MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1916.

Appendix to the Journals of the House of Representatives, 1917 Session I, H-07

H.—7

1917. NEW ZEALAN D.

MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1916.

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

The Hon. the Minister in Charge of Department for the Care of Mental Defectives to His Excellenoy the Governor. My Lord, — Wellington, 2nd June, 1917. I have the honour to submit to Your Excellency the report of the Inspector-General of Mental Defectives for the year 1916. I have, &0., G. W. Russell, Minister in Charge of Department for the Care of Mental Defectives.

The Inspector-General to the Hon. the Minister in Charge of the Department for the Care of Mental Defectives. Sir,— Wellington, Ist June, 1917. I herewith present the report for the year ended 31st December, 1916. A summary and analysis of the statistical tables in the appendix shows : The number of patients on the register at the beginning of the year was 4,200 (m., 2,448; f., 1,752); at the end 4,375 (m.j 2,555; f., 1,820) —an increase of 175 (in., 107; f., 68). The total number under care during the year was 5,135 (m., 3,016; f., 2,119), being 144 (m., 147) more than in 1915; while the average number resident, 4,251 (m., 2,483; f., 1,768) was 157 (m., 92; f., 65) in excess. The ratio of patients on the register to population, exclusive of Maoris, was 3946 per 10,000 (m., 45*89; f„ 32*97), or 1 patient in 253 (m., 218; f., 303); including Maoris—their number on the register is 38 only—the figures are 38*08 per .10,000 (m., 44-17; f., 31*90), or 1 in 263 (m., 226; f., 313). The admissions (excluding transfers—in., 50; f., 6) numbered 879 (m., 518; f., 361); the male admissions were 68 higher than, and the female the same as, in the previous year. Among these admissions are included 18 immigrants (3 with a history of previous attacks) who had been here for less than a year. Of the 879 cases admitted, one-sixth were of patients who had previously been treated to recovery in our institutions, leaving the number of first admissions 737 (m., 449; f., 288), an increase, compared with 1915, of 86 (m., 71; f., 15). The ratio of admissions to population (excluding Maoris) was 7*Bo per 10,000, and for first admissions 654; or, in other words, every 1,282 persons in the general population contri-

I—H. 7.

2

2

buted an admission, and every 1,529 a first admission. The previous decennial average was 7*42 and 6*07. The total number of patients discharged (excluding transfers) was 415 (m., 202; f., 213), of which 331 (m., 160; f., 171) were discharged as recovered. The remaining 84 (m., 42; f., 42), though not recovered, were sufficiently well to be placed under the care of relatives or friends. The percentage proportion of recoveries on admissions was 3766 (in., 3089; f., 47*37), as against 44*27 (in., 44*89; f., 43*21) in the previous year, and 39*78 (m., 37*29; f., 43*45) in the average for all years since 1876. The deaths numbered 289 (m., 209; f., 80), giving a percentage of deaths on the average number resident of 6'Bo (m., 8*42; f., 452), and on the total number (general register) under care during the year of 5*63 (m., 6*93; i., 377). The corresponding percentages for the previous year were 6*94 (m., 7*19; i., 6*58) and 5*79 (m., 6*01; f., 5*42) respectively. Not included in the above analysis are 1 male resident at the beginning of the year who had been sent for observation under Magistrates' order, and 62 (m., 41; f., 21.) so received during the year. Of that number, 20 (m., 13; f., 7) were formally committed, 7 (m., 3; i., 4) were under observation at the end of the year, and 36 (m., 26; f., 10) after a short period of observation and treatment no longer needed oversight in a mental hospital. Also not included are the voluntary boarders, of which class 26 (m., 12; f., 14) were resident at the beginning of the year, and 48 (m., 18; f., 30) were admitted during the year. Of the total, 35 (m., 13; f., 22) were discharged, 1 male and 2 females died, and 9 boarders (m., 5; f., 4) were transferred to the register of patients, leaving 27 (in., 11; f., 16) resident at the end of the year. It is necessary, owing to frequent misconceptions when returns of individual institutions are contrasted, to point out that comparisons of relatively small numbers are very misleading, because percentages which on the surface differ fairly widely are substantially equal as a test of care and treatment when due allowance is made for contributory factors. Take, for example, the factors influencing the returns of recoveries. It will have been noted above that Magistrates occasionally remand patients to a mental hospital for care, observation, and safe keeping, pending the determination of an application for a reception order. The distribution of these patients is irregular, as is also tho distribution of voluntary boarders. Of the patients sent for observation, 36 were probably saved admission under reception orders by being placed promptly under suitable care and treatment pending that procedure, delayed at first when improvement became manifest, and finally abandoned as unnecessary. Of the voluntary boarders, 35 were discharged recovered or greatly improved. These two classes furnished a recovery-rate of, roughly, 60 per cent., which is not credited to the institutions concerned, because the statistical tables deal only with persons admitted under reception orders. There are other factors also which cannot be gleaned from statistics, but among those that can it will be noted that Table IV, which deals with the duration of disorder on admission, demonstrates an unequal distribution between the institutions of acute and chronic cases. Then, if Tables 111 and V be contrasted, it will be seen that the proportion of recoveries is much lower than that of admissions up to the age of 15; that thereafter the reverse is the case to the age of 30; that then the proportions more or less balance for the next three decades; and, lastly, that there is a decidedly higher proportion of admissions after the age of 60 than of recoveries after that age. With small numbers different years will show differences in detail, but broadly these proportions are not far from the truth; and it should be added that certain mental disorders of greater or lesser curability are associated with age-periods. Turning to the individual institutions, it will be found that the distribution of favourable and unfavourable ages is unequal. Other factors might be reviewed in this connection, but enough has been said to indicate that grand totals should be the measure of our efficiency. Reference was made to the number of patients admitted who were over- 60 years of age. There were 160, and in 118 of these the principal assigned cause of insanity (Table XV) was senility—premature in some, but in others the ordinary decay of old age impairing the mental faculties. A large number of these old people merely needed a little oversight and nursing, and might well have spent the evening of their days at home, provided some one were at hand to perform dutiful and kindly offices. I am not going to make any comment on filial ingratitude—one does not know the actual state of things in this cottage or that house, and maybe the aged mentally infirm parent is parted with sorrowfully —but I consider it necessary to point out that many such patients are sent to us from Old People's Homes and Benevolent Institutions, and that in some of the cases thence received we have noted on admission symptoms which were the prelude of the final dissolution. We take over the care of this class, as indeed we must; it cannot be provided for entirely by home care or entirely in institutions under Charitable Aid Boards; but a certain amount of common-sense should be exercised with regard to those that can and those that cannot be cared for properly outside mental hospitals. It is useless to plead, "If doctors certify, then our responsibility ends." Of course, doctors will certify, and very properly so, if the authorities at the Home state they have no facilities for dealing with the case, but the responsibility of such authorities does not, end there, because such institutions should provide facilities for dealing with ordinary physiological senile decay. It is not right that such patients should be filling our infirmary beds. The matter of providing special accommodation is under consideration now; but before entering upon the expenditure and accepting the policy involved one would like to know whether the charitable-aid institutions cannot carry out the nursing, care, and supervision of the aged who are mentally infirm; and, if they cannot, I am of opinion that the Boards should pay this Department for the maintenance of patients transferred from these institutions.

