a i .■—

ys.’ n::c cj Institute Llbrary.

FIJI.

COUNCIL PAPER, No. 43.

F.A. 48/4/19. pt. 3.

ANNUAL

MEDICAL AND HEALTH REPORT

FOR THE YEAR

1937.

BY AUTHORITY: G. W. COCKBURN, ACTING GOVERNMENT PRINTER, SUVA.— 1938.

FIJI.

COUNCIL PAPER, No. 43.

F.A. 48/4/19. pt. 3.

ANNUAL

MEDICAL AND HEALTH REPORT

FOR THE YEAR

1937.

44c/>38 — 562

BY AUTHORITY: G. W. COCKBURN, ACTING GOVERNMENT PRINTER SUVA.— 1938.

177- _

Lands Department, 5uva.

CONTENTS

Map of Fiji.

Diagram showing Relative Incidence of Different Diseases.

I. Administration

II. Public Health .

Vital Statistics

III. Hygiene and Sanitation

IV. Hospitals and Dispensaries V. Nursing .

VI. Medical Education

VII. Prisons and Asylums

VIII. Meteorological

IX. General

Appendix A — Hospital Finance . .

,, B — Issues from Government Pharmacy

„ C — Revenue, Medical Department . .

„ D — Establishment and Staff Postings

Report by Medical Officer of Health and Port Health Officer Return of Infectious Diseases- — Tables, I, II and III Report on Colonial War Memorial Hospital..

Report by Government Pathologist

Medical Education of Native Races by Dr. D. W. Hoodless Note on the Central Medical School by Dr. V. W. T. McGusty, O.B.E. Report on Central Medical School, Suva Report on Central Leper Hospital, Makogai Report on Western Pacific Health Service Return of Diseases and Deaths at the Colonial War Memorial Hospital Return of Operations at the Colonial War Memorial Hospital Return of Operations at the Lautoka Hospital Return of Diseases and Deaths at other Hospitals Meteorological Returns

PAGE

1

2

3

5

6

7

8 8 9 9 9

11

12

12

14

24

27

29

30 33 36 41 45 47

50

51

52 54

THE DIAGRAMS SHOW THE RELATIVE INCIDENCE OF DIFFERENT DISEASES CAUSING ADMISSION TO, AND DEATHS IN, HOSPITALS OF THE COLONY DURING 1937.

INFECTIVE DISEASES.

GENERAL SYSTEMIC AND PREVENTABLE DISEASES.

TOTAL INCIDENCE, 2,796 TOTAL CASES, 8,136.

1938.

LEGISLATIVE COUNCIL, FIJI.

COUNCIL PAPER, No. 43.

Medical Department

(Annual Medical Report for the year ending the 31st December, 1937.)

The Acting Director of Medical Services to The Hon. the Colonial Secretary.

Medical Department,

Suva, 10th June, 1938.

I have the honour to submit, for the information of His Excellency the Governor, and for transmission to the Right Honourable the Secretary of State, the Medical Report on the Health and Sanitary conditions prevailing in the Colony of Fiji for the year 1937, together with the returns appended thereto.

I have, &c.,

V. W. T. McGUSTY,

Acting Director of Medical Services.

I.— ADMINISTRATION.

GENERAL DESCRIPTION OF THE ORGANISATION OF THE MEDICAL SERVICES.

In Fiji there is as yet no definite cleavage between the curative and preventive organisa¬ tions, the activities in both fields being co-ordinated under the Director of Medical Services at the centre and in country districts under the district medical officers in their dual capacity of general medical officers and medical officers of health in their respective areas. There are no privately owned hospitals, and with the exception of 13 private medical practitioners, all the medical activi¬ ties are centred in the Government. The present system, with respect to curative medicine, aims at centralisation as far as conditions permit on four main hospitals, one of which, the Colonial War Memorial Hospital in Suva, is intended to attain the highest standard of medical and surgical treatment, while the others, two of which are situated respectively at Lautoka and Labasa, con¬ tinue to be maintained at a level of efficiency that is commensurate with the requirements of country hospitals. It is proposed to erect a fourth central hospital in the Ba district. While the central hospitals are used for specialised work, as well as for general purposes, it has not yet been deemed advisable to close the provincial or smaller type of native hospital, which is a survival from the days of primitive communications, but which can still serve a useful purpose, especially in times of epidemics. The curative services extend from the hospitals into dispensaries under the district medical officers and native and Indian medical practitioners, and in this manner they are brought into close contact with all sections of the community.

The health and curative activities of Government are closely associated with one another at vital points of contact such as hospitals and dispensaries, the teaching institutions of medical and nursing students, and the central laboratory.

A.— STAFF.

Appointments. — Miss C. E. Dawes, Sister, Colonial War Memorial Hospital, 23rd February; Miss M. G. Moore, Sister, Colonial War Memorial Hospital, 23rd February; Miss C. A. Dawes, Staff Nurse, Colonial War Memorial Hospital, 23rd February; Miss E. E. Davis, Staff Nurse, Colonial War Memorial Hospital, 23rd February; Rev. Sister Mary Carlina, Nursing Sister, Makogai Leper Hospital, 1st April; Rev. Sister Mary Nizier, Nursing Sister, Makogai Leper Hospital, 5th March; D. P. Gordon, Caretaker, Quarantine Island, Makaluva, 4th May; Miss E. E. Wilmot, Sister, Lautoka Hospital, 28th June; Dr. E. V. Maxwell, Temporary Medical Officer, 26th July; Miss M. Hardy, X-ray Nurse, Colonial War Memorial Hospital, 28th October; Miss I. M. McLeod, Probationer Nurse, Colonial War Memorial Hospital, 2nd November; Miss J. I. Reeve, Probationer Nurse, Colonial War Memorial Hospital, 30th November; Miss M. I. McKenzie, Probationer Nurse, Colonial War Memorial Hospital, 30th November; Miss J. M. d’Emden, Probationer Nurse, Colonial War Memorial Hospital, 30th November; Miss A. K. Dally, Probationer Nurse, Colonial War Memorial Hospital, 30th November.

2

2

Resignations. — Miss E. J. Garnett, Probationer Nurse, Colonial War Memorial Hospital, 5th February; Miss E. Deighton, Probationer Nurse, Colonial War Memorial Hospital, 14th February; Miss R. E. Phillips, Probationer Nurse, Colonial War Memorial Hospital, 20th February; Miss S. M. Cameron, Probationer Nurse, Colonial War Memorial Hospital, 1st April; Miss A. M. L. Lane, Probationer Nurse, Colonial War Memorial Hospital, 1st April; Rev. Sister Mary Fidelis, Nursing Sister, Makogai Leper Hospital, 1st April; Miss N. H. Retemeyer, Sister, Colonial War Memorial Hospital, 24th May; Miss E. M. Southey, Probationer Nurse, Colonial War Memorial Hospital, 1st July; Miss M. P. Ragg, Probationer Nurse, Colonial War Memorial Hospital, 12th September; Miss E. E. Hollands, Sister, Colonial War Memorial Hospital, 25th September; Miss J. H. Warren, Probationer Nurse, Colonial War Memorial Hospital, 1st October; Miss P. J. Seager, Probationer Nurse, Colonial War Memorial Hospital, 9th October. Most of the resignations from the nursing staff are consequent upon the scheme of seconding nurses from New Zealand, and upon the necessity for nurses who have undergone their training to resign from the staff when they obtain their diplomas.

Retirements. — Dr. W. M. Ramsay, District Medical Officer, 15th April; Dr. W. Foskett, District Medical Officer, 3rd May.

Death. — Dr. C. H. B. Thompson, Medical Officer of Health, 22nd June.

B— LEGISLATION AFFECTING PUBLIC HEALTH AND MEDICAL SERVICES

ENACTED DURING THE YEAR.

The following Proclamation, Regulations, Declarations and Ordinances were passed during the year: —

Proclamation — -

No. 5 of 1937 prohibiting the importation of live rabbits except for use in Government Laboratories.

Regulations —

Regulations made under the Public Health Ordinance No. 29 of 1935 — -Public Health Regulations 1937.

Regulations made under the Public Hospitals Ordinance No. 2 of 1884: — Amending the Colonial War Memorial Hospital Suva Regulations 1928.

Declarations ■ — -

Declarating New Zealand to be a place infected with acute anterior poliomyelitis.

Declaring Hong Kong to be a place infected with cholera.

Declaring acute anterior poliomyelitis to be a quarantinable disease.

Ordinances — -

No. 30 of 1937 — Pharmacy and Poisons Ordinance.

No. 31 of 1937 — Dangerous Drugs Ordinance.

No. 35 of 1937 — Sub-division of Lands Ordinance.

C— FINANCIAL.

The total expenditure under the two heads,

Medical and Hospital,

was : —

1935.

1936/

1937.

Personal emoluments £40,468 7 4

£41,028 0 2

£42,212 4 10

Other charges . . 37,583 17 10

40,057 11 11

42,210 11 2

Totals . . £78,052 5 2

£81,085 12 1

£84,422 16 0

The revenue creditable to the Medical Department was: — 1934, £10,374 3s. 2d.; 1936, £13,699 19s. lid.; 1937, £13,231 19 4.

£9,383 19s. 3d.; 1935,

The daily cost per patient at the Medical Institutions of the Colony in 1936 and 1937 was respectively: —

1936. 1937.

s. d. s. d.

Colonial War Memorial Hospital .

5 8-4

5 10-9

Lautoka Hospital . .

3 8-6

3 7-9

Levuka Hospital . .

5 0-3

6 1-2

Labasa Hospital

2 6-4

2 110

Public Lunatic Asylum

2 4-4

2 3-4

Central Leper Hospital

14-1

1 4-4

Provincial Hospitals

0 10-9

2 4-0

Nadi .

2 0-3

2 9-9

Penang

19

2 3-1

Further details are given in Appendices A to C.

The Revenue of the Colony for 1937 amounted to £947,497 6s. 7d. Of this sum, £84,422 16s. Od. was expended on Medical Services. The Revenue received amounted to £13,231 19s. 4d. The net cost, therefore, was £71,190 16s. 8d., or 7-5 per cent, of the total

revenue. This is equivalent to an expenditure of 7-2 shillings per head of population.

II.— PUBLIC HEALTH.

A.— GENERAL PLAN OF ITS ADMINISTRATION.

In the Fiji group the public health problem has been complicated by the fact that one- half of its population is made up of communally living natives, while the other is composed of individualist groups of immigrants with East Indians predominating. To meet this situation two distinct health organisations are maintained which have to be co-ordinated at all essential points. To take first the case of the native Fijian, the vast majority of whom continue to live in tribal units in small scattered villages averaging, perhaps, 150 inhabitants as they did in pre-Colonial days. Each village has its headman, and tribal affinities have brought about the grouping of

GRAPH A.

SHOWING THE DECREASE AND INCREASE IN THE FIJIAN RACE FOR THE LAST 4/ \ EARS.

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villages into larger units, each of which is subject to the authority of a single chief. The present administrative areas are largely based on tribal affinities, and in regard to native administration, the principles of indirect rule are to some extent observed. The communal system is adminis¬ tered under a special code known as the Native Regulations in which public health laws are incor¬ porated. Native Medical Practitioners are suitably posted in the native areas where they hold responsible positions with respect to both curative and preventive medicine, more or less within the communal organisation. Each official in the native administration is assigned a share of public health responsibility, while the communal nature of the whole native social organisation ensures co-ordination. To turn now to the non-native sections of the community, it is found that with respect to public health, they are subject in particular to three laws, namely, the Public Health, Quarantine, and Pure Foods Ordinances. The chief executive authority is the Central Board of Health, which has an official chairman and an official majority. Under its control there are Local Authorities in both urban and rural areas, the Central Board of Health officiating in all areas not otherwise provided for. The public health staff of the non-Fijian communities consists of one full time Medical Officer of Health, whose direct authority is limited to the port and environs of Suva, the medical officers posted in rural areas, who are ex-officio Medical Officers of Health, qualified sanitary inspectors, and a staff of sanitary overseers and sanitary assistants. The co-ordination of the Fijian and non-Fijian systems is effected in country areas by the Government medical officers, while all health and curative activities are under the central control of the Director of Medical Services.

B.— INFANT WELFARE AND SCHOOL HYGIENE.

Fijian Infant Welfare, the control of which passes from the Native Administration to the Medical Department on the 1st January, 1938, has already played an important part in the public health of the Fijians, chiefly through the delegation of health responsibilities to the native women, whose status has thereby been raised, and whose influence is steadily inculcating what may be called a health consciousness in the villages. The present system was introduced by Dr. Regina Roberts, wife of an American Consul who has since been transferred to another country. Under it one or more intelligent women are appointed by the chief in every village to carry out the daily routine work, which consists of the inspection and treatment for minor ailments of the children, and attention to domestic hygiene. Under normal staff conditions infant welfare is supervised on a Colony wide basis by an inspecting medical officer, while four specially trained European nurses are continuously engaged in field work. An important result of the assumption of control by the Medical Department will be that the special staff of infant welfare nurses will pass under the control of the nursing superintendent who will henceforth play an important part in the work. It is also intended that the interest and co-operation of the district administrative officers, which has played a major part in the past, shall not be lessened when the work is controlled by the Medical Department. Infant welfare work is continued on to the medical care of school children, and in this connection all schools throughout the Colony were inspected by District Medical Officers or native or Indian medical practitioners, those in the actual Suva urban and rural areas being the special charge of the Medical Officer of Health.

C.—VITAL STATISTICS.

The graphs A and B, introduced in the Annual Report, 1932, have been extended for

1937.

The estimated population at the end of 1936 and 1937 was: — -

Race.

Males,

1937.

Females,

1937.

Total,

1937.

Total,

1936.

Increase.

Increase per cent.

Population

1936

Census.

Europeans

2,298

1,940

4,238

4,159

79

1-9

4,028

Half-castes

2,424

2,332

4,756

4,646

110

2-37

4,574

Fijians..

50,697

48,898

99,595

98,291

1,304

1-33

97,651

Rotumans (all races''

1,456

1,459

2,915

2,844

71

2.49

2,816

East Indians . .

50,394

38,939

89,333

86,778

2,555

2-94

85,002

Polynesians

1,053

514

1,567

1,462

105

7-18

1,475

Chinese

1,537

300

1,837

1,792

45

2-50

1,751

Others

605

551

1,156

1,114

42

3-77

1,082

Total . .

110,464

94,933

205,397

201,086

4,311

2-14

!

198,379

The number of births recorded during the last four years was:- —

Race.

1934.

1935.

1936.

1937.

Crude birth-rate per 1,000, 1937.

Europeans

42

62

64

71

16-75

Half-castes

90

162

160

150

31-54

Fijians . .

3,696

3,652

3,715

3,432

34-46

Rotumans

92

132

109

129

44-25

East Indians . .

3,098

3,210

3,484

3,357

37-58

Polynesians

39

54

26

74

47-22

Chinese . .

20

23

20

18

9-80

Others . .

119

35

56

53

45-85

Total . .

7,196

7,330

7,634

7,284

35-46

The general birth-rate in 1936 was 37.96.

4

The number of deaths recorded during the past four years was: —

Race.

1934.

1935.

1936.

1937.

Crude death-rate per 1,000, 1937.

Europeans

33

34

33

36

8-49

Half-castes

34

33

52

40

8-41

Fijiar.s . .

1,948

2,178

2,755

2,128

21-37

Rotumans

115

69

67

58

19-90

East Indians . .

845

716

1,069

901

1009

Polynesians

51

44

45

42

26-80

Chinese . .

4 .

10

15

6

3-27

Others . .

24

7

20

14

12-11

Total . .

3,054

3,091

4,056

3,225

15-70

The general death-rate for 1936 was 20-17.

The marriages, births, deaths and natural increase for 1937 were: —

Race.

Marriages.

Births.

Deaths.

Increase.

Decrease.

Europeans . .

46

71

36

35

Half-castes

44

150

40

110

Fijians..

816

3,432

2,128

1,304

Rotumans .

22

129

58

71

East Indians

875

3,357

901

2,456

Polynesians

17

74

42

32

Chinese . .

1

18

6

12

Others

23

53

14

39

Total

1,844

7,284

3,225

4,059

• •

The rates of natural increase were: — Europeans, 8-4 per thousand; Half-castes, 23-7; Fijians, 13-27; Indians, 28-30; Chinese, 6-7. The natural increase of all races was 20-18 per thousand.

Infantile Mortality, 1937.

Race.

No. of deaths under 1 year.

Rate per 1,000 births.

No. of deaths 1-5 years.

Europeans

1

14-08

3

Half-castes

8

53-33

4

Fijians . .

331

96-44

371

East Indians . .

187

55-70

105

Polynesians

2

2703

7

Others . .

4

75-47

3

Rotumans

10

77-52

8

Total . .

543

74-55

501

The number of Fijian births for 1937 was 3,432 which is a decrease of 283 on the number for 1936. The number of Indian births was 3,357 which also shows a decrease over the figure of the previous year amounting to 127. The birth rate per 1,000 of the whole population decreased from 37-96 in 1936 to 35'46 in 1937.

