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The Pamphlet Collection of Sir Robert Stout: Volume 77

Presidential Address ... delivered at the Annual Meeting of the New Zealand Branch of the British Medical Association

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Presidential Address

New Zealand. Printed for the Author by John Mackay. Government Printer, Wellington.


Presidential Address

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Before proceeding to deliver my address I desire to thank my fellow-members of the New Zealand Branch of the British Medical Association for the very high compliment they have paid me by electing me their President for the coming year, an honour which I very greatly appreciate. I also wish, on behalf of the members of the Wellington Section, to extend a hearty and cordial welcome to all our visitors. I regret to say that since our last annual meeting death has taken from our midst several of our members, men whom we could ill-afford to lose. I refer to the Hon. M. S. Grace, of the Legislative Council, a man who for forty years carried on the practice of his profession in Wellington, and won the affection, esteem, and regard not only of the members of the profession, but also of the large section of the community to whom he was known; Dr. Connolly, of Wanganui; Dr. Barnard, of Wanganui; Dr. Morice, of Greymouth; and Dr. Saunders, of Wanganui. On behalf of the Branch your Council has page 2 sent to the widows and families their deep sympathy and condolences.

You will see by the programme that we have a large number of papers for discussion—papers of considerable interest not only to the profession, but also to the public. Amongst them is a paper by Dr. Gow upon "Responsibility in Crime," which will be read on Thursday morning at 9.30; and, as a paper on such a subject would appear to have as much interest for the legal profession as for the medical, I do, on behalf of this branch of the British Medical Association, invite His Honour the Chief Justice, the Judges of the Supreme Court, Dr. McArthur, and any members of the legal profession who will honour us with their presence to take part in the discussion of that paper.

The Public Health.

We have the good fortune to live in a country the physical condition and climate of which conduces to the maintenance of a high standard of health and strength. That New Zealand is favourably situated as compared with other countries in this respect is shown by our low death-rate, which in 1903 stood at 10.40 per 1,000 of population, and by the fact that the mental and physical development of the people of New Zealand is second to that of no other country. If it is possible in any country to hold out the hope that by public measures they may approach what is called physiological old age and normal death that happy condition should be most nearly attained in a country so favourably situated as New Zealand.

Now, in order to reduce the death-rate to the lowest possible medium, and to maintain a high standard of physical development among the people, it appears to me that three factors are necessary. First, you should have a Government which is alive to all that concerns the health of the people. Secondly, it is necessary to have a highly educated and intelligent public who will adopt measures for the benefit of the public health by reason of their own conviction rather than by the compulsion of law. When the public recognise a truth in regard to public health they are quite willing to accept any inconveniences which the adaptation of that fact entails. This, I think, has page 3 been lately clearly shown by the ready manner in which the people were willing to be vaccinated when small-pox threatened the community. The third essential is a well-trained and scientifically educated medical profession. In New Zealand at the present time we have a Government which has always taken an active part in the public health of the colony, a Government which during its term of office has inaugurated a Public Health Department and a Pathological Laboratory, and I should here like to congratulate the Government and the Public Health Department upon the prompt and effective manner in which they have resisted the invasion of this colony by those two enemies to public health which so recently menaced our shores—namely, the plague and the small-pox. They are also to be congratulated upon having established at Cambridge a Sanatorium for the Treatment of Consumptives, and upon having determined to make provision for consumptive patients by means of annexes to various hospitals in different parts of the colony where the climatic conditions are favourable for the treatment of that disease. The Government has also instituted the very needful precaution of inspection of dairies and slaughterhouses, and through the Bacteriological and Agricultural Departments the inspection of dairying-cattle. More-over, to those who have spent the greater part of their lives in helping on the development and progress of the country, but who in their old age find themselves without the means of support, a pension has been provided for their declining days. It is gratifying to know that the Government has already done so much in the interests of the public health, and it is to be hoped that before very long it will be able to see its way towards establishing a much-needed institution, and that is a Home for Epileptics. Such a home, I feel sure, would confer a very great benefit on the community.

