MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1926.

Appendix to the Journals of the House of Representatives, 1927 Session I, H-07

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1927. NEW ZEALAND.

MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1926.

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

The Hon. the Minister in Charge of Department for the Care of Mental Defectives to His Excellency the Governor-General. Sir,— Wellington, 31st July, 1927. I have the honour to submit to Your Excellency the report for the year 1926 of the InspectorGeneral of Mental Defectives. I have, &c., J. A. Young, Minister in Charge of Department for the Care of Mental Defectives.

The Inspector-General to the Hon. J. A. Young, the Minister in Charge of the Department for the care of Mental Defectives. Sir, — Wellington, 30th June, 1927. I have the honour to submit my report for the year ended 31st December, 1926. The number of patients under care in the Mental Hospitals during the year was 6,204 ; and there were 5,467 on the register at the end of the year, being an increase of 336, made up of 171 males and 165 females. The death-rate for 1926 has been about the average—viz., 324 out of a total of 6,006 patients, or 5-2 per cent. The official figures for the year show a " recovery-rate " of 30 per cent, on the admissions ; but no such figures can ever afford more than very rough approximations : they cannot be relied on as a definite basis either for statistical comparison with other countries, or even with the records of, say, the last half-century in New Zealand itself. So-called " recovery " from insanity is a relative term, and in equally good institutions the " recoveries " may be set down as 25 per cent, or 40 per cent., or more, on the admissions, according to the point of view of those reporting or compiling the figures. Thus, an optimist could estimate the present recovery-rate as say 40 per cent, if he were to incline to the view that the 42 per cent, discharged under the joint heading of " recovered and improved " could justifiably be classified, with few exceptions, as " recoveries." It is tempting to be optimistic, and to hope that an improvement which has enabled a patient to be discharged may prove progressive and permanent; but long experience shows that hitherto only from 25 to 30 per cent, of the general average of people who have been declared insane remain permanently outside or die outside a mental hospital. A further deduction from true and permanent recoveries might be made for those who manage to continue outside among their friends, but only in a state of permanently enfeebled mentality. However, it would be too exacting not to credit our mental hospitals with what would ordinarily be set down as " recovery." It may be assumed that the 30 per cent, of recoveries recorded during the year for the Dominion is fairly satisfactory, and truly represents at least as high a standard of success as obtains in other comparable English-speaking countries. This does not mean that more need not and cannot be done for the insane in New Zealand, especially in the way of prevention, and of improved early care and treatment of incipient insanity ; but it will be some years before the full effect of the recent improvements, which have been asked for and undertaken, can be brought to full fruition. All such changes and reforms demand time. The widespread popular prejudice against resorting to institutions for the care and treatment of persons suffering from mental breakdown, until they have become positively dangerous or unmanageable, cannot be overcome, in New Zealand or anywhere else, until the public has been brought to realize that early competent treatment in special institutions is more imperatively necessary in the case of incipient mental disease than in any other form of illness.

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Weekly Conjoint Out-patient Clinics for Nervous Cases at the General Hospitals. Nothing but good has come of the weekly " Out-patient Clinics for Nervous Affections " which we commenced some two years ago at and in conjunction with the main General Hospitals. As might have been expected, the benefit has proved to be proportionate to the encouragement and support given to this work by the respective Hospital Authorities at the four centres. The Mental Hospitals Department greatly appreciates the frank and friendly spirit of professional co-operation in which their representatives attending the clinics have been received and welcomed at the General Hospitals. The following letters need no explanation : — Auckland General Hospital, 26th May, 1027. The Director-General of Mental Hospitals, Wellington. Dear Sir, — A Psychiatric Clinic has been in operation for some time at the Auckland Hospital, and is proving of considerable service to the community. Tn my last annual report I drew the attention of my Board to the good work that is being done. It is now a matter of general knowledge that such a clinic is being held; and the service is taken advantage of not only by members of the medical profession, but by people who come of their own accord. Parents with mentally defective children are particularly anxious to obtain advice at this clinic. Tn dealing with returned soldiers afflcted with various forms of psychic disorder the clinic is extremely useful, and is a means of keeping in touch with these sad cases, who require specially skilled and sympathetic direction. As regards the Hospital, we find the advice of Dr. Prins (Medical Superintendent, Auckland Mental Hospital) a great help in the elucidation of some of the knotty problems associated with patients who may be mentally abnormal. Dr. Prins is, by his tact and sound judgment, doing us a great service, and there is no doubt that the Psychiatric Clinic is a potent factor for good. Yours faithfully, C. E. Maocttre, Medical Superintendent. Waikato Hospital Board, Box 14, Hamilton, 20th May, 1927. The Inspector-General, Mental Defectives, Wellington. Dear Sir,— I am instructed to ask if your Department will consent to Dr. Macpherson, the Medical Superintendent of the Mental Hospital, Tokanui, consulting, when required, with the Board's Medical Superintendent on border-line cases, &c., at the Waikato Hospital. Such an arrangement would be very much appreciated by Dr. Gower and his staff, and would materially strengthen their hands in dealing with doubtful mental cases. The Board, of course, will undertake to pay the necessary travelling-expenses incurred. Yours faithfully, G. W. Johnson, Secretary. Provision for Temporary Lodgment of Alleged Mental Patients in Special Quarters in General Hospitals, pending Examination and Decision. It is to be regretted that, so far, nothing adequate has resulted from the efforts of the Department to ensure suitable provision in the General Hospitals for the temporary lodgment and accommodation of persons alleged to be insane, pending examination by the appointed judicial and medical authorities. This beneficient provision, it is earnestly hoped, will be made during the current year, along with radical improvement in the whole arrangements for dealing with patients prior to their admission to our mental hospitals, so as to prevent completely the unfortunate impression and suggestion of delinquency or criminality. It is, of course, obvious that persons suffering from mental impairment, or so-called " nervous breakdown," should be carefully screened from anything seeming to imply or suggest moral degeneracy or depravity. In the above matter we have been assured of the sympathy and hearty co-operation of the Commissioner of Police. It has long been the official instruction that police officers occupied in escorting mental patients do not wear uniforms, and the use of police vans has been exceptional. However, it is now arranged that even where a patient is refractory or difficult to manage, the Mental Hospitals Department will meet the cost of conveyance by taxi, thus completely doing away with the use of police vans. Degenerates and Sexual Offenders. As my colleague Dr. Theodore Gray (Deputy Inspector-General) has been earnestly engaged for nearly a year making investigations at Home and abroad into the practical problems which concern not only the care and treatment of the insane, but which bear also on the best practical means of dealing with people on the border-land between insanity and mere degeneracy or delinquency, I am glad to insert here the following short summary which he has kindly written in response to my request for an interim report: — Dr. Theodore Gray's Interim Summary Report. " During my recent tour of the United States, Canada, Great Britain, and the Continent of Europe my inquiries were directed towards two main fields—the Problem of the Feeble-minded, and the Care and Treatment of the Insane. " I am engaged in compiling a special report on these matters to the Hon. the Minister, but in the meantime I may briefly indicate some of the broad conclusions at which I have arrived. " (a) Throughout the world there is no known method of successfully treating or curing insane people which is not already being practised in our own mental hospitals. " I visited thirteen countries and almost one hundred institutions, and discussed this question with many leading alienists. I studied treatment in all its various phases and fashions, including hydro-therapy, so-called " occupational-therapy," and the use of electricity, ultra-violet rays,

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Roentgen rays, and. drugs. Concerning the use of drugs, I may say at once that nothing struck me more forcibly throughout the whole course of my investigations, both in the New and Old Worlds, than the excessive resort to sedative and hypnotic drugs for inducing rest and sleep, where we in New Zealand have been in the habit not of repressing but of rather giving fair play to normal activities, and thus aiding nature to restore the normal balance and re-establish health of body and mind. " I paid visits of inspection to every class of institution for the prevention of insanity, and for the care and treatment of the insane in all stages, including Behaviour Clinics, Psychopathic Hospitals and other such institutions ; and, while one recognizes that most methods have something to recommend them, I am more convinced than ever that in New Zealand our main resources for treatment are to be found in full facilities for ensuring the primary essentials— namely, fresh air, sunshine, hydro-therapy in its broadest sense, suitable diet, exercise, recreation, rest, and. sleep —everything, indeed, conducive to the establishment of active regular daily habits and the restoration of full enjoyment of the daytime—thus inclining the organism to the normal reaction of sound, refreshing sleep at night. " (b) It would be utterly futile and impracticable to adopt slavishly and blindly any of the various systems of dealing with mental disease followed in other countries. No two countries are alike in detail, and each has of necessity evolved, in this as in other matters, more or less in accordance with its own geographical, climatic, social, racial, and economic circumstances. " I have fully discussed with many of the leading alienists throughout the world the scheme outlined by yourself (as Inspector-General) in your reports for 1925 and 1926, and now being carried into effect, and they expressed general approval of the proposals as being on sound, progressive lines, and, in their opinion, admirably adapted to ensure the best results under our favourable New Zealand conditions. " (c) It is imperatively necessary that some provision be made in connection with our General Hospitals —particularly in the main centres —for the immediate reception, detention, and, when necessary, the certification of mental cases in the early stages. In many countries large so-called " Psychopathic Hospitals " have been established in order to meet this need —as well as to avoid the need of resorting to certification, when safely avoidable, and to afford teaching facilities for students. However, on the whole, my impression of these places was not favourable. They are extremely expensive to erect and to administer ; and in practically every instance their proper function, as hospitals designed to benefit the patients, appeared to me to have been almost lost sight of in the endeavour io facilitate the teaching of students. It was interesting to learn from the Directors of most of these Hospitals that they find themselves already faced with the question of ' stigma,' which by the very creation of these separate and specially named institutions (namely, ' Psychopathic Hospitals ') they had hoped to avoid. " I am satisfied that our requirements in this direction can be best met by the erection at the General Hospitals, in the main centres, of small detached blocks to accommodate, say, from six to twelve patients and staff. The smaller provision would certainly suffice in the meantime, and it would soon be seen what number of beds would be needed in each centre. " Admission to these quarters should be by provisional order or voluntary request, and the Magistrate could' visit, say, once or twice a week, or oftener, to certify when necessary. Personally, I should prefer, if practicable, to introduce the Canadian system —i.e., certification by doctors, and no judicial intervention ; but it is'doubtful if public opinion has yet reached the stage to enable this to be done in New Zealand. " (d) The ' Villa System 'of mental hospitals, with its large measure of freedom to patients (on parole), and the abolition of all yards and enclosed spaces, is gradually being recognized as likely to afford the greatest comfort to patients, and to promote their contentment and well-being by facilitating proper classification, &c. " A system of classification which has proved ideal in some respects is in vogue at Gheel in Belgium and at Lier in Norway. Here patients do not enter a mental hospital unless they become so acute as to be unmanageable. They reside in groups of twos and threes with families in the neighbourhood. I visited both Gheel and Lier and was greatly impressed with the obvious advantages both to the patients and the ratepayers; but the system is unsuited to our conditions here, and I feel that we must be content with the next best—viz., the ' Villa System.' " Comment on Dr. Grays Interim Report. It was fortunate indeed that Dr. Gray returned just in time to enable the above summary to be included in the present Annual Report. The mission with which he was sent out last August, by the Government, was to make a world-wide, practical investigation and research into what was being done elsewhere to cope with the growing manifestations of lack of control and breakdown (on mental, emotional, and moral planes) due to the increasing artificialities, stress, and complexities of modern ]jf e manifestations of weakness and failure which embrace consideration not only of everything appertaining to the prevention and practical care and treatment of neurasthenia and insanity in general, but also the still more difficult problems inquired into and reported on in 1924 by the New Zealand " Committee of Inquiry into Mental Defectives and Sexual Offenders." Dr. Gray's special qualifications for undertaking the highly responsible task with which he was entrusted when he set out were unquestionable, and this, of course, makes his present more matured opinions and conclusions peculiarly valuable. It would be out of place for me to. anticipate, in any way, what he may have to say in his full report, especially that portion of his report which will deal with the problem of sexual offenders, and procreation of degenerates.

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However, as the public is inclined to be impatient, and to demand instant action on the lines in dicated in the report of the Committee on Sexual Offenders, I think it only right to state (as a member of the Committee in question) that we all realized the extreme desirability of competent personal investigation (at Home, abroad, and in America), so as to find out on the spot what had been the history and the actual practical results of laws made and carried into effect (especially in some of the American States) in the case of sexual offenders and degenerates of either sex —from the authorizing of compulsory segregation to sterilization. In the voluminous reports and other documents and books obtained from America by the Committee it was shown that some of the more active and enterprising States which had confidently made drastic laws had been obliged to repeal them for various reasons. Most of the American authorities appeared to the Committee to have been losing their primary faith of late years in the advisability and practicability of extensively enforcing extreme measures — at least, until more knowledge on the subject was available. The most authoritative English opinion was found to be generally in the same direction ; but in New Zealand, on the other hand, popular opinion has rather inclined to the view that compulsory segregation and sterilization would prove a simple and beneficent panacea, and would practically wipe out in a few generations most forms of degeneracy, insanity, and criminality, the only steps necessary being the passing of a simple Act of Parliament, and the appointment, with full powers, of a special Court, presided over by a competent psychiatrist and a capable Judge ! The English tendency in all such matters has always been extremely cautious and conservative — probably too conservative —but it should be borne in mind that hasty legislation, authorizing compulsory mutilation or deprivation of liberty, without ample safeguards and clear warranty, would inevitably discredit and set back desirable and desired reforms, as has already occurred to some extent elsewhere. Granted sufficient time for a, competent Committee to be appointed to consider with Dr. Gray the local evidence which came before the previous Committee, together with the reports they received from outside ; and granted also ample time and opportunity to reconsider the whole situation with Dr. Gray, in the light of his direct personal knowledge of the subject, to which so much has been added during the last year—granted all these advantages, the New Zealand Government would, I am confident, be in a far better position to deal satisfactorily with these profoundly difficult and almost insoluble problems than any other country in the world. This would be the natural result of wisely delaying definite action until fully informed and soundly and authoritatively advised. I trust that this broad review of matters (with which you, as the Minister of the Department, are for the most part already quite familiar) will suffice to convey to your colleagues and to the whole community a fair idea of how Mental Hospital matters now stand ; and also to give them some idea regarding the future prospects of the service—as concern the patients and their friends on the one hand, and the Mental Hospital staffs on the other. As I shall presently be retiring from the Mental Hospital service of the Dominion, at the end of forty years from the time when I entered on my duties under the Department, I may say that it will be an unqualified satisfaction to myself that I shall hand over to a strong, straight, level-headed, and highly-qualified professional colleague in the prime of life, and one who, in spite of a full understanding of the complex problems and difficulties which lie ahead of him, is not daunted by them. Dr. Gray's four years' initial hospital training and experience at Home, supplemented by sixteen years of active, unremitting, and devoted work in New Zealand —and his recent investigations and experiences in America, at Home, and abroad—make him the ideal man to direct, administer, and control the Mental Hospital service of the Dominion. I trust that it may not be considered out of place for me to suggest, as a parting piece of advice, that, when appointed, Dr. Gray should be given the status and authority implied in the title Director-General —not merely Inspector-General, as heretofore. The extent and responsibility of the complex function of further evolving and completing the organization and successfully co-ordinating the work of a concern with a staff of between 1,150 and 1,200 persons, and about 5,500 patients, living in seven widely-separated main establishments (nine or ten in the near future, to say nothing of separate sub-branches) scattered over the face of a country nearly one thousand miles long,-needs for its efficient management, a competent unified scheme of authoritative direction, administration, and control, so as to ensure to the Government that the Mental Hospitals Department of the Dominion shall be run, not only on the best and most humane professional lines, but also that the mere business aspect of a Department which already involves directly and indirectly an annual expenditure equivalent to over half a million sterling (£500,000), to say nothing of estates, buildings, and equipment, having a present value approximating two and a half millions sterling (£2,500,000) shall not be lost sight of. In this connection I may point to the paramount practical importance of competent properly co-ordinated direction, supervision, and organization of farms and farming operations. Development along these, lines should enable each of the institutions to provide full and varied supplies of the best fruit, vegetables, cereals, &c., and thus meet our main special dietetic requirement (referred to in Miss d'Auvergne's report)—namely, to feed mental patients principally on relatively bulky, attractive, and satisfying fresh fruit and vegetables, demanding proper mastication—and thus reduce the proportion of over-stimulating and exciting foodstuffs rich in meat-proteins. Indeed, there is a special reason for lessening the proportion of meat in Mental Hospitals' dietaries, on account of the tendency of a high-protein to incite and inflame sexual manifestations and lessen the power of control in general. This is the fundamental ground for the common practice of giving no meat to epileptics, and either cutting it out, or greatly reducing the meat allowance in the case of all acutely maniacal or specially excitable patients.