The foregoing tables and figures show that in the general increase of population that is taking place, the East Indians have far out-stripped the Fijians. Indeed the satisfactory state of the Indian community cannot be better illustrated than by the figures for 1937, which, in spite of the persistence of sex disproportion, show a crude birth rate as high as 37-58 per 1,000 and a crude death rate as low as 10-09 per 1,000. Although the Fijian birth rate reached the satisfactory figure of 34-46 per 1,000, a death rate of 21-37 takes too heavy a toll, especially where approxi¬ mately 33J percent of all deaths are in children under five years of age.

Health Statistics of European and Non-European Officials 1937.

Europeans. Non-European.

Total number of officials resident

429

626

Average number resident

336

516

Total number on sick list

129

176

Total number of days on sick list

1,834

1,270

Average daily number of sick list

5-025

3-479

Percentage of sick to average number resident

38-395

34-108

Average number of days on sick list for each patient

14-217

7-216

Average sick time for each resident

5-458

2-461

Total number invalided out of the Colony

5

• • • •

Percentage of invalidings to total residents

1-165

• • • •

Total deaths

2

1

Percentage of deaths to total residents

•466

•16

Percentage of deaths to total average number of residents . .

•595

•193

5

D.— COMMUNICABLE DISEASES.

The Colony is fortunate in that its geographical position renders the entry of such diseases in vessels from neighbouring lands more susceptible of control. The occurence of infectious ill¬ nesses strange to the Fijians was soon associated in native experience with the advent of strangers, and prior to the acceptance of Christianity the recognised method of imposing quarantine restric¬ tions was by “ Club Law.”

Subsequent to the cession of the Colony to Great Britain, and as a result of the bitter lesson learned at the outset of the new era in 1875, when the occurence of a tragic epidemic of measles caused a mortality of nearly 20 per cent, of the non-immune native population, stringent precau¬ tions to safeguard the inhabitants from the consequences of importation of infectious diseases have been enforced. That such measures have proved successful, is indicated by the fact that despite a large influx of labourers and other immigrants from India at various times, Plague, Smallpox, Cholera, Schistosomiasis, and other diseases prevalent in the Orient, have never yet entered the Colony.

The pandemic of Influenza which in 1918 included the Austral-Pacific Zone in its ravages, levied a heavy toll of life in Fiji, at a period when owing to the Great War the Colony’s Medical Service was depleted in personnel and resources. Local epidemics of Influenza, continue to occur at intervals, but the cases have been of mild type.

Sporadic cases of clinical diphtheria make their appearance from time to time, and the presence of the Klebs-Loeffler bacillus has been verified bacteriologically, but the degree of virulence ha £ fortunately been very low. Scarlet fever has never been recorded, although severe strepto¬ coccal sore throat is relatively common.

The three most widespread communicable diseases which must be regarded as endemic, are Dysentery (bacillary and amoebic), Enteric fever, and Tuberculosis. During the year under review, 1,237 cases of Dysentery, 216 cases of Enteric fever and 342 cases of Tuberculosis, were notified to the Medical Officer of Health (see Tables). A Tuberculosis survey of the population is much needed, and has long been contemplated by the Medical Department, but the scattered distribution of the inhabitants among the eighty populated islands of the Group, together with shortage of staff have hitherto prevented its fruition.

Cases of Yaws continue to be found in the country districts, but natives have learned to appreciate the efficacy of treatment by the arsenicals and bismuth in this condition, and the fre¬ quently hideous scarring and deformity from tertiary yaws formerly seen is unknown among the younger generation. Contagious skin diseases, particularly Tokelau Ringworm (Tinea imbricata) and Scabies, are common in Fijian native communities, while Epidermophyton interdigitale is not infrequently found in Europeans and half-castes, and Tinea cruris in Indians. Measles, Mumps and Chicken-pox occasionally occur in epidemic form. In 1936, the two former were widespread in the Colony, but their incidence was low during the past year. The Fijians appear to have now acquired a much greater degree of immunity to measles than was formerly the case.

Under the terms of the Public Health Ordinance, 1935, Venereal disease is made notifiable, and its treatment compulsory, and Syphilis nowadays is rarely seen in the Colony except among crews of vessels calling at the Port of Suva, who attend for diagnosis and treatment under the terms of the Brussels Convention. Gonorrhoea appears to be the only member of the Venereal disease group found among the resident population. There is a remarkably small relapse rate among treated cases of Gonorrhoea in Fijians, and apparently an entire absence of late complica¬ tions such as stricture. It is interesting to speculate whether constant indulgence in kava drinking has any effect in achieving these results.

It is a matter for thankfulness that the severe and prolonged epidemic of Infantile Paralysis which afflicted New Zealand and parts of Australia, during the year, did not affect this Colony.

III.— HYGIENE AND SANITATION.

SUVA URBAN DISTRICT.

Sanitation in the town of Suva until recently was controlled solely by the health department, first of the Municipal Council and then of its successor the Town Board. In order to bring about the better supervision of the town’s sanitary services and at the same time co-ordinate them with the general services of the Colony, it was decided by the Town Board, and approved by Govern¬ ment, to place the town sanitary services and all of its health department officials under a Govern¬ ment official in the person of the Medical Officer of Health. Among measures adopted to improve the sanitary condition of the town of Suva during 1937 there may be mentioned a decision to have the sewerage system examined with a view to the introduction of a general scheme for its improve¬ ment; a decision to widen Ren wick Road; street improvements including curbing and guttering; the introduction of legislation to control the subdivision of land within the town boundary and to control the sale of fish; a decision to undertake as soon as the preliminary arrangements are completed, a scheme to build new markets on modern lines in the place of the present ones which have outgrown their usefulness, and finally a decision to appoint a second qualified Sanitary Inspector. Another matter which has an important bearing on the health of Suva is the decision to extend the town’s garbage services to suburban places for which the Town Board will receive subsidies from Government. The sanitation of the Suva Rural area is described in detail in the report of the Acting Medical Officer of Health on page 14.

6

IV.— HOSPITALS AND DISPENSARIES.

The Colonial War Memorial Hospital, a ferro-concrete two storeyed building, occupies a commanding position on a hill within the town boundary of Suva. It was opened in 1923 to replace the old Colonial Hospital. It has the fault of being inconveniently close to the present main traffic route into Suva, but this will soon be obviated by the construction of a by-pass road into which all long distance and heavy traffic will be deviated. It is the policy of Government to maintain the Colonial War Memorial Hospital, with respect particularly to its curative services, at a level of efficiency equal to that of larger hospitals in England and the Dominions, and for the present no other hospital in the Colony is expected to attain to the same standard. This hospital has at present approximately 180 beds and that number will soon be increased to over 200 in consequence of the scheme of development referred to in the 1936 Annual Report, the com¬ pletion of which is expected to occupy four years. This scheme has advanced almost according to plan and the new nurses’ quarters and the children’s ward are expected to reach completion in August, 1938. The new laundry, which also includes sterilization and hot water plants for the hospital, will be well advanced, if it is not actually completed before the end of 1938, and by the same date it is expected that the new students’ quarters and improvements in the X-ray Depart¬ ment will have been commenced. These important improvements comprise that part of the general scheme allotted to the years 1937 and 1938. In the two succeeding years it is intended to complete such of the works already mentioned as may still be under construction, and then to proceed in turn to the building of the classrooms and dormitories of the non-European nurses’ school, and afterwards to the construction of a maternity ward, of a ward for the observation of mental cases, and probably too, of a new building to combine the functions of a health centre and out-patient department. It was decided that the health centre, when completed, should be dedicated to the memory of His Late Majesty King George V and therefore named the King George V Health Centre. In order that the clinical, public health, teaching and other activities of a health centre may not be unduly delayed, it has been decided, pending the erection of a more permanent building, to utilise the old medical students’ quarters as a health centre and out-patient department as soon as the new students quarters are ready for occupation. When this proposal becomes effective the valuable space now occupied by the out-patient department within the Colonial War Memorial Hospital will be made available for an urgently needed increase in the accommodation for in-patients. The completion of this four year plan of development will place the hospital in all its departments on a level that will conform with modern standards, and closely connected with it there will be preventive and teaching branches of which the advantages should normally extend beyond Fiji to all the British dependencies in the Southern Pacific. The main features of the work done in the Colonial War Memorial Hospital during the year 1937 are set out in the report of the Medical Superintendent on page 27.

The Lautoka Hospital is constructed almost throughout its entirety of timber walls and iron roofs, and has 72 beds, a number which can be increased in emergencies. Well situated on rising ground within half a mile of the largest sugar mill in the Colony, it was opened in October, 1925. Previous hospital activities in the Lautoka area had been in the hands of the Colonial Sugar Refining Company, and Government’s first intention was to establish this hospital solely for use by Indians, but while it was actually in course of construction it became evident that its advantages could not reasonably be withheld from other races, and its accommodation had to be extended to meet these requirements. Arrangements were ultimately made for the Colonial Sugar Refining Company to join forces with the Government, and the scheme of co-operation thus begun between the Government and the Company with regard to hospital activities has since been extended to other sugar areas. The first item in the enlargement of the Lautoka Hospital consisted of a ward for Fijians which was donated by the Colonial Sugar Refining Company, and this was followed in succession by a European ward, a training school for native nurses and an X-ray Department, of which the plant was presented by the Company. It is natural that a hospital that was planned for a single purpose and extended for others both during and after its construction, should rather consist of a number of scattered buildings than have all of its activities housed under one roof. It is true that this form of construction is open to objection, but at the same time it is not uncommonly found elsewhere in circumstances similar to those which exist in Lautoka, and it causes very little practical difficulty in maintaining the requisite standards of efficiency. It may be said of Lautoka Hospital, which at present provides for a population of between 50,000 and 60,000, that it is main¬ tained at a very high level of efficiency, and that while in point of size it is steadily falling below the demand made on it by an increasing population, in point of the quality of its work it is com¬ mensurate with the requirements of the area which it serves. During the year there were 2,501 admissions to the Lautoka Hospital, the number of major operations reached the large figure of 470, and 7,129 patients were treated in the out-patient department.

The Labasa Hospital, which may be regarded as the central hospital for Vanua Levu and Taveuni, was established in 1931 as a result also of co-operation between Government and the Colonial Sugar Refining Company. It replaces the five separate hospitals which once existed in the district. It is well situated on rising ground in the vicinity of the most densely populated part of the Labasa areaf. It provides accommodation for 40 in-patients under a single roof. It is under the charge of the District Medical Officer, and has a resident staff of one Native Medical Practitioner, one Indian Medical Practitioner, one Sister in charge, one staff nurse and four native nurses. During the year there were 711 admissions to this hospital, and 9,155 patients were treated in its out-patient department.

In the Ba area there is one Government Hospital; two others that are owned by the Colonial Sugar Refining Company, and one that is maintained by the Methodist Mission. It is pro¬ posed to replace these small hospitals, except the one owned by the Methodist Mission, with a modern Government Hospital for which a site has been donated by the Colonial Sugar Refining

7

Company, who have also undertaken to contribute substantially towards its capital and recurrent costs. It is expected that the Ba Government Hospital will be ready for occupation before the end of 1940.

Levuka Hospital is small, but it is both convenient as to its design, and well equipped. It is central for the Lomaiviti and Lau districts, and has been maintained at its normal standard notwithstanding the lessened importance of Levuka in recent years that has resulted from the fall in the price of copra. This hospital is in charge of the District Medical Officer, and has a resident staff of one Native Medical Practitioner, one Sister in charge, and three native nurses. During the year there were 323 admissions and 3,467 patients were treated in its out-patient department.

Of the remaining hospitals, one is a relic of the old plantation hospital, one each was built in Nadi and Penang as part of a post war hospital extension plan, and the remainder are the native provincial hospitals, of which the period of maximum usefulness passed with the introduction of improved transport. A definite value still, however, attaches to the old provincial hospital, particularly in isolated places, on account of its convenience as a place for segregation and treat¬ ment purposes in times of epidemics. Dispensaries, apart from those attached to hospitals, have been established, as far as possible, at or near main centres of population, and at convenient places in most country areas.

The Native Medical Practitioners throughout the Colony treated 44,150 cases with 315 deaths. The following tables show the number of admissions and deaths at the hospitals of the Colony: — •

COLONIAL WAR MEMORIAL HOSPITAL.

Year.

Admissions.

Deaths.

Death-rate.

1933

2,509

161

6-41

1934

, ,

, ,

2,398

144

6-00

1935

# #

2,713

162

6-00

1936

# #

• •

3,074

228

7-42

1937

• •

• •

2,679

190

6-09

LAUTOKA HOSPITAL.

Year.

Admissions.

Deaths.

Death-rate.

1933

1,860

81

4-3

1934

1,862

88

4-73

1935

2,335

97

4-11

1936

2,055

116

5-64

1937

2,501

121

4-44

LEVUKA HOSPITAL.

Year.

Admissions.

Deaths.

Death-rate.

1933

249

11

4-6

1934

269

10

3-72

1935

287

10

3-48

1936

304

30

9-87

1937

323

14

4-33

LAMBASA HOSPITAL.

Year.

Admissions.

Deaths.

Death-rate.

1933

• •

• •

501

29

5-78

1934

• •

• •

522

29

5-55

1935

• •

# #

647

25

3-86

1936

• •

• •

763

36

4-72

1937

• •

• •

711

35

4-94

PROVINCIAL HOSPITALS

Year.

Admissions.

Deaths.

Death-rate.

1933

2,885

155

5-37

1934

2,398

135

5-63

1935

2,597

158

6.08

1936

3,573

240

6-72

1937

3,717

207

5-57

NATIVE MEDICAL PRACTITIONERS.

Year.

Cases treated.

Deaths.

1933

36,975

183

1934

37,416

261

1935

37,358

257

1936

42,171

293

1937

44,150

315

V.— NURSING.

The Colony continues to derive a great benefit from the scheme introduced in 1934, under which its nursing service is affiliated with that of the Health Department of the Government of New Zealand. For more than ten years the matron of the Colonial War Memorial Hospital has exercised nominal authority over the nursing staffs of other hospitals, which she has periodically

8

inspected. Considerable expansion has taken place during recent years in the nursing service both in its hospital and field branches, and to ensure co-ordinated direction the matron of the Suva Hospital was given definite authority throughout the Colony when her appointment of matron and nursing superintendent became effective on the 1st January, 1936. It is confidently antici¬ pated that this central control of all nursing activities, which include Infant Welfare as from the 1st January, 1938, will lead to a marked all round increase of efficiency.

The following table shows the number and the classification of nurses now holding appoint¬

ments in the Colony:—

Matron and Nursing Superintendent . . . . . . 1

Matron (Lautoka Hospital) . . . . . . . . 1

Assistant Matron . . . . . . . . . . . . 1

Sisters in Charge . . . . . . . . . . . . 2

Staff Sister . . . . . . . . . . . . . . 1

Sisters . . . . . . . . . . . . . . 11

Staff Nurses ..... . . . . . . . . 3

Nurse Housekeeper . . . . . . . . . . 1

Probationer Nurses . . . . . . . . . . 9

Infant Welfare Nurses (European) . . . . . . 5

Senior Native Nurse . . . . . . . . . . 1

Native Obstetric Nurses . . . . . . . . . . 89

X-ray Sister . . . . . . . . . . . . 1

Makogai Leper Hospital —

European Sisters . . . . . . . . . . 15

Native Nursing Sisters.. .. .. .. .. 10

VI.— MEDICAL EDUCATION.

The Central Medical School occupies a position of great prominence throughout Fiji and the other Pacific Island groups to which its activities extend. The details of work done during 1937 are set out in the Annual Report of the Principal, which is enclosed on page 33. There are enclosed on pages 30 and 41 two articles, the one entitled “ The Medical Education of Natives,” and the other entitled “ The Central Medical School and its Relationship to Health Problems of the Pacific.” These articles were prepared for submission to the Rural Hygiene Conference which was held in Java in August, 1937, and they are reprinted with this report by permission of the Director of the Health Services of the League of Nations.

The Nurses’ Training School. — This school was conducted under the auspices of the Australian Trained Nurses’ Association from its inception until 1934 when its control was handed over to the Dominion of New Zealand with the affiliation of Fiji’s nursing service with that of the Dominion. The nursing school has been of value to the Colony both by providing trained nurses who are experienced in local conditions, and by giving occupation to young women who are domiciled here. Altered circumstances, among which may be mentioned the expansion of the nursing services which is rapidly taking place, have led to the decision gradually to replace this school by another in which non-Europeans will be trained as nurses up to a standard slightly below that of the fully qualified nurse, but adequate for the purposes of the subordinate nursing posts of the Colony. The senior staff of qualified nurses will, under this proposal, be recruited from New Zealand.

