HOSPITALS IN NEW ZEALAND (REPORT ON), BY INSPECTOR OF HOSPITALS.

Appendix to the Journals of the House of Representatives, 1883 Session I, H-03a

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1883. NEW ZEALAND.

HOSPITALS IN NEW ZEALAND (REPORT ON), BY INSPECTOR OF HOSPITALS.

Presented to both Souses of the General Assembly by Command of His Excellency.

The Inspector of Hospitals to the Hon. the Colonial Secretary. Sir, — Wellington, 7th June, 1883. My appointment as Inspector of Hospitals took place on the 7th November, 1882, since which date I have taken an opportunity of making myself personally acquainted with every establishment of this nature in the colony—a work of no little magnitude, involving some 4,158 miles of travelling. Number. —Their number is at present thirty-eight, which does not include any separate buildings (often at a considerable distance) used as fever-wards. There are, in addition, the Armed Constabulary Hospital at New Plymouth j and the Immigration Barracks at Palmerston North, used in emergency as a receiving-ward, and visited by me. A similar provision at Bull's (Rangitikei) has been abandoned. Distribution. —The distribution is irregular, and appears somewhat capricious. A spirit of rivalry or emulation between neighbouring towns would appear to have had some part in this matter, and would be very praiseworthy if the hospital were entirely supported by local charity, but must be viewed differently where the burden of support falls upon the Government. It is not unlikely that the desire to possess a local medical practitioner, partially subsidized by the Government, may also have had some influence. With improved means of communication it may be found practicable to dispense with two or three, at least, of these hospitals, while the establishment of additional ones may become necessary. Situation. —On the whole the sites of the various establishments have been well chosen. Occasionally they have, from unavoidable circumstances, been placed in the midst of towns, or have gradually been surrounded through their growth. Design. —Some are merely adaptations of buildings erected for other purposes, such as exhibition buildings, immigration barracks, &c. Others have been originally badly planned, or have been injudiciously extended from time to time in a patchwork manner. There are, however, many of exceedingly good design, regarded from a sanitary point of view. Construction. —Wooden buildings are the rule, though there are some in the larger towns of stone, brick, and concrete. In outlying districts the great difficulties of transporting material are shown in rough-and-ready workmanship. Condition. —-It will be seen from the reports appended that considerable differences prevail under this heading. Some of the establishments have an appearance of homeliness and great comfort; others look starved and poverty-stricken ; while a third class present evidence of a very strict economy, without detriment to the well-being of the patients. One thing appears to me very plain : the best managed are those which are the subjects of local interest and support. Admission. —The mode of gaining admission to the colonial hospitals, either as an in- or out-patient, varies greatly. In some instances a subscription, varying from 10s. to £1 Is. for the year, entitles to free admission during that period, without any further payment; in others a weekly payment of from 10s. to £1 10s. is demanded in addition to the subscription; while in a third class it is not necessary to subscribe at all. As regards out-patients, the sum of 2s. 6d. or 5s v paid annually, may entitle to attendance and medicine,. i-H. 3a.

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for that period, for a man and his family. On visiting the hospitals a new-comer cannot fail to be struck with the presence of many patients who, if in England, would be treated at home by their private medical attendant. The form of application for admission into the old London hospitals still runs thus : " and your petitioner, being destitute of means whereby to obtain a cure," &c.; and it is only very recently that one of these institutions has set aside accommodation for paying patients, the primary object of this new departure being the increase of the hospital funds. Payment for Maintenance. —Of the benefit conferred on a community by providing a home in sickness there can be no doubt, provided always that adequate payment is made for treatment in a public hospital by those who can afford it. Weekly payments are here, in many places, carefully collected, and a promissory note for any balance due signed by the patient on his discharge. In some instances an embargo is laid upon his personal property, if he have any; and at one hospital all accounts are regularly settled by the benefit societies, "which also collect the subscriptions due to the hospital by their members. Abuses. —At other places payment is taken if offered, but never asked for, or pressed. The Destitute Persons Act of 1877 appears to give power to recover such moneys, and I learned that a judgment had been given in favour of one hospital, but the man left the neighbourhood nevertheless without payment. The collection of charitable subscriptions is vigorotisly carried out in some districts, while in others nothing is given or even asked. A general falling-off has taken place, as might well be expected under so irregular a system. The provision of free board and medical attendance during illness for those who ought to be able to pay for them must have a very bad influence in fostering habits of improvidence; injustice is done also to medical practitioners. I have heard of a tradesman, in a large way of business, availing himself of the payment of an annual subscription of 2s. 6d. to secure advice and medicine for his family at the public expense. The subscription, entitling a patient to admission to a hospital, is sometimes only commenced after the attack of illness has manifested itself. There are, however, other,abuses prevalent. It is not an unknown thing for drunken or dissolute persons to use the hospitals as convenient recruiting-places in the intervals of their periods of indulgence; but the greatest obstacle to their usefulness is that they are made the home of aged, infirm, and chronic cases, corresponding very closely to the permanent pauper inhabitants of an English union workhouse. Their presence seriously cripples the resources of a hospital, while the conduct and habits of many of them are subversive of discipline and cleanliness. In some of the larger towns whole wards are occupied in this way, to the exclusion of more deserving and improvable patients; and in one hospital want of room had compelled the committee to board out six of these old or infirm persons, at a weekly cost of 10s. each. Refuges. —The few refuges which exist are quite inadequate for the reception of this large and increasing class, for whom some cheajjer form of accommodation should be provided than that which they now enjoy in the hospitals. Hospital Books. —No regular system of book-keeping is in use at the various hospitals, which differ very much in their practice in this respect. It is very rare to find a medical case-book. The following extracts from the report of the Inspector of Public Charities for the Province of Ontario (1880) seem to be so applicable to the hospitals of this colony that I make no apology for transcribing them verbatim : —■ Province of Ontario. —" Coming now to the last branch of work, namely, hospitals for the treatment of bodily diseases, refuges for the poor, orphanages, &c, only within the last seven years has this class of institutions been subject to Government supervision and instruction. Before that time the Legislature annually voted funds in aid of their maintenance, but exercised little or no supervision over the administration of their affairs, leaving that in the hands of local boards of management. The Parliamentary grants in aid of these charities were not then based either upon the work performed or upon the number of inmates in the respective institutions, but an arbitrary sum was voted to each. Moreover, many of the structures used were quite unfitted for the purposes of the charities, and in some instances the administration of affairs was of the most lax character, and no proper or uniform method of obtaining tabulated statistical information was employed. To overcome these defects, an Act (the Charity Aid Act) was passed in 1874 to regulate the public aid to hospitals and charitable institutions, and to provide for their Governmental supervision and inspection. Under the provisions of this Act a certain fixed sum per day is paid by the province for the maintenance of each patient or person admitted; and, in order to stimulate and encourage

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private and municipal subscriptions to these charities, the province gives, in addition to this fixed allowance, a further sum per day for each inmate, equal in the aggregate to one-fourth of the money received from all other sources than provincial aid. The workings of this Charity Aid Act have produced the most satisfactory results. New and well-arranged hospitals have been erected, and old ones reconstructed; private subscriptions have been largely augmented; and greatly-increased efficiency in management has been obtained in nearly every institxition subject to the provisions of the Act. Inspection. — " Another point of almost equal importance relates to the supervision and inspection of the public institutions. Direct and sufficient authority is vested in the Government Inspector to deal promptly with all defects, irregularities, and troubles as they arise, no matter whether the defects are of a structural, administrative, or disciplinary character. Other methods of inspection may be equally, and perhaps more, effective ; but unless inspectors, commissioners, boards of directors, or other officials or bodies of a like character, are, in addition to their inspectoral and recommendatory powers, clothed with sufficient executive authority to remedy defects and supply deficiencies, it appears to me that the prime requisite of a system is wanting." I have not been able to ascertain the exact population of the Province of Ontario, but I have reason to believe that it was in 1880 very considerably in excess of that of New Zealand at the present time. If this be the case, it will be instructive to compare the number of hospital patients in each of these countries : —Ontario : 5,302 in-patients, 9,540 out-patients : total, 14,842. New Zealand : 6,110 in-patients, 8,985 out-patients : total, 15,095. The total amount paid in aid of hospitals by the Province of Ontario was £9,963. The appended tables give particulars of the receipts and expenditure, and also of the admissions, discharges, and deaths, during the year 1882. It will be seen that 522 of the in-patients died, the death-rate being about B's per cent, of the total number treated. At the close of the year the number of beds occupied was 621, or 7 more than at its commencement. The pressure upon the limited accommodation Jias, in some districts, been great, and enlargements and additions are contemplated or in process of being carried out. George Wallington Grabham, M.D. Lond., M.R.C.P., M.R.C.S., &c, The Hon. the Colonial Secretary. Inspector of Hospitals.

Table I.—Showing the Admissions, Discharges, and Deaths of the In-patients, and the Number of Out-patients Treated during the Year 1882.

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JXLi jr. j.. In-patients— Number of patients in hospitals on the 1st January, 1882 ... Adoiitted during the year 490 4,281 124 1,215 614 5,496 5,771 1,339 6.110 6,11 Discharges and deaths— Recovered Believed ... Not improved Died 3,427 344 77 420 983 112 24 102 4,410 456 101 522 Total discharged and died 4,268 1,221 5,489 Remaining in hospitals at 31st December, 1882 Out-patients— Total number of out-patients treated during the year 497 5,453 124 3,532 621 8,985

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Table II.—Showing the Nature of the Diseases of the Admissions during the Year 1882.

iv

Hospitals. Diseases of the Nervou3 System. Diseases of the Circulatory System. Diseases of the Respiratory System. Diseases of the Digestive System. Diseases of the Urinary System. Diseases of the Generative System. Diseases of the Organs of Locomotion. Genera] Injuries and Diseases not otherwise classified. Total. Akaroa ... Arrowtown Ashburton Auckland Blenheim Charleston Christclmrch Coromandel Cromwell Dunedin Dunstan Gisborne Grejmouth Greytown Hokitika Invercargill Lawrence Masterton Napier ... Naseby ... Nelson ... New Plymouth Oamaru Patea ... Kcton ... Queenstown Reefton EiTerton Ross Thames Timaru ... Waimate Waipawa Whan gaii ui Wellington West port ... M. 3 0 8 50 6 1 23 1 34 4 2 5 1 20 29 3 6 1 87 13 3 3 5 2 1 1 6 1 12 27 8 2 6 20 8 F. Tl. 0 3 2 2 3 11 19 69 1 7 0 1 41 64 0 1 14 48 2 6 0 2 3 8 0 1 8 28 6 35 3 6 2 8 0 1 22 109 2 5 6 19 0 3 2 5 0 5 1 3 2 3 0 1 0 6 0 1 3 15 5 32 2 10 0 2 3 9 13 33 0 8 M. 6 20 3 2 17 2 0 64 5 3 14 19 1 5 1 18 3 8 1 5 5 F. 2 4 0 0 11 0 1 25 0 0 0 3 0 3 0 1 0 10 0 1 0 Tl. 8 24 3 2 28 2 1 89 5 3 14 22 1 8 1 19 18 1 6 5 M. 1 4 0 42 4 3 24 4 4 74 9 18 2 33 41 5 10 1 40 5 7 1 9 3 1 22 9 7 3 23 25 7 3 1 35 11 P. Tl. 0 1 1 5 2 2 14 56 1 5 0 3 13 3V 0 4 0 4 37 111 1 10 3 21 1 3 1 34 4 45 0 5 2 12 0 1 11 51 2 7 3 10 1 2 2 11 0 3 0 1 1 23 0 9 1 8 0 3 5 28 5 30 2 9 0 3 0 1 10 45 0 11 M. F. 2 0 3 0 13 3 40 8 5 0 2 0 8 6 2 0 3 0 44 35 1 1 5 0 7 2 1 0 23 10 30 11 5 2 10 5 Tl. 3 16 48 5 2 14 2 3 79 2 5 9 1 33 41 7 15 M. 3 20 3 2 3 3 28 2 3 5 13 3 2 1 3 F. 0 5 0 0 0 0 "9 1 0 0 1 0 2 Tl. 3 25 3 2 3 3 37 3 3 5 14 3 4 1 9 M. 0 1 6 6 5 4 2 0 2 6 4 1 2 F. 3 0 1 3 25 85 6 1 "6 3 2 0 3 Tl. 3 1 7 9 30 89 2 1 8 9 6 1 5 M. 2 5 8 18 1 1 11 2 70 0 1 3 4 7 19 2 7 3 5 4 3 1 3 1 2 1 14 4 5 2 3 F. 0 0 0 3 1 0 4 0 15 1 0 0 0 6 5 1 0 0 2 0 4 4 0 0 0 0 0 0 1 0 0 Tl. 2 5 8 21 2 1 15 2 85 1 1 3 4 13 24 3 7 3 7 4 7 5 3 1 2 1 14 4 6 2 3 M. F. Tl. 12 0 12 22 5 27 42 0 42 432 118 550 46 3 49 9 0 9 354 44 398 18 0 18 33 3 36 177 54 231 16 3 19 29 9 38 30 8 38 9 1 10 135 22 157 45 12 57 19 2 21 90 16 106 13 4 17 11 5 16 36 7 43 9 0 9 49 1 50 47 5 52 18 2 20 4 0 4 50 7 57 38 4 42 11 4 15 3 0 3 110 28 138 109 17 126 27 11 38 63 9 72 47 4 51 198 100 298 30 0 30 M. 20 38 83 628 68 20 445 29 43 495 28 48 69 17 239 202 36 129 25 212 52 49 61 80 38 10 82 55 49 16 162 184 54 72 68 311 64 F. 3 8 11 174 6 0 144 0 4 274 8 10 17 2 53 45 7 33 4 72 13 23 8 16 2 1 12 4 7 0 44 35 19 13 9 133 1 Tl. 23 46 94 802 74 20 589 29 47 769 36 58 86 19 292 247 43 162 29 284 65 72 69 96 40 11 94 59 56 16 206 219 73 85 77 444 65 48 24 72 1 1 2 2 3 5 1 1 2 14 1 0 0 0 0 1 1 2 0 0 3 0 1 1 2 2 4 6 3 1 2 17 1 5 1 4 2 7 0 2 0 1 0 5 1 4 0 4 0 3 0 3 0 8 5 4 0 2 4 6 1 8 3 9 0 6 6 7 2 1 6 4 4 3 3 13 4 6 7 11 9 3 4 1 1 4 0 6 0 0 0 3 4 1 1 4 0 4 2 1 0 1 3 2 0 0 1 2 3 6 2 1 1 3 4 8 4 1 2 14 4 1 0 0 0 0 0 0 5 8 4 1 2 14 4 2 0 0 5 2 2 7 2 2 2 5 0 1 2 1 3 7 1 2 17 1 0 2 0 2 19 1 Totals 144 25 169 2,390 50S 2,898 405 165 570 235 68 303 491 123 614 327 124 451 56 153 209 232 49 281 4,281 1,215 5,491

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V

Table III.—Showing the Causes of Death during the Year 1882.

Table IV.— Showing Receipts on account of Hospitals during the Year 1882.

Note.—Auckland, Grejmoutli, and Patea supplied no information. ii.-H. 3a.

Diseases of the Nervous System, Diseases of the Circulatory System. Diseases of the Kespiratory System. Diseases of the Digestive System, Diseases of the Urinary System. Diseases of the Generative System. Diseases of the Organs of Locomotion. General Injuries and Diseases not otherwise classified. Total. Hospitala. M. F. Tl. M. F. Tl.i 1 0 1 1 0 I' 24 2 26' 10 1, M. F. Tl. M. F. Tl. M. P. Tl. M. F. Tl. Oil 10 1 M. P. Tl. M. F. Tl. M. 0 2 7 89 5 1 52 1 1 50 5 4 9 0 13 18 9 4 3 15 1 10 4 9 2 1 5 4 5 4 7 18 7 8 9 38 5 P. Tl 1 1 0 2 1 8 22 111 1 6 0 1 11 63 0 1 1 2 25 75 0 5 2 6 3 12 1 1 1 14 5 23 0 9 0 4 0 3 4 19 0 1 1 11 0 4 1 10 0 2 0 1 1 6 0 4 1 6 0 4 2 9 3 16 1 8 1 9 0 9 13 51 0 5 iiaroa i.rrowt.0 vvn Vshburton Auckland Blenheim Charleston Uhristchurch. ... Uorotnandel Cromwell Dunedin 3unstan jisborne 3-reymoutli Jreytown ilokitika invercargill £umara tfasterton Napier S'aseby kelson S"e\v Plymouth Damam ?atea ?icton J.neenstown Jeef ton Riverton 2 0 2: 21 9 80 1 0 1! 7 3 10, 1 0 1 9 4 13 10 1 12 3 0 1 1 2 0 2 10 1 2 0 2 9 4 13 Oil 6 1 7' 1 0 V 1 "6 1 To 1 0 1 1 10 1! 10 1 31 2 33 10 1 5 "2 7 1 0 1 18 9 27 10 1 3 0 3 Oil 4 0 4 6 0 6 3 0 3 112 3 6 9 1 0 1 Oil 8 4 12 2 0 2 112 2 13 3 0 3 10 1 10 1 3 "i 4 112 1 0 1 4 0 4 10 1 2 0 2 2 0 2 10 1 4 0 4 0 i 1 0 6 6 1 0 1 2 0 2 2 0 2 3 2 5 10 1 29 0 29 5 1 6 2 0 2 2 13 4 0 4 4 4 8 3 0 3 10 1 3 0 3 10 1 5 16 Oil 9 1 10 Oil 1 "6 1 2 13 1 0 1! 10 1 2 0 2 10 1 10 1 3 0 8 10 1 10 1 10 1 4 "6 4 2 13 2 "6 2 10 1 2 0 2 Oil 1 0 1 10 1 3 0 3 10 1 1 "6 1 3 0 3| 10 1 10 1 4 0 4 9 2 11 4 0 4 5 16 4 0 4j 21 7 281 2 "0 2 1 0 1 10 1 1 0 1 10 1 10 1 10 1 0 "i 1 Joss ... rhames Cimaru SVaimate Waipawa Wkanga,tmi Wellington Westport 1 0 1 i 1 0 1 1 0 1 1 1 0 1! 10 1 9 0 9 10 1 10 1 2 13 112 2 0 2 10 1 10 1 3 3 6 4 0 4 Oil 10 1 10 1 2 0 2 12 3 1 0 1 4 15 Totals 107 20 127 38 16 54 19 4 23 5 9 14 3 0 3 117 20 137420 102 522 f>4 22 86' 60 12 78

Subscriptions and Donations. ieceived from .Patients. From Government. From Uorou^h Council. From County Council. Kents and other lievenue. Total. Hospitals. £ s. d. £ s. d. 14 19 0 60 2 6 100 10 6 88 8 6 21 10 0 401 6 6 £ a. A. 378 0 6 354 8 3 523 13 7 323 1 3 174 3 0 4,338 10 9 85 12 6 282 0 10 6,121 18 3 197 5 10 416 18 8 124 17 2 2,500 0 3 811 8 0 307 12 0 1,079 7 8 171 15 11 ! 1,523 16 9 289 16 5 1,500 0 0 £ s. d. £ s. d. £ s. d. £ s. d. 392 19 6 834 19 1 1,032 5 3 1,183 10 0 280 15 6 4,739 17 3 246 15 4 592 0 8 6,518 9 9 507 13 1 1,048 4 9 296 14 10 3,483 16 11 1,737 11 2 703 6 0 1,946 19 8 393 13 10 3,195 5 3 685 10 2 1,603 19 6 151 0 0 1,366 14 5 462 1 10 1,448 18 2 1,252 10 0 720 11 11 928 10 6 1,843 1 1 2,290 5 2 471 13 S 888 7 8 1,187 0 2 5,625 13 3 827 1 4 Akaroa Arrpvvtown... Ashburton ... Blenheim ... Gharleston ... Chris tehurch Coromandel Cromwell ... Dunedin Dunstan G-isborne ... Grey town ... Hokitika InTercargill Kumara Lawrence ... Masterton ... Napier Naseby Nelson New Plymouth Oamaru jPicton Qucenstown Reef ton Kiverion ... Boss Thames Timaru "W aimate ... Waipawa ... Whanganui Wellington Wcstport ... 183 4 0 11 1 0 228 2 11 52 19 0 237 4 4 75 "4 8 321 15 6 425 0 0 11817 4 32 3 6 61 2 10 239 0 10 100 0 0 4 15 0 74 14 10 7 8 0 193 1 6 415 4 7 53 13 2 954 11 8 631 8 7 171 3 0 560 0 0 128 3 5 768 4 11 237 1 9 66 4 0 322 1 8 109 17 9 116 1 6 46 10 0 14 0 0 100 17 11 15 5 0 132 12 0 32 0 0 289 1 0 156 17 0 103 19 6 140 17 1 128 1 3 7 5 6 124 6 0 185 2 2 42 6 0 50 0 0 50 0 0 200 "0 0 100 0 0 61 14 6 100 0 0 150 0 0 61 14 6 325 0 0 10 0 0 15 5 0 45 16 8 159 6 0 25 0 0 89 2 7 1 15 0 15 9 3 425 10 4 30 15 9 537 14 6 415 8 8 171 0 8 233 14 0 176 11 6 ISO 19 2 21 13 8 228 11 9 ; •» 4 11 0 466 37 10 221 10 7 636 17 8 576 14 2 330 1 8 444 16 6 1,558 7 0 2,134 14 6 404 16 7 416 18 9 575 7 2 5,625 13 3 827 1 4 250 0 0 200 0 0 70 "0 0 100 0 0 356 5 0 2 10 0 150 0 0 5 5 0 77 3 7 25' 16 0 82 7 1 124 11 6 45 3 0 90 17 2 10 9 0 150 "0 0 394 5 0 2 0 0 202 8 0 1 Tntala 7,180 3 5 3,173 10 1 35,713 19 7 827 12 8 2,559 9 6 1,440 7 10 50,747 16 ! Totals

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* No information supplied. t These amounts were supplied by the Treasury.

Table V.—Showing the Expenditure on account of Hospitals during the Year 1882.

