H.—3la

Visits by husband and relatives to the patient in hospital must either be curtailed or else involve considerable additional expense. There are a number of small private hospitals in the district, but the facilities which they can offer admittedly are not as adequate as those in larger and more up-to-date hospitals. All these disadvantages of distance from modern hospital facilities which are, of course, inevitable in the case of many small communities, do not appear to be necessary or reasonable in a closely settled area like the Hutt Valley. Many of the arguments for concentration of services in one big central hospital do not apply to maternity hospital practice ; in many ways it is preferable to have a number of moderate-sized, but well-equipped and well-staffed, hospitals strategically placed to meet local requirements as far as is reasonably possible. Maori Population. There are two hundred or three hundred Maoris scattered through the Hutt and Makara Counties, the only settlement of any size being at Porirua Pa (89). There is an increasing tendency for the Maori mothers to come into St. Helens for confinement. Further ante-natal service through a district nurse would be helpful. Summary and Recommendations. (1) Wellington City.—ln considering the question of a new maternity hospital for Christchurch, the Committee discussed in some detail certain general principles which it believes should be kept in view in the development of the main public maternity hospital in each of the four main cities and put into effect as opportunity affords. These principles, modified to the needs of the University Medical School, are now seen applied in the Queen Mary Hospital in Dunedin, under Hospital Board administration, and they have guided the Committee in its recommendation for the new St. Helens Hospital in Christchurch, which will be under the control of the Department of Health. The Committee is of the opinion that the aim should be to develop a similar central hospital, capable of dealing with both normal and abnormal cases, in Wellington, either under the present St. Helens administration or else as a department of the Board hospital. Owing to the very definite advantages of maintaining the present system of midwifery training the Committee favours the continuation of Department of Health control. The separation of a small unit dealing with abnormal cases from a larger maternity hospital has disadvantages which are clearly apparent in Wellington. The number of cases is not, and is not likely to be, large enough to warrant the provision of a separate ward with an independent maternity-trained staff. It is recognized that even with a large combined maternity hospital a certain number of cases with complications in earlier pregnancy and a certain number of cases after confinement would still require to be admitted to the general hospital, but it should be possible to deal with all cases needing attention in labour in the central public maternity hospital of the type advocated. (2) Hutt Valley District. —The Committee regards the provision of a public maternity hospital in the Hutt district as urgently required. It understands that consideration is being given by the Wellington Hospital Board to the claims of this district, and strongly recommends that a maternity hospital should be established by the Board in the Lower Hutt locality to supply the need for both public and " intermediate " service—in other words, an "open" hospital. It is suggested that a hospital of fifteen to twenty beds would cover the present requirements. (3) The Committee is of the opinion that there is a need and an opportunity for more modern private maternity hospital facilities in Wellington. 33. MARLBOROUGH HOSPITAL BOARD DISTRICT. The area served by the Marlborough Hospital Board practically corresponds with the Marlborough Province. The Rai Saddle divides it from the Nelson district, and the southern boundary is the Clarence River, eighty-six miles south of Blenheim. The population of the province is 18,363, with an increase of 2-2 per cent, in the 1926-36 period. The centres included are Blenheim (5,063, increase 1-14 per cent.), Picton (1,361, increase 7-89 per cent.), Havelock (269, increase 44 per cent.), Seddon (324), and Ward (265). The inland portion is mountainous and poorly roaded ; elsewhere the roads are good. There are transport difficulties in some parts of the district occasioned by the necessity for launch travel and the crossing of snow-fed rivers at some periods of the year. The Wairau Valley is rich agricultural land growing mainly wheat and peas. The Tuamarina Valley is concerned with dairying, and the remainder of the country is occupied in sheep-raising. There are several public-works camps in the Rai Valley and towards Kaikoura, and there are a number of Maoris in the Havelock area.

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