MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1923.

Appendix to the Journals of the House of Representatives, 1924 Session I, H-07

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1924. NEW ZEALAND.

MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1923.

Presented to both Houses of the General Assembly by Command oj 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 July, 1924. I have the honour to submit to Your Excellency the report of the Inspector-General o[ Mental Defectives for the year 1923. I have, &c., M. Pomare, Minister in Charge of Department for the Care of Mental Defectives.

The Inspector-General to the Hon. Sir Maui Pomare, the Minister in Charge of the Department for the Care of Mental Defectives. Sir,— Wellington, Ist June, 1924. I have the honour to present my report for the year ended 31st December, 1923. The patients on the register at the end of the year numbered 4,996 (m., 2,839 ; f., 2,157), or 64 (m., 23 ; f., 41) more than at the beginning, and the daily average under treatment during the year was 4,868 (m., 2,789 ; f., 2,079), or 15 males more and 20 females less than in the previous year, while the total under care was 5,740. Patients belonging to the Native race numbered 70 (m., 36 ; f., 34) at the end of the year. The admissions numbered 808 (m., 442 ; f., 366), or 31 (m., 11 ; f., 20) fewer than in the previous year. Of these, 141 (including 2 Maoris) had been previously under care, making the proportion of readmissions 17-45 per cent., and 667 patients, including 11 Maoris, were admitted for the first time. The ratio to population of all admissions (exclusive of Maoris) was 6-23 (m., 6'69 ; f., 5-76) to 10,000, and of first admissions, 5-14 (m., 5'54 ; f., 4'73), so that 1,603 persons in the general population contributed one patient, and 1,943 contributed a patient admitted for the first time. These figures, the index of " occurring mental disorder," disclose an unusually low ratio. The discharges (excluding transfers) numbered 419, or 36 more than in 1922. One hundred, or 30 more, harmless unrecovered persons were returned to the care of friends, and 319 (m., 168 ; f., 151) recovered, 6 more than last year, representing a percentage of 39-48 (m., 38 ; f., 41-25) on the total admitted. With voluntary boarders added the percentage rises to 43-84. Altogether 54-69 per cent, of the inmates admitted were able to leave institutional care. Of a total of 5,740 patients under care 325 (m., 194 ; f., 131) died, or 5 - 66 per cent. An inquest is held in the case of every death, whatever the cause. The causes are detailed in Table XII, and the following is the percentage of causes mainly contributing : Senile decay, 32 ; disease of the brain and nervous system group, 27-7 ; heart-disease, 10-15 ; tuberculosis, 7-38.

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I mentioned last year that since the 1911 Act sanctioned the admission of voluntary boarders an increasing number each year has taken advantage of the provision, as demonstrated in the following table. It is necessary for an applicant to comprehend the meaning of the procedure, and in practice wo find that, while a large number may be classed as new cases of unconfirmed mental disorder, a fair proportion of recurrent cases seek admission on recognizing the early symptoms of relapse in the hope that an oncoming attack may be warded off or modified. Among the hopeful cases are a proportion of neurasthenics, but, on the other hand, some persons, labouring under organic disorders of the brain and cord, come for nursing care.

Voluntary Boarders.

It will be noted that there were 130 voluntary admissions in the year under review, that 94 were discharged, and that 9 boarders, representing only 3-86 per cent, of the total under care, had to be transferred to the register of patients (having shown mental disorder in degree sufficiently pronounced and sustained to render it improper for them to be continued as voluntary boarders), while the proportion of deaths was 2-57 per cent. The column devoted to " Not First Admissions " records readmissions on a return of illness in those previously treated to recovery as voluntary boarders. The figures above are an indication of public confidence and of good work being done. The average daily number of voluntary boarders in 1923 was 113 (m., 49 ; f., 64). In Table XIII the principal causes assigned for the mental breakdown in the admissions are stated ; but as a matter of fact they are merely approximations, and these, with the small [lumbers with which we, have to deal, show such divergencies from year to year that the proportion assigned to any one cause in any one year cannot.be assumed to be our average incidence. Causation is always complex, and the most potent factor is the individual. Thousands of persons have passed unscathed through physical or mental stresses which have proved too much for these patients. Take, for example, the critical periods (puberty, adolescence, the climacteric, and. old age), which accounted for 18 per cent. of the admissions, or the physiological act of child-bearing, which was assigned as a cause in about 5 per cent, of the women admitted. Clearly there must be and is a predisposing instability also, and when this is not directly traceable to inheritance it will be disclosed in ignorance or careless nurture and upbringing when the individual was young, or in. a disregard of the laws of wholesome and healthy living after the individual became a free agent, just those simple, almost obvious, requirements which when carried out faithfully ensure the state of well-being which comes from mental and bodily fitness and reacts in modifying an evil heredity. Hereunder the assigned causations in the table referred to are grouped and shown in their relative proportions : — M. F. T. Heredity .. .. .. .. .. .. 11-99 14-21 12-99 Congenital .. .. .. .. .. 15-38 9-01 12-50 Predisposed by previous attack .. .. .. 9-73 19-94 14-35 Critical periods .. .. .. .. .. 17-64 18-58 18-08 Child-bearing (puerperal, non-septic, and lactation) .. 0-00 5-19 2-35 Mental stress .. ... .. .. .. 10-18 6-56 8-58 Physiological defect and error .. . . . . 0-45 2-46 1-36 Toxic, including— M. P, T. Syphilis .. .. 5-88 0-37 3'34\ 14 . 7] Alcohol .. .. 7-69 1-67 4-95 J Traumatic .. . . .. .. . . 0-68 0-55 0-62 Disorder of nervous system, including — M. F. T. Epilepsy .. .. 4-30 6-25 4-95 5-66 7-38 6-11 Other bodily affections .. .. .. .. 3-85 6-83 5-19 No definite cause assigned . . . . .. .. 9-73 5-74 7-92 100-00 100-00 100-00 The voluntary boarders have increased so largely that one must include them hereafter when detailing the, number of inmates in relation to accommodation in the yearly returns Of the patients on the Register of State Institutions distributed as hereunder, classified under the Act, showing the number

Year. First Admission. Not First Admission. Total Admissions. Transferred to Register of Patients. Wed. Discharged. Remaining on Slst December. 1!)I2 191.3 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 M. I'. 'I'. 6 17 23 IS 19 37 17 I!) 30 15 17 32 13 23 30 14 21 35 23 38 01 31 39 70 20 38 04 39 3(1 78 47 38 85 44 50 94 M. I'. T. 0 0 0 0 2 2 3 2 5 1 2 3 5 si:; 1 13 II 5 II 111 5 19 21 1(5 12 28 II 15 2(i 10 l(i 2(i 15 21 30 M. X. T. (i 17 23 18 21 89 20 21 41 16 19 35 IS 31 40 15 34 49 28 49 77 36 58 94 42 50 92 50 54 104 57 54 111 59 71 130 M. W. T. 1 3 4 2 5 7 7 r, 12 3 4 7 4 4 8 (i 6 12 1 4 5 :s 3 6 3 4 7 2 3 fi (i 5 11 3 6 9 M. K. T. 0 0 0 (I 1 1 1 I 2 (I I 1 1 2 3 0 I I 2 2 4 0 2 2 1 2 3 5 1 6 4*48 3 3 (i M. F. T. 4 3 7 12 12 24 11 15 20 8 14 22 14 14 28 10 23 33 15 30 45 20 42 08 33 33 00 38 41 79 40 48 88 47 47 94 M. F. T. I li 12 5 14 19 0 14 20 II 14 25 10 15 25 9 19 28 19 32 51 26 43 (19 31 54 85 30 (i3 99 43 60 103 49 75 124

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on leave, and those resident at a given date, together with the, accommodation available and the number of wards into which it is divided.

These figures show an all-round shortage of accommodation for 171 men and 71 women. The ratio of excess means that in each group of 16 to 17 men there is one too many, and in each group of about 30 to 31 women there is one too many. It is not this odd one only who is incommoded, but the whole group more or less. However, were the odd ones alone affected the position could not bo for the law hands the patient against his will to us to be provided for, and he and his' relatives have a right to expect adequate housing. But, as I have previously indicated, bare sufficiency of accommodation is not enough ; there should be about 5 per cent, of excess of accommodation for classification, as from time to time the numbers of any one class of case vary considerably, and at the present time some of the wards have an excess of accommodation because of the shortage of patients suitabie for the, particular ward, which, of course, means that matters are so much the worse for those in some other ward. It is a great satisfaction to me, therefore, and to my officers that, recognizing this fact, you have helped to push forward a building programme of which the present position is as follows : —

Lf these works are completed in average time the resident population may bo expected to increase. in the interval by 112 (m., 58 ; f., 54), in which case there will be an excess of accommodation for 77 (m., 76 ; £~ 1). This will leave the position satisfactory in Auckland, Sunnyside, and Porirua. At Seacliff modernizing work now being carried out by the, artisan staff will continue ; but the main additions next taken in hand will be at Waitati ; Hokitika by being able to pull down the condemned buildings will have wiped out its reproach ; Nelson will have gone a further step in adapting the Mental Hospital for mental deficients, and with the " closed " villa at Stoke will be able to transfer thither Nelson patients who cannot be trusted in the " open door " sections. Concurrently the erection of villas will be necessary for women patients to be transferred from Nelson —the site for these

Patients on Register on.29th March, 1924, as classified. Mental Hospital. i ni Qaa tt I I m « v Class I, I (ft : Class III, Class IV, V, | 01a8s VI> Unsound Mind. | infirm rdiots. Imbeciles. minded Epileptics. M. r. M. 1'. M. J. M. 1'. M. F. M. F. Auckland .. . . .. 296 254 150 53 116 107 66 7 30 63 38 Cliristchurch .. .. .. 218 318 34 31 7 7 36 46 22 9 41 46 Dunedin (Seaolifi and Waitati) .. 436 32!) 41 39 13 5 51 26 40 37 55 44 Hokitika .. .. .. 129 42 34 13 2 2 4 2 1 8 3 Nelson (and Stoke) .. .. 37 43 87 44 .. I 58 17 5 5 28 7 Porirua .. .. .. 545 381 9 12 3 7 22 37 17 11 54 52 Tokanui .. .. .. 74 51 42 28 .... 29 17 16 I 5 3 Totals .. .. .. 1,735 1,418 406 220 34 28 305 213 109 94 254 193

inmates resident on 20th March, 1924. ou 1924. Mental Hospital. Less Absent Voluntary Total Number nf Bedrooms and ou Patients. Resident In Dormitories Probation. Boarders. Inst itution. Wards ' for ! ■ I M. F. M. r. M. P. M. If. M. F. M. 1'. Auckland .. .. .. 9 13 634 434. 5 11 639 445 9 9 629 480 Christchuroh .. . . . . 9 14 349 443 8 17 357 460 7 7 385 448 Dunedin (Seacliff and Waitati) .. 6 4 630 476 17 11 647 487 11 8 528 456 Hokitika .. . . .. 3 5 172 60 .. .. 172 60 4 3 156 88 Nelson (and Stoke) . . .. 1 1 214 116 3 2 217 118 4 4 213 119 Porirua .. .. .. 16 25 634 475 15 20 649 495 8 7 590 403 Tokanui .. .. .. 3 2 163 98 .. 2 163 100 3 2 172 100 Totals .. .. .. 47 64 2,796 2,102 48 63 2,844 2,165 46 40 2,673 2,094

Male. Female. Total. Auckland —- Proposod separate modern hospital ward, leaving present infirmary for senile, &o. Christchuzch — Staff quarters, emptying single rooms for patients, in course of construction Proposed farm buildings at Templeton Porirua — Tenders called for iive villas, each accommodating thirty-four Hokitika — Nearing completion, administration block, with admission wards and hospital Tenders called for " closed " villa .. Nelson — Tenders called for " closed " villa at Stoke Tokanui — Tenders let for admission ward 40 24 28 102 68 40 24 28 170 31 38 31 02 38 42 42 n 27 27 305 126 431

