of benefits, more frequent prescribing and, to a lesser degree, natural expansion accompanying increased population. The National campaign against tuberculosis, with finance provided to the States under the Commonwealth"State arrangement of 19'48, has shown progress in the level of control of the disease in Australia as a whole. However, it is apparent that the uniform attack on the disease envisaged at the initiation of the campaign has not yet been accomplished. The annual death rate has fallen again slightly, reflecting the success of modern treatment. The current figure of 3.9 deaths from pUlmonary tuberculosis per 100,000 of popUlation is very satisfactory. However, the continued incidence of new infections, with 3,570 notifications in all forms of tuberculosis during 1961, suggests the need for greater co-operation from the public and a more positive case-finding programme, at least in some States, if the goal of eradication is to he accomplished as rapidly as is desirable. Annual expenditure by the Commonwealth is now well below the peak year 1956-57 and has levelled out, being approximately the same as for the previous two financial years. The work of the Divisions of Human, Animal and Plant Quarantine was pursued vigorously. Although the steady increase in air traffic and reduced times of flights has greatly increased the problems confronting all three divisions, there was no evidence during the period that the quarantine barriers have been broken in any material respect. In December, 1961, it was first discovered that the Sirex Wood Wasp had become established in Victoria. Hitherto the wasp had been confined to Tasmania. At a conference in Canberra in February, 1962. a National Sirex Committee was established, with funds provided jointly by the Commonwealth and States, to survey the extent of the infection in detail and to adopt measures aimed at eradication. The Department's specialist laboratories, which carry out a wide range of research, collaborate with the medical professions and industry in many fields, provide specialiSJt services and in many instances have teaching functions associated with the Universities and other educational authorities, were active throughout the year. The work of these institutions is outlined in detail in this report. Officers of the Department co-operated, wherever opportunity presented, with the National Health and Medical Research Council, the principal functions of which are to advise the Minister for Health in the allocation of grants to encourage medical research, and to advise Commonwealth and State Governments on questions of public health. The Department continued to administer health services in the Australian Capital Territory and the Northern Territory. Commonwealth Health Laboratories which are located at strategic points throughout Australia, continued to collaborate in research projects and assisted local members of the medical profession by the pathological and other examination of clinical specimens to further the diagnosis of disease not otherwise readily identifiable. Australia continued ,to play an active role in the work of the World Health Organization. Australia is a financial member of the Organization and is repre~nted regularly at its Assembly and the meetings of its Regional Committees.

NATIONAL HEALTH BENEFITS The National Health Scheme bad its beginnings in 1946, when the Commonwealth entered into agreements with the States providing for payment by the Commonwealth of a hospital benefit of 6s. per day in respect of each daily occupied bed in public hospitals. The Scheme has since been expanded so that to-day it covers a wide range of benefits and services for the community. The Commonwealth provides substantial financial assistance towards meeting the cost of medical, hospital and pharmaceutical treatment for the individual generally. Special consideration has been given to the health needs of pensioners. The National Health Act was introduced in 1953 to consolidate into a single Act all legislation which provided the necessary authority for the separate services. The National Health Act 1953-1961 provides for the Medical Benefits Scheme, the Hospital Benefits Scheme, the Pensioner Medical Service and the Pharmaceutical Benefits Scheme. Commonwealth expenditure on these 'activities has continued to expand and in the year ended 30th June, 1962 amounted to £72,700,000 compared with £62,800,000 in the previous year. The graph below compares the amounts paid under each Scheme in 1960-61 and 1961-62. COMMONWEALTH EXPENDITURE UNDER NATIONAL HEALTH SCHEME 1960-61 AND 1961-62. £milli.on

·.

1960-61 30

1961-62

20

~.f

10

Phormoceul,cal Beneht~

Hospital

Medicol

Benefits

Benefits

PenSioner Medical Service

0/0 Increase .... 260/.

70/.

9'-

5%

10

Table I on page 22 sets out the total Commonwealth expenditure since 1st July, 1945, while tables II to XV on page 23 and 35 show the detailed statistics relating to each of the various benefits.

HOSPITAL BENEFITS During 1961-62 Commonwealth hospital benefits were of two types, known as Ordinary hospital benefits and Additional hospital benefits. Commonwealth Ordinary hospital benefit was provided for patients in public and approved private hospitals by way of deduction from the patient's hospital account at the rate of 8s. per day or, for pensioners enrolled in the Pensioner Medical Service, who were not contributors to a registered hospital benefit organization and who were patients in public hospitals, at the rate of 12s. per day. Additional hospital benefits are paid through the registered organizations to their members at the rate of 4s. per day to contributors who are insured for a Fund benefit of at least 6s. per day but less than 16s. per day, and at the rate of 12s. per day to contributors who are insured for a Fund benefit of at least 16s. per day. Contributors also receive the Fund benefit to which they are entitled under the rules of the organizations. As it is now ten years since the present Hospital Benefits Scheme, based on the principle of self-help, was introduced, this is an appropriate time to review the operation of the Scheme. Prior to the introduction of the present Scheme, under agreements between the Commonwealth and each of the State Governments, the Commonwealth paid the State Governments at the rate of 8s. for each day of hospitalization in a public hospital. This amount was also paid in respect of patients in approved private hospitals to the proprietors of the hospitals. In each instance, these payments were made on condition that the benefits were deducted from the patient's hospital account. On the basis of the Government's belief that the most effective way of providing further hospital benefits was to endorse the principle of self-help through a voluntary insurance scheme, the Commonwealth Government on 1st January, 1952, introduced the Additional Hospital Benefits Scheme whereby the Commonwealth provided a benefit of 4s. per day, additional to the 8s. per day Ordinary benefit, for patients who were members of a registered hospital benefits organization. The patient received the Additional benefit through the registered organization and the organization was reimbursed periodically. Certain minimum requirements for registration of a hospital benefits organization were hid down. Broadly these requirements were that the organization must provide for payment of hospital fund benefit of at least 6s. per day, must be nonprofit making and apply contributions received towards the payment or provision for payment of benefits and administrative expenses. In the year ended 30th June, 1953, the first full year of operation of the Scheme, Additional hospital benefit payments amounted to £643,582. Membership of registered hospital benefits organizations at 30th June, 1953 was 1,500,000 and 39 per cent. of the population was covered by the Scheme. The po~ition in 1952 and the years immediately following was that Commonwealth Ordinary benefit of Ss. per day plus Additional hospital benefit of 4s. per day plus Fund benefit of 6s. per day provided an insured contributor with 18s. per day which covered the normal daily public ward charge of 18s. With the rising

11

cost o.f hos~tal treatment, however, the charge for public ward hospitalization had been mcreasmg and by ~957 the usual charge was 36s. per day in all States except Queensland where publIc ward treatment was, and still is free. To meet this situation the Commonwealth, in conformity with the prin~iple of the insurance scheme, introduced from 1st January, 1958 a 12s. per day Additional hospital benefit .for contributors Who insured for a Fund benefit of at least 16s. per day. Accordmgly, as from 1st January, 1958 a person insured for 16s. Fund benefit received, ~ogether with Commonwealth benefits amounting to 20s., a total of 36s. a day whIch generally covered the public ward charges throughout the Commonwealth. As a result of the introduction of the increased daily mte of Additional hospital benefits, the payment of Commonwealth Additional benefits rose from £2,831,944 in 1957-58 to £6,146,007 in 1958-59 . . At this time an appreciable percentage of claims for Fund benefit was being rejected by the organizations under rules which provided for non-payment of benefits in cases of pre-existing ailments, chronic illnesses and cLaims in excess of the specified maximum. Although these exclusions were a source of criticism of the Hospital Benefits Scheme, the level of organizations' contributions did not permit them to extend benefits in such cases. To meet these problems, Special Accounts were introduced from 1st January, 1959. The basic principle of the Special Accounts in that the registered organizations provide a minimum rate of Fund benefit to contributors in respect of claims which would otherwise be disallowed under pre-existing ailment, chronic illness or maximum Fund benefit rules. This minimum benefit is referred to as the "standard rate" benefit and, in respect of hosiptal claims, is a Fund benefit of 16s. per day. If the contributor is insured in a table paying Fund benefit less than the standard rate, Fund benefit is payable at the insured rate. In recognition of the fact that older people generally require more hospital treatment than the remainder of the community the Special Account legislation requires tbat all contributors aged 65 years and over be transferred to the hospital fund Special Account. The National Health Act does not l'equire each registered organization to establish a Special Account, but having established one, the registered organization is required to pay these minimum Fund benefits either from the Special Account or from the general account of the organiZlation known as the Ordinary Account. Some organizations which did not establish Special Accounts amended their rules to provide that pre-existing ailment, chronic illness or maximum fund benefit rules would not operate so as to reduce a contributor's benefit below that which h. would receive as a Special Account contributor. An organization which has established a Special Account is required to credit to the Special Account all contributions receivable from the contributor after a certain date and if at the end of the financial year the payments from the Special Accounts for benefits and for reasonable management expenses exceed the contributions credited to the Account, the amount of the deficit is reimbursed by the Commonwealth. The deficits have continued to increase each year and in 1961-62 the Special Accounts Plan cost the Commonwealth £2,665,565. A contributor is not required to pay a higher rate of contri?ution ~~ virt"!e of his being a Special Account member, and, except for certain conditions, IS

I ,

.

;;'.

12

entitled to the same fund benefit as if he were an ordinary contributor. The main conditions are that the hospital must be recognized for Special Account purposes and that combined Commonwealth and Fund benefit must not exceed the amount of the hospital charge and certain extra charges. When the Special Accounts were introduced it was provided that Fund benefit was not payable to a Special Account contributor unless he was a patient in a hospital recognized for the purpose. The Act provided that benevolent homes, convalescent homes, homes for the aged, rest homes and institutions that cater'ed principally for permanent patients could not be recognized. The decision to exclude these institutions were based partly on financial considerations, partly on the ground that the Commonwealth was already contributing generously by way of Commonwealth Ordinary and Additional hospital benefits towards the maintenance of patients in these institutions, but principally on the ground that, in general, Fund benefit had never been paid for treatment in such institutions. The policy was subject to criticism mainly on the grounds that the rigidity of the provision excluded from benefit some patients in certain of these institutions, who, to all intents and purposes, were genuine hospital cases. In 1959, the National Health Act was accordingly amended to re-define the class of institution which was not to be recognized by omitting the reference to institutions catering for permanent patients and by providing also for payment of Special Account Fund benefit to particular individual patients in unrecognized hospitals where the patient was suffering from an illness or injury requiring treatment of the kind provided in recognized public hospitals and had in fact received such treatment. During 1961-62 a total of 2,177 cases received consideration under this provision and hospital fund Special Account benefit was authorized in full in 1,692 cases and in part in 94 cases. In 1961, the condition limiting the combined Commonwealth and Fund benefits for Special Account contributors to the amount of the hospital charge was liberalized to permit extra charges to be taken into account. These extra charges are those made by a hospital by way of theatre fees or charges for drugs, dressing (including plaster) or special nursing or laundry services incurred by a patient during his period of hospitalization. An indication of the success of the Special Accounts in extending the availability of benefits under the voluntary insurance scheme is shown in the fact that hospital benefit funds with more than 90 per cent. of the total membership have voluntarily established Special Accounts, while 11.6 per cent. of the ovenin membership of all hospital benefit& funds are members of Special Accounts. As charges for hospitalization have increased, hospital benefit tables have been introduced by registered organizations to afford opportunity to obtain adequate benefit cover. Most organizations now operate tables providing a combined Commonwealth and Fund benefit of 80s. per day, while a few organizations operate tables providing a combined benefit as high as 120s. per day.

,-

~

.

Influenced by increased hospital charges and the incentive of the higher Commonwealth Additional benefit, almost all members of registered organizations are now contributing to tables which pay a Fund benefit of at least 16s. per day; for more than 98 per cent. of the days for which Commonwealth Additional benefits are paid, those benefits are at the rate of 12s. per day. From a modest beginning where, at 30th June, 1952, only 25 per cent. of the population was covered by voluntary health insurance under the Hospital Benefits

13

Scheme and total benefit (including Fund Benefit) paid during 1951-52 amounted to £7,500,000, the Scheme has grown to' the stage that at 30th June, 1962, 73 per cent. of the pDpulatiDn is cO'vered and tDtal bene,fits paid in 1961-62 amDunted to £36,200,000. The graph belDw illustrates the grDwth of the Scheme between 1951-52 and 1961-62.

COMMONWEALTH AND FUND HOSPITAL BENEFITS PAID 1951-52 TO 1961-62 ~ Commonwealth Orchnory Benefit Commonwealth Additional Benefit Fund Benefit J including

c:::J ,..t'

Special Account defic;hJ

~ 1951,52 1952·53 1953·54 1954·55

195>56 1956·57

1957·58 1958--$9

1959-60 1960-61

1961·62 [mill ron

2S

30

)'

MEDICAL BENEFITS CDmmDnwealth Medical benefits are paid only to' financial cDntributDrs to registered Medical benefits DrganizatiDns. The benefits paid fDr each type Df medical service rendered by Dr Dn behalf Df registered medical practitiDners are set out in the Schedules to' the NatiDnal Health Act. Payments are made thrDugh the cDntributor's, registered organization, which, subject to' its rules, alsO' pays fDr each medical service a Fund benefit equal to' Dr greater than the amDunt of CDmmonwealth benefit. Cutain minimum requirements have been. laid down for re~stration Df a medical benefits organizatiO'n. These requirements are similar to' those for bMpita! benefits DrganizatiDns inasmuch as the organizatiDn mUll be non-profit making and apply contributiDl1S received tDwards the payment, Of provision for payment, Df benefits and administrative expenses. The orpnhation mU9t provide a Fund benefit equal to' Dr greater than the amounb specified far an the professional services included in the First Schedttte tet abe Natiolial Health Act. Generally, for a weekly cDntribution of between Is. 3d. aDd 2.. tot a ~1~}e person and 28. 6d. and 48. for a family, a COlltnDutor receives ~ .:ombiaed Commonwealth and Fund benefit ranging from 12~. to 1M. fot ill ~'Ileral prali:titioner cDnsultation to' £60 for SDme maJor operationS". The combined benefit mtlit not, however. exceed 90 per cent. of '.he fee &baraed by a medical ptactJ.t.ioDeJ' .

In adcfifian, most ~tered organaatiOflS provide Pond bedefttf for «tttiA ancitrary serrices mdt ~ pbysiothernpytre:3ltment, booJe nursing' aJJd opwmetrial services, for whic& no COtm'llOflWellltb benefit ~ paid.

14

The Special Accounts system also operates in the Medical Benefits Scheme to provide minimum Fund benefits to contributors in respect of claims which would otherwise be disallowed under organizations' rules relating to pre-existing ailments and maximum benefits. In the case of medical benefits, the standard rate is a Fund benefit for each medical service equivalent to the amount specified for that service in the First and Second Schedules to the National Health Act. Initially, the Special Account legislation required that all contributors to medical benefits organizations aged 65 years and over be transferred to the Special Account. However, it was found during the first year of operation of the Special Accounts that, so far as medical benefits were concerned, the contributors aged 65 years and over in many organizations were, in general, not a "bad risk" and their transfer to the Medical benefit Special Account was not necessary. Consequently, the requirement was waived for Medical benefits as from 1st January, 19.59. The Medical Benefits Scheme has also continued to develop. Contributors at 30th Junl~, 1962, numbered 2,846,25·7, covering 7,275,000 persons representing 68 per cent. of the population. This compares with a membership of 1,358,337 and a 39' percent. coverage at 30th June, 19'54, the end of the first year of operation of the Scheme. In addition, a large section of the community is substantially protected by the Pens'ioner Medical Service, Repatriation benefits and other provisions. As in the Hospital Benefits Scheme, members of registered organizations are contributing generally to tables which pay the higher rates of Fund benefit. The majority of members are now contributing to tables providing a Fund benefit of generally 166.2/3 per cent. of the Commonwealth benefit. The graph below sets out the benefits paid under the Medical Benefits Scheme from 1953-54 to 1961-62. COMMONWEALTH AND FUND MEDICAL &ENEFITS PAID 1953-54 TO 1961-62. Commonwealth Benefit Fund Benefit 1953·54 1954·55 1955.50 1956·57