To enable one to arrive at a fair estimate of the average intelligence of the public it is necessary to consider the quality of the education that is being imparted to the children at the public schools, and it may be taken that the standard of intelligence of this colony is that which is reached by the majority of the children at the time of their leaving school. It may bo conceded that a large proportion of the pupils before page 4 leaving school have reached Standard VII. As you know, Standard VII. of our public-school curriculum, outside the ordinary compulsory subjects, which includes military drill, makes provision for the study of such subjects as geometry, algebra, elementary mechanics, physics, chemistry, botany, book-keeping, shorthand, agriculture, physiology, geology, handwork, and mechanical drawing, as well as Latin, French, and German. This standard, I maintain, includes a very high quality of general education. I take it that the object of a high standard of education is to enable the individual to appreciate his responsibility to the State, and to perform in the completest manner his duties of citizenship.

Speaking from a medical point of view, I say it thus becomes a duty of every citizen to endeavour to maintain in himself—not for his own sake only, but also for the sake of his fellow-citizens—the best condition of personal health. Further, if an individual becomes affected by a contagious disease—it does not matter what the nature of that disease may be, whether it be syphilis—that scourge of civilised countries which not only has a serious effect on the individual, but may become transmitted to his offspring—a disease which I fear can only be diminished by the general enforcement of the Contagious Diseases Act—whether it be phthisis or one of this exanthemata—it is a part of his duty to assist in preventing by every means in his power the spread of the disease to others.

In order that, the young men and women of the colony may on leaving school be given some idea of their public duties in this connection I would suggest that there be added to their final course of study a simple treatise which might be drawn up by the Chief Medical Officer of Health for the colony, a treatise which would place them in possession of a few of the fundamental laws of public health and elementary hygiene, a treatise in which the names of the diseases which cause the greatest mortality in New Zealand might be mentioned.

The Medical Profession.

Then, as to the third factor of which I have spoken, a highly qualified medical profession: To enable one to page 5 judge of the proficiency of a profession it is necessary to look to the quality of the education the students and members of that profession receive at their own University. The Otago University provides for a five-years course for the M.B. degree, and, if we may judge by the high position taken by the graduates of the Otago University when they visit the Old Country in order to take degrees in different examining centres, it is safe to say that the standard aimed at and attained is a high one. But, in order to obtain a high standard of proficiency throughout the profession in New Zealand, it is essential that no graduates of a foreign school whose standard of education falls below our own—those, for instance, which only have a three or four-years course—should be permitted to practice the profession of medicine in New Zealand without first passing the final examination which is held every year at the Otago University. And I consider, moreover, that, although it may be seeking protection for the medical profession in New Zealand, medical men from those countries in which New Zealand graduates are debarred from practising should not be allowed to practice in New Zealand without first passing the Otago University examination.

I have briefly endeavoured to show that in New Zealand at the present time we have a strong partnership, consisting of the Government, a highly educated public, and a profession willing to do all that lies in its power to bring about such a condition of things as would conduce to a still lower death-rate and the making of an improved physical condition of the people. In order to bring about a diminution of the death-rate not only is it necessary to make a careful study of diseases in the living subject, but it is necessary also that fullest opportunities should be afforded of acquiring a more accurate knowledge of the results of disease after death.

In all large hospitals and kindred institutions for the teaching of the medical profession there are appointed pathologists whose duty it is to study and report upon the results of disease in the dead, and students are given ample opportunity of studying these same results at the hospital, but as soon as a student has taken his qualifications and leaves the hospital to page 6 start in private practice his opportunities of studying after death the effects of disease become very limited. For my own part, I believe it would be to the interests of public health if a post mortem could be made after every case, or almost every case, of fatal sickness. To allow of such a proposition being carried out it would be necessary to appoint one or more pathologists in each city, whose duty it would be to make a special study of those diseases which are affecting most largely the public health of the colony. Under such a system an individual who had the misfortune to succumb to a particular disease would be handing down to the rest of the community valuable material for an accurate knowledge of the effects of the disease of which he died—a knowledge which might and probably would have a decided effect on the earlier recognition and treatment of the disease in future generations. Moreover, this would also enable medical men to systematically gauge the importance of the symptoms which were present during life, and would be the means of forearming the profession to combat that form of disease in its earlier stages in the future. They would become familiar with the changes produced in the different organs during the course of the malady. A regular system of post-mortem examinations would also do away with the slur which is sometimes cast upon medical men that their mistakes are buried with their patients, and it certainly would lead to greater care and attention to the patient if that wore possible. To the general practitioner, often when opportunity offers and a post-mortem examination appears advisable it is impossible for him to make it owing to the risk involved of afterwards attending sick persons, more especially confinement cases. A post-mortem examination in every case would act as a deterrent to crime, and more particularly the crime of poisoning. The poisoner would know that before the body of his victim would be disposed of there would be a careful examination. An examination after death would also protect the helpless infant and young child from the sufferings: of starvation and neglect. It would also act as a deterrent against the crime of abortion.

