A.—3a

15. The questions submitted to the Committee for consideration are set out in paragraph 17 of the Chief Medical Officer's memorandum attached. Items (a), (b), and (c) are covered by paragraphs 7to 13 above. The conclusions of the Committee in regard to the other points are as follows : — (d) What should be the future policy of the Fiji Government in determining what permanent major improvements should be undertaken ? (e) How should questions of improvements causing increased costs for maintenance be decided ? It was agreed that questions affecting expenditure at Makogai should be decided by the Fiji Government, in whom the entire control of the institution should be vested ; but that before any works of a major importance involving increased capital expenditure were undertaken, or any substantial increase was made in the working-expenses of the institution, the other Administrations concerned should be consulted. (/) What security, if any, are outside Administrations prepared to give that they will remain in the scheme for a term of years ? The Chairman explained to the Committee the difficulty in which the Fiji Government would be placed, if, having undertaken, after consultation with the other Administrations, further and extensive public works at Makogai, any of the Administrations at present participating in the scheme were to withdraw from it. The Committee were of the opinion that any Administration which had already expended funds in providing accommodation for its patients would be unlikely to withdraw, and it was decided that any administration which had not made and did not desire to make a capital contribution should be required to give a guarantee that it would continue to participate in the scheme for a period of twenty years. (g) What is the maximum accommodation that can be provided, particularly in relation to watersupply ? and (h) To what extent will the increase of numbers increase the cost per unit owing to heavy expense in increasing the water-supply ? The Committee are of opinion that there is ample room on the island for future extension of buildings to accommodate any number of patients that is likely to be received at the Asylum from the various Island Administrations in the Facific ; but in this connection the question of water-supply is one of paramount importance. The water-supply at Makogai has been a source of trouble for several years owing to the increased number of patients and the installation of septic tanks. In dry weather it has become necessary to shut off the supply of water for several hours each day. Steps are now being taken, to do what is possible by sinking wells and supplying tanks to supplement the existing supply, a sum of £500 having been provided for the purpose in the current year's estimates of expenditure. Pending the completion of investigations which are at present being made, a close estimate of the cost of providing a water-supply which will be adequate to meet the probable future requirements of the institution cannot be given, but the Committee are advised that there is an ample supply to be obtained by impounding stormwaters, the approximate cost of impounding 1,000,000 gallons being £5,000. After a complete examination of the proposals for supplementing the present water-supply, the Committee came to the conclusion that the construction of a dam and reservoir for this purpose was vital to the present and future needs of the institution, and should take precedence over all other works of a permanent nature. (i) Is the appointment of a second Medical Officer an urgent question ? The Medical Superintendent explained to the Committee the difficulties with which he is faced in endeavouring to attend single-handed to the medical wants of the patients and in administering generally the affairs of the institution. Shortly they are as follows : With the greatly increased number of patients his whole time is occupied in the ordinary routine work of the island, and he has no opportunity of undertaking any research work which would be of benefit to the patients ; there is no other professional opinion which he can consult in cases of emergency ; he lives a life of great isolation ; his work is of a very depressing nature ; and he finds it practically impossible to leave the island even for a day or two. The Committee are convinced that, with the great increase in the number of patients on the island, and in order to provide the Medical Superintendent with the opportunity of having short spells of leave away from it, the appointment of a second Medical Officer is an urgent necessity. The Chief Medical Officer informed the Committee that in his opinion it would be of great advantage if a Medical Officer of the Fiji Service were stationed at Makogai for a period after arrival in the colony ; he would thus be given an opportunity of acquiring first-hand knowledge in one of the most important branches of his work—viz., in the diagnosis of leprosy—and his duties at Makogai would provide him with an excellent insight into Government methods and the ordinary routine- requirements of a Medical Officer. The second Medical Officer would be definitely junior to the Medical Superintendent, and would be required to remain at Makogai for so long as the Chief Medical Officer decided. It appeared to the Committee that this proposal of the Chief Medical Officer would provide an admirable solution of the difficulty. (j) What system of rendering accounts and an annual financial statement of expenditure should be adopted ? It was decided that accounts should be rendered as heretofore by the Medical Department in the case of— (a) New Zealand patients : To the Director of Public Health, Wellington. (b) Cook Islands : To the Minister for the Cook Islands, Wellington. (c) Samoa : To the Administrator, Western Samoa, Apia. (d) Tonga : To the Premier, Tonga. (e) American Samoa : To the Governor, Pago Pago. (k) What is the urgency for provision of (1) a motor-road from Nasau to Dalice, and (2) a refrigerating plant ? (1) The present means of communication between Nasau and Dalice is either by launch or by the existing bridle-track. As a rule, the Medical Superintendent travels to Dalice on horse-back, a

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