A Paper on New Zealand.

Mr. President and Gentlemen,

The European population amounted in 1893 to about 672,265 individuals, and the proportion of females to males was about 87.95 to every 100 males. The Maori population consisted of about 41,993 individuals, and the Asiatic population to about 4,044. Amongst the Maories there were more males than females, and amongst the Asiatics there were only 17 females.

The birth-rate in the Colony was 27.5 per 1,000 of mean population in 1893, in 1881 it was 37.95 per 1,000 of mean population; in England in 1891, the birth-rate was 31.2 per 1,000 of mean population. That the birth-rate in the Colony should have decreased so markedly, and that, with a small population and abundance of good food and fresh air, it should be less than the birth-rate in England, is remarkable, and I think, may be attributed to several different causes.

There is no doubt that in these days of the greater knowledg[unclear: e] the masses, the rudiments of anatomy, physiology and hygiene [unclear: a] studied and understood by large numbers of men and women, and [unclear: th] knowledge gained is made use of.

Moreover, with the advance of education, any religious impression that it is wrong and sinful amongst married people to use mean[unclear: s] prevent conception is not very strong.

Amongst some married people it is thought to be wrong to have children unless they have the means to support them; others, against believe that it is better not to have children when there is the possibility of transmitting to their children the legacy of some hereditary taint.

Perhaps, too, the fact that so many married women are at the present day engaged in occupations which would be seriously interfered with during the time that they were incapacitated from work Take, for instance, our own profession. We can all realise [unclear: ho] inconvenient the duties of maternity would be to a married woman practising as a general practitioner. Whilst, then, these causes ar[unclear: e] work, we may conclude that the birth-rate will continue to decreases As a nation, I believe that the French people have the greatest [unclear: cont] over the birth-rate.

Coming now to the death-rate of the Colony, it is satisfactor[unclear: y] find that it is not more than 10.23 in every 1,000 of living persons and this compares favourably with that of England, which is [unclear: 19-] in every 1,000 of persons living, and when one considers that considerable numbers of people have gone out to the Colony in searc[unclear: h] health, I think that we may conclude that the Colony is decidedly healthy place to settle in; and I submit that, indirectly, the death-[unclear: ra] might be brought down lower still if the New Zealand Government which is always alive to the interests of the masses, were to [unclear: introdu] certain new ideas, which could be introduced without difficulty i[unclear: n] new country with a small population.