~~:~~~~---....1.--II..-..,..---t------t-----t--I

1958·59 1957·58

~~~~~~~~~~~;========r==±;====~=i 5 10 15 20 25

1960-61 W,,:W:;,I,7hW.I,;Wh:

1959·60 1961·62 (million

1IIIIIIIi~~~~~~~~~~~~~~~~~~ .~.

Commonwealth Health Insurance Council: The Commonwealth Health Insurance Council is constituted under Section 136 of the National Health Act. Its functions are to advise the Minister on matters relating to the Medical Benefits ~ Additional, Hospital Benefits Schemes and to recommend means by which Improvements In methods and standards may be effected. The Council consists

IS

of the Director-General of Health as Chairman, six members nominated by the State Associations of registered organizations, members representative of registered organizations generally and one member nominated by the Federal Council of the Australian Medical Association. The Council met in Canberra in November, 1961. It discussed various aspects relating to the Medical and Hospital Benefits Schemes and made a number of recommendations to the Minister. Registration Committee: The Registration Committee, which is constituted under Section 70 of the National Health Act and consists of the Commonwealth Actuary or his representative and two officers of the Health Department, met on twenty occasions during the year ended 30th June, 1962, to consider amendments to rules submitted by registered organizations and make recommendations to the Minister in relation to them.

·

-

PENSIONER MEDICAL SERVICE The Pensioner Medical Service, which commenced on 21st February, 1951, and operates under Part IV. of the National Health Act 1953-1961, is a general practitioner medical service provided free of charge to eligible pensioners and their dependants. The Service is based on an agreement between the Minister for Health and the Federal Council of the British Medical Association in Australia which since 1st January, 1962, has become the Australian Medical Association. Broadly speaking, the agreement covers the provision of medical services by medical practitioners for pensioners and their dependants and sets out the terms and conditions to be included in the agreements that the Director-General of Health, on behalf of the Commonwealth, enters into with individual medical practitioners who wish to participate in the Service. The fees and allowances which will be paid by the Commonwealth to medical practitioners for the medical services are prescribed by Regulation under the National Health Act. Under this Service, participating doctors provide medical attention of a general practitioner nature, such as is ordinarily rendered by a general practitioner in his surgery or at the patient's home to enrolled pensioners and their dependants. This includes treatment of a patient who has undergone a surgical operation from the time that he returns home from a hospital. but the Service does not extend to specialist medic'al services. The pensiDner (Dr dependant) has freedom of choice as to which participating dDctor he will consult. Doctors participating in the Service are remunerated by the Commonwealth on a fee-for-service basis, the fees payable as at 30th June 1962, being 11s. for surgery consultations and 13s. for dDmiciliary visits. The table below sets out the fees paid to' participating doctors since the commencement of the Pensioner Medical Service:Fees Paid. Period. Surgery.

Domiciliary.

s. d. 21.2.51 1.7.51 1.1. 52 1.11.54 1.7.58

s. d.

to to to to to

30.6.51 3\,12.51 31.10.54 30.6.58 30.6.62

6 0 8 10 II 0 0 0

7 6 10 11 12 13 0 0

9 0

0 0

16

Under the agreement, doctors are entitled to be paid a mileage allowance by the Commonwealth of 4s. per mile for mileagetmvelled, one way, where the doctor is required to travel beyond a distance of three miles in metropolitan areas or provincial cities, or two miles in country districts, to attend a pensioner. A mileage fee of Is. per mile may also be collected by the doctor from the pensioner concerned, provided that no pensioner will be required, in any circumstances,to pay more than lOs. mileage fee. A doctor is also permitted to charge a pensioner an "after hours" fee of 58. where a 8ervice is given under the Pensioner Service outside the doctor's usual hours of practice. The permissible charges for mileage and after hours services explained above are the only charges that a doctor may make to a pensioner for attention provided under the Pensioner Medical Service. In addition to the general practitioner service given to enrolled pensioners, a full range of medicines is available free of cost from chemists upon presentation of prescriptions written by doctors. The number of doctors participating in the Pensioner Medical Service continued to increase in 1961-62. At 30th June, 1962, 6,012 doctors were enrolled, an increase of 151 on the number participating at 30th June, 1961. The table below sets out the number of doctors participating in the Pensioner Medical Service, the average number of medical services given by, and the average payment to, each doctor per annum, since the inception of the Service. Year ended lOth June. No. of participating Doctors at 30th June. Average No. of medical services per doctor p.a. Average payment per doctor p.a. £

1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962

.. .. .. .. .. .. ..

.. .. .. .. .. .. .. ..

.. .. .. .. .. ..

.. .. .. ..

. . .. .. .. .. .. .. .. ..

.. .. .. .. ..

.. .. .. ..

..

..

.. ..

..

2,980 3,502 3,898 4,239 4,567 4,730 4,990 5,243 5,531 5,685 5,861 6,012

230 699 886 1,009 1,061 1,142 1,106 1,120 1,165 1,220 1.212 1.236

7S 310 464 512 566 618 617 622 688 733 728 738

To receive the benefits of the Service an eligible pensioner must be in possession of 'an entitlement card issued by the Department of Social Services, which is the authority for the doctor to provide free medical attention under the Scheme and must be presented to the doctor on each occasion that medical treatment is required. An entitlement card may be retained by the person in whose name it is issued as long as he remains eligible for the Pensioner Medical Service. If. for any reason, 'a person ceases to be eligible, the card must be returned as soon as possible to the Department of Social Services. Persons eligible for the Pensioner Medical Service are persons receiving an age, invalid or widow's pension under the Commonwealth Social Services Act or a service pension under the Repatriation Act, subject to an income means test set out in the following paragraph, and persons receiving a tuberculosis allowance under the Tuberculosis Act. Dependent wives and children (under sixteen years of age) of persons who are eligible, are also entitled to the benefits of the Pensioner Medical Service.

17 The means test applied for new enrolments for the Pensioner Medical Service is the income test that had to be satisfied in order to qualify for a full soci-.tl

service pension as at 31st December, 1953. are, except in special circumstancesAge, Invalid, Widows' and Secvice Pensions.

Details of the means test applied Maximum permissible income* per week excluding pension.

Single pensioners Widow., " ., Married couple-both pensioners Married couple-one a pensioner

£ 2

2 ., .. 4 5

* The permissible income is that assessed by the Commonwealth Department of Social Services after makina allowances for dependent children, &C. Persons whose pensions commenced prior to the 1st November, 1955, and persons in receipt of a tuberculosis allowance may receive the benefits of the Pensioner Medical Service even if their income, lapart from pension, exceeds the above limits. The Pensioner Medical Service was introduced to provide a free general practitioner medical service to persons in indigent circumstances. At the time the Service came into operation, pensioners who satisfied the means test to qualify for a social services pension were considered to come within that class. However, with the progressive easing of the pensions means test and increases in pension rates, pensioners were being admitted who, by their means, could not be regarded as being in the indigent class. Accordingly, the limitations on eligibility above were imposed from 1st November, 1955, on all persons granted age. invalid. widows' or service pensions commencing on or after that date. The Pensioner Medical Service has shown a steady growth since its inception and the number of pensioners and their dependants enrolled in the Service increased a further 5.75 per cent. in 1961-62 to reach 810,317 or 7.6 per cent. of the popUlation at 30th June, 1962. Committees of Inquiry: Medical Services Comm~ttees of Inquiry have been established in each State under the provisions of Section 110 of the National Health Act. The personnel of each Committee consists of the Commonwealth Director of Health for the particular State and four medical practitioners appointed by the Minister for Health from among medical practitioners nominated by the Council of the State Branch of the Australian Medical Association. A member of the Committee holds office during the Minister's pleasure and not for a specified period. The functions of the Committees are to inquire into and report to the Minister for Health or the Director-General of He'alth on any matter referred to them arising out of the services or conduct of medical practitioners in respect of the Pensioner Medical Service. Broadly, the Committees' investigations are directed to breaches of the spirit and principles of the Pensioner Medical Service rather than to breaches of the statutory provisions of the National Health Act. The Committees' functions 'also include matters in relation to the prescribing by medical practitioners of pharmaceutical benefits. The Committees have no power to impose penalties or to take disciplinary action themselves. However. on completion of an inquiry, the Committee recommends to the Minister what it considers to be the appropriate action to be taten.

18 The Minister on receipt of the Committee's report may disallow, in whole or in part, p'ayment of fees to the doctor in respect of medical services specified in the report, reprimand the medical practitioner or terminate immediately the agreement entered into with the medical practitioner. Notice of the action taken may be published in the Commonwealth Gazette. A Federal Medical Service Committee of Inquiry has also been established consisting of the Director-General of Health and four medical practitioners appointed by the Minister for Health from among six medical practitioners nominated by the Federal Council of the Australian Medical Association. The Federal Committee deals with matters involving questions of principle or matters common to more than one State.

PHARMACEUTICAL BENEFITS SCHEME Pharmaceutical Benefits are provided by the Commonwealth in accordance with Part VII. of the National Health Act 1953-1961 and the National Health (Pharmaceutical Benefits) Regulations. In September, 1950, a scheme was implemented whereby certain life-saving drugs were made available on doctors' prescriptions. The drugs were dispensed by chemists of the patients' choice and the Department of Health paid the chemist for the benefits supplied. The Scheme was expanded in August, 1951, to provide, in addition to the life-saving drugs already available, a comprehensive range of medicines for pensioners who were enrDlled in the Pensioner Medical Service. No charge was made for benefits supplied either to the general public Dr to pensioners. Over the years, the lists of General Pharmaceutical Benefits and Pensioner Benefits were expanded to meet advances in medical knowledge. In March, 1960, a major departure was made from the previous Schemes. On the 1st March, the General and Pensioner Benefit Schemes were amalgamated and the entire range of drugs in both Schemes, with the exception of a small number of drugs restricted to eligible pensioners, was thenceforth made available to the general public. Eligible pensioners have continued to receive benefits free of charge, but other persons are required to pay a fee of 5s. for each prescription. Pharmaceutical Benefits Advisory Committee: The present to provide the community with therapy to CDver the general With this end in view the list of drugs available under the has continued to be enlarged by the addition of new drugs to Scheme is designed scope of medicine. broadened Scheme the list of benefits.

Drugs and medicinal preparations are added to the list of pharmaceutical benefits by the Minister for Health on the recommendation of an expert committee known as the Pharmaceutical Benefits Advisory Committee. This Committee is established under the National Health Act and is required to make recommendations to the Minister on the drugs and medicinal preparntions which it considers should be made available .as Pharmaceutical Benefits. The Committee also advises the Minister, when required, on the operation of the Scheme. tio The Committee consists of nine members. The Australian Medical Associaand The Federated Pharmaceutical Service Guild each submit a panel of n~es selected from members of their profession. From these panels the

19 Minister appoints to the Committee six doctors and a pbarmaceutical chemist. A pharmacologist and a Departmental pharmacist are also members of the Committee. Appreciation is recorded here of the valuable assistance rendered by this Committee in the operation of the Pharmaceutical Benefits Scheme. Operations of the Pbarmaceutical Benefits Advisory Committee: The Committee met on three occasions during the year. It recommended the addition of a total of 57 new drugs to the list of benefits. Of the drugs and medicinal preparations added to the list of benefits the most important categories were:(a) Synthetic Penicillins; (b) Antifungal antibiotic; and (c) Certain antibiotic and anti-tuberculous drugs for use in approved hospitals. In addition, the Committee recommended that a number of new forms and strengths of existing drugs be added to the list of benefits. An important recommendation of this nature was the addition of ready prepared eye-drops in sterile' form. The Committee ralso made a number of recommendations varying the categories of the diseases and conditions for which a number of drugs could be prescribed as pharmaceutical benefits. The most important of these recommendations was the imposition of restrictions on the tranquillizing drugs. Prescribers' Journal: The British National Health Service, concerned by the difficulty of busy doctors in obtaining early and reliable information about new pharmaceutical products, decided to produce in 1961 a journal that would provide early and impartial information on new drugs and medicinal preparations. This. journal is known as Prescribers' Journal. A similar problem exists for Australian doctors and it was considered that the Journal would prove of valuable assistance to doctors throughout this country. Negotiations have been completed with the British authorities and permission obtained to reproduce and distribute the Journal to doctors in Australia. The first issue of the Australian edition of the Journal will be made in August, 1962. Cost of the Scheme: E~pendituI'e by the Commonwealth for the year increased by £7,308,662 over that for the previous year to a total of £35,189,883 (including £9,097,498 for pensioners and £3,776,141 reimbursed for approved hospitals. Bush Nursing Centres, &c.). Total payments by patients at 5s. per prescription amounted to £6,503,888. The number of prescriptions represented by the above payments (excluding £3,776,141 reimbursement to approved hospitals, Bush Nursing Centres, &c.) totalled 37,714,406 made up of 11,664,036 for pensioners and 26,050,370 for the general public. Expenditure for benefit prescriptions (excluding approved hospitals and Bush Nursing Centres, &c.,) increased by £6,934,145. The increase consisted of £1,836,692 due to the rise in cost to the Commonwealth per prescription and £5,097,453 due to the increased volume of prescriptions. A marked increase in the average cost per benefit prescription towards the end of 1960-61 continued consistently throughout 1961-62. As a result the annual average cost rose from 19s. for 1960-61 to 20s. Id. for 1961-62. The increased

..

_;'

20 volume of prescriptions (the greatest contributing factor to increased expenditure) was due to a combination of an expanded list of benefits, more frequent prescribing and, to a lesser degree, the rise in population. Itemized expenditure on some of the more widely known therapeutic groups is set out below. Figures are based on claims received during the year and include .the patient contribution of 5s. per prescription but exclude reimbursements to approved hospitals and Bush Nursing Centres, &c. Therapeutic Category. Expenditure {or Period 1.7.61 to 30.6.62.

.....

-.

Broad Spectrum Antibiotics Penicillins Diuretics Tranquillizers Analgesics Cardiac drugs Sulphonamides Anti-Hypertensives .. Insulins Urinary Antiseptics Anti-Convulsants Vitamins Drugs for treatment of cancer Corticosteroids ..

£ 8,559,426 3,665,931 3,176,749 1,685,598 1,356,524 1,340,217 1,260,777 989,727 639,629 480,871 426,621 407,939 319,385 267,608

The remaining expenditure was on a wide variety of drugs whose usage is not so common. Legislation: Whllst there were no legislative changes in the Scheme during the year, there were several ,administrative changes. The Department of Health assumed responsibility for checking chemists' Repatriation benefit claims. These claims had previously been priced and checked by the Pharmaceutical Service Guild. The Public Accounts Committee had reported that this was an undesirable method of checking expenditure of public money .and recommended that the Department of Health carry out this check for the Repatriation Department. This bas involved checking a much wider scope of items than those covered in the list of pharmaceutical benefits. The volume of Repatriation prescriptions is in the vicinity of 4,000,000 per annum. An arrangement has now been reached whereby prices paid for Health benefits and Repatriation benefits are the same and Repatriation benefits which are not on the Health list are priced in accordance with Department of Health principles. It has been necessary to recruit additional staff to check claims, because of the introduction of Repatriation checking and the continued extension in the range of pharmaceutical benefits provided, and increased usage. The provisions for writing pharmaceutical benefit prescriptions were changed to pennit doctors to order less than the maximum quantity for the original supply and still order repeats of that benefit on the same prescription. This was done at the request of the Australian Medical Association, which considered that, on occasions, it was necessary, to ascertain with a small supply of a drug, 'the patient's reaction to it. If satisfactory, the patient would then procure the repeats ordered by the doctor.

21

Committees of Inquiry: Medical and Pharmaceutical Committees ot Inquiry have been established in each State to consider possible breaches in the supply of pharmaceutical benefits. The system is that references concerning doctors are investigated by a Committee comprising four practising medical practitioners (nominated by the Australian Medical Association) and the Director-General of Health or his nominee. Similarly references involving chemists are considered by a Committee comprising four members nominated by the Pharmaceutical Service Guild of Australia, the Commonwealth Director of Health of the State concerned, and a pharmacist who is an officer of the Department of Health. During ,the year, of the cases considered by Medical Services Committees, eight concerned supply of pbarmaceutical benefits whilst Pharmaceutical Services Committees considered 68 cases.

TABLE I

NATIONAL IIEALm Commonwealth Expenditure Hospital Benefit•. Medical Benefit••

Year Bndod.

I

Pharmaceutical Benefits.(a)

Pensioner Medical Service.

Tuberculosis.(c)

Free Milk for School Children.

Mental Institutions.

Total.

30th June, 1946 30th June, 1947 30th June, 1948 30th June, 1949 30th June, 1950 30th June, 1951 30th June, 1952 30th June, 1953 30th June, 1954 30th June, 1955 30th June, 1956 30th June, 1957 30th June, 1958 30th June, 1959 30th June, 1960 30th June, 1961 lOth June, 1962

.. .. .. .. .. .. .. ..

.. .. .. .. .. .. ..

.. .. " "

..

..

..

.. .. "

"

..

.. .. .. .. .. .. .. -- - - - - -

.. .. .. .. ..

"

..

.. .. " "

"

.. .. ..

.. "

£ 1,111,292 4,380,296 4,448,015 5,885,446 6,320,164 6,535,628 6,683,106 7,223,241 8,330,053 9,320,603 9,552,944 9,813,283 10,823,096 14,802,290 18,599,245 20,668,010 22,202,153

.. .. .. .. ..

.. .. ..

£

.. ..

..

£

.. .. .. .. ..

£

..

£

1,434,166 4,209,495 5,413,320 6,146,029 7,085,524 7,779,451 9,291,706 9,976,154 10,911,483

149,037 304,689 2,930,163 7,685,046 7,215,309 9,229,413 10,739,467 11,887,434 11,716,825 15,033,989 20,972,797 24,335,671 27,881,222 35,189,883

75,511 1,036,225 1,739,953 2,115,539 2,516,077 2,874,364 2,998,886 3,198,791 3,806,457 4,112,637 4,200,273 4,397,938

109,603 27,590 151,079 757,870 2,682,749 4,613,154 6,168,289 6,959,130 7,366,728 7,454,255 8,596,624 7,908,464 7,261,075 6,143,772 5,535,828 5,592,329

.. .. .. .. ..

£

.. .. .. 255,586 405,664 517,780 522,552 494,833 (b) 225,585

..

£

35,775 814,806 1,521,394 1,999,312 2,237,425 2,405,349 2,607,040 2,755,602 3,068,636 3,359,369 3,560,124 3,741,638

773,149 1,248,132 1,256,399 1,120,394 1,147,472 727,242 824,216

£ 1,111,292 4,489,899 4,475,605 6,185,562 7,638,309 12,665,490 21,350,117 24,390,738 30,562,446 36,615,380 40,360,815 43,126,819 48,061 865 58,811,100 66,989,872 72,548,853 82,859,640

~

(a) The amounts shown in this column include some minor expenditure under departmental votes. (b) Payments up to 30th June, 1955, were made under the Ment. Ilf.flilutiolJS Benefit .• Act 1948. (c) The !lmounls shown in Ihis ,olumn <\0 not include administrative expenses (Administrative expeo.'es for 1961-62 were £86,000): .

.

-

>-

f

~

" ~.r..1

1..,--

\~\

.

~\

',i.' \

fAiJLE it HOSPITAL BENEFITS CommoDwealth Expenditure Ordinary Benefit. Public Hospitals. Year Ended. 12•. per day (South Australian Part IV. Hospitals). Private Hospitals. Total Ordinary Benefit (Public and Private Hospitals). Additional Benefit.(c) Payments Towards Special Account Deficits. Orand Total (Common. wealth Ordinary Benefit, Additional Benefit and Payments Towards Special Account Deficits).

8s. per day.

12•. per day (pensioners).

Total.

30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, .

1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962

•• .. •. •• •. .. .• .. •• •• •. .. .. .. .. .. ..

.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

£ (a) 912,848 (a) 3,502,614 (a) 3,433,790

.. ..

£

..

4,561,202 4,762,431 4,915,202 4,997,876 4,186,144 4,197,570 4,598,496 4,551,223 4,314,566 4,201,007 4,680,741 5,527,778 5,551,606 (b) 5,804,977 (b) - - - - - - - - - - - _.

.. .. .. .. ..

.. .. .. .. .. 653,976 1,136,460 1,252,998 1,377,303 1,546,932 1,620,737 1,653,849 1,363,354 1,139,863 908,527

£

.. ..

80,441 95,882 103,405 105,012 131,443 139,984 145,542 146,283 173,781 186,650 (b)

£ 912,848 3,502,614 3,433,790 4,561,202 4,762,431 4,915,202 4,997,876 4,920,561 5,429,912 5,954,899 6,033,538 5,992,941 5,961,728 6,480,132 7,037,415 6,865,250 6,900,154

£ 198,444 877,682 1,014,225 1,324,244 1,557,733 1,620,426 1,642,522 1,659,098 1,768,856 1,852,609 1,880,692 1,980,222 2,029,424 2,167,151 2,409,490 2,727,734 2,945,045

£ 1,111,292 4,380,296 4,448,015 5,885,446 6,320,164 6,535,628 6,640,398 6,579,659 7,198,768 7,807,508 7,914,230 7,973,163 7,991.152 8,647,283 9,446,905 9,592,984 9,845,199

.. ., ., ., .,

£

., 42,708 643,582 1,131,285 1,513,095 1,638,714 1,840,120 2,831,944 6146,007 7,898,573 8,940,722 9,691,388

.. .. .. .. .. .. .. .. .. .. ..

£

.. ..

9,000 1,253,767 2,134,304 2,665,566 ----

£ 1,111,292 4,380,296 4,448,015 5,885,446 6,320,164 6,535,628 6,683,106 7,223,241 8,330,053 9,320,603 9,552,944 9,813,283 10,823,096 14,802,290 18,599,245 20,668,010 22,202,153

N

w

_-

(a)

61. per day up to 30th 1une, 1948.

(b) Fisuro subject to revision.

(c) Figures in this column do not include payments towards Special Account doflcits.

TA8LE III

HOSP1TAL BENEFITS Number of Registered Organi1.atiODS, M~bip, and Coverage as at 30th JlDle, 1961 and 30th JlDle, 1962 Number of Registered Organizations. As at 30th June, 1961. As at 30th June, 1962.

Membership as advised by Organizations. As at 30th June, 1961. As at 30th June, 1962.

State.

Estimated Coverage (including Dependants). As at 30th June, 1961. As at 30th June, 1962.

Percentage of Population Covered. As at 30th June, 1961.

. New South Wales Victoria Queensland South Australia Western Australia fasmania

As at 30th June, 1962.

~

.. .. ..

.. .. .. .. .. ..

.. .. .. ..

.. .. ..

.. ..

.. .. ..

Per cent. 30 47 3 14 10 11 30 46 3 13 11 10 113 1,189,756 860,323 311,409 314,793 257,992 109,787 3,044,060 1,225,338 901,596 292,579 336,445 269,123 104,645 3,129,726 2,808,000 2,313,000 779,000 740,000 605,000 255,000 7,500,000 2,946,000 2,415,000 724,000 786,000 623,000 244,000 7,738,000 71

78 53 74 81 71

Per cent. 73 81 47 80 83

68 73 .,.

Commonwealth

..

..

lIS

72

.'

t

+ I.{

"';~I

J."

"'"

'\

TABLE IV

HOSPITAL BENEFITS

Fund Benefit Statistics for years ended 30th June, 1961 and 30th June, 1962 Number of Days for which Fund Benefit was Paid. Average Amount of Fund Benefit per Day. Percentage of Members to whom Fund Benefit was Paid. Fund Benefit. Average Stay in Hospital (Days). Excluding Ancillary. Ancillary.

State.

Year ended Year ended Year ended Year ended Year ended Year ended Year ended Year ended Year ended Year ended Year ended Year ended 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 30th June, 19611961. 1962. 1961. 1962. 1962. 1961. 1962. 1962. 1961. 1962. 1961.

~

New South Wales Victoria .. Queensland South Australia Western Australia Tasmania ..

.. .. .. .. ..

..

4,188,497 2,223,364 1,114,748 940,374 955,542 317,741

4,331,336 2,442,035 1,214,823 1,049,659 1,002,128 301,227

£ 1 1 1 1 1 1

s. d. 11 4 5 9 6 16 7 8 6 7 0 3

£ 1 1 1 1 1 1

s. d. 14 2 9 0 6 6 14 0 9 6 18 11 8

Per cent. Per cent. 31.9 31.6 24.7 23.5 34.9 28.7 33.5 33.1 39.3 38.0 29.5 30.3 29.7 30.9

11.16 11.68 12.36 9.42 9.98 9.83 11.02

11.06 11. 31 11.79 9.19 9.76 9.59 10.78

£ 6,623,666 2,742,724 1,423,638 1,389,648 1,243,233 575,552

£ 7,391,703 3,542,933 1,611,677 1,782,608 1,477,617 585,892

£ 11,038 27,929 454 103,815 6,717 374 150,327

£ 16,291 111,806

815 127,168 55,736 1,492 313,308 ~--

Commonwealth -------

9,740,266 10,341,208

1 8 9

1 11

13,998,461 16,392,430

~---

TABLE

v

MEDICAL BENEFITS Number of Registered Organizations, Membership, and Coverage as at 30th June, 1961 and 30th June, 1962 Number of Organizations. State. As at 30th June, 1961. As at 30th June, 1962. As at 30th June, 1961. As at 30th June, 1962. As at 30th June, 1961.

Membership as advised by Organization.

Estimated Coverage (including Dependants). I

Percentage Population Covered. As at 30th June, 1961. As at 30th June, 1962.

As at 30th June, 1962.

~

New South Wales Victoria .' Queensland ., South Australia Western Australia ., Tasmania Commonwealth

..

.. .. .. .. ..

.. ., .. ., ., ..

.,

.. .. .. ..

..

.. ..

26 23 6 9 9 10 83

26 23 6 8 9 10 82

1,210,614 753,096 296,582 273,778 216,891 99,112 2,850,073

1,157,535 797,068 280,001 291,489 225,328 94,836 2,846,257 ------

2,842,000 2,126,000 765,000 687,000 523,000 230,000 7,173,000 -

2,804,000 2,253,000 719,000 707,000 564,000 228,000 7,275,000

Per cent. 72 72 52 68 70 64 68

Per cent. 69 76 46 72 75 64 68

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TABLE

vi

MEDICAL BENEFITS

Fund Bene8t Statistics for Years ended 30th June, 1961 and 30th June, 19& Services recejved-(Fee-for-service and Contract}.

Services received-Fee-for-service only.

Fund Benefit paid. Average No. of Services per Contributor.

State.

No. of Services.

Percentage ofO.P. Services to Total Services.

Percentage of Total Cost met byTotaiCosL Fund.

I Commonwealth.

Excluding Ancillary.

Ancillary.

Contributor.

19601961.

Year Year Year Year 1961- 1960- 1961- 1960- 1961- 1960- 1961- 1960- 1961- Ended Ended Ended Ended 1962. 11961.11962.11961.1 1962.1 1961.1 1962.1 1961.1 1962.13Oth June, 30th June, 30th June, 30th June, 1961. 1961. 1_ _ _ _ 1_ _ 1_ _ 1_ _ _ _ 1_ _ _ _ 1_ _ 1_ _ 1_ _ 1_ _ 1_ _ 1_ _ 1_ _ 1_ _ 1_ _ _ _ 1_1962. _ _- 1 -_ _ _ •_1962. _ __ 1961- 11960-11961-1 1962. 1961. 1962. 19601961.

I

I

I

~

New South Wales .. Victoria .. Queensland South Australia Western Australia

Tasmania

8,369,871 5,078,882 2,204,442 2,139,080 1,702,750 628,002

8,821,000 5,644,558 2,493,878 2,268,490 1,825,965 615,241

Per Per Per Per Per Per Per cent. cent. t t cent. cent. cent. cent. cent. 71 71 15,754,81616,874,521 37.2 38.1 26.1 25.8 36.7 76 74 8,919,36710,237,729 30.2 31.5 27.1 26.8 42.7 73 73 3,544,798 4,124,802 40.2 41.2 28.8 28.1 31.0 74 72 3,554,400 3,917,143 38.1 38.2 29.8 29.4 32.1 71 72 2,756,462 3,016,258 39.3 39.5 30.7 30.5 30.0 66 67 1,090,970 1,079,074 39.6 40.6 26.9 26.6 33.5

Per cent. 36.1 41.7 30.7 32.4 30.0 32.8

7.11 7.16 7.73 8.08 7.74 6.41

7.62 7.35 8.82 8.12 8.15 6.14

5,874,225 2,705,299 1,425,390 1,355,786 1,100,019 436,277

t

6,450,531 365,995 3,234,623 71,009 1,698,303 114,543 1,496,374 40,396 1,207,242 41,637 444,0011 35,601

t

t

477,988 99,48S 148,389 67,203 35,557 43,154 871,776

t

Commonwealth

.20,123,027121,669,132"73-n 35,620,813139,249,527 36.0 36.9 27.4 27.0 36.6 36.1 7.31 7.7112,896,99614,531,074 669,181

TABLB VII

PENSIONER MEDICAL SERVICE Pensioners aDd Dependants Enrolled in the Pensioner Medical Service as at 30th June, 1961 and 30th June, 1961 1960-61. .. -

1961-62• Total Number of Pensioners and ~danU

---

State.

Number of Pensioners Enrolled (Including Pensions and Allowances Current. Pensioner Wlve.>.

Enrolled.

Pen.ioners Enrolled (includ..il!¥ AllOW8n1llll Current. PenSioner Wlvca>.

Number of Pensiona and

Total Number of hnsioners and Dependants Enrolled.

New South Wales .. Victoria Queensland .. South Australia Western Australia .. Tasmania Northern Territory Commonwealth

.. .. .. .. .. .. .. ..

.. .. .. .. ., .. ..

..

.. .' .. ..

.. .,

.. ..

300,742 188,849 117,902 69,221 54,827 24,161 1,143 756,845

269,963 161,812 107,286 60,394 46,625 22,135 425 668,640

305,484 186,010 127,578 67,759 52,926 26,018 476 766,251

317,207 202,846 125,153 74,230 58,328 24,389 1,612 803,765

287,065 174,804 111,797 64,305 48,862 22,917 413 710,163

324,836 197.215 133,254 72,147 55,46S 26,937 463 810,317 -~

~

Australian Capital Territory figures Itfe inclUded In those shown for New South Wales.

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TABLE VIII

PENSIONER MEDICAL SERVICE

Payments to Participating Doctors for Years ended 30th June, 1961 and 30th June, 1962 1960-61. State. Number of Particlpatina Doctors. Payments to Doctors. Medical Services. Number of Participatina Doctors.

1961..{i2. Payments to Doctors. Medical Services.

MUeago.

Total.

MIJoaao· £ 19,806 15,994 5,582 3,838 756 6,074 76 52,126

Tocal.

~ New South Wales Victoria .. Queensland .. South Australia Western Australia Tasmania .. Northern Territory Commonwealth ---

.. .. .. .. .. .. ..

..

.. .. .. .. .. .. .. ..

.. .. .. .. .. .. .. ..

£. 2,297 1,732 744 517 414 152 5 5,861 1,873,575 988,139 S40,497 361,483 284,078 101,131 1,051 4,149,974

£. 16,732 13,690 6,050 4,311 811 6,578 107 50,299

£ 1,890,327 1,003,849 346,547 365,794 284,889 107,709 1,158 4,200,273

2,322 1,788 775 535 428 160 4 6,012

£ 1,904,092 1,077,594 S83,448 385,172 285,250 109,272 984

£. 1,923,898 1,093,588 S89,030 389,010 286,006 115,346 1,060 4,397,938 -

4,345,812

Australian Capital Territory figures are included in those shown for New South Wales.

TABLE IX

PENSIONER MEDICAL SERVICE Number of Services and Mileage Vouchers for Years ended 30th June, 1961 and 30th June, 1962 1960-61. State. Surgery. Number of Services. Domiciliary. Total. Number of Mileage Vouchers. 1961-62. Number of Services. Surgery. Domiciliary. Total. Number of Mileage VOUChers.

New South Wales .. Victoria Queensland .. South Australia Western Australia .. Tasmania Northern Territory Commonwealth

.. .. .. .. .. .. .. ..

.. .. .. .. .. ..

.. ..

.. ..

.. ..

.. .. .. ..

1,761,915 827,117 587,992 282,525 300,096 105,251 998 3,865,894

1,405,505 821,199 334,333 317,072 185,163 66,544 773 3,130,589

3,167,420 1,648,316 922,325 599,597 485,259 171,795 1,771 6,996,483 -

16,317 13,365 5,983 4,208 924 5,297 152 46,246

1,841,711 921,946 647,792 306,420 303,841 116,337 1,224 4,139,271 --

1,409,733 880,204 350,497 330,997 181,701 69,681 479 3,223,292 - _ ... _-

3,251,444 1,802,150 998,289 637,417 485,542 186,018 1,703 7,362,563

17,108 13,747 6,049 3,570 928 4,707 72 46,181

~

Australian Capital Territory figures are included in those shown for New South Wales .

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TABLE X

PHARMACEUTICAL BENEFITS EXPENDITURE Cost of Benefit Prescriptions. For Population Excluding Pensioners. State. Total Cost. Total Amount. 1960-61. 1961-62. 1960-61. 1961-62. Amount Met by Patients. 1960-61. 1961-62. Amount Met by Commonwealth. 1960-61. 1961-62.

I

For Pensioners.

Total Commonwealth Payment for Prescriptions.

I

Total Amount Met by Commonwealth. 1960-61. 1961-62. £

1960-61.

1961-62.

w

New South Wales Victoria .. Queensland South Australia .. Western Australia Tasmania .. Commonwealth

.. 12,302,606 15,601,092 9,052,182 11,601,192 2,114,647 2,640,195 6,937,535 8,960,997 3,250,424 3,999,900 10,187,959 12,960,897 .. 8,028,669 10,306,749 6,365,996 8,224,894 1,376,316 1,753,726 4,989,680 6,471,168 1,662,673 2,081,855 6,652,353 8,553,023 .. 3,959,767 5,208,478 2,882,650 3,857,511 708,422 915,753 2,174,228 2,941,758 1,077,117 1,350,967 3,251,345 4,292,725 .. 2,645,713 3,352,643 1,983,620 2,523,384 484,199 590,173 1,499,421 1,933,211 662,093 829,259 2,161,514 2,762,470 .. 1,947,471 2,514,810 1,448,308 1,905,013 340,245 436,499 1,108,063 1,468,514 499,163 609,797 1,607,226 2,078,311 .. 757,741 933,858 570,862 540,596 186,879 225,720 619,200 708,138 138,541 167,542 432,321 766,316

£

£

£

£

£

£

£

£

£

£

£

.. .

29,641,967 37,917,630 22,303,618 28,820,132 5,162,370 6,503,888 17,141,248 22,316,244 7,338,349 9,097,498 24,479,597 31,413,742 -------

NOTE.-Austraiian Capital Territory figures are included in New South Wales.

Northern Territory figures are included in South Australia.

TABLE XI

PHARMACEUTICAL BENEFITS PRESCRIPTIONS Number of Benefit Prescriptions. State.

Average Cost per Benefit Prescription. For Pensioners. For All Prescriptions. 196~1.

Total. 196~1.

For Population Excluding Pensioners. 1960-61. 1961-62.

For Population Excluding Pensioners. 1960-61. 1961-62.

For Pensionera. 1960-61. 11. d. 13 6 14 7 12 8 1311 13 9 14 4

1961-62.

1960-61.

1961-62.

1961-62.

1961-62.

New South Wales 13,188,911 15,736,247 7,727,184 9,578,615 Victoria Queensland 4,506,406 5,514,348 South Australia .. 2,889,138 3,408,362 Western Australia 2,086,513 2,523,068 Tasmania .. 818,483 953,766

..

8,381,840 10,574,917 5,442,499 7,024,291 2,809,918 3,667,916 1,937,899 2,363,851 1,359,355 1,748,332 557,554 671,063

4,807,071 2,284,685 1,696,488 951,239 727,158 260,929

5,161,330 2,554,324 1,846,432 1,044,511 774,736 282,703

18 20 17 18 18 18

s. d. 8 9 7 4 8 6

s. d. 19 21 18 19 19 19 20 10 6 11 8 11 7 1

21 23 20 20 21 20 21

s. d. 7 5 6 6 4 6 9

s. d. 21 11 23 5 21 0 21 4 21 10 21 1 22 2

s. d. 15 16 14 15 15 16 15 6 4 8 11 9 0 7

~

Commonwealth 31,216,635 37,714,406 20,489,065 26,050,370 10,727,570 11,664,036 NOTE.-Australian Capital Territory figures are included in New South Wales.

19 0

13

8

Northern Territory figures are included in South Australia.

.....

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TABLE XII

PHARMACEUTICAL BENEFITS Payments to Hospita1s, Bush Nursing Centres, Flying Doctor Services and MisceUaneous Hospitals, Period. New South Wales. Victoria. Queensland. South Australia. Western Australia. Tasmania. Bush Nursinl' Centres, &c.

Total.

w £ £ £

w

£

Twelve months ended ., 30th June, 1961 Twelve months ended 30th June, 1962 ., _ ..

£

£

£

£

892,418 1,226,868

1,310,000 1,268,179

594,896 706,344

255,397 208,278

207,692 326,171

86,028 4,891 -

55,193 35,410

3,401,624 3,776,141

NOTE.-The amounts shown under the heading" Bush Nursing Centres, &c. " are in respect of Bush Nursing Centres, Royal Flying Doctor Services and miscellaneous services located in various parts of Australia.

34 TABLE XIII

PHARMACEUTICAL BENEFITS Drugs Dispensed by Chemists Distribution by Therapeutic Categories (Benefits dispensed in hospitals are excluded) Therapeutic Category. Percentage of Total Expenditure. Percentage of Total Prescriptions.

Broad spectrum antibiotics Penicillins .. Diuretics Sulphonamides Analgesics .. Cardiacs Anti-hypertensives Tranq uillizers Anti-convulsants Vitamins Urinary antiseptics Insulins Drugs for treatment of cancer Corticosteroids Other drugs

22.9 9.8 8.5 3.4 3.6 3.6 2.6 4.5

9.2 7.3

5.6 4.5

6.6 4.8

1.5 4.5 0.7

1.1 1.1 1.3 0.9 0.9 0.7

1.9 1.2 0.2 0.4 0.2

35.1

51.4

TABLE XIV

FREE MILK. FOR SCHOOL CHILDREN Number of Children.· State. As

Payment•. 1961-62. £ 1,326,863 1,034,283 563,801 331,701 263,067 170,918 27,734 23,271 3,741,638 to

at 30th June, 1962.

• /'

I

New South Wales .. Victoria .. .. .. Queensland .. South Australia Western Australia .. Tasmania .. .. Australian Capital Territory Northern Territory Total Free Milk Scheme.

.. .. .,

..

..

..

.. .. ..

..

.. .. .. .. .. .. .. ..

.. .. .. .. .. .. ..

..

565,000 430,000 248,000 180,000 120,000 57,000 11,000 7,000 1,618,000

..

..

..

• These figures represent the approximate number of sc:hool children eligible

participate in tho

y ..

.\

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TABLE XV

DISPENSING OF PHARMACEUTICAL BENEFIT PRESCRIPTIONS A. Pharmaceutical Chemists approved under Section 90 of the National Health Act 1953-1961 for the purpose of supplying pharmaceutical benefits. B. Medical Practitioners approved under Section 92 of the National Health Act 1953-1961 for the purpose of supplying pharmaceutical benefits in areas in which there are no other pharmaceutical services available.

I New South Wales. As at 30th June.

Victoria. A. B.

Queensland. A. B.

I

South Australia. A. B.

Western Australia. A. B.

Tasmania. A. B.

Total Commonwealth. A. B.

A.

B.

--50 84 81 86 92 88 87 84 84 84 83 80 78

U.

w

1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962

.. .. .. .. .. .. .. .. .. ..

.. ..

.,

.. .. ., .. .. .. .. .. .. .. .. .. ..

1,200 1,252 1,323 1,368 1,452 1,519 1,574 1,615 1,681 1,763 1,818 1,877 1,933

2 25 26 29 31 32 31 27 28 30 29 34 36

1,038 1,054 1,070 1,102 1,170 1,206 1,245 1,284 1,299 1,348 1,383 1,402 1,414

6 6 7 8 8 5 6 7 7 6 6 6 6

285 332 348 388 437 476 520 554 571 603 645 676 696

3 4 5 5 6 7 8 8 8 9 9 7

6

265 292 305 329 368 384 396 403 424 433 436 449 459

27 30 29 24 25 20 20 19 18 16 17 14 13

202 208 212 221 232 243 261 270 282 292 296 311 312 ---

12 12 12 10 Jl

12 11 12 12 11

90 93 95 94 95 95 97 101 111

.. 7 8 10

11 12 11

11 11

10 7 6

113 118 123 127

12 12 12 11

3,080 3,231 3,353 3,502 3,754 3,923 4,093 4,227 4,368 4,552 4,696 4,838 4,941

TABLE XVI

States Grants (Mental Institutions) Act 1955 STATES' EXPENDITURE AND COMMONWEALTH GRANTS

New South WalesState Expenditure Commonwealth Grant VictoriaState Expenditure Commonwealth Grant QueenslandState Expenditure Commonwealth Grant South AustraIiaState Expenditure Commonwealth Grant Western AustraliaState Expenditure Commonwealth Grant TasmaniaState Expenditure Commonwealth Grant TotalState Expenditure .. Commonwealth Grant

1955-S6.

1956-57.

1957-58.

1958-59.

1959~O.

196~1.

1961-62.

Total

£

£ 1,150,666 383,555 1,581,639 527,213 264,203 88,068 385,400 128,467 155,565 51,855 206,923 68,974 3,744,396 1,248,132 -

£ 972,455 324,152 1,636,095 545,365 342,311 114,103 456,476 152,159 87,709 29,236 274,151 91,384 3,769,197 1,256,399 --

£ 590,492 196,831 1,858,862 619,621 355,536 118,512 366,983 122,328 51,631 17,210 137,677 45,892 3,361,181 1,120,394

£ 1,077,181 359,060 1,554,704 518,235 223,839 74,613 275,310 91,770 110,397 36,799 200,984 66,995 3,442,415 1,147,472

£ 1,298,642 432,881 251,461 83,820 292,927 97,642 137,073 45,691 45,827 15,276 155,798 51,933 2,181,728 727,243

£ 1,945,912 648,637

£ 7,661,638 2,553,879 8,220,000 2,740,000 1,890,731 630,244 1,741,495 580,499 712,149 237,383 1,065,000 355,000 21,291,013 7,097,005 W

.. .. .. .. ..

..

.. ..

626,290 208,763 1,337,239 445,746 199,764 66,588 36,735 12,245 29,953 9,985 89,467 29,822 2,319,448 773,149

.. ..

.. .. 212,151 70,718 83,518 27,839 231,067 77,022

0\

..

·. .. .. ·. .. .. ·.

.. .. ..

..

.. .. .. .. ..

..

.. 2,472,648 824,216

..

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37

tuberculosis, which has nO'w been developing Y smce the passmg O'f the Tuberculosis Act 1948 has shown consl era?le progress with the level of control of the disease in A~stralia as a whole, bemg the equal of that reached in the most advanced countries. HO'wever, it is apparent that a uniform attack Qn the disease as originally envisaged at the start Qf the campaign has not yet been achieved, in spite Qf the availability of CommO'nwealth finance. The States have each developed somewhat different approaches, to' some extent relative to' their fundamental geQgraphic, social and populatiO'n differences. It WQuld appear those with the smaller populatiQns have been able to' develop a more effective prO' gramme than the mQre densely PQPulated States. Thus, although brO'adly speaking, all States have an established framework for their control measures and there are mQre than sufficient beds, due to' the reduction in demand as a result O'f mO'dern treatment, further advances are still being made. A new and larger chest clinic was opened in Brisbane in March, 1962. Thus all States except New South Wales now have an ideal central base frDm which to' develQP and cQ-ordinate the State campaign. In order further to' develop cDntrQI Df tuberculosis in the NDrthern TerritO'ry, the positiDn Df Chest Physician (Tuberculosis) has been created. for 'd Annual expenditure by the CommQnwealth Department O'f Health is nQW well below the peak year 1956-57 and has levelled Qut, being approximately the same for the last twO' financial years. The fO'llDwing table shows the expenditure re'imbursed to' the States under the Tuberculosis Act 1948 from the inceptiDn Df the campaign until 30th June, 1961, as well as the amQunt paid to' sufferers:EXPENDITURE REIMBURSED TO STATES UNDER TUBERCULOSIS ACT 1948 TO 30TH JUNE, 1962 Period. Capital Reimbursements. Maintenance Reimbursements. Allowances Paid to sufferers. Total.

~~:on:!r~a~Paign agains~

TUBERCULOSIS DIVISION

1949-50 .. 1950-51 .. 1951-52 .. 1952-53 .. 1953-54 .. 1954--55 .. 1955-56 .. 1956-57 . . 1957-58 .. 1958-59 .. 1959-60 .. 1960-61 .. 1961-62 ..

.. .. .. .. .. .. ..

.. .. .. .. .. ..

.. .. ..

..

..

..

.,

.. .. ..

Total

..

.. .. .. .. .. .. .. ..

..

.

.. .

.. .. ..

.. ..

..

£ 236,179 404,600 645,131 1,163,439 1,295,476 1,710,812 1,747,722 2,378,647 2,128,462 1,411,062 729,236 388,018 378,095 14,616, 879 1

£ 346,142 943,554 2,114,291 2,982,321 3,738,885 3,800,578 4,050,581 4,805,003 4,569,215 4,844,106 4,376,256 4,236,687 4,400,034 45,207,653

..

£

1,344,891 1,777,620 1,907,945 1,876,582 1,904,467 1,689,774 1,460,650 1,254,693 1,062,609 1,025,473 946,446 872,853 17,124,003

£ 582,321 2,693,045 4,537,042 6,053,705 6,910,943 7,415,857 7,488,077 8,644,300 7,952,370 7,317,777 6,130,965 5,571,151 5,650,982 76,948,535

..

Tuberculosis Allowance (first commenced 13th July, 1950): The number in receipt Qf the allO'wance again decreased slightly in 1961, and in spite O'f the increase in rates in line with the CO'st of living and pensiO'n adjustments at 5th OctDber, 1961, the cost was below £1,000,000 for the second year in succession.

18 The scale of weekly rates was as follows:Sufferer with dependent wife Sufferer with dependent child or children only Sufferer without dependants-when not in an institution .. when maintained in an institution free of charge Allowance for children under sixteen years of agefirst child other children

I. .. d. 12 2 6 776 776 S 5 0 15 0 10 0 6,548 6,127 5,696 5,742 5,029 4,182 3,326 2,750 2,503 2,235 2,017

Table showing nlumber of recipients of allowance at 31st December1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 -1961

• Average length of time that sufferers are in receipt of the allowance is now half that of 19S1.

Notifications: It is pleasing to report a slight drop in the total number of notifications for Australia in line with the general trend overseas in developed countries, but this could still show sOme increase in the future should activities in case detection increase. TABLE OF NOTIFICATIONS OF TUBERCULOSIS, 1961 State New South Wales .. Victoria .. .. .. Queensland .. .. South Australia .. .. Western Australia . . .. Tasmania .. .. .. Australian Capital Territory .. Northern Territory .. .. Total Population. All Forms. Pulmonary. Rate per 100,000.

...

.. .. .. .. .. .. "

..

3,915,706 2,919,044 1,514,759 969,359 737,367 353,609 58,792 26,457 *10,495,093

1,455 727 686 230 293 129 12 38 3,570

1,365 614 650 196 252 115 11

36 3,239

34.8 21.0 42.8 20.2 34.1 32.5 18.7 136.0 30.8

..

..

.,

• Mean population for year ended 31st December, 1961. Number of NotificationsTuberculosis All Forms. Population. Rate per 100,000.

Year.

1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961

.. .. .. ..

.. ..

..

.. ..

.. .. ..

..

.. .. .. .. .. .. .. .. .. .. .. .. ..

..

.. .. .. .. .. .. ., ..

.. ..

..

..

.. .. .. .. .. .. .. .. ..

.. ..

.. .. .. .. .. ..

.. ..

.. .. .. .. .. ..

.. .. .. .. .. .. .. .. .. ..

..

.. ..

..

3,914 4,491 4,675 4,786 4,979 4,952 4,602 4,419 4,035 3,708 3,582 4,084 3,570

8,045,570 8,307,841 8,527,907 8,739,569 8,902,686 9,090,395 9,313,291 9,533,334 9,747,471 9,951,618 10,166,173 10,398,170 10,495,093

49 54 55 55 56 54 49 46 41 37 35 39 34

T NOTIFICATIONS 300

-....ooIf' • '~'

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INCIDENCE OF TUBERCULOSIS BY AGE GROUPS • AUSTRALI A . 1961 NOTIFICATIONS 300-

250

I IF~~~El'E' I

I ____ m ___

I i " '"

I i J7 ,- , .. .

250 -

200

200-

150

150 --I

~

"

' . ___ .4t

100

'

. ..

100-

,

..

•

50

. ..

"

'

. 1

........ _- _

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;

50 __

11

I'

1

1

1

1

I

AGE GROUP: 0·4

5-9

10-14

15-19

20-24

25-29

30-34 35-39 40-44 45-49 Total Malo 2.481. Female 1,08~.

50-S4

55-59

60-64

65-69

70-74

75 AND

OIiCR

40

Epidemiology: There has been no variation of the clear-cut preponderance of tuberculosis disease in males in the upper age groups in the fourth, fifth and sixth decades, with less than half as many female sufferers being found mainly in the twenties, thirties and forties.

The following table from Western Australia is informative as it shows that the incidence of ,tuberculosis in the foreign-born is double that of native-born Australians:NOTIFICATIONS OF PULMONARY TUBERCULOSIS AMONGST MIGRANTSWESTERN AUSTRALIA-1959-61 Arrived prior to 12.2.48. Arrived subsequent to 12.2.48. British, Full-fare. British, Assisted. Total. Aliens. Total Migrants Notified. Per cent. of total notifications.

1959 1960 1961

..

.. ..

60 73 47

9 15 14

15 13 4

32 29 31

56 57 49

116 130 96

36.3 43.9 45.9

Percentage of foreign-born in population (t 961) Census-22. 3.

Information available from tuberculin skin testing from the States does not as yet allow effective comparison of infection rates, and this is further complicated by evidence of non-specific sensitivity in Western Australia, Queensland and northern New South Wales, due to other mycobacteria. There would appear to be an encouraging drop in the percentage of reactors in the younger school children; varying figures from 3-4-9 per cent. in the ten-twelve-year olds, but still too high a percentage of reactors in the school leavers and adolescents from 10-15-20 per cent., indicating still the presence of too many unknown infective sufferers in the community. Prevention: B.C.G. vaccine (freeze dried C.S.L.) is now being used for negative tuberculin reactors in school children only in Victoria.

.~

Otherwise its use is restricted to persons at risk, nurses, medical students and contacts of known cases of tuberculosis. It is being increasingly advocated for negative reactors proceeding overseas to areas where tuberculosis is still endemic.

Following further encouraging published results of the United States Public Health Service trials on the prophylactic use of Isoniazid, * this method of prevention of disease is being used more with positive reactors of contacts, and applied to school children with large reactions, but the latter application is not as yet widespread, and the results will have to be carefully evaluated in future years. A new s:rological testt indicating activity of disease, looks promising, and may lead to Increased use of " secondary chemoprophylaxis" (or in effect treatment in this instance), with Isoniazid in patients with fibrocalcified disease' where activity cannot be proven bacteriologically. AP~~~~62 Shirley H. Ferebee and Frank W. Mount-Amer. Review of Respiratory Diseases, Vol. 85, No.4, Co • Tuberculo.sis Morbidity in a Controlled Trial of the Prophylactic Use of Isoniazid Among Household

n:~M::. r96~rodlagnostic

E t Sl?ocific Serum A!!g1utin~tion of Kaolin Particles Sensitized with Tubercle Phosphatide and 'ts ClinIcal Test for Tuberculosis. Hoshio Tabahashi-Amer. Review of kespiratorv

t-

41 -{..

Case DetectioD--Mass Mioiature Radiography: It would appear the overall yield from this method of case finding is now dropping to about 1 active case per 2,000 persons examined, compared to the 1 per 1,000 of a few years ago, but the different approach by the various States suggests that the results will have to be closely watched in the next few years.

Victoria is still the only State that has not employed compulsory surveys. Queensland has not yet covered its metropoHtan area.. New 70 mm. mirrorcamera equipment has been obtained by both these States. In all, 706 cases out of the 3,239 notifications of pulmonary tuberculosis during 1961 were discovered by this method, from 1,451,681 chest X-ray examinations.

An interesting analysis shows that mass surveys may be responsible for as high as 50 per cent. of the annual notifications in a State, falling to 25 per cent. or less, depending on the local factors of case-finding and the level of "control" the State has achieved. MASS MINIATURE RADIOGRAPHY State. Number Number Examined. Active T.B. Rate per 1.000. No. Inactive T.B. Rate per 1,000. Suspect per ActiveT.B. Rate 1,000. at 31.12.61.

New South Wales .. Victoria· ., .. South Australia Queenslandt Western Australia: .. ., Tasmania .,

..

740,969 276,289 117,633 155,842 53,681 107,267

434 71

31 96 14 60 706

.58 .26 .26 .61 .26 .61

4,524 781

1.763 1,649 6 12 8,735

6.1 2.8 14.9 10.58

..

478 "

.64

.11 .1<l 6

398 38 10 \73 1,097

3.3 .24 .18 1.7

Totals an interval.

.,

., 1,451,681

.48

.7

• Vollllltary mass surveys only.

t Country districts only.

*

Third survey recom.nenced after

The present analysis of annual statistics demonstrates that hospitals are responsible for notifying the next largest group of new cases, followed by private medical practitioners, suggesting that in most States, the latter should be encouraged to increase the referral of suspect cases for chest X-ray examination. The number of cases of tuberculosis reported in some States for the first time as a result of post-mortem examination., or by death certificates, indicates the degree of weakness of control measures in those States. Obviously there was lack of knowledge by the public health authorities of the risk of the spread of infection by these persons prior to their death. A compulsory mass chest X-ray survey Was carried out in Canberra in March and April. 1962; 32,477 persons over the age of eighteen years were examined, with the disclosure of 25 significant ca-ses of tuberculosis. of whom 22 were admitted to hospital. There were seven ca'Ses of lung tumour including five eases of pulmonary carcinoma, as well as a further 81 persons who wiII require chest clinic supemsion for "arrested" oc ... inactive" tuber-cWosis.

The survey was successful from th.e point of view of atrendaace. A check of records so far would indicate 95 per cent. or higher attendance of those eligihle. Identification of non-attenders is in progress.

42 Treatment: The number of beds in use for tuberculous patients (including Repatriation beds) as at 30th June, 1962, decreased from the previous year. distributed as follows:New South Wales Queensland Victoria South Australia Western Australia Tasmania Total 1,157 792 801 263 194 167 3,374

The use of Streptomycin, Isoniazid and P.A.S. as the main drugs in the treatment of tuberculosis has not altered, and is effective in rendering the patients non-infectious in considerably more than 90 per cent. of cases. The amount of primary and secondary drug resistance shown by the tubercle bacillus to these drugs does not seem to be increasing and at the moment can only be estimated at last year's figure of 2-3 per cent. The lack of standard procedures by the different State laboratories in estimating this problem, however, had been recognized, and following meetings of a Bacteriological Sub-Committee, certain recommendations regarding methods of examination and drug sensitivity testing for mycobacterium tuberculosis were finally circulated in June, 1962, and should allow of a more accurate assessment of this important factor. It is well known, of course, that P.A.S. is not an ideal drug due to the amount that must be taken and the side-effects of nausea and abdominal discomfort, but as yet no more effective drug has been discovered to replace it.

Of the "second line drugs" ,it is apparent that Ethionomide is assuming definite importance in the treatment of those patients resistant to one or more of the three main drugs, but it also produces gastric discomfort in approximately one-third of the persons taking it. Trials with one new drug, Ethambutol, are being carefully watched. Mortality: The annual death rate reflects the success of modern treatment and has dropped again slightly from the previous year. The majority of deaths reported as due to pulmonary tuberculosis also occur in the upper age groups. The figure of 3.9 deaths from pulmonary tuberculosis per 100,000 of the popUlation is therefore highly satisfactory. _ However, in appraising the position in regard to tuberculosis it is the continued IDcidence of new infectious sufferers and the prevalence of the numbers of persons requiring supervision for the complaint that must be now recognized as the problem.

43 MORTALITY

Year.

Population.

Deaths from Tuberculosis (all forms).

RAte per 100,000.

Deaths from Tuberculosis (Pulmonary).

Rat. per 100.000.

1949 .. 1950 .. 1951 .. 1952 .. 1953 .. 1954 .. 1955 .. 1956 .. 1957 .. 1958 .. 1959 .. 1960 .. 1961 .•

.. .. .. .. .. .. .. .. .. .. "

.. ..

.. .. .. .. .. .. .. .. .. .. .. " "

8,045,570 8,307,841 8,527,907 8,739,569 8,902,686 9,090,395 9,313,291 9,533,334 9,747,471 9,951,618 10,166,173 10,398,170 10,495,093

1,964 1,675 1,538 1,290 974 897 729 724 585 538 549 489 447

24.3 20.18 18.03 14.76 10.94 9.86 7.82 7.59 6.00 5.4 5.4 4.70 4.4

1,800 1,586 1,411 1,165 879 823 672 663 543 501 509 447 412

22.4 19.1 16.5 13.3 9.9 9.1 7.2 7.0 5.6 5.0 5.0 4.3 3.9

The picture is becoming clearer due to the gradual overall decline of tuberculosis in Australia. With the aim now at possible eradication of 'the disease, the deficiencies of the programme have become more apparent, and with this it is evident that any complacency would result in an unsatisfactory level of control. It has also become obvious that a more accurate assessment of the antituberculosis measures now being carried out is necessary so that activities may be directed to the best advantage.

Realizing this, the National Tuberculosis Advisory Council at its twelfth session in February, 1962, made recommendations on the definition and extent of the basic data required, and the necessity for the uniform establishment of an effective tuberculosis case register in each State and Territory. The next decade could be a decisive one in the application of knowledge and experience and the correction of weaknesses in the tuberculosis control structure. To accept the concept of eradication will perhaps require a revised national policy; it is a public health administrative problem that may necessitate a greater degree of central co-ordination. A new series of State returns (Statistical forms T.B.S. 1-15) was introduced to enable compilation of more accurate national statistics.

PUBLICATION THE VALUE OF REPEATED COMMUNITY-WIDE CoMPULSORY MASS CImST X-RAY SURVEYS IN CASE DETECTION FOR PULMONARY TuBERCULOSIS IN WESTEllN AUSTRALIA, by Alan King, Med. 1. Aust. Vol. 2, pp. 172-178 (July 29, 1961).

44

PUBLIC HEALTH DIVISION Poliomyelitis: In ,the year 1960-61 there were 191 confirmed cases of poliomyelitis in Australia. During the year 1961-62 the total rose to 572. Details are as folIows:Confirmed Cases.

States. 1960-6l. 1961--62.

New South Wales ., Victoria Queensland .. South Australia Western Australia Tasmania .. Northern Territory Total

.. .. " .. .,

..

..

.. .. .. .. .. ..

..

.. .. .. .. .. .. ..

.. .. .. .. .. ..

..

.. .. .. .. .. .. ..

11

75 25 32

..

367 21 157 19

47 1

..

6

2 572

..

..

..

..

..

..

191

The New South Wales outbreak was caused by Type I, whereas the Queensland outbreak was predominantly Type 3 poliovirus. A notable feature of the Queensland cases was that approximately one-third occurred in fully vaccinated perSOns. Both outbreaks ended in April, 1962. It was evident that, in the latter stages of the New South Wales outbreak, more Type 3 cases were occurring. In consideration of these experiences the National Health and Medical Research Council recommended, at its meeting in Adelaide in May, that Commonwealth and State imm.unization authorities be authorized to encourage and administer a fourth dose of Salk poliomyelitis Yac(:ine, a minimum of one year after the third dose of Salk vaccine. The recommendation was subsequently adopted. The Council also recommended that Sabin oral vaccine as a protection against poliomyelitis should be imported as soon as possible, to permit the vaccine to be used either in a possible emergency or for pilot studies or administrative procedures. The Council recommended that there should be no slackening in the campaign to immunize both children and adults with Salk vaccine pending the evaluation of live oral vaccine for Australian use. The Council's Poliomyelitis Committee advised that the use of Salk vaccine should be maintained in all States for all age groups, and that it should remain the basis of the immunization programme. This Committee deplored the fact that there were still a number of young children and young adults in the communiity who had not received their protection with Salk vaccine. dis~ase has not been maintained and, in fact, the total dropped more than 1,000

~ .

Infectious Hepatitis: The annual increase in the number of cases of this

durmg 1961-62. 1959~

1960-61 1961-62

6,148 12,347 11,557

t

-..;-

The incidence was highest during the summer months and the age group most commonly affected was 5-9 years, followed by the 10-14 years group. It is well known that many cases of infectious hepatitis are not notified and, in cases without jaundice, the diagnosis is often in doubt. However, on the figures available, country areas show a higher incidence ,than metropolitan areas, often in the ratio of two to one. The incidence has been lowest in Western Australia and highest in Canberra, which had a rate four times that of Sydney. There is no ready explanation of this wide variation in incidence in these two cities, but it may be related to the thoroughness with which cases are notified in the Australian Capital Territory. Desiccated Coconut: Following the visit to Ceylon in April, 1960, by the then Director of the Public Health Division, Dr. C. E. Cook, and the implementation of recommendations resulting from his discussions with the Ceylon Coconut Board, recent consignments of ,this product arriving at Australian ports have been free from pathogenic organisms. Consignments are branded clearly to identify the mill of origin and it is a comparatively simple matter to trace the manufacturer should that be necessary at any time. Customs (Prohibited Imports) Regulations: Data and literature on imported therapeutic appliances and devices are referred, from time to time, by the Comptroller-General, Department of Customs and Excise for advice (1) concerning accompanying literature, (2) regarding therapeutic claims made, and (3) occasionally when there is a suspicion that the goods may be of a dangerous nature to the user. Referrals during 1961-62 totalled eleven. Medical Statistics: Work on the Eighth Revision of the W.H.O. International Classification of Diseases was brought to completion. When the recommendations have been incorporated into a report, this will be forwarded to Geneva as Australia's contribution <to the Revision discussions. In this task the Department haa worked in close association with the Bureau of Census and Statistics.

IMMIGRATION MEDICAL SERVICE During the period under review, the Department again provided medical facilities in Migrant Centres contxolled by the Department of It:wJUara.tio.D At the Bonegilla Centre Hospital, 271 beds, cots and basinettes are installed

while at Scbeyvil1e, Waco! and Benalla. first..aid posts are manned for the benefit of migrants. The nwnber accommodated in all centres varied from a maximum of 4,514 in July, 1961, to a minimum of 1,576 in June, 1962. At Bonegilla the highest monthly intake of migrants was 915 during August. 1961, and the lowest monthly intake was 247 during May, 1962. A 'total of 1,092 in-patients, covering 7,200 bed days, w~re ~ted at Bonegilla, and 30,657 out-patient attendances were recorded, ~3. infecti~ cases tre~ted and 2,686 immunizations given at all Centres. In addition. 97 mmor operatlOos were performed. One hundred and eighteen babies were born in local hospitals to Centre

residents.

46

Staff figures at the Bonegilla Centre Hospital at the commencement and end of the period were1st luly. 1961. 30th June. 1962.

~

,I

Medical officers Nursing staff Orderlies Other

1

1

10

28 29

9 18 27

NATIONAL FITNESS MOVEMENT ADMINISTRATION The administration of the National Fitness Movement was carried out on 'the same lines as in pre.vious y,ears with the Commonwealth providing a central administration and the activities in the States centred around the State National Fitness Councils, the State Departments of Education and one University in each St'ate. FINANCE The Commonwealth Government again appropriated the sum of £72,500 for National Fitness activities during the year. This supplemented assistance given to National Fitness agencies in the States by State instrumentalities. The Commonwealth 'appropriation was allocated to& State National Fitness Councils .. State Education Departments Universities Central Administration .. Australian Capital Territory 36,954 17,000 12,400 3,396 2,750 72,500

/--

STATE NATIONAL FITNESS COUNCILS State Councils oontinued their State-wide activities in the fields of youth leadership training, assistance to youth and amateur sports organizations, the extension and conducting of camps and youth hostels, assistance in the conduct of holiday play centres and the running of swimming classes and schools. Details of the allocation of £36,954 from the National Fitness Fund to State National Fitness Councils are set out in the following table:Item. New South Wales.

Victoria.

QueensSouth Western . land. Australia. Australia. Tasmama.

1. Salaries and travelling expenses, Director and Assistant Director 2. Services to Associated Groups .. 3. Grants to voluntary Youth Organizations .. .. .. 4. Subsidies to local National Fitness .. Committees 5. Services to sports organizations .. 6. Development of Camps and Hostels Totals

£ 1,750 2,000 500 750 243 2,000 7,243

£ 1,750 2,000 500 750 243 2,000 7,243

£ 1,500 1,500 438 654 150 1,500 5,742

£ 1,500 1,500 438 654 150 1,500 5,742

£ 1,500 1,500

£ 1,500 1,500

438 654 150 1,500 5,742

258 384 100 1,500 5,242

47 STATE EDUCATION DEPARTMENTS The programmes in State Education Departments financed from the National Fitness Fund again provided for special instruction for teachers, the organization of school camps, the provision of bursaries for teachers and of materials for book and film libraries and teaching aids. The Commonwealth allocation of £17,000 to State Education Departments from the National Fitness Fund during the year comprisedItem. New South Wales.

Victoria.

I

Queensland.

South Western Australia. Australia. Tasmania.

1. Training of general teachers in physical education(a) Short courses ·. .. (b) Residciltial cour~~s 2. Proyj,ion of c~:rs(!r(c,; t::> e:~:tl:l~ selected teachers to undertake university courses .. .. 3. Developn1,e~lt of h·:aIt~ ~,:~d ph?8kal edl1cstio'l in practi~i!1G schooh and Teachers' Co!leges(a) Equipment .. (b) Camps for Teachers' College students .. 4. Publications, films, records, &c. S. Development of school camping and hostelling(a) Equipment of camps and schools .. ·. (b) School camping, hostelling .. Totals ·. "

£

£

£

£

£

£

I

I I

SOO SOO

SOO SOO

SOO SOO

300 500 600

300 500 600

300 500 600

..

..

.. 300 2S0 483

I

300 250 484

300 250 484

200 ISO 483

200

200 ISO 483

I I

ISO 483

I 400 200 2,833

SOO 300 2,834

500 300 2,834 I

500 300 2,833

400 200 2,833 I

I

400 200 2,833

I

UNIVERSITIES Through their courses in physical education the Universities continued to provide the trained personnel necessary to impart instruction and train others in physical education. The sum of £2,100 was again paid from the National Fitness Fund to each of the Universities of Melbourne, Queensland, Adelaide and Western Australia and the sum of £2,000 each was paid to the Universities of Sydney and Tasmania. AUSTRAUAN CAPITAL TERRITORY As in the past direct financial assistance from the National Fitness Fund was given to youth organizations and amateur sporting bodies for specific projects coming within the scope of National Fitness activities. Funds were also provided to assist in meeting the cost of instruction in physical education and promoting a physical recreation programme for young people in the Australian Capital Territory. Financial assistance was given to the Department of the Interior to conduct holiday play centres. COMMONWEALTH COUNCIL FOR NATIONAL FITNESS A meeting of the Commonwealth Council for National Fitness was held in Canberra on 1st and 2nd March, 1962.

48

The object of the meeting was to review past achievements and present activities and define the aims and policy of the Movement. The Council advised the Minister that the initial conception, planning and general direction of the Movement by the Commonwealth were sound and much had been achieved. Badly needed specialists in physical education are emerging from the university courses established! at Commonwealth request. Grants to the Physical Education Sections of Education Departments in each State are stimUlating interest in physical education throughout schools and laying the foundation of physical fitness in the community. The National Fitness Councils in each State, also established at Commonwealth request, are active permanent bodies assisting community sport, recreation and cultural activities. However, in the Council's opinion, the National Fitness Councils are not equipped to meet all present demands for their services much less the demands which will need to be met with the emergence of increased numbers of young people in the next five years due to population increase. The main need of the Councils was additional money to provide more trained staff, more adequate headquarters, increased camping facilities and a public relations campaign. Substantially increased Commonwealth leadership and interest were needed also. The future aims and policy of the movement were stated by the Council in these terms-" This Council now considers that it should concentrate its main attention upon physical education and upon community health and recreation as integral parts of a national health policy, at the same time maintaining co-operative relationships with voluntary youth organizations."

DIVISION OF NURSING An important aspect of the work of the Division of Nursing has been the arranging of basic and post-graduate programmes for nurses coming to Australia under the Colombo Plan Technical Co-operation Scheme and the World Health Organization. Countries participating in the Colombo Plan have nominated many trained nurses for post-graduate study in Australia. Malaya has nominated girls to undergo a three-year basic nursing training course. The post-graduate Nursing Colleges and Hospital Authorities have, as in previous years, played a most important part by providing the technical training required, and assisting the nurses to adapt to the needs in their own country the many procedures and ideas they are learning. Di'rel'Se 'I'rainUlg: There has boon con~iderable diversity in the types of training programmes arranged for the post-graduate Colombo Plan students. The majority of the students have followed the regular courses provided by the postgraduate Colleges. The specialities in which 34 students were studying during 1961-62 were Diploma in Nursing Administration, Diploma for Sister Tutor, Midwife Teacher Diploma, Certificate in Operating Theatre Management and Certificate in Ward Management. Other qualified nurses have studied the organized hospital courses in the following specialities: tuberculosis, paediatrics, plastic and cancer nursing. For those undergoiag College tou.rses field experience bas been planned by the Co:Ueges as an integral part of the students' study. This experience bat

,...

49

been planned concurrently with the course. Post-course hospital experience was arranged for several students on the completion of their formal college programme. This hospital experience is planned to extend, broaden and deepen the nurse's understanding of her special field. All the nurses attending College and formal hospital courses have qualified for the diploma and certificates awarded by the respective institutions.

The countries nominating these nurses are: Burma, North Borneo, Ceylon, India, Indonesia, the Philippines, Sarawak, Singapore and Thailand. Under the sponsorship of the World Health Organization two graduate nurses commenced the Midwife Teacher Diploma College Course. One came from Cyprus and the other from Korea. The arrival in Australia during 1961-62 of another 54 students from Malaya under the Colombo Plan for basic nursing training brought the number up to 70 undergoing a ,three-year course. This year's intake of nurses was placed in the following hospitals: The Royal Melbourne Hospital, The Royal Children's Hospital, St. Vincent's Hospital, The Alfred Hospital, The Queen Victoria Hospital, The Austin Hospital, The Repatriation General Hospital and the Footscray and District Hospital, Victoria. The Royal Adelaide Hospital, South Australia, the Royal Perth Hospital and the Fremantle Hospital, Western Australia. During the year eight Malayan nurses and five nurses from Ceylon completed a basic nursing course and return to their own countries to take up their nursing work as fully-fledged nurses.

AUSTRALIAN INSTITUTE OF ANATOMY The Australian Institute of Anatomy is situated in a building erected in Canberra by the Commonwealth Government under the Zoological Museum Agreement Act 1924. Prior to the passing of this Act, the Commonwealth Government had expressed regret that the Australian nation possessed neither a collection of specimens of the unique and fast disappearing fauna of Australia, nor a museum in which such specimens could be preserved for future generations. Sir Colin MacKenzie,the first Director of the Institute of Anatomy, presented his entire private collection of Australian fauna to the Commonwealth Government. This gift was housed in the Institute. T~ Institute became part of the Commonwealth Department of Health in 1931. The Institute consists of a museum section and a laboratory section. In the museum section, which is open to the public, a portion of the original collection of anatomical specimens assembled by Sir Colin MacKenzie is displayed, together with ethnological collections which have been added since the foundation of the Institute. The material has been arranged to present simple lessons in human hygiene, to display the anatomical features and peculiarities of Australian fauna, and to display aspects of the character of Australian aboriginals and natives of Papua and New Guinea. Work has continued with the revision of the displays illustrating aboriginal culture, such as ;the provision of shelter, the use of fire, and techniques of hunting, fishing and food gathering.

..

;r:

{~

50 An exhibit demonstrating the physiology of speech has been designed and is under construction. The travelling exhibit on Dental Health was -loaned for display at Adelaide and Perth. A number of Health Department sections are now situated in the Institute. These include the Museum and Medical Artistry Section, the Nutrition Section, the Commonwealth Health Laboratory for the Australian Capital Territory and a Veterinary Laboratory. Nutrition: The scientific research work of the Institute is now concentrated on problems of nutrition. It takes the form of field surveys of the dietary status of the Australian popUlation and laboratory investigations into the biochemistry of nutrition and metabolism. At the request of the Territory of Papua and New Guinea and the South Pacific Commission, a medical officer and a nutritionist carried out a study of the dietary intake and expenditure of energy by two groups of New Guineans-one living in the eastern highlands and another group living in a marine village on the coast of Papua. The report of this study is being prepared. In continuation of a study of the diets of young women in Australia, a survey of the diets of young women working in Caims was carried out during June, 1962. As part of a campaign for the prevention of goitre in Australia, the distribution of iodine tablets to the Department of Health in Victoria and in Tasmania has continued. The bi-monthly publication" Food and Nutrition Notes and Reviews" has been produced as for the past eighteen years. The pamphlets "Keep Fit With Food" and" Healthy Teeth For Your Children" have been revised. The following papers were prepared and read at the 10th Pacific Science Congress held in Honolulu: "Nutrition Problems in Australia and the Territories of Papua and New Guinea ", "Food Enrichment Policies in Pacific Islands, with Special Reference to Iodized Salt, Thamine-fortified Rice and Vitamin-A-fortified Foods ". PUBLICATIONS FOOD AND NUTRITION NOTES AND REVIEWS, Vol. 18, 1960, Nos. 7-12. IBID, Vol. 19, 1961, Nos. 1-6. (Published by the Commonwealth Department of Health.) REVIEW OF PROGRESS IN NUTRITION IN AUSTRALIA AND THE TERRITORY OF PAPUA-NEW GUINEA. N. E. Kirk and E. H. Hispley, (1961), Food and Nutrition Notes and Reviews, Vol. 18, p. 66. A THEORETICAL ASSESSMENT OF ADEQUATE DIETARY ALLOWANCES. Hipsley, (1961), Food and Nutrition Notes and Reviews, Vol. 18, p. 93. E. H.

~- -

'j

;.

THERAPEUTIC SUBSTANCES THERAPEUTIC SUBSTANCES ACT AND REGULATIONS The Therapeutic Substances Act and Regulations came into operation in 1956 'for the purpose of controlling standards of therapeutic substances imported into Australia, traded interstate or exported from Australia in accordance with the :standards fixed by the British Pharmacopoeia, the British Pharmaceutical Codex

r •

51

or by Regulation. The provision of the Act and Regulations also apply to the standards of therapeutic substances supplied in the form of pharmaceutical benefits and to the Commonwealth Government. A number of samples were obtained during the year and submitted for analysis by the official testing laboratories. EPIDEMIOLOGY The following information in respect of the year under review has been collated from information received from State Health Authorities:TABLE I

Diseases Notifiable in each State and Territory of Australia and Number of Cases Reported during the Year Ended 31st December, 1961 Disease. N.S.W.

/(

.. Acute Rheumatism .. Amoebiasis .. .. .. .. Ancylostomiasis .. Anthrax . . .. .. Bilharziasis .. ., , . Breast Abscess .. Brucellosis ., .. Chorea .' ,. .. Dengue . , Diarrhoea Infantile, . . .. Diphtheria .. .. Dysentery Bacillary .. Encephalitis .. .. .. Erythema Nodosum .. Filariasis .. .. .. Homologous S. Jaundice Hydatid .. .. .. Infective Hepatitis .. .. , . Influenza " .. .. Lead Poisoning .. Leprosy . .. .. Leptospirosis .. .. Leukaemia ,. .. Malaria .. .. .. Meningococcal Infection .. Ophthalmia .. .. Ornithosis .. .. .. Paratyphoid Fever .. Poliomyelitis .. .. Puerperal Fever .. .. Q. Fever .. .. .. Rubella .. .. .. Salmonella Infection .. Scarlet Fever .. .. Staphylococcal Infection (Infancy) .. .. .. Tetanus .. .. .. Trachoma .. .. Trichinosis .. .. Tuberculosis . .. Typhoid Fever .. .. Typhus (flea, mite or tick borne) .. .. " ' '

58

- - - - - - - - - -- -- -- 61 2 78

Vic.

Qld.

S.A.

W.A.

Tas.

N.T.

A.C.T.

Ausl.

* *

5

35

" "

40 ..

* IS 12 4 4 226 19 30

"

.. 53 25 7 33 1

.. .. .. "

9

·. ..

..

10 7

.. "

.. ..

8

.. "

8 1 192 2

.. .. ..

1

., "

* 1 3 5

* ,.

5

.,

*

.. 14 6

.. .,

.,

.. , .

233 15 267

..

·, 142 4 40 8 ,

.. 48 15 117 2

• • * *

604 2 95 22 22 J

* * .. ·.

97 11

. ·.

..

I I

11 .. 1 * 6,025 3,515 1,022 1,406 .,

'.

*

·. ., .. ·.

.. * I

• * * *

.. 40 .. .. .. .. .. 61

3 2 218

• • •

•

* 3 45 8 46

"

7

"

1 ., 175 61

• 41 •

• •

19 6 88 32 35

.. .. .. ..

•

262 15 13 2 2 29 2 6 I

12 304

.,

.. .. 1 18

•

103 43 .. 15 ., 6 6 1,261 .. 45 .. 395 .. 73 .. 23 .. 1 .. 1 .. 24 281 12,876

.. 62 7 1 11 3 3 3 5

•

..

•

..

* I

• • • •

•

68 7

273 78

•

693

4 3 154 25 131 38 97 1 33

..

2 5 3 1 44 I

•

•

..

.. ..

• • .. ..

493 42 11

*

66 36 129

• •

3

.. • .. 13 .. *

.. ..

264 43 45

• • •

7 40

• • ..

.. ..

.. ..

2 1 2 1

2o 86 108 47 53 15o 41 1o 11

2 1 IS

458 10o 131 • 27 1,098 4 88 12 1,091 121 52 508

,

1,455 S

• •

"

•

698 11

•

•

2 124

679 2 13

214 3

5 369 ., 238 4 4

•

• 128

.. ..

..

•

..

.. ..

50 J

12 3,474 .. 29

..

2

"

..

..

19

• Not notifiable.

NOTE.-No case of cholera, smallpox, plague, epidemic typhus or yellow fever was notified.

52 TABLE II

INFECTIOUS HEPATITIS: CASES NOtIFIED State. 19S8. 1959. 1960. 1961. 1962.-

.. New South Wales .. Victoria .. .. Queensland .. .. South Australia .. .. Western Australia Australian Capital Territory .. Northern Territory .. Tasmania ..

..

.. .,

., .,

.. .,

.,

..

3,262 1,053 469 307 396 16 45 51 5,599

3,183 1,452 762 749 142 16 53 21 6,378

4,924 2,385 719 1,121 256 88 23 44 9,560

6,025 3,515 1,022 1,406 262 281 61 304 12,876

3,358 3,533 884 504 117 88 101 630 9,215

Total Australia

..

..

- FJgUreS m this column are subject to confirmatlon.

TABLE III

POLIOMYELIDS STATISTICS-AUSTRALIA Showing Age and Sex, Type of Disease, 1st July, 1960, to 30th June, 1961 Paralytic. Age Group.

Non-paralytic. No Respirator. Total.

Respirator. Fatal. Not Fatal.

Fatal.

Not Fatal.

Fatal.

Not Fatal.

Males.

0-1 1- 4 5- 9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45 and over Total

2 2

2 26 18 5 4 5 11 9 5 3 1 89

3

I

3

2 29 18 5 4 8 16 10 5 3 1 101

2

3 Females.

7

0-1 1- 4 5- 9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45 and over Total

4 24 12 2 2 10 5 5 1 1 1 67

5 1

4 29 13 2 2 12 6 5 2 1 1

.4.

8

77

'r •

53 TABLE IV

POLIOMYELmS STATISTICS Total AD Persons 1955-56, 1956-57, 1957-58, 1958-59, 1959-60 aDd 1960-61 Number.

AgeOroup. 1955-56. 1956-57. 1957-58. 1958-$9. 1959-60. 1960-61.

0-1 1- 4 5- 9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45 and over Not stated Total

.. ..

.. .. .. .. .,

.. .. .. ..

.. .. .. .. ..

..

.. .. ..

15 200 241 167 115 117 ISO

10 66 69 36 16

.. 9 8 1

5 3S

.. .. .. .. .. ..

114 48 25 17 11 1,220

..

34 26 20 9 2 2 290

4 4 3

..

4 2 1 1 37

.. ..

24 9 5 4 10 6 2 2

7 24 13 1 1 3

.. .. ..

5 4 2 ..

6 S8 31 7 6 20 22 15 7 4 2 178

102

60

TABLE V

POLIOMYELITIS STATISTICS Summary 1955-56. 1956-57. 1957-58. 1958-59. 1959-60. 196~1.

State.

; Males.! Females.! Tota!.! Males.! Females. Tota!.! Males.! Females.1 Tota!.! Males.! Females. TOtal.! Males.! Females. Tota!. , Males./ Females.1 Total.

I

I

I

New South Wales Victoria Queensland South Australia Western Australia Tasmania Australian Capital Territory Northern Territory Total

175 128 64 83 186 12

88 108 42 77 233 9

I

263 236 106 160 419 21 11 4

45 37 18 36 8 25

37 25 18 25 4 12 ..

82 62 36 61 12 37

13 2 1 1 1 ..

8 3 1 4 1 2

21 3 3 5 2 3

12 46 1 1 I

6 32 2

6

5

1658

4. .

I

I .. ..

18 78 3 1 1 1

11 8 3 4 6 2

6 2 1 3

17 10 4 7 6 2

6 44 10 13

2 36 9 9

8 80 19 22

~

I

25

21

46

--s6211,220

116912I 290

.

..

..

..

..

..

I ..

--18- ---19----:;; --61- --4-1-

---wz 40 -W 60 lO1-;:;-178

6

8

14

3

..

I

3

t

....

...

-<,

55

BROADCASTING AND TELEVISION CENSPRSIlIP The censorship of medical talks and advertisements relating to' medicines, used ·m sound broadcasting and television, is carried out under the Broadcasting and Television Act 1942-1961. During the year, 1,559 commercials for broadcasting .lind 88 television commercials were received. BROADCASTING In the censorship of radio commercials no serious problems were encountered . .Some were rejected because the claims made were grossly exaggerated and several others were rejected because no precise knowledge of the method of treatment lidvertised was known. ~pproved

Of the 1,559 broadcast commercials received during the year 1,396 were without amendment, 94 were approved with amendment, and 69 were .rejected.

The standard attained by the advertising agencies who have submitted these llcripts over the past years has shown considerable improvement. There has been .a large degree of co-operation between representatives of the Australian Association of Advertising Agencies, ,the Australian Association of National Advertisers .:and the Department. TELEVISION Out of a total of 88 television commercials received during the year, 67 were :approved, 17 were approved with amendment and 4 were rejected. Some of the 'advertising agencies submit the television commercials in the form of a " storyboard" while others submit a typed script describing the audio and video portions of the commercial and giving the full text of the statements which wiII be made. GUIDE FOR MANUFACTURES AND ADVERTISERS A code relating to the advertising of proprietary medicines was brought to finality and was agreed upon by industry and the Department. This document achieved uniformity in the rules relating to press advertising and broadcasting and television censorship of commercials. Work is proceeding on the revision of the Departmental Notes on Censorship ;as applied to medical talks, advertisements and medical films. LEGISLATION The Director-General's authority is contained in the following sections of the Broadcasting and Television Act 1942-1961:Section 100 (6). A licensee shall not broadcast or televise an advertisement relating to a medicine unless the text of the proposed advertisement has been approved by the Director-General of Health, or, on appeal to the Minister under this section, by the Minister. Section 121 (l). Except as prescribed, a person shall not broadcast or televise a talk on a medical subject unless the text thereof has been approved by the Direotor-General of Health, or, on appeal to the Minister under this section, by the Minister.

56

Departmental policy can be summed up as follows:(a) Within a broad interpretation of the principles of truth and ethics, a reasonable degree of latitude is given to the advertiser, the objective being to provide a balance between his economic motives on the one hand, and the contents of, and therapeutic claims made for. his product on the other hand. (b) Claims for disease prevention or for" protection" against an illness or illnesses will, in future, require to be substantiated by unequivocal scientific proof. It is not consistent with current acceptable standards of ethics in patent medicine advertising for an advertiser to confuse exaggeration with a misleading and untrue statement. (c) A little exaggeration has, over the years, been permitted in all instances where it has been based on a definite truth and on incontrovertible facts. No scripts will be accepted for broadcast or television commercials in which claims for protection or prevention are merely selling propositions based on no, or on negligible, supporting evidence. (d) It is not desired to interfere unduly with the buying and selling of proprietary medicines in so far as any member of the public has a perfect right to purchase a product for self-medication if one is available. One merely wishes to ensure that he will have a fair chance of receiving the benefit which he expects to accrue from the recommended dosage.

>-.

57

NATIONAL REALm AND MEDICAL RESEARCH COUNCIL The Fifty-second Session of the National Health and Medical Research Council was held at University House, Canberra, on 2nd November, 1961, and the fifty-third Session at Parliament House, Adelaide, on 17th May, 1962. The Adelaide meeting was officially opened by the Honorable Colin Rowe, AttorneyGeneral of South Australia. The Commonwealth Assistant Director-General of Health, Dr. H. E. Downes, deputized for the Chairman (Major--General Refshauge), who was absent overseas. The membership of the Council during the year was as follows: MajorGeneral W. D. Refshauge (Chairman), Sir Edward Ford and Dr. C. E. Cook, representing the Commonwealth, Dr. R. W. Greville representing the Commonwealth Serum Laboratories Commission, Dr. E. S. A. Meyers (October, 1961) and Dr. C. J. Cummins (May, 1962) representing New South Wales, Dr. A. Fryberg representing Queensland, Dr. P. S. Woodruff representing South Australia, Dr. J. Edis representing Tasmania, Dr. K. Brennan (November, 1961) and Dr. R. Farnbach (May, 1962) representing Victoria, Dr. W. S. Davidson (November, 1961) and Dr. D. J. R. Snow (May, 1962) representing Western Australia, Dr. R. F. R. Scragg representing the Territory of Papua and New Guinea, Dr. W. F. Simmons representing the Australian Medical Association, Professor S. Sunderland representing the Universities having Medical Schools, Professor N. D. Martin (November, 1961) and Professor A. J. Arnott (May, 1962) representing the Australian Dental Association. Dr. J. N. Chesterman representing the Australian Regional Council of the Royal College of Obstetricians and Gynaecologists, Dr. J. G. Radford representing the Australian College of General Practitioners, Professor E. S. J. King representing the Royal Australasian College of Surgeons, Dr. J. J. Billings representing the Royal Australasian College of Physicians, Dr. A. V. Jackson (November, 1961) and Dr. J. A. Bonnin (May, 1962) representing the College of Pathologists of Australia, Professor V. L. Collins representing the Australian Paediatric Association, Dr. H. J. Ham representing the College of Radiologists of Australasia, Sir Norman Nock, a prominent layman appointed by the Commonwealth Government, Miss G. N. Burbidge, a pJ.1ominent laywoman appointed by the Commonwealth Government, and Dr. R. E. Richards (Secretary). The Committees of the Council during the year included: Medical Research Advisory, Public Health, Occupational Health, Food Additives, Food Standards, Antibiotics, Medical Statistics, Veterinary Public Health, Poliomyelitis, Preventive Medicine in General Practice, Traffic Injury Research, Advertising of Proprietary Medicines, Radio-active Isotopes, Radio-therapy Advisory, Medical Radiation, Ultrasonics, Epidemiology and Epidemic Diseases, Maternal and Child Health, Nutrition, Dental Research Advisory, Nursing, and Tropical Physiology and Hygiene. Medical Research: The Council approved the expenditure of £307,718 from the Medical Research Endowment Fund. Approximately 75 per cent. of this expenditure was for salaries of medical research personnel, 16 per cent. was for apparatus, equipment and consumable research supplies, and the remainder was for travel grants and grants-in-aid to particular laboratories. It was decided to organize regional sub-committees to visit the main cities and aid in the assessment of applications for medical research grants. A central register of research

58 grants was established, in co-operation with the National Heart Foundation and' Life Assurance Medical Research Fund of Australia and New Zealand and arrangements were made to stagger the dates of future meetings of the three groups ..

Food Additives and Food Standards: Considerable progress was made in drawing up a Ii!>t of safe food additives and colouring agents, which should be of value to· the food industry as well as helping to protect the public from toxic substances. Work continued on producing a comprehensive set of draft food standards, to aid in the development of uniform food legislation throughout the States. Tnfected Coconut: The contamination of imported desiccated coconut by Salmonella organisms was investigated, and it was recommended that the nuts be' sterilized before disintegration and be shipped in packages marked with the manufacturers' code numbers. Gunny sacks were considered unsuitable for the' transportation of coconut to this country. 'n

Pesticides: Work continued on the development of draft legislation for the control of agricultural chemicals and pesticides, and detailed proposals were completed for the control of phosphine, methyl bromide, hydrogen cyanide, and organic phosphates. Poliomyelitis: The Council recommended that, in an attempt to eradicate polio-myelitis in Australia, the administration of a fourth (booster) dose of Salk vaccine should be encouraged a minimum of one year aUer the third dose of the vaccine. The particular value of the oral Sabin vaccine was recognized in dealing with a threatened or actual outbreak of poliomyelitis, and the Cou.ncil therefore i'ecommended that a supply of this vaccine be imported and reserved for use in such: emergencies. The Council, however, did not recommend the use of Sabin vaccine' as part of the normal campaign against poliomyelitis. Measles: In view of the encouraging reports about an American measles vaccine;, it was suggested that consideration be given to the production of a similar vaccine by the Commonwealth Serum Laboratories. Traffic Injury Prevention: It was considered that while the epileptic who is under adequate control or who has an aura, presents a negligible risk of liability to road' traffic accidents., no one with a history of epilepsy should be permitted to drive a public vehicle. Hormones in Animal Production and in the Poultry Industry: Although theremay be economic advantages to the producer, the Council considered that from. the public health point of view the use of hormones for other than therapeutic purposes was inadvisable. Penicillin in Milk: Penioillin is often used for the treatment of bovine mastitis. and there is a risk that traces of penicillin may then get into milk which is sold' for public consumption. This constitutes a risk to people drinking milk who are hypersensitive to pencillin. Investigation is proceeding into the development of a suitable dye to mark veterinary penicillin so that traces of penicillin in milk~ could easily be recognized by the dye discolouration of 1!he milk. National Morbidity Survey: One hundred doctors in private practice agreed to' take part in a nation-wide survey, which will produce valuable information ~D' the incidence of illness episodes and the frequency and value of prophylactic: innoculations, surgical procedures and routine examinations. f •

59 Domiciliary Nursing: Detailed recommendations were formulated for the better orientation of nursing training towards domiciliary nursing, which should aim at extending the best of hospital care into patients' homes to minimize the burden on their families and ensure better follow-up treatment.

Snake Bite Anti-venene: In South Africa, snakebite treatment outfits (including anti-venene) are readily available for purchase by the lay public. It was decided to request the Commonwealth Serum Laboratories to i~vestigate th~ pr~cti~ab~ity of producing an effective snakebite anti-venene pack sUItable for wlde distrIbutIon .in Australia.

MEDICAL RESEARCH AND TEAClllNGINSTmJTIONS SCHOOL OF PUBLIC HEALTH AND TROPICAL MEDICINE The School of Public Health and Tropical Medicine performs the functions of teaching, investigation and consultation in the subjects relating to Public Health, Social and Preventive Medicine, and Tropical Medicine. The academic work of the School is under the direction of the University of Sydney, and various, training, consultative and professional services are maintained by the Commonwealth Department of Health. The main sections of the School comprise: Public Health and Preventive Medicine, Tropical Medicine, Bacteriology and Pathology, Biochemistry, Occupational Health, Environmental Health, Parasitology, Entomology and Vital Statistics. TEACHING ACTIVITIFS In addition to its University functions as an undergraduate department and postgraduate school of the Faculty of Medicine, the teaching activities of the School have also been directed into broader, extra-mural fields. This is in accord with Departmental policy that the School should be an Educational adjunct to the Commonwealth Health Services in maintaining and improving Public Health. During the period under review a course of three weeks in Occupational Health for medical practitioners, recently established as an annual feature, was well attended, and a further course for technical and managerial staffs in industry" on the prevention of occupational hazards, was arranged. Postgraduate Studies: Diploma in Public Health (one academic year).Subjects comprise: Bacteriology, Parasitology, Entomology, Physiology, Biochemistry, Nutrition, Public Health Practice and Administration, Vital Statistics. Epidemiology, Maternal and Child Health, Hygiene and Sanitation, Communicable Disease Control, Occupational Health and Health Education. In 1961 fifteen students were enrolled and in 1962 eight. Diploma in Tropical Medicine and Hygiene (six months) .-Subjects comprise: Parasitology, Entomology, Bacteriology, Vital Statistics, Tropical Physiology. Nutrition, Tropical Medicine, Tropical Hygiene and Sanitation, Epidemiology. Communicable Disease Control, and Child Health. In 1961 eleven students were enrolled and in 1962 fourteen. University Diploma courses (single subjects provided).Diploma in Dermatological Medicine: Mycology, Entomology. Diploma in Clinical Pathology: Parasitology. Diploma in Social Work: Physical and Mental Health. Diploma in Public Health Dentistry: Preventive Medicine, Public Health Administration, Epidemiology, Vital Statistics (with D.P.H.). Undergradnate Studies: Medicine (5th Year).-Preventive and Social Medicine (55 lectures and practical instruction). The number of students enrolled were 219 in 1961 and 236 in 1962. Medicine (4th Year) .-Helminthology. Science (3rd Year).-Protozoology (Advanced Zoology).

;

.

-I..

Architecture (3rd Year) .-Hygiene. Engineering (3rd Year) .-Industrial Hygiene and Safety.

61 Miscellaneous: Australian School of Pdcific Administration.-4Lectures for teachers, patrol officers and others attending ASOPA courses. Annual Course for Industrial Medical Officers.~Arranged by public advertisement-for medical practitioners. Courses for Armed Services.--Army: malaria control-local units; instruction to medical officers and to personnel, as arranged. Other services: as arranged. Annual Non-professional Course in Tropical Medicine and Hygiene.Arranged by public advertisement for missionaries, planters, nurses and other residents of tropical areas (30 lectures). Courses in association with New South Wales College Of Nursing.Diploma in Nursing Administration and Sister Tutor's Diploma.-Public Health and Preventive Medicine; Bacteriology. Diploma in Industrial Nursing. RESEARCH AND INVESTIGATION Bacteriology and Pathology: Serological examination oj meat inspectors.-A serological examination for evidence of Q fever, leptospirosis and brucellosis in Commonwealth meat inspectors in all States was completed. Medical mycology.-An investigation of dermatophytosis in the native inhabitants of the British Solomon Islands, in association with Dr. G. E. Hoult, of Honiara, is being continued. Histopathology oj tumours.-The long-term study of tumours in the native population of Papua and New Guinea, which was commenced in 1957 by the establishment of a Papua-New Guinea Tumour Registry, was continued. In thi~ project, the School is associated with the Department of Public Health of the Territory, the Tumour Clinic at St. Vincent's Hospital, Sydney, and the Department of Pathology, University of Western Australia. Enteritis necroticans.-A bacteriological investigation of an outbreak of food poisoning which occurred in the indigenous popUlation of a district in New Guinea is in progress. Leptospirosis.-A serological survey of leptospiral infection in domestic animals in New South Wales, to define animal reservoirs of this disease, was completed in association with the Veterinary Research Institute, Glenfield. Reports have been prepared for publication. Biochemistry: Serum protein studies.--Serum protein examinations of New Guinea natives, as part of a longitudinal study associated with a malariaeradication programme, continued into its third and final year, in association with the Department of Public Health of Papua-New Guinea. Correlation of electrophoretogram quantitation methods was continued in connexion with this and material from other sources. Cholinesterase levels in workers with organo-phosphorous compounds.-An investigation of cholinesterase levels in normal persons and in persons working with organo-phosphorous compounds, by various assay methods, is in progress. Micro-estimaJion of serum bromide.-An investigation of the micro-estimation of bromide in serum and biological tissues is to be completed. Amino-acid excretion.--Studies in the anrino-acid excretion of "benign It albuminurics are in progress.

.o::x.

62 Environmental Health: Radiant cooling.-In co-operation with the Engineering Division of the C.S.I.R.O., experiments to assess physiologically the effectiveness of a method of radiant cooling have been completed. A paper has been prepared and will be submitted for publication. Preferred thermal environment.-The results of a survey conducted at Darwin, Northern Territory, to inquire into the preferred thermal environment, are at present in process of analysis. Thermal comfort.-In association with the C.S.I.R.O., Division of Building Research, the analysis of the results of a field study of thermal comfort during both waking and sleeping conditions undertaken at Batchelor, Northern Territory, is proceeding. One paper has already been published. Acclimatization to cold.-In a cold room made available by the C.S.I.R.O., Dairy Research Section, studies in facial acclimatization to cold have been carried out in conjunction with the Antarctic Division of the Department of External Affairs. Antarctic physiology.-The results of physiological investigations conducted in Antarctica in 1959 by Dr. G. M. Budd are at present being analyzed. Thermal comfort in ships.-A paper entitled "Thermal Comfort in a Small Warship ", by Surgeon-Lieutenant D. A. Noble, has been completed and was submitted to the Medical Director-General, Department of the Navy, in December, 1961, who in turn submitted it for publication. Entomology: Myxomatosis and mosquitoes.-The field studies on myxomatosis transmission, conducted at Mt. Flora in association with the C.S.I.R.O., Wildlife Survey Section, have been restricted during this period. Observations have been made, however, in order to maintain the continuity of the studies. A further report of the series on this work was published. Biting midge (sandfly) investigations.-Work on the biting midges, in this period, was largely confined to consideration of the extensive data already collected. A paper on biting midges as possible vectors of virus diseases in the Townsville area was published, and a further paper, on sandflies as possible vectors of diseases of domesticated animals in Australia, was submitted for publication. Mosquito feeding habits.-Precipitin tests of the blood meals of mosquitoes, to determine their feeding preferences, were continued. Occupational Health: Health oj telegraphists.---<Further progress was made in the investigation of the health of telegraphists, including detailed analysis of the sickness and absence records of more than 2,000 employees in the PostmasterGeneral's Department. It has been proposed that a continuation of this project should include a comprehensive medical interview and examination, and appropriate environmental investigations. Blood changes in chemical workers.-A detailed analysis of changes in the blood of chemical workers was undertaken, with particular referenec to eosinophilia. Since so many chemicals were involved, however, it was not possible to reach any firm conclusions as to the agents that might have been responsible for the blood changes observed. Oxides of lead manufacture.-A survey of the health and working environment of men employed in the manufacture of oxides of lead was completed. No case of ill-health due to lead poisoning was discovered but there was evidence that some workers were exposed to lead in quantities higher than those of recommended standards. It is proposed to repeat the survey later in 1962.

I

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r

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63

Development of methods for the estimation of phosphine.-Analytical methods, particularly related to estimations in connexion with the use of phosphine for fumigation of grain, are in progress. Parasitology: Filariasis.~Investigations into the epidemiology and control of filariasis in New Guinea natives, conducted in association with the Department of Public Health of the Territory of Papua~New Guinea, are now in their third year. The programme is designed to select a routine method for the control of the disease, suitable for general use in the Territory. The control area, which has a population of about 1,000 in whom infection was high, is situated in the Finschafen sub-district. Dr. B. McMillan visited the area in September-October, 1961, for parasite estimations and the administration of a third course of diethylcarbamazone, the drug under trial for controlling the disease. The microfilaraemic density in treated persons remains at a very low level and the local people continue to support the scheme. Blood sampling will be carried out again in October, 1962, but treatment will be withheld until the parasite density begins to rise. This is not expected to occur fOT about three years, though the position will require continuous surveillance. In certain villages in Manus, which were surveyed last year, drug treatment was commenced in combination with mosquito control by residual spraying. Miscellaneous parasites.-Study of blood and alimentary parasites of various animals was continued, including observations on Leishmania species in marsupials and in culture. Preventive Medicine: B.C.G. and Leprosy.-An investigation was planned, in association with the Department of Public Health of the Territory of Papua-New Guinea, to determine the effect of B.C.G. vaccination on the incidence of leprosy. Development of pre-school children.--Studies in the health and development of pre-school children, conducted in association with the Institute of Child Healthand the Lady Gowrie Research Fellow, were continued.

~.

Radiobiology: The work of the Radiobiological Research Unit, under the direction of Dr. P. L. T. Ilbery, was supported by the New South Wales State Cancer Council. Mechanism of graft versus host reaction in radiation chimaerism.~Where the donor haemopoietic tissue in a primary radiation chimaera is of foetal origin, " adaptation" of the bone marrow for both donor and host type antigen has been demonstrated. Persistence of the phenomenon was tested by transplantation into a further generation of lethally irradiated host and donor type animals. Donor tissue from FI litters, one parent strain of which carried the T6 marker chromosome, was used to enable recognition of donor material. Two lines of radiation chimaeras have been followed to the third passage of donor haemopoietic tissue, through the incompatible host strain. At each passage, haemopoietic tissue was examined and shown to be donor tissue, by the presence of the marker chromosome in all cells. It was also possible to resuscitate lethally irradiated donor type animals (the unmarked component strain of the FI donor tissue) by transplantation of the donor tissue from each passage. Three host type mice surviving from the third passage, subsequently accepted skin grafts from both host and donor type animals, thus strengthening the evidence for the persistence of the phenomenon of adaptation. These animals were later passaged, and the donor tissue again observed to have persisted. These experiments have demonstrated the persistence of the phenomenon of adaptation of haemopoietic

tissue to both donor and host type antigens in transplantation to the third incompatible host. In these cases, the possibility that the donor material acts as a blood-forming transfusion, allowing a small number of host type cells to proliferate and form a host type isograft has been excluded.

Production of mouse strains.-An attempt is being made to produce sub-strains carrying marker chromosomes. Very low temperature storage.-The viability of tissues stored at-196°C. was tested. Leukaemic cells stored for between 7t and 12 months, and bone marrow cells stored for 13 months, proved viable when given to host mice. Radioleukaemia.-Last year results were reported on cytogenetic examination for chromosome aberrations of mice considered to be in the pre-leukaemic phase. Scoring was continued and it was found finally that 17 of the 25 mice considered to be in the pre-leukaemic state showed some chromosome abnormalities. All the pre-leukaemic cells carrying abnormal chromosomes failed to transplant, with the exception of one case already reported, in which chromosome aberrations were present in bone marrow as well as in the thymus. Tropical Medicine and Hygiene: Health of plantation workers, British Solomon lslands.-A study by Dr. R. H. Black included observations on the working conditions on coconut plantations, living conditions, disease patterns, diet, industrial hazards in the field and the mill and other workers. Advice directed towards the improvement of some of these was given in a series of monthly reports. The whole study was made within a framework of a social anthropological approach to the subject. Several papers are in preparation for publication based on results of this expenditure under the following titles: "The cuts of copra cutters "; " The house-groups of plantation labourers on a large coconut plantation"; "Heat hazard in a tropical agricultural enterprise: the hot air drying of copra"; .. Christianity as a cross-cultural bond in the British Solomon Islands ".

Goitre in New Guinea.-A goitre survey was carried out by Dr. W. B. Hennessy in the mountainous area to the north-east of Lae in the Territory of New Guinea. The higheSlt. incidence of goitre and the largest goitres were found at the headwaters of the rivers at highest altitudes and furthest from the town influence. The study was an assessment of the prophylactic effect of iodised oil previously given at an iodine depot by one of the medical officers of the Department of Public Health of the Territory of Papua and New Guinea some years before. A report is in preparation. CONSULTATIVE AND ADVISORY SERVICES The consultative service provided by the various sections of the School on their particular subjects has been widely used by Departmental institutions and by a wide range of Commonwealth and State departments, institutions and public authorities, individual doctors and others. Inquiries have continued to increase and in some sections must frequently be deferred on account of lack of staff to undertake requests requiring special surveys or investigations. Honorary consultant physicians' posts to various· hospitals are also held by various staff members. Consultative assistance has been afforded to a number of Commonwealth departments during this review period, including the Departments of Territories, Works, postmaster-General and External Affairs. Requests for advice have also been received from Territory Administrations.

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65

The Commonwealth Health Laboratories Consultant Service provides advice, as required, on pathology, bacteriology, biochemistry, parasitology and entomology, to the Commonwealth Health Laboratories. In recent years the work of the He'alth Laboratories has steadily increased in amount and complexity, due to the growing importance of clinical pathology in medical practice, and this has been reflected in the additional consultative assistance required. Occupational Health Services: A full-time medical service at the Munitions Filling Factory, St. Marys, is directed and medical and nursing arrangements supervised at the Small Arms Factory, Lithgow, by the Occupational Health Section of the School. As well as providing for the health and safety of employees, these services also furnish a valuable adjunct to the teaching facilities of the Section. The Anned Services have maintained close liaison with the School and requests for instructional and advisory services have been received from all three. Members of the School staff serve as consultants to the Army, some as serving officers, in tropical medicine, preventive medicine, environmental health, and other subjects. The Director is on the strength of Army Headquarters as Director of Army Health. Instruction is provided to local units and to individual members, whenever possible. Assistance has also been given in special investigational projects. Association with a wide range of health agencies, and professional, educational and community bodies has been maintained. The Department and the School are widely represented on such bodies by the personal, and usually unofficial membership of staff members. As these are generally admitted for their professional qualifications, this necessary work tends to be particularly time-consuming for senior staff. The following are among the bodies on which representation is maintained in this way: The National Health and Medical Research Council (and its various committees); the National Radiation Advisory Committee; the Council of the Australian School of Pacific Administration; the New South Wales Board of Health; the Health Advisory Committee to the New South Wales Minister for Heaith; the Poisons Advisory Committee of New South Wales; the New South Wales State Cancer Council; the World Health Organization (Expert Committees on Malaria, Public Health Education, Occupational Health); a wide range of University of Sydney advisory, administrative and research bodies; the Board of Social Studies; the Advisory Committee on Radioactive Substances; the University Extension Board; the Post-Graduate Committee in Medicine; the Royal Australasian College of Physicians (Research and Editorial Committees); the Australian Medical Association (Occupational Health Committee); the Solar Energy and Tropical Housing Research Committee, University of Queensland; the Royal Institute of Health (New South Wales Division); the Australian Water and Sewage Treatment Association; the Standards Association of Australia; the Royal Society of Tropical Medicine and Hygiene (local secretary); the Nuffield Fellowship Advisory Committee; the New South Wales Ambulance Association; and various other scientific and charitable bodies and hospital boards. GENERAL The installation of the climatic chamber for the Environmental Health Section, which is essential for its basic research in climatic physiology, is not yet completed, and the recruitment of specialist staff proceeds slowly, due to special qualifications required. The current investigational programme of the Section, and the advisory and consultative services already provided, display its potentialities in regard to Australian development. 1642/63.-3

66 A small laboratory for the diagnosis of smallpox, where satisfactory isolation could be maintained, was provided at the Quarantine Station, North Head, by the Commonwealth Director of Health, Sydney, and has proved of value. A special course of twelve lectures delivered to students for the Diploma in Public Health Engineering of the University of New South Wales by the Senior Lecturer in Medical Entomology was the first occasion on which the entomological aspects of sanitary engineering have been taught in Australia.

PUBLICATIONS SIMPLIFIED METIlOD OF STRO'NTIUM ANALYSIS IN HUMAN BoNE. By P. M. Horsford and P. L. T. Ilbery. Aus.t. J. Sci., 23, p. 298. INCOMPLETE TRISOMY IN A MONGOLOID CHILD EXHIBITING MINIMAL STIGMATA. By P. L. T. Ilbery, C. W. G. Lee, and S. M. Winn. Med. J. Aust., 2, 19'61, p. 182. A FREEZING ApPARATUS FOR PRESERVATIO'N O'F BONE-'MARRO'W. By P. L. T. Ilbery, S. Meszaros, and S. M. Winn. J. appl. Physiol., 16, p. 767. STUDIES O'N PO'ST-GASTRECTOMY MALABSORPTIO'N: THE IMPO'RTANCE O'F BACTERIAL CO'NTAMINATIO'N O'F THE UPPER SMALL INTESTINE. By W. B. Hennessy et al. Med J. Aust., 2, 1961, p. 257. SIGNIFICANCE TESTS IN DISCRETE DISTRIBUTIO'NS. J. amer. stat. Assoc., 56, p. 223. By H. O. Lancaster.

A MORPHO'LOGICAL STUDY OF VARIATION IN Tyrophagus (ACARINA) WITIl PARTICULAR REFERENCE TO' PO'PULATIO'NS INFESTING CHEESE. By Phyllis L. Robertson. Bull. ent. Res., 52, p. 501. A NBw HOST RECORD FO'R PlasmodiuJm relictum: THE SILVBR GULL (Larus novae-hollandia:e STEPHENS). By 1. 1. Lawrence and A. 1. Bearup. Indian J.

Malariology, 15, p. 11. Ceratopogonidae) p.230. THERMAL CO'MFO'RT AND ACCLIMATIZATION TO COLD IN A SUBANTARCTIC ENVIRONMENT. By G. Palmai. Med. J. Aust., 1, 1962, p. 9. OBSERVATIONS ON THE LIFE CYCLE OF Stictodora lari (Trematoda: Hetemphyidae). By A. 1. Bearup. Proc. linn. Soc. N.S.W., 86, p. 251. THERMAL COMFORT IN AUSTRALIA. By Margaret E. Hindmar:.h and K. R. MacPherson. Aust. J. Sci., 24, p. 335. SELECT GENERAL PRACTICE. ANTARCTICA. By G. M. Budd. Syd. Univ. med. J., 51, p. 20. BLOOD-SUCKING FLIES (Diptera) A1'.n MYXOMATOSIS TRANSMISSION IN A MOUNTAIN ENVIRONMENT IN NEW SOUTH WALES. II. COMPARSISON OF THE USE OF MAN AND RABBIT AS BAIT ANIMALS IN EVALUATING VECTORS OF MyxoMATOSIS. By A. L. Dyce and D. 1. Lee. Aust. J. Zool., 10, p. 84. A POLIo-LIKE ILLNESS IN ANTARCTICA. By G. M. Budd. Med. J. Aust., 1 AN INVESTIGATIO'N OF THE PO'SSIBLE RO'LE O'F BITING MIDGES (Diptera, IN TIlE TRANSMISSION O'F ARTHRO'PO'D-BORNE VIRUS DISEASES AT TOWNSVILLE. By Eric 1. Reye and David 1. Lee. Proc. linn. Soc. N.S.W., 86,

1962, p. 482. THE DISTURBANCE OF SLEEP BY EXCESS1VE WARMTH. and R. W. Muncey. Letter. Aust. J. Sci., 24, p. 454. By R. K. Macpherson

'" ,

67

ACCLIMA TIZA TION TO CoLD IN ANTARcnCA AS SHOWN B R T TURE RESPONSE TO A STANDARD CoLD STRESS By G M YBUdEdCTANL t EMPERAp. 886. . .... a ure, 19 3 ,

STRAIN. By P. L. T. Ilbery

,-f

ADAPTATION OF A LINE OF MOUSE BONE MARROW TO AN INCOMPATIBLE and S. M. Winn. Nature, 194, pp. 941-2. THE BIOTOPES OF EMPEROR PENGUIN ROOKERIES. By G. M. Budd. Emu, 61,pp.171-89. A DWARF EGG OF THE EMPEROR PENGUIN. By G. M. Budd. Emu, 61, pp.203-4. SOME NOTES ON IMMATURE EMPEROR PENGUINS. By G. M. Budd. Emu, 61, pp. 204-8. STUDIES IN THE PREFERRED THERMAL ENVIRONMENT. By R. K. Macpherson. Trop. Building Studies, 1 (2), pp. 113-30. PATTERNS OF CAUSE AND EFFECT RELATING TO INSECT BITES AND STINGS. By D. J. Lee. (Mimeographed.) THE ASSESSMENT OF THE THERMAL ENVIRONMENT. By R. K. Macpherson. Brit. J. industr. M ed (in press). HEALTH AND THE URBAN HOUSING OF INDIGENOUS PEOPLES IN HOT CLIMATES. By R. K. Macpherson. Archit. in Aust. (in press). HUMAN CLIMATOLOGY AND AUSTRALIAN ARCHITECTURE. By R. K. Macpherson. [Proceedings of the Royal Australian Institute of Architects Convention, 22nd-25th May, 1962.] Archit. in Aust. (in press). SKINFOLD THICKNESS IN RELATION TO BODY WEIGHT AND ARTERIAL BLOOD PRESSURE. By G. Palmai. Med. J. Aust. (in press). POPULATION STUDIES IN ROOKERIES OF THE EMPEROR PENGUIN Aptenodytes forsteri. By G. M. Budd. Proc. zoo I. Soc. Lond. (in press).

INSTITUTE OF CHILD HEALTH The Institute of Child Health is located partly in the School of Public Health and Tropical Medicine in the grounds of the University of Sydney and partly at the Royal Alexandra Hospital for Children. The staff of the Institute conduct research and also co-operate in both undergraduate and postgraduate teaching, this co-operation being facilitated as the Director of the Institute is also Professor of Child Health in the University of Sydney. Professor Stapleton and Dr. F. W. Clements are members of the Child Welfare Advisory Council of New South Wales. The Director is a member of the Special Committee set up by the Australian Paediatric Association to consider a higher qualification in Paediatrics, of selection committees for the Nestle Paediatric Travelling Fellowships of the Australian Paediatric Association, and of the Charles McDonald Mead Johnson Travelling Fellowship of the Australian Postgraduate Federation in Medicine, and the Mental Health in Childhood Study Group of the New South Wales Association of Mental Health. The Director attended the Annual Meeting of the New Zealand Paediatric Society as overseas guest speaker as well as the conference of the Canterbury Mental Health Council which were both held in September, 1961. The Director also attended, as one of the two Australian representatives, a World Health

68 Organization Conference on Child Health and the School held in Manila in November, 1961. The Director represented the Department at the Inaugural Meeting of the Australian Medical Association in Adelaide in April, 1962. A number of lectures and talks to outside bodies have been given by various members of the Institute staff.

RESEARCH Rheumatic Fever: The ,long-term study of the effect of oral penicillin prophylaxis on children who have suffered from rheumatic fever continues and its effectiveness in preventing recurrences is confirmed. Since the commencement of this study in 1952, nearly 200 children have been included in the group. Many of the children originally enrolled in the study group are now reaching adolescence, but are still being seen regularly at the Clinic. The opportunity has been taken to observe a number of social, educational and adjustment problems relating to these patients. The children in the control group c:ontinue to be seen annually. Hypothyroidism: The study of cretinism was continued. Seven children suffering from oongenital non-goitrous hypothyroidism have been enrolled in the prospective study and their progress, both physically and mentally, is being observed. The study of antithyroid antibodies in these children, their mothers and their siblings is being continued. The method used .is a modified tanned sheep cell agglutination technique. Endemic Goitre: The studies of endemic goitre in Southern Tasmania were continued. In association with the Senior Medical Officer, School Medical Service, Tasmania, and a number of general practitioners, therapeutic trials with thyroxine and dried milk were carried out on some 200 children who had either a persistent goitre or a seasonal enlargement of the thyroid gland. The results were inconclusive ,and plans were made to repeat the investigation in the second half of 1962 using larger doses of thyroxine. Studies of thyroglobulin antibodies in sem from these children are being continued. Goitre Survey in New Guinea: Assistance in the planning of, and in the chemical analyses associated with, a goitre study being carried out by Dr. Hennessy of the School of Public HeRilth and Tropical Medicine was given. Prematurity: The results of the study of premature babies with birth weights of 3 lb. or less was concluded and the results will shortly be ready for publication. Urinary Tract Infections: The long-term follow-up of ohildren with urinary tract infections was continued and a number of new patients were added to the study. The Aetiology of Croup: An investigation into the possible viral aetiology of patients admitted to the Royal Alexandra Hospital for Children during 1962 with croup and related respiratory infections is being carried out. Parent Education: The research initiated in 1960 on the determinants ot participation and non-participation in discussion courses on child-rearing was completed and a report compiled. This was submitted for the Degree of Master of Science. Neonatal Meningitis: A study of neonatal I?enin~itis and its sequelae was made by the Medical Regtistrar to the ProfessonaI Umt and assessments of the intelligence of some of these children were made.

69

Neonatal Hepatitis and POlycythaemia: A report. is in the medical press on this subject discussing the possible relationship of neonatal hepatitis to matemofoetal transfusion, in collaboration with the Institute of Pathology at the Royal Ale~andra Hospital for Children and the New South Wales Blood Transfusion Laboratories. Chromosome Studies: A report was prepared and presented at the Annual Meeting of the Australian Paediatric Association on a patient with a self-perpetuating ring chromosome, which is an almost unique abnormality to be found in 'a mentally retarded child. Studies of the chmmosomes in foetuses are being made. Cardiac Surgery: Furthe'rinstrumentation for cardiac surgery and diagnostic procedures was undertaken and modifications to the Ebsray R.A.H.C. Heart Lung Machines have been incorporated in models produced recently. Se,veral items of electronic equipment have been constructed to specific requirements, namely a 6-chaooel recorder for use in the operating theatre, a 2-channel recorder for post-operative monitoring, a miniature pacemaker and an B.C.G. monitor. More recently an electronic stethoscope has been constructed with an outlet for connection with a phonocardiogram, and tbis is at present under trial. Malignant Disease: A Tumour Study Group has been formed at the Royal Alexandra Hospital for Children to investigate problems in this field. Institutional Care: A study into various aspects of care of infants and small children in an institution is being undertaken. A detailed survey is being made of the incidence of infections, cross-infections, activities (both mental and physical) of a group of children and their mothers, with a view to identifying possible ways of ,avoiding institutional care and improving it when it is necessary. In this study we have the co-operation of the School of Social Work at the University of Sydney. The following persons have visited and spoken to the Institute staff and to the students:-Dr. Cicely Williams (Beirut); Professor W. B. Macdonald (Perth); Professor J. T. Rendle-Short (Brisbane); Dr. E. M. Darmady (England); Dr. Howard Williams ~Melbourne); Dr. John Menkes (U.S.A.); Dr. Mary Crosse (England); Dr. Donald Buckle (W.H.O.); Dr. Joan Segall (U.S.A.); Pmfessor B. S. Platt (England); Dr. Cecily de Monchaux (England); Dr. Lam Po Tang (Mauritius); and Dr. S. Dorairajan (India). Library: Additional books and journals in the fields of child growth and development, child psychiatry and clinicall paediatrics have been obtained with a view to making the Library more comprehensive.

PUBLICATIONS. THE RESPONSIBILITY OF THE GENERAL PRACTITIONER FOR HEALTH EDUCATION OF THE PUBLIC. F. W. Clements (1961). World Med. J., Vol. 8, p. 199. SoME PROBLEMS IN THE COMMUNICATION OF PROFESSIONAL KNOWLEDGE TO THE PUBLIC. F. W. Clements (1961). Aust. Dent. J., Vol. 6, p. 330. THE HEALTH OF THE CHILD IN AUSTRALIA. F. W. Clements (19'61). Quart. Rev. Pediat., Vol. 16, p. 221.

70 A MINIATURE CARDIOSCOPE. V. Hercus, D. Cohen and E. C. Hulme (1962).

Med. 1. Aust., Vol. 1, p. 44. MALIGNANT DISEASE IN CHILDHOOD.

D. Cohen and C. W. G. Lee (1961).

Med. 1. Aust., Vol. 2, p. 1015. THE EVALUATION OF ACCIDENTS TO CHILDREN. J. S. Cullen (1961). Amer. !. Public Health, Vol. 51, p 990. TRACING FAMILIES AND SECURING THEIR CO-OPERATION IN HEALTH SnroIESP. E. Grave (1962). (In Press.) A SELF·PERPETUATING RING CHROMOSOME. B. Turner, A. N. Jennings, Gesina M. den Dulk and T. Stapleton (19'62). Med. 1. Aust., Vol. 2, p. 56. POLYCYTHEMIA AND NEONATAL HEPATITIS. R. J. Walsh, R. D. K. Reye. and T. Stapleton (1962). Arch. Dis. Childh. (In Press.) PAEDIATRICS, PSYCHIATRY, AND DELINQUENCY. T. Stapleton (1962).

J.

Pediat., Vol. 60, p. 740. (1962). SOME CLINICAL FEATURES OF JUVENILE RHEUMATOID ARTHRITIS. Med. 1. Aust., Vol. 1, p. 507. H. Walsh

71

QUARANTINE ANIMAL QUARANTINE AND VETERINARY HYGIENE Increased speed of travel, increased international trade and an increased diversity of products of animal origin intended for importation into Australia from overseas, have each brought with them an increased variety of problems for the animal Quarantine administration.

LEGISLATION During the year amendments have been made to the Quarantine (Animals) legislation by Preclamatiens 69A, 70A and 71A of 13th and 20th July, 1961, and 10th April, 1962, respectively. Proclamatien 69A conselidated and revekedProclamatien 65A and Proclamation 67 A and also intreduced an amendment making it obligatory for horses. asses and mules to' be censigned by a reute which dees net pass threugh the Suez Canal, a precautien censidered necessary because ef an epidemic of African Herse Sickness througheut the Middle East. Proclamatien 70A censelidated and revoked Preclamation 62A and Proclamation 68A and alsO' introduced amendments to permit mevement by air from New Zealand to' Australia ef meat and edible parts ef animals and birds, and samples of fertiliser and stock feed ef animal erigin. This Proclamatien alsO' prohibited the importatien from all ccuntries excepting only Canada, New Zealand and the United States of America ef milk, including dried er powdered milk, cendensed or concentrated milk, milk albumen, cream and ice cream, unless special permission is granted by the Directer of Quarantine fer therapeutic purpeses, but allowance was alsO' incerperated in this Proclamation fer a limited quantity of prepared infants feed containing milk to' be imported with infants arriving as passengers. Proclamatien 71A amended Proclamation 70A insofar as cattle hides are concerned and these may enly be imperted now frem animals slaughtered fer human consumption in certain countries, considered to' be of low-risk in respect of Foat and Mouth Disease and specified as Canada, Fiji, New Caledonia, New Hebrides, New Zealand, Nerfelk Island, the Republic ef Ireland, the Territory of Papua, the Territory of New Guinea, Tonga, the United Kingdom of Great Britain and Northern Ireland, the United States of A:merioa or Western Samoa. In addition to' these amendments to' the legislation, the Minister has permitted the movement O'f horses, poultry, dogs and cats frem New Zealand to' Australia by aircraft, provided suoh mevement is made on an aircraft which flies only routes within or between the two countries; prior to this rela~a:tion of Quarantine requirements, these animals cculd only be brcught to Australia by sea vessel. An Act, cited as the Foot and Mouth Disease Act 1961, assented to on 31st August, 1961, provides fcr compensation to' owners in the event of an outbreak of Foot and Mouth Disease in the Australian Capital Territory or the Northern Territory. The States have each passed similar legislation or have taken steps towards doing so. This legislation is supported by an agreement between the Commonweallth and all States fer the sharing, on a stock population basis, of the cost of eradication should Foot and Mouth Disease be introduced into Australia.

72 IMPORTATIONS SUBJECI' TO QUARANTINE Domesticated Animals: Importations during the year comprisedFrom-Horses. Dogs and Cats.

Great Britain

New Zealand Total

.. ..

.'

.,

.. .. ..

.,

..

57 395

384 228 612

..

..

452

Laboratory Animals: Recognised scientific institutions in Australia imported 84 small lahoratory animals under Quarantine permits during the Year. In addition the Commonwealth Serum Laboratories continued the importation of monkeys from Asia for use in the preparation of Salk Poliomyelitis vaccine, a total of 2,941 arriving by aircraft; on arrival these aircraft were carefully disinsectised, cleaned and disinfected and all litter and waste was incinerated, as in previous years. Zoological and Other Animals: A total of 182 animals were permitted to enter Australia for permanent Quarantine in registered zoological gardens and circuses. Consignments of queen bees and large numbers of aquarium fish were also imported, inspected for disease and when found ito be healthy, were given Quarantine clear·ance. Products of Animal Origin: In recent years, with ia continuation of the total prohibition of importation for many species of animals, including all ruminants (cattle, sheep, goats, &c.) and pigs; the restriction on the importation of birds, including poultry, to those of New Zealand origin; the restriction on the places from which horses, dogs and cats may be imported to Great Britain, Northern Ireland, the Republic of Ireland, New Zealand ·and in the case of dogs and cats the Ohannel Islands as well; the marked movement in the animal Quarantine work is to problems associated with products of animal origin which represent ·a r.isk of introducing exotic animal diseases, as well as to problems associated with live animal imports. Products of animal origin which are either prohibited from importation, or alternatively need animal quarantine clearance before importation is permitted, include such items asoanned meats, products containing milk or egg, animal hides, and biological products intended for laboratory use or for ther~py. Applications for permission to import such products are all carefully conSIdered from the viewpoint of any risk they present of introducing to the livestock industry animal diseases, including such serious conditions as Foot ~d Mouth Disease of cloven-footed animals, Newcastle Disease of Poultry and SWlDe Fever. A wide variety of such goods subject to Quarantine control were imported during the year including hides, skins, wool, sausage casings, canned meats and other foodstuffs of animal origin. Also there were small sample lines of several products admitted under conditions of strict Qual'antine control, for examination and ,analysis by manufacturers investigating the practicability of marketing similar Austl'lllian-made products. After examination in this way, the samples have then been incinerated.

73

Biological Products: The implementation of Hem 28A of the Third Schedule to the Customs (Prohibited Imports) Regulations was continued to give Quarantine control of imported therapeutic substances, such as sera, glandular extracts derived from animals and vaccines and a close liaison was maintained in this field with the associated sections of the Department, especially the Pharmaceutical Section and the National Biological Standards Labor,atory. All applications for permission to import were carefully considered to ensure that there would be no risk of introducing diseases of animals, including exotic virus diseases. Where there was a significant Quarantine risk the importation was prohibited through the provisions of Quamntine Proclamation 60, under which the permission of the Director of Quarantine is required before importation maybe made of vaccines, cultures, viruses, disease germs or substances likely to contain disease germs or V1iruses.

The volume and variety of products in this category presented for consideration has increased appreciably in recent years. EXPORTS SUBJECf TO QUARANTINE The health certific,ation requirements to be met with animals intended for export vary according to the dictates of the importing country for the type of animal concerned,. Correspondence has been continued with prospective importing countries to ascertain full details of their current requirements in this regard, and when necessary, modifications to such requirements have been recommended to the prospective importing country, based on the relative animal disease-free status of Australia. In particular, it has been the policy of this Department to explain clearly that, despite ,the presence of Contagious Bovine Pleuro-pneumonia in Australia, the disease is endemic only in some areas oonfined to the north of the continent and to give assurance that caUle can be collected in the south and central areas of the continent with complete freedom from contact with this disease. However, despite such assurance some countries prohibit the importation of cattle while Contagious Bovine Pleuro-pneumonia is present on this continent and this disease rema,ins the gre'atest impediment on the grounds of animal health to the development of ,a cattle export trade to some countries. Some countries have restricted importation of pigs as a result of the occurrence and continued presence of Swine Fever in New South Wales. It is hoped that the strenuous efforts being made in that State to eradicate this disease will soon be successful. The principal animal exports were-Horses Cattle Buffaloes Sheep Goats Pigs.. Dogs and Cats Poultry Miscellaneous (including fish and birds) 618 10,567 92 212,835 834 142 810 1,175,519 46,394

Most of the cattle whic'h were exported were consigned to Hong Kong and the Philippines for slaughter, but there were also exports for dairy and breeding purposes. Malaya was again the principal importer of sheep for slaughter.

74

All exports were accompanied by health certificates issued by officers of the Animal Quarantine Service, together with appropl"iate certificates of testing for disease as specified by the importing country. ANIMAL QUARANTINE STATIONS At ,the States' capital cities ports, Animal Quarantine stations have functioned for detention of imported animals and, when needed in any State, for cattle undergoing Quarantine prior to export to Great Britain. As a result of a survey, made early in 1962, on costs involved in all States for feeding animals held in Quarantine stations, it was found that current charges need not be varied at present. MISCELLANEOUS QUARANTINE MATTERS Increased attention has been given to the dissemination of clear advice on Animal Quarantine requirements. The legislation relating to Animal Quarantine has been consolidated to facilitate reference by all aoncerned in this field. In addition, a summary of the prohibitions and restrictions under the Quarantine legislation as at June, 1962, has been cornpletedand widely distributed to Departments and overseas ports, for guidance. Liaison has been maintained with both the Department of Customs and Excise and the Department of Immigration to ensure that pamphlets issued for persons coming to Australia dearly state the need to observe the requirements of Animal Quarantine; also to have such information translated into the appropriate languages. A circular published by this Department for issue with passports has been revised and now includes advice on Animal Quarantine. Suitable advice on Animal Quarantine requirements was included in pamphlets prepared for the guidance of overseas visitors -attending the Empire Games in Western Austmlia. Customs offkers and Quarantine officers maintained close rliaison at the ports 2IIlld a·ir-ports. Whenever risk items were detected they were seized and subsequently incinerated. Customs officers also continued their assistance in the control of pet animals on 1,043 overseas ships which visited Australian ports during the year. CONFERENCES In September, 1961, the Biennial Conference of Commonwealth and States Veterinarians, under the aegis of the Australian Agricultural Council, was held in Canberra with the Director of Veterinary Hygiene as Chairman. Conference considered Ilegislative precautions designed to prevent the introduction of exotic diseases, and reviewed disease control measures in Australia. The Biennial Conference was preceded by -a meeting of the Chief Quarantine Officers (Animals) at which problems associated with Animal Quarantine legislation and administr,ation were considered. COMMITTEES CONVENED FOR SPECIFIC PURPOSFS In October, 1961, and February, 1962, the Director of Veterinary Hygiene attended, as representative of :this Department, meetings of the Standing Committee en Agriculture and as a departmental adviser at the meeting of the Australian AgIicultural CounQil held in February, 1962.

.-

/1

7S Arising out of the discussions at the Biennial Conference and subsequent meetings of the Standing Committee on Agricultur'e, a sub-committee was formed to consider the threat of possible screw-worm introduction to Australia from the North, and a further sub-committee was set up to consider pI10blems which can al"ise from residues which may occur in meat from the use of modem pesticides. The Director of Veterinary Hygiene is a member of each of these sub-committees. In November, 1961, a Consultative Committe;e on Swine Fever was convened in Melbourne by the Director of Veterinary Hygiene. It was attended by delegates from the State Departments of Agriculture in South Australia, Victoria, Tasmania, New South Wales and Queensland, the Commonwealth Department of Health, the Commonwealth Serum L'aboratories and the Commonwealth Scientific and Industrial Research Organization. This meeting considered experience in Victoria where pigs, believed to be resistant to Swine Feve;r virus, had been detected on two properties, the progress in the eradication campaign being pursued by New South Wales, and techical details related to diagnosis, control and eradication. As Chairman of the Cattle Tick Control Commission, the Director of Veterinary Hygiene conducted meetings in Lismore in July, 1961, Sydney in December. 1961, February and March, 1962, and in Brisbane in July, 1962.

HUMAN QUARANTINE -l

~

The Quiarantine service authorized under the Quarantine Act 1908-1961 was maintained during the year ending 30th June, 1962. With the increase in air traffic and the constant threat of the introduction of smallpox into Australia, the Quarantine Act was amended in 1961 to give Quarantine Officers full powers to inspect any vessel entering Australia and to conduct medical inspections and examiootions of any or all persons travelling on the vessel at a place on or in the vicinity of the vessel. Although no quarantinable disease was encountered during the year, a suspected case of cholera on the R.M.S. Strathmore (England to Australia via Suez and Manila) was notified prior to the arrival of the vessel at Brisbane in February, 1962. Eighty-two passengers were released under surveillance and allowed to disembark at Brisbane. As it was considered that the patient was too ill to be removed from the vessel at Brisbane, the Strathmore proceeded in qua[antine to Sydney with the patient on board in strict isolation. A Quarantine Officer travelled on the vessel from Brisbane to Sydney. On arrival at Sydney, the patient 'and contact were transferred to the North Head Quarantine Station. Disembarking passengers (186 in all) were released under surveillance and allowed to proceed. Every facility was provided at the Quarantine Station and specialists in the field of Tropical Medicine were called in to attend the patient. Despite active treatment, the patient died. A post-mortem examination revealed that death was due to portal ·thrombosis with massive liver infiarct. There was no evidence of cholera. Watch on Smallpox:-The quarantine service maintained the closest possible watch on all ships and aircraft reaching Australia during the outbreak of smallpox in Great Britain and West Germany. Strict observance was insisted upon the

76

requirement that everyone coming to Australia by air from overseas must be vaccinated, as well as all assisted migrants and other passengers on ships. No case of smallpox was detected by the Quarantine service during the outbreak. The Department was kept in close touch with the position in Britain and Pakistan, where the outbreak originated, by the Chief Commonwealth Medical Officer at Australia House, London, and the Australian High Commissioner at Karachi. During March and April six Commonwealth medical officers were sent to India to gain first-hand knowledge of the diagnosis and treatment of smallpox. They visited Calcutta and then spent nearly a fortnight studying the disease at the Infectious Diseases Hospital at Madras. It is essential that doctors associated with the Australian Quarantine service ·should be competent in the immediate diagnosis of smallpox. Since 1949, the Department has made a practice of sending small groups of doctors overseas periodically so that they can study cases in areas where the disease exists. In every instance they have received excellent practical training in diagnosis from courses of study arranged by the local authorities. Assistant Director-General of Health, Dr. G. M. Redshaw, represented Australia at a seminar on smallpox organized by the Regional Office of the World Health Organization in India and Ceylon, in February, 1962. TABLE I

Vessels Boarded and Oeared-1961·62 Surface. Port. Vessels. Crew. Air.

Passengen.

Vessels.

Crew.

Passengen.

.. Sydney .. Newcastle Port Kembla .. Botany Bay .. Coifs Harbour

.. '. .. .. ..

737 226 121 143 1 1,228 338 222 3 563 264 1 75 29 12 6 4 63 31 3 488

15,099 25,089 20,046 17,120 26 77,380 24,269 10,030 154 34,453 16,577 14 3,310 1,282 450 211 204 2,871 1,087 99

38,400 92 26 52

..

.. .. .. ..

779

.. .. .. 779 8,312 11

..

8,312

32,407

.. .. .. ..

Total (N.S.W.) .. Melbourne Geelong Portland

38,570 20,666 95

32,<W7

.. .. ..

..

.. ..

..

.. ..

2

..

.. 11 102

.. ..

12

Total (Victoria) ..

20,761 2,296 71 7 1

2 12

12 569

.. Brisbane Bundaberg .. .. Cairns .. Gladstone Mackay Mourilyan Harbour Rockhampton Townsville Thursday Island Urangan .. .. Amberley Total (Q'ld.)

.. ..

..

.. .. ., ..

.. .. ..

..

..

.. ..

.,

..

..

.. ..

1 256 1,120

.. .. .. .. .. .. .. ..

24 42

.. .. .. .. 127 .. .. 280 509

.. ..

.. .. .. .. ..

.. .'

..

46

319 934

26,H)5

3,752

78

77 TABLE I-continued

Vessels Boarded and Cleared-1961-62--continued. Surface. Port. Vessels. Port Adelaide Port Augusta Port Lincoln .. Port Pirie .. Cape Thevenard Whyalla .. Wallaroo .. Total (S.A.) Fremantle .. Kwinana .. Albany .. Bunbury .. Carnarvon .. Derby .. Esperence .. Geraldton .. Point Samson Port Hedland Wyndham .. Yampi Sound .. Perth Total (W.A.) Hobart Bell Bay Burnie Devonport Port Huon Crew. 11,106 202 1,270 1,611 187 50 1,512 15,938 67,820 9,380 2,631 2,114 152 897 689 2,935 683 8,828 286 617 Air.

Passengers. 3,819 7 14 1 8 3,849 116,889

Vessels.

Crew.

Passengers.

..

.. ..

.. .. ..

..

194 5 29 33 6 1 36 304 636 182 57 49 4 11 14 75 13 22 7 15

..

..

.. .. .. ..

.. .. .. .. .. .. .. .. ·.

·. ·. .. .. ..

.. .. .. ·. ·. ·. ·. ·. .. .. .. .. .. .. .. .. .. .. ..

.. .. .. .. .. .. .. ..

..

.. ..

.. .. .. ..

..

37 60 611 32 84 154 3 39

.. .. .. ..

..

..

.. ..

.. .. .. .. .. .. 209 209

.. .. .. .. .. .. .. .. .. .. .. .. 7,698 7,698

2,175 2,175

..

1,085 29 14 4 2 1 50

89,032 2,364 776 149 37 65 3,391 1.443 247,742

117,909 1,009 7

.. .. .. ..

..

Total (Tas.) Darwin

..

.. .. .. .. .. .. ..

.. .. ..

.. .. .. .. .. 1,349 2,417

..

.. .. .. ..

..

1,016 35 185,892

.. 10,833 21,840

.. .. .. .. .. .. 50,D30

44 3,762

Total All States ..

91,081

TABLE II

Jnfedlous Diseases on Overseas Vessels arriving in Australia 1st July, 1961, to 30th June, 1962 Disease Bacterial Meningitis Chicken P01 Diphtheria Gastro Enteritis Infectious Hepatitis Measles Mumps Rubella Typhoid Whooping Couzh No.ofeasea 1

102 13 3 6

48

24 37 1 1 236

78 TABLE III

Inspections and Examinations at Australian Ports Required under the Navigation Act 1st July, 1961 to 30th June, 1962 Number of Vessels Inspected. Port. Inspections. Primary

----Sydney Newcastle Melbourne Brisbane .. Cairns Townsville Port Adelaide Port Pirie .. Port Augusta Whyalla .. Fremantle Hobart Launceston Devonport Darwin

Annual Re-inspection.

Special Inspection.

Number of Seamen Examined.

48

1 10 24'

374 208 213 116

12 I

5

4

12

98 I

1 J 6

/>-.

203 20 7

2 1 8 70 36 1,259

·t·

• Only Medical and Hospital cabinets inspected.

PLANT QUARANTINE Activities aimed at preventing the importation of plant pests and disease from overseas were maintained during the year. This included close quarantine supervision of plants and seeds restricted to importation as small quantities to keep out specified dis·eases and pests. Other imported plant and seed material, whilst not so restricted in quantity, was subject to quarantine check inspection on arrival. Plant quarantine activity extends to inspection of any material of plant origin, arriving either by sea or air, and this brings it in contact with innumerable trade transactions. At the ports of entry in the States, officers of the respective State Department of Agriculture have continued to supervise plant quarantine activities on behalf of the Commonwealth. Amicable and co-operative relationships have continued between these Departments and the Commonwealth Department of Health. In the Northern Territory this Department has maintained an efficient vigil. LEGISLATION Four Proclamations made during the year related to plant quarantine activity within Australia. Proclamation SOP was a revision of 18P, whereby the movement of prescribed agricultural products within Australia was restricted. The control of the movement of citrus from north-western Australia was revoked in view of the fact that the appropriate authorities were satisfied that citrus canker had been eradicated from the Northern Territory as a result of action initiated in 1918. This Proclamation (SOP) introduced quarantine control on the movement of rice from north-western Australia, which is defined as the Northe'rn Territory plus that part of Western Australia north of latitude 26° S, to any other part of Australia, to protect the rice industry in southern Australia from specified disease and pests occurring in north-western Australia.

'f

..

79 The discovery of the Sirex Wood Wasp in Victoria in December, 1961, necessitated the issuing of ProclamatiO'ns 51P and 53P, defining the areas in eastern Victoria subject to Quarantine measures for the eradication of Sirex. With the finding of Sirex near Launceston, Proclamation 52P revoked Proclamation 49P and made coniferous plants in the whole of Tasmania subject to quarantine control. IMPORTATIONS There was a shortage of potatoes in the eastern States of Australia during the winter of 1961, when New Zealand had a surplus. Initially permission was granted for Australian processors, with facilities approved by Quarantine, to import potatoes from New Zealand for manufacturing purposes. Later in the season arrangements were made for bulk quantities, appropriately treated to prevent sprouting, to' be imported through the port of Sydney for genera] distribution. In all, about 5,000 tons were imported. Onions for culinary purposes were also imported in quantity (about 3,500 tons) from New Zealand. Careful quarantine scrutiny was maintained. Several approaches were made during the year to import bulk quantities of seed of certain agricultural crops. This was motivated by the desire of interested parties to get a new crop or new variety established quickly. Plant Quarantine has consistently taken the view that primary industries such as cotton, linseed, maize, safflower, each of which were presented for special consideration during the year, can best be served ultimately by small importations from overseas which can be grown under strict quarantine supervision for the first season to ensure that no new disease is introduced to Australia. This policy is strongly supported by State Departments of Agriculture. POLICY The policy of regulating the importation of plants including bulbs, rose budding eyes, orchids, shrubs and trees continued. The total importations for the year were 151,966, compared with 390,288 in the previous year. The co-operation of virologists in the State Departments of Agriculture and at the Waite Agricultural Research Institute in screening imported commercial fruit varieties for virus whilst in post entry quarantine has continued. This specialized service merits acknowledgment. Timber importations continued to assume a major role in plant quarantine activity at several ports. Large shipments came from Malaya, Borneo, and other sources in the region to the north of Australia. Certain consignments were found heavily infested with Ambrosia beetle and other timber pests. Fumigation with methyl bromide was ordered where necessary. Less than 1 per cent. of the timber imported from the South-East Asia region was ordered for treatment, but this small percentage taxed fumigation facilities in some instances. CONFERENCES In December, 1961, it was discovered that the Sirex Wood Was.p had become established in Victoria. It was first found in Tasmania in 1952. At a meeting of Ministers and representatives of all States with the Commonwealth Minister for Health, held in Canberra in February, 1962, a National Sirex Fund Committee was formed and a National Sirex Fund created, whereby the Commonwealth shared equally with the States as a group in providing £200,000. Private forest interests subsequently volunteered to contribute. The National Sirex Fund

80

is being administered by the Commonwealth Department of Health. The National Sirex Fund Committee is directing its activities in two spheres-one is survey and eradication and the other is research. There is a sub-committee for each of these two fields of activity. Representatives on these committees are drawn from Commonwealth and State Forestry Services, C.S.I.R.O., Waite AgricUltural Research Institute and the Plant Quarantine Division of the Commonwealth Department of Health. Early in June the Director of Plant Quarantine represented the Commonwealth at the Fourth Plant Protection Conference, held in Manila. Whilst in the region he visited Malaya for discussions with the Malayan timber authorities on the quarantine requirements and procedure for timber imported into Australia. Representatives from the Division attended certain conferences organized by the C.S.I.R.O. Liaison Section, which were of particular interest to Plant Quarantine. These included the Third Plant Diseases Conference, the Biennial Commonwealth and State Entomologists' Conference and the conference of seed testing officers. PUBLICITY During the year a publication relating to the properties and uses of methyl bromide for plant quarantine purposes was released for general distribution. It was prepared primarily to assist Plant Quarantine Inspectors throughout the Commonwealth. Part II of " Plant Diseases In and Outside Australia ", covering Fruit and Edible Nut Crops, was released for restricted distribution. Plant Quarantine pUblicity was given added impetus with ,the introduction of new ideas. The displays at capital city shows were re-vitalizedand the 19'62 Sydney Royal Show witnessed the introduction of two cartoon characters, " Freda Fruit Fly" and" Sadie Sirex", with their message conveyed to the public by means of a special device known as "Videophone". Several new posters aimed at exhorting the public to help keep unwanted pests and diseases out of Australia were designed and released for general display throughout Australia. All the other many diversified channels and media, developed through the Plant Quarantine Publicity Campaign, were maintained throughout the year.

-,.

+

,

81

TERRITORY HEALTH AUSTRALIAN CAPITAL TERRITORY The administration of health services in Canberra and the Australian Capital Territory is a direct responsibility of the Minister for Health through the Department of Health. The Department is called upon to perform certain duties which in the States would be carried out by local government instrumentalities. The functions of the Department include: health inspections, the operation of the Canberra Abattoir, a health laboratory, the District Nursing Service, the School Medical Service, the School Dental Service, veterinary services and an immunization service. HEALTH LABORATORY The Health Laboratory provided full clinical and consultant laboratory services to Canberra and adjacent hospitals, and to private medical practitioners in the area. The Laboratory also exercised technical control of the Red Cross Blood Transfusion Service, and carried out an extensive range of investigations in the public health and medico-legal fields. The following table compares activities during 1961-62 with those of the previous year. 1961-62. 1960-ti1.

Total examinations performed Total patients attended

189,883 56,127

149,879 45,897

.:~

TUBERCULOSIS CONTROL The Chest Clinic transferred to the "old Motor Registration Offices" at Acton, adjacent to the Canberra Community Hospital. A compUlsory mass chest X-ray survey was carried out in March and April; 32,477 persons over the age of eighteen years were examined with the disclosure of 25 significant cases of pulmonary tuberculosis, of whom 22 were admitted to hospital. There were seven cases of lung tumour including five cases of cancer of the lung, one neurofibroma and one hydatid cyst. A further 81 persons required chest clinic supervision for "arrested" or "inactive" tuberculosis. Over 300 reports were sent to private medical practitioners at the request of persons concerned relative to such other abnormalities as Bronchitis, Emphysema, Pulmonary Fibrosis, Pneumonitis and abnormalities of the heart, a number of which were already known to be present. DISTRICf NURSING SERVICE The District Nursing Service, functioning in co-operation with local medical practitioners, continued to .play an important par:t. in .helping to deal with ~e problems of medical care 10 Canberra. Home VISIts 10creased from 12,026 10 1960-61 to 15,428 in 1961-62.

.....

82 HEALTH INSPECTION A staff of four inspectors was engaged upon public health inspections. The following table shows ,the licences granted under the Public Health Ordinance compared with those of the previous year:1961-62. 1960-61.

-----------1-----------Prepared meat goods vendors Ice cream vendors Barbers' shops Milk distributors Milk shops Eating houses Meat vendors Boarding houses

143 10

147 12

42 47 110 50 38

44 50

104 50

31

34 29

Samples submitted for analysis were: Water chemical, 235; water bacterial, 790; milk chemical, 205; milk bacterial, 376; sewage effluents, 13; meat samples, 9; and miscellaneous foods, 15. Quarantine inspection of parcels arriving under bond at the Canberra Post Office was carried out by the inspection staff. Cases of infectious and notifiable diseases notified were: Infantile Diarrhoea, 12; Infective Hepatitis, 240; Malaria, 1; Meningococcal Infection, 1; Ophthalmia, 11; Poliomyelitis, 2; Rubella, 24; Salmonella Infection, 3; Scarlet Fever, 10; and Tuberculosis, 39. Legal action was taken in 27 cases for offences against the public health regulations.

CIULD HEALTH AND WELFARE During the year the School Medical Service was expanded by the appointment in January, 1962 of a second medical officer and a second nurse. The new team worked for five months of this year on routine examinations in primary (and a few secondary) schools on the South Side of Canberra. The Senior School Medical Officer continued as before to supervise Infant Welfare work and carry out Triple Antigen Immunization. She was assisted by a full-time school nUrse .and a part-time nurse working in the immunization clinics. Infant WeHare: Thirteen Mothercraft Centres and nine sub-centres are now functioning in Canberra. These are staffed by eight full-time and one part-time Triple Certificated Sisters employed by the Mothercraft Society. During the year 3,587 individual children under two years attended the Baby Health Centres. Visits to babies in their homes totalled 4,645.

Pre-Scbool Children: Pre-school children requiring special investigation were .examined. School Children: The total number of children examined was 6,213. Interviews with parents numbered 209. Notification of defects was made in re1spect of the following conditions:Vision, 362; Hearing, 143; Nose and throat, 120; Other conditions, 84.

83 Children with hearing loss either of minor degree or not requiring medical treatment numbered 109. An audiologist from the Commonwealth Acoustic Laboratories was available for consultation at Ainslie School at monthly intervals throughout the year. A class for the spedal education of young deaf children was established at Ainslie School. Immunization: Immunization sessions were held regularly at Baby Health Centres as in previous years, and have recently been extended to new suburbs. Those commencing courses of Triple Antigen numbered 2,255 and the majority of these were passed on to the Polio Clinic to begin courses there. Booster doses were given to 2,182 children in the age group eighteen months to twelve years. In all 8,235 injections were given at these sessions. School and Pre-School Dental Service: The number of children examined and treated totalled 8,787. New clinics were opened at the Campbell and Downer Primary Schools. Free Milk: Some 10,900 children attending 28 schools in the Territory each received one-third of a pint of milk a day. This milk was provided under the States Grants (Milk for School Children) Act, 1950.

Outdoor Recreation: The National Fitness Advisory Committee allotted the sum of £1,198 towards the cost of sports equipment, leader training and certain capital eXcpenditure on buildings. A regular grant of £250 was allocated to the Department of the Interior towards the cost of conducting vacation play centres during January, 1962. A further sum of £750 was shared equally between the Y.W.C.A. and the Y.M.C.A. as a contribution towards the cost of supervisors of physical activities. VETERINARY SERVICES The activities of the veterinary service of the Commonwealth Department of Health within the Australian Capital Territory include the prevention and control of disease in stock; proffering advice to district stock-owners with field diagnosis on a herd or flock basis, supported by laboratory confirmation; the supervision of the hygiene of dairies and piggeries and the control of the Canberra Abattoir. an establishment where a full-time meat inspection service of high standard is provided. Field and Laboratory Veterinary Service: Although the 2,832 points of rain recorded for the year exceeded the average yearly rainfall, estimated over a period of seventeen years, by 395 points, over half of the recorded rainfall was confined to November, December and January. The remaining months generally showed falls considerably below the monthly averages. This heavy summer rain resulted in a marked build up of haemonchus infestations in sheep, necessitating frequent drenching. With the approach of cooler, drier weather the infestation abated and fluke infestation became intensified, due to stock grazing close to watercourses and springs in search of green feed. Associated with the increased tendency towards fluke infestation there was an increased incidence of black disease. Failure of some graziers to vaccinate as a precautionary measure prior to expected outbreaks contributed to an increased incidence of this disease. With the approach of mid-winter, hand feeding of pregnant ewes was undertaken on many properties to supplement the dry feed available and as a precautionary measure against an expected high incidence of pregnancy toxaemia.

/

84 Advice was given to stock-owners on disease problems and autopsies .and specimen examinations were carried out, either in the field or in the laboratory at the Australian Institute of Anatomy. Radio broadcasts on subjects of topical interest to landholders in the Australian Capital Territory, including the photosensitization in sheep and sheath rot of wethers were given over Station 2CY and advice on correct poultry feeding was given through the columns of The Canberra Times. Because of the presence of swine fever in New South Wales, determined efforts were made to investigate every swine mortality notified and histopathological examinations of brain tissue of suspicious cases were made. Additional information was obtained by forwarding appropdate specimens to the Veterinary Research Station, Glenfield. Several cases of footrot and footscald in sheep were seen during the year. As on occasions both conditions are very similar .and difficult to differentiate,

and as it has been noted that footscald often precedes or follows an outbreak of footrot, similar control measures were adopted for both conditions, with regard to quarantine and treatment. Stock Diseases: Diseases and conditions investigated during the year included mortalities or economic loss caused by the following:Diseases declared under the Australian Capital Territory Stock Diseases Ordinance 1933-f958Cattle: Actinomycosis, eye cancer, black disease, brucellosis, mastitis and blackleg. Sheep: Contagious footrot and footscald, black disease, ovine brucellosis, and psorergates ovis, also lice and ked infestations. Poultry: Infectious laryngO-<tf!acheitis. Pigs: Infectious pneumonia, enteritis. Diseases and conditions not declared under the Australian Capital Territory Stock Diseases Ordinance 1933-1958Cattle: Footrot, bloat, liver fluke infestation, infertility, pink eye and calf diphtheria. She~p: Photosensitization, internal pa~asites including haemonchus, tnchostrongyles, lung worm and liver fluke (both acute and chronic), foot abscess, phalaris poisoning, carbon tetrachloride and organic phosphorus poisoning and pregnancy toxaemia. Poultry: Avian monocytosis, leucosis, internal parasites, vitamin A deficiency and chronic respiratory disease. Pigs: Malnutrition, middle ear infection, internal and external parasite infestations and intussusception of the small intestine. Stock Movements: Vigilance was exercised over stock movements into and out of the Australian Capital Territory to safeguard against the spread of diseases. Health certificates were regularly issued for the movement of animals from the Australian Capital Territory both overseas and to other parts of Australia following examination of the animals or birds to ensure that the requirements of the receiving countries or States were met.

t

85

Routine Veterinary Services: Regular dairy inspections Do maintain the standard of hygiene required by the Public Health (Dairy) Regulations were undertaken during the year. High standards of hygiene have no doubt contributed -considerably to the low incidence of bovine mastitis in the dairy herds within the Australian Capital Territory. Throughout the year 2,795 dairy stock were subjected to an intradermal tuberculin test. This included introdu-ctions of 18 cows and 24 calves. All cattle tested gave negative reactions. A total of 453 heifer calves were vaccinated with strain 19. With 178 of these calves the Commonwealth Serum Laboratories formulation was used in which 1 C.c. is injected subcutaneously as against the 5 c.c. dose. Periodic inspection of all piggeries both in the Australian Capital Territory and immediately adjacent to its borders within the Pastures Protection District of Braidwood was undertaken during the year as a safeguard against the introduction of Swine Fever into the Territory. Stock sales were attended and examinations made for the presence of notifiable diseases, particularly lice and ked infestations and footrot in sheep. A number of cases of eye cancer and actinomycosis was detected in cattle. These cattle were forwarded on an order for movement only to abattoirs for slaughter. Canberra Abattoir: Canberra Abattoir is managed by the Commonwe'alth Department of Health through the Division of Veterinary Hygiene with a veterinary officer as Superintendent. The Abattoir is operated on a solo system, under which the Department of Health supplies the facilities for the slaughter, dressing and chilling of animals for human consumption under hygienic conditions. Licences are granted to various operators to use these facilities by employing their own slaughtering staff. During the year 16 licences to slaughter at Canberra Abattoir were granted. The Commonwealth staff consists of two meat inspectors, an engine driver, a 'boiler attendant, a by-products foreman, a chiller attendant, a caretaker and six -slaughter house labourers. This staff, except the two meat inspectors, is .employed for the processing of by-prodUcts, which include meat meal, blood and bone, tallow, horns, hair, sinews and glue pieces. Six of the licensed operators ,employ between them a permanent staff of twenty slaughtermen and labourers as well as five meat van drivers. The remaining licensed operators either slaughter and dress animals themselves or have one of the six operators employing staff to do so under contract. Veterinary activity during the year, besides management and meat inspection 1Iupervision, included the use of abattoir facilities:(1) To provide biological material for the National Biological Standards Laboratory, the Entomology Branch of the C.s'I.R.O. and the Australian National University, for the Departments of Microbiology, Zoology, Nlysiology and the John Ou:rtin School of Medical Research. (2) For the C.SJ.R.O., Division of Plant Industry to complete an investigation into fat lamb raising in the Australian Capital Territory.

86 The year was one of increased activity at the abattoir. The number of licensed operators increased from 12 to 16 and the number of animals slaughtered: rose considerably on the previous year. The figures wereSheep and lambs Cattle Pigs 80,962, an increase of 12 per cent. on 1960-61 7,158, an increase of 33 per cent. on 1960-61 7,337, an increase of 35 per cent. on 1960-61

During the previous two years various projects were undertaken to expand the abattoir's capacity. The first half of 19'61-62 was a period of consolidation, followed during the second half of the year by a rapid increase in the number of beasts slaughtered, as evidenced by the following figures:-

I July-December, 1961 January-June, 1962 ..

Sheep and Lamb •.

Cattle.

Pigs.

Jo...

38,180 42,782

3,114 4,044

3,735 3,602

There is every indication that this trend will continue.

NORTHERN TERRITORY The task of providing a comprehensive health service for a small population widely scattered throughout a vast aTea continues to pose special problems for Ilhe Northern Territory Medical Service. In addition to these problems, the Service has to deal with an Aboriginal population to many of whom modem oonceplts of hygiene and sanitation are unfamiliar. In the main centres, hospitals are maintained fully staffed by nursing sisters. Tbe four major hospitals have full~time medioal staff. The hospital llit Batchelor is visited once a week by a visit~ng medical 'Offioer. A Leprosarium is: maintained and there is a medioa,) offi·cer who devotes his entire time to this· establishment and the problems of leprosy in the Northern Territory. The 'Outback is served by a Radio Medical Se,rvice operating from Darwin through Overseas Telecommunications Radio, and in Alice Springs over the Royal Flying Doctor Service network. Medical Officers of the Department are available at all times, day 'and night, to handle radio medical calls. In cases where p·atioots in the bush need hospital treatment, they are brought to departmental hospitals by air. Three De Havilland .. Dove" aircr-an are devoted entirely to the needs of thiose in remote areas. These aircraft Illre owned by the Department of Health and are staffed ·and serviced by TransAustralia Airlines. In addition to emergency service, medica.l officers and specialists, nursing sisters, dental offi·cers and health inspectors make regular visits to all areas. The 'appointment of health inspectors s.pecifically for the work in the field has been a signi,ficant step in a campaign to raise ,the standard of hygiene 8Illd sanitation throughout the less-developed areas of ,the Ter.ritorv.

·t

87

An intensive campai,gtl of immunization against common diseases is maintained, ,largely through the effurts of survey sisters, who also pay particular attention t.o the problems of infant health. A Schools Medical Service, based on Darwin, serves the entire Territory, and 'arrangements are under way to extend the specialized Imowledge of the medical officer in audiometric testing to children at missions, settlements and pastoral properties throughout the Territory.

f .

Situated, as the Territory is, in close proximity ,to highly endemic areas of malaria, particular attention must be paid to preventing the introduction of infiected mosqui,toes or human carriers. These precautions are also handled by quarantine staff. As there is still some endemic malaria in the Territory, an ,eradication programme was commenced, and it is hoped to achieve complete .coverage of the affected areas within the next two years. Infant Health sisters operate lI!1so in the main centres and district visiting is .1Carried out in Alice Springs 'and Darwin.

AERIAL MEDICAL SERVICE Activities continued to expand during the ye·ar. A major advance was t,be "Seeming of the third De Havilland "Dove" airoraft (VH-DHK) which replaced a Drover formerly stalt:ioned at Alice Springs. As a result it has been found possible to increase the frequency of visits to major settlements in Central Australia. Statistics a.re given below:-

Number of Emergency Flights Number of Routine Flights .. .. Miles Flown .. .. Hours Flown .. Patients Carried .. ..

Darwin.

Alice Springs.

Total.

.. .. ..

..

..

188 112 165,488 1,273 632

Nil 82 45,180 379 43

188 194 210,668 1,652 675

QUAIlANTINE .~_

TIm year was the busiest on record for the Quaoontine Service. LM'ge numbers of passengers and crew required clea!l'aillces through the port of Darwin. Many travellers continued to anrive without v,alid certificates of vaccination, and during the year 770 vaccinations for smallpox and 80 for cholera were plIlfonned at Darwin Airport. During the year it was round necessary to detain fOUT people in tbe Quarantine Station owing to doubt as to ;their vaccination status. None of the.!e de.veloped any disease during their period of detention.

88 In 1961-62 there was the usual activity in the fumigation of timber and other items of plant origin arriving by ship from overseas. The number of ships and aircraft cleared for the yeaxs ended 30th June, 1961, 'ood 30th June, 1962, are shown in the following table:-

Aircraft ..

Year.

Cleared.

Passengers.

Crew.

----..

..

.. ..

Ships

..

..

..

1961-62 1960-61 1961-62 1960-61

1,347 1,263 55 50

50,138 47,764 42 62

11,592 10,699 1,383 1,419

FREE MILK FOR SCHOOL ClULDREN The P["ee Milk Scheme is now operating very s,atisfactorily, and fresh milk is available to practically every school in the Territory. MILK SUPPLIES The facilities of ~e f'resh milk factory in the Darwin area continue toimprove. The installation of a flash pateurizer has improved the quality of the milk considerably. The reconstituted milk factory in Darwin has been very satisfactory. The goat dairy at K!atherine is still operating on a very small scale. The frozen fresh milk supply in Alice Springs is operating satisfactorily. It is kept under constant supervision by the Hea1t.hInspector. No bulk miNt deliv~ is allowed, all deliveries being in tetra-pak containers. This milk ia now being delivered to the TellLOOIlJt Crook area also.

j

SCHOOL MEDICAL SERVICE Dw-ing tile year 32 schools and pre-schools in tlbe Territory were visited. l1he total number of children examined was 2.500. The general standaJrd of healith is good. The ma:in defect found was in relation to eyesight. The appointment of an ophthalmologist has greatly assisted in dealing with these cases. HEALTH LABORATORIES Darwin: With the groMh of ,the Northern Territory popUlation and the Medical Services, the work of the Laboratory has inoreased. Investigation of bowel infeotions are an important part of tbis wort. the year various Shigella were isolated on 78 occasions from 48 patients. Of these patients 25 were aborigines. . This retleob a fall in isolation from among the aborigines compared witIh the previous yew, but·1)() significant change m those among the wh.UepopuJatioo... ... ..

Durina-

89

Salmonella typhi was isolated from three patients during the year. Two phage types, Dl and E1 of this organism were found, indicating ,that all cases did not occUtr from a common source. The only other Salmonella isolated during the year was Salmonella typhi-murium. A technique of Vi~antibody testing for typhoid diagnosis using red cells sensitized by Vi-eX!tract is be1ng used since the Vi-extraot was madeavaalable by Oommonwealth Serum Laboratories. A second case of Melioicdosis was found during the year. It is hoped tQ report .tills and the M Ulc,erail1s cases found last year in the medical litemture.

Investigations into the common causes of Aboriginal death continued. Such details as are known have been recorded on about 800 consecutive deaths since July, 1959. The pattern is becoming c1eare,r than was formerly possible. As an example, 24 of the 800 ,aborigines died of cancer. The high incidences oompared to the white popUlation ofcal'cinoma of the naso-phairynx and primary liver oell carcinoma. previously commented on are 'still obvious in these figures. Total number of patients for the year was Total number of tests for the year was 28,970 56,223

, • +

Alice Spring'i: The work in the labor,a.tmy has lapproximately doubled ,dUtringthe year. The number of patients has almost doubled, and the pathology work sent ,to Animal Industry Branch has trebled. The number of laboratory tests made during the year totalled 10,549.

HEALTII INSPECTIONS Generally food premises are well maintained, under regular inspection. With 1Jhe advent of road house licences, a general improvement in t!he 'standail'd of aocommodation and 'eating facilities is apparent.

WORK OF SURVEY SISTERS With the exception of inaccessible areas in Arnhem Land, there illre now no places where natives are living which are not being covered by survey work. During the year, 61 stations and other places, such as police stations, were vi'sited by the survey siste,rs, ,travelling s,ingly or together by Landrover. This entailed more than 10,000 miles iQf travelling over some of the NortJhern l1err1tory's most rugged land isolated roads. NATIVE HEALTH

DU1'"ing the year progress continued to be made in establishing contact with natives in remoteare,as. Visits were paid also to smaller stations ,and settlements which are not served by air and must be visited by road, often in four-wheel drive vehicles. Good progress was made in the leprosy control campaign, and the aboriginal's .confidence in the Department continued to grow.

90

The campaign :against Tubeil1cu1osis has also been stepped up. A ~ge' number of cases were brought to the main c'enues from remote areas for chest investigation. Many of these were follow-up ,examinations, and it is felt that the campaign against Tuberculosis is finding acceptance amongst the native population.

INFANT HEALTH CLINICS The number of babies enrolled .at Darwin Clinic during the year was 533 and at Alice Springs 212. The number of attendances at the Darwin Clinic was 11,651 whilst at the Alice Springs clinic the attendances numbered 2,630. New centres were opened during the year at Bagot Subdivision and Bagot Rescrve. The general health of children under five years of age in ,the Darwin aaea is; improving. ~

DENTAL SERVICE Extensions have been made to the Darwin Clinic, which should result in' that Clinicc being f.ar more functional than it has be'en in t1he past. In addition, a commenc,ement has been made on renewing the equipment at both Darwin and Alice Springs with the latest type of dental equipment. A thi:rd surgery is to be equ~pped 'at Alice SPlfingS Clinic. Dming the year the Overland Mobile Dental Unit was equipped with, Mobile Airotor equipment, a considerable improvement ovelf the previous equipment usoo. Also, plans have been made to have properly equipped and air-conditioned Mobile Units ,constructed f.or this work. This wilJ enable this Service to bring the advantages of modem dental treatment to people living in centres aw,ay from the two main centlfes of this Territory. The total number of ex:aminations <:arried out by the staff of the Darwin Dental Clinic, Alice Springs Dental Clinic, the Aerial and Overland Mobile' Units and the School Clinics for the years 1960-61 and 1961-62 is shown below:-

-

Darwin Clinic. 1961-62. 1960-61.

Overland Mobile. 1961-62. 1960-61.

Aerial Mobile, 1961-62. 1960-61.

Alice Springs. 1961-62. 1960-61.

Examinations

..

5,933

4,288

944

1,615

5,894

3,649

3,557

1,467

HOSPITALS Darwin: The work of 'the hospital continued to inoreas'e during the year.A complete review of the hospital organization and requirements has improved its efficiency and facilitated detailed planning of the future hospital'_ expansion.

91 The IIIlt111ber of medical offioers employed a,t the hospital did not increase .during the year, but all normal in-patient and out-patient services were 'maintained. The appointment of Dr. W. H. C. Hughes as Ophthalmic Surgeon enabled the hO'Spital eye clinic to be re-opened. Alice Springs: 'J1he Il'UlTIOOr of deliveries £ahled to' ;reaoh the record figure ,of 1960-61. Nevertheless, the ratiO' Df deliveries to' population represents 41 per 1,000, which is twic,e the average fO'r AustraliJll. (These figures do not :include aboriginal deliveries.) EffDrts are being made to' persuade native mDthers to' attend for regul8iI' ante-natal examinaJtions. Lack of ;ante-natal examination results in obstetrical :emergencies which are nev,er seen JlDwa,days in more sO'phisticated oommunities. COMMUNICABLE AND TROPICAL DISEASES Ankylostomiasis: AlcDpar cDntinued to' find gDDd acceptance amongst Northern TerritDry abDriginals. The difficulties recorded from O'ther States ~uch as gastrD-enteritis, disturbances have nDt sO' far been a prDhlem in the , Territory. Malaria: Only twO' cases of malaria were recDrded during the year, as against 13 in the previDUS year. One of these Wlas a malMia case which probably origi11ated in the SDlomDn 'lslands. Tl:tcI1e was one indigenous case from RDper River. This was in an 11-year-old native child. Immediately the diagnJOsls was made, a visit was paid to the Mission, mosquitoes oDllected, available popula'tion seen and arrangements made to' institute full-scale mass .. trea;tment. A mosquitO' survey fDr breeding grounds was car,ried out. Leprosy: Seventy-five leprDsy patients frDm 48 places were nDtified during the year. This is mDre 1Ihan dooble the number located during the previous year. It is not thoughttha;t this reflects an increase in the disease; rather it reflects greater 'activity m regard to the leprosy control oampaign. Co-operation "of 'ilie :abD!I'igina,l poprut1ation oonttinued to inareMe and many patients now present themselves voluntarily for examination. Difficulty in persuadmg .suffevell'S to receive ire.atment, such as to enter the East Arm Leprosarium, is decreasing significantly. Trachoma: The appDintment .of an Ophthalmic Surgeon has aided in coping w.itb this disease. Six oases were reported during tJhe year, as against 57 in the previous yea,r. Tuberculosis: With Ithe setting up of the Tuberoulosis Register in the TerritO'ry, a more satisfactory system of control has :been possible. The nUlIIlber of oases shown ,.on the Register at 30th June, 1962, was 44 Europeans and 131 Natives. Typhoid: There were fDur proven cases .of typhoid fever during the year. ·One of these was fmm Bathurst Island. The patient had ;resided in Darwin for some time. 1Ihe others occurred a;t the Oenpelli Mission. The cases from Oenpe1liall Dccurred during March, 1962. The settlement was placed 0000 · quarantine, ,a survey sister f,rom the Department was sent to 'assist the nUll'Sing ·staff and health inspectors visited frequently to :a,dvise and assiSitin sanitation measures. Mass immunization of all at OenpeUi was oarried out and no further · proven cases occurred. A 5earclt was made for a possi:b1e carrier in the DMwin .area, but withDut result.

92

TOTAL SALK AN'It-POLIOMYELrnS INJECnONS GIVEN IN THE YEAR 196t..Q

The foHowing tabler sets <mt the number of Sa:lk injections given to residents of 1Ihe Northern Territory in 1961-62:-

Darwin .. Alice Springs Tennant Creek Katherine Total

1st Injection.

2nd Injection.

3rd Iniection.

Total.

.. ..

.. .. ..

.. .. .. ..

.. .. ..

..

1,241 515 42 85 1,883

1,017 374 22 87 1,500

1,417 839 78 41 2,375

3,675 1,728 142 213 5,758

..

..

As a 'result of the intensive campaign carried 0UJt in 1960-61 there were rower persons requiring injections of Salk anti-poliomyelitis vaccine during the yeM 1961-62. NOTIFIABLE DISEASES The following table shows 1lhe diseases notified -in ,the financial year 1961-62 as compared with 1960-61:CENI'RE OF NOTIFICATION

.~. ~

Acute Rheumatism .. .. Ankylosromiasis " .. .. Amoebiasis .. .. .. Breast Abscess (occurring within 6 weeks of childbirth) .. .. Chorea (St. Vitus' Dance) .. .. Diarrhoea Unfantile) .. .. Dysentery (Bacillary) .. .. Infective Hepatitis .. .. .. Leprosy .. .. .. .. Malaria .. .. .. Mastitis (occurring within 6 weeks of childbirth) .. .. .. Meningococcal Infection .. .. Ophthalmia .. .. .. Pleural Effusion .. .. .. Poliomyelitis .. .. .. Puerperal Fever .. .. .. Rubella .. .. Salmonella Infection (other than TYPhoid Fever) .. .. .. .. Scarlet Fever .. .. .. Tetanus .. .. Trachoma .. .. .. Pulmonary Tuberculosis .. Non-pulmonary Tuberculosis .. Typhoid Fever .. .. .. Syphilis .. .. Gonococcallnfection .. .. Non-specific Urethritis .. Yaws .. .. ..

Darwin.

Alice SpriDgII.

Katherine. Tennant Creek.

1961-62.

1960-61.

3 164 2 1 2 29 35 44 72 2

.. .. ..

4

..

.. ..

1 113 20 14

.. 17 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 5 10 3

.. ..

9

.. .. .. .. .. .. .. .. .. .. .. 5 1 19

7 173 2 1 3 164 56 87 75 2 2 1 1 4 3 5 9 1 1 1 6 40 9 4 5 68 20 I 750

7 252 1

.. 3 392 52 43 36 14

.. .. .. .. 4 1 1

2 1 1

.. 2 10 1 4 2 1 5 1 57 45 13 5 3 25 14 1 992

.. 2 3 3

..

2 5

.. .. ..

.. ..

1 5 28 9 4 4 20 8

.. 1 1 1 12

..

.. ..

.. ..

.. ..

.. ..

Totals

..

..

.. ..

43 12 1

..

.. .. .. .. .. .. .. .. .. ..

..

..

"-i

,

'i';'

~.

\>"

.',IA.

HEALTH SERVICES PROVIDED AT MAIN NORTHERN TERRITORY HOSPITALS

Total number of daily occupied beds .. Total number of admissions .. Average number of daily in-patients .. Total number of births .. Total number of deaths in hospital Total number of post-mortem examinations Total number of major operations Total number of minor operations .. Total number of out-patients treated ..

Darwin.

Alice Springs.

Katherine.

Tennant Creek.

Batchelor.

1960-61.

1961-62.

1960-61.

1961-62.

1960-61.

1961-62.

1960-61.

1961-62.

1960-61.

1961-62.

..

.. .. .. .. .. .. .. ..

..

73,879 4,934 202 631 81 82 400 1,863 48,80819,323 77 8,806 14,376 1,938 1,785 20,295 822 3,594

77,069 5,062 219 647 98 96 45S 1,729 67,505· 20,004 81 7,340 11,991 1,648 2,074 23,360 660 3,170

28,621 2,644 78 244 73 22 177 403 14,148 6,618 25 2,816 4,075 596 476 15,412 944 4,526

31,567 2,381 86 225 67 29 146 492 15,537 8,163 31 3,442 5,392 397 429 14,942 365 1,527

8,227 600 24 62 24 22

..

7,510 581 21 47 16 15

..

107 4,168 11,921 38 663 813 151 205 13,666

68 4,975 11,471 40 289 376 103 132 15,063

3,057 410 8 51 9 12 2 82 5,741 1,946 5 368 496 60 66 8,670

4,408 618 11 45 11 14

..

..

.. .. .. .. .. ..

..

.. .. .. ..

60 6,989 2,577 7 265 329 79 88 9,943

.. ..

.. .. ..

750t 3,321t

967t 4,139

DispensariesPrescriptions dispensed .. .. Daily average of prescriptions dispensed per working day .. .. .. X-ray DepllrtmentNumber of examinations .. .. .. .. .. .. Number of exposures Ambulance ServicesNumber of trips .. .. .. .. ., Number of patients carried .. Number of miles travelled .. .. Physiotherapy Department.. .. Number of patients .. .. .. Number of treatments ..

t

10

.. ..

w

.. .. .. ..

.. ..

..

.. .. ..

_.

.. ..

.. ..

..

..

.. ..

.. ..

.. .. .. .. ..

Darwin Hospital Batchelor Hospital

t Out-patients seen at the Doctor's Clinic. t Out·patlents seen at the Daily Clinic,

*

These figures include Bagot Hospital.

94

COMMONWEALTH LABORATORIES COMMONWEALTH X-RAY AND RADIUM LABORATORY The Laboratory was established, as The Commonwealth Radium Laboratory, in 1929 and has since that time served as a national centre for radiological physics. The func,tioos of the Laboratory were extended to include the physical aspects of X-ray therapy in 1935, when it became The Commonwealth X-Ray and Radium Laboratory, and of X-ray diagnosis in 1939. In 1946 the Laboratory imported the first artificially-produced radioactive isotopes used in Australia and established a system for the procurement and distribution of these substances. Procurements, whether for medical, research or industrial purposes, were undertaken by the Laboratory until 1st July, 1961, but since that date the LaboratDry has 'be,en res:ponsible for the procul'ement Df isotopes for medical and medical reseaxcb IPlIirpOseS only.

The specialized resouroes of the Labomtory and its faciHties are available to all who work whh iDnizing radiations. RADIUM SERVICES In 1928, on the recommendation of the Di·rector.(}eneral of Health, the CommDnwealth Government pliJI'cbased ten grams of lI"adium ~or use in Australia in the ,treatment of cancer. The Laboratory is L1e custodian of this radium and maintains aoentral lreserve Df the ,national radium holding. Radium in~he fDrm of needles, tubes and plates is made available on loan to approved hospitaJ,s, subject tD ,an agreement between ,the Department and the management Df the hQsp~tal concerned. Commonwealth radium is 00 loan tQ centres as distant as Fiji. The Labor,atory holds a Secondary International Radium Standard, issued by tJhe InternatiDnal Radium Standards Commission in 1928. Against ,this standard ,the Laboi""atOi!)' has calibrated 'a number of sets of working substandards which are on ,Joan to centres in Australia and New Zealand. These sub-standards are used for the measurements of radium and radon activity. Thek use ensures that all such measurements are made in terms of the same ultimate standllll'd.

Statistical data of the Radtum Services of the Laboratory are presented in Table 1. Corresponding data for the previous year are induded for comparison.

j

~

I

RADON SERVICES

m radium therapy are ,the beta and gamma rays emitted by radium B and radium C. Radon. the gaseous decay product of radiUllll, also produoes mdiumB and radium C and can ·therefore be used in place of radium. Tlilii substirution has a number of practical and economic advantages. The radiations effective

95 Soluble radium for radon production is held by the Laboratory, by the Bureau of Physical Services, New South Wales, and by the Department of Physics, University of Queensland. Radon is regularly prepared at these centres in a variety of containers. The Laboratory supplies Il'adon for use by approved hospitals and approved private practitioners in Victoria, South Australia. Tasmania and Western Australia. lit will supply l"adon to centres in other States if the need arises. Until a few Y'eaIl'S ago, radon held an important place in industrial r,adiography by reason of its low monetary value and the small size of the highly active sources which oan be prepared. Alt the present time a~tificia1 radioisotopes 'Such as cobalt-60 !have largely replaced radon. In the year 1961-62, no radon was issued by the Laboratory for industria:! radio~aphy. ltadon has been supplied to the Cancer IInst1tute Board of Victoria (81 milliouries) and ,to .the School of CivU Defence at Macedon, Victoria (360 millicuries), for use in 1'esearch and instruction respectively.

l

&adon has lalSO been supplied by Ithe Laboratory to Ithe Australian Altomic Enell'gy Commission as the proouringautho~ity for l1adioactive materials intended for non-medica1 applioations. This radon (1,003 mimcuries) has been supplied through ,the A.A.E.C. to tlhe Bureau of Mineral Resourees, Geology and Geophysics for use in c3ilibrating airborne sointillometers; to the PostmasterGeneral's Department for use :in l1i:racing leaks in buried telephone cables and to an oil company for testing pipe lines. As radon decays with a half-life of 3.825 days, the total amount of radon purified always exceeds that at the time of use. Statistical data on the Radon Services of Ithe Laboratory are given in Table 2. As the Radon Service's in New South Wales and Queensaand use radium made available to 'them fmm the national iholding, statiSltical data on the Radon Services in those States are included in this Report in Table 3. Corresponding data for 'the previous year are included ,in this Table for comparison. The total activity of 'the radon issued by the Laboratory in ,the year 1961-62 for medical purposes in the form of needles, gynaecological rubes and capillary for implantat10n or construction of SlllJI'face moulds was 28,906 mil1icllJI'ies, of which 22,9'89 milliCiUries were issued to hospitals and 5,917 milLicuries to 8ppll'oved pIl'ivate practLtioners. The corresponding figures for the year 1960-61 were 27,247, 20,311 and 6,936 millicuries respectively. The total activity of radon issued for medical PUflPOses ,in ,these types of containers during the current year represents an increase of approximately six. peIl' cent. oVeIl'the issues for the year 1960-61. Operations with Precious Metals and Other Construction Work for the Radon Services: Radon issued in Australia and New Zealand for medical purposes is PrepaIl'ed in capillary tubing of pure gold. Many radon containers consist of gold rubes, of various diameters and -lengths, containing ,this l'adon-fiJ,led capillary. The Labora'tory constructs all the gold tubing used in the various radon services in Australia and in Itbe Dominion X ...Rayand Radium Laboratory, Christc:hUll'Ch, New Zealand. During the year 1961-62, alppl"oximately 1,474 feet of gold

..

~

96

tubing of all types was constructed-an increase of approximately 11 per cent. over the previous YOOf. The distribution, to the various centres, of tubing constructed during 1961-62 Js set out below. GOLD TUBING ISSUED TO RADON CENTRES 1961-62 Radon Centre. Gold Capillary. 0.3 rom. Pt. eq. Gold Capillary. 0.5 rom. Pt. eq. Gold Casing for Needles. 0.8 rom. Pt. eq. (ft.)

Melbourne Sydney Brisbane Adelaide

.. ..

.. ..

.,

.. ..

..

.. .. '.

.. ..

..

(ft.)

(ft.)

746i

Nil

4

85i Nil Nil 832t (715i)

58! 572t Nil 630i (577)

5! Nil

•

•

It IOi (17t)

Total 1961-62 (Total 1960-61) ..

In addition, twelve nasal applicators were constructed. X-RAY SERVICES The functions .of the iLabomtory include the physical aspects of ,the use of X...rays :in tTeatment and in diagnOosis. These activities are reported separately under the appropriate headings. X-ray Therapy: The Laboratory maintains ,the Austra:lian free-air standard chamber for the preoise realization of the 1"Oentgen. The poI'table sub-standM"d dosemeters used by .the local ,physical services in each State are calibrated by ieference to this standard. Work Oon the comparison of the LaboratOory free-rur standard with the transfer ohambers made available by the National Bure'au of StandM"ds, Washington, D.C., United States of America, has been completed, with satisfactory results. The calibmtion Oof dosemeters is not restricted to those owned by rthe ~ocal physical services; privately-owned dosemeters are calibrated by arrangement. The Laboratory may also repair sub-standard and other dosemeters when necessary. Seven dosemeters have been ca:librated in .the past twelve months. Seven calibrations of deep-therapy equipment, and nineteen of superficialtherapy equipment Ihave been made by ,the Labor:atory. Radiographic examinations of the fields of all new treatment cones supplied with therapy equipment is a routine ,test. Investigations of physical aspects of radiotherapy are carried out in close association with the Radiotherapy Advisory Committee of the National Health and Medical Re1search Coufllcil. Four samples of biological materials have been irradiated, three for the Department Oof Zoology, University of Melbourne and one for Oarlton and United Breweries Ltd.

_j

.~

j , ..,

X-rIllY Diagnosis: Many physical problems aa-ise in diagnostic radiology. There is, for example, ,the need to determine ~he relative efficiency of items of accessory equipment, photographic emulsions, intensifying 'and fluoroscopic screens, viewing boxes and scattered--radiation grids. In many cases suitable physical methods have to be dev,ised.

91 The need to keep to a minimum the exposure dose received :by paltients undergoing necessary xadiologioa:l investigations is clewly cecognized. The Laboratory is frequently consulted on methods of reducing this dose while still maintaining radiographic and fluoroscopic images of good diagnostic quality. Investigations of radiation dose to patients have been continued in association with the Medical Radiation Committee of the National Health and Medical Research Council and during the year appropi'iate measurements were made on fOUll" installaItions. (See also Radiation Protection Services.) In view of the increasing tendency to use tube voltages above 100 K.V.P. for Toutine diagnostic radiology, it is necessary to undertake physioaJ investigaHons in this field. A modern X~ray unit (150 K.V.P., 300 rnA) is maintained for ,this purpose at ,the Laboratory. The Laboratory carried outtbe first developmental work on miniature radiography in Australia 'and maintains a pilot plant so <that investigations in this field may be continued. By arrangement with the Australian College of Dentistry, an encephalometer unit is maintained at the Labol1atory. This device is so designed <that posterior-aIlIterior and ,lateral radiographs of the skull, taken at intervals over a period of years, may later be superimposed 'accurately, thus enabling investigations ,to be made of the grOWltlh of facial bones. The Laboratory has continued to co-operate with the Department of Anatomy in the University of Melbourne in such a project and during the year 259 patients have been radiographed. The encephalometer is available by arrangement to orthodontists in privaJte practice and 362 patients weTe examined in the yeaT. The cotTeSponding Dum'beTS in the previous yeM" were 208 and 320 patients respec.tively. Advice on the purchase of new equipment for hospital departments and on the condition of existing equipment is frequently sought from the Laboratory by State Governments and by hospital authorities. The Laboratory undertakes acceptance tests on new equipment when Tequested. Assistance has been given to the Department of Extemal Affairs in purchasing X-ray equipment of AusrtraHan manufactuTe for ~ort under the Colombo Plan. ISOTOPE SERVlCFS The ·functions of the Laboratory include the rproourement and distribution of redio-isotopes. Stable isotopes are also obtained as occasion l'equires.

, •

The Commonwealth Department of He'alth and the Australian Atomic EneTgy Commission have agreed on a l'e-distribution of activitie.s previously carried out by the Departmen1t of Health through this Labo'l'3tory. The operative principle-.,/ the present arrangement is ithat radio-isotopes required for medical use and meJicaI research are procured and distributed by this Labor:atory and that radio-isotopes required for non-medical use 'are procured and distributed by the AUSltraIian Atomic Energy Commission. This arrangement became effective from 1st July, 1961. As part of rtlhis arrangement the Department of Health, rthrough this Laboratory, is informed by the Austmlian Atomic EneTgy Commission of all orders for radio-isotopes received by the Commission. These orders are filled by the Commission only after receiving ,a .. clearance" from the Laboratory indicating that it does not object to the supply of the material for the stated purpose. During the year ended 30th June, 1962, 760 such" clearances" where issued. 1642/63.-4

98 Before lst July, 1961, the Laboratory had been responsible for the procurement and distribution of an tradi<Nsotopes used in Australia. As there were a number of orders still 'Oulstanding for radio--isotopes too be used in non-medica:l work ,it was agreed with the Australian Atomic Energy Commission tihatthe Laboratory should cDmplete the necessary taction on ,these. It is for this reason ,that the identifying ,letters NM (non-medical use) 'appear in Table 5. The importati'On of radio-is'OtDPes into Australia is restricted under tihe CustDms (prohibited l!mports) RegulatiDns. Appro~aI for importatiDn is now given either by the Direct'Or-General 'Of Health or by the Australian Atomic Energy Commission, depending on the category of use, after it has been established that the isotope wJll be used safely and usefully. :IsDtDpeS used in AustraHa for medical diagnosis, trellitment and rese!lirCh are obtained mainly from Britain, Canada, and the United States 'Of America. Some radio-isot'Opes have also been 'Obtained from ,tlhe Australian A>tomic Energy Commission. SDme specillil materials have been obtained from France, Holland and :Israel. In .the twelve m'Onths ended 30th June, 1962, 987 shipments (of which seven were of stable is'Otopes) including 37 different is'OtOpes ,and a large number of compounds have been procured and distributed by the LaboratDry. Of these, 47 shipments including five different isotopes were received from 'the Australian Atomic Energy CommissiDn. StatisHcal data on the isotopes procured and issued, 'and on their field of :appiicati'On, have been collected in Tables 5, 6 and 7. Table 6 shows the quantities of radio-isDtopes issued during the year by the Laborato[), for medical use in therapy and diagnosis. The Comm~ttee on Radio-IsDt'Opes of the National Health and Medical Research Counci'l co-'Ordinates medical use of radio-isotopes in Australia. Radio-isotopes required for medical purposes are, in general, obtained in bulk supplies, some of which a,re dispensed at the Laboratory into smaller amounts before distribution for diagnostic or ,therlllpeutic use on parocmar patients at specified times. In the year 1961-62, 11,227 such issues were made. This represents an increas'e of 29 per cent. 'Over the corresponding number (8,693) fDr the previDus year. Under Section 100 of the Nationa:l Health Act. these radio-isotopes, with the exception of yttrium 90, were made available free of charge to all classes of patient. In addition to the radio--isotopes procured Slpecifically for medical purposes (as ~isted in Table 5) occasional issues of radio-isotopes for research purposes have been made at cost from bulk supplies imported primarily for medical use. This procedure has enabled .groups requiring these materials for research to obtain them at a lower cost and with less delay than would have been occasioned by specific importations on their behalf. RADIATION PROTECTION SERVICES The e~panding use 'Of radiation and radioactive substances in medicine, research aDd industry and consideration of possible public health problems arising from these uses have resulted in an increased work-load for the various protection services of the LabDratory. The services of the Laboratory have been freely available to those undertaking the design and construction of facilities in which sources of radiation are

99

to be ~sed. During the year specifications of the requirements for adequate protectIOn against ionizing radiation were prepared for fourteen medical X-ray departments, and for one industrial and one research establishment. In addition to the work in radiation protection design,the Laboratory has been called upon to assess, by site monitoring, the degree of radiation protection provided in an installation and to evaluate the safety procedures in use. In the year 1961-62, 59 such radiation surveys were carried out in nine medical X-ray departments, 42 dental X-ray installations, one veterinary department, four industrial and three research facilities. At the request of the Tasmanian Branch of the Australian Dental Association, an officer of the Laboratory undertook a survey of 39 dental X-ray installations owned by members of the Branch in various parts of Tasmania. Aprons and gloves made of lead-filled rubber or plastic are used in radiology to reduce the levels of radiation dose of those occupationally exposed to radiation. Such articles are frequently sent to the Laboratory by local manufacturers and X-ray firms for inspection for flaws and measurement of lead-equivalent thickness in order to ensure compliance with recognized standards. During the year 50 samples were tested. Work is proceeding on a project to enable the accurate measurement of low concentrations of radon in air. For more than 30 years, -the Laboratory has provided a film-badge monitoring service through which the radiation dose received by those occupationally exposed to external radiation may be assessed. This service has been modified from time to time according to requirements. The Laboratory issues, on loan to institutions who wish to use the service for their employees, metal film-holders (badges) of special design. These holders contain filters so arranged that an exposed film may show seven different areas of absorption or backscattering of the incident radiation. A measurement of the photographic blackening on all or some of these seven areas permits accurate assessment of the nature and quantity of the radiation received. Under existing procedures, the Laboratory issues, at fortnightly intervals to all those registered in the service, the special films which are to be worn in the film.holders. Upon their return, after being worn for a working period of two weeks, the films are processed under standard conditions and the radiation dose lassessed against" standards" prepared in the Laboratory. A report is issued to the employer in each case. In addition the Laboratory maintains a cumulative record of the radiation dose received by each individual. The service is available to all radiation workers; the only charge made is that (at cost) for the films issued. The number of institutions registered in the film-badge service rose from 258 at the beginning of the year 1961-62 to 312 at the end of the year. The number of films assessed in the year 1961-62 was 31,118, compared with 26,238 for the year 1960-61. It should be noted that the increase in the number of radiation workers now covered by the film-badge service of the Laborntory is not truly reflected by a comparison of the figures for the years prior to 1960-61 with those of subsequent years. Prior to the 5th September, 1960, films were worn for a period of

100

one working week. With the operation of a modified service from thitl date. the period of wearing the films was extended to two weeks, except in a .few instances where experience had shown that higher radiation levels were possible. In fact, there was an almost two-fold increase in the number of persons using the film-badge service at the end of year 1960-61 as compared with the end of the previous year and a further increase of 18 per cent. has occurred in the year 1961-62. At the present time the film-badge service operated by the Laboratory is receiving films for assessment and report from centres in all States of Australia, in the Australian Capital Territory and in the Northern Territory. Some of these centres have been directed to the Laboratory by State authorities who are at present unable to provide or expland their own services. During the year, officers of the Laboratory co-operated with officers of the Australian Atomic Energy Commission and of the Commonwealth Department of Works in an investigation of the radiological safety of uranium mines. In addition to the specific activities mentioned above, the Radiation Protection Services of the Laboratory have been called on for advice and assistance by a large number of Commonwealth and State Departments and instrumentalities, by various Hospitals, by Universities, by industrial and research organizations and by private ~adiologists, other medical practitioners and dentists. The Assistant Director of the Laboratory attended the International Training in Radiation Health and Safety 'held at the National Institute of Radiological Sciences in Ch~ba City, Japan, from 24th October to 21st November, 1961. The course was jointly sponsored by the World Health Organization and the International Atomic Energy Agency. Cou~e

RADIOCHEMICAL AND LOW-LEVEL MEASUREMENT FACILfIY In its report of July, 1959, to the Prime Minister, the National Radiation Advisory Committee recommended the establishment, at the Laboratory, ofa low-level radiochemical facility. This facility was completed during the year. The facility was set up to permit radioactive assay of various radioactive substances present in minute amounts in environmental samples such as water and soil, in foods such as milk, grain, &c., in biological material such as human bone tissue and indus,trial effluent. The programme of work includes the routine assay for strontium-90 of public water supplies, of milk, of human bone tissue and of monthly fall-out collections made by the Australian Atomic Weapons Trials Safety Committee. A major difficulty in these assays is the determination in ,the samples of natural (non-radioactive) strontium which is present, in many cases, with large amounts of calcium. Ordinary chemical procedures are of no value. The problem has been solved by a method using the atomic absorption spectrophotometer. For the measurement of beta-ray-emitting samples of low radioaotivity, tJhe speciaJ. steel .. castle" designed and constructed in ,the Laboratory has proved very satisfactory. Upon the completion of ,the radiochemical laboratory early in the year. analytical methods for the measurement of the strontium-90 content of ashed biological samples were tested. These procedures were found to be satisfaotory and 31 samples were analysed during the year.

.(

~

,

!

. 101

~er tests were developed for assaying iodine-I3l in food and 'biological materIals and 126 samples were analysed during the year. We.a~ns .-r:ests Safety Committee in its Australia-wide monitoring of radioThe Labora.tory has continued to co-operate with ,the Australian Atomic

actIVIty ansmg from global fall-out. As part ofvhis assistance,in the year 1961-62, 1,748 samples of various materials were asbed and compounded for radio-chemica1 assay. Some of .the ashing was carried out by an officer of the Laboratory using a furnace provided for the PUll'ose by the Defence Standards Laboratories, Department of Supply. A furnace installed by the Laboratory in its own premises has also been used and 1,264 bone tissue samples were ashed in it during the year. ADVISORY SERVICES The Laboratory provides advisory services on physical problems arising in ,the use of X-rays and radioactive substances. The library service covers a wide range of current journals and provides for the indexing of ,the more important papers essential to the work of the Laboratory. 'J1he Laboratory is frequently consulted on specific problems by hospitals, by research groups and industri3l1 organizations, and :by Commonwealth and State Departments. This consultative work is an import function and continues to make considerable demands on the time of the staff and the facilities of the Laboratory. The Laiboratory has for many years been assooialted wiilh the Colombo Plan. Und~r ,this Plan equipment is supplied to countries of South-East Asia and people from tIbose countries receive training in Australia. In November, 1961, Mrs. A. Reyes, chettnist, and Mr. G. Bantugan, physicist, came to Australia as Colombo Plan Fellows from the Philippines and were attached to ,the Laboratory to obtain training and eX)perience in low-ilevel radio-chemistry and the assay of radioactive malterials of low activity. Under the Colombo Plan Training Scheme, the Laboratory has also been responsible for placing trainee radiographers in the X-ray Diagnostic and Radiotherapy depamnents of a number of hospitals. The progress of these trainees has been observed by the Laborarory and special assistance provided where necessary. LABORATORY REPRESENTATION Mern!bers of the Laboratory staff serve on many Australian committees WIbicIh deal with subjects of interest to .the Laboratory and which are related to its funotions. The DiTector is the Australian Representative on the United Nations Scientific Committee on the Effects of Atomic Radiation and is a Member of Oommittee ill of the International Commission on Radiological Prote'ction, of Committee IV of the InternationaJ Commission on Radiologicall Units and Measurements, of the Australian National Radiation Advisory Committee, of the Australian Atomic Weapons Tests Safety Committee and of the Boards of Studies of Nuclear Science and Engineering, Therapeutic Radiology and Diagnostic Radiology, of the University of Melbourne. A liaison is maintained with the Consultative Committee for the Standards of MeaSUTement of Ionizing Radialtion of tlhe International Boceau of Weights and Measures in Paris. The Senior Physicist (Isotopes), returned to the Laboratory on 2nd October, 1961, after serving for a year as one of the Scientific Secretaries on the Secretariat of ,the United N aJtions Scientific Committee on the Effects of Atomic Radiations. 1642/63.-5

HOOf ~i' I

~,)';'I.'

r;;

~~':'l;"':!}'

TAB~ ..~~

:.' '.~I)L

~~.\);\<

·"-if"'· _,:1"

(J r;~n "

'~.;

RADIuM SERVICES

1st JnIy, 1960,to, 30th June,' 1962' ,

.!

Quantity.

Item.

:,

1961-62. "

1960-61.

,

r. Total movement of Commonwealth radium (mgm) , .. Z. Quantity of radium measured (mgm) 3. Number of radium containers testedCommonwealth , , ., , . ,. , . Private 4. Number of searches for lost radium or radon containers ,

,

. .

,.

816 0 0 2

2,046 614

,

,

.

I

38 14 I

.,

..

..

1

I I

, TABLE 2 , (

.

RADON SERVICES

1st luly;196{),to 30ttlJtine, 1962,'

. Qua~tities of. Radon issued are those at time ~f. use Item,

1--,--_~Q_U_antitY'

), Radon.issued fora)1 PlJrp0sJ~~(mc) . ' . ,. , , ' " ,.r"t, )2,724; '2. RadoJ! issu"ed for treatm¢rit ~,urp6ses only (il1c)p,din g'items 11, 12 and 1 " , 13) (me), , ,. .. ,y '31;280 l 3. Total number of patients treated (not including items 11,12 or 13W. A"' /782 4. Radon issued to hospitals (me) .. ,. 22,989 :5, Location of hospitals towhlch 'f(i{!OTI ;";'a!lissued, 5' Metropolitan Counlry " 12. Interstate .5 6. Radon issued to private pra~titioners '(Aicludirii items 11, 12 13) (me) , ,. 8,291 7. Location of private practitioners to whom radon wlis ,issU:e'd~­ Metropolitan 11 Country .. 4 Interstate 3 8. Containers issued (including only capillary implants, needles and tubes of all classes) ,. 6,766 9. Returnable containers not returned 7 10. Implants (0,5 mm Pt. eq.) received' from SydneyNumber .. 39 Total Radon (me) 31 1 \. Nasal applicatorsNumber issued 9 Total Radon (me) 2,374 '. Total patients treated 246 12. Radon plates (eye applicators)Number issued o o Total Radon (mc) Total patients treatecl.t o i3. Radon ointmentNumber of issues o Totalrapon (me) " o I~: industrial sourees. ., 'Number iSstred . , ;.. .v:" . Totahadon (IIlC) .:. 15. Radon issued for research purposes (mc)

-'-____-:"----'....---"~I~t~2J

196b~1:

, - -iI .,39,399 29,9114' 664. 20,311

·7; 9,

3 9,613 .12 4

,.j

4 4,781 J

62 50

7 687

48

1', .2

Hr. j 8,3,45 1.01l

TABLE

2-conrinuI!d. I

I

Quantity.

i ,

-~l."·I~'Io:QC(i-.,4l1j,1ll~I; ... ';,.I,..J:fllh""f.. ,:;,...4;o.. ,..."... l~;).u~ ... 'lh-,::4;ii~I"':,"';''';·';';'-'-:'11,;·''''JI-l~t'''b-'41.ll)i~!l~r;;''u!-I,-'l,)IoJJ/,.ji.J~''4-~II$I--jlliJ<'liI'll11IPfn't~fl'f'I*~-'

i 1961-62.

' \

1960--61.

16~Total radon

17. Total radon l\ttj;ne of use (me) ."I.S,~~at!2item:u;3

, item 11"> .

tixtractedfrom- solution (iricY---' -. -. . ", -' _ .. J()Q.

105;455·'; 103,931 32,693 ;'~I."Jr,,,::

•. 39.310 37.2 188 .' ,; 1~

31,01 178 f : ,~

1

19. Number of purifications

,.:.,

• Victorian requirements of radon in gold capillarx. of O. 5 ffilD. ¥t: eq. filtration are obtained from the JlV~~~u of PhysicaJ Se:cvices"", S)'dney~ '. t ApI?rpx~tpatc. yvalues. ~ ~ '): Medical i*"csti~a.tions (1. ~c;n~Tce~ ~"l 4rte; (~fI:ld~/gati\inl;;(m~ 1,36},n<c.".-b£ the latter, 52 ,ources contalmng 1.003·mc)w<lfe·~d through the Australian Atomic Energy CommisJf~ll. By arraI!.£ement with lthe Australian Atomic w9!BY Commission the remaining: 72 sources, containing 160 ....fTIc. were ort.l:ered directly \l'om the Lab·oratory by the usen and were issued directly to them. I ',t,. fJ I ;.. ,~ ;~ ~ A-1.'"). d,Hn10q!,'~ry} l\/ ~ ;.~'~! ~

; ,

,

.

i

·t~BLE 3 ' ' RAD6N'SERi~l~; CENTllliS OTHER THAN C'x.R.L. ,',!>"

,.~)

~"'l~;;'-,,H

;: \

.. ,

'.

Quantities of Rapon~~ed ar~those attim} of use H

$,

it.

~(~\ ~O~i

"

---+---'----c----.------'",,.,.!'".)">'

'i I

Quantity.

Item.

.51 J .::

(} '. 1961-62.

tl1ltf t,;i .cIa nlWLJl i )1~\,! ,~a) Sydney,YJ11J'Y (!:;n~'·;,',!1 i'·-/. 1. Radon issuealli)H~ 1;,',', l t D ! i; HospitaB/:(;tW}h ~'r''''':lr) ", i,' "

"Tn" ".,,;i'!

! : t J....L __ ~ _ _ ,'_!_

<::u 0 '

1

--,- - -

I I U~o')

i. jc. j ,\

'!: 0i

Private "flit.m{l8ileN(~ ;1 ResearcM"/lilrpdlies;(mtipi, .J: tJ', 2. Total 'J-tfd!!il4!:-IfrllC'ted1ffoiti'\;olution l(me) 3. Total radon at time of use (mb) 1:',V;; . item }:J'I'JU;? l!~nL<):fU II' ~" 4. RatIO ~:~JOO'nri,,,·,;;,,!'J ,);(1'1 5. Number of Pur,/Ji\!WiOn'("-1 ~dlior~:l J111./Item .... '71.1-. Of ~~, . ,<-

~;,' (100:(

',I

6,446 2,138 387 22,485 8;971 39.9

I I

•<,'J 7,164 1,704

Nil 23,J£,) 8,8()g'

~ :f

t ..~

t~ cl

38.4

'~)/I

'.I b)

'H 18,309 435 260 32,276 19,004

10)

5;~!f 180

l~)iIods;:.r-:l)

tHfrtU0if,

frrU1~~~

(,1:

Centre. :.. L _ _ _ _ _ _ _ _-;--,-_ _~r,:.c)',2'.'

"il,~adium iTt .solution

.1r J i

.l:l......- (mSfllt· t

"'.Htoh:fon.f "'lvn.

I 'J(!

,; , ,mal Ra~on i-$;ued '. Useful Yield (me), c (me!mgm). --7Ic:.'---'-,-r--~;~--;'---+--------ID.'

$-i t\11

~

-~

Melbourne Sydney Brisbane

~fl.n()'·.:rfJo!JI'H· _~1

:>ml~~l'{fLOb'~.I~,l ( .

(Ht).qnl

hI "T '!~~\' ..,

)ti-5 , ~r.j. 1.

,,3, ~ l'~

1j7

I tI ') F' 'I

32~724f.!·I R,971~~ 15,854, ' 1

I!

12.5 10.2

17.0

104 TABLE 5

ISOTOPE SERVICES Isotopes procured by the Laboratory-1st July, 1961, to 30th June, 1962 I Isotope.

I 'I

_ _ _ _ _ _ _ ! Received.

of I Number Shipments

Quantity

1_ _ _

Ordered <"_,_c1_._ _

Use.-

1:::° Au"· Ba '33 Ba Uo

I.

1 3 11 4 3 1 2

1.1 i

~M M MR

1-----------Notes.

I

+ C S U1

355 3.2 0.05 2 4

132

10 1 2

66.5 1.3 5.1 0.54 0.33 0.2 0.004 1 1.1

I NM I ~~ } I 69 compounds M MR MR

M, M R I .. Mock iodine 131 .. (reference sources)

I

I Reference sources

Reference sources

6 Ca" I 3

NM M MR MR

1 1 1

19 1

NM M

0.025 14.3 3.2 256 24.6 0.5 1

2 10 3

MR MR M

MR M

21 13

MR

2 1 1

Fe" HI

4 7 13 3 I 4 1 63

1,000 0.2 5

NM NM MR M MR MR MR

M

Vitamin B12 Vitamin B12 Reference sources Chromic chloride Chromic chloride , Sodium chromate Sodium chromate Human serum albumin Industrial source Reference sources Ferric chloride Ferric chloride Gas Gas Water } 28 compounds other than above

2.3 20,000 10,000 16,200 400 7,801 35.5 gm

NM

~R M

1 2 3

MR MR M

fll1

60 1

32 1 75 136 19

12,960 10 622 1

99 113 10.8

MR M M M M

11 3

10.5 3 22 3

22 3

MR M MR M

4

5.7 9.1

14 1

M M M

0.5 94 1 1

NM M MR MR

68 1 Nail .. 1

Reference sources Reference sources 3 additional compounds sent foT' tritiation Iodide in thiosulphate Iodide in thiosulphate Iodide in isotonic saline Diodrast Hippuran Human serum albumin Human serum albumin Human serum albumin (metabolic) Human serum albumin (metabolic). Oleic acid Olive oil Polyvinyl pyrrolidone L-tri-iodothyronine L-tri -iodothyronine Triolein Triolein

105 TABLE

5-continued.

Isotope.

Number of Shipments Received.

I

Quantity Ordered (me).

Use.-

Notes.

I M MR NM MR NM M MR NM NM NM MR MR M MR I NM IM NM Orthophosphate in dilute HCI Orthophosphate in dilute HCI Orthophosphate in dilute HCI Orthophosphate in isotonic saline Orthophosphate in isotonic saline Colloidal zirconium phosphate

pu

..

·.

28 17 2 11 1

I 2,265 211 15

80 2

POIlO

..

.. .,

Raul ., S3li ·. So" . , Sf" yeo yl1

., ·. .'

29 1 1 I 1 16 1 1

550 10 2

}

2 compounds other than above Foil 4 compounds One plate

..

·.

.'

·. .,

I I 1 1 933

1 30 em 92 3 25 5 5 43 15 73,439

Industrial source Yttrium oxide rods

Totals

I

No irradiation units were procured by the Laboratory during the year.

Stable Isotopes

eaU Ca" Can KCl Mg" Mgu

1 1 1 1 1

,

NU

1

1 Totals 7

5mg IOmg 5 mg 5 mg 10mg 10mg 3.5 mg 48.5 mg

I MR MR MR MR MR MR

MR

I

Isotopes procured by the Laboratory for medical use from the Australian Atomic Energy Commission and despatched by the Commission direct to the ultimate user

Au lte ..

., ., .'

Cu"

..

K" · . Na" .. TaUt · . Totat~

·.

·. ·.

3 2 1 17 23 1 47

173 20 10 142 2 46 393

M M MR MR MR M

• Cateaori.. of U .. : V-Medical (diagnosis and/or treatment); MR-Medic:a\ Research; NM-Non-mcdIc&I.

Dl§;:gtIBUTION OF I§PlOPE~~';~~ ~llffl~ USE,,""lud u~~.l.nJhi£..table,the_'m[d

''.1ss.ue_''"deno1es ,an isotope. can1aIner despatched.from the. laboratory. The isotope in the container may consist of either an individual dose, or a bulk issue from which individ4a:l;:(IGstl$;will,pjl,~jl)'lwd~()The number of pat~s::treated_~ill therefore be at lea"qls great as t~ Ilur[lt\ec: of i.;sUlo,ic' ,,) j

(:)"'.!~ 1

•

.

b":', 1;~:!'lJ1,

Ii"

,',

1961~2,:'

1960-61. me at Use.

Isotope,:' ' ' ' ' ':"

,', '"

¢?~~i;~i:tf:X~~,,~_-~ Ii'; c;c ..,,, ".i,D

U;{:;

i~::,; }frl-

n1~ at ~ Number °tsue':'.:-T-jIOflSSUes, N'J',hber .. ,; ') (:, 14 I~--i

As"

Arsenate Colloidal gold

.cUiagnoS;g,,·c ~,:::'L,}O(~2"~,i:! ~

I

288 I'H 10 j 2.4

;,

0 6 0

Au ' ·'

0:,;;': r~agnosISI!

" j T~erapY;Hi

I '_.

.,~ 15 I

0

I,

1-r--:--~1--:--""''''6:-

I ~ :

I

Il.01~'''2 0"'12

I

Glyccr~!~~~~~~i~; j~,IiJagnosi~:~ ChlOrIde Vitamm 1312

r I

r Diagnosls,/ DiagnOSIs Diagnosis

i;f 0- _~ __ II~ ~ ~ ",,-.cq 599' !Y'n''-J

I~

3 0

rO,136'

UN

1@!1 10T 72

0.01

Co"

Vitamin B 12 salIne Chloride Human albumin

..

1 ,I

0,33

G!\¥~~eiWiilb'iolfi6'; ~asfi\; .. serum

(0

I I j

i

I DiagnOSIs Diagnosis Total Cr 61 Diagnosis :1

1'11';li(f3~ hI! r~3\"'I:.-';" oVS 95 --1-19-,10 2

I I I

[4 O. 17

0 0

0 0

1-1.

475 239

i~-:J7I~-I192,1

Ferric chloride

..

140 "

1. 3 ..

Acetic-H3-anhYdride pl1

DiagnO'~W\"'\ ',\<1\\1'; - - - 1 -

400

Iodide in sulphate

lOiil " !,

~A~L~ !6~i·Ot;tif;<,teJ. ;\; ,?;Q

/

~ j

r; "} (1 1960--61.

r i

::iI,IJ..---------~-_c_-----'\

i I

1961-62,

[sptQP~.

Chemical Form. ---~~----'

Use.

---p112

1--I

Orthophosphate in Therapy dilute hydrochloric Diagnosis acid CollOidal chromic Diagnosis phosphate Colloidal zirconium , Therap) phosphate TotalP"' Congo red

262 72

1,313 66

o 44 :l78:

o 427 1,806 0:

4

2.4 395

- - - - - -----------'

Diagnosis Therapy, Totals

I

yo.

I -----!----~- --~-I-------: ---- --- -'I ___

0

I

I !

0.7 __ _

Sintcred rod,

~=_i

I

I

__ 3--= _________0 I_~ 8,693

11,227 112;648

III

,594

, r

./

rABl.,E 7

ISOTOPES MADE A V AILABLE FOR USE IN RESEARCH FRO:VI BULK STOCKS PURCHASED' FOR MEDICAL USE DT.J'iUNG: 1960·61 AND 1961-62 . /. , ' The table presents data on the isslics made for research in the physical and biological sciences and for investigations of production problems in industry.

I~otoP«·1 I C r 61. Fe·". II31

1_-

I

1961-62. _

Total. AAE.C·(fl.)

I 960-61.(b)

Chemical Fo.mn.

.1

Medical Rese,:rCh· 1 Number j of Issues. Issue.

=:t5.7

1"Number

~ ~umbcr Issue. of Issues.

of Issues.

-:1-:-:- -N-u-O-'b-e-r-m-c~-:­ Issue. of Issues. Issue.

p32 'c'

..

pn pl.. ,J,

;

.. '.'

Chromate In isotonic ~aline· Chloride- in isotonic saline Iodide in thiosulphate Orthophosphate in dilute 'hydrochloric acid ' ColloidaL ~hfQmic phosphate Colloidal zirconium phosphate " f

21 II

0 I

0 0 101 145 0

21

5.7

! I

30 3

9.8

0.06

0 27 64.

11

I

0.06

I

0.005

I 74 219

101 320

,

116 216 102 375

102 414 0

166 559 0 0

0

0

I

0.5

0 "

0

I

0.3

I j

2

1.4

0

0

t

Material dellvered either direci to A.A.E.C. or 'to noh-Ih&lica'! users a'gainst A.:A.E.C orders' on the the,!labof.alofbl<·,: ,(IJ} The,figur"" for W60"6I~nclllde!s\lPPlios.isSjl~ frqm the L"bora\Ory both for.medical r~el{rc~ and 'for non"mi!dical purPoses. .. " .' . . ;!('a)

,

-

108 PUBLICATIONS AND LECTURES

1961-1962 Papers MEASUREMENTS OF STRONTIUM 90 IN THE AUSTRALIAN ENVIRONMENT UP TO DECEMBER, 1960. D. J. Stevens, et ai .. Nature 193; 188, January, 1962. STRO~TlUM

90 IN THE AUSTRALIAN ENVIRONMENT, 1957-1960.

D. J. Stevens,

et al., Aust. 1. Sci., 24; 397, April, 1962. GLOBAL FALLOUT IN AUSTRALIA DURING 1960-61. J. R. Blake, D. J. Stevens,

et aI., Aust. 1. Sci., 24; 467, June, 1962. Library Information Acc2ssion LIst and fnfonna1ion Bul1etin: December, 1961; March and June, 1962. Libr~ry

i,wcs of September

~~nd

Lectures MEASUREMENTS OF Low LEVELS OF RADIOACTIVITY. D. J. Stevens, to Scientific Meeting of Physics in Medicine and Biology, Adelaide, 25th September, 1961. STANDARDS OF RADIATION DOSE IN AUSTRALIA. J. F. Richardson, to Scientific Meeting of Physics in Medicine and Biology, Adelaide, 26th September, 1961. PERSPECTIVE ON RADIATION HAZARDS. D. J. Stevens, at a Symposium on "Radiation Safety in Medical Practice" held during the Twelfth Annual Meeting of the College of Radiologists of Australasia, 28th September, 1961. SAFE USE OF RADIO-IsOTuPES IN INDUSTRY. D. W. Kearn, at a meeting of Industrial Medical Officers, 2nd November, 1961. BASIC NUCLEAR PHYSICS; FI<;sIO:-l AND FUSIO:-I-TYPE NUCLFAR WEAPONS; RADIATlO"," ASPECTS OF NUCLEAR \VE.\PONS: and PEACl'TIME R,\DIATJON HAZARDS. D. W. Kearn at a "Course in Radiation Medicine for Medical Officers" conducted by the Royal Australian Army Medical Corps, 12th and 16th March, 1962. RADIO-IsOTOPES POR PHARMACEUTICAL CHEMISTS. A course of twenty lectures given at the CommonweaHh X-Ray and Radium Laboratory by members of the staff from 13th June, 1962. (This course was arranged at the request of the Victorian College of Pharmacy and was the second of its kind, a similar course having been held at the Commonwealth X-Ray and Radium Laboratory in 1960.)

COMMON\YFALTH ACOUSTIC HEARING AID SERVICES

L\nORAl'Oi~mS

The Commonwealth Acoustic Laboratories, with head-quarters in Sydney and branch laboratories in every Stat0, continued to provide hearing aid services to partially deaf children and adolescents, Repatriation cases including Service Pensioners, Military Services personnel, Commonwealth Social Services rehabilitation cases and others entitled to them. During 1961-62, a total of 8,278 new patients attended the laboratories, bringing the total of those who have received assistance since the establishment of the service to 71,366. Of the new attendances, 2,237 were fitted with Calaid hearing aids, bringing the

109

cumulative total number of fittings to 16,632. Of these, 10,314 were Repatriation patients, 6,014 were children, 109 social services cases. 134 adolescents, and 61 Military Services men and women. Improvements in the five models of Calaid hearing aids were continued Economical resistance/ capacitance coupled circuits were developed for all models, to increase their sta:bility and to allow further extension of Vheir dynamic range. A substantial step forward early in 1962 was the design of a new circuit for the most powerful model incorporating automatic volume control whiCih will a:llow better and more comfortable hearing for severely deaf cases. ReteDition of the standard hearing aid case rendered the incorporation of such improvements economically practicable. However, investigations of practicable ear level hearing aids for less deaf cases are proceeding, and the Director has been examining latest developments whilst overseas.

as new parts, components and experience became available.

IMPROVED AUDIOWGICAL AND PSYCHOLOGICAL SERVICES Since the Calaid hearing aids were fitted with induction coj,ls, considerable technical assistance has been given ,to ,1Jhe special educational authorities in the V'a:rious States regarding the instal1ation of classroom loop systems and auditory training units. Battery audiometers continued to be supplied on loan to school medical services to facilitate tlhe early detection of hearing losses and enable early treatment and prevention. Free field testing facilities for ascertaining deafness in infants have been developed and are being instaNed in the laboratories as space becomes available. During the period, complex hearing and oommunication disorders, especially those involving aphasic complications due to neurological defects, received particularly close attellltion following the return of the Assistant Director from the SltUdy of suCh iproblerns at Northwestern University in ,the Uni,ted States of America. Improved testing and psychodiagnostic methods were instituted in the la:boratories and various ,publications and addresses made which have increased practical collaboration with medical and educa'tional authorities concerned with this currently emphasised field. Audiological equipment for conducting the RainviHe Test, (10 assist in better differential diagnosis of conducHve from sensorineural hearing losses, was installed in each laboratory. La:tte<rly, a modified Bekesy type continuous recording audiometer has been imported and installed in the Sydney laboratory to assist in better differential diagnosis of retrococblear from coohlear hearing disorders. SimillaT equipment is lbeing obtained for other States. During 1961, the Commonwealth Commission for Employees' Compensation ad'Oplted the policy of having all Oommonwealth Hearing Compensation Cases referred to the laboratories for hearing and ear, nose and throat examina,tion. The laboratories have continued their inquiries in this field, ouIminating in the pUblication by the Director of an article on "Hearing Impairment and CompensaJtion" in the Journal of the Otolaryngological Society of Au&tralia. RFSEARCH AND DEVELOPMENT Research functions, specificaUy authorized under the Acoustic Laboratories Act, have had their importance re-asserted by the addition of physicai and psychological research 'Staff. 1642163.-6

110 ~o4se Control and Hearing Coosenation: Hearing protective devices developed hy the laboratories were evaluated and discussed with the Combined Defence Services Medical Committee, and field investigations have been proceeding. A compreihensive Laboratories' Report on "Hearing Conservation in Industrial Noise" has been released. Extensive noise ·control and hearing conservation work continued, partioularly in relation to the Navy and the R.A.A.F., the New South Wales and Victorian Departments of Railways, and the New South Wales DepaItment of Mines. An interdisciplinary investigation is being conducted into blue-metal quarries and briokpit noise and vibration in view of the economic importance eyf this field. FolIowing two years' work in the United States of America wilth a major noise consultant firm, a researoh psychologist has returned to the laboratories to contribute fhis e~perience and proceed with research into the effeots of impact noise on hearing and its relevance rto military and industrial problems.

The advice of the laboratories on the training of audiologists, audiometrists and speech therapists has been sought and discussions have proceeded with tertiary educational, hospital and other authorities. At present, there' is no comprehensive training of audiologists in Australia except within the Acoustic Laboratories. ULTRASONIC ECHOSCOPE APPARATUS U11"asonic eohoscope apparntus, using very high sound frequencies to produce echograms to enable the visualization of abdominal masses, has been developed and installed for research investigations at the Royail Hospital for Women. Paddington, New South Wales. Analogous instruments for neurological and eye investigations are being designed. The ultrasonic instrument for the ·treatment of giddiness in Meniere's Disease has been developed and used clinically. Follo,wing the Laboratories' proposal and an N.H. and M.R.C. recommendation, the senior physicist in charge of ultrasonic investigations has proceeded to the United States of America and Europe to examine latest developments overseas and to attend the World Cancer Congress in Moscow. During 1962 the Director of the laboratories attended international audiological, electro-acoustic and standards conferences in Europe and investigations in the United States of America.

PUBlJICATIONS AND LECl1JRFS 1961-1962 Reports ROCKS AltF.A NOISE. I. A. Rose. C.A..L. lnformlll Report, August, 1960. GENERAL PRINCIPLES OF THERAPY OF THE ApHASIAS. teachers, speech therapists et al. R. H. Farrant, -1961. Notes prepared for ~

CHrLDREN WITH APHASIC AND omER PSYCHONEUROLOOICAL COMMUNICATION DISORDERS IN NEW SoUTH WALES. R H. Farrant, C.A.L. Report No. 18, October. 1961. DESIGN OF WEAKLY FOCUSING ULTRASONIC TRANSDUCERS. G. Kossoff. C.A.L. Report No. 17, May, 1962.

111 EAR PROTECTIVB EQuIPMENT FOR ntE DEFENCE SERVICES.

R. A. Piesse,

C.A.L. Informal Report, February, 1962. HEARING CoNSERVATION IN

INDUSTRIAL NOISE.

R. A. Piesse, J. A. Rose and

N. E. Murray. C.A.L. Report No. 19, June, 1962.

ArtIcles THE STUDY OF THE COMMUNICATION DISORDERS AT NORTHWESTERN UNIVERSITY IN THE UNITED STATES OF AMERICA. R. H. Farrant, 1. Aust. Cou. Speech Ther., 1961, Vol. 11 (2), pp. 47-52. HEARING IMPAIRMENT AND COMPENSATION. N. E. Murray, I. Otolaryngol. EQUIPMENT.

Soc. Aust., 1962, Vol. 1 (2), pp. 135-145. CALIBRATION OF ULTRASONIC THERAPEUTIC

O.

Kossoff,

Acustica. 1962, Vol. 12 (2), pp. 84-90.

Papers and Addresses THE PSYCHODIAGNOSIS OF LANGUAGE DISORDERS IN CHILDREN. Address by R. H. Farrant to Annual Conference of Australian Branch of British Psychological Society. August, 1961. COMPARATIVE FACTOR ANALYSIS OF THE INTELLECTIVE ABILITIES OF DEAF VERSUS HEARING CHILDREN. Address by R. H. Farrant to Annual Conference of Australian Branch of British Psychological Society, August, 1961. COMMUNICATION DISORDERS IN CHILDREN; THEIR VARIETIES AND PSYCHOLOGICAL AsSESSMENT. Talk given by R. H. Farrant at Symposium on Communication disorders in children, Sydney, September, 1961. MODERN MANAGEMENT OF DEAFNESS. Part li: Hearing Aids. Lecture given by R. H. Farrant to Sydney University's Post Graduate medical committee's general revision course, 11th April, 1962. Lectures and demonstrations given to.North Sydney Branch of the Australian Association for Better Hearing. Parents and Teachers of the Subnormal Children's Welfare Association,

Crowle House. New South Wake School Medical Semce Nunea.

Occupational Health and Diploma of Public Health Graduate Medical Students.

Tecfmfcian Trainees, Department of Air. New South Wales Public Health Nursing Sisters.

6ydaey Hospital, &c.,

Audiome:tmcs.

Aha 10

~

similac aroupa in otlIer States.

112

SUMMARY OF CLINICAL ACTIVlI1FS 1st July, 1961 to 30th June. 1962

Repatriation .. Miscellaneous Social Services Army .. Royal Australian Air Navy .. Directors of Health Total

.. .. "

1961-62.

1. New Cases Attending Laboratories--.. .. .. Children

.. .. ..

..

Force .,

.. ..

.. .. ..

.,

.' .,

., .' .' ., ., .,

.. .. .. .. .. .. .. .. .. ..

.. ..

.. .. .. .. .. .. .. .. .. .. ..

..

.. .. .. ..

..

.. .. "

3,256 2,724 794 10 158 613 85 202 7,842 436 2,681 3,117 725 1,504 5 2

..

.. "

..

2. Civil Aviation ReferralsNew .. .. Repeat Tests .. Total

.. "

., ., .,

.. ..

..

"

3. Aid FittingsChildren and Health .. .. Repatriation .. Social Services .. Army .. Royal Australian Air Force ., Navy ..

.. .. "

"

., ., .,

..

.. ..

"

.,

., ., .,

.. ., .. .. .. ..

..

.. .

.. ..

.. .. ..

..

.. .. .. .. "

"

..

I

Total

..

.

2,237 9,399 1,970 3,879 23 35 12 4 15,322

4. Total Aids Currently Maintained a~ at 30th June, 1962., .. .. Repatriation .. .. ., ., .. .. .. Health ., .. Children .. " ., ., .. .. Social Services ., .. Army .. .. ., Royal Australian Air Force .. .. ., .. Navy .. .. ..

..

.. .. .. .,

..

.. ..

.. .. .. .. "

..

..

"

Total

..

"

.,

.,

..

..

NATIONAL BIOLOGICAL STANDARDS LABORATORY The National BiologioaJ Standards Laboratory which was established in Canberra in 1958 under the provision of the Therapeutic Substances RegWatioos continued its work of preparing standards. One of the main functions of t!b.e LalooraJtory is to prepare standards for therapeutic suibstances, both veterinary and human, for which no standards exist and for canying out work, and recommending modifications to existing standards to meet Australian conditions. The National Biological Standards Laboratory is divided into two broad disciplines-the Biological P·roducts Division and the Pharmaceutical Products Division. The Biological Produots Division is divided into four working lalboratories namely, Bacterial Products, Viral Products, Endocrine Products and

113

Antibiotics. The Pharmaceutical Products Division consists of Pharmaceutical Chemistry and Pharmacology laboratories. Each Division will be dealt with separately later in the rflPOrt. The first meeting of the Biological Products Standards Committee was held in Canberra in April, 1962. This Committee has been set up under the Therapeutic Substances Regulations Ito advise the Minister on 'the standard,s and matters relating to the standards of, antibiotics, antigens, antitoxins, blood derivatives, insulin products, sera, toxoids, vaccines and other biological products. AmDngst other things the CDmmittee gave consideration to the question of the batch numbering and expiry dating of aU produots of a biological nature and the views of the pharmaceutical industry have been sDught on the proposals before final recommendations are made. General: Since January, 1962, the National Biological Standards Laboratory has undertaken the examination of therapeutic agents recommended to the Minister by the Pharmaceutical Benefits Advisory Committee for inclusion as Pharmaceutica<l Benefits. This has been done with the twofold purpose of ensuring that only products of a satisfactory standard are provided at Commonwealth e~pense and as a cDntinuing medhanism whereby standards are provided fDr all such products where standal1ds do not exist. The latter aspect has been delayed by difficulties in recruiting qualified professional staff. BIOWGICAL PRODUCTS DIVISION Bacterial Products Section Although extensive advertising has heen undertaken in the United Kingdom, South Africa and other countries through the mediUilll of journals and the press a suitable applicant ,has not been foond to fiI.I the position of Officer-in-Charge of the Bacterial Products Laboratory. In the ciroumstances, sterility testing has been carried out by the Antibiotics Section. Antibiotics Section The main activity of the Antibiotics Products Laboratory was the examination of finished antibiotics prDdUICts available as Pharmaceutical Benefits, attention being concentrated on the more important antibiDtics such as the penicillins, tetracyclines and streptomycins. Some deficiencies in the official standards were found, many products having no requirements at aU, while many of the existing requirements are incomplete and ill-defined. Drafting of new or amended official requirements was commenced. Certification of products for eXpDrt, palticularly for UNI,CEF, was on a greatly increased scale compared with previous years. Many analyses were made on request from other CommonweaLth Departments and h'Ospitals. Advice and staff training was made available to' local manufacturers intending to carry out their own antibiotic assays. These activities have induced local manufacturers to' carry Dut much more quality control in Australia. Approximately 400 antibiotic samples were examined during the year. While shortcomings of a serious nature are rare, the incidence of minor non-cDmpliance with 'Official requirements or with reasonable corresponding requirements is ~till considera!ble. Besides biol'Ogical assays a variety of other tests have been camed out in the Laboratory, including determinatiDn 'Of moisture, tests fDr pyr'Ogens and toxicity and alkalinity Df glassware.

114

Sterility Testing Sterility testing was instituted on a routine basis during the year, and has since been carried out to maximum capacity. In all, some 470 products were examined for ste1rility, two only failing to pass the test. The original requirements for sterili!ty testing were found to be inadequate and considerable thought has been given to the framing of more suitable requirements. Liaison with mte pharmaceutical industry in relation to sterility testing has been considerable and mutually profitable.

The Endocrine Prodncts Section The Endocrine Products Section has sampled Insulin preparations from every manubcturer at present represented in Australia and assays have been carried out by the official methods. Since these methods require large numbers of animals and are very time-consuming research into alternate in vitro techniques has been commenced.

Highly purified 'Insulin has been obtained for a laboratory standard but the establishment of a National Standard will not 'be possible until adequate animal house facilities are available. Nevertheless the Laboratory has supplied Teference material to the C.S.I.R.O. and the Australian National University for research purposes. Progress has been made with 'the setting up of equipment for testing gonadotrophin and corticotrophin. Heparin products have been examined and a method of assay, which has far greater precision than the official one, has been developed. A report on the use of hormones in meat production has been made at the request of the National Health and Medical Research Council. The University of Sydney conferred the degree of Doctor of Science on the officer in charge of this section, for work published. He has also been invited by the National Science Foundation to present a paper at Houston, U.S.A., in 1963 on the " Endocrinology of Implantation ".

VIRAL PRODUCtS SECTION Work commenced on the modification of a building in the Commonwealth Serum Laboratories grounds, Melbourne, to house temporarily the Viral Products Section. It is proposed that when this building is completed the Laboratory will assume responsibility for the control testing of Salk Poliomyelitis Vaccine. In the field of Veterinary Vaccines, continued testing of Infectious Laryngotracheitis Vaccines has shown that vaccines produced in Australia have consistently met the virus potency standard defined previously. During the year a detailed interim standard for the vaccine, drawn up by the Viral Products Laboratory, has been discussed with the New South Wales Department of Agriculture and the manufacturers. Some modifications have been introduced to improve the safety of the vaccine.

115

PHARMACEU'I1CAL PRODUCfS DIVISION PHARMACEU'I1CAL CllEMISTRY The Pharmaceutical Chemistry Laboratory examined during the year 904 samples of 94 products from 78 manufacturers. Of these, 156 samples (17 per cent.) failed to conform to the appropriate standards. This is an improvement on the previous year when 24 per cent. of the 1,025 samples examined failed to meet a suitable standard. Approximately 9 per cent. of the failures were of a serious nature, such as low potency. The other failures were less serious, being due to incorrect labelling, non-uniformity of weight of tablets, &C. As well as routine samples, drugs and medicinal preparations which were submitted for inclusion in the Phannaceutical Benefits list were analysed. Only one serious failure was found and the recommendation made that this product be not listed. Listing has been deferred until the product passes further tests. Analyses for other Commonwealth Departments has continued, and close collaboration has been established with some of the State Departments of Agriculture. Work has begun on the definition of official standards where these do not exist or are inadequate at the moment. The collaborative study with industry on aspirin which commenced last year is continuing. Friendly relations with industry have been maintained. THE PHARMACOLOGY LABORATORY The Pharmacology Laboratory has undertaken, in the latter part of the year, the responsibility for pyrogen and toxicity testing for other laboratories. Some anomalies in the requirements for the absence of depressor activity in tetracycline antibiotics have been uncovered. At the request of hospital authorities, who feared undue toxic side-effects, a survey of the toxicity of streptomycin injections used in the treatment of Tuberculosis has been made. No significant evidence for such fears was found. An investigation of certain dental anaesthetics containing biologically active adjuvants disclosed incompatibilities in formulation which led to the withdrawal of import permission for one product. A pharmacological investigation of anomalous reactions with c,ertain eye drops revealed contamination with trace amounts of another potent alkaloid. The manufacturers immediately withdrew the offending batch of this product. The difficulties have since been overcome. Much effort was expended to evolve a satisfactory and simple assay for Rauwolfia alkaloids, with only partial success. Work in collaboration with the Analytical Chemistry Laboratory on thyroid extracts was placed before the National Health and Medical Research Council which, as a result, recommended 'the use of synthetic thyroxine in preference to the extracted gland, in medical practice. Recommendations ~or new standards for para aminosalicylic acid preparations have been formulated for presentation to the Therapeutic Substances Standards Committee.

116

PUBUCATIONS ADRENERGIC PROPERTIES OF THE CocKROACH CoRPUS CARDIACIUM. L. BartonBrowne, L. F. Dodson, J. K. Kiraly and E. S. Hodgson, General and ComparYJ'Jive Endocrinology, 1 : 232 (1961). STIMULATION OF UTERINE CoNTRACTION BY ExTRACTS OF THE CocKROACH. L. Barton-Browne, E. S. Hodgson and J. K. Kiraly, Periplaneta Sci., 134: 669 (1961). THYROID B.P. UNRELIABLE (Letter to the Editor). Wanless, Med. J. Aust., June 9, 1961. ,PROBLEMs ASSOCIATED WITH THYROID TABLETS. Pharm. (October 30, 1961.) J. K. Kiraly and J. W.

J. W. Wanless, Aust. J. of ~'y

INFLUENCE OF SPERMATOZOA ON THE CLEAVAGE RATE OF MOUSE EGGS. W. K. Whitten and C. P. Dagg, J. Exp. Zool., 48: 173 (1961).

COMMONWEALTH BUREAU OF DENTAL STANDARDS The Bureau of Dentall Standards is still working in close co-operation with the Standards Association of Australia and the Australian Dental Association for the production of first class dental materials. The position has been achieved where very few dentists will purchase dental materials that are not on the certified list or are not 'approved by the Bureau if the standard has not been completed. Importers use the Bureau to screen overseas products and will only handle them on acceptance of a favourable report. Australian subsidiaries of overseas companies and Australian manufacturers have received material assistance in setting up the production of a wide range of dental materials. The number of published standards is 21 and others are nearing completion. Some require extensive investigation and improvement in test equipment and methods. Standards ready for public critical review are elastomeric impression materials, cobalt-chromium alloy, gold solder and cold-processed resins for denture repairs. Still under committee review are silver solder, dental casting investment, stainless steel wires and dental burs. There are 154 dental products that have been accepted as certified materials. EDUCATION ACTIVITIES Assistance is being given in educating undergraduate and postgraduate dentists, dental mechanics and dental assistants in the properties, mixing and manipulation of dental materials. Three dentists are being assisted by advice and use of equipment for work towards a Doctorate and fourteen are being instructed for Master of Dental Science. Numerous lectures, displays and clinics have been given at congresses, conventions, study groups and to associated dental groups throughout Australian cities and articles have been published in local and overseas journals. Four of dlCI8 were reported in the American 1961162 Year book of Dentistry.

1

117

The Director spent more than four months abroad in America, Europe and Britain visiting dental institutions, research organizations and dental material manufacturers. He was awarded the Wilmer Souder Award from the International Association for Dental Research for outstanding and meritorious dental research. This is the first occasion it has been awarded outside the United States of America. The Director attended the International Dental Congress in Cologne, where he took an aotive part in discussions on International Standards for dental materials.

COMMONWEALTH HEALTH LABORATORIES The Commonwealth Health Laboratories are located at fifteen strategic areas in all States. In accordance with section 9 (1) (b) of the National Health Act the laboratories provide a clinicopathological diagnostic service for the medical practitioners and hospitals of the areas they serve. All laboratories functioned efficiently throughout the year in spite of staff difficulties due to the increasing ,demand on the service for serological tests concerned with blood transfusions, ,and the more detailed bacteriological investigations required following antituberculosis campaigns. The laboratories also assist in the epidemiological investigations of outbreaks of disease by collecting specimens and referring these to the central reference laboratories such as the World Health Organization Influenza Centre and other virus reference laboratories. Dr. R. A. Rimington, Townsville, and Dr. W. R. Horsfall, Cairns, presented important papers to the North Queensland Medical Oongress in June, 1962, concerning the health of the white man in the tropics. Dr. Rimington: A survey of Kerato Acanthoma incidence over five years. Dr. Horsfall: Haemoglobin values in pregnancy in a tropical area over five-year period. Laboratories are located at Albury, Alice Springs, Bendigo, Cairns, Canberra, Darwin, Hobart, Kalgoorlie, Launceston, Lismore, Port Pirie, Rockhampton, Tamworth, Toowoomba and Townsville. The number of pathological examinations and laboratory tests performed at ,each laboratory during the years 1960-61 and 1961-62 is as follows:Location 1960--61 1961-62

Albury Alice Springs 'Bendigo Cairns ,Canberra Darwin Hobart 'Kalgoorlie Launceston Lismore Port Pirie Rockhampton .. Tamworth 'Toowoomba Townsville

40,812 4,270 65,656 66,699 149,879 49,083 52,920 35,721 48,500 92,285 12,638 48,747 51,126 108,831 113,102

44,329 10,549 97,649 78,462 189,883 56,223 49,972 29,131 50,384 106,406 11,189 63,931 66,291 139,630 120,424

118

WORLD IlEALm ORGANIZATION The World Health Organization, fou·Jlded during 194&, is a specialized A~ncy­ of the United Nations. For practical purposes it is an indeperuknt body. The organs of W.H.O.are the World Health Assembly and RegiODal Committees the meetings of which are held annually; the Executive Board which meets twice a year and the Secretariat or staff of permanent officials headed by the Director-General of the Organization. The administrative control. is decentralized through the various regional offices of which there are six. Australia is assigned to the Western Pacific Region, the head-quarters of which have been established at Manila. Australia is a financial member of the World Health Organization and is represented annually at its Assembly and Regional Committees. The objective of this Organization is the attainment by all peoples of the highest level of health. Health information from W.H.O. is received by both the Commonwealth Departments of Health and &ternal Affairs. A close liaison exists between these two Departments. The information so received is correlated and forwarded to interested bodies in Australia and its Territories. Appropriate action on behalf of the Commonwealth is taken by the two Departments in consultation one with the other. F1FI'EENTII WORLD HEALm ASSEMBLY The Fifteenth World Health Assembly met in Gevena from 8th May to 25th May inclusive. The Australian delegation consisted o£Major-General W. D. Refshauge, Director-General of Health, leader; Mr. R. W. Furlonger, Head of the Australian Permanent Mission to the United Nations; Dr. R. C. Webb, Chief Medical Officer, AustraJia Home, London; Additional alternates wereDr. A. M. McArthur, Senior Medical OJlk:er; Dr. B. Royall, Chief Medical Officer, The Hague, Holland; Mr. P. G. F. Henderson, First Secretary and Consul, Australian ConsulateGeneral, Geneva. The World Health Organization had in 1962 a total membership of 115, the Assembly having welcomed Western Samoa as a new Member, and Jamaica and Uganda as Associate Members. REGIONAL COMMITfEE FOR THE WESTERN PACIF1C The Twelfth Session of the Regional Committee for the Western Pacific was held in Wellington, New Zealand, from 31st August to 5th September, 1961. The meeting was formally opened by the Prime Minister for New Zealand. Mr. K. 1. Holyoake, in the presence of the Minister for Health, Mr. N. L. Shelton, and the Assistant Director-General of W.H.O., Dr. P. M. Kaul, who represented the Director-General of W.H.O.

119

The Australian representatives were Dr. H. B. Downes, Commonwealth Department of Health, Canberra, and Mr. Robert Harris, representing the Australian Dental Association. Other non-governmental organizations in official relations with W.H.O. were present, these included Dr. Allan Stoller (World Federation of Mental Health) from Melbourne, and Dr. Ross-Smith (World Medical Association) of Sydney.

Tedmiul DIInssiom: The subject foe the technical discussions was "Dental Health". The discussions were well prepared and informative. The presence of a representative of the Australian Dental Association at this Regional Committee Meeting was fully justified. It demonstrated the active interest in the particular problems of dental health and dental services in the Region and its representative was able to contribute valuable information on long-term Australion research on the aetiology and control of dental caries in relation to diets and on ethnic and geographical distribution of dental caries and periodontal disease in an Asiatic country (fhailand).

COMMONWEALTH GRANTS AUSTRALIAN RED CROSS SOCIETY-BLOOD lRANSFUSlON SERVICE One of the most important of the services rendered by the Australian Red Cross Society is its Blood Transfusion Service which operates in all States and Territories of the Commonwealth. Since 1954 the Commonwealth has made an annual grant to each State Government, equal to 30 pee cent. of the certifiable operating costs of the Blood Transfusion Service incurred by the Society in each State, on the condition that 60 per cent. of the operating costs is met by the State concerned, leaving 10 per cent. of the expense to be met by the Society. Details of grants made by the Commonwealth during the period under review are included in the following table:State (Based on Expenditure for year enOOd 30th June. 1961) 1961--62

New South Wales Victoria .. Queensland South Australia Western Australia Tasmania Total

£ 47,260 52,515 33,647 19,231 16,115 5,776 174,544

ROYAL FLYING DOCTOR SERVICE The Royal Flying Doctor Service of Australia is conducted by a Federal Council comprised of representatives of six sections, namely: Queensland, Victoria, New South Wales, South Australia, Western Australia and the Eastern Goldfields (W.A.).

120

The work of all of the Councillors and the bodies which support and assist the administration is purely voluntary. The work of the Flying Doctor Service is aimed at providing medical services 10 the white and aboriginal populations in isolated areas and, in addition, as incidental to its main activitie'S, wireless communications are maintained and utilized for 'Social, private and business uses, and from time to time special purposes work is undertaken in connexion with 1100d relief, searching for lost parties and co-ordinating cattle movements. The service is not conducted with a view to profit. The service operates in Queensland, New South Wales, South Australia, Western Australia and the Eastern Goldfields. Charges are made in some sections of the service on a fixed basis while other sections do not make any fixed scale of charges but seek contributions from those who use their services, according to ability to pay. In some sections there is an arrangement to levy a fixed annual charge per person on graziers in certain areas. The service has grown very considerably in recent years. The Commonwealth has been making grants available towards the cost of conducting the Flying Doctor Service since 1936. The Commonwealth grant in 1961-62 was £67,494. This provided for £40,000 towards the cost of operational expenses and £27,494 towards the cost of capital expenses. The Commonwealth also continued to meet the cost of the contents of standard medicine chests supplied for use in the various centres serviced by the Royal Flying Doctor Service when doctors give medical advice by radio. HOME NURSING SUBSIDY SCHEME Home Nursing Subsidy Act 1956: The Home Nursing Subsidy Scheme which came into operation on 1st January, 1957, was designed to assist in the extension of home nursing activities, either by the expansion of existing home nursing organizations or the formation of new ones. To be eligible for a subsidy, an organization must provide a home nursing service, be a non-profit-making organization, employ registered nurses and be in receipt of assistance from a State Government. Subsidy payments are based on the number of nurses employed over and above the number employed during September, 1956, in the case of existing organizations and on the total number of registered nurses employed by newly formed organizations. A subsidy at the rate of £1,000 per annum is paid in respect of each additional nurse employed in the first instance and at the rate of £500 per annum in respect of nurses employed by newly formed organizations. The annual subsidy paid by the Commonwealth since the inception of the Home Nursing SubsidY Scheme was£ 1,807 1956-57 18,135 1957-58 34,538 1958-59 53,616 1959-60 78,014 1960-61 107,668 1961-62

,.

121

FREE MILK FOR SCHOOL CIDLDREN The States Grants (Milk jor School Children) Act 1950 makes provision for the Commonwealth to subsidize the States for the cost of providing free milk to school children. The State governments administer this scheme and the Commonwealth reimburses the cost of the milk supplied, and half the cost of any incidental expenditure. The subsidy for 1961-62 was £3,741,638, which permitted the free distribution of one-third of a pint of milk daily to approximately 1,618,000 school children attending public and private primary schools, kindergartens, creches, and aboriginal missions throughout Australia. There have been no changes in legislation affecting the supply of free milk to' school children during the year. Expenditure by the Commonwealth on the Free Milk Scheme since its commencement in 1950-51 is shown in Table 1 on page 22. However, these figures do not include amounts reimbursed to the States in respect of 50 per cent. ot capital and incidental expenditure, which was £11,801 for 1961-62.

, ;'"

.

MENTAL INSTITUTIONS Earlier Commonwealth action in the field of mental health is summarized in the Report covering the period ended 30th June, 1956. As there recorded. the Commonwealth Government, in June, 1955, made an offer to the States of a grant of £10,000,000 for the purpose of encouraging a capital expenditure programme of £30,000,000. The offer was made on the basis of the provision of £1 by the Commonwealth for every £2 by the States. All the States accepted the offer made by the Commonwealth and agreed to the grant being divided on a population basis which resulted in the States being eligible for the following amounts:£ 3,830,000 New South Wales Victoria 2,740,000 Queensland ., 1,460,000 895,000 South Australia 720,000 Western Australia 355,000 Tasmania 10,000,000 In November, 1955, the Commonwealth Parliament passed the States Grants (Mental Institutions) Act which provided the necessary legislation for the above grants to be made available tC' the States. Expenditure must have the prior approval of the Minister for Health. The grant is paid to the States as a part reimbursement of their expenditure and therefore the amount of Commonwealth contribution, within the above totals, is dependent upon the capital expenditure made by the States in oonnexion with their mental hospitals. Details of the expenditure by the States each year and the amount of Commonwealth grants paid to the States since the inception of the scheme are shown in Table XVI. on page 36. By Authority: A. J. ARTHUR, Commonwealth Government Printer, Canberra. .•..f--

I ..

1

. 1 Articles and other material published in this Journal may be reproduced provided dtle acknowledgment is made. Opinions expressed in these articles and other material should not be accepted necessarily as statements of policy of the Commonwealth Department of Health.

,

COMMONWEALTH

OF

AUSTRALIA

HEALTH JOURNAL OF THE DEPARTMENT OF HEALTH

By Authority;

MINISTER FOR HEALTH Senator the Hon. HARRIE W. WADE

. ISSUED QUARTERLY

VOLUME 13, No.2

JUNE, 1963

CONTENTS: Amc~

hp Australian 35 38

Diagnosis of Smallpox Explained to Doctors Sirex Wasp Campaign to Continue ____

Ministers Discuss Tuberculosis Campaign Challenges for Medical Practitioner in Antarctic American Experience Justifies Ban on SafHower Seed Death of Dr. C. A. M. Heydon National Fitness Leaders' Course Proposed ____ Valuable Results From Survey of Illness Precautions Against Foot and Mouth Disease Quarantine Delays Eliminated at New Oil Port Uniformity Sought in Medical Practice Australian Capital Territory Health Services Dramatic Rescue Mission in Northern Territory National Health Statistics ILLUSTRATIONS

39 41 "

45 46

48 49 50 52 54

55 60 61

Laboratory at Madras Infectious Diseases Hospital ____ Map of Antarctica Russian Visitors at Mawson Base "Auster" Emperor Penguin Rookery, near Mawson &~

35 41 42

« 48 52 54 57 ~

Commonwealth Directors of Health Confer ____ Quarantine Delays Eliminated at New Oil Port Medical Benefits Problem Discussed at Directors' Conference New Infant Health Centre Opens at Darwin

COVER ____________________________________

MEDICAL RESEARCH in the Antarctic. A physiological experiment at Mawson. The subiect is exposed to an air temperature of 50° F. for n~ hours. (Article, page 41.) ANARE photograph by J. M. Bechervaise.

Journal Health-June, 1963

1

I

THE LABORATORY of the Infectious Diseases Hospital at Tondiarpet, Madras. Photograph by Dr. R. Newton.

:.r

DIFFICUL TIES IN DIAGNOSIS OF SMALLPOX EXPLAINED TO AUSTRALIAN DOCTORS Invaluable Experience Gained In Visits to Madras By B. W. Royall·

THE ARRANGEMENT for a number of Commonwealth medical officers to travel to India to gain first-hand experience in the practical problems of Smallpox diagnosis and control was continued early this year with two separate groups spending two weeks each in the Madras area. In February a group comprised Dr. L. C. Rowan, Senior Medical Officer of the School of Public Health and Tropical Medicine, Sydney, Dr. B. E. Welton of Sydney and Dr. R. R. Bull of Sydney. A second group went overseas in March. It consisted of Dr. B. W. Royall, Acting Director of Health, Tasmania, Dr. M. A. Walker, Adelaide and Dr. R. Newton, Melbourne. Dr. R. S. Enders of Wewak, Territory of Papua and New Guinea, accompanied this group. In these days of fast air travel, the risk of Smallpox introduction to Australia presents increasing need fo1' the vigilance of specially trained quarantine staff. A fine w01'kin~ relationship to meet Australia's needs in this regard has been built up over a number of years by arrangement with the Commissioner of the Corporation of Madras, Mr. R. Balasubramanian, and the Health Officer, Dr. V. B. Sundarababa, for study under the direction of Dr. A. Ramachandra Rao, M.B., B.S .. B.Sc., Superintendent of the Infectious Diseases Hospital at Tondiarpet. Dr. Rao is a world authority and a WHO consultant on Smallpox. • 0

Dr. B. W. Royall is Acting Commonwealth Director of Health, Tasmania.

Tournal Health-Tune. 1963

35

High Incidence of Smallpox in Madras State In Madras State nearly 70 out of every 100,000 of the population died of Smallpox in the decade 1911 to 1920. This rate has steadily decreased to 10 per 100,000 during the period 1951-1960. However it has been noted that the disease flares up in a severe epidemic for~ once in five or six· years. There is also a definite seasonal trend with maximum incidence in the first quarter of the year. The periodic appearance of the disease in epidemic form has been attributed to several factors, namely, accumulation of susceptibles as a result of a defective system of birth registration, indifferent and faulty technique of vaccination, waning immunity of primary vaccination and absence of a definite programme of re-vaccination. Vaccination affords complete protection against the disease for a period of only three years. The Government of India has constituted a Central Expert Committee to suggest ways and means of eradicating the disease, as well as receiving assistance from WHO. In order to achieve the eradication objective, pilot projects are being conducted to estimate the approximate requirements of the eradication progtramme in respect of manpower, finance, transport, etc. Clinical Aspects of Smallpox From more than 20 years experience with the diagnosis and management of over 20,000 cases of Smallpox in Madras, Dr. Rao was able to demonstrate from some 50 cases in the hospital the importance of the nature of this distinct disease entity. He pointed out that all cases seen were either Variola Major or Modified Smallpox and that Variola Minor (Aastrim) did not occur in the Madras area nor, to his knowledge, in India. Dr. Rao described the Smallpox disease process as occurring in the following sequence: Invasion and incubation; onset of prodromata; eruption; clinical course; convalescence; and complications. Depending on the type of lesions and the severity of the rash, the disease may be classified into several varieties. Dr. Rao said it could not be assumed that the less the immunity of an individual the greater the likelihood of his developing a severe attack, but the converse might be true. There are several other factors which influence the degree of severity such as the intensity of exposure, the dose of the infection, besides the immunity of the person. Dr. Rao emphasised the importance of correct diagnosis for the Indian clinician. However, he stressed that for the Australian Quarantine Officer the correct diagnosis of smallpox was essential in order that this disease should not gain entry into a country where it is non-existent at the present time. Need to be Constantly Alert In the diagnosis of Smallpox, Dr. Rao directed prime attention to the following factors: (i) In every case one should put himself the question "Can this ~e a cas~ .o.f Smallpox?" The answer is to be obtained by systematIcally ehCitIng the correct history and studying the clinical features. 36 Journal Health-June. 1963

....

~)

'(

....

-'

j

(ii) Vaccinal status should be studied next. If a patient presents evidence of a successful recent vaccination within two years before the attack, one should consider carefully bebre the case is labelled as Smallpox. (iii) History of exposure to infection. This may not be always available but a positive association is probably significant. (iv) Symptoms before the rash appears. Even the mildest cases of Smallpox invariably give definite and more or less a typical prodomal history of fever, headache, backache, vomiting, etc., and the rash appearing on the fourth day of fever. There may be a very few exceptions but usually this history is very reliable and helpful in the diagnosis. (v) Study of the rash. Careful systematic examination of the whole body in a good light should be made in all cases. The rash of Smallpox has definite characteristics which are important in the clinical diagnosis of a case. Dr. Rao described the essential features under the following headings. l. The order of appearance of the rash. 2. The distribution of the rash on the body. 3. The characteristics of the skin eruptions. 4. The evolution of the rash. Difficulties In Diagnosis Certain unusual types of Smallpox can cause confusion for the doctor confronted with such a case. For example in a severe type, the patient may be overwhelmed and die before the rash has time to develop, in other cases the smallpox rash may be modified and finally smallpox may occur without any rash appearing. Further difficulty in diagnosis is experienced because other diseases may closely resemble Smallpox. Such diseases include Chicken Pox, Measles, Scarlet Fever, Typhoid Fever and Syphilis. The rashes due to drugs and allergic conditions may also resemble Smallpox. Impo.rtance of Vaccination in Madras Dr. Rao discussed the problems of Smallpox control in Madras City, where the disease exists throughout the whole of the year. The endemic level is about 500 to 1,000 cases each year. He emphasised the importance of notification of an cases, early confirmation of diagnosis, isolation and treatment, disinfection measures, together with vaccination on the widest possible scale. Dr. Rao indicated that calf lymph prepared in India gave almost 100 per cent "takes" on primary vaccination. However a recent study had cast some doubt on the effectiveness of the calf lymph vaccine for re-vaccination. It seems, under conditions prevailing in the Madras area, among them varying temperatures and lack of storage facilities, particularly in outlying villages, that liquid vaccine is not the solution to India's vaccination problem. A freeze-dried vaccine now being prepared from calf lymph at the King Institute, Guindy, Madras, is less dependent on low temperature storage, remaining potent for a very much longer period. Freeze-dried vaccine is likely to prove more effective and mare economical for future vaccination programmes in India. Journal Health-June, 1963

37

The Director Dr. S. Govindarajan and the Assistant Director, Dr. (Mrs.) Amb~jam Natarajan demonstrated the preparation of both types of vaccine during the visit to King Institute.

Valuable Work at Rural Health Unit A visit to the Rural Health Unit and Orientation Training Centre, Poonamallee, provided a further highlight. Here Dr. S. Subbiah and Dr. K. Gokale explained various aspects of health work undertaken at Poonamallee. These special units, in addition to normal health functions, were equipped to carry out training of young graduates in public health work and to conduct research into the best methods of combating health problems in rural areas where the majority of the population of Madras State is located. The success of the visits further cemented the strong Commonwealth ties which link India and Australia.

SIREX WASP CAMPAIGN TO CONTINUE FOR AT LEAST ANOTHER YEAR THE NATIONAL campaign against the Sirex Wasp has been extended for the remainder of this financial year and throughout 1963-64. The Commonwealth has undertaken to join with the State Governments in an extension of the agreement reached at the Premiers Conference in February, 1962, for the Commonwealth and the States to expend £200,000 on a £ for £ basis, on eradication of the Sirex Wasp wherever it appears; also on research. The Commonwealth and the State Governments agreed in March to expend a further £200,000 on the same basis, £20,000 to be spent during the remainder of the current financial year, and the remaining £180,000 during 1963-64. Each State's contribution will continue to be related to its area of State-owned susceptible softwood plantations. The effectiveness of the current survey and eradication programme and research measures will be evaluated late this year, to assist the determination of future policy. The spread of the Sirex Wasp appears to have been confined to Victoria and Tasmania, where many thousands of infested trees have been destroyed. More than three million acres of forest have been carefully searched for infestations. Meanwhile active research is being conducted into the most effective methods of control, including the use of parasites. The States have accepted fully the Commonwealth's view that continuation of the national camoaign is the most effective method available to protect Australia's 527,000 acres of pine forests, whose value as a national asset is estimated to be at least £80 million.

ANTI-MALARIA SPRAYING ON GUADALCANAL THE ENTIRE island of Guadalcanal, in the British Solomon Islands Protectorate, has been given its first protective layer of anti-malaria spr~ying. Ov~r 5,000 houses have been sprayed, oroviding protection agamst malana to more than 15,000 people on the island. WHO has assigned a team to help the Protectorate Government carry out the fight against this disease. 38

Journal Health-June, 1963

MINISTERS DISCUSS PLANS TO INJECT NEW VIGOUR INTO TUBERCULOSIS CAMPAIGN Compulsory Mass X-ray Surveys Declared Essential

STEPS to achieve greater uniformity and infuse additional vigour into the National Tuberculosis Campaign were agreed upon at a conference of State Ministers for Health, convened by the Commonwealth Minister for Health, Senator Wade, at Melbourne on April 18. Ministers who attended the conference were Mr. R. W. Mack (Victoria), Dr. H. W. Noble (Queensland), Sir Lyell McEwin (South Australia), Mr. Ross Hutchinson (Western Australia), and Mr. W. D. McNeil (Tasmania). The Under-Secretary of the New South Wales Department of Health, Mr. }. D. Rimes, represented his Minister, Mr. W. F. Sheahan, who was unable to attend. The Ministers and Mr. Rimes were accompanied by the State Directors of Tuberculosis and other departmental officials. Senator Wade was accompanied by the Director-General of Health, Dr. W. D. Refshauge, the Commonwealth Director of Tuberculosis, Dr. Alan King and other Commonwealth officers. No Room For Complacency

Opening the discussions, Senator Wade reminded the conference that this was the first occasion on which the Ministers had conferred on problems of tuberculosis control since the meeting presaging the national campaign in 1948. He said great progress had been made since that time. The death rate from tuberculosis had been sharply reduced and this infectious disease was no longer the grave threat it once represented. However, annual notifications of new cases were still high, and disturbing trends which had presented themselves recently had suggested that some of the ground made during the 14 years was not necessarily being held. For example, whereas 3,570 new cases of tuberculosis had been reported during 1961, there had been 3,829 notifications during 1962. From 3,500 to 4,000 cases had been located annually over the last five years. While these figures could to some extent reflect more efficient case-finding, it was evident that there was no room for apathy if they were to eradicate tuberculosis and a need existed to examine the methods of control that were being used. States Provided With "Weapons"

'!

The Commonwealth had provided the States with what might be described as the weapons with which to fight tuberculosis, and since 1948 it had expended more than £80 million in this field. Success in the campaign must, however, depend on what use th~ States made of these weapons. He felt that the situation with which thev were confronted warranted a reappraisal of the campaign and perhaps a new approach involving the adoption of greater uniformity and certainly new vigour. He hoped the conference would mean the initiation of a new era in the national fight against tuberculosis. Journal Health-June, 1963 39

The conference then embarked on a round-table discussion, without any set agenda, during which many suggestions for the future conduct of the campaign were debated.

Compulsory Surveys Essential The Ministers agreed unanimously that mass chest X-ray surveys were essential as the most effective means of discovering new or hitherto unsuspected cases of tuberculosis, that attendance at surveys should be compulsory and that compulsion should be enforced, if necessary by prosecutions, especially of persons who wilfully or negligently declined to attend. The conference also endorsed the desirability of conducting routine X-ray examinations of hospital patients, and' urged doctors in private practice to remain constantly alert for patients with symptoms of tuberculosis; not to rely entirely on periodic mass X-ray surveys to discover every unknown case. It was agreed that State Governments should take whatever steps were necessary to provide sufficient chest clinic facilities for the convenient examination and treatment of patients, maintaining adequate full-time medical staffs for such purposes.

Commonwealth Ready To Meet Cost Senator Wade emphasised that the Commonwealth was ready, under the terms of the Tuberculosis Arrangement, to meet the cost of providing all such facilities, provided they were formally approved. The importance of maintaining efficient case registers was stressed. It was agreed that the desirable objective was that every notified case should be registered, and kept "in sight", by means of uniform State registers. An annual "audit" of cases previously notified was regarded as essential as relapse was not uncommon, and patients could also be lost track of during the period of supervision that was essential from the point of view of public health. Senator Wade undertook to submit to the Commonwealth Government a request from the State Ministers that the currency of the Tuberculosis Agreement should be extended for five years. At present the agreement is extended indefinitely, but subject to discontinuance on six months notice by either the Commonwealth or an individual State Government, after June 30 this year. The State Ministers' view was that there would be more encouragement to plan ahead if there were a greater degree of permanence in the arrangement.

YAWS PRESENTS VAST INTERNATIONAL PROBLEM FROM 1950 TO 1962, 285 million persons have been examined in internationally assisted campaigns against yaws. Some 38 million of them were treated with long-acting penicillin, which is highly effective against this crippling disease. In campaign areas, the proportion of active cases in the population dropped from between 10 and 20 per cent a decade ago to generally less than 0.5 per cent by the end of 1962. Some 100 million people, however, still live at risk in endemic areas where little or no systematic work has yet been undertaken. 40

Journal Health-June, 196.'3

.HEARD ISLAND

MACQUARIE -ISLAND

SOUND

SOUTH AMERICA

MANY CHALLENGES FOR THE MEDICAL PRACTITIONER IN THE ANTARCTIC From Operations and Accidents to Veterinary Work By G. M. BuddO

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EVERY YEAR SOME 70 Australians winter in the Antarctic, as members of the Australian National Antarctic Research Expeditions (ANARE). Three of the ANARE stations-Mawson, Davis and Wilkes-are situated on the Antarctic continent, and the fourth is on Macquarie Island (see map). A fifth station, on Heard Island, has been abandoned since 1955, although it was reoccupied for six weeks this summer. The size of the wintering parties at the four stations currently occupied ranges from nine to 25 men. In each party is a medical officer, who is responsible for the health of the party. Each station is well supplied with medical equipment. Expedition members are carefully selected, the climate is a healthy one, and so the volume of day-to-day medical work is not large. Most of the time the doctor treats a limited range of ailments, few of which are really serious. Infections are unusual, except during the annual relief operation. o Dr. G. M. Budd, M.B., B.S., a senior medical officer on the staff of the School of Public Health and Tropical Medkine, Sydney, recently returned from one of several missions to' the Antarctic with ANARE.

Journal Health-June, 1963

41

Versatility fa Important Minor injuries are common, since life in the Antarctic involves a good deal of manual labour. Dentistry plays a large part in the doctor's practice, and there is a certain amount of veterinary work, on sledge dogs in Antarctica and on domestic animals at Macquarie Island. Not all of the conditions encountered are minor ones. The medical officer must be prepared to deal with any of a wide range of serious illnesses and accidents. Multiple injuries, severe burns, cancer, schizophrenia, paralytic poliomyelitis and intracranial haemorrhage have all occurred; appendicitis is common. Fatal accidents have occurred, and there have been many narrow escapes. The main threats to life are carbon monoxide and fire at the stations; crevasses and breakouts of the sea ice in the field. Little Opportunity For Evacuation There is virtually no chance of evacuating a seriously ill patient from any Australian Antarctic station, other than Macquarie Island, except during six weeks in midsummer (by ship), and outside help. is limited to advice sent by telegram. In a grave emergency one can request help from the Soviet stations some 400 to 800 miles away, but Antarctic conditions of daylight, weather and radio communications are often unsuitable for flying, and frequently make it quite impossible. Emergency flights are especially dangerous, and so one TWO RUSSIAN VISITORS, dogsledging with Australians at Mawson Base, enjoy a coffee break. Note the difference in their protective clothing. Dr. C. M. Budd, author of this article, is standing in the centre of the group, with cup in hand. ANARE photograph by J. M. Bechervaise.

K

tries to avoid having to request them. By voluntarily undergoing appendicectomy before leaving Australia, ANARE medical officers dispose of one common cause of such emergencies. Two men in each party receive a short training course in a Melbourne hospital to enable them to assist at surgical operations and to administer anaesthetics under supervision. Apart from this help during operations, the medical officer works alone. Whatever his practice may lack in numbers and variety, it compensates for in the comprehensiveness of the care required. He is personally responsible for every aspect of the care of the patient-from taking and interpreting the X-rays (after first arranging with the engineer for a suitable power supply, and mixing the developer) to carrying trays of food, making beds and cleaning bedpans. On occasion he has even had to manufacture his own surgical instruments. More than anything else, the Antarctic teaches respect for the fundamental aspects of medicine. "Public Health" Problema Unlike the Arctic, the Antarctic has no mosquitoes or other insects likely to transmit disease to man. The main public health problems are water supply and waste disposal, both being made difficult by the fact that water exists only in the solid state. At most stations the water supply is still a matter of cutting snow blocks with handsaw and spade and carrying them by hand to indoor melting tanks, and waste disposal a matter of carrying it in buckets to the chosen dumping areas. Outbreaks of enteric infection, although unusual, are always possible, especially during field trips (when sanitation becomes even more primitive and the consequences of illness doubly serious) and during the annual relief operation, when sanitary and messing facilities become overcrowded by the large number of newcomers. A case of paralytic poliomyelitis during a rec~nt relief operation emphasised the potential hazard, but fortunately no further recognizable cases occurred on that occasion. Opportunity fo.r Research Work Although on occasion the medical officer may be very busy indeed, usually his practice leaves him with enough time to undertake one or more research projects. An Antarctic wintering party is a useful group of subjects for medical research, for it is a "captive population"-complete with captive observer! It is a group of healthy men, confined for a year or more in a limited area and living a simple life, the main features of which can be readily documented. Longitudinal studies-in which repeated observations are made on the same subjects over long periods of time-are therefore more easily carried out than they are in the more complicated environment of "civilisaion". As would be expected, much of the work done relates to human responses to a cold climate, but many studies are not necessarily concerned with the cold at all. The isolation in which the men live makes studies in epidemiology and psychology of great interest. Another flroup of studies has been described as "fundamental hum:ln biology": serial observations of blood pressure, body weight, fat thickness, body temperature, etc., have shown seasonal rhythms Journal Health-June, 1963

43

which mayor may not be related to the seasonal changes in the environment. Correlations between the variables measured are of interestsuch as the high correlation observed on one expedition between blood pressure and fat thickness. Work in these fields is planned by members of the Environmental Health Section of the School of Public Health and Tropical Medicine, in the University of Sydney. Advice and assistance are given by other sections of the School, and particularly valuable help has been given by the Biochemistry Section. ANARE medical officers are attached to the School to prepare their programmes, and to analyse the results of their work on their return from the Antarctic. By studying, in this way, human responses to environments as extreme as the tropics and the Antarctic, we learn more about the THE "AUSTER" Empt·ror Penguin rookery, near Mawson, in late winter. It is midday and the sun is just above the horizon. ANARE photograph by C. M. Budd.

...

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basic mechanisms that govern responses to the less extreme, but equally important, environment in which most of us live. Personal Aspects of Expedition Life Probably the most valuable gain to be derived from a year in the Antarctic is the enrichment of one's personal experience. Almost without exception, men look back with pleasure on the interest and adventure ot the expedition's activities; on the satisfaction derived from being part of such a tightly integrated community; on the work done in the face of adverse circumstances; on the stimulating contacts with expeditions of other nationalities; on the charm of the antarctic animal populations; and above all, on the beauty and grandeur of the country itself.

AMERICAN EXPERIENCE JUSTIFIES BAN ON SAFFLOWER SEED IMPORTS THE COMMONWEALTH Government's refusal, last year, to permit the bulk importation from the United States of· some 500 tons of safHower seed for crop development in Australia has been shown to be fully justified. The United States Department of Agriculture recently announced that the discovery, for the first time, of Fusarium wilt disease in the Californian safHower crop had now been attributed to a seed-borne fungus. United States growers were warned to be extremely cautious to plant in future only seed produced in fields known to be free from wilt. Otherwise California's whole 200,OOO-acre crop would be endangered. The U.S. Department of Agriculture stated that there was no reliable seed treatment against the fungus and no known wilt-resistant variety of safHower. The oil from safHower seed is used principally in the paint and vArnish-making industry. The safHower-growing industry is developjng steadily in Australia. However, to prevent this development being handicapped by the introduction of diseases encountered in crops overseas, the Plant Quarantine Division of the Commonwealth Department of Health has consistently required that initial Australian plantings be made only from treated seed, grown in Australia under quarantine conditions. These plantings have been made by the Queensland Department of Agriculture and the C.S.I.R.O., which have made seed obtained from these crops available to Australian growers. It is expected that Australian growers will soon be producing sufficient seed for Australian requirements and perhaps for export. The adoption of a similar policy has paid handsome dividends in the development of the rice industry in New South Wales, which is the only commercial rice-growing area in the world free from disease. Last year an American company proposed the bulk importation of seed, in a quantity far beyond the practicability of quarantine supervision, to develop the industry on a large scale on the Darling Downs in Queensland, and other southern wheat-growing areas. The Commonwealth has been strongly supported by the Queensland Department of Agriculture in refusing permission for this bulk importation. Journal Health-June, 1963

45

DEATH AT 81 OF DR. G. A. M. HEYDON Distinguished Pioneer in Science of Parasitology and Generous Benefactor DR. GEORGE Aloysius Mackinson Heydon, M.C., B.A., M.B., Ch.M., D.P.H., D.T.M. & H., F.R.A:C.P., for many years an officer of the Commonwealth Health Department, died in Sydney, after a short illness, on April 27. He was aged 81. Until his retirement in 1946 he was Lecturer in Parasitology at the School of Public Health and Tropical Medicine, University of Sydney. After receiving his secondary education in Sydney and England, Dr. Heydon graduated in Arts at Cambridge in 1903. He then returned to Sydney for his medical studies, graduating in 1908. He was Resident Medical Officer at St. Vincent's Hospital, and later Assistant Medical Officer at the Coast Hospital, Sydney. In 1913 he was in medical charge of the Quarantine Hospital established by the N.S.W. Health Department for the reception (!)f Smallpox patients during a current epidemic. Service in Two Wars In World War I Dr. Heydon served with the A.I.F. in Gallipoli and France. For practically the duration of the war he was Regimental Medical Officer of the 8th Battalion. He attained the rank of Major, was wounded, and received the award of the M.e. He again served in World War II, this time as Consulting Parasitologist to Army Headquarters. Dr. Heydon joined the Commonwealth Public Service in 1921, when he was appointed Medical Officer-in-Charge of the newlyestablished Health Laboratory at Rabaul, capital of the Mandated Territory of New Guinea. He had prepared himself for such a poH, prior to returning to Australia at the end of the war, by obtaining the Diploma in Tropical Medicine and Hygiene and the Diploma in Public Health in Britain. Overcoming many difficulties, he established this laboratory as an invaluable part of the medical services of the Territory. Much pioneer work was performed on the definition of the local disease pattern, investigations were carried out on malaria, hookworm, dysentery, tuberculosis and other diseases, and early observations were made on the blood grouping of New Guinea natives. Valuable Contribution to Malaria Control A particularly valuable contribution, made in 1923, was the definition, by dissection and breeding experiments, of Anopheles punctulatus as the most important local vector of malaria. This at once placed local malaria-control measures on a sound footing and gradually proved to have widespread implications in Melanesia. In 1925 Dr. Heydon transferred from New Guinea to the Australian Institute of Tropical Medicine in Townsville, where, to a continuance of his laboratory work, was added the teaching of poshrraduate students for the Australian Diploma of Tropical Medicine. He succeeded Dr. P. A. Maplestone as Parasitologist to the Institute, and laid the foundations of his future eminence in parasitology. 46

Journal Health-June, 1963

On the incorporation of the Institute into the newly-founded Schoo! of t'ubJic l1ealth and Tropical Medicine at Sydney University in It:J30, Dr. Heydon became .Parasitologist to the School and UniverSIty Lecturer iQ Medical Parasitology. Here he became affectionately known to successive classes of graduate students in Tropical Medicme and .Public Health until his retirement in 1946. He was a devoted worker and added much to the knowledge of his subject, particularly in regard to the human protozoa and helminths of Australia and its Territories. Important Research Contributions His research work ranged widely over this field and produced imponant contributions, particularly on malaria, which included the detinition of the main anopheline vectors in both Melanesia and North Queensland, filaria, Unchocerca gibsoni and hookworms. As an Australian authority on parasitology, his advice and assistance were in constant demand and his services were at all times freely and gladly available. He was consultant in parasitology to the Commonwealth Health Laboratories and to many institutions. Enthusiastic Interest in Aviation After learning to fly in 1935, at the age of 53, Dr. Heydon became a skilled light aircraft pilot. He owned six different aeroplanes at various stages of his flying activity and in 1937 was runner-up of the Royal Aero Club of N.S.W. Championship Contest, against much younger pilots. He held a private pilofs licence up to the age of 74. About 1936 he teok up gliding with the same enthusiasm and was an Australian pioneer of this sport. Later he was the first in this country to tow a glider into the air by means of a powered aircraft, and one of the first to demonstrate the possibilities of cross-country soaring, by flying 101 miles from Narromine to near Condobolin. He was a founder and benefactor of the Sydney Soaring Club and contributed largely to the formation of the Gliding Federation of Australia, which controls gliding in Australia. He enabled many young pilots to learn to fly and glide and these, like his students remember him for his generous help and encouragement. Generous Support to Education Dr. Heydon was a generous supporter of educational and scientific courses and his gifts were widespread. His numerous benefactions included the donation of £35,000 to the University of Sydney for the establishment of the Charles Gilbert Heydon Travefling Fellowships in the Biological Sciences, as a memorial to his father, Mr. Justice Charles Heydon. He remained a scholar, "f youthful mind and assiduous application, till the end of his days. He was fascinated by the advances and the exciting prospects of science, read of it avidly and deeply, and for this alone lamented his vears. He also retained his love of lifelong devotee. philosophy, of which he was Dr. George Heydon occupies a special place in Australian Parasitology, as he does in the affections and memories of his colleagues and students.

a

Journal Health-June, 1963

47

COMMONWEALTH Directors of Health from all States conferred at Canberra from April 1 to April 5 on common problems and questions of departmental administration. Left to right, in this photograph, are the Acting Director, Tasmania, Dr. Bruce Royall, Assistant Director-General, Dr. H. E. Downes, Director, New South Wales, Dr. L. ]. Wienholt, and Director, Western Australia, Dr. J. B. Mathieson.

NATIONAL FITNESS LEADERS' TRAINING COURSE PROPOSED THE COMMONWEALTH Council for National Fitness, which held a two-day meeting in Sydney in April, invited the National Fitness Council of New South Wales to formulate detailed proposals for a training course for national fitness leaders. The invitation included the provision of a detailed syllabus, to be submitted to the other members of the Commonwealth Council for their comment. The Council agreed unanimously that the New South Wales National Fitness Council should conduct such a course under its own control at some time during the remainder of the year. The Council's proposal is that the training course shall be open to both professional and voluntary recreation leaders. The Commonweatlh grant to National Fitness Councils, which was increased last year by £27,500, has enabled the Councils to expand their activities in the fields of national fitness and recreation. All delegates to the Commonwealth Council said the increased grant had stimulated them to further efforts in this important field of community fitness and health. 48 Journal Health-June, 1963

VALUABLE RESULTS FROM SURVEY OF ILLNESS IN AUSTRALIA Statistical Data Now Being Analysed

VALUABLE results are being obtained from a survey of illness patterns in Australia carried out during the past 12 months by 100 doctors in general practice. Detailed tabulations are being prepared by the Bureau of Census and Statistics at Canberra. When completed, this data will be analysed and a full report prepared, which will be made available to the medical profession, teaching hospitals and public health authorities. The survey will afford increased knowledge of the incidence of various diseases and illnesses in Australia, as experienced in general medical practice as distinct from hospitals. Collation and analysis of this information will be of value to doctors as a whole, and is expected to be particularly useful to the teaching hospitals, enabling them to assess whether their training curricula are adequately oriented to the experiences medical students are likely to encounter after they begin practice. The initiative for the survey came through the National Health and Medical Research Council, which suggested that it be undertaken by general practitioners at strategic points throughout the Commonwealth. The Australian College of General Practitioners invited members to take part in the survey. This involved recording, on uniform cards, particulars of every sickness episode each doctor handled in the course of his practice over a period of 12 months. Serial numbers were substituted for patients' names for the purposes of the survey. One Million Visits Recorded

'::T

The 100 doctors taking part have, throughout the year, recorded between them, on some 300,000 cards, details of illnesses encountered in perhaps a million visits at surgeries or patients' homes. This recording involved each doctor in anything up to an hour's voluntary work every evening, in addition to his normal duties. The Department of Health received valuable co-operation from the Bureau of Census and Statistics and other government instrumentalities in conducting the survey. An unselfish public spirit was exemplified in the co-operation of the 100 doctors who participated. With no possible personal advantage, they undertook, purely in the public interest, a project involving them in hours of additional work and a great deal of individual inconvenience. It will be some months before the data recorded on the cards is processed, recorded and analysed. A great deal is known throughout Australia and the rest of the world concerning notifiable diseases. This survey, which has accumulated hitherto unrecorded information concerning the detail and patterns of other illnesses, was the first of its kind to be conducted in Australia. Journal Health-June, 1963

49

ELABORATE PRECAUTIONS AGAINST FOOT AND MOUTH DiSEASE Constant Vigilance at Australian Ports and Airport, A GREAT DEAL has been published concerning the ravages of foot and mouth disease among cattle in Great Britain, on the Continent and elsewhere. It is well known that the Commonwealth Quarantine Service is constantly alert to prevent the introduction of this disease to Australia. The extent of these precautions is perhaps not so well known. The following statement sets out, in general outline, the principal steps that are applied in this campaign at every airport and seaport in the Commonwealth, day by day, all the year round. Meat Imports Prohibited The importation of meat, except adequately heat-treateCl canned meat, is prohibited. The importation of cattle, sheep, goats and pigs-which are the animals at risk-is prohibited. Special precautions are applied to all countries recognised as infected. For practical purposes, "infected" countries of greatest risk are European countries, Asia and South America. Rural migrants from foot and mouth disease risk countries may not come to Australia by air. The boots and working clothes of these migrants, even arriving by sea, are cleaned and disinfected if this has not already been done under official supervision before departUre from overseas. Rural migrants are defined as persons who, at any time during three months before embarkation, have lived or worked on premises where livestock are kept. This includes salesmen, cattle dealers, etc.; also persons who have worked with meat or hides such as butchers, dealers and tanners. Australian consular and immigration authorities abroad have standing instructions to refuse air visas to such persons. Baggage Carefully Checked All travellers are warned not to bring meat or other materials of animal origin in their baggage, which is carefully checked by Customs to detect infringements. Should any such material be brought, it is seized and destroyed. Potentially infective material, such as straw and straw packing, is seized and destroyed by incineration. Other prohibited items, such as animal curios and trophies are disinf~cted .where this is practicable, or are re-exported, at' the Owner s optIon. Ships are required to have their garbage incinerated, or othe~­ wise disposed of, under quarantine supervision. The importation of used grooming brushes, halters and other equipment for handling animals is prohibited. Watch for Soiled Clothing T~e b.aggage of all travellers, especially from foot and mouth

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countnes, 50

IS

carefully watched for dirt. especially soil or manure, on Journal Health-June, 1963

footwear and clothing and Customs insp6lCtors have authority to insist on soiled footwear and clothing being cleaned and iterilized. This need rarely arises with general passengers and tourists, although dirt on farm workers' clothing and boots is sometimes encountered. Australians going overseas and migrants re-visiting their homelands, are given, with their passport or re-entry permit, a pamphlet drawing attention to the dangers of foot and mouth disease. 1his urges on them the importance of not posting home or bringing back with them prohibited materials or articles, and particularly urges them, if they visit rural areas, the need to be careful to have their clothes and footwear cleaned before they return, if they become contaminated. This precaution must depend to a considerable extent on the sense of responsibility to the people to whom the appeal is directed, but superimposed on it is the close supervision of all travellers applied by the inspecting Customs officers. A constant liaison is maintained between the Departments of Health, Customs and Immigration to ensure that these precautions are made as effective as possible, and additional avenues to tighten the screening are continually under examination. Travellers Are Tolerant

The procedures that have been applied in Australia are similar to and in some respects more stringent than those adopted in the United States and Canada, which have also succeeded in excluding foot and mouth disease, and are equally anxious that this exclusion shall be maintained. Travellers in general accept these restrictions tolerantly, especially when the importance of the policy is explained to them. It is felt that serious inconvenience, bordering on chaos, would be involved in applying closer individual scrutiny or questioning to every passenger on planes which may carry 60 or more passengers and ships with perhaps several thousand passengers.

i

PROFESSOR PUZZLED BY FITNESS OF SOMALI CAMEL HERDSMEN ATHEROSCLEROSIS is absent among the last remaining Somali tribes along the Kenya border, according to Professor V. Lapiccirella of Florence University (Italy) who has completed a detailed clinical and electrocardiagraphic examination of a group of 203 camel herdsmen. He found a total absence of any form of cardiovascular disease in this group, which is all the more remarkable in view of their way of life. Their nourishment consists largely of 5 to 10 litres of camel's milk a day. The fat content of this milk is twice that of cow's milk. Seasonallv they have to travel far in search of water and breathe in fine particles of sand raised by the wind. These tribes have been leading the same patriarchal pastoral life for centuries, auite unlike life in a modern city, and the survey suggests strongly that psvchological stress has much to do with the on"set of cardiovascular disease. Journal Health-June, 1963

51

QUARANTINE DELAYS ELIMINATED IN NEW SOUTH AUSTRALIAN OIL PORT QUARANTINE delays have been eliminated in the arrangement of Port Stanvac, the latest addition to South Australia's ports. Port Stanvac came into being following the building of the oil refinery near Hallett's Cove by the Petroleum Refineries (Australia) Pty. Ltd. The name STANVAC is derived from the name of the parent organization, the Standard-Vacuum Group. Located some 18 miles south of Port Adelaide on undulating farming country, Port Stanvac presents an eye-pleasing vision o{

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nature and industry. The site was chosen as the nearest place with water deep enough for oil tankers up to 87,000 tons.

No Wharf for Berthing The special feature of the port is that no wharf has been built for berthing of overseas tankers. On arrival, oil ships tie up to special mooring buoys, 4,500 feet from the shore. Their cargo of crude oil is discharged by coupling hoses to a 34 inch submarine pipeline leading directly to the refinery storage tanks. Similarly ships needing refueling are coupled to a smaller pipeline, receiving their requirements directly from processed oil tanks. However, a small wharf has been constructed to meet the needs of local vessels engaged in the distribution of the refined products to other Australian ports. This unusual set-up permits a unique quarantine arrangement in that tankers are permitted to enter ~he port during the hours of darkness, tie up and commence discharging crude oil while awaiting a sunrise quarantine clearance. The accompanying photographs, illustrating the layout of the port, pipelines and jetty, are published by courtesy of Advertiser Newspapers Ltd., Adelaide.

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FOUR X-RAY CAMERAS FOR VICTORIAN TUBERCULOSIS CAMPAIGN THE MINISTER for Health, Senator Wade, has approved the purchase, for £21,000, of four 70-m.m. mirror camera X-ray units, for use in the Victorian Government's compulsory tuberculosis surveys. These units, which are the most modern of their type available, will be used, with three purchased in 1961, to replace 35-m.m. lens cameras formerly in use. The Minister has also approved the installation, at a cost of £6,526, of a system of steam-heated natural convectors in the two tuberculosis wards at Mont Park Mental Hospital. The cost of this equipment will be financed by the Commonwealth under the Tuberculosis Arrangement.

TUBERCULOSIS TRAINING CAMPAIGN IN MALAYA A WHO REGIONAL Tuberculosis Advisory team has been conducting training courses in tuberculosis control work for various categories of health personnel in the Federation of Malaya since its arrival in May last year. By January 1963 the team had conducted one-month training courses for 237 nurses and three-month training courses for 72 assistant nurses. Training of laboratory assistants and X-ray operators started in February and in mid-63 the team will assess the BCG vaccination campaign in Malaya. The Government of the Federation of Malaya, meanwhile, has appropriated a total of 20,393,000 Malayan dollars for tuberculosis control activities for 1961-1964. Journal Health-June, 1963 53

A MEDICAL BENEFITS problem was under discussion when this photograph was taken at the conference of Commonwealth Directors of Health at Canberra in April. The Commonwealth Director, Queensland, Dr. A. H. Humphry, at left, is conferring with the Director of the Medical a.nd Hospital Benefits Division, Mr. A. A. M. Kelly, the Director, South Australia, Dr. C. S. Barbour and the Director, Victoria, Dr. H. M. Franklands.

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UNIFORMITY IN MEDICAL PRACTICE AIM OF NEW GENERAL COUNCIL PRACTICAL steps towards the achievement of uniformity of conditions relating to medical practice throughout Australia were taken at a meeting in Canberra in March of the presidents of the State and Australian Capital Territory Medical Boards. The representatives of the respective boards agreed that the conference should constitute itself as a council to be known in future as The General Medical Council of Australia, to act as an advisory body to the Commonwealth and State Governments On matters relating to medical practice. Membership, for the present, will consist of the presidents of each of the State Medical Boards and the chairman of the Medical Boards of the A.C.T. and the Northern Territory, both of which are subject to Commonwealth jurisdiction. This step had the prior approval of the conference of State Ministers for Health, held in 1962. The President of the Medical Board of New South Wales, Dr. W. Cotter Harvey, was elected as chairman of the Council. Dr. Cotter Harvey stated after the conference that the principal objective of the Council would be to suggest ways to achieve uniform conditions of registration of doctors and the maintenance of standards of medical education. The Council would also examine the feasibility of defining conditions for the registration of medical specialists. 54 Journal Health-June, 1963

109 PRACTISING MEDICAL PRACTITIONERS AND 21 DENTISTS Comprehensive Range of Health Services Available In Australian Capital Territory

A COMPREHENSIVE range of public and private health services is available to the residents ot the Australian Capital Territory. The public health services are conducted by the Commonwealth Department of Health, which in the Northern Territory and the A.C.T. assumes the responsibilities which in the States are accepted by the Departments of Health and the State Hospitals Commission, or its counterpart. Canberra has 109 practising resident members of the medical profession including specialists in all branches of medicine, and 21 practising dentists. Hospital In Process of Expansion

The Canberra Community Hospital, situated on a site of 22 acres at Acton, has accommodation for 300 patients. Its expansion to approximately 470 and later to 600 beds is now in progress. The hospital is controlled by a Board of Manegement who are responsible to the Minister for Health. It serves Canberra, the A.C.T. and nearby areas of New South Wales. It has public, intermediate and private beds. The staff consists of a medical superintendent, seven salaried medical officers, a radiologist and a psychiatrist employed on a sessional basis, 330 nurses and 226 professional, administrative and general staff. The hospital has medical, surgical, obstetric, children's and isolation wards, outpatients', physiotherapy and X-ray departments and a tuberculosis chalet. The ambulance service, which is attached to the Canberra Community Hospital, is controlled by the Hospital Board. It is equipped with four ambulance vehicles and one car and has a staff of 13. District Nursing Service

The Department of Health maintains a district nursing service for convalescents after discharge from hospital, for patients at home who would otherwise need hospital accommodation and for the aged. Responsibility for care of the aged whose families cannot look after them is shared with voluntary organisations. The District Nursing Service is available on request from a registered medical practitioner and a nominal charge is made for each visit. Pensioners are treated free. It is maintained seven davs a week and is staffed by five trained sisters. A sister is employed full time giving injections against poliomyelitis for children at infant welfare clinics and for adults at the Department of Health. This service carries out more than 15,000 home visits a year. A Health Laboratory, which serves both the Canberra Community Hospital and the general public, is located at the Institute of Anatomy. Journal Health-June, 1963

55

Clinical and Consultant Service The Health Laboratory provides full clinical and consultant laboratory services to Canberra and adjacent hospitals, and to private medical practitioners in the area, without charge. The Laboratory also exercises technical control of the Red Cross Blood Transfusion Service, and carries out an extensive range of investigations in the public health and medico-legal fields. The Laboratory carries out hundreds of tests annually of water supply and milk samples as a routine service. School Medical Services School medical services are also controlled by the Department of Health, with two medical officers and two trained nurses who are full-time officers. Routine examinations are carried out at all schools, public and private, within the Territory. The programme is planned to provide for examinations at primary and secondary level. During 1962, the total number of children examined in these age groups was 6,213. Examinations of children attending pre-school centres are made according to the time available, an attempt being made to cover children aged 4J~ to 5 years. An audiologist from the Commonwealth Acoustic Laboratories is available for consultation at Ainslie School at monthly intervals throughout the year. A class for the special education of young deaf children has been established at Ainslie School. Immunization Programme In addition, an immunization programme for the protection of children, aged from six months to 12 years against diphtheria, whooping cough and tetanus is carried out by the school doctor. Injections given during 1962 numbered 8,774. Anti-poliomyelitis injections are also given to children attending both primary and secondary schools and nearly 14,000 injections were given during 1962. These included 4th injections to those previously immunised. Anti-poliomyelitis injections numbering 6,235 were given, also, to infants and pre-school children and adults. The officer-in-charge of the school service also acts as medical adviser to the Mothercraft Council and at the Baby Health Centres. A School Dental Service staffed by 10 dentists and 11 dental nurses is available to all infants' and primary schools in the A.C.T. and to a limited extent to pre-school centres. This service examined and treated 8,800 children during 1962. The free milk service, providing 1/3 pint of milk per day, is available to 11,000 children under 13 years of age attending 28 primary schools. Baby Health Centres have been established by the Canberra Mothercraft Society and are subsidised by the Department of Health. New-born babies receive a home visit initially. Babies are weighed at home where attendance at a centre is impossible. Thirteen Mothercraft Centres Thirteen Mothercraft Centres and nine sub-centres are now functioning in Canberra. These are staffed by eight full-time and one

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56

Journal Health-June, 1963

OSCAR SCHROEDER, with his mother as escort, was the first baby to patronise the new Infant Health Centre in Peel Street, Darwin, which was opened on March 19 this year. He has just been handed over to Sister Crozier for "weighing-in" and other formalities. In the lower picture Mrs. Schroeder samples one of the modernistic chairs in the coloUTful new waiting room.

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half.-time triple certificated sisters employed by the Mothercraft Society. About 3,500 children under two years attend the centres and some 4,500 home visits are made annually. Public Health Service is provided by a Medical Officer and four trained health inspectors attached to the department. These officers are concerned with inspection of milk and water supplies, sanitation, food selling premises, restaurants, boarding houses and all other matters related to public health. Journal Health-June, 1963

.57

The activities of the veterinary service of the Department of Health within the Territory include the prevention and control of disease in stock; proffering advice to district stock-owners with field diagnosis on a herd or Bock basis, supported by laboratory confirmation; the supervision of the hygiene of dairies and piggeries and the control of the Canberra Abattoir, an establishment where a full-time meat inspection service of high standard is provided. Hospital Sprang from Small Beginnings The new hospital will afford the most efficient ward accommodation, equipment, staff training facilities, and ancillary services current hospital design can offer. The new construction is being undertaken in two stages. The first, recently started, will increase capacity to 470 beds, the ultimate of 620 beds being accomplished in stage 2. Meanwhile a new nurses' home to accommodate, initially, 250 nurses, is under way, and is expected to be completed later this year. Like the National Capital itself, however, Canberra Community Hospital has sprung from small beginnings. At the time of the transfer, in 1908, of the area now known as the Australian Capital Territory from the State of New South Wales to the Commonwealth, there was no hospital accommodation of any kind within its 900 square miles. Small Timber Casualty Ward To meet the needs of the staff employed on surveys and the preliminary engineering works associated with the establishment of the new Federal capital, a small timber casualty ward, capable of accommodating 10 hospital beds, was built in 1911, at Acton. Few other public buildings of any kind existed in Canberra at that time. Anyone in need of major medical treatment was taken to Queanbeyan Hospital. Wben the construction of Canberra began, several large timber wards were built. By 1916, accommodation and ancillary services had been provided for 14 more patients. These buildings were regarded at that time as purely temporary, but additions were made to them until, by 1926, the accommodation had increased to 60 beds. These buildings, which comprised the first Canberra Hospital, were on the site or the future Australian National University and are, in fact, still used by the University today. Pressure on the hospital increased with the transfer of parliamentary staffs from MeJbourne to Canberra early in 1927 and departmental st~ffs later in the year. By 1930 the hospital had accommodation for 68 patients. The steady growth of the capital in the 10 years that followed however, eventually compelled the abandonment of the earlier programme of timber extensions. . Provision Considered Over-liberal In 1938, plans were laid before the Parliamentary Standing Committee on Public Works for a permanent, brick hospital on a new site. This move was the beginning of the present hospital. 58

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Journal Health-June, 1963

The Department of Health asked the committee for a 147-bed hospital, with a home to accommodate 55 nurses. The committee considered this provision "over-liberal", and authorised the construction, instead, of a hospital with only 106 beds, although designed to permit expansion. When the new building was ready for use it was immediately made available to the United States Armed Forces for the Fifth Station Hospital, and occupied the building for some 12 months. The then Governor-General, Lord Gowrie, officially opened the hospital in February 1943. A tuberculosis ward was added later and subsequently additions were made to the obstetrics department. The nurses 'home has been extended on two occasions. To keep abreast of the growing population needs a number of patients and staff are at present accommodated in temporary buildings until the new nurses' home and main ward block at present under construction are completed. In its earliest days the Canberra Hospital functioned under the Administrator of the Territory. From 1924 until 1930 the Federal Capital Commission was the governing authority; then, with the advent of control by departments, the Department of Health became responsible. Control was vested in the Canberra Community Hospital Board in 1935. Today the board comprises eight members, five popularly elected and three appointed by the Commonwealth Minister for Health.

Registered Training School In 1933 the hospital was registered as a training school for general nurses and in 1949 the obstetric department was registered as a training school for obstetric nurses. The hospital became recognised in 1958 for training of assistants-in-nursing. The hospital's training school now functions with a staff of three tutor sisters, and an enrolment of 48 nurses for the general course and another 24 for midwifery each year. Since 1933, 204 nurses have graduated in general nursing, 144 nurses have gained their obstetric certificates. Thirty-five assistantsin-nursing have been awarded the prescribed certificate for training. Last year the hospital was approved by the Post-graduate Medical Committee of Sydney University for the training of medical graduates in their pre-registration year. The first student was trained at the hosnital in 1962, and three are serving on the hospital's medical staff this year.

LITTLE PROGRESS AGAINST FILARIASIS LITTLE OR NO progress has been made in controlling filariasis, a disease that infects some 200 million people in Asia and the Americas. Filariasis, which is caused by minute worms whose larvae are transmitted by mosquitoes, may give rise to elephantiasis. The epidemiology of the disease is not well understood and the drug which has been used in treatment since 1955 (diethylcarbamazine) is too toxic to be used in mass campaigns. Indeed, in some respects the situation may be said to have worsened, especially in regard to urban filariasis. JotIrnal Health-June, 1963

59

DRAMATIC RESCUE MISSION BY N.T. AERIAL MEDICAL SERVICE Day-long Flight to Save Injured Station Man

THE NORTHERN Territory Aerial Medical Service faced one of the most difficult assignments in its history early in November-and succeeded by the narrowest of margins in circumstances which might • reasonably have been regarded as impossible. About 8 o'clock on a Sunday morning an emergency call came over the Royal Flying Doctor Service radio network to Alice Springs. It gave meagre information that an elderly man had been badly injured at Anitowa Station, about 180 miles north-east of Alice Springs. The caller was unable to supply clinical details; apparently there were difficulties in transmission. Dr. C. S. Hampton, of Alice Springs Hospital and Sister Joyce Ellis began immediate arrangements to leave by air for the station. Lacking precise information as to the task ahead, they equipped themselves as best they could to meet practically any situation. As well as surgical instruments they included a liberal supply of blood plasma in their kit. Meanwhile the Hoyal Flying Doctor Service arranged for one of its charter planes to be put into service, and by 8.30 a.m. the party was on its way. Near Death From Loss of Blood

At Anitowa, Dr. Hampton and Sister Ellis found their patient was Mr. Stan Brown, aged about 70. His leg had been badly mangled in an accident with a heavy jack and he was close to death from loss of blood. Their first task was to keen him alive. They restored his condition as best they could with the brood plasma they had taken with them. He was then lifted aboard the plane, for the return flight. Mr. Brown was losing blood so rapidly, however, that despite everything Dr. Hampton could do, his condition began to deteriorate rapidly. The initial supply of blood plasma was running low. It was clear that not enough remained to keep Mr. Brown alive until the plane reached Alice Springs. The situation was explained to the Medical Superintendent of Alice Springs Hospital, Dr. Peter Dawes, who had been standing by the radio receiver for periodic reports. Dr. Dawes arranged for a further supply of plasma, and the Royal Flying Doctor Service immediately despatched a second plane to meet the first, on its way home. Transfusion on Lonely Airstrip

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Both planes landed on the airstrip at Amaroo Station. With the aid of the additional plasma Mr Brown's condition was at last sufficiently restored to permit the flight to be resumed, and the rescue plane reached Alice Springs about 1 p.m. 60

Journal Health-June, 1963

A~ ambulance h~rried Mr. Brown to hospital, but his condition was stIll far too weak to permit an operation. At 5 p.m., after a further eight pints of blood had been administered, it was possible to take him to the operating theatre. Doctors worked over him in the theatre for three hours. but his leg was so badly smashed that there was no alternative, in 'the long run, but to amputate it. His condition remained critical throughout the night, but by next day it was apparent that the almost superhuman endeavour of the previous 24 hours had not been in vain. It is to Mr. Brown, however, that the doctors give most of the credit. They say his "will to live" helped as much as they did. "Not a Bad Outfit" Two days later he was well enough to be taking an active interest in his condition. Told what had happened to his leg, he replied "Ah, well. Never mind", and inquired the prospect of getting a glass of beer. He got one. A week later he was hobbling around the hospital ward on a walking device. Mr. Brown has his own views about the FlYIng Doctor Service and the Northern Territory Aerial Medical Service. He considers "any outfit that works all day to save the life of an old codger like me is not bad".

HEART DISEASES MAJOR CAUSE OF DEATH IN AUSTRALIA, Canada, Denmark, Finland, France, Germany (Federal Republic), Netherlands, Norway, Sweden, Switzerland, United Kingdom and the United States of America, heart diseases top the list of causes of death and are responsible for about one third of all deaths. The 1960 death rates from these cases are higher than those for 1954-1956 in all the countries except France. Increases vary from 0.5 per cent in Australia to 17.5 per cent in Norway.

NATIONAL HEALTH STATISTICS TUBERCULOSIS ALLOWANCES No. of Persons Receiving Allowances as at 31st March, 1963 Payments for Quarter ended 31st March, 1963 Progressive Payments for Year ending 30th June, 1963 as at 31st March, 1963 --.

State

-----.~

New South Wales· Victoria .. .. Queensland .. South Australia Western Australia Tasmania .. Commonwealth

.. .. ..

60S

£

£

.. .. - - - - - - - -------- --------1,734 187,093 591,342 ..

.,

388 442 144 71 84

62,000 46,256 43,126 15,421 9,967 10,323

197,159 142,567 137,958 53,617 31,160 28,881

* Includes Australian Capital Territory. Journal Health-June, 1963

61

NATIONAL HEALTH STATISTICS-contInued MEDICAL BENEFITS No. of Progressive Payments Payments for Profor Year ending Quarter ended fessional 30th June, )963 as at 31st March, 1963 Services 31st March, 1963 for Quarter ended \ Common- \ organiza-I Commoo31st M:r, Organization wealth tion , wealth 1963 £ £ £ £ 2,305,780 1,862,188 1,134,848 5,692,926 3,492,787 641,557 2,704,121 2,182,623 1,318,354 801,150 889,297 290,609 1,438,698 601,335 443,629 954,314 306,768 1,318,752 602,297 413,370 971,813 724.263 221,256 297,977 440,660 229,614 385,818 124,191 74,731 155,820 5,424,246 3,942,505 1 2,669,769 12,512,128 Australian Capital Terntlty.

State

New South Wales· Victoria .. Queensland .. South Australia Western Australia Tasmania

..

..

.. .. .. .. .. .. ..

Commonwealth

----8,472,898

* Includes

..

PENSIONER MEDICAL SERVICE No. of Pensionersl P"yments for Ouarter ended and Dependants 31st March, as at 31st 1963 March, 1963 Progressive Payments as at 31st March, 1963 for Year ending 30th June, 1963 £ 1,428,228 831,464 463,763 298,228 230,528 86,536 707

State

New South Wales· Victoria .. Queensland .. South Australia .. Western Australia Tasmania Northern T~~ritory'

..

.. .. .. ., .. .. .. .,

Commonwealth

- - - - - - - - - - - - - - - -------828,632 1,137,927 3,339,454

324,057 208,833 136,954 74,013 56,821 27,482 472

£ 508,369 288,320 142,658 98,961 70,292 29,\08 219

• Includes Australian Capital Terntory.

COMMONWEALTH BENEFITS PAID AT 20s. PER DAY FOR PATIENTS IN APPROVED NURSING HOMES FOR QUARTER ENDED 31st MARCH, 1639 State State £ Private £

Total £

N.S.W. Vic... Qld. SA W.A. Tas. C'wealth

101,971 378,262 480,233 .. 134,512 262,748 128,236 120,371 190,315 69,944 .. .. 29,488 80,826 110,314 39,085 62,336 101,421 .. 15,019 20,399 35,418 - - - - - - - - - - - - - - - - - - - - ---------.. 440,446 740,003 1,180,449 " "

Benevolent homes, Convalescent homes, Homes for Aged persons, Rest ho",!es, etc., are entitled to approval as Nursing homes for the purposes of the NatIOnal Health Act. Patients in approved Nursing homes are entitled to a Commonwealth Benefit of 20s. per day which is deducted by the approved Nursing homes from the Patients' accounts (if any).

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62

Journal Health-June, 1963

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COMMONWEALTH HOSPITAL BENEFITS EXPENDITURE for 3 months ended 31st March, 1963 For Uninsured Patients at 8s. per day State Public £ 49,283 15,451 71,829 10,895 4,739 3,568 301 156,066 --

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For P.M.S. PenFor Insured sioner Patients Patients at 8s. at 36s. per day and 20s. per day Total £ 53,723 20,154 75,750 12,541 6,095 3,950 301 172,514 (b) (c)

Total Commonwealth Benefit Paid

Fund Benefit Paid to Insured Patients (c)

Private £ 4,440 4,703 3,921 1,646 1,356 382 . ..... . ..... 16,448

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.. .. .. .. .. ., .. ..

£ 304,250 96,688 168,494 63,569 42,894 20,502 1,273 697,670

£ 401,435 390,956 119,574 84,783 68,352 23,601 . ..... . ..... 1,088,701

£ 759,408 507,798 363,818 160,893 117,341 48,053 1,574 1,958,885

£ 1,852,880 929,937 415,155 510,611 395,534 154,077

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The hospital benefit expenditure shown in this table is that paid under the new Commonwealth Hospital Benefit arrangements introduced on 1st January, 1963. In addition to the expenditure shown, £2,574,142 was paid in the 3 months to 31st March, 1963, under the arrangements which terminated on 31st December, 1962. (a) Patients in approved hospitals who are not members of registered organizations are entitled to a Commonwealth Benefit of 8s. per day which is deducted by the hospital from their accounts. (b) Pensioners enrolled in the Pensioner Medical Service are usually entitled to free public ward treatment in public hospitals, for which a payment of 36s. per day is made to the hospital. (c) Patients in approved hospitals, who are members of registered hospital benefits organizations are entitled to Commonwealth Benefit of 20s. per day (or 8s. per day in a waiting period or if unfinancial), paid by the organization together with fund hospital benefits. ... Included in relative state amounts.

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PHARMACEUTICAL BENEFITS Details in respect to Chemists' claims received in Quarter ended 31st March, 1963:Cost of Benefit Prescriptions State For Population Excluding Pensioners Total Cost· Total Amount· Amount Met by Patients For Pensioners Total Commonwealth Payment for Prescriptions £ 3,155,755 2,014,235 1,034,276 690,253 510,968 197,456 7,602,943

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Amount Met by Commonwealth £ 2,1 %,825 1,484,088 693,367 479,189 356,880 137,779

I Total

Com~e~n~alth £ 998,930 530,147 340,909 211,064 154,088 59,677 2,294,81-5-

Amount

New South Wales Victoria Queensland .. South Australia Western Australia Tasmania Commonwealth

£ £ £ 3,841,671 2,842,741 685,916 2,455,134 1,924,987 440,899 1,267,188 926,279 232,912 845,858 634,794 155,605 621,129 467,041 110,161 241,894 182,217 44,438 -9,272,874- ~78~059~ ---u69J3~1~

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In addition, payments to Hospitals and Miscellaneous Expenditure amounted to £1,0)3,732 for the quarter. Number of Benefit Prescriptions A verage Cost per Benefit Prescription

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Total 4,045,271 2,425,998 1,402,552 889,347 634,307 252,172 9,649,647--

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Excl~ding PensIOners

I For Pensioners 1,298,329 659,916 469,584 265,921 193,028 74,159 2,960,937

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2,746,942 1,766,082 932,968 623,426 441,279 178,013 6,688,710

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DIRECTORY

COMMONWEALTH DEPAHTMENT OF HEALTH CENTRAL OFFICE PARKES, CANBERRA, A,C.T. Director-Gelleral: MAJOH-GENERAL \V. D. HEFSHAUGE, C.B.E., M.B., B.S., F.R.C.O.G., F.R.A.C.S., F.R.A.C.P. Assistant Directors-General: DR. H. E. DOWNES, M.B., B.S., D.P.H. DR. G. M. REDSHAw, M.B., B.S., D.P.H. R. H. D. WlIITE, O.B.E. Senior Medical Officers: DB. A. M. McAuTHUH, M.B., Ch.B., D.T.M. & H., r-.1.C.P.A. DR. W. F. H. CRICK, M.B., B.S. DH. AHTHUR SPEARS, M.B., B.S., D.T.M. & H. Dn. ALLEN GREEN, M.B., B.S., D.D.M., D.T.M. & H. Dn. H. C. WEBB, M.B., B.S., D.T.M. & H. (Chief Commonwealth Medical Officer at Australia House, London). Dn. C. W. PHILLIPS, M.B., B.S., D.T.M. & H. (Chief Commonwealth Mcdical Officer, Immigration Service, The Hague, Holland). Di1Asion of Public Health: Director-DH. A. JOHNSON, M.B .. B.Ch., B.A.O., B.A .. D.P.H. (Belfast). . Division of Tuberculosis: Director-DR. ALAN KING, C.St.}., B.Sc., M.B., B.S., F.C.C.P. ~atio1Jal Health and Medical Resemch COllncil: Secretary-DR. H. H. C. \VELLS, r-.1.D., B.S., B.Sc., M.R.C.P., D.T.M. & H. Pharmaceutical Division: Director-R. M. W. CUNNINGHAM, Ph.C., M.P.S. Division of Plant Quarantine: Director-DR. T. H. J. HARRISON, D.Sc.Agr. (Sydney), D.I.C. (London). Division of Veterinary Hygiene: Director-K. S. McINTOSH, B.V.Sc. Division of Nursing: Principal-MATRoN F. M. PETERSON. ~ledical and Hospital Benefits Division: Director-A. A. :-'1. KELLY, D.P.A., A.A.S.A.

STATE OFFICES SYDNEY: The Commonwealth Centre, Elizabeth Street, Sydney, N.S.W. Commonwealth Director of Health, DR. L. J. \VIENHOLT, M.B., B.S. :-'IELBOURNE: Commonwealth Offices, Spring Street, Melbourne, C. 1., Victoria. Commonwealth Director of Health, DR. H. M. FHANKLANDS, M.B., B.S., D.T.M. BRISBANE: Commonwealth Government Offices, Anzac Square, Adelaidt" Street, Brisbane, Queensland. Commonwealth Director of Health, DR. A. H. HUMPHRY, M.B., B.S., D.T.M.&H. ADELAIDE: C.M.L. Building, 41-47 King William Street, Adelaide, South Australia. Commonwealth Director of Health, DR. C. S. BARBOUR, M.B., B.S. PERTH: 473 Wellington Street, Perth, Western Australia. Commonwealth Director of Health, DR. J. B. MATHIESON, M.B., B.S., D.T.M. HOBART: Commonwealth Offices, Stowell Avenue, Battery Point, Hobart, Tasmania. Acting Commonwealth Director of Health, DR. BRUCE ROYALL, M.B., B.S., D.T.M. & H. DARWIN: Department of Health, Darwin, N.T. Commonwealth Director of Health, DR. I. D. BYRNE, M.B., B.S., D.T.M. & H.

DIRECTORY:

LABORATORIES AND RESEARCH OHGANISATlONS. Commonwealth X-ray and Radium Laboratory, Surry Place, Melbourne, C. l. Director, D. J. STEVENS, O.B.E., B.Sc. Commonwealth Acoustic Laboratories, Commonwealth Offices, .5 Hickson Road. l\filler's Point, Sydney, N.S.W. Director, N. E. MURRAY, O.B.E., B.E., B.Sc. Institute of Anatomy, Canberra. Medical Officer-in-Charge, Dr. E. H. I!rPSLEY, M.B., B.S. Institute of Child Health, University of Sydney. Director, Professor THOMAS STAPLETON, M.A., D.M., M.R.C.P. School of Public Health and Tropical Medicine, University Grounds, Sydney, N.S.W. Director, Sir EDWARD FORD, O.B.E., M.D., D.P.H., D.T.M., F.R.A.C.P., F.Z.S. Bureau of Dental Standards, 18 Lonsdale Street, Melbourne, C. l. Officer-in-Charge, A. R. DOCKING, M.Sc. National Biological Standards Laboratory, Canberra. Director, Dn. L. F. DODSON, M.B., B.s., Dip.Clin.Path., D.Phil. (Oxon.). Commonwealth Health Laboratories are located at the following centres:Townsville, Cairns, Rockhampton, Toowoomba, Lismore, Tamworth, Albury, Bendigo, Launceston, Hobart, Port Pirie, Kalgoorlie, Darwin, Canberra.

Any Teaeler desiTing to be placed on the mailing list for this Journal should forward his or her name and address to the Director-General of Health, Canberra, A.C.T.

J

SYDNEY:

V. C. N. BLIGHT. GOVERNMENT PRINTER

50292

5.63

1963.

OOl\IjIONWEALTH OF AUSTRALIA.

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REPORT OF Til'·

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MEDICAL RESEARCH COUNCIL .

FIFTY-FIFTH SESSION HELD AT

BRISBANE, 30TH AND 31sT MAY, 1963.

A. J.

ARTHUR,

By Authority: Commonwealth Government Printer, Canberra. (Printed in Australia.)

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MEDICAL RESEARCH ENDOWMENT FUND. This Fund was established under the Medical Research Endowment Act 1937 to provide assistance(0) to Departments of the Commonwealth or of a State engaged in medical research; (b) to Universities for the purpose of medical research; (c) to Institutions and persons engaged in medkal research; and (d) in the training of persons in medical research. The Fund consists of appropriations by the Commonwealth Parliament, gifts or bequests, and any income derived from investment of these amounts.

The Medical Research Endowment Fund is administered by the Commonwealth Minister of State for Health, and grants from the fund are made by the Minister, acting upon the advice of the National Health and Medical Research Council.

ORDER By His Excellency the Governor-General in and over the Commonwealth of Australia.

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HEREAS the National Health and Medical Research Council was constituted by the Governor-General by Order dated the seventeeath day of September, One thousand nine hundred and thirty-six: AND AND WHEREAS WHEREAS

the constitution of the Council has been amended by subsequent Orders: it is desirable that the constitution of the Council be further amended:

Now THEREFORE I, William Philip, Viscount De L'Isle, the Governor-General in and over the Commonwealth of Australia, acting with the advice of the Federal Executive Council, do hereby revoke all Orders constituting or amending the constitution of the Council and order and declare as follows:(a) there shall be a Council by the name of the National Health and Medical Research Council; (b) the Council shall consist of(i) Eleven official members, as follows:-

The person for the time being acting as the Commonwealth Director-General of Health. Two other officers of the Commonwealth Department of Health appointed from time to time by the Commonwealth Minister of State for Health. A representative of the Commonwealth Serum Laboratories Commission appointed from time to time by the Commonwealth Minister of State for Health. The person for the time being acting as the Director-General of Public Health of the State of New South Wales. The person for the time being acting as the Chief Health Officer of the State of Victoria. The person for the time being acting as the Director-General of Health and Medical Services of the State of Queensland. The person for the time being acting as the Director-General of Health of the State of South Australia. The person for the time being acting as the Commissioner of Public Health of the State of Western Australia. The person for the time being acting as the Director-General of Health Services of the State of Tasmania; and The person for the time being acting as the Director of Public Health of Papua and New Guinea; and (ii) Twelve other members, as follows:A person nominated by the Federal Council of the Australian Medical Association. A person nominated by the Royal Australasian College of Surgeons. A person nominated by the Royal Australasian College of Physicians. A person nominated by the Australian Regional Council of the Royal College of Obstetricians and Gynaecologists. A person nominated by the Council of the Australian College of General Practitioners. A person nominated by the College of Pathologists of Australia. A person nominated by the Australian Dental Association. A person nominated by the Australian Paediatric Association. A person nominated by the College of Radiologists of Australasia. A person nominated jointly by the Australian Universities having Medical Schools. An eminent man, and an eminent woman, not being medical or dental practitioners, appointed by the Commonwealth Minister of State for Health; (c) a member of the Council referred to in sub-paragraph (ii) of the last preceding paragraph shall hold office

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as a member for a period of three years and in the event of such a member ceasing to hold office before the expiration of that period, another person, being a person in the same class of persons as the member who has vacated the office, may be nominated or appointed, as the case may be, to fill the vacancy for the remainder of that period by the same process as that by which the member who has vacated the office had been nominated or appointed; (d) where an official member of the Council from a State is unable to attend a meeting of the Council, the

Minister of State for Health of that State may appoint a person to act as the deputy of the member at the meeting and the deputy so appointed shall be deemed to be a member of the Council at the meeting; /

(e) the Council shall hold such meetings as it considers necessary at such

times and places as it determines ,

but not less often than once in each calendar year; (f) at a meeting of the Council-

(i) the ~rson for the t~me being acting as Commonwealth Director-General of Health shall be charrman and preSIde; and (ii) twelve members constitute a quorum;

5 (g) the lunctions of the Council are-

(i) to inquire into and advise and make recommendations to the Commonwealth and the States on matters of public health legislation and administration and on any other matters relating to health, medical and dental care and medical research; (ii) to advise the Commonwealth Minister of State for Health on the application, and matters connected with the application, of the Medical Research Endowment Fund for the purposes of the Medical Research Endowment Act 1937: (iii) to co-operate with the Commonwealth Council for National Fitness appointed under the National Fitness Act 1941; (iv) to advise and make recommendations to the Commonwealth upon the expenditure of money upon medical research and as to projects of medical research generally; and (v) to inquire into and advise the Commonwealth and the States upon the merits of reputed cures or methods of treatment which are from time to time brought forward for recognition; (h) the Council may set up such Committees, constituted as the Council determines, as the Council considers

necessary to assist the Council in the exercise of any of its functions; (i) a member of the Council, or of a Committee set up under the last preceding paragraph, other than an

officer of the Public Service of the Commonwealth, shall be paid such amounts as allowances or expenses in respect of attendance at meetings of the Councilor of the Committee, as the case may be, as the Commonwealth Minister of State for Health determines; (j) the Council shall, as soon as practicable after each meeting of the Council, prepare and furnish to the

Commonwealth Minister of State for Health a report of matters dealt with at the meeting; and (k) the National Health and Medical Research Council as constituted by Order dated the twentieth day of

November, One thousand nine hundred and sixty-one shall be deemed to have been constituted under this Order and the members of that Council holding office immediately before the making of this Order continue to hold office as members of the Council constituted under this Order, until the expiration of their respective terms of office as determined at the time of their appointment, Dated this Fifteenth day of March, One thousand nine hundred and sixty-two.

DE L'ISLE, Governor-General. By His Excellency's Command,

HARRIE W. WADE, Minister of State for Health.

MEMBERS NATIONAL HEALTH AND MEDICAL RESEARCH COUN CIL FOR 1963.

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nwealth (Chairman); Major-General W. D. Refshauge, the Director-General of Health, Commo nwealth; Edward Ford}re prcsent ing the Department of Health of the Commo Pro~AessoJrhSir r. . 0 nson Commission; Dr. R. W. Greville, representing the Commonwealth Serum Laboratories Wales; Dr. C. J. Cummins, the Director-General of Public Health, New South Dr. K. Brennan, the Chief Health Officer, Victoria; , Queensland: Dr. A. Fryberg, the Director-General of Health and Medical Services ia; Austral South Health, Public of al r-Gener Directo Dr. P. S. Woodruff, the ia; Dr. W. S. David~on, the Commissioner of Public Health, Western Austral Dr. J. Edis, the Director-General of Health Services, Tasman ia; Papua and New Guinea. Dr. R. F. R. Scragg, the Director of Public Health of the Territory of ian Medical Association; Austral the of Council Federal the ting Dr. W. F. Simmons, represen Surgeons; of College sian Professor E. S. J. King. representing the Royal Australa ns; Physicia of College asian Austral Royal the ting Dr. J. J. Billings, represen Medical Schools; Professor S. Sunderland, representing the Australian Universities having of the Royal College of Obstetricians and Dr. J. N. Chesterman, representing the Australian Regional Council Gynaecologists; Practitioners; Dr. J. G. Radford, representing the Australian College of General ia; Dr. A. V. Jackson, representing the College of Pathologists of Austral tion; Associa Dent31 ian Austral the ting represen Professor A. J. Arnott, tion; Professor V. L. Collins, representing the Australian Paediatric Associa asia; Austral of gists Radiolo of College the ting Dr. H. J. Ham, represen Government; Sir Norman Nock, a prominent layman appointed by the Commonwealth Government. nwealth Commo the by ed appoint an laywom ent promin a e, Miss G. N. Burbidg ). Dr. R. H. C. Wells (Secretary of the Council

COMMITTEES OF THE COUNCIL.

MEDIC AL RESEA RCH ADVISORY COMM ITTEE. Dr. W. F. Simmons (Chairman). Professor S. Sunderland (Deputy Chairman). Professor Sir Macfarlane Burnet. Professor E. S. J. King. Professor H. N. Robson. Professor R. J. Walsh. Professor P. O. Bishop. Professor F. Fenner. Professor W. J. Simmonds. Dr. H. M. Whyte. Dr. I. J. Wood. Dr. R. H. C. Wells (Secretary of the Council).

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PlrnLI C HEALT H ADVISORY COMM ITIEE. ssor S' The Director, School of Public Health and Tropical Medicine (prof, C Ir.Ed)ward Ford) (Chairman). The Director-General of Public Health. New South Wales (Dr . C . Je . ummms I G · F . g A (D land Queens Services The D ~ector- enera of Health and Medical r' . ff)rYber ). The Duector-General of Public Health ' South Australia (Dr . P. S. W00dru , . 0 f Pub}'IC Health Tasmania (Dr H M L M ). · The D Irector . . . . urray ' ' f The Ch Ie ~e~lth Officer, Victoria (Dr. K. Brennan). 'd ) of Public Health, Western Australia (Dr . W . S. D aVI The COInlmSSlOner bl' H ealth for the Territory of Papua and New Gui son ' The D'~rect or 0 f .P~. IC t ~~ (Drho (DR. F. R. Scragg). The DIrector, DlVlslOn of Public Health, Commonwealth Departmen 0 r. A. Johnson) (Convenor). ea1t

7 COMMITIEES OF THE COUNCIL-continued. MEDICINE ADVISORY COMMITTEE. Dr. W. F. Simmons (Chairman). Dr. J. G. Radford (Deputy Chairman). Professor A. J. Arnott. Dr. J. J. Billings. Miss G. N. Burbidge. Dr. J. N. Chesterman. Professor V. L. Collins. Dr. H. J. Ham. Dr. A. V. Jackson. Professor E. S. J. King. Dr. R. H. C. Wells (Secretary of the Council).

ANTIBIOTICS COMMITTEE. Dr. E. F. Thomson (Chairman). Dr. K. F. Anderson. Dr. A. Johnson. Sir William Morrow. Professor H. N. Robson. Dr. Phyllis Rountree. Dr. R. H. C. Wells (Convenor). Dr. S. W. Williams.

DENTAL HEALTH COMMITTEE. Professor A. J. Arnott (Chairman). Professor Sir Arthur Amies. Professor J. F. Atkinson. Professor O. N. Davies. Mr. A. R. Docking. Mr. R. Harris. Professor A. M. Horsnell. Professor N. D. Martin. Professor E. Storey. Professor K. J. Sutherland.

EPIDEMIOLOGY COMMITTEE. Sir Edward Ford (Chairman). Sir Macfarlane Burnet. Dr. C. E. A. Cook. Professor F. Fenner. Dr. A. A. Ferris. Dr. E. L. French. Dr. R. W. Greville. Dr. A. Johnson. Dr. H. McLorinan.

FOOD ADDITIVES COMMITTEE. Dr. A. Johnson (Chairman). Dr. R. A. Bottomley. Dr. C. E. A. Cook. Dr. I. S. de la Lande. Dr. K. T. H. Farrer. Dr. P. E. Hughes. Mr. W. R. Jewell. Mr. E. S. Ogg. Professor F. H. Reuter. Dr. J. R. Vickery. Mr. J. P. Warry. Professor S. E. Wri8b t

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COMMITTEES OF THE COUNCIL-continued. FOOD STANDARDS COMMITTEE. Professor F. H. Reuter (Chairman). Mr. W. R. Jewell. Dr. A. Johnson. Mr. K. F. Kefford. Mr. W. H. Kelly. Mr. J. G. Krigsman. Dr. R. C. McCarthy. Mr. W. Madgwick. Mr. E. S. Ogg. Dr. V. M. Lewis. Mr. J. H. Smith. Mr. L. N. Thornton. Mr. J. P. Warry.

MATERNAL AND CHILD HEALTH COMMITTEE. Professor W. B. Macdonald (Chairman). Dr. Grace Cuthbert Browne. Dr. H. N. Chesterman. Professor V. L. Collins. Professor L. W. Cox. Dr. A. Johnson. Dr. B. P. McCloskey. Professor G. M. Maxwell. Professor S. L. Townsend. Professor T. J. Rendle-Short. Professor T. Stapleton.

MEDICAL STATISTICS COMMITTEE. Dr. A. Johnson (Chairman). Mr. R. Dibley. Dr. J. G. Graydon. Miss E. James. Professor H. O. Lancaster. Mr. V. E. Pickering. Mr. R. Spencer.

NURSING COMMITTEE. Miss F. M. Peterson (Chairman). Miss G. N. Burbidge. Miss P. F. Lee. Miss C. A. E. Michelmore. Miss M. Nelsen. Mrs. E. W. Sullivan.

NUTRITION COMMITTEE. Dr. F. W. Clements (Chairman). Professor V. L. Collins. Dr. E. Hipsley. Sir Norman Nock. Professor E. J. Underwood. ~-

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9 COMMITTEES OF THE COUNCIL-continued. OCCUPATIONAL HEALTH COMMITTEE. Dr. H. E. Downes (Chairman). Dr. A. Bell. Dr. A. J. Christophers. Mr. A. W. Findley. Professor D. Gordon. Dr. A. Johnson. Dr. D. D. Letham. Dr. G. H. McQueen. Dr. H. M. L. Murray. D~.

E. M. Rathus.

Dr. G. C. Smith. rvir. D. J. Stevens. RADIATION HEALTH COMMITTEE. Mr. D. J. Stevens (Chairman). Professor M. Clarke. Dr. A. G. S. Cooper. Dr. E. R. Crisp. Dr. M. G. S. Donnan. Dr. B. S. Hanson. Dr. H. J. Ham. Dr. W. P. Holman. Professor H. O. Lancaster. Dr. J. McRae . . Dr. R: Motteram. Mr. J. F. Richardson. Mr. R. 'Iv. Stanford. RADIO ISOTOPES COMMITTEE. Mr. D. J. Stevens (Chairman). Professor V. L. Collins. Professor G. C. de Gruchy. Dr. W. P. Holman. Mr. D. W. Kearn. Dr. W. E. King. Prcfessor E. S. J. King. Professor R. Nairn. Dr. D. P. Pearce. TRAFFIC INJURY COMMITTEE. Dr. A. Johnson (Chairman). Dr. J. H. W. Birrell. Dr. K. G. Jamieson. Dr. J. C. Lane. Mr. R. A. Money. Professor J. S. Robertson. Dr. J. I. Tonge. TROPICAL MEDICINE AND HEALTH COMMITTEE. Dr. R. H. C. Wells (Chairman). Dr. R. H. Black. Dr. C. E. A. Cook. Dr. R. L. Doherty. Professor Sir Edward Ford. Dr. A. Green. Professor W. V. Macfarlane. Dr..R. K. Macpherson. Dr. F. D. Schofield. VETERINARY PUBLIC HEALTH COMMITTEE . Dr. A. Johnson (Chairman). Mr. J. L. Anderson. Mr. A. L. Clay. Dr. G. Edgar. Dr. T. S. Gregory. Mr. K. S. McIntosh.

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SUB-COMMITIEES OF COUNCIL. DENTAL HEALTH DATA STANDARDIZATION SUB-COMMITTEE. Professor A. M. Horsnell (Chairman). Mr. L. M. Carr. Dr. B. Kruger. Professor N. D. Martin. FOOD AND COSMETICS COLOURS SUB-COMMITTEE. Dr. A. Johnson (Chairman). Dr. R. A. Bottomley. Mr. E. S. Ogg. Dr. J. R. Vickery. Mr. J. P. Warry. Professor S. E. Wright.

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FOOD IRRADIATION SUB-COMMITTEE. Mr. D. J. Stevens (Chairman). Mrs. Audrey Cahn. Mr. D. W. Kearn. Dr. A. Johnson. Professor F. H. Reuter. Dr. W. Scott.

HEALTH ADVERTISEMENTS SUB-COMMITTEE. Dr. A. Johnson (Chairman). Dr. R. J. Fambach. Dr. A. Green. Mr. B. Holt. Mr. W. Kelly. Dr. E. S. A. Meyers. Mr. J. Newton. Mr. Osborne. Dr. C. J. Ross-Smith. Mr. K. Thomas.

LABELLING OF HAZARDOUS SUBSTANCES SUB-COMMITTEE. Dr. A. Johnson (Chairman). Dr. F. W. Clements. Mr. W. H. Kelly. Dr. G. C. Smith. Mr. J. P. Warry Professor S. E. Wright.

NATIONAL MORBIDITY SURVEY SUB-COMMITTEE. Dr. A. Johnson (Chairman). Dr. W. Brein1. Professor H. O. Lancaster. Dr. J. G. Radford.

PESTICIDES SUB-COMMITTEE. Dr. G. C. Smith (Chairman). Dr. A. Bell. Dr. A. J. Christophers. Dr. A. Green. Mr. 1. P. Warry.

PESTICIDES RESIDUES IN FOOD SUB-COMMITTEE. Dr. J. R. Vickery (Chairman). Mr. S. L. Allman. Dr. A. Green. Mr. H. Nardin. Mr. J. P. Warry. Professor S. E. Wright.

II SUB-COMMITTEES OF COUNCIL-continued. POISONS SCHEDULE SUB-COMMITTEE. Dr. A. Johnson (Chairman). Mr. H. A. Braithewaite. Dr. I. S. de la Lande. Mr. W. H. Kelly. Mr. R. C. McCarthy. Dr. J. G. Radford. Dr. G. C. Smith. Dr. E. Thompson. Mr. J. P. Warry. Professor S. E. Wright.

POLIOMYELITIS SUB-COMMITTEE. Dr. Dr. Dr. Dr. A. Johnson (Chairman). J. Graydon. H. McLorinan. S. W. Williams.

PREVENTIVE MEDICINE IN GENERAL PRACTICE SUB-COMMITTEE. Dr. A. Johnson (Chairman). Dr. J. A. C. Bamford. Dr. D. E. Craven. Dr. A. Green. Dr. C. C. Jungfer. Dr. A. P. Millar. Dr. H. S. Patterson. Dr. H. Shannon. Senator Dr. R. J. D. Turnbull.

RADIATION TECHNICAL AND POLICY SUB-COMMITTEE. Mr. D. J. Stevens (Chairman). Dr. A. Bell. Dr. A. J. Christophers. Dr. I. Ferris. Mr. D. W. Kearn. Dr. D. D. Letham. Dr. G. H. McQueen. Dr. H. M. L. Murray. Dr. E. M. Rathus. Dr. G. C. Smith. Mr. B. W. Worthley. Dr. A. R. W. Wilson.

TRAINING OF RADIO ISOTOPES PERSONNEL SUB-COMMITTEE. Mr. D. J. Stevens (Chairman). Dr. W. P. Holman. Dr. D. F. Lawson. Dr. T. E. Lowe. Dr. R. Motteram. Dr. D. B. Pearce. Mr. K. R. Cox.

VlROLOGY SUB-COMMITTEE. Dr. A. A. Ferris (Chairman). Dr. R. L. Doherty. Dr. W. Howarth. Dr. D. Howes. Mr. I. Jack. Dr. A. Johnson. Mr. A. Murphy. Dr. L. C. Rowan. Professor N. F. Stanley. Dr. F. Warburton.

REPORT OF THE NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL. FIFTY-FIFTH SESSION, 30TH AND

31sT MAY, 1963.

The fifty-fifth Sessions of the National Health and Medical Research Council was held at the New Taxation Building, Brisbane on the 30th and 31st May, 1963. The following members were present:Dr. H. E. Downes (Chairman)', Sir Edward Ford rrepresenting the Commonwealth. J Dr. A. Johnson Dr. T. A. B. Keen, representing the Commonwealth Serum Laboratories Commission. Dr. D. A. Douglas, representing the Director-General of Public Health, New South Wales. Dr. A. Fryberg, Director-General of Health and Medical Services, Queensland. Dr. P. S. Woodruff, Director-General of Public Health, South Australia. Dr. H. M. Murray, representing the Director-General of Health Services, Tasmania. Dr. K. Brennan, Chief Health Officer, Victoria. Dr. W. S.'Davidson, Commissioner of Public Health, Western Australia. Dr. R. F. R. Scragg, Director of Public Health, Territory of Papua and New Guinea. Dr. W. F. Simmons, representing the Federal Council of the Australian Medical Association. Professor A. J. Arnott, representing the Australian Dental Association. Professor V. L. Collins, representing the Australian Paediatric Association. Professor S. Sunderland, representing the Universities having Medical Schools. Dr. J. J. Billings, representing the Royal Australasian College of Physicians. Professor E. S. J. King, representing the Royal Australasian College of Surgeons. Dr. J. N. Chesterman, representing the Australian Regional Council of the Royal College of Obstetricians and Gynaecologists. Dr. J. G. Radford, representing the Australian College of General Practitioners. Dr. A. V. Jackson, representing the College of Pathologists of Australia. Dr. E. R. Crisp, representing the College of Radiologists of Australasia. Miss G. N. Burbidge, a prominent laywoman appointed by the Commonwealth Government. Dr. R. H. C. Wells (Secretary of the Council). The Chairman introduced the Honourable Dr. H. W. Noble, Minister for Health and Home Affairs of Queensland, thanked him for inviting the Council to meet in Brisbane, and invited him to formally open the 55th Session of Council. -:( Dr. Noble addressing the Council, said that there had been a considerable change in our concept of public health during the last hundred years, and that where at first public health action was largely a fight against poor sanitation and its effects public health is now a social science directed towards the maintenance of adequate conditions of living to preserve good health. He suggested that this change was partly due to the success of medical research in finding ways to combat the infectious diseases, and that now more money should be channelled into the current problems of public health, such as mental illness and the problems of old age. Npting that Australia was justly proud of its food laws, which owed much to the work of the Food Standards, Food Additives and Public Health Committees of Council, Dr. Noble strongly suggested that Council should now form a Mental Hygiene Committee. . ., The Chairman thanked Dr. Noble for his address. Apologies for non-attendance were received from Senator H. Wade, Commonwealth Minister for Health, Major-General W. D. Refshauge, Commonwealth Director-General of Health, Dr. C. J. Cummins, Director-General of Public Health, New South Wales, Dr. J. Edis, Director-General of Health Services, Tasmania, Dr. R. W. Greville, Commonwealth Serum Laboratories, Dr. H. J. Ham, College of Radiologists of Australasia and Sir Norman Nock. The Chairman welcomed Dr. E. R. Crisp, Dr. D. A. Douglas, Dr. T. A. B. Keen and Dr. H. M. Murray as members of Council and Dr. A. Green, Commonwealth Health Department as an observer.

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MEDICAL RESEARCH ADVISORY COMMITTEE. The Medical Research Advisory Committee met in Brisbane on Monday, 27th, and Tuesday, 28th May. 1963. The report of the Committee was presented by Dr. W. F. Simmons, and Council approved the following recommendations.

14 Approved Research Institutes.

That the following two departments be registered as approved research institutes for the purposes of receiving National Health and Medical Research Council grants. Department of Child Health, University of Melbourne. Department of Opthalmology, University of Melbourne. Grant variations by Chairman of Council.

That the following decisions made by the Chairman of Council be confirmed:December, 1962Approval given to Professor R. W. Hawker, Department of Physiology, University of Queensland, to employ Mrs. B. Goodricke as Technical Officer Science on a part-time basis three days per week at three-fifths appropriate full-time salary, in lieu of Miss C. Walmsley (resigned). December, 1962-Approval given to Dr. J. T. Roberts, Medical Research Fellow, Department of Pathology, University of Melbourne, to work one-quarter-time at one-quarter of full-time £2,296 salary authorized. January, 1963-Approval given to Dr. 1. A. Hansen, Department of Biochemistry, University of Western Australia, to employ Technical Assistant Miss Davidson at £715 per annum salary instead of £664 previously allocated. January, 1963-Approval given to Dr. C. Kratzing, Department of Physiology, University of Queensland, to employ Mr. Beresford, a medical student, at £16 per week for eight weeks, out of unexpended 1962 grant. January, 1963-Approval given to Dr. E. Holdsworth, Department of Biochemistry, University of Adelaide, to employ Miss B. Brookman as a Technical Officer Science at a salary of £913 per annum, in lieu of Miss Culshaw (resigned). February, 1963-Approval given to Dr. G. M. Kellerman, Department of Biochemistry, University of Sydney, to employ Miss Peralta as a Technicial Officer Science at a salary of £968 per annum, in lieu of Mr. D. Jollow (resigned). February, 1963-Approval given to Professor E. C. Webb, Department of Biochemistry, University of Queensland, to employ Mr. D. J. Horgan as a Technical Officer Science at a salary of £1,156 per annum instead of £1,000 previously allocated for an unspecified person. February, 1963-Approval given to Dr. K. W. Knox, Institute of Dental Research, Sydney, to employ Mrs. E. Hall as a Technical Officer Science at a salary of £1,078 per annum, in lieu of Miss Glastenbury (resigned). March, 1963-Approval given to Dr. G. Burnstock, Department of Zoology, University of Melbourne, to employ Mr. C. Bell as a Technical Officer Science from 1st January, 1963,at a salary of £1,078 (£1,211 less C.O.L.), in lieu of Mrs. Cooper (resigning). March, 1963-Approval given to Dr. I. K. Buckley, Medical Research Fellow, Department of Pathology, University of Melbourne, to take twelve months leave of absence without pay and to accept an Eleanor Roosevelt Fellowship to study at the Pasadena Foundation for Medical Research in California. That the Chairman of Council by authorized to award Medical Research Endowment Fund grants for travelling expenses to enable medical, dental and science graduates receiving full-time salaries under Council grants to attend recognized congresses in Australia once a year, subject to the conditions associated with National Health and Medical Research Council grants approved by the Commonwealth Minister of State for Health. That in urgent matters concerning grants from the Medical Research Endowment Fund, which cannot conveniently wait for consideration by the full Medical Research Advisory Committee and by Council, the Chairman of Council be authorized at his discretion to vary the purposes for which individual grants approved by the Council may be used and to increase individual grants approved by the Council by not more than £250 if these are later shown to be inadequate for the purposes stated in the grant !>W!>l'ti~

15 Salary Scales. That the salary scales listed in Appendix I be adopted for use in connexion with National Health and Medical Research Council grants as from 1st July, 1963. Medical Research Grants. That the following grants for medical research be made for the period 1st July, 1963, to 31st December, 1963:UNIVERSITY OF ADELAIDE.

Department of Biochemistry, University of Adelaide. Professor R. K. Morton (New Grant). To study the enzymic system for biosynthesis of nicotinamide nucleotide coenzymes in immature and mature blood cells, the substrate specificities of the enzyme concerned in the biosynthesis from nicotinic acid and nicotinamide, and the comparative physiology of the synthesis of nicotinamide nucleotides in mammalian and avian species. £1,500 Grant-in-aid.

Dr. E. S. Holdsworth. Study the influence of various factors, e.g. cone. of glucose in the blood, effect of various hormones, &c., on the size of the glutamate pool. £165 Additional salary Technical Officer Science (Miss Brookman). Department of Medicine, University of Adelaide. Dr. B. Hetzel (Additional Grant). (i) Studies of the mechanism of action of thyroid hormones. (ii) Investigation of control of thyroid secretion. (iii) Study of the thyroid stimulating hormone property of the plasma in various thyroid diseases. (iv) Investigation of the chemical nature of the circulating thyroid hormone. £140 Metabolic shaking bath. £24 Travel expenses for Dr. J. S. Charnock to attend meeting of the Australian Biochemical Society. £175 Additional salary Technical Officer Science (Mr. B. Good). £360 Additional salary Research Officer (Dr. J. S. Charnock). Department of Microbiology, University of Adelaide. Professor D. Rowley. (i) Study of antigenic differences of Salmonellae in relation to pathogenicity. £137 lOs. Additional salary Technical Officer Science (Miss Mowatt). (ii) Study of the bacterial activity of mouse macrophages. £160 Additional salary Technical Officer Science (Miss E. Looke).

Professor G. Mackaness. Mechanism of acquired resistance to intracellular parasites. £165 Additional salary Technical Officer Science (Female). Department of Obstetrics and Gynaecology, University of Adelaide. Dr. R. I. Cox (Additional Grant). Gas chromatography of steroids. £330 Gas chromatography air oven and detector. UNIVERSITY OF MELBOURNE.

Department of Bacteriology, University of Melbourne. Professor S. D. Rubbo. (i) Phenotypic changes in virulence of Staphycococc~s aureus. . (ii) Combined active and passive immunization agamst tetanus WIth homologous serum. (iii) Studies in urinary tract infections. £188 Additional salary Technical Officer Science (Male).

16 Dr. B. W. Holloway (Renewal Grant). To study chromosomal mapping in Pseudomonas aeruginosa by sexual recombination and joint transduction. ,' , £270 Salary Technical Assistant (Miss A. Beaumont) for' the period' 1st August, 1963 to 31st December, 1963. £300 Media and glassware.

Dr. F. W. Gibson. (i) The metabolism of vitamin K derivatives by bacteria. (ii) The studies of a new intermediate in aromatic synthesis. £ 165 Additional salary Technical Officer Science (M r. G. Cox).

Professor V. (i)

(ii)

(iii)

Department of Biochemistry, Unil'ersity of Melbourne. M. Trikojus (Additional Grant). Studies on the specificity of intracellular proteinases and peptidases, particularly those of the endocrine glands. £24 7s. Travel expenses for ~'liss P. Jablonski to attend 2nd Asia and Oceania Congress of ~~ndocrjnology. £137 lOs. Additional salary Technical Of1!cer Science (Miss P. Jablonski). £49 lOs. Cost of livilJi dju<nic1t. Evaluate the action of hU;1~aa thyroid proteinase on human labelled thyroglobulin. Work on the goitre problem. £360 Autograd for coiumn chromatography. £24 7s. Travel expenses for iv1r. T. A. A. Dopheide to attend 2nd Asia and Oceania Congress of Endocrinology. £160 Additional salary Technical Officer Science (Mr. T. A. A. Dopheide) £66 lOs. Cost of living adjustment.

Dr. H. Bachelard (Additional Grant). £363 15s. Additional expenses during C. J. Martin Fellowship.

Department of DentaL Prosthetics, University of Melbourne. Professor H. F. Atkinson (New Grant). Studies of mandible movement during speech and mastication, and relationship of pressures developed during mastication to muscle activity. £758 Salary Electronics Technician for the period 1st July, 1963, to 31st December, 1963. £480 Tektronix double beam oscilloscope. £680 Grass camera, Model C.4. Department of Medicine, University oj'Melbourne. Professor G. C. de Gruchy (Renewal Grant). Red cell metabolism in congenital and acquired haemolytic anaemias .. £2,000 Part cost of direct recording spectrophotometer. £215 Additional salary Technical Officer Science (Mrs. Loder). Department of Obstetrics and Gynaecology, University of Melbourne. Dr. J. B. Brown (New Grant). (i) Application of oestrog~n, pregnanediol and gonadotropin assays to the study of, obstetric and gynaecological disorders. (ii) Development of methods for measuring oestrogens in blood. (iii) Simplification of methods for measuring sex hormones or their metabolites in urine. £2,000 Grant-in-aid. Department ~lPharmacology, University of Melbourne. Professor F. H. Shaw. The mechanism <;,f io~ic disc!iminatioll in the muscle cell, with particular reference to the role of lOllS 111 reSpIratory control mechanisms. , £160 Additional salary Technical Officer Science {Mr.D. Satchell).

17 Department of Physiology, University of Melbourne. Dr. D. A. Denton.

(i) Continuation of abl~tion stu~ies on the nervous system, kidney, liver and other organs to determIne the sIte of origin of ACTH. (ii) Study. of the effects <?f inferior vena caval and portal vein constriction on cortIcosterone secretIOn.

~f th~ time characteri~tic~ of ~ffect, and synergetic and antagonistic relatIOnshIps wIth adrenal artenal InfUSIOn of ACTH angiotensin histamine , , bradykinin, and Substance P will be extended.' (iv) Study of ~he~her Na+ defi~iency. augments the local 'adrenal sensitivity to ACTH, IOUIC change, angIOtenSIn II and other stimuli. (v) Continuati~n the proce<;iures for preparing of extracts of blood and organs for eXamInatIOn of specIfic aldosterone stimulating effect. (vi) Continuation of experiments to determine the conversion to aldosterone of putative radio-labelled precursors in the bio-synthetic process. (vii) Study of the metabolism of corticosteroids by infusion of radio-labelled compounds intravenously. (viii) Further investigation of the neural mechanisms involved in the selective appetite for Na+ shown by Na+ deficient sheep. £1,148 Salary Medical Research Fellow (Dr. G. Boyd) for the period 1st July, 1963 to 31st December, 1963. £386 Additional salary for Dr. D. A. Denton for the period 1st July, 1963 to 31st December, 1963, and promotion to Senior Medical Research Fellow, Grade III. £127 lOs. Additional salary Technical Officer Science (Mr. J. Coghlan). £147 lOs. Additional salary Technical Officer Science (Mr. J. Blair West). Dr. A. Shulman. The use of metal chelates in the investigation of biological mechanisms. £72 lOs. Additional salary Technical Officer Science (Miss Laycock). Professor E. B. Verney. Continuation of work on the factors affecting salt and water balances, using surgically prepared dogs. £137 lOs. Additional salary Technical Officer Science (Miss Williamson). (iii) The stl.!-dies

or

Department of Zoology, University of Melbourne. Dr. G. Burnstock. Autonomic nerve to smooth muscle transmission. £160 Additional salary Technical Officer Science (Mr. C. Bell). £66 lOs. Cost of living adjustment.

Professor G. (i) (ii) (iii)

MONASH UNIVERSITY. Department of Anatomy, Monash University. C. Schofield. Utilization of dynamic de.r0rmati~n cha~ge in peripheral nerves ,<following section) to study anatomIcal basIs of penpheral reflex phenomena In the gut. Investigation of site of origin and method of action' of 5-hydroxytryptamine in the gut, using tritium labelled tryptophane. Investigation of the neuronal degeneration associated with hereditary megacolon in mice. £188 Additional salary Technical Officer Science (Male).

Department of Biochemistry, Monash University. Professor J. Bornstein. Investigation into the metabolic effects of pituitary polypeptides derived from glands or growth hormone on metabolism of lipids by various tissues. £160 Additional salary Technical Officer Science (Miss Millar).

Dr. A. W. Linnane. . Study of the nature of the electron transport system in respiring yeast particles. £160 Additional salary Technical Officer Science (Miss Broome). £155 Additional salary Technical Officer Science (Miss Nowland).

18 Department of Medicine, Monash University.

Professor B. Hudson (Additional Grant). (i) Testosterone secretion rates. (ii) Testosterone in plasma. . ' £24 7s. Travel expenses for Miss A. Dulmanis to attend 2nd ASIa and Oceama Congress of Endocrinology. £127 lOs. Additional Salary Technical Officer Science (Miss Dulmanis). Departmen"t of Pathology, Monash University. Professor R. C. Nairn (New Grant). To study the localization and histological assay of cellular antigens in tissue culture and histological preparations. £2,000 Grant-in-aid. Department of Physiology, Monash University. Dr. M. E. Holman (Additional Grant). (i) Electrophysiology of sheep parotid gland. (ii) Studies on the passive electrical potentials of single muscle fibres. (iii) Comparative studies on the electrophysiology of smooth muscle. (iv) Studies on the transmission from autonomic nerve to smooth muscle. £500 Tektronix double beam oscilloscope. £100 Microscope accessories. £250 Micro-electrode puller. £150 Running expenses. UNIVERSITY OF NEW SOUTH WALES.

.Y-

Department of Medicine, University of New South Wales. Professor A. W. Steinbeck. (i) The comparison of " adrenocortical responsiveness " to three preparations of retard-corticotrophin. (ii) The assessment of anterior pituitary responsiveness using S.U. 4885. (iii) Further work on steroid excretions. £137 lOs. Additional salary Technical Officer Science (Miss Cooper). Department of Microbiology, University of New South Wales. Professor M. R. J. Salton. (i) Immunochemistry of bacterial cell walls and membrane structures. (ii) Biosynthesis of bacterial cell walls and membranes and the inhibitory effects of anti-Ie,ukaemic lipid analogues on the biosynthetic processes. £1,118 Chromo scan recording and integrating densitometer. £188 Additional salary Technical Officer Science (Male). UNIVERSITY OF QUEENSLAND.

I'- ~

Department of Biochemistry, University of Queensland. Professor E. C. Webb. (i) Study of the esterases of the liver. (ii) Investigation of the " isoenzymes " of animal esterases. £137 lOs. Additional salary Technical Officer Science (Mr. D. J. Horgan).

Dr. M. D. Doherty (New Grant). To study the species incidence of creatine kinase. £750 Grant-in-aid. Department of Dentistry, University of Queensland. Dr. B. J. Kruger (Additional Grant). Investigation of the mechanism by which trace elements inhibit dental caries. £477 Leitz Ortholux microscope. £858 Leitz Orthomat camera. L'1

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19 Department of Physiology, University of Queens/and. Professor R. W. Hawker.

(i) Oxytocin assay in whole blood and investigation of relationship of oxytocin blood levels to spontaneous abortion. (ii) Relation of oxytocin blood levels to human intra-amniotic pressures during labour. (iii) Investigation of oxytocic factors and precursors in blood. £132 lOs. Additional salary Technical Officer Science (Mrs. B. Goodricke) threefifths time per week. Dr. C. C. Kratzing. Study of the lipotropic effect of ethyl trichloracetate on the livers of choline deficient rats and of the intermediate metabolism of the liver so as to discover the mode of action of this drug. £165 Additional salary Technical Officer Science (Male).

UNIVERSITY OF SYDNEY.

Department of Bacteriology, University of Sydney.

Dr. S. Faine. Mechanism of virulence and pathogenesis of leptospirosis. £137 lOs. Additional salary Technical Officer Science (Mr. G. Lindlay). Department of Biochemistry, University of Sydney. Professor J. L. Still. Pyrrole and porphyrin metabolism of Serratia marcescens. £188 Additional salary Technical Officer Science (Male).

Dr. G. M. Kellerman. Studies on the synthesis of oleic acid in the mammal. £137 lOs. Additional salary Technical Officer Science (Miss Peralta). Dr. A. L. Hunt. Continued studies on the functional significance of the intermediary dRNA and high molecular weight hRNA induced concurrently with the nicotinic acid hydroxylase respiratory complex in Ps. fluorescens and commencement of studies on the structural organization and mechanism of synthesis of this complex in the particulate mesosome-protoplast membrane of the cell. £195 Additional salary Technical Officer Science (Mr. W. Sadler). £66 lOs. Cost of living adjustment. Dr. R. G. Wake. The biological replication of deoxyribonucleic acid in synchronously germinating spores of B. subtilis. £165 Additional salary Technical Officer Science (Miss R. Hunt). Department of Medicine, University of Sydney. Professor C. R. B. Blackburn. (i) Progressive hepatitis: continuation of study of biopsy material using fluorescent antibody staining techniques. (ii) Experimental liver disease: continuation of attempts to induce liver disease by auto-immune methods in rabbits. (iii) Continuation of study of colloid clearances and organ localization in patients with liver disease, and studies on liver blood flow. (iv) Continuation of study of steroid metabolism in selected patients with liver disease. (v) Follow-up of families of patients with haemochromatosis. £215 Additional salary Technical Officer Science (Miss Dale).

r l

Dr. L. Dintenfass (Additional Grant). Study of visco-elasticity of blood, red cells, cancer cells and other biological tissues. £150 For completion of visco-elastometer and viscometer. £87 lOs. Additional salary Senior Research Officer (Dr. L. Dintenfass).

Depqrtment of Pharmacy, University of Sydney. ~~

Professor S. E. Wright (Additional Grant). ~ ~ ~ ~c~ ~ ~ ~_ Investigation 9f the metabolism and excretiolLOffQod .actditives, drugs and substances foreign to the body. ~ ~ ~£2,18l Per annum salary Research Officer (Dr. M. B. Slaytor), as from date of departure from U.S.A. until 31st December, 1964. .£J32 . 10s. Additional salary Technical. Officer Science (Miss Milgate). Department of Physiology, University of Sydney.

Dr. C. W. Dunlop (Additional Grant). The study of cerebral cortical after-discharges following photic stimulation in the cat. £300 For technical assistance.

UNIVERSITY OF WESTERN AUSTRALIA.

Department of Biochemistry, University of Western Australia.

Dr. I. T. Oliver (Additional Grant). (i) Nucleic acid synthesis in neo-natalliver. (ii) Nucleic acid components of neo-natal rat liver. (iii) Enzymology of glycogen synthesis. £1,589 Radioactive chromatogram scanner. . (Equipment to remain the - - ~. _. ~ . . ~ ~ property of the N.H. & M.R.C.) £66 15s. Travel expenses for Mr. F.~J. Ballard ~to attend meeting of the Australian Biochemical Society. £137 lOs. Additional salary Technical Officer Science (Mr. F. llallard). Department of Microbiology, University of Western Australia.

L

Dr. C. J. Perrett and Mr. J. W. May (New Grant). Studies of the influence of environment on the hereditary properties of Staphylococcus aureus populations. £750 For completion of continuous culture apparatus. £200 Media, minor apparatus and maintenance. Department of Pathology, University of Western Australia.

Dr. R. A. Barter and Dr. F. A. Brisbout (New Grant). Study of growth and differentiation based on mass distribution in squamous epithelium, using interference microscopy. - ~£300 ~ For 20 Barr and Stroud optical filters.

INSTITUTES,

MELBOURNE.

Baker Medical Research Institute, Melbourne.

Dr. T. E. Lowe. (i) The synthesis of aldosterone in vitro, using isolated animal adrenals. (ii)· Investigation of the steroid pattern in the body fluids and excreta ofmonotremes and marsupials. £137 lOs. Additional salary Research Officer (Dr. M.Weiss). Dr. P. Fantl. (i) Metabolic and clotting activity of blood platelets. (ii) The phosphorus content of blood clotting factors. (iii) Qualitative changes in blood dotting factors, associated with haemorrhage. (iv) Substrate specificity of glycerides in the heparin-induced lipoprotein lipase. £137 lOs. Additional salary Technical Officer Science (Mrs. Strosberg).

21 St. Vincent's School of Medical Research, St. Vincent's Hospital, Melbourne. Dr. P. Edman (Additional Grant). Studies on the structure of proteins, using the phenylisothiocyanate method of determining aminoacid sequence. £6,709 Beckman Spinco Model 120 B aminoacid analyser. (Equipment to remain the property of the H.N. & M.R.C.) £629 Preparative column and stream divider. £170 Ion exchange resins and reagents. Walter and Eliza Hall Institute of Medical Research, Melbourne. Professor Sir Macfarlane Burnet (Additional Grant). (i) Studies in experimental immunology and biochemistry. £860 Travel expenses on twelve months' sabbatical leave for Principal Research Officer, Dr. G. L. Ada. (Return tourist class air fare and up to £250 additional expenses.) £165 Additional salary Senior Research Officer (Dr. A. Szenberg). £115 Additional salary Senior Research Officer (Mr. A. Pye). £172 lOs. Additional salary Research Officer (Dr. P. Lind). £155 Additional salary Technical Officer Science (Mr. N. Warner). £137 lOs. Additional salary Technical Officer Science (Miss G. Long). £132 lOs. Additional salary Technical Officer Science (Miss S. Ernyei). £137 lOs. Additional salary Technical Officer Science (Miss B. Cook). (ii) Clinical Research Unit.

(i) The investigation of autoimmune diseases. (ii) Systemic lupus erythematosus. (iii) Lupoid hepatitis. (iv) The L.E. cell phenomenon in lymphosarcoma. (v) Blood alcohol studies. (vi) Chromosome studies in macroglobulinaemia. (vii) Irradiation injury to the bowel. (viii) Magnesium levels in chronic diarrhoea. (ix) Serum vitamin B12 levels in chronic gastritis. (x) Hexosamine levels in Hodgkin's disease. £386 Additional salary for Dr. I. R. Mackay for the period 1st July, 1963, to 31st December, 1963, and promotion to Senior Medical Research Fellow, Grade III. £574 Salary Medical Research Fellow (Dr. W. H. Marshall) for the period 1st October, 1963, to 31st December, 1963. £172 lOs. Additional salary Research Officer (Dr. S. Weiden). £127 lOs. Additional salary Technical Officer Science (Female). INSTITUTES, WESTERN AUSTRALIA.

Department of Biochemistry, Royal Perth Hospital, Western Australia. Dr. G. A. Sarfaty. The pyrogenic activity and species specificity of endogenously produced steroid hormone metabolites when injected into man. £215 Additional salary Technical Officer Science (Miss Summers). INSTITUTES, SYDNEY.

Institute of Dental Research, Sydney.

Dr. K. W. Knox. To study the cell wall of Lactobacillus strains. .. £132 lOs. Additional salary Technical Officer Science (Mrs. E. Hall). Fairfax Institute of Pathology, Sydney.

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Dr. P. Rountree. . . ... Studies on staphlococcal epidemiology, particularly in. surgical.wound mfectIOns. 1'1~'" 11',

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22 Institute of Medical Research, Sydney.

Dr. M. R. Lemberg. (i) Continuation of the studies of cytochrome oxidase; in partlcular(a) modification of cytochrome oxidase by alkali ar,td !eversibility of denaturation of cytochromes a and as by neutrahzatIon; (b) modification of cytochrome oxidase by detergents; (c) further study of the 6. Fe2+ - Fe3+ difference spectra of cytochrome a and a 3 by the study of partial reduction; (d) the nature of the alteration of the enzyme to " mitochrome " and the haemins of such alteration products. (ii) Continued studies on porphyrin a and cryptoporphyrin a, in particular(a) the nature of the long alkyl side chains in both porphyrins; (b) the position of the formyl group in cryptoporphyrin, a; (c) further model experiments on compounds of haem a. £165 Additional salary Senior Research Officer (Dr. W. Lockwood). £92 lOs. Additional salary Research Officer (Mr. J. Barrett). £127 lOs. Additional salary Technical Officer Science (Miss Newton). £127 lOs. Additional salary Technical Officer Science (Miss Davies). £132 lOs. Additional salary Technical Officer Science (Mr. R. Sinclair). Dr. E. B. Durie. (i) Sensitivity of cultures to griseofulvin. (ii) Investigation of the absorption in vitro of griseofulvin by keratin substrates, using a variety of solvents. (iii) Cryptococcus neoformans in pigeons. (iv) Mycology reference laboratory. £155 Additional salary Research Officer (Dr. D. Frey). Dr. P. G. Stanley. Investigation of the proteins and enzymes of normal and pathological thyroid tissue. £92 lOs. Additional salary Research Officer.

~.--

Red Cross Blood Transfusion Service, Sydney. Professor R. J. Walsh (Additional Grant). (i) Chromatography study of the pathway of iron from transferrin to haemoglobin; study of transferrin saturation and related effects; and studies of phenylalanine and tyrosine levels in normally and red pigmented New Guinea natives. £946 lOs. Salary Research Officer (Miss P. Clark), for the period 1st July, 1963, to 31st December, 1963. (ii) Studies on the enzyme content of white blood cells (by Dr. G. T. Archer). £200 Albumin powder. (iii) Study of cellular haem formation. £200 Radio isotopes.

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MISCELLANEOUS. Dr. A. V. Southcott and Professor J. B. Cleland (Additional Grant). Injuries to JUan from marine invertebrates in the Australian region. £1,750 Publishing expenses for 2,000 copies of monograph in the Special Report Seri.es of Council. (Subject to the agreement of the authors that 500 copIes be reserved for free distribution; that up to 1,500 copies be offered for ~ale at 30s. each, the proceeds of the sales to be credited to the MedIcal Research Endo",ment Fund with the stipulation that these shall not exceed the total pUblication and distribution costs to the Council.)

23 Applications Deferred. Other applications from the following were deferred for reconsideration in October 1963 subject to re-applications being received. ' , Mr. E. Allcock, Department of Surgery, University of Melbourne. Professor J. Bornstein, Department of Biochemistry, Monash University. Mr. J. G. Brockis, Department of Surgery, University of Westert1 Australia. Dr. G. Burnstock and Dr. C. Folsome, Department of Zoology, University of Melbourne. Dr. F. D. Collins, Department of Biochemistry, University of Melbourne. Professor M. Ewing, Department of Surgery, University of Melbourne. Dr. B. W. Holloway, Department of Bacteriology, University of Melbourne. Dr. M. E. Holman, Department of Physiology, Monash University. Professor B. Hudson, Department of Medicine, Monash University. Dr. K. G. Jamieson, Department of Neurosurgery, Brisbane General Hospital. Dr. H. M. Lloyd, Department of Medicine, University of Queensland. Professor G. M. Maxwell, Department of Child Health, University of Adelaide. Professor A. K. McIntyre, Department of Physiology, Monash University. Dr. I. T. Oliver, Department of Biochemistry, University of Western Australia. Dr. A. M. Parfitt, Department of Medicine, University of Queensland. Dr. C. J. Perrett and Mr. J. W. May, Department of Microbiology, University of Western Australia. Dr. J. R. Rintoul, Department of Anatomy, University of Queensland. Professor G. C. Schofield, Department of Anatomy, Monash University. Dr. A. Shulman, Department of Physiology, University of Melbourne. Professor W. J. Simmonds, Department of Physiology, University of Western Australia. Mr. D. Watson, Royal Women's Hospital, Carlton, Victoria. Professor S. E. Wright, Department of Pharmacy, University of Sydney. C. J. Martin Fellowship. That Dr. S. L. Skinner's C. J. Martin Fellowship be extended for one year subject to satisfactory reports from Professor Robson and Professor Simmonds as referees. That no new C. J. Martin Fellowships be awarded for this year. Conditions associated with National Health and Medical Research Council Grants. That the conditions listed in Appendix II be applied to National Health and Medical Research Council Grants for medical research and training as from 1st July, 1963. Publication of Tasmania Birth Record Survey. That the results of this survey would be published to best advantage as a series of papers in medical journals. rather than as a Special Report of the Council. Submission from Professor S. D. Rubbo. That Professor Rubbo be informed that the Council takes into consideration all the relevant available information on both the persons and the projects concerned when making recommendations on grants for medical research, and that his application for a five year grant to work on unspecified projects is not approved. Major Equipment Requirements. The report of the Sub-committee that additional equipment for medical research costing about £665,000 should be provided during the 1964-6 triennium was approved. The Committee was informed that a submission had been forwarded to the Commonwealth Government requesting an additional allocation to the Medical Research Endowment Fund to provide equipment for medical research, and that Commonwealth consideration of this submission was being deferred pending receipt of recommendations from the Australian Universities Commission on the support of research in Universities. National Health and Medical Research Council Support of Research Institutes. The recommendations of the Sub-committee on the support of the Clinical Research Unit of the Walter and Eliza Hall Institutes were approved as follows:(i) That support should be continued in order that the presently proposed programme of clinical research may proceed. (ii) That a time limit dated 31st December, 1965 should be placed on this support clearly indicating that notice is being served not on the projects or the personnel, but on the awkwardness of present arrangements.

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24 (iii) That a formal request be made to the governing bodies ofthe Institute and of the Hospital

that the National Health and Medical Research Council be informed of their views on the future structure and function of the Clinical Research Unit: and that both bodies be informed that if it is the intention that the Clinical Research Unit should continue in its present form, the National Health and Medical Research Council considers that, in the best interests of all concerned, the salaries of the senior permanent staff should not be derived from National Health and Medical Research Council funds. It was also approvedThat it be Council policy to avoid further actual or implied commitments to provide the salary of a director of a research institute, department or unit, unless the Council has been consulted and has given prior approval to the appointment of the director. Ionic Research Unit, Department of Physiology, University of Melbourne.

,~/

That the following Sub-committee be appointed to investigate the organization, structure and future research support of the Ionic Research Unit, in consultation with the Vice-Chancellor and Dean of the Faculty of Medicine, University of Melbourne, and to report its findings and recommendations at the next meeting of the Medical Research Advisory Committee. Professor F. C. Courtice. Professor F. Fenner. Professor H. N. Robson. Professor W. J. Simmonds. Professor R. J. Walsh. Dr. H. M. Whyte. Dr. R. H. C. Wells (Convenor). Traffic Accident and Injury Research.

"Y ~

That the major causes of traffic accidents have already been clearly defined and studied in terms of factors arising from road and street conditions, factors relating to the design and functions of vehicles, and the human factors involved ill drivers. That very little of this information has been applied and that there is little value in enquiring further into accidents which have already happened and which could well have been prevented if existing information had been applied. That in other countries where the traffic accident record is much better than in Australia success in preventing traffic accidents has been due to action at the political, social and educational levels. That only those aspects of traffic accident and injury research which may be shown to be primarily medical should be supported by National Health and Medical Research Council grants. Townsville Skin Cancer Project.

The Medical Research Advisory Committee has considered the submission by Dr. Petherbridge on behalf of the Townsville Sub~Branch of the Australian Medical Association, and considers that the project does not justify the expenditure of public funds on the scale outlined. The Medical Research Advisory Committee recommends that the Medical Statistics Committee be requested to advise Council on the practicability and estimated cost of conducting a survey to reliably establish the racial incidence of skin cancer in Northern Queensland, the attributable morbidity and the aetiological relationship of solar radiation to the condition. The Medical Research Advisory Committee considers(i) that there is certainly an abnormally high incidence of skin cancer in Northern Queensland and this is largely attributable to exposure to solar radiation; (ti) that the patients with skin cancer in Northern Queensland could provide clinical material particularly for(a) statistical studies to establish the incidence, mortality and morbidity of skin cancer, and their relationships to race, solar exposure, age of onset; latent period; (b) possible controlled prophylactic studies. General Policy Concerning National Health and Medical Research Council Support for Medical Research.

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That the policy of the National Health and Medical Research Council be to support preferentially applications from those departments and institutes where(a) the specific type of work has already been developed in the department; (b) the application clearly concerns a major interest of the department; (c) the principal investigator is already established as a research worker.

25

ResearlhXd~:o~~~;~~~~t~ef~~ ~~ef~l¥i:s~mmittee visits prior to the October meeting of the Medical Perth Grants .Sub-committee (Professor F. Fenner, Dr. H. M. Whyte and Dr R H C W 11 )IntervIews on 26th and 27th September, 1963. . . . . e s Adelaide Grants Sub-committee (Professor F. Fenner, Professor E. S. J. King, Dr. H. M. Whyte and Dr. R. H. C. Wells)Interviews on 30th September and 1st October, 1963. Melbourne Grants Sub-committee (Professor H. N. Robson, Professor W. J. Simmonds, Professor R. J. Walsh and Dr. R. H. C. Wells)Interviews on 2nd, 3rd and 4th October, 1963. Sydney Grants Sub-committee (Professor E. S. J. King, Professor H. N. Robson, Professor W. J. Simmonds and Dr. R. H. C. Wells)Interviews on 7th, 8th and 9th October, 1963. Brisbane Grants Sub-committee (Professor E. S. J. King, Professor R. J. Walsh and Dr. R. H. C. Wells)Interviews on 10th and 11th October, 1963. Date and Place of Next Meeting.

Regional Grants Sub-committees.

That the next meeting of the Medical Research Advisory Committee be in Canberra on the 28th and 29th October, 1963.

PUBLIC HEALTH COMMITTEE. Sir Edward Ford presented the Public Health Committee report. Recommendations of the Antibiotic Committee, Epidemiology and Infectious Diseases Committee, Food Additives Committee, Food Standards Committee, Leprosy ad hoc Committee, Medical Statistics Committee and Veterinary Public Health Committee, which were channelled through the Public Health Committee and approved by Council, are included with the individual Committee reports. The following recommendations of the Public Health Committee were approved by Council. Advertisement of Pesticides.

(i) That, in agreement with a recent resolution by the Australian Paediatric Association, concern is expressed at what appears to be false and misleading advertising of certain insecticides and pesticides produced for household use. (ii) That some statements on the labels about the ingredients do not contain sufficient information about the relative toxicity of the products nor is the information expressed in such a way that it can be understood by the majority of the general public, and Council requests that the State and Commonwealth Health Authorities investigate these aspects of labelling and advertising of these products. (iii) That State poisons authorities be requested to take appropriate action in connexion with false advertising claims for the safety of organo-phosphorus pesticides. Advertisement of Vitamin Products.

That a code for the advertising of vitamin products, prepared by the Advisory Committee on Advertising, be examined by State Health Departments and be discussed by Dr. A. Johnson with a committee representing industry and the advertising agencies, with a view to presenting the code with any necessary amendments for consideration at the next meeting of Council. Handling of Condemned Offal.

That the Veterinary Public Health Committee be requested to report on the dangers of the spread of disease through the handling and disposal of condemned offal. Hormones in Cosmetics.

That cosmetics containing hormones should be supplied only on the production of a prescription. Inoculation of Migrants Against Infectious Diseases.

•

That the Commonwealth Department of Health be requested to investigate the usefulness of having migrants inoculated against certain diseases (e.g. typhoid, tetanus, diptheria, poliomyelitis) prior to embarkation or during the voyage to Australia.

26 Labelling of Hazardous Substances. . ' (i) That hazardous substances can be controlled adequately by incorporation in ~Ol~O\l~ schedules. (ii) That the Poisons Schedule Sub-Committee be requested to revise the existing poisons schedules to incorporate hazardous substances not yet scheduled.

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,~

Meeting of State Food Analysts. That the meeting of State Food Analysts last year was of great value to them and to State Health Departments, and that subject to the concurrence of the Commonwealth Director-General of Health another such meeting should be held later this year. Poliomyelitis Immunization. That in view of recent overseas experience and reports of Sabin vaccine, the Epidemiology Committee be requested to give a further opinion on the role of this vaccine at its next meeting. Pre-School Health Plan. That in view of the outstanding success of the pre-school health plan in Western Australia, in which children are examined by their family doctors on referral by the Infant Health Centres at 3 months, 6 months, 1 year and once again before school age, with records being kept on special cards" Every State should endeavour to implement a pre-school health plan along the lines of the one in operation in Western Australia." Safety Containers With Left Hand Thread. That from a practical public health point of view, poison containers with a left hand thread have little or no special advantages over those with the conventional right hand thread. Salmonella Infections. That the Veterinary Public Health Committee be requested to make practical recommendations in relation to the control of Salmonellae in meat and in by-products. Scheduling of Poisons. ProcedureThat in the lists of information required from manufacturers in relation to the scheduling of substances (Appendices A and B to the report of the 54th Session of Council) the following additional information be provided:(i) In the case of substances for human therapeutic use, any special incompatibility and the best method of assay. (ii) In the case of substances other than for human ther~oeutic use, the antidote if any. Atropine and Organo-phosphorus CompoundsThat packages of organo-phosphorus compounds should not be permitted to be sold having a companion pack of atropine attached thereto. Dextromethorphan(i) That dextromethorphan in substances containing 1 per cent. or less of dextromethorphan should be placed in Schedule 2. (ii) That dextromethorphan and its salts except in preparations containing 1 per cent. or less should remain in Schedule 4. Dextropropoxyphene(i) That dextropropoxyphene in substances containing 1 per cent. or less of dextropropoxyphene should be placed in Schedule 2. (ii) That dextropropoxyphene and its salts except in preparations containing 1 per cent. or less should be placed in Schedule 4. EphedraThat ephedra alkaloids, both natural and synthetic and their salts, except in substances for external use containing less than I per cent. of the alkaloids, should be placed in Schedule 3. Fluorides in ToothpasteThat fl~o~ides, metallic and ammonium, when intended for ingestion, except in dentifrices contammg 0.5 per cent. or less, should be placed in Schedule 2. IodoformThat iodoform should not be placed in a schedule. Potassium PerchlorateThat potassium perchlorate for therapeutic use should be placed in Schedule 4.

27 Revision of Uniform Schedules(i) Schedule 2(a) Mercuric potassium iodide. "1 per cent." should be altered to read" 2 per cent. " (b) Phenylene diamines. Add" except when included in Schedule 5 ". (e) The entry following" Antihistamine preparations" should read" for external topical use". (ii) Schedule 3A new entry to be made-" Antihistamine substances in preparations labelled and packed for motion sickness in packs of I 0 doses or less". (iii) Schedule 4(0) " Dextromorphan .. should be altered to read" Dextrorphan ". (b) Dinitrocresols. Add" for therapeutic use ". (e) Dinitronaphthol. Add" for therapeutic use". (d) Dinitrophenols. Add" for therapeutic use ". (e) A separate entry to be made for "Ethyl morphine and substances containing more than I per cent. of ethyl morphine". (f) A separate entry to be made for " Pholcodine and substances containing more than I per cent. of pholcodine ". (g) The entry following" Antihistamine preparations" should read" or purporting to be such, except for external topical use or preparations labelled and packed for motion sickness in packs of 10 doses or less". (iv) Schedule 8(a) That substances listed in Schedule 8 should be listed under their chemical names, where applicable, in connexion with their approved names. (b) That the entry relating to opium should read" Opium-in any form except the alkaloid papaverine and in any solution or dilution in an inert substance whether liquid or solid in any proportion of opium, and all preparations and admixtures (not being a solution or di1ution as aforesaid) containing more than 0.2 per cent. of morphine calculated as anhydrous morphine". Selenium CompoundsThat selenium, its salts and compounds, should be placed in Schedule 1 in all States in the interests of uniformity. Static Master Brushes. That the indiscriminate disposal of static master brushes after they had reached activities below useful limits could be a radiation hazard to young children. Sterile Eye Drops. That all eye drops should be sterile when dispensed and should contain some suitable effective bacteriostatic agent which should be named. Tetanus Immunization. (i) That doctors should be urged to ensure that patients are actively immunized against tetanus. (ii) That the Medical Statistics Committee be requested to enquire into the risks of tetanus following injuries in Australia, and into the risk of serious anaphylactic shock following the administration of anti-tetanic serum . . Traffic Injuries. (i) That a communication be sent through appropriate channels to the Standards Association of Australia urging that body to pursue energetically the acquisition of power to register a mark for safety belts which could be licenced to manufacturers of products meeting relevant Australian standards. (ii) That the Council supports the proposed extension of the traffic accident injury research project in Brisbane, and recommends that funds be made available for this purpose. (See also the recommendations in the report of the Medical Research Advisory Committee.) Use of Dangerous Drugs by Dentists. That dentists should be allowed to procure and administer cocaine and pethidine.

t.,.

I

I

28 ANTIBIOTICS COMMITTEE. Dr. A. Johnson presented the Antibiotics Committee report, and Council approved the following recommendations concerning the abuse of antibiotics:(i) That the attention of the Faculties of Medicine in all Universities be directed to this matter, and also that of the Post-Graduate Federation of Medicine. (ii) That Medical Practitioners should be asked by the States to inform the general public by every means, including literature, broadcasting and the press, of the inherent dangers in indiscriminate antibiotic and other therapy, and warn them of the undesirability of seeking from their medical attendants therapy such as " wonder drugs " or other popular "remedies" beyond the actual needs of their particular maladies. (iii) That Medical Practitioners should be kept constantly informed by the States that viral infections are not influenced by antibiotics, and that their use in these cases may do more harm than good.

DENTAL RESEARCH ADVISORY COMMITTEE. ' Professor A. J. Arnott presented the report of the Dental Research Advisory Committee, and Council approved the following recommendations. Causes, Prevention, Morbidity and Financial Costs of Dental III Health. (i) That the relative importance in Australia of many factors suspected to cause or prevent dental caries, the incidence, morbidity and financial costs of dental ill health are not known with sufficient accuracy to enable the dental health requirements of the nation to be reliably estimated. (ii) That much more information is required about the levels of many trace elements in soils and water supplies throughout Australia and about the incidence of plant and animal deficiency syndromes and human dental caries in different areas. -(iii) That support be given by the Commonwealth and State Departments of Health and the Medical Research Advisory Committee to a co-operative national epidemiological survey of the dental status of the Australian community and if possible with the aim of correlating the findings of such a survey with the available data on trace elements levels in soil and water supplies. Closure of Multiple Dose Containers of Local Anaesthetic Solutions. Because of the dangers of contamination and syringe transmitted infection to the patient, the Council strongly deprecates the use of multiple-dose containers and recommends the use of cartridges or other single dose containers for local anaesthetic solutions used in dental practice. Dietary Habits of School Children. That Professor Martin, Dr. Hipsley and Dr. F. Clements be requested to study the material collected by Professor Martin on the Dietary Habits of School Children and prepare a report for subsequent consideration by the Dental Research Advisory Committee at its next meeting. --j

Report on the Monograph, Fluoridation, by P. R. Sutton. That Professor Martin be asked to submit a report on P. R. Sutton's monograph on fluoridation for the next meeting of the Committee. Standardization of Obtaining and Recording Dental Health Data. (i) That a uniform method of obtaining and recording dental health data in this country should be used by the various agencies undertaking dental examinations. (ii) That a sub-committee be formed to enquire into the standardization of methods for obtaining and recording dental health data and to make recommendations to the Dental Research Advisory Committee before 31st December, 1963. (See under reorganization and membership of Committees). Trace Elements And Dental Caries Relationships. That the Secretary of the National Health and Medical Research Council be requested to make suitable enquiries and if possible, obtain for the Dental Research Advisory Committee a map of the ~! .... 4.-=1.... ,

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29 EPIDEMIOLOGY AND INFECTIOUS DISEASES COMMITTE£:. ~f Sir Edward Ford, the Chairman of the Epidemiology and Infectious Diseases Committee, presented the report and Council approved the following recommendations concerning influenza. (i) Following the results of the C.S.L. trials of divalent influenza vaccine, consideration should be given, at a later date, to a change over to this product if it should be proved satisfactory. (ii) There would be an advantage in carrying out further influenza serological studies of the type made by Dr. Ferris in 1959 and ]961. These studies should extend to each State.

FOOD ADDITIVES COMMITTEE. ~'~

The report of the Food Additives Committee was presented by Dr. A. Johnson, and Council approved the following recommendations. Benzoic Acid in Ales and Beers. That no further action should be taken at present regarding this additive which is used under certain circumstances to prolong the shelf life of ales and beers. Calcium Versenate In Soda Water And Soft Drinks. The the substance disodium mono calcium salt of ethylenediaminetetraacetic acid (Calciun:t EDTA) should not be approved for use in soda water or soft drinks. Chlorine Solutions in Poultry Processing. , That the water used for the cooling of eviscerated poultry carcasses may contain up to 200 p.p.m. of chlorine provided that poultry so treated shall not contain any free chlorine at the time of sale. Citrus Red. That consideration of Citrus Red for the colouring of citrus fruits should be deferred and it should be reconsidered by the Food Colours Sub-Committee in the light of further evidence now available. Colouring of Citrus Fruits. That the use of food dyes for the artificial colouring of the skins of citrus fruits should not be permitted. Food Irradiation. (i) That the States be requested to advise their Food Standards Committees and Departments of Agriculture that the Food Irradiation Sub-Committee is concerned at the apparent lack of scientific information regarding possible alterations in the constituents of food treated with radiation, and is taking action to obtain this information, and meanwhile recommends that until this information can be obtained and evaluated food treated with radiation should not be approved in Australia for consumption by man. (H) That for the purposes of approval and control of irradiated foods, the treatment of ". "'. -. foods With ionizing radiation (excluding ultra violet rays) should be regarded as - - -".'.:~ ',' 'eqUivalent to the :use of an 'additjvein food. ..': : , ' . , " , . Free Running Agents in Salt. That the rollowi~g should be approved as free running agents in salt - calcium silicate, sodium (or sodium calcium) silico-aluminate, magnesium carbonate, tri-calcium phosphate, calcium hydroxyphosphate. Oxytetracycline for Fish Preservation. That the use of oxytetracycline for the preservation of fish should not be approved. Potassium Iodate as

- -r

an Improving Agent in Bread Manufacture.

(i) 'That approval should be given to the use of potassium iodate as an improving agent

in bread in an amount not exceeding 20 p.p.m. on the basis of the weight of flour used. (ii) That the Public Health Committee should examine the possibility of encouraging bakers of bread in proclaimed areas of endemic goitre to use a bread improver containing not less than 2 p.p.m. potassium iodate per unit of flour and that if this proposal is adopted consideration should be given to abandoning other methods at present used to control goitre.

30 Sorbic Acid in Bulk Jams. That sorbic acid should not be permitted to be added to jams. Sulphur Dioxide in Meat. (i) That the addition of sulphur dioxide to chopped fresh meat should not be permitted. (ii) That States should give consideration to proper refrigeration as an alternative to the use of sulphur dioxide as a preservative in meat. Vegetable Black. That the substance known as "Carbon Black" which is permitted for use in fdodstuffs, should be known as follows :-" Carbon Black prepared from vegetable sources and free froQ1 any polycyclic hydrocarbon, when determined by the prescribed method. It may not be prepared trom coal-tar or petroleum products.

FOOD STANDARDS COMMITTEE. Dr. A. Johnson presented the Food Standards Committee report, and Coun6i1 approved the following recommendations. Draft 2-Final S t a n d a r d s . · That the final standards for flavoured milks, prescribed colourings, lemon butter, fruit flavoured spread, fruit flavoured fillings, ice cream and related products (dairy ice mix), as listed in Appendix III., be forwarded to State Food Advisory Committees for adoption. Skim Milk. The the Food Standards Committee's previous recommendation .. that skim milk should not be marketed under the name of non-fat milk" be reaffirmed. Uniform Bread Standards. That all States be requested to incorporate in their regulations the standards for meals and bread submitted to them by the Bread Research Institute. ~

NUTRITION AND HEALTH OF ABORIGINES COMMITTEE. A second interim report, relating to investigations by Dr. C. E. Cook and Dr. P. S. Woodruff in South Australia, was received. j-

LEPROSY

AD HOC

COMMITTEE. -4

A report was received from an ad hoc Committee set up by the Chairman of Council to consider and report on the problems of leprosy control in Australia. The Committee consisted of Dr. R. H. C. Wells (Chairman), Dr. R. H. Black, Dr. C. E. Cook, Dr. J. J. Elphinstone, Dr. M. H. Gabriel, Dr. J. Hargrave and Dr. W. A. Langsford. The Council accepted the report as a general principle for the control of leprosy (the relevant recommendations are listed in Appendix IV.), and recommended that Dr. A. Green and Dr. D. Russell be invited to attend future meetings of this Committee.

MEDICAL STATISTICS COMMITTEE. The Medical Statistics Committee report was presented by Dr. A. Johnson, and Council approved the following recommendations on cancer registries:(i) That the Medical Statistics Committee should meet with representatives of the Australian Cancer Society to discuss the nature of the records that should be maintained by the State central cancer registries. (ii) That, pending establishment of central cancer registries in each State, the work being done ~y va~i~us .bodies in the field. of cancer registration should be supported and i"I • .. ~ • .. ......

...

31

OCCUPATIONAL HEALTH COMMIITEE. The report o~ the Occupational H~alth Committee was presented by the Chairman, Dr. H. E. Downes, and Council approved the followmg recommendations:Aerial Spraying Problems.

That a medical officer from the Department of Civil Aviation should be co-opted to discuss aerial spraying problems with the Pesticides Sub-committee.

Commonwealth and State Activities in Occupational Health.

That a working party, consisting of Dr. A. J. Christophers, Dr. H. M. L. Murray and Dr. G. C. Smith, should make a further study of the respective roles of Commonwealth and State Departments of Health in the field of occupational health and report to the next meeting of the Occupational Health Committee. Safe Handling of Cyanides.

That the document entitled" Safe handling of cyanides on the waterfront" (Appendix V.) be approved for circulation to the Federal Advisory Committee on Waterfront Accident Prevention.

Schedule of Recommended Maximum Concentrations of Atmospheric Contaminants for Occupational Exposures.

(i) That the schedule be reviewed later during the year 1963, and after review be again issued as a special report of the National Health and Medical Research Council. (ii) That an allocation be made from the Medical Research Endowment Fund for the printing expenses involved. Uniform Legislation.

,-

That the following principles should be embodied in the proposed uniform legislation to control the use of certain anti-cholinesterase compounds:(i) The legislation should be formulated on the basis of the usual industrial employeremployee relationships, as it would thus be more likely to be effective. (ii) It should apply to cholinesterase-reducing pesticides, e.g. organo-phosphorus compounds and carbamates. (iii) Only the more toxic compounds should be controlled. (The substances mentioned in the Victorian" Use of Pesticides Regulations" could serve as a guide.) (iv) There should be requirements for protective clothing and other equipment. (v) There should be requirements for medical examinations (discretionary) and routine pre-employment and periodical blood cholinesterase tests. (vi) Cholinesterase tests to be performed by an approved method. (vii) Results of all examinations to be notified to the Department of Health. (viii) Employees to be advised of the results of cholinesterase tests. (ix) Employers to make arrangements for medical examinations and cholinesterase tests to be carried out in the employer's time . . (x) Adequate warning about hazards to be given to employees. (xi) Adequate washing facilities to be provided. (xii) Powers for Health Department to suspend employees from work or to restrict the duration of employment. (xiii) Powers for restrictions on age of sprayers. (xiv) Provisions for the safe disposal of containers. (xv) Provision for proper maintenance of equipment. (xvi) Provisions for proper storage of concentrates.

Use of Liquid Petroleum Gas Machines in Ships' Holds.

(i) That the facilities of the Occupational Health Unit of the School of Public Health and Tropical medicine should be made available to check the concentrations of carbon monoxide, under experimental conditions, in the vicinity of machines provided by the Federal Advisory Committee, for the purpose. (11\ ThM in inw,:"tiaptina thic; T)fOhlp.tn th~ r,O-O"'f'''<;>+;()''' ()f' n .. A 1) ...11 ~1-.." •• 1~ 1,.,,.~ ,,1,., ... ,,"!~,,~

RADIOTHERAPY ADVISORY COMMITTEE. _-The report of the Radiotherapy Advisory Committee was received, and -. the f()110wing recommendations were adopted:Co-operative ClinicaL Trials. .

That the Medicine Advisory Committee be requested t? consider the practic~bility of prospective clinical trials of radiation treatment on a cor-ordinated basIs throughout Australia. . Training of Personnel Using Radio Isotopes. (i) That a centralization of the necessary specialized facilities in each hospital for the use

of radio-isotopes is desirable. (ii) That courses of training for hospital radio-isotope technicians should be established in

Australia, and that candidates on successful completion of examinations and experience should be granted a certificate. (iii) That an appropriate body, initially, to issue such certificates might be a. Conjoint Board of the appropriate medical colleges represented on Council. (iv) That the Training of Radio Isotopes Personnel Sub-Committee be requested to undertake(a) The preparation of a suitable syllabus and conditions for certification; (b) The investigation of ways and means by which courses of training might be established in some or all of the capital cities.

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ULTRASONICS COMMITTEE. The report of the Ultrasonics Committee was received, and the Committees recommendation that it should be terminated was approved. Council recorded its thanks to the· Committee and commended it for the work it had done since its formation in 1955.

VETERINARY PUBLIC HEALTH COMMITTEE. The report of the Veterinary Public Health Committee was presented by Dr. A. Johnson, and Council approved the following recommendations:Antibiotics In Agriculture.

(i) That the problem of the use of antibiotics as preservatives in the fishing industry should be examined carefully, and information should be sought from all available sources regarding the treatment of fish by ice with an antibiotic content of 5 p.p.m. (including whether antibiotic is incorporated in the ice or added after the ice has been manufactured). (ii) That in the meantime the current recommendation of the Antibiotics Committee " that approval of the use of antibiotics for food preservation should 1;>e withheld until there is an adequate body of evidence to show that the potential hazards visualized are not important" should be upheld. Brilliant Blue as a Marker Dye in Penicillin for Veterinary Use. --

That if, as a result of mOre recent evidence, it is decided to remove the food colour Brilliant Blue F.e.F. from the list of approved food colours, Council considers that the proVision- ora suitable, harmless, colour to be used, if required, as a marker dye for penicillin for veterinary use, should be examined as a matter of urgency. Control of Q Fever.

That a gravid uterus should not be opened in an abattoir except in a specified controlled area. Incidence of Zoonoses in Each State.

. That a formal request be made to aU State Directors-General of Health to subrhit a report to the ChaIrman of the Veterinary Public Health Committee, as early as convenient, on the incidence of zoonoses in each State. Meat Inspection.

The standard of education for candidates for training as lay meat inspectors should be not lower than the Intermediate Certificate. • Skin Left on Calves after Slaughter.

. . That attention be drawn, once again, to the fact that no action appears to have been taken to - i ehmmate the practice of leaving skins on calves after slaughter.

33 REVIEW OF THE CoMMITTEES AND SUB-COMMITTEES OF CoUNCIi.. •

.Sit Edwwj.dFord presented the report of the ad hoc Committee formed at the previous meeting of. Council "loi consider the organization, functions and membership of all committees and subcommittees of Council". The following recommendations were adopted:General Organization and Administration.

(i) Council should continue to meet regularly twice a year. (li) Each regular meeting of Council should be closely preceded by meetings of three Advisory Committees (Medical Research, Public Health and Medicine). (iii) Each Standing Committee and Sub-Committee should meet at least once in each calendar

year.

.

(iv) The Chairmen or Convenors of meetings of Committees and Sub-committees must make written requests to the Secretary of the Council for approval to hold such meetings, setting out the agenda, dates and places of the intended meetings, and the members and co-opted members (if any) who will be attending. (v) As soon as practicable after each meeting of a Committee or Sub-Committee a report . of matters dealt with at the meeting must be forwarded to the Secretary of the Council. (vi) Whenever possible, the dates of Committee and Sub-Committee meetings should be arranged to allow reports of the meetings (40 copies desirable) to reach the Secretary at least four weeks prior to the subsequent Council meetings. (Exceptions-see (li) above) . .(Yii) .Chairmen of Committees of Council should present their reports in person to the relevant Advisory Committees, whenever it is convenient to do so. (viii) . All Com,mittees of Council may set up Sub-Committees with such terms of reference

and membership as may be required, subject to the prior agreement of the Chairman of the Council. (bt)! 7he Chairman and Secretary of Council are to be ex officio members of all Committees I of Council. {x)j The Chairmen of all Committees of Council should be appointed by Council.

(xi) The Chairmen of all Committees of Council should be empowered to co-opt members . to attend specific meetings of their Committees, providing that the prior permission of the Chairman of Council is obtained. (xii) With the exception of co-opted members, all other members of Committees of Council

must be appointed by Council. (xiii) The members of the Medical Research Advisory Committee and of the Standing and

Reference Committees of Council should be selected on the basis of their value to Committees as individuals and not as representatives of particular groups or -organizations. (xiv!) The functions and membership of the Committees of Council should be formally reviewed every three years. (ri)That the only current Committees of Council and Sub-Committees are to be those reformed below. and that all ()ther Committees andSub-Comttrittees are now formally terminated and will only be reformed if and when a specific need arises. Terms of Reference of Committees. Medic(lJ Research Advisory Committee.

(i) To advise Council on all matters connected with the application of the Medical Research . Endowment Fund for the purposes of the Medical Research Endowment Act of 1937. (ii) To receive and consider all applications for National Health and Medical Res~arch Council research grants and fellowships, except " Overseas ~ravelling Fellowships".

,

and to make recommendations in respect thereof to Council.

@li) To investigate and keep ~nder review the work supported by National Health and , Medical Research Council grants. ~' T:o advise Council on projects of medical and dental research generally.

34 Public Health Advisory Committee.

(i) To inquire into and advise the Council on all m~tte~s of public h~~an~ preventive medicine, and matters involving health legIslatIOn and adrmmstration by the Commonwealth and State Governments. (H) To receive, consider and transmit to Council its recommendations on the reports of the following committees (if and when appointed)(a) Dental Health Committee. (b) Epidemiology Committee. (c) Food Additives Committee. (d) Food Standards Committee. (e) Maternal and Child Health Committee. (f) Medical Statistics Committee. (g) Occupational Health Committee. (h) Traffic Injury Committee. (i) Tropical Medicine and Health Committee. (j) Veterinary Public Health Committee. and other Committees that Council may direct to report through the Public Health Advisory Committee.

.

.

y ",.

'.

(Hi) To receive, consider and report to Council upon the recommendations of aU the other committees of Council, insofar as they involve legislation or administration by the Commonwealth and/or State Governments. (iv) To receive and consider all applications for" Overseas Travelling Fellowships" (Public Health Fellowships) and to make recommendations in respect thereof to Council. Medicine Advisory Committee. (i) To inquire into and advise the Council on matters relating to medigal and dental care.

(H) To inquire into and advise the Council upon the merits of reputed cures or methods of treatment which are from time to time brought forward for recognition. (iii) To receive, consider and transmit to Council the reports of the following Committees (if and when appointed):(a) Antibiotics Committee. (b) Nursing Committee. (c) Nutrition Committee. (d) Radiation Health Committee. (e) Radio Isotopes Committee.

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and other committees that Council may direct to report through the Medicine Advisory Committee. // (iv) To receive, consider and report to Council upon the recommendations of all the" other Committees of Council insofar as they affect medical and dental 9are. Antibiotics (Reference) Committee. "To inquire into and advise Council through the. Medicine Advisory Com~ittee on all .. . matters concerning antibiotics referred to it by Council." ... . . Dental Health (Standing) Committee. " To inquire into and advise Council through the Public Health Advisory Committee on all matters relating to the prevention, control and treatment of dental diseases," Epidemiology (Standing) Committee. "To inquire into and advise Council through the Public Health Advisory Committee on human epidemiology and the control of epidemic diseases." Food Additives (Standing) Committee .

.. To inq~ire into a~d advise C~>uncil through the Public Health Advisory Committee on addItIves, chemIcal contammants and dye stuffs in food for human consumption." Food Standards (Standing) Committee.

i

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"To inquire into and advise Council through the Public Health Advisory Committee on ~~:"~!~~~~~s,,necessary for the safe manufacture, storage and sale of fpod for human

j

35 Maternal and Child Health (Standing) Committee, "To inquire into and advise Council through the Public Health Advisory Committee on the causation and prevention of maternal, infant and child ill health and mortality." Medical Statistics (Standing) Committee. "To inquire into and advise the Council through the Public Health Advisory Committee on matters relating to the standardization, collection, correlation al].d significance of human vital and health records and statistics." Nursing (Reference) Committee. " To investigate and consider any matters referred to the Committee by the Council concerning the training and functions of nurses, and to report to Council through the Medicine Advisory Committee." Nutrition (Reference) Committee. " To inquire into and consider any matters concerning nutrition referred to the Committee by the Council, and to report to Council through the Medicine Advisory Committee."

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Occupational Health (Standing) Committee. "To inquire into and advise Council through the Public Health Advisory Committee on all matters relating to industrial hygiene and occupational health." Radiation Health (Standing) Committee. "To inquire into and advise Council through the Medicine Advisory Committee on all matters relating to the effects in man of naturally occurring ionizing radiation or of artificial ionizing radiation used in industry or medical investigation, research or treatment, and to measures necessary for the prevention of ill health, genetic or somatic damage from such radiation." Radio Isotopes (Standing) Committee . .. (i) To inquire into and advise Council through the Medicine Advisory Committee on the utilization and control of radio isotopes in medical research, clinical investigation and therapy. (ii) To provide advice to the Director, Commonwealth X-ray and Radium Laboratory,

in connexion with requests for the use of radio isotopes, on the safety for persons being investigated or treated and the usefullness of the method." Traffic Injury (Standing) Committee. "To inquire into and advise Council through the Public Health Advisory Committee on the medical factors in the causation, prevention and treatment of injuries in traffic accidents," Tropical Medicine and Health (Reference) Committee. " To inquire into and advise Council through the Public Health Advisory Committee on all matters referred to it by Council relating to the aetiology, treatment, control and prevention of essentially tropical ill health and disease." . . Veterinary Public Health (Standing) Committee. "To inquire into and advise the Council through the Public Health Advisory Committee on matters relating to the infection, use, husbandry and control of animals and animal products, which may directly or indirectly affect human health." Terms of Reference of Sub-Committees. Dental Health Data Standardization (ad hoc) Sub-Committee. "To inquire into the standardization of methods for obtaining and recording dental health data and to make a final report with recommendations to the Dental, Health Committee before 31st December, 1963." Food and Cosmetic Colours (Standing) Sub-Committee. "To inquire into and advise the Food Additives Committee on the colouring matter and (h,~ ~tHff,C; in food for human consumotion and cosmetics."

v

Food Irradiation (Standing) Sub-Committe~. "To inquire into and ~dvis~ the Food .Additives Commitee on ~e~~tritive ya~ue, ,~afety and possible alteranons m the constituents of food. treated by lOlUzmg "radIatIOn. Health Advertisements (Standing) Sub-Committee. "To inquire into the advertising of drugs, proprietary medicines, food~,beverages and tobacco with particular regard to false and exaggerated claIms, and make reco~endations to the Public Health Advisory Committee." Labelling of Hazardous Substances (ad hoc) Sub-Committee. "To draw up draft regulations for the labelling of substances hazardous to human health and make recommendations to the Public Health Advisory Committee." \'

National Morbidity Survey (ad hoc) Sub-Committee. " To assist in the completion and assessment of the National Morbidity Survey planned and carried out in conjunction with the Australian College of General Practitioners, and to make a final report to the Medical Statistics Committee before 30th June, 1964." ...

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Pesticides (Standing) Sub-Committee. "To inquire into and advise the Occupational Health Committee on the hazards to human health associated with the manufacture, distribution and use of pesticides and allied substances. " Pesticides Residues in Food (Standing) Sub-committee . .. To inquire into and advise the Food Additives Committee on the problems associated with pesticide residues in food for human consumption and advise on safe tolerances for these residues." Poisons Schedule (Standing) Sub-committee. " To inquire into the scheduling of drugs and poison~ 10 the States and Territories and make recommendations to the Public Health Advisory Committee, and when necessary with the prior approval of the Chairman of Council, directly to the Commonwealth and States Health Authorities, on the scheduling of new drugs and poisons and the re-scheduling of others necessary to ensure safe and uniform control of these substances in Australia. tt Poliomyelitis (Standing) Sub-committee.

" (i) To assess the clinical and pathological records of all cases of poli~wyelitis and of cases of suspected poliomyelitis. (ii) When requested by the Chairman to receive and adjudicate upon reports of untoward {~ctiQllsor UlPesses wbj~hJ:Ilight be associated witp POli9 imn;t\l1rization.

(ill) To continue evaluatiop of the efficacy of Salk Vaccine.

(iv) To submit reports periodically on the incidence of pOliomyelitis "in Australia. (v) To report all findings and recommendations to the Public Health Advisory Committee." Preventive Medicine in General Practice (Standing) Sub-committee. " To inquire into and advise the Public Health Advisory Committee on problems of pr~ventive medicine in general practice, and to assist in the application of preventive medicine programmes approved by Council." Radiation Technical and Policy (Standing) Sub-committee. ~

"To inquire into and advise the Occupational Health Committee on public health problems concerned with the use of radio isotopes and irradiating apparatus in industry, commerce and non-medical investigations, and to advise on procedures and practices which would assist the Commonwealth and States in the implementation of their public health legislation controlling io~ing radiation."

JI

~

37 Regional Grants (Standing) Sub-committees. (Adelaide, Brisbane, Melbourne, Perth and Sydney.) "To visit research institutes approved for the purposes of receiving National Health and Medical Research Council grants for medical research and interview persons working under and/or applying for National Health and Medical' Research Council research grants, and to make recommendations to the Medical Research Advisory Committee. " Training of Radio Isotopes Personnel (ad hoc) Sub-committee. "To inquire into the training of personnel using radio isotopes for medical diagnostic purposes, and make a final report with recommendations to the Radiation Health Committee before 30th June, 1964, on the establishment of formal courses of training for these personnel with suitable certification for successful candidates." Virology (Standing) Sub-committee. " To inquire into and advise the Epidemiology Committee on matters concerned with the establishment and op~ration of Virus Reference Laboratories in Australia." The Inter-relationship of Council, its Committees and Sub-committees. Advisory Committees Committees Sub-Cd1ffInittees

Gran . t.s Bnsbane Grttnts Medical Research----------~-~~· Melbourne Grants Perth Grants Sydney Grants

~

A.~laide

Medicine----- Nutrition Radiation Health------'-- Training of Personnel Radio Isotopes

r

l~~~~iCs

Council-

Poisons Schedule Poliomyelitis Preventive Medicine in General Practice Health Advertisements Labelling of Hazardous Substances Dental Health------- Dental Data Standardization Epidemiology'----'="-............................. Virology ·OOd Irradiation Food Additives------ Foo? . and Cosmeti~ Colours PestIclde Residues'In Food Public Health.--'-'----'----'-\

U

Food Standartls· Maternal and Child Health Medical Statistics~""""-'-~~

National Morbidity Survey

Occupational

Health,--,,~~....... rRadiation Teiclurltal and Policy L:esticides

Traffic Injury Tropical Medicine and Health Veterinary Public Health

38 Membership of Advisory Committees of Council. Medical Research Advisory Committee.

Dr. W. F. Simmons, 270 Forest-road, Bexley, New South Wales (Chairman), until 31st December, 1964. Professor S. Sunderland, Dean of the Faculty of Medicine, University of Melbourne (Deputy Chairman), until 31st December, 1969. Professor Sir Macfarlane Burnet, Director, Walter and Eliza Hall Institute, Melbourne, until 31st December, 1963. Professor E. S. J. King, Department of Pathology, University of Melbourne, until 31st December, 1964. Professor H. N. Robson, Department of Medicine, University of Adelaide, until 31st December, 1964. Professor R. J. Walsh, Director, Red Cross Blood Transfusion Service, York-street, Sydney, until 31st December, 1965. Professor P. O. Bishop, Department of Physiology, University of Sydney, until 31st December, 1966. Professor F. Fenner, Department of Microbiology, Australian National University, until 31st December, 1967. Professor W. J. Simmonds, Department of Physiology, University of Western Australia, until 31st December, 1967. Dr. H. M. Whyte, Director, Kanematsu Institute, Sydney Hospital, until 31st December, 1968. Dr. I. J. Wood, 280 Walsh-street, South Yarra, Victoria, until 31st December, 1969. The Secretary of the Council (Dr. R. H. C. Wells). Dr. Billings gave notice that he would propose at the next meeting of Council that each appointment to the Medical Research Advisory Committee be for a period of five years, that the total number of persons on the Committee other than the Secretary of Council be 15, and that three members should retire each year and be ineligible for reappointment for one year. Medicine Advisory Committee.

The representative on Council of the Australian (Dr. W. F. Simmons) (Chairman) Medical Association The representative on Council of the Australian (Dr. J. G. Radford)(DeputyChairman) College of General Practitioners The representative on Council of the Royal Aus- (Professor E. S. J. King) tralasian College of Surgeons The representative on Council of the Royal Aus- (Dr. J. J. Billings) tralasian College of Physicians The representative on Council of the Australian (Professor A. J. Arnott) Dental Association The representative on Council of the Australian (Professor V. L. Collins) Paediatric Association The representative on Council of the Australian (Dr. J. N. Chesterman) Regional Council of the Royal College of Obstetricians and Gynaecologists The representative on Council of the College of (Dr. A. V. Jackson) Pathologists of Australia The representative on Council of the College of (Dr. H. J. Ham) Radiologists of Australasia A prominent laywoman member of the Council (Miss G. N. Burbidge) (providing she is a qualified nurse) The Secretary of the Council (Dr. R. H. C. Wells) (Convenor)

39 Public Health Advisory Committee. The Director, School of Public Health and Tropical Medicine, Sydney The Director-General of Public Health, New South Wales The Director-General of Health and Medical Services, Queensland The Director-General of Public Health, So'uth Australia The Director of Public Health, Tasmania The Chief Health Officer, Victoria The Commissioner of Public Health, Western Australia The Director of Public Health for the Territory of Papua and New Guinea The Director, Division of Public Health, Commonwealth Department of Health

(Professor Sir Edward Ford) (Chairman) (Dr. C. J. Cummins) (Dr. A. Fryberg) (Dr. P. S. Woodruff) (Dr. H. M. L. Murray) (Dr. K. Brennan) (Dr. W. S. Davidson) (Dr. R. F. R. Scragg) (Dr. A. Johnson) (Convenor)

"

Membership of Committees of Council.

(Subject to individual acceptance.) Antibiotics Committee (until 31st December, 1966). Dr. E. F. Thomson, General Superintendent, Royal Prillce Alfred Hospital, Sydney (Chairman). Dr. K. F. Anderson, Institute of Medical and Veterinary Science, Adelaide. Dr. A. Johnson, Director, Division of Public Health, Commonwealth Department of Health. Sir William Morrow, 185 Macquarie-street, Sydney. Professor H. N. Robson, Department of Medicine, University of Adelaide. Dr. Phyllis Rountree, Fairfax Institute, Royal Prince Alfred Hospital, Sydney. Dr. R. H. C. Wells, Commonwealth Department of Health (Convenor). Dr. S. W. Williams, 8 Collins-street, Melbourne. Dental Health Committee (until 31st December, 1966). Professor A. J. Arnott, Department of Dentistry, University of Sydney (Chairman). Professor Sir Arthur Amies, Department of Dental Medicine and Surgery, University of Melbourne. Professor J. F. Atkinson, Department of Dental Prosthetics, University of Melbourne. Professor G. N. Davies, Faculty of Dentistry, University of Queensland. Mr. A. R. Docking, Director, Bureau of Dental Standards, Melbourne. Mr. R. Harris, Director, Institute of Dental Research, Sydney. Professor A. M. Horsnell, Faculty of Dentistry, University of Adelaide. Professor N. D. Martin, Department of Preventive Dentistry, University of Sydney. Professor E. Storey, Department of Conservative Dentistry, University of Melbourne. Professor K. J. Sutherland, Faculty of Dentistry, University of Western Australia. Epidemiology Committee (until 31st December, 1966). Sir Edward Ford, Director of the School of Public Health and Tropical Medicine, Sydney (Chairman). Sir Macfarlane Burnet, Director of the Walter and Eliza Hall Institute, Melbourne. Dr. C. E. A. Cook, 23 Killarney-street, Mosman, New South Wales. Professor F. Fenner, Department of Microbiology, Australian National University. Dr. A. A. Ferris, Director, Epidemiological Research Unit, Fairfield Hospital, Victoria. Dr. E. L. French, Senior Principal Research Officer, Division of Animal Health, Animal Health Research Laboratory, Melbourne. Dr. R. W. Greville, Director, Commonwealth Serum Laboratories. Dr. A. Johnson, Commonwealth Department of Health (Convenor). Dr. H. McLorinan, Consultant in Infectious Diseases, Fairfield Hospital, Victoria.

Food Additives Committee (until 31st December, 1966).

Dr. A. JohlllSon, Commonwealth Department of Health (Chairman). Dr. R. A. Bottomley, Vice-President of Research, Mauri Bros. and Thompson Ltd. Dr. C. E. A. Cook, 23 Killarney-street, Mosman, New South Wales. Dr. I. S. de la Lande, Reader, Department of Human Physiology, University of Adelaide. Dr. K. T. H. Farrer, Kraft Foods Ltd., Melbourne. Dr. P. E. Hughes, Department of Pathology, University of Melbourne. Mr. W. R. Jewell, Flat 1, 1483 High-street, Glen Iris, S.E. 6, Victoria. Mr. E. S. Ogg, Government Analyst, Department of Public Health, New South Wales. Professor F. H. Reuter, Department of Food Technology, University of New South Wales. Professor V. M. Trikojus, Department of Biochemistry, University of Melbourne. Dr. J. R. Vickery, Chief of Division of Food Preservation, C.S.I.R.O., Ryde, New South Wales. Mr. J. P. Warry, Chemist, Commonwealth Department of Health. Professor S. E. Wright, Department of Pharmacy, University of Sydney. ,

Food Standards Committee (until 31st December, 1966).

Professor F. H. Reuter, Department of Food Technology, University of New South Wales (Chairman). Mr. W. R. Jewell, Flat 1, 1483 High-street, Glen Iris, S.E. 6, Victoria. Dr. A. Johnson, Commonwealth Department of Health (Convenor). Mr. K. F. Kefford, Division of Food Preservation, C.S.I.R.O., Ryde; New SOuth Wales. Mr. W. H. Kelly, Inspector, Department of Health and Home Affairs, Queen~land. Mr. J. G. Krigsman, Albright and Wilson Pty. Ltd. Dr. R. C. McCarthy, Secretary, Food and Drug Advisory Committee, South Australia. Mr. W. Madgwick, Chief Food Inspector, Department of Public Health, New South Wales. Mr. E. S. Ogg, Government Analyst, Department of Public Health, New South Wales. Dr. V. M. Lewis, Director, Henry Lewis and Sons Pty. Ltd. Mr. 1. H. Smith, Chief Clerk (Inspection Services), Department of Primary Industry, Canberra. Mr. L. N. Thornton, Deputy Chief Veterinary Officer, Department of Primary Industry, New South Wales. Mr. J. P. Warry, Chemist, Commonwealth Department of Health, Canberra. Maternal and Child Health Committee (until 31st December, 1966). Professor W. B. Macdonald, Department of Child Health, University of Western Australia

(Chairman). Dr. Grace Cuthbert Browne, Director of Maternal and Baby Welfare, New South Wales. Dr. J. N. Chesterman, 135 Macquarie-street, Sydney. Professor V. L. Collins, Department of Child Health, University of Melbourne. Professor L. W. Cox, Department of Obstetrics and Gynaecology, University of Adelaide. Dr. A. Johnson, Commonwealth Department of Health (Convenor). Dr. B. P. McCloskey, Assistant Chief Health Officer (Child Health), Victoria. Professor G. M. Maxwell, Department of Child Health, University of Adelaide. Professor S. L. Townsend, Department of Obstetrics and Gynaecology•. University of Melbourne. Professor T. J. Rendle-Short, Department of Child Health, University of QllCenslan4. Professor T. Stapleton, Director, Institute of Child Health, Royal AlexaJldra Hospital for Children, Camperdown, N.S.W. Medical Statistics Committee (until 31st December, 1966).

Dr. A. Johnson, Commonwealth Department of Health (Chairman). Mr. R. Dibley, Bureau of Census and Statistics, Sydney. Dr. J. G. Graydon, Statistician at Commonwealth Serum Laboratories. Miss E. James, Librarian, Royal Prince Alfred Hospital, and Council of Australian Association of Medical Record Librarians. Professor H. O. Lancaster, Department of Mathematics, University of Sydney. Mr. V. E. Pickering, Bureau of Census and Statistics, Canberra. Mr. R. Spencer, Bureau of Census and Statistics, Melbourne.

41 Nursing Committee (until 31st December, 1966).

Miss F. M. Peterson, Commonwealth Department of Health (Chairman). Miss G. N. Burbidge, "Horizons ", Pound-road, Warrandyte, Victoria. Miss P. F. Lee, Principal Matron, Department of Health, Western Australia. Dr. S. D. Meares, 149 Macquarie-street, Sydney. Miss C. A. E. Michelmore, Deputy Matron, Childrens Hospital, Adelaide. Miss M. Nelson, Matron, Royal Prince Alfred Hospital, Sydney. Mrs. E. W. Sullivan, Advisor in Nursing, Department of Health and Home Affairs, Queensland. Nutrition Committee (until 31st December, 1966).

Dr. F. W. Clements, Senior Lecturer, Institute of Child Health, Sydney (Chairman). Professor V. L. Collins, Department of Child Health, University of Melbourne. Dr. E. Hipsley, Director, Australian Institute of Anatomy, Canberra. Sir Norman Nock, I Lindsay-avenue, Double Bay, N.S.W. Professor V. M. Trikojus, Department of Biochemistry, University of Melbourne. Professor E. J. Underwood, Director, Institute of Agricultural Research, University of Western Australia. Dr. D. M. Walker, Reader in Animal Husbandry, University of Sydney. Occupational Health Committee (until 31st December, 1966).

Dr. H. E. Downes, Assistant Commonwealth Director-General of Health (Chairman). Dr. A. Bell, Director, Industrial Hygiene Division, Department of Public Health, New South Wales. Dr. A. J. Christophers, Chief Industrial Hygiene Officer, Victoria. Mr. A. W. Findlay, Senior·Chemist, Occupational Health Division, School of Public Health and Tropical Medicine, Sydney. Professor D. Gordon, Department of Social and Preventive Medicine, University of Queensland. Dr. A. Johnson, Commonwealth Department of Health. Dr. D. D. Letham,lndustrial Medical Officer, Public Health Department, Western Australia. Dr. G. H. McQueen, Principal Medical Officer (Public Health), Department of Public Health, South Australia. Dr. H. M; L. Murray, Director of Public Health, Tasmania. Dr. E. M. Rathus, Director of Industrial Medicine, Department of Health and Home Affairs Queensland. Dr. G. C. Smith, Director of Industrial Hygiene, Commonwealth Health Department and Lecturer in Occupational Health, University of Sydney (Secretary). Mr. D. J. Stevens, Director, Commonwealth X..,ray and Radium Laboratory, Melbourne. Radio Isotopes Committee (until 31st December, 1966).

Mr. D. J. Stevens, Director, Commonwealth X-ray and Radium Laboratory, Melbourne (Chairman). Professor V. L. Collins, Department of Chj1d Health, University of Melbourne. Professor G~ C. de Gruchy, Department of Medicine, St. Vincent's Hospital, University of Melbourne. Dr. W. P. Holman, Medical Director, Cancer Institute Board, Melbourne. Mr. D. W. Kearn, Physicist, Commonwealth X-ray and Radium Laboratnry~ Melbourne. Dr. D. P. Pearce, Epworth Hospital, Erin-street, Richmond, Victoria. Dr. W. E. King, 8 Co11ins-street, Melbourne, Victoria. Professor E. S. J. King, Department of Pathology, University of Melbourne. ProfessorR. Nairn, Department of Pathology, University of Monash~

42 Radiation Health Committee (until 31st December, 1966). Mr. D. J. Stevens, Director, Commonwealth X-ray and Radium Laboratory, Melbourne (Chairman). Dr. M. G. S. Donnan, Consultant Radiologist to Army and Honorary Diagnostic Radiologist, St. Vincent's Hospital, 111 Collins-street, Melbourne.

Professor M. Clarke, Department of Zoology, University of Tasmania. Dr. A. G. S. Cooper, Director, Queensland Radium Institute. Dr. E. R. Crisp, President, College of Radiologists, 12 Collins-street, Melbourne. Dr. B. S. Hanson. 163 North Terrace, Adelaide, South Australia. Dr. H. J. Ham, 135 Macquarie-street Sydney. Dr. W. P. Holman, Medical Director, Cancer Institute Board, Melbourne. Professor H. O. Lancaster, Department of Mathematics, University of Sydney. Dr. J. McRae, Department of Medicine, University of Sydney. Dr. R. Motteram, Pathologist, Cancer Institute Board of Victoria. Mr. J. F. Richardson, Assistant Director, Commonwealth X-ray and Radium Laboratory, Melbourne. Mr. R. W. Stanford, Department of Medical Physics, Royal Perth Hospital. Traffic Injury Committee (until 31st December,1966). Dr. A. Johnson, Commonwealth Department of Health (Chairman). .» •

....

.

Dr. J. H. W. Birrell, Police Surgeon, Melbourne. Dr. K. G. Jamieson, Neurosurgeon, Brisbane. Dr. J. C. Lane, Director of Aviation Medicine, Department of Civil Aviation. Mr. R. A. Money, Neurosurgeon, Sydney. Professor J. S. Robertson, Department of Pathology, University of Adelaide. Dr. J. I. Tonge, Director, Laboratory of Microbiology and Pathology, Brisbane. Tropical Medicine and Health Committee (until 31st December, 1966).

Dr. R. H. C. Wells, Commonwealth Department of Health (Chairman). Dr. R. H. Black, Senior Lecturer in Tropical Medicine, University of Sydney. Dr. C. E. A. Cook, 23 Killarney-street, Mosman, New South Wales. Dr. R. L. Doherty, Deputy Director, Queensland Institute of Medical Research. Professor Sir Edward Ford, Director, School of Public Health and Tropical Medicine, Sydney. Dr. A. Green, Commonwealth Department of Health. Professor W. V. Macfarlane, Australian National University, Canberra. Dr. R. K. Macpherson, Chief of the Environmental Health Section, School of Public Health and Tropical Medicine, Sydney. Dr. F. D. Schofield, Assistant Director (Medical Research), Department of Public Health, Maprik, Sepik District, New Guinea. Veterinary Public Health.Committee (until 31st December, 1966.).

Dr. A. Johnson, Commonwealth Department of Health (Chairman). Mr. J. L. Anderson, Chief, Division of Animal Industry, Department of Agriculture Stock and Fisheries, Port Moresby, New Guinea. . ' Mr. A. L. Clay, Director of Animal Industry, Queensland. Dr. G. Edgar, Director-General of Agriculture, New South Wales. Dr. T. S. Gregory, Chief of Animal Health Division, Council for Scientific and Industrial Research Organization. Mr. K. S. McIntosh, Director of Veterinary Hygiene, Commonwealth Department of Health. Dr. D. T. Oxer, Principal Veterinary Consultant, Commonwealth Serum Laboratories.

43 Membership of Sub-committees. (Subject to individual acceptance.) Dental Health Data Standardization Sub-committee (until 31st December, J963). Professor. A. M. Horsnel1, Dean of the Faculty of Dentistry University of Adelaide (ChaIrman). ' , Mr. L. M. Carr, Senior Dental Officer, Commonwealth Department of Health. Dr. B. Kruger, Department of Dentistry, University of Queensland. Professor N. D. Martin, Faculty of Dentistry, University of Sydney.

Food and Cosmetics Colours Sub-committee (until 31st December, 1966). Dr. A. Johnson, Commonwealth Department of Health (Chairman). Dr. R. A. Bottomley, Vice-President of Research Mauri Bros. and Thompson Ltd. Mr. E. S. Ogg, Government Analyst, Department of Public Health, New South Wales. Dr. J. R. Vickery, Chief of Division of Food Preservation, Commonwealth Scientific and Industrial Research Organization, Ryde, New South Wales. Mr. J. P. Warry, Chemist, Commonwealth Department of Health. Professor S. E. Wright, Department of Pharmacy, University of Sydney.

Food Irradiation Sub-committee (until 31st December, 1966). Mr. D. J. Stevens, Director Commonwealth X-ray and Radium Laboratory, Melbourne (Chairman). Mrs. Audrey Cahn, Department of Biochemistry, University of Melbourne. Mr. D. W. Kearn, Commonwealth X-ray and Radium Laboratory, Melbourne (Technical Secretary). Dr. W. Scott, Food Preservation Division, Commonwealth Scientific and Industrial Research Organization, Ryde. Dr. A. Johnson, Commonwealth Department of Health. Professor F. H. Reuter, Department of Food Technology, University of New South Wales. Professor V. M. Trikojus, Department of Biochemistry, University of Melbourne.

Health Advertisements Sub-Committee (until 31st December, 1966). Dr. A. Johnson, Commonwealth Department of Health (Chairman). Dr. R. J. Farnbach, Deputy Chief Health Officer, Victoria. Dr. A. Green, Commonwealth Department of Health. Mr. B. Holt, Secretary, Australian Association of Advertising Agencies. Mr. W. Kelly, Administrative Officer, Department of Health and Hom.e Affairs, Queensland. Dr. E. S. A. Meyers, Deputy Director-General of Public Health, N.S.W. Mr. J. Newton, Secretary, Australian Dental Association. Mr. Osborne, Secretary, Australian Newspapers Council. Dr. C. J. Ross-Smith, General Secretary, Federal Council of A.M.A. Mr. K. Thomas, Pharmaceutical Guild, 149 Dolphin-street, Coogee, N.S.W.

Ionic Research Unit Support Sub-Committee. See under Medical Research Advisory Committee report. lAbelling of Hazardous Substances Sub-Committee (until 31st December, 1965). Dr. A. Johnson, Commonwealth Department of Health (Chairman). Dr. F. W. Clements, Lecturer, Institute of Child Health, Sydney. Mr. W. H. Kelly, Inspector, Department of Health and Home Affairs, Queensland. Dr. G. C. Smith, Director of Industrial Hygiene, Commonwealth Department of Health Mr. J. P. Warry, Chemist, Commonwealth Department of Health. Professor S, E. Wright, Department of Pharmacy, University of Sydney.

National Morbidity Survey Sub-Committee (until 30th June, 1964) .. Dr. A. Johnson, Commonwealth Department of Health (Chamnan).

Dr. W. Breinl. 22 Woniora-road, Hurstville, New South Wales. Professor H. O. l.ancaster, Department of Mathematics, University of Sydney. Dr. J. G. Radford, 24 Carr-street, Coogee, New South Wales. Pesticides Sub-Committee (until 31st December, 1966). Dr. G. C. Smith, Director of Illdustrial Hygiene, Commonwealth Health Department (Chairman). Dr. A. Bell, Director, Industrial Hygiene Division, Department of Public Health, N.S.W.

Dr. A. J. Christophers, Chief Industrial Hygiene Officer, Victoria. Dr. A. Green, Commonwealth Department of Health. Mr. J. P. Warry, Chemist, Commonwealth Department of Health. Pesticides Residues in Food Sub-Committee (until 31st December, 1966). Dr. J. R. Vickery, Chief of Division of Food Preservation, C.S.I.R.O., Ryde, N.S.W. (Chairman). Mr. S. L. Allman, Chief Entomologist, Department of Agriculture, N.S.W.

Dr. A. Green, Commonwealth Department of Health. Mr. H. Nardin, Pesticide Chemist, Department of Agriculture, N.S.W. Mr. J. P. Warry, Chemist, Commonwealth Department of Health. Professor S. E. Wright, Department of Pharmacy, University of Sydney. Poisons Schedule Sub-Committee (until 31st December, 1966). Dr. A. Johnson, Commonwealth Department of Health (Chairman). Mr. H. A. Braithwaite, Australian Pharmaceutical Association.

Dr. I. S. de la Lande, Reader, Department of Human Physiology, University of Adelaide. Mr: W. H. Kelly, Chief Food and Drugs Inspector, Queensland. Mr. R. C. McCarthy, Poisons Administration, South Australia. Dr. J. G. Radford, Australian College of General Practitioners. Dr. G. C. SmIth, Director of Industrial Hygiene, Commonwealth Health Department. Dr. E. Thompson, Royal Prince Alfred Hospital, Sydney. Mr. J. P. Warry, Chemist, Commonwealth Department of Health. Professor S. E. Wright, Department of Pharmacy, University of Sydney. (Victoria to nominate an observer). Poliomyelitis Sub,.Committee (until 31st December, 1966). Dr. A. Johnson, Commonwealth Department of Health (Chairman).

Dr. J. Graydon, Statistician at Commonwealth Serum Laboratories. Dr. H. McLorinan, Consultant in Infectious Diseases, Fairfield Hospital, Victoria. Dr. S. W. Williams, H.on. Physician, Children's Hospital, Melbourne. Preventive Medicine in General Practice Sub-Committee (until 31st December, 1966). Dr. A. Johnson, Commonwealth Department of Health (Chairman).

Dr. Dr. Dr. Dr. Dr. Dr. Dr.

J. A. C. Bamford, 150 Douglas-avenue, South Perth, Western Australia. D. E. Craven, Central Buildings, Port Adelaide, South Australia. A. Green, Commonwealth Department of Health (Secretary). C. C. Jungfer, Lobethal, South Australia. A. P. Millar, 229 Macquarie-street, Sydney, New South Wales. H. S. Patterson, Cur. East and South-streets, Ipswich, Queensland. H. Shannon, 10 Ledbury-court, Toorak, Victoria. George~street,

Senator Dr. R. J. D. Turnbull, 143

Launceston. Tasmania.

Radiation Technical and Policy Sub-Committee (until 21st December, 1966)~

Mr. D. J. Stevens, Director, Commonwealth X-ray and Radium Laporatory, Melbourne i (Chairman). I

Dr. A. Bell, Director, Industrial Hygiene Division, Department of Publt Health, New Sputh Wales. . Dr. A. J. Christophers, Chief Industrial Hygiene Officer, Victoria. Dr. I. Ferris, Defence Standards Laboratory. Mr. D. W. Keam, Commonwealth X-ray and Radium Laboratory, ~elbourne.

Dr. D. D. Letham, Industrial Medical Officer, Public Health Department, Western Australia. Dr. G. H. McQueen, Principal Medical Officer (Public Health), South Australia. Dr. H. M. L. Murray, Director of Public Health, Tasmania. Dr. E. M. Rathus, Director of Industrial Hygiene, Department of Heal.h and Home Affairs, Queensland. Dr. G. C. Smith, Director of Industrial Hygiene, Commollwealth Health Department, and Lecturer in Occupational Health, University of Sydney. Dr. A. R. W. Wilson, Head of the Atomic Energy Commission Technical Policy Secretllriat. Mr. B. W. Worthley, Physicist-in-charge, Anti-Cancer Campaign Committee, South Australia. Regional Grants Sub-Committees (AdelaIde, Brisbane, Melbourne, Perth and Sydney). See under Medical Research Advisory Committee report. Training of Radio Isotopes Personnel Sub-Committee (until 30th June, 1964), Mr. D. J. Stevens, Director, Commonwealth X-ray and Radium Laboratory, Melbourne (Chairman).

Dr. W. P. Holman, Medical Director, Cancer Institute Board, Melbourne. Dr. D. F. Lawson, 12 Collins-street, Melbourne (R.C.O.G.). Dr. T. E. Lowe, Director, Baker Medical Research Institute, Alfred Hospital, Melbourne (R.A.C.P.). Dr. R. Motteram, Pathologist, .Cancer Institute Board, Melbourne (C.P.A.). Dr. D. B. Pearce, 12 Collins-street, Melbourne (C.R.A.). Mr. G. R. A. Syme, 14 Parliament-place, Melbourne eR.A.C.S.) . . Virology Sub-Committee (until 31st December, 1966).

Dr. A. A. Ferris, Director, Epidemiological (Chairman).

Resea~h

Unit, -Fairfield Hospital, Victoria ,... - -

Dr. R. L.Doherfy,DeputyDirector, Queensland :Irtstituteof Medical -'Research. Dr. W. Howarth, Institute of Medical and Veterinary Research, Adelaide. Dr. D. Howes, Viral Products Laboratory, National Biological and Standards Laboratory, Melbourne. Mr. I. Jack, RoyaJ Children's Hospital, Melbourne. Dr. A. Jqhnson, Commonwealth Department of Health (Convenor). Mr. A. Murphy, Microbiological Laboratory, Lidcombe, New South Wales. Dr. L. C. Rowan, School of Public Health and Tropical Medicine, Sydney. Professor N. F. Stanley, Department of Microbiology, University ofi Western Australia. Dr. Warburton, Commonwealth Serum Laboratories.

46 ASPIRIN AND PHENACETIN.

An interim report was received from the Royal Australasian College of Physicians in reply to Council's request that the College express an opinion on the problem of analgesic consumption and toxicity in Australia. The matter has been considered and will be kept under review by the Therapeutics Advisory Committee of the College. This Committee concludes that(i) It is proven that analgesics containing phenacetin are liable to cause methaemoglobinaemia and haemolytic anaemia if taken in excess, with chronic ill health as long as dosage continues. (ii) It has been proven that aspirin taken in a daily dose of 2. 5 to 4 gms. causes a daily faecal blood loss of about 5 ml. in some 70 per cent. of people. If long continued this could lead to significant anaemia, especially in women. Since 1938 there have been reports of massive blood loss from the upper alimentary tract after the ingestion of aspirin. (iii) It is not proven whether the taking of analgesics containing phenacetin may cause renal

damage, although there have been a number of reports containing reasonably strong circumstantial evidence that this is so. (iv) A study of a population sample is now needed to relate phenacetin intake to renal function. This could be sponsored by the National Health and Medical Research Council. (v) It is not justified, at present, to recommend the banning of phenacetin or restricting the sale of analgesics, but the Therapeutics Advisory Committee of the Royal Australasian College of Physicians consIders that anyone who wishes to take these preparations daily should be warned to do so only after obtaining medical advice and sanction. A letter on phenacetin was received from two members of the Poisons Advisory Panel,Professor S. E. Wright and Professor A. W. Steinbeck. AUSTRALIAN POST-GRADUATE FEDERATION IN MEDICINE.

.

'-

The Chairman's nomination of Dr. J. G. Radford to represent Council on the Australian PostGraduate Federation in Medicine was approved. MATERNAL MORTALITY.

Dr. W. F. Simmons presented a letter from the Queensland Branch of the Australian Medical Association concerning the determination of cause of death in women dying during pregnancy, parturition, or the puerperium. Council decided to refer this matter to the Maternal and Child Health Committee for consideration. PROPHYLACTIC USE OF ANTI-TETANIC SERUM.

An enquiry on the use of anti-tetanic serum, received from the Australian Medical Association, was referred to the Medical Statistics Committe,,! for consideration. . TAX EXEMPTION FOR SAFETY BELTS.

Dr. J. G. Radford presented a letter from the Australian College of General Practitioners advising of certain resolutions by that College on tax exemption for safety belts, .Council then adopted the following recommendation:That since the design of a motor vehicle may bear a direct relationship to injuries incurred by occupants in the event of an accident, and since correction of features contributing to a greater risk of injury, whilst improving safety, may increase costs, this Council recommends to the Commonwealth Government any action which might reduce these costs. OTHER MATTERS.

Council also received letters from the Commonwealth Director-General of Health on the supervision of drugs, the Australian Medical Association on the issue of milk to schoolchildren the Australian College of General Practitioners on the early detection of disease, and from Dr. D: N. Everingham through the Australian Medical Association. DATE AND PLACE OF NEXT MEETING.

It was agreed that the 56th Session of the Council would meet in Canberra on the 31st October and 1st November, 1963. TTTT?T T

n

n

41 APPENDIX I. .Salary scales for. full-time graduate research workers to be provided under National Hdalth and Medical Research CouncIl grants for medIcal research, as from 1st July, 1963. i

SCIENCE GRADUATES.

Technical OjJicers, ScienceMale: £1,376 (Probationary) Female: £1,188 (Probationary)

£1,431 £1.243

£1,531 £1,343

£1,631 £1,443

£1,781 £1,593

£1,~31 £1,143

£2,081 £1,893

I

Research OjJicersMale: £1,931 Female: £1,743 ~.;~

£2,081 £1,893

£2,181 £1,993

£2,281 £2,093

£2,381 £2,193

£2,481 £2,293

r

Senior Research OjJicersMale: £2,601 £2,721 Female: £2,413 £2,533 Principal Research OjJicersMale: £3,011 £3,141 Female: £2,823 £2,953

£2,841 £2,653

£2,961 £2,773

£3,081 £2,893

£3,201 £3,013

..

£3,321 £3,133

~

£3,271 £3,083

£3,401 £3,213

£3,531 £3,343

Senior Principal Research OfficersMale: £3,661 £3,888 £4,158 Female: £3,473 £3,700 £3,970

DENTAL GRADUATES.

Dental Research FellowsMale: £1,731 (Probationary) Female: £1,543 (Probationary)

£2,101 £2,491 £1,913 £2,303

£2,166 £2,556 £1,978 £2,368

£2,231 £2,621 £2,043 £2,433

£2,296 £2,751 £2,108 £2,563

£2,361 £2,881 ! £2,Q3 £2,69p

£2,426 £2,238

MEDICAL GRADUATES.

~, -~

Medical Research FellowsMale: £1,831 (Probationary) Female: £1,643 (Probationary)

£2,296 £2,686 £2,108 £2,498

£2,361 £2,751 £2,173 £2,563

£2,426 £2,881 £2,238 £2,693

£2,491 £3,011 £2,303 £2,823

£2,556 £3,141 £2,368 £2,953

£2,621 £2,433

Senior Medical Research Fellows, Grade 1Male: £3,011 £3,141 £3,271 Female: £2,823 £2,953 £3,083 Senior Medica/Research Fellows, Grade l l -Male: £3,271 - . £3,531 £3,401 Female: £3,083 £3,343 £3,213 Senior Medical Research Fellows, Grade IllMale: £4,433 Female: £4,245. NOTES.-

£3,401 £3,213

£3,661 £3,473

-,

(i) All the above salaries include the cost of living allowances which are £133 per annum for males and £99

per annum for females. (ii) The basic salaries for female graduates are £154 per annum less than those for mates, making the total

salaries for females (basic salaries plus cost of living aJIowances) £188 per anrium less than the total salaries for males. (iii) Science, dental and medical graduates, without honours or higher degrees will ndrmally be awarded the

relevant probationary salaries only, unless or until they have at least one _ experience.

year'~

suitablepost-gTaduate

APPENDIX II. CONDITIONS tr'O BE ASSOCIATED WITH NATIONAL HEALTH AND MEDICAL RESEARCH Cm.Jl'fCIL GRANTS FOR MEDICAL RESEARCH, AS FROM 1ST JULY, 1963. 1. Grants given fpr salaries of specified persons or the purchase of specific items may not be used for other. purposes unless the permission of the Chairman of the Council is obtained. 2. Each grant is !subject to annual review, except in cases where other provision is specified. (See provision 13).

3. Payment of mopey in respect of any grant shall be upon the terms and conditions specified in the grant, and shall wherever possible be made to the authorities of the institution at which the work is being performed. In respect of salary grants this shall be paid half yearly. The responsible authorities receiving each grant shall be required to certify not later than the 1st March in the following year that(a) the work specified in the grant application has been performed; (b) the monty has been expended solely upon this work and for the purpose specified; (e) salaries paid non-graduates under the grant were in accordance with the appropriate industrial awards; (d) all surpll)ls funds allocated in the grant and not expended as above have been returned. 4. All graduates working on full time grant salaries must devote their time to the approved research subjects and not engage in other wotk to the extent of more than four hours per week. 5. The working )fear shall commence on 1st January, and the working period shall beat least eleven months, unless otherwise authorized by Council. The conditions of sick leave shall be similar to those obtaining in the Institute or Department where the :grantee is working. 6. Research wod:ers of Research Officer or higher rank may be allowed up to six months' sabbatical leave, for the purposes of travel and study approved by the Council, after six years' service in Australia on full time salaries under Council grants. Each research w()rker on approved sabbatical leave will receive full salary and may be allowed. travelling expenses, which however shall not exceed the cost of return tourist class air fares plus a maximum of £250 for other expenses. 7. Any university or institution which is registered as an "Approved Research Institution" or receives a grant from the Council shall undertake to provide all overhead expenses and maintenance charges, and no portion of any grant shall be applied for these purposes, unless specifically appropriated by the Council. 8. Items of mino~ equipment provided under grants will become the property of the institutions to which the grants are given; but the Couqcil may, in respect of major equipment items purchased under grant and costing more than £1,000 specify that they shall J(emain the property of the Commonwealth subject to recall when demanded, and returnable in any event upon the completion of the research projects for which the equipment was granted. 9. Any institution to which apparatus is entrusted under these conditions must undertake to(a) maintain the apparatus in good condition; (b) retain the apparatus under its control, not lending it to other persons; (e) in the case of major equipment subject to recall, return it in the same good condition in which it was receiVJ:d, except for reasonable wear. 10. Every institution or individual in receipt of a grant from the Council will recognize and admit responsibility for training younger petsons in research, and will recognize that one of the primary objects of the Council in providing financial assistance for medical research is the encouragement of young medical and science graduates to take up medical research as a career. 11. The pUblication of results achieved from research carried on with the assistance of grants from the Council may be either in journaJs or in monographs, and shall state prominently at the commencement or end of each article that the work re<'orded has bl::en supported by a grant from the National Health and Medical Research Council. It is desirable that articles showing figures which are claimed to be statistically signifieantshould be checked by a competent statistician prior to publication. Four reprints of any publication. pf work suP.POrted by the Council "Shall be furnished to the SecretarY. . . 12. No work w~lly or partly supported by Council research grants may be made subject to patent unless the written specific permission of the Chairman of the Council is obtained. 13. The primary ,appointment of full time research workers of Senior Research Officer rank or higher shall be for five year~. Mter three years a Senior Research Officer or Fellow may be given two years' notice of the termination of his appointment, but in the absence of such notice being given the appointment would thereafter be reviewed annually and the appointee would retain the right to expect two years' notice of termination. 14. Notwithstamling th~ provisions in c?nditi~ns 2 and.B above, the Council may remove or dismiss any research worker suppo~te~ b~ a CO';lncll ~ant at any tIme WIth only SIX months' notice on the grounds of permanent incapacity due to age or IOfirmlty, or lOefficlency from causes other than age or infirmity or ml'sconduct Such d .. h b k 1_1 h . . ., . a eclslon owever h 11 s a not e t~ en un t::IS ~ e matter has been thoroughly mvestigated by the Council in consultation with the Medical Research AdvISOry Conimittee and the head of the department in which the research worker was employed. 15. If.a grantee leav~s an .institution to ~hich a grant is paid before the normal expiration of that grant the ant may be ter:mlOated at dIscretIOn of the ChaIrman of the Council, notwithstanding the provisions inl3 and'14. gr

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If??: '2 2

. 16. M~ca.l and idental graduates appointed to research fellowships may be permitted tos baste BClen ce denartmpnt if t'h,::.,u

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49 17. Medical, dental and science graduates receiving full time salaries under CouIlcil grants ~ay be allowed travelling expenses once a year, upon application to the Chairman of the Council to attend recognized icongresses in Australia. The allowances paid shall not exceed 80 per cent. of the cost of return tourist class air fares an~ subsistence allowances of £3 per day for not exceeding 3 days. 18. Graduate research workers receiving full time salaries under Council grants are eligible, unless the Council may decide otherwise, for superannuation allowances following probationary periods of employm~nt in research approved by the Chairman of the Council. The probationary periods shall be three years for Technical Officers Science and one year for workers of Research Officer of higher rank. The Council will pay up to an additional lQ per cent. of basic salary for the purpose of a recipient taking out an endowment insurance policy of a type and in a cqrnpany approved by the Melbourne University or Australian National University F.S.S.U. schemes. This grant will be dependent on the recipient giving an undertaking in writing to contribute at least 5 per cent. of basic salary to the premium. The head of the Approval Research Institution employing the receipient will be responsible for the arrangement being carried out. The Council will not accept any responsibility for any further payment in respect of a superannuation allowance after the recipient ceases to work under a Council salary grant, when the policy shall then bewme the sole responsibility of the recipient. If an endowment insurance policy is surrendered within three years of the date of ~tts commencement there shall be paid to the Medical Research Endowment Fund that proportion of the surrender value of the policy corresponding to the proportion of the total premium contributions paid by the Council. 19. A research worker receiving a full time salary under a Council grant may not receive ~dditional remuneration from another source in respect of the work which is the subject of the Council grant unless the prior approval of the Council or Chairman of the Council is obtained. 20. All communications in connexion with grants must be sent either by or through the Head of the Department or Institute where the work is being carried out. 21. The recipient of each grant must furnish a full report to the Chairman of the Council by 15th D~ember, describing the work performed by each person supported by the grant during the year, the nature of the project, the results achieved, the reports of the work published and the future results to be expected.

APPENDIX Ill. (THIS DOCUMENT HAS NO LEGAL STANDING).

