MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1909.

Appendix to the Journals of the House of Representatives, 1910 Session I, H-07

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1910. NEW ZEALAND.

MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1909.

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

CON TENT 8. PAGE PAGE Introduction 2 Financial ResultsNumber of Patients on Register .. .. 2 Contrasted with 1908 .. .. .. 8 Their Distribution .. .. .. .. 2 Receipts for Maintenance .. .. 9 Their Ratio to Population i .. .. .. 2 Centralizing Maintenance Matters .. 9 Admissions .. .. .. .. .. 3 Farming Operations .. .. 9 Their Ratio to Population .. .. .. 3 Conclusion .. ~ ~ .. .. '9 Deaths and Discharges .. .. 4 Early Treatment .. .. .. .. 5 Neuro-pathological Laboratory .. .. 5 Diploma in Psychological Medicine .. .. 6 Causes of Insanity .. .. .. .. 6 * , .. _ Reports of Visits to Mental Hospitals .. .. 10 Accommodation .. .. .. 7 M j. , a -.j..-d I ia _~ „ „ Medical Superintendents Reports .. 14 Superannuation .. .. 7 Appendix— Names added to Register of Mental Nurses .. 8 Statistical Tables .. .. .. .. 20

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The Hon. the Minister in Charge of Mental Hospitals to His Excellency the Governor. My Lord, — Wellington, 30th July, 1910. I have the honour to submit to Your Excellency the report of the Inspector-General of Mental Hospitals on the mental hospitals of the Dominion for the year 1909. I have the honour to be, Your Lordship's most obedient servant, Geo. Fowlds, Minister in Charge of Mental Hospitals.

" The Inspector-General to the Hon. the Minister in Charge of Mental Hospitals. Sir,— Wellington, Ist July, 1910. I have the honour to present the statutory report on the mental hospitals of the Dominion for the year ended 31st December, 1909. ' The number of patients on the register at the beginning of the year was 3,414 (males, 1,997; females, 1,417), and at the end 3,549 (m., 2,083; f., 1,466), an increase of 135 (m., 86; f., 49). The increase in 1908, the highest on record, exceeded that of the year under review by 39 (m., 2 ; f., 37). It is not the number only but the quality of the admissions which determines these annual increments;, therefore, when dealing with comparatively small figures one has not to contrast too strongly one year with another, but rest content with observing any general tendency which may be disclosed by larger figures—at least the averages of quinquennial periods. Taking the last three of these, one finds that in the period 1894-98 the average yearly admission-rate was 450, and the average yearly increment, the excess of admissions over discharges and deaths, was 88; the corresponding figures for 1899-1903 were 526 and 96, and for 1904-8 were 639 and 91. Distribution.— Counting 108 (m., 77; f., 31) absent on leave as still resident in the mental hospital whence they left, the 3,549 patients on the register at the end of the year were distributed as follows: — Males. Females. Total. Auckland 458 289 747 Christchurch 337 290 627 Dunedin (SeaclifT) ... ... 500 329 829 Hokitika ■■• 140 55 195 Nelson 97 105 202 Porirua 371 324 695 Wellington ... ... ... •■• ••■ 155 55 210 Ashburn Hall (private mental hospital) ... ... 25 19 44 2,083 1,466 3,549 Of those technically on leave, 33 men were resident at the Camp, near Dunedin, and 18 boys at the Home for Feeble-minded at Richmond. Ratio to Population.— -The following calculations show the ratio of patients on the register at the end of the year to the estimated general population, both exclusive and inclusive of the Native race. The number of Maoris on the register was 38 only (m., 24; f., 14). The proportion of the total insane to the total population was, — Exclusive of Maoris 35-72 per 10,000, or 1 in 280 Inclusive of Maoris 34-43 „ 1 m 290 The proportion of the male insane to the male population.— Exclusive of Maoris ... 39-57 „ 1 m 253 Inclusive of Maoris ... ... ... ■■• 38-15 „ 1 m .261 The proportion of the female insane to the female population, — Exclusive of Maoris ... ... ••■ ■•• 31-40 „ lin 318 Inclusive of Maoris ... ... ... ■•• 30-24 „ lin 331 Compare these figures with those of last year, and it will be seen that the ratio per 10,000 has advanced 099 for males and o'lB for females. As I have stated before, such ratios would find their parallel in general hospitals if those patients only were discharged who were apparently, restored to the state of bodily health and integrity which preceded the disorder or accident for which they were admitted. . . Of interest in this connection is the following comparison, quoted from an article by Vr. Urquhart in the Journal of Mental Science of April, 1909: — Edinburgh Royal Infirmary. Perth Royal Asylum. General Diseases. Nervous Diseases. Certified Insane. Total cases 4,082 873 982 Of whom percentage of— Recovered ... ... ••■ -■• <" 7 23(1 die Unrecovered ... ■•■ •■■ 555 69"3 51 o Died 10 '< 7 5 lb ' r

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Admissions. —Exclusive of 28 men and 79 women who were merely transferred from one mental hospital to another, the admissions numbered 716 (m., 419; f., 297). Of the 716 so admitted, 575 were placed on our general register for the first time, and of the 141 whose names had been previously entered therein all but 25 returned to the hospital whence they had been last discharged. Some of the 575 admitted for the first time had been insane before, but the 141 patients readmitted, while not representing the full number of relapses, sufficiently illustrate the well-known liability of mental disease to recur. Commenting on this in my last report, I said, — ''This tendency to recurrence is one of the anxieties surrounding the question of discharge. While some patients make an apparently complete and lasting recover}-, and some relapse after a long period of sanity, some, who remain well in an institution sufficiently long to justify their discharge, to claim it as a right, soon relapse when exposed to the influences of the larger world. During the past year we have been fortunate in the recoveries being to all appearance more stable, and in the relapsed cases of former years having been returned without any untoward event resulting from their insane conduct. Though naturally gratifying, it must be allowed that this is not a matter of skill but of good fortune." Shortly after the above report was presented, an ex-patient was responsible for a tragedy. Because his first attack was due to poisoning by alcohol and " pain-killer," the patient was kept in the mental hospital by moral suasion long after he could have claimed a legal right to be discharged. A question asked in the House last session elicited the fact that this patient had left in sound mind, that circumspection had been exercised in discharging him, and that the second attack followed quickly updn a relapse into intemperance. The public, naturally shocked by such an event, tends to desire a restriction of the liberties of the patients, and, on the other hand, requests are made for the discharge of patients against fte advice of the responsible medical officers. One must, as heretofore, pursue the only wise policy, that of reviewing all attendant circumstances and treating every case on its merits. The legal standard of a patient's fitness for discharge should be determined by considering whether he requires any longer to be under oversight, care, or control for his own good or in the public interest. The following is the return for 1909 of immigrants who became insane within one year of landing on our shores. The average for the three previous years is nearly 24: — „ ~ , No History of History of r ,, ~ Native ot Previous Attack. Previous Attack. iotaL United Kingdom ... ... 16 2 18 Commonwealth ... ■'■ ■ ■ • ■ 5 2 7 Other parts of Empire ... ... 1 1 Foreign countries ... ... ■•■ 1 ••■ 1 Total 23 5 28 Ratio of Admissions to Population. —Excluding the Native race (9 male and 4 female patients) and all transfers, the proportion of admissions (whether first or not) and first admissions 'to the estimated general population stands respectively at 715 and 5-76 per 10,000, or, in other words, every 1,398 persons in the general population contributed an admission and every 1,737 a first admission. Hereunder are tabulated the returns since 1899 :-r—

One has merely to glance at the ratio for 1908 to notice the improved position this year, especially with regard to first admissions.

Ratio to 10,000 of Population of Number of Persons iu Population contributing Year. Admissions. First Admissions. One Admission. ! One First Admission. ! 1899 1900 1901 1902 1903 5-93 6-39 6-83 6-48 6-78 4-71 502 561 507 5-60 1,685 1,565 1,464 1,542 1,473 2,119 1,990 1,774 1,971 1,783 Quinquennial average 6-50 5-22 1,540 1,915 1904 1905 1906 1907 1908 6-55 6-76 7-16 6-39 7-63 5-42 5-59 5-82 5-04 6-24 1,526 1,478 1,396 1,567 1,311 1,844 1,786 1,718 1,982 1,604 Quinquennial average 6-92 5-64 1,445 1,774 Decennial average ... 6-72 5-44 1,488 1,837 1909 745 5-76 1,398 1,737

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The figures in this return are obviously more serviceable than those calculated on numbers resident, but in drawing conclusions between the further and nearer quinquennium there must be kept in mind the fact that accretion plays a part in the growth of our population, and that insanity is a disease of adult life. Deaths and Discharges. —The total number of cases under care during the year was 4,237 (m., 2,444; f., 1,793); of these (excluding transfers), 377 (m., 197; f., 180) were discharged, and 204 (m., 136; f., 68) died. In 1908 the number under care was 3,984, the discharges numbered 348, and the deaths 222. The percentage of deaths calculated on the average number resident was 605 (m., 690; f., 484). The figures for the previous year were 7 - 39 (m., 908; f., 4 - 98). With the proportions per cent, calculated on the total number under care, the figures for 1909 and the previous year are respectively 4'Bl and 555. The percentage of deaths due to general diseases was 22 - 06, of which tuberculosis contributed 1323; to diseases of the nervous system 33*33, of which general paralysis contributed 1323; to diseases of the heart and blood-vessels 19T2; and to senile decay 1863. The percentage due to other causes was insignificant. Of the patients discharged, 349 (m., 179; f., 170) were classed as recovered, and 135 (m., 46; f., 89) as unrecoverecf, 107 of these (m., 28; f., 79) being transfers. The percentage of recoveries calculated on admissions was 4874 (m., 4272; f., 57"24). The recovery-rate the previous year was 4382 per cent, (m., 4225 : f., 45-91), and the average since 1876 stands at 4069 (m., 3865; f., 43-71). » In the last report was introduced a table giving the discharges, deaths, and number remaining of patients deemed to be recoverable. The innovation had to be explained, and, as the table may be unfamiliar still, in giving the results for 1909 a part of that introduction is quoted. The recovery-rate based on admissions " is not a standard for weighing the value of treatment, and even if the calculation be based on types of insanity in which there is a fair prospect of recovery, there are matters relating to the underlying physical condition and the life-history which turn the scale and are too complex and individual to express in general statistics. However, to arrive at something more definite than the percentage of recoveries calculated on admissions, a return is here presented of the year's history of patients in whose case treatment with a view to recovery was persevered in. The rest of the inmates are omitted, being those the nature of whose malady precluded the possibility of cure." . I would further state that, though the prognosis is boldly expressed, the classification under classes A and C includes patients whose chance of recovery is about and above the average, and under classes B and D are placed those whose chance is below the average right down to the borderline of the incurable. These classes may be roughly divided into those above and those below a 40-per-cent. chance of cure. Though confident that the medical officers have all patients capable of improvement marked out for special treatment, the value of this table is not merely in the return furnished, but in the knowledge that there is a yearly review in the case of all patients resident and a balancing of pros and cons with regard to prognosis in the case of each patient on admission.

An analysis of this table discloses some points of interest: — Class A, numbering 151, is made up principally of the undischarged remainder of Class C of the year before, which numbered 95. Of Class A of the year before, 29 were left, and under ordinary circumstances some of these would drop into Class B or out of this table, having been under treatment for over a year; but adding the whole 29 to the 95 we are still 27 patients short of the number which started the year under Class A. This means that a number of less hopeful cases (Classes B and D) had responded to treatment so effectually that when the prognosis of last year's residuum was reviewed they were placed in the higher class. Subtracting the 151, so composed, from the total of last year's figures of those remaining, we get 168, or 28 in excess of Class B in the above table. Inese 28 represent the measure of

Of 3,414 Patients resident ] Of 823 Patients admitted | Tr,toio on 1st January, 1909. I during 1909. -totals. Showing as on 31st December, 1909, the Discharges, Deaths, and Length of Residence of those remaining, after the Exclusion of all Cases deemed incurable on 1st January, 1909, or on Admission in Cases admitted during the Year. i i Class A. % s e R Class C. CI^ e D - ne U ctod e to e be Remainder, Sdtobe Remainder, Of Classes Of Classes „ . dfachareedaa after discharged as after A and C. B and D. Genelal - recovfred excluding excluding recovered. Incurables recovered. Incurableg _ M. I F. T. M. F. | T. M. F. T. M. I F. | T. II. j F. | T. j M. F. T. M. F. I T F. j T. 79 [ 72 151 69 J 71 140 122 105 227 99 90 189 201 m| 378 168 iai| j 329 :«;<) 3381 l| 707 Discharged recovered ,, unrecovered Died .. 63 7 2 59 1 1 122 8 3 29 7 4 31 1 2 60 8 6 65 55 2 120 2 22 6 2 25 2 3 47 8 5 128 7 2 114 1 3 242 8 5 51 13 6 56 3 5 107 16 11 179 20 8 170 4 8 1349 : 24 : 16 Remaining, residence 1 month or less Ditto 2 to 3 months „ 3 to 6 „ 6 to 9 „ 9 to 12 „ „ over 12 „ 15 16 13 5 8 13 16 13 4 2 28 32 26 9 10 10 18 15 19 7 8 16 18 9 9 18 34 33 28 16 15 16 13 5 8 7 13 16 13 4 2 11 28 32 26 9 10 18 10 18 15 19 7 29 8 16 18 9 9 37 18 34 33 28 16 66 25 34 28 24 15 36 21 32 31 13 11 48 46 66 57 37 26 84 '7 ii ±8 29 37 66 Total remaining .. 7 n 18 29 37 66 57 48 105 69 60 129 64 59 123 98 97 195 162 156 318

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acknowledged failure, a number which is remarkably low considering that 105 of the patients left over from last year had been more than a year in residence and that 76 of these were already in the lower grade. The inference is that the largest possible number has been included, and this is as it should be. The recovery-rate per cent, in Class A works out at 808, against 77'6jin the previous year, and in class Cat 528, against 619. Patients admitted in the last months of the year tell against Class C, and will figure in the recoveries of Class A in the ensuing year. Class A approximately represents the result of treatment not hampered materially by a time-limit. These percentage figures must not be compared with those in the tables in the Appendix, where all the recoveries (no matter when the recovered patient was admitted) are calculated on the admissions during the year under review. Another point brought out by the table is, taking the Ist January as a standard, the small proportion of curable patients in the mental hospitals on anj T given date. Though there were 707 more or less curable cases (378 more and 329 less) treated during the year, at the beginning of it 852 per cent, represented the proportion of the patients for which euro was possible, and 442 per cent, the proportion for which cure was probable. The figures on the corresponding date of the previous year were 855 and 494 respectively. I have for convenience been using the word " cure " as synonymous with the term " recovery " ; but such use is inexact, When one speaks of recovery one implies an ability on the part of the patient discharged to resume his place in the world for a longer or shorter period, or till death. Though there may be cases of cure, of complete removal of disease, of any tendency of the past to react prejudicially on the future, it would indeed be rash to class recoveries as cures. Early Treatment .—There is no panacea in the treatment of insanity; but a state of physical well-being must be established as soon as possible, lest the highly complex brain-tissue undergo changes which no after-effort can undo. The best hope, therefore, lies in early treatment, and skilled treatment —treatment directed with all the understanding which the present state of science gives. This may not be much, but it is all. Do or say what one may, there are a number of people who will not send relatives to mental hospitals in the early stages of insanity. They shrink from the required legal procedure, from acknowledging the nature of the malady to themselves, from being deprived of the euphemistic description of it given to neighbours, and, being ignorant of the paramount value of skilled early treatment, intrust the patient to the keeper of some so-called nursing home, who evades prosecution. Medical men freely express their difficulty in treating such cases, and of the necessity for special training. The matter has been much discussed in Britain, where in the chief towns specialists can be consulted, and strenuous efforts are being made to place the value of early treatment in a proper light, to popularize it. Over here, apart from the question of whether the chief centres are populous enough to warrant setting aside for the early treatment of mental disease special wards in general hospitals, it is doubtful if specially trained physicians —a sine qua. non —would always and everywhere be available to take charge of such wards and of out-patient departments attached thereto. The wards and the men will come in due course, and, recognizing this fact, provision is made in the Bill you are about to introduce in Parliament which will give effect to the general-hospital treatment of mental defectives without, undue legal harassments. The Medico-Psychological Association of Great Britain and Ireland, recognizing as great a uecessitj- for post-graduate work in psychological medicine as in public health or tropical diseases, has drawn up a provisional syllabus of subjects and regulations for a diploma; and their adoption by some of the universities is a matter of time only, and a short time. But the public cannot look forward with any certainty to supplying its needs in the Dominion from Home sources, though in the matter of assistant medical officers the Department has in the past and may in. the future. The suggested diploma would be a guarantee of fitness to recognize in certain vague symptoms, varying in each case, the indication of insanity in an incubation stage, and the employment of such knowledge, as far as lies in the power of the physician, to ward off the threatened attack; or, upon insanity supervening, to decide promptly on the line of treatment indicated by the special needs of the case, to heal the mental wound by first intention (if one may be permitted the analogy), preventing where possible secondary complications and disfiguring scars. When the new Bill becomes law, the admission of voluntary boarders may help to bring patients in these early stages under treatment in mental hospitals; but it is to be feared that many will continue, as at present, in outside care till, may be, recovery or till the malady is confirmed. It must not be forgotten that some patients recover in spite of treatment—there were records of recovery before Pinel— but if we are going to do the right thing, if we are going to progress, we must expend our energy on those who are doomed to stray in a direction leading to mental extinction unless skilfully guided. We must take advantage of the valuable work now being done in the older countries, extending the understanding of mental disease, and checking the tendency towards vague speculations. Neuro-pathological Laboratory. —l trust that in the next report I may be in a position to say that we are contributing our share in neuro-pathological investigations, through the generosity of Drs. Alexander and Gavin, of Dunedin. Tlie first has offered to build and provide the initial equipment for a special laboratory, the second to do the work required by Government institutions without fee or salary, provided that the Department bears the annual outgoing expenses (estimated at £200) in connection with work done for it. The importance of this offer you recognized in authorizing its acceptance, and I look forward hopefully to Dr. Gavin's work in our_ midst. He is recognized in England as one of a small band of diligent, enthusiastic, and original investigators, and the contribution promised of an annual report of his work should be interesting and valuable. I introduced this matter when speaking of the necessity for early treatment, and to