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has already been selected ; and for Tokanui, then able to receive direct admissions of both men and women, further villa accommodation will need to be anticipated. The above works refer to additional sleeping-accommodation only, but it will be realized that such additions carry with them the necessity for additions in other directions —for example, ate Porirua tenders have been let for a large extension of two day-rooms and additional lavatories, and plans have been prepared for an additional kitchen for all the male department outside the main institution. At Seacliff and Sunnysidc additions to the laundry are necessary, and a new laundry is wanted at Stoke. A tender has been let for a store at Nelson, and one at Tokanui is in course of erection. The details of expenditure and credits for the year ended 31st March, 1924, are shown in Tables XVIII and XVIIIa. In Tables XIX and XIXa the items are grouped, the amounts divided by the daily average number of patients (and boarders), so that the cost is shown in terms of per patient. It will be seen that the gross cost per patient was £74 9s. Ojd. ; the average, received for maintenance was £18 3s. 2Jd. ; deducting this and other repayments such as sales of farm-produce, &c, the net average cost for maintaining patients —that is, the sum paid to us by the Consolidated Fund — amounted to £51 6s. 6d. a head. In the, above, the Head Office administration expenses are included ; they represent 1-35 per cent, of the cost. Whether or not a patient pays his maintenance, or how much he pays is known in the Head Office only, and his treatment has relation to his mental condition alone and not to his ability to pay. As a matter of fact, some patients for whom nothing is received have special attendants, and obviously cost considerably more than the gross average. The following is a return of the expenditure on and receipts from our farms : — Expenditure. £ s. d. Receipts. £ s. d. Salaries and wages .. .. .. 14,655 I 2 Live-stock and produce— Feed .. ~ .. .. 4,934 13 6 Sold .. .. .. .. 13,500 8 6 Seed, fertilizers, &o. .. .. .. 2,849 6 7 Consumed .. .. .. 24,463 9 8 Implements, harness, &(■. .. .. 1,574 16 9 Stock .. .. .. .. 2,784 7 10 Rents, rates, &c. .. .. .. 190 9 3 Fencing, draining, roading .. .. 479 0 0 Harvesting, &c. .. .. .. 444 8 1 Railages .. .. .. .. 415 6 7 Buildings .. .. .. .. 91 5 3 Sundries .. .. .. .. 609 3 7 Balance .. .. .. .. 8,935 19 7 £37,963 18 2 £37,963 18 2 This, it goes without saying, is satisfactory ; but 1 must emphasize what I have said before, because the, fact must not be lost sight of, that even if the farms, which pay because they are worked well, did not show a credit on a balance-sheet, they would pay as therapeutic agents and would have to be continued. It is a commonplace truism that the brain does not energize in two directions at the same time, and it is necessary, therefore, to lessen morbid energizing by supplying interesting open-air employment, the most important among many other agents, if it were a mere, matter of working the, farms for profit, it would pay to have nothing but ordinary paid labour and the usual labour-saving devices, but the recovery rate would be lowered, and also the level of contentment, which would result in raising largely the percentage of disturbed and difficult patients, which is relatively low. The work of the staff during the year has been praiseworthy. In December the usual examination was held for the registration of mental nurses, when the following passed. In the list arc included some who had already passed in the second grade and sat again to get a first-grade certificate : — Auckland: First Grade—John Carroll, Olive Lowe, Kathleen Ann Shanahan; Second. Grade— Annie Margaret J ones, Robert Perry. Christchurch : First Grade —Annie Cbristey, Eva Leeming, Mary Elizabeth Ann Neads, Kathleen McAleer ; Second Grade —Mary Elizabeth Morgan, Rose Murphy. Dunedin: First Grade —Robert Short Anderson, John Brown, William Harrison Ellwood, John Howie, Catherine Jenkins, William McKenzie, Archibald McMillan, John Stafford O'Niell; Second Grade James' Blaokie, Thomas Brady, Janet Isabella Carswell, Jencttie Bryce Cooper, James Sketheway Moodie, James David Watson. Hokitikia : First Grade—Patrick Francis Mulrennan, Jack Thomas; Second Grade—Mollie Macfarlane, Alma Elizabeth Rowe, Martha May Louisa Schroder. Nelson : First Grade —Margaret Cecilia Noonan, Mara Elizabeth Heslop. Porirua : First Grade —Elizabeth Frances Godfrey, James Ogilvie Mackio, Harry Tyson, William Hudson Walker; Second Grade —John Alexander McLennan Brown, Harold Percy Bullock, Edgar Stanley Doddington, Esther Maud Jackson, Allen Rothery. Tokanui : First Grade —Margaret Farrell, Lena Kenny, Maude Kenny. This nursing certificate carries with it promotion to the senior staff, and it is not awarded to any with less than three years' service. The ratio of nursing staff to patients will vary with many considerations, the designs of the wards, the number of patients under special observation, the relatively more necessary in smaller institutions, and so forth ; but it is generally conceded that an average of not less than 1 to 10 patients is desirable—that is, one on duty, and as members of our staffs are off duty for a third of the year, allowance has to be made accordingly. The following gives the position on the 31st March : Auckland —1 attendant efficient to 13-5 patients and 1 nurse to 10-4 ; Christchurch—l to 7-4 and 11-2 ; Hokitika—l to 8-0 and 5-4 ; Nelson —1 to 10-2 and 8-7 ; Porirua—l to 11-4 and 10; Seacliff— 1 to 9-1 and 8-8 ; and Tokanui—l to 9-6 and 8-3 respectively. This year more than ever I feel and must express indebtedness to the District Inspectors anil Official Visitors for their labours ungrudgingly and faithfully performed, because unforeseen circumstances have limited the number of my own inspections. These ladies and gentlemen, who have the

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confidence of the patients and the respect of the, staff, have never demurred when, in addition to their usual visits, I have had to call upon them to inquire into any matter on my behalf, but have done so and reported immediately. You have met some of them on your rounds and read their reports of visits and investigations, and their recorded criticisms, which are passed on to you as they arrive, and I think you will, sir, agree with me that they have proved most valuable. Mr. John Alexander, Auckland, has been absent on leave, and will be welcomed back when he returns and.visits the Mental Hospital. The following additional new appointments have been made : Official Visitor, Dunedin The Reverend Hector Maclean. Official Visitors, Christchurch—Henry Havelock Hanna, Esq., solicitor, and Mrs. Lawrence Williams. Official Visitor, Auckland—The Reverend D. C. Herron, M.A., M.C. I record with regret the loss to Porirua by the death of Mr. Martin Chapman, K.C., District Inspector, Wellington. Death has also ceased the labours, as it alone could, of the friend to any one in trouble, Mr. Edwin Arnold, whose benevolence often led to his being imposed upon; but that never discouraged him. He was Official Visitor in the Wellington District for twenty-one years, and his memory will bo regarded with respect and affection. In addition to the visits of District Inspectors and Official Visitors, Mr. Holder has inspected the offices and stores and looked into many matters on my behalf, and Miss Hanna has made her round of inspection, residing at the hospitals so as to be present at all hours and at any part. My own visits were as follow :— Auckland. —Visited in April and May, 1923, and May this year. At the first of these visits a large number of works, decorating and modernizing the hospital, were in progress, and at the last I was glad to find that a great deal had been completed. The increased and more efficient bathingfacilities and the new properly ventilated lavatory blocks are a marked improvement, and the extensive alterations in the kitchen have improved its service and made it an entirely wholesome place to work in. I found this Department under women, and scrupulously clean. The, inmates of the Wolf Home were bright, and expressed themselves as comfortable. Both sides are under the care of nurses. A small section of the main building on the men's side, a dark and undesirable portion of the old part, has been entirely remodelled, and will make a most bright and comfortable self-contained place for a few well-conducted parole patients. Altogether, the year has shown a distinct advance. The general health of the patients has been good. Tokanui. —Visited in May, 1923, and May of this year. The male reception-house is in occupation, and tenders have been let for a corresponding block on the women's side. I saw work in progress on the store and office block. This will be, a great convenience, as it will be reached under cover from both sides of the institution. At present the stores are scattered. The development of the estate has made great progress, and much credit is due to Mr. McDonald, the Manager, whose trust in and kindly bearing towards the patients employed is not lost on them. The vegetable-garden has been largely extended. I am glad to say that the matter of piping the Pirongia water has been approved, which sets at rest our fear concerning the group of springs, our present source, giving out—they were very low for part of the year. I found the patients very well and doing well, well clothed, and well fed. Porirua. —Visited in April, May, and September, .1923, and in February of this year. As stated above, tenders have been let for five villas, three for men and two for women, which will clear the crowded wards. The large extension of Wards 4 and B day-rooms, for which tenders have been let, will give much-needed sitting-room accommodation. The daily routine of the institute goes on satisfactorily, and the general health of the patients has been good, but there have been a number of cases of scabies, some having it on admission. Whether these were the source of contagion has not been definitely settled, but every precaution was taken with them, and a steam disinfector has been installed to treat all clothing before being sent to the laundry. Last year I suggested that the Engineers' Department should be, moved to another site. We had to decide whether we, would increase the electric-lighting plant or purchase supply from the hydro-electric scheme. The, Engineers informed me that, as it is essential for us to use steam for many purposes, it will be, more economical to make our own electricity, and as 1 understand that the district will not get the hydro-electric supply, or, at any rate, not in the near future, I have asked the Public Works Department to go into the question of our supplying the wants of the district, and on its report the matter will depend. Nelson. —Visited in February, 1923, and in January of this year. Great credit is due to Dr. Gray for well-directed energy, and to his staff for adapting themselves enthusiastically to co-operate in the newer methods. When one realizes the advance made in the transfer of patients from Nelson and elsewhere to Stoke, where many who had been idle hitherto are working and on parole, and the changes that have been effected at Nelson, the opening of the reception-house (Braemar) under the charge, of Sister Brand, the home for deficient boys, El Nido, in occupation, and the small hospital ward, all efficient, accomplished at a relatively small outlay and working efficiently, one has reason to be satisfied. The purchase of the old canning-factory with its water-rights opens the way to the erection of villas for women patients at that end of the Stoke estate and for the, establishment of a genorai kitchen and laundry. Hokitika. —Visited in March, November, and December, 1923. At the last visit one could judge that the admission and hospital wards and the administration block would, be ready for occupation in three or four months. They are well designed for their purpose, and have been placed under Sister Rolfes, The hospital staff removed the buildings neighbouring the site, scrapping those of no fur 1 her use and utilizing good, material for a small isolation hospital. Tenders have been called for a " closed " villa, which will empty that part of the old buildings which have been the subject of comment, permitting of their being removed. Dr. Buchanan's residence is just in the site where a

