5

A.—3

Attached, hereto are extracts from the annual report of Dr. R. S. Trotter, the Chief Medical Officer :■— Hospital. —The in-patients for the year numbered 113, with an average stay of twenty-one days. You are already familiar with the classes of cases treated, as these are given, with the monthly reports. There were two deaths, both cases dying shortly after admission. Out-patients ; 398 visits and attendances were paid upon Europeans and 11,246 upon Maoris during the twelve months. The heaviest work was in August, when 88 visits and attendances were given to Europeans anel 2,671 to Maoris, This was during an epidemic of influenza, introduced from Tahiti, which was soon, got under control through hard, and persistent work. The following month, the attendances had dropped to 23 and 751 respectively. The lightest month was October, with 25 attendances upon Europeans and 572 upon Maoris. The most troublesome thing we had to deal with during the year has been ascaric lumbricoieies, it very large number of children and a few youths being affected. This will never be eradicated until elejgs are exterminated. There is no trouble of this sort in the islands free from dogs, except in an occasional case which has visited the dog islaneis. All dogs should be destroyed. Suspicions have been aroused, from time to time in regard to ankylostomiasis, a disease causeei by another very troublesome worm, and our Assistant Medical Officer, Dr. McKenzie, has found the we>rm here in the stools of patients taken into the hospital for observation. He has not yet found either the ova or the worms in the dog here, but they have been found in the cat in Moorea (Society Group). Investigations are also being made by Dr. McKenzie in regarei to the mosquitoes carrying filaria. Systematic injections of Novarsenobillon and Neokharsivan are being given for yaws with, good results, both in Rarotonga, where one morning a week is set aside for this work, and in the outer islaneis as the occasions of our visits to them fit in. The settlements generally are in a clean and healthy condition, but there arc odd houses here and there to which we have to draw the attention of the occupants from time to time. The schools generally are clean, and the scholars also, and the teachers co-operate in trying to bring to our notice any unhealthy pupils they see. Sores and bad teeth are the chief affections. Outer Islands. — All have been visited by the Medical Officers with the exception of Manuae (a labour island), whose labourers have been inspected, before going anel on their return, ami no elisease found amongst them ; Nassau, another labour island, with labourers from, another group, who may or may not have been inspected in Samoa before going to Nassau ; Suwarrow, uninhabited at present; and Takutea, also uninhabited. Palmerston and the northern islaneis were found to be healthy, anel the settlements kept in a cleanly condition. There is a markeei eiocrease in the incidence of tuberculosis in these islaneis. There was a slight outbreak of influenza in Mauke, with which the Assistant Medical Officer dealt on the spot. Cases of yaws were treated there and in Atiu, as also in Aitutaki and Mangaia. There was an outbreak of influenza in Aitutaki, and as there was no Medical Officer there at the time the Island. Nurse, Miss Blackie, hael the handling of it. A case of yaws got to Manihiki from Aitutaki just before, my arrival there. It was segregated and dealt with at once when found, but another case (a sister of the former) had gone on. to Rakahanga before I got to know of it, and there was no opportunity of getting back there to deal with it. This is regrettable, as these northern islands have been clear for years. The teeth of the children in Palmerston and the northern islands are good ; in Aitutaki and Mauke, indifferent; in Mitiaro, Atiu, and Mangaia, fairly good. Lepers. —There has been no increase in the total number of lepers during the year. The case at Palmerston died. All are segregated, and all are under treatment with the ethyl esthers of Chalinoogra oil. Some of the cases show distinct improvement, but one cannot say that any are cured. Some remain, as far as one can judge, in statu quo ante, and. an odd one is worse. General Remarks. —On the whole the Islands have boon healthy throughout the year, the only epidemic disease anywhere having been influenza of a comparativeiy mild type in the islands mentioned. Vital Statistics. Attached hereto are returns supplied by the Registrar of Births, Deaths, and Marriages :—

I» rths. Deaths. Marriages. Island. European. Maori. M. E. European. Mai m. I m ,m. I ori. Euro " Maori, pean. Remarks. M. I?. I F. Rarotonga Aitutaki Mangaia . ."• Atiu Mauke Mitiaro Manihiki Rakahanga Penrhyn 4 3 1 .. I 54 19 18 16 13 1 70 25 10 23 8 3 7 1 1 30 15 9 7 13 1 7 3 3 33 1.4 7 11 7 2 3 3 8 3 32 10 8 7 3 To 31 Dec, 1923. To 31 Mar., 1924, 5 8 11 42 4 To Oct., 1923. To 31 Dec, 1923. 4 To 31 Doc, 1923. Totals . . 5 | 3 145 148 2 88 8.8 3 70