3

H.—7

The accommodation at the State institutions and the patients on the register at the end of the year were distributed as follows : —

Note. —The number of single patients under the Act (i.e., patients iff private housee) is 88 yet tco insignficant to include in the general statistics—l malo was in s nglo care at tho beginning of tho year, 1 was added during the year, and 1 was transferred to a mental hospital. These figures show an excess of patients over accommodation numbering 147 (m., 137; f., 10). For present purposes the female excess may be regarded as negligible, but the male excess means that among eaelt group of dormitories, suitable for 200, 11 extra patients have had to be accommodated. In so stating the position it is necessary to point out that there cannot be an exactly even distribution of patients in different institutions in proportion to the available cubic space, and that the same applies to the different wards in which patients arc classified in each institution. Not only in each institution but in each ward there should be a margin for contingencies. Since the date of this return there has been an increase of 40 in the number of patients, and the accommodation at the Wolfe Home, Auckland (48 beds), has been vacated for soldiers. On the other hand, a new unit (50 beds) has been occupied at Tokanui by transfers from other institutions, and another unit for 53 patients should be ready in August or September. The male reception cottage (15 beds) at Seacliff is now in occupation, and the reception and hospital blocks at Porirua and Sunnyside are approaching completion, and these will accommodate 200 patients. Moreover, additions are being made to the infirmary ward at Auckland. These buildings will meet urgent requirements—in fact, theoretically, give us an excess of accommodation; but, as they are strictly for classification, there will bo times when there are vacant beds in some wards arid extra beds in others. This year's building programme is a further contribution to classification. Among the plans prepared is one giving effect to your wish to meet the representations of relatives who are willing to pay considerably more for patients in whom they are interested than our maximum of one guinea a week. Touching this maximum payment it should be pointed out that if allowance were made for interest on buildings our cost per bead would exceed the maximum we are permitted to charge, and very much so in the case of patients needing any special observation or care. Doubtless present conditions accentuate the difference between the maximum payment and the cost of maintenance, but even in normal times.3s. a day is inadequate to cover the cost of the majority of patients. The time has come to consider the revising of the maximum. To increase it would make no difference to those who cannot afford it, but persons who can afford to pay more adequately should be charged more according to their means up to the new maximum. Of course, this refers to the general body of the patients, and not to the few for whom it is proposed to provide special accommodation. In their case a minimum would be fixed and there would be no maximum, payment being dependent on the needs and circumstances of each case. It should be pointed out that we receive contributions towards the maintenance of about one-third of the patients. The remaining two-thirds have cither no estate or no relatives in a position to contribute. The amount collected by the Receiver in 1916 was £47,820, or an average of £11 6s. Bfd. per head of the average number of inmates. This is our highest record, and a very creditable achievement. The average last year was ,£lO 7s. 7|d. The farms in connection with the institutions have done well. The expenditure of £16,688 exceeds the value of our farm-produce consumed in the institutions by £44 only, and in addition £8,639 has been received in cash for sales, leaving a net profit of £8,595. When this sum and the amount received for the maintenance of patients and other receipts, such as refunds for medical certificates, are deducted from the total cost per patient, the average net cost per patient during the year works out at £32 9s. 2_d.

Males. Accommodation. Females. Total. Males. Patients. Fomales. Totals. Auckland .. .. 569 Christchurch .. .. 333 Dunedin (Seacliff and Wai- 490 tati) Eokitika .. .. 202 Nelson .. .. 101 Porirua .. .. 533 fokanui .. . . 100 9 ws 401 970 387 720 394 884 64 266 117 218 341 874 49 149 I 7SQ A n«i 626 320 567 196 82 574 1.00 O IRE 378 354 415 64 108 395 49 1,004 674 982 260 190 969 149 dshburn Hall A.bsent on probation, &c. .. 2,328 1,753 4,081 1,753 4,081 a, 400 21 69 2,465 1,763 4,228 21 69 24 33 45 102 2,555 1,820 4,375

H.—7

4

Shortly after the outbreak of war the Department placed its services at the disposal of the Government, in order that advantage may be taken of the special knowledge find skill its officers possessed for the treatment of mental and allied nervous disorders due to the stress of military service. The offer was accepted, and towards the end of 1915 a start was made at Karitane, near Seaclifi, where Dr. Truby King lent a seaside cottage. As numbers increased tents were provided for the overflow, and the little settlement was named Anzae House Hospital. It was arranged with the military authorities that as far as possible all soldiers for whom the special treatment was indicated would be sent there, but that where mental disorder was pronounced, in the first instance or during residence at Karitane, tho patient should be admitted to a mental hospital as affording him the best chance of recovery, and in the interests of other soldier patients. Patients so received, with due regard to their condition and well-being, were to be kept apart as far as possible. Quite recently the Wolfe Home, Auokland, has been added to our resources for North Island patients, Anzae House, Karitane, being reserved for those belonging to the South. The following is a statement in tabular form of all patients treated under the above conditions :—

The anxiety ever,, present with our Superintendents and the higher officials working under them has been intensified by the large number of experienced attendants who have volunteered for active service—the alacrity with which these attendants responded to the call is a sample of their quality. -Their places have had to be filled with what offered. Though we secured a proportion of suitable men, the institutions arc suffering from the depletion of our trained and experienced staffs and the substitution of temporary officers who have not had the necessary training and experience, and perhaps in a still greater degree the sense of discipline and responsibility, so necessary for the work. Our sheet-anchor has been the senior staff. Its loyalty and devotion to duty has not been in any way affected by the knowledge of rights of appeal conferred by legislation. Whilst fully recognizing the desirability and necessity of safeguards for the protection of the average civil servant from injustice and petty tyranny, it must (I think) lie recognized that the attempt to place all public officers on the same level in that behalf must lead to lack of control and weakness of discipline. The Superintendent of a great institution, having under him a large body of employees—of varying responsibility and more or less education—must have summary powers for disciplinary purposes that could never be safely applied to an ordinary clerical staff, the type which is largely distinctive of the Public Service. I strongly recommend this aspect to your consideration.

