A.—4a

8

Note. —In 1893 Dr. James Maxwell, M.D., published his " Observations on Yaws and its Influence in originating Leprosy," in which he described cases typical of ulcerative tertiary yaws, but attributed to leprosy. This probably remained the general teaching throughout the world until 1881, when Dr. Charlouis published " Uober Polypapilloma Tropicum." Even this paper was largely overlooked by the English-speaking races till Dr. Numa Rat published his " Yaws : its Nature and Treatment," in 1891. So that any reference to leprosy prior to 1881, or even 1891, in Samoa, where yaws is known to have been endemic, can only be accepted even by a medical witness where a clear history of the case be given. That yaws was by some clearly distinguished from leprosy is shown by the admirable account given of it in Demarara by R. Easton in 1834. The evidence put forward by Cantlie (" Prize Essays on Leprosy," by Thomson and Cantlie — the New Sydenham Society, London, 1897) that leprosy was comparatively recently introduced into the Pacific islands is much more definite. Cantlie is of opinion that leprosy first appeared in the Hawaiian (Sandwich) Islands about 1850, and it is of interest to note that one of the first cases of leprosy definitely diagnosed by a medical practitioner in Western Samoa was a Hawaiian, whose photograph is given (Fig. 13). The first medical evidence of the ju-osence of leprosy in Samoa is that of Dr. F. H. Davies in 1892. In " Prize Essays on Leprosy " is quoted a letter from Dr. Davies, of the London Mission, Tuasivi, Savai'i, in which he states : "I mentioned in my paper read at the Intercolonial Medical Congress held at Sydney, September, 1892, that we had in Samoa two cases of leprosy, both Chinese, and a suspected case in the person of an Hawaiian (Sandwich) Islander. One of the Chinamen died three years ago, and the other was deported. From evidence collected for (from ?) an African-English resident it would seem that at the present moment, in addition to the Hawaiian mentioned above, two half-caste Samoans and one pure Samoan are believed to have leprosy. I have never seen a case of leprosy among my numerous patients. Few, very few Chinamen are in Samoa, perhaps half a dozen at most. Ido not think leprosy has ever been endemic in Samoa." The next references to leprosy to be found in the records are found in tho German medical reports of 1903 to 1910 (Medizinal Berichte über die Deutschen Schutzgebiete). Report 1904-5 : The last Samoan with leprosy died during the previous report year. Report 1907-8 : Three cases of leprosy have come under notice —a white settler, a Melanesian, and a Chinese-Samoan half-caste. In all, eight cases of leprosy have been noted since 1896 —ono German, one Englishman, one American, one British-Samoan half-caste, one Polynesian, two Melanesians, and one Chinese-Samoan half-caste. (Note : Two of these are believed to have come from Hawaii.) Report 1809-9 : The German leper died 20th November, 1908. There are now only two cases of leprosy known in Samoa—ChineseSamoan -half-caste girl and a Melanesian. Report 1909-10 : During the report year four further cases of leprosy have been notified besides the two already known. They come from different villages lying far apart one from another. These four cases were advanced, and were therefore not infections of recent date. Reports 1910-14 : Not available for reference. When the New Zealand troops entered the Territory in 1914 there were twelve lepers in the station built at Ali —one German, one Melanesian, one BritisliTSamoan half-caste, and, so far as can be gathered from their names, nine Samoans. It is probable that of these twelve most, if not all, of the six cases known in 1909-10 are included. From 1914 until the 31st December, 1923, the following cases were discovered : 1915 —three Chinese, one German ; 1916—one Chinaman, one Samoan ; 1917—one Samoan, one Raratongan (found to be a leper on arrival as one of the crew of an island trading ship), one Chinaman ; 1920 — one British-Samoan half-caste, two Samoans (females) ; 1921 -one British-Samoan half-caste girl, three Samoans (two males, one female) ; 1922—0ne Chinaman, one Samoan (male) ; 1923 —two Chinese, four Samoans (three males, one female). Of the forty-four known cases of leprosy in the period 1892 to 1923, the nationalities were as follows : Englishman, 1 ; Germans, 3 ; American, 1 ; half-castes of above nationalities, 3 ; Chinese, .10; Raratongan, 1 ; Chinese-Samoan half-caste, 1 ; Melanesians, 2 ; Samoans, 22 : total, 44. All those reported before 1914 are now dead. Of the twenty-four reported since 191.4, all are alive except one German, three Chinese, and two Samoans. Chinese indentured labour was not introduced into Samoa until 1903, and the first recorded case of leprosy amongst indentured Chinese occurred in 1915. Since that date eight Chinese have been found suffering from leprosy. The increase in number of Samoans found suffering from leprosy is probably due more to the extension of the medical service throughout the islands leading to an increase in the number of cases discovered rather than to increase in incidence of the disease. The German leper station at Ali, on the mainland of Upolu, was found to be unsuitable owing to escape being fairly easy and to lack of facilities for expansion, and in 1918 the lepers were transferred to a new station on the island of Nu'utele, off the eastern end of Upolu. The isolated position of the station made it impossible to give them the treatment necessary for the cure or alleviation of their condition —all that could be done being done by the praiseworthy ministrations of a Sister of the Society of Mary and the Roman Catholic priest on the mainland opposite the island. In order to give these lepers an opportunity of treatment, arrangements were made with the Fiji Government for them to be admitted to the lepers asylum at Makogai —tho beautifully situated and splendidly equipped station under its control. In July and August, 1922, thirteen lepers (including one from American Samoa not included in the foregoing figures) were transported to Fiji, and in May of this year six more will be added to the number already there. Growth op the Medical Service. During the period 1900-14, during which Western Samoa was under German control, a commencement was made to organize a Government medical service, but much more attention was paid to the medical wants of the Europeans and the contract labourers than of the Samoans. The illustration (Fig. 14) reproduced in this report, taken from the German Annual Medical Report of 1907-8 (MedizinalBerichte über die Deutschen Schutzgchiete, 1907-8) shows the growth of the hospital from its commence-