THE SUNNYSIDE INQUIRY.

Lyttelton Times, Volume CXIV, Issue 16358, 30 September 1913, Page 8

THE SUNNYSIDE INQUIRY.

COMMISSION CONTINUES ITS SITTINGS.

TREATMENT OF MENTAL PATIENTS.

CASE FOR THE DEFENCE.

EVIDENCE OF ASSISTANT MEDICAL OFFICER.

The Commission of Inquiry into the treatment of certain patients at Sunnyside Mental Hospital resumed its sittings at tho Provincial Council Chambers yesterday, Mr V. G. Day, the Commissioner, presiding. Mr T. W. Stringer, K.C., appeared on behalf of the Department, Mr J. J. Dougall on behalf of the friends of the late W. A. Tribe, and Mr S. G. Raymond, K.C., on behalf of Dr W. B. Gow and Dr Ramsbottom.

Mr Raymond called evidence. A.GAOL WARDER'S EVIDENCE

William Alexander Maclachlan, -a warder at Lyttelton gaol, temporarily stationed at Addington, said he knew the patient Sidney Lionel Barrett. Barrett while at Lyttelton gaol twice attempted suicide and had to be kept under close surveillance. On one occasion when being brought to Lyttelton from Christchurch in the train, Barrett jumped off the train at Christchurch railway station, and on being caught said that he wanted an engine to kill him. Barrett complained of sleeplessness, and said he had no blood in his body. DR RAMSBOTTOM'S EVIDENCE. Dr Henry George Ramsbottom, assistant medical officer at Sunnyside, said that before coming to Sunnyside he had had four years' experience in mental hospitals in Scotland and New Zealand. He was at Auckland for six months, and had been at Sunnyside for two years. His duties consisted of tho medical care of the inmates and the keeping of psychological records. Since October ho had been in the institution each day. HOWIE'S CASE. Referring to Howie's case, he said that he entered up the particulars of the man in the case book when ho was admitted. The entry stated that Howie was " a simple old man, fast breaking up, very deaf and illusional," and with an idea that ho was in gaol. He was dirty in his habits. He did not think at the time that Howie would.last long. When a patient was admitted he went first to F Ward, unless he was frail, when he was sent to D Ward, the infirmary. For the first few days a patient was sent to bed. for observation, and for the first twenty-eight days friends were not allowed to visit except in tho case of sickness. Howie was restless and therefore was placed in a single room so that other patients should not be disturbed. In Howie's condition it was impossible that there should be anything but rapid deterioration. Ho saw Howie's eye when it was black and on inquiry found by report that the injury had been caused by the patient falling about the room. , He saw no reason to doubt that repor.tt Howie was restless but not violent. Every morning witness went round tho institution with the head attendant, and at noon he made a tour with the superintendent. Tn the afternoon he visited any case that required attention At* night he answered any call, attended to any case requiring him and made rounds at different times. In the case of injury to patients they were always asked how the injury happened, and if the reply was a «*»Pl«"J: l>v a patient an inquiry was held. " witness thought that the «"»"«£"£? demanded it the matter was, w: erred to the .superintendent. Howie was itritable and untidy in his dress. He obtained food, between 1 "* Tn the morning he had beef tea and in the afternoon egg and mk, while at night he often had hot mk, and, at least onoe, brandy and milk. On the Saturday before his death Howie contracted pneumonia. tie used to throw off his clothes when in . bed. and therefore it was better to have him up ami dressed, as then he was nab so liable to catch chills. On. the day after he contracted pneumonia witness saw Howie three times. On Monday Howie's heart, which was diseased, as noted on his admission and recorded in the books, gave out. »««>«•« of the feet was a symptom of heart disease

