MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1918.

Appendix to the Journals of the House of Representatives, 1919 Session I, H-07

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1919. NEW ZEALAND.

MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1918.

Presented to both Houses of the General Assembly by Command of His Excellency.

The Hon. the Minister in Charge of Department for the Care of Mental Defectives to His Excellency the Governor-General. My Lord,— Wellington, Ist October, 1919. I have the honour to submit to Your Excellency the report of the Inspector-General of Mental Defectives for the year 1918. I have, &c, F. H. D. Bell, Minister in Charge of Department for the Care of Mental Defectives. The Inspector-General to the Hon. Sir Francis Bell, the Minister in Charge of the Department for the Care of Mental Defectives. Sir, — Wellington, Ist September, 1919. 1 have the honour to inform you that my report addressed to the, Hon. G. W. Russell was completed before he relinquished and you assumed the administration of the Department. Under the circumstances I now present the report to you, together with an appendix of later date dealing with soldier patients from the beginning of the war to the 4th August, 1919. I have, &c, Frank Hay. The Inspector-General to the Hon. G. W. Russell, the Minister in Charge of the Department for the Care of Mental Defectives. Sir,— Wellington, 28th June, 1919. I herewith present the report for the year ended 31st December, 1918. A summary and analysis of the statistical tables in the appendix shows that the number of patients on the register at the beginning of the year was 4,515 (m., 2,61.1 ; I., 1,904) ; at the end 4,546 (m., 2,603 ;' f., 1,943) —a decrease of 8 males and an increase of 39 females. The total number under care during the year was 5,408 (tu., 3,093 ; f., 2,315), being 148 (m., 31 ; f., 117) more than in 1917, while the average number resident, 1,501 (m., 2,602 ; f., 1,899,) was 133 (m., 59 ; f., 74) in excess. The ratio of patients on the register to population, exclusive of Maoris, was 40-46 per 10,000 (m., 47-30 ; f., 33-9), or 1 patient in 247 (m., 211 ; f., 295) ; including Maoris-their number on the register is 61 only—the figures are 39-26 per 10,000 (m., 45-79 ;f„ 32-95), or lin 255 (m. 218 ;L, 303). The admissions (excluding transfers —m., 45 ; f., 9) numbered 839 (m., 437 ; f., 402) ; the male admissions were, 33 lower and the female 28 higher than in the previous year. Among these admissions are included 7 immigrants (1 with a history of previous attacks) who had been here for less than a year, and 35 New-Zealanders were admitted after return from abroad (2 with a history of previous attacks). Of the 839 cases admitted, one-sixth were of patients who had previously been treated to recovery in our institutions, leaving the number of first admissions 704 (m., 381 ; I., 323), a decrease of 30 males and an increase of 25 females compared with 1917. The ratio of admissions to population (excluding Maoris) was 7-37 per 10,000, and for first admissions 6-23, or, in other words, every 1,357 persons in the general population contributed an admission, and every 1,606 a first admission. The previous decennial average was 7-57 and 6-26,

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The total number of patients discharged (excluding transfers) was 360 (m., 171 ; f., 189), of which 283 (m., 142; f., 14.1) were discharged as recovered. The remaining 77 (m., 29; £., 48), though not recovered, were sufficiently well to be placed under the. care of relatives or friends. The, percentage proportion of recoveries on admissions was 33-73 (m., 32-49 ; I'., 35-07), as against 38-27 (m., 36-38; L, 40-64) in the previous year, and 39-38 ( m ., 36-92; f., 42-97) in tinaverage for all years since 1876. The deaths numbered 448 (m., 274 ; f., 174), giving a percentage of deaths on the average number resident of 9-95 (in., 10-53 ; I'., 9-16), and on the, total number (general register) under care during the year of 8-28 (m., 8-8(1; f., 7-51). The corresponding percentages for the previous year were. 7-28 (m., 8-06 ; f., 6-19) and 0-05 (in., 6-59 ; f., 5-14) respectively. As usual, some persons whose condition was doubtful as regards certification as mentally defective have been received for observation at the instance of the Magistrate. At the beginning of the year there were 10 (m., 5 ; f., 5) such, and 110 (m., 70 ; I'., 40) were received during the year. Of this number, 70 (in., 48; I'., 22) were discharged, 39 (in., 18; I., 21) had to be placed under ordinary reception orders, one woman elected to remain on as a voluntary boarder on the completion of the, period of observation, 3 men died, and 7 (m., 6 ; f., I) were under observation at the, end of the year. These cases do not figure in the statistics, nor do the voluntary boarders, of whom there was a daily average of 34 in the State institutions. At the beginning of the year there were 29 (m., 10; f'., 19), and 75 (m., 28; {., 47) were admitted during the, year. Five (m., 1 ; L, 4) had ultimately to be placed on the register of patients, 4 (in., 2 ; f., 2) died, and 44 (m., 15 ; f., 29) were discharged, leaving 51 (m., 20 ; f., 31) resident at tin 1 end of the, year. The results in the, case, of persons remanded for observation and in the treatment of voluntary boarders, whereby many are saved from being committed as patients, are, distinctly encouraging. Altogether 114 such inmates recovered or left much improved without formal admission as patients. This means a reduction of the recovery-fate in our statistics in the appendix, a factor which should be, kept in mind in making comparisons with former years before, the present system was established. The, above figures disclose an increasing desire to utilize at an early stage of the disorder the improving resources of our mental hospitals, and in not a few instances ex-patients have returned for a period as voluntary boarders. The recovery-rate is also reduced by the inclusion in the statistics of the mentally deficient, where recovery is manifestly impossible. It is hoped in the near future to segregate younger mentally deficient persons in a separate institution and deal with their statistics apart from those of patients labouring under acquired mental disease. This segregation will be, an advantage from all points of view, and will enable these deficients to be classified and trained according to their capacity for improvement. Some can merely be cared for, others, by the exercise of infinite patience, can be, taught to dress and feed themselves, others will progress as far as to assist in the work of the ward, and those of higher grade can be taught to be farm and garden workers or domestics, while the best can be taught to pursue some trade. Whether those with sufficient capacity should after training be allowed to compete, in the labour-market is another matter and need not be considered now. A further factor prejudicing the recovery-rate is the undue proportion of senile cases admitted. A large number of these patients could with little difficulty be managed in a properly administered Old People's Home. Over 20 per cent, of the admissions in the year under review were contributed between the congenitally deficient and persons mentally infirm through advancing age. At the present time there are about three, hundred patients who could be cared for in some simpler and less expensive institution than a mental hospital. Yet another source of reduction in the recovery-rate is due, to the carelessness of convalescent patients permitted out on probation. Under the Act, such persons should provide, a medical certificate of recovery before the expiry of the period of absence on leave, otherwise they must be entered in the register as '•' not recovered." Some, of course, have not recovered but are, harmless and continue well enough to remain in the care, of their friends, but in the case of others the Medical Superintendent knows that recovery is almost certain, and frequently the certificate as required by the Act which should convey this information, furnished after making inquiries and appeals, comes too late to permit the recovery being recorded. For the average of six years ending with the introduction of the Act of 1911 recoveries calculated on the admissions were 37-91 per cent., and the proportion of those discharged unrecovered 5-28, while for the, last six. years the proportions are 39-84 and 9-21 per cent, respectively. Some part of the higher proportion of " unrecovered " is due to recoveries unacknowledged, because we have been keeping to the letter of the law. These matters are brought forward not because one, is dissatisfied with the recovery-rate, but to indicate that it is really higher than represented, and jusoifies if such justification were needed the higher expenditure on our buildings, amenities, and resources for some years past. Analysing the table of causation, one has to bear in mind that the principal assigned cause is stated, and where no definite, conclusion has been come, to the cause is stated to be unknown. Heredity is difficult to ascertain, and is therefore inadequately expressed, in the, table. The inherited tendency to nervous and mental disorders stands in inverse ratio to the stress factor, whatever it may be. Take, for example, such stresses as are associated with puberty, adolescence, and the climacteric, critical periods of adjustment to altering consciousness to which all are subjected in the ordinary course of life, but which prove too great for only a few, the mentally unstable. Another example found in the toxic effect of influenza, which large numbers of the community experienced during the_epidemic, and in the case of thirty-eight persons only led to mental disorder.

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Other factors may be adduced to explain the selective, affinity, but undoubtedly the most potent is inherited mental instability. Hereunder Table XIII is restated in percentage proportions of the principal causes : — Male. Female. Total. Heredity .. .. .. .. .. 7-55 .11-19 9-29 Congenital and mental deficiency .. .. 9-39 13-18 11-20 Predisposed by previous attack ~ .. .. 6-87 12-19 9-43 Critical periods .. .. .. .. 4-12 7-71 5-84 Senility .. .. .. .. .. 12-13 11-19 11-68 Mental stress .. .. .. .. .. 11-90 9-20 10-61 Alcohol .. .. .. .. .. 9-61 2-49 6-20 Syphilis .. .. .. .. .. 10-07 0-75 5-60 Epilepsy .. .. .. .. .. 5-72 2-74- 4-29 Influenza .. .. .. .. .." 3-44 5-72 4-53 Other assigned causes .. .. .. .. 6-61 12-94 9-65 Unknown .. .. .. ..- .. 12-59 1.0-70 11-68 100-00 100-00 100-00 Such statistical returns tend to be fairly uniform, the ups and downs of one year being balanced by the figures of the next. The above, proportions, compared with the average, show a marked reduction in the incidence ascribed to heredity and alcohol, and an increase in congenital cases and to mental disorder associated with, syphilis. There is also an increase of about 2 per cent, in the incidence of mental stress, which is very little during a period of economic unrest and when it is remembered that this factor includes the special anxieties and worries incidental to the war, whether direct or indirect, and whether on the part of the soldier or the civilian. The influenza epidemic which visited the country towards the latter end of the year did not spare the mental hospitals. None escaped, but the epidemic manifested itself in varying extent and severity in different institutions. For easy reference .the facts are placed hereunder in tabular form, and in studying these, while, still a lively recollection exists of the visitation as a disturbing element in the general community, some conception may be possible of the anxieties of those controlling the smaller and special communities resident in mental hospitals. In this connection I wish to record my appreciation of the faithful services of the staffs during a very trying time.

Influenza. —Mental Hospitals. Table showing the Daily Average Number of Patients and Staff (respectively), the Number attacked, and the Proportion in which the Malady proved fatal.

Mental Hospital, Patients. Daily Average Number at i i 11 of Patients Number attacked by (and Boarders) resident Influenza, during Epidemic. Number died from Influenza. Percentage of Deaths of those attacked. Auckland Christchurch Seaclifi Hokitika Nelson Porirua Tokanui M. 657 319 617 195 97 578 114 P. T. 397 1,054 359 678 447 1,064 71 266 109 206 448 1,026 43 157 M. 46 52 153 2 0 306 41 F, 56 146 106 14 ] 104 0 T. 102 198 259 16 1 410 41 M, 0 1 10 F. I 0 8 T. 1 1 18' 1-00 0-5 6-95 16 4 6 0 22 4 5-36 9-75 Totals 2,577 1,874 4,451 600 427 1,027 31 15 46 4-47 Staff. Daily Average Number of Staff during ISpidomic. Auckland Cliristchurcli Seacliff Hokitika Nelson Porirua Tokanui.. M. 70 75 109 23 22 88 28 F. 37 54 70 12 19 52 11 T. 107 129 179 35 41 40 39 36 28 75 7 2 54 22 25 32 42 5 2 29 7 6.1 60 1.17 12 4 83 29 0 1 3 1 1 0 1 0 1 1 4 1 1-64 1-66 3-42 8-33 1 0 1 3-45 Totals 415 255 670 224 142 366 6 2 8 2-16

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Table showing Date upon which Epidemic Influenza first manifested itself in each Mental Hospital, and whether first among the Staff or Patients; also the Numbers (Staff and Patients together) under Treatment on each Saturday thereafter, together with some Explanatory and Supplementary Notes.

Notes. Auckland. —The, first cases were regarded as sporadic. The epidemic did not spread in a regular way, but as isolated cases in different wards. About half were of severe type. Among female, staff 2 cases were complicated by delirium and 2 (1 died) by pneumonia. Pneumonia supervened among a few female patients (with 1 death) and in 2 cases there was severe haemoptysis. One male attendant had pleurisy and pneumonia. The male cases were singularly free from complications. Christchurch. —First and last cases among the staff. Epidemic mild. Not included in above are 3 sporadic cases in August and September. Appeared simultaneously in many wards and followed no regular course. One male. patient, admitted in an advanced stage of pneumonic influenza from Christchurch General. Hospital, died. One, male, attendant died (pneumonic type) in his own house, 22nd November. Seacliff. —The first cases were among the staff, no patients being attacked till 15th November. Confined to one ward on male side at first : those attacked were isolated as completely as possible. The spread to separate-building wards was a week later. On the female side isolation was similarly carried out with similar results. The spread was more rapid among patients disturbed mentally who could not be so effectually isolated. Nature of epidemic—severe. Waitati. —First the gardener, then the cook in the main building was attacked. The epidemic was then in the main building and passed to the Epileptic Cottage, where 18 out of 23 patients were attacked. The Retreat (a separate cottage for parole patients) escaped, and so did the large women's ward, which was strictly isolated. No nurse or female patient was attacked. Nature of epidemic— severe. Hokitika. —Epidemic started with the female staff, and some members of the male staff were the, next victims. It was confined to the patients on the women's side till 16th November, when 2 male patients were attacked in separate wards. There, was no further cases among patients on the male side, but altogether 2 of the male staff were affected and 1 died. Nelson. —No male patients affected and only 1 female, a voluntary boarder. No deaths. Porirua. —Began among the staff, and believed to be first cases in district; then started in one ward, and within three days had spread to three others. The incidence was higher among the males, and the outside workers were first attackerl. The rapid spread and rapid decline were remarkable. There were practically no new cases after 7th December. The. type was on the whole severe. Tokanui. —On 17th September there was a sporadic case on the. women's side (patient), and again on the 9th October a nurse was attacked. There were no further oases till 6th November, whim the mailman contracted it after visiting a picture-show at Te Awamutu. It was at first confined to one ward for five days. There were no cases among the women patients, but 7 members of the female staff were attacked. The type was severe, 6 males having pneumonic complications. Among the 5 who died, 1 was alcoholic. Under section 38 of the Appropriation Act, 1918, the maximum chargeable for the maintenance of patients was increased to £2 2s. per week, and higher payments can- be received under special circumstances. The average cost of the maintenance of patients during 1.918 was £55 6s. 4|-d., exclusive of any allowance for accommodation. Taking this as equivalent to 5 per cent, on Public Works expenditure, £9 14s. would have to be added, making a total of £65 in round figures. Against the factor of depreciation is the expenditure on upkeep, both out of our own vote and the Public Works Consolidated Fund.

