MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1919.

Appendix to the Journals of the House of Representatives, 1920 Session I, H-07

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1920. NEW ZEA L A N T).

MENTAL HOSPITALS OF THE DOMINION (REPORT ON) FOR 1919.

Presented to both Houses of the General Assembly by Command of His Excellency.

The Hon. the Minister in Charge ok Department foe the Care of Mental Defectives to His Excellency the Admtnistbator of the Government. Sir—- Wellington, Ist August, 1920. T have the honour to submit to Your Excellency the report of the inspector-General of Mental Defectives for the year 1919. T have, &c, C. J. Parr, Minister in Charge of Department for the Care of Mental Defectives. The Inspector-General to the Hon. C. J. Parr, the Minister in Charge of the Department for the Tare of Mental Defectives. Sir,— Wellington, Ist July, 1920. 1 herewith present the report for the year ended 31st December, 1919. An analysis of the statistical tables in the appendix shows that the number of patients on the register at the beginning of the year was 4.546 (m., 2,603; 1, 1,943) ; at the end 4,647 (in., 2,667; f., I,9Bo)—an increase of 64 males and 37 females. The total number under care during the year was 5,509 (m., 3,178; f., 2,331), being 101 (m., 85 ; f.. 16) more than in 1918. while the, average number resident, 4,527 (ra., 2,620 ; f., 1,907), was 26 (in., 18 ; f., 8) in excess. The ratio of patients on the register to population, exclusive of Maoris, was 39-39 per 10,000 (m., 44-66 ; f., 34-01), or 1 patient in 254 (hi., 224 ; f., 294) ; including Maoris— their number on the register is 60 only—the figures are 38-27 Tpn- 10,000 (m., 43-31 ; f., 33-06), or lin 261 (m., 231 ; f., 302). The admissions (excluding transfers- m., 63 ; f., 17) numbered 883 (m., 512 ; f., 371) ; the male admissions were 75 higher and the female 31 lower than in the previous year. Among these admissions are included 13 immigrants who had been here for less than a year, and 59 New-Zcalandcrs were admitted after return from abroad, 58 being returned soldiers. Of the 883 cases admitted, 15-75 per cent, were of patients who had previously been treated to recovery in our institutions, leaving the number of first admissions 744 (m., 448 ; f., 296), an increase of 67 males and a decrease of 27 females compared with 1918. The ratio of admissions to population (excluding Maoris) was 7-66 per 10,000, and for first admissions 6-47, or, in other words, every 1,305 persons in the general population contributed an admission, and every 1,546 a first admission. The previous decennial average was 7-53 and 6-31. The total number of patients discharged (excluding transfers) was 437 (m., 233 ; f., 204), of which 337 (m., 190 ; f., 147) were discharged as recovered. The remaining 100 (m., 43 ; f., 57), though not recovered, were sufficiently well to be placed under the caTe of relatives or friends. The percentage proportion of recoveries on admissions was 38-17 (m., 37-11 ; f., 39-62), as against 33-73 (m., 32-49; f., 35-07) in the previous year, and 39-22 (m., 36-78; f., 42-79) in the average for all years since 1876. The deaths numbered 342 (ra., 212 ; f., 130), giving a percentage of deaths on the average number resident of 7-55 (m., 8-09 ; f., 6-82), and on the. total number (general register) under care during the year of 6-21 (m., 6-67 ; if., 5-58). The corresponding percentages for the previous year were 9-95 (m., 10-53 ; f. 9-16) and 8-28 (m., 8-86 ; f., 7-51) respectively. As usual, some persons whose condition was doubtful as regards certification as mentally defective have been received for observation at the instance of the Magistrate. At the beginning of the year there were. 7 (m., 6 ; f., 1) such, and 98 (m., 73 ; f., 25) were received during the year. Of this number, 57 (m., 46; f., 11) wen-, discharged, 42 (m., 28; f., 14) had to be placed underordinary reception orders, 2 men died, and 4 (m., 3 ; f., 1) were under observation at the end of the year. These cases do not figure in the statistics, nor do the voluntary boarders, of whom there was a daily average of 54 in the. State institutions. At the beginning of the year there were 51 (m., 20;"f., 31), and 95 (m., 36; I., 59) were admitted during the, year. Six (m., 3; 1, 3) had ultimately to be placed on the register of patients,' r 5 (m., 3 ; 'f., 2) died, and 66 (in., 24 ; f., 42) were discliarged,* , leaving*69 (m., 26 ; *f., 43) resident at the end of the year.T The*results in the case of persons remanded for observation and in the treatment""of"voluntary! boarders, whereby many are saved from being committed as patients, are distinctly encouraging. Altogether 123 such inmates recovered or left much improved without formal admission as patients.

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In the following table the general population and the mental-hospital population, with its admis' ; '>ns and recoveries, are arranged in. proportions per < ent. of age-groups.

Comparing the age-distribution of the general population with ours one immediately learns that insanity is an adult disease, one-third of the general and only one-sixtieth of our special population being contributed by persons under fifteen years of age. This fact disturbs the relative value of the other figures; but if the juveniles in each series were divided proportionately among the other groups the mental hospitals would still have a markedly higher proportion of elderly persons, due mainly to the higher tendency amongst the aged to mental disorder, partly to their small chance of recovery and to institutional care prolonging their lives, and partly to the admission of senile, patients who should be treated elsewhere than in a mental hospital. The proportion in the. admission table accentuates what has been said about senile, cases, and it will be noted that the proportion of juveniles is relatively higher. This has been observed of recent years, and called forth the remarks in my last report for the, necessity of a separate institution for their care, and training. The largest proportion of admissions and recoveries is contributed by persons between these extremes, and we would be in a. much better position to deal with them if we were not hampered by the presence in the same institutions of mentally deficient children and aged mentally infirm, quite, apart from the fact that they are occupying accommodation which was designed for the mentally unsound. The following table will make this clear. It is brought up to the sth June, 1920, and demonstrates a want of accommodation which would be more than adjusted if thosefin their dotage and the mentally deficient were provided for elsewhere. As things are, there are some adjustments still to be made by transfer of patients to new buildings. Our discharge-rate is high, our death-rate low, and. between these and the total admissions there is always a balance more or less permanently added to our population. I illustrated this some years ago by picturing the structural proportions which general hospitals would attain if the Boards were forced to keep patients till they had practically recovered the use of body and limb they had prior to their illness. Last year 883 patients were admitted, and 779 were discharged or died ; thus 104 were added to the mentally defective, population, or 10.1 to the mental hospitals, for 3 were transferred from mental hospitals to private care as single patients. We have, been endeavouring to keep) pace with estimated increments and a little more besides ; but the difficulty of getting material and labour has meant slow progress. At the present time buildings so delayed are being proceeded with at Auckland, Tokanui Nelson, Sunnyside, and "Waitati, and more will be. needed before these are finished. Considering the obligation to study economy, the shortness of labour in war years, and the slow rate of progress in building since, we. are not so badly off for bare accommodation as we might have been, had we not done a good, deal when we were able ; nor, for that matter, are we as badly off as many public bodies and private individuals are at present. But we want more than bai-e accommodation. By reference, to the table below it will be seen that the total accommodation is divided into a number of wards, and, I may add, some of these, wards are subdivided If patients labouring under the different classes of mental disorder could at all times be trusted to fill the wards as designed there would be very little trouble ; but one is dealing with a very uncertain quantity, and so one ward, may be overfilled while another has accommodation to spare. We are countering this by adding new wards instead of additions to existing wards, and so providing for more detailed classification. The reception wards are in this respect a noteworthy addition to our resources. A considerable portion of our expenditure will be directed not to adding to dormitory accommodation, but to enlarging old-time living-rooms and modernizing buildings which have got out of date but are too good to abandon, and also to carrying out renovations and repairs which were largely suspended during the war years.

Age-groups. Under 15 16 and under 20 20 „ 30 30 ,, - 40 40 ,, 50 50 „ 60 60 „ 70 70 ,, 80 SO and upwards. . Proportions at each Age-group of 100 Persons. In the General Population In Mental Hospitals on Admitted to Mental lies- Dlschaq (Approximate). 31st December, 1919. pitals in 1919. 1 Males. Females. Total. Males. ! Females. Total. Males. I Females. Total. Males. I. 30-17 .'12-58 31-81 ! 1-72 1-50 1-67 4-09 3-04 4-17 0-54 8-44 0-17 8-78 j 2-10 2-52 2-27 5-59 4-07 5-33 3-78 19-60 19-67 19-66 10-14 8-88 9-liO 20-16 16-57 18-66 21-62 16-73 15-99 16-39 22-15 20-17 21-31 22-56 24-04 23-18 28-11 10-44 10-08 10-26 24-09 24-69 24-35 17-97 25-14 20-97 27-57 6-96 6-13 6-57 17-92 21-15 19-29 12-37 11-60 12-05 10-27 4-47 3-98 4-24 13-53 13-14 13-37 6-59 I 9-39 7-76 5-95 2-62 1-96 | 2-30 I 6-41 l 6-37 6-39 7-18 4-14 5-91 2-16 0-51 I 0-44 0-49 1-94 1-49 1-75 2-59; 1-11 1-97 ged as Re< In 1919. Females. f 0-69 4-83 21-38 28-96 22-76 12-41 7-59 1-38 covered Total. (Mil 4-24 21-52 28-48 25-45 11 -21 6-67 1-82

Mentally Defective ; Mental Hospital. Class I, ! Class II, Unsound Mentally Mind. i lulirm. Patients on Register as classified on Patients on H 5tb June, 19211. Class 111, Class IV, ffi*?, V J Class VI, , . Idiots. Imbeciles. m ™™ d - Epileptics. , " 1 '"- (Agister. -Lrlster Accommodation on * 5th June, 1920. Absent on Pro- | iiation. Absent Number mi Pro- . nl Total. liation. Wards. M. ]f. M. If. Auckland .. 313 235 141 48 Christchurch .. 231 300 40 29 Dunedin (Seacliff 485 325 14 37 and Waitati) Hokitika . . 155 40 20 14 Nelson . . 24 34 35 39 Porirua . . 504 394 22 10 Tokanui . . 141 41 M. I''. M. .If. it. If. M. If. M. If. S (i 91 53 4 31 49 29 606 402 7 4 33 39 20 11 30 37 301 420 II 4 40 31 11 9 48 33 639 439 M. If. 5 13 II 18 4 2 M. If. M. If. M. If, 5 13 9 8 645 385 II 18 8 7 380 435 4 2 11 7 532 403 2 1 5 2 4 8 12 6 198 71 12 8 10 101 7 7, 9 8 97 100 4 4 22 27 : 16 15 55 30 623 480 15 3 2 1| I 3 149 49 l ____J 1 2 2 4 5 14 12 4 2 206 04 2 4 2 3, 92 l\04 5 14 10 8 590 403 ..• .. 4 2 172 99 28 53 48 372,617 1,893 Totals .. ,1,853 1,369 302 183 44 28 206 165 M 82i 204 146 2,673 1,973 ■ -H !