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that subject now fittingly revert. In the centres of population at any rate there should be sufficient encouragement for medical men to specialize, and when, in course of time, psychiatic wards are added to ordinary hospitals, to take charge of these, treating there —and this is most important— only those cases which can be properly treated in such wards. Diploma in Psychological Medicine. —These observations lead to a subject which the Otago Medical School may consider—namely, examining for this diploma candidates presenting certificates of having fulfilled requirements with regard to courses of study. In the meantime, and for many years to come, the number of graduates which would attend a special course of lectures and demonstrations would be too small to encourage the University to be anything more than an examining body; but with a neuro-pathological laboratory, which Dr. Alexander tells me he would willingly place at the service of graduates, and the resources of the Dunedin Hospital, the University, and the Seacliff Mental Hospital, any one anxious to qualify for the diploma would get assistance from teachers in practically all the subjects. The curriculum laid down by the Medico-Psychological Association, and approved by the Commissioners in Lunacy, by the principal universities of Great Britain, and by the Royal College of Physicians, is made up of five obligatory and a choice of one of five optional subjects as follows .-— Obligatory. —(l) Anatomy, physiology, and Pathology of the Nervous system; (2) psychology, normal and morbid; (3) clinical pathology; (4) clinical neurology; (5) psychiatry, systematic, clinical, and medico-legal. Optional. —(l) Experimental psychology; (2) bio-chemistry; (3) bacteriology; (4) comparative anatomy and physiology of the nervous system ; (5) eugenics. About the practicability of the University examining, and granting diplomas, I am not in a position to express an opinion—l merely throw out this suggestion for what it is worth; but I have no uncertainty about the special knowledge required by those who have to advise on the care and treatment of the insane. More particularly is such special knowledge essential when it can be exercised before the malady becomes confirmed, and, if possible, at its inception, if not when still more timely counsel is of use. Causes of Insanity. —These have been well epitomized by Mercier as heredity and stress in inverse ratio. Heredity —that is, the inherent tendency—may be derived only from insane ancestry, but persons labouring under allied neuroses, the epileptic, hysterical, neurasthenic, transmit an inheritance which, given the requisite stress, produces insanity. Alcohol and some \ other toxins operating upon parents lower the ratio of stress necessary to produce unsoundness of mind in the offspring To effectually prevent the transmission of such heredity by State interference save by extending the definition of persons who may be brought under oversight, care, or control, is, in the meantime, outside practical politics, and must wait that growth of public opinion which develops into reform. When the public is really alive to the value of eugenics, perhaps legislative interference will not be necessary. As to the factor of stress, one has to aim at modifying inherited weaknesses in order to raise the ratio which can be borne without untoward result--a matter not so much of tempering the wind but of hardening the shorn lamb. Stress may be applied by the environment in the form, say, of financial disaster, poisoning by alcohol, and so forth, or it may generate within the system, as, for example, in the form of unaccustomed sensations of growth and decay associated with critical periods, or of poison produced in or not eliminated from the body owing to physiological error or pathological changes. Commonly, many forms of stress act at the same time, act and react, till the searcher after causes finds himself in a labyrinth. To differentiate and disassociate these, and lead to the path which becomes simple when known, we look to the guide, the investigator in his laboratory. For statistical purposes the principal assigned cause in the case of admissions is given m Table XIII in the Appendix, and hereunder these have been summarized with the proportion per cent, under each heading. Under heredity are cases in which no other cause was given or the other cause was quite inadequate. The physiological unfitness of the particular organism to bearstress is well exemplified if we take one of the headings and analyse it. It will be seen that nearly 7 per cent of the women admitted became insane through the performance of functions for which woman is anatomically and physiologically designed, and in the performance of which the normal woman could not have her reason disturbed. Male. Female. Total. Heredity 14-32 14-63 14-46 Congenital deficiency ... ... ••• 8"95 8-51 8-75 Previous attacks " 738 11-17 9"1 I Critical periods , •■• 1342 lo'l6 H'22 Child-bearing ... ... ••• 6 9 ? f*° Mental stress 8"28 IM7 9-60 Physiological defects and errors ... ... 4-47 U6O 316 Alcohol ... 17-90 4-26 11-66 Other toxins 5-87 345 4"49 Traumatic ?-46 053 I'sß Diseases of the nervous system ..: ... 0 - »2 o 05 a it SLIT 5 ' di ~" ::. ■:: :» » S 100-00 100-00 100-00

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Dr. Truby King has made some interesting remarks on the prevention of insanity in his annual report j to which I would draw your attention. He deals with early nutrition in relation to cerebropathies, a matter upon which he has earned the right to speak with authority. In this connection, even from the limited point of view of this Department, I desire to place on record an opinion that the work and example of Lady Plunket, during her residence in the Dominion, in exalting the ideal of motherhood, will leave a beneficial impress on our future statistics. When dealing with heredity in a former report I stated that a lessened resistance, similar in its after-effects, might be created by ignorance of the nutritive needs of the rapidly developing organism for some months before and some years after birth, and that the subject was one of immense importance to the State. It will be seen that the bearing of Lady Plunket's mission upon this aspect of the subject is direct, and justifies the opinion expressed. Weekly Reports. —One of our statutory books is a Medical Journal in which the Medical Officer of each institution records once a week, among other matter, an epitome of facts relating to the employment and recreation, and the health of the patients. The information required has been extended to a summary of the work of the institution from week to week. A copy is sent to the Head Office, bringing it directly in touch with the doings in each mental hospital. One is able to institute comparisons concurrent with the happenings, and have a knowledge of the salient factors in the life of the whole body of the patients. This return has proved very useful. Accommodation. —To make proper provision for the patients has given us much anxiety. In addition to keeping pace with the natural growth, there has been the knowledge that the population of Mount View would have to be provided for, and therefore additions have been in progress, large at Porirua and on a smaller scale elsewhere; but necessitating some crowding pending the outlet to our overflow which will be provided by the proposed mental hospital at Tokanui. It was expected that by this time we should have been busy there with building operations, but to the taking of the Native portion of the land objections have been lodged, and these have still to be heard before we can get to work. In the meantime, preliminary buildings are designed, and, once the objections have been disposed of, there will be no delay in making a start, I had hoped to publish in this report a, lithograph of the estate, showing the details of the proposed scheme of the new hospital; but, under the circumstances, this must be incorporated in the next report. The general interest evoked by your communication of the broad guiYling principles laid down, and of its unqualified approval by the Press of the Dominion, is very encouraging to those who are engaged in the working-out of details. Some papers had apparently published their articles before getting the full text of your rema.rks, and were led into the misconception that the proposed hospital at Tokanui was to replace the existing mental hospitals. Of course, such centralization is out of the question. Ine mission of the Tokanui Hospital for some years to_ come will be the absorbing of the yearly increment, leaving the other hospitals much the same size as they are at present, by providing for the reception by transfer of numbers of patients who as a class can be managed in less expensive institutions than the ordinary mental hospital. This class comprises for the most part patients who keep very fairly well under skilled supervision, but are quite unable to adjust themselves to the larger environment of the world outside the institution. Their transfer will supply workmen to assist in developing the new estate, and accommodation in the hospital they have left for patients requiring stricter supervision and more active treatment. The Wolfe Bequest Hospital is practically completed, and will soon be in occupation. The success which has attended the reception cottage established at Seacliff some years ago assures the new hospital filling a want, if any assurance be needed. At the time of writing, the Mount View Mental Hospital has ended its career of usefulness. The majority of the patients have been removed to Porirua, and a few, the remainder, have gone to Sunnyside and Seacliff. When we are free to build at Tokanui, a proportion of the patients so transferrd will be sent there, leaving the accommodation which was provided for them to meet future needs The removal from Mount View was a large undertaking, carried out, to the credit of all concerned, without a hitch. Work was found for all members of the Mount View staff, and in the destination chosen for them and for the patients transferred individual preferences were given effect to as far as possible. No one unassociated with the care of the insane can realize the difficulties under which the officers worked during the last year of the hospital m order that the patients should not suffer inconvenience or restrictions of liberty nor yet be exposed to danger conditions difficult to fulfil with'a large building under progress across the front of the old, and with portions of the old building being removed as the patients who had occupied it were transferred. I must take this opportunity to congratulate the officers and other members of the staff. In the last report he would issue from Mount View I asked Dr. Crosby to place on record the history of that institution. In my many visits during its closing year I. had some touching evidences of the attachment of the patients to the old place. The Staff —I have every reason to believe that the nursing staff and other workers are satisfied and have performed their duties faithfully, and I would once more point out the hardship they suffer with respect to the superannuation allowance when compared with employees in other Departments of the public service. Their salary is obviously the money paid plus the emoluments of board, lodging, washing, &c. If we required them to live out we should have to pay a higher salary and on this the superannuation allowance would be calculated as a matter of course; but we require them to live on the premises, and the value of the emoluments (by which sum m effect their salary is reduced) should benefit them when they come to retire. ' The following names were added to the Register of Mental Nurses. Names which appeared before are those of candidates who had obtained second-grade certificates (under 70 per cent, of

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marks) and had the ambition to re-enter for examination and gain a first-grade certificate. Examination papers were answered in December, and the viva voce part of the examination was conducted by Miss Maclean and myself, with the co-operation of the Superintendents, during our visits of inspection to the mental hospitals. Four of the Matrons asked to be allowed to sit for examination. They were given a special examination with a more advanced paper to answer, and all four passed in the first grade: — Auckland: Sophia Campbell (Matron), Violet Jane Campbell, Josephine A. Gibbons, Mabel Latimer, Zara Minchin, Albert George Smith. Christchurch: Elizabeth Hanna (Matron), Edward Condon, Frieda Hilmer, Norah Leonard, Mary C. Lowe, Timothy Mansfield O'Connell, Alexander Suttie, William. Suttie. Seacliff: John Bambery, Malcolm Beasley, Rose Galbraith Donald, Mary Gabriel Fitzgibbon, William Glenday, William Saunders Loder, Edith McLellan, Hannah Isabella Pay, John Carmody Quill, Robert Sangstcr, Margaret Louisa Stephens, George James Sutherland. Hokitika : Edmund Dale, Mary Catherine Dolph, Austin Edward Dowling, Michael Hanrahan, John Kavanagh, William Selby. Porirua: Margaret Ogilvie (Matron), Ada Winifred Field. Wellington : Williamina C. McDougall (Matron). Ashburn Hall: Eliza Margaret Isabel Leydon, Annie Poppelwell. Financial Results. —The details of expenditure are given in Tables XX and XXI, and it will be seen that there has been a decrease in the total expenditure per head, less receipts, in every institution as compared with the previous year, making an average of ,£1 9s. 9d. less per patient. The expenditure in different institutions must perforce vary according to circumstances-— e.g., local prices, freight on supplies, climate governing fuel and. nature of clothing, scattered or concentrated buildings and farm lands, number of patients entailing proportionately more or less paid labour, and so forth. But in each hospital expenditure is carefully considered, and economy—that is, a providing for all that is necessary without waste —enforced. What has been said regarding vital statistics refers equally to expenditure, too much must not be inferred in comparing one year with another ; but the result set forth in the following table is gratifying, nevertheless :—

In this table Head Office salaries and expenses (£1,663 13s. lOd.) and medical fees (£1,318 12s. 6d.) are omitted. Giving these value, the net annual cost per patient is £25 os. 9Jd, as against £26 10s. Bd. for 1908, a decrease of £1 9s. lljd. In stating the cost per patient above, interest on capital expenditure is omitted, and also for repairs charged to the Public Works Consolidated Fund. Adding these items, the approximate full cost per annum per patient will be.— s. a. & s. a. Average gross cost in mental hospitals ... ... ... ... 34 13 3{ Proportion of Head Office salaries and expenses ... ... 10 0 „ fees for medical certificates, &c. ... ... 711 ,_ 017 11 „ interest (averaged at 4 per cent.) on Public Works expenditure from July, 1877, to 31st March, 1910 ... 7 0 6f Proportion of interest (averaged at 44; per cent.) for capital cost previous to above period ... ... ... ... 0 14 \\\ Gross cost ... ... ... ... ... ... 42 8 9i Less receipts for maintenance and sale of produce ... 10 10 5 Net cost ... £31 18 4J In 1908 the full cost so reckoned was £44 ss. 10jd., and the net £34 7s. 84d.

Mental Hospital. Total, Cost I per Patient. 1909. 190 Total Cost per Patient, less Receipts for Total Cost ! Maintenance, per Patient. ■ Sales of Produce, &c. 38. 1909. 1909. Total Cost per Patient, less Receipts for Decrease . | Increase . Maintenance, Sales of Produce, &o. mckland !hristchurch ieacliff lokitika Jelson 'orirua Vellington .uc hr ea [ol [el 'or Vei ckland ristchurch icliff kitika lson rirua sllington 1 £ s. d. . ! 25 15 llf .. j 38 2 9J .. I 42 4 1 .. 26 4 4J .. 30 4 5 .. I 33 19 5 .. ! 40 18 0i £ s. d. 25 15 llf 38 2 9J 42 4 1 26 4 4J 30 4 5 33 19 5 40 18 0} . . [_ £ s. d. £ s. d. I 17 13 Hi 26 9 3i L- 23 2 3f 38 18 1 29 2 10 43 3 llf l 23 9 10f 26 1 U 22 15 7f 32 7 3 25 1 9i 34 18 Of [• 29 2 9f 42 7 8| £ s. d. I £ s. d. £ s. d. 19 11 9 1 17 9i 26 17 6i 3 15 2| 30 1 If 0 18 3f I 23 14 0-| 0 4 If 24 9 2f j 1 13 7 25 10 101 ,091 29 8 6i 0 6 3i Average,! Averages ... JS .. 34 13 3i 34 13 3i l 24 2 101 35 10 9i 25 12 71 : 1 9 9

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tW t T tt A T 7 h[C }- is . sometimes forgotten is that these statements refer to the average cost and IttTt II at l 1 rt C ° 8t w e ,°-\ leBS * c The ™*7 admittedlrefue n % cost !,! t fif • Pe '' WGek S whlch 1S tbe mi "imum maintenance rate which can be chareectt on account of the extra care and attendance necessary. charged) were^^TeM 8 IIiTtSM 19 T O9 » on the average number resident, tne leceivers Ine tact that we are now paid the old-age pension in case of pensioners sent "to mental hospitals must be given some credit for a share in the above. pensione, s sent to The. time of the clerks, who act as receivers of maintenance, and their assistants, in attending o correspondence, statutory notices, and books, requisitions, &c, checking of supplies keep g tally of produce sold and consumed, of stores got and issued, &c„ is very fullv 1 occupied P and with the increase of patients the increased work almost demands additional assistance lis CleiT a n eS patters occupy about fourteen hours per week of the time of the Chief Cleik in each of the larger hospitals, and that if relieved of this labour the need for additional assistance would be warded off for some years at any rate. The procedure adopted in adju ting le maintenance charged to the various persons liable is as follows: On the admission of a Lien! inquiry is made concerning- relatives liable under the Destitute Persons Act, and to them an information paper is forwarded by post, or through the police when the address is not known or the first-sen paper is ignored. When the information papers are returned to the receiver, he provisionally assesses the amount to be paid per week by each of the persons liable, issues accounts accordingly, and sends the papers to the Head Office. Here they are carefully revised the provisional assessment being approved, reduced, or (very seldom) increased, according to circumstances elicited from the papers or further correspondence. The files are then returned to the local receiver it at any time questions arise about any payment, the file has to be returned to the Head Office' and a matter involving perhaps only a few shillings has to be studied anew. However trifling the assessment, the file has to be gone into carefully in order to do justice both to the relative to whom a difference of, say, sixpence per week may mean everything, and to the Department which knows the value of an aggregate of small payments. Because of the following facts—namely, that the Heart Ufnce already has so much to do with this work, that it is inconvenient having files passing backward and forward, that clerks in the mental hospitals have their time fully occupied and ask tor further assistance, that probably fourteen hours per week covers the assistance wanted and that this is about the time estimated to be taken up with maintenance-work, I have to advocate in the interests of convenience and economy the addition of a clerk, at the Head Office who would deal with all maintenance matters, keep the records, save much correspondence and much of my valuable time spent at present in perusing files the contents of which could be communicated in a few words and the gist of the subject disposed of by a question and an answer. I have brought this matter under your notice, and suggested that Mr. Wells, clerk at Mount View, who is well experienced in this class of work, would be a suitable man to occupy the position. In the following table the farming operations during 1909 are valued, and the results bear testimony to the profitable management of the estates. The total increase in 1908 over 1907 was £84 6s. Bd., and the increase in 1909 over 1908, it will be seen, was £461 15s. lOd. The value of the produce consumed is assessed at current rates, which can be largely checked by the price of the produce sold for cash.