Mental Hospital Auc kland. Christ-* church. Dunei Seacliff. din. 1 Hokitika. Waitati. I Nelson. Porirua. ; Tokanui. 28th Sept. 8th Nov. 8th Nov. , I Date First Case 4th Oct. 5th Nov. 11th Nov. First Week h N Nov. Patient or Staff Patient. Nurse. Attendant. Gardener. Nurse. Nurse. Staff. M Mail " Messenger. Number under treatment on — October 5 .. 12 .. 19 .. 26 .. November 2 . . 9 .. M. F, T. 4 0 4 4 I. 5 10 2 12 23 20 43 18 8 26 18 8 26 18 8 26 1.5 12 27 3 27 30 0 21 21 0 12 12 I. 4 5 0 I 1 0 I I M. V. T. 0 I I 4 2 6 22 88 110 41 47 88 21 65 86 11 51 62 4 20 24 3 8 1.1 4 4 8 2 0 2 2 0 2 M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M, F. T. 16 .. 23 ... 30 .. December 7 .. 14 .. 21 .. 28 .. January 4 . . 11 .. 3 2 5 2 0 2 10 5 15 9 0 9 66 33 99120 0 20 104 48 15218 0 18 60 54 11415 0 15 25 47 72 7 0 7 9 8 17 3 0 3 (1 7 13 2 0 2 2 3 5 5 16 21 4 8 12 2 0 2 0 1 1 2 3 5 6 4 10 191 35 229 235 61 296 139 30 169 13 34 47 7 15 22 4 10 14 •1 10 14 3 0 3 2 0 2 1 0 1 6 0 6 39 2 41 21 7 28 9 4 13

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The. various main items of expenditure are detailed in Table XXI. They vary in different institutions according to the number of patients and leical conditions. The Department recognizes that economies in food-supply and in little, comforts which largely sum up the pleasures in the-, life of a mental hospital patient were-, not admissible-,, and the energies of our officers have been in saving waste and by keenness in buying to advantage whenever opportunity offered. An exceptional deal in any commodity at one institution has been circularized to others, permitting their participation. Some years ago 1 advocated standardization throughout the Public Service of various things commonly used by many Departments, their purchase under the increased advantage of a larger and definite order, and their distribution by a special Stores Department, which would exercise itself to keep supplies in stock at the lowest level compatible with efficiency. The Department wemld be affiliated with the stores branches of certain Departments specializing in particular lines. The experience of the last few years has confirmed me in the opinion that a great advance could be. made in simplification of methods, togethe-r with an all-round reduction of cost, both initial and supplemental, and an improvement in quality and suitability, if a properly organized Stores Department, knowing the requirements of the-, Public Service and fixing a common standard for each item, undertook its purchase or manufacture and distribution. This statement will be more convincing if one take an example or two say, cloth for uniforms. Uniforms are- supplied annually in the Public Service, requiring some thousands of yards of cloth, and there must be a particular fabric which is the all-round best for the- purpose. Where there are not gooei reasons advanced feu- making an exception this cloth should be adopted feu- all Public Service uniforms, the distinctions between one- Department and another being in the make-up. Take another example sanitary fittings. We have standardized these, tei some- extent, anel, though the supply of standard patterns of recent years has been interrupted, our experience has demonstrated the enormous advantage of replacing one article by a, facsimile, both in regard to ease of requisitioning and the saving of time and labour eif plumbing. Not a little proud eif buying well anel eliminating waste- it, is amusing tei reflect that such economies may recoil on one-. It has been seriously advanced that, as we manage to provide for patients at an average cost of £65 per head for everything, we should not charge more than that sum, otherwise well-to-do patients are [laying a special tax. The trustee or the person liable for the maintenance of a well-to-do patient should remember that an average cost of £65 per annum means an expenditure of two guineas a week or more on certain patients—those who need more medical and nursing attention, or who are more destructive, or otherwise require more supervision or care than the average, a class not confined to but including for the most part all recent admissions. The expenditure on the average patient will approximate the "average cost as stated, while robust, clean patients, requiring little supervision, are obviously at the- other extreme and cost less than the average. But, whatever the- cost, anel apart from the nature of the case, the rise and fall is largely governed by the numbers dealt with, and in no case could a patient be privately managed— given the same medical attention, food, clothing, recreation, &o.—for anything like the amount charged. The poorer patient, by his mere presence, is lessening the cost to the better-off, and there is no hardship or injustice in charging an amount which in some particular case may be in excess of the actual cost - an excess which, if it exist, would be applied to a reduction in the appropriation for the upkeep of mental hospitals. Another fact which is often lost sight of is that the grounds, gardens, and general amenities of the institutions have been improved in the course of years, and that present-day patients are getting the great advantage of all this past work, an advantage which does not appear in the table of average cost, except tei a fractional extent for annual upkeep. If any of our improved estates were capitalized at what would be; their selling-value rather than at what was originally paid for them, a maximum charge of 6s. a day for maintenance, medical treatment, <fee., of persons who were too troublesome or destructive-,, or what not, to be kept at home leaves little ground for complaint on the part of those in a position to pay the full amount. Of course, it need not be pointed, out that there are some patients who are not paid for at all, and that all assessments are made strictly according to the means of the persons liable to contribute. In 1918 the total amount collected for. maintenance was £52,657, equal to £11 14s. 4-jd. per head on the-, average number of patients and voluntary boarders resident. You, Sir, have from time to time received letters from persons wishing to pay more adequately to have their relatives cared for in some special institution. We now have buildings at each of the larger institutions admirably suited for reception-houses which are centres of treatment, dealing with a maximum of twenty-five patients in a ward ; but the request made was for something more exclusive— for something which would be more a home than a hospital—and as the desire expressed was backed by offers to pay five guineas a week or more you were impressed by the sincerity of your correspondents, and, acting on instructions, the Department considered, to begin with, the question of building near one, of the centres, provided some land could be acquired, suitably laid out, and conveniently placed for visitation by our expert medical staff —a sine qua non. At this time our attention was drawn to a, property near Hornby Station, which fulfilled our initial requirements, and permitted of extensions with a minimum of alteration. The house, which is well placed in regard to sun and light, stands in 50 acres of land —lawns, gardens, orchard, and grass paddocks—and is well sheltered from prevailing winds. The outlook is cheerful and extensive. Negotiations were entered into for purchase, and we hope to enter into possession in September next. Among the manifest advantages of this situation is the fact of its being on the road between Sunnyside and our farm property at Templeton, where it can be visited in the ordinary round of the Medical Superintendent of Sunnyside, though, completely separated from, that institution. It is not contemplated that male patients will be admitted to begin with. Among other items reducing the cost of maintenance are our farming operations. The produce supplied from our farms for the use of patients, totalling in value £19,734, is not included in Table XXI under " provisions." The actual cash receipts for sales of stock and produce (£10,588) and by-products (£3,526) totalled £14,114, and there were sundry other receipts. All these have been collected together in Table XXa in the appendix, and show a total of £69,195. A statement of farm expenditure and receipts will be found, on pagess 6 and 7.

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Statement of Expenditure and Receipts, etc., in connection with the Farms at the Mental Hospitals. Dr. £ s. d. Or. , £ s. d. To Salaries and wages .. .. .. .. .. .. 7,036 14 7By cash sales of produce, &c. .. .. .. .. ..- 10,588 0 5 Feed .. .. .. .. .. .. .. 5,146 13 7 Value of produce grown on farms and consumed in the mental hospital.. 19,734 9 6 Seeds, &c, manures .. .. .. .. .. 2,044 19 7 Implements, harness, repairs, <fee. .. .. .. .. 1.288 7 1 Stock .. .. ... .. .. .. .. 1,324 17 8 Pent, rates, &c. .. .. .. .. .. .. 1. 103 8 5 Fencing, roading, &c. .. .. .. .. .. 497 14 1 Harvesting, threshing, &c. .. .. .. .. .. 820 9 3 [ Railages .. .. .. .. .. .. .. 348 18 7 Buildings . . .. .. .. .. .. .. 104 1 1 Sundries .. .. .. .. .. .. .. 510 14 3 Balance .. .. .. .. .. .. .. 10.095 11 9 £30,322 9 11 £30,322 9 11

Statement of Expenditure.

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t Hokitika. Nelson. Porirua Tokanui. ! 1 Total. Auckland. Christehnrch. Seacliff. Salaries and wages Feed .. Seeds, &c, manures Implements, harness, repairs, &c Stock Rent, rates, &c. Fencing, roading, &c. Harvesting, threshing, &c. Railage Buildings Sundries " L £ s. d. 260 0 0 267 5 11 255 10 1 79 19 11 49 9 6 2 18 0 1 13 10 66 15 9 £ s. d. 1.275 0 0 227 14 0 326 16 11 580 8 2 1.205 1 2 794 4 11 449 0 1 649 19 9 27 3 4 65 2 10 24 13 2 £ s. d. 3,035 10 0 2.758 1 2 541 7 7 217 11 3 54 0 0 193 16 0 49 12 10 185 19 11 411 9 2 £ s. d. 481 17 9 19 9 9 22 12 6 13 17 6 22 16 4 £ s. d. ' £ s. d. £ s. d. 360 0 0 405 0 0 1.219 6 10 165 5 9 1.648 10 10 60 6 2 154 19 11 446 5 9 297 6 10 33 5 5 85 4 11 277 19 11 400 9 16 0 210 115 7 6 22 19 8 68 7 6 .. 52 9 2 3 16 0 .. 130 15 6 4 2 5 .. -34 15 10 7 16 2 £ s. d. 7.036 14 7 5.146 13 7 2.044 19 7 1.288 7 1 1.324 17 8 1.103 8 5 497 14 1 820 9 3 348 18 7 104 1 1 510 14 3 Totals .. 983 13 0 5,625 4 4 7.447 7 11 560 13 10 793 17 0 I 2,710 5 0 I 2,105 17 1 20.226 18 2 i

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Statement of Receipts. The statement of receipts is extended in the following table : —

The purchases of stock do not include cattle or sheep bought for more or less immediate consumption, where we provide our own meat-supply. With regard to such stock a grazing-rate is credited to the farm and charged against the cost of meat. Where stock reared on the estate is taken to the, abattoir the farm is credited with the value. We, are now supplying meat at Seaclift', Sunnyside, Hokitika, and Tokanui, and successfully, as the patients are getting prime quality and the cost to the Department is less than it would be under contract. Even if it were a fraction more it would be justified by the uniform excellence of quality. Balance-sheets have been drawn up to demonstrate the year's work in this direction, and as. they are interesting a sample (that furnished by Sunnyside) is reproduced hereunder. Here the sheep and cattle are purchased at the, Addington Market and killed at the City Abattoir. Statement of Beef and Mutton Transactions fob 1918. Christchurch Mental Hospital. On hand, Ist January, 1918— £ s. d. On hand, Ist January, 1918— £ s. d. Beef, 1,204$ lb. at 1.-96 d. .. .. .. 20 2 8 Beef .. '.. .. 20 2 8 Mutton, 2881b, at 5-67 d, .. .. .. 0 10 1 Mutton .. .. 6 16 1 On farm, Ist January, 1918— £ s. d. Returned from abattoir during Cattle, JO at £14 12s. .. .. 140 0 0 1918— Sheep, 74 at 20s. 0-Bd. .. .. 98 0 0 Beef, 100,572 lb. at 5-25 d... 3,513 19 1 Cattle bought, 207 at £19 os. 7-ld. Mutton, 93,850 lb. at 4-87 d. 1,904 8 10 (insurance included) .. .. 4,001 5 0 Sheep bought, 1,008 at 325. 3-od. .. 2,693 15 3 Grazing on mental hospital farm— Cattle, at 4d. per day .. .. 62 9 4 Sheep, at 4d. per week .. .. 90 13 0 Abattoir charges— Cattle .. .. .. 61 5 0 Sheep , . .. .. 64 2 6 Cartage of beef from abattoir .. 25 18 10 Cartage of mutton from abattoir .. 17 12 2 Proportion butcher's salary (£75+£75) 150 0 0 Proportion incidentals at sales (50s. + 505.) .. .. .. .. 5 0 0 Proportion upkeep of freezer (£so+ £50) 100 0 0 . 7,516 8 1 7,549 6 10 Less. Cattle sold at auction, 3 at £16 7s. 6d. (average) .. .. .. 49 2 6 Sheep sold at auction, 20 at 335. 9d. .. 33 15 0 On farm, 31st December, 1918— Cattle, 6at £18 10s. .. .. 11l 0 0 Sheep, 43 at 335. 7d. .. .. 72 4 I Hides sold at auction, 188 .. .. 472 16 7 Skins sold at auction .. .. 796 12 0 Hides on hand (20), valued at .. 40 0 0 Skins on hand (20), valued at 7 19 0 Fat sold (£O2 3s. lid.+£lol 13s. 3d. .. 103 17 2 Fat sold after refining (half each) .. 270 1 7 Fat, 2,203 beef and 2,202 mutton at 3d. —refined and made into soap at Mental Hospital .. .. 55 1 3 Fat, 780 lb. beef and 780 mutton at 3d. —refined in Mental Hospital and used for baking .... 19 10 0 2,098 0 2 £5,451 6 8 £5,451 6 8 Cattle slaughtered, 208 ; average dressed weight, 771 -98 lb. ; average consumption per diem, 437-98 lb. Sheep slaughtered, 1,079; average dressed weight, 55-89 lb. ; avorage consumption per diem, 254-38 lb, On hand, Ist January, 1919; Beef, 1,974$ lb. ; mutton, 1,288 lb,

