A.—3

" The total visits to the out-patients department by the Maoris numbered 9,888, and 344 attendances, &c., were paid on Europeans. The most prevalent complaints were respiratory (especially in the colder months), and alimentary, from indiscretions of diet. About fifteen or twenty come daily for dressings, injections of bicreol, or for hook-worm treatment, the latter being always recommended. Filarial abscesses which are pointing well are always attended to in this department. Phthisis is alarmingly prevalent, arid there are many cases of haemoptysis. " The hospital in-patients for the year numbered 180, of whom 15 were European. Some major and many minor operations were performed under general anaesthesia. " Tubercular patients are being received on to the wide veranda facing the sea, were there is maximum fresh air and sunlight. " Numerous visits were paid to outpatients and to confinements. " Mass Treatment. —Following on the report of Dr.. Lambert, of the International Health Board of the Rockfeller Foundation, and his findings in regard to hookworm and round-worm, mass treatment was resorted to. Before December was far advanced all the schools of Rarotonga and Mangaia had received treatment, and all adults, save a few adherents of Ratana and a few Others still steeped in superstition. We are grateful for the enthusiastic assistance of Mr. Binsted, Superintendent of Schools, and of the headmasters and teachers in seeing that school-children came for their medicine. The whole population of Pukapuka, Manihiki, and Rakahanga have received mass treatment, also the majority at Mangaia, while Aitutaki is now being attended to. " There appears to be a steady increase in the population as a group, but especially is the increase noticeable in Rarotonga, Aitutaki, and Mangaia —i.e., where the people are receiving skilled attention. " Typhoid.—Sporadic cases occurred in Rarotonga, and an outbreak in Mangaia which would have been very serious had it not been efficiently handled by Nurse McGruther. " The schools were periodically examined and treated both medically and dentally, and clinics were held for the school-teachers. " Sister Walshe, who was in charge of Aitutaki, has at her own request relinquished her position, and I would like to record here her excellent services to the island, which deeply regretted her departure. We were fortunate in obtaining the services of Sister Greaves to succeed her. " I desire to record my appreciation of the excellent work done by the Matron and her staff at the Rarotonga Hospital, for I am assured that the hospital has never been so consistently taxed to provide accommodation. The Maori trainees discharge their duties efficiently, and should in time be fit to send to some of the islands. Indeed, one, Ani Pirangi, has already been tried out at Aitutaki, and nothing but good has been reported of her work there. " Bicreol is being used in all cases of yaws, and generally with excellent results. In our trip in December through the Northern Group, Pukapuka and Rakahanga were given the benefit of at least one injection where indicated, 220 for former and 45 for latter. " Leprosy.—The steady campaign against this disease, so deeply rooted in some of the northern islands, is being continued, and the combing being as thoroughly done as time will permit. It is our endeavour to recognize the disease in its incipient stages, so that cures will be quicker and more dependable. In May of last year the N.Z.G.S. " Hinemoa " transported forty lepers to Makogai. Another case has recently been discovered in Rarotonga. We must expect further cases till we get beyond the incubation period of the disease. Penrhyn is badly infected. " Recommendations and Suggestions for the Future Medical Welfare of the Group.—No one cognisant of the scattered nature of the islands coming under this Administration will deny the necessity for a third doctor to attend efficiently to the needs of these people. I would not suggest that he would be always necessary, but while we are so busily engaged combating leprosy and carrying on campaigns against the other foremost tropical diseases there is an urgent need. It would be well if such a person had experience in leprosy and in tropical diseases. " A consumptive sanatorium—a series of shelters of well-built leaf huts, open to the sun, would suffice, and is urgently called for. Tuberculosis is the scourge of the islands of Rarotonga and Mangaia, and the percentage of deaths due to it is high. The cost of such an institution should not be exorbitant. " If the Sanitation Committee fail voluntarily to clean up their respective villages, I would suggest the appointment of a Health Inspector to attend to sanitation, W.C.s, urinals, slaughterhouses, picture-palaces, ice-cream shops, food, cake and food vendors, bakeries, old houses, refuse-heaps, pigsties, water-holes, as well as the fumigation of infected houses, &c. " In making provision for the future the careful choosing and training of promising educated Maoris as Native medical practitioners is strongly advocated. It should be cheaper than the Fijian scheme, and should suit our requirements. " A district nurse capable of attending to the sanatorium and having general training as well, and Plunket, too, if possible, would be preferable to a second nurse for the hospital." Dental Clinic. The clinic, under Mr. F. B. Rice, 8.D.5., continues to do work of great benefit and convenience to the community. The clinic was open in Rarotonga from April till November, and in Aitutaki from December to March. The number of patients during the year totalled. 1,041, and the attendances 2,094. The fdllowing operations were performed : Fillings, 1,445 ; extractions, 1,198 ; miscellaneous, 901 ; total, 3,544,

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