In conclusion, I desire to express my appreciation of the good work being done in all our institutions, my thanks for the co-operation of Miss Maclean, the Assistant Inspector, of the Deputy Inspectors and Official Visitors, and my acknowledgment of the support received from yourself. . I have, &c, Frank Hat,

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Produoe sold for Cash. Produce consumed in Mental Hospital. Total. Auckland Christchurch Seacliff Hokitika Nelson Porirua Wellington ... £ s. d. 539 10 5 1,742 15 3 1,717 10 9 44 10 0 195 9 8 1,256 0 6 194 14 4 £ s. d. 2,321 9 10 1,865 17 1 3,636 3 9 467 11 11 778 2 7 1,975 18 4 492 11 0 £ s. d. 2,861 0 3 3,608 12 4 5,353 14 6 512 1 11 973 12 3 3,231 18 10 687 5 4 Total... Total for 1908 ... 5,690 10 11 5,770 5 2 11,537 14 10,996 4 6 5 17,228 16,766 5 9 5 7 Increase in 1909 Decrease in 1909 541 10 1 461 15 10 79 14 3

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ENTRIES OF VISITS OF INSPECTION TO THE VARIOUS MENTAL HOSPITALS.

Auckland Mental Hospital. 23rd March, 1910. I visited this Hospital on the 10th, 11th, 14th, 16th, 17th, 18th, and to-day, seeing during the course of the visit all the patients, giving each an opportunity to converse with me, and inspecting the buildings and various parts of the estate. To sum up my impressions in a few words, I feel confident that the care of the patients, the cure of the curable, and the contentment, so far'as possible, of all, is dominating the management, and that the relations between the patients and staff are highly satisfactory. Special interviews were accorded to patients desiring the same; in each case the question being that of discharge. There were no rational complaints. In all but two of the above cases the mental condition of the patients obviously unfitted them for liberty. In one of the remaining two, after due consideration, I decided against liberation ; in the other I agreed with Dr. Beattie that discharge depended upon a change of environment from that from which the patient had been admitted. With this view the patient acquiesced, and arrangements are being made accordingly. The general health of the patients is good. The food inspected was of excellent quality and sufficient. On the 17th there were on the register 756 patients (male, 465; female, 291), of whom 13 (m ■ 7 ; f., 6) were absent on trial, leaving 743 (m., 458 ; f., 285) resident. Of these, 462 (m., 305; f , 157) were usefully employed, the farm and garden absorbing 191 men. The average number at Divine service is 153 (m., 96; f., 57), and the recreation of the patients is duly attended to I saw a bowling-match played against an outside team, and on the 15th was the annual picnic, in which 360 patients (m. 237; f., 123) participated. The busy life, the good food, the open-air recreations, have certainly left their impress upon the patients, the general body of whom looked cheerful and bionzed. With respect to the Hospital buildings, I found every part scrupulously clean and well ordered. , , Dr Beattie is now living in the Medical Superintendent's residence, which has been well and economically built by the staff and the patients, with a little outside assistance. His old residence is almost ready for the accommodation of forty women patients. I expect that they will be moved in by the first of the month. „,,,,,. The Wolfe Bequest Hospital building is progressing favourably ._ I feel confident, both in respect of site and convenience of working, that it will fulfil anticipations. The placing of the laundry machinery was finally dealt with on the 18th, when Mr. Holmes, Engineer-in-Chief of the Public Works Department, visited with me. I have once more to express my satisfaction with the working of this Hospital, with the good work of the staff, and my confidence in the management.

Christchurch Mental Hospital. 11th December, 1909. I inspected this Mental Hospital on the 9th, 10th (including a night round), and this morning. Dr Gow who had recently returned from a holiday in Britain, was again m charge. lam glad to find him in excellent health. We discussed various matters requiring attention. The most pressing need at present is for additional single rooms for women, and a site was selected for these. , „ . . , „„ „ , -, o\ My last visit was in August. In the three months' interval 43 patients (males, 30 ; females, 13) have been admitted, 23 discharged recovered (m., 13; f., 10), 7 (m) unrecovered, and 6 (m., 4; f 2) have died; leaving an increment of 7 patients (m., 6; f., 1). Twenty-eight patients (m 24, f" 4) were absent on probation. All the resident patients were seen, and given an opportunity to' speak to me. No rational complaint was made. The number of unemployed is 78 (m At, f 41) • those doing useful work and thereby contributing to their health and happiness numbered 513 (m., 272; f., 241). The recreation of the patients is well looked after. During the visit 1 saw them at cricket, bowls, tennis, and croquet. The staff is working harmoniously. They stand in the following ratio to the patients: Day attendants, 1 to 1030; day nurses, 1 to 1044. I was pleased to find everything in good order. 29th April, 1910. At getting-up time on the 15th I came to see the male patients bathed in the new general bathroom They were put throvgh with great thoroughness and expedition. After being soaped and led under warm showers (temp. 95°) they seemed to enjoy a turn ,n the swimming-bath emp 90°). The time occupied in undressing, bathing (shower and swimming) and dressing an inrHvidual was twenty-four minutes, but, as the patients went through m batches of ten, taking rix Snnl to £?&£, 100 patients were bathed in an hour. The estimated cost for heating the my s tour I inspected this Hospital on the 24th and succeeding days, finishing this evening.

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On the 28th there were resident 606 patients (m., 314; f., 292), all of whom were seen. No rational complaint was made. 1 found the wards clean and tidy, the bedding and clothing in good order and appropriate to the season, and the food of good quality and sufficient. Though a large number of patients are under special care, there was comparative freedom from excitement, Those classed as under special care include 42 epileptics, 9 general paralytics, 10 patients who are actively suicidal, and 16 (not above included) who are regarded as dangerous. Out of 107 who are liable to be wet and dirty, the return on the 25th showed that 11 only were actually so. This speaks well for the nursing staff. As heretofore, the patients continue to be well employed, and to enter largely into recreations and social functions. I heard them sing heartily at the harvest festival service, anfl was present at the fortnightly dance. The building of the block of single rooms for women is progressing satisfactorily. I hope to find them occupied at my next visit, as I know that they will add largely to the resources of the Hospital. Being for a disturbed class of patient, the windows will need to be shuttered; provision has therefore been made, independently of the windows, for free cross-ventilation. The following works, now that accommodation has been attended to, should be put in hand — namely, reservoir for the new well, and a boiler-house for an additional boiler. Dr. Gow and I went over the site selected for the reception-house, measuring the ground and arranging how the gardens, &c, should be laid out. The statutory books were up to date and in good order. During the course of the visit Dr. Gow and I took the candidates for registration as mental nurses in the viva voce part of their examination. Seacliff Mental Hospital. 17th August, 1909. The present inspection has lasted from the 13th until to-day, and during that period I have seen the patients under varying conditions —in-doors and out-of-doors, at meals, at work, and at their recreation, and, as usual, have made night rounds. On the 13th the number resident was 782 (males, 468; females, 314), being 49 (in., 23; f., 26) in excess of accommodation. The surplus number will be absorbed soon, as the additional building —an extension on the east of the main building —is now practically completed. The Camp has not been gazetted as a Mental Hospital, but it is under the supervision of Dr. King. Here patients who can be more easily managed are sent on probation, giving them a change of environment, and relieving the accommodation in the mental hospitals for the more actively insane. I have little to add to my last report. As usual, all the patients were seen, each was given an opportunity to speak to me, and I conversed with many. No rational complaint was made. The health of the patients is good. Their food, clothing, and general comfort is properlyattended to, and all that is included under care and treatment continues to be directed and carried out in a manner which is highly satisfactory. The statutory books are up to date, and are neatly and correctly kept. 23rd April, 1910. I visited this Mental Hospital on the 15th, 16th, 19th, 21st, 22nd, and this morning. During the visit the candidates for registration as mental nurses underwent the viva voce part of the examination. The 22nd was devoted to an inspection of the auxiliary at Waitati, and on the 21st I went to the fishing-station at Puketeraki. I may here mention that I visited the Camp on the 20th, and found everything going on satisfactorily. All the patients there are on probation, and, though the institution is not a part of Seacliff, it is under the medical supervision of Dr. King and his assistants. The number of patients resident at the Mental Hospital on the 16th was 810 (m., 482; f., 328), all of whom were seen during the course of the visit, and given an opportunity to converse with me. No rational complaint was made. The number of patients confined to bed was eight only, and they were being appropriately treated. Their maladies were of an ordinary kind. No patient was suffering from any injury, and there have been no serious accidents since the last visit. The general health of the patients is excellent, They are well clothed and fed, and, considering the number under care, the amount of individual attention they receive is surprising and gratifying. The salient features of the case of each patient to whom I directed attention were readily supplied without reference to case-books, a fact which indicates both the personal and scientific basis upon which treatment is carried out, and doubtless has a large share in the contentment which was manifest. The single-room and associated dormitory accommodation being added to the male side of the main building at my last visit is now completed, and very largely augments the resources for treating disturbed cases. When dormitory space can be spared in the older building, to which the new is attached by a bridge passage, an alteration of windows, such as was carried out successfully in the corresponding women's division some years ago, will be necessary to provide adequate dayroom space. The building known as Simla is managed on the open-door system, all the patients therein being practically on parole. This is very excellent for classification, but has the serious drawback that at the present time there are nineteen vacant beds. I discussed the best way to fill these with Dr. King, and we decided that by collecting them in one pavilion and making that part more secure it would take an intermediate class. The most urgent need at Waitati is an addition of single rooms to the Epileptic Home.

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I went over the farm and discussed questions in relation thereto with Dr. King and the farmmanager. The estate is not an easy one to work; there are many acres of native bush between different parts of the farm which an ordinary settler would burn and put down in grass, a proceeding which the Department could not consider, on account of the duty it owes both the patients and the public to preserve the natural beauty of the locality. It will, however, be necessary to obviate the driving of the milking-herd long distances to the main byre, by adding to the one above Simla. The time for milking-machines has arrived —our herd is distinctly good, is getting progressively better, and it would be unthrifty to reduce it; whereas the available labour is insufficient for the needs of the estate. Inquiring into this, the very general testimony is that the patients are not as good workers as they used to be, and that much useful time is lost-in keeping down the weeds overrunning the estate from Native lands in the neighbourhood. The work at the fishing-station is done on sound principles, and, though extensive, has larger possibilities. The patients thoroughly enjoy fish dinners. The excellent quality of the smoked fish is generally acknowledged. There is here a source of supply for other Government institutions. Much is now sent free of cost, but on provision being made for a regular supply an arrangement could be entered into advantageous to all parties. The staff is working well, and the last-joined officer, Mr. Glanvill, who was promoted from Porirua, is proving himself a good head attendant. Dr. King is ably seconded in his work by Dr. Tizard at Seacliff and Dr. Donald at Waitati.

Hokitika Mental Hospital. 3rd May, 1910. I visited this Mental Hospital yesterday and to-day, going through all parts of the institution, seeing all the patients, and, also, with the Medical Officer, giving the candidates for registration as mental nurses the viva voce part of their examination. The various parts of the establishment were scrupulously clean, and the grounds were in good order. Rain detained most of the patients in the day-rooms, and I was pleased to note complete freedom from excitement. There is a smaller proportion of acute and a larger proportion of patients unfit for employment than the average. This is largely due to the transfers to Hokitika which have taken place from time to time. All the patients had an opportunity to speak to me, and no complaints were made. The following changes have taken place since the beginning of the year, when, including 7 (5 males and 2 females) absent on trial, there were on the register 195 patients (m., 140; f., 55) : Admissions since have numbered 4 only (m., 1; f., 3), 4 patients (m., 3; f., 1) have been discharged (recovered), and 6 have died (in., 4; f., 2); leaving on the register 189 patients (m., 134; f., 55), of whom 5 (m., 3; f., 2) are absent on trial. The actual number resident is therefore 4 fewer than at the beginning of the year. Of those resident, 101 are usefully employed, and only 2 are confined to bed for medical reasons. Eleven patients are subject to epileptic fits, and 1 patient is under special observation. The general health of the patients is good, and it is evident that they are carefully looked after. The amusement of the patients is provided for both by the usual house dances and entertainments, and by outside shows, games, races, &c. As. many as 57 are able to participate in such recreations, and 73 attend Divine service. The statutory books were up to date and in good order. -I am very-satisfied with the state in which 1 found everything.

Nelson Mental Hospital. .. .:.: - 31st May, 1910. I visited this Mental Hospital on the 29th and 30th, and found it clean, tidy, and well ordered throughout. There were resident 178 patients (males, 84; females, 94), all of whom I saw, and conversed with the majority. No complaint as to their comfort or treatment was made, and a number of the more rational testified to the consideration with which they were treated by the officers and staff/ 1 saw the patients at their meals, and noted that the food was varied, of good quality, and abundant. There has been a large addition to the number of women patients. The additional accommodation supplied by the moving and re-erection of the Toitoi Valley School is most suitable. _ The work was carried" out very satisfactorily, and the pleasant, light, airy dormitories are quite a feature of the Hospital. ■ The day-room for disturbed cases —divided in two for better classification —has added largely to the resources of the institution, and the additional day-room accommodation for the wellconducted patients, made by incorporating a small dormitory and passage with the previous dayrOom, and throwing out an octagonal pavillion between the two, provides a large, well-shaped room, allowing the patients to group themselves into little parties distant from each other, while under complete supervision. The inclusion of the nurses' mess-room in the kitchen, the conversion of the bathroom into their mess-room, and the conversion of a verandah into a bathroom, have_ completed the changes incidental to the transfer of a number of the women patients from Mount View.

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Miss Maclean visited on the 25th February, when there was no sickness in the institution, and the course of things was uneventful. Since then the district has been visited by a severe epidemic of influenza, which spread very rapidly among the patients, attacking 39 of their number (m., 9; f., 30). Happily, the staff, who have been unremitting in their attention, entirely escaped. 1 think it is due to Dr. Johnstone, who is acting for Dr. Mackie, to state that all convalescent patients able to appreciate things clone for them spoke to me of his care and attention to their needs at all hours of the day and night. There was a heavy mortality, confined entirely to the chronic insane who were already enfeebled in body from one cause or another. Altogether, 11 patients died (m., 4; f., 7), four of whom were congenital idiots, 1 laboured under chronic mania, and 6 were sunk in dementia. From an investigation of the various cases, I must express my opinion that, considering the refusal to take nourishment and medicine, and the necessity to resort to artificial means not only among those who succumbed but among many now convalescent, the staff is to be congratulated on having done as well as it did. There is no mortuary on the Mental Hospital estate, that at the General Hospital having hitherto served for both institutions. The number of deaths within a limited period has given prominence to this fact, and I agree with the representations which have been made that we should have a mortuary of our own. Mr. Fell, the Deputy Inspector, made a note to this effect when visiting the institution on the 18tn April. I selected a site, and on my return will design a suitable building. The farm continues to be worked skilfully. The land acquired from the College Trustees has been ploughed; and the Valley Farm, to which I was driven by Mr. Chapman, is being worked profitably. The statutory books and registers are neatly kept, were in good order, and up to date. The work of this institution is being carried out faithfully and well.