Native Obstetric Nurses. — -The Native Obstetric Nurse is trained in the Colonial War Memorial Hospital, and it is largely due to the competence of the service to which she belongs that the Government decided to establish a school with improved facilities for training non- European women in general and obstetric nursing. The inauguration of the enlargement of the present school is expected to take place during the year 1939.

VII.— PRISONS AND ASYLUMS.

In addition to the central gaol at Suva there are prisons attached to the headquarters of all country stations which are used chiefly for short term prisoners. These country prisons have, as far as possible, been subjected to regular inspections by Medical Officers, and have been main¬ tained in a satisfactory condition. It is generally observed that in spite of discipline and hard work the physical and mental condition of prisoners undergoes a rapid improvement as a result of a wholesome diet and regular hours, and that this improvement is maintained throughout the period of their detention.

The central goal in Suva is well constructed as regards all its departments and is maintained in a cleanly condition which is a credit to the responsible officials and an asset in the preservation of the health of the inmates. During the year under review there were 66 admissions to the gaol infirmary while 300 prisoners were treated as out-patients for minor ailments. The only infectious diseases were three cases of influenza and four of dysentery. There were also three cases of gaol dropsy which responded to dietetic treatment. There is an Indian Medical Practitioner in per¬ manent residence at the gaol which is also visited three times weekly by a visiting medical officer.

The Public Lunatic Asylum is the only mental hospital in the Colony. It occupies one of the finest sites in the neighbourhood of Suva and provides accommodation for its inmates in buildings which conform on the whole with modern standards. The Asylum grounds which are protected by high fences, are spacious enough to provide ample room for exercise and recreation for the patients. The institution is under the immediate charge of a head attendant and his assistant, both Europeans, and under them there is a staff of warders and wardresses, all natives of Samoa selected on account of the special aptitude of the people of those islands for the duties of attending on persons of unsound mind. The buildings and their surroundings were well main¬ tained throughout the year in their usual sanitary condition and considering the characteristics

9

of the inmates it is largely to the credit of those responsible for their welfare that they remained so free from sickness, and that no cases of epidemic disease occurred among them during the year. The Public Lunatic Asylum is regularly visited by the visiting medical officer and periodically inspected by a Board of Visitors. The total number of patients treated during the year was 124, of whom 79 had remained over from 1936 and 45 were new admissions. Twenty-six patients were dis¬ charged unconditionally. There were 1 1 deaths and 87 patients remained at the end of the year.

VIII.— METEOROLOGICAL.

The total rainfall at Suva for 1937 was 106-63 inches, compared with the average of 119-46 over a period of 53 years. The wettest month was March, when 17-53 inches fell and the driest month was June, when 2-23 inches were recorded. There were 260 wet days, the wettest being March 19th, when 7-87 inches fell.

IX.— GENERAL.

Drugs and Poisons Ordinance (Dangerous Drugs).

Permits to withdraw from the Dangerous Drugs Store were granted for the following amounts of Dangerous Drugs during 1937: — Chlorodyne 234 ounces; Liquor Opii Camph pro Tincture Cone (1-7) 200 pints; Syr. Codeine Phosphate 100 pints; Pulv. Ipecac. Co. (Dover’s Powder) 30 lb; Tablet Pulv. Ipecac Comp. (Dover’s Powder) 100 lb — 444 bottles; Liquor Opium pro Tincture Cone. (1-9) 5 pints; Morphine Hydrochloride 1 ounce; Pulv. Opium 1 lb; Dental Anaesthetic-Cocaine Hydrochloride § ounce (Cocaine).

An irreparable loss to Government and the Colony was occasioned by the sudden death on the 22nd June, of Dr. C. H. B. Thompson, Medical Officer of Health.

V. W. T. McGUSTY,

Acting Director of Medical Services.

APPENDIX A.

COLONIAL WAR MEMORIAL HOSPITAL.

Return showing the Expenditure and Revenue in each of the last ten years and the cost per bed occupied

Year.

In-patients.

Daily average in hospital.

Expenditure

Cost per head per day.

Personal

Emoluments

Cost per head per day. Other Charges.

Cost per head per day. Total.

Patients

fees

received.

Fees, if paid, of patients treated gratuitously

£

s.

d.

d.

d.

d.

£

s.

d.

£

s. d.

1928

2,141

72-60

11,061

19

0

45-6

54-5

100-1

1,461

11

2

3,580

3 6

1929

2,464

80-3

11,029

0

0

42-3

48-0

90-3

1,534

11

5

3,097

15 0

1930

2,805

87-51

10,976

18

2

39-2

43-4

82-6

1,377

0

9

4,551

4 0

1931

2,303

87-04

10,690

19

1

43-8

36-9

80-5

1,628

6

5

3,278

0 0

1932

2,345

95-2

11,085

5

5

40-5

35-2

75-7

2,098

3

7

6,662

5 0

1933

2,509

104-83

11,382

19

6

38-4

33-1

71-5

2,067

5

3

5,497

18 10

1934

2.398

106-45

11,762

7

0

37-7

34-9

72-6

1,999

17

7

5,428

18 2

1935

2.713

118-07

12,237

16

10

31-92

36-22

68-14

2,245

4

4

5,421

1 0

1936

3,074

124-83

12,970

8

8

30-76

37-66

68-42

2,038

8

8

6,109

11 0

1937

2,679

106-71

11,513

10

10

28-25

42-70

7095

2,143

3

9

6,025

9 0

Remarks. — Salaries of the Medical Officers are included. The expenditure on the Central Medical School is not included. The cost of drugs used for out-patients is included. The expenditure under Works Department votes is not included.

LAUTOKA HOSPITAL.

Return of Expenditure for each of the past five years and the cost per bed occupied.

Year.

Average daily number in hospital.

Expenditure.

Cost per he

Personal

Emoluments

-ad per day.

Other

Charges.

Total.

£ s. d.

d.

d.

d.

1933

48-0

3,245 8 8

14-2

30-2

44-4

1934

49-0

3,366 14 1

13-2

32-0

45-2

1935

49-83

3,419 17 0

15-95

29-18

45-13

1936

500

3,557 18 0

14-74

29-92

44-66

1937

60-4

4,036 15 4

14-55

29-39

43-94

Remarks. — Does not include salaries of Medical Officers or of expenditure under Public Works Department.

Cost of all drugs used is included.

LEVUKA HOSPITAL.

Return of Expenditure for each of the past five years and the cost per bed occupied.

Average daily

Cost per head per day.

Year.

number in hospital.

Expenditure.

Personal

Emoluments

Other

Charges.

Total

1933

13-0

£ s. d. 1,012 6 5

d.

16-3

d.

34-9

d.

51-2

1934

8-16

956 19 7

25-2

51-8

77-0

1935

11-11

982 2 6

19-62

38-61

58-23

1936

11-02

1,014 5 8

18-42

41-92

60-34

1937

9-9

1,102 14 9

22-2

51-0

73-2

Remarks. — Does not include salaries of Medical Officers or expenditure under Public Works Department. Cost of all drugs used is included.

10

LABASA HOSPITAL.

Return of Expenditure for each of the past five years and cost per bed occupied.

Average daily

Cost per head per day.

Year.

number in hospital.

Expenditure.

Personal

Emoluments.

Other

Charges.

Total.

£ s. d.

d.

d.

d.

1933

22-5

1,408 8 8

11.8

29-3

41-1

1934

14-67

1,212 5 9

18-6

35.0

53-6

1935

20-05

1,485 8 7

13-91

34-81

48-72

1936

34-22

1,591 8 0

7-88

22-59

30-47

1937

29-6

1,576 10 10

91

25-9

35-0

Remarks. — Does not include salaries of Medical Officers or expenditure under Public Works Department. Cost of all drugs used is included.

LUNATIC ASYLUM.

Return of Expenditure for each of the past five years and cost per patient per diem

Average daily

Cost per head per day.

Year.

number in asylum.

Expenditure.

Personal

Other

Total

Emoluments

Charges.

£ s.

d.

d.

d.

d.

1933

81-0

3,183 4

11

12-6

13-2

25-8

1934

79.0

3,261 10

7

12-8

144

27-2

1935

77-0

3,462 1

6

14-87

14-7

29-57

1936

83-7

3,628 9

0

13-78

14-65

28-43

1937

86-6

3,607 8

0

13-1

14-3

27-4

Remarks. — Expenditure under Public Works Department votes and Medical Officers salaries not included.

MAKOGAI CENTRAL LEPER HOSPITAL.

Return of Expenditure for each of the past five years and the cost per patient per diem.

Year.

Average daily number in Hospital.

Expenditure.

Cost per head per day.

Total

Personal

Emoluments

Other

Charges.

£ s. d.

d.

d.

d.

1933

450-16

12,846 15 8

7-0

11-8

18-8

1934

448-25

13,292 18 10

7-06

12-44

19-5

1935

510-29

13,359 13 10

5-89

11-32

17-21

1936

571-35

14,072 11 8

545

10-67

16-12

1937

572-98

14,290 15 5

5-23

1117

164

Remarks. — Does not include expenditure under Public Works Department votes which was in 1936, £1,823 10s. Id., on maintenance and £1,555 12s. 6d. on permanent improvements, and in 1937, £1,806 3s. lid., on maintenance and £2,977 16s. 8d. on permanent improvements

RETURN SHOWING DAILY COST PER BED OCCUPIED DURING 1936 AND 1937 OF THE HOSPITALS AND ASYLUMS OF THE COLONY.

1936.

1937.

Hospital.

Aver, daily No. in Hosp.

Cost per head per day.

Aver, daily No. in Hosp.

Cost per head per day.

Colonial War Mem. Hospital

124-83

s.

5

d.

8-42

106-71

s.

5

d.

10-95

Lautoka Hospital

5000

3

8-66

60-4

3

7-94

Central Leper Hospital

571-35

1

4-12

572-98

1

4-4

Levuka Hospital

1102

5

0-34

9-9

6

1-2

Labasa Hospital

34-22

2

6-47

29-6

2

110

Public Lunatic Asylum

83-70

2

4-43

86-6

2

3-4

Penang Hospital

11-24

1

•9

10-69

2

3-12

Nadi .

11-90

2

0-3

12-34

2

9-55

Ba .

15-02

1

1-58

14-76

1

4-32

Taveuni

20-40

1

8-49

24-2

1

2-87

Rewa . .

17-00

1

4-65

19-34

1

7-96

Kadavu

9-70

1

10-67

8-56

2

4-85

Nadroga

21-59

1

2-08

5-00

4

10-8

Ra

10-00

1

11-2

8-76

3

7-38

Bua

16-75

1

0-77

3-12

6

3-64

Savusavu

13-94

1

7-87

6-2

3

2-4

Lau (Lomaloma)

14-10

1

11-97

1200

1

8-5

Colo East

15-15

1

5-48

9-92

1

614

Rotuma

6-80

3

3-12

6-72

3

2-1

11

APPENDIX B.

Value of Issues from the Government Pharmacy during 1937.

Memorial Hospital

1. Medical Department —

A— Hospitals and Dispensaries — Bau Beqa Cikobia Colonial War Davuilevu Dreketi Gau Kadavu Koro

Korolevu i wai Korovou, Tailevu Labasa Lakeba . .

Lautoka Lekutu Levuka Lodoni Lomaloma Matuku Moala . .

Momi . .

Nabouwalu Nadarivatu Nadi . .

Nadroga Naduri Naduruloulou Nailaga Nakasaleka Namarai Namata Namosi Nanukuloa Nasau . .

Natewa Natuatuacoko Navatusila Navua . .

Nayavu Penang . .

Rewa . .

Rotuma Savu Savu Serua . .

Taveuni Tavua . .

Veitogo Viria Visoqo . .

Vunidawa Wainibokasi Wainunu Y asawa

£

s.

d.

26

12

8

30

6

7

46

11

5

2,712

4

5

63

3

3

44

13

2

20

9

1

79

15

11

65

4

3

26

17

1

27

11

1

606

5

0

84

14

0

1,289

6

1

40

6

1

321

9

1

14

7

10

112

1

2

45

9

6

26

18

9

35

3

2

86

11

1

34

19

5

238

1

3

173

9

8

37

12

8

23

2

11

146

15

10

32

16

1

49

9

6

17

15

10

22

14

2

288

8

5

21

9

1

63

1

10

29

3

7

17

19

1

49

16

6

63

1

7

138

18

10

46

2

4

105

10

0

153

15

0

43

13

0

478

1

7

78

16

3

23

5

1

33

14

6

22

1

8

76

5

2

249

5

1

43

4

2

21

14

6

Total Hospitals and Dispensaries B — Native Obstetric Nurses C — Public Institutions —

Public Lunatic Asylum Central Leper Station

.... 8,630 15 3

35 16 6

255 6 11 984 13 3

Total Public Institutions D— Typhoid Immunization Campaign — Labasa Levuka

North West Viti Levu

Ra

Rewa

Suva

Taveuni

1,240 0 2

45 0 0 7 17 6

340 6 3 6 15 0 101 5 0

85 2 11

27 0 0

Total Typhoid Immunization

• t

613 6 8

12

£

s.

d. £

s.

d.

E — Other Medical

. . .

606

12

1

Total Medical

11,126

10

8

2.

Fijian Infant Welfare Scheme

• • .

, •

481

9

10

3.

Other Government Departments — -

Schools

54

18

8

Police

7

15

5

Gaol Infirmary

65

0

3

4.

Other Government Departments . .

163

14

6

Total Government Departments

291

8

10

5.

Native Lands Commissioner Surveyors

. . .

. •

0

17

3

6.

Missions

• • «

, •

57

15

4

7.

Private Accounts

. . .

170

15

5

Total Issues from Government Pharmacy

• • .

, *

12,128

17

4

APPENDIX C.

Revenue, Medical Department.

Head IV— 1936. 1937.

1.

(i) Dairy Licences, Suva and Levuka . .

£39

7

6

£40

5

0

4.

Drug Permits

13

5

0

15

5

0

Head

22.

V—

Hospital Fees, Colonial War Memorial Hospital, Levuka, Labasa & Lautoka Hospitals .

3,565

11

5

3,802

7

9

24.

Meat Inspection Fees

386

6

6

472

5

0

25.

Central Leper Hospital Fees

6,067

8

2

5,180

18

8

26.

Fees, Plantation Labourers, Lautoka and Labasa Hospitals

1,000

0

0

1,000

0

0

27.

Central Medical School . .

1,706

16

6

1,813

9

2

Head

2-

IX—

-{a) Makaluva and Nukulau Fees

87

18

0

107

14

6

(b) Sale of Government Drugs . .

159

18

5

169

4

9

(c) Fumigation and Disinfection Fees

168

1

3

255

2

3

(d) Sale of Stock .

8

15

0

21

5

0

3.

Sale of Produce, Makogai

251

6

9

140

18

2

4.

Bakery Receipts Makogai

231

13

11

201

13

2

9.

Ten per cent. Profits Makogai Canteen .

13

11

6

11

10

11

Total . .

£13,699

19

11

£13,231

19

4

APPENDIX D.

Establishment.

The Medical Staff of the Colony as ’sanctioned for the year 1937 was: —

Administrative. — Director of Medical Services, 1 ; First Class Clerk, 1 ; Third Class Clerks, 2; Fourth Class Clerks, 3; Pharmacist, 1; Messenger, 1; Packers, 2.

Medical. — District Medical Officers, 12; Native Medical Practitioners, 63; Indian Medical Practitioners, 7; Native Obstetric Nurses, 58.

Colonial War Memorial Hospital. — Medical Superintendent, 1 ; Assistant Medical Superin¬ tendent, 1; Native Dispenser, 1; Matron, 1; Assistant Matron, 1; Nursing Sisters, 5; European Probationers, 13; Nurse-Housekeeper, 1; Native Obstetric Nurses, 1; Native Nursing Pupils, 20; Steward and Clerk, 1; Servants, 24; Fourth Class Clerk, 1; X-ray Technician, 1; Hall Porter, 1; Seamstress, 1 ; Night Attendants, 2.

Levuka Hospital. — Nurse in Charge, 1 ; Native Dispenser, 1 ; Nurses (native), 2; Servants, 4.

Lunatic Asylum.— Head Attendant, 1 ; Assistant Attendant, 1 ; Female Resident Attendant, 1; Native Attendants, 9 male, 6 female; Servants, 2.

Central Leper Hospital. — Medical Superintendent, 1 ; Clerk, 1 ; European Nursing Sisters, 15; Native Sisters, 10; Overseer, 1 ; Native Constables, 3; Servants 19; Leper Patients employed as Servants, Headmen or School Teachers, 12; Bakers, 4.

Labasa Hospital. — Nurse in Charge, 1; Native Medical Practioner, 1; Native Nurses, 2; Servants, 5.

Lautoka Hospital. — Native Medical Practitioner, 1; Matron, 1 Nursing Sisters, 3; Dresser, 1; Native Nurses, 7; Servants, 11.

Pathological Division, — Pathologist, 1; Technician, 1; Native Attendants, 3.

