A.—3

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I resided with the Resident Agent, Mr. Duncan. His wife and daughter had been victims, some weeks previously, to the prevailing fever epidemic. Both were very ill. Miss Duncan is now quite well again. Mrs. Duncan, however, is quite a wreck, and Ido not think she runs a chance of complete recovery unless she can get away from the tropics for some six months. The tropical climate, even at its best, does not admit of satisfactory recovery from acute diseases in all cases, especially in women. In the case of an island like this, where the conditions of life are very rough and food very poor, a woman has a very poor chance. As Mrs. Duncan has done a great deal of work among the Natives in times of sickness—Work that she is by no means called upon or paid to do—it is to he hoped that the Administration will see its way to grant her a passage to New Zealand and back, as I understand they are far from well off. It must he thoroughly understood that I consider a change from the tropics to be absolutely necessary in this case. A young European came under my care. He is a young man of degenerate tendencies who had been giving a great deal of trouble for the past few weeks, owing to his mental condition. I examined him, and came to the conclusion he was suffering from delusional insanity, and I therefore advised the Resident Agent to have him taken to his home and there confined under the care of a policeman till the departure of the s.s. " Talune," by which steamer he was intending to go to New Zealand on his way to England. He has improved somewhat the last few days, hut if he is not considerably better I shall take the necessary steps to have him put under restraint in Auckland, as I understand he has no friends in New Zealand. I am, of course, fully responsible for his treatment so far. On the 19th May, I visited the leper island with the Resident Agent. I saw two of the patients ■ —Kaimoumou (a lad) and Daniel (an old man). The third patient was fishing in his canoe. The lad Kaimoumou had very little to show beyond a macular anaesthetic patch or two on the buttocks and back of the thighs. He is said to have had several larger patches of a like description on the back, but these have now disappeared. He has certainly improved, but the presence of the abovementioned patch is still suspicious. The old man, Daniel, is an old case, having been eight years on the island. His face is gnarled and disfigured by the disease, which, however, appears to be quiescent, as the ulceration which used to be a marked feature in his case is now completely healed. The island is a pretty spot, and the patients are Well cared for, being visited every month, and plenty of their own particular food is supplied. That same day I was called to see a woman, lapou Vaine, at Vaipae, one of the villages in the island. She had come up to Vaipae six months ago from Manihiki. I considered that she Was suffering from leprosy in an early stage, and she will be sent to the island as soon as possible. And here appears a difficulty. The house is a one-roomed affair, with four beds. Three of them are occupied, and the fourth is vacant. It is not desirable to place even an elderly woman as this is in the same room with men, yet the interests of public health demand that she should be isolated. For the present a screen will be placed round her bed for her to undress by, and materials will be sent to the island to erect a shed or hut for her, which, however, she will be very unlikely to sleep in at night, owing to the Natives' fear of ghosts. If possible, she should be removed to Penrhyn, as I presume there is accommodation for females there. As regards the immediate future of this island from a health point of view, the Administration is lucky in having the services of Mr. and Mrs. Wicks, who arrived in the island by the " Huanui," with myself. They are Seventh-day Adventist missionaries, with a practical knowledge of medicine and surgery, Mrs. Wicks being a trained nurse and Mr. Wicks having undergone a medical course. They have been of the greatest assistance to me, and I am confident they will do a great deal of good to the people in instructing them in the elementary rudiments of hygiene. I have made a list of dressings and such articles as they are likely to want, which Mr. Duncan can give them when they ask for it. I hope the Administration will give them every assistance in this matter, as I am confident that their stay among the people will be productive of great good from the health point of view. For the rest, the question of medical visitation is a difficult one. A suitable man could do a good deal during a two-months stay in the island ; but it must be remembered that the conditions of practice here are very rough—the climate is trying, many of the cases are of a revolting and disgusting character, and the absence of vehicles and the poorness of the roads make it necessary to do all the visiting on foot, usually carrying a bag as well. Therefore the man selected, if he is a suitable one, requires a high salary, and also a good assortment of drugs and instruments to accompany him. The stock here, though perhaps enough to place in the hands of a layman, is woefully deficient for the serious diseases one is called upon to treat. I think under normal peace conditions it would be possible to engage a man in New Zealand for a six-months job every year, during which time he could go round the entire Group, provided the schooners' time-table admitted of it. The ideal method for the tour would be a Government vessel, but the cost of this arrangement would be such that I suppose the idea must be abandoned. The Hospital at Rarotonga might be enlarged, both as to accommodation and certainly nursingstaff, so that people from the outlying islands could be sure of finding admission and treatment. As it is they are not willing to go up to the Hospital. All these suggestions entail a heavy expenditure of money, and I do not know if it can be borne by the Administration at the present time. Judging, however, from the condition of this island, which I understand is by no means the worst of the Group, the Native race is in danger of dying out, not so much from direct disease, but from the failure to bear children on the part of many of the women, as the result of untreated venereal disease. Is it worth while trying to save them ? In conclusion, I must gratefully acknowledge the assistance I received from Mr. and Mrs. Wicks (mentioned above), Mr. and Mrs. Sterling, and the Rev. G. H. Eastman, and H. Strickland, a very intelligent Native practitioner. R. L. Norman, Acting on Special Service to Cook Islands Administration.