MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1917.

Appendix to the Journals of the House of Representatives, 1918 Session I-II, H-07

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Session 11. 1918. NEW ZEALAND.

MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1917.

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 Excellency the Governor-General. .My Lord, — Wellington, Ist November, 1918. I have the honour to submit to Your Excellency the report of the Inspector-General of Mental Defectives for the year 1917. I have, &c, 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, 29th June, 1918. I herewith present the report for the year ended 31st December, 1917. A summary and analysis of the statistical tables in the appendix shows that the number of patients on the register at the beginning of the year was 4,375 (m., 2,555; f., 1,820); at the end 4,515 (m., 2,611; f., 1,904)— an increase of 140 (m., 56; f., 84). The total number under care during the year was 5,260 (m., 3,062; i., 2,198), being 125 (m., 46; f., 79) more than in 1916, while the average number resident, 4,368 (m., 2,543; f., 1,825), was 117 (m., 60; f., 57) in excess. The ratio of patients on the register to population, exclusive of Maoris, was 40"64 per 10,000 (m., 47-96; f., 3362), or 1 patient in 226 (m., 209; f., 297); including Maoris—their number on the register is 54 only—the figures are 3933 per 10,000 (m., 4631; f., 3262), or 1 in 254 (m., 216; f., 307). The admissions (excluding transfers—m., 37; f., 4) numbered 844 (m., 470; f., 374); the male admissions were 48 lower and the female 13 higher than in the previous year. Among these admissions are included 24 immigrants (6 with a history of previous attacks) who had been hero for less than a year. Of the 844 cases admitted, one-sixth were of patients who had previously been treated to recovery in our institutions, leaving the number of first admissions 709 (m., 411; f., 298), a decrease of 38 males and an increase of 10 females compared with 1916. The ratio of admissions to population (excluding Maoris) was 752 per 10,000, and for first admissions 637, or, in other words, every 1,329 persons in the general population contributed an admission, and every 1,570 a first admission. The previous decennial average was 747 and 613. The total number of patients discharged (excluding transfers) was 386 (m., 209; f., 177), of which 323 (m., 171 ; f., 152) were discharged as recovered. The remaining 63 (m., 38; f., 25), though not recovered, were sufficiently well to be placed under the care of relatives or friends. The percentage proportion of recoveries on admissions was 3827 (m., 3638; f., 4064), as against 3766 (m., 3089; f., 4737) in the previous year, and 39-66 (m., 37*17; f., 43-33) in the average for all years since 1876.

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The deaths numbered 318 (m., 205; f., 113), giving a percentage of deaths on the average number resident of 728 (m., 806; f., 6-19), and on the total number (general register) under care during the year of 605 (m., 669; f., 5-14). The corresponding percentages for the previous year were 6-80 (m., 842; f., 452) and 5"63 (m., 6.93; f., 3"77) respectively. As usual, some persons whose condition was doubtful as regards certification as mentally defective have been received for observation at the instance of the Magistrate. At the beginning of the year there were 7 (in., 3; f., 4) such inmates, and 79 (m., 44; f., 35) were received during the year. Of this number, 46 (m., 27; f., 19) were discharged, 29 (m., 15; f., 14) had to be placed under ordinary reception orders, one woman elected to remain on as a voluntary boarder on the completion of the period of observation, and 10 (m., 5; f., 5) were in residence at the end of the year. These cases do not figure in the statistics, nor do the voluntary boarders, of whom there was a daily average of 20 in the State institutions, At the beginning of the year there were 27 (m., 11; f., 16), and 49 (m., 15; f., 34) were admitted during the year. Twelve only, or 6 of each sex, had ultimately to be placed on the register of patients, 1 died, and 34 (m., 10; i., 24) were discharged, leaving 29 (m. ( 10; f., 19) resident at the end of the year. The results in the case of persons remanded for observation and in the treatment of voluntary boarders is very gratifying; many are thereby saved from being committed as patients. Altogether 80 such inmates recovered or left much improved without formal admission as patients, which is highly satisfactory. It means a statistical reduction of the recovery rate, but that is of no real moment. The figures disclose an increasing desire to utilize at an early stage of the disorder the resources of the mental hospital, and in not a few instances ex-patients have returned for a period as voluntary boarders. The year under review, being two and a half subsequent to the outbreak of war, may be accepted as a typical war year, and some provisional conclusions may be approached on the effect of war conditions on. the population of New Zealand in relation to the incidence of mental disorder by analysing the following table. People are apt to be carried away into hasty conclusions by the total number of those resident in mental hospitals showing a yearly increase, forgetting that accumulation is inevitable. We have a comparatively low death-rate, and though we have a comparatively high recovery-rate and a few patients are discharged unrecovered, the deaths and discharges cannot balance the admissions, and the difference, for the most part, is made up of incurable cases. These patients in institutions live longer than they would outside, and so year after year the numbers go up and become disproportionate to the general population. The true test of the extent of mental disorder in the population is to be found in " occurring " insanity, of which admissions to mental hospitals furnish the best record. The figures in the table represent the ratio of the patients to 10,000 of the general population in the mean of three pre-war years and in 1917. The patients are divided into age-groups. The exclusion of Maoris from the age-groups from 1910 to 1912 would have entailed much unnecessary labour, and therefore they have not been excluded from the corresponding groups in 1917; but in all cases they are excluded from the total. The value of the figures for comparison is not affected materially; but, as the calculations are based on the general population exclusive of Maoris, the ratio of mentally defective in age-groups including Maori patients will be a fraction too high.

Mentally Defective Persons to 10,000 of the General Population.

From a glance at the ratio totals it is clear that there is no increase in the incidence of mental disorder. Larger numbers were admitted in 1917, but the population was larger, and relatively to the population the number of males is practically unchanged-—of females a fraction fewer—the difference for both sexes representing about 24 patients fewer than warranted by the increase of population since the control pre-war period. Passing to the analysis of the age-periods, it will be noted that there is a fractional increase in the proportion of males of military age. Since the 1911 census there has been an actual diminution of the general male population between the ages of 20 and 35, and a diminished increase to the age of 45, due to depletion for the Expeditionary Force and restricted immigration. The less physically fit and, broadly speaking, more likely to be subject to mental disorder have been left behind. Further, to the general population of military age was added 6,131 returned soldiers, and 31 of these were received into mental hospitals as patients. Had the returned soldiers been ordinary immigrants one would have expected them to contribute about 7 patients; but these

i Mean o: Adm f Years 1910 titted in One ,o 1912: Age-groups. I mean Ac 1917: Admittei Year. i Jnder 20 .. 10 to 30 10 to 40 :0 to 50 iO to 60 10 to 70 .. )ver 70 .. Males. 1-13 9-29 1.2-07 14-79 15-95 15-72 31-25 Females. 1-04 • 8-01 11-38 14-25 12-91 13-20 20-72 Total. 1-09 8-68 11-75 14-57 14-61 14-60 26-96 Males. 1-62 10-42 12-38 15-35 11-75 17-67 23-64 i j | | Females. 1-26 7-44 9-77 13-58 10-99 11-55 20-71 Total. 1-45 8-64 11-01 14-51 11-40 14-93 22-36 All ages 8-42 8-42 6-99 7-74 8-45 i 6-60 7-52

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31 patients must not be accounted as coming from returned soldiers who have been incorporated in the population, but from soldiers abroad who are not included in the population. At the end of the year that body would number not less than 80,000, and an equal number of'the leftbehind population of the same age and sex contributed between 90 and 100 patients. The surmiso of the greater liability to mental disorder among persons rejected for military service is strengthened by these figures, which indicate the relative immunity of the Expeditionary Force. It is surprising, therefore, that the ratio to the general population of males of military ago admitted to mental hospitals in 1917 is so very little in excess of the pre-war figures. When reviewing the higher ages in the tables it is to be remembered that population figures perceptibly diminish when higher ages arc reached, and therefore the reduction or addition of a few patients accounts for a more marked divergence from the pre-war standard than with earlier ages. It is interesting to note that the proportion of adult females admitted was consistently lower in 1917, and to reflect that this group in the population includes the wives, mothers, sisters, and other kin of our soldiers. Speculating on the average age of the fathers, in the absence of accurate information, one would place it at between 50 and 60, and our figures show that 42 fewer per 10,000 of the male population at that age became mentally disordered in 1917 than in the pre-war period. The parents and wives of our soldiers have been subjected to great and unusual mental stress, and there were in 1917 no material conditions to counterbalance the stress, which did not exist in 1911, yet the figures disclose that in the very age-groups which include the near and dear the ratio of mental disorder is reduoed. The presumption which occurs naturally is that the fathers and mothers of our best are themselves of sterner stuff, and able to withstand anxieties and griefs. Doubtless this is true to a large extent; but the explanation is rather to be found in the nature of the stress and the altruism it has called into being. The determination to resist the barbaric assault on liberty and justice has developecl and strengthened the higher emotions, and braced the individual as it has the nation. Next to ensuring that the ruthless ambition of a State or group of States shall be curbed for all time, the rulers of the civilized nations have placed upon them the responsibility to understand, and, understanding, to direct the higher social sense now pervading and uniting their communities, so that the unique opportunity may not be lost to the commonwealth. Returning to the nature of the stress which has been placed upon the parents, wives, and other relatives, one realizes that it is something terribly real, leaving no room or occasion for morbid vanities or mischievous introspections. These people have met their troubles in the spirit in which the soldiers have met the enemy : they have never doubted the cause nor, even in the dark days, a victorious issue; they have known the worst that could befall them when they bade farewell, and came to look upon anything that was not death as something to be thankful for, while death itself, if it laid the soldier low, brought the bereaved into a morally exalted community of suffering. They have had no reproaches shadowing them, nor have they been weighted by petty vexations; and because they have had to do with great things and have done them greatly, their reason has been preserved. An imbecile child or a, senile parent or grandparent who could no longer be suitably sheltered at home has come under our care in a few instances, but such cases have not been prominent in the past year. The drop in the proportion of senile patients may in some measure be due to cases of some duration having been already parted with. We have again experienced admissions of senile mentally infirm persons from charitable-aid institutions, cases which for a small extra expenditure in dormitory classification and nursing could have been kept on in an Old People's Home. They would have been a little more troublesome and a little more expensive to keep than the other inmates, and their committal as patients to a mental hospital is a convenient shelving of responsibility. I dwelt on this subject in my last report, and repeat now what I consider would prove a remedy—namely, that the Charitable Aid Board responsible should pay full maintenance for patients so transferred. The maximum statutory charge for maintenance is £1 Is. per week. Many patients have neither estate nor relatives able to contribute anything for their support, for some it would be no hardship to pay more than the statutory maximum, and between these extremes are a number paying varying sums according to their means. Altogether £53,650 was received in 1917—a highly satisfactory amount—which, distributed over the daily average of patients and voluntary boarders, works out at £12 7s. per head per annum. The total cost of collection (salaries, postages, stationery, &c.) was under 1 per cent., a result which is-very creditable to the Receiver. The total average annual cost per patient in 1917 was £50 17s. 7|d., a computation which does not include anything for rent for the accommodation supplied. Allow for this, and it is clear that the cost exceeds the statutory maximum charge. Then again, the average cost refers to the average patient, whereas the maintenance of recent and acute patients costs considerably more than a guinea a week. The maintenance expenditure for food, clothing, &c, has risen with the general higher cost of living, and salaries and wages have gone up very materially. It is time, therefore, that the maximum charge was revised. The revision will make no difference to those whose means are inadequate, but we should be in a position to collect twice the present maximum from the well-to-do. You, sir, have also raised the question of special institutions for those capable of paying a maintenance rate of four guineas and upwards, according to the needs of the particular case. Provision will need to be made to enable us to charge and collect sums' in excess of one guinea. Our receipts for maintenance and from the farms, &c, reduced the total cost quoted above to a net cost of £35 2s. lfd. per patient per annum—a very satisfactory figure under present circumstances.