~~~~~~J~~~~~~~r;~~~~B~~~ItLi~~C?~:gR~~~o~~~~LAr~O~R~~1~'. STANDARDS FOR FLAVOURED MILKS. Flavoured Milk. 1. (a) Flavoured milk is milk to which has been added harmless flavouring substances with or with~)Ut sugar, permitted colouring, mono- and di-glycerides of fat forming fatty acids, alginates and gelatine. It shall con tam not less than 3 parts per centum of milk fat and not less than 8 parts per centum milk solids not fat. Labelling(b) Every person who sells any package of flavoured milk shall attach thereto a label in which shall be written in letters of not less than 12 points face measurement, the words" Flavoured Milk" immediately preceded or followed by the name of the flavour. Where the article has been flavoured with any imitation fruit or vegetable essence, extract or infusion, the label shall also contain in letters of not less than 12 points face measurement immediately following the desi$Ilation " Flavoured Milk" the following statement:IMITATION (here insert kind of flavour). Flavoured Skim Milk. 2. (a) Flavoured skim milk is skim milk to which has been added harmless flavouring substanCes, with or without sugar, permitted colouring, mono- or di-glycerides of fat forming fatty acids, alginates and gelatine. It shall contain not less than 8 parts per centum of milk solids not fat. Labelling(b) Every person who sells any package of flavoured skim milk shall attach thereto a label in which shall be written in letters of not less than 12 points face measurement, the words" Flavoured Skim Milk" immediately preceded or followed by the name of the flavour. Where the article has been flavoured with any imitation fruit or vegetable essence, extract or infusion, the label shall also contain in letters of not less than 12 points face measurement immediately following the designation" Flavoured Skim Milk" the following statement:IMITATION (here insert kind of flavour). STANDARDS FOR PRESCRIBED COLOURINGS. 1. (a) The following substances shall be permitted colourings within the meaning and for the purpose of these regulations :Annatto. Caramel. Cochineal. Saffron. Carbon Black prepared from vegetable sources and free from any polycyclic hydrocarbon. Chlorophyll and other vegetable colourings (except Gamboge and other harmful vegetable colourings, the use of which is hereby prohibited.)

