CO885-(2-3) — Page 195

PUBLIC RECORD OFFICE

TUITI

C.O.8

Reference :-

885

PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO

a. Endowment and Funds.

b. Structure and Sanitary State.

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was reported in general terms that the hospital and asylum of that island were in a completely satisfactory condition; and yet it appears from more particular returns subsequently furnished that both those institutions, though far from being the worst of their class, are very defective in several of the most vital points of construction and management.

The insufficiency and want of certainty which impair the value of the answers generally have been fatal to the utility of most of those which are replies to demands for exact statistical information. The proportions of deaths, discharges, and cures are wholly omitted in a large number of instances, and in many of those in which they are given, the clearness of the questions has not prevented the answerers from selecting ways of reckoning often incon- venient in themselves and incapable of being compared with each other.

It must be remembered in considering the necessity for reformation, that these returns are made by persons on whom there lies at least a moral responsi- bility, and that they must be construed accordingly.

4. Statements made in Part I with reference to the general condition of hospitals and asylums in the colonies of each division are not, to be taken to apply to every such institution in the division, unless it is expressly so stated, but to have reference to the characteristics generally prevailing in the majority of instances. Any important exceptions to general statements are mentioned either with the general statements, or under the head of the particular institution in Part IV. Cases where no information is given, or can be implied, are disregarded in the general statements.)

PART 1-GENERAL CONDITION OF THE HOSPITALS AND ASYLUMS.

West Indian Colonies.

5. The West Indian hospitals and asylums are universally destitute of permanent endowments, and receive but little aid from private subscriptions. A portion, generally inconsiderable, of their funds is derived from payments made by patients who are not paupers, or in the case of seamen and labourers, by their captains or employers, and the remaining charges, after having been passed by the managing boards, and, in some cases, by the Governor, are paid by the public treasuries.

6. In the character of their buildings and in all sanitary arrangements these institutions are for the most part signally defective. The buildings are in many cases old barracks, prisons, or private houses, in no way adapted for their present purposes, and wanting in every requisite for economy of labour, or the first conditions of health. In only three out of the whole number of twenty-seven, from which answers have been received in this division, is there any tolerable provision for sewerage, drainage, and latrines; and of hese, three, namely, the Port of Spain hospital in Trinidad, and the Antigua and Jamaica asylums, the first has been supplied only since the date of the despatch, and the third is a new structure erected since the Commission of 1861. Drainage left to nature, often in cases where nature would have to work uphill, latrines without water, and adjoining the wards, sewerage passing through open gutters into cesspools, the very cleansing of which in a tropical climate only diffuses miasma, are the ordinary arrangements in matters vital in hospitals, and not less than ordinarily important in asylums. Space and ventilation are equally disregarded. Whilst it is now established that from 800 to 1,000 cubic feet of space per head is necessary in associated and from 1,250 to 1,500 in single dormitories in temperate climates, and probably a quarter more under the tropics, there are six places where less than 500 is allowed. The asylum of Dominica gives 300 in single cells, the Vieuxfort hospital in St. Lucia 281 in associated wards, and the majority of the rest range from 500 to 800, and this often with the most imperfect ventilation; with reference to which it must be remembered that it is found to be practically impossible to ventilate properly a room of very insufficient size.

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From the tone of the answers, it would appear that there is a general ignorance of the necessity for any extraordinary care in these respects, and of the existence of any settled principles regarding them. The effects are not the less manifest in the prevalence and destructiveness of gangrene, dysentery, and skin and bowel complaints generally, which, as is well known in European hospitals, are the invariable concomitants, and often the first indications, of sanitary defects.*

There is one of those institutions the sanitary condition of which calls for particular remark as an instance of inveterate neglect in the face of warning, and as a proof of the necessity for strong measures of reform. In November 1861, the Commissioners appointed to examine into the state of the hospital and asylum at Kingston in Jamaica, reported that-

"No doubt can exist as to the unsuitableness of the Female Hospital as

a place of medical treatment. It may be almost said to reverse every condi- tion which ought to be observed under such circumstances. The wards, which are of wood, are small, low in the roof, close, and ill-ventilated. They are so slightly raised above the ground that the carthy exhalations, after rain, cannot but act injuriously on the patients. Except by closing the windows, and substituting one evil for another, no efficient protection exists against the damp or cold. Unglazed, few in number, and badly constructed for the admission of light and air, those windows are only apertures. Of Ward No. 5, the position is such as to expose its inmates to the rays of the western sun, which heat in upon it with a glare and intensity certain to cause suffering. To remedy this inconvenience by a screen, or other contrivance, no attempt has yet been made. As regards sewerage, matters could not possibly be in a more unsatis- factory condition. Of the privy, when we visited the institution, the state was such as to make it disgusting to approach it. No apartment is provided for the performance of operations, but only a shed, open at the sides, in which formerly, from the pure necessity of the case, this nice and delicate department was conducted. Originally (1850) the subject of these remarks was nothing but a makeshift (having been formerly what is known as a negro yard) to relieve temporarily the Male Hospital, and was never intended as a permanent institution," &c. (Page 10 of Report.)