I have said before that one of the most ennobling effects of education is to induce people to give their page 7 best energies to the State, and if we carry that argument to its logical conclusion it may be assumed that the same education will remove from them any objections to conferring such a benefit upon the community as a more accurate knowledge of the disease from which they died. It would be a part of the duty of the pathologist to certify the cause of death to the Registrar-General. By this means there would be an absolutely certain and accurate compilation of the death statistics. There would be no such class as ill-defined and non-specified causes. If, then, a person has during life exercised his educated intelligence for the benefit of the commonweal—speaking from a public-health point of view—by preserving in himself the highest standard of health that he is capable of, by preventing the spread from himself to others of any contagious disease from which he may have suffered; if by his death he has given up what knowledge the study of the disease to which he has succumbed may reveal for the sake of his fellow-creatures, then I believe he will have exercised his duty of citizenship as far as public health is concerned to its fullest extent.

Contagion and Infection.

A very large number of the diseases which affect our death-rate are due to some infective germ or bacillus which, by contagion, causes the spread of the disease from one to another, and I may state as examples scarlet fever, diphtheria, whooping-cough, influenza, typhoid fever, epidemic pneumonia, phthisis, &c., and our duty as medical men is to prevent as far as our knowledge allows a spreading of the disease. We are careful to isolate the patients in hospitals or private houses; to have them nursed by trained women who thoroughly understand the laws of infection, and we use all kinds of methods of treatment which have as their object the destruction of the germs of the disease and the restoration of the patient to health. Sometimes it happens that the dose of the disease—if I may so term it—which is introduced into the blood is too virulent, and in spite of all our efforts the patient succumbs.

Some of the diseases which affect our death-rate are caused by morbid growths, such as cancers, &c. page 8 Our present method of disposing of that mass of disease—germ-infected tissue or cancerous infiltrated tissue—is inconsistent with the methods of germ-destruction which we adopt during life. Our present method is to coffin the body with its diseased structures and the germs of disease, and to bury it a considerable depth in the ground. Probably to all of us during the course of our experience in practice cases where the dead and even the buried dead have affected the health of the living are not uncommon. To cite an example, not long ago a patient died of a form of pneumonia. He was put into the coffin, which was closed. His brother, aged forty-one, came down just before burial and wished to see the face of his dead brother. The coffin was opened. This happened on a Tuesday; the healthy brother, apparently in the best of health on the Tuesday, died of the same disease on the Friday. That mass of germs, whose period of active life is unknown to us, is put into a closed coffin (which in the course of a few years must decay) and is buried in the earth. To cite another case, a body was buried, and through excavations being made was brought within a few inches of the surface. A depression took place immediately above the body, and this became filled with water. A person wishing to fill up this depression attempted to remove the water, which was foul-smelling, but he had to desist after ten minutes' work. He became infected with a disease which seriously affected his health for a period of some months. This body had been buried for fifty years. Of what disease he died is unknown. I believe that a virulent epidemic of yellow fever was traced to the opening-up of an old cemetery in Rio.

If, however, the body is examined after death by a skilled pathologist, and the exact cause of death is certified to by him—it being a part of his duty in all cases of suspicion to examine the contents of the stomach and other tissues for poison—then this method of the disposal of the dead might give way to a method more in keeping with our action in treating disease during life, and the dead body with its germs of disease cremated. Even after cremation, if there happen to he any suspicion of death having been caused by arsenical page 9 poisoning, the arsenic can be detected in the ashes of the cremated bodies. I fear, however, that this more complete and cleanly method of disposing of our dead will not become universally adopted for many years to come.