1.	I believe that if the Government would appoint one or [unclear: mo] pathologists according to population in each town [unclear: a] district, the duties of the pathologist to be The performance of a post-mortem examination (in the presenc[unclear: e], course, of practitioners interested) in every case of [unclear: dea] which occurs, and that he should send in the report of the examination to the Registrar-General. The effect of this would page 3 be that it would be an educating factor to all medical men in practice; they would become more familiar with the changes produced in the different organs by disease than they can possibly be now; they would never incur the risk of, after being obliged to make a post-mortem, going to attend a sick person, a confinement, for instance; they would also obtain a more exact knowledge of the effects and results of treatment in disease, and this increased knowledge would lead to the more efficient treatment of the sick. A regular post-mortem examination would, I belive, act as a deterrent from crime, especially from the crime of poisoning; the poisoner would know that, before the victim of his crime was disposed of, there would be a careful examination of the body. Moreover, a compulsory examination after death would protect the helpless infant and the young child from the results of wilful neglect; and lastly, there would follow, as a natural result, the general adoption of cremation, instead of burial, as the proper method of disposing of the dead. This would mean that the germs of disease, especially of infectious disease, would be destroyed and not buried.
2.	Then, again, the appointment of a medical officer of health for every district, whose duty it should be to investigate the causes of epidemics of such diseases as typhoid, &c., the examination of milk, water, and food, the inspection of dairies, slaughter-houses, &c., would tend to diminish the amount of disease.
3.	I am afraid that this third clause will be considered impracticable by many, because it will be said that it would interfere too much with the liberty of the individual. However, if it could be attempted anywhere, it could be tried in a new country with a small population, and by a Government so much interested in the general welfare of the community. I mean this: that every couple, before marrying, should be called upon to produce a medical certificate of health from a duly qualified medical practitioner. The result of this would be that every newly-married couple would probably be a healthy couple, with the result of a happier married life and a healthy progeny. You will say that later on in my paper I recommend New Zealand as a country to which it is advisable to send tubercular patients, and yet, when they get out there, I would prevent them from marrying. My answer to this is that marriage is inadvisable to the distinctly tubercular, because it is injurious to the individual, and because, also, if there are children, there is the probability of the transmission of the hereditary nidus.
4.	I would also advocate that tubercular disease, especially phthisis, that most terrible destroyer of human life, should be included amongst the infectious diseases which have to be notified, and page 4 that on such notification the Registrar-General should sen[unclear: d] paper to the friends of the infected person, and to the infected person himself, in which should be clearly stated some such suggestions for their guidance as have been made by the medical staff of the City of London Hospital for Diseases of the Chest, Victoria Park:— 1. —It is certain that the material (or "phlegm" coughed up by persons suffering from consumption) contains the seeds of the disease. 2. —The phlegm, therefore, should not be swallowed. Such a [unclear: ha] may lead to consumption of the bowels. 3. —Consumptives should not, when indoors, spit about the floor, [unclear: b] should spit into special spitting cups (or pots), half full of water 4. —The spitting cups should be emptied into a bright fire or [unclear: int] the pan of the water-closet, but never anywhere else, [unclear: a] especially not into the dust-heap. Out of doors a [unclear: pock] handkerchief may be used, but all soiled handkerchiefs should be boiled for at least five minutes when they are being washed 5. —The room in which a consumptive lives, by day or by night, should be well aired, and the windows should be thrown wide open [unclear: sa] soon as the patient leaves it. The windows should always [unclear: no] kept a little open at the top, both by day and by night. The [unclear: chiu] neys should not be stopped up, but should be freely open for the passage of air. The floors of the room should be kept very clean, and great care should be taken that no dust remains upon them. They should be cleaned with a wet cloth. 6. —Consumptive patients ought to sleep by themselves. 7. —Mothers who are consumptive should not suckle their children and should not themselves make use of the children's feeding bottles, cups, spoons, &c.

These suggestions are not alone made for the benefit of [unclear: sufferen] from consumption, but also in the interests of the family, for by adopting these means the spread of cousumption may be prevented.

To these should be added one that all cups, glasses, forks, spoons &c., used by phthisical patients should be carefully scalded.

Such a history as the following is not uncommon:—A [unclear: m] working in a close office with two or three others develops phthisis. While he is able, for many months, he continues his work. He is troubled with a cough, and often spits on the floor while at work; the sputum dries during the day, at next morning the office is swept out, with the result that the dust is stirred up, and with it also the germs of the disease When he and his fellow workers come to the office in the morning, they inhale or swallow the germs which are floating about in the atmosphere, and then, after a longer or short time, one or more of his companions develops the disease.

Syphilis, also, ought to be considered as a highly contagions disease, which has not only a serious effect on the diseased person but is also transmitted to his offspring. But sentiment and shame will prevent the notification of syphilis. Therefore, with a view of lessening the amount of syphilis in the country, I would finally urge the enforcement of the Contagious Diseases Act.

I have brought these views forward because their adoption would tend indirectly to reduce an already low death-rate; and I also bring them forward as a medical man, whose duty is to cure disease when possible, to prevent disease when possible, and to stamp out disease if possible.

This population of New Zealand, which is about 672,265 people, has to bear a National debt of £638,874,491, amounting to about £57 8s. 10d. per head, but this will not appear to be very great, when you consider, as the Agent-General has pointed out, that this debt would be disposed of by the sale of the Railways in New Zealand, which are almost entirely the property of the Government.

The value of the imports including specie into the Colony amounted in 1893, to £6,494,279, whereas the value of the exports amounted to £8,557,443. The chief exports are Wool, Gold, Frozen and Potted Meats, Butter, Cheese, Kauri, Gum, &c.

Any further information on Taxation may be obtained from the Official Year Book of New Zealand.

Education is free and Secular at the Public Schools of the Colony, and all children between the ages of 7 to 13 are compelled to attend. They are taught reading, writing, arithmetic, history, English grammar and composition, geography, history, elementary science, drawing, object lessons and vocal music; girls, in addition are taught sewing, needle-work, and the principles of domestic economy. For all boys also there is provision made for military drill.

