H.—3la.

Modern opinion on maternity services recognizes that the best service is obtained and optimum pain-relief can only be given when the doctor gives close supervision to all cases. This is incompatible with a position where the doctor attends only those cases which develop abnormalities in the mechanism of labour. No provision is made for indigent cases outside the Cromwell annexe. Admission there entails long journeys for those resident far from Cromwell, and though the Plunket nurse gives some ante-natal care the amount received is insufficient. Recommendations. (1) Arrangements should be made to permit of the admission to Ranfurly Hospital (Maniototo Hospital Board district) of those patients for whom it is more convenient. Note. —This is an instance where closer co-operation between adjoining Hospital Boards is advisable in the interests of the patients. (2) Improved facilities in the form either of a public annexe or a subsidized hospital should be provided at Alexandra where indigent and other patients could receive attention closer to their homes. 46. MANIOTOTO HOSPITAL BOARD DISTRICT. This is a sparsely settled farming area bounded by the Waitaki, Waihemo, Taieri, Tuapeka, and Vincent Counties. Its population of 3,000 has increased by 15-19 per cent, during the past ten years. Its centres of community interest are Ranfurly (449), and Naseby, a dying mining town (219). There are two doctors in the district, and both reside in Ranfurly, where there is a public maternity ward of eight beds. The average number of occupied beds is 2-4 ; the number of patients confined therein last year was sixty-two. The fees are £4 4s. per week wards, and £5 ss. per week single rooms, inclusive of all services. The doctor informed the Committee that he attends all confinements. The patients have free choice of doctor, but as no fees are charged by the doctor and only one of them is paid by the Board for the service the free choice of doctor is theoretical rather than real. The maternity ward is adequate for the needs of the district. It is well equipped and adequately staffed. Ante-natal work is carried out at the hospital, and although some patients have upwards of forty miles to travel the Superintendent says that they attend regularly for ante-natal care, but not for post-natal examination. The difficulty in obtaining sufficient confinements for the nursing trainees is likely to be accentuated rather than improved as time goes by. Transport and telephone facilities are as good as in other South Island east coast country districts. Recommendations. The Committee is of the opinion that the maternity hospital provision in this district is very satisfactory, but recommends that the local doctors be granted the right to attend private patients in the maternity ward and to charge the customary medical fees. 47. SOUTHLAND HOSPITAL BOARD DISTRICT. This is a very big district, including a large area of sparsely settled country. It consists of the Stewart Island, Southland, and Lake Counties, extending from Lake Wanaka over to the West Coast, and extending down to the sea in the form of a wedge whose base extends along the coast from the Invereargill side of Riverton to Chasseland's Mistake. The population of this large district is approximately 64,000, and the people are engaged in gold-mining, timber-milling, mixed farming, and fishing. During the past decade the population has shown the following increases : Southland County, 9 per cent.; and the Lake County, 56-72 per cent. The centres of community interest and their population changes are : — Invereargill, 25,772 ; increase 15-97 per cent. Bluff, 2,058 ; increase 26-9 per cent. Wyndham, 574. Mataura, 1,500 ; increase 21-36 per cent. Gore, 4,635 ; increase 18-39 per cent. Winton, 888 ; increase 2-2 per cent. Lumsden, 543 ; increase 1-69 per cent. Queenstown, 931 ; increase 15-8 per cent. Arrowtown, 279. Pembroke, 292. The number of doctors in the area is twenty-eight —three at Gore, two at Mataura, one at Wyndham, fourteen at Invereargill, one at Bluff, two at Winton, one at Lumsden, two at Queenstown, one at Arrowtown, and two at Pembroke.

5—H. 3IA.

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