H.—3l.

At present, out of twenty-eight training-schools only six give a preliminary course, four of three weeks and two of a month. When pupils are paid during this course it is hardly fair to expect a great deal from Hospital Boards, but there is no doubt our preliminary training is inadequate. In Great Britain where preliminary-training schools have been successfully in operation for many years, the course ia from two to four months. As a beginning it would appear possible for our hospitals to inaugurate a two months' course, the pupil paying £10 for this course. This would allow sufficient finance for the hospital to board the nurse during these two months and pay for a tutor sister to teach her. It is true that the number needed per year in some of our hospitals would not justify such a scheme, but there is no reason why New Zealand should not copy the plan adopted in Finland where there are five preliminary-training schools attached to the larger hospitals, the smaller ones sending their candidates to these centres to be trained. Probably six or seven such centres would adequately cover New Zealand, and it could be put into operation with very little cost to the Hospital Boards, as in places where such centres would be established there would be already sufficient accommodation and necessary equipment. The realization that ward sisters are definitely part of the teaching-staff and are responsible for the largest portion of the nurses' training is a subject which has been again and again stressed. But it is impossible for the ward sisters to adequately care for their patients' well-being, administer their wards, and teach their staff, unless they have adequate assistance of other trained staff. A further point is that while sisters may be attached to one ward for too long a period of years, at the same time frequent changes are as bad if not worse. The sister must be attached to the ward long enough for her to build up that personal contact which is so invaluable. On the other hand, if she is left indefinitely in one ward her mind becomes so set in one phase of work that it is impossible for her to adapt herself to new requirements. District Nursing. —For some time past the development of a district nursing service to alleviate the length of days' stay in hospital of many acute and chronic patients has been discussed. Auckland Hospital during the past two years has developed this type of work extensively. Under the charge of an experienced and well-trained district sister, staff nurses in their fourth year attend to early discharged cases. The average numbei of cases so treated per month for the last year has been forty-five and the number of nurses employed three. This, as can be understood, is a very cheap service to the Board, and is one that can be recommended strongly to other Boards with city populations. Obituary. In September of last year Miss Hester Maclean, R.R.C., Florence Nightingale Medal, passed away after an illness of some months. Miss Maclean was appointed Assistant Inspector of Hospitals in 1906, Matron-in-Chief of the New Zealand Army Nursing Service in 1911, and with the reorganization of the Department in 1920, became Director of Nursing, finally retiring in 1923. The nursing profession in New Zealand owes much to Miss Maclean's vision and courage. At the time of her appointment State registration had only just come into force, and the consolidation of this Act and stabilization of training-schools was largely her work. In addition, she carried out the formation of the New Zealand Army Service, as well as establishing a journal for New Zealand nurses and assist ing in the formation of the New Zealand Trained Nurses' Association. The fact that Miss Maclean was awarded the Royal Red Cross, Ist Class, at the termination of the war, and later the Florence Nightingale Medal (the first to be awarded in New Zealand) shows that her services were appreciated by her country, but probably her greatest appreciation lies in the warm regard she is still borne in by all those nurses who came intimately into contact with her understanding and generous personality. In conclusion, I would like to thank the staff of the Department and the matrons of the hospitals for their ready interest and assistance. Such co-operation makes for a unity of purpose which in the present difficult times is doubly appreciated. M. I. Lambie, Director, Division of Nursing.

PART VII.—MATERNAL WELFARE.

REPORT OF INSPECTOR OF MATERNITY AND PRIVATE HOSPITALS. T. L. Paget, L.R.C.P. (Lond.), M.R.C.S. (Eng.). I have the honour to present my annual report for the year ended 31st March, 1933. The decline in the maternal-mortality rate throughout Now Zealand, which has continued without interruption since 1927, warrants the anticipation expressed in my report of last year that the measures instituted for maternal welfare would be justified by results. The maternal-mortality rate for New Zealand of 4-06 places New Zealand in a position in which she can be favourably compared with those countries having a specially low maternal-death rate. This is shown in Table I, taken from the report of the Departmental Committee on Maternal Mortality and Morbidity of the British Ministry of Health, 1932, to which the figures pertaining to New Zealand have been added.

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