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Sanatoria for the more Sensitive and Curable Patients. The special neuropathic hospitals for care and treatment of incipient recent and recoverable cases, as projected, have been completed and occupied at Porirua and Hornby, and similar institutions at Auckland and Seacliff are ready for occupation. Four of these homelike Sanatoria have been built and equipped. These are either situated in a separate district, some miles away from the main institution, and have no suggestion of association with it, either in name or locality, as is the case at Hornby (Canterbury) and Puketeraki (Otago) ; or, where this did not happen to be feasible, a similar sanatorium has been erected on the main Mental Hospital estate, but located as far as circumstances would permit from the parent institution. This is the case at Porirua, where an absolutely ideal site has been availed of, commanding the bay and the whole surrounding country, yet remote from the Mental Hospital and not within even a distant view of it. At Auckland it was impossible to locate the sanatorium far from the main buildings, but it is placed on the opposite side of the road. A quickly growing effective shelter-belt (purposely planted the previous year, and already about 6 ft. high) will entirely screen off the new buildings in the course of the next six months ; and the undulating, well-laid-out and well-planted garden-grounds will soon be very attractive. As this sanatorium stands on relatively high ground, commanding an extensive view across five or six miles of picturesque, open country, backed by Mount Eden and the heights of the city, it supplies all that can be desired in the way of a temporary residence for the more sensitive and curable women patients. Systematic adjustment and improvement of Diet to meet varying requirements in the different Mental Hospitals. Under the above heading, in my first Annual Keport (made nearly two years ago) occurs the following passage : — " As great advances have been made of late in the science, practice, and economics of dietetics (especially as applied to feeding during infancy and early childhood, and the catering for armies and persons boarded in schools, sanatoria, hospitals, &c.), it is gradually coming to be recognized that trained experts will have to be appointed in order to supervise and direct the feeding of all hospital patients, whether the evidences of ill health manifest themselves mainly on the bodily or on the mental side. In either case —digestion and nutrition being always more or less impaired — suitable adjustment of food and feeding-habits must be provided for. With this in view a professional dietitian (Miss d'Auvergne) has been appointed by the Mental Hospitals Department to organize, supervise, and direct the feeding arrangements in all our mental hospitals, in conjunction with the Inspector-General and the local Medical Superintendents. This lady, after going through the three-years course in domestic science at Otago University, further qualified herself by taking a special practical course of training as a Hospital Dietitian at one of the most advanced centres in the world for practical and progressive dietetics —viz., Johns Hopkins University, Baltimore. " It is recognized that, while the scale of food and feeding in the general and mental hospitals of the Dominion, and throughout the British Empire, is liberal —indeed, generally somewhat beyond what is desirable, especially in regard to meat —systematic scientific adjustments to meet the needs and tastes of individuals ought to be provided, as one of the most essential features of all curative treatment of those sick in body ("medical" or "surgical " cases) or sick in body and mind (so-called " mental " cases)." Miss d'Auvergne took up her duties in September, 1925, and worked unremittingly for more than a year at the various Mental Hospitals in the Dominion. She lived with and among the staffs and patients, taking an intimate interest and part in the whole life of the institutions, and conducting her inquiries and investigations in a spirit which won for her everywhere the help and co-operation of all concerned. Miss d'Auvergne's mission was a singularly delicate and difficult one ; and had she not shown great broad-mindedness, tact, and consideration in dealing with the authorities and members of the staffs responsible for the catering, feeding, and allied domestic arrangements she would inevitably have evoked hostility and obstruction, instead of winning every one, as she did, to assist her in getting a thorough grasp of the local facts, figures, and practical results. In her carefully-drawn-up report of some 500 pages foolscap, consisting largely of typed dietetic statistics, scientific calculations, comparative tabulations, &c., which form the basis of her deductions, suggestions, and practical recommendations, Miss d'Auvergne has left behind her a sound, permanent, exhaustive record which will enable her successors (if they will work harmoniously and progressively with the central and local authorities) to carry out in practice the improvements and advances which we know to be necessary, but which need more time, patience, money, and practical workingknowledge of the whole subject than any country can fairly be expected to command for this particular purpose as a moment's notice. This is neither the time nor the place to give more than a few condensed extracts from Miss d'Auvergne's report. Her main task has been to gather and analyse facts and figures, and to submit her deductions and conclusions for others to carry into practical effect, as time and opportunity may make possible. Miss d'Auvergne left the Department to be married shortly after completing her report. Extracts from Miss d'Auvergne's Findings as to Diet in the various Mental Hospitals of the Dominion. " Calculations.—The actual calculations show that in all our Mental Hospitals the dietary is slightly above the average requirement for life and health. . . .

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" The total food-requirement is well looked after, but the proportions of the foodstuffs used have not been judged so well. . . . Many people think that without meat in the diet they cannot keep healthy and fit, and this has caused a higher proportion of meat than is necessary or desirable to creep into the diet merely to satisfy the patients (and their friends). This, of course, brings the percentage of protein (flesh-forming material) above the requirement, and unbalances the diet. " It is not generally recognized that the percentage of protein in bread, and in porridge-and-milk is considerable, and that as these foodstuffs form a good proportion of the daily diet, the giving of too much meat will increase unduly the percentage of protein, and a high protein diet may, of course, cause ill health to the healthiest individual. . " In most cases the classes of foodstuffs used are very sound, and only on rare occasions is a poor quality of food bought, though there have been a few instances of deterioration due to unnecessarily long storage. " In most of the Mental Hospitals the actual cooking is fair, but owing to the lack of equipment and some lack of management there tends to be undue delay in serving. " In most of the institutions I got the ' containers ' restocked, or they are being replaced by better receptacles which will keep the food hot. I found that the type of conveyances also needed more attention, in cases where food had to be taken from one building to another, in order to deliver it in a satisfactory condition. Further, in the serving of the food from the containers to the tables too much time tended to be lost, and the food allowed to grow cold unnecessarily. " It seemed to me that where matters were not satisfactory in the above connections the fault lay not in the foodstuffs or in their cooking, but rather in the delay between the time when they were dished and their delivery and service in the wards. The Actual Meals.—" When one walked through the dining-halls in the various Mental Hospitals one was impressed by the largeness of the meals, and in very few cases could any one comment on the meals being too small. " To my knowledge there are few, if any, cases where patients are underfed ; and, as one passes through the institutions, the physical condition of the people strikes one as normal. "As a check on the patients losing weight (which might, of course, occur insensibly in any institution with a thousand patients) a book is kept, and every patient's weight is recorded once a month. By this means no appreciable loss of weight can fail to be detected, and patients found to be going downhill are, of course, ordered special diet with a view to restoring normal health and condition." Notes or Conversation between the Inspector-General, Dr. Gribben (Medical Superintendent, Seaclipp), and Miss d'Auvergne (Dietitian). Sir Truby King : I want to ask Miss d'Auvergne a few questions bearing 011 points in her report. (a) Re undue delay in the method of distributing the food in containers, and serving the meals from the containers to the tables. Miss d'Auvergne : I found the quickest service was at Christchurch and Waitati; Auckland was least satisfactory ; but alterations were effected more or less in all the places in the direction of speeding up, special attention being directed to this in Auckland. (b) Re quantity of food. Sir Truby King : Can you recall any cases in which the quantity of food was too little ? Miss d'Auvergne : No ; that practically never occurs. It might happen perhaps that on an occasion there would be a slight shortage, but this was very rare, and excess was the rule. (c) Re butter-supply. Sir Truby King : What do you feel as to the sufficiency or otherwise of the present ordinary butterration for chronic patients in the Mental Hospitals ? Miss d'Auvergne : I consider 1 \ oz. of butter a day (the present allowance) to be a sufficient average. (Note. —There is no such rationing-scale in the case of recent and recoverable patients.) (d) As to the recording of patients' weights once a month. Sir Truby King : Did you find matters fairly satisfactory with regard to the weighings, recordings) and special diet ? Miss d'Auvergne : Yes. (e) Re kitchens being old and out of date. Sir Truby King : You concluded that generally there ought to be better and more up-to-date kitchen equipments ? Miss d'Auvergne: Yes, that is so for the most part ; but Ido not. advise any extreme changes meantime. Of course, the equipment should, as far as possible, be made uniform and efficient in the long run ; but it would not be wise to rush ahead too quickly, especially with the present kitchen staffs. (f) Re position of kitchen ranges, coppers, steamers, &c. Miss d'Auvergne: I have practically nothing to add to what I have said in my report.

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(g) As to employing cooks experienced, in institutional cooking. Sir Truby King : You imply that we ought to have properly trained and experienced cooks for all the institutions, and not the type of woman who has merely drifted into cookery by chance, and has had no fundamental training or understanding of essentials and first principles ? Miss d'Auvergne : Yes. Sir Truby King: Of course, you understand, and no doubt you would agree, that such advances can only be brought about gradually, and as opportunity offers, because we have very few competent professional cooks in this country. Dr. Gribben : Yes, considering the shorter hours professional cooks are working in restaurants, &c., it is difficult to get them to accept and adapt themselves to our longer hours, especially in those institutions that are more isolated. Sir Truby King : Do you agree with these remarks of Dr. Gribben and myself ? Miss d'Auvergne: Yes. Sir Truby King : That is to say, that while we are all at one concerning the desirability of systematizing and improving the kitchen equipment! and cookery in our Mental Hospitals, and getting higher-grade cooks, there are insuperable difficulties in the meantime, in most cases at least, with regard to putting this into effect. (h) Re the need of constant skilled, instruction, training, and supervision, so as to bring the dietary in Mental Hospitals, throughout the Dominion, up to a higher standard, and in order to establish and maintain better cooking facilities and means of delivering and serving meals. Sir Truby King : I understand that, judging from your own experience in the Department, you consider it would be necessary to have a skilled Dietitian going round the Mental Hospitals, and sojourning in the different institutions from time to time, as you have done yourself, so as to improve the standard and maintain it on a better and more I 'systematic footing. You think this would be worth while, or more than worth while ? Miss d'Auvergne : More than worth while. Alterations, Improvements, and Additions. Besides the foregoing matters which form part of the general policy and programme laid down in my previous reports, it must be understood that at each of the Mental Hospitals numerous mainten-ance-works and improvements have been effected throughout the year. The main undertakings have been as follows : —• Auckland. 1. The provision of a Nurses' Home to accommodate sixty nurses. Modern ideas as to the care and treatment of the insane call for more individual attention than heretofore, particularly in regard to recent and recoverable cases, and this provision will not only enable us to accommodate an increased staff, but will make for all-round health, contentment, stability, good will, esprit de corps, and efficiency. 2. It is intended to appoint an additional Medical Officer, and a cottage has been provided for him. 3. Alterations have been made to a detached building in order to provide a special Hospital Ward for Males. This has been occupied during the greater part of the year, and is in charge of a trained general nurse who was previously a sister at the Wellington Hospital. Tokanui. It has been found that the very large estate of nearly 5,000 acres at Tokanui was too extensive to be worked effectively by the patients. As the Prisons Department required additional land for the neighbouring Waikeria Reformatory, we handed over to them 3,500 acres, retaining 1,200 acres —quite sufficient for all our requirements, present and prospective. Porirua. 1. A considerable addition has been made to the water-storage reservoirs to cope with the increased accommodation. 2. The electric lighting of the recently erected detached villas had considerably overtaxed our power plant; but this difficulty has now been overcome by taking part of'our'supply from the Hutt Power Board. 3. In addition to the formation of several necessary roads upon the estate, a convenient new drive has been provided from the main highway to the new villas. 4. The purchase of new laundry machinery has eased the pressure to which this department has been subjected for a long time. Ghristchurch. 1. A villa for male working patients is approaching completion at Templeton. This villa is situated on an entirely separate Mental Hospital property of 338 acres, seven miles from the main institution. The building, which will accommodate forty-eight patients, is of a type which has been designed as a standard, combining economy of design with the maximum provision of light and fresh air. It will be essentially suitable for chronic patients needing, most of all, a healthy, congenial open-air life, and capable of more or less useful occupation. 2.'Alterations and additions to the farm buildings. 1 * 3. General painting and renovations have been carried'out, and these have been effected largely by patients, working under the direction of attendants and artisans,

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Nelson. 1. A new villa has been opened at Stoke Farm, enabling a much better degree of classification to be effected. 2. The laying-out of the grounds round the new villa and elsewhere has been excellently done by the younger patients under the direction of the Head Attendant. 3. A new sanitary block has been added to the main building. Seacliff. 1. Very considerable improvements and repairs have been effected in the institution and farm buildings at Seacliff, and this applies also to the " Orokonui" (Waitati) and "Cherry Farm" (Waikouaiti) branch estates. 2. Increased water-storage has been installed at Seacliff. 3. A new motor-garage has been erected to house the institution motor-lorries. 4. Several alterations have been made to provide a site for the new stores, laundry and' kitchen blocks, the plans of which are complete. A commencement should be made as soon as possible with these extensive and absolutely essential provisions; they were due, and would have been put in hand twelve years ago, but for the war. lioleitika. Extensive improvements have been effected at Hokitika in the course cf the last few years; and alterations made to an existing ward during 1926 have made it possible to vacate completely the prison building which formed a part of the old institution. General. As foreshadowed in my report for 1924, it is intended that the Auckland institution shall be removed into a country district, where the erection of a new and up-to-date villa mental hospital will afford the patients many advantages now denied them by reason of the close settlement crowding in around the present premises at Mount Albert. The first step towards the removal has been taken by the purchase of an ideal estate of over 600 acres near Drurv. Plans are now being prepared for a building to accommodate the pioneer working patients who will do ail preliminary, work of fencing, scrub-cutting, &c., and complete the drainage of about 150 acres of rich, deep, raupo swamp land, with a view to intensive cultivation as vegetablegardens, &c. No more convenient or suitable property could have been secured in the whole Auckland Province. It fulfils all the requirements, and only needs proper development. This property, with over a square mile of undulating land, specially good for farming, gardening, fruitgrowing, and plantation, commands charming and very extensive views in every direction. To the northward, an arm of the Manukau runs into the property, and will afford full facilities for bathing, boating, and the use of a motor-launch which can be availed of for plying to and from Onehunga wharf and for fishing or other pleasure outings. Increase op Medical Staff. In connection with the establishment of clinics at the General Hospitals, the erection of private entry-lodges and the opening of the new sanatoria or neuropathic hospitals, &c., it has been decided to increase substantially our medical staff, in order that full effect may be given to these advances without delay. It is, of course, of the utmost importance 10 the patient that decision as to treatment and the class of accommodation most suited to his of her particular case should be arrived at in consultation, before the patient approaches the institution proper, in the hope that admission to the main central hospital may not be found necessary. The evaluation of symptoms and the analysis of each case in its initial stages needs very considerable knowledge and experience, and advantage was taken of Dr. Gray's presence in Britain to select suitable medical officers, with this requirement specially in view. From a list of eighty-five applicants Dr. Gray selected Drs. Waters, Hayes, and Childs, and they will join our staff in the course of the year. Besides holding the Diploma in Psychological Medicine, each of these doctors has had considerable psychiatric experience, particularly in regard to the treatment of incipient mental disorders along lines which are on trial elsewhere. Two of them have held important positions at the well-known Maudsley Hospital, London, and Dr. Gray is satisfied that each of them is exceptionally well qualified to assist in the fuller adaptation of our Department to meet advancing requirements indicated in the present report. In conclusion, f desire to express to the members of the head office staff my great appreciation of their unfailing helpfulness, loyalty, and devotion to duty throughout the year; and the same applies to the whole of the professional, clerical, and general staff of the Department. Further, I cannot speak too highly of the valuable assistance we have received from the honorary Deputy Inspectors and Official Visitors, and the welcome help given all over the Dominion by the clergy, and by private voluntary visitors, entertainers, and donors. F. Truby King, Inspector-General,