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Hospitals. Wine, Ale, Drugi and Instruments. Fuel and Light. Bedding and Clothing. Furniture, Crockery, &c. Salaries and Wages. Water Supply. I Printing and Advertising. For Interest. For Insurance. For Commission. Other Expenses. Provisions, Washing. Funerals. Eepairs. Total. — Akaroa Arrowtown ... Ashburton Auckland* Blenheim Charleston Christchurch.... Coromandel ... Cromwell Dunedin J) unstan Gisborne Greymouth*... Grey town Hokitika InTercargill ... Kuinara Lawrence Masterton Napier Kaseby Kelson New Plymouth Oamaru Patea* Picton Queenstown ... Eeefton Biverton Eoss Thames limaru Waimate Waipawa Whanganui ... Wellington ... Westport £ b. a) 108 18 6 126 4 11 275 13 7 £ s. d. 6 4 6 6 0 0 86 13 6 £ a. a. 65 18 5 26 10 6 99 17 8 £ s. d. 22 5 6 58 17 9 £ e. d. 13 4 0 £ a. d. - \ £ s. d. £ s. d. 180 0 0 373 5 9 332 18 4 £ s. d. £ s. d. 1 10 0 9 0 0 £ s. d. 40 12 6j 39 0 9 £ a. a. I 23 12 0 11 1 2 £ s. d.j £ s. a. 1 2 10 0 12 17 3 £ s. d. £ a. d. 18 14 1 54 18 7 41 5 0 £ s. a, 392 19 6 677 i9 -9 1,032 5 3 13 19 5 43 15 8 7 6 0 ... 371 0 6 66 13 0 1,280 2 3 72 5 2 135 19 4 1,808 6 6 195 9 6 200 15 3 k 44 5 3 0 9 0 235 5 5 3" 9 6 276 16 3 10 19 2 0 12 6 244 14 0 11 7 0 34 17 4 522 11 4 11 14 9 90 10 6 38 13 7 19 10 0 462 6 3 0 17 0 31 17 5 371 16 8 33 1 8 266 11 5 3 12 0 7 15 2 71 3 6 33 11 0 4 0 0 18 12 7 220 12 10 26 10 3 ... 2 5 0 9 2 3 336 17 4 238 0 0 1,479 13 7 188 14 6 350 0 0 2,063 0 0 368 2 0 205 16 0 9 0 0^ 37 15 6 8 3 0 ... I 49 10 0 27 19 0 30 4 6 492 2 3 7 2 0 16 19 8 465 11 4 8 11 8 11 15 6 12 9 9 10 1 0 33 11 0 17 2 4 21 15 5 1312 6 ... 0 12 4 4"'o 0 2'"5 6 5 5 0 ... I 34 19 6 14 8 6 228 16 10 17 13 7 16 16 3 163 3 10 12 14 0 566 11 1 964 16 2 389 13 C 4,739 17 3 321 14 4 631 13 3 6,121 13 3 650 12 10 1,253 12 0 75 "io 0 7 13 0 11 "? 0 11 3 9 ... 34" 7 0 82 17 6 ... 39 15 3 ... 93 7 6 907 6 0 454 2 7 199 17 6 479 6 7 114 13 5 825 12 3 161 9 0 362 12 7 146 9 1 200 9 1 0 15 0 147 6 8 64 7 6 25 9 6 93 12 4 2 5 0 107 3 4 41 19 9 315 14 6 134 2 0 51 2 6 222 9 9 15 17 6 386 7 6 58 14 3 154 5 0 63 7 7 123 10 8 151 5 5 112 16 11 49 2 0 112 2 6 76 8 6 36 13 2 4 11 6 146 16 6 12 5 6 101 14 10 8 14 6 15 0 0 ... 15 "4 6 77 13 2 175 5 7 1,145 0 0 762 19 8 393 7 6 531 5 4 197 12 10 783 5 9 320 7 6 692 19 6 392 0 0 382 3 0 I ... 9 19 0 37 3 3 69 0 11 10 0 25 8 3 2'l9 0 9 9 0 33 5 0 58 19 3 70 15 0 52 8 6 21 8 0 96 4 5 222 16 7 16 14 0 52 6 7 3 5 0 68 16 0 31 10 2 18 3 6 34 16 9 4 0 0 92 5 10 14 1 5 9 2 0 10 0 30 18 9 0 7 0 30 8 Oj 9 18 0 2 12 6 39 0 0 5"5 0 3 15 0 23 10 0 5 5 0 . i 3 9 10 453 17 1 373 11 8 38 19 6 83 10 9 392 6 11 3,517 11 0 2,074 19 11 810 16 0 1,818 5 8 445 18 2 3,268 2 10 616 5 5 1,556 9 4 833 3 0 1,170 1 11 107" 2 4 66 15 5 6 4 3 28 5 7 24 7 0 43 0 11 197 5 9 5 0 6 27 10 11 7 15 2 422 14 8 28 9 6 72 11 1 74 8 IO! 85 5 7j 82 0 9 56 1 6 43 16 9 124 2 11 24 8 0 89 12 2 ... 41 12 0 8 5 0 29 3 7 7' 1 10 41 3 0 ... 71 2 5 318 13 6 192 4 6 170 17 7 251 13 1 433 17 4 450 10 9 404 0 8 292 1 0 251 9 11 « 8 18 3 13 6 9 9 9 3 16 4 C 9 4 6 73 13 6 127 15 0 14 1 0 30 0 0 50 13 1 7 16 S 78 18 7 38 1 2 96 2 6 35 9 f. 118 11 C 266 4 I 74 3 t 51 10 8 116 6 6 26 7 5 96 17 8 72 0 2 39 3 1 34 17 6 108 11 2 180 2 9 28 1 0 9 11 7 19 16 10 1 15 6 20 0 0 37 9 11 23 0 0 11 17 5 53 16 0 19 18 6 ... 24 2 0 54 17 7 41 5 0 7 5 8 3 14 5 33 13 3 21 5 11 206 3 4 433 12 0! 478 10 6' 339 11 9^ 385 19 0.' 766 11 2 858 0 0 480 10 0 216 12 0 332 16 5 2 0 6 i ; 6 0 0 6 10 6 5 0 0 16 0 0 218 0 6 0 0 16 0 0 5 18 6 13 10 6 2 5 0 14 16 0 2 16 6 13 14 4 4 7 8 66 18 8 6 6 8 69 11 0: 254 17 0 173 14 10! 28 7 7 9 10 10 8 1 19 13 0 44 0 9 11 11 6 ! 26 6 0 15 1 6 ! 25 7 0 14 11 0\ 11 14 0 5 2 6 ... I 33 10 8 8 0 0 9 10 0 12 0 0 10 9 0 7 2 6 10 15 0 34 2 6 11 11 4 4 7 0 2 0 0 36 0 0 7 18 0 19 11 8 27 17 101 35 0 5 10 14 1 20 13 034 4 6! 67 16 4 72 11 7 110 8 7 36 11 9 413 14 5 1,056 13 0 996 12 8 744 16 2 906 18 1 1,990 7 1 2,287 15 0 1,130 1 3 727 1 10 1,038 11 10 f5,625 13 3 |827 1 4 ! ... ... ! 81 12 8 38 8 6 26" 2 3j I ... j 34 2 3 39 18 4 410 0 ... ... ... Totals ... 11,423 4 10 1,644 7 7 3,570 8 6! I 2,478 11 10 1,085 9 10 I 1,075 16 8; 261 9 5 16,386 1 10 I I; 321 5 6 2,377 18 4 51,647 12 2 :102 14 o' '642 0 9 136 2 0 241 18 2 |91 8 0 3,253 0 4

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SPECIAL REPORTS ON HOSPITALS.

AKAEOA. Pleasantly and conveniently situated in about a quarter-acre of ground, which is neatly kept as pasture and flower-beds. The building is of wood, with shingled roof; and is surrounded on three sides by a verandah with roof of corrugated iron. It is in very good general repair, and is now being painted externally by the Master. The entrance is behind, through a small lobby, which serves for a doctor's room and for vaccination purposes. There are two wards, each containing four beds ; a small kitchen ; and a bedroom for the Master and Matron. This room is very dark and gloomy, and would be greatly improved by the insertion of some glass in the adjoining roof of the verandah. The kitchen is suitable for its purpose, and contains a small range, a sink, and a cupboard for small stores. The wards are clean and fairly tidy. They are each lighted by three sash-windows. Fretwork ventilators in the ceilings'open into the chimneys of the open fireplaces, and there are inlets for fresh air about half-way up the walls. The bedsteads are mostly of iron, with canvas stretchers; one or two wooden ones are in use. There are mattresses of flax and of horse-hair. The bed-clothing was very clean. Cocoanutfibre matting is placed on the floors, and bedside lockers are provided. Only two patients were in the hospital at the time of my visit ; both were males : one had a fractured leg, while the other was simply old and infirm, and a fit case for a refuge. The whole of the beds were occupied a short time ago, and two cases of typhoid fever were provided for in the neighbouring immigration barracks. The dietary is at the discretion of the Matron, subject to the advice of the Medical Officer, who visits almost daily. Prescriptions are made up at a chemist's, and stimulants procured, as required, from the hotel. All supplies are obtained by yearly contract, and are of good quality. A book of the Master's checks the tradesmen's accounts by daily entries of quantities supplied. Better accommodation is required for stores, some of which are kept in the bedroom. Everything in the kitchen department I found to be scrupulously clean. Behind the hospital, but very close to it, are outbuildings containing a good woodshed ; a proper mortuary ; a laundry, with copper, washing-troughs, and mangle; and, adjoining it, a bath-room. Here also are situated urinals and closet for males, and a closet for females. Pans are used, in which carbolic powder is sprinkled : these are frequently emptied, and the contents buried away from the hospital; but a very offensive smell was apparent in the building from this source. I have recommended the Master to put all the ashes in the pans, to absorb the moisture and gases. The drainage of the sink, laundry, and urinal runs direct into the sea. The only water-supply now available is rain-water. It would be very desirable, in case of failure, to have a piece of piping conected with the adjoining house (the Postmaster's), where there is an excellent supply of spring-water from a creek on the hills. No provision is made for fire-extinction. All accounts are examined before payment by the Secretary of the Christchurch Hospital, who also visits this place from time to time and alters the inventory as may be necessary. This inventory of property is well kept. 20th January, 1883.

AEKOWTOWN. This hospital is about a mile from the above-named town, and about ten miles from that at Frankton. It is very questionable whether the latter should not have been enlarged and improved, instead of erecting another establishment at so short a distance. The hospital is constructed of wood, on a stone foundation, and has a corrugated-iron roof. It contains a large ward for males; a smaller one for females ; kitchen and pantry ; dispensary ; small bath-room ; two rooms for the use of the Committee and Medical Officer; and a Steward's room. In the rear is a detached building which may be used as a fever-ward, but which is not furnished. There is also a detached earth-closet for each sex. The wards have a very cheerful and airy appearance. There are large sash-windows, with green blinds, and open fireplaces for coal or wood. Neat iron bedsteads are provided with straw paillasses and wool mattresses and pillows. Good blankeis, red rug-counterpanes, and scrupulously clean linen were noticed upon each of them. The furniture includes large tables, washstands, cane chairs, screens, and commodes. There were, at the time of my visit, three beds occupied by male patients, who expressed themselves perfectly satisfied with their treatment (as well they might be). There were a number of newspapers and books on the table; which, I was pleased to find, was not used for meals, any convalescent patients going to the kitchen for this purpose. The kitchen is roomy and airy. There is here a good range and boiler. Good crockery, knives, forks, and spoons are in use; and there is none of the objectionable enamelled-iron ware so often found in institutions in the colony. Adjoining the kitchen is a good pantry, where things are also washed up, there being no scullery or sink. All goods ordered are entered in a book, which is compared with the accounts sent in. No diet-scale is in use. I examined the bread, and found that it is made at home, and is of excellent quality. No part of the grounds is used as a kitchen-garden, there being no labour available for its cultivation. Vegetables are purchased as required. There is an excellent supply of water from a spring in the grounds, pumped up by a hydraulic ram. No provision is made against fire. Liquid drainage is conducted away upon the land at a distance ; solid matters are buried at one. The dispensary is well fitted and stocked. There is a small stock of surgical instruments. A prescription-book is carefully kept; and patients are required to pay, when able, sums varying from £1 to £1 10s. per week. A tickeb from a subscriber is necessary for admission, except in case of accidents. These is a book of printed rules in use. The Committee meet every month at the Town Hall; and some of them visit the hospital weekly. The Medical Officer is expected to attend daily. With some trifling exceptions, the arrangements of this hospital are very*good; and the perfect manner in which it is kept reflects the greatest credit on those who have charge of it. Everything was most orderly and scrupulously clean. My inspection gave me very great pleasure. sth February, 1883.

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ASHBTIRTON. I hate this day made an inspection of the hospital, which is an imposing-looking building, situated in about eight acres of land, about half a mile from the railway-station. The construction is of red brick, with white-stone dressings and slate roof. The internal walls are plastered, but have not yet been distempered or painted, and have a very bare appearance. Some of them require to be washed down. On either side of the principal entrance is a room for the Master and Matron. These are lofty, cheerful, and well lighted. Behind these rooms are the surgery, kitchen, scullery, coalhouse, and closets for the staff, and also a tortuous passage leading to the male wards. The front of the building, to the left of the entrance; is occupied by an enclosed corridor, with many windows. The floor is of concrete, and, as the sun only shines on this part of the building early in the morning, the place is cold and comparatively useless for the patients, for whose use two benches are placed here. From the centre of this corridor a passage runs back, having on either side small rooms called " private wards." Of these there are seven for males. They are provided each with a bed, washstand, dressing-table and glass, and an immense locker like a seaman's chest; there is also a very large and cumbrous earthcommode. These rooms are intended for patients paying £2 2s. per week, but do not prove a success. Only one is now occupied, and that by an ordinary patient suffering from typhoid fever. At the end of the passage are double-doors opening into the principal male ward. This ward contains ten beds, two of which have been borrowed from the private wards. The space is insufficient for such a number, the loftiness of the room not compensating for the inadequate floor-space. In the rear of this Ward are folding-doors opening into a rambling passage, on one side of which are a lavatory and a bath-room, and on the other three closets and two urinals. Above the officers' rooms, surgery, and kitchen, are situated the rooms for female patients, comprising a ward with four beds, two private wards, linen store, bath-room, servants' bedroom, and slop-closet. The hospital is badly planned and ill-constructed. The kitchen is constantly used as a passage from one part of the house to another, and, until recently, it was necessary to go out of doors for this purpose. Much room is wasted, and the large number of private wards is obviously a mistake. The whole of the south-west side of the building is very wet from rain driving through the walls, while it has already been found necessary to remove and to renew the roof. The large male ward is spoiled in appearance by a central fireplace with large brick-chimney. It is also very draughty. New folding doors have recently been put up, but they are so twisted that they cannot be properly closed. All the wards are lighted by sash-windows, and have fretwork ventilators in the ceilings, with valvular openings, about 8 feet above the floor-line, in the walls. Open fireplaces are everywhere used : one of these, in a small room, being of immense size. Mantelpieces and fenders are of stone. The bedsteads are of iron, with straw paillasses, hair mattresses and pillows. All the bedding was in excellent condition. There are some small bedside lockers (to replace the large chests removed elsewhere), and Windsor and other chairs. A rather large table with deal form serves for meals, there being no proper dining-room for convalescents. There are no pictures or ornaments. Two newspapers are supplied, and efforts are being made to provide a library. Earth-commodes, of enormous dimensions, are provided, and there are small and neat washstands. In the private wards are strips of felt carpet, dressing-tables, and toilet-glasses. Candles are in use, though gaa-pipes are laid everywhere, these not yet being yet connected with the town gasworks. The male bath-room is provided with a separate furnace and tank, and is, consequently, never used but as a receptacle for lumber. The female bath-room is supplied with hot water from the kitchen boiler. The kitchen is suitable for its purpose, and a good scullery adjoins it. There is a good cooking-range. The surgery serves as an operating-room, and is well provided with instruments. Drugs are not kept, prescriptions being made up in the town under a contract. The laundry is a detached building at the rear of the kitchen, containing an ironing-stove (which is out of repair), a circulating-boiler for providing hot water, a copper, some washing-troughs, and a small mangling-machine. The hot-water boiler is too slow and costly in its action for use, and has not been heated for some time past. At a short distance from the hospital is a row of detached buildings, consisting of fever-hospital, mortuary, padded room, and stable. The fever hospital contains two small wards, each intended for two beds. The cubic space allowed is certainly not sufficient. No bath-room, lavatory, or closet is provided, and there is no accommodation whatever for a nurse. The south-west wall is fearfully wet. The mortuary is suitable for its purpose, but wants some kind of lobby or screen at the entrance. The single room is provided with leather-covered pads, which line the walls and floor. These are stained with wet and other matters, and cannot be removed for cleaning. The room is not weather-proof, though new skylights have been provided ; nor is it, in my opinion, a safe place of custody for an active lunatic. The stable is used by the Master, who keeps, at his own expense, a horse and trap to fetch the Medical Officer when necessary. The grounds have a neglected appearance. There is a small flower-bed in front of the entrance, and about 1£ acres are well cropped with vegetables and strawberries. The remainder is in grass. Rain-water is collected in a large underground tank for laundry use. A good supply of drinking-water is pumped by a wind-engine from a tube-well into four iron tanks, mounted on a timber staging. No provision is made against fire, nor is any alarm-bell available. The sewage runs into a tank near the kitchen-garden, where it is utilized. It was formerly collected in a cesspool very near the building. The night-soil has been also used in the garden, but will, in future, be removed by a contractor. All stores are supplied under contracts, and those which I saw were of good quality. The quantities are checked by the Master when the accounts are sent in. An inventory of all hospital property is in existence, but nothing has ever been added or written off. No medical books appear to be kept, but I examined the prescription and diet cards. The Master keeps a register of all patients admitted, and enforces payment, under the direction of the County Council, where possible. At the time of my visiting there were nine in-patients, eight of whom were males. All were proper cases for hospital treatment. There have recently been several deaths. Visits by the clergy are frequent, but the public.fid not appear much interested in the hospital. The Committee seem to attend very rarely at the building, but transact all their business at the Council's offices. The Medical Officer appears to be very regular in his attendance, and was highly spoken of by the patients, who also stated that they were well and kindly treated by the Master and Matron. It appears to me that there is more

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work to be done here than can be properly accomplished by these last-mentioned officers, provided as they are with only one female assistant. Of their industry and ability Ijhave no doubt, but they cannot keep the hospital and grounds in creditable order without additional assistance. 23rd January, 1883.

AUCKLAND. I hate made a thorough inspection of this hospital and the surrounding premises, and have seen and conversed with all the patients—ninety-eight in number. The building is stuccoed; three storeys in height. The four principal wards occupy the wings on the two higher floors; and at the two outer corners of each wings are towers containing the lavatories, closets, and bath-rooms. The central portion of the two upper storeys contains the two fever-wards, Matron's and nurses' rooms, above; and, below, the Board-room, operating-room, library, and accident-ward. On the ground floor are the dining-room for convalescents ; the kitchen, scullery, and pantry; various store-rooms, several small private wards, two rooms for the medical officer, and, at the extreme end, the dispensary and reception-room. In the basement are the mortuary and engine-house. The situation of the hospital is admirable, and magnificent views of the harbour and surrounding country may be had from the balconies which run along the front of the building on the two upper floors. The estate covers about eleven acres, upon part of ■which are situated the " refuges " for men and women. There is neither flower- nor vegetable-garden. Nothing whatever appears to be done is this direction : I did not see a flower either inside or outside the hospital. The buildings generally appear to me to be in good repair. The water-supply is derived from the city mains at considerable pressure. There is one internal hydrant, and sufficient indiarubber hose to reach any part of the establishment. A small engine can be used for pumping if the ordinary supply should fail. The boiler supplies steam for cooking and water-heating. It is examined annually by a Government official. The hospital, as a whole, may be said to be well planned. The large wards are about 13 feet high, and are lighted by sash-windows, the upper part of which is hinged to open inwards. There are also ventilators in the ceilings, and " hit-and-miss " ventilators near the floor-line. Open fireplaces are arranged for burning wood, and gas-pendants are used for lighting. Linoleum floorcloth is laid down along the centre of the floor. There are Venetian blinds in front, and others of blue holland behind. Iron bedsteads are in use, and these are fitted with straw paillasses and hair mattresses. The pillows are filled with flock or hair, very few feather ones being in use. Many of the bedsteads are very hollow in the middle, and the paillasses and mattresses are in very bad condition. Vermin are said to abound; and I can well believe that this is the case, as I saw evidences of much neglect. The whole of the mattresses urgently require re-making. It would perhaps be better to burn the paillasses and replace them with new ones, after repairing the bedsteads, and taking means to prevent the laths from rusting and injuring the cases. The bed-clothing I found to be of good quality, regularly changed, and very clean. This was also the case with the patients' under-linen and nightdresses. Small dwarf lockers are placed beside each bed: these are too low to form tables for use at meals. There is a folding camp-stool at the foot of each bed, and some "Windsor chairs in each ward. In the large female ward are two plain rocking-chairs; but I could find no others, nor any form of easy-chair, elsewhere. A table, at which convalescent patients take their meals, near the end of each ward, and two commodes, complete the list of furniture. There are no pictures, and only a few plain Scriptural texts on the walls. The smaller wards have a very similar outfit. The female nursing (which is confined to the large ward for females and to the female fever-ward) is performed by the Matron, an assistant nurse, and a night-nurse. The Matron takes her meals in an adjoining room, but sleeps at home; as also does the night-nurse. In this division of the hospital the patients appeared to be well and kindly treated, and so they expressed themselves to me. Everything was, moreover, orderly and very clean. I cannot, however, approve of the arrangement whereby, at present, the same nurses attend upon the ordinary patients and those suffering from fever. The same thing is done when scarlet fever is present. The means of isolating such patients in the central rooms are by no means efficient, and the mode of nursing them not satisfactory. The male fever-ward has nine beds : eight of these are occupied by typhoid-fever cases, and the other by an old-patient, who does the whole of the nursing, and sleeps in the same ward. At present ho has some assistance from a convalescent patient, and he certainly does everything in his power for the good of those under his charge. The ward he keeps beautifully clean also ; but the arrangement is a very bad one, and may end in disaster. The nursing —if I can call it by that name —in the other male wards is of the most wretched description. In No. 1 there is an old man who is paid to take charge of it. No. 3 is under the care of another old man brought from the liefuge for that purpose. In the other wards there is no assistance but what the patients can render to each other. Such a system as this would not be tolerated at Home, nor have I seen anything so bad at any other of the colonial hospitals. Convalescent patients are overtaxed with scrubbing and other onerous work. If they can perform this without injury, they ought not to remain in hospital; and if, as I believe, it is likely to retard or interfere with their recovery, they should not be expected to do it. As it is, there are evidences of neglect apparent everywhere. The rooms are not cleaned, as the rules (hanging on the walls) enjoin. Bath-rooms are littered with brooms, rags, boots, and clothing ; window-sills with medicines, papers, and dressings, for which no proper places are provided ; and, worse than all, the beds of helpless patients remain unmade for days together. A radical change is required here, and could not fail to produce good results. The lavatories, baths, and closets are of good construction, and in good working order. An apparatus* for heating water in the wardpantries is of bad construction,-and makes the whole building seem to vibrate. A small coil of steamtubing should be placed in these tanks, with an outlet for condensed water: this would obviate the disturbance. The convalescents' dining-room is not used as such, which is a matter for regret. I saw here three patients occupying " shake-downs;" of which there was also one in the Board-room. Some of the small wards on the lower floor have been occupied by patients of filthy habits, and by cases of delirium tremens. They are very offensive, and require a thorough renovation. The whole interior of the hospital requires colouring and painting. The woodwork is particularly shabby. A cool safe is

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required in which the supply of milk may be kept sweet. There is an extraordinary arrangement in the lower corridor for conveying a body to the mortuary—in the form of an inclined tunnel, with a tramway. The mortuary is ill-arranged, and very foul-smelling. The only ventilation is up the said shaft into the hospital, when the trap-door is opened. The two rooms allotted to the Medical Officer are small, bare, and ill-placed. The operating-room is large and well-lighted, but does not appear to be used-. It is fitted with a very cumbrous, expensive, and useless table. There is also here a good cabinet for surgical instruments, but there are none worth mentioning. A proper stock is absolutely necessary, and should be obtained without delay. The store-rooms are kept in excellent order, as also is the dispensary. The stock of bed-clothing and linen is insufficient. I examined the various books, and found that a general inventory of property is well and regularly kept. The sum of 2s. daily is exacted from those patients who are able to pay for their maintenance. No medical records or case-books appear to have been kept. The Committee recently appointed meet frequently in town, and often visit the hospital. The establishment is at present overcrowded, but would be large enough for the requirements of the district if it were possible to get rid of at least twelve " refuge cases " who now encumber its wards. There are many excellent features in the building, which ought, under a proper organization, to make quite a model hospital. 28th March, 1883.

