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hospital, and were it not for the great
assiduity of one of our Magistrates, Captain
Rough, who is a constant visitor at the
hospital it would be practically uncared
for by the public,—for the Superintendent
could not possibly find time for such an
office—and a great and unreasonable respon-
sibility is thrown on the medical attendants,
whose duty, besides their proper function of
prescribing for the sick, should be confined, to
conferring with the committee upon such mat-
ters as may require the advice of a Physician.
2nd. The position and tenure of office of
the medical staff is very indefinite, and not
such as to give them any permanent interest,
in the welfare of an establishment to which
they are only temporarily attached. Pend-
ing the removal of the Hospital to a site
the great distance of which will occasion an
increased demand upon their time, it will
be necessary for the Government, if they
wish to retain the services of professional
men whose time is of any value, to consider
whether it will be better to make a reason-
able increase in the payment of the visiting
staff, or to appoint a resident physician.
Patients who resort to hospitals, generally
do so from the desire they have, to be atten-
ded by medical men residing in the town,
whose private practice and therefore range
of experience is large. In England and
Australia, it is usual to secure the services
of such men, by a small salary, and by
adding to the staff a junior medical man, as
resident physician, who carries out the
instruction of the visiting staff, and whose
residence in the Hospital prevents any
undue encroachment on their time. These,
posts in England are generally filled by
young medical men, who have served their
time in the hospital, and are glad to avail
of themselves of a small salary and the oppor-
tunity of acquiring increased experience.
In this country a much larger salary would
have to be paid, to secure and retain the
services of an efficient man.
More than 25 per cent of the patients
treated were gold-miners from the West
Coast, and as the mining extended north-
wards into this province, there were evi-
dences of an increased demand on the
Hospital. During the past month (May,)
there were more patients in the Hospital
from the West Coast than at any time during
the preceding twelve months.
I am informed that a good deal of sickness,
such as is incidental to a mining population,
exists at the West Coast, and that there is a
general desire among the diggers under
medical treatment, to be removed to Nelson,
for the sake of the more speedy recovery,
which its better climate and accommodation
effect. Those who can afford it come at their
own expense, and are treated by myself and
other medical men in hotels and lodging houses;
but as many cannot do so, doubtless the
item for medical expenditure on the gold-
fields for the next year, will be very large,
and it will, in an economical point of view, be
desirable to enquire whether local hospitals
should be maintained by the Province, or
whether it will be better and cheaper to re-
move the patients, when practicable, by
steamer to the Nelson Hospital, where pro-
visions are cheaper, and the time requisite
for recovery shorter.
It is usual to estimate the relative cost of
hospitals by reference to the expense of each
occupied bed per week. From our estimates
of the past year it will be seen that the cost
per patient per week in the Nelson Hospital
is about 18s., a sum which would average
somewhat less, were the number of patients
to increase, as within certain limits no cor-
responding increase would be required to the
administrative department.
Many patients come to the hospital, who
have expended all their means in paying for
the advice of uneducated persons professing
to be medical men at the West Coast. To
remedy this evil it will be desirable that
some act should be passed by the General
or Provincial Government, authorising the
publication, once a year, of a list of the duly
qualified medical practitioners, in New
Zealand, for the information of persons re-
quiring medical aid.
Warm baths of different forms are now
considered a most valuable adjunct to medi-
cal treatment, when judiciously administered
in suitable cases, and I had hoped that the
establishment lately erected on the public
reserve in Hardy-street, would be available
for the hospital patients, and also for those
under the care of medical men in private, as
the ground was leased to the tenant for three
years free of rent. As, however, the tenant
publicly advertises some system of charlatan-
ism, and practises as a medical man, though
not in any way educated or legally qualified
as such, I am precluded from sending either
the hospital or my private patients to the
baths, lest, by visiting them for the purpose
of ascertaining whether they are properly
administered, I might be thought in any way
to sanction quackery. I think it my duty to
call attention to the matter in hopes that
Government may be able to find a remedy.
S. A. CUSACK, M.B., F.R.C.S.
Nelson, June 1, 1867.

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