A.—4A

Infantile Moktality. This is large. Every married woman was questioned as to the number of children she had had, and the number that had died. I found that out of 848 children born to 191 women, 278 had died. This gives a roughly estimated mortality of one in three, although not all these died in infancy. The greatest mortality undoubtedly occurs during the first year, and it is very large during the first week. On asking the mothers what their children had died of, I found that in the majority of cases death was attributed to a disease known locally as mumu. This, they told me, was characterized by high fever and a red blush all over the body, and was frequently rapidly fatal. I was shown only one case, and that was a child two weeks old suffering from Pemphigus neonatorum. This, they said, was one form of mumu. Dr. F. W. O'Connor, in his " Researches in the Western Pacific," page 28, mentions this mumu as occurring in the Ellice Islands, and states that it nearly always ends in an outbreak of yaws. I could find no connection between mumu and yaws in the Tokelau Islands. Apia, Western Samoa, July, 1926. APPENDIX C. A CASE OF RUPTURED ECTOPIC GESTATION. By W. C. Mac Knight, M.8., C.M., F.R.C.S. (Edin.). Op. case 185 : A Samoan woman, aged thirty years, was admitted in the evening suffering from severe abdominal pain and collapse. A ruptured ectopic gestation was diagnosed, and she was operated on shortly after admission. The abdomen was found to be full of blood. The bleed-point was found at the middle of the left fallopian tube, where there was a small empty sac. This was excised, and the cut-ends united and covered with peritoneum. Some adhesions, evidence of old inflammation, were found on the right side of uterus. The abdominal wall was closed in layers. Patient stood the operation well in spite of the great loss of blood and the shock, and made a rapid recovery. OP. CASE 81: STREPTOCOCCIC INFECTION OF KNEE-JOINT; LYMPHO-SARCOMA OF SMALL INTESTINE. By W. C. Mac Knight, M.8., C.M., F.R.C.S. (Edin.). Samoan, male, aged forty-three years. Patient was admitted suffering great pain from a distended knee. Aspiration showed the contents to be purulent fluid loaded with streptococci. The condition was probably originally filarial. The knee was drained by two tubes passing down to but not into the synovial sac—the end being stitched to the capsule of the joint. This method of treating suppurating joints, which we owe to Willems, the Dutch surgeon, has proved most satisfactory in all cases in which I have used it. In the present instance the patient made a rapid recovery with full and perfect movements of joint. Three months later he was admitted to hospital with a history of a swelling in left lower abdominal quadrant of two months' duration—no constipation, no loss of flesh. At operation the growth was found to be in the lower end of ileum, involving the whole circumference of bowel. The growth was excised with 2 in. of healthy bowel on each side. The bowel-ends were joined by end-to-end anastomosis. The patient made a rapid recovery and put on weight. Unfortunately, he died about four months later of cardiac failure following a series of muscle-abscesses, probably filarial in origin. He had no sign of recurrence of growth and no abdominal discomfort. The growth was reported on by the pathologist, University of Otago, N.Z., who classed it as a sarcoma-lympho-type. SIMULATION OF INTESTINAL TUMOUR BY MASSES OF ASCARIDES. By W. C. Mac Knight, M.8., C.M., F.R.C.S. (Edin.). A Samoan female child aged two years was admitted to the hospital at 9 p.m. on 23rd January. Her parents stated that she was in good health until the day of admission, when her bowels moved three times at intervals of an hour, and that she vomited at 6 p.m. and 7 p.m. Examination showed a fairly healthy child. Temp. 99° F. ; pulse, 80 ; resp., 20 ; no evidence of pain. There was a sausage-shaped tumour in upper abdomen, extending from above and to the left of umbilicus, across abdomen, and down to region of caecum. There was another smaller mass in right lower abdomen. Examinatio)! per rectum showed no ballooning, no haemorrhage. The lower mass could be felt. The sausage-shaped tumour, diarrhoea, and vomiting suggested intussusception, but the absence of pain, haemorrhage, and the general condition of the patient negatived this. On the following day the masses had disappeared, leaving only small hard knots. Next day these had disappeared, and the child appeared quite well, but passed two round worms (Ascaris lumbricoides). She was treated with Santonin, and from 25' th January to 9th February she passed altogether 131 round worms.

Approximate Cost of Paper.—Preparation, not given; printing (500 copies), £26.

Authority: W. A. G. Skinner, Government Printer, Wellington.—l92B.

Price 9d.]

18