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MEDICAL SUPERINTENDENTS' REPORTS. AUCKLAND MENTAL HOSPITAL. Dr. Prins reports : — I have the honour to present to you my annual report for the year ending 31st December, 1926. During the year there have been 1,296 patients under care, with an average of 1,075 resident. The new cases numbered 202, of whom 139 were admitted for the first time. The discharges numbered 68. The admissions were fewer than last year, which can probably be accounted for by Tokanui taking part of our district, and the fewer number of discharges is largely accounted for by a much larger number than last year leaving the Hospital on probation. The deaths numbered 80, senile decay and heart-disease being the principal causes. Sixty-four voluntary boarders were treated, 35 being new admissions, while 22 were discharged and one died, leaving 41 in residence. In no case was it found necessary to resort to certification for further detention. The ventilation of the wards has been completed throughout with very marked benefit. The new male hospital ward has been opened, and is meeting a great want. It is bright and airy, and the almost total absence of restraint has caused the patients—mostly new admissions—to react, so that the amount of trouble and anxiety due to a patient breaking his parole has been most gratifyingly small. The airing-court in Male 3 Ward has been enlarged and asphalted. This has greatly improved the general appearance, and has added to the comfort of the patients. The airing-courts and parks have been provided with bubble fountains. The Wolfe Home continues to be used as an admission ward for every possible female case. The croquet-lawn and tennis-courts are much used in the summer, and the evening concert parties are much appreciated. A new departure has been made in allowing suitable cases to go out in small parties unattended, thus avoiding the morbid curiosity of the general public. This has been most successful, and has made a real pleasure of what was formerly an unpleasant duty. The same principle has also been extended successfully to the other parts of the building. Another change has been made in dividing Park House into two wards. The improvement is noticeable, and the new day-room, in furniture and appearance, compares more than favourably with any there is in the Hospital. A new washing-machine and extractor will shortly be installed in the laundry, and electrically-driven machinery has been introduced. A painting gang has been formed, and has done remarkably well both inside the building and out. The new unit for nervous disease is nearly completed, except for the main sewerage connections. It was a great disappointment that the Entertainment Hall was found to be unsuitable for the installation of a cinematograph. During the winter lectures were given to the nurses and attendants, and there were the usual dances, entertainments, visits by bands, &c. Parties of patients also attended various picture-theatres and entertainments in the city, seats being kindly provided by the various managers concerned. The bowlers have been as enthusiastic as ever, home and away matches being played. The Rotary Club has given many gifts of all kinds, and also was responsible for the annual Christmas tree, a memorable evening resulting. Mesdames Arthur D., R. M., F. W., Joseph, and John M. Wilson, and Mrs. John Alexander each generously donated the sum of £25 to a fund from which six gramaphones were purchased, and the balance is being held to help necessitous cases on discharge, a most useful and necessary adjunct to our work. Church services have been held, and regular visits paid by Rev. D. Macpherson, Rev. E. C. Budd, and Father Holbrook, while on the 26th December the Archbishop of New Zealand visited, and preached at the afternoon service. A weekly clinic at the Public Hospital has been started, and an increasing number of patients and their friends are attending. Cases are also seen in the Hospital wards, and I have to thank the Hospital Board and Dr. Maguire for their interest and co-operation. During the year the Auckland Clinical Society held one of their regular meetings at the Hospital. Cases were demonstrated by our medical staff, and the exhibition of patients' work arranged by the Matron created much interest. During the coming year it is intended to repaint the whole building, an internal telephone system will be installed, and a very necessary Nurses' Home will be built. I am indebted to Messrs. Blomfield and Alexander for their help and advice on numerous occasions, and to Mrs. Armitage, Mrs. Von Sturmer, Miss Jackson, and Sister Hannah, who have also visited regularly. In conclusion, I have to thank all my staff for their help and co-operation.

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TOKANUI MENTAL HOSPITAL. Dr. Macpherson reports: — I have the honour to forward my report on the Tokanui Mental Hospital for the year ending 31st December, 1926. On the Ist January, 1926, there were 315 patients (210 males and 105 females) on the register. In a.ddition to 18 transfers, the admissions during the year numbered 47 (30 males and 17 females). The total number of patients under care was 380 (244 males and 136 females). Nine male and 5 female patients were discharged recovered ; two males were discharged relieved; and two males and one female were discharged not improved. Two male and 2 female patients were transferred to other institutions. Deaths during the year totalled 20 (16 males and 4 females), so that there remained on the register at the close of the year 337 patients (213 males and 124 females). During the year 7 male and 11 female voluntary boarders were under treatment. Four males and 4 females were discharged, and 1 male and 1 female patient died, thus leaving under care on the 31st December, 1926, 2 males and 6 females. Of the 20 deaths occurring daring the year, 4 were due to lobar pneumonia and 3 to senility. The incidence of typhoid fever during the latter part of the year suggested the presence of a carrier. The cases, two in number, occurred on the female side, and steps were taken to locate the carrier, but without avail. The general health of the inmates has, on the whole, been good. The Frank Hay Ward was opened for the reception of patients at the beginning of the year, and its comfortable and homelike surroundings make it very suitable for the reception of recent as well as convalescing patients. Extensive decorative work has been carried out during the year. The whole of the outside of the institution, excepting the two latest units, has been painted, and the interior woodwork cleaned and painted or stained. Owing to the increase in the number of the female nursing staff it was found necessary to provide a separate dining-room, and this we managed by utilizing the old storeroom. This gives the staff a sitting-room as well as a dining-room, and greatly adds to their comfort. lam hoping that the erection of the mortuary will be put in hand shortly, as the present arrangement is neither satisfactory nor, indeed, sanitary. A commodious fruit and vegetable store is in course of erection, and will prove of great benefit to the institution in remedying the past lack of storage facilities. Recreation for our inmates has been provided by occasional concerts and dances during the winter months, and I have again to express my thanks to Mr. Battson, of Te Awamutu, for the kindly interest he has taken in the matter of promoting entertainments for our patients ; also to Mrs Wood, of Te Awamutu, for parcels of magazines and sweets. All arrangements and alterations necessary for the installation of the cinematograph here have been completed, but the apparatus has not yet come to hand. During the year we lost the services of Mr. Brabyn, our Official Visitor, and shall miss his kindly interest in the welfare of the institution. I have to acknowledge the loyalty and steady co-operation of the responsible officers during the year. In conclusion, I should record that from the Ist April to the 30th September of last year the institution was controlled by Dr. R. M. Beattie.

PORIRUA MENTAL HOSPITAL. Dr. Tizard reports :— I have the honour to present my report on the Porirua Mental Hospital for the year ending 31st December, 1926. On the Ist January there were 1,261 patients in the Hospital. At the end of the year the number was 1,322 —viz., 723 males and 599 females, inclusive of 27 males and 44 females absent on probation —thus showing an increase of 61 (39 males and 22 females). The total number under care during the year was 1,539 (829 males and 710 females), the average weekly number resident being 1,232 (684 males and 548 females). Ninety-one (35 males and 56 females) voluntary boarders were under treatment during the year : of this number 3 females were committed as ordinary patients, and 30 were discharged (8 males and 22 females). Of those admitted on remand—l 3 (8 males and 5 females)- 2 males and 2 females were committed as ordinary patients, and 1 male and 1 female were admitted as voluntary boarders. Of those admitted on urgency request, there were 11 (6 males and 5 females : of this number 9 were committed as ordinary patients. Of 131 discharged, 99 were discharged recovered, 14 not improved, and 18 transferred to other Mental Hospitals. The deaths during the year were 86 (48 males and 38 females), general paralysis, phthisis, circulatory disease, and senility being the principal causes. During the year three villas have been opened to accommodate male patients. Of these two contain mostly workers, and all of them are parole patients, who greatly appreciate their liberty within the estate. The remaining villa contains a type of more or less helpless patient. One of these villas is under the management of female nurses, and their work is much appreciated by the inmates. The addition of these villas has greatly improved our classification of male patients. The convalescent home, " Vailima," still continues to fulfil a long-felt want for convalescent and, by direct admission, for suitable female patients, who, as well as friends and relatives, have been laudatory in expressing their opinions of the home and its beautiful garden and walks. A similar home for male patients is under construction, and will be opened shortly. This home will be under the supervision of female nurses, and occupies a site commanding a magnificent outlook on the surrounding country. The Admission Cottage will shortly be available, thus enabling us to examine new admissions there instead of their being brought directly to the main building.

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The new male and female hospital wards have been opened during the year, thus giving us accommodation and facilities to treat the sick on the same lines as a General Public Hospital. In view of the increase in the number of our admissions on the female side, the question of accommodation is again becoming an urgent problem ; on the male side this is not a pressing matter. Wards F and Don the female side require either extending or additional wards built; the same applies to Ward 3 on the male side. I must again draw attention to the kitchen in the main building, which requires to be extended and remodelled in order to bring it up to our requirements, as also does the male dining-room, also used as a recreation-hall, which is inadequate and far too small to accommodate the number of patients attending the dances, cinema, &c. The necessity for transferring the piggeries from its proximity to the male and female villas to a site further distant still remains. Our lighting plant will shortly be relieved for a time by the installation of power from the Mangahao supply, thus allowing us to light the additional buildings adequately. The present lack of accommodation in the store is an urgent matter, the space being far too limited for our requirements, as, in addition to the space required for our own use, we are the distributing centre for stores to other Mental Hospitals. The majority of the male patients are still usefully occupied in assisting in the many activities and work being carried out on the estate, deriving much benefit from such employment. The attendance by the public requiring advice and treatment at Wellington Public Hospital is increasing, and incipient mental and nervous patients are induced to come early under treatment, and in-patients are seen in consultation with Hospital staff. The weekly entertainments still continue to be much appreciated by the patients, and my sincere thanks are given to those who by their thoughtfulness and kind attention to the amusements help to lighten the lives of those less fortunate than themselves. Amongst the many who frequently give their services are the Red Cross Society, the Victoria College Social Service Club, and various other clubs and bands. Mr. Prosser also has our thanks for the free passes he gives for patients attending the cinema pictures in the village. I also have to thank the ministers of religion for the services they render to the patients, and the Official Visitors (Mrs. Fraser, Mrs. McVicar, and Messrs. Bothamley and Bradey) for their continued interest in the welfare of the patients and Hospital. My thanks are also due to my colleagues (Drs. Blair, Hunter, and Cox) and to the staff generally for their loyal support and assistance in carrying out the work of the Hospital. NELSON MENTAL HOSPITAL. Dr. Jeffreys reports :— I have the honour to forward my report for the year 1926. On the Ist January there were 357 patients on the register, and at the end of the year there remained 389 (males 269, females 120). The total number under care during the year was 406 (280 males and 126 females), and the average number resident was 368. There were 49 admitted during the year, and of these no fewer than 23 were imbecile boys under the age of fifteen, the youngest being only two years of age. There were 11 voluntary boarders under treatment during the year, and of these 2 were discharged and 2 died, leaving 7 remaining at the end of the year. Two males and 5 females were discharged as recovered, and 1 male as not improved; and 9 patients died. The death-rate was again remarkably low, being only 247 per cent, of the average number resident. The general health of the patients has been good. There were four cases of diphtheria among the female staff at Nelson, and one patient, an imbecile boy at "El Nido," was also infected. As these nurses had all been on duty at " El Nido," nasal and throat swabs were taken from all the patients of this ward, and two of the boys were found to be carriers. These two were sent to the Public Hospital for isolation and treatment, and there have been no other cases since. Owing to the number of imbecile boys who have been admitted to " El Nido " from all parts of the Dominion during the year, this ward is far too full, and until the new villas are erected at Stoke it will be impossible to avoid the overcrowding, for. although all the bigger boys have been sent out to Stoke to make room for the new-comers, it is obviously inadvisable to send any of the smaller ones, as they could not at present be separated from the adults, for owing to lack of accommodation the classification at Stoke is still far from perfect. The new villa at Stoke has been opened and is in charge of female nurses, and the men greatly appreciate the comfort and homelike surroundings. An up-to-date washing-machine has been installed in the old laundry at Nelson and is a great boon, but a new laundry is urgently required, for with the number of defective children we have here the washing is out of proportion to the size of the institution, and it is almost impossible to cope with the work in our small out-of-date laundry. The water-supply at Stoke is far from satisfactory, and, although it will no doubt be improved by the relaying of the pipe-line from the reservoir, the question of making use of the excellent supply in Poorman's Valley will shortly have to be considered. A new lavatory block has been erected at the main building at Stoke, and is a great improvement. A large proportion of the men at Stoke and Nelson are usefully employed, and the majority of these enjoy the privileges of full parole. In addition to the weekly dance through the winter months, numerous concert parties have visited Stoke and Nelson throughout the year, and lately a number of inmates from both institutions have been taken into Nelson once a week to the pictures. These amusements are very much looked forward to by the patients.

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The Christmas-tree festivities this year were held in the grounds at Nelson, which was beautifully illuminated by vari-coloured electric lights, and the proceedings were enlivened by the Nelson Regimental Band, which was in attendance. The innovation was thoroughly appreciated by the patients, and by the visitors who had generously contributed towards the entertainment. I desire to express my thanks to the ministers of religion who conduct services, and to Mrs. Scantlebury and Mr. Gould, Official Visitors, for their interest in the patients ; also to Dr. Hay and the other officers and staff for their loyal assistance throughout the year. HOKITIKA MENTAL HOSPITAL. Dr. Buchanan reports : — At the beginning of the year there were 221 patients on the register; at the end of the year there remained 159 males and 67 females, making up a total of 226. Admissions numbered 27 ordinary patients. Discharges were 9, and deaths 13. The general health of the patients has been good. The programme of reconstruction commenced five years ago at this Hospital is now showing definite results. In place of the old and rambling buildings huddled up against each other, there is now to be seen a specimen of the villa system of housing mental patients. The wards are self-contained, and, on the whole, set well apart from each other. No villa houses more than forty patients, the average number being about thirty. The breaking-down of all yard-enclosures and the consequent opening up of pleasing vistas undoubtedly engages the attention of even some of the most enfeebled minds, and diverts many of the patients from brooding over their fancied wrongs. This is reflected in the fact that assaults among patients are fewer than formerly, and that there is a lessened necessity for lis to resort to methods of restraint. It is interesting to note that the majority of our patients were transferred here from the Porirua and Christchurch Mental Hospitals about ten years ago, and it is quite certain that the patients transferred were by no means of the best-behaved type. Though much work has been achieved in the modernizing of this institution, there is yet much to be accomplished before anything like completion is reached. Our wants are still great. The most pressing requirements are : — 1. Erection of a new ward on the site of " Moana." Because of its relative isolation, this is the situation par excellence for a ward to house the most refractory of the female patients. At present " Moana " houses thirteen patients and four nurses. The opinion of the Public Works Department is that the ward will not economically stand alteration because of its age. I suggest that a new building on this site should be capable of housing thirty patients and contain ten single rooms. This would allow us to destroy a block of ten single rooms (a dingy and unsightly relic of the past) which abuts directly on to the new female-reception unit. We have of necessity to use these rooms for the most noisy and violent patients, and their propinquity to newly admitted patients is most unsatisfactory. 2. A system of fire-alarms. At present the only means of alarm is to ring a bell situated at the most central part of the institution. The wards, which are all wooden, are now discrete and spread out over an extensive area, and there might consequently be an undue delay before fire-fighters could be summoned to one of the more distant wards. I would, suggest that an intercommunicating telephone system be installed. This would meet the case, and also be useful in the event of other emergencies which of necessity must arise from time to time in the different wards. 3. Increased accommodation for nurses. Nurses perforce are using rooms that should be available for patients. There is, in general, an all-round lack of suitable accommodation for nurses. 4. A water-supply independent of the borough water-supply. Not only is the latter supply expensive, but it is the expressed opinion of some of the members of the Borough Council that it is in a precarious state owing to the bad condition of the mains. The Borough Council charges us Is. 3d. per 1,000 gallons. About two years ago I had a well sunk on our own grounds, which gave us good potable water in sufficient quantity for our needs. The Westland Hospital, which lies adjacent to us, procures its water from a well on their property similar to that which we have already sunk on our own ground. They pump more water than is necessary for their requirements. The Hospital Board have suggested that they should sell us their surplus water at sd. per 1,000 gallons. They guarantee a daily supply of 5,000 gallons. If we accepted this offer we would have to build an elevated reservoir. Would it not be better in that case to pump our own water into it ? 5. A recreation-hall. The lack of a, hall suitable for Church services, cinematograph entertainments, wireless and other concerts, and dances is much felt, and results in an inadequate amount of entertainment for the patients. 6. The construction of farm buildings on a new site. The Public Works Building Overseer when asked to value the present buildings expressed the opinion that the stable buildings, barn, dairy, and pigsties, were valueless because of their great age and state of disrepair. The present buildings are an eyesore, and are situated too close to " Te Maire." Below I give a summary of new work accomplished during the year: Erection of Sefton Ward, which houses twenty-seven patients (the greater part of this building was constructed from suitable portions of old F Ward moved to the new site) ; building of a new large bathroom, a scullery, and the installation of a hot-water supply at " Aorangi" ; building of a bathroom,

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lavatory, and installation of hot-water supply at " Egmont " ; building of a garage at. Medical Superintendent's residence ; demolition of the old gaol; demolition of old A Ward ; erection of a large coal and store shed from suitable portions of old A Ward; reclamation of over 8 acres swamp ground; addition of about § acre to the kitchen garden; increase to the recreationground, and fencing the whole area for the purpose of grazing sheep ; laying out new fowl-runs ; roadmaking and laying out of grounds in front of the institution formerly occupied by old wards ; making of new airing-court at " Aorangi." The annual picnic, an event always looked forward to by the patients, took place at Kokatahi. The outing proved a great success and was handsomely contributed to by many of the townsfolk. I would especially like to record my appreciation of the many concerts given to us by the Hokitika Band. They are always a great source of pleasure. I have had good, helpful, and loyal service from all my staff.