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in Table Xlii the principal cause is stated as assigned on admission. Omitting cases in which no cause was assigned and grouping others, the percentage proportion of the principal causes operating in the admissions of the year under review was as follows : — Male. Female. Total. Heredity .. .. .. .. .. 8-56 8-13 8-38 Congenital mental deficiency .. .. .. 18-29 12-95 16-02 Predisposed by previous attack. . .. .. 6-86 17-1.6 11-14 Critical physiological periods .. .. .. 4-49 J -14 7-1.3 Senility .. .. .. .. .. 13-79 10-24 12-26 Mental stress (prolonged) .. .. .. 10-79 11-74 11-14 Alcohol .. .. .. .. .. 11-03 4-20 8-38 Syphilis .. .. .. .. .. 10-06 0-31 6-00 Epilepsy .. .. .. .. .. 5-21 3-31 4-38 influenza .. .. .. .. .. 2-99 2-70 2-87 Other causes .. .. .. .. .. 7-92 \ 18-04 12-14 When one recognizes that the healthy, stable brain, Uie organ of mind, will withstand the assault of massed stresses, it is obvious that the factor of heredity is understated; and also the fact is not sufficiently brought out that numbers of those contributing to this table, have had their resistance reduced by impaired general health, or bj some stress often not recognized as such, acting from within the organism, or without, over long periods, and itself impairing the mental and emotional faculties, or imperilling them when the system has to submit to some intercurrent toxic or other stress, regarded as the exciting cause of the mental disorder. Other predisposing influences are necessarily more serious where there is a family history of insanity or the higher neuroses, and experience bears out Mercier's dictum that heredity and stress are in inverse ratio. We cannot insure ourselves or carry a charm against the onset of mental disorder, but for those with a bad heredity to sit with folded arms awaiting the stroke of doom argues an extraordinary pusillanimity, or an ignorance—a guilty ignorance—of the value of a proper environment. The lawmakers of Erewhon were not altogether absurd when they classed illness as crime. Perhaps never before was there so general a mental stress, operating insidiously and predisposing to mental, moral, and nervous disorder, as there is at. present; and. as there arc so many persons blind to their own needs, there was never a greater need for directing and safeguarding the health of the community, it would not be out of place to illustrate the nature of the present spirit of restlessness. Any one reading this will have passed through two critical periods at least—puberty and adolescence— associated with the special development and the. maturing for function of organs, from which each impulse of thb process is transmitted to the brain. Every other organ is likewise forwarding messages, but these, having become familiarized by repetition, cease to disturb the consciousness. It is otherwise with new or unaccustomed messages —received as indefinable, obscure, and voluminous sensations—which are profoundly unsettling till in due course they themselves become familiar and provide an. important contribution to an ego now stable and modified by the. experience. The differences in. deportment during the transition are matters of common knowledge, and it needs no high degree of observation and understanding to appreciate the accompanying intellectual, moral, and emotional instability. It is by virtue of this recognition that the torrent with its destructive tendency is directed by the wise, into channels of safety; but, unfortunately, there are many who are not wise or wisely instructed. While this state of mind is expressing itself in vanities, departures in thought, feelings, and conduit from the hitherto normal, the, individual is under a stress, the nature of which he doe;; not realize till the. danger is past and he can regard himself in the retrospect. These is an analogy between such stresses acting from within and. a disturbance of the same faculties by indefinable resentments and discontents acting from without, the individual in this critical period of the world's history. The present cycle of dissatisfaction with what is has been developing, with exacerbations and remissions, through some generations ; and individuals wishing to gain the ultimate at onee —without a thought of the resulting chaos —while restlessly attempting to adapt themselves to varying conditions, have glimpsed the mirage of social Utopias and experienced the inevitable disappointment. Little wonder that some look back regretfully at tin; passing of the simpler life in thought and labour which preceded the eraj of science and the newer purpose. So gradual has been the recurring process that the stages are, hardly recognizable of individual revolts aggregating to a mass consciousness, of that mass gathering momentum to reach the unattainable, staggering back disappointed, and then disintegrating, while across the void echoes the wisdom of the ancients, ■"You will go safest in the middle." The importance of the reference in this connection is that mental and emotional instability undoubtedly accompanies the exacerbations, a fact easily demonstrable where in gathered numbers words and deeds are applauded which each unit in the security of his home would repudiate and abhor. With no prophetic gift, but as an ordinary deduction, I stated that the war would reduce the ratio of insanity; and, now that the effect of this period of high purpose and genuine altruism seems to be exhausting itself, there is a danger of. losing our ethical values ; and tin; ordinary stresses which lead to mental disorder will meet with less resistance, when the. individual, taken at a disadvantage, is attempting to adjust himself to an environment apparently slipping on its foundations. The war, in a measure the consequence of a general half-reasoned sense ot revolt, by the very magnitude of its disastrous upheaval compelled a consideration of the world-sickness, and this has led to a helterskelter rush for remedies. It has disclosed to many for the first time that the pervading unrest, whatever its origin was, is tending to make mankind depart from aspirations for a high and attainable ideal in which the happiness of the individual is merged in the well-being of. the whole, community. Though it may not be, apparent to the individual, the general condition induced is one of mental perplexity, of moral titfulness and emotional hunger, and predisposes to nervous disorder and a perversion of ethical standards. There are abundant signs of a. sense, of chafing under irksome restrictions, without consideration whether their complete removal would, mean interference with the liberty of others; of a call tor self-expression, good, bad, or indifferent; of a, desire lor self-gratification in the enjoyment of the present, and a discarding of precedents—till pointing to an iconoclastic attack on

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old conventions as such, with no thought of their origin and value to Uiie community, or thenadaptation and moulding to necessary changes, it is such straining for expression in the midst of revolt which gives and the futurist, essaying to replace the masterpieces of art; which impels the son of the composer of the " Blue Danube " to startle our sense ot harmony with " Don Quixote"; which accounts tor women joining recklessly in dances the meaning and source of which could hardly be referred to in a smoking-room; which draws inspiration for its literary romances from a pathological text-book. lor newness at any cost has had its cycles, and is recorded thus by one whose insight into human nature remains unequalled : — A Wlioro doth the world thrust fortli a (.So be it now, there's no respect how vile) That is not quickly buzzed into his cars? „„, Then all too late comes counsel to be heard, Where will doth mutiny with wit's regard — Direot uot him wiiose way himself will choose, i But we are not dealing with circumstances under which this advice was given. Much may be done __in _the political sphere, but that is beyond my bnei. There are, however, social questions on which there cannot be political differences, m which there is an obligation on those in and having the power to direct in the way oi physical, mental, and moral safety. The rejections from the Expeditionary Force, coupled with the reports on the indifferent physical condition of numbers of school-children, indicate as clearly as anything can that the, underlying cause of most of the unfitness to stand hardships exists before school age. If the natural and proper needs of life are supplied before and after birth, the average infant, child, and adult will be so much the better able to resist the effect of predisposing and the attack of the direct causes of disease, whether physical or mental or moral, and the proportion of the robust will rise to demonstrate that people are not abusing the advantages of this highly favoured country. lam glad that the Government Contemplates taking up systematically this question ol social service, and, feeling strongly as I do that not alone the physical but the future mental and moral health of the community is largely dependent on the care of the young organism, it is fortunate we are in a position to get the benefit ol the experience of Dr. Truby King, who has a world-wide reputation in this branch, oi medical science. Our relatively small population can be instructed in domestic science, usmg the term m its widest application, with a completeness impossible in larger communities. Further, with the knowledge that undue excitation of the infant is harmful, it will also be realized that some decided check should be placed on the precocious excitement of older children —on the vivid presentation of vice and the glamour of lawlessness, in spite of the, ultimate triumph of vntue, depicted in the class of moving picture which by its supply has created its own demand, and is ethically destructive, i thanked you, sir, privately, and 1 do so now publicly, for having taken up this matter. The therapeutic value of the. farms, even if we had to work them at a loss, makes them a necessity, but year by year the farming operations, including kitchen-gardening and fruit-growing, have been so successful that their primary object tends to be overlooked- -that of diffusing a sentiment of privacy and freedom while providing normal healthy occupation in the open air. The expenditure for the year on all the farms amounted to £24,171, and the receipts £36,878, leaving a profit oi £12,707. The following is a statement of the receipts : —

In Table XXi the bulk ol the farm expenditure is divided among "salaries, " iarm, and "miscellaneous," ol produce sold lor cash account 3s. id. of "receipts oi ail kinds " ; but the value oi produce of our own growing consumed, approximately £5 per head, is not shown m Table XXi, and in assessing lull actual value ol lood consumed this sum should be added to the item oi " provisions." There are also .some minor sources contributmg to the credits ; but the chief receipts are collected lor the maintenance oi patients. These have been highly satisiaotory. The total amount was £69,43; i 12s. lUd., averaging per head £15 ss. Sd., an increase of £3 lis. 3£d. over the previous year. The collection oi maintenance was reorganized in 1910, removed to the Head Uifiee, and placed under Mr. Weils as iteoeiver. The first year showed an improvement, and then only amounted to £7 7s. 7Jd. per head. The total cost oi collection is about 1-4 per cent. The improved credits, placed against the necessaiily increased expenditure in spite ol careful buying, have kept the cost per patient within reasonable limits. Thus, lor the year ended the 31st -December, 1919, the gross cost per head oi £63 2s. 9|d. (no allowance made lor interest on buildings, &c, by way of rent) was reduced to £42 Bs. 5d., an increase ol only £2 9s. over the previous year. total expenditure for the year ending 31st December, as shown in Table XX, was, in round figures, £286,847 ; the credits amounted to £94,1011, ieavmg a net expenditure of £192,717. The synchronous rise oi credits with expenditure is being mamtamed. At the balance at the end oi the financial year tfie corresponding figures were £303,705, 1112,951, and £190,804, the item oi receipts for maintenance having risen to £86,887.

Mental Hospital. Produce soid. Value of Produce consumed. Total. Au.ukia.iid Ohrietcimreh .. BeaeJsH Hokitika .Nelson I'onrua Tokanui £ s. d. 1,314 14 2 4,683 19 4 a,750 13 4 to 368 2 5 2,379 10 10 1,811 12 3 & s. d. 3,180 7 7 4,880 15 1 G,2U3 18 1 J2U 12 1 1,609 7 11 3,416 2 1 2,577 15 7 £ s. d. 4,500 1 9 9,534 14 5 9,960 11 5 720 12 1 1,977 10 4 5,795 12 11 4,389 7 10 Totals 14,264 12 4 ZZ,o»J 18 5 36,878 lU 9

