H.—3l

4

But there is one special danger, which was commented on by the Medical Superintendent of the Wellington Hospital in his report on the Otaki Sanatorium : " There is a tendency when treating patients in New Zealand to attempt to kill the germ of consumption by cultivating the germ of laziness and sluggishness." Dr. Hardwick-Smith then goes on to say that it is questionable whether it is better for a patient to survive the disease than " lose his moral fibre." In these remarks I heartily concur, and it should be the aim of all responsible to counteract the tendency referred to, especially if the early cases come forward, as it is hoped they will, for sanatorium treatment. If such patients do not do all they can to assist the Boards in an efficient and economical management of the institutions, they will not only act against their own interests, but against the interests of those who come after them. The public will not stand the expense that additional sanatorium accommodation will entail unless they feel that they are getting a measure of return for the expenditure, not only in the shape of persons cured of the disease, but of persons ready and willing to resume the battle of life. We know that the statistics of sanatoria where graduated labour under medical supervision is one of the features of treatment compare very favourably with those of institutions where the patients remain in more or less enforced idleness. In health, want of occupation is sure to lead to moral and physical degeneracy, and the same applies to the consumptive patient whose day is passed in discussing symptoms with his fellow-patients, or in criticizing the management of the various institutions in which he has been an inmate. Whether in the early or late stages of the disease, we should do everything in our power to improve the lot of the consumptive. For those who are fatally stricken let us provide the very best accommodation and treatment possible, and in this we must not be influenced entirely by the cost; but for those who are able, but unwilling, to make a dogged effort to keep themselves in a condition to resume the struggle of life, let no false sentiment be allowed to deter us from doing our duty. Te Waikato Sanatorium. Staff. When I took over the control of this institution in June last there were forty-five patients under treatment, with a staff composed as follows : Medical—A non-resident Medical Superintendent, who attended the institution from Cambridge ; nursing—a Matron, six trained nurses, and eight probationers ; domestic —two cooks, an assistant cook, two laundresses, six housemaids, five porters, a gardener, an engineer, and a carpenter ; clerical —a clerk and assistant clerk. Thus the true institutional staff consisted of thirty-seven persons. In addition to the above, there were employed on the farm a manager, two labourers, and a man in charge of the horses—a total staff of forty-one persons. In the conduct of this institution I have ever before me the example set by Dr. Patterson, of the Frimley Sanatorium, with regard to the employment of consumptive patients who are medically fit to undertake some of the lighter duties connected with the domestic and outdoor work of such institutions. The results of Dr. Patterson's work are widely known, and graduated exercise and work under medical supervision are now recognized by the profession and a large section of the public as essential concomitants to the open-air treatment of consumption. Having had personal experience of Dr. Patterson's methods when Home in 1906, and having seen and read what his results are —how he sends out a very large proportion of his patients fit to resume the battle of life, and, what is also of importance, confident of their powers to do so—l should be signally failing in my duty, and unworthy of the trust reposed in me by virtue of my office, if I did not use every effort in my power to follow Dr. Patterson's splendid example. My duty is clear, and, brutal as it may seem, I have no hesitation in saying that sanatorium treatment is of little avail if it is only to result in turning out the lifelong invalid. Is it wrong to aim at turning out the sanatorium patient as a whole man, ready to do his duty by his family and the State ? The reduction of the nursing staff may appear to need explanation. As it is now, there is one nurse for every 3 - 5 occupied beds —a very high average for such an institution, where the demands on the nurses' services are not to be compared with those in an ordinary hospital. Also, it will be seen that by a more careful selection of the patients —referred to in another part of this report—and the admission of patients in the earlier stages of the disease, there is no need for such a large nursing staff. Admissions. One hundred and five patients were admitted during the year 1908-9. Prom the representations of the Medical Superintendent it was clear that many patients were being admitted in such an advanced stage of the disease that they were not likely to derive permanent benefit from sanatorium treatment, and that they occupied beds to the exclusion of those who were likely to benefit by such treatment.