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villa is wanted for women patients. We have now progressed sufficiently to build a residence for the Medical Superintendent, and when he has moved into it, to adapt his uresent one for a villa for women. The new buildings are lighted by electricity, the drainage, has been led to the sea, and roads have been made in anticipation of the changes. I found the patients well clothed and well fed, and those able, to appreciate the improvements expressed themselves as contented. It must be a satisfaction to Dr. Buchanan to find his energy bearing fruit. Christchurch. —Visited in March, November, and December, 1923. The renovations have proceeded apace, and the dining-room extensions are in occupation, and. twenty-four bedrooms, with sitting-room, &c.,.for the attendant staff arc in course of erection. A small infirmary for women on the ground floor and some, extensions in the laundry will bring this hospital up to date. I have every reason to be satisfied with the condition of the patients and with Dr. Crosby's evident interest in their care anil treatment. The farm at Templeton would give scope for change and healthy occupation of some twenty to thirty patients, and plans have been prepared for a suitable building. The Lodge, Hornby, continues excellent in every way for ladies whose mental condition is not so disturbed as to destroy the amenities for the others. When I last visited, the patients expressed themselves as pleased with the house and its gardens, with the resident lady doctor, and with the nurses, leaving me with the impression that the experiment was and will continue to be a success. Seacliff. —Visited in March, June, and December, 1923. The artisan staff has been employed in demolishing some old buildings, and the replacement, with, extensions, of these is not yet completed. I discussed with Dr. McKillop some necessary extensions in the vicinity of the bowling-green and the need of some villas at Waitati. Being assured of the improved water-supply and that the earth-slip does not affect the laundry, I agreed to plans being prepared for the extension of the same ; also for the erection of new farm buildings on a different site from the present, whore the buildings have been twisted by the slip acting over a number of years. I found the patients well—no one seriously ill - the institution in good order, and the staff working well. The patients take a great interest in the recreations provided. The cricket and football ground was too limited, and at my last visit was being extended by lowering its surfaco and diverting a portion of the main drive. Ashburn Hall. —Visited in March, June, and December, 1.923. This comfortable little licensed hospital is picturesquely situated. It is quite evident that the patients therein receive individual attention from Dr. Will and the Matron, their relations with whom are most cordial. In conclusion, I have to express my appreciation of the Medical Superintendents, each for his devotion to his own institution and his desire to make it the best, and my thanks for their unusual helpfulness by writing fully about or calling at headquarters to discuss matters which they knew 1 would go into on the spot had circumstances not detained me in Wellington. My special thanks are due, to the Head Office staff, which has worked in the most complete harmony and co-operation. I have, to record with regret the death of my Deputy, Dr, William Baxter Gow, who after experience in England came to this country as Medical Superintendent of Mount View and was therefrom transferred to Sunnyside. After some years at that hospital his health broke down, and, recognizing the difficuity he had in adequately and efficiently visiting the wards, I arranged for him to change places with Dr. Gribben, then the Deputy Inspector-General. As I mentioned in my last report, Dr. Gow's health did not improve, and he was on sick-leave. In February of this year he retired, and last month the end. came. He had struggled bravely against heavy odds, and will be gratefully remembered by his old staff and patients, in whose welfare he was always actively interested. J have to express my thanks to yourself and the Government who have made it possible for me to take leave abroad in terms of medical advice tendered, and I am looking forward to be able in due, course to make a virtue of the necessity which takes me to Europe, to study on the spot advances in matters connected with care and treatment of mentally defective persons which may be adapted beneficially to the requirements and resources of this country. 1 have, &c, Fkank Hay. Hon. Sir Maui Pomare, K.8.E., C.M.G.

MEDICAL SUPERINTENDENTS' REPORTS. AUCKLAND MENTAL HOSPITAL Dr. Beattie reports : — The number of patients resident during the year was 1,058, and the total treated during the year was 1,279. The number admitted was 209. The recovery-rate was much more favourable in the case of the, female patients than in that of the males, the rates being 39-31 per cent, for males and 52-17 per cent, for females. The character of the cases admitted, and especially with regard to debility and general enfeeblemont, must always be, an important factor in the recovery-rate, but one cannot help the feeling that the greater care and sympathy exercised on the female side plays a big part. It, is much easier to get suitable nurses than suitable attendants. Moreover, lam not satisfied, that the discipline on the male side is what it used to be or what it ought to be. The death-rate on the male side was 9-36 per cent, and on the female side 5-42 per cent. The, chief causes of death were senile decay, chronic brain-disease, and general paralysis. These caused 36 deaths of males and only 12 of females. The other causes wore in units. The construction of a suitable male hospital where female nurses can be employed is now an urgent necessity, and I. am glad to know that progress is being made in that direction. Considerable improvements have been made structurally in the Hospital during the year, and they are still being carried out.

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The general work of the Hospital is progressing fairly favourably, but one cannot fail to note, the increasing difficulty in getting patients to suitably employ themselves. This must act prejudicially upon the recovery-rate and upon the general health of the, patients. I have to thank the proprietors of the Herald for papers gratuitously supplied for patients' use, the District Inspector and Official Visitors for their consideration and help, and the Medical Officers for their loyal support. The work of the Matron and nurses on the female side has been specially gratifying. TOKANUI MENTAL HOSPITAL. Dr. Gribben reports : — The annual statistics show that our population at Tokanui -Mental Hospital increased from 251 (153 males and 98 females) on the Ist January to 264 (163 males and 101 females) at the end. of the year. Patients admitted for the first time numbered 18 (10 male and 8 female), while 1 male patient was readmitted. Transfers from other institutions totalled 4(3 male and 1 female). A total of 274 patients were under care during the year. Three male, and 3 female patients were discharged recovered, and I female patient discharged relieved. There were 2 deaths (1 male and 1 female) during the year, the causes of death being heart-failure a,nd acute peritonitis respectively. One female patient was transferred to another institution. The number of patients on the register at the 31st December, 1923, was 264 (163 males and 101 females). The average number resident during the year was 254 (156 males and 98 females). Voluntary boarders at the beginning of the year under care numbered 4, while 3 new cases were admitted during the period under review. Of this number, 4 were discharged, and 1 died of senile decay, thus leaving 2 voluntary boarders under care, on the 31st December, 1923. The general health of the patients has been excellent throughout the year, especially so considering the advanced age of many of them. We had some fifty cases of influenza last November, all of which made a good recovery. The musical people of the district have kindly provided us with concerts at intervals during the year. Fortnightly dances for patients during the cold weather, and occasional visits to the picturetheatre in Te Awamutu, help to relieve the monotony of their lives. The furnishing of the new male admission block was completed early in the year, and the admission of male patients was made, possible. The installation of an efficient water-supply is a matter of increasing urgency. The well which constitutes the'present source is becoming more variable and unreliable in its output. Extension of operations in the kitchen garden has made it possible to supply the patients with a greater variety of vegetables than was formerly available. Work on the farm has proceeded satisfactorily. Apart from the usual cropping operations, some 350 acres of new country have been cleared, ploughed, and laid down in grass. The extent of the work in hand now renders imperative the appointment of an assistant to the Farm-manager. The untiring energy of Dr. Macphorson and the, loyal co-operation of the stall' generally have made the work of the year a pleasure. PORIRUA MENTAL HOSPITAL. Dr. Jeffreys reports : — The total number of patients under care during the year was 1,361 (770 males and 591 females), including 6 transfers (4 males and 2 females) from other institutions. There were 238 admissions (134 males and 104 females), and of these only 33 (16 males and 17 females) were readmissions. The, average number resident during the year, including 31 voluntary boarders, was 1,124 (644 males and 480 females). Of the 122 patients who were discharged, 87 (51 males and 36 females) were recorded as recovered, making the recovery-rate 36| per cent, on the number admitted. The actual recoveryrate was, no doubt, considerably higher, but 33 patients who were on probation failed either to report themselves or to furnish a medical certificate at the expiration of their probationary period, and under section 85 of the Mental Defectives Act had to be written off as unrccovered. It is only reasonable to assume that a fair proportion of these had recovered. The deaths during the year were 83, or per cent, of the average number resident. The chief causes of death were senile decay 27, general paralysis 8, phthisis 8, cardiac disease 6. Eight deaths from tuberculosis was an exceptionally large number for this institution, but a majority of the cases were secondary to influenza, and one female patient was in an advanced stage of pulmonary tuberculosis on admission and died very shortly afterwards. On the whole, the general health of the patients has been remarkably good. The overcrowding is still a cause of great anxiety and added responsibility, but it is a relief to know that a substantial grant has been made for the erection of a number of villas, that the plans are prepared, and that in the course of a few months the work will be well under way. The longer one is associated with the mentally defective the more one realizes the inestimable value of suitable occupation, not only as a palliative, but as one of the most important curative means at our disposal. Every patient who is capable of working is encouraged to occupy himself in some useful way, and at present 56-8 per cent, of the male patients are employed, the majority of them outside—on the farm, in the gardens, or with one of the special working-parties. Considering the number of senile and feeble patients who are physically unfit to work, and the number who are mentally unfit, this percentage must be regarded as highly satisfactory and as reflecting great credit upon the staff, who have it constantly impressed upon them that the good of the patients, not the work to be done, must be the first consideration. There are rarely more than 14 or 15 male patients capable of employment who refuse to occupy themselves in any useful way. Only 42-| per cent, of the women patients are " workers," but there is not the same variety of occupation for them as for the men, and practically none out-of-doors, but a number of them get the benefit of open-air exercise in daily walks, and in the summer frequent picnics are arranged for them by the nurses, among whom there is a pleasing rivalry to give their charges a good time.

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I regret losing the services of Dr. Monaghan, who left to take up private practice, but was most fortunate in procuring as his successor Dr. Blair, one of the most capable and conscientious medical officers it has been my good fortune to be associated with. I have to acknowledge my indebtedness to him and to Dr. Prins and other officers for their able assistance. NELSON MENTAL HOSPITAL. Dr. Gray reports : — During the year 1923 we have had under care 379 patients, with an average resident number of 306. Our average number has increased by 43, mainly due to transfers from other institutions. Our recovery-rate upon the direct admissions was 37 per cent., which is satisfactory considering that the irrecoverable male imbeciles from all over the Dominion are admitted to this institution. Our death-rate was 9 per cent, upon the average number resident, the principal cause (25 per cent.) being senile asthenia. The general health of the patients has been good. The experience of each successive year adds to my conviction that in the villa system we have the means not only of ideal classification, but also of obviating all the objectionable features which loom so largely in the public mind. At Stoke, Nelson, we have already seven different degrees of classification, which enables each type to be dealt with hi a villa appropriate to its needs. During the year the two outstanding events have been the opening of the reception block and the provision of a well-equipped male hospital block. The former- named Braemar—is in charge of Sister I. D. Brand, R.R.C., who has had a large experience in mental hospitals and other institutions in Britain and is au fait with the latest methods of treatment. In addition to her ordinary duties Sister Brand gives lectures and nursing demonstrations to the staff, which are much appreciated. The inauguration of the male hospital ward has marked a big advance. This ward, to which most of our male, cases have been admitted, is staffed by female nurses, and the experiment has been an unqualified success. I am satisfied that 90 per cent, of our male admissions into mental hospitals could be looked after by female nurses with much benefit to patients and institutions. The employment of indoor male staff is more or less a survival of the prison tradition, and we should aim at their replacement by nurses, retaining only sufficient males to deal with the really few recalcitrant cases we meet. El Nido—the boys' villa—has 64 residents, and enlargement will have to be considered in the near future. The nurses in charge do excellent work, not only in providing for the comfort of the boys, but in training them to useful occupations. The development of Stoke farm goes on steadily, and the institution is admirably suited for its function as a parole colony. Excavations are being carried out for the new " closed " villa, and plans are well forward for the new laundry and three female villas on lovely sites facing the sea. No less than 72-5 per cent, male patients are usefully employed, and 65-5 per cent, are on parole. I am very glad to record that the public of Nelson are showing a kindly and practical interest in the institution. The children of Hampden Street School sent for our juvenile Christmas-tree a handsome donation, while the public of the neighbourhood, through the School Committee, has arranged a picnic for the children. These and similar acts of kindness arc most encouraging. There have been no regrettable incidents throughout the year, a state of matters which is largely due to the excellence of my officers and staff to whom my thanks are due. HOKITIKA MENTAL HOSPITAL. Dr. Buchanan reports : — The number of patients on the register at the beginning of the year was 242. At the end of the year there remained 236, made up of 171 males and 65 females. There were 19 admissions, 10 discharges, and 15 deaths. The general health of the patients has been good. Since my last report Love Bros, have been building the male reception wing of the admission block and a central administration block. The female wing, built by ourselves, has been completed for some months now with the exception of the plumbing. I hope to have both wings in workingorder by the, end of June, 1924. An old building which stood on the site of the above has been removed, renovated, and set up as a small fever hospital. The large recreation-ground has been completed. This will be of immense benefit to the patients. The appointment of a sister, who has qualified in both mental and general training, to take charge of the new block is a most important innovation. The training of the nurses will naturally be more comprehensive, and the nursing of the sick and new admissions will be centralized. This cannot but be of immense benefit to all concerned. 1 must again express my appreciation of the loyal manner in which my staff has co-operated with me during this difficult period of reconstruction. CHRISTCHURCH MENTAL HOSPITAL. Dr. Crosby reports : — The year opened with 812 patients on our register, and closed with 806—viz., 359 men and 447 women. During the year 136 patients were admitted (60 males, 76 females), making a total under care of 948 (437 males, 511 females). Sixty-nine patients were discharged (35 males, 34 females), and 34 males and 27 females died.

