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As Dr. Paget shows in his report, these figures for maternity hospitals and for " elsewhere " are not comparable, since the figures given for the latter group include cases of septic abortion and ectopic gestation. As these conditions are not treated in maternity hospitals, it is necessary to exclude them when making a comparison. Twenty-six deaths occurred from these causes, and when they are deducted from the sixty-three deaths which occurred " elsewhere " a death-rate pf 3-87 per 1,000 live births is found instead of one of 6-62. Perhaps it is necessary to add that the inference must not be drawn from these figures that the maternal-mortality rate of the country is below 4 per 1,000 live births. In calculating this maternal death-rate it is necessary to include both septic abortions and ectopic gestations, in order that it may be comparable with the rate obtaining in other countries. Consequently, figures obtained by their exclusion are artificial, and are solely for the purpose of enabling the comparison of two sets of domestic statistics. That such a rate is considerably higher than is necessary can be seen by comparing it with the results obtained, not merely in the St. Helens Hospitals, but in many of the other larger maternity annexes to general hospitals, and particularly in those which are also recognized as training schools for midwives. The number of cases recorded is insufficient to afford positive data, and it will be necessary to wait for some five years or so to obtain sufficient numbers. Still, one thing is clear, that in the year 1929 the death-rate amongst patients confined in the maternity hospitals of the country was slightly less than amongst those confined in private houses. For this satisfactory state of affairs the. efforts of Dr. Paget to bring private maternity hospitals up to a proper standard are largely responsible. Dr. Paget has analysed in his report the results of hospitals devoted solely to midwifery and of hospitals which take also medical and surgical patients. He shows that in the latter group a rate of mortality occurred during the past year which must be regarded as very serious. Whereas in the unmixed maternity hospital the mortality rate for the country was 3-03 per 1,000 labours, the rate in the mixed hospitals was 8-23 per 1,000 labours. As I have suggested already, I think that obstetrical prognosis will be largely improved when the care of normal women is left to midwives during labour, because the risk of infection brought by a practitioner whose practice is " mixed " is greater than that brought by the woman who only practices midwifery. A similar argument applies even more strongly to the " mixed " maternity and general hospital with its " mixed" environment, equipment, and nursing staff. Personally I have always been opposed not merely to mixed hospitals, as Dr. Paget classifies them, but also to maternity hospitals possessing one or more wards for emergency cases. Dr. Paget's figures strongly support opinions which I have given in the past on this point, and I now hope that the attention of the Department will be focussed on the evil which he has proved. The abolition of mixed obstetrical and general practice by practitioners can only come slowly, and through public opinion, but the abolition of the more dangerous " mixed " hospital is within the powers of the Department. It is customary to talk and write at the present time as if it was impossible to trace the causes of an unduly high rate of maternal mortality. This seems to me to be a wrong attitude to adopt. The causes are, I think, realized by most thinking people, but the inertia of existing conditions is too great to allow them to be overcome. The inertia itself is a product of many factors —economics, popular beliefs, custom, tradition. Some day it will collapse like a house of cards, and the mortality of five and six per 1,000, which we find in sections of the statistics of the past year, will be reduced to a rate comparable with that found during the same period in institutions whose practice rests on a logical basis. Anle-partum Baths in Maternity Hospitals.—l am glad to say that the much-needed abolition of ante-partum baths has come several steps nearer fulfilment, and, in a number of public hospitals, such baths have been forbidden. The practice of the obstetrical world is tending rapidly in this direction. In the new maternity hospitals in Sydney there are no bath-tubs provided for ante-partum patients. A similar course has been, followed in most newly built maternity hospitals, and will be followed in the new hospital at Christchurch, and also, I hope, at Dunedin. Professor B. P. Watson, formerly Professor of Midwifery in Edinburgh University, and now of the Sloane Hospital, New York, writes as follows : " None of our patients ever receive a tub-bath ante-partum ; all our bathing is done on a sloping slab with running water. I believe with you that the full tub-bath is a menace to the patient." Now that the Obstetrical Society has expressed its approval of the abolition of such baths, it is hoped to be able to begin measures to stop the practice in all hospitals, public and private. Dr. Paget will, I hope, shortly direct his efforts in this direction. It is well to remember that, the poorer the type of hospital, the greater is the danger from " full baths," and that consequently, unless the practice is stopped in private as well as in public hospitals, the resulting benefit will be insufficient. The New St. Helens Hospitals. There is one other matter to which I must refer, because it is intimately connected with some of the most important suggestions which I have made to you, Sir, from time to time. So long ago as 1925 I urged the importance of creating in the large centres maternity hospitals of sufficient size to develop into really good training-schools for midwives and medical students, and into post-graduate schools for medical practitioners. At the time an opportunity was present of creating such a hospital in Wellington. It was, however, unfortunately lost in spite of the efforts of the Department, largely owing to the fact that the Trustees of the Alexandra Home thought their single girls might not be so well looked after in an enlarged St. Helens Hospital. Now, a similar scheme is on the verge of successful accomplishment in Christchurch. A site has been obtained. An agreement of amalgamation

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