64 1 16 4

654 3 4 4

5

H.—7

Inspections. The thanks of the Department is due to the District Inspectors and Official Visitors, who have done useful work and presented valuable reports reflecting their interest in the patients. Mr. Smail, whose daily visits at Sunnyside are appreciated by both patients and staff, follows the excellent principle of assuming that he is a close friend or relative of each patient, whom he visits without emotion, but to whom he can extend sympathy, advice, and assistance when necessary. Mr. dimming has been appointed to a similar office at Seacliff. Miss Maclean, Assistant Inspector, has paid visits to different institutions, and conducted examinations in nursing. Hereunder are epitomized notes of my visits to the different institutions, which may be prefaced with the general statement that all patients were seen and given an opportunity to speak to me, and that they were adequately clothed and well fed and cared for. Auckland. —Visited in February, November, 1916, and March, 1917. Dr. Cow, my Deputy, did relief duty at this hospital in. January of this year to enable Dr. Beattie to have a holiday, and later we were able to get the services of Dr. Clayton, enabling Dr. Tizard to have a spell. Dr. Beattie in his annual report notes the large admission-rate, due to the increase of population in the north, filling all the recent additions. The admission of Waikato patients at Tokanui is under contemplation, as the main surplus at Auckland is not made up of patients who can be readily transferred thither. These and other difficulties notwithstanding, to the credit of the Medical Officers and senior staff, the year has been uneventful. Further progress has been made in the scheme of inside alterations, modernizing the main institution, chiefly in the kitchen. An addition to the male infirmary is now being carried out. Sunnyside. —Visited in January, April, June, August, November, December, 1916, and May, 1917. Dr. Gribben was single-handed after Dr. Lee went to the front, but was relieved for a vacation by Dr. Jeffreys, from Nelson. More recently the services of Dr. Beale were secured. The main day-room, F ward, has been converted into a constant observation dormitory, and C ward attic dormitory has been closed because of insufficient escapes in case of fire. The installation of the Vigilant automatic fire-alarm will relieve the anxiety of the administration. The expediency of having a stand-by electrical plant has been mentioned, but for the main supply the stand-by, in my opinion, should not be provided by the consumer, and all the stand-by wanted for the Vigilant could be supplied from a few cells, the cost of which is negligible. The kitchen offices have been further improved by the new vegetable-room, and now the kitchen itself needs extensive alterations. The food inspected was of excellent quality and well cooked. The purchase of the Templeton Farm will add greatly to our resources. Seacliff. —Visited in June, August, October, December, 1916, and May, 1917. Dr. Gray left for the front when Dr. McKillop, who had attained the rank of Major, returned invalided, and was able to replace him. Tho medical care of the institution at Waitati, seven miles south, and of Anzae House Hospital, Karitane, three miles north of Seacliff, is efficiently administered from that centre. The successful introduction of nurses in the male-reception cottage, library ward, and infirmary has afforded relief to the male staff, who have a number of difficult and dangerous cases to contend with. The general health of the patients was good. Here, as at Sunnyside and Hokitika, the improvement of the meat-supply following our purchasing our own stock, and killing was very evident—we get the best. With Mr. Anderson's assistance, Dr. King, Mr. Miller, and 1 discussed various engineering matters requiring attention— e.g., means to render the water-supply more adequate; central bathrooms, similar to those established some years ago and working successfully at Sunnyside; freezing-chambers for our produce, including fish, which we get in large quantities from our fishing-station at Karitane, and other matters, which, however, under present conditions must be deferred. Hokitika. —Visited in August, 1916, and January and May, 1917. Mr. and Mrs. Downey, lay Superintendent and Matron of this Hospital, retired at the end of the year after long and faithful service, and the institution sustained a further'loss in the death of Dr. Macandrew, its Visiting Medical Officer, who was respected and beloved by patients and staff. Mr. Sellers succeeded Mr. Downey, and Miss Williams was appointed Matron, and will take up iter new duties as soon as she can be spared from Sunnyside. The health of the patients and staff has been good till quite recently, when an attendant was found to be suffering from enteric, and three other attendants contracted the malady. The first attendant died; the others are progressing favourably. A carrier has been discovered. No patients were affected. With this exception there was nothing calling for special report. Nelson. —Visited January, 1916, and January, 1917. The new kitchen is now completed, and promises to be a successful start for a new order of things, for the old building has more than served its time. The next addition should be the reception cottage, and then the orderly rebuilding of the main institution ward by ward. Our drainage also should be led into the new sewer —at present it passes into the old sewage system now used chiefly for storm-water. The Richmond Home for Defective Boys, which was associated with Nelson Mental Hospital, has been handed over to the Education Department, and the boys who could not be educated have been transferred to a special ward at Nelson, where they are just as well off and are apart from the other patients. Looking to the future and the provision which will have to be made for this class, I would suggest that it be kept in mind when planning the new building scheme at Nelson. There is not a big admission-rate in this hospital, and a small institution will meet the requirements of the district for the mentally unsound —sufficient for the land area at our disposal. Nelson, therefore, and because of its beautiful climate, is the most suitable of our institutions for mentally deficient children. Porirua, —Visited February, March, April, September, October, 1916, and January, February, March, April, 1.917. Dr. Hassell, for the greater portion of the time, had this strenuous

H.—7

6

charge with one assistant, Dr. Hodgson, but was able to change places with Dr. Crosby, of Tokanui, for a short spell, so that each had the benefit of different surroundings. Dr. Hodgson was anxious to get to the front, and this was arranged when Dr. Levinge, who had retired from the medical supcrintendency of Sunnyside twelve years ago, placed his services at the disposal of the. Department in any capacity that would release a younger man for the war. Later Dr. Moore, who was in the Dominion for his health, came to Porirua as Second Assistant. The shortage of staff lias been felt very keenly at times, but, happily, things have moved smoothly and the general health of the patients has been good. The reception and hospital block is uearing completion, and will be a notable addition to our resources. A start has been made to pipe the septic-tank effluent to the harbour. Tokanui. —Visited in January, March, November, December, 1916, and January, March, 191.7. The difficult) 1 of replacing single by married men because of scarcity of married accommodation in the district is felt here as at Seacliff. Four additional cottages have been built, on the estate, and the first temporary kitchen and stall rooms have been economically adapted to serve for married quarters. The permanent water-mains have replaced the temporary, the work being carried out largely by our own staff. The third unit was occupied in March, and the fourth is well on. its way. Owing to labour difficulties the progress on the estate has not been as much as anticipated, but, on the other hand, it has been fairly satisfactory. A centrally placed milking-shed has been erected. Among the farm requirements is a slaughterhouse, which will enable us to provide our own meat from the estate. The health of the patients lias been excellent. Ashburn Hall. —Visited in June, August, December, 1916, and May, 1917. This private licensed institution fills a public want. There is no doubt that the comfort of the patients is considered, and that Dr. Will exercises a most kindly supervision. In conclusion, but not as a formality, 1 have to thank the Head Office staff for work done without an eye turned to tho clock, the staffs of our institutions for surmounting the many difficulties with which they have been beset, and yourself for your active support. I have, &c., Frank Hay.

MEDICAL SUPERINTENDENTS' REPORTS. AUCKLAND MENTAL HOSPITAL. Dr. R. M. Beattie reports : — During the year ending 31st December, 1916, we had 1,216 patients under treatment. Of these, 268 were admitted during the year, and of that number 170 were males. At the end of the year 1,010 remained on our books. Our population continues to grow at a greater rate than our accommodation. It should be borne in mind that the progress of the Auckland Province is greater, and. is likely to continue greater, than that of any other province in our Dominion. It becomes necessary, therefore, to anticipate an increase of patients proportionate to the increase in population, and to make provision for their accommodation. At the present time, notwithstanding our recent additions, we are overcrowded, and if we are to look forward to a disproportionate increase due to the war we will have to surmount some difficulties. Considering, however, the large number of returned soldiers and the small number admitted to our mental hospital—B in ail—there is no present reason to assume that the present incidence will be materially affected. Of those soldiers returned who have come under my treatment I am bound to say that influences other than the war have been the predisposing and most probably the exciting causes of their affliction. Several of my ex-patients have gone to the front, and we must at least, expect some of them to return mentally afflicted and become a permanent burden upon the country. Our recovery and death rates were about normal. In both cases the females compared favourably with the males. The male recoveries amounted to 31*17 per cent, and the female to 56*12 per cent., whilst the male death-rate was 9*75 per cent, and the female 5*66 per cent. This must be attributed largely to the character of the cases admitted. The relative proportion of males who were senile, alcoholic, or syphilitic was decidedly larger. The amount of physical illness during the year was small, probably not more than that amongst an equal number of the general population. Several cases of typhoid occurred, but fortunately without any fatal results. It is to be hoped that the incidence of this disease will be reduced in future owing to the fact that we have now a complete drainage system linked up with the city sewerage. Our staff is, especially on the female side, as satisfactory as one can expect under present conditions. I cannot say that I have had a more devoted female staff than I have at present, but the frequent changes imply inexperience and anxiety, I have to accord to Dr. Tizard and the senior officers my sincere thanks for their sympathy and help. To the District Inspector and the Official Visitors I am indebted for their interest in the Hospital and in myself, and for the consideration which they have always shown to me personally. The Herald proprietors, Miss Fleming, and Mr. Maepherson are, as usual, entitled to our thanks and the thanks of the Department.

