The following table gives the deaths by nationality and sexes:

Close supervision has been kept over the various water supplies. sewage-disposal plants, new building construction, drainage, and waste disposal on the different islands. The laboratory examination of all potable waters has been conducted by the sanitary engineer. The disposal of pineapple waste has received constant attention. The large majority of the canneries are now either disposing of their waste by incineration or hauling it to the fields for fertilizing.

SANITATION.

Oahu. During the height of the influenza epidemic in March and April the entire inspection force was detailed to make day and night inspections throughout the congested portion of the city and the various strikers' camps for the purpose of locating and deporting cases of sickness, and so assist in the efforts to render prompt aid to all requiring medical attention. In January, 1920, the Japanese and Filipino workers on the various plantations on Oahu went out on strike and almost immediately they and their families came to Honolulu in large numbers. Tenements, old warehouses, temples, churches, and private homes soon became overcrowded. This congestion and the lack of proper sanitary facilities rapidly made these premises dangerous to the community, and the Japanese Federation of Labor was compelled to erect several temporary camps with proper sanitary facilities.

The campaign inaugurated for the eradication of dilapidated and unsafe buildings in Honolulu has been very encouraging. To date there have been 272 buildings torn down and 35 tenement houses converted into apartment houses. This campaign was conducted by the chief sanitary inspector of Oahu, the deputy fire marshal of the Territory, and the building inspector of the city and county of Honolulu.

Hawaii. The plague campaign in the Hamakua district has been energetically continued throughout the year, yet in spite of all measures there occurred 11 cases of human plague, all fatal, while 23 plague-infected rodents were trapped or found dead. In this plague campaign the board of health received valuable help and financial assistance from the shippers' wharf committee of Hilo and the various plantations. It was hoped that, as there had been but one case of rodent plague and no human cases during the preceding year, the

plague infection in rodents had been destroyed or had died out, but the reappearance of the disease in so marked a manner shows that it is as formidable as ever. Every effort is made to destroy and eradicate all possible rat harbors in the villages and plantation camps, and by intensive trapping and poisoning to furnish a rat-free zone about all habitations.

Maui and Kauai.-Work on both islands has progressed well under the respective chief sanitary inspectors.

GOVERNMENT PHYSICIANS.

There were 26 Government physicians for the 29 districts, who attended to the indigent sick, examined and vaccinated school children, and were in charge of the registration of vital statistics in their respective localities.

PURE FOOD BUREAU.

During the year virtually all places handling food in the Territory have been inspected by the food commissioner. In addition to the food work conducted by his deputies on Hawaii, Maui, and Kauai in conjunction with their regular duties as sanitary inspectors, the commissioner made four extended tours to these islands. In general, the majority of the food markets were found satisfactory, but many violations of the food laws as regards adulterations, misbranding, and food insanitation were found. These inspections were of great benefit and have resulted in marked improvement in the handling and serving of food products.

INSANE ASYLUM.

At the beginning of the fiscal year there were under treatment in the insane asylum, paroled and escaped, 278 male patients and 104 female, a total of 382. There were admitted during the year 76 males and 32 females, a total of 108. Cases under treatment during the entire year totaled 490. Fifty patients, comprising 32 men and 18 women, were discharged as recovered; 18 men and 5 women were discharged as improved; and 32 men and 8 women died during the year. At the close of the year there remained 378 patients, 274 men and 104 women.

LEPROSY.

On June 30, 1920, there were 546 lepers at Kalaupapa settlement, a decrease of 65 as compared with the number a year previous. This is the smallest number of patients since the year 1872. The following tables give population and nationalities at Kalaupapa and Kalawao:

The number of lepers living at the different homes in the settlement are as follows: Baldwin Home, 69; Bishop Home, 43; Bay View Home, 62; General Hospital, 20; McVeigh Home, 13; outside, 339.

On July 1, 1919, there were 21 males and 15 females, a total of 36 kokuas (helpers) at the settlement. During the year 1 male and 1 female kokua were admitted; 2 males and 2 females were discharged, leaving 20 males and 14 females, or a total of 34 as of June 30, 1920. Other well persons living at the settlement on June 30, 1920, were 25 males and 17 females, a total of 42; this makes a total population at the settlement of 639.

General repair work and painting has been done and additions made to various buildings during the year. At the Bay View Home, whose 66 patients are all in advanced stages, considerable beneficial work has been done in the building of concrete walks from the four wards to the dining room. The inmates are very grateful for these walks, as they can now get to the dining room without waiting for the nurses to lead them.

Law and order.-During the year 50 persons were arrested and brought before the Kalaupapa district court for various offenses,

ranging from disturbance of quiet of night to manufacturing liquor illicitly. Convictions were had in 39 cases; fines and costs amounting to $239.60 were paid. In addition to the 50 arrests, the police department made a number of raids on "swipes" makers, seizing and destroying several hundred gallons of the vile stuff.

Food supply.-There were used 453,207 pounds of taro in the manufacture of poi for the inmates of the settlement. Of this amount, 212,520 pounds were from the board of health lands in Waikolu Valley and at Puahi. There were purchased 44,206 pounds from private parties in the settlement, and 196,481 pounds from planters at Halawa, Wailau, and Pelekunu Valleys, Molokai.