rk

(For the purpose of this Regulation a synthetic vegetable colouring chemically the same as a natural vegetable colouring, shall be regarded as a natural vegetable colouring.) Coal Tar Dyes as follows:(here follows the list of dyes as approved by the F.A.C.). (b) Each permitted colouring matter shall conform to the following requirements:-

It shall contain, relative to 100 per cent. dry active dye. (i) no toxic intermediates; (ii) not more than 10 parts per million of lead; (iii) not more than 1.5 parts per million of arsenic, calculated as AS 20 3 ; (iv) not more than a total of 100 parts per million of heavy metals other than lead calculated as the respective metals. (c) When a dyestuff is sold admixed with any diluent for use as a colouring matter in foods the diluted preparation shall conform with the requirements of sub-clause (b) of this clause and shall have on the label of the package containing the diluted preparation a statement in bold faced sans serif capital letters of not less than eight points face measurement as to the proportion of total dyestuff contained therein.

(d) Where the addition to any food of any coal tar dye is permitted by these regulations the Plfoportion of 100 per

'):

cent. dry active dye so added shall not exceed:(i) one part in 15,000 in drinks as consumed; (ii) one part in 7,500 in cordials; ~

.

(iii) one part in 3,500 in any o solid food when the food is sold ready for consumption ~r when the food is . r • r r r . . .

I

51 2. Labelling of Colourin.g .Matter-Coal tar dyes which are sold for the purposes of colouring foods shall have on the la~l of the package contammg th~ .colour the number under which the colour is indexed in the Society of Dyers and Colounsts, Colour Ind~x, Seco~d EdItIon, 1956. When more than one colour is containeq in the package, the index n~ber ~f each colour In the mIXture shall be placed therein. Where a colour has no index number the name of the dye, as gIven m paragraph (a) of Clause (1) of this Regulation, shall be placed on the label of the ,package.

STANDARDS FOR LEMON BUTTER, FRUIT FLAVOURED SPREAD AND FRUIT FLAVOURED FILLING. Lemon Butter. 1. Lemon Butter is a preparation of butter, egg, sugar, citric acid, water, and flavouriQg substances derived solely from lemons, with or without glucose syrup or solid glucose. It shall not contain less than 4 per cent. butter fat, and not less than 1.5 per cent. of egg solids. It may contain permitted colouring. It shall not contain any other added substance.

Fruit Flavoured Spreads and Fruit Flavoured Filling. .,1.

2. (a) Fruit flavoured spread and fruit flavoured filling are preparations of sugar, edible oils and fats, and other

wholesome foodstuffs, with flavouring wholly derived from fruit. They shall contain not less than 2 per cent. of fat. They may contain pennitted colouring and not more than 2 per cent. of prescribed modifying agents. (b) Labelling.-There shall be written in the label attached to any package contain~g fruit flavoured filling or fruit flavoured spread in bold-faced sans-serif capital letters of not less than ten points face measurement the words " ... (here insert the name of the fruit) FILLING (or SPREAD). Imitation Fruit Flavoured Spread and Imitation Fruit Flavoured Filling:. 3. (a) Imitation fruit flavoured spread and imitation fruit flavoured filling are preparations of sugar, edible oils and fats, artificial flavouring substances, and other wholesome foodstuffs. They shall contair- not less than 2 per cent. of fat. They may contain pennitted colouring and not more than 2 per cent. of prescribed inodifying agents. (b) Labelling.-There shall be written in the label of imitation fruit flavoured spread (or filling) in bold-faced sans-serif capital letters of not less than ten points face measurement the words" IMITATION .... (here insert the name of the flavour) FLAVOURED SPREAD (or FILLING). Prohibitions. 4. (a) The words" butter" " cheese" " curd" shall not appear on the label attached to any package containing

(::r

fruit flavoured spread (or filling) or imitation fruit flavoured spread (or filling). The word" fruit" or the name of any kind of fruit shall not appear on the label of any package containing imitation fruit flavoured spread (or filling) unless accompanied in unifonn size and kind of lettering by the word " imitation". (b) Pictorial representation of butter, fruit or eggs shall not appear on the label attached to any package containing . fruit flavoured spread (or filling) or imitation fruit flavoured spread (or filling).

STANDARDS FOR ICE CREAM AND RELATED PRODUCTS. Ice Cream. 1. (a) Ice cream is a frozen preparation of milk or cream or milk products and other whQlesome foodstuffs, with or without flavouring and/or pennitted colouring. (b) Ice cream shall contain not less than ten parts per centum of milk fat and not less ~han one pound and eleven ounces of food solids to the gallon. (c) The use of farinaceous matter in the preparation of ice cream is prohibited. Flavoured Ice. 2. Flavoured ice is a frozen preparation of edible fats and other wholesome foodstuffs with or without flavouring and/or pennitted colouring. It shall contain not less than five parts per centum of edible fats. Ices or Ice Blocks. 3. Ices or ice blocks are frozen preparations of Wholesome foodstuffs with or without fllilvouring and/or pennitted colouring. . (a) Milk Ices or Milk Ice BlocksMilk ices or milk ice blocks are frozen preparations of milk or milk and water with or without sugar and/or glucose and fruit juice, with or without prescribed colouring; tlley shall contain not less than 8 per cent. of whole-milk solids. (b) Fruit Ices or Fruit Ice BlocksFruit ices or fruit ice blocks are frozen preparations of fruit squash, fruit juice, fruit juice cordial or raspberry vinegar with or without sugar and/or glucose and water with or without prescribed colouring; they shall contain not less than 5 per cent. of fruit or fruit juice. (c) Water Ices or Water Ice BlocksWater ices or water ice blocks are frozen preparations of water sugar and/or glucose and flavouring with or without prescribed colouring.

I

(d) Ice ConfectionsIce confections are ices or ice blocks not standardized elsewhere in this sub-regulation.

Labelling. 4. (a) Every person who sells any package containing ice cream, milk ice or milk ice block, fruit ice or fruit ice block. water ice or water ice block or ice confection shall attach thereto a label in which shall.be written in letters of not less than 12 points face the words " Ice Cream ", .. Milk Ice or Milk Ice Block ", .. Fruit Ice" 01" .. Fruit Ice Block ... , .. Water Ice or Water Ice Block" or .. Ice Confection" as the case may be. (b) Every person who sells any package containing a flavoured ice shall attach thereto a label in which shall be written in letters of not less than 12 points face the words" Flavoured Ice " either preceded with or followed by a description of the type of flavoured ice in letters of smaller size. The word" milk" shall not appear in the label unless the fat present is wholly milk fat. (c) The word" cream" shall not appear in any label other than that attached to a package containing ice cream. (d) Every person who sells any flavoured ice from a machine or appliance containing such product in bulk shall conspicuously display a notice adjacent to such machine or appliance on which shall be printed in letters of not less than 48 points face the words" FLAVOURED ICE" immediately preceding or immediately following the trade name of the product.

,.

Declaration of the Presence of Colouring and Flavouring. 5. Every person who sells any package containing ice cream, flavoured ice, water ice or water ice block, or ice confection, shall attach thereto a label in which shall be written in letters of not less than 6 points face the words" Artificially Coloured" or .. Artificially Flavoured" or .. Artificially Coloured and Flavoured" when the contents contain artificial flavouring, artificial colouring, or artificial colouring and flavouring, as the case may be. Stabilizers. 6. The addition to ice cream, flavoured ices, or ices or ice blocks of gelatine, sodium alginate, edible gum, pregelatinized starch and the mono and di-glycerides of fat-forming fatty acid is hereby permitted either singly or in combination proportion not exceeding 1.4 per cent. Processing. 7. Ice cream, flavoured ices, ices or ice blocks containing any milk or milk products must before freezing be heat processed. They shall not contain any pathogens nor Escherichia coli (Type 1) in one millilitre nor more than fifty thousand micro-organisms in one millilitre, when determined by the prescribed method. Mixes. 8. (a) An ice cream mix is a mixture of foodstuffs intended for use in making ice cream. A flavoured ice mix is a mixture of foodstuffs intended for use in making flavoured ices. A milk ice block mix is a mixture of foodstuffs intended for use in making milk ices or milk blocks. A fruit ice block mix is a mixture of foodstuffs intended for use in making fruit ices or fruit blocks. A water ice block mixture is a mixture of foodstuffs intended for use in making water ices or water ice blocks. An ice confection mix is a mixture of foodstuffs intended for use in making ice confections. Dairy ice mix is a mixture of foodstuffs intended for preparation in the home of a frozen preparation the fat content of which consists only of milk fat. It may contain the stabilizers named in Clause 6. It should not contain any farinaceous matter except as may be allowed in Clause 6. When prepared according to direction on the label the product shall contain not less than 5 per cent. milk fat, and not more than 1.4 per cent. of stabilizers as named in Clause 6. (b) Mixes, when prepared according to instructions written on the label attached to the package shall yield a product which conforms with the standard prescribed in these regulations for ice cream, flavoured ice, milk ice or milk ice block, fruit ice or fruit ice block, water ice or water ice block or ice confection, as the case may be.

(c) Mixes may contain flavouring and prescribed colouring.

Label/ing(d) Every person who sells any package containing ice cream mix, flavoured ice mix, milk ice block mix, fruit ice block mix, water ice block mix, ice confection mix, or dairy ice mix shall attach thereto a label in which shall be written(i) in bold face sans serif capital letters of not less than twelve points measurement as prescribed in Regulation-the words" Ice Cream Mix ", .. Flavoured Ice Mix ", " Milk Ice Block Mix ", " Fruit Ice Block Mix ", "Water Ice Block Mix ", "Ice Confection Mix" or "Dairy Ice Mix" as the case may be, and (ii) instructions for the preparation of a product which will conform with the appropriate standard prescribed in this Regulation; except in the case of Dairy Ice Mix which shall have written on the label instructions for the preparation of a product containing not less than 5 per cent. milk fat. (e) A person shall not make any claims or statements in the label or advertisement relating to any product that such product may be used for the production of ice cream unless when prepared according to the instructions on the label or advertisement it yields a product which conforms to the standard prescribed in these regulations for ice cream.

,.<,

....

53 APPENDIX IV. ! NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL, MAY, 1963. RECOMMENDATIONS OF AD HOC LEPROSY COMMITTEE.

1. The minimum aim of leprosy control measures in this country should be the eliminatioJi of leprosy within this century. This is possible with currently known preventive control and therapeutic measures. , 2. The basic principle at present of leprosy control is to reduce infection by reducing conulct between susceptible individuals and infectious cases. , 3. All persons not known to have leprosy should be regarded as susceptible. 4. Infectious, " potentially infectious" and non-infectious states of leprosy can, for practi~l purposes, be defined and recognized. (See full report for details.) 5. At present, it should be Australian policy to isolate all infectious cases of leprosy from susceptible persons, and to similarly isolate all " potentially infectious ,. cases except those where there is reasonable assurance that they will be clinically and bacteriologically examined at least one every three months and will receive adequate treatment. 6. Every attempt should be made by the States and Territories to avoid the necessity of isolating" potentially infectious" cases, by providing the necessary facilities for regular outpatient treatment and reassessment of as many of these cases as possible. 7. The terms" leper ", "lazaret" and "leprosarium" should no longer be used. The curable nature of the condition should be stressed by referring to people with leprosy as " leprosy patients" or" patients with Hansen's disease" and to special leprosy isolation establishments as " leprosy hospitals ", " hospitals for the treatmen. of Hansen's disease" or simply " isolation hospitals". ' 8. Admission to leprosy hospitals should be strictly limited to the following groups:(i) .. Infectious" and those" potentially infectious" patients it is necessary to isola~ (see above). (ii) Other leprosy patients who, in the opinion of the Chief Medical Officers or such: other medical officers as they may specifically designate, require treatment which cannot be adequately given elsewhere. (iii) Crippled and other leprosy patients who, in the opinion of the Chief Medical Officer,s or such other medical officers as they may specifically designate, cannot maintain a standard of living oJ.1tside leprosy hospitals adequate to maintain effective resistance to the advance or reactivation of th~ disease, or prefer to remain in leprosy hospitals because of disfigurement. .. Leprosy suspects" should not be admitted to leprosy hospitals unless the diagnosis is c9nfirmed, and they are certified as" leprosy patiepts ". It is not necessary to admit a patient to a leprosy hospital merely iq order to establish the diagnosis of leprosy. 9. All active leprosy patients should have continuous and effective specific anti-leprosy drug treatment for a mandatory minimum period of five years and treatment should be continued in these patients fOIl' at least two years after they become inactive. 10. Once patiepts are started on specific anti-leprosy drug treatment they should be encouraged to continue the therapy indefinitely (at reduced doses). 11. Leprosy patients never diagnosed as active should also be encouraged to take spqcific anti-leprosy drug treatment indefinitely (at reduced doses). ' 12. Leprosy is a condition which may relapse, and it is considered both desirable and feasilille to attempt to follow up all known cases in Australia indefinitely. It is considered that all .. open cases should be examined both clinically and bacteriologically at least once every three months, that all " active" cases should be examined both clinically and bacteriologically at least once every six months, and that all other cases should be clinically examined at least once every six months fpr life. These routine examinations should, if possible, be conducted by medical practitioners with experience or speciallt'aining in leprosy, and the records of past examinations should be available during each examination for reference. ' As long as patients remain " leprosy suspects " they should be reviewed at least every three months, and wherever possible these examinations should also be made by medical practitioners with experience or s~ial training in leprosy. "Leprosy contacts" should be registered and an attempt should be made to follow themiup with annual checks for at least ten years after their last known contact with infectious leprosy. 13. The protective value of BCG vaccination against leprosy is considered sufficiently possi1:Jle to justify vaccinating all known Mantoux negative children who have been in close contact with open cases of leprosYr 14. It is recommended that arrangements be made to give all doctors and trained nursing sisters in charge of hospital wards, outpatient departments, missions and stations in the northern parts of Australia ~hort courses in leprosy hospitals to help them in their orientation to and recognition of leprosy. 15. Positive recommendations are made for re-educating the general public and those at risk about leprosy. 16. It is considered that a1l1eprosy patients, whether aborigine or non-aborigine should tie paid:0) appropriate sickness benefits whenever they are temporarily unable to work due to sickness; (ll) appropriate invalid pensions when they are permanently incapacitated for work ~ue to leprosy or other causes; (iii) appropriate unemployment benefits whenever they are unemployed and are not rei::eiving sickness benefits or invalid pensions but are capable of working. The committee re-affirmed the recommendation of the 1950 and 1956 National Health and M~dical Research Council reports on leprosy control that an allowance equivalent to the Tuberculosis Allowance should be paid by the Commonwealth in respect of leprosy under similar conditions to those prescribed for tuberculosis. The payment of unemployment benefits to leprosy patients, as above, is considered a most! important requirement for the maintenance of lir.'ing standards for leprosy patients, adequate to maintain effective resistjance to the advance or ,reactivation of the diseaS¢. In this connexion,leprosy patients not required to be isolated should: not be considered unfit for employment simply l>ecause they have leprosy, but ." potentially infectious" leprosy pati~ts, not required to be

·54 APPENDIX V. SAFE HANDLING OF CYANIDES ON THE WATERFRONT. SUMMARY OF RELEVANT INFORMATION AND INTERIM RECOMMENDATIONS.

(Prepared by the Occupational Health Committee of the National Health and Medical Research Council, March, 1963.) 1. In this summary the term" cyanide ", where unqualified, refers to hydrogen cyanide (hydrocyanic acid, prussic acid), cyanogen or to a simple inorganic salt of cyanide such as potassium, sodium, calcium or copper cyanide. Where it is necessary to make a distinction between these forms of cyanide, they will be referred to specificially. It should be realized, however, that the dangers associated with the handling of cyanide salts are due to the formation of hydrogen cyanide in the salts by the action of acids or of moisture. 2. Very large amounts of cyanides are used in the chemical, metal and plastics industries, and a relatively small quantity is used for fumigating. Occupational poisoning by cyanide may result from the inhalation of hydrogen cyanide or cyanogen gas, or of the dust of cyanide salts, or from the absorption of hydrogen cyanide through the skin, but despite widespread use, cyanide has rarely caused death or serious poisoning in occupational exposure. Non-occupational poisoning is usually due to the accidental or intentional ingestion of cyanide salts or to unwitting entry to a fumigated atmosphere. Exposure to Cyanides on the Waterfront.

).

3. The" Rules Relating to Dangerous Goods, and the Packing, Stowing and Carriage of Dangerous Goods" issued by the Director of Navigation in 1955 in pursuance of the Navigation (Dangerous Goods) Regulations contain requirements concerning cyanides. The allowable methods and materials for packing vary according to the form of cyanide being transported. (i) Cylinders, used for stabilized and anhydrous hydrogen cyanide and for cyanogen, may be transported on deck or under deck in a well-ventilated space; they are to be adequately secured, not overstowed by heavy cargo or carried over coal, and away from food, living quarters and corrosive, inflammable or combustible substances. The Rules provide for protection of the valves of cylinders by metal caps, and where not so protected cylinders must be transported as deck cargo only. Anhydrous hydrogen cyanide may also be shipped, on deck only, absorbed on porous material in stout tins, or in glass packed in tin cases. (ii) Solid cyanides may be shipped in glass or earthenware containers, tins or cans, polythene bags or vulcanised rubber-lined cartons, provided such containers are packed with suitable protective material in wood cases. Solid cyanides may also be transported in metal drums, without other packing. 4. Although the Rules deal with methods of packing, stowing and carriage of cyanides from Australian Ports, there can be no guarantee that cyanides will not arrive in Australia from overseas ports in a manner not conforming with these requirements. In practice cyanides are rarely shipped other than in metal drums containing up to 250 lb., or in heavy tin cans containing 50 lb.; the latter mayor may not be packed in wooden crates. Therefore, while mention is made in these notes to hazards in the handling of cylinders containing hydrogen cyanide or cyanogen, major emphasis has been placed on handling of solid cyanides in drums or cans. It is obvious that glass, earthenware and polythene containers, even packed in wooden crates, would be more vulnerable to breakage than drums or cans, and that extra care would be needed in handling them. 5. On the waterfront, the risk of poisoning by inhalation of cyanide may occurr (i) when cylinder valves leak or are broken in handling, or (ii) when drums or cans have burst in the hold in transit (as a result of inadequate stowage and violent rolling of the ship) and the spilt powder has subsequently been contaminated by acid or acidic substances; or by water. 6. In the first sitUation, rapidly lethal concentrations of hydrogen cyanide may occur in the immediate vicinity of the leak; however, when in uncapped cylinders, volatile cyanides are carried as deck cargo only, in which case rapid dispersal of the gas is to be expected, and when under-deck capping as specified in the Rules would make damage to valves in transport or handling an unlikely occurrence. 7. In the second case, the concentrations attained will depend on factors such as the volume of free space and degree of natural ventilation in the hold and the amounts of cyanide and acid or water which come into contact. Lethal concentrations could be attained, but the probability of such an occurrence is remote. Water itself, even atmospheric moisture, will liberate hydrogen cyanide from strongly alkaline cyanides; in the past, contact of spilt powder with water in a completely unventilated hold has resulted in the establishment of hazardous concentrations of hydrogen cyanide, and in one case in deaths. However, if the hold of a ship is adequately ventilated, a hazard from this source is considered unlikely. 8. Skin absorption may proceed from contact with either liquid or gaseous hydrogen cyanide; liquid hydrogen cyanide boils at 25° C., so that if spilt as a liquid rapid evaporation is likely to occur. The vapour is explosive and inflammable. Powdere~ cyanide salt is not absorbed as such through the skin to a significant degree, but the action of atmospheric moisture or sweat may form hydrogen cyanide from powder deposited on the skin. The extent to which hydrogen cyanide is absorbed through the skin from moist cyanide salts is not accurately known. While the hazard would not appear to be great, it is reasonable to demand that adequate precautions be taken to prevent undue contact of the skin with spilt powder. 9. In addition, hydrogen cyanide may be used on the waterfront for the fumigation of holds or of stores on the wharves against rat or other infestation. Fumigation is carried out by fumigating contractors or departmental officers whose responsibility it is to ensure that the treated space and the equipment used are securely sealed against leakage, that warning notices are erected and unauthorized persons are excluded, and that adequate ventilation is arranged after treatment.

).'

55 Toxic Effects of Cyanide. or minutes of co~encement .o.f exposure. Mild poisoning produ~es symptoms such as unsteadiness, weakness, giddiness ~e.a~ache, C?nfUSlOn and vomIting: In severe cases, loss of conSCIOusness may be almost instantaneous. The breathing, !ll1tIally rapId and ~eep, becomes Iffegular, slow and gasping, and the pulse weakens. Consulsions may appear Death IS usually due to faIlure of breathing. . 11. I:Iydrog(::D cyanide is not irritating to body surfaces, but sodium and potassium cyanides in strong solution act as alkahs, caUSing irritation of skin, eyes and lining of nose and throat.

. to. Because of the rapidity of absorption of hydrogen cyanide, symptoms of poisoning m"y appear within seconds

Treatment of Poisoning. 12. In ~i1d cases of occupational cyanide poisoning recovery follows rapidly on removal,from the contaminated atmosp~ere, wIth no ~reatme~t other t~an the administration of amyl nitrite by inhalation, provided absorption from contaminated clothes IS not stIli proceedmg, In more severe cases, treatment is of utmost urgen4Y and should not await arrival of medical help. A.

First-aid Measures(i) Remove patient from contaminated area, rescuer being protected by a cyanide canister respirator.

Send for a doctor. (ii) If breathing is feeble or has ceased, apply artificial respiration by mouth·to-mouth or mouth-to-

nose method until oxygen apparatus is available. (iii) If patient is breathing, break ampoules of amyl nitrite in handkerchief and hold under nose every three minutes. (iv) Remove or cut off clothes if contaminated; wash skin and cover patient. (v) If cyanide has been swallowed and patient is still conscious, induce vOq1iting by placing finger in throat or by giving drink of salt water. B.

Additional Treatment by Doctor, Nursing Sister, or Specially-trained First-Aid Attendant (if patient not already revived)(i) Inject into vein 10 ml. 3 per cent. sterile sodium nitrite solution at rate of 3 to 5 mI. per minute, followed immediately, through same needle at same rate, by 50 ml. 25 per cent. sterile sodium thiosulphate solution. (ii) Inject blood pressure stimulant if necessary, e.g., methyl-amphetamine. (iii) Apply external heart manipulation if pulse has ceased. (iv) If cyanide swallowed and vomiting not yet induced, wash out stomach (useless if over half-hour after ingestion).

-,

Prevention. 13. Cyanides should be stowed securely in dry, isolated, well-ventilated spaces away from sjources of water, acid, heat and open flame. Such conditions may be obtainable in stores on wharves, but are unlikely fully to be realized in holds. Smoking should be prohibited. 14. Statutory Rules 1959, No. 97, of the Navigation (Cargo-Hazards Prevention) Regulatiops prescribe inspection by a surveyor and an approved chemist before handling if a spillage has occurred or if containers of hazardous substances are damaged. Therefore, before any work is carried out in a space containing cyanides, an inspection should be made to determine the condition of the drums or cylinders. Should a spillage be detected or suspected as loading proceeds, the incident should be reported in accordance with the Regulations.

.-;,;-

15. In the absence of water contact, a spillage of sodium or potassium cyanide presents very little hazard to the men engaged in unloading, but it may present a much greater hazard to the general public as a result of contamination of other cargo. Special care should be taken in respect of calcium cyanide as contact with moisture! will liberate hydrogen cyanide. 16. The following precautions are therefore recommended in the handling of cyanide cargp. (i) Where contact of the cargo with water is not suspected, the men should wear glC!>ves and overalls and, in the event of a spillage, this should be swept up dry and the men involved should be given washing time at breaks and at the end of a shift. (ii) Where it is suspected that a cargo of cyanide has been subject to contact with water, a preliminary inspection by a surveyor, helped if necessary by a competent chemist, should be carried out. If the possibility of water contact with the cargo can be eliminated as a result of thiis inspection, then the conditions laid down in Paragraph 16 (i) would apply. Where the possiblity cannot be eliminated, the unloading should be carried! out under the direct supervision of a competent chemist and the procedure adopted will depend upon:the nature of the risk. Generally it would be advisable to augment the ventilation of the hold by mechanical means. (iii) Where it is considered that lethal concentrations of hydrogen cyanide may exist, entry should be made only by trained operators wearing cyanide canister respirators, and appropriate first aid measures, including apparatus for administering oxygen under positive pressure, should b~ available. 17. Cyanide canister respirators should comply with the Specification A.S. No. Z. 18 of the Standards Association of Australia, and should be used and maintained in accordance with the Code of Recommended Pilactice for Respiratory Protective Devices, A.S. No. CZ. 11.

Bv Authority: A. J.

ARTHUR,

Commonwealth Government Printer, Canberra.

BRITISH SOLOMON ISLANDS PROTECTORATE ../ Report on the Progress of Health Activities During 1962

GENERAL REVIEW INCLUDING STAFF POSITION Undoubtedly the most important item in the Departlmnt' s calendar for 1962 was the completion of recruitment and training of staff, and the launching of field operations of the malaria eradication pilot project, organized in collaboration with the World Health Organization. The School Health Service, inaugurated in 1961, has proved popular with the majority of the educationaJ. authorities, and was extended to all four districts. By the end of the year, twenty of the principal schools in the Protectorate had been brought within the scope of the service, which aims to provide routine annual medical inspection of schoolchildren, and the provision of immunizing procedures.

, r

~

....

"

";

Known foci of persistent yaws in North Malaita continued to cause concern, and though no major recrudescence of the disease occurred, a specially mounted attack on these areas was launched by four teams constituted for the purpose in the latter part of the year. The operation was completed in under tyro months, during which 26 cases of infectious yaws were found among the 15 287 people examined. With the arrival of the first District Health Sister, who was posted to Malaita District in the middle of the year, real. progress to took place in the in-service training and supervision of rural. nursing and midwifery staff. The appointment for the first time to the Protectorate, of a fully qualified health inspector in August, gives much promise for early improvement in the field of environmental sanitation, a field in which ~rovezrent is certainly overdue. The staffing position otherwise generally showed some all round

firstly by the appointment of a new matron in August, and secondly as the result of a full complexoont of ~dical officers all of whom were at post in the latter quarter of the year. The Inspector-General of the South Pacific Health Service helped to alleviate the rather difficult assistant medical officer staffing position by the secondJ:n3:=lt in 1vby of another Fijian Officer to the Protectorate Establishment. The following numbers of junior staff proved adequate during the

~rove~nt,

year: Nurses Dressers/Medical Assistants Trainee Medical Assistants Trainee Nurses 18 90 28 19

- 2 In addition there were 22 nurses employed by local councils during the year to staff rural maternal and child welfare clinics, whose supervision and. supplies are provid.ed by the M;!dical Department.

2.

TRAINING OF NURSING .AND AUXILIARY PERSONNEL

The third year of the services of the \{orld Health Organization Sister Tutor at the Central Hospital Training School was again very successful. Recruitment continued to be satisfactory though the educational standard of recruits, particularly girls, left much to be desired. A second curriculum and teaching routine has now been est established, and in short, the year may be best described as one of consolidation. Overseas training of students continued in 1962 (a) at the Central. School in Suva, Fiji, where five Solomon Islands students were in training. All being well the senior two will qualify as Assistant Medical Officers (AMOs) in 1965. In ad.clition, a Fijian, specially trained for service with the Protectorate Government as an Assistant Dental Officer, qualified successfully at the end of 1962, and after further practical training, is expected to arr!ve in the Protectorate towards the end of 1963, and (b) at the MaJ.aria School at Minj in the New Guinea Highlands, where by courtesy of the Territory of Papua and New Guinea Department of Health, a number of entomological. technicians and the Assistant ~dical Officer in charge, underwent training for service with the ~aria eradication pilot project. ~dical

3. 3.1

PREVENTIVE.AND SOCIAL MEDICINE General

With a large proportion of the Department's resources devoted to the oalaria eradication pilot project, it proved possible to do little more than consolidate and maintain progress achieved in other fields. 3.2 Health education

The Department's new Health Education Officer, who returned from training at lJ:lndon University in 1961 was fully employed during the year in work directly connected. with the ~aria ~radication pilot project, and the successful progress of the field. teams to date would appear to testify to his efficiency, no local opposition having been encountered despite earlier forebodings.

3.3 School medical services Although no personnel are fully allocated to the recently established. School Health Service, District Medical Officers and AMOs realized tha.t this was a fruitful and rewarding channel for their activities with the satisfactory results mentioned in the general review above.

!

r

L

.. 3 ..

3.4 Infant and child welfare The British Solomon Islands Branch of the British Red Cross Association provided funds for the construction of a maternal and. child welfare clinic in Honiara, and during the year a number of clinics were established by the M3dical Department in that building. These included inoculation, baby and infant welfare, and. ante-and. post -natal care clinics. Elsewhere district medical staff were encouraged to extend similar work so far as possible and, as mentioned. above, availability of a district health sister was a major step forward in encouraging such activities as part of the normal duties of rural nurses and. midwives. Lack of shipping with suitable refrigeration facilities however continued to hamper any extension to the more rural areas of quadruple vaccine immunization. BCG vaccination on the other hand was facilitated, particularly through the School Medical Service, by the introduction during 1962 of heat resistant glutamate dXled BCG vaccine of Japanese origin. 3· 5 Dental health

Simple conservative dentistry is ava1lable in Honiara at the hands of medical staff, and a private dental surgeon from Rabaul, Territory of Papua and New Guinea, visits Honiara for two weeks approximately every six months. othe!'"ln.se there is normally neither dental officer nor assistant dental officer in the service of the Protectorate Government. With the new air service from Fiji, hOvJever, arrangements were made towards the end of the year to have a visit from the Government Senior Dental Officer in the Fiji Service preparatory to the secondment of the Fijian Assistant Dental Officer mentioned above.

3.6 Mental health The modern treatment introduced during 1961 at the Government Mental Hospital in Honiara appeared to have been effectual if the unusually low number of patients detained. at the end. of the year was any indication. There were ten male and three female patients so detained under certificate at the end. of the year.

4. 4.1

ENDEMIC AND EPIDEMIC DISEASE

Malaria eradication £ilot ~oject

The malaria eradication pilot project tended to make a rather slow start due to d.ifficulties in recruitment, both locally and from overseas, delay in the arrival of essential training supplies from overseas, and the necessity to have some entomological technicians trained in the neighbouring tlerritory of Papua and New Guinea. HOV1ever, these teething troubles were overcome and the project steadily gained impetus during the remainder of the year.

..

-'

1

- 4The pilot project area constitutes the island of Guadalcanal (including Savo) and the majority of the islands in the New Georgia Group. Preliminary surveys were carried out from April 1962 onwards, in both areas, to collect full malariometric and entomological data, while geographical reconaissance located, measured and mapped all houses to ensure total coverage of spraying operations. Dissemination of information about the project was carried out by the Health Education Officer who instructed village leaders, teachers, and the pilot project staff in the various aspects of the programme. i-lith the commencement of spraying operations in October 1962, DDT was applied at a dosage rate of 2 gro:::lB per square metre to the internal surfaces, undereaves, under underfloors and posts (i.e., in the case of raised houses) of all s structures occupied by people after dark. It will be seen, therefore, that the project is at present in the very early stages of the attack phase, the first of the six-monthly spray rounds in the pilot project area having only been recently completed, and. the second spray round began.

By the end of April 1963, at the conclusion of the first spray round, 21 900 people in Guadalcanal and 16 406 in the New Georgia Group had been covered by house spraying. This represents 29.4% of the Protectorate population of 130 000. No evidence of vector resistance to nM has so far been found.

Epidemiological evaluation has been based upon serial blood films taken from approximately 50% of the population of the pilot project area, but the results are not yet sufficiently Imown. Although insufficient time has as yet elapsed for statistically valid conclusions to be drawn, two very encouraging factors are that in the inaccessible south-east coast of Guadalcanal, the first 3552 postspraying blood films confirm a three-fold reduction in malaria incidence (age group separation not yet available); and secondly, the overall malaria incidence in the islD.nd of Savo has gone down from 37% to 0.42% only two months after spraying and drug treatment commenced - a 93-fold reduction. It is difficult to estimate pro·s:Pects for the complete eradication of malaria, with the pilot project still at a cOnIplratively early stage. Planning is going ahead on the basic presumption that a practical method of interrupting transmission will be found, and that it will be implemented in a malaria eradication campaign after a pre-eradication survey programme commencing in 1965 and lasting for approximately one year. 4.2 Tuberculosis

Tuberculosis continues to be the second major problem, but due to the departmental efforts concentrated on malaria eradication, no major attack on this disease is contempla..ted at present. The new Tuberculosis Central Registry appears to be operating satisfactorily, however, and systematic tracing of house contacts of known cases has been established as far as practicable; 215 new cases were on the register as at

.. - 531 December 1962. As mentioned above the introduction of heat resistant BCG vaccine has facilitated an extension of the vaccination programme commenced in 1959.

4.3

Yaws

During the past three years the residual infected. areas in North Malaita received special attention, being given a disproportionate allocation of the limited district staff time and resources in an effort to eradicate the disease from them. Many of these small pocl{ets of residual infection were thus satisfactorily d.ealt with, but it was realized that the most refractory area (North East Ma.laita) could only be kept under control by the maximum deploymnt of district resources. Accordingly four special teams coni sting of three AMJs, three medical assistants, an assistant health inspector and a dresser all experienced in yaws 'WOrk, were organized from the combined Central and Malaita Districts, and deployed in the affected areas in November and December, 1962. During what in effect was a mass resurvey, completed before the end of the year, 26 cases of infectious yaws were found among the 15 287 examinations carried out, and it is hoped that a major blow has been dealt to the residual yaws in the country. Follow-up assessment surveys are planned.

4.4

Leprosy

The new Central Leprosy Register is also 'WOrking well so far as the follow-up dOmiciliary treatment and contact-tracing of know cases are concerned; 83 new cases were on the register as at 31 December 1962.

4.5

Helminthiases

Helminthiases are very common and are only likely to improve concommitnntly with an improvement in village sanitation. Touring staff are well aware of this, and encourage the construction of proper latrines in villages both by demonstration and exhortation. With few exceptions, however, progress in this field continues to be very slow. 4.6 The only epidemic of consequence recorded d.uring 1962 was an outbreak of influenza during the months of August, September" October" November, during which some 4000 cases \rere notified, but fortunately with only four deaths directly attributable to the disease.

5·

HOSPITALS, CLDfICS AND CURATIVE SERVICES GENERALLY

The situation generaJ.ly remained as in 1961, no new hospital buildings of any consequence having been undertaken by the Government, though C.D. & W Schemes are in hand both for the reconstruction in permanent materials of the Rural Hospital at Malu IU in North Malaita, and to subsid.ize the local council construction of rural health maternity and child welfare clinics.

..

- 6 6. VOLUNTARY AND CHARITABLE ]NSTITUTIONS

The Solomon Island Branch of the British Red Cross Society, the New Zealand Leper Trust Board, and the New Zealand Council of Organizations for Relief Service Overseas continued to provide much material and financial assistance to the welfare of the Protectorate during 1962. The Red Cross is particularly energetic in the field of maternal and, child welfare, and in ad.di tion to having provided the clinic building mentioned, above, hfl8 1IDdertaken to provide the services of a fully trained health sister who is scheduled to arrive in the Protectorate during January or early February 1963.

BRu"EI ,/.~ Rep~rt on the Prc:gl'e~~ of _Health Activities, 1962*

1

GEl-JERAL

Brunei is a State in the Island of' BQj:neo situated between Sarawak and North Borneo. Its area is 2226 square miles (5765 km2 ). The general health of the people of Brunei has been satisfactory. The state can be considered as one of the healthiest of the tropical countries in the East. It has fo~ years been free from dangerous infectious diseases like smallpox, cholera and yellow fever. Cholera, which has attacked Sarawak a..'1d North Borneo during the last year, was kept away from the State through intensive Q..uarantine measures which were enforced by the health authority. 2 POPULATION AND VITAL STATISTICS The population of' Brunei as recorded at the last census,held on

10 August 1960) was 83 877. Population estimates for the period of 1957-1962 and other important vital statistics are given below. 1000 population, infant deaths per 1000 live births, maternal mortality rate per 1000 total live and still births and natural increase • Mean population, rates of births ~nd de~ths

at all ages, per

. Year Population (mid-year) Live Birth Rate Death Infant Rate Mortality (all Rate ages) Maternal Natural Mortality Increase Rate

1957 1958 1959 1960 1961 1962

66 918 71284 77 673 82 609 84 249 91 186 :

45.23 56.79 50.78 49.90 51.18 43.65

15.09 ll.76 1l.30 11.10 7.19

l36.1h 88.88 93.07 69.18 47.77 50.75

unrecorded unrecorded

2 182 3 488 3 266 3 188 3 706 3 352

4.00 4.8 2.76 2.99

I

6.89

*Prepared by Dr. Abdul Wahe.b Bin Mohamed Ariff, D.P.H. (Lond.), state Medical Officer, Brunei

-2-

3

INFANT DEATHS

The number of deaths of infants under one year of age registered in 1962 was 202 as compared with 206 in 1961. This shows a progressive drop in the number of infant deaths among the 11ve births before reaching the age of one year. The infant mort ali ty rate in 1962 was 50.75 against 136.14 in 1957, i.e., five years ago. The toteil number of 11ve births registered in 1962 was 3980 and the total number of deaths 628. The crude death rate in 1962 was 6.89 deaths per thousand mid-year population, which is the lowest on record in the state, and which ~can match favourably with any country in the world. The total number of deaths among all ages has gradually declined from 935 (1959) to 628 (1962) though during the same period the population has continued to increase. The known leading causes of death in 1962 were gastro-enteritis and colitis (42), tuberculosis of the respiratory system (37), bronchopneumonia (26), unspecified pneumonia (16) and dysentery all forms (7) ..

4

CCMMUNICABLE DISEASE CONTROL

Among the cases notified in 1962 were influenza culosis (154), chickenpox (167), measles (39), malaria (21), dysentery (27), leprosy (2) and diphtheria (20). tion against poliomyelitis in 1960 has resulted in the cases in 1961 and 1962 (36 cases in 1960).

(4925), tuber(27), typhoid Mass immunizaabsence of

5

RECRUI'lMENT AND TRAINING

There has been great success in the recruitment of staff especially doctors and qualified tutors for the training schools. A sister tutor and a midwifery tutor were recruited to intensify the training in the field of nursing and midwifery. 6 NATIONAL DEVELOPMENT PLAN 1962 - 1966

The plan has provision for extensive expansion in 1962-1966. Four district health centres, 15 sub-di~trict health centres,35 midwife quarters-cum-c11nics, 4 district hospitals (including one 500bedded General Hospital), 5 cottSge hospitals and 38 dental clinics (statiC and mobile) will be constructed throughout the state.

7

BRUNEI REVOLT

An Emergency Medical Service was set up to deal with the wounded and dying during the revolt which broke out on 8 December 1962. The staff of this department were at their posts to deal promptly wi th the casualties which included 36 wounded and 14 dead wi thin 48 hours of the Revolt. Up to the end of 1962, gy cases were attended by this department.

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- 3 -

8

MIDWIFERY SERVICES

A school of midwives was started by the Midwifery Tutor to intensify training in midwifery work. 24 983 home visits were made by 45 government midwives before, during and after births; 252 premature babies were born in the State in 1962. A premature baby unit was established at the General Hospital for the first time to reduce infant deaths among premature babies.