Produce sold for Cash. Value of Produce consumed. Total. Mental Hospital. Luckland !hristchurch .. ieacliff lokitika kelson 'orirua tokanui £ s. d. 1,045 8 0 2,859 15 6 3,281 7 4 £ s. d. 2,978 1 4 5,172 7 10 5,322 16 5 786 14 6 1,605 11 0 3,230 11 7 638 6 10 £ s. 4,023 9 8,032 3 8,604 3 786 14 1,958 16 4,680 2 2,236 19 d. 4 4 9 6 9 9 6 353 5 9 1,449 11 2 1,598 12 8 Totals 10,588 0 5 19,734 9 6 30,322 9 11

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The staff has not yet approached its normal numbers after the severe depletion caused by the war. In the Head Office we elected to carry on understaffed rather than introduce temporary clerks where so much of the work is confidential, but at the institutions the shortage of the nursing staff had to be made up the best way it could, and there is no denying the fact that many of the stop-gap appointments have been a source of anxiety, and that we shall be greatly relieved when the transition period is over. The responsible and senior officers must be complimented on their loyal, co-operation, especially on distributing the duties so as to make, the best use of the, more promising probationers. The shortage among the attendants is easily explained, but the. shortage, was and is more felt among the, female staff. This complaint is not confined to mental hospitals. Naturally the avenues for women's work were widened on the withdrawal of the fittest men, and the wages earned by them were so much above the usual average that one, must expect some time to elapse before the vacancies are suitably filled. Meantime, the Public Service Commissioners have raised the salaries in a classification about to be gazetted, which should prove very satisfactory to the nursing staff, who, except in the case of married attendants, are affected very little by the increased cost of living, being provided with free residence and certain emoluments, and are charged for board a sum that is actually under cost. Certain officers e.g., medical officers, clerks, engineers, farm-managers —were, in the past given a salary of so-much (-ash and found (themselves and families). The system had been in operation ab ttrbe condila, but was manifestly unequal, and the opportunity was taken of commuting the allowances for a cash payment absorbed in the new salary and requiring these officers to find themselves, providing, however, free residence, fire, and light because of the advantage to the institution to have, them resident on the estate. On the estimates it will appear that these officers are having their salaries unduly increased, but in point of fact they are not, for a, considerable portion of the increment they are getting in money was paid to them heretofore in food, which we purchased with that money and gave to them. These officers are given the privilege of purchasing supplies from the institution stores. We should like to be in a position to extend this principle to all employees, but there are gravedifficulties in the way. The Public Service Association has, I understand', made arrangements for getting its members a reduced tariff at certain hotels, and would be fulfilling a, helpful function in extending the principle by getting tenders from certain firms for the supply of goods to its members at special rates. This would be more satisfactory than the Government providing advantages to one Department over another. In the absence of some generally applicable scheme it may be possible for us to arrange, with our contractors to supply our employees at reduced rates, if the) - combined to send orders sufficiently adequate to make it worth while lor the contractor. The matter would not have arisen had we not done away as far as possible with the old system and allowed the officers who hitherto drew their supplies from our stores to substitute buying from the stores. In course of time the origin of this privilege, will be lost sight of, and officers not possessing it, will tend to consider that they have, a grievance. I have touched on the subject of certain officers- happily only a few—being unsatisfactory, and when these by effluxion of time are placed on the permanent staff there is a difficulty in dispensing with their services unless they acknowledge their offence when charged. Proof frequently needs the evidence, of patients, and we are not going to subject .patients to cross-examination or the odium of sympathisers, and therefore unsatisfactory officers have to be, retained, until a charge of inefficiency is supported by flagrant neglect of duty. This is very unfair to the Superintendents, who are responsible for the care and control and general well-being of the patients, the real sufferers when discipline slackens ; and it is also unfair to the charges or other senior officers, of whose devotion to duty and to their patients I cannot speak too highly. In the interests of the patients the least I can suggest, is an extension of the probationary period, so that the inefficient and otherwise unsuitable may be weeded out and pass on to some employment for which they are temperamentally fitted. The number of patients and extent of accommodation in. the different institutions at this date, is stated below, the patients being classified according to the nature of their mental disorder or deficiency in terms of the definition of " mentally defective person " in the Act..

Analysing the classification above, it may be stated that, all persons in ('lass 1 would have been included under the old term "lunatic"; that of Class II a. proportion would come under the same term, but a fair number could be treated in Old Persons' Homes as senile patients did these institutions possess the requisite, simple nursing facilities. Classes 111, IV, and V include persons exhibiting mental deficiency in different degrees. Nearly all these patients should be segregated from the other classes,

Mei itally Defei itive Person is. ». , Mental Hospital. Class I. Unsound Mind. Class II. Mentally Infirm. Class III, Idiots. Class IV. Imbeciles. Class V, Feebleminded. Class' VI. Epileptics Total. Accommodation. Auckland Christchurch .. Dunedin (Seacliff and Waitati) Hokitika, Nelson Porirua Tokanui M. v. 297 220 171 212 472 325 M. it. 170 35 64 68 44 37 M. 1'. 8 4 (i 2 10 3 M. F. .67 24 35 37 39 31 M. V. 47 74 20 2(i 7 9 M. 1'. oi 35 ISO 35 57 35 M. I'". T. 650 392 1,042 320 380 700 029 410 1 ,009 M. v. 'r. 015 385 1,030 330 385 715 532 403 935 148 42 25 32 474 353 109 39 20 14 35 41 27 18 2 I 13 7 4 3 0 I 7 2 10 1(1 25 21 1 2 4 8 (i (i I (i IS I 0 14 5 9 7 40 30 I I 195 72 207 98 103 201 586 443 1,029 112 13 155 206 04 270 88 118 200 590 403 993 152 19 201 Totals 1,696 1,223 360 213 43 21 184 127 101 141 212 148 2,596 1,873 4,469 2,543 1,807 4,350

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It is noteworthy that some higher-grade imbeciles and feeble-minded persons managed to get into military camps and the Expeditionary Forces before their condition was discovered. Class VI includes those epileptics who, on account of their mental condition, require oversight, care, and control. The mental condition of some patients of this class is at times the most disturbed, and dangerous of any, and at other times, or in other cases, the mental disturbance is relatively mild. With regard to accommodation, the usual transfers are in contemplation for adjusting balances, and certain works are in progress to make up the deficiencies and augment the resources in respect to classification. Auckland will be relieved by Tokanui; but the, increase of population in Auckland District has to be anticipated, and additions are planned for 60 males and 80 females, mostly to classify the semi-disturbed ; but one small ward on the female side will be for patients of faulty habits. At Tokanui another male unit for 50 has been opened, and a similar unit for females is nearing fitness for occupation. This unit, together with one for 20 working patients on a remote part of the estate, have been delayed by tin- workmen being lent to the Public Works Department because of the extreme urgency of providing accommodation at. Motuihi Quarantine Island. It has been decided to begin the, direct admission of patients at Tokanui, and for this purpose suitable blocks for 23 males and 27 females have been planned and approved. These buildings completed, patients from the Waikato district will be admitted here, instead of going to Auckland. Tokanui is also an outlet for the relief of Porirua. The extensions at Tokanui necessitate a properly equipped laundry : heretofore we have got on with hand washing and an improvised diying-chamber. At Porirua during the, current year the excess on the women's side will be met by transfer, and additions will need to be made next year. Tenders are, about to be called for a reception-house at Nelson suitably planned to meet local requirements, and to be an instalment in the rebuilding of this hospital. At the present time one of the women's wards is occupied by mentally deficient boys. At Hokitika provision has been made, for a Medical Superintendent's residence. The lay Superintendent's house will be adapted for patients, and I trust that a block for boiler-house, bakery, kitchen, and laundry will soon be started as a nucleus for the gradual rebuilding of the institution. At Christchurch the preparation of the Eeceiving and Hospital Block is proceeding. I reported to you the faulty plaster, and you visited the building and saw the work we had carried out since the building was handed over to us. I trust that it will soon be ready for occupation, and that there will bo an official opening, as was the case at Porirua, when a parliamentary party inspected buildings of similar general design. Plans have been prepared for extending the day-room and dining-room for the more disturbed women patients, who require as much space as possible in their living-rooms, which are cramped at present. Without material!}' adding to the cost these extensions will be. carried out. in a style architecturally fitting the main building, of which they will form a part. A small ward is also necessary for patients with faulty habits. At Seacliff accommodation has been added to take the patients from The Camp, who wore being maintained there at a high cost, with no compensating benefit, and a unit for 56 patients has been authorized and will be placed at Waitati. Taking generally the question of accommodation and classification, the main desiderata at present are the Segregation of juvenile deficients', and a small institution for the few patients we have or are likely to have of the criminal class. For the first the Nelson District would be the most convenient for our purpose, especially if the Stoke institution were handed over to us ; for the second some spot near the boundary of our Tokanui Estate with the Waikeria Reformatory property. This project I have discussed with the Inspector of Prisons, and he agrees that it would be a suitable site from his point of view also. Visits of Inspection. I am glad to have this opportunity to express my thanks to the District Inspectors and Official Visitors for their helpful co-operation in advancing the welfare of the patients ; to my colleagues Miss Maclean and Dr. Gow for their reports of visits, and to the latter especially for doing relief duty at Seacliff for five weeks, including February this year. Mr. Ewington, after long and faithful service, resigned his position as Official Visitor at Auckland Mental. Hospital. He wrote paying a tribute to the improvements that had been carried out, and thanking you, the Department, and the officers of the Hospital for the sympathy and support he had always received, stating that he relinquished the office on medical advice. Mr. Ewington's understanding of the patients, and his tact in dealing with them, acquired after many years of intimate association, and his willingness at all times to make special visits for his own satisfaction or at the instance of the Department, made his services particularly valuable and will make his loss the more felt. A serious loss to Sunnyside was sustained by the death in February last of Mr. Smail, who, as patients' friend, visited the institution for about three hours or so daily. He accepted his duties as a serious charge, and his joyous presence in the wards was looked forward to by the patients and staff. Every week I had a report from him of his visits—reports which exhibited his enthusiasm for the work in hand, the well-being of the patient. Talcing him all in all we shall not look on his like again. Auckland. Visited in February, March, August, 1918, and in January and June, 1919. The, male infirmary is now completed and in occupation. The main kitchen has been remodelled, and suitable mess-rooms Tor the staff an; ready for occupation. Shelter-sheds are about, to be erected in connection with the Women's Annexe, Renovations, repainting, and decorations, largely suspended during the war, are to be undertaken now, so as to restore as soon as possible the cheerful aspect of the wards. Questions regarding additional buildings, the influenza outbreak, and the staff difficulties have been mentioned in other sections of this report. The war depletion and the indifferent probationers was perhaps felt here more than elsewhere, but Dr. Beattie, in indifferent health, battled on with the assistance of Dr. Tizard and the senior staff, putting his outlook tersely in his last, report, thus : " We fully realize, the insignificance of our difficulties in the face of the immensity of our national crisis."

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Sunnyside. —Visited in February and September, .1918, and in January, February, and May, 1919. I have mentioned elsewhere the additions about to be carried out and the Peception Block being fitted for occupation. The laundry cannot now do the work, and extension will need to be undertaken. Meanwhile a proportion of the washing is sent to Mount Magdala. The temporary adjustments in the kitchen permit of its working fairly satisfactorily, but we hope to get, the new kitchenpans and make the kitchen thoroughly efficient. On the farm a building to house implements is badly wanted. Dr. Gribben will doubtless mention in his report the satisfactory working of the home farm, and that at Templcton. It remains for us to add the term " creditable," knowing the personal interest he has taken in the matter. Owing to the slackening off of repairs and renovations during the, war a lot will need to be done, especially on the male side, where the old plaster is disintegrating and patching has proved unsatisfactory. The, problem will reed to be tackled and replastering carried, out ward by ward, and until this is done, money spent in decoration is wasted. The different departments of this Hospital are working well. The cinema entertainments are much appreciated, and the conduct of the patients viewing the pictures in. large numbers has been uniformly good. The shortage of the female staff is remarkable, considering that few will ever have been better off than they are in. the Nurses' Home. Seacliff. —Visited in February and September, 1918, and in February, 1919, when Dr. Cow, the Deputy Inspector-General, was doing relief duty at the Hospital. The ground-slip mentioned in my last report, together with the indifferent water-supply at (Seacliff proper, has determined additions which would have been put up in the slip area being transferred to Waitati. The laundry also requires considerable extension, and this also should be transferred to Waitati, where there is a. sufficient, water-supply, leaving a small laundry at Seacliff for urgent, work. , With the facilities provided by motor traction the main laundry could be economically worked at Waitati. Tin; central bathroom is about to be started. A new water-reservoir has been erected above Simla, where the sanitary arrangements have been remodelled. The staff shortage has been least felt at this Hospital, and the work of the year has been up to its usual standard. Dr. Jeffreys is still acting for Dr. King, whose leave has been extended to complete the special work he is doing in England. A number of minor works are, to be carried out at. Seacliff and Waitati, in addition to those enumerated elsewhere in this report. Hokitika.- Visited in February and September, 1918, and in February and June, 1919. Tt was decided to place this institution under a Medical Superintendent, but owing to the absence of medical officers at the front the appointment has been delayed. It will be made during the current year, on the retirement of Mr. Sellers, the. return of Dr. King, and other contingencies permitting the readjustment of the medical staff. There are few admissions here, and every now and then the vacant accommodation is filled to relieve other institutions. The institution is old, and will need to be rebuilt bit by bit. The, institution is most scrupulously clean, and in spite of its age and shortcomings is comfortable. Nelson.- Visited in January and December, 1918, and in June, 1919. Everything working smoothly. Another instalment to the rebuilding is about to be gone on with. The patients are comfortable, because the old building is kept fresh and clean. Dr. Mc.Killop is Acting Superintendent. in the absence of Dr. Jeffreys. Porirua. —Visited in February, July, September, and. December, 1918, and in March and April, 1919. The new Reception Hospital is evidently filling a. need, and we have had many appreciative letters from patients and their relatives. Dr. Hassell has had the assistance of Drs. Prins and Macphorson in carrying on the administration of this large institution th ough another successful year. There is an excess of patients on the female side, which in due, course will be, relieved by transfer to Tokanui. The drainage system has been completed ; the septic-tank effluents are now piped into the harbour. We lease some Maori land in connection with the farm, and, as the leases are running out, we should consider the question of purchase. The buying of stock and doing our own killing for meat-supply is contemplated; Under the will of the late Mr. R. C. Bruce a sum of £500 was left to Porirua. This considerate and kindly legacy is much appreciated. I discussed its application with the trustees, and it was decided to purchase a first-class cinematograph outfit for the patients' recreation. Tokanui. —Visited in February, August, November, 1918, and in January, 1919. The development which was set back owing to the war is now to be. pushed on, and 'n anticipation we are erecting a building for twenty working patients and staff at ?n end of the estate remote from the, present institution buildings. The Prisons Department have completed a well-graded road through the property past the proposed site, of the ultimate main institution. The many works in progress or contemplated this year are mentioned elsewhere in the report. Some uneasiness has been caused by the fact that the water (which is otherwise pure and a good potable, sample) shows a marked tendency to attack the. boiler-plates. The Dominion Analyst is giving every assistance 1 to solve the problem. Ashhurn Hall.-- Visited in February and September, 1918, and in January and. February, 1919. This private mental hospital, placed in beautiful surroundings, continues to fulfil the function of a, comfortable home-like institution for patients able to appreciate it. As it will be some, time before this report can be presented to Parliament in the ordinary course it is intended to add a special note regarding the work of the Department in relation to soldiers from the beginning of the war to as late a date as possible. In conclusion, Sir, I have to thank you for your support and encouragement, to congratulate the administrative heads of the different institutions and those associated with them on the successful conclusion of another year's work, and to express my indebtedness to the Head Office .staff for their loyal co-operation, T have, [&c, Frank Hay.

