H.—ls

The preponderance of evidence establishes fully the fact that trained female nurses are the most efficient. We think, therefore, the Government would act wisely in obtaining such. The Head-nurse, or Matron, should be responsible for the cleanliness of the wards, and the cooking and distribution of the food to the patients, as well as the conduct of her assistants. This system is in operation both in Sydney and Melbourne. It is stated on the most reliable authority that the good effect of the introduction of the system has been made abundantly clear, and that it is a vast improvement on the old state of affairs when wardsmen were employed. There are doubts expressed both in Melbourne and Sydney about the success of the system of an honorary medical staff, and proved abuses have arisen in connection therewith. But, however workable in large cities, in our opinion it is not capable of accomplishment here at present. Under any circumstances it is necessary to have a duly-qualified resident House Surgeon, who should be restricted from practising otherwise. Although the duties have been efficiently discharged by a single surgeon in the past, still the evidence goes to show that there is no reason to doubt but that they would be performed as well, and with no little public advantage, if the Government appointed four medical men for a period not exceeding three years, with an honorarium of £100 a year each, under conditions as to attendance, duties, &c. Such a staff, with the House Surgeon, could constitute a Sub-Board, whose duty it would be to make representations for the guidance of the General Board on all matters pertaining specially to their technical department. Stringent rules will require to be framed as to the admission and disposition of patients, and the conditions under which operations could be performed ; and care will require to be exercised to provide that each medical officer is responsible for the patients under his control. We beg to draw particular attention to the number of paupers in the Hospital who cannot be relieved or benefited in any way by medical treatment: such as those suffering from old age or some incurable disease. It appears to us very desirable to prevent a continuance of this abuse in the new Hospital. W Te would recommend that the Medical Officer should have instructions to exclude all such from entrance therein. They could be treated with equal benefit to themselves, and with less expense to the public, in other institutions. Generally, accidents and acute cases should be allowed in by the House Surgeon ; but the admission and discharge ot all other cases should rest with the Board, on the certificate of the medical one. The object of a hospital is the relief of the sick ; and, in order to check the amount of imposition practised, it is worthy of consideration whether a law could not provide that a patient's indebtedness to the Hospital should be a first charge against any property he has or may become possessed of, and define the liability of relatives. Out-patients should be treated twice weekly; but, as gratuitous relief has a tendency to pauperize, to prevent fraud none should be relieved unless their indigent circumstances have been vouched for by an officer appointed for that purpose. A high authority (Dr. Stewart) states, " I am convinced that the system of free dispensaries is the most efficient means for creating paupers that can be devised;" and colonial evidence appears to indorse the assertion. We cannot exaggerate the importance of using every endeavour to exclude vermin from the wards in the new 7 Hospital. We think that all patients should be carefull} 7 cleansed at the time they are transferred to it, and provided with a perfectly clean set of clothes. It would be wise to avoid removing arry of the material, if possible, from the old to the new building; but, if absolutely necessary, only after having undergone the utmost purification. It appears desirable that the clothes of the patients, when admitted, should be subjected at once to some process, such as a heated oven, &c, for the double purpose of ridding them of vermin and of infection. We also think it advisable that washhouses should be provided, to do away with the need of sending the clothes elsewhere. Visitors might be prevented from sitting on the beds, and should be admitted on stated days and between certain hours only. A good fence round the boundary of the land would be of advantage, and would aid in maintaining discipline. Water could possibly be obtained with advantage from the Kyber Pass Reservoir. All the property of the institution should be marked, and the clothing and blankets numbered and dated in addition, so that their destination could easily be traced, and persons in improper possession punished. We think it objectionable that any officer or servant should derive any advantage or emolument other than their stipulated salary ; neither should they, or convalescent patients, be required to perform other duties than those provided for in the rules; and under no pretence whatever should any one be permitted to take drugs or any of the instruments or appliances away from the institution. Any animals or birds which can conveniently be maintained on the property should be for the benefit of the institution alone. Amusements, flowers, and music contribute largely to aid in the recovery of the sick. We believe a library would be appreciated by many ; and, if invited, philanthropic members of the community would doubtless cheerfully assist in creating one, as also iv providing either a piano or harmonium. Few positions could more reward the services of an intelligent gardener. Paths require to be laid off, trees planted, and, with the assistance of the convalescent patients, a bountiful supply of vegetables might be produced. Pauper patients, when able, must render any assistance when required, on pain of dismissal. We do not think that the time has yet arrived when the Hospital can be utilized to train pupils for the profession.

2