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The farm-produce grown on our estates and consumed in the institutions was valued at £17,301, and in addition we received £9,578 for cash sales. The sales are £2,883 higher in Table XXa, which includes credits for hides, fat, &c, not directly produced on our farms. After deducting expenditure, we had a credit balance on the year's work of £8,381. The buying of stock to provide for our own supply of beef and mutton continues to work satisfactorily at Christchurch, Seacliff, and Hokitika, and an abattoir is about to be erected at Tokanui. The staff has been much depleted by the number of trained men, including Medical Officers, who have gone to the front. I trust that we shall be in a position to publish a complete Roll of Honour in the next report, and suggest that a memorial be placed in each of the institutions. Great credit is due to the seniors left behind in grappling with the problem of carrying on their duties with an undue proportion of probationers, and 1 am glad that their devotion and the nature of their duties generally have been recognized by a substantial increase in the salary scale. Very reluctantly we were compelled to appeal for exemption from military service of a number of officers, and I believe against their will. We have gone on the principle that the war was paramount, and that in common with others we would have to suffer some loss of efficiency, and it was only when we reached the limit of safety, when further depletion would have been unfair to the patients, that we appealed for men of some length of service capable of assisting and directing the probationers. Discipline has, of course, suffered from the undue number of new hands, and also from a cause I mentioned in my last year's report—the loss of local control under the Public Service Act. One should have the power to deal with minor delinquents promptly and on the spot, or a certain amount of slackness is bound to creep in, and will in time increase the anxiety of responsible officers from charge attendants and nurses upwards. The probationary period should be increased from one year to three—that is, until a probationer passes the Senior Examination. With local or effective control during the first three years' service our difficulties under the Public Service Act will be largely modified. The following is the distribution of patients resident in the State mental hospitals on the 29th June, 1918, and the sleeping-accommodation in associated dormitories allowing 600 cubic ft. per bed, and in single rooms : —

Over all, this shows a shortage of accommodation equivalent to placing 31 beds in a 30-bed dormitory, or a loss of 20 cubic feet of space per bed. Were the distribution of the patients' in different institutions, or in different wards of the same institution, at all uniform, this shortage of accommodation, especially under present conditions, would be negligible. The locality distribution of admissions and discharges is irregular, and cannot be equalized by periodic transfers; there are also many factors limiting the number and classes of transferable patients. In the large institutions male patients are classified in eight to ten wards, and women patients in seven or eight, planned for an average distribution. Thus when a particular class of patient is in excess a particular ward gets crowded, and the excess has to be distributed at night as best it can, and be collected again in the morning. There is a want of elasticity in function in the older type of building, which began as a, completed whole for about 600 patients, without any prevision of demands for more than that number. When extensions were carried out it was no easy problem to redistribute the wards in terms of special adaptability for any particular class of cases. The newer type of building, with separate units each for about 50 patients, permits of units being added according to necessity without interfering with the existing structure or its particular function. This is the type which is being built at Tokanui and adapted in most of our recent additions. At Auckland an addition to the infirmary ward is about completed, and a unit should be added to each of the new auxiliaries, both to meet the need for accommodation and to further classify the patients. With regard to Seacliff, additional dormitory accommodation has been authorized to enable us to close the institution at The Camp, Otago Peninsula. The Camp was purchased many years ago for the criminal insane, but people in the locality protested against such an institution being started there, and triumphed. The place became an encumbrance. Because of its relatively small size and its distance from supervision, it could be used for a few patients only and of a class which is better and more economically maintained elsewhere. To cut short the unnecessary expenditure it has been decided to remove to Seacliff the 27 patients now resident at The Camp. Other additions at the southern institution are being carried out at Waitati at the Epileptic Cottage, and two 50-patient units are also to be erected there.

Mental Hospital. Males. Patients. Females. Patients. Totals. Males. .ccommodation. Females. Totals. Auckland Seacliff (and Waitati) Porirua Christchurch Hokitika Nelson Tokanui 658 604 580 325 204 98 120 395 443 433 378 62 105 44 1,053 1,047 1,013 703 266 203 164 623 532 586 330 196 .101 152 359 403 403 385 72 107 49 I 982 935 989 715 268 208 201 Totals 2,589 1,860 4,449 2,520 1,778 4,298

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At Christchurch the occupation of the reception and hospital block (four divisions each for 25 patients) has been delayed because of the plaster cracking. When this is remedied it will add to the resources of Sunnyside a building similar to the one which is proving a boon at Porirua. Some addition is needed for ground-floor accommodation for aged patients. At Nelson it is intended to build one of the pavilions in accordance with the scheme for rebuilding that institution. At Hokitika some additions are being carried out on the women's side. At Tokanui the original temporary building is about to be abandoned for its present employment now that the third male unit is almost ready for occupation. A unit of 50 women is now in progress. These buildings at Tokanui will relieve some of the excess at Auckland, but we are nearing the time when we shall be able to admit direct to Tokanui, beginning in the surrounding district, which at present sends patients to the northern institution. The buildings Hearing completion will meet our excess as far as mere accommodation is concerned, but more than that is necessary for satisfactory classification; and all the time one must go on building without pause in order to keep pace with a yearly increment of about 150 patients. Visits of Inspection. I have again to express appreciation of the work of our District Inspectors and Official Visitors, whose manifest interest in their respective institutions and sympathetic regard for the patients is most helpful. My thanks are also due to Miss McLean, who has found time amidst her responsible duties of Matron-in-Chief, N.Z. Army Nursing Service, to pay special visits to the institutions and to hold viva-voce examinations in nursing. I have to record with regret the resignations of Mrs. Reynolds and Mrs. Field as Official Visitors at Hokitika and Nelson respectively, and the death of Mr. C. Y. Fell, one of the District Inspectors at Nelson, whose loss is felt by the patients and the Department. Mr. Smail, at Christchurch, and Mr. Cumming, at Seacliff, in the capacity of patients' friends, spend many hours weekly in the institutions, passing freely through the wards, <fee, conversing with the patients and helping them when opportunity offers. They send me a weekly report of their work, with special reference to .any matter they wish to bring under my notice, and it is very gratifying to learn from them of the general well-being of the patients. Hereunder are epitomized notes of my visits to the institutions. On these visits, some extending over many days, all the patients are seen and given an opportunity to converse with me. Occasionally there were complaints of wrongful committal or detention, but in no case did investigation bear these out. Such complaints are generally made by patients whose minds are most obviously disordered, but, having no insight of their condition, they naturally feel aggrieved at the loss or restriction of their liberty. On all the visits the food was examined and found to be of good quality and of a high caloric value. The bedding and clothing were satisfactory in kind and quantity. The wards were clean. Mr. Souter, Chief Clerk at the Head Office, has carried out his usual round of the institutions to check the stock in the stores and wards, and has reported favourably on the card system, and that he found the stock in good order. Auckland. —Visited in March and November, 1917, and in February and March, 1918. The Wolfe Bequest Hospital has been set aside for soldiers labouring under war neuroses. This has reduced the accommodation at this institution and its amenities for the ordinary patients; but the successful results attending the treatment of the soldiers here has justified the temporary inconvenience. The male infirmary nearing completion will be a great improvement on the past accommodation. The old big dormitory will be transferred into a cheerful day-room, and the sick and infirm will be classified in small associated dormitories and in single rooms. The new auxiliary buildings are already fully occupied, and plans are in preparation for additional units. There have been a number of exacting cases, and the staff has been very much depleted by numbers serving at the front. Dr. Beattie and his senior assistant, Dr. Tizard, both in indifferent health, have worked unremittingly; the junior assistant has not been a permanent officer. A number of the senior attendants and nurses have shouldered the extra burden faithfully. Sunnyside. —Visited in May, June, and December, 1917, and in February, 1918. The chief want here is an addition to the day- and dining-room, accommodation for disturbed and excited women patients, a class which requires more than the usual floor-space in living-rooms. This can be accomplished without great difficulty and economically. The delay in completing the reception building is disappointing. The furniture is being procured and made, so that there will be no further delay once the building is fit for occupation. The resources of the farm, garden, and orchard have been employed to great advantage for the benefit of the patients. The increase in the dairy herd has supplied our needs for butter without reducing the milk item in the dietary, and the Matron has made full use of the orchard by providing a plentiful and varied supply of home-made jam. The diet of the patients is excellent and generous. I was pleased to note the co-operation on the part of the staff to make the institutions as comfortable as possible for the patients. The new auxiliary farm at Templeton is proving the acquisition it promised to be. It was found more profitable to concentrate on the dairy herds and not raise mutton and beef; fat stock has therefore been bought at Addington, and topped off when necessary, so that we have had prime meat supplied and a saving effected. The laundry extension has to wait till after the war, and also the completion of the kitchen renovation, which involves the installation of a series of new-type cooking-pans; meantime the existing apparatus has been altered and arranged to facilitate labour, and Mr. Rose, the engineer, has introduced some ingenious and original electrical heating units. Seacliff. —Visited in May and December, 1917, and in February, 1.918. During the year Dr. Truby King received a call to England to assist in organizing the infant-life-protection

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movement. Because of the importance of the matter, especially at the present time, and of Dr. King's special knowledge and power of imparting it, he was given leave without pay, and Dr. McKillop, senior assistant, replaced him at Seacliff as Acting-Superintendent. Dr. McKillop, a Major in the N.Z.M.C. at Gallipoli, had been invalided home, but his health was restored before Dr. King left. By the courtesy of the Defence Department Dr. Gray, another of our officers with considerable experience in mental diseases, was recalled from France, and recently resumed duty at Seacliff. . The general health of the patients has been good, and the condition of the patients, their diet and their clothing, and the order maintained throughout the institution, reflect credit on those officiating in Dr. King's absence, and on the staff working under unusually hard conditions at the present time. Connected with Seacliff are the Camp Auxiliary Mental Hospital (which, as stated above, it is proposed to close) and Waitati. At this last institution the accommodation for epileptic patients is being enlarged and improved. It is also proposed to add two units for 50 patients each. The medical staff also visit the Anzac House Hospital at Karitane. At Seacliff proper the new reception-cottage for men is working excellently, and without exception the inmates expressed their satisfaction to me on my visits. The same remark applies to the Anzac House Hospital, which for convenience we administer and visit for the Defence authorities, but the inspection of which does not come strictly under this Department. It is placed under the charge of Mr. Maurice Quill, our second head attendant at Seacliff. The ground-slip towards the north end of the main building makes slight gradual and uniform progress, but is not yet dangerous. It is here that many years ago two isolation cuts were made, and part of the building on the slip was placed on a floating foundation. There is a perceptible twist in a line of single rooms in this locality built in wood. These and a similar row on the male side, both built many years ago, have repaid their original cost, and should be rebuilt after the war. The general store-rooms need extension, and I went into this matter in detail, so that the work could be carried out without delay when the building programme was no longer limited to urgent requirements. A. general bathroom in the cloister or ambulatory between the main administration block and the first male pavilion is planned, and should now be proceeded with. The basement here is used for fire appliances, which can be as conveniently placed elsewhere, and is easily and privately reached from both sides of the institution. It will repeat the features instituted at Sunnyside and working there so successfully—of foot-baths, tepid showers, and swimming-pool, as well as ordinary plunge-baths, with dressing and undressing rooms. Hokitika. —Visited in January and May, 1917, and in February, 1918. Mr. Sellars, who succeeded Mr. Downey as lay Superintendent, is carrying the, institution on in its old successful traditions. Miss Williams, the newly appointed Matron, was transferred to the Education Department, and was succeeded by Miss Drummond, from Seacliff. The laundry has no machinery, and though hand washing can be carried on for some time yet, a.proper drying-chamber is necessary. Hitherto, with a plentiful supply of clothing, delay in the laundry owing to wet weather, &c, did not make any material difference, but the obligation to keep expenditure down when prices for clothing are so high and our class of goods practically unprocurable has accentuated the primitive laundry arrangements. This institution is very old, and has almost served its time. The recognition of this fact has kept us from introducing modern kitchen and laundry appliances until they formed a unit of the rebuilding scheme. Old though it be, the institution is kept scrupulously clean, and the patients are comfortably provided for. Nelson. —Visited in January and July, 1917, and in January, 1918. The drainage alterations were completed, and many small works have been carried out pending the rebuilding. The old institution continues to shelter the patients comfortably, being kept scrupulously clean and in good order. The patients are well fed and clothed. Dr. HasselPs health had been indifferent towards the latter part of last year, and in January this year Dr. Jeffreys exchanged positions with him, and already he has benefited by the change of work and scene, and hopes soon to resume duty at Porirua. Porirua. —Visited in January, February, March, April, June, July, August, September, 1917, and in January and April, 1918. The principal feature since last report is the occupation of the reception and hospital block, which is beautifully situated, apart from the main Mental Hospital, and is well adapted for its purpose. There has been a very large depletion of the Porirua staff as a result of the war, and therefore the work of the senior officers has been very anxious. Dr. Moore was transferred to Auckland, and Dr. Prins entered the service towards the end of the year, and after doing interim duty at Sunnyside, and was stationed at Porirua. Dr. Jeffreys relieved Dr. Hassell in January. The piping of the septic-tank effluent into the harbour is progressing satisfactorily. The purchase of the Mitchell property adjoining the Mental Hospital estate is a noteworthy addition to our resources. A patient was admitted suffering from cerebro-spinal meningitis. Fortunately the condition was immediately diagnosed, and precautious were taken against infection, which proved successful. The automatic-telephone service between the different parts of the institution and the officers' quarters is proving useful and most convenient. Tokanui. —Visited in January, March, November, and December, 1917, and in February, 1918. The third male unit is about ready for occupation, and arrangements are being made for furnishing. The hot-water supply is still to be carried to it. AVhen this is completed the first building (temporary) can be dismantled, and partly re-erected on a distant part of the estate at headquarters for working the land in that locality. The main road to this point is very bad in winter, and daily transport means a large shrinkage of working-hours. The second unit for women patients is now being built. The next most urgent requirements are the laundry and administration offices and stores. The fire service is now installed, and has been done by our own labour. We have also fitted up a cool chamber. It has been almost impossible to get a sufficient number of competent ploughmen to bring the undeveloped lands under cultivation,

