3

H.—7

Reviewing the average cost per patient during the year, there is an increase of £1 Is. 7d. over 1914, a figure which demonstrates the economy which has been exercised, considering that the extra cost of provisions alone has been in excess of this at every institution, making an average increase on that one item of £1 15s. 6d. Another unavoidable increase, averaging 14s. Id. per patient, was due to salaries; necessary repairs charged to our vote increased by £1 Is. 3Jd., and the increased cost of drugs accounted for 6d. extra in the surgery account. These items total £3 lis. 4d. per head over the cost last year; but against this there was an economy in the other items of £1 13s. 9d., and the receipts (maintenance, sales of produce, &c.) were 16s. in excess of the previous year, leaving the net cost per patient £30 Is., as against £28 19s. sd. in 1914, or an excess of £1 Is. 7d. The decrease in the cost per head at Christchurch is apparent rather than real, being due to an abnormal increase in the previous year. For example, perishable stores were replenished in the last months of 1914 and reduced the average cost for the early months of 1915, and considerable non-recurring expenditure followed upon the destruction of No. 3 attic dormitory by fire in March of that year. Visits of Inspection. The following are in addition to the visits paid by District Inspectors and Official Visitors. As a general note it should be stated that every patient has the opportunity of a private interview, and that every complaint not obviously absurd is inquired into. Should any matter require rectification or adjustment this is done, but complaints, save against loss of liberty on the part of patients who cannot be trusted, are limited, to a very few patients. There have been no epidemics, and the general health of the patients has been good. Auckland. —Visited January, March, May, of 1915, and in February of this year. Both auxiliary buildings are now fully occupied. The renovation of the women's side is proceeding apace; the improved lighting and ventilation and the cheerful effect of repainting and decorating is an agreeable transformation. When the addition to the male infirmary ward is made and a further transfer of patients to Tokanui has been carried out it will be possible to treat the male side, ward by ward, similarly. In the infirmaries are many mentally infirm suffering from senile decay, and Dr. Beattie remarks, " 1 regret that too many senile cases are still admitted to this Hospital, exhibiting, in some cases, a desire to shirk home responsibility." The new drainage system is approaching completion, permitting connection with the city and suburban system and relieving the institution of a difficulty with which it has had to contend for a number of years. Dr. Beattie, Dr. Tizard, and the senior staff have had a strenuous year. Swnnyiside. —Visited in February, March, June, August, December, 1915, and in January and April, 1916. In Dr. Gow's indifferent health the anxiety and responsibility of managing a large institution was too great a strain, and Dr. Gribben changed places with him, at first temporarily, then permanently. Later Dr. Lee went to the front and Dr. Gribben was left single-handed. He had himself put in an application to get to the front, but at my desire permitted it to bo left in abeyance, because I thought that his knowledge and energy were necessary for the administration of this institution, and that he would be serving his country at least equally well by remaining behind. The Nurses' Home is a great boon, and also relieves accommodation on the women's side; but the completion of the reception and hospital block is looked forward to, both to increase the accommodation and means of classification. The fire-alarm system is inefficient and obsolete, and something will need to be done pending a complete automatic installation. The kitchen is now served by women under the control of the Matron. The food is well cooked, and the uniformly excellent quality of' the meat, apart from any question of cost, justifies the change from buying meat to buying stock and fattening for our own use. Without this strain placed upon the farm the land at our disposal was insufficient for our needs, and it will be necessary to add an auxiliary farm within easy distance for its administration and that of an auxiliary institution on the same site. Seacliff. —Visited in March, June, November, December, 1915. Here, as at other institutions, work has been carried out under great stress owing to changes in the staff due to the war. Dr. Boss resigned to enter into private practice, and Dr. Gray was persuaded to defer his application for leave to go to the front. The supply of medical men for our work is limited, and, as a fair proportion of our assistant medical officers have gone on active service, the work of those left behind is correspondingly increased. I consider that in setting aside personal inclinations, in realizing the needs of our patients, and in carrying out extra duties ungrudgingly these men are acting bravely and according to the best traditions of their profession. The medical wants of Waitati are meantime served from Seacliff. In addition to the work of the institution, Dr. King is actively assisting the military authorities in the treatment of special cases. Realizing the great abnormal stress to which soldiers have been subjected, cases of mental shock and allied states are receiving skilled treatment apart from mental hospitals. So well adapted is the environment selected for these cases, with its free open life, that one feels that the best possible is being done. The soldiers visited were happy and getting on well. Where not obviously contra-indicated, the policy is to extend the benefits to all cases in the first instance, but, of course, where for the good of the patient or in the interests of the community it is necessary to admit in the first place or transfer any such patient to a mental hospital, false sentiment is not allowed to stand in the way. Happily the number of soldiers mentally defective in terms of the Act is remarkably few so far. Buildings proposed are included under the heading of accommodation. The completion of these will add greatly to the comfort and well-being of the patients. The water-service from Waitati has not been an unqualified success. There has been no extension of the slip. Apropos of a patient suffer-