A.—3.

With the small staff which has been available much has been accomplished, but there is still a great deal more to do, and what we can still accomplish depends to a large extent on what funds can be made available for medical work, which to date has cost per head of population in the Cook Islands about one-half of the amount that is spent per head in New Zealand on medical and social services. Leprosy. —This disease has caused the Administration considerable anxiety, especially at the Island of Penrhyn, where leprosy was first introduced from Honolulu many years ago. Since then the disease has spread insidiously and somewhat rapidlv, and the majority of the cases already transferred to Fiji came from Penrhyn, situated 750 miles north of Rarotonga. The Government has approved the building of a segregation hospital at Penrhyn, which is to be placed in charge of one of the Native medical practitioners, and all cases in the Cook Group will immediately upon diagnosis be removed to this establishment for segregation and treatment "pending their removal to Fiji. 1 6 Tuberculosis.—This disease requires serious attention, especially in Rarotonga, where advanced cases are either taken into the General Hospital where there is little opportunity of isolating them from the other patients, or else they remain at their own homes where they are always a source of danger to the other members of the family. The provision of a consumptive sanatorium appears to be the only way to meet the position, and it would be of great benefit as patients in the early stages of the disease could be scientifically treated, as well as isolated. The provision of such an institution has necessarily been delayed on account of lack of funds. The following are extracts from the Annual Report of the Chief Medical Officer (Dr. E. P. Ellison) Rarotonga. Ihe general health has not been good. A shortage of staple foods following the hurricane lowered resistance to disease. The incidence of tuberculosis increased, and chicken-pox was epidemic. There have been four epidemics of influenza, some severe ; an epidemic of summer diarrhoea—altogether the worst year in my experience. Influenza occurred in April (mild), July (mild), September (severe), February, 1936 (severe). Chicken-pox.—Numerous cases. Leprosy.—One case discovered in Avarua in May. Typhoid.—Five cases due to drinking contaminated well-water. Paratyphoid B.—One case. Summer diarrhoea and vomiting of infants occurred in December and January in many parts of the Island, but was fatal to four in Tutakimoa and three in Titikaveka where parents failed to report until cases were either dying or in a state of extreme exhaustion. Trachoma.—One case. Several cases of pterygium. Yaws. —A few tertiary cases only. Disease practically wiped out in Rarotonga. Two primary cases—one from Mauke and one from Mitiaro. Venereal Disease.—Twelve gonorrhoeal cases have come voluntarily for treatment. A venereal disease clinic is always available. Syphilis.—Three cases (not Cook Islanders). The frequent communication between Rarotonga and Tahiti is always a source of danger. Rheumatic Fever.—A few cases only, but rheumatism in one form or another is fairly common. Filariasis.—Prevalent; with periodic fevers leading often to hydroceles and abscesses. Elephantiasis. —Several cases still to be seen. A more intensive anti-mosquito campaign is indicated. Gambusia have greatly reduced the mosquito nuisance in areas where taken. Malaria, measles, diphtheria, scarlet fever, and infantile paralysis are not known. Whooping-cough is said to have occurred in the past. Tuberculosis.—Sixteen cases died from it and many are seriously affected, some senile and many adolescent. Insanity.—Two cases ; one died, the other probably temporary. Skin Infections. —Boils, carbuncles, occurring chiefly during the months of December, January, and February from lack of vegetables. Scabies and seborrhcea are seen frequently. Linchen and Ringworm.—Several cases. Cancer is becoming more noticeable—three Maoris and one European. Of the Maoris two have European blood. It is very rarely that cancer is found in Maori of the full blood. Water-supplies. As practically the whole of the inhabited area of Rarotonga has a reticulated supply, the chief concern is now the water-holes from which some people still draw e.g., Tupapa, where, following an outbreak of typhoid, some of these were closed. Child-welfare.—Another year of praiseworthy voluntary work was completed and the cup awarded to Tukuvaine for the least number of deaths and most consistent work. The usual annual concert was held, followed some days later by Rarotonga's first baby show at Muri. Prizes were awarded for those under one year and those under two years. The movement seems firmly established.

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