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MEDICAL SUPERINTENDENT'S REPORTS. AUCKLAND MENTAL HOSPITAL. Dk. Beattie reports — The total number of patients under our care duringjthe year was 1,306 -782 males and 521 females. The number admitted was 245—129 males and 11.6 females. Njne males and 15 females were admitted as a consequence of the influenza epidemic. The other chief causes were senility, congenital and hereditary conditions, and syphilis. The recovery-rate was -14-22 per cent. In addition to those discharged recovered .1.1 patients were discharged unrecovered and were placed under the care, of responsible relatives. The death-rate was much heavier than usual, being 13-20 per cent, of the average number of patients resident during the year. This is accounted for by the large number due to senile decay (28), chronic brain-disease (28), phthisis (20), and general paralysis (14). A large number of influenza cases were treated with only one death. In this case, too, influenza was a secondary rather than a primary cause. Although our drainage system is now apparently quite satisfactory we still have occasional attacks of enteric fever : one death occurred from this cause during the year. As our Maori patients have in many cases been found to be carriers, we are unable to attribute the attacks to any other source of infection. The general work of the Hospital has progressed with varying degrees of efficiency. With few exceptions the best of our young men left on active service, and we have unfortunately been unable to replace them. We are still unable to do so, and one cannot but feel dissatisfied with the general condition of affairs. 1 cannot dissociate myself from the impression that part of the lack of discipline and the general air of disinterestedness, if not actual negligence, at present existing is to be accounted for by the operation of the Public Service Act, which, in its application to a mental hospital, where the conditions obtaining are so totally different from those, in any other public; institution, leads to a subordination of the authority of the, controlling officers, and is consequently prejudicial to the recovery and general well-being of the patients, Where patients are so mentally helpless and therefore so entirely dependent upon those in charge, of them, and when their evidence is almost invariably totally discounted in a Court of law, it is surely necessary to provide us with a staff whose natural qualifications justify their tenure of office. Any conditions which hamper the superior authorities in the proper regulation and control of the staff is bound to be reflected sooner or later in the decline of the patients' interests and the, rude awakening of the public; mind to the gravity of the position. I have to thank Dr. Tizard and the senior officers, chiefly, for their loyal service to myself and to the Hospital, also the District Inspector and the Official Visitors for their interest and readiness to help at all times. We have to thank the Herald for newspapers supplied daily, and Miss Fleming and various city bands for continued generosity. SUNNYSIDE MENTAL HOSPITAL. Dit. GiuBBEN reports:— At the beginning of the year 1918 there were 748 patients on the register, of whom 362 were males and 356 females. During the year there were admitted 59 males and 63 females, and at the, end of the year there were remaining 744 patients, a decrease of 4 for the year. There were 58 deaths (32 males and 26 females), giving a death-rate of 8-17 per cent, on the average number resident. There were 29 recoveries (15 males and 14 females), giving a rate of 2397 per cent, on the admissions. The health of the patients on the whole was good. The difficulties consequent upon the committal of persons who are suffering from physiological senile changes are in no way diminished, and in this connection I would like to repeat the suggestion in my report of last year that some, definite action should be taken in amending the law so that these unfortunate old people could be cared for under conditions specially adapted to their needs. The matter of repairs and renovation in the buildings generally, which it has not been possible to effectively deal with during the war, is now one of urgency, and it will be necessary to put in hand a general scheme throughout practically all the wards, at all events of the old buildings. There is also inimodiate need of extension to improve the accommodation and conditions of patients at present resident and to. make necessary provision for increases. The work on the farm has gone on satisfactorily, and the season promises to be a fruitful one. Another year's experience in the killing of our own meat has still further convinced me of the advisability of adopting this system where it is at all possible. For the year the cost of beef was 5-25 d. per pound and that of mutton 4-87 d. per pound. Apart from the economy of the system, the quality of the meat that it is possible to secure, combined with the opportunity given by variations in the patients' dietary, strongly commends this system. The shortage of staff and the increased proportion of junior members incidental to the war have combined to increase the responsibilities of the seniors, whose loyalty and enthusiasm have done much to case the difficulties consequent upon the situation. The patients' entertainments have been continued as before, and the acquisition of a picture outfit of our own will now enable us to give entertainments for odd hours during the winter evenings PORIRUA MENTAL HOSPITAL. Dr. Hassell reports : —■ In referring to the statistical tables for the year 19 L 8 it will be noted that the total number of patients under care at this mental hospital was 1,240 (697 males and 543 females), while the average number resident was 1,012. 251 were admitted, of whom 46 were readmissions, and 100 died (66 males

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and 34 females). The, total number under care was only 1 more than in the previous year ; the 1 number admitted for the first time (205) was the same as in the previous year (1917). The recovery-rate was low, the percentage on admissions being 29-80. This is largely due to the exceptional number of incurables admitted, including 20 suffering from general paralysis, 37 from congenital mental defect, and 21 from senility. The percentage of deaths was unusually high, the ratio to the average number resident being 9-88 per cent. It may be noted that in the 100 deaths, 21 were due to senile decay, 20 to general paralysis of the insane, and 22 to influenza. I have already reported to you on the severe epidemic of influenza as it affected the population of this Hospital, but I may be allowed to recall some of its more salient features. Altogether nearly 500 were prostrated by the disease -viz., 306 male patients, 104 female patients, 54 attendants and officers, and 29 nurses. The epidemic lasted a little over a month, starting at the end of October. Early in November it attacked patients in several wards, and rapidly spread notwithstanding various precautions taken. On the 23rd November 296 patients were confined to bed with the, disease. Then there was a rapid decline in the number of new cases. On the 7th December there were only 44 cases confined to bed, and after this date scarcely any new cases occurred. It is remarkable that the, first eases to contract the disease were outdoor workers employed in tin- garden oi- on the farm. The young and strong seemed to be more readily infected ; the old and infirm, escaped, altogether or were mildly attacked. The, women seemed to be less readily infected than the men. The most serious complication of influenza was pneumonia, which occurred in about 10 per cent, of the cases, and accounted for all the deaths except one, which was due to rapid heart-failure. Other complications were bronchitis and pulmonary congestion and bleeding from the nostrils. Most of (he deaths occurred in the young (under age 35). With a serious epidemic prevalent in the wards, and a large proportion of the staff also incapacitated with the disease, the institution passed through, the most trying time in its history. Those who were able had to work longer hours. Many of the usual activities had to be stopped, and our energies concentrated on the nursing of the sick. To tide over the emergency we were fortunate in obtaining the assistance of a number of R.H.M.C. orderlies. The whole staff deserve much credit for their devotion to duty at a most trying time. The work of diverting the Hospital sewage from the neighbouring stream carrying it past the township and discharging it into the harbour has taken longer to accomplish than I anticipated, ft involved the construction of a tunnel over 300 ft. long under the, ridge at the to]) of the orchard, and this took many months. The work is now complete, and the new sewers are in commission. With one exception the sewage from all the buildings is now discharged directly into the harbour, the exception being that from the, piggeries, which still discharges into the neighbouring stream. This drainage should be linked up with the new system. I have gratefully to acknowledge the consideration of the authorities in permitting me to exchange duties with Dr. Jeffreys, the Mental Superintendent at Nelson, thus allowing me a rest and change from the more arduous work at Porirua for nearly eight months during the year. There have been few changes in the higher grades of the stalf. Dr. Prins joined the medical staff early in January, and his,years of previous experience! as medical officer in the London County Asylums and elsewhere enhances his value. Dr. Macpherson joined in June in succession to Dr. W. Simpson. Dr. Macpherson's interest in his professional, work and his enthusiasm have always been noticeable, and were greatly appreciated during the influenza epidemic. There has been difficulty in procuring sufficient attendants and nurses. Even now, months after the war, the nursing staff is very seriously reduced, but I am hopeful that the recent increase of salary offered by the Department may attract more candidates for vacancies. SEACLIFF MENTAL HOSPITAL. Dr. Jeffreys reports : — At the beginning of the year there were 1,034 patients (605 males and 429 females) in the institution. Exclusive of transfers from other institutions, 170 patients were admittecV— 89 males and 81 females. Fifty-nine patients were discharged recovered (27 males and 32 females), 2 males and 6 females discharged relieved. There is no doubt that a number of our patients who have actually recovered while on trial have had to be, written off as unrecovered under section 80, subsection (8), owing to their failure to report themselves. At the beginning of the year there were 8 voluntary boarders. During the year 23 voluntary boarders (7 males and 16 females) were admitted ; 8 were discharged recovered, 6 relieved, and 3 were placed under reception orders, leaving 14 remaining. The general health of the, patients has been good if we exclude the influenza epidemic. There were 97 deaths, the majority being among patients between sixty and ninety years of age. Five of Ike male patients died of general paralysis, and 1 male patient committed suicide. During the influenza epidemic 10 male and 8 female patients died, and we also lost 3 of the male staff and 1 nurse. I should like here to record my appreciation of the work of the staff 1 and voluntary workers during this most trying period. 'The Camp Mental Hospital, Otago Peninsula, was definitely closed in October, and the patients now occupy a new ward built for their reception here. I trust that a purchaser may be found for this place. The plans have been prepared for building the new wards at Waitati, and this work will be gone on with as soon as possible. The plans for the new central baths at Seacliff have also been completed, and it is only owing to stress of other work that this has not been commenced. I have to gratefully acknowledge the good and conscientious work done, by Drs. Gray and Macpherson and by officers of the various departments of the institution. I also wish to record our indebtedness to Mr. Gumming, Patients' Friend, for his very real interest in the welfare of the patients and ex-patients, and for his organizing of recreations.

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APPENDIX.

APPENDIX I. Table I.—Showing the Admissions, Readmissions, Discharges, and Deaths in Mental Hospitals during the Year 1918.

Table II.—Admissions, Discharges, and Deaths, with the Mean Annual Mortality and Proportion of Recoveries, etc., per Cent. on the Admissions, etc., during the Year 1918.

In mental hospitals, 1st January, 1918 Admitted for the first time Readmitted Transfers.. M. F. T. M. 2,611 V. 1,904 T. 4,515 381 56 45 323 79 9 704 135 54 [ 482 411 893 Total under care during the year 3,093 2,315 5,408 Discharged and died— Recovered Relieved Not improved Transferred Died 142 17 12 45 274 141 36 12 9 174 283 53 24 54 448 490 372 862 Remaining in mental hospitals, 31sfc December, 1918 2,603 1,943 4,546 Increase over 31st Decembor, 1917 8* 39 31 Average number resident during the year 2,602 1,899 4,501 * Decrease.

Mental Hospitals. In Mental Hospitals on 1st January, 1918. Admissions in 1018. Admitted for tho I Not First First Time. Admission. Transfers. Total Number of Patients under Care. Auckland Christchurch Dunedin (Seacliff) Hokitika Nelson Porirua Tokanui A s h b u r n Hall (private mental hospital) Totals M. F. T. 653 408 1,061 362 386 748 605 429 1,034 186 67 253 100 114 214 557 427 984 123 46 169 25 27 52 M. I'. T. 107 99 206 54 47 101 77 64 141 12 15 27 5 8 13 119 80 205 M. F. T. 21 15 36 2 18 20 12 17 29 ..I 1 3 .. 3 18 28 46 M. F. T. M. F. T. 1 2 3 782 524 1,306 3 . . 3 421 451 872 17 5 22 711 515 1,226 20 .. 20 218 83 301 1 .. 1 109 122 231 3 2 5 097 543 1,240 123 40 169 32 31 63 45 9 54 3,093 2,315 5,408 7 4)1 2,611 1,904 4,515 381 323 704 56 79 135 Mental Hospitals. Patients disch: irged and died. In Mental Hospitals on Discharged recovered. Discharged not rocovered. Died, Total discharged and died. 31st December, 1918. Auckland Christchurch Dunedin (Seacliff) Hokitika Nelson Porirua Tokanui Ash burn Hall (private mental hospital) Totals .. M. F. T. 52 55 107 15 14 29 27 32 59 4 4 8 3 3 6 40 33 73 51. F. T. 5 8 13 35 0 41 7 0 13 2 1 3 5 4 9 15 27 42 M. 77 32 62 17 7 66 8 5 F. 62 26 35 5 8 34 2 2 i. 139 58 97 22 15 100 10 7 M. F. T. 134 125 259 82 46 128 96 73 169 23 10 33 15 15 30 121 94 215 8 2 10 11 7 18 M. F. T. 648 399 1,047 339 405 744 615 442 1,057 195 73 268 94 107 201 576 449 1,025 115 44 159 21 24 45 i .. i 5 5 10 142 141 283 2 141 283 74 57 131 274 174 448 490 372 862 2,603 1,943 4,546 Mental Hospitals. Average Nurubor resident during the Year. Percei of Recov Admit during tl itage ories on isions io Year. Pe Deatl Nun duri rcentage of is on Average lber resident ing the Year. Percentage of Deaths on Total under Care. Auckland Christchurch Dunedin (Seaclifi) .. Hokitika . ; kelson Porirua I'okanui ishburn Hall (private mental hospital) Totals M. F. T. 654 399 1,053 4 332 378 710 2 617 444 1,061 3 190 68 258 -2 90 106 202 3 576 436 1,012 2 114 43 157 23 25 48 1 M. F. T. 40-62 48-25 44-22 26-79 21-54 23-97 30-34 39-51 34-71 25-00 33-33 28-57 37-50 37-50 37-50 29-20 28-95 29-80 M. I 40-62 48-26-79 21-30-34 39-25-00 33-37-50 37-29-20 28-14-29 '. M. F. T. 11-77 15-54 13-20 9-64 6-88 8-17 10-05 7-88 9-14 8-95 7-35 8-53 7-29 7-55 7-43 11-46 7-80 9-88 702 4-65 6-37 21-74 8-00 14-58 M. 9-84 7-60 8-72 7-80 6-42 9-47 6-50 15-62 F. T. 11-83 10-64 5-76 6-65 6-50 7-91 6-00 7-09 7-46 6-49 6-26 8-06 4-35 5-91 6-45 11-11 14-29 '.'. 9-09 2,602 1,899 4,501 32-49 35-07 33-73 10-53 9-16 9.95 8-80 7-51 8-28

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Table IV.—Duration of Disorder on Admission.

