H.—3la.

and consequently a more suitable site for a hospital. The doctor makes a weekly visit to Ruatoria, and monthly visits to Te Araroa and Tiki Tiki, and it is thought that, by suitable arrangements, these visits could be made to comprise ante-natal services which, together with a clinic at Waipiro Bay, would put the ante-natal work on a better footing than is at present the case. Te Araroa. The small hospital which formerly served the district has been closed for six years, and the Board considers that it could be reopened only at considerable loss, the preponderance of patients being Maoris. The distance to Waipiro Bay (forty-four miles) will be a drawback to patients from this district attending the new hospital, and it is thought that, when the road to Opotiki (eleven miles) is completed, the majority of patients will prefer the latter centre. Maori Conditions.—The Maori population in this district is very large, no fewer than 5,624 residents out of a total of 8,134 being Maoris. It follows that no discussion of ante-natal and district work is possible without reference to Maori conditions, and a general survey of maternity services in the district is therefore incorporated under this heading. The district nurses at Te Araroa and Tikitiki give ante-natal and post-natal advice and attend a considerable number of confinements. In the past they have, on occasion, had to treat abnormalities for lack of medical assistance. They are now able to get the doctor from Te Puia for emergencies, but in times of flood this may not be possible. They endeavour to persuade patients to go to hospital, and the tendency to do so is increasing among the younger Maoris. More extensive hospital accommodation is urgently needed on this account, the present four-bed hospital at Tokomaru having sometimes had to accommodate nine patients. There is no district nursing service at Tokomaru Bay nor at Waipiro Bay, and these two settlements urgently require the assistance of competent nurses. Many Maoris are still confined at home by Maori methods, and ante-natal work is rendered difficult by racial superstitions. Toxa3mia is, fortunately, a rare condition among the Maoris who, on the whole, are healthy as long as they can obtain their own natural foods. Unmarried Maori mothers are usually sent to the Salvation Army Home in Gisborne. Summary and Recommendations. Owing to the inadequate hospital accommodation, domiciliary midwifery among the Maoris is the rule in the Waiapu district. Apart from the small hospital at Tokomaru Bay, no provision exists for the treatment of abnormalities. Serious emergencies infrequently have to be dealt with in patients' own homes under unfavourable conditions, and in some cases where the doctor is not available by the district nurses. Extension of both hospital and district services is urgently required. The Committee endorses the intention of the Hospital Board to establish a larger hospital and has serious doubts regarding the project of converting a private house at Waipiro Bay, which is situated at a considerable distance from medical and hospital facilities. The Committee suggests that the_ establishment of this hospital be regarded as an emergency measure, and that the possibility of erecting a maternity hospital at Te Puia at a later date be borne in mind. In the interests of improved ante-natal and post-natal care the Committee recommends that the Hospital Board pay an adequate salary to the doctor at Te Puia for conducting clinics at Ruatoria, Tikitiki, and Te Araroa, and also that the present excellent district services be extended by the appointment of nurses at Tokomaru Bay and Waipiro Bay. It is thought that well-trained and competent Maori nurses would be suitable for these positions. 19. COOK HOSPITAL BOARD DISTRICT. This district extends from the northern boundary of the Wairoa district to a point on the coast a few miles north of Tolaga Bay. In shape it is a rectangle of roughly forty-five miles from north to south by thirty miles east to west. It includes the counties of Cook, Waikohu, and Uawa. Gisborne (13,587 inhabitants, 3-48 per cent, increase of population during 1926-36 period) is the commercial and shipping centre of the district, and is the situation of the general hospital. The small Township of Tolaga Bay (429 inhabitants), twenty-five miles to the north, is the only other hospital centre. The total rural population of the district is 11,987, an increase of 6-65 per cent, in Cook and 3-66 per cent, in Uawa, being offset by a decline of 6-65 per cent, in Waikohu, during the 1926-36 period. Sheep-farming is the principal industry. Gisborne. Public-hospital Facilities.—The former St. Helens Hospital has been replaced by a modern and up-to-date annexe of thirteen beds, situated in the grounds of Cook Hospital. It is a training school for five maternity nurses. Cases are attended by midwives, and the Superintendent of the annexe is on call for all abnormal cases. Morphia, nembutal,

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