A.—3

22

from excessive overeating and irregularity of meals. This fact is well borne out by the absence of the condition in those who stay in hospital for any length of time, where they receive daily three ordinary meals. " Several cases of pneumonia received attention, and all these did well and made good recoveries. In all cases it was the basal lobes that were picked out, and in no case has one encountered the severe type that is met within New Zealand. Judging from the inseverity of the attacks here, one would say that recovery is almost certain where the proper care and treatment is administered. " Nine fresh cases of pulmonary tuberculosis were met with, and from this condition there were nine deaths in old standing cases. In some cases where there was hsemoptosis with marked clinical symptoms the recovery was remarkable, and therefore one tends to suspect another infective agent, possibly bronchial spirochsetes. " One case of glandular tuberculosis was treated, and one of tuberculer peritonitis, which died. Both were in young children. " The deaths numbered 65, as compared with 69 last year, and most of the deaths were of persons over sixty. " Neglect of the Sick and Aged. —At times one encounters marked cases of neglect, especially of the aged. ' Only an old person 'is an expression one commonly hears. In several instances one feels that this callous indifference has been a potent factor in the cause of death. With reference to the sick the negligence arises mostly in failing to send for the Medical Officer until the patient is in extremis. " Care of the Infants. —This is a matter which is receiving great attention, and in this connection Sister Butler is doing admirable work. There is no doubt that several young weakly babies would have died if it had not been for the careful and untiring attention they received from the Sister. Young mothers are too prone to leave the care of their newly born children to old women who chew taro and other indigestable products and then give it to the babies. Many mothers are not over keen to nurse their children, and artificial feeding on sweetened condensed milk is too often resorted to. One would attribute this largely to laziness. In all cases where the natural means of feeding is available it is most emphatically insisted upon. Glaxo is not stocked by the traders, so a stock is kept at the hospital, and this can be purchased by the Natives at landed cost. Feeding-bottles are given out free, and Sister Butler gives instructions as to their use and the means of keeping them clean. " Premature and weakly infants, and babies whose mothers cannot supply the natural food, are brought to hospital for three months. This gives these children a good start, which they would not receive in their homes. At the end of the term mentioned the female who is to have the future care of the child is brought into hospital for one week, and receives instructions as to how to carry on. When the child is returned to its village it is brought to the car on the days of the island round, so that progress may be noted. " The deaths in children under one year were nine, and of these some were victims of the old custom of feeding already referred to. " Venereal Disease. —Thirty-seven cases of gonorrhoea came up for treatment. There is still a tendency to conceal this condition and to tinker about with Native remedies. The police have done good, work in bringing suspects up for examination. In all instances both parties were treated, and if a sufferer refused to divulge the name of the individual conveying the infection threats of punishment brought to light the other offending party. The gonorrhoea is of a mild type, and in the male rarely gives rise to the disability of stricture. " Eye Conditions.—The severe epidemic of conjunctivitis that occurred last year and kept us so busy at the hospital was not in evidence this year. " Skin Conditions. —A few cases of scabies were treated. The Alofi and Hakupu schools were entirely cleaned of any skin-disease, and attention has also been paid to the London Missionary Society subsidized schools. Periodically sulphur in a palatable form has been issued to the teachers, and each child receives a course of sulphur. This has proved beneficial. " Treatment of Yaws. —For this condition 199 injections of Salvarsan were given. " Weekly Rounds. —The usual rounds of the outlying villages were made twice weekly, when drugs were left at the respective villages, the sick attended to, and houses inspected. Patients treated in their villages numbered 677. " Hospital. —The Natives now come in willingly when advised to do so. Persuasion has to be resorted to only amongnt the older folks, who seem loath to leave their fales (houses) when sick. The number of patients admitted to hospital was 205, and average duration of stay was nineteen days. 2,770 visits were made to the dispensary and surgical out-patients department. " In August another leper case, in a girl of eleven years, was detected and isolated in the hospital grounds. In November the two cases then in isolation were removed to Makogai. " The work of the staff of Native nurses has been highly satisfactory. One of the nurses left towards the end of the year, and her place was filled by a senior pupil of the Tufukia School. " The smoothness with which this institution has been run during the past year is due entirely to the good work of Sister Butler, who deserves much praise for the manner in which she has trained the Native nurses and for the high efficiency to which she has brought them. Her admirable work amongst infants has already been referred to. " Before closing this report I desire to mention the excellent help Mr. A. McKenzie, headmaster, Tufukia School, is rendering the medical staff by the lively interest he is taking in our endeavours to break down old injurious customs. Improvements in certain sections of our work will come only by the way of education and patient work on the minds of the young. Any subject connected with the medical department which can take the form of a lesson is eagerly seized upon by Mr. McKenzie and