H.—3l

8

Projected additions, more especially a Nurses' Home, have been abandoned on account of the war, although really urgently needed. Ten pupils have been trained ; ten are now in training. The staff remains the same. Note by the Medical Officer. - Complications among the babies: One had enlarged thyroid; one had a sixth finger projecting from first interphalangeal joint of little finger ; one had laryngeal spasm. There was an epidemic of benign pemphigus, which affected about eight children. There were seventeen babies born prematurely from two weeks to two months ; six of these were three sets of twins ; four of the prematures died. We had two precipitate labours; one case of phlegmasia ; one acute hysteria bordering on mania ; three were treated beforehand for eczeman and two for pruritis. H. Maclean, Assistant Inspector. Te Waikato Sanatorium. The Medical Superintendent, Te Waikato Sanatorium (Dr. Bernstein), reports as follows : — The patients treated during the year numbered 190 ; patients discharged during the year numbered 119. Of the discharged patients forty-six made a very considerable improvement and were fit to go to work again. The rest were not really suitable cases for a sanatorium, the disease being too advanced. Fifty-two of them, however, were much relieved and felt well, but will only continue to feel well so long as they are allowed to take life easily. Some have returned to work against advice. Twenty-one made only slight improvement, and ten patients died. Of course, these results cannot be compared with those of sanatoria who carefully select their cases. Nobody has been refused admission during the past year, although it is regrettable so many advanced cases are still sent here. Many of these advanced cases should have been treated apart from the sanatorium cases proper.. They are practically kept in bed, and are best treated in wards. They do not require separate shelters, as this makes it more lonely for them and the administration very difficult. It is important, therefore, that the proper policy of the institution be defined. If the institution is to be kept as a sanatorium proper, and the patients selected from the standpoint that they can be got fit for work again, the buildings are satisfactory, except that extra wards near the main building should be built to accommodate the male patients at the beginning of their treatment, when they may be confined to bed. If it is intended that advanced cases be treated, then still further large wards quite separate from the others are required. For an illness like tuberculosis, that requires prolonged treatment, distance from home for a sanatorium case is no objection—in fact, it is an advantage —because it is advisable for patients not to see too much of their relatives. But for really advanced cases it is natural that if they have friends or relatives they should be near them. For the intermediate cases a stay in the Sanatorium will be of great educative value in teaching them how to live a proper life and to be no danger to the community. I have previously pointed out it is of great importance that a sanatorium should not be too small. The larger the sanatorium, within limits, the more efficient is the treatment, and, of course, the more economical. In the past year the institution has been put in a thorough state of repair, of which it was badly in need. Every part has been painted and the structure is now sound. The number of available beds has been increased by making use of other buildings and the erection of a new shelter. The number of occupied beds has been greater than before, and the male beds have been practically full throughout the year. Financially the year has been better than previous ones. In spite of the unusually large expenditure for maintenance, due to the extensive repairs and painting this year, and the increase of equipment and stock, which was at a low ebb, the cost has been considerably reduced both absolutely and still more per bed, and this, together with the fact that the receipts from fees and farm have increased, has made the net cost to the Government over £1,600 less than in the previous year. (The statement of receipts and expenditure is sent separately.) The farm and grounds have been greatly improved, much new land being opened up. A new orchard has been planted. There has been a good supply of fruit, vegetables, and eggs throughout the year, and all the mutton is killed on the estate, and our own pigs are killed for ham and bacon. The swamp at the foot of the farm has been thoroughly drained, and in the coming spring there will be sufficient good pasture for a dairy herd to supply all the milk for the Sanatorium. I am very pleased to report the friendly spirit to the place manifested by so many medical practitioners throughout the Dominion sending cases for an opinion. This co-operation of the profession is steadily increasing and will be an important factor in quelling the disease. It appears to me that patients are becoming less afraid to come to the Sanatorium, though great fear exists. When it is the practice to send patients at the first suspicions of the disease there will be some hopes of greater benefits. Most of the patients also keep in touch with me either by letter from themselves or through their doctor, or come direct to report themselves. This I have previously stated is important, for thus might relapses be detected and quickly treated before becoming advanced. Practically every patient who has left before being advised to do so has returned for further treatment, sadder and wiser. They generally feel so well that they think they are fit for work before they really are. This spirit is also steadily improving, and patients are being more and more guided by advice, and consequently receive more permanent benefit. To keep in better touch with patients I would suggest that facilities for examining them be provided in several big centres where one might also come into more personal consultations with the practitioners. There is now great need of some provision for after-care of the patients. I am pleased to report that the staff have now settled down to the new conditions, and there have been very few changes—fewer than in any previous year. It is a pleasure to report that Dr. E. E. Roberts still maintains his connection with the institution as consulting physician, Alfred Bernstein, Medical Superintendent.