CO885(2-3) — Page 202

PUBLIC RECORD OFFICE

TUITIT

Reference -

C.O.885

3 PUBLIC RECORD OFFICE, LONDON

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perhaps the control of the finance, together witra power of visitation besides or in conjunction with other inspectors, and a limited authority to hear complaints brought against the medical chief, and to report their conclusions to the inspector-or the Governor. The first of these functions is one which requires only honesty, and could hardly be transferred with equal convenience to any other person or body; and for the second, the boards are not necessarily unfit, though the work might be more efficiently performed by the auditor-general of the colony in cases where there is no property to be administered. If they should retain this duty, it would perhaps be advisable that, in connection with it, they should have the appointment of the clerk or bursar, and that they should be incorporated and granted all necessary powers for holding and dealing with interests in realty. In case it should at any time appear necessary to remove a medical superintendent, the power of removal, subject to the sanction of the Governor, ought to follow that of appointment.

As for their legislative functions, these ought to cease to be necessary. If a proper code of regulations were drawn up once for all by competent professional authorities, nothing more would reniain to be done except to give the medical chief the power to make alterations in the executive arrangements subject to the approval of the inspectors, and, as at present, of the Governor, or to give a similar power to the inspectors themselves.

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The patronage of all inferior offices, such as those of head-nurses nurses, or keepers, ought undoubtedly to go to the medical chief. ought to have the power both of appointment and of summary removal, since no one else can judge of the actual efficiency of the attendants, and great harm might be done to the patients by delay. Should the removal be unjust, a complaint would lie against the chief to the board, as suggested above.

A difficult question arises with reference to the appointment of chaplains in asylums. However great the spiritual or the disciplinary value of religious services may be to the insane, want of judginent in their use may sometimes give occasion to more than countervailing evils. Considering the delicacy of the question in cach case, it would seem to be desirable that the appoint- ment should be made by the governor of the colony,

There remains the power of visitation and inspection, which must form the subject of a separate section. As suggested above, it would be well that the boards should visit and report at certain and uncertain times, in con- junction with other visitors, but they are very unfit to be the sole depositaries of such a power.

With reference to the measures suggested in this section, it is to be observed that they do not necessarily involve any increase of expense. It may not always be easy to find a medical officer who will reside and relinquish private practice without a larger salary than in some cases is at present provided; but on other grounds it is absolutely necessary to find one on some terms, and under the proposed system he may not be less willing to come, inasmuch as be will have larger powers and freer scope for action.

A note of the institutions to which it is suggested that these provisions should be extended more or less completely as may be practicable in each case is appended."

The four hospitals of Victoria are managed by committees of the subscribers. The nature of their government has been described in section 36. The evils which exist in them are of a kind which would disappear under the influence of a sanitary act, and of more effective inspection.

But in those institutions where the provisions above described might be adopted, they would at once cut off the source of those two great classes of defects which flow from divided opinions and want of specific knowledge in the governing body; they would make abuses of omission more rare in proportion, as what is one man's business is more likely to be done than what may be the business of either of several men: and though it may be true. on the other hand, that the plan of government by a single chief is compatible with the existence of greater positive wrongs than any which the mere inefficiency of boards places it in the power of subordinates to practise, yet such a plan, whilst giving greater power to commit them, would admit also of more complete and more manageable securities against their commission. Such securities are to be found in inspections and reports,

• See Appendix. Nør - H.

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51. Where these are wanting, there is no protection against the existence Inspectors. of abuses even under good forms of government. Much less under the present forms is it possible to be satisfied of the non-existence in many cases of graver faults than any which are confessed, merely from their not appearing in answers made by officials who are not under the check of regular and efficient inspection, and who, if they are responsible, have a strong reason for silence, or, if they are so little responsible as to be relieved from fear of blame, must be ill situated for the acquisition of any certain or intimate knowledge of the conduct of their subordinates.

It is suggested that in all cases there should be general inspectors not otherwise connected with the institutions, whose duty it should be to make regular and irregular inspections, especially of the sanitary arrangements, to receive the reports made by inferior officials and by unofficial visitors, and to report at stated times to the Governors, suggesting measures which may appear necessary.

The institutions already subjected to such inspection are, with one temporary exception, amongst the best of the whole number, and they owe their excellence io the exertions and suggestions of their inspectors. The faults which they still retain are those sanitary ones which it appears to be hopeless to attempt to cure without the operation of sanitary acts.

In the larger colonies, with many institutions, it would be necessary to appoint two or more inspectors, and to give them regular salaries. In the smaller ones, where the work would be light or occasional they might be unpaid, or receive only fees for their reports.

In addition to such general visitation, and to the present inspections by the boards and the Governors, it would be well that visits should also be made in all cases by judges and juries, and that their attention and that of casual visitors should be directed, by a regular form of questions, to those important points which are likely to escape their notice.

General inspections must be further supplemented by a better system of Reports. reports. Reports may be of three kinds. The first sort are reports of the actual working of a system made by the officers who carry out the system to the inspectors or other governing body; and this kind cannot be too many or too minute, for they are the best, if not the only means of keeping the officers in a state of thorough attention. An attendant will slur over many things if he is to have himself for his sole judge, which he will do exactly and conscien- tiously if he has to write down an account of his measures, and of his reasons for them, for the judgment of superior authorities; and the mere fact of having to state reasons will necessitate his having some reason in cases where he would otherwise act by impulse or routine. This is of especial importance in the case of those who have the care of lunatics. It ought to be the first principle in the treatment of the insane, to deal with them as nearly as may be as if they were sane, and to infringe firmly when necessary, but otherwise as little as possible, both as a matter of right and for the

of purpose habits and natural independence. It is not more the business of a keeper to cure, on their do all that is necessary to supplement what is wanting in the judgment and self-preservative instincts of the patient, than it is his business to do no more than this, and not to drive or confine him unnecessarily and yet in practice those who have had experience of lunatic asylums say that nothing is more common than causeless tightening or relaxing of discipline in particular cases, without consideration of whether there is any reason for so interfering or neglecting to interfere with the patient's inclination. If the keepers were required to report both the particular departures from rule, and also the reasons for them, they would be less likely to act without reasons.

la this view it is greatly to be desired that it should be made a part of the duty of all head keepers or matrons in asylums and hospitals to report any case of exceptional treatment, and the reasons for it, and a part of the duty of the inspectors to examine such reports, and judge of the validity of the causes assigned. A list of questions to be filled up weekly by the chief keeper of each ward of an asylum with reference to this object has been framed by a Commissioner in Lunacy, and is appended in Note 5. A similar form for head nurses in hospitals ought to be obtained from medical authorities.

• Appendix, Note IX.

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