Table III.— Ages of Admissions.

Ages. Auckland. Christchurck. Dunedin (Seacliff). Hokitika. Nelson. Porirua. I Tokanui. Ashburn Hall (Private Mental Hospital). i Total. Under 5 years .. From 5 to 10 years „ 10 „ 15 „ „ 15 „ 20 „ „ 20 „ 30 „ „ 30 „ 40 „ „ 40 „ 50 „ „ 50 „ 60 „ „ 60 „ 70 „ „ 70 „ 80 „ „ 80 „ 90 „ „ 90 „ 100 „ Unknown Transfers Totals M. F. I. 1 1 2 1 2 3 0 3 3 4 5 9 23 18 41 29 20 49 15 27 42 18 11 29 11 16 27 8 6 14 4 2 6 14 3 17 1 2 3 129 116 245 31. F. I. o i l 0 1 1 6 1 7 5 10 15 15 12 27 6 21 27 6 9 15 11 6 17 7 2 9 0 1 1 o i i 3 0 3 59 65 124 31. F. T. 0 1 1 3 0 3 4 3 7 19 9 28 19 17 36 14 21 35 10 15 25 3 3 6 13 7 20 3 1 4 1 4 5 17 5 22 106 86 192 1 1 2 1 6 1 0 0 20 32 r. t. i 2 0 1 4 6 3 4 3 9 0 1 2 2 3 3 0 20 16 48 si. 0 1 1 1 3 1 1 1 9 F. i 2 9 1 0 9 0 0 8 T. 1 3 3 2 3 3 1 1 17 M. F. T. i 6 i 3 2 5 8 5 13 23 17 40 38 32 70 ■ 33 23 56 14 21 35 8 8 16 7 5 12 1 1 2 1 0 1 3 2 5 140 116 256 If. F. T. 31. 0 2 1 2 2 0 7 F. 1 1 1 0 i 4 T. 1 3 2 2 2 11 I Ji. f. T. 1 1 2 2 4 6 7 7 14 23 15 3? 73 61 134 105 87 192 76 97 173 53 56 109 35 35 70 38 22 60 8 9 17 1 0 1 15 8 23 45 9 54 106 86 192 | 32 16 48 9 8 17 140 116 256 7 4 11 482 411 893

Auckland. Christehiu-ch. Dunedin (Seacliff). Hok'itika. Kelson. Porirua. Tokanui. Ashburn Hall (Private Mental Hospital). Total. First Class (first attack and within 3 months on admission) Second Class (first attack above 3 months and within 12 months on admission) Third Class (not first attack, and within 12 months on admission) Fourth Class (first attack or not, but of more than 12 months on admission) Unknown .. .. .. Transfers .. .. M. F. T. 87 74 161 9 12 21 8 2 10 24 26 50 | 1 '2 3 M. F. T. 26 30 56 9 4 13 12 20 32 9 10 19 0 1 1 3 0 3 M. F. T. 41 28 69 10 9 19 19 21 40 19 23 42 17 5 22 M. 6 1 1 4 20 8 14 3 4 1 2 4 8 0 20 M. 1 0 6 1 1 F. 5 1 0 0 T. 6 1 6 3 1 M. F. T. 85 57 142 5 5 10 22 35 57 25 17 42 M. F. T. M. 5 0 o F. 3 1 0 T. j M. F. T. 8 251 205 456 1 34 35 69 68 79 147 2 84 82 166 „ 3 2 5 1 0 1 1 45 9 54 Totals 129 116 245 59 65 124 106 86 192 ■ 32 16 48 9 9 8 8 17 17 140 116 256 ! 7 4 11 482 411 893 I

15

H.—7

Table V.—Ages of Patients discharged "Recovered" and "Not Recovered" during the Year 1918.

Table VI.— Ages of Patients who died.

! I Auckland. Christchurch. i Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall (Private M.H.). Total. I Ages. I I Re- Not recovered, covered. Re- j Not recovered, covered. Re- Not re- j Re- ! Not re- Re- 1 Not re- | : covered, covered, covered, covered. : covered. : covered. Re- Not Be- Not re- Recovered, recovered, covered. covered. covered. i I Notre- I covered. Recovered. Not recovered. M. F. T. M. F. T. M. F. T. ; M. F. T. M. 1". T. M. F. T. M. F. T. M. F. T. j M. F. T. Under 5 years .. .. .. From 5 to 10 years .. » W ., 15 „ .. I .. .. 10 1 .. 10 1 .. .. 10 1 „ lo „ 20 „ ..156. .. 404.. 112 „ 20 „ 30 „ .. 8 11 19j 0 1 1 1 5 6 1 0 1 5 5 10 0 1 l| 1 1 % .. 10 1 „ 30 „ 40 „ .. .13 7 20j 1 1 2 2 2 4 1 2 3 9 12 211 1 1 2: 1 0 l 1 .. 112 „ 40 „ 50 „ .. 12 18 30: .. 45920259 14 31421 3101011 „ 50 „ 60 „ ..7613.123022112459 .. .. ! 0 1 1 0 1 1 „ 60 „ 70 „ ..6 3 9! 0 2 2 2 0 2 0 1 1 .. 0 110 11 .. „ 70 „ 80 „ .. 12 3i 01110110120 2: Oil.. .. 10 1 » 80 „ 90 „ .. .. .. .. .. .. -112 0 11 -• Unknown .. ..437112'... Transfers .. .'. .. ; 2 0 2j .. 29 2 31] .. 12 0 2 II. F. T. M. F. T. M. F. T. M. F. T. 3 0 3 1 1 2 0 1 1 5 8 13 0 3 3j 12 9 21 2 11 13 1 2 311 11 22 3 5 8! 10 17 2 9 2 4 & 2 3 5 112 10 1 2 13 .. 6 2 8 M. F. T. M. F, T. M. F. T. .. '.'. 10 1112 M. 2 9 21 39 34 18 10 5 0 4 F. T. M. F. T. 0 2: 1 0 1 6 15! 1 1 2 30 51 1 6 7 31 70 6 16 22 45 7910 8 18 16 34 5 8 13 7 17 1 5 6 2 7 2 2 4 11112 3 7 112 ;45 9 54 '.'. .. 4 4 8 Totals .. 52 55 107 5 8 1315 14 2935 6 4127 32 59 7 6 13 4 4 8 2 1 3 3 3 6 5 4 9 40 33 7315 27 42 1 0 1 5 5 10 142 141 283'74 57 131 I

Ages. Auckland. I Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall (Private M.H.). Total. From 5 to 10 years » 10 ,, 15 „ • • 15 ,, 20 „ „ 20 „ 30 „ 30 ,, 40 ,, „ 40 ,, 50 ,, „ 50 „ 60 „ „ 60 „ 70 „ „ 70 ,, 80 „ „ 80 „ 90 „ „ 90 „ 100 „ Unknown While on trial M. F. T. 101 12 3 5 4 9 9 5 14 18 10 28 10 10 20 13 18 31 8 6 14 7 6 13 3 03 2 13 i M. 2 0 1 0 2 6 4 6 8 3 0 F. T. 0 2 1 1 0 1 1 1 1 3 5 11 4 8 7 13 3 11 3 6 1 1 M. P. T. 101 6 17 10 1 11 10 6 16 6 5 11 7 3 10 14 13 27 8 6 14 M. F. 2 0 4 1 3 1 3 1 3 1 2 1 T. 2 5 4 4 4 3 M. F. 2 6" 2 0 0 1 0 1 0 4 2 2 1 0 T. 2 1 1 4 4 1 M. F. T. 1 2 3 0 2 2 3 3 6 10 2 12 14 4 18 13 5 18 11 3 14 7 5 12 3 6 9 3 2 5 10 1 H. P. 1 0 1 0 1 2 5 0 T. 1 1 3 5 I 51. 1 0 1 1 2 F. 0 1 1 0 0 T. 1 1 2 1 2 M. F. T. 3 2 5 13 4 6 5 11 24 8 32 40 11 51 52 29 81 36 27 63 42 38 80 40 31 71 24 18 42 112 3 0 3 2 13 Totals 77 62 139 32 26 58 62 35 97 17 5 22 j 7 8 15 66 34 100 8 2 10 5 2 7 274 174 448

H.—7

16

Table VII.—Condition as to Marriage.

Admissions. Discharges. Deaths. Auckland— Single Married Widowed Unknown Transfers M. F. T. 09 43 112 51 49 100 8 22 30 ■ ' • •! I 2 3 M. F. 28 J 22 25 ' 35 2 6 T. 50 60 8 M. 37 35 5 F. 18 28 16 T. 55 63 21 2 '6 2 Totals 129 116 245 57 03 120 77 62 139 ('HRISTOHURCill — Single Married Widowed Unknown Transfers 27 25 4 27 29 9 54 54 13 13 5 3 9 9 0 22 14 3 17 0 23 11 11 22 3 9 12 3 0 3 29 2 31 1 "o I Totals 59 (i5 124 50 20 70 32 26 58 Dunedin (Seacliff) — Single Married Widowed Unknown Transfers 50 31 8 33 39 9 83 70 17 12 18 2 18 18 2 30 36 4 38 19 5 7 20 8 45 39 13 17 5 22 2 0 2 Totals 100 86 192 34 38 ' 72 62 35 97 Hokitika— Single Married Widowed Unknown Transfers 8 3 I 8 4 4 10 7 5 ' 5 1 (I I 2 2 6 3 2 13 I 3 2 0 3 15 1 0 20 0 20 Totals 32 16 48 5 11 17 5 22 Nelson— Single Married Widowed Unknown Transfers 4 4 0 3 4 I 7 8 I 5 1 2 4 7 5 5 2 0 3 3 o 8 5 2 1 6 1 2 1 3' Totals 9 8 17 •8 7 15 8 15 Porirua—Single Married Widowed Unknown Transfers 74 54 9 38 64 12 112 118 21 21 27 I 21 34 3 42 61 4 43 18 5 14 11 !) 57 29 14 3 *2 5 0 2 8 Totals 140 116 256 55 60 115 66 34 100 Tokanui— Single Married Widowed Unknown Transfers 6 2 0 2 0 4 Totals 2 10 Ash burn Hall— Single Married Widowed Unknown Transfers I 4 2 1 2 1 2 6 3 1 I I 6 2 1 3 1 1 3 2 2 4 4 8 Totals 7 4 11 6 5 11 5 2 7 Totals— Single Married Widowed Unknown Transfers 233 153 386 172 191 303 32 58 90 85 74 159 77 102 179 9 13 22 102 50 212 89 70 165 22 48 70 45 9 54 45 9 54 I 6 I Totals 482 411 893 216 198 414 274 174 448

H.—7

Table IX.—Ages of Patients on 31st December, 1918.

Table VIII.— Native Countries.