7

H.—7

SUNNYSIDE MENTAL HOSPITAL. Dr. St. L. H. Gkibben reports : — At the beginning of the year 1916 there were 702 patients on the register, of whom 348 were males and 354 females. During the year there were admitted 73 males and 71 females, and at the end of the year there were remaining 692 patients, a decrease of 1.0 for the year. There were 51 deaths, giving a death-rate of 7*4 per cent, on tho average number resident. There were 63 recoveries (23 males, 40 females), giving a rate of 437 per cent, on the admissions. The health of the patients was on the whole good. In view of the long-continued epidemic nl' scarlet fever in Christchureh it was deemed advisable to keep the institution closed to visitors for some months, and this precaution fortunately kept us clear of the infection. The building of the receiving-block is being carried on, but conditions incidental to the war make progress slow. The whole kitchen system urgently requires reorganization, and the laundry also in. its present state is unable to cope with the work, but the arrangement of having part of the washing done outside will make it possible to carry on till a time more opportune for undertaking additions. The substitution of steam by electric power which is being gradually carried out will effect a considerable economy in the expenditure of coal. The installation of the " Vigilant " fire-alarm system will fill a much-needed requirement, but in this connection the failure of the Lake Coleridge electric supply which has occurred at different times for varying periods will render some sort of stand-by plant necessary if complete efficiency is to be attained. The purchasing of stock and having it killed at the public abattoir, a practice which has now been in vogue for a complete 3'ear, lias proved from every point of view an unqualified success. Not only is the quality of the meat much better and the amount consumed lessened, but the price, including all charges, for both mutton and beef during the past twelve months lias averaged 4Jd. per pound. In view of our results I feel justified in recommending the adoption of this system at any public institution where it is practicable. The committal of senile cases from Old People's Homes the moment they become restless or require some extra attention is becoming more and more frequent, and, apart from the embarrassment which the admission of such numbers of these cases causes us, I am convinced that it would be more economical for them to be given a little more attention at the various homes provided for them. The usual amusements have been supplied to the patients, and in this matter I wish especially to thank the Hayward's Picture Enterprises (Limited) for their monthly picture entertainment, which is highly appreciated and eagerly looked forward to by the patients. The absence of an Assistant Medical Officer during the year has naturally necessitated the saddling of the officers and senior members of the staff with greater responsibility, and I cannot speak too highly of the loyalty and enthusiasm displayed in circumstances which were rendered still inure difficult by the numerous changes in the staff attributable directly and indirectly to the war. I have to express my gratitude to those ladies who supplied periodicals for the amusement of the patients during the year. SEACLIFF MENTAL HOSPITAL. Dr. F. Trubt King reports .- — At the beginning of the year there were 975 patients (573 males, 402 females) in the institution. Exclusive of transfers from other institutions, 191 patients were admitted (inclusive of "voluntary boarders"), and 80 were discharged relieved or recovered, being 42 per cent, on the admissions and readmissions combined, or over 48 per cent, on the patients admitted for the first time. During the year 17 voluntary boarders were admitted, and 15 were discharged relieved or recovered. The general health of the patients has been good. There were 72 deaths, being 6 per cent, of the total number under treatment. The majority of the deaths were among patients between sixty and ninety years of age, and nine of the younger adults died of general paralysis. There has been no suicide or serious accident of any kind during the year. Our most urgent structural needs for the next twelve months in connection with patients will be improved bathing facilities, suitable accommodation for tubercular patients, and further accommodation for women patients. The most pressing need for the staff is the erection of a number of cottages for married male attendants. Owing to all the single attendants volunteering for military service, the male staff now consists almost entirely of married men. Even before the war the accommodation available in the neighbourhood was much short of our requirements, but now we have some 25 married men who reside at a distance. This is a very serious and growing evil, and I trust it will be met as far as possible during the year. Another outcome of the war is the provision needed for returned soldiers suffering from neurasthenia, due to wounds, shell-shock", &o. To meet this class of nervous prostration, which does not come within the scope of a mental hospital, but calls for a healthy life in the open air in pleasant surroundings, with facilities for sea-bathing, boating, &c, we have a well-equipped seaside cottage at Karitane, besides a number of tents and a large marque. This Convalescent Home,

H.—7

8

admirably managed by Mr. and Mrs. Quill, is highly appreciated by the men. The results have been most encouraging, rapid improvement taking place in most cases, resulting generally in recovery and discbarge. The best spirit prevails. The farm and garden returns for the year have been exceptionally good; and the undertaking of our meat-supply by the farm-manager, Mr. Sutherland, continues to be a great success, both from the pecuniary point of view and as regards the quality of the meat supplied. Though the fishing-season has been a comparatively poor one, the institution has been kept well supplied through our fishing-station at Karitane and stocks in the freezer. The Orokonui Branch Mental Hospital and the Camp Auxiliary on the Peninsula have been well conducted by their respective staffs. We were very sorry to lose Dr. Gray in the middle of the year, owing to his taking up military duty and leaving for the front. Since then I have had every assistance from my colleagues Drs. McKillop and McPherson. Religious services have been held by various denominations throughout the year. Our thanks are due to the Otago Daily Times and Witness Company and to the Evening Star Company for newspapers supplied free, and also to other donors and entertainers who have contributed to the amenities of our institutions. PORTRUA MENTAL HOSPITAL Dr. Gray Hassell reports : — The statistical tables for the year 1916 show the following totals: The number of patients under care, 1,180; average number resident, 947; admissions, 241; discharges, 135; and deaths, 54. A comparison of the statistics with those of the previous year (1915) indicates that the incidence of insanity in the part of the Dominion served by this Mental Hospital has declined. The actual number of admissions has declined by 10, but the decrease by 55 in the number discharged, and by 16 in the number of deaths, and the transfer between this and other mental hospitals account for the inoremenl nf patients on our register from 936 at the beginning to 982 at the end of the year. Tho general health of the patients has been good. There has been little sickness in the wards, and I am glad to say no cases of typhoid. The death-rate for a mental hospital was particularly low, being only 5*7 per cent, of the average number in residence. Owing no doubt to war conditions we have had much the same difficulty as in 1915 in maintaining the staff of attendants and nurses at the required strength. This was particularly the case in regard to the nurses, and our shortage was often from 15 to 20 per cent, below our proper number. I fear we shall have difficulty in obtaining the additional nurses required for the new auxiliary building, which I expect will soon be complete and ready for occupation. Dr. Hodgson was on duty throughout the year, and for seven months was the only Assistant Medical Officer. Dr. O. J. Reid left at the end of March to join the Army Medical Service, and Dr. McKillop, having returned invalided from the front, started duty on the Ist June, but was transferred to Seacliff at the end of July. I have to gratefully acknowledge the good and conscientious work done by the senior officers of the various departments of the institution.

9

H,—7

APPENDIX.

Table I.—Showing the Admissions, Readmissions, Discharges, and Deaths in Mental Hospitals during the Year 1916.

Table II.—Admissions, Discharges, and Deaths, with the Mean Annual Mortality and Proportion of Recoveries, etc., per Cent. on the Admissions, etc., during the Year 1916.

e A— H. 7.

