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" Sir,— " The Hospital, Rarotonga, 10th October, 1911. " I have the honour to report that I left Rarotonga on the 30th August on a medical inspection of the Cook Group, returning Ist October. As you are aware, I did not expect any material benefit would accrue from it to the Natives from a medical point of view, the stay on the various islands being too brief, the object being on my part to make myself acquainted with the different diseases and the requirement of the Natives in this respect, and report to you thereon. " The health of the islands as a whole was in a most deplorable condition, as was this island when I arrived —syphilis predominant, working havoc with the constitution of Natives and materially affecting the birth-rate. I found no evidence of plague amongst the residents of the various islands, nor could I hear of any ever having been heard of. I did not hear of any disease amongst rats —they are numerous at Penrhyn. " The diseases I found most prevalent were syphilis—secondary, tertiary, and constitutional (primary —few cases are seen, as the Natives treat the sores themselves, with baneful results) : intermittent fever of an irregular type, gonorrhoea, uterine diseases, phthisis, rheumatism, skin-diseases peculiar to the tropics, leprosy, beriberi (a form of which is peculiar to and endemic in the Northern Group), and other diseases which are met with amongst white races as well as coloured. " There were no medicines for the treatment of the Natives on the Northern Group, and only on two of the Southern —Aitutaki and Mangaia —there being no regular means of communication with the other islands except in the fruit season, and then at irregular intervals. You must expect a large increase in the drug account over and above my estimate to you if their requirements are to be met. " Leprosy is rife on every island except Rarotonga. I know myself of thirty-seven or thirtyeight cases —fifteen in Penrhyn, five in Rakahanga, six in Manihiki, three in Pukapuka, three in Palmerston, three in Aitutaki, one in Mangaia and one in Mitiaro —a suspect; but the Natives hide these cases, so in all probability there are many more. These cases consist of the tubercular nodular form, and one of nerve-degeneration. I cannot in this report go into the heredity and contagiousness of this disease, but draw your attention to the fact that all contagious diseases demand certain conditions for their diffusion. In some these conditions are readily complied with ; in others they are complied with with greater difficulty, and perhaps rarely occur. Leprosy in my opinion belongs to the latter class. " I would strongly advise that, in the interests of the patients, in the interests of the inhabitants, and having regard to the fruit trade, all these cases are collected by a Government vessel and isolated at Penrhyn ; that the children of leprous parents should be removed from the leprous surroundings ; that the voluntary isolation of lepers in colonies on the island should be encouraged. In countries where leprosy forms a chief centre isolation is the best means of preventing and controlling the disease. " As the leper patients are now situated the situation is distressing in the extreme—no fresh water for washing, no soap, no change of garments —filth predominates. Complaints were made to me in Penrhyn that the man in charge (not efficient) appropriated most of the rations ; at Rakahanga, that they had not sufficient food, and their relatives would not give them any. The same applies to Manihiki. At Penrhyn the Native huts were not at all suitably kept. Rations should be allowed of flour, tea, biscuits, sugar, beef, and soap to supplement their Native diet of coconuts and fish. There is no supervision of the Native in charge at Penrhyn. lam of opinion that a large shed with iron roof and tanks for water should be erected at Penrhyn, sides covered with purau, for the least affected cases, and that Native huts should be used for the worst cases, constructed on the plan of the hut occupied by the man in charge. " The island for the lepers at Aitutaki is too close to the main land, as there is frequent communication by other Natives. Water there is an urgent need—all they have is that taken to them once a week from the main island, and sometimes from stress of weather delayed several days. The same want of cleanliness applies there also. My remarks re shed apply here also. "At Palmerston the position of the two boys is still more disgraceful. They were placed on a bare sandbank without shade or water by the order of Mr. Hall, L.M.S., on account of the infectious and contagious nature of the disease ! To an adjoining island, upon which a suspect had been placed, and which I found to be leprous, I ordered these two boys to be at once removed. They complained bitterly of the way they had been treated by the people of Palmerston in refusing them food or water from their canoes in passing, and had to wait a day or longer before it was brought to them. These statements were made in the presence of the Rev. Mr. James, of the London Missionary Society, as well as myself, on the occasion of thefrecent visit. " The health of the people of Mauke, Atiu, Aitutaki, and Mangaia is in such a bad condition that it would take a medical man six months on each island to rectify before they could be visited at stated intervals. Accommodation there is none, and it would have to be provided in the shape of a hospital tent, &c, and orderly, the houses of the Resident Agents being of the most meagre description, none of them capable of offering sleeping-quarters, many of the Natives having more pretentious dwellings. I do not see how these people can be attended to medically without a suitable vessel being placed at the disposal of the Administration and practically in the hands of the Health Department. The French plan, on the other hand, might be adopted as in their outlying islands, and that is a medical man is Resident Agent with assistants for office-work. " I cannot emphasize more strongly than point out the urgent necessity that steps should at once be taken to relieve the enormous amount of suffering which exists in these islands, as I have pointed out to you in my report. " I brought eight patients back with me, two cases being beriberi, for observation and treatment, three cases for operation, and three medical cases. Had the hospital been larger I could have filled it three or four times over with deserving cases. There are ten patients in the hospital at the present time. " I naye > &c -> " Chief Medical and Health Officer. " Captain J. Eman Smith, Resident Commissioner, Rarotonga,"

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