have been investigated, most of whom have been ordered to discontinue sale of milk because of noncompliance with regulations. Contagious diseases reported during the past fiscal year totaled 1,065, an increase of 750 cases over the number reported for the previous year. This increase is more apparent than real and, it is believed, is due to a more conscientious concern on the part of physicians in following the law requiring the reporting of contagious diseases. Another factor in this connection is the regulation passed by the board of health placing pneumonia on the list of reportable diseases. Practically all disinfecting done this year was in the Puna district, where typhoid and paratyphoid occurred. All privy vaults within a radius of a mile were burned out with sulphuric acid, also a krelos solution was used on the privies and about some living quarters. Six cases of confirmed human plague occurred during the past fiscal year. One in the month of July, 1928, two in August, two in September, and one in the month of June, 1929. All occurred in the Hamakua district and all had a fatal termination. Eleven infected rodents were taken during the year. Of these 1 was trapped, 9 found dead, and 1 killed. One was of the species mus Norvegicus; 2 mus Alexandrinus; 7 mus Rattus, and 1 the species undeterminable, the latter being but a portion of skull and hide. There were 121,211 rodents destroyed during the year. Of this number 105,485 were examined macroscopically, 26 received a microscopic examination, and 15 were examined bacteriologically, through animal inoculation. Eleven of this number proved to be plague infected. Puumaile Home. The patients, as a whole, in Puumaile Home are happy and contented. On July 1, 1928, there were 71 patients in the home. There were 78 admitted during the year, making a total of 149 treated. Of this number 33 died, 13 left the home against advice, 3 were transferred to the Philippines, and 12 were discharged, leaving 88 patients on June 30, 1929, of whom 45 are children. Japanese was the predominant race among the patients, there being 27. Total cost per patient per day was $1.68. Maui sanitation.-The health of the people and the general sanitary condition of the county of Maui during the past year was good. The island of Molokai was visited twice during the year. Sanitary conditions of stores, restaurants, bakeries, and other foodmanufacturing places, were found satisfactory. The island of Lanai was visited twice during the year. The sanitary condition of camps and stores was very good. Contagious diseases numbering 1,783 were reported by physicians during the year. Twenty-five typhoid cases were reported and all close contacts were immunized with typhoid prophylactic serum. A close check was kept on all vegetable gardens to ascertain the character of fertilizer used. Kauai sanitation. Several old-type camp dwellings have been demolished and replaced with modern 1-family cottages. Several recently constructed commercial houses, stores, and markets show the advantages of good ventilation, light, and refrigeration. The opening of the electric light and power systems at Kapaa and Hanapepe during the past fiscal year is a marked improvement. Work on the new Lihue water system is in progress. Sixteen commercial dairies, milking a day average of 406 cows with a production of 1,600 quarts, were under constant supervision and the analysis of milk shows legal percentage of fats and solids, etc. It is interesting to note that there were no cases of typhoid during the year, when for years past there have been several cases each year with a deplorable number of fatalities. Inspections of foods, etc., in markets and grocery shops resulted in the destroying as unfit for human consumption of 4,116 tin swells and 632 pounds of decayed fish and meats. Public-health nursing. Thirty-one nurses carried on this work during the past year. Thirteen of these were graduate public-health nurses. In the diphtheria immunization campaign 38,678 children, ranging from 6 months to 10 years of age, were immunized; 14,906 for Hawaii, 2,986 for Maui, 4,004 for rural Oahu, 2,180 for Kauai, 394 for Molokai, and 11,222 for Honolulu. The school work has consisted largely of assisting the government physicians and health officer in the physical examination and vaccination of children in 179 of the public schools in the Territory. An important part of the follow-up work is the classroom inspection. There were conducted during the year 1,267 infant and preschool conferences throughout the Territory with a total attendance of 22,308 babies. A detailed report of the activities of the division of maternal and infant hygiene is submitted separately. Maternal and infant hygiene.