A—3

At the beginning of the year under review the inhabitants of Niue were suffering from a severe epidemic of whooping-cough, which did not subside until the end of March, 1948. The general health then improved slowly, but suffered a grave setback during the measles epidemic, which began in August and persisted until November, 1948. During this period 3,056 cases were seen, and it is probable that the total number greatly exceeded this figure. Hospital care and treatment was only possible with the severer complications. Since then there has been a slow but continual improvement in the health of the people, despite a minor epidemic of influenza which occurred in February, 1949. Table 4 : The number of cases of infectious diseases occurring over the period of the past five years are set out in the following table :

Though details of the state of nutrition of the whole population are not available,, a rough survey of the children of the island was made in 1946, and revealed that a number were suffering from malnutrition. Cases of malnutrition occur particularly in infants from six to twelve months old. The principal causes were the incorrect feeding of' infants, and the effect of such Native customs as early weaning. A scheme for providing daily supplies of milk to school-children has been in operation during the year under review and the beneficial results of thus improving the nutrition of Niuean children are already apparent. xßesides the necessity of impressing upon the Niueans the vital importance of correct hygiene, the special current problem for the Health Department lies in the recruiting of an adequate trained European and Niuean staff. With its isolation and lack of social amenities, Niue is not a popular station for long-term appointments. Owing to thegreat expansion of medical services throughout the world, the difficulty of obtaining adequate trained staff is likely to remain for some time. The Niuean staff will receive valuable additions when the two students at the Central Medical School, Suva, and the four student nurses at Apia Hospital, Western Samoa, become available for service on the island.

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Disease. 1944. 1945. 1946. 1947. 1948. Yaws 713 1,038 1,173 1,218 327 Tuberculosis —all forms 11 26 13 27 65 Infective jaundice 78 112 49 65 24 Gonorrhoea 21 44 171 88 26 Typhoid fever 15 13 12 7 Infantile gastro-enteritis '72 Dysentery (unclassified) 5 Leprosy 1 1 2 "2 Pneumonia and broncho-pneumonia 25 29 41 427 83 Puerperal fever 3 2 7 9 Varicella .. .. .. 1 25 5 8 1 Whooping-cough 606 237* Measles 3,056 Influenza 1.97 112 Ringworm 37 ]L46 55 1,222 Widespread Scabies 166 163 33 ,, Filaria 207 181 120 132 Prevalent Myositis tropica .. 6 6 60 10 „ Tetanus .. .. .. -. i 0 *Total for whole epidemic : 843 cases.