I have here a map of the North Island which shows its irregular outline; the two principal cities are Wellington the capital of the Colony situated on the border of its fine harbour at the extreme South of the Island (it is said of Wellington that it has no climate but that its climate is a series of samples, well gentlemen I can certify that some of the samples are particularly good) and Auckland, the Naples of the South, situated in the bight of Hauraki Gulf and well sheltered by numerous islands, with a climate which for nine months of the year is simply perfect. In the centre of the island is a large lake, Taupo, which is in width and length about 20 miles. Around Lake Taupo is a vast tract of barren scoria country; 40 miles north of Taupo is Rotorua, the centre of the remarkable Hot Lake district. All over the Island are numerous mountain ranges, the mountains ranging from 1,500 to 4,000 feet in height, but there are three notable mountains which page 6 attain a greater height. Steaming Tongariro with its little cloud [unclear: o] vapour overlaying it rises as a group of volcanic cones to the height [unclear: o] 7,515 feet. The cones are still active and emit with much force and noise large volumes of steam, intermixed with strong smelling and pungent vapours. It is said that owing to the pungency of these vapours it is inadvisable for Alpine climbers to approach the edges [unclear: o] the crater.

An extinct volcano, snow-capped, the walls of the crater sloping ice-bound to a lake at the bottom some 300 feet below the [unclear: edg] Silent Ruapehu looks down on his steaming companion fro[unclear: m] height of 9,100 feet. The third high mountain is Mount [unclear: Egmont] which also is a snow-capped extinct valcano, rising as a perfect [unclear: con] from the plains of Taranaki, to a height of 8,300 feet. Besides the mountainous features of the country, there are vast tracts of undulating country and extensive plains. The whole Island is well watered by numerous rivers and streams. Some of the rivers are navigable [unclear: fo] short distances by small steamers.

In this map of the Middle Island, you will see that the [unclear: Southe] Alps run down from North to South rather to the West Side of the Island; the highest mountain in the range is Mount Cook, 12,349 feel high. There are several other summits which reach to altitudes varying from 10,000 to 12,000 feet. These high peaks are covered with perpetual snow, and on both sides of the range are extensive glaciers, the largest being the Tasman Glacier which is 18 miles long by 2 wide. In the Middle and the Southern portion of the island are several large lakes of great beauty, and in the extreme South West are the [unclear: magnifie] fiords or sounds. In every part of the island are numerous rivers and creeks. The chief towns are Christchurch, Nelson, the garden of New Zealand, Dunedin and Invercargill. In both islands large area[unclear: s] land are covered by fine forests.

The climate of these islands resembles very much that of [unclear: Gre] Britain, but it is warmer and more agreeable, the extremes of daily temperature varying throughout the year by an average of 20 per cent only. The temperature of the North Island is higher than that of the South. London is 7° colder than the North and 4° colder than the South Island. The mean annual temperature of the different season for the whole year is in spring 55°, in summer 63°, in autumn 57° and in winter 48°. The daily range of temperature is greatest in the summer and least in the winter, and the hottest days in summer are followed by cool, pleasant evenings. The average difference between the mean temperature of the warmest and coldest months is 17°.

On the West Coast the climate is more equable than on the East Coast, and the rainfall is greatest on the west and north-west aspects of the islands, and on the West Coast of the South Island is very considerable, amounting to 125.94 in some places. In the northern parts of New Zealand the rainfall is twice as great in winter as it is in summer, but in the South Island it is distributed more equally over the year.

The prevailing winds are north-westerly, followed by south-westerly, with an occasional southerly burster. A fine day with a light southerly wind is most exhilarating.

Now, gentlemen, let us go to Rotorua, the centre of the strange hot lake district.

This district covers a distance of 50 miles in length and 20 in width, and an area of about 600,000 acres, some 1,000 to 2,000 feet above the sea level. Rotorua, with its numerous hot thermal springs, its geysers and mud volcanoes, its green, yellow, and blue lakes, its terraces of silica, is a part of New Zealand that no tourist should fail to visit, and to anyone suffering from the effects of overwork I know no place whore he will get greater pleasure and benefit than he will at Rotorua and its immediate neighbourhood.

Then the Government have established a hospital, which is in charge of a medical man of long experience, and whose knowledge of the therapeutical value of the waters is second to none, and all patients page 8 who go to Rotorua for the benefit of their health ought to consult him, before using the baths, as to which is the best bath for their particular ailment.