17

Countries. Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall (Private M.H.). Total. DO . England .. _q Scotland Ireland Wales New Zealand Australian States France Germany .. Austria Norway Sweden Denmark .. Italy China Maoris Other countries Unknown .. I i I M. F. T. M. F. T. M. F. T. 142 76 218 86 94 180 104 61 165 30 17 47 22 17 39 99 73 172 66 44 110 47 50 97 72 50 122 3 2 5 j .. 3 14 238 211 449 155 217 372 t 261 227 488 34 12 46 10 10 20 24 23 47 2 0 2 6 2 8 1 1 2 ' 11 1 12 21 1 22 112I10 1 3 1 4 | 0 1 1 4 0 4 51 6 404 30 3 2 0 2 2 13 2 1 3 4 0 4 .. 10 1 10 1 2 0 2 11 0 11 24 13 37 , 0 2 2 4 0 4 24 5 29 9 11 20 6 2 8 43 14 57 .. 9 3 12 648 399 1,047 339 405 744 615 442 1,057 M. F. T. 33 14 47 12 5 17 39 11 50 2 0 2 72 38 110 11 4 15 5 0 5 1 1 2 5 0 5 7 0 7 5 0 5 1 6 1 2 0 2 M. F T. M. F. 4 9 13 169 97 14 5 55 30 8 7 15 59 68 112 62 61 123 213 212 14 5 32 15 10 1 10 10 1 4 7 10 1 0 1 10 10 1 6 3 7 0 10 1 3 0 2 0 2 13 8 6 10 1 16 10 9 20 29 T. : 266 85 127 j 425 47 11 1 j 1 9 7 3 2 14 26 M. 28 4 15 2 51 3 1 4 1 1 1 1 1 2 F. T. 6 34 0 4 7 22 1 3 30 81 0 3 0 1 0 4 0 1 0 1 0 1 6 i 0 1 0 2 M. 3 5 1 1 11 0 F. T. M. F. T. 6 9 569 363 932 2 7 228 148 376 0 1 307 237 544 0 1 12 5 17 12 23 1,063 1,008 2,071 4 4 115 72 187 4 0 4 29 11 40 28 3 31 10 3 13 25 4 29 14 2 16 16 0 16 22 0 22 39 22 61 59 28 87 63 37 100 Totals 195 73 268 94 107 201 576 449 1,025 115 44 159 I 21 24 45 2,603 1,943 4,541 I I

Ages. Auckland. Christchurch. Dunedin (Sea- - cliff). Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall (Private M.H.). Total. From 1 to 5 vears 5 „ 10 " „ „ 10 „ 15 „ „ 15 „ 20 ,. „ 20 „ 30 „ „ 30 „ 40 „ „ 40 „ 50 „ „ 50 „ 60 „ „ 60 „ 70 „ „ 70 „ 80 „ „ 80 „ 90 „ Upwards of 90 ,, Unknown M. F. 1 1 1 2 2 9 8 7 66 47 133 77 164 95 128 83 77 49 29 19 9 2 T. 2 3 11 15 113 210 259 211 126 48 11 M. F. T. 1 2 3 3 8 11 8 9 17 26 37 63 81 84 165 72 91 163 59 88 147 55 45 100 22 31 53 12 8 20 M. F. 0 2 1 1 4 1 7 11 57 42 137 92 147 111 110 86 88 52 46 32 15 12 3 0 T. | 2 I 2; 5 18 99 229 i 258 ' 196 140 78 27 3 M. F. T. 0 1 1 1 0 1 10 6 16 42 10 52 39 19 58 42 11 53 28 8 36 20 11 31 . 3 3 6 SI. F. T. M. F. 10 1 10 1 3 3 10 2 12 5 9 10 3 13 12 17 11 7 18 95 59 14 13 27 150 109 13 23 36 119 99 17 22 39 | 101 79 8 19 27 : 69 50 5 5 10 j 20 22 112 12 2 T. 6 14 29 154 259 218 180 119 42 4 M. 3 15 29 37 18 8 5 F. T. 0 3 6 21 6 35 14 51 7 25 8 16 1 6 M. F. 0 1 1 0 2 5 8 10 7 5 2 2 1 1 T. 1 1 7 18 12 4 2 M. 2 7 24 49 280 587 593 483 340 149 43 3 43 F. T. 3 I 8 11 30 5< 47 9( 205 48i 391 971 457 1,05( 386 86( 236 571 123 27i 29 7! o : 28 7: 30 8 38 0 2 2 .. 10 4 14 3 12 15 '.'. 0 2 2 Totals .. 115 44 159 21 24 45 648 399 1,047 339 405 744 615 442 1,057 195 73 268 94 107 201 576 449 1,025 2,603 1,943 4,541

H.—7

18

Table XI.—Length of Residence of Patients discharged "Recovered" during 1918.

Table X.—Length of Residence of Patients who died during 1918.

Length of Residence. Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. 1Tokanui. Ashburn Hall (Private M.H.). Total. M. F. T. 10 5 15 10 9 19 12 5 17 6 1 7 3 2 5 7 6 13 3 4 7 4 3 7 8 4 12 6 4 10 0 3 3 1 1 2 5 14 19 2 1 3 M. 5 3 3 4 4 1 3 3 1 1 1 2 0 F. 3 0 1 1 0 4 0 4 1 4 1 0 5 2 T. 8 1 4 4 4 8 2 I 1 I 7 , 2 M. 5 9 3 4 1 11 3 1 4 7 1 4 8 1 F. T. 5 10 2 11 0 3 1 5 2 3 2 13 2 5 4 5 3 7 2 9 3 4 3 7 6 14 0 1 M. F. T. M. 1 F. 1 T. 2 M. 6 2 5 3 7 10 6 7 8 5 1 1 5 F. 5 3 2 2 5 3 1 4 1 3 0 1 4 T. 11 5 7 5 12 13 7 11 9 8 1 2 9 M. F. T. M. 2 F. 0 T. 2 M. 29 22 23 17 15 35 14 16 32 21 7 8 31 4 F. 19 16 9 6 10 16 8 16 9 15 7 7 32 4 T. 48 38 32 23 25 51 22 32 41 36 14 15 63 8 Under 1 month From 1 to 3 months .. „ 3 „ 6 „ „ 6 „ 9 „ „ 9 „ 12 „ „ 1 „ 2 years » 2 „ 3 " „ >. 5 „ 7 „ „ 7 „ 10 „ „ 10 „ 12 „ „ 12 „ 15 „ Over 15 years Died while absent on trial -• i 0 0 3 7 2 1 0 6 2 1 3 7 1 0 1 1 1 0 1 1 1 0 1 0 2 0 2 1 1 2 1 2 1 1 1 2 0 4 0 0 0 2 0 1 1 2 i 4 0 0 1 1 1 1 i o o 1 1 1 1 1 1 0 1 5 1 1 1 6 2 1 2 3 Totals 77 62 139 32 26 58 62 35 97 17 5 22 7 8 15 8 2 10 ! 5 2 7 274 174 448 66 34 100

Length of Residence. Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokauui. Ashburn Hall (Private M.H.). Total. Under 1 month From 1 to 3 months .. „ 3 ., 6 „ 6 „ 9 „ „ 9 „ 12 „ 1 „ 2 years „ 2 „ 3 „ „ 3 „ 5 „ „ 5 „ 7 „ „ 7 „ 10 „ „ 10 „ 12 „ „ 12 „ 15 „ Over 15 years M. F. T. 2 1 3 13 12 25 15 22 37 4 9 13 3 2 5 11 3 14 3 4 7 1 2 3 M. 0 6 1 4 F. T. 1 1 5 11 3 4 3 7 M. F. T. 2 1 3 9 14 23 2 4 6 5 2 7 3 3 6 3 5 8 M. F. 1 0 i i T. 1 2 M. 0 1 F. T. 2 2 0 1 M. 10 7 9 8 1 3 2 F. T. 6 16 7 14 6 15 7 15 3 4 4 7 0 2 M. F. T. M. F. T. M. F. 15 9 35 40 29 36 21 21 8 8 20 14 8 5 2 5 0 1 1 0 0 1 1 1 2 0 T. 7c 6J 4: 34 ] 1 4 5 2 6 14 3 7 1 1 1 2 2 2 2 0 1 3 0 2 1 1 0 i 1 1 1 2 1 0 1 i 6 1 1 i 2 Oil 0 i 1 0 1 1 1 0 1 1 0 1 1 0 1 o i 1 1 0 1 Totals 52 55 107 15 14 29 27 32 59 40 33 73 4 4 8 3 3 6 i o i 142 141 28:

19

H.—7

Table XII.—Causes of Death.

Causes. ■6 1 i ! ! 5 £ as ■dto sr 3 5 12 1 to d J 1 E 8 r3 a <e o E-i 1H S2% 3 <8 O 1 I. General Diseases. Tuberculosis— General Of bowels Of peritoneum Of lungs Pyaemia Septicaemia Influenza Carcinoma Sarcoma Leukaemia Pernicious anaemia Enteric fever M. F. 10 10 2" 0 0 1 M. F. 1 I 1 1 H. F. 1 0 3 1 I 0 I 0 10 8 3 0 1 0 M. F. M. F. 0 1 1 0 1 0 M. F. 5 2 M. F. 0 1 M. F. M. F. 2 2 1 0 20 15 1 0 3 0 28 15 3 2 1 0 1 0 1 0 1 2 0 1 16 6 0 1 2" 0 1 0 l" 0 1 2 II. Diseases of the Nervous System. Mania, oxhaustion from Melancholia, exhaustion from .. General paralysis of insane Organic brain-disease Cerebral haemorrhage Meningeal haemorrhage Cerebro-spinal sclerosis Epilepsy Cerebral congestion Cerebral softening Abscess on brain 1 1 2 5 12 2 11 17 2 3 1 2 2 0 3 2 2 2 3 0 5 0 0 1 1 1 1 ' 0 0" 1 20" 0 2" 0 2" 1 4 5 5 5 39 2 15 20 7 6 5 3 1 0 l" 0 1 2 0 1 l" 6 1" 0 1 0 15 12 1 0 0 1 0 1 I 0 0 1 0 I III. Diseases of the Respiratory System. Broncho-pneumonia Pneumonia Pleurisy Bronchitis Goitre Pulmonary congestion I" 1 0 1 1 0 l" 0 2 2 1 1 2" 0 2 2 5 3 1 0 0 2 1 0 2 0 o" 1 0 1 1*0 1" 0 l" 0 IV. Diseases of the Circulatory System. Valvular disease of the heart .. Endocarditis Pericarditis Congenital malformation Heart-failure Arterio-sclerosis 4 3 l" 0 1 0 4 6 0 3 5 0 0 2 3 5 1 0 3 0 19 19 1 0 1 0 1 0 5 1 1 0 2" 0 l" 1 l" 0 1 0 l" 0 v. dlskases of the digestive System. Hsematemesis Diarrhoea Peritonitis Intestinal obstruction Acuto enteritis 1 0 1 0 1 0 1 0 l" 0 1 0 1 0 2 0 2 0 1 0 l" 0 1 0 VI. Diseases of the Genitourinary System. Chronic nephritis Cystitis 1 0 o l 1 0 0 1 1 2 1 0 VII. Old Age. 17 11 14 . 10 22 18 2 3 3 2 12 9 1 0 Senile decay 71 53 VIII. External Causes. Suicide .. .. Dislocation of cervical vertebrae \ caused by a fall 1 1 1 0 1 0 0 1 2 2 1 0 IX. Died while absent on Trial 2 1 1 1 3 2 Total .. .. j 77 62 32 26 62 35 17 5 7 8 66 34 8 2 5 2 274 174

H.—7

20

Table XIII. —Principal Assigned Causes of Insanity.

Causes. Auckland. Christchurch. Dunedin Wnl .i H i,„ (Seacliff). Hokl t' kft - Nelson. Porirua. Tokanui. Ashburn Hall. Totals. ! Heredity Congenital Previous attack Puberty and adolescence Climacteric Senility Pregnancy Puerperal state Lactation Mental stress— Sudden Prolonged (including war strain) Privation Solitude Sexual excess Masturbation Insomnia Alcohol Drug habit Syphilis Toxaemia Traumatic Post operative .. Organic brain-disease .. Epilepsy Apoplexy Arterio-sclerosis Sunstroke .. Chorea Cancer Cardiac disease Graves' disease Phthisis 111 health Influenza Cerebral haemorrhage Overstudy Unknown Transfers M. F. 12 12 16 13 6 10 1 3 0 6 16 16 M. F. 2 6 4 0 4 17 0 2 0 2 7 4 M. F. | M. F. 14 23 3 1 7 12 J 1 2 7- a \ ... 7 1 i .. os; .. 15 9 I 1 4 M. F. 2 3 0 2 2 0 0 I M. F. 13 24 11 17 10 3 0 4 11 10 0 1 0 8 M. F. M. F. 0 1 2 0 M. If. 33 45 41 53 30 49 18 10 0 21 "53 45 0 1 0 18 0 2 1 2 o" 2 0 1 0 1 0 6 .. 0 1 o" 1 0 1 16 12 0 1 1 2 1 0 1 0 7 5 13 1 2 0 4 0 0 2 1 2 8 2 2" 0 10 6 0 3 6 0 2 0 10 0 '.'. 1 0 22 13 1. 0 1 0 18 3 0 2 18 2 2 0 l" 0 I 0 0 1 52 36 1 0 1 1 1 2 1 0 1 0 42 10 0 2 44 3 2 0 7 0 0 2 0 2 25 11 2 1 4 5 1 0 0 1 0 1 1 0 10 I 0 5 0 i" 2 4" 4 3 0 '.'. o" 1 6 3 3 1 I 0 0 1 6 3 1 0 0 3 1 0 0 1 0 1 1 1 0 1 1 0 1 1 9 15 I 1 1 2 13 6 1 2 3 2 '.'. 110 2 0 1 1 4 5 5 0 1 0 1 1 1 5 8 15 23 1 1 1 3 55 43 45 9 2l' 24 3 0 0 1 2 3 12 17 5 20 0 l" 0 1 0 17" 8 3 2 Totals 129 116 59 65 106 86 32 16 9 8 140 116 7 4 482 411

H.—7.

Table XIV.—Former Occupations of Patients.