To illustrate how the uneducated mind views cremation I will recite you a story which I have heard told: A dignitary of the Church had several parishes under his control to which he appointed vicars. To one of these he appointed a clergyman who became extremely popular. After a few years he removed this parson to another parish, much to the disapprobation of the people with whom he had been living for so many years. Shortly afterwards the dignitary died, and by the desire stated in his will was cremated. When one of the old parishioners, who had been annoyed at the removal from his parish of his favourite pastor, heard of it he exclaimed. "Well, it served him right for taking Mr. So-and-so from us."

Three Serious Diseases.

I wish now to consider briefly three classes of disease the study of which would help to diminish our death-rate. I refer to puerperal fever, phthisis, and cancer. It ought to be possible to reduce the mortality from puerperal fever to a minimum. The number of deaths which resulted from puerperal fever in 1902 was registered as twenty-five in number. Although this does not seem to be very high, it does not in any way indicate the number of women who have been invalided more or less for life as the result of disease brought about by septic infection. In order to minimise as far as possible the amount of disease to which women are liable at childbirth, it is necessary that every woman about to be confined should be given the opportunity of placing herself under the care of a duly qualified and registered nurse. It is, unfortunately, at the present time in New Zealand impossible for any woman to qualify as an obstetrical nurse; she has to go either to Melbourne or Sydney or to Great Britain to obtain the necessary certificates. This entails a much greater expense than most women can afford. An effort should therefore be made to establish either in one or in all the four principal centres of the colony a school for the instruction page 10 of women in obstetrical nursing. For such a purpose it would be necessary either to build a special hospital for the benefit of the poor, or to convert such a home as we have now in Wellington—namely, the Alexandra Home—into an obstetrical hospital. The maintenance of such a hospital might be borne partly by fees paid by the patients, by the fees charged to the nurses for the course of instruction, by public subscription, and possibly the addition of a subsidy from the Government. The period of instruction should be at least twelve months. There should be weekly lectures given by medical men, and daily lectures by a qualified matron. These nurses, before receiving a certificate, should attend at least ten cases in the hospital, and ten cases under medical supervision in private houses. They should also be taught the care of infants, especially relating to the causes and treatment of infantile diarrhoea. The examination of these nurses might very well be held at the same time as the examination of the ordinary medical and surgical nurses, which is held yearly under the Government Nurses' Registration Act. By having thoroughly trained obstetrical nurses, who would have been taught all the more recent methods of guarding against the possibility of septic infection, the dangers immediate and remote attendant upon childbirth would be very materially lessened, and the mortality of new-born infants markedly decreased.

At this point I would like to call attention to the practice among women of artificially feeding their infants, and I feel it my duty as a medical practitioner to state that the natural feeding of the child by the mother does undoubtedly conduce to the health of both. Nor can I abstain from referring incidentally to the subject which at the present time is occupying the attention of all thinking people—that is, the decreasing birth-rate of the Australasian Colonies. The birth-rate in New Zealand in 1903 was 20.61 per 1,000 of population, which shows that in New Zealand there is a very good margin over the death-rate. An ex-haustive report has within the last week been prepared by a Commission specially set up in New South Wales to inquire into the subject, and there seems to be no doubt that if an effort is not made to divert the inclinations of the people from unwholesome channels page 11 the sacredness of the marriage-tie will be jeopardized and the very existence of the race threatened. It is a matter which requires the earnest consideration of both the men and women of our race. So soon as a people begin to consider their own selfish ends to the exclusion of the well-being of the community as a whole it follows that in the end the race must surely suffer; and, moreover, interference with functions that are natural to the body must produce deterioration and disease, and such dreaded diseases as melancholia and other forms of mental disease and cancer.

Spread of Phthisis.

The disease which causes the heaviest mortality in New Zealand is undoubtedly phthisis. Very great interest is now being taken in all parts of the civilised world in the subject of the prevention and cure of this too common disease, and it is important to note that His Majesty the King is taking an active interest in the research which has for its object "the prevention and curative treatment of consumption." It seems to me that, in the lesson on the elementary laws of health which I have suggested should be impressed upon the children of the Seventh Standard before leaving school, one of the things to be explained would be the cause of this disease. They would be informed that a chronic cough is a source of danger, that the frequent catching of colds is very often a predisposing cause of consumption by rendering respiratory tracts less able to resist the disease, and that the germs of the disease are in the breath and phlegm of persons suffering from pulmonary phthisis.

