CO885(2-3) — Page 205

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Despatches, 5,288, May 2, 1863; 11,542, Nov. 5, 1863; 12,052, Nov. 24, 1863.

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cheaply maintained separately. (See Report of the Select Committee of the House of Lords on the State of the Lunatic Poor in Ireland, 1843, p. xx., *and ss. 3805-3810.)

57. These suggestions are based chiefly on the reports and recommen- dations of the Commissioners in Lunacy, on the facts carefully collected and illustrated by experience in Miss Nightingale's "Notes on Hospitals," and on the statements of the defects actually existing in the colonial hospitals and asylums. The rules with reference to the residence of a medical officer in hospitals, to his restriction from private practice, to the size of wards, the space and area proper to be allowed to each patient, and the admission of cases of contagious and infectious diseases in general wards, have been submitted to the Royal College of Physicians, and have received the sanction of its approval and concurrence.

58. In conclusion it is to be observed, that it is vain to expect complete or permanent reformation until the existing systems shall have been changed by the transfer of powers to efficient and responsible persons, and by provisions for more complete and more authoritative inspections supplemented by more practical reports, or until some means shall have been found for enforcing regard to the primary and indispensable conditions of sanitary security. The measures which have been proposed for the attain- ment of these chief ends involve great changes and difficulties, but any reform which should be effectual would save as great difficulties in the future as any which would have to be encountered in the present. The state of these insti- tutions, if they are allowed to remain unaltered or half reformed in essential points, will long be a perpetual source of increasing complications, to be patched up by expensive makeshifts; whilst if these primary conditions are secured they will quickly and inevitably draw with them all minor reformis.

Though such reformation cannot be thoroughly effected in most cases without heavy initial expense, it would be an expense not wholly barren of returns. The outlay would produce good interest in the forms of speedier and therefore cheaper cures, of increased capabilities which would delay the often pressing need for extension, and in the quicker restoration of the sick to profitable labour. In this country it is calculated that every death of an agricultural labourer at the age of twenty-five involves a loss of more than 2001. to the wealth of the nation, and though the value of a labourer in the colonies may in some cases be less than his value here, in most it would be much more.

Another illustration of the economical difference between good and bad systems may be taken from Miss Nightingale's "Notes on Hospitals." It is there calculated that in Europe the annual cost of properly nursing 1,000 patients in wards of nine beds would be 12,8321. 58., and in wards of thirty beds, 6,600, or not much more than half. However this may be (and it is the calculation of one than whom no one has had greater experience), it is certain that the difference would he great enough to make reform desirable even from the point of view of interest. To this is to be added the considera- There is no excuse for tion of justice to those whom it is pretended to cure. any preventible excess in the rates of mortality or duration of treatment, and if institutions of mercy do not conform, so far as is reasonably practicable, to those conditions under which alone their patients have a fair chance of recovery, it must be a question in some cases whether they ought to exist at all,

PART IV.

59. Jamaica. The labours of the Commissioners appointed in 1861 to report upon the Kingston hospital and lunatic asylum, and to suggest such measures as might to them seem necessary for the improvement of those institutions, have left little to be done but to ascertain how far their recommendations have been executed. Great improvements, some of them dating from a period before the Commission, have undoubtedly been made, and in many important points the suggestions of the Commissioners have been, or are in course of

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being, carried into effect. At the hospital, two out of the three buildings for male patients are now in a generally satisfactory condition; a much-needed system of drainage and sewerage, thongh delayed by the failure of the engineer, is at last in progress; and out-patients receive relief at the house. or if necessary at their homes. The new asylum also promises in a short time to be complete and efficient, and the two Institutions are at length provided each with a separate medical staff, and both are subjected to a more complete system of visits and inspection, by the Governor, by an honorary board of inspectors, and by an officer whose especial business it is to scrutinize their sanitary and financial arrangements. But though many defects have been remedied much has vet to be done. At the hospital one male building remains unimproved and deficient in space and accommodation. The female building is still as unfit an adjunct to an institution of mercy as when it was characterized by the Commissioners as almost reversing every condition which ought to be observed under such circumstances. It remains disgracefully wanting in every sanitary and structural requirement. (Sec. 6, supra.)

In addition to these deficiencies, both sides of the hospital are in- sufficiently supplied with hot baths. Two only of the nurses are resident; merely infirm paupers still crowd the wards-"blind and paralytic, and utterly destitute persons, who sometimes remain for a long series of years." blind woman has been a resident for more than nineteen years.

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The only declared faults in the new asylum are the want of proper employ- ment and amusement for the insane, and of lavatories. Large grounds are being prepared, but in 1863 the only provision for the one, besides fenial services, was a barrel organ; for the other, a basin in each ward. The only information given as to space is a statement that the gross internal measurement of the entire building gives 2,000 feet to each patient. Deducting walls, day fooms, servants rooms, surgeries, store-rooms, passages, stairs, &c., it is to be feared that the single cells must be much too small.

Considering the attention which the Commissioners and the Governor have given to this subject, and their opportunities for acquiring information on the spot, it is improbable that any more efficient scheme of reform which should be practicable can he invented at this distance, and with very imperfect materials for forming a judgment. It is therefore suggested that the attention of the Legislature and of the board should be again directed to the necessity of remedying, as speedily as may be, the above-mentioned defects in the execution of the Commissioners' recommendations, and, in addition, that their attention should be called to the measures described in paragraphs 50, 54, 55, and 56.

A new set of rules for the administration of the hospital have recently been drawn up, amended by the board of visitors, the Executive Committee, and the Lieutenant-Governor, and finally approved by the Executive Committee. The rules had been the subject of adverse comment by Dr. Bowerbank, the original instigator of inquiry into the state of the hospital and asylum, and some of the amendments were made at his suggestion. He is still dissatisfied, but now that the attention of the Legislature and the Lieutenant-Governor has been strongly drawn to the subject, it does not appear probable that there can be any ground for further action in the matter of rules and regulations. Nor, supposing Dr. Bowerbank's views to be correct, do the points in which they have not been carried out appear to be of great importance.

One only of his charges calls for remark. In his original dissent from the rules he said,'" I am cognizant of the fact that the majority of the officers, nurses, and servants at present attached to this Institution, strange to say, were those employed under the old régime and who thus, as they did or could see nothing wrong in the management, are likely now to adhere to their old ways and practices if altered [allowed?j."" The Governor having called on Mr. Trench, the Inspector and Director, for information on this point, it appeared that fourteen of the attendants in the hospital and asylum had been so employed, and further that five of them were proved by the evidence taken by the Committee to have been implicated in the former abuses. These five Mr. Trench was directed by the Governor to discharge without delay. It also appears that one of the present medical officers had been attached to the hospital for the two years ending in March 1846, but no reflection is cast upon his character.

It is to be added that the more recent despatches disclose nothing which lessens the necessity for calling attention to the matters referred to above.

PUBLIC RECORD OFFICE

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LTC.O.885

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