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Twenty-seven persons came in as voluntary boarders, of whom five sought admission for the second time. The number of cases remanded for observation by the Magistrates was seventeen. The average number resident during the year was 784, there being 171 more females than males. As is usual, the prominent causative factors of the insane states of those admitted were heredity, previous attacks, and senility. The recovery-rate on those admitted was 31-62. We were visited during the year by a Spiritual Healing Mission, for which many of the patients were prepared, but, unfortunately, its curative results were negative and did not influence our discharge-rate. The most frequent causes of death were senile decay, epilepsy, and general paralysis of the insane—that hitherto progressively fatal disease which at last, happily, shows promise of becoming amenable to treatment. The general health of the community was satisfactory, though a troublesome skin-affection appeared among some of the patients during the winter and spring months. This caused a good deal of inconvenience and expense. The building extensions on the female side have been completed. The increased accommodation is now in use and is greatly appreciated. Additional accommodation is still required in the female infirmary ward, but I recognize that our artisan staff will be fully occupied this year with the buildings already authorized. The furnishings throughout the institution, especially carpets, are showing the effects of constant use and are in much need of replenishment. A little has been done in this direction, but much more will be necessary this year to bring the institution up to the standard of a well-appointed mental hospital. The social life of the institution has been continued on lines that have hitherto been acceptable to the patients. Our thanks are greatly due to the visiting chaplains for their regular religious ministrations. I am grateful for the appointment of Mrs. Williams as Official Visitor in the place of the late Miss Colborne-Veel, anil also for that of Mr. H. H. Hanna in a similar capacity. The year brought with it the retirement on superannuation of our head gardener, Mr. Henry Brown, after twenty-five years of good and faithful service to the institution. I am glad again to take this opportunity of expressing my thanks to Drs. Beale and Roberts, and to the officers and members of the staff, for the great help they have given in carrying on the work of the Mental Hospital. SEACLIFF MENTAL HOSPITAL. Dr. MoKillop reports :—- On the Ist January there were 1,101 patients on the register. During the year we had 151 admissions (83 men and 68 women). Eighty-nine patients were discharged, and 15 transferred to other institutions. The total number of committed cases under care was 1,252, and 1,100 patients remained on the 3lst December. Thirty-seven voluntary boarders received treatment —8 males and 2 females were discharged recovered, 1 female was committed, and I died, leaving 15 men and 10 women under this section. Of the 89 discharged cases, 61 were recovered, making the male recovery 44 per cent, on the number admitted. The figures must be regarded as satisfactory considering that almost one-third of the admissions suffered from mental trouble, for over twelve months prior to committal. The general health of the patients has been very satisfactory. There were 52 deaths (29 males and 23 females), 4-7 per cent, of the, number resident. It is worthy to note that 27 of the deaths were of patients over 70 years of age. The Mental Hospital buildings and property have been maintained in good order by the artisan staff, who have also been engaged in the execution of various new undertakings for the provision of additional accommodation and improvement in administration. During 1924 I trust it will be, possible to obtain grants for works of greater magnitude. The Public Works Department have, at present under consideration plans of proposed now kitchen, bakery, stores, laundry, and farm, buildings. The present kitchen, bakery, and laundry facilities are totally inadequate for an institution of this size, and the farm buildings are in an unsatisfactory and dangerous condition. Work on the farm and garden continues, as in previous years, to provide a large number of male patients with suitable employment, which is performed by them with interest and benefit to themselves and with advantage to the institution. The farm returns have again been satisfactory. The patients' recreation has been arranged on the usual lines ; the weekly picture-show is always very much appreciated. Mr. Gallaway continues to take a keen interest in this hospital, and pays regular visits. The institution is indeed fortunate in having a Deputy Inspector who takes such a live interest in its affairs. To the Official Visitors (Miss Monson and Mr. Slater), Mr. dimming (the Patients' Friend), and to the clergy of all denominations I tender my sincere thanks for their regular visits and for their attention to our inmates. Dr. Church left us to go into private practice on the WesfJ Coast, and was succeeded by Dr. Williams. I desire to record my thanks to Drs. Lee, Roberts, Church, and Williams for the help they have always afforded mo in the medical and general work of the institution. I have also to thank Mr. Hughes and office staff, the Matron, Head Attendant, and other heads of departments for their loyal and efficient assistance, and the staff as a whole for the satisfactory manner in which its work has been performed.

2—H. 7.

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APPENDIX.

Table I. —Showing the Admissions, Readmissions, Discharges, and Deaths in Mental Hospitals during the Year 1923.

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 1923.

Tn mental hospitals, 1st January, 1923 Admitted for the first time Readmitted M. 365 77 F. 302 04 T. 667 141 M. 2,816 \ 442 F. 2,110 366 T. 4,932 808 Total under eare during the year 3,258 2,482 5,740 Discharged and died— Recovered Relieved Not improved Died (Not including transfers —Males 41, f( males 24.) 168 42 15 194 151 38 5 131 319 80 20 325 419 325 744 Remaining in mental hospitals, 31st December, 1923.. 2,839 2,157 4,996 increase over 31st December, 1922 23 41 64 Average number resident during the year .. 2,789 2,079 4,808

Mental Hospitals. In Mental Hospitals on 1st January, 192.!. Admitted for the First Time. .dmissions in 1923. Not First Admission. Transfers, Total Number of Patients under Care. Auckland Christchurch Dunedin (Seaclifi) Hokitika Nelson Porirua Tokanui Ashburn Hall (private mental hospital) Totals M. F. T. 646 424 1,070 377 435 812 631 470 1,101 172 70 242 184 110 294 636 487 1,123 153 98 251 17 22 39 M. 89 47 03 8 28 114 10 (i F. 73 59 51 5 10 85 8 5 T. 162 106 114 13 44 199 18 11 M. 27 11 18 3 1 16 1 F. 17 14 15 I 17 T. 44 25 33 4 1 33 1 M. F. T. (I 2 3 ) (2 3 5 ) (2 2 4 ) ( 1 1 2 ) ( 28 12 40 ) (4 2 6 ) (3 1 4 ) ( .. 1 1) M. 763 437 714 184 241 770 107 23 F. T. 516 1,279 511 948 538 1,252 77 261 138 379 591 1,361 107 274 28 51 2,816 2,116 4,932 365 302 667 77 64 141 ( 41 24 05 ) 3,258 2,482 5,740 Mental Hospitals. I Patients disci discharged, transfei -rod, and died. Died. Total discharged transferred, and died. I, In Mental Hospitals on Hist December, 1923. Discharged recovered. Discharged not recovered. "g d Transferred. ] M. Auokland .. .. 4( Christchurch .. 25 Dunedin (Seacliff) .. 3f Hokitika .. .. i Nelson .. .. t Porirua .. 51 Tokanui .. .. 2 Ashburn Hall (private 1 mental hospital) Totals .. L6S M. F. T. 46 48 94 22 21 43 35 31 00 2 2 4 8 8 10 51 30 87 3 3 6 1 2 3 M. F. T. 8 2 10 13 13 26 12 7 19 2 2 4 2 .. 2 18 17 35 1 1 2 1 3 T, M. F. T. 10 (13 2 15) 26 ( 9 3 12) 19 (13 2 15) 4(2.. 2) 2(2 I 3) 35 ( 2 14 16) 1 (.. 1 1) 3 (.. 1 1) M. F. T. 59 23 82 34 27 61 29 23 52 7 8 15 17 11 28 46 37 83 1 1 2 1 1 2 M. F. T. 120 75 201 78 64 142 89 63 152 13 12 25 29 20 49 117 104 221 4 6 10 4 5 9 M. 037 359 625 171 212 653 163 19 F. T. 441 1,078 447 800 475 1,100 05 236 118 330 487 1,140 101 264 23 42 168 151 319 57 43 100 (41 24 65) 194 131 325 460 349 801 400 349 809 )9 2,839 2,157 4,990 Mental Hospitals. Average Nu resident di the Yea imber nring ir. of Percentage .tecovorios on admissions •ing the Year. Percentage of Deaths on Average Number resident during the Year. du] Luckland Jhristchurch hinedin (Seacliff) lokitika Jelson 'orirua Vikanui tshburn Hall (private mental hospital) .. M. F. 034 424 357 427 627 408 171 67 196 110 630 403 156 98 18 22 M. 634 357 627 171 196 630 156 18 F. T. 424 1,058 427 784 468 1,095 67 238 110 306 463 1,093 98 254 22 40 M. F. T. 39-65 53-33 45-63 37-93 28-70 32-82 43-20 46-95 44-89 18-18 33-33 23-52 27-58 50-00 35-55 39-23 35-29 37-50 27-27 37-50 31-57 10-60 40-00 27-63 M. F. T. 9-26 5-21 7-60 9-52 6-32 7-78 4-04 4-84 4.72 4-09 11-93 0-32 8-66 10-00 8-48 7-30 7-99 7-59 0-64 1-02 0-78 5-55 4.54 5-00 Totals .. 2,789 2,079 2,789 2,079 4,868 38-00 41-22 39-48 0-95 0-30 6-67

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Table IV.—Duration of Disorder on Admission.

Table III.— Ages of Admissions.