BLENHEIM. I hate this day made a thorough inspection of this establishment. The Secretary was away from home, but I succeeded in finding the Medical Officer, Dr. Cleghorn, and obtained from him a good deal of information. The situation is convenient and healthy, but there is no view. The estate is about one acre in extent, and is surrounded by a board fence. The building was erected for immigration barracks, and is not well suited for the purposes of a hospital. It is a wooden building of two storeys, with a lean-to of one storey at the rear. The roof is of shingles ; and there are no rain-shoots. It is in substantial repair, and weathertight, but wants painting. The lean-to has never yet had a coat of paint. There is a well-kept garden, containing good crops of vegetables ; and also a number of raspberry canes, and a few fruit-trees. The rest of the ground is occupied as drying-grounds and a chicken-yard. About fifty head of poultry are kept for hospital use. The water-supply is from an artesian well, and is very good. The water rises to the ground-level, and is available in the scullery by means of an ordinary pump ; but there is no provision whatever against fire. There are no drains or cesspools : the slops and refuse are put into a hole and buried. Four privies stand at a short distance from the building, and are fitted with receptacles in which earth is placed. The soil is emptied occasionally and buried. Five rooms were in occupation as wards at the time of my visit. There are two other rooms upstairs which have not yet been used. They are not lined, and are encumbered with bunks and other fittings used by the immigrants. The ventilation of the wards is by sashwindows and openings near the ceiling; I saw also one Tobin's tube ventilator. Heating is accomplished by open grates in which coal is burned. Kerosene-lamps are in uso. The -wards presented a very untidy and poverty-stricken appearance. The floors were not very clean, and articles of all kinds were lying about in a very untidy fashion. The bedsteads are mostly of iron, and are so dilapidated that rough pieces of board are placed across them beneath the mattresses. The mattresses are filled with flax ; the pillows with raupo. One or two feather pillows are in use: these are old and dirtylooking. No surplus stock is in hand, and there is scarcely any store of linen. The counterpanes are old and of various descriptions. There are some plain deal tables and forms, a washstand or two, and a few old chairs. Holland blinds are in use. Some unframed prints are fixed to the plain wood walls, and there are a number of newspapers, given by the club, and also some books. The kitchen is a large and suitable room, with a nearly-new kitchener. The stock of crockery, knives, and forks, is small, but of suitable kind. In the lean-to building is a room which serves the purposes of scullery, laundry, and washhouse. These is also a small store-room, and a lumber-room with a meat-safe." No bathroom is provided; but there are two portable baths. There is no mortuary. The Steward and Matron occupy two rooms on the ground-floor, and are assisted in their work by a servant-girl. They appear to be industrious people, and kind to the patients, who all spoke well of them. Eleven beds were occupied, all by male patients; fourteen days ago there were sixteen in-patients of the male sex. Females are seldom admitted. Two or three of the patients were simply infirm from age ; and one, a young man, was labouring under symptoms of insanity. It is not unusual here to admit insane persons for observation or temporary care. In this instance some of the relatives were staying with and taking care of the patient. I heard no complaints, though I conversed separately with every one. There is no fixed dietary, this matter being left to the Steward and Matron ; and a liberal supply given. In fact, the patients have as much as they choose to eat, unless put on special diet by medical order. The food appeared of good quality; but the bread was heavy and not so good as it should be. Stimulants are supplied to the hospital in single bottles, and given only by medical order. Medicines are supplied from a druggist. When any new articles are required for use, the Secretary authorizes the Matron to purchase them, but he does not inspect the old ones. No inventory is kept; the only book being a prescription-book, and a diary kept by the Matron. There is a contract-price for nearly all articles used. The Committee seldom visit the hospital. The Secretary is there, perhaps, once a fortnight. Beyond occasional visits by the clergy, there are scarcely ever any visitors :in fact, no interest seems to be taken in the hospital by the inhabitants of the district. This can scarcely be wondered at as the place is very uninviting, and is infested with bugs. The Medical Officer visits daily, and much oftener when necessity arises. Patients are admitted by his order. No separate accommodation exists for infectious cases. It is scarcely worth while to spend much money on a building which it would be desirable to pull down and replace by a more suitable one; but, if this cannot be done, it is desirable —(1) To paint the building externally, (2) to provide a mortuary, (3) to make a bath-room by partitioning off a part of the lumber-room, (4) to fix a force-pump and provide some fire-hose, (5) to repair the bedsteads, (6) to provide a supply of bedding and linen, (7) to provide a coal-shed. ' I may add that the sum paid to the Medical Officer (£5O a year) appears to me to be a very small one. 29th November, 1882.

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CHAELESTOK The hospital stands in about an acre of land, close to the town. There is a small portion of the grounc cultivated as a kitchen-garden, and a few flowers are grown. The remainder is in grass, aad no utilized. The principal building is erected of wood, with a shingled roof, and contains one large ward with eight beds, for male patients. At one end is a verandah, used as a carpenter's shop, and at thi other end a lean-to building contains a lavatory and a dispensary. The dispensary has a small stocl of drugs, but no surgical instruments of any importance. These latter appear to be provided, wher necessary, by the Medical Officer. The lavatory contains a night-commode and a small sink, into whicl the slops are poured. This is also used occasionally as a urinal, and discharges into an open guttei just outside. This is an objectionable plan, and sure to prove offensive at times. If not removec altogether, the sink should be trapped and the drain enclosed. The ward is lofty and airy ; the wall; are boarded, but, for about 6 feet in height, have been covered with calico and whitened. A good mam unframed prints are on the walls, and I noticed a clock and two models of ships in glass cases. Ther< is a range of book-shelves, but the books are very limited in number. Newspapers are rcgularl] supplied for the patients' use. The windows have sashes, arranged to open either above or below. A good fire is burning in an open grate. The bedsteads are of iron, and have straw paillasses am mattresses. One or two are filled with flax. Hair pillows are in use, and two contain feathers. Th< bedding is very good and clean. Two of the bedsteads are specially fitted for changing bedridder patients. In the ward is also a large table, with American-cloth cover, and forms, for use at meals Two male patients at present occupy beds. A corner of the ward is divided off with green-baiz< screens. Here is kept a portable bath, and a quantity of clothing and linen are in it and upon i vacant bed. A proper linen-press is much needed. Holland blinds are fitted to the windows. A detached building, in shape like the letter [_, contains the kitchen and three other rooms occupied bj the Steward, and also for purposes of vaccination. The kitchen is roughly constructed and draughty It contains a good American stove and a dresser, with suitable crockery. Outside is an opening ink which kitchen slops are poured. These find their way, through a partially-covered drain, to a sort oi dry race outside the kitchen-garden. Near the kitchen is a good coal-shed, where also kerosene, &c. are kept. A small mortuary is situated at a short distance, and, being seldom required for its specia" use, is occupied with a good deal of lumber. In the kitchen-garden are two closets with a cesspool, which has not yet required emptying, but has an overflow into the neighbouring dry race. This may give trouble at some future time. Pans containing dry earth or ashes would be preferable. The watei is obtained from two tanks which collect the rainfall. Supplies are obtained under contract. Writter orders are not given. The Steward keeps an account of the bread and the milk supplied, but not of the meat. There is no diet-scale. The inventory of hospital p-roperty has not been corrected for severai years. The Committee meet monthly in the town, and visit the hospital every week. The Medicai Officer attends daily, and oftener when desirable. The Steward has the whole of the nursing and domestic work to do without help. The buildings have a rough-and-ready sort of appearance, and the furniture is scant and meagre ; but I found everything very clean, aud the patients expressed entire satisfaction with their surroundings. The sum of £1 weekly seems to be collected, wherever possible for their maintenance. 23rd February, 1883.

CHBISTCHURCH. I hate this day made a thorough inspection of this hospital, with its grounds and outbuildings. The situation is very good, being conveniently near the town, and adjacent to the river, on which a boat is kept for the use of the patients. The estate occupies about eight acres, all of which is well kept. A large kitchen-garden supplies abundance of vegetables to the establishment. The old buildings contain t*vo.,wards and a dining-room on the ground-floor, and three wards above. These rooms are principally used for old men who are convalescent, but are also used for cases of erysipelas and typhoid fever. Only one patient was upstairs at the date of my visit. In this block also are the store-rooms, and the apartments allotted to the House Steward and Housekeeper. All are very suitable for their purpose, but I cannot say the same of the kitchen and its offices, which are situated at the back of the old buildings. This part of the structure requires rebuilding, and the cooking-apparatus replacing, as it is extravagant in fuel, and, in great measure, worn out. The scullery is small and offensive-smelling, being undermined by rats. The new buildings are constructed of concrete below, on piers and arches; with a superstructure of corrugated iron and wood. There are three principal wards, two for males and one for females, which open in front into a handsome and useful corridor; on either side of the passages leading from the wards are situated convenient rooms for the nurse, the ward-kitchen, the store-room, and a special small room for troublesome or noisy patients. Above these blocks of rooms are small dormitories, three in number: one of these is reserved as a ward, the other two being used as bedrooms by the assistant nurses and cleaners. At the back of the principal wards are projecting buildings, containing, on one side, the bath-room and lavatory, and, on the other side, the closets and urinal. A central projection in front of the new building contains the apartments of the House Surgeon (two sitting-rooms, two bedrooms, and a dressing-room), the staff-room, the dispensary and waiting-rooms. The principal wards are lofty and airy. There are large windows, the central portion of which opens, and ventilation is assisted by a fretwork opening in the ceiling, and by a large central gas-sunlight. There are also, for lighting the wards, several gas-pendants. The windows have Venetian blinds over their lower portion, the upper panes of glass being painted white. Heating is accomplished by fireplaces standing out in the centreline of the wards, and having descending flues. Iron bedsteads, of old pattern, with iron laths, are in use. Upon these are .placed a straw paillasse and a hair mattress. There is one woven-wire mattress in use for a patient who has fractured his spine. The blankets and sheets were good and scrupulously clean, as also were the counterpanes and pillowcases. The pillows are filled with flock, but there are a few containing feathers. The furniture comprises a large deal table, with forms for use at meals. There are Windsor chairs and a few rocking- and arm-chairs ; bedside lockers, and a small washstand.

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There is also a smaller table, and a well-contrived cupboard for containing the patients' medicines. Some flowers and a few prints were to be seen, and I ascertained that there is an abundant supply of newspapers and books, the latter being kept in the library by the Dispenser. The ward-kitchens are supplied with all requisites, as also are the ward store-rooms, but no inventory of properties is kept by the nurses. The baths are constructed of marble slabs, and there is a furnace and boiler for each of these rooms, used weekly. If a hot bath is required at other times, hot water is carried from the wardkitchen. Earth-closets are in use, and are fairly well looked after ; a contractor empties the receptacles twice weekly. The condition of all the wards was, at the time of my visit, very creditable, and I formed a good opinion of the nurses. The patients appeared to bo carefully and kindly treated. I saw dinner served in two of the rooms : it consisted of roast mutton, greens, potatoes, and broth, and seemed nicely cooked. The diet-scales were submitted to me, and I made particular inquiries as to the mode of ordering and issuing extras and stimulants. The nurses take their meals in their own rooms; but the other servants, male and female, dine in the large kitchen, which is very hot and unsuitable for this purpose. The only sitting-room available for their use is a small one used for vaccination purposes. The laundry comprises a washhouse and an ironing-room, with hot-plate, mangle, wringer, and washingmachine. There are also three coppers and a number of washing-troughs. The number of articles washed amounts sometimes to eighty-six dozen weekly. There is a convenient mortuary not far from the laundry, at the back of the hospital. The water-supply is derived from three artesian wells, attached to which are three hydraulic rams, which raise a portion of the water into iron tanks placed on timber stagings. The liquid drainage from the laundry, sinks, urinals, and baths runs direct into a " creek," which, running round along the front of the hospital, discharges itself into the adjoining river. No doubt the overflow from the artesian wells tends to purify this creek, but the arrangement is an objectionable one. If a proper outlet for drainage were obtainable water-closets might, with advantage, be submitted for the earth-closets now in use. The hospital buildings are in good general repair ; the sum of £245 having been spent last year in painting the exterior. Some internal painting or distempering is needed. There are no appliances for use in case of fire, but there is an electric-bell communication with the police-station. No separate building exists for fever-patients, and insane persons are never admitted. The beds in occupation to-day are seventy-one. Only eight out-patients attended this morning. There are often thirty to forty of this class on one day. A good deal of care seems to be taken in excluding those who are not proper objects of charity, and in enforcing payment where possible. Every patient is furnished, on his discharge, with an account of what is due from him, at the rate of 3s. a day. A treatment-register and a prescription-book are kept in the dispensary, a general register in the staff-room, and a register of patients and payments in the Steward's office. The drugs are obtained on yearly contract from a local druggist, and, it is said, on very favourable terms. The contract price of milk is 7|d. per gallon, and of butter Is. a pound for the whole year. The stores are very carefully kept and issued by the House Steward and the Housekeeper, but no store ledger or other book is in use. The diet-lists are made up daily. Any property belonging to a patient is taken care of by the Steward when required, but he has no property-book, nor is_any receipt given when the property is again delivered to the patient. A large number of visitors attend the hospital, and gifts of useful things are not infrequent. Until recently there was an appointed clergyman, who performed Divine service at the hospital on Sunday mornings. At present there is no arrangement for this purpose. Altogether my visit gave me a very favourable impression of the management of this institution, and of the zeal and ability of its officers. 19th January, 1883.

COBOMANDEL. I hate made an inspection of this hospital and its surroundings. It is pleasantly situated, a little way from the town, in three acres of ground, part of which is not in any way fenced in or utilized. A good stream of pure water appears to form its boundary on two sides. The building is of wood, with shingle roof; and is in good repair externally, having recently been painted. There is a central portion, with verandah, and two projecting wings. These latter contain, in front, the Board-room and the dispensary ; and, behind, the kitchen and the Warder's room. The central part comprises the male ward, a small fever-ward, and a bath-room. Behind the hospital is a three-roomed cottage, a good deal out of repair, containing bedsteads, bedding, and a quantity of lumber. The small fever-ward contains at present one male patient, suffering from typhoid fever. The furniture of the room consists of an iron bedstead, a deal table, and a large and clumsy commode. There is one sash-window, with a holland blind; no fireplace; and the boarded walls have been, at some former time, very roughly papered. The male ward has four beds, and contains one patient suffering from fracture of the thigh-bone. One bedstead is an old iron one, of military pattern ; the others are roughly constructed of wood. Flax mattresses and pillows are in use. The bed-clothing is very clean. There are also here a plain wood table and five chairs. The walls are dirty, and roughly papered. The ceiling badly requires cleaning and whitewashing; and the floor has a dirty, stained appearance. A roll of texts hangs on the wall. There is no fireplace. The room is lighted by three sash-windows. The bath-room has an iron bath, supplied from an outside rain-water tank. This water is used for all domestic purposes also. The kitchen is a suitable room, and has a small cottage-range. The boiler requires renewing, it having been cracked. The crockery, knives, forks, and spoons are suitable, and very clean. The dispensary is fairly stocked with drugs, but I saw no surgical instruments. There I found a general register of the patients, and a case-book. The latter contains no entry since January last. The Board-room is large and well lighted. There are here a large cloth-covered table, and seven chairs. The hospital is in sole charge of a warder, who is a single man, and a.cguired his knowledge of nursing while a patient in the Auckland Hospital. He appears to be vei'y kind and industrious, but is, himself, in delicate health. The interior of the building requires much cleaning and renovating, and some furniture of a better kind is very desirable. The fever-ward is too small, and could not accommodate two patients. I was glad to learn from the Medical Officer that the Board-room is sometimes used for this purpose. This room and the dis-

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pensary should be used as wards, and the smaller rooms as offices, for which they are quite large enough. With any increased number of patients it would be necessary to provide additional staff for nursing and housework. There is a good fenced garden, which is rapidly going out of cultivation for want of labour ; and is, in its present condition, useless. The liquid sewage is poured upon some part of the garden. Night-soil is put into a detached privy, and the excreta of fever-patients buried in a deep hole. The Warder has only been a few weeks in his present situation, and was unable to give me much information as to the procuring of supplies and the checking of accounts. 31st March, 1883.

CEOMWELL. Situated in twenty acres of ground, on an elevated plain, one and a half miles from the town. The hospital is built of stone, with a stucco front, an iron roof, and a central ventilating-shaft. The front rooms are a large ward for males, a smaller one for females, a ward with three beds, the dispensary, and the Warder's room. Behind these rooms a passage runs, in the rear of which are the kitchen, pantry, and bath-room. A lean-to building in the rear contains wash-houso and stable. At some distance behind the hospital is the dead-house ; and there are separate detached earth-closets for each sex. The wards present an aspect of homeliness and great comfort. They have large sashwindows and glazed doors opening to the grounds. It is hoped, when funds permit, to erect verandahs outside these doors —?• very desirable improvement. There are ceiling ventilators in connection with the central shaft. Open fireplaces are provided, but, not being found sufficient, have been replaced by iron stoves. The floors are covered with linoleum floor-cloth ; framed pictures are hung on the walls, and a good supply of books and papers is provided. Iron bedsteads are fitted with straw paillasses and chaff (winnowings) beds and pillows of excellent quality. There are also hair mattresses, an airbed, and feather pillows for special use. Some of the rug-counterpanes are old, but serviceable, and the whole of the bed-clothing is beautifully clean. Green-holland blinds are fitted to the windows, and suitable chairs, tables, and lockers are provided, The bath-room contains a portable bath only. The dispensary is well kept, and has a good stock of drugs. Surgical instruments are provided by the Medical Officer, iso prescription-book is kept, but there is a general register, giving all particulars of the patients and their payments, which vary from £1 a week for subscribers to £2 for non-subscribers. A particular account is kept of all stores procured and issued: this book is balanced monthly. All goods are procured by written order. No diet-scale is in use, and there is no inventory kept. Admissions are obtained by subscribers' tickets, but accidents need no recommendation. The kitchen is a good one, and has a large American range, with boiler. Crockery of good quality is provided. The dinner to-day consisted of soup, roast mutton, and .potatoes. There is a small, well-arranged pantry adjoining the kitchen, but no scullery. The water used for domestic purposes is rain-water; for washing, &c, it is obtained, by means of a small race, from the hills. Liquid drainage is disposed of, with the ashes, in a distant hole ; poultices and refuse are burned ; night-soil is buried. There is a small flower-garden, and unsuccessful attempts have been made to grow vegetables, for which the soil is by no means fitted, being too dry and shingly. The Committee hold monthly meetings in the town, and visit the hospital occasionally. The Medical Officer, Dr. Btackpoole, appears to take much interest in his work. I found beds occupied by two men and two women, all of whom were proper subjects for hospital treatment; they 'were perfectly contented. In a word, the hospital is well planned, under good management, and in most praiseworthy order. 7th February, 1882.

