21

A.—3

Europeans), and in part to the habit of smoking cigarettes, of which they smoke and inhale (as has already been said) a large number during the day. Ascites. —One case of abdominal dropsy came under my care in the person of a woman named Muter, aged about thirty-three, which I attributed to peritoneal tuberculosis. As frequently happens in these cases, the tubercle has appeared in the peritoneum and lungs, but not in the bowels; the latter, when I saw her, showed no signs of ulceration ; doubtless the involvement of the bowels is only a question of time. I performed paracentesis on the 27th July, when a little over five gallons of clear straw-coloured fluid was withdrawn. She was greatly relieved by the operation, but about a fortnight later signs were not wanting to show that the peritoneal cavity would soon be filled again. Hernia. —l saw one case of congenital hernia in a man aged about thirty-two, which first appeared three or four years ago ; it was of enormous dimensions, but could be easily reduced. I think that hernia is less common amongst the native population than amongst Europeans. Diseases of the Lymphatic and Glandular Systems. Under this heading the most important complaint to be met with is that condition known as strumous disease of the glands, to which allusion has already been made when speaking of scrofula. Diseases of the Mouth. Banula. —l saw one case of ranula in a boy aged fifteen, which was cured by simply making a free incision into it, and clearing out all the contents of the cyst. Diseases of the Urinary and Generative Organs. Diseases of the Kidneys. —None came under my notice. Stricture of the Urethra. —One case. Hydrocele. —l saw no case amongst the natives. One case, which had attained enormous dimensions, I saw at Earotonga, but as it occurred in a European nothing more need be said of it. Elephantiasis scroti. —This complaint, which is frequently met with in Fiji and Samoa, where a scrotum weighing 501b. is by no means uncommon, does not appear to affect the natives of Earotonga to any great extent. I saw two cases, but they were both of moderate proportions. The disease is believed to be produced by the jigger-worm (Filaria medinensis) or the Filaria sanguinis hominis, which act by blocking up the lymphatics. Diseases of the Connective Tissue and Skin. Scabies. —l met with only two cases of scabies, in the persons of a European and his native wife. The Earotongians are naturally a very clean people, abhorring dirt about the person, so that diseases like scabies and phthiriasis, so common amongst the Solomon-Islanders and NewHebrideans, are very uncommon. I have no hesitation in attributing the source of this complaint in these two cases to the European, who was one of those dirty, idle vagabonds, from which the Pacific Islands are no less free than other parts of the world. Phthiriasis (or lousiness) of the head, due to the Pediculus capitis, is to be met with amongst the natives, but I think scarcely so frequently as amongst the poor and their children in a European country. This is very different to the Melanesian or Papuan race, amongst whom it is the exception rather than the rule to find any one free from lice. This is explainable, I think, by the difference in hair in the two races, the frizzly hair of the Melanesian affording a better nidus for the pediculus than the straight hair of the Polynesian. Erysipelas has already been alluded to under the head of specific fevers. Carbuncle. —l met with a case of carbuncle, which did well after making several free incisions into it. Pemphigus infantilis. —I met with one case of this, which appeared the second day after birth. It consisted of a pustular bulbous eruption on the hands, feet, buttocks, thighs, and chest. This eruption, which is found only in children the subject of hereditary syphilis, is usually confined to the hands and feet. The child appeared to be otherwise fairly healthy and well nourished, and was living when we left, aged about ten days. Children in whom pemphigus appears are as a rule shortlived, dying generally within a week; but Mr. Jonathan Hutchinson, in his work on syphilis, p. 417, records a case which occurred in January, 1882, the subject of which lived long enough to pass into another phase of the disease some two months later. This case was doubly interesting, as it was also the only case of hereditary syphilis which I saw during my month's stay on the island. Bupia. —l saw several cases of rupia of the limpet-shell type (B. promiscens). In every case there was a clear history of syphilis, and the subjects were thin and cachectic. Scleroderma. —l met with one case of this rare disease at Avarua. The subject was a native woman, the wife of a half-caste man, whose name, I think, was Euakai. It consisted of several patches of induration on the right side of the chest and right breast, also on the legs. The integument was considerably thickened, and was a little whiter than the healthy skin, smooth in places, showing signs of old cicatrices, and ulcerating in others. Over the smooth white skin there was a certain amount of anaesthesia, but no analgesia. She did not appear to suffer pain to any extent, and her general health was unimpaired; the body well nourished, and inclined to corpulency. Elephantiasis arabum (or Barbadoes leg).—This disease, which is so common in most of the South Sea Islands, is comparatively rare in this island. I saw several cases, but only one that had attained to a large size, which was in the person of a native of Aitutaki Island, who was on a visit to the island. In this man the right leg was enormously thickened, and had numerous appendages hanging from it. He could only move about with great difficulty. It is possible that many more cases exist than were met with during so short a stay as we made ; but I am inclined to