Ages. Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson Porirua. Tokanui. Ashburn Hall (Private Mental Hospital). Total. Under 5 years .. From 5 to 10 vears „ 10 „ 15" ., „ 15 „ 20 „ „ 20 ,. 30 „ „ 30 „ 40 „ „ 40 „ 50 „ „ 50 „ 60 ,. „ 60 „ 70 ,. „ 70 „ SO „ „ 80 „ 90 ., „ 90 „ 100 „ „ 100 „ 105 „ Unknown Transfers M. F. T. 1 0 1 5 0 5 13 4 22 12 34 32 27 59 21 27 48 15 9 24 9 6 15 6 6 12 3 0 3 M. F. T. 0 2 2 1 1 2 1 2 3 2 1 3 12 13 25 8 25 33 8 14 22 9 7 16 10 3 13 4 3 7 2 1 3 M. -F. T. ! 2 3 5 11 5 16 18 12 30 14 12 26 10 9 19 12 15 27 6 4 10 7 5 12 1 1 2 M. 1 1 1 1 4 2 p_ 1 0 1 0 1 T. 9 1 2 3 4 3 M. F. T. 3 0 3 5 16 4 1 5 2 1 3 3 6 9 5 4 9 1 2 3 0 1 1 3 0 3 2 0 2 1 0 1 51. F.' T. 0 5 5, 2 3 5 2 3 5 17 20 37 27 20 47 30 23 53 23 17 40 11 4 15 i 17 4 21 1 1 2 0 2 2 M. 0 2 2 2 2 1 2 F. 1 0 2 1 3 1 0 T. 1 2 4 3 5 2 2 M. F. T. 0 1 1 2 2 4 1 0 1 0 1 1 1 1 2 1 0 I 1 0 1 M. F. T. 3 2 5 7 7 14 14 10 24 21 15 36 77 67 144 90 90 180 73 81 154 64 50 114 43 19 62 39 18 57 8 4 12 0 2 2 0 1 1 ■• 1 0 1 1 2 3 1 1 2 2 3 5 2 2 4 1 0 1 1 2 ■■ 2S 12 40 4 2 0 3 1 4 0 1 1 3 1 4 41 24 65 Totals 83 68 151 6 6 12 483 390 873 117 92 209 60 76 136 12 7 19 57 28 85 134 104 238 14 9 23

Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall (Private Mental Hospital). Total. 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. 77 59 136 M. P. T. 30 32 62 K. F. T. M. F. T. 34 21 55 8 4 12 M. F. T. M. F. T. 1 9 10 76 52 128 M. F. T. 5 5 10 M. F. T. 2 4 6 M. F. T. 233 186 419 3 6 9 5 4 9 6 8 14 2 0 2 34 20 54 1 1 2 2 1 3 53 40 93 24 15 39 14 21. 35 18 21 39 3 2 5 5 4 9 2 2 4 1 0 1 10 1 68 65 133 12 10 22 9 16 25 23 10 39 21 3 24 18 28 46 4 2 6 1 0 1 88 75 163 1 2 3 2 3 5 2 2 4 112 28 12 40 4 2 0 57 28 85 134 104 238 3 1 4 0 1 1 41 24 65 Totals 117 92 209 60 76 136 83 68 151 12 7 19 14 9 23 6 0 12 483 390 873 I I I J

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Table V.—Ages of Patients discharged "Recovered" and "Not Recovered" during the Year 1923.

Table VI.— Ages of Patients who died.

1 ' I 291 19 86 618 ISI 891 f Z Z 8 Z I Z Z 0 9 8 8 IS 18 OS i8 98 ISS I f 91 8 8 9 Z f f Z Z n 6 SS 99 18 38 88 91 ZZ 8? IS SS SS f lZf6 9f " W°i 69 fZ If '' I I 0 • • I I 0 ■ • 91 f I S • ■ 8 I Z • • Z 0 Z " ST Z 81 "' SI 8 6 '' SI Z 81 ' - ' ' ' sjajsurai f Z Z 8 0 8 " '• •' S I I I 0 I '• '■ " 101 '• '• IIOTOTIOI " " "' ! • ■ • • • • • ■ •• • • • • •• • ■ • • •• • • • • .... . • " 001 " 06 " 8 I Z " ' ' • " ' • I 0 I ' ' ' ' I I 0 • • '' I 0 I ■• | • ■ ■ " 06 " 08 " 8 0 8 8 Z 9 101 •' •' •' 80S SOS " •• " " " ' SIIS0SII0S0SS08 " 08 " OL " 6 89 SI 8 SI •' •' ' " • S I I f 0 f •' • I0IIIOSIISSO8IS8O8I0IS OS " 01 " 09 " 81 9 I Lf 61 8S I I 0 T 0 I ' ' "" S I I 81 9 L ' ' I I 0 "" '' SS8SI 868 I S 9 S f S I I fl Li " 09 " OS " 81 6 6 f8 ft Of '• '• '■ S S 0 S S 8 8S II SI " 9 8 81 I 01 0 IS 0 S 81 t 6 i S S II 8 88 I S 8S 91 SI " OS " Of OS SI 8 6i Sf- IS • ■ I I 0 • ■ 8 0 8 8 9 S fl 9 8 I 0 I f I 8 " " 9 8 8 OS 01 01 f 8 I 01 i 8 1 0 I iS il 01 " Ot " 08 SI S 01 Si SS LS I 0 I I I 0 • ■ I I 0 9 8 8 6S 81 91 ' ' SSI ' ' I I 0 8 0 8 81 8 S S S 8 6 I 8 * ' SI 8 L " 08 " OS SOSOISS •• •• •' IOIIOI '• SIIIOI " " SSI •' SSO SOS "OS "SI" S S 0 I I o • • I I 0 I I 0 ■ • • • • • ■ • • • I I 0 ■ • • • "" " " si " 01 9 8 8 •• •• •• •• f S S I 0 I •• 110 " oi <n S rao-1.1 • • • • • • • • SJB8A g J9pnj^ *X '£ 'It 'X "W *X 'SL "M *X "K 'X *K 'X '& *I\[ 'X *K *X 'IM 'X *K *X '3. 'K 'X 'M 'X 'J "K 'X '& *K 'X '& *K *X *X *W 'X "K 'X "W 1 ! P9J0AOO9J ._„i_, 'p9J9AOO *p9J9AOO - p9I9AOO -p9J9AO0 "p9J9AOO "p9J9A0D "P9I9AOO 'P9I9A00 'P9J9AOO P9I9AOO *p9I9AOO -p9I9A0D *p9I9AOO *p9J9A00 'P9I9AOO *p9J9AOO -91 -9-J£ -91 -9}J -9J !jO£r -91 -91 !}<>£ -91 -91 -91 !»0£[ *S9§V *l«»ox 'piuwioj; 'vnJiiOj utpgnxia -pn«p{Oiiv uaiiqqb y

6S8 1ST f6l S I I SIT £8 18 9f 8Z [I LI SI 8 £ S6 SZ 6S 19 iS K S8 8S 66 " " " WJ S I .. .. •' •• SSI '• '• '• " •" •" ujioinpin f S Z •' '' I I 0 '• ' • ' ' • • SIS ' • • ' ■' " OOI " 06 " 08 II 91 ' ' ' • 6 f I I I 0 8 12 8 f f 8 8 9 6 I f • "" " " 06 " 08 " fL IZ 86 • • I 0 I ?? 8 II 9 Z f 8 0 8 61 9 81 8 I L SI I II '' " ' " 08 " OL " ee 61 98 I 0 I •" *19 8 tie Z Z 0 9 Z f 01 e 6 81 8 SI • • •" " • " 01 " 09 " 16 OS 18 •• 61 f II I I 0 f 8 I 6 Z 8 SI 8 f fl S SI "" " " 09 " 06 " 6f 6S fS ■■ I I 0 6 t> 6 f I 8 •• 8 6 8 II 6 9 91 6 I " " " " 06 " Of " 9S 81 81 • • ' • 8 f f t 8 I •' S S 0 6 8 S I I 9 - ' "" " Of " 08 " 61 6 01 I I 0 "" 9 f S SOS •' 8 I S 6 S 8 SIT " " " " 08 " OS " 6 8S '• " SIT •• •' I I 0 I 0 I I I 0 '• "" " OS " 61 " 5 I I ' ' '' I I 0 I 0 I "' ■ • '' ' ' ■' " " 61 " 01 " 6 I f '• 8 I S I 0 I I 0 I " "16 S I I • • •• " S I I •• •• " •• " "" " "" 6 ispTijl "I *J 'IV M. -J\[ "I -J 'K 'I -.1 'It 'I -J -15 "I -a •!« "I 'jl 'H 'I 'J 'K 'X 'a "W 1®»0X I[?H T nJ"QMsV 'jmiTOtoi "biuijoj 'nosiax WIBPIOH '(ijipess) nipsnna -qojnqoisuqo -pjrepi™v 'sqSSv

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Table VII. —Condition as to Marriage.

Admissions. Discharges. Deaths. Auckland — Single Married Widowed Unknown Transfers It. F. T. 07 32 99 38 44 82 8 14 22 3 0 3 I 2 3 M. F. T. 32 17 49 19 29 48 3 4 7 M. F. T. 27 11 38 22 9 31 9 3 12 1 0 1 13 2 15 Totals 117 92 209 67 52 119 59 23 82 ChbiSTOHUROH — Single Married Widowed Unknown Transfers 30 20 7 1 2 31 33 9 0 3 61 53 16 1 5 19 15 0 1 9 11 22 1 0 3 30 37 I 1 12 17 8 25 8 5 13 3 5 8 0 9 15 Totals 60 70 136 44 37 81 34 27 01 Dunedin (Seaclifi) — Single .. Married Widowed Unknown Transfers 58 31 89 22 28 50 1 7 8 20 20 40 19 15 34 2 3 5 14 M 25 13 9 22 2 3 5 2 2 4 j I 13 2 15 Totals 83 08 !51 00 40 100 29 23 52 Hokitika — Single Married Widowed Unknown Transfers 7 1 8 3 3 0 0 2 2 1 0 1 1 1 2 2 0 2 2 4 0 3 1 4 I 5 0 3 2 5 2 0 2 Totals 12 7 19 6 4 10 7 8 15 Nelson — Single Married Widowed Unknown Transfers 22 8 30 0 7 13 1 1 2 7 4 11 3 4 7 13 5 18 3 0 9 1 0 1 28 12 40 2 1 3 Totals 57 28 85 12 9 21 17 11 28 Porirua — Single Married Widowed Unknown Transfers 45 48 93 75 40 121 10 8 18 24 30 54 43 20 63 2 3 5 14 10 24 28 10 44 4 11 15 4 2 0 2 ii 16 Totals 134 104 238 71 67 138 46 37 83 Tokanui — Single Married Widowed Unknown Transfers 10 0 1 4 14 3 3 1 2 1 1 1 2 2 0 3 3 1 1 0 0 1 1 1 3 1 4 0 1 1 Totals 14 9 23 3 5 2 Ashburn Hall — Single Married Widowed Unknown Transfers 4 2 0 3 1 1 7 3 1 1 2 0 1 1 1 2 3 1 1 1 2 0 1 1 0 1 1 Totals 6 12 3 4 Totals — Single Married Widowed Unknown Transfers 243 158 401 166 165 331 28 43 71 5 0 5 41 24 65 112 104 8 1 41 85 97 12 0 24 197 201 20 1 05 90 75 22 7 47 51 24 i) 137 126 46 16 Totals 483 390 873 260 218 484 194 131 325

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Table IX.—Ages of Patients on 31st December, 1923.

Table VIII.— Native Countries.