CHRISTCHURCH MENTAL HOSPITAL. Dr. MgKillop reports I have the honour to present my report for the year 1926. On the Ist January there were 835 patients on the register (372 males and 463 females.) The admissions during the year were 192 (90 males and 102 females). Eighty-seven patients were discharged, and 3 transferred to other institutions. The total number of committed patients was 1,027, and 870 remained at the end of the year. Sixty voluntary boarders received treatment, and 32 (14 males and 18 females) were discharged recovered during the year. The general health of the patients has been very satisfactory. There were 67 deaths (30 men and 37 women), a large proportion of the deaths being due to senile decay. The Neuropathic Hospital for men at Hornby is now occupied. The value of this new building, and of the Lodge, Hornby (for females) cannot be overestimated, and is already reflected in the increased recovery-rate. lam pleased to note that a modern farm colony, with accommodation for forty-eight men, is in course of erection at.Templeton. This will relieve to a very great extent the overcrowding at Sunnyside, and will permit of a much better classification. The painting squad, organized eighteen months ago, has been kept fully occupied, and has done exceptionally good work The farm buildings have been renovated, and most of the exterior of the institution. During the coming year it is intended to make considerable alterations that will help to brighten the interior of the building and add greatly to the comfort of the inmates. lam pleased to record a most successful year on the farm. Much has been done in the way of fencing and development generally, and the labour and money expended has been well repaid. I have again to express my indebtedness to Professor Hercus, of the Otago Medical School, for the great assistance he has given in research work, more particularly in goitre and general paralysis. Weekly visits have been paid to the Christchurch Hospital, where out-patients may obtain advice and treatment, and in-patients are seen in consultation with the Hospital staff. The patients' recreation has been arranged on the usual lines. The weekly dances and cinematograph entertainments were well attended. Through the kindness of the Rotary Club and other friends of the institution, radio equipment has been installed in the main building : four loud-speakers have been installed, and it is hoped that before long a loud-speaker will be available for each ward. I have to tender thanks to Canon Revell for his great efforts in bringing this scheme to a realization. To Mr. Acland (District Inspector), to the Official Visitors (Mrs. Williams and Mr. Hanna), to Mr. Souter (Patients' Friend), I tender my sincere thanks for their regular visits and for their untiring attention to our inmates. I further tender my thanks to my colleagues, Drs. Russell and Hart, and to Mr. Thomas and office staff, to the Matrons and Head Attendants, for their loyal and efficient assistance, and to the staff as a whole for the satisfactory manner in which its work has been performed. SEACLIFF MENTAL HOSPITAL. Dr. Gribben reports : — I beg to submit my report for the year ended 31st December, 1926. At the beginning of the year there were 1,130 patients on the register (623 males and 507 females), and at the end of the year 1,132 (617 and 515 females.) The admissions numbered 165 (83 males and 82 females.) Eighty-seven patients were discharged comprising 43 males and 44 females. Of voluntary boarders 35 remained from the previous year, and 27 were admitted. Twenty-one voluntary boarders were discharged, 2 committed as ordinary patients, and 2 died. Two patients (1 male and one female) were admitted on remand for observation. Seventy-six patients died during the year (46 males and 30 females). The average weekly number of patients resident during the year was 1,108 (615 males and 493 females). During the year 17 patients escaped and all were replaced. The health of the patients on the whole has been good. An epidemic of measles went through the institution, but fortunately most of the were of a mild type, and in the few instances in which more serious manifestations were present complete recovery took place. Three female patients and one male sustained fractures. Of the females one (an epileptic) broke her arm in a fall, another met with a fracture of the leg by jumping off the roof in an attempt to escape, while a third, aged seventysix, sustained a fracture of the leg. The male patient (an epileptic) fractured the base of his skull as a result of a fall.

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The .building programme included additions in the shape of seven single rooms and a bathroom to D Ward, together with a general overhaul of the ward, including improvement in ventilation facilities, a new verandah, and general painting of the building. The new Admission Cottage is approaching completion, whilst work at the seaside sanitorium at Puketeraki has advanced to the stage where the roof is being put on. Additional lavatory accommodation has been provided on the male side. The sleeping-accommodation at Waitati has been increased by cutting off part of the large dav-room of No. 2 Ward and using it as a domitory, and by fitting up a small temporary building adjacent to this ward for a similar purpose. At Waitati also electric light has been installed, and this has proved a great boon, in addition to ensuring greater safety, especially in the old wooden buildings. To revert again to Seacliff, new concrete tanks have increased the water-storage for domestic and emergency purposes. There have also been the usual repairs to buildings, which have occupied attention. On the farm also there has been considerable activity in the matter of new buildings, and renovations and repairs. New buildings include a detached boiling-down house at the slaughterhouse, where an addition was also made in the shape of a well-ventilated room in which to hang mutton. An ample water-supply has also been installed. An implement-shed, which was badly needed, was erected, whilst other new buildings included a brooder-house, a poultry house and runs, a hack-stable and farm-stores at the main byres. In addition extensive repairs were made at the main and Simla byres, and similar operations are to be carried out in connection with the piggeries amd the draughthorse stable. A painting party is at work, and it is hoped that by the end of the summer all necessary outside painting on the estate will have been completed. So far as farming operations are concerned, the season in early spring was somewhat adverse, but it has improved and at the moment promises to be an average one. The unfavourable spring weather was more noticeable in its effect on the crops at Cherry Farm, but these have improved in a remarkable manner as a result of the better weather recently experienced. The introduction of the practice of co-operation, whereby the wants of one Mental Hospital are supplied, when possible, by another institution in the Department, is a line of policy which should be productive of excellent results. Work at the fishing-station has been carried on, but it has now become necessary to go further off the coast for supplies of fish. Regular religious services have been held by the clergy of the different denominations. The amusement of the patients has received attention, and in addition to the ordinary seasonal games a successful picnic and sports meeting was held. There have been regular dances and picture entertainments, whilst a large number of patients visited the New Zealand and South Seas Exhibition held at Dunedin. We have also had visits from the Pipe and Tramway Bands and the Commercial Travellers' Male Choir, all of which were much appreciated. The thanks of the Department is also due to the manager of the Otago Witness, for free copies of the Christmas Number. Mr. Gallaway (District Inspector), Mr. Slater (Official Visitor), and Mr. Gumming (Patients' Friend), have paid regular visits to the institution. In conclusion, I wish to tender my thanks to members of the staff for their co-operation in carrying out the work of the year. STATISTICAL. The patients on the register at the end of the year numbered 5,467 (m. 3,044, f. 2,423), or 210 (m. 123, f. 87) more than at the beginning ; and the daily average under treatment during the year was 5,213 (m. 2,926, f. 2,287), or 180 (m. 96, f. 84) more than in the previous year, while the total under care was 6,204. Patients belonging to the Native race numbered 72 (m. 40, f. 32) at the end of the year. The admissions numbered 947 (m. 508, f. 439), or 72 (m. 63, f. 9) more than in the previous year. Of these, 165 had been previously under care, making the proportion of readmissions 14-06 per cent., and 782 patients (including 15 Maoris) were admitted for the first time. The ratio to population of all admissions (exclusive of Maoris) was 6-88 (m. 7-25, f. 6-50) to 10,000, and of first admissions 5-67 (m. 6-05, f. 5-27), so that 1,452 persons in the general population contributed one patient, and 1,764 contributed a patient admitted for the first time. The discharges (excluding transfers) numbered 383, or 42 less than in 1925. 102 (or 4 less) harmless unrecovered persons were returned to the care of friends, and 281 (m. 136, f. 145) recovered —38 less than last year, representing a percentage of 29-67 (m. 26-18, f. 30-75) on the total admitted. AVith voluntary boarders added the percentage rises to 35-87. Altogether, 44-98 per cent, of the inmates admitted were able to leave institutional care. Of a total of 6,204 patients under care, 354 (m. 207, f. 147) died, or 6-77 per cent, on the average number resident. 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, 25-61 ; disease of the brain and nervous system group, 31-17 ; heart-disease, 14-81 ; tuberculosis, 8-02. 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 numbers 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

14

H.—7.

complex, and the most potent factor is the individual. Hereunder the assigned causations in the table referred to are grouped and shown in their relative proportions :— Males. "Females. Total. Heredity.. .. .. .. .. .. 15-02 13-21 14-18 Congenital .. .. . . .. .. 12-25 7-97 10-26 Predisposed by previous attack .. .. ~ 10-47 18-22 14-18 Critical periods .. . . . . .. .. 18-77 28-92 23-49 Child-bearing (puerperal, non-septic, and lactation) .. .. 5-01 2-32 Mental stress . . .. .. .. .. 8-69 11-61 10-05 Physiological defect and error .. .. .. 4-54 4-55 4-55 Toxic, including — M. f. t. W*? • • I'}} V'ofi 15-21 3-19 9-63 Alcohol .. 7-11 1-36 4-44J Traumatic .. .. .. .. . . 0-98 .. 0-52 Disorder of nervous system, including — m. f. t. Epilepsy " .. 5-13 3-64 4-44 7-31 5-01 6-24 Other bodily affections .. .. .. .. 2-02 0-49 0-77 No definite cause assigned .. .. .. .. 4-74 1-82 3-81 100-00 100-00 100-00

Voluntary Boarders.

It will be noted that there were 171 voluntary admissions in the year under review, that 120 were discharged, and that 21 boarders, representing 6-56 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 on average number resident was 5-92 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 1926 was 152 (m. 61, f. 91). MENTAL NURSES. In December the usual examination was held for the registration of mental nurses, when the following passed : — Auckland: First Grade —Edward Barraclough, Douglas Henry Kirkland, Oliver Nicklinson, Margaret Reid ; Second Grade —William Wallace Adams, Robina Blair, Daisy Ethel Parker, Henry Edmund Shaw. Tokanui: First Grade—Paul Helwig ; Second Grade —Robert Bourke, Edward Croasdale, Alastair Henry Kinghorn. Porirua : Second Grade —Arthur Barstow, James Brown, Stanley Bertram Brown, Andrew Gibb, Carl Otto Hasse, Elsie Storeys Hodgens, Harold Jarvis, Peter Andrew Lambert, Frederick John Oliver, Alexander Smith, Annie Cullen Wardrop, Julia Wallace. Nelson : Second Grade —Gladys Lilian Allport, Olive Hannah Bell, Naomi Mary Brown, Ida Emily Eyles, William Gourlay Gorman. Hokitika : First Grade—Wreford Jack Carter, William Henderson, Mary Jane Rosevear ; Second Grade —Imelda Agnes Mary Martini, Ernest Edward Oliver. Christchurch : First Grade —George Bell Browning, James Callaghan, Ngaio Madeline Carter, Alexander Park Craig, Victor Hugh Drain, Myrtle Evelyn Ferguson, Florence Isabel Hodges, Arthur Sylvester Preston, Bessie Watson, John Edward Willis; Second Grade — Charles Edward Davies, John William Hartley, Thomas Arthur Turnbull, William Welton. Seacliff : First Grade —Doris Alice Guild, Clorine Gladys Smith, Mary Isabella Westwood; Second Grade — Henry Dickson, Annie Hyde, Olga Law, Arthur Little, Williamena Frances Lobb, Malcolm McDougall, Bridgie O'Connor, William Simmons, James Hyslop Wilson.

15

-first 1 Tint, First ! Total Transferred I Eemaining Admission, j Admission. , Admissions. Eegjer Died. Discharged. M. F. T. M. F. T. M. F. T. M. J?. T. M. F. T. M. F. T. M. F. T. 1912 .. .. 6 17 23 0 0 0 6 17 23 1 3 4 0 0 0 4 3 7 1 11 12 1913 .. .. 18 19 37 0 2 2 18 21 39 2 5 7 0 1 1 12 12 24 5 14 19 1914 .. .. 17 19 36 3 2 5 20 21 41 7 5 12 1 1 2 11 15 26 6 14 20 1915 .. .. 15 17 32 1 2 3 16 19 35 3 4 7 0 1 1 8 14 22 11 14 25 1916 .. .. 13 23 36 5 8 13 18 31 49 4 4 8 1 2 3 14 14 28 10 15 25 1917 .. .. ; 14 21 35 1 13 14 15 34 49 6 6 12 0 1 1 10 23 33 9 19 28 1918 .. .. . 23 38 61 5 11 16 28 49 77 I 4 5 2 2 4 15 30 45 19 32 51 1919 .. .. 31 39 70 5 19 24 36 58 94 3 3 6 0 2 2 26 42 68 26 43 69 1920 . . .. 26 38 64 16 12 28 42 50 92 3 4 7 1 2 3 33 33 66 31 54 85 1921 .. .. 39 39 78 11 15 26 50 54 104 2 3 5 5 1 6 38 41 79 36 63 99 1922 .. .. 47 38 85 10 16 26 57 54 111 6 5 11 4 4 8: 40 48 88 43 60 103 1923 .. .. 44 50 94 15 21 36 59 71 130 3 6 9 3 3 6 47 47 94 49 75 124 1924 .. .. j 38 44 82 16 20 36 54 64 118 4 8 12 6 3 9 39 48 87 54 80 134 1925 .. .. 64 59 123 15 34 49 79 93 172 10 15 25 6 3 9 60 63 123 57 92 149 1926 .. .. j 71 60 131 11 29 40 82 89 171 10 11 21 7 2 9 ' 49 71 120 73 97 170

H.—7.

APPENDIX.

Table I.—Showing the Admissions, Readmissions, Discharges, and Deaths in Mental Hospitals during the Year 1926.

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 1926.

