H.—22a

3

perforations (not three), the larger one opening at least 1 in. long." With statements of this nature before us, we should have felt great difficulty in arriving at any satisfactory conclusion. Fortunately, the exhumation of the body of Wallis White was ordered by the Colonial Secretary. The post-mortem was conducted by Drs. Savage and Bull, and the stomach and intestines were preserved and shown to us Both of these gentlemen gave us much valuable testimony, and their evidence, coupled with our own personal examination of the specimens, enabled us to judge of the value of conflicting testimony in this matter. The stomach and incised intestines have been sealed up and delivered to the Inspector of Police. Ethel Maud Mclndoe. One of the charges made against the Senior Medical Officer was that he had performed the operation of hysterectomy upon Ethel Maud Mclndoe, and that the operation was unnecessary and unjustifiable. A careful investigation of this charge showed that the operation was performed by Dr. Parkes, one of the honorary staff, assisted by Dr. Collins. The conclusion to which we are led by the expert medical evidence is that the diagnosis of the disease was, under the extraordinary circumstances surrounding the case, a reasonable one, and that the operation was justifiable. In addition to the cases above mentioned, numerous complaints were made against the Senior Medical Officer as regards surgical practice. We do not consider it is necessary to discuss these complaints in detail. Some were apparently abandoned, as no evidence was led in respect of them, while others appeared, when investigated, to be of little or no importance. Those complaints which refer to the absence of the Senior Medical Officer from the Hospital, his perfunctory attendance in the wards, and his actions as regards the pathological laboratory will be dealt with under the head of general administration of the Hospital. Constitution op the Board. The Board is elected annually, and a continuous policy (so necessary to the proper management) is impossible. It is complained that the Board is not a suitable body to manage a Hospital, as its functions include dealing with questions of charitable aid. This latter complaint can be met by the creation of the Hospital into a separate institution, in accordance with sections 42 and 43 of " The Hospitals and Charitable Institutions Act, 1885." To meet the first-mentioned difficulty, we suggest an alteration of the statute whereby the Board would be elected for three years, and thereafter a certain portion of the members (say, one-third) should retire annually in rotation. It should consist of representatives elected by the local bodies, and nominated by the Government, and provision should be made whereby there should always be at least one medical man on the Board. Present Condition of the Hospital Buildings and Suggested Improvements. The present condition of the Hospital buildings, as regards the buildings themselves, with the exception of the Children's Hospital and the Nurses' Home, is far from satisfactory. The main or old building consists of a basement and two upper stories. The basement is in a highly insanitary condition — damp, and cheerless. It is in this portion of the building that the padded room for what may be termed semi-lunatics and delirium-tremens cases is situated. The next floor, in which the first tier of wards and the operating-room are found, is entered by a double flight of stone stairs, up which all patients have either to walk or be carried. The accident ward is on this floor. The large wards in each floor are, in their construction, entirely out of date, and are, as regards their construction, devoid of those safeguards which modern science considers of the first importance, especially as regards surgical cases. The lavatories are in a very insanitary condition, the bath-rooms small and inconveniently situated, and the arrangements as regards privacy, both in the male and female lavatories, are of the most imperfect character. The operating-room can only be regarded as a makeshift. It is a small room, lighted only from one end, possessing none of those safeguards from septic influences which modern surgical science imperatively demands. There is no separate room in which to administer anaesthetics, no withdrawing-room or dressing-room for the surgeons. A patient must be brought into the room partially clothed, in full view of the surgeons, surrounded by the instruments which are to be used upon his or her body. In short, the modern surgical requirements are conspicuous by their absence. There is no lift, and the patients have to be carried up and down flights to and from the operatingroom. A large and up-to-date operating-theatre is in course of construction as an adjunct to the Children's Hospital, which has been constructed from the Costley bequest. This building with its operatingtheatre is situated about 150 yards from the main Hospital, and between the hospitals is situated an old wooden building known as the fever or typhoid ward. It is proposed to remove it, and to construct on or near its site new and expensive surgical wards connected by a covered corridor with a new operating-theatre. It is absolutely necessary that either this should be done or a new and up-to-date operating-theatre should be constructed in connection with the old building. The former course we consider the best, as it would be almost impossible to render any of the wards of the old building sufficiently aseptic for surgical work ; it would be out of the question to carry patients to and from the old buildings to the new operating-theatre for operation. Next to the Children's Hospital is the Nurses' Home, and beyond that is a new building intended for the residence of the Senior Medical Officer. This could, no doubt, be utilised in other directions. In another portion of the grounds are suitable buildings intended for possible small-pox and plague outbreaks. We beg to strongly recommend that the alterations to the old main Hospital building urgently.required should be immediately undertaken under the supervision of a competent architect, subject to" the approval of the head of the Hospital Department.