M. F. T. M. 2,448 F. 1,752 T, 4,200 [n mental hospitals, 1st January, 1916 \dmitted for the first time Readmitted transfers.. 449 69 50 ' 288 73 ' 6 737 142 56 ) 568 367 935 Total under care during the year 3,016 2,119 5,135 discharged and died— Recovered Relieved .. .. .. Not improved Died 160 35 57 209 171 34 14 80 331 69 71 289 461 299 760 Remaining in mental hospitals, 31st December, 1916 2,555 1,820 4,375 increase over 31st December, 1915 .. 107 68 175 Average number resident during the year 2,483 1,768 4,251

In Mental HosMental Hospitals. pitals on 1st January. 1916. Admil Fir Admissions in 1916. Total Number : of Admitted for the Not First Transfers under toe First Time. Admission. rransieis. under bare. Admissions 1] itted for the Not Fin rst Time. Admissic M. F. T. M. Auckland .. .. 584 364 948 144 Christchurch .. .. 348 354 702 61. Dunedin (.Seacliff) .. 573 402 975 88 Hokitika .. .. 181 67 248 11 Nelson .. .. 102 108 210 9 Porirua .. . . 550 386 936 129 Tokanui . . .. 91 50 141 Ashburn Hall (private 19 21 40 7 menf al hospital) Totals . . .. 2,448 1,752 4,200 449 Pa Mental Hospitals. Discharged Dis recovered. noti M. F. T. M. F. T. M. F. T. M. F. T. 144 79 223 22 17 39 4 2 6 754 462 1,216 61 52 113 9 18 27 3 1 4 421 425 846 88 61 149 12 13 25 7 2 9 680 478 1,158 11 7 18 20 0 20 212 74 286 9 16 25 3 2 5 2 0 2 116 126 242 129 66 195 23 23 46 2 1 3 704 476 1,180 11 .. 11 102 50 152 7 7 1.4 1 . . 1 27 28 55 F. T. H. F. 79 223 22 17 52 113 9 18 61 149 12 13 7 18 16 25 3 2 66 195 23 23 7 1.4 '.'. 288 737 69 73 itients discharged and die scharged -p., , recovered. f 449 288 737 69 73 142 50 6 56 3,016 2,119 5,135 Patients discharged and died. In Mental Hospitals on Discharged ,,. , Total discharged 31st December, not recovered. iJlbd - and died. 19m M. F. T. M. Auckland .. .. 55 57 112 11 Christchurch .. . . 23 40 63 33 Dunedin (Seacliff) .. 24 30 54 12 Hokitika . . .. 2 2 4 1 Nelson .. .. 7 3 10 Porirua .. .. 49 39 88 30 Tokanui .. .. ■ • 2 Ashburn Hall (private • • 3 mental hospital) M. F. 'I'. M. F. T. M. F. T. M. F. T. 11 3 14 59 21 80 125 81 206 629 381 1,010 33 7 40 32 19 51 88 66 154 333 359 692 12 6 18 52 20 72 88 56 .144 592 422 1,014 14 5 13 1 14 16 7 23 196 67 263 10 3 13 17 6 23 99 120 219 30 26 56 40 1.4 54 119 79 198 585 397 982 2 0 2 0 1 1 2 1 3 100 49 149 3 2 5 3 1 4 6 3 9 21 25 46 F. 'I'. M. F. 3 14 59 21 7 40 32 19 6 18 52 20 4 5 13 1 10 3 26 56 40 1.4 0 2 0 1 2 5 3 1 Totals .. . . 160 171 331 92 92 48 140 209 80 48 140 209 80 289 461 299 760 2,555 1,820 4,375 Average Number Mental Hospitals. resident during the Year., Porcontago of Recoveries on Admissions during the Year. Percentage of Deaths on Average Number resident. during the Year. Percentage of Deaths on the Admissions. M. F. T. Auckland .. .. .. 605 371 976 Christchurch . . .. 334 355 689 Dunedin (Seacliff) .. .. 591 414 1,005 Hokitika 183 62 245 Nelson .. .. •• 84 107 191 Porirua .. .. .. 563 384 947 Tokanui 100 49 149 Ashburn Hall (private mental 23 26 49 hospital) Totals .. .. 2,483 1,768 4,251 M. F. T. 33-13 59-37 42-75 32-86 57-14 45-00 24-00 40-54 31-03 18-18 28-57 22-22 58-33 16-67 33-33 32-24 43-82 36-51 30-89 47-37 37-66 M. F. T. 9-75 5-66 8-20 9-58 5-35 7-40 8-80 4-83 7-16 7-10 1-61 5-71 11-90 2-80 6-80 7-10 3-65 5-70 0-00 2-04 0-67 13-04 3-85 8-16 M. 1C T. 35-54 21-87 30-53 45-71 27-14 36-43 52-00 27-03 41-38 118-18 14-29 77-77 83-33 16-67 43-33 26-32 15-73 22-41 42-86 14,29 28-57 8-42 4-52 6-80 40-35 22-16 32-88 i

H.—7.

Table IV.—Duration of Disorder on Admission.

Table III.—Ages of Admissions.

10

564 31

316796 1 4 61

11

H.—7

Table V.— Ages of Patients discharged "Recovered" and "Not Recovered" during the Year 1916.

Table VI.— Ages of Patients who died.

64 31

649 1 4

EL—7

12

Table VII. —Condition as to Marriage.

Admissions. Discharges. Deaths. All OKLA'ND Single Married Widowed Unknown .. .. Transfers M. F. T. 92 40 132 63 48 111 11 8 1.9 M. F. T. 25 21 46 30 35 65 4 4 8 M. F. T. 28 5 33 28 13 41 3 3 6 4 2 6 7 0 7 Totals 170 98 268 66 60 126 59 21 80 Ohristohuroh— Single Married WidoWed Unknown Transfers 46 21 3 25 38 7 71 59 10 20 8 0 13 23 6 33 31 6 14 16 1 5 9 5 19 25 6 3 i 4 28 5 33 I 0 I Totals 73 71 144 56 47 103 32 19 51 Dunedin (Seacliff) — Single .. Married WidoWed Unknown Transfers 61 36 3 35 31 8 96 67 11 21 S 2 14 20 2 35 28 4 32 4 36 1.6 10 26 4 6 1.0 7 2 9 5 0 5 Totals 107 76 183 36 36 72 52 20 72 Hokitika — Single Married Widowed Unknown Transfers 6 5 0 2 2 9 7 2 1 2 0 I. 3 2 2 5 2 1.0 1 2 0 1 0 10 2 2 20 '(') 20 Totals 31 7 38 o 6 13 1 14 Nelson —■ Single .. .. .,. Married Widowed Unknown Transfers 9 2 1 4 12 2 13 14 3 4 3 0 3 4 6 10 0 2 1 12 1 2 0 2 Totals 1.4 18 32 3 10 10 3 13 PORIRUA Single Married Widowed Unknown Transfers 96 50 6 35 41 13 131 91 19 46 26 0 23 33 7 69 59 7 20 17 3 7 4 3 27 21 6 2 1 3 7 2 9 Totals .. .. 154 90 244 79 65 144 40 14 54 Tokanui — Single Married Widowed Unknown Transfers 2 0 2 0 1 1 11 0 11 Totals 11 0 11 Ashburn Hall (private mental hospital) — Single Married WidoWed Unknown Transfers 1 4 2 3 3 1 4 7 3 1 2 3 3 0 6 i 3 1 1 0 1 2 6 2 Totals 7 15 3 Totals — Single Married .. .. Widowed Unknown ... .... Transfers 311 181 26 145 456 175 356 41 67 117 72 189 80 119 199 6 21. 27 114 81. 13 23 39 18 137 120 31 50 6 56 49 7 56 1 0 1 Totals 568 367 935 252 219 471 209 80 289 L

H.—7.

Table IX.—Ages of Patients on 31st December, 1916.

Table VIII.— Native Countries.