13

Sanitary — (1) General. — Medical Officer of Health, Suva, 1 ; European Sanitary Inspectors, 5; Fijian Sanitary Inspector, 1; Indian Sanitary Inspectors, 2; Police Officers who are also Sanitary Inspectors, 6; European Caretaker, Quarantine Station, 1 ; Indian Caretaker, Quarantine Station, 1

(2) Ankylostomiasis Campaign. — Indian Sanitary Inspectors, 5.

Medical Staff Postings.

The Medical Staff postings on 31st December, 1937, were: — •

A. H. B. Pearce, L.R.C.P. & S. (Edin.), L.F.P.S. (Glasgow); D.P.H. (Dublin), F.R.San.I., Director of Medical Services.

P. Harper, M.D. (Dunelm), M.R.C.S., L.R.C.P., District Medical Officer.

A. J. Borg, M.D. (Malta), District Medical Officer, on leave.

H. S. Evans, M.R.C.S., L.R.C.P., District Medical Officer, Rewa.

T. Clunie, M.B., Ch.B. (Aberdeen), Medical Superintendent, Colonial War Memorial Hospital, on leave.

M. L. McCauley, M.B., Ch.B., B.A.O. (Dublin), District Medical Officer, Labasa.

R. J. Snodgrass, L.R.C.P. (Edin.), L.R.C.S., L.D.S., R.C.S.E., District Medical Officer, Ba.

C. J. Austin, M.B., Ch.B. (Edin.), Medical Superintendent, Makogai Leper Asylum, on leave.

W. G. MacNaughton, M.B., Ch.B. (Glasgow), Acting Medical Superintendent, Makogai Leper Asylum.

G. T. Barnes, M.B., Ch.B. (Birmingham), D.T.M. & H. (Eng.), District Medical Officer, Ra.

W. Worger, M.R.C.S. (London), L.R.C.P. (England), Acting Medical Superintendent, Colonial War Memorial Hospital.

F. Widlake, L.M.S.S.A. (London), District Medical Officer, Taveuni.

D. C. M. Macpherson, M.B., Ch.B. (Glasgow), D.T.M. (Liverpool), C.P.H. (Johns Hopkins), Pathologist; also acting as Medical Officer of Health, Suva.

D. W. Hoodless, B.Sc. (Lon.), L.M.S.S.A., Principal, Central Medical School.

R. W. D. Maxwell, M.B., Ch.B. (N.Z.), District Medical Officer, Levuka.

J. S. Cramer, M.B., Ch.B., F.R.F.P. & S. (Glasgow), L.R.C.P. & S. (Edin.) District Medical Officer, Nadroga.

E. V. Maxwell, M.B., Ch.B. (N.Z.), Assistant Medical Superintendent, Colonial War Memorial Hospital.

Leave. — Dr. A. H. B. Pearce, 1st January to 29th January; Dr. P. T. Harper, 1st January to 31st March; Dr. H. S. Evans, 1st January to 14th January; Rev. Sister Mary Berchmans, 1st January to 31st January; Rev. Sister Mary Benigna, 1st January to 31st January; Miss J. Sinclair, 1st January to 27th May; Miss L. M. Lea, 15th January to 22nd April; Dr. T. Clunie, 4th February to 31st December; Dr. W. M. Ramsay, 12th February to 14th April; Rev. Sister Mary Alice, 5th March to 16th July; Rev. Sister Mary Philbert, 5th March to 16th July; Dr. A. J. Borg, 1st April to 31st December; J. Anning, 11th April to 31st December; A. Caldwell, 12th April to 23rd May; Miss N. H. Retemeyer, 25th February to 24th May; W. C. Cockell, 5th May to 2nd December; Miss M. M. Rial, 28th May to 31st December; Miss E. E. Hollands, 25th June to 24th September; Dr. C. J. Austin, 23rd July to 31st December; F. A. Taylor, 16th Sep¬ tember to 31st December; Miss A. Storck, 5th July to 15th August; P. Burge, 11th October to 31st December.

14

REPORT BY Dr. D. C. M. MACPHERSON, ACTING MEDICAL OFFICER OF HEALTH AND PORT HEALTH OFFICER ON THE WORK OF THE SANITARY DIVISION IN 1937.

I have the honour to submit the Annual Report together with relevant tables on the work of the Sanitary Division of the Department.

Staff. — It is with deep regret that I have to record the death on 22nd June as the result of an accident of Dr. C. H. B. Thompson who had occupied the post of Medical Officer of Health for Suva for eleven years. During his tenure of this responsible office, many important advances were made in the scope and extension of public health work throughout the Colony, and his wide experience and mature judgment were greatly valued by the Head of his Department and by Government.

Dr. D. C. M. Macpherson who had been acting as Medical Officer of Health during Dr. Thompson’s absence from the Colony on leave, again assumed duty as from the 19th June and was appointed to be a temporary member of the Suva Town Board.

The Medical Officer of Health was gazetted as a member of the Subdivision of Lands Board on 30th November, 1937.

Mr. W. C. Cockell, Senior Sanitary Inspector, Central Board of Health, proceeded on nine months vacation leave as from 5th March, and resumed duty on 3rd December.

Mr. C. Kendrick, Chief Sanitary Inspector Central Board of Health took over Mr. Cockell’s duties in addition to his own while the latter was absent from the Colony.

Mr. W. A. Milne, Meat and Food Inspector, was granted five days local leave as from 3rd September, and was transferred to Lautoka on 30th September.

Mr. Colin Charles Belcher was appointed to the Health Office as a temporary clerk in training from 15th September. His appointment was terminated on 15th December.

Mr. R. B. Fyfe, Sanitary Inspector was transferred from Lautoka to the Health Office on 30th September to carry out the duties of Meat and Food Inspector.

Mr. Matthew Samuels was transferred to Labasa on 23rd February for three months while Mr. Andrew Caldwell, Assistant Sanitary Inspector was on leave.

General. — -The Medical Officer of Health is an official member of the Suva Town Board and Chairman of the Health Committee of that body. He also acts as Adviser to the Central Board of Health and is a member of the Town Planning and Subdivision of Lands Boards.

During the year arrangements were made whereby the Medical Officer of Health assumed control of the Town Boards Sanitary personnel, and this officer will in future direct all public health activities in both the urban and rural sanitary districts of Suva.

It was originally the intention of Government that the Medical Officer of Health should be provided with office accommodation in the part of the new Government buildings reserved for the offices of the Medical Department. Owing to the sale of the site of the old Pharmacy Building the whole question of housing the personnel of the Sanitary Division was reconsidered and it was deemed desirable to erect a separate building nearer the centre of the town and in closer proximity to the wharves. Plans have accordingly been prepared and approved, and construction of the new buildings will be commenced early in 1938.

The new building is situated on a portion of the wharf reclamation opposite the Government Bonded Store and new Pharmacy with frontages to Rodwell Road and Renown Street. Ferro¬ concrete is the material to be used, and the building will house the Health personnel of both 'the Government and Town Board. In addition to ample office accommodation, a new oil-fired steam pressure disinfector with vacuum formalin attachment will be installed at the rear of the premises and also a specially ventilated fumigant store. A clinical room with appropriate fittings for inoculations, vaccination and examination of leper contacts, &c., has also been included in the plan.

The work of the Division has increased enormously during the past three years, largely as a result of the practical operation of the Public Health Ordinance of 1935. The great activity in building operations in Suva and vicinity has entailed much supervision and the detailed and regular inspection of dairy premises and products, to be thoroughly effective, necessitates the employment of a fulltime dairy inspector in the near future. Considerable reorganization of the Division has been proposed and should alternately be productive of more unified and continuous Public Health effort throughout the whole Colony.

Fijian Child Welfare. — During the year the Fijian Native Welfare Nurse who will in future

be attached to this office paid visits as detailed below: —

Place. No. of visits.

Nasese . . . . . . . . . . . . . . 25

Rewa Street . . . . . . . . . . . . 1

Flagstaff . . . . . . . . . . . . . . 17

Asylum Road . . . . . . . . . . . . 9

Laqere . . . . . . . . . . . . . . 12

Tamavua River . . . . . . . . . . . . 20

Kalekana . . . . . . . . . . . . . . 18

Suvavou . . . . . . . . . . . . . . 12

Bau Street . . . . . . . . . . . . . . 15

Viti-Solomoni (beyond Flagstaff) . . . . . . 1

V unimoli . . . . . . . . . . . . . . 1

15

Place. No. of visits.

Lami . . . . . . . . . . . . . . 4

Tacirua . . . . . . . . . . . . . . 3

Colo-i-Suva . . . . . . . . . . . . . . 2

Makila (near Muanikau Girls' School) . . . . . . 1

Vunidilo . . . . . . . . . . . . . . 7

Nasova . . . . . . . . . . . . . . 3

Caubati (4J mile, Rewa Road) , . . . . . . . 1

Two miles . . . . . . , . . . . . , . 2

Total .. .. 154

Infectious Diseases.

Dysentery was prevalent during the first quarter of the year, the highest incidences being in the Rewa, Nadroga, Suva and Lautoka districts. A steady and very satisfactory decrease throughout the following months was reported in all districts excepting Savu Savu, where an epidemic occurred in the middle of the year with 89 cases and 13 deaths.

Altogether 1,213 cases of bacillary and 24 cases of Amoebic dysentery with 67 deaths were reported to this office.

A considerable number of cases were notified in the early part of the year from the Flagstaff and Toorak areas in the Suva District. The water supply in the Flagstaff region is definitely unsatisfactory and has been the subject of a special report to Government.

Deaths from Dysentery with corresponding Number of Cases.

District.

Deaths.

Cases.

District.

Deaths.

Cases.

Suva

5

87

Nadroga

2

74

Ba and Tavua

2

49

Navua

2 -

19

Bua . .

2

16

Rewa

30

434

Kadavu

3

16

Savu Savu

13

103

Lautoka

3

68

Lomaiviti . .

2

23

Nadi

4

147

68

1,036

The percentage of deaths among total cases reported is 5-416. Total number of cases reported for the year 1,237.

Broncho Pneumonia. — Nadi, Lautoka, Ba and Tavua show the highest incidence of this disease — the total number of cases for the Colony was 223 — an increase of 34 over last years figure.

Measles. — One hundred and sixty cases were reported from the country districts in the early part of the year but the disease appears to have subsided completely, no notifications being received during the final quarter of 1937.

Enteric Fever. — Total for Colony — 216. An outbreak of 11 cases was reported from Nadarivatu, the earliest cases occuring in July and August.

Influenza has been prevalent throughout the Colony. One thousand seven hundred and eighty-four cases having been notified. The disease was mild in type and few cases developed serious complications or sequelae. The total includes 1,142 Fijians and 572 Indians.

Cerebro Spinal Meningitis. — One Indian at Nadi.

Cerebral Meningitis. — One Fijian case reported from Lomaiviti.

Epidemic Dropsy. — Twelve cases of epidemic dropsy were reported from Ba at intervals throughout the year, and two from Suva. All cases were among Indians.

Poliomyelitis. — Acute poliomyelitis had been prevalent in New Zealand since December, 1936 — 840 cases with 42 deaths were reported by weekly cables up till the middle of July when the epidemic was officially considered over.

In view of the considerable passenger traffic between the Dominion and Fiji it was resolved that all persons disembarking from vessels in Suva should be placed under quarantine surveillance; and New Zealand was accordingly proclaimed an “ infected place ” under the terms of the Quaran¬ tine Ordinance No. 42 of 1928, and Acute Poliomyelitis a Quarantinable disease within the meaning of that Ordinance. No case of the disease occurred in the Colony during the year. Poliomyelitis has also been prevalent in Melbourne, Victoria, whence it appears to be gradually spreading north into New South Wales.

Food Poisoning. — During the first quarter four cases of food poisoning were investigated, three adult Fijians and one Fijian child aged 14 years, living in Toorak, being affected. It was discovered they had eaten Kai (shell fish) obtained from Rewa. The child died after being admitted to hospital in Suva.

Landry’s Paralysis. — One adult Indian case was notified by Dr. Harper, Lautoka Hospital, whose detailed report was forwarded by the Medical Officer of Health to the Director of Medical Services. This was the first case of this disease to be reported to this office.

Undulant Fever. — During the 2nd quarter an Indian woman from the rural district of Suva was admitted to hospital suffering from this disease. By co-operation with -the Pathological Laboratory and the Veterinary Section of the Agricultural Department, the source of infection was finally traced to a cow whose milk the patient had been in the habit of drinking.

16

Cholera. — Under the terms of the Quarantine Ordinance No. 42 of 1928, Hong Kong was on the 9th September proclaimed a place infected with Cholera. Special precautions were accord¬ ingly observed in regard to the granting of pratique to ships from Chinese and Japanese ports, and very satisfactory arrangements for the inoculation of the crews of such vessels with cholera vaccine prior to leaving the port of departure were made with shipping agents and the Port Health Authorities in Hong Kong.

Leprosy. — Examination of discharged lepers, 13; examination of contacts of lepers, 57; examination of suspected lepers, 3.

Infectious disease inquiries and examinations made by Medical Officer of Health and or Health Office staff in Suva District: — Visits re infectious diseases, 72; premises disinfected, 55.

Vaccination and Inoculation.— T. A. B. Inoculations, 922; small-pox, 10.

Port Health Work and Administration.- — Number of oversea vessels boarded, 155.

Medical Inspections. —

1936.

1937.

Passengers . .

3,785 (landing, 3,421 through 364

3,323 (landing, 3,063 through 260)

Crews

2,662

3,802

Labour

Total . .

6,447

7,125

Nett tonnage of vessels entering Colony at Port of Suva, 911,157. show an increase of 8 over 1936.

The number of vessels boarded

Fiji:-

Port of Suva. — Infectious diseases in or in the vicinity of ports in communication with

Disease.

Ports or countries.

Quarters of the year.

Bronchial catarrah

Samoa

1,

Cholera

Calcutta

Hong Kong

1, 2, 3, 4

3, 4

Diphtheria . .

New South Wales

1, 2

Dengue

Queensland and Thursday

Is. .. 1, 2

Influenza

San Francisco

Queensland . .

New Zealand

1, 2, 3

1, 2, 3

1, 2, 3

Measles

Honolulu

L

Poliomyelitis

New Zealand

New South Wales

1, 2, 3, 4

3, 4

Small-pox . .

Calcutta

Hong Kong

Los Angeles

1, 2, 3, 4

1, 2, 3, 4

2

Weils disease

3 cases in Queensland in 2nd

quarter & 8 cases in 3rd quarter.

Inspection and Fumigation of Shipping and Anti-Rat Measures.

This includes vessels arriving from plague infected or suspected ports, vessels arriving from malarial ports likely to be harbouring adult anopheles mosquitoes — overseas vessels not holding deratisation or deratisation exemption certificates issued within the previous six months, vessels prior to going on the slip and local boats when undergoing six monthly surveys are fumi¬ gated by the Port Sanitary Staff.

The following table shows the number of vessels fumigated during 1937: —

Class of vessel.

Method of fumigation.

Rats destroyed by fumigation.

Cyanide

Cube cyanide

Total.

Rattus

Rattus

units.

& sulphuric acid.

rattus.

norvegicus.

Total.

Overseas

10

10

5

2

7

Local vessels

19

50

69

47

3

50

Totals

29

50

79

52

5

57

Of the ten overseas vessels fumigated, rats were recovered from one only, this being the s.s. “ Reaverly ” from Japan via Shanghai and Hong Kong. The seven rats recovered were examined by the Government Pathologist and found to be healthy and negative to B. Pestis.

The compulsory fumigation of local vessels every six months has been the means of reducing the rat population of these boats to a minimum; not only does it rid vessels of rats, but it also destroys cockroaches and other vermin.

Of the 69 local vessels fumigated, rats were recovered from only seven.

During 1937 the use of sulphur dioxide gas as a fumigant for shipping has been entirely dispensed with, the fumigant used being cyanide units or cyanide cubes and sulphuric acid.

Cyanide units were used for all overseas vessels and for the larger local vessels.

“ International ” deratisation certificates issued numbered 10.

17

In addition to the fumigation of vessels an Indian ratcatcher is employed trapping rats at the wharves and in some areas of the town. The results of this work is shown in the following table : —

Type of trap set.

No. of traps set.

No. of rats caught.

No. of rats sent to laboratory for bacterio¬ logical exami¬ nation.

Spring trap

9,087

1,942

Cage traps

779

166

....

Sticky trap

1,105

496

....

Totals . .

10,971

2,604

600

Of the 2,604 rats caught — 2,154 were Rattus norvegicus (brown rat) and 450 Rattus rattus (black rat). Six hundred rats were sent to the Government Laboratory for Bacteriological examination and found negative for B. Pestis.

Visits have been paid to the wharves when overseas vessels were in port to ensure that satisfactory rat guards are placed on all moorings ropes.

Only in one or two instances was it found necessary to request the Masters of vessels to provide rat guards, and such requests were immediately complied with.