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. i The stall has not yet returned to its normal proportions, but there are indications that the new salary__soale, with the less than wholesale cost deducted for maintenance, Leinuiieration attractive when contrasted with the substantial reduction of wages m other occupations by tfie high cos. ol living, and not a lew members of tfie nursing staff who lelt to better themselves under cite lure ol shorter working-hours and these seemingly higher wages have applied to ie-enter the seiVice. The unmarried nursing stall is m a better position than the rest oi the community with regard to cost oi living, but the Government has generously not considered this i,.ct when allotting the oost-01-iiving bonus. Unmarried members oi the nursing staff are charged £25 for complete maintenance, and the married £15 for meals when on duty. Their respective salaries, after making these deductions and without adding any bonus, are, as loflows : Curses, £90 to ills. Attendants--Unmarried, £15/ to £.17U ; married, £180 to £200. Charge nurses, £130 to £i4u. Ohaige attendants— Unmarried, £185 to £200 ; married, £2.15 to £230. The maintenance deduction in the. case oi Matrons is £50, making their net salary —Ulass 0, £160 ; Ulass B, £170 to £180 ; and Class A, £190 to £210. Head attendants ate provided, where possible, with residence, lire, and light at a charge oi £45, and have the privilege of dealing at the institution store, because formerly they drew tree rations from the store, and this payment in kind was commuted lor cash when the salaries were readjusted. Where the house cannot be provided, and the above privilege with it, the deduction is only H'Zo lor meals when on duty. D.duotnig the lull £45, the net salary is —Ulass U, to £3UO ; Ulass A, £3ZU to £34U. There have been many changes among the probationers ajd junior members of tne stall, and these have, naturally increased the responsibility of the seniors, wnoseiiiteffigent oversight, sympathetic care, and kindty control oi: the patients lam glad to be in a position to record. (Such devotion to duty more than anything else stimulates the desire to improve their conditions whenever ana wherever possible ; but belore much can be done we must have a full staff, and be m a position to effect some structural changes to improve the mess-rooms, &c, in some of the institutions. We have set our own example in the .Nurses' Home at Sunnyside, ana the cottages for married men at Tokanui. There have been some changes m the higher staff, and it will be as well to bring the record up to date. Dr. Dray llassell, alter years' service, retired on superannuation in May, lU2U. His knowledge and ripe experience as an alienist, ins urbanity, his judicial cum, una ins Kindly disposition contributea to making a personahty which will long be associated with Porirua. When he came to that institution as its first Medical Superintendent the place must have been desolate ; and the transloimation to its present beauty of lecieation-grounus, trees, shrubberies, anu colour testify to his energy and skill 111 landscape gardening ana the accomplishment ol his desire to improve the amenities of the patients. The thanks of the Government and the appreciation of ins medic.d coliea ri ues expressed on ins retiring was no mere compliment. Dr. Truby ivmg, alter an absence oi two years on special service in England, returned to ISeaolifi at the beginning of this year, and Dr. Jeffreys, who was relieving firm, resumed duty at iNelsoii, and was subsequently promoted to succeed Dr. iiasseli at Porirua. Dr. Meruliop, Who had been appointed iVledical (Superintendent at liokitika, never entered upon his duties there, but relieved and atterwaras succeeded Dr. Jeffreys at .Nelson. The Comptroller-General oi Prisons, wishing to place the Waikena Beiormatory on a scientific footing, asked tor and obtained the loan oi Dr. Gribben, the Medical Superintendent of ISunnyside Mentat Hospital. This reformatory being within easy distance oi the Tokanui Mental Hospital, Dr. Gribben also exercises supervision over Tokanui, an experienced Assistant Medical Uliicer being resident. Dr. Crosby, who has done such excellent pioneer work at Tokanui, was transierred to iSunnyside, where many years ago he had been Assistant Medical Officer under Dr. Levmge. Mr. ISouter, Chief Clerk at the Head Office, retired on superannuation after thirty years' devoted service. Mr. J. M. iiussefl, the much-esteemed senior clerk in the [Service, was appointed to succeed him. As Mr. iiussefi's health had been indifferent, and was getting worse, he was granted six months' sick-leave, but did not long survive. With him there passed irom the Public (Service an efficient and conscientious officer and a loyal gentleman. On hearing oi Mr. iiusseil's illness, Mr. iSouter, whose leave on retirement had not yet expired, returned to Jus desk until another appointment should be made, i wish, to take this opportunity to express to Mr. iSouter my appreciation of the niatter-ol-course manner in which, fie came to our assistance in the emergency. Tollowiug upon Mr. iiusseil's coming to Wellington, Mr. Thomas, at las own request, was transferred to iSunnyside, and Mr. Hughes was appointed Chief Clerk at ISeachff. Mr. Barnes, Head Attendant at Porirua, was, at his own request, transferred to ISunnyside, and Mr. Quill, of ISeachff, was promoted to succeed Mr. Barnes at Porirua. Tfie vacancy at iSunmside was caused by tne death oi Mr. Harris, who had thirty-one years' iaitliiul service to his account. Mr. Harris had been on sick-leave lor ooine months, and his loss will be felt by the patient.-s to whom his kindly genial manner had endeared him. Miss McDougall, Matron of iSoacfiti, has been transferred to Auckland, and Miss Mayze was promoted to succeed Miss Hanna, who was appointed to the Head Office as inspecting Matron —technically an Assistant Inspector. Miss Hanna's qualifications fiad much to do with the creation of the new oiiice. i felt the need oi some one thoroughly acquainted with, tfie ways of patients and tfie domestic economy of mental hospitals to inspect the women's side of these institutions ; and for each inspection to last over some days, so that every aspect of a patient's hie may come under critical and iieipiul review e.y., bathing, dressing (including the quality of the clothing), food and its service, work, recreation, undressing, night supervision, and so forth. WoliK.B fi\ PfiOUfiESS AND IN PItOSPIiUT, AND VISITS Of llNSriiUliO-N. i have mentioned our difficulties m gettin_, materials and iabour lor uujfding, and some urgent works are progressing very slowly. This naturally means a degree of congestion m tfie wards which, tfie additions were designed to relieve. .Nevertheless, both with the shortage oi accommodation and in the numbers of the nursing stall, the work of the year has been remarkably f.ee of untoward incidents, and the general health ol the patients has been good. Once again 1 nave to express my tfianks to the District Inspectors and Oificiai Visitors for their undiminished interest in their respective

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institutions and tfie welfare, of the patients therein, for their helpful criticism and co-operation. It regret that I record the resignation of Mr. Stewart, Auckland, and Messrs. Park and Gallaway, Dunedin, and cannot let the occasion pass without expressing the Department's appreciation of their excellent work, a labour of love often performed at great personal inconvenience. Fortunately, Mr. Gallaway's business arrangements allowed him more leisure recently, and he has permitted himself to be reappointed. Auckland. —Visited in January, June, July, December. 1919, and May, 1920. The chief difficulty has been a shortage of staff, involving the necessity of making selection from often very indifferent applicants, tlius directly increasing the responsibility of Dr. Beattie, his medical colleagues, and the senior nurses and attendants —conditions winch bring out the good qualities of the best, but expose the inefficient, and dishearten a few who under other circumstances may have proved moderately good. The staff's new mess-rooms are as good as alteration of the old building will permit, and with the present higher pay and many privileges enjoyed it is hoped there will be a return to the relative number and quality of the staff of some years ago. I have stated in previous reports that if not possible to revert to local control, at least the probationary period should be extended, because the nature ol our work and its responsibilities in dealing with the irresponsible arc not comparable with any other branch oi the Public Service. Doubtless, the unrest is in some measure a reflection of the general unrest, requiring on all sides adaptation during the transitional period. I have reverted to this subject in this connection because the situation is more acute here than elsewhere, and also to give a meed of praise for the care exercised over the patients under trying circumstances. Very little in the way of works and buifdings has been accomplished beyond the usual maintenance and some urgent matters ; but a start has been made with an extensive addition to the Park House, which, when completed, while increasing the accommodation, will be, a decided advance in classification. iSunnyside. -Visited in January, February, May, July, September, December, 1919, and January, February, March, June, 1920. I found things satisfactory save in the matter of urgently needed extension to day- and dining-room accommodation for Wards Nos. 2 and 4, and I was glad to see that a start has been made. The new Beception and Hospital Block now in occupation is most suitable for its purpose and a notable addition to our resources, it is reached from Martin's Boad, and, while separated from the main institution, gains many advantages from its proximity, not the least being the ease with which frequent medical and administrative visits can be paid. Many patients paid spontaneous tributes to the comfort of their surroundings and the consideration shown to them. 'There has been a further extension of the employment of electricity lor power and cooking. Urgent repairs have been carried out, but now that the new buildings are a going concern the old building will need to be systematically overhauled. Delay in carrying out alterations is responsible for the Hornby institution not being opened lor occupation yet. Once, the needed alterations and additions are completed, the place, will adapt itself wonderfully well for the particular class of patients lor which it was purchased. An additional 3 acres of land fronting Martin's Boad has been purchased, and the cottage on it has been added to and altered as a residence for the Chief Clerk. The farm continues to be managed efficiently, and I recommend that the leased portion be purchased. The response to improvement and the returns from the supplementary farm at Templeton has more than justified that purchase. This has been another successful year in providing beef and mutton of the best quality, and in other respects also the patients' diet is exceptionally good. tieactiff. —Visited February, July, December, 1919, and January, March, 1920. A number of moderate to minor works have been carried through with our own labour, and at present an additional unit lor women is being erected at Waitati. The building oi a central bathroom at the front was postponed for the usual reasons governing building in these days. The alternative scheme, of adapting the kitchen, bakehouse, and offices for a central bathroom and additional stores accommodation, after building a new and. up-to-date kitchen, <fee, near the boiler-house, is much tin; better, but will be more costly and will take longer to accomplish. In our old buildings the centrally placed, indifferently ventilated kitchens incapable of extension for increasing numbers are, a decided handicap at present, and the plan to improve this state of affairs, while providing a centrally placed bathroom similar to that at Sunnyside, is attractive. The care of the patients, consideration for their comfort, and the granting of as large a measure, of liberty compatible with their mental condition has been carried out in the usual satisfactory way The report of a Commission set up to investigate the complaints of a returncd-soldier patient not only showed these to be groundless, but is a testimonial of the individual care bestowed and consideration shown to patients by the administrative medical and nursing staff. liokitika. —Visited February, June, 1919, and June, 1920. A house planned for a Medical Superintendent could not be proceeded with. I was unable to lease a suitable residence near the institution, so, in the meantime, the old arrangement of a lay Superintendent and visiting medical officer has been continued, it is hoped that we shall soon be in a position to place this institution on the same footing as Nelson. In saying this, one must give credit to Mr. Seilars for the knowledge and energy he brings to bear in. all departments of his work, rendering the change over to the, medical-control system less urgent than it would otherwise have been, and thank him for placing an extension of these services at the disposal of the Department, pending accommodation being provided in the near future for a Medical Superintendent. Nelson. —Visited June, .1919. The weekly reports from here are uneventful, and indicate that this little institution is unostentatiously fulfilling its object. Dr. Mclviilop, after acting for Dr. Jeffreys, who was acting at Seacliff, is now Medical Superintendent. The new Beception Block is proceeding slowly, and some renovations have been carried out at the old building, giving it a new lease ol life. D>\ Mclviilop has been in close touch with, the Head Office. Porirua. —Visited frequently. The principal work here has been the completion of the drainage system, whereby the septic-tank effluents are carried into the harbour.

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As in the case of Peaeliff, so here, the original kitchen is too limited, and is surrounded hv buildings. The remedy in the case of Porirua is to remove the boiler-house, engine-room, and workshops to a separate building (a scheme strongly recommended by our chief engineer), and, this completed, use the vacated buildings for a central kitchen, &c, for which they are. wel' adapted. The Beception House Hospital, named "Banta," after the local name of the elevation on which it is situated, continues to give satisfaction to the administration and patients. The older building is crowded, especia'ly on the, women's side, and arrangements are under way for transferring fifty patients to Tokanui. There has been a shortage, of nurses, at times very acute, and great praise- is due to the Matron and others for having made the very best of their limited resources. Tokanui. —Visited February, July, December, 1919, and May, 1920. The farm development has progressed apace, and a, permanent camp has been erected on a remote part of the estate to facilitate the working without loss of time in transit. There is a talk in the district of a railway to join up Te Awamutu and Putaruru, passing through the Mental Hospital estate almost on the lines surveyed for the private light railway I advocated when we first took over the property. The lay-out scheme of this institution was based on this light railway, and when that was abandoned we built as near the existing railway-station as possible. It is a satisfactory site, but not the best, and should the projected railway become an accomplished fact the main, future addition should be in the neighbourhood of the trig., as first contemplated, the present institution then becoming a succursal hospital, most valuable for classification. Against this contingency an excellently graded road haw been constructed I'roni the trig.site to the main road, and also back to the Waikeria Reformatory, considerably shortening the journey from the Reformatory to Te Awamutu. This road was constructed by the labour of the Reformatory inmates. We have carried out a number of works with our own labour, and the Rubb'c Works Department hayc completed another unit of the building scheme to accommodate fifty patients, and are now engaged in adding two blocks, one on the men's and one on the women's side, to enable us to diTectiy admit patients to Tokanui, and not only under transfer as at present Admitting Waikato patients wil' by so much relieve Auckland. The so'dier patients from Auckland were removed to Tokanir, and the transfer has proved beneficial, We are, at present negotiating with the Te Awamutu Borough Council for connecting the Mental Hospital with their Pirongia water-supply. Ashhurn Ball. —Visited January, February, July, December, 1919, and January, March, 1920. This licensed Mental Hospital aims to provide a comfortable rest-home, and carries out this aim creditably by sinking as far as possible the institution element. In conclusion, I have to thank the administrative heads for their loyal co-operation and the staff working under them, who, T am sure, will not consider the distinction, invidious if I make special mention of the chief clerks for their keenness in purchasing at the best advantage supplies for which we could not let. contracts. That patients should not suffer from soaring prices, while, keeping expenditure within reasonable limits, has been a responsible and attractive problem. Lastly, I feel I have much, to be grateful for in reviewing the friendly working-spirit existing between the members of my Head Office staff. This is no new thing, but recently they have been severely tried by changes and other emergencies and have proved superior to the ordeal. It is a pleasure to work with such helpers. I have, &c, Feank Hay.