13

Countries. Auckland. Christchurch. """"^j 8 "* Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall (Private M.H.). Total England and Wales Scotland Ireland New Zealand Australian States France Germany Austria Norway Sweden Denmark Italy .. China ... Maoris Other countries Unknown M. F. T. M. F. T. M. F. T. 158 83 241 85 92 177 98 62 160 31 16 47 19 . 20 39 97 70 167 79 48 127 45 48 93 85 58 143 230 188 418! 154 174 328 •■ 250 204 454 32 12 44 12 12 24 19 18 37 ..202 5 3 8i 3 1 4 9 1 10 17 1 18 Oil 10 1 ..202 .. .415 7 2 9 303 3 0 3 2 1 3 2 13 2 1 3 50 5202 10 1 10 1 2 0 2 13 0 13 11 11 22! 0 1 1 10 1 23 5 28! 4 7 11 9 7 16 24 11 35 2 2 4! M. F. T. 36 16 52 13 6 19 48 12 60 61 26 87 11 5 16 6 0 6 1 0 1 6 0 6 6 0 6 5 0 5 3 0 3 0 2 2 M. F. T. M. F. T. 12 18 30 163 86 249 2 3 5 53 23 76 14 21 35 64 55 119 46 50 96 220 194 414 12 3 35 15 50 2 2 4 10 1 10 1 8 7 15 10 1 Oil 10 1 6 3 9 10 1 6 0 6 5 0 5 2 0 2 2 13 7 3 10 '■ 17 23 40 14 10 24 M. F. T. 25 7 32 3 0 3 14 7 21 46 35 81 2 0 2! 1 0 1 4 0 4 1 0 1 1 0 1 1 0 1 1 0 1 1 0 1 M. F. T. 4 7 11 5 2 7 11 14 25 0 2 2 i 6 i H. F. T. 581 371 952 223 140 363 349 249 598 1018 885 1903 112 66 178 5 2 7 33 12 45 23 3 26 9 1 10 26 5 31 14 3 17 19 0 19 23 0 23 22 16 38 72 52 124 26 15 41 Totals 629 381 1,010 ! 333 359 692 I 592 422 1,014 196 67 263 196 67 263 99 120 219 585 397 982 99 120 219 585 397 982 100 49 149 100 49 149 21 25 46 21 25 46 2555 1820 4375 2555 1820 4375

64 1 386 4

JEL—7

14

XI.—Length Table of Residence of Patients discharged "Recovered" during 1916.

Table X.—Length of Residence of Patients who died during 1916.

Length of Residence. Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua Tokanui. Ashburn Hall (Private M.H.), j Total. Under 1 month From 1 to 5 months .. „ 3 „ 6 „ 6 „ 9 ., .. • „ 9 „ 12 „ 1 „ 2 vears ., 2 „ 3 " ,. „ 3 „ 5 ,. „ 5 „ 7 „ „ 7 „ 10 ., „ 10 „ 12 „ „ 12 „ 15 „ Over 15 years Died while absent on trial 31. 5 10 12 8 1 3 2 1 4 1 2 1 7 2 F. 0 2 1 2 1 1 2 2 2 2 1 1 3 1 T. 5 12 13 10 2 4 4 3 6 3 3 ; 2 10 3 31. F. 7 1 3 1 1 0 1 1 5 3 0 1 4 0 1 2 0 1 2 3 2 0 6 6 x. 8 4 1 2 8 1 4 3 1 5 2 12 31. 1 4 4 4 5 4 3 5 5 6 1 1 8 1 F. T. 1 2 1 5 3 7 0 4 0 5 1 5 2 5 1 6 2 7 0 6 2 3 1 2 6 14 0 1 31. 1 1 1 1 0 3 1 2 3 F. 0 0 0 0 1 0 0 6 0 T. 1 1 1 1 1 3 1 2 3 31. 1 1 2 0 5 1 F. 1 0 1 1 0 0 T. 2 1 3 1 5 1 I H. F. T. 7 29 5 0 5 4 0 4 2 0 2 112 4 3 7 9 2 11 3 1 4 1 0 1 112; 1 0 1 10 1 14 5 31. 0 F. 1 T. 1 M. 1 1 1 F. 0 0 1 T. 1 1 2 M. 22 25 22 16 12 11 19 14 13 10 6 5 30 4 R. T. 4 26 5 30 4 26 3 19 5 17 6 17 8 27 6 20 6 19 7 17 3 9 3 8 19 49 1 5 ; Totals 59 59 21 80 21 80 32 19 51 32 19 51 52 20 72 52 — 20 72 i 13 13 1 1 14 14 10 10 3 3 13 13 40 14 54 40 14 54 0 0 1 1 1 1 : 3 3 1 1 4 4 i 209 80 289 209 80 289

Length of Residence. Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson Porirua. Tokanui. Ashburn Hall (Private M.H.). I Total 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 I M. F. T. ; 3 5 8 11 16 27 I 20 13 33 ! 11 7 18 2 3 5 5 8 13 3 4 7 0 1 1 31. F. T. 1 0 1 5 14 19 8 9 17 5 7 12 1 5 6 1 3 4 2 1 3 0 1 1 M. F. T. 0 1 1 11 9 20 4 8 12 5 3 8 4 2 6 0 4 4 0 2 2 0 1 1 31. 1 0 0 1 F. 0 1 1 0 T. 1 1 1 1 | 31. 1 2 2 2 0 F. T. 1 2 0 2 0 2 1 3 1 1 M. 9 16 4 6 1 7 3 2 0 1 F. T. : 5 14 i 5 21 ! 12 16 6 12 3 4 5 12 0 3 2 4 1 1 0 1 31. F. T. 31. F. T. 31. F. T. 13 11 24 44 44 88 37 43 80 29 24 53 10 14 24 15 21 36 8 7 15 2 4 6 0 3 3 2 0 2 Totals 55 57 112 23 40 63 I 24 30 54 2 2 2 2 4 4 7 7 3 10 3 10 49 49 39 88 39 88 160 171 331 I I

15

H.—7

Table XII.—Causes of Death.

4813

H.-7,

Table XIII. —Former Occupations of Patients.