21

Occupations. a o a ■< ■-> <i 09 'C re: o § DC a ■- a a L So, —, m a?. 10 «1 Occupations. A a g •a 3 a a 2 .g o Z a a < 5 § Q es m oo a <d r5 rr _• ® ,-S o a M w a o "3 Q K S5 % ■ — a — in ■ «* 2 s a CO X 4) •S Sa i 9 '2. o X rl * § 2 » .3 3 a a £ c En "3 o t- -■ u O rH "i o Aboriginal Natives .. IS Agent Architect Auctioneer .. .. ! Bakors and confectioners Bagmaker .. ... Beekeeper Blacksmiths .. ... Boilermaker .. ... Bookseller Bootmakers Bottler .. .. . Bricklayers .. ... Builder .. ... Bushman Butchers Cab-proprietor Candlemaker . . ... Carpenters and joiners.. ! Carrier .. ... Cheesemakers.. ... Chimney-sweep Civil servants.. Clergyman .. ... Clerks and accountants Commercial travellers .. Compositors and printers Contractor .. ... Cook .. ... Creamery-manager Dentist .. ... Drapers .. ... Draughtsman.. ... Drivers .. ... I Engineers .. .. < Farm labourers Farmers .. .. i Firemen Fisherman Fish-merchant Fruiterer Fruit-merchant Gardeners .. .. '. Grocer Gumdiggers .. .. ! 12 i i i i i :i i 2 1 1 i ' i i i 2 i i '2 2 i i i i i l i 2 i i Ma 14 1 1 1 2 1 1 3 1 1 4 1 2 1 2 5 1 1 6 1 2 1 3 1 6 2 2. 1 1 1 1 3 1 6 9 8 42 3 1 1 1 1 15 1 2 LES. Hawker Horse-trainers and jockeys Hotelkeeper Kitchenmcn Labourers Masseur Messengors Milkman Miners Minor Motorman Musician Old-age pensioners Painter Plasterer Platelayer Plumber Porters Prisoners Prisoners of war Railway employees Sawmiller Seamen Secretary Shearer Sheep-farmer Shepherds Shop-assistants Soldiers Stableman Station hands Stonemason Storemen Tailors Tinsmith Upholsterer Watchmaker Wharf labourers Wheelwright Woodcarvor No occupation Transfers l i 35 i 5 1 1 3 1 3 i 2 i 18 i i i i 37 3 I i i 2 1 I i 3 i 2 i I 2 ..I .. ll .. 1 .. 45 .. 1 .. l! .. :: :: ..j.. 'a .. .. . j i .. 2 .. lj .. i .. 1 3 1 2 140 1 2 1 10 1 1 1 5 4 1 I 1 2 3 2 5 1 3 1 1 1 2 2 32 1 3 1 3 2 1 1 1 2 1 1 24 45 i 4 2 1 i i .. i i 4 i i l i .. i io 17 1 17 .. i 3 1 .. i .i 3 4 7 8 3 i i 3 1 i i 1 .. 2 .. 1 2 I 1 1 1 .. 'e 13 io 2 4 '2 1 .. 1 .. i i i i i i 3 7 I 2 17 "% 20 i 12 .. 12 3 '4 5 2 4 1 Totals 129 59 106 32 3 .. 7 482 2 140 .40 .. Fem, VLES. 1 3 2 2 3 1 1 2 1 2 29 9 Aboriginal Natives .. ' Barmaid . . ... Boot-finisher .. ... Canvasser .. ... Clerk Companion .. ... Confectioner .. ... Cooks Domestic duties .. 9Dressmakers Governess .. ... Hairdresser .. ... Hatmaker .. ... Housewives .. ... i i 94 1 i i i 25 1 1 19 2 1 1 i i 8 1 1 1 1 1 1 3 290 8 1 1 1 37 Machinist Minors Nurses Old-age pensioners Schoolgirls Second-hand doalor Shop-assistant Sisters of Mercy Tailoress Teachers No occupation Transfers 1 3 2 i i 2 i i i ... "i .. 2 '.'. 2 .. 116' .. I I 13 6 103 3 i i 4 2 2 3 i.6 5 2 'i i i 1 29 *6 2 Totals 116 65 86 16 8 411

EL—7

22

Table XV.—Showing the Admissions, Discharges, and Deaths, with the Mean Annual Mortality and Proportion of Recoveries per Cent. of the Admissions, for each Year since 1st January, 1876.

M. F. T. In mental hospitals, 1st January, 1876 .. .. .. .. .. ..482 254 736 In mental hospitals, 1st January, 1919 .. .. .. .. .. .. 2,603 1,943 4,546

Year. I Admitted. Discharged. I Died. Remaining Average Numbers 31st December in resident, each Year. Percentage of Recoveries on Admissions. Percentage of Deaths on Average Numbers resident. Becovered. Relieved. Not Improved. 1876 1877 1878 1879 1880 1681 1882 1883 1884 1885 1886 1887 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 M. 221 250 247 248 229 232 267 255 238 294 207 255 215 230 230 234 231 281 320 379 296 300 355 264 335 373 352 454 340 399 401 421 434 447 639 455 593 543 526 461 568 507 482 F. 117 112 131 151 149 127 152 166 153 I 160 i 165 I 161 : 146 ; 161 ! 160 201 158 j 179 I 256 I 302 i 170 244 : 258 ! 247 j 263 i 224 198 I 237 j 240 280 277 279 325 376 371 322 394 349 366 419 367 378 411 T. | 338 I 362 378 399 378 359 419 421 391 454 372 416 361 391 390 435 389 460 576 681 466 544 613 511 598 597 544 691 580 679 678 700 759 823 1,010 777 987 892 892 880 : 935 885 893 M. 129 123 121 112 100 93 95 102 89 95 99 103 116 93 98 88 89 101 107 105 104 102 114 88 103 125 135 144 157 149 157 160 180 179 i 182 163 i 184 i 175 207 : 202 160 171 i 142 |5,541 F. 79 57 68 76 67 65 59 78 77 76 60 78 92 53 88 74 76 89 76 77 70 73 110 99 96 104 99 101 106 121 126 139 146 170 145 168 141 162 162 157 171 152 141 T. 208 180 189 188 167 158 154 180 166 171 159 181 208 146 186 162 165 190 183 182 174 175 224 187 199 229 234 245 263 270 283 299 326 349 327 331 325 337 369 359 331 323 283 M. F. 17 8 20 9 14 14 15 13 36 25 41 36 49 32 13 20 17 9 10 5 11 17 34 17 31 28 31 30 23 17 33 24 21 17 17 12 15 11 24 19 25 16 26 32 13 23 15 25 39! 10 40| 17 26i 15 41 25 24 13 45 32 28 22 31 19 9 13 17 22 30, 29 23! 16 17 44 35! 48 27: 29 ! •26 34 35 34 32 20 17 36 1,0931 937 T. ! 25 29 1 28 28 61 77 81 33 26 15 28 51 59 61 ■ 40 57 38 29 26 43 41 53 36 40 49 57 41 66 37 77 50 50 . 22 39 59 39 61 83 56 60 69 52 53 2,030 : M. F. I T. M. 6 6 ! 12 36 7 2 9 42 3 3 6 51 8 3 11 55 5 2 7 54 8 1 9 49 5 7 I 12 60 10 9 i 19 65 18 12 30 68 73j 29 1 102 73 12 8 20 57 74 2 2 | 4 78 3 1 4 70 12 5 17 76 14 30 i 44 79 8 2 10 74 9 9 ; 18 78 55j 84 ! 139 64 128: 139 267 101 20j 12 ! 32 86 17! 31 48 105 47 151 88 7 42 49 114 25 65 90 99 33 3 36 102 10 9 19 ! 120 84 12 96 129 9 2 1 11 120 23 21 44 147 6J 14 j 20 ! 146 53 32 i 85 ! 168 9' 6 j 15 i 148 29 i 68 97 ! 136 164 55 ! 219 186 11 7 18 198 116 18 164 193 78 36 114 , 196 23 16 39 193 ! 21 67 1 88 172 ! 57 14 71 209 43! 9 j 52 1 205 57 21 : 78 274 ! I l,415i 961 2,376 .4,838 F. 12 21 17 16 20 14 19, 18: 24! 22! 19 27 26 30 35 41 34 23 35 42 32 43 60 43 46 72 55 44 70 67 85 64 74 68 97 105 87 111 88 ! 112 80 113 174 2,285 T. M. I F. T. M. F. I T. 48 5191 264 783 491 257 | 748 63 581| 291 872 541 277 • 818 68 638 319 957 601 303 j 904 71 695 361: 1,056 666 337 'l,003 74 729 396[ 1,125 703 371 1,074 63 769 406i 1,175 747 388 1,135 79 827 442 1,269 796 421 11,217 83 892 483 1,375 860 475 1,335 92 938 514] 1,452 911 497 1,408 95 981 542 1,523 965 528 j 1,493 76 1,009| 604 1,613 984 559 ' 1,543 \ 101 1,053: 643 1,6961,034 613 1,647 I 104 1,041] 64011,6811,045 641 jl,686 I 100 1,074 : 687| 1,7611,046* 660*1,707 111 1,0951 702 1,7971,078" 685"-1,763 120 1,115] 734{ 1,8491.089J 699*1, 789£ 108 1,154' 763 ! 1,9171,125 1 714|l,839f 101 1.229; 810; 2,039] 1,172 1 758 11,930 99 1,308| 860i 2,1681,241 | 812 ;2,053 143 1,3291 885 2,214 1,313 1 849 ;2,162 118 1,390: 925] 2,3151,347 j 882 148 1,440 ! 990 : 2,4301,411 944 2,355 148 1,47211,008 2,480:1,438 j 973 2,411 157 1,512,1,045 2,557.1,487 1,004 2,491 I 145 1,581:1,091 2,672:1,534 11,049 '2,583 174 1,6541.119 2,7731,622 ,1,094 2,716 175 1,7151,133' 2,8481,671 11,114 ,2,785 173 1,7711,188 2,9591,741 1,160:2,901! 190 1,801:1,237 3,0381,780 1,198 2,978 I 214 l,836 l l,276: 3,112,1,796 1,232 '3,028 j 231 1,900:1,306 3,2061 1,823 1,265 3,088 ! 232 1,9091,331 3,2401,851 1,285 ]3,136 j 222 1,99711,417 3,414|1,894 1,346 :3,240 204 2,08311,465 3,548,1,970 1,404 '3,374 283 2,1601,510 3,670 2,028 1,445 3,473 | 303 2,2201,536 3,756|2,105 1,496 !3,601 280 2,2731, 640 3,9131-2, 146 1,551 3,697 307 2,3321,632 3,9641-2,252 1,597 3,849 ! 281 2,4081,703 4,11112,309 1,641 :3,950 284 2,4481,752 4,2002,391 1,703 4,094 | 239 2,555,1,820 4,3752,483 1,768 ,4,251 318 2,6111,904 4.515:2,543 1,825 J4,368 448 2,603 1,943 4,546J2,B02 1,899 !4,501 7,123 .. 1 .. .. .. .. M. F. T. M. 54-53) 66-01 57-56 8-21 49-20 5080 49-72 7-76 48-98! 51-90 50-00 8-48 45-16; 50-33 47'11 8-25 43-66! 44-96 44-17 7-68 40-08 j 51-10 44-01 6-29 35-58 38-81 36-75 7-53 40-001 46-98 42-75 7-55 37-39 50-32 42-45 7-46 32-31! 47-50 37-66 7-56 47-82: 36-36 42-74 579 40-39, 48-75 43-61 7-15 53-95 6301 57-62 756 40-43 j 32 92 3734 669 42-61! 55-00 47-69 7-05 37-61, 36-82 37-24 7'25 3853: 48-10 42-42 6-58 35-94! 49-72 41-30 6-66 39 63 : 45-18 41-03 5-16 41-27 46-66 43-40 7'69 37-41 4402; 39-82 6'38 35-92 37-82! 36-69 7-44 44-88 51-89 48-07 6-12 32-31' 44 33 37-58! 7-67 30-74! 36-50 33-27 j 6-45 3906: 46-64 42-17 6-29 38-35 51-56 43-01 718 40-56 j 44-69! 42-17 7-41 46-18: 44-17 45-34 6-74 41-39 j 48-21 44-19: 8-18 39-75 j 47-73 42-94] 8-01 44-29: 57-68 4967 9-08 42-25 j 45-91 43-82 j 7-81 42-721 57-24 48-74; 6-90 38-40] 46-18 41-50! 9-17 36-38 53-00 43-27 i 9-41 40-17! 37 01 38-74 j 8-99 37 55 i 50-94 42-98 ! 8-70 40-67 I 45-12 42-51! 8-36 44-89! 43-21 44-27' 7'19 30-89 ■ 47-37 37-66 8-42 36-38: 40-64 38-27 8-06 32-49 35-07 3373 1053 F. 3-58 7-58 5-61 4-74 5-39 3-60 4-51 3-78 4-82 4-16 3-39 4-40 405 4-54 511 5-86 4-76 303 4-31 4-94 3-63 4-55 6-17 4-28 4-38 6-58 4-94 3-79 5-84 5-44 6-71 4-98 5-50 4-84 6.71 7-02 5-61 6-96 5-36 6-58 4-52 6-19 916 T. 6-70 7-70 7-52 7-07 6-89 5-55 6-49 6-21 C-53 6-36 4-91 613 6-16 5-86 6-29 6-71 5-87 5-23 4-82 661 5-29 6-28 614 6-30 5-61 6-41 6-28 5-96 6-38 707 7-48 7-39 6-85 6-00 8-15 8-41 7-57 7-98 711 6-94 6-80 7-28 9-95 15,008 10,296 4,424 9,965 25,304

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Table XVI. —Showing the Admissions, Readmissions, Discharges, and Deaths from the 1st January, 1876, to the 31st December, 1918.

Table XVII. —Summary of Total Admissions: Percentage of Cases since the Year 1876.

'ersons admitted during period from 1st January, 1876, to 31st December, 1918 .. teadmissions M. F. T. 11,982 7,846 19,828 3,026 2,450 5,476 M. F. T. Total cases admitted .. )ischarged cases— Recovered Relieved Not improved Med 15,008 10,296 25,304 5,541 4,424 1,093 937 1,415 961 . 4,838 2,285 9,965 2,030 2,376 .7,123 12,887 8,607 21,494 Total cases discharged and died since January, 1876 temaining, 1st January, 1876 482 254 736 Remaining, 1st January, 191-9 2,603 1,943 4,546

Males. Females. Both Sex Both Sexes. leeovered lelieved lot improved )ied .. Remaining 36-92 7-28 9-43 32-24 14-13 42-97 9-10 9-33 22-19 16-41 I 39-38 8-02 9-39 28-15 15-06 100-00 100-00 100-00

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Table XVIII.—Expenditure, out of Public Works Fund, on Mental Hospital Buildings, etc., during the Financial Year ended 31st March, 1919, and Liabilities at that Date.

Table XIX.—Total Expenditure, out of Public Works Fund, for Buildings and Equipment at each Mental Hospital from 1st July, 1877, to 31st March, 1919.