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and this, combined with the expense of fencing-material, the difficulty of transport, and other factors, lias made us concentrate on the area nearer the buildings. This is in a high, state of cultivation, and with a fair acreage now in permanent pasture we shall soon be well placed to direct the full energy of the workers to breaking up new country. We have a very good take of lucerne, and our cropping returns demonstrate that with careful cultivation really good results can be got from this soil. A start has been made to bring in the block south of the road from the creamery to Waikeria. Ashbum Hall. —Visited in May and December, 1917, and in February, 1918. This private licensed hospital is under Dr. Will, who takes a kindly and individual interest in the patients. In common with all institutions, this one has had its troubles with depletion of staff and changes among the probationers, but apparently every effort has been made by the management to prevent this factor from inconveniencing the patients. There are very few cases of acute mental trouble, and for the majority of the patients the institution is a comfortable home. In conclusion I have to thank, the staff of the Head Office, who have worked short-handed and at times under high pressure, but always willingly. I have, &c, Frank Hay.

MEDICAL SUPERINTENDENTS' REPORTS.* AUCKLAND MENTAL HOSPITAL. Dr. Beattie reports : — We had 1,235 patients under treatment during 1917, as compared with 1,216 in 1916. The average numbers resident were 633 males and 384 females, giving a total of 1,017. The number admitted during the year was 225. This number was considerably less than that of last year, when 268 were added to our numbers. Of the 135 males admitted, 45 were labourers and 16 farmers. The chief causes were congenital deficiency (32), heredity (24), senility (18), alcohol (16), and syphilis (15). At the end of the year 1,061 patients remained on the books, an increase for the year of 51. It is necessary to point out that during the year no additions were made to our accommodation. Our refractory wards, both male and female, were very much overcrowded, and with the prospect of a considerable increase in the coming year the successful administration of the Hospital becomes wellnigh impossible. If we are not to build in anticipation of patients, or be able to transfer friendless patients to other institutions, it becomes essential to make annual additions to our accommodation to meet our increasing population and provide for classification. The returned soldiers have not added appreciably to our numbers. The few cases admitted have been due to causes outside the war. Ido not anticipate a large increment as a direct result of the war, but we have probably not yet begun to feel the effects of the many contributing factors which the war has introduced. The recovery-rate was: For males, 3704 per cent., and for females, 3333 per cent. The death-rate was : For males, 932 per cent., and for females, 8 - 07 per cent. Two female deaths were caused by typhoid fever. No defect was discovered in drainage or in water or milk supply. The mild epidemic was probably due to a carrier. It is generally easy to ascertain the previous existence of typhoid when considering our European patients, but it becomes practically impossible in the case of Maoris. My opinion inclines to the belief that Maoris are responsible for our outbreaks. Examination has revealed the existence of several Maori carriers. In addition to our ordinary committals 46 patients were sent to us on remand. Of these, II were ultimately committed. The remainder were discharged recovered, or will be so. We had also 6 voluntary boarders. The general activities of the Hospital have been carried on as usual. The administration has been more difficult and anxious than usual on account of the numbers who have left us for military service and the difficulty of securing suitable candidates to fill their places. I have had, as is usual, to rely upon the loyalty and fidelity of the senior staff, but more so this year than previously. We fully realize the insignificance of our difficulties in the face of the immensity of our national crisis. My thanks are due to the District Inspector, the Official Visitors, the Medical Officers, and staff generally for the advice and support which have been loyally accorded me. SUNNYSIDE MENTAL HOSPITAL. Dr. Gribben reports : — At the beginning of the year 1917 there were 692 patients on the register, of whom 333 were males and 359 females. During the year there were admitted 73 males and 63 females, and at the end of the year there were remaining 748 patients, an increase of 56 for the year. There were 44 deaths, giving a death-rate of 63 per cent, on the average number resident. There were 30 recoveries (14 males, 16 females), giving a rate of 22 per cent, on the admissions. The health of the patients was generally good. There was, of course, the usual proportion of senile cases, which fill up the infirmary wards and, especially under present conditions, severely tax the senior and experienced members of the staff. I think it is a pity that something definite

* Dr. Truby King was unable to furnish a report on Seacliff, as the returns were not prepared when he left for England early in January, 1918.

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8

is not done in the way of amending the law so that this class of patient, who after all is merely suffering from a physiological senile degeneration, could be treated in institutions for old people apart altogether from mental hospitals. There was one suicide during the year, that of a male patient who, while engaged with a working-party at the new reception block, suddenly rushed up a ladder on to the cave of the building and threw himself head foremost to the ground. As a result of the acquisition of land at Templeton it has been possible to considerably extend farming operations. The buying and killing of our own stock continues an unqualified success. Taking into account all charges, our meat for last year cost vs —for mutton 5'67d. per pound, and for beef 4'96d. per pound. I need not point out that this, for first-quality meat, under present conditions, is much better than could be done under any other system of supply. War conditions have, # of course, added to. the difficulties of administration, but the officers and members of the staff generally have loyally and energetically co-operated to meet the altered conditions. The patients' entertainments have been continued, and I am indebted to a number of ladies and gentlemen in Christchurch for books, magazines, and periodicals. PORIRUA MENTAL HOSPITAL. Dr. Hassell reports :— The total number of patients under care during the year was 1,239 (730 males and 509 females), while the average number resident was 967 (560 males and 407 females). 205 (124 males and 81 females) were admitted for the first time, and in addition 50 patients were readmitted and 2 transferred from other mental hospitals. Of those discharged, 118 (72 males and 46 females) had recovered, which makes a recovery-rate of 4627 per cent, of the number admitted. The total number of deaths was 77, which amounts to nearly 8 per cent, of the average number of patients in residence. Both recovery and death rates were somewhat higher than in former years. About half of the deaths were caused by' senile decay (18 cases), phthisis (12 cases), and general paralysis (8 cases). Not included in the above statistics were 11 cases who gained admission by voluntary request, of whom 3 had subsequently to be committed owing to an accentuation of their mental disorder, 1 died from general debility, and 7 were discharged relieved or recovered. The event of most importance during the year was the completion and opening of the new home designed to accommodate two classes of cases —first the early cases and convalescents, and secondly the, physically sick. The home largely consists of four pavilions, two for male and two for female patients, and is so constructed that the two classes of cases are treated apart. Besides the pavilion dormitories there are a number of single bedrooms for special cases. Altogether upwards of 50 male and 50 female patients can be accommodated. The whole forms a very convenient and well-equipped institution, to which is attached a home for 30 nurses. The situation is good, well away from and out of sight of the main Mental Hospital, and on a hill which in the early days, when Porirua was well populated by Maoris, was called " Ra-uta." This name has been adopted by the Department for the new home. At the end of the year the installation of the automatic-telephone exchange was almost completed, and since then the system has proved a great convenience and a valuable aid to administration. Now all wards in the main building, in the auxiliary buildings, and at " Ra-uta " are in direct telephonic communication with my office and house, as well as with the Assistant Medical Officers' residences and other senior officers' quarters. For many years the large volume of effluent (amounting to upwards of 50,000 gallons in the twenty-four hours) from the septic tanks has been discharged into the stream which flows through the property into the Porirua River some distance above the township. To prevent any contamination of that stream, which was certainly noticeable in the dry summer weather, it was decided to lay a sewer to carry the effluent past the township and discharge it into the harbour. Preparation for this work has been in hand, and I hope it will be completed during the current year. The general health of the inmates has been satisfactory. No epidemic invaded the institution, although two isolated cases of typhoid fever occurred in the female wards. I regret to have to record two serious accidents : one to a patient working on the farm, who threw himself from the hay-loft and injured his spine and died shortly afterwards, and the other a suicide in the case of a parole patient who was living at " Ra-uta." Details of these cases were duly forwarded to you. War conditions again seriously interfered with the working of the Hospital, and it was impossible to procure sufficient attendants and nurses. The shortage varied, and at its worst reached as much as 21 per cent, of the complement of attendants and 24 per cent, of the nurses. Dr. Hodgson, who was transferred from Seacliff Mental Hospital in May, 1915, was permitted by the Department to join the New Zealand Expeditionary Force in the autumn. I regretted losing the services of so valuable an officer. His going was made possible by the generous offer of Dr. Levinge, who, as senior Medical Superintendent in the service, had retired about twelve years previously. Dr. Levinge offered to rejoin the service and take a junior position in order to release a Medical Officer for military duty. Dr. Levinge commenced duty on the Ist March, and in the following month Dr. Moore also joined the medical staff. Dr. Levinge resigned at the end of September, and about the same time Dr. Moore was transferred to the Auckland Mental Hospital owing to bad health. They were succeeded by Dr. W. Simpson, who had recently returned from the front, and by Mr. Roberts, who was a senior student of medicine of the Otago University. Fortunately there were no changes in the personnel of the senior officers of the various departments of the Hospital.

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APPEND I G E S.

APPENDIX I. Table I. —Showing the Admissions, Readmissions, Transfers, Discharges, and Deaths in Mental Hospitals during the Year 1917.

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 1917.

2—H. 7.