Rations. The following rations and special allowances were furnished the leper folk during the year:

Weekly rations.-Beef, 7 pounds per week; or in lieu thereof, if desired, 5 pounds salmon per week; or in lieu thereof, if desired, 7 pounds of fresh fish. per week. Paiai (unmixed poi), 21 pounds per week; or in lieu thereof, if desired, bread (hard), 81⁄2 pounds per week, with 1 pound of sugar; or in lieu thereof, 12 pounds of flour with 1 pound of sugar.

Monthly rations.-Soap, one bar (2 pounds) to each leper; salt, 5 pounds to each leper; matches, four packages to each leper; kerosene, 2 quarts to each house if occupied by one family; 4 quarts or more if occupied by two or more families.

In addition to the above rations, each inmate receives a special allowance of 75 cents weekly, drawn at the Kalaupapa store. Each inmate is also entitled to a clothing allowance of $14 yearly.

During the year there were purchased from Molokai ranch 433 head of beef cattle, of which number 16 were lost on the steep trail leading down to the settlement and 2 died on the road to the slaughterhouse. The remaining 415 head dressed 190,187 pounds. An additional 65 head of cattle were killed from the board of health herd, which dressed 24,688 pounds. This makes a total of 214,875 pounds of beef issued during the period. Fifty-three-pigs were killed for food, dressing 8,630 pounds, and 16,180 pounds of fish were purchased and issued to the inmates.

There are 691 head of live stock at the settlement, 15 horses, 498 cattle, 144 hogs, and 34 donkeys.

Kalihi Hospital.-Regular instruction has been given all the children of school age at Kalihi Hospital, which is the receiving station for leprous cases, situated at Honolulu. Amusements have been furnished for the inmates and outdoor sports freely encouraged. All of this has made for the happiness and contentment of the patients. The number of inmates at the end of the fiscal period was 116, as follows:

Nationality of patients remaining in Kalihi Hospital.

Kalihi boys' home.-This home is for nonleper boys of leper parents. Of the 43 boys at the home at the beginning of the period, 3 were discharged to attend school, and 2 deaths occurred, leaving 38 boys at the end of the year.

Kapiolani girls' home.-This is a similar home for girls. There were 68 girls living at the home on June 30, 1919, of whom 6 were discharged to relatives and 3 died, leaving 59 girls on June 30, 1920. Leprosy investigation station.-Acting Asst. Surg. J. T. McDonald, United States Public Health Service and director of United States leprosy investigation station, continued in full charge of the treatment of the patients at Kalihi Hospital.

The spirit of cheerfulness and contentment that one finds in the patients at Kalihi Hospital to-day is largely due to the active interest and unselfish devotion which Dr. McDonald has shown every patient under his charge.

President A. L. Dean, of the University of Hawaii, has continued his active interest in the preparation of the ethyl esters of chaulmoogra oil, and has given much valuable assistance and advice to the board of health.

The following letters cover in detail the medical and surgical work at Kalaupapa settlement, Molokai, and Kalihi Hospital, Honolulu :

Hon. FREDERICK E. TROTTER,

President Territorial Board of Health, Honolulu, Hewaii.

DEAR DOCTOR: I beg to submit the customary annual report from the attending physician to Kalihi Hospital. At its reorganization by your board a few years ago, it was appropriately and officially invested with the designation; hence its old name of leprosy receiving station, still used by many intelligent people, should be discontinued.

Early in the month of February the prevailing epidemic of influenza reached the hospital, when 57 of our people were attacked, 6 passing promptly into a pneumonia of malignant type to which 2 succumbed, one, a young man recently admitted, far advanced in leprosy; and the other a stout, healthy, robust girl in whom her leprosy had been arrested and who was ready for parole. In a month to six weeks the epidemic had entirely passed. Of the three other recorded deaths, one, having developed leprosy in a sanitarium where he was being treated for tuberculosis, was sent to us and later on died from his former disease. The other came in with leprosy considerably advanced but in a dying condition from tuberculosis, living a few days only. There was one death from typhoid. Aside from the above, the general health of the patients during the year has been excellent.

Three institutions are deeply interested in Kalihi Hospital and have worked together the past year in complete harmony and without a sign of friction. They are the Territorial board of health, the leprosy investigation station of the United States Public Health Service, and the University of Hawaii. I believe it can be justly claimed that their combined efforts the past year have achieved results in the treatment of leprosy unparalleled by any institution in the world.

There should be accorded to the resident house superintendent, Mrs. Bessie Clinton, a large and full measure of credit for her constant and watchfui supervision of the social and general welfare of the entire hospital community. She has been the inspiration of something going on continually to divert the minds of the patients from their misfortune, so there has been maintained a wholesome atmosphere of contentment and cheerfulness. The entertainments embrace frequent social gatherings, balls, concerts, theatrical exhibitions, movies, etc., for evenings in the assembly hall, while for out of doors there have been championship athletic contests, races of various kinds, a special anniversary pageant, occasional luaus, the patriotic observance of all holidays. National, Territorial, municipal, and special-the more the better for us. Then there are the daily military setting-up exercises on the lawn, inaugurated and