Ages. Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanur. Ashburn Hall (Private M.H.). Total. I From 1 to 5 vears 5 ., 10' „ „ 10 „ 15 „ „ 15 „ 20 „ „ 20 „ 30 „ „ 30 „ 40 „ „ 40 „ 50 ,. „ 50 „ 60 „ „ 60 ., 70 „ „ 70 „ 80 „ „ 80 „ 90 „ Upwards of 90 years Unknown M. F. T. 4 3 7 2 4 0 9 11 20 80 38 118 133 95 228 156 118 274 111 91 202 82 45 127 31 18 49 7 2 9 M. F. T. 0 2 2 2 8 10 2 5 7 8 9 17 36 36 72 75 86 161 82 110 192 68 87 155 53 65 118 23 29 52 9 8 17 M. F. T. 10 1 2 2 4 3 7 10 26 9 35 60 33 93 102 80 182 152 112 264 124 120 244 82 64 146 53 37 90 12 8 20 M. F. T. 1 1 2 9 2 11 30 11 41 47 17 64 46 22 68 22 5 27 12 4 16 4 3 7 M. F. T. 5 2 7 32 1 33 19 3 22 14 4 18 20 14 34 23 12 35 33 21 54 22 29 51 23 15 38 11 7 18 2 2 4 M. F. T. 0 5 5 0 15 15 4 6 10 74 54 128 120 95 215 181 111 292 125 90 215 88 69 157 50 30 80 11 10 21 0 2 2 M. F. T. 4 0 4 5 5 10 24 18 42 48 24 72 38 24 62 23 23 46 10 7 17 M. F. T. 2 0 2 2 4 6 3 2 5 4 9 13 6 4 10 1 3 4 1 1 2 si. 6 40 26 66 286 509 702 538 379 191 46 0 50 F. T. 4 10 19 59 34 60 40 106 182 468 401 910 515 1,217 472 1,010 290 669 135 326 34 80 2 2 29 79 22 16 38 12 3 8 "3 11 8 8 16 11 0 11 Totals .. 171 65 236 i 212 118 330 637 441 1,078 359 447 806 625 475 1,100 653 487 1,140 163 101 264 19 23 42 1 2,839 2,157 4.996

966'f LST'S 6S8'S Zf S3 61 f9S TOT 891 Ofl'I i8f 869 088 8[T ZIZ 983 S9 TIT OOT'T 9Lf 639 90S 9f? 6S8 8I0'T Ift £89 " " " WU 93 88 82 •" • • ' • 68 fZ- ST • • • • <51 S L 9 f I "' " " " uALOinpijl OZT 88 ?8 '' 9 T 9 99 6T iS Z 0 Z 9 T 9 f T 8 OT 9 f 98 OT 9S •' " '" jaq;o 01 fS 98 •• Z 0 Z OS OT OT 9 5 f TOT SOS T T 0 88 TS IT " " SUO-BJE 61 0 61 - ' •' TOT " 808 808 TOT SOS - " '" " ' " ' B1I R0 STTTT " '• 80S '• 808 TOT " 9 If " " " " %I 61 f IT '• TOT 9 S 8 TOT " 8TS 8 T S SOS " " " " (I SS 8 6T •• •• f Z Z SOS 9 0 9 SOS 808 9 16 '■ " "" '■ uapa^S 9T8 8T • TOT 9 T f TTO TOT fOt "" f T 8 " " "" "" 98 8 88 '• 808 • TOT " TOT f S S £3 T 93 -- '" '' wxjsny 88 8T0S TOT ST Si SOS 808 STT f S S 9 S f " "" SOS '• '• TOT •' '■ •" TOT •' '• '• •' aouuj^ f IS S8 S8T 8 8 0 8 S 9 8f ST 8S OT f 9 9T S fl Zf ZZ OS SS II ST 69 8S 9f " " " uBn^sny SSL'S S8S'l Oif'l OS il SI 8fl f9 f8 t<)9 68S SIS 60S f9 6fl 601 88 II 0S9 86S iSS 89f US I6T SSS LfZ 88S " " " pnmpiaz Aia N IZf S8T 6SS •' SI S 01 66 8f TS 8T L II 8S 6 63 f6 If SS 19 9S IS 86 68 fS " •" pirei^I 688 68T 961 STT 18 91 ST SS 81 fS 91 9 01 SI 9 I 8SI 19 il Of 81 SS Sf SI OS ' • '' • ■ • • pui!I*oog 918 6SS 186 I Z 9 IS 91 68 SSS Si 8ST SS 01 ST 88 6 63 6fl 66 f6 Oil f6 9L 90S 81 8ST '' •' '' sai«A\ pus pnBjgn a •lL "LI "IM *X \I *K *1 '£ *H '.I "K "I "H *1 '£ * JM '£ '£ *I\[ '£ '& 'W *£ '& "H [fBHnmqqsv' 'mnnjioj, isnraoj -uosiaij "BTOPIOH -eagi'mpauna pireppiiv sau»unoo

H.—7.

Table XI.—Length of Residence of Patients discharged "Recovered" during 1923.

Table X.—Length of Residence of Patients who died during 1923.

15

( 618 ISI 891 8 S I 9 8 8 18 98 19 91 8 8 f Z Z 99 18 68 1 Sf IZ ZZ f6 8? 9? " " " sp4°i SJ'BQA C[ J9A(J Six •• •• I I 0 " " I 0 I •• •• •• •• ST " ST " St " 01 " g z I • • • • [01 " " " Z Z 0 • ■ '" " ' • • Ot " L L S Z " " I T 0 " 9 g o I I 0 " " " " " L " e " 618 " •' 101 " " I8TS 808 SOS '' '• «e"g" 5168 "• " 9 f T " " f Z Z 1[0 S S 0 '• •' •• " 8 " S fZ ZZ "" ' • H 1 L 8 [ Z •' 01 f 9 6 9 8 OT 9 f '' ' • "' s.reaA z " T " 08 f[ 91 ' • TOT TT 8 8 T T 0 '' 9 8 Z 8 T S 6 9 8 '' "' "" " Zl " 6 " If 81 ffi •' TOT ST 8 6 S T T " 6 9 8 9 T f ST I 9 " " " 6 "9 " g8 Of Zf ■' f 8 T 8S OT 8T f Z Z Z Z 0 ST I 8 8 9 8 TS TT OT " " " " 9 " 8 " fL Z8 Sf Z T T " ST I 9 f Z Z " fT 9 6 TT f L 08 8T IT " " •• g 0} \ uiojj; gT 9 8 I T 0 '• " STT SOS " "• 889 " '" •' " MTOOin T iapu : l •1 \a *K *1 'SL *K *X '£ -W "X M *K *X *W *X ! *X 'IV *X -J *K *X *W Woj, n?H l nmqq8y > tm.ajoa -aosiOM -BJippioH ufpatma -pn«H»ny -900851893 jo

SSS 1ST *61 3 I I SIT 88 18 9t 83 II LI SI 8 L Z2 S3 63 19 LZ fS 38 S3 60 " " spajoi egg •• •• g 6 I " ' I I 0 TOT" •' no +n0sqe ainpu poi([ G9 eg Of I 0 I I 0 I SI 9 L 8 0 8 9 t Z 91 L 6 i 31 2 L SI 8 01 " " " " g T isaq o[ 8 /, ■■ •• SIS 110 •• 6 S S * f 3 3 5 3 0 •• " fit " SI " Zl L 2 ' • I I 0 I 0 I T I 0 • • 8 3 16 3 8 I I 0 • • • • ■ • " 51 " 01 " SI 9 6 " " SSO SSO 8 I S I 0 I f I £ 808 " " " " 01 " L " si e i •" " ioi sii " ssi \ f z z sos • • • • • • " i " e " ?S LI LI " " 61 01 6 SII 8 S I 2 Z S SIS SII '' '' "" " 6 " S " ZZ 9 LI •" " L f 8 IOI IOI I 0 I I S I I II I 01 " " " " 8 " S " If 81 8S " " 01 f9 L 8 f '• f Z Z Lf8 SI S 8 " '• " sjuajf z " I " II S 8 " " SOS IOI I I 0 SII Sir •• SI " 6 g[ o SI " " SOS SOS '• I 0 I ! 3 0 3 909 " "6 "9" SS 6 tl " " 8 f f SII " ' SIS SIS L 3 2 "" "" " " 9 " 8 " SS SI OS " " SSS SOS 10ISSS 886 if S ■■ •• snpnom S <n T tnoi^ fS SI SI II 10 f I 8 I I 0 " SSI 9 f Z 689 " •' '' '• qjuooi i lapnrt *1 *»i "IVT "X "ill 'K "X "ii "K -X °»i£ 'K "X '<1 K X ii K X K X K *X "J "IV 'TOOI •mn'BJioi j -Btiraoa; -nosiaN «TOPt°H j i™°nnn ■tpmqojsjJiio aDnapissa jo q(Su9q Il»H j J . f *-L

H.—7

16

Table XII. —Principal Assigned Causes of Death.

Causes. •ti s 4 Sao I I x ri 2 T. ■3 § 5 O H a a) & I £3 3 o H I. Gbnbeal Diseases. Tuberculosis--General Of lungs Acute miliary Chronic rheumatism Diabetes Typhoid fever Carcinoma Iniluenza Graves' disease Addison's disease Anaemia (pernicious) Septicemia Sapremia Toxajmia M. F. 2 4 1 0 l" 0 M. If. 2 4 1 2 I 0 1 0 M. V. 2 0 0 1 1 0 1 2 M. F. 0 1 1 1 M. l<\ 1 0 2" 0 M. I''. 3 5 3 0 31. 1'. M. F. M. 7 2 2 0 1 2 0 •> I 0 0 2 0 0 F. 9 4 0 1 0 0 1 1 0 I 0 1 1 0 1 0 0 1 0 1 II. Diseases of the Nervous System. Melancholia, exhaustion from . . Mania, exhaustion from Acute delirium, exhaustion from Confusional insanity, exhaustion from General paralysis of insane Dementia (alcoholic) Organic brain-disease Epilepsy Apoplexy Cerebro-spinal meningilis Cerebral haemorrhage Sclerosis Bulbar paralysis Tabes 1 0 0 0 1 0 10 0 2 1 1 2 I I 0 1 0 1 0 1 1 0 1 0 1" 0 0 3 0 1 0 1 0 1 2 0 0 1 8 0 1 3 3 2 1 0 0 2 21 1 1 0 12 7 10 10 1 2 1 0 3 4 0 1 0 1 1 0 2 0 5 2 0 1 0 1 2 2 I 0 1 1 12 1" 0 1 0 0 1 1 1 0 1 0 I I 0 1 0 I 0 Marasmus III. Diseases of the Respibatory System. Pneumonia (lobar) Bronchitis I I 1 1 1 3 3 2 3 5 0 5 1 I 2 (I 2 4 IV. Diseases of the Circulatory System. Heart-disease Valvular disease of the heart Myocarditis Aneurism Arterio-sclerosis 3 0 3 0 0 I 0 3 0 2 1 1 3 1 I 0 0 I 2 4 1 0 10 5 0 1 1 9 2 1 0 0 I 0 1 0 V. Diseases of the Digestive System. Ulcer of stomach Enteritis Colitis Malnutrition due to internal obstruction I 0 1 1 l" 0 1 1 1 0 0 1 0 1 0 I Gangrene ol stomach Peritonitis Volvulus Exhaustion following sprue 0 1 0 1 0 0 0 1 1 i 1 0 0 1 1 0 VI. Diseases of the Genitourinary System. Bright's disease Pyelonephritis Ursemia Rupture of bladder 1 0 6 i 3 0 1 1 5 1 0 1 1 0 1 0 1 0 1 0 VII. Diseases of the Skin. Gangrene 1 0 1 0 VIII. Old Age. Senile decay 21 0 8 4 13 12 2 4 5 2 16 11 86 39 IX. Ill defined. I 0 0 I 1 I X. Died while on Trial. 1 0 0 2 1 2 2 4 Totals 59 23 34 27 29 23 7 8 17 11 40 37 1 1 1 1 194 131

H.-7,

17

Table XIII. —Principal Assigned Causes of Insanity.

3—H. 7.

