23

A.—3

From these considerations it is evident that the question of providing a constant and plentiful supply of water is one which from the standpoint of public health demands immediate attention. The provision of large concrete tanks for the collection of rain-water might prove sufficient, but it might be possible to locate some of the underground channels carrying water under the Makatea from the central valley to the sea, and if this were done wells could be sunk and the water brought to the surface by means of pump's. As mentioned above, this has been found possible in one instance in the village of Onerua, where, however, the well has been sunk too near the sea, and consequently at high water the water is more or less salt. Disposal of Excretal and other Refuse. The houses of the Europeans are provided with dry closets, but the Maoris follow the usual Native custom of utilizing the bush or seashore for the deposition of the excreta. Owing to the activity of the purifying influences of the sun, wind, and rain in a climate such as that of Mangaia, and probably more particularly on account of the action of the nitrifying organisms which flourish in a rich soil containing much organic matter, offensive material is soon oxidized and rendered inoffensive, so that this habit of the Natives cannot be said to constitute a nuisance. It is probable that the introduction of privies or closets would be from some points of view more objectionable, at any rate at the present time. Domestic refuse is usually thrown down in the vicinity of the dwellings, and, although remnants of food are soon disposed of by the numerous pigs and fowls, tins, coconut-shells, &c., are left lying about in a very unsightly manner, and by forming receptacles for stagnant water offer a breeding-place for mosquitos. A useful regulation might be made dealing with this question, in. view of the importance of destroying all mosquito breeding-grounds, it being now well established that the insects act both as carriers of disease and as the host of some of the parasites causing disease in man. Leprosy. No case of this disease was observed. Elephantiasis. This is not of very common occurrence in the island; probably not more than 1 per cent, of the adult population show manifestations of filarial infection, a very small proportion as compared with, say, the Island of Huahine, where seven-tenths of the adult male population are affected. Yaws. This disease is very common, and probably the majority of the children pass through an attack sooner or later. Owing to the want of cleanliness of the Natives, and to the slight regard which they pay to this condition, extensive sores are frequent, and in several instances cases came under my observation in which the subsequent cicatricial contraction had led to crippling of the limbs so serious that in two cases affecting young men there was absolute inability to walk of some years' duration. Syphilis. A considerable proportion of the population suffers from this disease. Treatment is usually sought only when tertiary lesions of the skin, Arc, manifest themselves, and the disease is rarelyseen in its earlier stages. Hereditary syphilis is frequently observed. Other Diseases. Muscular rheumatism is of frequent occurrence, as are also chronic bronchitis and asthma. It is probable that the laborious work entailing exposure to chill in connection with the extensive taro swamps acts as a powerful predisposing circumstance with regard to these diseases. Skin-diseases : As mentioned above, the majority of the Natives are affected with a form of body-ringworm (Tinea versicolor). Other skin-diseases are common. Arrangements made for the Treatment of the Sick. A room suitably fitted with shelves for use as a dispensary was placed at my disposal through the kind offices of the Rev. J. Hutchin, of the London Missionary Society. At this dispensary the sick were attended to each morning except on Tuesdays and Fridays, which days were set apart for visits to the settlements of Ivirua and Tamarua. In the afternoons 1 was able to visit at their homes those who could not attend the dispensary. Cases requiring Hospital Treatment. In addition to diseases for which immediate curative treatment could be instituted, a certain number of cases were seen requiring hospital care, and for which only palliative treatment could be given at the time. Some of these cases refused to undertake the journey to Rarotonga, being naturally diffident about exhibiting their infirmities on board a public steamer; in other cases of loathsome or contagious skin-disease I did not, for obvious reasons, consider it advisable to recommend the journey. I am convinced, however, that if proper transport facilities were provided for such cases much good would be done by taking advantage of the well-equipped Hospital at Rarotonga. Number of Gams treated,. In all 547 visits were made to the dispensary, comprising 337 new cases and 210 second and subsequent attendances. One hundred and sixty-one patients were visited in their own homes in Invirua and Tamarua, and 39 irr Oneroa. I am, &c, A. R. Maclurkin, Assistant Medical and Health Officer. The Chief Medical and Health Officer for the Cook Islands,