16

M. F. T. M. F. T. In mental hospitals, 1st January, 1926 .. .. .. .. 2,921 2,336 5,257 Admitted for the first time .. .. .. .. 425 357 782 1 , no Af)r , n Readmitted 83 82 165 / 508 439 947 Total under care during the year .. .. .. 3,429 2,775 6,204 Discharged and died— Recovered .. .. .. .. .. .. 136 145 281 Relieved .. .. .. .. .. .. 27 35 62 Not improved .. .. .. .. . . 15 25 40 Died .. .. .. .. .. .. 207 147 354 (Not including transfers —Males 20, females 22.) 385 352 737 Remaining in mental hospitals, 31st December, 1926 .. .. .. 3,044 2,423 5,467 Increase over 31st December, 1925 .. .. .. .. 123 87 210 Average number resident during the year .. .. .. .. 2,926 2,287 5,213

, „ I Admissions ill 1926. 1 Total Nnmhnr In Mental Hos- j i iotai numoer Mental Hospitals. pitals on j . ! 1st January, 1926. ; Admitted for the Not First Transfers i under fw First. Time. ' Admission. Iransrers. j under Care. M. F. T. M. F. T. M. F. T. M. F. T. M. Jt. T. Auckland .. .. 618 476 1,094 84 55 139 32 25 57 (3 3 6) 737 559 1,296 Christchurch .. .. 372 463 835 80 85 165 7 16 23 (3 1 4) 462 565 1,027 Dunedin (Seacliff) .. 623 507 1,130 64 61 125 14 19 33 (5 2 7) 706 589 1,295 Hokitika .. .. 159 62 221 9 12 21 4 2 6 1 .. ) 172 76 248 Nelson .. .. 239 118 357 33 6 39 4 2 6 (4 0 4) 280 126 406 Porirua .. .. 684 577 1,261 124 115 239 20 16 36 (1 2 3) 829 710 1,539 Tokanui . . .. 210 105 315 28 15 43 2 2 4 (4 14 18) 244 136 380 Ashbnrn Hall (private 16 28 44 3 8 11 .. ( .. ) 19 36 55' mental hospital) — — — : Totals .. 2,921 2,336 5,257 425 357 782 83 82 165 (20 22 42) 3,449 2,797 6,246 Patients discharged, transferred, and died. T , T , . Tr In Mental HosMental Hospitals. Discharged Discharged : ' discharged, 31st P December, recovered notrecovTed. | Transferred. Died. tmnsferred, 1926. - . - _ . M. F. T. M. F. T. M. F. T. j M. F. T. M. F. T. M. F. T. Auckland .. .. 28 19 47 5 12 17 ( 2 2 4)! 50 30 80 85 63 148 652 496 1,148 Christchurch .. 24 42 64 10 13 23 ( 3 0 3)' 30 37 67 65 92 157 397 473 870 Dunedin (Seacliff) .. 20 23 43 18 20 38 ( 5 1 6)j 46 30 76 89 74 163 617 515 1,132 Hokitika .. .. 2 1 3 1 3 4(2 0 2)1 8 5 13 13 9 22 159 67 226 Nelson .. ..25 7 101 .. 181 9 11 6 17 269 120 389 Porirua .. .. 52 47 99 3 11 14 ( 3 15 18) 48 38 86 106 111 217 723 599 1,322 Tokanui .. .. 9 5 14 4 1 5 ( 2 2 4) 16 4 20 31 12 43 213 124 337 Ashburn Hall (private 1 3 4 .. ( 3 2 5) 1 2 3 5 7 12 14 29 43 mental hospital) . Totals .. 136 145 281 42 60 102 (20 22 42); 207 147 354 405 374 779 3,044 2,423 5,467 Average Number | Percentage Percentage of Mental Hospitals. resident during 1 0 'SS»» Deaths on Average the voar Admissions Number resident during the Year. j during the Year. I I M. F. T. M. F. T. M. F. T. Auckland .. .. .. .. .. 614 461 1,075 24-14 23-45 23-96 8-14 6-51 7-44 Christchurch .. .. .. .. .. 380 460 840 25-28 41-58 34-04 ! 7-89 8-04 7-97 Dunedin (Seacliff) .. .. .. .. 615 493 1,108 25-63 28-75 26-21 I 7-48 6-08 6-86 Hokitika .. .. .. .. 155 62 217 15-39 7-14 11-11 5-16 8-06 6-00 Nelson .. .. .. .. .. 251 117 368 5-40 62-50 15-55 I 3-18 0-85 2-45 Porirua.. .. .. .. .. .. 684 548 1,232 36-11 35-88 36-00 ! 7-01 6-50 6-17 Tokanui .. .. .. .. .. 212 118 330 30-00 29-82 29-78 7-54 3-39 6-06 Ashburn Hall (private mental hospital) .. .. 15 28 43 33-33 37-50 36-36 6-66 7-14 7-00 Totals .. .. .. 2,926 2,287 5,213 .26-18 30-75 29-67 j C-06 6-42 6-77

3—H. 7

H.—7.

Table IV.—Duration of Disorder on Admission.

Table III.— Ages of Admissions.

17

Diinprtin I Ashburn Hall Ages. Auckland. Christchurch. (Seacliff) Hokitika. | Nelson. Porirua. Tokanul. | (Private Mental Total. | I Hospital). J ; I I I M. F. T. M. F. T. M. P. T. M. F. F. M. F. T. M. F. T. M. F. T. M. F. T. M F. T. Under 5 years .. .. .. .. Oil .. .. .. 707 Oil .. .. 729 From 5 to 10 years .. .. .. 112 055 101 .. 808 .. .. .. 10 6 16 » 10 „ 15 „ .. .. .. 1 2 3 3 1 4 4 0 4 .. 5 0 5 1 5 6 3 1 4 .. 17 9 26 „ 15 „ 20 „ .. .. .. 9 3 12 6 6 12 5 1 6 1 0 1 .. 12 10 22 3 0 3 .. 36 20 56 „ 20 „ 30 „ .. .. .. 18 10 28 25 12 37 15 4 19 1 2 3 3 0 3 28 14 42 5 3 8 1 0 1 96 45 141 „ 30 „ 40 „ .. .. . . 13 17 30 13 26 39 17 18 35 6 3 9 5 1 6 32 24 56 6 4 10 0 3 3 92 96 188 „ 40 „ 50 „ .. .. -. 22 19 41 9 17 26 10 20 30 1 2 3 4 0 4 30 36 66 2 3 5 2 0 2 80 97 177 „ 50 „ 60 „ .. .. .. 15 14 29 9 15 24 11 11 22 3 4 7 1 2 3 24 25 49 2 4 6 0 2 2 65 77 142 „ 60 „ 70 „ .. .. .. 17 5 22 10 11 21 11 18 29 1 0 1 1 3 4 11 6 17 3 1 4 0 3 3 54 47 101 „ 70 „ 80 „ .. .. .. 14 3 17 11 4 15 4 4 8 0 1 1 2 2 4 5 6 11 5 0 5 .. 41 20 61 „ 80 „ 90 „ .. .. .. 347 134 044 022 101 112 011 .. 6 15 21 Upwards of90„ .. .. .. 101 011 .. .. .. 011 .. .. 123 Unknown .. .. .. .. 213 .. .. .. .. 022 101 .. 336 Transfers .. .. .. .. 336 314 527 .. 404 12 3 4 14 18 .. 20 22 42 Totals .. .. .. 119 83 202 90 102 192 83 82 165 13 14 27 41 8 49 145 133 278 34 31 65 3 8 11 528 461 989

Auckland. Christohurch. (Seaeliffl. Hokitika. Nelson. Porirua. Tokanui. ' (Private Mental Total. Hospital). _ T . _ M. r. T. M. F. T. M. F. T. M. F. T. M. F. T. ! M. F. T. M. F. T. M. F. T. M. F. T. First class (first attack and within 3 months 36 19 55 43 39 82 25 29 54 5 7 12 7 3 10 77 74 151 15 5 20 1 4 5 209 180 389 on admission) Second class (first attack above 3 months and 8 7 15 9 9 18 5 5 10 1 1 2 4 2 6 ! 17 19 36 0 3 3 .. 44 46 90 within 12 months on admission) Third class (not first attack, and within 12 38 26 64 17 29 46 21 23 44 5 3 8 6 2 8 ! 16 11 27 7 3 10 1 3 4 111 100 211 months on admission) Fourth class (first attack or not, but of more 18 18 36 18 24 42 27 23 50 2 3 5 20 1 21 34 27 61 8 6 14 1 1 2 128 103 231 than 12 months on admission) Unknown .. .. .. 16 10 26 .. .. .. .. .. .. ; .. 16 10 26 Transfers .. .. .. .. 336 314 527 .. 404 123 4 14 18 .. 20 22 42 Totals .. .. .. 119 83 202 90 102 192 83 82 165 13 14 27 41 8 49 145 133 278 34 31 65 1 3 8 11 528 461 989

H.—7.

Table V.—Ages of Patients discharged "Recovered" and "Not Recovered" during the Year 1926.

Table VI.— Ages of Patients who died.

18

Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. (Private Total. Ages. Be- Not re- Re- Not re- Re- Not re- Re- Not re- Re- Not re- Re- Not re- Re- Not re- Re- Not re- x> . , Not covered, covered. covered, covered, covered, covered. covered, covered, covered. covered, covered, covered, covered, covered, covered, covered. covered. recovered. _ I I I i I M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. Under 5 years From 5 to 10 years .. .. Oil.. .. .. .. .. .. .. .. .. Oil.. .. .. .. .. 022 „ 10 „ 15 .. .. .. . • ■ ■ -. .. .. .. 0 1 1 0 2 2.. . .. .. 011022 „ 15 ,, 20 „ ..011011134202011325011 .. .. .. 2461 0 1 .. .. .. .. 3 10 13 63 9 „ 20 „ 30 „ .. 3 2 5 1 2 3 6 9 15 2 1 3 6 0 6 4 2 6 . . 1 0 1 0 1 1 .. 12 10 22 0 2 2 3 3 6 1 0 1 1 1 2 .. 31 26 "57 9 7 16 „ 30 „ 40 „ .. 8 5 13 0 4 4 4 13 17 1 2 3 3 4 7 4 4 8 1 0 1 .. .. .. 18 9 27 1 3 4 2 2 4 2 0 2 0 1 1 .. 36 34 70 8 13 21 „ 40 „ 50 „ .. 8 6 14 3 0 3 5 9 14 .. 5 9 14 0 8 8 .. 0 1 1 2 1 3 .. 9 12 21 .. 1 0 1 .. .. .. 30 37 67 3 9 12 „ 50 „ 60 „ .. 3 3 6 0 2 2 4 5 9 1 5 6 5 5 10 4 1 5 1 0 1 01 101 1 .. 8 6 14 0 1 1 1 0 1 .. 0 1 1 .. 22 21 43 5 10 15 „ 60 „ 70 „ ..213022033033145314 .. 011022 .. 235123 .. 011 .. .. 5 13 18 4 10 14 ,, 70 ,, 80 ,, ..1 0 1 .. 202426 .. 022 .. .. .. .. 123 .. 202 .. .. .. 628448 „ 80 „ 90 „ .. 2 0 2 .. .. ■ • ■ ■ .. .. .. .. .. .. .. .. .. .. 2 0 2 Upwards of 90 „ . . .. 10 1 .. . . .. • • .. .. .. .. .. .. . . .. . . .. .. 10 1 Unknown .. ..112 .. .. .. .. .. •• .. 10 1 .. .. .. 101 .. .. 112202 Transfers .. .. .. 224 .. 303 .. 516 .. 202 .. .. .. 3 15 18 .. 224 .. 325 .. 20 22 42 Totals .. 28 19 47 7 14 2122 42 64 13 13 26 20 23 43 23 21 44 2 1 3 3 3 6 2 5 7 1 0 152 47 99 6 26 32 9 5 14 6 3 9 1 3 4 3 2 5 136 145 281 62 82 144 [

Ages. Auckland. Ohristchurch. Dunedin (SeacliS). Hokitika. Nelson. Porirua. Tokanui. Total. M. T. T. M. F. T. M. F. T. M. F. F. M. F. F. M. F. T. M. F. T. M. F. T. M. F. T. From 5 to 10 years .. .. .. Oil Oil .. .. 202 .. .. i .. 224 „ 10 „ 15 „ .. .. .. .. .. Oil .. .. 2 2 4 .. 1 .. 2 3 5 „ 15 „ 20 „ .. .. .. Oil 022 101 .. .. 202 .. .. 336 „ 20 „ 30 „ .. .. .. 5 1 6 1 0 1 4 0 4 .. .. 1 7 8 1 0 1 .. 12 8 20 „ 30 „ 40 „ .. .. .. 0 3 3 2 4 6 4 0 4 1 0 1 .. 6 4 10 .. Oil 13 12 25 „ 40 „ 50 „ .. .. .. 7 4 11 5 6 11 4 2 6 2 0 2 1 0 1 6 6 12 .. ! .. 25 18 43 „ 50 „ 60 „ .. .. .. 8 9 17 6 4 10 11 6 17 2 1 3 1 1 2 11 5 16 3 1 4 1 0 1 43 27 70 „ 60 „ 70 „ .. .. .. 12 2 14 7 8 15 3 6 9 1 0 1 2 0 2 10 4 14 4 1 5 Oil 39 22 61 „ 70 „ 80 „ .. .. .. 12 5 17 7 9 16 13 8 21 1 0 1 1 0 1 8 6 14 8 1 9 .. 50 29 79 „ 80 „ 90 „ .. .. 3 4 7 2 3 5 5 7 12 1 3 4 1 0 1 2 2 4 Oil .. 14 20 34 „ 90 „ 100 „ .. .. .. .. 1 0 1 .. .. 0 2 2 .. .. 1 2 3 Unknown .. .. .. .. 303 .. .. Oil .. .. .. .. 314 Totals .. .. .. 50 30 80 30 37 67 46 30 76 8 5 13 8 1 9 48 38 86 16 4 20 1 2 3 207 147 354

H.—7.

Table VII. —Condition as to Marriage.

19

I Admissions. | Discharges. Deaths. I I Auckland— m. p. t. m. f. t. m. f. t. Single.. .. .. .. ~ .. 58 33 91 10 11 21 21 11 32 Married .. .. .. .. .. 41 34 75 14 13 27 18 11 29 Widowed .. .. .. .. .. 10 13 23 4 7 11 5 8 13 Unknown .. .. .. .. .. 7 07 5 0 5; 606 Transfers .. .. .. .. .. 336 224! Totals .. .. .. .. . . 119 83 202 35 33 68 I 50 30 80 Chbistohuboh — Single .. .. . . .. .. .. 52 50 102 18 29 47 16 20 36 Married .. .. .. .. .. 28 38 66 13 24 37 11 5 16 Widowed .. .. .. .. .. 6 13 19 1 2 3 3 12 15 Unknown .. .. .. .. .. 101 Transfers .. .. .. .. 314 303! Totals .. . . .. .. .. 90 102 192 35 55 90 I 30 37 67 Ddnedin (Seaoliff) — Single .. .. .. .. .. .. 51 32 83 27 20 47 28 11 39 Married .. .. .. .. .. 25 32 57 10 19 29 12 14 26 Widowed .. .. .. .. .. 2 16 18 1 4 5 6 5 11 Unknown Transfers .. .. .. .. .. 527 5 16 Totals .. .. .. .. .. 83 82 165 43 44 87 46 30 76 Hokitika— Single .. .. .. .. .. .. 10 3 13 1 1 2 6 1 7 Married .. .. .. .. .. 279 213 213 Widowed .. .. .. .. .. 145 022 022 Unknown .. .. .. .. .. .. .. 0 11 Transfers .. .. .. .. .. .. 202 Totals .. .. .. .. .. 13 14 27 5 4 9 8 5 13 i Nelson— Single .. .. .. .. .. .. 28 3 31 2 1 3 6 0 6 Married .. .. .. .. .. 64 10 134 Widowed .. .. .. .. .. 314 011 213Unknown Transfers .. .. .. .. •• 404 Totals .. .. .. .. .. 41 8 49 3 5 8 8 1 9 PORIBUA — Single .. .. . . .. .. .. 79 72 151 14 27 41 20 12 32 Married .. . . .. .. .. 57 45 102 39 24 63 23 14 37 Widowed .. .. .. .. .. 8 14 22 2 7 9 5 12 19 Unknown Transfers .. .. .. .. .. 1 2 3 3 15 18 Totals .. .. .. .. .. 145 133 278 58 73 131 48 38 86 Tokanui— Single.. .. .. .. .. .. 17 8 25 8 3 11 9 0 9 Married .. .. .. .. .. 13 8 21 437 729 Widowed .. .. .. .. .. | 0 1 1 10 1 0 2 2 Unknown .. .. .. .. Transfers .. .. .. .. .. 4 14 18 2 2 4 Totals .. .. .. .. .. 34 31 65 15 8 23 16 4 20 Ashburn Hall — Single .. .. .. .. .. .. 235 12 3 112 Married .. .. .. .. .. 123 Widowed .. .. .. .. .. 033 011 011 Unknown Transfers .. .. .. .. .. .. 325 Totals .. .. .. .. .. 38 11 459 123 Totals— Single .. . . .. .. .. 297 204 501 81 94 175 Married . . .. .. .. .. 173 170 343 83 87 170 Widowed .. .. .. .. .. 30 65 95 9 24 33 Unknown .. .. .. .. .. 808 505 Transfers . . .. .. .. .. 20 22 42 20 22 42 Totals .. .. .. .. .. 528 461 989 198 227 425 207 147 354

H.—7. I

Table IX.—Ages of Patients on 31st December, 1926.

Table VIII.— Native Countries.