Porirua Mental Hospital. 17th May, 1910. At this date there are resident 738 patients (males, 377; females, 361), all of whom were seen and many conversed with. During the past year' I have paid several visits of a duration, each time attending to some particular business and going carefully through a section of the building, seeing and conversing with the patients therein. On every occasion I found the place in perfect order. On one of these I was accompanied by Sir John Batty Tuke, of the New Saughton Hall Asylum, Edinburgh, who made the same observation. He also expressed satisfaction with the convenience and completeness of the laundry arrangements. The new building designed for disturbed women is in occupation, and the structural innovations with respect to ventilation and the admission of sunlight into each of the rooms are working satisfactorily. When the grounds in connection with this block are fenced in it will be a very complete and suitable ward for its purpose. The addition lo the auxiliary building for men will soon be ready. Tins Hospital will now tap the whole district south of the Auckland Province, and therefore it must be the first relieved when buildings go up at Tokanui. It has, for the area and quality of its land, just about reached the limit of patients that can be economically managed on the estate. As usual, I found everything progressing well, the food good, proper regard being paid to. the employment and recreation of the patients, great care being exercised in their treatment, and, generally speaking, a spirit of contentment among the patients capable of appreciating their environment. ■ ■ -■ .

- ■:: ■": . - Wellington Mental Hospital. ~;/, 6th May, 1910. --T went his last round of the wards with Dr. Crosby, and saw the 149 patients resident Dr. Crosby -leaves to-day for the Old Country for a well-earned holiday, and to take the opportunity of studying at first" hand the recent advances in his special work. During the past year I have paid numerous visits to the Mental Hospital, and on each occasion found everything progressing Batlß ShS»'ilie removal of the last of the women patients on the 16th April when 49 were transferred to Porirua, the tension as regards management has been much relieved. I .am pleased to record my impres ion that order, cleanliness, and discipline have not suffered from the knowledge that he institution was about to be demolished. This fact speaks volumes for Dr. Crosby s thoroughness and for the support he has received from his officers and staff; for the shghtest slackness ■Shtf under the ci/cumstances,. have proved a demoralizing influence past recall The patients mi this and former occasions have expressed their regret that Mount View was being closed, a sentiment which must be very gratifying to those who have cared for them. Bth June, 1910. -- 0 On the 2nd instant with Dr Elliott who has bee. wUh a stS, toTt'ore teniae, .Ac. So far as their help is concerned tilt and I have just seen them depart for Porirua, and. close the history of Mount View as a Mental Hospital.

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Ashburn Hall Licensed Mental Hospital. 23rd April, 1910. I visited this Mental Hospital on the 18th and 22nd, on the second date examining the candidates for registration as mental nurses. number of patients on the 18th was 51 (males, 27; females, 24), of which number 9 (m., 2; f., 7) were voluntary boarders. I spoke to all, and became the recipient of numerous expressions of good will towards the staff and management. No rational complaint was made. Indeed, the homelike aspect of the different units which compose the Hospital was intensified by the complete absence of noisiness and obtrusive supervision. I came upon little groups doing needlework, playing games, reading, writing, or otherwise occupied, with the supervising members of the staff taking part in the social life. This is a tribute to the example and administration of Dr. Alexander and Mrs. Milne, the Matron. The buildings were neat, clean, well furnished, and in excellent order, and the beautiful grounds continue to be well kept. At each visit one finds pieces of furniture replaced, buildings repainted, rooms repapered, and additions made for the comfort and convenience of the patients, giving evidence of a desire on the part of the proprietors to anticipate recommendations. The outdoor occupations and recreations are well considered. Quite a number of the patients play golf, tennis, and croquet. The value of fresh air in treatment is appreciated by keeping the patients out-of-doors as long as possible, and by having the living and bed rooms well ventilated. The food inspected was of good quality and was well served. As serving to show that refinements do not escape attention, in order that the breakfast bacon may be palatably thin a proper cutting-machine has been installed. Of matters, since the last visit, calling for report, such as casualties, the use of restraint, &c, history has been uneventful. The case-books continue to demonstrate the scientific manner in which treatment is carried out, and these and the other statutory books and registers are well kept and up to date.

MEDICAL SUPERINTENDENTS' REPORTS. AUCKLAND MENTAL HOSPITAL. Sir, — 1 have the honour to submit my report for 1909. Our population has increased during the year by 10 only. This was due chiefly to the decreased admissions, which totalled 155, of whom 102 were males and 53 females. It is fortunate that the number of admissions was so much reduced. It is not to be expected, however, that this lessened rate will be repeated during the coming year. I desire to draw your attention to the large numbers of both male and female refractory patients in this Hospital, and the necessity for "more adequate accommodation for this class. In this connection, too, I trust that at some early date an institution will be established fairly contiguous to our mental hospitals and under the same control where the mentally infirm and others less actively insane can be placed. We have a number of patients permanently resident, some hovering on the border-line, some subject to frequent relapses, and, while under institutional care, apparently normal between their attacks, but all of whom are incapable of earning their own livelihood beyond the reach of sympathetic and often expert supervision. These patients could be managed in a simpler institution, where there could be a general relaxation of that supervision and discipline which must necessarily be associated with a mental hospital, and where they would, under proper guidance, contribute largely towards their own support, On retrogression, or relapse, such patients could be replaced without formality in the mental hospitals, with which all along they would be nominally associated. I am convinced that such an institution would fill a want and lead to economy in administration. The chief contributing causes of the year's insanity were heredity (284 per cent.), alcoholism (142 per cent. —only 2 females), senility (B'4 per cent.), and epilepsy (sB per cent.). Of the males admitted, 29 were labourers, 9 were gum-diggers, 9 of no occupation, and 8 farmers. The other trades and occupations contributed only in units. Of the 53 females admitted, 49 were engaged in domestic duties. Of the males, 35 were married and 59 single. Of the females, 29 were married and 15 single. Deaths. —Males, 42; females, 17: an average on the number resident of S'OI per cent. The chief causes were senile decay, 10; tuberculosis, 9; general paralysis, 7. One death was due to typhoid fever. For some years past we have had one or two cases of typhoid in each year. The disease, however, has never assumed even a mild epidemic form. Recoveries. —Males, 50-9 per cent, ; females, 604 per cent: an average total of 543 per cent. There have been some serious accidents during the year, but no fatalities as a consequence. The usual outdoor work has been carried on successfully. Next year the Wolfe Home will engage a good deal of my attention. The staff has worked harmoniously and well. I gratefully acknowledge the help received from the Deputy-Inspector and Official Visitors, and also from the higher officers of the staff.

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Our thanks are due to the Herald proprietors for a gratuitous supply of daily papers; to Mr. Macpherson for controlling the religious services; and the many ladies and gentlemen who have contributed towards the patients' amusements. I have, &c , The Inspector-General, Mental Hospitals, Wellington. X- M. Beattie.

SUNNYSIDE MENTAL HOSPITAL. I have the honour to furnish my annual report for the year 1909. In the first place, I have to record my thanks to the Government for my leave of absence, and am pleased to say that I feel greatly benefited by the relief from duty and the holiday in the Old Country On my return I found the institution in the good order in which I anticipated it would be under Dr Gribben's management, and take this opportunity of thanking Dr. Jeffreys and the staff for their loyal support of Dr. Gribben in the arduous duty of acting as locum tenens. No new building was carried on in my absence-only repairs and finishing of work which had been begun The new dairy and cowsheds were brought into commission, and are now working satisfactorily, and are a pleasure to see. The Shorthorn cows are giving good records, and after a year or two's culling 1 feel confident that we shall have a herd worthy of the traditions of Sunnyside The mothers' records have been so good that I have experienced no difficulty in disposing of the young bulls from them and our imported dairy bull. The time has now come for a further importation, and, from the prices received for our stock, I am in a position to recommend a further ° Utla The deep°weli e has been sunk, and I should like to see the cistern erected without delay, as there is a supply of splendid water now running to waste. Th P e P new baVooms are in use, and, as both the Minister m Charge seen are -iving satisfaction to the staff and pleasure to the patients. The whole bathing ariange-mente-showering, soaping and washing, reshowering, and then the tepid swimming-bath-insu,-e perfect cleans ng and healthy exercise, and I am assured by the attendants that bathing the patients has blrne a plLsure, as far as the behaviour of the patients is concerned, as compared to former condTt ons The patents like it, and, in fact, have to be watched to «c that they do no slip in for second turn The bathing is got through on two mornings weekly before breakfast and 100 patients are bathed per houi- 8 at an estimated cost in coal-consumption of ss. for each bathmg"Owhig to the extension of. the hot-water system, extra machinery in shop, &c, and an extra boiler become an urgent necessity. . previous year At the end of the year we had 627 patients, being an increase of 24 ovei the previous Ttere were 129 admissions during the year, and 66 recoveries, giving a percentage of slightly ° Ver There were 31 deaths which gives a percentage of 54 on the average number resident. TnHsual religious.services and the patients'"entertainments have been carried out throughout ° 1 have, &c, the )' ear - W. Baxter Gow, M.D., Medical Superintendent. The Inspector-General of Mental Hospitals, Wellington.

SEACLIFF MENTAL HOSPITAL. Mental Hospital, Seacliff, 18th June, 1910. blB '~ I have the honour to submit the following report on the Seacliff Mental Hospital for the h6ad Sout some fuller comment, the citation low death-rate and a low mental-recovery rate wonld be Jg^ l^ en ' tir6 i y w Wg sion would be formed of ,erygream = incidence 7 B few words may be said regarding the factors admis-sion-rate, death-rate, and discharge-rate. ; _ (1.) The Admis.on.rate is really increasing, but this is our Institutions are year by year being made mo TZented on as a formerly have been kept by their friends and fLt a iust one. In my experience reflection on the natural guardians; but this just troublesom6 rela .

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either for the patients themselves or for the rest of the family, and very often the pressure comes trom neighbours, who resent the presence in their midst of persons whom they regard as obiectionable and dangerous. ' J On the other hand, as the growing amenities of mental hospitals become year by year more obvious to the public, the prejudice against placing- patients under the care of the State becomes less and less This is particularly noticeable in the case of old, infirm, or hopeless patients, hut unfortunately does not apply appreciably to the care of recent and curable cases of mental illness Here the dominant consideration in the minds of friends, and to a large extent of the medical profession itself, is, as it always has been, "Is there any chance that the patient will recover in the course of a few months if kept outside an institution, because, if so, home treatment would be preferable tor the rest of the family—indeed, preferable to all concerned." The recovery of a patient m the course of a few weeks or months in a mental hospital is rarely accepted by relations m the proper spirit Instead of realizing that a total change of environment has proved highly beneficial, and has hastened if not determined recovery, they are inclined to turn on the family adviser and say, " If you had been a little more far-seeing "and patient we should all of us have been spared this humiliation." As long as acknowledged derangement of the bodily organ called the brain is regarded as discreditable, while derangement of any other organ is regarded as interesting and respectable, institutions dealing with so-called "mental disease" will always be confronted with the initial difficulty of rarely receiving patients until their malady has been long established, and has usually reached the stage of being regarded as almost if "not ouite hopeless.. l ' . (2.) The Death-rate, of course, gives some indication as to the general health of survivors the average bodily health of the inmates lias been good, the total deaths being only 43—that is per cent, on the patients under care and treatment, or less than 5J per cent on the average population. Two-thirds of the patients who died were over fifty years of age, 10 were between seventy and eighty, 1 was eighty-one, and another eighty-four. Eight were "general paralytics." (3.) The Discharge-rate of patients relieved and recovered for 11)09 (viz 67 out of 181 admissions) is about 10 per cent, below the average, in spite of the fact that the recovery-rate of women was above the average. The low recovery-rate for males is easily accounted for ' During the year 20 utterly hopeless male patients suffering from dementia of many years' standing were transferred to Seacliff from other mental hospitals. Properly speaking these should not count as new admissions, since if the intake were composed solely of such patients our recovery-rate would obviously stand at nil—just as it does in any hospital for incurables. Apart from the transfers, the other main factor responsible for the low recovery-rate for males is the direct admission of an unusually large proportion of absolutely hopeless cases as will be seen by the following analysis :— Out of 110 male patients admitted during 1909 there were, 20 transfers of absolutely hopeless demented cases of long standing from other mental hospitals. 15 general paralytics—all necessarily hopeless. 12 hopeless chronic alcoholic dements of long standing. 12 senile dements ranging from sixty to eighty-four years of age. Of these, one improved sufficiently to be able to return, to the care of his family. 8 hopeless cases of fixed delusional insanity of years' standing. 8 hopeless chronic epileptics. 6 imbeciles and idiots, either born defective or whose mental development had become — arrested in childhood. Total, 81. Of. the remaining 29 admissions, 2 were fatally ill with cancer and pernicious anasmia respectively, leaving 27 cases from which to draw possible recoveries. Twelve out of this 27 were readmissions—patients who had been previously under institutional treatment from once to six times. When it is considered that some of the balance of 15 "first admissions" were of more or less hopeless types (dementia prsecox, long-standing chronic insanity, &c), it will be realized that, notwithstanding the high admission-rate of 110 males, the year's' intake afforded singularly little scope for recovery—indeed, had it not been for "recoveries" or "improvements" drawn from the previous year's admissions, the discharge-rate would have shown still lower. On the other hand, some of the 1909 cases are of course recovering in 1910. As a mere coincidence it happens that the recoveries among women stand higher for 1909 than during any preceding year —viz., just on 60 per cent, of the admissions. Reviewing the destiny of all patients who are brought to the Mental Hospital, it is clear (when every allowance has been made for the admission of an exceptionally 1 hopeless type of males during the past year) that the average prospect of persons certified as insane in advanced states of mental disease (as is usually the case) is poor indeed. Every year of experience impresses one more and more with the conviction, that, while in the vast majority of cases early admission to mental hospitals affords the only means of doing justice to the insane, the main hope of keeping down. the number of insane in our population lies ultimately in prevention. As long as the comparatively simple chronic degenerations of the spinal cord' remain, as they still are, incurable, and for the most part little affected by " treatment," we have no reason to anticipate much success when dealing with organic affections of the infinitely more delicate, complex, and vulnerable brain-tissues—affections for the most part slowly and insidiously led up : to by of ill health and injudicious living acting on nervous systems lacking the average of initial nutritive and resistive powers,