MTCDTOAL STTPTCTCTNTTCNPTCNTR' "REPORTS. AUCKLAND MENTAL HOSPITAL. Dr. Beattie reports : — We began the year with 1,047 patients and ended it with 1,008. The number admitted during the year was 270, of whom 147 were males and 123 females, making the total under care for the year 1317. The numbers discharged or removed were 76 males and 51 females, recovered ; 2 males and 10 females discharged not improved ; 46 males and 6 females were transferred, and 78 males and 46 females died. The recovery-Bate calculated on the admissions was 51-7 per cent, for males and 41-4 for females. The death-rate calculated on the average, number resident was 12-2 per cent, for males and 11-5 for females. The chief causes of death were senile, decay, 21 ; chronic brain-disease, 29 ; general paralysis, 17 ; heart-disease, 13. Although the death-rate was high, it should be stated that the genera] health of the patients was good, excepting that the health-tone of many of those, admitted during the year was lower than usual. We were free from epidemic disease. The work of the institution has been carried on on the usual lines ; but for the most part with difficulty, and rarely with any satisfaction. The. shortage of staff persists in spite of increased wages and improved conditions. The common unrest and unstability has permeated the Hospital, with a consequent constant inflow and outflow of staff. Preference has been given to returned soldiers. """ An innovation was introduced by the appointment of Dr. Mary Wilson, for one year only, at her own request. I had felt for many years that a lady doctor could best perform the work of the female division, and fortunately this opportunity occurred to make a recommendation. Dr. Wilson's appointment, from my point of view and from that of the Hospital, proved an eminently happy one. She has done her work to my complete satisfaction, and she has gained the confidence and appreciation of the, patients and their relatives. '"^.^ A 1 great deal requires'to be Mone yet to make the Hospital approach our desires, but T fully recognize the difficulties in the way.

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Our religious services and entertainments have been carried on as usual. The farm continues to be capably managed. Our thanks are due, to the farm-manager and the other senior officers for the work accomplished in the face of innumerable difficulties. We have to gratefully acknowledge the assistance of the District Inspectors and the Official Visitors, and to express our thanks to the Herald for gratuitous daily papers, to Mr. McPherson for weekly religious services, and to various city bands for music, which was specially appreciated. PORIRUA MENTAL HOSPITAL. Dr. Hasselt, reports : — The, total number under care during the year was 1,283 (723 males and 560 females) ; the average number resident was 1,029. 258 were admitted, of whom 39 were re ad missions and 7 transfers from other mental hospitals. 79 died (46 males and 33 females). The total number under care was 43 more, and those admitted for the first time 7 more, than in the previous year. The official recovery-rate was only 29-8 per cent, of the. number admitted. This low rate is partly accounted for by a number of patients sent out on probation failing to present themselves for examination at the. end of the period, and so, in accordance with the Act, they had to be recorded as "discharged unrecovered." There is little doubt that a fair proportion of these had recovered. The percentage of deaths on the average number resident was 7-67. Of the 79 patients who died, 33 suffered from disease associated with old age and 12 from, general paralysis. On the whole the physical health of the patients has been good, and no epidemic, sickness visited the institution. Unfortunately, two cases of suicide occurred —one a liberty patient and the other a voluntary boarder. Details of these cases have already been supplied to you. There has been a serious shortage in the nursing staff on the female side. Although our need was well advertised in the Wellington and provincial papers, the substantial increase of salaries offered has not induced sufficient candidates to come forward to fill vacancies. The care and treatment of the female patients was also handicapped by overcrowding in the wards. During one of your visits of inspection I laid stress on the unsuitable mess-room accommodation for both the attendants and the nurses. Those rooms are dull, cheerless, and altogether too small. This part of the Institution certainly wants remodelling and fitting accommodation provided. At his own request, and for family reasons, Mr. Barnes, who has for a number of years been head attendant, was transferred to the staff of the Christchurch Mental Hospital in August. I regretted very much losing the services of so trustworthy and capable an officer. The""vaca.ncy at this Mental Hospital was filled by the promotion of Mr. Quill from the Seacliff 'Mental* Hospital staff, and he has proved himself well qualified for the, post. I have to acknowledge the able assistance afforded me by my colleagues Drs. Prins and Macpherson and by senior officers of the. staff. I much regret that the Chief Clerk, Mr. Holder, has been in poor health for a great part of the year. He certainly needs a. rest and change from his present duties, which he, has performed with singular ability and conscientiousness for many years; CHRISTCHURCH MENTAL HOSPITAL. Dr. Gribben reports : — At the beginning of the year 1919 there were 744 patients on the register, of whom 339 were, males and 405 females. During the year there were admitted 94 males and 64 females, and at the end of the year there were remaining 780 patients, an increase of 36 for the year. There were 38 deaths (22 males and 16 females), giving a death-rate of 5-3 per cent, on the average number resident. There were 60 recoveries (25 males and 35 females), giving a rate of 37-9 per cent, on the admissions. The general health of the patients has been satisfactory. Unfortunately, amongst admissions there was, as usual, a, considerable proportion of patients suffering from physiological senile degeneration, for whom some provision other than that available in mental hospitals should be. provided. One male patient attempted suicide. There were no serious casualties. The need for the proposed extensions on the female side has now become urgent; the work has started, and. its completion will considerably relieve the difficulties at present being experienced. A large, amount of renovation and repair work called for in the, wards, which it was impossible to cope with during the war, will have to be undertaken. Tn many places the old plaster is perished and falling off the, walls. The patients' entertainments are being carried on with as much variety as possible, and in this connection the possession on the place of a plant for the running of pictures has proved a great boon, for not only are regular entertainments of this class much appreciated, but it has been possible to provide extra odd hours during'the winter evenings, which'have been a'distinct success"and are eagerly looked forward to. "* *"" The buying of stock at the market and having it killed for our use at the public abattoir has again proved a. very pronounced success. During the past year mutton has cost 5-55 d. per pound and beef 5-08 d. per pound. Apart from, the question of economy, it must'be borne in mind that the, quality of the meat is of the, best, and this again results in a. smaller consumption. Furthermore, this system, admits of a. much greater variety in the. meals tha.n is possible* r under"'oontract. an important item in institution dietary. Tt is with sincere regret that, T record the death of Mr. T. I. Small. Possessed of a deep, practical sympathy for those afflicted,""combined with a character absolutely fearless and a, whole-souled devotion to duty that wa.s a. shining example to any one associated with him, Mr. Smail made, of the

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position of " Patients' Friend "an unqualified success. Having experienced the many advantages arising out of the establishment of this position, I have no hesitation in recommending its continuance. It is essential that the, Patients' Friend should be an enthusiast who familiarizes himself with the characteristics and idiosyncrasies of the patients individually, and to do this it is necessary, as Mr. Smail often pointed out, to visit the institution as nearly as possible every day. Dr. Lee returned to duty in. October after having been absent on active service for four years. I have to thank the staff for their enthusiastic co-operation, which has enabled the work of administration to be carried out under very pleasant conditions.

SEACLIFF MENTAL HOSPITAL, Dr. Jeffreys reports : — At the beginning of the year there were, 1,057 patients (615 males and 442 females) in this institution. Exclusive of transfers from other institutions there were 150 admissions (94 males and 56 females), and 21 of them (8 males and 13 females) wen; readmissions. Inclusive of 10 males and 12 females absent on trial, there were 1,077 patients (633 males and 444 females) remaining in the, Hospital on 31st December, while the, average number resident during the year was 1,068 (624 males and 444 females). Voluntary boarders are not included in the above. Taking into consideration the number of incurables admitted (including several imbeciles from Otekaieke), the recovery-rate was satisfactory, the percentage on admissions being 37-33. The general health of the patients has been good. There, were 66 deaths, and 18 of these were due to senile decay and 6 to general paralysis. The new block at Waitati for the accommodation of 50 female patients was commenced towards the end of the year, but owing to the shortage of material and the difficulty in procuring carpenters lam afraid it will be some considerable time before the building is completed. A new reservoir has been erected above Simla, and the sanitary arrangements there are now quite satisfactory. The soldiers at Anzac Hospital, Karitane, and the patients at Waitati have been visited by one or other of the medical staff from Seacliff. Mr. Quill, who has been in charge of Karitane from May, 1916, was promoted to head attendant at Porirua in July last, and it has been difficult to satisfactorily fill his place. This small hospital has benefited many returned soldiers, and no doubt has been the means of preventing a considerable number from being committed to a mental hospital, and Dr. King's generosity in lending his cottage for all these years cannot be too highly appreciated. I regretted losing the services of Dr. Maopherson, who resigned early in the year, and also those of Mr. Thomas, Chief Clerk, who was transferred to Sunnyside in December. I wish to record my appreciation of the good work done by Dr. Gray; and we were fortunate in procuring the services of Dr. Blair, whose ability and zeal considerably lightened one's responsibility. I again wish to record our indebtedness to Messrs. Park and Gallaway, District Inspectors, and to Mr. Cummings, Patients' Friend, for his continued interest in the patients. Miss Monson and Mr. Slater, Official Visitors, have visited the institution most regularly and shown great interest in the patients. Owing to the distance of this institution from the, town, apart from the usual dances, the patients have not had as many entertainments as one could wish, and consequently the. visit of the Dunedin Peace Choir was greatly appreciated. It is to be hoped that before long we will have our own cinematograph.

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APPENDIX.

Table I. —Showing the Admissions, Readmissions, Discharges, and Deaths in Mental Hospitals during the Year 1919.

Table II.—Admissions, Discharges, and Deaths, with the Mean Annual Mortality and Proportion of Recoveries, etc., per Cent. on the Admissions, etc., during the Year 1919.

M. p. T. M. 2,603 p. 1,943 T. 4,546 In mental hospitals, 1st January, 1919 Admitted for the first time Readmitted Transfers.. 448 64 63 296 75 17 744 139 80 575 388 963 Total under caro during the year Discharged and died — Recovered Relieved Not improved Transferred Died 190 37 6 66' 212 147 44 18 17 130 337 81 19 83 342 3,178 2,331 5,509 511 351 862 Remaining in mental hospitals, 31st December, 1919 2,667 1,980 4,647 Increase over 31st December, 1918 64 37 101 Average number resident during the year 2,620 1,907 4,527 * Three transferred to private care aB single patients.

Mental Hospitals. In Mental Hospitals on 1st January, 1919. Admitted for the First Time. .dmissions in 1919. Not First Admission. Transfers. j Total Number of Patients under Care. Auckland Christchurch Dunedin (Seaclifi) Hokitika Nelson Porirua Tokanui Ash b urn Hall (private mental hospital) Totals M. 648 339 615 195 94 576 J15 21 F. T. 399 1,047 405 744 442 1,057 73 268 107 201 449 1,025 44 159 24 45 M. 127 74 86 14 13 125 1 8 I'. T. 95 222 50 124 43 129 0 20 9 22 87 212 1 2 5 13 M. F. 19 28 16 11 8 13 0 1 2 1 18 21 T. 47 27 21 I 3 39 M. 1 4 2 8 2 4 41 I p. 3 4 0 1 3 6 0 T. 1 7 6 8 3 7 47 1 M. 795 433 711 217 111 723 157 31 p. 522 469 502 80 118 560 51 29 T. 1,317 902 1,213 297 229 1,283 208 60 i 6 1 2,603 1,943 4,546 448 296 744 64 75 139 63 17 80 3,178 2,331 5,509 Mental Hospitals. Discharged recovered. Patients disch; ■ged and died. Total discharged and died. In Mental Hospitals on 31st December, 1919. Discharged not recovered. Died. Auckland Christchurch Dunedin (Seaclifi) Hokitika Nelson Porirua Tokanui Ashburn Hall (private mental hospital) Totals .. M. 76 25 29 6 3 49 p. 51 35 27 2 4 28 T. 127 60 56 8 7 77 M. P. I. 42 16 58 18 6 24 8 6 14 0 1 1 1 2 3 30 37 67 4 2 6 6 4 10 M. 78 22 41 13 7 46 2 3 P. T. 46 124 16 38 25 66 2 15 7 14 33 79 0 2 1 4 M. F. T. 196 113 309 65 57 122 78 58 136 19 5 24 11 13 24 125 98 223 6 2 8 11 5 16 M. 599 368 633 198 100 598 151 20 P. T. 409 1,008 412 780 444 1,077 75 273 105 205 462 1,060 49 200 24 44 2 0 2 190 I 147 337 109 74 183 212 130 342 511 351 862 2,667 1,980 4,647 I Mental Hospitals. Average Numl resident duri the Year. ber ing Percei of Recov Admif during tl ntage 'eries on ssioiis he Year. Percentage of Deaths on Average Number resident during the Year. Percentage of Deaths on Total under Care. Auckland Christchurch Dunedin (Seaclifi) Hokitika Nelson Porirua Tokanui Ashburn Hall (private mental hospital) Totals M. 635 337 624 195 96 586 127 20 F. T. 397 1,032 378 715 444 1,068 72 267 104 200 443 1,029 45 172 24 44 M. P. T. 52-05 41-46 47-21 27-78 57-38 39-80 30-85 48-21 37-33 42-86 28-57 38-10 20-00 40-00 28-00 34-27 25-93 30-68 M. p. T. 12-28 11-59 12-02 6-53 4-23 5-31 6-57 5-63 6-18 6-67 2-78 5-62 7-29 6-73 7-00 7-85 7-45 7-68 1-57 0 1-16 15-00 4-17 9-09 M. p. T. 9-81 8-81 9-42 5-08 3-41 4-21 5-77 4-98 5-44 5-99 2-50 5-05 6-31 5-93 611 636 5-89 6-16 1-27 0 0-96 9-68 3-45 6-67 22-22 0 14-29 2,620 1,907 4,527 3711 39-62 38-17 8-09 6-82 7-55 6-07 5-58 6-21

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Table IV.—Duration of Disorder on Admission.