3980 births were registered in 1962 when 45 trained midwives were available for institutional and home deliveries. About 70 per cent of deliveries in 1962 were delivered by midwives. There were 12 maternal deaths in 1962 as against 12 in 1961. 9

DENTAL HEALTH SERVICES

A total of 23 772 attendances was recorded by the Dental Department; 10 450 fillings were carried out and 14 667 dental extractions made. Dr. B. Rice, Chief Dental Officer, World Health Organization, Geneva, visited the State in October 1962. Dr. G. H. Leslie, Director of Division of Dental Health, New Zealand visited Brunei 18-19 June 1963 to acquaint himself wii{h dental developments in the State. Colonel J.F. Fuller of New Zealand, WHO Consultant, visited Brunei 20-23 July 1963. The purposes of his visit were to consult the Government with a view to determining the existing information on national dental health problems and to explain the survey training phase of the dental epidemiological survey project.

10

ANTI-MALARIAL SERVICES

The World Health Organization has assigned Dr. M. M1yairi to help the Government to formulate a comprehensive plan of operation for a malaria eradication programme and to provide the necessary technical advice required by the Department. The plan of operation had already been approved; the project of the whole malaria eradication programme in Brunei from 1963 to 1968 will amount to $5 504 630.

11

ANTI-TU:BERCULOSIS CAMPAIGN

A plan of operation for an anti-tuberculosis campaign with technical advice from the World Health ,Organization is being studied by the Government. 12

HEALTH SERVICE PERSONNEL

The monthly average of fUll-time government doctors during the year has grown from strength to strength (4.8 in 1957; 6.3 in 1958; 6.8 in 1959; 7.1 in 1960; 7.8 in 1961 and 9.6 in 1962); 1962 ended with a strength of 18 doctors (14 government and 4 non-government) in the State, i.e., one doctor per 5000 inhabitants. The total strength of the permanent staff of the Department has generally increased 436

. - 4 -

(1961) to 473 (1962). Up to the end of 1962 there were 14 government doctors, 3 dental officers, 114 nurses (all grades), 33 hospital assistants, 5 X-ray technicians, 10 laboratory technicians, 4 dispensers and 4 health inspectors. Training facilities for nurses, hospital assistants and midwives are available in Brunei. 13 straits GOVERNMENT EXPENDITURE ON HEALTH SERVICES The budget for 1962 was $47 017 590 for the whole State of which $4 767 010 (10.1 per cent) were allocated to the health services.

CHINA (TAIWAN) t,/

Report on the Progress of Health Activities During the Fiscal Year 1~63 (1 July 1962 - 30 June 19 3)

1.

TUBERCULOSIS CONTROL PROJECT BCG Vaccination

1.1

During the period under review 658 369 tuberculin tests were completed; 469 204 persons, or 71.3%, were vaccinated with locally produced liquid vaccine; 169 476, or 25.7%, of the total completing tests were pre-school children while the rest were school-entrants and school-leavers~ An attempt is being made to decentralize ,the BOG work from the health bureaux to the local health stations, where it will be integrated with other permanent health services. A study on simultaneous vaccination of BCG and smallpox vaccine was conducted during the year and the result has shown that the simultaneous vaccination of these two kinds of vaccine is safe and effective.

1.2

Mass chest surveys

Using the mobile 70 mm photofluorographic units, 449 012 persons were examined during the year, including 147 717 persons who voluntarily joined the community surveys. Of the total number examined, l2 619 were suspected as having active tuberculosis. All suspected cases are referred to the health agencies for sputum examination and necessary treatment. 1. 3

Mass sputum examinations

Sputum examinations are carried out free of charge at health stations, health bureaux and at some special institutions. During the period, 142 553 persons received free sputum examinations on one or more occasions. Those persons found to have positive sputum are eligible for free drug treatment, and during the period 5 605 new open cases were found and given free treatment.

1.4

Domiciliary chemotherapy

DomiCiliary chemotherapy is provided through the existing health agencies near the patients' residences with regular follow-up from the health and tuberculosis centres. About 20 000 persons are currently receiving free drugs, these include school-teachers and other special groups.

1.5

The second prevalence survey

The second tuberculosiG pr0va,lcncl.,; S1.lr'..r0Y VIlS cOCDcnced July 1962, five years after the first one. Seventy sampling areas have been selected from different strata. The methods used include tuberculin tests for children below five years of age, photofluorographic examination of those ten years and above, and bacteriological

- 2 -

examination of' those found to have puJJnonary abnormalities on X-ra;y. Up to the end of June 1963, 64 areas had been completed. The coverage of the various kinds of examination was as high as 99%. 2. MATERNAL AND CHILD HEALTH PROJECT

2.1

Training

Details of the training courses given to medical officers and nurse/midwives from health stations and the refresher training for private midwives are given in the follOwing table.

1263 Medical officers Nurse and/or midwiv~s Private midwives Health stations covered by MCH training Two days pre-pregnancy health training for nurses or midwiveEl.and doctorsin health stations Three da;ys pre-pregnancy health orientation course for staff of local farmer's association Three days pre-pregnancy health training for full time PPH workers in health stations One day training L.1 milk bar work for nurse/midwivo..;s Three da;ys nutritional training for local mother

1953-1963 ,-

14 10 0 0 24 56 44 261 600

llOO

405 509 358

288

549 150 495 600

2.2

Supervision

The number of supervisory visits paid to health stations by the MCH staff is gi ven below:

1963 Number of health stations visited Number of visits to these health statior.s Number of stationsvisited j oi!1tly by MCH stp..ff Number of visits to milk bar Supervisor of PPH work at health station 5

1953-1963 347 1053 83 174 428 1963 Total Attendance

5 2

84 230 duri~

2.3

Activities in the demonstration clinics and areas New cases Antenatal Post-natal Child health conference Mother's class ChiJ.cl<'crc.ft Pre-pregnancy health

Old c&ses

543 261 762

1553 1003 1146

2106 163 644 1908

1264

•

- 3 -

New Cases Immunization D.P. 342 (1st shot) D1 (D.P. Booster) D2 (D. Toxoid) 16 (1st shot) Cholera Measles: study 2 study 3 Blood collected for S.T.S. Home deliveries 232 (2nd shot)

Old Cases 111

Total Attendance 685 139 33 10 970 195 235 542 10 189 117 171 566 838 1

(completed)

17 (2nd shot)

Home visits Antenatal Post-natal Newborn Infant Pre-school children Schoolchildren Venereal disease patient Follow-up of measles vaccination Survey.of measles epidemic Field trip 3. 3.1 DIPHTHERIA-PERTUSSIS IMMUNIZATION PROJECT

34 6 847 691 778

Plan of operations

Under the revised plan of operations children from 6 to 24 months of age are to be immunized with three injections of DP combined vaccine, and children between 3 and 4 years of age who had previously completed three injections of DP are to be immunized with one booster injection of 0.5 cc diphtheria toxoid. 3.2 Production of vaccine

During the fiscal year 1963, 571 000 person/doses of DP combined vaccine and 30 000 person/doses of diphtheria toxoid were produced. 3.3 3.3.1 Mass immunization project DP combined vaccine immunization

This project has been carried out on a caznpaign basis with approximately six months being spent on one campaign. During this fiscal year, the 13th campaign was completed and the 14th and 15th campaigns are now in progress. The number of children who received DP combined vaccine is given below:

- 4 -

No. of No. received No. received No. received No. received campaign 1st injection 2nd injection 3rd injection booster inj. 13th 14th 15th 156 625 175 308 6 512 145 912 139 228 16 751 134 247 108 384 1 020 120 276 126 361

Date July 1962-June 1963

" "

Morbidity and mortality of diphtheria The monthly figures of cases and deaths during the recent year are shown in the following tables: Incidence of diphtheria: Jan. Feb. Mar. 38 1963 1962 96 1961 72 Five year 148 median (1958-1962 ) 33 44 31 84 30 54 37 79 ~r. Ma~

,-

Jun. Jul. AuS' SeE' Oct. Nov. Dec. 26 9 12

Total 446 511

19 22

11 8 11

22 59

45

30

6 13 28 24 33 47

9 35 73 77 30 63 67 114 86 111 108 113

Deaths of diphtheria: Jan. Feb. Mar. A"li.r. Mal Jun. Jul. Aug .. SeE' Oct. Nov. Dec. 1963 1962 1961 Five year median (1958.1962) 4. 4.1 14 8 16 Total 45 55 i

5

6

7 3 7

4 4 2 10

3 1

4 1

5

3

2 1 2 4

1 5 5

2

3 3

2 3 5

4 6 11

3 8 13

6 14 14

VENEREAL DISEASE CONTROL PROJECT Case. finding and treatment B,y Health Centres

By Hospitals 45 091 4 000(8.7%) 2 039(4.4%) 196 1 109(60.1%)

No. No. No. No. No.

of of of of of

STS (new cases) reactors cases requiring treatment: cases transferred cases treated

487 922 20 312(4.2%) 16 744(3.~~) 669 12 532(77.8%)

In addition to the STS taken from new cases by government health and medical service units, 11 800 blood specimens were collected by private doctors and sent to the local laboratories through the health stations.

- 5 -

Eleven thousand five hundred and ninety-nine cases were periodically examined and 6061 cases required re-treatment. Three thousand one hundred and sixty-nine cases of gonorrhea were diagnosed and treated, and 1180 cases of other venereal diseases were treated at government service units. The cwnulati ve total of STS taken from new cases by government health and medical agencies from September 1953 to June 1963 is 4 626 104. 4.2 Venereal Disease Demonstration Clinic

-

'1"--

Five thousand six hundred and sixty-nine new cases were seen at the Venereal Disease Demonstration Clinic and 890 cases (15.7%) were diagnosed as syphilis, 456 cases as gonorrhea and 983 as other venereal diseases. 4.3 Reference Laboratory The major activities were as follows: (i ) routine performance of STS New cases: Re-tests Axmy

No. of STS: No. of STS: No. of STS:

8 030 No. of reactors: 736 No. of reactors: 1 268 No. of reactors:

580( 7.2%) l63(22.l~)

88(

6.9%)

(ii) (iii) (i v) ( v)

training of local laboratory technicians; supervision of 22 local laboratories; co-operation with the Venereal Di sease Demonstration Clinic in performing G.C. culture; experiment on tissue culture of treponema pallidum in rabbit testicles; serologic evaluation survey of 22 local laboratories; participation in the Serologic Evaluation Study sponsored by the Venereal Disease Research Laboratory of the United states Public Health Service.

(vi) (vii)

5. 5.1

ENVIRONMENTAL SANITATION PROJECT Improved drinking water in the rural areas (1) (2) seven village water works (total design population 14 318) have been completed; the construction of 198 deep wells, 314 shallow wells and the reconstruction of 365 existing wells in villages with cholera cases last year was also completed.

J

-6 5.2 Waste disposal

1 j

(1) general survey of refUse and night sctl disposal in Taiwan Province; (2)

establishment of refUse composting plant in Hualien (20 tons/day completed 80%); construction of a night soil pasteurization station in Chai-yi City (120 tonS/day); demonstration of gasification of organic refUse in the rural area for waste disposal.

(3) (4)

5.3

Food .sanitation (1) The cor::.struction of KU:.•3-Kuan Demor.~tre.tion Market- wc.e

completed. (2)

The Institute of Environmental Sanitation (IES) began the routine examination of raw milk in the Northern Dairy Farms Sanitation Centre. With the co-operation of the Joint Commission on Rural neconstruction and the Taipei County Government, 43 dairy farmers of Taipei Hsien have been selected to take part in an improved sanitation project in order to reduce the bacterial count in raw milk.

(3)

5.4

Rural sanitation improvement

(1) Lromotion of private latrine construction: 2471 were completed in those villages which had cholera cases last year.

(2)

Demonstration area: the drainage system and pig pen construction in two demonstration areas, Shen-Kang and Lun-ching, were completc~.

(3) The water supply and sewage disposal in local health bureaux and stations were improvedj the design and preparation of a list of equipment for a water supply and sewage disposal system in 96 health bureaux and stations were completed.

5.5

Industrial hygiene (1)

Demonstration of hookworm control (a)

Coal Mine Shih Ti Coal Mine Ching Tong Coal Mine

Workers 1 100

Families 1300 250

350

- 7 -

rate of reduction in hookworm infection Shi Ti Coal Mine Ching Tong Coal Mine (2) 42.2% to 11.9% 41.5% to 11. 3%

j,n industrial hygiene survey was made of factories in Taipei Hsien, Taipei City) Taoyuan Hsien, Miao-li Hsien, Yi-lan Hsien, Keelung City, Taichung Hsien and ,City, totalling 50 plants. Three thousand and forty-seven workers were medically examined.

(3) 5.6

Training (1) Sanitarian training: with the financial and technical assistance of WHO and UNICEF, the 46th sanitarian class, which lasts for a period of three months, started on 17 June 1963 with 29 trainees. Industrial hygiene and safety inspector training: eleven classes in industrial hygiene and safety inspector training, each of which lasted for a period of two weeks, have been conducted in Taipei and Kaohsiung Districts this year with a total of 385 graduates. Third country training: seven sanitation workers from Thailand, six from Okinawa, and four from Korea received training from the IES. ~uality

(2)

(3)

5.7

Water

control

Twenty one thousand eight hundred and thirty-five water samples from 227 distribution systems were examined by the lES between July 1962 and June 1963; 96.10% were considered of good ~uality and safe for drinking. One thousand three hundred and fifty-seven samples from public and private wells were examined by the local health bureaux; 43.47% of the samples were condemned as unsuitable for drinking purposes. The pollution of Keelung river, Tang-shui river and Hsin-tien Creek near Taipei was surveyed and 996 samples from 180 sampling points along these rivers were taken and analyzed physically, chemically and bacteriologically. The Biochemical Oxygen Demand was as follows: Hsin-tien riv.er Maximum parts per million Average parts per million Minimum :part s per million 137.20 13.64 0.4 Tang-shui riv.er 810.50 198.13 0.9 Keelung river 260.50 22.12 0.60

'.,.

- 8 -

This indicates that Tang-shui river is most seriously polluted and the need for sanitary improvement is very urgent.

5.8

Vector control (1) The intestinal parasite infection rate was surveyed in the inhabitants of eleven environmental sanitation demonstration villages.

(2) The stools of persons working in the Taiwan coal mines were ex~mined with flotation and stoll's dilution eggcount technique, both quaJitati ve and quanti tati ve, for hookworm. (3) Experiments on fly baiting were carried out in Hsinchi village, Yin-lin Hsien.

(4) Fly control was introduced in Pingtung compost pl.a.Lt. (5) Experiments were made on cockroaches with DDVP baiting.

5.9

Air pollution study (1) A~ air pollution survey covering 20 stations was

carried out in Taipei, Keelung and Kaohsiung. (2) A survey was made of the effect of radioactive fallout in food, rain, and drinking water.

6.

~CHOMA CONTROL PROJECT

6.1

School mass campaign

Approximately 97% of the 1 972 548 primary schoolchildren were examined, and 16.6% were diagnosed as having active trachoma. Over 99% of the cases requiring treatment received one course of intermittent treatment at school.

r , Grade Examined No.

- 9 -

School Ma.i3s Campaign 1962-1963 Clinical Findings Active Tr. No. Tr. D No. 676~ '-

N. D. No.

Requiring treatment

%

%

%

No.

%

1 2 3 4 5 6 Total

366437 342446 316729 302464 300790 280238

65612 17.9 57507 16.8

1.8 24325 6.6 96704 26.4 1.6 20282 5.9 83161 24.3

537~

51907 16.4 502C 1.6 18011 5.7 74938 23.6 48142 15.9 471] 1.6 17028 5.6 69881 23.1 48293 16.0 4505 1.5 16616 5.5 69418 23.1 45458 16.2 427E 1.5 15613 5.6 65349 23.3

1909104 316919 16.6 3065_ 1.6 111879 5.9 459451 24.1

6.2

Community control programme

One hundred eighty nine thousand one hundred and sixty households in the communities of low and medium trachoma prevalence rate included in the first year of operations have been examined. This represents a coverage of 1 078 400 persons; 568 004 persons were found to require treatment. They are at present under treatment in their homes and are being supervised by the community workers especially recruited for the purpose.

.

As Peng-hu Islands have a high trachoma prevalence rate, they have been subjected to mass treatment without a prior case-finding examination; 8054 households comprising 40 969 persons are.under heme treatment. ,....... )

One hundred and fifty-four community examiners and 259 community workers have received training.

6.3

Clinical trials

In an attempt to assess the relative merits of erythromycin and eye Ointment, 2316 trachomatous schoolchildren have been divided at random into four groups. The following treatment regimens were allocated, again at random: tetra~cline

(4)

(1) (2) (3)

tetracycline two applications per day; erythromycin two applications per day; erythromycin one application per day; control (no treatment).

The treatment groups follow the intermittent schedule.

- 10 -

7. 7.1

MENTAL HEALTH PROJECT Training of mental health personnel

Considerable attention has been given to the training of psychia.tri.c personnel at the Kaohsiung Mental Hospita~ by assigning one senior psychiatrist and one junior psychiatrist to the hospital for a period of one year for intensive training, in order to make this hospital a mental health centre for southern Taiwan. 7.2 Teaching of psychiatry and mental health

Twe more colleges have been added to the already long list of teaching activities: teaching of psychiatry at the Kaohsiung Medical School and teaching of social case work at the Department of Sociology, National Taiwan University.

7.3

Psychiatric services

The number of cases treated at the Taipei Children's Mental Health Centre has shown a 50 per cent increase in the last half- year. This may be regarded as indicative of the more enlighted public. attitude to mental health.

7.4

Community mental health (a) Public health and mental health In addition to the mobile clinic attached to the Taoyuan Public Health Centr~two more important activities have taken place • a child health conference at the Public Health Teaching and Demonstration Centre and a mental health conference at the MCH Institute in Taichung. In both conferences the mental health team has taken an active role in integrating mental health into public health practice through actual case discussion and lectures. (b) School mental health Ten primary schools and fourteen secondary schools in Taipei and Taoyuan are now included in the active school mental health programme, in which emphasis is laid upon the teaching of mental health principles to the teachers for the purpose of orientating them to the personality aspects of schoolchildren and to their role in preventing behaviour problems. This special class for mentally retarded has begun to receive the support of the education authorities and the community in general and plans to start a course to train more teachers with a view to expanding this work. \

7.5

Research

Th~ fifteen-year follow-up epidemiological survey of the rural, smalltown and urban communities has been completed and the data are

r

- 11 -

now being processed for analysis. Active research activities are in progress on many mental health subjects connected with the Chinese culture.

8. 8.1

MALARIA ERADICATION PROJECT

14alaria surveillance

During the year, the province was divided into four areas and various surveillance measures were applied in varying intensity according to the epidemiological malaria potentiality of each area. In order to provide geographically unbiased and chronologically continuous information for the certification of malaria eradication, it is necessary to supplement the present surveillance se~ by establishing a passive case detection system which keeps a continuous vigilance over the whole province. Up to the end of the reporting period, 245 rural malaria working groups and 315 township malaria vigilance units (altogether about 5000 voluntary collaborators in both categories) had been progressively organized to participate in the case detection activities.

Altogether, 602 086 bloodsmears were examined and 40 parasite carriers were detected; the positive cases were found in the 335 228 bloodsmears collected through active case detection, 16 positives in the 222 973 bloodsmears collected through passive case detection, and 43 885 bloodsmears with 10 positives as a result of the epidemiological and follow-up investigations of the confirmed malaria cases. The blood examination rate was 5.39% on an average, or 468.25% in active foci, 61.11% in the potential foci, 29.34% in the formerly hyperendemic area and 2.02% in the non-malarious area. Among 40 carriers, 15 cases (37.5%) were infected with P. malariae, 24 cases (60.0%), with P. vivax, one case (2.5%) with ~. faiciparum and none of mixed infection.- Gametocytes were found in 22 cases. As many as 22 cases were classified as indigenous, 9 relapsing, 8 imported, one induced and none of not ascertained. Tbey were distributed in 35 families located in 29 villages of 24 townships in 13 countries.

8.2

Discovery and control of malaria transmission foci

During the year, two more new foci of transmission were discovered, one at Chang-chih, Pingtung County (9 vivax infections) in September 1962 and the other at Feng-pin, Hua.-lien County (5 malariae infections) in November 1962. Malaria transmission had been eliminated in all the existing foci up to the end of December 1962.

8.3

EntomolOgical vigilance

A systematic monthly anopheline survey was continued at the fixed stations and supplemented by seasonal anopheline survey at other places. In general the population of the main vector, Anopheles minimus, has remained very low compared with the pre-spraying days.

· - 12 -

,

8.4

Residual-insecticide house-sprayin6

Focal sprayiag was carried out once every four months in active malaria fOCi; a total of 1566 structures occupied by 15 355 people were directly covered by the spraying. 8.5 Surveillance of imported rnalaria

The prevention of introduced infection from imported malaria has become increasingly important. Twenty-one cases* of relapsing vivax infection were found among 4392 evacuees from the Sino-Burmese borderland in March-June 1961 through follow-up investigations. Re-treatment , of all the evacuees with chloroquine and primaquine in a full therapeutic course (~4 days) was carried out during April-June 1963. In addition, 842 refugees from Mainland China came to the province through Hong Kong during the year; three were found to be infected with E. vi vax.

'-

-

*These cases are not included in the number of case indicated in the 3rd paragraph of item 8.1.

JAPAN

v

Report on the Progress of Health Activities for the Fiscal Year 1962 (April 1962 - March 1963) 1.

ORGANIZATION OF NATIONAL AND LOCAL HEALTH ADMINISTRATION

There were no changes in the organization of the Ministry of Health and Welfare during the period under review as far as the health service is concerned. The prefectural and municipal health centres continued to carry out their routine functions as local community health service agencies. There were 808 health centres throughout Japan at the end of M3.rch 1963. 2. VITAL STATISTICS

The estimated population was 95 178 000 on 1 October 1962. The following table gives some of the vital statistics data for 1962 with a comparison with 1961. 1961 Births: Number Rate (per 1000 population) 1962

.......................... ...... ..........................

1 616 005 1 589 372 16.9 17·0 695 644 7.4 45 465 28.6 1 914 12.0 179 895 101.7 710 022 7·5 42 784 26.5 1 794 11.1 177 254 98.8

Deaths: Number Rate (per 1000 population) Infant deaths:

......

Number •.••.•••••••••••••..••••••

Rate (per 10 000 total births)

I~ ',,:,-

Maternal deaths: Number ....••...••...••.••..••••.

Rate (per 10 000 total births) still-births: Number •••.•.•.••.•••..•.••..••..

Rate (per 1000 total births)

....

The average life expectancy at birth for the Japanese people, prepared on the basis of the 1961 data, indicates 66.0 years for males and 70.8 years for females; the comparable figures for the previous year being 65.4 years for males and 70.3 years for females.

3.

MATERNAL AND CHILD HEALTH

During the calendar year 1962, 769 927 visits were made to the clinics by mothers and 4 807 449 by children. Public health nurses paid 206 234 home visits on mothers and 873 178 on children.

At the end of March 1963, there were 227 maternal and child health centres in the rural areas. During the calendar year 1962 , 74 332 premature births were reported, indicating an increase of 8168 co~ared with 1961.

4.

TUBERCULOSIS CONTROL

In the calendar year 1962, the number of deaths from tuberculosis decreased further, there being only 27 782 (rate: 29.2 per 100 000 population). During 1962, 39 380 000 persons (37 093 000 persons for 1961) received a health examination for case-finding purposes. AJOOng them, 34 CJ70 000 (31 808 000 for 1961) were exa.m:Lned by photof1uoro.. graphy. The case-finding rate for 1962 was 0.27% (0.34% for 1961). AJOOng those tuberculin negative, 5 412 000 were vaccinated with BCG.

j

The total number of registered tuberculous patients at the end of 1962 was 1 544 277 (16.1 per 1000 population), 62.4% of which were active cases; 25.9% of the active cases were hospitalized, 54.7% were under domiciliary treatment, 14. 5% did not receive co~lete medical treatment and the remaining 4.8% cannot be traced. During the same period, 383 773 cases were newly registered. In 1961, the total expenditure on tuberculosis treatment was estimated to be 81 billion yen (71 billion yen for 1960). This is equivalent to 14.8% (16. 7~ for 1960) of the total expend!ture on medical care for all kinds of illness. During 1962, tuberculosis treatment was given in 67 800 medical establishments, including hospitals and dispensaries. At the end of 1962, there were 241 305 beds allocated to tuberculosis patients and the bed occupancy rate was 8C1'/o.

5.

COlotIDNICABLE DISEASE CONTROL

The number of persons who received immunization during the calendar year 1962 was as follows: 3 702 000 for smaJ.lpox; 20 l84 000 for typhoid and parat)'phoid fever; 2 483 000 for diphtheriaj 100 000 for whooping cough,; 3 670 000 for diphtheria-whooping cough combilled,; 11 000 for epidemic typhus and 2 824 000 for #poliomyel1tis (k:f.lled vaccine) •

During the reporting period, Japan has remained free from the quarantinable diseases (an account of the imported cholera cases is given in the next paragraph), and in 1962 there was a marked decrease in mst of the other acute communicable diseases. As shown in the following table, the incidence of poliomyelitis was dramatically reduced after the successful oral administration (July - September 1961) of Sabin type virus vaccine (13 million doses) to.all children in the age group from three months - six years and most of those from six to ten years of age. So far, this situation has been maintained with only 289 cases being reported for the whole calendar period 1962. This is about 1/12 compared with the corresponding figure s in 1961.

- 3 Number of cases Period January - July ................

1960 2256

1961 1933 384

1962 164 32

August

........................ 1031 September - December .......... sm Total .................... 5606

.1d:2. 2436

--22. 289

";»

Mass vaccination against influenza was carried out during the autumn season of 1962 for almost all children in the kindergartens, primary schools and junior high schools. No epidemic of influenza was reported, and no influenza virus was isolated during the period, October 1962 - June 1963.

6.

INTERNATIONAL QUARANTINE

During the calendar year 1962, 19 515 vessels and 6951 aircraft, involving 999 199 and 407 806 persons, respectively, were subjected to quarantine inspection; 128 462 persons received preventive vaccinations for quarantinable diseases, 1065 vessels underwent deratting and 3755 vessels received deratting exemption certificates. Since January 1962, Japan has strengthened the quarantine measures against cholera El Tor which was then prevalent in the Philippines, with the belief that this disease should be included in the term of cholera under the International Sanitary Regulations. In the case of the epidemic of cholera in Hong Kong and China (Taiwan) from July to September 1962, forty cholera carriers including three cases (which were the ~rted cases) were detected on seven ships upon their arrival at Japanese ports. However, it was possible to prevent the introduction of the disease into Japan because of the rigid quarantine measures.

7.

ENVIRONMENTAL SANITATION At the end of March 1962, a population of 53 952 461 (about

57.2!{0 of the total population) was covered by some kind of public water supply. At the end of March 1963, there were 51 cities operating sewage treatment plants and a population of 7 000 000 benefitted from these services. At the end of December 1962, there were 227 cities operating night-soil disposal plants. A population of 24 352 000 was covered by a garbage disposal programme, either by incineration or compo sting methods. The insect and rodent control programme, supported by the community organizations, has been continued. A slight increase of performance in sanitary and food inspection was indicated compared with the previous yea,r.

- 4 .. Under the stream Pollution Control Law, three control water zones were deSignated and effluent quality standards for these zones were issued. A new Smoke Control Law was enacted in December 1962 in order to cope with the air pollution problems.

8.

NUl'RITION

At the end of ltU'ch 1963, there were 132 authorized nutritionist training schools and about 60 000 licensed nutritionists. According to the 1962 nutrition survey, the nutrient intake per capita per day as cODg?ared with that of the previous year is as follows: anima] protein 8.3% increase, fats 8.4% increase, vitamin A 5.1% increase and vitamin ~ 5.8% increase. As to the intake classified by foodstuff, the improvement in the nutrition of the people has been remarkable cODg?ared with that of the previous year. For example, there was an 18.5% increase in the consumption of milk and milk products, 20.8% in eggs, 32 .4% in meat and 15.2% in fats and oil. The same can be said for rice consumption, there being a 3.2% increase, although the tendency to rely on rice is still strong among the Japanese people I thus constituting a factor in vitamin Bl deficiency.

9.

DENTAL HEALTH

One hundred and fifteen out of the 808 health centres in Japan (at the end of March 1963) are equipped with dental facilities and dentists, and are playing an important role in the preventive dental health programme. During 1962, 316 412 dental health guidance consultations were given to pregnant women and 900 469 consultations to children. 10. MENTAL HEALTH

continuous efforts were maintained for the betterment of the mental health programme during 1962 including care for the mental cases. The number of mental hospitals, mental beds, etc. at the end of J'lme 1962 as compared with the same date in 1961 is sho'Wll below: 1961 !ental hospitals 1962 561 293 112 149 123 185 10)

.............

520

Units in general hospitals ••• (not investigated) Mantal beds In..patients

.................. ..................

99 332

101265 108.0

Bed occ\lP&.n.cy ••••••••••••••••

, • - 5The facilities for mental health guidance at the end of March 1963 were as follows: Number Mental health centres Child welfare centres Home s for mentally retarded children Mentally retarded children Day care centres National Home for Mentally Retarded Children Prefectural mentally retarded persons consultation centres Home s for mentally retarded persons Home for training and education of juvenile delinquents 11. MEDICAL SERVICE

.

Administered under M:!ntal Health Law Child Welfare Law Child Welfare Law Child Welfare Law Child Welfare Law Law for the Welfare of M9ntally Retarded Persons Law for the Welfare of M9ntally Reta.rded Persons

47 prefectural and 6 municipal 138 1 6 5 (10 585 inmates) 43 (1700 children) 1 (125 children) 46

2 national (250 children) 56 local (5831 children)

Child Welfare Law

At the end of the ca.lendar year 1962, there were 6428 hospitals (6229 for 1961) with a total bed capacity of 752 714 (716 372 for 1961), showing an increase of 199 hospitals and 36 342 beds c~ed with 1961. As of the same date, there were 61 366 general clinics (60 301 for 1961) and 27 488 dental clinics (27 263 for 1961), showing an increase of 1065 general clinics and 225 dental clinics. As of the same date, there were 105 437 physicians (11.1 per 10 000 population), 34 163 dentists (3.6 per 10 000 population), 62 645 pharmacists (6.6 per 10 000 population) and 204 394 nurses (21.5 per 10 000 populat.ion). This means an increase of 2437 physicians, 1163 dentists, 2645 pharmaCists and 18 394 nurses. 12. PHARMACEUTICAL CONTROL

During the calendar year 1962, 1954 pharmaceutical inspectors visited 201 664 out of an estimated 370 000 establishments, such as the drug and medical supply manufact.urers and pharmacies. A control was also maintained over ampheteJnine preparations and narcotics.

.. 6 .. 13. INTERNATIONAL CO-OPERATION IN THE HEALTH PROGRAMME

During the calendar year 1962, the Government extended its services and co-operation in connection with the international health progra.tnne, and :z::eceived and trained twenty.. seven WHO fellows, one TAO fellow, eleven US/AID trainees and one Colombo Plan trainee. It also released twelve experts to work with the Colombo Plan and one expert to work with the Middle and Near East and African Teclmical Assistance Programme s . The Ministry of Health and Welfare acted as host to the WHO Seminar on Japanese Encephalitis and other Arbovirus Infections which was held in Tokyo during the period 5...14 November 1962.

•

I

A Brief Report on Public Health Administration in Japan 1963 (January 1962 ~

July 1963)

.... .With Pertinent Informations on Social Welfare and Insurance Program

.---

Ministry of Health and Welfare Japanese Government

1 August 1963

L

CONTENTS

I

Chapter Page 1. Organization of National Health Administration· .. ············· ................................... 1 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. Main Laws under the Jurisdiction of the Ministry of Health & Welfare··············· 3 Finance of the Ministry of Health & Welfare····················································.· 5 Organization of Local Health Administration .. ··········· ......................................... 5 Health Center······················.· ........................................................................... 5 Population············.................... ................................................................ ........ 7 Vital Statistics·· ................................................................................................ 9 Life Tables in Japan·················· .. ··················.··.···.· ................. · ..................... ·13 Deaths by Leading Causes················································································ ·15 Maternal and Child Health·················································································17 Family Planning···················.· ....... ··· .............................................................. ·19 Health Education················· .................................................................. ···········20 Tuberculosis Control· ...................................................................................... ··20 Adult Disease Control······················································································ ·23 Communicable Disease Control· ......................................................................... ·25 Port Quarantine Service··················································································· ·31 Environmental Sanitation ............................................................................... ··32 Nutrition········································································································ ·37 Dental Health·································································································· ·38 Mental Health················ ..................................................... ·····························39 Rehabilitation Service······················································································ ·42 Radioactive Isotope and Peaceful Use of Atomic Energy·· ....... ······· .. ··················43 Occupational Health························································································· ·44 Medical Service ................................................................. ·.· .. ··················· .. ·····44 Pharmaceutical Affairs······················································································ ·49 Major Research and Training Institutes in Public Health Programs· .. ··················52 International Cooperation on Health Programs·················· .··.··.··························54 Public Assistance, Child Welfare and Social Insurances································ .. ···· ·54

1. Organization of National Health Administration The chart below shows the organizational structure of the national health and welfare administration in Japan as of 1 August 1963. The idea of close coordination among the fields of preventive medicine, medical care, social welfare and social insurance is maintained. The Public Health Bureau, Environmental Sanitation Bureau, Medical Affairs Bureau, Pharmaceutical and Supply Bureau, Maternal and Child Health Section of the Children's Bureau, Rehabilitation Section of the Social Affairs Bureau, and the Health and Welfare Statistics Division, of the Ministry of Health and Welfare, share responsibilities on planning national health policy and programs in the field of preventive medicine, environmental sanitation, medical care, pharmaceutical control, maternal and child health, and social health, respectively. These Bureaus direct the health programs by giving orders to the 46 local prefectural governments. On July 1, 1962, the Social Insurance Agency was newly established· in the Ministry to manage out-door service of social insurance and national pension. As a result, the Insurance Bureau and the Pension Bureau underwent some re-organization. Some changes were also made in the Repatriation Bureau, and, the Recreation Facilities Section was newly created in the National Parks Division on the same date. On April 1, 1963, the Food Chemistry Section was established in the Environmental Sanitation Bureau by absorbing such functions related to food chemistry which were used to be handled in the Food Sanitation Section. On the same date, the Offices of the Counsellors for Nursing Affairs and for Dental Affairs in the Medical Affairs Bureau were changed to the Nursing Section and Dental Health Section, respectively. The Narcotic Section in the Pharmaceutical and Supply Bureau was divided into two sections on the same date, and they were named as the First Narcotic Section and the Second Narcotic Section. r

-

Minister's Secretariat

--Personnel Affairs Section General Affairs Section Accounts Section Office of the Personnel Welfare Ofiicer Office of the Program Evaluation and Planning Office of the Counsellor for Liaison in International Affairs --Office of the Counsellor for Scientific and Technical Affairs -Administration Section Vital Statistics Section Health & Welfare Health Statistics Section -- Statistics Division Social Statistics Section Mechanical Counting Section -Office of the Statistical Investigator -

National Parks I-Administration Section Division - - - Planning Section -Recreation Facilities Section -Planning Section Nutrition Section Health Center Section -Public Health B u r e a u - - - - - - - - - Tuberculosis Prevention Section Communicable Disease Control Section Mental Health Section -Quarantine Section -Environmental Sanitation Section Sanitation Facilities Section Water·Works Section --Environmental Sanitation Bureau Food Sanitation Section Veterinary Sanitation Section (Con'd) -Food Chemistry Section

-2-General Affairs Section Medical Affairs Section Hospital Guidance Section Management Section -Medical Affairs Bureau National Hospital Section National Sanatorium Section Supplies and Equipment Section Nursing Section I-Dental Health Section -Enterprise Section Pharmaceutical Affairs Section Drug Manufacturing Section Pharmaceutical & Supply Bureau---- I Inspection Section Biologics and Antibiotics Section First Narcotic Section -Second Narcotic Section -General Affairs Section Public Assistance Section Rehabilitation Section -Social Affairs Bureau - - Life Improvement Section Institution Section Office of the Counsellor for the Investigation of Daily Life Security Law -Planning Section Child Protection Section -Children's Bureau - - - Maternal and Child Welfare Section -Maternal and Child Health Section -Planning Section Health Insurance Section -Insurance Bureau - - - - I National Health Insurance Section Medical Care Section -Acturial Research Affairs Section -Planning Section 'B Pension Section P - enslOn ureau Pension Fund Operation Section -Acturial Affairs Section -General Affairs Section Bereaved Families Relief Section Demobilization Section -Repatriation Bureau - - - First Pension Affairs Section First Allowance Screening Section Second Pension Affairs Section Second Allowance Screening Section -Investigation Section

I

----I

-Director's Secretariat _ _ I-Genera~ Affairs, Section -InspectIOn SectIOn

Soci~g~~~u;ance_

-

M d' I C I--Health Insurance Section e ~~~ura~~e Division-- _ ~:li:r~sp~~~~~~nf~s~:~~~: Section

-National Pension Section -Pension Insurance--- Welfare Pension Section I -Accounting Section Division -Institute of Population Problems Institute of Public Health National Institute of Mental Health National Institute of Nutrition National Institute of Health Port Quarantine Offices National Hospitals National Sanatoria National Institute of Hospital Administration National Institute of Leprosy Research Affiliated Institutions- National Cancer Center National Institute of Hygienic Sciences National Homes for the Blind National Rehabilitation Center for the Physically Handicapped National Rehabilitation Center for the Deaf and Mute National Recuperation Homes National Homes for the Juvenile Training and Education National Home for Mentally Retarded Children

3 -

I-Social Insurance Appeals Committee -Social Insurance Service Training Institute LIB h Offi I-Regional Branch Offices of Medical Affairs Bureau oca ranc ces- -Regional Narcotic Investigators' Offices

2. Main Laws under the Jurisdiction of the Ministry of Health & Welfare 1. Laws on Administration: Health Center Law (1947) Ministry of Health & Welfare Establishment Law (1949) Laws on Preventive Medicine: Communicable Disease Prevention Law (1897) Leprosy Prevention Law (1907) Trachoma Prevention Law (1919) Parasitosis Prevention Law (1931) Venereal Disease Prevention Law (1948) Preventive Vaccination Law (1948) Rabies Prevention Law (1950) Quarantine Law (1951) Tuberculosis Control Law (1951) Laws on Environmental Sanitation: Natural Park Law (1931) Friseur Artists Law (1947) Food Sanitation Law (1947) Entertainment Facilities Law (1948) Public Bath House Law (1948) Hotel Business Law (1948) Law Relating to Processing Plants of Dead Animals and Others (1948) Law Regarding Graveyards, Burial and Others (1948) Cleaning Business Law (1950) Slaughter House Law (1953) Wastes Disposal Law (1954) Beauty Artists Law (1957) Water-Works Law (1957) Law Concerning Improved Management of Business Dealing with Sanitation (1957) Sewerages Law (1958) Water Pollution Control Law (1958) Law for Cooks (1958) Smoke Control Law (1962) Laws on Health Statistics: Regulations Regarding Declaration of Still-birth (1946) Ordinance Regarding Vital Statistics (1946) Other Laws on Public Health: Nutritionists Law (1948) Eugenics and Maternal Protection Law (1948) Mental Health Law (1950)

2.

3.

..

4.

5.

-

4

6.

7.

Nutrition Improvement Law (1952) Law for Loan of Scholarship for Studies in Public Health (1957) Law for Health Protection and Medical Security for A-Bomb Explosion Sufferers (1957) Law for Health Laboratory Technicians (1958) Laws on Medical Care: Law for Masseurs, Acupuncturists, Moxa-cauterists and Judo-orthopaedists (1947) Medical Service Law (1948) Medical Practitioners Law (1948) Dentists Law (1948) Dental Hygienists Law (1948) Public Health Nurse, Midwife and Nurse Law (1948) Law for Dissection and Preservation of Dead Body (1949) Law for Medical X-Ray Technicians (1951) Law for Dental Technique (1955) Cornea Transplantation Law (1958) Law for Medical Care Facilities Finance Corpxation (1960) Laws on Pharmaceutical Affairs: Law for the Control of Poisonous and Powerful Agents (1950) Awakening Drug Control Law (1951) Narcotic Control Law (1953) Taima (Marihuana) Control Law (1953) Opium Law (1954) Bleeding and Blood Donor Supply Service Control Law (1956) Pharmaceutical Affairs Law (1960) Pharmacists Law (1960) Laws on Social Welfare: Child Welfare Law (1947) Disaster Relief Law (1947) Welfare Commissioners Law (1948) Consumers' Livelihood Cooperative Association Law (1948) Law for the Welfare of Disabled Persons (1949) Daily Life Security Law (1950) Social Welfare Service Law (1951) Law for the Loan etc. of Welfare Funds for Mothers and Children (1952) Law for the Welfare of Mentally Retarded Persons (1960) Law for the Welfare of the Aged (1963) Laws on Social Insurance: Health Insurance Law (1922) National Health Insurance Law (1938) Seamens' Insurance Law (1939) Welfare Pension Insurance Law (1941) Social Insurance Medical Fee Payment Fund Law (1948) Health Insurance Law for Daily Workers (1953) National Pension Law (1959)

,

8.

9.

__ 0

5

0--

3. Finance of the Ministry of Health & Welfare Annual budget of the Ministry is shown in the following table as compared with the total national government expenditures. Our fiscal year covers the period from April 1 through March 31 the following year. Table 1. Budgetary Expenditure of the Ministry as Compared with the Total Expenditures of All National Government Agencies. Fiscal Year __ 0

Expenditure of All National Government Agencies Million Yen

Expenditure of Ministry of Health & Welfare Amount Million Yen \

Percentage

~-

1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963

925,536 1,027,251 999,880 1,013,300 1,034,900 1, 137,465 1,312,131 1, 419, 248 1, 569, 675 1,952,771 2,426,801 2,850,008

72,128 73,176 83,816 84,613 90,317 101,462 107,258 130,543 164,715 227,625 272,329 331,309

% 7.8 7.1 8.4 8.4 8.7 8.9 8.2 9.2 10.5 11. 7 11. 2 11. 6

4. Organization of Local Health Administration Each prefectural government and larger municipal government have their own health departments in order to carry out their health programs in compliance with the national policies and programs directed by the Ministry of Health & Welfare. These prefectural and municipal governments divide their administrative boundaries into several "health center districts," and the local health center is established in each one of those districts. For the reason of geographical conditions, most of the health centers have their branch health units within their health center districts. Further details on the health center are described in the following chapter.

5. Health Center Outline The first health center in Japan was established in Tokyo in 1935. Then, in the following year, the Health Center Law was enacted and the lO-year program for health center construction was started. There were 306 health centers in 1943, which increased in number to 770 in 1944 due to the amalgamation of all governmental health consultation agencies. The health center in pre-war days had only health consultation in tuberculosis control, maternal and child health, and maintenance of health of pre· service men. However, in 1947, public health program in this country was reorganized. Accordingly, the Health Center Law was completely revised, and the new health center program started. Legal Basis According to the Health Center Law of 1947, the local government is required to establish the health center, and the national government is responsible to share the cost. 46

-

6 ---

prefectures, and 29 municipalities (one was reduced as of 1 April 1963, because 2 municipalities were amalgamated into a new large municipality), designated by the Cabinet Order, have their own health centers. The director of health center is specified to be the medical doctor by law. The character of health center defined by law is primarily as the community health service agency, and secondarily as the administrative supervising agency based on the power, delegated by the governor or mayor. Number, Standard Scale and Organization

As of the end of 1962 fiscal year, there were 808 active health centers in Japan. According to the changing need for public health administration, the organizational standard of health center was re-examined, and the new standard was effected in April 1960. accordingly, all health centers are now classified by the size of health center district, its population, and its industrial costitution. 4 basic types have been settled, i.e., urban health center, rural health center, urban-rural health center, and health center with small population in big area. These are abbreviated as U, R, UR, L type. As the exceptional type health center, the health center with small population in small area has been classified as S type. According to the new classification, there are 196 U type health centers, 80 UR type health centers, 423 R type health centers, 94 L type health centers and 15 S type health centers. It was reported that the total number of health center personnel subsidized under health center grants was 21,826. This includes 1,746 physicians, 105 dentists, 5,661 public health nurses, 842 nutritionists, 1,845 X-ray technicians, 1,160 laboratory technicians as the main technical personnel. In addition to those, there are also 1, 806 food inspectors, 1, 237 sanitary inspectors, 919 veterinarians for rabies and slaughtering control. Therefore, 25,788 staff are now working in all the health center:>. It is about 31.9 per health center and 27.4 per 100,000 population. Function and Program

The function and program of health center include activities in the different fields. Thus, all community health programs have been integrated into the health center activities. Followings are the basic functions defined by the law: Health education; vital and health statistics; improvement of nutrition and food sanitation; evironmental sanitation; public health nursing; medical social service; laboratory service; prevention of tuberculosis; control of venereal disease and other communicable diseases; maternal and child health; dental hygiene, and other local health program as required, such as endemic disease control, etc. The Table 2 in the next page shows the main health center activities during the year 1962 with comparison for the year 1961. As the routine program, the health consultation clinic, well baby conference, mass chest survey, home visit, community health education, inspection and field supervision on sanitary operation are carried out. The health education is integrated into every phase of routine process.

Table 2. Main Health Center Activities.

7 --

(Jan.~Oec.)

~-~--.

.""

1961 1962 -------------------------i-------;------Total number of health consultation session Inside of health center 243,951 260,578 At district 22,642 22, 756 X-ray examination TB control: 35mm & 6x6 26,322,660 26,395,016 large film 1. 594, 251 1. 619,502 Crippled children: 6 x 6 90,274 96,362 large film 47,453 59,985 Laboratory examination Bacteriological culture for acute notifiable C.O. 4,543,100 4,912,051 Wasserman test 133,421 125,440 Precipitation test (VORL) 1,249,065 1. 136,641 TB bacili culture 246,141 258,740 TB fastness test 81,227 71,290 Health education session Total number of educational session 151,966 150,760 prenatal examination Actual number of examinee 325,955 334,398 Total number of examinee 440,216 426,135 Well baby examination (under 12 M) Actual number of examinee 1. 355, 603 1,310,608 Total number of examinee 2,448,630 2,429,780 Total number of dental examination 1,516,155 1,327,009 Total number of nutrition consultation 1. 397, 642 1. 363, 043 Immunization 10,891,854 16,501. 202 Carrier investigation in dysentery control 4,565,238 4,097,694 Parasite examination 6,729,356 7,444,796 Total number of food establishments inspected by food inspectors 2,878,983 2,836,580 Total labour used for environmental sanitation field work (person-days) 194,533 185,691 Total number of household visited by public health nurses Actual number 1,003,845 1. 027,537 Accumulated number 1,479,098 1. 512, 451

I

Tuberculosis control, insect and rodent control, and maternal and child health promotion are highlight programs. Recently, the community organization process has been extensively developed for performance of all health programs. Finance

The health center is financed by local and national government. The item of national subsidy is divided into 2 categories; one is the health center subsidy based on Health Center Law and the other is the program subsidy based on the respective legislation concerned. According to the Health Center Law, the national government is responsible to share the cost of health center expenditure both recurrent and non-recurrent ones. When the health center is newly established, the national government shares one half of the expenditure for construction and necessary equipments, and it also subsidizes one third of running expenses. Local government pays the rest of expenses. For 1963 fiscal year, the total amount of national health center subsidy is 3,093 million yen. For 1962 fiscal year, it was 2,906 million yen.

6. Population Table 3 in the next page shows the estimated population of Japan by age group and sex as of Oct. 1, 1962, based on the census taken on October 1, 1960 and vital changes thereafter. (Including Japanese nationals and foreigners in Japan). The latest national census taken as of Oct. 1, 1960, revealed that the Japanese population increased to 93,418,501 by that time. However, the rate of population increase for 5 years between 1955 and 1960 censuses was the smallest one ever recorded in the Japanese censuses except the years during the last World War.

Table 3. Population by Age Group and Sex for All Japan. (Estimated on Oct. 1. 1962) Age Groups All Ages Total Thousand 95.178 1.582 1.547 1.573 1.597 1. 540 7.838 8.352 11.066 9.245 8.735 8.280 7.850 6.703 5.210 4.870 4.465 3.674 3.196 2.327 1.659 984 508 Male Thousand 46.744 812 793 804 815 777 4.000 4.253 5.637 4.694 4.352 4.109 3.943 3.204 2.317 2.260 2.115 1.817 1.556 1.102 745 400 179 59 13.890 30.369 2.485 Female Thousand 48.434 770 754 770 782 763 3.838 4.099 5.429 4.550 4.383 4.171 3.907 3.498 2.893 2.609 2.350 1.856 1. 640 1.225 914 585 328 157 13.366 31.859 3.209 26.012

o 1 2

3 4 O~

4

5~

9

10~14 15~19 20~24

25~29 30~34 35~39 40~44 45~49 50~54 55~59 60~64 65~69 70~74 75~79 80~84 85~ 0~14 15~64 65~

~.

216 27.257 62.227 5.694

15~49

Fig. 1.

Population by Age Groups in 1962.

(Estimated on Oct. 1. 1962)

Age

Male

) ~~ 00-84 Dve

85 &

75-7 70-7

Fema Ie

I I L

1 1 J 1 1

I

r

J I

I

1

65-69 60-64

1

55-59

40-44 35-39 30-34 2 5-29 0-24 2 5-19 1 0-14 1

50-54 4 5-49

1 1

I

1 I I

1 1

1

1 1 5,000

5 -9

5,000

0 -4 0 o

"T

I

Thousand Persons

-

9

~

....

7.

Vital Statistics

The nation-wide vital statistics survey has been yearly carried out continuously since 1899 in Japan. However, no reliable data were available for the years from 1944 to 1946 due to the confusion resulting from the last W orld War. Birth Annual Change of Birth Rate. Between 1900 and 1919, the birth rate in Japan was between 30 and 35 per 1,000 population, but it rapidly rose to 36.2 in 1920, which was the highest rate since 1900. But after this peak, it had been declining as the years advanced until 1939 when the rate reached the lowest pClint (26.6), and from about 1940 it again started to rise. This rise has been regarded as being attributable to the Fig. 2. Annual Change of Live Birth Rate. (per 1,000 population) pro-natalist policy supported by the government at that time. During 3 years from 1944 to 1946, the birth rate seems to have been considerably low, judged from various reasons, although no accurate data were available because of the confusion caused by the war. The birth rate in 1947 was abnor- . mally high, showing 34.3, but such an 10 extraordinary rise of birth rate is considered to be due to a sudden increase of postponed marriages and reunited families of the people after the termina- - Year tion of the war. After such an extraordinary rise, the birth rate started to decline rapidly, and reached 17.2 in 1957. This rapid decrease of birth rate may be attributable to the decrease of marriage, the wide spread of contraceptive measures, and the prevalence of artificially induced abortions. However, in 1958 the rate was recorded as 18.0, and a tendency of halting the decline was seen for the first time in the post-war years. The rate has been decreasing since then and reached 16.9 in 1961; the lowest rate ever experienced in Japan. It was 17.0 in 1962. (Refer Table 5 and Fig. 2). Death Annual Change of Death Rate. From 1900 to about 1930, the death rate was around 20 per 1,000 population every year, excepting the high rates of 27.3 and 25.4 in 1918 and 1920 because of the world-wide pandemic of influenza. It kept decreasing in the following years until it became just 16 in 1941 in spite of the war. After the war, the number of deaths Fig. 3. Annual Change of Death Rate. (per 1,000 population)

---'Year

-

10Table 4. Vital Statistics in Japan. (Number) Infant Neo-natall Mater-I . Natural Deaths Deaths nal StJP M<;tr- Divorces Increase (under (under 1 D th 1 births nagesl ea s 1 yr.) 28 days)

ID h Year Population Live Births 1 eat s

I

I

1900 1905 1910 1915 1920 1925 1930 1935 1940 41 42 43 44 1945 46 47 48 49 1950 51 52 53 54 1955 56 57 58 59 1960 61 62

43,847,000 1, 420, 5341 910,7441 509,7901 220,211 46,620,000 1.452,770 1,004,661 49,184,000 1,712,857 1,064,234 448,109 648,623 220,450 276,136 288,634 335,613 297,008 258,703 233, 706 190,509 191, 420 190,897 195,219

112,259 103,382 126,910 125,337 139,681 121, 238 104,101 97,994 81,869 77,829 76,177 76,588

6,2001137,9871346: 528 6,185 142,092 350,898 6,228 157,392 441, 222 6,452 141, 301 445,210 7,158 144,038 546,207 6,309 124,403 521,438 5,681 117,730 506,674 5,698 115,593 556,730 5,070 102,034 666,575 4,929 103,400 791,625 4,586 95,448 679,044 4,542 92,889 743,842 ... ... ...

63,828 60,061 59,432 59,943 55.511 51, 6871 51, 259 48,528 48,556 49,424 46,268 49,705 .. . 1

52,752.000 1,799,326 1,093,7931 705,533 55,963,053 2.025,5641.422,096 59,736,822 2,086,091 1, 210, 706 64,450,005 2,085,101 1, 170,867 603,468 875,385 914,234

69,254,148 2,190,704 1,161,936 1,028,768 71,933,000 2,115,867 1, 186,595 929,272 71,680,200 2,277, 2831 1,149,5591,127,724 72,384,500 2,233,6601,166, 63 1,067,030 72,883,100 2.253,5351,219,0731,034,462 ... ... .., 73,064,300

1

... ...

...

... ... ... 71. 998,100 ... ... ... 73,114,100 78,101,473 2,678,792 1, 138,238 1,540,554 80,002,500 2,681,624 950,610 1,731. 014 81,772,600 2,696,638 945,444 1. 751,194 83,199,637 2,337,507 84,573,000 2,137,689 85,852,0002,005,162 87, 033, 00011, 868, 040 88,293,0001,769,580 89,275,52*,730,692 90,259,0001,665,278 91. 088, 000 1. 566, 713 92,007,000 1, 653,469 92,971,000 1, 626, 088 93,418,501 1, 606, 041 94,285,000 1,589,372 95,178,000 1,616,005 904,876 1,432,631 838,998 1,298,691 765,068 1,240,094 772,547 1. 095, 493 721. 491 1. 048, 089 693,523 1,037,169 724,460 940,818 752,445 814,268 684,189 969,280 689,959 936,129 706,599 695,644 710,022 899,442 893,728 905,983

...

... 83,047 72,907 71.485 64,142 58,686 51,015 47,580 42,726 38,646 38,232 33,847 32,237 30,235 27,362 26,255 24,786

...

205,360 165,406 168,467 140,515 122,869 99,114 91,424 78,944 68,801 67,691 62,678 57,052 54,768 49,293 45,465 42,784

... .. . ... .. . .. . ... .. . .. . 4,488 123,837 934,170 79,551 4,437 143,963 953,999 79,032 4,601 192,677 842,170 82,575

4,117 3,691 3,417 3,373 3,262 3,095 2,838 2,677 2,560 2,381

216,974 217,231 203,824 193,274 187,119

715,081 671,905 676,995 682,077 697,8091

83,689 82,331 79,021 75,255 76,759 75,267 72,040 71,651 74,004 72,455 69,410 69,323 71,108

183,265 714,861 179,007 715,934 176,353 773,362 185, 1481 826,902 181,8931 847, 135

2,097 179,281 866,115 1,914 179,895 890,158 1, 794 177,254 928,305 1

Note: Figures for 1962 are provisional.

in 1948 became under 1 million and the death rate decreased to 11.9, in spite of the fact that considerable incidences of deaths must have occurred during and directly after the war period. It further continued to decrease as low as to 7.8 in 1955. It was 8.0 in 1956, and 8.3 in 1957, respectively, showing a slight increase. However, it again de::reased to 7.4 in 1958, and was kept on the same level in 1959, showing the lowest rate ever recorded in the history of vital statistics in Japan. Because of the prevalence of influenza which showed a highest peak in April 1960, the death rate for 1960 slightly increased to 7.6. However, the rate 7.4, being on the lowest level, came back once again in 1961, and slightly rose again to 7.5 in 1962. (Refer Table 5 and Fig. 3). The informations on the ten leading causes of deaths can be found in Chapter 9 (page 15). Infant Death Annual Change of Infant Death Rate. The changes of infant death rate have been

-11Table 5. ;

Vital Statistics in Japan. (Rates) (1900~ 1962)

Live Birth Rate Year

Death Rate

IIncrease Natural Rate

Infant Death Rate

Nee-natal I Maternal Still-birth Marriagel Divorce I Death Death Rate Rate Rate Rate Rate

Per 10,000 Per 1,000 total total Per 1,000 Per 1,000 Per 1.000 Per 1,000 Per 1,000 1,000 Per 1,000 births births Per popupopupopulive live popupopu(live birth (live birth lation lation lation births births lation lation and and still-birth) still-birth) -

1900 1905 1910 I I I

32.4 31. 2 I

20.8 21. 6 21. 6 20.7 25.4 20.3 18.2 16.8 16.5 16.0 16.1 16. 7 ...

I

11. 6 9.6 13.2 13.4 10.8 14.7 14.2 14.91 12.9 15.7 14. 7 14.2 ...

155,0 151. 7 161. 2 160.4 165.7 142.4 124.1 106. 7 90.0 84.1 85.5 86.6

79.0 71.2

39.81 38.8 [ 33.3 33.21 33.0 28.5 25.8 24. 7 22.9 20. 7 19.7 19.4

88.5 89.1 84.2 72.8 66.4 56.3 53.4 50.1 46.0 43.4 41. 0 39.6

7.9 7.5 9.0 8.4 9.8 8.7 7.9 8.0 9.3 11. 0 9.4 10.2

1. 46 1. 29 1. 21 1.14 0.99 0.87 0.80 0.70 0.68 0.69 0.64 0.68 ...

34.8 34.1 36.2 34.9 32.4 31. 6 29.4 31. 8 30.9 30.9

74.1 69.7 69.0 58.1 1 49.9 44.7 38. 7 34.2 34.1 33.8

1915 1920 1925 1930 1935 1940 41 42 43 44 1945 46 47 48 49 1950 51 52 53 54 1955 56 57

I I

"

.

...

...

... ... :34.3 33.5 33.0 28.1 25.3 23.4 21. 5 20.0 19.4 18.4 17.2 18.0 17.5 17.2 16.9 17.0

... ... 14.6 11. 9 11. 6

... 19.7 21. 6 21. 4 17.2 15.4 14.4 12.6 11.9 11. 6 10.4 8.9 10.5 10.1 9.6 9.5 9.5

...

... ... 76.7 61. 7 62.5 60.1 I 57.5 49.4 48.9 44.6 39.8 40.6 40.0 34.5 33. 7 30. 7 28.6 26.5

., . :H.O 27.2 26.5 27.4 27.5 25.4 25.5 24.1 22. :{ 23.0 21. 6 19.5 18.6 17.0 16.5 15.3

... ...

...

... ., . t6.0 15.7 15.9 16.1 15.7 15.5 16.4 16.7 16.2 15.4 15.4 13.9 13.2 11. 6 lD.8 10.0

... 44.2 50.9 66.7 84.9 I 92.2 92.3 93.8 95.6 95.8 97.1 101.2 100.7 100.6 100.5 101. 7 98.8

... ...

...

... ... 12.0 11. 9 10.3 8.6 7.9 7.9 7.8 7.9 8.0 7.9 8.5 9.0 9.1 9.3 9.4 9.8

... ... 1. 02 0.99 1. 01

10.9 9.9 8.9 8.9 8.2 7.8 8.0 8.3 7.4' 7.4 7.6 7.4 7.5

1.01 0.97 0.92 0.86 0.87 0.84 0.80 O. 79 0.80 0.78 0.74 0.74 O. 75

58 59 1960 61 62

I

Note: FIgures for 1962 are provIsIOnal.

..

+-

almost the same as the death rates for all ages. Before 1925, the infant death rate was around 160 per 1,000 live births every year excepting the high rate in 1918 (188.6) due to the pandemic of influenza. It declined in the course of the years after 1925 until it became below 100 in 1940, and reached 39.8 in 1955. Both in 1956 and 1957, it did not decrease, but in 1960, it remarkably decreased to 30.7 from the year 1959, which was then 33.7, and went down further, reaching 26.5 in 1962. (Refer Table 5 and Fig. 4). Maternal Death Annual Change of Maternal Death Rate. The maternal death rate around 1900 was approximately 40 per 10,000 total births (live births and still-births), but it decreased every

12--

year until it reached the low rate in 1943, showing 19.4. Although some sharp increase of maternal death rate was expected after the war due to the increase of artificially induced abortions, it remained at the level of 16.0 in 1947. Thereafter, it kept a decreasing trend, reaching 10.0 in 1962, showing the lowest rate ever recorded in Japan. (Refer Table 5). Still-birth

Fig. 4.

Annual Change of Infant Death Rate. (per 1,000 live births)

200

Annual Change of Still-birth Rate.

50

In the vital statistics in Japan, a stillbirth is defined as a foetal death in the fourth month of pregnancy or later. Year The still-birth rate in Japan was around 90 per 1,000 total births (live births and still-births) about in 1900, and kept decreasing until it became about 40 in 1943 After the war, it again started to show the high rate of 44.2 in 1947, and rapidly increased in the following years and became 101.2 in 1957. In 1958, it decreased to 100.7 and kept almost on the same level since then. It increased suddenly to 101.7 in 1961, showing the highest rate in Japan, and then dropped to 98.8 in 1962. It has been believed that the increasing trend which was seen before 1957 acconnts for influences of the enforcement of Eugenics and Maternal Protection Law of 1948. This is proved by the fact that the proportion of artificially induced abortion to the total still-births increased to 51.6% and 50.2% in 1956 and 1958, respectively, from 21.6% in 1948, though it decreased to 45.2% in 1962. This is enough to prove how widely the artificial abortions have been carried out in Japan, and this fact explains that the increasing number of population are becoming aware of the heavy burden of a big family. As the increase of artificially induced abortions is not desirous from the viewpoint of maternal health, the government is making efforts to educate people to use safer methods of contraception.

Marriage Annual Change of Marriage Rate. The marriage rate in this country since 1900 up to about 1935, had been approximately between 7 and 8 per 1,000 population, excepting some slight fluctuations before and after 1920. It went up to 9.5 in 1937 due to the war which started in the same year. Although the marriage rate went down rapidly, it again rose to 9~ 11 after 1940, as the marriage was encouraged by the government in the course of development of the war. Then in 1947, it became 12.0, showing the highest rate since 1900. However, it was considered to be a temporary state caused by family re-union and increase of postponed marriages after the war. It decreased to 10.3 in 1949, and went further down to 8.0 in 1955, and 7.9 in 1956, respectively, to the normal level recorded in the pre-war days. Since 1957 it has been keeping an increasing trend, reaching 9.4 in 1961, and 9.8 in 1962. (Refer Table 5) ,.. .:~

13

Divorce

Annual Change of Divorce Rate.

The divorce rate in 1900 was 1.46 per ] ,000 population,

and since then it kept decreasing until it became 0.63 in 1938. But after the war, it suddenly rose again showing about 1.0. This is partly because of an increase of marriage after the war, and partly because of the new attitude of the people toward divorce. Since 1959, however, the rate has been slightly decreasing year after year, reaching 0.74 in 1961. However, it became 0.75 in 1962, showing a slight increase from the previous year. (Refer Table 5).

8.

Life Tables in Japan

Average life e:<pectancy at birth for the Japanese people, according to the Abridged Life Table prepared on the basis of 1961 data, indicates 66.0 years for male and 70.8 years for female, showing a slight increase compared with that of 1960. According to the 10th Life Table (complete) based on the popUlation census and vital statistics for the period of 1 January~31 December 1955, it was 63.6 years for male and 67.8 years for female, showing a slight difference from the data by the Abridged Life Table. The prolongation of the average life expectancy at birth for both men and women has been remarkable in the recent years. This is particularly due to the sharp decrease of mortality rates of younger population and partly due to an increase of older population.

Table 6. Number of Living (a) I -----.-~~---

(IX).

Male --~~-

Age Year 0

I

I

1

I

5

I

10

i

20

I

30

I

40

I

50

I

60

I

70 23,149 24,519 26,014 21. 591 24,306 26,434 3,572 17,481 29,230 36,686 38,110 42,997 39,544 46,031 46,446 49,870 49,434 49,823 49,384 47,872 51,448 52,429 52,114 53,647

*1891~1898 *1899~1903 *1909~1913 *1921~1925 *1926~1930

100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000

85,105 84,314 83,950 83,796 85,990 88,697 80,130 87,530 91,402 93,500 93,370 94,331 94,100 94,240 94,950 94,890 95,380 95,817 95,830 95,918 95,767 96,216 96,354 96,637 96,826

76, 239 1 76,887 76,410 75,567 78,457 81. 788 70,674 81,477 85,120 89,747 89,514\ 91. 382 90,773 91,056 92,505 92,604 93,411 94,215 94,230 94,437 94,355 95,030 95,183 95,616 95,936 I

73,655 74,891 74,564 73,749, 76,786 80,141 66,377 79,668 83,694 88, 589 88,449 90,481 89,784 90,236 91,672 91,817 92,776 93,537 93,533 93,818 93, 766 94,494 94,650 95,130 95,481

69,716 71,310 70,846 69,336 72,845 76,189 55,709 76,116 81,067 86,395 86,609 89,132 88,138 88,887 90,465 90,709 91. 637 92,499 92,498 92,847 92, 781 93,586 93,760 94,238 94,590 1

63,917 65,596 65,020 62,950 66,721 69,441 29,841 65,705 74,152 80,187 81, 079 85,653 83,631 85,236 87,540 87,964 88,945 89,938 89,972 90,423

58,178 60,101 59,889 57,618 61, 693 64,242 19,997 57,410 67,997 74,432 75,902 81,802 78,964 81. 401 84,142 84,834 85,841 87,047 87,080 87,628

50,534 52,629 52,999 50,267 54,349 57,034 14, 782 48,596 60,804 67,648 69,331 75,859 72,702 75,479 78,515 79,546 80,765 81, 963 82,032 82,603

39,073 41.160 42,136 38,517 42,283 44,712 9,253 35,499 48,903 56,111 58,026 64,481 61. 300 64,018 67,269 68,218 69,658 71,115 71,193 71,319

*1935~1936

1945 1946 *1947 1948 *1950~1952

1

1949

1950 1951 1952 1953 1954 *1955 1955 1956 I

1957 1958 1959 1960 1961

90,437 87,677 82,624 70,947 91, 364 88,751 83,991 73,095 91, 683 89,156 84,589 73,837 92,217 89,750 85,168 74,280 92,640 90,285 85,836 75,257

*Note: Complete hfe table.

--- 14

(b) Year 0 1*1891 18981 100,0001 *1899~1903 100,000 *1909~1913 100,000 *1921 ~1925 100,000 *1926~1930 100,000 *1935~1936

Female. Age

~

1

1

1

5 78,028 78,339 77,818 77,110 79,866

1

10

1

20

1 1

30

1

40

I I

50

1

60

I 1

70 27,594 28,745 29,783 27,465 31,544 35,328 17,204 34,258 40,014 46,348 47,799 53,063 49,317 55,734 56,525 61, 115 60,960 60,937 60,683

86,620\ 85,908 85,496 85,600 87,586 90,083 84,310 90,350 92,336 94,360 94,110 95,027 94,740 94,910 95,580 95,510 95,950 96,311 96,340 96,278 96,895 96,675 96,969 97,238 97,456

75, 4831 76, 245 75,770 102 75, 78,053 1 1

1

7l,073\ 71, 652 70,540 69,379 73,069 76,792 65,266 80,346 82,067 87,367 87,329 89,978 88,819 89,664 91,315 91, 596 92,556 93,473 93,477 93,621 94,315 94,507 94,925 95,416 95,852

64.479\ 64,874 63,5551 61,885 66,215 70,130 55,703 73,608 76,195 81,704 82,329 86,813 84,737 86,412 88,686 89,257 90,412 91, 525 91, 451 91,799 92,503 92,874 93,450 94,045 94,607

57,7731 58,308 57,373 55,536 60,312 64,515 47,893 67,513 70,945 76,7l7 77,728 83,189 80,528 82,736 85,426 86,319 87,648 88,969 88,917 89,405 90,077 90,777 91, 410 92,151 92,820

51,006 51, 794 51, 352 49,411 54,285 58,537 39,959 60,781 65,129 71,100 72,359 78,325 75,347 77,765 80,857 81,921 83,833 84,968 84,959 85,518 86,153 87,196 87,94~

41, 826 42,998 43,113 41,055 45,819 49, 862 30,113 50,825 56,170 62,163 63,746 69,7l3 66,639 69,099 72,345 73,529 76,599 77,213 77,219 77,641

1945 1946 *1947 1948 *1950~1952

100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000

83,229 76,731 85,189 86, 101 1 90,664 90,304 92,079 91, 382 91,759 93,119 93,237 94,016 94,800 94,817 94,849 95,556 95,566 95,969 96,366 96,707

81. 564, 73,278 83,630 84,793 89,676 89,320 91, 275 90,477 90,979 92,402 92,547 93,461 94,271 94,277 94,346 95,076 95,163 95,562 96,000 96, 395 1

1

1949

I I

1950 1951 1952 1953 1954 *1955 1955 1956 1957 1958 1959 1960 1961

88,750 89,621

78,208 61.110 79,777 ' 64,165 80,672 65,561 81, 567 65,761 82,607 67,246

I

*Note: Complete life table. Table 7. Expectation of Life at Birth. l~o) Y ear

Ml ae

F emae

* 1891 ~1898 * * *

*

1899~190:~ 1908~1913 1921~1925 1926~1930

42.8 44.0 44.3 42.1 44.8 46.9 23.9 42.6 50.1 55.6 56.2 59.6 58.0 60.8 61. 9 61. 9 63.4 63.6 63.9 63.6 63.2 65.0 65.2 65.4 66.0

44.3 44. ~) 44.7 ·13.2 46.5 '19,6 37.5 51.1 54.0 59.4 59.8 63.0 61. 5 64.9 65.5 65.7 67.7 67.8 68.4 67.5 67.6 69.6 69.9 70.3 70.8

The The The The The

1st 2nd 3rd 4th 5th

Life Life Life Life Life

Table Table Table Table Table

* 1935~1936 1945 1946 *1947 1948

The 6th Life Table Abridged Life Table h

The 8th Life Table Abridged Life Table

*

1950~1952

1949

1950 1951 1952 1953 1954 *1955 1955 1956 1957 1958 1959 1960 1961 I

" Table The 9th Life Abridged Life Table

" " " Table The 10th Life Abridged Life Table " • • " h h

"

*Note; Complete life table.

- 15-

9.

Deaths by Leading Causes

As a recent trend, the deaths from the infectious diseases such as tuberculosis, pneumonia and bronchitis, etc. have decreased greatly, and the deaths from malignant neoplasms and other degenerative diseases have been gradually increasing, comprising more important proportion in the total deaths. In 1961 and 1962, so-called adult diseases such as vascular lesions affecting central nervous system, malignant neoplasms, heart diseases, and some others, increased as in the previous years. The increase of deaths from accidents is notable in the recent years.

Table 8. Annual Change of Deaths and Death Rates by Leading Causes. C1900~1962) (Rate per 100.000 population) (Con'd to the next page) Vascular Lesions affecting Central Nervous System B22 N

Malignant Neoplasms B18 N 20,334 26,668 32,998 37,789 \

Heart Diseases B25-27

Senility B45a

Year

Pneumonia and Bronchitis B31. 43a, 32 R

I

R

I

R

N

I

R 48.1 55.5 65.0 63. 7 63.5 66.8 63.8 57.6 63.3 59.2 60.1 62.3

N

I

I

N

I

i

R 226.1 247.4 262.0 261.1 408.0 275.6 200.1 186.7 185.8 175.9 177.4 191. 8 .. . .. . 174.8 98.6 100.0

1900 1905 1910 1915 1920 1925 1930 1935 1940 41 12 13 41 1945 46 47 48 49 1950 51 52 53 54 1955 56 57 58 59 1960 61 62

69.799 76,169 64,888 67,921 88,186 96,293 104,942 114,554 127,847 125,124 125,349 120,985

159.2 163.4 131. 9 128.8 157.6 1'61. 2 162.8 165.4 177.7 174,6 173.2 166,0

46.4 57.2 67.1 71. 6 72.6 70.6 70.6 72.3 72.1 73.9 74.5 73.5

21,107 25,888 31,976 33.586 35,540 39,895 41,138 39,902 45,542 42,543 4:3,487 45,128 ...

57,442 65.233 59,117 59,346 73,468 70,065 76,591 78,972 89,540 89,673 95,998 99,162 ...

131. 0 139.9 120.2 112.5

99,130 115.326 128,877 137,730

40,648 42,177 45,488 50,080 51,879 52,949 53,897 53,580 ... ... ... 53,886 56,633 59,889 c

131. 3 228,330 117.3 118.8 114.0 124.5 125.1 132.6 136.1 164,649 128,976 129,318 133,649 126,120 128,438 139,762

or

.-

... 101, 095 94,329 100,278 105,728 105,858 110,359 116,351 116,925

::: I

.. .. ... , ,

.. .. ..

,

...

...

, ,

129.4 117,9 122.6 127,1 125.2 128,5 133. 7 132.4 136,1 148,4 151,7 148.6 153.7 160.7 165.4 169.1

69.0 70.8 73.2 77.4 78.5 80.9 82.2 85.3 87,1 90.7 91. 3 95.5 98.2 100.4 102.3 103.1

.. . 48,575 49,046 52,763

...

... 62.2 61. 3 64.5 64.2 63,6 61. 3 64.9 60.2 60.9 66.0 73.1 64.8 67.7 73.2 72.1 75.4

...

... ... 78,342 63,639 65,574

I

... ... 100.3 79.5 80.2

... ...

.. .

... 136,524 78,911 81,812

64,428 66,354 69,488 71,578 75,309 77,721 81,879 83,155 87,895 91,286 93,773 96,442 98,081

53,377 53,750 52,603 56,477 53,128 54,351 59,543 66,571 59,603 62,954 68,400 68,017 71,798

58,412 59,796 59,514 67,514 61,334 59,932 68,414 73,283 51,046 52,687 54,139 54,880 54,713 I

70.2 70. 7 69.3 77.6 69.5 67.1 75.8 80.5 55.5 56,7 58.0 58.2 57,5

77,565 69,555 57,586 62,091 48,256 43,154 43,683 53,923 43,832 42,018 46,045 39,245 42,663

93.2 82.2 67.1 71. 3 54. 7 48.3 48.4 59.2 47,6 45.2 49.3 41. 6 44.8

121,504 133,931 138,181 136,767 142,858 150,109 155,966 160,917

I

Note: Figures for 1962 are provisional.

\

16 -Accidental Deaths Year N

Tuberculosis (all forms) Bl,2 N

BE47,48

Gastritis, Duodenitis, Enteritis and Colitis B36, 43b N

Suicide BE49 N I

Nephritis and Nephrosis B38 R 13.4 17.4 19.1 19.2 19.0 20.5 21. 6 20.5 13.7 13.6 13.0 12.1 . ..

I 1

R ,

I

R 163.7 206.0 230.2

I I

R

I I

I I

N 13,259 10,129 26,603 39,064 55,546 59,873 63,435 56,026 54,703 49,900 51, 108 49,708

I

R 30.2 21. 7 54.1 74.1 99.3 100.21 98.4 . 80.9 76.0 69.6 70.6 68.2 ... ••• I

1900 1905 1910 1915 1920 1925 1930 1935 1940 41 42 43 44 1945 46 47 48 49 1950 51 52 53 54 1955 56 57 58 59 1960 61 62

19, 874 20,469 21. 800 24,321 26,198 24,982 26,295 29,023 28,408 28,808 31, 134 33,519 ... ...

45.3 43.9 44.3 46.1 46.8 41. 8 40.8 41. 9 39.5 40.2 43.1 46.0 ...

71,771 96,030 113,203 115,913 125,165 115,956 119,635 132,151 153,154 154,344 161,484 171,473 ...

58,664 I 133.81 63,979 104,950 137.2 I 213.4 I 223.7 254.2 238.2 221. 4 173.2 159.2 142.8 142.0 153.2 ...

5,8631 8,089 9,372 10,153 10,630 12,249 13,942 14,172 9,877 9,713 9,393 8,784

219. 7 117,988 223. 7 194.1 185.6 190.8 212.9 215.3 223.1 235.3 ... 142,278 142,288 142,673 119,931 114,538 102,387 102,784 111,688 ...

...

,

... 38,533 38,975 34,277 32,850 31,968 31,215 34,236 34,812 33,265 33,258 34,528 35,785 41, 662 38,964 41, 614 38,127

... 49.3 146,241 48. 7 143,909 41. 9 138,113 39.5 37.8 36.4 39.3 39.4 37.3 36.8 37.9 38.9 44.8 41. 7 44.1 10.1 121. 769 93,307 70,558 57,849 55,124 46,735 43,874 42,718 36,274 32,992 31,959 27,916 27,782

...

...

...

...

... 187.2 179.9 168.8 146.4 110.3 82.2 66.5 62.4 52.3 48.6 46.9 39.4 35.5 34.2 29.6 29.2

... ... 106,838 87,890 75,748 68,540 57,214 45,552 40,139 34,436 28,289 27,077 23,425 23,128 21, 674 19,791 18,383 17,121

...

...

136.8 109.9 92.6 82.4 67.7 53.1 46.1 39.0 31. 7 30.0 25.7 25.1 23.3 21. 2 19.5 18.0

... ... 12,262 12,753 14,201 16,311 15,415 15,776 17,731 20,635 22,477 22,107 22,136 23,641 21,090 20,143 18,446 16,439

... ... 15.7 15.9 17.4 19.6 18.2 18.4 20.4 23.4 25.2 24.5 24.3 25.7 22. 7 21. 6 19.6 17.3

... 45,047 36,561 33,707 26,978 24,701 22,108 20,160 19,511 19,122 19,459 19,509 17,440 16,426 15,429 14,478 13,850

... ...

... 57.6 45.7 41. 2 32.4 29.2 25.8 23.2 22.1 21. 4 21. 6 21. 4 19.0 17.7 16.5 15.4 14.6

I ,

Table 9. Percentage Increase or Decrease in Death Rates by Selected Causes. International Abbreviated \ List Number B22 B18 B25~27

Causes of Death \

1947 \

1961 0 +41.5 +25.2 -49.0 -77:7 + 4.8 -84.5 -88.8 - 4.4 -81.0

I 1962 + 2.2 +42.6 +30.9 -49.6 I

B45a B31, 32, 43a BE47, 48 B1,2 B36, 43b BE49 B38

I I

Vascular Lesions affecting Central Nervous -21.8 System Malignant Neoplasms - 4.6 Heart Diseases + 8.0 Senility -12.0 Pneumonia and Bronchitis - 6.4 Accidents +17.7 Tuberculosis (all forms) - 1.9 I Gastritis, Duodenitis, Enteritis, and Colitis -21.0 Suicide -23.4 Nephritis and Nephrosis -28.8

~76.0

+ 5.3 -84.7 -89.6 -15.6 -82.0

Note: The rates for the year 1935 are taken as the base, 100.

17 Fig. 5. Death Rates by Leading Causes in 1962.

-

o Vascular lesions affecting central nervous system··············· Malignant neoplasms ........................................................ . Heart diseases····································································· Senility·····.· ..................................................................... . Pneumonia and bropchitis including pneumonia of the new born ..................................................................... .. Accident .......................................................................... . Tuberculosis. all forms ...................................................... Gastritis, duodenitis, enteritis. and colitis ........................... Suicide .............................................................................. r-;ephritis and nephrosis· ..................................................... ~ ~

50

100

150 1

200

c:::::L 1947 ~

1962

1;;;;;::=======::1

b;::;;:==========:::J

2:

I;;;:::=::::J "'"

10. Statistics

Maternal and Child Health

I •

As stated in Chapter 7 (page 9), "Vital Statistics" of this report, there has been a steady decline in the numbers and rates of neo-natal deaths and infant deaths in the recent years, while the figures for still-birth have remained considerably high. Matemal deaths also have been gradually decreasing in numbers and rates, but still it should be noted that there should be a great deal to be done to improve maternal health in this country. Of a total of 1,606,041 live births in 1960, number of confinements which took place in hospitals, clinics or maternity homes, was 804,557, representing a percentage of 50.1 to the total. This is a remarkable rise in the rate of institutional confinements for these 10 years; the figure being 3.6 for 1949. Analysis of maternal and infant deaths by leading causes of death for the year 1962 with the comparison for the past several years is shown in the following tables.

Table 10.

Infant Deaths and Death Rates by Leading Cause>; of Death. Infant Deaths 1950 Infant Death Rates (per 1,000 live births)

I

1955 1 1961

I

1962

1_.!:.:~_~.l_1_9_55---'-1_19_6_1-7-1_1_96_2_1 60.1 1 4.2 13.3 8.3 2.4 1.1

----

All Causes Infectious and parasitic diseases Pneumonia and bronchitis Gastro-enteritis

1 1

140,515 1 68,801! 45,465 42,784: 9,841 2,491 1,123 1,0891

39.8 1.4 9.4 3.4 2.1 0.8 22.7

28.6 1 0.7 7.7 1.9 2.0 1.6 14.8

26.5 0.7 6.8, 1.8 2.1 1.7 13.4

1

31,155 16,325 12,293 10,978 19,435 5,821 3,048 2,887

Congenital malformations 5,540 3,564 3,100 3,358 Birth injuries, post-natal asphyxia 2,462 1, 325 2,548 2,765 and atelectasis Other diseases peculiar to early infancy and immaturity unqualified 72,082 39,275 23,353 21, 707

30.8

-18 Table 11. Maternal Deaths and Death Rates by Leading Causes of Death. Maternal Deaths (1950~1962) I

Maternal Death Rates (per 10,000 live births) 1950 \ 1955 \1959 \1960 \1962 17.6 1.5 17.91 14.6 13.11

I I

I 1950 \1955 \ 1959 \ 1960 \1962 All Causes Puerperal fever Toxaemias of pregnancy Haemorrhages Ectopic pregnancy Abortion without sepsis Others

i

I 4,117 I 3,095,2,381 2, 097 1 1 ,914 351 141 116 108 87 1,396 1.124 1, 147 831 474 373 261 121 488 505 908 592 292 76 397 809

11. 8[ 0.51 4.3

0.8 6.5 4.8 2.2

0.7 5.6 3.6 1.8

507 232 63 378

1

694 482 248 69 334

6.0 4.9

0.7 5.0 3.2 1.4

3.0, 1.5

2.0 1.1 2.1

O. 7 2.9[

0.5 2.4

0.4 2.4

0.4 2.1

Clinics for Mothers and Children All expectant and nursing mothers and guardians of young children are encouraged to receive health guidance concerning pregnancy, child-bearing and child care from medical, dental and nursing staff. To this effect, the prefectural and municipal health centers regularly provide the ante-natal, post-natal, and child health clinics, where mothers and young children could obtain advice and preventive treatment. In addition, an increasing number of local government authorities are providing such clinics for mothers and children living in their areas. According to the reports so far received, these health clinics have been attended mostly by the infants under 1 year of life, while attendances at clinics are falling off as the child grows older. To counteract this, a special program has been in operation since 1961 for all 3-year-old children to attend clinical sessions arranged by the health centers. The main purpose of those special clinics is not only to give routine medical examinations and advices on the general health of children, but also to find the children with the physical and/or mental defects which need medical or protective treatments. During the calendar year 1962, 769,927 visits were made to the clinics by mothers, and 4,807,449 by children, (743,570 and 4,466,796 for 1961, respectively), showing 26,357 and 340,653 increase, respectively, against the year 1961. Home Visiting Activities In addition to the provision of clinical services at the health centers, home visiting for mothers and children is generally conducted by the nursing staff of the health centers and of other health agencies. The number of home visiting conducted by the public health nurses was 206,234 for mothers, and 873,178 for children during the calendar year 1962, which showed decreases by 2.1% and 2.7%, respectively, comparing to the figures for the year before. As it seems to be of a great importance to provide more sufficient care for newborn infants in order to reduce the high neo-natal death rates, the health centers have been making special arrangements for midwives in private practice and public health nurses to pay frequent home visits to newborh infants since 1961. A special project to provide the home visiting services to the mothers suffering from toxaemias of pregnancy has been in operation since 1962. Because of a lack of nursing staff in the health centers, midwives in private midwifery practice are employed on part-

J

i

I

r

-

~

I

· 19 -

time basis for these home visiting. A new program has been commenced from this year, whereby the patients of serious toxaemias of pregnancy can receive medical treatment in hospital mostly through the public expense. Voluntary Activities The voluntary community activities have been encouraged for maternal and child health program in rural as well as in urban areas. A large number of community organizations act in close co-operation with the local health authorities, and take part in mothercraft training and in distributing UNICEF-donated skim milk and in other various services. MCH Centers in Rural Areas In the rural areas, where mothers and children have to travel a long way for receiving

medical examination and treatment because of lack of medical and nursing personnel and facilities, the provision of maternal and child health services presents great difficulties. Therefore, the establishment of MCR centers surely meets to a great extent the needs of mothers and children in such areas. Though it is small, the building includes rooms for ante-natal and post-natal clinics, class-room, demonstration room for nutrition guidance, and accommodations and facilities for child-bearing mothers. MCR centers have been established in 227 remote villages since 1958. and additional 50 centers will be constructed in 1963. Premature Births Every infant born with the weight of 2,500 grammes or less has to be reported to the

respective health center immediately after its birth. Public health nurses or midwives of the health center may visit the families with premature infant to advise them in regard to the proper care of such infant at home, and in case of need, baby-incubators of open type are lent out to the family. The premature infants in need of more complicated care are received into the hospitals which have been designated for this purpose, and the costs uf hospitalization are mostly supported by the national and local authorities' grants-in-aid. During the calendar year 1962, there were 74,332 premature births reported, (66,164 for 1961), presumably representing about a half of the actual number of cases of premature births occurred in that year. Public health nurses paid visits to 52,744 cases (51,677 for 1961) of premature infants during the same period. Tuberculous Children

Children staying in tuberculosis sanatoria for a long-term treatment of bone and joint tuberculosis as well as other tuberculosis may receive financial aids from national and prefectural authorities covering all expenses for medical treatment, school education and other daily living costs required by the children. Approximately, 1,000 children were aided under this scheme during 1962. Other Services As for the informations regarding rehabilitation of the physically handicapped children, they can be found in Chapter 21 (page 43) of this report.

11.

Family Planning

After the W orid War II came to an end, there followed the days of general social confusions and economic distresses. The explosive expansion of population caused by the

-

20-

repatriation of Japanese people from overseas countries and by the high live-birth rates was driving this country into a worse situation. In such days in 1948, a law was carried into effect, the provisions of which made the induced abortion legal under certain medical and social indications. For the following years, the reported induced abortion remakably increased in number, reaching to 1,000,000 or more cases a year. The government at that time felt it necessary to put a brake on this trend for preventing mothers from the undue harm of the operation, and decided in 1952 to push forward the family planning movements in order to switch the practice of controlling births from induced abortion to contraceptlOn. At the beginning of the movement thus resumed, the voluntary organizations did introductory work to the general public, and in 1955 the Ministry of Health and Welfare launched a special program to disseminate the practice of contraception among indigent families. Thus, the prefectural and municipal health centers have been playing leading and supervising parts in family planning services, public and voluntary, in the areas. The health center not only routinely provides consultation clinics, but also frequently organizes mother's classes, discussion groups and other group meetings on the subject of family planning. Personal guidance is conducted by the nurse and midwife who are entitled to be a "contraception instructor." In the above-stated special program for indigent families, the costs needed for personal guidances and contraceptive appliances and drugs are aided by the expenditures of the central and local government. Besides the services provided through administrative channel, some of the big companies in commerce, industry, mining, transportation etc. have been taking up the guidance on family planning as one of the welfare measures to their workers. A special project to provide the family planning guidance to the newly married couple by giving textbook and by travelling clinic in rural areas has been started from this year.

12_ Health Education The local health centers perform extensive health education program in the field of communicable disease prevention, care for infants, insect and rodent control and improvement of environmental sanitation. In addition, the school health education is performed by the school authorities under the direction of the local Education Board, whereas the industrial hygiene education is conducted by the local Labor Standards Offices. In the rural area, agricultural extension service is carried out under the direction of the Ministry of Agriculture and Forestry which includes health education program for the farmers. Radio and TV broadcast, movies, slides and exhibits are employed f'xtensively. National congress on health education have been held annually for training and for conference, and the regional discussion groups on health education meet often for the exchange of views and ideas.

13. Tuberculosis Control Tuberculosis Control Program in General The tuberculosis control program is completely defined m the Tuberculosis Control

-

21-

Law of 1951, covering the respJnsibility of national and prefectural health authorities on the expenses for prevention of diseases and medical treatment of the patients. This law also provides for the health examination for case-finding, BeG immunization, reporting and registration of new cases. The voluntary activities for tuberculosis control has assisted the government for carrying out the program a great deal. Because of development of chemotherapy and Fig. 6. Annual Change of Tuber· technique of surgical operation, it has obtained culosis Death Rates by Age Groups. good results in the last ten years for slowing down the tuberculosis death rates every year, and the 500 1935 decrease is remarkable among younger age group 400 compared with the older age group.(Fig. 6). There were 27,782 deaths, (29.2 per 100,000 population) 300 during the calendar year 1962. 200 In order to ascertain the actual condition of the prevalence of tuberculosis in the whole country, the government conducted the nation-wide o 10 20 30 40 50 60 70 80 surveys in 1953 and 1958. In the survey of 1958, Age grou.p ____ Death Rales(per 100,000 PopukJtlon) 301 areas with 68,269 people were selected, and more than 98% of these people were examined with radiograph and some of them underwent bacteriological examination. The result of the survey showed that the prevalence rate was 3.3% and that the prevalence rate of younger age group remarkably decreased in comparison with that of 1953. It also indicated that the number of severe cases to require hospitalization was 860,000 and those with cavity were 410,000. According to the follow-up surveys of above survey conducted in 1954, and 1959, the incidence rate of pulmonary tuberculosis in a year was 0.37% in 1954 and 0.23% in 1959. The government conducted the third survey this year. Early Case Finding and Preventive Vaccination The health examination for case-finding consists of routine and extraordinary examination; the former is applied to all the people above 6 years old once a year free of charge, and the latter is applied to some professional groups such as barbers, food-handlers, and family member of patients, etc. The method of routine examination is shown in Fig. 7. As for extraordinary exami-

L

Fig. 7. Age O~

Method of Health Examination.

5 Tuberculin Test

Negative->BCG inoculation < Positive Negative->BCG inoculation Normal A bnormal-> Detailed examination (Radiography and bacteriological examination)

Tuberculin Test

< Positive->Photofluorography <

15~29

Tuberculin Test---Negative->BCG inoculation { PhotOfluorograPhY} Normal

30~

Photofluorography, <Abnormal->Detailed examination (Radiography and bacteriological examination)

-

22

-~

nation, persons are required to receive only the detailed examination regardless of their ages. During the calendar year 1962, 39,380,000 persons (37,165,000 persons for 1961) received the health examination for case-finding purposes, covering 40.3% of the total population. Among them, 34,070,000 (31,837,000 persons for 1961) were examined by photofluorography. The case finding rate for 1062 was 0.27%(0.34% for 1961). Among those negative reactors against tuberculin, 5,412,000 (5,590,000 persons for 1961) were immunized with BeG vaccine during the same period. (Table 12). Table 12. Tuberculosis Health Examination and Preventive Vaccination. (1953~1962)

(in thousand persons) No. of Persons Examined 21,922 26,531 33,152 35,714 38,838 37,165 39,380 Tuberculin Test Examined Persons 18,547 20,439 24,880 21,120 21. 411 19,140 19,216 Examined with Photofluorography 14,295 17,923 24,589 29,679 32,625 Examined Persons with diagnosed Radiography as TB Case 639 755 1,000 1,205 142 130 108 132 142 117 106 Personsreceived BCG Vaccination 8,126 6,094 6,690 6,279 6,346 5,590 5,412

Year

I

Positive Reactors 11,322 13,117 16,280 13,896

1953 1955 1957 1959 1960 1961 1962

I

13,346 12,607 12,866

I

1,269 1.180 1,211

I

31. 837 34,070

I

(Note: A year stands for the calendar year period).

Reporting and Registration

The law requires the physicians to report to the respective health center when they detect tuberculous patients. These reported cases are registered in the health centers. The total number of registered patients as of the end of 1962 was 1,544,277 (16.1 per 1,000 population), 62.4% (59% for 1961) of which were active cases. 25.9% of active cases were hospitalized, 54.7% were under domiciliary treatment, 14.5% did not receive complete medical treatment and remaining 4.8% (7 % for 1961) was unknown of any disposition. The number of newly registered cases during the calendar year 1962 was 383,773 (401 per 100,000 population), 22.7% of those were infectious. Medical Treatment The law specifies that one half of the treatment expense of patients requiring chemotherapy and surgical operation is to be paid through the local government fund, one half of which is subsidized by the national treasury. The rest of the expense may be covered

by social insurance and public assitance. The law requires that, in the case when a person engaging in certain occupation such as barber, food-handler, etc. is found to have infectious case, he may be prohibited to continue his work, and in the case where there is a danger of infecting his family, he may be compulsorily hospitalized. In these cases, the expenses of medical treatment will be born by the government fund. The total amount of expenses for the treatment of tuberculous patients in the country

··23 -

is estimated to be about 81.4 billion yen in 1961, (74.1 billion yen in 1960), which was equivalent to 14.8% (16.7% for 1960) of the total amount of expenses spent for medical care of all kinds of illness. Facilities The medical treatment for tuberculous patients was given in about 67,800 institutions including hospitals and dispensaries during the calendar year 1962. As of the end of 1962, total number of tuberculosis beds amounted to 241,305 and the occupancy rate was 80%. Table 13. Rate of Newly Reported Tuberculosis Cases. ,.~.

Table 14. Number of TB beds and Occupancy Rates. Year 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 \ Number of TB Beds \ 125,204 153,861 178,424 210,062 236,183 252,803 261,375 263,235 260,124 252,208 245,975 241,305 Occupancy Rates (%) 96 96 96 95 91 86 83 82 77 76 78 80

Year 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962

.4

IRate of Newly Registered Tuberculosis Cases (per I 100,000 population)

I

I

636 698 683 583 593 580 574 572 542 538 524 446 407

14.

Adult Disease Control

Among the chronic diseases, although the death rate of tuberculosis has been on a steady decline after the last World War, the vascular lesions affecting central nervous system, malignant neoplasms, and heart diseases, have been increasing in the recent years, and they have been occupying a leading position among various causes of death. We treat them as "adult diseases", and in 1958, the government established the "Anti-Adult Disease Council" in order to set up the plans for preventing and controlling these adult diseases. Surveys The government carried out a survey on malignant neoplasms in 1958 on nation-wide scale for a total of 13,127 patients discharged from 4,594 general hospitals for the period of September ~ October 1958. The table in the next page shows some of the results of· this survey. The survey revealed that 76.3% of the total patients belong to the age group between 40~69. The survey also revealed that there was a remarkably comparable result by sex and sites of disease. Male digestive cancer represents 70.1% (stomach 51.5%), which quite differs from the trend in the Western countries, and cancer of the respiratory system is 9.6%. For the female, the highest rate belongs to female genital organs representing 42.4%, digestive cancer is at 31.9% (stomach 21.0%) and breast cancer at 12.2%.

-

24Table 15. No. of Patients of Malignant Neoplasms by Sites and Sex. (1958) Male No. Female

I

% 100.00 2.8 70.1 3.5 51. 5 2.3 3.8 3.4 0.8 2.2 2. 7 9.6 2.2 4.0 3.4 0.1 -

No.

I

% 100.00 1.4 31. 9

Total Buccal cavity and pharynx Digestive organs and peritoneum Oesophagus Stomach Large intestine Rectum Liver Biliary passage Pancreas Others Respiratory system Larynx Lung and bronchus Others Breast Female genital organs Cervix uteri Others Male genital organs Urinary organs kidney Bladder and other urinary organs Other and unspecified sites Skin Brain Thyroid gland Others Neoplasms of lymphatic and haematopoietic tissues Lymphosarcoma and reticulosarcoma Leukaemia and aleukaemia Others

5,844 162 4,098 202 3,009 137 220 200 48 126 156 558 127 233 198 7 --

7,283 99 2,323 49 1.530 160 204 113 67 94 I 106 233 18 98 117 891

O. 7 21. 0 2.2 2.8 1.6 0.9 1.3 1.5 3.2 0.3 1.4 1.6 12.2 42.4 3:~.1

I

3,085 2.432 65:~

"

-

9.0 -

139 164 54 110 387 84 16 28 259 329 124 169 36

2.4 2.8 0.9 1.9 6.6 1.4 0.3 0.5 4.4 5.6 2.1 2.9 0.6

--

90 28 62 356 53 9 96 198 206 69 116 21

1.2 0.4 0.9 4.9

O. 7 0.1 1.3 2. 7 2.8 1.0 1.6 0.3

I

-

25 ---

Furthermore, in 1961, the government carried out a nation-wide survey on adult diseases other than malignant neoplasms for a total of 28,000 persons over 30 years of age. The survey was carried out in the form of mass examination including blood pressure measurement, electrocardiography and ophthalmoscopic observation of ocular fundi. According to the interim report of the survey, some of the findings are as follows: 1) 25% of those who were examined showed 150 mm/hg or over in systolic blood pressure (160 mm/hg or over in case of the age group of 60 years and over); 2) 13% of 8,600 examinees in electrocardiography showed abnormal findings of heart; 3) 35.% of 8,400 examinees in ophthalmoscopic observation of ocular fundi showed abnormal changes of retinae (among them 3 % being higher grades). 4) It was estimated that the number of those suffering from the vascular lesions affecting central nervous system was ab:mt 310,000 persons in the whole country. Control Activities

In 1962 all the prefectural health departments were more or less involved in various types of activities in the field of adult disease control, such as epidemiological investigation, early detection and diagnosis, health education and retraining of medical personnel. 302 health centers were concerned with prevention and control activities against hypertension and heart diseases, and 118 health centers cooperated with 1,202 hospitals and clinics in early detection of cancer. As for health center activities on the adult disease control in 1962, 260,701 persons were examined either at health center clinics or in the form of mass examination, and 253,774 home visits were made by public health nurses.

15.

Communicable Disease Control

Communicable Disease Control Program

The communicable disease control program is based on the Communicable Disease Prevention Law (1897), Preventive Vaccination Law (1948), Venereal Disease Prevention Law (1948), Tuberculosis Control Law (1951), Leprosy Prevention Law (1907), Trachoma Prevention Law (1919), and Parasitosis Prevention Law (1931). Particularly, the Communicable Disease Prevention Law provides, in detail, diseases with reporting obligation by the physicians, isolation of patients, disinfection of the infected places, and other specific obligation of the national and local health authorities. At present the following 11 diseases are specified by this law, i.e., cholera, dysentery, typhoid fever, paratyphoid fever, smallpox, epidemic typhus, scarlet fever, diphtheria, epidemic meningitis, plague, and Japanese encephalitis. In addition, the following 13 diseases are required to be reported of their occurrence by physicians, i.e., influenza, rabies, infectious diarrhea, whooping cough, measles, acute poliomyelitis, malaria, tsutsugamushi disease, filariasis, yellow fever, anthrax, tetanus, and relapsing fever. From June 1959, acute poliomyelitis, one of those notifiable diseases, has been designated by a separate regulation as the disease for which the same legal control measures as in the case of those 11 diseases mentioned above are to be enforced by the health authorities.

-- 26 -

The Preventive Vaccination Law of 1948 provides enforcing of both regular and emergent immunization. a. Regular immunization: 1. Smallpox-3 times: during 2 ~12 months after birth, during 6 months before entering primary school, and during 6 months before graduating from primary school. 2. Diphtheria-4 times: during 3~6 months after birth, during 12~18 months after the first immunization, during 6 months before entering primary school, and during 6 months before graduating from primary school. 3. Typhoid Fever and Paratyphoid Fever-during 36~48 months after birth, and thereafter, once a year up to 60 years of age. 4. Whooping Coug-h-twice: during 3 ~ 6 months after birth, and during months after the first vaccination. 5. Poliomyelitis-twice: during 6~21 months after birth, and during 12~18 12~ 18

months

after the first vaccination. b. Emergent immunization: Besides the regular vaccination program, the law provides immunization for epidemic typhus, cholera, plague, influenza, and Weil's disease at the time of their epidemics.

Table 16.

Number of Persons who received Immunization. (1957 ~ 1962)

------ -- - -'-- ---. ,

~

---

Vaccination

------

-

Year "---

I

1957

Smallpox Vaccination Typhoid & Paratyphoid Vaccination Diphtheria Vaccination Pertussis Vaccination Diphtheria-Pertussis Combined Vaccination Epidemic Typhus Vaccination Poliomyelitis Vaccination (killed vaccine)

Thousand Thousand ThOUSandj Thousandl Thousand Thousand 3,702 3,753 4,262 3,915 3,918 3.916 24,611 3,861 1.466 --

I

1958

I

1959

I

1960

I

1961

I

1962

23,893 3,811 1,391 -

23,082 4,696 1, 914 1, 358 23

21, 940 :~,

18,701 2,973 208 3,195 15

20,184 2.483 100 3,670

718 741

2,763 10

25 --

23 ---

11 2,824

-I

--

-

I

I

Prevalence of Major Communicable Diseases During the period of January 1962~Apri1 1963, Japan has remained free from the

quarantinable diseases. Most of other acute communicable diseases remarkably decreased and were well under control during the same period. l. Cholera One imported case of cholera was diagnosed clinically on 11 May 1963 at Kawaguchikocho (a lake-side town), Yamanashi Prefecture. The patient, an English gardner aged 22, arrived in Tokyo on 7 May from Bombay by Air India. Symptoms began on 9 May and he was isolated in Gakuroku Red Cross Hospital on 11 May. The National Institute of Health confirmed the diagnosis of cholera (lnaba type) on 12 May.

v

\

'

')..

I'

\"

~ (1920~ 1962)

Table 17. Annua.l Change of Cases, Deaths, Case Rate and Death Rate for Communicable Diseases. (Rate per 100,000 population) ._-----

----,--

Cholera Year 1920 1925 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 Cases 4,969 624 -

Dysentery Cases 12 ,723 14,720 29,672 29,655 32,249 38,040 42,939 48,964 52,053 78,283 80,221 97, 249 83,689 58,803 55,785 50,188 55,196 96,462 88,214 39,219 14,665 23,961 49,780 93,039 111,709 108,009 98,810 80,654 84,437 74,780 81,577 85,695 93,971 91,538 73,999

Typhoid Fever Cases

Paratyphoid Fever Cases

I Case Rate IDeaths IDeath Rate 9.0 1.1 -

I Case Rate I Deaths IDeath Rate 23.0 24.9 46.5 45.7 49.0 56.9 63.4 71. 3 74.9 111.8 .113.9 !137. 3 117.3 82.7 77.7 69.4 76.2 134.0 120.7 50.2 18.3 29.3 59.8 110.0 130.1 124.1 111.9 90.3 93.6 82.1 88.7 92.2 100.6 97.1 77.7 8,148 7,514 13,014 13,002 13,547 H,874 15,484 15,915 16,710 19,712 21, 955 24.890 22,025 16,295 14,268 10,208 11,208 20,107 13,409 9,573 5,157 7,765 11, 968 I 14,814 I 13,585 10,851 9,341 6,042 5,165 3,763 3,176 2,457 2,048 1, 636 1, 107 1

ICase Rate IDeat h s I IDeath Rate 97.0 112,073 77.3 10,468 64.8 8,340 58.9 8,163 6,936 53.8 57.5 7,632 62.6 8,129 55.3 7,192 I 52.9 6,847 7,062 54.4 59.7 7,803 53.4 6,954 57.0 7,106 57.1 6,904 49.6 6,428 72.6 6,925 79.3 7,844 7,999 80.5 61.1 5,446 22.8 2,926 11. 9 1,433 936 7.8 5.9 630 4.6 351 3.4 189 2.9 157 2.9 124 2.2 105 2.4 80 2.3 76 54 2.1 I 37 1. 71 1.7 39 1.1 34 12 1. 0 1 1

ICase Rate IDeaths IDeathi Rate I Cases I Case Rate IDeat h s IDeat Ratl 783 I 1. 41 3,166 5.7 442 i 0.7 I O. 7 430 0.6 i 7 0.0 372 0.5 I 0.0 23 308 0.6 0.5 305 368 0.5 0.6 333 375 0.5 320 319 0.5 0.4 113 0.2 279 0.4 178 0.3 276 0.4 0.1 263 90 0.4 0.1 295 60 287 0.4 293 0.41 575 0.8 312 I 0.4 0.4 308 654 0.9 281 0.4 381 0.5 0.7 546 0.8 508 0.4 564 0.8 311 526 O. 7 1,614 2.2 0.6 17,954 24.6 466 316 0.4 386 0.5 29 0.0 170 0.2 124 0.2 116 0.1 5 0.0 80 0.1 86 0.1 49 0.1 32 0.0 2 0.0 6 0.0 16 0.0 2 0.0 24 0.0 1 0.0 13 0.0 19 0.0 7 0.0 8 0.0 _. 8 0.0 6 0.0 _. 3 0.0 10 0.0 729 69 4 8 44 55 35 16 20 8 6 33 60 62 61 73 44 319 3,029 85 3 14 2 12 1

I

Smallpox

3,417 363 2 -

4

0.0 -

1

-

6.21 0.6 0.0 0.0 -

-

-

-

57 18 -

0.1 0.0 -

-

-

11 10 1 5

0.0 0.0 0.0 0.0 -

-

-

560 -

-

1,245 -

1.7 _.

-

-

0.7 -

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

14. 7 53,756 12. 7 45,768 20.4 41, 367 20.1 I 38,202 20.6 35,437 22.3 38,408 22.9 42,420 23.2 37,980 24.0 36,799 28.0 38,124 31. 1 42,074 35.1 37,837 30.8 40,706 22.4 40,595 19.4 35,589 13.81 52 ,519 15.2 57,448 27.8 57,933 17.6 44,658 12.3 17,809 6.4 9,486 9.5 6,391 14.4 4,883 17.5 3,878 15.8 I 2,898 12.5 I 2,521 10.6 I 2,567 6.81 1,939 5. 7 2,123 2,113 3.5 1 1, 901 41 2.6 1,546 2.2 I 1, 572 1,061 1.7 910 1. 2 I 1

21. 8 7,697 13.9 5,052 8.5 17.7 13.1 4,467 7.0 12.6 4,042 6.2 4,694 10.5 7.1 11.4 5,279 7.9 12.0 4,462 6.6 4,173 6.1 10.5 4,747 9.8 6.8 4,439 6.3 10.0 6,100 8.7 11.1 5,227 9.8 7.4 9.9 6,251 I 8.8 6,233 8.8 9.5 6,218 8.7 8.8 9.4 12,382 17.1 10.6 14,819 20.4 11.0 10,059 14.0 9,154 . 12.5 7.2 6.1 3.7 4,728 3.6 2,917 1.8 2,189 2.7 1.1 0.8 1,711 2.1 0.4 1,302 1.5 0.2 835 1.0 0.2 1, 098 1.3 0.1 0.9 760 0.7 0.1 590 0.1 509 0.6 0.1 0.4 344 0.1 1,149 1.2 0.4 411 0.0 I 319 0.3 0.0 0.0 213 0.2 0.0 0.2 203 1

1.: 0.1 0.( 0.( 0.1 0.1 0.1 O. ( O. ( O. ( O. (

I

O. ( 0.1 0.1 O. ] O. ]

1

1

0.1 0.4 4. C 0.1 0.0 0.0 0.0 0.0 -

-

-~

-

-

-

-

-

I

-

-

-

._--

~ ....,

(Continued to the next page)

(Con'd from the preceding page)

(Rate per 100,000 population) 'I

Year 1920 1925 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962

Epidemic Typhus Scarlet Fever Diphtheria Epidemic Meningitis Japanese Encephalitis Case Deatli'----Case ~ ~~Death ' Case '--Death - - - - - Case i Death Case Deafh Cases I Rate I Deaths I Rate 1 Cases I Rate " Deaths I Rate Cases I Rate 1Deaths I Rate 1 Cases I Rate 1 Deaths I Rate Cases I Rate I Deaths I Rate 66 28 1 3 3 4 26 18 1 17 5 3 87 100 1,374 3,941 2,461 32,366 1,106 475 111 938 3 16 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 O. 0 0.0 0.0 0.1 0.1 1.9 5.4 3.4 44.3 1.4 0.6 0.1 1.1 0.0 0.0 3 1 3 1 1 5 1 3 1 2 3 14 23 129 622 260 3,351 135 47 18 68 2 1 0.0

I

'" ()C

~ 0.0

-I -

I

I 1, 368 I 2.;) I 2,573 4.3 [ 0.0 6,025 1 9.4 I 0.0 6,480110.0 0.0 8,257 12.51 0.0 1 12,631 I 18.9 0.0 16,688124.61 0.0 16,506 24.0 1 0.0 16,707 24.0 O. 0 17, 602 25. 1 19,002 27.0 0.0 19,907 28.1 I 0.0 19,325 27.1 I 0.0 14,997 21. 1 0.0 12,688 17.7 0.2 9,891 13.71 0.8 6,354 8.8 0.4 2,405 3.3, 4.4 2,208 3.0 I 0.2 2,635 3.41 0.1 2,982 3.7 I 0.0 4,602 5.61 0.1 5,149 6.2 0.0 5,096 6.0 6,168 7.2 12,619 14.5 0.019,861122.5: 13,486115.1 12,172 13.5 14,499 15.9 13,734 14.9 9,882 10.6 1 8,786 9 . .1 6,251[6.6 8,382 8.8

I

I-

-I

---I

102 I - 0.2 15,113 1 27.3 284 0.5 13,775 23.3 1 303 0.5 18,522 29.0 327 0.5 '121,048 32.4 336 0.5 21, 811 33.1 40! 0.6 I 28,500 42.6 50~ 0.7 29,992 44.3 488 0.7 28,054 40.9 467 - 0.7 28,117 40.4 454 O. 6 28, 003 40. 0 1 398 0.6 28,323 40.2 475 0.7 35,803 50.6 388 0.5 38,303 53.7 268 0.4 40,442 56.9 217 I 0.3 44,431 61.9 165 0.2 63,756 88.21 114 0.2 94,274 130.1 82 0.1 85,833 119.2 100 0.1 49,864 68.2 0.1 28,307 36.2 42 I 0.1 16,377 20.5 58 0.1 14,555 17.8 33 0.0 12,621 15.2 34 0.0 10,749 12.7 48 0.1 8,381 9.8 56 0.1 9,589 11.0 87 0.110,49011.9 62 0.1 15,557 17.4 63 0.1 18,395 20.4 44 0.0 15,423 16.9 31 0.0 15,641 17.0 38 0.0 17,936 19.3 22 0.0 14,921 I 16.0 32 0.0 9,790110.4 21 0.0 I 7,451 7.8 1

711

,

--' 3,801 1 I 6.9 1 3,595 6.1 I 4,069' 6.4 4,582 7.1 4,509 6.9 5,418 8.1 5,215 7.7 4,432 6.5 4,321 6.2 4, 236 6. 0 4,118' 5.8 5,255 7.4 4,728 6.6 4,985 6.9 5,134 7.0 5,419 7.3 6,192 I 8.4 7,826 10.8 3,825 5.0 3,390 4.3 1,903 2.4 1,635 2.0 1,182 I 1.4 895 1.1 639 0.7 773 0.91 795 0.91 913 1.0 I 980 I 1.1 887 1.0 619 0.7 706 0.8 497 0.5 286 0.3 182 0.2

1I 949 I 1. 7 1 530 1 445 0.8 1 2751 275 0.4 1 168 280 0.4 165 238 0.4 165 359 0.5 239 1 _ 1,186 1.8 599 1, 304 1. 9 699 1, 003 1.4 601 839 1. 2 479 995 1.4 580 1,632 2.3 886 1,350 1.9 707 i 1, 160 1. 6 524 1 8231 1.1 443 1,113 1.5 398 1,468 2.0 396 4,384 6.1 1,072 1,436 2.0 455 3,373 4.3 1,187 2,052 2.6 650 1,446 1.8 492 1,193 1.4 367 1,111 1.3 302 912 1.1 227 8591 1.0 196 67610.8 155 630 0.7 161 610 0.7 147 760 0.8 155 638 0.7 135 573 0.6 124 526 0.6, 112 504 0.51 97 390 0.4 56

1. 0 0.5 0.3 0.3 0.3 0.4 0.9 1. 0 0.9 O. 7 0.8 1.2 1.0 0.7 0.6 0.5 0.5 1.5 0.6 1.5 0.8 0.6 0.4 0.4 0.3 0.2 0.2 0.2 0.2 0.2 0.1 0.1 0.1 0.1 0.1

• 1 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 201 0.3 263 0.3 4,757 5.9 1,284 1.6 5,196 6.2 2,188 2.6 3,545 4.1 1,729 2.0 1,758 2.0 3,699 4.1 4,538 5.0 1,793 2.0 3,900 4.2 1,979 2.1 1, 607 1. 7 2,05312.2 1,363 1.4 I

• • • • • • • • • • • • • • • • • • 99 228 2,620 1,177 2,430 956 1,437 720 732 1,373 1,600 744 1,349 723 650 826 521

• • • • • • • • • • • • • • • • • • 0.1 0.3 3.3 1.4 2.9 1.1 1.7 0.8 0.8 1.5 1.8 0.8 1.5 0.8 0.7 0.;)

O.~

Note: The population used as the basis of computation of these rates is the estimated population excluding Okinawa. The number of deaths for 1925~ 1942 is only for Japan Proper, exclusive of Okinawa, but the number of cases and deaths for 1943~1945 includes Okinawa. Consequently, there is some inconsistency in this table; the number of cases were taken from the Morbidity Statistics, and deaths were from Cause-of-Death Statistics and Vital Statistics. (number of deaths in 1962 is provisional).

f

t

7

__

- 29 -

2. Poliomyelitis The number of yearly reported cases of poliomyelitis has been showing an increasing tendency from 1955 till 1960. A serious epidemic occurred in Hokkaido in the summer season of 1960 with 1,600 cases, which was about 29% of the total cases which were reported in that year in Japan; the incidence rate of which was 31.8 per 100,000 population. Again in April, 1961, a relatively sharp increase in the number of reported cases was seen in Kyushu, particularly in Fukuoka, Kumamoto and Oita Prefectures. The active immunization against polio with Salk vaccine was introduced in the early summer of 1959. The epidemic in Hokkaido stimulated the public of a need for a large scale use of the vaccine, and a nation-wide program started in January of the following year, first 0:1 a voluntary basis, and then the vaccination became compulsory in April. Despite this intensive campaign with Salk vaccine, the fear for polio epidemic was so great that the Ministry of Health and Welfare decided to use the live oral polio virus vaccine (Sabin strain) in June, 1961. This emergency immunization carried out for the period of July-September 1961 covered all children aged from 3 months up to 6 years and most of those from 6 to 10 years of age. The number of the vaccinated through oral administration of the Sabin I, II, III mixture reached about 13 millions, among which 10 million children were immunized in the form of candy and 3 million infants were in syrup form. The mass campaign with the live oral Table 18. Comparison of Polio Outbreaks.

I--

I I I--

No. of Poliomyelitis Cases __ 1960 2,256 1, 031

I I

Period Jan.~July

I

I

1961 1, 933

I I

1962 164 32 93 289

I

August Sept.~Dec.

I

384 119 2,436

2,319 5,606

polio virus vaccine (Sabin strain) was carried out again from February to May in 1962. This immunization covered all children aged from 3 months up to 12 years. Type I Sabin vaccine administered for the first time, and type II and III bivalent vaccine administered during 6~ 8 weeks after the first vaccination.

Total

About 170 million children were fed each type of syrup form vaccine through this campaign. After these administration, the incidence was dramatically reduced as shown in Table 18. Dysentery The number of cases of dysentery has been gradually decreasing since 1960. The incidence rate and the death rate of dysentery reported during the period of 1962 were 77.7 and 1.2 per 100,000 population, respecively. Almost all of the cases were due to bacillus dysentery and only 71 were amebic dysentery. Some of the recent trends which should be taken into consideration are that the occurrence during summer month ha~ shown a smaller proportion to the total cases compared with that in the previous years, and the institutional or community-wide outbreaks have become more frequent. Out of 563 epidemics in 1962, 18.8% were classified as water-borne, 24.8% as food-borne, 48.8% as direct contact, and the rest 7.6% were not known. More intensive effort is being made for the periodic examination and health education of food-handlers, workers in water-supply work and other people dealing with food for public consumption. 3.

-- ilO ---

4. Influenza A total of 983,105 cases including 7,735 deaths were reported during the year 1957 when there was the Asian influenza epidemic (A 2 type virus). According to the epidemiological investigation, it was estimated that nearly 56% of the total population in Japan, i.e., 50 million people, were affected with the influenza. Thereafter, no serious epidemic has occurred until around April 1960, when A2 type virus influenza again became rampant throughout the country. A total of 142,829 cases, including 3,176 deaths were reported, and it became the 2nd big epidemic following 1957 epidemic. However, from around December 1960 till early 1961, an epidemic by B type virus influenza broke out throughout Japan, and as of 15 July 1961, number of reported cases reached 111,594 including 1,120 deaths, indicating that the epidemic became the 3rd big one since the last World War. As for immunization program, we have been using inactivated combined vaccine (AI, A2 and B type).

Table 19. Cases and Case Rate for Reportable Diseases. (Other than those in Table 17) ~-

I Malaria Measles Whooping Cough Influenza Poliomyelitis Tetanus Rabies Anthrax Tuberculosis Leprosy Trachoma Infectious Diarrhea Tsutsugamushi Disease Schistosomiasis ]aponica Filariasis Syphilis Gonorrhea Chancroid Lymphogranulomatosis Inguinale

1957

1958

1959

1960

1961

1962

INumber! Rate Number! Rate Number! Rate Numberl Rate Numbe1Rate Number! Rate

I

33 0.0 65.886 72.3 20.112 22.1 983.105 1.079.3 1.718 1.9

16 0.0 28 0.01 29.351 31. 9 75.417 81.1 29.948 32.5 9.742 10.5 32.944 35.8 2.610 2.8

16 O.O! 22 0.01 18 0.0 48.395 51. 8 39.192 41. 6 63.809 67.0 3.890 4.2 5.225 5.5 11.552 12.1

19.401 20.9 142.892 153.0 111.830 118.6 474.723 498.8 2.917 3. 1 5.606 6.0 2.436 2.6 289 0.3 I

I

853 0.9 853 0.9 820 0.9 760 0.8 945 1. 01 --- -3 0.0 5 0.0 3 0.0 2 0.0 520.829 571. 9 498.779 542.1 499.873 537.7 489.715 524.3 420.460 445.9 257 0.3 362 0.4 295 0.3 235 0.2 il61 0.4 77.922 85.5 37 0.0 41 664 61 0.0 0.7 0.1 63.404 68.9 45 0.0 35 1.983 122 0.0 2.2 0.1 54.992 59.1 131 0.1 40 936 39 11.468 9.970 266 6 0.0 1.0 0.0 12.3 10.7 0.3 0.0 45.173 48.4 226 0.2 63 449 59 0.1 0.5 0.1

707 0.7 -- 2 0.0

29.il66 ill. 1 2il.476 24.7 47 0.0 58 0.1 109 430 80 7.313 6.364 207 5 0.1 0.5 0.1 7.8 6.7 0.2 0.0 72 359 0.1 0.4 1.6 6.6 5.4 0.3 0.0

1. 536 6.301 5.125 256 5

18.011 19.8 86.195 94.6 2.216 2.4 25 0.0

13.211 14.4 24.367 26.5 733 0.8 13 0.0

10.126 10.8 8.736 9.4 214 0.2 10 0.0

I

I

· . 31 ..

The latest epidemic of influenza is the one occurred in the middle of January 1962, which, however, practically disappeared by the end of April in the same year. This epidemic appeares to be multicentric, spreading from urban areas to rural communities. The number of cases reported during that time was more than 470,000. Serological and virological examinations taken in several places demonstrated that the epidemic was due to A2 type virus. Mass vaccine administration against influenza was carried out from October to December 1962, using killed influenza virus vaccine, and most of all children in junior high school, primary school and kindergarten were vaccinated. Influenza epidemics had not been reported during October 1962~ June 1963. 5. Filariasis Endemic areas of filariasis have been found in the southern prefectures of Japan, and the estimated number of carriers is about 1 million. Since 1962, eradication programs had started in Ehime, Kochi, Nagasaki, Kumamoto, Kagoshima Prefectures and in Hachijo Island in Tokyo with the financial aid from the Ministry of Health and Welfare. The control measures taken in the selected endemic areas are 1) blood examination of the entire population excluding infants under 1 year old (about 500,000 persons), 2) treatment of carriers with diethylcarbamazine (expected carrier rate, 4%), and 3) mosquito control with residual spray. This approach is in principle to be continued for three years.

16. Port Quarantine Service The port quarantine service in this country is being carried out by the Quarantine Stations, Branch Quarantine Offices and Detached Quarantine Offices located at 46 seaports and 5 airports, in accordance with the Quaratine Law of 1951 (partially amended in April 1956) and the Law concerning Special Instances of the Quarantine Law relating to Military Vessels, etc. The set·up of those quarantine stations as of 1 July 1963 is as follows:

Table 20. a) b) a) Seaport Stations (2)

Names of Quarantine Stations at Seaports and Airports. -_._----_._--------

(1) ---

Hakodate; Kobe; Moji; Naga saki; Nagoya; Sasebo; Yokohama Hakata; Hiroshima; Kagoshi ma; Niigata; Osaka; Otaru; Shimizu; Tokyo --.

__.............. - - - - - - - - -

b) a) b)

Fushiki-Toyama; Iwakuni; lz uhara ; Kamaishi ; Kure ; Muroran ; Niihama ; Tokuyama-Kudamatsu; Waka matsu; Wakayama-Shimotsu; Yokkaichi; Yokosuka Naze .-~-~-

(3)

Chiba; Misaki; Yaizu; Maizu ru; Mizushima; Miike Aomori; Funakawa; Miike; Hachinoe' Hososhima; Karatsu; Kushiro; Matsuyama; Misumi; Nanao; Onahama '. Rumoi ; Sakai; Sakaide ; Sakata; Shiogama ;Tsukumi ; Tsuruga ; Y oron ; China; Wakkanai; Miyako; Saiki Kagoshima; Os aka; Tokyo Airport

Airport Stations

I (4) I Itazuke; I wakuni;

Note: These names are the names of quarantine stations, and their branches and detached quarantine offices, and not necessarily bear the same names as the ports where they are attachd.

