SUNNYSIDE MENTAL ASYLUM.

Star (Christchurch), Issue 10886, 29 September 1913, Page 5

SUNNYSIDE MENTAL ASYLUM.

THE TREATMENT OF PATIENTS.

CASE FOR THE DEFENCE.

EVIDENCE OF DOCTORS AND ATTENDANTS.

The Commission of Inquiry into the 1 treatment of certain patients at Sunnyside Mental Hospital resumed its sittings at tlio Provincial Council Chambers this morning, Mr V. G. Day, 1 the Commissioner, presiding. \ Mr T. W. Stringer, K.C., appeared on behalf of tlio Department, Mr J. J. Dougall on behalf of the friends of | the lato W. A. Tribe, and Mr S. G. ■ Raymond, K.C., on behalf of Dr J. B. Gow and Dr Ramsbottom. ' Mr Raymond called evidence. A GAOL WARDER'S EVIDENCE. ( William Alexander Maclachlan, a warder at Lyttelton gaol, temporarily 1 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 occa- 1 sion when being brought to Lyttelton < from Christchurch in the train, Barrett i threw himself under the train at Christchurch railway station. 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 bofore coming to Sunnyside ho had had four years' experience in mental hospitals in Scotland and New Zealand. He was at Auckland for six months, and had been at Sunnysido for two years. His duties consisted of the medical care of the inmates and the keeping of psychological records. Since October he had been in the institution each day. HOWIE'S CASE. Referring to Howie's case, he said that he entered up tho 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 lie 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 tho 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 he disturbed. In Howie's condition it was impossible that there should be aiiytliing but rapid deterioration. He saw Howie's eyo when it was black and on inquiry found by report that the injury had bisen caused by the patient falling about the room. He saw no reason to doubt that repoit. Howie was restless but not violent. Every morning witness wont round the institution with the head attendant, and at noon he made a tour with the superintendent. In 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 complaint by a patient an inquiry was held. ir witness thought that the circumstances demanded it the referred to the superintendent. , Howie » «• ritable and untidy m his dress. Howie obtained food between meal times Howie in the morning had beef tea and in the afternoon egg and mi fe, while at niglit he often liad hot milk, and, at least once, brandy and milk. On the Saturday bofore his death Howie contracted pneumonia. Howie used to throw off his clothes when in bed and therefore it was better to have him up and dressed. He was not so liable to catch chills. . On the day after lie contracted pneumonia witness saw Howie three times. On Monday Howie's heart, which was diseased, as noted on Howie's admission and recorded in the books, gave out. Swelling of the feet was a symptom of heart disease. IMPROVED NURSING POSSIBLE. He thought that for senile cases and cases of illness women made better nurses than men, and should be used, but in general male cases nien were better. There was no provision at Sunnvside for women nurses on the male side of the institution. Howie was not put in the padded cell. In addition to the black eve, Howie had , abrasions on his nose and right cheek. , Howie usually wore a brown tweed suit. Sometimes clothes were supplied _ t>y friends, but it was undesirable, since clothes often had to be washed and as they were not stamped they got lost in the laundry. Patients _a-t times required changes of clothes twice a day. BARRETT'S CASE. ; With reference to Sidney Lionel Bar- : rett, Dr Ramsbottom said that the case book described Barrett as in a state or agitated melancholia, suffering from delusions that he had different diseases, that lie was wasting away, that he had no blood in his body and that he never slept. He often saw Barrett asleep at nifrht, 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 had suicidal tendencies. Barrett at times did suffer from , insomnia, but he slept more than he thought. Both witness and Dr Gow attended Barrett within five minutes ot the accident that occurred to Barrett. The patient had wounds on his skull, but when witness made an examination he could find no fracture, and ho thought that there were not serious injuries. On the following day Barrett refused food, but was fed and given opium. That night he slept but later ho grew worse and died at 3.45 a.m. A post-mortem examination was held, and it was found that the skull was fractured. In the last two years tho coroner in almost every case ordered the post mortem examination to be made by an outside medical man in. When the relatives of Barrett visited tho institution witness explained the circumstances of the whole case. Barrett was under treatment for melancholia. TRIBE'S CASE. He saw Tribe shortly after his admittal and made records of 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 ho held in contempt. It was reported to him that. Trine had received a black eye < from a blow by a patient whom he had ; provoked. It was not possible to segregate Tribe. Hie injury was in- i flirted while the patients were in tho airing court, where there were one i hundred and twenty patients together. ] BLACK EYES •' BOUND TO OCCUR," i Black eyes were bound to occur in < mental hospital. Tribe was 1 always untidy in his clothing, but latterly his clothes had to be changed i two or three times a day. He had ' seen Tribo rubbing dirt on himself < at'.er having sprinidcd himself with water, and had.-seen him pack* rubbish inside his slii'rtji 'He lost; allsense of y;:

