A.—4.
Government orders and instructions, has operated to prevent registration, this fact becoming very noticeable when the returns for the past six to nine months from certain districts are compared with those of the previous year. This matter will be referred to again under the heading " Vital Statistics." The situation is further complicated by the fact that the activities of the Man have not ended with a ban on registration of births and deaths, but unfortunately they have also caused all Women's Committees under the Child Welfare scheme to cease to function, and, worse still, owing to their action nearly all sanitary control in the various villages has been lost. This means that a very large proportion of the villages in Upolu and Savai'i have gone back to the conditions existing before sanitation was introduced and enforced by Government officials. It will take some considerable time to re-establish sanitary control, and it is remarkable that the health of the Natives has suffered so little. Whilst the activities of the Mau have had no appreciable effect on the attendances at the hospitals and out-stations of both islands from the clinical point of view—the attendance at the main hospital in Apia naturally showing a big increase owing to the large number of Natives assembled in Apia for some months on end—the great setback has been the inability to carry out any supervising work during the year in the shape of medical malagas round the islands. (a) Apia Hospital area : This area, which contains 66 per cent, of the population of Upolu, is easily reached by fair motor-roads extending from Mulifanua on the west to Falefa on the east of the north coast. It contains the main hospital at Apia, where there are four European Medical Officers, two Native medical practitioners, six cadets in training, besides twenty-four Samoan nurses, of whom fifteen are trainees. In addition there are five Samoan cadets at the Suva Memorial Hospital in Fiji undergoing a three-years course of training to become Native medical practitioners. The hospital is well equipped, being electrically lighted, with an X-ray plant and separate European and Samoan maternity departments. The laboratory is the largest and best-equipped in the South Pacific, being fitted with " Silverlite " gas for heating purposes, the plant being also used for the sterilizers in the operating-theatre. There are four out-stations (dispensaries) in charge of trained Native nurses in this area —at Lufilufi (the Methodist Mission), Malua (the London Missionary Society's headquarters), Fasito'otai, and Mulifanua. Of these, Malua has been temporarily closed, but is being carried on for the time being by a trained nurse who has married and settled there. (b) Aleipata Hospital area is still under the charge of a European Medical Officer, who'has an interpreter-cadet and two trained Native nurses to assist him. He also makes periodical trips round his district. (c) Lefaga —Safata area has now three dispensaries in charge of trained Native nurses —at Fusi, Sataua (Lotofaga), and Matautu. (d) Fagaloa Bay, which is very inaccessible, is still in charge of a trained Native nurse. (e) Tuasivi Hospital area is staffed as Aleipata Hospital, and serves about 45 per cent, of the population of Savai'i, a large amount of work being done from this hospital as a base. A trained Native nurse is in charge of the dispensary at the Methodist Mission at Satupaitea. (/) Safotu Hospital, on the north coast of Savai'i, is still doing good work under the charge of a Native medical practitioner assisted by a Native nurse. (g) The part of Savai'i from Salailua to Asau is a difficult one to cater for owing to coastal conditions. At present we have still three dispensaries in the district, each with a trained Native nurse —at Gagaemalea, Samataitai, and Asau. In the near future it is hoped to place a Native medical practitioner at Falelima, which will command the whole of the western end of the island. Infectious Diseases. These returns do not include all cases of infectious diseases occurring in the Territory, but only those notified from Apia Hospital: Dysentery, bacillary, 25 ; dysentery, amoebic, 1 ; pneumonia, lobar, 46 ; pneumonia, bronchial, 8 ; enteric fever group, 23 ; leprosy, 3 ; pulmonary tuberculosis, 9 ; tubercular peritonitis, 2 ; Meningitis, T. 8., and pneumococcus, 6 ; gonorrhoea, 1 ; beriberi, 8 ; tetanus, 6 ; puerperal septicaemia, 3. (1) Bacillary dysentery is endemic in Western Samoa, the cases reported occurring from February to July. There was a small outbreak on the east coast of Savai'i in January and February, 1928, but it soon petered out. (2) Influenza : Very few cases have been met with during the year. (3) Hookworm : Only 606 treatments have been given during the year, and no bad cases were met with. It has not been possible to undertake malagas for this purpose. (4) Yaws : The total number of injections given throughout the Territory for the past year is 7,450, regular treatment having been carried out in the Apia Hospital and district, in the Aleipata Hospital area, and along the north coast of Upolu from Mulifanua to Falefa. Tuasivi Hospital district has also had regular treatment, and the rest of Savai'i was attended to on a malaga commenced at the end of December, 1927. Very few primary sores are now met with, and the disease is well under control, though naturally it will take some years to stamp it out. (5) Leprosy : In May, 1927, seven lepers were transferred to Makogai, the Leper Asylum in Fiji, and there are now two cases in hospital awaiting transfer. We have twenty-eight lepers in Fiji at present: Samoans, nine males, six females ; Chinese, three males ; half-caste Europeans, three males, three females ; Solomon-Islanders, three males ; Cook-Islander, one male. Quarantine. During the year eighty-five vessels arrived from overseas, and pratique was granted in every case. Quarantine Intelligence Service.—As last year, this consists of weekly radios from New Zealand giving information as to existent epidemic diseases present in that country, and also any valuable information in respect to other parts of the Pacific. In addition, fortnightly messages from London
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