H.—3la

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Isolation. As regards the isolation of infectious cases, it appears that the management of Kelvin Hospital complied with the general requirements of the Department. The Commission considers that these requirements are insufficient. The only satisfactory means of isolation is the provision of accommodation detached from the main building, and this should in future be insisted upon by regulation. Were such detached accommodation provided it might frequently render unnecessary the closure of the hospital, thereby avoiding the Joss of revenue consequent upon closure, and thus to some extent compensating the licensee for the capital cost of such accommodation. Disinfection. It is recommended that a standardized plan of disinfection both as regards contacts and premises be formulated, and compliance therewith insisted upon by regulation. Disinfection of premises and equipment should be carried out under the supervision of a sanitary officer of the Department of Health. it is recommended that Regulation 9 (5) of the regulations of 1907, requiring written authority from a medical practitioner before a nurse who has been in contact with an infectious case can lawfully resume duty, which regulation, apparently with the consent of the Department, has been treated as obsolete, be again put into operation, and all managers of maternity hospitals notified accordingly. 6. General comments and recommendations. (A.) The Legislation, and, the Regulations made by authority thereof. —The Commission is of opinion that the several statutes dealing with private hospitals, and also with notifiable infectious diseases occurring therein, referred to in paragraph 4 of this report, contain all that is necessary for the purpose of governing and regulating these matters. The regulations also referred to in the same paragraph are, however, sadly in want of reconsideration. The Commission, was astonished to hear from counsel for the Department that the regulations of 1907 were out of print, and, further, to hear from Dr. Hughes that he had never been supplied Avith a copy and knew nothing of them. After this it was not surprising to learn that neither the Manager of Kelvin Hospital nor any of the medical practitioners had heard of these regulations. It is fair, however, to say that the leaflet referred to in paragragh 4, which purports to expound " the law as regards private hospitals," contains with some exceptions all that appears in the regulations, together with several requirements which are not .law but merely expressions of the departmental will. This state of things cannot be deemed otherwise than most unsatisfactory. It is recommended that all regulations and departmental requirements, instructions, and recommendations pertaining to private hospitals, maternity and otherwise, be collated, revised, brought up to date, and, together with the recommendations on this subject of the Maternity Mortality Committee of 1921, and the Private Maternity Hospital Committee of 1923, gazetted in the form of regulations under the statutes affecting hospitals now in force. (B.) Staffing of Private Maternity Hospitals. —Kelvin Hospital was staffed apparently to the satisfaction of the Medical Officer of Health, guided as he would be by the provisions set out in the leaflet above referred to, which prescribed that for every six patients there must be a registered midwife. It was in fact licensed for fifteen, patients. Generally the number did not exceed twelve, but there were occasions when fourteen were on the books. The Commission is convinced that the proportion of one registered midwife to six patients is inadequate, and recommends the proportion of one to four. This is in accordance with the recommendation in the report of the Maternity Mortality Commission of 1921. Further, it is recommended in this connection that in hospitals licensed for more than six patients the person charged with the duty of housekeeping, although a registered midwife, be not counted in the required proportion.