-The report of the division of maternal and infant hygiene shows an increase in infant mortality over that of last year of 18.07 per cent for the Territory, the rate being 101.76 per 1,000 live births. By races, the Filipinos show the highest rate, 244.51 per 1,000 live births; Hawaiians, 202.25; Asiatic-Hawaiian, 132.63; Porto Rican, 110.03; Caucasian-Hawaiian, 109.70; Russian, 76.92; Korean, 69.77; Japanese, 66.74; Chinese, 64.84. There were conducted in the Territory this past year 1,260 childhealth conferences, with a total attendance of 22,308 babies ranging from 3 weeks to 6 years of age. Every effort is made to keep children with acute infections away from the conferences. There were established 6 new health centers in the Territory this past year-3 on Kauai, 1 on Hawaii, and 2 on Maui. The prenatal work consisted largely of visits made by the nurses to prenatal cases in their homes. There were 749 visits made to 256 cases. Maternal mortality rate for the Territory is higher this past year by 1.19 per cent over that of last year. Medical inspection of schools.-Inspection of the children of the public schools was made by the government physicians of their respective districts. A total of 42,699 children of the public schools were examined and defects noted, of which there were 12,359 with defective teeth, 4,311 poor nutrition, 7,504 adenoids and tonsils, 1,241 trachoma, 1,938 conjunctivitis, 573 heart disease, and 223 tuberculosis suspects. There were 6,812 vaccinations in the public schools, of which number 5,185 were successful. In addition, 3,639 children of the kindergartens and private schools in Honolulu and on the other islands were examined, of which number 1,077 had defective teeth, 738 adenoids and tonsils, 150 poor nutrition, 41 trachoma, 60 conjunctivitis, 49 were tuberculosis suspects, and 28 heart disease; 1,191 were vaccinated, with 1,042 successful takes. A summer round-up of children who are to enter school in September was made in Honolulu in the spring of the year under the auspices of the Parent-Teachers' Association. Nutrition cases under the care of the nutrition bureau of the department of public instruction have been examined at the chest clinics of the board of health, attention being given to the pretuberculous children. Immunization_against diphtheria was effectively carried out throughout the Territory Bureau of tuberculosis.-After a careful review of the reports by former directors of activities of the tuberculosis bureau in past years and a study of the organization of similar departments in several places in the States the following aims and purposes were proposed: 1. Recording of all diagnosed cases of tuberculosis and the interpretation of statistics so obtained. 2. Education of the public and the medical profession to the needs of an active antituberculosis campaign. 3. Correlation of health measures in tuberculosis control. 4. Supervision of tuberculosis work in the islands. 5. Examination for diagnosis of indigent contact and suspect cases, hospitalization of certain ones, supervision of other cases treated in the home and following discharge from the sanatorium, through the chest clinic. The following is a summary of all diagnosed cases of tuberculosis in the Territory of Hawaii: Cases remained on register July 1, 1928. New cases registered during fiscal year ending June 30, 1929 Reentered cases.. Deaths---. 2, 297 942 50 Total.. 3, 289 406 Intercurrent deaths. 42 Removed as apparently cured and arrested.. 385 Removed as nontubercular, unlocated, mistaken diagnosis, and other A study of the morbidity and mortality statistics through these reported cases gives the Territory a morbidity rate of 277.4 and a death rate from the disease of 113.5. The reduction from the rate of 121 per 100,000 population last year is a real gain. Following is the death rate since 1913: Tuberculosis-Cases and deaths by racial classification Honolulu city had 425 new cases reported, with 211 deaths; Oahu (excluding Honolulu), 132 cases, 23 deaths; Hilo city, 47 cases, 42 deaths; Hawaii (excluding Hilo), 107 cases, 32 deaths; Maui (including Molokai), 182 cases, 58 deaths; and Kauai, 99 cases and 40 deaths. Government physicians.-There were 30 government physicians employed during the fiscal year ended June 30, 1929. In the medical inspection and vaccination of the children of the public schools 38,456 children were examined by the government physicians in their respective districts and 5,745 vaccinations done. A total of 3,495 special examinations were made during the year by the various government physicians, including private-school children, preschool, underweight children, and bad tonsil cases. There were 145 tonsil and adenoid operations performed and 730 tonsilectomies. Typhoid immunizations numbered 7,844, the government physician, Lahaina district, having immunized 7,586 persons. The reports of the government physicians received show 28,133 immunizations against diphtheria by toxin-antitoxin. On the island of Maui 21,332 treatments were given by the government physician of the Lahaina district to children suffering from trachoma; and 130 cases in the Makawao district, 95 cases in the Puunene and Kihei districts, and 13 cases in the Kahului district were under treatment during the year by the government physicians. Patients on temporary release received a total of 1,603 injections. Territorial hospital for insane.-An institution for the insane was opened in 1864. The hospital plant, including the new plant at Kaneohe, is valued at $526,880.63; total acreage of hospital property owned, 167 acres, of which 29 acres is under cultivation; total acreage cleared during year at Kaneohe, 10 acres, net per capita cost, $1.0386; number of officers and employees, 71. |