17

A.—l

Enclosure. Department of Public Health, Hosprtals, and Charitable Aid, Sin, — Wellington, N.Z., 3rd December, 1.913. I have the honour to submit the following interim report on the recent epidemic of smallpox under the headings outlined in the letter from the Assistant Secretary of the Local Government Board to the Under-Secretary of State, forwarded to His Excellency the Governor under date of 14th August, 1913. Cases of smallpox notified to date — European ... ... ... ... ... ... ... 113 Maori ... ... ... ... ... ... ... 1,771 Total ...... ... ... ... ... . 1,884 Last case notified, 4th November. Deaths reported (verified) — European ... ... ... ... ... • ... Nil. Maori ... ... ... ... ... ... ... 26 It is well known that many deaths have occurred among the Maoris that have not been reported, and the Department has reason for believing that there have been at least forty-seven deaths among the Natives. With the exception of one case reported in Wellington and one in the Hawke's Bay District all the outbreak has been confined to the Auckland Province. At the time of writing—3rd December —there are four cases of smallpox in the Dominion, viz : two convalescent cases at Port Waikato, one convalescent case at Tauranga, one case convalescent at Taupiri. These cases will be discharged during the ensuing week. It will be noted that there are no cases in Auckland City. 1. Source op Infection. There is no doubt that the disease was introduced to the Bay of Islands district by a Mormon missionary named Shumway, who left Arizona, U.S.A., on the Bth March, Vancouver by s.s. "Zealandia" on the 19th March, arriving at Honolulu on the 26th March, Suva on the 4th April, Auckland on the Bth April. After a stay of four days in Auckland Mr. Shumway arrived at Ramarama, in the Bay of Islands, on the 13th. Prior to his arrival at Ramarama he felt ill, and was considerably indisposed, the chief symptoms being pain in the back, vomiting, and headache. From Ramarama Mr. Shumway proceeded to Te Horo, 14th April, and Awarua, 22nd April. It was at Te Horo that Mr. Shumway (and others) first noticed he had a rash. It is difficult to get exact dates from Native sources, but Mr. Shumway is confident that smallpox broke out at Te Horo and Awarua within a fortnight of his visit to these Maori settlements, and from what can be gathered from Native sources the epidemic first appeared at the Maungakawhia and Mangere was within fourteen days of the return of their representatives from the hui at Te Horo. A few days before the Mangere case was recognized as one of smallpox a hui had been held in this pa, which was attended by Natives from various parts of the Waikato. This hui was responsible for the outbreaks of the disease in the Maungataotiri, Taupiri, and Parawera pas (villages). (Note. —Mr. Shumway has no knowledge where he contracted the disease. It is well known that a mild form of smallpox has been prevalent in the United States and Canada for some years past, and a few cases have been reported in Vancouver during 1912-13. It has been stated that when the "Zealandia" touched at Suva on her voyage to Auckland in April last a Chinese coolie ship with cases of smallpox on board was in quarantine at that port.) 2. Measures taken to Prevent the Spread op the Disease. Briefly, the measures taken to prevent the spread of the disease were as follows : — A. Local Measures. —The patients and all contacts were isolated as soon as possible. Where practicable the patient was removed to hospital, and the contacts vaccinated and kept under observation for- fourteen days. In some instances all contacts were quarantined. As soon as the patient was removed the premises were disinfected or burned as the circumstances demanded. B. General. —Vaccine was first issued to medical practitioners in the infected districts, and the public urged to submit to vaccination without delay. Several medical officers were specially appointed by the Department to visit the Native kaingas, to make house-to-house inspection. to isolate suspicious cases, and to vaccinate Natives young and old. As the disease was chiefly prevalent among the Natives measures were promptly taken in the infected districts to prevent their travelling by railway, shipping, and public conveyances. The police were instructed to prevent Natives from visiting the European settlements. The chief Native routes were blocked. It was at first very difficult to prevent, Natives from infected districts from travelling to other kaingas —the wandering instincts of the Maori are well known ; nevertheless, owing to the loyal assistance of certain chieftains and other Natives of authority, the Department was better enabled to restrict the movements of the Natives than was at first thought possible. As soon as a sufficiency of lymph was assured vaccination became general throughout the Dominion —particularly the North Island. 3. Hospitals. Where practicable all cases were removed to the nearest hospital, otherwise they were treated in situ, but the latter was found to be most unsatisfactory. Consequently camp hospitals were

3—A. 1.