I would suggest also, in addition to imparting such knowledge as I have above stated, that there should be a periodical examination of the weakly children in our public schools. By such an examination the family predisposition to any disease might be discovered, and, at any rate, the signs of early phthisis might be detected and arrested. I would recommend that at the commencement of each year the height and weight of each child and its age should be taken. By this means of periodical examination the Government would obtain a valuable report upon the health and physical condition of the young in the country.

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I would like here for the benefit of the public to assess the infectivity of pulmonary phthisis, because it is possible, in the eagerness which we may display to arrest the disease, to become unduly harsh in our treatment of those who are unfortunate enough to suffer from the complaint.

Dr. H. Trimbell Bulstrode, in delivering the Milroy Lectures of the Royal College of Physicians, London, has pointed out that at the present time there may be said to be two schools of thought with regard to the channels of infection between man and man: the one school maintaining that the greatest danger is to be attributed to the tubercle bacillus contained in the dry sputum, whilst the other considers that there is more potency for harm in the droplets thrown off by a tuberculous patient during coughing. He admits that pulmonary tuberculosis is infectious, but holds that the communicability of the disease can only be contrasted, but not compared, with that of such diseases as smallpox, whooping-cough, typhus, &c. I will quote also from another authority, Dr. Newsholme, who believes that we must accept Dr. Bulstrode's statement cum grano salis. Dr. Newsholme states that "Phthisis is caused by phthisis, and does not occur, so far as we know, apart from the existence of a previous patient suffering from the disease. The tubercle bacillus is not ubiquitous. It haunts the vicinity of the consumptive. An extensive experience amongst notified cases compels me to the conclusions that defective nutrition, insufficient sunlight and ventilation, domestic uncleanliness, are mere adjuvants to the spread of the disease, and that this spread may occur in their absence. Unless cleanliness involves also the prompt destruction of infective material, infection may spread almost regardless of environment." He illustrates a case of infection which I will now read: "Mrs. X. lived in a large house open to the sea and in an excellent sanitary condition. After several years' illness she died from phthisis in May, 1902. The disease was acquired before coining to the town. As shown in the following scheme, her only child died seven months earlier from tuberculous meningitis, and her sister, who nursed her for some months before she died, had a 'very bad cough' when she left the town some months page 13 after Mrs. X.'s death. Y. Z., aged eighteen years, entered Mrs. X.'s service as general servant in November, 1901. One of her daily duties was to wash Mrs. X.'s handkerchiefs and to clean out her spittoon. No precautionary instructions were ever given to her. She left her place in the following April, when she was admitted to hospital suffering from 'bronchitis and pleurisy.' Before entering Mrs. X.'s service she had been in good health. She subsequently returned to her mother's home, and died there from acute phthisis on the 18th July, 1902. Her brother V. Z., living at the same address, who up to the onset of his illness had a healthy outdoor occupation (driving a cart for a news-agent), was notified on the 6th January, 1903, to be suffering from phthisis. He was then stated to have been ill for only nine weeks, though he looked ill for a few weeks previously. The early diagnosis was made in consequence of the detection of tubercle bacilli in his sputum. He died from acute phthisis on the 30th April, 1903. Meanwhile a sister, W. Z., entered Mrs. X.'s service just before her sister Y.Z. left it, and took on the latter's duties, except that she declined to wash the handkerchiefs of the patient. (These were sent to wash without any preliminary treatment. What about the poor 'sorter' at the laundry?) Mrs. X.'s sister now washed out the spittoons. W. Z. swept out the sick-room. She remained in Mrs. X.'s service until January, 1903, and as she frequently visited her sister Y. Z. during this time she bad double opportunities of infection, assuming carelessness on the part of either patient. On the 29th January, 1903, W. Z. was notified to be suffering from phthisis. She was admitted to the borough sanatorium on the 19th February, and discharged on the 21st March greatly improved. On the 4th June she was readmitted owing to a return of cough and expectoration. She left on the 2nd July, and since then has kept well and is in domestic service." He points out also that phthisis is rarely acquired by nurses in public institutions, and also that it is frequently acquired by nurses or relatives in private houses. Which means that in hospitals every care is taken to see that the expectoration is received into spittoons containing perchloride of mercury or some other germicide; the wards are kept page 14 scrupulously clean and well ventilated, and every precaution taken. In private houses it is often not possible to take all the same precautions as you would in a hospital. However, I consider that when a person knows he has phthisis he ought to find out all the precautions it is necessary for him to take to prevent his communicating the disease to his neighbour. The sources of infection being limited, it is certain that if all proper precautions are taken the risk of infection is not so very great.