Nothing appears to have been as yet done to destroy the applicability of these strictures.

7. Defects of internal economy are very difficult to discover, and in c. Internal Eco- estimating them many allowances must be made both in excuse and in aggrava- nomy. tion. ⚫

The hospitals uniformly make a merit of entirely excluding “contagious" or "infectious" cases: an exploded prejudice where the wards are roomy and well-ventilated, but one which may not be groundless where the atmosphere is of itself enough to breed fever, though it can be no apology for not providing proper wards for the treatment of such cases with others.†

Some of the hospitals are crowded with incurables, and the asylums with mere idiots who take nothing but harm from confinement and association with the insane.

In the majority of instances there is no resident medical officer, a want which is the occasion of great evils.

The proportion of nurses or keepers to patients, though not always of itself apparently insufficient, is yet really so in many cases if all the circum- stances are taken into account. Many fewer nurses in proportion are required where there are a great number of patients properly classified in large wards with every appliance for economy of labour and time than are necessary in these small and inconvenient and ill-found establishments.

Lastly, the asylums are generally without provision for religious services, and uniformly without proper means for the amusement and employment of the insane. Curative treatment of insanity is, indeed, not yet in its infancy in the West Indian colonies. It is, however, satisfactory to find that the idea of excessive restraint is generally repudiated even in them.

8. The government is in almost all cases vested in boards which are d. Constitution. composed parily of er officio members, partly of nominees of the Governors, and

• At the Rosesu infirmary in Dominica, 12 out of 29 deaths, in 1863, were from skin diseases

and dysentery; and diarrhma was the cause of 2 deaths out of 3 at the Bermuda asylum.

+ Small-pox must be excepted from the general rule; and see p. 20.

B 2

nij

F

e. Supervision and Reports.

MAURITIUS.

4.

usually include some members of the councils. These boards monopolize all superior functions. They make regulations subject to the Governor's approval, they judge of complaints, they administer the finances, appoint to offices, inspect and report (nominally at least), and finally some of their members, as being also members of the Legislature, approve in council what they have done as commissioners.

In one instance (Castries in St. Lucia) unlimited power is given to the medical officer, and in other cases there are more or less slight variations, but such is the general model.

9. In the matter of inspection and reports, which rise in importance in pro- portion to the badness of the management, there is a great deficiency. Except the discretionary visitations of the Governors, which are not always very frequent, there is seldom any provision for inspection by persons not connected with the institutions. The regulations in some cases provide for the appoint- ment by the boards of visiting committees from their own number; but as they are the only check on themselves, there is no security that they perform their duties, and as a matter of fact in at least two instances even the statutable inspections are confessedly neglected.

Reports or lists of admissions, discharges, and deaths, are sent annually or semi-annually to the Governors, and frequently to the boards, which themselves publish annual statements; but there is nowhere any provision for that kind of reports which is of more value than any others reports, that is, of the actual working of every part of an institution, made frequently to superior authorities otherwise unconnected with the management.

10. To sum up, of all the twenty-seven establishments, putting aside the new asylum in Jamaica, one only, the Port of Spain hospital in Trinidad, can be said to be in a most satisfactory condition. Throughout all the rest, in a greater or less degree, runs the same complexion of structural and sanitary defectiveness, of insufficient attendance, internal mismanagement, and want of supervision, resulting in the case of the hospitals in an unnecessary waste of life and means, and in the asylums in the substitution in effect of a system of imprisonment for one of cure. Conspicuously the worst are the hospitals and asylums of British Guiana, St. Lucia, and Dominica, which hardly yield, it may be believed, to what those of Jamaica were two years ago, and have not yet wholly ceased to be.

11. No doubt much of what is bad in these West Indian institutions is to be ascribed to the smallness of the islands, and of their populations and revenues. Their poverty suggested the mistaken economy which accepted the first site and building which offered as sufficient for the wants of a limited number of applicants; and to minuteness of scale is chiefly to be traced their general want of system, and their slovenly and ineffective management.

But it is to be feared that much is also, in the case at least of the hospitals, the result of a want of due consideration for the immigrants for whom they were in many instances originally established. Though the first of these causes cannot be obviated, it is time that the second should cease to operate to the discredit and loss of the entire communities.

12. Mauritius.-The expenses of the treatment of lunatics at the lunatic asylum of Mauritius are chargeable to the poor relief funds of the districts in which they are domiciled. The same rule seems to be followed at the hospital.

The sites and buildings of both institutions are small and inconvenient, and better situated and more commodious structures are urgently required. Several of the present wards are too confined, and the existence of sanitary defects, though not otherwise confessed, seems to be indicated by the great prevalence of bowel diseases.

The asylum provides no sufficient employment for the lunatics, and the hospital is without any resident or restricted medical officer, and without any proper system of inspection by superior authorities.

In other respects these two institutions seem to be very well managed,

The rapid increase of Indian immigrants necessitates the establishment

of district hospitals for their accommodation.*

It is remarked in Mauritius that the Indians and coloured creoles or ex-apprentices feel a great dread of entering the hospital, and conceal their diseases often till they become incurable.

• See s. 74, p. 28.