Disinfection of Imported Articles. — All articles, subject to disinfection, imported into the Colony have been disinfected unless the consignee produced a certificate of approved disinfection issued by a recognised Health Authority. The following table shows class of article, number and method of disinfection:—

Method of disinfection

Class of article.

Number

disinfected.

Steam under pressure.

Formalin.

Re- conditioned felt hats

, ,

180

180

Second hand overcoats

# #

61

61

Horse hair

• •

1 bundle

1 bundle

242

62

180

Port Food Inspection.- — By arrangement with the Customs Department imported food stuffs are inspected at the Customs Shed by one of the Food Inspectors of the Health Department. This procedure has resulted in the following foodstuffs being condemned and destroyed as being unfit for human consumption : — -

Quantity condemned

Articles of food. and destroyed.

Rice . . . . . . . . 47 bags

Mustard oil . . . . . . 555 galls.

Dhall . . . . . . . . 4 bags

Bovine kidney . . . . . . 1 case

Sausages (pork) . . . . . . 1 case

Rabbits (frozen) . . . . . . 1 case

Sanitation of Local Vessels. — Inspections have been made of these vessels when up for fumigation. In some cases the crews quarters are most insanitary through lack of reasonable ventilation, constant overcrowding and bad lighting. This is a matter which demands future attention.

General Sanitation work carried out in the Rural Sanitary District of Suva and

Investigation of Infectious Diseases in Urban Suva.

(a) Sanitary Inspections made in Rural Sanitary district of Suva:— Number of inspections, 3,926; re-inspection, 2,411; total visits, 6,337.

One thousand three hundred and eighty-nine more visits were made during the year than in 1936. The Native Medical Practitioner attached to the Departjment, is largely responsible for the increase. This officer's inspections were done amongst the Native and Solomon settlements in and around Suva.

(b) Sanitary Improvements. — The following is a summary of sanitary improvements com¬ pleted during the year as a result of advice, verbal request or written notice by the inspectors : —

Summary of Sanitary Improvements.

New latrines constructed Latrines repaired or cleaned Insanitary latrines filled in Septic tanks installed Septic tanks repaired New wells constructed Wells protected, covered or repaired Insanitary wells filled in Water tanks repaired Premises connected to pipe water supply New bathrooms or washing places constructed Bathrooms and washing places repaired cleansed or drained Insanitary bathrooms demolished

57

769

50

15

1

1

32

3

1

1

15

3

18

New drams constructed . . . . . . . . . . . . . . 21

Drains repaired or cleansed . . . . . . . . . . . . . . 386

Accumulations of rubbish removed . . . . . . . . . . . . 429

Bush, &c., cut . . . . . . . . . . . . . . . . . . 457

Nuisance from keeping of animals abated . . . . . . . . . . 4

New kitchens erected . . . . . . . . . . . . . . . . 4

Kitchens repaired . . . . . . . . . . . . . . . . 5

Insanitary buildings demolished . . . . . . . . . . . . 23

Steps and stairways repaired . . . . . . . . . . . . 2

Floors repaired . . . . . . . . . . . . . . . . . . 1

Walls repaired . . . . . . . . . . . . . . . . . . 1

Roof repaired . . . , . . . . . . . . . . . . . . 2

Nuisance from mosquito breeding abated . . . . . . . . . . 11

Nuisance from dead animals abated . . . . . . . . . . 1

Gutters and R.W. pipes repaired and renewed . . . . . . . . 3

Fences removed . . . . . . . . . . . . . . . . 7

Nuisance from septic tanks abated . . . . . . . . . . . . 1

Nuisance from defective drainage . . . . . . . . . . . . 1

Written notices served . . . . . . . . . . . . . . 150

Prosecutions under Public Health Ordinance.- — -Only one person was prosecuted during the year under the above Ordinance — a European who had carried out extensive alterations to a building without having first obtained permission to do so from the Local Authority.

The prosecution of individuals in connection with breaches of Public Health Regulations is avoided wherever possible, as more permanent results can often be obtained by the exercise of tact and persuasion on the part of the inspector and thus obtain the co-operation of the offender.

Insanitary Buildings. — Twenty-one closing orders were served on owners of insanitary buildings, with a view to total demolition. Of 21 such buildings 19 have been demolished, and the owners of the remaining three were given an indefinite extension of time, as they were Indians of the poorest class and totally unable to bear the cost of erecting a new structure. Apart from the above, four buildings were voluntarily demolished by the owners following a verbal request from us.

There still remain many insanitary buildings in the Rural Sanitary District of Suva, but to carry out immediate wholesale demolition of these premises would create a serious shortage of house accommodation for the poorer classes.

The extensive building operations at present being carried out in Suva have no doubt caused an influx of workers from other localities with increased demand for house accommodation, and it appears to be necessary to proceed slowly with the demolition of dwelling and tenement houses until new buildings are available for occupation.

The question of a housing scheme for the working classes in and around Suva may have to be considered if the present shortage of accommodation continues.

New Buildings. — It is pleasing to be able to report that a decided improvement has taken place during the year in the standard of the new buildings erected. The inspectors have been successful in discouraging the use of wooden shutters, and the installation of glazed windows instead.

The coming into force of the new Public Health Regulations has been of great assistance to the Health staff in regard to effecting improvements in the standard of new buildings erected and especially in connection with sanitary plumbing and drainage.

The following is a summary of applications received in respect to new buildings and altera¬

tions to existing buildings: —

Total number of applications received . . . . 169

Total number of applications approved . . . . 138

Total number of applications disallowed . . . . 31

The following shows the classification of buildings approved: — -

Tenement house . . . . . . . . . . . . 4

Dwelling-house . . . . . . . . . . . . 102

Combined dwelling and store . . ... . . . . 1

New kitchen . . . . . . . . . . . . 9

New bathroom . . . . . . . . . . . . 1

School . . . . . . . . . . . . . . 1

Wireless apparatus room . . . . . . . . 1

Motor garage . . . . . . . . . . . . 5

Store . . . . . . . . . . . . . . 3

Alteration to existing building . . . . . . . . 11

All sites were inspected before the application was approved.

Periodical visits were paid to all new buildings under construction, and instructions given to effect alterations when found necessary.

Eighty certificates were issued on completion of buildings complying with the requirements of the building regulations.

Septic Tanks. — The number of septic tanks installed in the Rural Sanitary district of Suva during the year was 15 — this being an increase of 14 over 1936.

All applications to install a septic tank are submitted to the Central Board of Health for approval.

19

The standard of drainage plans in connection with the installation of septic tanks has greatly improved. The new Public Health Regulations has enabled us to confine the execution of this class of work to either a licensed plumber and drainer or an approved person.

Articles of Clothing Disinfected.

Class of article.

No. disinfected by steam under pressure.

No. disinfected by formalin.

Total.

Blankets (Fiji Defence Force)

582

582

Articles of clothing

, ,

150

150

Box in which clothes were packed . .

• •

1

1

Totals

582

151

733

The leper barge has been maintained. Leper contacts have been visited to arrange for six-monthly inspection by the Medical Officer of Health. Visits were made in connection with suspected lepers and arrangements made for their medical inspection.

Discharged lepers from Makogai on arrival at Suva were housed, fed and repatriated.

Sampling of Suva Water Supply and Suva Sea Baths. — The arrangement made in 1936 for the regular sampling of Suva water supply and the Suva sea baths was continued during the year.

The following shows the source of sample and number of samples taken for bacteriological examination : —

No. of samples for bacteriological

Source of sample.

examination.

Shipping main

. .

42

High level main

33

Low level main

34

Reservoir (Asylum Road)

9

Reservoir (main storage)

4

Reservoir (Toorak)

6

Intake head No. 7

1

Intake head No. 2

2

Pumping station

1

Rewa River

Total . .

2

134

Sixty-one samples were taken from Suva sea baths for bacteriological examination. All were reported satisfactory.

Surface Clearing and Sanitation. — This work has been continuous during the year with the exception of the last two weeks in December when the main gang had to be paid off as financial provision for the year was exhausted.

Vacant Crown lands have been cleared of long grass and bush, old drains cleared, new drains made, and accumulations of rubbish removed from the foreshore at Suva Point — the Grand Pacific Hotel to Nabukalau creek, and from the more thickly populated areas of Rural Suva. Two men have been continuously employed at the Suva Point Settlement, and one man at the King’s Wharf, the latter worked seven days a week and his chief duty was to keep the public latrines at the wharf in a sanitary condition. He also cuts the grass on vacant Crown land in the vicinity of the wharf.

In April of this year a 1|- ton Ford lorry was purchased for the purpose of removing accumu¬ lations of rubbish.

The following is a summary of work done in connection with the clearing and draining of vacant Crown lands: —

Locality.

Approximate area of land cleared and burnt off.

Length of new drains made.

Length of existing drains weeded and cleaned.

acres.

yards.

yards.

Government Domain . .

92

Pender Street . .

1

Samabula

10

Domain Road East . .

6

1,356

4,196

Draiba . .

4

Williamson Street

2*

Nabukalou Creek

4

119*

1,365

4,196

Summary of Work done by Lorry.

Rubbish and tins removed.

Loads of sand and earth for filling in purposes.

No. of

miscellaneous

trips.

Total mileage.

Gallons of benzine used.

232

118

406

4,656

331

Miscellaneous trips include, transport of labour and native staff when no other vehicles were available, trips in connection with provision of grass and sawdust for animals at the Laboratory, cartage for Medical Department and Pharmacy.

Ankylostomiasis. — A hookworm survey of the schools in and around Suva was commenced on the 12th August; fecal specimens were collected from the children and fowarded to the Govern¬ ment Laboratory for microscopical examination. Treatments were also given to children showing infestation.

The following table shows by race the number of persons examined, positive to hookworm and the rate per cent, of infection: —

Race.

No. of persons examined.

No. positive to

hookworm.

Rate per cent, of hookworm infestation.

Indians . .

131

59

%

45

Fijians . .

785

265

34

Other Races . .

55

6

11

Four hundred and eighteen persons were given treatment, the drug used being carbon tetrachloride with magnesium sulphate.

Meat Inspection.

(a) Slaughtering has been carried out regularly at the following registered slaughter-houses. Tamavua (Leyland’s and Corbett’s), and Rewa Road 9 miles (Halal Meat Company).

All meat from animals slaughtered for human consumption at the above slaughter-houses has been examined before being exposed for sale.

The following is a summary of carcases inspected: — -

Bullocks.

Cows.

Calves.

Sheep.

Pigs.

Totals.

Passed

1,518

527

225

1,098

958

4,326

Condemned . .

67

46

1

4

41

159

Totals

1,585

573

226

1,102

999

4,485

Inspection fees amounted to £371 9s. Od., this being 3s. 6d. less than that received during

1936.

There has been a decided reduction in the number of sheep and pigs slaughtered during 1937.

(b) Causes of condemnation (whole of carcase including organs) : —

Bullocks . . . . . . Generalised tuberculosis

Extensive bruising Exhaustion

Cows . . . . . . Generalised tuberculosis

Bruising

Emaciation with tuberculosis Calves . . . . . . Tuberculosis

Sheep . . . . . . Acute septic metritis

Caseus lymphadenitis Fever

Generalised pyaemia

Pigs . . . . . . . . Generalised tuberculosis

Fever

Stephanurus dentatus

(c) Causes of condemnation ( organs , &c) : —

Ox — Forequarters

Tuberculosis

24

Injury

1

Part of fore-quarters

Bruising . .

5

Flanks

Soiled during emergency slaughter

2

Foreleg and shoulder

Bruising

1

Tumours

2

Neck meat

50 lb soiled during emergency slaughter

Hindquarters

Tuberculosis

! 33

Injury .

1

Multiple abscesses

1

Peritonitis

2

Internal haemorrhage

1

Part of hindquarter . .

Bruising

1

Ribs

Soiled during emergency slaughter

4

Internal haemorrhage

6

Tumours

8

Heads . .

Tuberculosis

173

Mutilated by gunshot . . . . '

8

Actinomycosis .

1

2

1

44

1

1

1

1

1

2

2

36

2

1

21

Livers . .

Tails

Kidneys

Cows — Forequarters

Part of forequarter

Hindquarters

Part of hindquarters

Udder flanks

Kidneys

Tails

Calves— Livers

Heads

Hindquarters

Tail

Sheep — Forequarters

Heads

Ribs

Livers

Pigs — Forequarters

Heads

Abscesses

Hindquarters and flanks.

Flank and lumber regions.

Ham

Livers

Kidneys

Angiomatosis

Tuberculosis

Bacterial necrosis

Distomatosis

Fever

Congestion

Injury .

Cirrhosis Abscesses Fatty infiltration Hydatids

Fatty inflammation

Nephiritis

Hydronephrosis

Tuberculosis

Tuberculosis

Bruising

Tuberculosis

Bruising

Injury " .

Primary mastitis

Tuberculosis

Hydronephrosis

Inflammation

Bruising

Tuberculosis

Bacterial Necrosis

Fever

Tuberculosis

Injury .

Injury .

Injury

Pyaemia

Abscesses

Pleurisy

Abscesses

Pleurisy

Calcified cysts

Distomatosis

Fever

Fatty degeneration

Fatty infiltration

Cirrhosis

Cysticercus

Pleurisy

Bruising

Tuberculosis

Abscesses

Tuberculosis and worm infection

Tuberculosis abscesses

Injury

Abscesses

Bruising

Tuberculosis

Cirrhosis

Fatty infiltration Congestion Fatty degeneration Abscesses Distomatosis . .

Calcified cysts Hydatids Cysticercus Injury

Stephanurus dentatus

Abscesses

Tuberculosis

Hydronephrosis

Nephritis

236

133

153

30 40 21

1

3

3

5 1

6

4 4

3

4 4

3 2 1 1 2 2 1 1 2 8 1

4 1 1 1 2 4 2 1 1

195

218

3

1

39

1

31

4 2

67

1

2

2

1

1

2

152

113

17

6

5

3 1

4 1 1 1

167

2

2

2

10

Slaughter-house Premises. — There are two registered slaughter-houses in Suva Rural Sanitary district — one is situated on the Suva-Rewa Road near the nine mile peg, and is owned by an Indian — the other at Tamavua is owned by Messrs. Leyland’s and Corbett’s.

22

The Tamavua slaughter-house is an old building and does not conform to modern standards and should be replaced.

The question of erecting a public abattoir has already been considered by the Central Board of Health, who have appointed a committee to carry out investigations and make a report upon the whole situation.

Carriage of Foodstuffs. — All vehicles used for the carriage of meat and other foodstuffs are not granted registration until first approved by the Pure Food Inspector.

Inspection of Food Shops. — All Foodshops in the Sanitary District of Rural Suva have been inspected at intervals during the year.

Food Sampling. — The following tables show the numbers of food samples taken during the year, number adulterated, and action taken.

[a) Pasteurised Milk ( produce of Rewa Co-operative Butter factory ) : —

Particulars of sample.

No. of samples taken.

No. of samples complying with Government standard.

No. of samples not up to Government, standard.

Raw milk prior to pasteurisation

4

3

1

Pasteurised milk .

41

26

15

Totals

45

29

16

all the above were random samples.

( b ) Other Articles Sampled : — -

Article.

No. of samples taken.

No. of samples adulterated.

Prosecutions.

Result of legal action.

Raw milk

102

61

13

10 cases fined; total amount

Cream

1

• • • •

....

in fines, £47 15s. 6d. ; 3 cases

Mustard oil

5

4

• • • •

to be heard in January, 1938.

Of the 61 samples of raw milk found to be adulterated 36 were considered satisfactory as they were only slightly deficient in solids-not-fat, and showed a high fat content.

Inspection of Dairies and Dairy Herds. — There are 28 registered dairies in the Sanitary District of Rural Suva. These premises have been inspected at intervals and orders given to carry out improvements where necessary. All herds have been tuberculin tested by the Veterinary Department.

New Dairy Regulations.- — -Under the new Dairy Regulations all premises where mill; or cream is produced, collected, stored or distributed for sale, require to be registered. This has increased the number of dairies under the control of the Central Board of Health from 28 to an estimated number of 64. To be added to these are ghee producers.

Some of these dairies are situated in the province of Colo East which is about 60 miles from Suva, others are located at Navua, a distance of over 30 miles. With the present staff it is almost impossible to inspect all these premises.

Revenue received through the Health Office. — It may be of interest to give the source and

amount of revenue earned through the Health Office for the y

ear. This

is as follows

Dairy Licences . .

£32

2

6

Meat inspection fees

371

9

0

Fumigation fees

177

8

3

Fines

50

15

6

£631

15

3

Rural Sanitary District of Navua. — The only work done in this district during the year has been in connection with approval of plans for new buildings. Later in the year arrangements were made for a European Inspector to visit Navua weekly for this purpose. The following

applications were received and approved: —

Application to erect a store . . . . . . 1

Application to erect dwelling-house . . . . 7

Application to erect motor garage . . . . 1

Application to erect kitchen . . . . . . 1

Alteration to existing building . . . . . . 1

Arrangements have also been made to carry out a complete sanitary survey of this district commencing in January, 1938,

23

Meteorological.

