A.—4a.

unnecessary. Another important change has been effected in the replacement by Samoans of practically all the Chinese labour employed in the European hospital, and for outdoor work on the hospital grounds. Only one Chinaman is employed in the European hospital, acting as assistant to the European cook in the kitchen. The work of the Chinese houseboys is done by junior Samoan nurses, who benefit greatly thereby, as it enables them to receive more practical instruction in the preparation of light diets —especially milk foods—and in the best methods of cleansing feeding-utensils. They also see the type of diet suitable for the different cases, and take more interest in the dieting of their patients when they eventually take over full nursing duties. The heavy work of scrubbing and cleaning is done by Samoan youths, some of whom eventually hope to be accepted as cadets for training as native medical practitioners. This work, with its regular hours, is good for testing the discipline of boys who have not had the advantage of education in one of the residential mission schools, and enables us to ascertain more of their character before we accept them as cadets. Statistics. This year the gross totals of cases treated are given for the financial year Ist April, 1924, to 31st March, 1925, to compare with the expenses incurred, whereas the analysed hospital statistics have been given for the calendar year 1924, which practice will be continued in future reports. Treatment—Medical. The past year has fortunately been free from epidemic disease as far as can be judged by the hospital records. A few sporadic cases of several of the infectious diseases have been admitted, but never in sufficient numbers to indicate the presence of an epidemic. Gastro-enteritis of infants and young children has been prevalent throughout the year, and has been one of the chief causes of death in the hospital. Pneumonia has been responsible for the largest number of admissions of any medical disease, and also has the largest mortality. Of the fifteen deaths that occurred amongst the 108 cases treated for the above-mentioned diseases (in the Samoan wards of the hospital), all but one occurred within twenty-four hours Of admission, showing that if we could get the patients suffering from these complaints brought up for treatment at an earlier stage of the disease we would probably be able to reduce the mortality. Enteric fever was fairly prevalent in the cold season of the year, but only eight of the twenty cases clinically diagnosed were confirmed by bacteriological or serological methods : of these, five were due to the Bacillus typhosus. The beneficial effect of the " malagas " (expeditions) for the eradication of yaws by injections of novarsenobillon is well shown by marked decrease in the number of patients applying for these injections at the hospital, and also in the much larger percentage of patients that received the full course of three injections. Confinement cases amongst the Samoans have come to the hospital in great numbers, but at present we admit only cases of difficult labour, as we have no accommodation for normal cases. Treatment —Surgical. Filarial abscesses still account for the greatest number of cases, but they have decreased in number compared with recent years. Several cases of tubercular peritonitis were subjected to exploratory laparotomy, but only in one early acute case was there permanent benefit; in the others the condition showed only temporary improvement. This may be accounted for by the firm fibrous rolling and matting of the great omentum that appears to take place at an early period jin theTdisease when it affects the Samoan. Chinese Coolies. The number of cases admitted to hospital and reporting for treatment has shown a steady decrease. The most noticeable feature is the reduction in preventable disease, such as beriberi, nil ; dysentery, nil; enteric fever, two cases. Apia Hospital.—Attendance, Operations, etc., for the Year 1924-25. General attendance (includes out-patient attendance, out-patient dressings, N.A.B. injections, and injections for elephantoid fever) .. .. .. .. .. .. 30,419 Out-patient attendance (Europeans and Samoans) .. .. .. .. .. 10,104 Out-patient dressings (Europeans and Samoans) .. .. .. .. .. 12,822 N.A.B. injections—First injections .. .. .. .. .. 3,789 Second injections .. .. .. .. .. .. 1,605 Third injections .. .. .. .. .. .. 449 5,843 Injections for elephantoid fever .. .. .. .. .. .. .. 613 European in-patients .. .. .. .. .. .. .. .. 130 Samoan in-patients .. .. .. .. .. .. .. .. 576 Chinese and Melanesian in-patients .. .. .. .. .. .. .. 277 Chinese and Melanesian out-patients .. .. .. .. .. .. .. 324 Operations —Major .. . . .. .. .. .. .. .. 70 Minor ~ ~ .. .. ~ .. .. .. 15 385

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