A.—4 A,

the party moved on to the village where the next injections were to be given : in this way injections were given every day from Monday till Friday, and on the Saturday the party returned to the other end of the district in readiness to start the second injections on the following Monday morning. This is the method usually adopted on these malagas. Throughout the district 695 people were injected, consisting of 35] males and 344 females, who received 1,892 injections. The proportion of these cases to the population was slightly less than the average throughout the islands. The age incidence of people receiving injections is shown in the following table. The ages are frequently incorrectly given and have to be estimated, but probably as a whole the table is fairly accurate, except for the first and second age-groups, which shoidd have larger numbers, because most of the primary and early secondary cases were not brought for treatment.: — TABLE OF AGE INCIDENCE. Up to 1 year .. .. 2 Up to 13 years .. .. 32 ~ 2 years .. 26 „ 14 ~ 16 3 „ .. ..36 „ 15 „ .. 14 4 „ .. ..36 „ 16 „ ..12 „ 5 „ .. ..37 „ 17 „ ..8 „ 6 „ .. ..41 „ 18 „ ..10 „ 7 „ .. ..46 „ 19 „ .. ..11 „ 8 „ .. ..40 „ 20 „ ..9 „ 9 ~ .. .. 31 Adults .. .. .. 188 „ 10 „ .... 47 — „ 11 „ .. ..27 695 „ 12 „ .. .. 26 During this malaga the type of each patient's lesion was noted, as well as the dose, and any reason for giving less than the normal amount. In August, 1924, a second malaga was made through the same district, and nearly all the-cases were seen that had received injections on the first malaga, and from this source, together with those that had come to the Apia Hospital, it was found that seventy-seven cases had relapsed, comprising thirty-one females and forty-six males. Number of cases receiving one injection, 24 ; relapses, 4 16-6 per cent. Some of these cases did not belong to the district, and had left before the second or third dose was given, so that the proportion of relapses is certain to be inaccurate. Number of cases receiving two injections, 135 ; relapses, 20 = 14-8 per cent. Number of cases receiving three injections, 536 ; relapses, 53 —10 per cent. Eight of the fifty-three cases received doses that were smaller than our standard dose for age, due to the patient having associated illness, such as mumps. The cases were divided into the following types : (1) Primary sores ; (2) generalized secondary papular rash ; (3) dermatitis, secondary ; (4) " crab " tonas ; (5) secondary ulceration ; (6) gummatous infiltration and ulceration ; (7) synovitis ; (8) dactylitis ; (9) tibial nodes and sabre-blade tibiro ; (10) dermatitis, slaty ; (11) plantar and palmar dermatitis ; (12) hyperkeratosis. The number of each type injected and the number of relapses is shown in the following table : —

Type I—primary1—primary sores : The proportion of relapses in the few cases treated is very high. This is partly explained by the fact that four out of the six cases were so ill that they received only half the dose that they should have had for their age. Another case was a breast-ulcer on a mother nursing a baby which had the primary sore, and a generalized secondary rash, well marked round the lips, which was so ill that it could only have a small dose, 'which did not""cure the condition and probably led to the mother being reinfected. The number of primary and early secondary rashes seen appeared to be so small compared with the numbers in the later stages that at the time of giving the second injection an order was given that all children under two years were to be brought up for inspection. At this inspection only one child was seen that had reached two years of age without being infected, but none was infected under the age of six months.

18

Type of Case injected. — _ _ _ — Totals. 1. 2. 3. | 4. 5. I 6. 7. 8. 9. 10. 11. j 12. Cases receiving Three Injections. Number of cases injected .. ..I 6 1 196 j 110 I 89 5 37 1 2 3 28 54 j 5 536 Number of relapses .. .. j 5' 32 6 8 .. 2 I 53 Percentage of relapses . . .. 83 16*3 I 5*45 | 8-9 .. 5*4 . . .. .. . . . . . . 10 Cases receiving Two Injections. Number of cases injected .. .. I 1 1 41 I 30 22 2 ! 14 1 | .. I .. I 9 | 13 2 | 135 Number of relapses . . .. j 1 13 3 1 .. 2 20 Percentage of relapses . . .. 100 ' 41-4 ' 10 4-5 . . 14-3 .. ! .. ! .. I .. . . .. 14-8 Cases receiving One Injection. Number of cases injected .. .. .. 7 8 II II 4 I .. I .. I .. I If ] 1 24 Number of relapses .. .. .. 2 2 ..j .. ..I .. .. .. .. .. .. 4 Percentage of relapses .. .. .. 28-5 25 .. .. .. .. j .. . . j .. 1 . . .. 16-6 I I I I I i I