self-respect. The details of liis-ocaes were not told to the patient's friends. It, would have been very distresses 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. one of tho worst oases the institution had had in recent years. _ uncommon to find perversion jaySwes of insanity. In Tribe's case his tion for his wife was apparently turned to dislik© 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 a fire in tho 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 O ward they undressed in the corridors, whore all the doors were locked to prevent patients going into rooms. If patients wore allowed-to enter tho rooms they might commit suicide before they, could be seen, or they might, as had often happened/ wait ■to attack an attendant. . ■ Tho Commissioner: If a _patient aid 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. Con- . tinning, the witness said that the undressing in a common room was a general rule in mental hospitals in the dominion. In Scotland dangerous cases 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. latients did not undress in the rooms they slept in. Obher patients in wards undressed in the day rooms. The .corn--dors 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 ho received brandy and milk. For breakfast patients/had bread and butter and tea, for dinner there wove two courses. No special record was kept of the dietary of patiente in the infirmary ward. . _ The Commissioner: In an hospital complete records of .this kind would bo kept. Were no. records kept by you in Tribe's ca6e?, . Tho 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 ot a patient communicating with the doctor. The doctors 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 Tribe "limping, but there was induration of the skin on his feet, due to his running about with 'bare feet. Mrs Tribe approached witness and told hini ( that one "of her husband's feet was m~ a very bad condition, swollen up, and painful. Witness said he had' not noticed it,' and subsequently had Tribe removed, from C ward to D ward. He at once went and saw Tribe, and asked why he had not mentioned his toot. There was inflammation of the foot and leg, reaching from the middle or the foot to the laddie of the calf. There were some cracks m tho_ haid skin of the heel, but no wound in the toe. There was no broken skill, save for the cracks, and no suppuration. The condition of the foot was not at i all serious, and did not aftect the patient's general health in the slightest. The leg was dressed with carbolic and afterwards boracic acid, the usual treatment in such cases. Mrs tribe telegraphed an inquiry as to the condition of Tribe's foot on the Friday before Tribe's death, and witness replied that it was improving. Oa the Sundav Tribe's physical condition was very low. Up to that time witness had no reason to suppose Tribe-was jiear death. In cases of mama there was emaciation, and a depreciation of physical condition. Witness told Dr Gow, on the Sunday, about Tribe's condition. Dr Gow said: " I wonder what young Tribe will think? He rang me uo last night to ask after his father s foot I told him it was getting better and he thanked me and rang off. t 1 hope he won't take, that as an indication that his father's general condition is improving. ; 0n 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 dyjng. The Commissioner: W r ould it not be the duty of the attendant to let you know of a serious change in the condition of a dying person? ' Dr Ramsbottom: Any change should be, and is, reported to mo. Continuing, tho witness said that he could not say whether |e rweived a report in the case of Tribe s . falling into a state of coma. GOURLAY'S CASE. The admission book an the of Lewis Allan Gourlay showed .hat, the patient was emotional and argumentative. Gourlay was quite rightly detained at Sunnyside, for lie was insane. Witness heard no complaints , Gourlay in respect to dirty blankets. Gourlay was in F Ward, were tho most acuto cases were kept. If Gourlay.'-had dysentery the attendants would have known and would have reported it. HERLIHY'S CASE. Daniel Herlihy's case was one., of chronic mania. The stats of Herlihy s ears might be caused by violence, but it be " insane ear," a condition m which infiltration of the cartilages caused a thickening of the car and aly sorption of the cartilages. Herliliy was one of the pets of the establishment, lie was teased in order to please him. Tho onlv wav to get a smile out of the old fellow was to tease hnn. Patients were often compelled to work m their own best interests. CROSS-EXAMINATION. To Mr Dougall: " Acute mania " was mania that had not developed into' a chronic mania. It was more pronouixoed and took more out of the patient. Dr Hay : Tho term " acuto'' is sometimes used'to mean "recent." The witness, continuing, said that the modem idea was to make mental hospitals more bright'and attractive, with carpets in at least some' of,, the rooms. There was a carpet on the floor of Tribe's room when Tribo died. A more comfortable and attractive room would not have doiio .a mail in Tribe's mental state the slightest good.. Tribe could be rational occasionally. He could conceal his objbctionablo habits f from visitors for half an hour at jv time or so. - He could 'not 'retain- his saliva 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, Tli« institution could be managed by a tiuperintendent and two assistants. The clothes should fit better than they did. but the institution had to do tho'best it could with the materials it ljad at hnnd. 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 ■worse, and the next, entry was on Juno 23, recording his death, and stated that Ke had gradually failed. Entries were made every month lor tho,'first t)ireo months, and then threemontldy notes were resorted io. Any particular incident regarding sickness would be entered. Dr Gow gave Dr Orchard the information concerning the caflse of Tribe's death. Death was due to exhaustion following on acute mania._ He knew on Sunday that Tribo dying. Mr Dougall: Thc.se other witnesses knew that ho 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 moye<l from F \\ ard because ho was interfering. He was sent .to G : ward, where the patients were quieter and not so likely to damage him. i The cut on Tribe's toe wius not repoj't<>d. i» writing, because the head. attendant said that it was not worth reporting. . Mr Dougall: But your regulations say that no injury is to be considered too trivial toboreported. Witness : It is a question as to what is an injury. ; .Mr Dougall: Then it was the attendant's fault P •. , - Tito Commissioner: The attendant reported. it. . . >Mr Dougall : But the wound vas over an inch :in length. Witness: I' did not see_ it. Continuing, • Dtßaipsbottom said that Tribe •w as sent ;to the infirmary ward, on ac-ertunt-of tho injury to his foot. Overfeeding was beneficial in treatment for lunacy. -Tribe had, 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 the classification ;of : patients could bo greatly improved. Tho cottage in German? and .America had hoen successful, and . in' New Zealand • there were detached .buildings. At Sunnyside the system was carried out on the female tide. It would be better if there was »n artificial heating system in Sunny»ide, but. owing to the construction of the building it was impossible to instal any. '~. , • - v!