20

Countries. Auckland. Christchurch. Hokitika. Nelson. Porirua. Tokanui. (Privat^M^H ] ) Total. I M. F. T. M. F. T. | M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. England and Wales .. .. 120 83 203 70 92 162 84 57 141 29 9 38 14 13 27 160 90 250 45 14 59 4 3 7 526 361 887 Scotland .. .. .. .. 31 17 48 23 17 40 62 52 114 6 2 8 13 5 18 42 25 67 12 4 16 2 2 4 191 124 315 Ireland .. .. .. .. 47 38 85 28 32 60 54 43 97 24 9 33 10 3 13 47 57 104 14 16 30 .. 224 198 422 New Zealand .. .. .. 311 295 606 241 302 543 370 332 702 68 43 111 179 54 233 391 369 760 112 84 196 8 22 30 1,680 1,501 3,181 Australian States .. .. .. 40 25 65 20 16 36 18 24 42 11 3 14 10 6 16 34 27 61 9 3 12 0 2 2 142 106 248 France .. .. .. .. 101 .. .. 101 101 .. 202 .. 505 Germany .. .. .. .. 61 7 224 20 2 101 101 65 11 213 .. 20 9 29 Austria .. .. .. .. 27 1 28 022 10 1 .. 202 01 1 303 .. 33 4 37 Norway .. .. .. .. 40 4 011 30 3 202 .. 30 3 101 .. 13 1 14 Sweden .. .. .. .. 31 4 404 40 4 303 202 31 4 .. .. 19 2 21 Denmark .. .. .. -. 2 0 2 213 21 3 .. 101 52 7 101 .. 13 4 17 Italy .. .. .. 31 4 .. .. 505 101 325 101 .. 13 3 16 China .. .. .. .. 20 2 101 50 5 303 .. 10 1 101 .. 13 0 13 Maoris .. . . .. 19 19 38 .. .. 1 0 1 5 2 7 13 11 24 2 0 2 .. 40 32 72 Other countries .. .. 22 8 30 6 7 13 12 6 18 5 1 6 1 0 1 15 9 24 8 2 10 .. 69 33 102 Unknown .. .. .. .. 14 7 21 0 1 1 .. .. 29 37 66 .. .. .. 43 45 88 Totals.. .. .. 652 496 1,148 397 473 870 617 515 1,132 159 67 226 269 120 389 723 599 1,322 213 124 337 ' 14 29 43 3,044 2,423 5,467 I __J

I Ages. Auckland. Christchurcb. ' Sea " j Hokitika. Nelson. Porirua. Tokanui. (PrWateM^H') Total. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. Prom 1 to 5 years .. .. 01 1 022 .. .. 14 0 14 0 1 1 .. I .. 14 4 18 5 „ 10 „ .. .. 2 3 5 0 13 13 1 0 1 .. 25 3 28 0 6 6 .. j .. 28 25 53 „ 10 „ 15 „ .. .. 3 5 8 10 3 13 4 4 8 .. 47 4 51 0 19 19 2 2 4' .. 66 37 103 „ 15 „ 20 „ .. .. 19 10 29 11 10 21 15 6 21 2 1 3 22 2 24 17 15 32 6 1 7 .. 92 45 137 „ 20 „ 30 „ .. .. 85 48 133 55 43 98 76 40 116 5 3 8 27 14 41 98 59 157 13 11 24 .. 359 218 577 „ 30 „ 40 „ .. .. 96 96 192 72 62 134 92 92 184 28 9 37 31 16 47 143 123 366 26 21 47 1 1 2 489 420 909 „ 40 „ 50 „ .. .. 153 118 270 98 136 234 156 118 274 46 18 64 30 17 47 198 140 338 58 29 87 2 6 8 741 582 1.323 „ 50 „ 60 „ .. .. 127 107 234 61 102 163 119 121 240 43 23 66 33 27 60 141 120 261 65 28 93 2 6 8 591 534 1,125 „ 60 „ 70 „ .. .. 98 57 155 49 68 117 78 89 167 16 4 20 25 22 47 76 68 144 28 20 48 7 11 18 377 339 716 „ 70 „ 80 „ .. .. 41 30 71 34 23 57 57 35 92 9 5 14 12 8 20 41 34 75 8 11 19 1 3 4 203 149 352 „ 80 „ 90 „ .. .. 12 9 21 6 10 16 12 9 20 4 3 7 1 4 5 8 14 22 3 1 4 1 2 3 47 52 99 Upwards of90„ .. .. .. 112 202 .. 101 101 .. .. 516 Unknown .. .. . . 16 12 28 .. 5 1 6 6 1 7 1 3 4 .. 4 0 4 .. 32 17 49 Totals.. .. .. 652 496 1,148 397 473 870 617 515 1,132 159 67 226 269 120 389 723 599 1,322 213 124 337 14 29 43 ? 3,044 2,423 5,467

H.—7

Table XI.—Length of Residence of Patients discharged "Recovered" during 1926.

Table X.—Length of Residence of Patients who died during 1926.

21

Length of Residence. Auckland. Christchurch. Hokitika. Nelson. Porirua. Tokanui. ("privan-'Vi'lV.'; : Total. j ' . . J M. F. T. M. F. T. M. J. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. Under 1 month .. .. .. .. 10 1' .. 202 .. 112 527 .. .. 93 12 Prom 1 to 3 months .. . . . . 6 4 10 8 12 20 3 5 8 .. Oil 11 11 22 3 0 3 1 1 2 32 34 66 3 „ 6 „ .. . . . . 8 5 13 8 14 22 2 4 6 .. 0 1 1 13 13 26 3 4 7 0 1 1 34 42 76 6 „ 9 „ .. .. . . 3 4 7 2 2 4 2 3 5 .. .. 6 4 10 . . .. 13 13 26 9 „ 12 „ .. .. .. 2 0 2 3 3 6 3 0 3 .. 0 1 1 5 6 11 2 0 2 0 1 1 15 11 26 1 „ 2 years .. .. .. 3 3 6 0 4 4 5 7 12 2 1 3 .. 6 6 12 .. .. 16 21 37 2 „ 3 .. .. .. .. 011 101 .. .. 224 112 .. 448 „ 3 „ 5 ,, .. .. .. 314 Oil 022 .. 101 415 .. .. 85 13 „ 5 „ 7 „ .. .. .. 022 033 011 .. .011 .. .. ..' 077 7 „ 10 „ .. .. .. .. 0 2 2 112 .. .. 0 11 .. .. 14 5 „ 10 „ 12 „ .. .. .. 10 1 10 1 .. .. ... 0 11 .. .. 2 13 12 15 Over 15 years .. .. .. 101 .. 101 .. .. .. .. .. 202 Totals .. .. .. 28 19 47 22 42 64 20 23 43 2 1 3 2 5 7 52 47 99 9 5 14 1 3 4 136 145 281

Leugtl. of Residence Auckland. Christchurch. (Seacfii'O Hokitika. Nelson. Porirua. Tokanui. (Private M.H.). Total. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. Under 1 month .. .. .. 606 246 303 .. 202 268 022 112 16 13 29 From 1 to 3 months .. .. .. 516 58 13 167 112 101 73 10 202 .. 22 19 41 „ 3 ,, 6 „ .. .. .. 64 10 303 426 101 .. 538 .. .. 19 9 28 6 „ 9 „ .. .. .. 7 4 11 3 1 4 3 1 4 .. .. 2 3 5 .. .. 15 9 24 9 „ 12 „ .. .. .. 202 .. 112 .. .. 314 202 011 83 11 1 „ 2 years .. .. .. 57 12 044 314 112 101 4 3 7:2 0 2 .. 16 16 32 2 „ 3 „ .. .. .. 1 2 3 3 3 6 5 2 7 .. .. 8 2 10 . . .. 17 9 26 3 5 .. .. .. 224 224 426 011 101 459 .. .. 13 12 25 „ 5 „ 7 ,, .. .. .. 336 426 134 .. 101 055 .. .. 9 13 22 7 10 .. .. .. 123 011 415 .. 101 213 .. .. 85 13 „ 10 „ 12 „ .. .. .. 0 1 1 0 5 5 .. -■ 1 0 1 2 0 2 1 0 1 .. 4 6 10 „ 12 „ 15 „ .. .. . . 1 1 2 0 2 2 5 2 7 2 1 3 .. 1 2 3 .. .. 9 8 17 Over 15 years .. .. .. .. 10 2 12 8 5 13 11 9 20 3 1 4 0 1 1 7 4 11 8 2 10 .. 47 24 71 Died while absent on trial .. .. 112 .. 101 .. .. 101 101 .. 415 Totals .. .. .. 50 30 80 30 37 67 46 30 76 8 5 13 8 1 9 48 38 86 j 16 4 20 1 2 3 207 147 354

H.—7.

Table XII.—Causes of Death.

22

-d $3 13 OCT s I I I CaU3es - J I 3s ; d S i ||s ■3 i ; f 5 8 1 I |5« * 3 5 13 o a? o o 5 +? •«s 8 n w j & £ g § M. F. M. P. I M. F. M. F. M. F. M. F. M. F. M. F. M. F. I. General Diseases. Tuberculosis — General .. .. .. .. .... .. 10 .. .. .. 10 Of lungs .. .. .. 42 10*10 .. .. 49 .. .. 13 11 Cerebral syphilis .. .. .. 0 1 .. . . .. .. , . ,. 0 1 Cancer .. .. .. 102210220 .. 24 .. .. 78 Grave's disease .. ..01 ! .. ,. .. .. .. 01 Lymphadenoma .. . . .. 0 1 . . .. .. .. .. 0 1 Lymphatic leucaemia .. .. .. 1 0 .. .. .. I 10 Pyaemia .. .. .. 10 .... .. .. .. .. .. 10 Dysentery .. .. ..3 3 .. .. .. .. 1 0 0 1.. 4 4 Pernicious Anaemia .. .. .. .. .. ., .. 0 1 . . ! . . 0 1 II. Diseases of the Nervous j System. Melancholia, exhaustion from .. .. 1 4 [ 1 2 .. .. 03 .. .. 29 Mania, exhaustion from .. 1 10 11 2 .. .. 11 35 General paralysis of insane .. 4 0 5 1 5 0 .. 1 0 15 0 1 0 .. 31 1 Dementia, paralytic .. .. .... .. . . .. 10 .. .. 10 Organic brain-disease .. ..01.. 31 .. .. .. .. .. 32 Epilepsy .. .. 2 13 3:32 20 1 0 3 1 .. ! .. 14 7 Hemiplegia .. .. ..01 .. .. .. .. .. .. .. 01 Cerebral hemorrhage .. ..4431 10 .. .. 01 20 .. 10 6 Cerebral tumour .. .. .. .. | .. .. 10 .. j .. 10 III. Diseases of the Respiratory System. Pneumonia .. .. ..200120 .. 2031 ..j.. 92 Pneumonia (lobar) .. .. .. 11 .. .. .. .. 4 0.. 51 Pulmonary congestion.. .. . . .. .. .. .. , . 10 1.. 10 Chronic Asthma .. .. .. .. .. .. 10.. 10 Bronchitis .. .. .. .. 2 0 .. .. .. 11 ..1142 IV. Diseases of the Circulatory System. Heart-disease .. ..94 J 5 2 .. .. 6 6 1 1 .. 21 13 Valvular disease of the heart .. .. 1 0 j 6 2 0 1 .. .. .. .. 73 Endocarditis .. .. .. .. 0 1.... .. .. .. .. 01 Arterio-sclerosis .. ..10 131.. .. .. 21 .. .. 44 Myocarditis .. .. .. .. 0 3.... .. .. .. .. 03 Thrombosis .. .. .. .. 0 1 j .. j 0111 .. .. 13 V. Diseases of the Digestive System. Enteritis .. .. 1 1 1 1 ! .. I .. .. _ 22 Diarrhcea .. .. ..01 .. .. .. .. .. .. .. 01 Colitis .. .. .. .. I .. .. .. 0101 VI. Diseases of the Genitourinary System. Pyonephrosis .. ..10 .. ..].. .. .. .. .. 10 Nephritis .. .. .. .. .. .. .. .. 1110 .. 21 VII. Diseases of the Skin. Gangrene .. .. .. .. 11 .. .. .. .. .. .. 11 VIII. Diseases of the Bones. Osteoma of pelvis .. .. .. .. .. .. 10 .. .. .. 10 IX. Old Age. Senile decay .. .. 14 9 7 11 15 17 3 3 2 0 5 6 4 2 .. 50 48 X. Ill-defined Causes. Coma .. .. .. .. .. .. 01 .. .. .. .. 01 Cachexia .. .. .. .. .. .. 10 .. .. .. .. 10 XI. Died while on Leave ..21 .. .. .. .. 1110 .. 42 Totals .. .. 50 30 30 37 46 30 8 5 8 1 48 38 16 4 1 2 207 147

H.—7

Table XIII.—Principal Assigned Causes of Insanity

23

CVhriRt- DnnAfHn Ashburn Causes. Auckland, c h urc h i (Seacliff) Hokitika. Nelson. Porirua. Tokanui. Hall Total. I I I I I M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Heredity .. .. .. 15 10 19 12 9 11 3 2 10 0 15 20 5 3 .. 76 58 Congenital .. .. 18 8 8 13 17 5 0 3 11 2 4 1 4 3 .. 62 35 Previous attack .. 4 9 9 25 18 26 .. .. 20 19 2 1 .. 53 80 Puberty or adolescence 14 9 11 5 .. .. .. 9 9 .. .. 34 23 Climacteric .. .. 03 09 0 13 03 .. 0 22 01 .. 0 51 Senility .. .. .. 19 10 17 14 10 10 1 3 3 4 6 10 5 0 0 2 61 53 Lactation .. .. .. .. 02 .. .. .. 0 5 01 .. 08 Puerperal .. .. ..0 3 0 5 0 3 .. .. 0 3 .. .. 0 14 Mental stress — Sudden .. .. .. .. .. 21 .. .. 03 .. .. 24 Prolonged .. .. .. 97 58 68 22 10 16 17 24 11 42 47 Alcohol .. .. 40 91 41 30 20 12 4 20 .. 36 6 Syphilis .. .. ..11 1 4 1 30 .. 20142 20 36 4 Drug habit .. .. .. .. .. 10 .. .. 11 .. .. 21 Isolation .. .. .. .. .. .. .. 10 .. .. ..10 Post-operative .. .. .. 01 .. .. .. 0J01 .. 03 Traumatic .. .. .. .. .. .. .. .. 20 3 0 .. 50 Overwork .. .. .. .. 10 .. .. .. .. .. 1121 Epilepsy .. .. ..53 23 72 10 .. 9 6 22 26 16 Arterio-sclerosis .. ..7201 .. .. 10 10 .. ..'93 Encephalitis .. .. ..10 .. .. .. 1010 .. .. 30 Influenza .. .. .. .. .. . .. .. .. .. .. 0 10 1 111 health .. .. ..5 7 .. .. .. 1 0 15 6 1 0 j 22 13 Toxic .. .. ..32 .. .. .. .. 01 .. .. 33 Cerebral tumour .. .. .. 1 0 .. .. .. .. j 1 0 Cerebral haemorrhage .. .. .. 1 0 .. .. .. .. ..10 Hemiplegia .. .. .. .. 10 .. .. .. .. .. ..jlO Organic brain-disease .. .. 12 .. .. .. .. 20 .. ..;32 Heart-disease .. .. 02 .... .. .. .. .. .. ' 0 2 Grave's disease .. .. 01 .. .. .. .. .. .. 1 0 1 1 Neurasthenia .. .. .. .. .. 10 .. .. .. ..10 Infantile paralysis .. .. .. .. 1001 .. ..ill Insomnia .. .. .. .. j .. .. .. .. 0 1 • 0 1 Unknown .. .. .. 01 01; .. 21 32 17 0 21 02: 24 8 Transfers .. .. .. 33 3152 .. 40 12 4 14 .. 20 22 Totals .. .. 119 83 90 102 83 82 13 14 41 8 145 133 34 31 3 8 528 461

H.—7

Table XIV.—Former Occupations of Patients.

