H.—3l

A stricter insistence upon the provisions of the Undesirable Immigrants Restriction Act is required, and must be enforced. The establishment of the sanatorium at Cambridge is, I am pleased to say, an accomplished fact, and already excellent results have been obtained. It is well, however, to continue to impress upon the public the fact that such institutions are for the cure of persons suffering from consumption, and not for the reception of those insusceptible of relief. For the incurable, indigent sufferers —and, unfortunately, they number many — further and different provisions must be made. The scheme which I suggested may yet, I trust, be adopted. It has several merits, not the least of which is that it would not entail much outlay, while it would insure a maximum amount of safety. Leaving out of the question the humanitarian aspect, it cannot be too firmly insisted upon that to house, care for, and look after the indigent incurable consumptive would be a profitable task for the State to undertake. At the present time there are some three hundred known cases of the disease, which, either by reason of want of funds or severity of symptoms, ought to be within the walls of an institution. Now, if ten small annexes were to be erected in connection with ten country hospitals in districts well known for their beneficial influences in cases of this disease, the whole difficulty would be overcome. The same staff that now manage these hospitals could look after the occupants of these proposed open-air hostels, or, at the most, with the aid of an additional nurse or two. The creation of an entirely new institution, with its consequent expense, would be avoided. The inmates of these open-air shelters would obtain many of the advantages associated with a sanatorium pure and simple, while the space of that institution would not require to be encroached upon by incurables to the exclusion of those whom assuredly such differentiated institutions greatly benefit, and for whom alone they should be set apart. There have been many applications for admission to the sanatorium at Cambridge which have had to be refused, and until some scheme such as I have shadowed out is adopted there must always be many disappointed. A hospital for the treatment of consumption differs greatly from all other hospitals in many respects, but in one above all others —vacancies can occur only at long intervals. A broken leg may take a month, a case of pneumonia may take two, but the patient who enters a sanatorium can rarely hope to leave under many months—six, nine, twelve, or it may be eighteen. Thus it is that long terms must elapse between admissions, and consequent disappointments to the many who eagerly wait for an entrance to their Mecca. It is hard to make the waiters understand the reason for their non-admittance, but there it lies. I had hopes that in some measure the institution at Cambridge would have been selfsupporting, but until some provision is made in the way already indicated it will not be. The prolonged nature of the disease usually leaves its victim with an impoverished purse, as well as an inability to work, and by the time he seeks or obtains an entrance to a sanatorium his power to pay has long gone by. Whether a scheme of insurance such as obtains in Germany and France will ever find favour with the working-man here is difficult to decide, but until then the State must look for its credits in the restoration of the crippled worker and his consequent value to the commonweal. Under many disadvantages the Matron (Miss Roehfort) and Drs. Makgill and Roberts have done excellent work. The Cambridge Sanatorium promises to be one of the finest institutions of that class in the world. Its success as a curative agent is assured, but it means money, time, and a continuance of the same self-sacrifice on the part of those in immediate attendance upon the sick. The detailed reports of the officers in charge of the various districts are appended. Not the least pleasing feature of the past year is the interest shown by the individual in matters pertaining to sanitation and health. The departmental officers have come to be recognised as consultants on these matters, and their advice and counsel have been sought on all and every aspect of public health, from the choosing of a trade or profession to the selection of a home or the installation of a septic tank. The establishment of a healthy interest in matters that make for the increased vigour of the race is, after all, of the greatest moment. The State can do much, but it is to the individual we must look for reforms which will be permanent and for progress that will be sound. I have, &c, J. Malcolm Mason, M.D., D.P.H. Camb., Chief Health Officer.

VI