Causes. Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall (P.M.H.). Totals. Heredity Congenital Previous attack Puberty or adolescence Climacteric Menstrual Senility Lactation Puerperal Mental stress — Sudden Prolonged Solitude Alcohol Syphilis Drug habit Post-operative Traumatic Epilepsy Arterio-sclerosis Debility Lobar pneumonia Phthisis 111 health Influenza Neurasthenia Meningitis Cerebral haemorrhage .. Organic brain-disease .. Anaemia (pernicious) .. Overwork Emotional excitement.. Thyroid insufficiency .. Unknown Transfers M. F. 20 15 28 8 5 23 0 1 0 8 M. F. 7 9 5 0 8 12 M. F. 10 9 10 5 16 21 6 3 0 7 M. F. 1 0 M. F. I 4 12 3 M. F. 14 15 9 10 13 17 4 5 M. F. 1 0 3 1 I II I 0 M. F. M. F. 53 52 68 33 43 73 15 II 0 28 0 5 03 29 0 2 0 17 o' 1 4 1 0 I 0 1 0 11 0 5 20 9 0 2 0 4 14 8 9" 5 11 5 1 I 5 0 2 1 1 0 0 4 0 6 0 2 0 1 8 8 1 1 1 0 7 2 3 0 1 2 1 0 5 (i I 0 5 0 5 1 1 0 0 1 1 0 5 4 0 1 6 0 7" 1 3 1 5 ' 5 0 1 6 0 0 1 4 2 I 0 I 0 17 0 6 2 17 0 I 0 4 0 5 1 0 1 1 0 7 8 0 3 1 II I 0 1 0 1 0 1 0 25 15 17 8 2 0 34 (i 26 1 1 1 1 2 2 0 19 21 0 1 0 1 0 I 1 0 II 21 3 4 0 I. 0 1 2 1 4 3 0 1 2 4 1 1 0 1 43 21 41 24 2 1 2 0 1 7 1 5 0 1 0 1 1 2 0 1 0 1 2 1 1 0 1 1 1 2 I 0 1 4 0 1 1 ' 0 0 1 1 0 0 1 0 1 3 I 17 3 I 2 8 6 2 3 5 3 2 2 2" 1 1 1 28 12 11 8 4 2 0 1 Totals 117 92 60 76 83 68 12 7 57 28 134 104 14 9 6 6 483 390

H.—7.

Table XIV.—Former Occupations of Patients.

18

Occupations. a IS o . ■ < B ~ - 0 9 3 a S ° o a) a 9 Si « a s ,- CO Occupations. T3 a a 3 « a 4 n .0 a co 'E 3 5 3 a ; 3 ID E s 0 tij P, Cu ■3 H a D co 3 u 0 3 5 a o 0 H o W a o in A e8 I! 0 rr 3 a o H ■ 15 Accountants .. .. ■ i Apprentice Architect Artist Attendant Baker .. . . 1 BasketmaketBlacksmiths .. .. 5 Bookbinders Bootmakers Bricklayer Bushmen Business-managers Butchers . . . . 1 Caretaker Carpenters . . . . 1 Carters Civil servants.. Clergy men Clerks .. .. .': Commercial traveller Contractors .. . . J Cooks .. .. 1 Cooper . . .. 1 Dentist Drapers .. .. 1 Drover Engineers .. .. '.. Factory hand . . 1 Factory-manager .. 1 Farmers .. 12 Farm hands Fireman .. ... Fisherman Flax-millers Gardeners .. .. 1 Gum-diggers .. . . i llotclkeeper Inmates of special schools Ironmonger Jewellers Labourers .. .. 31 Machinist; Manufacturer.. Ma ,10s. 4 1 3 I ll 3 7 J 2 1 I 3 8 2 1 1 4 1 1 4 3 I 1 1 2 4 2 5 2 2 I 1 1 1 3 3 2 1 1 1 1 49 41 ■ 1 1 2 i '4 3 1 1 1 i 1 i 5 2 2 2 1 i .. i .. i .. i .. 3 .. 2 .. 1 .. 1 .. 2 .. 4 .. 1 .. 1 .. 3 '.'. 5 I 1 .. 1 .. 2 .. 1 1 1 1 1 1 0 2 2 1 2 2 0 1 10 4 3 " 2 10 1 2 4 1 1 4 1 7 1 1 53 8 1 1 2 4 2 1 9 1 2 136 1 1 3 1 Maoris Master mariner Mechanicians Medical practitioner Merchants Miners Missionary Musicians News-runner Nurseryman Painters Pensioners Photographers Physical instructor Piano-tuner Plasterers Platelayer Polisher Porters Prisoners Rabbiter Railway employee Saddler Salesmen SawmiUers School-teachers Seamen Settlers Shearers Shipping agent Soldier Stock-dealer Stonemason Storekeepers Students Tailors Tennis-racquet stringerTrimmer Weaver-Wool-buyer Nil .. Transfers 4 1 1 i 1 i 3 1 3 .. 1 .. 1 i 1 1 5 3 2 2 i 2 3 1 1 1 1 i i 1 1 4 1 '2 1 i 1 2 1 ••I i 1 i i i i 1 1 .. i 2 3 .. 2 1 3 1 1 13 i i i i 2 .'. i 13 7 4 4 . .1 13 2 4 .. '2| i .. ] i i 1 3 i .. i i 2 i 2 2 1 1 i 9 ii.. 44 1 7 1 .. 1 .. ii i 1 .. 1 .. 7 7 2 2 13 28 io 4 .1 37 il 12; 36 3 3 1 3' Totals . . llI7 00' 83 12 57 134 14 1 483 1 0 Apprentice Clerks Dealer .. .. 1 Domestic duties .. Ii Faotory employees Inmate of special school Machinists .. .. ] Maoris .. .. S Milliner Music-teacher.. Nurses .. .. 1 1 .. 1 I Fem. lLES. i 7S 52 2 53 4 i2 84 5 1 5 •• 4 1 2 1 292 2 1 3 2 1 1 5 Pensioners School-teachers Shop assistants Students Tniloress Typiste Waitress Nil .. Transfers 1 1 1 i l 1 1 1 i 1 2 < 1 1 2 6 3 3 1 1 1 38 24 i 2 i i I .. i 3 2 is 3 7 2 2 12 ii 2 1 i i 1 1 i i i 1 2 .. Totals 92 76 68 7 28 104 9 6 390

H.—7

19

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.

Discharged. Died. Remaining, 31st December in each Year. 'Average Numbers resident. Percentage of Recoveries on Admissions. Percentage of Deaths on Average Numbers resident. Year. Admitted. Recovered. Believed. Not Improved. 1875 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 18S6 1887 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 M. F. 221 117 250 112 247 131 248 151 229 j 149 232 127 267 ! 152 255 ' 166 238 153 246 133 207 165 255 161 215 146 230 i 161 230 160 234 ! 171 231 158 281 179 270 176 252 165 278 159 284 193 254 , 212 259 199 300 202 320 1 223 352 192 355 226 332 236 360 251 395 264 359 241 426 318 419 297 474 314 448 317 458 381 466 318 509 359 450 361 518 : 361 470 374 437 402 512 371 455 418 ... 479 402 453 i 386 442 306 T. 338 362 378 399 378 359 419 421 391 379 372 416 361 391 390 405 389 460 446 417 437 477 466 458 502 543 544 581 568 611 659 600 744 716 788 765 839 784 868 811 879 844 839 883 873 881 839 808 M. F. T. 129 79 208 t 123 57 180 121 68 i 189 112 76 188 100 67 167 93 65 j 158 95 j 59 I 154 102 ! 78 1 180 89 77 166 95 76 171 99 60 159 103 78 181 116 92 208 93 53 146 98 88 1 186 88 74 162 89 76 165 101 89 190 107 76 183 105 77 182 104 70 174 102 73 175 114 110 224 88 99 187 103 96 199 125 104 229 135 | 99 : 234 144 I 101 245 157 l : 106 283 149 121 270 157 126 283 160 139 299 180 146 326 179 170 349 182 145 327 163 168 331 184 141 325 ! 175 162 337 207 162 369 202 157 359 160 : 171 331 171 I 152 323 142 j 141 283 190 147 337 162 148 310 178 193 371 156 157 313 168 151 319 1,395 5,220 11,615 i 1, M. 17 20 14 15 36 41 49 13 17 10 11 34 31 31 23 33 21 17 15 24 25 17 13 15 29 20 26 26 24 29 28 22 9 17 29 2'3 17 35 27 20 35 32 17 37 27 30 32 42 1,181 : F. T. M. F. T. M. | F. T. M. F. T. 482 254 736 8 j 25 2 8 10 36 12 48 519, 264 783 5 25 3 2:5 42 21 63 5811 291 872 14 28 4 4 8 51 17 68 638 319 957 13 28 9 4 13 55 16 71 695J 361 1,056 25 61 5 , 2 7 ; 54 20 74 729; 396 1,125 36 77 9 ! 2 I 11 49 14 63 769! 406 1,175 32 81 5 ! 6 ! 11 60 19 79 827 1 442 1,269 20 33 I 10 9 i 19 65 18 83 892- 483 1,375 9 26 1 18 12 30 68 j 24 92 938 514: 1,452 5 15 25 2 27 73 ; 22 95 981 542 1,523 17 28 12 7 19 57 19 76 1,009 604 1,613 17 51 .... .. 74 27 101 1,053 643 1,696! 28 59 2 3 5 78 26 104 1,041 1,681: 30 61 3 1 4 70 30 100 1,074' 687 l,76ll 17 40 12 5 17 76 35 111 1,095 702! 1,797 24 57 14 .. 14 79 41 120 1,115 734 1,849 17 38 8 2 10 74 34 108 1,154 763 1,917 12 29 10 8 18 78 23 101 1,229 810 2.0391 11 26 5 4 | 9 64 35 99 1,308! 860 2,168; 19 43 1 2:3 101 42 143 i 885 2,214, 16 41 2 1:3 86 32 118 1,390 925 2,315 12 29 10 .. 10 105 43 148 1,440 990 2,430 23 36 7 1 8 88 60 148 1,472 1,008 2,480 19 34 2 1 3 114 43 157 1,512 1,045 2,557 10 39 4 4 99 46 145 1,581 1.091 2,672 17 37 .. 2 2 j 102 72 174 1,654 1,119! 2,773 15 41 10 9 19 120 55 175 1,715 1,133 2,848| 24 50 2 2 129 44 173 1,771: 1,188 2,959 11 I 35 1 1 j 120 70 190 1,801: 1,237! 3,038! 24 I 53 j 147 67 214 1,836 1,276| 3,112 22 i 50 .. 1 1 146 ; 85 231 1,900 1,306! 3,206 13 35 168 : 64 232 1,909 1,331 3,240 12 21 1 .. 1 148 74 222 1,997 1,417 3,414 11 28 1 1 136 68 204 2,083 l,465i 3,548 27 56 186 97 283 2,160 1,510' 3,670 16 39 4 2 6 198 105 303 2,220 1,536 3,756 44 61 11 5 16 193 87 280 2,273 1,640 3,913 48 83 1 5 6 196 111 307 2,332 ! 1,632 3,964 29 56 6 ; 9 1 15 193 ; 88 281 2,4081 1,7031 4,111 32 58 10 11: 21 172 j 112 284 2,448 1,7521 4,200 34 : 69 7 I 8 1 15 209 80 289 2,555: 1,8201 4,375 20 ! 52 6 5 i 11 205 113 318 2,611 1,904 ! 4,515 36 53 12 12 j 24 274 174 448 2,603' 1,943 4,546 44 81 9 : 13 : 22 212 130 342 ! 2,667| 1,980| 4,647 37 64 6 10 16 210 166 376 j 2,717 2,037 4,754 21 51 15 9 24 201 117 318 2,772 2,099 4,87l! 20 52 10 8 18 211 184 395 2,8161 2,116 4,932! 38 80 15 5 20 194 131 325 2,839| 2,157 4 990 1,034 2,215 303 206 509 15,866 3,013 8,879 M. F. T. M. F. T. M. F. T. 491 257 748 54-53 66-01 57-56 8-21 3"58 ! 6-70 541 277 818 49-20 50-80 49-72! 776 7'58 ' 7-70 601 303 904 48-98 51-90 50'00! 8-48 5"61 ! 7-52 666 337 1,003! 4516 50-33 4711 8-25 4-74 7-07 703 371 1,074' 43-66: 44-96 44-17 7-68 539 6-89 747 388 1,135 40-08' 51-10 44-01! 6-29 : 3"60 5-55 796, 421 1,217. 35-58! 38-81 36-75 7'53 ' 4-51 6'49 860; 475 1,335 40"00 46'98 42-75 7'55 3"78 621 911! 497 1,408: 3739 1 5032 42-45 7-46 4-82 6-53 965 528 1,493 38-62 57-14 45-12 7-56 4-16 6'36 984 559 1,543 47-82 36'36 4274 5-79 3-39 4'91 1,034 613; 1,647 40'39 48-75 43-61 7-15 | 4-40 613 1,045 6411 1,686 5395 6301 57-62 7'56 ' 4-05 6-16 1,046: 660 1,707 40-43 32-92 37-34 6'69 1 4-54 5-86 l,078j 685! 1,763: 42-61 5500 47-69: 7-05 5-11 6-29 1,089 699: 1,789! 37-61 43-27 40-00 7-25 5-86 6-71 1,125 714 1,839! 38-53 48-10 42-42 6-58 4-76 5-87 1,172 758 1,930 3594 4972 41-30! 6-66 3'03 5-23 1,241 812 2,053 39-63 43-13 41-03 5-16 4-31 4-82 1,313 849 2,162 41-67 46-66 4364 7'69 4-94 6'61 1,347 882 2,229: 37-41: 44-02 39-13 638 363 5-29 1,411 944 2,355 35'92! 37'82: 36-69: 7-44 4-55 6-28 1,438 973 2,411 44-88 51-89' 48-07 6-12 617 6-14 1,487 1,004 2,491 33-98 49'49 40-83 7'07 4-28 6-30 1,534 1,049, 2,583 34-33 47-54 39-64 6-45 4-38 5-61 1,622 1,0941 2,716! 39'06 46'64 4217 6-29 6-58 6'4l l,67ll 1,114 2,785J 38-35 5156 4301 7T8 494 6-28 1,7411 1,160] 2,901: 40-56 44-69 4217 7-41 3-79 5-96 1,780 1,198 2,978 47'59 44-91, 46-30 6-74 1 5-84 \ 6-38 1,796 1,232 3,028 41-39' 48-21 44-19 8-18 I 5-44 I 7-07 1,823 1,265 3,088 39'75 j 47-73! 42-94 8"01 1 6-71 7-48 1,851 1,285 3,136 44-29 ! 57"68 49'84 9'08 4-98 ! 7-39 1,89* 1,346 3,240 42-25 45-91 43'82 - 7-81 5-50! 6-85 1,970 1,404 3,374; 42-72! 57-24 48-74 6'90 '4-84 6-00 2,028! 1,445 3,473| 38-40 j 46-18 4150 9-17 , 6-71 8-15 2,105. 1,490 3,601 36-38 53-00 43-27 9-41 7-02 8-41 2,146 1,551 3,697 40-17 37-01 3874 8-99 5-61 7'57 2,252 1,597 3,849 37-55 50-94 42-98 870 6-96 7-98 2,309 1,641 3,950,40-67,45-12 42-51 j 8-36 5-36 7-11 2,391 1,703 4,094j 44-89 1 43-21 44-88 7-19 ,6-58 6-94 2,483 1,768 4,251 30'89' 47-37 3766' 8-42 4-52 ' 6-80 2,543 1,825 4,368j 36-38 40'64i 38-27 8-06 6-19 7'28 2,602 1,899 4,501 32-49 35-07 3373 10-53 9-16 9'95 2,620 1,907 4,527 37-11 39-62, 38-17 8-09 6'82 7'55 2,674 1,980 4,654 35-63 35-32 35-51 7-85 8-40 8-08 2,723 2,031 4,754 37-23 47-88 4211 7"38 5-76 6-69 2,747 2,062 4,809 34-44 40-67 3731 ; 7-67 ! 8-92 8-21 2,789 2,079 4,808 38-00 41-25 39-48! 6-95 | 6.30 6.67 16,102 11,370 27,478 6,395! 5,220 11,615 I 1,181 8,879 j I I | I Excluding transfers between institutions —1,495 males, 1,011 females.