DTTNEDIN. 1 hate this day inspected this establishment, including the outbuildings and grounds, have examined the books and the stores, and have seen every patient, with the exception of two. The building was erected for an exhibition, and considerable ingenuity has been exercised in adapting it to its present use. It is built of brick, with a facing of stucco and a basement of stone. At the back is a large wooden annexe, containing the out-patients'department; the dispensary; a large ward occupied by chronic, incurable male patients ; and a very large room which serves for an exercising space for convalescents, and also as a drying-room for clothing in wet weather. Near this part of the building is a new and commodious reading-room, supplied with books, magazines, and papers. There is a library also in another part of the hospital, which is well stocked with books purchased by means of a special fund. A small wooden annexe on the north side contains the lying-in department, which consists of two wards, a small kitchen, and a room for the midwife. The front part of the hospital contains a vestibule and a very large entrance-hall; also three large wards for male patients, officers' dining-room, operat-ing-room, and single room for an excited patient. On the floor above are the officers' quarters ; and also six wards, three being for male patients and three for females. In the basement are various store-rooms, and the kitchen ; also a dark, damp, and unsuitable strong-room. A row of detached wooden buildings, on the south side, consists of dead-house and post mortem room, earth-closets and urinals, stables, ashpit, and vegetable house. On the north side are placed the laundry and a small greenhouse. The grounds are exceedingly well kept, and comprise ornamental gardens and a large area stocked with fruit-trees and vegetables. The whole of the buildings appear to be in good repair. The drainage runs into a cesspool, which is situated too near the hospital for safety (about 50 feet). Here the solid matters accumulate, and are taken away once a week. The earth-closets are also emptied at the same time, together with the ashpit. The water-supply is from the city mains, and is delivered under great pressure. Hydrants and hose are provided for extinguishing fire, and have recently been tested.. Kain-water is not saved, being too dirty for use in the laundry. The wards are lofty, well-lighted, and airy. The brick walls are coloured; and in some of the rooms a painted dado has been introduced. The windows have large flap openings at top and bottom, well protected to prevent draught ; and other ventilators are in use in and near the ceilings. Open fireplaces are adapted for burning wood. Gas-brackets are provided for lighting. The furniture is plain and

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substantial. Large deal dining-tables with forms are placed in the centre of each ward, there being no separate dining-room for convalescents. There is linoleum on the floors, and there are pictures, dolls, and other ornaments. Bedside lockers are provided, and there is a large cupboard for medicines and appliances. Some of the bedsteads are of iron and others of wood. There are some hair mattresses, but the majority are of straw, and are burned when the patients are discharged. I saw some feather pillows, and ascertained that there are three water beds for use. The bed-clothing I found to be scrupulously clean. At the end of each ward is a high partition, behind which are bath-rooms, lavatory, and water-closet. No offensive smell was anywhere perceptible. A general appearance of tidiness and comfort prevailed; and a number of patients to whom I spoke expressed satisfaction with their surroundings. In one of the wards are eleven male patients who might, with propriety, be removed to a benevolent institution or refuge. Six others of this class are boarded out with their friends, at an expense to the hospital of 10s. each per week. The out-patients average about twentyfive to thirty daily. They sign a declaration that they are proper objects of charity. Those of the in-patients who can pay for their maintenance are pressed to do so. Admission is granted by the Resident Medical Officer to all cases medically or surgically suitable. Recommendations are sometimes brought, but are not insisted upon. The dispensary is well stocked with drugs obtained under an annual contract. All stores are also obtained under contracts, and I found them to be of good quality. A careful system of book-keeping is in use at this hospital, all supplies being carefully checked. There is a diet scale in use with daily-ration-sheets for each ward. No inventory of hospital property is kept. A register is kept of all admissions and discharges, but there is no " case-book." At the time of my visit there were in the hospital two cases of scarlatina. These patients had been admitted for some other disorder, and were carefully isolated, as far as practicable. There are no fever-wards, and patients suffering from other infectious disorders than typhoid f-ever are refused admission. There is a small room used for fumigating infected clothing with sulphur; but a proper hot-air chamber for this purpose is needed. The hospital is visited, at frequent intervals, by the Committee, who hold also their monthly meetings here. Visits from the clergy are numerous, and Divine service is performed twice weekly. Valuable assistance is rendered to patients on their discharge by means of the " Dempsey " fund. The revenue from this source amounts yearly to about £260 ; part of which, however, has to be devoted to other special objects. There can be no doubt that the hospital is under good and able management. 29th January, 1883.

In the course of my inspection I took the opportunity of making inquiries respecting the treatment of M. M., who was admitted into the Dunedin Asylum on the 16th of January last, after having been a patient in this hospital from the 10th January. M. M. is suffering from severe burns on the soles of the feet, the left thigh, and the right calf, alleged to have been caused by the application of hot-water bottles and tins while in a state of collapse and insensibility from exposure and drink. I questioned the Medical Officer, and also the Housekeeper and nurse, but could elicit no further explanation of this unfortunate occurrence than that stated by Mr. Roberts in his letters to Dr. Neill. The Housekeeper and nurse both assert (and I have no reason to disbelieve them) that the patient was first covered with a double blanket, outside of which the hot-water tins and bottles were applied ; and that during the time of their application she never moved. It will be well, in future, to insist upon the use of proper flannel covers with these hot-water appliances, and never, as in this case, to delay the removal of an insane patient to the Asylum. I have drawn the attention of the Chairman of the Committee to the matter, and it will receive further attention.

DUNSTAN. Situated about one mile from Clyde, in grounds of about thirty acres, near the river. The building is an old one, constructed of wood, with an iron roof. It affords accommodation for about twenty patients, and at the time of my visit was occupied by four men and two women, all of them hospital cases. The two wings of the building contain wards for male patients, one of them (not occupied) being reserved for Chinese. The ward for females is situated to the right of the front entrance, on the other side of which is the dispensary. A passage divides this portion of the building from the Wardsman's two rooms, the kitchen, stores, coalhouse, and washhouse. The building badly requires painting externally, and the large wards (which have boarded walls whitewashed) require renovating. lam told that arrangements are being made for doing this work without delay. The wards have sash-windows, ceiling ventilators, and open fireplaces; but stoves are used in winter. It being a hot day, the rooms, which are not lofty, were very warm, but the patients were able to be outside in the open air. Iron bedsteads are used. These have good straw paillasses ; and beds and pillows filled with winnowings, good red-and-white counterpanes, and very clean sheets and blankets were on each bed. There was also plain and suitable ward-furniture, and a number of books and papers. The dispensary is large and well stocked with drugs and a fair supply of surgical instruments. I here examined the prescription book, which is well kept, and also a very well-arranged store-book, which is balanced and submitted to the Committee monthly. All accounts are checked by the Medical Officer and the "Wardsman, and afterwards by the Committee. There is a good register of patients and books relating to paying patients :£1 10s. per week is charged to subscribers, and £2 2s. to non-subscribers. The only inventory kept relates to surgical appliances. No diet-scale is in use. The Committee meet once a month, and visit once or twice a week. There is a fair kitchen, with suitable fittings and crockery. No scullery exists... Connected by a sort of passage with the wards at the ends of the building are water-closets, which are only used in emergencies, earth-closets being provided at a distance from the Hospital. Liquid drainage runs into the river. Solid matters are buried. Rain-water is used for drinking ; a supply for other purposes is obtained from a small race. There is a small detached building for a mortuary, and a suitable detached residence and a stable for the Medical Officer, who seems to

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pay much attention to his duties. The patients seemed to be made very comfortable, but the construction of the building gives it a somewhat dull and gloomy appearance. It is evident, however, that tbose who have the management make the best of the present arrangements. Good order and cleanliness prevailed. The soil of the estate is very dry and poor, but a portion is under cultivation, and has a fair crop of potatoes : the remainder is utilized for pasture. 7th February, 1883.

GISBOENE. This hospital was inspected by me very hurriedly while the steamer remained at the port. It is situated about a mile and a half from the town itself, standing in grounds of about five acres. The building is of wood, and appeared to be in good repair. It consists of a central portion and two wings ; these latter containing the male and the female ward. The central portion contains a private ward (unoccupied), two rooms for the Steward and his wife, a good dining-room, and a kitchen. In a small detached building is a room used as a washhouse, and a ward which is used for any patient whose disease is of an offensive nature. The male ward contains six beds : four of these are now occupied, and there is a male patient in the building just spoken of. The female ward has five beds, four of which are in use. My visit was at 7.25 a.m., when the day's work had not commenced at the hospital. Making due allowance for this, and for the serious character of some of the cases, I found the wards in fair order, and free from any offensive odour. The bedsteads are of iron, some being of a special pattern, with an arrangement for raising the patient to a semi-recumbent position. The mattresses are filled with flax. These and the bed-clothing I found in good order and very clean. Mosquito-curtains were in use. There is not much furniture here, but some good cupboard lockers, and a few unframed texts and pictures on the walls. The private ward is suitably furnished; but the detached ward appeared to be bare and comfortless. Attached to the wings of the hospital by a well-ventilated lobby are small buildings containing a good lavatory, with three basins, a good small bath-room, and a pancloset. It would be well to use ashes or dry earth in these closets, and certainly to empty them more frequently than once a fortnight, as is now done. The presence in the hospital of several patients suffering from typhoid fever renders this a matter of some importance. The dining-room presents a good feature, which is seldom found in the colonial hospitals. Wherever possible, convalescent patients, and those who are able to leave their beds, should take their meals away from their wards. In this case the dining-room conveniently adjoins the kitchen, which is fitted with a good range and suitable crockery and utensils. Rain-water is the only water-supply, and is preserved in iron tanks. Liquid drainage is conducted away into the sea. Situated at a short distance from the hospital is a special building for fever-patients. It has,.two good wards, with offices ; and a small kitchen, fitted with a colonial oven. I was told that only cases of scarlet fever were to be treated here ; but I am of opinion that, although it may be safe to treat single cases of typhoid fever in a general ward, it is improper to accumulate any number there, and to risk thereby the infection of the nurses or the other patients. I saw three individuals suffering from this disease, and regret that they were not in the well-arranged fever-hospital. Altogether my very hurried visit gave me a good impression ; and the Warder and Matron appeared to be active and efficient persons, though at present a good deal overtaxed by the severity of the cases under their charge. 19th March, 1883.

GEETMOUTH. The hospital is situated about a mile and a half from the town, and is well placed, commanding a fine view of the sea. The buildings are of wood, the older portion having a shingled roof, the newer one of corrugated iron. There are two large wards for male patients, and also a smaller one with three beds. A single ward serves for females, of whom there were only two, at the date of my visit, occupying beds. All these rooms are lofty, and well ventilated by means of sash-windows, ceiling openings, and Tobin's tubes; good coal-fires were burning in the open grates. There are iron bedsteads of neat pattern, each having two flock mattresses and flock pillows; a few feather pillows are available for special cases. The bedding was. in good_ order, and very clean. Large tables, and forms with backs, are used at meals. There are also caned chairs, and good bedside cupboards. The windows are fitted with Venetian blinds ; framed pictures hang on the walls; and cocoanut matting is laid on the floors. Kerosene-lamps are in use, as the cost of laying a gas-main from the town would be great. Opening out of each ward is a good bath-room, with basins and a well-ventilated pan-closet. A very orderly nurses' room is situated next to the ward for females. The kitchen has a good range, with boiler and two ovens. There is also here a sink, as there is no scullery. Near it are two wellarranged store-rooms, one for linen, the other for general purposes. The dispensary is an excellent room, well stocked with drugs. A glazed cabinet contains a good stock of surgical instruments. Prescription-books for both out- and in-patients were shown to me, and a very good general register. There are contracts for all supplies ; and orders are given from a printed book with counterfoil. All accounts are entered in a journal and carefully checked. A very good patients' property book is regularly kept and signed. There is an inventory of hospital property, but it requires periodical revising. Patients are admitted by orders from the Committee, and payments at the rate of £1 10s. a week are expected, but seldom received. It does not appear to me that any pressure is used to secure payment. Next to the dispensary is the operating-room; here there is a small library of books for the patients' use j and I .learned that they have also a regular supply of newspapers. A passage separates the kitchen from the new building, which was erected for chronic or "benevolent-institution cases, but has never been used. It contains two good wards, divided by a central passage, and might be found valuable in the event of an outbreak of fever. A small detached laundry contains a copper and a mangle ; but no means of drying clothing or linen in wet weather. The House Steward resides in a detached house at the back of the hospital. The grounds are well kept, and the building is surrounded by beds of flowers. A good kitchen-garden is well stocked with vegetables and fruit-trees. In this is 2—H. 3a.

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a building used as a lumber-room, and containing also three closets. There is also in the kitchengarden a small mortuary. The water-supply is principally rain-water, which is collected in a number of iron tanks ; there is also a well with a pump. A supply in readiness for flre-extiuction is kept in numerous buckets ; hose is attached to the tanks ; and large portions of the walls of the wards are hinged, to open as fire-escapes. I saw, and conversed with, the whole of the patients : there can be no doubt that they are treated with much kindness and consideration. The whole of the establishment I found to be in excellent order, and scrupulously clean. The Committee visit it every fortnight. The Medical Officer attends twice daily, and oftener when necessary. 19th February, 1883.

G-REYTOWN. The hospital is about a mile from the town. It stands on light and sandy soil, the estate comprising about an acre and a half, fenced in with posts and rails. The ground is principally covered with rough grass, which has invaded the paths. There are some flower-beds in front, and a drying-ground behind, but no portion is utilized as a kitchen-garden : in fact there is an appearance of neglect over the whole. The building is pleasantly situated, facing nearly due north, with a good view of the hills in front. It is in good general repair, but the lower part requires painting externally. There are two wards, the walls of which have been recently plastered. These were untidy-looking, and the floors were not clean. Ventilation is by sash-windows and apertures in the ceilings. There are open fireplaces for burning wood, &c. Kerosene-lamps are used for lighting. Iron bedsteads, with chaff beds and pillows on straw paillasses, are provided. The counterpanes and sheets were very clean. Brushes and combs are provided for each patient, and towels, which are kept in the kitchen. There is a very small stock of linen and bedding. The ward furniture comprises small tables, Windsor chairs, and pieces of carpet. There are no washstands, and blinds have not been put up since the plastering was finished. There is a picture-screen in the women's ward, and a large number of books and papers are provided. There were some cut flowers, a few plants in pots in the passage, and a large number of flowering-plants under the verandah. No lavatory or urinal is provided. The kitchen has no range or boiler, but a colonial oven. The cookery and utensils are of suitable character. The scullery is little more than a cupboard, and has no sink or water-supply. Under a verandah at the back of the hospital there is a rain-water tank supplying a sink, and here the crockery, &c, is washed up. There is also here a meat-safe, which should be removed to a shady place near the rain-water tank, as it now receives the full morning sun. The stores were kept in a small room, and were found to be of good quality. A bedroom only is provided for the Steward and Matron. A dispensary and surgery combined contains a stock of drugs, procured from a local chemist, and a few instruments, splints, &c. Stimulants are not kept in stock at present, but procured as required. The books kept are a diary for visits and suggestions, and a register of admissions and discharges. No book is kept by Steward or Matron, and they have not seen any inventory. There is no dietary scale, but liberal meals are given, vegetables and fruit being purchased as required. No out-patients attend the hospital. Inpatients are admitted by orders from the Committee, and an annual subscription of ss. appears to entitle to admission. The members of the Committee visit the hospital in rotation, and the Secretary is frequently there. There are very few visitors other than friends or relatives of the patients. A Church of England and a Roman Catholic clergyman attend at times. In the grounds of the hospital are two immigrant-cottages, each containing three small rooms. One of these is used as a laundry, bath-room, and store-room, and was found to be very dirty and untidy. The other cottage can be utilized as a fever-hospital, but has been occupied for ten months by a Maori boy, who has a severe gunshot wound of the knee. His whole family seem to have taken up their residence here, and have made the place, together with the laundry, very filthy. They have also placed three pigs in an empty stye at the back. A small detached building is provided for the mortuary. This needs ventilation and a window-blind or screen. Two privies and a fowlhouse complete the outbuildings. The water-supply is from a well with a common pump. No provision is made against fire. The drain from the sink runs out at the back of the land. The privies are emptied about once a month, the soil being buried. Other refuse is burned. Besides the Maori boy there was only one in-patient at the date of my visit. This was a man with a fracture of the spine. He had no complaint to make but of the bedding, and feared ho would get bed-sores. The Steward and Matron have only held office three months, and therefore some allowance may be made for the slovenly appearance of the hospital and its belongings. They assured me it was much worse when they first arrived. I recommend that a kitchenrange and boiler be provided; that the exterior of the building be painted ; and that a better kind of bedding be procured, at least for severe cases. 14th December, 1882.

HOKITIKA. The hospital is about a mile and a half from the town, and is placed upon elevated ground, commanding a fine view of the sea. The grounds are about fifteen acres in extent. A large portion is planted with ornamental trees and flowers ; another large part being used as a kitchen-garden, and well stocked with vegetables. The building is of wood, with a corrugated-iron roof, and appears to be in good general repair. Internally some painting is needed, especially in the wards ; and some leaky tanks near the roof of the store-room require repairs. Koughly speaking, the ground plan of the hospital has the form of the letter J-j ; the four projections containing the wards, and the central part a large corridor, operating-room, dispensary,, &o. The kitchen and servants' rooms are placed at one of the hinder corners of the building, being approached by a verandah. The two front wards are in use for male patients —medical-and surgical. At the back is the female ward. The fourth ward is not at present in use. These rooms have good sash-windows, with green-holland blinds. There are ventilators in the ceilings, and open fireplaces in the centre of the floor. Kerosene-lamps are used for lighting. The bedsteads are of iron ; bedding in good order, and very clean. The paillasses and mattresses are filled

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with hay, as also are the pillows. There are a few hair mattresses for special cases. Deal tables with forms are provided for use at meals, all of which are taken in the wards. There are also a number of cane-seated chairs, and some rocking-chairs. Bedside table-lockers, of good and simple pattern, are placed by each bed. Each patient has two cards placed on the wall above him : one of these shows particulars of the case, the other the diet. There is a large dresser at the end of the ward, with drawers below for linen and stores, and shelves above for crockery. It also contains a small cupboard for special medicines. There are some good commodes, with earthenware pans. A number of books and newspapers are available for the use of patients, and there are a few pictures on the walls. In a projecting building at the end of each ward is a bath-room, with two basins ; and, adjoining it, a pancloset, which is emptied daily from outside. The female nurse occupies a very comfortable looking room at the entrance to her ward. The other servants are badly provided for in the matter of any dayaccommodation, there being only one small and gloomy room for their use when at meals or off duty, The operating-ward is at the end of the large entrance-corridor, and is very well lighted and arranged. I saw here a good stock of surgical instruments, in excellent order. Opening into this room is the dispensary, which is supplied with drugs, under contract, by a local chemist. A small room, entered from the dispensary, is the only provision made for the Steward and Dispenser, and is certainly inadequate for the purpose. The kitchen is small, but has a good cooking-range. There is a good pantry next to it, but no scullery. Most of the washing-up is done in the verandah outside. The store-room is small and poorly fitted. It is also very wet, from the leaky tanks already alluded to; but this matter has already engaged the attention of the Committee. There is no accommodation provided for patients suffering from fever, or other infectious disease. The laundry occupies a detached building in the rear of the hospital, and is a very good one. It contains a wash-house ; a drying-room, and a small bedroom for the laundress. Behind the laundry a small wooden erection contains four pan-closets and a urinal; and near this is a good range of pig-styes, in a state of remarkable cleanliness. A small but suitable mortuary completes the list of buildings. As regards water-supply the rainfall furnishes an ample quantity, which is stored in numerous tanks. I noticed a large number of buckets, hung up in accessible places, and all kept filled, in case of fire. There are also a number of fire-ladders, properly housed. The liquid sewage is conducted into a neighbouring creek, and finds its way into the sea. Night-soil is mixed with earth, and eventually used in the garden. At the time of my visit beds were occupied by twenty-seven males and four females. Of these, four might properly be inmates of a benevolent institution. I conversed with all, and could hear no complaint, but, on the other hand, a good deal of praise of the general arrangements and comforts of the hospital, and the kindness of the staff. The charges made for maintenance in the hospital (to subscribers of £1 annually) are £2 10s. for the first week, and £1 10s. for subsequent weeks. These sums are paid to the hospital by the various local Committees, and not by the patients. The system is good, but is open to some abuse. Outpatients are seen, at the hospital-rooms in the town, twice weekly. If not themselves subscribers they must bring a ticket from a subscriber. Their prescriptions are dispensed at the hospital, and are entered in a book with counterfoil. The books kept at the hospital are very complete. The admissionbook gives very full particulars of each case; and three case-books give the treatment and progress of the patient. There is a well-arranged book showing diets and extras ; and a stores-ledger, with debtor and creditor account of every article used. This book is balanced monthly. All orders for stores are given by printed order, with counterfoil; and the accounts properly checked. There is also a book showing the daily number of patients, and the daily consumption of each article. A complete inventory of hospital property exists, and is corrected yearly. Articles are condemned by the Steward, with the approval of the Committee. The Committee meet fortnightly at the hospital, and visit the wards ; making a report of each visit in a book. The Medical Officer also records his visits, which are at least twice daily. I had the pleasure of visiting the wards with him, and can entertain no doubt that he devotes much time and great interest to his work. The Steward and Dispenser is evidently a valuable officer, and I can speak very favourably of the rest of the staff. The whole hospital is well managed and in a very creditable condition ; and I have not yet seen in the colony so good a system of book-keeping, medical and general, as that in use at this establishment. There is great need here of two small wards, in which special cases might be appropriately treated. These might be erected at comparatively small expense. The large wards are at times overcrowded, and the resources of the hospital severely taxed. 15th February, 1883.

INVEECARGILL. The hospital is situated in the town, but has a good area of land round it, which is utilized as a lawn, a drying-ground, and a small meadow; no part is cultivated as a vegetable- or flower-garden. I have this day inspected every part of the establishment, which is at present under the charge of Dr. Galbraith, the Resident Medical Officer being away on sick leave. The hospital consists of three blocks which are united behind by a corridor. At one end an old building runs back, and contains a kitchen, ilaundry, pantry, and bath-room. The left-hand block consists entirely of the Medical Officer's rooms, and has only recently been built. The central block has, on the right of the entrance, a well-fitted dispensary ; on the left, a room used by the Committee, and also for out-patients ; behind this is a small ward with two beds ; while upstairs are three other small wards. The right-hand block contains a male ward and a male nurse's room ; upstairs is a female ward, and also a room for a nurse; there is also a dining-room in this block. The wards are plainly but suitably furnished; iron bedsteads are used, with straw mattresses and chaff beds and pillows. The bed-clothing I found to be good and very clean. There are large sash-windows, and open fireplaces, and one or two other ventilators. A few chairs, bedside locke-rs, small brackets, washstands, and plain tables, complete the furniture. There are also commodes, which are of necessity in frequent use, as no water or other closets are situated near the wards. A few pictures adorn the walls, and there are one or two bookshelves with books and papers. An earth-closet is provided for each sex at the back of the corridor, but can only be used by the convalescent patients, or those who are not confined to bed. The kitchen is small and poor; there

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is a small range here, with boiler at back, and there is also a large copper which supplies hot water to the bath-room. The laundry is small, and opens into the kitchen. Behind this part of the hospital is a detached brick building, containing store-room, coalhouse, two closets, and a deadhouse. Still further back is an old wooden building covered with corrugated iron, and used occasionally as a feverhospital. This structure formerly served as a lunatic asylum; it contains one large and two small rooms, with a bath-room. I found beds occupied by eleven male and two female patients, all of whom were properly inmates of-the hospital: all appeared to be contented with the treatment they received. Inquiries were made as to the purchase of stores, and it was found to be done by means of printed orders, properly checked with the invoices ; everything is supplied under contract. Registers of both in- and out-patients are kept, and payments obtained at the rate of £1 10s. per week, wherever practicable. There is a regular diet-scale, but no case-book is kept, and no inventory of hospital property has been taken for two years. I saw a good stock of bed-clothing, and an excellent cabinet of surgical instruments. The Committee visit the wards daily, and evidently take much interest in the hospital. Dr. Gralbraith attends morning and evening, or oftener when required. The buildings are by no means well planned, but are made the most of. There is a deep well with force-pump for water-supply, and rain-water is also collected in large tanks. Liquid drainage runs away beyond the hospital grounds. The closets are emptied frequently, and the contents of the commodes are thrown, with other refuse, into an ash-pit: this is a bad plan and may be a source of danger. The grounds behind the hospital require to be cleared of a good deal of lumber when labour can be had for this purpose. The buildings generally appear to be in good repair. Ist February, 1883.

