A.-3

8

The foregoing, I submit, fully justifies my statement that prior to my time there never was a hospital that could be called such. The new Hospital, its furniture, instruments, and equipment, with the erection of the Chief Medical Officer's residence and the Nurses' Home, cost some £3,300, which had to be provided out of revenue as it came in. For the year under review the cost of the upkeep of the Hospital, and other recurring expenses in connection with attention to the health of the people, was £1,120, as against £910 in the previous year. I submit that all that it is possible to do under the present circumstances is being done, but it is not enough to preserve the race. Want of proper communication for the medical staff with the outlying islands seriously hampers the work in these islands, and until the New Zealand Government is prepared to assist the Cook Islands Administration as indicated in my letter to you of the 29th April last nothing further can be done. Prior to my time no visits of any value were paid to the outlying islands, in consequence of the fact that it was impossible to do so for want of our own shipping service. Flying visits have been paid by the doctors when travelling in the London Missionary Society's steam yacht " John Williams," but, as that vessel only remains for two days at the outside at any one island, the visits of the doctors were practically valueless. Arrangements have now been made for the Assistant Medical Officer to visit those islands at which the Union Company's steamer calls, but this arrangement can only be carried out in the case of two or three of the near islands. The time has now arrived when it is imperative that the health of the Natives should be thoroughly attended to, and if this is to be done I respectfully submit that, as pointed out in my letter above referred to, it will be necessary for the New Zealand Government to provide an auxiliary schooner of about 120 or 150 tons, fitted with an oil-engine with horse-power sufficient to drive her from five to six knots an hour. In it quarters should be provided for the Medical Division, with sick-bays erected to convey ailing Natives from the various outlying islands to the main Hospital at Rarotonga. At the present moment no one can tell how far leprosy has spread in the Cook Islands, but I can say, for I have seen it myself, that it is there to a considerable extent, and the manner in which the lepers now live is nothing short of disgraceful. The number of lepers, however, is not sufficient for it to be assumed that leprosy is of indigenous origin. It has evidently been imported in comparatively recent years, and steps should be at once taken to prevent it becoming endemic. In his " Tropical Diseases," Patrick Manson, M.D., an eminent authority, says with regard to leprosy, " So generally is it diffused in tropical and subtropical countries that it would be more easy to specify the tropical countries in which leprosy has not, than to enumerate those in which it has, been ascertained to exist." Dr. Manson goes on to say that an interesting and, from the etiological standpoint, an important circumstance about the geographical distribution of leprosy is its appearance in recent times and rapid spread in certain islands whose inhabitants, there is good reason to believe, had previously been exempt. In the Sandwich Islands leprosy was noted among the aborigines for the first time in 1859. Soon after its presence was recognized the disease spread so rapidly that by the year 1865 there were 230 known lepers in a population of 67,000. By 1891 the Native population, from various causes, had diminished to 44,232 ; of these 1,500 were lepers —about one in thirty. In New Caledonia leprosy was unknown until 1865, and in 1888 the lepers numbered 4,000. On page 390 of the same work Dr. Manson says, " Though we are in absolute ignorance as to the process of infection, we may be quite sure that in leprosy there is an act of infection, and that the infective material comes from another leper. Leprosy has never been shown to arise de novo." It is unnecessary for me to dwell upon the loathsome features of this terrible disease, but I may say that I have visited the known lepers of the Cook Islands —these have been isolated as far as possible —and it can only be characterized as a most painful and revolting sight. The fact that our Islands are liable to a similar increase as was experienced in the Sandwich Islands and New Caledonia, unless something is done to arrest the disease, and that at once, makes it unnecessary for me to say more than that it is of the most vital importance that the matter be tackled without any delay whatever. The Cook Islands Administration is prepared to do its part, but, as pointed out in the report of the Chief Medical Officer, the collection and isolation of lepers cannot be carried out until the Administration is in possession of a vessel of its own. The disease may be regarded as incurable in those who have contracted it, but it is those who are at present free from taint that it is our duty to protect. On page 361 of " The Principles and Practice of Medicine " (William Osier, M.D., another noted authority), the following remarks will be found under the head of " Heredity " : " For years it was thought that the disease was transmitted from parent to child, but the general opinion, as expressed in the recent Leprosy Congress in Berlin, was decidedly against this view. Of course, the possibility of its transmission cannot be denied, and in this respect leprosy and tuberculosis occupy very much the same position, though men with very wide experience have never seen a newborn leper. The youngest cases are rarely under three or four years of age." It is recognized that little can be done to alleviate the sufferings of the unfortunate lepers now existing, but the children of the afflicted ones and others liable to come into contact with the present cases can and should be protected from developing this awful disease. I append the reports of the late Chief Medical Officer, Dr. Perceval, and also of the present Chief Medical Officer, Dr. Baldwin, together with my memorandum covering the former : — " Sic, — " Cook Islands Administration, Rarotonga, 13th October, 1911. " As indicated in my letter of the 3rd instant (No. 667), I have now the honour to enclose herewith a copy of the Chief Medical Officer's report of the health of the Natives in the Group. The report is of a very serious nature, and I respectfully request that no time should be lost to place the health of the Natives on a better footing. This, as pointed out, cannot be done unless the Government possesses a schooner of its own in these waters. I await your instructions in the matter. " I have, &c, " J. Eman Smith, " Resident Commissioner. " The Hon. Sir James Carroll, K.C.M.G., Minister for Cook Islands Administration. Wellington,"