H.-7

20

Table XVI. —Showing the Admissions, Discharges, and Deaths from Ist January, 1876, to 31st December, 1923 (excluding Transfers). M. F. T. In hospitals 31st December, 1875 .. .. .. .. 482 254 730 Admissions .. .. .. .. .. .. .. 10,102 11,370 27,478 10,584 11,030 28,214 Discharged—- m. k. t. Recovered.. .. .. 0,395 5,220 11,015 Relieved .. .. .. 1,181 1,034 2,215 Not improved .. .. 303 200 509 Died .. .. .. 5,800 3,013 8,879 13,745 9,473 23,218 Remaining on 31st December, 1923 .. .. .. 2,839 2,157 4.990

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

Males. Females. Both Sexes. Recovered 39-71 45-88 42-20 Relieved 7-34 9-08 8-06 Not improved 1-87 1-81 1-85 Died .. 36-43 26-48 32-31 Remaining 15-65 16-75 15-52 100-00 10000 100-00

21

H.—7

Table XVIII.— Expenditure for Year ended 31st March, 1924.

Auckland. Ob***™*Hokitika. Nelson. Porirua. Tokanui. Head Office. Totals. I ! Salaries Official Visitors Advertising, photographs, books, &e. Bacteriological research Bedding and clothing Buildings, including additions, &e. Dental Services Developmental work, &c. Farms, maintenance of Fencing, draining, and roading Freight, cartage, and transport Fuel, light, power, and water Funerals, expenses of Furniture and fittings Gardens and shrubberies, expenses of Law-costs Laundry Machinery, repairs and stores Medical fees for certificates, &c. Motor-cars (2), purchase of .. Motor-vehicles, maintenance of Nursing staff — Engagement of .. Uniforms, purchase of Office equipment Patients, expenses connected with — Gratuities " Patients' Friends " Recreation Transfer Payment of life-insurance premium (patient) .. Postage, telegrams, &c. Printing and stationeryRations Rents and rates Stores Surgery and dispensary — Drugs and instruments Wines, spirits, ale, and porter Telephone services, &e. Transfer and removal expenses Travelling allowances and expenses Treatment and maintenance in general hospitals — Patients Staff .. Contingencies, including unforseen, &c. £ s. d. £ s. d. 24,816 2 3 31,244 3 11 50 8 0 23 0 0 23 7 5 £ s. d. £ s. d. 45,707 15 10 ' 12,422 1 2 52 10 0 8 8 0 29 19 0 5 5 0 6 0 0 0 12 6 7,932 6 3 1.587 15 4 2,838 2 8 251 0 6 18 13 0 52 7 6 £ s. d. 12,422 17 1 4 4 4 £ s. d. £ s. d. 37,159 9 2 11.709 10 1 29 14 6 0 0 6 £ s. d. £ s. d. 4,424 9 6 179,906 9 0 2 2 0 113 8 0 10 7 7 131 18 4 6 12 6 32,330 7 7 6,521 9 0 197 2 0 1,206 15 6 15.068 16 10 680 7 1 916 14 7 23,626 8 7 409 3 6 901 19 3 174 14 5 4 4 0 4,671 3 7 1,549 8 4 1.937 8 0 300 1 11 523 8 0 7,067 6 3 4,424 4 7 617 7 7 709 4 5 6 8 0 105 10 0 1,975 4 2 356 2 3 0 10 6 8,031 10 7 1,312 0 5 1,436 18 8 312 13 5 13 3 0 0 10 0 1,206 15 6 2,126 0 4 3,777 13 6 225 13 6 8 6 11 248 16 0 2 3 2 4,623 4 10 1.366 3 5 69 10 0 20 9 6 159 3 4 44 7 8 17 13 2 9 9 6 799 11 3 2,461 19 3 11 15 2 85 o 6 1 1 11 86 10 0 4.603 4 4 5,028 18 7 105 14 0 113 0 0 95 0 4 72 3 5 3 1 11 108 14 6 3,811 8 5 625 2 10 280 16 6 19 7 9 270 15 1 140 2 4 5,504 13 8 | 640 12 9 20 0 0 8 5 0 371 3 6 76 1 8 18 7 2 4 4 0! 1.893 14 6 938 14 11 432 19 23 1 11 368 10 66 13 6 1,467 1 3 49 1 9 167 6 1 1,259 11 0 72 5 0 83 19 4 17 8 2 504 18 5 612 10 0 146 8 9 433 3 2 494 16 0 349 3 0 222 8 8 38 14 10 79 16 0 147 6 0 92 3 6 405 17 6 92 19 7 333 0 2 142 17 9 535 17 6 43 1 0 152 15 11 183 5 0 0 8 0 '.'. 19 12 6 143 7 6 84 11 6 0 10 0 i 0 5 0 401 2 2 571 1 11 9 10! 3 13 6 967 13 4 171 6 0 7 3 7 0 11 2 3 IS 4 171 12 10 0 17 6 10 0 0 637 3 5 152 10 2 0 10 0 2 3 0 „ - . 20 13 4 3,072 9 10 23 4 7 47 4 10 108 14 2 24 19 6 100 0 0 1,252 5 0 1,198 1 1 70 13 10 55 4 0 494 14 11 12 0 3 100 0 0 1,721 17 11 446 17 10 86 4 S 17 17 5 85 13 6 150 110 10 3 3 898 16 7 200 0 0 6.809 18 2 297 0 0 14 0 0 150 18 10 581 16 9 79 4 6 707 4 4 72,922 19 11 2.159 11 11 4,508 1 8 530 6 1 13 17 3 1.195 12 8 464 17 7 53 2 10 14 0 0 81 10 10 28 1 9 120 1 5 46 1 4 14,932 14 5 2.027 15 2 162 11 5 859 10 8 192 0 3 00 8 7 75 4 7 98 7 8 127 7 *3 13,985 7 8 13.925 19 4 1,630 7 9 748 4 11 1,041 10 2 124 6 5 35 6 10 144 13 2 37 8 3 19,650 14 11 4,206 9 1 366 12 9 995 18 6 311 7 8 25 18 11 54 0 9 4,193 19 4 359 9 6 345 16 9 520 2 4 12 13 6 7 8 3 31 14 10 19 12 2 6 11 0 3 3 9 97 7 5 88 15 11 808 13 10 109 11 5 6 13 3 6 13 0 61 16 9 8 0 3 2 16 5 20 17 9 217 3 10 54 9 10 186 15 5 1 7 6 30 14 9 7 5 6 43 10 5 800 0 9 158 0 8 61 15 5 8 9 3 208 9 11 16 19 2 2,929 1 2 105 0 2 27 18 2 405 6 0 40 14 5 372 3 2 1,105 19 10 74 12 2 157 11 1 1 19 0 17 7 0 0 5 0 56,575 7 8 65,889,12 9 19,818 3 1 23,919 8 4 22 17 6 22 1 0 65 17 0 49 14 0 12 7 6 110 33 9 0 75,020 2 2 23.478 18 6 26,724 16 0 6,266 17 8 59 5 0 133 19 0 0 10 6 34 4 6 Total expenditure Credits 95,484 1 7 22,476 18 11 26,999 11 5 3.329 13 1 24,215 7 0 7,308 17 11 5.090 18 10 368,231 7 11 1 17 10 114,369 5 4 5,089 1 0 253.862 2 7 Net expenditure 36.757 4 7 41,970 4 5 16,906 9 7 48,295 6 2 17,212 0 10 68.484 10 2 19,147 5 10 I 1

H.—7

Table XIXa.

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

Table XVIIIa— Showing Details of Credits.

22

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H.—7.

Table XXI.—Total Expenditure, out of Public Works Fund, for Buildings and Equipment at each Mental Hospital from 1st July, 1877, to 31st March, 1924.

Table XX.—Expenditure, out of Public Works Fund, on Mental Hospital Buildings, etc., during the Financial Year ended 31st March, 1924, and Liabilities at that Date.

By Authority : W. A. G. Skinner, Government Printer, Wellington.— 1924.

Approximate Cost of Paper. — Preparation, not given ; printing 575 copies), £36 10s.

Price 9d.]

23

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