Month.

January . .

February

March

April

May

Tune

July

August September October . . November December

Inches.

Total average.

8-78

11-51

8-29

11-36

17-53

14-82

12-13

12-32

16-49

10-58

2-23

6-38

4-76

5-27

11-46

8-15

6-95

7-57

6-63

8-86

5-87

10-14

5-51

12-50

Total average over a period of 53 years.

Legislation Affecting Public Health.

Regulations. —

Public Health Regulations for the whole of the Colony were passed during the year. Amendments to Public Health Regulations.

Proclamations. —

Declaring Acute Anterior Poliomyelitis to be a quarantinable disease.

Proclaiming that the Dominion of New Zealand is a place infected with Acute Anterior Poliomyelitis.

Declaring that Hong Kong is a place infected with cholera or from through which cholera may be brought or carried.

Gazette Notices.

Appointments. —

Dr. D. C. M. Macpherson to act as Medical Officer of Health.

The Commissioner of Lands to be an Official Member of the Central Board of Health.

Notices. —

Appointing Central Board of Health to be the Local Authority for the Rural Sanitary districts of Suva, Navua and Colo East.

TABLE I.— INFECTIOUS DISEASES— NOTIFICATIONS BY DISTRICTS.— 1937.

24

1,213 Bacillary, 24 Amoebic.

25

TABLE II.— INFECTIOUS DISEASES NOTIFICATIONS (CASES) BY NATIONALITIES.— 1937.

Disease.

Europeans

Half-

castes.

Fijians.

Rotumans.

Indians.

Chinese.

Others.

Totals.

Ankylostomiasis

6

6

301

3

303

7

626

Broncho-pneumonia

6

111

• •

105

• «

1

223

Lobar-pneumonia

1

2

48

• •

18

69

Dengue fever

• •

19

• •

1

...

20

Cerebral meningitis

• •

1

• •

3

• •

4

Cerebral spinal menin¬ gitis .

. .

• •

• •

• •

1

• •

1

Chicken-pox

21

34

• •

5

• •

60

Conjunctivitis . .

• •

1

32

• •

12

1

46

Diptheria

4

. .

• j

5

• •

. .

9

Dropsy . .

• ♦

• •

14

• •

14

Dysentery

24

807

10

374

22

1,237

Erysopelas

1

• *

• •

. ..

1

Enteric fever

4

77

• •

128

7

216

Infantile diarrhoea

• •

78

8

• •

86

Influenza

8

4

1,142

118

512

1,784

Landry’s paralysis

• •

• •

1

• •

1

Leprosy . .

• •

36

8

29

3

76

Measles . .

156

• %

3

1

160

Puerperal fever . .

1

• •

1

8

10

Ringworm

2

512

I

153

2

10

680

Scabies . .

2

10

1,404

371

286

6

2,079

Tetanus . .

2

• •

3

• •

5

10

Trachoma

1

• •

101

••

41

• •

143

Tuberculosis, pulmonary

2

4

220

8

102

4

2

342

Undulant fever . .

• •

....

• •

• •

1

• •

• •

1

Venereal disease

8

7

54

• •

263

5

3

340

Whooping cough

1

3

• •

14

• •

18

Yaws

6

2,724

1,816

33

1

1

4,581

Tuberculosis, other

2

40

1

7

• •

1

51

Totals

85

51

7,903

1

2,337

2,435

13

64

12,888

26

TABLES III.— INFECTIOUS DISEASES— MONTHLY INCIDENCE (CASES).— 1937.

Disease.

Area.

Jan.

Feb.

Mar.

April.

May.

June.

July.

Aug.

Sept.

Oct.

Nov.

Dec.

Totals.

Ankylostomiasis

A

6

3

5

2

2

. ,

18

B

1

2

1

1

7

3

2

17

C

74

9

29

61

41

114

34

61

42

60

49

17

591— 626

Broncho-pneu-

A

. .

, .

. .

. .

. .

1

. .

• •

. .

• •

1

monia.

B

, ,

1

1

1

• •

3

C

15

11

12

15

14

27

20

22

29

21

24

9

219—223

Lobar-pneumonia

A

. .

. .

. .

. .

. .

• .

. •

B

. ,

, .

. .

• .

. .

. .

C

6

5

8

2

5

12

2

9

4

4

7

5

69— 69

Dengue fever

A

. .

. .

• •

. .

• •

• •

• •

B

, ,

. ,

. .

, ,

. .

• •

. .

C

,

1

. .

. ,

, #

12

3

4

20— 20

Cerebral menin-

A

. .

, ,

, ,

. .

. ,

• c

• •

. .

. .

gitis.

B

. .

. .

. .

. .

. .

1

. .

• •

1

C

, .

1

. .

. .

1

1

• •

3 — 4

Cerebral spinal

A

. .

. *

. .

. .

• •

• •

. .

• •

meningitis.

B

. .

. .

. .

. •

• •

• •

• •

C

1

. ,

. .

, ,

• •

. .

• •

1 — 1

Chicken-pox

A

, ,

, .

. .

17

1

• ,

. •

2

1

1

22

B

,

, ,

2

, .

2

C

2

' 2

3

1

10

9

3

1

2

3

36— 60

Conjunctivitis . .

A

. ,

. «

. •

. .

• .

7

1

• •

1

9

B

1

# *

1

. .

1

1

4

C

2

3

2

4

3

2

5

3

5

4

33— 46

Diphtheria

A

. .

1

. •

• .

. .

. .

. •

• •

1

B

2

, .

1

. .

3

C

1

# #

1

2

1

5— 9

Dropsy . .

A

2

• •

. •

, .

• .

• •

• •

• •

2

B

. ,

• .

• •

C

8

3

1

. ,

12— 14

Dysentery

A

11

ii

8

6

1

• •

5

2

1

45

B

6

14

14

2

3

1

. ,

. •

. •

3

43

C

279

341

162

131

106

27

23

22

18

8

ii

21

1,149—1,237

Erysipelas

A

1

. .

. .

. .

. .

. .

. «

• •

1

B

, #

. .

, ,

. .

, .

. .

. .

. .

. •

C

. ,

. .

* *

. •

— 1

Enteric fever

A

1

2

1

1

1

2

1

l

1

11

B

# ,

, ,

1

2

3

C

23

15

24

18

31

13

18

20

6

11

6

17

202— 216

Infantile diarrhoea

A

, ,

, ,

, ,

. ,

. .

• •

• •

B

# #

. ,

. ,

. .

C

3

16

13

7

5

8

2

4

4

5

13

6

86— 86

Influenza

A

1

21

10

20

9

36

, #

97

B

1

, .

8

9

C

71

72

83

106

119

186

148

236

184

176

220

77

1,678— 1,784

Landry’s paralysis

A

• •

• .

. .

. .

. .

• •

• •

• •

• •

B

, #

. •

• t

C

1

, .

. .

. .

1— 1

Leprosy . .

A

• .

. .

. .

. .

« •

• •

. .

• •

B

1

, .

• .

• .

1

2

C

3

16

7

4

5

13

1

5

2

5

5

8

74— 76

Measles . .

A

, .

# .

, .

, .

. .

. .

B

, ,

• •

. .

C

97

49

ii

2

1

# .

. .

• .

. .

160— 160

Puerperal fever . .

A

. .

• •

, .

. ,

, ,

. .

• •

• •

. .

• •

B

, .

. ,

. •

C

1

l

2

1

1

1

3

10— 10

Ringworm

A

.

12

9

11

5

12

. .

49

B

12

2

, .

16

17

is

62

C

29

33

53

76

27

38

33

74

30

106

58

12

569— 680

Scabies . .

A

7

12

18

16

1

. .

, .

54

B

18

, ,

12

15

22

67

C

109

122

141

114

103

121

135

403

126

259

242

83

1,958—2,079

Tetanus . .

A

1

# #

, #

1

. •

1

3

B

, ,

, ,

. .

C

1

2

2

2

7— 10

Trachoma

A

2

. #

, ,

, •

2

B

, ,

, ,

, ,

. .

C

6

13

14

7

6

8

17

14

12

15

17

12

141— 143

Tuberculosis, pul-

A

, ,

, ,

1

2

2

1

. ,

1

2

1

2

12

monary.

B

1

1

, ,

2

1

. .

1

. ,

1

3

2

. •

12

C

18

20

25

23

20

23

28

26

30

36

35

34

318— 342

Tuberculosis,

A

# #

, ,

, .

other.

B

, ,

. •

C

4

5

4

3

3

3

3

1

7

8

6

4

51— 51

Undulant fever . .

A

# ,

, ,

, ,

, •

B

, .

1

# ,

. ,

, ,

, ,

. ,

. .

1

C

, ,

. ,

# ,

. .

— 1

Venereal disease

A

1

1

4

1

3

1

1

3

3

18

B

t #

1

1

. .

2

C

16

21

io

40

37

21

4

59

19

31

33

29

320— 340

Whooping cough

A

. .

. .

, .

, .

1

, .

. .

. •

• .

. .

2

• •

3

B

1

1

2

5

9

C

1

2

, ,

3

. .

6— 18

Yaws

A

4

2

2

2

. ,

• •

. .

10

B

. .

. ,

. .

C

344

528

637

201

236

413

228

528

207

634

413

202

4,571—4,581

Totals . .

1,134

1,308

1,262

886

821

1,074

771

1,559

1 821

1

1 1,449

1,203

600

12,888

27

REPORT BY Dr. W. WORGER, ACTING MEDICAL SUPERINTENDENT, COLONIAL

WAR MEMORIAL HOSPITAL.

Staff Changes. — Dr. Clunie, the Medical Superintendent, went on leave in February and I relieved him. Dr. Widlake the Assistant Medical Superintendent was transferred to Taveuni in February and Dr. Cramer took his place. Dr. Cramer was transferred to Sigatoka in June and Dr. E. V. Maxwell was appointed Assistant Medical Superintendent.

Nursing Staff.- — Miss Lea, the Matron, went on leave in January and returned in April, Miss Hughes acting as matron during Miss Lea's absence. Miss Hughes was transferred to Lautoka as Sister-in-Charge on May 23rd. Sister Sinclair returned from leave on May 29th and was posted to the Colonial War Memorial Hospital as Assistant Matron. Sister Storck was transferred from Lautoka to Suva on March 6th. Sister Montgomery was transferred from Suva to Lautoka on March 5th. Sister Retemeyer resigned on February 25th. Sister Carew was transferred from Suva to Labasa as Sister-in-Charge on December 16th. Sisters Moore, Dawes and Staff Nurses Davis and Dawes joined the staff on February 27th. Sister Hardy was appointed X-ray Sister and commenced duty on November 6th. This is a new appointment. Nurses Ragg, Cameron, Phillips and Garnett completed their training. The nursing staff at present consists of: — Matron, Assistant Matron, 5 Sisters, 2 Staff Nurses, 9 Probationers, 1 House keeper, 1 Senior Native Nurse, 23 Native Nurses in training and 1 X-ray Sister.

Work in the Hospital.- — During the year 2,679 patients were admitted for treatment: —

1936.

1937.

Europeans . .

• • • •

448

357

Fijians

. . . .

935

845

Indians

• • • •

1,227

1,113

Others

. .

464

364

• Total . .

3,074

2,679

The daily average for 1937 was 106-71. A detailed list of diseases is attached at the end of this report. Seven hundred and eighty-three operations were performed during the year. A list is attached. Five hundred and sixty-eight anaesthetics were given. These being given either by the Dispenser Native Medical Practitioner Vilikesa or the Assistant Medical Superintendent. European patient’s anaesthetics were either given by Drs. Paley, Beattie or the Assistant Medical Superintendent. The work in the wards though interesting was moderate.

The following injections were given: — N.A.B., 790; T.A.B., 63; A.T.S., 269.

Obstetric Ward. — Two hundred and fifty-two cases were admitted. This ward was well patronised as usual. During 1938 a new ward is to be built, this will relieve the congestion that often occurs. A detailed list of cases admitted is as follows: — Admissions, 252; births, 219; Fijians, 94; Indians, 88; Others, 37. Among there wese: — Triplets, 1 set; twins, 9 sets; still born, 13 (7 due to prematurity); caesarian sections, 4; instrumental delivery, 5; perforation, 1.

Out-patient attendances were as follows: —

Race.

1936.

1937.

Europeans . .

. . • •

1,758

1,188

Fijians

• • • •

7,057

7,065

Indians

• • • •

6,995

8,054

Others

. .

1,520

1,905

Total . .

17,330

18,212

On December the 4th the Is. charge for drugs or dressings to Indians was abolished. This imme¬ diately led to an appreciable increase in the number of “ chronic ” patients. During the latter part of the year the visitor’s days and hours were changed. Evening visiting being abolished. A card system was also introduced whereby a patient is only allowed two visitors at a time. This has made a marked difference at visiting times. Visitors are now controlled and the “ sight-seeing element ” (which was difficult to control and was a pest) is abolished. The wards are visited now only by genuine friends of patients and not sight-seers.

Epidemics. — There were no serious epidemics during the year in hospital.

X-ray Department. — This has done good work as usual. I enclose a report of the department.

Interesting Cases. — During the year there were a few unusual and very interesting cases which I think are worth recording.

Perforated Lung. — An old Indian of over sixty was brought to hospital with the history of having been thrown from his horse. On arrival (having been brought on a rude stretcher from some 40 miles beyond Nausori) he was found to be in a very collapsed state, suffering from a per¬ forated wound of the chest and lung under the left clavicle. The wound was cleaned and he made a remarkable recovery.

Gored by a Bull. — An Indian farmer was gored by his bull. On admission and examination he was found to have a large and long wound just above his left Poupart’s Ligament, this had lifted up the skin off the subcutaneous tissue right up to his lower left rib margin where he also had a small wound in the skin; this small wound had perforated also the abdominal cavity so that three coils of small intestine were prolapsed under the large skin wound. The wounds were cleaned, intestines replaced and he also made an excellent recovery.

28

Tetanus. — A woman was admitted with tetanus. She gave a history of having attempted to produce an abortion by inserting Croton leaves into the vagina seven days previously; there was no other history of any likelihood of other infection and I was of an opinion that the Croton leaves must have carried in the infection. She made a good recovery.

Head Injury.- — A Fijian man had his head caught between a punt and a concrete bridge. When examined on admission the lower jaw was found to be fractured in two places, the upper jaw was also fractured and was quite loose under the skin. By the kindness of Mr. Mount (Dentist) who made special metal dental splints excellent results followed and a good recovery was made.

Burns.- — A number of severe burns were admitted. These were treated by first thoroughly cleansing the part whilst the patients were under an anaesthetic then applying a solution of 5 per cent. Tannic Acid in Flavine and immediately applying a covering of 10 per cent. Silver Nitrate. This gave an immediate coagulation which formed a firm covering. The solutions dry quickly and only one application is needed. This method is an advantage over the Tannic Acid treatment which requires numerous applications.

Ante and Post Natal Clinics.

Ante Natal Clinic. — This is increasing in numbers gradually. Eighty-five mothers attending with a total number of visits of 231. They were Fijians, 38; Indians, 30; Others, 17. Thirty- three mothers were admitted to the Obstetric Ward for observation and treatment.

Post Natal Clinic.—- This was only started in May. Sixteen mothers attended. Fijians, 6; Indians, 7; Others, 3; with a total number of 98 visits. This is a good beginning and I think will continue as the wives of two principal chiefs are constant attendants with their babies.

Students. — The third and fourth year students have put in their usual hospital training and have done good work. This year two night dressers have been employed for night duty. This has relieved the students of ordinary night duty and has given them more time for study. Students now only do night duty on special occasions.

Hospital Alterations. — During the latter part of the year a start has been made on the building of the children’s new ward. This is being erected over the medical ward which has meant that the medical ward has had to be evacuated. The patients being accommodated in the small isolation block.

A new mortuary has been built. It is spacious and airy and is situated in a more convenient position than the old one. It is a block consisting of one room for Europeans and one for Natives with a coffining room in between. There is accommodation for six bodies.

A start has also been made on the erection of new quarters for the nursing staff. This, it is hoped will be ready for occupation by the middle of 1938.

Visits. — The Board of Visitors paid their usual quarterly visits. On November 11th His Excellency the Governor visited the hospital and laid a wreath at the base of the Memorial Tablet. On Xmas Day Lady Richards visited the hospital.

X-Ray Report.

The number of patients examined during 1937 was S10, a decrease of 465 on 1936. The number of films exposed, 1,195, showed a decrease of 765 on the 1936 figures.

The examinations conducted were: —

Bones and teeth . . . . . . . . 533

Chests . . . . . . . . . . . . 129

Barium meals and enemata . . . . . . 47

Abdomen . . . . . . . . . . 28

Sinus and mastoids .. .. .. .. 17

Opacol (for gallbladder) . . . . . . 12

Uroselectan . . . . . . . . . . 22

29

REPORT B\ Dr. D. C. M. MACPITERSON, GOVERNMENT PATHOLOGIST ON THE WORK OF THE PATHOLOGICAL AND RESEARCH DIVISION.

of 696 on fhp fotfl for tv a 10nS carried out during the year was 5,731, being a decrease

of 393 on the total for 1936 This decrease is mainly accounted for by the marked decline in the

number of throat swabs submitted for examination for suspected diphtheria, and of specimens for investigation m connection with diseases belonging to the Typhoid and Food Poisoning groups.