- 32-

1. Those 7 quarantine stations shown in the column (1) a) are equipped with the quarantine hospital, detention house, disinfecting room and deratting facility. 2. Those 15 quarantine stations shown in the column (1), and 12 branch quarantine offices shown in the column (2) a), and 6 detached quarantine offices shown in the column (3) a) have the equipment and personnel necessary for deratting. 3. Those 1 branch quarantine office shown in the column (2) b), and 23 detached quarantine offices shown in the column (3) b), have no such facility mentioned above, but are able to perform routine quarantine business. 4. Those stations other than those in column (4) are able to issue the deratting exemption certificate also. 5. The airport quarantine service is being carried out at 5 airports shown in the column (4), and the Tokyo International Airport which is designated as the Sanitary Airport is equipped with the disinfecting room. During the year 1962, 19,515 vessels and 6,951 aircrafts, involving 999,199 and 407,806 persons, respectively, received quarantine inspection, 128,462 persons received vaccination for quarantinable diseases, and the vessels which received deratting service amounted to 1,065, and those which received deratting exemption certificate amounted to 3,755, respectively. Since January 1962, Japan had strengthened quarantine measures against cholera EI Tor which was then prevalent in the Philippines, with the belief that this disease should be included in the term of cholera under the International Sanitary Regulations. In the case of epidemic of cholera in Hong Kong and China (Taiwan) from July to September 1962, 40 cholera carriers including 3 cases (which were the imported cases) were detected among 7 ships upon their arrival at Japanese ports. However, we could prevent introduction of cholera into our country because of our rigid quarantine measures.

17. Environmental Sanitation Sanitation Facilities 1. W ater-Works According to the latest available information, the population served with water supply system during the year 1962 is shown below:

I Urban Rural Private Total

Number

I Population served I

1.093 12.384 2.674

43.459.575 8.040.761 2.452.125 53.952.461

I

16.151

I

In average, 57.2% of the total population is served by these water supply systems. Under the provisions of Water-Works Law of 1957, the water supply installation can be provided by cities, towns, villages, syndicate, private, provinces, and other communities so as to elevate the standard of public health by improving the environmental sanitation and by supplying safe drinking water. The Ministry of Health & Welfare may subsidize for the establishment of water supply system and so-called small-scale water supply system

--- 33 -

(covering less than 5,000 population), with one fourth of the total expenses. 2. Sewage Treatment As of the end of March 1963, there were 51 cities operating sewage treatment plants, and 7,000,000 population was covered by those services. 60 cities have been constructing sewage treatment plants. Under the provisions of Sewerage Law of 1958, the sewerage installation can be provided by public expenses of cities, towns and villages, and its construction is limited on public land. As for t.he administration of sewerage. Ministry of Health and Welfare is responsible for the sewage treatment and Ministry of Construction for the sewers. 3. Nightsoil Disposal The difficulty of nightsoil disposal is the most important environmental sanitation problem. According to the result of special survey made in 1960, only 29% was disposed by digestion plants and sewage system. 24% was used for fertilizer in rural farm, though this has been decreasing year by year and the chemical fertilizer has been replacing the role of nightsoil. 18% was dumped into ocean. In the calendar year 1962, there were 227 cities, operating nightsoil disposal plants. Additional nightsoil disposal plants have been under construction in other 233 cities. As one of the nightsoil treatment program, 7,000,000 population was benefitted by the sewage disposal plants in 51 cities as mentioned in paragraph 2. Nightsoil digestion plant is planned to connect to the sewage system in future. This is a special situation in Japan, due to difficulty of construction of sewers. According to the 5-year national program, it is planned that 21,000,000 population will be covered by flush-toilet system by the end of 1967. 4. Garbage and Trash Disposal Incineration is the most basic principle for disposal of garbage and trash. According to the result of special survey made in 1960, 37% of garbage and trash were incinerated in the designated public cleaning districts. In 1962, 23,000,000 popUlation was covered by incineration service and 1,352,000 population through compost plants. Insect and Rodent Control Under the present provision of Communicable Disease Prevention Law, the cities, towns, and villages are responsible for the control of insects and rodents, under the technical guidance of the prefectural governments, with financial assistance of the Ministry of Health and Welfare. At present each of the local health centers have the full-time staff to perform technical guidance for its district.

Ever since 1950, the model districts have been established in various parts of the country in order to demonstrate insect and rodent control prugram under the initiative participation of organized community people, and this has been quite successful not only in the control of h'1sects and the prevention .)f insect-borne diseases but also in popularizing the basic hygienic understanding and public consciousness, and thus in the general development of community social life. In 1955, the government initiated the three-year project for the movement of establishing "the life free from mosquitoes and flies", by which the eradication of insects was promoted. This movement was widely supported by positive understanding and cooperation of general public as proper movement for the improvement of people's every-day living, and the nation-wide effort was put into action. As the result,

-

34-

although this three-year project was over, even at present the movement is continuing under the supervision 01 each prefectural government_ In view of the fact that this kind of organized activities of community is needed in various health and welfare programs, the government took the special budgetary measure in 1959 in inaugurating the National Council for the Promotion of Community Health and Welfare Programs (juridical person), for the purpose of development of organized projects in the communities. Sanitary Inspection and Supervision According to the health center service report, 1,237 sanitary inspectors are engaging in field sanitary inspection and supervision. The distribution of their labour among various program is shown below: Inspection of commercial establishments under the jurisdiction of sanitary regulation ................................................... 86,248 person-days Rodent control ............................................. 12,286 person-days Insect controi ................................ · .... · .......... 30,225 person-days Public cleaning· ........ ·· .. ·· .. · .. ···· .... ·· ..... · ......... 23,408 person-days Drinking water facilities .............................. 16,585 person-days Public nuisance·· .. ····· .. · .. · ...... ·············· .. ·· .. ···· 4,417 person -days Others ......................................................... 21,361 person-days, Actual labour for field operation· .................... 178,482 person -days Administrative Regulation Under the provisions of the "Law concerning Improved Management of Business Dealing with Sanitation" (1957), in order to improve management of commercial establishment under the jurisdiction of sanitary regulation, the Central Council is provided in the Ministry of Health and Welfare to discuss the operational and trade standard which is satisfactory to maintain good sanitary condition. The Local Council is also provided in each prefecture to settle local standard which is based on principle of the standard settled by the Central Council. This locally settled standard is required to be approved by Fair Trade Commission

of Prime Minister's Office. Public Nuisance According to the rapid development of industry, transportation, and heavy concentration of urban population. public nuisance has been growing as serious public concern. Noise, smoke, air pollution, stream pollution are most common problems in public nuisance in this country. Until December 1962, the law dealing with protection of stream for public use is the only national legislation existed in these fields. The Economic Planning Board of the Prime Minister's Office has primary power and responsibilities for execution of this law; Ministry of Health and Welfare shares the responsibility from the side of public drinking water resource protection. Air pollution control program is now on the schedule of new administrative development. The Smoke Control Law was enacted in December 1962 in order to cope with the air-pollution problems. The designation of smoke emission source and specific noxious substances has been completed, and the control district designation and emission standard are ready for issue.

-

35-

Food Sanitation 1. Food Inspection

4,637 food inspectors (including 2,710 inspectors holding an additional post) are stationed in 808 local health centers to work on 2,045,762 food· handling establishments (including 1,090,438 establishments which are not required to be licensed). They perform inspection on the establishments and supplies of food and drinks. 2. Food Poisoning During the year 1962, the reported food poisoning cases were in total 1916 involving 38,166 patients and 167 deaths. (for 1961, 53,362 patients and 238 deaths in a total of 2,631 food poisoning cases). As regards the causes of food poisoning, 601 cases with 19,537 patients and 12 deaths were due to bacterial infection and entero·toxin; 6 cases with 45 patients were due to chemical poisoning; 169 cases with 483 patients and 85 deaths were due to poisonous plants and animals; and others were unknown. As regards the type of food causing these poisoning, 1,020 cases with 14,218 patients involving 125 deaths were by fish, shellfish and their products: 198 cases with 3,201 patients involving 8 deaths were cereals, vegetables and their products; 58 cases with 1,762 patients involving 3 deaths were by milk, egg, meat and their products; 247 cases with 9,707 patients involving 3 deaths were by other food, and 393 cases with 9,278 patients involving 28 deaths were by unknown food. As regards the kind of places where the causative food was taken, 1,021 cases with 9,790 patients involving 149 deaths were at home; 471 cases with 19,354 patients involving 2 deaths were at the establishments for mass feeding such as in the business place, school, hospital and so on; 128 cases with 2,600 patients involving 2 deaths were at hotels; 104 cases with 1,753 patients involving 6 deaths were at restaurants; 165 cases with 4,460 patients involving 4 deaths were at other places and 27 cases with 209 patients involving 4 deaths were at other unknown places. 3. Food Additives Chemical synthetics to be used as food additives are fully controlled by authorization system by the government, and they are listed in the Enforcement Regulation of Food Sanitation Law. Approximately, 292 chemical synthetic food additives are authorized for use at present. The manufacturers or processors of synthetic food additives or their preparations are required to have a qualified self· inspector by the law. In addition, the additional certification system is applied to coal·tar colours and several other food additives. These specified additives are required to be tested for each lot and to be certified by the Minister of Health and Welfare or the Prefectural Governor concerned before sale. The first edition of Official Book on Japanese Standard of Food Additives was published on March 15th, 1960. Thereafter, 3 supplements were issued; the first one in December 1960, the 2nd one in July 1961, and the 3rd one in June 1962. This Official Book prescribes the standard of 301 food additives, including chemical synthetic and natural food additives, for their definitions and standards of identity, specified use or restrictions, etc. This book was made by the Sub·Committee of Food Sanitation Invesigation Council which is provided by the Food Sanitation Law.

~

-

36-

4. Food Preservatives Recently many attempts have been made to utilize antibiotics to preserve food, especially fish. However, it is necessary to have further investigation on the allergic condition which antibiotics may give rise, or the creation of microbial resistance to antibiotics, and the effects on the intestinal flora. Under these circumstances, the use of chlortetracycline is only permitted in case of using it in the ice which is used for preserving such fish to be used as the raw material for such product as "fishcake, canned fish, salted fish and drycured fish." In this case, the amount is restricted to less than 5 p.p.m., and its possible residue in/on fish is restricted to less than 0.1 ppm. 5. Inspection of Imported Foodstuff The imported food is inspected by the inspectors of the Ministry of Health and Welfare at the main ports in this country. During the year 1962, 6,800,000 tons of food were imported to this country, and appro· ximately 1,700,000 tons of food were rejected or ordered to give additional process to make them safe for human consumption as the result of inspections. These were soya·beans containing morning glory seeds, milk products contaminated with bacteria and mould, confectioneries coloured by unauthorized coal·tar colour, and other food decomposed due to mis-handling. Veterinary Sanitation The following table shows the number of food animals slaughtered and of carcasses condemned during the year 1962. Table 21. No. of Animals Slaughtered and of Carcasses Condemned.

(1962) ----I

- Cattle Total No. Slaughtered No. prohibited from slaughtering No. of condemned carcasses No. of condemned parts (meat) No. of condemned parts (intestines)

----

I Calves ---------

Sheep

Goat

! Swine

Horses

Total

656.923 [ 187.417

81.995 01 71 318 1

123.4;--1~4.489 01 81 721 596 1 1.367\ 28. 856 1 I,

135.322 81 751 2.828\

7.429.579 623 1.997 41.953

I 1

13 1 387 1 8. 863 1

61 153 1

I I \

1. 0161 6.474\

211. 919 1

8.291

I I,

5, 227 1, 2.983.37fl

18.32513.233,614

-

Rabies Control

The rabies control program is also under the veterinary sanitation program in this country. There has been no cases of rabies in dogs after 1956. Finance of Environmental Sanitation Total budget of Environmental Sanitation Bureau for expenditure on environmental sanitation in 1962 was 3.8 billion yen (excluding personnel expenses). It is steadily increasing year by year. Total amount of national subsidy for local government in 1962 was 3.5 billion yen; these are subsidized for construction of nightsoil digestion plants, compo sting plants, sewage terminal disposal plants and small rural water plants. The amount of public loan for sanitary facilities allocated in 1962 was 68 billion yen.

-

37-

18.

Nutrition

,

-..I'

Nutritionist License of nutritionist is given to those graduating from the training school of 2 to 4 years authorized by the Minister of Health & Welfare or to those successfully passing the national examination for nutritionist. There are 132 authorized training schools for nutritionists and about 60,000 licensed nutritionists as of the end of March 1963. Cook The Cooks Law enacted in May 1958 stipulates the authorization on and supervision of the training institutions of cooks and the examination for qualifying cooks. There are 33 authorized training schools and approximately 400,000 licensed cooks as of the end of March 1963. National Nutrition Survey Since 1946, the national nutrition survey has been conducted four times every year in order to determine the condition of nutrition of the entire population. In the survey, intake of nutrients, physical measurements (height, weight, sitting height, etc.), physical symptoms probably due to nutritional deficiency (anemia, loss of knee jerk, cheilosis etc.) and also blood pressure are surveyed. According to the detailed evaluation based on the 1962 nutrition survey, the nutrients intake per capita per day as compared with that of the last year is as follows: animal protein 8.3% increase, fats 8.4% increase, vitamin A 5.7% increase, and vitamin BI 5.8% increase. As to the intake classified by foodstuff, the improvement of food-life of our people has been remarkable compared with that of the last year. For exampie, 18.5% more intake was made on milk and milk products, 20.8% more on eggs, 32.4% more on meat and 15.2% increase on fats and oil. The same can be said of rice consumption, there being a 3.2% decrease, though the tendency of relying on rice is still strong among the Japanese people, constituting a factor in vitamin BI deficiency. As to the general physique of the Japanese people, it was lowered as a result of poor food situation during and immediately after the War. However, during the past 16 years the remarkable increase was made in the height and weight of both male and female, and in 1962 it indicated also that the physique especially the height of male has still increased compared with that of the last year. Mass Feeding Many mass feeding places such as hospitals, schools, working places, etc. have been organized after the last World War from the view-point of nutrition improvement. Particularly, the school feeding has spread throughout the country, and at present over a half of the children of primary schools benefit from complete school lunch program. Demonstration Kitchen Car Since July 1954, several prefectures have initiated mobile nutrition demonstration services. They built the bus-type mobile-kitchen cars, completely equipped with necessary cooking utensils, supply of water and gas fuel, for nutrition demonstration. They are called "Demonstration Kitchen Cars," and the trained nutritionists are using the cars for lecture demonstration on preparation and cooking method for balanced diet for the housewives

-- 38 -

and women group. Such mobile nutrition demonstratioll has become very popular and is receiving warm welcome from the housewives wherever they go. At present each prefecture has at least one such car for that purpose. Enriched Food The taking of enriched food has been strongly advocated by the Ministry of Health

and Welfare, and at the end of December 1962, the number of enriched food permitted by the Ministry in accordance with the provisions of "Nutrition Improvement Law" amounted to 1,607. Those food such as the rice, flour, bread, noodle, bean-paste, jam, soft drinks, canned fruit, biscuit, etc, are enriched with vitamin A, thiamine (vitamin B riboflavin (vitamin B2 ), vitamin C, calcium, iron, lisin, etc. Particularly, the enriched rice has been encouraged for use in order to prevent malnutrition caused by the use of polished rice. When enriching rice, 1 gram of rice containing 1.2~1.5 mg. thiamine and a bit of riboflavin will be mixed in the polished rice at the ratio of 1 to 200. j ),

19. Dental Health Prevalence of Dental Caries The high percentage of prevalence of dental caries in age group was revealed by the dental survey carried out in November 1957. It was 84.1% in male and 86.0% in female, 85.1% in average. The survey also revealed that the number of DMF permanent teeth per

capita was those as follows: Table 22. Number of DMF Teeth. (per capita. permanent teeth) __

----------Sex 1-

_________________________

Age_-=-,I___~6 ~~~--1------;---1-_~_~~~_1_-5___'_ _ ______ 20

1

Male Female

0.5

2.1 2.4

3.1

4.3

0.7

4.0

5.0

Preventive Program 115 health centers out of a total of 808 health centers equipped with dental facilities and dentists, and the schools are playing important role in carrying out preventive program on dental health through dental examination and health guidance. Each school has the school. dentist in accordance with the School Health Law. Dental examination, health

,....

{

guidance and advice are being given effectively in those facilities, and particularly many schools have been taking proper preventive measures in their own facilities. Since 1952, the dental examination and health guidance for pregnant women and infants have been put into practice in accordance with the Child Welfare Law in the health centers or by guidance dentists designated by the Law. Consequently, 376,472 dental health guidance for pregnant women was given in 1962, for infants it was 900,469. Based on the Child Welfare Law amended in 1961, the program of dental examination and dental health guidance for 3 year-old children was carried out, and 593,434 infants were covered by the program in 1961, and its result is shown in Table 23.

Table 23.

39

~

-----------1

Results of Examination on 3-year-old Children. ---~------

---------

(1961)

I Dental Canes

Malocclusion --593,434----1-

Diseases oi--ISoft Tissues of Oral Cavity 593,134 8,442 1.4%

Others

N~~~ii~?d;;n-----l-----~,~~~---

593,434 3,559 0.6%

1_ _

1

~Aff~~~e~f Ch~dr:~ ______ 'l

__

463,760 -

25,806

I

j

Percentage of Children

II

_ I_ _

Aff_e_ct-=-~___

_ ____7_8_.l_~__

----~ 4.3%

-1-I

I

In 1962, 2,697 pregnant women received oral prophylactic treatment, and 66,762 infants received topical application of fluoride and oral prophylactic treatment, as the preventive treatment program which was commenced two years ago. Fluoridation of water has been put into practice in Yamashina district, Kyoto, since 1952, and the prevalence of dental caries in that area has been reduced by 30% comparing with other areas of the country; the fluorine content in the water in that area is 0.6 ppm. The Department of Dental Health Research of the National Institute of Health has been conducting many researches on the prevention and treatment of dental disease and oral health. The information on the number of dental clinics, dentists, etc. can be found in Chapter 24 (pages 45 and 47).

20. Mental Health Legislation

The mental health program has increasingly attracted public and professional attention in these years. In accordance with the recent developments in the concept of mental disorder, the Mental Health Law was put into force in 1950, repealing all the previous legislations which had the main objective in the safe custody of mental patients. Under this Law, in addition to the provisions of institutional care for the patients, the community care and the preventive work in mental health services are accelerated. Services for the mentally retarded children and child guidance activities are provided under the Child Welfare Law of 1947. In order to extend service for the mentally retarded people in general. the Law for the Welfare of Mentally Retarded Persons was enacted in March 1960. Surveys

Since 1954, special statistical surveys on mental health have been carried out 3 times by means of stratified sampling on a nation-wide scale. which is as follows: (1) Mental health survey in 1954, the purpose of which was to clarify prevalence of mental disorders in Japa:1, (2) Statistical survey of hospitalized mental disorders in 1956, the purpose of which was to know actual status of hospitalized cases from the medical and social viewpoints, and (3) Statistical survey of attitudes of the mental disorderd persons or their families toward medical treatment in 1960, a part of which cases were placed under observation for follow-up survey in 1961. According to the survey in 1954, the estimated prevalence rates of mental disorders were found to be 1.55% in male, 1.41% in female and 1.48% in total, respectively, and the

-- 40-

I

percentage distribution by sex of cases was 50.7% in male and 49.3% in female, respectively. The followings were, on the other hand, revealed by the survey in 1956. 61.4% of the total was the male patient and remaining 38.6% was female, which showed a comparatively higher proneness of hospitalization of patients as much as the sex distribution of morbid cases in the community is concerned. 70.0% of the total was schizophrenia, while, according to the percentage distribution by diagnosis of mental disorders in the prevalence survey in 1954, 15.5% of the total was schizophrenia. Percentage distribution by duration of stay in hospital at the time of survey of the hospitalized mental disorders was broken down as follows; less than 3 months 20.9%, 3-6 months 13.5%, 6 months-1 year 13.6%, 1-2 years 16.5%, 2-5 years 22.4%, 5 years and over 13.0%. According to the survey in 1960, the estimated number of new attending cases to the mental hospital in a year was approximately 254,000. The percentage distribution by diagnosis of cases in 3 surveys are shown in the following table. Table 24. -

Percentage Distribution by Diagnosis of Mental Cases. -

Morbid cases in the community in general (survey in 1954) Total Schizophrenia Manic Depressive psychosis Epilepsia Mental disorder due to syphilis Mental disorder due to intoxication Other psychoses Mental deficiency Other types of mental disorder (including neurosis) 100.0 15.5 1.1 9.6 1.4 7.0 7.3 44.5 13.5

New attending cases to mental hospital (survey in 1960) 100.0 24.1 8.4 9.9 1.7 4.3 9.1 3.5 38.0

Inpatients in mental hospital (survey in 1956) 100.0 70.0 3. 7 3.8 8.3 2.3 4.3 3.0 4.8

I i

I i

[ I

I

I

Social Security of Hospitalization Fee The Mental Health Law of 1950 was partly amended in March 1961, and has been enforced since Oct. 1, 1961. Under the amended provisions, the hospitalization fee to be paid by prefectural government for compulsory hospitalization is being subsidized by the national government with the ratio of eight tenth. Percentage distribution by the way of payment of hospitalized patient is, as of the end of March, 1963, approximately as follows; Mental Health Law 36.2%, Daily Life Security Law 34.3%, Employees' Health Insurance and others 29.5%. Mental Hospitals The latest figures of hospital accommodations for mental patients are shown below. Table 25. Psychiatric Beds.* National, Prefectural and Municipal 9.722 10,744 12,175 13,508 14,800 17,533 19,226 20,505 24.9 23.5 21. 3 20.4 19.4 19.6 19.4 18.2 Private, Juridical Persons [ & Others 29,388 34,905 45,045 57,857 61,333 71,781 80,117 92,244 75.1 76.5 78.7 79.6 80.6 80.4 80.6 81. 8 (March, every year)

.-

I 1955 1956 1957 1958 1959 1960** 1961** 1962**

I

I 39,110 45,649 57,220 66,365 76,133 89,314 99,343 112,749

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Note: * All psychlatnc beds 111clud111g beds 111 the mental hospitals and general hospitals. ** As of the end of June.

-- 41 ---

The latest figures of mental hospitals (excluding the psychiatric units in the general hospitals), their beds, hospitalized patients, bed occupancy, and monthly out-patients are shown in Table 26. The mental hospitals as classified by the bed-capacity are shown in Table 27. The mean capacity is calculated to be 154 in 1962. Table 26. 1-_

Mental Hospital.

(end of December) 1

----------_===~--T-1956 i 19;;-:~~-1;59J 1960J_~~lI962 Mental Hospitals Mental Beds Inpatients Bed Occupancy

I

291! 348 I 391 I 432 485 : 520 I 561 139,362 47 ,851 155,669 i 63,089 70,028177,2581186,396 , 42,973 : 50,982 1160,325 I 67,607 ! 76,329 I R4,213 95,845 I 109.21 106.5 108.4 I 107,21 109.0 I 109.0 i 110.9 I· 1 "I"

Monthly Out-patients I 50,711 : 64,033 Monthly Out-patients per 1 Hospital I 174 184 1

71,352 I 90,752 117,688 1132,643 1156,6861 183 ; 210 1 243 I 255 I 279 '1

Mental Health Centers and Child Guidance Clinics There are 47 prefectural and 6 muniTable 27. Capacity of Mental Hospitals. cipal Mental Health Centers in this country (end of June, 1962) operated under the Mental Health Law, --! Mental Hospitals through which local health authorities I Bed Capacity [- . FIgures % provide services for persons in psychological difficulties as well as mental disorders. --~~=~:--I---- ~! -----~:!

--

Child guidance services are also provided at 138 Child Welfare Centers by the local welfare authorities under the Child Welfare Law. Care for the Mentally Retarded

40~49

50~59 100~149 l.S0~ 199

19 156 142 87 81 18 15 16 561

3.4 27.8 25.3 IS.5 14.4 3.2

200~299 300~399

As of the first of April, 1963, 10,585 400~499 2.7 mentally retarded children were under the 500 and over 2.9 care of 165 Homes for Mentally Retarded Total 100.0 Children, and 1,700 children were attending 43 Mentally Retarded Children Day Care Centers. The National Home for Mentally Retarded Children was established in April 1958 and has been operating particulary for the severe cases of mentally retarded children. All of them are now operated under the Child Welfare Law. Under the provisions of the Law for the Welfare of Mentally Retarded Persons of 1960, each prefecture has the Prefectural Mentally Retarded Persons Consultation Center, and besides, there are 27 Homes for Mentally Retarded Persons as of July 1963. Training and Education of Juvenile Delinquents The children commiting or liable to commit delinquent acts are admitted to the Home for Training and Education of Juvenile Delinquents where they are given training and education under the Child Welfare Law. As of the first of April, 1963, there were 5,831 juvenile delinquents who were accommodated in 56 homes. There are two national homes for the juvenile delinquents, one for boys and the other for girls.

- - 42 --

21.

Rehabilitation Service

Statutory Provisions and Organization for the Services As for the rehabilitation services for the physically handicapped persons, it is provided under the Law for the Welfare of Disabled Persons of 1949 that it is the duty of the prefectural governors to establish and operate the consultation centers (50 centers in 1963) where the blind, deaf and crippled adults could be examined and receive the guidance from the medical, psychological and vocational standpoints, and to provide the prefectural social welfare offices (1,033 offices in 1963) with the staff specialized in the services for the welfare of physically handicapped persons. Provisions of the services for physically handicapped children under 18 years of age are included in the Child Welfare Law of 1947. In this case, consultation clinics are provided at the health centers. Preparation and Training of OT and PT Because of the keen interest and demand shown among those people engaged in the rehabilitation service for the physically handicapped as well as among medical profession to develop well organized rehabilitation service in utilizing occupational therapists and physical therapists, the government has recently planned to start preparation and training of OT and PT workers. As one of its stimulant and to serve the immediate need to prepare OT for the local rehabilitation centers for the handicapped, the government requested WHO to provide 3-month OT training consultant for 1962 and 2-month consultant for PT for 1963. The government, further, felt necessity of starting formal training program for OT and PT, since we have no professional workers in those fields, and the Training School for OT and PT was established in April this year, and it is now offering the basic course for the first academic year. Blind Persons Blind persons and persons with defective vision are provided under the laws with walking-sticks, artificial eyes, pairs of glasses, etc., and if necessary, with the medical treatment for the recovery of vision. There are 3 national and 3 prefectural Homes for Blind Adults where the blind adults are given the vocational guidance and medico-psychological treatments they need. Blind and partially sighted children are received in 32 Homes for Blind Children and are educated in 78 Schools for Blind Children. There are several publishers who are publishing books in braille points, and also several libraries for the use of the blind. Deaf Persons Persons with deafness or defective hearing are provided with various hearing aids and medical treatments for the recovery of hearing. The National Rehabilitation Center for the Deaf and Mute was established to give the persons with deafness or defective hearing the comprehensive medico-psychological treatments and vocational guidance. There are 40 Homes for Deaf Children and 105 Schools for Deaf Children.

-.

· . 43

~-

Crippled Persons

Crippled adults and children have been provided under the law with prosthetic appliances, wheel-chairs, etc., and, in cases of need, medical treatments. The National Rehabilitation Center for the Physically Handicapped in Tokyo and 44 Prefectural Rehabilitation Centers provide crippled adults with medical treatments, physiotherapy and vocational guidance. The Hospital-Homes for Crippled Children provide integrated services of medical care and rehabilitation for the seriously crippled children. As of the first of May, 1962, there were 5,453 accommodations for children in 55 Hospital-Homes for Crippled Children all over Japan. In addition to the hospital-homes, there are 32 special schools and 221 spe::ial classes where the crippled children are receiving school education.

22.

Radioactive Isotope and Peaceful Use of Atomic Energy

The use of radioactive isotope CR.!.) in this country has been commenced since 1950, and now it is being used at more than 900 institutions. It is mostly used in medicine in the field of research, diagnosis, and treatment, which is about 77% of the total R.I. The organization of the government responsible for the development of the peaceful use of atomic energy in this country is the Atomic Energy Co:nmission and the Atomic Energy Bureau of the Science and Technics Agency of the Prime Minister's Office. Particularly, the Isotopes Section of the said Bureau of the Agency is the main body in the national government in dealing with the production of R.I., planning, and execution of its use, while the prevention of hazard that may occur through the use of R.I. is dealt with in the Radiation Safety Section of the same Bureau. In view of the gradual increase of the amount of radioactive fall out due to the nuclear explosion tests frequently made in the recent years, the Headquarters of Counter-Measures for Radioactive Fall Out was established in the Cabinet on 31 October 1961, and on 25 April 1962, the Radioactive Section was newly established in the Atomic Energy Bureau of Science and Technics Agency to ensure satisfactory counter-measures for radioactive fall out be carried out. The various Ministries are sharing the respective responsibilities in the research work and the use of R.I. in the field of their own concern. Various research work on the use of R.L in the field of public health is being carried out at the National Institute of Health, Institute of Public Health, National Institute of Hygienic Sciences, National Institute of Nutrition, National Institute of Mental Health, and National Institute of Leprosy Research, all of which belong to the Ministry of Health and Welfare, and particularly, the Department of Radiological Health was established in the Institute of Public Health on April 1962. The laboratory facilities for R.I. at those institutions are being strengthened and expanded under the current year in order to carry out more intensive research work. The use of R.I. in the field of medicine for diagnosis and treatment is also being done at the National Cancer Center and National Hospitals, among which the First National Hospital of Tokyo, Second National Hospital of Tokyo, Osaka National Hospital, National Sanatorium Tokyo Hospital, National Sanatorium Toneyama Hospital and National Sanatorium Obuso are the main ones. In order to perform coordination of the research work on the medical use of R.l. and the prevention of radiological hazard, the National Institute of Radiological Sciences was

--- 44 --

created in 1957 under the jurisdiction of the Science and Technics Agency. For the purpose of preventing possible health hazards from radiation that may arise along the development of peaceful use of R.I., "Law concerning Prevention of Radiation Hazards due to Radioactive Isotopes and Others" was enacted in June 1957. While, for the purpose of preventing possible hazard that may occur at the medical institutions and drug manufacturing factories, the necessary requirements are provided in the Enforcement Regulations for Medical Service Law and the Enforcement Regulations for the Pharmaceutical Affairs Law which were revised in May 1959 and Feb. 1961, respectively. In addition, since August 1959, the Radiation Council of the government has been studying about the Recommendations of the International Commissions on Radiological Protection (9 Sept. 1958), and they reached the conclusion that in principle the said recommendation should be accepted in this country also. As to atomic reactors in this country, there are now 6 reactors, 2 of them were built for the Japan Atomic Energy Research Institute, and 4 of them are the small type atomic reactors for physical research purpose in some of the universities and the private research institutions. The atomic reactor for the medical use has been contemplated, but no definite plan has been made yet.

23.

Occupational Health

The occupational health program in this country, where the term "industrial hygiene" is used, is based on Labor Standards Law, Pneumoconiosis Law, Ordinance on Protection of Ionizing Radiation Injuries and their concerned regulations, and is implemented by the Ministry of Labor. As of the end of December 1962, there were 2,313 labor standard inspectors, who made the inspection of 294,606 factories out of the total of 1,723,678 factories (as of 1 Jan. 1963) including inspection of the health condition of the facilities. Pneumoconiosis, organic solvent poisoning, caisson diseases, and ionizing radiation iujury are the major occupational disease problems, and necessary preventive measures have been taken. The patients are given benefits out of workmen's compensation scheme for their treatment. Under the Labor Safety and Hygiene Regulations, the enterprise engaging in manufacturing business which have more than 50 workers and those non-manufacturing enterprise having more than 100 workers are required to appoint the health supervisors duly licensed by the government.

24. Hospitals and Clinics

Medical Service

Medical Service Law provides the detailed qualification for hospitals (medical care facilities having 20 or more beds), while the law does not provide such detailed requirements in case of clinics (medical care facilities without any bed or with less than 19 beds) and the administrator of these clinics must endeavor not to keep their patients for more than 48 hours except when inevitable circumstances exist. The hospitals are inspected and graded yearly by the medical inspectors on the basis of physical facilities, professional staff, and hospital management. This inspection system contributes greatly for the improvement of hospital services to the patients. It is true that the number of hospitals and their beds has increased rapidly in the

L -; I"" ~\;;:i h,j I ~~ ~~ I-~t! .-J A PI:' J },) I (.( ;;;'l recent years, and they are thought to be quite sufficient in number as far as per population ratio is concerned. However, we are now confronting with the problem of inadequate hospital planning and distribution, which resulted in receiving complaints of scarcity of medical facilities in some areas.

fROM'

f'l.(

SLIC I"

H ~~. ,~)

"'.I

v;;"

In order to relieve the problem, the Medical Service Law was amended, whereby the government can exercise its authority in controlling their planning and distribution of the public and non-profit hospitals. As for function of medical facility, because of the progress of medical science, it is necessary to improve function as well as to increase the number of hospitals and clinics. In order to meet these demand, government has established "The Law for Medical Care Facilities Finance Corporation" in July, 1960. By this regulation, the Corporation will lend low-interest and long-term loan to the private hospitals and clinics. The funds of this Corporation are about 5,500 million yen. The following tables show the statistics of hospitals and their beds. Table 28, Hospital 6,428 (as of the end of 1962) 6,229 ( 1961) Number of Hospitals and Clinics. General Clinic 61,366 (as of the end of 1962) 60.301 ( 1961) Dental Clinic 27,488 (as of the end of 1962) 27,263 ( 1961)

Table 29. a. Number of Hospitals.

Number of Hospitals. Beds, and Bed Occupancy Rate, (as of the end of 1962) 1

-..... Kind of [ Total [Tuberculosis . [ Mental [ . [ Communicable _ --,·------Hospital Leprosaria _________ Sanatoria Hospitals Disease Hospital _ Number of Hospitals 6,4281 516 583 14 52 Number of Bed b. '.

i

General Hospital 5,263 536,406

752,7141

105,517

92,317

14,260

4,214

Number of Beds and Bed Occupancy Rate. (1962) .

~i

Kind of

I

Total

1 I

1'B Bed 241, 305 80.0

[Mental Bed [LeprOSY Bed[ 120,300 1

C~~:~ni~~~le I 23,094 21. 9

General Bed 357,755 81.1

Number of Bed Bed Occupancy Rate

I 752,714

14,260 72.9

I

83.0

108.9

Note: "Bed Occupancy rate refers to the number of in-patients per 100 beds of the official rated capacity.

Medical Care Personnel Better standard of qualification for medical care personnel has always been the matter

of great concern for the government. The Fig. 8 in the next page shows the qualifications of various personnel as of 1962. Table 30 in the next page shows the number of training institutions for personnel and of students graduating annually. Under the requirement of various Japanese laws, such as Medical Practitioners' Law etc., the person holding a license to practice as the respective medical care personnel in a foreign country is allowed to practice in such capacity of the respective medical care

-- 46 ---

personnel In this country only when he obtains the Japanese license concerned after passing successfully the national or prefectural examination. Also, the law does not allow any reciprocal arrangement between the countries concerned as regards qualification for practicing referred to above. Fig. 8. Standard of Qualification for Medical Care Personnel.

Table 30. Number of Training Institutions for Medical Care Personnel and of Students Graduating Annually. (as of July, 1~J(j3) ------------i-----------------

Number of Training Institutions ------

I I

I

Number of Students Graduating Annually

Physician Dentist Pharmacist Public Health Nurse University Junior College Others Mid-wife Clinical Nurse University Junior College Others X-ray Technician Dental Hygienist Dental Technician As"istant Nurse

46 8 31 37 2

3,067 800 3,340 1,075

1 34 1, 065

25 245 2 5

535 6,683

238 19 19 6 570

810 565 165 17,090

Tables 31, 32 and 33 in the next page show the number of personnel. Although statistically speaking, the number of physicians, dentists and pharmacists is about the same as those in European countries on a per-population basis, the government has been confronted with the difficulties of excessive concentration of those personnel in the urban areas and of lack of qualified personnel in the field of public health work.

Table 31. Physician Year ---

Number of Medical Care Personnel. Pharmacist [Public Health Nurse Midwife Clinical Nurse

1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 --

Total Per ITotal I Per Total I Per Total I Per Total) PerNo. 10,000 No. 10,000 No. 10,000 No. 10,000 No. 10.000 Total i~rooo No. p' Pop. . Pop. i Pop. , Pop. Pop. op. Thou[Thou-I IThOU!Thou-! ThOU-, ThOU-, sand 1 sandi sand sand I Mod 85 9.9 29 3.4 50 5.81 12 1.4 55 6.4 105 12.2 90 10.31 30 5. 91 12 1. 41 56 6.5 3.5 511 112 12.9 92 10.5 31 3.5 51 5.8 12 1. 4 56 6.3 119 13.5 95 10.6 31 5.9 3.51 52 121 1.4 55 6.21 130 14.6 96 10.7 32 3.5 53 12i 5.9 1.4 54 6.0 137 15.2 98 10.8 121 32 3.5 55 6.0 1.3 52 5. 7 145 15.9 100 10.9 3.5 32 57 6.1 1.3 12[ 52 5.7 160 17.4 101 10.9 58 6.3 13' 3.5[1 1.3 52 5.6 170 331 18.3 103 11. 01 33 3.61 6.5 1.4 13i 52 5.6 186 19.9 104 0 33 3.51 62 6.5 3 51 5.4 195 1 i 20.7 11. 1 1. 41 105 11.1 34 62 6.6 141 1.4 50 4.8 204 21. 5 3.61 [ 1 1 1 I

I

I

Dentist

I

I

,ondl

WI

Table 32. Number of Physicians and Dentists by Type of Work. (as of the end of 1961) No. of Physicians & Dentists Type of Work Owner of hospital or clinic Employed in hospital or clinic Teacher and research worker of clinical medicine Teacher and research worker of medicine other than clinical medicine Engaged in other public health service Others Total Physician Number 50.917 37,027 9,385 2,029

Dentist Number 45,589 5,864 796 197 200

2,504 2,418 104,280

971 53,617

Table 33. Number of Nurses and Midwives Actually Engaged in the Work in 1962. Type of Work ---I--publiCHealth Nurses Midwives 29 1. fi2R

Clinical Nurses 1,000 19,1. 520 298

---Admi-~~~ration

,:nd

Tea~in;-r-------7-,t---!---1fi8 5,715 992 6,015 347 13,606

Hospitals and Clinics Health Centers Industries Schools Cities, Towns and Villages Private Duty Others Total

lfi5

2,440 10,895 238 45,955 5,705 1,124 205,087

Note: The figures of clinical nurses include 1,214 male nurses, 81,560 assistant clinical nurses, and 693 assistant male clinical nurses.

Medical Care Statistical Survey 1. National Health Survey The government has been conducting National Health Survey (Family Sickness Survey) and Patient Survey since 1948, on a nation-wide scale based on the sampling method. In the National Health Survey, about 10,000 households or 50,000 people in 210 areas in this country are sampled, and enumerate the incidence and prevalence of diseases and injuries among the people by the type of diseases or injury, geographic ar~, occupation,

-

48-

economic status, sex, age, etc., and also by how those diseases and injuries are treated, and how much the patients pay for the treatments. Table 34. Incidence of Diseases and Injuries, and Sick Days among the People. (per 100 population a year) .4f",

Name of Disease and Injury Total I. II. III. IV. V. VI. VII. VIII. IX. X. XI. XII. XIII. XIV. XV. XVI. XVII. YI. (s.m.) Infective and parasitic diseases Tuberculosis Neoplasms Allergic endocrine system, metabolic and nutritional disease Diseases of the blood and blood-forming organs Mental, psychoneurotic and personality disorders Diseases of the nervous system and sense organs (s.m.) Diseases of eye (s.m.) Diseases of ear Diseases of the circulatory system Diseases of the respiratory system (s.m.) Acute nasopharyngitis (common cold) Diseases of the digestive system (s.m.) Diseases of teeth and teeth-supporting structure Diseases of the genito-urinary system Deliveries and complications of pregnancy, child-birth, and puerperium Diseases of the skin and cellular tissue Diseases of the bones and organs of movement Congenital malformations Certain diseases of early infancy Symptoms, senility and ill-defined conditions Accidents, poisoning and violence Convalescent cares, plastic treatment and fitting of prosthetic devices

I

Incidence Rate

I Sick Days 2,836.9 218.6 150.0 33.7 96.0 21. 0 23. 1 337.3 --

210.9 5.5 0.4 0.6 2.5 0.7 0.2 12.7 -

-

,1. 2

83.0 74.3 39.7 17.1 1.8 0.4 9.0 12.0 -

281.1 501. 4 383.4 653. 7 195. 1 71. :l 11. 3 123.2 135.2 6.9 1.7 98.2 202.4 20.6

0.1 19.7 17.6 1.2

Note: The Incidence Rate and Sick Days are derived from the National Health Survey in Oct. 1961. Table 35. How the Diseases and Injuries are Treated. (Based on the National Health Survey in Oct.)

1960 Total Number of Diseases and Injuries Treated Not Treated Consulted Physician Consulted Dentist It {ACUpuncturist, Moxa-cauterist Consu ed Massagist or Judo-orthopaedist Treated by Home Drug Others

1961 --~----

100.0% 99.4 0.6 53.0 5.6 4.6 43.0 1.2

100. OJ,;' 99.3 0.7 53.9 6.2 3.8 42.0 1.1

Note: When disease or injury is treated by two or more kinds of treatments, each of them is counted one.

2. Patient Survey In the Patient Survey, 599 hospitals (1/10 of the nation's hospitals), 579 general clinics (1/100 of the nation's general clinics) and 266 dental clinics (1/100 of the nation's dental clinics), are sampled, and enumerate number of in-and-out patients who visit those institutions by type of diseases or injury, sex, age, and the method of paying the charge for treatment, together with the length of stay of hospital in-patients. (Refer Table 36).

-- 49 --Table 36. ~....

Number of Patients visited Hospitals and Clinics. (per 100,000 population a day)

I I. II. III.

Name of Disease and Injury Total Infective and parasitic diseases Tuberculosis (s.m.) Venereal diseases (s.m.) Neoplasms Malignant neoplasms _ (s.m.) Allergic endocrine system, metabolic and nutritional diseases Diseases of the blood-forming organs Mental, psychoneurotic and personality disorders Diseases of the nervous system and sense organs Diseases of eye (s.m.) Diseases of ear (s.m.) Diseases of the circulatory system Diseases of the respiratory system Acute nasopharyngitis (common cold) (s.m.) Diseases of the digesti ve system Diarrhea and enteritis (s.m.) Diseases of teeth and teeth-supporting structure (s.m.) Diseases of the genito-urinary system Diseases of the female genital organs (s.m.) Deliveries and complications of pregnancy, child-birth and puerperium Diseases of the skin and the cellular tissue Diseases of the bones and organs of movement Congenital malformations Certain diseases of early infancy Symptoms, senility and ill-defined conditions Accidents, poisoning and violence Special conditions and examinations without sickness Prenatal cares and postpartum observations (s.m.) Convalescent cares, plastic treatment and fitting of prosthetic devices Fitting of dental devices (s.m.)

I Total IInIOutPatients Patients Patients 5,054 538 319 19 56 35 194 21 127 683 314 160 246 524 174 1,353 178 713 152 68 62 444 163 15 7 33 340 27 27 68 68 1

669 240 223 8 28 18 9 4 103 31 6 3 27 16 0 86 2 0 22 4 19 5 15 4 2 3 51 4 4 0 0

4,386 298 96 11 28 16 185 18 24 653 308 158 219 507 173 1,267 176 713 130 64 43 439 148 11 4 31 289 23 23 68 68

IV. V. VI. VII. VIII. IX. X. XI. XII. XIII. XIV. XV. XVI. XVII. YO. YI.

I

Note: The number of patients are derived from the Patient Survey of July 12, 1961.

25. Pharmaceutical Affairs Legislation A new Pharmaceutical Affairs Law and Pharmacists Law which were promulgated and became effective on 1 February 1961 are now the basis for the requirements for pharmaceutical production and sale, etc. and control of pharmaceutical products and qualification and

-~

licensure of the pharmacists. Inspection of Drugs, Devices and Cosmetics The licensing system is adopted, under the Pharmaceutical Affairs Law, for all manufacturers of drugs, quasi-drugs, cosmetics and devices for the sake of quality control. Besides, the installation of every manufacturing factory has been improved, in accordance with the standards newly established by the Law. During the calendar year 1962, the Ministry provided 1,954 inspectors all over the country, who made a total of 201,664 inspections (9,391 for manufacturers, 35,027 pharmacies, and 157,246 others) out of a total of 370,000 places (20,696 manufacturers, 21,011 pharmacies, and others) in order to prevent adulterated, misbranded, or exaggeratedly advertised pharmaceutical merchandises to be sold to the public. Japanese Pharmacopoeia, Japanese National Formulary and Others The Japanese Pharmacopoeia VII was published on April 1, 1961, while the Minimum

-

50-

Requirements for Biological and Antibiotic Preparations have been revised. Poisoning by Organic Phosphorous Preparations The organic phosphorous preparations have been used as agricultural insecticides since

1952. As parathion and methylparathion are especially dangerous, this Ministry established the technical standards concerning the method of their manufacture, storage, use, etc., by the Cabinet Order. However, in spite of strenuous effort of the government, there have been many poisoning and fatal cases, of which figures are shown in the following table. Table 37. Number of Poisoning Cases and Fatal Cases by Parathion Preparations. C1958~ 1962)

Year 1958 1959 1960 1961 1962

Number of Poisoning Cases Operatives 816 484 535 553 302

Number of Fatal Cases Operatives Misuse 35 26 26 21 20 ! 1 11 5

I

Misuse

I

I I

Suicides 515 453 468 470 436

····-·D~·r-·-E-m-u-ls-i-on--I

Amout of Consumption of Parathion

I

16,379,000kg

873,OOOL 1, 093, 000 "

2 11

i

I 17,789,000 " 18,536,000 " 19,616,000 " 16,657,000 "

18

2,434,000 1,478,0001,200,200 q

.... Control of Awakening Drug

~

There has been no violation of Awakening Drug Control Law of 1951 by the authorized dealers. However, 563 persons were arrested because of illicit manufacturing, sale or possession of those amphetamine preparations and the like, in 1962. And also, by this law, the raw materials (1-phenyl-2-methylaminopropanol-1, 1-phenyl-2-dimethyl-aminopropanol-1, phenylacetic acid and others) are controlled as nearly the same as the awakening drugs. Narcotic Control Narcotic Control Law, Opium Law and Taima Control Law were partially amended on 11 July 1963. The purpose of the amendment was to arrange provisions relating to commitment of narcotic addicts to hospital, and to increase penalties against narcotic crimes, in view of increased number of narcotic addicts and more vicious narcotic crimes in recent years. During the year 1962, the narcotic control conducted by the law enforcement agencies resulted in sending 2,418 persons as violators to the Prosecutors' Office, which includes 1,773 cases (2,176 persons) of violation of the Narcotic Control Law; 203 cases (208 persons) of violation of the Opium Law; and 34 cases (34 persons) of violation of the Taima Control Law. The following items have been newly designated as the narcotic drugs, under Cabinet Order No. 421 of 1 November 1962; Nicocodine, Pethidine-intermediate-A, Pethidine-intermediate-B, Moramide-intermecliate, methadone-intermediate, Noracymethadol and their salts. Blood Transfusion Service Blood transfusion service is being controlled by two laws. One of them is "Pharmaceutical Affiairs Law" aiming at the maintenance of the quality of blood products such as the citrated whole blood, unfiltered normal human plasma, etc. and the other is "Bleeding and Blood Donor Supply Service Control Law" aiming at the protection of the donors' health from the ill effect which may be <:aused by improper bleeding. Thus, since 1951,

..

- 51Table 38. Production of Main Drugs and Devices. Production Quantity Kinds Items

1961 (Jan.-Dec.) Antibiotics Penicillin Dihydro-Streptomycin -Sulfate Chloramphenicol Chlortetracyclin Tetracycline Salkomycin Trichomycin Kanamycin-sulfate

I

1962 (Jan.-Dec.) 379,156 Billion l.U. 44,761 kg. 24,394 " 320 " 26,571 " 37 " l.U. 25,776 Billion 10,043 357,384 1, 333, 506 272,947 23,710 22,700 39,810 157,854 237,385 105,265 186,466 18,625 27,207 971,887 145,009 429,427 3,445 20,798 11,907,900 437 480 20,360 265 23 5 9,269,500 730 19 3,016 5,293 113 35,282 559,931 22,505,865 13,548 105,797 10,307 270,535 37,515 18,138,686 123,736,580 24,669 21,853 32,789 31, 257 82,654 30,046,835 46,930,715 171,998,302 kg.

358, 687 Billion 1. U. 42,890 kg. 19,500 " 2,503 " -

kg. 40 32,671 Billion l.U.

-

Anti-tuberculosis Sodium -p-Aminosalicy late Agents Ca1cium-p-Aminosalicylate Isoniazide Sulfa-drugs Sulfadiazine Sulfaguanidine Sulfathiazole Sulfisoxazole S ulfisomidine Sulfadimethoxin Vitamin Vitamin Vitamin Vitamin B, B2 B6 C

223,707 1,024,485 19,469 28,342 26,895 175,207 281,683 132,806 14,683 23,569 754,996 1,356,812 306,198 3,996 775 11,403,100 527 4,091 3,542 39 22 6 7,952,300 970 122 5,584 6,730 135 313,147 471,045 20,394,045 12,278 80,348 15,602 200,647 30,261 14,018,708 97,412,889 27,213 69,285 26,739 26,746 65,327 26,541,297 41,454,828 164,509,589

kg.

"

" "

• " " " , " " " " " " " t. doses

" " • " " " " " " " • "

Vitamin Preparations

,

Insecticides

Chlororophenotan Benzenehexachloride (99% T, Lindane) Santonin Cholera Vaccine Dried BCG Vaccine Diphtheria Antitoxin Diphtheria Toxoid Influenza Virus Vaccine Pertussis Vaccine Plague Vaccine Rabies Vaccine for Human Use Small-pox Vaccine Tetanus Antitoxin Tetanus Toxoid Tuberculin Typhoid & Paratyphoid Vaccine Typhus Vaccine Unfiltered Normal Human Plasma Citrated Whole Blood (Human)

Anthelmintics Biologics

" t. doses l.

t.

" " " " " doses I.

doses

" • " " •

t.

Medical Instruments

I X-Ray Film,

" " " " " " dozens pieces

• " " • " "

12 x 10 X-Ray Apparatus Centrifuge Lamps for Operation Sterilizer Apparatus Operating Table Injection Syringe Injection Needle Dental Equipment Handpiece

dozens pieces

" " " " " " " kg.

"

" " " " " "

Dental Instruments

• " kg.

Dental Materials Acrylic Resin Impression Material Dental Cement Porcelain Tooth and Acrylic Resin Tooth Sanitary Materials Absorbent Cotton Gauze

" " pieces pounds meters

" pieces pounds meters

"

-

52 --

there have been 47 licensed blood banks and about 100 hospitals such as Japan Red Cross Hospitals or National Hospitals which are rendering such services within the respective hospitals. Since 1961, the mobile blood collection system has been adopted in order to perform more convenient blood collection and there are now 17 mobile blood collection units being operated by the Japan Red Cross. Production of Drugs and Devices The supplies of drugs and devices are not only sufficient for the domestic consumption but enough to export with the exception of only a very few items. The yearly production amount of main drugs and devices are shown in Table 38 in the preceding page.

26. Major Research & Training Institutes in Public Health Programs For the purpose of performing research work on technical problems as well as training and educating public health technicians of various categories which are necessary for promoting public health program in this country, those major research or training institutes illustrated in the below table are established and are functioning as the affiliated institutes of the Ministry of Health and Welfare. Table 39. Kind and Orgnization of Public Health Research and Training Institutes. (as of 11arch 1963) Name of the Institute Institute of Public Health National Institute of 11ental Health National Institute of Nutrition National Institute of Health National Institute of Leprosy Research National Institute of Hospital Administration National Institute of Hygienic Sciences 21

I Establishment Date of I No. of I Staff 29 11ar. 1938 I Jan. 1952

Organization

I Locality Tokyo Chiba Tokyo Tokyo Tokyo Tokyo Tokyo

17 Sept. 1920 121 11ay 1947 1 July 1955 1 June 1949 1 11ar. 1874

National Cancer Center

1 Feb.

1962

219 116 departments, 1 library 38 6 departments, 1 section 6 departments, 62 1 section 543 15 departments, 1 library 2 branchesll 1 department, 27 1 section 14 3 departments, 1 section 290 12 departments, 1 library, 1 branch 21 4 experimental stations 416 1 hospital 1 institute (4 departments) 1 department

Tokyo

I

Note:

1) 2)

One branch is in Nagasaki and the other The branch is in Osaka.

III

HIroshIma.

Institute of Public Health This institute is performing training of public health technicians as well as study and research on the application of basic theory in medicine and public health which is necessary for such training program. The training programs consist of 3 regular courses al1d 10

- -- 5:i --

short courses, and the graduates of those courses totaled 10,855 up to March 1963; the majority of them being in government service, both national and local, actively participating in the health program in the different fields. It is to be mentioned that the Rockefeller Foundation of U. S. A. had rendered a great deal of financial contribution particularly in its foundation. The institute has been also extending its service to the foreign trainees in the recent years, who have been sent under UN-WHO or US-AID training programs. National Institute of Mental Health This institute is performing study and research on mental health as well as rendering consultation service on mental health by its mental health clinic and training of mental health workers as a national training center in mental health program. It has been closely associated with the Koonodai National Mental Hospital. National Institute of Nutrition This institute is performing survey and research on nation's nutrition condition and eating habit, physiological assay on nutrients of food and other assay and analysis of certain specified food and enriched food based on the Nutrition Improvement Law. National Institute of Health This institute is performing study and research on the infectious diseases and other specified diseases, and food sanitation. It is also giving training course, performing national assay of antibiotics and biological preparations and their experimental production. Because of the particular work of the institute, it is designated as the various WHO Western Pacific Regional Centers and Reference Laboratories, i.e., for influenza, enterovirus diseases, leptospira, Shigella, and respiratory virus diseases. National Institute of Leprosy Research This institute is performing study and research on the prevention and treatment of leprosy. It is closely associated with the National Leprosarium "Tama Zensho-en." National Institute of Hospital Administration This institute is performing study and research on hospital administration, and giving training for hospital administrators. National Institute of Hygienic Sciences This institute is performing test and assay of drugs (excluding biologics and antibiotics for which the tests are given at the National Institute of Health), food, food additives, cosmetics and devices. It also performs cultivation and research of medicinal plants, and research on drug manufacturing, and other test, investigation and research on those which are necessary from the standpoint of hygiene and sanitation. National Cancer Center This Center consists of hospital, research institute, and administration department. The hospital is giving the best diagnosis and treatment to the cancer patients by using the equipments of the highest quality. The major projects of the research institute are to make original research in the biochemical, chemotherapeutic and pathological aspects of cancer. The function of administrative department is not only to control the affairs of the hospital and the research institute, but is to perform the fundamental anti-cancer program throughout the country.

-

54-

27. International Cooperation on Health Programs The Ministry of Health and Welfare participated in the international technical cooperation in the health, medical and social service fields under the various schemes through the service of Overseas Technical Cooperation Agency which was established by the Foreign Ministry in 1961. As far as our Ministry is concerned, the emphasis was placed on the medical technical assistance for the countries in South-east Asia, Middle and Near East and Africa. During the year 1962, the government accepted and trained 27 WHO fellows, 1 TAO fellow, 11 US-AID trainees and 1 Colombo Plan trainee, and newly despatched 1 WHO project staff to Liberia (altogether 11 Japanese nationals are now serving for WHO), 12 experts under Colombo Plan, and 1 expert under Middle and Near East and African Technical Assistance Program in medical and public health fields. In order to disseminate correct information on the medical and public health situation in our country to the neighboring countries and other interested countries, the Ministry started to prepare sound movie films in technicolor in 1961. The first one entitled "A Report of Medical Services in Japan" and the second one entitled "TB Control in Japan" were completed in March 1962 and March 1963, respectively, and have been already circulated among the countries concerned by the overseas Japanese legations, Under 1962 year WHO fellowship program, a total of 17 WHO fellowships were awarded for our country by the WHO and received three-month WHO consultantship assistance for occupational therapist training in the program for the rehabilitation of the physically handicapped. The WHO Seminar on Japanese Encephalitis and Other Arbor Virus Infections was held in Tokyo during the period of 5-14 November 1962, and the Ministry assisted the seminar as the host government.

28. Public Assistance, Child Welfare & Social Insurances For the reference of readers, some of the informations on the program of public assistance, child welfare, and social insurances are given below. Public Assistance Public assistance is provided under the Daily Life Security Law (Law No. 144 of 1950) to all persons under certified cases of need after means test. Programs consist of, 1) Livelihood Aid, 2) Educational Aid, 3) Housing Aid, 4) Medical Aid, 5) Maternity

Aid, 6) Occupational Aid, and 7) Funeral Aid. Assistance is provided in principle as an out-door care, while some cases may be institutional. All aids except medical care are provided by cash. There are 1,033 Welfare Offices in Japan (approximately one per 100,000 population), and their welfare officials as case workers are providing services assisted by 127,330 volunteer workers, who are called welfare commissioners. The aids are financed 80% by the national government and 20% by the local governments. The following tables show some of the statistical data on public assistance.

~-

.

-

55-

Table 40. Fiscal Year

Number of Recipients and Amount of Payments. Rate of Recipients to the Total Population Amount of Payment (Monthly Average) Thousand Yen 3,789.125 3,647,312 3,728,648 4,089,055 4,645,422 5,101, 038 6,227,962 7,003,989

I I

No. of Recipients (Monthly Average)

I I

II

1955 1956 1957 1958 1959 1960 1961 1962

1. 929, 408 1,775,970 1,623,744 1,627,571 1,669,180 1, 627, 508 1,643,445 1,674,060

\

I

I

2.16 1. 97 1. 79 1. 77 1. 80 1. 74 1. 74 1. 76

%

I

Note: 1)

Provisional figures.

Table 41.

Number of Recipients and Amount of Payments by Type of Aids. (Monthly average, fiscal year 1962)

Item

Livelihood Educational Housing Aid Aid Aid I

Medical Aid

Maternity Occupational Aid Aid

Funeral Aid

Recipients (in thousand) Amountl l (in million yen) Note: 1)

1,524 2,805

521 255

I

703

488

0.5 2

7 32

3 II

I 253 3,151

I

I Provisional figures.

I

I

Child Welfare

Child Welfare Law (Law No. 164 of 1947) provides for a comprehensive program of care for children ages up to 18 years, and health and welfare of mothers. Programs consist of, 1) a net-work of child guidance clinics, 2) maternal and child health, 3) orphanages, 4) training homes for juvenile delinquents (ages up to 14 years), 5) homes for mentally retarded children, 6) homes for physically weak children, 7) homes for physically handicapped children, 8) homes for deaf and mute children, 9) homes for blind children, 10) mothers homes, and 11) infants homes. Social Insurance

The following table shows a bird's-eye view of all kinds of social insurances, giving some informations about the pertinent laws with their dates of promulgation, responsible agencies, the coverage of insurer and the insured people, etc.

-

56~·

Table 42. Classification of Social Insurances. Law Health Insurance Law Welfare Pension Insurance Law Unemployment Insurance Law Workmen's Accident Compensation Insurance Law Seamen's Insurance Law National Public Service Mutual Aid Association Law National Health Insurance Law Health Insurance Law for Daily Workers Mutual Aid Association Law for the Teachers and W orkers of Private Schools Mutual Aid Association Law for the Employees in the Public Enterprises Mutual Aid Association Law for the Employees in the Agriculture & Fishery Organization National Pension Law

... .. I Insured

I Date I 1922 1941

Responsible Ministry Health & Welfare Ministry

I

Insurer Government, Union Government

"

1947 Ministry of Labor 1947

" "

Employees in the working places (compulsory or voluntary)

"

& Welfare 1939 Health Ministry --.

"

Seamen Government employees

Aid 1948 Ministry of Finance Mutual Association & Welfare 1938 Health Ministry

Self·Government Other persons beside81 Union, Other those insured Bodies Government Mutual Aid Association Daily workers Teachers and wor· kers of private schools Employees in the public enterprises Employees in the agriculture & fishery organization Whole population those 20~59 years old, except those covered by other pension schemes Officials of cities, towns and villages, teachers and workers of public schools, and police officials

1953 1953

" Ministry of Education

1956 Ministry of Finance 1958 Ministry of Agriculture & Forestry

"

" Government

-Health & Welfare 1959 Ministry

Local Public Service Mutual Aid Association Law

1962

Ministry of Home Affairs

Mutual Aid Association

In the following tables, figures in "Coverage" and in "Pension" refer the data as of the end of March. Table 43. Coverage Fisc al No. of No. of Yea r Working Places Insured Thousand Thousand Health Insurance Managed by Government.

I

Benefit Medical Care (in kind) Othersi For Dependant For Primary Insured Cases Amount , Cases Cases i Amount I Amount Thousandl Million Yen Thousand Million Yen Thousand Million Yen

I

I

1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962

193 224 236 244 267 298 317 348 383 416 443

4,399 4,988 4,941 5,242 5,991 6,631 7,037 7,961 8,902 9,755 10,252

14,995 17,869 20,928 22,589 25.920 29,065 29,294 34.380 39,719 45,339 49,730

15,284 20,585 27,900 30,345 33,335 37,728 42,957 51,897 60,358 79,651 99,304

13,220 15,669 17,605 18.623 21,334 24,672 24,481 27,558 30,953 33,816 36,391

4,791 6,058 7,211 7,609 8,630 10,072 11,133 13,210 14,873 18,386 22,067

1, 733 1,886 2,043 2,111 2,105 2,341 2,419 2,584 2,782 3,107 3,442

5,473 6,656 8,068 8,553 8,337 9,420 10,404 10,943 12,157 14,711 18,840

Table 44. Health Insurance Managed by Association.

57-

I

Coverage Fiscal Year As~ocia-

No. of tlOn

I

------

I Benefit i Medical Care (in kind) Others No. of For Depen dant Insured -For~yTnsured Cases Amount I Amount Cases I Amount Cases Thousand Thousand Million Yen Thousand M illion Yen Thousand Million Yen

I

I

I

I

1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962

820 873 894 907 924 968 1,010 1,046 1,091 1,129 1,197

3,105 3,314 3,220 3,313 3,516 3,752 4,003 4,496 5,046 5,629 5,959

13,461 14,707 16,021 16,591 18,104 19,794 19,631 22,276 25,331 28,496

10,761 13,292 17,252 17,837 18,865 20,619 22,827 27,088 31,236 40,666

14,732 17,655 19,159 20,740 22,957 25,862 25,479 28,170 30,967 32,677

4,734 6,177 7,187 7,720 8,465 9,832 10,817 12,852 14,524 17,822 ...

8,686 8,804 9,157 9,625 9,973 11,766 12,127 13,656 15,105 15,946

...

8,172 9,309 10,619 10,553 10,483 11,616 12,581 13,828 15,214 18,364

...

Table 45. Fiscal Year Coverage No. of No. of Working Insured Places Thousand Thousandl

Welfare Pension Insuranse. Benefit Pension No. of Pensioner Thousand Lump-sum

I

I

Amount Million Yen

I

Cases

Thousand

I

Amount Million Yen

1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962

I

i

I

205 239 I 254 265 288 I 322 327 361 399 436 469 I

7,034 7,790 7,883 8,227 9,154 10,023 10,393 11,746 13,224 14,710

15,58Z _

95.8 119.2 132.5 163.4 191. 8 218.2 242.4 272.6 302.5 337.3 378.5

1,917 2,483 3,446 4,340 3,127 5,856 6,514 7,413 8,623 9, 757 11,159

I

99 117 163 207 190 216 247 245 251 253 281

I

1, 807 2,617 2,719 2,716 2,343 2,691 3,231 3,162 3,354 3,650 4,411

I

Table 46. Unemployment Insurance. Fiscal Year Coverage No. of Working No. of Insured Places \ ------Thousand Thousand Benefit Weeks ~nemployed

I I

I

Thousand

I

Amount Paid Thousand

1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962

208 230 235 242 261 284 308 342 375 420 456

6,849 7,695 7,921 8,064 8,987 9,770 10,410 11,669 13,086 14,532 15,467

14,931 16,153 22,028 19,038 13,421 14,824 20,546 17,138 16,294 17,148 22,265

20,669 25,404 35,552 30,834 24,362 27,952 40,383 35,201 35,393 41, 856 61. 795

Note: Excluding daily laborers. Table 47. I

Workmen's Accident Compensation Insurance. Benefit Cases Thousand

Fiscal Year

I-No. of J::'lacesCoverage I No. of Insured - I Workmg Thousand Thousand

I

Amount Paid Million y-en

...i._.

1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962

I I

I

372 454 491 559 586 658 700 751 808 866 842

8,057 9,363 9,679 10,244 10, 725 12,207 13,012 14,500 16,186 17,975 18,558

1,419 1,572 1. 721 1, 693 1, 937 2,163 2,225 2,426 2,768 3,005 3,233

11,764 13,928 16,111 16,187 18,387 21,242 22,373 24,433 27,172 32,125 38,947

- 58Table 48. Seamen's Insurance. (a) Ordinary Insurance. Coverage Fiscal No. of No. of Year Ship- Insured No. of owners Pensioner Thousand Thousand Long-term Benefit --Pension- -Lump-su~ Amount Cases Amount Benefit Short-term Benefit Others Medical Care (in kind) For Primary For Depen-, Insured Amodant I A Cases unt AmoCases U1~o-1 Cases unt

I

I

I

Thou- Million sand Yen

Thou- Million Yen sand

Thou- Million ThouYen sand sand

Million

Yen

Thousand

Million Yen

1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962

7.3 7.9 8.0 8.1 8.4 8.9 9.3 9.7 9.7 10.0 10.3

144 154 162 165 177 189 199 206 216 225 227

19 20 21 22 21 22 23 24 26 27 29

205 244 467 519 544 587 663 749 862 950 1. 072

1.9 2.3 1.8 1.4 1.5 1.6 1.8 1.9 1.9 1.7 1.8

132 189 192 205 231 224 320 342 351 372 411

726 770 901 1, 007 1,058 979 914 1,014 1.061 1,147 1,223

655 783 1,032 1,115 1, 194 1,231 1,411 1.661 1.771 2,202 2.690

475 574 681 766 905 1,070 1,094 1.247 1.390 1.497 1, 560

173 220 272 301 353 429 491 583 648 784 917

82 89 112 135 139 150 169 188 195 206 224

505 614 785 899 947 1, 056 1, 314 1.495 1,600 1,877 2,421

I

(b) I

Unemployment Insurance. Coverage Benefit Cases

Fiscal Year

I

I I

I I 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962

No. of Ship-owners I Thousand

No. of Insured Thousand

Thousand

I

Amount

Million yeni

5.6 5.9 6.0 6.0 6.2 6.6 6.8 7.2 7.2 7.4 7.9

92 93 93 93 103 113 115 120 126 140 143

137 139 132 107 90 81 124 115 96 90 135

265 303 292 241 224 213 342 322 281 310 567

I I I

I I

Table 49. Coverage Fiscal No. of No. of Year Ass'n Insured I ~o. en s~f 1oner Thousand

National Public Service Mutual Aid Association. Benefit

Long-term Benefit --Pension Lump-sum

--I

Amo-I Cases unt

Amount

Thou- Million sand Yen

I

Short-term Benefit Medical Care (in kind) \ Others For Primary For Insured Dependant C Amount o Ama Cases unt - Cases A u:::' -lases

I

I

Thou- Million Yen sand

Thou- Million ThouYen sand sand

Million Yen

Thousand

Minion

Yen

1952 1953 1954 1955 1956 1957 1958 1959 1960 1961

30 29 29 29 26 27 27 27 27 27

2.531 2.590 2,634 2.695 2.040 2.069 2,129 2,137 2.160 2.221

188 188 191 193 30 31 22 24 30 39

6.735 8,274 8.398 8.473 1,569 1.646 1.128 1.489 2,489 3,892

153 102 102 80 72 80 85 69 53 60

2.778 2.380 3.204 2.875 2.637 3.733 4,703 3,853 3.547 4,711

10,872 11.336 11.887 13.284 9,596 10.470 10.035 10.913 11.487 11 940

9,443 8.984 11.024 10,857 12.843 12.112 14,159 14.462 11.189 12,322 11.763 14.024 12,062 13.864 13.291 15,192 14,040 15.840 16,414 16.354

2,945 3.797 4.552 5.340 4.899 5.548 6,012 7,021 7.481 8.562

3.061 3.315 3.675 2,442 1.100 1,053 1, 062 942 1.068 1, 752

4.083 5,236 5,192 4.238 2,590 2.654 2,771 3.383 7,943 5.224

Note: Figures for years after 1956 do not cover those coming under the Public Enterprise Organization, and those for 1962 are not yet available.

Table 50. Coverage Fiscal Year No. of Unions 4,990 5,131 3,669 3,169 2,870 2,941 3,167 3,365 3,599 3,636 No. of Insured Thousand 23,089 24,906 26,633 28,711 30,582 33,576 37,239 43,437 46,17l 46,809 Medical Care Cases National Health Insurance. Benefit Others Cases

59 --

1

i

1952 1953 1954 1955 1956 1957 1958 1959 1960 1961

Thousand 29,27l 34,147 41,231 49,158 58,245 68,945 74,947 93,134 113,053 124,100

I

Amount Million Yen 18,134 23,734 31,308 37,388 45,326 54,819 67,125 91,022 117,117 157.188

Thousand

I

Amount Million Yen

...

...

542 604 701 756 784 876 975 1, 075 1,151

259 341 478 551 613 757 991 1,209 1,467

Note: Figures for 1962 are not yet available.

Table 51.

Health Insurance for Daily Workers.

>Fiscal Year

I 1956 1957 1958 1959 1960 1961 1962 ---

Coverage No. of Insured (estimates) Thousand 748 802 1, 032 1,162 1,142 1,009 903

Benefit Medical Care (in kind) For Primary Insured For Dependant Cases Cases I Amount I Amount Thousand Million Yen Thousand Million Yenl 1,759 2,564 570 939 2,001 3,015 1,150 676 3,768 1,531 2,327 891 4,737 2,849 2,062 1,156 3,233 5,426 2,392 1,293 3,485 6,926 2,535 1, 555 8,923 2,631 1, 859 3,749

Others Cases Thousand 46 50 78 128 146 155 169

I

I

I

Amount Million Yen 77 79 123 208 247 372 501

I

Table 52.

National Pension. Non-Contributory Pension No. of Recipients Thousand

--_. Fiscal Year

I I

Contributory Pension Amount of No. of No. of Insured Recipients Benefit Thousand Million Yen Thousand

I

I

I

1959 1960 1961 1962 -

-

--

-

...

Amount of Benefit Million Yen

...

18,241 18,533

11. 3

275

2,501 2,542 2,665

30,213 30,796 32,367

.'

<-

Compiled by the Office of the Counsellor for Liaison in International Affairs, Minister's Secretariat, Ministry of Health & Welfare Japanese Government Tokyo, Japan -------------------

-'-

REPUBLIC OF KOREA Report on the Progress of Health Activities in 19G2

1.

GENERAL

--J

In 19'~,2 the Government made every effort to improve the health of the people in accordance with the Five-year Economic Plan. As a result of the plan to re-organize the health services, which was legally established in 1961, health activities have been considerably expanded at each level of the national and local health administration. A net work of local health services has been established in which emphasis is placed on specific problems and needs. Since 1961 WHO-assisted projects have played a major role in the development of public health activities. The assistance provided by UNICEF represents another advance in the expansion of health programmes. The number of health personnel registered in 1962 was as follows: Physicians Dentists Nurses Midwives Pharmacists Herb medical Total 2.

·....... . · ....... . • • • It • • • • •

8 105

1 630 6

• •••••••• • • • • • • • It •

4 976

557

~ 141

~octor.

•

•••••• t

•

3 170

.................. 29 579

EDUCATION AND TRAINING

Public health workers are given short .. term in· service training at the National Institute for Public Health Training (NIPHT), Ministry of Health and Social Affairs. The School of Public Health, Seoul National University, is responsible for the academic training of health personnel. The number of schools is as follows: No. of Annual Numbers Graduates Medical schools Dental schools Pharmaceutical schools • •••• Nursing schools • •••• Herb medical school* • •••• Total

·.... · ....

8 1

b27

13

100 1 150

25 1

797

175

..............

48

2 849

3.

MEDICAL AND HEADTH FACILITIES

There are 20 general hospitals, each of which has a capacity of 100 beds or more. During 1962, there were 182 health centres; this

*No new enrollment

- 2 -

number has now risen to 189 making a ratio of one centre for each Gun (county) and Ku (city). The health centre serves as a local health unit as well an administrative agency.

as

Institutes General hospitals Hospitals Health centres Clinics Tuberculosis sanatoria Leprosy institutes Mental bospit als Total

Beds 3 003 '7 477

·...... · ...... · ...... ·...... · ...... ·...... • 6 •••••

L)

141

182 3 328 9 40

---2 3 719

19 261 660 32 634

2 233

,.-

• • • • • • • • • II • • • • • • •

4.

LOCAL HEALTH SERVICE DEMONSTRATION PROVINCE

Based on the recommendation of the joint WHO/USAID survey team, a local health service demonstration province was established in Chungchong Namdo at the beginning of 1963. WHO, UNICEF, the Scandinavian Countries, USAID and the Korean Government are participating agencies. The immediate objectives are to establish integrated health services, as a basis for the upgrading of all health services, and to train health personnel. There are 5 provincial hospitals, 17 health centres, 51 sub-health centres and public doctors' clinics involved in the project.

5. 5.1

MAJOR PUBLIC HEALTH PROBLEMS Acute communicable diseases

No case of smallpox was reported in 1962. However, typhoid fever and Japanese encephalitis were reported as major communicable diseases. The Government has carried out vaccination campaigns against typhoid fever (17 million persons), smallpox (3 million), DPr (0.7 million) and typhus fever (100.000). Poliomyelitis vaccination was started in the urban areas. 5.2 Chronic communicable diseases

5.2.1 Tuberculosis Tuberculosis is recognized as a major public health problem in Korea, with an estimated 1 000 000 cases; 4% of the population. There were only 2700 tuberculosis beds in 41 hospitals for this large number of patients. In order to set up an effective tuberculosis control programme, the Government has replaced hospital care with domiciliary treatment. A total of 100 COO patients has been registered by the medical and health centre services since the start of the programme in 1962; all have received domiciliary treatment.

-,

.. o.

3 ..

Mass tuberculin testing, BeG vaccination of pre-school and school_ children, and mass case-finding activities were carried out by mobile vaccination teams and by the health (~entres. WHO and UNICEF are aSSisting in another pilot project; which was initiated in 1963, to study the epidemiological characteristics of the disease and to develop simple and inexpensive case .. finding and treatment methods appropriate to local conditions. ..... ·f

No. No. No. No. 5.2.2

of of of of

patients registered persons tuberculin tested persons vaccinated with BOG persons X-rayed

· ..... . ·..... . ·..... . ·..... .

19 b69 3 357 241 1 856 675 711 800

Leprosy

Leprosy in Korea is a major problem with an estimated 100 000 cases. The Government has spent a large portion of the hea~ budget on the support of the 32 320 leprosy patients who were segregated in the leprosaria and colonies. In addition, there ar.e an estimated 70 000 patients to be found and put under treatment. According to a survey of the patients formerly segregated, more than 65% were found to be non-infectious. Accordingly, the law of compulsory segregation was amended to abolish compulsory segregation. Home -care instead of institutional care is now emphasized and out-patient clinics and mobile units playa very important role in this. Bacteriologically negative patients are to be discharged from hospitals and leprosaria and either sent home or to self-help settlements. The infectious and disabled cases in private colonies are to be transferred to the national leprosaria for further medical care. Of the non··infectious patients capable of undertaking work,400C have been discharged from national and private leprosaria and resettled. The number of registered patients remaining in institutions throughout the country is 27 919. Institutes National institutes Pr1vnte.colonies Mobile clinics Health centres Cases

·..... . · ..... . ·..... . ·..... .

3 56 2

8 700 12 359

182

6.

FAMILY PLANNING

According to the last census at the end of 1962, the population in South Korea alone is 24 990 000. The natural rate of increase is 28.8 per 1000 population. In order to solve this problem, family planning was adopted as a major policy. The key staff were trained by the Ministry of Health so that they could carry out family planning campaigns throughout the country. Two staff members were assigned to each centre for this purpose and free contraceptives were distributed to the indigent reproductive ag~group.

- 4

No. of personnel assigned •.•••••••.•••••••.• No. of pc:rsons sUPlllicc1 with cont:raccpti ves 8.nd medi cine •••••••••••••••••••

366 378 500 85 000

No. of personnel trained -)(.

• •••.••••••••••••••

7.

ENVIRONMENTAL SANITATIOn

With the promulgation of the Food Sanitation Law on 20 January 1962 the Government has tried its best to improve food sanitation and to deal with the nutritional problems. The regulation provides for measures and requirements concerning the production of food for sale and export and the inspection of food services. A number of public wells have been established to i~rove the drinking water supply throughout the country, especially in the local areas where improved environmental sanitation is badly required.

r -~ I

Ii"" ~r,<,> .

BRIEF REPORT OF THE PROGRESS OF HEALTH ACTIVITIES FEDERATION OF MAJAYA

.

I

1. MaJ.~a

The general health of' the population of' the Federation of' has shown a s~ow but steady progress during the past f'i ve years. The f'ollowing statistical returns will confirm the above statement: ~957 ~958 ~959 ~960 ~96~

.. ·r

Census Population Population Death rate

Estimated

Estimated

Estimated

Estimated

6 278 763 12.4

6

5~5

385

6 697 827 9.7

6 909 009 9.5

7

~36

804

11.0

9.2

MaternaJ. death rate per ~OOO live births Infant death rate per ~OOO ~ive births Fi ve ~.

3.2

2.8

2.~

2.4

2.0

75

79

66

69

60

~eading

causes of' deaths

PyreJda of' unknown origin 34.8% mention of Psychosis

35.6%

31.1%

29.67%

31.%

2. Senility without ~7 .Cifo ~7.% ~9.4% ~O.~%

19.75% 9.64%

20.5% 8.~10

3.

Inf'anti~e

Convulsions ~O.O% of' early infancy

11.0% 2.% 0.8%

4. Certain diseases 3.2% 2.5% 2.7% 0.6% 3.0% 2.67% 2.9% 0.7%

..

,

5•

Vio~ence

Common Diseases amongst the E9pulation

1. Tuberculosis Pulmonary tuberculosis which aff'ects about 3.4% of the population continues to be a maj or health prob~em in the country. 2.

MaJ.aria

Whi~e malaria is still endemic in the rural areas, it is well under contro~ in urban areas where re~ar anti..malariu measures are being carried out. Anti-maariu m~s are wo carried out in some of' the ~arger estates in the country.

- 2 -

3. Yaws This has ceased to be a public health problem in many States.

4..

Filariasis

This is still prevalent in certain localized areas but steps are actively being taken to have them treated. :

5. Gastro-enteritis and diseases of the bowel continue to be a disease and problem among the rural population. With the Rural Health Services getting into stride it is hoped that this problem will be tackled soon. 2. RURAL HEALTH SERVICES

With the object of improving the health of the rural population, Who comprise nearly 70 per cent of the total population, the Government, following its declared policy, began its Second Year Development Plan with the construction of midwives quarters-c~clinics, sub-health centres and main health centres. Each midwives quarters-cum-clinic is to serve 2000 people; each sub-health centre to SEl" ve 10 000 of the population and each main health centre is to serve 50 000 of the population. A Medical and Health Officer is to be posted to a main health centre and he is the officer to be in charge of one main health centre, 4. sub-centres and 25 midwives quarters-cum-clinics. The Medical and Health Officer is responsible to the Medical Officer of Health of the District. A Dental Officer is also to be posted to everyone of the main health centres and he takes care of the Dental Service in the rural health set-up. The function of the health centre is curative as well as preventive, with emphasis on the preventive aspect, maternal and child health service is the main scope of work of the health unit, followed by environmental sanitation. The year 1962 saw the biggest number of midw! ves clinics and sub-health centres built during the Second Five Year Development Plan. The number of main health centres, sub-health centres and midwives clinics completed in 1961 and 1962 axe as shown below:

Main health centres

1

12

Sub-health centres Midwives quart,rs- 'eum-clin1cs

3 29

39 318

There is an increasing awareness on the part of the rural population in accepting scientific medicine. This increasing demand in turn requires more staff that have to be provided by the Mim.stry of Health. While there is a shortage of trained personnel at the present jlm.cture, it is hoped that before lang there will be suf'ficient trained staff, particularly of the category of public health nurses, to man the health units that have been constructed.

f

•

- 3 The increasing demand made on the health units is as shown overleaf.

Number of hame confinements Number of hame visits

48 803 842 619

53 246 961

360

During visits, either by the health visitor, midwife, health inspectors or health overseers, health education is al~s given.

3.

NATIONAL TUBERCULOSIS CONTROL CAMPAIGN

_:.t

Pulmonary tuberculosis continues to be the No.1 public health problem in the Federation of Malaya. By virtue of its importance, a Senior Tuberculosis Specialist ~s appointed in 1958 and the !l8.tiooal. tuberculosis campaign was set up in 196J.. The control campaign takes the following forms: (1) ) Case-finding. This is done by means of the mass miniature x,..ray campaigns. Cases found to be suffering from tuberculosis are admitted into hospital and treated. Provision of allo'Wallce to dependants of tuberculous patients to enable them to be isolated and treated in hospital. Other cases discovered either at the out-patient clinios of hospitals and at the health centres are advised to get admitted and be treated in the hospitals. BOG vaccination of new borns in Maternity Hospitals. BCG is offered free at all health clinics to infants and schoolchildren as well as contacts. 'WaS

(2)

(3)

(4)

In 1962, the number of persons vaccinated with BCG as against 85 196 in 1961.

156

587

Tra1l'1:L::lg of personnel in the technique of BOO vaccination is carried ou~ at the National Tuberculosis Centre at Kuala Lumpur.

4.

MALARIA ERADICATION PILOT PR()J]OCT

As mentioned else'Where, malaria is endemic in the rural areas. In urban areas, regular anti-malarial control measures are carried out and this disease does not, therefore, present a problem in such areas. With a view to eradicating malaria in the country a pilot project was started in 1960 and had been going on satisfactor~ since then. The work of this survey will be completed next year and on the result of this survey the Government will decide as to its future pollcy tOliards malaria.

~\

- 4 -

5.

YAWS CONTROL CAMPAIGN

The campaign which started in 1958 in areas where the incidence of yaws was highest, viz: Kelantan and Trengganu, has done much to reduce the disease among the rural populat:lo n where it is mostly found. The incidence in those two States is now less than 1 per cent. Work to stamp out the disease was extended to Kedah and Pahang in January 1961. This campaign is carried out 'With the assistance of WHO and UNICEF. The number of persons treated in 1962 was 13 146.

h.

FILARIASIS

Research with regard to the prevalence and distribution of the disease still goes on under the wing of the Institute for Medical Research. In 1962, 24 980 persons were examined. Of these, 2 144 were found to be infected. The number of persons treated in 1962 was 31 691.

7.

LEPROSY

The main and biggest leprosarium in the country is at Sungei Buloh where the number of in-patients on an average is 2 527. There are 4 other smaller ones in the country, v_z: Jerejak, Tampoi, Kota Bahru and Kuala Trengganu. in Pulau

Yaws control teams are being taught how to detect leprosy and so far this has shown great promise. This might well lead to the detection of leprosy to be combined with Yaws Control.

8.

MENTAL HEALTH

Two large mental hospitals treating a daily average of 5793 patients are located in the states of Perak and Johore. In addition to these hospitals, there are a number of out-patient psychiatric clinics attached to the General Hospitals of the country. $2.5 million have been set aside under the Second Five Year Development Plan for improvement of the mental health services. On the recommendation of the WHO Consultant on Mental Health, the syllabus of basic nursing in this country is being revised to include Mental Health in the training of nurses. There are now 2 qualified psychiatric specialists in the service and, in addition, scholarships are being provided for more officers to undertake post-graduate training in this field of medicine.

.' -1"-

,. - 5 -

9.

DIHITHERIA

Diphtheria is an endemic disease in the urban areas, although cases do come also from the rural parts of' tl:e country. Innoculation against diphtheria is given in all health centres and clinics in the country.

A mass considered. 10.

inoculation campaign against the disease is being

NUTRITIONAL SERVICES

Nutritional deficiency diseases are prevalent in the rural areas where the standard of living of the population is low. Government has, hcwever, instituted preventive and curative measures to combat the various nutritional diseases. Mothers and children are given iron and vitamin pills as a routine measure at all health c3ntres and nealth dlinics. Through the assistance of UNICEF, sldUnmed and whole powdered milk are given to all ante-natal mothers and mothers showing deficiency diseases. Health education of the public on nutrition is given by staffs attached to the various health clinics and also by public health 1nBpectors whenever opportunity arises. 11.

DENTAL SERVICES

Government dlental c-linics exist in towns and in rural areas. There are static as well as mobile dental clinics. Emphasis is on schoolchildren as well as ante-natal mothers. Under the Rural Health Development Plan there is provided in every main health c'entre and s;ub-h.ealth centre a d·ental c·linic. 12.

MEDICAL CARE

The 66 general and district hospitals in the country are being improved at a cost of $24 million. Additional wards an ancil~ lary buildings are being provided to these hospitals and up-to-date. almost half the provision for improvement has been spent. The three out-moded and inadequate hospitals in Kuala Iium,pur, IO..ang and Seremban will soon be replaced with new up_to_date hospitals and three 50-bedded rural hospitals will be constructed,during the tenure of the Second Five Year Development Plan. In addition, a 800-bedded teaching hospital and medical centre costing about $25 million will soon be constructed in close proximity to the Medical Faculty, University of Malaya. The overall total cost of' replacing out-dated hospitals, the provision of rural hospitals and the teaching,hospital is estimated to be in the region of $88 million. The new 220_bedded maternity hospital in Kuala Lumpur has been completed and is ~ow in operation. The total number of hospital beds has now increased from 13 570 in 1960 to 14 454 in 1963. 13. TRAINING FACILITIES

In the Federation of Malaya there are today the following facilities for the training of medical and health personnel:

1.

Three training s'chools for the training of student nurses.

~

'.

- 6 2. A g,chool for the training of p'Ublic b:ealth nurses. A a'chool for the training of public h.ealth inspectors. A rural health training s.chool for the training of auxiliary rural health 'WOrkers. Fi ve iJUdwifery training Slchools for nUrses.

3.

4.

5.

6. A school for the training of dispensers. 7. A school for the training of laboratory assistants.

There are also _ 1. 2. Eighteen approved hospitala for the training of Assistant Nurses. Seventeen approved hospitals for the training of rural midwives.

Ministry of Health, Federation of Malaya.

NEW ZEALAND

Report on the Progress of Health Activities during 19621-

1.

GENERAL As we commented in the "Second Report on the World. Health Situation

1957-1960" there are virtually no major public health problems in New Zealand and the machinery for coping with the classic public health problems is efficient and well established. In compiling this short report, therefore, comment is confined to six aspects of our work during 1962 which delegates from other countries may find peculiar interest.

2.

POLIOMYELITIS VACCINATION PROGRAMME

The leader of the New ZeaJ.and delegation to the 1963 World Health Assembly briefly described this programme, but I need not apologize for repeating the facts in this report. FollOwing an earlier extensive immunizing programm; using Salk vaccine, a two stage mass programne with trivalent Sabin vaccine was instituted in 1962. During the period April~uly 1962, 97% of the estimated 780 000 school and pre-school children (excluding infants) received two doses. During the second stage, of 1 600 000 adults and adolescents who had left school, 1 170 059 received one dose and 1 116 004 received two. The percentage of the iImnunized population is 8CJ1, and, in the younger age group, 97%. (Infants up to twelve months are dealt with in a separate three-dose programme which commenced ~t 1961.)

The vaccination progra.mme is currently including infants and permanent new arrivals from overseas. In the Island Territories

18 879 out of an estimated population of

25 000 received Sabin vaccine. statistical Summary -~

i·

Children* Population First Doses

Adults Second First Doses Doses

Totals Second Third Doses Doses Infants only

Second Third First Doses Doses Doses Infants only

2471 030

829530

789185

27653 ~ 170059

1 116 004

1 999 589 1 905 189 18879 2000

27653

Island Territories (all age group ) Miscellaneous (service personnel broad, etc)

17947 2000

!l 020'468 1925 136 *Including infants under 12 m::>nths vaccinated since Aug. 1961: up to 31.12.62.

Summary states position

~pared by Dr. D.P. Kennedy, Director, Division of Public Health, New ZeaJ.and

T-····-_····

3.

NEW DRUGS

AIoondments have been made to tre Food. and Drugs Act which require all new drugs and all changes in drugs on the New Zeland market to be notified to the Director-General of Health. This notification scheme does not in any sense imply approval or endorsement of drugs but enables the Department to draw the attention of importers or manufacturers to any matters which contravene the Food and Drugs Act, the ledical Advertisem:mts Act or the Poisons Act. Where necessary, information contained in notifications is referred to a technical. committee which can make recomn:endations to the Government regarding restriction or control. The information service now established by WHO in this respect is warmly welcomed by this health administration.

4.

1961 STI:C;LE CONVENTION ON NARCarIC DRUGS

New Zea..land ratified the 1961 Single Convention on Narcotic Drugs on 26 March 1963.

5.

QUARANTINE

The New ZeaJ.and Department of Health is convinced that the preflight (''blocks-away") method of disinsecting is the best and it encourages air1~es to adopt it. Only two of the five international airlines operating schedule flights in New Zealand, however, use it. Tests to denxmstrate the convenience of this zoothod, compared with postarrival disinsecting were undertaken during the year by WHO in co-operation with the Pan .AlIerican Airways on their scheduled passenger flights between Fiji and Auckland.

6.

CERVICAL CANCER CAMPAIGN

A country-wide campaign to encourage wozoon to visit their doctors for early diagnosis of possible cervical cancer has been instituted.

7.

MAORI HEALTH SURVEYS

The Maori people have a higher incidence of SOIOO diseases than their European cO'\mterparts. ~dical Research Units are now making surveys in some predOminantly Maori communities to discover the causes of some of these complaints (e.g., gout, diabetes, obesity) and the first public health remedial. measures have been put in hand by having public health nurses test the haemoglobin levels of M3.0ri mothers and infants and administer iron where anaemia is apparent.

NORTH BORNEO Report on the Progress 01'

Health Acti vi ties

1.

GENERAL ORGANIZATION OF

THE

Hl~ICAL

SERVICES

The lvledicul Directorate is the.; organizing and controlling body of the Service and consists of' the Director, Deputy Director, Principal Medical ufficer of Health and Principal Matron. In addition, there is also an Accountant and Senior Superintendent of Medical Stores. The country is divided into eight medical areas with a medical officer .. in-charge of each area, who is also the health officer to the Local Authority therein. Each medical area has a hospital based at the administrative centre of the area, and dispensary/hospitals and dispensaries located at suitable points in the area to provide as far as possible, medical aid evenly spread throughout each medical area. These medical areas are Jesselton, Sandakan, Tawau, Labuan, Lahad Datu, Kudat, Keningau, and Beaufort with the area hospitals sited at the place names mentioned. In the main, the services provided are curative, but maternal and child health and environmental sanitation services are available and are being steadily expanded. The Malaria Eradication Scheme has invaded every segment of the country and is the most accurately dispersed service of all. Finally the Tuberculosis Control Scheme, having made its beginnings in the past three years, is making inroads into its own problem in those parts of the country where activity is possible and seems most urgently re~uired. The Malaria Eradication Scheme is still largely autonomous from the area services. However, in the set plan for the eradication programme integration with other services is essential and it is intended that it will eventually become a part of the whole. 2. FINANCES

The total funds available from government funds during 1962 was $5 275 620.00. This includes personal emoluments. This was 15-1/2% more than was available in 1961. This figure does not include expenditure by Local Authorities for various activities in relation to sanitation. Nor does it include Capital Expenditure on new buildings, water supplies, etc. The Service was also indebted to the generous aid which it continued to receive from external sources such as the Colonial Development and Welfare Fund, the World Health Organization, the United Nations Childrens Fund and the Colombo Plan.

~

2 '.

During the year 1962 the World Health Organization more than its allocation towards the Malaria Eradication Scheme, the United Nations Childrens Fund also increased its contributions to this scheme. doub~ed

3. 3.1

THE MEDICAL SERVICES STAFF

Medical officers

At th~ time of writing, there are 25 medical officers in the Service. This includes three in the Medical Directorate, one ealaria eradication scheme officer and one tuberculosis control officer. Two officers are on leave. .The post of specialist physician is yet to be filled. Among the increases in staff over 1961 establishment we now have a surgeon at Sandakan, an ophthalmologist and three medical officers.

3.2

other medical staff for hospitals and dispensary services Matron, Sister Tutors and Sisters 12 Senior Staff Nurses and Senior Hospital Assistants 19 Staff and Student Nurses and Hospital Assistants 229 Assistant Nurses 59

3.3 nurses.

Dental services Two dental surgeons and ten auxiliaries, including four dental

3.4

Laboratory services A senior laboratory technician and nine technicians.

3.5

Maternal and child health services Health Sisters (including one for training rural health nurses) Rural Health Nurses and Probationer Health Nurses •••• 44 Local Authority-employed Rural Health Nurses •••• 13

....

In addition, 19 of those listed under other medical staff above assist whole or part time in the Maternal and Child Health Services.

3.6

Environmental hygiene services Health Inspectors Village Health Inspectors •••••

•••••

19 11

3

3.7

Malario. Eradic:.tior'. scheme I::,S

Total number employed spraymen, etc. = 382. 3.8

technicians, scoutR, microscopists,

Tuberculosis Control Scheme

Tvro hc:~,lth visi to.C'S &nd 31 other stGff including teclmicians and assistcmt nurses.

In addition to the above, six United States Peace Corps Volunteers were assigned to the Service in 19()2 three nurses, two laboratory technicians and an occupational therapist.

4.

HOSPITAL SERVICES

This refers mainly to the curative element of the service in terms of hospital and dispensary facilities. 2 Total bed strength . 671 General Hospitals Cottage H9spitals 7 Total bed strength .- 542 Dispensaries 13 exclusi vely for out-patient Dispensaries with sick beds - 19

5.

HOSPITAL ATTENDANCES

Attendances at hospitals and dispensaries for 1962 are quoted~ Attendances for 1957 are also quoted for comparison. As a compliment to the Malaria Eradication Scheme; malaria cases treated are also shawn. New Cases Attending Malario. Cases Percentage Malaria

1957 1962

259 244 424 900

45 343 14 827

17% 3.48%

Total out-patient attendances (new and repeat cases) were

645 335 and a further 100 000 cases were treo..ted by Travelling Disl>ensaries. TOtal in-patients treated during 19c2 were 25 031.

6. 6.1

TRAINING OF PERSONNEL FOR THE YEAR 1902 Local training

In training as nurses or hospital assistants 8 qualified

54

In training as rural health nurses 25 li:) qualified In training as malaria technicians or assistant malaria technicians 35

4 "

0.2 29.

Overseas training under government or overseas scholarships The total numbl3r of persons sent for training during 19(;2 ,vas These were as follovlS: Ncdicc,l Degrees Phe.rmncy Midwifery Dental Nursing Mental Nursing Health Visitors Health Inspectors Malaria Eradication other Nursing Cc;mrses Radiology

...... ·.... · ...... · ..... · ..... · .... · ...... ·.....

" c: 1

8

4 2 3 2 2 1

4

In addition there are 16 persons in various stages of courses for a oedica1 degree and 22 local girls are in training as nurses in the United Kingdom or Australia.

7.

EPIDEMIC DISEASES

This being a brief report only diseases of note will be described. 7.1 Malaria - The Eradication Programme

The WHO/UNICEF-assis'ted malaria eradication programme continued as scheduled. There were two expansions to the scheme, i.e., on 1 January 1962 and 1 July 1962.' Except for certain non-malarious urban areas the whole country is now under the campaign. Progress varies from area to area, The Western Coastal strip from Sipitang to the rural approaches of Jesse1ton is ahead of schedule, and had arrived at the pre .. consolidation phase in 1962, whereas the Western Interior region has lagged. However, here also it is anticipated that work will proceed to the consolidation phase during 1963. In the Border Sector spraying will have to be continued till the Republic of Indonesia's proposed campaign across the border in Kalimantan is underway. From July 1962, DDT was used throughout the country, replacing dieldrin in the small areas where it had previously been used, At the turn of the year the total population in the various phases of the campaign compared with the position twelve months ago was as fdlows: End of 1962 Attack phase only (spraying and mass treatment) Pre-consolidation (attack plus surveillance) 255 t,56 End of 1961 1 89

383

151 888 15 421 422 ,965

Consolidation Total

.. ,

49 337 15 9v1 254 681

The programmers prestige is now such that the Horld Health Or.,?;anization has designo,tcc. this country ::t training eTC', for Lic.laria eradication and 1)+ persons iroti] overseas came here on study courses during 19~2.

7.2

Tuberculosis

The Tuterr,].llosis C-:mtrol Scheme

This project lS trc',Olns ~'. :l1~,rc modero.tc p~,cc.; compo.red with the Mo..laria Eradication Scheme. There are only 32 mcnbcrs i::1 the control team and the work done by them has been considerable. Tuberculin testing and BeG inoculations have been done in many of the schools, and .Tere extended during the year to rural areas in Kota Be Iud , Tuaran, Tenom and Semporna districts and in the area along the railway line from Papar to Beaufort. Mass X-ray campaigns were also conducted at kampongs along the road from Jesselton to Kota Belud. Routine case finding, treatment, and follow up continued in areas previously surveyed. The work visited here in justified early integrated with done so far was assessed by Sir Harry Wunderly who May 1962 and it was decided that the progress made planning of a country-wide operation to be closely the development of area health services.

7.3

~aracholera

Du~ing 1962 this country suffered its first outbreak of a major epidemic disease for many years - paracholera. ~1e disease which had already been notified in Sarawak, Macao, Hong Kong and the Philippines eventually appeared in this country.

In all, a total of 47 cases occurred between 17 January and the end of June. There were 6 deaths. A total of 325 000 inOCUlations and re-inoculations were given during efforts to control the disease. All areas were finally declared free from infection on 30 June 1962.

7.4

Diphtheria

Thirty-one cases of diphtheria were recorded in 1962 compared with 40 the year before. The progress of the inoculation campaign against this disease was hampered by efforts being diverted to the control of paracholera.

7.5

Intestinal infections and infestations

About 10% of all illnesses diagnosed are in this category. Much more health education is required in this direction. The country's piped water supplies are being increased steadily.

8.

PREVENTIVE MEDICINE

The Malaria Eradication Scheme and Tuberculosis Control Programme have been mentioned. Apart frOl:1 these the main services provided in preventive medicine are for maternal and child hecclth and to ir.Jprove environ mental sanitation. There is no school health service except dental facilities for schoolchildren and the surveys done by the Tuberculosis Control team. 9. and MATERNAL AND CHILD HEALTH SERVICES La~uan,

Health centres are situated at Jesselton, Sandakan, Keningau and one is planned for Tawau in the near· future.

MCH Clinics are held at 68 different places, as compared with 58 in 1961. This expansion was mainly on the east coasts at Tawau and Sandakan where little had been done previously. The services in Lahad Datu are also being increased and will be extended even more when the Marine Dispensary arrives there in September 1963. Attendances (antenatal and child welfare) for the year 1962 were 137 715 as compared with 137 125 in 1961. The United Nations Chi1drens Fund continued to support the service generously with triple antigen, clini~ and midwifery equipment and skim milk. 10. ENVIRONMENTAL SANITATION

The health inspectorate was increased from 15 to 19 health inspectors. They were concerned with general sanitation, port and airport health and disease control. Tbey also assist the Local Authorities wlEn required. This small inspectorate has not been able to do much for more remote rural areas where hygiene remains backward. In these areaS it is expected that some impact will be made through the Local Authorities Health Committees which have recently been formed. 11. NUTRITION

The general nutritional state is above average for rural countries in South-East Asia. Cases of beri ..beri and iron deficiency <:',:l('.er.1ias are, however, not uncommon, being associated mainly with pregnancy and lactation and among labourers in timber camps where there is no dietary supervision.

,.

•

- 7 -

The nutri tionnl state in the remoter areas is still belov7 avero.ge, being Qssociated with poor agriculturcl conditions, a reliance on tapiocc" 2,nd 8:',80 to ford the::: bulk of the dL~t) c.nd intestinal disorders resulting fron pr)or sanitation ,':.nd hclninthic infestations.

The curr.::..:nt clc:vclop:!cnt

pu~:L()d

contirl11.(;s till the end of 1964.

In addition to "hat has already been achieved, several major projects were added to the list and have been completed or are in the process of being completed. These are: five new major rural dis· pensaries, extension of the Tenoro Hospital, a training school for rural health nurses and two marine dispensaries. Outstanding projects previously approved include the new Tawau Hospital, the new Mental Hospital and the new Out patient Department at Jesselton. The new Out.patient Department at Jessel .. ton has now been expanded, and included in the works will be a new central laboratory, extensions to the Nurses Training School, extension of the Dental Centre and an ophthalmic operating theatre. During 1962 a Development Plan for major improvements to the country's medical services as a whole was drafted. Th~s covers the period 1963 - 1970 and places special emphasis on rural area hospitals and health services, but provides for substantial improvements in all other aspects of medical and public health facilities.

Republic of the Philippines Department of Health OFFICE OF THE SECRET lillY BRIEF REPORT ON HEALTH July

30, 1963

Contained herein are the accomplishments and activities of the Department of Health for the Fiscal Year 1962-1963. Also~uded are such facts dealing with the nature of bureau of departmental functions and the consequential structure in the field of health during the period covered by the report and as derived from the performance of those functions. Since the last Secretary of Health occupied his position in not more than a year, the activities listed in his administration must not be considered definitive. Available Health Services Various health services are being provided by agencies of the Department of Health from the national level to the smallest barrios of the country. The Bureau of Health Services provides technical knowledge on matters involving the prevention of diseases, while the Disease Intelligence Center gathers, compiles, and evaluates vital, health and epidemiological data to guide policies and control procedures which will be implemented in the field operational units. The Office of Health Education and Personnel Training serves as an advisory and consultative body to all units of the Department of Health and other governmental and voluntary agencies on all matters related to the health education of the public. It also develops, evaluates and disseminates health edllcational materials. Likewise, it undertakes the training of health personnel, both local and foreign along the latest developments, methods and techniques for a more effective and efficient health service. The available health services are fanned out to provinces, cities, municipalities and barrios through eight regional health offices, provin. cial health offices and rural health units. As of 1962, there were 1,331 rural health units with a complement of 1,281 rural health physicians, 290 dentists, 1,571 public health nurses, 1,978 midwives, 1,175 sanitary inspectors and 288 dental aides. The Rural Health Units provide health and medical services at the grassroots level, penetrating the remotest sitios of the country. A good portion of the work of the rural health units is devoted to the prevention of disease and promotion of health and about 30 per cent of their efforts is directed to the treatment of the sick and the injured. The maternal and child health services in the country are supplemented by 563 puericulture centers manned by 196 physicians, 4 dentists, 273 nurses and 430 midwives. These centers represent the communites' civic consciousness and participation in the promotion of the health of mothers and children.

The Bureau of Disease Control provides technical kn~edge in the control of such diseases as malaria, tuberculosis, leprosy, social diseases, cancer and mental disorders. It maintains and supervises 28 chest clinics, 19 social hygiene cliniCS, 1 !rental institution and 8 sanitaria allover the countr,y. The medical care program of the Department of Health is handled by some 174 government hospitals with a total bed capacity of 15,575 beds. This is supplemented by 208 private hospitals ,.d.th a total bed capacity of 9,269 beds. About 15 per cent of govern:rrent hospital beds and about 40 per cent of the bed capacity of private hospitals are vacant during a good portion of the year. During certain times of the year, however, the total admission exceeds the available bed capacity because of seasonal diseases. The rehabilitation of the disabled and other patients is undertaken by the various hospitals before the patient leaves the hospital or wllen the patients are already in their hoTOOs. Patient rehabilitation is necessar.y in order that these disabled patients may be acceptable to society and become productive individuals who can support themselves. Besides the basic health services rendered by the Department of Health, special services are made available to keep diseases from other countries out of the countr.y and to continuously keep up with the latest knowledge about disease and its various aspects. Thus, there is the Bureau of Quarantine which stands guard on incoming boats and planes for a sharp lookout on diseases that may possibly enter the dountr.y through these points. The Bureau of Research and LaboratJries on the other hand, undelt3kes studies and researches on sp~l drugs, mediCines, vaccines and on the causative organisms of various diseases. THE ENVIRON}lliNTAL SM~ITATION PROGruu~

Recognizing the need for a Long Range Environmental Sanitation Program for the Philippines, the 5-year plan of said Program was prepared and implemented in 1958. Upon the assumption of the new Secretar.y of Health in 1962, an aggressive environmental sanitation program was launched implementing the second Five-Year-Plan. It is gratifYing to state that an appreciable improvement on environmental sanitation throughout the Philippines for the last five or six years has been observed because of extensive and intensive campaign on this important aspect of public health by the public health workers in the Regional Health Offices with the coordination, cooperation, support and understanding of the community, civic and professional organizations and all other agencies concerned with the promotion of public health. WATER SUPPLY The water supply of the City of Manila and the suburbs has been increases for 100 million gallons per day in 1955 to 161 million gallons per day as of June 30, 1961. As to the provincial, city and muniCipal water supplies, the number of piped waterworks went up from 478 in 1955 to 920 as of June 30, 1962. There were 18,190 deep wells in operation compared to 4,786 wells six years ago, As to spring developments which are also sources of water supplies in the Philippines, there were about 2,000 developed springs compared to 99 developed springs five years ago (1955). All these sources of water supplies serve about 41 %of the entire population of the Philippines. The UNICEF in support of the program on environmental sanitation has provided a total of $140,000 for

- 3 FY 1962-63 of which $23,000 for water supply equipment and materials for about 100 health centers at an average of $230 per center. At present we have now the necesElary number of health centers benefitted for this amount of $23,000. We have in our program the provision of all health centers adjacent to public shoools without water facilities and with water facilities to be given by the UNICEF. Sanitar,y engineers are making the necessar,y surveys for these health centers with the assistance of the UNICEF, which body has also approved the amount of $30,000 for water supply equipment and materials for two demonstration areas for two communities, one in Sual, Pangasinan, and the other in Bo. Pooc, Talisay, Cebu. 'Water supply installations are being attempted in areas where the NWSA cannot cover with the necessary arrangement and understanding with the latter.

EXCRETA DISPOSAL The most common methods of excreta disposal in the Philippines are the antipolo system, bored-hole latrine, pit privy, water-sealed type, septic tanks (with water system) and others. There was always an increasing number of toilet constructiop.. since 1954 up to 1957. In 1958, about 15% of the total number of families have toilet or about every 2 families were provided with one type of excreta disposal system. The data was obtained from the records available in the Bureau of Health Services and furnished by the provincial healt.h officers at that time. For an intensive and extensive campaign to help prevent intestinal parasitism and gastro-intestinal diseases through proper excreta disposal a Program on the Operation Comfort Room in Every Home was prepared. This program is now furniShed the Regional Offices for their guidance in launching this campaign. The latest estimates of ,the number of families with toilet is about 48%, excluding toiltts that are not considered sanitar,y. In tLis estimate, it now includes the water-seal type which is the type being promoted by the Department of Health due to its advantages over the other types of toilets in the rural areas. At present, there 'are now communities having 100% toilet construction. To mention some: Matalom, Hilongos, and La Paz of Leyte; Carmen, Bo. Pooc, Talisay of Cebu; and Minalin and Bo. Sta Rita, Mexico of Pampanga. REFUSE DISPOSAL

The prevalent open dump method of refuse disposal is now generally abandoned in favor of the sanitary land-fill nethod. Another Irethod known as composting is being introduced or tried as one of the solutions of refuse disposal. The City of Manila has constructed a Pilot Plant in Composting with 10 tons capacity daily. The plant is now in operation and providing a good compost product. A composting plant is under construction in Cabanatuan City and another will be constructed in Dagupan City. If the sale of the compost can balance the operating expenses and thp. amortization cost of the plant, this method of refuse disposal would be an attractive method 0: refuse disposal. STREAM POLLUTION In previous years, there were complaints about pollution of bodies of water within the countr,y caused by discharge of wastes coming from dessicated coconut, sugar refining, beverage, mine, domestic (sanitary sewage), etc. There has been practically no activity r6garding water pollution control anc abatement. However, in 1960 a nationwide survey was made to determine the extent of water pollution by industrial, mining,

... 4agricultural wastes, etc. There are nO'l'-T two mobile laboratories and surveys for water pollution control and abatement. Surveys were made in Cebu, Bataan and Rizal provinces and Quezon City and Iligan City. Remedial measures were recommended to solve the problem. AIR POLLUTION In previous years, this phase of environmental sanitation did not receive much attention, Since the Philippines is now being more and more industrialized, it was deemed necessar.y to include in the Long Range Environmental Sanitation, tbeproject on air pollution control and abatement. A connnittee was created for air pollution and abatement in 1961. The survey team made some tests from sources of air pollution, mostly in Nanila and the suburbs. The air pollution project which was established with commodity assitance from ICA (now AID) is still making studies of the Chemical Industries. , The project has made some studies and analyses on fume emission. Recommendation were made to solve the health hazard and with the cooperation of the management, the problem is practically solved. The project has started the study on the extent of air pollution contributed by fhe motor vehicles in the Manila Metropolitan area. A National Water and Air Pollution Commission under the Department of Health has bee proposed by the NEC to prepare and develop a general comprehensive plan for the control and abatement of water and air pollution. RADIOLOGICAL RESEARCH Radiation if not properly controlled or improperly used, will constitute a public health problem. A National Radiological Health Cimmittee was created, one function of which among others is to adopt and promulgate such rules and regulations regarding the safe disposal of radioactive wastes and to safeguard the general public for the ill effects of radiation. Adminstrative Order No. 96 s. 1962 of the Secretar.y of Health Provides the rules and regulations regarding the use of ionizing radiation for the protection of health in the Philippines. The Division of Environmental Sanitation of the Bureau of Health Services is charged to implement this Administrative Order No. 96. Section 2 of these rules and regulations provides that every operator of a radiation installation shall register such installation ~~th the health officer having jurisdiction prior to July 1, 1962. A private hospital in Dagupan City and two government hospitals in Baguio City were surveyed by a Survey Team to evaluate the potential radiation hazard in the vicinity of the X-ray equipment therein. roOD SANITATION A campaign for the sanitation of food establishments,restaurants, markets, etc., have been intensified. Foodhandlers classes in the provinces and cities have been conducted for food establishments owners and managers and other personnel involved in food production, transportation" distribution and preparation. TRAINING SANITARY INSPECTORS There are now three advanced training centers established for

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Manila ra~n~ng Gent~r~ Dagupan Training Center, and Cebu Training Center. The.Davao Tra~n~ng Center is expected to open as soon as the community as~~stance from ~ICEF amounting to $6,200 rThich is expected to arrive th~s year i~ rec:~ved. There is a total of 513 sanitary inspectors already tra~ned ~n the three training centers. A STATISTICAL GRAPH ON rnOLEHA EL TOLi

ihe.a~vanced training centers for Sanitary Inspectors, name~:

(Ju~y) Epidemiological activities continued to be concentrated on Cholera El Tor in view of the continuation of the slight resurgence of ca~es in certain areas previous~ noted. Also, some activities were made ~n connection with 'ehe Project - Studies on Cholera El Tor, one aspect of which, that pertaining to the therapeutic value of oral fluids has been done by NA~ffiU-2 personnel at the San Lazaro Hospital and plan- ' ning on the field vaccine evaluation stUdies proposed in the province of Albay. Surveillance was performed with emphasis on influenza and ~astro-enteriti8 ~ich for the first time since the disease appeared ~n the count ry, reported 26 cases wi tb. 9 deaths. (October) During the month, the epidemiologcial activities continued to be centered mn Cholera EI Tor. The field research epidemiological studies in Bacolod City and Negros Occidental were in the final phases, and a report is being prepared. Also, the occurrence of a few cases of Hemmorrhagic fever in Lubao, Pampanga necessitated sending a field investigating team. The Chief of Center attended the meeting of the Technical Committee of the Pakistan-SEATO Cholera Research Laborator,r at Dacca, East Pakistan during the month of October 9~11, 1962, having been ap90inted as member of the Panel of Expert Consultants in the fields of Epidemiology and Disease Control. The incidence for the entire country continued to show a declining tred. The outbreak in llocos Norte which occurred in the latter part of September did not progress, no further cases being reported after 2 weeks. On the other hand, renewed activity was reported from Ak1an, Bataan, Negros Oriental and Cotabato; while Manila and suburbs, Masbate, Cavite, Riza1, Negros OCCidental, Bulacan, Laguan, Batangas, Samar and the cities of Calbayog, 5ilay, Dumaguete, Cebu, Tacloban and Bacolod persisted to have sporadic cases. The provinces of Occidental Mindoro and Palawan reported cases, some of whom were confirmed bacteriologicallY, for the first time during the mo~th under review, since the disease was introduced into the Philippines last year. ( November). A. low incidence continued to be observed.. Principal reporting areas were Aklan, Samar, Negros Occidental, Masbate, Wegros Oriental and the cities of Bacolod, Dumaguete, OZamis, Tacloban, Calbayog and Si1ay. Romblon, Capiz, Pangasinan and San Carlos City again reported a few cases after some time without any, while the Manila area became practically free from the infection. By the last week of the month, a considerable number of cases and deaths were reported from Carcar tand Sibonga, both of Cebu province, raising the 'VJeekly figures from the preceding week's lm·mst incidence on record since the start of the outbreak last year. A few rectal swab specimens received during the month from Misamis Oriental, Camarines Sm', Sorsogon and Legazpi City were found to be positive for El Tor Vibrio. Onsets of the cases were from the :43rd

week (October) to the 46th week ( . . ~ddle or November). or particular .~. h positlve cases from Lega_pi City (onset on October) ~llC represent the onlY cases recorded from the city.

interest were the 2

1,- .

(December) An outbreak of Cholera El Tor in certain barrios in Brooke's POint, Palawan, was reported. Epidemiological investigation and institution of control measures were performed by the regional and local health offices, in consultation with the Disease Intelligence Center. Except for this outbreak, the over-all incidence of Cholera El Tor throughout the country continued to be at low endemic level with only sporadic cases reported in some areas. The incidence during the month was such higher than the low levels that prevailed during the preceding month, on account of an outbreak in Palawan. The outbreak started on the 49th week of 1962 and the peak was attained on the last week of January. Heavily involved were Brooke's Point and the AborlanPanacan area. As of the 3rd week, 148 cases with 117 deaths have been recorded. other areas reporting a few cases each during the month were Aklan, Bulacan, Camarines Norte, Camarines Sur, ~~sbate, Pampanga, and the cities of ~~nila, Bacolod, Bututan, Cagayan de Oro, Calbayog, Caloocan, Cotabato, Dumaguete, Iligan, Marawi, Ormoc, Ozamis, San Pablo and Tacloban. 1963 (January) A high incidence marked the first week of the month because of outbreaks in Sibonga and Carcar in Cebu. However, the high incidence rapidly declined and went back to the low levels observed previous to the Cebu outbreak which apparently lasted only 2 weeks (last week of November and first week of December), and remained that low for the rest of the month. Bacolod City continued to report the most number of cases among the reporting areas other than Cebu, probably as a result of the close surveillance being undertaken in connection with the epidemiological studies being conducted. Few sporadic cases continued to be reported from Aklan, Antique, Masbate, 1-fisamis Oriental, Samar, Zamboanga del Norte, and the cities of Cagayan de Oro, Calbayog, Ozamis and Silay. The province of Camarines Norte, for the first time, had a bacteriologically confirmed case, while Butuan City and Sulu again reported a case eaoh, after 7 weeks and 13 weeks, respectively, without any. .Nanila surrounding areas remained practically free as few suspected areas admitted at the San Lazaro Hospital were found to be bacteriologically negative. (February) Low levels of incidence prevailed during month. Reporting areas with just one or few cases each were Aklan, Bohol, Bulacan, ~~sbate, Misamis Oriental, Samar, and the cities of Bacolod, Butuan, Calbayog, Cotabato, Dumaguete, Iligan, San Pablo and Tacloban. (March) Only very few cases were reported during the month from Bohol, Samar, Cotabato City and Bulacan. Rectal swab specimens received from Bacolod City and Pamplona, Cagayan were all negative for El Tor Vibrio. (April) Cholera EI Tor has again shown an apparent resurgence from Cotabato City and Province.

(May) Due to a reported outbreak of Cholera El Tor at Cotabato, a Senior Epidemiologist left for the area on May 8, 1963 to conduct surveillance and investigation on the outbreak. He conducted surveillance also in the neighboring tow~ involved. Rectal swab specimens from several cases hospitalized at the Provincial Hospital were taken and brought by him to Manila for bacteriological confirmation by the Bureau of Research and Laboratories. Advice was given to local health authorities on control measures against the disease, case findings and the reporting mechanism to be followed while there are still cases occurring. THE ivJ.ALARIA ERADICATION PROGRAM Malaria eradication is a condition precedent to the success of the economic and social development envisioned in the government's fiveyear socio-economic program. The Department of Health has completely revised the plan of operation which took effect on April, 1963. This operational plan includes full-scale, all-out implementation of the program with full cycle spraying in all pre-determined attack areas, recruitment of personnel to full complement, and purchase of anti-malarial drugs necessary for the treatment of residual cases of malaria. During the 1954..1958 dieldrin was found effective against malarial mosquitoes. In 1959 however, it was found that malaria-carrying mosquitoes had developed a resistance against diadrin. This problem was further compounded by the opening of more roads which led to the migration of the population from non-infected areas to the interiors, where infestation and transmission was still present. From 1959's 29,000 confirmed cases come mostly from the interior and fringes of dommunities where people migrated in search of land and new opportunities. Due to the Dill resistance 'Which may later develop, time is the essence of eradication. Money, personnel, and supplies must be made available if the objective of eradication is to be realized. ThE ANTI-S~~LLPOX

VACCINATION

PROG~l

Statistics show that as of November 30, 1962, a total of 2,010,545 persons were immunized, while imported and locally produced vaccine totalled to 5,803,000. During the past years, the srrallpox vaccination program was hampered by the lack of sufficient pe remmel. To remedy this fundamental obstacle, 300 emergency vaccinators were employed to assist the rural health personnel in carrying out the vaccination program. Due to certain technical requirements in the release of funds for the employment of these vaccinators, they were only able to start the work in the latter part of January. In this connection, the Department noted that priority areas in Mindanao and Sulu, Where the danger of accidental introduction of smallpox exists, due to their accessibility from North Borneo, Celebes, and other danger spots in IndoneSia, have almost fully covered. In view of the foregoing, the following were recommended: (a) an additional 5,000,000 doses of freeze-dried vaccine be imported; and (b) the employment of the additional 300 emergency vaccinators assigned to various regions to contribute to the increase of vaccinations in those areas

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extended for another six months, for which additional funds were requested. THE SANITARY TOILET PROGRAl1 The sanitary toilet program was launched on July 1, 1962, as part of the over-all policy of the Department on Environmental Sanitation. The end objective is a "comfort for every home~',' A reccr.t survey reveals that there are 2,069,245 families with sanitary toilets. This represents 48% of the total number of families. Th~re are about 2,289,103 families without toilets. This constituted 52ft> of the total number of falni1ies. These communities, hOl-Tever, were as a result of the initial campaign have shown satisfactory response in toilet construction. These communities are in Pampanga, Leyte, and Cebu. t. '

PREVENTABLE DISEASES The Proposed Programmed for Anti-smallpox vaccination was initiated because of the risk of dissemination of infection from smallpox in endemic areas in other countries Which still remains a problem. The WHO had planned to implement its smallpox Eradication Program since 1958 and reiterated the urgency of such a plan in the Resolution of the World Health Assembly in ~~y 1962. 'Vaccination activities have consistently been undertaken by the Department of Health following the provisions of Section 1051...1057 of the Revised Administrative Code, strengthened by Act 3573 of the Philippine: Legislature in 1929. In view of the level of immunity found and wh:ic h was only~O per cent, attributed to some factors. One of the factors was the introd'lction of E1 Tor in September, 1961, which had greatly diminished the performance of vaccinating teamd. There is also a proposed diptheria, pertussis and tetanus immunization program. This has been prepared, but because of financial difficulties, its impleffientation was held in obeyance. The WHO, thru the cooperating agencies took the initiative of giving a helping hand in the project. Being desiroas of gettine- a mutual agreement regarding the Dill immunization v-lith reference to the purposes of the project, it shall be none other than a friendly relations. PROPOSED POLIO},l1ELITIS PROGHAMr'iE 'ihe Philippines is still besH ,:it.h many public health problems. One of these is poliomyelitis which has been endemic in the country. Its endemicity produces some limited amount of natural immunity on the population. The d~gree of immunity, however, is relative and as further detailed study was done on how many per cent actually of the population is naturally protected. Previous experience revealed that there were outbreaks of Poliomyelitis in certain groups of the populace. These facts maybe attributed

to the improving Filipino sanitary ways of living. Being such, public health workers believe that immunization is still the number one weapon in the field of preventive medicine. An immunization programme on Polio~elitis is the most logical step to be taken. Mass immunization is considered the answer to the problem but it will prove too costly on operation due to the high price of the vaccine. Choice, manner of distribution and other factors connected with the vaccine should be determined as a guide to the program. Inasmuch as the cost of mass immunization is too expensive, it should be done institutionally or in selected groups only since the most vulnerable to the disease is the younger age group. But a mass immunization should be readied just in case of any eventualities. years The estimated population of 0-4/in the Philippines is over 5,000,000 and to produce the maximum protection to this group, 80% should be the goal which/~;OOO,oou children and the amount of vaccine, will cost more than 3 million pesos. In the program, all health agencies and some C1V1C organizations will be involved. Facilities for mass immunization propaganda'~ should be made available to bring the campaign to a success. There maybe no deficienaes forecasted in the programmes presented especially in the Diptheria Pertussis and Tetanus Immunization because of the support in the form of equipment and ~terials given by the UNICSF in the production of the vaccine. The same is true with antismallpox vaCCination, because of the improved vaccine virus now being prepared locally. In the cholera inoculations some deficiencies maybe encountered in the lack of sufficient funds for the supply of this immunizing agent, however, indications are that emergency funds for the purpose could easily be given prompt attention especially in times of outbreaks or epidemics.