To - Mr; Raymond: In Sunnyfiide last year 50 per cent of the patients admitted recovered. On resuming after the luncheon adjournment Mr Dougall continued his cross-examination of Dr Ramsbottom. ; .CLASSIFICATION, - Tho -witness said that on the male side there rieto four wards in the main building and two outside. There was a sysfcent' of classification in* the main building.' - ; In I) Ward, the infirmary ward, were infirm, aged, invalid and epileptic cases, in F Ward the worst cases'and: the recently-admitted ones were ■ placed: The other two wards were upstairs, ; and' were, reserved for the * quieter''patients. Tribe was supposed to be ran'epileptic subject. He Laklorily'otle Seizure in the institution to witness knowledge* An epileptic pight be maniacal, and epilepsy, nught develop iiito dementia. In Tribe's case there Were "niatiiacal symptoms. Witney considered 'that -Tribe was not in.a dying condition, and under the .circumstances ; everything ..tjiat <;ould be done iii the way 1 of : oare' and attention was done, Witness believed that an insane person's'chances of recovery would be increased jf 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 gdod thing for the insane persons, but it would come hard on the sane porsons. People who were sent to'Sun'nyside had proved themselves not . amenable" to the influence of the ' sane. ' •. INQUESTS AT THE INSTITUTION. At inquests at Sunnvside the evidence was given by the doctor and by the attendant who was present at the time of death: In only one case in witness's; experience had an outside doctor been called in. In the infirmary charts and records were kept of the', patients!.condition, but they could not keep euch records for the whole 700 persons. : - MR DAVEY'S EXAMINATION. " To Mr Davey: Witness made notes regarding patients' cases in his notebook, arid transferred particulars to the-case-book within a few days. Wit- j ness could gee nothing strauge in i Howie's' habits, becoming dirty in his i habits shortly after entering the insti- ' tution, though he had previously been j very clean. Old: men were subject to | sudden ohanges in these matters. The I clothes supplied to patients were of! moleskin and tweed. It was very hard j to give out clothes that fitted the ! patients. l The. clothes were" usually whole, but of course they got torn. .Tliere might be buttons off sometimes. The infirmary was always full of patients. There was no special room in j the institution for very acute cases, j HOWIE'S CASE. ;'Witriess 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 pacing 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 were a number of projections in the room which would inflict injuries. It was never suggested or reported to witness that Howie had been ill-treated either by attendants or by patients. The head attendant reported that Howie's face was briiised and discoloured. That would refer, to the black eye. Witness could not say whether he was told that Howie's.friends complained that tho 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 Eneumonia patient would be kept in ed 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 he was in the institution. While he was quite intelligent he could not be trusted. During the last two months he spent at the institution Gourlay whs- quite competent to describe accurately any incident that came under his notice. If Gourlay had been quite rational, however, he would have made complaints to witness or to Dr-Gow regarding the incidents he now •Jleged 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 was not ; dismissed. Witness could not imagine any attendant ill-treating Herlihy. To M/ Rnymond: The retention of Gourlay Jlti the institution was a matter for Ijt Gow. Witness had no voice 111 itj.aild there was nothing in Gouray's assertion that witness thought should have been discharged earlier. ; Gourlay might be prone to exaggerate. Witness considered Gour-

lav was more or Ic.ss recovered towards the end of his stay. but he did not think it safe to release him. Harnngton wa.s not being failed as a witness, because he luid loft t|i? institution. Howie was nover nlnced m n " dump stable or roll." The night attendant was not necessarily retina in not IPporting Howie's black eye on April 10. He may not. have noticed the injury. THE OOMAI EXAMINES. To the Commissioner: No report reached him of the injury to Tribe a lirel referred to bv Mrs '1 rib.; in lt.-r evidence. When he examined the hoei there were no signs oi any injury to correspond with the details given by Mrs Tribe. The swelling ol the leg was not)line; out of the ordinary. If (ho leg was green as .Mr 'lhornton bad described, it"'would bo duo to a largo bruise several days old or to gangrene. Gangiw.o enme on rapidly ai tny.es, but the change from the conditions described as existing or. Thur«la.v to oam'reno was not probable. More accommodation should Ik- provided at Simnyside. so that rr-ale patients on entering the institution should not bo put in with rcfrnctory caws. The bearing of the evidence was adjourned until "Wednesday, at, 10.HO a.m. 'flie Commissioner slated that he would visit the institution to-morrow at 11 a.m.