H.—3l

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the theoretical and clinical instruction in many of the smaller training-schools is bound to be inadequate. The possession of a medical qualification or a midwifery certificate does not mean a capacity to teach, and, when the lecture or coaching is merely an incident in the life of a busy practitioner or Matron, it cannot be expected to be of high quality." The second suggestion which I propose to make is that next year I should be authorized to inspect the larger maternity-training schools instead of the midwifery schools, which for the moment do not want inspection. I think that, so far, my inspections have led to the consolidation of and to improvement in midwifery training, and I hope a similar result may follow similar efforts in the case of maternity training. There is a possible danger which invests the proposed changes. The midwifery training centres, though ample for the needs of the country, can only train a certain number of pupils. If the present practice of " generally " trained nurses seeking midwifery certificates, irrespective of whether or not they propose subsequently to practice midwifery, is to continue, it is probable that there will be an excess number of candidates. In such a case the woman who definitely proposes to practice midwifery may be unable to get a training. To obviate this I submit that two steps are necessary. The first is to persuade Hospital Boards that it is both unnecessary and inadvisable to prescribe a midwife's certificate as a necessity for candidates for the majority of hospital posts. Training in maternity nursing is undoubtedly advisable for such posts, but midwifery training is wholly unnecessary, unless the post involves the teaching or practice of midwifery. I find that, rightly or wrongly, there is an impression that the Health Department is responsible for the unnecessary demand for midwifery certificates, and I think it might be well if this impression was definitely removed, and the opposite course recommended. The second step is to raise the repute of the maternity nurse by enabling her to register in Great Britain and other countries. The present training of the maternity nurse, and still more the training which will shortly come into force, is, if anything, above the standard adopted for midwives in Great Britain in all but one particular —namely, that she does not obtain the minimum number of conductions prescribed by the Central Midwives Board. When the new system is adopted there is no reason why maternity nurses should not obtain these conductions. Consequently, if this is the only barrier to their recognition, it can and should be removed, and recognition applied for. Once this has been obtained, it will tend more than anything else to reduce the number of unnecessary applicants for midwifery training. My only other remark under this heading is that the establishment of ante-natal clinics, in all hospitals recognized as complete training-schools for maternity nurses, is essential, and will, I hope, be carried into effect. The Training op Medical Students. I should like to congratulate the Obstetrical Society on the able and successful manner in which it has come to the aid of the Medical School of Otago University, and has brought practical help to the efforts which this Department has made for the past eight years. The effort, which has resulted in the creation of a full-term professorship, came as the necessary climax to all other efforts to incite its establishment. When the new maternity hospital at Dunedin is built, the foundations will have been laid of a new system of training, which will enable the past efforts of Professor Riley and his teaching staff to be brought to the completion which these gentlemen have so long desired, and which, if the financial position of the school had allowed, would long before this have been reached. I trust that in the making of the new arrangements one point will not be forgotten. Clinical instruction will still be necessary in places other than Dunedin, and the teachers who will provide it at the different St. Helens Hospitals must be paid sufficiently to enable them to devote the necessary time to it. Such payment must come either from the general funds of the school or from the surplus funds collected by the Obstetrical Society. When one or other of these is available, it should be possible to devote the money, now allocated by the Department to the payment of their medical officers in respect of the teaching of medical students, to payment for their increased work in the teaching of midwives and in the general duties of the hospital. Pari passu with the changes in the Dunedin school, and the improved clinical teaching in St. Helens Hospitals, should come the use of the obstetrical material in general hospitals for the instruction of students attending them, and of the junior hospital staff. I have urged many times the necessity for the recognition of this, and for the appointment of obstetricians and of gynaecologists to the staff of the large general hospitals. Such a step is necessary, both for the instruction of students and for the welfare of patients. At the time of writing my last report neither in the Auckland nor in the Wellington General Hospital did such an appointment exist. Since then, a Consulting Obstetrician has been appointed on the staff of the Wellington Hospital. It is obvious that such an appointment is not a satisfactory solution, either in regard to the treatment of the cases of difficult labour, which are admitted to the Hospital, or in regard to the teaching of the students and junior staff of the Hospital. I therefore sincerely hope that the Board will reconsider the matter, with a view to bringing their system into accordance with modern practice and with the obstetrical needs of the country. Dame Janet Campbell's Report on Maternal and Child Welfare in Australia. This most valuable report will well repay study by all those interested in maternity and child welfare. Its preparation and the investigation which proceeded it are the most important events that have occurred in the obstetrical world of the Southern Hemisphere during the past year. I have already made a short quotation from it, and if space allowed I could include many others with advantage. The conditions existing in Australia differ markedly from those existing in this country, and I think I may congratulate you, Sir, on the fact that many of Dame Janet's most important suggestions have been either already adopted here, or their wisdom and necessity recognized.