24

3 ~ ~ £ w f. £• S s So: rd gj s d Occupations. . 2 ® m Occupations. 2 m 3 ! ! I I p g -3 s 1 ! a i , « -3 ? 3 ! 1 | 1 I I I I Ills! | I I i ® PS^SOqoO^O ■«fOQWS5Ci<E-i<iB -"SOQMlaPMB^B Males. Accountants .. .. Ill I ■ 2 \ Medical practitioners I .. 1 1 .. .. 3 Apprentice .. .. 1 j 1 Messenger .. 1 .. . . I Artist .. 1 .. .. 1 Mill hand . . . . 1 1 Billiard-marker .. ..j 1 .. .. 1 ! Miners .. .. 22 1, 211.... 9 Bakers .. .. lj .. 1 .. .. 2 Motor-drivers.. .. 1 .. l! .. 1 2 .. .. 5 Blacksmiths .. .. .. ] 2 1 2 .... 5 j Orchardists .. .. 1 1 1.. 3 Bookkeeper .. .. 1 1 Overseers .. 1 1 .. 2 Boilermaker .. .. .. 1 1 Musician .. .. 1 ! .. 1 Bootmakers .. .. 1 1 2 4 j Painters . . .. 3 2 5 Brassfinisher .. .. .. 1 1 Pensioners .. .. 2 1 .. .. 3 Bushman .. 1 .. 1 I Piano-tuner . . . . ] 1 Butchers .. .. .. 1 1.... 2.... 4 Plumbers .. .. I 1 .. .. 2 Carriers .. .. 2 2 Porters .. .. 2 2 Carpenters .. .. 2 1 5 .... 8 Printer .. ; .. .. 1 .. .. ] Civil servants.. .. 2 3 1 1 7 Prisoners .. .. 2 1 2 .... 4 Clerks .. .. .. 2 3.... 4.... 9 Rabbiter .. . . 1 ! 1 Compositors .. 3 .. .. 3 Railway employees i .. .. 2 .. .. 2 Contractor . . .. .. 1 1 Saddler .. 1 . . .. 1 Cooks .. 1.... 3.... 4 Sailmakers .. .. 1 .. .. j .. 1 2 Drapers .. .. .. 2 2 .... 4 Sawmiller .. I 1 1 Driver .. .. 1 1 School-teachers .. .. 2 .... 1 2.. .. 5 Electrician .. I 1 Seamen .. . . 1 2 ...... 3 .. .. 6 Engineer .. . . 1 1 Shepherd .. .. .. 1 1 Engine-driver.. .. .. ] 1 Showman .. .. 1 .. .., 1 Factory employees .. 1 1 .. .. 2 Stationers .. . . .. 1 1 2 Farmers . . .. 12 3 6 1 2 24 9 1 58 Stevedore .. 1 .. .. 1 Farm hands .. .. .. 9 .. 2 1 .. 4 .. 16 Storekeepers . . .. .. 2 2| 4 Flax-mill hand 1 .. .. 1 Storemen .. .. 1 1 .. I .. 1 1.... 4 Fireman .. 1 .. .. 1 Students . . .. .. 2 I 3 Fitters .. 2 .... 2 Tailor .. 1 1 Furniture-dealer .. 1 1 1 Tanner . . .. .. 1 1 Fruiterer .. .. .. 1 1 Telegraphists .. . . .. 2 .. 2 Gardeners .. .. 2 4 2 1.. 9 Tilemaker .. II.... 1 Grocers .. .. 1 1.... 2 Tram-conductor ] .. 1 Gum-diggers .. . . 3 .. .. 1 .. .. 3 Traveller .. .. .. 1 .. 1 Horse-trainer .... ..' 1 1 Warehouseman .. 1 I Hotelkeeper .. .! .. 1 I Watchmakers.. .. 2 .. .. 2 Importers .. .. 2 .. 2 Wood-turner .. .. 1 .. .. 1 Insurance agents .. 1 I .. I ] 2 No occupation .. 29 8 20; .. 22 14 6 .. 99 Jeweller .. .. I .. 1 .. .. j 1 Unknown .. .. 4 4 Labourers .. .. j 23 26 33 7 4 45! 5 .. 143 Transfers .. .. 335.. 414.. 20 Land agent .. 1 . . .. 1 Laboratory assistant .. .. .. 1 .. . .1 ... ..j .. 1 Totals .. 119 90 83 13 41145 34 3 528 Machinists .. ..[12 1 ■ • ■ ! • • 3 Females. Bookbinder .. .. 1 .. 1 School-teachers .. 1 2 3 .. 1 2 .. lj 10 Caretaker .. .. 1 1 .. 1 Student .. 1 1 Clerks .. .. .. 2 ! .. 2 Tailoress .. 1 .. .. 1 Domestic duties .. 58 71 55 12 7 117 1G 4 339 Typists .. .. 3.. 1 4 Dress nakers .. 1.... 2 .... 3 Waitress .. I 1 Factory employee I 1 No occupation .. 14 24 17 .... 7 1 ..! 63 Masseuse .. 1 1 Unknown .. .. 1 .. I Music-teachers .. .. 1 1 2 Transfers .. .. 3 1 2 .... 2 14 .. 22 Nurses .. 1 1 2 Pensioners .. . . .. 1 .. 2 .. 1 .. .. 4 Totals .. 83102 82 14 8133 31 8 461 Prisoners .. .. 1 I.... 2

4—H. 7

H.—'7.

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.

25

Discharged. Remaining, i, r „™c,p u,, m hpi-Q Percentage Percentage of Deaths Year. Admitted. i Died. 31st December in iimuers of Recoveries on on Average Numbers „ . I -o.-j , T , T » each Year. resident. Admissions. resident. Recovered. ! Relieved. Hot Improved. I I i I , M. i F. T. M. r. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 1875 .. .... .... .. 482 254 736 1876 jr.. 221 117 338 129 79 j 208 17 8 25 2 8 10 36 12 48 519 264 783 491 257 748 54-53 ! 66-01 57-56 8-21 3-58 6-70 1877 .. 250 112 362 123 57 180 20 5 25 3 2 5 42 21 63 581 291 872 541 277 818 49-20 50-80 49-72 7 76 7-58 7-70 1878 .. 247 131 378 ; 121 68 189 14 14 28 ! 4 4 8 51 17 68 638 319 957 601 303 904 48-98 51-90 50-00 8-48 5-61 7-52 1879 .. 248 151 399 112 76 188 15 13 28 j 9 4 13 55 16 71 '695 361 1,056 666 337 1,003 45-16 50-33 47-11 8-25 4-74 7 07 1880 .. 229 149 378 100 67 I 167 j 36 25 61 I 5 2 7 54 20 74 729 396 1,125 703 371 1,074 43-66 44-96 44-17 7-68 5-39 6-89 1881 .. ! 232 127 359 93 65 ! 158 41 36 77 ! # 2 11 49 14 6.3 769 406 1,175 747 388 1,135 40-08 51-10 44-01 6-29 3-60 5-55 1882 .. 267 152 419 95 59 154 49 32 81 5 6 11 60 19 79 827 442 1,269 796 421 1,217 35-58 38-81 36-75 7-53 4-51 6-49 1883 .. 1 255 166 421 102 78 180 j 13 20 33 10 9 19 65 18 83 892 483 1,375 860 475 1,335 40-00 46-98 42-75 7-55 3-78 6-21 1884 .. : 238 153 391 89 77 166 17 9 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 6-53 1885 ..I 246 133 379 95 76 171 10 5 ' 15 25 2 27 73 22 95 981 542 1,523 965 528 1,493 38-62 57-14 45-12 7-56 4-16 6-36 1886 .. I 207 165 372 99 60 159 ! 11 17 28 j 12 7 19 57 19 76 1,009 604 1,613 984 559 1,543 47-82 36-36 42-74 5-79 3-39 4-91 1887 .. 255 161 416 103 78 181 34 17 51 74 27 101 1,053 643 1,696 1,034 613 1,647 40-39 48-75 43-61 7-15 4-40 6-13 1888 .. 215 146 361 116 92 208 1 31 j 28 59 : 2 3 5 78 26 104 1,041 640 1,681 1,045 641 1,686 53-95 63-01 57-62 7-56 4-05 6-16 1889 .. i 230 161 391 93 53 146 31 i 30 61 3 1 4 70 i 30 100 1,074 687 1,761 1,046 660 1,707 40-43 32-92 37-34 6-69 4-54 5-86 1890 .. 230 160 390 98 88 186 i 23 17 40 i 12 5 17 76 35 111 1.095 702 1,797 1,078 685 1,763 42-61 55-00 47 69 7-05 5-11 6-29 1891 .. 234 171 405 88 74 162 33 24 57 i 14 .. 14 79 j 41 120 1,115 734 1,849 1,089 699 1,789 37-61 43-27 40-00 7-25 5-86 6-71 1892 .. 231 158 389 89 76 165 21 17 38 , 8 2 10 74 ! 34 108 1,154 763 1,917 1,125 714 1,839 38-53 48-10 42-42 6-58 4-76 5-87 1893 .. j 281 179 460 101 89 190' 17 12 29 10 8 18 78 23 101 1,229 810 2,039 1,172 758 1,930| 35-94 49-72 41 30 666 3-03 5-23 1894 .. 270 176 446 107 76 183 15 11 26 ! 5 4 9 64 35 99 1,308 860 2,168 1,241 812 2,053139-63 43-13 41-03 5-16 4-31 4-82 1895 .. 252 165 417 105 77 182 24 19 43 1 2 3 101 42 143 1,329 885 2.214 1,313 849 2,162 41-67 46-66 43-64 7-69 4-94 6-61 1896 .. 278 159 437 104 70 174 25 16 41 2 1 3 86 32 118 1,390 925 2,315 1,347 882 2,229; 37-4! 44-02 39-13 6-38 3-63 5-29 1897 .. 284 193 477 102 73 175 17 12 29 ; 10 .. 10 105 43 148 I 1,440 990 2,430 1,411 944 2,355 35-92 37-82 36-69 7-44 4-55 6-28 1898 .. 254 212 466 ! 114 110 224 13 23 36 ! 7 1 8 88 60 148 1,472 1,008 2,480 1,438 973 2,411 44-88 51-89 48-07 6-12 6-17 6-14 1899 .. 259 199 458 88 99 187 15 19 34 | 2 1 3 114 43 157 1,512 1,045 2,557 1,487 1,004 2,491 33-98 49'49 40-83 7-67 4-28 6-30 1900 .. 300 202 502 103 96 199 29 10 39 ! .. 4 4 99 46 145 1,581 1,091 2,672 1,534 1,049 2,583 34-33 47-54 39-64 6-45 4-38 5-61 1901 .. 320 223 543 125 104 229 20 17 37 2 2 102 72 174 1,654 1.119 2.773 1,622 1,094 2,716139-06 46 64 42-17 6-29 ; 6-58 6-41 1902 .. 352 192 544 135 99 234 26 15 41 10 9 19 120 55 175 1,715 1,133 2,848 1,671 1,114 2,785 1 38-35 51-56 43-01 7-18 j 4-94 6-28 1903 .. 355 226 581 144 101 245 26 24 50 2 2 129 44 173 1,771 1,188 2,959 1,741 1,160 2,901 40-56 44-69 42-17 7-41 3-79 5-96 1904 .. 332 236 568 157 106 263 24 1] 35 1 1 120 70 190 1.801 1,237 3,038 1,780 1,198 2,978147-59 44-91 46-30 6-74' 5 84 6-38 1905 .. 360 251 611 149 121 270 i 29 24 53 147 j 67 214, 1,836 1,276 3,112 1,796 1,232 3,028 41-39 48-21 44-19 8-18 5-44 7-07 1906 .. 395 264 659 157 126 283 28 22 50 1 1 146 85 231 1,900 1,306 3,206 1,823 1,265 3,088 39-75 47-73 42-94 8-01 6-71 7-48 1907 .. 359 241 600 160 139 299 22 13 35 168 I 64 232 ] 1,909 1,331 3,240 1.851 1,285 3,136:44-29 57-68 49-84 908 4-98 7-39 1908 .. 426 318 744 180 146 326 9 12 21 1 1 148! 74 222 1,997 1,417 3,414 1,894 1,346 3,240! 42-25 45-91 43-82 7-81 5-50 6-85 1909 .. 419 297 716 179 170 349 17 11 28 1 1 136 68 204 2,083 1,465 3,548 1,970| 1,404 3,374 42-72 57-24 48-74 6-90 4-84 6-00 1910 .. 474 314 788 182 145 327 j 29 27 : 56 186: 97 283 2,160 1,510 3,670 2,028] 1,445 3,473. 38-40 46-18 41-50 9-17 6-71 8-15 1911 .. 448 317 765 163 168 331 ! 23 16 39 4 2 6 198 105 303 2,220 1,536 3,756 2,105 1,496 3,601 36-38 53-00 43-27; 9-41 7-02 8-41 1912 .. 458 381 839 184 141 325 1 17 44 ! 61 11 5 16 193 87 280 2,273 1.640 3,913 2,146; 1,551 3,697 i 40-17 37-01 38-74; 8-99 5-61 7 57 1913 .. 466 318 784 175 162 337 35 48 i 83 1 5 6 196 111 307 2,332 1,632 3,964 2,252, J,59J7 3,849! 37-55 50-94 42-98; 8-70 6-96 7-98 1914 .. 509 359 868 207 162 369 27 29 56 6 9 15 193 88 281 2,408 1,703 4,111 2,309| 1,641 3,950! 40-67 45-12 42-51! 8-36 ! 5-36 7-11 1915 .. 450 361 811 202 157 359 ! 26 32 58 10 11 21 172 112 284 2,448 1,752 4,200 2,391 1,703 4,094 44-89 43-21 44-88 7-19 ! 6-58 6-94 J916 .. 518 361 879 160 171 331 35 : 34 69 I 7 8 15 209 • 80 2S9 2,555 1,820 4,375 2,483; 1,768 4,251 30-89 47-37 37-66 8-42 , 4-52 6-80 1917 .. 470 374 844 171 152 323 [ 32 j 20 52 ! 6 5 11 205 ; 113 318 2,611 1,904 4,515 2,543] 1,825 4,368 36-38 40-64 38-27 8-06 j 6-19 7-2S 1918 .. 437 402 839 142 141 283 17 ] 36 53 ] 12 12 24 274 ] 174 448 j 2,603 1,943 4,546 2,602! 1,899 4,501 32-49 35-07 33-73 10-53 9-16 9-95 1919 .. 512 371 883 190 147 337 37 44 81 I 9 13 22 212 ] 130. 342 | 2,667 1,980 4,647 2,620; 1,907 4,527 37-11 39-62 38-17 8-09 ! 6 82 7 55 1920 .. 455 418 873 162 i 148 310 I 27 37 64 6 10 16 210 I 166 376 2,717 2,037 4.754 2,674 1,980 4,654 35-63 35-32 35-51 7-85 ! 8-40 8-08 1921 .. 479 402 881 178 193 371 30 : 21 51 ! 15 9 24 201 117 318 2,772 2,099 4,871 2,723 2,031 4,754 37-23 47-88 42-11 7-38 j 5-76 6-69 1922 .. 453 386 839 156 157 313 32 20 52 10 8 18 211 184 395 2,816 2,116 4,932 2,747 2,062 4,809 34-44 40-67 37-31 7-67 8-92 8-21 1923 .. 442 366 808 168 151 319 42 38 80 15 5 20 194 131 325 2.839 2,157 4.996 2,789 2,079 4,868 38-00 41-25 39-48 6-95 6-30 6-67 1924 .. 446 377 823 152 128 280 30 42 72 9 11 20 221 95 316 2,873 2,258 5,131 2,808 2.146 4,953 34-08 33-95 34-02 7-87 4-42 6-37 1925 .. 445 430 875 144 175 319 29 37 66 23 17 40 201 123 324 2,921 2,336 5,257 2.830 2,203 5,033 32-36 40-69 36-45 7-45 ! 5-57 6-43 1926 .. 508 439 947 136 145 281 27 : 35 62 15 25 40 207 147 354 3,044 2,423 5,467 2,926 2,287 5,213 26-18 30-75 29-67 6-16 ! 6-42 -77 17,501 12,622 30,123 6,827 5,668 12,495 1,267 ! 1,148 2,415 350 259 609 6,495 3,378 :9,873 I Excluding transfers between institutions —1,476 males, 1,019 females.

H.—7.