I have had printed the analysis of the baths which seem to be the most efficacious in the treatment of disease, and I have also had printed the analysis of Puriri Water, which I have found most useful in the treatment of gout. I know of one instance where a gentleman had had for many years at least one, often two, attacks of gout during the course of each year and was thereby incapacitated from work for longer or shorter periods of time. He had had all kinds of treatment from many different practitioners but for some years now he has not suffered at all, and he attributes his freedom from gout during that time to the fact that he drinks this water daily, the only other treatment he adopts is that of having a Turkish bath once or twice a week.

"Te Pupunitanga," commonly known as the "Priest's Spring and Bath"; aluminous and strongly acid (reaction acid).

"Whangapipiro," commonly known as "Madame Rachels's Bath"; saline waters with silicates (reaction alkaline).

"Te Kauwhanga," commonly known as "Cameron's Bath;" hepatic, feebly saline, with excess of acid (reaction acid).

"Puriri," about ten miles from Grahamstown.

The diseases which I have seen benefitted by these baths are-Scabies, Ringworm, Alopecia, Sycosis, Eczema, Psoriasis, Neuralgia, Sciatica, Lumbago, Rheumatism, Gout (when diet is also attended to), Anœmia and Amenorrhea, Ozœna, Chronic Laryngitis, Leucorrhœal discharges, Pruritus Vaginæ, Ulcerations of Cerrix, Endo-Cervicitis, Hæmorrhoids, Anal Fissures, Cystitis, Paraplegia after Diphtheria. Patients who are suffering from overwork are much benefited by a trip to the hot lake district, as also are those who suffer from functional liver disturbances, to whatever cause they may be due. But there is one class of patient who ought not to go to Rotorua, and that is the phthisical. I have known of severe hæmoptysis coming on in phthisical patients who have visited the district.

Without in any way disparaging the climate of England, and while I know that many phthisical patients recover without leaving this country, yet for several reasons I am persuaded that, in the majority of cases, a trip to, and a sojourn in New Zealand, is a very great advantage. In the first place the change and long sea trip improve the general health and restore power to the weary phagocytes to continue the fight against the invading bacillus; secondly, when on a patient the tubercle bacillus has placed his mark, that patient may be considered to be in the position of having a favourable nidus for its growth and development, and by remaining in an overcrowded country he is much more likely to take in by the lungs, or by the intestinal canal, fresh quantities of the poison, than he would in a country where there is a small population and plenty of fresh air.

Of this number, especially under the head of phthisis, many of the deaths occurred, no doubt, in cases sent to the Colony in advanced conditions of the disease. There are many individuals in the Colony who have come out suffering from phthisis who, having regained their health, have decided to remain in the Colony, and there are also numerous examples where, after regaining their health, they have returned cured to the old country to resume their occupations. A friend of mine, when a student at a London hospital, developed phthisis. He was sent by Dr. Fagge to the Cape, where he improved; he then returned to the hospital, but after six months broke down again. He was carried on board a P. and O. vessel with high fever and other symptoms. During the voyage he improved, and on his arrival in New Zealand he was able to get about. He lived in Wellington for five years, where he slowly and steadily gained strength, and eventually, after having had several severe attacks of hœmoptysis, got quite well. He then finally returned to his hospital, qualified, and has been practising in England for the last five years.

Before mentioning the class of people who will derive benefit by coming out to the Colony I should like to mention the chief routes by which people travel, as, in my opinion, it is important that a medical man should advise the route which will give the patient the greatest benefit.

