H.—7.

" The total food-requirement is well looked after, but the proportions of the foodstuffs used have not been judged so well. . . . Many people think that without meat in the diet they cannot keep healthy and fit, and this has caused a higher proportion of meat than is necessary or desirable to creep into the diet merely to satisfy the patients (and their friends). This, of course, brings the percentage of protein (flesh-forming material) above the requirement, and unbalances the diet. " It is not generally recognized that the percentage of protein in bread, and in porridge-and-milk is considerable, and that as these foodstuffs form a good proportion of the daily diet, the giving of too much meat will increase unduly the percentage of protein, and a high protein diet may, of course, cause ill health to the healthiest individual. . " In most cases the classes of foodstuffs used are very sound, and only on rare occasions is a poor quality of food bought, though there have been a few instances of deterioration due to unnecessarily long storage. " In most of the Mental Hospitals the actual cooking is fair, but owing to the lack of equipment and some lack of management there tends to be undue delay in serving. " In most of the institutions I got the ' containers ' restocked, or they are being replaced by better receptacles which will keep the food hot. I found that the type of conveyances also needed more attention, in cases where food had to be taken from one building to another, in order to deliver it in a satisfactory condition. Further, in the serving of the food from the containers to the tables too much time tended to be lost, and the food allowed to grow cold unnecessarily. " It seemed to me that where matters were not satisfactory in the above connections the fault lay not in the foodstuffs or in their cooking, but rather in the delay between the time when they were dished and their delivery and service in the wards. The Actual Meals.—" When one walked through the dining-halls in the various Mental Hospitals one was impressed by the largeness of the meals, and in very few cases could any one comment on the meals being too small. " To my knowledge there are few, if any, cases where patients are underfed ; and, as one passes through the institutions, the physical condition of the people strikes one as normal. "As a check on the patients losing weight (which might, of course, occur insensibly in any institution with a thousand patients) a book is kept, and every patient's weight is recorded once a month. By this means no appreciable loss of weight can fail to be detected, and patients found to be going downhill are, of course, ordered special diet with a view to restoring normal health and condition." Notes or Conversation between the Inspector-General, Dr. Gribben (Medical Superintendent, Seaclipp), and Miss d'Auvergne (Dietitian). Sir Truby King : I want to ask Miss d'Auvergne a few questions bearing 011 points in her report. (a) Re undue delay in the method of distributing the food in containers, and serving the meals from the containers to the tables. Miss d'Auvergne : I found the quickest service was at Christchurch and Waitati; Auckland was least satisfactory ; but alterations were effected more or less in all the places in the direction of speeding up, special attention being directed to this in Auckland. (b) Re quantity of food. Sir Truby King : Can you recall any cases in which the quantity of food was too little ? Miss d'Auvergne : No ; that practically never occurs. It might happen perhaps that on an occasion there would be a slight shortage, but this was very rare, and excess was the rule. (c) Re butter-supply. Sir Truby King : What do you feel as to the sufficiency or otherwise of the present ordinary butterration for chronic patients in the Mental Hospitals ? Miss d'Auvergne : I consider 1 \ oz. of butter a day (the present allowance) to be a sufficient average. (Note. —There is no such rationing-scale in the case of recent and recoverable patients.) (d) As to the recording of patients' weights once a month. Sir Truby King : Did you find matters fairly satisfactory with regard to the weighings, recordings) and special diet ? Miss d'Auvergne : Yes. (e) Re kitchens being old and out of date. Sir Truby King : You concluded that generally there ought to be better and more up-to-date kitchen equipments ? Miss d'Auvergne: Yes, that is so for the most part ; but Ido not. advise any extreme changes meantime. Of course, the equipment should, as far as possible, be made uniform and efficient in the long run ; but it would not be wise to rush ahead too quickly, especially with the present kitchen staffs. (f) Re position of kitchen ranges, coppers, steamers, &c. Miss d'Auvergne: I have practically nothing to add to what I have said in my report.

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