IMPROVED NURSING POSSIBLE. He thought that for senile cases and eases of "illness women made better nurses than men. and should be used, but in general mal* oases .men were better. There was no provision at Sunuvside for women nurses cm the male sicle of the institution. Howie was not put in the padded cell. In addition to the' black eye, Howie bad abrasions on his nose and nght click. Howie usually wore a brown tweed suit. Sometimes clothes were siipp bed by friends, but it was undesirable, since clothes often had to be washed, and as thev were not stamped they got lost in the* laundry. Patients at. times required changes of clothes twice a day. BARRETT'S CASK. With reference to Sidney Lionel Barrett, Dr Ramsbottom said that the case book described Barrett as in a state of nijitated melancholia, suffering from delusions that he had different diseases. that he was wasting away, that he had no blood in his body and that he never slept. He often saw Barrett asleep at night, and on inquiring of him on the following morning was told by Barrett that he had not slept. The patient did not. work because he was under observation, since he bad suicidal tendencies. Barrett at times did suffer fronn insomnia, but he slept more than he thought. Both witness and Dr Gow attended Barrett within live minutes of the accident that occurred to him. The patient had wounds on his skull, but when witness made an examination he could find no fracture, nnc] he thought that there wore not serious injuries. On the following day Barrett refused food, but was fed and given opium. That night lie slept soundly, but later he grew worse and died at 3.45 a.m. A post-mortem examination was held, and it was found that the skull was fractured. When the relatives of Barrett visited the institution witness explained tho circumstances of the whole case. Barrett was under treatment for melancholia. TRIBE'S CASE. Witness saw Tribe shortly after his admittal and made records oi' his observation of the case. The patient suffered from delusions of grandeur and of persecution. After a time the patient lost his delusions, but lost his memory and became dirty in his habits. He. was extremely restless and interfered with other patients, whom he held in contempt. ' It was reported to him that Tribe had received a black eye from a blow hy a patient whom he had provoked. It was not possible to segregate Tribe. The injury was in-

dieted while the patients were in the airing court, where there were one hundred and twenty patients together.

BLACK EVES "BOUND TO OCCUR,"

Black eyes were bound to occur in every mental hospital. Tribe was always untidy in his clothing, but latterly his clothes had to be changed two or three times a day. H<> had seen Tribe rubbing dirt on himself after ltaving sprinkled himself with water, and had seen him pack rubbish inside his shirt. He lost all sense of self-respect. The details of his case were not told to the patient's friends. It, would have been very distressing for them to have heard such gruesome details. Classification according to rank was impossible in the institution, but there was a classification according to mental derangement. Tribe was one of the worst cases the institution had had in recent years. It was not uncommon to find perversion in cases of insanity. In Tribe's case his affection for his wife was apparently turned to dislike and aversion. The bedclothes supplied to Tribe at the time Mr Bingham visited him were sufficient. There would probably be three and they were good blankets. There was no'artificial heating apparatus in the room where Tribe was, but there was n fire in the dormitory. There was no single room on the male side in which there was heating apparatus.

UNDRESSING IN THE CORRIDOR. In D ward patients undressed in the ward, but in 0 ward they undressed in the corridors, where all the doors were locked to prevent patients going into rooms. If patients were allowed to enter the rooms they might commit suicide before they could be seen, or they might, as had often happened, wait to attack nu attendant. . Tho Commissioner: If a patient did not have suicidal or homicidal tendencies why should he not be allowed to undress in the room? Witness: There must be routine in an institution of the kind. Patients might take rubbish into the rooms. Continuing, the witness said that the undressing in a common room was a general rule in mental hospitals in the dominion. In Scotland dangerous casos were kept in dormitories for observation. Suicidal patients were kept under special observation. Matches might be taken into the rooms. The doctors who knew best had decided that it was right to undress in common rooms. Patients did not undress in the rooms they slept in. Other patients in wards undressed in tho day rooms. Tho corridors were not open, but were warm. A QUESTION OF DIETARY. Tribe, when in D ward, was on special diet. He received beef tea, and the night before he died he received brandy and milk. For breakfast patients had bread and butter and tea, for dinner there were two courses. No special record was kept of the dietary of patients in the infirmary ward. The Commissioner: In an ordinary hospital complete records of this kind would be kept. Were no records kept bv yon in Tribe's case? ' The witness said that no records were kept. Tribe was suffering from no specific ailment. It was a case of general physical decay. The attendants had nothing to do with the matter of a patient communicating with the doctor. The doctors went into every ward, and spoke to any patients they chose, and any patient might speak to them. Tribe was suffering from mental confusions and disorientation. TRIBE'S BAD FOOT.