,

DRUG PHICES With the recent upsurge of local drug prices, the Health Secretary formally recoIrmended the purchase by the government through the National Marketing Corporation of 18 million worth of "wonder drugs" as a means of bringing down prices. The above-mentioned maybe broken down in a list of drugs needed by government hospitals and rural health units based on requisitions made from July 1, 1960 to June, 1961 when the Department of Health was forced to cut down its purchases of drugs due to high prices. For the hospitals was proposed an estimated requirements of r882,000 worth of antibiotics, 1378,000 worth of steroids and 1315,000 worth of sulfanamides or a total of 11,575,000. For the rural health units, requirements are estimated at 1152,031 for broad spectrum ar.tibiotics. 155,022.50 for narrow spectrum 8.ntibiotics and r165,375 for sulfanamides, or a total of ~75,428.50. The estimates did not include antibiotics prescribed by physicians and which were bought by patients out of their personal flmds Ql.ring to the limited appropriations of the hospitals for medicine. And the estimates do not reflect the actual needs of the government hospitals and rural health units, thereby necesSitating the increase of purchases to 18 million or four times the requisi~ tion for the last fiscal year. The Health Secretary, in recommending for

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NAl{ARCO importation of drugs1 alluded as a precedent to similar purchases made by the United States defense supply agency and veterans administration from the Italian pharmaceutical laboratories. As an example, a recent importation limited to tetracycline and chlortetracycline products cost only $4,228,129.63, while the same amount of drug firm announced recently the reduction of price of a life-saving medicine by almost 50 per cent. The big reduction in price further proved the Health Secretary's contention that prices of antibiotics in the Philippines is about four times higher than the figures in other countries. In the current relapse of Cholera El Tor and other diseases and considering the difficulty of most people in buying life-saving drugs~ the Health Secretary suggested the lifting of patents held by foreign drug companies to allow the ~anufacture of similar drugs here at cheaper prices, the compulsory licensing of foreign firms of local drug manufacturers to produce these drugs and the importation from Italy and other European countries of f8 million worth of these drugs at rates much lower than those quoted by American drug fims. Presently 1 with the patent-holders arguing that the cost of research and control have generated the soaring of drug prices, the above-mentioned lowering of price of a particular medicine was decided upon with apparent reluctance; and though this still falLS short of the goa1 1 the spirit of cooperation shown by the drug firms is commendable. From price quotations supplied by drug firms and from its series of purchases of health and medical supplies this year 1 the Department of Health learned that the prices of about 40 per cent of mediCine, drugs, sera, and medical and hospital equipment being sold in the local market have increased from 10 to 30 per cent in tariff imposed on raw materials imported by local drug manufacturers and the adoption of the decontrol program vlhich had increased the $l-to-12 rate of exchange to $1 to n.90 or 13.95. Despite these conditions, prices of highly ethical and antibiotics or "broad spectrum" drugs like terramycin, dehydrostreptomycin, suromycin and mysticlin had remained steady. The only drug of this category which price had decreased was chloromycetin. The prices of medicine for diarrhea, coughs, fever, dysentery, mental and heart disee.ses increased from 10 per cent last year to 20 per cent since January 1. On the other hand, the prices of proprietary medicine like Scotch Emulsion and other ""light" medicines, antitetanic serum and other sera had sho~maight increases since the start of the year.

TdE

MEDICARE PROGH.Ml

Not vuthstanding the general misunderstanding that has surrounded circumstances of "medicare", the Health Secretary voiced some clarifications on a beneficial national health services that could be adopted in the Philippines. The inspiration for the plan, ~ich recalls the more advantageous aspects of the national health service in England, would require an interpretation of a medical care program that would not intrude on a patientls right to choose his own phYSician and the liberty of a doctor to practice his profession. Here 1 it must be emphasized that the administration of' such a program would not necessarily imply a socialized medicine.

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The program's objective is to provide adequate medical care to everyone in accordance to his needs, preserving freedom of choice of medical attendance and with this thereby seeking to destroy the class barrier that the present system tends to create. The concept of medicare is based on fact that medical service should not be given on the ability to pay but to give the poor equal access to facilities as the rich would receive. Figures show that 61.9 per cent of registered deaths in the Philippines did not receive medical attention. In ¥~nila alone, 46 per cent died ~Qthout the benefits of medical attention. Andyet anyway, close bf 8,000 hospital beds in government and private hospitals in the countr,y remain unocdupied because of the inability of the sick to pay. To combat these unfavorable results, a plan has been proposed which will work on the following principles: (1) the system recognizes U:·3 responsibility of the individual to provide a reasonable sum for his own care and for those who are dependent on him, provided that he is in a position to do so; (2) the scheme is voluntary. The people are free to use or not to use the facilities offiered. There shall be no compulsion either from the patient or from the doctor. There shall be no interference in the making of private arrangements at private cost; (3) tte people shall be free to choose their own doctors and to receive care in the hospital of their own choice; (4) the doctors shall be free to pursue their professional practice in their own individual way and shall not be subject to outside interferer.ce; and (5) the dector-patient ~e1ationship shall be preserved and the whole scheme shall be founded on the familY doctor-patient concept. In this connection, ~he Philippine Medical Association had agreed on a general approach to organize the system, and this will include the use of all government and private facilities, including specialist service, the expansion of rural health units, the use of private medical practitioners who are willing to participate in the sysfem; the use of appropriations for the health department, the medical are allotments from the Social Security 8ystem (8.S.8.), the Government Service Insurance System (G.S.I.S.), four to seven per dent of land taxes and voluntary contributions from members of the community who wish to join the plan; the creation of a Philippine Health Service Commission to implement the program. According to estimates made by the department of health, the medicare program will cost seven to nine per cent of the total national budget in any ~ven fiscal year of the Philippines.

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I

SARAWAK

::>-'

MEDICAL AND HEALTH DEPARTMENT

ANNUAL REPOR1' 1962

Price: $1.50

Medical and Health Department, Kuching, Sarawak, Borneo.

Sir, I have the honour to submit for the information of His Excellency the Governor, and for transmission to the Right Honourable the Secretary of State, Part I of the Annual Report for 1962, of the Medical and Health Department of Sarawak.

'.

I have the honour to be,

Sir, Your obedient servant, D. A. BAIRD, Director of Medical Services THE HONOURABLE THE CHIEF SECRETARY, KUCHING .

. or

CONTENTS

Paragraphs

I II III IV V

Background information General Review Staff Visitors Training: ( a) Overseas (b) Local Departmental and Divisional Organisation Preventive and Social Medicine Epidemic and Endemic Diseases: (a) Malaria (b) Tuberculosis (c) Leprosy (d) Endemic Goitre (e) Dysentery and Enteric Fever (f) Trachoma (g) Quarantinable diseases Hospitals and Dispensaries: ( a) General Hospitals .. (b) Static and Travelling Dispensaries Special Hospitals: (a) Sarawak Mental Hospital .. (b) The Rajah Charles Brooke Memorial Hospital Specialised Services: (a) Ophthalmic Services (b) Dental Services (c) Pathological Laboratory Services (d) X-ray Services (e) Physiotherapy Services (f) Surgical Services (g) Obstetrical Services .. (h) Maternal and Child Health Services (i) Medical Stores Services Voluntary Organisations

1-18 19-26 27-30 31

VI VII VIII

32-36 37--46 47-49 50-60 61-64 65-69 70-71 72

-

73 74 75 76-95 96-100 101-106 107-112 113-114 115 116-124 125-126 127

IX

X

XI

}

128

.~-

[

XII

129-130 131-133134-141

MEDICAL AND HEALTH DEPARTMENT ANNUAL REPORT 1962 PART I I. BACKGROUND INFORMATION

Sarawak occupies an area of about 47,500 square miles Q1n the northwest coast of the island of Borneo. It lies between latitude 0° 50' and 5° North, and longitudes 109 36' and 115° 40' East and the territory occupies slightly less than a sixth of the island. which is the third largest in the world. 0

2. The climate is tropical, with a heavy rainfall, a uniform temperature and a high humidity. From early October until the middle of February, the n?rtheast monsoon brings heavy rainfall, especially in the coastal belt. The ramfall averages between 150 and 180 inches in most areas, and the mean annual rainfall at Kuching is 158 inches. There is, however, normally a daily mean of three to seven hours of sunshine, depending on the season. On the whole, the climate is a pleasant and equable one, in spite of the tropical situation of the country. It is never cold, and although it can get fairly hot in the day-time the heat is never oppressive and the nights are generally cool. The temperature is uniform, varying between the mean maximum of 87'9°F and a mean minimum temperature of 72'5°F in 1959. 3. The total population at the census held in June, 1960 was 744,529. This showed an increase of 198,144 over the figure obtained at the previous census in 1947, i.e. an average annual increase of 15,242, during the thirteen years. Of the total population, 375,846 were males, and 368,683 females. Sea Dayaks, with a population of 237,741, still form the largest single racial group, followed by the Chinese with 229,154, the Malays with 129,300, the Land Dayaks with 57,619 and the Melanaus with 44,661. Other indigenous races, totalled 37,931 and there were 1,631 Europeans. Since 1947, there has been a percentage increase of 57.9 in the case of the Chinese population, compared with a percentage increase of only 24.9 for the Sea Dayaks, 36.6 for Land Dayaks, 32.7 for Malays and 25.6 for Melanaus. 4. Malays, Kedayans and many Melanaus profess the Muslim faith. There are a .number o~ Christian. Missions at work in Sarawak - Anglican, Roman CatholIc,. ~ethodls~, EvangelIcal. and Seventh Day Adventist. There are also small commumtIes of Hmdus, BuddhIsts and Bahais. The 1960 census revealed that ther~ .were 174,123 persons professing the Muslim faith, 117,755 professing ChnstIans and 452,651 of the other religious beliefs. 5 .. ~?raw:'lk. is divide~ .into five Divisions for administrative purposes and each DIVISIon IS m turn dIVided into Districts, under the charge of a District Offillcer. The 1960 census showed that the population of five Divisions was as f o ows:First Division 247,954 Second Division 109,422 Third Division 261,487 Fourth Division 96,666 Fifth Division 29,000

-2The Annual Report on the Registration of Births and Deaths for the year 1961, showed that, at the end of 1961, the estimated figures for the five divisions, corrected for births and deaths, but excluding immigration and emigration, were as follows:First Division 258,800 Second Division 111,917 Third Division 268,857 Fourth Division 99,621 Fifth Division 29,839 769,034 Including the balance of immigrants over emigrants, the total population, as estimated on 31st December, 1961 was 769,526. At the end of June, 1962, the total estimated population was 776,990. The control of local affairs is largely in the hands of elected District Councils, which in turn elect representatives to the Divisional Advisory Council, under the chairmanship of the Resident. Divisional Councils nominate members to sit on the Legislative Body, called Council Negri, and this body in turn elects members to Supreme Council over which the Governor presides. The capital of Sarawak is Kuching, which is also the administrative headquarters of the First Division. Headquarters of the Second, Third, Fourth and Fifth Divisions are Simanggang, Sibu, Miri and Limbang, respectively. 6. Of the total estimated area of 47,500 square miles about three-quarters is still covered by primary rain forest, and the remainder is mainly used for settled and shifting cultivation (six per cent and eighteen per cent respectively). Although Sarawak is basically an agricultural country, the soil is generally poor and shallow, some being extremely acid in reaction, and over much of the accessible part of the country the inherent poverty of the soil has been accentuated by wasteful practices associated with the cultivation of dry padi. The shifting cultivation of hill padi, normally practised, results in reduced fertility unless the ground is allowed to be fallow for fifteen years or so, after each crop. 7. The main cash crops are rubber, pepper, sago and coconuts, and a considerable proportion of the general revenue of Sarawak is derived from the export duty levied on rubber and pepper. There are also large and important forest reserves, and timber production ranks after ~gr~cultur~ as the most important economic activity carried on in Sarawak. The pnnclpal mmerals known to occur in Sarawak are bauxite now the main mineral export, oil which has been produced from the Miri oilfields' for fifty-one years, but is now decreasing in quantity, gold in small quantities, and coal. The la.st ~amed is ~nown to occur. in. payable quantities, but so far, lack of commumcatlOns h~s ~lscouraged exp~OltatlOn. The new road from Kuching to Simanggang passes wlthm reasonable dIstance of one

know:. fie:. :::i:i:a:1 ::o:;~a::nd;::::~::: the a~tual penduction 01

wet padi in Sarawak is inadequate for l!S needs, a~d approxImately half of the country's requirements are imported, mamly from Sl.am. Other food crops such ta ioca maize yams and sweet potatoes are used m rural areas, to supplement a~ p A ~oticeable feature of the agricultural economy is the small number of r:~:~tock, and the almost e?tire absence of mixed farming. The few small herds of cattle which exist are mamly confined to the sandy coastal area, though buffaloes

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are reasonably plentiful in the Fifth Division. The only classes of livestock kept in significant numbers are pigs and poultry. 9. Sarawak is a relatively healthy country by tropical standards. Bilharziasis, yellow fever, typhus, plague and relapsing fever are not encountered, nor has there been a case of smallpox for many years. The same could have been said about cholera, but for the outbreaks of "El Tor" para-cholera, which occurred during 1961 and 1962. Due to the poor standard of environment sanitation, however, dysentery and the enteric diseases continued to occur in distressingly large numbers. Leprosy is prevalent also, and endemic goitre occurs in the interior. 10. The policy of the Government in the field of public health, as enunciated in 1960, is as follows:"Believing that good health is one of the most important assets of any community, it is the policy of Government to promote the health of all the people of Sarawak in so far as its financial resources will permit. This will be achieved by: (a) protecting the community against the common communicable diseases, by free protective vaccination and inoculation, and by such other methods as may be available from time to time; (b) educating the public in matters concerning the preservation of health and the avoidance of disease; (c) encouraging the establishment of maternal and child health services as a means of maintaining the health of mothers and children; (d) advising district councils in their effort to improve the sanitary and living conditions of the people; (e) maintaining hospital and dispensary services for the effective treatment of the sick and injured; (f) providing a dental service complementary to the private practitioner service, with particular emphasis on the care of children."

11. More and more emphasis is being placed, each year, on the preventive aspects of the work of the department. Mass health campaigns, such as the Malaria Eradication project, the Tuberculosis Control scheme, and the campaign against yaws, which was successfully completed in 1956, are already having a marked effect on the general health of the population. 12. In the field of curative medicine, hospital and dispensary facilities throughout the country have steadily improved over the past five years. There are now four main general hospitals situated at Kuching, Sibu, Simanggang and Miri and a small divisional hospital at Limbang in the Fifth Division. During the year a new forty-bed district hospital at Sarikei in the Third Division was brought into use, with a medical officer in charge. In addition to these Government institutions there is a forty-six bed general hospital at Kapit, run by the Methodist Mission, and there are small mission hospitals, dealing almost exclusively with maternity cases, at Kanowit, Sarikei, Mukah, Long San and Serian. Other institutions run by the Government Medical Department are the Rajah Charles Brooke Memorial Hospital for patients suffering from leprosy, situated at the Thirteenth Mile, on the Kuching-Penrissen Road, and the Sarawak Mental Hospital, seven miles from Kuching. In all there are 1,780 beds in Government hospitals and 115 10 non-Government hospitals making a total of 1,895 beds available for the

':,

'!'c

-4population of 769,526. In additio~ there are 219 restbeds attached to the thirty static dispensaries run by the MedIcal Department. 13. There were eighteen private medical practitioners registered in Sa!a~ak at the end of the year, in addition to the thirty government doctors and specmhsts, six Shell Oilfields doctors, three Mission doctors and one Peace Corps doctor. 14. There were four Government dental officers and 145 private dentists registered during 1962, but of the latter only six, including two employed by the Shell Oilfields Limited possessed degrees or diplomas scheduled under the Dentists Registration Ordinance, the others being registered under a special provision of the Ordinance. 15. Outside Government Service, there was only one qualified pharmacist in Sarawak, attached to the Methodist Mission hospital at Kapit. Eighty-three annual licences to sell poisons on a restricted basis were, however, issued to business concerns during the year. 16. The number of midwives registered under the Midwives Ordinance was 440 of which 168 were in Central and 103 in Local Government employment. 17. It was decided, during the year that as from the first of January, 1963 all ulu dressers, at present in local authority service will be taken over by Government in implementation of its declared policy that all curative services will be a central government responsibility. The number to be taken over is twenty-one, making a total of ulu dressers in government employment after 1st January, 1963, of fifty-one. 18. Government's total estimated recurrent expenditure for 1962 was $68,616,336.00 of which $7,161,561.00 was allocated to Health Services, representing approximately 10.4 per cent of total budget. This compares with 10.2 per cent in 1961, 11.1 per cent in 1960 and 10.9 per cent in 1959. In addition the sum of $1,738,738.00 was provided in the Development Estimates for work on development projects during the year. This included $805,000.00 for the Malaria Eradication Project, $195,298.00 for the Tuberculosis Control Scheme, $144,000.00 for the completion of the New Central Medical Stores, 'and . $154,886.00 for the first phase of the New Kuching General Hospital. There was also a sum of $298,000.00 provided for items of Capital Expenditure and $50,000.00 for minor improvements to hospitals and dispensaries. -,

II. GENERAL REVIEW 19. There has been no major event to report during 1962, comparable with the El Tor cholera outbreak which occurred during 1961. From October 19th, 1961 until 15th November, 1962, no further case of the disease was reported in Sarawak. During November and December, 1962, however, an outbreak of El Tor cholera occurred in the upper Serian District of the First Division, close to the border with Kalimantan. The outbreak was confined to kampongs situated on the upper reaches of two tributaries of the Sadong river with the exception of an isolated case which occurred in a downriver kampong. In all there were sixteen confirmed cases including three deaths. The last confirmed case occurred on the 10th December. Vaccinations were carried out in all affected areas, the total number done being 15,228. Strict measures were taken to prevent the spread of the disease, the origin of which is ascribed to an unconfirmed report of an outbreak across the border, in Indonesian Borneo. '

.-

-520. In the absence of any major epidemics of infectious disease, it has been possible to concentrate the efforts of the Department on the two major health schemes being undertaken at present, namely the Malaria Eradication Project, and the Tuberculosis Control Scheme. Steady progress has been made with both during the year, and fuller details are given later in the section dealing with endemic and epidemic diseases. 21. At the end of the fourth year of the 1959-1963 Development Plan, several of the schemes have already been completed, and others are due to finish next year. Completed schemes include the Sarawak Mental Hospital, the new Sarikei and Simanggang Hospitals, the Sibu Hospital extension scheme, and the new Central Medical Stores and Manufacturing Laboratories. The improvements to the Rajah Charles Brooke Memorial Hospital have been completed with the exception of the water storage dam, the construction of which is due to start very shortly. New dispensaries were completed during the year at Daro in the Third Division, and at Bekenu, in the Fourth Division. A dispensary at- Belaga (Third Division) is under construction and tenders for dispensaries for Muara Tuang (First Division) and Pus a (Second Division) have been called for. 22. Further improvements to Kuching Hospital, following the transfer of the Central Medical Stores to its new buildings at Tanah Puteh, were started towards the end of the year and will be completed early in 1963. It will then be possible to transfer the general and medical administration sections of the hospital, and the nurses training school, to the converted Stores building, leaving extra ward accommodation available in the main hospital building. 23. Considerable progress was made during the year, in the planning of the new Kuching General Hospital. Following a visit to Australia in August, by the Director of Public Works, final arrangements were made for a firm of Australian hospital architects to be appointed under Colombo Plan auspices to plan and design the new hospital. The Australian Government made a Colombo Plan grant of $175,000.00 towards the cost of this work. Three members of the firm arrived in Kuching in September and spent over two months investigating the problem, and preparing a draft narrative and preliminary plans. They are now engaged in preparing sketch plans and working drawings in Australia, and it is hoped that subject· to the availability of funds, construction of Phase I of the hospital should begin about the end of 1963 or early in 1964. 24. In anticipation of the extra 200 beds planned in the first phase of the new hospital, a new wing to the Nurses Home is being built, to accommodate an extra thirty student nurses. This is due to be completed in March, 1963 before the start of the new Preliminary Training School course. 25. As stated in paragraph 57 of the 1961 Annual Report a new Rural Health Improvement Pilot Scheme was drawn up and submitted to Government at the end of 1961. This obtained the approval of Supreme Council in May. The scheme envisages the recruitment, in batches, of hand-picked men from ulu areas of Sarawak where agricultural extension workers have already operated or are operating, for training in rural health work including simple environmental sanitation. After completion of their training, each "Health Overseer" will be posted to an area covering about four average size longhouses or an average size kampong, to help to improve the general health and hygiene of the people. It was hoped to start the first course of training before the end of the year, but unavoidable delays in the building of a training centre at Tarat, adjoining the Agriculture Department's Extension Training Centre rendered this

-6impossible, and the pilot scheme will start at the beginning of 1963. If it proves a success, it is hoped to extend the scheme to other parts of the country, and later to integrate it with other Local Government activities in the field of Public Health. 26. At the request of Government, proposals for a new Medical and Health Development plan, to cover the period 1964 to 1968 were prepared during the year. This will be given further consideration in 1963.

DI. STAFF 27. The senior staff of the department as at the 31st December, 1962 was as follows:Designation Director of Medical Services Deputy Director of Medical Services Assistant Director of Medical Services Ophthalmologist Medical Specialist Surgeons Specialist-Alienist Senior Medical Officers Medical Officers Dental Officers ... Establishment Actual 1 1

Remarks

1

3 1

3 21

Kuching, Sibu & Miri

2~ } 5 9

3

Superintendents

8

1 R.C.B.M. Hospital 2 S.M. Hospital ) 2 Health Superintendents T.D. Superintendent I Med. Stores Supt. LI Lab. Superintendent

r

11

Radiographer Principal Matron Matrons (Grade II) Sister Tutors Health Sisters ... .Almoner Nursing Sisters Administrative Assistants Pharmacist

1

3 2 4 1 23 3

2 2 3 21

2 on temporary monthto-month tenns.

3

28. 1962 has again been a difficult year, as far as the filling of specialist and medical officers posts is concerned. At the beginning of the year there were vacancies for an Ophthalmologist, a Medical Specialist and six medical officers. At the end of the year the two specialist vacancies remained unfilled but an Ophthalmologist has been selected and is due to arrive in the middle of January. In spite of the recruitment of four new medical officers, there were still five vacancies, two of which have been filled by medical officers recruited on a temporary basis. One local medical officer who returned to Sarawak after completion of his training in Singapore, on a Government Scholarship, in 1961, resigned during the year, a second failed to return to fill a vacancy held open for him, and a third, who was trained in Australia under Colombo Plan auspices also failed to return as expected.

...

-729. At the end of the year all vacancies on the establishment of matrons, nursing sisters, health sisters and tutors had been filled with the exception of one health sister already selected but not due to arrive until February, 1963, and two nursing sisters, one already selected and due to arrive in February also. Three vacancies on the establishment were filled by nursing sisters locally recruited on a month-to-month basis. 30. The Assistant Director of Medical Services represented the Government of Sarawak at the Thirteenth Session of the World Health Organisation Regional Committee for the Western Pacific Region, held in Manila from September 20th to 25th and thereafter attended the Fourth Asian Malaria Conference from the 27th September to 3rd October. He also visited Taiwan to study malaria eradication in March, and attended a conference on cholera in Manila, in April. The Medical Officer-in-Charge of the First Division participated in a Seminar on Rural Health Services, held in Taiwan from November 21st to December 5th, by the World Health Organisation, and a Health Superintendent represented Sarawak at another seminar, held in Manila in October on Food Sanitation. IV. VISITORS L

31. The following distinguished visitors from overseas paid visits to Sarawak during the year either to give expert advice, or to inspect various aspects of the work of the department:WHO Area Representative, Epidemiological Dr. W. W. Yung Station, Singapore. Sir John Martin Mr. W. I. J. Wallace Dr. W. L. Barton, M.B.E.

Permanent Under-Secretary at the Colonial Office. Head of the Far Eastern Department Colonial Office. Government Liaison Officer to the Malaria Eradication Project in Zanzibar. WHO Consultant, c/o Army Attache, American Embassy, Bangkok. Regional Entomologist, WPRO, Manila. Prof. of Midwifery and Gynaecology, Aberdeen University, Scotland. Colombo Plan Adviser on Tuberculosis. Deputy Regional Representative, United Nations Technical Assistance Board, Kuala Lumpur. Chief Medical Officer and Director of Malaria Service, British Solomon Islands Protectorate. Director of the National Malaria Service, Federation of Malaya. British Writer, on behalf of United Nations: Agencies.

Dr. Oscar Felsenfeld Professor C. Y. Chow Sir Dugald Baird Sir Harry Wunderley M. A. Vaidyanathan

Dr. J. D. MacGregor Dr. Ling Ding Seng Professor Ritchie Calder, C.B.E.

-8Mr. Jack Ling Mr. S. Matsui Professor E. E. Rich Prof. Vere Hamsworth Mr. Lance Joseph Dr. J. A. B. Nicholson, Acting Director of Medical Services, North Borneo. Professor of Medical Nutrition, Royal Tropical Dr. H. A. P. C. Oomen Institute and University, Amsterdam. Chief Medical Officer to the Ministry of Dr. J. M. Liston, C.M.G. Technical Co-operation. of the Ministry of Health, Singapore. Dr. S. R. SayampanathanChief Dental Health Officer of the WHO HeadDr. F. B. Rice quarters in Geneva. WHO Consultant. Professor N. A. Milone Senior Regional Malaria Adviser, WPRO, Dr. M. Postiglione Manila. Mr. F. E. L. Carter, C.B.E. Deputy Director General of the Overseas Audit Service. Area Representative, UNICEF, Bangkok. Mr. S. Polak M.B.E. -

Public Information Officer, UNICEF Regional Office, Bangkok. Director of the Colombo Plan Bureau. Master of St. Catherine's College, Cambridge. Professor of Naval and Imperial History. University of Cambridge. Third Secretary, Australian Commission, Singapore.

Mr. Allan R. Tompson Mr. Eric D. Lyon Mr. Rod Le Rossignol Dr. F. F. Lorang

")

~ Representative of Messrs. Leighton Irwin and I Co. Pty. Ltd., Australia, Architects. J Anaesthetist from Australia.

V. TRAINING (a) Overseas

32. During the year nine members of staff returned to duty, having completed the following training courses overseas:-

Course Dentistry Post-graduate Medical (D. Path. & D. Ophth.) Dental Nursing General Nursing Health Inspection Leprosy - Operative techniques

Number 1 2

Where taken Singapore United Kingdom New Zealand United Kingdom Singapore India

..

1 1 (Male) 3 1

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stud~nts an? eleven serVIng officers undergoing training in medical or paramedIcal subjects at the end of the year as shown in the following table making a total of forty-four in all:'

33.

In addition the!e were a further thirty-three Government sponsored

Course Medicine Dentistry Pharmacy Dental Nursing General Nursing Mental Nursing Physiotherapy Dental Mechanic Social Welfare Leprosy - physiotherapy Radiography

United Kingdom 1

4 1

Colombo Malaya or Plan Singapore Countries 2 17 2 1 1 8 1

Total 20 3 1 8 5 1 1 1 2 1 1

1 1 2 1 1

44 34. As in previous years, valuable help in the training of personnel of all kinds has been received from Colombo Plan countries, and in particular from Canada, New Zealand and Australia. Canada has already granted scholarships in Medicine to sixteen students and a further four have been chosen to go there very shortly. New Zealand is training four girls in dental nursing each year for the school dental service, and Australia is providing short courses in radiography, mental nursing, dispensing and operating theatre techniques in addition to degree courses in medicine and dentistry. Further offers of help under the Colombo Plan have recently been received from neighbouring territories such as Singapore and Malaya and this increasing assistance from countries in which conditions closely approximate to those pertaining in Sarawak, is particularly welcome. As a result of these offers, scholarships have been awarded to students to study dentistry, public health, dental mechanics and social welfare, in either Singapore or Malaya, and it is also hoped next year to send nurses for public health nursing training. 35. During the year two Colombo Plan scholarships were granted by India to a medical officer and a senior hospital assistant, for study courses at the Christian Medical College and Hospital, Vellore, South India. The former studied the operative treatment of leprosy patients suffering from deformities, and the latter preventive physiotherapy. It is planned to send another hospital assistant in 1963, for training in theatre technique, and post-operative ward care. 36. World Health Organisation fellowships were awarded, during the year to a medical ?ffi.cer to take part in a training course in the epidemiology and control of tube~culoslS In Prague, and to an entomological technician to attend a training course .In entomology, conducted by a W.H.O. Entomologist and members of the national staff of the North Borneo Malaria Eradication Project.

I -10 ,(b)

Local 37. The departmental training of nurses and hospital assista~ts wa~ fully maintained throughout the year. .Tw~nty:six nur~es and four hosp~tal ~sslstants passed their final qualifying exammatlon !n K11:c~mg General HospItal, m 1962, and there were forty-six student nurses m trammg at the end of the ye.ar. In addition one student nurse and one student hospital assistant pass~d thel~ final qualifying examination, and there were ni~e student nurses a~d hospItal assIstants in training at the Sarawak Mental HospItal. As reported m the 1961 Annual Report, no further male nurses ~re be~ng recruited at present, except fo~ ~he Mental Hospital. The eleven hospItal ~sslstants who were s~nt for speCIal trammg in the diagnosis, treatment and preventIOn of the common dIseases of the co~ntry, finished their course of training in August and ten of them were successful III t)1e final qualifying examination, The eleventh will resit after a further six months. traming in Miri General Hospital. After their examination, the eleven hospital ass~stants received a two months' training in the diagnosis and treatment of leprosy, III the new B.L.R.A. training centre at the R.C.B.M. Hospital. During this period they also received some training in the control and treatment of patients suffering from mental diseases, given by the Specialist-Alienist, Sarawak Mental Hospital. They have all now been posted to outstation dispensaries.

38. The Divisional Medical Officer, Fourth Division, who supervised the training of these hospital assistants completed a "Handbook of Diagnosis and Treatment for Hospital Assistants" which has now been published in cyclostyled book form and distributed to all static and travelling dispensaries in the country. It will be the standard book of treatment for all hospital assistants in future, and the "Standard list of Drugs" mentioned later in paragraph 49 is based on this handbook. 39. Further courses of training for hospital assistants, in the nature of refresher courses for those already working in rural dispensaries, are planned for 1963. 40. The local training of X-ray technicians, laboratory technicians and dispensers, also continued at the General Hospital, Kuching, and in the Central Medical Stores, and Central Laboratory. Three dispensers passed their flnal qualifying examination. There were fourteen student laboratory technicians, three student dispensers and one student X-ray technician in training at the end of the year. 41. Following an informal meeting between the Medical Officer-in-Charge of the Central Laboratory, and the Secretary of the Institute of Medical Laboratory Technology in London early in 1962, a formal request was made for recognition of the Central Laboratory as a training centre for the purposes of the intermediate examination of the Institute. The Committee of the Institute gave its approval in July, and has also offered to try and arrange for their representative to visit Kuching during a forthcoming trip to Hong Kong where the intermediate examination is held each year. It is hoped to send selected members of the laboratory staff to Hong Kong to sit for this examination in future years, and perhaps later to send one or two of them to the United Kingdom for the final examination leading to the full A.IM.L.T. diploma. 42. The "Home Help" scheme outlined in paragraph 32 of the 1961 Annual Report, continued during the year, and there were encouraping reports of the success of the scheme from several districts. The Travelling Dispensary Superintendent continued to train new "Home Helps" in remote areas thought to need

-11so~e kind of medical help, and also to supervise the work of those previously

tramed. By the end of the year, there were 261 of these voluntary workers scattered throughout the five div~sions, that is an increase of 143 over the figure at the end ~f .1961. For financIal reasons, and also due to lack of supervisory staff, the trammg of further "Home Helps" had to be curtailed towards the end of the year. 43. The training of entomological assistants and microscopists for the Sarawak Malaria Eradication Project continued under the direction of the World Health Organisation advisers, and the supervision of the senior Government staff attached to the Project. As already mentioned above, one entomological technician attended a special training course in entomology in North Borneo thus enabling him to give simple practical training to his subordinate staff. ~.

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44. The local training of midwives, in the Midwifery training school in Kuching, continued, and the first midwives trained according to the new twoyear syllabus described in paragraph 34 of the 1961 Annual Report, qualified during the year. Sixteen trained nurses successfully completed their extra years' midwifery training to become fully-trained nurse-midwives, and a further sixteen girls qualified as trained midwives, after the full two years course of training. Fifty-one midwives, of whom seventeen are trained nurses, were in training in December. 45. In view of the fact that the help of hospital assistants in charge of rural dispensaries is often called upon, in emergencies by district midwives, a new scheme was started during the year to give hospital assistants some obstetrical experience. Five men in the Kuching General Hospital were first given a course of instruction, and this proved so successful that the syllabus has now been commended to other divisional hospitals. 46. In connection with the extension of the Tuberculosis Control Scheme to the Third Division, thirteen assistant health visitors recruited in Sibu completed their training in Kuching. One student radiographer, also recruited in Sibu, was given a course of training in Kuching by the Colombo Plan Radiographer. VI. DEPARTMENTAL AND DIVISIONAL ORGANISATION

47. Appendices I, II and III show in the form of charts, the Departmental, Sectional, and Divisional Organisation of the Medical and Health Department. 48. Each Division now has a Divisional Medical Officer-in-Charge, but the full divisional staff as shown in Appendix III, is not yet available in all the Divisions. There are, for instance, only three health sisters available at present, one in each of the First, Third and Fourth Divisions, and the Maternal and Child Health Clinics in the Second and Fifth Divisions are supervised by the Health Sisters in the First and Fourth Divisions respectively. The "Rural Services Supervisors" shown on the same chart will be of senior hospital assistant status and provision has been made in the 1963 estimates for three such posts. These men will be responsible to the Divisional Medical Officer under whom they serve for the supervision of all static and travelling dispensaries, ulu dressers and homehelps. 49. During the year a Divisional Medical Officers' conference was held in Kuching, on May 22nd and 23rd. Matters of departmental policy were discussed

l .-

-

12-

and standard lists of drugs and equipment for use in static dispensaries, in hospitals, and by ulu dressers and other medical auxiliarie~ were finally ~pp~oved. These lists have been published in a cyclostyled book which has been distnbuted to all concerned. VII. PREVENTIVE AND SOCIAL MEDICINE

50. Work was completed on the drafting, of a comp~ehensive ~ew P~bl!c Health Bill, which was taken through its vanous stages 10 CouncIl Ne.gn 10 December. It will come into effect on the 1st January, 1963. The new Ordmance deals with administration, notification, prevention and suppression of disease, the suppression and destruction of disease-bearing insects, water supplies, food and drugs, nuisances, offensive trades, sanitation and buildings, hospitals, maternity homes, nursing homes, health centres and mortuaries, and burials and exhumations. There is also a considerable volume of subsidiary legislation covering a large number of other public health subjects. The object of this Ordinance is to make better provision in the law relating to public health in Sarawak and to consolidate and bring up to date the existing law and to set it out in one piece of legislation. 51. In the First Division, the pit latrine project which was described in paragraph 57 of the 1961 Annual Report, under the heading of "Dysentery and Enteric Fever", made considerable progress during 1962, and achieved great success in certain areas. Over 450 latrines were constructed by the local people with advice and assistance from government. Aqua-privies were also installed in a large number of houses in Bau, Serian and Simunjan in the First Division. Both the Kuching Municipal Council and the Kuching Rural District Council held campaigns to clean up the town and rural kampongs during the year, and a similar campaign was held in Bau. The more immediate results were good and similar schemes are being encouraged elsewhere. ' 52. Free protective inoculation against diphtheria, tetanus and whooping cough, is available in all Maternal and Child Health Clinics and free vaccination against smallpox is available generally at all government medical centres. Cholera vaccination is only free when undertaken as a specific health measure in the face of an outbreak such as occurred in November and December. There have been rather many sporadic cases of diphtheria reported, and inoculation campaigns have been carried out in certain areas of the country, especially in the First Division. Health Education

53. Increased emphasis was placed on the public health and preventive aspects of their work, during the training of hospital assistants and midwives. The house-to-house visiting by the assistant health visitors attached to the Tuberculosis Control Scheme in Kuching, and latterly, in Sibu, has afforded an opportunity for the general principles of health education to be spread more widely, in addition to the more specialised advice given about tuberculosis. The small outbreak of cholera in the First Division in November and December also provided the department with an opportunity of stressing, once again, the dangers of poor environmental sanitation, and the need for cleanliness in the home and its surroundings, in the streets and markets and in all public eating places. As in previous years, lectures have been given by members of the department to scholars, student teachers, administrative cadet officers and clerical staff taking courses in the

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The New Central Medical Stores and Manufacturing Laboratories, at Tanah Puteh, Kuching. (See paragraph 131).

A Sarawak Malaria Eradication Project worker spraying a longhouse. (See paragraph 61).

Mantoux testing of school children in a Malay School by staff of the Tuberculosis Control Project. (See paragraph 65).

.

An Assistant Health Visitor (Tuberculosis) explains the drug regime to a patient, during a domiciliary visit. (See paragraph 67).

..;,..'

Above, the students hostel. and below, the classroom at the Rajah Charles Brooke Memorial Hospital, built with funds donated by the British Leprosy Relief Association. (See paragraph 108).

The official opening ceremony of the new Dispensary at Bekenu, Fourth Division. (See paragraph 98).

The new garden at the Sarawak Mental Hospital. (See paragraph 103).

-15means it is hoped to reduce the re-admission and relapse rate. Hospital Assistants attending refresher courses are now being given instruction in the follow-up care of mental patients. A more detailed account of the work done in the Sarawak Mental Hospital will be found in the section on Special Hospitals. Figures of admissions and discharges and other statistics will appear in Part II of this report to be published later. VIII. EPIDEMIC AND ENDEMIC DISEASES (a) Malaria 61. The Sarawak Malaria Eradication Project proceeded according to plan. In what are now called the "border areas" supporting approximately one-fifth of the population of Sarawak it has not yet been possible to interrupt transmission. This is due largely to the absence of eradication measures in Kalimantan. 62. The rest of the country containing four-fifths of the population is in consolidation and is well covered by active and passive case detection. Every effort was made to increase the passive case detection system with a view to future reduction in the number of active case detection units when areas are placed in the maintenance phase. Investigation and the radical treatment of all cases was carried out in all consolidation phase, and in most attack phase, areas. 63. In January, 1963, the Revised Plan of Operations covering the period 1961-63 was signed by the World Health Organisation, and the Sarawak Government. An advance from M.E.S.A. funds to cover local costs was requested and received towards the end of the year. The Project received continued assistance from a W.H.O. Advisory Team consisting of a Malariologist, Entomologist, and Sanitarian. 64. The project will be described in greater technical detail, together with relevant statistics, in Part II of this report. (b) Tuberculosis 65. The Tuberculosis Control Project made considerable progress. Activities continued in the Kuching Municipal Council area, where all schools, and five of the nine municipal wards were covered before the end of the year. 66. In October, staff of the Project moved to Sibu to start activities there. They had been recruited from the Third Division in 1961, and received their training in Kuching in preparation for their eventual transfer back to Sibu. At the same time peri-urban communities living across river from Kuching were visited by Project staff, and approximately 1,700 pupils, were Mantoux tested. 67. Mass miniature radiography continued in Kuching and was started in Sibu. Sputum examinations were carried out in appropriate cases and treatment with INH or PAS and INH instituted whenconsidered necessary. Assistant health visitors made frequent home visits to check on defaulters. Alterations were carried out to: the A.~.A.S. Chest Clinic to improve record keeping, filing and sputum collectIOn. ThIS has speeded up the flow of patients through the clinic .

•

. 68. . Colombo Plan assistance continued during the year. The Colombo Plan nursmg SIster and the radiographer continued with the training of Kuching and

-16 Sibu staff. Supplies of tuberculin, vaccine, films, and drugs arrived on schedule, from Colombo Plan sources. 69. The project is described in greater technical detail including relevant statistics, in Part II of this report. (c) Leprosy 70. There have been two major advances in the ~eld of leprosy treatm~nt during 1962. Firstly, two members of the staff, a medIcal officer and a seruor hospital assistant, have received specialised training in the Christian College and Hospital, Vellore, South India, as a result of which surgical treatment start~d during the year, in the small theatre at the Rajah Charles Brooke Memonal Hospital the equipment for which was generously provided by the British Leprosy Relief Association. The Association also provided tools to equip a workshop where artificial limbs and special footwear for patients can now be made. The services of the physiotherapist, jointly sponsored by the British Red Cross Society and the British Leprosy Relief Association, have been of great benefit to crippled patients, and over a hundred patients regularly attend twice weekly sessions for massage and exercises.

71. The second major advance has been in the field of training of hospital assistants, destined for posting to rural dispensaries throughout the country. As reported in the 1961 Annual Report, the British Leprosy Relief Association made a generous grant of £5,734 towards the building of a training centre and hostel, at the R.C.B.M. Hospital. This centre was completed during the year, and the first batch of trainee hospital assistants took up residence in September, for a two months course of training in the diagnosis and treatment of leprosy. This course was most successful, and it is planned to hold further courses of a similar nature, in 1963. Fuller details of the work done in the R.C.B.M. Hospital will be found in the section on Special Hospitals and statistics will appear in Part II of this report. (d) Endemic Goitre

72. Although the Third Division is now adequately provided with iodised salt, prepared at the salt-iodisation plant in Sibu, it has unfortunately not been found possible to install a similar plant in Kuching to cover the First and Second Divisions, as planned. This has been due to the difficulty of finding suitable accommodation for the plant, and to inadequate information regarding the importation and subsequent distribution of salt, after its arrival in Kuching. Detailed information has now been collected and the problem is being given further study. (e) Dysentery and Enteric Fever

73. Inpatient returns for 1961, showed that dysentery was the second most common condition treated in the wards of the four main hospitals, and typhoid"'~ fever, including paratyphoid, took eighth place. Outpatient statistics for the same year showed that the commonest group of conditions seen was that relating to diseases affecting the digestive system including worm diseases, diarrhoea, enteritis and dysentery. No less than 110,168 cases belonging to this group were treated out of a total of 440,854. Of this number, 30,000 were cases of diarrhoea and enteritis. During 1962, the same picture has emerged and the relevant statistics .~_. will appear in Part II of this report. After tuberculosis, enteritis is the most pressing public health problem in Sarawak. The new Rural Health Improvement

--17Scheme, already described in paragraph 25 of this report, is being launched in an effort to improve environmental sanitation in rural areas, and so reduce the incidence of these intestinal diseases, which are due mainly to poor or in many cases non-existent sanitary facilities and poIlu ted water supplies. The fact that typhoid fever has not assumed epidemic proportions in spite of the frequency of its occurrence, is presumably due to the fact that there are no community water supplies in the ulu, while in towns and bazaars where piped supplies are available, the water is fuIly treated. (f) Trachoma

74. In the absence of an ophthalmologist during the year it was not possible to consider further plans for the control of this disease. News of the appointment of an ophthalmologist was received, towards the end of the year, and it is hoped that he will arrive in Sarawak early in 1963. The Divisional Medical Officer, First Division, reports that, in addition to trachoma and conjunctivitis there appears to be quite a degree of Keratomalacia which may be a contributing factor. The distribution of V.N.I.CE.F. "Vitamin capsules" should help to prevent this. (g) Quarantinable diseases

75. An account of the outbreak of cholera in the First Division has already been given in Chapter II, General Review. No cases of smallpox, plague, yellow fever, louse-borne typhus or louse-borne relapsing fever occurred during the year. IX. HOSPITALS AND DISPENSARIES (a) General Hospitals 76. The new Sarikei Hospital contammg forty beds completed in March was not fully commissioned until November. The opening of this new hospital should to some extent relieve the pressure on the Lau King Howe Hospital, Sibu, especially in the fields of traumatic surgery and abnormal midwifery. With the opening of the new network of roads leading to Sarikei, this hospital will later serve the Saratok area of the Second Division, and some areas in the Third Division which, in the past, looked to Sibu for hospital treatment. 77. Alterations to the General Hospital, Kuching, led to an increase in the total number of beds available, from 342 to 369. The distribution of beds in the six Government hospitals, as at 31st December, 1962, was as foIlows:Hospital General Obstetrics T.B. Infections MenIal Total

....

1. 2. 3. 4. 5. 6.

Kuching General Hospital Lau King Howe Hospital, Sibu Simanggang General Hospital Miri General Hospital Limbang Hospital Sarikei Hospital

234 171 65 77 12 40 599

49 32 4 10

76* 48 36 61

10 19

10

369 280 105 148. 12 40 954

• _ _ -..J..

95

221

29

10

* Including twenty beds in an annexe seven miles from Kuching.

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78. To this total can be added 129 beds in mission hospitals, the majority of which are for obstetrics. The largest of these hospitals is a general hospital of forty-six beds, situated at Kapit, in the Third Division and run by the Methodist Mission. It contains X-ray and operating theatre facilities and has two doctors, a dentist and a pharmacist on its staff. The other mission hospitals are run by the Roman Catholic Mission at:12 beds First Division Serian 10 beds Third Division Sarikei 5 beds Third Division Mukah 40 beds Third Division Kanowit 16 beds Fourth Division Long San 129 79. There is therefore a total of 1,083 general beds in the country or one bed per 687 of the population, excluding the special beds for the treatment of leprosy and mental disorders. This compares with one bed per 724 of the population in 1961. General Hospital, Kuching

80. This hospital serves Kuching and district, the whole of the First Division and that part of the Second Division which has easier access to Kuching than to Simanggang. With the opening of the new Sarikei Hospital, however, it is expected that most of these Second Division patients will eventually be treated there, rather than in Kuching Hospital. During 1962, alterations to the hospital have increased the total number of available beds from 342 to 369, and there will be a further increase in 1963 when the building previously occupied by the Central Medical Stores Section, is converted into offices and training accommodation for nurses and midwives, thus releasing extra ward space in the hospital itself. Maintenance and re-decoration of the hospital buildings by the Public Works Department, has been regularly done throughout the year, and there has been a general improvement in the facilities in wards and other departments. 81. The addition to the staff of the physiotherapist sponsored jointly by the British Red Cross Society and the British Leprosy Relief Association, has been most valuable and welcome. Her services are shared by the General Hospital and the Rajah Charles Brooke Memorial Hospital, to the great advantage of both. 82. The facilities at the Tuberculosis annexe at seventh mile, have been considerably improved during the year. The buildings have been re-painted, both inside and out, ceilings have been fitted in all the rooms making them much cooler, and glass louvred windows have been installed. A cook has been employed to cook for those patients not able to fend for themselves, thus increasing the usefulness of this unit. 83. The Health Centre, which deals with all outpatients in Kuching with the exception of senior Government officers and their families, treated large numbers of patients though hampered at times by a shortage of staff and frequent changes in personnel. 84. Due to difficulties in recruiting Specialists and Medical officers, the staff of the hospital and health centre has been below strength all year. The shortage of locally trained nursing staff is steadily improving each year as the

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Training School turns out more trained nurses. In anticipation of an intake of about thirty additional student nurses early in 1963, work has started on an extension to the Nurses Home.

The Lau King Howe Hospital, Sibu 85. The main effort during the year was directed towards the better employment of available space and the improvement of the services provided within the existing resources of the hospital. The main improvement was the reorganisation of the outpatient department with the institution of special clinics for diabetic, cardiac and medical cases. The hospital office was moved from the outpatient department and the space made available was converted into a chest clinic. By moving the miniature X-ray unit from the west to the east wing of the department it was possible to group all the tuberculosis services in the east wing and the majority of the outpatient services in the west wing. It is planned later to move the dental clinic to new premises and utilise the space for special clinic consulting rooms, so that eventually all general outpatient services, including laboratory facilities will be grouped together in the west wing of the department. The conversion of the old miniature X-ray room to a card record room has resulted in an improvement in the flow of patients through the outpatient department, and an extra consulting room for preliminary screening of patients by hospital assistants or nurses, has helped also in this direction. A medical officer is now available on an almost full-time basis for this department, as a result of an improvement in the medical staff situation in the hospital. 86. To improve the space available for nursing and isolating sick children, the childrens' ward was transposed with the female medical ward. This has proved a successful move. A reception room for admission has been set up near the hospital entrance and has resulted in the smoothing out of a number of minor difficulties. The room is staffed by a trained hospital assistant from 6 a.m. to 9 p.m. and he is in addition responsible for the preliminary work involved in the examination of recruits for Government service. 87. Other improvements to the hospital include the completion of the filling of the hospital compound and its drainage, the installation of a new R /3 X-:r;ay set in the main X-ray room of a new 70 mm. Odelca camera unit for mass miniature radiography in the chest clinic, better drying facilities in the laundry and the provision of a light paging system for the medical staff. Plans were prepared for the addition to the obstetric wards of a reception and labour unit, but lack of funds has postponed further consideration of this meantime. 88. The staff situation in the hospital improved during the year by the addition of one medical officer and one nursing sister.

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Simanggang General Hospital 89. There have been a few minor improvements made to the hospital during the year, including the completion of the re-tiling of floors and bathrooms and the repainting of all the buildings, air-conditioning of the laboratory and dispensary store, and the installation of venetian blinds in the wards. A quarter to accommodate two nursing sisters was completed and occupied in March. 90. The completion of the Kuching to Simanggang trunk road has made access to Simanggang much easier, and has opened up large areas of the First and Second Divisions, previously very isolated. As a result the work done in the hospital has increased appreciably during 1962. Inpatient returns for the first nine months of the year exceeded the total admissions for the whole of 1961. Fuller details will be included in Part II of this report.

-20Miri General Hospital 91. Alterations to the children's ward of the hospital, and the conversion of the old teaching block, to a ward, helped to improve the general over-crowding arising from the increase in admissions. The Tuberculosis section of the hospital, with sixty beds underwent no major alterations during the year. The steady increase in work in the hospital, described in paragraph 83 of the 1961 Annual Report, continued during 1962. 92. During the latter part of the year, the Divisional Medical Officer has done clinical work in the hospital when not involved in divisional administrative duties. Having obtained the Diploma in Ophthalmology during his leave, he has been able to take over the ophthalmological work in the Fourth Division, and so compensate to some extent for the lack of a Specialist Ophthalmologist. 93. The first training course for hospital assistants, was completed in August, and ten of the eleven students successfully passed the final qualifying examination.

Government Hospital, Limbang 94. Work in the small hospital has steadily increased since the posting of a medical officer to the Fifth Division in August, 1961. During 1962 a Mobilix X-ray machine was installed and numerous minor works completed, such as the provision of an incinerator, bicycle and laundry sheds, extra furniture and medical equipment. The provision of radiological facilities for the examination of cases of tuberculosis has led to the establishment of a large and well-attended chest clinic at the hospital, to which cases are referred from the static and travelling dispensaries in the division, and by the staff of the Borneo Evangelical Mission in Lawas. The staff of the hospital was increased by the addition of a clerk and an additional assistant nurse.

Government Hospital, Sarikei 95. As already mentioned in paragraph 76 of this chapter, this forty-bed district hospital came fully into operation in November. Prior to the opening of the wards, the nursing sister in charge conducted a training course for assistant nurses. During the two months of its operation, it was increasingly evident that full use would be made of the facilities available by the population in Sarikei and the surrounding areas. (b) Static and Travelling Dispensaries

96. There were thirty static dispensaries and ten travelling dispensaries in operation throughout Sarawak at the end of the year. This compares with thirty static and twelve travelling dispensaries on January 1st. Bekenu dispensary opened during the year, adding one to the list of static dispensaries, but in March, Sarikei dispensary became the outpatient .department of the new hospital there, so the total remains the same. The new Daro dispensary was still under construction at the end of the year. Belaga dispensary was replaced by a new building and the new dispensary buildings at Marudi were completed. The sites of new dispensaries at Muara Tuang in the First Division and Pus a in the Second Division were chosen, though work has not yet started on the buildings. . . 97. .oue .to the replacement of the travelling ~ispensaries by static dispensanes at SlmunJan and Bekenu, the number of travellmg dispensaries has dropped f!o~ twelve to ten. Ho~ever, ~ certain amount of travelling is still done, on a limited scale, by the hospital assistants at both places, as is the case at some other

-21dispensaries in the country for example Lawas, and Sundar. The only travelling road dispensary, which is based on Kuching and is under the control of the Divisional Medical Officer, First Division, extended the scope of its activities, following the appointment of a full-time hospital assistant to run it. It now pays weekly visits to kampongs and bazaar on the Matang, Penrissen and Simanggang roads reaching as far as Abok in the Second Division. 98. The enthusiasm with which new medical facilities are welcomed by local people, can be gauged by the following account of the official opening of the new Bekenu Dispensary, a photograph of which appears in the centre of this report. "People of all races in Subis District gathered at Bekenu on the 6th of July to witness the official opening of the new dispensary. Many people had come considerable distances from both upriver and downriver Sibuti and from Niah. The ceremony was held at 5 p.m., and was preceded by the firing of Chinese crackers. Speeches were made by the Sarawak Administrative Officer, Bekenu; the Chairman of the Subis District Council; Tua Kampong Sabeng; Penghulu Mancha; and Sim Kheng Hong, Kapitan China, Bekenu. All the speakers expressed the extreme pleasure of the people in the district for having at last a static dispensary of their own, and their great satisfaction at having such a fine building. The Divisional Medical Officer, Fourth Division, in his speech stressed that the completion of Bekenu Dispensary was another step forward in the fulfilment of Government's policy to improve services to people living in rural areas, and mentioned the Sarawak Malaria Eradication Project, the new training course for hospital assistants and the training of home helps as other examples of the ways in which Government was trying to improve the lot of rural dwellers. He then cut the ribbon across the entrance with a pair of gilt scissors presented by Mr. Sim Kheng Bok, Bekenu. Following the ceremony a party was held in the dispensary, through the generosity of numerous businessmen in the Bekenu area. Coloured lights decorated the dispensary for the ceremony, through the kindness of the Kapitan China, Bekenu." 99. The number of restbeds in static dispensaries is now 217 as shown below:First Division No. of Restbeds 1. Bau Dispensary 4 2. Lundu Dispensary 4 3. Serian Dispensary 5 4. Tebakang Dispensary 4 5. Nonok Dispensary 3 6. Simunjan Dispensary 5

Second Division

7. 8.

9. 10. 11. 12. 13. 14. 15.

Lubok Antu Dispensary Engkilili Dispensary Lingga Dispensary Sebuyau Dispensary Betong Dispensary Spaoh Dispensary Debak Dispensary Saratok Dispensary Kabong Dispensary

4 5 7

7 15 8 0 6 10

Third Division

22No. of Restbeds

16. Binatang Dispensary 17. Matu Dispensary 18. Dalat Dispensary 19. Mukah Dispensary 20. Balingian Dispensary 21. Kanowit Dispensary 22. J ulau Dispensary 23. Song Dispensary 24. Kapit Dispensary 25. Belaga Dispensary Fourth Division

12 6 6 8 6 10 14 8 4 8 -'

26. 27. 28. 29. 30.

Marudi Dispensary Bintulu Dispensary Bekenu Dispensary Fifth Division

10 14 10 10 4 Total 217

Lawas Dispensary Sundar Dispensary

The decrease of two restbeds compared with 1961 is due to the deletion of Sarikei Dispensary with twelve beds, replaced by the forty-bed hospital, and offset by the addition of the ten restbeds in Bekenu Dispensary. 100. There are fifty-one ulu dressers throughout the country, distributed as follows:Number Employed by First Division Second Division Third Division Fourth Division Fifth Division Total 7

9 5

26 4

6 Local Authority 1 Community Development All Government 2 Government 3 Local Authority 24 Government 2 Local Authority All Government

.... -'

51

As already reported in paragraph 17 of Chapter I of this report, all the non-government ulu dressers are being absorbed into the Government establishment on January 1st, 1963, and will thereafter come under the direct supervision of Divisional Medical Officers and their supervisory staff.

.

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x. (a) Sarawak Meotal Hospital

SPECIAL HOSPITALS

101. The Psychiatric Specialist reports that in mental health work the most serious hindrance to a better appreciation of the patients troubles, is the language difficulty. There are so many different languages and dialects spoken that no staff member is able to cover more than a small number of patients for a detailed study of the individual. At the best, vocabularies are limited, and this makes group activities and communication between patients very difficult. Contact with patients, through such media as, occupational therapy and the patients' social club, are therefore very important, and constantly being reviewed and improved. The language difficulty is one reason, for outpatient treatment rather than hospitalisation, being preferred wherever possible. This allows the patients' family to play their part in the therapeutic care of the patient, with whom they can maintain contact. For the same reason, a small number of day patients have been treated at the hospital, as in previous years. 102. The senior staff position remained the same as in previous years namely one Psychiatric Specialist and two Superintendents, one in charge of administration and the other of nursing. A local hospital assistant who returned from New Zealand two years ago having obtained his R.M.N. certificate, is due for promotion to the post of male charge nurse, on the nursing sisters salary scale, at the beginning of 1963. A second hospital assistant has been awarded a government scholarship to study mental nursing in the United Kingdom. Two nurses passed their final qualifying examination during the year and nine probationer nurses entered the second year of their training course. 103. With the co-operation of staff of the Department of Agriculture, a soils survey was made of hospital land behind the hospital buildings, with a view to extending the outdoor activities of male patients. The land has now been cleared, vegetables and fruit trees planted, and the possibility of poultry-keeping explored. Four courses of training for hospital staff were held, each lasting two to four weeks on the practical aspects of vegetable and fruit growing, poultrykeeping and fish ponds. Further courses on the same subjects are planned for other hospital assistants during 1963. 104. The Psychiatric Specialist contributed an eighty-page article entitled "Folk Psychiatry in Sarawak with a Tentative System of Psychiatry" to an anthology of folk psychiatry edited by Dr. A. Kiev of the British Institute of Psychiatry. In the preparation of this he was assisted by a Dayak hospital assistant who holds the R.M.N. qualification, and by Museum and Education Department staff. 105. The hospital took part in the Trade Fair organised by the Kuching Chapter of the Sarawak Junior Chamber of Commerce, and a wide variety of goods which had been made by patients in the occupational therapy department of the hospital were displayed and sold at the stall. A weaving loom, operated by a patient was also on display. The proceeds went to the patients' welfare fund. 106. During the year, an increased number of visitors, including district councillors from outlying districts, sports delegations, students and teachers, visited the h.ospital and were shown round. This is an encouraging trend, and is welcomed by the hospital staff.

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(b) The Rajah Charles Brooke Memorial Hospital

107. The treatment of all patients suffering from leprosy in Sarawak, Brunei and North Borneo is carried out at the Rajah Charles Brooke Memorial Hospital at 13th Mile, Penrissen Road near Kuching which can accommodate 400 patients, or more if required. The medical care of the patients is supervised by the Medical Officer-in-Charge of the Kuching General Hospital, while a colleague with special training in surgical rehabilitation is responsible for the operative work. The hospital is run by a lay superintendent and a small staff of hospital assistants. The Physiotherapist attached to the General Hospital, also visits the R.C.B.M. Hospital twice weekly, and holds massage and exercise sessions for those in need of preventive and post operative physiotherapy. There has been a marked improvement in many of them, and they all enjoy her visits. An attendant at the hospital spent three months in the Sungei Buloh Leprosarium, Malaya, on a course of training in the making and fitting of artificial limbs, and special footwear, and is now in charge of the workshop, equipped by a grant from the British Empire Leprosy Association. This new venture is proving a great success, in the prevention of foot ulceration. An article describing the making of the original artificial limbs earlier in the year, written by the superintendent was published in the October edition of the Leprosy Review. 108. The two buildings designed for the accommodation and training of hospital assistants, and built and equipped with a grant provided by B.L.R.A. were completed in June. The first course of training was conducted from September to November. The eleven hospital assistants attending the course, received practical training in prevention, diagnosis, treatment, the ward care of patients, and dispensary work. All new patients, all patients suffering from reactions, and those about to be discharged were examined by the students. Lectures were given by the hospital staff, and clinical demonstrations by the Medical Officer-in-Charge. These young men were presented with their hospital assistants' certificates by Dr. J. M. Liston, C.M.G., Chief Medical Officer to the Department of Technical Cooperation, and formerly Director of Medical Services in Sarawak during his official visit to the hospital in October. They have now been posted to rural dispensaries where the follow-up treatment of discharged patients, and the detection of new cases, will be part of their duties. The discharge of smear-negative patients and their treatment on an outpatient basis was started for the first time during the year. This has been well received by the patients as it enables them to return home earlier, and so attend to their domestic affairs. As more and more hospital assistants are brought in for refresher courses, this new trend will expand, and should result in others in need of treatment coming along at an earlier stage in the disease. 109. Other buildings completed during the year including a new pumphouse in which two new water pumps have been installed. Work has started on two new staff quarters, due to be completed early in 1963, and on alterations to the sanitary blocks attached to the hospital wards. A new generating set, to supply amongst other things additional electric power for the operating theatre, has been ordered and is due for installation early in 1963. 110. In addition to the work done by patients in the workshops, gardens, the school, and the treatment centre, some also work in the hospital wards as attendants. These patients received training from the hospital assistants, and now help in the routine work in the wards. 111. Under the direction of the Warden, the school continues its work amongst the children. There are complications due to the varying ages and

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1

"

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standards of education, but all pupils derive considerable benefit from the classes held. Art and handicrafts play a big part in the school curriculum, and the services of a teacher from the Batu Lintang Training College to assist in teaching these subjects, are greatly appreciated. For the first time, one of the young patients sat and passed the Sarawak Junior Certificate examination, under the supervision of Red Cross voluntary workers. He is very anxious to become a teacher, and has been given every help and encouragement by a tutor from the Batu Lintang Training College. 112. Several visits were paid to the hospital by guest parties of entertainers from Sarawak and Malaya, and these were enjoyed by the patients and by the large number of non-patients from round about who now turn up whenever a concert is scheduled in the hospital. As in former years, regular help was received from the Kuching Division of the British Red Cross Society, and voluntary helpers paid fortnightly visits to distribute gifts and reading material, and generally to help and encourage the patients. The Salvation Army Girls Home continued to give invaluable help by looking after babies born to patients in the hospital. Clergy of different denominations visited regularly, and gifts were received from various sources including the Chinese Chamber of Commerce, the Turtle Board Trust, the Social Welfare Council, the Muslim Welfare Association and the Anglican Youth Association. XI. SPECIALISED SERVICES

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(a) Ophthalmic Services 113. Another year has passed without the services of an Ophthalmic Specialist, though word was received towards the end of the year that a suitable applicant had been appointed, to fill the vacant post. A medical officer returned from study leave in the United Kingdom, however, having obtained the Diploma in Ophthalmology, and his services in this direction have been available to a limited extent, in the Fourth Division. It was not found possible for the Military Authorities in Singapore to release their ophthalmologist for visits to Sarawak as in 1961, due to pressure of work. 114. In the Health Centre, Kuching, the eye clinic continued its routine work, under the Senior Hospital Assistant, trained originally by the late Dr. Wallace. Statistics of the work performed will be included in Part II of the report. (b) Dental Services 115. A brief report of the activities of this section has already been given in Chapter VII. Dental health statistics will be included in Part II of the report. (c) Pathological Laboratory Services 116. The process of unification of all pathological laboratory services in Sarawak, which commenced during 1960 under the direction of the Medical Officer-in-Charge of the Central Laboratory was virtually completed during 1962. Nearly all the techniques employed in the various laboratories have now been standardised. When the older members of the technical staff have had the benefit of refresher courses, a levelling of standards throughout the laboratories should result.

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117. In November the first of three annual visits was paid by a team of research workers from the Medical Research Council in London, to study encephalitis in Sarawak. This research programme is being jointly financed by the Medical Research Council and the Sarawak Government. The team consisting of three doctors is accommodated in the building at 7th Mile, previously occupied by the First Division S.M.E.P. Unit. The Medical Officer-in-Charge of the Central Laboratory has been working in close co-operation with the team during their two months visit. Further visits are planned during 1963 and 1964 to collect additional material and examine further patients. 118. Histopathological work previously referred to the Institute for Medical Research in Kuala Lumpur, is now carried out in the Central Laboratory, Kuching, which also serves as a reference centre for all problems encountered in divisional laboratories and for many special investigations which cannot be performed in them. The Central Laboratory in addition, has continued to function, as the training centre for all technical staff, and as the clinical pathological laboratory for the Kuching General Hospital and its subsidiary units. 119. A new laboratory was opened in Sarikei Hospital during the year, and a trained technician was posted to it. 120. The day-to-day bench training of student technicians has been the responsibility of the four sectional heads in the Central Laboratory, under the overall supervision of the Medical Officer-in-Charge. There were fifteen pupil technicians, seven in their final year of training (one being trained for Sibu Urban District Council Maternal and Child Health Clinic) four in their second year and four in their first year. As reported in Chapter V, Training, paragraph 41, recognition was given by the Institute of Medical Laboratory Technology, to the Central Laboratory as a training centre. for the Intermediate examination for Associateship of the Institute. It is hoped in the future to send selected staff with the necessary qualifications to sit this examination. 121. The Medical Officer-in-Charge paid a visit to Jesselton, at the request of the Director of Medical Services, North Borneo, to advise on ways of developing the laboratory service. It has been agreed to make facilities available in Kuching to train some of their technical staff, as part of the programme of cooperation between the Medical departments of the two territories. 122. A small extension was added to the Central Laboratory building enabling the entire Blood Transfusion Service to come under the direct supervision of the Medical Officer-in-Charge. The Kuching Division of the Red Cross Society continues to be responsible for the organisation of the blood donor panel, but all the technical work connected with the collection, typing and storing of the blood is carried out by the government laboratory staff. This has generally improved the storage and handling of donor blood and the easier management of the Bank with a great reduction in the wastage of valuable blood. The standard of serological work in connection with blood transfusions has also been improved, thanks to the help received from the staff of the Medical Research Council Blood Group Reference Laboratory who performed genotyping of staff members. 123. The Central Syringe Service in the Kuching General Hospital which is run by the laboratory, was expanded in August, exactly two years after its inception as a pilot scheme, to cover the whole hospital. 124. In the divisional laboratory attached to the Lau King Howe Hospital, Sibu, the allocation of an additional room has made a marked difference to the

• I

. j

I

.. .

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27-

running of the laboratory, but accommodation is still inadequate. It is hoped later to obtain further accommmodation in the outpatient section, as already mentioned in paragraph 85 of this report, and to move the Blood Bank into closer proximity with the laboratory as has been done in Kuching. (d) X-ray Services

125. There are now X-ray units attached to the hospitals in Kuching, Simanggang, Sibu, Sarikei, Miri and Limbang, in the Chest Clinics in Kuching and Sibu, and in the Health Centre, Kuching. A new R /3 X-ray set was installed in the main X-ray room of the Lau King Howe Hospital, Sibu, and the old double twin set has been sent to Singapore for overhaul before being installed in Sarikei Hospital where at present, only a Mobilix unit is available. A new 70 mm. Odelca mass miniature radiography unit has also been installed in the chest clinic in Sibu, replacing the old 35 mm. set. In the Health Centre, Kuching, alterations have been made to allow an X-ray room with small dark room attached, to be made available for the Mobilix machine, previously housed in the adjacent Chest Clinic. This will enable outpatient X-ray work to be done on the spot, in future. 126. One member of the staff attended a nine months course in practical radiography at Melbourne, Australia, and is due to return to Kuching early in 1963. (e) Physiotherapy Services 127. :rhe arrival of an experienced physiotherapist from the United Kingdom, sponsored jointly by the British Red Cross Society and the British Leprosy Relief Association, has been of great help to the General Hospital, and Rajah Charles Brooke Hospital, Kuching. In addition to the practical work she is doing amongst patients, she is also helping to establish and organise a physiotherapy department in the General Hospital, and to advise on the ordering of new equipment, for the physiotherapy section of the new Kuching General Hospital. ({) & (g) Surgical and Obstetrical Services

·"

128. Details of the work done by these specialised services will be included in Part II of the report. (h) Maternal and Child Health Services 129. There has been steady progress in the field of maternal and child health, and posting of a health sister to the Fourth and Fifth Divisions is a welcome development. It is hoped that the maternal and child health services in Kuching will be taken over by the Kuching Municipal Council following the arrival of their new Medical Officer of Health, early in 1963. In Sibu, the Sibu Urban District Cout;lcil Clinic and the domiciliary work in the council area, have now been completely taken over by Council staff, following the return from New Zealand of a staff who was successful in obtaining her health visitors' certificate, under a Colombo Plan scholarship. The part-time services of the government health sister have now been withdrawn, and she will in future devote her fulltime services to the supervision of divisional maternal and child health and other health activities such as the Tuberculosis Control Project, in the Third Division. . 130. Pla~~ are in. hand for the sett!ng up .of ~ew local authority clinics in Slmanggang, Mm and Llmbang. Staff are m trammg m Kuching, and U.N.I.C.E.F. has been asked to provide the necessary equipment.

-

28-

(i) Medical Stores Services 131. The main event of the year was, of course, the completion and occupation of the new Central Medical Store buildings at Tanah Puteh, in October. The storage facilities, and the productive capacity of the manufacturing laboratories have been greatly improved as a result. A new 27 punch rotary tabletting machine, a double-conical dry mixer, a bottle washing machine and other modern equipment were installed and have made this new section one of the most modern in the South East Asia region. 132. The post of pharmacist remained vacant throughout the year. The new post of Senior Storekeeper created in 1962 to replace the post of Chief Dispenser, was filled, and this has relieved the superintendent to some extent. A trained dispenser was promoted to the rank of senior dispenser, and three studeJ?-t disl?ensers passe? their final qualifying examination and were promoted to tramed dIspensers, dunng the year. Three new student dispensers were recruited and commenced training. 133. The Ceneral Medical Store continued to handle stores for the whole country, except in respect of supplies consigned direct to Sibu by the Crown Agents. Due to excessive heat from the sun, it was necessary during the year to air-condition the Store at Simanggang Hospital.

XII. VOLUNTARY ORGANISATIONS 134. The Social Welfare Council has continued to act as the central welfare agency to which Government funds for welfare work are paid over for distribution to various charitable organisations in Sarawak. 135. The Sarawak Branch of the British Red Cross Society has continued its work of relief for the victims of fires and other disasters, the training of firstaid workers, the organisation of blood transfusion services in Kuching, Miri and Simanggang and the running of a transit hostel in Kuching for patients and their relatives and friends, from distant places, who require some place to stay for a day or two, when visiting Kuching for medical attention. The Red Cross physiotherapist, jointly sponsored by B.L.R.A. has been of great help to the spastic and crippled children attending the classes held at Red Cross Headquarters. 136. The Anti-Tuberculosis Society of Sarawak (AT.AS.) has maintained its interest in the anti-tuberculosis project in Kuching and voluntary workers have assisted in various ways such as counting and packaging P.AS. and I.N.H. tablets. An honorary almoner has investigated all cases requiring food parcels or other assistance. Funds were provided for a reception counter at the new chest clinic attached to the Lau King Howe Hospital, Sibu. The two tuberculosis longhouses at Marudi and Bintulu in Fourth Division maintained by the Miri branch of AT.AS. have continued to provide accommodation for patients on routine treatment. 137. The Sarawak Society for the Blind, commenced the building of its training centre early in November, and a few weeks later the foundation stone was laid by His Excellency the Governor. Present at the ceremony were Mr. and Mrs. Babonau, senior executive officers of the Royal Commonwealth Society for the Blind, now in Borneo to assist in blind training and rehabilitation work. The Babonaus will visit Sarawak in 1963, when the centre has been completed, to organise the first training courses there.

,;

-

A

•

-

29-

138. The Salvation Army has continued its invaluable work in maintaining homes for boys and girls requiring care and attention and for the aged. Children born to parents with leprosy, in the Rajah Charles Brooke Memorial Hospital, have also been looked after in the Girls Home. 139. The Sibu Benevolent Society maintains a Nursing Home in Sibu and an old peoples home "McCarthy Lodge" at Salim on the Rejang river. The former is for aged men and chronic cases of tuberculosis. A medical officer from the hospital in Sibu, visits it periodically. The caretaker has been trained as a "home help". The latter accommodates old people of both sexes. A subcommittee of the Benevolent Society looks after the blood donor panel, as there is no branch of the Red Cross Society in Sibu. Other Voluntary Agencies

140. In Miri, a home for aged paupers is run by a voluntary relief committee. In Kuching, a Home for the Aged is maintained by the Sarawak Social Welfare Council. It is situated twelve miles from Kuching on the Simanggang Road, and accommodates 130 old people. There is a new hospital ward for thirty patients which is run with the help of Roman Catholic nuns and is visited regularly by the Divisional Medical Officer, First Division. 141. Other organisations such as the Chambers of Commerce, the various Chinese, Dayak and Malay Associations, the Corona Society and Church organisations have given voluntary assistance in different ways to hospitals and other medical institutions. Kuching, 4th January, 1963.

,,-' .,

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SARAWAK

GOVERNMENT

MEDICAL AND HEAL TH DEPARTMENT DIREC TOR OF MEDICAL SERVICES

r--- --ASSI STANT DIRECTOR

DEPUTY

DIRECTOR

PRINCIPAL

MATRON

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... 0 lIe CENTR ... LABORATORY

PSYCHIAT.,ST S ..... H,

MO.lle KUCHINIO COlON. HaSP.

SUPT. DENT Al OFFICER

SUPT. CENTIUL MEDICAL

I I HOSPITU NATRONS

STORES

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DIVISIONAL MEfJlCAL OFFICERS

SISTU TlJTORS

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TREAT ... eNT CENTRE'

Appendix II

SARAWAK GOVERNMENT

MEDICAL AND HEAL TH DEPARTMENT SECT IONAl ORGANISA nON KUCHING GENERAL

HOSPITAL II"JAH CHARLES IJROOKE MEMORIAL HOSPITAL. ___ .

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Appendix III

SARAWAK

GOVERNMENT

MEDICAL AND HEAL TH DEPARTMENT DIVISIONAL ORGANISATION LOCAL GOVT. -, MCH. & ENVIRONMENTAL SANITATION

DIVISIONAl STORES (STOREKEEPER)

U"SOAr- J DIVISIONAL HEADQUARTERS ( D.M.O.)

/L~EAL TH AlSI~TANT )

r-----.---g PORT HHL T~ DIVISIONAL HOSPITAL (NO.IIC)

r-ZE~~~~~~--------------------------------NALARIA ERADICATION __(~_~SUP T.)

1'1/' RURAL SERVICES ( R . SERVICES SUPERVISOR)

TB. CONTROL HS.

If I.

J

SARAWAK

MEDICAL AND HEALTH DEPARTMENT

ANNUAL REPORT 1962

,.

\ . >

MEDICAL AND HEALTH DEPARTMENT, KUCHlNG, SARAWAK, BORNEO.

Sir, I have the honour to submit for the information of His Excellency the Governor, and for transmission to the Right Honourable the Secretary of State, Part II of the Annual Report for 1962, of the Medical and Health Department of Sarawak. I have the honour to be,

Sir, Your obedient servant, D. A. BAIRD, Director of Medical Services. THE HONOURABLE THE CHIEF SECRETARY, KUCHING.

l

MEDICAL AND HEALTH DEPARTMENT ANNUAL REPORT 1962 PART II Introduction Part I of this Report, which has already been published gave a general account of the activities of the Medical and Health Department during 1962. In Part II more detailed statistics of in-patients and out-patients treated, morbidity returns for hospitals and dispensaries, and other relevant statistics are given, together with more detailed accounts of the Malaria Eradication Project and the Tuberculosis Control Scheme.

I. GENERAL HOSPITALS (a) In-Patient Returns 1. The following are the in-patient returns for all hospitals for 1962. These are compared with the previous four years:Hospital Kuching General Lau King Howe, Sibu Simanggang General Miri General Limbang General Sarikei General*

1958 7,925 4,594 1,205 2.174

1959 8,395 5,637 1,326 2.079

1960 8,416 6.028 1,625 2.812

1961 8,589 7,320 1,559 3,475

1962 9,900 7,525 2,147 3.447 517 178

--- --Totals 15.898 17,437

--18,881 20,943 23,714

2. There has therefore been an increase in the total number of in-patients treated in hospitals. of 2.771 compared with the 1961 figure. This is partly due to the opening of Limbang and Sarikei hospitals. but over the past five years. the in-patients treated in the four main general hospitals have increased by 7,121. i.e .• an increase of almost forty-five per cent.

*These figures refer to the period November 15th to December 31st only.

~/

-2(b) Out-Patient Returns 3. Out-patient returns for hospital out-patient departments are shown below. These are compared with the 1961 returns:Hospital Out-Patient Department Kuching (a) Health Centre ... (b) Senior Service O.P.D. Total Sibu '" Simanggang Miri '" Limbang '" ... Sarikei* '"

I ... ... ... .. .

No. of New Patients Treated

No. of Minor Operations Performed ----

No. of Medical I Examinations 0/ Candidates for Government employment

1961 24,273 2,252 26,525 32,646 10,520 31,897

I 1962 I 24,835 2,410 27,245 40,719 14,968 15,019 ,6,935

1961 1,557 420

1962 -~-

1961 -

1962 1,815 267 2.082 712 277 326 -

2,430 516

2.012 114 2,126 572 204 397

~7-1~46 881 : 219 I 881 1

... ... ...

... ... ... Total

...

I

1,145 429

... ...

-t 49 -

... '"

...

-

... ...

1

-- - ----5,425 5,479

128,113

132,131

5.935

7.515

4. There has been an increase in the total number of new patients treated, minor operations performed, and medical examinations carried out, compared with the previous year. (c) X-Ray Services

5. A summary of the work done in the various X-ray departments, attached to hospitals and out-patient clinics is given below:No. of Patients X-Rayed Kuching General Hospital 5,067 3,050 Chest Clinic, Kuching (Large) Chest Clinic, Kuching (70 mm) 3,249 Lau King Howe Hospital Sibu (Large) 11,341 Lau King Howe Hospital Sibu (Miniature) 4,569 Miri General Hospital: General (1,927) ... 4,752 Chest (2,825) ... Miri T.B. Hospital: General (265) 5,490 Chest (5,225) ... J 461 Limbang General Hospital

}

.. ·1

Total

37,979

tThe Sarikei Hospital Out-patient returns have been included under the Static Dispensary returns, since the hospital did not become fully operative until mid-November, 1962. t All minor operations in Miri are performed in the hospital.

-36. Returns frQm the twO' main general hospitals in Kuching and Sibu show the variety of work done in their X-ray departments:-

Number of Examinations Nature of film 1. 2. 3. 4. 5. 6. 7. 8. 9.

Kuching 2.557 1,944 83 263 434 39 146 30 19 Total

Sibu 4,752 2,281 61 205 236 383 87 43 7 8,055

Chest* Bone Gall Bladder Genito-urinary Gastro-intestinal AbdQmen (straight) Obstetrical Sinuses Miscellaneous

::.1

5,515

(d) Physiotherapy Service, Kuching 7. A fully-qualified physiotherapist, jointly sponsored by the British Red Cross Society, and the British Leprosy Relief AssQciation, commenced work in Kuching, on the 30th July, 1962, and the treatment of in-patients in both the General HQspital and the Rajah Charles BroQke Memorial HQspital was instituted, as well as the treatment of Qut-patients. In the R.C.B.M. Hospital a class of fifty-sixty patients for hand and foot massage was held twice weekly, and eight patients received specialised preoperative treatment. 8. In the Kuching General Hospital the figures were as follows:-

Total number of patients treated Male Female Total attendances Out-patients Electrical treatments Physical treatments Fractures

202 160 42 1,456

535 147 46

In-patients Electrical treatments Physical treatments 40 688

*Chest X-rays in Kuching are done mainly in the A.T.A.S. Chest Clinic and not in the hospital, except for in-patients.

-4(e) Surgical Services 9. The number of operations performed during the year are shown below. These are compared with the four previous years:-

1958 Kuching General Hospital Lau King Howe Hospital, Sibu ... Simanggang General Hospital Miri General Hospital Limbang General Hospital 2,709 1,945 260

1959 2,992 3,379 253

1960

1961 2,687 3,890 256 2,344 ---

1962 1,910 3,581 489 3,601 78 ----

2,684 3,046 359 2,117 8,206

2,914

6,624

9,177

9,659

10. The drop of 777 in the total number of operations performed in the Kuching General Hospital is offset by an increase of 873 in the number of minor operations performed in the Health Centre, as shown in paragraph 1. B. 11. The most common surgical emergencies treated were, as in previous years, acute appendicitis, perforated gastric and duodenal ulcers, and abdominal trauma. Inguinal hernia and thyroid enlargements were common non-emergency conditions dealt with. Fractures, dislocations and lacerations were commonly encountered in all hospitals, and the treatment of these traumatic conditions continued to occupy much of the time of the surgeons and medical officers. In the Kuching General Hospital, for instance, some of the commoner conditions treated were:(1) Emergencies

(a) Abdominal Acute Appendicitis Others, including trauma (b) Suture of lacerations (c) Fractures and dislocations

95 66 163 255 69 38

(2) 1nterval cases (a) Inguinal hernia repair (b) Thyroidectomy (f) Obstetrical and Gynaecological Services

12. The figures of hospital deliveries throughout the country, continued to rise during the year. Compared with the two previous years, the 1962 figures were as follows:1960 1961 1962 2,586 2,905 3,175 Kuching General Hospital 1,097 1,029 Lau King Howe Hospital, Sibu 987 273 183 232 Simanggang General Hospital 330 564 546 Miri General Hospital 22 Limbang General Hospital 4,196 4,670 5,063

-513. Maternal deaths in the four hospitals totalled twelve made up as follows:Kuching Sibu Simanggang Miri 4 6 2

0

This is a decrease of eight compared with 1961, and represents a maternal death rate of only 2.37 per 1,000. The majority of deaths occurred in admissions from distant parts of the country, often moribund by the time they reached hospital.

14. The extent to which the hospitals catered for the obstetric abnormality is shown in the following table: Kuching Caesarean Section ... "--<'

Sibu

Simanggang

Miri

Total

69 71

Forceps Delivery ... Manual removal of placenta Plural births Post Partum haemorrhage Toxaemias of pregnancy and the puerperium Abortions Stillbirths

96 36 164 188 350 25

49 35 22 30 103 45 360 52

5 1 6 3 12

36 10

5 10 24 27 77

159 117 129 79 303 268 864 84

8 77 4

3

15. In the General Hospital Kuching, 157 major gynaecological operations were carried out, including thirty-one hysterectomies and twenty-two ectopics. 474 minor gynaecological operations were also performed. (g) Ophthalmic Services

16. As already reported in Part I, there was no Ophthalmic Specialist during the year, but the Eye Clinic, in the Health Centre Kuching continued its routine work under the Senior Hospital Assistant. Statistics of the work performed in this clinic are given below:Year New Patients treated

1958 1959 1960

2,972 3,282 3,743 3,472 3.887

"

1961 1962

17.

6 ---

The main conditions treated were:Refractive errors Inflammatory diseases Injuries Degenerative diseases Congenital and hereditary diseases Neoplastic conditions Nutritional Diseases Diseases due to climate Blindness 816 2,325 278 250 38 31 14 127 8

18.

The causes of blindness in the eight cases seen were as follows:Optic Atrophy Trachoma Glaucoma Panophthalmitis

3 2 2 1

The number of minor eye operations performed in the Eye Clinic were as follows:Pterygium Styes Meibomian Cysts Meibomian Abscess Others Total 79 75 111 182 246 693

II. SPECIAL HOSPITALS A. Sarawak Mental Hospital 19. Total Admissions in 1962 New Admissions Re-admissions New admissions suffering from Schizophrenia 545 293 252 (46.2%) 132 (45%Y

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.

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20. The diagnostic classification of new admissions, was as follows:Chinese Schizophrenias Affective Psychosis Organic Psychosis ... Epilepsies Neurological Disorders Neurosis Arnentias N.A.D. Total Percentage

Malay

s. Dayak L. Dayak 22 12 15 2 0 3 0

Others

Total

Percenlage

74 9 35 5 1 5 3 5 137 50

24 10 23 3 0

3 1 0

5 2 8 0 0 2 0 0

7 5 5 1 0

132 38 86 11

45 13

64 21

55 18

17 5

2 0 0 20 6

1 15 5 5 293

29.4 3.7 0.4 5 1.7 1.7

100.

21. Number of patients in the Sarawak Mental Hospital on 31st December, 1961 ... Plus total admissions :. Total number of patients treated during 1962 Number of patients in hospital on 31/12/62 Number of discharges during 1962 Number of deaths in hospital 280 545 825 267 542 16

_./

22. The number of voluntary and temporary admissions increased further during the year, with a corresponding decrease in the number of remand patients. Percentage of Voluntary Patients

1958 1959 1960 1961 1962

0% 17% 46% 63% 83%

Thus in 1962 five out of every six admissions were on a voluntary basis. 23. New Out-patients Registered Kuching Sibu Total

.....

1958 1959 1960 1961 1962

19 207 290 310 264

290 160

19 207 290 600 424

Total attendances in 1962 were 3,871. Of the 424 new out-patients registered, 71 % were Chinese, 14% Malays, 6% Ibans, 4% Bidayuhs, and 5% others. Twenty of the Kuching Out-patients, and sixty-seven of those seen in Sibu, were subsequently admitted to hospital, i.e .• 7.6% and 41.8% respectively. giving an average of 20.5% compared with 13.8% in 1961.

-824. The following table summarises the work of this section since 1954. The increased number of out-patient attendances despite a reduction in the number of new out-patients registered, points to an improvement in the long-term followup treatment. Discharges from S.M.H. Deaths In

Year

Admissions to S.M.H.

S.M.H.

------ -----

I ..

New OutPatients in Kuching and Sibu -

Total OutPatient attendances at Clinics -

1954 1955 1956 1957 1958 1959 1960 1961 1962

... I

112

90

27 ----

1--13~~

1---···--75--.~-29

154 174 195

I - - - - - i110

-I-----I 24 27 1

2 13

12 -----

40 48

...

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110 120

8

I 34 15 24 21 16

I 19 207 209 600 424 1_ _

I ... I I

I 338 429

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342 405 567

I

367 1,743 3,227 3,871

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581 544

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.,....... 4000

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2750 2500 2250 2000 1750 1500 1250 1000 750 725 700 675 650 625 600

I

A,daissions: Discharges: Deaths: New Out-patients: ~

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575 550 525 500 475 450 425 400 }75 }50 }25 }OO

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-10B. Rajah Charles Brooke Memorial Hospital 25. (a) Number of patients in hospital on 31/12/61 (b) Number of patients admitted during 1962 ... (c) Number of patients discharged during 1962 ... (d) Number of deaths during 1962 (e) Number of patients in hospital on 31/12/62 375 87 82 12 368

26. Admissions increased by thirty-seven compared with 1961. Twentythree of the new admissions were smear negative, and sixty-four smear positive on admission. Nineteen of the latter (29.5%) were very heavily infected and highly contagious and showed smear-ratings of from 3 + to 5 +. 27. Of the eighty-two patients discharged, twenty-six were patients who had become smear-negative and wished to return home for various reasons. They were allowed to leave, on condition they continued out-patient treatment at the hospital or dispensary nearest to their homes. All discharged patients have regular check-ups, and receive maintenance treatment at the nearest dispensary or hospital. 28. Of the twelve deaths, six patients had been in hospital for periods varying from thirteen to twenty-two years, and with one exception all were over sixty years cf age. The causes of death were:Fractured skull Diabetes Hepatitis Cardiac failure Broncho-pneumonia Cerebral haemorrhage Pulmonary tuberculosis Malignant disease Total 1

1 1 3

1 2 2 1

12

29. Of the 368 patients on the roll at the end of the year, 79 (21 %) were from North Borneo.

-1130. The following table shows the racial classification of patients in hospital at the end of 1962, new admissions during ] 962, and discharges during the year. -----------------------~------~---~-------

Race Sea Dayak Land Dayak Kayan Group Other Sarawak Natives Chinese Malay Melanau N.B. (N.M.N.)

Indonesian Other ---------

Total

:~ I! : 36~_~.1_-87=_-1=;~=~ Admissions Discharges 3 9 26 15 16 9 8 1 87 7 14 12 24 15 8 2 82

31. The age-groups of patients admitted and discharged during 1962 are shown in the following table: -

Age Group 5 10 20 30 40 50 60 10 years 20 years 30 years 40 years 50 years 60 years 70 years

Over 70 years Total

III. STATIC AND TRAVELLING DISPENSARIES 32. Returns of new patients attending static and travelling dispensaries during the year, and admissions to rest-beds in the static dispensaries are shown below. In each case, there was an increase in the number of patients treated, compared with 1961. -

-12 -

(a) Static Dispensaries 33.

No. of Restbeds 4 4 5 4

New Patients 18,438 14,307 22,291 8,481 4,761 lO,832 4,341 13,658 8,337 6,511 8,764 5,312 5,611 13,633 4,080 22,531 14,986 4,811 6,986 7,303 3,561 7,689 12,326 10,865 17,785 6,566 lO,251 10,457 8,384 658 294,516

Admissions 48 151 57 55 15 35 56 127 75 87 273 232 127 352 27 174 72 57 99 133 166 377 318 55 99 247 346 75 26 3,961

First Division 1. Bau Dispensary 2. Lundu Dispensary 3. Serian Dispensary 4. Tebakang Dispensary 5. Nonok Dispensary . .. 6. Simunjan Dispensary 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30.

3 5 4 5 7 7 15 8 0 6 10 12 12 6 6 8 6 10 14 8 4 8 10 14

Second Division Lubok Antu Dispensary Engkilili Dispensary Lingga Dispensary ... Sebuyau Dispensary Betong Dispensary Spaoh Dispensary Debak Dispensary Saratok Dispensary Kabong Dispensary Third Division Sarikei Dispensary* Binatang Dispensary Matu Dispensary Dalat Dispensary Mukah Dispensary Balingian Dispensary Kanowit Dispensary Julau Dispensary Song Dispensary Kapit Dispensary Belaga Dispensary Fourth Division Marudi Dispensary Bintulu Dispensary Fifth Division Lawas Dispensary Sundar Dispensary

10 4 219

*The figures for new patients is for the whole year, and includes out-patients seen at the out-patient department of the new Sarikei Hospital. The figure for admissions is for patients admitted to the restbeds in the old dispensary only, and does not include 178 in-patients admitted to the new hospital between 15 f 11 f 62 and 31/12/62 which are recorded in paragraph I A.

~ (" -+-

13No. of Patients Treatea 8,792 20,098

(b) Travelling Dispensaries

34.

Base Kuching Kuching

First Division Travelling Dispensary No.2 Road Dispensary

Second Division Nil Third Division Travelling Dispensary No.7 Travelling Dispensary No.8 Travelling Dispensary No.9 Travelling Dispensary No. 17 -.-'

Sarikei Kanowit Kapit Belaga

11,220 4,496 6,190 1,427

Fourth Division Travelling Dispensary No. 11 Travelling Dispensary No. 12 Travelling Dispensary No. 13 Travelling Dispensary No. 14 Tatau Bintulu Bekenu Marudi 3,980 2,683 6,349 6,725

Fifth Division Travelling Dispensary No. 16* Limbang 2,583 74,543

*This Travelling Dispensary did not operate during December, 1962, due to the Emergency following the Brunei Rebellion.

-14IV. DENTAL SECTION STATISTICS 35. The total attendances at all the dental clinics were as follows, compared with 1961:1962 1961 33,022 34,347 Kuching 12,945 18,232 Sibu 2,663 5,177 Miri 448 Simanggang 36. A breakdown of the services rendered is shown below:Kuching 32.234 Sibu 11,710 1,601 303 47 Miri 2,406 Simanggang 328 Total 46,678 11,621

Dental Extractions Fillings Dentures Repair of Dentures Periodontal Treatment X-rays Application of stannous fluoride Orthodontic Appliances Gold inlays and crown bridges

9,612 573 82 205

369

39

} 21

1,005 205 375 504 4

263 504 2

91 2

29

29

37. There has been a decrease in the total services rendered in respect of the first five items, due mainly to a reduction in the number of Dental Officers available during the year, necessitating the temporary closure of the clinic in Miri, except for short visits by Dental Officers from Kuching. V. PATHOLOGICAL LABORATORY SERVICES

38. The following table gives a summary of the examinations carried out at each individual laboratory during 1962:INVESTIGATIONS Haematology: Haemoglobin Cell counts Other tests

CL 10,642 7,794 1,639 3,503 1.666 7,125 302 250 4,740 2,922 1,044 719 4,104 3,142 3,230 2,539 1.317

HC 5,875 2,655 245

SM 591 115 709

RCBM 558 564 5

SG 5,554 3,878 1,005 617

SIBU 11,079 8,519 2,680 5.691 1,026 5,006 336 116 8,442 1,522 573 839 10,897 8,425 1,900 525 214 183 88 1,562 69,723

MIRI 5,586 3,599 1,157 957 411 1,147 201 64 5,270 756 480 718 4,578 6,162 1,427 606 210 111 90 414 33,944

TOTAL 39.885 27,124 7,440 10.768 3.175 15,909 974 469 35,961 5,389 2,404 10,725 35,178 31,320 7,854 3,820 1,791 606 17,783 3,652 262,237

Blood Transfusion: Blood grouping Compatibility tests Serology: Kahn tests Widal tests Other tests Chemical Pathology: Urine analyses Blood tests Other tests Parasitology: Blood smears Faeces Bacteriology: Tuberculosis sputa Swabs Faeces Urine Blood cultures Scrapings for leprosy Other tests Total

n

2,631 135 39 13,221 85 3,172 12,295 10,219 382 637 72 517 626 325 169 4 63 460 275 3,482 189 146 4,697 2,218 2,682 915 150 50 141 135 48,197 3,592 19,648 28,736

171 7 1,541 58,397 48 17,550

39. All preparation of reagents, stains and culture media is now centrally undertaken at the Central Laboratory, which also prepares acid-citrate-dextrose for collection of blood for transfusion and water for injection, and maintains the Central Syringe Service which has now been extended to cover the whole of the Kuching General Hospital. All these materials are prepared in the Central Laboratory and dispatched to various hospitals and laboratories. In 1962, the Central Laboratory prepared 440 litres of culture media, 2,549 120 ml. bottles of acid-citrate-dextrose, 20,846 25 ml. vials of water for injection and cleaned, assembled and sterilized nearly 80,000 syringes for use in the Kuching General Hospital. Until October, this laboratory also manufactured nearly 10,000 bottles of crystalloid solutions for use in the First Division hospitals and dispensaries, and cleaned, assembled and sterilized 943 rubber blood transfusion sets before the switch-over to the use of plastic disposal sets. Details of the preparation work done are given below. Blood transfusion sets cleaned, assembled and sterilized Crystalloid solutions preparedin 500 ml. volumes III

943* 9,057 bottles* 536 bottles 2,549 bottles 20,846 vials 440 litres 3,031 78,024

200 ml. volumes

Acid-citrate-dextrose solution for blood collection, 120 ml. volume Water for injection Culture media Blood collecting sets for Kahn Tests Syringes cleaned, assembled and sterilized for Syringe Service

*Preparation of these was stopped in October, 1962.

40. The Central Laboratory also acts as a reference laboratory and during the year 176 sera positive to the Kahn test were submitted to further tests, 111 strains of pathogenic intestinal bacteria were checked and subgrouped and three transfusion reactions, none of which were found to be due to serological causes, were fully investigated. 41. In the major hospitals in the country 1,889 blood transfusions were administered. No comparison with previous years is possible as a uniform recording system has not, until 1962, been carried out in all the hospitals. The record of transfusions is as follows: Recipients DD'nors Kuching Simanggang Sibu Miri Total 846 68 786 189 1,889 1,000 68 794 196 2,058

CENTRE

16 --

+- ,

RECIPIENTS

C

M 146. 6 76 44 272

D

E

0 16 4

TOTAL

Kuching Simanggang Sibu Miri Totals

490 9

177 53 199 53 482

17

846 68 786 189 1,889

507 62 1,068

17

30 50

DONORS CENTRE

C R 139

M

D

E

0 R

Kuching Simanggang Sibu Miri Total Totals

P 125 2 35 162

R 90

P 184

R 52

P 143

R

P 1 230

7 35 12 54 93 D P

P 29

TOTAL R P 289 711

TOTAL 1,000

6 255 32 432 594

4 222 27 343 567 C

8 32 224

35 220 17 324 489

9 13

4 62 18 I

45 732 10 39 1154 88

23 62 J08 904 E

68 794 196 2,058 European 31 118

165

314

315 M R

Legend:

=

a = Remarks:

Chinese Others

= Malay = Relatives

= Dyak = Panel donors

=

1. 2.

No, of pints discarded-

(a) for serological reasons (b) stored beyond expiry date

Balance held at 31st December, 1962-20 pints.

42. All processing of and reporting on specimens submitted for histopathological investigation is now carried out in the Central Laboratory, occasional problems being referred for opinion to the Consultant Pathologist at the Institute for Medical Research in Kuala Lumpur. In 1962, 720 surgical pathology specimens were thus investigated, far more than in any previous year. In addition, 158 tissues removed at autopsy were submitted for histology and fourteen specimens for exfoliative cytology. Details of this work are given below:(a) Surgical Pathology:

Hospital Kuching General Health Centre Simanggang General Lau King Howe, Sibu Miri General Limbang Christ Hospital, Kapit Others No. of Specimens 319

38 21 249 55 8 25 5

720 (b) MOl bid Anatomy:

No. of postmortem dissections (Kuching only) (Hospital 35, Medico-legal 11)

46

Post-mortem histologyKuching Simanggang Miri Christ Hospital, Kapit

11

~

149 2 4 3

158 (c) Exfoliative Cytology:

14

WORK OF THE MALARIA PROJECT IN 1962 Introduction

43. The climatic conditions contributing to the presence of Malaria in Sarawak are to be found in the opening chapter of Part I of this Report, under the heading of background information. 44. There is no obvious seasonal incidence of Malaria and transmission can occur throughout the year. Prior to the commencement of the project it was known that the hilly areas were hyperendemic, while the low lying plains and coastal areas, in the absence of nearby hills, were hypoendemic. This difference has been associated with the distribution of the main vector A .leucosphyrus. Surveillance Areas

45. The country is divided into areas where malaria eradication is in either the attack phase or the consolidation phase. Urban areas are considered to be non-malarious as a result of disappearance of the vector Anophelines. The urban areas comprise the towns of Kuching, Sibu and Miri. 46. The attack and consolidation phase areas were further tentatively subdivided, at the beginning of the year, into al, or a2 and bi or b2 areas. 47. The al areas are those areas in the attack phase which lie along the border with Indonesian Kalimantan. They are constantly at risk by importation of infection from an uncontrolled reservoir and vector control measures must continue here until the neighbouring state begins its long promised project. 48. The a2 area~ are those which, when transmission is interrupted, can pass into the consolidation and eventually the maintenance phase. They are therefore potential areas of eradication. 49. The bi areas are former hyperendemic areas in which the interruption of transmission has been achieved: the b2 areas are former hypoendemic areas which have reached the same stage. 50. The attack phase areas are covered by the regular spraying of all dwellings and farm-huts twice a year. Those in t.he consolidatio.n ~hase are not sprayed unless a case is detected, when focal spraymg of the lo~alIty ~s updertaken and may be further extended, depending on the results of the lI?-ves.tlgatlon of the original case. The population covered by the attack, and consolIdatlon phase, and urban areas is shown in Table 1. Investigation of Cases 51. All cases occurring in consolidation phase areas are invest!gated as a matter of emergency and training programmes are being planned to mcrease the

~

18-

numbers and improve the standards of investigators. The investigation comprises a blood survey in the area, an entomological su~vey and a .sl!rvey of th~ his~ory of the case to determine as accurately as possIble the ongIll of the IllfectlOn. A similar investigation is carried out in attack phase areas also, if staff and time permit. Detection of Cases 52. Active case detection is undertaken by men who are given an itinerary covering all the dwellings and houses in an area. These they visit each month and collect blood films from all people, who have fever, from whatever cause, or who have had fever during the interval between visits. They also administer a suppressive dose of an antimalarial drug to those cases pending the result of the blood slide. In addition, they are given with their itineraries, the names of thO'se known cases of malaria whom they are to follow up. These patients have had radical treatment, consequently they are not given suppressive treatment when their blood films are taken. 53. Passive case detection is the duty of all government hospitals, dispensaries and ulu dressers. In addition the voluntary home helps have been brought into this system of detection. They are provided with slides after receiving the basic training necessary and are encouraged to take films from all those whO' attend with fever, and to send the films as soon as possible, for microscopy. 54. With the extension of passive case detection to remote areas through the incorporation of home helps and ulu dressers, and with their rapidly increasing prestige, it is thought that passive case detection will in time largely replace active case detection, particularly in the b2 areas. Other forms of Detection 55. Other forms of detection are undertaken through the medium of mass blood surveys, and epidemiological and special surveys. Included in this group are all slides taken from non-fever cases. Surveillance Results 56. The results of the work of the surveillance units are shown in Table 2, and a breakdown of the results for the various phases is shown in Tables 3, 4 and 5. 57. It will be observed that the Annual Parasite Index is high in the consolidation phase areas of Divisions I and II. This is being corrected in 1963 by the relegation of certain areas to the attack phase and the resumption of twice yearly spraying in these areas. 58.. The origin o~ infection in those cases which could be investigated is shown III Table 6. ThiS table shows clearly the threat of Indonesian visitors to Divisions I and II, since almost all the cases imported from abroad come from across the Kalimantan border. ~ 59.. The speci~s distribution of p~ra~ites is shown in Table 7. The high p.oporhon of P.falclparum to other speCIes IS due to the number of films collected from infected Indonesian visitors to the First and Second Divisions.

Spraying Results 6~. !he PO'Pulation number of households and the areas in the attack and consolIdation phases for the years 1959 ~ 1963 are shown in Table 8. This

-

19

~

gives an index of the progress of the scheme during this period. During 1964 some of the consolidation b2 areas will be ready to pass into the maintenance phase having had no indigenous malaria for the preceding three years. The number of structures covered by regular spraying in the attack phase areas and the quantity of insecticide used is shown in Table 9. TABLE 1 DISTRIBUTION OF POPULATION IN PHASES Division First Second Third Fourth Fifth

Attack Phase Consolidation _______ __ Phase_ _ "

I

1

j

Urban Areas I 76.509 -

Total 260,507 114,961 274,725 101,560 30,468

I

'"

... ...

... ...

67,886 31,327 18,466 25,450 12,158 155,287

116,112 83,634 225,129 62.083 18,310

i

I

I

'"

I I

'"

... . ,.

... ...

31,130

I I

'"

'"

... Total

... ...

I I i i

14,027

I I I

-

I I

505,268

! I I

I 782,221

121,666

Allowance has been made for an annual population increase of 2.5 ()C over the census figures of 1960. TABLE 2 SURVEILLANCE RESULTS ~"--

Division I --------"

Division II

- - - " - - --~I

I I

Division III

Division IV --"--

Division V

Total -----

PCD Slides taken Positive ACD Slides taken Positive Others Slides taken Positive Total Slides taken Positive SPR ABER API Of

10,981 185 11,482 115 53,919 304 76,382 604 0.79 29.3 2.32

18,327 144 10,063 20 88.131 82 66,521 246 0.37 57.9 2.14

I I

8,230 98 18.864 76 26,565 49 53,659 221 0.41 19.5 0.81

8,818 45 20,276 16 21,904 133 50,998 194 0.38 50.2 1.91

3,069 14 7,431 23 5.247 15 15,474 52 0.33 51.7 1.71

49,425 486 68,116 249 145,766 583 263,307 1,318 0.50 33.7 1.68

/0

01 (0

0/00 ::::

'-

SPR ABER API

= =

Special Parasite Rate. Annual Blood Examination Rate. Annual Parasite Incidence per 1000 population.

~

20

~

TABLE 3 CONSOLIDATION PHASE RESULTS Division First Second Third Fourth Fifth

I

I ... ... ...

Films 36,867 45,292 46,147 34,392 6,934 169,632

Positive 60 37 75 20 5 197 I

SPR% 0.16 0.08 0.16 0.06 0.07 0.12

I ABER% 31.8 54.2 20.5 55.4 37.9 33.6

API

0/00

... ...

... ...

0.52

0.44 0.33 0.32 0.27 0.39

... ... ...

... ... Total

... ... ...

...

TABLE 4 ATT ACK PHASE RESULTS Division First Second Third Fourth Fifth

I

Films 35,727 21,229 6,673 15,999 8,813 88,441

Positive 517 209 146 173 47 1,092

SPR% 1.45 0.98 2.19 1.08 0.53 1.23

ABER% 52.6 67.8 36.2 62.8 72.5 56.9

API

0/00

... '"

... ... ...

.. .

7.62 6.67 7.91 6.80 3.87 7.03

... ...

...

... '"

... ... Total

... ... ...

I

TABLE 5 RESULTS IN URBAN AREAS -~-

Division First Second Third Fourth Fifth

Films

Positive 27 -

SPR% 0.71

I

ABER% 5.0

I API 0/00 0.35

... ... ...

... ... ...

... ... ... ... .. .

3,788

839 607

1 1 0.12 0.16

2.7 4.3

0.03 0.07

... ...

... ... Total

5,234

-

0.55

4.3

0.24

...

29

_ ....... G ...

-

21-

TABLE 6 ORIGIN OF INFECTION IN CASES INVESTIGATED <::> Ii::

::s

'" I

"'l

Division -

" ." """ "'l" .... <..> Ii::~

" ]-~ I:l:::~

~

"'l~ 1::0

~

->::0, "'l ~ "

"..., 34 18 41 48 3

t~ .... 109 100 22 19 13 263

""'" 0::

-

" ...... ~~~ o::~

<..>~

~ ~.§ ~ I .§~~~ 2 1

.... _t::>. -~--

t~~ 39 7

t:~~~ 2,:::;:: ~

~ <..> ::::" "'l..., Ii:: 0 .... <..>

" -§ <..>

"'l

..... 0 4 3 I

~

~ 327 162 210 136 29 864

~

First Second Third Fourth Fifth Total

I I

143 31 140 66 13 393

0 1 0 0 0 I

I

4 3 0

0 0 0 3

0 0 7

I I

,

144

\

,

!

53

I I

1

TABLE 7 DISTRIBUTION OF PARASITE SPECIES I

Division First Second Third Fourth Fifth Total

P.vivax 369 152 177 106 27 831

P.falciparum 181 76 17

I

------ -_.

I P.malariae I 40

I I

Mixed infection 0~~X/----;;;;;ax/ falciparum malariae 11 1 1 3

--I

i Total _ _ ~_ _ 604 246 222

I

17

I \

-

I

27 77 4

7 20

2 1 16 \ -

2

194 52 -----

I

-~--~I 301 I 165

I

5

1,318

TABLE 8 POPULATION, HOUSEHOLDS, AND AREA ..

_---Area in Sq. Km. 123,360 111,858 54,822 53,296 52,768

Date 1959 1960 1961 1962 1963

Consolidation Phase Area in Population Households Sq. Km. 29,919 60,352 478,659 505,268 512,898 4,713 10,973 87,029 91,867 1,761 13,263 70,299 71,825 72,353

Attack Phase Population Households 609,735 590,218 188,485 155,287 164,171 110,861 107,312 34,270

I I

I

93,254

I I

28,234 29,849

-

22T"" I

TABLE 9 SPRAYING STATISTICS - - - _.. _ - Sprayed

Structu:~_._I __ Structu~es , Farm-huts

Unsprayed because Other Reasons Insecticide Used-Kilos

~~-ses 37,7;0

----1i

--16,813

---I

I

Refused

1,623

557

DDT 75% w.d.p. 17,385.05 kilos

'

MATERNAL AND CHILD HEALTH SERVICES 61. The following statistics from the Kuching District Maternity and Child Health Clinics permit a comparison of the work done in these centres during the past four years. Child Health Ante-natal Post-natal Total Attendances Attendances Attendances Attendances 1959 1960 1961 1962 64,111 65,735 71,604 83,042 28,542 33,818 37,699 50,887 4,531 5,127 6,019 7,920 97,094 104,680 115,322 141,849

-r-

62. A similar series of figures represent the work done at the Sibu Maternal and Child Health Clinics.

Child Health Ante-natal Post-natal Total Attendances Attendances Attendances Attendances 1959 1960 1961 1962 36,509 40,001 50,787 40,298 14,239 16,072 15,516 17,802 2,964 3,660 5,648 5,653 53,712 56,073 71,951 63,753

63. Figures obtained from Sarikei, a smaller centre, indicate that this service is earni.ll ~ an increasing popularity.

Child Health Ante-natal Post-natal Total Attendances Attendances Attendances Attendances 1959 1960 1961 1962 1,752 3,586 8,025 7,541 2,407 4,409 4,565 6,530 190 510 578 688 4,349 8,505 13,168 14,759

-

23-

TUBERCULOSIS CONTROL PROJECT I. General

64. This project has already been referred to in general terms in Part 1, Section VIII of the Annual Departmental Report for 1962. 65. Reference should also be made to the Annual Departmental Report for 1961, which discusses the initial phase of the project. II. Statistics

66. III.

Reference should be made to Appendix I of this report.

Matters of Technical Interest

67. With the agreement of the Colombo Plan Consultant on Tuberculosis, the interpretation of -a "negative" reaction to' the Tuberculin Test (10 T.U.) was changed from under 5 mm. to under 10 mm. As a result the proportion of positive cases is not comparable with that of previous years. A graph showing reactions in children is attached as Appendix II. This indicates percentages of children with "negative" and positive reactions at various ages. It should be noted that the percentages of population in various age groups, for the various sizes of reaction, must be added together to obtain the true extent of positive reactors, whether these be considered to be 5 mm. and over, or 10 mm. and over. 68. Follow-up Mantoux testing after B.CO. vaccination will be carried out during 1963.

-·24 -

.,..-- .

APPENDIX I

1961 Population under control Number on chemotherapy on December 31st Number of new cases diagnosed during the year Number declared arrested during the year Total number tuberculin tested Total showing reaction greater than 9 mm Total number vaccinated with B.CG. during the year Total number X-rayed during the year Number of houses visited to trace contacts Number of contacts traced Number of contacts found positive Number of houses surveyed Population of houses surveyed RCG. vaccinations in houses surveyed 80 881 51.843 2,131 805 279 12.277 8.824 5.754 8.872 288

1962 63,463 2.500 703 380 17.916 7.571 15.647 26.915· 117 1.116 50 3,445 36.070 6.551

READTIOlil TO TnB TUBERCULIN TEST (10 T. U.) IN OOHOOL CHILDRKR, IN KUCHmG, READ AJ'TER 72 HOURS - 1961

100

5

90

80

III

5 C!> ~

Ao

70

'"

-'

~ CIl

r"I

5 H

~ z 0 ~ H

60

;.; ....

50

0

~ Ao

~ 40

5i f-< 15

r"I

~ Ao

30 10-14 5-9 DID 20 20+ DID 15-19 DID 0-4

DID

."

\.

-.26 MORBIDITY RETURN FOR IN-PATIENTS TREATED IN THE KUCHING, SIMANGGANG, SIBU AND MIRI HOSPITALS International Classification of Diseases (Intermediate List) A A A A A A A A A A A A A

A A A A A A A A

A A A A A A A A A A A A A A

1 2 3 4 5 6 7 8 9 10 11 12 J3 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

Tuberculosis of respiratory system ... Tuberculosis of meninges and central nervous system Tuberculosis of intestines, peritoneum, and mesenteric glands Tuberculosis of bones and joints Tuberculosis, all other forms Congenital syphilis. Early syphilis Tabes dorsalis General paralysis of insane All other syphilis Gonococcal infection Typhoid fever Paratyphoid fever and other Salmonella infections ... Cholera Brucellosis (undulant fever) Dysentery, all forms Scarlet fever Streptococcal sore throat Erysipelas Septicaemia and pyaemia Diphtheria Whooping cough Meningococcal infections Plague Leprosy Tetanus Anthrax, Acute poliomyelitis Acute infectious encephalitis Late effects of acute poliomyelitis and acute infectious enephalitis Smallpox Measles Yellow fever Infectious hepatitis Rabies

Cases 1,274 29 22 18 83 11

2 5 12

33 138 2

3 588 1 3 8 14 181 2 14

46 ' 44 1 42

8 17

166

-- 27Cases A A A 36 37 38 Typhus and other rickettsial diseases Malaria Schistosomiasis Hydatid disease Filariasis ... Ankylostomiasis Other diseases due to helminths All other diseases classified as infective and parasitic Malignant neoplasm of buccal cavity and pharynx Malignant neoplasm of oesphagus Malignant neoplasm of stomach Malignant neoplasm of intestine, except rectum Malignant neoplasm of rectum Malignant neoplasm of larynx Malignant neoplasm of trachea, bronchus and lung, not specified as secondary Malignant neoplasm of breast Malignant neoplasm of cervix uteri Malignant neoplasm of other and unspecified parts of uterus Malignant neoplasm of prostate Malignant neoplasm of skin Malignant neoplasm of bone and connective tissue ... Malignant neoplasm of all other and unspecified sites Leukaemia and aleukaemia Lymphosarcoma and other neoplasm of lymphatic and haematopoietic system Benign neoplasm and neoplasms of unspecified nature Non-toxic goitre Thyrotoxicosis with or without goitre Diabetes mellitus A vitamino9is and other deficiency state Anaemias Allergic disorders; all other endocrine, metabolic, and blood diseases Psychoses Psychoneuroses and disorders of personality Mental deficiency Vascular lesions affecting central nervous system 11

83

A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A \.

39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70

75 42

230 159 5 21 64 16 13 10

•

22 15 52 11 1

8 18

66 26 10 156 41

32 125 163

239 199 145 126 11 122

-

28Cases

A 71 A 72 A 73 A 74 A 75 A 76 A 77 A 78 A 79 A 80 A 81 A 82 A 83 A 84 A 85 A 86 A 87 A 88 A 89 A 90 A 91 A 92 A 93 A 94 A 95 A 96 A 97 A 98 A 99 A 100 A 101

A ]02 A A A A A A 103 ]04 105 106 107 108

N on-meningococcal meningitis Multiple sclerosis Epilepsy Inflammatory diseases of eye Cataract '" Glaucoma Otitis media and mastoiditis All other diseases of the nervous system and sense organs Rheumatic fever Chronic rheumatic heart disease Arteriosclerotic and degenerative heart disease Other diseases of heart ",. Hypertension with heart disease Hypertension without mention of heart Diseases of arteries Other diseases of circulatory system Acute upper respiratory infections Influenza Lobar pneumonia Bronchopneumonia Primary atypical, other, and unspecified pneumonia Acute bronchitis Bronchitis, chronic and unqualified '" Hypertrophy of tonsils and adenoids Empyema and abscess of lung Pleurisy All other respiratory diseases ,,' Diseases of teeth and supporting structures Ulcer of stomach Ulcer of duodenum Gastritis and duodenitis Appendicitis Intestinal obstruction and hernia Gastro-enteritis and colitis, except diarrhoea of the newborn Cirrhosis of liver Cholelithiasis and cholecystitis Other diseases of digestive system Acute nephritis , , .

11

2 27 136 22 13

61 82 58 49 87

166 79 105 9

60 306 40 77

362 49

156 160 153 20 11 113 42 170 150 90 294

203 527 74 97

294 119

-.---

-"29 Cases A 109 Chronic, other, and unspecified nephritis Infections of kidney Calculi of urinary system Hyperplasia of prostate Diseases of breast Other diseases of genito-urinary system Sepsis of pregnancy, childbirth, and the puerperium Toxaemias of pregnancy and the puerperium Haemorrhage of pregnancy and childbirth Abortion without sepsis or toxaemia ... Abortion with sepsis Other complications of pregnancy, childbirth, and the puerperium Infections of skin and subcutaneous tissue ... Arthritis and spondylitis Muscular rheumatism and rheumatism unspecified ... Osteomyelitis and periostitis Ankylosis and acquired musculoskeletal deformities All other diseases of skin and musculoskeletal system Spina bifida and meningocele ..• Congenital malformations of circulatory system All other congenital malformations Birth injuries Posnatal asphyxia and atelectasis Infections of the newborn Haemolytic disease of the newborn All other defined diseases of early infancy Ill-defined diseases peculiar to early infancy, and immaturity unqualified Senility without mention of psychosis ... Ill-defined and unknown causes or morbidity and mortality Motor vehicle accidents Other transport accidents Accidental poisoning Accidental falls ... Accident caused by machinery ... Accident caused by fire and explosion of combustible material 71 170 107 15 28 584 81 217 207 785 79 2,051

A 110 A III

A 112 A A A A A A 113 114 115

116 117 118 A 119 A 120 A A A A A A A A A A A A A A A 121 122 123 124 125 126 127 128 129 130 l31 l32 133 l34 135

642 103 32 47

•

22 100

16 71 4 6

6 4

275 39 10

..

-

A 136 A l37 AEl38 AEl39 AE140 AE141 AE142 AE143

1,099 l3 14 12 81 18 10

AE144 AE145 AEI46 AE147 AE148 AE149 AN138 AN139 AN140 AN141 AN142 AN143 AN144 AN145 AN146 AN147 AN148 AN149 AN150

3014 14

Accident caused by hot substance, corrosive liquid, steam and radiation Accident caused by firearm ... Accidental drowning and submersion All .other accidental cau~es Suicide and self-inflicted injury Homicide and injury purposely inflicted by other persons (not in war) ... Fracture of skull Fracture of spine and trunk Fracture of limbs Dislocation without fracture Sprains and strains of joints and adjacent muscle Head injury (excluding fracture) Internal injury of chest, abdomen, and pelvis Laceration and open wounds ... Superficial injury, contusion and crushing with intact skin surface Effects of foreign body entering through orifice Burns Effects of poisons All other and unspecified effects of external causes Total

2 59

II

22 21 216 11

16

78 21 410

123 54 83 29 37 17,799

.

"T

~31~

OUT.PATIENT MORBIDITY RETURN 1962 International List Classificalion Number 001-008 010-019 020-029 030-035 040·042 045-048 055 056 060 061 073 080-081 085 087 089 095 11O-117 127 123-130 135 036-138 140-239 240-245 250-254 260 280-286 290-293 300-318 370 389 390-398 341-398 400-468 470 473 480-483 490-493 500-502 471-527 540-545

Disease or Condition

'(-

I

~

"

Tuberculosis of respiratory system Tuberculosis - all other forms Syphilis Gonorrhoea Typhoid and paratyphoid fevers and other Salmonella infections Dysentery, all forms Diphtheria Whooping Cough Leprosy Tetanus Yaws Acute Poliomyelitis and its late effects Measles Chickenpox Mumps Trachoma Malaria Filariasis Worm Infestations Scabies All other diseases classed as infective or parasitic including fevers of unknown origin Neoplasms (Tumours) Allergic Disorders (asthma. urticaria) Diseases of Thyroid Diabetes mellitus Avitaminosis and other deficiency states Anaemias Mental Disorders Conjunctivitis Blindness Diseases of ear All other diseases of C.N.S. and sense organs Diseases of the Heart and Blood Vessels Common Cold Tonsillitis, acute Influenza Pneumonia Bronchitis Other respiratory diseases Diseases of the stomach ... Carried forward

No. of cases treated in Government Hospitals & Dispensaries 842 229 84 695 79 4,454 104 1,438 18 4 1,863 3 1,795 1,556 159 533 508 811 33,660 5,944 17,163 408 7,872 798 170 17,042 14,953 353 9,626

No. of cases treated in NonGovernment Dispensaries 231 38 25 6 93 753 23 63 3 18 59 3 809 272 25 17 191 11 4,471 373 3,375 68 1.090 138 6 1,889 1,453 9 1.070

Total 1,073 267 109 701 172 5,207 127 1,501 21 22 1,922 6 2,604 1,828 184 550 699 822 38,131 6,317 20,538 476 8,962 936 176 18.931 16,406 362 10.696

371-388 Other diseases of eye

4,882 75 9,228 2,035 1,180 43,719 11.049 4.702 1,560 20,156 24.736 13,598

607 19 1,008 146 203 5,629 867 735 696 1.668 1,804 726

5,489 94 10,236 2,181 1,383 49,348 11.916 5,437 2.256 21,824 26,540 14,324

~ .,

'>-

International List Classification Number

32No. of cases treated in Government Hospitals & Dispensaries 210 33,008 24,580 456 4,193 2,142 2,295 28,410 32,503 13,068 5,432 12,097 796 89 1,197 18,606 629 439,795

J No.o/cases treated in NonGovernment Dispensaries 25 5,163 2,202 88 396 216 533 2,358 3,162 1,539 343 688 307 5 245 2,263 21

.. Total 235 38,171 26,782 544' 4,589 2,358 2,828 30,768 35,665 14,607 5,775 12.785 1,103 94 1,442 20,869 650 490,039

Disease or Condition

560-561 571-764 530-578 580-587 600-609

610-637 640-659& 661-689 Complications of pregnancy 690-698 Boils, abscesses, cellulitis and other local skin infections 700-716 Other diseases of skin 720-727 Arthritis and Rheumatism 730-744 All other diseases and musculoskeletal system 795 Diseases, cause unknown E810-E845 Road accidents E850-E858 Water transport accidents E916 Accidents caused by fire E800-E999 Other accidents E870-E895 Poisonings Total

Brought forward Hernia Diarrhoea and Enteritis ... Other diseases of digestive system Diseases of the Liver, Gall-bladder and Pancreas Diseases of urinary system (excluding Gonorrhoea see 030-035) Diseases of genital organs

.....

50,244

rr

SINGAPORE B~rt on the Progress of Health Activities .~uring

the Year 1902 1

1.

GENERAL

The Ministry of Hea.lth continued during the period under review to make further progress in the provision of an island-wide medical and health service. It was able to do this as a result of the unification and reorganization of the Medical and Health Service which was completed during last year. Prior to unification, responsibility for health and medical services in the State of Singapore was divided between the City Council, the Rural Board and the State Government.

/

2.

VI'l'AL STATISTICS

Vital statistics maintain a progressive decline. The birth rate in 1962 was 34.1 (compared with 35.5 in 1961) the crude death rate remained constant at 5.9 (compared with 5.9 in 1961) and infantile mortality 31.2 (compared with 32.3 in 1961).

3.

ADMINISTRATION

The reorganization of the Ministry into two major divisions, Hospital and Health, was implemented and carried out during the year. This involved the reorganization of the Health Division and the absorption into the Ministry of the City Council and Rural Board He~lth Departments.

4.

FINANCE 1

The aggregate public expenditure on medical and health services in 1962 was $58.4 million, representi~ 15% of the Budget of the State of Singapore. This represents $34/= per capita. The income from hospital fees, etc. amounted to $6.2 million. The difference between income and expenditure is financed predominantly from public revenue.

5.

MAJOR EVENTS OF PUBLIC HEALTH

SIGNIFICANCE IN 1962

5.1

Polio Immunization Campaign

An island-wide immunization campaign to immunize children from six months to· six years of age against pOlio was launched in March· 1962. The oral Sabin vaccine was used and children received their vaccine in two doses at MCH clinics. The campaign was brought to a successful conclusion in November 1962, after about 89% of the vulnerable child population had been controlled; 436 537 doses were administered during the campaign period. The administration of oral poliO vaccine will become routine pro~dure in 1963, both for the pre-school child and the primary school entrant.

- 2 -

5.2

Compulsory Diphtheria Immunization

The Diphtheria Immunization Ordinance, 1961, was brought into operation on 31 March 1902, making immunization of all children under the age of twelve resident in Singapore compulsory. The response to legislation has been good, and since April 1962, 18 576 infants and 32 698 toddlers have completed their immunization against diphtheria.

5.3

Crematoria at Mount Vernon

A modern gas-operated crematoria was opened in Mount Vernon off AlJunied Road in November 1962.

6.

THE ENVIRONMENTAL HEALTH SERVICES

These services have maintained effective control of general sanitation and hygiene, the control of malaria and the control of the sale of food and drugs.

6.1

General Sanitation and Hygiene

The scheme of kampong sanitation started in 1954 continued to make progress and a further 16 kampongs were sanitated during 1962 in conjunction with the anti-malarial work. This included the construction of concrete drains, concrete aprons to standpipes and servicing existing facilities. During the year, the HOusing and Development Board completed 11 249 housing units in St. Michael's, Queenstown, Bukit HO Swee, MacPherson Road Estate and arrangements for refuse removal were made. 6.2 Anti-Malaria Section

For the past eleven years, there has not been a single case of indigenous malaria, and this has been due to the extensive control measures against the disease maintained by the Anti-Malaria Section. Anti-malaria works were maintained satisfactorily and a fUrther 2490 yards of concrete drains were constructed. Anti-malaria concrete drains, earth drains and sub-soil pipelines were .regularly maintained. Filling of the tidal swamp in the Kolam Ayer Basin continued and more than two acres of land were reclaimed by controlled tipping, reducing the breeding grounds of A. Sundaicus. Similar tipping in the Bedok River bed has been carried out, here to again control A. Sundaicus. About six acres of land has been reclaimed.