Table III.— Ages of Admissions.

Ages. Auckland. Christchurch. Dunedin (Seaclifl). Hokitika. Nelson. i Porirua. Tokanui. Ashburn Hall (Private Mental Hospital). Total. Under 5 years From 5 to 10 years 10 „ 15 „ 15 „ 20 „ ,- 20 „ 30 „ 30 „ 40 „ 40 ., 50 „ 50 „ 60 „ 60 ., 70 ., 70 „ 80 ,. 80 „ 90 „ 90 „ 100 „ Unknown Transfers M. F. T. 12 3 4 2 6 5 8 13 37 17 54 27 30 57 25 30 55 12 12 24 9 10 19 13 6 19 4 0 4 M. F. T. 2 0 2 3 0 3 5 3 8 16 8 24 25 14 39 17 17 34 6 8 14 9 7 16 3 1 4 2 0 2 M. 2 6 8 20 20 14 9 5 8 2 F. T. 3 5 0 6 1 9 11 31 9 29 15 29 7 16 3 8 5 13 2 4 M. 1 2 4 2 3 2 F. 0 0 3 2 2 0 T. 1 2 7 4 5 2 M. 2 1 0 2 1 3 4 1 1 F. 0 1 1 3 1 2 2 0 0 T. 2 2 1 5 2 5 6 1 1 M. F. T. 2 2 4 2 13 9 5 14 21 20 41 35 29 64 29 22 51 23 10 33 8 14 22 9 3 12 5 0 5 0 2 2 4 3 7 M. 1 0 41 F. T. 0 1 1 1 6 47 M. 2 1 0 5 1 1 F. 1 0 3 1 0 6 T. 3 1 3 6 1 1 M. 2 8 15 28 101 113 90 62 33 36 13 0 11 63 F. T. 0 2 8 16 3 18 18 46 60 161 87 200 91 181 42 104 34 67 15 51 2 15 2 2 9 20 17 80 .. 9 6 15 1 0 1 2 3 5 4 3 7 2 4 6 8 6 8 2 i 3 Totals .. 147 123 270 94 64 158 147 111 258 42 7 49 96 60 156 22 7 29 17 11 28 10 5 15 575 388 96!

Auckland. Christeburch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall (Private Mental Hospital). Total. M. F. T. 98 64 162 M. F. T. 35 21 56 M. F. T 32 23 55 M. 9 F. T. 5 14 I M. 8 F. T. 4 12 M. F. T. 85 61 146 8 2 10 31 30 61 19 15 34 M. 1 0 F. T. 0 1 1 1 M. 7 2 F. T. 5 12 0 2 M. F. T. 275 183 458 First class (first attack and within 3 months on admission) Second class (first attack above 3 months and within 12 months on admission) Third class (not first attack, and within 12 months on admission) Fourth class (first attack or not, but of more than 12 months on admission) Unknown Transfers 11 11 22 3 5 8 13 10 23 24 23 47 18 4 22 10 17 27 2 2 1 3 1 3 1 2 3 4 2 4 53 32 85 74 7S 152 34 43 77 16 7 23 34 12 46 1 0 1 4 1 5 108 78 186 1 0 1 2 0 2 4 3 7 2 4 6 8 0 8 2 i 3 4 3 7 41 6 47 1 0 1 2 0 2 63 17 80 Totals 147 123 270 94 64 158 96 60 156 22 7 29 17 11 28 147 111 258 42 7 49 ; 10 5 15 575 388 961

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Table V.—Ages of Patients discharged "Recovered" and "Not Recovered" during the Year 1919.

Table VI.— Ages of Patients who died.

Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall (Private M.H.). A Total. Ages. Be- . Not re- Re- Not re- Re- Not re- : Recovered. : covered, covered. j covered. : covered. ; covered. . covered. Not re- I Recovered, j covered. Not recovered. Recovered. Not Re- I Not rerecovered. : covered. | covered. Recovered. Not recovered. Recovered. Not recovered. j I. |m. f. t. m. f. t. Under 5 years From 5 to 10 years | „ 10 ., 15 „ ! 1 0 1 ., 15 ., 20 „ j 1 4 5 ., 20 .. 30 „ 21 10 31 0 1 1 „ 30 ., 40 „ 17 14 31 0 1 1 ., 40 .. 50 .. 20 11 31 .. 50 .. 60 ., 6 8 14 „ 60 ., 70 .. 4 1 5 0 11 ., 70 ., 80 „ 112 „ 80 .. 90 „ „ 90 .. 100 „ Unknown . . .. 5 2 7 16 7 Transfers . . .. .. 41 7 48 Totals .. 76 51 127 42 16 58 SI. F. T. SI. F. T. SI. F. T. 31. F. T. SI. F. T. M. F. T. 31. F. T. SI. F. T. : SI. F. T.JSI. F. T. JI. F. T. SI. F. T.|3f. F. T. St. F. T. SI. F. T. SI. F. T. - .. ■• ■• 3 1 4 1 10 11 8 6 14 7 8 15 3 4 7 26 8 1 0 1 0 110 1110 1 10173 10 011112 2 1 3, 9 8 17 1 1 2 3 1 4 0 1 1 8 8 16 1 1 2; 3 5 8 .. 10 1 20 2, 213112 0 110 110 1110 1 .. 0 1 1 •• 0 1110 1.. .. .. .. 1 314202 .. .. .. .. 7 112 .. 8 6 14: 6 12 18 .. 0 1110 1 .. j 40 15 13 28 7 11 18 .. 2 1 3| .. 2 0 2 52 0 11 .. 16 5 21 7 6 13 .. 2 0 2:.. .. 51 2 13 .. 3 0 3 2 4 6 .. .. 10 1 .. 19 0 11 .. 3 2 5 112 .. .. .. .. 11 10 10 11 .. .. .. .. 4 -.011 12 10 1 7 14 3 1 4 31 71 7 16 23 42 94 14 15 29 33 84 9 7 16 18 37 3 5 8 11 22: 4 3 7 2 6 0 3 3 10 11 •• - 10 1 11 1 12 .. 5 2 7 12 3 .. 4 15.. .. .. 448 2 7 2 6 8 i 66 17 83 " ■• .. 25 35 60 18 6 24 29 27 56 8 6 14 6 2 8 0 1 1 3 4 7 12 3 49 28 77 30 37 67 4 2 6 2 0 2 6 4 10190 147 337109 74 183

Ages. Auckland. Christchurch. I Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall (Private M.H.). Total. From 5 to 10 years .. 10 ., 15 ., „ 1-5 ., 20 „ „ 20 „ 30 „ ., 30 .. 40 „ ., 40 ,. 50 „ ,. 50 ., 60 „ „ 60 „ 70 „ ,. 70 ., 80 „ „ 80 ., 90 „ „ 90 ., 100 „ Unknown 31. F. T. ..11 2 .. ! o l i .. : 16 5 11 7 6 23 8 7 15 .. '< 11 6 17 14 10 24 11 7 18 .. | 6 3 9 ..140 4 si. 1 0 0 1 4 2 7 4 2 1 F. T. 1 2 1 1 1 I 1 2 5 7 1 8 2 6 2 4 1 2 i si. 0 4 8 9 4 6 10 F. T. 1 1 2 6 5 13 2 11 3 7 5 11 7 17 si. 0 1 3 8 1 F. 1 0 1 0 0 T. 1 1 4 8 1 si. 1 1 0 0 1 1 2 1 F. 0 0 1 3 1 0 1 1 T. 1 1 1 3 2 1 3 2 31. F. T. 0 2 2 2 2 t 6 3 9 8 3 11 6 6 12 8 10 18 11 5 16 4 2 6 1 0 1 si. 1 1 F. 0 0 T. 1 1 si. 1 1 1 0 F. 0 0 I) 1 T. ; 1 1 1 1 1 2 0 10 2 28 31 38 42 25 1 6 F. 2 2 3 9 13 19 19 26 19 16 0 2 T. 3 4 3 19 41 47 50 64 61 41 1 8 Totals .. .. | 78 46 124 ; 22 16 38 41 41 25 66 25 66 13 13 2 2 15 15 7 7 7 7 14 14 46 33 79 46 33 79 2 2 0 0 2 2 3 3 I I 4 4 212 212 130 342 130 342

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Table VII.—Condition as to Marriage.

Admissions. Discharges. Deaths. Auckland— Single Married Widowed Unknown Transfers M. If. T. 85 43 128 50 66 116 (i 14 20 5 0 5 1 0 1 M. F. T. 52 17 69 23 36 59 2 7 9 M. ' If. T. 38 18 56 31 16 47 9 12 21 41 7 48 Totals 147 123 270 118 67 185 78 46 124 CHBisioktraoH — Single Married Widowed Unknown Transfers 55 24 79 29 32 61 6 5 11 16 18 33 17 19 36 0 3 3 12 5 17 9 8 17 I 3 4 4 3 7 11 112 Totals 94 64 158 43 41 84 22 16 38 — " _ _ Dunedin (Seacliff) — Single Married Widowed Unknown Transfers 111 21 82 27 22 49 6 13 19 ; 20 10 30 8 17 25 4 4 8 22 8 30 14 7 21 5 10 15 2 4 6 5 2 7 Totals 96 60 156 37 33 70 41 25 66 Hokitika — Single Married Widowed Unknown Transfers 9 2 11 5 4 9 0 I 1 4 2 0 2 1 3 4 2 0 2 1 3 9 I 10 1 0 I 3 1 4 8 0 8 Totals 22 7 29 (i 3 9 (i 3 9 13 2 15 Nelson —■ Single Married Widowed Unknown ; Transfers 8 7 15 0 2 8 1 I 2 2 1 3 0 3 3 1 0 I 4 3 7 2 2 4 1 2 3 2 i 3 1 2 3 17 11 28 4 6 10 7 7 14 Totals I'OMUUA— Single Married Widowed Unknown Transfers 81 52 10 38 119 57 1.09 13 23 45 28 2 19 41 4 64 69 6 24 15 7 5 16 12 29 3L 19 4 3 7 4 i. 5 Totals 147 111 258 79 65 144 46 33 79 Tokanui — Single Married Widowed Unknown Transfers LI 2 4 0 4 0 2 2 2 0 2 41 6 47 Totals 42 7 49 4 2 6 2 0 2 Asiibukn Hall — Single Married Widowed Unknown Transfers ;; 5 4 0 2 2 1 7 (i 1 3 1 0 0 3 1 1 0 1 2 0 2 0 I 1 I 0 1 4 4 8 ■• Totals 10 5 15 8 4 12 3 1 4 Totals— Single Married Widowed Unknown Transfers 304 137 441 .1.74 186 360 29 IS 77 5 0 5 03 17 SO 145 67 212 79 119 198 9 IS 27 112 40 152 74 49 123 20 11 67 lili 17 S3 Totals 575 3SS 903 299 221 520 212 130 342

H.—7

14

Table IX.—Ages of Patients on 31st December, 1919.

Table VIII.— Native Countries.