16

is 'cj a $ Occupations. . £ to *> " ~ H ; n h q to , .h : 3 " £ -a h § 5 r" HJ CCJ -H p jj g 0 '£ a h) I % £ M a jd a o o o ; o • < o P W 1 g hjH CO d . ■rj d §1 I« a & 5 a -; «* ■a 3 -g CD t_ «1 * I CO S \ *£ ■X Cl."S u ' — a S3 9? 1— co OcenpatioiiP. u cq ™y 1 1 I I « \i 1 §1 1 -i 1 s i I 1 \M 3 s a fi £ o | o o rga o < O P ffi C, CM H J tAboriginals .. . . 61 Accountant . . . . 1 . Bakers . . . . '. I .. 1 .. .. 1 , Billiard-saloon keeper . . 1 Biscuit-factory hand .. 1 Blacksmiths .. . . 1 .. 1 Boardinghous'e- keeper . . I Bootmakers .. .. 1. . . 2 .. .. I . Bricklayer .. .. .... I .. .. I . Bushman .. . . I Butchers .. . . 3 2 Oab-.drivers .. . . 2 . Cabinetmakers .. .. .. 2 . Canvasser .. . . . . 1 ......... . Carpenters and joiners. . 5 3 2 . . . . 7 '. Carters .. I 1 Cheosemaker . . 1 . Chemist . . 1 . Civil Servant .. j . . .. 1 . Clergymen .. .. 1 . . 1 Clerks .. .. 5 2 7; .... 5 . Coach buildors 12 Compositor .. 1 . Commercial traveller .. I .. Cooks .. . . . . I 2 .. . . 4 . Dentist . . .. 1 . Dealer .. .. I Drapers .. . . 1 .. 1 1 . Electrician .. 1 , Engine-driver .. 1 Engineors . . . . 3 1 Farmers .. .. 1.7 12 11 .. 3 13 . Farm hands . . . . 8 .. I Fellmongers . . 1 1 . Firemen .. 2 Fisherman .. 1 . Fitter . . I Flax-mill hands . . 1, 2 . Fruiterers . . I .. 1 . Furniture-manufacturer Gardeners .. .. I 5 2.... 1 . Gold-miners .. 4 Grocers, .. .. 1 1 '. 1 . Groom. . . 1 , Gumdiggers .. . . 4 Hotelkeepers .. .. 1 1 Jockeys .. .. 1 .. 1 .. .. 1 . Labourers . . ' .. 46 25 21 3 4 68 . Mal ,ES. 2 i 3 "2 2 i 1 2 I "2 "2 1 1 7 1 i 1 1 2 7 1 1 1 5 1 4 1 ! • ■ '.'. i ■.. I "I " .. .. 6 1 2 1 1 2 1 4 2 1 5 1 3 2 1 .. 17 2 1 1 I 2 .. 19 I •• 3 I I 7 1 1 2 1 I 4 3 59 ! ■• 9 2 2 1 1 3 T ? 9 4 3 I 4 2 3 I .. 167 Land agent .. 1 .. .. 1 Lineman .. .. 1 ] Mechanic .. .. .. 1 . . .. I Medical practitioners . . 2 2 Merchant .. 1 J. Messengers .. .. 1 I . . .. 2 Milkman .. .. 1 1 Miners . . . . 2 . . 5 . . 1 I . . . . 9 Minor .. I 1 | Motorman .. .. 1 .. 1 Music-teacher.. . . 1 ., | No occupation .. 2 10 6 .. 3 21 Old-age pensioners . . 5 . . I (i Painter .. 1 . . .. 1 Paper-rulers . . 2 . . .. j 2 Photographer.. I .. .. 1 Plasterers . . . . 2 I 3 Plumbers .. 2 2 Porter . . . . 1 ] Postmaster .. i 1 ] Printer .. ! 1 ,. ,. 1 Prisoners . . . . 6 . . j (i Prisoners of war ; 2 . . .. 2 Quarryman .. 1 ] \ Saddler . . . . L .. I | School-teachers .. 2 . . 2 Seamen .. .. 1 1' 2 . . . . 1 .. .. 5 Shipwright . . ...... I 1 1 Shop-assistant .. .. 1 1 Slaughterman 1 .. .. 1 Soldiers .. .. 4 .. 8 .. .. 9 .. .. 21 Stableman . . . . I I Stevedore .. j 1 . . •. . 1 Steward .. .. 1 1 Storemah .. ...... ! ... .. 1 Student . . .. .. 1 ' I Tailors .. .. .. 1 1 .. .. 2 .. 1 5 Tanners .. 1 .. .. 1 .. .. 2 Tinsmith .. 1 . . .. ] Warehousemen .. 2 .. I 3 Watchmaker . . . . 1 1 Wheelwright . . .. ' 1 1 Transfers . .' ., 4 3 7 20 2 2 11 1 50 Unknown . . .. . . I 6 7 Nil . . . . . . 12 8 20 Not insane . . . . 2 ' 2 i '2 1 1 2 1 1 2 5 2 i 6 i 2 1 '.'. i .. 1 10 6 ..; 1 '■'■ 2 2 '.'.\ 1 1 3 1 1 I 1 2 I 2 1 9 I 1 1 21 (i 1 2 1 3 2 I 1 1 6 2 I I 2 5 1 I .1 21 I 1 1 1 1 5 2 I 3 1 I 50 7 20 2 .... 'i '2 i 1 1 . .1 .; 1 .. 1 1 12 4 .1 . . 8 i 9 ii 1 3 is '.'. 3 ••! 'l 1 i 1 '2 1 .1 i i '2 1 1 .. 1 1 .. I 2 1 1 1. :: (- i 2 1 1 4 .. 1 5 2 i 1 1 3 7 1 (i 20 20 2 i '2 ii i 1 ii 2 8 25 i 21 3 4 i 68 Totals .. .. 170 73107 31 14 154 II 8 568 170 73 107 31 14 ,154 ii 8 568 Aboriginals . . .. 5 Book-keeper .. i Clerk . . .. 1 Domestic duties .. 75 58 56 6 16 77 Dressmakers . . 5 Labour agent. . I Lady-companion .. .. I Laundress . . . . . . 1 Machinist .. . . . . 1 Masseuse . . Milliners .. .. 1 1 Minor .. I 1LES. 0 1 2 : 6 9 .. J I . . 1 1 I 6 I . . ?em. 58 56 5 I 6 16 i 77 5 5 1 1 293 5 I 1 I I 1 2 1 I No occupation . . 6 6 9.. 1 6 . . . . 28 Nurses . . . . I .. 1 .. J 3 Old-age pensioner . . I 1 School-teachers .. 2 2 2 . . .. 6 Sisters of Mercy I . . 1 .. ., 2 Storekeeper .. .. 1 1 Tailorosses . . I 1 . . .. 2 Typistes ■"."."." . . 1 . . J 1 3 Transfers . . . . 2 I 2 . . . . 1 . . . . (i Not insane .. . . 2 2 ; 2 .. ~2 1 28 3 1 a 2 1 2 3 6 2 I 1 1 I .. .. 1 I 2 I i 2 2 1 1 i i i 1 Totals .. .. 98 71 76 7 18 90 .. 7 367 98 71 76 '. 7 7 18 90 7 367

17

H.—7

3—H. 7

Table XIV.—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.

M. F. T. In mental hospitals, 1st January, 1876 .. .. .. .. .. .. 482 254 736 In mental hospitals, 1st January, 1917 .. .. .. .. .. .. 2,555 1,820 4,375

4 964 13 4 4

H.—7

18

Table XV.—Principal Assigned Causes of Insanity.

Table XVI.—Showing the Admissions, Readmissions, Discharges, and Deaths from the 1st January, 1876, to the 31st December, 1916.

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

Causes. Auckland. «*** gSSJjgJ, Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall. Totals. Heredity Congenital Previous attack Puberty and adolescence Climacteric Senility Pregnancy Puerperal state Lactation Mental stress, sudden .. ,, prolonged Privation Solitude Sexual excess Alcohol .. Drug habit Syphilis Toxasmia Traumatic Organic brain-disease . . Epilepsy Apoplexy Arterio-sclerosis Sunstroke Chorea Cancer Cardiac disease Grave's disoase Phthisis 111 health Unknown Not insane Transfers M. r. 16 21 35 9 10 5 3 5 0 4 30 10 M. F. 2 2 12 7 7 .16 5 5 0 1. 9 II 0 1 M. F. 18 16 11 7 9 19 9 1 0 1.0 16 4 M. F. 0 2 1 0 M. F. 2 4 4 0 1 2 0 I 0 2 I. 4 M. F. 2 14 10 5 3 2 16 li 0 8 14 9 0 I M. F. M. F. 1 4 M. F. 41 63 73 28 30 44 33 18 0 26 78 40 0 2 0 13 0 5 4 1 35 24 1 0 3 4 0 1 63 11 5 2 0 1 3 0 0 4 0 3 0 1 15 9 0 I. 1 0 3 I. 0 6 2 0 8 6 0" 3 ()" I l" 0 0 2 ()"' 2 9" 4 I 0 2 1 0 1 17 5 l" 2 3 1 0" 1 14 0 2 1 4" 0 23" 4 10 1 1 2 4 2 5" 0 7 1 0' 1 17 I 1 0 40 4 1 2 7 2 I I 17 14 6 0 5 2 1 0 0 1 0 1 1 0 1 1 2 0 8 8 65 43 2 2 50 6 1 0 0 1 5 3 1 0 I 0 I 0 7 3 4 0 2 1 1 0 0 I 2 6 2 2 2 0 3 1 1" 0 0 1. 1 0 1 1 2 0 I 0 44 29 2 3 5 3 2 2 4 2 5 5 15 1.1 I 0 3 1 7' 2 20 0 2" 0 2 I 11 0 1" 0 Totals 1170 98 73 71 107 76 31 7 14 18 154 90 11 0 8 7 568 367

64 91 34 4

Males. Females. Both Sexes. recovered telieved lot improved Med .. temaining 37-29 7-45 9-38 31-09 14-79 43-45 9-27 9-79 21-02 16-47 39-78 8-18 9-55 27-02 15-47 100-00 100-00 100-00

H.—7

Table XVIII.—Expenditure, out of Public Works Fund, on Mental Hospital Buildings, etc., during the Financial Year ended 31st March, 1917, and Liabilities at that Date.

