15

H.—7

MEDICAL SUPERINTENDENTS' REPORTS.

AUCKLAND MENTAL HOSPITAL. Sir — I have the honour to forward you my report for the year 1911. On account of the increasing number of admissions extending over a series of years, there has been considerable overcrowding, thereby rendering the administration work difficult. I trust that the overcrowding will soon be remedied, so as to enable us to effect a good system of classification and thus increase the comfort and happiness of our patients and conduce to their more rapid recovery. Our admission-rate continues to increase. Our discharge-rate remains more or less constant — males, 34-1 per cent. ; females, 50-5 per cent. ;or an average of 40-5 per cent. The total death-rate was 9-01 per cent. —males, 8-7 per cent. ; females, 9-1 per cent. Of the total deaths 63-01 per cent, were due to senile decay (20), phthisis (13), epilepsy (7), and general paralysis (6). Phthisis caused the death of 12 male patients and of only 1 female. Towards the end of the year a few typhoid cases arose. These seemed to me clearly traceable to a nurse who became infected, undoubtedly outside of the Hospital. Dr. Watson was appointed Senior Assistant Medical Officer in September, and for the short period of the year after his appointment his work was to be commended. There have been a good many resignations amongst the female staff, principally probationers, but with the increased salaries, shorter hours, and longer holidays now prevailing for both males and females it is to be hoped that there will soon be a better condition of things in this respect. The older members of the staff have been of the greatest assistance to me in carrying out the administration of the Hospital under difficult circumstances. The Herald proprietors (for gratuitous papers), Miss Fleming, of Onehunga (for a weekly cab for the use of patients), Mr. McPherson, and others, merit the thanks of the Department. To the Deputy Inspector and the Official Visitors I am personally indebted for their interest in the patients, and for the sympathy and support accorded to myself. I have, &c, The Inspector-General, Mental Hospitals, Wellington. R. M. Beattie.

PORIRUA MENTAL HOSPITAL. Sir, — I have the honour to submit the following report on this Mental Hospital for the year 1911. At the beginning of the year we had 897 patients on our register, and at the close 928 (531 males and 397 females), including 12 men and 23 women absent on trial. There were 244 admitted, including 2 patients transferred from other mental hospitals. 197 patients were admitted for the first time — an increase of 7 per cent, on the previous year. Of the 131 discharged, 115 were discharged recovered. In proportion to the number admitted, the recovery-rate was therefore a little over 47 per cent. There was an unusually heavy mortality-rate. The number of deaths was 82, which amounts to a ratio of 9-35 per cent, of 887, the average number in residence. Included among the causes of death were 9 from typhoid fever, 10 from senile decay, and 10 from general paralysis. In my previous report I referred to the outbreak of typhoid fever. The epidemic commenced early in the autumn, fifteen cases becoming affected in March, seven in April, eight in May, one early in June, and one in September. The epidemic was therefore practically confined to the three autumn months. I have already informed you how the patients affected were not resident in any particular part of the buildings —cases kept developing sometimes here and sometimes there, both in the male and female wards. I have also informed you of the steps taken to discover the cause of the trouble, and how the officers of the Public Health Department aided in the investigations. After eliminating every other probable cause of infection, Dr. Frengley, the Medical Officer of Health, was of opinion that the trouble was due to the presence in the Hospital of one or more " typhoid-carriers " who had infected the others, and this theory was put to the test. A list was made of all those who were known or suspected to have had typhoid previously, and their condition investigated. The Public Health Bacteriologist found that the serum of one of the female patients gave a positive " carrier reaction " as did the serum of a man who had'had typhoid fever many years ago. This patient was employed in our bakery, and handled much of the bread used throughout the institution. It is therefore not surprising that the incidence of the epidemic should have been so erratic in its distribution. A short time ago those who had suffered in the recent epidemic were submitted to examination, and, it was found that one male and one female patient responded to the " carrier reaction." Precautions have been taken against further infection from these patients. When one comes to review the cases of typhoid it is remarkable how many were senile, weak, or otherwise of low resistive power when attacked by the fever, and it is surprising that the mortality was not even greater than it was. *Of the nine deaths due to the epidemic, four were suffering from general paralysis of the insane, and three were confirmed epileptics whose prospect of longevity was in any case poor. The nurses and attendants who nursed the typhoid cases deserve great credit for the care and devotion they displayed in the discharge of their duties. Unfortunately, one of the nurses and three of the attendants contracted the disease, and one of the latter, Attendant K. Boulton, died from com-