il.—31a.

Manaia . Most of the maternity work of this district is conducted in a small private hospital with two maternity beds and two medical and surgical beds. The average number of confinements is sixty per year. There is one maternity nurse, who takes an occasional single case in her own home. A few indigent cases are taken under the arrangement with the Hawera Board which has already been explained. There is only one doctor in the district, and all ante-natal supervision is given by her. Eltham. Eltham has good private-hospital accommodation, both in type and in number of available beds. Two " mixed " private hospitals under the control of private doctors have three and four maternity beds respectively. There is also a licensed maternity hospital of three beds under the control of a midwife. Fees average £4 4s. to £5 ss. per week. There are about one hundred and twenty confinements per year in the three hospitals. Here, as at Stratford, the doctors advanced very reasonable arguments in favour of well-conducted " mixed " hospitals to meet the needs of medium sized towns. The doctors state that they experienced no difficulty in regard to ante-natal care. Anaesthesia is used in the customary manner, and the use of analgesics varies. Domiciliary practice is negligible. The town is in the Hawera Hospital Board district, and that Board's arrangement for the treatment of indigent cases in the local maternity hospitals applies ; this assistance is given almost entirely to registered unemployed. Kaponga. There are four maternity beds available in a " mixed " private hospital, and this accommodation appears to be adequate and reasonable for a country district of this size. About fifty cases are dealt with each year. There is practically no domiciliary attendance. The Kaponga area is divided between three Hospitals Boards — New Plymouth, Stratford, and Hawera. The indigent cases for whom the New Plymouth Board are responsible are referred to Opunake, Stratford cases are arranged for in the Stratford annexe, and Hawera Board cases are admitted to the local hospital under the agreement with the Board. Ante-natal care is capable of further development. Pain-relief is practised to an average degree. Recommendations. (1) The chief need in this district is for proper public maternity hospital facilities in Hawera. The erection of a maternity annexe at the Hawera Hospital is recommended. It is also recommended that this annexe be " open " to the medical practitioners of the district. (2) Meantime it is considered that some adjustment of the fees payable to private hospitals and doctors for attendance on indigent cases is desirable. (3) It is also recommended that indigent patients resident in the Stratford district, but being nearer to and usually attended by the medical practitioner in Kaponga or Eltham, should have the right of admission to the private hospitals, the responsibility for the fees being that of the Stratford Hospital Board. 28. PATEA HOSPITAL BOARD DISTRICT. This small Hospital Board serves a district very similar to that of Hawera, which it adjoins to the south. It includes the towns and vicinity of Patea (1,309) and Waverley (684), and a considerable area of sparsely populated back-country. Patea. The Patea Hospital Board controls a maternity annexe of six beds which could serve the district adequately, but which it is not fully meeting the need on account of the system under which it operates. The hospital fee is £5 ss. per week, reducible to £4 4s. per week if paid in advance or by Is. per day if paid within twenty-eight days. (The rate in the general wards is £3 7s. per week, reducible by Is. per day if paid in twenty-eight days.) Although it was stated by the Board that women could go to the annexe and be attended without a doctor, in actual practice the Superintendent, who is the sole practitioner in the district, attends all cases. No special provision is made by the Board for the medical attention of indigent cases ; the doctor therefore has the right to charge his fee to the patient in all cases, and although there is no suggestion that the right is harshly applied and the fee is frequently never collected, yet there is always a certain sense of responsibility involved,

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