In mental hospitals, 1st January, 1917 Admitted for the first time Readmitted Transfers.. M. 411 59 87 P. 298 76 4 T. 709 185 41 M. 2,555 507 P. 1,820 378 T. 4,375 885 Total under care during the year Diseharged and died— Recovered .. .. ... Relieved Not improved Transferred Died .. .. 1.71 82 0 117 205 152 20 5 4 118 323 52 11 41 318 3,002 2,198 5,260 451 294 745 !— Remaining in mental hospitals, 31st December, 1917 2,611 1 ,904 4,515 Increase over 31st Deeomber, 1916 56 HI 140 Average number resident during tho year 2,543 1,825 4,368

. ,. . . „ Admissions in 1917. Total Number In Mental Hor- n jMental Hospitals. pitals on -. Pntinntu 1st January, 1917. Admitted for the Not First T ,.„...„ ... , ,... <'„„. First Time. Admission. iransleis. nuclei caie. ' i M. F. T. : M. I'. T. M. I'. T. M. I'. T. M. K. 'J'. Auckland .. .. 629 381 1,010 j 114 78 192 21 12 33 .. i 7(14 471 1,235 Christchurch .. .. 333 359 692 I 65 51 118 li 111 16 2 2 4 40(1 422 828 Dunedin (Sear I ill') .. 592 4221,014! 74 60 134 II 17 28 4 I. 5 681 500 1.181 Hokitika .. .. 196 67 263 14 10 24 0 I L .. 210 78 288 Nelson .. .. 99 120 219 9 12 21 2 5.7 .. 110 137 247 Porirua .. .. 585 397 982 ' 124 81 205 III 31 50 2 0 2 730 509 1,239 Tokanui .. .. 100 49 149 .. .. 27 0 27 127 19 176 Ash burn Hall (private 21 25 46 I I 6 17 2 1 3 34 82 66 menial hospital) ■—— —■— ■——, ■ Totals.. .. 2.555 1,820 4.375 411 298 709 59 70 135 37 4 41 3.062 2.198 5,260 i Patients discharged and died. In Mental Hos- ,..,., ... _ , pitals on Mental Hospitals. i -ii q t nncenibmDischarged Discharged m fl Total discharged -ust ijecemoei, recovered. not recovered. jjiou. ftnd d j od _ M. P. T. M. IT. T. M. F. T. M. F. T. M. F. T. Auckland .. .. 50 30 80 2 2 -I 59 31 90 111 63 174 .653 408 1,06.1 Christchurch .. .. 14 16 30 4 2 6 26 IS 44 44 36 80, 302 386 748 Dunedin (Seaolifl) .. 26 41 67 : 13 5 18 37 25 62 76 71. 147' 605 429 1,034 Hokitika .. .. 5 li II 2 2 4 17 3 20 24 11 35 186 07 253 Nelson .. .. 2 12 14 ! 2 13 6 10 16 ' 10 23 33 100 114 214 Porirua .. .. 72 46 118 4li 14 80 55 22 77 173 82 255 557 427 984 Tokanui .. .. .. 10 1 3 3 6 4 3 7 123 46 189 Ashburn Hall (private 2 I 3 5 3 8 2 1 3 9 5 14, 25 27 52 mental hospitall —• 1 ■ j — -— Totals.. .. 171 152 323 75 29 104 205 113 318 451 294 745,2,61] 1.904 4.51.5 j ~~~Z ~ AwageNunil,,, v£S5TB£» *SS8X« Mental Hospitals. resident during Admissions Number resident , J v f«o n,,, tneYeai. during the Year. during the Year. tin. Admissions. _ " ~ i ~ i " — M. F. T. M. F. T. M. I-'. T. M. F. T, Auckland .. .. .. 633 384 1,017 37-04 33-33 35-56 9-32 8-07 8-85 43-70 34-44 40-00 Christohuroh .. •• 329 364 693 19-72 26-23 22-73 7-90 4-95 6-35 36-62 29-51 33-33 Dunedin (Seaolifl) .. .. 596 423 1,019 30-59 53-25 41-36 6-21 5-91 6-08 43-53 32-47 38-27 Hokitika .. .. .. 191 6+ 255 35-71 54-55 44-00 , 8-90 4-69 7-84 121-43 27-27 80-00 Nelson .. .. 93 109 202 18-18 70-59 50-00 6-45 9-17 7-92 54-55 58-82 57-14 Porirua .. .. 560 407 967 50-35 41-07 46-27 9-82 5-41 7-96 49-11 19-64 30-20 Tokanui .. .. .. 118 48 L66 .. 2-54 6-25 3'61 Ashlnmi Hall (private mental 23 26 49 ! 18-18 16-67 17-65 8-70 3-85 0-12 18-18 16-66 17-65 hospital) ' '• Totals .. .. 2,543 1,825 4.368 | 36-38 40-64 38-27 8-06 6-19 7-28 43-62 30-21 37-68

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Table III.— Ages of Admissions

Table IV.—Duration of Disorder on Admission.

Ages. Auckland. Christchurch. Dunedin (Seaclirf). Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall j (Private Mental \ Hospital). Total. Under 5 years . . From 5 to 10 years „ 10 .. 15 „ ,. 15 ,. 20 „ ,. 20 „ 30 „ ,- 30 „ 40 „ „ 40 „ 50 „ „ 50 „ 60 „ ., 60 ., 70 „ „ "0 .. 80 „ „ 80 „ 90 „ Unknown Transfers M. W. T. 0 1 1 0 1 I 5 5 10 19 20 39 34 25 59 35 18 53 14 12 26 14 1 15 4 6 10 2 13 8 0 8. M. F. T. 2 1 3 4 1 5 5 3 8 8 14 22 12 11 23 15 11 26 6 4 10 11 9 20 6 3 9 2 4 6 2 2 4 M. F. T. 3 1 4 4 1 5 15 13 28 20 22 42 15 21 36 9 4 13 7 6 13 6 6 12 6 3 9 4 15 M. F. 2 6 3 2 3 3 1 4 0 2 3 0 2 0 T. 2 5 6 5 2 3 2 I M. F. T. ! M. 2 0 2 ! 2 10 10 2 1 3. I 0 Oil 8 1 5 6 i 22 1 1 2 j 34 1 3 4 i 33 0 3 3 I 19 0 2 2 16 Oil 5 3 0 3 4 2 F. T. 0 2 2 2 4 4 6 14 20 42 I 27 61 28 61 13 32 6 22 a 10 1 5 0 2 M. F. T. 6 27 M. 0 1 3 3 1 1 F. 0 1 i. l l 6 4 3 1 1 3 M. F. T. 4 1 5 3 3 6 9 8 17 22 17 39 68 72 140 107 91 198 105 85 190 51 41 92 49 26 75 24 21 45 20 9 29 8 0 8 37 4 41 Totals .. 135 90 225 73 63 136 89 78 167 j 14 11 25 j 11 17 28 145 112 257 | 27 0 27 13 20 507 378 885

Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Hokitika. Nelson. l'< Nelson. Porirua. orirua. To! Tokanui. kanui. (I Ashburii Hall (Private Mental Hospital). Privat Hos urn Hail te Menta spitali. Total. . i First Class (first attack and within 3 months on admission) Second Class (first attack above 3 months and within 12 months on admission) Third Class (not first attack, and within 12 months on admission) Fourth Class (first attack or not, but of more than 12 months on admission) Unknown .. . . .. Transfers M. F. T. 90 66 156 11 7 18 22 0 31 12 8 20 M. F. T. 37 26 63 4 9 13 12 11 23 18 15 33 2 2 4 M. F. T. 33 35 68 15 6 21 5 24 29 32 12 44 4 1 5 M. F. T. 6 2 8 3 3 6 4 6 10 1 0 1 M. F. T. M. 13 4 100 5 2 7 9 26 8 7 15 12 2 F. 5 37 15 0 T. 155 10 63 27 2 M. 27 F. T. 0 27 M. 8 3 0 0 2 F. T. 3 11 1 4 1 1 1 1 1 3 M. 275 41 71 F. T. 190 465 31 72 95 166 83 58 141 37 4 415 h . , : Totals .. 135 90 225 j 73 63 136 89 78 167 14 11 25 ; 14 11 25 11 17 28 145 11 17 28 145 112 257 112 : 257 27 27 0 27 0 27 13 13 7 20 20 507 378 81

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Table V.—Ages of Patients discharged "Recovered" and "Not Recovered" during the Year 1917.

Table VI.— Ages of Patients who died.

Auckland, Christchurch. Dunedin (Seaclul). j Hokitika. Nelson. Porirua. Tokanui. (Private JIH ) Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall (Private M.H.). J Total. Totai. ._!__ _ . ]_ | I I I ' I Ages. " ■ Be- Not re- ; Re- Not re- Re- Not re- Be- j Not re- | Be- Not re- Be- Not Be- Not re- Re- Not recovered, covered, covered, j covered, j covered, covered, covered, covered, covered. - covered. covered, recovered, covered, covered, covered, covered. i i i i i Recovered. Kot . recovered. M. F. T. 51. F. T. M. F. T. M. F. T. M. F. I. M. F. T. M. F. T. M. F. T. M. F. T. H. F. T. M. F. T. M. F. T. M. F. T. 11. F. T. M. F. T. M. F. T. Under 5 years .. .. .. .. .." .. .. .. .. .. .. .. 10 1 From 5 to 10 years.. 10 1.. „ 10 „ 15 „ .. .. 10 1.. .. .. .. .. .. .. .. 011.. „ 15 „ 20 ,,..0 1 1J .. '12 3 .. 10 1 .. - .'. .. 0 1 1 I li I 2 I 3 2 O 2 ,. 20 „ 30 „ ..6 8 14 .. 2 4 6 1 0 1 4 10 14 1 0 I 1 0 1 .. 0 (i 6 .. 8 10 IS i 3.8 .. 1 0 1 1 0 1 .. 30 „ 40 „ ..13 10 23 .. 4 6 10 .. 3 14 17 0 1 1 1 0 1 .. 1 3 4 I o I 22 11 33 3 I 4 .. .. .. 10 1 „ 40 „ 50 „.. 15 8 23 0 1 1 4 2 6 2 0 211 10 21 3 1 4 0 2 2 1 1 2 1 0 1 .. 20 15 35 2 7 9 .. .. .. 0 11 ,. 50 „ 60 ,,..8 1 9 112 2 13 .. 5 5 10 I 2 3 I 3 4 0 1 1 0 2 2 0 1 1 14 5 19 3 0 3 .. .. I o 1 0 1 1 „ 60 „ 70 ,,..2 1 3 .. 11-9 .. 2 2 4 10 10 11 .. .. .. 5 2 7 0 11 .. .. 0 11 „ 70 „ 80 ,. .. 3 1 4 .. .. ! 0 1 1 .. 30 310 1101.. .. 12 3.. „ 80 „ 90 .. .. .. .. 1 0 1 I 0 1 .. .. .. .. 10-1 Unknown .. ..202.. Transfers .. .. .. .. ..112.. 314.. .. .. .. 29 1 30 .. .. .. 415 Totals ..50 30 80 2 2 4Jl4 16 30 4 2 626 41 6713 5 18 5 6 112 2 4 2 12 14 2 I 372 46 11846 14 60 .. 10 12 1 3| 5 3 S M. F. T. M. F. T.. 1 II 1 10 1 112 4 5 9 3 0 3 22 38 60 8 3 11 44 44 88 5 2 7 51 37 88 n 11 19 31 17 4S 5 6 11 10 8 IS 1 1 2 5 3 8 4 1 5 1 (' 12 0 2 2 0 2 37 4 41 171 152 323 75 29 104 1 0 1 2 1 3 1 5 3 8 171 152 323 75 29 10-

_. .. . .. i Ages. Auckland. Auc ckland. r Christ Christchurch. itchurch. E Dunedin (Seacliff). Dunedit u (Seacliff). Hokitika. Nelson. Porirua. Tokanui. I Ashburn Hal! (Private M.H.). Total. From 5 to 10 wars „ 10 „ 15' ,. „ 15 ,. 20 „ „ 20 ., 30 .. „ 30 ,. 40 .. „ 40 „ 50 ,. „ 50 ., 60 ., „ 60 ., 70 .. „ 70 „ 80 ,. „ 80 „ 90 „ „ 90 „ 100 „ Unknown •• i 0 1 I 2 1 3 4 0 4 16 4 20 6 6 12 5 7 12 11 2 13 11 4 15 2 6 8 1 0 I 1 0 1 ji. 0 4 16 6 5 11 11 1 F. T. 1 I I 3 0 4 4 20 6 12 7 12 2 13 4 15 6 8 0 I 0 1 si. 1 1 5 I 3 1 0 1 1 2 3 .i I) 5 I 1 2 3 0 3 7 6 13 7 (i 13 I :; 4 F. T. 0 1 2 3 0 5 1 2 0 3 6 13 (i 13 :; 4 M. 0 2 1 10 (i 8 3 F. T. 1 1 4 6 3 4 3 13 4 10 3 10 5 13 2 5 H. F. ' 2 0 3 0 2 (i 3 2 5 1 2 (I T. 2 ■J 2 5 6 M. F. • 1 II 1 0 0 2 0 3 0 3 1 2 2 0 1 0 T. 1 1 2 3 3 2 1 BC. F. T. M. F. ' Oil '.'. 6 17 11 5 10 II s 4 12 . 11 7 3 10 11 2 13 1 1 8 6 14 4 0 4 T. 2 2 M. F. T. 1 0 1 I 0 1 o i i M. F. 1 0 1 1 3 3 14 7 36 15 29 15 24 17 40 19 40 25 14 11 2 o 1 0 T. 1 6 21 51 44 41 59 .15 25 1 „__ _____ , Totals .. 59 31 90 26 18 44 37 25 62 17 3 20 li 10 16 55 22 77 •i ii 9 1 205 113 31s I I

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Table VII. —Condition as to Marriage.

