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PUBLIC RECORD OFFICE
Reference -
ETLITTI
C.O.885
3 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT, PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
Medical Chief.
Clerk.
Sub-Chiefs.
Attendants.
Diel.
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rainwater, should be provided. It should be carefully analysed, to determine the proper material för pipes and tanks. The tanks should be covered in.
f. The resident medical chief should have qualified both as a surgeon and as an apothecary. He should pay especial attention to sanitary matters and to the conduct of the servants, and should have the charge of all records, and frequently inspect the wards, cells, and every other place, and the provisions in store.
In cases where the powers of boards may be transferred to him, he should have the same powers of suing for all dues and debts to the institution which at present belong to the boards.
iii. The clerk or storekeeper should examine all contract supplies before acceptance and all the stores daily. He should give the security of a bond for the performance of his duties. He may be non-resident.
iv. The institutions should be in all cases divided into sections, each under the superintendence of a head matron or keeper, whose especial duty it would be to enforce cleanliness, and overlook the inferior attendants, and to make daily reports to the medical chief and to the inspectors. Such head attendants ought to be well enough paid to make it an object to them to keep their places by zeal and honesty.
v. On the character of the attendants depends in a great degree, espe cially in asylums, the comfort, tranquillity, and chances of recovery of the diseased. Their wages ought to be liberal, and they should receive periodical increase for good service. They ought to be, if possible, sufficiently well educated to be able to read to the patients.
vi. Patients ought not to be limited in the quantity of their food by way of punishment, unless with the express authority of the medical chief. Also the food should be from time to time varied in kind, and should be, so far as may be practicable, assimilated to that naturally used by the patients.
55. Suggestions with reference to hospitals only :-
i. In many of the hospitals the existing small wards should be consoli-
dated wherever it is practicable, by removing the partitions.
ii. Provision should be made for limiting the period of office, if not in the case of the medical chief, at least in that of the other physicians and surgeons. Such a system was tried by Sir H. Barkly in Demerara, and afterwards by him introduced into Jamaica. It is said, by increasing the chances of appoint- ments, to induce the immigration of students.
iii. There will almost always be private practitioners who would be willing to visit as honorary medical officers. The external element thus introduced would be of great value.
iv. In every hospital having twenty beds or more there should be at least one resident medical officer who shall not be engaged in private practice.
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v. With proper provisions for sufficient space, area and ventilation, contagious and infectious diseases, with the exception of small-pox, may he received in limited numbers in general wards appropriated to adult patients.
vi. In wards containing less than thirty patients, the proportion of nurses should not be less than one to seven. For any number of patients not exceeding forty contained in a single ward one night nurse is sufficient. forty distributed in two or more wards at least two night nurses are required.
vii. Where there are many native or Indian patients there should be a native or Indian employed to advise as to prejudices and requirements. It is found in Mauritius and elsewhere that natives are very unwilling to enter the hospitals.
56. Suggestions as to asylums only:-
i. The provisions regulating the admission of lunatics into asylums are not in the majority of the smaller colonies sufficiently definite, or calculated to exclude the possibility of abuse. The forms which are prescribed in Nova Scotia seem to be well adapted for such small colonies as have not regularly organized Lunacy Commissions. The certificates should be made upon oath."
ii. Classification of lunatics is generally precluded by the nature of the buildings, but its want is in some of the returns made a matter of regret. It is, therefore, necessary to observe that all recent experience has proved much classification to be generally injurious. Many lunatics of one type
Appendix, Note 1V.
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confined to their own society only become confirmed by one another's example.
iii. This rule does not extend to the case of idiots. They are imitative, and are only made worse by contact with the positively insane. There is no doubt that they ought to be excluded from the general asylums, which they in several instances encumber, and which ought to be retained for those who are curable or dangerous.
iv. Where restraint is necessary the arms alone should be confined, and it is less injurious to the patient to be allowed to run or leap and work off his excitement with his legs free in a padded room, than to be forcibly held down by the strength of attendants.
v. The most important means for the proper employment and amuse- ment for the insane is a sufficiency of land for exercise and for cultivation. The Chief of the Toronto asylum, which is the best in Canada, says that "no curative means had recourse to in the treatment of insanity can be compared to that of moderate field or garden labour." The Canadian Inspectors- General of Asylums, Prisons, &c., perpetually urge the necessity for additional land. "The cultivation of the soil," they say, "is not only the most pleasing Canada, O. 13. occupation for the insane, and that in which they are apt to take most interest, but it is also the one most conducive to their bodily and mental health, and bears most directly upon the diminution of expense to the Government in their support." And again, "It is held by all writers on insanity that employment Canada, O. 87.
in the fields has not only a most beneficial tendency as a curative process in the treatment of the patients, but that it is, at the same time, a kind of employ ment in which patients can be induced to engage when they will refuse to do anything else. It is also a work in which many of them, though unwilling at first, come to take an interest, keeping alive the faculties of the mind, while it ministers to a healthy exercise of the body." In the United States, it is
asserted in the report of the Toronto asylum, no new public asylum is allowed to be established without at least 150 acres adjoining and the Commissioners in Lunacy of this country have laid it down that the land belonging to an asylum should, when practicable, be in proportion of not less than one acre to four patients.
It may, however, be doubted whether in tropical climates, out-door labour can be so extensively or beneficially employed. It would be desirable to invite suggestions from experienced persons as to this point, and as to the best substitutes which may be practicable.
Other means which may be suggested as of proved or obvious value are gymnasia, regular military drill, regular festivals to vary the monotony of life and provide subjects for expectation, music, books, newspapers, and games, which it would be superfluous to mention if the inventiveness of the officials did not at present, in many asylums, limit itself to walks in airing-courts and menial services.*
It is to be added that, since the insane in many cases are, and generally might be, employed in profitable work, there ought to be stringent regulations to prevent any being retained in confinement for the value of his services, an abuse of which there have been instances both in this country and in the colonies. With this object the attendants should be forbidden to derive any profit from the labour of the patients, whose work should be estimated, and the surplus value, if any, after payment of the cost of their treatment, be refunded to them on their discharge.
vi. Rewards in money, or otherwise, for good behaviour have been found to be beneficial.
vii. The friends of patients should be allowed to visit them on any days if they live at a distance, or one or two set days in each week if near, subject only to refusal by the medical in chief, the precise reasons for which refusal should be in each case notified to the inspectors.
viii. The proportion of attendants should be not less than one to fifteen patients.
ix. Separate establishments should if possible be provided for incurable patients. They are an incumbrance in curative institutions, and can be more
It is not meant that there is anything necessarily objectionable in employing to a limited extent, on some kinds of menial service, patients who have been used to it at home.
But in no case should such employments be the only or the chief resource.
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