KUMABA. The hospital is situated close to the town. The building is a wooden one with iron roof, and is at present being enlarged by the erection of an additional male ward, with bath-room and closet. The accommodation, when completed, will include two good wards for males and one for females. There is a small dispensary, a bath-room, kitchen, nurses' room, and warder's room in the older part of the building. The warder's room will be destroyed by the passage leading to the new ward; and the proposed partitioning-off of a portion of this ward for another room is, in my opinion, a thing to be condemned, as it will entirely spoil the new building. A suitable room for the warder should be erected elsewhere. The wards are airy and cheerful. There are sash-windows and ceiling ventilators. The walls are painted, and there are green-holland blinds. Open fireplaces are arranged for burning wood. The bedsteads are of iron, some of them being shaky and dilapidated. Two flock mattresses are furnished to each bed. Each patient has also a flock pillow and two filled with feathers, The bedclothing I found to be very clean. Rocking and other chairs are provided, and tables with forms for meals, all of which are taken in the wards. Bedside lockers, with a shelf, are in use; and there are some unframed pictures on the walls. The bath-room is well fitted and supplied with cold water from an outside tank.. Adjoining it is a well-ventilated earth-closet. The kitchen is small, but well kept; there is no range, but a colonial oven, and good crockery is provided. The dinner to-day consisted of hashed beef, potatoes, cabbage, and rice pudding. There is a diet-scale, but it is not adhered to. The dispensary has a small stock of drugs, and a fair stock of surgical instruments, but not sufficient. Here the register of admissions is kept. I also found that a case-book contained a good history of each patient. These are admitted by ticket; but, practically, no one is refused. Subscribers pay £1 a year, and the sum of £1 10s. weekly is charged for maintenance in the hospital. Payments under this category seem to be infrequent. All goods are supplied under contracts. No proper order-book is in use, and I saw no inventory of hospital property. The Committee visit the hospital weekly. A good strip of land is cultivated and cropped with vegetables. The liquid sewage runs into an adjoining gully. Solid refuse is utilized in the garden. The rain-water is collected, and forms the only source of supply. The detached buildings include an open shed, used as a laundry; a mortuary; and two detached closets. My visit gave me a good impression. The wardsman and the nurse keep the hospital in excellent order ; and the Medical Officer takes much interest in his work. All the patients appeared to be comfortable and contented. The beds occupied were four in number (males). 19th February, 1883.

LAWBENCE (TITAPEKA). I hate this day made my inspection of this establishment, which is situated in grounds of about four acres, in a good position near the town. The hospital proper has only been built about three years, and replaced an old wooden structure. It is of red brick, with iron roof; and contains on one side a large ward for male patients, and on the other two smaller wards, one being for males and the other for females. In the centre are four smaller rooms —viz., the dispensary, the store-room, and the Steward's sitting-room and bedroom. The entrance-hall communicates, by means of a covered way, with a detached kitchen : this is fitted with a range and a boiler for supplying hot water to the baths, &c, but the arrangement does not work well. There is also a sink here, there being no scullery provided. A small wooden building in the rear is used as a Chinese ward, and has, at present, only one occupant. Three patients have been at one time in this ward, but it is too small for this number. Adjoining is an attendants' room. A brick building close by is used for a fever-ward, but is too small to accommodate more than two patients. In each corner of this structure is a small room —viz., a padded room, store-roomj-lavatory, and closet. The fever-ward would be much improved by throwing into it the space now occupied by the two latter, and reconstructing them in a small annexe. The padded room is very small, and is occasionally used, for some days together, for a lunatic patient. Persons of this class should be removed with the least possible delay to a proper asylum. The other detached buildings include a small laundry, a coal-shed, stable, mortuary, lumber-room, and two newly-erected brick closets. These are emptied daily, the soil being buried. The liquid drainage of the hospital runs through a trapped drain into a creek at some distance. There is no water-supply other than rain-water,

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a portion of which is collected in an underground cemented tank, and another portion in iron tanks beneath the roof. The grounds are fairly kept, but more assistance is needed to get them into good order. In front of the building are some flower-beds, and at the side a well-stocked and well-kept kitchen-garden : all this work is done by the wardsmen and patients. The buildings are apparently in good repair. The wards are clean and well ventilated. Iron bedsteads, of neat pattern, are in use; but there are a good many old and dilapidated wooden ones, to replace which funds are, as yet, wanting. Straw paillasses are used, with chaff or flock beds, flock or feather pillows, and excellent bed-clothing. The whole were in good order and beautifully clean. There are bedside cupboards provided ; and the wards are decorated with plants in pots, and some pictures. I also noticed a neat bookshelf, well stocked with books, which, as well as newspapers, are gifts to the hospital. On the floors are strips of cocoanut matting. Open fireplaces, with grates for coal, are provided ; and kerosene-lamps are in use. The windows are large, and open at top and bottom ; there are also ceiling ventilators. The bath-rooms and earth-closets are separated from the wards by lobbies, in which are situated lavatories ; hot and cold water being laid on. The ward furniture is plain and suitable, but a few more chairs are much needed. The dispensary is well fitted and stocked with drugs ; there is here also an excellent cabinet for the surgical instruments, the stock of which is, unfortunately, too small. The store-room is very good, and in excellent order. I inspected all the books, and found them properly kept. All stores are obtained under contracts, and all goods received are carefully checked. Stock is taken every month in the store-room, and an inventory of all property taken yearly by the Committee and Secretary. A daily ration-list is kept, and examined monthly by the Committee, and compared with the accounts of goods received and the stock in store. Payments are obtained from patients wherever possible. Stamped promissory-notes are signed by them on their discharge, and a collector calls upon them afterwards for payment. The Committee visit the hospital sometimes twice in one week, and evidently take considerable interest in its working. The Medical Officer also is very attentive to his duties, and is highly spoken of by the patients. He has only lately recovered from a dangerous form of fever, resulting, in my opinion, from certain insanitary matters connected with the old wooden house in which he resided at the hospital. The Committee have very properly removed the house altogether, and hired another for the purpose in the vicinity of the hospital; but it is very desirable that a suitable residence shall be provided in the grounds of the establishment for the use of this officer. The class of cases received here is of a serious nature. There are many accidents from the mining districts ; and there is only one patient occupying a bed who would more properly be an inmate of a benevolent institution. An unsuccessful attempt has been made to remove this patient elsewhere. Altogether I saw eleven patients, two of whom were females. They all spoke to me in high terms of the comfort and kindness which they experienced. The condition of the whole establishment is most creditable; the new buildings are well designed, and good'management and economy are everywhere apparent. The Steward and Matron are valuable officers. The former (who formerly served me in England) acts also as dispenser. It appears to me that additional female assistance is needed, especially when, as often happens, there is night-nursing to be done. 31st January, 1883.

MASTEETON. The hospital is well situated on somewhat elevated ground, about half a mile from the town. The soil is a loamy clay, and was formerly swampy, but has been well drained. The estate (about three acres) is fenced in with posts aud wire. In front it is laid down in grass, and planted with shrubs ; behind are the drying-ground and the kitchen-garden. This is in admirable order, and supplies abundance of vegetables, fruit, and flowers to the hospital. Water is obtained from a well, by means of a force-pump, to which 120 feet of l|-inch hose can be fitted, in case of fire. The hose is good, and kept on a reel under proper shelter. Two ladders are also in readiness for use. Eain-water is caught in a tank, and used in the bath. A cesspit, filled with boulders, is situated at some distance from the hospital towards the south-east, and receives the drainage of sink, lavatory, bath, and urinal. This gradually soaks away into the land. All refuse is burned and used in the garden, with the soil from the closets. The building is of wood, with a shingle roof. The whole is in good repair, but badly requires painting externally. There are three wards, which"are very clean and bright-looking, and a good view is obtained from the windows as the patients lie in bed. Open fireplaces for wood are provided, and the lighting is by kerosene-lamps. Sash-windows and openings in the ceilings give proper ventilation. Very neat iron bedsteads are provided with straw paillasses, hair mattresses, and feather pillows. White counterpanes are in use, and these, with every other article, I found to be most scrupulously clean. There is no large stock of bedding or linen, but quite sufficient for all practical purposes. One patient was lying on an excellent spring-mattress. The ward furniture comprises washstands, reclining chair, tables, Windsor chairs, brackets above the beds, commodes of simple constructioD, carpets, and green blinds to the windows. A proper cupboard contained the medicines and appliances. A few books were seen, but there were no papers or pictures. There is a very good lavatory, with four basins ; each patient has his own towel. A bath-room is provided, and there is also a portable zinc bath. Hot water has to be obtained from the laundry. The kitchen has no proper range, but a colonial oven only, The room is neatly furnished, and the crockery and utensils are good. The scullery is properly fitted, and contains the meat-safe. I examined the bread and other stores, which are kept in a room for the purpose. A bedroom adjoining the kitchen is used by the Steward and Matron, James Bulpitt and his wife. Their sitting-room is now occupied as a bedroom by a young mtm, who assists in nursing troublesome cases, and work's in the grounds. A detached laundry contains a copper and% good wringing and mangling machine. Attached is a lean-to shed, intended for a mortuary, but unsuitable for this purpose, and used as a toolhouse, adjoining which is a staJl for the Medical Officer's horse. Behind this building stand three detached closets for patients, and a urinal. The closets are emptied every week. Within the hospital building is a room intended for a dispensary. Medicines are, however, procured from a chemist in the town. There is here a stock of surgical instruments, worth £50 to £70. A small consulting-room is used as a mortuary. A

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register of patients is kept by the Medical Officer, and there is also a diary, in which are recorded the visits and recommendations of the Committee, with other matters. An inventory is well and regularly kept. A member of the Committee visits the hospital at least once a week, with great regularity. A. Church of England minister also attends weekly, but there are seldom any other visitors than the friends and relatives of the patients, and a very few presents are received. At the time of my visit there were three beds in the male division occupied, and a female was expected in the afternoon. Patients are admitted by an order from some member of the Committee, subject to the approval of the Medical Officer. Accidents are provided for without any formality. No fixed dietary is in use, but the meals are liberally provided and well served. A good detached ward gives accommodation for two or three infectious cases. Nothing could exceed the good order and condition in which I found everything pertaining to this institution, and which reflects the highest credit upon the Committee and the Medical Officer. The Steward and Matron devote their whole time and energies to their work, which they carry out with great ability. Of them the patients spoke to me very warmly, as regarding their kindness and attention. It is a matter for regret that so little is done by the town residents in the matter of visiting the hospital. I recommend that a kitchen range, with boiler, be procured, and that the building be painted externally. 11th December, 1882.

NAPIER. The hospital stands on very high ground a short distance from the town, and commands an extended view of the sea and the surrounding country. The building is constructed of wood, with an iron roof, and appears to be in good general repair. The grounds are well kept. There is a good kitchengarden, and a number of flower-beds and grass-plots. There is a large ward and a small private one for each sex. A room intended for the use of convalescent patients has also been converted into a fever-ward for males. The large wards are lofty and handsome rooms of great width. They are lighted by sash-windows, above each of which is a flap, opening inwards. Openings in the ceilings and vertical tubes assist in the ventilation. Gas is used for lighting, and an open fireplace in the end wall is intended to heat the ward. It is, however, ill placed, and its use necessitates the removal of a bed ; its influence is not felt at the outer extremity of the ward. Small projections at the corners of the outer walls contain closets and bath-rooms with lavatory basins; a small intercepting lobby, with cross ventilation, intervening between each of them and the wards. The beds are placed about two feet from the walls, so that access can be had to the patients on all sides. The floors are of plain wood, those portions behind the beds being stained and varnished. The walls are distempered in a pink tint, and the wooden ceilings whitewashed. No bedside or other carpets are in use in the large wards. There are iron bedsteads of a good and neat pattern. Well-made straw paillasses and hair mattresses, with chaff or flax bolsters and feather pillows, form the bedding. The bed-clothes are of excellent quality and scrupulously clean and well kept. Bedside lockers are provided, having a box above and a cupboard below. Small metal brackets are intended for the medicines; and a press contains the spare linen and appliances. Two good tables with American-cloth covers, a chair commode, and two or three Windsor chairs complete the furniture. More chairs are required, as many of the patients have no other seat than their beds. Good framed pictures adorn the walls, and numerous books and papers are in use. A general appearance of comfort and cleanliness prevails in these wards and their adjuncts. The fever-ward is not so suitable for its purpose, and has no closet or lavatory accommodation. When filled with patients suffering from typhoid fever there will not be entire freedom from risk of infection of nurses or others ; and it is quite unfit for the use of patients suffering from scarlatina. There are here five beds, three of which are occupied by cases of typhoid fever. The private wards (one for each sex) contain, each of them, a patient suffering from this same disease; they are comfortable and lofty rooms, with two beds, washstands, chest of drawers, tables, carpets, and various ornamental objects. Better provision for the isolation of those suffering from infectious diseases is a desideratum. The convalescent patients now take their meals in the servants' hall, which is a suitable room near the kitchen. Altogether there are now twenty-four patients in the hospital, with each of whom I had some conversation. No complaint whatever was made to me upon any subject. There is a deficiency of rooms for the occupation of the staff. A male warder sleeps with his patients; and the Matron occupies two rooms intended for ward-kitchen and nurses' room. Two rooms only are available for the Resident Medical Officer. A small room serves as kitchen and scullery for all the wards : there is here no proper convenience, and the place is dirty and untidy. Considerable allowance, however, must be made for this state of things, as a nurse and two servants have recently left, and have not yet been replaced. The kitchen is in good order; but, with its fittings, is inadequate for the cooking of so large an establishment. It will shortly be enlarged. The adjoining store-rooms are in the best possible order, and the supplies of good quality. There is here no Steward, but these departments are under the care of the MatroD, of whose capabilities I formed a good opinion. The operating-room, at the back of the hospital, is a small room with concrete floor, and has no fireplace. The dispensary is well stocked with drugs; surgical instruments are few in number, but a supply has been ordered in London. A good Board-room, near the entrance of the hospital, contains a very nice library for the patients' use. Here I inspected the various books and sheets in use. Prescriptionbooks for both in- and out-patients are carefully kept by the Medical Officer, who also performs the dispensing. General registers of patients and case-books are kept by him in a very careful manner. There is also a patients' property book, and a general inventory of hospital property, which last has recently been corrected by the, Matron. The sum of 3s. a day is charged to patients who can afford to pay, and are not subscribers to the hospital. Those who subscribe £1 Is. annually appear to be entitled to become'-in-patients or out-patients during the whole year without further payment. The diet-scale was inspected, and also good and well-kept tables of rations and extras. A detached building contains a small workshop, a capital washhouse and ironing-room, and a coach-house, used as a lumberroom. Near this is a small mortuary. Considerable storage is provided for rain-water, and the town

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water appears also to be available and could be used in case of fire. The liquid sewage runs into the town drains. The closets in use are of the dry-earth kind. The contents of these are buried in the kitchen-garden, while the vegetable and other refuse is removed by a contractor. Commencement has been made of an enlargement of the hospital, which will no doubt remedy some of the defects above alluded to, and diminish the overcrowding of beds which now prevails, particularly in the large ward for females. It is very evident that considerable interest is taken in the hospital by the Committee and the public generally. The condition in which I found every part of the establishment reflects great credit upon those who are concerned in its administration. 16th April, 1883.

NASEBT. The hospital is well placed in grounds of four acres, near to the town. The main building is of wood, with iron roof, and contains in front the ward for males, the dispensary, and a small ward for females. Behind are the kitchen, Steward's room, another small ward for women, bath-room, and washhouse. A verandah occupies a portion of the front. The walls have sash-windows and ceiling ventilators. Open fireplaces have been replaced by stoves, as being more economical and efficient. Kerosenelamps are used. There are wooden bedsteads with straw paillasses, and flock mattresses and pillows. These are not so comfortable as hair, but were not complained of. There is an ample supply of waterand air-pillows for those who need them. Good rugs are supplied to each bed, with slate-coloured blankets and very clean linen. There is a large table in the men's ward for meals, all of which are taken here ; and two small bedside tables. There are no lockers ; but I noticed a bookshelf, well filled, and also newspapers, draughtboards, &c, with framed pictures on the walls. There are some cane-seated and other chairs. Commodes are used in the wards, with a removable bucket, there being no closets but detached ones at a distance. The bath-room has a fixed bath with douche. There is also here a lavatory with a number of clean towels. In the adjoining female ward is a large ne-st of drawers containing surgical instruments and appliances. The kitchen is good, and has an American kitchener in a recess. Good crockery and utensils were here, all exceedingly clean and well arranged. There is no scullery, but a very good store-room. The dispensary is very suitable for its use, and well stocked. Here I saw a very complete patients' register, containing also notes of the treatment adopted. A pre-scription-book is properly kept. Payments are obtained from all patients able to contribute: £1 a week is charged, and I am informed that last year all the patients paid for their maintenance in the hospital except six. The Wardsman takes charge of any money found on patients, and enters the same in a book. Pass-books are kept for all goods supplied by contract. Entries are afterwards made of them in the store-book, which is submitted to the Committee. An inventory of hospital property is said to be kept by the Secretary. The Matron "has a list of all linen and bedding. No diet-scale is in use. The Committee meet monthly; but some of them visit the hospital every week. The Medical Officer attends at least once daily. The water used for drinking is rain-water ; a supply for other purposes is obtained from a dam. All liquid sewage is run into a race, and finds its way to the river. Solid matters are either burned or buried. The detached closets are kept perfectly clean. An iron building, in the rear of the hospital, contains a lumber-room and a coalhouse. At some distance to the right is the fever-hospital, not in use. This is a concrete building, containing, in front, two rooms with a bed in each. Behind is a small kitchen; and attached to the back of this hospital is an iron building, used as the mortuary. The grounds are prettily planted with trees and flowers. A kitchen-garden furnishes all the vegetables used in the hospital. I found four male patients occupying beds, and satisfied myself that they were very properly inmates. All expressed themselves to me as very comfortable. The hospital is well planned, carefully superintended, and kept in admirable order by the Wardsman and the Matron. There can be no doubt of their industry, as they have no assistant whatever. My visit was paid at an early hour, but everything was very satisfactory. 9th February, 1883. '

NELSON. I hate this day visited the hospital at Nelson and seen all the patients. The estate is well situated on high ground, a short distance from the town, and embraces about six acres. There are some reserves of land elsewhere which are hospital property, as lam informed, but they are at present of little value. The grounds present some shady walks for the convalescent patients; but no part is utilized as a kitchengarden, there being no labour available for this purpose. The building has a good external appearance, and is in substantial repair, having recently been painted externally. It is constructed of wood, with a slated roof, and, with the exception of the central portion, has no second storey. The central groundfloor portion contains the waiting-room, consulting-room, dispensary, kitchen, stores, and bath-room, with a private room for the dispensary ; above are the quarters of the .Resident Medical Officer. Each wing of the building forms a large ward, for males and females respectively, in front of which is a verandah. There is also a large empty ward at the rear of the building on the male side, which is used for infectious diseases, and sometimes for such patients as are noisy and excited— e.g., cases of delirium tremens. There would be no difficulty in erecting a similar ward on the other side, so that both sexes might be separately treated. The wards are large and airy, the ventilation being effected by sashwindows and openings in the walls and ceilings. They present a cheerful appearance, and are substantially, though very plainly, furnished. There are deal tables ; deal seats, with backs ; bedside lockers, with backs to form a plain seat; bedside brackets; and a few American reclining-chairs. There are also some commodes of plain construction. A number of unframed prints hang on the walls; and I observed a number of cut flowers. The bedsteads are of iron, with hair mattresses upon straw paillasses. I'eather pillows are in general use. The blankets and linen were scrupulously clean, but much worn. A very small stock of bedding and linen is kept; but new things are always obtainable, at short notice, when required. Books, periodicals, and papers abound in the wards : these are gifts from townspeople. Open coal fires are used for warming. The lighting is effected by gas. The water

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supply is sufficient and good; it is derived from the town mains: but there is not sufficient pressure for extinguishing fire in the roof, nor is any hose provided for the purpose. Hot water is supplied from a copper in a small detached building. This is only used for bathing purposes. There is also a boiler behind the kitchen fire. No ward kitchen exists; but all the washing-up is done in the central kitchen. At the central end of each ward is a sitting-room and a bedroom for the nurse, and at the other end are lavatories and earth-closets. These are emptied by the town nightman regularly, and gave no offensive smell when seen by me. The drainage from the hospital runs through pipes into a watercourse at some distance. The night-soil is buried, and all other refuse burnt. The laundry is a small detached building with a Bradford's washing machine. A small detached mortuary serves for both hospital and asylum. At the time of my visit eleven males and seven females occupied beds in the wards : they were all proper cases for hospital treatment, and all expressed themselves as perfectly satisfied with the surroundings. Hospital clothing is not supplied to the patients, but is sometimes provided on their discharge. There is a benevolent fund for this and other purposes. About £100 is at present in hand. About 270 out-patients are attended annually. These and the in-patients are carefully selected by the Committee, and admitted, if approved, by the Medical Officer. I examined the stores, drugs, surgical instruments, books, and diet-scales, also the lists of extras in use ; and inquired as to contracts and the mode of procuring the various articles in use. Everything appeared to be done systematically, and to be checked by the Committee. The staff is by no means large ; and in this, as well as in other matters, it was very obvious to me that a rigid economy is practised here, without any detriment to the comfort and well-being of the patients. Altogether my visit gave me great pleasure, and I formed a high opinion of the services of Dr. Boor, the Medical Officer. I recommend that some portion at least of the interior, including the passage and small kitchen, be at once painted. This should be done to prevent decay. 2nd December, 1882.

