26

A.—3

outside, but these facts need not prevent a stop being put to the proliferation of the insects as much as posible. There seems no reason why a by-law should not be made compelling all occupiers to keep the vicinity of their dwellings clear of stagnant water, and to screen their water-tanks; no hardship would be inflicted, and I am of opinion that the mosquitoes could be reduced in the villages by 90 per cent, with corresponding benefit to the community. Active operations against mosquitoes are now being undertaken in most tropical British or American colonies, and it is certainly advisable to take the matter very seriously in hand in these islands. Leprosy. Before visiting the leper islet I discovered one case of leprosy in the settlement of Arutanga. This was the case of a youth about twenty-one years of age, born in Manihiki, but who had resided in Aitutaki for one year and seven months. From the history of the case the disease had probably been contracted in Manihiki, although the patient had not noticed any abnormal symptoms until after he had been some months in Aitutaki. His parents and a sister and brother are said to be alive and well on the Island of Manihiki. On visiting the leper islet I found, in addition to the above patient whom I had sent there, three reputed lepers (male), and one woman who was not diseased, but who had elected to accompany her husband into exile. Two of the men were without doubt lepers, but the husband of the woman just mentioned I did not consider leprous, and I therefore directed that this man and his wife be allowed to return to the main island. There are at present, therefore, only three lepers on the islet, all males. The conditions under which I found these unfortunate people living when I paid my visit were regrettable. No accommodation whatever has been provided for them. They themselves have erected some low huts made of coconut and pendamus leaves, much inferior to a purau house. There is no roof of size sufficient to form a collecting surface for rain-water, which consequently has to be brought from the main island. This water is stored in a small zinc tank open at the top, and only large enough to hold the drinking-water. At my visit there was only a small quantity of somewhat dirty water at the bottom of the tank, with several dead insects floating on the top. Of water for washing or for bathing sores there is none. The condition, therefore, of the lepers as regard cleanliness needs no description. In these days when leprosy is not by any means regarded as an absolutely incurable disease it seems very wrong that these people should be confined under the above conditions and removed from all medical attention, which they are as much entitled to as sufferers from any other malady. Until more satisfactory arrangements are made with regard to the lepers in these islands, the least that can be done is to satisfy their requirements in the way of shelter, water, food, and clothing. A shelter, which need only be made of purau, could be put up at little cost, and if roofed with galvanized iron to serve as a collecting surface for rain-water, and a suitable tank erected, the first two items would be sufficiently provided for. With regard to food and clothing, the present unsatisfactory system is to leave the provision of these to the friends and relatives. It would be well, therefore, if the Resident Agent could see his way to visit the islet from time to time, and observe for himself if the people concerned were doing their duty in this respect. Arrangements made for the Treatment of the Sick. On my arrival on the island a dispensary was set up in the Courthouse, at which the sick were attended to daily. On Tuesdays and Fridays visits were paid to Vaipae and Tautu. In all, 727 visits were made at the dispensary, comprising 522 new cases and 205 second and subsequent attendances. 199 visits were paid to patients at their own homes. Summary of Diseases treated. Diseases of the alimentary system ... ... ... ... ... 85 Diseases of the respiratory system ... ... ... ... ... 67 Diseases of the circulatory system ... ... ..." ... ... 9 Diseases of the nervous system ... ... ... ... ... 23 Diseases of the lymphatic system ... ... ... ... ... 8 Diseases of the urinary system ... ... ... ... ... 5 Diseases of the female organs of generation ... ... ... ... 41 Diseases of the male organs of generation ... ... ... ... 5 Diseases of the connective tissue ... ... ... ... ... 9 Diseases of the female breast ... ... ... ... ... 8 Diseases of the eye... ... ... ... ... ... ... 11 Diseases of the ear... ... ... ... ... ... ... 3 Diseases of the nose ... ... ... ... ... ... j Diseases of the teeth .. ... ... ... ... ... 37 General diseases ... ... ... ... ... ... ... 24 Syphilis ... ... ... ... ... ... ... ... 21 Elephantiasis ... ... ... ... ... ... ... 17 Leprosy ... ... ... .... ... ... ... .. 3 Diseases of the skin ... ... ... ... ... ... 71 Diseases of the organs of locomotion ... ... ... ... ... 74 I have, &c, A. R. Maclcrkin, Assistant Medical and Health Officer. The Chief Medical and Health Officer for the Cook Islands.