One of the most serious problems facing this Territory to-day is that of tuberculosis, which continues to increase steadily despite a constant fight by the antituberculosis bureau. The 1919 legislature appropriated nearly 100 per cent more money for the present period than was had for the last two years.

PURE FOOD BUREAU.

This bureau has done much toward making the restaurants more careful in the quality of the food served, as well as dealers in general lines of foodstuffs sold.

INSANE ASYLUM.

At the end of the fiscal year, June 30, 1918, there were under treatment in the institution, paroled, and escaped, 251 males and 94 females, a total of 345. There were admitted during this year 84 males and 33 females, a total of 117. A total of 462 patients, 335 males and 127 females, were treated during the year. A total of 34 patients, 22 males and 12 females, were discharged as recovered, and 5 males and 3 females were discharged as improved during the year. For the same period of time 38 deaths occurred, 30 males and 8 females; there remaining in the institution and on parole as of June 30, 1919, 278 males and 104 females, or a total of 382.

dence was reshingled and all rooms painted. The buildings occupied by patients have been repaired and painted. One hundred feet of picket fence was erected, and new gates with concrete posts installed. During the year Brother Dutton interested the boys in raising vegetables which were purchased and issued as rations at Kalaupapa.

Bishop Home. It was necessary to make extensive repairs at this home. One of the large dormitory buildings was practically rebuilt and two additional rooms for those who act as guardians of the younger girls were added. The other buildings have all been painted and whitewashed. Heavy concrete posts and gates were erected.

Bay View Home. The buildings at this home being all new, few repairs were necessary. Six hundred and ten feet of picket fence was erected with large concrete posts at the entrance.

McVeigh Home. The buildings at this home have been painted, inside and out. A new French range was installed and as a further fire protection a 28-foot concrete smokestack was built.

General. Necessary repairs have been made to the general hospital, dispensary, visitors' house, and the Kalaupapa store and warehouse. During the year the Territory purchased 448 head of cattle, at a total cost of $31,530. During the year 63 head of government cattle were killed, and pigs, weighing 9,339 pounds.

Several shortages of taro were experienced. There were purchased during the period 316,783 pounds of taro and 1,144 bags of sweet potatoes. There are now under cultivation 11 acres of taro in Waikolu Valley and 9 acres at Kalaupapa.

Kalihi Hospital. A circulating hot-water system has been installed. Hot water is now delivered to all the cottages, and at the kitchen the dishes and cooking utensils are thoroughly cleansed by steam.

There has also been established an incipient hospital separate and apart from the main institution. Here any suspicious cases may be treated. With the assistance of the medical profession this will materially help the fight against this disease.

On June 30, 1918, there were 38 patients in the hospital; 125 were admitted during the year; 60 were transferred to Molokai; 10 declared not lepers; 19 were paroled and allowed to return to their homes with orders to report regularly to the Government physician in their district; 5 males and 1 female were removed by death, leaving 65 patients in the hospital on June 30, 1919.

The nationalities of those declared lepers and the districts from which they came are shown in the following tables:

District.

TABLE II.

Examined.

Declared lepers.

Declared not lepers.

Male. Female. Total. Male. Female. Total. Male. Female. Total.

1 This case is a boy born at the settlement, 16 years ago, of leprous parents. Shortly after birth he was taken from the settlement by relatives, and resided on Kauai up to July 8, 1918, when he was examined and found to be afflicted with the disease.

Kalihi boys' home.-There are in this home 43 boys, children of leprous parents, their ages ranging from 1 to 19 years. During the year a new building was built to be used as a workshop and laundry. The pavilion formerly used as a play room for the smaller boys was converted into a schoolroom. New beds and other furniture were purchased, and the necessary minor repairs made.

Kapiolani girls' home.-There are at present 68 girls in this home, children of leprous parents.

Resident physician, leper settlement.-Dr. W. J. Goodhue has faithfully performed the duties of resident physician for the past 17 years. Wonderful results have been accomplished through his various treatments. He has performed a number of major and minor operations, and also has charge of the sanitary work at Kalaupapa.

Leprosy investigation station. The Territory is especially fortunate in having the director in charge of the Federal investigation and laboratory station in Kalihi take charge of the treatment at the Kalihi hospital.

During the year Director Acting Asst. Surg. H. T. Hollman resigned and Dr. J. T. McDonald was appointed. He has continued the work in a very satisfactory and unselfish manner.