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It appears to me that the efficacy and importance of preventive measures cannot be too strongly impressed on parents and guardians, since they can make or mar the power of control and indeed the whole mental and moral destiny of the children intrusted to their care just as surely as they can determine their bodily health and fitness—largely, indeed, by the same means How many parents realize that most cases of epilepsy in adults are found to have been preceded by convulsions in infancy, or by incontinence of urine—in other words, by nervous explosions and irritabilities induced mainly by wrong feeding and otherwise careless or ignorant rearing ! How many parents grasp the fact that early indigestion robs the organism of power of control in every direction in after-years, and is a prime factor in the vices of puberty and adolescence, besides rendering the individual an easy prey to vice and insanity throughout life ' Education m parenthood offers, I submit, the main hope for the reduction of insanity. The clear conclusions bearing on the above, which 'are set forth in Professor Lugaro's remarkable and authoritative book ("Modern Problems in Psychiatry": Manchester University Press, 1909) appear as hopefuFas they are convincing. After dwelling on the widespread havoc wrought m the brams of children by parental alcoholism and syphilis—generally regarded as the leadingscourges of the nervous system—Professor Lugaro says, "The infections which arise in the first years of life, and especially the inflammations of the gastro-intestinal tract—the result of unsuitable alimentation during the lactational period—are the most important factors in determining the majority of cerebropathies, and in this way a crowd of idiots, imbeciles, and epileptics is produced, who encumber, asylums and are an. enormous drain on the internal economy of the country, as also on public charity. All measures directed towards favouring natural maternal feeding, and providing the poor with the means for carrying out artificial feeding according to the most rational methods, form the best means of prophylaxis against the infantile cerebropathies. In the most civilized nations ... the movement in favour of the use of prophylactic means is very strong and steadily growing. In fact a notable reduction in the infantile mortality has been.effected, and along with this a diminution in the number of the deformed, and of children physically and mentally weak from earliest infancy." The following paragraph taken from my official report of four years ago still expresses what appear to me to be the most important considerations for the mental well-being and efficiency of the race:— " If women in general were rendered more fit for maternity, if Instrumental deliveries were obviated as. far as possible, if infants were nourished by their mothers, and boys and girls were given a. rational education, the main supplies of population for our asylums, hospitals, benevolent institutions, gaols, and slums would be cut off at the sources. Further, I do not hesitate to saythat a very remarkable improvement would take place in the physical, mental, and moral condition of the whole community." There has been no serious accident or casualty of any kind during the year. The steady increase of our population demands more ample accommodation in the way of day-rooms. Such additions as could be made to the existing buildings by the ordinary artisan staff of the institution have been effected year by year, but something more adequate is needed at the present time. Another highly desirable improvement, long under contemplation, is the erection of a separate cottage for male patients, similar to the one built for the women some fourteen years ago. The retreat at Waitati serves its purpose, but the above is wanted at Seacliff to give to men the advantage so long possessed by the women patients. The two new wings at Seacliff supply bedroom-space which was much needed, but the increase of our patients by sixty-six in the course of the year makes it necessary that we should have further sleeping accommodation for women patients and nurses, the nursing staff having quite outgrown the accommodation in the Nurses' Home. The branch institution at Waitati has proved a great advantage by affording the means of further dividing and classifying male patients. The farm, garden, and fishing-station continue to supply a large proportion of the food needed at the institution, and in some directions there is an ample surplus. The progressive development of the fishing-station promises to satisfy not only all our own needs, but also those of other Government institutions in the South Island. Arrangements have now been, made whereby it is estimated we can insure an average catch of a quarter of a million pounds of fish per annum". Our largest return hitherto has been 100,0001b. By means of salting, smoking, and freezing there will be no difficulty in making regular and varied provision not only during the summer, but also throughout the winter. We have at present 13 tons of fish stored frozen at Port Chalmers. The annual expenditure per patient at Seacliff appears somewhat high owing to several misleading factors. Thus the Waitati institution is included under the Seacliff returns, and the nominal cost per patient at Waitati is more than double the cost at Seacliff. This is due to the fact that a great deal done at Waitati in the way of development and permanent improvements is being charged under the. head of annual expenditure. Further, the cost per head at the smaller institution is necessarily much higher than at the larger one, a matter which will adjust itself as the number of patients at Waitati increases. The inclusion of Waitati in the Seacliff accounts makes the expenditure at the latter institution appear more than £2 a head higher than it really is, though even at Seacliff a number of minor permanent improvements and additions have been provided for as usual out of annual expenditure during the year. The exigencies of rapid increase of population make it necessary not only to keep pace in the way of maintenance, but also in the way of extensions and additions in all directions, and, while this necessary expansion and development going on all the time is 3-ear by year greatly enhancing the capital value of the estate and premises, there is no provision for showing this in any waj in the annual returns. As for repairs, the buildings for the most part are not merely kept from

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depreciating —they are being made constantly more and more sound, sanitary, and serviceable by the steady replacement of work, inadequate in the first instance, by suitable permanent structures and provisions. ' Thousands of pounds have had to be spent in ventilation and drainage-works, sanitary appliances, &c, and hundreds of pounds are spent every year in providing galvanized-iron ceilings as the original plaster falls from the laths. Similar expenditure has had to bo incurred in connection with bathrooms and closets throughout the main building, the wooden floors having rotted away and been replaced with concrete. Regular religious services have been held by the various denominations throughout the year. The thanks of the authorities are due to the Otago Daily Times and Witness Company and to the Evening Star Company for newspapers and journals supplied free. To Dr. Tizard and to the other officers and members of the staff 1 wish to express thanks for hearty co-operation in carrying out the work at Seacliff; similar thanks are due to Dr. Donald and the staffs at Waitati and the Camp. I have, &c, The Inspector-General of Mental Hospitals, Wellington. F. Trubt King

PORIRUA MENTAL HOSPITAL. Sm Mental Hospital, Porirua, 6th June, 1910. I have the honour to submit the following report on this Mental Hospital for the year 1909. The total number of patients under care was 861, and the average number resident 653 (350 males and 303 females). Leaving out of account the transfers between this and other mental hospitals, of whom 26 came from Wellington in October last to replace a similar number sent from here to Nelson Mental Hospital, it will be observed that the admissions amounted to 176, of whom 35 were readmissions. Eighty-four patients were discharged recovered, a ratio of 477 per cent, to the number admitted; while 40 died, making a death-rate of a little over 6 per cent. (6T2) of the average number resident. As compared with the previous year the above figures show an increase of 40 patients in the average number resident, and an increase of about 20 per cent, in the number admitted. . This, however, may be partly accounted for by the restriction of the admissions to the sister institution at Mount View in anticipation of its being closed. In reviewing our statistics and comparing one year with another, it has been impossible in the past to come to any definite conclusions, owing to the fact that the districts served by us and the Mental Hospital at Mount View have had no definite dividing-line. I anticipate a large increase in the admissions in the immediate future—at any rate, until the.new Mental Hospital in the North is established and ready to receive patients. With the disappearance of Mount View Mental Hospital the district which the Porirua institution will serve will comprise the whole of the North Island excepting the Auckland Province, as well as Marlborough in the South. I view the position, with some anxiety. The wards here are already full, notwithstanding the recent additions to our accommodation, which unfortunately will be fully occupied by the patients from Mount View when, the last of them come from there. Our position will then be that we shall have upwards of forty patients more than we have convenient accommodation for, and I fear that the position will be considerably accentuated before the end of the year 1910.' The general physical health of the patients has been satisfactory, and no serious accident has occurred excepting in. the case of a female patient who escaped in June and was found drowned about three weeks afterwards. The circumstances of that unfortunate occurrence were supplied to you at the time. The policy of work for all who can be induced to follow some useful occupation has been consistently followed. This has resulted in a very satisfactory production from our farm, gardens, &c, as the returns forwarded to you will show.' But the value of the work done appears to me of less'importance than the physical and mental health which the patients gain by the labour involved. No important change has taken place in. the staff. I am fortunate in having, the assistance of capable and experienced senior officers. Dr. Scannell was Acting Assistant Medical Officer for the greater part of the year, and towards its end Dr. Jeffreys returned to duty here from the Christchurch Mental Hospital. I am. pleased to say that the Church of England vicar of this parish has undertaken to conduct services at the Hospital on two Sundays each month, thereby relieving the Primitive Methodist clergyman who for several years has acted as sole honorary chaplain. l haye ' &c -' The Inspector-General, Mental Hospitals, Wellington. Gray Hassell.

WELLINGTON MENTAL HOSPITAL. a • Mental Hospital, Wellington, sth May, 1910. I have the honour to submit the last report on the Mount View Mental Hospital, containing the statistics for 1909 and those for the first four months of 1910. At the beginning of 1909 the Government announced its intention of doing away with this Mental Hospital, and of building a new one on a site selected in the country. The wisdom of

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this step is obvious when one considers the decayed condition of many parts of the building, the great risk from fire, and the restricted avenues of employment that are available for the patients. Mount View was built in 1873, and received the patients from the old Karori Asylum. The site for the building had been prepared by prison-labour during the preceding year. The building was completed by May, 1873, and gave accommodation for 28 males and 28 females. As the number transferred from Karori was 39 men and 31 women, one sees that overcrowding was experienced in the early days. As time went on, increased accommodation was built until the total provided was approved for 139 males and 88 females. The yearly admissions show a rough gradual rise till 1898, when the maximum of 143 for the year was reached. In all, 3,142 patients have received treatment here during the last thirty-six years. Of these, 2,401 have been discharged under the headings of— recovered, 1,312; relieved, 346; not improved, 743; and 513 have died. Up till 1884 the institution was under the management of a lay Superintendent, and was visited daily by the Prison Surgeon. In that 3-ear Dr. E. G. Levinge was appointed Resident Medical Superintendent, and he remained in charge until 1887. He carried out much work of reorganization, in order to place Mount View on an equality with institutions of similar nature in Great Britain. On Dr. Levinge's promotion in 1887 to the charge of Sunnyside he was succeeded here by Dr. Radford King, who remained in charge for one year. In 1888 Dr. Gray Hassell became Medical Superintendent. It was owing to his foresight and grasp of the future requirements of the institution that much work of an important and practical nature was carried out. The value of this work —road and reservoir making, the laying-out of gardens and airing-courts for the patients—must have been as greatly appreciated by Dr. Hassell's other successors as it has been by myself. Following Dr. Hassell on the list of those who have been in charge at Mount View come the names of Dr. Ernest Fooks, now deceased, and Dr. Baxter Gow, now of Sunnyside. From the homelike character of its interior, lacking as it does much of the formally institutional, Mount View has found many friends among its inmates. Its passing-away is accompanied by feelings of sorrow and regret among all members of its staff. To revert to the statistics for 1909, I find that at the beginning of the year there were 249 patients under care, and at the close there were 205, 4 men and 47 women having been transferred to other institutions. The average number resident was 239. Fifty-two patients were admitted, 12 of whom were readmissions ;10 patients died, making a death-rate of slightly over 4 per cent. One man, liberated on trial after a year's care, committed suicide by hanging. In addition to the admission of certified cases, 24 persons whose sanity was in question were admitted on the Magistrates' warrant for a short course of treatment : 9 of these were discharged, and 13 required to be certified as insane. The general health of the community was again good, and no untoward occurrence took place. The work of the institution, especially at the end of the year and for the first four months of 1910, was restricted to a great extent both by the building operations for the Governor's residence and by the fact that Mount View was shortly to be closed. Nevertheless I have to acknowledge with thanks a large amount of good work done by the officers and members of the staff. Much work of an unusual nature in connection with the closing of the institution has devolved upon the clerk. lam much indebted to Mr.-Wells for the capable and energetic way in which he has carried this out. I hope some means may be found of retaining his services for our Department. I have, &c, The Inspector-General, Mental Hospitals, Wellington. Arthur Crosby.

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APPENDIX.

Table I.—Showing the Admissions, Readmissions, Discharges, and Deaths in Mental Hospitals during the Year 1909.

Table II.—Admissions, Discharges, and Deaths, with the Mean Annual Mortality and Proportion of Recoveries, &c., per Cent. on the Admissions, &c., during the Year 1909.

M. F. In mental hospitals, 1st January, 1909 Admitted for the first time .. .. .. .. 363 23' Readmitted .. .. .. .. .. .. 84 13! M. F. T. M. P. T. 1,997 1,417 3,414 363 84 237 139 600 223 j 447 376 823* Total under care during the year Discharged and died— Recovered .. .. .. .. .. .. 179, 171 Relieved .. .. .. .. .. .. 17 2! Not improved .. .. .. .. .. ,. 29 6' Died .. .. .. .. .. .. 136 61 179 17 29 136 170 22 67 68 349 39 96 204 2,444 1,793 4,237 361 327 688 Remaining in mental hospitals, 31st December, 1909 2,083 1,466 3,549 Increase over 31st December, 1908 86 49 1.35 Average number resident during the year 1,970 1,404 3,374 ♦Transfers.—28 males, 79 females; total, 107.

Admissions in 1909. Mental Hospitals. In Mental Hospitals on 1st January, 1909. Total Number of Patients under Care. Admitted for the j First Time. Readmitted. Total. M. F. T. Auckland.. .. .. ! 452 285 737 mristchurch .. 324 279 603 Dunedin (Seacliff) .. ... I 450 313 763 Hokitika .. .. .. I 146 59 205 kelson .. .. .. 91 61 152 3 orirua .. .. .. j 355 303 658 Wellington .. ..153 96 249 lshburn Hall (private mental : 26 21 47 hospital) : Totals .. .. 11,997 1,417 3,414 .1 M. F. 89 46 63 43 79 54 12 9 11 0 86 55 19 21 4 9 T. 135 106 133 21 11 141 40 13 M. 13 17 31 2 12 5 4 F. 7 6 17 51 50 7 i. T. 20 23 48 53 62 12 5 M. F. T. 102 53 155P) 80 49 129( 2 ) 110 71 181( 8 ) 12 9 21 13 51 64(4) 98 105 203( 5 ) 24 28 52( 6 ) 8 10 18(7) M. 554 404 560 158 104 453 177 34 F. 338 328 384 68 112 408 124 31 T. 892 732 944 226 216 861 301 65 363 237 600 84 139 223 447 376 823( 8 ) 2,444 1,793 4,237 Mental Hospitals. Discharged recovered. Patients disc] larged and died. Total discharged and died. In Mental Hospitals on 31st December, 1909. Discharged not recovered. Died. M. F. T. oickland .. .. .. 52 32 84 Jhristchurch .. .. 39 27 66 )unedin (Seacliff) .. .. 18 39 57 lokitika .. .. .. 7 8 15 Ielson .. .. .. 4 0 4 'orirua .. .. .. 46 38 84 Wellington.. .. .. 11 19 30 Lshburn Hall (private mental 2 7 9 hospital) ■ Totals .. ..179 170 349 M. F. T. 2 0 2 8 0 8 11 4 15 12 3 0 2 2 13 29 42 4 47 51 7 5 12 M. 42 20 31 10 3 23 7 F. 17 11 12 3 5 17 3 T. 59 31 43 13 8 40 10 M. 96 67 60 18 7 82 22 9 F. T. 49 145 38 105 55 115 13 31 7 14 84 166 69 91 12 21 M. F. 458 289 337 290 500 329 140 55 97 105 371 324 155 55 25 19 T. 747 627 829 195 202 695 210 44 179 170 349 46 89 135 136 68 204 361 327 688 2,083 1,466 3,549 Mental Hospitals. Average Num resident dur: the Year. iber ing Percentage of Recoveries on Admissions during the Year. Pe Deat] Nun dur: 3rcentage of ;hs on Average nber resident •ing the Year. Percentage of Deaths on ;he Admissions. .uckland 'hristchurch .. )unedin (Seacliff) lokitika Jelson 'orirua Wellington .shburn Hall (private mental hospital) Totals M. 454 297 460 141 89 350 154 25 F. 282 277 313 53 70 303 86 20 T. 736 574 773 194 159 '653 240 45 M. F. T. 51-49 60-38 54-55 52-00 55-10 53-23 19-78 59-09 36-31 58-33 88-89 71-43 33-33 .. 23-53 46-94 48-72 47-73 45-83 70-37 58-82 33-33 70-00 56-25 M. F. T. 9-25 6-03 8-02 6-73 3-97 5-40 6-74 3-83 5-56 7-09 5-66 6-70 3-37 7-14 5-03 6-57 5-61 6-13 4-55 3-49 4-17 M. F. T. 41-58 32-08 38-31 26-67 22-45 25-00 34-07 18-18 27-39 83-33 33-33 61-90 25-00 100-00 47-06 23-47 21-79 22-73 29-17 11-11 19-61 1,970 1,404 3,374 42-72 57-24 . 48-74 6-90 4-84 6-05 32-46 22-90 28-49 Transfers.—(1) 1 male. (2) 5 males. (8)Total: 28 males, 79 females. (3) 19 males, 5 females. (4)1 male, 46 females. (5) 27 females. ( 6 )1 female. (1)2 males.

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Table III.—Ages of Admissions.

Table IV.—Duration of Disorder on Admission.

Table V.—Ages of Patients discharged "Recovered" and "Not recovered" during the Year 1909.

