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1877. NEW ZEALAND.

AUCKLAND HOSPITAL COMMISSIONERS (REPORT OF THE).

Presented to both Houses of the General Assembly by Command of His Excellency.

The Hosiutal Commissionees to the Hon. F. Whitakee. Sic, — Auckland, 17th July, 1877. In compliance with your letter, dated 3rd January last, wherein you request us to report upon the present condition of tho Hospital, and offer suggestions for its future managenrent, we beg to inform you that wo have inspected the old buildings as well as the new one about to be occupied ; we have examined witnesses orally, and the medical profession in this provincial district by circular ; and have collected such other information, as to the administration of these institutions in the neighbouring colonies, as the time at our disposal would admit of, in order that we might reap the results of their experience, and be enabled to avoid offering suggestions which, however suited to Home circumstances, it is apparent are defective here. We have the honor to report that wc found tiro wooden building at present used as the Hospital old, dilapidated, and unfitted for the purpose. Its interior presented a clean appearance, but evidence disclosed the fact that it is infested with bugs. As we shall subsequently allude to this matter when pointing out the precautionary measures we consider necessary to prevent this nuisance in the new building, we will only now notice that in the Sydney Infirmary, a rubble building, the most strenuous efforts were quite ineffectual to check, and impotent to get rid of it. This cannot be construed into a reflection on the management here, when the character of the building is considered. The administration as a whole, tinder the absolute control of Dr. Philson, has been so far satisfactory that it makes the task of suggesting any alteration both unpleasant and difficult. But his generous answers to our circular questions greatly lightened the burden of our duty; and even should our views meet with approval, and be adopted, we venture to express the hope that his services would not be lost to the institution over which he has so long and faitlrfully presided; and in the expression of this hope we feel assured that we correctly interpret public opinion. The site of the new Hospital appears to us to have been admirably chosen. The patient is placed in a condition to enable Nature to do her part in furtherance of the physician's art. The design embraces the most advanced principles of construction. There is plenty of light, air, and convenience for the speedy removal of refuse. The only objectionable feature that occurs to us is its distance from the city and harbour, where accidents of a serious description most frequently occur. Some provision to meet such cases ought to be made. Wc recommend that lightning-conductors be erected immediately. We recommend that a Board of Management of (say) seven members be appointed. Clergymen and medical men are found to be objectionable. The Government might nominate three, including the President (having a deliberative as well as a casting vote) ; and the bodies from whom the funds for the maintenance of the Hospital are derived to elect the others. One nominated and oue elected member may retire annually, but be eligible for re-election or re-appointment, provided a certain standard of attendance is attained. Members retiring might be chosen by lot. The Board should be supreme in its authority over every one connected with the institution. It appears to us that it would be difficult, if not impossible, for the Government to exercise an efficient control over the Hospital in this district. Both in Sydney and Melbourne large Boards have been discovered to be a mistake, resulting in an absence of vigorous and consecutive action, if not in utter neglect of matters of great importance to the institutioirs. In an earnest and active Board would be embraced all that would be required to secure the good government of the Hospital. We are of opinion that such a Board would find it necessary to secure the services of a person thoroughly competent to act as Dispenser aird Clerk or Secretary. This officer should have the general supervision of the institution and officers (except the Matron, if trained female nurses are employed throughout), with power to discharge and temporarily employ until the next meeting of the Board, to whom he would be responsible, and for whom he would act as the mouthpiece, rendering it unnecessary—as it is undesirable-—for members of the Board to take any individual action.

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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.

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Several matters of serious importance, such for instance as to the materials with which the wards are lined, have neither been overlooked nor undervalued by us. A few years hence this question ought to claim the earnest attention of the authorities, for our investigation informs us that there is a miasmatic atom —so minute as to have escaped detection as yet, and which ventilation cannot reach— that even permeates the solid structure, resulting in susceptible persons going to buildings so infected, with curable ailments, being subject to diseases of a very destructive character. Although it would have been of advantage to have had the walls and ceilings coated with a composition impervious to this poison, still we cannot undertake the responsibility of advising the Government to make any alteration in this direction at present. Additional attention to the preparation of the food would be repaid by beneficial results, and a check imposed in respect thereof, so that the servants could not supply themselves at the expense of the patients. A strict record of all property belonging to each individual on entrance ought to be kept. But these and other details, such as rules, &c, would be a duty devolving upon the management, of whatever description. In concluding this report we cannot forbear expressing our regret that it is not so exhaustive as we could have wished, or the importance of the subject seems to demand. We would only add that all the suggestions we have ventured to make arc supported by evidence that appears to us conclusive. We cherish the hope that some of them may prove of public use. We have, &c, W. J. Htjest, Chairman. Thomas Moeein. William Swanson. A. K. Tayloe. The Hon. F. Whitaker, Auckland. J. S. Macfaelane.

Authority: Geouge DrDSBr/EY, Government Printer, Wellington.—lB77.