6.3

Food and Drugs Control,

This section, through the Inspectorate, paid 11 824 inspection v.lsits to food premises, including markets, hawker congregation and military food supply depots. A total of 1912 samples of food and drugs was submitted for analysis to the Government Chemist and the University of Singapore and though this is an all-time record, it still fall short of the recommended ratio of 3 samples per 1000 population per year.

r

7. THE H.ATERI~AL iLND

- 3 -

CHILD HEALTH SERVICES

The MCH Service provides antenatal and post-natal care, a domiciliary nidwifery service and a domiciliary after-care service. The facilities available for child-health cover the infant and the pre-school child. Services include preventive and curative work, and are effected through a networl~ of 33 major clinics) 21 visiting centres and 8 mid\vife centres situated throughout the city and rural areas •

"-

.

There has been a progressive increase in the number of both expectant mothers and children attending these clinics, and this reflects an increased health awareness on the part of the public.

8.

HEALTH EDUCATION AND TRAINING

Considerable emphasis was given to the development of education in health in 1962, when a five-phase programme to introduce health education on a formal basis into primary schools was formulated. Three of the phases were implemented in 1962. These consisted of (a) a conference of heads of 15 primary schools in Singapore; (b) a special course of instruction in health education for some 35 primary school-teachers; and (c) preparation of health education ~aterial for use in schools. The remaining two phases are,to be implenented in 1963. 9. THE SCHOOL HEALTH SERVICE

The School Health Service is responsible for the prevention of diseases and the promotion and maintenance of health among schoolchildren. It provides the following services: (a) routine and special examination of schoolchildren; (b) treatment of minor ailments and nutritional defects; (c) reference of cases to specialists in the various institutions for investigations, treatment or advice; (d) control of tuberculosis in the school population; (e) control of other infectious diseases; (f) sanitary inspection of school premises, and (g) ensuring the compliance of the provisions of the Education Ordinance (1957) and the regulations made thereunder. It also advises on plans for school buildings and assists in the Health Education Programme of the Department. . In 1962, the total school population was 401 587, of which 55 722 were new entrants. The number of schools in the State at the end of the year was 568, including 5 new schools which were opened in 1962. One hundred thirty-two thousand three hundred and ninetytwo schoolchildren were examined for the year, this representing apprOximately 33% of the total school population. 10. DENTAL SERVICE

Five school dental clinics were built and put into operation during the year and construction work on a l4-chair central school dental clinic commenced in October. The Dental Nurses I Training

- 4 -

School at the InBtitute of Health has begun to function fully and beginning from 1963, a steady stream of ~rain~c1 school,dental nurses at the rate of 20 per year irill be recru~ ted J.nto the School Dental Service. The Dental Nurses' Training School has been given assistance by UNICEF in the form of dental equipme~t for its gradua~es at the . rate of 20 sets per year for the next f~ve years (tentat~ve) beginmng from 1964, and a 32-seater school bus. ~

,

..

11.

MASS FREE X-RAY .AND THE FIGHT AGAINST TUBERCUWSIS

The Government's campaign against tuberculosis was continued with increased vigour. Towards the end of the year equipment from UNICEFfWHO aid began to arrive and by the early part of 1963 the following equipment had been received to augment the scope of the programme. (1) (2) (3) a 70 mm Odelca-Siemen X-Ray Unit with Generator fitted on 2 Landrovers, two Volliswagon Microbuses and two Taunus stationWagons for transportation of field workers, a fluorescent microscopy unit together with miscellaneous equipment for the Tuberculosis Culture Laboratory, one public address system.

(4)

The Mass X-Ray Community Survey was continued, 52 749 persons were examined in 1962. A further 34 213 persors were examined up tc August, 1963.

As a result of this mass X-ray case-finding the number of new active cases notified has increased. The number of new notifications in 1962 was 5773 bringing the total number of active cases in the Tuberculosis Register to 21 890. BOO vaccination of newborn infants was carried on. In 1962, 45 654 babies out of a total of 59 084 births were given BCG within one month of birth. The coverage being 77.4% of all births in the State. Tuberculin testing amongst primary school-entrants apd leavers was intensified. All the primary schools were covered and 13 583 children were tested; 25 247 negative reactors were given BPG vaccination. I I

As a part of the anti-tuberculosis measure in sch001~10 725 secondary school leavers, 13 849 school teachers and 1999 s~hool hawkers were X-rayed by the mass X-ray units. The X-rays of secondary school leavers will in future be done annually, whereas the school teachers and other staff are examined once every two years.

- 5 -

Contact Il':.ve.st.iga:tion During the year 1962, 8804 nevr contacts were registered at the Contact Clinic faJ.' investigation and the Health Visitor of this unit visited in all 20 G19 patients and contacts at their homes. 12 • WHO ASSISTANCE

WHO assistance has been continued in the field of nursing, midwifery, public health and radiography.

TERRITORY OF PAPUA AND NEW GUnmA

Report on the Progress of Health Activities ::;:4:~

,

1.

GENERAL The Department of Public Health in the Territory of Papua and

New Guinea has the responsibility for providing a comprehensive health

service for some two million people, spread over an area of 183 000 square miles of' di'verse and difficult terrain. To carry out this task, the Department is at present organized into six professional divisions and.one Administrative division, and is also decentralized into f'our convenient geographical regions. In the abbreviated Annual Report f'or the year 1963 which follows, only some of the more important features and activities of the Department can be considered. 2. ADMINISTRATION The staff of the Department numbers 6025. specialist~and

officers, 369 expatriate nurses and medical assistants, 31~7 territorial nurses, hospital and medical assistants qualified or in training. It also includes 1467 aid-post orderlies and 1355 hospital orderlies. Total expenditure by the Department amounted to £4 974 706 ($11 093594). This sum includes the Department's own budget for its operation amounting to £4 019 409 ($8 963 282) - an increase of 12% over the previous year, £f3 073 310 ($1 974 481) .for buildings and maintenancQ and £71 000 ($158 330) for Hospital Engineering Services. Major building during the year included construction of a regional base hospital, a district hospital and a nurses' training school all of which are nearing completion. A malaria research school was completed and opened in the Eastern Highlands District. Three small rural hospitals were also completed and opened ·during the year, and an amount of minor building was undertaken at other rural hospitals and elsewhere. The Department now operates 100 hospitals including four major regional hospitals with specialist services. The number of hospitals includes ten speCial hospitals fol:'- tuberculosis and Hansenide cases staffed by Missions for the Administration. In addition there are six rural health centres and 1467 aid-posts established by the Administration. All the health centres and some of the a:i.d-posts are conducted in association with local government councils .who make same contribution to all aspects of operation including salaries} drugs and dressings, buildings and environmental· sanitatj.on projects, on a proportional scale related to the ability of the Council to pay. 'An1nnovation during the year was the introduction of AQ~inistration.. guaranteed bank loans to enable councils to acquire vehicles for their 1nfantwelfare services. Three councils have already taken adv~mtage of these loans while two ~thers bought vehicles for health work outright.

97 medical officers, including

14 assistant medical

This total includes

yr

_ 2 -

3.

MEDICAL SERVICES,

I I

In-patients treated in Administration gener"h hospitals_ numbered 107 728. This represented an increase of just ove;r~ll 000 admissions from the previous year. Major causes of admission ere pneumonia, (11.36% of total admission), malaria (10.04%), infe. tions of the skin and subcutaneous tissues (5.92%), wounds of variousl kinds (5.oa%), and deliveries and· complications of pr:gpancy and chi~~ir~h(5.0l%). other diseases making up the 12 maJor causes of a ss~on were gastroenterities, ankylostomiasis and other helminthic inrestations, bronchitis, other diseases of the skin and musculoskelefa1 system, acute upper respiratory tract infection, malnutrition and, eye diseases, all in that order. The 12 major causes of admission represented some 57 452 cases or 62.50% of the total admissions. : Deaths in hospitals were 2817 or 2.61% of in~patients treated. In addition to in-patients in general hosPit~lS the daily average number of in-patients in special Administration hospitals was 2681. I I

I

The number of out-patients reporting at genetal hospitals was 363 945; the estimated number of out-patients repo~ing to the 1467 Administration aid-posts spread through the Territory was well over a million. !

Patrolling of surrounding villages is an imp~rtant part of the routine duties of those in charge cf aid-posts. Inladdition, 313 routine medical patrols were carried out by expatri4te staff who visited 2309 major vill~ges and examined some 260 O~O people. In all 6923 days were spent on these patrols. These figur~s ~o not include special patrols undertaken in relation to the antilcholera and smallpox vaccination campaign. l I •

The work of the Chris~ian Missions in medical activities is considerable, but exact figures for the year areno~ available at this stage. Grant-in-aid was extended to 32 Mis.sion nur~es and 33 Mission aid-post orderlies working in areas not otherwise c~vered by Administration or other mission services. I

The Pharmaceutical Section of the Department lope ned a new District Medical Store during the year. There are ~ow five medical stores operating in the Territory - three major basei medical stores and one other District Store. I The Artificial Limb Factory at 16e moved to al'l new modern factory during the year. The Department's comprehensive dental service! graduated 13 ~ent~l assistants during the year. The main activitt of the service ~s d~rected to preventive measures in SChOOlChildreni' The ~umber of these children regist,ered in the service rose sharpl during the year to 24 581 from 16 532 in the previous year. The num er of schools covered rose from 198 to 267, nearly 28 000 initial xaminations I

I

..

, 3 were conducted with 9600 revision examinations. ments completed was' 35 767. The number of treat.:;:

4.

PREVENTIVE MEDICINE

. The threat o~cholera crossing the border from West New Guinea, where nearly 500 deaths were recorded, had to be met along with the possibility of smallpox entering the Territory from one of the Asian foci of this disee,se. Largely through the activities of patrol teams a;nd'clinic workers, 560 000 people were vaccinated against smallpox . byj;p.eend of the year. In addition to temporary vaccination against cholera; in all e.·reaD at risk, a small start was made with the major long-term prevention measure against the disease in the provision of safe water to villages •. Satisfe,ctory progress vTas made in the first full year of operat:ton of the Department I s Local Government Council Health Assistance scheme in all council areas, ancI' there was a growing' demand for. simple safe water systems to be installed. Poliomyelitis ou~breaks occurred at five centres and all of these were rapidly halted by the use of both Sabin and Salk vaccines. This was the first occasion in the Territory that Sabin vaccine had been used. Almost all cases ,of the disease occurred in children under fiV€ years. Triple antigen caw~aigns were continued throughout the year through all Administration and mission medical centres, and by medical patrols visiting villages. . It is est~~ted that 1 400 coo people of the Territory live in endemic malarious areas and the remaining 600 000 live in areas where malaria occurs in epidemic forms. 'Ihe ~orbidding terrain and low· population densities make ill9.1aria eradication a difficult and costly task. Nevertheless, by the end of the year 380.000 people had been protected by the spraying campaign which now covers an area of 32 400 square miles. FO"'..lr tuberculosis control units were engaged in epidemiological investieations during the year. This vTork was combined with casefinding e.~d BCG vc..cc::;')lo.~.;ion programmes. In all 181 350 people were exe.tn:i.nec.. BeG vaccination 1fas given to a total of 101 000. Thirty eight thousand and one hundred people i·rere examined by photo-fluorogra,?;)hy and other X.. ray techniques. A survey of certain SUb-districts of the Eastern Highle.nds shmved a continuance of a remarkable freedom from tuberculosis. The increasing movement betvTeen the Highl~nds ~nd the Coast makes it impo~sible to prevent tuberculosis entering the Highlands, and hence the-aim is to offer the w1destprotection with BCG to convert the entire Highland population into a Mantoux positive comnnu~ity, thus substantially retarding the spread of the disease.

~----

- 4 -

<

Approximately 2350 patients are now receiving tuberculosis in Administration and mission hospitals patients are being managed by out-patient services. I

eatroent for "1st 1750

The Hansen's Disease section was augmented dur~ng the year by the formation of a new leprosy control unit for the ~ghlandS. It is estimated that there are 7000 cases of leprosy in the Highlal1ds and that some 3285 of these are receiving or have receive treatment at some time or other. There are 272 established Admini~tration and 76 mission treatment centres in the Highlands, ranging f om Hansenide Colonies to village aid-posts. During the year, the ew leprosy control unit undertook a series .of 24 patrols on case-finding and assessment I work. The first comprehensive survey of health stand1rds and morbidity was commenced in the Highlands. Surveys of selected tepresentative areas of all regions of the Territory have been plann~d. These surveys will provide accurate base-line material at present n~t available and will provide a valuable guide for the evaluation of f1l.ture pu.blic :iealth campaigns of all kinds, and also determine health proplems needing attention. I

..

5.

INFANT, CHILD AND MATERNAL HEALTH

The Division undertaking this work is also kno as the Queen Elizabeth II Infant, Child and Maternal Health Servic. MOther and infant care is given through 15 fixed and 528 village clinics open daily, weekly or fortnightly according to the needs 0 the community. There were 124 577 attendances by children under the ge of one year and 262 653 attendances by children aged from one to ~our years. Five thousand nine hundred and eighteen women listed ~or antenatal care with Administration clinics, and from incomPletel' report p show that 11 615 women attended Mission clinics. There are 141 miSSion centres subsidized by t~e Administration undertaking infant, child and maternal health work. I .

34 000 children were enrolled and over 30 000 examin tions were made during the year. School services are also conducted through the general health services of the Department and IO-m r gional isupervisors are available to guide officers as required. An important activity of the Division is the ~raining of ICMH assistants. There are two Administration and t1n Christian Mission Training Schoolsand in all 208 girls were in training. During the year 55 girls graduated as infant welfare .assistants and 26 as midwifery assistants. I

Apart from clinic work a school health servic

is operated and

The Pre-School Section gives children from 3 0 5 ye~rs of age an education appropriate to their development. n all ~here are now 35 pre-schools operating throughout the Terr tory. IA mailN box scheme is conducted for families on out-stations who are not able to attend a pre-school centre.

- 5 6. :.: MEDICAL TRAINING The Division of Medical Training is concerned with full-time courses for assistant medical officers, nurses, medical assistants, and aid-post orderlies. In-service training courses are also given to laboratory technicians and X-ray technicians. During the year, four years of the f'ive-yea,r Assistant Medical Officer course 'tV'ere being conduc·ced at the Papuan }~edical College. Thirty-eight students in all were enrolled in this course. \

Schools of nursing are established in Port Moresby and Rabaul "There 250 students, both T.:'.€n and ·women are in training. The second post-basIc ccurse in obstetrics commenced at Rabaul during the year "rlth 9 students attending. A three-year course of study fo::.~ medical assistants duced during the year, with 13 students a.ttending. vTaS

intro-

Ei.sht students graduated from the one-year medical assistant course :['01' young men who have successfully completed the three-year basic general certificate nltrsing course. Tb.ere were 301 students in t:caining at 5 aj_d-post training schools. situated in various parts of the Territory.Eighty-sev~n aidpost 0:"1derlies successfully completed training during the year. Ten Territory students, including three in the Assistant Medical Practitioner Course, are continui:::tg courses at the Central Medical School, Suva.

7.

MEDICAL RESEARCH

The formation of the Papuc:. and New Guinea Medical Research Advisory Committee during the year puts at the Territory's disposal research adv-.i.ce and R,ssistance frcm some of AustJI.'8. lia f s most eminent medical scientists. Research worl'>: was continuer:!. in projects related to Kuru, neonatal teta.nus, tinea imbricata, childhood anaemia.,? childhood lymphoma, arbovirus studies, malad a, leprosy and nutrition. It is not possible to indicate work carried cut in a :cpcrt of this size.

8.

ME.WTAL HEALTH

This division is still in the ir..i'ancy of its development. A new mental hospital which will ultimctely cater for 300 patients and will incorporate the best features of' wodern mental r.ospi tal practice, has been ::;>lanned and has reeched ·:~hc working draving staee, P.11 aJ.1nex to this hospita.l in e, garden netting h~s already "been cO!l'~1?leted and is used by convalescent pat:',ents undergoing rehabilitation in gardening pursuits before returning to their villages.

- 6 -

At .the existing mental hospital at Bomana there tas a d$.ily average of 38 patients for the year. ,

~~d

Valuable staff additions included an occupational therapist a psychiatric social worker.

The Permanent Committee ouMental Health which co~cerns itself with matters of prevention and practical measures whichrmay reduce the incidence of mental ill-health in the Territory, met t~ce during the year. i

I HEALTH EDUCATION i

In all of the divisional activities briefly ment~oned above,

health education is an important component. There is a~' special health education section in the Department which serves all un'ts of the Department. };t'or the first time in several years health educa ion was under cont1nuous guidance and will soon be a tool for every h. alth worker to use. I 10. OVF...RSEAS STUDIES I

In all .52 members of the Department of Public He~lth attended overseas study courses or seminars. Six officers wereepgaged on WHO fellowship courses, one was awarded a WHO travelling seminar f'r;.'loivship and tlu\·;c others attended WHO seminars. '

TERRITORY OF PAPUA AND NEW GUINEA

ANNUAL REPORT 1962-63

DEPARTMENT OF PUBLIC HEALTH

Port Moresby: V. P. Bloink, Government Printer.-10750/8.63.

.-

.. _-

CONTENTS Page No.

Letter of Transmission The Director's Review Summary of Expenditure Organization and Administration Division of Medical Services Dental Health Service Division of Preventive Medicine Malaria Service Tuberculosis Control Section Hansens Disease Section Health Education Section Queen Elizabeth II Infant, Child, and Maternal Health Service.... Pre-School Services .... Division of Medical Training Division of Medical Research Division of Mental Health .... Port Moresby General Hospital Highlands Region Islands Region Mainland Region Papua Region Appendix I Post-Graduate Training and Ol'erseas Study, Con/ermce Attendances and Overseas Tours of Duty. Appendix II Articles Published by O/ficers of the Department Map of Territory of Papua and New Guinea

1

3 4 5 7 9 10

11 12 13 14 15 16 17 18 19 20

21 22

23 24

25

26 27

"

,

Telephone 4191 Telegraphic Address" HEALTH" Port Moresby

DEPARTMENT OF PUBLIC HEALTH, Konedobu, Papua,

TERRITORY OF PAPUA AND NEW GUINEA

1st September, 1963.

HIS HONOUR THE ADMINISTRATOR, BRIGADIER

SIR DONALD CLELAND, C.B.E., a.st.].,

DEPARTMENT OF THE ADMINISTRATOR, PORT MORESBY.

Dear Sir Donald, The Annual Report of the Department of Public Health for 1962-1963, which I now present, endeal'of(rs to outline the Departmmt'J achiel lements over a period of accelerated change.

Some of these changes hal'e meant that the Department must grapple with new public health problems, once remote and now immediate. Others have bem related to further graduations from the Department's training institutions. Many of these graduates are already manning without direct oversight important field posts in the Department. Other changes again have been associated with the increasing development of the Departmmt as a health promotion organization in ad(/ttioll to its long-standing roles in (tire and prevention. I would like to exprfJS my appreciation of the efforts of all members of the Department who have 'Ipplied themselves to these changes and their consequences with dedicated teamwork.

ASJociated with the Departmmt in its efforts to improve health has bem the important and growing health contribution of the ChriJtian Missions. I would particularly commend those missions providing health services in remote areas where no others are available. . This report includes only a mmtmum of statistical material and those seeking greater detail on any activity might consult the partiotlar unit concerned within the Department. The Official Repol'tJ of the Administration for the tUlo TerritOl'ieJ also Cdl'1')' additional statistical detail. Yours sincerely, R. F. R. SCRAGG, Director of Public Health.

Port Moresby General Hospital and Papua Medical College from the air. This is the major institution of fbe Department of Public Health, and it also houses the Central Laboratory, Tuberculosis Contl'ot Section headquarters and other important specialist units.

The Director's Review Director of Public Health: Dr. R. F. R. Scragg, M.D., D.T.M.&H.

events during the year have importantly SEVERAL influenced the policy and actions of the Department. The threat of cholera crossing the border from West New Guinea, where nearly 500 deaths were recorded, had to be met along with the possibility of smallpox entering the Territory from one of the Asian foci of this disease. The strenuous and successful vaccination measures taken in the Sepik and Western Districts were a good public health achievement by District Health staff and Health staff specially seconded from other areas. The major long term prevention measure against cholera is the provision of safe water to villages, but only a small start has been made in introducing simple water schemes and in educating people in their use. In this context might be mentioned the satisfactory progress made in the Department's Council Health Assistance Scheme in its first full year of operation. In all areas there is a rising demand for safe water schemes by Councils. In this year also Councils made the first purchase of vehicles for health work in their rural health centres under Administration guaranteed loans. The formation of the Papua and New Guinea Medical Research Advisory Committee has put at the Territory's disposal research advice and assistance from some of Australia's most eminent medical scientists. Two meetings were held during the year--one in Port Moresby associated with a visit by the Committee to Territory research projects. last May members of the Public Health Committee of the National Health and Medical Research Council of Australia visited the Territory to acquaint themselves at first hand with the public health situation in relation to Australian problems. The visit was followed by a regular meeting of the committee in Port Moresby. During the year Papuans and New Guineans continued to fill an increasing number of responsible positions. Some opposition was voiced to the posting of experienced Assistant Medical Officers to senior field positions, but this necessary venture has allowed these men to fill a role in their country commensurate with their training and that filled by their contemporaries elsewhere in the Pac~fic. At the same time it was possible to reassure all expatnate staff on their essential role in the Department's work. The rapidly expanding general educat~on programme will ens~re an adequate supply of new recrUlts for the many categones of health workers. The major resolutions of the Regional Medical Officers conference of 1962 have been put into effect. The B.C.G. vaccination campaign in the Highlands should

prevent the entry of Tuberculosis to this susceptible area. The triple vaccine programme by hospital staff has already covered a large number of villages, giving protection against tetanus, diphtheria and whooping cough to children under three years of age. For the first time in several years Health Education is now under continuous guidance and will soon be a tool for every health worker to use. Our prime activity for the coming year must be the extension of infant welfare services by every health worker doing as much as they can in this field. In providing better services for the population most at risk-the pregnant mother, the infant, and the school child-the whole community benefits. At the same time our health extension work through Councils must involve all Councils and as many other people as possible in thinking positively about Community health and in taking action to improve their environment. The increased emphasis on training and public health measures is shown in the following statistics ; In the seven years from 1956 to 1963 the percentage of the Health Budget spent on : Hospital Services has fallen from 75.18 to 58.24. Community Health has increased from 18.75 to 22.16. Medical Education from 2.10 to 13.17. Research from nil to 1.1 5. The increase in the numbers of trained indigenous staff has allowed a significant shift in emphasis to public health activity, and at the same time laid the foundations for a medical service that this country can afford. There are many roads to good health. Better health follows successful economic ventures and better education, and always the health worker must be alert to recognize and encourage progress in spheres not directly associated with health aims, but in the long run perhaps bringing better net health gains. As this report goes to press, the Territory is on the eve of welcoming overseas delegates and representatives to the 14th Western Pacific Regional Committee Meeting of the World Health Organization. The Territory is singularly honoured that it has been chosen as the venue for this important international meeting-:-in a sense recognition of the health progress to which all Health staff, past and present have actively contributed.

r = TERRITORY OF PAPUA AND NEW GUINEA

DEPARTMENT OF PUBLIC HEALTH SUMMARY OF EXPENDITURE 1962·63. Expenditure

ITEM £ £

Salaries and Allowances and Contingencies.... .... .... Salaries and Allowances .... Incidentals Communications, Printing, Library and .... .... Travel, Transport and Freight .... .... .... ... ",. .... Patrol Expenses '

.... ... , . ...

.... .... ....

1,960,076 44,73) 320,)32 20,) 19 371,684 58,861 134,216 201,520

.... .... .... 2,345,862

Medical Services Drugs and Dressings Transport of Patients

....

....

.... ....

.. ..

....

. ... . ...

.... 430,545 ....

Subsidies to Missions for Medical Serf,ices .... . ... .... General Medical Sen-ices .... .. .. .... . ... Hansenide and T.n. Hospitals .... Medical SubJidieJ to Local Government Councils for Services "',

335,7% 20,288

Special Services-

.... ... , .... Malaria Service Visiting Specialists and Research .... .... Training Materials and fees .... Infant, Maternal Welfare .... ... .... Artificial Limb Factory .... .... Health Education .... .... .... Tuberculosis Survey .. .. Pre-School Play Centres .... .... Blood Transfusion Service .... .... .... .". Town Sanitation ,

.... . ...

....

.... .". . ...

... .... .... ~

.... .... .

...

<, ••

. ...

.... . ... ... , .. .. .... ....

.... .... " .. .... . ...

.... .... . ... .... .... . ... .. ..

91,805 18,369 31,)38 24,041 2,456 1.368 16,550 2,269 17,501 4,412

.... .... .... . ... .... .... .... .... .... 210,309 66,659 610,010

Capital Equipment General Stores

....

.. ..

.... ....

.. .. .. ..

.... .. .. ....

.... ....

....

....

....

TOTAL DEPARTMENTAL BUDGET

£4,019,409

Expenditure by other Departments and AgencieJ on behalJ of Public Health.... .... .... .... .... New Construction ... .... . ... Hospital Engjneerin~'" .... .. .. .... .... .... Maintenance of Buildings .... .. " .... .... .... . ... .... .... New Vehicles TOTAl, ....

£ 807,160 71,000 66,150 10,987 £4,974,706

L

Organization and Administration HE Department of Public Health is at present organized in seven divisions, each headed by an Assistant Director, responsible to the Director of Public Health. These divisions are: • Medical Services. • Preventive Medicine. • Infant Child and Maternal Health. • Medical Training. • Medical Research. • Mental Health. • Administration. The field services of the Department are organized on a regional pattern, based on four convenient geographical areas, viz.,

T

Important appointments during the year included an Anaesthetist, a Paediatrician, two Dental Officers, a Bacteriologist, a Biochemist, two Entomologists, a Psychiatric Social Worker and a Senior Occupational Therapist. Indigenous staff who graduated and returned from the Central Medical School in Fiji were one Assistant Medical Officer, (increasing the nwnber of Assistant Medical Officers working in the Territory to 14), and one Assistant Health Inspector. The nwnber of Medical Assistant graduates of the Papuan Medical College accepting full responsibility as Officers-in-Charge of departmental hospitals increased from six to fourteen. Recruitment difficulties were experienced in obtaining Medical Officers and Specialists including a second Psychiatrist and a Senior Pathologist. Nursing recruitment, together with the services of locally married nurses and the turn-off of Territorial Nurses from the Schools of Nursing, saw greater stability in this service than for many years. HOSPITALS AND BUILDING PROGRAMME: Disregarding two intermediate annexes for paying patients as separate hospitals, the Department conducts in all 100 hospitals including one general and ten special hospitals operated by various missions for the Administration. Three new hospitals were opened. These are at Amanab (Sepik District), Kol (Western Highlands District and Wonenara (Eastern Highlands District). In the building sphere the year was one of planning and construction rather than completion. The new Regional Base Hospital at Lae was nearing completion at the year's end as was also the new district hospital at Daru. The Nurses' Home at the Papuan Medical College was also nearing completion. Work on all special hospitals continued. Drawings for the new Northern District Hospital and Goroka Regional Base Hospital and laloki Mental Hospital were advanced. Design on these hospitals is now complete. In all, a total of £807,160 was spent on construction of new permanent departmental buildings. This does not include minor new work money spent on replacement of semi-permanent and bush material buildings at many of the Department's centres. In maintaining the special engineering services associated with the larger base and district hospitals, £59,535 was spent. FINANCE: Departmental expenditure at £4,019,409 showed an increase of £431,183 or 12 per cent. over the previous year. Detail of expenditure is shown on page 6. Revenue, mainly from statutory fees paid by pay~ng patients for services, amounted to £106,015 representmg an increase of 17 per cent. above 1961-62.

• • • •

Papua Region. Highlands Region. Mainland Region. Islands Region.

Each Region operates under a Regional Medical Officer responsible to the Director of Public Health. The present organization is outlined in the diagram on page 8. Re-organization proposals have been made to meet the changing pattern of health acitvities, and these are still under consideration outside the Department. DEPARTMENTAL STAFFING: At the close of the year the total strength of the Department was 6,025. This compared with 5,548 at the end of the previous year. The following table gives an analysis of staff breakup for these periods. TOTAL STAFF 30.6.63 30.6.62

Indigenous-Staffed. Second and Third Division Auxiliary Division Administration Servants .... Others Labourers Expatriate. Permanent Officers Exempt Officers and Employees Temporary Employees Part-time Employees

23 149 4,366* 51 635 409 115 224 33

12 78 4,246 53

398 413

,J

89 226 33

.. Includes 307 staff for Mission-staffed Administration Hospitals.

The year was notable for the fact that Divisional indigenous staff doubled. These officers were dispersed generally through the department's activities, but an increase in administrative and clerical positions was encouraging, as these categories have tended to lag behind ~he technical and professional fields in numbers. IntenSIve on-the-job training was introduce~ at the .Departmental Headquarters during the year to gIve expe~lence to the~e clerical and administrative workers who wtll take certam present Headquarters activities, including staff work and accounts, into the Regional organizations.

ORGANIZATION AND ADMINISTRATION-continued. HEALTH STATISTICS AND EVALUATION SECTION: This Section now in its second year commenced its first comprehensive survey of health standards and morbidity. This is being conducted in the Highlands. Surveys of selected representative areas of all regions of the Territory are planned. These surveys will provide accurate baseline material at present not available, and will provide a valuable guide for the evaluation of future Public Health

campaigns of all kinds, as well as determining problems needing special attention. The Survey team consists of an Epidemiologist, Medical Officer, Dental Officer and four other specially trained Assistants. The Section processes hospital and other departmental statistics, and provides an advisory and consulting service for research projects requiring statistical advice.

PRESENT ORGANIZATION CHART:

DIRECTOR Of PUBLIC HEALTH

Medical Board Board of Studies Papuan Medical College

Permanent Council on Mental Health and Cultural Development Health Education Council Papua and New Guinea Medical Research Advisory Council

ADMINISTRATION Personnel Accounts Building Transport Communications

Health Education StatisticsEpidemiology Hospital Statistics Demography Vital Statistics

I Medical Serylces Hospitals Specialist Medical Services Radiology Pathology Dental Services Pharmaceutical Services Artificial limb Factory Preventive Medicine Malaria Eradication Tuberculosis Control Leprosy Control Sanitation Quarantine Special HospitalLB. and Leprosy Mental Health Hospitals Surveys

I -Child Health Nutrition Kuru

I Training School Health Pre·Schools

I Medical Training TrainingAssistant Medical Officers Medical Assistants Nurses Aid Post Orderlies Assistant Health Inspectors Publications library

Medical Research

-field Clinics

Infant, Child and Maternal Welfare

--

.'

Regianal Field Smices Papua New Guinea Islands New Guine~ Highlands New Guinea Mainland Local Hospital Services Aid Posts Local Health Services Health Centres field Surveys Mission liaison Sanitation Local Government Council liaison

--

Division of Medical Services Assistant Director : Dr. H. N. White, M.B., B.S.

Division is in general concerned with the curative T HEservices of the Territory with emphasis on Medical Patrolling, the provision of hospitals and aid posts, equipping of these esablishments as well as adequately staffing I them-both in regard to numbers and provision of specialist assistance in such fields as medicine, surgery, radiology, anaesthesia, obstetrics, paediatrics and ophthalmology. In all treatment there is an overlapping preventive component and the divisional policy encourages education to prevent relapse or recurrence of illness among all patients, as well as prevention of disease in villages patrolled. Apart from its medical services the division includes a Dental Service-considered separately in this reporta Pharmaceutical Service, artificial limb factory and central medical library. Hospital Statistics As the accompanying table shows, there were 107,728 patients treated in general Administration hospitals during the year. This represents an increase of just over 11,000 admissions from the previous year. Pneumonia admissions rose by two per cent. over the previous year. Malaria admissions remained static.

and 33 additional mission-trained Aid Post Orderlies were subsidized by the Administration through their missions to operate Aid Posts in remote areas. TWELVE MAJOR CAUSES OF ADMISSION ADMINISTRATION GENERAL HOSPITALS. Nunlber Di~charged

Per

cent.

In addition to inpatients in general hospitals the daily average number of inpatients in special Administration hospitals was 2,681, this representing no significant change over the previous year. General hospital outpatients numbered 363,945. Deaths in hospitals were 2,817 or 2.61 per cent. of patients treated. This compares. with 2.42 per ~ent of inpatients who died in the prevlOus year. The Increase in deaths and percentage of deaths could be related to the higher incidence of pneumonia cases and the numbers of these who reach a moribund state before being taken to hospital. Births in Administration hospitals numbered 3,762. Most of these cases were referred from ante-natal clinics. This figure together with the 7,103 births known.to have occurred in Missions Hospitals indicates the groWIng confidence with which mothers will enter hospital for confinement. At the six Rural Health Centres, 111 babies were born during the year and these were all cases in which institutional confinement was indicated at ante-natal examination. The number of village Aid Posts administered by the Department on the 30th June, 1963, was 1,461. PatroIIi.ng of surrounding villages is an important part of the routIne duties of those in charge of Aid Posts. In addition, 313 routine medical patrols were carried out by expatriate staff who visited 2,309 major villages, apart from hamlets, and examined some 260,000 people. In all, 6,923 days were spent on these patrols. Thes~ figures do not i?clude special patrols undertaken in reiatlOn to the anti-cholera and anti-smallpox vaccination campaigns. r_,.._~ :,... ,..;...l TIr."" .QV~.Q rlro...1 l-....... :::t? --.,:('(';n..... l\r.....('~f;" ....

1. Pneumonias (A.89-A.91P 2. Malaria (A.37) 3. Infections of Skin and Subcutaneous Tissues (A.121) 4. Lacerations and Contusions (AN.143, 145, 146) 5. Deliveries and Complications of Pregnancy and Childbirth (A.115A.120) 6. Gastro Enteritis (A.1 04) 7. Ankylostomiasis, Other Helminthic Infestations, and all other diseases classified as infective and parasitic (A.41-A.43) 8. Bronchitis (A.92-A.93) 9. Certain other diseases of the Skin and Musculoskeletal System (A.126) (at least 90 per cent. TUs) 10. Acute Upper Respiratory Tract Infections (A.87) 11. Malnutrition (A.64, A.134) 12. Eye Diseases (A.74-A.76) - Other Diseases ....

12,240 10,820 6,384 5,404 5,400

11.36 10.04 5.92 5.02 5.01

5,108 5,024

4.74 4.64

4,860 4,752

4.51 4.41

2,676 2,640 2,044 40,376 1107,728

2.48 2.45 1.90 37.50 100% of

TOTAL

....

* NUmbers in brackets refer to W.H.O. Intermediate List 150 Causes for Tabulation of Morbidity and Mortality.

Pharmaceutical Services Section This section provides and distributes all medical supplies, hospital equipment, surgical instruments and fiel.d technical supplies used by the Department of PublIC Health and Missions undertaking Administration-approved health work. In June, 1963, 3. new District Medical Store was opened at Wewak. Base Medical Stores operate at three centres-Port Moresby, lae and Rabaul, with one other District Medical Store at Madang.

A total of 92 persons are currently engaged in ~he Section, including 12 pharmacists, 62 storemen,. 1~ cle~ICal staff and two X-ray engineers, and two artIfiCIal lImb makers. During the year goods to the value of £560,000 w~re received from Australia and 17 other overseas countnes. tn'"!T f>(,l';,.,~('~t

This total included £43,000 for hospital and !abora.f.R:>' 000 for dressin!!s £96000 for Anti-

DIVISION OF MEDICAL SERVICES-continued. and Cholera vaccines used as a precautionary measure and £90,000 for Vaccines. The latter included Smallpox against spread of these diseases from West New Guinea, and Salk and Sabin Oral vaccines used successfully to contain several widely dispersed outbreaks of poliomye'litis. Supplies obtained for Special Services included 144,310 lb. of DDT and £58,000 worth of prophylactic, therapeutic and mass administration drugs against Malaria. Supplies of various kinds for the Tuberculosis Control Programme cost £20,000 with an additional £28,000 for therapeutic drugs for Tuberculosis and Hansens Disease. Dental Service supplies worth almost £6,000 were purchased and £2,000 was spent on Artificial Limb Factorys items. Medicines are provided free to all inpatients and outpatients at Administration non-paying hospitals, clinics and Aid Posts. 7,940 Subsidized Prescriptions at a prescription fee of 6s. each for those for whom free drugs do not apply, were dispensed by the seven private pharmacists in the eleven months ended May, 1963. Drugs costing the Department £9,941 were supplied to the pharmacies for this purpose. In January, 1963, the range of expensive life-saving drugs available under the scheme was increased from 17 to 37. Stores movements in the year included overseas imports in excess of 700 ship-tons and 30,000 lb. received by air-freight, while outward issues from the medical stores included some 845 ship-tons by sea, 186,000 lb. by internal air-lines and 229,000 lb. by road transport (from Lae into the New Guinea Highlands). 6,598 separate orders were filled. Three expatriate nurses obtained their Tutor Diploma this year, and two the Nursing Administration Diploma. Two are now studying for the Tutor Diploma, and one in Nursing Administration. One further expatriate nurse is studying Public Health Nursing in Hawaii under World Health Organization Fellowship arrangements. This year the first Papuan woman graduated with three certificates from Australian Schools of Nursing.

Departmental Librar),. The Departmental Library has a total book-stock of 6,500 titles, 330 current periodicals, 1,840 back numbers of periodicals and 45,700 pamphlets, booklets, publications of scientific institutes, International and Government agencies, congress papers and others. Ti~le additions during the year numbered 545. In addition, the Library provides medical reference books and literature for 189 small branch libraries in the Territory. A photocopying service provided approximately 400 required articles and the central information and research service of the Library handled 700 reference queries and undertook 130 bibliographic researches. In order to have readily available references, an up to date biblography is kept of literature published by Departmental authors. Restricted bibliographies are compiled on subjects specific to the Territory. INCIDENCE OF NOTIFIABLE DISEASES 1962-63. Acute Anterior Poliomyelitis Anthrax Cerebro Spinal Meningitis Chicken Pox .... Dengue Diphtheria Dysentery Bacillary Dysentery Amoebic Dysentery Unclassified Encephalitis-all types German Measles (Rubella) .... Gonorrhoea .... Granuloma Inguinale Infantile Diarrhoea Infective Hepatitis Influenza Leprosy Leptospirosis Lympho Granuloma Venereum Measles- (Morbilli) Mumps Ophthalmia Neonatorum Paratyphoid Group Puerperal Fever Scarlet Fever Soft Chancre .... Trachoma Tuberculosis-Pulmonary Tuberculosis-Other forms .... Typhoid Group Typhus (Mite born scrub, etc.) Whooping Cough-Pertussis

Nursing Services. During the year General Nursing Final Examinations were held in Port Moresby and Rabaul. In all, 19 women graduated; of these 11 were Papuans, six New Guineans and two British Solomon Islanders. Nineteen men also graduated-nine Papuans and ten New Guineans. Eighteen of the women are now working towards their Midwifery Certificate, while most of the men are undertaking the Medical Assistant Course. In the Division of Infant and Maternal Health, 31 girls graduated with both Infant Welfare and Midwifery Certificates, whilst 60 graduated with Infant Welfare only, and 26 with Midwifery cnly. Five Territorial Nurses obtained a post-graduate Infant Welfare Certificate, and a further five are now taking this training. Seven Territorial Nurses obtained their Midwifery Certificate. Infant Welfare trammg is conducted by Christian Missions in various parts of the Territory. The Department of Public Health conducts training schools at Saiho and Port Moresby in Papua, and a post-graduate course at Minj in the New Guinea Highlands. . Territorial and Infant Welfare nurses are staffing, Without expatriate supervision, Rural Health Centres at !apipipi and Vunapaka in New Britain, Marshall Lagoon m Papua and Bena Bena and Kerowagi in the New Guinea Highlands. . Exp~t~iate ~lUrses nu~ber 201, including 149 working m . AdminIstratIOn hospitals and tutoring duties, with 52 m the Infant and Maternal Welfare Services.

137 3 320 1,242 23 16 268 73 1,216 85

196 282 18 2,945 239 3,423 988 14 12 2,611 213 10

> '

2

19 15 1

540 1,397 528 10 20 1,075

Dental Health Service Senior Dental Officer: Dr. D. E. Barmes, D.D.Sc.

63 was the entry to the second year of training of T 13 Dental Assistant students. This assures the service of a significant increase in operating field staff in the coming year. At the same time, intake to the Dental College was not at a desirable level, there being only five first year students. Possibly more difficult years will follow before the fruits of the present higher general education drive will favourably affect intakes. Results of a base line dental survey have given a broad picture of dental disease patterns throughout the Territory. Further survey and research programmes have been outlined by this work through the wide range of disease prevalence discovered. Future planning and distribution of staff can now be soundly based according to geographical distribution of dental disease prevalence. The School Dental Service with its direct and indirect preventive measures continues to expand and since the policy of central development and consolidation has been maintained, all main schools and the most needy sections of the school population are included. Field staff has risen from ten dental officers, seven dental assistants to ten dental officers, eleven dental assistants. The number of children registered in the service has risen sharply to 24,581 from 16,532 in 1961-62 and the number of schools covered to 267 from 198 in 1961-62. Tours extend the service from ten base centres to 47 sub-centres. Dental Assistant students at the Dental College now number 18 with 13 due to complete the course early in 1964. Student standards in this two year auxiliary course are increasing yearly and the success already attained by field staff thus trained should be augmented by future drafts. Depending on the number that qualify in 1964 the number of dental centres will increase from ten to 23, so that a considerable increase in numbers and distribution can be expected in that year. The basic importance of this auxiliary type of training to the service is emphasized by this expansion.

HE outstanding development in this service in 1962-

Dental health education, as a major preventi~e measure, will develop significantly when this increase In field staff occurs, and should have a widespread effect on controlling dental disease. Increase in treatment provided during the year is outlined by the statistics below. Particularly in the school service the increase is most satisfying as it lays emphasis on the conservative approach to the problem as a whole. School service fillings have increased by fifty per cent. and the already small number of extractions by less than forty per cent. . Initial examinations still outnumber revision examina! tions and will do so for a number of years while the service is expanding. Maturity of the service is, however, demonstrated by the significant percentage of the total represented by revision patients. Treatment figures in the adult service also show slight overall increases indicating that the activities of this part of the service have been maintained. The following short annual statistics reflect some of the progress made in the Dental Health Service during the year : o -'" 0'~

-

.ct ~ '" 0000 12,701 3,429 10,672 9 61 20,437 12,084 9,054

" -'" ~s ",+>

+>

..,+>

..... oj

"'",0

M

.., "'..... oj .... +> ",0

(.')t;

",,,, " oj

:::E-<

....

",E-<

.... Total Fillings Total Extractions Periodontal Treatment Oral Surgery .... Prosthetics .... ComTreatment pleted ExaminaInitial tions Revision Examinations

7,820 14,767 1,493 140 1,168 15,330 15,768 552

20,521 18,196 12,165 149 1,229 35,767 27,852 9,606

(16,475) (16,336) (13,115)

(136) (577) (26,318) (19,951) (7,491)

Division of Preventive Medicine Assistant Director: Dr. T. K. Abbott, M.B., B.S., D.P.H., D.I.H.

rl1HE Division is responsible for promoting health through rural and town sanitation. disease control ~nd ~radication prograI?mes, provision of epidemiological mtelltgence and plannmg and enforcement of desirable public. health Iegi.slation-particularly in regard to safeguardmg the Terntory from introduction of new diseases. The Division has three major near-autonomous sections, apart from a general and co-ordinating section. These are ; • Malaria Service. • Tuberculosis Control Section. • Leprosy Control Section. These sections are dealt with separately in later parts of the report. Epidemics and the threat of epidemics caused considerable activity in the Public Health field. The outbreak of Cholera in West New Guinea caused particular concern, and in that Territory accounted for nearly 500 deaths in some 1,500 cases. As a temporary measure patrols were sent to all border areas in the Western and Sepik Districts and the entire population of these areas was vaccinated agains the disease. At the same time the more permanent measure of introducing safer water supplies was :investigated and where possible simple, safe water schemes were introduced. Much, however, remains to be done in this field. Full measures were taken to provide completely equipped portable emergency hospitals to deal with any outbreak of cholera, and these are held in reserve, along with sanitation equipment which could be needed in any group of villages affected. In association with the anti-cholera patrols and others, and at all clinics, the campaign against Smallpox was stepped up during the year and at 30th June it was estimated that 560,000 people had been vaccinated, including all persons living in the vicinity of the West New Guinea border. Poliomyelitis outbreaks occurred at five centres and all of these were rapidly halted by the use of both Sabin and Salk vaccines. This was the first occasion in the Territory that Sabin vaccine has been used. Almost all cases occurred in children under five years. The mortality rate was negligible, and intractable paralysis rare. There were severe outbreaks of measles (morbilli) in two areas. These affected many hundreds of children, with a number of the usual complications, including pneumonia, resulting in some deaths. Epidemics of this disease still continue to be more severe in their individual effects and sequelae than counter-part epidemics in say Australia. Triple antigen campaigns were continued throughout the year through all Administration and Mission Medical centres.

3,800 lb. of fresh meat and 264,000 tiqs of prepared foods, 2,000 lb. of fresh fruit and vegetalles, as well as quantities of ice cream and sweets. Certain traders, in response to the t aditional male custom in many areas of dying hair w th lime, have introduced imported hair dyes containing p-hyenylene diamine or p-teluylene diamine. A rise in the incidence of dermatitis led to a prohibition of importation into the Territory of hair dyes containing these chemicals. Arising from this prohibition 320 packets of hair dyes were seized during the year. Particular attention was paid to hygiene standards in Barber Shops and only those fulfilling the required standards are licensed. Fogging, spraying, filling, draining and oiling operations were undertaken in all towns for mosquito eradication. This work is incidental to the Malaria eradication scheme and its aim in addition to destroying disease vectors, is to control pest mosquitoes. Anti-rat activities were given special attention during the year at all ports and town centres. COUNCIL HEALTH SERVICES: The year marked the first full year of operation of the Administration scheme for local Government Councils establishing their own health services and the Administration provided a total cash assistance of just over £20,000 to Councils. This scheme embraces all aspects of Council health work and includes Aid Posts, Council Health Centres and other services. It covers subsidy for salaries, drugs, buildings; environmental sanitation and includes loan provisions for acquiring vehicles for health work. In brief, Councils provide an amount related to an ability-to-pay rating determined by the Director of Native Affairs and ranging over four stages. This amount is matched by an Administration subsidy appropriate to the stage. Under the scheme, Councils are particularly encouraged to undertake environmental sanitation projects with the emphasis on provision of safe water to villages. Administration subsidy on these projects is on a pound for pound basis, although in special cases where need is great and Council funds low, a 100 per cent. subsidy may be allowed. Launching the scheme was not without anticipated administrative difficulties, but since it was introduced in January, 1962, 237 simple safe water schemes ranging from a single tank to larger reticulated systems have been completed and subsidized. In 1962-63, 113 villages benefited from these safe water installations. The loan scheme by which Councils are enabled to purchase a vehicle for Rural Health Centre use against an Administration-guaranteed bank loan, came into operation during the year and three Councils availed themselves of loans, whilst two others paid cash for Health Centre vehicles. There are now six Council Rural Health Centres in operation. Whilst emphasis at these is on prevention of illness and promotion of better health, outpatient services are provided, and accommodation is available for acute

...

HEALTH INSPECTION; Health and Food Inspectors

inspection

carried out routine public protection duties such as weekly inspection and milk sampling of Territory dairies and of food premises of all kinds. Condemnation

of food-stuffs included a total of

37,000

lb.

of

cereals,

cases

~W1;f;" " ~ •.

•

Malaria Service Dr. Senior SPecialist (Malariology) : J. J. Saave, M.D., D.P.H., D.T.M.&H.

A N estimated 1,400,000 people of the Territory of Papua and New Guinea live in endemic malarious areas and the remaining 700,000 live in areas where malaria occurs in epidemic forms. The objectives of the Malaria Eradication Programme have been carefully defined to suit the malarial patterns peculiar to this country.

..t""'--

being undertaken by Health Department staff in conjunction with their medical duties. Supervisory responsibilities are wherever possible given to indigenous personnel. Mission and Government hospitals are co-operating in an active malaria case search undertaken by the Malaria Service. Blood slides are being examined in Malaria Laboratories established at Rabaul, Port Moresby, Minj, Kundiawa and Maprik. Methods of case detection (active surveillance) are being pre-tested in the original pilot project area in the Maprik Subdistrict. Co-operation on malaria eradication matters with the British Solomon Islands Protectorate Administration is well established and eradication operations are carried out in the Treasury and Shortland Islands of the British Solomon Islands Protectorate by the Territory of Papua and New Guinea Malaria Service. The training and refresher courses for Malaria Laboratory Assistants in entomology, parasitology and general laboratory techniques were held in Malaria Schools at Minj and Kundiawa. The duration of the formal course is 10 months. Twenty-nine squad leaders attended a ten-month course in eradication techniques at Rabaul. Extensive health publicity and health education relevant to the Malaria Eradication Programme has been conducted utilizing pamphlets, film strips, posters, broadcasts and other media. The Territory was represented at the fourth Asian Malaria Conference held at Manila in September-October, 1962 . MALARIA ERADICATION PROGRAMME. Region

This programme is conceived as .. progressive malaria elimination" at the community level, using six-monthly residual indoor spraying with DDT and mass drug administration with selected anti-malarials. It is a phased programme with special emphasis on continuous measurement of malarial disease in the community, exploratory studies and eradication operations. During the year eradication programmes were continued in the entire New Guinea Islands Region, Milne Bay District and the Sepik. The attached schedule shows the areas given anti malarial protection. Spraying operations in the Sepik District have extended to Yangoru, Wewak, But-Boiken, Pagwi and Imonda and were combined with a mass drug administration with Chloroquine-Pyrimethamine. This extension completed a protective perimeter around the former pilot project at Maprik. At present 93,444 people are given an anti-malaria protection in the Sepik District. A notable event was the opening of a modern Malaria School and Research Centre at Kundiawa in the Eastern Highlands District. This replaces the Malaria School at Minj, though certain malaria research activities will still be continued at Minj. 1-

~I

A Regional Malaria Eradication Centre for the Sepik . and Madang Districts is being established at Wewak and a Regional Malaria Laboratory has been completed at Maprik. A research project was started at Nissan Island, Bougainville District, in August, 1962, to test the eradication efficacy of 4-amino and 8-amino quinolines. Haemoglobin and enzyme deficiency studies are being conducted. Interruption of transmission was achieved in this area in November 1962 and studies of malarial relapses were undertaken. In addition to eradication activities, exploratory surveys were continued in the Highlands and have commenced in the Northern District. Parasitological and entomological surveys were carried out in a planned manner in the various areas of the Territory. At 30th June, 1963, there were 523 persons engaged on a full time basis in Malaria Service activities. In certain areas the supervision of eradication operations is

District

Square Miles

Population Protected *

Papua Region Mainland Region New Guinea Islands Region

Milne Bay District Sepik District Morobe District Madang District New Ireland District Bougainville District New Britain Distriet Manus District

3,830 4,958 432 184 3,816 4,100 14,284 800 32,404

65,531 93,444 6,095 436 38,008 53,785 105,523 17,232

TOTALS

····1

I

380,054

¥

Based on 1960 population figures.

Tuberculosis Control Section Senior Specialist (Tuberculosis) : Dr. S. C. Wigley, M.B., B.S., M.R.C.P.

PIDEMIOLOGICAL studies have shown no variaE tion during the year from the known pattern of tuberculosis infection in the Territory. The disease is predominantly coastal in distribution. Its incidence is directly related to the degree and duration of contact with European communities undergone by the Melanesian communities, and the degree of urbanization or culture change which has occurred in these communities. Four tuberculosis control units have engaged in epidemiological investigations during the year. The investigations have been combined with case finding and B.CG. vaccination programmes. This year 181,350 people have been seen. 101,000 people have been given B.CG. vaccination, and 38,100 people have been examined by photofluorography and other X-ray techniques. Studies on 73,000 people in the Chimbu and Goroka Subdistricts of the Eastern Highlands continue to demonstrate their remarkable freedom from tuberculosis. Findings are summarized in the following Table : Infection rates in percentages, on an age/sex basis in : 1. Chimbu Subdistrict-overall infection rate 0.6 per cent.

The treatment of tuberculosis is carried out in Administration and Mission Hospitals throughout the Territory, including seven special hospitals. In addition important ambulatory and domiciliary treatment services operate in seven centres, namely New Ireland, Nissan Island, the Gazelle Peninsula, the Trobriand Islands, Orokolo and Beara in the Gulf District, and in Port Moresby. Approximately 2,350 patients are now recelvmg treatment in hospitals, and 1,750 patients are being managed by outpatient services. In addition to these patients, 1,650 school children are receiving prophylactic treatment with Iso-nicotinic acid hydrazide (I.N.A.H.) in schools in Port Moresby, Rabaul, and in the Highlands. A further 564 school children are either receiving, or shortly will receive this prophylactic therapy in the Kairuku Subdistrict. The total number of patients receiving treatment in some form or another will then be approximately 6,170. Biological prophylaxis with B.CG. vaccine, and chemical prophylaxis with I.N.A.H. is regarded by the section as having the utmost importance in the control of tuberculosis in the Territory. Experience indicates that chemical prophylaxis undertaken for two years with I.N.A.H. alone will result in reconversion to a Mantoux negative state in approximately 50 per cent. of those given the drug. Expansion of prophylaxis programmes is an urgent aim of the Section, and this is being achieved by closer integration of tuberculosis control into the general medical framework of the Department. . Two thoracic surgery units visited the Territory during the year and 71 operations were done. The total number of operations done since 1956 was increased to 584 on 504 patients. The conditions managed included cardiovascular abnormalities in addition to tuberculous and non-tuberculous lung conditions. The operative mortality rate for this series is 4.3 per cent. Patients discharged from treatment are reviewed wherever it is possible to do so at six !ll0nth~y intervals after dischrage. Over 4,000 people fall mto thiS category. The cover achieved in this review programme ranges from 25 per cent. of the patients who should be seen every six months at out-station centres, to 85-90 per cent. of the patient~ who should be seen, at the major centres. Ease of communication is the limiting factor here. In Papua X-ray examinations are provided at places already established as treatment centres where X-ray services do not exist. During the year 3,031 such large film examinations were carried out by the field X-ray unit in the Trobriand Islands, Mapamoiwa, Kairuku, Orokolo, and Beara. The Central Tuberculosis Laboratory continues to function in Lae. It supplies culture material to centres in all Regions. A close association with the Health Education Cou~cil has been establishe~, and ':"0'.lst:uc.tiv~ wor~ ,.~~ _;d~~~~~

15-30 31m. f. m. f. 0.1 0.2 8.4 1.4 4.8 0.7 0.1 0.2 4.3 2.6 78.6 per cent. of the infection lies in the age groups 15 years and older. In these groups 81.8 per cent. of the infection is in the male members of the community. 2-6 m. f. 0.1 0.1 0.1

0-1 m. f. 0.0 0.2

7-14 m. f.

2. Goroka Subdistrict-overall infection rate 0.5 per cent. 7-14 15-30 31m. f. m. f. m. f. 0.4 0.2 5.0 1.1 2.1 1.2 0.3 2.3 1.6 86.4 per cent. of the infection lies in the age groups 15 yeats and older. The male-female ratio in this group is 54-46. 2-6 m. f. 0.0 0.0

0-1 m. f. 0.0 0.0

In the Erave division of the Southern Highlands District the overall infection rate is higher than in the Eastern Highlands areas mentioned, namely 17.4 per cent. It is higher also in the southern part of the Eastern Highlands where in the Karamui and Daribi census divisions the rate is 3.7 per cent. These higher infection rates are related directly to the higher degree of contact undergone by these people through traditional trade routes to heavily infected coastal groups. The increasing ease with which people from the Highlands and coast visit from one area to the other makes it impossible to prevent T.B. entering the Highlands, and hence the aim is to offer the widest protection with B.CG. to convert the entire Highland population into a Mantoux positive community, thus substantially retarding the spread of the disease. The prototype chest clinic at the Port Mo.resby General Hospital is now well established. Local Village surveys, school surveys~ .and i~tra-hospital .a~ivities are carried out from the clmlc, as IS the supervlSlon of Out-----.natient Treatment Services in Port Moresby and surround-

Hansens Disease Section Senior Specialist (Leprology) : Dr. D. A. Russell, M.B., B.S., D.P.H.

EPROSY appears to be endemic in most parts of L the Territory. Case finding surveys show that five forms of the disease occur in Papua and New Guinea, namely: Indeterminate, Tuberculoid, Dimorphous, Lepromatous and Polyneuritic, but that the Tuberculoid or non-infectious form predominates. There is also a predominance of males over females affected. It is established that there are about 10,000 cases of leprosy in the Territory, and that about 6,000 of these are untreated. The estimated overall prevalence of the disease in the Territory is 5.71 per 1,000.

rural or primitive conditions. In addition drugs such as Thiosemicarbazone, Diaminodiphenyl sulfoxide (Medapsol), Etisul cream and liquid, and Ciba 1906 are also available, but the use of these latter drugs has been more limited due to unfavourable reactions. The results of treatment on the whole have been satisfactory where supervision is available, although there have been some serious cases of drug intolerance and marked frequency of lepra reaction, requiring the use of Antimonial preparations and the steroids. The assessment of deformity in patients in the Territory according to the classification of deformity suggested by W.H.O. Technical Report Series 1961, No. 221, revealed that 2,200 patients were in need of specialized surgical assistance. At present rehabilitation measures in leprosy patients cover simple physiotherapy and operations by our two surgeons competent to do routine orthopaedic procedures. The Artificial Limb Factory at Lae provided prostheses for 12 patients. Increased emphasis has been placed on occupational therapy in all colonies. B.C.G. vaccination of the new-born in leprosaria is encouraged as a preventive measure and the vulnerable members of the general population are covered by the Tuberculosis Control Service . In May a combined leprosy and tuberculosis Seminar was conducted at Rabaul and four papers on Leprosy (Classification, Therapy, Role of B.C.G. in Leprosy, the Role of Heredity in Leprosy) were delivered to about 30 medical field staff. During the year the first Regional Leprosy Control Unit was formed and based at Mount Hagen in the Highlands. The new control unit will undertake case finding surveys to determine the exact prevalence of the disease ; will organize, supervise and check treatment of all cases through existing or extended facilities, and promote health education regarding the disease through local leaders, using tape recordings in local dialects and films. There are, in all, in the Highlands 272 Administration and 76 Mission points where referred patients can obtain controlled outpatient treatment. Treatment centres include Aid Posts, Mission clinics, general hospitals and Hansenide colonies. Under a policy commenced in 1956 an attempt has been made to encourage the non-infectious patient to receive outpatient treatment in his own village in the area where the disease occurs. Particular emphasis has been given to non-infectious patients receiving outpatient treatment in four highly endemic areas. These are Wabag in the Highlands, Bogia and Begasin in the Madang District of New Guinea, and Orokolo in Papua. In all 2,854 outoatients are receiving treatment in Papua and

Two case finding surveys conducted in New Guinea and one in Papua during the year revealed the following results : -

Prevalence, per cent. No. of People Examined ;;l '" 0

-; Po Po ,,» 0" " ~ "

»

'" ;; ;; ;;l ~

·0

.., H

;;l

"

.,

2 Po

E

:3 ';: Z ;;l OJ

..:: ~

'" 0

Po

0

~oj

,"~

~

,

"

H~

E-o

is

E

OJ", '0._

~S

New Britain Kilengilolo and Bariai Regions ~/

3,110 1.73

1.54

.099

.032

.032

.032

Duke of York Islands Coastal Villages near Port Moresby

3,579 1,945

1.02 1.64

0.66 0.97

0.30 0.46 0.05

0.055 0.15

Leprosy is a rural disease, and as the rural areas of the Territory provide tremendous problems rega~~i?g terrain, transport, the development of health faCllttJes and general education of the people and the training of health personnel, the progress of outpatient treatment will therefore depend on surmounting these problems. Isolation of infectious patients is effected through Hansenide Colonies, six of which are controlled and fully subsidized by the Administration, though under the administrative care of various Mission organizations. Partial subsidy is provided for five other colonies organized and conducted by the religious missions. In addition treatment for infectious cases is also available in special wards provided at certain Administration and Mission General Hospitals. During the year 1962-63 the number of patients in the various colonies and hospital wards was 2,570. There were 3,272 admissions and 3,113 patients discharged from the various institutions. The drug of choice in the treatme?t. of leprosr is Daosone as it has been found to be cltmcallv effectIve,

Health Education Section Senior Health Educator: Mr. R. W. Carlaw, B.A., Dip.H.Ed.

ECAUSE of staffing difficulties the Health Education Section has only been functioning as an active fulltime unit for five months of the 12 months period ended 30th June, 1963.

B

During that time a full programme has been undertaken. Three training courses have been held for inservice staff, one at Kundiawa for Malaria staff, one at Rabaul for general Medical staff both indigenous and expatriate, and one at Rabaul for Health Centre staff. The Health Education staff have also taken part in an adult education course in the New Britain District. Two major posters have been designed and produced, and a large quantity of pamphlets and posters suitable for use in schools in this country have been obtained from the Queensland Health Education Council. A Film Strip Library has been organized containing at present 175 film strips and a catalogue has been circulated throughout the Territory. Five flip-charts each involving some 12 to 16 cards have been prepared and are in the hands of the printers for preparation. A series of Visual Aids on Tuberculosis involving the use of three posters, a flannelgraph, and a fully illustrated sixteen-page booklet all of which are prepared in simple English, Motu and Pidgin, has also been drawn up and is almost ready for distribution. Field work accomplished during the year has been confined largely to Malaria Eradication and Nutrition. Some minor difficulties of community acceptance were experienced in the Malaria Eradication programme in the Sepik District, and the Senior Health Educator and an Assistant were posted to the spraying operations. The Senior Health Educator remained long enough to assess the situation, but the Assistant has remained and has effectively brought the community on side with the spraying campaign and has increased community understanding of the malaria problem. In the field of Nutrition the Health Education work lras been largely confined to the application of recent research into the problem of the protein malnutrition arising from weaning practices in the Highlands. Research by the Departmental Nutritionist has shown that peanuts ground into a paste provide adequate protein for the growing child. The problem has been to convince the people in affected areas of the value of peanuts, and to motivate the people to grow adequate peanuts, to roast them, and then to bring them to a central point for grinding. This work has been in the hands of a team, one working in a Health Education capacity, the other contributing the anthropological component. After a period of nine

months work in the area a group of ten to fifteen thousand people are more aware of the benefits of the peanut [or their children, and the children themselves are demandmg this food. The most useful and effective media used by Health Education in this Territory would be the .. plastigraph :', a modification of the better known flannelgraph. Next m importance would come the film-strip which has the d.isadvantage of requiring a power supply and some eqUIpment for its use. Coloured film-strips are particularly popular. Posters have not been used to any great <:xtent in the Territory due (a) to the lack of supply of SUItable posters and (b) to the people's lack of familiarity with this media. Pamphlets likewise have not proved of ~ar­ ticular value. Plans have been made for the working out of a .. radio doctor" series over the two Administration Radio Stations located at Rabaul and Wewak. Scripts are in preparation for a Radio Doctor session at least once a week with health talks following through on two other sessions, making three sessions of fifteen minutes each per week. Health talks are already a feature of radio programmes, and radio receivers are becoming increasingly popular. Recently the Health Education Section established a workshop in Port Moresby and it is planned to produce from there film-strips and posters appropriate to Territory needs. The use of Smm. movie film is undergoing a trial. This media is cheap and does not require expensive equipment for projection. Scripts on Leprosy, Tuberculosis, Malaria and Nutrition have been prepared and it is proposed to film in the area to which the fIlm is directed so that there may be a cultural indentification with the theme of the film. One script will be used perhaps seven or eight times throughout the Territory directed toward an equal number of cultural major groups. The newest media to be used in Health Education work in this Territory has been that of puppets. These have been used in schools in the Lae area and reports on their effectiveness have been encouraging. The Health Education Council has met twice during the year and has given its attention to the problems associated with the recent introduction of wider drinking laws. A film strip on Alcohol education, and three pamphlets on the personal and social effects of alcohol have been produced by the Executive Officer under the auspices of the Council. A poster on Nutrition has also been produced by the South Pacific Commission under the direction of the Council. During the year membership of the Council was extended to include three representatives of the indigenous community.

Queen Elizabeth II Infant, Child and Materna I Hea Ith Service Dr.

J.

Assistant Director: Refshauge, M.Sc., M.B., B.S., Dip.Ed., D.P.H.

HE aim of this Service (which is also a full division T of the Department) is to reduce infant and maternal morbidity and mortality and to foster family health through clinic services, pre-schools, school health services, health education and a training programme for indigenous workers in the Infant and Maternal Health and Pre-School fields. Pre-School Services are considered separately in the next section of this report. The Infant, Child and Maternal Services of the Division are staffed by three full time and one part time expatriate Medical Officers, 50 expatriate Nurses and 98 trained Papuan and New Guinean Infant Welfare and Midwifery Assistants. Care is given through 15 fixed and 528 village clinics, open daily, weekly or fortnightly, according to the needs of the community. Clinics are staffed by expatriate Nurses and Papuan and New Guinean Trained Assistants. Women and Children from several villages come together and make a village clinic, and these are visited regularly from the nearest fixed clinic or rural health centre. At the clinic the physical and mental development of the infant and child is noted, and expectant mothers are examined and guided through pregnancy, emphasis being on hygiene and nutrition. At clinics, immunization against whooping cough, diphtheria and tetanus is undertaken and B.CG. vaccination is given where recommended by the Tuberculosis Section. Expectant mothers are given immunization against tetanus during pregnancy. Since the outbreaks of poliomyelitis during the year, Sabin vaccine has been available for all infants and Salk vaccination for older age groups. Clinics held by the Department had 124,577 attendances by children under the age of one year and 262,653 attendances by children between the ages of one to four years. 5,918 women registered for ante-natal care with the Administration clinics and 11,615 with Mission clinics. There are 141 Mission Centres, subsidized by the Administration, undertaking Infant, Child and Maternal Health work. Most of these Missions are now accenting village clinics, holding clinics in villages far beyond their base centre. They are in many instances, helped in this by Assistant Nurses who have graduated from their own Training Schools. A School Health Service is operated by the Division. This year 34,009 children were enrolled in the areas where the service is working, and 30,128 examinations were made during the year. In each year, the School Health

Section examines children attending school for the first time, and also those in fourth grade. Abnormalities found are followed up as necessary, and any child who has been ill or has shown some retrogression in his studies, is checked. Treatments are given as required and the team visits the schools again every two months to check those in need of attention. Field officers of the Department undertake School Medical work where special Divisional staff are not available. The LCM.H. Regional Supervisors are available to guide these people as required. In Port Moresby and Rabaul, urban school children have a School Nurse attending to their minor ills each week. This is a service which considerably reduces absenteeism from school. Commonest complaints attended to are sores, otitis media and externa, and conjunctivitis. An experimental Family Planning project commenced last year was successfully continued in Port Moresby. Assistance in this experiment is restricted to families having at least three living children. There are two Administration and ten Christian Mission Training Schools for Assistants and there are in all 208 girls in training as Assistants. The Assistants must pass in theory, oral and practical examinations conducted by the Department in each subject before graduation. During the year 55 graduated as Infant Welfare Assistants and 26 as Midwifery Assistants giving a total of 141 with both certificates. Marriage causes a high wastage amongst trainees but the value of even partial training is reflected into village life. This year the first graduates in General Nursing and Midwifery attended a new post-graduate course for Infant Welfare Training. The five who graduated from this course now hold three Certificates. The training of traditional midwives at Manus Island is continuing, but it is found that frequent refresher courses are necessary. The training is of eight weeks duration and seeks to encourage the so-called "hands off" technique. Midwives return to their own villages after training. There are five Rural Health Centres which now have trained Assistants in charge of their Infant, Child and Maternal Health services. In six areas trained assistants, whose husbands have been posted to rural areas, have been able to undertake valuable rural clinic work, whilst some assistants have also been posted by the Missions to isolated areas to carry out I.CM.H. work.

Pre-School Services Pre-School Officer : Miss E. D. Ryan, M.Ed.

RE-SCHOOL Centres in the Territory are giving children from three to five years of age an education which is appropriate to their particular stage of development. Children are helped to meet new situations, develop skill in thinking and obtain new knowledge in a changing environment. Pre-schools are set up in urban areas and there are now thirteen .. A" type Centres, six .. S" type Centres and Sixteen .. T" type Centres catering for a total of 1,1 S 7 children. Sixteen trained teachers are assisted by seven graduate pre-school assistants, 20 pre-school a.ssistant trainees and seven supervisors with some in-service training. .. A " type Centres offer an Australian type pre-school programme. Ten" A " type Centres are open for full-day care from 8.30 a.m. to 3 p.m., whilst the others are open from 8.30 a.m. to 12 noon. Children under four years of age do not stay all day. Fees are charged by the Committee of Management. The trained teacher is employed by the Administration and the Assistant by the Management Committee. The Administration subsidizes buildings on a 60/40 basis and also guarantees a bank loan to provide building funds for the Committees. Equipment is provided by the Committees. .. S" type Centres are small subsidized Centres catering for up to 2S children. Many have plans to erect new buildings when enrolments and funds are sufficient. These Centres are staffed by teachers with no formal training in pre-school work, but who receive some instruction during regular visits from the Pre-School Officer. Free milk is provided by the Administration for both .. A" and .. S " type Centres . .. T" type Centres provide a pre-school programme for children learning English as a second language. No fees are charged. The Centres are all under the close supervision of trained teachers, assisted by indigenou.s pre-school assistants in training. The Centres are housed in buildings adapted for pre-school conditions, e.g., a Council House, a Women's Club, the ground floor of a school, verandah of a hospital and low cost homes.

P

Several Centres have had buildings constructed of native materials with a cement floor. This work has been done voluntarily by the parents of the pre-school children. Some .. T" type Centre Committees rent the .. A" type Centre building and use it in the afternoons. The Department of Public Health supplies all basic expendable equipment and pays the staff. The Committee of Management of parents assists in the general management of each Centre. Fund raising efforts are conducted by the parents and the money raised is utilized for the purchase of more equipment for the Centres. A .. Mail Box Scheme" operates for pre-school children of families on out-stations who are not able to attend a Pre-School Centre. Suitable story and parent guidance books, together with information about preschool activities that can be conducted in the home, are sent out to over 90 families. A library of 3,000 books is maintained in Port Moresby for this purpose. A Pre-School Bulletin is published quarterly by the Pre-School Office, and 700 copies are distributed to outstation families, parents of pre-school children and other interested persons in the Territory . A Territory Scholarship Scheme for the training of Territory born girls of all races as Pre-School Teachers is available and ten students are in training at Sydney and Brisbane Kindergarten Training Colleges. Five girls are expected to graduate this year. Seven teachers, trained under this scheme, are currently engaged in teaching in the Territory. A three-year course of training for Pre-School Assistants is offered to indigenous girls, 16 years and over, with the minimum education level of Standard 6. In 1963, all students accepted had passed their seventh standard examinations. Training Centres are in Rabaul and Port Moresby and a Training Officer is in charge of training in both areas.

Division of Medical Training Dr. E. Assistant Director: Wright, M.B., B.S., D.T.M.&H., D.P.H.

J.

Division of Medical Training in 1962-63 T HEfull-time courses in the following fields : Assistant Medical Officers,

held

Nurses, Medical Assistants, and Aid Post Orderlies. In-service training courses were also given to Laboratory Technicians, X-ray Technicians, and Aid Post Orderlies. Apart from the Division of Medical Training, certain service units of the Department train specialized workers for their specific fields of activity, and include Maternal and Infant Welfare Assistants and Orderlies, Dental Assistants and Malaria Control Assistants. Ten Territory students are continuing courses at the Central Medical School, Suva. These include three students undergoing training as Assistant Medical Officers, four as assistant Dental Officers and three as Laboratory Technicians. In 1963 four years of the five year Assistant Medical Officer course were being conducted at the Papuan Medical College. There were5 students in Fourth Year Medicine. 10 students in Third Year Medicine. 13 students in Second Year Medicine. 10 students in First Year Medicine. These students receive a wide general education in addition to their professional studies and results in external examinations are good. More than 49 individual subjects were passed in the Queensland Junior Public Examination, and five students passed the Queensland Senior Public Examination (Matriculation) in Physiology. Nursing Training continued with 38 students graduating from the basic three year course. Schools of Nursing are established at Port Moresby and Rabaul where 215 students, both men and women, are receiving training. The second post basic course in Obstetrics commenced at Rabaul during the year with nine students attending. A three-year course of study for Medical Assistants was introduced during the year. The course is a full time course for students at Standard IX level. Thirteen students are taking the course.

The Medical Assistant Course for young men who have successfully completed the three year basic General Certificate course is a one year course of special training for the Medical Assistant Certificate. Eight students graduated from this course during the year. Medical Assistants are important health workers with a wide var!ety of duties connected with hospitals, rural health serVIces, and other disease control organizations. They may work on their own or as a part of the staff of an establishment. Aid Post Orderlies are trained to take charge of Aid Posts or first treatment centres of which there are 1,461 spread throughout the Territory. Aid 1:>ost Orderlies perform an important first line function in the treatment of disease and are playing an increasing part in disease control and prevention, and in Health Education. There are 301 students in training at five Aid Post Training Schools situated at Saiho, Lae, Wewak, Mount Hagen, and Goroka. Eighty-seven Aid Post Orderlies successfully completed training during the year. A principle of selection is that candidates for Aid Post work must be acceptable to the people. Most Aid Post Orderlies have some years of schooling before commencing the two year training programme. From some primitive areas students are accepted who have little or no formal education. They are taught to read and write before entering the Aid Post training course proper. The system of Medical Education has been developed so that any person in the Department can progress and is limited only by ability and ambition. An Aid Post or Hospital Orderly, for example, who has passed Standard VII or an equivalent special examination, could be admitted to the course of training for the General Certificate or Territorial Nurse. Several Hospital Orderlies have, in fact, already been trained in advanced courses, and have received certificates as Medical Assistants. The Division undertakes the publication of the Papua and New Guinea Medical Journal, which in addition to its wide Territory circulation, has an overseas mailing list of 1,400 copies.

Division of Medical Research Assistant Director :

Dr. F. D. Schofield, M.D., M.A., M.R.C.S., M.R.C.P., D.T.M.&H.

EDICAL Research in the Territory has been greatly assisted by the formation in October, 1962, of M the Papua and New Guinea Medical Research Advisory Committee, under the Chairmanship of Sir MacFarlane Burnet, O.M., F.R.S. As a result, the collaboration of research workers in Australia has been obtained for a number of projects, and long-term grants have been made available to a neurologist and two anthropologists for the study of kuru. Kuru: Anthropological investigators have discovered that the disease has had a comparatively recent origin and spread among the Fore people of the Eastern Highlands. This has concentrated efforts upon the search for any change in the local environment that could be producing the phenotypic expression of the kuru gene. Tinea imbricata: In studies at Maprik in the Sepik District, first infection with tinea imbricata (grile, sipoma) has. been found to be closely associated with malnutrition. This disease, which is very common in some lowland areas of the Territory, has been shown to give rise to a severe social and economic disability for those who suffer from it. Further epidemiological studies, designed to elucidate the most effective methods of control and treatment, are in progress, with mycological assistance from the Sydney School of Public Health and Tropical Medicine. Malaria: A controlled study of the effect of three years antimalarial measures, on Sepik people in a holoendemic malarious environment, has shown that the health of childre~" has been greatly improved. There has also been a significant improvement in the health of women of childbearing age, but no discernible improvement in the health of adult men, on whose efforts the economic development of the District must chiefly depend. This study has also revealed that there exists a severe degree of irreversible damage to the livers and spleens of many adults, which appears attributable to the effects of chronic malnutrition. Neonatal tetanus: With the collaboration of the National Institutes of Health, Washington, the maternal aptibody titre which will protect new-born infants against neonatal tetanus has been determined. With this titre as a standard, the effects of various immunizing tetanus toxoids, including two adjuvant preparations, are being compared. Further studies at Maprik designed to discover the simplest method of effectively immunizing mothers in the rural tropics, have been arranged with the collaboration of the Kanematsu Memorial Institute, Sydney. Childhood anaemia: Studies on the causes and prevention of anaemia in childhood at Aguganak in the Sepik District are nearing completion. In W osera, Sepik District, dietetic and nutritional investigations combined with agricultural and anthropological studies by workers

from Canberra and London, have obtained information upon which administrative action to alleviate the plight of this very malnourished population can be based. Enteritis necfoticans: This very severe disease, which was discovered and described by two medical officers at Goroka, is quite common in the Highlands and appears to be almost unique to this Territory at the present hme. Preliminary epidemiological investigations suggest it may be comparatively easily prevented. These investigations, and clinical and bacteriological studies, are being continued by the two medical officers, with the help of the bacteriologist of the Department of Agriculture, Stock and Fisheries, and the Wellcome Institute, London. Childhood lymphoma: This particular form of cancer, has been found only among people indigenous to this Territory and a part of tropical Africa. Workers in Africa have found circumstantial evidence that it may be caused by a virus transmitted by a mosquito. Doctors in this Territory are studying the epidemiological, clinical and pathological aspects of this disease, with the advice and assistance of experts from Australian centres. Leprosy: Theoretical considerations suggest that the prevalence or clinical severity of leprosy in a Community might be decreased by mass vaccination with B.C.G., but this has not been proved by a controlled field study. Such a study was started, in the last year, at Karamui, by the Leprosy, Tuberculosis and Research Services of P.H.D. and the Epidemiologist of the Sydney School of Public Health and Tropical Medicine. This collaborative project is designed to last at least five years. Besides providing information on the possible efficacy of B.C.~., it may throw light on the genetics of leprosy and on Its method of spread. The Department of Native Affairs and local missionaries are giving invaluable support to the project. Arbovirus studies: Work continues in association with the Australian National University and the University of Maryland, U.S.A. Nutrition: The Nutrition Research Unit of P.H.D. at Kundiawa is now closed, but further physiological studies are planned by visiting workers. The field work on the extension of finely ground roasted peanuts, as a subsistence weaning food for young children, is making progress in Highland village council areas, under the direction of the Regional Medical Officer. Staff: The positions for Assistant Director, Specialist in Child Health and Administrative Officer in the Division are the only ones staffed. Those for Nutrition, Pathology, general duty medical officer and laboratory technicians are vacant. It is anticipated that in December, 1963, a neurologist from Wellington, New Zealand, will take up the Kuru position, on a grant for a project lasting two years. Photo shows Central Laboratory Port Moresby which operates independently of the Medical Re=ch Division.

Division of Menfaf Health Assistant Director : Dr. B. G. Burton-Bradley, M.B., B.S., D.P.M.

of Mental Health is still in its formative T HE Division stages and activity during the past year was directed to developing and extending psychiatric knowledge into the general medical services of the Territory and to the reduction of the incidence of mental ill-health. Theoretical and clinical psychiatric training for Assistant Medical Officers was continued. These officers received psychiatric training in conjunction with their residential experience at the Port Moresby General Hospital. In the course of this training they make regular visits to the Bomana Mental Hospital and also visit the Territory's main Corrective Institution for instruction in the psychiatric aspects of prison detainees. A psychiatric nursing course, commenced last year at the Bomana Mental Hospital for indigenous hospital staff, was continued. The course consists of three stages of increasing grades of complexity, each stage consisting of 100 lectures. The number undertaking the course increased to ] 5. Decentralization of 'Mental Health Services in various parts of the Territory continued. There are psychiatric annexes attached to Port Moresby, Rabaul, Madang and Wewak General Hospitals, and a similar annexe is under construction at the new Lae General Hospital. These annexes are air-conditioned and are structurally designed along modern lines. They can handle all classes of psychiatric patients. Electro-convulsive units are now available at Rabaul, Lae, Wewak, Madang, Samarai, Port Moresby, and at the Bomana Mental Hospital itself. Some 12 medical practitioners in the Territory now administer this form of treatment, and because of this referrals to Bomana are gradually decreasing. During the year the Assistant Director of the Division visited various District centres and in addition to examining and advising on psychiatric patients seen discussed local psychiatric problems with medical officers. The central hospital for psychiatric work in the Territory at Bomana continued to operate but its structural and other inadequacies became more apparent. A complete new hospital to be erected at Laloki is on the

design board and has reached the working drawing stage. The new hospital will ultimately cater for 300 patients and will incorporate the best features of modern mental hospital practice, The first stage of the new hospital is in full operation and consists of quarters for convalescent patients undergoing rehabilitation and engaging in gardening pursuits. There were 51 admissions to Bomana Mental Hospital during the year. Thirty of these were Papuans and 21 New Guineans. Thirty-nine males and 12 females were admitted. There were 30 discharges including 21 Papuans and 9 New Guineans. All patients receive psychotherapy, and ataractic (tranquillising) therapy was provided for the majority of patients. Approximately one-third of the patients received electro-convulsive treatment. The daily average of patients was 38 (32 males and 6 females). Valuable staff additions during the year included an occupational therapist and a psychiatric social worker. Failure to recruit an additional psychiatrist will delay proposed extension of studies into the impact of urbanization on the mental health of members of primitive rural societies. The assistance of outside agencies in pursuing this work is now under consideration. The Mental Disorders and Treatment Ordinance 1960, and the Mental Disorders and Treatment Regulatiom 1952, came into force during the year. The permanent committee on Mental Health an? Cultural Development met twice during the year. ThIS Committee concerns itself with matters of prevention and direct attention to practical measures which may reduce the incidence of mental ill-health in the Territory. Items considered during the year included vendetta killings, an analysis of offences committed by Administration Servants, psychological examination of Public Service applicants, desirability of establishing clubs with multi-racial membership, the effects of loneliness in outstation life, and the need for health propaganda preceding various mass health campaigns.

Port Moresby General Hospital Superintendent:

-

.

Dr. L. T. Champness, M.B., B.S., D.C.H., D.T.M.&H.

HE Port M9resby General Hospital is the major base hospital and senior medical training hospital for T the Territory, and is regarded as a Headquarters unit of the Department with the Medical Superintendent directly responsible to the Director of Public Health. The hospital complex includes the separate Territory Central Laboratafy and other important sections providing services on other than a local basis. The Territory-wide Tumour Registry is maintained at the hospital, and hospital buildings also provide temporary Headquarters accommodation for the Divisions of Medical Training, Medical Research, Mental Health and the Tuberculosis Section. The professional medical staff of the hospital includes specialists in Medicine, Surgery, Ophthalmology, Paediatrics, Anaesthesia, Gynaecology and Obstetrics, Pathology, Radiology and Radiotherapy. Ancillary services are provided by the Physiotherapy, Dental and Pharmacy Departments attached to the hospital. At times during the year staffing shortages were experienced, particularly among nurses, but at the year's end the position had stabilized. Of the 48 nurses currently employed, seven have a Territorial Nurses qualification from the hospital's School of Nursing. The nurse patient ratio works out at one nurse to six patients which is equivalent to standards maintained in any hospital of this size. All sections of the hospital showed increased activity, and in a number of fields pressure on space and facilities suggested the need for added accommodation. The increase in inpatient admissions and outpatient admission could be attributed to growth of the town but also largely to the increasing confidence which the population is showing in the benefits obtainable from the hospital. Patients admitted during the year numbered 7,816, 1,089 more than in the previous year, 803 of these admissions were referred from outside Port Moresby. The daily average of inpatients was 308 compared with 298 in 1961-62. 146 deaths occurred in hospital, or just on two per cent. of admissions. 22 patients were transferred to Australia for specialized attention not available in the Territory. 1,810 surgical operations were undertaken, an increase of 419 over the previous year. The total number of outpatients treated was 95,522.

addition, the hospital trains Hospital Orderlies and Ambulance Drivers. In-service training for clerical' staff is also provided. The Pathology Department serving the hospital is part of the Territory Central Laboratory and provides services in Biochemistry, Bacteriology, Haematology, and Histopathology. A total of 40,764 pathology tests were done in this Department during the year. This represented an increase of 10,134 tests above the previous year. An interesting and comprehensive anatomical museum is being built up within the Pathology Department at teaching media for students enrolled in the Medical College. A consultant service in Pathology is maintained with members of the Perth (W.A.) University, the School of Tropical Medicine and Hygiene, Sydney, and the University of New South Wales. Figures for the X-ray Department show a further reduction in work processed and number of patients dealt with, but as mentioned in the previous report, the reduction indicates a continued increase in the work being taken over by the Anti-T.B. Unit. The Department made 12,702 examinations, using 21,000 films whilst the Anti-T.B. Unit, also situated in the hospital grounds, X-rayed some 10,000 people. The Radiotherapy Department gave 3,041 treatments to 239 patients. The Red Cross Blood Transfusion Centre associated with the hospital is now fully operative. A total o f . . . 2,757 pints of blood were provided to the hospital during the year by the Centre, which campaigned strongly for donors during the visit of Thoracic Surgery Units from Australia and in other emergencies, and was always able to supply all blood requested. The Physiotherapy department provided 6,208 treatments compared with 4,765 for 19G1-62. The hospital Pharmacy supplied just on 30,000 items to wards. Some difficulties were experienced with air-conditioning electrical equipment and steam generating plant during the year and on occasions break-downs caused major

The hospital co-operates with the Papuan Medical and Nursing Colleges in programmes of medical and

inconvenience. The hospital engineering services however responded well to all difficulties, particularly where tem-

nursing training. At the present time 38 Assistant Medical Officer students are receiving training at the hospital. A three-year training course is also c~nducted .at the hospital for students in Pathology and RadlOlo~ with ~6 students attending, 12 in Pathology and four m Radiology. In

porary measures to assist patients relying on power operated supportive therapy were needed. Paying patients paid £24,590 services provided. 1fi

statutory fees for

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1HE Highlands Region comprises the Eastern and 1 Western Highlands District of New Guinea and the Southern Highlands District of Papua. These three districts form a continuous region in the centre of New Guinea covering an area of 23,600 square miles with a population of approximately 780,000. The major part of the Region is above 5,000 feet and the people of the area, unlike those of the Coastal regions, live in isolated groups of two or three houses which are erected near the family gardens and situated mainly in the valleys or on the mountain slopes. Medical services in the Region are conducted both by the Administration and Christian Missions. The Administration conducts 24 hospitals and one Hansenide Colony (which, though fully supported financially by the Administration, is staffed by Mission personnel), There are 388 Administration Aid Posts. Regional staff consists of 16 Medical Officers, two Dental Officers, 72 other classified staff and 995 other Administration servants, most of whom are Hospital and Aid Post Orderlies. The Missions conduct 11 hospitals and two Hansenide colonies on their own account. Mission staff comprises four Medical Officers and 47 other classified staff. Missions also conduct a total of 67 Aid Posts and Clinics. Medical ancillary services provided by the Administration are Tuberculosis and Leprosy control teams, School Dental Services, Malaria School at Kundiawa and Infant Welfare Training Schools at Minj and Kainantu. Also at Goroka, in association with the Red Cross, there is a Blood Transfusion Service. The work of the Leprosy Control Unit commenced early in 1963 and the task of this unit is to record all cases of Leprosy in the Highlands and to supervise and control treatment of both inpatients and outpatients. The work of the Tuberculosis Control Team continues and the survey team has tested 73,287 resulting in the B.C.G. vaccination of 54,746 additional people. Also travellers moving from the Highlands are tested and given protective B.CG. and those returning from the coast are screened and treatment arranged where necessary. Active cases found are hospitalized for treatment and all contacts examined. Mass X-ray examination of 8,132 people was carried out at Goroka, Kainantu, Kundiawa and Erave and forty cases of active tuberculosis were found; 29 of these were Highland people and eleven were coastal people working in the Highlands. The Malaria School was transferred from its temporary premises at Minj to a fine new modern school at

The premises vacated by the Malaria School at Minj have been taken over as an Infant Welfare Training School. This school was previously situated at Kerowagi. Two Tutor Sisters are in charge. Recently the school graduated its first five triple certificated Nurses in Infant Welfare. An additional small school is functioning at Kainantu in the Eastern Highlands under the supervision of Salvation Army Nursing Sisters. Four trainees are at present being trained in obstetrics and infant welfare field work. This school is also giving field experience to recently graduated LCM.H. Assistants. The Sighere Rural Health Centre is now well established and is staffa! by a Medical Assistant, three trained LCM.H. Assistants and an Assistant Health Inspector. To aid them in their field work the Bena Local Government Council recently purchased a Land Royer. Councils at Minj and Kerowagi have also purchased Land Rovers to aid Infant Welfare and other health activities in their council areas. To encourage peanuts as a milk substitute for feeding children aged from six months to two years an anthropologist and one other field worker have' resided at Waiye in the Chimbu Subdistrict for the last 18 months. These workers have, by demonstration and instruction, combined with full awareness of the attitudes of the people, prepared the way for willing acceptance of suitably prepared peanuts as a food for young children. Considerable patience has been necessary to have the people accept peanuts as a food rather than as a cash crop only. During the year at all establishments a total of approximately 440,000 Highlanders received treatment. This total represents treatments given at the 24 Administration Hospitals, the eleven Mission Hospitals, the three Hansenide colonies, 388 Administration Aid Posts and the 67 Mission Aid Posts and Clinics. Inpatients admitted to Administration Hospitals totalled 40,012 and outpatients 92,744. Mission and Administration Hansenide colonies treated 1,426 inpatients and 6,324 outpatients and 200,200 outpatients were treated at Administration Aid Posts. Triple Antigen vaccinations given to children three years and under totalled 37,753. At the Mission Hospitals 9,587 inpatients were treated and 75,600 outpatients received treatment at Hospitals, Outpatients' Departments and Clinics. A modern hospital at Sopas in the Western Highlands was opened by the Seventh Day Adventist Mission, and a Hospital for voluntary Kuru patients and particular!y orphans of Kuru , ....._.... ,..,~ ,.,r~

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Regional Medical Officer: Dr. C. Haszler, M.D., D.T.M.&H.

HIS Region embraces the four Island District, of T New Britain, New Ireland, Bougainville and Manus. Within the Region there is a population of 250,000 and about half of these live in the New Britain District, where there is a heavy concentration in the Gazelle Peninsula. Fifteen Medical Officers and five Assistant Medical Officers and 149 other classified staff are employed in the Region. There are 694 indigenous medical, 177 nonmedical and 147 labourers. In the 19 Administration hospitals 14,692 inpatients and 50,983 outpatients were treated during the year. 1,839 operations were performed. There are five major Mission hospitals in the Region and one new Mission Hospital with 40 beds was opened up at Lavongai on the south coast of New Hanover. The Missions also look after two Hansenide colonies-one at Torokina (Bougainville) and one at Anelaua (New Ireland)-and a Tuberculosis Hospital at Bitapaka near Rabaul (New Britain). There are now 294 Administration Aid Posts in the Region. The number of Health Centres in the Region has increased. In addition to the Health Centres in the Gazelle Peninsula, a Health Centre was opened at Baluan (Manus District) and the P.H.D. station at Namatanai was transformed into an Administration Rural Health Centre. At present nearly 40,000 people are looked after by Health Centres in the Region. All Health Centres operate in close association with the Local Government Councils. In co-operation with the Councils, during the past year 222 environmental sanitation projects were completed, including 208 simple safe water supply schemes in villages. Depending on the stage of the development of the Council, subsidies of either 50 per cent. of total cost or 100 per cent. of material costs were paid by the Administration on these projects. The Blood Transfusion Service collected 3,200 pints of blood with the aid of evening visits to villages. This service greatly assisted the work of the visiting thoracic surgery team in November, 1962.

The Rabaul School of Nursing attached to Nonga Base Hospital has 108 students and during the year postgraduate courses were started for nine obstetrical traineesthese have already gudu8ted and a further 18 are now in training. Seven Hmpital Assistants and five Nursing Assistants graduated from the school during the year. During May and April, 1963, seminars were held for the Health Department's senior staff and personnel, on the subjects of Tuberculosis, Leprosy, Health Education and Health Centres. Lecturers were Senior Specialists attending from Port Moresby and regional senior staff. Active Departmental interest was shown in health aspects of resettlement schemes for groups of people moved from highland areas to the lowlands, changing from a subsistence level economy to a cash economy. These settlements are at Silaga, Wasilau and in the North Bainings. A smallpox vaccination .campaign was completed in the Region with a good coverage achieved. A special research project has been instituted at Nissan Island by different sections of the Health Department. The possibilities of malaria eradication and T.B. control are under investigation by expert staff. Mass treatment against filariasis and the infant welfare attention have also been intensified. The outcome of these public health projects are being watched with interest. Tuberculosis surveys have been extended to the south coast of New Britain and Manus District. A survey of Bougainville and a re-survey of a major part of the New Ireland District were completed. 21,690 people were tested, 6,966 B.C.G. vaccinations were given and X-ray examination of 6,420 people was carried out. A Leprosy survey was completed in the Cape Gloucester area and Duke of York Islands and domiciliary treatment established. Malaria spraying activities are well established throughout the whole Region. Drug distribution is under introduction. Intensive training activities are undertaken at the Rabaul Malaria Institute for team leaders and squad leaders. Blood survey readings are done at the Malaria Institute Rabaul for New Britain and New Ireland and at Port Moresby for Bougainville and Manus. '

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Regional Medical Officer:

Dr. J. L. Jameson, M.B., B.S., D.T.M.&H.

HIS Region includes the Morobe, Madang and Sepik T Districts with a population of 580,000 in 53,700 square miles. is divided into three diversified geographic It

regions-the Sepik River swamplands, separated mountain areas and narrow coastal strips. This Region has perhaps the best developed medical services and includes three major hospitals-at Wewak, Madang and Lae. Admissions to the 33 Administration General Hospitals in the Region numbered 32,356. A total of 157,935 outpatients were also treated at these hospitals. Three special hospitals for Hansens Disease and Tuberculosis are operated by Missions at Aitape, Finschhafen and Bogia on behalf of the Administration. In addition, Missions conduct seven of their own hospitals in the Region. Grant-in-aid was approved for 14 new Mission Health Workers, including eight Nurses and six trained Aid Post Orderlies, operating in areas not covered by the Administration's services. There are 473 Administration Aid Posts in the Region, and Aid Post Orderlies constantly patrol villages in the vicinity of their base. 113 routine patrols, accounting for 560 days on patrol and taking in 1,133 villages apart from hamlets, were undertaken by expatriate staff. These routine patrols exclude the continuous, heavily staffed patrols augmented by staff from other regions which were undertaken in the border areas of the Sepik District, following the outbreak of cholera in West New Guinea. Staff in the Region includes 14 Medical Officers and the Assistant Medical Officers, and l21 other professional and technical staff. Staifin:; difficultie<; were encountered in a number of fields during the year, but in many cases higher responsibilities were satisfactorily accepted by experienced Orderlies to fill temporary gaps. In particular, rural hospitals at Nuku, Aiome and Josephstaal were successfully conducted by Senior Orderlies. The construction of the Lae General Hospital, which will be the major base hospital for the Region, was well advanced by the end of the year, and all buildings were standing, if incomplete. The Community Self-Help hospitals at Mumeng and Morobe were completed. The Territory'S Artificial Limb Factory, which was built as part of the major hospital project, was completed and is now in use. This factory compares with any in Australia and provides modern facilities for the provision of all types of limb prostheses for amputees. 47 new limbs and appliances were manufactured and 15 rebuilt during the year. 325 pairs of crutches were made at the factory. Tuberculosis surveys undertaken in the region tested

6,375 X-ray films taken. As a result of these surveys the inpatient level rose in special hospitals and e.g., 307 patients were admitted to the Butaweng Tuberculosis hospital at Finschhafen. The Malaria Eradication Campaign now protects just on 100,000 people in the region, or a sixth of the population. The area involved is approximately 5,500 square miles, 5,000 square miles of this being in the Sepik District. A follow-up investigation on the filariasis control project on the Rai Coast, in the Madang District, showed promising results. A thorough evaluation of this study will be made in the coming year. Poliomyelitis epidemics occurred in the three districts of the region, but all were rapidly brought under control by the use of Sabin and Salk vaccines in the affected areas. Except in a few instances, the course of the disease was mild. The temporary measures taken against cholera by way of vaccination have been mentioned under patrolling activIty. These patrols also undertook a mass smallpox vaccination which included all persons in the border areas. Anti-yaws activities with penicillin were carried out in certain remote pockets where isolated cases of yaws were observed. The region is, however, now virtually free of this disease, which ten years ago was a major cause of morbidity. Infant welfare work was extended, although staffing problems hindered this expansion. Administration difficulties in this context were offset by new, full Mission infant welfare services in two areas, and partial services in six other areas. The Regional J.C.M.H. Supervisor toured widely in the region and gave assistance in establishing clinic work at many established medical posts. A new medical store to service the Sepik District was set up at the Wewak General Hospital, and has shown its worth in improved supply distribution to outstations. The presence of a private dentist in Lae enabled the Administration Dental Service in the Morobe District to concentrate its efforts entirely on the indigenous population and school work in each subdistrict. Dental services based at Madang and Wewak were also continued. The Aid Post Training Schools at Lae and Wewak had just over 100 students in training and 35 students received graduation certificates. During the year projects to provide safe drinking water in the villages were completed in 26 villages of the region under the Administration's Health Assistance to Councils Scheme. This scheme, which is still in its

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Regional Medical Officer:

Dr. W. D. Symes, M.B., B.S., D.T.M.&H., D.P.H.

HE Papua Region includes the whole of Papua with _ the exception of the Southern Highlands District T and the Port Moresby General Hospital. There are 367,175 people living in an area of approximately 83,315 square miles-the lowest population density of the four health regions in Papua and New Guinea. Health workers in the Papua Region have taken "medicine to the people" with a planned programme of comprehensive medical care at village level. During the past year there has been a marked increase in ~he number of children covered by a school health serVICe, improved supervision and assistance to Aid Posts, a greater interest in health education and numerous projects to improve village environmental sanitation either through local government councils or self-help schemes. Health activities at village level have attacked ill health and disease on the broad front of curative, preventive and promotive medicine. In practically every area activities have been limited by a shortage of trained staff, vast distances, small village size, poor communications and the low population density. Subsidies amounting to £9,200 were paid to local government councils in the Papua Region for approved village environmental sanitation projects and buildings used for health purposes. At least 90 per cent. of this money was spent on providing safer and wholesome water for 12,000 people living in 24 villages. Technical and economic factors often limit ready availability and quantity of water supplies but there was no compromise on the safety of water. Village water systems installed have included tankage, sanitary wells fitted with rugged reliable handpumps, protected springs and projects involving mechanical pumping (windmills and diesel engines). The major difficulty experienced in the programme to improve village water supplies has been the lack of sound technical advice as there is no public health engineer in the Territory. Six permanent Aid Posts were constructed by local government councils taking advantage of the building subsidy. These have prestige value but make no lasting contribution to community health. Money spent on water systems gives the best return in terms of improved individual and community health. Medical Assistant and Hospital Assistant graduates from the Papuan Medical College have been posted to four subdistricts where they are in charge of the hospital and health services in the area. These health workers have made an important contribution to the medical care

programme at village level. They have experienced difficulty with the administrative rather than the medical and public health aspects of their work. Difficulties experienced in establishing the Mashall Lagoon Rural Health Centre were solved during the year. The health team, under the leadership of an Assistant Medical Practitioner, includes two Infant, Maternal and Child Health Assistants, a Hospital Assistant and Aid Post Orderlies. Water transport, essential to effective field work, was purchased for the Centre by the Local Government Council on an Administration guaranteed bankloan. Regular village clinics (infant welfare, antenatal, postnatal, general outpatients) are conducted by the health team for the 6,000 people living around the lagoon. There is an active school health service, immunization programmes and health education activities. As communications improve these services will be provided for an additional 3-4,000 people. During the year 20,668 inpatients were admitted to the 26 Administration hospitals in the Papua Region and 62,283 outpatients were treated. This slight increase on the previous year reflects the value of a comprehensive Aid Post system; 375,051 patients were treated at the 306 Aid Posts thus relieving the hospitals of a heavy work burden. This has enabled hospital staff to vigorously pursue their medical programme at village level. The Tuberculosis Control team tested 36,652 resulting in the B.C.G. vaccination of 9,153 people. X-rayexamination of 17,175 people was carried out. Mission health services treated 10,012 inpatients and 347,891 outpatients at hospitals and "aid post" type medical establishments. Mission health workers have been active in the field of Infant, Maternal and Child Health. There are five heavily subsidized Mission Tuberculosis and/or Hansenide institutions in the Papua Region. There are nine Medical Officers and 52 classified staff employed in the Papua Region. Papuan personnel number 638 and include medical, non-medical and labouring staff. Qualified indigenous staff is increasing year by year with improved output from the Papuan Medical College. However there is an acute shortage of doctors, medical assistants, nurses, public health inspectors and other trained staff in the Region. The medical care programme at village level will be intensified during the coming year. Village health clinics, i.e., general clinics concentrating on infants, children and pregnant women, will be increased during the coming year. Every health worker will be expected to conduct these clinics within a day's journey of his station.

APPENDIX I. POST-GRADUATE TRAINING AND OVERSEAS STUDY. Diploma of Public Health, London University, completed 1962: Dr. W. D. Symes (W.H.O. Fellowship). Diploma of Public Health, Sydney University, completed 1962: Dr. R. E. Mylius. Diploma of Tropical Medicine and Hygiene, Sydney University, completed 1962: Drs. A. Siko, T. G. C. Murrell, J. Y. Hancock, C. Matthews, C. Heaysman and V. Zigas. Diploma of Tropical Medicine and Hygiene, Sydney University, commenced 1963: Drs. S, Jackus, D. Bockman, R. J. Biddulph and B. G. Burton-Bradley. Diploma of Tropical Medicine and Hygiene, London University, commenced 1963: Dr. R. G. Hingston. Certificate of Hospital Administration, University of New South Wales, completed 1963: Messrs. N. Malone, H. N. Cox, J. Irvine. Certificate of Hosp;~al Administration, University of New South Wales, commenced 1963: Messrs. R. A. Keys, G. N. Blythe, T. A. Milan. Diploma of Nursing Adminislfatiofl, New South Wales College of Nursing, completed 1962: Misses E. A. McAllister, E. Huxley. Diploma of Nurse Tutor, New South Wales College of Nursing, completed 1962: Miss L. Moorhouse, Mr. P. A. C. Kelly. Diploma of Nurse Tutor, Australian College of Nurses, Brisbane, completed 1962: Miss E. M. Taylor. Diploma of Nurse Tutor, New South Wales College of Nursing, commenced 1963: Messrs. D. H. Rowe and J. Woodford. Diploma of Nursing Administration, New South Wales College of Nursing, commenced 1963: Miss V. Quirk. Refresher Training in Medical Technology: Mr. E. Shelton, undertook one month's refresher training in Brisbane. UniversitJ Free Place: Mr. R. W. Carlaw was awarded a Free Place in 1962 to complete the Degree of Bachelor of Arts of the Queensland University. Refresher Training Chemical Allalysis: Mr. R. W. Beck undertook three months training in government analyst work prior to appointment. Diploma of Industrial Health: Dr. T. K. Abbott commenced study for the Diploma in the United Kingdom. Refresher Training in OPhthalmology: Dr. J. Loschdorfer undertook one month'~ refresher training in the U.S.A. Membership of the Royal College of Physicians: Dr. R. Maclennan successfully completed the requirements for membership of the College. Anatomy Studies, Sydney University: Dr. 1. S. Reid completed his study of the teaching of Anatomy. Settior OjJicen Course, A.S.O.F.A.: Dr. R. Barnes and Mr L. M. Tomlinson attended the 1963 Course. Diagnosis and Treatment of Smallpox: Dr. P. Enders visited Madras for training in treatment of Smallpox. Cholera Study: Dr. C. Hoogland undertook training in the treatment of Cholera in West Irian. Refresher Training in Maxilla-Facial Mechanics: Mr. B. Callins undertook one month's refresher training in the United Kingdom. Diploma of Clinical Pathology, Sydney: his studies. Dr. J. Kariks continued Dr.

Certificate of Public Health, Fiji School of Medicine, 1962: R. Taureka completed his studies.

W.H.O. Fellowship in Clinical Medicine: Dr. J. Duke undertook advanced training in Tropical Medicine, Calcutta, India. W.H.O. Fellowship in Paediatrics: Dr. 1. Maddocks undertook training at Makerere College, Uganda. W.H.O. Fellowship in Health Education: Mr. K. F. Riggall undertook the Diploma of Health Education, London University. W.H.O. Travelling Seminar on Medical Education: Dr. L. A. Malcolm participated in a Seminar conducted in Russia. WH.O. Fellowship on Illfant, Child and Maternal Welfat"e: Miss V. Bignold completed a tour of Hong Kong, Singapore, Malaya and the Philippines. JIV.H.O. Fellowship ill Public Health Nursing: Miss J. Porter commenced studies at the University of Hawaii. W.H.O. Seminar on Encephalttis: the Seminar held in Tokyo. Dr. F. D. Schofield attended Dr. F. D.

JIV.H.O. Semin,zr 011 Publication of Field Trials: Schofield attended the Seminar held in Geneva.

Membe"ship of the Royal Ausl1alian College of Physiciatls: Dr. L. T. Champness undertook study in preparation for the College examinations. W.H.O. Seminar 011 Rural Health Services: the Seminar in Taiwan. Dr. F. Tuza attended

Fellowship of the Royal College of Surgeons: Mr. W. Cadzow completed the requirements of the College for admission as a Fellow.

CONFERENCE ATTENDANCES AND OVERSEAS TOURS OF DUTY_ U.N. Trusteeship Council Meeting, 1962: Dr. H. Mulas. Australian Cancer Congress, 1963: Dr. L. T. Champness. Dr. J. J. Saave. Dr. J. J. Saave.

National Health and Medical Research Council Meeting, Australia: Dr. R. F. R. Scragg. Territory Medical Research Advisory Committee Meetings, Australia: Dr. R. F. R. Scragg and Dr. F. D. Schofield. Inspection of Students, Fiji School of Medicine: Scragg. Dr. R. F. R.

W.H.O. 13th Regional Meeting, Manila: Fourth Asian Malaria Conference, Manila: Recruitment Interviews, Australia: L. Jameson.

r

Dr. H. N. White and Dr. Mr. V.

Pharmaceutical Services Liaison, Sydney:

r Holna. Mr. Dr.

South Pacific Rural Health Conference, Tahiti: Dr. R. F. R. Scragg and Dr. K. Sugoho. Medical Census Consultation, Sydney: Dr. A. P. Vines. Research Consultations, Sydney, Canberra and Brisbane: Dr. F. D. Schofield. Lectures in Tropical Medicine, Brisbane UniversIty: Dr. F. D. Schofield. Tuberculosis Survey, Nauru: Dr. S. C. Wigley. 1963 Meeting of the Post Graduate Federation of Medicine: L. T. Champness. Dr.

Australian Physiotherapy Congress: Miss P. Davies. Australian Pre-School Association Meeting: Miss E. D. Ryan.

Annual Meeting Royal Australasian College of Surgeons: F. G. Smyth. Annual Meeting of Royal Australian College of Physicians: I. Maddocks. Aviation Medicine Meeting: Dr. R. A. Cooke. Medical Students Association Convention, Adelaide: Phillip Kame and Jeffrey Tuvi.

Messrs.

APPENDIX II. ARTICLES PUBLISHED BY THE OFFICERS OF THE DEPARTMENT OF PUBLIC 1st JULY, 1962·30th JUNE, 1963. ABBOTT, T. (1962). .. Ichthyosarcotoxism." Papua and New Guinea med. ,., 6:26. BAILEY, K. V. (1962) ... Peanut feeding for infants and toddlers." Papua and New Guinea med. J., 6:30. BAILEY, K. V. (1963) ... Team studies infant nutrition in New Guinea Highlands." South Pacific BuiJ., 13:38. BARNES, R. (1962). .. Labour obstruction by a septate vagina." Papua and New Guinea med. ,., 6:25. BIDDULPH, J. (1962). .. Brief survey of childhood. mortality and morbidity in a New Guinea mainland hospital." ,. trap. Pediat., 8:57. BIDDULPH, J. (1962) ... Furazolidone in the treatment of Gastroenteritis in children." Papua and New Guinea med. J., 6:9. BURTON-BRADLEY, B. G. (1963) ... Culture and mental disorder." Med. ,. AusI., 1:539. CAMPBELL, C. H. (1962) ... A case of Leptospirosis occurring in Papua." Papua and New Guinea med.,., 6:5. FARAGO C. (1963) ... Review of 110 cases of Cancer of oral cav'ity in Papua and New Guinea." Brit. med. J., 1:1264-1266. FARAGO, C. (1963). •• Report of 1,160 registered tumour cases in Papua and New Guinea." Cancer, 16:670-680. GAL, K. (1962). .. Tropical Eosinophilia in a Papuan child." Papua and New Guinea med J., 6:23. KARIKS J. (1962). .. Some observations on serum protein in K;"ashiorkor and its changes during treatment." Med J. Ausl., 2:411. MURRELL, T. c., ROTH, L. (1963). .. Necrotizing Jejunitis,a newly discovered disease in the Highlands of New Guinea." Med.,. AUSI., 1:61. PETERS, W. and CHRISTIAN, S. H. (1963). .. The bionomics, ecology and distribution of some mosquitoes (Diptera, Culicidae) in the Territory of Papua and New Guinea." Acta. Tropica., 20:35. RODRIGUE, R. (1962). .. Intestinal obstruction caused by Ascaris Lumbricoides." Papua and New Guinea med. ,., 6:22. RUDGE, J. (1962). .. Rural Health Centres." Papua and New Guinea med. ,., 6:33. RYAN, B. P. (1962). .. Symphysiotomy for contracted pelvis." Papua and New Guinea med.,., 6:13. SAAVE, J. J. (1962) ... Cancers of extremities in New Guineans." Papua and New Guinea med. J., 6:17. HEALTH DURING THE PERIOD

SCHOFIELD, F. D. and PARKINSON, A. D. (1963) ... Social Medicine in New Guinea. Beliefs and practices affecting health among the Abelam and Warn peoples of the Sepik District." Part 1. Med J. Aust., 1: 1. SCHOFIELD, F. D. and PARKINSON, A. D. (1963) ... Social medicine in New Guinea. Beliefs and practices affecting health among the Abelam and Warn peoples of the Sepik District." Part II. Med J. Aust., 1:29. SCHOFIELD, F. D., PARKINSON, A.D. and JEFFERY, D. (1963). .. Tinea imbricata. Its causes and eff.ects." Trans. roy. Soc. trap. Med. Hyg. 57: SPENCER, T. E. T. (1962) ... Suction device for catching mosquitoes." Papua and New Guinea med.,., 6:32. SPENCER, T. E. T. (1962) ... The malaria pattern in the Territory of Papua and New Guinea." Med ,. Ausl. 2:873. In Press and/or Unpublished BARNES, R., McKAY, J. .. Report of a case of flagellate causing a urinary infection." GLASSE, R. M ... The spread of Kuru among the Fore: a preliminary report." June, 1962. GLASSE, R. M. .. South Fore society: A preliminary report." June, 1962. GLASSE, S. H. .. Social effects of Kuru: A preliminary report." June, 1962. RUSSELL, D. A. .. Case-finding, follow-up and management of Leprosy cases with particular reference to the integration of these activities into those of the established health services." W.H.O. Technical Series. RUSSELL, D. A. and SCOTT, G. .. A preliminary report of a • blind' controlled experiment to investigate the effect of B.C.G. vaccination on Leprosy in a closed community." To be read at the 8th International Congress of Leprology, Rio de Janeiro. ' SCHOFIELD, F. D ... The effect of malaria control on haemoglobin values in the Sepik District." TORPY, D. and ScHOFIELD, F. D ... The effect of malaria control on Serum Protein patterns." Other Publications PRE-SCHOOL BULLETIN. (Pre-School Officer Publication, Port Moresby) quarterly (roneoed). THE YEARS AHEAD. Health supplement in the South Pacific Post, 7th June, 1963.

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ORIGINAL: VIET-NAM

FRENCH

Report on the Progress of Health Activities During 1962 - 1963 1. GENERAL

During the year under review, health activities were mainly concentrated on existing health programmes, such as:

(1) 2) 3)

4)

5) 6) 8) 9) 10) 12) 1

1)

ll)

malaria eradication rural health maternal and child health tuberculosis control epidemiology and immunization health statistics mental health leprosy control sanitation drug control pharmaceutical supplies training of medical and para-medical personnel

Three programme co-ordination meetings held at the Department of Health have enabled the people concerned to follow the development of health activities and to recommend measures to ensure efficient co-operation, as for example in the integration of programmes, particularly in the rural areas. Indeed, the year 1962-1963 was characterized by a vast expansion of health activities in the rural areas. In order to keep in line with the general political and socio-economic development of the country, which places particular emphasis on the rural areas, the Department of Health has used all means and facilities to develop its health services from the provincial centres down to the hamlets, through the district and the village centres. One particular feature is the creation of the "strategic hamlets" 'Which are administrative units grouping an average of 2000 inhabitants and covering almost the entire rural population. The creation of these "strategic hamlets" has enabled the inhabitants, who represent approximately 8CJ11p of the total population of 14 000 000, to benefit from the progress of science and civilization from the social, economic and health points of view, as well as from the democratic principles of the Constitution. The people are also united in civic and political groups better able to fight communist subversion from the north. The advantages of a rational implementation of public health programmes at this level are considerable. 2. MALARIA ERADICATION PROGRAMME

In the malaria eradication programme, the spraying of DDT, once or twice a year, is more easily carried out in the hamlets where the houses are grouped together instead of being widely scattered as beforej case-finding will also be more efficient.

~

I

- 2 -

3.

TUBERCULOSIS CONTROL PROGRAMME

Four "strategic hamlets" have been selected on the basis of their representative features (lowland, mountain, coast), as tuberculosis pilot areas which will provide a basis for the future expansion of the programme. The first results of the survey yielded interesting figures on the tuberculosis morbidity in the rural areas. In Thanh Ke Estimated population Tuberculin tested Number of tests read

1190 1144 713 - the Mantoux test gave an induration of 10 mm and above positive positive .. 7910 positi ve .. 91.6% positive

o to 6 years 7 to 14 years 15 to 19 years 20 years and above

- 4% ... 48%

T.b1s gives an average positivity of 61.5% (Saigon

59.4%)

X-ray: Out of 193 persons examined, 35 had shadows suspicious of pulmonary tUberculosis, i.e., 4.4% (10.2% in Saigon). Other epidemiological surveys will follow, but it can already be seen that tuberculosis is a major public health problem. which should be treated on a priority basis.

4.

MATERNAL AND CHILD HEALTH PROGRAMME

Between 1 July 1962 and 30 June 1963, the activities of the maternal and child health programme were extended to the provinces, with the object of establishing and re-organizing the paediatric services of the hospitals and maternity. hospitals. The number of prenatal clinics increased from 23 to 44, the post-natal clinics from 13 to 32, the well-baby clinics from 14 to 32,. and the paediatric services in the provincial hospitals from 2 to 8. In order to provide the required qualified personnel for the development of these services, a training centre for midwives was started in Binh-Duong, about 30 kilometres from Saigon. Sixteen midwives were t~ained in two four-month courses for midwifery tutors, eight supervising mid'Wi ves in one .four-month course, a two-month refresher course was organized for eight mid'Wives, and a paediatric course was arranged for fifteen nurses from the Nhi-Dong Children's Hospital in Saigon.

The role of the rural midwives is of the greatest importance in the rural health programme. Not only do they perform deliveries, but they give prenatal and post-natal care to mothers and look after the children until they have reached school-ase •

· . ~

- 3 -

5.

IMMUNIZATION PROGRAMME

The immunization programme has grown rapidly, particularly the triple vaccination campaign against diphtheria, t(ienus and pertussis for children from six months to six years. From January 1962 to June 1963, 1 171 337 vaccinations had been given to the estimated 1 023 790 children in Saigon and the provinces. A poliomyelitis vaccination programme (Babin vaccine) is under study and will be started next year. One of the corollaries of this programme is its health education component, and as a result of the vaccination campaign the population is becoming more and more aware of the importance of preventive medicine.

6. 6.1

OTHER ACTIVITIES

Mental health

1-

Among the other health activities which should be mentioned is the re-organization of the mental health services. A rehabilitation centre.has been established and encouragement given to the patients through the organization of an exhibition where pictures painted by former patients were sold.

6.2

Leprosy

Leprosy control received the full attention of the Department of Health. In a seminar attended by the directors of all the leprosy centres throughout the country, the situation was evaluated and a number of most useful decisions and recommendations were adopted concerning the development of the programme. The seminar reached the follOwing conclusions: (a)

leprosy is a contagious disease, particularly when lepromatous, but curable with adequate sulfone treatment; contagious cases should be isolated in special hospitals and centres; when associated with any other particularly acute disease, leprosy should be considered as a chronic infection and the medical officers should select the place of treatment in an understanding and enlightened way; sulfone treatment gives good results, but reactions to the drug sometimes constitute an obstacle to proper treatment, particularly in the case of a lepra reaction;

(b) (c)

(d)

•

- 4 -

(e) (f) (g)

the role of BCG in the prevention of leprosy deserves further study in Viet-Namj the prevention of leprosy through chemo-prophylaxis in mass campaigns requires more precise.infomation; an important point in the treatment of patients is their professional occupation; interest in this should be encouraged and the necessary facilities organized; social work is essential in all leprosy centres and constitutes a very useful tool for the moral rehabilitation of the patients; legislation adapted to the particular conditions of the country and based on modern concepts is most useful; any solution to the leprosy problem should be viewed from both the medical and humanitarian point of view;

~"

(h)

(i)

(j ) (k)

according to same participants, a special "resettlement" centre for cured patients would be useful and its establishment was recommended to the authorities in charge of the national programme; training periods in leprosy control centres were recommended for medical and para-medical personnel dealing with leprosy.

(1)

It should also be mentioned that an "Association of Friends of Lepers" was created and that rehabilitation centres were opened in Saigon.

7.

CONCLUSIONS

Many other activities were undertaken in the various fields of health during the year, all of them aiming at raising the standards of health of the population. The main guidelines for the activities of the Department of Health were the following: medical extension work, development of preventive services, re-organization of the health services, development and expansion of the health programmes, etc.

•

WESTERN SAMOA Report on the Progress of Health Activities, 1962-63 1. GENERAL

The Independent State of Western Samoa did not experience any major outbreak of infectious diseases or epidemics in the period 1962-63. The estimated population as at 31 December 1962 was 118 463 which showed a further increase of approximately 4000 since the last census on 25 September 1961. The birth rate for 1962 was 42.4 per 1000 of population and the death rate 7.5 per 1000. ~257

The 1963 estimates for the Health Department amounted to 245, which is 11 per cent of the total government expenditure.

Poliomyelitis immunization with trivalent oral Sabin vaccine was started at the beginning of 1963 at a fee of 1/- per dose. This programme has been well received in the town area of Apia but less enthusiastically in the rural areas. The activities of the Women's Committees in the health field has been further strengthened and in the last year, thirty-one new committees were formed with an increase in membership of almost 1000. There are now 15 500 members in Western Samoa, which is 13.5 per cent of the total population over fifteen years. The maternity and child welfare work continues to occupy a prominent portion of the district nurses duties. For the first time a number of members of the Women's Committee attended Apia Hospital for instructions in maternity delivery work. The first few groups have now returned to their villages and there is a marked improvement in maternity delivery. Over 3000 health talks and demonstrations were given to Women I s Committees, mostly by the district nurses. 2. HOSPITAL SERVICES

2.1 The tables attached contain the ove:~l figure~ from( theAnnAP~e'~ 1) Main Hospital and the outstations for cl~n~cal se~ces see • 2.2 Eye Clinic (Apia Main Hospital) Number of daily attendances: 1961 1962 53 66 5790

- 2 -

2.3

Dental Clinic (Apia Main Hospital) The following are the figures for 1962:

Restoration Dressings Extractions X-rays ScaJ.ings Dentures Miscellaneous Operture s Examinations Total Operture s Total Attendance 2.4 Laboratory

3 365 1 035 8208 529 2 921 271 1 648 11 655 29 601 8 937

The laboratory of the Apia Main Hospital is the only one in Western Samoa and it has not only to perform clinical laboratory work but also public health laboratory work, including medicolegal work.

2. 5

Dispensary

The dispensary, like the laboratory, is the only one serving the whole Territory of Western Samoa.

2.6

X-ray The number of examinations carried out were as follows: Chest miniature Chest large film Bones and jOints, etc. Abdomens, including barium. meals, enema, pyelogram, etc. Unidentified Total 2 135 3 730 1 556 322

92

7 835

3.

YAWS

. A yaws control project was carried out in 1955 with the aSSl.stance of WHO and UNICEF. The resurvey in 1958 showed that yaws had been brought under control. However, the Fifth Annual Yaws week in 1962 prodUced some evidence that there is a persistent prevalence of a few cases. statistical Data Estimated population (Total) No. of children rechecked No. of infectious yaws found No. of pseudo-hyperkeratosis No. of yaws hyperkeratosis other skin disease s 114 000 60 622 2

2 300

4

000

. 4. TUBERCULOSIS

- 3 In view of the persistence of occasional cases of yaws the study of this question by the WHO Treponematoses Advisory T~am. may be of value.

A tuberculosis control project was started in November 1960 with the assistance of WHO and UNICEF. The first phase of the project was the nation-wide case-finding programme which was completed in March 1963. In those twenty-nine months, ll3 657 persons were registered; 93.9 per cent of the 55 763 children aged 6 months to 14 years were examined and 4.6 per cent showed the tuberculin positive reactions. Of the 56 060 persons, aged 15 years and over, 93.9% were examined and 2.7% showed significant positive lesions. The treatment was largely based on domiciliary care. The second phase of the project took the form of a resurvey of the places visited. This commenced in April 1963 and in two months most of the registered domiciliary cases had been reviewed. The resurvey in Upolu was completed during this quarter, thus finishing the major part of the field work as well as the second phase of the project. Most of the chemoprophylaxis cases completed the initial six months of isoniazid treatment, only the chemotherapy cases have now to be followed up. It was found that due to the frequent movement of a large portion of the population, close supervision of the registered chemotherapy cases was much more difficult than initially anticipated, especially in the Apia Town area. A third-year follow-up examination of random sample areas has also been completed and the data are now being analyzed. Valuable information on the country's tuberculosis situation is expected. The Anti-Tuberculosis Association of Western Samoa held a successful first annual meeting on 17 August 1963 and raised ~050 for its initial project "An X-ray Unit for Savai Ii" .

.;,

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• UPOLU~

o ut- patient Attendances Admissions 7531 666 -1'

Deaths in Hospital 169 7 2 4 2 14 20

Major Operations 1 340 9 4 3 2 36 12

Minor Operations 4892 932 683 680 272 2745 297 394 331 299 255

Maternity Deliveries 1444 25 27 1 1 52 18 18, 3

Maternal Deaths 3

Premature Binhs 18 2 1 1

Still Binhs 19 4 ,2

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