Ages. Auckland. Christchurch. Dunedin TT„iH«t« (Seacliff). H °kitika. Nelson. | Porirua. Ashburn Wellington. M.H.). Total. Under 5 years From 5 to 10 years „ 10 „ 15' „ „ 15 „ 20 „ „ 20 „ 30 „ ., 30 „ 40 „ , 40 „ 50 „ „ 50 „ 60 „ , 60 „ 70 „ „ 70 „ 80 „ Upwards of 80 „ Unknown M. F. T.I 1 0 1 M. F. T.I Oil 112 M. F. T. M. F. T. M. F.-T. M. F. T. M. F. T. M. F. T. M. F. T. 112 3 2 5 13 4 19 16 35 89 83 172 110 107 217 93 62 155 66 49 115 27 33 60 31 7 38 7 5 12 0 8 8 112 112 24 12 36 25 20 45 21 8 29 15 7 22 2 3 5 9 0 9 3 14 4 15 16 9 25 19 10 29 12 12 24 14 5 19 6 7 13 7 2 9 112 1 0 1 0 11 2 4 6 24 19 43 28 18 46 26 7 33 15 14 29 6 6 12 5 2 7 3 0 3; 12 3 3 3 6 2 3 5 10 1 4 0 4 112 12 3 2 5 7 3 12 15 2 7 9 2 9 11 0 8 8 3 0 3 10 1 Oil 10 8 18 14 26 40 26 28 54 22 19 41 14 12 26 7 8 15 4 0 4 0 3 3 o i l 1 o 1 8 8 16 6 10 16 6 4 10 2 2 4 Oil 12 3 0 2 2 0 6 6 2 2 4 3 0 3 2 0 2 10 1 0 'k 8 Totals .. 102 53 1551 180 49 129 110 71 181 112 9 21 13 51 64 98 105 203, 24 28 52 8 10 18 447 376 823

Auckland. <g** . Ashburn (Beachfl" Hokitika.i Nelson. Porirua. Wellington. {F f^ te M.H.). Total. Mrst Class (first attack, and within 3 mos. on admission) lecond Class (first attack, above 3 mos. and within 12 mos. on admission) 'hird Class (not first attack, and within 12 mos. on admission) 'ourth Class (first attack or not, but of more than 12 mos. on admission) Inknown M. F. T. 51 23 74 M. F. T. 40 18 58 M. F. T. 28 22 50 M. F. T. M. F. T. 10 2 12 6 0 6 M. F. T. 53 40 93) I M. F. T. J 15 15 30 M. F. T. 17 8 M. F. T. 204 127 331 23 9 32 3 6 9 13 7 20 10 110 1 11 11 22 112 3 1 4 56 35 91 9 5 14 20 13 33 19 13 32 1 5 6; 4 5 9 23 36 59 5 7 12 112 82 85 167 11 11 22 15 12 27 50 29 79 0 2 2 2 46 48] 111 18 29 3 5 8 3 1 4 95 124 219 8 5 13 2 0 2 10 5 15 Totals 102 53 155 80 49 129 110 71 181 12 9 2113 51 64=1 I I m 105 2031 [ 24 28 52 8 10 18 447 376 823

Ages. Auckland. Christchurcb. Recovered j rec^rea j Recovered| reo^ed Christchurcb. Recovered „„ Not . recovered Dunedin (Seacliff). Hokitika. Recovered Not recovered M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. From 5 to 10 years „ 10 „ 15 „ „ 15 „ 20 „ „ 20 „ 30 „ „ 30 „ 40 „ „ 40 „ 50 „ „ 50 „ 60 „ „ 60 „ 70 „ „ 70 „ 80 „ Upwards of 80 Unknown 1 1 2 9 7 16 23 10 33 8 9 17 10 5 15 1 0 1 1 0 1 112 8 5 13 11 10 21 8 4 12 9 3 12 2 3 5 0 11 1 0 1 3 0 3 3 0 3 8 12 20 2 16 18 3 5 8 2 4 6 3 2 5 112 2 2 4 2 13 2 0 2 2 4 6 3 2 5 0 11 112 1 2 3 10 1 1 0 1 10 1 2 0 2 10 1 1 0 1 Totals 52 32 84 2 0 39 27 66 8 0 8 18 39 57 11 4 15 7 8 15 12 3 Nelson. Pori: •ua. Weill igton. Ashburn Hall (Private M.H.). To, ;al. Ages. Re- | Not recovered, j covered. Recovered. | Not recovered. Recovered. Not •ecovered. Re- '\ Not recovered, covered. Recovered. Not recovered. M. F. T. M. F. T. M. F. TM. F. T. M. F. T. kt. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 'rom 5 to 10 years „ 10 „ 15 „ . 15 „ 20 „ „ 20 „ 30 „ „ 30 „ 40 „ „ 40 „ 50 „ „ 50 „ 60 „ „ 60 „ 70 „ „ 70 „ 80 „ ipwards of 80 „ Jnknown 3 0 3 0 1 1 0 11 10 1 6 2 8 14 9 23 12 7 19 9 10 19 3 7 10 12 3 0 11 12 3 4 6 10 3 7 10 4 9 13 15 6 Oil 4 5 9 2 8 10 3 2 5 2 1 3 Oil 13 4 0 7 7 1 14 15 16 7 0 11 11 13 4 0 2 2 0 2 2 12 3 Oil 112 0 1 1 Oil 2 2 4 3 2 5 1 0 1 1 0 1 10 1 8 5 13 45 44 89 54 55 109 31 32 63 31 22 53 7 8 15 2 4 6 0 1 1 2 5 7 4 12 16 10 24 34 13 17 30 8 20 28 5 8 13 2 2 4 2 0 2 10 1 0 2 2 Totals 4 0 4 0 2 2 46 38 84 13 29 42 11 19 30 4 47 51 2 7 9 7 5 1: 179 170 349 46 89 135

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Table VI.—Ages of the Patients who died.

Table VII.—Condition as to Marriage.

Ages. I j I Auckland. Set j (SeTlfft? I hokitika. j Nelson. I j I Porirua. :Wellington. Ashburn I Hall (Private M. H.). Total. 'rom 5 to 10 years „ 10 „ 15 * „ „ 15 „ 20 . „ 20 „ 30 „ „ 30 „ 40 „ , 40 „ 50 „ „ 50 „ 60 „ „ 60 „ 70 „ „ 70 „ 80 „ fpwards of 80 Inknown | M. F. t. : j j 1 0 1 I 13 14 1 I 8 2 10 • 5 3 8 : 9 1 10 ■ 9 716 3 0 3 M. F. T. I M. F. T. Oil 2 0 2 j 0 1 1 0 3 3 ! 2 0 2 2 13 3 0 3 6 3 9 4 3 7 1 1 2 : 11 2 13 4 3 7 2 3 5 5 0 5 : 8 2 10 j 1 0 1 M. F. T. oil oil M. F. T. 2 02 M. F. T. 10 1 10 1 2 0 2 4 3 7 4 3 7 7 4 11 15 6 3 1 4 0 11 M. F. T. 0 11 1 1 2 2 13 M. F. T. M. F. T. .. 11 2 0 1 1 14 1 5 .. 7 5 12 : 16 9 25 24 12 36 I 25 10 35 19 13 32 33 15 48 7 18 10 1 10 1 5 16 3 0 3 Oil 14 5 2 0 2 2 0 2 Totals 42 17 59 20 11 31 | 31 12 43 :10 3 13 3 5 8 23 17 40 7 3 10 1136 68 204

Admissions. . Discharges. Deaths. Auckland— Single Married Widowed M. F. T. 59 15 74 35 29 64 8 9 17 M. F. T. 33 12 45 20 19 39 112 M. 14 18 10 F. T. 5 19 5 23 7 17 Totals 102 53 155 54 32 86 42 17 59 Ghristchurch — Single Married Widowed 48 21 69 28 18 46 4 10 14 32 7 39 13 19 32 2 13 4 12 4 5 9 4 16 2 6 Totals 80 49 129 47 27 74 20 11 31 Dunedin (Seacliff) — Single Married Widowed 83 37 120 20 28 48 7 6 13 17 23 40 12 16 28 0 4 4 14 12 5 2 16 7 19 3 8 Totals 110 71 181 29 43 72 31 12 43 HOKITIKA— Single Married Widowed 7 3 i 2 6 1 9 9 3 4 2 2 5 4 1 9 6 3 7 2 1 1 2 0 8 i 1 Totals 12 9 21 8 10 18 10 3 13 Nelson— Single Married Widowed Unknown 6 23 29 3 18 21 4 4 8 0 6 6 2 1 1 1 1 0 3 2 1 1 1 1 1 1 3 2 2 4 Totals 13 51 64 4 2 6 3 5 8 PORIRTJA — Single Married Widowed 61 43 104 32 52 84 5 10 15 42 25 67 16 34 50 18 9 18 5 0 8 26 6 11 3 3 Totals 98 105 203 59 67 126 23 17 40 Wellington— Single Married Widowed 18 10 28 6 15 21 0 3 3 11 31 42 4 29 33 0 6 6 4 2 1 1 2 0 5 4 1 Totals 24 28 52 15 66 81 7 3 10 Ashburn Hall — Single Married Widowed 6 2 6 12 4 6 6 3 0 6 12 5 8 1 1 Totals 8 10 18 9 12 21 Totals— Single Married Widowed Unknown 288 157 445 129 170 299 30 43 73 0 6 6 147 110 257 71 127 198 7 22 29 62 23 85 52 27 79 22 18 40 Totals 447 376 823 225 259 484 136 68 204

H.— 7

23

Table VIII.—Native Countries.

Table IX.—Ages of Patients on 31st December, 1909.

Table X.—Length of Residence of Patients who died during 1909.

Countries. ! Auckland. Chvistchurch IWJSim. Hokitika. Ashburn Nelson. 1 Forirua. Wellington, j (p^^te I M.H.). Total. ■ M. F. T. England and Wales 134 79 213 Scotland ..84 9 43 Ireland .. j 58 59 117 New Zealand .. 147 115 262 Australian States \ 23 8 31 Prance .. 2 0 2 Germany .. 4 8 7 Austria .. 10 0 10 Norway .. 0 1 1 Sweden .. 8 19 Denmark .. 3 14 Italy .. 10 1 China .. 10 1 Maoris .. 16 9 25 Other countries .. 17 4 21 Unknown .. j M. F. T. M. F. T. 99 94 193 97 58 155 37 20 57| 104 65 169 47 54 101 92 64 156 117 101 218!l53 119 272 13 8 21 17 16 S3 10 1 3 1 4 7 1 Si 10 1; 3 0 3 6 17 10 14 0 4 2 1 3] 0 2 2 2 0 2! 1 0 1 2 0 2 12 0 12 112 8 10 18 7 3 10 M. F. T. 30 15 45 13 3 16 39 15 54 40 20 60 2 2 4 3 0 3 M. P. T. 21 21 42 7 5 12 15 23 38 44 48 92 2 4 6 2 0 2 M. P. T. 128 77 205 I 36 25 61 56 62 118 104 140 244 13 6 19 10 1 7 4 11 Oil 1 1 2 4 2 6 ]202 I 3 0 3 ■202 6 3 9 8 3 11 M. P. T. 45 16 61 10 3 13 23 3 26 59 25 84 6 0 6 0 3 3 M. F. T. 7 2 9; 7 3 10 1.01 10 13 23 0 11 ■ • M. F. T. 561 362 923 248 133 381 331 280 611 674 581 1255 76 45 121 4 0 4 26 12 38 11 1 12 11 6 17 25 3 28 10 4 14 11 1 12 21 0 21 24 14 38 49 24 73 10 1 4 0 4 i 0 2 2 1 0 ll 2 0 2| 112| 1 "i 2 3 0 3 10 1 10 1 2 0 2 4 0 4 2 0 2 1 0 1 2 13 112 5 3 8j Totals .. J458 289 747 337 290 627 500 329 829 140 55 195 97 105 202 371 324 695 155 55 210 25 19 44 ! 2083 1.466 3549 L I

I " j ""I i • Ages. ] Auckland. Christchurch. j Dunedin • (Seacliff). Hokitika. Nelson. Porirua. Wellington. Ashburn Hall (Private M.H.). Total. J 1 I I M. P. T. 1 to 5 years .. 1 0 1 5 „ 10 , .. j 1 1 2 10 „ 15 , .. ! 1 1 2 15 „ 20 „ ..17 2 9 20 „ 30 „ .. ! 38 23 61 30 „ 40 ,. 116 69 184 40 „ 50 „ .. Ill 67 178 50 ,60 „ .. i 97 59 156 60 „ 70 „ .. ! 50 37 87 70 , 80 „ ... 27 23 50 Upwards of 80 .. ! 6 4 10 Unknown .. j 4 3 7 Totals .. 458 289 747 J M. F. T. i 0 1 1 2 2 4 112 11 7 18 I 48 36 84 68 52 120 66 67 133 59 57 116 44 44 88 33 20 53 5 3 8l M. F. T. M. P. T. M. P. T. M. F. T. M. F. T. M. F. T. M. F. T. 112 4 5 9 7 5 12 44 39 83 224 160 384 434 307 741 454 323 777 425 286 711 312 212 524 138 89 227 25 16 41 15 23 38 0 1 1 10 1 0 3 3 12 15 27 32 40 72 85 60 145 95 81 176 75 67 142 53 40 93 14 15 29 4 3 7 Oil 3 8 11 60 40 100 92 74 166 110 68 178 105 61 166 90 52 142 33 22 55 7 3 10 2 0 2 Oil 8 7 15 20 11 31 29 5 34 25 8 33 30 14 44 15 5 20 3 0 3 8 3 11 15 8 23 8 24 32 16 17 33 18 18 36 21 15 36 7 2 9| 12 3 0 16 16 3 3 6 20 5 25 44 13 57 26 14 40 39 10 49 18 7 25 4 15 112 3 14; 2 4 6 14 5 7 6 13 6 3 9 5 16 1 0 ll 11 I 15 337 290 627 500 329 829 140 55 195 97 105 202 2083 1466 3549 371 324 695 155 55 210 25 19 44

Length of Residence. Auckland, j Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Ashburn Wellington. (p Ha» e M.H.). Total. I I Under 1 month From 1 to 3 months .. , 3 ; 6 „ 6 „ 9 , 9 , 12 1,2 years „ 2 „ 3 . „ 3 , 5 » . 5 „ 7 . „ 7 „ 10 „ . 10 , 12 „ „ 12 „ 15 „ Over 15 years Died while absent on trial M. F. T. 4 0 4 7 3 10 2 2 4 3 0 3 2 13 5 2 7 4 2 6 4 3 7 112 2 0 2 M. F. T. 4 3 7 1 0 1 10 1 10 1 4 15 3 3 6 2 0 2 1 0 1 0 11 M. F. T. 3 14 2 0 2 7 0 7 10 1 2 13 2 3 5 2 13 10 1 4 0 4 2 13 2 0 2 0 11 3 4 7 M. F. T. 0 1 1 0 11 2 1 3 2 0 2 M. F. T. Oil 2 0 2 12 3 M. F. T. 112 3 2 5 3 2 5 10 1 4 2 6 2 0 2 3 14 0 2 2 2 0 2 Oil 2 13 2 5 7 M. F. T. 10 1 i i 2 0 11 1 0 1 112 M. F. T. | i M. F. T. 13 5 18 13 6 19 14 5 19 6 0 6 8 4 12 16 13 29 15 3 18 11 7 18 10 4 14 6 17 3 14 6 5 11 14 14 28 10 1 5 6 5 oil 8 2 10 10 1 12 3 112 10 1 0 22 2 0 2 1 0 1 Totals 42 17 59 20 11 31 31 12 43 10 3 13 3 5 8 23 17 40 7 3 10 136 68 204

H.—7

24

Table XI.—Length of Residence of Patients discharged "Recovered" during 1909.

Table XII.—Causes of Death.