NEW PLYMOUTH. Asr excellent site of about six acres is set apart for the hospital, in close proximity to the town. It commands a beautiful view of the town and the sea; and might, with some amount of levelling, be made into a very pretty spot. At present a small portion only is made use of: this is the kitchengarden, containing about one-third of an acre, and well cropped with vegetables for the patients' use. The hospital is an old wooden building, much improved by recent alterations, but not satisfactory from a sanitary point of view, as shown by the frequent prevalence of erysipelas within its walls. It contains a central or main ward; another for accidents ; a fever-ward ; and a detached building containing two rooms for female patients. There is also a small room, in which two females might be placed, in the principal building; and there are four single rooms which formerly belonged to the Lunatic Asylum. One of these is occupied by a syphilitic patient, and another has been converted into two earth-closets. A kitchen with its adjuncts, dining-room for male convalescents, bath-room, Steward's rooms and dispensary, and store complete the list. The main ward is entirely lined with matchedboarding, and has sash-windows, with ceiling ventilators. It contains eight iron bedsteads, with straw paillasses, flax mattresses and bolsters, and feather pillows. The blankets and linen are old, but very clean and well kept. There are two fireplaces for wood-burning. G-reen-holland blinds, and others of muslin, are attached to each window. Plain bedside stools, a few old chairs of odd patterns, and a table complete the furniture. There is no floor-covering nor bedside mat, and no picture or ornament. The other wards have a still rougher appearance, the walls and ceilings being not so well finished. Their furniture is similar in character. A good tubular air-bed is in use in the accident-ward. The fever-ward is not at present occupied. A good lavatory with three basins, and a lead-lined bath, are situated near the main ward. Water is laid on to them. Rain-water is used ; but a service is also being laid from the town's main. The earth-closets are very well attended to, and quite free from smell. The kitchen is a fairly good one: it has a colonial oven, and a good outside safe. Crockery and cutlery are good; but use is still made of the objectionable enamelled ironware. Behind the kitchen is a dining-room for about six convalescent male patients. Opening out of this room is a store for linen and bedding, the stock of which is small, but sufficient for present use. In front of the kitchen are two very neatly-kept rooms for the Steward and his wife, who holds the position of Matron. They are assisted in their work by a male orderly ; a second being occasionally engaged for nightnursing. A washerwoman is hired four days in each week. The dispensary is a small room, containing a sufficient stock of drugs, but no surgical instruments. A. supply of these has recently been ordered in England. A register of patients is kept, and payments of £1 Is. a week are exacted from them wherever possible. About £150 was derived from this source last year. Those who have not paid sign a written promise to do so when able. A cash-book of receipts and expenditure was submitted to me, and an abstract of rations and extras. There is no regular diet-scale in use. The Steward purchases necessaries in the cheapest market, there being at present no contracts in force. Printed orders, with counterfoil, are in use. Patients' property is taken care of by the Steward, who gives a receipt for the same, and will, in future, obtain one on restoring the same. An inventory of hospital belongings is •properly kept. Unserviceable articles are condemned by the Committee. A visitors' book was shown to me, and I learned that, in addition to visits by the clergy, there is a Church of England service held in the wards every Saturday. The Committee meet monthly in the town ; and, individually, make frequent visits to the hospital. At present there are eight patients, all of them suitable cases— namely, six males-and two females. They are well nursed and kindly treated. The whole of the hospital is kept in excellent order and scrupulously clean. There are some outbuildings—namely, a stable of rough construction, a straw-shed, a fowlhouse, and a very miserable washhouse without any floor and situated in a hollow. Some better provision for this purpose is very badly needed. After concluding my inspection, I had a conversation with Dr. O'Carroll, the Visiting Medical Officer, who devotes much valuable time to his work at the hospital. 25th April, 1883.

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OAMAETJ. Eemaekably well situated on elevated land, commanding an extensive view of the town and the sea. The building is a stone erection with iron roof, and is at the present time undergoing considerable alteration and enlargement. To the left of the entrance is a small waiting-room containing books and papers for patients' use. A wardrobe here is used for the surgical instruments and appliances, of which there is a fair stock. Adjoining is a small dispensary, used also as a consulting-room, plainly furnished. Here are kept a register of patients and their payments (at the rate of from £1 to £2 weekly), a book showing the amount of stimulants used daily, and an inventory of the surgical instruments. No prescription-book or case-book is kept. The drugs are procured in quantity from Dunedin, and occasionally from a local chemist. On the right hand of the entrance are the sitting-room and bedroom of the Steward and Matron. On the opposite side of the passage a part of the old building is being converted into a warders' room; a larger dispensary, to serve also as an operating-room; and a linen-store. The left wing of the building contains two small wards in front and a larger one behind. A portion of this latter has been screened of£ as a passage leading to a new small wooden building, which contains a bath, an earth-closet, and an ordinary sink. The object of the screen appears to be that both sexes must use this bath-room, and also the closet, until another temporary one is put up. The right wing has also three rooms, of which two are now used as a servants' room and a kitchen. A passage separates the back portion of this wing from the new part in course of erection, and which will provide a kitchen, store-room, and servants' bedroom. The new kitchen is rather low, and there is scarcely room enough provided for a proper range. A sink is here provided, as there will be no scullery. A new stone building (detached) will provide a dairy and a coal-shed side by side. I cannot speak highly of the arrangements, either new or old ; supervision of the wards is now, and will be, difficult. It appears to be intended, moreover, to erect an additional ward at the back of the building, opposite the new kitchen. Here no view will bo had from the windows. It would have been preferable to erect any new buildings as wards in front of the old building, and to utilize the old wards as offices. The soil here is a stiff clay ; and, if this plan would have necessitated raising the floors a little above the uneven ground, so much the better for sanitary reasons, as the dampness now creeps up the walls at the back. The provision made for baths, closets, and urinals is not in accordance with modern notions. It would perhaps bo difficult to maintain any degree of order and tidiness during the progress of these building operations, and therefore great allowance must be made for the condition in which I found the wards; but I will state here that the floor of the large one, now occupied by male patients, appeared to be very dirty, and that, though the bedding in use appeared to be clean and in good order, I saw paillasses and mattresses stowed away which it would be better to burn at once. There are only two hair mattresses, the others being filled with chaff or straw, but I found that there were some feather pillows. Iron bedsteads are used, and the other furniture is plain and suitable. The wards have sash-windows, open fireplaces, and ceiling ventilators. Gas-pendants are used for lighting. Beds are occupied to-day by seven males and one female. The latter was in the front ward, quite alone and locked in. She was in a half-delirious condition. The kitchen, where the nurse was engaged, is at the back part of the other end of the hospital. I allude to this matter not as a reflection upon the Nurse, but as showing the bad arrangement of the building. A male patient, with chest disease of long standing, was lying in a good tubular air-bed, a gift to the hospital. At the back of the hospital are several detached wooden buildings : of these, the laundry, workshop, stable and cow-house, and the new small mortuary call for no particular remark. Still further back is the fever-hospital, which is built of stone, and contains three small wards (not now occupied), a nurses' room, and a small kitchen. These are fairly suitable for their purpose, but there is no provision whatever for closets, lavatories, baths, or urinals. The use of the bath is considered in England to be of considerable importance during convalescence from scarlet fever. There is not even a portable bath which could be used for the purpose, unless it be an old tub. The kitchen-garden has been destroyed by building operations, and very little is done in the way of cultivating flowers, of which there are some beds on one side of the hospital. Two cows are kept (one of which is lent to the hospital by a member of the Committee), and butter is made by the Matron. All stores are supplied by contract (quarterly), and checked by the Steward. A general inventory was taken about fifteen months ago, but is not now correct, and should be revised. A book of printed rules is in use for officers, servants, and -patients. The printed diet-scale produced is not strictly adhered to. The water-supply is obtained from the town's mains; some of the rainwater is also collected for use in the laundry. The liquid drainage runs out upon the land at a distance from the hospital; solid matters are buried. The Committee visit the hospital at least once a month, and go into the accounts, and also any complaints which may be made. A good many other visitors also attend, and gifts are by no means so rare as at other hospitals. The clergy are frequent in their visits. I conversed with all the patients separately, and gathered from them that they were kindly and comfortably treated. 25th January, 1883.

PALMEESTON NORTH. A eeseeye of above three acres has been granted for the purpose of a hospital. The land was formerly covered with heavy bush, of which the stumps still remain. On it are four cottages of two rooms each, erected for immigration purposes. The reserve fronts the principal street of the town, down the centre of which runs the railway-line. It will in course of time be surrounded by a denselypopulated neighbourhood, ancfethe municipal authorities, not without some show of reason, object to its use for hospital .purposes. Consequently the buildings upon it are only occasionally and temporarily used for patients, for whose admission into the hospital at Wanganui an annual subscription of £25 is paid by the Borough Council. The cottages have been taken care of by a woman, who has been allowed to live rent-free, and for whom some subscriptions have been collected, she being herself an object of charity. The local authorities wish to erect a hospital on a portion of a reserve adjoining 3—H. 3a.

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the land set apart for a public park. This reserve is claimed by the "Wellington College Trustees, but they pay no rates upon it, and are said to have no title. The hospital reserve could perhaps be sold for hospital purposes, if a new site be granted ; or an exchange of land might be made. The township is surrounded by dense bush, with numerous saw-mills. Severe accidents are not infrequent. 19th April, 1883.

PATEA. The hospital is a wooden building of two storeys, with iron roof, situated close to the town, on an elevated site commanding extensive views. The estate includes about seven acres of broken land, a part of which only has been fenced in. None of this is utilized in any way, with the exception of a small patch of kitchen-garden cultivated by the Steward, nor are there any paths but tracks, which are very muddy in wet weather. The estate is bounded behind by a creek running towards the sea. The situation is good, but exposed to the winds, and having no trees to give any shelter. The ground-floor contains three wards, a dispensary, kitchen, and Steward's room; there is also a small lean-to shed in the rear. The upper floor has never been completed. The roof is open at the eaves, and the only portion utilized is a room partitioned off for the nurse. The cold wind which enters here makes the whole hospital draughty, as there is no staircase-door. The wards on the ground-floor accommodate respectively four, four, and three beds. They are plain rooms with roughly-boarded walls and ceilings. One has a fireplace, another a small stove, but the third has no means of' warming it. Wind comes through the walls, arid renders the wards very draughty and uncomfortable. A lining of canvas and paper, which might be varnished, would obviate this. There are sash-windows, with holland blinds. Some of the bedsteads are the old military iron ones; others are home-made of wood; and there are three modern iron ones, one of which has no laths, but a bottom of sacking. Straw beds, with flock bolsters and pillows, are in use, but there are no paillasses. The bed-clothing is of good quality, and very clean. A press, in one of these rooms, contains a small stock of spare blankets, but very little linen. Some plain wooden chairs, two commodes, and plain tables complete the furniture. A few shelves have been put up, and there are bedside carpets. A number of unframed prints have been placed on the walls, and there is an abundance of newspapers, and a few books. The dispensary opens out of the smaller ward. It contains a large ship's medicine-chest, but I saw no stock of surgical instruments. Here is kept a register of patients, who also sign a book promising to pay the sum of 3s. a day for their maintenance. Very few, however, appear to be able to pay this sum. For want of better accommodation the butter and milk are kept in the dispensary, which has even done duty also as a mortuary. The Steward's room is small and draughty. Behind it is the kitchen —a fair-sized room which has recently been lined with matched-boarding. It contains a colonial oven, and a cupboard for stores. Good crockery, cutlery, &c, are provided. Provisions are obtained from the contractors by means of orders from a printed book, with counterfoils. The lean-to shed is too small to be used fop washing, which has to be performed, at great inconvenience, out of doors. For want of a copper, an iron pan is heated over a fire kindled on the ground. The outbuildings comprise privies for males and for females. A urinal of galvanized iron has recently been erected, but has neither receptacle nor drain. A very objectionable way of disposing of vegetable and other refuse, together with the slops, is practised—viz., by throwing it down the sloping ground behind the hospital. It cannot fail to cause a nuisance, if not an absolute danger to health. A proper drain might be easily and cheaply provided. Eain-water is used for domestic purposes. There is also a well on the premises. There is no regular dietary. Dinner to-day consists of roast beef and potatoes, with suet pudding. All vegetables are purchased. Eight patients —all of the male sex —at present occupy beds. One or two of these might properly be inmates of a refuge. The whole of the wards are sometimes occupied by male patients, and it has been necessary at such times to provide accommodation for a female patient in the nurse's room. An additional ward for this purpose should be fitted up, at small cost, in the second storey. The staff (resident) consists of the Steward and his daughter, who keeps the establishment in good order and very clean. The patients are also well attended to. A starved and povertystricken appearance, however, pervades the whole hospital, upon which some expenditure is absolutely necessary unless its doors are to be closed. The Committee have no funds in hand at present. There are no private or other subscribers, and no endowments. 24th April, 1883.

PICTON. I hate this day inspected the hospital at Picton in every part, seen the whole of the grounds, and conversed with the patients. I had also an interview with the Medical Officer, Dr. Scott, and afterwards with a member of the Committee (the President was away from home). The situation is excellent. The buildiDg stands in about seven acres of land, and faces the north. A portion of the estate is a paddock, which is let to a tenant, and is gradually being cleared of scrub. Part of the remainder is utilized as a kitchen- and fruit-garden, with walk and seats (sheltered) for the patients. The building is a wooden one of two storeys, with verandah and balcony in front. It is roofed with corrugated iron, and is in fair repair, though some of the external boarding is perishing where it is in contact with the ground, and painting is required generally. There are four wards, which can accommodate twentyfour beds; a good kitchen, scullery, larder, and store-closet; also a surgery and bath-room. In a detached building are the mortuary, laundry, lavatory, coal-shed, and tool-house ; also three privies. There is a good water-supply from a reservoir on the hills, which was constructed for railway use. In case of fire a pump will force water from a well through indiarubber hose, of which three 30-feet lengths are provided. The ventilation is by large sash-windows, and there is a ventilator in the wall of one of the female wards upstairs. Wood is burned on open hearths. Some coal is used in the kitchener, and here the linen is dried and aired. Kerosene-lamps are in use. The privies are of the dry-earth style, and are emptied every week, the soil being buried at some distance. The water from the kitchen and laundry runs along an open gutter at the back, and finds its way into a small stream at the entrance

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of the grounds. No cesspits exist; and the ashes are utilized in the kitchen-garden. The bath-room is on the ground floor at the rear of the hospital. There is a zinc bath, with cold-water supply. Hot water is brought from the adjoining kitchen. The bedsteads are of local manufacture, —wooden, with canvas stretchers. Hay mattresses are in use, but do not seem to be comfortable. There are hair bolsters and feather pillows for the beds which are now in use. The sheets, blankets, and counterpanes were much worn, but scruj)ulously clean. The ward furniture comprises plain tables and forms for meals ; there are some Windsor chairs, and one or two riding- and rocking-chairs, but many of these are broken and worn out. No other furniture is in use. There are no floor-coverings, except a small piece of cocoanut-fibre matting in the entrance passage. Holland blinds, with rollers, are provided for the windows. No pictures or ornaments worth mentioning were seen. There is a most excellent library of books for the use of the patients and nurses : these are kept by the Medical Officer in the surgery, and given out whenever required. Three newspapers are also provided. The stock of bedding, blankets, and linen is very small, and almost worn out; if it were required to make up ten or twelve beds, more would have to be procured for the purpose. Many of the articles shown to me as being on the inventory should be " written off" as rags. There is no clothing in stock. The garden has been much neglected and overgrown with grass and weeds, but is now by degrees being got into good order and well cropped with vegetables. I inspected the food, and found it of good quality. The dietary is a liberal one (with the exception that only potatoes have been in use; other vegetables will shortly be available). The meals are well cooked and well served, everything being beautifully clean. Extras are only given by the order of the Medical Officer, who himself serves out any stimulants which may be used. The Medical Officer visits the hospital daily. Two members of the Committee make a weekly inspection. Visitors are admitted thrice weekly. The hospital is now in charge of a married couple—Mr. W. Hall and wife. They appear to be very suitable people for their position, and the general order and cleanliness do them great credit. The man occupies all his spare time with the garden. Their salary is £78 a year, with rations; and they occupy a very small room, about 12 by 9 feet, which they furnish for themselves. At the time of my visit there were four in-patients, all of the male sex. One of these is a blind man in good bodily health: he has been nine months in the hospital. Some efforts are being made to get him sent to Ireland, his native country. Two of the other patients are merely infirm from old age. One of these makes himself very useful (Crossley, aged 78). No out-patients attend at present. No complaints of any kind were made to me, but all expressed themselves satisfied with their treatment. The fencing of the estate is becoming very dilapidated, and requires extensive repairs. The hospital requires painting and colouring. The door of wardsman and Matron's room requires altering, so as to open on the lobby, and not into the ward for females. A sink, with water-supply, is required in the scullery. A clothes-horse is required for drying and airing clothes, &c. Some additional carpenters' and garden tools are much needed. 28th November, 1882.

QUEENSTOWN. The hospital is situated at Frankton, about four miles from Queenstown, and was intended to serve for the whole of this district. It well placed on elevated ground, about eleven acres in extent, and faces Lake Wakatipu. The building is of wood, and shows very obvious signs of the difficulty of procuring materials at the time of its construction. The roof is of iron, and has recently been entirely renewed, but the floors badly require attention. They should be entirely removed, when practicable, and relaid in better material. The two wings of the building contain the wards —viz., two for males and one for females. The central portion contains dispensary, kitchen, pantry, store-room, washhouse, and rooms for warder and nurse. A detached cottage, to the right of the hospital, is the residence of the Medical Officer. The wards are fairly suited for their purpose, and are lighted by sash-windows. There are ceiling ventilators and open fireplaces. The walls are lined with boarding, which is varnished, and has a dark and heavy appearance. Iron bedsteads, of old pattern, are in use ; and each is furnished with chaff paillasse, flock mattress, and flock pillow. There are red-and-white checked, counterpanes and good blankets. These, with the linen, I found to be exceedingly clean. The ward furniture is of rough and primitive make. From each of the end wards a passage leads to a small building containing two earth-closets. These were well attended to, and perfectly free from smell. The kitchen looks old and dilapidated. The floor is in a very bad state of repair. There is a good small range, with boiler behind. The washhouse is a poor, narrow, and ill-lighted shed. The dispensary is well stocked and in good order: there is here a fair stock of surgical instruments. A general register of in-patients is well kept; also a payment-book, which is examined monthly by the Committee, and initialled by the Chairman. The Committee attend at the hospital monthly, and examine the accounts. All goods are procured, under contract, by written orders, which are compared with the accounts when sent in. There is no diet-scale in use. At the time of my visit there were in the hospital six males and two females : they all appeared to be contented with their surroundings. Two of the men were proper objects for the care of a benevolent institution : one of them, however, makes himself useful here as a carpenter. Altogether there is accommodation for twenty-two patients. There are not many visitors at this hospital. The clergy visit it at times, and always attend when requested. Newspapers are kindly provided by their proprietors, and there are a few books which were formerly given by the Provincial Government. The grounds are utilized in part as a kitchengarden, and there are some flower-beds in front of the hospital. "Water is pumped up from the Lake by a force-pump at the flour-mill below. There is no provision against fire. The liquid drainage is conducted away beyond the grounds, and there are no cesspools : the night-soil is buried. A small detached building is intended^ for use as a mortuary. I had the pleasure of seeing the Medical Officer, Dr. Douglas, who evidently takes much interest in his work, and labours under much disadvantage as regar<te\the building and its appliances. It was, I think, a mistake to expend money upon the roof. The whole hospital really requires to be rebuilt. It is evidently doing good work, and is much needed in this district. sth February, 1883.

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EANGLTIKEI. A house situated at Bull's,near Greatford, was formerly used for a cottage hospital. I learn that this purpose has now been relinquished, any patients being sent to the Wanganui Hospital, to which an annual subscription is paid.

EEEFTON. The hospital is placed close to the town, in grounds of about one acre, part of which is very neatly kept as a flower-garden, and another part is well cropped with vegetables. The building, which is a wooden one, contains' one large and two smaller wards ; a kitchen, and the rooms allotted to the Steward and Matron. The wards are light and cheerful. There are sash-windows, ceiling ventilators, Tobin's tubes, and open fireplaces for wood. The walls have a wood dado, and are neatly papered above ; they are hung with numerous pictures, which are on wooden stretchers and varnished. The bedsteads, which are iron ones, have straw paillasses and flock mattresses. Each bed has a flock pillow, and another filled with a soft silky flax. A few contain feathers. The bed-clothes are good in quality and perfectly clean. On the floor are strips of cocoanut matting. Bedside table-lockers are provided, and a large table for meals : this has a good American-cloth cover. Cane-bottom and other chairs are in use. The windows have blinds of green holland. Some well-filled book-shelves and a number of newspapers furnish means of amusement. The kitchen has recently been enlarged, and is a very fair one. It contains a good range, of American pattern, with a boiler. The crockery is of good quality. There is here also a largo linen-press. Washing-up is performed at a sink outside the door, but under cover. A small outbuilding serves for washhouse and bath-room. There is here a portable copper. Another older building contains workshop and coalhouse. The mortuary stands at a short distance from the hospital, and is sufficient for its purpose. A portion of it has been divided off to serve as a dispensary. There is here a good stock of drugs, kept in excellent order. The surgical instruments are kept in a, chest of drawers in one of the Steward's rooms, and seem to be fairly adequate for hospital purposes. No closets adjoin the hospital, but there are two detached ones a little way off. Behind them is a cesspit for the soil, which gives off a very offensive smell. It would be far preferable to fill up this pit, and use pans with dry earth or ashes. The water-supply is from a well, about 13 feet deep. Liquid drainage, from the sink, is conducted away, and runs out upon the land outside the hospital fence. The dispensing is performed by the Steward, who is also the Wardsman and the Secretary ; his wife being the Matron and Nurse. Prescriptions are entered by him in a book. All stores are obtained under contract, pass-books being always used, and the accounts properly checked. There is a well-kept cash-book, showing all receipts and expenditure; and an inventory of hospital property is taken every half-year. Payments are carefully collected from the patients. Subscribers of £1 annually are admitted at 15s. a week; non-subscribers paying £1 on admission, and £1 10s. weekly. A manuscript register of the patients is regularly filled up, but no case-book is kept. The Committee visit about once a month, and hold their regular meetings in the town. Beds are now occupied by six men and one girl. I saw them at tea, and conversed with them individually: they all spoke in praise of the arrangements of the*hospital. The Medical Officer visits daily, and oftener if required. There is a general appearance throughout the whole establishment of order, cleanliness, and great comfort. The Steward and Matron, Mr. and Mrs. Preshaw, appear to have no assistance in the domestic work ; and the condition in which I find the hospital reflects great credit upon their industry and ability. 20th February, 1883.