With regard to the cure of this disease, it is to be observed that Dr. Marmorec, late of the Pasteur Institute, states that he has been able to isolate the true toxin from cultures of the tubercle bacillus. He has tried the toxin on patients, but the cases are at present too few to allow of a definite opinion to be formed as to the therapeutic value of the serum.


The alarming increase in this colony of the class of diseases called cancer is a subject which must receive the earnest attention of the medical profession. It is impossible in an address of this kind to touch however lightly on the different theories as to the cause of cancer. The subject, however, is of such importance that I hope you will allow me to quote from the Official Year-book the principal organs which are affected in males and females in the cases of death from cancer. In males in 1902 the stomach was affected in a much greater proportion than any other organ. Next to the stomach came the mouth, lip, and tongue, &c.; then the intestinal canal; and then the liver. The other organs of the body were affected to a very much less extent. In females the stomach was often affected, but to a less extent than in males. In equal proportion to the stomach come the organs of reproduction, then the mammary gland, then the intestinal canal and liver, then the mouth, tongue, throat, &c., the other organs very slightly affected. It would also appear that the time of life at which deaths from cancer begin to be numerous is 35 for males, and 30 for females. The maximum of deaths is reached at the period of 60 to 65 for males, and 55 to 60 for females.

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I would like to state here that if I were asked by a healthy man how he should direct his life in order that he might live to an old age I would advise him to ascertain, if possible, to what disease he was most liable by heredity, and by care and study delay as long as possible, or altogether prevent, its advent. I would also advise him to be moderate in all things—in his eating and drinking and smoking, in his exercises and amusements, in his studies and occupation. There is no doubt that abuses and excesses cause deterioration and loss of vitality and susceptibility to disease, and that injury and constant incitations in a debilitated person can convert a normal cell into a malignant one, a healthy tissue into a diseased one, and a normal structure into a cancerous one.

To arrive at the true nature and origin of this disease, and eventually its prevention, it is necessary to have constant and numerous examinations made after death by skilled pathologists. The present treatment of the disease is very unsatisfactory. It almost invariably consists of excision where excision is permissible. The treatment by the x rays and the violet rays seem to relieve pain, and in many instances to cause retrogression of the disease, but, unfortunately, the disease is apt to recur. The serum treatment is of too recent application to give any decided results. The definite results produced by radium and helium are at present unknown.

The Insane.

Turning now briefly to a subject which affects the self-respect of the community, it is with great pleasure that we see the Government is changing the name of our asylums into that for "hospitals for mental diseases." I would urge it now to make some further changes. I would suggest that they should build an annex to our principal hospitals, which should be used by persons who feel that they are becoming mentally afflicted. These persons might be allowed to enter such buildings as patients voluntarily without being in any way certified to, and should be discharged when cured of their mental ailment. I would urge also that in those cases of mental disease where it is necessary that a certificate signed by two medical men should page 16 be given the document signed might be altered as follows:—
  • "The Hospital for Mental Diseases Act, 1882," Sections 5, 6, 19, and 25; and "The Hospital for Mental Diseases Act Amendment Act, 1891," Section 2.
  • Certificate that a Person is Suffering from Mental Disease, and a Proper Person to be Detained Under Care and Treatment.
I, the undersigned, being a medical practitioner in actual practice, hereby certify that I, on the___day of___, one thousand eight hundred and ninety-___, at___, separately from any other medical practitioner, personally examined___, of ___, and that the said is suffering from such-and-such form of mental disease within the meaning of this Act, and a proper person to be taken charge of and detained under care and treatment; and that I have formed this opinion upon the following grounds, viz.:—
(1.)Facts indicating mental disease observed by myself.
(2.)Other facts (if any) indicating mental disease communicated to others.
On the above facts I advise that he be taken—
(1.)To the Hospital for Mental Disease.
(2.)To the annex attached to the Hospital.

