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The programme of building improvements inaugurated last year has been completed, thus providing accommodation for twenty more patients. All buildings have been rewired and brought under the Mangahao scheme, thus dispensing with the necessity for the engine-room. A 4 in. watermain has been laid from the borough supply, and owing to the increased amount of water available a properly equipped fire-controlling apparatus has been installed. Thanks to the bequest of the Brown McMillan fund, and very largely owing to the exertions of Mr. Morse, the local picture-theatre proprietor, patients are enabled to enjoy pictures weekly, while an occasional outing in the Matron's car adds to their pleasure. The staff work amicably together, and the patients appear to be contented and happy. In regard to the hospital, at the beginning of the year there were four in ; since then eighty-five have been admitted, and eighty-nine discharged, including twenty-six relieved, fifteen unrelieved, and nine died. An ambulance has been provided by the Palmerston North Hospital for the conveyance of patients who are considered unsuitable for treatment in the Otaki Hospital. The trees which were planted in the swamp were destroyed by fire, and the area has been replanted and the new trees well established. It is proposed to plant three acres on the other side of the road in the swamp with eucalyptus trees ; the gardens generally have been improved. The farm under the Agricultural Department has shown a very satisfactory return, the produce generally being of good quality. SECTION 4.—PUKEORA SANATORIUM, WAIPUKURAU. Dr. G. Maclean, Medical Superintendent; Dr. G. M. Soon, Assistant Medical Superintendent; Miss A. L. Lundon, Matron. The year which has just closed has been remarkable for many changes of a progressive nature. The expenditure for new buildings and new services is the highest on record for one year in the history of this institution, which is thus rendered more and more efficient as a complete unit for the work of treating sufferers from pulmonary tuberculosis. There has been a decrease in the number of patients treated during the past twelve months, but there has also been a decided decrease in the number of notifications of T.B. for the North Island, and very noticeably so in the hospital districts within more easy reach of the Pukeora Sanatorium. For eight months of the year 1926-27 (the only figures at present available for this review) notifications dropped from 250 recorded in the previous year to 158, corresponding periods being compared in each case. From observance of the notification figures —not entirely reliable as a basis for assumptions as to incidence of the disease—and from consideration of the steadily decreasing death-rate, we are able to say that there is much less pulmonary tuberculosis, particularly in the North Island of New Zealand. This sanatorium has 174 beds available for male patients, and of these the average number occupied daily has been 91-05. It will thus be seen that there is ample provision made for treatment of all cases which can be reckoned suitable for sanatorium. 1 am pleased to report that the average type of case referred here for treatment during the year has improved, and in consequence the average number of days per patient under treatment has lessened again. The average mean residence per patient this year is the lowest figure on record— viz., 113 days, or approximately four months When it is remembered that no set period can be so determined for patients—that the time needed for repair depends upon the extent of damage already done—it will be readily admitted that the above average stay per patient, considered with the percentage of cases treated in which the disease has been " arrested," is the shortest treatment period possible and compatible with efficient hospital control. In regard to the question of how long a patient should remain in sanatorium, R. C. Wingfield says the correct answer should be, " I do not know how long it will take, but you must remain under treatment until you have made the maximum amount of improvement possible in your case." With military pensioners it is easy to convince the patient to accept this view, but with civilians economic pressure—e.g., the plight of the patient's wife and children during his stay in ' hospital —has a very distinct bearing on the length of treatment we can advise. It is interesting, nevertheless, to note that at this sanatorium for the year there is but eight days difference between the average mean residence period for military pensioners and civilian patients, with the advantage to the former. The percentage of service patients —i.e., those ex-soldiers whose disability is accepted by the Pensions Board as due to war service—is diminishing year by year, and has now reached the low figure of 28-9 per cent, of the total patients treated during the year. It is pleasing to record that there is an increasing tendency with medical practitioners of good standing to refer cases for an educative period of treatment as soon as the diagnosis is made, and such use of the sanatorium by the private medical practitioner is welcomed. Women's Temporary Accommodation.—The temporary accommodation provided in February, 1926, was closed on the 30th November, 1926, when additional accommodation became available at the women's sanatorium, Otaki. During the ten months thirty-four women were treated. The average mean residence in days was 128-2, and the results of treatment were as follows : Disease arrested, 13 ; improved, 18; unrelieved, 2; died, 1. The unrelieved cases were transferred back to hospital annexes. Staff Changes.—The retirement of Miss Thurston, C.8.E., R.R.C., in March of this year constitutes not only a loss to the Department but also to the entire nursing service of the Dominion. Miss Thurston was well known as Matron-in-Chief of the N.Z.A.N.S. during the war period, and I feel sure that a very wide circle of friends and co-workers join with us, who have been more intimately associated with her in recent years, in wishing her a very pleasant holiday and many years of health and prosperity in retirement. For the period intervening between Miss Thurston's departure and

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