RIVEETON. This hospital has been .visited by me to-day. It is a wooden building (formerly immigrants' barracks), situated on high ground a little way from the town; and contains a ward for each sex, kitchen and washhouse, dispensary, and three small rooms for Steward and Matron. I found that there were six male in-patients and two female. All were proper cases for hospital treatment. There is only one empty bed —namely, in the ward for females. There are two attics in the roof, one of which is occupied by a female servant; the other has been occasionally used for a patient, but is too low and not airy enough for this purpose. It appears to me that increased accommodation is urgently needed. The wards are plainly but comfortably furnished. The old wooden stretcher-beds might with advantage be replaced with more modern ones. Straw or chaff beds and pillows are in use, but I saw one good feather bed and pillow in the women's ward. Besides lockers, comfortable chairs and some books and paper s are provided. Dinner was served in my presence, and consisted of good thick broth and meat boiled in it; potatoes, carrots, and turnips were given, and bread, also tea, was supplied to those who wished for it. I took the opportunity of tasting the broth. The kitchen is fitted with two colonial ovens ; behind it is a washhouse, used also occasionally as a bath-room. The dispensary is in front of the Steward's rooms, and is well stocked with instruments and drugs procured direct from England. The Steward performs the dispensing. In front of the building is an enclosed verandah containing some plants in pots. Behind the hospital is a detached brick building containing one good-sized room. This is intended for a fever-hospital, but is not furnished; and, fortunately, has not at present been required for use. The mortuary forms part of a detached wooden building, which contains also a lumber-room. There are detached pan-closets, two for each sex. The soil is buried in the kitchengarden. Liquid sewage runs into the adjacent bay. Rain-water only is used. There is a deep well, but the water is said to bo bad. The grounds are utilized, as a small meadow at one end of the hospital, and as a kitchen-garden UtPthe other. This is well stocked with vegetables. Stores are supplied to written orders, and carefully checked. A book is kept in which the in-patients are registered, and there is a diary showing the attendances of the Medical Officer. No inventory of the hospital property exists. Payments at the rate of 10s. per week are exacted from patients where possible. The Committee visit the hospital frequently, and also hold their monthly meetings there. The patients were unanimous in stating that they were kindly and well attended to. The whole establishment I found scrupulously clean, and in excellent order. 2nd February, 1883.

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ROSS. The hospital is on high ground, about one acre in extent, near the town. It is built of wood. The front portion, which is newer than the other, contains three wards and a room used by the Committee. The back portion is much older, and contains kitchen, dispensary, Steward's bedroom, &c. The whole establishment has a poverty-stricken appearance, which is more especially observable in the older portion. The wards have sash-windows, and ventilators in the ceiling ; open fireplaces for burning wood. There is cocoanut matting on the floors, and some unframed pictures are fastened to the walls, which are boarded below and papered above. The bedsteads are roughly made of wood; the canvas stretchers are very loose. Hair mattresses are provided, and there are pillows of flock and chaff; the bed-clothing is of good quality and very clean. All meals are taken in the wards, there being deal tables and forms for that purpose. There are also bedside boxes, one or two good commodes, and some rough home-made bedside tables. Two lever bedsteads, designed by the Medical Officer, are in use for special cases. I saw a fair supply of newspapers and two or three books for the patients' use. At the time of my visit there were four beds occupied, all by male patients, who were very properly inmates of the hospital. The kitchen is old and unsightly ; a smoky chimney has made it very black, and it does not appear to be weather-proof. There is a colonial oven here. Everything was very clean and orderly in this department. The dinner, in process of cooking, consisted of beefsteak stew, potatoes, onions, and tea for those who desired it. Near the kitchen is the dispensary—not now used for this purpose, a portion of the large female ward having been screened off as more suitable. Drugs are provided, and stimulants also, by the Medical Officer, at the cost of the hospital. He also uses his own surgical instruments, those belonging to the establishment being imperfect and out of repair. A good water-bed is available for use if wanted. The Steward's bedroom is small and gloomy; a little detached cottage, of one room, is used by him and his wife as a sitting-room. The Medical Officer resides in a small house within the hospital grounds. The other detached buildings comprise a small mortuary, a good bath-room, and two pan- or trough-closets. The sewage runs away into a small watercourse; solid matters are buried. An excellent water-supply is derived, under considerable pressure, from a race. I. made inquiries as to the supply of stores, all of which are obtained under contract, by written order, and properly checked. A regular diet-scale is in use, but I could not learn that any inventory of property is kept up. A record of admissions, discharges, and diseases is kept, but no case-book. Patients, on admission, must produce an order from a subscriber, unless they themselves subscribe 10s. a year. Accidents require no recommendations. The Committee meet at the hospital monthly, and also visit it at uncertain times. Payments are collected by the Committee. The grounds of the hospital are small, but are not planted or cultivated in any way. The patients appeared to be contented, but their surroundings are by^no means so cheerful as they might be, and are at many of the small and outlying hospitals in the colony. 18th February, 1883.

■ ROTORTIA. I hate this day made an inspection of the proposed site of the new township ; visited the various springs and baths, and also the Medical Officer's house, and the bath-pavilion. Dr. Hector, who was staying at Ohinemutu, kindly gave me valuable information and guidance. The Medical Officer's house was constructed for the use of the bath attendant, and is a mere cottage, only suitable for its original purpose. Attached to it is a patch of garden-ground, which gave evidence that there will be no difficulty here in the cultivation of trees or plants. The bath-pavilion is not well placed, being too low down near the lake, and over a hot spring, the steam and emanations from which have defaced and injured the building. It is not well arranged. The-small bath-rooms are not sufficiently ventilated, and this stuffy atmosphere causes headache. The so-called Priest's Bath is an open pool, with timbered sides, presenting a rough and uninviting appearance. It appears, however, to be in much request. I saw here five or six bathers, whose skins gave unmistakable evidence of the active properties of this spring. All expressed themselves as being benefited by its use, as did every other invalid with whom I conversed, and who had tried its virtues. The hardship p_f getting to the bathing-pavilion from the distant hotels, and the impossibility of hiring any vehicle, unless at a prohibitory cost, limits the use of the baths very greatly. The accommodation is far too small, and objection is very naturally raised to the association in the same pool of persons some of whom may be suffering from skin-diseases or other affections of a repulsive character. Although the resources of this district have so far only been utilized in the most rudimentary fashion, it is surprising to learn what good has been already done under the present difficulties of approach, residence at a distance from the springs, and expense of living. An hotel situated on the new township should prove a great success; and there is an urgent need of accommodation for that large class who could afford to pay the entire cost of good plain food and lodging, but who cannot meet hotel charges. The benefit to be derived from the waters would be immensely increased by the discipline and regimen of a well-ordered hydropathic establishment, where only suitable food and drink were allowed, under proper medicaL advice and supervision. I was sorry to learn that Dr. Lewis, the Resident Medical Officer, was absent from the district, being convalescent from typhoid fever, of which several cases had occurred at Ohinemutu. I heard it remarked that the disease was due to the unhealthy site and emanations of the new township. It is, however, not difficult to prove that these emanations consist largely of vapours charged with sulphur compounds and some sulphurous a.cid, which is one of the most powerful disinfectants yet known. The cause of the outbreak of fever is not far to seek; aud may, I believe, be found in the bad 'sanitary arrangements of the old Township of Ohinemutu, where I saw the sewage of a large hotel running from a pipe upon the open ground, in close proximity to a hot creek much frequented by the Maoris for the purposes of washing and cooking. This sewage finds its way eventually into the river, from which drinking water is procured. The ground here is covered with manuka scrub, and is littered with refuse of all kinds, and saturated with the excrements of Maoris and their pigs. The site of the Township of Rotorua appears to offer good facilities for proper drainage, and an excellent water-supply can be had, though perhaps

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the first cost maybe large. The ground is very level, and might be easily traversed by light tramways, or other modes of conveyance, to and from the baths. 7th April, 1883.

THAMES. The hospital is close to the town, and stands in grounds of about two acres. The building is a wooden one, which has been badly planned from the first, and to which small additions have from time to time been made. The principal part of the hospital is contained here, but there is a separate structure for the kitchen and other offices, and a detached block containing the wards for female patients. The male wards contain respectively five, nine, five, and two beds :of these, nineteen are at present occupied. They present a very dull and gloomy appearance, and are dangerously overcrowded. The cubic space is insufficient, and the floor-space greatly below what is now deemed essential for successful treatment. A verandah, which surrounds the hospital on three of its sides, contributes to the dulness, but it has been deemed necessary to obscure the glass in the lower sashes of the windows with paint; and in D ward boards have been screwed up in front of the lower panes to obviate the possibility of any draught. The result is that nothing can be seen through the windows, and the admission of light is greatly obstructed. The walls and ceilings have a stained and dirty appearance, though I was assured that they had been recently lime-washed. Many of the bedsteads are of the old military folding type, but have been widened by placing wooden laths upon them. Others, of more recent make, and also of iron, are too slight, and become very hollow in the middle. Straw paillasses are in use, with mattresses and pillows of flax. Some of these are very hard, and require re-making. The bed-clothing is of good quality and very clean, but the stock is by no means large enough. The remaining ward-furniture is meagre and poor. There are a few wooden chairs and tables, and two or three bedside open lockers, as well as some small wall-brackets. A few coloured texts and unframed pictures complete the list. There are open fireplaces arranged for burning wood. Gas is used for lighting. There are no closets or lavatories, but there is a very untidy room used for the latter purpose, and for a bath-room. Here bandages, &c, are washed and hung to dry, and there are all sorts of utensils, bottles, and appliances, for which no proper place seems to exist. Opening out of D ward is a pan-closet. There is no lobby, nor any means of keeping the smell out of the ward but by the use of disinfectants. I learned, however, that the receptacle is emptied several times daily. There are, in the garden, well-kept earth-privies for the use of those who can leave their wards. The dispensary and consulting-room are small, but sufficient for their uses. A good stock of surgical instruments is provided. Drugs are obtained in bulk from London. I examined the books kept by the Steward, and found that the consumption of all articles was very carefully registered and checked. There are contracts for most of the things used, and accounts are carefully compared with the tradesmen's pass-books. A register of in-patients and of out-patients was submitted for my inspection, and also a monthly report book. These are kept by the Acting-Steward during the illness of Mr. Aitken, who has for some time been disabled, and now occupies the small ward with the two beds. Two small and very bare-looking rooms are allotted to the Steward, who seems to be active and energetic, and to have a good knowledge of his work. One room in this building remains to be mentioned: this is called the library, as it contains a few old books and a number of papers. Its principal use, however, is as a room for meals. There are here two wood settees, a form, an easy chair, and two tables: one of these is used by convalescent patients, and the other by the twelve old men inhabiting the liefuge, which adjoins the hospital grounds, and is under the same management. Connected by a covered-way with the male hospital is a small but suitable kitchen, fitted with an excellent range of local manufacture, and also a sink and plate-rack. There is a good store-room adjoining, in which I saw a quantity of fruit preserved in tins, for winter use, by the cook. Everything here was clean and in good order. Behind the kitchen is a linen store, and a room occupied by the gardener as a bedroom, but also used as a receptacle for spare bedding. At the back of the hospital is a well-stocked garden, which is managed by a gardener who receives board, lodging, and merely nominal wages. On the farther side of the garden is the hospital for females. This is under the charge of a trained nurse from London, and contains three wards for two, two, and three beds. The latter is far too small for its purpose. There are also here a room for the nurse and a small scullery. Two new rooms, just added, furnish accommodation for three additional patients. Three women now occupy beds in this department. The supplies are all fetched by the nurso, who has only such assistance as may be occasionally rendered by a convalescent patient. The male wards are managed by three paid male warders. I made the usual inquiries as to water-supply and disposal of refuse. The former is obtained from the town pipes, while the liquids from sink and bath find their way into the street drains. The verandah presented an untidy appearance, being encumbered with such things as an old water-bed, various pieces of board, surgical appliances, boxes, &c. Altogether there is a general want of order, discipline, and smartness about the establishment, the appearance of which compares unfavourably with other colonial hospitals. No time should be lost in providing additional accommodation for male patients; and this should not be done by the addition of a small room only, but by the erection of a large and modern ward, with proper sanitary appliances. The patients made no complaints to me, but said that they were well fed and kindly treated. The Committee appear to take much interest in the hospital, which they inspect weekly. All worn or broken articles are submitted to them before being condemned. No proper inventory, however, is kept up as it should be. On the day following my inspection I again visited the hospital, and had the opportunity of meeting the Committee, with their Secretary, Medical Officer, and architect. I was pleased to find them fully alive to the defects of the building, and to the importance of providing, without delay, additional accommodation. The hospital serves a large and populous district, where the industries carried on result in many and serious accidents. It would be well to prepare pl-aiis for a new building, which could be built by degrees, utilizing, in the meantime, the present one. A large ward for surgical cases seems an immediate necessity, and this should be planned so as to form a part of an eventually entirely new establishment. I regret to find that the subscriptions have greatly diminished, and that persons use the hospital who can perfectly well afford to pay for the services of a private medical practitioner. 3rd April, 1883.

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THAMES REFUGE. As this establishment is worked as a portion of the hospital, in which its inmates, moreover, take all their meals, I have felt it my duty to inspect it. It is separated by a small piece of private property from the hospital garden. The building is of wood, well planned, and furnished with an excellent broad verandah in front, and an extensive garden behind. This is well cropped and cultivated by two of the inmates, and the produce utilized for the benefit of the hospital. In it is a good pigstye, with a sow and litter of young, kept very clean. The drainage from the stye, and that from a neighbouring privy, run into a manure-pit, the contents of which are used in the garden. There is also a capital store-house. _ The Eefuge affords accommodation for twelve men, who sleep in five comfortable rooms, suitably furnished, and provided with basins and water-taps. The bedsteads are of iron ; they have flax mattresses and good clean bed-clothing. There is also a bath-room and a store. To the left of the entrance is an excellent sitting-room, with a number of books, papers, and pictures. The dietary given is the same which the hospital patients are allowed, and is liberal. Every part of this small establishment is in the most creditable condition —bright, cheerful, and scrupulously "clean. I could not help wishing that some of the hospital patients could be exchanged for its inmates, as the contrast between their respective surroundings is very great. 3rd April, 1883.

THAMES EEVEE-HOSPITAL. A house has lately been acquired on lease for this purpose at Parawai, about two miles from the town, and an endeavour will be made to secure the freehold. The building is a good deal dilapidated, but repairs will be put in hand forthwith. It stands in about five acres of elevated land, commanding a good view, and of the healthfulness of the site there can be no doubt whatever. There are five rooms, besides a kitchen, scullery, store-room, and a small conservatory. A good verandah forms the frontage. I have no doubt that a very suitable hospital can be made of this house, and that it will supply a want much needed. 3rd April, 1883.

TIMAKF. This hospital is well situated about a mile from the railway-station, on elevated ground, with a good view of the sea. It stands in about 4J acres of land, which is said to belong to the Park ; about one acre is well cropped as a vegetable- and fruit-garden ; and the large portion in front of the hospital is tastefully laid out as a flower-garden, and kept in beautiful order. The building consists of a central and older portion, a largo wing on the right, and two wings on the left-hand side. The central block contains the administrative offices, viz., consulting room, dispensary, store-room, Steward's room, Steward's office, kitchen, and its offices; there are also two rooms for the [Resident Medical Officer. To the right is the old female ward, now used only as a sort of work-room for the Malron. Above the central portion are two bedrooms, occupied by four servants, and another by the Steward and Matron. The latter is badly situated, and the Medical Officer's room is small and close. The old female ward might with advantage be subdivided to remedy these defects. In the entrance-hall is a bookcase containing a small but good library of entertaining books for the patients' use. The kitchen is small and poor; there is a good range here, but trial is being made of cooking by gas, which, if not too costly, is sure to prove successful. Adjoining are a scullery, pantry, and larder; the scullery has a "geyser " for heating water by means of gas. The right-hand wing of the building is connected with the central block by a covered passage, and was erected as a fever-hospital. It contains a large ward in front, with ten beds, none of which are in use at present. The back part of the wing contains another ward with sixteen beds: this is occupied as a female medical and surgical ward. Adjoining it is a smaller room with two beds, and also a ward kitchen, nurses' room, and store. Bath-rooms, lavatories, and earth-closets are properly placed at the extremities of the large wards; and between these projections, in the front part of the wing, is a small portion curtained off as a reading-room. On the lefthand side of the building is the male medical ward, and behind it a smaller one with two beds, a storeroom, ward-kitchen, and nurses'room. The wing to the extreme left has a large ward with twenty-two beds, with similar arrangements in its rear. The bedsteads are of iron, with straw paillasses, hair mattresses, flock bolsters, and feather pillows. The whole of the bed-clothing is scrupulously clean, and, though some of it is much worn, in excellent repair. The floors are waxed, and very clean ; but that in the large male ward is rendered very unsightly from rough usage by nailed boots. The windows are large, and have top fan-lights, which are readily opened. Various appliances for introducing fresh air, and getting rid of that which is foul, are in use. There are in the larger wards central double fireplaces, with ascending chimney-shafts. Lighting is effected by gas-pendants. Plain and suitable furniture is provided, and also small ornaments and cut flowers, imparting to all the rooms a comfortable appearance. The windows are fitted with green Venetian blinds. Earth-closets are in use, and regularly emptied by the town contractor. One of the baths is heated (experimentally) by gas. The dispensary is a very commodious one; drugs supplied by a local chemist. There is a good cabinet of surgical instruments of considerable value. Here also is kept the register of out-patients, who are now permitted to attend upon any day. No prescription-book is kept, nor case-book. The Steward keeps the in-patients' register, and procures payment where possible from patients, at the rate of £1 Is. a week : some of these,bring a recommendation for admission, but the Medical Officer admits any patient whom he may consider to be suitable for treatment. The Steward also keeps a stores ledger, and a book showing what stimulants are issued ; he has also an inventory of hospital properties, which he corrects every half-year ; no ward inventories are in use. There is a fixed scale of dietary, but no printed rules for officers, servants, patients, or visitors. The Committee meet at the Council Chamber, when the Steward attends as Secretary ; members of the Committee visit frequently at the hospital. Other visitors than relatives of patients are few, and gifts of useful or ornamental things rare.

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The clergy are frequent in their attendance. At the time of my visit there were twenty-four male and two female in-patients : two of these would be properly inmates of a refuge, one of them having occupied a hospital bed for eighteen years. The laundry is a detached building behind the kitchen, and contains a drying-closet and a few other simple appliances; the drying-closet is not used, being troublesome and extravagant in fuel. Behind this building is a large fowl-yard ; near it is the mortuary, a small and poor wooden building. Water is laid on from the town's supply at a nominal annual charge ; the rain-water is collected for use in the laundry. The buildings I found to be in good repair. Great order and cleanliness everywhere prevailed, and the patients appeared to be very kindly treated. My visit gave me a pleasing impression, and I was satisfied that the Steward and Matron render valuable service. 24th January, 1883.

WAIMATE. The hospital here has been built about three years, and stands in an estate of fourteen acres. Part of this is cultivated as a flower-garden, and about a quarter of an acre is well cropped with potatoes. The building is of brick, faced with stucco, and is in excellent repair. On the right of the entrance-hall is the sitting-room of the Steward and Matron; to the left is the reception-room, where also the out-patients are seen. A book lies here containing dates of the Medical Officer's attendances, which appear to be frequent and regular. At the back of these rooms a corridor traverses the hospital, and into this the various rooms open. Adjoining the reception-room is a female ward with four beds ; and next to it a nurses' room. On the other side of the passage is a ward with two beds ; also a linen store, very well kept, and an earth-closet near to an outer door. Here also is an excellent dispensary, well stocked with drugs, splints, and appliances, and containing a cabinet of very valuable surgical instruments. Nothing could exceed the good order in which all these things are kept. A prescription-book is carefully entered up, also a book for stimulants used, and a register of patients and their payments, which seem to receive here very careful attention ; an account, at the rate of £1 a week, being given on the patient's discharge. To the right of the entrance, and behind the Steward's room, is a store-closet; and a bath-room and lavatory, supplied with hot water from the kitchen boiler. The passage opens at this end into the men's ward, which contains nine beds. The back portion of the building contains the kitchen, scullery, and the bedroom for the Steward and Matron. The kitchen has a good range and is properly fitted up, as also is the scullery. The wards are scrupulously clean and very comfortably and appropriately furnished. Large sash-windows have hinged flaps at the top for ventilation, and there are various other inlets and outlets for air. Open fireplaces are provided, and kerosene-lamps are used. Each ward has a fixed basin provided with water-taps. There are \rery neat bedside lockers and tables combined, good commodes, windsor chairs, and neat plain tables. In the large ward is a cupboard containing books and papers, which are regularly supplied. On the floors cocoanut matting is laid, and there are a few pictures on the walls. Neat iron bedsteads are used. There are straw paillasses with hair mattresses ; good red blankets, and red-and-white check counterpanes ; all in the best order and scrupulously clean. In the male ward is an excellent continuous-current battery. Adjoining this ward is an earth-closet, with a well-ventilated lobby. At the rear of the hospital are some detached buildings. One of these, erected for immigrants, is used as a store, and is in excellent order. The stores also are of good quality, and supplied by half-yearly contract, to the written order of the Steward, who checks all the quantities, and makes out a daily list of rations and diets. Another detached building contains a suitable laundry and a mortuary ; while a third building is the fever-hospital. There are here two wards, containing four and five beds, well and neatly furnished; and in the centre a nurses' room. At the extreme ends are well-arranged lavatories, closets, and urinal. All these detached buildings are of wood. The water is obtained by a force-pump from a good deep well. Bain-water is also collected. The liquid drainage is conducted through a trapped drain to a portion of the estate near the river, and causes no nuisance. The night-soil is removed by the contractor. A very fair inventory of properties is kept by the Steward. Financial matters are managed by the County Council, some of whom occasionally visit the hospital. The clergy attend whenever requested, and there are many visitors, especially on Sundays, but few presents are received. Patients are usually admitted by an order from the Medical Officer. There were, at the time of my visit, nine beds occupied, one woman and her child being in the fever-hospital. All the cases were of a severe character. The hospital is exceedingly well planned, but a nurse's room is required at the rear of the large men's ward, where supervision is now very difficult. For good order, cleanliness, and comfort I have not seen its equal in the colony ; and the utmost credit is due to the Steward and Matron, who devote their whole energies to their work. The assistance they receive is by no means large, and the dispensing likewise devolves upon the Steward, who appears to deserve a somewhat higher salary than he now receives. 24th January, 1883.