Admissions. Discharges. Deaths. Discharges. Deaths. Auckland— Single Married Widowed Unknown Transfers M. F. T. M. I<\ T. M. V. T. 75 31 l()6 27 10 37 34 8 12 54 50 104 22 22 44 20 II 31 6 9 15 3 0 3 5 12 17 M. If. T. 27 10 37 22 22 44 3 0 3 M. 34 20 5 F. I 8 ) II i 12 'i'. 31 17 Totals 135 90 225 52 32 84 59 31 90 52 32 84 59 31 DO CHP.ISTOHUROH — Single Married WidoWed Unknown Transfers 25 26 51 7 4 II 14 6 20 .. 40 23 63 8 II 19 9 7 16 .. ! 6 12 18 2 2 4 3 5 8 2 2 4 112 7 8 2 4 II 2 I I 19 4 14 !l 3 6 7 5 20 16 8 1 I 2 Totals 73 63 136 18 18 36 26 18 44 18 18 36 26 18 44 Dunisdin (Seacliff) — Single Married Widowed Unknown Transfers Totals 16 36 82 10 22 32 I!) 10 21) 211 32 61 23 23 46 12 10 22 10 I) ill '■ 3 0 3 6 5 II 4 15 3 14 89 78 167 39 46 85 37 25 62 10 °3 3 22 23 0 32 46 3 I!) 12 6 10 10 5 21) Ti 3 I 4 39 46 85 37 25 62 Hokitika — Single Married Widowed Unknown Transfers 9 I 1(1 5 2 7 14 I 15 2 6 8 2 4 6 (III ..13 47 022 314 5 2 0 2 4 2 7 6 2 14 0 3 I 1 1 15 1 4 Totals 14 II 25 7 8 l, r > 17 3 20 — 1 ' — — 7 8 1.5 17 3 20 Nelso n— Single Married WidoWed Unknown Transfers , , . 8 7 15 3 3 6 4 5 II 3 7 10 I I 8 I) 1 2 3 0 3 3 ! 0 2 2 13 4 I 0 3 8 2 6 9 2 4 I 1 5 2 3 ll 3 4 Totals 11 17 28 4 13 17 0 10 16 17 28 4 13 17 6 10 16 L i POIUR.JA Single Married Widowed Unknown Transfers Totals .. 78 38 116 52 20 72 29 7 36 54 59 113 ' 34 31 65 18 9 27 . . | 11 15 26 3 8 II 8 6 14 2 0 2 29 I 30 I ______________„_ .. I 145 112 257 118 60 178 55 22 77 52 34 3 20 31 8 72 05 I I 29 18 8 7 II 6 36 27 II 29 I 30 118 60 178 53 22 77 Tokanui— Single Married Widower] Unknown Transfers 10 1 2 2 4 112 '.'. ! 27 0 27 '.'. .'. Totals .. i 27 0 27 I 0 I 3 3 0 Ashbijun Hall (private mental hospital)— Single Married Widowed Unknown Transfers Totals 2 13 2 2 1 I ii I 7 4 11 1 1 2 1 0 I 2 13 .. Oil '.. 2 I 3 j 4 I 5 j 13 7 20 7 111 213 20 II 2 3 fOTALS — Single Married Widowed Unknown Transfers 243 140 383 107 63 170 117 39 156 189 181 370 HI 100 191 02 41 103 38 53 91 11 14 25 26 33 59 37 4 41 37 4 41 Totals 507 378 885 240 181 427 205 113 318

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Table IX.—Ages of Patients on 31st December, 1917.

Table VIII.— Native Countries.

i I 1 I Countries. Auckland. Christchurcli. Dunedin (Seacliff). Hokitika. •j Nelsou. Porirua. Tnkanni Ashburn Hall lokanui. (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. 156 S7 243 80 98 178 34 18 52 23 17 40 76 48 124 48 50 98 225 203 428 179 195 374 37 11 48 12 in 22 2 1 3 i .. j 5 3 8 ! 3 14: .. 20 2 22 112 .. I 2 1 3 1 .. !" .. I 6 1 7 3 0 3 2 1 3 I 3 1 4 5 0 5 I 10 1 2 0 2 .. 22 14 36 ! 0 1 1 .. ! 28 7 35 7 9 16 .. ! 32 11 43 13 4: ; M. F. T. 106 60 166 98 76 174 80 55 135 257 215 472 24 19 43 9 1 10 10 1 | 4 0 4 | 3 0 3 1 2 1 3 1 0 1 12 0 12 2 0 2 6 2 8 M. F. T. 30 14 44 14 6 2,1 42 12 54 62 29 91 11 4 15 5 0 5 1 1 2 5 0 5 7 0 7 6 0 6 3 0 3 0 1 1 M. F. T. 7 8 15 3 6 9 12 7 19 58 65 123 1 4 5 2 0 2 1 0 1 1 0 1 1 0 1 2 13 12 23 35 M. F. T. I 163 94 257 50 25 75 56 65 121 210 2J1 411 32 15 47 1 0 1 4 8 12 0 1 1 112 6 3 9 8 0S 4 0 4 2 0 2 7 4 11 13 10 23 M. F. T. M. F. T. 31 7 38 4 6 10 4 0 4 6 17 15 7 22 58 32 90 15 16 31 3 0 3 0 4 4 10 1 4 0 4 10 1 10 1 10 1 10 1 10 1 10 1 10 1 M. 577 232 329 1.064 120 5 28 27 9 24 16 18 24 34 58 46 F. T. 374 951 149 381 244 573 956 2,020 67 187 1 6 13 41 4 31 3 12 4 28 3 19 0 18 0 24 20 .54 28 86 38 84 Totals .. 653 408 1,061 j 362 386 748 _J 605 429 1,034 186 67 253 100 114 214 557 427 984 ; 1 557 427 984 123 46 169 123 46 169 25 27 52 25 27 52 2.611 1,904 4,515 2.611 1,904 4.515 i

I . I Ages. From 1 to 5 years 5 „ 10 „ ,. 10 ., 15 „ „ 15 „ 20 „ „ 20 .. 30 „ ., 30 ., 40 ., „ 40 „ 50 „ „ 50 ., 60 „ ,. 60 „ 70 „ .. 70 „ 80 ., .. SO .. 90 „ Upwards of 90 years Unknown Auckland. Christchurch. DUH cHff, <Sea " M. F. T. M. F. T. ____. F. T. .. I .. 112:022 112 25 7 6 4 10 3 1 4 6 S 14 5 9 14 i 10 8 18 69 54 123 30 39 6!) j 40 40 80 139 80 219 90 84 174 i 137 82 219 176 98 274 80 85 165 ! 149 104 253 117 83 200 59 79 138 ! 98 85 183 .. 79 50 129 48 46 94 j 90 53 143 28 21 49 34 30 64 j 59 38 97 .. 12 3 15 7 7 14 i 17 16 33 2 0 2 25 6 31 112 Hokitika. M. F. T. 9 4 13 38 9 47 38 16 54 ! 36 11 47 31 9 40 20 10 30 4 2 6 10 6 16 Nelson. Porirua. M. F. T. M. F. T. 2 0 2 Oil 10 1 2 3 5 10 2 12 7 13 20 5 3 8 10 14 24 11 8 19 90 55 145 12 18 30 143 108 251 IS 28 46 116 92 208 22 16 38 ! 99 74 173 9 13 22 66 45 111 6 15 21 21 20 41 2 3 5 2 2 4 10 1 2 8 10 Porirua. M. F. T. 0 1 1 2 3 5 7 13 20 10 14 24 90 55 145 143 108 251 116 92 208 99 74 173 66 45 111 21 20 41 2 2 4 1 0 1 l 4 I ! M 2' 4 2: Tokanui. M. F. T. 3 0 3 15 6 21 29 7 36 41 15 56 20 8 28 9 8 17 5 0 5 12 3 Tokanui. i. F. 3 6 15 6 2 29 7 3 11 15 _ 20 8 2 9 8 1 5 0 1 2 T. 3 21 36 56 2S 17 5 3 Ashburn Hall | (Private M.H.). '. M. F. T. i oil l 112 i 4 2 6 8 3 5 8 i 9 12 21 7 5 4 9 5 0 2 2 3 0 3 3 '.. M. 3 4 28 39 265 592 621 460 337 173 47 39 Total. F. T. 4 7 4 8 25 53 43 82 207 472 390 982 443 1.064 368 828 228 565 136 309 33 80 0 3 23 62 Totals .. .. 653 408 1,061 362 386 748 605 421) 1,034 | ] 1 I 186 67 253 100 114 214 557 427 984 123 46 169 25 27 52 2,611 1.904 4,515 !_

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Table XI.—Length of Residence of Patients discharged "Recovered" during 1917.

Table X.—Length of Residence of Patients who died during 1917.

Length of Residence. i ! Auckland. C Auckland. Christchurch. Christ itchui [rcit. Dunediu (Seacliffi, Dunediu (Seacliffi. Hokitika. Hokitika Ne: Nelson. »lson. ! Pori Porirua ■irua Tol Tokanui. -kanui. '■ C Ashbum Hall (Private M.H.). Ashbum H (Private M. aall Tc Total. 'otal. J L_ !__ L_ J_ !_ !_ L_ L_ Under 1 month From 1 to 3 months .. „ 3 „ 6 „ - 6 „ 9 „ 9 „ 12 ,. 1 ,, 2 years .-, 2 „ 3 * „ ,, 3 ,, 5 ,, ., 5 ,, 7 ,, „ " „ 10 „ ., 10 „ 12 „ „ 12 „ 15 „ Over 15 years Died while absent on trial M. F. T. 4 3 7 7 8 15 7 0 7 6 0 6 2 3 5 10 4 14 1 3 4 6 5 11 2 0 2 2 0 2 V. lot 5 5 13 3 0 3 M. 4 2 0 2 0 4 1 1 2 1 9 F. 2 3 1 0 2 3 0 2 0 3 T. o : 5 : 1 1 3 4 12 M. F. T. 5 3 8 4 4 8 1 I 2 0 2 2 3 2 5 2 1 3 1 0 1 4 3 7 1 2 3 3 1 4 4 I 5 1 1 2 8 4 12 M. F. 1 0 2 0 0 1 2 0 3 2 1 0 3 0 5 0 T. 1 I 2 5 1 3 5 I ~ II. 1 (I 1 0 2 1 0 1 1 2 0 1 0 3 2 1 T. 2 2 1 2 4 2 I M. 11 s 5 3 2 4 6 4 3 2 1 4 2 0 F. 6 2 0 1 0 1 1 1 I 0 2 I T. 17 10 5 4 2 5 4 3 1 6 5 1 H. 0 1 2 0 F. 0 0 2 T. j 1 1 2 9 31. F. 1 0 i 6 o i T. 1 1 1 51. 25 23 13 15 20 13 19 0 10 32 4 F. 14 18 4 3 14 4 16 5 1 3 IS X. 39 41 17 18 14 34 17 35 14 14 8 11 50 6 Totals 59 31 90 26 18 44 26 18 44 ' 3,7 25 62 37 25 62 17 3 17 3 20 20 6 6 10 10 16 16 55 55 22 77 22 i , 3 3 3 3 6 6 2 1 2 1 3 3 2(15 2(15 113 31 11 3 318 : !__ i

Length of Residence. Auckland. Christchurch. Dunedin (Seacliffi. [ Hokitika. Nelson. I l_ Porirua. Tokanui. Ashburn Hall (Private M.H.). 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 .. ■ - 31. F. T. 4 2 6 13 5 18 8 10 18 12 6 18 2 1 3 5 4 9 2 0 2 2 2 4 1 0 1 1 0 1 j 31. F. I. : 112; 5 4 9: 3 5 8 134: 2 1 3 0 1 1 1 1 2 1 0 1 31. F. T. 2 I 3 6 12 18 8 9 17 1 8 9 2 2 4 3 5 8 2 I 3 2 2 4 0 1 1 -31. F. 3 0 1 2 1 1 0 1 0 1 0 1 T. 3 2 1 1 - I 31. F. 0 1 1 2 0 1 0 2 1 0 (l 4 0 1 0 1 | T. i 1 2 1 4 1 1 31. F. T. 12 3 15 23 12 35 13 14 27 3 3 6 10 4 14 7 7 14 0 I 1 2 ii 2 0 1 1 1 I 2 1 0 1 31. F. T. 31. F. T. 1 0 1 1 II I 0 1 1 M. F. 22 S 50 37 33 40 17 23 18 S 15 22 4 3 2 2 3 1 2 0 0 1 T. 30 87 13 4(1 26 37 14 4 2 2 1 - — Totals 50 30 80 50 30 80 14 16 30 ]4 16 30 26 41 67 26 41 67 5 6 I 5 6 11 11 2 12 I 2 12 14 1 14 72 40 118 72 46 118 2 1 3 2 1 3 171 152 171 152 323 QQ4

H.—7.

