H.—lB

13

I believe that I have now discussed at some— but I trust not at undue—length all the prominent features in the matters brought before me for inquiry, omitting nothing of much importance m itself, or of which the consideration appeared likely to be fruitful. It only remains for me to place the conclusions at which I have arrived in a more succinct form, for facility of reference and of understanding. The House Surgeon : This officer has been shown to have committed on one occasion a somewhat serious error of judgment in sending away to a nursing-home a patient whose_ condition was such that she ought to have been at once admitted to the ward. In other eases which seemed on their face to suggest negligence or carelessness, the element of culpability appears wholly or nearly to vanish upon a careful consideration of all the circumstances. In one instance a temporary indiscretion was exhibited in the attempt to induce patients to attend the religious services in the wards by making their Sunday passes dependent on such attendance. All the other charges against the House Surgeon are, in my opinion, either false, or frivolous, or sufficiently answered by the plea of admission and justification. The appointment of an assistant resident medical officer is, in my opinion, one of the urgent needs of the Hospital. The Matron: Nothing has been proved against this lady, except her concurrence with the House Surgeon in the attempt—which was not persisted in—to make the Sunday passes of the patients depend on their attending the Church services. The matron may be somewhat deficient in the experience of housekeeping desirable in so large an establishment, but, whatever her experience, she ought to have assistance inthat department, since the nursing business, in which her efficiency is unquestioned, seems to be quite enough for the energies of one person. . . . . . The Secretary and Steward: No abuse of office has been, in my opinion, proved against this officer, but the system of letting contracts for the burial of the poor, with which his name has been connected, decidedly requires reconsideration and reform. , The union of the officers of steward with that of secretary and treasurer is, I think, objectionable, "the duties of steward being, in consequence, less strictly performed than they should be. But the appointment of a housekeeper may, perhaps, mitigate this difficulty. The advice of some skilled person should be obtained as to the best way of keeping the accounts of the secretary and treasurer, with proper checks upon them, and the scheme should include the Destitute Persons' Fund, now administerd by the Chairman of the Board. The Food and Cooking: This department has varied for a long time in respect of quality under both heads, showing frequent fluctuations between excellence and inferiority. The kitchen improvements now'to be carried out may remove all causes of complaint. The chief present desiderata appear to be the appointment of a housekeeper to look after this department; and an alteration m the meal-hours by which the interval between the evening-meal and the next morning's breakfast may be materially reduced. The former of these requirements might perhaps be met by the appointment of " house-sister," to be held by the ward sisters in rotation for three or six months at a time This plan has been proposed by Mrs. Neill, and is, I believe, supported by Miss Maude. Nursing: There is little further to be said under this head, except that the modern system requires to be steadily pursued, and. extended by degrees to all parts of the Hospital administration which have not yet been brought within its operation. _ _ This seems a fitting occasion to mention the great want that exists of some regular provision for nurses who have done good service in their time, but who, from age, infirmity, or other causes not attributable to any fault of their own, are becoming unfit for active service. Something might be done in this direction by a combination of public and private resources, and I have no doubt that there are many persons who would, if properly appealed to, by subscriptions, donations, or legacies, aid in establishing an adequate Nurses' Pension Fund. Some alteration appears to be wanted in respect of the mght-nursmg and the hours ot duty required in this department. Upon this subject the matron, with Mrs. Neill's advice, will, no doubt, be able to do all that is necessary. Wardsman and Dresser: The employment in what is virtually the office of assistant-surgeon ot a person who is neither a qualified medical man, nor pursuing the curriculum necessary for becoming one, is an expedient which might be justifiable in the early days of a hospital on a new goldfield; but'in any institution pretending to aim at even a moderate standard of modem completeness and efficiency it is an incongruity which should be no longer tolerated. And it has been shown in a former passage of this report how little likely is the present holder of this office to help or harmonize with an improved system of nursing. Chronic Cases and Infirmities of Age : Nothing is more urgently needed than some provision for cases of this sort outside the walls of the Hospital. The admission of such cases, which are not suited to a general hospital, is a cause of overcrowding and inconvenience ; and to it, doubtless, may be largely attributed the difficulty which sometimes occurs in the prompt admission of more suitable cases and the necessity of discharging others a little sooner than would otherwise be the case. The Hospital Board : I do not propose to say anything about the constitution of this body, except that I believe that if it were elected from a larger constituency there would be less opportunity given to local and personal influences in the management of the Hospital, and the Board would probably be able to" exhibit more courage and firmness in pursuing a straight course without fear or favour. But in whatever manner elected it is essential that the Board, if it thinks its head officers competent and trustworthy, should trust them in matters coming under their supervision. Nothing but very strong reasons should be allowed to weigh against a recommendation of the House Surgeon and the matron, and the hands of these responsible officials should be strengthened by all legitimate means in maintaining discipline and order. 3—H. 18.