H.—7

19

cardiac case, one with a gangrenous spot on the hand, one with phthisis (pulmonary), one with spastic paralysis, and two general paralytics make up the nine serious cases. There are no bedsores. The institution was clean and tidy, and looked cheerful. Particularly homely are those parts of the women's side where the patients are capable of appreciating their environment. Unfortunately, the single rooms for turbulent and noisy patients on the women's side are near the main road, and persons hearing a noise when passing are apt to get a false impression. During the days of my visit the entire noise in this quarter was made by one woman. She is labouring under chronic mania (chronic when she was admitted), and, not having the use of her lower extremities, the excitement does not spend itself in natural exercise, but in shouting. The food was inspected and found to be of good quality and abundant. The meals were served in an orderly way. The bread from the new bakehouse is good, and the result of the first year's working would seem to justify the prediction that the cost of the erection will be wiped out by the profit in working by the end of the present year. Every effort is made to classify the patients according to their mental state, and when the women's side includes the present quarters of the Medical Superintendent, and the reception-house is added, the classification will be fairly complete —at any rate, for some time to come. I remarked to Dr. Beattie that the nursing staff appeared to be brighter and more alert, and was pleased to hear that they were working well. There have been a number of changes, but for the most part among probationers who do not properly belong to the staff. Needless to add that I agree with Dr. Beattie in not retaining the service of a probationer who does not give promise of becoming an efficient nurse or attendant. In the senior members of the staff the juniors have good models—39-5 per cent, of attendants and 156 per cent, of the nurses have been in the service for five years and upwards. The attendants' mess-room is undergoing alterations, and in the meantime they are dining on the stage. The following is a note of a week's dietary for the staff :—

(When in season, lettuce, tomatoes, &c, Jib. or more daily at tea. Eggs or fish for breakfast for Roman Catholics on Friday. The weight of meat for men is ljlb., for nurses lib.). The ratio of the nursing staff to patients is as follows : — Full Nursing Staff. Average Effective Staff. Day attendants ... ... ... Ito 11-4 patients Ito 14-4 patients. Night attendants ... ... Ito 205 „ Ito 205 „ Day nurses ... ... ... Ito 9 „ Ito 11 „ Night nurses ... ... ... Ito 135 „ Ito 135 It should be added, in explanation, that the average effective number as given above is greatly reduced by the including of Sundays, and the ratio is not so disproportionate on week-days, and that the night staff is not required to visit all the patients. The patients are so classified with regard to sleeping accommodation that the work of the night staff is concentrated, and certain portions of the building are mainly visited as a fire-precaution. I saw all the patients and conversed with many, and received no complaint that was not manifestly absurd, and very few such—in fact, the general content was remarkable. The most pressing need in the establishment is laundry machinery, such as has already been installed at Porirua, Seacliff, and Sunnyside. The washing is done by hand, and this is, of course, a burden in so large an institution. The kitchen requires to be extended by the inclusion of the scullery. A new residence for the Medical Superintendent (plans are prepared) should be gone on with without delay, in order to overtake the surplus of women patients waiting to be accommodated in his present house. I examined the statutory books and registers, and found them up to date, and neatly and correctly kept. A large proportion of the deaths have their cause verified by post-mortem examinations. In the register of mechanical restraint there are no entries since the 25th May. Those before that date refer to the use of a loose jacket in the case of one man and four women. Save in the case of one woman, who had an outburst of extreme violence, and was restrained for three hours during the day, the use of such mechanical means has been restricted to the night hours. The cause of the restraint in the case of the man and one woman was to prevent self-injury, in the case of the two other women to prevent interference with surgical dressings. The usual neatness of the lawns and gardens, and the ploughed fields testified to the activity of the outdoor work; and I was pleased to see that the park was laid out and fenced for giving scope to exercise patients who cannot be trusted with working-parties. A small garden is fenced off from the main park for the betterbehaved of the above class. Dr. Beattie's individual knowledge of his patients is a tribute to his memory, to his personal interest in them, and to his professional interest in their cases. lam satisfied that his administration is dominated by a desire to do the best he can for the patients committed to his care.

Breakfast. Dinner. Tea. Daily Sunday Porridge Chops or cold meat, or £ lb. bacon Chops or cold msat ... Mince or steak and onions Chops Steak or cold meat ... Chops or stew Gold corned beef Potatoes and vegetables Eoast beef, plum-pudding Brea'i and butter. Cheese and jam. Monday Tuesday ... Wednesday Thursday ... Friday Saturday ... Soup, roast beefSoup, stew, or roast mutton, pudding Soup, roast beef, or steak-pie ... Soup, boiled mutton, pudding ... Soup, corned beef, pudding Soup, roast mutton ... Scones, or cake, or pastry. Cold meat and pickles, or stew, or mince. Jam. Scones, or cake, or pastry. Pish and jam. Cold meat and pickles, stew, or mince.