Witness did not notice In bo limping but there was induration of the skin on his feet, due to his running about with bare feet -Mrs I.ribe approached witness and told him .that one of her husband's feet was in a very bad condition, swollen up, and painful. Witness said he had not noticed it, and subsequently had Iribc removed from C ward to I) ward. He at once went and saw Tribe and asked why he had not mentioned his loot. There was inflammation of the foot and leg, reaching from the middle of the foot to the middle ot the call. There wore some cracks in the hard .skin of the heel, but no wound in the toe There was no broken skm, save for the cracks, and no suppuration. The condition of the foot was not at all serious, and did not affect the patient's general health in the slightest The leg was dressed with carbolic and afterwards horacic acid, the usual treatment in such cases. Mrs lnbe telegraphed an inquiry as to the condition of Tribe's foot on the Inday before Tribe's death, unci witness replied that it was improving. On the i Sunday Tribe's physical condition was verv low. Up to that time witness had no 'reason to suppose TriDe was near death In cases of mania there was emaciation, and a depreciation of physical condition. Witness told Dr Gow, on the Sunday, about Tribes condition. Dr Gow said: "I wonder what voting Tribe will think? He rang me lip last night to ask after his lathers foot. I told him it was getting better and he thanked mo and rang on. . I 1 hone he won't take that as an indication that his father's general condition is improving." .On Monday morning at ten o'clock witness visited ! Tribe and found him in a comatose condition.

WHEN TRIBE WAS DYING. Witness knew more or less certainly on Sunday night that Tribe was dying. The Commissioner: Would it not bo the duty of the attendant. to let you know of a serious change in the condition of a dying person. |)r Ramsbottom: Any change should lie, and is, reported to me. Continuing, tho witness said that he could not say whether he received a report in the case of Tribe's falling into a state of coma.

GOURLAY'S CASE. The admission book in the case of Lewis Allan Gourlay showed that the patient was emotional and argumentative (iourlay, was quite rightly detained at Sunnyside, for he was insane. Witness heard no complaints from Gourlay in respect/ to dirty blankets. Gourlay was in V Ward, where the most acute cases were kept If Gourlay had dysentery the attendants would have known and would have reported it.

HERUHY'S CASE. Daniel Hornby's case was one of chronic mania. The state of Herliky a ears might be caused by violence, but it might be - insane ear, a condition in which infiltration of the cartilages caused a thickening of the ear and absorption of the cartilages. Herliby was one of the pets of the establishment. He was teased in order to please him. The only way to get » smile out of the old fellow was to t**se him Patients were often compelled to work in thenown best interests.

THE .MODERN IDEA OF-MENTAL HOSPITALS.

To Mr Douga-ll: "Acute mania" was mania that had not developed into a chronic mania. It was more pronounced und took more out of the patient. Dr Hay: The term " acute" is sometimes used to mean " recent, - ' The witness, continuing, said that the modern idea was to make mental hospitals more bright and attractive, with carpets in at least some ot the rooms. There was a carpet on the floor of Tribe's room when Tribe died. A more, comfortable and attractive room would not have done a man in Tribe's mental estate the slightest good. Tribe could be rational occasionally. Ho could conceal his objectionable habits from visitors for half an hour at a time or eo. Ho could not retain hie saliv.i in the presence of visitors. Tribe when admitted was not unconscious and not incapable of moving. SHORTCOMINGS OF THE INSTITUTION.

There were 700 patients at the hospital and that number was excessive for

one man. The institution could be managed by a superintendent and two assistants. The clothps should fit better than they did, but the institution had to do the liest it could with the materials it had at hand. TRIBE'S DEATH.

For two months and a half Tribe's habits were clean. There was no great change. On May 12 there was an entry to. the effect that his condition was woicee, and. the n<?xt entry was on June 23. recording his death, and stated that he had gradually failed. Entries were made every month for the first three months, and then threemonthly notes were resorted to. Any particular incident regarding sickness would be entered. Dr Gow gave Dr Orchard the information concerning tho cause of Tribe's death. Death was due to exhaustion following on acute mania. He knew on Sunday that Tribe was dying. Mr Dougall: These other witnesses know that he was dying some -weeks before that. Witness: They were not medical witnesses and had not had the experience of insanity cases that I have had. ATTENDANTS' REPORTS.