Table XII.—Causes of Death.

15

4 - S T3 _ g S H o ■id t. -> "—' < 6 5 H* o H Us.? HjjgJ ~ a 3 § -a o III II* I & S \ HH H o Eh Causes. g -g a SrJ H". O I. General Diseases. Tuberculosis — M. f. i m, if. General Of bowels .. .. . . I I Perth onou 111 .. . . 0 1 Lungs .. .. .. 5 4 10 1 Grave's disease . . . . 0 1 Typhoid .. . . .. 0 2 Septicemia Dysentery .. .. .. 10 Leucaemia Carcinoma Uterus .. .. . . 0 I Tongue .. ., . . .. Ill Bowels .. .. .. .. II) Jaw Kidney Stomach . . Exophthalmic goitre M. V. I M. If. M. |f. 0 1 II.. 0 1 5 4,0 I 0 3 0 1 0 2 M. E. M. If. 0 1 0 3 '.'. 10 '.'. 5 3 I " 0 K. If. M. V. M. V. 31. F. M. If. 0 17 5 0 1 .. I 0 1 10 .. .'. ' ' '.'. 0" I ','. '.'. 10 10 M. F. 0 I I 1 0 1 12 15 0 2 0 2 1 0 I 0 I 0 5 3 0 I 1 0 I 0 I 0 0 1 1 0 I 0 10 I I) 5 3 0 I 10 10.. I 0 II. Diseases of the Nervous System. Mania, exhaustion from .. 3 0 1 I Melancholia, exhaustion from . . . . 10 General paralysis of insane .. 6 12 0 Organic brain-disoasc . . . . II 9 2 0 Cerebral hsernorrhage .. .. 2 I Cerebellar abscess Injury to spinal cord Epilepsy .. .. ..0120 3 0 I I 2 I I 0 0 I 2 0 5 I) II II 2 0 I I 2 1.. 4 0 2 1 5 0 II 4 0 2 0 5 I 2 0 2 0 0 I .7 I .. .. i 2 0 . . . . I 0 1 3 I ; 1 1 . . 1 10 I 0 II 10 8 2 I 0 20 3 16 10 12 4 I 0 I 0 9 3 8 2 1 0 20 3 16 10 12 4 I 0 1 0 9 3 2 0 0 1 2" 0 5" I 2" 0 TTI. Diseases of the RespiRAtoby System. Pneumonia .. .. ..10 10 Pleuro-pneumonia . . Bronohitis Broncho-pneumonia .. 0 1 10 10 0 1 I 0 1 0 I 2 3 . . .. 5 4 5 1 1 2 4 0 1 0 1 ll 11 .. II 2 (I .. .. 2 0 TV. Diseases of the Cmor/. latoby System. Valvular disease of heart .. 8 1 2 0 Fatty degeneration of heart .. .. 0 2 Heart-failure.. .. ... Cardiac dropsy Rupture of aneurism of heart 12 12 2 1 I II 3 0 I 2 I 2 0 2 2 1 .. . . 14 8 n ■> 14 0 5 3 0 8 2 1 0 1 2 I I II 3 (I 0 2 2 0 .. .. 5 1 3 0 ii I .. .. .. 0 I V, Diseases of the Digestive System. Colitis .. .. .. I Acute gastro-enteritis Peritonitis, septic II) I 0 10 10.. . . . . |() 2 0 .. .. 2 0 1 1 2 0 0 0 VI. Diseases of the Genitourinary System. Nephritis, acute ,, chronic .. .. .. 10 Cystitis I I " 0 10 1 0 1 .. .. .. II 2 0 .. .. 2 0 0 1 2 1 1 0 VII. Diseases ok Skin ami Cm,1.in.ar Tissue. Gangrene .. .. ..10 10 VIII. Diseases of the Bonks. Abscess of. mastoid . . Osteo-mvelil is I - 10 . . 10 10 .. -10 IX.. Puerperal State. Septicemia .. 0 1 0 1 X. Old Age. Senility .. ■• ..I 16, 8 1.1 13 II II) 3 I 3 I 4 2 13 5 0 I .. 58 40 XI. External Causes. Fracture of skull from precipitation .. I 0 (suicide) Fracture of skull from falling .. I 11 Suffocation (suicide) (epilepsy) . . Hanging (suicide) I. 0 I II 10 . . . . 10 10 .. .. II) 10 . . . . 10 XII. [ll defined. Debility Syncope .. . . Asthenia .. .. . . .. III Marasmus On trial .. .. • .. j 3 0 1 Totals .. .. 59 31 26 18 __„ 1 - 0 I II 37 25 17 3. 0 1 . . . . (II 2 0 (II II) I I 0 I .. .. 4 2 6 10 I 55 22 3 3 2 1 205 113

H,-7

16

Table XIII. —Principal Assigned Causes of Insanity.

Causes. 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 Toxaemia Traumatic Organic brain-disease Epilepsy Apoplexy Arterio-sclerosis Sunstroke Chorea .. .. Auckland.: &*£«-_ £Sm" Hokitika, Nelson. Porirua. Tokanui. A8 |j3jH j ■ _ _ J_ M. I". , M. F. | M. F. 31. F. St. F. j M. F. ' M. F. M. F. 11 13 8 6 9 9 3 5 2 3 25 33 .. 2 0 20 12 ! 0 7 | 6 3 I 0 5 2 I) 7 0 I - 10 32 ; 0 3 13 16 162 39 5100 1 0 7 i 0 2 0 9 0 1 0 2:012 II 7 10 8 , 19 II 4 0 3 3 17 8 .. 2 0 0 10 1.. ..'01 0 6 0 1,0501 .. 01 0 1 .. 0 ] .. .. 0 1 ..10201 18 8 2 2 5 0 . . 10 7 5.. 0 4 5 1) . . . . Ill . . 3 (I 10.. 15 I 9 I I 9 I 4 O 0 I 27 8 i .. 0 1.. 13 2 .. | 5 0 . . .. II 0 .. 10 10 5 1 2" -0 l" 0 .. .. 0 1 I'M 10 3 2 19 1)!.. 0 I 5 I I 12 10 . . . . . . 3 2 3 0 Totals M. F. 60 69 32 24 32 59 13 15 0 33 66 37 0 3 0 14 0 3 0 3 3!) 19 8 1 I 0 64 12 0 I 30 2 9 2 I 0 20 16 5 4 3 0 :: :: :: r o :: I ll Cancer Cardiac disease Grave's disease Phthisis 111 health Unknown Not insane Transfers 1 0 0 2; 0 21 .. .. 02 5 5 1(1 . . . . . . 5 (i 10 S .",1 23 ! I 0 0 2 j .. '26 7 1 0 0 (i 11 11 68 40 ! 2 2 4 I , . . 2 0 27 0 2 I 37 4 Totals 135 DO 73 63 89 78 1.4 11 11 17 145 112 27 ! 0 I 13 7 i 507 378

a.—7.

Table XIV.—Former Occupations of Patients.

3—H. 7.

17

s § HH CS hh o Occupations. £ cc a -a a s 4S S 1 g a U V S •* " a ja a o o ■f, v 0 k y, X) 9 8 XI -H'l te o I — I a S Hi ' 'S , t3 -rH a b h I 1 I I I ! ! I £ ■>, Z & r- CO a d ij hI* 3 .a Occupation?, £ ■3 3 I h |_J b s ® a a a £ •e «s £s — a hh \n ■ «5 a . g 3 e3 3 I -a S is 3 o o o o 43* 0 « Z ft H jj H 73 o (6 S L •fi O Aboriginal natives .. 6 Agents .. 2 .. . . Analyst .. Apiarist .. .. .. 1 Bank officer .. Bakers and confectioners .. .. 2 . . Barbers .. .. 2 Battery hand.. '.. I Blacksmith .. ..I 1 . . Boardinghouse-keeper ,. Boilermaker . . .. 1 Boxmaker .. .. . . I Bottle-gatherer .. 1 .. .. ... Bricklayers and masons 2 Builders .. .. I Bushmen .. .... 1 ..... I Butchers .. .... 1 2 I . . Canvassers .. .. 2 ........ Carpenters .. .. 1 2 Carters and drivers .. 1 1 1 ..' 1 (Jarver .. .. | Clergymen .. ...... I Clerks and accountants 4.3 I .. 1 (Commercial travellers ,. 2 I ('ompositors and printers .. I (iontraetors . . .. ■ 1 .. .. I (looks .. .. .. 1 I . . .. Crane-driver . . I . . Draughtsman.. . . I .. Electrician .. Engine-drivers .. .. 1 .... Engineer's apprentice .. .. .. 1 .. .. Farmers .. .. 16 11 7, 1 .. Farm hand .. .. •.!,.. .. 1 Fencer .. .. .. I .. j .. .. Firemen .. .. .. 11 ...... Flax-millers .. .. I Fruiterers .. Fruitgrower .. 1 .. .. Garage-mahager .. Hardeners .. .. ! .. 2 2 .. .. Groom .. .. 11 ........ Hatter .. .. ..'.... j ... . Hotclkecpers . . .. .. j I 1 ... Jewellers .. .. ..' .. . .! .. J ockey .. .. .. 1 .... Labourers .. .. 45 j 20 22 5 I Land agent .. .. .. I Laundryman .. .. .. | ' •• --I . .. 2 I , 1 I . 2 ; Males. I •• •• ' :! :: :: '2 :: :: 1 1 :: :: .! :: :: J 4 10 :: :: : i|:■:■:: \ .. .. i\..-.. 1 1 .. .. 1 ,. .. 1 .... 5 .. .. 8 .. I ..! 2 3: .. .. 8 1: ..; .. I > 1 .... 1 .. .. 1 .. .. 1 .. .. I .... 1 .. .. 2 .. .. 1 .. .. 1 1 .. .. 1. 4 2 2 i 1 -i 2 3 .. 2 7 ........ 1 3 .. .. 3 .. .. 4 2 i .. .. 1 .. .. 1 .. .. 11 .. .. 32 I 4 1 .... I .. .. I 1 1 1 .. .. I .. .. 2 1 .. - 1 1 1 I .. 3 6 .. .. 38 .. .. 2 27 2 37 2 I 1 1 1 2 1 1 ■.- 1 1 2 I ..| .. .. I .. .. I .. .. 1 '.'. '.'. . .1 .. .. 2 : . . 4 .. 7 .. .. I .. .. .. .. I 7 .. .. 1 .. .. 1 .. .. 1 .. .. 2 6 I Master mariners .. 2 1 2 Mechanics .. .. 2.. .. ] Merchants .. ....... 1 Messenger .. 1 Mill hands .. . . I 2 Miners .. .. 3 2 2 Minors .. 1 j Moulders .. .. .. 2 1 j Motorman . . ...... 1 | Musician ..- .. .. . . ] Newspaper-seller ,. | .. I 1 j Optician .. 1 Painters .. .. \ 2 I 2 Pedlar .. .. I .. 2 Pensioners, old-age .. I . . 2 Photographer.. 4 Piano-tuner .. . . I . . 2 Picture-theatre manager .. 7 j Plasterer .. 11 Plumbers .. .. I .. 1 Policeman . . 2 Porter .. 16 Prisoners .. .. 4 .. 4 Prisoners of war 2 Railway inspector 3 Railway signalman . . I . . 4 Run holders .. I Schoolboys .. . . 2 1 I School-teachers .. j 2 1 Seamen . . .. j I . . 2 Settlers . . . . 2 . . 1 Shepherd .. .. I 1 .. 48 Shop-assistant 1 Soldiers .. .. 8 2 1 Solicitors . . .. I . . 2 Station-manager .. 1 . . 2 Storeman . . 2 Sugar-cane grower .. I . . 1 Surveyor .. I Tailor's .. ..'.... 8 Taxi-driver . . . . I . . 1 I Threshing-mill owner 1 [Tram-conductor .. .. 1 2 I Train-examiner .. . . I 2 Union secretary 1 No occupation .. 8 7 137 Transfers .. .. .. 2 1 2 . .1 . . . . .... . . i I 1 .. .. 1 1 2 1 11 ... 2 48 1 1 I .. .. 2 I .. .. 2 2! .. .. 2 1 .J .. 1 1 4 .. .. 8 ..! .. .. 1 I .. .. 1 .. .. .. 2 1 .. 1 2 .. .. .. I 44 .. .. 137 I .. .. 1 II .. .. 1 2 II .. j 2 .. 1 .. i i i .. i 7 14 .. 3 6 .. 2 4 .. .. 2 27 ! 73 89 14 11.145 27 * i.j .. i 1 Totals . . .. 135 ( 73 14 11 145 27 13 1507 Aboriginal natives .. 3 .. Barmaid .. .. .. Civil servant .. Domestic duties .. 84 28 57 4 12 Dressmakers' .. .. .. I I .. .. Factory hands .. .. I I .. Governess .. .. ........ Housewives .. .. ..I 25 2: 6 .. Labour agent.. .. • ■, •• 1 .. *.. Laundress .. .', 1, . . Minor .. .. .. .. 1 j .. .. 'f.males. •! ] •• i .. .. .. I: .... 1 .. :.\ .. .. i .. .. ..! 2 .. 1 .. '.. .... 1 ..!..... .. 1 .. (i 10 .. 3 8.. 63J 78! Ill 17112 .. .. ,,j 1 .. .. I Fem 13 .. i .. .. ! i .. i .. .. i 12 98 .. 5 288 2 :: * :: :: i ' i .. ,. ! ..j.. i ..j ..: ..! .. j l 3 Music-teacher • • ! • • 1 Nurse .. ...... 1 Pensioners, old-age 288 Schoolgirl .. .. • .. ,'.| 2 School-teachers i 2 Sister of Mercy 1 I Shop-assistant 33 No occupation .. 3 6 1 Transfers .. .. ! .. 2 :: :; .... 1 1 .. ..; 1 .. .. 2 .. 1 1 .. 1 .. '.. .. 3 1 1 ... .. 1 .. .. I .. 3 8 .. .. 30 I 4 I .. 1 1 Totals .. 90 63J 11 17 112 .. 7 378 .. 7

