A.—3

12

avail themselves of it. Thus skiiirdiseases (and these are many and varied), tropical ulcers, and the lesions of frambcesia, &c, are rapidly clearing up. Many minor operations have been done, and people must now recognize the importance of asepsis. I regret to say that there was a heavy infantile mortality. To combat this we must uproot some of their old deep-rooted practices. One is their early weaning of infants at two, three, and four months, and substitution of the mother's milk by taro, banana, &c. This early weaning appears to be due to their custom of adopting infants out. Thus many of the deaths have been due to malnutrition. In cases where the child has contracted influenza and died it has been due as much to negligence on the part of the parents in carrying out medical instructions as to interference from witch-doctors, who abound in certain villages. A great deal can be done by education, and I think a translation into Niue, with adaptations, of the Plunket pamphlet, as suggested originally by Nurse Copland, an excellent idea. That we have in charge of'the London Missionary Society here a gentleman of the standing of the Rev. Mr. Beharrel, with a tendency towards medical work, is also fortunate. No doubt he will continue to grant us'space in his monthly paper, Talahau. But to spur the mothers on, to make them anxious for the welfare of their babies, nothing to my mind would appeal to them more than the knowledge that they will be rewarded. Therefore I think your suggestion as to a baby bonus an excellent one. I only hope that your increasing expenditure in the hospital and education will not prevent you from carrying it into effect. The future of this island depends upon a diminishing death-rate. I desire to thank Mr. Morris for his willing assistance and advice during the year. The heavy tines inflicted on witch-doctors have had a deterring effect on their activities. The improvement of the roads most used medically has not only brought all villages within easy access, but has lessened the wear-and-tear and general upkeep of the car. I desire to express our appreciation of the kind gift of this motor-car, which has enabled so much to be done, and which I am sure has been the means of saving many valuable lives. The people must surely now recognize that the Government desires to help them. A hospital is now in the course of erection, and ere now would have been completed were, it not for the unfortunate loss of the " Jubilee." ' During the period under review the, health of the island was not good. There were three epidemics of influenza, the first being mild, with few deaths, these being among the aged. But in the months of August and September, following a visit from Samoa by the auxiliary schooner " Ajax," there swept over the island a severe type of influenza, with pneumonia a common complication. To my mind this epidemic in no wise, differed from the pneumonic influenza which swept over New Zealand during the latter months of the year 1918. The symptoms or physical signs, together with the' course of the disease, were similar. Congestion occurred mostly amongst the strong, virile, male adults, and the rapidity of its appearance was remarkable. It was noteworthy that both the young and the aged generally escaped complications. The number of deaths was small, fortunately —far smaller than I expected, for at one period there were over a hundred pneumonias. I attribute this result to the. Niucans being non-alcholic, to the improved means of conveyance, to their previous experience in combating influenza being excellent training as to method, and to the absence of fright. When we take into consideration that many deaths in New Zealand were from relapsing pneumonia due to over-anxiety to resume work, and that the Niuean has no such desire when ill, we see that this alone must have been an important factor in reducing the number of deaths. Another epidemic followed the succeeding visit of the same vessel from Samoa, but though this was of the ordinary febrile type complications occurred amongst the young, leading to a high infantile mortality. This was due to startling negligence on the part of parents in carrying out instructions as much as to interference on the part of medicine-men and. of witch-doctors. It is noteworthy that on both occasions a clean bill of health was presented and a thorough examination did not reveal trouble. The run from Samoa is but a matter of thirty-six hours, which falls far within the incubation period.of most infective fevers. I would therefore suggest for your consideration the improvement of the quarantine station at Amanau, both in regard to landing and accommodation. That there is an increasing passenger-list is worthy of notice. Water-supply : Last year's rainy season was. later than usual, and cave-water was being used. To provide against the contingency again arising I would further suggest the supplying of large tanks to villages in most need of them, or the sinking of pumps into caves with drinkable water. Consumption: This disease is becoming more and more noticeable, and I think the only satisfactory method of combating it is the provision of shelters d la Samoan. Leprosy: There was one case brought under my notice and isolated. Venereal disease is still very prevalent, especially the gonococcal variety. I hope, however, to get these diseases under better control this year. Skin-diseases are slowly and steadily disappearing. Many surgical cases came under notice, such as appendicitis, ulcerations of the stomach and duodenum, likewise cervical glands, &c. I view the future of this branch of the Polynesian race optimistically. The, old idea of their being doomed to extinction Ido not entertain. They are a race thirsting for education. Should it be denied them ? Marked evidence of their desire to learn is shown in their free gifts of land for schools. Their clearing of the, same, the hewing-out of timber, and building of the schools gratis is a healthy sign, I take it, pointing to a prosperous future. 1 have, &c, E. P. Ellison, The Resident Commissioner, Niue Island. . Chief Medical Officer.