The second black eye inflicted on Tribe was not reported by the attendant. Tribe was moved from F Ward because ho was interfering. He was sent to 0 ward, where the patients wero quieter and not so likely to damago him. 'The cut on Tribe's toe was not reported in writing, because the head attendant said that it was not worth reporting. Mr Dougall: But your regulations 6ay that no injury is to be considered too trivial to be reported. Witness: It is a question as to what is an injury. Mr Dougall: Then it was the attendant's fault? The Commissioner: The attendant reported it. Mr Dougall: But the wound was over an inch in length. Witness: I did not see it.

Continuing, Dr Ramsbottom said that Tribe was sent to the infirmary ward on account of tlie _ injury to his foot. Overfeeding was beneficial in treatment for lunacy. Tribe liad sufficient food, although there were times when he would not take his food properly, while at others he bolted his food. , IMPROVEMENTS POSSIBLE.

_ If money were forthcoming tho classification of patients oould be greatly improved. The cottage system in Germany and America had been successful, and in New Zealand there were detached buildings. At Sunnyside the system was carried out on the female side. It would be better if there was an artificial heating system in Sunnyside, but owing to the construction of the building it was impossible to instal any.

To Mr Raymond: In Sunnyside last year SO per cent of the patients admitted recovered.

On resuming after tho luncheon adjournment Mr Dougall continued his cross-examination of Dr Ramsbottom. CLASSIFICATION.

The witness said, that on the male side there wero four wards in the main building and two outside. There was a system of classification in the main building. In D Ward, the infirmary ward, were infirm, aged, invalid and epileptic cases. In F Ward the worst cases and tho recently-admitted ones were placed. The other two wards were upstairs, and were reserved lor the quieter patients. Tribe was supposed to be an epileptic subject. He had only one seizure in the institution to witnesses knowledge. An epileptic might be maniacal, and epilepsy might develop into dementia. In Tribe's case there were maniacal symptoms. Witness considered that Tribe was not in a dying condition, and under tho circumstances everything that could be done in the way of care and attention was done. Witness believed that an insane person's chances of recovery would be increased if he associated with sane persons, but the probabilities were that one insane person' would have more effect on twenty sane persons than twenty sane persons on one insane. It might be a good thing for the insane persons, but it would come hard on the sane persons. People who were sent to Sunnyside had proved themselves not amenable to tile influence of the sane.

INQUESTS AT THE INSTITUTION. At inquests at Sunnyslde the evidenoe was given by the doctor and by the attendant who was present at the time of death. In onlv one case in witness's experience had an outside doctor been called in. In the infirmary charts and .records were kept of tiie patients! condition, but they could not keep such records for the whole 700 persons. MR DAVEY'S EXAMINATION. To Mr Davey: Witness made notes regarding patients' case 3 in his notebook, and transferred particulars to tlie case-book within a few days. Witness could see nothing strange in Howie's habits, becoming dirty in his habits shortly after entering the institution, though he had previously been very clean. Old men were subject to sudden changes in these matters. The clothes supplied to patients were of moleskin and tweed. It was very hard to give out clothes that fitted the patients. The clothes were " usually whole, but of course they got torn. There might be buttons off sometimes. The infirmary was always full of patients. There was no special room in the institution for very acute cases. HOWJE'S CASE.

