H.—3la

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Influence of the Arrival of " Niagara " and, " Makura " : — (1.) " Niagara" — Dates of Arrival. —Ports called at. Was there evidence of the. presence in New Zealand of the pneumonic type of disease before the arrival of the " Niagara " ? Is there evidence that the severe type was spread in New Zealand or at other way ports by passengers or crew off the "Niagara " ? With, the knowledge existing at the time, would the quarantining of the " Niagara " have been reasonable : if so, to what extent ? Disposal of " Niagara " patients -(a) On shore ; (b) on the vessel. Cargo. Difficulties as to working cargo. Labour conditions. (2.) "Makura." —Circumstances regarding the quarantining of this vessel. Difficulties as to working cargo and berthing. Difficulties as to opening the quarantine-station at Motuihi. Influences affecting the Spread of Influenza in New Zealand : — Possible influences on virulence of epidemic, (a.) Lack of natural immunity among the people of New Zealand, (b.) Weather' conditions, (c.) Congested areas in town. (d.) Native population, (c.) Military camps. (/.) Seamen's quarters, (g.) Workers' dwellings, milk, " batches," &c. Measures taken by Department to Control the Epidemic after it was established in New Zealand,: — Efficiency generally of such measures. Measures in connection with Hospital Boards. Were Boards prepared for this emergency? Temporary emergency measures. Responsibilities of Boards. Medical Profession. —Were the services of the medical profession used to the best advantage ? Difficulties. Nursing Service.- Was it adequate ? Voluntary aid nurses ; Red Cross and St. John Ambulance workers. Assistance from Outside Services generally. — Ambulance local Committees ; voluntary sanitary Inspectors. Measures necessary for strengthening Public Health Administration in the Dominion : — Is the Department in a position to cope satisfactorily with (a) sanitary work in normal times ; (b) epidemics such as the recent influenza outbreak ? Any Additions to Staff necessary: — Clinical Medical Service.— Local Government.- Are the responsibilities of Department and the local authorities sufficiently defined ? Did lack of definition affect the conduct of measures necessary to cope with epidemic ? Possibility of effective sanitary administration by local bodies as at present constituted. Medical officers for local bodies. Position of Hospital Boards in scheme for sanitary administration. Sanitary Inspectors. —Defective Public Health Act. Congested Areas: — Their existence. The remedy. The housing problem; its influence on the existence of insanitary areas. Amendments in law necessary for dealing with insanitary areas and houses. Is there need for special legislation as regards housing and town-planning ? Interim Report. The Commission, fearing a possible recrudescence of the epidemic, thought it proper to prepare and submit to Your Excellency a report dealing with the second subject-matter under our order of reference---namely, " The best methods of preventing or dealing with such occurrence in the future." This report was forwarded to Mr. J. Hislop, Secretary to the Department of Internal Affairs, on the 23rd April, 1919, for submission to Your Excellency. We have nothing further to add upon that head, but desire that our Interim Report be read together with this our Final Report. Introduction op Epidemic. Dealing with the order of reference in detail we have, — (1.) " The causes of the introduction and extension of the recent epidemic of influenza in New Zealand." It is evident that the " introduction of the recent epidemic of influenza " must be taken to mean its introduction from outside the Dominion. It is admitted that the latest and virulent form of the local epidemic is practically identical in form, incidence, characteristics, and date of appearance (allowing for the time of travel, which is the same as that required for human travel) with the pandemic influenza which, originating in the east and travelling westward, has devastated the Continent of Europe, Great Britain, and America. Even if it were established—as seems to be contended for in some of the very able and interesting scientific reports supplied to us by two bacteriologists and pathologists of the Department, and by the members