WAIPAWA. The county hospital is at Waipukurau, a short distance from the town. It stands in an estate of about five acres, and commands a view of the surrounding country. The grounds are surrounded by a belt of coniferous and other trees, and a large portion is cultivated as a kitchen-garden and orchard. There are four wards in the building, a dispensary, committee-room, dining-room for convalescents, kitchen, three rooms for the resident staff, store-room, bath-room, &c. In front is a verandah. The wards contain respectively five, five, two, and two beds. They are comfortable rooms, well lighted by sash-windows, and ventilated by vertical tubes. The floors are originally oiled, but are now scrubbed in the ordinary way. The walls are plastered with Keene's cement, and these, with the ceilings, have not yet been finished by colouring. Wood is burned on open hearths, and kerosene-lamps are in use. A portion of the floors is covered with cocoanut matting. Iron bedsteads, of good pattern, are furnished with. straw paillasses, and mattresses, bolsters, and pillows filled with flax. Good bed-clothing is kept scrupulously clean. There are small, low bedside-cupboards; an iron painted washstand in each

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ward, Windsor chairs, commodes, and a very cumbrous reclining-chair. fAfew texts are placed on the walls, but there are, at present, no pictures or other ornaments than a clock. Daily newspapers are supplied, and there are a number of illustrated papers and a few books. At present there are six male patients and three females. One of the former is aged and partially blind ; he might very properly be an inmate of a refuge. The wards have a comfortable look about them, are very clean and orderly, and their inmates quite satisfied with the treatment they receive. There is a small bath-room on the male side, fitted with a lead-lined bath, to which water is not laid on. Out of this room opens an earthcloset, very clean and emptied daily. A similar arrangement exists on the female side, but there are a lavatory basin and a lumber-closet in place of the bath. The kitchen is a very good room, but a portion has been temporarily partitioned off as a store or pantry. There is an excellent range, with two ovens and a boiler. Next to the kitchen is a dining-room, where eight convalescent patients can sit at table. The room is used as a sitting-room also at other times. The two rooms provided for Mr. and Mrs. Putnam, the Steward and Matron, are very suitable for their purpose, and kept in the best possible order. A room ia also provided for a servant and next to it is a neatly-kept, store-room. There is a good and sufficient stock of linen and blankets, and the crockery in use is of a very neat pattern. The dispensary is remarkably well fitted up, and is well furnished with drugs and all necessary surgical instruments and appliances. It is to the left of the entrance-door, and opposite to it is the small committee-room. Here I saw a very good and light couch, with adjustable seat, for the use of patients. A detached building, behind the kitchen, and placed in a fenced yard, contains coalhouse, mortuary, and a good washhouse. A washerwoman is employed here one day in each week. In course of erection near the hospital building is a good fever-ward, with nurses' room and domestic offices; on the other side of which another ward can hereafter be placed. The drainage from the hospital runs through an open gutter over the land at the back. The contents of the earth-closets are buried. Water is obtained from an underground rain-water tank, and could be used to extinguish fire by means of a force-pump and hose, which is also used for filling the bath. Admission to the hospital is free to subscribers of 10s. annually, without any further payment. From nonsubscribers 3s. a day is exacted, where practicable. Supplies are ordered by the Steward, and the tickets sent by the contractors are compared with their accounts when presented. A diary of occurrences, admissions, and discharges, is kept by the Steward. The Medical Officer being from home I could not ascertain particulars as to any books kept by him. Before leaving I had the pleasure of an interview with the Treasurer, who evidently, with other members of the Committee, takes great interest in this institution. They are certainly fortunate in their choice of Steward and Matron. The whole establishment is well arranged, and kept in excellent order. 19th April, 1883.

WANGANUI The hospital stands in about two acres of land, in the town, near the river. The building is constructed of wood, with an iron roof. Some portions are more than thirty years old, while two small fever-wards were added only four months ago. The wards are seven in number, and afford accommodation for twenty-six beds altogether, of which twenty were occupied at the time of my visit —viz , eighteen by male patients and two by females. The fever-wards are at present used for ordinary surgical cases. They are arranged to contain four beds each. The floors are of plain wood. There is a varnished-wood dado; the walls and ceilings being whitened. The upper portion of the windows opens on a pivot; and ventilation is promoted by vertical tubes and archimedean roof ventilators. The windows have blinds of green holland. G-as-pendants are used for lighting, but no provision has been made for warming these rooms. Some of the bedsteads are of wood ; others of iron (mostly of old pattern), with canvas stretchers. Some of these are very loose, and hollow in the middle. Straw paillusses are provided ; the mattresses appear to be filled with a coarse kind of flax, and the pillows are also of flax. Six feather pillows, however, are distributed through the wards, and there jare three spring-mattresses. Small bedside lockers, in the form of a stool with a small box at the bottom, are placed by each bed. There are some good plain commodes, a plain table, and one or two chairs in each ward. A few unframed- pictures and texts complete the list of furniture, which is similar in character in all the rooms. These have a bare and somewhat poverty-stricken appearance, particularly the older ones, the walls and ceilings of which are very dirty, and do not appear to have been whitewashed for many years. The floors, however, as well as the bedding, are kept very clean. In the older wards are open fireplaces for wood. Stoves will probably be placed in the fever-wards. I saw dinner served in the hospital. It appeared to be of good quality and nicely cooked. No separate dining-room is provided for convalescents. The dietary scale was shown to me, and I noticed that no provision was made for the supply of other vegetables than potatoes. There is a small portion of ground cultivated as a kitchengarden by the Steward, for his own use ; and he occasionally supplies a few green vegetables to the patients. The kitchen is of fair size, but old and very draughty. Five doors open out of it. The w^lls and ceiling badly require renovating, being very dirty. There is no range or boiler; a colonial oven is in use. At the back of the kitchen is the sitting-room for the Steward and his wife. Supplies are obtained by contracts, and tradesmen's accounts properly checked. A daily ration-sheet was submitted to me. This is examined monthly by the Committee. There is a sufficient stock of bedding and linen, which is neatly kept in a small store-room. Washing is not done on the premises, but is contracted for. The dispensary contains a very small stock of drugs, which are obtained, as required, from a local druggist. There w-sa good general case of surgical instruments, and a supply of splints and appliances, but no other instruments worth naming. A prescription-book is kept, and a register of patients. I also-'saw a small library for their use, and learned that daily and other papers are regularly supplied. The sanitary arrangements are very defective. Only one water-closet adjoins the hospital: this opens out of a male ward, and has no intercepting lobby. The water is kept constantly running here. There are three out-door water-closets, which are so inconveniently placed 4—H. 3a.

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that they are not used by the female patients. Into these are emptied the contents of the commodesVegetable refuse is thrown into a hollow in the ground, behind the building, mixed with ashes, and removed once a month. Poultices and rags are thrown into a disused shallow well, at no great distance from the male wards. Earth is said to be thrown in occasionally ; but I could see nothing except foul mass of rags. This arrangement is most objectionable. Matters of this kind should either be burnt or removed without delay. Liquid drainage runs into the town sewer. Water is supplied from the town's mains; rain-water is also collected, and filtered for drinking. There is a small bath-room, with a portable zinc bath, to which cold water is laid on, but I saw no lavatories or washstands. The mortuary is a small, dilapidated shed. The resident staff consists of the Steward, his wife, and a male assistant. They all sleep in rooms situated in the roof of the building, and which are neither commodious nor comfortable. The whole of the establishment is kept by them in praiseworthy order. There is no night-nurse, and their duties must be at times very onerous. The patients appeared to be kindly and attentively treated. I had the pleasure of meeting Dr. Earl, the Medical Officer ; and the Chairman also came to the hospital during my visit, and gave me much useful information. It appears that the hospital receives subscriptions of £25 a year each from the Boroughs of Marton, Eeilding, and Palmerston, and from the Counties of Wanganui, Manawatu, and Bangitikei; these bodies also pay Is. 6d. per diem for each patient sent by them to the hospital; the £25 a year is intended to meet the expenses of the staff. There are no other subscribers whatever; but patients are expected to pay £1 Is. a week, if able. Some endowments yield an annual rental. The institution is under the management nominally of a Board, which has representatives from each subscribing body ; but, practically, it is in the hands of the Borough Council, who visit it (judging from the Visitors' Book) at somewhat long intervals. The district served is a very extensive one, reaching from Patea to Foxton, and including Palmerston and its surrounding country. The hospital is altogether unworthy of the Town of Wanganui, and it is, in my opinion, a mistake to build any further extensions of it. The erection of a new establishment was contemplated some time ago; and a good site of three or four acres, on St. John's Hill, is still available for this purpose. The matter ought not to be delayed, and some provision should be made for the aged and infirm persons who now encumber the wards, and cripple the resources of the hospital. The present site would doubtless realize a considerable sum for building purposes. 21st April, 1883.

WELLINGTON. I hate spent two days (23rd and 24th) in inspecting this hospital, of which I have examined every part, together with the grounds and outbuildings. Every patient has had an opportunity of conversing with me (no official being present), and of making any statement. It cannot be said to be well planned. It is constructed of brick, with stucco front and corrugated-iron roof; and consists essentially of a very large corridor in front, from which run back four large wards, separated by courtyards. In front of the corridor, in the centre, are rooms for the Resident Medical Officer, with the dispensary, waitingroom, consulting- and operating-rooms. There are also, in front, four private wards, with bath-rooms, water-closets, and store-rooms attached. At the back of the block of building is the kitchen, also scullery, larder, three rooms for servants, and a dining-room for convalescent patients of each sex. The front corridor is unnecessarily large ; it receives the sun all day, while the large wards have no other view than that of the courtyards, and are consequently dull and gloomy. The building is nearly new, and is in substantial repair, but has not yet been painted or coloured internally. The walls and ceilings consequently have a dirty appearance. The detached buildings consist of fever-hospital, laundry, mortuary, and. various stores, which will be noticed later. The grounds occupy about twelve acres. They are not cultivated ;. no one is at present employed in them. Some cows from the asylum were grazing there. No kitchen-garden exists, and a general air of untidiness prevails. Very few seats were noticed. It is right to mention that the ornamental courtyards are very creditably attended to by the carpenter and a patient (Hunt) who has been eight or ten years in hospital. There are no entrance-gates to the estate, and horses, &c, often stray in. I was unable to-learn any particulars as to insurance against fire; but I inspected such appliances as were provided for its extinction. There are small (1-inch) stand-pipes outside the main building, to which a 60-feet length of indiarubber hose can be attached. This hose is roughly mounted on a barrow. Of the four principal wards, three are set apart for male patients, and one for females. These wards are said to be 88 feet long, 24 feet wide, and 20 feet high. Each is said to contain twenty-four beds, but there were three additional ones (not at present occupied) in one of them. The number of in-patieuts at the date of my visit was eighty-six—fifty-nine males and twenty-seven females. The wards are lighted by lofty sash-windows, which open above and below. There are fan-lights above the sashes, which might with advantage be made to open also. Tobin's tube ventilators are in use, and there are outlets for foul air near the ceilings. The warming of these rooms is accomplished by open fireplaces for wood. No grates exist, and coal cannot therefore be used; but it is a matter for consideration whether the latter fuel would not prove more economical. The drainage from the building runs out into an open ditch near the entrance to the grounds—an arrangement which is likely to prove offensive, if not deleterious. There are no cesspits, and the baths and sinks appear to be properly trapped. The closets in use are earth-closets. They have no self-acting arrangement, nor any hopper for dry earth. A compound of waste lime from gasworks is sprinkled on the soil with a trowel, and spilled about on the seats. This material is not dry, and does not absorb the urine. There is a very offensive smell. -These closets are emptied at night, twice weekly, by a town nightman. The closets, being at a considerable distance from the wards, can only be used by the convalescents. The bedside commodes are emptied into them, and the pans afterwards washed in the bath. Some other provision ought to be made for this purpose. The kitchen refuse (wash) is taken away daily, a nominal sum being paid for it. The ashpit is emptied every Saturday : the poultices and rags are thrown here. I was surprised to find that the cinders are not sifted and used: a sloping riddle might be erected for the purpose in front of the ashpit. The water-supply is entirely from the town waterworks, and>

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considerable trouble and anxiety nave been caused by the recent scarcity. There is no means of storing water, with the exception of seven 400-gallon tanks in the roof. Some additional tanks should be placed on the adjoining high ground for this purpose. I saw three out of use at the asylum, which might perhaps be spared. The rain-water is not collected at all. There are two tubular boilers, with furnaces at the rear of the building, for supplying hot water. The flues are badly arranged, and difficult to clean. The supply from these is very unsatisfactory. A high-pressure boiler behind the kitchen range gives a very limited quantity, there being no hot-water tank to contain a store in the roof. The ward-kitchens have each a high-pressure boiler at the back of a small range, but these work so badly that they are rarely used ; in fact, I found a large saucepan heating over a fire in one of the wards for making a fomentation. The laundry has an independent supply, with two furnaces. All these arrangements involve great waste of fuel, and might with much advantage be superseded by a large boiler, centrally situated, and capable of burning the cinders not now utilized. The bedsteads are of iron, with woven-wire mattresses. A horse-hair mattress is placed on each, and the pillows are likewise of hair. There are a few spare mattresses. An objectionable plan, of putting a new patch over a soiled and worn-out place, seems to be in use. There was an abundant supply of blankets, no less than t*ix hundred new ones being in store. Some counterpanes wanted changing, and complaint was made of the scarcity of sheets also, but I saw abundance of these in the store-room. These will be issued for use forthwith. The Matron assured me that she did not know of any in store. There are screens in the wards, and a few Windsor chairs, bedside boxes, commodes ; and a small table, with wooden forms for seats, in one of them. Two or three cane-bottom chairs were seen, but more seats of a comfortable sort are required, and the wooden forms should be taken away. More commodious tables also are wanted, and washstands. Bedside lockers might be provided with advantage, to contain medicines and extras, some of which are now put beneath the bed. There are no bed-rests, nor any tables for use at meal-times by those who are confined to bed. Two rocking-chairs were seen in the female ward. In the large corridor were a few flowers in pots, and a quantity of cut flowers in some of the wards. These had been brought by some ladies, who also kindly provide a number of illustrated and other papers. There were no pictures, but a few texts fastened to the walls. The ward-kitchens were untidy. A very large cask containing mustard, a large rough box of linseed meal, and a large bag of poppy-heads were standing on the floor of one of them. These articles might be issued in smaller quantities, and cupboards provided to contain them. A plate-rack is neoded, and a receptacle for mops, brooms, and pails. A towel-roller is also wanted, and a proper supply of cloths for washing up. The lavatories were in fair order, but towels were very scarce. The baths are made of wood. The general kitchen has a large range, with three ovens and hot-plate rack. All the boiling is done in saucepans. The cook is young, and has only been a short time in the service. She appears to be industrious and willing, but requires to be taught-to work systematically. A general appearance of muddle and slovenliness prevailed. All the meat and vegetables for those who dine in the wards are served and cut up in the kitchen. They are taken to the patients without any method, and put roughly before them. The plates were cold and dry, and there was a scarcity of knives, forks, and spoons. I noticed that a great many patients either took no notice of, or absolutely refused, their dinners, which consisted of roast mutton, potatoes, and greens. All the convalescents who can do so dine in the room set apart for that purpose, and, on the female side, a whole joint is sent into the room. Here the food is hot, but miserably served. There were no mugs or glasses on the table. Salt was put on in a large basin, and no cruets were in use. The cloth was dirty. The whole meal was finished very speedily. Complaint was very general as to the food and its serving. The supply of vegetables was said to be deficient, and the tea was almost universally condemned. The nurses dine together in the dining-rooms after the patients, and it is the practice to wash up all the crockery, knives, forks, &c, which have been used here, and in some of the wards, in a pail in this room. The larder and scullery are good, but require some fittings. A screen is also required to keep the afternoon sun oft the meat-safe, which is not now in use on this account. There is a general store, and a drug-store, in a detached building. These are encumbered with various things which belong elsewhere, and require rearranging. The mortuary occupies a detached building, and contains an ante-room, which is used for inquests. A hinged shutter should be fitted to the louvre ventilator opening into (he deadhouse. The laundry is a small detached building, containing a copper, with its furnace ; a stove for heating flat-irons; and some washing troughs, supplied with hot water from, an outside furnace. There are thus three fires for this small building. The soiled linen is roughly washed in large bowls by the nurses at the back of the wards (before being sent to the laundry) and dried on the grass. This custom should be at once altered, and provision made at the laundry for the purpose. There is no machinery here except some small wringing-machines, which are much too narrow, and tear the clothes. The drying-ground is not protected by a proper fence from an adjoining road, and articles may easily be stolen. Infected linen is submitted to a hot-air chamber before being sent to the laundry. The fever-house is a detached building, containing one large ward. This has been divided longitudinally by a wooden partition into male and female divisions, but there is only one lavatory, bath, and closet, which is a very inconvenient arrangement. The windows are too high up. The nurses' room contains a small cooking-range, and must at times be unbearably hot. There is no press, drawers, or pegs for clothing ; and no provision for coals and cinders, which form two heaps outside the building. A stand-pipe, with hose, for washing windows and flushing gutters would be of advantage. I found that proper precautions were taken in the conveyance of food and linen to and from this building. At present there is only one inmate, a man suffering from measles. When not wanted in the fever-hospital the nurse will fill up her time with needlework, &c. A number of complaints were made to me by thg-patients in the female division : many of these proved, upon investigation, to be almost groundless, and many statements were made by one patient and contradicted by another. They related chiefly to neglect by the Matron and by nurses ;to insufficiency of nurses ; and to badly-cooked and badly-served food. I have reason to believe that the Matron is not by any means well fitted for her post, and that one of the nurses (II.) is rough in her manner to the patients ; some of whom, however, gave her a good character for industry. The medicines and extras

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when ordered are administered by the nurses, and no complaint was made on this score. Two pounds of tobacco per week are distributed by the Steward, principally amongst the old men. The dispensing is also performed by this officer. As regards the work of a Steward, it seems to me that he is not efficient, and thai; his services should be dispensed with. Inquiries were made by me as to the supply and prices of food, fuel, gas, drugs, surgical instruments, <fee.; also regarding the admission of patients, the payments required from them, and the custody and disposal of anj property or valuables brought in by them. An inventory of the hospital property has lately been taken by Dr. King, who is at present in charge, but this was found to be, in some respects, incomplete. Worn-out or broken articles are written off by the Steward and Matron. A great many articles are not marked at all. This is the case with the whole of the towels and counterpanes. A. religious service appears to be held twice weekly, and frequent visits are made by the clergy to individual patients. Frequent visits are made by ladies, and the public are admitted on Wednesdays and Sundays. This privilege seems to be greatly abused, and many go to the hospital out of mere curiosity. The names are not all entered in the Visitors' Book, yet I counted 108 for Sunday last, and as many as 280 have been, registered on one day. Care is now exercised in selecting those patients who are proper objects of charity ; with the result of diminishing the average number of out-patients from 115 daily (six weeks ago) to 65 at the present time. A good many of the in-patients are of the incurable class, some of them having no disease but old age and its infirmities: these would be more properly provided for in a benevolent institution. Care will no doubt be taken to prevent any increase of this class. The Honorary Medical Officers appear to devote a good deal of time to their duties at the hospital. The out-patients are seen by Dr. King, who has been in charge since November Ist, 1882. The books have been very carefully kept by him ; and he has effected many improvements and earned the good-will of the patients. Of the rest of the staff it will not be necessary to speak ; but I would point out that the carpenter is called upon to exercise a variety of trades and occupations, such as engineer, stoker, fitter, glazier, plumber, and gardener, and that for all these occupations he is expected himself to provide all the requisite tools. This appears to me to be a very unusual thing, and to deserve consideration; the more so as I believe the man to be a very valuable servant, whom it would be difficult to replace. I recommend that the following articles be procured for his use : One 26-ft. ladder and one 16-ft. ladder, to replace others, which are rotten and dangerous; three 60-feet lengths of hose, for use in the courts in case of fire, &c.; gas-fitting tools, of the value of about £10; some iron castings (of which he has the patterns), for garden-seats. When practicable he should be provided with a proper workshop also. It may be well to consider whether a properly-fitted laundry could not be erected at the brick kiln to serve for both the hospital and asylum. The vacant office of Resident Medical Officer should be filled up without delay. There ought to be no difficulty in doing this, as the post appears to me to be a desirable one. With the assistance of an efficient Matron and a good Steward great improvements are to be expected in the administration. 25th November, 1882.

WESTPOBT. The hospital is a wooden building, a short distance from the town, and faces the sea. It stands in an enclosure of light sandy soil ; part of which is in use as a kitchen-garden, and is well stocked with fruittrees and vegetables. At the entrance are neat paths and well-kept flower-beds. There is a large and airy ward, with open roof, for male patients ; and a small one, with two beds, for females. At present seven men and one woman occupy beds. Several of these might be appropriately treated in a benevolent institution. The large ward has sash-windows, Tobin tube and ceiling ventilators. A large stove in the centre furnishes the means of heating it. Iron bedsteads are furnished with straw mattresses, pillows of flax and of feathers, good grey blankets, and very clean linen. There is a large ta.ble for meals, and Windsor chairs ; brackets are fixed over the beds ; there are no bedside lockers or tables. The plain-boarded walls have upon them a few framed and untamed pictures, and there are some cut flowers on a table. A rocking-chair and green-holland blinds complete the list of furniture. Opening from the end of the ward is a lavatory with a portable bath, and adjoining this room is a closet and a urinal. Dry eurth is used in the pan, and the liquids run through a tubular drain into loose sandy soil at some distance. Solid refuse is burietl. The female ward has a very comfortable appearance ; next to it is a very comfortable sitting-room, formerly used by the Steward. The kitchen has a small range and boiler, and is very neatly kept; good crockery is used. Behind the kitchen is a washhouse, with a portable copper and a washing-machine, and near it a general store, kept in very good order. The mortuary occupies a building at some distance in the rear: it is suitable for its use and very clean. Th« dispensary is near the male ward. Until recently all drugs were provided at the cost of the Medical Officer, who still has to find all surgical instruments which may be needed, the hospital possessing none of any importance. The general register is well kept, but no case-book is in use. There is no diet-scale, but diet-sheets are ill use for each patient. The dinner to-day consisted of poultry (from the hospital grounds), cabbage, potatoes, and beef-tea. All goods are obtained by contract, and when received are weighed and entered in a book for comparison with accounts sent in. The inventory of hospital property requires revision. The Steward (recently appointed) will give this matter his attention. The Committee meet every month in the town, and pay occasional visits to the hospital. Patients are admitted by " ticket," and charged 255. a week for their maintenance. I saw and conversed with every patient, ;md formed the opinion that they were well and kindly treated. The Medical Officer evidently takes much interest in his work, and I had the pleasure of conversing"*with him regarding the working of the hospital. Beyond the occasional help of a convalescent patient, the Steward and the cook have no assistance in the nursing and domestic work. The whole establishment I found in excellent order and scrupulously clean. No efforts appear now to be made to secure either subscriptions or payments from patients, nor is any trouble taken to ascertain whether they are proper subjects for charitable assistance. 22nd February, 1883.