A—4

In May, 1947, there was a sharp epidemic of mild influenza affecting about twothirds of the population but causing death in only a few cases, all old people. Later in the year whooping-cough became epidemic, and again, while the incidence has been high, the complications have been slight —some deaths from broncho-pneumonia in young children have occurred. The main endemic diseases are filariasis, hookworm, yaws, tuberculosis, and enteric fever, with the usual seasonal incidence of bacilliary dysentery, food poisoning, and gastro-enteritis. There is no leper settlement in the Territory. Leprosy occurs, and diagnosed cases are kept in a special compound at Apia Hospital to await transport to the leper settlement at Makogai in Fiji. Professional prostitution does not exist in the Territory. Direct health education is carried on by means of radio broadcasts, articles in the official publication in the vernacular, and by demonstrations and lectures to the women's committees in the villages by European and Samoan Medical Officers and Health Inspectors. Indirectly, the people are being led to a better appreciation of health and sanitation by the example of the Samoan members of the Government Health Service throughout the Territory and by education in schools. Typhoid inoculations and whooping-cough and tetanus immunization are widely used. All the normal preventive immunization material is kept in stock and used as the occasion demands. The Medical Department co-ordinates, as far as possible, the work of the missions in the health field. This, however, is relatively unimportant compared with the work performed by the Department. Each district hospital and dispensary is in part an ante-natal clinic. The main clinic is at the Apia Hospital in charge of a qualified New Zealand midwife and under the direction of a European Medical Officer. Much of the work of the District Nurses with the women's committees is in this field. Women who attend hospital for childbirth are attended by a European doctor, Samoan medical practitioner, or midwife. In the districts they are attended, if they so desire, by the Samoan medical practitioner or District Nurse. Most Samoan women, however, are attended only by the old women of the family or village. Where difficulties are encountered, it is usual to call a Samoan medical practitioner or to bring the patient to hospital. A large proportion of maternity work in Apia Hospital therefore deals with abnormal and neglected cases. There has been a tendency in the last few years to seek earlier medical attention than was previously the case. The practice of midwifery is not controlled by regulations. School medical services do not as yet completely cover the Territory, but on the main island of Upolu most schools are visited on an average twice weekly, and yaws injections are given weekly in most. All school-children are seen at least once or twice a year. At the main Samoan school in Apia there is a permanent health clinic with a nurse in attendance during school hours. Pre-school care is given by the District Nurses through the village women's committees. The general standard of nutrition is fairly high, although no special nutritional measures have been introduced, nor is any supplementary feeding supplied to children at school. The normal diet of the Samoan consists mainly of taro, bananas, and breadfruit (in season) supplemented by fish and, on special occasions, by fresh pork or beef. In addition, tinned meat and other European foods are consumed. There are no wild animals of importance as a food-supply, and wild birds and wild-plant life do not form an important part of the Native diet.

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