H.—3la.

The population of 17,000 has shown an increase over the last decade of 7-61 per cent., while Oamaru, the largest town and the seat of Hospital Board control, has a population of 7,487, an increase of 6-91 per cent, over the past ten years. Other centres'of population are Hampden, twenty-one miles south of Oamaru (308), and Kurow, forty-four miles inland from Oamaru. There are eleven medical practitioners in the area —nine in Oamaru, one at Herbert, and one at Kurow. The only public maternity hospital in the district is at Kurow, which is about halfway between the coast and the Alps. It is a seven-bed hospital (six maternity and one emergency), and is an " open " one. The fees payable to the Board are 9s. a day, the patient being responsible for her own doctor's fees. Theoretically indigent cases are attended free of charge, but as the local residents are not aware of this, the doctor is left to collect from the patient whatever sum is considered equitable. The average number of occupied beds last year was 2-1, and the number of cases confined during the year sixty-two. In Oamaru itself there are four private maternity hospitals supplying twenty-five beds. Indigent patients are sent to a private hospital at the Hospital Board's expense. A most undesirable practice has been inaugurated by the Waitaki Hospital Board, which lets the provision of maternity care for indigent cases by tender. The contract price, which is £5 12s. 6d. per case, is below cost. The practice of providing such services by tender is most undesirable, for obvious reasons. Uncomplicated indigent cases are attended by the nurse alone, who can obtain medical assistance from the hospital staff if she considers she needs it. Ante-natal care for indigent cases is at a minimum, no records are kept and postnatal examination is rare. In the year 1936-37, twenty-three indigent cases were provided with services. Pain-relief. —In the Kurow Maternity Hospital, all the cases being doctor-attended, pain-relief approximates that in ordinary private practice. Indigent cases in Oamaru receive pain-relief, which is limited to that possible under nurse-attendance conditions. Transport facilities are as good as in other well-roaded country districts. Recommendations. In the opinion of the Committee the time has come when the Waitaki Board should provide a public maternity annexe in association with, the public hospital in Oamaru. 43. OTAGO HOSPITAL BOARD DISTRICT. This area includes the counties of Waihemo, Tuapeka, Waikouaiti, Peninsula, Taieri, and the City of Dunedin. It extends from Shag Point in the north-east to the Taieri River in the south, a distance of fifty-six miles, and inland it extends about the same distance. In the rural area the occupation is, in the coastal area, mixed farming with relatively close settlement, grading into the larger holdings of sheep-farmers inland. The area is well roaded, but between Palmerston and Dunedin there are two large hills. The road between Middlemarch and Dunedin, a distance of fifty-two miles, is also hilly and slow travelling. The population is about 103,000, and changes of population in the several counties over the past ten years have been —Waihemo, decrease of 7-89 per cent. ; Tuapeka, increase of 0-86 per cent. ; Waikouaiti, decrease of 4-26 per cent. ; Peninsula, an increase of 12-81 per cent. ; and Taieri, a decrease of 0-43 per cent. Allowing for the influx of visitors to the exhibition in 1926, the population of Dunedin has remained stationary during the same period. The largest centre of population in the area is Dunedin, with a population of 81,961, including the urban area. Other centres are —Mosgiel, ten miles south-west of Dunedin (2,105), showing an increase of 12-32 per cent, during the past ten years ; Outram, seventeen miles south of Dunedin (372), an increase of 8-5 per cent ; Waikouaiti, twenty-four miles north of Dunedin (597) ; Palmerston South, thirty-six miles north of Dunedin (799), decrease 0-62 per cent. ; Lawrence (676), increase 1-65 per cent. ; Roxburgh (479), increase 18-27 per cent. ; Tapanui (316) ; Port Chalmers (2,165) shows a decline of population of 15-73 per cent. ; Middlemarch (143). The area is served by forty-nine doctors, of whom thirty-eight are in Dunedin, two in Palmerston, two in Port Chalmers, two in Mosgiel, one in Outram, one in Middlemarch, one in Roxburgh, one in Lawrence, and one in Tapanui. The Hospital Board maternity hospitals in the country districts are : — Palmerston South. —Here there is a five-bedded maternity hospital with an average occupied bed rate of 1-6, and forty-two patients were confined therein last year. The hospital is an "open" one, and all cases, including indigent cases, are " doctor attended."

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