18

H.—3l

Thirty-seven applications have been received from patients seeking admission, and so far as possible they have been personally examined by Dr. Roberts or myself to ascertain their suitability. That this precaution is necessary is evident from the condition of some who are too evidently in so advanced a stage that treatment is hopeless, _and it is sad to notice the number of deaths among the applicants. The function of such an institution is not yet fully understood, and applications are largely from those in the later stages of the disease, the earlier cases evidently not comprehending that the course of treatment is particularly suited to their condition. A difficulty presents itself in regard to finding suitable light work for the cases under our care, for the monotony of the life would be greatly relieved, and the patient often benefited, by some such employment. Nor should this monotony and the isolation of the situation be forgotten in regard to the staff, and every effort will be required to provide amusement, and in all ways lighten the burden and dull routine of the work. Quarantine Precautions. In addition to the ordinary routine work of the Port Health Officer, the following special matters must be reported : — The Precaution against Plague. —All vessels from infected ports were quarantined and fumigated. The licensing and examination of passengers continued till the 6th August from the Ist April. Till then nineteen vessels and over two thousand passengers were so examined. Two defaulters were prosecuted and fined. Deposits on all vessels from infected ports were obtained to cover cost of disinfection. All this entailed an enormous amount of work on the office. Later, vessels arriving from Honolulu, where plague had broken out, were subjected to special examinaion. Return of South African Troopships. —From the arrival of these troopers in August till the last cases left Motuihi at the end of September a very great deal of time was occupied in attending to the various matters resulting from their presence here. Even on into October the accounts for the expenses at the Quarantine Station kept the office very busy. The " Britannic" arrived on the 7th August, with three cases of measles and one of pneumonia on board. These cases were conveyed to the Hospital. All the blankets were collected, and sealed up in the hold. The "Montrose" arrived on the 19th August. On boarding her with Dr. Sharman we found that there had been an outbreak of scarlet fever and of measles on board, while many of the men were suffering from broncho-pneumonia, due, no doubt, to the insanitary conditions which seemed unavoidable in troopships conveying irregular contingents. It must be admitted that in the cleanliness and order which result from discipline, the colonials had much to learn from the British soldiers, who by obedience and systematic attention to detail are able to avoid the evils which were so strikingly apparent on these vessels. The clean smart appearance which Thomas Atkins retains, even after a long voyage, was conspicuous by its absence in these men. We were informed that the scarlet fever had hroken out shortly after leaving Africa, and that measles had appeared later. Evidently the medical arrangements had been unable to cope with the outbreak, and a state of chaos reigned. Thus we could not at first learn from the medical officer in charge the number of cases of each disease, and a hurried classification had to be made, partially relying on the statements of the patients themselves. This occasioned some delay. Meanwhile the whole of the kits were opened on deck, and the contents carefully sprayed with formaline by the Fumigating Officer, and all the men not in hospital were inspected by Dr. Sharman and myself. It was found that over eighty cases were in hospital—about fifty being scarlet fever and measles, and the bulk .of the remainder pneumonia. How many of these latter were really the sequelae of infectious diseases it was difficult to ascertain. It was decided to place all the sick who could with safety be landed upon Motuihi, and convey the more dangerous (about eighteen in number) to the Auckland Hospital, where the authorities had been warned previously of the likelihood of such a contingency. Owing to the lack of wharfage accommodation at the quarantine island, a difficulty was experienced in landing the patients, which had to be done in boats, the vessel being taken round to the north side, as a fairly heavy sea was running at the usual landing-place. In all, thirty-eight cases of scarlet fever (mostly convalescent), nine cases of measles, and twelve of pneumonia were placed on Motuihi ; the available accommodation, when these cases were classified in the different buildings according to their ailments, being completely taken up. The buildings were found in first-class condition. Acting on instructions from Dr. Sharman, who had visited the island a day or two previously, the caretaker had fires burning and beds ready. The troop surgeon and ten orderlies were detailed to look after the patients, and a day or two's supplies of food and drugs were landed with them. The " Montrose " then returned to Auckland, but the more serious cases were not sent to the Hospital till next day, as it was by this time very late. I personally supervised their removal by ambulance and cab. A sergeant and two nursing sisters accompanied them to assist the Hospital authorities. The cabs used were subsequently disinfected by Inspector Winstanley as a precaution, though the cases supposed to be infectious were sent in one of the ambulances. After the removal of these cases the sick-quarters were thoroughly fumigated, but as fresh cases of measles were developing among the troops the vessel was ordered out into the stream again, the military authorities finding it impossible to prevent the public from being admitted on board, though orders had been given to this effect. During the eight days the "Montrose" was in Auckland nine fresh cases of measles occurred, and were sent down to Motuihi. Others occurred on shore since ; and when they found themselves ill, the men, fearing detention in quarantine, stayed on shore with friends without reporting sick or obtaining permission from the military authorities. This no doubt resulted in the spread of measles in the district, as the numbers notified rapidly rose from this time.