H?—31a,

Recommendations. (1) The Committee is of the opinion that the maternity facilities in the Marlborough district are on the whole adequate, but considers that some adjustment of the staffing arrangements should be made at the outlying hospitals, particularly at Havelock, to relieve the Sisters in charge at reasonable intervals and to ensure assistance when the number of patients exceeds the normal. (2) It is advised that consideration be given to the possibility of utilizing the district nurses-to a greater degree in ante-natal work amongst country mothers and that some provision be made for waiting mothers. (3) It is recommended that definite financial arrangements be made for medical attendance on indigent maternity patients both European and Maori. 34. NELSON HOSPITAL BOARD DISTRICT. The area served by the Nelson Hospital Board includes the City of Nelson and extends north-west through the Motueka Valley, over the high range of the Takaka hills to the Takaka Valley, and along the coast to Collingwood ; the southern boundary is beyond Murchison, eighty miles from Nelson through hilly country. Nelson is the principal centre. Its population is 11,188, with an increase of 10-5 per cent, in the period 1926-36. The surrounding districts with small towns are Motueka (2,118), Takaka (1,528), Collingwood (1,517), Brightwater (600), and Richmond (1,136). A rich, closely settled agricultural plain extends twenty miles west of Nelson, and settlement is also close in the Motueka and Riwaka districts, where the rich farmingland is mainly used in the growing of fruit, hops, and tobacco. Elsewhere in the country districts the population is scattered. The country in the vicinity of Murchison. suffered very severely in the 1929 earthquake, and the settlers are only now recovering from their losses. Roading.—Although many of the roads are over very hilly country, access to all parts of the district appears to be reasonably satisfactory. The distance of some of the outlying farming areas from the centre does, however, introduce considerable transport difficulty for those without motor-cars. Nelson. Public-hospital Facilities.—The Nelson Hospital Board has provided a maternity annexe with accommodation for fourteen patients. The number of patients attended last year was 198, with an average of 7-6 occupied beds. It is bright, fairly modern in construction, and up-to-date in equipment. The fees are £4 4s. per week. Extensions will probably be required in the near future, particularly if the hospital is conducted as is advised on the " open " system. The question of making this hospital an " open " one was discussed with the Medical Superintendent, who can see no serious difficulty other than the necessity for the additional accommodation. All first confinements and abnormal cases are attended by the Medical Superintendent or the Assistant Medical Superintendent, other cases being attended by the Sister in charge. Nembutal, and chloroform by the Murphy inhaler, are administered in cases attended by the Sister. Where a doctor is in attendance analgesics and anaesthetics are used to a greater degree. An ante-natal clinic is conducted at this hospital. Private-hospital Facilities.—There is one " mixed " hospital taking an average of seven to eight maternity cases a month. The staff on the maternity side of the hospital consists of the lessee, who is a trained midwife, another midwife, and a probationer with experience. The night nurse in the medical side attends to the babies at night. A new private maternity hospital is contemplated. Ante-natal supervision is given to private patients by their own doctors. Brightwater. There is a small private hospital with three beds in Brightwater doing about twenty cases a year. There is no doctor resident in the township, but doctors attend from the neighbouring towns of Richmond or Wakefield. The fees are £4 14s. 6d. per week. Richmond. There is a mixed medical, surgical, and maternity hospital in this township. The lower floor is reserved for the maternity cases, and accommodation is provided for four patients. The two local doctors do practically all their maternity work in hospital. The fees are £5 ss. per week. Motueka. Motueka has no public maternity hospital accommodation, but a subsidy of £200 is paid by the Nelson Hospital Board to the larger of the two private maternity hospitals, which is owned by the Board, for the treatment of indigent cases. As is frequently the case under such an arrangement, the classification of indigent cases is indefinite, and the position is not altogether satisfactory either for the nurse or for the patients.

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