. Staff.— Bt. D. C. M. Macpherson, Government Pathologist was in charge of the Labora- tones during the year. In consequence of Dr. Thompson's regretted death he also continued to act as Medical Officer of Health, Port Health Officer, and School Medical Officer for Suva. Mr. E. Pery- Johnston is technician., and Native Medical Practitioner Macu Salato is Senior Native Assistant. No changes took place in the Junior Laboratory staff during the year.

Dr. Hoodless, Principal of the Central Medical School, has continued to give valuable and much appreciated asssitance and advice in connection with morbid histology.

Additional Equipment. The new laboratories and equipment have given every satis¬ faction in operation. Among the major items of apparatus purchased during the year were a Bolton and . Williams Photo-Electric colorimeter, Cambridge Electrometric titration apparatus, Leitz Freezing microtome, Saitorius air-damped Balance, Dennstedt Electric organic combus¬ tion furnace, Kjehldahl apparatus for six simultaneous estimations, electrically heated, Soxhlet apparatus for six simultaneous estimations, electrically heated, Electric Stirrer, Sodium vapour lamp, and Micro-distillation apparatus.

Special Grants. The sum of £500 (Fiji) was donated by the International Health Division of the Rockefeller Foundation for the purpose of purchasing additional biochemical equipment. This makes a total contribution of £4,200 by the Foundation towards the building and equipment of these laboratories.

In 1936, prior to the completion of the buildings, the laboratories were visited by Lord Trent, Chairman of the great British firm of Boots Ltd., chemical manufacturers and druggists. Later visits were paid by two other directors and the production manager of the company. The interest shown by these gentlemen resulted in an offer by the Directors of Boots Pure Drug Com¬ pany to contribute a sum of £500 (sterling) towards the cost of purchasing additional equipment for the teaching of laboratory subjects to students of the Central Medical School. This munificent offer was gratefully accepted by Government.

Teaching. — A number of post-graduate students were attached for varying periods to the laboratories during the year, and received practical instruction in Clinical Parasitology, Bacter¬ iology and Pathology. A course of lectures in these subjects combined with demonstrations was also given to the students of the Central Medical School and European probationer nurses at the Colonial War Memorial Hospital. A course in Forensic Medicine and Toxicology has been insti¬ tuted and was given to medical students of the third year.

Police. — The Pathologist is also Police Surgeon, and the duties of this post involved an unusual amount of both clinical and laboratory work in 1937. A number of the cases were of con¬ siderable medico-legal interest, requiring protracted and patient investigation. The precipitin test for human blood was carried out several times, in addition to the usual microscopic, chemical, and spectroscopic tests. Sir Herbert Dowbiggin, Commissioner of Police for Ceylon, was an interest¬ ed visitor to the laboratory.

Animals. — Rabbits, guinea pigs, white rats and white mice were imported from New Zealand and installed in the animal house. All have remained healthy, but although the rats and mice have bred well, neither rabbits nor guinea pigs have shown their usual prolific rate of increase. A special proclamation by His Excellency the Governor in Council was required to authorise the importation of these rabbits — the first, it is believed, ever to enter the Colony.

Research. — -The whole time of the present staff is very fully occupied with routine work and teaching, and little time can be found for participating in special research. The Secretary of State for the Colonies has accordingly been requested by Government, and has agreed, to bring the facilities possessed by these laboratories to the notice of the Medical Research Council and the various British Schools and Departments of Tropical Medicine, in order that the incumbents of research scholarships and fellowships may consider the claims of Fiji and the Western Pacific Territories as an important and interesting field of research in tropical diseases. The Governments of Australia and New Zealand have similarly been approached. It is the intention of this Adminis¬ tration to place at the disposal of adequately trained research workers who wish to carry out original investigations which not only may benefit the inhabitants of the Colony but add to the sum of medical knowledge, all hospital and laboratory resources of the Medical Department.

Visitors. — Many distinguished medical men and others have visited the laboratories during the year. Of special interest to the staff was the visit of Emeritus — Professor Sir Robert Muir M.D., Sc.D., F.R.C.P., LL.D., the doyen of British Pathologists, a remarkable number of whose former students, inspired by his genius and enthusiasm as a teacher and scientist, occupy University chairs and other leading positions in Pathology and Bacteriology throughout the English-speaking world. Lord McGowan, the distinguished Chairman of Imperial Chemical Industries, was also an interested visitor.

30

Summary of Examinations Performed During 1937.

Total number of examinations of faeces for dysentery (A & B.) Positive Shiga . .

,, Flexner .

,, Schmitz.

,, Sonne . .

,, Entamoeba histolytica ,, Balantidium coli

Total number of examinations for typhoid and food-poisoning Positive B. Typhosus . .

,, B. Enteritidis (Gaertner)

Total number of —

Kahn Tests performed Throat swabs examined for K.L.B.

Sputa examined for T.B.

Agglutination Tests performed Blood counts performed Blood cultures .

Biochemical examinations Occult blood examinations . .

Milk examinations Water examinations Pus examinations Puncture fluid examinations . .

Urine examinations

Venereal disease examinations (other than Kahn) Autogenous vaccines prepared Pathological specimens sectioned and mounted Blood group examinations . .

Total number of stools examined for worms and ova

734

124

19

10

9

6

2

137

10

1

286

83

163

96

321

39

52

10

49

230

13.

28

183

108

16

55

44

1.948

hookworm

653

= 33-5

trichuris

146

= 7-4

ascaris

58

= 2-9

oxyuris

40

= 2-0

trichostrongylus .

14

= 0-7

hymonolepis nana

6

= 0-3

Total number of rats for B. Pestis

616

Miscellaneous examinations not included above but inclusive of autop¬ sies and medico-legal investigations . . . . . . . . 520

Total of all examinations performed in the Laboratory for 1937 . . 5,731 Total of all examinations performed in the Laboratory for 1936 6,124

Decrease during 1937 . . . . . . . . . . . . . . 393

In addition to the above, 689 bottles of anti- typhoid vaccine, valued at £775 2s. 6d. and 24 bottles of staphylococcal vaccine, valued at £27, were prepared during the year. Fourteen clinical photographs were taken, developed, and printed.

MEDICAL EDUCATION OF NATIVE RACES BY Dr. D. W. HOODLESS.

INTRODUCTION.

During the last twenty years there have been numerous education conferences, commissions, and committees in nearly every part of the world, and a vast number of reports on native education have been published. In addition to these reports, educated men and women, many of whom have spent a lifetime among native races, have published their own individual reports, thus adding to the complexity of this subject. At the present time, therefore, an educational officer in any state or colony is almost unable to keep in touch with the amazing ramifications of the accumulated mass of educational reports, pamphlets, books, and theses. There is, however, one term which is continually being repeated in almost every one of these reports. This term is the hyphenated word “ culture-contact.” Teachers of every description, government, mission, professional, amateur, have all now realised that in the education of native races the essential difference is that a system of European culture is being engrafted upon a totally different native culture of the indigenous race of the country concerned.

The so-called educational training of any native race is generally divided by a European educationalist into the following divisions: (1) primary, (2) secondary, (3) vocational or technical, and (4) professional. The European educationalist has gone forth to every country or clime where it was possible for him to go, and with the very best intentions in the world has made up his mind that the four rungs of the education ladder as he knows it are the very best mental training for every boy and girl and youth that may cross his path. Even now, with the term “ culture-contact ” staring him in the face, he finds the greatest difficulty in adapting his teaching practice to the person being taught rather than to the subject-matter which he thinks he ought to teach.

If “ culture-contact ” means anything at all, surely it must provoke any educationalist to keep in mind the fact that his aim should be to train natives to be better and still better natives, and not to train natives to be even perfect imitation of Europeans.

31

The title of this article is Medical Education of Native Races,” but before one can enter into a discussion of this, some brief reference must be made to the more elementary kinds of educa¬ tion for native races, since these are essential as a foundation for the ultimate medical education. A brief examination will immediately show that it is impossible to generalise so as to include such diverse types as, for example, the inland tribes of Papua on the one hand, and let us say for example the Sudanese races on the other hand. In fact, education of native races, speaking generally, may roughly be divided into the following groups:- — -

(1) races with very little contact with Europeans, e.g., in Papua;

(2) races with moderate contact with Europeans, but where there are no large cities and

the native races retain a greater part of their old style of living, e.g., in Fiji;

(3) races with still more contact with Europeans, in countries where there are large cities

fins industrial centres;

(4) races with centuries of contact with Europeans, and possessing forms of culture in

literature, religion, and art, e.g., in Ceylon.

This article will concern itself more particularly with the first two only of these groups, for it is fairly obvious that in countries for which the Sudan and Ceylon may be regarded as more or less typical, there will exist for the favoured few an opportunity of proceeding within their own area, to the highest professional attainments if financial circumstances so permit.

Primary Education.

The question has often been asked, "Are native races such as the Fijians educable up to the European standard ” ? Personally I am prepared to state that given equal facilities, a healthy average Fijian youth, if taken early enough, can be educated to exactly the same extent and in every way similarly to any European youth.

However, it may be stated that in Fiji at the present time the broad principle underlying primary education in this Colony is to give the native boy and girl a simple form of education which will tend to make him or her a better Fijian in every respect: with the accent on the word Fijian. It is found, however, that it is impossible under modern economic conditions to exclude a certain measure of Europeanisation of the Fijian race. In the old days their “ education ” con¬ sisted of a natural process of acquiring a knowledge of their spoken languages, and a simple acquisi¬ tion by purely imitative methods of house-building, boat-building, and all the various forms of practical “ education.” The very fact that their spoken languages were reduced to a written form by the early Missionaries, and that the natives were then taught to write, was the first step in the Europeanisation of this or any other native race such as the Fijian. It is futile for certain persons to continue to repeat ad nauseam that " We must not Europeanise the Natives.” Teaching them to write even their own mother tongue : teaching them the use of ordinary coinage and simple money sums- teaching them the use of soap, kerosene lamps, &c., all these things are just as much Europeanising the Fijian as teaching him to write and speak English.

Throughout the Pacific at the present time it may be stated definitely that those in control of primary education are endeavouring to divorce a native boy or girl as little as possible from his native surroundings. Every effort is being made to keep him happy and contended on his native soil, while at the same time the economic and social progress of the native races is being kept in mind.

Higher Education.

In an article such as this it is not necessary to give in detail an account of the secondary and vocational types of educational training which are available for a certain number of Fijian boys and girls. It is sufficient to state that for the last fifty years there has been an opportunity for any keen native youth to advance in his educational training in order to become a native mis¬ sionary, native clerk, or a native teacher, &c. The Missionary Societies in Fiji were in the main part responsible for this further education. The first Government school for Fijians was not opened until 1906; and the official Education Department was not commenced until 1916. It is interesting to note, however, that twenty years before there were any Government schools for Fijians, and thirty years before there was an Education Department, a former Chief Medical Officer, Dr. G. Corney, had inaugurated a system of training Fijian medical students for a certificate which would enable them to practice medicine and surgery among their own kith and kin.

Medical Education among Fijians.

The origin of the system of training Native Medical Practitioners in Fiji was probably due to a consideration of the devastating measles epidemic in 1875, and also to the fear that small¬ pox might be introduced into Fiji from an immigration vessel from India. In order to make vaccination less costly and more easily available, it became necessary to inaugurate a system of training native medical assistants, and the Native Medical Practitioners Ordinance was passed in June, 1888. The first three certificates to qualified Native Medical Practitioners were granted in November, 1888, and six more certificates were awarded during 1889. From that date up to 1905, a qualified native medical practitioner received £5 per year from his Province and £2 10s. Od. a year from the Government, and he was not allowed to demand any reward for his services, but might accept any gift that any person offered to him. In 1905, the salary scale^was increased to £l8-£50 per annum, and in 1917, the scale was increased to £30-£50, £50-£75, and £75-£100. Again in 1926 these scales were changed to £45-£75, £75-£120, and £120-£150.

For several years after 1888 the number of students remained at eight, and a balance of gains and losses left the number of Native Medical Practitioners at about 20. These were in practice in the various Provinces in the Colony. At first the supervision of this medical training was entirely in the hands of Dr. Corney and his equally enthusiastic Matron, Miss M. C. Anderson. As time went on the number of students gradually increased up to 16-18, divided into three years, with five or six students in each year of training, and the teaching staff was increased to four.

32

The opening of the Colonial War Memorial Hospital at Suva in 1923 soon gave rise to the idea of developing the old Fiji Medical School into a Central Medical School, to which native students from other island groups might be admitted. In 1927-28, with the assistance of the Rockefeller Foundation, the Central Medical School was built. In this connection the services of Dr. S. M. Lambert of the Rockefeller Foundation proved invaluable not merely in obtaining financial assist¬ ance from the Foundation but also in making personal contact with the various medical depart¬ ments and Administrations which were willing to co-operate in the combined scheme.

The number of Fijian students has continued to be 18, and to these must be added two or three Fijian post-graduate Native Medical Practitioners who return to the School for refresher courses. The number of students from distant island groups was 20 in 1929, and has since been increased up to 24. These latter students include native youths from Tonga, Western Samoa, Eastern Samoa, Gilbert and Ellice Islands, New Hebrides, Cook Islands, British Solomon Islands, and Nauru.

Annual reports on the Central Medical School, Fiji, have been regularly published, and reference should be made to these reports for detailed particulars concerning the native medical students, their courses of study, examination results, and a general outline of this scheme of medical training. A copy of the Annual Report on the Central Medical School for 1937 is attached as Annexure I to this article.

Quite a large number of eminent people have visited the Central Medical School, Fiji, during the last eight years. Among these visitors there have been medical men of high standing from many parts of the world. Perhaps it has been due in a large measure to the unique novelty and unexpectedness of finding South Sea natives, dressed in native costume, who are capable, of giving excellent demonstrations in anatomy; for this or other reasons, these visitors have without excep¬ tion been so full of praise that they have gone away with high impressions and perhaps without an understanding of the limitations and restrictions which must necessarily be attached to this medical training in Fiji.

Numerous articles on the Central Medical School in Fiji have already been written during the last few years. To anyone who is desirous of obtaining exact information not only in regard to the Central Medical School itself, but also in regard to the Native Medical Practitioner service in Fiji as a whole, the following three articles may be recommended for perusal: —

(1) “ Native Medical Practitioners,” by Dr. A. Montague, in the Native Medical Practi¬ tioner Journal, November, 1930.

(2) “ Native Medical Education in the Pacific,” by Dr. A. H. B. Pearce, in the Report of

the Second International Pacific Health Conference, Sydney, September, 1935.

(3) “ The Native Medical Practitioner in the Pacific,” by Dr. V. W. T. McGusty and

Dr. T. Clunie, in the Tropical Diseases Bulletin, November, 1936.

Each of these three articles has been written by medical officers who have had a close, intimate and personal contact, spread over a number of years, with this medical training in Fiji. In addition, and as already mentioned the multifarious details of the medical training given at the Central Medical School in Fiji are set out in the official Annual Reports, copies of which will be sent on application.

The Native Medical Practitioner Service in Fiji.

Under the old Fiji Medical School at which the medical training was given in the native language, the number of qualified native practitioners gradually increased from 10 in 1890, 17 in 1900, 33 in 1920, to 46 in 1929, in which year the Central Medical School was opened. Since 1929 the number of Native Practitioners has further increased from 46 to 67. These 67 represent the remaining balance of qualified Native Medical Practitioners out of a total of 172 to whom certi¬ ficates have been granted since 1888. This loss of 105 over a period of 50 years has been due to death, resignation, dismissal, &c. An examination of the number of qualified Fijians who have left the medical service during the last ten years shows an average loss of two each year, and corresponds with the above figure of 105 over 50 years. At the present time, although there are nominally five Fijian medical students in each year of the four-years’ course of training, the average number of Fijian students who qualify is only four per year. Hence it is seen that the net increase in the number of Fijian Medical Practitioners is only two each year, and at the present rate it will take another twenty years to build up a corps of 100 qualified practitioners.

The cost of the Native Medical Practitioners was approximately £75 for ten of them in 1890, and this has risen to £7,500 for 67 in 1937. The chief reasons for this large increase in the total cost are: —

(1) the abolition of payment of taxes in kind and payment of salary of certain native

officials in money instead of communal services, and

(2) the marked increase in the cost of living, more especially from 1914 onwards.