Length of Residence. Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Ashburn Porirua. I Wellington, i /p^ ttl l. M.H.). Total I Under 1 month From 1 to 3 months . 3 „ 6 „ . 6 „ 9 „ „ 9 „12 „ „ 1 „ 2 years .. „ 2 „ 3 „ .. „ 3 „ 5 „ .. „ 5 „ 7 „ .. „ 7 „10 „ .. „ 10 „12 „ .. „ 12 „15 „ .. Over 15 years M. F. T. 10 1 .. 14 4 18 .. 11 10 21 .. 11 4 15 ..1268 .. ! 10 7 17 ..112 10 1 ..101 M. F. T. 1 0 1 9 1 10 8 6 14 4 6 10 9 6 15 6 3 9 13 4 112 Oil M. F. T. 1 1 2 7 7 14 2 9 11 2 9 11 16 7 4 5 9 112 0 1 1 M. F. T. I M. F. T. 10 1 10 1 2 13 10 1 2 0 2 2 0 2 0 3 3 1 4 5 10 1 j i j M. F. T. M. F. T. 7 3 10 2 3 5 9 9 18 4 2 6 10 9 19 2 5 7 4 4 8 13 4 6 3 9 0 3 3 7 7 14 I 1 1 2 2 13 10 1 10 1 0 110 2 2 M. F. T. 13 4 0 1 1 0 1 1 112 M. F. T. 13 7 20 45 26 71 36 40 76 26 27 53 18 28 46 30 28 58 7 6 18 3 2 5 14 5 Oil '.'. 0 1 1 oil 0 11 Totals .. 52 32 84 I 39 27 66 18 39 57 7 8 15 4 0 4 46 38 84 | 11 19 30 2 7 9 179 170 349 I

Causes. I I Dunedin (Seacliff). Hokitika. Nelson. Porirua. Wellington. Asllburn Hall (Private M.H.). Total. Group 1. —General Diseases. Influenza Enteric fever Pneumonia, lobar „ broncho Tuberculosis:— " Of lung (phthisis) Tubercle of other organs General Carcinoma Anaemia, pernicious Diabetes mellitus M. T. 1 0 0 1 1 0 6 2 1 0 M. F. i' i 0 3 M. F. 0 1 4 2 M. F. 0 1 0 1 M. F. M. F. 1 3 M. F. M. F. M. F. T. 10 1 Oil 3 5 8 Oil 15 10 25 10 1 Oil 3 14 1 0 1 0 2 2 1 1 0 1 1 0 1 0 0 1 4 2 1 0 1 0 6' i • • Group II. —Diseases of Nervous System. Meningitis, cerebral (not tuberculous) Softening of brain Organic disease of brain (not otherwise defined) General paralysis of insane Mania, exhaustion from Melancholia, exhaustion from Epilepsy Locomotor ataxy Other diseases of nervous system 1 0 0 1 3 3 1 0 i 2 1 1 I 5 0 6' 2 10 1 12 3 13 7 20 6 1 5 1 1 0 8 0 4 2 ! 23 4 27 10 1 10 1 8 4 12 2 0 2 10 1 i o 3 2 1 0 1 1 2 1 2' 0 1' 0 i' o Gboup III.—Diseases of Heart. Valvular disease, endocarditis (not infective) Fatty (and fibroid) degeneration of heart Eupture of heart .. Syncope, heart disease (not specified) 3 2 1 1 2 1 1 1 2 0 0 1 2 0 10 5 15 112 2 0 1 0 1 1 1 1 1 0 1 0 6' 2 i' 0 10 1 7 4 11 Gboup IV.—Diseases of Bloodvessels. Cerebral hemorrhage, thrombosis, embolism Apoplexy, hemiplegia Senile gangrene 1 0 1 0 0 1 2 13 3 0 1 0 2 0 0 1 5 16 10 1 Group V.—Diseases of Respiratory Organs. 1 0 Bronchitis 1 0 1

H.—7

Table XII.—Causes of Death— continued.

Table XIII.—Principal Assigned Causes of Insanity.

4—H. 7.

25

Causes. i i i r~~ I m™-o+ i r>. j- Ashburn Auckland.; <g™£ j g*»g« Hokitika. Nelson. I Porirua. ; w * I I I M.H.). Total. Group VI.—Diseases of Diges- . tive System. Diseases of stomach (not malignant) Enteritis (not epidemic) Intestinal obstruction .. Peritonitis (not tuberculous) .. 1 0 1 0 2 0 2 i o 0 1 6' i Oil 10 1 Oil Group VII.—Diseasf.s of Lymphatic System and Ductless Glands. Graves' disease 0 1 1 Group VIII,—Disf.ases of Urinarx System. Chronic Bright's disease, albumin- 0 1 uria Prostate, disease of Urethra, stricture of Group IX. — Conditions not Specified. Debility .. Old age (senile decay) .. .. j 9 3 0 1 0 1 0 2 2 1 0 1 0 1 0 1 10 1 0 1 5 0 2 1 1 0 4 0 1 4 4 4 i' o 11 2 26 12 38 Died while absent on probation 1 o 1 0 1 Totals .. .. ! 42 17 31 12 20 11 10 3 3 5 7 3 136 68 204 23 17 i

Causes. Auckland. Christ- : Dunedin church. 1 (Seacliff). Hokitika. j Nelson. Ashburn Porirua. I Wellington. i ( p?. al i t I I M. H.). Total. Heredity Congenital mental deficiency Previous attack Puberty and adolescence .. Climacteric Senility Pregnancy Puerperal state Lactation Sudden mental stress Prolonged mental stress Privation Over-exertion (physical) Masturbation Sexual excess Toxic:— Alcohol Tuberculosis Influenza Other specific fevers Syphilis Other Toxins Injuries Sunstroke Lesions of the brain Disease of the ear Epilepsy Other defined neuroses Graves' disease Cardia-vasoular degeneration Valvular heart disease General ill health No factor ascertained, history defective M. F. 20 11 11 3 3 0 3 0 0 5 9 4 0 2 0 5 M. F. 8 6 6 6 9 3 8 2 3 812 8 M. f. 14 14 14 9 6 6 0 1 0 3 6 5 M. F. 2 1 M. F. 1 2 1 9 M. F. 14 13 4 2 14 28 3 6 0 2 8 7 M. F. 3 1 4 3 1 5 3 0 0 3 1 2 M. F. 2 7 M. F. T. 64 55 119 40 32~72 33 42 75 17 9 26 3 21 24 40 27 67 0 2 2 0 19 19 0 5 5 2 9 11 35 33 68 3 1 4 1 1 2 7 1 8 9 3 12 l"l 3 0 6' 1 7 8 0 2 0 1 1 6 14 8 0 "l 1 "l i"o 3 "4 0 11 0 2 0 2 0 1 1 0 2"l 8 9 2 1 1 1 3 1 2' 0 1 0 8 0 2"o 2 3 1 0 2"o 20 2 15 3 21 2 0 1 0 1 0 1 7 1 1 0 4 4 16 2 3 3 80 16 96 0 1. 1 0 4 4 2 2 4 22 4 26 0 2 2 10 1 1.1 1 1 2 6 2 8 1 1 2 19 15 34 0 1 1 0 6 6 2 0-2 0 1 1 4 6 10 46 53 99 i' 0 4 1 i"o 0 3 1 1 6 1 2"l 2"o 0 2 5 0 1 "0 2"o 01 2" 1 1 0 i' 0 l"l 4 1 1 0 4 0 6 3 1 "2 2 "0 0 "4 0" 1 6 5 0 1 0 1 0 1 2"o 0 2 0' 1 0" 2 2' 2 7 4 11 9 4 0 "l 12 5 4 5 0 27 9 6 1 "3 3 1 2 "l ' Totals .. 102 53 12 9 13 51 80 49 110 71 98 105 24 28 I 8 10 447 376 823

H.—7.

Table XIV.—Former Occupation of Patients.

26

fl o Occupation. . >» a fl M : £ fl u 1 I fl '• s x ' £ a u 0 : a < ; o CO a s Q 3 • >s ■aj ™ p, ~H CO 0 3k I S ™" cS ! M a £ s s ; g a? • fc £ £ 3 & Occupation. IS a (3 o s fl o --, S fl 0 "S fl o S es 03 GO '5 a s P -2 03 . >S g g .3 3a a I (2 & I JH_ e6 a 3 o K M 3 o M -M fl o : u a : * < ; o Mai. .ES. ..; .. 1 .. 1 .. .. 1 .. 1 :::': :: :: I 1 1 . 1 1 .. 1 .. .. 13 .. 1 .. .. 1 1 V 17.. .. 25 1 .. 2 .. .. 5 1 ; 2 i 1 .. 1 .. .. ! 3 .... 1 .. 1 1 ! 5 : 2 1 1 1 .. 1 .. .. 1 1 3 11.... 2 .. .. 1 .. 4 4 .. 1 .. .. 1 .. 1 .. .. 1 .. 1 .. 1 5 .. 1 .. .. 1 1 1 .. 1 .. .. 1 2 .. 1 .. .. 3 .. 1 .. .. 2 1 .. 1 .. .. 2 1 1 i 1. I 1 1 i 1 .. ..I .. .. : 1 .. 2j .. .. j 8 Army pensioner .. I II .. Blacksmiths .. I .. I 1 Billiard-markers .... 1 Boardinghouse-j .. 1 keepers Bookbinder .. 1 • • Bootmakers .. I 1 1 Bottler .. ...... Bottle-washer .. .. 1 Builder .. .. J 1 .. Bushmen .. 1 Butchers • • • • Cab-drivers .. .. Cabinetmaker .. 1 Carpenters .. j .. 1 Carters .. .. I .. 1 Clerks and account- j 6 2 ants 1 i 2 .1 i ..:..'.. .. ! 1 j ..: ...... i 2 ..: 1 .. ' .. 2 1 2 .. 1 I .. 4 .. j 1 . . : j 1 'i! '.'. '.'. . '.'. ! 3. ..: 2 1 .. 3 :: ! . 2 :: ::| I 13 2.. 10 ..: 2 4 ..: 2 .. 1 14 Machinist Meat-inspector Meat-preserver Meohanic Medical practitioner Messenger Miller Miners Musician Newspaper-seller .. Night-watchman .. No occupation Orchardist Painters Photographer Plasterers Ploughman Plumbers Picture-framer Prospectors Rabbiters Railway guards Ranger Retired banker Roadman Sailors Sawmillers School-boys Schoolmasters Settler Shearer Shepherds Shipwright Solicitor Stableman Steward Stonemasons Storekeepers Storemen Surfaceman Tailors Tanner Telegraphist Tinsmith Tram-conductor .. Veterinarian Watchmaker Wood-carvers 1. 1 1 4 1 | ■ • 1 .. 1 4 3 '.'. i 1 1 1 '4 '3 i i 1 9 1 1 1 3 5 '.'. i "l 3 5 i '.'. "2 '.'. '.'. "2 '2 1 1 2 3 1 3 1 .. 2 .. 1 11.... 1 1 i Commercial travel- ' 1 1 lers Compositor .. . ■. Contractor .. I 1 Cooks .. ..;.... Cooper .. .. .. 1 Creamery manager I 1 .. Dentists .. ..:.... Dentists' assistants .. 1 Drapers .. .. 1 .. Engine-drivers .. 1 .. Engineers .... Expressman .. j .. Factory hand .... I ... Farmers .. .. j 8 8 Farm hands .. \ 2 .. Flax-merchant .. j .. 1 Flaxmillers .. 1 .. Fisherman .... Gardeners .. 2 2 Grocers .. ..13 Groom .. .. I .. Gum-diggers .. 9 Hairdresser Horse-trainers .. 1 .. Hotelkeepers .. 1 Jockey .. .. .. > 1 Journalists .. .. 1 Labourers .. 29 32 Lighthouse-keeper .. Lithographer Lumper .. .. . ■ 1 ..j .. .. I .. 3 '' 1 i 1 ........ 1 i .... .. I .. 1 ! ..I 2 .. I .. 3 .. .. .. ; .. 1 .. .. .. 1 .. 1 ..11 11 .. 2 . . j . . : . . 2 I ..' 1 .. ; .. 2 1 .. 1 .. .. 3 : .. 1 .. 10 5 4 50 .. 5 .. .. 12 1 .. 1 .. .. 2 .., 1 .. .. 1 ..I 1 8 ..! .. .. ! .. 5 .. 1 .. .. 1 9 .. .. 1 .. 1 .. 1 .. .. 2 .. 1 .. .. 2 1 2 6 35 9 .. 156 I .. .. 1 ! .. 1 .. l .. I .. I 1 j .. 1 • •! ' 2 .. .. 1 .. .. 14. .. .. 1 1 i 1 i 1 i i .. 1 '.'.] 1 ..: 1 '.'. '.'. .. '.'. i 1 1 1 i| .... ..: 1 .. ..! 2 .. .: 1 .. .. 1 .. 8 15 .. .. 5 .. i; 1 1 1 .. .. 1 .. 11 .. 2 2 1 1 1 11.... 1 1 2 '8 1 " 10 ..I 5 1 1 1 1 1 2 3 1 .. .. '2 3 .. 3 1.. 1 1 .. 1 .. 1 ..: 1 1 1 1 1 1 .. 1 .. .. 1 1 .. 1 1 1 .. 1 1 " i .. 1 1 1 , 1 1 32 1 .. .. 11.. 32 39 6 i 0 6 35 .. 1 1 1 .. 1 ..; 1 1 .. ..! .. 2j 80 lio! 12! 13 1 98! i ! Totals 102 13 981 24 8 j 447 1 1 ..; .. Fem ales. 21 4 .. .. 6 ..! 4 .. .. 1 1 .. 6 3 ! .. 16 .. 1 .. \. 5 .. 1 I' .. 1 .. .. 1 .. 1 .. .. 1 .. 6 .. .. 9 17 17 1 .. 1 .. 5 51105 28 10 376 Artist .. ..11.. Barmaid .. .. j 1 .. Clerk .. ...... Cook .. ..'.... Domestic duties .. 49 43 Dressmakers .. 1 1 Governess Laundress Machinist Music-teacher .. 1 1 49 1 1 '.'. ..j '.. 43 58 9 1 1 .. 1 1 .. 1 .. .. 1 1 1 30 88 21 9 307 2 .. .. 1 6 .. .. 1 .. 1 .... 1 .. 1 .. 1 .. .. 1 .... 1 ; .. !• 1 1 HO 2 1 88 21 9 1 1 .. 1 .. No occupation j Nurses Photographer's assistant Restaurant-keeper Tailoress Teachers Unknown Vagrants 1 .. ..I .. .. 1 1 .. 3 .. .. 6 17 .. 2 1.. 1 .. 49| 71 9 51105 1 1 j .. Totals .. 53 i

H.—7

27

Table XV.—Showing the Admissions, Discharges, and Deaths, with the Mean Annual Mortality and Proportion of Recoveries per Cent. of the Admissions for each Year since 1st January, 1876.

5--H. 7.