Countries. Auckland. Christchurch. Dunedin (Seacliff).. Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall (Private M.H.). Total. England and Wales.. Scotland Ireland New Zealand Australian States France Germany Austria Norway Sweden Denmark Italv China Maoris Other countries Unknown M. F. 135 73 24 13 56 42 221 226 35 13 1 0 5 2 16 1 2 0 4 1 2 0 4 0 2 0 21 16 29 5 42 17 T. 208 37 98 447 48 1 7 17 2 5 2 4 2 37 34 59 SI. E. T. M. F. 84 102 186 109 59 20 17 37 97 71 41 49 90 j 66 46 190 221 411 : 295 239 14 10 24 ! 24 24 112 7 1 12 3 10 4 0 3 0 3 5 0 2 13 2 1 10 10 1 10 0 0 11 4 0 11 8 19 4 2 4 1 T. 168 168 112 534 48 8 1 4 5 3 1 10 4 6 5 31. F. T. 38 15 53 12 5 17 39 13 52 72 36 108 11 4 15 4 0 4 1 1 2 5 0 5 SI. F. T. 3 6 9 14 5 6 4 10 74 70 144 0 4 4 1 0 1 1 0 1 10 1 SI. F. 138 94 49 24 61 62 269 241 35 20 3 0 5 6 0 1 2 1 4 1 5 2 2 0 7 5 18 5 T. 232 73 123 j 510 | 55 11 5 7 I 2 12 23 M. F. T. 36 7 43 6 0 6 17 9 26 67 33 100 5 0 5 1 0 1 4 0 4 1 0 1 i 10 1 1 0 1 1 0 1 1 6 1 2 0 2 8 0 8 M. F. T. SI. F. T. 4 7 11 547 363 910 3 14 212 135 347 10 1 287 225 512 12 13 25 | 1,200 1,079 2,279 0 3 3 124 78 202 5 0 5 23 10 33 23 4 27 10 2 12 23 2 25 12 4 16 15 0 15 ,17 0 17 37 23 60 67 20 87 65 35 100 6 0 6 4 0 4 1 0 1 2 0 2 3 14 1 6 1 3 14 1 0 1 8 16 24 Totals 599 409 1,008 j 368 412 780 I 633 444 1,077 198 75 273 100 105 205 598 462 1,060 151 49 200 20 24 44 2,667 1,980 4,647 I

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15

H.—7

Table XI.—Length of Residence of Patients discharged "Recovered" during 1919.

Table X.—Length of Residence of Patients who died during 1919.

Length of Kesidence. Auckland. Christchurch. Dunedin (Seaeliff). Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall (Private M.H.). Total. Under 1 month From 1 to 3 months 3 „ 6 6 „ 9 9 „ 12 ,, 1 „ 2 years 2 ., 3' ., 3 „ 5 „ 5 „ 7 7 .. 10 .. .. 10 „ 12 „ „ 12 „ 15 „ Over 15 years Died while absent on trial M. F. T. 7 3 10 15 8 23 10 4 14 5 4 9 3 0 3 7 6 13 4 4 8 3 3 6 4 6 10 5 2 7 3 0 3 1 2 3 11 4 15 si. 2 3 1 2 2 2 2 5 1 1 1 0 0 F. 1 0 1 1 0 3 2 1 0 1 3 1 T. 3 3 2 3 2 5 4 7 2 1 2 3 1 si. 5 4 3 0 5 0 3 5 2 2 1 9 F. T. 2 7 3 7 1 4 1 1 0 2 2 7 1 1 5 8 2 7 1 3 2 4 2 3 3 12 si. 0 3 2 1 6 F. 0 1 1 0 0 0 T. 1 1 4 2 1 6 si. 1 1 1 0 1 1 0 0 2 F. 0 1 0 2 1 1 1 1 0 | T. 1 2 1 2 2 2 1 1 2 si. 10 4 3 2 2 5 2 3 3 2 1 0 9 0 F. 6 1 1 2 2 0 0 3 0 1 7 1 T. 16 5 4 4 4 9 3 3 5 1 1 16 1 SI. 1 1 F. 0 T. 1 1 si. 1 0 1 1 F. 0 1 0 0 T. 1 1 1 1 si. 25 27 19 9 9 21 9 14 17 13 8 3 38 0 F. 12 12 9 S 2 13 14 13 11 7 4 9 14 2 T. 37 39 28 17 11 34 23 27 28 20 12 12 52 2 - __ Totals .. 78 46 124 22 22 16 38 16 38 41 41 25 66 25 66 13 13 2 2 15 15 7 7 14 46 33 79 I 2 0 2 3 1 4 212 130 342

-Length of Eesidence. Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall (Private M.H.). Total. I ! Under 1 month .. From 1 to 3 months 3 „ 6 6 ,. 9 9 „ 12 ., 1 .. 2 years 2 „ 3 „ 3 „ 5 „ ., 5 ,, 7 „ „ 7 „ 10 .. „ 10 ., 12 „ „ 12 „ 15 „ Over 15 years SI. F. T. 7 0 7 23 18 41 19 13 32 9 3 12 6 8 14 3 4 7 4 2 6 13 4 2 0 2 1 0 1 1 6 1 si. 4 7 4 2 2 3 1 1 1 0 F. T. 0 4 4 11 5 9 3 5 7 9 9 12 4 5 2 3 0 1 1 1 si. 1 3 11 3 4 5 1 1 0 0 0 F. T. 1 2 4 7 4 15 2 5 2 6 8 13 1 2 2 3 1 1 1 1 1 1 si. 3 1 1 0 1 F. 0 0 1 1 0 T. 3 1 2 1 1 I I si. 1 1 1 0 F. 0 3 0 1 T. 1 4 1 1 SI. F. T. 6 17 15 6 21 10 11 21 5 1 6 3 8 11 6 0 6 2 1 3 2 0 2 SI. F. T. si. 1 1 F. 0 0 T. 1 1 31. 23 50 47 19 16 17 8 3 5 1 1 F. 2 35 34 11 25 21 8 7 1 2 1 T. 25 85 81 30 41 38 16 10 6 3 2 I •■ Totals .. 1 ■• ! 76 51 127 76 51 127 25 35 60 29 27 56 6 2 8 3 4 7 49 28 77 2 0 2 190 147 33'

H.—7.

Table XII.—Causes of Death.

16

Causes. -3 o a < i | <3 si sr 3 a 1 a I I '3 3 J o EH 3*3 "as 3 es o , I-6W -i I. General Diseases. Tuberculosis— General Of bowels Peritoneum Lungs Pyaemia Septicaemia Influenza Carcinoma Enteric fever.. Diabetes M. If. 7 1 ST. F. 3 1 SI. F. I 0 3 0 I j SI. FT. •• SI. F. ()" 1 SI. F. I 0 3 2 M. F. _ M. F. SI. K. 10 10 16 5 0 I 0 1 0 2 2 0 0 4 1 1 1 0 2 0 2 0 5 I. 14 2 0 2 0 II. Diseases of the Nervous System. Mania, exhaustion from Melancholia, exhaustion from .. General paralysis of insane Organic brain-disease Cerebral haemorrhage Epilepsy Cerebral congestion Cerebral softening Cerebral tumour Locomotor-ataxia Myelitis Meningitis 0 2 3 1 15 2 II 18 3 0 6 3 0 I 3 0 2 3 I 0 0 1 0 I 2 0 6 0 1 0 2 2 3 2 1 0 I 0 1 0 0 I. 1 0 0 I. 1 0 0 I. 1 0 1 0 0 5 1 0 0 2 1 0 0 5 1 0 0 2 14 5 I I 0 35 8 15 21 8 2 10 8 I 0 I 2 0 1 0 l" 0 I o 2 0 1 0 2 0 10 0 1 10 10 0 1 1 0 I 0 III. Diseases of the Respiratory System. Broncho-pneumonia Pneumonia Lobar-pneumonia Pleurisy Bronchial asthma Bronchitis Goitre Pulmonary congestion.. 3 I 3 1 1 0 0 1 0 1 0 1 1 I 2 0 1 0 0 I 1 I 2 0 0 1 7 3 2 0 11 10 0 2 11 10 0 I 1 0 0 1 I 0 0 1 I 0 IV. Diseases of the Circulatory Systesi. Valvular disease of heart Endocarditis Fatty degeneration of heart Heart-failure Arterio-sclerosis Gangreno Embolism 11 2 I 1 1 1 9 I 4 0 l" 0 5 5 0 1 0 1 0 4 1 0 5 5 0 1 0 1 0 4 1 0 1 o 1 0 1 0 32 9 :: I ()" I 2 2 0 4 1 1 1 1 1 0 o" 1 1 1 V. Diseases of the Dioestive System. Acute enteritis Chronic, enteritis Volvulus Cholecystitis 0 1 0 1 0 1 1 0 0 1 0 1 0 1 11 o" I 0 1 1 0 VI. Diseases of Genitourinary System. Acute nephritis Chronic nephritis Cystitis 1 0 1 0 10 2 1 10 2 0 I 0 0 I VII. Old Age. Senile decay 13 8 II 6 6 12 4 0 5 3 5 3 12 9 12 9 1 1 52 39 1 1 VIII. External Causes. Suicide 0 1 I 0 I 0 11 IX. Died while absent on Trial 0 1 1 0 1 0 1 0 2 Totals 78 46 1212 130 22 16 41 25 13 2 7 7 40 33 2 0 3 1

17

H.—7

Table XIII.—Principal Assigned Causes of Insanity.

3-H. 7.

Causes. Auckland. Christchurch. §25$. Hokitika. Nelson. Porirua. Tokanui. Ashburn Hall. Totals. Heredity Congenital Previous attack Puberty and adolescence Climacteric Senility Pregnancy Puerperal state Lactation Mental stressSudden Prolonged (including war strain) Privation Solitude Sexual excess Masturbation Alcohol Insomnia Drug habit Syphilis Toxaemia Traumatic Post operative Organic brain-diseaso Epilepsy Apoplexy Arterio-sclerosis Sunstroke Tumour of brain Chorea M. F. 15 6 31 18 7 9 M. F. 2 5 12 1 1 20 11 5 0 8 11 7 0 1 M. F. 13 8 20 0 11 13 3 1 0 5 11 7 m. f. 2 3 2 2 I 1 0 M. F. 1 2 ' 5 3 2 2 0 1 0 1 2 0 M. F. 5 3 15 13 10 13 7 1 0 2 16 8 0 I 0 7 M. F. M. P. 2 0 M. F. 40 27 85 43 32 57 21 8 0 29 04 34 0 2 0 22 0 1 0 10 22 12 2" 0 0 3 0 13 0 2 0 1 14 21 6 3 12 4 2 1 13 10 1 0 2 0 1 ' 0 2" 0 50 39 1 0 2 2 o" 2 1 0 13 7 17 2 5 1 4" 0 2 0 10 12 4 0 ' 1 2 1 53 14 12" 0 9 0 0 2 3 0 10 3 1 0 1 17 0 0 1 4 0 1 2 46 1 0 2 4 1 0 3 1 ,0 24 11 1 0 1 1 0" 1 O" 2 1 0 8 3 7 4 6 3 3 0 0 ' 1 1 0 0 ' 3 1 3 l" 0 2" 0 3" 0 CancelCardiac disease Graves' disease Phthisis 111 health Influenza .. .. Cerebral haemorrhage Over-study Spiritualism Blindness Diabetes Locomotor-ataxia Unknown Not insane Transfers 10 2" 5 8 8 1 ' 0 0 1 2 0 0 1 1 0 7" 0 1 0 0 2 0 1 0 4 4 1 4 0 1 ' 0 1 0 0 2 2 1 9 16 14 9 5 0 1 0 0 I 0 1 1 0 1 0 48 38 0 1 63 17 0 1 1 0 1 0 23 30 11 5 9 2 0 1 4 3 2" 0 3 1 l" 0 2" 4 8 0 2" 1 4" 3 41 ' 6 I 0 Totals 147 123 94 64 96 60 22 7 17 11 147 111 42 7 10 5 575 388

H.—7.

Table XIV. —Former Occupations of Patients.

