A.—4b

agitations raised in opposition to the Administration, but they have never been substantiated. lam compelled to recall to your memory a series of fourteen allegations which were made in 1922 against the administration of the Medical Department at the instigation of the Apia Chamber of Commerce, of which most of your committee were prominent members. These charges—some serious and some trivial —were inquired into by a Commission consisting of His Honour the Chief Judge, Mr. C. R. Orr Walker, who found two of the complaints to be in some part true but quite trivial and unavoidable, and the other twelve to be entirely disproved. His Honour concluded his report as follows :— '' I deem it but fair to remark that, notwithstanding the fourteen allegations —some serious and some trivial —no adverse comment can be made upon the management of the hospital, whilst the staff have come through the ordeal of the inquiry with their reputation absolutely unsullied." The Administration, in view of the present state of health of the Native people, quite properly resent any inference that the Medical Service of the Territory is in the least degree less efficient than it was in 1922, and your assertions in this respect must be dismissed as being not only untrue but quite unsupported. On the other hand, I refer you to the high tributes paid to our Medical Department by two such highly qualified and impartial observers as Dr. S. M. Lambert, Director of Pacific Operations, Rockfeller Foundation, U.S.A., and Dr. Norman Whyte, travelling representative of the Medical Secretariat, League of Nations, Geneva. But the most striking testimony is to be found in the steady increase of the Samoan people in health and numbers. The natural increase last year constituted a record. (6) European Nurses. —It is a travesty of facts to infer that the nine European sisters attend only to the 144 European in-patient admissions for the year. It is rather unbelievable that the authors of your report are so little conversant with their subject as to imply that the Samoan in-patients receive no treatment or supervision from the European sisters. There are nine European women on the staff —one matron and eight sisters. Four sisters are on duty daily in rotation in eight-hour shifts, two being in charge of the European hospital and two of the Samoan ward and Fales. Their hours are 6 a.m. to 2 p.m., and 2 p.m. to 10 p.m. One night sister takes charge every night for one month of the whole hospital from 10 p.m. to 6 a.m. One siste has charge of the operating-theatre and Samoan out-patient department, being liable to recall as required. One sister is in charge of the maternity department (European and Samoan), lectures to the nurses on midwifery, and is also in charge of the Sisters' Home and is sub-matron. One sister, after completing her month of night duty, acts as relieving sister for the following month to enable the other sisters to have three days off each per month. It has been found that this break is necessary in the climate. In addition, after six months of service, each sister gets seven days' leave added to her three days' monthly allowance. There is no annual holiday given other than the days mentioned. This plan works well, the work in the Samoan ward and Fales being very trying, especially in hot or wet weather owing to the absence of shade and shelter. The Administration has wisely decided, after due deliberation, that one and a half years' continuous work is enough for most European women in Samoa. Two years has been given a trial and has failed, so that it is evident that three years is too much without leaving the Islands. One does not doubt but that a second term of one and a half years might be advantageous from the point of view of the extra knowledge required, but health considerations are paramount. The training received by our sisters in New Zealand before going there is so thorough that they very soon adapt themselves to the altered conditions in the tropics ; and, after all, the principles underlying nursing treatment are the same for every form of diseases. The European sisters in Samoa perform two important functions— (1) They take complete charge of either the European or Samoan ward, and are responsible to the matron and Resident Medical Officer that the work is properly carried out and that the ward equipment is kept in good order. It is absolutely essential to have a white sister at each end of the hospital, as without supervision little or no work would be done and no proper treatment given. (2) They teach the Samoan nurses, and this is very important, as nursing-work can only be taught by careful instruction on the part of those in charge of the wards, and I am satisfied that this is conscientiously done in Samoa. Expense of one-and-a-half-years system as against three years : The difference in cost to the Administration between bringing down and returning four nurses, with their salaries, &c., in three years is £80 more than if two nurses stayed for three years —a sum more than balanced by the possibilities of a breakdown necessitating more frequent changes. I am advised that we cannot do with less than our present staff of European sisters, as a smaller staff would mean longer hours (which cannot be worked in that climate) and a considerable loss of efficiency. We want more Native nurses, and so we must see they are properly trained. Sanitary Inspectors.—These are absolutely necessary in every community which is sufficiently advanced to go in for sanitation, particularly in conjunction with any hookworm campaign. Both the Inspectors are hardworking, honest men, and well worth their salary. The Senior Inspector has to make rapid trips round Apia and districts, and is therefore entitled to transport for the purpose. It is impossible to compare his position or salary with that of the Postmaster, who, in any case, cannot lay claim to transport allowance. lam satisfied that the work of a Sanitary Inspector in any Native community is of the highest importance, and carries with it great responsibility. It is doubtful if any of the members of your committee appreciate the qualifications required of these Inspectors ; and, again, you carefully refrain from referring to a similar sanitary campaign which has just been started in Tonga. The Lady Secretary. —The present Medical Superintendent of the hospital has had three year's experience of this hospital—more than one year of which has been spent in charge of it—and, in his opinion, the Secretary is not overpaid for the work done. The office is now far more efficiently staffed

39