Table XIX.—Total Expenditure, out of Public Works Fund, for Buildings and Equipment at each Mental Hospital from 1st July, 1877, to 31st March, 1917.

19

64 9

64 4 6

H.—7.

Table XX.—Showing the Expenditure for the Year 1916.

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

Approximate Coat of Paper. —Preparation, not Riven ; printing (800 copies), £18.

By Authority : Marcus F. Marks, Government Printer, Wellington. -1917

Price 9d.]

20

Mental Hospital. Bedding Provisions. Salaries. and „„?' Clothing. cle Zi ng . pensary. i Portei . Farm. -«J »<>■„> Total Cost Total Cost; Total Cost , Buildings Total Cost "„£??" per Head, less per Head, IperHead.less Decrease and I^S£ J ' per m Repayments less I Receipts of in Repairs. „5?„ „tV, s " Patient, t ™!:™~ fOT ' Mata " Receipts of all kinds pre- 1916. .cellaneous. tenance. tenance . all kinds. | vious Year. Increase in 1916. Auckland Christchurch Dunedin (Seacliff) Hokitika Nelson Porirua Tokanui f s. d. I .. : 12 6 3J .. I 14 9 li .. 11 0 7| .. ! 14 4 1J .. 12 15 5| .. 11 18 2J .. 18 2 1 £ s. d. ; 12 9 Of 19 5 3i 21 0 10 17 4 2\ 21 6 10 I 17 9 1 32 7 10J £ s. d. £ s. d. 2 18 10 2 3 3 5 8 5f! 4 11 11J 3 6 5i 2 19 4f 1 3 10t 0 7 2J 2 6 4J 2 7 2J 3 16 0J 2 18 7i 4 1 8 3 2 7i £ s. d. £ s. d. £ s. d. 0 2 6| 0 0 1J 0 II \\ 0 4 11 ! 0 0 3i 2 8 3J 0 6 7| 0 0 0| 3 3 l| 0 2 10f 0 0 2J 0 5 8} 0 5 94 .. 16 4| 0 5 6f! 0 0 2 2 15 4| 0 2 9i .. 9 3 4| £ s. d. j £ s. d. ; £ s. d. £ s. d. | £ s. d. £ s. d. £ s. d. ! 0 9 3 2 16 0J 33 16 6+10 8 6| 23 8 0| 22 3 9f 21 5 9J 1 2 11 6 15 of- 54 6 8|l2 13 9 ! 41 12 11} 36 12 6 33 2 7| 2 5 3 6 15 0 50 17 4+11 14 0 ! 39 3 4J 34 8 6J 33 12 Ofl 0 6 0 1 15 9| 35 10 0| 6 16 1 ! 28 13 11* 27 9 10 27 6 11 ' 3 1 3J 4 5 6J 47 14 101 10 11 9| 37 3 1 36 4 8 35 17 6|: 0 12 5J 3 17 8J 43 13 2|l3 7 1 j 30 6 1J 28 12 6i 26 18 8 1 19 8 7 15 4J 76 15 5jH 4 4 If 72 11 34 63 3 7 84 16 3f £ s. d. £ s. d. 0 18 04 3 9 10| 0 16 5| 0 2 11 0 7 li 1 13 10} 21 12 S|, t ,: Averages .. 12 12 Oil 18 2 10i, 3 10 10i| 2 17 4 0 4 9i; 0 0 if 2 6 1J 1 4 ljpst 16 6i| 45 14 sill 6 9 34 8 0J 31 6 9£ 30 1 0 1 5 9i Table XXIa. Including first five items in Table XX ; i 46 17 2|; i ; 32 9 24 31 3 7 1 5 74 Table XXIb. Richmond Home for 13 Feeble-minded Patients on probation 17 at The Camp 5 9i 37 7 7i .. 3 8 0 1 8f 32 1 4 j 2 10 10i 2 13 2f 0 8 5J II I I 2 9 llij .. 12 10 3J 69 1 7 11 17 0J 57 4 6| 54 8 4 ! 54 9 3£ 0 0 llf 2 10 2 ; 0 16 If 7 0 7 65 2 5f| .. .. 65 2 5| 64 11 5£ .. 0 11 04 I

Items. Aucklaud. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. Total. Inspector-General Deputy Inspector-General .and_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 £ s. d. 25 4 0 700 0 0 372 18 1 362 10 0 145 8 4 10,585 0 2 12,055 4 5 2,116 16 6 2,879 16 4 125 6 8 6 5 0 544 19 8 453 0 8 2,742 18 9 £ s. d. 15 15 0 700 0 0 476 11 6 255 7 3 11,844 6 3 9,975 14 8 3,172 16 5 3,742 2 9 169 11 6 10 7 0 1.665 2 5 790 13 3 4,673 19 2 £ s. d. 25 4 0 700 0 0 764 18 1 529' 2 6 196 7 3 19,120 17 9 11,186 4 11 3,011 6 2 3,368 3 8 335 7 4 2 10 0 3.200 9 2 2,294 10 11 6,844 10 2 £ s. d. 12 12 0 260 0 0 286 11 6 100 0 0 3,557 6 3 3,480 6 6 88 7 1 292 10 0 35 11 7 2 11 0 70 3 8 73 10 0 438 12 2 •£ s. d. 475 0 0 16 10 10 118 4 3 128 15 0 3,380 9 11 2,465 3 11 455 16 3 447 10 5 55 19 9 254 9 8 591 11 5 825 4 3 £ s. d. 42' 0 0 700 0 0 463 15 3 461 18 1 157 10 0 14,720 18 1 11,291 10 6 2,777 16 6 3,605 4 9 264 2 4 7 17 0 2,625 7 7 589 4 4 3.682 14 0 £ s. d. £ s. d. 1,000 0 0 .. 750 0 0 1,198 2 11 1,270 17 4 514 17 0 120 15 0 700 0 0 4,235 0 0 1,618 2 3 286 11 6 1,948 6 4 983 7 10 4,126 13 10 67,335 12 3 2,697 10 9 53,151 15 8 466 8 10 12,089 7 9 608 8 4 14,943 16 3 20 15 10 1,006 15 0 29 10 0 1,366 5 1 9,726 17 3 295 9 4 5,087 19 11 1.157 9 11 20,365 8 5 Totals Repayments, sale of produce, &c. .. I 33,115 8 7 .. j 11,391 3 4 37.492 7 2 12,221 5 2 37.492 7 2 12,221 5 2 51,579 11 11 8,698 1 9 16,670 3 8 1,962 10 4 9,214 15 2,221 13 8 0 41.389 18 5 14,252 17 10 11,439 1 11 2,025 9 3 197,663 2 8 60,745 2 7 Actual cost . . .. .. I 21,724 5 3 21,724 5 3 25,271 2 0 25,271 2 0 34,909 8 3 6,735 11 5 6,993 2 8 27,137 0 7 9,413 12 8 136,918 0 1 I * Not included in Table XXI.