TT.—7.

18

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.

, nlHhlMBll Year. I Admitted. Recovered. Remaining Average Numbers „ Percentage Percentage oi ; Died. 31st December iu resident ot Recoveries on ou Average Ni Relieved. Not Improved. each Year. Admissions. resi dent Discharged. Remaining Average Numbers 31st December m resident, each Year. Percentage of Recoveries on Admissions. Percentage oi Deaths ou Average Numbers resident. Died. Recovered. Relieved. Not Improved. I 1876 1377 1878 1879 1880 1881 1882 1883 1884 1885 1386 1887 1833 1839 1390 1891 1892 1S93 1894 1895 1396 1397 1398 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 M. 1 F. : T. M. j F. T. 221 117 338 129 I 79 208 .. ! 250 112 ! 362 123 I 57 180 ! 247 131 378 121 68 189 248 151 ' 399 112 | 76 18S 229| 149 378 100 67 167 232 127 359 93 65 15S 267 152 419 95 59 154 255 166 421 102 78 180 238! 153 391 S9 77 166 294 160 454 95 76 171 207] 165 372 99 60 159 I 255] 161 416 103 78 181 215 146 361 116 92 208 ] 230 161 391 93 53 146 j 230: 160 390 98 88 186 234 201 435 SS 74 162 231' 15S 389 , S9 76 165 281; 179 460 101 89 190 320 256 576 107 76 183 379 302 681 105 77 182 296 170 466 104 70 ! 174 300 244 544 102 73 175 .. ! 355 258 613 114 110 224 264 247 511 88 99 187 | 335 263 59S 103 96 199 \ 373! 224 597 125 104 229 352l 192 544 135 99 I 234 454 237 691 144 101 245 ! 340 240 580 157 106 263 : 399| 280 679 149 121 270 40l| 277 678 157 126 2S3 4211 279 700 160 139 299 434 325 759 180 146 326 447 376 823 179 170 349 639 371 1,010 182 145 327 455 322 777 163 168 331 593 394 987 184 | 141 325 5431 349 892 175 j 162 337 526 366 892 207 162 369 .. ! 461 419 880 202 j 157 359 .. 568 367 935 160 I 171 331 507 378 885 171 i 152 323 | 14,526 ! 9,885 24,411 5,399 4,283 '9,682 1,< M. F. i T. M. F. T. H. F. T. M. ; F. T. M. F. T. M. F. T. M. F. 17 8 25 6 6 12 36 12 48 519 264i 783j 491 257 748 54-53 6601 57-56 8-21 3-58 20 9 29 7 2 ; 9 42 j 21 63 58l| 291 872 541 277 818 49-20 50-80 4972 7-76 758 14 14 28 3 3 j 6 51 | 17 68 638: 319 957: 601 303 904 48-98 51-90 5000 8-48 ! 5-61 15 13 28 8 3 11 55 j 16 71 695J 361 1,056! 666 337 1,003 4516 5033 4711 825 4 74 36 25 61 5 2 7 54 20 74 729; 396 1,125 703 ' 371 1,074 43-66 4496 44-17 7-68 5-39 41 36 77 3 1 9 49 ! 14 63 769j 406 1,175 747 388 1,135 4008 51-10 44-01 6-29 360 49 32 81 5 7 12 60 '■ 19 79 827 442 1,269 796 421 1,217 35-58 38-81 36-75 7-53 4-51 13 20 33 10 9 19 65 18 33 392 483 1.375 S60 475 1.335 40-00 46-98 42-75 7-55 3-78 17 9 I 26 18 12 30 68 24 92 938! 514 1,452 911 497 1,408 37-39 50-32 42-45 : 7-46 4-82 10 5 15 73 29 102 73 22 05 981 542 1.-523 965 528 1.493 32-31 4750 3766 7-56 j 4-16 11 17 28 12 8 20 57 19 76 1,009 604 1,613 9S4 559 1,543 47-82 3636 42-74 1 579 3-39 34 17 51 74 27 101 1,053 643 1,6961,034 613 1,017 40-39 4875 4361 715 4-40 31 23 59 2 2 4 73 , 26 104 1,041 640 1,6811,045 641 1,686 5395 6301 57-62 7 56 : 4-05 31 30 61 3 1 4 70 30 100 1.074 6S7 1,7611,046$ 660*1,707 40-43 3292 37-34 669 4-54 23 17 40 12 5 17 76 ; 35 111 1,095 702 1,797 1,078" 685 1,763 4261 55-00 4769 7-05 511 33 24 57 14 30 44 79 41 120 1,115 734 1,849 1,089§ 699*1,7891 37-61 30-82 3724 7-25 5-86 21 17 38 8 2 10 74 34; 108 1,154 763 1,917 1.125 714jl,839| 33-53 48-10 4242 6'53 4-76 17 12 29 9 9 18 78 23 101 1,229 S10, 2,0391,172 758 1,930 35-94 49-72 4130 666 333 15 11 26 55 34 ; 139 64 j 35 99 l,308j 860 2,1681,241 812 2,053 39 03 4518 41-03 5-16 4-31 24 19 43 128 139 267 101 42 143 1,329 885 2,2141,313 849 2.162 : 41-27: 4666 43-40 769 4-94 25 16 41 20 12 32 36 32 118 1.390 925 2,31511,347 S32 2.229 37-41 44 02 39-82 : 6-38 3-63 26 32 53 17 31 48 105 43 14S 1,440 990 2,4301,411 944 2.355 3592 37-S2 36-69 7-44 4-55 13 23 36 104 47 151 83 60 : 148 1,472 1,008 2,4801,438 973 2,411 44-88 5189 48-07 6-12 6-17 15 25 40 7 42 49 114 43 157 1,5121,045 2.5571,487 1,004 2,491 '■ 3231 44 33 37-58 7-67 4-28 39 10 49 25 65 90 99 46 145 | 1,581 1,091 2,6721,534 1,049 2,583 3074, 3650 33-27 6-45 4-38 40 17 57 33 3 36 102 72 174 1,654 1,119 2,7731,622 1,094 2,716 13906 46-64 42-17 6-29 6-58 26 15 41 10 9 19 120 55 175 1.7151,133 2,8481,671 1,114 2,785 3835 5156 43-01 7-13 4-94 41 25 66 84 12 96 129 44 173 1,7711,188 2,9591,741 1,160 2,901 40-56 44-69 42-17 7-41 3-79 24| 13 37 9 2 11 120 70 190 1,8011,237 3,0381,780 1,198 2,978:46-18 44-17 45-34 6-74 5-84 45 32 77 23 21 44 147 67 214 1,8361,276 3,112 1,796 1,232 3,028 4139 48-21 44-19 8-18 5-44 28 22 50 6 14 20 146 85 231 1,9001,306 3,206,1,823 1,265 3.088 3975 47-73 42-94 8-01 ; 6-71 31 19 50 53 32 85 168 64 232 1,9091,331 3,2401,851 1,285 3,136 44-29 57-68 49-67 908 4-93 9 13 22 9 6 15 148 74 222 . 1,997 1,417 3,414 1,894 1.346 3,240 ' 42-25 45-91 4382 7-81 5'50 17 22 j 39 29 68 97 136 63 204 2,0831,465 3.548,1,970 1,404 3.374 42-72 57-24 48-74 6-90 4-84 30 29 59 164 55 219 186 97 283 2,1601,510 3.670|2,028 1,445 3,473 38-40! 46-18 41-50 9-17 6-71 23: 16 ! 39 11 7 18 198 105 303 2.2201,536 3.756i2,105 1,496 3,601 36-38 53-00 43-27 9-41 ! 7-02 17 44 j 61 146! 18! 164 193 S7 280 2,2731,640 3,9132,146 1,551 3,697 40-17 37 01 3874 8-99 5'61 35 48 1 83 78 36 114 196: 111 307 2,332 1,632 3,964 2,252 1,597 3.849:37 55 50-94 42-98 870 6-96 27 29 56 23 16 39 193 83 281,2,408 1,703 4,1112,309 1,641 3,950 40-67 45-12 42-51 8-36 5-36 26 34 60 21 67 88 172 112: 284 12,448 1,75-2 4,2002,391 1,703 .4,094 ! 44-89 43-21 44-271 7-19 ; 6-58 35 34 69 57 14 71 209 80] 289 2,555 1,820 4,3752,483 1,768 4,251 30-89 47-37 37-66 8-42 i 4-52 32 20 52 43 9! 52 205 113 318 2,6111,904 4.515 2,543,1,825 4,363 36-38 < 40-64 3827 806! 6-19 ,076 901 1,977 1,358 940 2,298 4,564 2,111 ! 6,675 : T. 6-70 770 7-52 7-07 6-89 5-55 6-49 6-21 6-53 6-36 4-91 613 616 5-86 6-29 6-71 5-S7 5-23 4-82 661 5-29 6-28 6-14 6-30 5-61 6-41 6-28 5-96 6-38 707 7-48 7-39 6-85 6-00 8-15 8-41 7-57 7-98 7-11 6-94 6-80 7-28 b,682 -1,076 901 In mental hospitals, 1st January, 1876 In mental hospitals, 1st -January, 1918 M. F. T. 482 254 736 .. 2,611 1,904 4,515

H.—7

19

Table XVI. —Showing the Admissions, Readmissions, Discharges, and Deaths from the 1st January, 1876, to the 31st December, 1917.