Table XVl.—Showing the Admissions, Discharges, and Deaths from Ist January 1876, t< 31st December, 1926 (excluding Transfers). M. F. T. In hospitals, 31st December, 1875 .. .. .. .. 482 254 736 Admissions .. .. .. .. .. .. .. 17,501 12,622 30,123 17,983 12,876 30,859 Discharged— M. E. T. Recovered .. .. .. 6,827 5,668 12,495 Relieved .. .. .. 1,267 1,148- 2,415 Not improved .. .. 350 259 609 Died .. .. .. .. 6,495 3,378 9,873 .— 14,939 10,453 25,392 ' Remaining on 31st December, 1926 .. .. .. 3,044 2,423 5,467

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

26

Males. j Females. Both Sexes. Recovered .. .. .. .. .. 38-02 44*01 40-49 Relieved ., .. .. .. .. 7-04 8-92 7-82 Not improved .. .. .. .. .. 1-94 2-01 1-97 Died .. .. .. .. .. .. 36-10 26-31 31-99 Remaining .. .. . . .. . . 16-90 18-75 17-73 100-00 100-00 100-00

H.—7.

Table XVIII.— Expenditure for Year ended 31st March, 1927.

■5—H. 7

27

Auckland. Christchurch. 1 Hokitika. Nelson. Porirua. | Tokanul. Head Otnce. Totals. £ s. d. £ s. d. ! £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. Salaries .. .. .. .. ... .. 30,807 13 7 35 ; 608 13 8 , 49,445 15 10 13,686 19 0 16,142 3 5 43,114 8 10 15,682 17 6 7,086 4 10 211,574 16 8 Official visitors .. .. .. .. .. 52 10 0 25 4 0 23 2 0 10 10 0 .. 16 16 5 .. .. 128 2 5 Advertising, photographs, books, &c... .. .. 2 14 9 75 10 19 80 4 11 0 5 17 0 336 070 18 75 61 14 6 Bacteriological research .. .. .. .. 550 130 0 15 0 110 0 16 0 16 12 6 1 11 6 .. 27 40 Bedding and clothing .. .. .. .. 5,568 14 7 5,088 18 5 6,793 11 8 811 0 4 1,657 16 7 7,964 18 3 1,331 4 0 .. 29,216 3 10 Buildings, including additions, &c. .. .. .. 1,393 5 10 1,055 13 10 3,048 16 6 202 19 8 57 2 10 976 3 2 524 17 10 .. 7,258 19 8 Dental services .. .. .. .. .. 10 3 0 98 17 7 97 4 4 33 12 6 6 6 1 109 19 3 0 12 6 .. 356 15 3 Developmental work .. .. .. .. .. .. .. .. .. .. 1,648 5 9 .. 1,648 5 9 Farms, maintenance of .. .. .. .. 817 17 4 2,286 11 1 4,025 111 552 10 10 1,299 18 11 1,954 7 11 2,830 16 0 .. 13,767 4 0 Fencing, draining, and roading .. .. .. 50 7 5 241 14 10 758 18 0 23 7 4 99 2 2 295 18 1 248 2 7 .. 1,717 10 5 Freight, cartage, and transport charges .. .. 48 7 4 93 8 6 391 7 6 70 19 10 121 15 6 155 17 0 107 9 5 .. 989 5 1 Fuel, light, power, cleaning, and water .. .. 4,966 0 2 5,085 13 0 5,048 15 1 1,040 6 8 2,188 1 4 5,415 19 5 1,526 10 3 .. 25,271 5 11 Funerals, expenses of .. .. .. .. 75 16 6 70 0 0 45 0 0 14 12 10 28 0 0 77 10 0 109 18 6 .. J 420 17 10 Furniture and furnishings .. .. .. .. 737 19 8 318 3 8 279 10 8 42 9 7 62 3 2 587 1 11 120 5 4 .. ! 2,147 14 0 Gardens and shrubberies, expenses of .. .. 13 14 0 196 0 11 43 12 7 17 10 6 33 5 7 73 5 3 79 6 6 .. 456 15 4 Laundry .. .. .. .. .. .. 433 8 8 561 9 8 2,600 18 2 1,066 10 3 200 8 8 390 0 9 191 15 3 .. 5,444 11 5 Machinery, repairs, and stores .. .. .. 63 10 3 325 7 3 299 15 9 6 18 8 38 11 8 229 6 10 94 9 8 .. 1,058 0 1 Maintenance fees overpaid, refund of .. .. .. 40 4 0 .. .. .. .. .. .. 40 4 0 Medical fees for certificates, &c. .. .. .. 487 4 6 444 3 8 378 5 0 49 3 0 60 1 6 643 1 7 107 12 0 2 2 0 2,171 13 3 Motor-vehicles, maintenance of .. .. .. 11 17 1 23 10 11 196 13 7 53 11 10 118 2 0 78 14 2 100 1 0 .. 582 10 7 Motor-vehicles, purchase of .. .. .. .. .. 703 8 0 607 8 0 529 9 6 13 14 0 94 14 0 174 14 0 .. 2,123 7 6 Nursing staff — ■ Engagement of .. .. .. .. .. .. .. .. .. 7 4 0 29 4 0 3 12 0 .. 40 0 0 Uniforms, purchase of .. .. .. .. 385 2 0 431 6 9 235 19 7 122 10 10 122 12 11 520 16 6 136 16 4 .. 1,955 4 11 Office equipment .. .. .. .. .. 10 0 5 22 6 6 0 12 0 0 2 6 0 14 6 3 18 5 6 18 1 10 2 0 54 14 5 Patients, expenses connected with —• Gratuities .. .. .. .. .. 118 14 8 1 8 6 339 7 1 46 2 8 90 5 0 87 12 11 12 16 7 .. 696 7 5 " Patients' Friends" .. ... .. .. .. 100 0 0 100 0 0 .. 1 .. .. .. .. 200 0 0 Recreation .. .. .. .. .. 970 9 3 1,418 16 3 1,834 16 1 295 4 3 476 16 9 1,232 18 10 438 10 5 0 11 1 6,668 2 11 Transfer .. .. .. .. .. 11 4 2 6 10 6 39 0 1 .. 8 6 6 77 4 1 20 18 8 .. 163 4 0 Postages, telegrams, &c. .. .. .. .. 66 3 1 89 13 11 100 11 6 19 6 9 29 4 5 120 16 6 34 8 3 199 6 5 659 10 10 Printing and stationery .. .. .. .. 202 5 8 268 3 2 266 19 11 79 8 8 88 5 1 241 18 4 73 19 11 140 11 10 1,361 12 7 Rations .. .. .. .. .. .. 15,929 13 4 12,832 2 5 17,779 6 2 4,105 8 2 5,396 7 2 16,416 5 1 2,951 0 9 .. 75,410 3 1 Rents and rates .. .. .. .. .. .. 1,964 19 7 219 17 7 .. .. .. .. .. 2,184 17 2 Stores .. .. .. .. .. .. 891 12 4 921 15 2 1,136 1 3 164 8 10 295 10 5 i 1,003 7 6 213 5 0 .. 4,626 0 6 Surgery and dispensary — Drugs and instruments .. .. .. .. 218 8 3 343 5 4 305 3 8 37 3 0 113 1 2 443 17 10 54 18 9 .. 1,515 18 0 Wines, spirits, ales, and porter .. .. .. 7 15 0 15 19 10 6 8 6 13 6 2 12 6 31 17 8 .. .. 71 7 2 Telephone services, &c. .. .. .. .. 43 1 8 126 5 4 164 10 8 18 6 11 54 16 0 81 16 5 56 4 9 74 12 11 619 14 8 Transfer and removal expenses .. .. .. 70 19 11 7 8 5 16 2 0 11 2 0 .. .. 5 9 0 35 1 7 146 2 11 Travelling-allowances .. .. .. .. 6 13 10 117 14 9 90 10 9 39 2 6 80 7 8 3 15 0 20 5 2 377 11 7 736 1 3 Travelling-expenses .. .. .. .. 88 11 9 76 14 10 330 13 7 57 13 10 44 0 0 92 8 6 58 4 6 366 19 2 1,115 6 2 Treatment and maintenance in general hospitals — Patients .. .. .. .. .. 98 5 6 3 16 6 93 13 8 18 0 0 57 1 6 137 15 0 11 13 0 .. 420 5 2 Staff .. .. .. .. .. .. 1 3 6 7 7 0 7 1 0 .. 47 3 6 6 19 0 11 16 3 .. 81 10 3 Contingencies, including unforeseen expenditure .. 188 998 42 18 5 1 12 6 1 15 0 100 0 16 8 7 15 6 66 16 5 Grant in lieu of leave .. .. .. .. .. .. 65 0 0 .. .. .. .. .. 65 0 0 Total expenditure .. .. .. .. 64,668 2 8 71,040 16 3 97,278 13 3 i 23,240 11 3 29,049 10 6 82,731 10 5 28,992 10 8 8,319 6 4 405,321 1 4 Credits .. .. .. .. .. 22,569 13 5 23,482 11 7 31,101 1 0 3,118 18 5 9,198 10 3 29,222 19 8 11,501 4 0 .. 130,194 18 4 Net expenditure .. .. .. .. 42,098 9 3 47,558 4 8 66,177 12 3 20,121 12 10 19,851 0 3 53,508 10 9 17,491 6 8 8,319 6 4 275,126 3 0

H.—7.

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

Table XVIIIa.— Showing Details of Credits

28

i *\r ecessaries i Average j j Bedding Buildings : } Fuel, Light, | Surgery j Wines, incidentals' Total Cost j Repayments; Other j Net Cost I Net Cost | Decrease j Increase Mental Hospital. Number j Salaries. | and and | Farm. | Water, and I Pro-visions, j and | Spirits, Ale,; a ' I per j for Re- | per i previous in J in [resident.! : Clothing. Repairs. ; Cleaning. i Dispensary, and Porter. l M;i3cellaneous Patient. Maintenance, payments. Patient. Year. ! 1926-27. 1926-27. J j I : j I I j I i j j j I II ! I ; i I I : I I I £ 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. £ 8. d. £ s.jjld. Auckland .. .. 1,117 27 12 6J 4 19 8i 1 4 1I| 0 14 7J 4 8 11 14 5 2f 0 3 11 0 0 If 4 7 10 57 17 10| 18 19 10 14 37 13 9£ 43 12 5 5 18 7i .. i Christchurch .. 863 41 8 1| 5 17 lli 1 4 5J 2 12 llf 5 17 lOi 14 17 4| 0 7 114 0 0 4J 9 19 3J 82 6 4£ 21 13 U 5 11 1 55 2 If! 51 8 8 .. 3 13 5j Dunedin (Seaclift) .. 1,144 43 6 7 5 18 11J 2 13 3j 3 10 4| 4 8 3 15 10 10 0 5 4 0 0 1J 9 6 11 85 0 8 21 17 9 5 5 11£ 57 16 llj 61 10 4J 3 13 4f| Hokitika .. .. 223 61 8 51 3 12 8| 0 18 2J 2 9 6i 4 13 3f 18 8 2£| 0 3 4 0 0 7 ' 12 9 11J104 4 4 11 0 2{ 2 19 6' 90 4 7£ 92 10 4J 2 5 9J Nelson .. .. 374 43 3 2j| 4 8 8 0 3 Of 3 9 6 5 17 0 14 8 7 ; 0 6 OJ 0 0 If! 5 17 3 ! 77 13 5} 18 12 10J 5 19 0||63 1 6J 46 5 3 .. 6 16 3J Porirua . .. 1,298 33 4 7 6 2 9J 0 15 OJ 1 10 1J 4 1 11 12 14 5 0 6 10 0 0 6 4 18 7 63 14 9 20 8 6J 2 1 9 41 4 5| 37 1 10| .. 4 2 6 Tokanui .. .. 343 45 14 5£| 3 17 7J 1 10 6J 13 1 2 4 9 0£ 8 12 1 0 3 .. j 7 2 4f: 84 10 6 16 12 9j|l6 17 10 50 19 lOf 76 7 9f 25 7 11 Head Office (Wellington) .. 16 5 .. .. .. ••! •• •• ..'047 1110 .. .. 1110 1 9 8£ .. 01 3J Totals .. 5,362 39 10 4J 5 9 0 1 7 1 2 11 4 4 14 3 : 14 1 3 j 0 5 8 0 0 3j[ 7 12 7 75 11 10 , 19 17 7 j 4 8 0j| 51 6 2$ 53 3 8 1 17 5J I I I I I I I . [

Credits. Auckland. Christchurch. Dunedin. Hokitika. Nelson. Porirua. Tokanui. Totals. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. | £ s. d. £ s. d. £ s. d. Receipts for maintenance .. .. •• •• 21,214 6 6 18,689 14 0 25,038 16 10 2,455 12 3 6,972 8 5 26,513 6 9 5,706 19 11 106,591 4 8 Receipts for farms .. .. •• 657 4 3 2,540 15 11 2,359 10 3 108 8 0 1,465 11 1 1,195 6 1 5,135 7 5 13,462 3 0 Miscellaneous .. .. .. .. •• 698 2 8 2,252 1 8 3,702 13 11 554 18 0 760 10 9 1,514 6 10 658 16 8 10,141 10 8 Totals .. .. .. .. •• 22,569 13 5 23,482 11 7 31,101 1 0 3,118 18 5 9,198 10 3 29,222 19 8 11,501 4 0 130,194 18 4 I ! I ; | i I

H.—7.

Table XX. —Expenditure, out of Public Works Fund, on Mental Hospital Buildings, etc., during the Financial Year ended 31st March, 1927, and Liabilities at that Date.

29

t Net Expenditure lor Year I Liabilities Mental Hospitals. j ended 81st March, 19-27. , on 31st March, 1927. £ jg Auckland .. .. .. .. .. .. 19,988 1,799 Christohuroh (Sunnyside) .. .. .. .. .. 7,229 246 Hokitika.. .. .. .. .. .. .. 1,745 75 Nelson .. .. .. .. .. .. .. 805 Porirua .. .. .. .. .. .. .. 16,004 687 Seacliff .. .. .. .. .. .. .. 17,888 679 Stoke .. .. .. .. .. .. .. 2,691 138 Tokanui .. .. .. .. .. .. .. 1,658 45 Waitati .. .. .. .. .. .. .. 637 Total .. .. .. .. .. 68,635 3,669

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, 1926.

Approximate Cost of Paper.—Preparation, not given ; printing (675 copies), £47 15s.

By Authority : W. A. G. Skinner Government Printer, Wellington.— 1927.

Price 9d .]

30

Total Mental Hospitals. 1877-1918. j 1918-19. 1919-20. 1920-21. 1921-22. 1922-2B. 1923-24. ! 1924-25. 1925-26. 1926-27. J^fy' to 31st March, 1927. £ £ £ £ £ £ £ £ £ £ £ Auckland .. .. .. .. 145,472 1,171 543 8,040 9,013 777 j 5,188 2,393 2,073 19,988 194,658 Reception-house at Auckland .. .. 5,059 .. •• -• •• .. .. .. .. 5,059 Christchurch (Sunnyside) .. .. 181,606 1,238 2,490 5,139 3,494 2,245 j 1,497 6,272 2,901 7,229 214,111 Dunedin (The Gamp) .. .. .. 4,891 .. •• .. •• .. .. .. .. .. 4,891 Hokitika .. .. .. .. 3,727 .. ■■ .. 984 4,789 1 10,216 16,013 8,034 1,745 45,508 Hornby .. .. .. .. .. .. 7,370 928 2,682 122 .. .. .. .. 11,102 Motuihi Island .. .. .. .. 561 .. •• .. •• .. .. .. .. .. 561 Napier .. .. .. .. .. 147 .. • • • • • • .. j .. . • .. • • 147 Nelson .. .. .. .. .. 25,845 200 208 3,496 3,316 1,929 j 1,429 2,389 1,182 805 40,799 Richmond .. .. .. .. 1,097 .. • ■ •. • • .. I .. • • .. • ■ 1,097 Seacliff .. .. .. .. 180,664 966 2,069 40 3,389 1,602 1,246 3,016 4,767 17,888 215,649 Stoke .. .. .. .. .. .. .. .. .. •• 337 1,450 3,095 12,568 2,691 20,951 Tokanui .. .. .. .. 68,124 8,105 4,111 5,381 9,774 5L5 2,743 16,076 8,097 | 1,658 124,584 Waitati .. .. .. .. 8,437 498 848 3,620 3,217 848 i 194 .. .. ; 637 18,299 Wellington .. .. .. .. 29,641 .. .. .. .. .. j .. .. .. ' .. 29,641 Wellington (Porirua) .. .. .. 203,337 2,462 638 724 5,969 688 2,578 18,374 38,213 j 16,004 288,987 Totals .. .. .. .. 858,608 14,640 18,277 27,368 41,838 13,852 26,541 68,438 77,835 j 68,635 1,216,034