Witness did not remember whether he saw Howie's swollen feet or not. Howie had a weak heart, and swollen feet were a- common symptom. The pains in Howie's chest were doubtless due to pneumonia, but other pains he complained of were due probably to his falling about his room. There wore •a number of projections in the room which would inflict injuries. It was never suggested or reported to witness that Howie had been. ill-treat(!d either by attendant* or by patients. The head attendant reported that Howie's face was bruised and discoloured. That would refer to the black eye. Witness could not say whether lie was told that Howie's friends complained that the attendants had been ill-treating Howie. He would not have taken much notice of it in any case, as he was satisfied how Howie s injuries were caused. A pneumonia patient would be kept in bed in an ordinary hospital. The classification at Sunnyside could be improved. GOURLAY'S ALLEGATIONS. Witness was quite sure that the friends of patients were given good attention at the institution. He had heard no complaints from Gourlay about dirty blankets. Gourlay was not sane while lie was in the institution. While ho was quite intelligent he could not be trusted. During the last two months he spent at the institution Gourlay was quite competent to describe accurately any incident that came under his notice. If Gourlay had been quite rational, however, lie would have made complaints to witness or to Dr Gow rogarding the incidents he now alleged he saw. Witness found Gourlay truthful. His statements could not be always absolutely relied on, but they were somewhere near the truth. Witness never saw patients sleeping in the urinals. They might sleep near them. The attendant Harrington left the institution of his own accord. He

I was not dismissed. Witness oould not imagine any attendant ill-treating Hornby. To Mr Raymond: The retention of Gourlay in the institution was a matter for Dv Gow. Witness had no voice in it, and there was nothing in Gourlay's assertion that witness thought Gourlay should have been discharged earlier. Gourlay might be. prone to exaggerate. Witness considered Gourlay was more or less recovered towards the end of his stay, but he did not think it safe to release him. Harrington was not being called as a witness, because he had left the institution. Howie was never placed in a " damp stable or cell." Tho night attendant was not necessarily remiss in not reporting Howie's black eye on April 10. Ho may not have noticed the injury.

THE COMMISSIONER EXAMINES. To the Commissioner: No report reached him of the injury to Tribe's heel referred to by Mrs Tribe iu her evidence. When he examined the heel there wero no signs of any injury to correspond with tho details givtn by Mrs Tribe. The swelling of the leg was nothing out of the ordinary. If the leg was green as Mr Thornton had described, it would lie due to a large bruise several days old or to gangrene. Gangrene came ou rapidly at times, but tho change from tho conditions described as existing on Thursday to gangrene was not probable. More accommodation should be provided at Sunnyside. so that male patients on entering the institution should riot be put in with refractory cases, put in with refractory cas>>3. It would be better if the senile cases wero kept separate from other patients. A large number of senile cases in Britain were, not in the asylums as lunatics, and if cuch were done iu Nov.' Zealand the percentage of lunatics in the dominion would bo greatly reduced. THE STAFFING. There were two night attendants for 370 patients. Under the present system the number of attendants was sufficient at night. On day duty there were enough attendants, although the institution could do with a few more. There w-ere forty-four attendants, but each, obtained ninety-two days' leave each year, and about a fifth wero always "off. The average was 12.5 patients to each attendant. The attendants worked about 13* hours each day. The Commissioner: Don't you think that is too long? Witness: Oh. no.

The Commissioner: They have _ an eight hours' shift in a publio hospital, and this work is more nerve-racking. Witness: It is not so hard. Continuing, Dr Ramsbottom said that another assistant was required to do justice to tho patients. To Mr Stringer: The Mental Defectives Act, 1911, had inoreased the demand on the institution's accommodation.

Mr Raymond said that according to the latest statistics the percentage of recoveries at Sunnyside was 50.03, or 5 per cent better than the figures'of any other mental hospital in the dominion, the general average of recoveries being 35.74. At Sunnyside there were fifty-two deaths last year, practically one a week. THE CHAPLAIN'S EVIDENCE. The Rev Frank Dunnage, vicar of Hals well, and Anglican chaplain at the Sunnyside Mental Hospital, said he had the right of entry to the institution at any time. Ho had even* opportunity of seeing the conduct of the attendants towards tho patients. He had watched the attendants when they did not know he was there, and he had been struck hy their kindness towards the patients. Their care and tenderness for the most repulsive cases was a revelation to him. The food at Sunnyside was of good quality. Ho had tasted the tea and bread. Some of the patients got food between meals. He had often thought n small infirmary ward should be provided on the men's- side, as was done on the women's side. Some of tho small rooms used for patients who were ill were rather dull and cheerless. The hearing of the evidence was adjourned until Wednesday, at 10.30 a.m. J'he Commissioner stated that ho would visit the institution the following day at 11 a.m.