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

Persons admitted during period from 1st January, 1876, to i w 31st December, 1917 .. .. .. .. ..11,6 Readmissions .. .. .. .. .. . .. ! 2,9 M. F. T. 11,601 7,523 19,124 2,925 2,362 5,287 «. ] 301 7,, 125 2,: F. ,523 ,362 T. 19,124 5,287 M. F. T. Total cases admitted Discharged cases— Recovered .. .. .. .. .. .. i 5,3 Believed .. .. .. .. .. ..1,0 Not improved .. .. .. ., .. 1,3 Died .. .. .. .. .. .. ..4,5 199 4, 176 158 564 2, ,283 90.1 940 ,111 3 .1 0 1 9,082 1,977 2,298 6,675 14,526 9,885 21,411 5,399 4,283 9,082 1,076 901 1,977 1,358 940 2,298 4,564 2,111 6,675 12,397 8,235 20,632 Total cases discharged and died since January, 1870 I Remaining, 1st January, 1876 482 234 736 Remaining, 1st January, 1918 2,611 1,904 4,515

Males. Females. Both 8ex Hoth Soxes. .Jecovored Relieved Slot improved Died Remaining 37-17 7-41 9-35 31-42 14-55 43-33 9-11 9-51 21-36 16-69 39-66 8-09 9-42 27-35 15-48 100-00 100-00 100-00

H.—7

20

Table XVIII.—Expenditure, out of Public Works Fund, on Mental Hospital Buildings, etc., during the Financial Year ended 31st March, 1918, 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, 1918.

Mental Hospitals. 1877-1909. 1909-10. 1910-11. 1911-12. 191-2-13. 1913-14. 1914-15. 1915-16. 1916-17. 1917-18. Total Net Expenditure. 1st Julv, 1877, to 31st March. 1918. Auckland Reception-house at Auckland Motuihi Island Tokanui Wellington Wellington (Porirua) Christchurch Seaclifi Waitati Dunedin (The Camp) Napier Hokitika Richmond Nelson .. £ 107,005 530 29^656 125,414 121,258 152,016 660 4,891 147 3,465 1,097 18,950 1,524 1,788 10,348 1,1-33 2,797 256 1,992 £ 463 2,531 'l66 8,121 1,063 4 6 *353 £ 105 105 4,303 1,762 412 1,480 . 442 200 135 105 21,935 4,867 5,382' 4,007 200 : £ 8,908 561 8,874 1,°951 616 3,257 1,634 '200 £ 23,434 10,379 6 j 552 5,107 7.413 911 200 £ 2,774 10,640 17 i 518 15.157 6,721 671 1,417 £ 76 5,639 11^722 24,346 997 24 1,798 £ 1,048 6, ±88 10,399 7,647 597 535 £ 145,472 5,059 561 68,124 29,656 203,337 181,606 180.664 8,437 4,891 147 3,727 1,097 25,845 !— Totals .. 565,089 19,838 19,838 12,707 12,707 8,809 8,809 _] 46,181 46,181 26,001 26,001 53,996 53,996 54.898 54.898 44,602 44,602 26,502 26,502 858, 623 858, 623 I I I I

Mental Hospitals. Net Expenditure for Year ended 31st March, 1918. Liabilities on 31et March, 191~ Auckland Tokanui .. Porirua .. Christchurch Seacliff .. Waitati .. Nelson .. £ 1,048 6,188 10,399 7,647 597 88 535 15 1,831 504 250 Totals .. 26,502 26,502 2.600

21

H.—7

Table XXa.— Showing Details of Credits.

Table XX.— Showing the Expenditure for the Year 1917.

Itenis. Items. Auckland. Christchurch. Auckland. Christchurch. uuneam Hnkirikn Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokauui. Total. (beaciitt). i I __ _____\ i_ ! I _ , I .. . 1 £ s. d. £ s. d. £ s. d. £ s. d. £ s. a. ; £ s. d. £ s. d. £ s. d. 1,000 0 0 750 0 0 1,009 0 1 1,026 19 0 449 10 9 135 9 0 700 0 0 4,195 0 0 2,122 2 8 228 13 6 2.101 7 9 1,009 1 11 5,239 4 5 74,333 11 6 2,630 2 11 60,145 19 10 605 11 9 13,752 0 7 458 12 10 19,514 14 4 17 8 4 1,098 11 4 44 1 8 1,268 7 11 11,198 6 6 465 2 5 5,603 18 1 1,050 6 7 21,059 5 1 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 31 10 0 15 15 0 700 0 0 700 0 0 641 12 8 212 13 11 388 15 0 5X)i 11 6 151 13 4 258 14 6 11.446 7 6 13,495 4 9 12,980 4 5 11,028 -5 7 2,305 18 1 3,350 19 8 3,475 6 4 4,609 18 4 157 17 1 247 7 2 11 4 0 14 17 0 496 12 1 3,363 1 10 348 1 9 524 10 11 2,252 11 1 5,216 9 9 25 4 0 12 12 0 700 0 0 200 0 0 : 710 0 0 228 13 6 580 15 8 ... 255 1 1 50 4 4 20,398 13 6 3,768 11 9 13,877 7 11 3,649 16 4 4,173 6 4 119 4 5 5,215 18 10 324 16 9 419 8 6 17 0 2 6 19 2 0 15 0 3,338 8 2 32 16 2 : 3,002 15 1 80 8 0 7,100 12 7 576 11 3 495 0 0 5 11 1 158 16 10 130 0 0 4,099 6 7 3,073 18 9 538 13 8 647 2 6 52 2 3 294 18 2 693 10 11 703 17 0 50 8 0 700 0 0 552 5 0 471 8 9 163 8 8 15.886 3 0 12,906 3 11 2.658 6 8 4.7S2 18 9 187 7 10 10 6 6 2,404 2 2 489 9 0 4,158 16 10 Totals Repayments, sale of produce, &o. 35,387 13 4 43,539 9 11 12,799 6 10 13,978 8 11 59,804 10 10 9,061 9 8 £ 18,309 9 10 2,398 7 11 59,804 10 10 18,309 9 10 9,061 9 8 10,892 17 9 45,421 5 1 2,398 7 11 2,928 13 4 15,015 10 7 10,892 17 9 2,928 13 4 45,421 5 1 15,015 10 7 12,434 17 2 220,777 13 7 3,016 16 2 68,446 13 7 Actual oost 22,588 6 6 29,561 1 0 41,495 1 0 6,663 1 9 41,495 1 0 6,663 1 9 7,964 4 5 7,964 4 5 30,405 14 6 30,405 14 6 9,418 1 0 152,331 0 0 * Not included in Table XXI.

Credits. Auckland. Ckristcmu-ck. Dunediu (Seacliff). Hokitika. Nelson. Porirua. Tokanui Total. Receipts for maintenance For sales of stock, produce. &c. * Other receipts-)- ! £ s. d. £ s. d. £ s. d. ! £ s. d. 11,759 8 5 10,139 18 4 12,897 10 0 1,912 6 8 835 16 7 3,601 11 6 4,332 8 4 370 13 2 204 1 10 236 19 1 1,079 11 6 115 8 1 £ s. d. 2,481 3 1 372 0 2 75 10 1 £ s. d. : £ s. d. 13,173 15 2 ! 1,285 14 10 1,587 8 9 ! 1,361 10 7 254 6 8 369 10 9 £ s. d. 53,649 16 6 12,461 9 1 2,335 8 0 Totals 12,799 6 10 j 13,978 8 11 18,309 9 10 2,398 7 11 2,928 13 4 15,015 10 7 3,016 16 2 15,015 10 7 3,016 16 2 68,446 13 7 • Ifot included £17,300, value of farm produce and stock consumed in the institutions. t Not included £797 17s. 6d. received in repayment of medical fees for certificates.

H.—7.

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

Mental Hospital. I Bedding "#&£"* Surgery s e |v Provisions. Salaries, i and W f*F- and Dis- Spi "' s i Ale ' Farm. Clothing, j cle a a^ g . Pensary. p^ „ . 1 „ Total Cost Total Cost Total Cost Buildings 5JJSJS"? Total Cost m T?5f?" per Head, less per Head, pei-Head.less Decrease and Per rnents toi Repayments , less i Beeeipts of In Repairs. °i7™ „ Patient. , „ " for "Main- : Receipts of ,all kinds pre- 1917. cellaneous. tenauce. tenanC e. all kinds. ' vious Year. Increase in 1917. Auekland Christchurch Dunedin (Seacliff) Hokitika Nelson Porirua Tokanui £ s. d. j £ s. d. ! £ s. d. : £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. . 12 14 6 13 1 11| 3 8 If 2 5 21 0 3 1 0 0 2j 0 9 9 0 6 10 2 4 2 34 13 10J11 10 7 23 3 3 22 2 11 22 3 9f 0 0 lOf 15 16 lOf 21 16 3f 6 12 5j 4 16 U 0 7 1* 0 0 5 I 4 16 7f 0 15 1 7 9 lOf 62 11 li 14 11 44 47 19 0 42 9 54., 36 12 6 .. 5 16 11J 13 10 61 22 1 lOf 5 1 8 4 1 4J 0 8 2 0 0 1J 3 5 1 2 18 6| 6 18 5 58 5 94. 12 11 5 45 14 4J 40 8 10J 34 8 6J .. 6 0 4| 14 6 3 16 14 1} 1 5 of 8 9 4| 0 1 4 0 0 OJ 0 2 6| 0 6 3| 2 5 2| 35 10 8| 7 9 11} 28 0 8| 26 2 7 27 9 10 1 7 3 14 18 54 23 14 7} 3 2 10 2 12 3,- 0 5 Of .. 1 8 7J 3 7 4 3 8 4 52 17 6} 12 0 lOf 40 16 8 38 13 2f 36 4 8 .. 2 8 6| 13 6 1-i 18 7 6 4 18 7| 2 14 9| 0 3 10| 0 0 2J 2 9 6J 0 10 1 4 5 9 46 16 6J13 11 7* 33 4 10J 31 6 11 28 12 6| .. 2 14 4f : 15 16 10f 35 15 7 2 15 3 3 12 114- 0 2 1 .. 7 12 9f 2 16 0* 6 6 6J-J 74 18 2 7 14 11 67 3 3 : 56 14 8+ 63 3 7 6 8 10* Averages .. 13 17 2}j 19 7 9f 4 9 1U 3 3 41 0 5 0} 0 ll 2i 2 11 7J 1 5 10 4 17 Of 41) 18 1J12 7 3J-1 37 10 10 j 34 2 7J 31 6 94- .. 2 15 10J I I ! i I I | I | I 4 17 Of 4!) 18 1J12 7 3* 37 10 10 i 34 2 7* | L L 31 6 9Jj 2 15 10J Table XXIa. Including first five items in Table XX [ ! 50 17 7 l 35 2 1| 32 ll 2J 2 12 iii Table XXIb. Patients on probation 20 0 4J 40 2 8 3 4 at The Camp 6 ! 2 13 3|0 6 3J 3 10 7 1 0 ljjlO 14 5i 81 12 2f 81 12 2| 65 2 5} 16 9 9

28

n.—7

-APPENDIX 11. A Brief Note on the Work op tut? Department with respect to Soldiers prom the Beginning of the War. to the Ist September, 1918. We have dealt with two classes —those who could be treated without being placed under reception orders, being held as voluntary patients or as military patients, and accommodated, with few exceptions, either at the Anzac Hospital, Karitane, near Seacliff, or at the AVolfe Home, Auckland; and those whose condition was such that they could not be properly treated outside ;i mental hospital, and were admitted under Magistrate's order. Some of the patients in the first group were on the border-line of the second, and those who passed beyond that line had to In- placed under reception orders and taken to a mental hospital, both for their own good and Ihe good of the patients at the special hospital. Total number admitted as voluntary boarders or military patients.. I2(i (from camps, 7-. returned soldiers, II!)). „ discharged recovered .. .. .. ..80 ~ „ nnrecovered .. .. .. .. 15 „ died .. .. . . . . .. . . 0 ~ transferred to mental hospitals under reception order,. 24 ~ remaining under treatment .. .. .. 7 Total number admitted under Magistrates' orders .. .. 130 (from camps, 49 ; returned soldiers, 81). ~ discharged, recovered .. .. .'. ..55 died . . .. .. .. .. .. 8 ~ remaining under treatment .. .. .. 67 In a large majority of the second group the personal or family history indicated a predisposition to mental disorder.

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