Admitted. Discharged. .Not Improved. Died. ' I Remaining . Average Numbers 31st December m resident. each Year. Percentage of Recoveries on Admissions. Percentage of Deaths on Average Numbers resident. Year. :ecoveri id. :elievei 1876 1877 1878 1879 1880 1681 1882 1883 1884 1885 1886 1887 1888 1889 1890 1891 1892 1893 1894 18951896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 M. F. | T. 221 117 : 338 250 112 I 362 247 131 ] 378 248 151 I 399 229 149 | 378 232 127 ; 359 267 152 I 419 255 166 ; 421 238 153 391 294 160 454 207 165 372 255 161 416 I 215 146 i 361 I 230 161 j 391 230 160 : 390 234 201 ' 435 231 158 ! 389 281 179 I 460 320 256 | 576 379 302 : 681 296 170 466 300 244 i 544 355 258 | 613 264 247 I 511 335 263 I 598 373 224 ! 597 352 192 : 544 454 237 I 691 340 240 | 580 399 I 280 i 679 401 277 I 678 421 279 700 434 325 I 759 447 376 i 823 M. 129 123 121 112 100 93 95 102 89 95 99 103 116 93 98 88 89 101 107 105 104 102 114 88 103 125 135 144 157 149 157 160 180 179 F. 79 57 68 76 67 65 59 78 77 76 60 78 92 53 88 74 76 89 76 77 70 73 110 99 96 104 99 101 106 121 126 139 146 170 T. 208 180 189 188 167 158 154 180 166 171 159 181 208 146 186 162 ] 165 190 183 182 174 175 224 187 199 229 234 245 263 270 283 299 326 349 M. 17 20 14 15 36 41 49 13 17 10 11 34 31 31 23 ! 33 21 17 15 24 25 26 13 15 39 40 26 41 24 45 28 31 9 17 I F. T. [ M. F. 8 25 6 6 9 9 ! 7 2 14 28 ] 3 3 13 28 I 8 3 25 61 5 2 36 77 j 3 1 32 81 5 7 20 33 : 10 I 9 9 26 : 18 12 5 15 73 29 17 28 12 8 17 51 28 59 2 2 30 61 3:1 17 40 12 j 5 24 57 14 I 30 17 38 8:2 12 29 9:9 11 26 55 j 84 19 43 128 ! 139 16 41 20 I 12 32 53 17 i 31 23 36 104 : 47 25 40 7 42 10 49 25 65 17 57 33 3 15 41 10 9 25 66 ! 84 12 13 37 I 9 2 32 77 I 23 21 22 50 I 6 14 19 50 ! 53 32 13 22 ! 9 6 22 39 j 29 67 647 1,498 815 717 T. 12 9 6 11 7 9 12 19 30 102 20 4 4 17 44 10 18 139 267 32 48 151 49 90 36 19 96 11 44 20 85 15 96 M. 36 42 51 55 54 49 60 65 68 73 57 74 78 70 76 79 74 78 64 101 86 105 88 114 99 102 120 129 120 147 146 168 148 136 F. T. 12 48 21 63 17 68 16 : 71 20 I 74 14 j 63 19 j 79 18 83 24 92 22 95 19 76 27 101 26 ' 104 30 100 35 i 111 41 120 34 108 23 101 35 99 42 143 32 118 43 148 60 148 43 157 46 145 72 I 174 55 175 44 173 70 190 67 214 85 231 64 232 ! 74 222 68 204 I M. 519 581 638 695 729 769 827 892 938 981 I 1,009 I 1,053 I 1,041 1,074 1,095 1,115 1,154 1,229 1,308 1,329 1,390 1,440 1,472 1,512: 1,581: 1,654: 1,715: 1,771: 1,801 1,836 1,900: ! 1,909: i 1,997 I 2,08.3: F. I 264 291 ! 319 i 361 I 396 i 406 442 483 514 542 604 643 640 687 702 734 763 810 860 885 925 990 1,008 1,045 1,091 1,119 1,133 1,188 1,237 1,276 1,306 1,331 1,417 1,466 T. ' M. F. 783: 491 257 872 : 541 277 957: 601 303 1,056 666 337 1,125: 703 371 1,175 747 388 1,269 796 421 1,375' 860 475 1,452 911 497 1,523: 965 528 1,613 984 559 1,696:1,034 613 1,68111,045 I 641 1,7611, 046JJ 660J 1,7971,078 ! 685 1,8491,089! 699J 1,9171,125 : 714| 2,0391,172 I 758 2,1681,241 I 812 2,2141,313 I 849 2,3151,347 I 882 2,4301,411 i 944 2,4801,438 973 2,5571,487 1,004 2,6721,534 1,049 2,7731,622 1,094 2,8481,671 1,114 2,9591,741 1,160 3,038:1,780 1,198 3,1121,796 1,232 3,20611,823 1,265 3,2401,851 1,285 3,41411,894 1,346 3,5491,970 1,404 T. 748 818 904 1,003 1,074 1,135 1,217 1,335 1,408 1,493 1,543 1,647 1,686 1,707 1,763 1,7891 1,839| 1,930 2,053 2,162 2,229 2,355 2,411 2,491 2,583 2,716 2,785 2,901 2,978 3,028 3,088 3,136 3,240 3,374 M. , 54-53 49-20 48-98 45-16 43-66 4008 35-581 40-00 37-39 32-31 47-82 40-39 53-95 40-43 42-61 37-61 38-53: 35-941 39 63 41-27] 37-41 35-92 44-88 32-31 30-74 39 06 38-35 40-56 46-18 41-39 39 75 44-29 42-25 : 42-72 1 1 P. 66-01 50-80 51-90 50-33 44-96 51-10 I 38-81 46-98 50-32 47-50 36-36 48-75 6301 32 92 55 00 36-82 I 48-10 j 49-72 I 45-18 I 46-66 44-02 37-82 51-89 44-33 36-50 46-64 51-56 44-69 44-17 4S-21 47-73 I 57-68 i 45-91 j 57-24 T. 57-56 49-72 5000 47-11 44-17 44-01 36-75 42-75 42-45 37-66 42-74 43-61 57-62 37-34 47-69 37-24 42-42 41-30 4103 43-40 39-82 36-69 48 07 37-58 33-27 42-17 43-01 42-17 45-34 44-19 42-94 49-67 43-82 48-74 1 M. F. 8-21 3-58 7-76 758 8-48 5-61 8-25 1 4-74 7-68 j 5-39 6-29 1 3-60 7-53 4-51 7-55 1 3-78 7-46 4-82 7-56 : 4-16 5-79 ' 3-39 7-15 ; 4-40 7-56 j 4-05 6-69 : 4-54 7-05 511 7-25 5-86 6-58 : 476 6-66 ' 303 5-16 I 4-31 7-69 I 4-94 6-38 : 3-63 7-44 1 455 6-12 6-17 7-67 4-28 6-45 4-38 6-29 6-58 7-18 4-94 7-41 3-79 6-74 [ 5-84 8-18 : 5-44 8-01 j 6-71 ! 9-08 '1 4-98 j 7-81 ! 5-50 ] 6-90 I 4-84 T. 6-70 7-70 7-52 7-07 6-89 5-55 6-49 6-21 6-53 6-36 4-91 6-13 6-16 5-86 6-29 6-71 5-87 5-23 4-82 6-61 5-29 6-28 6-14 6-30 5-61 6-41 6-28 5-96 6-38 7 07 7-48 7-39 6-85 6-05 -- 10,234 6,919 17,153 13,955 3,025 6,980 I 851 1,532 i I 3,012 1,318 4,330 r I 1 1 ■• .. I .. J .. In mental hospitals, 1st January, 1876 In mental hospitals, 1st January, 1910 M. F. T. 482 254 736 .. 2,083 1,466 3,549

H.—7

28

Table XVI.—Showing the Admissions, Readmissions, Discharges, and Deaths from the 1st January, 1876, to the 31st December, 1909.

Table XVII.—Summary of Total Admissions: Percentage of Cases since the Year 1876.

Table XVIII. —Expenditure, out of Public Works Fund, on Mental Hospital Buildings, &c., during the Financial Year ended 31st March, 1910, and Liabilities at that Date.

Persons admitted during period from 1st January, 1876, to 31st 1 M. f. t. December, 1909 .. .. .. .. .. 8,332 5,299 13,631 Readmissions .. .. .. .. .. .. 1,902 1,620 3,522 M. F. T. Total cases admitted .. .. .. Discharged cases— Recovered .. .. .. .. .. ..; 3,955 3,025 6,980 Relieved .. .. .. .. .. ..I 851 647 1,498 Not improved .. .. .. .. .. ..: 815 717 1,532 Died .. .. .. .. .. .. .. I 3,012 1,318 4,330 Total cases discharged and died since January, 1876 10,234 6,919 17,153 8,633 5,707 14,340 Remaining, 1st January, 1876 482 254 736 Remaining, 1st January, 1910 .. .. .. .. 2,083 1,466 3,549

Males. Females. Both Sexes. Recovered Relieved .. Not improved Died Remaining | ! 38-65 8-32 7-96 29-43 15-64 100-00 43-71 9-35 10-37 19-05 17-52 40-69 8-73 8-94 25-24 16-40 100-00 100-00

Mental Hospitals. Ne e: Net Expenditure for Year ended 31st March, 1910. et Expenditure for mded 31st March, 1! Liabilities ou 31st March, 1910. Auckland Reception-houee at Auckland Wellington Porirua Christchurch Seacliff Waitati Dunedin (The Camp) Nelson Hokitika [ £ a. d. 1,523 10 2 1,788 8 0 10,347 13 10 1,133 4 5 2,796 17 9 1,992' 6 1 256 7 0 £ s. d. 4 15 4,381 0 0 3,314 '<3 10 Totals .. 19,838 7 3 19,838 7 3 7,699 S 3

fl.—7

29

Table XIX.—Total Expenditure, out of Public Works Fund, for Buildings and Equipment at each Mental Hospital from 1st July, 1877, to 31st March, 1910.

Mental Hospitals. 1877-1902. 1902-3. 1903-4. 1904-5. 1905-6. Auckland Reception-house at Auckland Wellington Wellington (Porirua) Christchurch Seacliff Waitati Dunedin (The Camp) Napier Hokitika Richmond Nelson £ s. d. 94,909 9 4 £ s. d. 698 6 1 £ s. d. 1,284 4 1 532 1 10 6,377 15 0 4,238 4 11 1,360 17 0 £ s. d. 2,413 12 5 £ s. d. 5,600 7 3 26,633 5 0 103,108 7 0 103,529 13 2 132,110 0 9 1,468 10 2 2,144 19 1 155 11 1 4,973 0 1 235 5 9 5,387 11 3 3,266 1 7 3,229 0 10 2,602 14 6 1,944 4 6 1,434 3 6 147 0 0 1,284 16 7 3,014 3 6 238 17 2 874'11 8 890 16 2 156 11 5 989 4 8 493 17 3 13,870 9 7 487* 6 7 1,144' 5 8 526 19 10 Totals 475,593 1 5 10,166 10 3 15,812 0 2 15,949 7 10 16,235 6 7 Mental Hospitals. 1906-7. 1907-8. 1908-9. 1909-10. Total :et Expenditure. 1st July, 1877, 31st March, 1910. Auckland Reception-house at Auckland Wellington Wellington (Porirua) Christchurch .. Seacliff Waitati Dunedin (The Camp) Napier Hokitika Richmond Nelson £ s. d. 527 17 3 4 10 0 482 0 9 1,175 12 2 1,962 6 5 1,997 4 5 320 10 2 899 7 11 £ s. d. £ s. d. 253 7 10 1,318 8 9 462 10 0 61 16 0 198 2 1 106 10 0 2,369 14 10 1 2,246 13 5 2,018 2 7 , 4,143 14 11 1,313 17 6 : 5,598 4 8 252 4 10 86 18 10 918 18 8 58 16 9 £ s. d. 1,523 10 2 1,788 8 0 10,347 13 10 1,133 4 5 2,796 17 9 £ s. d, 108,529 3 2 2,317 4 0 29,655 15 7 135,761 1 1 122,393 3 7 154,813 6 6 659 13 10 4,891 6 10 147 0 0 3,721 7 0 1,096 19 3 20,942 13 11 19 7 0 107 14 7 552 8 11 200* 0 0 j 1,675* 0 0 256 7 0 1,992* 6 1 Totals .. 8,048 19 7 7,986 18 4 j 15,296 3 4 19,838 7 3 584,926 14 9

H.—7.

Table XXI.— Average Cost of each Patient per Annum.

Table XX.— Showing the Expenditure for the Year 1910.

Approximate Cost of Paper.— Preparation, not given; printing (1,650 copies), £28 los.

By Authority : John Maokat, Government Printer, Wellington. -1910. Price yd]

30

Mental Hospital. Provisions. Salaries. Bedding and Clothing. : F Wa f J e? ht ' Sal 'S el 'y Wines > w aier, an(J Spirits, Ale, Cleaning. ! Dispensary, and Porter. Buildings] Farm. and Repairs. j Total Cost rii.t.n, /-,„„.. j Total Cost ; Necessaiies, Total Cost Kepayments iperHead,less„j; < ii** V ,",* 'perHead, less Decrease ilnereasi Incidental,, for Main- Repayments pel^ p a^>f s | Receipts of in in a ° d 1 Patient. tenance. ! for Main- „f s ?ni\P t ,L all kinds pre- 1909. 1909. cellaneous. tenance. ot a11 kmds - ! vious Year. Auckland Christchurch Dunedin (Seacliff) Hokitika Nelson Porirua Wellington £ s. d. I £ s. d. 7 3 3 I 10 8 6f 8 4 6J 13 11 8J 7 12 1 j 15 18 5J 9 9 61 I 12 3 6 8 9 6 13 13 61 7 14 5 ! 13 18 11 12 0 4J 17 12 71 £ s. d. 2 5 4J 3 19 8 3 11 10£ 1 8 41 1 1 Of 2 13 0 2 6 21 £ s. d. ! £ s. d. I £ s. d. 2 1 54 0 1 11| 0 0 2 4 5 71 0 3 21 0 0 5f 3 4 3 0 7 9| I 0 0 4| 0 4 10J 0 0 0| ! 0 0 2f 1 18 2 0 2 2| I 0 0 11 2 7 OJ 0 3. 8 0 0 41 3 11 2 0 3 7f 0 0 5| : 1 I £ s. d. £ s. d. 0 13 6f 0 5 61 2 9 6f 1 8 101 3 15 9 2 7 91 0 5 tJO 1 5| 1 0 If 0 0 41 2 1 311 7 5 1 7 7f 0 6 3 I I I | I £ s. d. ! £ s. d. \ £ s. d. \ £ s. d. \ £ s. d. £ s. d. 2 16 11 ' 25 15 11| 7 3 9 : 18 12 2| | 17 13 llj 19 11 9 3 19 If : 38 2 91 11 18 lOf I 26 3 10| 23 2 3| j 26 17 61 5 5 8i I 42 4 1 9 16 41 : 32 7 8f 29 2 10 : 30 1 If 2 11 01 1 26 4 41 2 6 8£ 23 17 8 23 9 lOf ; 23 14 0J 3 19 4 30 4 5 6 3 If 24 1 31 : 22 15 7f j 24 9 2f 3 13 4 1 33 19 5 6 16 9f 27 2 71 25 1 91 25 10 10J 3 9 7f j 40 18 01 10 15 41 30 2 8 29 2 2j 29 8 6J £ s. d. 1 17 9i 3 15 2J 0 18 3J 0 4 If 1 13 7 0 9 1 0 6 3J £ s. d. •• Averages .. 2 15 3f ! 0 3 lOf ! 0 0 4 J2 0 5f } l 3 2|: 3 16 9} 1 34 13 31 8 9 61 j 26 3 9 1 24 2 101 25 12 71 19 9 8 2 1& ! 13 14 31 2 16 10 Table XXIa. Including first five items in Table XX j I 25 0 91 26 10 8j 19 111; j 35 11 21 ; Table XXIb. B^eW^Sl f " 13 4 U 38 9 101 2 11101] Pa t!cfn n at Matp 13 0 lj 17 9 101 1 3 5j j 2 12 0 17 5 0 2 61 _ 5 10 7 1 11 9f 4 13 111 68 14 9 ; 9 17 6f 1 2 1 „_ _ 5 9 llj I 39 15 51 j _ .. 58 17 21 56 19 3 39 15 51 60 11 11J 3 12 8J 1 56 18 ij 27 2 111 ') '

Items. Auckland. Christcnu.cn. ! Hokitika. Nelson. Porirua. Wellington. Total. Iβ speotoi'-General * Assistant Inspector* Clerks* .. Medical fees* Contingencies* Official Visitors Superintendents Assistant Medical Officers Visiting Medical Officers Clerks Matrons Attendants and servants Rations Fuel, light, water, and cleaning Bedding and clothing Surgery and dispensary Wines, spirits, ale, and porter Farm Buildings and repairs Necessaries, incidental, and miscellaneous Totals Repayments, sale of produce, &e. £ s. d. .. 25 4 0 600 0 0 300 0 0 '.'. 274 11 8 160 0 0 .. : 6,315 13 11 .. : 5,271 12 6 ! 1,525 12 5 I .. i 1,670 3 4 .. 73 7 2 J 6 0 0 1 498 7 4 J 203 3 0 J .. j 2,064 11 1 I .. \ 18,938 6 5 .. ! 5,962 2 3 £ s. d. J £ s. d. 8 8 0 I 25 4 0 750 7 6 ! 600 0 0 282 18 4 ' 637 10 0 £ s. a. 12 12 0 215 0 0 190 15 0 £ s. d. £ s. d. 25 4 0 215 0 0 : 600 0 0 257 9 2 217 0 7 ! 309 3 4 100 0 0 115 0 0 1,642 8 2 7,799 11 0 1,347 11 1 ! 5,042 2 2 303 7 3 ! 1,535 16 11 167 9 6 I 1,730 3 9 17 16 4 j 120 0 3 0 18 0 11 8 4 '160 0 2 I 1,347 6 0 2 17 11 ; 895 0 11 630 13 8 I 2,394 14 11 L_ £ s. d. 600 0 0 J 25 0 0 160 0 0 J 100 0 0 3,346 3 1 i 2,884 10 3 i 854 2 10 ! 554 9 11 43 14 5 ! 5 12 0 i 331 13 6 75 3 1 835 15 0 i £ s. d. 949 6 4 50 0 0 480 0 0 1,318 12 6 184 7 6 96 12 0 3.580 7 6 1,502 17 6 407 15 7 1.550 3 4 820 0 0 37,698 3 4 26,983 17 0 9,206 9 3 9,461 6 3 648 12 4 55 10 5 6,739 7 4 3,865 3 4 12,778' 8 6 409 10 7 396 17 9 110 0 0 . 150 0 0 6,236 13 11 10,499 2 5 4,722 2 4 ; 5.877 12 6 2,456 14 9 2,483 11 0 2,286 13 0 ' 2,777 6 0 91 13 0 : 301 17 8 13 18 0 15 8 7 1,422 5 4 ! 2,927 17 6 828 15 4 1,845 15 7 2,271 14 7 4,085 17 9 85 0 0 1,858 10 10 1,838 6 2 47 4 1 275 0 9 0 3 6 2 5 6 51 17 6 11 7 6 495 1 6 21,891 14 8 32,624 0 9 8,623 7 6 : 10,097 8 0 I 13,268 7 2 ■ 22,526 12 9 5,086 4 4 528 6 0 4,805 2 8 i 22,183 0 9 1,182 14 0 ! 5,799 9 9 9,816 4 1 J 118,377 0 0 2,829 11 7 J 35,022 19 1 Actual cost .. j 13,026 4 2 13,268 7 2 ■ 22,526 12 9 3 4,557 18 4 3,622 8 8 J 16,383 11 0 6,986 12 6 83,354 0 11 I I - I • Ni it included in Table XXI.