CO885(2-3) — Page 203

Suminary.

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This first kind of reports would be for the information and satisfaction

of the inspectors.

The second sort are already to some extent in use, but require to be modified if they are to produce much benefit. They are, general reports made at stated periods (1) by the medical chiefs, and (2) by the inspectors where they exist, of the condition and further requirements of the institutions. These reports should be as short as possible, and directed particularly to certain prescribed points, and might be made semi-annually. If they were sent to this country and published in one general volume, together with Reports of the kind next to be mentioned, and the whole re-distributed throughout all the colonies, they would become a valuable means of comparison and of dis- seminating useful suggestions and true principles of management.

The third sort are reports of a statistical kind for scientific purposes. It is no doubt very important that such reports should be periodically made up on an uniform plan, but they are involved in so many difficulties that it does not appear to be desirable to attempt to introduce them generally, except in the most simple form. It must be remembered that a mere number of tables of admissions, discharges, ages, duration of disease, per-centages, antecedents, &c., resulting in isolated numerical sums, are of no scientific valne and cannot lead to any result. What is wanted is not merely numerical statistics of many sets of facts, but the relations between such different sets of facts. But these relations cannot be exhaustively shown without an almost infinite series of comparative tables. It therefore becomes necessary to select those particular series of facts between which it is especially desired to discover a relation, and to frame a table for each such relation. But even with the most frugal selection of relations to be illustrated, and with the clearest directions for filling up the forms, the work has some tendency to become too It must also be cumbrous for any but practised statisticians to manage. considered that most of the colonies are too small to give any security that in them exceptions may not override the ordinary facts and give a false colour to the whole, and that even if full statistics were obtained from all the colonies, the area from which they would be drawn would still be but a small portion of the globe, so that the importance of the returns would not by any means equal their number.*

An extended form of statistical returns for lunatic asylums has been prepared which is intended to illustrate those relations which seemed to he most important. This form has been modified by the Commissioners in Lunacy, who suggest that it should be tried as an experiment in one of the larger colonies. Canada would seem to be the best field for trial, both because of its nearness and because of the number of its asylums, and of the perfection of its system of inspection. There is also appended a short and manageable form for all other asylums, and another for hospitals. If more full statistics are desired from hospitals, it will be desirable to procure forms from the College of Physicians, or to obtain a sufficient sanction for those which are given in Miss Nightingale's "Notes on Hospitals" (1863), and which are not untried, and appear to be approved by high authorities.

There would be this advantage in enforcing somewhat elaborate returns— that whether accurately filled up or not, they would lead to greater care and diligence in the use of the ordinary case-books and records.

52. To sum up the measures proposed in the three last sections, it is suggested-

1. That for those colonies, for the condition of which the Crown is responsible, a draft ordinance should be framed to regulate all conditions of sites and construction in future hospitals and asylums, and to enforce such alterations in existing ones as may be necessary for the provision of proper sewerage, drainage, space, area, ventilation, water supply, light, and other sanitary requisites; and also, if this should appear practicable, to fix a minimum number of attendants in each kind of institution, with other permanent economical regulations; and that the great expediency of framing and passing similar measures should be suggested to the legislatures of the colonies which have responsible governments.

H. That where boards exist, if the local authorities should see fit, they * It would be necessary in general to limit the demand for returns to such as could be furnished by officers of ordinary intelligence without any unreasonable amount of trouble.

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should be remitted to the functions of appointing the medical chief, controlling the finance, hearing complaints and reporting them to the inspectors or the Governor, and visitation; whilst, on the other hand, they should be deprived of all executive power, which should go to a resident medical chief; that their legislative power should cease, a limited authority to alter the regulations being transferred to the medical chief and the inspectors; and that the medical chief should exercise the patronage and control of all offices except that of the clerk or bursar, which should remain with the boards, and that of the chaplain in the case of asylums, which should be given to the governor,

III. That inspectors should be appointed to visit and report, with especial reference to sanitary condition, and should have the power of suspendling all officers, except the medical chief;

That reports in the form given in Note 5 for asylums, and similar ones for hospitals, should be required to be filled up by all head keepers and matrons, and sent regularly to the inspectors;

That statistical returns should be demanded from the medical chiefs of hospitals and asylums, in the forms set forth in Notes 6 and 7 respectively;

That the more extended additional statistical form of Note 8 should be tried in the Canadian asylums, if the authorities should see fit.

That the form of questions given in Note 9 should be required to be filled up by all official visitors, and sent to the inspectors; and

That the medical chief and the inspectors should make independent reports of the condition and requirements of the several institutions, and that these together with the statistical returns should be published, and redistri buted throughout the colonies.

Should these changes be made, it would be necessary to define and the distinguish accurately the powers and duties of the medical chiefs, tl inspectors, and the boards.

53. These three principal recommendations for Acts to regulate sanitary arrangements, for the transfer of powers from boards to single chiefs, and for more complete inspection and reports, apply equally to hospitals and asylums. Of the following minor suggestions, the first six contained in Section 54, also are applicable to both; the seven in Section 55, regard hospitals' only, and the remainder in Section 56, have reference only to lunatic asylums. consi- One alone of the whole number (that in Section 56, v) involves any derable expense.

54. Minor suggestions, with reference to both hospitals and asylums:- i. (a.) Open sewerage, sewerage into adjoining cesspools witliout outlet, and untrapped and unflushed sewerage, ought not to be permitted.

(b.) As a condition of easy and effectual ventilation, as well as for econo- mical reasons, associated wards should in general contain not less than sixteen nor more than about thirty-two beds.

(c.) It is equally necessary for ventilation that there should be allowed for each patient, 1,000 cubic feet of space, in associated wards, and 1,500 in single rooms in temperate climates, and a quarter more where the climate is tropical, and this in addition to thorough ventilation and frequent cleansing of walls, ceilings, and floors.

(d.) In associated wards the total superficial space allowed to cach patient, including the area of the bed, should not be less than 7 fect by 11, in general hospitals, and about 5 by 9 in asylums. The height of the ward should not fall short of 13 feet, nor the width of 22 feet.

(e.) The air introduced by ventilation must not have been previously heated. Such heating destroys its purity and gives it unwholesome properties. The only proper means of ventilation are open grates and ventilating flues.

(f.) In very cold climates, as in Canada, sufficient warmth cannot be obtained by hot water pipes. Stoves or grates are the only efficient

means.

(g.) It is of great consequence that the wards should be well lighted. It is laid down by high authority that in hospitals the windows should be ope third of the wall space.*

(h) Not less than 25 gallons of water per patient per diem, exclusive of

Notes on Hospitals, p. 19.

D 2

Minor Suggestions.

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