This annex to the hospital would practically serve the purpose of an intermediate place between the general hospital and the special hospital.

The Maoris.

Touching briefly upon the gradual diminution of the numbers of the Native race—a race the perpetuation of which it should be our earnest endeavour to maintain—it is gratifying to note that one of their own number has been' intrusted by the Government with the maintenance and improvement of the health of the Maori people. It is an astonishing feature of the energy and adaptability of the Maori people that they have been able to so quickly adopt the rules and usages of our civilisation, and that in the space of fifty years they should have been able to produce men who were able to pass the examinations in different professions such as medicine and law is a remarkable fact. No doubt Dr. Pomare, with the aid of the Natives themselves, will be able to check the death-rate amongst the Native people.

Lately I happened to be travelling in the Waikato district, and while being driven by a Maori for some page 17 distance I engaged in conversation with him, and found that he was well informed on many different subjects; that he was well clad and shod, and understood the value of warm clothing both night and day and wherever he was; that he understood the European ideas of work and continuity of work; and that he was quite as well informed as the average European workman, if not better. I mentioned to him that he seemed to me to be different from other Maoris I had met in the district, and I asked him how it was. He told me that he had been brought up from infancy by Europeans.

Shortly afterwards I was asked to go to a Maori pa to see a young child which was suffering from whooping-cough. The child was in a tent, the ground of which was partly covered with mats. The only clothing the child had was a little vest and a shawl. The little thing was suffering a great deal of pain from the commencement of an attack of pleurisy. The parents and relations of the child exhibited the greatest anxiety for his health, but had no idea at all how a child of that age should be clad, or fed, or housed. The only chance they had of getting a prescription made up was by sending it forty miles. The prescription was sent, but after a week no medicine had arrived. If the child, as it often did, cried at night, and would ask to be taken out into the fresh air, they would take the child out into the open at any time during the night. I felt perfectly helpless, and could not help thinking at the time that if I could only get the services of a trained nurse that child's life might have been saved, and I also thought of the strong Maori who stated that he owed his knowledge of the value of proper clothing, &c., to having been brought up by Europeans; and the thought has struck me since that it might be possible to have nurses in the different districts where the bulk of the Maoris live, and these nurses might be detailed off to look after the young Maori race under the instruction of Dr. Pomare. If it is possible to save the race, it will be so by looking after their young, and by taking charge of their young and bringing them up under European methods. One often hears of philanthropic women who go away to India and China in order to take part in mission-work in those countries. I would suggest that there is in New Zealand an opening for page 18 such women, first of all, to make themselves competent nurses, and, after that, to devote their energies to the preservation of the health of the young of the Maori race. In connection with this care of the Maoris by medical men of their own race, it is interesting to note that the New Zealand University has this year placed upon it rolls the first Maori medical graduate. Moreover, I am informed that his student career was remarkably satisfactory, and that he passed a brilliant examination.

In conclusion, I wish to draw the attention of the profession to the Benevolent Fund. The Benevolent Fund contains only seventy-one members, and has now to its credit a little over £700. No use can be made of this capital until £1,000 has been subscribed, when the interest of that amount will always be available for any deserving case. I would urge members to subscribe to this fund, and would remind those who wish to do so that a donation of £10 would make them life-members. The committee of the fund, without touching the capital, have already made several grants in specially urgent cases.

I wish to thank you for the kind way in which you have listened to what, I am afraid, is rather a tedious address. I also wish to draw your attention to the Medical Defence Union, which only numbers about a hundred members. The subscription to this is very small, only 5s. for members of the New Zealand Branch, and it is to be hoped that a large number of members will join this year.


Dr. Colquhoun moved a vote of thanks to Dr. Collins for the excellent address he had given. He might mention that a distinguished layman who was sitting next him said there was not a single word of the address he had not followed with interest and delight.

The vote of thanks was carried by acclamation.

The President read a letter from Dr. Irving, of Christchurch, in reference to the Defence Fund and the Provident Fund. He did so in order to bring the matter again before the members of the Association. There was no doubt that in years to come there would be numerous calls upon both, and it appeared to him that both funds should be supported by all medical men.

Printed for the Author by John Mackay, Government Printer.—1904.