If it were possible to comprehend and to evaluate the many direct and indirect effects that the formation of an auxiliary medical service of qualified Native Medical Practitioners has had upon the Fijian race, it would then be possible also to determine whether the results have been worth the cost measured in £ s. d. Without attempting to make a critical and complete survey, it cannot be denied that the Native Medical Practitioner service in Fiji has brought a reasonable measure of Western medical treatment to all the 100,000 of the Fijian population. In fact it has been stated that the arrest of the decline in the Fijian population, and the present satisfactory increase are both due in a very large measure to the good work of the Native Medical Practitioners. The present 67 Fijian Native Medical Practitioners form an integral part of administration of the Colony, and they may be regarded in one sense as the basis on which the public health and hygiene of the Fijian race is maintained. It should be added, however, that the control, guidance, and general direction of these Native Medical Practitioners by a dozen European medical officers is absolutely essential.

33

NOTE ON THE CENTRAL MEDICAL SCHOOL IN SUVA IN RELATION TO THE

HEALTH PROBLEMS OF THE PACIFIC BY Dr. V. W.T. McGUSTY, O.B.E.

There is in Suva an institution known as the Central Medical School, where young natives from Fiji and other Pacific islands receive a four years’ course in medicine followed by a qualifying examination which entitles them to practise as Native Medical Practitioners, and assures them of medical careers in the service of their respective administrations.

To the Colony of Fiji belongs the credit of instituting the native medical practitioner system, the other participating administrations with their approximate populations being as follows: —

British Solomon Islands Protectorate (United Kingdom) . . 94,000

Gilbert and Ellice Islands (United Kingdom) . . . . . . 33,700

Tonga (Kingdom) . 29,000

Western Samoa (New Zealand) . . . . . . . . . . 47,000

Eastern Samoa (United States of America) . . . . . . 10,000

Cook Islands (New Zealand) .. .. .. .. .. 11,500

Niue (New Zealand) . . . . . . . . . . . . 4,000

New Hebrides (Condominium) . . . . . . . . . . 55,000

Nauru (Australia) .. .. .. .. .. .. .. 1,600

285.800

Fiji (native population) . . . . . . . . . . . . 97,000

382.800

The Native Peoples of the Southern Pacific.

The administrations participating in the native medical practitioner scheme contain repre¬ sentatives of each of the three main subdivisions of the Pacific islanders — namely, Polynesians, Micronesians and Melanesians; and, while there exists as between Polynesian and Micronesian, on the one hand, and Melanesian, on the other, marked differences both in physical characteristics and mental capacity, all of the three peoples, prior to European intervention, were in the neolithic stage of civilisation. Similarities in diet and climate, and the diffusion of culture which resulted from the great Polynesian migrations that are said to have taken place in spite of primitive craft and vast ocean distances, have tended further towards the creation of affinities and the obliteration of differences in the form of their social systems. Since the communal form of society is found to be more or less universal in its distribution, it is a factor of great importance in preparing a form of government suited to the character and requirements of the Pacific islanders, and the ultimate success of any public health undertaking depends on the extent to which it can be moulded into the framework of their society. In the realm of disease, affinities are taken a step further, because, with the exception of malaria, which is confined to the New Hebrides and Solomon Islands, identical problems arise everywhere as regards both indigenous diseases and those which have been intro¬ duced with European colonisation.

The Inception of the Native Mecical Practitioner.

The native medical practitioner service owes its being to Dr. B. G. Corney, an early Chief Medical Officer of Fiji, who seems, in the first instance, to have conceived the idea of using young natives as public vaccinators and dispensers, and, later, encouraged by their success in these capacities, to have determined upon giving them a more comprehensive training and much more responsible duties in the capacity of native medical practitioners.

The first eight students to qualify as native medical practitioners received their certificates in January 1889. The health situation at that time in Fiji can only be described as most pre¬ carious. The Colony had been under British rule for but fifteen years, and the natives, under the influence of the Christian missions, were only just emerging from a state of savagery. To the many indigenous diseases there had been added a host of others which were introduced by the European colonists with tragic results to the non-immune natives; and public health work was obstructed on all sides by prejudice and superstition. In the absence of sufficient revenue to provide for an adequate health service, it was necessary, if the United Kingdom was to discharge her responsibilities, to find a solution at once cheap, rapid and conforming with native custom to deal with the very serious problem of disease in these very susceptible people. These were the actual circumstances in which Dr. Corney inspired the creation of the native medical practit'oner service.

The Central Medical School.

The earliest students, limited in number to eight, learned their profession in the wards of the old Colonial Hospital, where they worked as dressers and male nurses and received clinical instruction at the hands of the Resident Medical Officer. In 1901, the amenities of the school were improved by the provision of better housing for students, a lecture theatre and rudimentary teaching equipment. During succeeding years, theoretical teaching was incorporated in the syllabus, while the practical side of the course also improved with the steady increase in the volume of work at the Colonial Hospital.

Until 1927, the Medical School was purely an institution of the Fiji Governnent, but changes in its constitution were already in the course of preparation, for the International Health Division of the Rockefeller Foundation, seeking an economic and effective means to make premanent the result of its health campaign among the native peoples of the other southern Pacific islands, found the solution of its problem in the native medical practitioner system, which had then been in successful operation in Fiji over a period of more than thirty years. As a result of negotiations

4

Conducted between the Foundation and the Government of Fiji, and of generous financial assist¬ ance from the Foundation, the buildings and equipment of the Suva Medical School were extended and improved in time for it to be opened in 1928 as the Central Medical School, with forty students in residence, who were drawn from seven separate Pacific administrations.

Coincident with these events, the system of teaching was expanded and reorganised. A full-time tutor, whose title has now been changed to principal, was appointed to take charge of the school, and lectureships in the subjects of a course similar to that of an ordinary medical college were distributed among local doctors and other persons, who willingly undertook the duties of honorary lecturers. In 1931, the period of studentship was increased from three to four years, and in 1935 the teaching facilities were further enhanced by the addition of a well-equipped patho¬ logical laboratory and the appointment to take charge of it of a highly qualified pathologist.

English has to be used as the medium of instruction to overcome the difficulty of teaching students whose mother tongues differ widely from each other. The careful selection of candidates, including an entrance examination, ensures, as far as possible, that the students are competent to take the course. As the school contains students of East Indian, Polynesian, Micronesian and Melanesian origin, differences in educational standards and intellectual capacity throw a serious burden on the principal.

The Central Medical School is essentially a Government institution and is financed by the contributions of the participating administrations, such contributions being proportionate to each administration’s quota of students. The full cost of maintaining a student at the school was £73 (Fiji) in 1934, so that the cost to his Government of each student’s full course of training amounts to approximately £300 (Fiji).

From its inception until the end of 1936, 195 native medical practitioners have graduated from the Central Medical School.

Preservation of Native Character in Native Medical Practitioner Service.

Reference has been made to the fact that all natives from the administrations participating in the Central Medical School scheme observe communal habits of living. The aim of the Central Medical School is to fit its graduates for the normal responsibilities of medical practitioners and health officers without removing them from their native environment. The success of the native medical practioner service depends on its conforming with native society, and its maintenance at an economic level that is within the capacity of each administration. Students at the Central Medical School are, therefore, encouraged to dress themselves after the manner of well-born natives, and to retain as many of their native habits of living as it is possible under conditions of studentship. When the young graduates return to their homes with a wholesome respect for the manners and customs of their own people, they regain their proper place in native society, whence they can most readily spread the knowledge they have acquired, and where they do not tend to covet living standards above those of their tribal chiefs. On the other hand, any attempt to raise the status of the school to the level of a European medical college would inevitably result in the graduates leaving their native environment and, in consequence, to an increase in the cost of the native medical practitioner service that would defeat the object for which the Central Medical School was created.

The Indian Medical Practitioner.

With the increase of the East Indian population of Fiji, the Government decided to train Indians to be medical practitioners on the same lines as Fijians. The first East Indian graduates received their certificates in 1925; but, owing to the individualistic habits of Indians, the service, while of undoubted value, is less suited to their requirements than to those of the Fijians, and the number of Indian medical practitioners has been restricted for the present to ten.

The Native Medical Practitioner in Practice.

The distributions of native medical practitioners among the administrations where they are now serving is as follows: —

Fiji

. . 62

British Solomon Islands Protectorate

4

(including one Fijian)

Gilbert and Ellice Islands

10

(including one Fijian)

New Hebrides

1

(a Fijian)

Eastern Samoa

. . Nil

(in training)

Western Samoa

10

Cook Islands .

3

Nauru .

. . Nil

(in training)

Tonga. .

7

As a rule, each native medical practitioner is assigned a medical district where he controls the health of the native population, and in some cases of all other sections of the community as well. Every native medical practitioner is nominally controlled by a European medical officer, but the degree of his responsibilities is in practice fixed by the extent to which communications are available. It is extremely important that the work of native medical practitioners should be subject to regular inspection; but, as this is not always practicable outside of Fiji, it has been satisfactory to find that graduates of the school are, in the main, capable of dealing on their own initiative with the great majority of medical and health problems.

The native medical practitioner is essentially a State servant who has been accustomed from studentship to a system of State medicine. As rigid control by Government is regarded as

35

essential to the efficient maintenance of this service, no private students are accepted at the Central Medical School, and the right to practise is restricted as closely as possible to the holders of Govern¬ ment appointments.

The course of training emphasises operative surgery and fits most of the graduates to contend with ordinary surgical emergencies. It also stresses public health and preventive medicine, and it is in this sphere that the value of the native medical practitioner is highest. The conditions are very similar in all the Southern Pacific territories, and the native medical practitioner is competent to deal with ordinary epidemics, such as dysentery and enteric, to carry out the mass treatment of ankylostomiasis, yaws and ringworm, and to conduct preventive measures, such as soil sanita¬ tion, and infant welfare. It would be difficult to devise a better solution of the health problems of the Pacific islanders under the conditions that now prevail.

Conclusions.

None of the administrations participating in the native medical practitioner scheme could afford to embark on expensive medical services; but, by a pooling of resources in the Central Medical School undertaking, it is believed that they will be able to elaborate a common form of health organisation that will meet the requirements of their native populations. The system is still in an experimental stage in most places, but the success that has been obtained in Fiji justifies the hope that the results will prove favourable in other places.

While the scheme was evolved to meet the special circumstances of communally-living South Sea islanders, experience with the individualistic Indians, although less successful, has also proved it capable of modification to meet other conditions.

Its main essentials are economy and the maintenance of the native medical practitioners as closely as possible at the economic level of the people amongst whom they work, and these considerations are liable to be overlooked by over-enthusiastic supporters, as well as by destructive critics.

36

REPORT BY Dr. D. W. HOODLESS ON THE CENTRAL MEDICAL SCHOOL, SUVA.

Students. — During the year there were 43 students in residence at the two dormitories. The following table shows the race of the different students in each year: —

Western Samoa Eastern Samoa Tonga

Cook Islands Gilbert and Ellice Islands Solomon Islands New Hebrides .

Nauru

Fiji — Fijians

Rotumans

Indians

1 1

1 2 1

1 2

2 1 1

1 1 1

1 . 1

6 4 4

1

1

14 12 14

Total. 7 2

4

3

5

4 1 2

2 16

1

1 2

3 4 47

1st year. 2nd year. 3rd year. 2 2 2

Post-

4th year, graduates.

1

The four post-graduates in the above list were qualified Native Medical Practitioners, and only one of them, the Samoan, resided in the students’ dormitory. During 1937, one of the Fijian students in the 2nd year was dismissed in June owing to lack of progress in studies, one Tongan student in the 2nd year was certified as medically unfit, and the three students in the 4th year completed their period of training so that on December 31st, 1937, the number of students and post-graduates was reduced to 42. Lectures will recommence on Monday, January 17th, 1938, for 38 students and 4 post-graduates, and there will be no new entry class during 1938.

Health. — One Tongan student certified to be suffering from pulmonary tuberculosis had to discontinue his studies in October, and he finally returned to Tonga on January 3rd, 1938. No other cases of serious illness amongst the students have occurred during 1937. This was in marked contrast to the record for 1936 when numerous minor cases of measles and mumps and several serious cases of pneumonia occurred. The diet scale provided for the students is a liberal one, and includes an ample supply of animal fat and green vegetables. A careful supervision has been continuously maintained over the health of the students generally, but, as one would expect, the health record of the students depends largely upon that of the native population in Suva for the students mix freely with their native friends in Suva both at games and during their leisure hours. All the medical students, if not already protected, were vaccinated against smallpox and inoculated against typhoid fever, and the latter inoculation will be repeated in their third year. In spite of the risk, which of course is run by all persons doing medical work, of daily con¬ tact with infectious cases, the good health of the students may be attributed to: — (a) adequate facilities for sports and games, ( b ) a good dietary, and (c) early and adequate medical treatment of all minor illnesses.

Discipline. — The discipline of the students has continued to be excellent throughout the current year. Reference has been made in previous annual reports to several interesting factors which ensure a very good esprit de corps among the students. The ages of the students range from 17 years to 25 years and this age-range covers the most difficult period in the life of a native youth. By means of a system of lectures and practical work regularly maintained, and by means of class examinations held every three months a constant check is kept in the progress made by each student. This constant routine of theoretical and practical work acts as probably the chief factor in maintaining good discipline and order. At the same time it must be admitted that no success could be achieved without the enthusiasm which each and every student puts into his work. One of the complications which have arisen during recent years is the ever-increasing Europeanisation of the native races in the Pacific, and this has gradually crept into the social life of the native medical students. The Cook Islands students are almost completely Europeanised and wear trousers, shoes, &c., and the Fijian student in his short loin-cloth and bare feet looks with envy at his Cook Islands colleague if they are both on night-duty and the mosquitoes are bad. Every endeavour is made to encourage the Fijian student to remain true to his own culture and customs, but it is obviously impossible to give a medical training to these native students from Fiji, Tonga, and Samoa, &c., without at the same time giving a large measure of Western culture. We cannot throw away the test-tube and the microscope and go back to the methods of the old bush-doctor with his herbs and mystic incantations.

Boarding arrangements. — All the students are boarders, and there are two Indian cooks who prepare and serve the meals. The present kitchen is much too small for the amount of cooking which is necessary. When the new cement dormitory is built it is anticipated that adequate facilities will be provided for the cooking and serving of meals. In addition to the two Indian cooks there is one Indian laundryman. Each student is allowed to send ten articles to the laundry each week.

The whole of these boarding arrangments for the students, or what one may call the domestic side of the Medical School, were apparently constructed on the basis of the old Fiji medical school prior to 1929 when the number of students was never more than 18 in all. When the new electric laundry is erected for the Hospital there will be no need for a separate hand laundry for the students. It would probably also be much more economical to arrange for one large general kitchen so that meals could be prepared under European supervision not only for hospital patients but for the 40 native medical students, the 20 Fijian nurses, and the large Indian staff of servants.

During 1937 the average total cost per student was £74, which included £26 for food and £2 for laundry expenses.

37

Courses of studies — In 1931 the course of studies was extended from three years to four years. This four years’ course is divided into a junior period of \\ years followed by a senior period of 2\ years. The junior students receive instruction in Physics, Chemistry, Biology j Anatomy and Physiology, and attend the Medical School every morning and afternoon. The senior students are on duty in the hospital from 8 a.m. to 1 p.m. each day, and attend lectures in the afternoons or evenings by the members of the honorary staff which include twelve lecturers, eight of whom are Medical Practitioners. The senior students act as dressers and clinical assistants in the hos¬ pital, and form an integral part of the staff of the hospital under the direction of the Medical Superintendent. 1 he duties of the senior students in the hospital include work in the medical wards, surgical wards, women’s wards, European wards, the hospital dispensary and out-patients. Strictly speaking the junior students are not required to do any hospital duty, but in actual prac¬ tice one or more of them volunteer every afternoon for relieving duty in the out-patients depart¬ ment or for “ special-duty ” while the senior students are at lectures; and again, during the Christmas and mid-year holidays all the junior students put in four weeks of relieving duty in the hospital so that the senior students may take their own holidays.

Funds were made available for 1937 so that students will no longer be required to do “ night- duty ” in the hospital. As the new men selected for this work had had no medical training it was necessary for senior students to continue for the first three months of the year in order to train the new night-duty attendants.

When the Central Medical School was opened in 1929 a printed syllabus of studies was prepared, but it was soon found that a formal syllabus in any one subject could not be rigidly followed. In practice it has been much more satisfactory to allow each lecturer complete freedom in his own subject, and the position is safeguarded by appointing a co-examiner who is entitled to set and mark half the total number of questions in each final or qualifying examination.

The following text-books are in general use by the students: — Wheeler and Jack’s Hand¬ book of Medicine] R. L. Spittel’s Essentials of Surgery, E. C. Mekie's Handbook of Surgery, Hale White’s Materia Medica ; Henry Jellett’s A Short Practice of Midwifery for Nurses] and Anatomy, Physiology and Hygiene by A. M. Ashdown and E. Bleazby. In addition, several copies of the larger text-books in each subject are available for occasional use by the students. It is pleasing to be able to report that during 1937 several of the students bought their own copies of Buchanan’s Anatomy and Rose and Carless’ Surgery.