18

Occupations. ■a « p -4 4 3 A HJ II. 0 i» s D CO a ID a a D +6 •Ej Oh Th & =3 4H w: a* 8 o ssS CO -r; Occupations. .a o u a si V CO 'C £1 B a <o CO 3 -o ID a s R ill Id £1 —p. —. CO -3 ° a j 3 3 40« DO cS £ 0 H 9 3 o u x '2 id o 9 5 o3 M 0 H 3 o 3 | o 3 < a £] 4= 3 o W a o en i» Z 3 a o 3 a c3 o H o H Mai JES. Accountants Apiarist Architect Bakers Blaoksmiths .Bricklayers' apprentice Boilermaker Bookseller Bootmakers Brass-finisher.. Bushmen Butchers Cab-driver Cabinetmaker Canvassers Caretaker Carpenters Carters Cheesemakcr Chinaman Clerks Clergyman Commercial travellers .. Commission agents Contractors Cooks Drain layer Drapers Driver Engineer Farmers Farm labourers Firemen Fisherman Fitter Flax-cutter Flax-miller Gardeners Grocer Groom Gum-diggers Hairdressers Hatters Hawker Horse-trainer Hotolkeopcrs Insurance agents Ironworker Jeweller Labourers Land agent Liftman .. 1 1 1 1 1 4 2 1 2 i 2 i i - i i 9 i i 3 1 1 2 1 1 i ••I 2 1 1 3 2 1 1 1 4 1 2 2 1 I 2 1 14 2 1 1 10 1 2 2 3 3 1 3 1 1 60 12 3 1 1 1 1 4 1 1 2 2 2 1 1 3 2 1 1 136 1 1 Linesman Machinist Maoris Messenger Milkman Mill hands Miners Minors Motor mechanic Musterer Old-age pensioners Orchardists Painters Paper-ruler Photographers Physicians Ploughman .. Plumbers Porters Postman Printers Prisoners Railway surfaceman Retired Saddler Sailors Salesman Schoolboys Schoolmasters Settler Shearer Shepherds Soldiers Solicitors Station hand Stovedore Steward Storekeeper .. Storemen Tailors Taxi-driver .. Tourist Tram-conductor Valets Watchmakor .. Waterside workers Works foreman Unknown No occupation Transfers 6 I 1 I 2 1 1 3 i 1 5 1 2 i I 2 i l 1 1 3 1 3 3 2 1 3 i l 3 2 i 2 1 2 1 1 7 1 1 2 6 3 1 1 10 2 3 1 3 2 1 2 2 1 4 5 1 2 1 5 1 5 5 1 1 4 46 2 1 I 1 1 2 5 1 1 1 2 1 3 1 4 44 63 i i i i 3 .. 2 2 1 .. 2 1 2 17 11 3 2 13 3 3 io 3 5 2 1 2 16 1 .. 2 13 .. 17 1 i i i 1 .. 1 .. 1 .. 1 .. 3 .. 1 1 1 1 .. i l i 3 i 1 1 .. 1 i l • -i .. 1 2 .. i i 3 .. 1 .. .. 4 9 7 1 4 i • •: . .i i i 44 1 13 2 I 2 ii! 4 1 31 26 26 7 8 ii i I Totals 147 94 96 22 17 147; 42 10 575 Barmaid Book-keepers.. Children Cooks Domestic duties Dressmakers Gum-digger Housekeepers Housewives Inmate special school . . Laundress Maoris Femj .LES. 2 .. 2 .. 4 ioi i 24 2 1 37 3 5 8 1 1 95 i 1 4 1 2 6 2 275 3 1 2 31 1 1 5 Nurses Old-age pensioners Saleswomen .. School-teachers Storekeeper .. Tailoress Typist No occupation Transfers .. 2 2 2 3 i 1 i 1 3 1 6 6 2 4 1 1 1 20 17 i 2 1 1 6 81 i 3 .9 4 I 5 3 (i i 1 5 Totals 123 64 60 7 111 5 388 II

19

■H.—7

4—H. 7

Table XV.—Showing the Admissions, Discharges, and Deaths, with the Mean Annual Mortality and Proportion of Recoveries per Cent. of the Admissions, for each Year since 1st January, 1876.

Discharged. 1 I Died. Remaining, Average Numbers 31st December in resident, each Year. Percentage of Recoveries on Admissions. Year. Admitted. Percentage of Deaths on Average Numbers resident. Recovered. Relieved. Not Improved. 1876 1877 1878 1879 1880 1881 1682 1883 1884 1885 1886 1887 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 M. 221 250 247 248 229 232 267 255 238 294 207 255 215 230 230 234 231 281 3201 379' 296! 300 355 264 335 373 352 454 340 399! 401 421 434 447 639 455 593 543 526 461 568 507 482 575 F. 117 112 131 151 149 127 152| 166 153 1 1601 165 ! 101, 146 161 160 20l! 158' 179 256| 302 170 244 258 247 263 224 192 237 240 280 277 279 325! 376 371 322| 394 349 j 366 419 ' 367 378 411 1 388[ T. 338 362 378 399 378 i 359 419 421 391 454 372 416 361 391 j 390 435 389 j 460 576 6S1 466 544 . ! 613 511 59S 597 544 691 580 679 678 700 759 823 1,010 777 987 892 892 880 935 885 898 963 M. 129 123 121 112 100 93 95 102 S9 95 99 103 116 93 98 88 89 101 107 105 104 102 114 88 103 125 135 144 157 149 157 160 180 179 182 163 184 175 207 202 160 171 142 190 F. 79 57 68 76 67 65 59 78 77 76 60 78 92 53 8S 74 76 89 76 77 70 73 110 99 96 j 104 99 101 106 121 126 139 146 170 145 168 141 162 162 157 171 152 141 147 T. 208 180 1S9 188 167 158 154 180 166 171 159 181 208 146 186 162 165 190 183 182 174 175 224 187 199 229 234 245 263 270 283 299 326 349 327 331 325 337 369 359 331 323 283 337 M. F. 17 8 20 9 14 14 15 13 36 25 41 36 49 32 13 20 17 9 10 5 11 17 34 17 31 28 i 31 30 23 17 I 33 24 21 17 1 17 12 ! 15 11 ; 24 19 25 16 26 32 13 23 15 25 39 10 40 17 26 15 41 25 24 13 45 32 28 22 31 19 9 13 17 22 30 29 23 16 17 44 35 48 27 29 26 34 35 34 32 20 17 36 37 44 T. 25 29» 28 2S 61 77 81 33 26 15 28 51 59 61 40 57 38 29 26 43 41 58 36 40 49 57 41 66 37 77 50 50 22 39 59 39 61 83 56 60 69 52 53 81 M. 6 7 3 8 5 S 5 10 18 73 12 2 3 12 14 8 9 55 128! 20 17 104 7 25 33 10 84 9 23 6 53 9 29 164 11 146 78 23 21 57 43 57 72 F. 6 2 3 3 2 : 1 7 1 9 12 29 S 2 1 5 30 2 9 84 ! 139 12 31 47 42 65 3 9 12 2 21 14 32 6 68 55 7 18 36 16 67 14 9 21 30 T. 12 9 6 11 7 9 12 19 30 102 20 4 4 17 44 10 18 139 267 32 48 151 49 90 36 19 96 11 44 20 85 15 97 219 18 164 114 39 88 71 52 78 102 M. F. T. SI. I. 1. M. 36 12 48 519! 264 783 491 42 21 63 581 ! 291 872 541 51 17 68 638 319! 957 601 55 16 71 695. 361 1,056 666 54 20 74 729! 396j 1,125 703 49 14 63 769 406! 1,175 747 60 19 79 S27; 442 1,269 796 65 18 S3 892! 483 1,375 860 68 24 92 938 514 1,452 911 73 22 95 981 5421 1,523 965 57 19 76 1,009 604! 1,613 984 74 27 101 1,053, 643! 1,6961,034 78 26 104 1,041 640! 1,6811.045 70 30 100 l,074i 687; 1,7611,046* 76 35 111 1,095 702! 1,7971,078 79 41 120 1,115 734| 1,8491.089J 74 34 108 1,154! 763 ! 1,917 1,125 78 23! 101 : 1,229 810 2,0391,172 64 35 99 : 1,308 860 2,1681,241 101 42 143 ' 1,329! 885 ; 2,2141,313 56 32 118 1,390 925 1 2,3151,347 105 43 14S • l,440j 990! 2,4301,411 88 60 148 , 1,4721,008| 2,4801,438 114 43 157 ■ 1,5121,045 2,5571,487 99 46 145 l,58l|l,091j 2,672,1,534 102 72 174 I 1,654 ! 1,119, 2,7731,622 120 55 175 I 1,7151,133 2,8481,671 . 129 44 173 i 1,7711,188 2,9591,741 : 120 ! 70 190 : 1,8011,237 3,038,1,780 147 67 214 1,836 1.276 1 3,1121,796 : 146 85 231 ; 1.9001,306 3,2061,823 : 168 64 232 | 1,9091,331 3,2401,851 : 148 74 222 : 1,997 1,417 3,4141,894 : 136 68 204 i 2,083 1,465. 3,5481,970 i 186 '■ 97 283 ! 2,1601,510 3,6702,028 ] 198 105 303 1 2,220 1,536 3,756 2,105 J 193 87 280 ! 2,273 1,640 3,9132,146 ] 196 111 307 ! 2,3321,632 3,9642,252 1 193 88 281 I 2,4081,703! 4,1112,309 ] 172 112 284 2,448 1,752 4,2002,391 1 209 80 289 2,555 1,820 4,375 2,483 J 205 113 318 2,6111,904 4,515 2,543 j 274 174 44S 2,003 1,943 4,546 2,602 ] 212 130 342 2,667 1,980:4,6472,620 : 5,050 2,415 7,465 J .. .. I .. F. < T. 257 748 277 818 303 904 337 1,003 371 1,074 388 1,135 421 1,217 475 1,335 497 ,1,408 528 [1,493 559 1,543 613 1,647 641 1.686 , 660j!1,707 685" 1.763 699J 1,789J 714|1,839| 758 ,1,930 812 2,053 849 2,162 882 2,229 944 2,355 973 (2,411 1,004 ! 2,491 1,049 ,2,583 1,094 [2,716 1,114 2,785 1,160 12,901 1,198 2,978 1,232 |3,028 1,265 3,088 1,285 3,136 1,346 3,240 1,404 3,374 1,445 3,473 [l,496 3,601 |1,551 3,697 ! 1,597 3,849 1,641 3,950 1,703 ;4,094 1,768 |4,251 1,825 j4,368 1,899 |4,501 1,907 4,527 If. 54-53 49-20 4S-98 45-16 43-66 40-08 35 58 40-00 37-39 3231 4782 40-39 53-95 40-43 42-61 ■ 37-61 '■- 38-53 35-94 39 63 41-27 37-41 35-92 44-88 32-31 30-74 3906 38 35 40-56 46-18 41-39 39-75 44-29 ; 42-25! 42-72 ! 38-40 36-38 40-17 j 3755 40-67 44-89 30 89 36-38 32-49 37-11 F. 66-01 5080 51-90 50-33 44-96 51-10 38-81 46-98 50-32 47-50 36-36 4875 6301 32 92 55-00 36-82 1 48-10 49-72 4518 46-66 44 02 37-82 51-89 44-33 36-50 46-64 51-56 4469 44-17 48-21 i 47-73 j 57-68 45-91 ! 57-24 46-18 53-00 37-01 •50-94 i 45-12 43 21 47-37 40-64 3507 I 3962 T. M. F. T. 57-56 8-21 3-58 6-70 49-72 7-76 7 58 770 5000 8-48 5-61 752 47-11 8-25 4-74 7-07 44-17 7-68 5-39 6-89 I 44-01 6-29 3-60 5-55 36-75 7-53 4-51 649 42-75 7-55 3-78 6-21 42-45 7-46 4-82 6-53 37-66 7-56 4-16 636 42-74 5-79 3-39 4-91 43-61 7-15 4-40 6-13 57-62 7-56 4-05 6-16 37-34 6-69 4-54 5-86 47-69 7-05 511 6-29 37-24 7-25 5-86 6-71 42-42 6-58 476 5-87 41-30 6-66 303 5-23 41-03 516 4-31 4-82 43-40 7-69 ! 4-94 6 61 39-82 6-38 ! 3-63 5-29 36-69 7-44 ; 4 55 628 48-07 6-12 6-17 6-14 37-58 7-67 4-28 6-30 33-27 6-45 i 4-38 561 42-17 6-29 6-58 6-41 43-01 7-18 4-94 6-28 42-17 7-41 3-79 5-96 45-34 6-74 584 6-38 44-19 8-18 5-44 707 42-94 8-01 6-71 7'48 49-67 908 4-98 7-39 43-82 7-81 550 6-85 48-74 6-90 I 4-84 6-00 41-50 9-17 ! 6-71 8-15 43-27 9-41 7-02 8-41 38-74 8-99 I 5-61 757 42-98 8-70 6-96 7-98 42-51 8-36 536 711 44-27 7-19 , 6-58 6-94 37-66 8-42 ' 4-52 6-80 3827 806 6-19 7-28 3373 10-53 9-16 995 38-17 8-09 6-82 7-55 15,583 10,684;: :26,267 i [5,731 4,571 10,302! i i |l,13ol 981 12,111 1, ,487 991 981 l,487l 12,478 .. i .. In mental hospitals, 1st January, 1876 In mental hospitals, 1st January, 1920 SI. F. T. 482 254 736 .. 2,667 1,980 4,647

H.—7

20

Table XVI. —Showing the Admissions, Readmissions, Discharges, and Deaths from the 1st January, 1876, to the 31st December, 1919.

