H—3l

VIII

can be found neither in the average household nor in the routine of the life of the average patient. A few patients of unusual self-control and wisdom, whose families and attending nurses and friends have sense and decision, and who have the means of surrounding themselves with all the comforts, can do as well or even better than at the best sanatoria ; but these are rare exceptions. The allurements of business and pleasure and of social dissipations ; the temptations of appetite and the fashions of eating, of dress and of social usages ; the love of travel and the desire to roam from place to place —putatively for health, but mostly for mental diversion —these are dangers that handicap most patients with chronic tuberculosis who live at home or outside of an institution. They follow their inclinations chiefly, and try to carry out the advice of their doctors somewhat. Too often the sole advice that is followed is confined to the taking of some drugs, and perhaps residence in a particular place. If the doctor gives minute directions in all particulars necessary to accomplish the best effects, the patient usually finds that they are so radical, and so completely change all the habits and regimen of his life, as well as perhaps his occupations, that he is apt to think them unnecessary and fussy, and to be ready to neglect most of them. In a sanatorium he finds it easy to follow all of them, for there it is the fashion to do this ; there is no temptation to the contrary, and the new life and novel regimen furnish both occupation and amusement. Despite the fact that a great many unfavourable cases have been admitted, the results, as Dr. Pentreath points out, are quite as good as those obtained in some of the best institutions in the older countries. In order that accurate comparisons may be drawn from figures great care must be exercised in defining the exact value of the various units. The varied values which may be attached to such a word as " cured " when used in reference to consumption militates against the usefulness of comparing different institutions. Then, again, the selection capable of being exercised in respect to the cases admitted will play a most important part in the results obtainable. Just as there are surgeons who claim never to have had a death follow a certain operation, so there are sanatoria which claim a very high percentage of cures —simply because the one always refuses to operate unless upon a suitable patient, and the other asks the doomed consumptive to seek shelter somewhere else. It is all the more pleasing, therefore, that we have been able to obtain the satisfactory results that we have. In April of this year Dr. Pentreath was appointed Resident Medicyl Superintendent; the many and arduous duties up till then carried out by the Matron have now been lessened, and she will be freer to devote herself to the personal supervision of the patients. The tribute paid by you to Dr. Roberts at the opening of the sanatorium was well deserved. The legislation of last year, giving as it did greater powers to Hospital Boards to erect annexes for the treatment of persons suffering from consumption, is pregnant with great good. Already some of the Boards have set to work —notably Wellington, New Plymouth, Blenheim, Invercargill, and Waimate. The Wellington Board has decided to erect two four-bed shelters at Otaki, while in Christchurch Nurse Maude has been able, through private help and assistance from the Charitable Aid Board and the friendly societies to establish an encampment for working-men and the indigent sufferer. As a result of a series of addresses Dr. Valintine has been able to collect about £700 from the residents and friendly societies in the Taranaki District for a small establishment to be placed at New Plymouth. The private sanatoria at Dunedin and Christchurch are also doing good work. What is wanted, however, is a more general movement on the part of the Hospital Boards. There is great reluctance expressed towards the reception of advanced cases of the disease, and many Boards are unwilling to undertake the provision of accommodation for what might be termed hopeless cases. In assuming this attitude I think they are wrong. Picture the lot of a person ordered from a general hospital because of the nature and hopelessness of his ailment —poor, without friends capable of lending him help, he drifts into a low-class boardinghouse and has to be maintained by the help of the Charitable Aid Board. There is no saving to the community, his lot is made harder, and, most important of all, he becomes a potential agent of danger to all who come near him unless he exercises an amount of self-denial and carefulness much greater than can be hoped for. As things are at present the indigent incurable is to my mind the greatest menace to the State, and, if our war against consumption is to be successful, provision within an institution must be made for him. There are no very great difficulties in the way, and adequate house-room would entail no further charge to the State. At present he has to be maintained, and his cost inside would assuredly be less than it is outside. It needs but that the the various Boards should erect small annexes, distinct from the general hospital, but near enough to be capable of being controlled by the same administrative staff. In this way all danger to the occupants of the main hospital would be avoided, and the cost of maintenance and administration would not be great. Bearing in mind that the vast majority of the cases of consumption contracted during adolescence and the later periods of life are due to infection by means of the sputa of infected persons, until we are able-to control and educate these unfortunates, little hope of stemming the tide can be looked for. A sojourn in a sanatorium or a spell of treatment in an institution means more than the cure or comfort of the patient. The training he receives will bear fruit in many ways. He will be taught the great-