A.—4a.

Treatment : Surgical. Great strides have been made' in this department. There is now a surgeon in charge of all cases admitted to hospital in every department. The number of operations performed for the year under review is 171 major and 810 minor operations. Among the former are gastroenterostomies, hysterectomies, resections of bowel, and operations on the gall-bladder as well as ectopic gestations. As most of these important operations have been performed on Samoans, those who know and realize what Samoan psychology is will fully appreciate the advance in surgery which has been made. It speaks volumes for the confidence the Samoans have in a surgeon that they will submit cheerfully to operations of this nature. Last year's forecast in regard to the use of local anaesthesia has come true, and with a perfected technique, all hydroceles as well as elephantoid scrota and most hernias are now operated upon by this method, which has so many advantages over general anaesthesia, not the least of which being that one man can do the work which previously required two at least. Abscesses account for sixty-two admissions, mostly due to the Stephlyococcus albus or aureus, and it will be interesting to know whether they have any connection with filarial infection or not, the e-vidence so far being against such incidence. More and more cases of cancer are coming to light —intestinal, stomach, and uterine being most frequently met with. Many cases are inoperative when seen, others again being confirmed by an exploratory operation. It is difficult to state with any accuracy, up to now, if cancer is really on the increase or not, as Samoans, in common with many other peoples, prefer to experiment with their own methods of treatment in cases with doubtful symptoms, and the increase as noticed recently may be merely coincidental, due to the fact that a great number of cases have been overlooked previously through not coming up for treatment in time. Chinese Coolies. The number of admissions is slightly diminished compared with last year, no special disease predominating. Apia Hospital : Attendance, Operations, etc., for Year 1927. General attendance (includes out-patient attendance, out-patient dressings, N.A.B. injections, and injections for elephantoid fever) .. .. .. .. .. .. 39,533 Out-patient attendance (European and Samoan) .. .. .. . . 15,546 Out-patient dressings (European and Samoan) . . .. .. .. . . 20,286 N.A.B. injections — First injections .. .. .. .. .. .. .. 1,265 Second injections .. .. .. .. .. .. .. 1,177 Third injections .. .. .. .. .. .. .. 1,130 3,572 Injections for elephantoid fever .. .. .. .. .. .. .. 129 European in-patients .. .. .. .. .. .. .. .. 177 Samoan in-patients .. .. .. .. .. .. .. .. 589 Chinese and Melanesian in-patients .. .. .. .. .. .. .. 349 Chinese and Melanesian out-patients .. .. .. .. .. .. 192 Operations — Major .. . . . . . . .. . . .. . . . . 171 Minor .. .. .. .. .. .. .. .. .. 810 X-rays .. . . .. . . .. . . . . .. ■ • ■ • 33 Beport of the Laboratory, Government Hospital, Apia, 1927. The total of routine specimens recorded is 1,237. The specimens comprise the following : — Fceces.—Ova (each specimen examined by direct smears and Willis method): Hookworm ova (positive), 39 ; ascaris ova (positive), 11 ; trichuris (positive), 38. Adult worms : In most cases 3 specimens obtained after treatment were examined. Hookworm (positive), 17 ; ascaris (positive), 7. Occult blood (positive), 11. Bacteriological examinations: Positive T. 8., 1; B. dysenteriae " shiga " (positive), 23 (in 22 specimens the organism was confirmed by fermentation reactions and agglutination tests) ; E. hystolytica (positive), 3. Urines. —Total specimens examined, 390, containing—Albumin, 238 (in 4, an estimation of albumin was requested) ; sugar, 29 ; blood, 49 ; bile, 16 ; acetone, 4 ; urea estimations, 5. Centrifugalized deposits were examined in all but 7of the specimens. Those containing pus cells, 195 ; casts, 29. Bacteriological reports were made from smears in non-catheter specimens, and cultures in the case of catheter specimens. Organisms present: Bacillus coli, 61 ; streptococci (including enterococci), 29 ; staphylococci, 7. Sputa.—Number examined, 123. Gram and Ziehl Neelson smears were prepared from each specimen, while cultures were prepared from 29. Number positive for T. 8., 21 (1 by guinea-pig inoculation). Bron. spirochaetosis : Specimens were examined by smears and dark-ground illumination, but no positives have been found. Blood Specimens. —Widals : Number done, 47. Positive B. typhosus, 22 ; positive paratyphosus " A," 1 ; positive paratyphosus " B," 4. The serum in one case agglutinated all three, in a dilution of 1/250. Blood cultures: Streptococcal, 2. Filarial examinations : Positive, 33. A total of 171 positives was obtained in specimens collected for other purposes. Total cell-counts, 59; haemoglobin estimations (Sahli's method), 71 ; differential counts, 131 ; blood-sugar estimations, 17 ; Van den Bergh's test for bile-pigments, 9.

2—A. 4A.

9