Table XVII. —Summary of Total Admissions: Percentage of Cases since the Year 1876.

Table XVIII. —Expenditure, out of Public Works Fund, on Mental Hospital Buildings, etc., during the Financial Year ended 31st March, 1920, and Liabilities at that Date.

Persons admitted during period from 1st January, 1876, to 31st December, 1919 .. Readmissions M. F. T. 12,430 8,142 20,572 3,153 2,542 5,695 M. f. T. Total cases admitted Discharged oases— Recovered Relieved Not improved Died 15,583 10,684 26,267 5,731 4,571 1,130 981 1,487 991 5,050 2,415 10,302 2,111 2,478 7,465 13,398 8,958 22,356 Total oases discharged and died since January, 1876 Remaining, 1st January, 1876 482 254 736 Remaining, 1st January, 1920 2,667 1,980 4,647

Males. Females. Both Sexes. Recovered Relieved Not improved Died .. Remaining 30-78 7-25 9-54 32-41 14-02 42-79 9-18 9-27 22-61 16-15 39-22 8-04 9-44 28-42 14-88 100-00 100-00 100-00

Mental Hospitals. Net Expenditure for Year | ended 31st March, 1920. Liabilities ou 31st March, 1920 Auckland Tokanui Porirua Christchurch (Sunnyside) Horn by.. Seaclifi .. Waitat-i .. Nelson £ 543 4,111 638 2,490 7,370 2,069 848 208 £ 68 204 6,647 Totals 6,919 18,277

21

H.-7

Table XIX.—Total Expenditure, out of Public Works Fund, for Buildings and Equipment at each Mental Hospital from 1st July, 1877, to 31st March, 1920.

Table XX.— Showing the Expenditure for the Year 1919.

Mental Hospitals. 1877-1911. 1911-12. 1912-13. 1913-14. 1914-15. 1915-16. 1916-17. 1917-18. 1918-19. 1919-20. Total Net Expenditure 1st July, 1877, to 31st March, 1920. £ £ £ £ £ 108,992 105 135 8,908 23,434 4,849 105 105 561 166 4,303 21,935 8,874 10,379 29,656 143,883 1,762 9,550 1,951 6,552 123,454 412 4,867 616 5,107 154,817 1,480 5J382 3,257 7,'il3 660 442 4,007 1,634 911 4,891 147 3,727 1,097 21,295 200 200 200 200 597,634 8,809 | 46,181 26,001 53,996 I £ 1,171 8,105 2,462 1,238 966 498 200 £ 543 4,111 638 2,490 7,370 2,069 848 208 £ 147,186 5,059 561 80,340 29,656 206,437 185,334 7,370 183,699 9,783 4,891 147 3,727 1,097 26,253 Auckland Reception-house at Auckland Motuihi Island Tokanui Wellington Wellington (Porirua) Christchurch (Sunnyside) Hornby Seacliff Waitati Dunedin (The Camp) Napier Hokitika Richmond Nelson £ 2,774 £ 76 £ 1,048 | 10,640 5,639 6^188 17,518 15,157 11,722 24,346 10,399 7,647 6,721 671 997 24 597 88 1.417 1,798 535 Totals 14,640 18.277 54,898 44,602 26,502 891,540

Items. Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. Total. Inspector-General* Deputy Inspector- General and Assistant Inspector* Clerks* .. .. .. .. .. Medical fees* Contingencies* Official visitors Superintendents Assistant medical officers Visiting medical officers Clerks Matrons .. ■ Attendants and servants Rations Fuel, light, water, and cleaning Bedding and clothing Surgery and dispensary Wines, spirits, ale, and porter Farm Buildings and repairs Necessaries, incidentals, and miscellaneous £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. 1,075 0 0 825 0 0 1,514 18 0 1,215 14 0 1,418 15 2 168 0 0 5,343 19 2 3,409 7 4 258 4 10 3,342 6 11 1,360 11 1 110,929 1 10 65,441 8 0 16.589 4 0 27,663 19 11 1,933 13 2 88 10 11 14,427 14 1 4,707 2 11 25,134 13 7 .. .. .. •• .. 11 11 0 320 16 8 44 2 0 950 0 0 966 8 3 50 8 0 11 11 0 697 1 8 987 10 0 911 5 0 468 19 1 50 8 0 770 16 8 1.062 15 0 630 4 2 987 10 0 225 0 0 33 4 10 209 1 8 153 12 0 5,605 12 3 3,552 19 2 688 5 9 1,107 17 5 71 4 0 834 10 7 211 5 0 23,366 5 2 13,772 14 8 3,790 12 3 6,217 0 2 274 4 3 6 12 6 2,495 16 3 530 17 4 4,255 18 9 713 15 0 812 10 0 137 13 4 350 19 1 16,021 17 7 18,437 0 2 15,244 7 3 11,941 16 5 2,971 10 5 4,569 12 1 6,166 15 5 5,489 5 1 256 2 2 806 15 11 19 18 0 39 0 10 859 10 10 3,157 10 0 508 1 10 739 17 2 2,795 3 8 7,213 17 4 772 9 8 332 18 4 34,025 1 0 14,737 13 2 3,539 18 10 6,676 5 0 425 11 9 20 16 7 4.303 12 3 1,875 14 3 6,939 3 11 139 3 4 5,183 0 3 4,268 4 3 182 1 2 1,472 14 3 63 13 3 2 3 0 137 14 9 7 17 0 577 10 10 35 0 0 8,290 5 5 1,923 13 1 847 3 6 534 2 7 36 1 10 743 8 10 927 19 2 982 0 2 2,730 1 2 116 16 2 2,370 18 11 Totals Repayments, sale of produce, &e. 47,353 10 2 17,561 3 5 55,026 4 2 75,533 4 5 19,262 2 7 27,363 7 0 12,591 9 9 2,637 19 2 14,705 9 5 3,436 4 1 57,716 7 2 20,267 4 8 17,871 12 8 3,602 5 4 286,847 4 11 94,130 6 3 Actual cost 29,792 6 9 35,764 1 7 48,169 17 5 9,953 10 7 11,269 5 4 37,449 2 6 14,269 7 4 192,716 18 8 * Not included in Table XXI.

H.—7.

By Authority : Mabctjs F. Masks, Government Printer, Wellington.— 1920.

Table XXI.— Average Cost of each Patient per Annum.

Approximate Cost of Paper. — Preparation, not given; printing (550 copies), £35.

Table XXa.— Showing Details of Credits.

Price 9d.

22

Credits. Auckland. Christchurch. Dunedin (Seacliff). Hokitika. Nelson. Porirua. Tokanui. Total. Receipts for maintenance For sales of stock, produce, &c. Other receipts £ s. d. 15,051 0 11 1,341 17 2 1,168 5 4 i £ s. d. 11,606 16 6 7,103 0 8 552 5 5 £ s. d. 20,275 3 8 5,419 18 4 1,668 5 0 £ s. d. j £ s. d. 2,182 3 4 I 2,782 10 1 228 6 9 468 17 6 ! 227 9 1 184 16 6 £ s. d. £ s. d. 16,322 7 7 I 1,212 10 9 3,442 4 10 2.296 16 6 502 12 3 92 18 1 £ s. d. 69,432 12 10 20,301 1 9 4,396 11 8 Totals .. 17,561 3 o 19,262 2 7 27,363 7 0 2,637 19 2 3,436 4 1 20,267 4 8 3,602 5 4 94,130 6 3

Mental Hospital. Bedding L^ < 3 e '- Surgery j Provisions. Salaries. and and' and Dis- Farm. Clothing. CIeaning pensary. Wines, Spirits, Ale, j and Porter. I Buildings and Repairs. Necessaries, T . , „ . RepayTncidentals 1<M ~'^ osc ments for and Mis- p a ti en t Maincellaneous. ' tenance. Total Cost Total Cost Total Cost I perHead.less per Head, per Head, less Decrease Increase Repayments less Receipts of , in in for Main- Receipts of all Kinds pre-! 1919. 1919. tenance. all kindB. vious Year. Auckland Christchurch Dunedin (Seacliff) Hokitika Nelson Porirua Tokanui £ s. d. £ s. d. .. 14 12 3| 17 15 4J .. 16 11 3 ' 29 4 5 .. 13 11 8 34 2 3J .. 15 19 8£ 22 0 5 ...17 4 ll| 32 3 10J ..13 2 7 25 2 9f .. ! 11 3 8± 54 2 10J £ s. d. 5 18 3 7 12 3J 6 3 Of 5 10 3fj 5 7 6f| 5 18 6J 3 2 li) . i . . „ £ s. d. £ s. d. £ s. d. 2 16 11J 0 4 11 0 16 of 6 6 9 1 2 i\ 4 7 7 3 5 3 0 7 10J 3 19 3f 0 13 7f| 0 4 9J| 0 10 3f 3 6 10 I 0 6 11 j 3 12 2J 3 12 3J 0 5 2f 2 7 7 4 18 6£i 0 4 2J15 17 5J £ s. d. 0 0 4| Oil 0 0 4J 0 0 2 £ s. d. 0 9 9 1 0 61 1 14 7 0 0 7 4 10 1 0 10 1J 0 13 7 £ s. d. 2 13 7J 10 0 1| 6 7 11 2 3 3| 4 15 4 4 1 If 13 15 81 £ s. d. ! £ s. d. 45 8 OJ-14 8 1\ 76 6 4J!16 1 11| 69 12 3f 18 13 8} 47 3 2£| 8 3 5J 71 7 8«13 10 If 55 0 5 15 11 2} 103 18 ljj 7 1 0 £ s. d. 30 19 5 60 4 5 50 18 7 38 19 8f 57 17 6f 39 9 2| 96 17 1£ £ s. d. 28 11 3£ 49 12 Of 44 7 11 37 5 7 54 14 1£ 35 14 0 82 19 2f £ s. d. : £ s. d. £ s. d. 26 9 7 I .. 2 1 8* 49 0 2J ! .. 0 11 10J 44 1 9J .. 0 6 If 30 15 7 .. 6 10 0 50 12 4f .. 4 1 8J 34 16 7 .. 0 17 5 67 0 9£ .. 15 18 5J o 6' i* "i • • Averages .. 14 8 lj' 27 9 5J 6 1 9} 3 13 Oil 0 8 6J ! 3 3 6J, 0 0 4f 1 0 8f 5 10 7f 61 16 2fl5 5 8 46 10 6J 41 1 9J 38 19 0 2 2 9, I I Table XXIa. Including first five items in Table XX £ s. d. £ s. d. £ s. d. ! £ s. d. £ s. d. £ s. d. £ s. d. ' £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. 63 2 9f; .. .. 42 8 5 £ s. d. £ s. d. £ s. d. 39 18 5J .. 2 9 111