H.—l

8

with unhealthy conditions. The details of the process of cleaning which the wards undergo are given in the evidence of Mr. Burns ; but Dr. Truby King expressed himself as dissatisfied with the degree of disinfection of the wards which is secured by the means adopted. It certainly appears to us a most wasteful expedient to sacrifice one-fourth part of the available ward-space with such doubtful results, and it would seem to be a more reasonable procedure to put the floors, walls, and other parts of the wards in such thorough order that they could be kept constantly clean and healthy, as is done in other hospitals. (jj.) New Hospital. —The evidence shows a complete unanimity on this point. Even the few witnesses who expressed their contentment with most of the existing conditions were strongly in favour of having a new hospital. It is a grave question whether the expense of thoroughly refitting and sufficiently enlarging the present building so as to obviate its defects would not be more costly and less satisfactory in the long run than to erect a new hospital on modern lines; but, as the question of expenditure was not before us, we offer no opinion on that subject. (q.) Dangers requiring Immediate Remedy. —Dangers which require immediate remedy have, in our opinion, been proved to exist by the evidence, the most pressing being those arising from the defects in the ventilation and closet arrangements, and the position of the kitchen. The provision of special wards for the septic and infectious cases, the building of a nurses' home, and the improvement of the floors, walls, and ceilings, so that the practice of fallowing the wards may be discontinued, would, we are of opinion, set free sufficient space to relieve the present overcrowding. In this way temporary relief ought to be obtained to a sufficient extent to enable the Hospital to be continued in use for some years, and until a new hospital can be provided. On the other hand, to convert the present building into a permanent hospital would require radical changes and improvements, the nature of which we shall have occasion to point out. (r.) Domestic Management. —The domestic management of the Hospital was praised by all the witnesses, and it was urged—apparently with good reason —that the defects of the Hospital had been largely neutralised by the zeal and assiduity of the steward, Mr. Burns, and by the faithful attention of the matron and nurses. (s.) Results of Practice. —The actual results of the medical and surgical treatment of the cases in the Hospital, as testified to by the members of the medical staff, are on the whole satisfactory, but it is admitted that this has been largely due to the extra precautions and to the extensive use of antiseptics, of which there appears to have been a larger proportion used than in other similar institutions. In concluding this review of the evidence, which bears on ths general charge against the sanitary condition of the Hospital, it is incumbent on us to state that in our opinion no blame rests on the Trustees. Dr. Coughtrey appears to have commenced pointing out the defects of the Hospital as early as 1875, and great improvements were made in consequence, which improvements have been steadily going on as means permitted. It was not until May, 1887, when there was a conference of the medical staff with the Trustees, that any important defects were brought to their notice. It is true that in 1885 the staff had called attention to the defective state of the ventilation of the wards, and were asked by the management to make a suggestive report, but they never did so, and nothing was done ; and at the conference above referred to the question of improving the ventilation was not mooted, and the only suggestions made were for an improved system of nursing, a properly-equipped room for surgical operations, in which the students could be present and derive proper instruction, and, lastly, the providing of certain special wards. All these demands seem to have been complied with as far as possible, the operating-theatre alone having cost £1,604 16s. Bd., which was a very substantial concession to the requirements of the Medical School. The total amount which has been spent under the present trust on repairs and additions since 1886 has been £4,060 16s. 7d. In the end of 1888 some members of the medical staff had the advantage of examining other hospitals throughout the colonies, and the experience thus gained appears to have focussed the impression which for many years they had entertained as to the insanitary conditions which pervaded the Dunedin Hospital. This led to an active protest, which in February, 1889, after animated discussion, took official form as a memorandum from the medical staff to the Trustees. This memorandum was drafted by Dr. Lindo Ferguson; but there seems to have been some irregularity in its formal acceptance by some members of the staff, and now it appears from the evidence that some of the staff are disposed to repudiate any responsibility for the strictures it conveys. This memorandum is referred to in the evidence as ExlribitNo. hi., and is an important document, asserting the existence in the hospital arrangements of most of the defects that have been brought up during the present investigation. It was hardly the fault of the medical staff that such a protest was not made at an earlier date. Of late years, especially since the researches of Pasteur and Koch, the methods for the treatment and prevention of disease have been almost revolutionised, so that what are now taught to be necessary safeguards can only be found described in the latest editions of the standard text-books; but the success which crowns the modern methods for the treatment of disease is so pronounced as to make it the imperative duty of every enlightened physician and surgeon to insist on their adoption in hospital practice, both from motives of humanity and economy. In the course of the evidence placed before us frequent reference was made to the system of " Listerism " in surgery, which means the creation of such thoroughly antiseptic surroundings that operations can be safely performed even where an infected atmosphere is prevalent. This expensive and in some respects uncertain method of treatment is now being superseded in hospitals by an aseptic method of treatment, depending for its success on thorough cleanliness, thorough dilution of the ward-air, and other provisions that enable the prevention rather than the destruction of the evil influences arising from pathogenic germs. It is not unnatural that the promulgation of such radical changes should have been received at first with some little.distrust, even by members of the profession, and still less is it to be wondered at that the Trustees, who have the responsibility of administering