1.	The Long Sea Trip in a Sailing Vessel. In this case a person is at sea for three months. A portion of the time is spent becalmed in the tropics; a month or more is spent, also, in bitterly cold and rough weather; the food on board is not fitted for any kind of invalid, and these vessels do not all carry a doctor.
2.	The Direct Route by Steamer, either by the Shaw-Saville Line or the New Zealand Company's steamers. These vessels have every comfort on board, and take about forty-two days to accomplish the voyage. They call at Teneriffe, the Cape, and perhaps Hobart, so breaking, to a certain extent, the monotony of the passage; but for the last three weeks of the voyage the weather is often rough and cold; snow and hail are not uncommon, and the rapid changes from one climate to another, especially after leaving the Cape, are very trying. At the Cape the climate may be tropical, and then within three days there may be intense cold, with snow or hail. These steamers carry a medical man.
3.	The Suez Canal Route, by Peninsular and Oriental or Orient line of steamers. These steamers are very comfortable; they also carry a medical man. The journey is more like a pleasant yachting expedition. The changes in climate are slow and gradual. They are never at sea for more than ten days at a time, and touch at several places of interest, such as Malta, page 12 Port Said, Suez, Aden, Colombo, Albany, Adelaide, Melbourne, and Sydney. At Sydney there is a change to the Union Line, and by their steamers the passage to Auckland or Wellington is made. It is better not to travel by this route during the hottest months of the year.
4.	Across America. To America by steamer, across the continent by rail to San Francisco, thence by steamer to Auckland, calling at Honolulu. The Canadian Pacific route may be mentioned in addition.

It may be asked: Does consumption attack people in the Colony? Certainly it does.

To those phthisical patients who determine to try New Zealand as a health resort I should recommend the following places as suitable to dwell in:—

In the North Island.

1.	Russell.
2.	Whangarei.
3.	Auckland and its suburbs.
4.	Tauranga.
5.	Napier, Kuripapanga, and Erewhon.
6.	Manawatu district. Palmerston, North.
7.	Wellington, Paikakariki, and Featherstone.
9.	New Plymouth.
10.	Wauganui.

page 14

South Island.

1.	Nelson.
2.	Kaikoura.
3.	Fairlie Creek.
4.	Naseby.
5.	Palmerston South.
6.	Queenstown.

Speaking generally, the North Island is the better place in the winter months and the South Island in the summer months. To those who want to remain in the North Island all the year round I should recommend Kuripapanga or Erewhon for the summer months, and Napier in the winter. Kuripapanga is a two days' coach journey from Napier. It is situated in the mountains, about 1,500 feet above sea, and, as a summer climate, is delightful. I have seen patients improve by a short residence there in a wonderful manner.

Again, they might spend the summer months at Featherston or Paikakiriki, and winter in Wellington.

For those who wish to spend the whole year in the South Island, Nelson is the best place; but, if they will spend only the summer months in the South Island, in my opinion, by far the best place is Naseby, in Central Otago.

To a patient who makes his health the first consideration, and is determined to rid himself of the disease if possible, I should recommend Naseby as a summer resort, and for the winter I should advise him to go to Russell or Auckland and its suburbs or Tauranga: or, better still, to take a trip to the Cook Islands, and spend a couple of months pleasantly visiting Rarotonga or Mangaia, or Aitulaku. I believe repeated changes do phthisical patients more good than remaining in one spot. Patients who come out for their health ought to be prepared to spend eighteen months or two years in the Colony, and during their sojourn they should continue treatment.

Another important practical point in sending phthisical patients out is to recommend them to have a two-or four-berthed cabin to themselves. It is wrong for a phthisical patient to be put into a cabin with a healthy person, and, moreover, the owners of the steamer ought to be informed that the patient is phthisical, and advised that, at the termination of the voyage, the cabin should be thoroughtly disinfected and repainted.

With regard to clothing in the Colony, every person should be advised to wear flannel or woollen underclothing.

To all of you, especially those who are constant visitors to the out-patient departments and wards, the picture of the tardy flight of syphilis from the presence of mercury is familiar, and I am glad to say, that, as far as my experience goes in the Colony, where Mercury has as his faithful page 15 allies abundance of good food and fresh air and a warm and equable climate, the rout of syphilis is accomplished in a shorter time and very effectually. I certainly think that a trip to New Zealand would be beneficial to many who suffer from syphilis.

Every four or five years we have a severe epidemic of measles. This is probably not because the disease is of a more virulent type in those years but because at the end of every four or five years there are a larger number of susceptible individuals and also that this is a disease where there seems to be less immunity to subsequent attacks than in other diseases of the same nature, it is not uncommon to find people who have had measles even two or three times.

Measles is a terribly fatal disease amongst the Maories. The mortality from measles in 1893 was 511 individuals. In the same year diphtheria claimed 128 victims, and typhoid 128, cancer 332. Hydatid disease is fairly common but not so common as in Australia. Typhus, small-pox, hydrophobia, are unknown.

(After the paper I was able to show sixty lantern slides which had been kindly lent me by the Agent-General.)