24

Mental Hospitals. 1877-1910. 1910-11. 1911-12. 1912-13. 1913-14. 1914-15. 1915-16. 1916-17. 1917-18. 1918-19. Total Net Expenditure, 1st July, 1877, to 31st March, 1919. Auckland Reception-house at Auckland Motuihi Island Tokanui Wellington Wellington (Porirua) Christchurch Seaclifi Waitati Dunedin (The Camp) Napier Hokitika Richmond .. Nelson £ 108,529 2,318 463 105 2,531 105 £ £ 135 8,908 105 561 21,935 8,874 £ 23,434 10,379 £ 2,774 £ 76 £ 1,048 £ 1,171 £ 146,643 5,059 561 76,229 29,656 205,799 182,844 181,630 8,935 4,891 147 3,727 1,097 26,045 166 4,303 10 |640 5,639 6-1.188 8,105 29,656 135,762 122,391 154,813 660 4,891 147 3,721 1,097 20,942 584,927 ' 8,121 1,762 1,063 412 4 1,480 442 . 9,550 1,951 4,867 616 5,382 3,257 4,007 1,634 6,552 5,107 7,413 911 ■ 17,518 15,157 6,721 671 11,722 24,346 997 24 10,399 7,647 597 88 2,462 1,238 966 498 .. •• 6 .. .. ■■ 353 200 200 200 200 1,417 1,798 535 200 Totals .. , , , 12,707 8,809 46,181 26,001 53,996 54,898 44,602 26,502 14,640 873,263

Mental Hospitals. Net Expenditure for Year ended 31st March, 1919. Liabilities on 31st March, 1919. . £ 1,171 8,105 2,462 1,238 966 498 200 £ Auckland Tokanui .. Porirua .. Christchurch SeaclifT .. Waitati .. Nelson .. 630 50 78 Totals .. 14,640 758

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r

Table XX.— Showing the Expenditure for the Year 1918.

Table XXa.— Showing Details of Credits.

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Items. Auckland. Christchurch. Dunedin (Seaclifl). Hokitika. Nelson. Porirua. Tokanui. Total. Inspector-General* Deputy Inspector-General and Assistant Inspector* Clerks* .. Medical fees* Contingencies* Official Visitors Superintendents Assistant Medical Officers Visiting Medical Officers Clerks Matrons Attendants and servants Rations Fuel, light, water, and cleaning Bedding and clotliing Surgery and dispensary Wines, spirits, ale, and porter Farm Buildings and repairs Necessaries, incidental, and miscellaneous £ s. d. £ s. d. 50 8 0 11 11 0 700 0 0 700 0 0 631 18 10 348 5 4 422 16 8 541 13 10 169 10 0 292 10 0 13,758 11 4 16,337 2 3 15,030 15 9 11,697 12 8 2,477 13 0 3,923 14 2 4,571 14 0 4,148 6 7 267 17 6 634 16 9 26 11 0 31 10 0 721 17 11 3,494 5 10 488 8 3 572 7 3 2,557 18 11 6.060 16 6 £ s. d. 46 4 0 543 15 0 554 12 8 622 12 9 219 11 8 23,790 11 3 14,885 7 6 4,195 8 8 6,596 17 4 416 3 4 40 17 2 4.454 9 1 1,818 7 10 7.363 7 4 £ s. d. 11 11 0 200 0 0 225 0 0 103 19 3 4,165 0 2 4.365 1 7 134 16 0 774 3 6 24 2 10 2 17 6 40 16 2 115 14 10 270 1 5 £ s. d. 645 7 9 172 17 6 137 10 0 4,405 10 9 3,560 8 3 801 19 4 1,041 7 10 44 13 2 £ s. d. 48 6 0 604 15 10 663 0 5 506 5 6 179 10 8 16,979 6 4 14,319 6 2 3,408 10 7 5.332 13 6 247 14 5 6 5 0 2,910 12 9 508 15 4 4.955 12 0 £ s. d. £ s. d. 1,000 0 0 750 0 0 1,136 1 1 935 6 7 555 7 11 168 0 0 700 0 0 4,093 18 7 2,197 17 3 225 0 0 2,266 6 3 1,102 11 7 5.881 10 9 85,317 12 10 3,303 7 10 67,161 19 9 806 11 0 15,748 12 9 642 4 8 23,107 7 5 51 3 3 1,686 11 3 108 0 8 959 17 11 13,015 16 8 253 2 2 4,550 2 10 1,300 8 5 23,482 15 11 433 17 0 793 7 2 974 11 4 Totals Repayments, sale of produce, &c. 41,876 1 2 13,755 10 I 48,794 12 2 13,703 9 6 65,548 5 7 18,240 14 9 10,433 4 3 2,492 4 2 13.011 10 1 2,485 5 6 50,670 14 6 15,144 11 1 13,898 6 0 3,373 4 6 248.609 9 4 69,194 19 7 Actual cost 28,120 11 1 35,091 2 8 47,307 10 10 7,941 0 1 10,526 4 7 10,525 1 6 179,414 9 9 35,526 3 5 * Hot included in Table XXI.

Credits. Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. Total. Receipts for maintenance For sales of stock, produce, &e.* .. Other receiptst £ s. d. 12,344 0 8 1,078 1 5 333 8 0 £ s. d. £ s. d. 8,500 8 4 13,257 1 0 4,817 17 4 4,108 3 9 385 3 10 875 10 0 £ s. d. 2,018 12 10 419 3 11 54 7 5 £ s. d. 2,196 10 4 274 13 3 14 1 11 £ s. d. 13,227 5 9 1,497 17 9 419 7 7 £ s. d. £ s. d. 1,113 6 1 52,657 5 0 1,918 14 8 14,114 12 1 341 3 9 2,423 2 6 Totals .. 13,755 10 1 13,703 9 6 18,240 14 9 2,492 4 2 2,485 5 6 15,144 11 1 3,373 4 6 69,194 19 7 * Not included— £19,734, value of farm produce and stock consumed in the institutions. t Not included— £788 I5s. 2d. received in repayment of medical fees for certificates

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Table XXI.— Average Cost of each Patient per Annum.

26

Mental Hospital. Provisions. Salaries. Bedding L ®*' ti I Ue1 ' Surgery and »rS and DisClothing. Cle^? ng pensary. Earn, sSile. Total Cost .gfc pjgjgs Porter. **»-■ ™**- _e"»cV £„*££• tenatiee. Total Cost per Head, less Receipts of all kinds. Total Cost per Head, less Decrease Increase Receipts of in in all Kinds pre- 1918. 1918. vious Year. Auckland Christchurch Dunedin (Seacliff) Hokitika Nelson Porirua Tokanui £ s. d. £ s. d. .. 14 3 0| 14 16 3J .. 16 6 9 25 9 3 .. 13 17 5J 24 0 5f .. 16 18 4 18 4 94, .. 17 2 4£J 25 15 6 .. 14 0 9i 18 12 2J .. 21 0 9| 41 18 5 £ s. d. £ s. d. £ s. d. £ s. d. 4 6 1J 2 6 8 0 5 Oi 0 13 7J 5 15 10* 5 9 74. 0 17 8} 4 17 7J 6 2 ll| 3 18 21 0 7 9 4 3 OJ 3 0 OJ 0 10 5i 0 1 10* 0 3 2 5 0 11 3 17 HO 4 3i! 2 1 81 5 4 6} 3 6 10 0 4 101 2 17 Of 4 115 2. 0 6 61 6 2 34, £ s. d. £ s. d. i 0 0 6 0 9 2* 0 0 10* 0 16 0" 0 0 9i 1 13 lOf 0 0 3 0 8 llf 3 16 3i 0 0 H 0 9 llf 1 12 3 £ s. d. £ s. d. 2 8 2 39 8 71 8 9 3*. 68 2 llf 6 17 3 i 61 1 9i 1 0 Hi 40 8 9i 4 13 8|: 62 11 1J 4 17 2 49 13 6* 8 5 7f 88 10 5f £ s. d. £ s. d. 11 12 5J 27 16 2 11 17 5i 56 5 6£; 12 7 If 48 14 8 7 16 5f 32 12 3A. 10 11 2* 52 0 if 12 19 4| 36 14 2J 7 1 9f 81 8 8 £ s. d. ! 26 9 7 49 0 2* 44 1 9i( 30 15 7 ! 50 12 4f 34 16 7 ! 67 0 9J] £ s. d. 22 2 11 42 9 51 40 8 10J 26 2 7 38 13 2f 31 6 11 56 14 81 £ s. d. £ s. d. 4 6 8 6 10 9 3 12 11 4 13 0 11 19 2 3 9 8 10 6 Of Averages .. 14 18 10} 21 4 5-1 5 2 10 I 3 10 1 0 7 6 ! 2 17 11J 0 0 5} 1 0 3 5 4 6i 54 6 11J 11 14 4J 42 12 7 38 19 0 ; 34 2 7lj 4 16 4J ~ Table XXIa. Including first five items : in Table XX i 55 6 4} 39 18 5* 35 2 If 4 16 3f Table XXIb. Patients on probation at 10 10 1*1 34 7 6f' 1 The Camp | I 2 10i 2 4 10 0 4 9J 3 2 0 I 0 5 61, 6 17 HI 64 14 9J 64 14 9J 81 12 2f 16 17 5* 1

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27

APPENDIX 11. A Note on the Work of the Department with respect to Soldier Patients from the Beginning of the War to the 4th August, 1.919. We had no reason to believe that a disproportionate number of men of average mental stability would, as a result of the stress of military service, become mentally deranged. The anticipation happily proved correct. Past experience has demonstrated that a man of sound mind, fighting honestly for a cause, will face dangers and undergo great privations without losing his mental balance. He may pass through terrible anxieties, but they are seldom for himself, and he is maintained by a normally reacting mental and moral exaltation, which sweeps away petty vanities and vexations, widens his horizon to include his comrades, and directs his thoughts and energies for the general good. It is different with those predisposed to mental disorder. Even with the best of intentions on their part, one expected, especially where this predisposition was marked, that the adjustment to unexpected changes of environment, possibly short of service at the front, would prove a disturbing factor. With instability of lesser degree many may come through all right, but they are playing with gunpowder. Furthermore, there are often feeble-minded persons, who pass muster to begin with, but who would be rejected subsequently, either at the camp or actually at the front, when their limitations became revealed under a more complex order of things than that to which they had become accustomed in civilian life. This group we expected would come under our care to be refitted for and placed in their old surroundings, and we also regarded it as inevitable that ex-patients, falsely confident of their mental and emotional stability, would, suppressing their past history, enlist, and that a proportion would be returned to our care. One recognized the soldier as the selected of the community between certain age-limits, and, though under peace conditions some who looked physically strong would have proved mentally infirm and come to us as patients in the ordinary course, yet from an equal number of soldiers passing through war conditions and of civilians of the same age rejected as soldiers we estimated a much larger proportion of mental patients from the civilians, and undoubtedly the estimate has proved correct. On the other hand, one naturally looked for a larger proportion of allied nervous disorders indirectly and directly resulting from war conditions, and also that these, in some cases, would prove to be the incipient stage of mental disease. It was absolutely necessary that all such cases should have the best expert medical skill available, and it was arranged with the Defence authorities that we would specialize at Seacliff, where we could treat the soldiers in three divisions, practically apart from other patients or only with a few civilian patients in a like mental condition and companionable. The divisions were : For the last mentioned nervous* group'a house at Karitane belonging to Dr. Truby King was placed at our disposal, and this was strictly reserved for soldiers. Next, for the best mental patients received under Magistrate's order the Reception Home was to be used. This building is known as Clifton House, and is beautifully situated on the Seacliff Estate. The next best patients were to be treated in the Library Ward at Seacliff. This was our admission ward before Clifton House was built. For patients whose mental condition debarred them from admission to any of these three divisions the environmental factor would be negligible ; but when, upon improvement, a change could be appreciated, a change would be made, according to the mental condition of the patient, to one of the special divisions. Keeping in view the necessity for expert medical attention and nursing, of which we had the monopoly, and bearing in mind that our own staff was depleted by the war, this arrangement offered incomparably the best advantage to the soldier. Once the system was started there were importunate and insistent demands to have the soldiers treated near their relatives. Patients were transferred, and later admitted direct to some of the other institutions to satisfy the natural desire of friends and kinsfolk. This meant that, though Seacliff maintained the ascendency, the, patients were scattered among all the institutions, and their number at any one time at any other institution was so small, and the forms of mental disorder so varied, that any attempt to treat them apart from civilian patients was futile. There was one exception besides the Anzac House Hospital, Karitane— namely, the Wolfe Bequest Hospital at Auckland, which was for a time strictly set aside for soldiers who could be treated without the necessity of a Magistrate's order. Forty-five such patients passed through this special institution, thirty-seven of whom recovered, and of the remainder six had to be placed under Magistrate's order. In each of these cases there was well-marked mental disorder on admission, and they were, placed in the Wolfe Home experimentally. The cases of individual military patients at Karitane and Wolfe, Home are classed in one tabular statement hereunder, and in another the cases of all soldier patients treated under Magistrate's order. To this second table is added the number in which heredity or other predisposition to mental disease was ascertained. There are other bases in which such predisposition was suspected, but the facts have not been communicated to us. Cases received from camps or home service are differentiated from those of returned soldiers. Received, as Voluntary Boarders or Military Patients. From As Returned ~, Camps. Soldiers. lotal - Number of individuals admitted .. .. ..- 14 152 166 Number placed under reception order . . . . .. 3 -28 31 Number discharged recovered .. .. .. .. ..10 100 111) Number discharged unrecovered . . .. .. . . 1 9 10* Number died .. .. .. . . .. .... 2 2 Number of individuals remaining . . . . .. .... J 3 13 Number readmitted and remaining .. . . . . .... 5 5 Total remaining on 4th August, 1919 .. .. .. .... 18 18 * At tho date of the last published return some patients had progressed sufficiently to be. tried on probation, but as that return did not include patients on probation they were entered provisionally as " unrecovered." When reported to us by the examining .Military Board that recovery had taken place the figures in the return were amended.

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28

Received under Magistrate's Order. From As Returned Total Camps. Soldiers. Number of individuals admitted .. . . .. . . 56 112 168 Number discharged recovered .. .. .. . . 29 30 59 Number discharged unrecovered .. .. .. ..3 8 11 Number died .. .. .. .. ..3 5. 8 Number of individuals remaining . . .. . . . . 21 69 90 Number readmitted remaining .. .. .. . . 2 5 7 Total remaining on 4th August, 1919 . . .. . . .. 23 74 97 Individuals classed as imbecile or feeble-minded and those who had history of mental disorder before joining Army .. ..11 24 35 Individuals predisposed to mental disorder by heredity or personal habits before joining Army .. .. .. .. 28 31 59 Of 168 patients, total predisposed to mental disorder .. .. 39 55 94 Approximate Cost of Paper. —Preparation, not given; printing (825 copies), £45.

Authority : Marcus P. Marks, Government Printer, Wellington.—l9l9.

Price 9d.