President Dean of the College of Hawaii has given valuable assistance in the preparation of chaulmoogra oil. The results of the last year's work are especially gratifying. Twenty patients in all were paroled. Each one has been examined regularly without a recommittal.

The following letters cover in detail the medical and surgical work at Kalaupapa, Molokai, and Kalihi receiving station, Honolulu: To the president and members of the Territorial board of health, Honolulu, Hawaii.

DEAR SIR AND GENTLEMEN: Herewith I respectfully submit for your consideration a report of the medical and surgical department of the leper settlement for the period ended June 30, 1919.

The mainstay or principal treatment for leprosy in the settlement here still consists of chaulmoogra oil in some one of its forms of administration, although a number of other treatments are given, which will be tabulated in the order of their importance. Following are noted number of patients on the chaulmoogra-oil treatment:

(a) Chaulmoogra oil and guaiacol comp., hypodermically.

(b) Chaulmoogra oil and guaiacol comp., per orem..

(c) Chaulmoogra oil, plain per orem..

(d) Chaulmoogra oil, plain inunction...

(e) Chaulmoogra oil and eucalyptol, and other combinations for inunction.

With reference to the hypodermic injections it may be noted that these are given twice a week in doses of 5 cubic centimeters to the injection. Average of above hypodermic treatments for the period of this report number 4,216.

Total number of patients on chaulmoogra oil in some form, including hypodermic and inunctional medication, number 304.

The case noted in the previous report on the Varham preparation of chaulmoogra oil, hypodermically, has not progressed satisfactorily, and has been discontinued, the patient refusing to take the treatment any longer. I have given this treatment a faithful trial, and I am much disappointed in my experience with it. This was so highly recommended to me that I hope reports will reach me later on from other fields, giving more satisfactory results than I was able to secure with it.

I hope to be supplied in the near future with some of the acids of chaulmoogra oil, as prepared for medication by Dr. Dean, president of the College of Hawaii, and proving so successful at the Kalihi receiving station.

A new treatment during the past year has been nuclein solution No. 1, hypodermically, and nuclein solution No. 2, per orem. I have had two patients on the above treatment, whom I believe have been decidedly benefited. This preparation is prepared by Messrs. Parke, Davis & Co.

Locally, trichloracetic acid is used on a great many cases for indurations and nodular thickenings, and other dermic lesions of the disease. Semerak paste and ointment are also very efficacious for the same lesions. CO, has been dropped during the period of this report for two reasons. Firstly, because the acid and paste above noted have become more popular with the patients, and, secondly, because the CO2 was so difficult to obtain in a continuous supply.

Other special and general treatments, tabulated, are as follows:

Cases of tonsillar treatments and those for leprous rhinitis as noted in the previous report, still continue to form a large percentage of local treatments. Regular examination of patients for leprous rhinitis is a systematic procedure, especially with reference to the various "Homes," and appropriate treatments for the same, principally through atomization, are given both in the "Homes" and at the dispensary.

Personal calls made by the physician for the period of this report slightly exceed that tabulated on the previous report, owing to the prevalence for a period of three months of a mild epidemic of influenza, which, however, was not the much dreaded Spanish "Flu," as noted below. The mortality did not exceed that resulting from any other ordinary intercurrent ailment.

Baldwin Home, 157; Bishop Home, 286; Bay View Home, 745; hospital, 415; general settlement, 2,294.

Prescriptions filled at Kalaupapa Dispensary, 11,950; at hospital, 904; at Bishop Home, 817; at Baldwin Home, 1,462; asceptic surgical dressings at dispensary, 3,165, at hospital, 5,275; at Baldwin Home, 8,125; at Bishop Home, 6,897; at Bay View Home, 10,950.

Under surgical procedures may be noted the following:

Major operations, 39; minor operations, 312.

In the department of bacteriology may be noted the following:

Various patients snipped weekly and systematically as a check on benefit of different methods of treatment and progress of the disease, number by actual count, 6. Total of such examination for he period, 312.

Other examinations to determine presence, or otherwise, of tuberculosis, number 16. Patients examined number 5, of which only 2 proved positive. Other examinations under this heading for various intercurrent infections number 23.

Milk has been supplied as noted in the previous report to the Bishop and Bay View Homes. Milk has also been supplied to patients outside of the homes, subject to mquisition from the attending physician. This valuable adjunct to dietetic treatment of serious cases will have to be discontinued through lack of sufficient pasturage for cattle, dating from June 30, this year.